pediatric anesthesia thesis topics

Hot Topics in Safety for Pediatric Anesthesia

Affiliation.

• 1 Division of Pediatric Anesthesia, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
• PMID: 33233518
• PMCID: PMC7699483
• DOI: 10.3390/children7110242

Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.

Keywords: patient safety; pediatric anesthesia; perioperative safety events.

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Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019

• Published: 22 August 2021
• Volume 126 , pages 8749–8759, ( 2021 )

Cite this article

• S. G. Grace   ORCID: orcid.org/0000-0001-7583-717X 1 ,
• F. S. S. Wiepking   ORCID: orcid.org/0000-0002-3509-7549 1 &
• A. A. J. van Zundert   ORCID: orcid.org/0000-0002-1836-6831 1  

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Publication of research in anaesthesia is increasingly competitive. Understanding what topics of research are more likely to be published and where, is clearly valuable for authors seeking to optimise reach and impact of their work. This study aimed to identify the relative proportion of anaesthesia articles by topic for five anaesthesia journals over a 10-year period from 2010 to 2019, including any differences between journals and regions. We chose five anaesthesia journals based on current impact factor. All journal issues published between 2010–2019 were checked for total number of articles with only original research articles being further categorised by topic, country of research, funding status and citation count. Of 5782 original research articles analysed, the most frequent article topics published were translational studies (16%) and clinical practice (16%). Obstetric anaesthesia was the least frequent published (4%). Translational studies were the most frequently funded (84%) while articles on paediatric anaesthesia were least frequently funded (29%). The average number of citations per funded article was 37 versus 28 for non-funded articles. Translational studies were the most frequently published topic of research conducted in North America (25%) and Asia (25%), but of only average frequency in Europe (9%). Studies in obstetric and paediatric anaesthesia are less well-represented in anaesthesia literature and researchers may experience greater difficulty publishing these topics and obtaining funding accordingly. Authors should be aware of the diverse publishing tendencies of the different journals in anaesthesia in order to save time and effort when submitting research for publication.

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Abbreviations

British Journal of Anaesthesia

European Journal of Anaesthesiology

Regional Anesthesia and Pain Medicine

High-income country

Low/middle-income country

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Acknowledgements

Many thanks to Rachel Ling and Aakanksha Sahu for their assistance with the original data collection.

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Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Brisbane and the University of Queensland, NHB, Butterfield St, Herston, Brisbane, QLD, 4006, Australia

S. G. Grace, F. S. S. Wiepking & A. A. J. van Zundert

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Samuel Grace: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft; Floris Wiepking: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft; André Van Zundert: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft.

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Correspondence to A. A. J. van Zundert .

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Grace, S.G., Wiepking, F.S.S. & van Zundert, A.A.J. Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019. Scientometrics 126 , 8749–8759 (2021). https://doi.org/10.1007/s11192-021-04129-0

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Received : 24 May 2021

Accepted : 05 August 2021

Published : 22 August 2021

Issue Date : October 2021

DOI : https://doi.org/10.1007/s11192-021-04129-0

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99+ Best Thesis Topics In Pediatrics For Students In 2023

Thesis Topics In Pediatrics plays an important role in a student’s academic life, shaping their future in the field of child healthcare. But what exactly is a thesis topic in pediatrics? It is a specific subject or issue within the field of child health that a student chooses to research and write about for their thesis.

Selecting the right thesis topic in pediatrics is crucial, as it sets the course for an extensive research journey. In this blog, we delve into the significance of making a wise choice, offering guidance on how to choose a good thesis topic in pediatrics.

We also provide a comprehensive list of 99+ Thesis Topics In Pediatrics for students in 2023, ensuring that you find an area that resonates with your passion and curiosity. Furthermore, we highlight the importance of thesis research in pediatrics and offer tips for writing a successful thesis in this specialized field.

Stay tuned with us to explore the world of Thesis Topics In Pediatrics, while learning how to avoid Common Mistakes in your research journey!

What Is A Thesis Topic In Pediatrics?

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In pediatrics, a thesis topic is a specific subject or question that a student or researcher chooses to study in-depth. It’s like a special area of interest within the field of child healthcare. For example, a thesis topic in pediatrics could be about childhood obesity, which means focusing on understanding and finding solutions for the issue of children being overweight.

To pick a thesis topic in pediatrics, you need to think about what aspect of children’s health you want to explore, like a puzzle you want to solve. Once you decide, you’ll research, gather information, and maybe even conduct experiments to learn more about your chosen topic. The goal is to contribute new knowledge to the field and help improve the health and well-being of children. So, a thesis topic in pediatrics is like a special project that helps us understand and address important health issues in kids.

Why Is It Important To Choose A Good Thesis Topic?

Choosing a good thesis topic is crucial because it sets the direction for your entire research project. It determines what you will study and how you can contribute to your field. A well-chosen topic can make your research more interesting, meaningful, and impactful, while a poor choice might lead to difficulties and a less valuable outcome.

• Relevance: A good topic should be relevant to your field and address important questions or issues.
• Interest: It’s important to choose a topic that genuinely interests you, as this will keep you motivated throughout your research.
• Contribution: Your topic should offer the potential to add new knowledge or solutions to existing problems.
• Feasibility: Ensure the topic is manageable within your available time and resources.
• Guidance: Seek advice from professors or mentors to select a well-defined and researchable topic.

How To Choose A Good Thesis Topic In Pediatrics

Here are some steps on how to choose a good thesis topic in pediatrics: 

1. Identify Your Passion

Start by thinking about what aspects of pediatric healthcare truly interest you. Consider what makes you curious and excited, like helping kids with allergies, or understanding growth patterns in babies. Identifying your passion is the first step to selecting a good thesis topic, as it ensures your enthusiasm and dedication throughout the research process.

2. Relevance to Pediatric Health

Your chosen topic should be relevant to the world of children’s health. It should address a problem, question, or issue that affects the well-being of children. For instance, you could explore topics like childhood vaccinations, nutrition, or common illnesses among kids. The more relevant your thesis topic is, the more impact your research can have on improving pediatric healthcare.

3. Seek Guidance from Experts

It’s a wise idea to consult with professors, advisors, or experts in the field of pediatrics. They can provide valuable insights and suggest research areas that are both interesting and feasible. They’ll guide you to ensure your thesis topic is well-defined and researchable.

4. Feasibility and Resources

Consider the resources and time available for your research. A good thesis topic in pediatrics should be manageable within the scope of your project and the resources at your disposal. Think about whether you can access the necessary data, equipment, and support to investigate your chosen topic effectively.

5. Potential for Contribution

Assess whether your thesis topic offers the opportunity to contribute something new to pediatrics. Consider whether your research can provide solutions, insights, or new knowledge that can benefit children’s health. A good thesis topic should have the potential to positively impact pediatric healthcare.

