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Multiple studies are reporting the pandemic’s impact on the mental health of Canadians, but what effect is it having on our nation’s Veterans and their spouses? 

“With concerns about COVID-19 infection and drastic changes to everyday life, the pandemic is taking a toll on the health of Canadians,” explains Dr. Don Richardson, Associate Scientist at Lawson Health Research Institute and Director of the MacDonald Franklin Operational Stress Injury (OSI) Research Centre, located at St. Joseph's Health Care London's Parkwood Institute. “And it may be particularly distressing for those vulnerable to mental illness.”

Population studies show that Veterans are at double the risk of mental illness when compared to the rest of the population. They experience higher rates of depression, anxiety and loneliness. Spouses of Canadian Veterans are also at higher risk of distress, as they may sometimes undertake significant caregiving responsibilities that that require significant emotional and time investments.  

“It’s currently unknown how the pandemic will impact Veterans and their spouses, but it could result in particularly serious outcomes,” says Dr. Anthony Nazarov, Associate Scientist at Lawson and the MacDonald Franklin OSI Research Centre. 

In a new project from Lawson and the Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), researchers will seek answers to these questions by partnering with up to 1,000 Canadian Veterans and 250 spouses of Canadian Veterans. Through online surveys, the project will hear directly from Veterans and their spouses to assess the pandemic’s effects on their well-being over time. The team hopes results can be used by health care workers and policy-makers to support Veterans and their families during both the current pandemic and future public health emergencies. 

“We want to hear from all Canadian Veterans and their spouses, whether they’re doing well or not and whether they’re seeking care or not,” explains Dr. Nazarov. 

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From left: Drs. Don Richardson and Anthony Nazarov

Participants will complete online surveys, available in both English and French, once every three months for a total of 18 months. They will be asked questions about their psychological, social, family-related and physical well-being, and any relevant changes to their lifestyle and health care treatment. 

“Veterans who regularly access health care services could encounter significant changes, including a move to virtual care appointments. This could lead to increased caregiving responsibilities for spouses,” says Dr. Nazarov. “Given the uncertainty surrounding the pandemic, these changes may persist well into the future, mandating a thorough assessment of patient satisfaction and treatment outcomes.”

The team hopes results can be used to support the wellness of Veterans and their families during public health emergencies. This includes providing health care professionals and policy-makers with information to guide emergency preparedness policies and health care delivery models. They hope results can also be used to recognize early signs of distress in order to target with early interventions.

“We are seeking to understand the impact of COVID-19 on Veterans and their families to identify if this global pandemic is leading to psychological distress or triggering historical traumas,” says Dr. Patrick Smith, CEO of the Centre of Excellence on PTSD. “The Centre’s primary goal is to increase Canadian expertise related to military and Veteran mental health, suicide prevention and substance use disorders. This study can help us understand if the pandemic is having debilitating and life-altering effects, and help us address a potential mental health crisis.”  

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Dr. Patrick Smith

Dr. Gregor Reid, a scientist at Lawson Health Research Institute, and his Western University PhD student, Camilla Urbaniak, have previously shown that live bacteria are present in the breast tissues of healthy women. This proves the existence of a breast tissue microbiome. In past studies, Reid and Urbaniak have also proven that human milk contains beneficial bacteria. “Since breastfeeding decreases a woman’s risk for breast cancer, we wondered if beneficial bacteria, like those found in human milk, may be playing a role in lowering the risk of cancer and whether other types of bacteria could be influencing cancer formation,” said Dr. Reid.

To explore these questions, Urbaniak obtained breast tissue samples from 58 women who had either benign or cancerous tumours. In addition, she obtained 23 samples from healthy women undergoing breast reductions or enhancements. Through an analysis of these tissues, Urbaniak found that the bacteria present in the breasts of healthy women differ from those found in the breasts of women with breast cancer. 

Women with breast cancer had elevated levels of both Escherichia coli (E. coli) and Staphylococcus epidermidis. A NASA study has confirmed the London research findings and further identified bacteria associated with breast cancer. Urbaniak and Reid went even further by showing that these bacteria can cause significant damage, known as double-stranded breaks, to DNA. When this occurs, the body tries to repair the damage. However, these repairs often result in errors which can lead to the development of cancer.

Tissues taken from the breasts of healthy women showed high levels of Lactobacillus and Streptococcus, known to promote health and display characteristics that can prevent cancer. For example, Streptococcus produces antioxidants that can help prevent DNA damage.

