Individuals with both psychiatric and substance use disorders, defined as concurrent disorders, are more complex to diagnose and treat due to several interacting health and social challenges. In the absence of appropriate treatment people with concurrent disorders are at high risk for increased morbidity and mortality. A growing body of evidence recommends abandoning the traditional single-disease health model in favour of a multimorbidity approach to care. Despite available evidence, important gaps persist in our understanding of how individual and health system context influence service utilization and outcomes for people with complex multimorbid disorders (e.g. concurrent disorders). The proposed research will establish a prospective cohort of individuals with a concurrent disorder. Individuals will complete a series of brief questionnaires and provide consent to use their personal identifiers for linkage to a number of health databases. This research offers a unique opportunity examine health outcomes associated with multi-morbidities and understand patterns of health care utilization overtime. This research will advance knowledge to inform best practices and service reforms for the optimal delivery of care in BC.
Year: 2021
Does timing matter? A trial of intermittent fasting in haematological malignancies
Does when we eat make a difference to our health? We know that food choices can impact cancer risk but what if the timing plays a role as well? Evidence shows that fasting may slow cancer growth through a process called autophagy. Through an interdisciplinary research team, I am currently running a small trial testing the effects of intermittent fasting (IF) in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) at BCC-Victoria who not on anti-cancer treatment. Specifically, I am asking whether IF regimens, differing in fasting timing and duration, stimulates autophagy, improves quality of life, impacts gut microbiome, and/or results in clinical benefit (i.e. reduced lymphocyte count). I am also following participants’ safety, ability to follow the fast, and fasting preferences. While early results look promising, I propose growing this study into a larger trial with three phases to clarify the effects of IF on cancer and the microbiome. Understanding these effects may help discover simple diet recommendations for patients with cancer that cause a response in cancer cells or slow cancer progression, are safe and reduce treatment side effects when used alongside current, standard treatments.
Neuropsychological functioning in treatment resistant schizophrenia
Schizophrenia is a severe and disabling psychiatric illness involving primary symptoms of psychosis (hallucinations, delusions, disordered thinking and behavior). Unfortunately, as many as 30% of patients respond poorly to standard antipsychotic medications and are considered to have treatment resistant schizophrenia (TRS). Neuropsychological impairment is an important clinical feature of schizophrenia, as cognitive deficits predict poor treatment response, daily functioning, and disability. However, very little is known about cognitive functioning in the clinically complex subset of patients with TRS. The aims of this project are therefore to investigate the severity, pattern, and variation in cognitive functioning among individuals with TRS, and to determine whether cognitive difficulties predict treatment response and functioning. This will be achieved by analyzing clinical and neuropsychological data that has been collected on TRS patients who have been treated within the BC Psychosis Program since 2012. Findings using this unique dataset will have a direct impact on shaping assessment and treatment strategies, improving prognosis and ability to predict functioning, and improving clinical decision-making and planning.
Design and pilot of a culturally resonant intervention to treat substance use disorder among South Asian men
Substance use disorder is a growing problem affecting racialized men in Canada. There is increased awareness and understanding about why and how racialized men use substances, yet little is known about effective treatments and interventions. The project will use anti-racist research methods to design and study an intervention to support a racialized group, South Asian men who use substances. The team will consist of Punjabi men who use substances, community organization members, health care providers, and researchers. Using a rigorous facilitated approach that highlights evidence from literature and draws upon members’ life experiences, the team will design an intervention to support South Asian men who use substances in the Lower Mainland. Once the design is complete, the intervention will be studied in a feasibility study and pilot randomized controlled trial (RCT) in preparation and justification for a full scale RCT.
Exploring oxidative phosphorylation as therapeutic vulnerability in high risk acute myeloid leukemia
The standard of care for AML patients was introduced in the 1970s and has not significantly changed since then. Patients suffering from acute myeloid leukemia (AML) with unfavourable genetics are characterized by dismal overall survival due to poor treatment response to standard chemotherapy. In this research proposal, I aim to better understand the energy metabolism of high-risk AML cells and explore this as a novel treatment avenue. My research will create a rational for future clinical trials to improve patient care and develop novel treatment perspectives for a patient collective with a bleak prognosis.
Leveraging computational modelling and 3D bioprinting in pursuit of a regenerative therapeutic approach for male infertility
A desperate need exists to develop technology to regenerate sperm that can be used for in vitro fertilization (IVF) among men who lack sperm production, such as pediatric cancer survivors. In Canada, approximately 2,440 boys aged less than 15 will be diagnosed with cancer each year. Fortunately, the field of oncology has made significant improvements in survival rates, which are estimated to be 83%. However, treatments will render up to 97% of paediatric cancer survivors infertile with no sperm production, despite over 75% eventually desiring to have biological children. While stem cells (sperm precursors) can be retrieved prior to cancer therapies, no technology currently exists to regenerate sperm, which is required to achieve a pregnancy. This project proposes to utilize single cell sequencing and along with state-of-the-art computational modelling to reveal molecules and pathways that are key regulators of developing sperm from stem cells. These findings will be screened and tested to identify critical molecules that help generate sperm in 3D bioprinted structures. Results from this study will contribute to developing the understanding and technology to regenerate sperm for men lacking any ability to father biological children.
Perinatal anxiety screening study
Anxiety disorders are the most common of all mental health conditions. They affect 20 percent of pregnant and postpartum people, and are associated with significant distress and life interference for sufferers, as well as negative consequences for the fetus and infant.
Little, if any, routine screening for these disorders is conducted. This is mostly because accurate screening tools have yet to be identified. The majority of screening studies have used poor quality research methodology or have assessed measures which appeared to perform too poorly to be recommended for widespread use. The result of this is that perinatal anxiety disorders often go unidentified, resulting in continued suffering and life impairment.