Here are 99+ best thesis topics in pediatrics for students in 2023: 

General Pediatrics

• What primary care doctors do for kids’ health care.
• Pediatric obesity prevention and management strategies.
• Management of common pediatric infections like ear infections.
• Improving vaccination rates and vaccine hesitancy in pediatric populations.
• Early childhood development and its impact on future health.
• Pediatric pain management and the use of analgesics.
• Child abuse prevention and identification.
• Pediatric nutrition and dietary interventions.
• Pediatric sleep disorders and their implications.
•  Improving access to healthcare for underserved pediatric populations.

Subspecialty Pediatrics

•  Advancements in pediatric cardiology and congenital heart diseases.
•  Childhood cancer research and treatment innovations.
•  Pediatric neurology and the management of epilepsy in children.
•  Pediatric gastroenterology and inflammatory bowel diseases.
•  Neonatology and preterm birth outcomes.
•  Pediatric rheumatology and autoimmune disorders in children.
•  Development of new diagnostic tools in pediatric radiology.
•  Pediatric endocrinology and the management of diabetes in children.
•  Advances in pediatric nephrology and kidney diseases.
•  Pediatric pulmonology and respiratory conditions in children.

Public Health Pediatrics

•  Addressing health disparities in pediatric populations.
•  Pediatric immunization programs and public health outcomes.
•  Child injury prevention and safety measures.
•  Pediatric mental health awareness and access to care.
•  How things in a child’s surroundings can affect their health.
•  Strategies to combat childhood obesity on a public health level.
•  Child abuse prevention and community interventions.
•  School-based health programs and their effectiveness.
•  Public health responses to pediatric infectious disease outbreaks.
•  Promoting oral health in pediatric populations.

Social and Behavioral Pediatrics

•  Understanding the psychosocial impact of chronic illness on children.
•  Pediatric mental health screening and early intervention.
•  Effects of social media and screen time on child development.
•  Parenting strategies for promoting positive child behavior.
•  Pediatric sleep patterns and their influence on behavior.
•  Bullying prevention and intervention in schools.
•  Cultural influences on child-rearing practices and health outcomes.
•  Coping mechanisms for children facing traumatic events.
•  Impact of family dynamics on child behavior and development.
•  Promoting healthy relationships and communication skills in children.

Pediatric Research

•  Novel treatment approaches for rare pediatric diseases.
•  Genetic research in pediatric medicine.
•  Long-term outcomes of pediatric interventions and therapies.
•  Pediatric drug development and safety testing.
•  Ethical considerations in pediatric research.
•  Impact of emerging technologies on pediatric studies.
•  Pediatric clinical trials and patient recruitment.
•  Epidemiological studies in pediatric populations.
•  Advances in pediatric imaging and diagnostic tools.
• Translational research in pediatric medicine.

Pediatric Education

•  Innovative teaching methods in pediatric medical education.
•  Integrating technology into pediatric curricula.
•  Pediatric simulation and its role in medical training.
•  Pediatric residency training program improvements.
•  Interdisciplinary collaboration in pediatric education.
•  Teaching communication skills to medical students for pediatric care.
•  Assessment and evaluation methods for pediatric education.
•  Pediatric ethics and professionalism in medical education.
•  Global perspectives in pediatric training.
•  Teaching cultural competence in pediatric healthcare.

Global Pediatrics

•  Challenges in providing pediatric care in low-resource settings.
•  Child health in conflict zones and refugee populations.
•  Global efforts to combat pediatric infectious diseases.
•  Health programs for emerging country moms and children.
•  Pediatric healthcare in humanitarian crises.
•  International adoption and child health outcomes.
•  Addressing malnutrition and child mortality worldwide.
•  Cultural competence in global pediatric healthcare.
•  Pediatric medical missions and volunteer work.
•  Strategies for improving pediatric healthcare access globally.

Historical Pediatrics

•  The evolution of pediatric medicine throughout history.
•  Key figures and milestones in the history of pediatrics.
•  The impact of historical epidemics on child health.
•  Historical approaches to pediatric surgery.
•  Changing perceptions of childhood and child-rearing.
•  Historical development of pediatric hospitals.
•  History of pediatric immunizations.
•  Historical advances in neonatology.
•  Early pediatric healthcare practices and remedies.
•  Pediatric medical education in the past.

Ethical Issues in Pediatrics

•  Informed consent and decision-making for pediatric patients.
•  Ethical challenges in pediatric clinical trials.
•  Allocation of limited medical resources in pediatric care.
•  Pediatric end-of-life care and decision-making.
•  Genetic testing and privacy concerns in pediatrics.
•  The ethics of pediatric organ transplantation.
•  Balancing autonomy and beneficence in pediatric care.
•  Cultural considerations in pediatric healthcare ethics.
•  Ethical issues in pediatric research involving vulnerable populations.
•  Conflicts of interest and transparency in pediatric healthcare.

Emerging Issues in Pediatrics

•  Implications of telemedicine in pediatric practice.
•  The impact of climate change on child health.
•  Precision medicine in pediatric care.
•  Pediatric mental health in the digital age.
•  Genetic editing and its potential in pediatrics.
•  Addressing the challenges of pediatric obesity.
•  Pediatric considerations in the era of AI and robotics.
•  Healthcare disparities in the post-pandemic world.
•  The role of artificial intelligence in pediatric diagnostics.
• Ethical considerations in the use of gene-editing technologies for pediatric conditions.
• Quantitative Research Topics For STEM Students
• Mental Health Research Topics

Importance Of Thesis Research In Pediatrics

In this section, we are going to discuss some importance of thesis research in pediatrics:

1. Advancing Child Healthcare

Thesis research in pediatrics is important because it helps advance the field of child healthcare. Through in-depth studies and investigations, researchers can find new ways to treat and care for children, making them healthier and happier.

2. Solving Pediatric Problems

Thesis research in pediatrics is like solving puzzles. Researchers tackle important problems, like childhood diseases or nutrition, and work to find solutions. This research can lead to better treatments and practices that improve the lives of young patients.

3. Building Knowledge

Thesis research adds to what we know about children’s health. It’s like adding pieces to a big jigsaw puzzle. Each study contributes a piece of knowledge, and together, they build a clearer picture of how to keep kids well.

4. Training Future Experts

Thesis research helps train future pediatric experts. Students who do this research learn a lot about how to care for kids, so they can become doctors, nurses, or scientists who help children when they grow up.

5. Sharing Wisdom

Thesis research isn’t just for the researchers. They share their discoveries with other doctors, nurses, and healthcare professionals. This way, what they learn can help kids everywhere, not just in one place. It’s like spreading the knowledge to make a bigger difference in pediatrics.

Tips For Writing A Successful Thesis In Pediatrics

Here are some tips for writing a successful thesis in pediatrics:

Tip 1: Clear and Specific Topic

Your thesis in pediatrics should have a clear and specific topic, like “Childhood Asthma Management in Urban Areas.” This makes your research focused and helps readers understand what you’re studying.

Tip 2: Research and Read

Do a lot of study before you write. Read studies, books, and articles that are connected to your subject. This helps you figure out what is known and what you need to find out more about.

