Research Location: University of Victoria

Honouring all our relations: Advancing health and wellness of uncounted Indigenous peoples in BC through addressing gaps in population health and wellness reporting

Reporting on population health is important to monitor trends, identify priorities, and track progress to address inequities. All Indigenous peoples have the right to be counted. Yet, over 88,000 Indigenous people in British Columbia (BC) who do not have ‘Status’ under the Indian Act or are not registered with Metis Nation BC are currently ‘uncounted’ in population health reporting.

Responsibility for reporting on health of BC residents lies with the Office of the Provincial Health Officer, including collaborative reporting on health of diverse Indigenous peoples in BC. Currently, there is no process to report on health of uncounted Indigenous peoples. Gaps include: lack of formal relationships with those representing uncounted Indigenous peoples; no way of identifying this population in BC health data; absence of research frameworks reflecting uncounted Indigenous peoples’ perspectives; and no implementation plan for province-wide surveillance involving uncounted Indigenous peoples.

This study aims to support health of uncounted Indigenous peoples in BC by addressing current gaps in population health reporting, through partnerships that uphold Indigenous self-determination, decision-making and perspectives of health and wellness.

The impact of the loss-of-function ankyrin-B p.S646F variant on cardiomyocyte and neuronal excitability: Implications for diagnosis and treatment of heart disease

The electrical rhythms underlying heart and brain function are sustained by proteins that form pores in cellular membranes that flux ions like calcium and sodium. These pores are anchored in place by a molecule called ankyrin-B (ANKB). We discovered a genetic change in the Gitxsan Nation of Norther BC that results in a version of ANKB (ANKB p.S646F) associated with heart defects at birth, arrhythmias, sudden death, seizures, and cerebral aneurysms. We showed that this version of the ANKB molecule is mishandled by immature heart cells; however, we do not fully understand how this ANKB version contributes to clinical manifestations. As a clinician-scientist and expert in microscopy-based measurement of cellular excitability, I am well-positioned to bridge this important knowledge gap. By imaging calcium and voltage changes in living cells, I will study the impact of partial loss of ANKB and expression of disease-associated ANKB p.S646F versions on heart and brain cell excitability. I will also compare heart cell excitability data with patient electrocardiograms to help understand the connections between fundamental laboratory and clinical observations.

Developing patient-specific technologies to improve functional outcomes following joint replacement

The inability of patients to perform daily tasks after joint replacement remains a significant challenge as well as a burden on health systems because these poor results often require additional treatment (e.g. rehabilitation) and re-replacement. This challenge can be addressed by surgeons using individual patient characteristics to personalize how they perform joint replacement surgery. However, many surgeons perform too few procedures to effectively personalize their plans and thus technologies are needed to provide assistance.

The goal of this research is to develop an improved understanding of how patient specific factors affect the results of joint replacement as well as to develop technologies that can collect data about each patient’s individual characteristics and use these data to assist surgeons in optimally planning each surgery. This will be achieved by a combination of computer-based biomechanical research, statistical modelling, and novel sensor development. This work will improve our understanding of personalized joint replacement, yield new clinical technologies, enable surgeons to more effectively personalize surgery, result in improved patient function, and improve the health systems in BC and beyond.

Exploring the role of insulin in regulating female reproductive health and age-related reproductive decline

Female reproductive decline (indicated by rising rates of infertility, birth defects, and miscarriage) is an early sign of aging, and is largely due to deteriorating quality of oocytes, or egg cells. Identifying the signaling pathways and mechanisms that control oocyte quality and reproductive decline is essential for better addressing female reproductive health issues, and can also provide key insights into other aspects of aging.

Our research focuses on the ties between nutrients, reproduction, and aging. In organisms ranging from worms to humans, signaling pathways that detect nutrients — such as the insulin signaling pathway — seem to play crucial roles in coordinating metabolism, reproduction, and lifespan. We will use a mouse model of genetically reduced insulin to determine how lowering insulin affects oocyte quality and reproductive success during aging. We will also study how insulin levels determine features of polycystic ovary syndrome, a common hormonal disorder, and evaluate long-term consequences of temporary nutrient excess or depletion.

We anticipate that this research will inform effective strategies to better manage female reproductive health, as well as to improve health during aging.

