Catalyst Grants

Project Title: Development of an educational video series on chronic pelvic pain in gynecology for Canadian health care providers-in-training

Principal Investigator: A. Fuchsia Howard, Associate Professor, School of Nursing, University of British Columbia

Co-Investigators: Natasha Orr, Paul Yong, Leanne Currie, Karim Qayumi, Margaret Carlyle, Helena Daudt, Rachel Langer, Michelle Lisonek, Navjit Moore and Aimee Hayward

Summary: Chronic pelvic pain affects approximately 15% of women and an unknown number of gender diverse people. Despite its common and devastating effects, it is often dismissed and mismanaged by healthcare providers due to stigma, normalization and lack of education on this topic. This study will develop an engaging video series on chronic pelvic pain using an iterative development process to address gaps in knowledge. This project will be guided by a group of experts including people with lived experience of chronic pelvic pain, students, researchers, and clinicians. The videos will be implemented into the University of British Columbia medical and nurse practitioner school’s curriculum. Additionally, we will translate research findings to the community. By providing a video series to address gaps in medical education, this project aims to improve health care provider understanding of this complex symptom and ultimately improve care for people with chronic pelvic pain.

Project Title: Exploring trauma-informed technology design among marginalized populations seeking abortion care

Primary Investigator: Abdul-Fatawu Abdulai, Assistant Professor, School of Nursing, University of British Columbia

Co-Investigators:Wendy V. Norman, Stephanie Begun, Martha Paynter and Cam Minh Duong

Summary: Abortion is an essential healthcare service in Canada, with approximately 100,000 abortions provided annually. In recent years, the adoption of digital health has facilitated access to abortion services particularly for marginalized populations who face geographical, systemic and intersecting barriers in access to abortion care. However, there are legitimate concerns of how these technological advances can contribute to, exacerbate, or even create traumatic experiences among marginalized populations who may have prior experiences of trauma.Recognizing the increasing deployment of digital health in abortion care, any potential unintended consequences may limit their use – further exacerbating inequities in access to abortion services among those with the greatest need. Using an interpretive phenomenological approach, the aim of this proposed research is to explore patient-centered approaches for designing and deploying trauma-informed digital health interventions for abortion care. This research will inform approaches on how to create and deploy emotionally safe digital health interventions that has the least potential of perpetuating, exacerbating or creating trauma among a potentially marginalized population including among survivors of trauma.

Project Title: Qualitatively Exploring Opportunities to Support Older Women’s Sexual Health and Wellbeing in Fraser Health Authority’s Assisted Living Sector

Principal Investigator: Valorie Crooks, Professor & Associate Vice-President Research, Department of Geography Simon Fraser University

Summary:

British Columbia’s Fraser Health (FH) Authority houses 31 Assisted Living (AL) communities, home primarily to seniors who can maintain independence while receiving some care. Currently, FH has 1,281 AL residents. Of those, 883 (68.9%) are women. Our pre-research exploration focused on sexually transmitted and blood-borne infection (STBBI) prevention in AL has involved conversations with administrators and care providers. It has become clear that residents are rarely conceptualized as having sexual health needs. Thus, most AL communities lack policies around intimacy or more broadly supporting sexual well-being, let alone STBBI prevention. Advancing our exploratory focus on STBBIs, here we propose a pilot study to understand opportunities for better supporting older women’s sexual wellbeing in FH’s AL.

First, we will conduct a focus group with AL leaders to facilitate dialogue about policies and practices around women’s sexual wellbeing. Second, we will conduct 10 walking interviews with Care Aides or other front-line staff to identify barriers and facilitators to sexual wellbeing in AL environments. Third, we will conduct up to 20 unstructured interviews with older women AL residents to support the development of a conceptual framework for understanding what constitutes sexual wellbeing in this care context. We will co-leverage our CIHR Planning Grant pre-research activities and the pilot study run through this WHRI Catalyst Grant to form the basis of a larger program of research focused on advancing opportunities for better sexual health care and STBBI prevention for the older women who make up the majority of AL residents in FH.

