International collaborations in health education leverage diverse perspectives and resources to address global health care challenges and shape the future of health care systems. Understanding the historical dynamics of these partnerships—particularly between high-income and low- and middle-income countries—is crucial for guiding equitable and effective international health initiatives.
In a recent study, researchers from The Institute of Education Research at UHN, The Wilson Centre, the University of Toronto, and Addis Ababa University (in Ethiopia) partnered to analyze a historic collaboration between an Ethiopian Emperor and a Canadian religious leader that advanced health education in Ethiopia. This collaboration highlighted the importance of respect, trust, and equity in international partnerships.
The research team used a historical case study approach to examine contextual, structural, political, and social influences that shaped the historic partnership. Their findings highlighted how mutual respect and trust were essential in overcoming challenges and achieving shared goals. The partnership’s success ultimately led to the establishment of the Addis Ababa University, marking a significant milestone in advancing higher education in Ethiopia.
However, power dynamics within the partnership revealed persistent challenges that hindered equitable collaboration. Western education models heavily influenced the curriculum, often overlooking local knowledge and cultural perspectives. These challenges caused discontent and resistance to change, reflecting broader inequities that persist within global health education and care.
By examining the success and challenges of historical partnerships, this study emphasizes the need to acknowledge the underlying power dynamics in international partnerships that may hinder inclusive and equitable approaches, ensuring that diverse perspectives are integrated into future global health collaborations.
Dr. Lucy Vorobej is a co-first author of the study and a postdoctoral research fellow in Dr. Cynthia Whitehead’s lab.
Dr. Dawit Wondimagegn is a co-first author of the study and was the former Vice President of the Addis Ababa University. Dr. Wondimagegn is an Associate Professor of Psychiatry at the Addis Ababa University in Ethiopia and an Invited Member of The Wilson Centre.
Dr. Brian Hodges is a co-author on the study and a Clinician Investigator at The Institute for Education Research at UHN. Dr. Hodges is also UHN’s Executive Vice President of Education and Chief Medical Officer and a Professor in the Department of Psychiatry at the University of Toronto.
Dr. Cynthia Whitehead is the senior author of the study and a Senior Scientist at The Institute for Education Research at UHN. Dr. Whitehead is also the Director and a Scientist at The Wilson Centre, as well as a Professor in the Department of Family and Community Medicine at the University of Toronto.
This work was supported by UHN Foundation and Dr. Whitehead holds the BMO Financial Group Chair in Health Professions Education Research at UHN. Dr. Vorobej has also received postdoctoral funding from Associated Medical Services.
#Vorobej L, #Wondimagegn D, Baheretibebe Y, Bizuneh B, Hodges B, Petros A, Jobin S, Whitehead CR. Probing the past: historical case study analysis to inform more just and sustainable global health partnerships in education. BMJ Glob Health. 2024 Nov 18. doi: 10.1136/bmjgh-2024-015415.
#Joint first authors
Two recent studies from UHN’s Toronto General Hospital Research Institute (TGHRI) have advanced our understanding of best practices in care. These studies examined whether health outcomes, such as stroke recurrence, disease burden, and quality of life differ between men and women.
A research team led by Dr. Eric Horlick, Clinician Investigator at TGHRI, and Dr. Lusine Abrahamyan, Scientist at TGHRI, investigated whether there were sex-based differences in stroke recurrence following patent foramen ovale (PFO) closure for stroke. Limited clinical data had suggested men were more likely than women to benefit from the procedure.
A PFO is a small congenital hole in the heart, present in 25% of the population, that is a recognized risk factor for stroke. Evidence from trials suggests that an outpatient, catheter-based procedure under local anesthesia, called PFO closure, yields better outcomes than medical therapy alone. However, real-world data on long-term differences in outcomes for men and women after PFO closure is not available.
To determine whether outcomes differ, Dr. Horlick’s team analyzed the long-term results of PFO closure in men and women. They reviewed the detailed medical charts of patients from their practice at Toronto General Hospital who had undergone the PFO procedure, one of the largest programs internationally in the region.
Out of 783 patients in the study, 349 (44.5%) were women, and 434 (55.5%) were men. Results showed that women were generally younger and more likely to experience migraines, while men had more risk factors for heart disease. There were no differences between men and women in the success of the procedure or outcomes within 30 days and over a median follow-up period of 14 years (e.g., repeat stroke risk, survival, and atrial fibrillation).
