Research Spotlight: National Medical Lab Week

Meet Dr. Vilte Barakauskas, BCCHRI/WHRI joint-researcher and clinical biochemist working at BC Children’s Hospital, who is part of a team working to establish reference intervals for pregnant women to better interpret lab test results.

Dr. Barakauskas works alongside a large team of people who obtain, process, and analyze specimens – like blood or tissue samples – in the department of Pathology and Laboratory Medicine at the BC Children’s  and Women’s Hospitals campus. As a clinical biochemist she works closely with medical lab technologists, medical lab assistants (MLAs), and clinicians in a role focused on interpreting lab test results, to aid in accurate diagnoses and management of disorders and diseases.

In her day-to-day work, she is also involved with quality oversight in the lab to help ensure that they are producing reliable, accurate, and timely results, as well as providing consultation for healthcare providers and physicians. This might include assisting with test result interpretation by reviewing records, producing interpretive reports, evaluating test performance, or helping to find, select, or order and utilize appropriate tests. She is also involved with decisions around implementing new types of tests or developing tests when a need is identified.

In addition to her role in the lab, Dr. Barakauskas is helping to establish reference intervals for pregnant women around the time of labour through the Pregnancy Reference Intervals for Safe Medicine (PRISM) study. For the average person, lab results are interpreted by comparing against a set of reference intervals. These are a range of data compiled from ‘healthy individuals’ (commonly adults), which can help determine whether or not a patient’s test results are within a normal range, or if there might be a need for further investigation and testing.

However, for patients who belong to a population outside of the ‘average, healthy adult’, it becomes difficult to determine when there is a cause for concern. Dr. Barakauskas offers the example of pediatric medicine, where babies and kids are developing so quickly that it becomes harder to pinpoint what ‘normal’ should look like in test results.

Similarly, pregnancy is a time period during which physiology changes and test results might appear abnormal when compared with non-pregnant adults. Currently, there is little available information about reference intervals for this population, and less data directly applicable to our diverse population of women in British Columbia. Access to representative reference intervals is important because they help reduce the risk of under or over diagnoses and support appropriate patient care.

Creating reference intervals is a daunting task, Dr. Barakauskas explains, as it requires a lot of blood sampling and a lot of data. Further, she emphasizes the added difficulty of collecting specimens from ‘healthy’ populations, who are less likely to require bloodwork as part of their routine care, and thus volunteers for research participation and blood collection are required.

As a result, her team is conducting this research both through a recruitment process, where they seek out ‘healthy’ pregnant women to collect blood from, and through retrospective data analysis, where existing data is sorted using mathematical methods. While the study’s primary goal is to produce reference intervals and improve test interpretation, it will also allow the team to compare these two research methods for future development of reference intervals for other populations.

Dr. Barakauskas and her team have finished recruitment for the initial PRISM study of women around the time of labour, throughout which they had great collaboration across lab staff, nurses, and healthcare providers. They are currently starting sample and data analysis. She would like to acknowledge the mothers who participated, along with all the MLAs, lab technologists, nurses, students, BCCH Biobank and others who invested their time and hard work in the PRISM study and is grateful for the mentorship of co-investigators Dr. Wee-Shian Chan, Head of the Department of Medicine at BC Women’s Hospital, and Dr. Benjamin Jung, Clinical Biochemist, currently at SickKids. Together with Dr. Kate Chipperfield, Hematopathologist in the department of Pathology and Laboratory Medicine, Dr. Chan and an expanded team of clinician and patient collaborators, they will work to begin recruitment for the next iteration of PRISM which will look at blood from healthy mothers postpartum, as well as blood from their infants.

Members of the PRISM research team, and BC Children’s laboratory staff.

To learn more about PRISM click here. To read more about Dr. Barakauskas, click here.

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

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!

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.

Member Spotlight: Dr. Paula Gordon

Last month Minister of Health Adrian Dix announced that BC would become the first province to share breast density results with all women and their healthcare providers with their mammography screening. Dr. Paula Gordon, Medical Director of the Sadie Diamond Breast Program at BC Women’s Hospital, along with the organization Dense Breasts Canada, was instrumental in advocating for this policy change.

In honour of Breast Cancer Awareness month, we spoke to Dr. Gordon about this change and its impact on women throughout the province.

 

  1. What was your involvement in the push toward communicating breast density results in BC?

I’m a volunteer advisor to Dense Breasts Canada, a non-profit group of breast cancer survivors and medical professionals striving to educate women and physicians about the risks associated with having dense breasts.

