University of British Columbia – Page 16

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.

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.

TEC4Home: Telehealth for emergency-community continuity of care connectivity via home monitoring

Patients with long term medical conditions like heart failure or chronic lung diseases typically get admitted to and discharged from hospitals frequently because their conditions fluctuate. For example, one out of four patients older than 65 with heart failure often needs to return to hospital within one month of a previous emergency room or hospital stay. Today, using electronic monitors, patients can measure their own blood pressure, weight, and blood oxygen from home, and send their measurements to doctors or nurses so they can supervise the patient’s state of health. We are testing this home health monitoring approach to see if it can help patients with heart failure or chronic lung diseases stay healthy and safe at home.

In our research program called TEC4Home, we hope to show that home monitoring: 1) helps patients to manage their illnesses better themselves because they know their own bodies best, and 2) allows nurses and doctors to follow patients closely without needing to visit them. We expect to show that these patients will stay well and not need to revisit emergency departments, thereby helping hospitals to save money or save the beds for sicker patients.

We will first invite 90 patients with heart failure from Vancouver General and St. Paul’s Hospitals to test the home monitoring approach after they go home. Findings will allow us to make improvements before we expand to enroll 900 patients in 30 hospitals in BC in a formal clinical study.

Provided TEC4Home is found to help patients and decrease hospital costs, we will expand this service to be offered to other patients with heart failure across BC. We will invite companies that make monitoring equipment to develop newer and better versions, and use our experimental approach to test these devices to ensure they are safe and useful. We will also test TEC4Home with patients with chronic lung diseases to expand TEC4Home to serve patients with more than one type of long term disease.

We will work closely with doctors, nurses, patients and families, hospital managers, government leaders, technology companies, and health researchers. Patients will not only test the approach, but will also be involved in planning and carrying out the research. We will share findings with governments and health organizations so that home health monitoring, if proven effective, will become a routine part of treating patients. We will present at medical conferences and publish to share learnings beyond BC.

End of award update: June 2021

Most exciting outputs:
The home health monitoring (HHM) research is now being applied in practice, within the fabric of the health system. What we have learned is being applied and has been used in policy making. Methods and an evaluation framework have informed not only this project, but the evidence used in the real world.

While results from the full randomized controlled trial are forthcoming, the findings from our feasibility study showed signals of overall positive impact. This included reduction of emergency department revisits, hospital readmissions, and hospital length of stay. Results also showed an improvement in quality of life and self-efficacy. Further, feedback from patient participants indicate the HHM service was well received and helped participants feel safer and more supported at home after discharge from the hospital.

The TEC4Home Heart Failure study also resulted in the expansion of the concept to new conditions (like hypertension) and new technologies (such as an in-home medication dispenser). These new projects will continue to collect and build a body of evidence to best inform how digital health can help support the transition of care from hospital to home for a variety of patient populations in BC.

Impact so far
The findings from this project have been used to inform the ongoing implementation of home health monitoring in BC. It is our goal to continue to add to this evidence and see the application of these findings in the health system.

Potential future influence
At a provincial level, as noted above, the PI, K. Ho, is a member of the Digital Health Committee in BC. This involvement allows for project findings to be applied in alignment with existing policies and to inform emerging policies.

Further, the PI, K. Ho, is also a member of multiple national committees, such as the Canadian Virtual Care Task Force (focused on digital health implementation and education); the National Research Council (focused on medical device research with influence on national digital health research in practice); and the Health Canada scientific advisory committee (focused on the regulation and support of industry in digital health). All of these memberships provide opportunities for health policy influence.

Next steps
Over the course of the next year (to Mar 2022), we will be completing the final analysis of our TEC4Home Heart Failure randomized controlled trial. The results will be shared back to our various project committees and partners, including all of the patient participants. We will also seek more dissemination opportunities, such as publication in a high impact journal and presentation at conference(s).

In addition, as previously mentioned, with recently acquired funding, we are applying the TEC4Home concept to new conditions (hypertension) and new areas of impact (medication adherence). We are also incorporating the use of data analytics to deepen our understanding and the application of home health monitoring. This expansion of TEC4Home will continue to develop the evidence base of the use of technology to support patients safely at home, as they transition from acute to community care.

