Débats autour des races canines et de la santé publique à Montréal et au Québec (2016–2019)

ObjectivesWe examine the public policies that have been formulated to reduce the incidence of dog bites. We do so to encourage the adoption of policies aligned with One Health promotion.MethodsThis case-study research involved an ethnographic approach. Our qualitative analysis derived from participant observation, policy documents, media coverage, and interviews with stakeholders in Montreal (Quebec).ResultsFollowing on from a human fatality due to dog bite injuries, the City of Montreal decided to ban certain types of dogs based on their ‘breed.’ In the ensuing discussions, the ‘Calgary model’ emerged as an alternative to breed-specific legislation. These discussions led to a change in policy direction for Montreal, and for Quebec as a whole. Furthermore, we discerned marked improvements with respect to intersectoral coordination in the wake of this controversy.Conclusion‘Policy mobilities’ offer a useful conceptual apparatus for understanding how public policies for dog bite prevention are polarized around controversial proposals, to the detriment of discussions that focus on policy implementation.     

Soutien au réseau des services de garde montréalais dans la prévention et la gestion de la COVID-19 : un service à 3 pôles

SettingFrom April 2020, in sight of child care reopening, the Direction régionale de santé publique de Montréal (DRSPM) conducted a situational analysis with its child care (CC) partners in order to learn about the challenges they envisioned in their role in preventing and managing COVID-19. The CC partners requested access to preferred public health support.InterventionThe DRSPM established a service consisting of three components: (1) telephone support available 6 to 7 days/week for CC managers facing a COVID-19 situation; (2) a regional committee combining four Montreal representatives of CC associations and one from the Ministère de la Famille; (3) prevention brigades formed by front-line health workers from the Centres intégrés universitaires de santé et de services sociaux (CIUSSS).OutcomesThis health promotion intervention (1) enabled CC services to handle the pandemic with better capability and confidence through facilitating access to accurate and positive information; (2) supported the commitment and collaboration of CC services by acting as a mediator between them and decision-makers; and (3) responded to the psychosocial needs of community members.ImplicationsThis service helped to adjust public policy and promote community resilience by raising awareness of the importance of balancing COVID-19 prevention and the collateral impacts of the pandemic.     

Practice report: an Alberta Métis model for COVID-19 vaccine delivery

SettingIn January 2021, the COVID-19 vaccine became available to First Nations, Métis, and Inuit (FNMI) over the age of 65 living in First Nations communities or Métis settlements in Alberta. In March, vaccine eligibility in Alberta expanded to include FNMI peoples of younger ages and in urban settings. The Métis Nation of Alberta (MNA) and other Indigenous organizations recognized that FNMI populations might be better served by tailored vaccine programs.InterventionThe MNA is the government for the Métis people in Alberta. During the COVID-19 pandemic, the MNA has supported its citizens, through financial and mental wellness support, access to personal protective equipment, and messaging regarding public health orders. When vaccines became available, culturally appropriate virtual vaccine information sessions were provided. In March 2021, the MNA delivered the first Métis-led COVID-19 vaccination clinic. Unique to the clinic’s success was the location, online booking process, and community presence. The clinic focused on cultural safety, including the availability of Indigenous health professionals to community members, and cultural reference points throughout the clinic.OutcomesIn the first MNA clinic, over 1300 people were vaccinated. Visitors shared appreciation for the culturally specific aspects of the clinic, which contributed to increased safety and comfort.ImplicationsBased on the success of the first Métis-led vaccination clinic, similar services in communities with high numbers of Métis people have been approved. This innovative practice initiative could provide a model of COVID-19 vaccine service delivery that could be used to meet the needs of Métis citizens in other jurisdictions in Canada.     

Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches

BackgroundIt has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well‐being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers.MethodsA systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference‐management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included.ResultsThe interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of individual refugees/asylum seekers and their families; skills of primary health care workers; system and/or service integration models and structures; and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them.ConclusionThis review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health.Patient or Public ContributionPatient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.     

