Characterizing Traumatic Brain Injury in Survivors of Intimate Partner Violence

Intimate partner violence (IPV) is remarkably prevalent: ~15-50% of women are will likely experience IPV in their life. Following an IPV episode, the survivor can have negative mental health outcomes including: post-traumatic stress disorder, anxiety, and depression. These injury outcomes may be rooted in structural or functional changes in the brain. Currently, there is very little direct evidence for the potential link between IPV and traumatic brain injury (TBI), specifically how the latter may have an influence on the outcome and trajectory of survivors. Following a TBI, neuropathological changes (physiological and anatomical) are reported as a rapid onset of neurological impairments.

Given the subtle nature of the deficits, it is often difficult to determine injury extent, or when a patient has recovered. From a clinical perspective, current diagnosis mainly relies on self-reported symptoms such as: headaches and dizziness. The subjective nature of self-reported symptoms and the possibility of bias, clouds symptom presence and magnitudes. The physiological measures (cerebral autoregulation, autonomic function) in this investigation will serve as objective diagnostic markers to develop advanced screening tools to inform treatments for IPV survivors presenting to shelters. This study has been endorsed by the Ministry of Women’s Health, which will use the findings to alter the manner in which health care and social workers assist with this population.

Physical exercise to mitigate the effects of physical inactivity on brain health

Problem: Many older adults experience prolonged bed rest as a result of injury, surgery, or hospitalization and this may have detrimental effects on both their cognitive (i.e. thinking) and physical abilities. Ensuring older adults engage in daily exercise during bed rest may counteract the negative consequences of physical inactivity on cognitive abilities.
Research Overview: Maximizing on an opportunity provided by CIHR and the Canadian Space Agency, we will determine: 1) the effects of 14 days of bed rest on cognitive function in adults aged 55 to 65; 2) the impact of daily sessions of physical exercise in counteracting the effects of bed rest on cognitive function; 3) the mechanisms (i.e. how) by which bed rest and impacts cognitive function and its influencing factors (e.g. sex). Participants will be randomized to a group with either 14 days of bed rest with three physical exercise daily sessions (total of 60 minutes) or a control group (bed rest only).
Potential Impact: Promote the development of novel interventions and rehabilitation strategies to counter the adverse effects of physical inactivity, including bed rest, on cognitive health in older adults during transitions in care.

Anti-inflammatory cytokine function in individuals with type 2 diabetes: Impact of hyperglycemia and the restorative effects of exercise

Chronic low-grade inflammation (i.e. the persistent low-level production of pro-inflammatory factors by immune cells) is a major contributor to the development and progression of type 2 diabetes (T2D). We have recently demonstrated that cells from individuals with T2D also have impaired anti-inflammatory responses — a defect that appears to be driven by hyperglycemia. Despite these novel observations, the relationship between hyperglycemia and impaired anti-inflammatory responses (and the underlying mechanisms) across individuals with varying levels of glycemic control has not been examined. Moreover, the ability of a lifestyle intervention to restore anti-inflammatory responses via normalization of blood glucose levels in individuals with T2D has not been evaluated. As such, we aim to: 1) determine whether a dose-response relationship exists between the level of hyperglycemia and magnitude of impairment in anti-inflammatory responses across individuals with varying levels of glycemic control, 2) explore the mechanisms linking hyperglycemia to impaired anti-inflammatory responses, and 3) evaluate the efficacy of a daily post-meal walking intervention to restore anti-inflammatory responses in individuals with T2D.

Psychiatric morbidity in multiple sclerosis during the prodromal period (Psych-MS)

Multiple sclerosis (MS) likely begins years before the first neurological symptom by a set of not-clearly defined, subtle symptoms, leading patients to increasingly seek medical attention years before diagnosis. Some may even require psychiatric care during this period. This phase of the disease is known as the MS prodrome. Our plan is to better characterize psychiatric healthcare encounters during this phase of the disease by analyzing anonymized and linked administrative health data that is generated whenever an individual visits a doctor, is admitted to a hospital, or fills a prescription at a pharmacy. We aim to specifically look at any visits resulting in a diagnosis of depression, anxiety, or bipolar disorder by a physician, any visits to psychiatrists, and also look at prescriptions filled for medications, such as antidepressants. These ‘psychiatric data’ generated during the five years before patients’ first MS symptom will be explored and compared to that of individuals from the general population. We believe that advancing our understanding of the MS prodrome may help us identify patients sooner in their disease course, allowing for earlier treatment, and eventually prevent disease progression.

Using a mobile health aerobic exercise program to improve psychological distress in healthcare professionals: A randomised controlled trial

Healthcare professionals account for the largest sector of government employees in Canada and report more than twice as much high work stress and greater depression than the average employed Canadian. Due to the current pandemic, healthcare professionals are now reporting an increase in their depression, anxiety, and distress linked to their risk of becoming infected with COVID-19, quarantine and isolation, and being separated from their families. The stress faced by healthcare professionals should be cause for concern among our public health organizations, as stress has serious health consequences for healthcare workers, including medical errors, depression, burnout, absenteeism, and premature mortality. I am proposing to conduct a randomised trial of an aerobic exercise mobile app intervention (yoga and whole body weight-based training) that requires little physical space or equipment and is easily completed at home or in a small office, to improve healthcare professionals’ psychological distress and wellbeing. This work is expected to provide a feasible, engaging, and accessible solution to implement in every medical setting that will improve work stress, health, and quality of life among Canadian healthcare professionals.