The purpose of this research is to identify one or more accurate and reliable perinatal anxiety disorder screening tool(s). To do this, we will conduct a large scale study of pregnant and postpartum people in which we assess the accuracy of the most promising perinatal anxiety disorder screening tools.
This research will provide important information to inform healthcare providers, policymakers and scientists, about the most effective approach to screening for anxiety disorders during pregnancy and the postpartum period.
Understanding and mitigating the impact of COVID-19 on the mental health of parents and caregivers of children and youth with support needs in British Columbia
This Child, Youth & Family Mental Health Impact Grant is co-funded through a partnership between Mental Health Research Canada, Michael Smith Health Research BC, and the BC Ministry of Children and Family Development.
While COVID-19 has affected the mental health of all Canadians, those with complex family needs have struggled even more. The strain is especially great on parents and caregivers of children and youth with support needs experiencing (or at risk of) developmental delay or disability.
Research studies about the impact of the pandemic on parental mental health tend to view parents of children with support needs as a homogenous group, or they tend to explore separate diagnostic categories (such as Autism Spectrum Disorder and medical complexity).
Lead investigators Dr. Jennifer Baumbusch and Angela Clancy will not replicate existing studies but will extend what is currently known, particularly in the context of British Columbia.
The investigators and their team will compare mental health impacts with a larger pan-Canadian sample. They will also compare mental health impacts within the sample of parents of children with support needs based on diagnostic categories, individual factors of parent and child (such as gender, age, race, ethnicity, education, family structure and household income), and community factors (such as geographic location and size of community) — and compare between these categories.
The goal is to identify specific strengths and vulnerabilities of different sub-groups that can be used to customize supports.
The BC research team will also explore existing knowledge about programs (such as peer-to-peer and one-on-one counselling) and promising practices (such as virtual/tele-health and enhanced respite) that help mitigate mental health impacts and foster family resilience.
Progress Update – March 2022
Lead investigators Dr. Jennifer Baumbusch and Angela Clancy, together with Chelsea Jokisch, a patient with lived experience, share their key discoveries and insights so far, in this webinar hosted by Mental Health Research Canada.
Enhancing patient self care and management of atrial fibrillation within primary care
Atrial fibrillation (AF) is the most common heart problem causing an irregular pulse. Individuals who poorly managed their AF risk developing serious problems like stroke and heart failure. Self-care, is when individuals actively maintain health through health-promoting practices, health monitoring, and managing illness. Family doctors and nurse practitioners (primary care providers) provide most of the AF care in BC, and yet are often not able to support their patients’ self-care because of limited time and other more urgent problems. They need new ways to address AF self-care. Teaching patients to self-care for their AF can improve their quality of life, reduce their stress, increase their ability to stay on track with their treatment plan (taking mediations), and can prevent serious problems. This research will study ways to improve self-care practices in primary care by bringing together a group of doctors, nurses, patients and researchers to look at what we already know about AF self-care in the literature and what resources exist in BC to support self-care. Second, they will put together all this information and then have a meeting to identify some of the possible solutions to address AF self-care in practice and research.
Team members: Louann Janicki (Interior Health); Ryan Wilson (UBC Okanagan); Peter Loewen (UBC); Nelly Oelke (UBC Okanagan); Norma Hilsmann (UBC Okanagan); Jessica Baskerville (South Okanagan Similkameen Division of Family Practice); Kim Orwaard-Wong (Interior Health); Kristi Maltby (Interior Health); Cameron Towle (Interior Health); Robert Janke (UBC Okanagan); Ryan Tooby (Divisions of Family Practice – Bella Coola); Tannis Andersen (Interior Health); Pam Hruska (Interior Health); Kaylee Neill (UBC Okanagan); Denis Decleva (AF Patient); Beth Whalley (Central Okanagan Divisions of Family Practice)
Contraception and abortion in BC meeting: Experience guiding research guiding care
Why: Access to abortion and contraception is a challenge in BC, particularly for underserved populations. Innovative models of care developed in response to the COVID-19 pandemic have potential to better meet BC’s needs. We aim to convene key stakeholders to discuss these emerging opportunities, learn best practices, identify policy solutions, and co-create a roadmap for equitable family planning in BC.
What: BC Women’s Hospital and UBC’s Contraception & Abortion Research Team (CART) will convene a hybrid in-person/online one-day event. Top speakers will convey the latest evidence and interactive breakout circles will engage interdisciplinary invitees.
Who: We will convene patients, health authorities, clinical administrators, public health and community services, government leaders, and urban and rural clinicians (physicians, NPs, nurses, midwives, pharmacists, social workers).
When: March 4, 2022 from 8 a.m. to 4:30 p.m.
Where: Virtually via Robert H. Lee Alumni Centre, UBC
Anticipated outcome: The knowledge exchange and meaningful collaboration supported through this meeting will lead to co-development of new research priorities and policy opportunities that can directly impact equitable access to contraception and abortion care in BC.
Team members: Cheryl Davies (BC Women’s Hospital and Health Centre, and Provincial Health Services Authority); Wendy Norman (UBC); Regina Renner (UBC); Natasha Prodan-Bhalla (Chief Nurse and Professional Practice Officer); Glenys Webster (Women’s, Maternal and Early Childhood Health); Ann Pederson (Interim Executive Director); Michelle Fortin (Options for Sexual Health); Unjali Malhotra (First Nations Health Authority); Madeleine Ennis (UBC); Ali Fuchshuber (UBC); Laura Schummers (UBC); Kate Wahl (UBC); Zeba Khan (UBC and Options for Sexual Health); Carly Rivers (Contraception and Abortion Research Team); Ama Kyeremeh (Contraception and Abortion Research Team)