L’influence de l’identité professionnelle sur la détresse psychologique dans les métiers spécialisés des secteurs de la construction et manufacturier au Québec

ObjectiveThis study explores how the structure of professional identity and its undermining are associated with symptoms of psychological distress in the skilled trades, focusing on the construction and manufacturing sectors in Quebec. One limitation of the current research is its neglect of professional identity, even though this concept is important to explaining psychological distress symptoms.MethodsThe sample includes 282 workers from four manufacturing and seven construction sites in Quebec. Data were collected for the years 2016 and 2017. Multilevel regression analysis was carried out with the statistical software Stata 13. Five variables were controlled in this study: sex, gender, age, type of team and occupational sector.ResultsThe results of multilevel regression models, addressing variations across 54 participating teams, suggested that a low skilled trades self-esteem, a higher professional identification, a low integration of differences, heavy demands at work, and job insecurity are associated with psychological distress, as are the factors of being a woman or being a younger worker.ConclusionStudy results corroborate the importance of taking preventive actions on identity dimensions to reduce psychological distress symptoms. In particular, at the level of skilled trades culture, it would be beneficial to incorporate values based on a better inclusion of all workers and an open mind with regard to differences.     

Audit de l’équilibre glycémique de patients diabétiques sous analogues de l’insuline : à propos de 2915 assurés de la CNAM (Tunisie)

Background: Insulin analogues are increasingly prescribed in Tunisia. These molecules, covered by the National Health Insurance Fund (CNAM) in Tunisia under certain conditions, have an important and constantly increasing cost. Aim: To audit the diabetes control among insured in the Northern district of the CNAM (Tunisia), treated with insulin analogues in 2019 and to assess factors associated with good glycemic control. Methods: Retrospective observational study including patients with diabetes who applied for renewal of insulin analogues between March and April 2019 in the northern district of the CNAM. Results: Our study included 2915 diabetic insured. The sex ratio was 1.08. The mean age was 56.5 ±18.56 years. More than half of the diabetic insured were followed by a specialist physician (44% by endocrinologists, 7% by internists, 6% by nutritionists and 4% by other specialists). The average duration of treatment with insulin analogues was 5 years ± 1.41. Almost three quarters (74%) of the diabetic insured were type 2 diabetics. The mean daily dose of rapid-acting, short-acting and premixed insulin analogues were 30±15.49 IU/d, 38±18.36 IU/d and 65±19.38 IU/d respectively. HbA1c targets were achieved in 8% of the diabetic insured. In univariate analysis, the variables significantly associated with diabetes balance were follow-up by a physician specializing in endocrinology (OR=3.14, 95% CI [0.98-10.08]), internal medicine (OR=5.06, 95% CI [1.49-17.21]) or nutrition (OR=2.06, 95% CI [0.54-7.77]), type 1 diabetes (OR=1.67, 95% CI [1.26-2.22]) and basal insulin therapy regimen (OR=1.88, 95% CI [1.39-2.54]). In multivariate analysis, the independent and significant factors associated with glycemic control were type 1 diabetes (ORa=1.81, 95% CI [1.37-2.39]) and basal insulin therapy regimen (ORa= 1.77, 95% CI [1.30-2.40]). Conclusion: This study showed that the majority of diabetic insured on insulin analogues had a poor controlled diabetes. Type 1 diabetes and basal insulin therapy regimen were the two factors associated with good glycemic control after multivariate analysis. A review of criteria for reimbursement of insulin analogues by the National Health Insurance Fund is necessary in order to rationalize the expenses related to these molecules.     

Australian asylum policies: have they violated the right to health of asylum seekers?

Objectives : Notwithstanding recent migration policy amendments, there is concern that Australian asylum policies have disproportionately burdened the health and wellbeing of onshore asylum seekers. There may be a case to be made that Australian governments have been in violation of the right to health of this population. The objective of this paper is to critically examine these issues and assess the implications for public health practice.
Methods :The author undertook a review of the recent empirical literature on the health effects of post-migration stressors arising from Australian policies of immigration detention, temporary protection and the restriction of Medicare to some asylum seekers. This evidence was examined within the context of Australia's international law obligations.
Results : Findings reveal that Australian asylum policies of detention, temporary protection and the exclusion of some asylum seekers from Medicare rights have been associated with adverse mental health outcomes for this population. This is attributable to the impact of these policies on accessing health care and the underlying determinants of health for aslyum seekers.
Conclusion : It is arguable that Australian Governments have been discriminating against asylum seekers by withholding access on the grounds of their migration status, to health care and to the core determinants of health in this context. In so doing, Australia may have been in violation of its obligation to respect the right to health of this population.
Implications : While the 'right to health' framework has much to offer public health, it is an undervalued and poorly understood discipline. The author argues for more education, research and advocacy around the intersection between heath and human rights.     

