Interdisciplinary Health / Santé interdisciplinaire

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Adaptation during a longitudinal integrated clerkship: the lived experiences of third-year medical students at the Northern Ontario School of Medicine.
(Laurentian University of Sudbury, 2013-07-31) Dubé, Tim V.
There are three interrelated concepts of what medical students learn, which include the formal, informal, and hidden curriculum. Several researchers who have investigated notions of the hidden curriculum have demonstrated how the experiences of medical training entrenched in the hidden curriculum can have a profound impact on medical student adaptation. The most influential transitional stage in undergraduate medical education is the third-year clinical clerkship, when medical students transition from classroom learners into clinicians. The Northern Ontario School of Medicine’s (NOSM) clinical clerkship year consists of a mandatory eightmonths of living and working in rural and northern communities throughout Northern Ontario, and learning in the context of rural family practice. Informed by a social constructivist research paradigm, I explored how 12 third-year students described the challenges they had to manage and, in response, the strategies they employed to adapt to their clerkship. I elicited their experiences and perspectives to contribute to a rich understanding of how students at the NOSM describe developing processes of adaptation during the Comprehensive Community Clerkship. Data were collected between August 2011 and April 2012, including: a) pre-clerkship interviews and a demographic questionnaire, b) mobile methods in the form of ‘guided walks’ in the communities, and c) post-clerkship interviews. The quality of the data collection and analysis were enhanced through processes of methodological and interpretive rigour, representativeness and authenticity, rich description and contextual relevance, audit trail, and reflexivity. Through an inductive thematic analysis of the data, the findings provide a rich description of events experienced such as medical training in one’s hometown or a familiar community, iv transitions including adaptation to the clinical setting and to the medical profession, and the influence of the clerkship on career path, personal well-being, and empathy for patients. The findings serve to advance our understanding of how medical students describe developing processes of adaptation throughout a longitudinal integrated clerkship. Implications are considered for medical students, the NOSM, the clerkship communities, and medical schools nationally and internationally. I propose recommendations regarding the suitability of authentic methods in medical education research, and discuss the implications for rural and northern health research.
After the dust settles: a qualitative study of underground workers exposed to an aluminum dust prophylaxis
(2020-05-26) Aubin, Danielle M.
From 1943 to 1980, some underground gold and uranium workers in Ontario were required to inhale aluminum powder, up to approximately 30 minutes daily, for silicosis prevention. This qualitative descriptive study explored the perceived impact of exposed workers to the aluminum powder. Sixteen respondents from Northeastern Ontario participated in interviews which were transcribed verbatim and analyzed thematically. Themes that were constructed on a personal impact level included: 1) compulsory exposure, 2) hesitancy to complain, 3) feelings of betrayal, and 4) concern about health impact and dying. Themes on an organizational impact level included: 1) confidence and trust in company, 2) lack of knowledge, and 3) need for compensation and formal apology. Workers’ perceived that their long-term health was impacted by exposure on a personal and organizational level. The latest information from this study on McIntyre powder will enhance the knowledge within the occupational health and safety system.
Are nurses protected? Observing the risk of skin contamination when donning and doffing personal protective equipment, using a Canadian protocol.
(2017-03-30) Desrochers, Chelsie
This study aimed to determine whether the Public Services Health and Safety Association’s donning and doffing protocol for Ebola are effective in the prevention of skin and clothing contamination. Ten third-year nursing students performed a donning and doffing simulation, which included donning personal protective equipment (PPE), being sprayed with GloGerm, performing eight simulated movements, and doffing PPE. Fluorescent stains were observed using an ultraviolet scan and were documented by their location and size. Four participants (N=4) experienced at least one contamination event following the doffing of PPE. Contaminations were observed on: the left dorsal lower leg (41.3mm; 64.0mm); the right dorsal lower leg (77.9mm); the left plantar (9.5mm); the left index finger (2.8mm); the right middle finger (1.6mm); the left scapula (38.1mm); and the right buttock (57.2mm). Areas of difficulty in the protocol included donning and doffing: the gown, N95 respirator, and the outer footwear. Failures with the equipment, including breaches and punctures, also contributed to the documented contamination. Near-miss incidents were observed in nine of the twenty-four steps in the protocols and occurred a total of twenty times. Revisions to the protocols were completed and included additional information for the following protocol steps: hang hygiene, N95 respirator, gown, outer footwear, verification process.
