Subvention de mentorat clinique en santé des femmes
Le subvention de mentorat clinique en santé des femmes vise à faire avancer la recherche clinique sur la santé des femmes et à renforcer les capacités de la prochaine génération de cliniciens-chercheurs en santé des femmes. L’objectif est de faire en sorte que les personnes en stage, aux études supérieures ou en résidence soient jumelées à des spécialistes de la santé des femmes dans le cadre d’un projet de recherche d’un an visant à améliorer les soins cliniques.
Domaines de recherche
Les questions de recherche doivent :
- se concentrer sur la santé des femmes (aux fins de cette subvention, le terme « femme » inclut les personnes de sexe féminin ET toute autre personne qui s’identifie comme femme).
- Les questions de recherche doivent aussi porter sur un ou plusieurs des domaines de recherche suivants :
- ménarche ou ménopause;
- santé pelvienne ou urogynécologie;
- utilisation hors indication de testostérone chez les femmes éprouvant une baisse du désir sexuel;
- hormonothérapie substitutive pour les personnes subissant des traitements d’affirmation de genre.
La somme totale disponible dans le cadre de cette possibilité de financement est de 600 000 $, ce qui devrait permettre d’accorder environ douze (12) subventions de mentorat. La somme maximale par subvention est de 50 000 $ pour une période d’un (1) an.
Le formulaire de demande est maintenant fermé.
Boursiers / Boursières
L'information est fournie dans la langue dans laquelle le récipiendaire l'a présentée.
Acceptability of bariatric surgery in young women with endometrial cancer: a qualitative study
Rachel Soyoun Kim
Chercheuse principale : Sarah Ferguson, University Health Network (Toronto, ON)
Stagiaire : Rachel Soyoun Kim
Résumé : Obesity is a significant cause of uterine cancer. Uterine cancer used to be most prevalent in women over 60; however, as obesity has been rising across the population, an increasing rate of uterine cancer has been observed in women under 40. The standard treatment for uterine cancer is hysterectomy, or removal of the uterus. This radical treatment is devastating for women of reproductive age who still want to have children. In an effort to preserve fertility, hormone treatment with progestin has been explored as an alternative to hysterectomy. However, progestin does not address obesity, the true cause of uterine cancer. In addition, it causes weight gain and is associated with high chance of cancer recurrence. Weight loss is a promising new treatment for uterine cancer that preserves fertility while addressing the root cause of uterine cancer - obesity - thus preventing recurrence. For women with obesity and uterine cancer, significant weight loss is required on a timeline that can only be achieved realistically through weight-loss surgery, such as bariatric (stomach reduction) surgery. Weight loss through bariatric surgery has the potential to treat obesity, preserve fertility, and more effectively treat uterine cancer. The purpose of this study is to explore the perceptions and attitudes towards bariatric surgery as a fertility-preserving treatment for uterine cancer in younger women (40 years old and younger) who have both uterine cancer and obesity. The results of this study will inform clinical practice through more productive oncologist-patient conversations, and the development and design of a larger pilot study of bariatric surgery as a treatment for uterine cancer.
Cannabis Use in Menopause: Capturing the Experiences and Perspectives of Women
Chercheuse principale : Nese Yuksel, University of Alberta
Stagiaire : Katherine Babyn
Résumé : Hormonal changes during menopause can lead to a variety of symptoms. The use of cannabis for medical purposes has grown in Canada since legalization of recreational cannabis in 2018, with one of the largest growing markets being people in midlife. Some women may be choosing cannabis to help with symptoms commonly seen in menopause. Unfortunately, there is not a lot known about the use of cannabis in menopause. The purpose of this study is to describe the experiences and perspectives of menopausal women with cannabis. This study will help us understand if and how menopausal women are using cannabis. The study will be conducted in two phases at the interdisciplinary Edmonton Menopause Clinics. In the first phase, we will conduct a survey of women who are in menopause to identify if they are using cannabis to help with symptoms and to describe for which symptoms. The second phase will involve interviews of the women to capture their experiences and perspectives with cannabis.
Cardiac Outcomes of Menopausal Women Prescribed Concurrent Hormonal and Statin Combination Regimens in British Columbia
Chercheur principal : Gavin Stuart, University of British Columbia
Stagiaire : Alexandra Lukey
Résumé : Heart disease continues to be the leading cause of premature death for women in Canada. Historically, much of what is known about the treatment and pathophysiology of the disease has been tested on men and then transferred to women. We know there are differences between men and women in the development, presentation and response to treatment for heart disease. Despite this, most heart disease research is not sex specific.