Tip 3: Organized Structure

Structure your thesis in a clear and organized way. Use headings and subheadings to divide sections like introduction, methods, results, and conclusions. This makes it easier for readers to follow your research.

Tip 4: Methodology Clarity

Explain your research methods in simple language. Describe how you collected data and why you chose those methods. It helps others understand the validity of your findings.

Tip 5: Concise and Clear Writing

Be clear and to the point when you write. Stay away from lingo and hard words. Your goal is to make your thoughts clear for as many people as possible. Make sure that your writing makes sense and is easy to understand.

Common Mistakes To Avoid When Working On Thesis Topics In Pediatrics

When working on thesis topics in pediatrics, it’s essential to avoid common mistakes to ensure your research is successful. Here are seven mistakes to steer clear of:

• Lack of Clear Focus: Failing to choose a specific and focused topic can lead to confusion and make your research less effective.
• Inadequate Literature Review: Not thoroughly reviewing existing research can result in repeating what’s already known.
• Poor Planning: Inadequate planning may lead to a disorganized thesis and missed deadlines.
• Insufficient Data Collection: Gathering inadequate data can weaken the credibility of your research.
• Complex Language: Using overly technical or complex language can make your thesis difficult to understand.
• Ignoring Feedback: Failing to seek feedback from advisors or peers can result in missed opportunities for improvement.
• Overlooking Proofreading: Neglecting to proofread your work may lead to errors that affect the quality of your thesis.

Thesis Topics in Pediatrics play a vital role in student research in 2023. These topics are specific areas of study within child healthcare, offering students a chance to make a meaningful impact. Choosing the right topic is crucial, as it should be both interesting and relevant to pediatric health. With over 99 possible thesis topics to explore, students have a wide range of options. Thesis research in pediatrics contributes to improving child healthcare, adding to knowledge, and training future experts.

To succeed, students should focus on clear writing, organized methods, and thorough literature reviews. Avoiding common mistakes like unclear focus, inadequate data, and complex language is also essential. By understanding the importance of selecting a good thesis topic, students can contribute positively to the field of pediatrics.

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A List Of Unexplored Dissertation Topics In Anaesthesia

Anaesthesia is a medical term which means “loss of sensation”. The medications and their related catalysts are called anaesthetics. These anaesthetics are very useful and crucial in performing the medical tests and the surgical operations in order to induce sleep. It is necessary to put the patient to sleep because this prevents the person from feeling any kind of discomfort and pain and it also enables the surgeons to perform a very wide range of medical procedures that regularly need to be performed for various reasons.

Here we have a number of dissertation topics for your inspiration and needs. These topics are perfect and very suitable for your purpose of starting a good thesis based on a strong but unexplored research in field of anaesthesia. One can do their homework on any of these terms of interest. These dissertation topics are also a good choice for writing an essay for your medical speeches and exhibitions.

Here is a list of some interesting dissertation topics in the field of anaesthesia that have not been appropriately explored yet are:

• The comparatively exhaustive relation between fentanyl, hyperbaric lignocaine and intrathecal hyperbaric lignocaine during spinal blockade.
• Pain relief via intramuscular route post operation with comparison of inhibitors NSAID and COX-2
• The effect of intrathecal tramadol for surgery of hernia on the behavior of subarachnoid blocks.
• The overall influence and effect of intrathecal midazolam on the block of subarachnoid for the caesarean section.
• Comparatively vigorous study of pre operated bilateral infraorbital block of nerve along with the peri incisional infiltration for the need of post-operative pain relief in the cleft lip surgery in the matters of pediatric cases.
• Comparison of intra venous esmolol and oral clonidine for attenuation of the stress response to intubation and laryngoscopy in the middle ear surgery procedures.
• Effects of low dose dexmedetomidine upper infusion on the perioperative hemodynamic response and the post-operative analgesia requirements in the patients that are undergoing laparoscopic cholecystectomy.
• Dexmedetomidine acting as an adjuvant to the intrathecal hyperbaric bupivacaine for the spinal block characteristics and the post-operative analgesia for the lower limb orthopedic surgeries.
• Air way management in the field of pediatric anaesthesia (the Pro seal laryngeal mask airway v/s the endtracheal intubation).
• The efficiency and effectiveness of dexamethasone while getting added as an adjuvant to the combination of local anaesthetics in the brachial plexus block for the post-operative analgesia.
• The placental morphology and mechanism in the pregnancy induced hyper tension along with its clinical significance.

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The SPA-AAP Pediatric Anesthesiology 2024 event has not started yet. Live lectures will take place April 12 - 14, 2024 . Please make sure you are registered for this event and check back later. Thanks for participating!

SPA-AAP Pediatric Anesthesiology 2024 April 12 - 14, 2024

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Meeting Attendance & CME Credits If you register for the meeting, either in-person or virtual, you may view the sessions live or on-demand and still claim CME credit. Recordings will be posted within 5-7 business days following the completion of each session. All attendees, whether viewing the sessions live or on-demand, will have 90 days after the end of the live meeting to complete the online evaluation and claim your CME credits. Questions? Please email us at  [email protected] . EDUCATION MISSION STATEMENT The SPA-AAP Pediatric Anesthesiology 2024 Meeting will focus on topics of interest to those who provide anesthesia, sedation, pain management, and critical care services to infants and children. The overall goals of this program are to: enable attendees to reinforce their existing fund of knowledge; to introduce them to new, state-of-the-art techniques; and to provide them with information that will improve the perioperative care of children. SCOPE & TYPES OF ACTIVITIES The program brings together experts from clinical and basic science disciplines related to pediatric medicine, anesthesia, and surgery. General topic areas include anatomy, pathophysiology, anesthetic pharmacology, sedation, pain management, patient safety, and child advocacy. We will also discuss practice and career management issues. The presentation format is varied, and includes lectures and refresher courses, panel discussions, hands-on workshops and problem-based learning discussions. Additionally, an important part of the program is the presentation of new clinical and basic science research in oral and moderated poster-discussion forums. Significant attendee involvement and feedback are encouraged in all aspects of the program, and will be facilitated by the use of real time computerized audience polling as well as sessions where the audience directly participates in case discussions. Program content is, in fact, the direct result of membership input and extensive audience polling at prior meetings. TARGET AUDIENCE This program is intended for anesthesiologists and other practitioners who care for children in their practice of anesthesiology and/or critical care. It is also intended for clinical and basic science researchers whose areas of investigation relate to pediatric anesthesia. ACCREDITATION AND DESIGNATION SPA/AAP Program:  The Society for Pediatric Anesthesia is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Society for Pediatric Anesthesia designates this Live Course for a maximum of 27.75  AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

For  CRNAs: This program has been prior approved by the  American Association of Nurse Anesthesiology  for  22.75 Class A CE credits ; Code Number 1044266; Expiration Date 4/14/2024.