Building resilience and community capacity: the Sachigo Lake wilderness emergency response education initiative
(Laurentian University of Sudbury, 2014-05-21) Curran, Jeffrey
The Sachigo Lake Wilderness Emergency Response Education Initiative represented a partnership between Sachigo Lake First Nation in northern Ontario Canada, and medical professionals and university researchers from outside the community. This study was one component of a larger community-based participatory research program to develop locally relevant first response training to address the isolation from emergency healthcare in Sachigo Lake. The aim of this qualitative study was to complete a formative evaluation to understand how a five-day comprehensive training course implemented in May 2012: (a) met the local needs of Sachigo Lake; and (b) fostered resilience and community capacity. The results of this study describe the unique features of delivering first aid training in a remote context and illustrate the intrapersonal and interpersonal impacts of the program. Health promotion through community based first aid education is a model with potential to improve emergency care in the absence of formal emergency medical services.
Conceptualizing cultural safety in a clinical setting: how can health professionals implement culturally safe practice with Indigenous patients?
(2024-08-14) Skrinar, Hannah
Despite emerging research on cultural safety training for healthcare and social services workers, there remains a gap in the literature on ways by which regulated health professionals can practically implement culturally safe practices for Indigenous patients. This scoping review is aimed at conceptualizing different ways by which healthcare professionals can implement cultural safety into their practice. This can be done through human resources, community partnership, engagement, and the manipulation of physical spaces. Within each of the categories, practical examples of cultural safety were identified. The literature search yielded 41 articles and was conducted using key-word searches. Articles were then screened using the inclusion and exclusion criteria to find papers investigating practical implications for culturally safe healthcare. The literature review was divided into four sections: 1) human resources; 2) communication; 3) engagement; and 4) partnership, health services, and physical spaces. In the human resources category, results include incentivizing employees who strive for cultural safety and recruiting local Indigenous community members. The communication, engagement, and partnership search yielded findings such as demedicalizing terms and using family meetings as a means of communication. Findings in the health services portion included delivering health education to patients in the form of circle sharing and including traditional foods in nutritional counseling. Lastly, the physical spaces category produced results such as displaying local Indigenous artwork and making traditional medicines and materials available to patients. Results from the review offered real-life examples that can be used to reduce the gap between cultural safety training and execution of culturally safe health care delivery.
Developing dementia health promotion materials for Indigenous people in an urban Northern Ontario community
(2017-06-26) Webkamigad, Sharlene
This thesis considers health promotion materials on dementia for Indigenous people using health literacy and cultural safety as guiding frameworks. The author examined the question “How can we develop health promotion materials about dementia to meet the needs of Indigenous peoples living in urban Northern Ontario?” using two decolonized approaches to community-based participatory action research. Two-eyed seeing combines biomedical information with Indigenous knowledge to develop fact sheets. An understanding of local tribal teachings guided the research locally. Methods involved qualitative data analysis of two focus groups and five one-on-one interviews exploring the fact sheets’ appropriateness. Results suggest the need for a shared understanding of Indigenous and Western cultures; improved cross-cultural communication; the importance of grounding health promotion materials in culture; and, strategies for dementia awareness in Indigenous health literacy. These research findings can be translated to inform policy and practice through key recommendations regarding the development of health promotional materials.
Does exercise-induced inflammation serve a useful purpose across the adult age span?
