Envisioning urban Indigenous-led pathways to mental wellness through community-based research in the interior of British Columbia and new partner engagement in the north

Colonialism, racism, and a lack of culturally safe care result in poorer mental health outcomes for Indigenous peoples in Canada. Indigenous-led services grounded in local values and priorities improve culturally safe care and wholistic health for Indigenous peoples. Urban (off-reserve) Indigenous peoples are, however, often excluded from mental health planning that affects them. This is especially felt by urban Indigenous peoples residing in rural and northern areas. Building on established partnerships with five British Columbia (BC) Interior Friendship/Métis Centres, and Interior Health, this research aims to change this. Together we will: 1) renew/strengthen existing relationships; 2) explore local mental wellness needs and priorities; 3) develop community-led pathways for promoting mental wellness; and 4) engage new community and health system partners in Northern BC. Local Elders, community research liaisons, and advisory teams will direct and facilitate information gathering and sharing. This may include surveys, talking circles, and community gatherings. Results will be community-owned, and shared with directions from communities.

Impact of a combined exercise and counselling intervention on mental health in people with spinal cord injury who live with chronic pain: A psychobiological approach

People with spinal cord injury (SCI) who live with chronic pain report poorer mental health (e.g. depression and anxiety symptoms) than those without disability. Poor mental health can further limit social participation (including employment) and physical functioning, and increase the use of health care services. Therefore, there is a need for safe, accessible, and affordable strategies to improve pain and mental health in this population. Exercise may be an effective strategy, but it’s not known if people with SCI living with chronic pain also benefit. Forty-two adults with SCI reporting chronic pain will receive a personalized exercise prescription and weekly exercise counselling. An equal group will go on a waitlist. After six months, we will test for differences in mental health between the groups, and if changes in fitness, pain or social factors can explain these differences. We will interview participants to gather their perspectives on the program, and what we can do better to improve mental health. This study will be the first to test if exercising improves mental health, how much exercise is needed, and the processes by which exercise may improve mental health in people living with SCI and chronic pain.

Improving access to breastfeeding support in British Columbia: Needs assessment of a virtual health intervention

Breastfeeding has numerous benefits for parents and infants. However, many parents encounter challenges with breastfeeding that can lead to early breastfeeding cessation. In addition, persons across British Columbia (BC), especially those in rural or remote regions, cannot access breastfeeding support. This has been especially true during the COVID-19 pandemic, as social distancing protocols and anxiety over personal safety have decreased opportunities for face-to-face interactions. My postdoctoral work will identify effective telehealth strategies and interventions to deliver breastfeeding support to persons living in BC. This study will have three phases: a literature review of effective virtual breastfeeding support; interviews to understand the support needs and acceptance of virtual breastfeeding support among healthcare providers and persons; and development of a clinical guideline for virtual breastfeeding support. Knowledge gained from this study will be used to develop a framework for the provision of virtual breastfeeding support. In addition, it will inform health policy, research, and practice for new parents living in rural BC or those who experience challenges in receiving face-to-face breastfeeding support.

Advancing anti-colonial implementation science and knowledge translation with the xacqanaǂ itkiniǂ (Many Ways of Working on the Same Thing) research team

xacqanaǂ itkiniǂ (Many Ways of Working on the Same Thing) is a long-term working relationship between Ktunaxa First Nation, Interior Health, University of Victoria, and University of British Columbia – Okanagan. Over the last three years, the xacqanal itkinil team developed a new approach to research that is led by Ktunaxa peoples and reflects Ktunaxa culture. We tested this approach in Ktunaxa communities by hosting a series of gatherings and land-based activities, where community members shared their vision for a healthy community. The team recently received a five-year CIHR Project Grant to build off the first phase of the partnership to work towards Ktunaxa Nation’s vision for a healthy community. We will work with community partners to co-design and implement interventions (i.e. programs, policies, practices), with the aim of transforming the culture of the health system to better serve Indigenous peoples and the wider population. This fellowship will directly contribute to monitoring and evaluating the interventions and their implementation to understand what is working well, what challenges are encountered along the way and how they are addressed, as well as how this work can be carried forward into the future.

