Research Location: University of British Columbia

Optimal pregnancy and postpartum health for everyone

After childbirth, mothers are at risk of death and disease. Patient engagement can improve the relevance and impact of research in this area; however, patient partners often do not reflect the diversity of the community. This limits the research and its results. This is especially important in BC, which is the most ethnically diverse province in Canada. The proposed research project aims to answer the following three questions: 1) How can we improve the diversity of patient partners in pregnancy and postpartum-related research? 2) Is a mobile application appropriate and acceptable for self-screening of postpartum complications? 3) What is the frequency, timing, and factors associated with postpartum complications and hospital readmissions in BC? The proposed research will promote equitable representation of pregnant and postpartum individuals in research, improving our understanding of their health and health concerns. It will be a core component of my portfolio of patient-oriented maternal health research in BC and globally.

Using high-throughput experiments and machine learning to understand the role of non-coding mutations in cancer

Cancer is caused by mutations in the DNA that cause a patient’s cells to grow out of control. Some of these cancer-causing mutations change how genes are regulated; that is, which genes are turned on or off in the cell. Essentially all cancers have activated the TERT gene because TERT is essential for cancer growth. We understand TERT regulation better than most genes, but even here we cannot predict how mutations alter TERT expression. Overall, we do not understand which genes or mutations can promote cancer via altered gene regulation. Our work aims to learn the code that cancer cells use to interpret regulatory mutations. We will make many artificial mutations in large scale, and measure how much each mutation affects the amount of gene made. We will model how the cells interpret these mutations using a computer, and apply the model to find new cancer mutations. We will these computer models to discover how often mutations alter gene regulation in cancer, and highlight genes whose regulation is important in particular cancers. In the long-term, our work will allow us to better diagnose and treat cancer by showing how a particular patient’s tumor’s mutations alter gene regulation and cancer growth.

Towards a mathematical theory of development

New technologies like single-cell RNA sequencing can observe biological processes at unprecedented resolution. One of the most exciting prospects associated with this new trove of data is the possibility of studying temporal processes, such as differentiation and development. How are cell types stabilized? How do they destabilize in diseases like cancer and with age? However, it is not currently possible to record dynamic changes in gene expression, because current measurement technologies are destructive. A number of recent efforts have tackled this by collecting snap-shots of single cell expression profiles along a time-course and then computationally inferring trajectories from the static snap-shots. We argue that this inference problem is easier with more data, and the right way to measure the “size” of a data set is really the number of time-points, not the number of cells. We propose to collect the first single cell RNA-seq time-course with more than one thousand distinct temporal snapshots, and we develop a novel mathematical and conceptual framework to analyze the data. This tremendous temporal resolution will give us unprecedented statistical power to discover the genetic forces controlling development.

Generating, co-creating, and implementing solutions and supports for older adults with cancer and their caregivers

The number of adults over age 65 in Canada is growing as baby boomers age. Older adults are the most likely to be diagnosed with cancer and likely to have other chronic health conditions. These health conditions may mean increased medications, medical appointments, and/or difficulties getting around, which combine to make the cancer experience more challenging. Older adults may also require help from family or friends to attend their many cancer and other health appointments (family doctor, geriatrics, and other specialists). COVID-19 has created additional challenges for older adults with reports of reduced or limited treatment offerings, and a sudden shift to virtual appointments.

My research responds to ongoing calls to rethink how we provide care for older adults with cancer. Specifically, we will partner with patients, community groups, health system leaders, and clinicians to co-create and implement tools to make cancer management easier for older adults. This work focuses on improving the processes rather than merely supporting individuals to navigate complex systems. This research will have important implications for health systems, clinicians, and researchers, but most significantly for older adults with cancer.

Indigenous community-based health research in British Columbia’s interior

Indigenous health injustices and inequities are formed by colonial structures that are paralleled within health research itself. Therefore, Indigenous health research must re-center Indigenous Peoples approaches, or it risks re-colonization.

Thus, I aim to reframe Indigenous Peoples, cultures, knowledges, and capacities as central to a promising health future. My program of research focuses on three primary community-based health projects, which are guided by Indigenous approaches to health and research with community-partnerships as the foundation. First, in partnership with the Okanagan Nation Alliance, we are working together to frame community data within Sylix Okanagan approaches to health and data. The second project partners with Indigenous Programs and Services at the UBCO campus, to offer a healthy masculinities program for students. The third project brings together a cluster of experts to support urban Indigenous health in collaboration with Metis Centres and Friendship Centers in the Okanagan region.