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Top ten priorities for anesthesia and perioperative research: a report from the Canadian Anesthesia Research Priority Setting Partnership

Les dix priorités principales pour la recherche périopératoire et en anesthésie : un rapport du partenariat canadien pour l’établissement des priorités de la recherche en anesthésie, dolores m. mckeen.

1 Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS Canada

2 Department of Women’s & Obstetric Anesthesia, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS B3K 6R8 Canada

Jillian C. Banfield

Daniel i. mcisaac.

3 Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON Canada

Jason McVicar

Colleen mcgavin.

4 BC SUPPORT Unit, Vancouver, BC Canada

Mary Anne Earle

Claire ward, katharina kovacs burns.

5 Patients for Patient Safety Canada, Edmonton, Canada

6 School of Public Health, University of Alberta, Edmonton, AB Canada

Donna Penner

7 Altona, MB Canada

Gilbert Blaise

8 Centre Hospitalier de l’Université de Montréal, Montréal, QC Canada

Thierry de Greef

9 Montreal, QC Canada

Katherine Cowan

10 James Lind Alliance, University of Southampton, Southampton, UK

Andreas Laupacis

11 Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto, Toronto, ON Canada

The purpose of the Canadian Anesthesia Research Priority Setting Partnership (CAR PSP) was to identify a top ten list of shared priorities for research in anesthesia and perioperative care in Canada.

We used the methods of the James Lind Alliance to involve patients, caregivers, healthcare professionals, and researchers in determining the research priorities in Canada. In a first survey, participants submitted questions that they want research to answer about anesthesia and perioperative care. We summarized those responses into a longlist of questions. We reviewed the literature to see if any of those questions were already answered. In a second survey, participants chose up to ten questions from the longlist that they thought were most important to be answered with research. From that list, the highest ranking questions were discussed and assigned a final rank at an in-person workshop.

A total of 254 participants submitted 574 research suggestions that were then summarized into 49 questions. Those questions were checked against the literature to be sure they were not already adequately addressed, and in a second survey of those 49 questions, participants chose up to 10 that they thought were most important. A total of 233 participants submitted their priorities, which were then used to choose 24 questions for discussion at the final workshop. At the final workshop, 22 participants agreed on a top ten list of priorities.

The CAR PSP top ten priorities reflect a wide variety of priorities captured by a broad spectrum of Canadians who receive and provide anesthesia care. The priorities are a tool to initiate and guide patient-oriented research in anesthesia and perioperative care.

Résumé

L’objectif du Partenariat canadien pour l’établissement des priorités de la recherche en anesthésie (CAR-PSP) était d’établir une liste des dix principales priorités pour la recherche sur les soins anesthésiques et périopératoires au Canada.

Méthodes

Nous avons utilisé la méthodologie de la James Lind Alliance pour impliquer des patients, des aidants, des professionnels de la santé et des chercheurs afin de déterminer quelles étaient les priorités en matière de recherche au Canada. Dans une première enquête, les participants ont envoyé des questions sur les soins anesthésiques et périopératoires auxquelles ils voulaient que la recherche réponde. Nous avons résumé ces envois par une liste exhaustive de questions. Nous avons passé en revue les publications pour voir s’il existait déjà des réponses à ces questions. Dans une deuxième étude, les participants ont choisi dans la liste jusqu’à dix questions qui leur semblaient les plus importantes et pour lesquelles la recherche devrait fournir des réponses. À partir de cette liste, les questions les mieux classées ont été discutées et un classement définitif leur a été attribué au cours d’un atelier où tous les participants étaient présents en personne.

Résultats

Au total, 254 participants ont envoyé 574 suggestions de recherche qui ont été résumées en 49 questions. La littérature a été examinée pour s’assurer que ces questions n’avaient pas déjà reçu des réponses adéquates, et dans une seconde étude, les participants ont choisi jusqu’à 10 questions qu’ils jugeaient les plus importantes parmi ces 49 questions. Au total, 233 participants ont communiqué leurs priorités qui ont alors servi à choisir 24 questions ouvertes pour la discussion dans un atelier final. Dans cet atelier, 22 participants se sont mis d’accord sur une liste des dix principales priorités.

Les dix principales priorités du CAR-PSP sont le reflet d’un grand éventail de priorités venant de Canadiens de tous horizons qui reçoivent ou fournissent des soins d’anesthésie. Ces priorités sont un outil permettant d’entamer et de guider une recherche axée sur le patient dans le domaine des soins anesthésiques et périopératoires.

Current research in anesthesia and perioperative care has focused on studies to better understand physiology and applied pharmacology as well as to assess safety or postoperative pain relief. Such studies advance knowledge about anesthesia and perioperative practice but may not provide readily translatable meaningful answers to relevant patient-centred questions. 1 , 2

Summary of the CAR PSP process and timeline. CAR PSP = Canadian Anesthesia Research Priority Setting Partnership

Funding sources, vested researcher interests, publication pressure, and consumer interests are all potential contributors to influencing the research agenda, often moving it away from the needs of the patients it is meant to serve. 3 For these reasons, although there is much in common between the research that researchers and patients wish to see done, there are often important mismatches. 4 , 5

Canadian anesthesia research is generally delivered through “ responsive funding ” programs to which researchers propose topics to various funding bodies. In Canada (as is elsewhere), the funding pool for anesthesia-related research is increasingly competitive and the research community is looking for direction and funding priorities. 6 – 8 There is now recognition for a “needs-led” program, driven by a systematic approach to identifying and setting research priorities. A Canadian anesthesia and perioperative care research priority-setting framework could assist decision-makers to balance competing demands particularly as research funders are increasingly held accountable for resource allocation. 9 – 12

Most Canadians will experience at least one surgery in their lifetime. 13 In 2015–2016, there were approximately 1.47 million inpatient surgical procedures conducted in Canadian hospitals. 14 Patients receive anesthesia and perioperative care for a variety of surgeries (or for the birth of a baby), but the consistent factor for these patients is the provision of anesthesia care. The large body of knowledge and diverse experience that these patients have is rarely drawn upon.

While most researchers remain guided by the medical model, hoping to understand physiologic mechanisms or prevent adverse outcomes, the social model of research seeks to answer questions and measure outcomes that matter to patients. This approach can increase the relevance and quality of research and lead to better patient outcomes, improved patient experience, and a more sustainable healthcare system. 15 – 17 Regardless of the indication for surgery or anesthesia care, we assume that Canadian patients want to know that anesthesia care (in combination with the procedure they are undergoing) will help “ cure ” their disease, improve their health, reduce pain, or lead to the safe delivery of their newborn. But their priorities can only be truly discovered through patient-oriented research and patient engagement. 18

Patient-oriented research engages patients as partners, and focuses on patient-identified priorities and improving patient outcomes. 19 Notably, engaging patients in research does not limit the focus of the research to clinically focused questions. Patients can be, and are, engaged in preclinical research. 20 Patients’ perspectives are essential to supporting a patient-oriented approach to research, regardless of the specifics of the research question. Patients’ perspectives are also essential to understanding whether healthcare services and procedures make a difference to patients’ health status and quality of life. 21 An extensive search revealed a dearth of patient-oriented research in the published anesthesia literature. 5 , 22 , 23

Formal processes, like those established by the James Lind Alliance (JLA), are being advocated to identify shared patient-oriented priorities and to propose topics for new research. 24 Formal research priority setting is a systematic way of making the case to stakeholders for funded research on relevant, clinically important questions. 25 , 26 The JLA method focuses on joint patient, caregiver, and clinician input to develop a “ top ten” list. The JLA is a non-profit initiative, supported by the National Institute for Health Research in the United Kingdom (UK). The JLA methods for identifying shared clinician and patient/informal caregiver priorities around unanswered clinical questions have been used for over a decade to prioritize research uncertainties in almost 100 healthcare conditions internationally, including anesthesia and perioperative care priorities for the British National Institute for Academic Anesthesia (NIAA). 25 Additional information on the JLA methods is available at http://www.jla.nihr.ac.uk/ .

