Program: Scholar

Improving the implementation and impact of evidence-based health promotion interventions in real world settings

Findings from health promotion research that could help Canadians live healthy lifestyles are often not applied in practice. This gap between health promotion research and health promotion practice is particularly concerning for people with spinal cord injury (SCI). Despite people with SCI's urgent need for interventions that respect their unique challenges and barriers to health behaviour change, there are very few health promotion interventions designed for people with SCI. To ensure health promotion research improves the health of all Canadians, there is an urgent need to improve the use of health promotion research in practice.

The aim of this five-year knowledge translation research program is to examine methods for improving the use of health promotion research in real-world practice. Given the lack of health promotion interventions for people with SCI, this research program will examine how we can improve the use of health promotion evidence to enhance the health of people living with SCI. 

Dr. Gainforth will examine how successful and unsuccessful practitioners apply health promotion techniques when promoting healthy behaviours to people with SCI and develop the first evidence-based guidelines, tools and interventions to improve knowledge translation partnerships between researchers and members of the SCI community. Lessons learned from practitioners will be used to develop and test tools and interventions to help other practitioners successfully promote healthy behaviours to people with SCI.

Ultimately, this research will develop best practices for building capacity among researchers and community members to conduct and share research in partnership. In turn, findings and the approach can support other research teams aiming to use partnerships to conduct and share research that enhances the health of marginalized groups.

Breaking the link between obstructive sleep apnea and cardiovascular disease using a translational experimental approach

Previous research by Dr. Foster has illustrated that angiotensin receptor blockade can abolish the blood pressure response to intermittent hypoxia (IH), reduce oxidative stress and increase nitric oxide bioavailability. In addition, recent work suggests heightened peripheral neurovascular transduction in response to baroreflex activation.

Building on this work, over the next 5 years Dr. Foster will focus on the cardiovascular consequences of IH associated with obstructive sleep apnea (OSA). Since OSA and IH directly contribute to the morbidity and mortality of hypertension, myocardial infarction and stroke, there is an urgent need to establish a treatment capable of protecting OSA patients from IH-induced cardiovascular disease (CVD).

Dr. Foster's research will elucidate the mechanisms by which AT1R antagonists or statins could protect OSA patients from IH-induced CVD. By breaking the link between CVD and OSA, and capitalizing on the pleiotropic properties of angiotensin receptor blockers and statins, this research is ultimately intended to generate a novel treatment. This knowledge will provide the necessary proof of concept for large-scale clinical trials, and will help reduce stress on health care infrastructure and improve the health, quality of life and longevity of Canadians.

Examining the addiction treatment and recovery trajectories of youth in British Columbia’s Lower Mainland

Addiction treatment is critical to addressing the tremendous health and social harms experienced by street-involved youth (SY) with substance use disorders (SUD), including the current fentanyl overdose crisis. To date, the addiction treatment and recovery landscape in British Columbia (BC) reflects a mix of regulated, publicly funded programs (e.g., methadone and Suboxone programs, residential detoxification and treatment programs), as well as unregulated privately and publicly funded programs (e.g., informal recovery houses, Twelve Step programs) that span acute and community healthcare settings. Sustained drug use cessation is an important goal of these programs. However, it is recognized that for many youth their addiction treatment trajectories include periods of engagement, dis-engagement, and re-engagement with various programs, as they move in and out of periods of relapse, increases and reductions in drug use, and drug use cessation. The recovery trajectories of youth who remain largely outside of healthcare settings are also often characterized by this kind of dynamic process.

Dr. Fast will examine and inform ongoing efforts in the Lower Mainland to create a more comprehensive and coordinated system of addiction services for youth, and generate new knowledge to optimize the integration of evidence based addiction treatment across the acute and community healthcare settings accessed by SY. Integrating the methods and perspectives of medical anthropology and implementation science she will advance understandings of how individual, interpersonal, organizational, and structural factors operating in, but also across, acute and community health care settings in the Lower Mainland shape the delivery, uptake, and outcomes of youth addiction treatment interventions.

