Dr. Hélène Côté receives a CIHR Fall 2018 Project Grant

Dr. Côté received the award for her project “The BCC3 cohort: Cellular aging in women living with HIV”.

  1. In a few sentences, what is your research about?

My research focuses on the health of women living with HIV and their children. We are studying how the virus and the medications used to treat the infection affect cellular aging processes and their health over time. We are also asking how exposure to HIV and medications during pregnancy may affect mother and child in the short and long term.

  1. What impact do you hope your research will have?

By understanding and teasing apart the effects of chronic viral infection(s), of various HIV medications, and other sources of stress on cellular aging, we hope to gain important knowledge on which medication may be safer for women, both before and during pregnancy, as well as later in life. We also want to identify the modifiable factors we should work on to promote healthy aging.

  1. Are you using any innovative approaches in your research?

We seek to have a holistic approach to research. We consider not only the clinical and demographic factors that may affect markers of cellular aging but this recent grant, through a collaboration between two ongoing cohorts in BC (CARMA and CHIWOS), will also consider how other common chronic or latent viral infections (herpes virus, cytomegalovirus, etc.) and how psycho-social factors (mental health, stigma, etc.) may also affect cellular aging and comorbid diseases.

Dr. Regina Renner receives a CIHR Fall 2018 Project Grant Recipient

Dr. Renner received the grant for “The Canadian Surgical and Medical Abortion Provider Survey (CAPS)” project.

  1. In a few sentences, what is your research about?

Our research is about exploring abortion provider characteristics and clinical practice in regards to first and second trimester medical and surgical abortion. This is a national survey, and we’re hoping to capture potential changes to the results of a similar survey conducted in 2012, since Mifepristone was introduced in Canada in 2015.

  1. What impact do you hope your research will have?

This work will provide crucial evidence to inform health policy, system and service leaders and regulators charged with providing equitable, free-of-harassment, and high-quality nation-wide access to abortion services. These high impact decisions may result in: expansion of access to abortion care, in particular to women residing in rural and remote areas, credentialing of multidisciplinary providers, organization of services, update of guidelines, and creation of educational opportunities.

  1. Are you using any innovative approaches in your research?

We aim to expand our sample framework compared to the previous 2012 survey in order to capture changes in abortion care workforce since the implementation of Mifepristone in 2015. That will probably be the biggest challenge – to have a very broad sampling framework to capture abortion providers that work in bigger clinics, solo providers, rural or urban providers – people  who might not necessarily identify as an ‘abortion provider’, but provide services as part of their other clinical work.

In order to conduct the best possible survey with the most optimal sample framework we have built a large multidisciplinary research team including family planning experts from across the country.  Our repeatedly CIHR funded Canadian family planning network (Contraception & Abortion Research Team, CART-GRAC) engages with the national health professional organizations for nurses (CNA), gynecologists (SOGC), and family physicians (CFPC), in addition to government leaders. Additionally, we paired more junior researchers, like me, with senior researchers, like Dr. Wendy Norman. This is a fantastic career development opportunity for me.


Dr. Regina Renner is a family planning specialist and Clinical Associate Professor in the UBC Department of Medicine, Division of Obstetrics and Gynecology. She has been a CART member since 2011 and is also the Co-director of the Family Planning Fellowship at UBC.

Spotlight: International Day for Women and Girls in Science

February 11th is International Day for Women and Girls in Science! In honour of this day we’re shining the spotlight on Paula Duarte-Guterman, Ph.D., a Postdoctoral Research Fellow at the Djavad Mowafaghian Centre for Brain Health.

Q: What is your area of research?

A: Pregnancy and motherhood can have long-term effects on women’s physiology, health, and aging. I am interested in understanding how past motherhood experience affects the brain, cognitive decline, and risk of developing Alzheimer’s disease later on in life. 

Q: What inspired you to pursue a degree/career in science?

A: I love asking questions (why?, how?) and learning new things every day. 

Q: What advice would you give to girls and young women who want to pursue education/work in STEM?