This underscores the importance of updating clinical trial data with robust longitudinal data disaggregated by sex and demonstrates how sex-based analyses can enable more personalized, evidence-based care decisions. The researchers recommend further studies include sex-based analyses to further advance care which will enhance the reproducibility of findings, benefit women’s health, and help support guideline development. Many future trials will be designed from the outset focussing on the relative benefits of new and existing therapies for men and women.
In another study from TGHRI, a North American team led by Dr. Florence Wong, Affiliate Scientist, looked at sex differences in how patients perceive the burden of ascites from cirrhosis of the liver—fluid collecting in spaces of the abdomen—and how it impacts their quality of life.
Ascites develops in about 31% of patients within the first year after being diagnosed with cirrhosis—scarring of the liver. As cirrhosis progresses, the ascites become increasingly difficult to control and treat. Due to factors such as physical discomfort, changes in body appearance, dietary restrictions, and increased stress, patients typically experience a reduced quality of life.
Research suggests that women with liver disease may experience a poorer quality of life, possibly due to a greater disease burden or a stronger impact from the same disease severity. As individualized care is becoming increasingly important in cirrhosis, this study aimed to explore whether men and women with advanced liver disease and ascites experience differences in quality of life, what factors contribute to these differences, and how they affect daily functioning.
Researchers studied 392 men and 184 women with cirrhosis and severe ascites, comparing symptoms, mental health, physical activity, and overall quality of life between men and women using various tests and questionnaires.
Results showed that women with cirrhosis and ascites had more severe symptoms than men at the same stage of the disease, which affected their quality of life, even though their physical functioning remained similar. Women reported lower mental well-being, than men. Despite the negative emotional impact, women were able to conduct their daily activities as adequately as men. Interestingly, women who were referred for transplants exhibited reduced physical function compared to men. This difference was not present in the patients not referred for transplant.
This study highlights the differences in the lived experience of women and men and the importance of using both clinical and patient-reported data to provide better, more personalized care.
By examining whether certain conditions, treatments, and disease burdens affect men and women in distinct ways, both studies contribute to a more nuanced body of knowledge that promotes better outcomes for all patients.
UHN is committed to producing high-quality research that reports on sex and gender in treatment efficacy, health outcomes, and experience of disease. Research that addresses these knowledge gaps illuminates the path to reducing health disparities based on sex and gender. Studies like these build knowledge in under-explored areas and contribute to UHN’s reputation as a leading research hospital.
Dr. Eric Horlick is senior author of the Flores-Umanzor et al., 2024 study. Dr. Horlick is a Clinician Investigator at TGHRI, Professor of Medicine at the University of Toronto (U of T) and the Peter Munk Chair in Structural Heart Disease at Toronto General Hospital; Dr. Lusine Abrahamyan is a co-first author of the study, Scientist at TGHRI, and an Associate Professor at the Institute of Health Policy, Management and Evaluation at U of T; Dr. Eduardo Flores-Umanzor is co-first author of this study, Interventional Cardiology Specialist at Hospital Clínic de Barcelona, and former Interventional Cardiology fellow working with Dr. Horlick at Toronto General Hospital.
Dr. Florence Wong is first and corresponding author of Wong et al., 2024. Dr. Wong is an Affiliate Scientist at TGHRI and Professor in the Division of Gastroenterology at U of T.
Flores-Umanzor et al., 2024 was supported by the Peter Munk Cardiac Centre, the Ontario Ministry of Health and the Ministry of Long-Term Care, and UHN Foundation.
Dr. Horlick is a consultant for Abbott, Edwards, and Medtronic and has received research grants from Abbott and Occlutech for other projects. Dr. Horlick is supported by the Peter Munk Chair in Structural Heart Disease.
Wong et al., 2024 was part of the North American Consortium for the Study of End-Stage Liver Disease project. The study was supported by UHN Foundation.
Dr. Wong is a consultant for Sequana Medical and has received research grants from Grifols, and Mallinckrodt for other projects.
#Flores-Umanzor E, #Abrahamyan L, Asghar A, Schrutka L, Everett K, Lee DS, Osten M, Benson L, Horlick E. Sex-Based Differences in Long-Term Outcomes Following Transcatheter Closure of Patent Foramen Ovale for Cryptogenic Stroke. Circ Cardiovasc Interv. 2024 Nov;17(11):e014467. doi: 10.1161/CIRCINTERVENTIONS.124.014467. Epub 2024 Nov 19.
