Where Are the NGOs and Why? The Distribution of Health and Development NGOs in Bolivia

Background The presence and influence of nongovernmental organizations (NGOs) in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution of NGO activity across municipalities in Bolivia. Methods The research question is addressed using a geographic information system (GIS) and multiple regression analyses of count data. We used count data of the total number of NGO projects across Bolivian municipalities to measure NGO activity both in general and in the health sector specifically and national census data for explanatory variables of interest. Results This study provides one of the first empirical analyses exploring factors related to the distribution of NGO activity at the national scale. Our analyses show that NGO activity in Bolivia, both in general and health-sector specific, is distributed unevenly across the country. Results indicate that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. Results for NGO activity in general and health-sector specific NGO activity were similar. Conclusions The uneven distribution of NGO activity may suggest a lack of co-ordination among NGOs working in Bolivia as well as a lack of co-ordination among NGO funders. Co-ordination of NGO activity is most needed in regions characterized by high NGO activity in order to avoid duplication of services and programmes and inefficient use of limited resources. Our findings also indicate that neither general nor health specific NGO activity is related to population need, when defined as population health status or education level or poverty levels. Considering these results we discuss broader implications for global health and development and make several recommendations relevant for development and health practice and research

A Two-Stage Cluster Sampling Method Using Gridded Population Data, A GIS, And Google Earthtm Imagery in a Population-Based Mortality Survey in Iraq

Background Mortality estimates can measure and monitor the impacts of conflict on a population, guide humanitarian efforts, and help to better understand the public health impacts of conflict. Vital statistics registration and surveillance systems are rarely functional in conflict settings, posing a challenge of estimating mortality using retrospective population-based surveys. Results We present a two-stage cluster sampling method for application in population-based mortality surveys. The sampling method utilizes gridded population data and a geographic information system (GIS) to select clusters in the first sampling stage and Google Earth TM imagery and sampling grids to select households in the second sampling stage. The sampling method is implemented in a household mortality study in Iraq in 2011. Factors affecting feasibility and methodological quality are described. Conclusion Sampling is a challenge in retrospective population-based mortality studies and alternatives that improve on the conventional approaches are needed. The sampling strategy presented here was designed to generate a representative sample of the Iraqi population while reducing the potential for bias and considering the context specific challenges of the study setting. This sampling strategy, or variations on it, are adaptable and should be considered and tested in other conflict settings

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The Role of Emotions in Generating and Sustaining Climate Action for Youth Climate Champions: An Exploratory Study in Northern Ontario

Young people are frequently positioned at the forefront of the climate movement while also often being considered vulnerable to the mental and emotional impacts of climate change. While climate emotions research is rapidly increasing, little is known about young peoples’ lived emotional experiences of climate change and climate action. This research, grounded in social constructivism, aimed to explore the emotions, supports, and experiences that are generative and supportive of climate action for youth climate champions in Northern Ontario, Canada. In the spring of 2022, 12 youth climate champions (ages 15-24) participated in semi-structured interviews and asynchronous letter writing. This paper describes two thematic networks that were derived using thematic network analysis. The first network, climate emotions, is characterized by five organizing themes: 1) ecoanxiety, 2) emerging loss and grief, 3) triggers, 4) coping strategies, and 5) impacts on living and life. The second network, motivations and support for youth climate action, is described through three organizing themes: 1) action is unique to person and place, 2) intersections of emotion and action, and 3) key relationships and supports. Reflecting on this research, we offer two insights relevant to those engaging in health and education spaces with youth. First, there is a need to establish accessible, safe spaces for young people to collectively recognize, explore, and process complex climate emotions. Second, education systems across rural and remote regions are strategically positioned to support the health and wellbeing of young people through the implementation of holistic climate education that includes opportunities for engaging in collective climate action

Climate emotions and anxiety among young people in Canada: A national survey and call to action

