Mary De Vera
Relevant Degree Programs
Great Supervisor Week Mentions
Mary de Vera has been a great supervisor! She has the talent to motivate her students while providing them with the scientific tools to achieve their goals. Thank you so much, Mary de Vera, for your supervision and dedication!
#GreatSupervisor Week @UBC! 140 characters aren't enough to describe how supportive, encouraging, inspiring, and fun @maryadevera is. Can't live without her!
Graduate Student Supervision
Doctoral Student Supervision (Jan 2008 - Nov 2020)
Objectives: To examine biologic use before or during pregnancy among women with autoimmune inflammatory disease by: 1) Describing the patterns of use, discontinuation, and 10-year secular trends; 2) Evaluating the association between biologic exposure before or during pregnancy and adverse maternal and infant outcomes including: preterm deliveries, small-for-gestational-age (SGA) births, congenital anomalies, and serious infections; and 3) Reviewing existing literature and meta-analyzing my findings with published results. Methods: Using provincial population-based administrative health data linked with the perinatal registry and prescription dispensations database, a cohort of women with autoimmune inflammatory disease who had at least one pregnancy during 2002-2012 was identified. Descriptive statistics, multivariable modeling, and high-dimensional propensity score (HDPS) methods were used to describe the patterns of perinatal biologic prescriptions and assess associations with outcomes of interest. Results were meta-analyzed with findings from existing literature.Findings: 1) Perinatal biologic use has increased significantly over 10 years, comprising 5.7% of all pregnancies in this population by 2012. Most often women discontinued their biologic in the first (31%), or second (38%) trimesters, while 98% of those on treatment during the second trimester continued through to delivery. Only disease type was associated with discontinuation. 2) After applying HDPS matching, there were no associations observed between biologic use before or during pregnancy and risk of preterm deliveries (OR 1.13, 95% CI 0.67 to 1.90); SGA (OR 0.91, 95% CI 0.46 to 1.78); or congenital anomalies (OR 1.06, 95% CI 0.46 to 2.47). The theoretical concern of serious infections due to immunomodulatory effects of biologics was not observed. 3) Meta-analysis of unadjusted risk estimates showed significantly increased risks of congenital anomalies, preterm deliveries, and low birth weight babies associated with biologic exposure. However, pooled adjusted risk estimates showed no significant associations. Conclusions: Using novel methods to address potential confounding and pooling existing evidence, the findings from this thesis demonstrated that treatment with biologics before or during pregnancy are not associated with a number of important perinatal outcomes. These findings help patients and clinicians weigh risks and benefits of treatment options in pregnancy, and support difficult decision making around using biologics in a vulnerable population.
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Master's Student Supervision (2010 - 2018)
Introduction: Suboptimal medication adherence and poor health outcomes in patients with gout, the most common inflammatory arthritis, has prompted efforts to optimize care delivery. The Virtual Gout Clinic, an electronic health technology supported collaborative care model for gout involving rheumatology, pharmacy, and dietetics, offers a promising solution. The purpose of this thesis is to gain an in-depth understanding of how individuals engage in managing their gout and also explore the complexity of the Virtual Gout Clinic using mixed methods to optimize the context and delivery of this care model.Objectives: 1) To explore individual experiences with gout in a Canadian population and to understand the phenomenon of becoming actively engaged in the management of gout with an emphasis on factors which facilitate management; and 2) to explore how participants with gout experience the Virtual Gout Clinic and to understand and explain quantitative outcomes from the evaluation of this care model.Methods: For the first objective, I used a constructivist grounded theory design and conducted semi-structured telephone interviews with participants diagnosed with gout completing the Virtual Gout Clinic. I applied an explanatory sequential mixed methods design for objective 2, as this design enables interview questions used in the qualitative component to be informed by quantitative outcomes of the Virtual Gout Clinic (adherence, serum uric acid) for a comprehensive final interpretation. Results: 1) Analysis of 12 interviews constructed four themes: describing the severity of gout; processing the diagnosis and management of gout; interfering with management of gout; and facilitating management of gout. 2) The experience of the Virtual Gout Clinic was described by three conceptual categories: learning through the Virtual Gout Clinic; receiving personalized support; and knowing someone cares. Suboptimal health outcomes were explained by practical and perceptual barriers to gout management, such as lacking knowledge and fearing side-effects of medications. Conclusion: This thesis provided novel insight into the process of patients becoming actively engaged in the management of gout with an emphasis on facilitating factors. An interdisciplinary model of care is a promising approach to optimize care delivery by providing both emotional and practical support as well as ongoing individualized education.
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