Project Title: Home Assessment of Blood Pressure in Pregnancy (HABPY)

Primary Investigator: Karen Tran, Clinical Assistant Professor, Department of Medicine, University of British Columbia; General Internist, Vancouver General Hospital and BC Women’s Hospital

Co-Investigators:Wee Shian Chan, Nadia Khan, Allison Thiele, KS Joseph and Sarka Lisonkova

Summary: Hypertensive disorders of pregnancy (HDP) is due to high blood pressure (BP) during pregnancy. This can lead to complications to mom and baby. Detecting and treating high BP can prevent these problems. One solution is home BP telemonitoring (HBPT). We will conduct a study to see the feasibility, safety, and acceptability of HBPT program among pregnant people with HDP.Pregnant people with HDP will measure their BP at home and send BP readings to their doctor using an App. Their doctor will monitor their BP and adjust their medications. To test for feasibility, we will calculate how many people are interested, join, complete, or drop out from the study. We will see how many develop very high BP to ensure safety of HBPT. Participants will complete surveys about their experience. If we can get better control of BP in pregnancy, we can potentially improve the health of moms and babies

Project Title:High-Resolution MRI versus Standard Pelvic MRI Protocol for Pre-operative Evaluation of Rectosigmoid Deep Infiltrating Endometriosis

Primary Investigator: Emily Pang, Clinical Assistant Professor, Department of Radiology, University of British Columbia; Abdominal Radiologist, Vancouver General Hospital

Co-Investigators: Mohamed Bedaiwy and Caroline Lee

Summary:  Rectosigmoid deep infiltrating endometriosis (DIE) is a condition where tissue similar to the lining of the womb invades the wall of the large bowel. This is estimated to occur in 5-12% of individuals with endometriosis and can cause significant pelvic pain including pain with menstrual cycles, bowel movements, and sexual activity. While traditionally diagnosed at the time of surgery, there has been a recent trend towards diagnosis using non-invasive imaging methods such as MRI or advanced ultrasound. However, access to advanced ultrasound is limited to specialized centers in Canada whereas MRI is potentially more accessible. Rectosigmoid DIE can be difficult to visualize using the current standard pelvic MRI settings.

The information required is similar to that needed for large bowel cancer, which use high resolution MRI settings specially adapted to the large bowel. We propose that modifying the standard pelvic MRI settings to include similar high-resolution images could allow better evaluation of the extent of rectosigmoid DIE for surgical planning. We believe that the results of this study have the potential to allow earlier diagnosis of large intestinal endometriosis, provide clearer images of the disease to allow the surgeons to plan surgery more effectively, and improve access to imaging for women who have limited access to specialized centers for advanced endometriosis ultrasound.

Project Title: Assessing the impact of the novel Neonatal Complex Care Program through family-reported experiences

Primary Investigator: Emily Kieran, Clinical Assistant Professor, Department of Pediatrics, University of British Columbia; Neonatologist, BC Children’s and BC Women’s Hospitals

Co-Investigators: Julia Charlton and Manon Ranger

Summary:  Children with complex medical needs (CMN) are those with complex chronic illnesses necessitating specialized care, functional disability, significant family-identified service needs, and high health care utilization. At BC Women’s Hospital Neonatal Intensive Care Unit (NICU), babies with CMN are cared for in a dedicated unit by a multidisciplinary Neonatal Complex Care Team (NCCT). The NCCT focuses on proactive management of an infant’s unique care needs together with their family caregivers, promoting consistency of care and preparing for the transition to community. The NCCT works to empower the family caregivers (caregivers) so that upon NICU discharge they are the champions of their child’s care. The experiences of caregivers with the NCCT have not been assessed but are critical to understand the impact of the NCCT.

Our aim is to assess the NCCT model of care through family-reported measures. We will be using surveys and semi-structured interviews to probe for caregivers’ experiences and perspectives during their NICU stay and the initial post-discharge period. We will explore topics related to their satisfaction with NCCT-focused care, transitions from acute to complex care and discharge home, confidence in navigating the medical system, mental and psychosocial well-being, and out-of-pocket expenses. This crucial information can help us identify aspects of the program that were most valuable to caregivers, area of improvement, and opportunities for future clinical and research directions.

