Interventions to prevent the progression of prediabetes to type 2 diabetes (T2D) are needed. This need is greater among individuals self-identifying as an ethnic minority in Canada, because they are at greater risk for developing T2D and at a younger age than individuals of European descent. While there is strong evidence that physical activity (PA) can reduce diabetes progression, adherence to PA is poor following diabetes prevention programs. Compounding this problem, diabetes prevention programs are failing to reach ethnically diverse populations. Alternative methods of promoting PA that is appealing to ethnoculturally diverse populations is needed. Electrically assisted cycling is an activity that can lead to positive health outcomes. E-bikes enable people to exercise outside and may reduce barriers of access to, and cultural resistance to joining, an exercise facility. This research will examine the effectiveness of using e-bikes as a method of increasing PA among individuals identifying as an ethnic minority who are at risk of developing T2D in interior BC. This research will provide information on a new, alternative form of promoting PA as part of a diabetes prevention program that can be used to tailor existing programs.
Program: Trainee
T-cell repertoire analysis for immune monitoring in renal transplantation
Kidney disease affects 1 in 10 Canadians with an estimated cost of over $2 billion per year. Transplantation is the treatment of choice for kidney failure, but unfortunately approximately 30% of kidney transplants are lost to severe immune rejection. This leads to approximately 500 Canadians losing their transplant every year and returning to dialysis. These patients have a four-fold increased risk of death, decreased quality-of-life, and a cost of up to $1 million each to the healthcare system over their remaining life. Despite improvements in transplant care, there are still no proven methods to detect early immune rejection. Our goal is to develop a new minimally invasive blood-based test to monitor the immune system of transplant patients to detect immune rejection before kidney damage happens. This would allow transplant doctors to intervene early with powerful immune regulating medications and prevent irreversible damage to the transplant kidney. Our approach would not only benefit patients and their families with improvement in survival, quality of life, caregiver burden, and personal health expenses, but also the healthcare system, with reduced costs related to dialysis, re-transplantation, and improved organ availability.
A randomized controlled trial of a cognitive control intervention for major depressive disorder
Major Depressive Disorder is common and debilitating. Individuals with depression show biases toward negative, and away from positive, information– referred to as cognitive control biases. These lead to difficulty regulating emotions, unhealthy biological responses to stress, and ultimately, greater depression. Cognitive control biases are not adequately treated by current therapies. The objective of this clinical trial is (1) to test the effectiveness of a new cognitive control intervention (CCI) for depression and (2) to understand how it works. Participants will be assigned to a 4-week CCI group or a control group. Cognitive control biases, emotion regulation, and depression will be measured before and after CCI and 6 months later, and biomarkers of stress will be collected post-CCI. I predict that the CCI group will show improved cognitive control biases and emotion regulation, healthier biomarkers of stress, greater decreases in depression, and higher remission rates after CCI. Changes in cognitive control biases, emotion regulation, and biomarkers are expected to account for outcomes. CCI has the potential to be an accessible, virtual alternative to current therapies, and findings will inform our understanding of depression.
Housing, homelessness, and care trajectories among young people who use drugs in Vancouver
The proposed study will employ longitudinal qualitative and ethnographic methods to examine how urban young people who use drugs (YPWUD) navigate experiences of housing and homelessness across time. Cities like Vancouver are creating more comprehensive and integrated systems of services for YPWUD, including programs that aim to simultaneously address their housing and care needs (e.g. supportive housing with on-site access to harm reduction, opioid agonist therapies). Innovative social science research is needed to describe how particular supportive and temporary modular housing models can both ameliorate and exacerbate health and social harms among YPWUD, including overdose. The proposed anthropological and community-based participatory action research study will generate new knowledge to support the development, adaptation and scale up of targeted housing and substance use care interventions for YPWUD. Working together with a Youth Advisory Council comprised of YPWUD and youth co-researchers, study findings will be disseminated via youth-driven outputs aimed at a broad public; presentations and community reports for youth, their providers and key decision makers; and press releases, media interviews, and social media engagement.
Addressing emerging health system priorities in cervical cancer prevention: determining optimal strategies for human papillomavirus test-based primary screening
Cervical cancer remains a significant women’s health issue in Canada even after the introduction of cytology screens (i.e. Pap smears) in 1949, which resulted in a reduction of cases. It is frequently diagnosed in young women, who are embedded in careers, raising families, or still planning to conceive. Treatment can affect women’s ability to work, care for families and cause infertility, and survival rate is often low. It is thus vital to improve preventative screening programs using recent testing innovations. Testing for human papillomavirus (HPV) is more effective than cytology, but it is not yet used in BC. HPV FOr CerviCAL Cancer (FOCAL) was a trial investigating HPV testing. Participants were followed for ten years post-trial through linkage to the BC Cervix Screening Program to create the FOCAL-DECADE cohort. We will use data from this cohort to compare long-term rates of cervical precancer between those who received cytology or HPV testing, expecting significantly reduced rates in the HPV group. These results will inform decision-makers, like the provincial screening program, of best screening practices (e.g. screen interval), aiding transition to HPV-based testing programs, thus helping reduce cervical cancer across BC.