# Contributed equally
Wong F, Reddy KR, Tandon P, Lai JC, Garcia-Tsao G, O'Leary JG, Biggins SW, Vagas HE, Thacker L, Kamath PS, Bajaj JS; NACSELD III Study Group. Sex differences in patient-reported outcomes and perception of ascites burden amongst outpatients with decompensated cirrhosis and ascites.: Sex Differences in Ascites Burden Perception. Am J Gastroenterol. 2024 Nov 27. doi: 10.14309/ajg.0000000000003251. Epub ahead of print.
Princess Margaret Cancer Centre’s (PM) Dr. Abdulazeez Salawu has been named a recipient of the new Marathon of Hope Cancer Centres Network Patient Voices in Research Initiative (MOHCCN), a first-of-its-kind funding opportunity in Canada, designed to address disparities in cancer research.
The MOHCCN program was developed collaboratively by cancer patients, survivors, and caregivers from across the country. They selected the research themes, reviewed applications, and worked with a scientific council to evaluate and award funding.
The initiative aims to address current gaps in precision oncology, including unequal access to treatments and clinical trials. It will also fund projects exploring lifestyle interventions to improve patient survival and quality of life, as well as research into the psychological impact of prolonged survival with aggressive cancers.
As a Clinician Investigator and Staff Oncologist at PM, Dr. Salawu leads a research team that unites collaborators in Toronto and Montreal to address disparities in access to cancer research initiatives. His project, titled ‘Patient-focused evaluation of disparities among participants enrolled in precision oncology studies’ was awarded funding of $151,500.
“Our project aims to examine who participates in cancer research and identify barriers faced by underrepresented groups, such as language, finances, or lack of information,” says Dr. Salawu. “Ultimately, we want to identify any existing gaps, and develop ways to make cancer research more inclusive, benefiting all patients.”
Congratulations to all recipients!
To read more about this funding initiative, click here.
A new study from the KITE Research Institute explored the barriers faced by Canadians with disabilities when using wayfinding technology and provided key insights into improving accessibility and usability.
Wayfinding technologies, such as GPS applications, wearable devices, and digital information booths, help enhance navigation efficiency, safety, and accessibility. However, for people with disabilities, significant barriers to use exist, including high costs and interaction challenges. A better understanding of these barriers would lead to more inclusive designs and equitable access.
Researchers surveyed over 200 Canadians with varying disabilities, including those with mobility, visual, hearing, memory, and learning disabilities, to better understand their experiences using different types of wayfinding technology. Participants were asked about their use of wayfinding mobile applications, websites or web applications, wearable devices, assistive devices, and digital or interactive public devices.
Key barriers identified included the high cost of using and maintaining the technology, reliance on internet connectivity, and technology literacy demands beyond the average user’s knowledge. Participants also identified interaction challenges, such as difficulties with touchscreens or voice controls, and physical barriers surrounding public wayfinding tools.
By highlighting these barriers, this study emphasizes the need to include wayfinding technologies in national accessibility standards and consider the perspectives of diverse users in their design. As these technologies become more inclusive, they hold the potential to transform lives and promote more equitable access to public spaces and opportunities.
Esther Leung is the co-first author of the study and a former Master’s student in Dr. Alison Novak’s Lab.
Ealu Li is a co-first author of the study and a former Master’s student in Dr. Alison Novak’s Lab.
Dr. Alison Novak is the senior author of the study and a Senior Scientist at the KITE Research Institute. At the University of Toronto, Dr. Novak is a Faculty Member of the Rehabilitation Sciences Institute and an Associate Professor in the Department of Occupational Science & Occupational Therapy.
This work was supported by UHN Foundation and Accessibility Standards Canada.
#Leung E, #Li E, Primucci M, Edwards T, Houston D, Levine IC, Campos JL, Dutta T, Novak AC. Toward a better understanding of barriers to wayfinding technology use for people with disabilities. Assist Technol. 2024 Nov 13:1-8. doi: 10.1080/10400435.2024.2423608.
#Shared first authorship
UHN Researcher and Clinician, Dr. Dafna Gladman has been named an Officer of the Order of Canada. This prestigious distinction—one of the country’s highest civilian honours—recognizes her foundational contributions to the field of psoriatic arthritis (PsA) and efforts to advance our understanding of this chronic disease. PsA is a chronic autoimmune disease that causes joint inflammation, pain, and stiffness, often alongside psoriasis.