Project Title: Defining the impacts of preventing insulin excess in a mouse model of polycystic ovary syndrome (PCOS)

Primary Investigator: Nicole M. Templeman, Assistant Professor, Department of Biology, University of Victoria

Summary: Abnormally elevated insulin is associated with many detrimental health effects, including obesity, type 2 diabetes, and reduced female reproductive health. It is a common feature of polycystic ovary syndrome (PCOS), the most prevalent female reproductive disorder. PCOS is characterized by a wide range of symptoms that include disrupted hormone levels, irregular menstrual cycles, cysts on the ovaries, and often metabolic impacts such as elevated insulin. However, it is not yet known if preventing an elevation in insulin levels can effectively protect against the onset of PCOS, or alleviate its symptoms. Using an experimental manipulation to generate PCOS-like features in a mouse model of genetically reduced insulin, we will determine how suppressing insulin levels affects a spectrum of reproductive and metabolic characteristics of PCOS. We will also determine if limiting insulin levels improves fertility, pregnancy outcomes, incidence of gestational diabetes during a pregnancy with PCOS, and the health of the offspring. Since high insulin levels can be normalized in humans via lifestyle changes, we anticipate that our work could inform effective strategies to better manage symptoms of PCOS by limiting excess insulin.

Project Title: Harnessing placental pathology findings for “big data” perinatal population health research:  A validation study

Principal Investigator: Jennifer Hutcheon, Associate Professor, Department of Obstetrics & Gynaecology, University of British Columbia

Co-Investigators:Jessica Liauw, Jefferson Terry and Larisse Melo

Summary:The placenta plays a central role in healthy pregnancy. For the pregnant individual, an unhealthy or injured placenta can cause potentially life-threatening complications such as pre-eclampsia or serious blood loss; for the fetus, it can cause growth restriction or stillbirth. Yet despite the importance of this organ in pregnancy, information from laboratory examination of the placenta after delivery (which can tell us about problems with placental development) is rarely used by population health researchers trying to understand the causes and consequences of placentally-mediated pregnancy complications. We believe that this is because of logistical issues: findings from placental examinations are recorded in free-text, narrative reports, making them impractical for statistical analysis or linkage with the large population databases that are used in perinatal population health research.

This project will test a new approach to see if text recognition software can be used to convert the information contained in laboratory placental examinations into discrete variables more amenable to “big data” population health research. We will validate a text recognition program previously developed in Pittsburgh, USA, in our British Columbia setting – a step that is crucial before reliably using this approach for epidemiologic studies. We will check the program’s accuracy by comparing its results against a review of the original medical record. Converting information on placental health into a format that is more useable for “big data” research will help us better harness this organ’s critical information in our efforts to understand and prevent serious pregnancy complications for the pregnant individual and newborn.

Project Title:Establishing the Underlying Network of Affective and Unwanted Genital Symptoms in Women and Individuals with Persistent Genital Arousal Disorder/Genito-Pelvic Dysaesthesia

Primary Investigator:Samantha Dawson, Assistant Professor, Department of Psychology, University of British Columbia

Co-Investigators: Katrina Bouchard and Marta Kolbuszewska

Summary: Persistent Genital Arousal Disorder/Genito-Pelvic Dysaesthesia (PGAD/GPD) is a chronic health condition characterized by unwanted, unprovoked genital sensations, without associated sexual interest or desire. PGAD/GPD is not well understood, but the condition affects up to 3% of women and individuals with vulvas. PGAD/GPD is highly comorbid with mental and physical health difficulties and negatively affects people’s ability to engage in basic daily activities. Unfortunately, we do not know what factors worsen PGAD/GPD symptoms over time, and no psychological treatments have been developed. Data from case studies and cross-sectional surveys reveal that PGAD/GPD symptoms are linked with negative emotions and difficulties regulating these emotions. The main purpose of our study is to examine how negative emotions, emotion regulation strategies, and PGAD/GPD symptoms relate to one another using a method called network analysis. The longitudinal design will address a critical knowledge gap by allowing us to examine how these associations evolve over time. This research will identify core mechanisms that maintain PGAD/GPD symptoms, which will inform the development of psychological interventions for this debilitating and distressing condition.