A commonly used drug therapy to prevent heart disease is the cholesterol lowering drugs known as statins. Although found to be effective in preventing both first and consecutive heart attacks in men, these drugs have found to be significantly less effective in prevention of heart attacks in women. Also, many women who are diagnosed with heart disease are near the age or past menopause. Many women of this age group are prescribed hormone therapy to treat symptoms related to menopause. The interaction between hormonal therapy and statins is just beginning to be understood. One recent study found that the combination and of hormone therapy and statin drugs resulted in greater prevention of heart attacks in women than statin therapy alone. However, more research needs to be done to better understand why this may be happening as well as if combinations of different types of hormone therapy and statin drugs may show greater benefit than others. We will use a population-based data set to determine whether we can confirm the benefit of combined therapy and, we will search for specific hormone and statin combinations for superior benefit (e.g. simvastatin with estrogen alone)? This research has the potential to significantly impact the outcomes of heart disease in women as well as contribute to what is known about sex specificity of heart disease.
Cognitive Behavioural Therapy for Sexual Concerns During the Menopausal Transition: A Low Risk Treatment Protocol
Sheryl M Green
Chercheuse principale : Sheryl M Green, McMaster University
Stagiaire : Melissa Furtado
Résumé : The menopausal transition is associated with a number of physical, emotional and psychological changes that have an adverse impact on a woman's functioning and overall quality of life. Sexual concerns (e.g., low sexual desire, pain during intercourse, poor body image) are highly prevalent among peri- and post-menopausal women, with 68% to 86.5% of women reporting these concerns at some point during the transition. Hormone therapies, including estrogen, progesterone, and testosterone treatments, are currently the most commonly prescribed treatments for sexual concerns during menopause. However, these treatments are associated with potential health risks and side effects for some women. Cognitive Behavioural Therapy (CBT) is a psychological treatment that has been proposed as a low-risk alternative treatment for menopausal symptoms. Thus far, CBT has been shown to be effective for some menopause symptoms, such as hot flashes, depression, anxiety, and poor sleep. However, sexual concerns have either not been targeted at all during these interventions or, when directly targeted, only modest improvements have been observed. This study will evaluate the efficacy of a new four-session CBT protocol designed specifically to target commonly reported sexual concerns among women during the menopausal transition. The impact of CBT on sexual concerns, related distress, and associated difficulties (e.g., anxiety, depression, body image, relationship satisfaction) will be evaluated. This study will be the first to investigate the efficacy of a low-risk alternative treatment program specifically tailored to address the unique sexual concerns that women report during menopause.
Efficacité de la rééducation sensitive pour réduire la douleur lors des relations sexuelles chez les femmes atteintes de vestibulodynie provoquée : essai clinique randomisé
Chercheuse principale : Mélanie Morin, University of Sherbrooke
Stagiaire : Isabelle Quintal
Résumé : La vulvodynie (douleur/inconfort vulvaire) est une problématique présente chez 8 à 16 % de la population féminine et affecte donc une proportion importante de femmes au Canada. La vestibulodynie provoquée, caractérisée par une douleur à l'entrée du vagin lors d'un toucher et/ou une pénétration est la forme la plus fréquente de vulvodynie. Elle limite la qualité de vie et les relations sexuelles de ces femmes. La vestibulodynie provoquée est souvent traitée par des applications de crème de lidocaïne avec des résultats mitigés. Récemment, plusieurs évidences en recherche indiquent que des mécanismes au sein du système nerveux central contribueraient à cette condition. La méthode de rééducation sensitive (MRSD) est une approche innovante et prometteuse pour le traitement des douleurs qui vise à influencer les mécanismes de perception sensitive du système nerveux central. Plus de quatre-vingt professionnels au Canada sont formés à la MRSD, qui a fait ses preuves avec d'autres clientèles présentant de la douleur. Tout récemment la MSRD a été utilisée avec succès chez des cas de vulvodynies traités dans une clinique en Suisse. Cette méthode recommande de diminuer le contact cutané avec la zone douloureuse et d'appliquer progressivement quotidiennement des stimulations confortables. La présente étude contrôlée et randomisée vise à comparer les effets de la MRSD à ceux de la lidocaïne pour la vestibulodynie. Cinquante-deux participantes seront assignées aléatoirement à l'un des deux traitements pour une durée de 12 semaines pour en valider l'efficacité. Les évaluations, avant et après l'intervention, documenteront les effets sur la douleur, la fonction sexuelle, la perception de changement, les variables psychologiques et la sensibilité vulvaire. Si les résultats sont concluants, les professionnels de la santé auront un nouvel outil pour améliorer la vestibulodynie provoquée et ainsi améliorer la qualité de vie de nombreuses canadiennes.