We set out to conduct a Canadian anesthesia and perioperative care research priority setting exercise as a rare and valuable opportunity to bring together patients, informal caregivers, and clinicians to suggest priorities for the Canadian anesthesia research agenda. 24

We used the JLA methodology to conduct a research priority setting partnership (PSP). See the Figure for the steps followed.

The Canadian Anesthesia Research Priority Setting Partnership (CAR PSP) was overseen by an independent senior JLA advisor (K.C.). We formed a steering committee (SC) with equal representation of anesthesia providers and patients/informal caregivers. The SC informed and directed all the research processes associated with the CAR PSP. This project received research ethics board approval (IWK Health Centre Research Ethics Board #1023459, June 7 2018).

Identifying and inviting partners

Where possible, Canadian partners with diverse anesthesia experiences were identified. Partners included patients and informal caregivers, clinicians, including anesthesiologists, nurses and allied healthcare professionals, all with experience of anesthesia and/or perioperative care. Medical specialty societies, professional and patient organizations and individuals were identified by the SC and invited to endorse the project and/or to nominate people for either the SC and/or attendance at the in-person final prioritization workshop. Eleven national organizations formally agreed to partner with the CAR PSP (Table  1 ).

Table 1

Partner organizations

Further partner recruitment through connections to Strategy for Patient-Oriented Research (SPOR) Units, to request aid in their respective jurisdictions, was facilitated by the Maritime SPOR Unit. The SPOR units are funded by the Canadian Institutes of Health Research to facilitate patient-oriented research. Voices and experiences from diverse and under-represented groups were specifically solicited through targeted recruitment, including contacting representative organizations.

Scope of the Canadian Anesthesia Research Priority Setting Partnership

The CAR PSP invited questions about all aspects of care during anesthesia and the perioperative period, and the management of longer-term problems that originated during this period. The management of chronic pain was not considered unless the pain originated around the time of anesthesia. The initial scope was discussed and further defined and clarified as part of the first SC meeting. This manuscript reflects the critical components of the CAR PSP protocol, and the full version is available at: http://www.jla.nihr.ac.uk/priority-setting-partnerships/anaesthesia-canada/ . To facilitate future comparison with the one existing perioperative PSP, the scope of the CAR PSP closely mirrored the UK NIAA PSP. 25

Inclusion criteria

The scope included all the work conducted by anesthesiologists, including obstetric and resuscitation care, as well as that conducted both by the wider perioperative team and the care pathway from initial intention to treat or operate onwards. “Onwards” was meant as an open-ended word signifying that long-term problems attributable to the surgery/intervention and management period must also be considered.

The perioperative period was defined to span the time from when a decision is made to have surgery or anesthesia care to the time that the patient returned to preoperative function, recovered to a stable functional level, or fully recovered from having surgery. There was no age limit and we actively encouraged involvement of people from diverse populations such as parents of newborns and young children, the elderly, Indigenous peoples, and those with disabilities.

Exclusion criteria

As the PSP focused on “perioperative care”, we excluded the surgery itself. We focused on the management of patients’ physical wellbeing within the hospital environment throughout all procedures and its impact on recovery thereafter. Many anesthesiologists provide critical care services, but this was felt to be beyond the scope of the current PSP.

Identifying unanswered questions (first survey)

We created and managed the CAR PSP online surveys using REDCap (Research Electronic Data Capture) 27 , 28 hosted at the IWK Health Centre, Halifax, NS. Web links to the CAR PSP surveys were distributed by some of the 11 partner national perioperative organization email listservs and newsletters. In addition to patient networks (e.g., Patients for Patient Safety Canada, Patient Voices Network), the surveys were promoted through the project’s website ( http://www.car-psp.ca ), Twitter (@car_psp), and Facebook (fb.me/carpsp).

Respondents to the first survey were asked to submit three questions that they would like anesthesia researchers to address. Specifically, respondents were asked “Based on your experience, what questions do you have? No question is too big or too small! Please provide up to three questions about anesthesia or perioperative care that you want research to answer. You can provide details about your own experiences, if you would like to do so.” Prior to this question, participants saw a page with plain language explanations of the terms “anesthesia” and “perioperative care.”

Respondent demographics were assessed weekly and the survey closed once efforts to gain responses from all Canadian provinces and territories, across ages, sex, and types of healthcare providers within the main groups of respondents (clinicians, patients, and caregivers) were made. Targeted efforts to recruit respondents included contacting groups like Prostate Cancer Canada (for male patients), the Society of Rural Physicians of Canada (for rural and/or family physicians), and the Assembly of First Nations (for Indigenous respondents). At our request, some organizations shared the survey via their social media and/or newsletters.

Question management

Following the first survey, all submitted questions were aggregated into a longlist of summary questions with duplicate or highly-related questions aggregated into single questions. An independent information specialist, with previous priority-setting experience from an unrelated PSP, in consultation with members of the SC, then removed any out-of-scope questions. The SC reviewed this work, and a SC subgroup worked with the project manager (J.B.) to further refine wording and to develop a final list of summary questions.

Verifying uncertainties and reviewing evidence

With the help of an evidence synthesis specialist from the Maritime SPOR Unit, the longlist of summary questions was compared with the published literature to determine the extent to which any of the questions were already answered. This process followed JLA guidance of reviewing Cochrane systematic reviews (SR) published within the past three years. Specifically, the evidence synthesis specialist retrieved Cochrane SRs by the anesthesia group, and these were reviewed by the project manager, with consultation of SC members. These longlist summary questions were subsequently divided into those “with an answer” and those “without an answer” in the scientific literature. Questions were considered unanswered if the SR was not up to date (within the last three years); the SR did not have enough available evidence; the SR evidence was of insufficient quality; or the SR was inconclusive/unable to make conclusions.

Interim prioritization (second survey)

A refined longlist of “summary” questions unanswered by the literature from the first survey was put into a second national online survey. This survey gave respondents an opportunity to review the longlist and choose which questions ought to be discussed for final prioritization. Participants across Canada were asked to choose up to ten questions that they thought were top priorities from the longlist, according to their personal or professional experience. Participants in the second survey were recruited in much the same manner as for the first survey. For the second survey, however, we also directly emailed participants from the first survey who had provided their email addresses.