Project Title: Rooting Children’s Mental Health in Place-based Contexts: Stories of Community Resilience and Opportunities for Further Supporting Young Women and Girls in Rural Settings

Principal Investigator: Maya Gislason, Associate Professor, Faculty of Health Sciences, Simon Fraser University

Summary:Climate change has been identified as a growing priority for health professionals. Youth today not only live in a world contoured by intensifying climate impacts but will also be exposed to a range of associated health risks across their life course. Furthermore, climate change amplifies social inequities and pre-existing health risks, and has been documented as being increasingly distressing to children, with disproportionate impacts to young women and girls. This ground-breaking research, rooted in the principles of Planetary Health Equity, will produce the robust evidence needed to both advance, and further fund, a new generation of innovations in young women and girls’ community-based mental health support servicing.

The first aim of this research is to analyze existing literature and statistical data on how climate change and mental health concerns intersect for young women and girls in rural and remote communities in British Columbia (BC). The second aim is to identify opportunities for taking an integrated approach to planetary and human health by linking climate change adaptation and mitigation initiatives with broader equity informed and place-based mental healthcare support servicing in these regions through interviews with health providers and allied youth-oriented medical personnel in rural and remote communities. The third aim is to leverage this foundational research to apply for funding to conduct a next phase of engaged, youth driven research with young women and girls in BC. A Living Repository showcasing effective integrated community health and sustainability initiatives will be shared widely.

Project Title:The Role of DNA Methylation in CIUE Inflammatory Signaling

Primary Investigator: Jefferson Terry, Clinical Associate Professor, Department of Pathology and Laboratory Medicine, University of British Columbia; Pediatric and Perinatal Pathologist, Children’s & Women’s Health Centre of BC

Co-Investigators:Wendy Robinson

Summary: Chronic Intervillositis of Unknown Etiology (CIUE) is an unusual type of placental disease that affects about 1 in 600 pregnancies in British Columbia. In CIUE maternal inflammatory cells abnormally collect in the placenta where they cause damage that leads to early pregnancy loss or stunted growth in the few babies that survive. To make matters worse, CIUE usually recurs in future pregnancies and can deny people the ability to successfully bear children. Medications have been tried to prevent CIUE in future pregnancies but right now there is no good treatment to stop it from happening again. To improve CIUE treatment we need to know why CIUE happens. We have found out that a certain type of inflammation is overactive in CIUE but we do not know why this occurs. If we can discover the cause of this certain type of overactive inflammation, we might be able to reliably prevent it from happening again in subsequent pregnancies.

Project Title: Sexual health among women with vulvar lichen sclerosus and their partners: A daily experience and longitudinal study

Primary Investigator: Katrina Bouchard, Assistant Professor, Department of Obstetrics and Gynaecology, University of British Columbia; Registered Psychologist, BC Centre for Vulvar Health

Co-Investigators: Meghan Rossi, Samantha Dawson, Melanie Altas and Ulrike Dehaeck

Summary: Vulvar lichen sclerosus (VLS) is a chronic skin condition that affects the external genitals or vulva (e.g., labia and clitoris). Symptoms of VLS include genital pain, burning, itch, and irritation, which can cause significant distress and prompt women to seek treatment at the BC Centre for Vulvar Health (BCCVH). Over time, VLS can cause irreversible changes to the appearance of the vulva. Even with regular treatment, women with VLS frequently experience difficulties in their sex lives, like low sexual desire and pain during sex. Despite these sexual problems, many women with VLS remain sexually active with a partner; however, engaging in sex may be motivated by wanting to avoid negative outcomes (e.g., prevent partner from losing interest in the relationship; avoidance sexual motives).

The goals of our study are to assess the sexual motives of women with VLS and examine how different types of sexual motives (e.g., pursuing connection, avoiding conflict) relate to the sexual health outcomes of women with VLS and their partners. We will recruit 101 women with VLS and their partners from the BCCVH Vulvar Disease Clinic. Couple members will independently complete online questionnaires about their sexual motives and sexual health at baseline, for 28 days, and 3 months later. We will test if avoidance sexual motives are associated with poorer sexual outcomes in couples’ daily lives and over time. The study results will inform educational materials and psychological treatments at the BCCVH to promote sexual health among women with VLS and their partners.

