Depression has recently become the leading cause of disability, worldwide. It affects one out of every 20 Canadians, causing significant suffering to patients and their families and costing the economy CAD$32.3 billion each year. Previous efforts to address the burden of disease caused by depression have mostly been focused on expanding access to mental health services.
Recent analyses, however, suggest that the prevalence and burden of depression has remained the same in the last two decades, in spite of the intensified efforts to improve access to mental health services. This is mainly because not enough efforts have been spent on providing treatments that are adequate, appropriate, and equitable, and also because of the lack of investments on prevention.
In my research program, I propose to:
- study treatment patterns that are adequate and that work for specific group of people at specific times
- examine complex combinations of social factors that influence access to mental health services, and
- identify community-based activities that promote mental wellness and resilience. The program of research has the potential to generate recommendations at the individual, health system, and community level that can be implemented to reduce the prevalence and burden of depression over time.
Up to 73% of people who are able to walk post-stroke suffer a fall, commonly within the first few months after discharge home. Optimizing the approach to rehabilitation of walking balance remains vital to long-term outcomes post-stroke. A fall poses a significant risk of injury and erodes confidence. The loss in confidence alone can lead to decreased activity levels, loss of independence and social isolation that affect quality of life and overall health, even hastening death.
After stroke, much of the focus of rehabilitation is on improving balance and walking. However, no objective measures are available to assist clinicians in making important treatment decisions such as walking balance task type or intensity of the challenge. Unlike retraining of walking endurance that uses established measures such as heart rate to monitor and plan progression of walking endurance, there are no objective measures to guide progression of rehabilitation of walking balance.
To address this issue I am working with clinicians and people with stroke to:
- develop clinically useful balance measurement technology for use during rehabilitation;
- better understand the interaction between physical ability and confidence during rehabilitation of walking post-stroke; and
- incorporate this new technology together with algorithms that model rates of change to personalize the level of challenge of walking interventions and assure the best outcome for each individual with stroke.
A defining characteristic of cancer cells is their ability to grow and replicate in an uncontrolled manner. Cancer cells have altered signaling pathways that allow them to bypass checkpoints that would normally prevent their rapid growth. STAT3 protein is a master regulator of cancer cell signaling and is found to be overactive in 70 % of cancers. While healthy cells can survive without STAT3, cancer cells become addicted to overactive STAT3 and are sensitive to disruptions in this pathway.
As a result, several drug-like molecules have been explored for their ability to inhibit STAT3 signaling in cancer cells. While some have shown promising anti-cancer effects, issues with selectivity and toxicity have prevented their clinical use. With the goal of identifying better STAT3 inhibitors, my research program uses cutting-edge techniques to determine how STAT3 inhibitors function in cells. We investigate what exactly the inhibitor binds to inside a cancer cell and how that affects STAT3 signaling. We also use these techniques to develop our own STAT3 inhibitors which we then explore as novel anti-cancer agents. Our ultimate goal is to produce new medicines that can help patients win their battle against cancer.
The healthcare system is undergoing a paradigm shift toward person- and family-centred care. While this is a critical priority, it will be challenging to put into practice. One strategy to implement this change is shared decision-making (SDM), a process that supports patients and providers to discuss the risks and benefits of options, clarify preferences, and make choices based on their informed values. Knowledge translation and implementation science (KT/IS) are key approaches for accelerating this system change.
To advance the science of implementing evidence into policy and practice, I will implement and assess evidence-based SDM tools in routine primary care, focusing on maternal health.
Key objectives include to:
- Investigate factors contributing to successful implementation of SDM tools in routine care,
- Adapt, implement, and assess health care professional training to support uptake of SDM,
- Investigate how documentary film can work as a method of knowledge translation to support patients’ informed choices, and
- Evaluate partnerships between researchers and policy makers to catalyze the implementation of SDM.
This research will be used to advance person- and family-centred care in maternal health and in primary care more broadly.
Primary care includes the day-to-day services provided by family doctors, nurse practitioners, and other health care providers. High quality primary care that follows patients over time and coordinates specialist and hospital care is key to an effective and efficient health care system. Unfortunately, many Canadians struggle to get primary care where and when they need it, despite there being more family doctors per person than ever before.
My research program seeks to answer the following questions:
- How can we make sure we have the right number of health care providers to meet the needs of Canadians now and in the future?
- How can we efficiently organize delivery of primary care to meet the needs of patients? How do we improve access to effective care for underserved groups, including people managing both mental and physical health conditions and recent immigrants and refugees?
I analyse routinely collected data from health care delivery and look at the impact of policy changes using statistical models. I work in partnership with researchers who have complementary skills collecting information through interviews and focus groups. My research teams include patients, care providers, and people who plan health services. This helps make sure we ask questions that matter and that research results will help change our health care system.