A nuanced, ethnographic understanding of these places and contexts will inform policy and practice recommendations to improve the addiction services system for adolescents and young adults so that it meets the needs of SY, pursuant to the goal of addressing SUD and the overdose crisis among this population. Dr. Fast will employ innovative and participatory arts-based methods to generate and disseminate policy and practice recommendations that align with the complex realities and everyday lived experiences of SY.

Opioid addiction research program to improve prescribing practices and reduce overdose

Canada is amid an opioid crisis, with six or seven deaths a day due to opioid overdose. Prescription opioid misuse can also transition to illicit opiate and intravenous drug use, substantially increasing the risk for overdose and blood-borne infections. Rates of overdose death due to counterfeit fentanyl have also risen and represent a growing crisis in most regions in Canada, with British Columbia (BC) being particularly hard hit. Half of the 800 anticipated overdose deaths for 2016 in BC are expected to involve fentanyl.

Dr. Fairbairn’s research will:

  • Address the effectiveness of a randomized controlled trial to evaluate a designated opioid prescriber intervention using BC’s centralized prescription network to reduce inappropriate opioid dispensation and overdose risk.
  • Inform overdose prevention strategies by characterizing the inter-relationships between medication prescribing patterns and patterns of illicit drug use.
  • Evaluate the longitudinal impacts of new overdose prevention initiatives and addiction treatment guidelines on overdose outcomes.

This research directly responds to BC’s recent declaration of a public health emergency, Health Canada’s urgent call to develop strategies to tackle the overdose epidemic, and the global challenge of prescription opioid abuse by generating evidence for safer prescribing practices and informing and broadening the evidence base for the treatment of opioid addiction.

Development and assessment of strategies to promote social integration into new communities

Social connections and social support networks are essential for physical and mental health. In fact, recent research suggests that how long people live is better predicted by the quality of their social relationships and how well they are integrated in their community, than it is by how much they smoke and drink, or whether they are obese. Loneliness, on the other hand, is linked to negative health outcomes including depression, poor sleep quality, more hospital and doctor visits, and compromised immune system functioning.

This research will focus on the processes involved in successful social interactions with strangers, friendship formation, and social integration. It will focus on questions including: Why do some people have a harder time making friends than others? How do people develop a sense of belonging when they move to a new community? How do the size of someone's social networks, and the availability of social support, influence specific health outcomes like immune function and cardiovascular disease risk? Given that Canadian culture is characterized by high rates of immigration and residential mobility, developing effective evidence-based strategies for combating loneliness and social isolation can have direct benefits for individuals and communities alike.

Knowledge translation activities for this research will include active engagement with broad audiences of university administrators and advisors, student mental health groups, and community members. Dr. Chen will produce reports for groups directly involved in promoting community social integration efforts, whilst serving as a scientific/faculty advisor for initiatives to disseminate research findings directly to the public. She will use research findings to develop specific interventions to facilitate friendship formation and social integration, targeted to individuals who are experiencing social disruptions or difficulty transitioning into new environments. Enhanced knowledge about these topics is expected to contribute to the public good and welfare of British Columbians.

Cardiovascular genetics: Phenotypes, genotypes and cellular mechanisms

Cardiovascular disease (CVD) is the leading cause of death of Canadians, and is strongly influenced by genetic factors. Integrating basic biomedical research into how specific gene variants influence the function of cardiac cells, with clinical research of patients and families with early onset CVD, will lead to important advances in translating the results of genetics research to improved care for patients and families with CVD.

Advancing Healthcare Diagnostics for Neurodegenerative Disorders

Alzheimer’s disease causes progressive neurological decline and substantially decreases the quality of life of patients and their caregivers. In 2011, 747,000 Canadians had Alzheimer’s disease or another form of dementia. With a rapidly aging population, this figure is projected to rise to 1.4 million by 2040, costing $293 billion/year, thus representing an urgent and rapidly growing healthcare issue.