Project Title: Investigating risk factors and outcomes in young women with nonobstructive coronary artery disease in a women’s heart clinic

Primary Investigator: Tara Sedlak, Clinical Assistant Professor, Department of Medicine, University of British Columbia; Cardiologist and Medical Director of the Leslie Diamond Women’s Heart Health Clinic, Vancouver General Hospital

Co-Investigators: Natasha Prodan-Bhalla and Emilie Théberge

Summary: Ischemic heart disease (IHD) is a leading cause of preventable death in women in Canada, and incidence rates are not decreasing in younger women. In recent decades, researchers have reported sex differences in the risk factor constellations and pathologies of IHD presentations, diagnosis, and medical management. Examples of under-diagnosed presentations of IHD include myocardial infarction with no obstructive coronary artery disease (MINOCA) and ischemia with no obstructive coronary artery disease (INOCA), which are significantly more common in women than men.

The Leslie Diamond Women’s Heart Health Clinic (WHC) in Vancouver is one of the few WHCs in Canada and specializes in diagnosing and treating women with (M)INOCA. This study aims to investigate over 230 women followed for at least 3 years in the Vancouver WHC. Our aims are twofold: First, we wish to investigate whether younger patients presenting with (M)INOCA have different risk factor profiles compared to older patients. A key advantage of this all-women study is that it covers a depth of emerging female-specific and non-traditional risk factors that are rarely studied (i.e., due to absence or rarity in men) despite evidence of increased IHD risk. Second, we will investigate whether attendance at a women’s heart clinic improves cardiac symptom frequency and severity, improves perceived quality of life, and lowers depression and anxiety scores over a 3-year period compared to baseline. The results from this proposed study will improve our understanding of women’s heart health pathologies in IHD and help guide improvements in medical management of these entities.

Project Title: Measuring gender equity within the relationships of young women and gender non-binary youth in British Columbia, Canada: Implications for gender transformative policy and programming in Canada

Principal Investigator: Angela Kaida, Associate Professor, Faculty of Health Sciences, Simon Fraser University

Co-Investigators: Kalysha Closson and Valerie Nicholson

Summary: The Relationship and Gender Equity Measurement Among Gender-inclusive Young women and Non-binary youth (RE-IMAGYN) study will engage young women and gender non-binary youth to examine existing gender equity measures. Researchers aim to offer recommendations for improving these measures to better inform actions aimed at advancing gender equity and the sexual and reproductive health and rights of diverse young women across the life course. Their team will contribute new knowledge on how research can be done by, with and for young women and non-binary youth in BC, including data collection, analysis, use, and dissemination. The youth advisory committee established will also aim to support future BC-based projects that seek to challenge the gender binary through inclusive collaboration and engagement of young changemakers. Findings from RE-IMAGYN will inform programs and policies aimed at reducing gender inequity and improving the lives, relationships, and health of young women and gender nonbinary youth.

Project Title: Injectable Opioid Agonist Therapy (iOAT) Administration in a Perinatal Population

Primary Investigator: Charissa Patricelli, Clinical Associate Professor, Department of Family Practice, University of British Columbia; Medical Director, Perinatal Addictions, BC Women’s Hospital + Health Centre

Co-Investigators: Karen Urbanoski, Arianne Albert, and Nicole Carter

Summary: The purpose of conducting this study is to improve the lives of women and their newborns who are affected by substance use. This represents an under-studied group that faces unique contexts and barriers to services and supports. It is imperative that women have access to services that are effective, safe, and acceptable. Injectable Opioid Agonist Therapy (iOAT) is a life saving treatment, expected to reduce overdose rates and significant fetal/neonatal harm, that will allow women with severe opioid use disorders to bond with, and parent their newborns. This study will generate novel evidence to support clinical decision-making with women who use substances, and set the foundation for future research on this topic.