My research program seeks to promote Indigenous health, health knowledges, capacities, and outcomes in ways that community understand as meaningful, and thereby support Indigenous control of Indigenous health.

Breaking Barriers: Empowering Primary Care Providers to be Instigators of Change in Hearing Health Care Practice

Health Research BC is providing match funds for this research project, which is funded by the Vancouver Foundation’s Participatory Action Research Investigate Grant. 

 

Up to 65% of adults in British Columbia (BC) aged 60+ will develop hearing loss. Fewer than one-quarter of these adults use hearing health care, with most delaying treatment 7 to 10 years on average. Untreated hearing loss affects health-related quality of life with links to social isolation, depression, greater risk of falls, and reduced financial security. For adults with concerns about their hearing, primary care providers (PCPs) are often a first point of contact for help seeking, and yet for reasons that remain unclear, PCP referrals to hearing health care are inconsistently and infrequently practiced. This problem was identified as a top priority through focus groups conducted in 2020. These graphics illustrate the focus group discussions that led to the development of this research question.

 

We will use a community-based approach to identify reasons for lack of referral and develop strategies that empower primary care providers to be key instigators for increased, timely uptake of hearing health care by individuals with hearing concerns.

 

The research team, all based in BC, is led by Lorienne Jenstad, PhD, an audiologist and associate professor at the University of British Columbia; Brenda Poon, PhD, the research program lead at the Wavefront Centre for Communication Accessibility; and Ruth Warick, PhD, president of the Canadian Hard of Hearing Association, Vancouver Branch. The team works closely with other individuals who have lived experience of hearing loss, physicians, nurses, clinical audiologists, and community organizations.

 

Ultimately we hope that primary care providers and the general public will have better recognition of the importance of hearing health and better understanding of the process to receive hearing health services, leading to timely uptake of hearing health care by individuals with hearing concerns and the potential to improve long-term health outcomes.

FOCUS on Adolescents: A mixed-methods study to optimize COVID-19 recovery and renewal efforts among adolescents in Canada and France

This award is co-funded by Health Research BC, through CIHR’s Operating Grant: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada. 

 

The COVID-19 pandemic and its corresponding health, social, and economic implications present potential lasting consequences for inequalities and vulnerabilities to manifest across later phases of the life course — a trend that may have significant impacts for adolescents aged 15-19. For example, school closures and other public health measures (e.g. isolation) have had significant effects on adolescent health — an age group whose need for social engagement and connection are essential for development. However, little is known about how social, economic, and cultural changes related to COVID-19 will affect adolescents’ health and social well-being over time.

 

To fill this knowledge gap, Dr. Rod Knight (principal investigator, assistant professor, UBC Department of Medicine) and Dr. Marie Jauffret-Roustide (co-principal investigator, research scientist, INSERM, University of Paris) are launching an international research study to extend their CIHR-funded France-Canada Observatory on COVID-19, Youth Health, and Social-wellbeing (FOCUS) – a research program launched in June 2020 to evaluate the impact of COVID-19 on youth aged 19-29 living in Canada and France – to include adolescents aged 15-19.

 

The FOCUS on Adolescents project will work alongside a group of adolescents from Canada and France to adapt the FOCUS Study’s program of research to include adolescents in a series of annual interviews and bi-annual national online surveys. At the end of the study, a participatory summit will be held in each country with youth and key stakeholders working with adolescents (e.g. clinicians, community members, policy makers) to identify interventions that best address the social and health needs of adolescents.

 

This research project will provide policy makers and clinicians with high-quality, real-time evidence to inform COVID-19 public health responses to improve health outcomes and reduce health inequities among adolescents.

End of Award Update – July 2024

 

Results

Our main objective was to involve adolescents aged 15-18 in our FOCUS research infrastructure, including the development and implementation of an online survey in Canada and France. To achieve this objective, we successfully engaged via in-person and virtual meetings with community organizations providing health and social support services to adolescents in both countries. These partnerships allowed us to adapt our online questionnaire and promotion strategies to reach and recruit a large group of adolescents in both countries: more than 300 adolescents took part of our survey in both countries. Involving adolescents in our research represents a key opportunity to investigate the differences between adolescents and young adults in terms of mental health and substance use, and therefore provide specific recommendations about the impact of the COVID-19 pandemic in each group.

 

Impact

During this research project, we implemented an international consortium of researchers from various disciplines, including Canadian and French researchers, which was a critical step to identify context-specific factors (e.g., differences in perceptions of mental health needs and vaccination) influencing research outcomes and developing further international, comparative research projects. We have presented research findings and other ongoing data analyses related to the FOCUS Study at international conferences and to our community partners as part of our knowledge mobilization activities.