Advancing health equity in the cancer care sector: Identifying organizational and contextual factors impacting the integration of equity-oriented healthcare for marginalized populations
Alarming differences exist in cancer outcomes for people who are marginalized. Due to racism, discrimination and stigma, these groups experience extreme difficulties accessing cancer care and are diagnosed with cancers so late they have higher rates of preventable death than other groups. Some of these differences can be addressed using equity-oriented healthcare (EOHC), which directs resources to those with the most need, and reduces mismatches between health services and the actual needs of marginalized people. However, EOHC has not been studied within the context of cancer care. This study is about understanding the organizational contexts and conditions needed to build capacity for EOHC within cancer care in BC. We will: 1) conduct an environmental scan to identify strategies used elsewhere (Canada, internationally) to deliver EOHC in cancer care; 2) observe and interview key informants and healthcare providers who are trying to use EOHC in delivering cancer care, and marginalized patients who are trying to access cancer services, to better understand factors that support the provision of EOHC in cancer care. Results will be used to develop recommendations and action strategies to support cancer organizations to deliver EOHC.
Paediatric spinal cord injury in Canada: Using administrative claims data to examine long-term health outcomes and healthcare utilization
A spinal cord injury (SCI) is defined as damage to the spinal cord that results from traumatic (e.g. motor vehicle accidents or falls) or non-traumatic (e.g. spina bifida or tumour diagnosis) causes. Children with SCI often require extensive medical follow-up and rehabilitation, and are at increased risk of adverse health effects (such as bladder issues, respiratory and cardiovascular disorders, and death) compared to children without SCI. Despite presumed increases in the number of Canadian children living with SCI over time, little is actually known about paediatric SCI in Canada. Using electronic health data from British Columbia and Ontario and health analytics, my proposed research aims to address existing SCI knowledge gaps by 1) developing national case definitions for traumatic and non-traumatic paediatric SCI, 2) estimating the number of Canadian children living with SCI, and 3) increasing understanding of long-term health outcomes and healthcare utilization among children with SCI. Findings from this research will, for the first time, describe paediatric SCI in Canada, identify paediatric populations most at risk of SCI, and identify opportunities to improve paediatric SCI care in British Columbia and across Canada.
The effect of temperature on brain bioenergetic stress in hypoxia
Cooling the brain is a therapeutic strategy to protect it from stress. The long-held belief is that cooling the brain reduces its activity — and thus its need for oxygen — thereby tilting a favourable balance of oxygen supply and demand. However, recent data from our lab challenges this paradigm. We have shown that brain blood flow is reduced by whole-body cooling, and this dramatically impairs oxygen supply to the brain. Therefore, it is important to know exactly how much the brain’s activity is reduced so that we can determine whether the balance of oxygen supply and demand is improved or further disrupted. Surprisingly, this is unknown in the human brain. Our objective is determine how the brain’s oxygen supply and demand is affected by cooling and heating, and how this impacts its resilience to stress. We will heat and cool healthy human subjects and expose them to low oxygen, whilst measuring markers of brain stress. We will then collect the same markers of brain stress in patients with brain injury before, during and after therapeutic cooling. Together, these studies will expose how temperature affects the brain’s resilience to stress and provide rationale for how best to harness the cold to protect the brain.
Immigrants, work and health: Evaluation of services to reduce inequities
Work is a marker of successful integration for immigrants to Canada. While we know much about the health outcomes and employment patterns of immigrants within the Canadian context, less is known about the impact of work on health, in particular on work disability experiences. Emerging evidence suggests that immigrants take longer to return to work following a work injury/illness compared to Canadian-born workers. Provision of employment-related and rehabilitation services are meant to provide access to safe work and minimize work disability but, this has not been examined in immigrant populations. Using a unique research opportunity that will merge immigration data with 1) workers’ compensation and medical services data; and 2) settlement service use for the working population of British Columbia, the purpose of this study is to examine the impact of rehabilitation and employment-related services on work and work disability experiences of immigrants compared to Canadian-born workers, along the continuum from injury to rehabilitation to return to work and income earning. Evidence of different experiences and effectiveness of services can inform best practices and reduce health inequities for all workers, including immigrants.
Impact of prostate cancer subtypes on bone remodeling and microarchitecture in metastatic lesions of the spine: A combined cellular, genetic and mineralization study
One in nine men will develop prostate cancer (PC) in their lifetime. Although modern therapies have increased the survival rate, almost all advanced cases will metastasize to bone, with the axial skeleton being the most frequent location. Bone metastases (BM) are the most severe complications of PC generating severe pain, fractures, and spinal cord compression. So far, it is not clear how PC BM are related to pain and fracture. Most cancers that generate bone complications, are associated with bone loss. However, PC is associated with bone formation. The aims of this project are to understand the structure of this new formed bone, how prostate cancer cells induce these changes, and if there are any specific types of PC associated with these changes. The ultimate goal is improving disease management and preventing complications of PC BM.
I have observed the microstructure structure of PC BM in mineral and protein content. Also, I have identified different types of PC cells in the PC BM, meaning the cells are undergoing a transformation process in the bone. These results are unprecedented, and my aim is now to expand the sample size and to explore the structure of PC BM in greater detail in order to prevent its severe consequences.