Early and accurate diagnosis of Alzheimer’s disease is critical because timely access to healthcare and community services has the potential to slow disease progression and improve quality of life. Current approaches for diagnosis rely on traditional imaging tests and observation of the signs and symptoms of the disease. Adding the measure of proteins found in cerebrospinal fluid (biomarkers) helps doctors correctly identify the disease. This project aims to create better tools for timely diagnosis of Alzheimer’s disease and other dementias, and make these tools easily accessible to those that need them.

This program of research will develop a comprehensive understanding of how biomarkers for Alzheimer’s disease impact clinical decision making and healthcare costs. It will develop an Alzheimer’s disease diagnostic tool and with input from patients, their families, their doctors and other relevant stakeholders, address barriers to uptake and use in the healthcare system. In addition to Alzheimer’s disease, this research will investigate development of diagnostic technologies for related disorders such as frontotemporal dementia and Lewy body dementia.

The ultimate goals of this work are to build a diagnostic platform for early detection and diagnosis of cognitive impairment; establish BC as a leader in neurodegenerative diagnostics; and ease the psychological, physical and financial burdens for people with dementias and their families.

Chemical suppression of nonsense mutations for the treatment of frontotemporal dementia

Michael Smith Foundation for Health Research/Pacific Alzheimer Research Foundation Scholar Award

 

Frontotemporal dementia is a progressive neurodegenerative syndrome, and the second most common cause of young-onset dementia after Alzheimer’s disease. Members of our team recently reported that loss-of-function mutations in the gene for a protein called progranulin cause 25 percent of frontotemporal dementia cases. Of these mutations, 30-40 percent are “nonsense mutations” that act as stop signs to prematurely end a process required to produce normal progranulin. When progranulin production ends too early, it leads to a shortened protein that cannot carry out the normal brain functions, eventually leading to dementia in the sixth decade.

 

The goal of this project is to investigate small molecule combinations that can bypass the abnormal “stop sign” in the progranulin gene, increasing the normal production of this important protein. The small molecule combinations will be refined and optimized to find the most effective combination. This approach, also referred to as “suppression of nonsense mutations”, offers the possibility of developing a new drug for patients with frontotemporal dementia cause by a progranulin mutation. The team also plans to develop a mouse model of frontotemporal dementia to test the small molecule combinations in a living organism.

 

The long-term goal of the project is to bring new drugs for frontotemporal dementia into clinical trials. An effective therapy would alleviate the devastating impact of dementia in many patients and their families, in BC and beyond.

End of Award Update

Source: CLEAR Foundation

 

We studied frontotemporal dementia (FTD) with the aim of developing novel drugs for this devastating condition. A subset of FTD patients have a genetic mutation that leads to reduced levels of an important protein called progranulin. Our project aimed to develop a drug that could counteract this genetic mutation. We used brain cells cultured in a dish to test new drugs and found a known antibiotic to have properties that could increase progranulin in this model.

 

This work laid the foundation for ongoing research to develop drugs to increase progranulin in patients with certain forms of FTD.

 

 

CALOR: Cooling Autoinflammation with cLinically Oriented Research

MSFHR/Cassie and Friends Society for Children with Juvenile Arthritis and Other Rheumatic Diseases Scholar Award

Childhood rheumatic diseases such as juvenile arthritis, lupus, vasculitis and fever syndromes are the most common childhood chronic illnesses. In Canada, the diseases affect approximately 10,000 children and youth. The affected children have recurrent attacks of inflammation in joints, muscles, and critical organs due to inappropriate activation of blood cells and molecules in the immune system.  Some rheumatic diseases are life- or organ-threatening and all have significant potential for lifelong poor health and disability. There are no cures and few treatments that are specific and safe for a growing child.

This project, CALOR (Cooling Auto-inflammation with CLinically Oriented Research), aims to develop ways to better measure inflammation in these diseases, especially low levels of inflammation that, if present, may justify continuation or re-starting of therapy to stave off an inflammatory attack. The project uses advanced informatics and a systems biology approach, including novel cellular phenotyping of first responder cells of the innate immune system, to find markers of inflammation.