Dr. Gladman is a Senior Scientist at UHN’s Schroeder Arthritis Institute. She also serves as Deputy Director of the Centre for Prognosis Studies in Rheumatic Diseases, Director of the Psoriatic Arthritis Program, and Co-Director of the Lupus Clinic at Toronto Western Hospital.
Her innovative research has transformed the care of autoimmune diseases like PsA and lupus, leading to breakthroughs in diagnosis and treatment worldwide. She developed a comprehensive patient database, driving discoveries in genetics and early detection, and has set global standards in patient care. A trailblazer and mentor, Dr. Gladman’s work continues to transform lives and inspire the next generation of researchers.
“Members of the Order of Canada are builders of hope for a better future,” said the Governor General in a news release. “Thank you for your leadership and visionary spirit, and welcome to the Order of Canada.”
The award will be presented during an upcoming ceremony; details will be announced later.
To see the full list of appointees, read the Governor General’s press release.
The Order of Canada, created in 1967, recognizes individuals who have made extraordinary contributions to Canadian society. More than 8,000 people from all sectors have received this prestigious honour.
Welcome to A Year in Research, a celebration of impactful health research at UHN. This festive social media campaign highlights our strides in innovation, collaboration, and patient-centred care—core to shaping the future of health care.
This year, UHN redefined patient-centred research through initiatives like Pride in Patient Engagement in Research (PiPER), ensuring that every discovery directly impacts real-world outcomes by integrating patient voices at every step. Breakthroughs in regenerative medicine brought stem cell therapies from the lab to the clinic, offering new hope for complex diseases, while cutting-edge innovations have transformed cancer treatment on a global scale.
UHN also emerged as a leader in artificial intelligence, with advances in AI-powered diagnostics and robotics revolutionizing personalized care and transforming how we approach prevention and treatment. Inclusion, diversity, equity, and accessibility (IDEA) principles have guided research to address health disparities, ensuring equitable care for all communities.
The future is also bright for the next generation of scientists. Programs like UHN STEM Pathways and the Office of Research Trainees are fostering emerging researchers, empowering them to tackle the challenges of tomorrow. Collaboration has been key, with UHN’s six research institutes and five hospitals working together to accelerate discovery.
Our scientific achievements would not have been possible without our academic partner, the University of Toronto, our foundations—The Princess Margaret Cancer Foundation, UHN Foundation, and the West Park Foundation—and support from all levels of government, the private sector and many nonprofits. We also share our success with our patient partners, who inspire us to make a difference.
Stay tuned as we celebrate this remarkable journey over 8 days, sharing stories of progress, partnerships, and promise. Together, we’re creating A Healthier World—one discovery at a time.
Explore the Stories Behind the Progress:
● Bringing Discoveries to Life: Learn how UHN translates research breakthroughs into life-changing health solutions.
● Better Together: Discover how UHN engages patients to strengthen research and improve outcomes.
● Bridging Gaps: See how UHN integrates health equity into research to serve diverse communities.
● Unlocking the Future with AI: Explore UHN’s innovations in AI and robotics that are reshaping health care.
● Inspiring the Next Generation: Find out how UHN supports emerging researchers to address tomorrow’s challenges.
Turquoise water, breezy warm air, and the soothing sound of sea waves as they wash over the sand before retreating into a colourful underwater world.
It’s no surprise that Dr. Federico Gaiti, who grew up in Reggio Emilia, Italy, a country surrounded by the beautiful Mediterranean Sea, developed a passion for scuba diving and marine biology.
“I became more and more interested in why we have such stunning diversity of colours and forms underwater,” says Federico, who completed his Bachelor’s and Master’s degrees at the University of Bologna. Mediterranean bluefin tuna, sea anemones, jellyfish, and sponges—not only were they companions for his scuba diving adventures, but they also became central to his research.
His quest to trace the origins of multicellular life led him to the southern hemisphere, where Federico pursued a PhD in Evolutionary Biology and Genomics at the University of Queensland, Australia. The Great Barrier Reef, with its unparalleled diversity of life forms, provided a wonderful opportunity to peek into the ocean’s evolutionary secrets—and eventually led to his career in cancer.
“Life began as single-celled organisms and gradually evolved into complex, multicellular forms. Cancer, on the other hand, seems to reverse-engineer this evolutionary journey,” says Federico.
