麻豆AV

Corresponding Principal Investigator:

Alton Russell, Department of Epidemiology,听Biostatistics,听and听Occupational Health

Co-PIs:

• Jesse Papenburg, RI-MUHC Glenn Site (CORE and IDIGH) and Montreal Children鈥檚 Hospital
• Nathaniel Osgood, Department of Computer Science, University of Saskatchewan

Mosquito-transmitted diseases like West Nile virus are hard to predict, and their risk is increasing in Canada due to climate change. Risk can be monitored by trapping and testing mosquitos or by testing wastewater for viral genetic material shed by infected people. In this project, we will develop a new framework for an adaptive West Nile virus monitoring strategy. First, we will develop a machine learning model to forecast West Nile virus risk month-over-month across census divisions with uncertainty. Then, we will use framework called 鈥榚xpected value of sample information鈥� to estimate when and where new data (testing trapped mosquitos or wastewater) is likely to reduce uncertainty in a way that leads to better deployment of preventative measures. The framework will be designed to deploy finite resources in ways that maximizes health benefits and health equity, ensuring that risk is not disproportionately born by geographic areas with vulnerable populations.

Alton Russell is an Assistant Professor in the Department of Epidemiology, Biostatistics, and Occupational Health in the 麻豆AV School of Population and Global Health. He leads the Data-Driven Decision Modeling Lab鈥搊r D3Mod鈥搘hich aims to enable the efficient, effective, and equitable use of finite healthcare resources by developing, assessing, and applying methods from decision-analytic modeling and data science. The D3Mod lab鈥檚 research spans many areas of public health and medicine, including blood donation and transfusion, infectious disease surveillance, opioid harm reduction, and the prevention and treatment of cancers. Alton received undergraduate training in Industrial Engineering and Public Health at North Carolina State University, Masters and Doctoral training in Management Science and Engineering at Stanford University, and completed a postdoc at the Massachusetts General Hospital Institute for Technology Assessment and Harvard Medical School.

Corresponding Principal Investigator:

Annie Leung, 麻豆AV Health Center; Research Institute-麻豆AV Health Center

Co-PIs:

• Julia Burnier, RI-MUHC Glenn Site (CORE and IDIGH) and Montreal Children鈥檚 Hospital
• Samara Perez, Department of Oncology, Faculty of Medicine and Health Sciences

In Canada, over 16 million women are at risk of developing cervical cancer. Screening with the Pap smear test by a doctor has reduced the number of cases by more than 80%. However, Indigenous women are still disproportionately affected and are three times more likely to be diagnosed with cervical cancer. Reasons for this disparity include geographic barrier in getting a pap smear, lack of culturally sensitive approach to counseling and education on why screening is performed, discomfort associated with the examination, and historical trauma leading to mistrust in healthcare institutions. A new way of detecting cervical abnormalities is being introduced across Canada called human papillomavirus (HPV) testing. HPV causes the majority of cases of cervical cancer and gives women the option of self-collecting a vaginal swab at home, which can significantly improve access. Along with this technique, liquid biopsy is a new non-invasive technique that detects molecules associated with HPV found vaginal swabs and urine. We demonstrated the ability of liquid biopsy to detect cervical abnormalities among women living in Montreal. Given the unique experiences and barriers faced by Indigenous women, our team aims to explore and engage Indigenous members to co-create educational resources and future implementation plans that is culturally sensitive.

Dr. Annie Leung is a gynecologic oncologist at the 麻豆AV Health Center in Montreal, Quebec, Canada. She is affiliated with the Departments of Obstetrics and Gynecology, Oncology, and Pathology. In her clinical practice, she treats patients with gynecologic malignancy throughout the cancer journey offering surgery, chemotherapy, targeted therapies, and palliative care. For cervical pre-cancer, she also provides care in colposcopy clinic for patients with abnormal paps and positive HPV results.

In her research, she is a Scientist at the Research Institute of the 麻豆AV Health Center where she leads a translational laboratory investigating biomarkers relevant to cervical pre-cancer and cancer. Specifically, her expertise is in the detection of protein markers and circulating tumor DNA. The clinical and research needs of cervical cancer screening and management has led her to collaborate with the Office of Indigenous Affaires to explore ways to improve care for Indigenous populations.