Project outcomes may include sensitive measures of subclinical inflammation that better direct treatment decisions for children with a rheumatic disease. Central to the approach is early engagement of clinicians and patients to establish research priorities, to connect affected families with each other, and ultimately to identify ways to support BC family doctors so that ongoing patient care can be close to home. The CALOR project is founded on a recently developed Canadian Auto-inflammation Disease Registry and a nucleus of invested clinicians, researchers and families at BC’s Children’s Hospital.

End of Award Update: September 2022

Most exciting outputs

The major goal of our research program is to improve the lives of children with rare diseases that cause inflammation in the bones, muscles and joints. Vasculitis is one of these diseases caused by inflammation in the blood vessels of major organs. This is a very rare disease in children, affecting approximately 1 in 250,000 children. One of the exciting things that we have been able to do is create the largest database of clinical information (from over 600 affected kids) and frozen samples (from over 250 affected kids) that allows us to do meaningful studies on this disease. Before this, studies described no more than 25 children with vasculitis. Even more exciting, we were able to identify nine children that were originally diagnosed with vasculitis but had a newly discovered (as of 2014) disease, called DADA2. This is important because the treatment for vasculitis and for DADA2 is different.

Impacts so far

The Michael Smith Health Research BC/ Cassie and Friends Society Scholar Award has given us the opportunity to develop a connection with Cassie + Friends Society, a national organization dedicated to advancing research, information, connection and support for children living with a rheumatic disease. This relationship has helped shape our research program (are we asking research questions that are meaningful to patients and families?) and educated our trainees about the challenges for families and patients in everyday life and as part of a research study. In the lab, we have established two tests to help physicians diagnose two rare childhood syndromes, called DADA2 and ‘Type I Interferonopathy (Type 1 IFN). Kids with these diseases benefit from particular biologic therapy, therefore, it is important that they get diagnosed and started on the correct treatment as soon as possible. In the first two years that we offered these tests, we were consulted up to three times monthly and proceeded with testing for 20 children from around the province who were referred to various subspecialties at British Columbia Children’s Hospital. Results of our testing was conclusive in all but one case, affirming the suspected disease in five cases, and supporting a change in treatment for six patients.

Potential future influence

Since 2015, we have had 42 aspiring researchers, from high school students through to postdoctoral fellows, contribute to our program of research. For the vast majority, this was their first exposure to patient-oriented research in a health care setting, and in the study of rheumatic diseases that affect children. Our alumni have pursued a variety of academic and health related careers, and we trust that in those pursuits they will share their knowledge and experience with others in order to generate continued support and enthusiasm for patient-centric studies, especially rare diseases that affect children.

 

Next steps

The Michael Smith Health Research BC/ Cassie and Friends Society Scholar Award has allowed us to build a solid foundation of infrastructure, resources, and key collaborations with Cassie + Friends Society and the Rheumatology Health Care Team at BC Children’s Hospital. We have secured new funding from the Canadian Institutes of Health Research and the (US) National Institutes of Health to continue to advance our understanding of rheumatic diseases in a way that will improve the lives of affected children.

 

Useful links

Transforming Urban Form for Mobility: Interventions to improve population health

Governments are making major investments in transit, cycling, and walking infrastructure to alleviate the pressures of traffic congestion and emissions. These changes may have lasting impacts on population health.

The aim of this five-year program is to generate new evidence on the impact of population health interventions on health and health equity along two lines:

  1. “Population Health Intervention Research” will generate new knowledge on the impact of population-level interventions on mobility.
  2. “Methods and Tools for Intersectoral Action” will develop and apply novel methods and tools to study urban form, and to facilitate uptake by intersectoral stakeholders.

This work aims to generate new, locally-relevant evidence in order to understand how to enhance health and mobility in mid-size cities and suburbs. While these settings are very common in Canada, they are surprisingly absent from the literature.

 

The program will assess how changes to urban form, such as new cycling networks or education programs, influence how people choose to travel, and how safety-conscious and active they are. This will be studied in the population overall, and also specifically with groups facing greater mobility challenges (e.g. women, new immigrants, older adults). The work will focus on how an investment in a city-wide cycling network for people of all ages and abilities impacts uptake, safety and equity.