Introduction: Young people have a unique positionality in relation to the mental and emotional dimensions of climate change: they have contributed the least to the crisis, they are and will be disproportionately impacted, and they have limited opportunities and invaluable perspectives for influencing action. Evidence increasingly illustrates that young people are particularly vulnerable to climate distress and anxiety. Methods: The purpose of this study was to generate knowledge about climate emotions and climate anxiety among young people using a representative survey. We surveyed 1000 young people (aged 16–25) across Canada. The online survey asked respondents about: (i) climate emotions and their impacts, (ii) perspectives on the future due to climate change, (iii) perspectives and feelings about government (in)action, (iv) perspectives on supports, programs, and resources needed to cope with climate emotions and anxiety, and (v) perspectives on climate change education (including socio-emotional dimensions). Data were weighted to improve representativeness according to age, gender, and region. Descriptive analyses were conducted, scales were generated, and textual responses were analyzed using thematic analysis. Results: Young Canadians are experiencing a diversity of challenging climate emotions. At least 56% of respondents reported feeling afraid, sad, anxious, and powerless. 78% reported that climate change impacts their overall mental health and 37% reported that their feelings about climate change negatively impact daily functioning. Data also illustrate that climate change is contributing to negative perceptions about their future. For example, 39% of respondents report hesitation about having children due to climate change, 73% report thinking that the future is frightening, and 76% report that people have failed to take care of the planet. Respondents rated governmental responses to climate change negatively and reported greater feelings of betrayal than of reassurance. The data show that young Canadians need a diversity of coping supports and believe the formal education system should be doing more to support them. Conclusion: This study adds to the emerging and increasingly concerning evidence base on climate emotions and anxiety among young people. We conclude by summarizing key directions for future research

Student perceptions and lessons learned from flipping a masters level public health course | Perceptions des étudiants et leçons tirées d’une classe inversée pour un cours de maîtrise en santé environnementale et professionnelle

The flipped classroom instructional model has emerged as an alternative to conventional lecture-based teaching that has dominated higher education for decades. In 2013, a cohort of graduate-level public health students participated in a flipped environmental and occupational health course. We present the design, implementation, and evaluation of this course. Using data collected from a post-course survey, focus group sessions, and classroom observation, we examine student perceptions of the flipped classroom instructional model and synthesize lessons learned from flipping the classroom more broadly. Post-course survey data indicate that students had generally positive perceptions towards the flipped classroom instructional model. Four major themes emerged from the focus group data in relation to perceptions of the flipped classroom: knowledge application, content delivery, innovation, and connecting the online and in-class components. These results are promising and suggest that this approach warrants further consideration and research. Le modèle pédagogique de la classe inversée a émergé comme solution de rechange à l’enseignement traditionnel par cours magistraux qui a dominé l’éducation supérieure pendant des décennies. En 2013, une cohorte d’étudiants en santé publique aux cycles supérieurs a participé à un cours inversé sur la santé environnementale et professionnelle. Nous présentons la conception, la mise en œuvre et l’évaluation de ce cours. À l’aide de données recueillies par l’entremise d’un sondage après le cours, lors de séances de discussion en groupe et d’observation en classe, nous examinons les perceptions qu’ont les étudiants du modèle pédagogique de la classe inversée et résumons les leçons tirées qui sont pertinentes pour les cours inversés en général. Les données du sondage réalisé après le cours indiquent que les étudiants avaient des perceptions pour la plupart positives du modèle pédagogique de la classe inversée. Quatre thèmes principaux ont émergé des données du groupe de discussion relativement aux perceptions sur la classe inversée : mise en application des connaissances, diffusion du contenu, innovation et lien entre les composantes en ligne et en classe. Ces résultats sont prometteurs et suggèrent que cette approche devrait faire l’objet de plus de considération et de recherche

What Drives Climate Action in Canada’s Provincial North? Exploring the Role of Connectedness to Nature, Climate Worry, and Talking with Friends and Family