A: Surround yourself of a good support system (family, friends and colleagues) and look for mentors that will support your career. In the end enjoy it and have fun. I am fortunate that my job is also my hobby!

Dr. Melanie Murray and team awarded UBC Partnership Recognition Fund grant

Congratulations to Dr. Melanie Murray and team who have been awarded a UBC Partnership Recognition Fund grant entitled “Research mentorship and training for Indigenous PLWH” in collaboration with the Canadian Aboriginal AIDS Network (CAAN)!

The grant was awarded to Dr. Murray, Valerie Nicholson, member and previous Chair of CAAN, and Amber Campbell, Master’s student. The team will train two peer-research associates who will then help conduct two CV-building workshops for Indigenous community members interested in research.

CIHR Fall 2018 Project Grant Recipients

Congratulations to WHRI members Dr. Hélène Côté, Dr. Gillian Hanley, and Dr. Regina Renner, who have been awarded CIHR project grants.

CIHR Project Grant Recipients

PROJECT TITLE The BCC3 cohort: Cellular aging in women living with HIV
PRINCIPAL INVESTIGATOR Hélène Côté
AMOUNT $822,375 operating
TERM 5 years
PROJECT TITLE The effectiveness and cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention
PRINCIPAL INVESTIGATOR Gillian Hanley*

* WHRI/BCCHRI member

AMOUNT $302,176 operating
TERM 4 years
PROJECT TITLE The Canadian Surgical and Medical Abortion Provider Survey (CAPS)
PRINCIPAL INVESTIGATOR Regina Renner*, Bonnie Henry, Marie-Soleil Wagner

*WHRI member

AMOUNT $407,780 operating
TERM 4 years

Study Spotlight: SUPPORT

Where can women turn when they’re experiencing postpartum depression (PPD)?
Madison Lackie, a Masters student working with Dr. Lori Brotto and the UBC Sexual Health Laboratory, is part of a team working on creating a web-enabled intervention option for PPD which would allow women to access evidence-based cognitive behavioural therapy from the comfort of their own home.

Postpartum depression affects approximately 10% of new mothers, and risk can increase 2-5 times in immigrant and indigenous populations. Madison’s work is part of a multiphase research project, which seeks to address barriers to access of healthcare, especially for women in higher risk populations.

“We’re hoping this will help to support care providers in communities across BC by providing additional care options for patients, especially while waiting for care to become available,” Madison explains. “Some waitlists for specialized care for PPD can be upwards of a year, so providing something that can support women in the interim is very important!”

Since her research began, the team has established partnerships and networks throughout the province, and focus groups with non-Aboriginal Canadian women have begun and are nearing completion for groups in the Lower Mainland, Prince George, Victoria, and Kelowna. Focus groups with Indigenous and immigrant women will begin later this year.

Transcription has started and will be analyzed for emergent themes and how they compare across populations and locations in order to create an appropriate, culturally safe and sensitive treatment program. The app will be developed in partnership with a local web-technology development firm, and the team is looking into the use of artificial intelligence (AI) in app development, to enable a customized and adaptable user experience.

The team hopes to have enough data collected to begin developing a prototype later this year.

For more information on the project, click here.

2018 Women’s Health Research Institute Catalyst Grant Recipients

The Women’s Health Research Institute (WHRI) is very pleased to congratulate the recipients of the 2018 Women’s Health Research Institute Catalyst Grants. This competition was funded thanks to the dedicated support of the BC Women’s Hospital + Health Centre Foundation.

This grant competition provides support for pilot studies in women’s and newborn’s health, which aim to generate preliminary data; test new approaches, methodologies or tools; bring new teams together; and/or support new research in women’s and newborn’s health from established researchers.