Addressing food insecurity and the double burden of malnutrition in a changing climate

Malnutrition is a serious public health concern in Inuit and northern regions of Canada, driven by a complex array of social and ecological determinants, including poverty, food insecurity, and climate change. In northern communities, country foods (wild foods harvested from the lands and waters) often comprise an integral component of food systems and contribute to food security, nutrition, and social and cultural integrity. Yet, many country foods are also high in environmental contaminants (e.g., mercury and persistent organic pollutants), which have negative implications for health. Meanwhile, due to transportation challenges, available retail foods in northern and Inuit communities tend to be pre-packaged, processed, and expensive.

In this research program, I will use existing health survey data to evaluate dietary patterns in Nunavik (northern Quebec) and associated nutritional benefits and health risks. Through interviews and community workshops, I will also identify political, social, geographical, and environmental factors that impact food access, affordability, and desirability. Findings will be shared with decision-makers to generate evidence for sustainable and healthy food systems in northern regions across Canada.

The impact of parasites and microbes on immunity at mammalian mucosal surfaces

Under normal healthy circumstances our intestines are home to hundreds of species of microbes, collectively termed the microbiota. Our intestines can also be colonized by parasites, such as parasitic worms (helminths). Both the microbiota and helminths can affect the functioning of our immune system, which in turn, can influence our susceptibility to a variety of infectious, allergic, and inflammatory diseases. Research in my laboratory is focused on understanding the mechanisms by which helminths and the microbiota affect immune system functioning during normal development and during states of disease.

The incidence of allergies and inflammatory bowel diseases has increased dramatically in Canada over recent decades, and there is an urgent need both to understand the factors driving disease development and to identify new treatment strategies. My laboratory uses the mouse model system where the molecular mechanisms of interaction between components of the immune system, the microbiota, and helminths can be identified. Understanding the mechanisms by which the microbiota and helminths can influence immune system functioning may reveal new ways to treat or prevent allergic and inflammatory diseases.

Childhood obesity management using innovative digital technology

Childhood obesity is a major public health challenge in Canada. Without intervention, overweight children will likely continue to be overweight during adolescence and adulthood. Family-based lifestyle programs delivered at local communities can be effective. However, many families cannot attend these in-person programs due to travel distances and program availabilities. The current situation has turned increasingly dire in the COVID-19 landscape, where face-to-face, group, and facility-based interventions are no longer viable. With continued improvements in the sophistication and access to digital communication technology (e.g. Internet, wearables, smartphones), delivering tailored lifestyle programs using these tools may be well-suited to meet these challenges.

The goal of this project is to evaluate the long-term efficacy and the cost of delivering a stand-alone web-based and a blended in-person and web-based program in improving health-related outcomes in children who are overweight or obese in British Columbia (B.C), Canada. This project can be incredibly impactful for B.C. residents as this web-based program can improve the access, reach and personalization of family-based childhood obesity management programs.

Disseminating research outputs on actions to modernize gender, sex, and sexual orientation documentation in Canadian electronic health records

Co-lead: 

  • Jody Jollimore
    Community-Based Research Centre for Gay Men's Health

Team members:

  • Roz Queen
    UVIC
  • Marcy Antonio
    UVIC
  • Kelly Davison
    Canada Health Infoway
  • Karen Courtney
    UVIC
  • Aaron Devor
    UVIC

In this REACH project, we will share our prior research and engage stakeholders to discuss A) how our prior research output can address the needs of sexual and gender minorities (SGM) through improved gender, sex and sexual orientation (GSSO) documentation in electronic health records (EHRs), and B) how the prior output and action plan may be transformed into setting-specific knowledge tools.  

Our research team worked with Canadian stakeholders to improve the definition, collection and use of GSSO data in EHRs and generated the following outputs:

  1. An environment scan of how GSSO data are defined in EHRs
  2. Literature reviews of GSSO documentation — current approaches, gaps, needs and improvement efforts
  3. GSSO terms people commonly use to identify themselves
  4. An action plan with a set of broad, equity-oriented clinician-focused interventions to improve GSSO documentation in EHRs

In partnership with the Community-Based Research Centre, we will translate these findings into appropriate media and forms for dissemination to our diverse stakeholder groups. The expected outcomes of this project are enhanced dissemination to stakeholders and SGM-tailored knowledge translation tools in different healthcare contexts in BC.

Building bespoke artificial cells and tissues on a chip for drug discovery

Human cells are fascinating and complex: they reproduce, break down food to create energy and communicate with each other. The ‘skin’ of the cell, the cell membrane, plays a crucial role in choreographing interactions between a cell and the outside environment, for example by allowing or prohibiting the access of drugs from the cell exterior to the cell interior.