  1. How is breast density related to breast health?

It’s normal and common to have dense breasts. But having dense breast tissue puts a woman at increased risk for getting breast cancer. Having the highest category of breast density is a greater risk factor than having a mother or sister with breast cancer. And when a woman’s breast tissue is dense, it makes it harder to see a cancer on a mammogram. Cancers and normal dense tissue both appear white on a mammogram, so looking for a cancer “is like looking for a snow ball in a snowstorm.” Women with fatty breasts are at lower risk AND it’s easier to see cancer in a fatty breast.

  1. Why is it important that women are informed about their breast density?

Mammograms miss 50% of cancers in women with dense tissue. So, women with dense breasts need to know that they can’t have the same trust in the accuracy of their mammogram, than women can if they have fatty breasts. They should still have mammograms, but should also do breast self-examination, and should discuss the option of additional screening with ultrasound, with their family doctor. BC Cancer will initiate a program to educate physicians about dense breasts in 2019.

  1. How will this decision impact women in BC?

Hopefully, women who learn that they have dense breasts will be in a position to make informed decisions about their health. ALL women would ideally improve their lifestyle to reduce their risk of getting breast cancer.

Changes include:

  • Maintaining a healthy body weight, especially after menopause
  • Doing regular, moderately-intense exercise
  • Reducing the use of hormone therapy after menopause (use the lowest possible dose for the shortest possible time, avoiding oral estrogen, and balancing the risks with the benefits to their quality of life
  • Minimizing their alcohol consumption: there’s a linear relationship between alcohol use and breast cancer risk. So enjoy, but in moderation
  • Have routine screening mammography.

Women with dense breasts should discuss the option for supplemental screening with their family physician. Currently, there is evidence to show that ultrasound finds an additional 3-4 cancers per thousand women. But like any screening test (like mammograms and pap smears) ultrasound can create false alarms, which can necessitate additional testing to determine whether cancer is present, or not. But when ultrasound finds these cancers, they are usually small, and not yet spread to lymph nodes. So these women are good candidates for less aggressive surgery and often do not require chemotherapy. When not found early, women are more likely to need mastectomies and chemotherapy.


Read more about the announcement here.

Meet the Researcher: Dr. Cheryl Krasnick Warsh

Dr. Cheryl Krasnick Warsh, FRSC is a historian at Vancouver Island University, who also served as Executive Director of the Western Association of Women’s Historians, and Editor-in-Chief of the Canadian Bulletin of Medical History. She presently is co-editor of the international journal Gender and History. Her work focuses on the history of healthcare and health research, and within those fields, the inequalities women have faced in accessing care and inclusion within the healthcare system.

Dr. Warsh started her career as a historian of healthcare nearly 35 years ago.  Studying this history, she explains, adds greater dimension and context to our current healthcare concerns and advances in medicine. The history of gender inequalities in the healthcare system is rich with examples of women’s concerns being treated as psychological, related purely to their reproductive systems, or simply ignored.

“It goes right back to Greek medicine and the first physicians, Galen and Hippocrates,” says Dr. Warsh. “Galen postulated that the centre of a woman’s life was the womb, and the woman was built up around it. Women’s reproductive organs really guided everything about her health from puberty to menopause and beyond.”

She describes that when doctors had no clear cut answer for the cause of a woman’s ailment, they defaulted to the ‘theory of the wandering womb’. If a woman was suffering from a migraine, for instance, they might put sweet smelling herbs near her pelvis and garlic and other bad smelling things near her head to “entice her womb from her head and put it back where it belongs.”

This association between a woman’s wellbeing and her reproductive organs carried on well into the 20th century. Dr. Warsh’s first research was on the London Psychiatric Hospital  during the last decades of the 19th century, where asylum superintendent Richard Maurice Bucke had a theory that “much of a woman’s mental illness related to her ovaries. If she couldn’t be treated, then maybe they needed to be taken out.”

Over the past hundred years or so, the fate of women’s healthcare and health research largely shifted toward the assumption that their care is interchangeable with men’s. She explains that medical science primarily experimented on men, and women’s unique concerns have been downplayed.

“Women were expected from a young age to take care of reproductive health in ways that may not be healthy,” she says. “When the first birth control pill was tested through the FDA in the late 1950s the FDA didn’t yet have scientists there. They had a woman employee whom they sent to get a Master’s degree in science so that she would be ‘qualified’ to test the birth control pill. The early pill had severe side effects.”