(2015-08-10) Cartier, Sophie Melanie Louise
Inflammation is a protective biological response involving immune cells, blood vessels and molecular mediators, initiated upon the induction of cell injury (Abbas, Lichtman, & Pillai, 2007). The purpose of nflammation is to both eliminate the cause of the injurious agent (Abbas et al., 2007) as well as remove dead cells and tissues, damaged from the initial assault (Lapointe, Frenette, & Côté, 2002), and to initiate tissue repair (Ricciotti & FitzGerald, 2011). Inflammation as an event is a generic response to any injurious insult, which includes exercise-induced injury (Nehlsen-Cannarella et al., 1997). Exercise-induced muscle damage is defined as an injury from a mechanical force applied externally, causing structural stress or strain, resulting in cellular or tissue responses (Mueller & Maluf, 2002). An acute inflammatory response is sometimes instigated during exercise (Nehlsen-Cannarella et al., 1997); its initiation and magnitude depend upon the degree of physiological stress applied during the exercise bout (McFarlin, Flynn, Stewart, & Timmerman, 2004). Exercise-induced inflammation is typically seen in endurance sports where there is overuse of specific tissues (McFarlin et al., 2004). Physiological stress increases as intensity, duration and internal stimuli (e.g., blood glucose levels) increase (McFarlin et al., 2004). Thus, prolonged and intensive exercises significantly increase the induction of and the magnitude of an inflammatory response (McFarlin et al., 2004). Exercise-induced inflammation also stimulates the activation of the hypothalamic-pituitary adrenocortical (HPA) axis, characterised by elevated levels of cortisol and other mediators, inducing immune suppressive effects and thereby reinstating immune homeostasis (Tsigos & Chrousos, 2002). However, the immunosuppressive effects of the HPA axis may be detrimental to individuals if over-stimulated (Tsigos & Chrousos, 2002).Various methods have been employed in training regimes to counteract this inflammatory response Exercise-Induced Inflammation 7 (Bleakley, McDonough, & MacAuley, 2004; Gleeson, Nieman, & Pedersen, 2004; Quintero, Wright, Fu, & Huard, 2009). Carbohydrate supplementation is one method (Gleeson et al., 2004; McFarlin et al., 2004; Mitchell et al., 1998; Nehlsen-Cannarella et al., 1997; Nieman et al., 2004; Nieman et al., 1998; Scharhag, Myer, Auracher, Gabriel, & Kindermann, 2006). Others, such as cryotherapy (Bleakley et al., 2004) and RICE (rest, ice, compression, and elevation; Quintero et al., 2009), are also commonly used to reduce the exercise-induced inflammatory response under conditions where muscle soreness and/or injuries occur following physical activity (Bleakley et al., 2004; Quintero et al., 2009). The underlying theory is that reducing the inflammation will improve muscle tissue recovery (Bleakley et al., 2004; Quintero et al., 2009). The exercise-induced inflammatory response is necessary for performance adaptation (Kurtz, Loebig, Anderson, DeMeo, & Campbell, 1999), although, it may also lead to injury and is often associated with pain or discomfort by the individual (Abbas et al., 2007). Considering these two, opposing concepts, it would be valuable to understand the appropriate management of exercise-induced inflammation for both injury prevention and performance gains. Further complicating this question are external factors, which can enhance or reduce systemic inflammation (Gomez, Nomellini, Faunce, & Kovacs, 2008; Weiskopf, Weinberger & Grubeck-Loebenstein, 2009). In particular, age has significant impacts on both immune function and underlying inflammatory status (Franceschi et al., 2007; Gomez et al., 2008; Weiskopf et al., 2009). For example, aging impacts immune function by weakening immune responses to infections (Gomez, Boehmer, & Kovacs, 2005). Therefore, the purpose of this paper is to answer two questions: 1) ‘Does Exercise- Induced Inflammation Serve a Useful Purpose?’; and 2) ‘How Does Aging Affect this Process?’ To address these questions, this paper will first: i) review the role of inflammation as part of the Exercise-Induced Inflammation 8 innate immune response; ii) examine the positive and negative consequences of the exercise induced inflammatory response; and iii) outline the age-related effects on both the immune system and underlying inflammatory status.
An examination of some theories that address the heavy alcohol consumption of university students
(2015-05-05) Treleaven, Taylor M.