Project Title: A Woman’s Journey to Parenthood: Memory, Self-Schema, and Well-Being During Fertility Treatment

Principal Investigator: Daniela Palombo, Assistant Professor, Department of Psychology, UBC

Co-Investigator: Samantha Dawson

Summary: Parenthood is a cherished goal for many individuals, yet 1 in 6 Canadian couples experience infertility (the involuntary absence of conception). The journey through infertility can be characterized by joy and excitement (e.g., following news of conception), but also distress and sadness (e.g., with news of a failed treatment or pregnancy loss). This study explores the possibility that infertility-related medical experiences, particularly negative news, can form poignant memories with important intra- and interpersonal outcomes for women. They further explore whether stronger social support can serve as a buffer to foster more positive well-being and mental health outcomes for women. Clarifying links between memory, social support, and well-being in women seeking fertility treatment can be used to help women and couples better navigate their fertility journey, protecting them against reduced quality of life, and fostering more positive interactions between a woman and her medical team.

Project Title: Understanding equity and access in care pathways for later termination of pregnancy in Canada

Primary Investigator: Jessica Liauw, Clinical Assistant Professor, Department of Obstetrics and Gynaecology, University of British Columbia

Co-Investigators: Jennifer Chisolm, Brigid Dineley, Madeleine Ennis, Liv Knutzen, Elise Lavoie Label, Robin Leung, Sarah Munro, Regina Renner, Julie Robertson, and Emily Wiesenthal

Summary: Second and third trimester abortion is a critical yet complex health service. In Canada, when patients are diagnosed with serious fetal anomalies and/or maternal complications, most are referred to a Maternal Fetal Medicine Centre on their care pathway to accessing second and third trimester abortion services. However, knowledge of how these services are delivered across Maternal Fetal Medicine Centres remains limited, which prevents us from promoting optimal care. The purpose of this study is to better understand the service delivery of second and third trimester termination of pregnancy for maternal or fetal complications in Canada. Through semi-structured interviews, researchers will seek healthcare providers’ perspectives on how this care is delivered and the facilitators of and barriers to this care. This project has the potential to gain unique insight into the provision of abortion services for fetal or maternal complications in Canada and foster opportunities for collaboration among health care teams across the country. Ultimately, they aim to improve the delivery of comprehensive and equitable services for patients seeking second and third trimester termination of pregnancy.

Project Title: Using Nanomedicine to Target Mutant p53 for the Treatment of Triple Negative Breast Cancer Patients

Primary Investigator: Nikki Salmond, Postdoctoral Fellow, Faculty of Pharmaceutical Sciences, University of British Columbia

Co-Investigators: Karla Williams and Shyh Dar-Li

Summary: A breast cancer sub-type called triple-negative is responsible for up to 15% of all breast cancer cases. As compared to other breast cancer subtypes, individuals diagnosed with triple-negative breast cancer have fewer treatment options and are more likely to have their disease come back despite treatment. Over 80% of triple-negative breast cancer tumors have a defect within their p53 tumor-suppressive pathway which normally prevents tumors from growing. If p53 can be turned back on, the cancer cells will initiate a suicide mechanism and undergo cell death. Researchers plan to use a unique delivery system to restore the p53 pathway in triple-negative breast cancer cells and ultimately destroy the tumor. This project has the potential to develop one of the first targeted therapies for triple-negative breast cancer and will contribute valuable work towards improving the overall survival of triple-negative breast cancer patients.

Project Title: Maternal Immune Signaling, Depression, and Antidepressants during pregnancy

Primary Investigator: Tim Oberlander, Professor, Department of Pediatrics, University of British Columbia

Co-Investigators: Liisa Galea, Joanne Weinberg, Tamara Bodnar, and Wansu Qiu

Summary: Up to twenty percent of new mothers experience perinatal depression (PND) and, currently, selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice. However, no studies to date have examined the effects of SSRIs on inflammatory and vascular markers during the perinatal period. This is surprising, as evidence indicates that these biomarkers are elevated during pregnancy, which underscores why the perinatal period is a time of high risk for depression. Our study aims to fill these gaps. It will examine the independent and interactive effects of mood disturbances and SSRIs on a broad range of inflammatory biomarkers and markers of vascular signaling in pregnant women. This research will create a better understanding of the effects of maternal antidepressant use on women and their babies.

