Most parents struggle with their baby’s sleep in the first year. Severe and persistent sleep difficulties can harm parent-child relationships and infant and parental mental health. Parental education, individual consultations, and/or group sessions can help parents improve their baby’s sleep but parents are often overwhelmed with rigid or conflicting advice. Canadian families are diverse, and what works for one may not work for others. For example, a family may be impacted by depression, poverty, or both, and these intersecting factors will affect what educational content and delivery will work best. The SLeep solUtions to proMote Better Early childhood Relationships (SLUMBER) program will give families options to meet their specific needs to get everyone sleeping better. Each part of the program will be designed in partnership with parents. We will develop groups of program options (portfolios) and test them to see who, how, and why they help. This personalized approach will prevent and/or lessen sleep problems with the added benefit of supporting parent-infant relationships and infant mental health. Having a baby is stressful, and this research will support sleep as a foundational pillar of family mental health and well-being.
Research Pillar: Clinical Research
Supporting Mental Health in Adolescents and their Parents: Using Developmental Science to Refine and Promote the Uptake of a Local Community Intervention
Stressors encountered in daily life such as family conflicts contribute to the risk of experiencing mental health issues such as anxiety. Conflicts between parents and their children increase in adolescence, but research has focused primarily on its mental health implications for adolescents and not also parents. Parents of adolescents go through their own developmental transitions (e.g., midlife) that bring significant stressors with them. Therefore, both parental and adolescent developmental status and mental health need to be understood to help families develop healthy communication and conflict skills, which may benefit the mental health of both individuals. We need to identify which types of emotion patterns are associated with increased risks, or protection from, the development of mental health issues in response to stressors. We aim to identify parent-adolescent emotion dynamics in the context of stress that are associated with both parents’ and adolescents’ anxiety. The primary impact will be to refine an existing community-based intervention for parents of anxious adolescents and to promote its accessibility by involving families and counsellors in the redevelopment process.
Organ-sparing minimally-invasive endoscopic resection techniques program: incorporating high-quality endoscopic management into everyday clinical practice
Colon cancer is a leading cause of death, disability and healthcare costs in BC. This emphasizes the importance of removing polyps during colonoscopy, which are pre-cancerous growths in the colon that develop into cancer over time.
Large polyps (LPs) are especially important. They are common and are more likely to be cancerous at the time they are removed. A number of techniques have been created to safely remove LPs during colonoscopy, including those which can cure early cancers. These techniques, called minimally-invasive endoscopic resection techniques, stop patients from undergoing unnecessary surgery which can lead to disability and death. However, many patients with LPs are still undergoing unnecessary surgery in BC and worldwide.
We propose a research program on LPs with two key goals: 1) identifying the best techniques to safely remove LPs; 2) Incorporating these techniques into everyday clinical practice. These goals will be achieved by collaborative research projects with national and international experts within this field including the BC Colon Screening Program.
Achieving these goals has the potential to improve the health of patients in BC and reduce healthcare costs.
Moving online: Developing physical activity interventions with and for young people diagnosed with cancer
Physical activity is safe and beneficial for children, adolescents, and young adults diagnosed with cancer. However, few physical activity programs are available for young people diagnosed with cancer. This is partly because cancer is rare in young people, and so it is hard to create programs that can be accessed by everyone. In my research, I create and test physical activity programs that consider the needs of young people diagnosed with cancer. Over the next 5 years, I will work with children, adolescents, and young adults diagnosed with cancer and their parents, cancer support organizations, fitness professionals, healthcare providers, and researchers to create online physical activity programs that are safe and accessible. I will then implement and test these physical activity programs with young people diagnosed with cancer across Canada. My work will lead to new physical activity opportunities with the potential to improve the health of young people diagnosed with cancer across the country.
Smart Discharges for Mom+Baby: Saving mother-newborn dyads by developing a predictive risk model to identify vulnerable dyads and guide delivery of post-discharge care
The risk of a mother or baby dying is highest in the first six weeks after birth. The World Health Organization (WHO) recommends regular follow-up visits for all mothers and their newborns. This is not always possible. In resource-constrained countries, a lack of money and nurses at hospitals and limited time and money at home often stops mothers from seeking care. In our study, we will build a score to identify mother-baby pairs that are most at risk of getting sick or dying in Uganda. The health of a mother impacts the health of their baby, and vice versa. Our risk score combines the risk of the mother and baby so that both can get care when they need it. A nurse can use this score to guide the number of follow-up visits recommended for the pair. In this way, mothers and babies at higher risk receive more visits. We will also talk to parents and nurses to determine what stops mothers and babies from receiving a follow-up visit. We will work with our Ugandan partners to remove these barriers so that improvements in care are long-lasting. In the future, we can use this approach to improve the health of mothers and babies in smaller, remote towns in BC, where specialized care for mothers and babies is not always readily available.