Despite widespread calls to action from the scientific community and beyond, a concerning climate action gap exists. This paper aims to enhance our understanding of the role of connectedness to nature in promoting individual-level climate action in a unique setting where climate research and action are lacking: Canada’s Provincial North. To begin to understand possible pathways, we also examined whether climate worry and talking about climate change with family and friends mediate the relationship between connectedness to nature and climate action. We used data collected via postal surveys in two Provincial North communities, Thunder Bay (Ontario), and Prince George (British Columbia) (n = 628). Results show that connectedness to nature has a direct positive association with individual-level climate action, controlling for gender and education. Results of parallel mediation analyses further show that connectedness to nature is indirectly associated with individual-level climate action, mediated by both climate worry and talking about climate change with family and friends. Finally, results suggest that climate worry and talking about climate change with family and friends serially mediate the relationship between connectedness to nature and with individual-level climate action. These findings are relevant for climate change engagement and action, especially across Canada’s Provincial North, but also in similar settings characterized by marginalization, heightened vulnerability to climate change, urban islands within vast rural and remote landscapes, and economies and social identities tied to resource extraction. Drawing on these findings, we argue that cultivating stronger connections with nature in the places where people live, learn, work, and play is an important and currently underutilized leverage point for promoting individual-level climate action. This study therefore adds to the current and increasingly relevant calls for (re-)connecting with nature that have been made by others across a range of disciplinary and sectoral divides.Other UBCNon UBCReviewedFacultyResearche

A Scoping Review Examining Governance, Co-Creation, and Social and Ecological Justice in Living Labs Literature

Living Labs (LLs) are increasingly being used as an approach to address complex sustainability-related challenges. Inspired by existing knowledge and practice gaps, calls for further examination of governance and co-creation in relation to LLs work, and our experiences in the Lake Superior Living Labs Network, we conducted a scoping review of the recent (2015–2019) LLs literature. This review focused on peer-reviewed LLs literature aimed at addressing sustainability-related challenges and involving universities as key collaborators specifically. This scoping review addressed the research questions: how are LLs conceptualized, described, and applied? how are LLs governed? How is co-creation supported in LLs work? and, are social and/or environmental justice considered in LLs work? From the 729 citations gathered in the electronic database searches, 48 papers were identified as relevant through the screening and eligibility assessment. We found that this literature is growing rapidly, highly interdisciplinary, and predominantly taking place within European urban centres. We summarize the findings in relation to our research questions and outline implications for interrogating governance, unpacking co-creation, and working towards social and ecological justice in LLs research and practice. We conclude by outlining four key research directions to advance LLs work, including, (1) expanding research across a greater diversity of settings; (2) examining and analyzing governance and power dynamics; (3) exploring how learning evolves via co-creation; and (4) examining how universities are impeding and/or supporting advances in relation to governance, co-creation, and justice in LLs work

A novel integration of online and flipped classroom instructional models in public health higher education

Background: In 2013, a cohort of public health students participated in a ‘flipped’ Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach. Methods Using mixed-methods, we examined learning experiences and perceptions of the flipped classroom model and assessed changes in students' self-perceived knowledge after participation in the course. We used pre- and post-course surveys to measure changes in self-perceived knowledge. The post-course survey also included items regarding learning experiences and perceptions of the flipped classroom model. We also compared standard course review and examination scores for the 2013 NextGenU/Flipped Classroom students to previous years when the course was taught with a lecture-based model. We conducted a focus group session to gain more in-depth understanding of student learning experiences and perceptions. Results Students reported an increase in knowledge and survey and focus group data revealed positive learning experiences and perceptions of the flipped classroom model. Mean examination scores for the 2013 NextGenU/Flipped classroom students were 88.8% compared to 86.4% for traditional students (2011). On a scale of 1–5 (1 = lowest rank, 5 = highest rank), the mean overall rating for the 2013 NextGenU/Flipped classroom students was 4.7/5 compared to prior years’ overall ratings of 3.7 (2012), 4.3 (2011), 4.1 (2010), and 3.9 (2009). Two key themes emerged from the focus group data: 1) factors influencing positive learning experience (e.g., interactions with students and instructor); and 2) changes in attitudes towards environmental and occupation health (e.g., deepened interest in the field). Conclusion Our results show that integration of the flipped classroom model with online NextGenU courses can be an effective innovation in public health higher education: students achieved similar examination scores, but NextGenU/Flipped classroom students rated their course experience more highly and reported positive learning experiences and an increase in self-perceived knowledge. These results are promising and suggest that this approach warrants further consideration and research.Population and Public Health (SPPH), School ofNon UBCMedicine, Faculty ofReviewedFacult