Evaluating the Risk of Cardiovascular Disease in Women with Endometriosis
Chercheuse principale : Olga Bougie, Queen’s University
Stagiaire : Jessica Blom
Résumé : Cardiovascular disease (CVD), a class of conditions affecting the heart and blood vessels in the body, remains the leading cause of premature death for women in Canada. Unfortunately, women with CVD are underdiagnosed and experience worse prognosis compared to men. This is likely due to the fact that much of many of the diagnostic and treatment strategies are based on research performed preferentially in men. There is an urgent need to reduce CVD in women, which requires recognition of CVD risk factors specific to women.
In 2016, the Nurses' Health Study II became the first study to suggest an association between endometriosis, a female specific disease, and CVD. Endometriosis is a chronic condition of pelvic pain affecting up to 10% of the female population. Although it is known as a gynecologic condition, it is becoming clear that endometriosis leads to chronic inflammation and oxidative stress in multiple organ systems. Furthermore, women with endometriosis are more likely to receive surgical and medical management which lead to early menopause - an independent risk factor for CVD. We hypothesize that women with endometriosis are at an increased risk of developing CVD. To investigate these hypothesis, we will use a population-based approach to determine the association between a diagnosis of endometriosis and subsequent risk of CVD. We plan to conduct a retrospective cohort study using data sets from the Institute of Clinical Evaluative Sciences (ICES) in Ontario. Secondly, we will use a biometric approach, including blood tests and other investigations, to assess CVD risk in women with a surgical diagnosis of endometriosis and age matched controls. It is important to investigate if patients with endometriosis are at increased risk of CVD. Identifying such patients can allow for implementation of effective prevention strategies to reduce the risk of CVD diagnosis as well as the negative impact of this condition.
Exogenous estrogen exposure and cardiovascular risk in women
Chercheuse principale : Sofia Ahmed, University of Calgary
Stagiaire : Cindy Kalenga
Résumé : Cardiovascular (CV) disease is the leading cause of death in women globally, highlighting the importance of studying sex-specific cardiovascular risk factors, such as exposure to estrogens. Sixty percent of reproductive age women use a contraceptive, and globally 60000 women become menopausal daily. The birth control pill and postmenopausal hormone therapy taken by mouth are associated with increased risk of hypertension and heart attack, though how a women takes estrogen hormones (by mouth or by another route, such as through the skin or other) of may change this risk. The goal of the proposed program of research is to investigate the association between how a women takes estrogen (by mouth or not) and cardiovascular risk in women. We hypothesize that non-oral exogenous estrogen, compared to oral exogenous estrogen, exposure will be associated with lower markers of cardiovascular risk.
We will evaluate the role of the route of administration (by mouth or other) of estrogen on the risk of high blood pressure and heart disease throughout a woman's life. How stiff a person's blood vessels are is a marker of future risk of heart attack. We will measure and compare the blood vessel stiffness in healthy postmenopausal women using non-oral (not by mouth) hormone therapy to that of menopausal women using oral hormone therapy and women not using any hormone therapy. This research program will advance our understanding of how commonly used estrogens impact cardiovascular risk and address the broader understanding of women's cardiovascular health.