Examining motor imagery-related brain function in health and after stroke to leverage its prescription

Many stroke survivors (~85 percent) in Canada experience long-term impairments in arm and hand function. To aid recovery, motor imagery (the mental rehearsal of movement) shows promise as an adjunct therapy. Yet, its effectiveness is varied. We think this is due to a lack of basic knowledge about how motor imagery works. Motor imagery is thought to work similarly to physical therapy, whereby repetitive physical practice drives changes in brain function necessary for learning and recovery. However, we do not know a lot about how motor imagery drives changes in brain function. Using a blended approach not yet taken, we will examine changes in both brain function and behaviour driven by motor imagery. Importantly, we will examine how changes in brain function are altered and can be optimized after stroke, to improve its effectiveness. Findings will provide new information about how motor imagery should be applied to maximize learning and recovery, directly informing its use and prescription in stroke rehabilitation. Overall, this research represents a critical step in improving interventions for stroke recovery, leading to improved daily function and better quality of life for Canadians living with stroke.

Enhancing patient self care and management of atrial fibrillation within primary care

Atrial fibrillation (AF) is the most common heart problem causing an irregular pulse. Individuals who poorly managed their AF risk developing serious problems like stroke and heart failure. Self-care, is when individuals actively maintain health through health-promoting practices, health monitoring, and managing illness. Family doctors and nurse practitioners (primary care providers) provide most of the AF care in BC, and yet are often not able to support their patients’ self-care because of limited time and other more urgent problems. They need new ways to address AF self-care. Teaching patients to self-care for their AF can improve their quality of life, reduce their stress, increase their ability to stay on track with their treatment plan (taking mediations), and can prevent serious problems. This research will study ways to improve self-care practices in primary care by bringing together a group of doctors, nurses, patients and researchers to look at what we already know about AF self-care in the literature and what resources exist in BC to support self-care. Second, they will put together all this information and then have a meeting to identify some of the possible solutions to address AF self-care in practice and research.

Team members: Louann Janicki (Interior Health); Ryan Wilson (UBC Okanagan); Peter Loewen (UBC); Nelly Oelke (UBC Okanagan); Norma Hilsmann (UBC Okanagan); Jessica Baskerville (South Okanagan Similkameen Division of Family Practice); Kim Orwaard-Wong (Interior Health); Kristi Maltby (Interior Health); Cameron Towle (Interior Health); Robert Janke (UBC Okanagan); Ryan Tooby (Divisions of Family Practice – Bella Coola); Tannis Andersen (Interior Health); Pam Hruska (Interior Health); Kaylee Neill (UBC Okanagan); Denis Decleva (AF Patient); Beth Whalley (Central Okanagan Divisions of Family Practice)

Neural and muscular mechanisms of age- and sex-related impairments in muscle function and fatigue in old and very old adults

Even in the absence of disease, ageing leads to impairments in muscle function, limiting the abilities of many older adults to perform daily activities, such as walking. These functional declines are due to ageing-related impairments in the brain, spinal cord, and muscles. However, these declines in function are poorly understood in adults over 80 years of age, which is especially true for older females, as these groups are typically omitted from human physiology research.

To improve our understanding of ageing-related changes in muscle function, we will evaluate brain, spinal cord, and muscle function during force or power production and compare differences among young (18-30 years), old (60-69 years), and very old (over 80 years) females and males. The inclusion of very old adults is critical, as these individuals are most susceptible to impairments in muscle function. Furthermore, we are focusing our efforts on the thigh muscles, as they are vital for daily activities and mobility, and are greatly impacted by advancing age. This project will provide foundational knowledge to guide the development of interventions, such as age- and sex-specific exercise prescriptions, to restore muscle function and quality of life for older adults.

Anti-inflammatory cytokine function in individuals with type 2 diabetes: Impact of hyperglycemia and the restorative effects of exercise

Chronic low-grade inflammation (i.e. the persistent low-level production of pro-inflammatory factors by immune cells) is a major contributor to the development and progression of type 2 diabetes (T2D). We have recently demonstrated that cells from individuals with T2D also have impaired anti-inflammatory responses — a defect that appears to be driven by hyperglycemia. Despite these novel observations, the relationship between hyperglycemia and impaired anti-inflammatory responses (and the underlying mechanisms) across individuals with varying levels of glycemic control has not been examined. Moreover, the ability of a lifestyle intervention to restore anti-inflammatory responses via normalization of blood glucose levels in individuals with T2D has not been evaluated. As such, we aim to: 1) determine whether a dose-response relationship exists between the level of hyperglycemia and magnitude of impairment in anti-inflammatory responses across individuals with varying levels of glycemic control, 2) explore the mechanisms linking hyperglycemia to impaired anti-inflammatory responses, and 3) evaluate the efficacy of a daily post-meal walking intervention to restore anti-inflammatory responses in individuals with T2D.

Let’s ride! Supporting individuals at risk of type 2 diabetes who self-identify as an ethnic minority in a community-based diabetes prevention program using electrically assisted bicycles

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.

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.