Corresponding Principal Investigator:

Dr. Matthew Hunt, 麻豆AV School of Physical and Occupational Therapy

Co-PIs:

• 厂茅产补蝉迟颈别苍 Jodoin, 麻豆AV Faculty of Law
• Arun Maiya, Manipal University

Persons with disabilities (PWD) experience heightened risk of being harmed or wronged in situations of disaster or crisis. In the past two decades, increased attention has been paid to the ways that disasters impact PWD and to the development of strategies to respond to the needs of PWD in disaster preparedness and response. Despite these high-level recommendations, practical implementation of disaster preparedness, relief, and reconstruction often falls far short of an inclusive approach that is responsive to the diverse capabilities and needs of PWD. In this study, we will engage with the experiences of PWD in Kodagu District, Karnataka State, India who have been affected by flooding and landslides, and where a disability inclusive disaster response approach has been initiated. In doing so, we will draw together insights from the concepts of adaptive capacities and structured health vulnerabilities to orient our inquiry. We will conduct in-depth interviews and focus-groups with PWD, including leaders of Disabled Persons Organizations, as well as interviews with government officials and members of intergovernmental and non-governmental organizations. Our aim is to develop policy-relevant knowledge about planning and implementing inclusive disaster risk reduction and disaster response strategies from the perspectives of PWD.

Corresponding Principal Investigator:

Dr. Jessica Duby, Department of Pediatrics

Co-PIs:

• Nancy Feeley, Ingram School of Nursing
• Abner Tagoola, Jinja Regional Referral Hospital

Despite increased coverage of hospital-based maternal and newborn care, the neonatal mortality rate in Uganda remains persistently high. An insufficient number of health care workers is a significant barrier to providing optimal care in Ugandan hospitals. For hospitalized sick and small newborns, their own mothers may be a vital but largely untapped resource to improve the quality of care. In addition to being the most invested in their child鈥檚 outcome, mothers in Uganda typically stay at their newborn鈥檚 bedside throughout hospitalization. In high income countries, systematic efforts to engage parents in all aspects of their newborn鈥檚 hospital care, such as the Family Integrated Care Model (FICare), has resulted in improved outcomes for patients and parents. Our study will develop and test a regionally appropriate FICare model in a neonatal unit in a Ugandan public hospital. We will use a combination of qualitative and quantitative methods to evaluate the acceptability and feasibility of increased maternal participation in the neonatal unit. Our results will inform a subsequent, multi-center cluster-randomized control trial that evaluates the effect of a regionally-adapted FICare on the Ugandan healthcare system. This initiative may offer a sustainable and scalable solution to improve the quality of hospital-based care for sick and small newborns in low-resource settings.

Co-Principal Investigators:

• Dr. Andrew G. Kirk, James 麻豆AV Professor and Department Chair, Department of Electrical and Computer Engineering in the Faculty of Engineering
• Dr. Mark Trifiro, Associate Professor, Division of Endocrinology and Metabolism of the Department of Medicine in the Faculty of Medicine.

Reliable, simple and rapid detection of E. coli bacterial contamination is essential in ensuring the provision of clean drinking water. Traditional approaches based on bacterial culturing methods require hours or even days to obtain an answer. An alternative approach is to employ genetic amplification. Bacterial DNA or RNA is amplified many millions of times using the polymerase chain reaction (PCR) process, providing very high sensitivity and specificity. Current commercial PCR machines are bulky and often take an hour or more to provide a result. We have recently demonstrated an optically driven PCR system that can provide an answer in less than five minutes. In this project we will adapt that system to deliver a portable, low-cost and easy-to-use testing system for water samples that will provide operators with on-the-spot results. This will lead to more rapid intervention, resulting in fewer incidents of water-borne bacterial infection and should help to allow boil-water advisories to be lifted earlier. The project will be carried out in collaboration with a First Nations community through the Ontario First Nations Technical Services Corporation (OFNTSC).

Co-Principal Investigators:

• Dr. Jill Baumgartner, Assistant Professor and William Dawson Scholar in the Department of Epidemiology, Biostatistics and Occupational Health in the Faculty of Medicine
• Dr. Omid Rouhani, Assistant Professor in the Department of Civil Engineering in the Faculty of Engineering

Motor vehicle traffic is a significant and increasing source of urban air pollution in low- and middle-income countries, particularly in Latin America and Asia. Traffic-related air pollution is emitted from both combustion (i.e., tailpipe emissions) and non-combustion sources (i.e., tire wear, brake wear, and resuspended road dust). Many epidemiologic studies associate exposure to traffic-related air pollution with increased cardiovascular hospitalization and death. However, the importance of different combustion and non-combustion sources of traffic pollution on human health are unknown, posing a barrier to the formulation of transportation infrastructure planning and policy to mitigate the health risks of traffic. Particularly little is known about the health impacts of traffic-related air pollution in low- and middle-income countries where the chemical composition and dispersion of traffic pollution differs from high-income countries due to differences in vehicle fleets and maintenance, road infrastructure, and city planning (i.e., the proximity of homes to traffic). We propose to leverage existing research infrastructure in urban Bucaramanga, Colombia and conduct a pilot study that combines novel air pollution exposure metrics and biological monitoring in retired adults to investigate the most harmful PM components and sources of traffic-related air pollution.