“This study provides clear evidence that the breast tissue microbiome differs between healthy women and those with breast cancer,” said Dr. Reid. “Our colleagues in Spain have recently shown that probiotics with lactobacilli can be ingested by women and reach the mammary gland. This raises the questions of whether women, especially those at risk for breast cancer, should take probiotics to increase the proportion of beneficial bacteria in the breast.”

In addition to prevention, this finding could have potential for helping with the management of patient disease. “It may be possible to increase the abundance of beneficial bacteria at the expense of harmful ones through the use of probiotics,” said Dr. Reid. “Antibiotics targeting harmful bacteria may also be another option for improving breast cancer management. Additional research is warranted to further explore the role of the breast tissue microbiome in the development and prevention of breast cancer.” 

“In the near future, I hope we can discover which bacteria or combination of bacteria promote cancer development and which ones could help protect against it, and the mechanisms by which they do so,” said Urbaniak. “The next logical step would then be to unravel how we can use this knowledge to protect women from getting breast cancer or how we can manipulate the microbiome to help treat cancer once a woman gets it.”

The study, “The microbiota of breast tissue and its association with breast cancer”, was featured in Applied and Environmental Microbiology, a journal of the American Society for Microbiology. Dr. Gregor Reid is the Director, Canadian Centre for Human Microbiome and Probiotic Research at Lawson Health Research Institute and a Professor of Surgery, and Microbiology and Immunology at Western University. Urbaniak, who recently completed her PhD at Western University, will soon be a postdoctoral fellow at the NASA Jet Propulsion Laboratory (JPL) in Pasadena, California where she will perform microbiome analyses on samples collected from astronauts as well as those collected from the surfaces of the International Space Station.

Exposure to professional experiences can help students envision themselves in specific professions and Dr. Donna Goldhawk aims to do just this by introducing medical research to high school science students. As coordinator of Youth Outreach for the Ontario Research Fund (ORF) grant entitled “Heart Failure: Prevention through Early Detection Using New Imaging Methods,” she is pleased to announce the call for applications to the 2019 Summer Studentship program.

This year, a total of three ORF summer scholarships are available at Lawson Health Research Institute (London), University of Ottawa Heart Institute (Ottawa), and Sunnybrook Research Institute (Toronto). Interested applicants can forward their cover letter and resume to @email by May 15, 2019. 

Dr. Goldhawk is a Scientist at Lawson Health Research Institute and an Assistant Professor in Medical Biophysics at Western University. Since 2009, she has helped inspire students to pursue research by training them in her lab. In conjunction with secondary schools in the Thames Valley region and the Partners in Experiential Learning (PEL) program, she teaches youth that choosing a scientific career allows for multiple opportunities to fuse interests with a specific area of focus. 

The PEL program was introduced in 2004 by Dr. Jim Koropatnick, Lawson Scientist, and Mr. Rodger Dusky, a retired secondary school teacher. PEL has been a long-standing partnership between the Thames Valley District School Board, London District Catholic School Board, Ministry of Education, Western University, London Health Sciences Centre and St. Joseph’s Health Care London.

This unique academic co-op education program identifies high school students interested in research and prepares them for placement in a health research environment. The students earn high school credits and receive training in basic laboratory research. In Dr. Goldhawk’s experience, PEL attracts an excellent caliber of student who is eager to learn, aspiring to pursue further education and capable of contributing to the science of molecular imaging.

Through the ORF, the Ministry of Research and Innovation emphasizes the value of attracting youth to the scientific enterprise. Students can expect experiential learning tailored to their current understanding of science and aimed at expanding this knowledge for a greater appreciation of biomedical research. For example, in Dr. Goldhawk’s laboratory cardiac research is focused on the measurement of iron contrast using MRI.  

“Many cells have naturally distinct iron metabolism; however, we are also using genes from magnetic bacteria to improve the magnetic sensitivity of mammalian cells. MRI can then be used to detect disease processes,” states Dr. Goldhawk. “We are particularly interested in reporter gene expression for MRI, a term coined to describe how changes in the pattern of gene activity and its related protein activity may be visualized.”

Her current team not only includes graduate and undergraduate students at various stages in their programs but also an international collaboration with Dr. Weiwei Zhang, a Western Visiting Scholar from China. In this setting, high school students step into a work atmosphere where they can interact with individuals at different levels. As well, molecular imaging research works closely with multiple areas so students acquire training in both biology and physics. 