Mechanisms underlying syncope: Defining the role of postural sway and gastric distension, and investigating the possibility of a cerebral trigger
Some people faint often, negatively impacting quality of life. Fainting occurs when the heart cannot pump enough blood to the brain. Standing still pulls blood into the lower body reducing its return to the heart. However, even when standing still, our body sways and these movements may prevent fainting by pushing blood to the heart. Water drinking might also help by stretching the stomach, raising blood pressure. Also, seeing blood/having blood drawn can cause fainting, suggesting the brain may trigger a faint, not the heart. We will examine: i) the role sway plays in fainting, ii) if fizzy water drinking wards off fainting, and iii) brain activity during emotional triggers. Using wearable sensors, we will compare heart rate, blood pressure, and sway patterns in the lab and in soldiers who faint on parade. We will test if drinking fizzy water increases blood pressure more than still water. We will also compare blood pressure, heart rate, and brain activity in fainters and non-fainters while participants watch a video of a blood draw to show the role of the brain in initiating faints. These studies will help us better understand fainting, relieving the healthcare burden and improving quality of life for people who faint.
Transcutaneous spinal cord stimulation for treating neurogenic bladder dysfunction following spinal cord injury
As much as 80 percent of people with a spinal cord injury (SCI) develop urinary bladder problems. Recovery of bladder function is consistently rated as a top treatment priority for people with SCI. Left unmanaged, bladder dysfunction can result in frequent urine leakage or unwanted urine retention that often cause kidney or urinary tract infections which drastically reduce overall quality of life. Despite the prevalence of this issue, treatment for restoring bladder function remains under-emphasized in SCI research. Of even greater concern are consequences associated with rapid, and often life-threatening, increases in blood pressure triggered by bladder care. Electrical spinal cord stimulation via surgically implanted electrodes is a potential treatment option that has been shown to promote functional recovery after SCI by modulating silent spinal circuits. However, the surgical implantation of electrodes and the stimulator is invasive, expensive and has inherent risks. We propose to improve bladder function and prevent associated blood pressure surges via non-invasive spinal cord stimulation using electrodes placed over the skin, thereby minimizing patient risk and obviating the need for invasive and expensive surgery.
The role of the innate immune system in hypoxic ischemic brain injury post cardiac arrest
In Canada, more than 50,000 cardiac arrest (i.e. “heart attack”) patients simultaneously suffer from brain injury due to reduced brain blood flow and oxygen delivery. Primary brain injury occurs following the initial reduction in brain blood flow following cardiac arrest, and in some cases, secondary brain injury occurs after brain blood flow is restored to normal levels. However, the physiological mechanism(s) responsible for secondary brain injury following cardiac arrest remain unclear, and the data available in humans are very limited. We hypothesize that a key contributor to secondary brain injury following cardiac arrest is due to consequential activation of the human body’s innate immune system, which signals for excess brain inflammation and results in cellular damage. The proposed investigation, which will be conducted at Vancouver General Hospital, aims to measure key biological markers to quantify brain inflammation in post cardiac arrest patients. The findings from this study will improve our overall understanding of the mechanism(s) that contribute to brain injury characterized by reductions in blood flow and will potentially identify potential therapeutic targets and improve quality of life in these patients.
Dissecting heterogeneity in COPD: A functional imaging-guided-omics study
Chronic obstructive pulmonary disease (COPD) is a common lung condition with no known cure. Understanding lung abnormalities in COPD is critical to develop new treatments. However, lung abnormalities in COPD are ‘patchy’, and test samples (e.g. biopsies) used for laboratory studies may not be from the most diseased areas. We will use advanced lung imaging techniques (magnetic resonance imaging (MRI) and computed tomography (CT)) to identify ‘high-disease’ areas in the lungs of volunteers with COPD, and take samples from these areas using a camera inside the lungs (bronchoscopy). We will take samples before and after treatment with a common antibiotic medication (azithromycin) and test for changes in lung genes. Our approach may ultimately help develop new treatments for the 384 million people worldwide who suffer from COPD.
Determination of the optimal SARS-CoV-2 vaccination strategy to achieve a robust and long-lasting immune response
Global COVID-19 vaccine distribution has been inequitable, with high-income countries afforded widespread access to vaccines and boosters, while among the low-income countries only 2 percent of individuals are vaccinated. Consequently, over 50 percent of the world’s population remains unvaccinated. Fortunately, however, data from vaccinated cohorts can inform the most efficient and effective community-level vaccination strategies for the unvaccinated populations. Currently approved mRNA vaccines were initially tested with dosing intervals of 21-28 days; however, this may lead to suboptimal immunity. Further, data informing the optimal timing and frequency of booster doses is lacking. This project will answer critical questions regarding the optimal vaccination strategies to achieve a robust long-lasting immune response. In this study I will employ data from a prospective national cohort of adult paramedics, providing sociodemographic data and serum blood samples. I will identify the optimal vaccination strategies to achieving a robust immune response at 12, 18 and 24 months, including examining differences between sex, race, and age. These data will inform ongoing global vaccination efforts, to maximize efficiency and long-term protection.