The following paper investigates some of the many theories used to explain underlying reasons contributing to student drinking. Reasons for student drinking include escape from reality, social discomfort, former child abuse and neglect, and specific personality types. After reviewing various theories of addiction, this paper uses a deductive approach to identify the three theories most relevant student binge drinking: the social learning theory, the behavioural theory, and the personality theory. From social reasons to behavioural and personality related reasons, students drink to be more social and to cope with stress, but these rewards do not come without risks. The ability of theory to adapt to address the unique needs of individuals makes it an important, albeit underused, tool. Using theory to inform intervention strategies, then, is essential for developing effective treatment. Future research in this area should focus on methods for integrating theory with addiction treatment.
Examining the effects of the holistic arts-based program on teachers’ stress, mindfulness and teaching practices
(2019-06-26) Hardy, Amanda
The concept of teacher stress has received extensive study in the field of education. School boards, unions, and governments acknowledge the high prevalence of stress amongst teachers. Efforts to mitigate the negative effects associated with teacher stress on teacher wellbeing and student learning conditions have led to the development of a number of interventions including Mindfulness-Based Interventions (MBIs). MBIs offer participants training in developing non-judgmental present moment awareness, which has been shown to decrease stress, anxiety, and depression. My research study examined the effects of a specific MBI, the Holistic Arts-Based Program (HAP) on teachers’ reported stress levels, mindfulness skills, and their teaching practices. HAP is an arts-based 12-week MBI designed to make mindfulness concepts and skills more accessible through the use of arts-based methods. Previous studies found that participating in HAP has positive benefits that include improved attention, coping skills, self-awareness, and self-esteem. Data was collected pre- and post-HAP. Teachers were interviewed and completed the Five Facet Mindfulness Questionnaire (FFMQ) and the Teacher Stress Inventory (TSI). Findings are promising regarding the feasibility, suitability, and benefits of HAP for teachers. The qualitative thematic analysis led to the development of the following themes: (1) more accurate and comprehensive understanding of mindfulness, (2) participants’ experiences learning mindfulness through experiential arts-based group work, (3) personal and professional benefits of learning mindfulness, and (4) educational consequences of teachers learning mindfulness through arts-based methods. The TSI and FFMQ also suggested that teacher participation in HAP contributed to decreased teacher stress and increased teachers’ mindfulness, their presence, and capacity to offer mindfulness activities to students. This study demonstrates how HAP could support teachers in increasing their own selfawareness and mindfulness practice, thereby mitigating some of the negative effects of stress. Participants in this study also demonstrated a keen interest in bringing mindfulness into their schools and classrooms. Future consideration may be given to offer arts-based mindfulness training to teachers in different formats such as full-day workshops or professional development sessions.
An exploration of accident/failure at attribution and the potential implications for future research in occupational health psychology with psychiatric nurses
(2016-05-24) Desroches, Justin C.
The current review of the literature provides an overview of Attribution Theory (AT) and the themes, trends and gaps that have emerged for this construct within the field of occupational health psychology. AT is a widely published area of research and has served as a theoretical framework to investigate how individuals interpret accidents and their causes. Within this framework, researchers have investigated cognitive biases such as the selfserving bias, the false consensus effect, the actorobserver bias, the fundamental attribution error, the ultimate attribution error, Fischoff’s hindsight bias, the hedonic relevance bias, the optimism bias, and defensive attribution theory. Themes and trends of this review include subjective attribution tendencies, the types of attributions and their relation to safety behaviours, controversies regarding the assumptions of responsibility and the importance of accurate accident appraisals. Current gaps in the literature include somewhat dated research and only partial use of Weiner’s AT model (1985; 2010). In addition, there seems to be a paucity of research on AT as it applies to occupations with a high prevalence of accidents such as psychiatric nursing. The review further describes the extent to which the theory may be useful for occupational health and safety, accident prevention and in psychiatric nursing where practitioners face not only the common risks inherent to the profession but also the significant and unique risks in mental health facilities such as patient aggression and violence. This paper concludes by suggesting avenues of possible research as it applies to this profession, methodological challenges and the implications for future studies.
