The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students.

BACKGROUND: Black medical students have been consistently underrepresented in Canadian medical schools, and data on the impact of discrimination on their medical education remain limited. In this cross-sectional study, we aimed to investigate the experiences of Black medical students through the Black Medical Students' Association of Canada (BMSAC). METHODS: We developed a 63-item instrument around the domains of inclusion and diversity, wellness, discrimination, career advancement and diversity in medical education. The anonymous web-based questionnaire was sent to 128 medical students and first-year residents from all 17 Canadian medical schools via the BMSAC listserv. We obtained frequencies for demographic data and self-reported experiences. RESULTS: We received 52 responses. Of respondents, 59% had at least 1 personal encounter with discrimination in medical school. Discrimination was experienced in both clinical and academic contexts, notably from patients, peers and hospital staff. Students further along in their medical training were more likely to endorse having experienced discrimination in medical school. Most respondents had positive experiences with academic and clinical inclusion, as well as resiliency in the face of discrimination. However, most respondents had negative experiences relating to reporting discrimination, their well-being, career advancement, sentiments of minority tax and low diversity in medical education. INTERPRETATION: We found that discrimination has important implications on the learning experiences of Black medical students surveyed from the BMSAC. This directly challenges the notion that Canadian medical schools are impervious to racism and highlights the need for advocacy and systemic changes to eliminate institutional racism.

Envisioning healthy futures: Youth perceptions of justice-oriented environments and communities in Northern British Columbia Canada.

Through an anti-colonial and critical race theoretical framework as well as arts-based methods (photovoice) that engage Indigenous and non-Indigenous youth, we explore the question: what do youth perceive as healthy and just environments and communities? Youth identified two overarching, strength-based messages: Firstly, youth demonstrate the need for a structural-level analysis of the conditions that influence individual-level outcomes of environmental health. Secondly, youth perspectives on healthy and justice-oriented environments and communities challenge environmental health scholars to consider youth as powerful actors. Youth perspectives of healthy and justice-oriented communities present a necessarily structural perspective to consider not only the impacts of environmental decision-making on health, but the conditions that have allowed for harmful impacts. In doing so, youth demonstrate the need for intersectional and complex understandings of health and wellbeing when discussing the environment. And, as we argue here, challenge us as scholars of environmental health to do the same.

Media framing of emergency departments: a call to action for nurses and other health care providers.

BACKGROUND: As part of a larger study focused on interventions to enhance the capacity of nurses and other health care workers to provide equity-oriented care in emergency departments (EDs), we conducted an analysis of news media related to three EDs. The purpose of the analysis was to examine how media writers frame issues pertaining to nursing, as well as the health and social inequities that drive emergency department contexts, while considering what implications these portrayals hold for nursing practice. METHODS: We conducted a search of media articles specific to three EDs in Canada, published between January 1, 2018 and May 1, 2019. Media items (N = 368) were coded by story and theme attributes. A thematic analysis was completed to understand how writers in public media present issues pertaining to nursing practice within the ED context. RESULTS: Two overarching themes were found. First, in ED-related media that portrays health care needs of people experiencing health and social inequities, messaging frequently perpetuates stigmatizing discourses. Second, media writers portray pressures experienced by nurses working in the ED in a way that evades structural determinants of quality of care. Underlying both themes is an absence of perspectives and authorship from practicing nurses themselves. CONCLUSIONS: We recommend that frontline nurses be prioritized as experts in public media communications. Nurses must be supported to gain critical media skills to contribute to media, to destigmatize the health care needs of people experiencing inequity who attend their practice, and to shed light on the structural causes of pressures experienced by nurses working within emergency department settings.

Explaining differential vulnerability to climate change: A social science review.

The varied effects of recent extreme weather events around the world exemplify the uneven impacts of climate change on populations, even within relatively small geographic regions. Differential human vulnerability to environmental hazards results from a range of social, economic, historical, and political factors, all of which operate at multiple scales. While adaptation to climate change has been the dominant focus of policy and research agendas, it is essential to ask as well why some communities and peoples are disproportionately exposed to and affected by climate threats. The cases and synthesis presented here are organized around four key themes (resource access, governance, culture, and knowledge), which we approach from four social science fields (cultural anthropology, archaeology, human geography, and sociology). Social scientific approaches to human vulnerability draw vital attention to the root causes of climate change threats and the reasons that people are forced to adapt to them. Because vulnerability is a multidimensional process rather than an unchanging state, a dynamic social approach to vulnerability is most likely to improve mitigation and adaptation planning efforts. This article is categorized under:Vulnerability and Adaptation to Climate Change > Values-Based Approach to Vulnerability and Adaptation.

