The ongoing drug toxicity and overdose (OD) crisis has ruined the lives of many people in British Columbia (BC). Opioid agonist therapy (OAT) reduces the risk for an OD, but not everyone who needs OAT has access to and is taking OAT. People living with HIV (PLWH) are disproportionately affected by the OD crisis and may be less likely to have access to OAT. This project aims to contribute to a strategy to connect people who visit an emergency department (ED) or a hospital due to a nonfatal opioid OD (NFOOD) with primary care and OAT. I will use routinely collected health data on all PLWH and a 10 percent random sample of the general population in BC, between 1992 and 2020. I will investigate — of everyone who visited an ED or a hospital after a NFOOD — who is most at risk of 1) not being connected to primary care and OAT, and 2) a repeated OD. I will compare people living with and without HIV. I also will have conversations with professionals from various backgrounds and individuals with lived and living experience. Through these, I hope to learn more about barriers to care. Based on what I learned, I will formulate recommendations on how to help people that experienced a NFOOD connect with care that best suits their needs, including OAT.
Research Pillar: Clinical Research
The relationship between the cortico-reticulospinal tract and motor function in stroke survivors
Stroke is a leading cause of long-term disability in Canada that causes movement impairments on one side of the body. In cases of severe movement impairment, there is often extensive damage to the primary descending motor pathway in the brain originating from the opposite side of the body. When this pathway is damaged, secondary motor pathways are altered which may support recovery in these individuals. Several of these secondary motor pathways originate from the same side of the brain as the impaired limb and are therefore undamaged in cases of stroke. My research aims to comprehensively investigate the role of the secondary motor pathways in motor function with chronic stroke survivors that have severe movement impairments. This research will use a combination of state-of-the-art brain stimulation and brain imaging techniques to gain novel insight into the relationship between the secondary motor pathways and the control of voluntary movement. My research will provide valuable insight into the role of the alternative motor pathways. In turn this information can be used in clinical practice to implement rehabilitation strategies that lead to better recovery and improved quality of life in individuals with severe strokes.
The role of Inflammatory bowel disease in the development of Alzheimer’s disease
People with inflammatory bowel disease (IBD) are six times as likely to develop Alzheimer’s disease and on average seven years sooner than people without IBD. IBD will affect 1 percent of Canadians in the next 10 years and there is no cure for this illness. IBD causes intestinal microbiome, neural, immune, and endocrine dysregulation, but the exact mechanisms that drive the development of Alzheimer’s and other dementias are unknown.
The goal of my research is to elucidate the mechanisms by which IBD increases the risk of Alzheimer’s and dementia with the long-term goal of developing pharmacological interventions.
The association of genetic risk factors with morphology and outcomes in interstitial lung disease
Interstitial lung disease (ILD) is a diverse group of illnesses with a variety of causes. The current approach to diagnosing ILD depends on the specific patterns observed on imaging studies (CT scan) and lung biopsy. There is increasing evidence that an individual’s genetics play a complex and important role in determining disease behaviour across different ILD subtypes. This study will examine whether common genetic risk factors predispose patients to different forms of ILD, influence treatment response, and predict prognosis. Investigating these genetic risk factors will improve our understanding of the biology that drives ILD and will help to develop a better system for ILD classification and diagnosis.
Risk and protective factors for cognitive health across the adult age span: Impacts of physical and mental health and illness on cognitive outcomes
The virus causing COVID-19 can invade the brain, raising concern over long-term impacts on thinking abilities. We aim to identify long-term impacts on these cognitive abilities in those who have had COVID-19, and pinpoint factors that predict long-term outcomes. Adults positive for COVID-19 and those with no evidence of infection, are completing a series of cognitive and psychological tests in a current study. The proposed project will follow these individuals over time, with one and three-year follow-ups to examine changes in cognition across time. We will examine group differences in cognition, mental health, and other factors at each time point, determine if one or more cognitive profiles (clusters) characterize COVID-19 positive individuals, examine changes in these profiles across time, and test a screening measure to detect these cognitive difficulties. Findings will inform clinicians (e.g. neurologists, rehabilitation specialists) on trajectory of recovery of function and inform healthcare service provision in BC. Results will help ensure long-term impacts of infection are appropriately addressed, so those affected can efficiently resume complex activities requiring cognitive effort (e.g. employment, academic pursuits).
Valvular heart disease and bioprosthetic heart valves: Defining mechanisms of degeneration and therapeutic discovery from bedside to bench
Aortic stenosis (AS) is a narrowing of the valve that controls blood flow from the heart to the body. AS results in significant decline in quality of life and can be fatal if untreated. Unlike most types of heart disease, there is no medication to treat AS and the primary therapy option is replacing the diseased valve with an artificial one by open-heart surgery or transcatheter implantation (insertion of an artificial valve through the blood vessels leading to the heart). Unfortunately, artificial valves can be dysfunctional and have limited durability, which can lead to heart failure, the need for repeat valve replacement, or death. With a focus on clot that can form on artificial valves, this research aims to determine the causes of valve dysfunction and degeneration, define methods to detect and predict which patients will experience valve dysfunction, and identify methods to increase valve durability. Overall, this work will provide critical new information to guide clinical care and the future evolution of artificial heart valve use that will improve the outcomes and quality of life of patients with AS.
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.
Development of an ex-vivo-in-silico framework to inform medication use decisions for breastfeeding women
Children can inadvertently be exposed to the medications their mothers receive through breastmilk. As such, breastfeeding mothers need to weigh both the risks and benefits of medication use for themselves as well as their children. Unfortunately, the majority of drugs prescribed to breastfeeding women lack sufficient information to understand these risks. Due to this lack of information, women may opt to delay needed drug therapy or discontinue breastfeeding altogether — choices that can negatively impact the health of both mother and child. The proposed research program looks to address this information gap by combining lab-based studies with advanced computer modelling to predict how drug intake by the mother translates to drug exposure in the breastfed child. Lab-based studies will answer the question, “How much drug is present in breastmilk?” Whereas, advanced computing will be used to create virtual children and mothers to answer the question, “How much of the drug administered to the mother will be transferred to the breastfeeding child?” This will work ultimately serve to provide breastfeeding women and their caregivers with vital information to make the decisions regarding safe and effective drug therapy.