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.
Year: 2021
Building on the strengths of first responders as a critical first point of contact: Improving emergency care in remote Indigenous communities
Applying an ethnographic and story-based approach, the objective of this project is to develop a deeper understanding of the unique challenges faced by first responders in four remote Indigenous communities on the West Coast of Vancouver Island. Working collaboratively with first responders and community health leaders, this project will identify: existing community supports; interventions that can improve the experiences and effectiveness of first responders; and an assessment of these interventions. First responders provide a critical first point of contact for serious injury or accidents in many remote Indigenous communities. These positions are often held by unpaid volunteers with little access to supports such as training and post-incident clinical debriefing. Despite these challenges, they provide an invaluable service to their communities, access to emergency services has been identified as contributing to the health disparities faced by Indigenous communities. Improving effectiveness of first responders in emergency situations will require building on the strengths already present within communities, by identifying avenues for more sustainable first response services and support.
Role of SASH1 in generation of hematopoietic stem cells
For many patients with a serious blood disorder or malignancy the primary treatment option is a stem cell transplant (SCT), which involves destroying the unhealthy blood cells of the patient and replacing them with healthy donor stem cells. Unfortunately, a large number of patients are unable to find a suitable donor, and die as a result. Thus, there is an urgent need to identify new sources of healthy blood stem cells for these patients.
One promising solution is to harvest other types of cells from the patient and reprogram them to become blood stem cells, which can then be reintroduced later. Key to the success of this approach is placing the cells in an environment which mimics how the first blood cells are generated during embryonic development (called endothelial to hematopoietic transition [EHT]). To date little research has focused on the external cues needed for EHT, and this presents a bottleneck to producing stem cells for SCT. Therefore, our project will use models of EHT to identify external drivers of EHT, and the mechanisms by which they program cells to transition into blood cells. The knowledge from this project will help to create protocols to reproducibly reprogram patient-derived cells into blood cells for SCT.
Multifunctional immunomodulating conjugates for targeting and treating glycocalyx dysfunction in inflammatory conditions
Diseases that involve the heart or blood vessels, autoimmune diseases (e.g. diabetes, multiple sclerosis), or the rejection of transplanted organs affect about 1 in 3 Canadians and constitute a significant cost to the Canadian economy. In the perpetuation of these diseases glycocalyx shedding plays a key role. The glycocalyx (literally meaning “sugar coat”) is a sugar polymer-based structure that covers the surface of the cells, which are lining all organs and blood vessels. It lies at the interface between bloodstream and organ tissue and represents the protective front line against inflammatory and immune-mediated diseases. Thus, we aim to specifically target and treat glycocalyx dysfunction by rapidly rebuilding it through a new cell surface engineering approach, which should enable organs to maintain or reestablish their function. To do so, we will develop polymer conjugates which can selectively bind and retain on the endothelial cell surface. The conjugates will present sugar moieties which resemble the natural glycocalyx layer. We anticipate to realize a novel approach with significant therapeutic potential to improve treatment for diverse disease conditions where glycocalyx dysfunction is contributing to the pathology.
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.
T-cell repertoire analysis for immune monitoring in renal transplantation
Kidney disease affects 1 in 10 Canadians with an estimated cost of over $2 billion per year. Transplantation is the treatment of choice for kidney failure, but unfortunately approximately 30% of kidney transplants are lost to severe immune rejection. This leads to approximately 500 Canadians losing their transplant every year and returning to dialysis. These patients have a four-fold increased risk of death, decreased quality-of-life, and a cost of up to $1 million each to the healthcare system over their remaining life. Despite improvements in transplant care, there are still no proven methods to detect early immune rejection. Our goal is to develop a new minimally invasive blood-based test to monitor the immune system of transplant patients to detect immune rejection before kidney damage happens. This would allow transplant doctors to intervene early with powerful immune regulating medications and prevent irreversible damage to the transplant kidney. Our approach would not only benefit patients and their families with improvement in survival, quality of life, caregiver burden, and personal health expenses, but also the healthcare system, with reduced costs related to dialysis, re-transplantation, and improved organ availability.
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.
Housing, homelessness, and care trajectories among young people who use drugs in Vancouver
The proposed study will employ longitudinal qualitative and ethnographic methods to examine how urban young people who use drugs (YPWUD) navigate experiences of housing and homelessness across time. Cities like Vancouver are creating more comprehensive and integrated systems of services for YPWUD, including programs that aim to simultaneously address their housing and care needs (e.g. supportive housing with on-site access to harm reduction, opioid agonist therapies). Innovative social science research is needed to describe how particular supportive and temporary modular housing models can both ameliorate and exacerbate health and social harms among YPWUD, including overdose. The proposed anthropological and community-based participatory action research study will generate new knowledge to support the development, adaptation and scale up of targeted housing and substance use care interventions for YPWUD. Working together with a Youth Advisory Council comprised of YPWUD and youth co-researchers, study findings will be disseminated via youth-driven outputs aimed at a broad public; presentations and community reports for youth, their providers and key decision makers; and press releases, media interviews, and social media engagement.
Addressing emerging health system priorities in cervical cancer prevention: determining optimal strategies for human papillomavirus test-based primary screening
Cervical cancer remains a significant women’s health issue in Canada even after the introduction of cytology screens (i.e. Pap smears) in 1949, which resulted in a reduction of cases. It is frequently diagnosed in young women, who are embedded in careers, raising families, or still planning to conceive. Treatment can affect women’s ability to work, care for families and cause infertility, and survival rate is often low. It is thus vital to improve preventative screening programs using recent testing innovations. Testing for human papillomavirus (HPV) is more effective than cytology, but it is not yet used in BC. HPV FOr CerviCAL Cancer (FOCAL) was a trial investigating HPV testing. Participants were followed for ten years post-trial through linkage to the BC Cervix Screening Program to create the FOCAL-DECADE cohort. We will use data from this cohort to compare long-term rates of cervical precancer between those who received cytology or HPV testing, expecting significantly reduced rates in the HPV group. These results will inform decision-makers, like the provincial screening program, of best screening practices (e.g. screen interval), aiding transition to HPV-based testing programs, thus helping reduce cervical cancer across BC.
Advancing health equity in the cancer care sector: Identifying organizational and contextual factors impacting the integration of equity-oriented healthcare for marginalized populations
Alarming differences exist in cancer outcomes for people who are marginalized. Due to racism, discrimination and stigma, these groups experience extreme difficulties accessing cancer care and are diagnosed with cancers so late they have higher rates of preventable death than other groups. Some of these differences can be addressed using equity-oriented healthcare (EOHC), which directs resources to those with the most need, and reduces mismatches between health services and the actual needs of marginalized people. However, EOHC has not been studied within the context of cancer care. This study is about understanding the organizational contexts and conditions needed to build capacity for EOHC within cancer care in BC. We will: 1) conduct an environmental scan to identify strategies used elsewhere (Canada, internationally) to deliver EOHC in cancer care; 2) observe and interview key informants and healthcare providers who are trying to use EOHC in delivering cancer care, and marginalized patients who are trying to access cancer services, to better understand factors that support the provision of EOHC in cancer care. Results will be used to develop recommendations and action strategies to support cancer organizations to deliver EOHC.