The impact of a student-led anti-racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism.

INTRODUCTION: Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine. METHOD: A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis. RESULTS: Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education. CONCLUSION: This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.

Trends in Injector Deaths in Ireland, as Recorded by the National Drug-Related Deaths Index, 1998-2014.

OBJECTIVE: The purpose of this study was to provide trend analysis on all deaths among drug users who injected at or around the time of their death in Ireland between 1998 and 2014. METHOD: A review of the data recorded by the National Drug-Related Deaths Index (NDRDI) was conducted to identify individuals who were known to be injecting at or around the time of their death, from 1998 to 2014. RESULTS: Between 1998 and 2014, 16,500 deaths were recorded by the NDRDI. Of these, 792 (5%) people were known to be injecting at or around the time of death; 90% were poisoning deaths (n = 715) and 10% nonpoisoning deaths (n = 77). The majority of those who died while injecting were male (n = 682; 86%). Most people were living in Dublin city or county (n = 550; 69%). One fifth of those who died were homeless (n = 149; 19%). Opioids, specifically heroin, were implicated in the vast majority of injector poisoning deaths (n = 673; 94%), most commonly in association with polydrug use (n = 417; 62%). Single opioid poisoning resulted in 256 deaths (38%), and two fifths of those who died by single opioid poisoning were not alone at the time of death (n = 105; 41%). CONCLUSIONS: This study is the first to describe the trends in all deaths among drug users who injected at or around the time of their death in Ireland between 1998 and 2014. The analysis provides empirical evidence that can be used by policy makers to support the ongoing improvement of drug treatment services, harm reduction initiatives, and overdose prevention strategies for people who inject drugs.

SMAD Signaling in the Airways of Healthy Rhesus Macaques versus Rhesus Macaques with Asthma Highlights a Relationship Between Inflammation and Bone Morphogenetic Proteins.

Bone morphogenetic protein (BMP) signaling is important for correct lung morphogenesis, and there is evidence of BMP signaling reactivation in lung diseases. However, little is known about BMP signaling patterns in healthy airway homeostasis and inflammatory airway disease and during epithelial repair. In this study, a rhesus macaque (Macaca mulatta) model of allergic airway disease was used to investigate BMP signaling throughout the airways in health, disease, and regeneration. Stereologic quantification of immunofluorescent images was used to determine the expression of BMP receptor (BMPR) Ia and phosphorylated SMAD (pSMAD) 1/5/8 in the airway epithelium. A pSMAD 1/5/8 expression gradient was found along the airways of healthy juvenile rhesus macaques (n = 3, P < 0.005). Membrane-localized BMPRIa expression was also present in the epithelium of the healthy animals. After exposure to house dust mite allergen and ozone, significant down-regulation of nuclear pSMAD 1/5/8 occurs in the epithelium. When the animals were provided with a recovery period in filtered air, proliferating cell nuclear antigen, pSMAD 1/5/8, and membrane-localized BMPRIa expression were significantly increased in the epithelium of conducting airways (P < 0.005). Furthermore, in the asthmatic airways, altered BMPRIa localization was evident. Because of the elevated eosinophil presence in these airways, we investigated the effect of eosinophil-derived proteins on BMPRIa trafficking in epithelial cells. Eosinophil-derived proteins (eosinophil-derived neurotoxin, eosinophil peroxidase, and major basic protein) induced transient nuclear translocation of membrane-bound BMPRIa. This work mapping SMAD signaling in the airways of nonhuman primates highlights a potential mechanistic relationship between inflammatory mediators and BMP signaling and provides evidence that basal expression of the BMP signaling pathway may be important for maintaining healthy airways.