 

Potential Influence

Our research activities allowed us to engage in constructive discussions with health providers and peer workers from community organizations regarding the influence of determinants of health on youth health and social wellbeing. For example, specific data analyses have been planned to inform community organizations about the health needs and concerns of adolescents and young adults in the current post-pandemic context.

 

Next Steps

Throughout the remainder of the FOCUS Study, we will continue to engage with community organizations and youth representatives to collaborate on the preparation of scientific articles. In order to accelerate the availability of our research findings, we will also develop a set of scholarly and policy-oriented deliverables, including those designed for key decisionmakers (e.g., government officials), as well as brief summaries of evidence, which we will promote through media engagement (e.g., media interviews, posts on social media platforms). For example, the preliminary findings of the 2023 FOCUS survey have been summarized in a community report that will be shared and presented to youth community organizations in France and Canada.

 

 

Useful Links

The DISCO study: Rethinking STI prevention

Syphilis, chlamydia and gonorrhea are three of the most common sexually transmitted infections (STI). Over the last decade, these STIs have seen a resurgence in many parts of Canada, with most infections seen in major urban centres. These infections have primarily affected gay, bisexual, and other men who have sex with men (gbMSM). Recently, a small pilot study found that doxycycline — an inexpensive, well-tolerated antibiotic — given daily may prevent new STIs in gbMSM. Another study looked at the use of doxycycline given after a sexual encounter for prevention of STIs, and the results of this study showed protection against STIs as well. Based on these promising data, along with the concerning increases in STIs seen in Canada, the current study will examine the use of doxycycline as either a daily prevention therapy (preexposure prophylaxis, or PrEP) or an ‘after sex’ prevention tool (postexposure prophylaxis, or PEP) for STIs in gbMSM. While examining for efficacy as its primary goal, this study will also do an examination of some of the potential challenges and concerns associated with the use of a daily antibiotic: drug resistance, tolerability and side effects, and how acceptable this drug is for people to take regularly.

Neuropsychological functioning in treatment resistant schizophrenia

Schizophrenia is a severe and disabling psychiatric illness involving primary symptoms of psychosis (hallucinations, delusions, disordered thinking and behavior). Unfortunately, as many as 30% of patients respond poorly to standard antipsychotic medications and are considered to have treatment resistant schizophrenia (TRS). Neuropsychological impairment is an important clinical feature of schizophrenia, as cognitive deficits predict poor treatment response, daily functioning, and disability. However, very little is known about cognitive functioning in the clinically complex subset of patients with TRS. The aims of this project are therefore to investigate the severity, pattern, and variation in cognitive functioning among individuals with TRS, and to determine whether cognitive difficulties predict treatment response and functioning. This will be achieved by analyzing clinical and neuropsychological data that has been collected on TRS patients who have been treated within the BC Psychosis Program since 2012. Findings using this unique dataset will have a direct impact on shaping assessment and treatment strategies, improving prognosis and ability to predict functioning, and improving clinical decision-making and planning.

Sharing the podium: Identifying solutions to meaningfully collaborate with youth in mental health and substance use research

Mental health and substance use (MHSU) are key health concerns for youth in British Columbia. Involving youth in research for these topics improves the development of MHSU interventions and solutions. However, youth may not want to engage in MHSU research due to concerns about confidentiality, stigma, and other barriers. Researchers may also perceive barriers in finding and working with youth researchers.

Our project goal is to identify barriers for youth engagement in MHSU research and recommend solutions for these issues. Two key activities will be used to bring together youths and researchers to identify the perceived barriers for each group and how these barriers can be overcome. These activities include a small-group discussion (utilizing nominal group technique) and a World Cafe. Our team will synthesize these results and outline a list of recommendations for youth engagement in MHSU research. We also plan to use this output to pursue additional funding for a pilot study using these recommendations. The pilot study would measure changes in youth research engagement and research outcomes due to the recommendations.

Team members: Dan Nixon (Providence Health Care and Foundry); Krista Glowacki (UBC); Kirsten Marchand (Providence Health Care and Foundry); Nikki Ow (UBC); Travis Salway (SFU); Hasina Samji (SFU); Steve Mathias (Providence Health Care and Foundry); Renee Cormier (Providence Health Care and Foundry); Anne Gadermann (UBC); Sarah Munro (UBC); Amanda Butler (Providence Health Care and Foundry); Chloe Gao (UBC)