To support similar representation of key partnership categories, we pre-specified that responses to the second survey would be considered by respondent category (patients and caregivers; healthcare providers) so that their priorities could be considered independently. This strategy ensured that the top ten priorities from each group were included in the shortlist for the workshop.

Final prioritization workshop

The final prioritization to determine the CAR PSP top ten priorities was held as an in-person workshop. Individuals and members from partner organizations were invited to send expressions of interest to participate. The SC sought to involve a balance of patients and healthcare providers at the workshop. Participants were selected to represent geographical and experiential diversity.

The workshop followed the JLA’s standard method, an adapted nominal group technique, in which participants work in three small groups with balanced representation of patients, caregivers, and clinicians, to rank the short-listed questions. After each group ranked its priorities, prioritizations were averaged across the three groups. This allowed for a second round of prioritization in three newly formed but similarly balanced small groups. Again, an aggregate ranking was calculated. The final top ten priorities were then determined by consensus through a large group plenary discussion facilitated by the JLA advisor (K.C.).

A total of 254 respondents submitted 574 initial questions. Nine responses were submitted in French. See Table  2 for demographic details. A total of 505 in-scope questions were aggregated into a longlist of 49 summary questions. The SC agreed that 69 questions were not in-scope, so they were not aggregated into the summary questions. Table  3 shows an example of how the initial questions were aggregated into summary questions. Following the evidence review, the SC agreed that no questions were fully answered, so the longlist of 49 questions was retained for the interim prioritization survey. Table  4 shows this longlist of questions.

Table 2

Profile and demographics from respondents of the first online survey

For the first survey, participants were able to select as many participant types as applied to them. For example, a participant could select that they were both a patient and a healthcare provider

AB = Alberta; BC = British Columbia; MB = Manitoba; NB= New-Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan. NICU = neonatal intensive care unit; RN = registered nurse

Table 3

Example explanation of how initial questions were aggregated into a summary question

Table 4

Longlist of summary questions

Summary of interim prioritization results (second survey)

A total of 233 respondents submitted their priorities for the 49 anesthesia summary unanswered questions. Ten responses were submitted in French. Table  5 shows the demographic details. The results were computed within the groups of patients/caregivers and healthcare providers (Table  6 ). The ten highest-ranked priorities for both groups were considered independently. Given that there were some differences, and some commonalities, in the ten highest-ranked priorities for both groups, this resulted in 24 questions that were most highly ranked by both groups of respondents. These were considered at the final in-person prioritization workshop.

Table 5

Profile and demographics from respondents of the second online survey

AB = Alberta; BC = British Columbia; MB = Manitoba; NB= New-Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan

Table 6

Shortlist of 24 summary questions created with equal clinician and patient/caregiver weighting from the second survey

*For questions that had a tie rank with another question within the same column (e.g., for the overall ranks from the interim survey, the first two questions were tied)

Final prioritization workshop and “top ten”

Three facilitators (one senior advisor from the JLA, and two with experience facilitating JLA PSP final workshops) supported 22 participants (14 (64%) patients/caregivers) in the final in-person prioritization workshop. Following two rounds of group-level prioritization, the full workshop agreed, by consensus, on the CAR PSP top ten priorities (Table  7 ).

Table 7

Canadian Anesthesia Research top ten priorities

The top ten list from this PSP contains many patient-oriented priorities, such as improving pain control after surgery. The list reflects shared priorities of patients and healthcare providers. For example, the priority around preventing errors and patient injuries was derived from initial questions submitted by both patients and healthcare providers and ranked highly after the second survey (patients: #3, healthcare providers: #4) and at the final workshop (#4).

The Canadian anesthesia community is changing how it thinks about research in anesthesia and perioperative care, aligning the agenda to patient-oriented research. This opportunity to engage patients’ perspectives around anesthesia and perioperative care is timely and has the potential to improve research impact and patient outcomes. 29 – 31 The CAR PSP top ten priorities reflect a wide variety of priorities that capture a broad spectrum of Canadians who receive and provide anesthesia care, and the scope of anesthesia practice. Using the CAR PSP top ten priorities to shape the Canadian anesthesia research agenda will reflect shared concerns around the impact of anesthesia and perioperative care on patient-reported outcomes and experience. These top ten priorities complement and can, in many cases, align with the typical curiosity-based research that has always been fundamental to anesthesia research.

The CAR PSP featured responses from hundreds of Canadian patients, healthcare providers, and others, and reached a consensus priority list from an initial submission of 574 questions. The CAR PSP top ten priorities included factors most important to improve patient outcomes and satisfaction, impacts of shared decision-making, error prevention, and the impact of reducing opioids at time of surgery.

The CAR PSP top ten priorities are general in-scope and should not be considered specific research question themselves, nor hypothesis generating. They should serve as starting points for researchers, funders, and decision-makers. They also identify questions around anesthesia care, where the answers can have immediate translatable impacts on our patients’ daily lives.

Strengths of our study include using an established methodology to elicit shared priorities on anesthesia and perioperative care, the number of participant submissions, and the balance of patient, caregiver and clinician participation. Even with effective promotion and publicity, a PSP may face limited stakeholder engagement. Anesthesia does not involve caring for patients with a chronic condition/disease, nor a well-defined patient group, so engagement can be challenged. The CAR PSP survey response numbers were similar to other PSPs in Canada and to the NIAA PSP. 32 , 33 (Canadian population of 37 million, approximately 3,300 anesthesiologists; UK population 61 million, approximately 11,000 anesthesiologists, NIAA PSP reported 623 respondents and 1,420 suggestions.) 13 , 25 , 34 , 35

The CAR PSP captured responses from individuals from all provinces, with a range of ages, and with a good balance of gender identity. PSPs are not designed to attract a representative sample, instead the JLA process relies on engagement, and the SC focused on getting responses from members of key stakeholder groups. Whenever the SC saw that responses from a particular group (e.g., northern communities) were lacking, we targeted outreach to those groups. Despite as many efforts as were practical within time constraints and budget, these were not always successful (e.g., no respondents from the territories) and this is a limitation.

Our focus on the entire anesthesia and perioperative care period, over a wide range of subspecialty anesthesia care for diverse surgical procedures and patient groups, could be considered too broad. This PSP, unlike some others, including the NIAA, did not group the initially submitted questions into subspecialty-related anesthesia themes or patient groups (e.g., cardiac anesthesia or pediatric patients). Subspecialty questions were grouped into more manageable broad-based summary questions. As such, there are few anesthesia subspecialty top ten priorities. Nevertheless, examples of submitted questions, the summary list of 49 questions, and the 24 highest-ranked questions are available to researchers to review on the JLA website. Researchers are encouraged to explore in more depth the original questions that contributed to the research questions in the prioritization survey. Furthermore, as a first PSP in the Canadian anesthesia community, our methods and experience could support future efforts for setting priorities within more specific aspects of perioperative care.