What is the effect of prolonged sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting.

OBJECTIVE: Sedentary behaviour has long been associated with neck and low back pain, although relatively little is known about the thoracic spine. Contributing around 33% of functional neck movement, understanding the effect of sedentary behaviour and physical activity on thoracic spinal mobility may guide clinical practice and inform research of novel interventions. DESIGN: An assessor-blinded prospective observational study designed and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology. SETTING: UK university (June-September 2016). PARTICIPANTS: A convenience sample (18-30 years) was recruited and based on self-report behaviours, the participants were assigned to one of three groups: group 1, sitters-sitting >7 hours/day+physical activity<150 min/week; group 2, physically active-moderate exercise >150 min/week+sitting <4 hours/day and group 3, low activity-sitting 2-7 hours/day+physical activity <150 min/week. OUTCOME MEASURES: Thoracic spine mobility was assessed in the heel-sit position using Acumar digital goniometer; a validated measure. Descriptive and inferential analyses included analysis of variance and analysis of covariance for between group differences and Spearman's rank correlation for post hoc analysis of associations. RESULTS: The sample (n=92) comprised: sitters n=30, physically active n=32 and low activity n=30. Groups were comparable with respect to age and body mass index.Thoracic spine mobility (mean (SD)) was: group 1 sitters 64.75 (1.20), group 2 physically active 74.96 (1.18) and group 3 low activity 68.44 (1.22). Significant differences were detected between (1) sitters and low activity, (2) sitters and physically active (p<0.001). There was an overall effect size of 0.31. Correlations between thoracic rotation and exercise duration (r=0.67, p<0.001), sitting duration (r=-0.29, p<0.001) and days exercised (r=0.45, p<0.001) were observed. CONCLUSIONS: Findings evidence reduced thoracic mobility in individuals who spend >7 hours/day sitting and <150 min/week of physical activity. Further research is required to explore possible causal relationships between activity behaviours and spinal musculoskeletal health.

Diversity and Activity of Communities Inhabiting Plastic Debris in the North Pacific Gyre.

Marine plastic debris has become a significant concern in ocean ecosystems worldwide. Little is known, however, about its influence on microbial community structure and function. In 2008, we surveyed microbial communities and metabolic activities in seawater and on plastic on an oceanographic expedition through the "great Pacific garbage patch." The concentration of plastic particles in surface seawater within different size classes (2 to 5 mm and >5 mm) ranged from 0.35 to 3.7 particles m-3 across sampling stations. These densities and the particle size distribution were consistent with previous values reported in the North Pacific Ocean. Net community oxygen production (NCP = gross primary production - community respiration) on plastic debris was positive and so net autotrophic, whereas NCP in bulk seawater was close to zero. Scanning electron microscopy and metagenomic sequencing of plastic-attached communities revealed the dominance of a few metazoan taxa and a diverse assemblage of photoautotrophic and heterotrophic protists and bacteria. Bryozoa, Cyanobacteria, Alphaproteobacteria, and Bacteroidetes dominated all plastic particles, regardless of particle size. Bacteria inhabiting plastic were taxonomically distinct from the surrounding picoplankton and appeared well adapted to a surface-associated lifestyle. Genes with significantly higher abundances among plastic-attached bacteria included che genes, secretion system genes, and nifH genes, suggesting enrichment for chemotaxis, frequent cell-to-cell interactions, and nitrogen fixation. In aggregate, our findings suggest that plastic debris forms a habitat for complex microbial assemblages that have lifestyles, metabolic pathways, and biogeochemical activities that are distinct from those of free-living planktonic microbial communities. IMPORTANCE Marine plastic debris is a growing concern that has captured the general public's attention. While the negative impacts of plastic debris on oceanic macrobiota, including mammals and birds, are well documented, little is known about its influence on smaller marine residents, including microbes that have key roles in ocean biogeochemistry. Our work provides a new perspective on microbial communities inhabiting microplastics that includes its effect on microbial biogeochemical activities and a description of the cross-domain communities inhabiting plastic particles. This study is among the first molecular ecology, plastic debris biota surveys in the North Pacific Subtropical Gyre. It has identified fundamental differences in the functional potential and taxonomic composition of plastic-associated microbes versus planktonic microbes found in the surrounding open-ocean habitat. Author Video: An author video summary of this article is available.