I design and build lab-on-a-chip devices, which are plastic chips the size of a postage stamp inside of which I can manipulate tiny amounts of liquids. I use these lab-on-a-chip devices to create artificial cells to be able to study how the cell membrane regulates access to the cell interior. Human cell membranes have lots of different components that are used to transport drugs into and out of the cell.

Since the cell membrane is complex, we do not always know exactly which component is interacting with the drug molecule, and what effect it has. The cost of developing a new drug is around 2.6 billion USD and a significant proportion of drug candidates fail because we cannot predict how they interact with cells.

My research will help design drugs that can interact with cells more efficiently, so that they can get inside the cell in order to work properly.

Managing the risks of future BC COVID-19 outbreaks using mathematical and statistical modelling

Cases of COVID-19 have gone undetected, likely causing future waves. The aim of our research is to develop mathematical and statistical tools for the early detection of future BC COVID-19 waves, and to evaluate control strategies for a future wave. A key component is the estimation of unreported cases and the probability of transmission in high-risk subgroups (such as the elderly and homeless). Our mathematical model will determine disease spread and testing policies interactions. We will then identify early detection strategies for future waves. To track the patterns of individual behaviours and evaluate intervention strategies, we will develop a computer simulation model. With other provinces facing the same problems, our tools can be applied to the national pandemic.

End of Award Update: June 2022

Most exciting outputs

The most exciting development from this project is a model to estimate hidden (e.g. asymptomatic or untested and unconfirmed) COVID-19 cases based on public case, recovery, death count data. We applied this model to the Northern Health Region for the first 30 weeks of the pandemic and found that:

  1. Actual cases were 2.5 to 6.25 times higher than the number of detected cases.
  2. Detection rate depends on the number of tests (confirming the intuition that more testing helps find the positive cases).
  3. Community spread rate changes with every BC recovery plan phase (increased control measures reduces community spread, increased travel/reducing restrictions increases spread).

A second development is our theoretical investigation into the effect of contact tracing through a novel mathematical model. The reproduction number (the average number of new infections coming from a single COVID-19 positive case) decreases as contact tracing efforts increase. This is because cases that are found through contact tracing will often isolate. However, when there is a large transmission rate, contact tracing alone may not control the infection. Thus, additional public health measures to decrease transmission are required for contact tracing to be effective. Further, increased testing rate increases the effectiveness of contact tracing.

The Island Health team has made great strides studying outcomes of control measures through agent-based mathematical models to simulate real world scenarios. The team has also been working on profiling contact events between COVID-19 cases and other patients or healthcare workers while accessing or providing service. This provided another method of contact tracing within Island Health service locations.

Impact so far

Our methods and tools are in place for the next pandemic (including open source R code available online). Dr. Cowen was interviewed by the CBC in November 2021, making the public aware of the issue of hidden case counts in the Northern Health Authority region of B.C. This interview came just as case counts began to increase in the region with the Delta wave.

Potential influence

The work done to estimate hidden populations can be done with new variants, different regions, and across the country. The tools that have been developed for Island Health specifically in relation to pandemic response, can and have been adapted to provide actionable insights into other public health crises (i.e. opioid) and pressing operational challenges (e.g. pressure on emergency departments).

Next steps

Our research is part of an ongoing program to improve population models, and we are continuing to apply our methods to a broad range of problems. We have continued our research on developing statistical models for count data and have drafted a manuscript for a Canada-wide model of COVID-19. Similarly, we are just finishing up drafting an article on the mathematical models that consider contact tracing. These include:

  • Parker, MRP, J Cao, LLE Cowen, LT Elliot, J Ma. Multi-site disease analytics with applications to estimating the extent of COVID-19 in Canada.
  • Bednarski, S, LLE Cowen, J Ma, T Philippsen, P van den Driessche, M Wang. A Network SIR Contact Tracing Model for Randomly Mixed Populations.

PhD student Matthew Parker has plans to present the Canada-wide modelling work at several conferences this summer and Dr. Cowen has been invited to present the work at the International Chinese Statistical Association Canadian Chapter in Banff.

MSc student Viet Dao is developing a statistical model based on Island Health lab testing data to provide another method of estimating hidden cases. Dr. Cowen is in the process of hiring a post-doc funded by NSERC EIDM and a UVic Aspirations 2030 Fellowship to continue this work, deploying it to all of BC. Dr. Cowen has hired a second post-doc funded by the Canadian Statistical Sciences Institute to develop models using Island Health’s data to estimate the homeless population and study the number of COVID-19 cases within this population.

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