Let’s ride! Supporting individuals at risk of type 2 diabetes who self-identify as an ethnic minority in a community-based diabetes prevention program using electrically assisted bicycles

Interventions to prevent the progression of prediabetes to type 2 diabetes (T2D) are needed. This need is greater among individuals self-identifying as an ethnic minority in Canada, because they are at greater risk for developing T2D and at a younger age than individuals of European descent. While there is strong evidence that physical activity (PA) can reduce diabetes progression, adherence to PA is poor following diabetes prevention programs. Compounding this problem, diabetes prevention programs are failing to reach ethnically diverse populations. Alternative methods of promoting PA that is appealing to ethnoculturally diverse populations is needed. Electrically assisted cycling is an activity that can lead to positive health outcomes. E-bikes enable people to exercise outside and may reduce barriers of access to, and cultural resistance to joining, an exercise facility. This research will examine the effectiveness of using e-bikes as a method of increasing PA among individuals identifying as an ethnic minority who are at risk of developing T2D in interior BC. This research will provide information on a new, alternative form of promoting PA as part of a diabetes prevention program that can be used to tailor existing programs.

A randomized controlled trial of a cognitive control intervention for major depressive disorder

Major Depressive Disorder is common and debilitating. Individuals with depression show biases toward negative, and away from positive, information– referred to as cognitive control biases. These lead to difficulty regulating emotions, unhealthy biological responses to stress, and ultimately, greater depression. Cognitive control biases are not adequately treated by current therapies. The objective of this clinical trial is (1) to test the effectiveness of a new cognitive control intervention (CCI) for depression and (2) to understand how it works. Participants will be assigned to a 4-week CCI group or a control group. Cognitive control biases, emotion regulation, and depression will be measured before and after CCI and 6 months later, and biomarkers of stress will be collected post-CCI. I predict that the CCI group will show improved cognitive control biases and emotion regulation, healthier biomarkers of stress, greater decreases in depression, and higher remission rates after CCI. Changes in cognitive control biases, emotion regulation, and biomarkers are expected to account for outcomes. CCI has the potential to be an accessible, virtual alternative to current therapies, and findings will inform our understanding of depression.

Paediatric spinal cord injury in Canada: Using administrative claims data to examine long-term health outcomes and healthcare utilization

A spinal cord injury (SCI) is defined as damage to the spinal cord that results from traumatic (e.g. motor vehicle accidents or falls) or non-traumatic (e.g. spina bifida or tumour diagnosis) causes. Children with SCI often require extensive medical follow-up and rehabilitation, and are at increased risk of adverse health effects (such as bladder issues, respiratory and cardiovascular disorders, and death) compared to children without SCI. Despite presumed increases in the number of Canadian children living with SCI over time, little is actually known about paediatric SCI in Canada. Using electronic health data from British Columbia and Ontario and health analytics, my proposed research aims to address existing SCI knowledge gaps by 1) developing national case definitions for traumatic and non-traumatic paediatric SCI, 2) estimating the number of Canadian children living with SCI, and 3) increasing understanding of long-term health outcomes and healthcare utilization among children with SCI. Findings from this research will, for the first time, describe paediatric SCI in Canada, identify paediatric populations most at risk of SCI, and identify opportunities to improve paediatric SCI care in British Columbia and across Canada.

Investigating sex differences in dyspnea across the spectrum of chronic obstructive pulmonary disease severity

Chronic obstructive pulmonary disease (COPD) results in breathlessness, reduced activity level and quality of life. The number of women with COPD in BC is increasing. Healthy women experience more breathlessness during exercise compared to men. Women with mild COPD experience even more breathlessness and report worse quality of life. The basis for sex differences in breathlessness across the full spectrum of COPD disease severity has not been studied and is the main focus of our proposed research.

We will explore how breathlessness differs between women and men with mild-to-severe COPD in a group of patients that undergo lung function testing and specialized exercise testing as well as using data from a Canadian cohort study of COPD patients. We will also use high resolution imaging of the lungs to relate structural changes due to COPD to the symptoms women experience.

This is the first study to explore sex differences in breathlessness across COPD disease severity from two perspectives, using detailed exercise tests and a complementary COPD database. Understanding breathlessness in women with COPD is a first step in order to develop effective treatment strategies for the increased symptoms women experience.

Can we identify dementia risk from 24-hour wrist-worn actigraphy? Using machine learning to identify risk factors for dementia during the 24-hour day

By 2031, there will be a projected 674,000 Canadians living with dementia. Early detection of dementia risk will thus be critical to reducing dementia prevalence. Circadian rhythms (i.e. the ~24-hour biological clock) are critical to the maintenance of the sleep-wake cycle, and sleep-wake disturbances are common in people at risk for and living with dementia. Several studies have identified circadian risk factors for cognitive decline and dementia using wrist-worn actigraphy (a common field measure for indexing the sleep-wake cycle of circadian rhythms). However, there are opportunities to use the power of artificial intelligence, specifically machine learning (ML), to enhance the sensitivity and specificity of wrist-worn actigraphy (WWA) for detecting sleep-wake cycle disturbances which are associated with increased dementia risk. Thus, I will use ML and WWA data from the UK Biobank (90,000+ participants with valid data) to identify risk factors for dementia from the 24-hour sleep-wake cycle. The results of my project may provide a non-invasive and sensitive method to identify patients at greater risk for cognitive decline and dementia.