Corresponding Principal Investigator:

Dr Faiz Ahmad Khan, Department of Medicine

Co-PIs:

• Amrita Daftary, Department of Epidemiology Biostatistics and Occupational Health
• Nathalie Boulanger, Centre de sant茅 Tulattavik de l'Ungava

Tobacco use is the world鈥檚 leading preventable cause of non-communicable diseases (NCDs). The World Health Organization鈥檚 MPOWER framework for tobacco control, based in community and legislative action, has worked in most of Canada but failed in the Inuit region of Nunavik where 67% of adults continue to smoke cigarettes daily. Here, rates of hospitalization and death from smoking-related NCDs remain disproportionately high. Research involving Indigenous populations suggests that interventions should be designed in line with 鈥淚ndigenous ways of knowing and doing鈥�, and through the development of meaningful relationships with Indigenous community members. We propose to build such relationships with听 Nunavimmiut, with the overarching aim of collaboratively designing Nunavik-specific smoking cessation interventions. We will use participatory methods to conduct environmental scans, key-informant interviews, consultations and focus group discussions to explore contextual influences on smoking, and determine how evidence-based interventions can be tailored to the social fabric of the Nunavimmiut. The resulting knowledge, co-produced with all stakeholders, will be synthesized to select interventions for piloting with the support of community members and local village clinic staff. This initiative may help catalyze faster declines in smoking among the Nunavimmiut by sparking the development of effective, sustainable, and scalable smoking cessation interventions.

Corresponding Principal Investigator:

Anne Cockcroft, Department of Family Medicine

Co-PIs:

• Monica Ruiz-Casares, Department of Psychiatry
• Luis Rolando Raiz Bekker, CIET International, Guatemala

Guatemala has some of the worst maternal and child health (MCH) statistics worldwide, and Indigenous communities suffer a disproportionate burden of illness. Paternal distress and substance use, inequitable gender attitudes, and domestic violence are major risk factors for maternal and child morbidity and mortality and poor child growth and development. Despite research highlighting the importance of fathers in promoting MCH, few studies have evaluated interventions targeting perinatal paternal involvement. No intervention studies have addressed paternal engagement specifically in indigenous contexts. Existing interventions, based on Western views of involved fatherhood, fail to capture indigenous perspectives and discount political and social determinants of paternal involvement. Using a participatory approach, our project will be among the first in Latin America to develop a holistic, collective, strengths-based intervention for addressing the wellbeing and positive engagement of indigenous fathers. Our pilot research, to pave the way for a subsequent community-led cluster randomized controlled trial, aims to create an evidence-based, feasible and locally acceptable community mobilization protocol to improve MCH through changes in gender norms, reductions in domestic violence and promotion of fathers鈥� wellbeing and positive engagement in MCH. Our innovative approach recognizes that community engagement in designing solutions is a key component of sustainable transformation.

Corresponding Principal Investigator:

Raphael Lencucha, School of Physical and Occupational Therapy

Co-PIs:

• Nicholas King, Department of the Social Studies of Medicine,
• Seema Sahay, National AIDS Research Institute

Today鈥檚 deeply interconnected world greatly heightens the trans-border risk of infectious disease. The spread of Ebola in 2015 illustrates this vulnerability, while revealing that many countries are ill-prepared to prevent, detect, assess, notify and respond to infectious disease outbreaks. Although national governments are charged with the responsibility of safeguarding the health of their citizens, these responsibilities are embedded in a web of international standards, norms and commitments. Recently, there has been a push for the World Health Organization (WHO) to facilitate the development and implementation of international legal frameworks to address trans-border health concerns. The International Health Regulations (IHR), which came into force in 2007, is one such legally binding agreement that aims to standardize disease surveillance, reporting and response among the 196 national governments who are members. Despite enthusiasm surrounding the potential for IHR to strengthen global response to infectious disease outbreaks, as of 2016, only 33% State Parties have fully implemented the IHR core obligations. The low levels of implementation points to the need to better understand the relationship between governments and these international institutions. In exploring this relationship we argue that geopolitical, cultural and economic factors are of paramount importance. Our study engages with international relations theory to understand the factors that shape IHR implementation in India. Our approach seeks to gain a local understanding of the relationship between India and the global political economy, the meaning India assigns to IHR commitments, and the notion of global health security more broadly. We will use a combination of qualitative interviewing and ethnographic methods to examine how decision-makers engage with IHR commitments.