Limitations

Given that the surveys for this PSP were only available online, we acknowledge that they were not accessible to people who may not use, or have access to, the internet. We relied on word-of-mouth, social media, and partner organizations to advertise the surveys, so we likely missed potential respondents who are not engaged through these methods. Our surveys garnered more responses from healthcare providers than patients and caregivers, though our SC had equal representation and our final workshop had more patients and caregivers than healthcare providers.

The final workshop took place over a full day in Toronto. Although we covered expenses for travel, and provided an honorarium for patients to attend, this kind of workshop excludes potential participants who cannot take time off work or cannot travel for other reasons.

The methods used for establishing a top ten list of priorities were qualitative in nature. We followed a well-established methodology that invites a variety of perspectives to contribute in different ways (i.e., SC, participation in surveys, final workshop). All these opportunities to contribute are complementary and instrumental in arriving at a top ten list of priorities. A different top ten list of priorities may have resulted had different people joined the SC or participated in the surveys or final workshop.

Future initiatives

Only one other country, the UK, has incorporated shared patient/caregiver input regarding anesthesia research priorities. 25 The CAR PSP adds to the breadth of what is currently known from the UK. Differences in demographics, varied geographic location and population density, as well as healthcare funding models and delivery between Canada and the UK exist. As such, there is not enough experience to know whether research priorities identified in one country can be adopted by another country. An in-depth comparison of the CAR PSP top ten and the NIAA top ten is warranted to assess similarities and generalizability across countries. It appears that the top ten lists for both countries share some similar questions. For example, both PSPs identified pain after surgery and long-term effects of anesthesia as priorities for research. Differences exist, however, such as with the priority around the impact of reducing opioids during surgery appearing in the Canadian list, but not the UK one.

Additionally, we will assess how the CAR PSP priorities ranking differed between the patient/caregiver and clinician groups and impacted the CAR PSP top ten priorities.

Using the CAR PSP top ten

Following the established methodology of the JLA, the Canadian anesthesia research community now has a made-in-Canada top ten list of shared priorities that can help situate and direct their projects. Funders may choose to focus their calls for applications around these priorities. Commitment to patient-oriented research can also be shown by funding proposals that align with the top ten priorities, funding projects with patient partners as co-investigators on the research team, or including patient reviewers in the grant review processes.

The top ten priorities are not prescriptive. If a topic did not rank in the final top ten, this does not mean it is unimportant research. Researchers are encouraged to consider how their current and future projects can align with the top ten. For example, the priority of “How can anesthesiologists improve pain control after surgery?” lends itself to a broad range of research questions, from preclinical research leading to development of new drugs, to psychological interventions that help patients manage pain.

Call to action

The CAR PSP top ten priorities represent the collective wisdom of the participants who contributed to the CAR PSP and they deserve the attention of the research community. The CAR PSP top ten priorities are a call to action and serve as a valuable tool to initiate and guide patient-oriented research in anesthesia and perioperative care. This initiative is particularly important in anesthesia research where the patient perspective has not frequently been incorporated. This PSP has forged important relationships among patients/caregivers, healthcare providers, and researchers, and is a springboard for a sustained culture of patient engagement within anesthesia research.

Author contributions

Dolores M. McKeen, Jillian C. Banfield , Daniel I. McIsaac , Jason McVicar , Colleen McGavin , Katherine Cowan and Andreas Laupacis contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Mary Anne Earle , Claire Ward , Katharina Kovacs Burns , Donna Penner , Gilbert Blaise and Thierry De Greef contributed to acquisition, analysis, and interpretation of data. The Perioperative Anesthesia Clinical Trials Group ( PACT) contributed to the conception and design of the project.

Acknowledgements

We thank the editorial board of the Canadian Journal of Anesthesia who provided French language translation of the two surveys. We thank the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT Unit (MSSU) for their support and connections to other Canadian SPOR Units to request support and recruitment aid in their respective jurisdictions. Specifically, we thank Leah Boulos, Brian Condran, Julia Kontak, and Michelle Fiander. We also thank Melissa Crane for her work to synthesize the initial questions into summary questions. We are especially grateful to Katherine Cowan for her expert guidance throughout this project.

Conflicts of interest

Funding statement.

The Canadian Anesthesia Research Priority Setting Partnership was funded through a Canadian Institutes of Health Research – Strategy for Patient Oriented Research (CIHR SPOR) Collaboration Grant. This Top 10 priorities are an initial output of a grant aimed to support patient-oriented Canadian anesthesia research. Collaborating funding organizations: Association of University Departments of Anesthesia (ACUDA). Canadian Anesthesiologists’ Society (CAS). Canadian Institutes of Health Research (CIHR). Dalhousie University Department of Anesthesia, Perioperative and Pain Medicine. Northern Ontario School of Medicine Department of Anesthesia. Perioperative Anesthesia Clinical Trials Group (PACT). University of Manitoba Department of Anesthesia

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

This article is accompanied by an editorial. Please see Can J Anesth 2020; 67: this issue.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Children of Flint water crisis make change as young environmental and health activists

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Their childhood memories are still vivid: warnings against drinking or cooking with tap water, enduring long lines for cases of water, washing from buckets filled with heated, bottled water. And for some, stomachaches, skin rashes and hair loss.

Ten years ago in Flint — April 25, 2014 — city and state environmental officials raised celebratory glasses as the mayor pressed a button to stop the flow of Lake Huron water supplied by Detroit for almost half a century. That set in motion a lead and bacteria public health crisis from which the city has not fully recovered.

But dozens of children of the water crisis — now teenagers and young adults — have turned their trauma into advocacy. They provide input on public health initiatives, participate in social issue campaigns, distribute filters and provide free water testing for homeowners.

They know that Flint is a place that still struggles. The population has fallen by some 20,000 in the past decade, leaving abandoned houses as targets for arsonists. Almost 70% of children live in poverty, and many struggle in school. Although the water has been declared safe to drink, distrust runs deep, and hundreds of lead water pipes remain in the ground because homeowners were allowed to opt out of replacing them.

‘We’re old news, but we’re still living this’ — mistrust still flows in Flint

Detroit hosts the July Democratic debate. Some candidates have campaigned in nearby Flint, but the city’s struggles and water crisis haven’t been a focus.

July 30, 2019

But the young activists say they want to help make a difference and change how their city is perceived by outsiders. And they want to defy expectations.

“One of the biggest issues about growing up in Flint is that people had already decided and predetermined who we were,” said 22-year-old Cruz Duhart, a member of the Flint Public Health Youth Academy.

“They had ideas about our IQ, about behavioral things, but they never really stopped to speak to us and how we thought about it and the type of traumas that we were going through.”

It’s always been easiest for 16-year-old Sima Gutierrez to express herself through art. Drawings, paintings and wire sculptures decorate her family’s tidy bungalow.

