Study of Neurophysiology in Childhood Concussion (SONICC)

Dr. Julia Schmidt’s research investigates the neurophysiology of concussion (mild traumatic brain injury) in children and youth. Dr. Schmidt spent over 10 years as a clinician in brain injury rehabilitation (Australia and Canada) prior to engaging in research training in Australia. She seeks to better understand injuries in order to more effectively determine rehabilitation strategies.

Concussion is a major public health concern, particularly in children and youth due to their vulnerable developing brain. The neurobiology of recovery from concussion in children and youth remains largely unexplored. Dr. Schmidt aims to:

  1. Sensitively quantify the severity and impact of concussion.
  2. Map neurophysiological changes that occur acutely after concussion using transcranial magnetic stimulation.
  3. Determine the time course of change associated with recovery from concussion.

Dr. Schmidt’s study will help to determine if the neurophysiology in children and youth are biomarkers of recovery. In turn, this can be employed as outcome measures in the development of new interventions and inform return to play decision-making.

Identifying prodromal signs of multiple sclerosis: a multi-centre approach

Multiple sclerosis (MS) is a neurodegenerative disease for which there is no known cure. It is among the most common causes of neurological disability in young adults in the Western world and affects approximately 2.3 million people worldwide, including an estimated 75,000 Canadians. The symptoms of MS and related morbidity have a major impact on quality of life: weakness, fatigue, disability and depression can all influence social, family and work life.

Some intriguing preliminary findings from one study based in Manitoba indicated that people with MS had more medical consultations than people without MS, even throughout the five-year period prior to MS onset. This implies that the disease already starts to develop long before the currently recognized clinical onset of MS. However, these findings have yet to be replicated and it remains unknown as to what the reason(s) were behind the measurable increases in medical consultations.

The aim of this project is to search for early signs and symptoms that could facilitate more timely recognition of MS and to narrow down the relevant time window when searching for factors triggering MS.

I will examine databases of medical records from people with MS in British Columbia, Saskatchewan, Manitoba and Nova Scotia. I will explore their physician and hospital visits before MS onset and before MS diagnosis, and I will compare this data to medical information from the general population. I will also examine the reason(s) for the physician and hospital visits.

I hypothesize that among people who go on to develop MS, I will identify specific associated “disorders” that drive the elevated health service utilization before MS onset.

I will help the research team share the findings directly with BC provincial decision makers via one-on-one meetings and presentations. Connections with patient advocate groups will enable me to also raise awareness of the results among people with MS.

Ultimately, the results of this study could contribute towards an earlier recognition of MS.

Understanding health equity and resource development (UnHEARD): New tools for assessing the health equity implications of unconventional natural gas development on rural and remote communities in northern British Columbia

Resource extraction and development activities are the primary drivers of social and economic development for communities across northern Canada, and therefore are significant determinants of community well-being. However, there is growing global recognition that the benefits of resource development are not distributed evenly across the supply chain, and that new tools are required to understand how anthropogenic changes in the natural environment affect population health.

This study uses the case of unconventional natural gas development in northern BC’s rural and remote communities to enhance the scientific understanding between resource development pathways and human health. BC is currently preparing for the rapid development of its natural gas reserves in conjunction with other diverse forms of land use and development (e.g. forestry, mining, industrial agriculture, etc.). However, the health impacts of rapid industrial growth are not well understood, and differences will be abound between gas extracting regions in the northeast of the province, gas transportation corridors through the northern interior, and gas exporting communities on the northwest coast.

In seeking to contextualize health impacts associated with resource development across the supply chain, this research will work to develop a new health equity impact assessment tool that is rooted in international best practices to explicate the intersections between ecosystems, the boom and bust cycle of resource-dependent towns and regions, and the resulting impacts on human health which are often overlooked in existing provincial environmental assessment and cumulative effects assessment protocols. Indeed, an explicit focus on health equity is a purposeful way to understand how health impacts are distributed across time and geographic space related to rapid resource development, thereby giving voice to health issues that often go UnHEARD during project permitting and planning. This work will involve the integration of a variety of data types to track changes in the distribution of health outcomes over time, and enable the identification of programs and protocols capable of mitigating associated health risks. Accordingly, this research will inform provincial regulatory processes through an expanded understanding of environmental disturbance as a context for health promotion, while assisting regional stakeholders in minimizing harmful impacts of industrial activities on community and worker health.