Corresponding Principal Investigator:

惭补迟丑颈别耻听惭补丑别耻-骋颈谤辞耻虫, Department of Epidemiology,听Biostatistics,听and听Occupational Health

Co-PIs:

• 颁补迟丑别谤颈苍别听贬补苍办颈苍蝉, Department of Epidemiology,听Biostatistics,听and听Occupational Health
• 厂丑别濒濒别测听颁濒补谤办, Department of Sociology

UNAIDS put forward the ambitious 90-90-90 target to end the AIDS epidemic by 2030. This target aims for 90% of people living with HIV (PLHIV) to be aware of their HIV-positive status, 90% of those diagnosed to receive antiretroviral therapy, and 90% of those on treatment to have a suppressed viral load by 2020. HIV testing remains an important bottleneck in this cascade, however, and obtaining reliable epidemiological data on the proportion of PLHIV aware of their status is difficult. Such information is nevertheless crucial to effectively monitor HIV prevention efforts. Tracking progress towards achievement of this 鈥渇irst 90鈥� target could be improved by combining population-based surveys and programmatic data in a coherent deterministic/statistical model. This type of integrative systems modelling is especially useful to fully consider HIV incidence, mortality, testing behaviours, as well as to coherently combine different sources of data. We aim to produce validated yearly estimates of the first 90 in sub-Saharan Africa, where 2/3 of the world鈥檚 PLHIV reside. Our proposed framework has never been applied to this problem before and is an innovative way to answer a policy-relevant question that remains at the crux of the global health agenda.

Corresponding Principal Investigator:

Dr. Neil Andersson, Department of Family Medicine

Co-PIs:

• Dr. Cedric Yansouni, 麻豆AV
• Dr. Jorge Rafael Arostegui, CIET Nicaragua

A recent multi-centred randomised controlled trial published in the听British Medical Journal听demonstrated the unprecedented value of community-driven pesticide-free vector control in dengue prevention -- called听Camino Verde(Green Way).

Based on this experience, successful control of zika, which shares the听Aedes aegypi mosquito as its vector,听needs several non-trivial paradigm shifts from conventional vector control logic and practice. The team behind听Camino Verde听proposes to support transformation of how the global community prevents, detects and responds to infectious disease threats through engaged game learning, resource allocation and motivational skill.

The Game of Zones is one of strategy, where the player or team tries to outsmart the epidemic, initially in a fantasy setting, increasing their understanding of community engagement and eco-zone dynamics. The second level of the Game includes speed and decision accuracy as key motivators. The third level introduces a vector control dashboard for simulation based on real data and standard budgetary allocation which can be linked to expected impact based on real meta-analyses of potential interventions and combinations of interventions. Mystery and surprise come in the form of new outbreaks, other agencies with competing strategies, and politically motivated decisions that can complicate prevention efforts in complex ways across different eco-zones.

Within the 18 months of funding, the Game game will be play-tested and deployed in educational initiatives in Nicaragua and Mexico. By the end of the project it will be available for use in other countries as part of a much larger international zika/dengue/chikungunya prevention initiative. A number of proposals for funding will hopefully extend its use and relevance in a number of international settings.

Game of Zones could have a considerable societal impact. Meaningful community engagement is fundamental for zika control and also relevant for anyone tasked with informing and motivating communities to prevent disease outbreaks or to reduce burden of disease.听An interdisciplinary team will examine and test the relevance of the game for other infectious diseases similarly hampered by outdated paradigms of vertically managed disease control.

Corresponding Principal Investigator:

Dr. Colin Chapman, Department of Anthropology and 麻豆AV School of Environment

The devastating impacts that diseases like Ebola, the sudden appearance of diseases like SARS and Zika, and the immense social and economic costs created by viruses like HIV underscore our need to understand the factors determining the origin and spread of infectious diseases. Given that wildlife often share disease with humans and cause the emergence of may diseases, studying where people and wildlife interact is critical. 听After developing a phone based health reporting system for remote clinic, we will develop and field test the use of a mobile clinic established to build a union between health care and conservation to rapidly evaluate the disease emergence and test a series of hypotheses concerning factors that related to first occurrence and spread of emerging diseases.

