In the next 20 years, the percentage of adults aged ≥65 in Canada is projected to increase by nearly 60%, and among all Provinces British Columbia is aging the fastest. As our population ages, identifying factors that foster healthy aging is crucial for improving the health of older adults, and containing healthcare costs. One way to cultivate healthy aging is by increasing preventive service use (e.g., flu shots, screening for chronic conditions). Yet, <50% of adults aged ≥65 are up-to-date with them.
Thus, a central challenge is to identify modifiable factors that increase their use. The objective of this proposal is to identify key psychosocial well-being factors that are associated with increased preventive service use and begin piloting interventions. Building on prior work, the central hypothesis is that several hypothesized psychosocial well-being factors are associated with increased use of preventive services.
Regarding outcomes, this research is expected to have knowledge translation value as study results will identify psychosocial factors that might emerge as novel targets for interventions aiming to increase preventive service use; further, we will pilot test scalable interventions that target identified factors.
Problem: British Columbia is being increasingly impacted by climate change and therefore the health and wellbeing of children in this region are at risk, and will be throughout their lives unless action is taken.
Overview: Conducted for, by and with children, this research will answer 2 questions: How is children’s health being impacted by climate change? Can taking action on climate change through community projects, strengthen and build resilience in children, even in the age of climate change? A central focus of this work will be on mental health and wellbeing.
Outcomes: After filling a significant scientific knowledge gap about the public health impacts of climate change on children in BC, evidence gathered will be used to help develop community projects that tackle a local impact of climate change.
Impacts: This research will identify why and how certain community projects on climate change protect, and even improve, the mental health and wellbeing of children and make recommendations for how other communities can use this information to build their own healthy children, healthy community projects. These successes will be shared with decision makers to support the choices they make around climate change and health.
Decision makers need to decide how to best allocate limited societal and healthcare resources to fund different healthcare services. Health economic evaluation is a tool commonly used to inform these types of funding decisions; however, which costs to consider in economic evaluation can have a significant impact on the resulting funding decision. A societal perspective considers costs within the formal healthcare sector (e.g., physician, hospital and drug costs) as well as costs outside the healthcare sector (e.g., work productivity costs of patients and their family caregivers). Existing health economic evaluations have largely ignored patient and caregiver work productivity costs mainly due to the limitations in current measurement methods.
My program of research will focus on the development of methods that will provide accurate estimates of patient and caregiver work productivity costs. These methods will then be applied and tested in an economic evaluation of new treatments for recurrent Clostridium difficile infection. Ultimately, my research findings will help improve health economic evaluations for other diseases, leading to better healthcare decision making in BC, Canada and beyond.
End of Award Update – March 2024
Results
My research program has provided practical recommendations on how to measure, analyze and present work productivity loss among patients and their caregivers in clinical trials.
Impact
There are increasing research interests in measuring the impact of health care interventions on work productivity loss by following the practical recommendations developed during my award period.
Potential Influence
There will be consensus methods for measuring, analyzing, and presenting work productivity loss results across studies. This will improve the comparability between studies.
Next Steps
More related articles will be published in journals and presented at conferences. Workshops will be organized to teach on the methods of measuring, analyzing, and presenting work productivity loss.
Useful Links
www.thevolp.com
Mild traumatic brain injury (mTBI), commonly known as concussion, is a major public health concern. Around 42 million of the world's population sustain mTBIs annually. In Canada, ice hockey has the highest sports concussion rates in children and youth. In British Columbia, 2.4 million dollars were spent on hospitalization for mTBI in 2010. Furthermore, recent studies have linked multiple mTBIs from sports with heightened risk of long term brain changes. Despite the prevalence, the diagnosis and prevention of this condition is currently ineffective, due to the lack of knowledge of the injury mechanism.
In the proposed research program, I aim to gain a better understanding of the mechanism of mTBI. Specifically, I will study sports-related mTBI in ice hockey athletes, and investigate the effect of head accelerations on brain function. Players will be instrumented with mouthguard sensors to measure head motion and wearable electroencephalogram (EEG) sensors to measure brain response during practices and games. From the analysis of these data, we will gain a better understanding of the cause of injury. This understanding can help develop better diagnostic and prevention technologies to improve concussion management in and beyond BC.
My research aims to answer two questions: when and under what circumstances do some young people intentionally physically harm themselves, and how can we improve our clinical tools to reduce these behaviours? Intentional self-harm is alarmingly prevalent in young British Columbians: around 5-7% of BC youth have attempted to end their own lives, 10-15% have experienced serious suicidal thoughts, and 15-18% have engaged in non-suicidal self-injury. These behaviours can have devastating impacts on youth, their families, and their communities. Providing care for suicidal youth is among the most stressful tasks that mental health professionals face, due in part to the difficulty of accurately predicting risk.
To address this important health problem, we need to improve knowledge of:
- signs of imminent, near-term risk of intentional self-harm, and
- dynamic processes of accumulating risk or resilience in vulnerable youth. My research uses linked provincial health records, prospective cohort studies, and smartphone and wearable technologies to study how risk and resilience for intentional self-harm evolve over hours, days, weeks, months, and years. The research will be used to create and improve decision-making and self-monitoring tools that youth, caregivers, and clinicians can use to reduce and prevent self-harm.