Exploring indigenous and visible minority women’s access to preventive breast and cervical cancer screening in Canada: a narrative review
(2023-03-14) Richer, Rebecca D.
Canada’s health care system is founded on the principles of need rather than ability to pay, priding itself for its decentralized, publicly-funded health care system that provides firstdollar coverage for preventive services across all provinces and territories (Allin et al. 2020; Kumachev et al. 2016). Despite best efforts through federal sharing and the indisputable evidence for early preventive mammography and Pap smear screening, profound disparities are found in service availability, utilization and accessibility for Indigenous and Visible Minority women in Canada (Amankwah et al. 2009; Demers et al. 2015; Ferdous et al. 2020). The purpose of this narrative review is threefold: to explore the incidence of breast and cervical cancer amongst Indigenous and Visible Minority populations in Canada, to explore potential barriers associated with the uptake of mammograms and Pap smear tests by these two populations; and to explore achievable interventions to improve access to cancer preventive services for Indigenous and Visible Minority women. This review uses the WHO Social Determinants of Health framework (SDOH) (World Health Organization 2010) rooted in equity to guide the review of the literature, and the Five Dimensions of Accessibility of Healthcare Services (Levesque et al. 2013) to guide the thematic analysis of intervention models. An initial literature search was conducted using Google Scholar and Science Direct databases for articles published from 2000 to 2022, yielding 8,462 articles. After screening for irrelevant titles, and non-Canadian studies, 97 publications remained. After 71 duplicates and publications that did not meet the search criteria were removed, a manual search was performed, yielding a total of 34 publications that were included in the narrative review. Of these 34 articles, 17 articles concerned Visible Minority populations and 17 articles, Indigenous populations. The articles included in this review covered four provinces: (1) British Columbia, (4) Manitoba, (13) Ontario and (2) Quebec, with the remaining 14 referencing Canada as a whole. The studies shared similar trends in breast and cervical cancer incidence and screening uptake for Indigenous and Minority women, with Pap smear uptake being lower than the national threshold and mammography uptake being lower in these populations compared to the rest of the Canadian population. Through thematic analysis, the most common barriers influencing accessibility and underutilization of preventive breast and cervical cancer were found to include socioeconomic status, culture and communication, education, lack of appropriate health care providers, and societal beliefs and attitudes towards cancer screening amongst both populations. Finally, possible interventions were identified in the literature that may inform strategies to achieve more equitable access to healthcare services tailored to Canada’s multicultural society.
Exploring media representations of overweight & obese women’s dietary and exercise behaviours in the biggest loser: a self-determination theory approach
(Laurentian University of Sudbury, 2014-10-22) Tennant, Melissa
Objective: The purpose of this study was to use self-determination theory (SDT) to gain a better understanding regarding how weight loss practices (i.e., dietary and exercise behaviours) and weight loss strategies for overweight and obese women were portrayed within the reality television show The Biggest Loser (Season 13). The psychological, behavioural and health promotion implications were of interest. Design and Method: An ethnographic content analysis (see Altheide, 1996) of media representations of all 18 episodes within season 13 of The Biggest Loser were undertaken with a specific focus on five female contestants. Results: Analysis revealed that weight loss was portrayed under an over-arching theme: reaching weight loss goals equals success/not reaching weight loss goals equals failure. Multiple meanings of weight loss and implications emerged depending on four distinct sub themes: a) fat women’s lack of self-control; b) weight loss strategies associated with disordered exercise practices; c) weight loss promoted as a privilege; and d) weight loss as a new and improved self. These themes had motivational implications when interpreted within the context of SDT. Conclusion: This study extends the understanding of the ways in which certain forms of media (i.e., reality television) construct and reinforce particular cultural, social and behavioural norms concerning the promotion of weight loss practices in overweight women. This study also extends previous exercise psychology literature seeking to conceptualize and study the promotion and selfregulation of exercise and weight loss practices from a SDT perspective within a cultural context (i.e., the media).