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer related deaths mostly due to the absence of symptoms as the cancer develops. This leads to diagnosis after the tumor has already become widely invasive and cannot be surgically removed. Unfortunately, surgical removal of early stage tumors is the most effective treatment option and other treatments, such as chemotherapy, are woefully ineffective.
Thus, there are two major fronts where research could improve the outcomes of pancreatic cancer patients:
- early detection and
- more effective treatments. Early detection requires knowledge of the events associated with tumor development, while improving treatments requires a thorough understanding of pancreatic cancer. It is clear that a 'one-size-fits-all' strategy has largely been ineffective for pancreatic cancer. We hypothesize that this is partly because PDAC is a 'catch-all' diagnosis for tumors that look the same, but may have different properties due to differences during their development. Our research program seeks to identify these differences and ultimately leverage the differences to improve patient outcomes through the development of personalized treatments.
Personal identity–one's psychological sense of personal continuity–is an important aspect of mental health, informing one's motivations, behaviours, and social relations. Disruptions in identity can contribute to prevalent conditions such as personality disorders. Indeed, distorted identity is a core aspect of personality dysfunction and disorder, contributing to considerable negative health and social outcomes–and a prominent challenge for health care providers and systems. Interventions that strengthen identity during young adulthood may be a potent way to mitigate personality dysfunction, preventing entrenched impairment and setting a course for positive mental health.
This proposal features a novel psychosocial intervention aimed at strengthening identity and reducing personality-related dysfunction among vulnerable young adults–tested in a randomized controlled trial. The intervention is designed for use by non-specialists to maximize transferability and impact on access and quality of care. Building on the applicant's work in maladaptive personality and identity, the project is set within a broader program of research on identity-focused intervention, including within early psychosis and recovery from alcohol misuse.
Anemia is a condition in which there is a decrease or destruction of red blood cells causing inadequate transport of oxygen throughout the body. It is a major public health problem affecting ~25% of the global population, or ~9 million Canadians of all ages.
In infants and children, anemia can impair brain development and decrease learning ability. In adults, it can cause fatigue, lower work capacity and increase the risk of adverse pregnancy outcomes (e.g. low birthweight). Causes of anemia can include micronutrient deficiencies (e.g. iron or folic acid), infection and disease, and genetic hemoglobin disorders (e.g. thalassemia). Understanding the causes of anemia is critical to inform appropriate strategies to prevent and treat anemia, and to reduce the risk and burden of disease.
Dr. Karakochuk's research program will seek to improve diagnostic methods and investigate novel biomarkers for anemia and iron deficiency, and assess the risk-benefit of iron and folic acid supplementation programs designed to treat anemia and other chronic diseases. The ultimate goals are to reduce the burden of anemia and to inform safe and effective nutrition policy, programs and interventions for individuals and populations in Canada and globally.
Mental health and substance use (MHSU) challenges are leading health issues facing youth globally. In Canada, 20% of the youth population experiences mental health disorders, and youth aged 15-24 have the highest rates of past year substance use and related harms. To address these concerns, MHSU researchers and advocates argue for a population health approach incorporating promotion, prevention, and treatment within a 'healthy public policy' framework. Yet while much research has focused on the prevention and treatment of youths' MHSU challenges, there has been limited focus on mental health promotion.
Further, while there is growing recognition of the importance of engaging youth in matters that affect their lives, there is a paucity of evidence-based guidance on how to do this effectively. This study contributes to addressing these substantial gaps by exploring how to meaningfully engage youth in the policymaking process to promote MHSU outcomes. Participatory approaches and mixed methods are being used to generate knowledge and inform a framework to guide youth-engaged research and action to better tackle the MHSU needs of Canadian youth.
Infectious diseases remain a serious and constant threat despite the high standards of sanitation and health care enjoyed by the British Columbians. Moreover, British Columbians, living in a major port of entry to Canada, face an increased risk of contact with emerging infectious diseases as exemplified by SARS. An effective disease surveillance system requires multiple health organizations to work together and share information with each other. Advances in genomic technology have improved the detection and characterization of disease-causing microbes and provide public health practitioners a better surveillance tool. Yet, genomic data is voluminous and complex, creating a challenge for our health care system and practitioners. Moreover, contextual data needed to interpret genomic data often contain sensitive and private information making sharing of contextual data across jurisdictions a challenge.
Dr. Hsiao's research program builds innovative technology solutions to improve organizational efficiency, trust, and capacity of BC's public health surveillance network. Our work will stop the spread of diseases, reduce the overall disease burden and health care cost, and ultimately improve the health and well-being of British Columbians.