Recipient of the Auxiliary to BC Women’s Catalyst Grant

Dr. Pascal Lavoie, Division of Neonatology, Department of Pediatrics, University of British Columbia

Team: Pascal Lavoie (PI), Suzanne Vercauteren (Co-PI), Jefferson Terry (Co-PI), Soren Gantt (Co-I), Wendy Robinson (Co-I), Alexander Beristain (Co-I), Ruth Grunau (Co-I), Rajavel Elango (Co-I)

Project: BC Women’s Hospital Preemie BioBank

Summary: In Canada, 8% of infants are born premature, before 37 weeks of gestation (40,000 infants per year). These infants suffer increased medical complications at birth with life-long health consequences. Health research is essential to discover new treatments for these problems. Biobanks are crucial to provide researchers with biological materials (e.g. human cells and tissues) to model disease process and the effect of new treatments without imposing a health risk to patients. The purpose of this project is to consolidate the BC Women’s Hospital (BCWH) Preemie Biobank initiative, the first Biobank in Canada dedicated to the collection of biological cord blood and placental tissues for research related to preterm birth and health problems in premature babies. Our main objective is to seek parents’ opinions and involvement into directing the process and priorities of the Biobank. The results of this study will also provide guidance on how to improve the acquisition of high quality biological specimens for innovative research, from the perspective of health providers. In the long-term, we hope that this study will enhance our ability to positively impact the health of premature babies through discovery research.

Recipient of the 2018 WHRI Catalyst Grant

Dr. Cindy K. Barha, Postdoctoral Fellow, Department of Physical Therapy, University of British Columbia

Team: Cindy K. Barha (PI), Liisa Galea (Co-I), Teresa Liu-Ambrose (Co-I), Rachel Crockett (Co-I)

Project: Momnesia: Investigating the neural basis for reduced memory and executive functions across pregnancy

Summary: Over 80% of women complain of declines in cognition during pregnancy. The negative impact of these deficits on maternal quality of life is significant. Although not well-studied, objective measurements support the claims of subjective memory declines during pregnancy. Fewer studies have examined executive functions during pregnancy, the capacity to plan, organize, and monitor goal-oriented behaviours; however, evidence does support declines in this as well. Importantly, little is known about the mechanisms underlying these declines in memory and executive functions in humans. Therefore, the aim of the proposed study is to examine the role of activation in the two brain regions that subserve these two cognitive domains, the medial temporal lobe and prefrontal cortex, using functional near-infrared spectroscopy (fNIRS), a cost-effective, non-invasive alternative to neuroimaging that is safe for use during pregnancy. We will also look at how pregnancy-related hormones, sex of the baby, severity of nausea/vomiting during pregnancy, and level of physical activity are involved in these cognitive deficits. We will recruit 15 women pregnant for the first time and 15 age- and education-matched non-pregnant women. All women will be assessed at 3 time points: for pregnant women at 12, 24, and 37 weeks since last menstrual period, and for control women at 3-month intervals. The resulting data will greatly aid in our understanding of how pregnancy affects the brain of women and has the potential to improve the mental health of women in British Columbia and beyond to ensure each child and mother thrives.

Recipient of the 2018 WHRI Catalyst Grant

Dr. Laura Schummers, Postdoctoral Fellow, Department of Family Practice, University of British Columbia

Team: Laura Schummers (PI), Wendy Norman (Co-I), Kim McGrail (Co-I), Elizabeth Darling (Co-I), Sheila Dunn (Co-I), Glenys Webster (Principal Knowledge User)

Project: Catalyst to facilitate Access to Mifepristone and Outcomes Study (CAMOS)

Summary:

Background: One in three Canadian women have at least one abortion. Until 2017, 96% of abortions were performed surgically in fewer than 100 (primarily urban) facilities. Access to abortion services was inequitable; including significant urban-rural disparities. The medical abortion drug mifepristone became available in Canada in January 2017. Mifepristone can be provided in primary care and is a safe, effective alternative to surgical abortion. Thus, mifepristone could improve abortion access and reduce inequities considerably. However, the extent to which mifepristone introduction has impacted abortion service access, abortion related adverse events, and health system costs, is not known. Health system leaders have identified an urgent need to understand the implications of this major abortion policy change.

Research Question: What was the distribution of abortion access, abortion-related adverse events, and abortion costs in BC and ON before the introduction of mifepristone medical abortion?