Project Title: UP-MIFE: Understanding Patient experiences of medical vs surgical management of Miscarriage to Improve delivery and Facilitate implEmentation: A mixed-methods approach

Principal Investigator: Brigid Dineley, Clinical Assistant Professor, UBC Department of Obstetrics & Gynecology

Co-Investigators: Pearl Van Dijk, Arianne Albert, Astrid Christoffersen-Deb, Paula Beattie

Summary: One in four Canadians will experience a miscarriage in their lifetime. Although common, the experience can be emotionally devastating. Supporting individuals in making an informed choice about managing their miscarrriage while attending to their emotional needs can also be challenging for healthcare providers. This proposal aims to equip individuals experiencing a miscarriage, as well as providers, with the information needed to guide that process.In 2018, the Early Pregnancy Assessment Clinic (EPAC) at BCWH initiated a protocol for medical management of miscarriage using mifepristone and misoprostol. The protocol was established to facilitate greater self-care for individuals wishing to avoid surgery. Medical management is offered in addition to surgical and expectant options. Working collaboratively with a patient partner, we will evaluate the efficacy and acceptability of this approach. We will compare surgical to medical management. Our primary outcome will be a negative pregnancy test 4 weeks post-miscarriage. We will collect lived experiences of individuals who have completed their miscarriage management in EPAC via interviews.

The study findings will generate patient-level feedback that we will use to enrich our current protocols. As we are the busiest EPAC center in the country, we are well positioned to carry out this study and disseminate these protocols nationally. Given the current limitations to in-person care in the setting of COVID, providing individuals with a management option that avoids hospitalization is especially important. Ultimately, our goal is to promote exemplary miscarriage care that provides choice and empowers individuals in what can be a difficult experience in their lives.

Project Title: Phase II 6-month Cyclic Progesterone/Spironolactone Pilot Therapy Trial in Polycystic Ovary Syndrome—pre-post one-arm feasibility study

Primary Investigator: Jerilynn C. Prior, Professor, UBC Department of Medicine

Co-Investigators: Joel Singer, Azita Goshtasebi, Marshall Dahl, Sonia Shirin, Dharani Kalidasan, Faye Murray

Summary: Androgenic Polycystic Ovary Syndrome (PCOS) creates physical/emotional burdens in 4-20% of premenopausal women living with PCOS (WLWP) including: few menstruations per year, subfertility, hirsutism/acne and low quality of life by validated PCOS Questionnaire (PCOSQ). Combined hormonal contraceptives (CHC), the current standard-of-care, improve PCOSQ only 16%; with stopping CHC, benefits disappear within 6-months. We hypothesize too-fast brain/luteinizing hormone (LH) pulses cause PCOS. Progesterone (P4) slows LH when testosterone (FreeT) is normal. Combining two approved medications, Cyclic P4 with anti-androgen, Spironolactone (Sp), will likely provide effective, durable benefits. WLWP lit-review suggested significant P4 7-14-day benefits. A 6-month prospective feasibility study of CyclicP4/Sp is necessary.

Project Title: Targeted physical activity to improve mobility and falls risk in women living with ovarian cancer

Principal Investigator: Kristin Campbell, Professor, UBC Department of Physical Therapy

Co-Investigator: Anna Tinker, Gillian Hanley, Cheri Van Patten, Dawn Mackey, Iris Lesser, Linda Trinh

Summary: Reduced physical function is common in women living with ovarian cancer and increases their risk of decreased bone density, and negatively impacts their cardiovascular health, muscle strength and muscle mass. Our team recently reported that women with a prior diagnosis of ovarian cancer are also more likely to die from falls compared with similarly aged women in the general population. In older women, specially designed physical activity can improve physical function and reduce risk of falls. This has not been tested in women with ovarian cancer. This project will test the feasibility of delivering a virtual physical activity program and its effect on mobility, balance, muscle strength, and fitness in women with ovarian cancer. Participants will be referred by their medical oncologist to take part in a 12-week virtual, supervised physical activity program completed at home using a videoconferencing system. Classes will include aerobic and muscle strengthening exercises and patient education on relevant health topics, along with activities to foster group connection and peer social support. This virtual program has the potential to reduce key barriers to physical activity programming in cancer care, providing greater access to programming for women, especially those who do not live in city centres. Additionally, it will provide a referral pathway for oncologists to recommend programming delivered by exercise professionals familiar with cancer. The project has strong potential to positively impact the lives of women living with and beyond ovarian cancer, and support women’s health in British Columbia.