Now the self-described “very shy” teen who rarely spoke up, for fear nobody wanted to hear what she had to say, collects water samples in people’s homes and takes them to the Flint Community Water Lab, where more than 60 high school and college interns have provided free testing for thousands of residents since 2020.

She helped plan public awareness campaigns about topics like gun violence and how racism affects public health as a member of the Flint Public Health Youth Academy.

World & Nation

A ‘man-made disaster’ unfolded in Flint, within plain sight of water regulators

Almost two years ago, the leaders of Flint, Mich., lifted glasses of water in the air — clear water — to toast a plan to save money for their struggling city.

Jan. 22, 2016

“I wanted to be surrounded by people who weren’t going to cover up the whole fact that people are still having problems,” said Sima. “I was able to ... share my life [with] anybody else who’s going through what I’m going through.”

It was a decade ago that she complained her stomach hurt when she drank water. Her mom insisted it would help Sima’s body flush out medication she took for an autoimmune disorder that was causing her hair to fall out in patches and leaving her skin with light splotches.

Residents had begun reporting skin rashes and complaining about discolored, smelly and foul-tasting water soon after the city began drawing from the Flint River to save money, until it could hook into a new Lake Huron pipeline. But they were assured everything was fine.

Sima said she wasn’t aware of problems until one of her elementary school classmates, Mari Copeny — then a 7-year-old beauty pageant winner known as Little Miss Flint — began protesting. Mari became the face of the crisis, and continues to highlight environmental justice issues to almost 200,000 Instagram followers and to raise money, including for water filters that she gives out in communities across the U.S.

“I want to keep on using my voice to spread awareness about the Flint water crisis because it’s not just Flint that has a water crisis,” Mari said. “America has a water crisis.”

Michigan reaches $600-million deal in Flint water crisis

Michigan is reaching a settlement to pay $600 million to compensate Flint residents whose health was damaged by lead-tainted water, a source says.

Aug. 20, 2020

Almost a year and a half after Flint made its switch, residents frustrated with the water quality reached out to an expert who then found high lead levels caused by the city’s failure to add chemicals that prevent pipe corrosion. State officials had said these were unnecessary. Around that same time, a pediatrician discovered that levels in kids’ blood had doubled after the switch.

Outbreaks of Legionnaire’s disease, including a dozen deaths, ultimately were also linked, in part, to the city’s water supply.

Flint reconnected to its old water line shortly afterward, but because pipes continued to release lead, the state provided residents filters and bottled water.

Lead is a potent neurotoxin that can damage children’s brains and nervous systems and affect learning, behavior, hearing and speech. There is no safe childhood exposure level and problems can manifest years later.

Data collected over a decade now show that children in Flint have higher rates of ADHD, behavioral and mental health problems and more difficulty learning than children assessed before the water crisis, said Dr. Mona Hanna-Attisha, the pediatrician who first flagged rising lead levels in Flint kids’ blood. She said other issues, including nutrition, poverty, unemployment and systemic inequalities also could be factors.

Sima and three of her sisters were found to have elevated lead levels and have since been diagnosed with attention-deficit hyperactivity disorder; Sima also has a learning difficulty.

Congressional inquiry faults Michigan officials and EPA for Flint water crisis

Congressional Republicans quietly closed a yearlong investigation into the crisis over lead in the Flint, Mich., drinking water supply, faulting both state officials and the Environmental Protection Agency for contamination that has affected nearly 100,000 residents.

Dec. 16, 2016

“I felt responsible for forcing my child to drink something that was hurting her so bad, and I didn’t believe her,” said her mother, Jessica Gutierrez, who works as a public health advocate for hospitals and nonprofits and fears for her daughters’ long-term health.

Guilt and anxiety are “part of the trauma of the crisis,” Hanna-Attisha said.

That’s why it’s important for kids from Flint to feel they’re being heard, to be part of the solutions, she said. For example, the Flint Youth Justice League, an advisory board to her Pediatric Public Health Initiative , has offered suggestions on programs that include prescribing fresh fruits and vegetables, reducing poverty and connecting residents to public services.

“Our young people are amazing,” said Hanna-Attisha. “They are not OK with the status quo and they are demanding that we do better for them and for generations to come.”

Asia Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths.

Ex.-Michigan Gov. Snyder charged in Flint water crisis

Former Michigan Gov. Rick Snyder has been charged with two counts of willful neglect of duty in the Flint water crisis.

Jan. 13, 2021

But just a couple years later, she was talking to kids from Newark, N.J., guiding them through their own lead-in-water crisis. Over Zoom meetings, the kids from Flint explained parts per billion, how to test water for lead and how they had coped with fear.

“They felt the exact same way that I felt when I was ... going through it,” said Asia, 20, now an aspiring accountant and one of 18 interns at the Flint Public Health Youth Academy.

They’re paid a monthly stipend to run the academy — writing grants, creating budgets, analyzing data, conducting focus groups and creating public awareness campaigns. They have a biweekly talk show on YouTube, where they’ve discussed everything from mental health to COVID.

Last summer, they planned and hosted a summer camp for dozens of kids that focused on gun violence and school shootings. This year, together with the Community Foundation of Greater Flint, they’re coordinating a youth summit on community violence.

Dr. Kent Key, a public health researcher with the Michigan State University College of Human Medicine in Flint, started the academy after studying health disparities in the Black community as part of his doctoral dissertation.

He wanted to introduce Black kids to potential health careers, but also felt like “everyone had written Flint youth off because of the impacts of lead.” So he gave them more than a voice, he said. He gave them control.

Scathing report finds Michigan ‘fundamentally accountable’ for Flint’s water crisis

After months of finger-pointing over who is responsible for the water contamination problem in Flint, Mich., a scathing report squarely names the very people who vowed to root out who was to blame — the state itself.

March 23, 2016

“I did not want [the water crisis] to be a sentence of doom and gloom for youth,” he said. “ I wanted it to be a catapult ... to launch the next generation of public health professionals.”

Dionna Brown, who was 14 when the water crisis began, became interested in advocacy after taking a class on environmental inequality at Howard University. Now she’s planning her life around it — completing a master’s degree in sociology from Wayne State University with plans to become an environmental justice attorney.

She’s also national director of the youth environmental justice program at Young, Gifted & Green, formerly called Black Millennials for Flint and founded by advocates from Washington to support Flint after the crisis.

Brown holds a two-week summer environmental justice camp in Flint every year to teach teens about issues such as policy, climate justice, sustainability and housing disparities. She also works with kids in Baltimore and Memphis.

She said the water crisis made Flint kids resilient.

“I tell people all the time: I’m a child of the Flint water crisis,” said Brown. “I love my city. And we put the world on notice that you cannot just poison a city and we’ll forget about it.”

Webber writes for the Associated Press. AP video journalist Mike Householder contributed to this report.

More to Read

This mega-city is running out of water. What will 22 million people do when the taps run dry?

March 21, 2024

EPA orders Watts metal recycler to prevent water pollution

March 13, 2024

Column: Republicans would rather keep poisoning children with lead than pay for a fix

March 11, 2024

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