Exploring traditional roles of first nation older adults to promote the quality of life for those experiencing alzheimer's disease and related dementia's
(2017-10-03) Cornect-Benoit, Ashley
The emergence of Alzheimer's disease and related dementia’s (ADRD) in Indigenous populations across Canada is a rising concern as prevalence rates exceed those of non- Indigenous populations. Culturally appropriate approaches to address the increased prevalence of ADRD are guided by the Indigenous Wholistic Theory and the Intergenerativity Model. Community-based participatory action research led by interviews, focus groups and program observations aid in identifying barriers and facilitators of success for intergenerational social engagements in the Anishinaabe community of Wikwemikong, Ontario. A qualitative thematic analysis guides future recommendations for programming opportunities to foster traditional roles of older First Nation adults and intergenerational relationships. This project results in culturally appropriate suggestions to improve healthy brain aging in older populations through increased social interactions with youth and the nurturing of traditional roles. The results of this study are relevant to other Indigenous communities who may wish to adopt the framework to their own community context.
Factors that impact opioid agonist therapy in Northern and Rural Ontario
(2016-09-06) Franklyn, Alexandra Michelle
Opioid agonist therapy is the gold standard of care for opioid dependence. However, the efficacy of treatment may be hindered by concurrent drug use, including cocaine and benzodiazepines. This thesis examines the impact of concurrent drug use on treatment retention, and whether it is differentially impacted by geographic region. We conducted a retrospective cohort study using electronic medical records from 58 opioid agonist therapy clinics in Ontario. One-year treatment retention was the primary outcome of interest. Both baseline cocaine and benzodiazepine users experienced decreased retention rates than non-users. Patients who used concurrent drugs at higher frequencies experienced decreased retention rates compared to those who used less often. Northern and urban patients were more likely to be baseline cocaine users, and Southern urban patients were more likely to be benzodiazepine users. Both baseline and continued concurrent drug use is predictive of treatment drop out in Northern and Southern patients.
Getting to the root: ceremony leader perspectives of the healing potential of ayahuasca drinking for eating disorders
(2020-08-11) Kingston Miller, Annie
Ayahuasca is a plant medicine traditionally used by Indigenous groups in the Amazon. Researchers are now exploring its healing potential for mental illnesses. This qualitative study evaluated the perspective of fifteen ceremonial leaders’ using content analysis on the healing potential of ayahuasca drinking among individuals with eating disorders. Leaders’ theories of eating disorders included the belief that eating disorders: are reflective of a deeper issue, including unprocessed trauma; have an adaptive function; affect health on multiple levels; are similar to addiction. Leaders’ theories on the healing mechanisms of ayahuasca included that ceremonial experiences: support participants to process and integrate underlying causes of the illness; facilitate physical, spiritual, mental and emotional healing; enhance and reorganize relationships with symptoms, self, community and creation; and support healing through a general shamanic approach. From their perspective, ayahuasca offers a potentially new and novel treatment option in the healing of eating disorders.
The good student or the good patient? The barriers encountered by undergraduate medical students with disabilities at the Northern Ontario School of Medicine
(2021-08-24) Belanger, Rachel
The American Association of Medical College’s (AAMC) Lived Experience report was released in March 2018 with hopes of broadening the diversity of medical students to include more of those with disabilities (Meeks & Jain, 2018). The authors hoped to generate discussion and study the lived experiences of current medical students, residents and practicing physicians with disabilities to learn about the barriers and supports that they have and continue to encounter along their journeys in medicine. In response to the Meeks & Jain (2018) publication, the purpose of this study was to replicate their study with the research question “What are the barriers encountered by undergraduate medical students with self-identified disabilities at one Northern Ontario medical school?”. The Lived Experience Project provides a unique opportunity to learn about, and compare the experiences of, participants in this study to medical students at one medical school in Northern Ontario (Meeks & Jain, 2018). In doing so, the climate and culture of this school and how this affects the treatment and education of students with disabilities, including the barriers they face in the academic accommodation process, in medical environments and throughout medical school as a whole were explored. A qualitative descriptive study design was used. Data was collected using an initial demographics-based survey followed by a semi-structured interview. Interviews were conducted in person or by telephone. Data was transcribed and analysed using Braun & Clarke Thematic Analysis (2013). It was found that the participants of this study found barriers directly associated with their medical education in addition to barriers indirectly associated with their medical education and finally, barriers outside of medical school. Supports in the lives of participants were also identified as a theme in the current research, suggesting a positive impact in the lives of medical students with disabilities. No barriers specific to being a student in Northern Ontario arose, which may be in part to the nature of the sample and small sample size. Implications for this research include reviews of accommodation policies, revision of technical standards at a national and institutional level as well as strengthened communication between the student, the medical school, faculty, and administration.