“To retain the interest of talented young scientists, it is essential to provide them with interesting challenges that reward their curiosity and ambition to learn,” explains Dr. Goldhawk. “In hospital-based research institutes, youth are also exposed to the clinical side for which our research is targeted. This is a quality scientific experience for youth interested in expanding their outlook, performance, technical, problem-solving and record-keeping skills. I think it is essential to build these opportunities into our scientific programs.” 

The following column was provided to Hospital News by Dr. David Hill, scientific director, Lawson Health Research Institute. 

Dedicated health researchers across the country are working every day to make discoveries that improve patient outcomes and support a higher quality of life. Our research hospitals have a mandate to develop and test new treatments, technologies and procedures that address our most pressing health challenges.

There is a cycle of health innovation that is supposed to happen – scientific discoveries are made, they transition to clinical trials and then are adopted as an improved standard of care. This is followed by evaluations of the new method and moving along to the next cycle of refinements and improvements. But the reality in Canada is that gaps, in some cases chasms, disrupt the creation and adoption of evidence-based health innovations.

This starts with discovery. The research funding climate in Canada continues to be extremely difficult. Despite the Federal Government outlining substantial new investments in discovery research in Budget 2018 much of that money will not be available to researchers until 2020 and beyond, and the Canadian Institutes of Health Research (CIHR) continues to be limited by a low funding rate of around 14 per cent. Funding for large, definitive clinical trials is especially difficult to support with public funds. Too many good ideas are left unfunded, and in that environment researchers can feel it’s wiser to propose incremental and ‘safe’ science that avoids controversy and the risk of losing support for experienced research teams built up over many years.

Yet researchers are persistent and manage to secure funding from a range of smaller agencies. Unfortunately, many of these do not fund the indirect costs of research necessary to cover administration, infrastructure, equipment maintenance and upgrades, and the investigator’s salaries. Indirect costs are estimated to be approximately 40 per cent on top of direct study costs. In research hospitals these costs generally fall on the institutions to find funding outside of the provincial government budget that covers the costs of hospital care. This is a negative spiral whereby the more successful a hospital becomes in attracting research funds, the bigger the gap in finding the resources to support that research.

When innovative solutions to health care problems are delivered, backed by solid evidence, adoption into our hospital-based care is often far from rapid. Currently, in most provinces, there is no funding mechanism to translate health innovation to the ‘real world’ setting of our front-line care. Yet, such a mechanism is crucial to the translation of science. Clinical trials are carefully designed with strict protocols and criteria for a highly specific population of patients. Innovations that work in a clinical trial do not always work in the real world where patient populations and settings are much more complex.

Following a clinical trial, innovation needs to be tested at the point of care. Without funding to do this, research innovation hits a roadblock. Scientists are left waiting and hoping that one day their provincial government might look to incorporating their innovations into the health system funding schedule. Meanwhile, their work may be used to inform health care improvements in other nations.

An example can be found in medical imaging research. Canadian scientists, including those at Lawson Health Research Institute, are leaders in the development of positron emission tomography (PET) biomarkers to improve diagnosis and understanding of disease using PET scans.  PET biomarkers are successfully created and then validated in clinical trials across our nation, but there is little funding to translate them back in a timely fashion to patient care in our hospitals. While countries like the US and Europe readily adopt these innovations, Canada lags behind.

This gap was addressed in a report to the Federal government by the Advisory Panel on Healthcare Innovation entitled “Unleashing Innovation: Excellent Healthcare for Canada” and published in 2015. The panel recommended the formation of a Healthcare Innovation Agency of Canada open to hospitals and other care providers in order to evaluate health innovations in the real-world setting of our health system. Scientists would apply by putting forward evidence from their research, including that collected from clinical trials. They would then design a new translational study to test their innovation at the point of care, with the goal of building evidence for presentation to provincial government.

Will everything tested at the point of care succeed? No; some things will fail in the real world. This is why such a fund is so important. It will show whether or not an innovation truly benefits patients and if it’s ready for wider adoption. If successful, the evidence will highlight the right time to bring innovations into the mainstream standard of care. By bridging this gap in the system, we can improve patient care and ensure a timely return on the investment in science.

Dr. David Hill is scientific director at Lawson Health Research Institute, the research institute of London Health Sciences Centre and St. Joseph’s Health Care London.