Useful Links
Digital Emergency Medicine (DigEM) website: TEC4Home Heart Failure | Digital Emergency Medicine (ubc.ca)
https://digem.med.ubc.ca/projects/tec4home-telehealth-for-emergency-community-continuity-of-care-connectivity-via-home-telemonitoring/

Feasibility Study publication: Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre-Post Study – PubMed (nih.gov) https://pubmed.ncbi.nlm.nih.gov/34081015/

Trial Protocol publication: Supporting Heart Failure Patient Transitions From Acute to Community Care With Home Telemonitoring Technology: A Protocol for a Provincial Randomized Controlled Trial (TEC4Home) – PubMed (nih.gov)
https://pubmed.ncbi.nlm.nih.gov/27977002/

VCH news article about launch of trial: TEC4Home moves forward to clinical trials – Vancouver Coastal Health (vch.ca)
http://www.vch.ca/about-us/news/news-releases/tec4home-moves-forward-to-clinical-trials

Blog post by HeartLife: TEC4Home: Improving self-care management for heart failure patients – HeartLife Foundation
https://heartlife.ca/2019-3-1-tec4home-improving-self-care-management-for-heart-failure-patients/

Identifying prodromal signs of multiple sclerosis: a multi-centre approach

Multiple sclerosis (MS) is a neurodegenerative disease for which there is no known cure. It is among the most common causes of neurological disability in young adults in the Western world and affects approximately 2.3 million people worldwide, including an estimated 75,000 Canadians. The symptoms of MS and related morbidity have a major impact on quality of life: weakness, fatigue, disability and depression can all influence social, family and work life.

Some intriguing preliminary findings from one study based in Manitoba indicated that people with MS had more medical consultations than people without MS, even throughout the five-year period prior to MS onset. This implies that the disease already starts to develop long before the currently recognized clinical onset of MS. However, these findings have yet to be replicated and it remains unknown as to what the reason(s) were behind the measurable increases in medical consultations.

The aim of this project is to search for early signs and symptoms that could facilitate more timely recognition of MS and to narrow down the relevant time window when searching for factors triggering MS.

I will examine databases of medical records from people with MS in British Columbia, Saskatchewan, Manitoba and Nova Scotia. I will explore their physician and hospital visits before MS onset and before MS diagnosis, and I will compare this data to medical information from the general population. I will also examine the reason(s) for the physician and hospital visits.

I hypothesize that among people who go on to develop MS, I will identify specific associated “disorders” that drive the elevated health service utilization before MS onset.

I will help the research team share the findings directly with BC provincial decision makers via one-on-one meetings and presentations. Connections with patient advocate groups will enable me to also raise awareness of the results among people with MS.

Ultimately, the results of this study could contribute towards an earlier recognition of MS.

‘APP’lying Supportive Movement: Trauma-Informed and Culturally Safe Physical Activity Programming for Young Pregnant and Parenting Women Marginalized by Poverty, Racism, and Trauma

Physical activity has been found to have numerous physical, emotional and psychological benefits, particularly for young pregnant/lone parenting women (YP/LP). Unfortunately, physical activity declines through adolescence, and women who are marginalized by poverty and racism have lower levels of leisure time. There is a lack of research on physical activity for YP/LP women who are marginalized by poverty, racism, and/or trauma, thus little is known about the barriers and facilitators for physical activity for this population. Physical activity is especially important for these women because they have a greater risk for obesity, anxiety, depression, low self-esteem, and PTSD.

My proposed mixed methods participatory research will focus on physical activity with YP/LP women who are marginalized by poverty, racism, and trauma – arguably some of the most marginalized women in Canada. My research has the following objectives:

Assess current health and physical activity behaviours engaged in by YP/LP women.
Understand the perceived barriers and benefits of physical activity for these women and establish strategies to support YP/LP in a culturally safe and trauma-informed manner.
Assess if existing quality of life measures are relevant for this population and determine if there is a correlation between quality of live and physical activity levels for these women.
Translate the knowledge gained to create a technologically-enabled approach to support/improve YP/LP well-being.

This research will take place with partnering organizations on Vancouver's Downtown Eastside that serve pregnant and parenting women. I will work with participants to create and implement a technology-enabled health intervention that is culturally safe, age relevant, trauma-informed, and cost effective.

Understanding the evolution of expectant and new parents’ beliefs and behaviours about pediatric vaccination in British Columbia

Vaccines are the most effective way to prevent many communicable diseases, yet immunization rates in British Columbia are below the level required to mitigate outbreaks of infectious diseases. This can be partly explained by some parents’ doubts and concerns about pediatric vaccinations, termed “vaccine hesitancy”.

Numerous interventions have tried to address these concerns by focusing on communication between physicians and parents when their child is already several months old. Yet there is evidence that some parents make decisions about their child's vaccinations even before the first mention of vaccines in doctors’ offices or public health clinics; this makes the pre-natal period a potentially underutilized opportunity for initiating vaccination communication. Parents’ beliefs may also change over time in response to new information or conversations within their social networks.

