Mifepristone Implementation Research in Canada

Principal Investigator: Dr. Wendy Norman

Primary Contact: Sarah Munro, Post-doctoral Fellow, 604-875-2424 ext 4990, Sarah.Munro@ubc.ca

About the study: Mifepristone, approved by Health Canada, will be introduced in 2017. Currently 96% of Canadian abortions are surgical, largely concentrated in the largest cities close to the southern border. Overcoming barriers for provision of mifepristone abortion by current and new abortion providers could help to address this disparity. We are undertaking this national study to measure, and concurrently address, the facilitators and barriers for successful initiation and ongoing provision of medical abortion, and to measure changes to abortion access throughout Canada.

Why is this research important? This foundational research at the time of introduction for an innovative practice in Canada, will support advances for training programs and will inform health policy, system and service improvements to facilitate equitable access to medication abortion options for women throughout Canada.

What impact has this research had on policy? This study has involved close partnership with decision makers responsible for mifepristone policy in Canada. During the study period, our research-policy collaboration accelerated health system change through concurrent identification and mitigation of barriers to implementation of mifepristone. The research evidence contributed to removal of the federal requirements for observed dosing, practitioner training, practitioner registration, and physician-only prescribing and dispensing.

Study status: In the process of data collection and has begun preliminary analysis.

Who can participate? This study has three groups of participants: (1) physicians and pharmacists completing mifepristone training certification; (2) physicians and pharmacists who were eligible to provide mifepristone abortion services but did not complete certification; and (3) health service stakeholders who have an influential role in the health policy, system, and/or services that contribute to adoption and diffusion of abortion practice in Canada.

Co-Investigators: Drs. Tamil Kendall, Jan Christilaw, Edith Guilbert, Jennifer Blake, James Meuser, Philip Emberley, Rollin Brant,  Melissa Brooks, Stirling Bryan,  Dustin Costescu, Sheila Dunn, Angel Foster, Janusz Kaczorowski,  Sarah Munro, Regina Renner, Judith Soon, Eleni Stroulia, Flora Teng, Ashley Waddington, Marie-Soleil Wagner.

Funded by: CIHR, MSFHR, BC Women’s Hospital + Health Centre

Pregnancy Reference Intervals for Safe Medicine (PRISM)

Co-Principal Investigators:  Dr. Vilte Barakauskas and Dr. Benjamin Jung

Primary Contact:  Ashton Ellis, 604-875-2000, x 7841, ashton.ellis@cw.bc.ca

About the study:  Laboratory tests are often used by doctors to help diagnose medical concerns.  Care providers interpret test results by comparing a patient’s results to the results of a healthy population with similar characteristics, but there is limited information on what normal lab results are like during pregnancy.  Researchers at UBC and BC Women’s Hospital are studying healthy pregnant women to develop a guide to help health care providers interpret lab test results in pregnancy.

Why is this research important?  This study will help researchers at UBC and Children’s & Women’s Health Centre of BC to develop reference ranges specifically for women around the time of labour.  This will help health professionals identify and manage health problems that could impact moms and babies.

Study status: Recruiting

Who can participate?   

Women delivering at BC Women’s Hospital may participate if they meet the following criteria:

  • Age 19 to 45 years
  • Healthy with a low-risk pregnancy
  • Expecting one baby
  • Not smoking during pregnancy

What’s required?

  • 10-15 minute medical history questionnaire
  • Blood samples taken around the time of labour or C-section
  • 5 minute follow-up phone call or online survey

In total, this study may take up to 30 – 40 minutes of your time

Co-Investigators: Dr. Wee-Shian Chan, Dr. Khosrow Adeli, Dr. Hoaracio Osiovich, Dr. Suzanne Vercauteren

Contact Ashton Ellis to participate (ashton.ellis@cw.bc.ca).

Consent form: PRISM consent form-FINAL-19Mar2018

Maternal Microbiome Legacy Project

Principal Investigator: Dr. Deborah Money

Primary Contact: Zahra Pakzad, Research Coordinator, 604-875-2424 ext. 6379, zahra.pakzad@cw.bc.ca

About the study: The role of bacterial communities throughout the body in health and disease is being widely studied. Preliminary research shows a possible link between delivery type (vaginal or caesarean delivery) and the bacterial communities found in the gut in early infancy. In Canada 1 in 4 women have a caesarean delivery and there is some evidence of increased risk of conditions such as asthma, celiac disease, and allergies in caesarean-born infants. To date no cause for this increased risk has been identified. Some researchers have proposed that this potential transfer of maternal vaginal bacteria may be prevented by a caesarean delivery. This may result in altering the establishment of the infant’s own bacterial community. However a clear link between delivery type and the infant’s bacterial community has not been established.