Method: Our research team aims to conduct a population-based cohort study among all patients undergoing abortion in British Columbia and Ontario from January 2012-December 2019 using administrative health data (e.g., billing codes; hospital discharge records; prescriptions). This Catalyst Grant will support crucial pilot work to 1) determine similarities and differences in data sources to ensure cross-province consistency for abortion and outcome measures, and 2) describe abortion usage, abortion access, abortion-related adverse event rates, and abortion service costs in BC and ON before the introduction of mifepristone medical abortion.

Impact: This Catalyst Grant will facilitate the first comprehensive examination of Canadian abortion services following mifepristone introduction and will provide critical information for health system leaders to evaluate recent abortion policy changes.

Member Spotlight: Congratulations to Dr. Laura Schummers!

This month our spotlight is on Laura Schummers, a Postdoctoral Fellow working with the Contraception and Abortion Research Team (CART-GRAC)! Laura was recently awarded a Michael Smith Foundation for Health Research (MSFHR) Research Trainee Fellowship for her project “Mifepristone outcomes study: Examining abortion access, outcomes, and costs following the introduction of mifepristone”, as well as a Health Systems Impact Fellowship co-funded by CIHR and the BC Ministry of Health for her work “Population-based epidemiological analysis to evaluate and inform reproductive health policies in British Columbia.”

Laura’s work uses epidemiological and health services research methods to better understand the causes and predictors of reproductive, maternal, and infant pregnancy outcomes. Her doctoral work looked at population-level administrative health data to examine the relationship between maternal age, pregnancy spacing, and adverse pregnancy outcomes. Findings from her study of  adverse pregnancy outcomes and maternal age detail risks for different maternal ages, and suggest that risks for both mother and baby increase gradually with increasing maternal age, rather than abruptly increasing at specific ages (such as age 35 or 40). Her doctoral work recently made waves across the media, suggesting that waiting less than a year between pregnancies increases risk for infants, regardless of maternal age, and increases risks for mothers for those age 35 or older. These findings provide useful tools for clinical counselling and family planning, and can help reassure older women who may also be weighing age-related risks that it is worth spacing pregnancies out 1-2 years.

Her postdoctoral work will look at the extent to which introduction of the medical abortion drug Mifepristone improved abortion access in Canada, as well as any other outcomes of this policy change. Laura will look at administrative health data to see how access was impacted, and whether or not there are new challenges to address, such as patient safety or health systems costs.

The fellowship places Laura in a unique position, as she has is co-located within the BC Ministry of Health in the Public Health Services division, Perinatal Services BC, and BC Women’s Hospital, along with her academic site in Women’s Health Research Institute. This means that the policy organizations responsible for implementing the change are working with her to evaluate their impact, and that she can try to ensure her research findings are easily interpretable for a policy audience.

Congratulations, Laura!

REFERENCES

Laura Schummers, S., Jennifer A. Hutcheon, P., Sonia Hernandez-Diaz, D., & al, e. (2018). Association of Short Interpregnancy Interval With Pregnancy Outcomes According to Maternal Age. JAMA Internal Medicine.

Schummers, L., Hutcheon, J. A., Hacker, M. R., VanderWeele, T. J., Williams, P. L., McElrath, T. F., et al. (2018). Absolute Risks of Obstetric Outcomes Risks by Maternal Age at First Birth: A Population-based Cohort. Epidemiology, 379-387.

Dr. Jerilynn Prior: The ABCs of Osteoporosis

Osteoporosis, a disease which deteriorates bone tissue and increases the risk for fractures, affects approximately 2 million Canadians (Osteoporosis Canada). November is Osteoporosis Awareness month, a time to raise awareness and discuss prevention – but often popular conversation doesn’t include young women and the steps they can take to decrease their risk.

Dr. Jerilynn C Prior is an endocrinologist who authored the ABCs of Osteoporosis Prevention for Teenaged Women to help bridge this gap and raise awareness among healthcare providers, young women, and their caregivers about the unique steps they can take for better life-long bone health.