As mothers are the primary decision-makers about vaccination, understanding maternal beliefs about pediatric vaccination is essential to ensure effective messaging and service delivery. It is also crucial to understand the beliefs and preferences of fathers and other co-parents, given the important role they play in shaping vaccination decisions.

Few studies to date explore how parents’ vaccination beliefs shift over time, particularly how parents’ beliefs before the baby is born continue to evolve during the first few months of their child’s life, and none to our knowledge in regions of BC where immunization rates are well below the Canadian average. Parental attitudes on southern Vancouver Island reflect specific local vaccination cultures and thus, may vary significantly from those on the mainland.

This longitudinal qualitative study explores decision-making processes about vaccinations among expectant and new parents in Victoria, BC by conducting four interviews with each mother, and two interviews with fathers or other co-parents, from the third trimester until just after the child’s first birthday. Analysis will focus on identifying points of leverage that may inform future interventions, providing data on the optimal time and method to engage parents.

Knowledge translation is integrated into the study design through collaborations with Island Health. Findings from this study will be presented for discussion in workshops with key stakeholder groups, disseminated through publications and conference presentations, as well as via a short radio piece.

Exploring the factors that influence implementation of mifepristone abortion practice in Canada: The CART-Mife Study

Approximately one-third of Canadian women will have an abortion in their lifetime. About 100,000 occur annually, of which 96 percent are provided using surgery. Mifepristone, the gold standard for medical abortion, was recently approved by Health Canada with availability anticipated in 2016. Mifepristone abortion delivered in primary care settings has been shown to be safe, effective, and not to increase abortion rates. However, international implementation of this practice varies and may be due to differences in health systems, provider training and supports, and regulations.

Best practices in knowledge translation indicate that, to maximize the impact of this health service innovation, it is necessary first to understand the barriers and facilitators that will influence mifepristone implementation in Canada. Health Canada has specified several extraordinary restrictions, including that physicians and pharmacists who provide mifepristone must be certified through an accredited training program. We propose that training and certification alone will be insufficient to support adoption and distribution of this innovation, especially in rural areas and among clinicians not currently providing abortion care.

This study seeks to explore the question “What are the barriers and facilitators that influence successful implementation and ongoing provision for medical abortion service?” Specific research objectives include:

Exploring health policy, system, and service barriers and facilitators to physicians and pharmacists’ adoption of mifepristone practice.
Developing a theoretically informed framework for supporting the implementation of mifepristone practice in Canada.

This research is embedded within a larger mixed methods program of study. I will use qualitative methods founded on Diffusion of Innovation theory. The results of the study will inform the development of a theory-based knowledge translation framework for promoting the implementation of mifepristone practice in Canada. Findings may be generalizable to implementation of other health service innovations in sexual and reproductive health in the Canadian health services context. Knowledge about the effect of the full range of health policy, system, and service determinants on access to mifepristone abortion is needed to realize the potential to increase equitable, safe, confidential abortion care closer to home.

Development and Validation of the Patient Engagement In Research Scale (PEIRS)

Patient engagement in research occurs when patients meaningfully and actively take part in the conduct and decision-making at any stage of the research process from inception through impact evaluation. There is a paucity of validated measurement tools to evaluate whether interventions to improve patient engagement in research support their successful engagement.

This project aims to develop and validate the Patient Engagement In Research Scale (PEIRS) for use by patients who partner in health research (i.e. patient partners), and to evaluate the degree to which they are meaningfully and effectively engaged in the research process. PEIRS will be developed with patients for patients. Our key objectives are to generate an item-bank reflecting the elements of patients’ experiences as partners in research; use the most relevant experiences to develop the PEIRS; then, evaluate the validity and reliability of PEIRS.

We will used a mixed qualitative and quantitative study design. First, a secondary thematic analysis will be conducted on in-depth interviews of 20 patients with arthritis who have experience as research partners. An extensive list of items relevant to the quality of patient-researcher partnership will be developed. Second, we will invite 10 patient partners to participate in a Delphi process to prioritize, select, and modify the items. We will then conduct usability testing with another 10 patient partners to identify and address any problems in the provisional PEIRS. Third, we will recruit 100 patient partners from across Canada to test the PEIRS’s validity and reliability. Specifically, factor analysis will examine its structural validity. Concurrent validity of PEIRS will be tested against an established measure of overall satisfaction and experiences of the public and patients as project partners in a health system organization. In addition, we will assess the association between PEIRS scores and participants’ ratings of the “meaningfulness” of their engagement.