This study will use advanced gene-based methods to profile the bacterial communities present in women who deliver vaginally or via caesarean section and connect these to the infant gut bacterial community in the first 3 months of life. This research will lead to a deeper understanding of the potential role of the maternal bacterial community on the infant gut bacterial community

Why is this research important? The practice of “vaginal seeding” has emerged, where a newborn delivered via caesarean section is swabbed with the mother’s vaginal secretions to transfer the mother’s vaginal bacteria to the infant, mimicking what the infant would have been exposed to during vaginal birth. However the benefits of “vaginal seeding” have not been evaluated and the safety of this practice has not been proven despite it coming into clinical use. The goal of our study will be to determine if the maternal bacterial community is actually transferred to the infant during delivery and if the different types of deliveries alter this transfer.

Interested in ParticipatingFollow the link to the survey, to have us contact you.

Study status: Launching March 5, 2018.

Co-Investigators: Dr. Janet Hill (University of Saskatchewan), Dr. K.S. Joseph (University of British Columbia), Dr. Julie van Schalkwyk (University of British Columbia), Dr. Arianne Albert (B.C. Women’s Hospital, Vancouver), Dr. Chelsea Elwood (University of British Columbia), Dr. Soren Grantt (University  of British Columbia), Dr. Kirsten Grabowska (University of British Columbia), Dr. Jennifer Hutcheon (University of British Columbia), Dr. Matthew Links (University of Saskatchewan), Dr. Amee Manges (University of British Columbia), Dr. Sheona Mitchell (University of British Columbia), Dr. Tim Dumonceaux (Agriculture and Agri-Food Canada, Saskatchewan), Dr. Zoe Hodgson (B.C. Women’s Hospital), Dr. Janet Lyons (University of British Columbia).

Funded by: Canadian Institutes of Health Research (CIHR)

News: 

New $1.4 M CIHR Project Grant brings together three sites across the department to define the maternal legacy

Recruitment Materials:

  1. Recruitment Survey
  2. Recruitment Poster
  3. Recruitment Postcard

#ItsNotInYourHead

#ItsNotInYourHead is a campaign launched by Dr. Lori Brotto and the Women’s Health Research Institute to raise awareness about provoked vestibulodynia (PVD) and evidence-based psychological interventions for improving pain management.

PVD is pain experienced when contact is made with the area near the entrance to the vagina, known as the vulvar vestibule. This pain often occurs during sexual activity, but it can also be triggered by clothing, inserting tampons, pap tests, sitting, or any other touching sensations.  Many women are unable to receive an accurate diagnosis since there are no visible indicators that something is wrong in an exam. This can lead to frustration, hopelessness, and feelings of isolation as patients are led to believe that their pain is “all in their head”.

Dr. Brotto conducted research at the University of British Columbia with two groups of women living with PVD, treating one with mindfulness-based therapy, and the other with cognitive behavioural therapy.  Both groups of women saw improvement in their ability to manage pain.

The #ItsNotInYourHead campaign launched October 6th, 2017 with a short video describing the condition and letting women know that their pain is real.  To follow the campaign, follow @NotInYourHead17 on Twitter and Facebook. You can join the conversation about provoked vestibulodynia using the hashtags #ItsNotInYourHead and #PVD.

Vaginal Microbiome Group Initiative

vogue

Principal Investigator: Dr. Deborah Money

Primary Contact: Zahra Pakzad, Research Coordinator, 604-875-2424 ext. 6379, zahra.pakzad@cw.bc.ca

About the study: The VOGUE study team is comprised of a diverse group of scientists and clinicians from across Canada who are using genomic methods to study the microbial ecosystem (microbiome) of the vagina in varying states of health and disease. The VOGUE research program comprises 5 sub-studies, each examining the vaginal microbiome of distinct clinical populations: healthy non-pregnant women, women living with HIV, women with recurrent vulvovaginitis, pregnant women at low risk for preterm birth, and pregnant women at high risk for preterm birth. The team is united in their goal of capitalizing on advances in genomic sequencing technology to analyze the composition, distribution, and function of vaginal microbes, and probe the links between these microbes and disease to guide the development of novel diagnostic tools and interventions to improve women’s health in Canada and around the world.