Genetic Testing in Females with Ovarian Cancer: Impact of Reflexive Tumour Genetic Testing on Clinical Care
Kelly A Metcalfe
Chercheuse principale : Kelly A Metcalfe, University of Toronto
Stagiaire : Jeanna McCuaig
Résumé : Ovarian cancer is the deadliest of all gynecologic cancers and the 5th leading cause of cancer death in women. Ovarian cancers can be caused by genetic changes (mutations). Most mutations occur in the BRCA1 and BRCA2 genes, which are inherited from a parent (germline) or develop in a tumour (somatic). Genetic testing is very important in ovarian cancer because patients with germline or somatic BRCA mutations can have targeted treatment with drugs called PARP inhibitors. In Ontario, all ovarian cancer patients have reflexive BRCA tumour genetic testing (RTGT). This means that BRCA genetic testing is completed automatically on all ovarian tumours as part of ovarian cancer surgery. RTGT gives ovarian cancer patients genetic information quickly so their doctors can decide the best cancer treatment. A second germline genetic test (blood test) is still needed to tell patients if there is a hereditary cancer risk in their family. RTGT can improve cancer care but its effects on patient psychological response and use of germline genetic testing are unknown.
This study will examine the quality of patient care associated with RTGT in a group of ovarian cancer patients. Researchers will measure the patient psychological impact of RTGT and examine the effect of RTGT on use of germline genetic testing. To measure the patient impact, ovarian cancer patients who received RTGT results will be asked to fill in surveys about their experience. To look at changes in the use of germline genetic testing, researchers will compare the rate of referral and patient uptake of germline genetic testing in the year before and after the start of RTGT. The results of this study will be used to develop RTGT processes at hospitals around the world to make sure ovarian cancer patients and their family members get the information and support they need. This will reduce gaps in the care of ovarian cancer patients, help to find families with a hereditary cancer risk, and prevent ovarian cancer.
Improving treatment for Sexual Interest/Arousal Disorder in women through the application of the Approach-Avoidance Motivation Model
Lori Anne Brotto
Chercheuse principale : Lori Anne Brotto, University of British Columbia
Stagiaire : Faith Jabs
Résumé : Sexual health is recognized as a fundamental aspect of physical and mental health, yet adequate treatment options for sexual difficulties are scarce. Women with Sexual Interest/Arousal Disorder (SIAD) are in need of accessible psychological treatment options that can address the social and psychological aspects of their sexual concerns. The aim of our research is to better understand women's sexual health by providing a structured mentorship plan for a future health care provider, who is also a researcher, in women's sexual health. We will do this by studying the goals that women have for sex, and attempting to manipulate them as a means of improving women's sexual well-being. This approach has been used successfully in women without sexual concerns, providing a solid foundation for the current project. We will explore sexual well-being by focusing on three different aspects: sexual desire, sexual satisfaction, and sexual behaviour) and also measuring relationship satisfaction. The findings from this project will be translated to gynaecologists offering clinical care to women to ensure that the treatments they offer are supported by science.
Menopause in young women with cancer: a population-based approach
Maria Del Pilar Vélez
Chercheuse principale : Maria Del Pilar Vélez, Queen’s University
Stagiaire : Amanda Baillargeon
Résumé : Women who had cancer during adolescence and early adulthood (15-39 years), especially those who receive chemotherapy and or radiotherapy, may start their menopause at a younger age. Early menopause can cause infertility, osteoporosis, cardiovascular disease, sexual health problems, anxiety, and depression, all of which may affect quality of life. Our research program will use extensive administrative data available in Ontario and a survey to identify factors related to early menopause in women affected by cancer during adolescence and early adulthood. We will also investigate what type of treatments they are receiving, including hormone therapy, and how often they have consulted with a physician specialized in Menopause, and the type of clinical surveillance they are receiving. We will also ask in our survey if they will be willing to participate in a long-term follow study. Our ultimate goal is to improve the reproductive health and quality of life of female adolescents and young adults with cancer.
Preventing unnecessary surgeries for endometriosis with the Central Sensitization Inventory
Chercheur principal : Paul Yong, University of British Columbia
Stagiaire : Natasha Orr
Résumé : Endometriosis affects 1 in 10 reproductive-aged women, or approximately 1 million women in Canada. It is defined as tissue from inside the uterus (womb), being able to grow as implants outside of the uterus, in other parts of the body. Endometriosis is a common cause of infertility and pelvic pain, including painful periods, painful sexual activity, and chronic pelvic pain. Treatment consists of hormonal medications or surgical removal of the implants.