Human immunodeficiency virus -1 (HIV-1) –Transactivator of transcription protein (Tat) effects on Macrophage polarization
(Laurentian University of Sudbury, 2015-08-10) Sarwan, Sylvia
The human immunodeficiency virus (HIV) relies on its encoded proteins to orchestrate cellular mechanisms for its replication and to induce inflammatory responses that recruit and compromise lymphocytes. Among them is the HIV trans-activator protein (Tat). Tat is required for the viral replication and enhances the infection of HIV in the host organism. Tat may also have an impact on the functions of the macrophage, an important player in pathological changes of AIDS patients. Some evidence exists that may suggest a more M2 like behavior of HIV infected macrophage. Tat has been shown to down-regulate P53 in macrophages. HIV infected macrophage had higher amount of arginase and became a major source of HIV viral load in patients with late stage AIDS. In this study, we investigated the possible role of Tat in the functional polarization of macrophages, a process that switches macrophage function between pro- inflammation (M1) and promotion of tissue repair and healing (M2). Effects of Tat on the macrophage were studied with human monocytic THP-1 cells that have been stably transfected with wild type Tat, or N terminus segment of Tat 1-48 aa or C terminus segment of Tat 37-86aa. Lipopolysaccharide (LPS), an activator of M1 macrophage, was used to activate these THP-1 cells. Exposure to LPS led to significant increase in inducible nitric oxide synthase (iNOS) in un-transfected THP-1 cells, GFP transfected cells, and cells with Tat 37-86 aa. However, THP-1 cells expressing wild type Tat or Tat 1-48aa showed no increase in iNOS whereas a rise in arginase was observed in Tat 1-48aa after LPS exposure. We also studied SOCS 1 and SOCS 3 expression and observed a greater SOCS 1 induction only in clones that had elevated iNOS in response to LPS. Wild-type Tat had no effect on SOCS 1 expression and cells with Tat1-48aa showed a decrease in SOCS 1. Cells expressing Tat 1-48aa displayed reduced HDAC 3 and SOCS 3 levels. Our data demonstrated that wild type Tat and Tat 1-48aa may impair or diminish the response of THP-1 cells to LPS. Our data may also suggest that wild- type Tat and Tat1-48aa have conditioned THP-1 cells towards M2 polarization. This may also suggest that cells expressing wild- type Tat or Tat 1-48aa may exhibit M2 behaviours.