Why is this research important? The healthy vagina is host to millions of microorganisms, including many types of “good” bacteria that protect against invading pathogens, and help to promote healthy pregnancy. Until now, clinicians and scientists have had relatively unsophisticated tools at their disposal for studying this critically important ecosystem. It has only been with recent advances in genomic sequencing technology that researchers have been able to uncover and truly understand the sheer number and diversity of organisms that inhabit the vagina (the vaginal microbiome). From a single swab taken from the vagina, we are now able to sequence a section of the DNA from each type of bacteria present, and use this unique DNA “fingerprint” to identify them. As we move toward more sophisticated ways to diagnose and treat imbalances in the vaginal microbiome, this will allow us to develop more personalized and targeted interventions, in order to restore a microbiome that optimizes reproductive health in individual women. Ultimately, we hope our work will lead to significant breakthroughs in the health and well-being of women in Canada and around the world.

Study status: Recruitment is limited to the VOGUE 1B2 sub-study (women with recurrent vulvovaginitis). Recruitment for all other sub-studies is complete. Data analysis, manuscript development, and knowledge translation are ongoing.

Study results/publication:

Albert AY, Chaban B, Wagner EC, Schellenberg JJ, Links MG, van Schalkwyk J, Reid G, Hemmingsen SM, Hill JE, Money D, and the VOGUE Research Group. A study of the vaginal microbiome in healthy Canadian women utilizing cpn60-based molecular profiling reveals distinct Gardnerella subgroup community state types. PLoS One. 2015;10(8):e0135620.

Co-Investigators: Dr. Alan Bocking (University of Toronto), Dr. Sean Hemmingsen (National Research Council’s Plant Biotechnology Institute, Saskatchewan), Dr. Janet Hill (University of Saskatchewan), Dr. Gregor Reid (University of Western Ontario), Dr. Tim Dumonceaux (Agriculture and Agri-Food Canada, Saskatoon), Dr. Gregory Gloor (University  of Western Ontario), Dr. Matthew Links (Agriculture and Agri-Food Canada, Saskatoon), Dr. Kieran O’Doherty (University of Guelph), Dr. Patrick Tang (Sidra Medical and Research Center), Dr. Julie van Schalkwyk (University of British Columbia), Dr. Mark Yudin (University of Toronto).

Funded by: Canadian Institutes of Health Research (CIHR) and Genome BC

Advances in Screening and Prevention in Reproductive Cancers (ASPIRE)

Principal Investigator: Dr. Gina Ogilvie

Primary Contact: Heather Pedersen, Research Coordinator, 604-707-2424 x5473, Heather.pedersen@cw.bc.ca

About the study: ASPIRE is a women’s health initiative using innovative models and technologies to improve access to reproductive health in low income settings. Since 2007, ASPIRE has conducted various community-based cervical cancer screening initiatives in Kampala, Uganda using self collection-based HPV testing. The project takes an integrated health services approach to address cervical cancer along other reproductive health issues including sexually transmitted infections and HIV.

Why is this research important? Cervical cancer, despite being almost entirely preventable, remains a leading cause of death among women in low and middle income countries largely due to the absence of screening programs in these regions. Cost-effective and acceptable tools are needed to improve access in low income settings. By integrating cervical cancer and reproductive health screening with routine HIV services, the health of vulnerable women can be protected while most effectively utilizing resources.

Study Status: 1) Randomized controlled trial comparing HPV self collection vs VIA in Kampala: complete; 2) Integration of cervical cancer screening with HIV services: under development; 3) Reproductive health & pregnancy outcomes in adolescents: under development.

Study results/publications:

Moses E, Pedersen HN, Mitchell SM, Sekikubo M, Mwesigwa D, Singer J, Biryabarema C, Byamugisha JK, Money DM, Ogilvie GS. Uptake of community-based, self-collected HPV testing vs. visual inspection with acetic acid for cervical cancer screening in Kampala, Uganda: Preliminary results of a randomized controlled trial. Trop Med Int Health. 2015; 20(10):1355-67.