These are only a few examples of the long history of inequalities in healthcare, and understanding where we came from can be helpful for understanding where our system stands today.

“When you do a little bit of history on anything, you find out a lot more than you expected,” says Dr. Warsh.


Read more about Dr. Warsh here.

Meet the Researcher: Catriona Hippman

In honour of World Mental Health Day we talked to Catriona Hippman, a WHRI researcher, genetic counselor, and Clinical Assistant Professor in the Department of Psychiatry at the University of British Columbia. Check out this Q&A to learn more about psychiatric genetic counselling, and her research on reproductive mental health!

Catriona Hippman headshotWhat is psychiatric genetic counselling, and what does a counsellor in this field do?

Genetic counselling is a growing field, and is defined as “the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease.” Psychiatric genetic counselling entails helping people make personal meaning of the research that has been conducted in the area of psychiatric illness. People might see a psychiatric genetic counsellor if they have a family member with a mental illness (such as a child or parent), and they want to understand more about how they can help to protect their child’s – and their own – mental health. Someone who has a mental illness themselves might see a genetic counsellor to discuss what’s known about the causes of mental illness and what has contributed to their experience of mental illness. Psychiatric genetic counsellors can also talk to women and their partners about how to protect their mental health during and after pregnancy, discuss options in terms of how to manage mental health during pregnancy and the postpartum period, and answer questions about chances for their child to develop a mental illness. An important part of a psychiatric genetic counsellor’s role – regardless of the reason for an appointment – is to address feelings of guilt or shame that often impact families affected by mental illness.

How do genetics play a role in mental health?

While we know that genetic factors play a part in developing a mental illness, we also know that genetic factors alone do not cause mental illness. Anyone who would like to understand more about the causes of mental illness and the role genetics plays in mental health can contact the psychiatric genetic counselling specialty clinic at BC Women’s Hospital – the Adapt clinic: http://www.bcmhsus.ca/our-services/genetic-counselling-(the-adapt-clinic).

What drew you to focus your research on reproductive mental health?

Like many, I was drawn to work in an area that is very personally relevant. Mental illness has ravaged the lives of many of my closest friends. I have seen repeatedly how much suffering is caused by mental illness, and – fortunately – how much people can thrive when they receive support for their mental health. As a feminist, I am particularly passionate about supporting women to care for their mental health at a time when they are most vulnerable – during and after pregnancy.

What impact do you hope to make with your research?

My vision is for all women to feel empowered to care for their mental health, and my mission is to improve women’s reproductive mental health through translational research.

What is the coolest thing about the work you do?

I cherish the connections that I make with women who participate in my research, and I deeply value hearing their stories and working with them to make meaning of their experiences. It is a privilege that women tell me about some of the most personal and private aspects of their lives, and I see it as my responsibility to promote change on a large scale, in whatever way I can, through my research.


Learn more about World Mental Health Day 2018 here.

Researcher spotlight: Meet Dr. Sarah Munro

Dr. Munro is a WHRI researcher and implementation scientist doing work on access to contraception and informed, shared decision-making. She holds a joint post-doctoral position between the Contraception and Abortion Research Team (CART) and the Dartmouth Institute for Health Policy and Clinical Practice (TDI).

Dr. Sarah Munro headshotChoosing the right form of contraception is not always an easy task. Misinformation, high costs, or familiarity with a particular method are all reasons a patient may not consider different options for contraception. This gap is what led Dr. Munro, principal investigator Dr. Rachel Thompson, and the team at Dartmouth to develop and evaluate a set of tools called Right For Me, which supports patients to make informed, shared decisions for contraceptive methods. The tools are comprised of a collection of decision aid handouts, a video and prompt card outlining three key questions to ask during clinic visits, and training for healthcare providers. The tools aim to aid patients in selecting the form of contraception that best matches their values and needs.

The Right for Me study was conducted with funding from the Patient Centered Outcomes Research Institute (PCORI), which focuses on research that directly involves and benefits patients. Patient partners from diverse backgrounds collaborated throughout the research process – from identifying which outcomes to measure, to creating a video summary of the study protocol. Dr. Munro recently completed the qualitative evaluation of the implementation of Right for Me. Stay posted for her publication in the coming months!

Moving forward Dr. Munro will be adapting the Right For Me tools for a Canadian audience. She will continue working with Dr. Wendy Norman and other researchers at WHRI and across the province to implement these successful tools to support shared decision-making for patients and providers involved in maternal, sexual, and reproductive healthcare.

Learn more about RightForMe.org.