The original ABCs of Osteoporosis Prevention came about when Dr. Prior was invited to speak with Bill Good on CKNW. She describes her rainy walk to the station and how she began trying to put her advice into an easy-to-follow alphabetical format.

For teenaged women, the ABCs begin with ‘A’ for Active, followed by ‘B’ for Brawny.

“Brawny fits because you need normal muscle for bone to be normal, and it’s also an opportunity to talk about keeping a steady, normal weight. If you have to lose weight, lose it very slowly – otherwise you will lose bone.”

Next are ‘C’ for Calcium, ‘D’ for Vitamin D and ‘E’ for Easygoing which Dr. Prior emphasizes as a very important step.

“I think I was one of the first people to identify that those…who we were seeing with osteoporosis were high-strung, or on-edge, or anxious, or insecure – you can use all kinds of different terms,” she says. “There are connections we now know of between the sympathetic nervous system and links between depression and bone loss. Anything that raises cortisol affects your bones.”

Similarly important is ‘F’ for bone formation, because most medications and supplements “work to prevent bone loss, but don’t work to increase new bone,” she explains. And, like calcium and vitamin D, hormones are also a critical component for bone formation.

“Basically, for adolescent men it’s important that their testosterone rises into normal male range. For women, it’s important they get their cycles at the normal time each month and develop normal ovulation and progesterone,” she says. “When it comes to the ‘F’ – formation and fertility – one instruction for adolescents is to avoid the birth control pill if at all possible.”

Population-based Canada-wide data from the Canadian Multicentre Osteoporosis Study (CaMos) in adolescent women found that the “use of combined hormonal contraception before age 19 or 20 appears to interfere with gaining toward peak bone mass in the hip region. Furthermore a meta-analysis of studies of spinal bone change by use of combined hormonal contraception or not shows that those using the Pill are significantly losing bone although this data is so far only published as an abstract.”

“I now have pretty strong data about the role of progesterone in bone formation, [although] it is still controversial. It has taken me twenty five years of gathering and interpreting [data] and doing studies that would show it. These data were recently published in an open-access Climacteric review.”

Finally, ‘G’ and ‘H’ are combined for Good Habits. That is, regular sleep, avoiding excessive alcohol and any tobacco, and, importantly, having a good diet. Data derived through principle components analysis of diet variables among those who completed a food-frequency questionnaire in the CaMos  cohort found that menopausal women who were predominantly on a nutrient-dense diet had fewer new fractures over time than menopausal women on a more calorie-dense or Western-type diet.

The ABCs of Osteoporosis Prevention have been adapted by Dr. Prior for premenopausal women, menopausal women with osteoporosis, midlife women, healthy menopausal women, men who have prostate cancer who are on androgen-ablation therapy, and now, adolescent women. With a CIHR grant the adolescent and premenopausal ABCs are being disseminated through both English and French animated videos. The print materials for all of these are available through the CeMCOR website. Additionally, Dr. Prior is engaging with both the public and healthcare professionals to bring this important information to light through workshops and public talks.

In future, Dr. Prior hopes to adapt the ABCs for adolescent and older men, too.

Watch the ABCs of Osteoporosis Prevention for Teenaged Women here.

Watch the ABCs of Osteoporosis Prevention for Premenopausal Women here.


Jerilynn C. Prior BA, MD, FRCPC is a Professor of Endocrinology and Metabolism at the University of British Columbia working on women’s health. She studies menstrual cycles and the effects of ovulation and its disturbances on women’s later life osteoporotic fracture, heart attack and breast cancer risks. She is British Columbia Centre Director of the Canadian Multicentre Osteoporosis Study (CaMos, www.camos.org), a 20-year prospective 9-centre population-based bone and general health study; she is also the Scientific Director and Founder of the Centre for Menstrual Cycle and Ovulation Research (www.cemcor.ca ).

References
J. C. Prior. (2018) Progesterone for treatment of symptomatic menopausal women. Climacteric 21:4, pages 358-365.