The Effect of Psychosocial Stressors on Health Behaviours and Indicators of Cardiometabolic Risk in the Transition to Young Adulthood

Adolescence and young adulthood are critical periods for health promotion and disease prevention. Cardiometabolic risk (CMR) refers to a set of indicators that increase an individual’s risk for diabetes, heart disease or stroke. These indicators start to show predictive variability in adolescence and identification and implementation of early strategies for risk management can have significant long-term health benefits. Much of what we know about CMR comes from studies of adults; therefore, research focusing on earlier age groups is needed.

The first objective of the proposed research is to describe the frequencies of select, non-invasive CMR indicators, including body mass index (BMI), systolic and diastolic blood pressure (BP), and waist circumference in young adulthood (ages 22-29). Research in psychoneuroimmunology documents the deleterious effects of stress on physical health; however, less attention has been given to adolescents and young adults.

The second objective is to examine how psychosocial stressors that become salient in adolescence (e.g. internalizing symptoms and interpersonal stress) predict CMR.

The third objective is to examine how these stressors compromise the enactment of key health behaviours (e.g. physical activity, eating habits, sleep duration) leading to increased CMR.

The project will use six waves of the Victoria Healthy Youth Survey (V-HYS), a 10-year longitudinal study that surveyed youth (N = 662) biannually from 2003 (T1; ages 12-18) to 2014 (T6; ages 22-29). In-person measurements of CMR (BMI, systolic and diastolic BP, waist circumference) were collected at T6. Measurements of internalizing symptoms, interpersonal stress (e.g. peer victimization), and health behaviours were collected at each wave.

Findings will highlight the variability in CMR in young adulthood and increase knowledge on the effects of two salient stressors on CMR from adolescence to young adulthood, providing new information about targets for prevention and interventions. The results will also inform guidelines for early identification and preventative healthcare.

Knowledge translation efforts will include 1) peer-reviewed publications, conference presentations, media reports, and policy formats; 2) creating an infographic about CMR in young adulthood to release to the media; and 3) developing a training tool to educate healthcare professionals about the relations between stress and CMR in these young age groups.

‘APP’lying Supportive Movement: Trauma-Informed and Culturally Safe Physical Activity Programming for Young Pregnant and Parenting Women Marginalized by Poverty, Racism, and Trauma

Physical activity has been found to have numerous physical, emotional and psychological benefits, particularly for young pregnant/lone parenting women (YP/LP). Unfortunately, physical activity declines through adolescence, and women who are marginalized by poverty and racism have lower levels of leisure time. There is a lack of research on physical activity for YP/LP women who are marginalized by poverty, racism, and/or trauma, thus little is known about the barriers and facilitators for physical activity for this population. Physical activity is especially important for these women because they have a greater risk for obesity, anxiety, depression, low self-esteem, and PTSD.

My proposed mixed methods participatory research will focus on physical activity with YP/LP women who are marginalized by poverty, racism, and trauma – arguably some of the most marginalized women in Canada. My research has the following objectives:

  1. Assess current health and physical activity behaviours engaged in by YP/LP women.
  2. Understand the perceived barriers and benefits of physical activity for these women and establish strategies to support YP/LP in a culturally safe and trauma-informed manner.
  3. Assess if existing quality of life measures are relevant for this population and determine if there is a correlation between quality of live and physical activity levels for these women.
  4. Translate the knowledge gained to create a technologically-enabled approach to support/improve YP/LP well-being. 

This research will take place with partnering organizations on Vancouver's Downtown Eastside that serve pregnant and parenting women. I will work with participants to create and implement a technology-enabled health intervention that is culturally safe, age relevant, trauma-informed, and cost effective.

Understanding the evolution of expectant and new parents’ beliefs and behaviours about pediatric vaccination in British Columbia

Vaccines are the most effective way to prevent many communicable diseases, yet immunization rates in British Columbia are below the level required to mitigate outbreaks of infectious diseases. This can be partly explained by some parents’ doubts and concerns about pediatric vaccinations, termed “vaccine hesitancy”.

Numerous interventions have tried to address these concerns by focusing on communication between physicians and parents when their child is already several months old. Yet there is evidence that some parents make decisions about their child's vaccinations even before the first mention of vaccines in doctors’ offices or public health clinics; this makes the pre-natal period a potentially underutilized opportunity for initiating vaccination communication. Parents’ beliefs may also change over time in response to new information or conversations within their social networks.