Teng FF, Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha JK, Steinberg M, Money DM, Ogilvie GS. Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda. BMJ Open 2014;4:4 e004783.

Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha JJ, Steinberg M, Jeronimo J, Money DM, Christilaw J, Ogilvie GS. Factors associated with high-risk HPV positivity in a low-resource setting in sub-Saharan Africa. Am J Obstet Gynecol 2014 Jan;210(1):81.e1-7.

Ogilvie G S, Mitchell S, Sekikubo M, Biryabarema C, Byamugisha J, Jeronimo J, Miller D, Steinberg M, Money D M. Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda. Int J Gynaecol Obstet 2013; 122 (2): 118–123.

Mitchell S, Ogilvie G, Steinberg M, Sekikubo M, Biryabarema C, Money D. Assessing women’s willingness to collect their own cervical samples for HPV testing as part of the ASPIRE cervical cancer screening project in Uganda. Int J Gynaecol Obstet 2011;114(2):111-115.

Co-Investigators: Deborah Money, Jan Christilaw, Josaphat Byamugisha, Sheona Mitchell, Angela Kaida, Ashley Roberts, Curren Warf, Patricia Spittal

Funded by: CIHR, CFRI, BCCDC Foundation, UBC, BC Women’s Foundation

Partners: University of British Columbia, Makerere University, BCCDC

Websites:

http://www.aspireafrica.ca/aspire/

WelTelOAKTREE: Text Messaging to Support Patients with HIV/AIDS in British Columbia

WelTelOAKTREE: Text Messaging to Support Patients with HIV/AIDS in British Columbia

Principal Investigator: Dr. Melanie Murray

Primary Contact: Evelyn Maan, Research Program Manager, 604-767-5044, emaan@cw.bc.ca

About the study: WelTel Oak Tree is a study that enrolled 80 HIV+ individuals from the Oak Tree Clinic at BC Women’s Hospital. Participants received a cell phone and/or unlimited text messaging capability if they did not have it already, and for one year received a weekly text message stating “How are you”. Participant problems and non-responses were followed up by a nurse. Data on demographics, CD4 counts, HIV viral loads, HIV medication adherence and attendance at appointments were collected for the year prior to the intervention and during the intervention for comparison. Data assessing quality of life was also collected at three points during the one year study period. Cost effectiveness and cost benefit of the intervention were looked at to assess feasibility of transferring the intervention to a programmatically funded facet of patient care.

Why is this research important? In Canada, around 65,000 people are living with HIV/AIDS, approximately 14,300 of whom are women. AntiRetroviral Therapy (ART) has led to enormous improvements in the health and survival of individuals with HIV. Moreover, by decreasing the amount of virus circulating in the body (viral load), HAART offers the possibility of treatment as a preventative measure. However, high levels of engagement in care, timely initiation of ARVs, and adherence to medication are required to maximize the benefits of HAART in order to prevent resistance, progression to AIDS, transmission or mortality. Unfortunately, engagement in ongoing HIV care can be poor, with one study from the United States (US) showing only 52% retention in care over 1 year. Further, adherence among high-risk populations is low, with women being less adherent partly due to their role as care providers for children and partners, potential abuse in partner relationships, fear of stigma, homelessness, and concerns regarding side effects. Conversely, active drug use (especially cocaine), lack of social supports, and depression are just a few of the variables that affect both men and women alike. Current methods of engagement in care have failed to overcome these barriers to adherence, which makes finding an effective adherence intervention critically important. Mobile health (mHealth), the use of mobile phone technology to deliver health care, is an emerging area of disease management that can assist in patient adherence to prolonged chronic treatment regimens and monitoring of care. A randomized controlled trial (WelTelKenya1), conducted by Dr. Richard Lester et. al, tested the clinical effectiveness of text message support for HIV treatment adherence in Kenya. WelTelKenya1, of which 67% were women, showed that patients receiving text message support had significantly higher rates of treatment adherence and viral suppression than patients who received standard care alone. In Canada, cell phone penetration exceeds 70% and is expected to reach 100% within the next decade. The WelTel system offers a clinical management model that can be carried out using standard services offered by cellular network providers with minimal additional infrastructure and is both flexible and scalable.