Historically, the endometriosis implants themselves were thought to be the primary cause of pain. However, recent research as shown that in many patients with endometriosis, the primary cause of pain consists of changes in the central nervous system (brain and spinal cord) – known as central sensitization – rather than the endometriosis implants themselves. In these patients with central sensitization, repeated surgery to try to remove endometriosis implants is unlikely to be helpful. The problem is that research methodologies to measure central sensitization are not practicable for the clinical setting. There is a need for a clinical tool that can easily identify central sensitization, thereby helping clinicians and patients to determine when surgery is not likely to be helpful. Recently, the Central Sensitization Inventory (CSI) – a patient-reported questionnaire – has been shown to be validly identify patients with central sensitization.
In this proposal, we will use the CSI in an ongoing prospective registry for endometriosis. We will determine whether the CSI can predict whether endometriosis surgery is effective or not. A cut-off for the CSI score will be identified, which can be used by clinicians and patients in their shared decision making about whether to proceed with surgery. The goal will be to reduce unnecessary repeat surgeries for endometriosis in women. This will be achieved by promoting the CSI in the national clinical practice guidelines for endometriosis and for pelvic pain.
Uterine preservation versus hysterectomy for pelvic organ prolapse surgery: A mixed methods prospective cohort study exploring health outcomes and patient beliefs
Erin A Brennand
Chercheuse principale : Erin A Brennand, University of Calgary
Stagiaire : Natalie Scime
Résumé : Pelvic organ prolapse (POP) is a medical condition in females where pelvic organs, such as the uterus, bladder or bowel, fall out of normal position and press into the vagina. POP will affect up to half of Canadian women in their lifetime, usually in relation to older age, higher body weight, and birthing children. Affected women often experience urine leakage, physical discomfort, embarrassment, and decreased quality of life. Surgery to correct POP is common, and approaches can be broadly divided into those that keep the uterus intact and those that remove the uterus from the patient's body. At present, we do not have enough high quality scientific evidence on which approach can best fix POP and restore quality of life, nor on the reasons women prefer to keep or remove their uterus during surgery. Our study will follow over 200 patients at the Pelvic Floor Clinic in Calgary, Alberta from their initial visit to 8 weeks after surgery to evaluate health outcomes and compare decision-making experiences between women who choose to keep versus remove their uterus during POP surgery. Our diverse team of doctors, researchers, and patient partners will collect study data using medical charts, questionnaires, and one-on-one interviews. Data on health outcomes will be statistically analyzed, and data on patient experiences will be analyzed by identifying themes across responses. As the Canadian baby boom generation ages, the number of women with POP is expected to increase and research on POP is needed to guide decision-making. Our study will address this need and will provide women contemplating surgery for POP and their care providers with trusted information on the risks and benefits of each surgical approach. Our findings will also help care providers understand how patients think about, and decide upon, whether to keep or remove their uterus, which may improve how they counsel and educate patients about surgical decisions.
Women Living with HIV: Severity and Treatment of Menopausal Symptoms
Melanie C Murray
Chercheuse principale : Melanie C Murray, University of British Columbia
Stagiaire : Elizabeth King
Résumé : People living with HIV across the world are aging. In 2030, it is estimated that ~70% of individuals with HIV will be over 50 years. In conjunction with this evolving landscape of HIV, the UNAIDS has called for a "new worldwide focus on persons living with HIV aged 50 or older." For women living with HIV (WLWH), one of the most important life events nearing this age is that of menopause, a time accompanied by changes in physiology that affect quality of life and aging processes. Preliminary research suggests that WLWH experience menopause differently than HIV-negative peers and some studies suggest symptoms are heightened and undertreated in WLWH compared to the general population. Key knowledge gaps exist in understanding menopausal symptoms in WLWH including their evolution, biologic basis and management. All of these gaps serve as barriers to provision of optimal patient-centred care for WLWH.
To further understand the menopausal experience in HIV, we will conduct a series of studies using 2 large cohorts of Canadian WLWH throughout stages of menopause. We will assess menopausal symptoms and follow their progression longitudinally. We will then assess hormonal changes throughout menopause, comparing important sex hormone levels (such as estrogen) during the menopausal transition compared to controls, and relate these hormones to symptom experience. Finally, we will evaluate the largest population of menopause hormone therapy used in WLWH in order to elicit characteristics of and barriers to use, thereby adding to the limited collective experience of hormonal therapy use in HIV. It is imperative moving forward that health providers adopt a tailored approach to address the complexities of reproductive health in HIV care. Further elucidating differences in the menopause experience in HIV from its progression and hormonal basis to treatment implications is a crucial step toward adopting a holistic approach to one of life's most important transitions.
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