Flames of transformation: Igniting better mental and physical health for racialized and gendered North Americans.

COVID-19 is catalyzing both crises and opportunities for communities of color. The crisis of high mental and physical morbidities and mortalities exposes persistent inequities while providing opportunities to celebrate the power of rejuvenated anti-racism movements, fueled partly in response to the extremism of ultra-conservative governments, the circumstances to reflect deeply on racism because of forced stay-at-home-orders, and digital technologies primarily driven by youth. In marking this historical moment of longstanding anti-racism and decolonial struggles, I assert the importance of foregrounding women's needs. In analyzing racism, rooted in colonialism and white supremacy, and its impacts on mental and physical health status, I focus on improving racialized women's lives within the larger context, concentrating on the determinants of health. I contend that fanning the flames to scathe the racist and sexist foundations of North American society will break new ground for sharing wealth, bolstering solidarity and sisterhood, and ultimately improving Black, Indigenous, and Women of Color (BIWOC) health. Canadian BIWOC earn approximately 59 cents to the dollar earned by non-racialized men, creating vulnerabilities to economic downturns, such as the one Canada is currently in. BIWOC care aides, at the bottom of the healthcare hierarchy, are emblematic of other Black, Indigenous, and People of Color (BIPOC), who face risks of frontline work, low wages, poor job security, unpaid sick days and so forth. To that end, policy recommendations include employment equity initiatives that hire groups of racialized women who consciously express solidarity with each other. Cultural shifts within institutions will be key to providing safe environments. Improving food security, internet access and BIWOC-related data collection linked to community-based programming while prioritizing research on BIWOC will go a long way toward improving BIWOC health. Addressing racism and sexism within the healthcare system, aiming for equitable diagnostic and treatment foci, will require transformative efforts including determined leadership and buy-in from all levels of staff, long-term training and evaluation programs, audited by BIPOC communities.

Wellbeing Convene during COVID-19: A pilot intervention for improving wellbeing and social connectedness for staff, students, residents, and faculty.

Background: Canada is facing its worst crisis among healthcare workers in recent healthcare history. Anxiety, depression, suicidal ideation, and severe burnout are higher than before the COVID-19 pandemic. University Faculties of Medicine (FoMs) are vital to healthcare systems. Not only are they responsible for training personnel, but clinicians and staff from FoMs often work directly within healthcare systems. FoMs include students, staff, residents, faculty members, residents, researchers, and others, many experiencing higher stress levels due to pandemic tensions. Most FoMs emphasize cognitive and psychomotor learning needs. On the other hand, affective learning needs are not as well addressed within most FoMs. Finding innovative means to ameliorate mental and emotional health status, particularly at this critical juncture, will improve health and wellness, productivity, and retention. This article discusses a pilot program, Wellbeing Convene during COVID-19, in a Canadian FoM, which aimed to (1) provide staff, faculty, residents, and students with a toolkit for greater wellbeing and (2) build a sense of community during isolating times. Results: Participants found the program beneficial in both regards. We recommend that these kinds of programs be permanently available to all members in FoMs, at no cost. Wellness programs alone, however, will not solve the root causes of mental and emotional stress, often based on concerns related to finances, hierarchical workplace structures, and nature of the work itself, among other factors. Conclusion: Addressing the mental and emotional health of people in FoMs is vital to improving productivity and reducing stress of FoMs, healthcare professionals, and, ultimately, patients.

And Still She Rises: Policies for Improving Women's Health for a More Equitable Post-Pandemic World.

The COVID-19 pandemic has spawned crises of violence, hunger and impoverishment. Maternal and Infant Health Canada (MIHCan) conducted this policy action study to explore how changes that have arisen during the COVID-19 pandemic may catalyze potential improvements in global women's health toward the creation of a more equitable post-pandemic world. In this mixed methods study, 280 experts in women's health responded to our survey and 65 subsequently participated in focus groups, including professionals from India, Egypt/Sudan, Canada and the United States/Mexico. From the results of this study, our recommendations include augmenting mental health through more open dialogue, valuing and compensating those working on the frontlines through living wages, paid sick leave and enhanced benefits and expanding digital technology that facilitates flexible work locations, thereby freeing time for improving the wellbeing of caregivers and families and offering telemedicine and telecounseling, which delivers greater access to care. We also recommend bridging the digital divide through the widespread provision of reliable and affordable internet services and digital literacy training. These policy recommendations for employers, governments and health authorities aim to improve mental and physical wellbeing and working conditions, while leveraging the potential of digital technology for healthcare provision for those who identify as women, knowing that others will benefit. MIHCan took action on the recommendation to improve mental health through open conversation by facilitating campaigns in all study regions. Despite the devastation of the pandemic on global women's health, implementing these changes could yield improvements for years to come.