Study status: The study is no longer enrolling participants. Data analysis and manuscript preparation is underway.

Study results/publication:

Mean ART adherence improved from 61.7% to 68.3% (p<0.0001), and median population HIV log10VL declined by 0.70 log (p=0.007) from pre-intervention to intervention years.

Median VL decline for responders (response rate ≥50%) was 1.03 log (vs. 0.39 log, p=-.03), and adherence increase 13.7% (vs. 0.8%, p=0.008) versus non-responders (response rate <50%).

Managing “problem” responses required 53 minutes of Health Care Practitioner time per high-risk, vulnerable participant enrolled per year, for a cost per patient of $45.20.

Total intervention cost (including phones, plans, staff time) was $375.74 per patient per year.

Friesen K, Qiu AQ, Goktepe O, Maan EJ, Pick N, Alimenti A, Kestler M, Money D, Lester R, Murray MCM. Weekly text-messaging (Weltel) to engage vulnerable HIV+ populations: It works, what does it cost? (Oral Presentation, 25th Annual CAHR Conference, Winnipeg, MB.  May 12-15, 2016).

Friesen K, Qiu A, Goktepe O, Maan EJ, Pick N, Alimenti A, Kestler M, Smillie K, Money D, Lester R, Murray MCM and the WelTel OAKTREE Study Team. mHealth to Improve Health:  Effectiveness of a weekly text messaging intervention to improve ART adherence and HIV Viral Load in a Canadian Context: WelTel OAKTREE.” (Oral presentation), The 6th International Workshop on HIV and Women, Boston, February 21-22, 2016.

Murray, MCM, Friesen K, O’Shaughnessy S, Albert A, Maan EJ, Pick N, Alimenti A, Kestler M, Smillie K, Money D, Lester R, and the WelTel OAKTREE Study Team.  mHealth to Improve Health:  Effectiveness of a weekly text messaging intervention to improve ART adherence and HIV Viral Load in a Canadian Context: WelTel OAKTREE. (Poster Presentation), International AIDS Society Meeting, July 19-22, 2015. Abstract WEPED849, http://www.ias2015.org/WebContent/File/IAS_2015__MED2.pdf.

Friesen K, O’Shaughnessy S, Maan EJ, Makela N, Pickering B, Lester R, Pick N, Murray M.   How R U?  WelTelOAKTREE: Text messaging and nursing support to improve care for HIV positive patients taking antiretroviral therapy (cART) in British Columbia.  (Oral Presentation), 2014 Canadian Association of Nurses in AIDS Care (CANAC) Conference, April 24-26, 2014.

Co-Investigators: Dr. Ariane Alimenti, Karen Friesen, Dr. Richard Lester, Dr. Deborah Money, Dr. Neora Pick, and Dr. Laura Sauve.

Funded by: Gilead Sciences Inc. and Bristol-Myers Squibb

Prospective study of an interdisciplinary pelvic pain & endometriosis clinic (Etiology of dyspareunia in endometriosis)

Principal Investigator: Dr. Paul Yong

Primary Contact: Heather Noga, Research Coordinator, WHRI, 604-875-2424 ext 4924, Heather.Noga@cw.bc.ca

About the study: BC Women’s Centre for Pelvic Pain and Endometriosis is a tertiary referral centre in British Columbia dedicated to managing chronic pelvic pain (CPP) and endometriosis. The Centre offers a unique interdisciplinary approach that includes pain education workshops, pelvic floor physiotherapy, counselling, and medical and surgical management. The purpose of this study is to prospectively collect data from patients at the clinic to investigate long-term patient outcomes, and the etiology and treatment of CPP. Participants in the study will have their clinical intake questionnaires, physical exam, surgery, and pathology data included in the research and answer follow-up questionnaires at 6 months and 1-5 years.

Why is this research important? Chronic pelvic pain (CPP) (pelvic pain that lasts at least 3-6 months in duration) affects 15% of reproductive-aged women. It is a condition that can involve many physical, psychological, and behavioural consequences and have a devastating impact on quality-of-life. One of the most common origins of CPP is endometriosis, a condition in which endometrial tissue that usually lines the uterus grows outside of the uterus. However, pelvic pain may also result from numerous other gynaecological, musculoskeletal, gastrointestinal, or urological conditions, and can be difficult to manage. Therefore, there is benefit to an interdisciplinary approach in the management of CPP compared to standard treatment.