As mothers are the primary decision-makers about vaccination, understanding maternal beliefs about pediatric vaccination is essential to ensure effective messaging and service delivery. It is also crucial to understand the beliefs and preferences of fathers and other co-parents, given the important role they play in shaping vaccination decisions.

Few studies to date explore how parents’ vaccination beliefs shift over time, particularly how parents’ beliefs before the baby is born continue to evolve during the first few months of their child’s life, and none to our knowledge in regions of BC where immunization rates are well below the Canadian average. Parental attitudes on southern Vancouver Island reflect specific local vaccination cultures and thus, may vary significantly from those on the mainland.

This longitudinal qualitative study explores decision-making processes about vaccinations among expectant and new parents in Victoria, BC by conducting four interviews with each mother, and two interviews with fathers or other co-parents, from the third trimester until just after the child’s first birthday. Analysis will focus on identifying points of leverage that may inform future interventions, providing data on the optimal time and method to engage parents.

Knowledge translation is integrated into the study design through collaborations with Island Health. Findings from this study will be presented for discussion in workshops with key stakeholder groups, disseminated through publications and conference presentations, as well as via a short radio piece.


Evidence-informed decision making in cancer survivorship: evaluating a comprehensive, multi-disciplinary prostate cancer supportive care program

Approximately 24,000 Canadian men were diagnosed with prostate cancer in 2015, and the majority of them will face long-term treatment-related health effects that will impact their quality of life, and have significant cost implications for our health system. Examples of these effects include sexual, urinary and bowel dysfunctions, as well as depression, anxiety and other psychological or psychosocial problems. Comprehensive, evidence-based supportive care programs that address these concerns are needed.

Recognizing this gap prompted the development of a survivorship supportive care program for prostate cancer patients at the Vancouver Prostate Centre. This program addresses both the physical and psychological needs of prostate cancer survivors and their partners from the time of diagnosis. It is comprised of six complementary educational modules and individual clinic visits with providers, and administered by a multi-disciplinary team (urologists, radiation/medical oncologists, and professionals in sexual medicine, psychology, counselling, nutrition, and physiotherapy). This research will assess the costs and benefits of the survivorship program, and will consider the incremental benefits associated with each module in order to improve the program. We will address the following questions: 

  1. Do men who have been diagnosed with prostate cancer and have participated in a program have a different pattern of health services use in the year following primary treatment compared to non-participants?
  2. Do participants of the program self-report better quality of life and symptom management than non-participants?
  3. Is the program cost-effective compared to usual standard of supportive care for individuals with prostate cancer?

The project will use a combination of administrative data, patient medical records, patient self-reported outcomes and primary cost data to develop and populate a simulation model that will track patients along care pathways within/outside the program. The model will provide an overall estimate of the program’s cost-effectiveness.

This evaluation will improve the quality and efficiency of the program and will inform the development of other cancer supportive care programs across BC. Ultimately, it has the potential to have a significant and lasting impact on the landscape of supportive care for cancer survivors.

Exploring the factors that influence implementation of mifepristone abortion practice in Canada: The CART-Mife Study

Approximately one-third of Canadian women will have an abortion in their lifetime. About 100,000 occur annually, of which 96 percent are provided using surgery. Mifepristone, the gold standard for medical abortion, was recently approved by Health Canada with availability anticipated in 2016. Mifepristone abortion delivered in primary care settings has been shown to be safe, effective, and not to increase abortion rates. However, international implementation of this practice varies and may be due to differences in health systems, provider training and supports, and regulations.

Best practices in knowledge translation indicate that, to maximize the impact of this health service innovation, it is necessary first to understand the barriers and facilitators that will influence mifepristone implementation in Canada. Health Canada has specified several extraordinary restrictions, including that physicians and pharmacists who provide mifepristone must be certified through an accredited training program. We propose that training and certification alone will be insufficient to support adoption and distribution of this innovation, especially in rural areas and among clinicians not currently providing abortion care.

This study seeks to explore the question “What are the barriers and facilitators that influence successful implementation and ongoing provision for medical abortion service?” Specific research objectives include:

  1. Exploring health policy, system, and service barriers and facilitators to physicians and pharmacists’ adoption of mifepristone practice.
  2. Developing a theoretically informed framework for supporting the implementation of mifepristone practice in Canada.

This research is embedded within a larger mixed methods program of study. I will use qualitative methods founded on Diffusion of Innovation theory. The results of the study will inform the development of a theory-based knowledge translation framework for promoting the implementation of mifepristone practice in Canada. Findings may be generalizable to implementation of other health service innovations in sexual and reproductive health in the Canadian health services context. Knowledge about the effect of the full range of health policy, system, and service determinants on access to mifepristone abortion is needed to realize the potential to increase equitable, safe, confidential abortion care closer to home.

Development and Validation of the Patient Engagement In Research Scale (PEIRS)

Patient engagement in research occurs when patients meaningfully and actively take part in the conduct and decision-making at any stage of the research process from inception through impact evaluation. There is a paucity of validated measurement tools to evaluate whether interventions to improve patient engagement in research support their successful engagement.

This project aims to develop and validate the Patient Engagement In Research Scale (PEIRS) for use by patients who partner in health research (i.e. patient partners), and to evaluate the degree to which they are meaningfully and effectively engaged in the research process. PEIRS will be developed with patients for patients. Our key objectives are to generate an item-bank reflecting the elements of patients’ experiences as partners in research; use the most relevant experiences to develop the PEIRS; then, evaluate the validity and reliability of PEIRS.

We will used a mixed qualitative and quantitative study design. First, a secondary thematic analysis will be conducted on in-depth interviews of 20 patients with arthritis who have experience as research partners. An extensive list of items relevant to the quality of patient-researcher partnership will be developed. Second, we will invite 10 patient partners to participate in a Delphi process to prioritize, select, and modify the items. We will then conduct usability testing with another 10 patient partners to identify and address any problems in the provisional PEIRS. Third, we will recruit 100 patient partners from across Canada to test the PEIRS’s validity and reliability. Specifically, factor analysis will examine its structural validity. Concurrent validity of PEIRS will be tested against an established measure of overall satisfaction and experiences of the public and patients as project partners in a health system organization. In addition, we will assess the association between PEIRS scores and participants’ ratings of the “meaningfulness” of their engagement.

This research project employs an integrated knowledge translation approach, in which researchers and experienced patient partners are working together at every stage of the research process, from inception through knowledge translation. PEIRS will address an important barrier to advancing the science and practice of engaging patients in research, namely the lack of a validated measure to assess effectiveness of patient engagement strategies. As such, this research contributes to support meaningful engagement of patients in health research.

Improving health equity through cross-cultural collaboration: Learning from Indigenous-developed programs to strengthen public health systems in preventing the harms of substance use in BC

A function of public health systems and services is to reduce health inequities. The harms of substance use impact British Columbians differently based on their social position and access to resources. Over the last decade, BC has had renewed interest in health equity as demonstrated by several key policy documents. Initial research findings however, have demonstrated that the application of a health equity lens is a challenge for public health decision makers and practitioners. However, for many public health service providers, First Nations and Aboriginal health organizations and service providers are seen as leaders in the understanding and application of health equity principles.

Accordingly, there is an immense opportunity in BC for collaboration and learning with First Nations and Aboriginal health partners to optimize health equity for all British Columbians. Despite these opportunities, little is known about the synergies between Indigenous knowledge and health equity strategies related to the reduction of harms of substance use in BC. In particular, more research is needed to understand if Indigenous approaches to health and wellness can be imported into the current BC public health system and to  explore how Indigenous-developed programs and services can inform health equity strategies related to reducing the harms of substance use in BC public health systems and services.

This research project will be one of the first to systematically examine how health equity strategies in the BC public health system could benefit from Indigenous knowledge and worldviews. This project has the potential to impact the health of all British Columbians by informing the development of more equitable health programs and services. In addition, by prioritizing Indigenous ontologies and processes, this project also has implications for how Aboriginal communities in BC are perceived and esteemed, thereby having the potential also to specifically improve the well-being of those communities. In addition, this prioritization has the potential to mitigate epistemological colonialism and shift power relations which are integral in promoting health equity for Indigenous peoples.

Dr. Shahram received a 2017 Health Policy Fellowship to promote Indigenous health in BC’s southern interior by integrating cultural safety and health equity assessments into the fabric of the Interior Health. Her 2016 Trainee Award will placed on hold during her health policy fellowship assignment.