Corresponding Principal Investigator:

Dr. Jonathan Chevrier, Dept of Epidemiology, Biostatistics and Occupational Health

Co-PIs:

• Dr. Jill Baumgartner,听Institute for Health and Social Policy / Dept of Epidemiology, Biostatistics and Occupational Health
• Dr. Scott Weichenthal, Dept of Epidemiology, Biostatistics and Occupational Health

Wood and other biomass fuel is used for cooking and heating by nearly half of the world鈥檚 population and by over 90% of the rural population in sub-Saharan Africa. The resulting household air pollution, and in particular fine particulate matter (PM2.5), is associated with a 3.5-fold elevated risk of acute lower respiratory infections, the leading cause of child death in sub-Saharan Africa. Further, exposure to PM2.5 causes systemic inflammation and oxidative stress, which may alter immune response to vaccines. Yet, few studies have 1) characterized exposure to PM2.5 in African children, or 2) examined the association of exposure to PM2.5 with immune response to vaccines or susceptibility to infection in humans. The Steinberg Fund will allow us to pilot instruments and protocols, and obtain preliminary data to support a larger grant application whose objective will be to fill these important knowledge gaps. Data will be obtained from a subset of South African children participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a NIH/CIHR-funded birth cohort study of 751 mother-child pairs. This study has wide-ranging implications given the high disease and mortality burdens caused by infectious diseases in children from areas where biomass is used.

Corresponding Principal Investigator:

Dr. Jai Shah, Douglas Hospital Research Center

Co-PIs:

• Jitendriya Koul, MBBS, Jagti Medical Center
• Jaswant Guzder, MD FRCPC, Jewish General Hospital

Mental disorders, most of which originate in youth, are major contributors to disability, morbidity and mortality. They are also precipitated and exacerbated by violent conflict, which in turn reduces access to much-needed care 鈥� particularly in the developing world. In this project, we will better understand youth perceptions of mental health (and the varied influences on it) in the Jagti township of ethnic Kashmiris who were forced to leave their ancestral homelands following the 1990 conflict in Jammu & Kashmir. We will engage local stakeholders and guide community-based efforts (led by lay health workers and assisted by mobile technologies) to identify untreated cases of major mental disorders (psychotic, bipolar and depressive disorders). In the context of meager mental health services and stigma, we will then begin providing youth (aged 15-35) and their families with appropriate mental health services through partnerships with local psychiatrists. The project aims to increase awareness of mental illness and receptiveness to its care, including within local community organizations in Jagti. More broadly, it will identify and highlight the mental health needs of internally displaced populations: a neglected and growing challenge yet to be addressed in global mental health.

Corresponding Principal Investigator:

Dr. Julia von Oettingen, 麻豆AV Health Centre, Montreal Children's Hospital

Co-PIs:

• Louise Pilote,听麻豆AV Health Centre, MGH
• Kerling Israel, Hopital Universitaire de Mirebalais / Partners in Health

Background

Despite high prevalence estimates of diabetes and hypertensive disorders in pregnancy in Haiti, including postpartum cardiomyopathy (PPCM), these conditions remain vastly unrecognized. Access to adequate gestational screening remains limited.

Project Idea

The goal of this project is to improve maternal and infant health and prevent the intergenerational transmission of non-communicable diseases (NCD) by addressing major pregnancy-related NCDs.

Methods

We designed a cross-sectional study to screen for diabetes, hypertension and PPCM in 650 pregnant women in Haiti鈥檚 Artibonite region. Participants will be enrolled from a local antenatal care (ANC) clinic in the catchment area of St. Nicholas Hospital in St. Marc. The study鈥檚 longitudinal cohort arm will assess health outcomes in the pregnant women detected to have one or both conditions, and in their offspring.

Expected results

1. To obtain an accurate estimate of the prevalence of hypertensive disorders and diabetes in pregnant women who visit an ANC in Haiti.
2. To gain knowledge about the feasibility of implementing a screening protocol, establish setting-adapted screening and treatment strategies, and document outcomes of these pregnancy-related NCDs.
3. To validate a screening questionnaire for postpartum cardiomyopathy (PPCM).
4. To transfer knowledge about research protocol design, research conduct and data interpretation.