Study status: Recruitment, data collection, data analysis, and manuscript development is ongoing.

Who can participate: All patients referred for chronic pelvic pain and/ or endometriosis to the BC Women’s Centre for Pelvic Pain and Endometriosis.

Study results/publications:

Yosef, A., Allaire, C., Williams, C., Ahmed, G., Al-Hussaini, T., Abedellah, M., Wong, W., Lisonkova, S., Yong, P. (2016). Multifactorial contributions to the severity of chronic pelvic pain in women. American Journal of Obstetrics & Gynecology, epub ahead of print.

Co-Investigators: Dr. Catherine Allaire, Dr. Christina Williams, Dr. Mohamed Bedaiwy.

Funded by: Canadian Institutes of Health Research (CIHR), Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Women’s Health Research Institute (WHRI).

Clinic website: http://www.womenspelvicpainendo.com/

Clinic page on research: http://www.womenspelvicpainendo.com/research/

Research Newsletter:

October 2016 Research Newsletter

Endometriosis – Determinants of Oncogenesis (ENDO-ONC) Full Scale Study

Principal Investigator: Dr. Paul Yong

Primary Contact: Heather Noga, Research Coordinator, 604-875-2424 ext 4924, Heather.Noga@cw.bc.ca 

About the study: The aim of this study is to determine whether there are unique genetic changes in endometriosis that may play a role in malignant transformation to ovarian cancer or in the symptoms of pelvic pain and infertility. This will be done by comparing surgical tissue samples from women with endometriosis to women without endometriosis.

Participants in this study agree to provide for research purposes: a saliva sample, tissue removed from their surgery, endometrial biopsy (a sample from the lining of the uterus – only if a sample is not already being removed for clinical purposes).

Why is this research important? Endometriosis affects 10% of reproductive aged women, causes pain and infertility, and is now known to also be associated with ovarian cancer. Studying gene mutations and expression changes in surgical tissue samples of women with or without endometriosis will help us understand how it can lead to pain, infertility, ovarian cancer, and other associated symptoms.

Study status: Recruitment and data collection is ongoing.

Who can participate: You have (or are suspected to have) endometriosis OR another benign gynaecological condition, You have chosen surgical treatment.

Co-Investigators: Dr. Catherine Allaire, Dr. Christina Williams, Dr. Mohamed Bedaiwy, Dr. Jessica McAlpine, Dr. David Huntsman.

Funded by: Canadian Institutes of Health Research (CIHR), Canadian Cancer Society Research Institute (CCSRI), Women’s Health Research Institute (WHRI)

Partners: Ovarian Cancer Research Group (OvCaRe), Centre for Translational and Applied Genomics (CTAG).

Clinic website: http://www.womenspelvicpainendo.com/

Clinic Research Page: http://www.womenspelvicpainendo.com/research/

Does a Women’s Heart Center Change Clinical Outcomes?

Does a Women’s Heart Center Change Clinical Outcomes?

Principal Investigator: Dr. Tara Sedlak

Primary Contact: Emma Branch, Research Assistant, WHRI, 604-875-2424 ext 4796, Emma.Branch@cw.bc.ca

About the study: This study has two aims: firstly, to create a database of patients attending the VGH/BCWH Women’s Heart Center (WHC) to facilitate the ability of future investigators to conduct research on a number of different of issues surrounding women and heart disease. The second aim is to examine whether attendance at a WHC improves outcomes of patients with heart disease or at risk for heart disease. We will collect clinical information and some basic demographic information and store this in a de-identified database. We will also ask participants to complete a total of 4 questionnaires over a 5 year period.

Why is this research important? It is not yet known whether specialized care centers like the Women’s Heart Center improves outcomes in women compared to usual care. Through this study we hope to better understand how gender specific care can impact the outcome for woman with a range of different cardiac conditions.

Study status: Ethics approval in progress.

Who can participate? Any woman who is being seen within the Women’s Heart Center at Vancouver General Hospital and/or BC Women’s Hospital will be invited to participate in this study who is fluent in English.

Co-Investigators: Natasha Prodan-Bhalla, Dr. Karin H. Humphries.