Gut health is closely connected to our microbiota, a unique, constantly evolving, group of trillions of bacteria that live in our bodies. Gut microbes produce compounds that are absorbed into our blood, providing nourishment and also affecting the gut environment. The digestive tract is composed of many different local areas, called habitats, in which physical and chemical properties such as water availability, salt concentration, acidity or temperature are tightly controlled by human-microbe interactions. These habitats are dramatically changed by inflammatory bowel disease (IBD) and in return affect which microbes can survive within them. Despite the importance of the gut environment to IBD, we know little about its effects on the gut microbiota and on the progress of the disease.
I will use a combination of cutting-edge experimental and computational techniques to study the connection between the gut microbiota, the gut microenvironment, and IBD. My laboratory will study tissues from IBD patients to identify what aspects of the gut environment and microbiota can predict flares and remission. We will also study isolated bacteria and study how they respond to, as well as modify, their environment in a mouse model of IBD. This research will lead to health and economic benefits for Canadians, by developing microbiota based therapies for diseases of the digestive tract that affect millions of Canadians.
Regenerative medicine such as stem cell based therapy holds great promise towards addressing many diseases that afflict millions of Canadians, including many forms of cancer, muscular and neurological degenerative disorders, diabetes, and arthritis. However, this promise has yet to be fully realized. Despite the many advances in stem cell biology, little is known on the mechanisms governing stem cell identity and on how this identity can be effectively changed and applied towards its target function. The lack of understanding in basic stem cell biology not only has hindered the proper application of stem cell therapy, but has also led to the proliferation of unproven and potentially unsafe applications in many private Canadian clinics.
My research aims to bridge this gap by studying how embryonic stem cells are able to self-maintain indefinitely, while retaining the ability to differentiate into any cell type of the body. Using cutting edge technologies such as gene editing, genomics, and single molecule imaging, our group plans to dissect the molecular underpinnings that make stem cells such versatile therapeutic agents.
Endometrial cancer (EC), or cancer of the uterus, is the most common gynecological cancer in Canada, with new cases and deaths increasing annually, due to an increase in the rate of common risk factors, like obesity. In British Columbia, the number of new EC cases is projected to increase by 50% and mortality to double by 2031. We must investigate economically feasible prevention strategies to control the rate of this cancer.
For women diagnosed with EC, it is difficult for clinicians to reliably distinguish between cancers that can be cured and those likely to progress, because parameters currently used to make this judgement are not reliably measured. Consequently, we give toxic treatment (chemotherapy and radiation) to many patients who may only require surgery, and fail to treat others as aggressively as we should.
My research program adopts a precision medicine approach, defined by the individualized care to EC patients, to predict:
- which patients are at high risk of developing EC, and
- and of those, which patients are likely to progress. Precision medicine can also improve early screening efforts to reduce EC incidence by detecting and treating pre-cancers, promoting early improved diagnosis, and targeting treatment recommendations for EC patients. This will benefit both patients and the healthcare system, as fewer EC patients will be given expensive toxic cancer treatments that are not needed, or to which they are unlikely to respond.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people face judgment and discrimination on the basis of their sexualities and genders. This leads many LGBTQ people to avoid seeking treatment from the healthcare system, to hide aspects of their sexuality/gender when seeking care, or to selectively visit LGBTQ-affirming providers.
The goal of this research program is to develop a comprehensive understanding of healthcare access patterns among LGBTQ people in BC.
Objectives:
- To describe points of healthcare access for LGBTQ people (‘where’)
- To explore LGBTQ people’s reasons for avoidance, concealment, and provider selection when seeking healthcare (‘why’)
- To characterize the ways in which service providers in BC ensure that their services are LGBTQ-affirming (‘how’)
Administrative health data, surveys, and interviews with providers and LGBTQ people will produce a detailed description of where, why, and how LGBTQ individuals navigate healthcare.
Collaborators include public health clinics, community organizations, and general practitioners. This research will provide recommendations to adapt BC’s healthcare system so that LGBTQ people receive the services they need, when they need them.
Cancer is a complex disease with many factors which determine how rapidly cancer cells can grow and spread throughout the body. Significant differences exist within the cancer cell population of a patient. These differences shape the interaction of cancer cells with the surrounding healthy tissue, with dramatic variation between patients. This so called cancer heterogeneity has profound implication for patient prognosis, and is one of the primary challenges to developing effective cancer treatments. Recent technological advances now allow for the measurement of multiple aspects of individual cells within a cancer. This has created an opportunity to precisely characterize the set of mutations in each cancer cell, along with their functional consequences and how they impact interactions with surrounding cells. My group will develop statistical machine learning approaches to analyze the complex datasets generated by these technologies.
Working alongside clinicians and biologists at BC Cancer, part of the Provincial Health Services Authority (BC Cancer), we will apply these computational methods to study the evolution of metastatic breast cancer and the mechanisms of relapse in follicular lymphoma. Ultimately this research will provide important insights that can guide the development of better strategies for the diagnosis and treatment of these cancers.
