Kitchen table justice: Co-developing Indigenous-informed food justice participatory action research strategy to support holistic health and redress health inequities with paroled women in BC

This grant will support research planning with women who have been recently incarcerated and will directly support future research guided by Indigenous approaches to holistic health and health equity through food-based program development. We will build relationships with paroled research users through the making and sharing of food, and the inclusion of research users, stakeholders and Indigenous Elders in all activities. Specifically, we will: (i) conduct a literature synthesis on the potentials of food justice to support holistic health equity for women on parole, and (ii) meet bi-weekly to: (a) collaboratively develop a terms of reference and governance structure that outlines team roles and responsibilities and decision-making processes; (b) engage in co-learning about food-related health and social inequities to develop a shared understanding of the potentials of food to support health; and (c) explore potential solutions and actions to redress overlapping health, prison and food inequities. Additionally, we will: (d) collaboratively plan and develop a grant application to support subsequent research to co-develop a food justice health intervention with and for women leaving prison in BC.

Team members: Angel Willard (Elizabeth Fry Society of Greater Vancouver); Kelsey Timler (UBC); Lisa Bowden (Elizabeth Fry Society of Greater Vancouver); Nyki Kish-Field (University of Fraser Valley); Lyana Patrick (Simon Fraser University); Valerie Napoleon (University of Victoria)

Cancer and aging research engagement: Identifying priorities to enhance research and care of older adults with cancer and their caregivers

Cancer is most common amongst older adults. Older adults with cancer have distinct needs due to underlying health conditions and social situations, which may include a lack of social and financial supports. These factors often affect their ability to manage treatments, cope with treatment side effects, and make health care decisions. For older adults who do not speak English, have limited knowledge about the health care system, or have poor understanding of health or illness; navigating the cancer system is even harder. Older adults are often cared for by informal caregivers, such as family members, due to limited resources or services available to support older adults with cancer in the community. Caregivers face challenges trying to balance their caregiver role, not only for the older adult, but also for their younger dependents; work; and their own health needs.

Through virtual meetings and priority setting work, we will achieve the following goals: establish partnerships between older adults, caregivers, and diverse seniors’ groups; identify key research priorities to improve cancer care for older adults and their caregivers in BC; and develop a five-year research agenda to improve care for older adults with cancer.

Team members: Caroline Mariano (BC Cancer); Bonnie Leung (BC Cancer); Lorelei Newton (University of Victoria, and Canadian Association of Nurses in Oncology); Daniel Renouf (BC Cancer); Sabrina Wong (UBC); Lisa Quay (Jewish Community Centre); Keiko Funahashi (Tonari Gumi); Anthony Kuperschmidt (West End Seniors Network)

How can health economic models better reflect patient and public values? Understanding stakeholder perspectives and research priorities through the Peer Models Network

Researchers build computer models to explore the potential costs and benefits of different ways of providing health care — and model results influence health services in BC. This project will bring together BC experts (‘health economic modelers’) and connect them with research users and members of patient and public organizations. First, modelers will meet with research users to understand current processes of model development, decision-making, patient and public involvement, and transparency (i.e. clear, culturally safe, accessible information) in modeling. Then, modelers, research users, and members of patient and public organizations will meet at two online engagement sessions. Sessions will highlight what health economic modeling is; how models are developed; why modeling involves making social and ethical decisions that affect patients and members of the public; what modeling processes in BC are like; how models are being used in policy-making; where patient and public input in modeling is most important; and the goals of transparency. Participants will be invited to discuss and record their research priorities and perspectives on appropriate processes, creating shareable knowledge and connections for future collaboration.

Team members: Ian Cromwell (Canadian Agency for Drugs and Technology in Health); Stephanie Harvard (UBC); Manik Saini (BC Ministry of Health); Jemal Mohamed (BC Ministry of Health); Leah Grantham (Independent Consultant); Amin Adibi (UBC); Eric Winsberg (University of South Florida); Nick Bansback (UBC); David Whitehurst (Simon Fraser University)

Walking away from depression: Leveraging physical activity to treat symptoms and improve well-being in individuals with major depressive disorder

Major depressive disorder (“MDD”) is a chronic condition characterized by sadness and loss of pleasure. MDD is a leading cause of disability (WHO, 2020), and costs the Canadian economy billions each year (CAMH, 2021; CASHC, 2016). In 2016, the Canadian Network for Mood and Anxiety Treatment recognized exercise as a first-line treatment for MDD. This statement should have revolutionized care: not only does exercise reduce symptoms, but it also improves health and quality of life. However, the past five years have seen little progress in “mainstreaming” exercise as a treatment option. This means patients are being denied access to a safe and effective treatment.

We are left with a question: How can we get more people with MDD more active more often?

The purpose of my postdoctoral fellowship is to answer this question. I will oversee a program of research that examines how British Columbia’s public health system can provide exercise as a treatment for MDD. I will investigate barriers to uptake; strategies to overcome barriers; and engage in program development and evaluation. This research will be conducted in collaboration with patients, healthcare providers, and communities to ensure it is feasible, relevant, and sustainable.

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.

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.

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.

The role of mechanics in EMT and cancer metastasis

The World Health Organization reports that cancer is the second leading cause of death globally, responsible for 1 in every 6 deaths. This ratio doubles in Canada, with the Canadian Cancer Society estimating that nearly 1 in 2 Canadians will develop cancer, and about 1 out of 4 will die from it.

Recent anticancer therapies target the epithelial-to-mesenchymal transition (EMT), a process that converts tightly bound cells into loosely associated motile cells. In cancers, this results in progression with metastasis and improved resistance to treatments.

Evidence shows the role of mechanics in driving EMT but how the biochemistry and the mechanics coregulate this process remains largely unknown.

We propose to investigate this question in the case study of stem cell cultures, which undergo EMT in a controlled environment. We will develop a mathematical model to link mechanical stresses and cytoskeletal energetics, and we will validate it experimentally in collaboration with the Zandstra Lab.

This proposal will enhance BC’s and Canada’s leadership in healthcare-oriented research, as understanding EMT is essential not only for cancer but also for many other biological processes, such as organogenesis and tissue regeneration.