The impact of medical instructors' attitudes towards patients with developmental disabilities on undergraduate medical students in Northern Ontario
(2020-04-20) Groom, Alicia
The attitudes possessed by health care professionals are an important factor in patients with developmental disabilities’ (DD) ability to access services, particularly in rural and remote regions, such as Northern Ontario. Despite the expressed need for greater education in medical school on DD, students and providers often report discomfort when working with these patients. This major paper aimed to answer the question: What impact do instructors and preceptors have on medical students’ attitudes towards patients with developmental disabilities? Social Power Theory (French & Raven, 1959) was used to explore the themes in the literature. A total of 56 articles published between 1980 and 2019 were identified and reviewed for this analysis. Three main themes were identified in the literature including: (1) Barriers to accessing health care, including both providers’ and students’ knowledge and attitudes; (2) Gaps in the health care curricula and formal education; and (3) the power dynamic and culture of medical education. The results of this review indicate that there is a lack of formal education and few clinical opportunities for students to learn about DD. Patients with DD have expressed a desire to be included in medical education in a professional capacity as an educator; this position of power may provide them with an opportunity to improve students’ knowledge while reducing potential biases. Although medical educators are experts in their field, they are often not formally trained as educators. The implications of this lack of formal training are that much of preceptors’ teaching styles are left to their discretion, which may include negative teaching approaches such as “ritual humiliation”
Improving the response to intimate partner violence experienced by First Nations people in the primary care setting: provider perspectives on Manitoulin Island
(2019-10-18) Rizkalla, Kristin Michelle
Indigenous women and men living in Canada experience disproportionately high rates of intimate partner violence (IPV) compared to non-Indigenous women and men, which is best explained within a colonial context. Despite the wide range of adverse physical, sexual and psychological outcomes of IPV, a coordinated approach to the phenomenon has yet to be established in the healthcare and social services system on Manitoulin Island, a region in Northeast Ontario. This project was aimed to address that gap at the primary care level through community based participatory research. Using a Grounded Theory and qualitative research approach, primary care providers (n=31) participated in focus groups and interviews to discuss their perceptions of what is required to improve the response to IPV in the primary care setting. The analysis focused on elucidating the barriers and facilitators that exist within current practices, those of which prevent or ease the delivery of care to First Nation patients who are experiencing IPV. Suggestions for culturally relevant improvements at a health care provision and community level are discussed. Further studies should include knowledge translation back into the communities on Manitoulin Island as well as the perspectives of the survivors of intimate partner violence and their perception of what can be improved within current provider practices.
The influence of social determinants of health on child physical health in Greater Sudbury neighbourhoods
(2016-04-27) Cox, Kent
There is increasing awareness that social determinants of health are associated with growing health inequities, or avoidable differences, among many populations. The City of Greater Sudbury is experiencing these health inequities, including inequities in child physical health and wellbeing. This study will examine the relationship between specific social determinants of health and child physical health and wellbeing in Greater Sudbury neighbourhoods. The goals of this research are 1) to explore the relationships between specific social determinants of health and child physical health and wellbeing in Greater Sudbury neighbourhoods, 2) explore the collective influence of social determinants of health on child physical health and wellbeing, and 3) examine unique relationships that may exist between the social determinants of health and children physical health in neighbourhoods for the City of Greater Sudbury. The complexity, nature, and interactions of the social determinants of health within society makes observing them quantitatively difficult. This requires many different social determinants of health to be studied separately from one another, as well as together, in order to understand how they influence child physical health and wellbeing. In order to better understand these interactions, the social ecological model of health promotion presents an ideal theoretical framework for examining multiple variables and their correlations and, therefore, is used in this study. This study is an ecological crosssectional study using secondary data analysis of the 2011 National Household Survey (Statistics Canada) and the Early Development Instrument which was developed by the Offord Centre for Child Studies. This study involves a multi-variate analysis with the dependent variable of child physical health being represented by a composite measure of child physical health and wellbeing, and multiple independent variables including different measures of neighbourhood income, education, unemployment, lone-parent families and poverty. Child physical health and wellbeing is represented by the Early Development Instrument (EDI) - a questionnaire completed by the teacher or an Early Child Educator (ECE) when the child is in senior kindergarten. The EDI is a comprehensive measure of child physical health and wellbeing because it includes gross/fine motor skills, physical readiness for the school day, and physical independence. The social determinants of health are represented by the National Household Survey – a voluntary sample survey using a random sample collected by Statistics Canada, which the federal government uses to collect social and economic data about the Canadian population (Statistics Canada, 2011). IV Descriptive statistics address the assumptions of linear regression as well as examine the nature and normalcy of the independent and dependent variables. Then the presence of outliers are tested using univariate, bivariate, and multivariate detection methods. Linear and multiple regression tests are then used to analyze the influences of the social determinants of health on child physical health and wellbeing. The results of this study demonstrate the challenges of exploring geographical differences in the health of a population, and how those differences in health may be socially produced. Furthermore, this study provides insight into better understanding how child physical health and wellbeing in Greater Sudbury neighbourhoods may be influenced by socially produced health disparities.

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