During his PhD, he studied marine sponges, one of Earth’s most ancient groups of multicellular animals, along with jellyfish, corals, anemones, etc. “In multicellular animals, cells cooperate and specialize in different functions to maintain a harmonious system,” he explains.
“But cancer cells lose this ability—they behave more like single-cell organisms. They prioritize their own survival, proliferate uncontrollably, and lose specialized functions, often reverting to a more primitive, undifferentiated state. Much like single cells adapting to new environments, cancer cells evolve rapidly to withstand external pressures, such as therapy.”
“It felt like a natural next step to blend my background in evolutionary biology with a drive to tackle problems that directly impact human health.” Federico shifted toward human-centred biomedical research during his postdoctoral studies at Weill Cornell Medicine in New York.
Now, instead of studying the separation of single-celled organisms and marine sponges, Federico focuses on mapping the evolutionary family trees of tumour cells to better inform cancer development and progression.
An edge he gained from his “past life” is a deep understanding of how genes are regulated within cells, namely the study of epigenetics. This includes regulatory elements like non-coding RNAs, DNA methylation, and chromatin marks. In his earlier work, he had previously used this knowledge to identify how the regulatory genome has evolved across different animal species. Today, he needs to determine how these same regulatory mechanisms change between different lineages of cancer cells.
With Dr. Dan Landau, a leading expert in cancer evolution, Federico unravelled that, in both leukemia and gliomas, epigenetic changes accumulate within cells, driving tumours to evolve. These changes contribute to the tumour’s diverse and uneven cellular makeup over time.
Gliomas are hard-to-treat tumours that affect the central nervous system including the brain and spinal cord. The team found in gliomas, there are distinct cellular states, driven by specific epigenetic changes that are important for the tumour to develop.
One such state involves malignant cells regressing into a more primitive state, resembling neural progenitor cells—a type of cells that are close to stem cells, undifferentiated, and can self-renew.
“When malignant cells revert to this more primitive, undifferentiated state and acquire stem cell-like features, they become the fuel for the tumour growth,” Federico adds, “We found that these epigenetically-encoded cell states are inheritable—one cell in this state can propagate its lineage and contribute to the cancer progression process.”
Differences in DNA methylation, a particular chemical modification of the cells’ DNA, give rise to these various cellular states, and affect which genes the cells can transcribe and express. To decode these complex layers of gene regulation, Federico used a method called multiomics single-cell profiling, which looks at each individual cell from patient glioma samples, and creates a profile of their DNA methylation, transcriptome, and genotyping information. He coupled this analysis with a method to trace and differentiate cancer cell lineages and eventually mapped the evolutionary family tree to understand how different glioma cells are related and change over time.
“Studying how tumour cells evolve from early onset to a more developed stage can give us insights on how to intervene early and how to prevent cancer progression,” Federico says.
Federico brought his interests and expertise to the Princess Margaret (PM) where he continues to explore how malignant glioma cells evolve while invading normal brain tissues. Collaborating with other scientists at PM, his team is broadening the use of this integrative method to investigate cell diversity and evolution in various other cancers, which will help develop targeted therapies for early detection and prevention.
The rising star in single-cell cancer biology moved to Canada and established his lab at PM in 2021, a move that brought both exciting opportunities and new challenges for Federico.
“Becoming an independent researcher and leading a lab introduced me to new experiences that I hadn’t encountered before,” says Federico, “I am fortunate to have great mentors at PM, such as Drs. Mark Minden and Vuk Stambolic, who continue to guide me through the highs and lows of this new role. Their senior mentorship serves as a strong example that helps me at times when I mentor my own trainees.”
Federico leans on his communication skills to lead a multidisciplinary research team. “Everyone is unique in their own way. They can have different backgrounds, skill sets and communication styles. Being approachable and listening attentively have helped me adapt my mentorship approach to fit each trainee’s unique needs.”
Meet PMResearch is a story series that features Princess Margaret researchers. It showcases the research of world-class scientists, as well as their passions and interests in career and life—from hobbies and avocations to career trajectories and life philosophies. The researchers that we select are relevant to advocacy/awareness initiatives or have recently received awards or published papers. We are also showcasing the diversity of our staff in keeping with UHN themes and priorities.
Research conducted at UHN's research institutes spans the full spectrum of diseases and disciplines, including cancer, cardiovascular sciences, transplantation, neural and sensory sciences, musculoskeletal health, rehabilitation sciences, and community and population health.
Learn more about our institutes by clicking below:
