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Co-leads:
- Christine Lee
Island Health
- Katharine McKeen
Victoria Division of Family Practice
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Trainee:
- Jocelyn Chai
University of British Columbia
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Dr. Christine Lee and her research co-lead Dr. Katharine McKeen, a primary care physician (PCP) with the Victoria Division of Family Practice (DFP), are employing a patient-oriented research (POR) approach to raise awareness and disseminate evidence of fecal microbiota transplant (FMT) to treat recurrent Clostridium difficile infection (rCDI). FMT, the administration of feces from a healthy screened donor, is demonstrated to be both safe and more effective than the usual ways to treat rCDI. Estimates from three recent Canadian studies indicate that only 1,000 rCDI patients have received FMT, yet approximately 10,000 Canadians each year are diagnosed with rCDI.
The team is proposing a distributed knowledge translation approach, one that will enable them to reach diverse stakeholders: patients, families, PCPs, and healthcare decision makers (HCMs). Using a POR approach, they will co-develop a digital story that will enable their patient partner to share her lived experience of rCDI and FMT, and then the research team will relay the evidence for FMT. This video will be used for public outreach and as an education tool. They will also engage PCPs and HCDMs through presentations at their respective networks. During this outreach, the digital story will be displayed.
The overall goal is to increase FMT access for patients diagnosed with rCDI. The objectives are to:
- Raise awareness of rCDI and FMT.
- Inform stakeholders of FMT’s safety and effectiveness.
- Engage PCPs and HCDMs in a constructive dialogue to discuss the benefits of and evidence for FMT for rCDI.
The expected outcomes and outputs are to:
- Raise stakeholder awareness of FMT and its benefits as a treatment for rCDI. Output: Production and launch of a digital story telling video on rCDI and FMT as an education and public awareness tool.
- Foster communications with PCPs and increase their awareness of regional FMT resources. Output: Share the digital story and engage PCPs in a constructive dialogue via a café scientifique style discussion at the DFP “Dine and Learn” session.
- Increase HCDMs awareness of regional FMT resources and FMTs positive contributions to the healthcare system overall. Output: Share the digital story and engage HCMs through presentations to Island Health's Medical Advisory and Clinical Practice Councils.
The team will evaluate the impact of their work by using the domains of the Canadian Academy of Health Science “Making and Impact” framework: advancing knowledge; research capacity building; informed decision making; health impact; and broad social and economic impact.
Among office workers, physical activity has been shown to have the potential to improve absenteeism, work productivity and psychological and physical health.
Dr. Stork’s research will incorporate physical activity into the workplace using high-intensity interval training (HIIT) – short-duration exercise that consists of multiple brief, high-intensity efforts, separated by periods of rest.
In Phase 1, physically inactive office employees will undergo an 8-week HIIT program of either one daily HIIT session completed during lunch break, or brief exercise bouts dispersed throughout the workday as 'exercise snacks.' Phase 2 will deliver an 8-week optimized HIIT program designed for sustainability based on a process evaluation of Phase 1. Dr. Stork will measure physical and psychological health, physical activity behaviour, absenteeism and work productivity immediately and up to six months following the program.
The HIIT programs will be implemented in Kelowna's Landmark Centre office towers. Community partners will be engaged early on in the research process to work together to successfully ensure that the program is evidence-based and implemented in a sustainable manner that adequately serves the community. The HIIT programs implemented will undergo a process evaluation to better understand the barriers and facilitators and to optimize and tailor the design and delivery of future programs.
Spinal cord injury (SCI) is a complex pathophysiology, characterized not only by paralysis but also severe autonomic cardiovascular dysfunction. After SCI, strokes are 300 – 400% more likely to occur compared to non-disabled individuals.
One potential explanation for this is autonomic dysreflexia (AD), a life-threatening condition whereby persons experience sudden, transient episodes of high blood pressure. Such volatile swings in blood pressure in individuals with SCI result in structural and functional changes within peripheral blood vessels and lead to the deterioration of peripheral organs, including the brain. In the general population, chronic hypertension is a key risk factor for cerebrovascular dysfunction (increased stroke-risk and cognitive impairment). However, it is currently unclear whether the cumulative load of AD plays a similar role in cerebrovascular and cognitive impairment in persons with SCI.
Using the latest technological advances in magnetic resonance imaging, Dr. Nightingale’s research will examine differences in the structure and function of micro-vessels in the brain between two groups of SCI participants with different durations of SCI (and thus AD exposure), relative to an able-bodied age-matched control group. The results of this research will lead to a better understanding of AD in SCI individuals, and potentially improve treatment to better prevent the occurrence of stroke.
In Canada, poor mental health among Indigenous youth is an ongoing issue. This leads to high rates of suicide, addiction, violence, chronic diseases and chronic pain. A potential reason for these challenges is historical trauma linked to government policies intended to eliminate Indigenous cultures, including residential schools, the 'sixties scoop' and the child welfare system.
With Indigenous families in the Fraser Valley and Lower Mainland, British Columbia, Dr. Cooper will explore how people understand historical trauma, mental health and abuse. With participants, she will also explore experiences with current mental health programs and interventions. The focus will be on strengths and challenges experienced by First Nations parents and youth aged 11-14.
Indigenous and qualitative arts-based approaches will be used to unpack key themes related to mental health and community wellbeing, and participants will help guide the creation of resources that will aim to improve health within Indigenous families and communities.
Gay, lesbian, and bisexual youth (GLBY) are at increased risk of experiencing substance use disorders (SUD) in comparison to their heterosexual counterparts. The aim of Dr. Ferlatte’s research is to identify the factors associated with SUD experienced by GLBY to inform interventions.
This will include:
- Examining individual, social and structural factors that influence SUD among GLBY through photovoice methods.
- Identifying challenges experienced by GLBY in accessing SUD-related care by gathering experiences through an online survey.
- Identifying how a coordinated set of interventions and policies could best be adapted to address SUD among GLBY through two world cafés, where GLBY and other stakeholders (e.g., intervention decision makers) will be invited to identify solutions to this issue.
The findings of this research will be shared through presentations, articles, and photovoice exhibitions to inform policy and programming decision-making that improves SUD care for GLBY.
Hepatitis C virus is an important public health concern in Canada; however, there is limited information concerning the impact of new direct-acting antiviral therapies on manifestations outside the liver (extrahepatic manifestations, or EHMs), including chronic diseases, cancers, and health-care resource utilization in Canada.
This knowledge is important, as new HCV treatments are generally restricted to those with advanced liver disease and there are no estimates of the reductions in EHMs that can be achieved with expansion of therapy.
Using data from an administrative-linked population-based cohort in BC, Dr. Rossi will assess the impact that HCV treatments have on EHMs and associated health-care utilization.
Results from this study could lead to improved clinical and population health practices in BC by:
- Helping to inform targeted treatment strategies by identifying patients at the greatest risk of developing EHMs associated with HCV.
- Identifying areas where additional allocation of resources will be necessary to manage chronic comorbidities associated with aging.
This study will also provide a better understanding of the challenges and limitations associated with using administrative data for population health research.
Human papillomavirus (HPV) infection is a prerequisite for the development of cervical cancer. Screening for cervical cancer after HPV infection is possible by cervical smear testing, and since 2006 direct prevention of HPV infection has been available in the form of three different vaccines.
These vaccines need two or three doses, and protect against the most common types of cancer-causing HPV. Unfortunately, at this moment globally, women at the highest risk for cervical cancer are not reached by any of these prevention measures. Barriers to vaccine implementation and achieving higher uptake include high costs and lack of the infrastructure required for administering multiple vaccine doses.
Some studies have suggested sufficient and sustained protection against HPV infections occurs after just one dose of the vaccine. Evaluation of one dose of the HPV vaccine is complicated, since it is unknown how and at what level immune responses guarantee protection against infections.
With this study, Dr. Donken aims to measure the effectiveness of single dose vaccination in a real-world setting and to explore whether antibodies are boosted after exposure to HPV in vaccinated women, potentially reducing barriers to vaccine implementation and improving vaccine uptake among those at a high risk for cervical cancer.
While increased access to HIV treatment and other health services has contributed to significant declines in HIV among several key populations in British Columbia (BC), it is estimated that as many as 1 in 6 gay, bisexual, and other men who have sex with men (gbMSM) will be diagnosed with HIV in their lifetime.
To address this health equity concern, BC recently expanded access to a once-a-day pill, called pre-exposure prophylaxis (PrEP), that can prevent HIV acquisition. However, gbMSM who use drugs report reduced adherence to PrEP, as well as to other antiretroviral therapies (ART) that could prevent transmission—thus reducing the overall efficacy of these policy-driven interventions.
Recognizing the diverse experiences of substance-using gbMSM, Dr. Card, along with an interdisciplinary team at the Community Based Research Centre for Gay Men’s Health, will leverage data from the Sex Now Survey to improve our understanding of:
- Which patterns of substance use contribute to poor adherence.
- How we can best address the factors that negatively impact this population.
- What obstacles might limit successful intervention among this population (e.g., feasibility and acceptability).
Working with community members and front-line service providers, Dr. Card will also participate in community consultations to develop an empirically-valid and community-based intervention that will improve adherence among gbMSM who use drugs.
Abortion is a common reproductive health procedure, with nearly one-third of women in Canada having had at least one abortion. However, abortion access is not equitable. Most abortions are surgical, and are provided in a small number of facilities located in BC’s largest cities. Some women, particularly those in rural or remote regions, experience significant wait times and must travel long distances to reach abortion services.
The medical abortion drug mifepristone became available in BC in 2017. Mifepristone can be provided in primary care and is a safe and effective alternative to travelling to large centres for surgical abortion, enabling abortion to occur at earlier (and therefore safer) gestations. Mifepristone medical abortion delivered in primary care has the potential to improve equity for abortion access and outcomes in BC, while reducing pressure on surgical services.
Dr. Schummers’ research will centre on a population-based cohort study using BC linked health administrative data to understand abortion access, outcomes, and costs before and after mifepristone became available.
The results of this study will inform knowledge users and health policy-makers about the effect of mifepristone medical abortion delivered in primary care on abortion service access, outcomes, distribution, and costs.
Human papillomaviruses (HPV) can lead to cervical cancer and other anogenital, head, and neck cancers in both women and men. A safe and effective vaccine against the most common types of HPV associated with cancer was introduced in 2008 into BC’s exemplary school immunization program. However, rates of HPV vaccine uptake have remained low, with less than 70% of eligible students receiving the vaccine each year.
Evidence suggests parents are more likely to consent to an HPV vaccine for their child if they engage in a conversation with a trusted health care provider. Suggesting that simply leveraging existing public health infrastructure could improve HPV vaccine uptake to reduce the future burden of HPV related diseases.
Dr. Racey’s research will evaluate the implementation and impact of a tailored messaging intervention, delivered by public health nurses , to improve HPV vaccine uptake for grade 6 girls and boys in a rural community in BC. BC’s robust immunization registry and monitoring will allow the measurement of HPV vaccine uptake across comparable communities to assess the impact of the intervention.
The results of this research will be directly relevant to school-based immunization programs across BC and Canada, and could lead to or help inform future expansion of the intervention.