Project Title: The Impact of COVID-19 on Births Following Spontaneous Conception and Assisted Reproduction in British Columbia: A Prospective Population-Based Study

Primary Investigator:Mohamed A. Bedaiwy, Professor, UBC Department of Obstetrics & Gynecology
KS Joseph, Professor, UBC Department of Obstetrics & Gynecology

Co-Investigators: Emma Branch

Summary: Many effects of the COVID-19 pandemic have already been seen socially and economically. However, no studies have identified how the pandemic has affected fertility and reproductive issues. The negative psychological and financial impact of the pandemic could have led to a reduction in birth rates for various reasons including financial insecurity and reduced access to assisted reproductive technologies for infertile couples. On the other hand, with people spending more time at home there could be an increase in spontaneous conceptions. The aim of this study is to examine birth rates of spontaneously conceived babies and those conceived via assisted reproduction in British Columbia before and following the COVID-19 pandemic. Insight into changes in birth outcomes, following both spontaneous and assisted conception, will provide information on an important but as yet unexamined aspect of the pandemic, and potentially inform public health policy related to family structure and population growth.

Project Title: Screening for Perinatal Anxiety Disorders: A Randomized Controlled Trial

Primary Investigator: Nichole Fairbrother, Clinical Associate Professor, UBC Department of Psychiatry

Co-Investigators: Arianne Albert, Patricia A. Janssen, Martin M. Antony, Sara Norris, Benicio Frey, Fanie Collardeau

Summary: One in five pregnant and postpartum women suffers from one or more anxiety or anxiety-related disorders (AD). This is significantly greater that the number of women who suffer from depression during the perinatal period. Despite the availability of evidence-based treatments for anxiety, and the fact that perinatal AD are associated with broad-ranging and long-lasting negative outcomes for women (e.g., depression) and their offspring (e.g., and low birth weight, preterm delivery, and emotional difficulties), screening for these disorders is rare. Without screening, women in distress are left untreated or misdiagnosed, and they and their infants suffer as a result. However, little is known about the impact of perinatal AD screening on mental health outcomes and treatment access. Encouragingly, perinatal women report high acceptability for screening initiatives, and active efforts to elicit anxiety symptoms are essential as women who are not questioned about their mental health are much less likely to seek help. The extant evidence tells us that screening, when combined with individualized follow up and referral, allows the majority of identified women to access treatment.The proposed study represents the first randomized controlled trial of the effect of personalized perinatal AD screening feedback and referrals on mental health outcomes, treatment seeking behaviours, and the use of mental health services.

Project Title: The Role of Neuroinflammation in Adolescent Female Negative Cognitive Bias

Primary Investigator: Travis Hodges, Postdoctoral Fellow, UBC Department of Psychology

Co-Investigators: Liisa Galea

Summary: Major depressive disorder (MDD) affects 20% of the population, and women are twice more likely than men to have MDD. Women exhibit more severe cognitive symptoms of depression, including negative cognitive bias, the increased perception of neutral situations as negative. Further, negative cognitive bias in at-risk adolescent girls predicts future depressive episode onset. Current treatments to reduce MDD symptoms are only effective for a subset of the population and are not effective for reducing negative cognitive bias, thus discovering mechanisms of negative cognitive bias may allow for improved treatments for MDD and MDD symptom prevention. MDD is associated with increased inflammation in the brain, including in the hippocampus, amygdala, and frontal cortex. Further, increased neuroinflammation is associated with MDD and cognition disruption via impairment of pattern separation, which is required for cognitive bias. We will test the hypothesis that proinflammation in the brain regulates negative cognitive bias in adolescent female rats. Adolescent female rats will undergo chronic unpredictable stress, a procedure that elicits depressive phenotypes in rodents, and a fear-based cognitive bias task. We will determine the involvement of proinflammatory cytokines in the hippocampus, amygdala, and frontal cortex in negative cognitive bias via electrochemiluminent assays. We will also test whether negative cognitive bias is dependent on proinflammation by blocking the activity of the cytokine IL-1β via the antagonist Anakinra. Ultimately, we hope that determining the association between proinflammation and negative cognitive bias will result in tailored precision treatments for cognitive dysfunction in young women at risk for MDD.