Premenstrual Syndrome and Its Impact on the Quality of Life of Female Medical Students at Bisha University, Saudi Arabia.

OBJECTIVE: The severity and chronicity of PMS can lead to the impairment of studies, and it can also affect relationships, activities, quality of life (QoL), and academic performance. This study aimed to determine PMS frequency and its associated factors in order to assess the quality of life (QoL) among female medical students at Bisha University, Saudi Arabia. METHODS: This study was cross-sectional and included 388 female medical students in the Faculty of Medical Applied Sciences and the Faculty of Medicine at Bisha University. The participants all filled in a self-administered questionnaire. The Premenstrual Syndrome Scale (PSS) was used based on the diagnostic and statistical criteria for PMS assessment. PMS was diagnosed after the presence of five or more severe premenstrual symptoms had been resolved following menstruation (adapted from American Psychiatric Association). DATA ANALYSIS: The data obtained were analyzed using SPSS 25.0. A chi-square test was used to test the associations between the study variables. A logistic regression analysis technique was used to select the group of variables. Participants were asked to provide consent to participate in the study. IRB was obtained from the University of Bisha, College of Medicine. RESULTS: The participants were aged 19.5 ± 4.9 years, and the prevalence of PMS was 64.9%. Most of the female students were of extroverted personality types (35%). In addition, 13.4% were obese or overweight, and 19.5% of the 50% with PMS exercised regularly (p < 0.05). Menstruation significantly influenced the related quality of life subscales (p < 0.05). CONCLUSION: PMS significantly influenced daily activities related to quality of life and homework. Moreover, almost half of the female students experienced the effects of menstruation in their learning environment. Therefore, among female students, the modification of risk factors should be considered a critical intervention point.

From millstones to milestones: Scaffolding a house of public health on political science foundations.

Background: We analyze the University of British Columbia's Department of Political Science's first course on health, "Global Politics and Health," to determine whether one course could inform political science students to tackle health issues. The major concept was global public health is politics writ large, as determinants of health are rooted in economic and social power. Course objectives encouraged student agency in ameliorating population health status. Methods: We use three surveys, with qualitative and quantitative components, to assess interest and knowledge of public health issues, and determine whether student agency increased as the course progressed. Results: We confirmed that political science develops an excellent foundation for the analysis of issues related to global public health status. One course can stimulate curiosity in health issues. Unexpectedly, we discovered that students' greatest learning outcome integrated personal, interpersonal, and scholarly analyses of health issues. This provided an avenue for students outside of the health sciences to frame mental health, sexuality, and other stigmatized subjects within scholarly discourse. After the course, virtually all students had developed a sense of agency, hope, and tools to understand the roots of mental and physical health. Following case studies on various countries, students quickly grasped the significant impact of politics and economics on people's health. Discussion: We recommend that political science departments offer courses that focus on health for all alongside existing courses on healthcare systems' politics. Furthermore, departments of public health may benefit from including political science courses as core elements of their curriculum to assist graduates in navigating the highly politicized infrastructure of public health. Both disciplines stand to gain from this interdisciplinary opportunity-- in the service of better health for all.

The perspectives of educators, regulators and funders of massage therapy on the state of the profession in British Columbia, Canada.