This research project employs an integrated knowledge translation approach, in which researchers and experienced patient partners are working together at every stage of the research process, from inception through knowledge translation. PEIRS will address an important barrier to advancing the science and practice of engaging patients in research, namely the lack of a validated measure to assess effectiveness of patient engagement strategies. As such, this research contributes to support meaningful engagement of patients in health research.

Advances in the treatment of sexual dysfunction in men: Applications for mindfulness-based cognitive therapy

One in eight men will be diagnosed with prostate cancer in their lifetime. Advances in prostate cancer treatments mean that the number of prostate cancer survivors is higher than ever; however, prostate cancer treatments come with side effects, many of which are life-long. Up to 90 percent of prostate cancer survivors will go on to experience erectile dysfunction (ED) — difficulties obtaining/maintaining an erection sufficient for sexual activity that can be highly distressing for both men and their partners. Although some medical treatments for ED exist (e.g. Viagra), these medications tend not to be very effective for these men.

Mindfulness (non-judgmental present-moment awareness) is a new tool in sex therapy that has been shown to be effective in treating women with sexual dysfunction. Mindfulness has also been shown to have psychological and physiological benefits for men who have survived prostate cancer (for example, it improves quality of life as well as immune system functioning in these men). The current research study aims to take the same mindfulness-based sex therapy that is effective for women, and adapt it for men with ED following prostate cancer treatments and their partners.

Men experiencing ED following prostate cancer treatment will be recruited from the Vancouver Prostate Centre to take part in a mindfulness-based group therapy. Men will be randomized to either an immediate or a delayed treatment group. The group will consist of six to eight other men and their partners, and involves two-hour sessions for four consecutive weeks, with home practice activities in between sessions. Content of the sessions will include education, elements of sex therapy, and mindfulness training. We predict that mindfulness therapy represents a new and important treatment that will ultimately help improve quality of life in the growing number of men who experience ED following prostate cancer treatments.

This project will examine optimal combinations of psychological and medical care for men with ED following treatment for prostate cancer and their partners, with the ultimate goal of improving conceptualization and treatment. In order to increase men’s access to sexual health care, knowledge translation is pivotal. I will collaborate with Dr. Lori Brotto and Dr. Tia Higano to share the findings with academics (e.g. conferences, publications) and stakeholders (e.g. media), and train clinicians to deliver MBCT for men (e.g. clinical psychology students at UBC, paraprofessionals in sexual health clinics across UBC and Vancouver hospitals).

Neurally-produced estradiol enhances the neuroprotective actions of insulin

Alzheimer’s disease is a debilitating disorder that is on the rise in British Columbia’s aging population. A growing pool of evidence suggests that Alzheimer’s disease may involve insulin, a hormone whose activity in the pancreas is linked with type 1 and type 2 diabetes. Insufficient action of insulin in the brain can be a cause of Alzheimer’s disease, which is increasingly being called “type 3 diabetes” because of this.

During my graduate studies, I observed that insulin is produced in the brains of mice and humans, with highest expression in the hippocampus. My preliminary results also suggested that deletion of brain insulin in mice leads to cognitive deficits.

Estradiol enhances insulin production and response in the pancreas. However, these effects of estradiol in the brain have never been confirmed. Yet when expressed together in the hippocampus (a brain structure critically involved in memory), estradiol and insulin promote neuron growth and survival as well as synapse formation and maintenance.

I will test the hypothesis that estradiol produced by neurons enhances the production and action of insulin in the brain, and that this has beneficial effects in a rat model of Alzheimer’s disease.

I will inhibit estradiol production in the brain and then test how local insulin expression and signalling are affected in the brains of the rats. I will also examine the neurons and synapses in adult rats and will perform behavioural and cognitive tests. A drug that blocks insulin receptors will be used to confirm that insulin signalling is the true cause of any changes I observe.

I predict that inhibition of brain estradiol production will reduce brain insulin expression/action and increase negative effects associated with Alzheimer’s disease in this rat model.

Studying the role of brain estradiol production and its potential to increase brain insulin activity in the brain could ultimately lead to new treatments for Alzheimer’s disease.

End of Award Update

Source: CLEAR Foundation

Dr. Mehran’s hypothesis was that estradiol produced by neurons enhances the production and action of insulin in the brain, and that this would have beneficial effects in a rat model of Alzheimer’s disease. However, even using some of the most sensitive assays, they failed to yield a difference.

However, Dr. Mehran discovered that second-generation antipsychotic medications inhibit insulin maturation. This finding is important because these medications are used to treat patients with psychosis and Alzheimer disease. These medications may be contributing to cognitive harm, by reducing levels of brain insulin.