BACKGROUND: Registered Massage Therapists (RMTs) are valuable members of the healthcare team who assist in health promotion, disease prevention, treatment, rehabilitation and palliation. RMT visits have increased across Canada over the past decade with the highest increase in British Columbia (BC). Currently, RMTs are private practitioners of healthcare operating within a largely publicly funded system, positioning them outside of the dominant system of healthcare and making them an important case study in private healthcare. In another paper we examined the perspectives of RMTs themselves. Here, we offer perspectives of regulators, educators and funders of Massage Therapy (MT) on advancement of the profession. METHODS: We interviewed 28 stakeholders of MT in BC - including members of the MT regulatory board, representatives from MT colleges in BC and public and private health insurers. RESULTS: All three groups identified research, particularly on efficacy of MT, as playing a vital role in enhancing the professional credibility of MT. However, participants noted that presently research is not a large feature of the current MT curricula and we analyze why this may be and how it can improve. Finally, conferral of baccalaureate degree status could assist RMTs in gaining recognition with the general public and other healthcare professionals. CONCLUSION: RMTs have potential to ameliorate population health in a cost-effective manner. Their role in British Columbia's healthcare landscape could be expanded if they produce more research and earn degree status.

Massage therapy and labor outcomes: a randomized controlled trial.

INTRODUCTION: Massage is a time-honored method by which women have received comfort throughout the millennia, yet it has not been rigorously evaluated in the modern day delivery suite. No study to date that we are aware of has evaluated the effect of massage therapy by a regulated massage therapist on labor pain. The purpose of this study was to evaluate the effectiveness of massage therapy provided by registered massage therapists in managing pain among women in active labor. METHODS: BC Women's Hospital, Vancouver, BC. RESEARCH DESIGN: a randomized controlled trial. PARTICIPANTS: 77 healthy nulliparous women presenting in spontaneous labor. INTERVENTION: Swedish massage administered for up to five hours by a registered massage therapist during labor vs. standard care. Main outcome measures include: cervical dilation at the time of administration of epidural, compared using estimated marginal means in an analysis of covariance. We also compared perception of pain at three time periods during labor according to cervical dilation at 3-4 cm, 5-7 cm, and 8-10 cm using the McGill Present Pain Intensity Scale. RESULTS: The mean cervical dilation at the time of epidural insertion after adjustment for station of the presenting part, cervical dilation, and status of membranes on admission to hospital was 5.9 cm (95% CI 5.2-6.7) compared to 4.9 in the control group (95% CI 4.2-5.8). Scores on the McGill Pain Scale were consistently lower in the massage therapy group (13.3 vs. 16.9 at 3-4 cm, 13.3 vs. 15.8 at 5-6 cm, and 19.4 vs. 28.3 at 7-8 cm), although these differences were not statistically significant. CONCLUSIONS: Our findings from this pilot study suggest that massage therapy by a registered massage therapist has the potential to be an effective means of pain management that may be associated with delayed use of epidural analgesia. It may therefore have the potential to reduce exposure to epidural analgesia during labor and decrease rates of associated sequelae.

Inspiring health advocacy in family medicine: a qualitative study.

CONTEXT: The Canadian Medical Education Directions for Specialists identifies health advocacy as an essential role for physicians. Health advocacy is also an integral part of the principles of family medicine. It relates to the physician's responsibility to identify and respond appropriately to the social determinants of health and the healthcare needs of vulnerable and marginalized populations. The competencies related to health advocacy are regarded by medical educators as difficult to integrate into residency training. OBJECTIVES: This qualitative study investigates what family medicine residents, educators and physicians perceive inspires them to engage in health advocacy, and explores how best to incorporate related competencies into medical training. METHODS: In-depth, semi-structured interviews conducted with a purposive sample of four family medicine residents, three physicians and two educators who self-identified or were identified by peers as health advocates. Interviews were recorded, transcribed and analyzed using framework analysis. Transcripts were made available to the participants to ensure transcript accuracy. FINDINGS: Early exposure to social injustice, parental influences, role modeling and internal motivators were seen as important inspirations for health advocacy. CONCLUSION: Creating an enabling and nurturing environment prior to and during residency training may be necessary to sustain the motivation to engage in health advocacy. Findings from this study suggest possibilities for a resident-guided participatory curriculum development process around health advocacy. Recommendations for promoting health advocacy in postgraduate training include effective integration of health advocacy in the curriculum by providing protected time and resources, providing experiential learning opportunities and fostering a community of practice for physician health advocates.