L’économie comportementale au service de la santé

The COVID-19 pandemic is bringing about far-reaching structural changes on both the economy and public health, and conventional methodologies have to be fine-tuned to assist public health decision making. In this context, behavioural economics, which is situated at the crossroads between economics and social psychology, is an undeniably innovative field. In contrast with conventional models, the economic models of behavioural economics incorporate psychological and social determinants to produce more accurate predictions of individual behaviour. In the last 20 years, the scientific community has been using this approach’s quantitative tool, experimental economics, in many areas of health, including prevention, promotion, human resources and social signage. Studies have come up with effective solutions that have improved best public health practices and provided sources of inspiration that should not be overlooked in the fight against COVID-19. They have allowed natural human behaviour to take a central role again, helped us to understand how the social and economic environment influences individuals, and enabled us to anticipate human reactions and so make faster adjustments to public policies.     

Important Gaps in HIV Knowledge,Attitudes and Practices Among Young Asylum Seekers in Comparison to the General Population

Migrants are disproportionately affected by HIV in many European countries, including Finland. We aimed to compare the HIV-related knowledge, attitudes and practices (KAP) of young asylum seekers to those of the general young adult population. Two cross-sectional surveys were conducted among 20- to 25-year-old young adults: The TIE study among asylum seekers (n?=?47) and the World AIDS Day 2014 study among the general population (n?=?485). Important gaps in HIV KAP were identified especially among the young asylum seekers. For the general young adult population, previous HIV testing was associated with female gender, better HIV knowledge and increased sexual activity. Health education concerning HIV needs to be further enforced among young adults in Finland. Due to poorer HIV knowledge, young asylum seekers might be especially vulnerable to HIV. The asylum process is a window of opportunity for health education and HIV testing.     

Place du Bilan Médical Périodique dans les Soins de Santé de Base en Tunisie

The objective of primary health care is to reduce mortality and morbidity. This kind of care was very efficient in communicable diseases, malnutrition and maternal and neonatal diseases; however, their impact on non communicable diseases and mental disorders control is not obvious. In Tunisia, primary health care was introduced in the early 1980s; a lot of progress were notified in particular in health of mothers and children in particular, but only slightly in non communicable diseases control and mental health promotion. Therefore, a new approach would be strongly recommended to remedy this situation. The Medical Periodic Check-up (MPC) implemented in North America would have a positive impact in the prevention and management of non communicable diseases. What would be the place of this MPC in primary health care in Tunisia? The MPC has two main objectives: the prevention of specific diseases and health promotion. However, despite its efficiency and usefulness, the MPC could be costly, especially for countries with limited resources. Current evidence suggests that the most appropriate approach would be to take periodic preventive health visits tailored to the level of risk. The frequency of visits depends on the age, sex and state of health of the individual. In conclusion, there are strong arguments in favor of the introduction of MPC in primary health care in Tunisia, especially among adults in non communicable diseases control strategy. However, it''s highly be recommended that the BMC should be oriented according to the risk levels in order to optimize resources. It is also important to educate and the public, especially women and young adults, to benefit from periodic medical and dental examinations.     

Facteurs de sévérité chez les patients Algériens hospitalisés pour COVID-19

Introduction. Determining the profile of COVID-19 patients with low pulsed hemoglobin saturation in oxygen (SpO₂) could help clinicians identify those with a poor prognosis. Aim. To identify and to compare the clinical, biological and radiological data of Algerian patients hospitalized for COVID-19 and divided according to the SpO₂ measured at admission, at rest, and in ambient air. Methods. A prospective study was carried out on Algerian patients hospitalized for COVID-19 during the period from March 9 to April 30, 2020. The general characteristics of the patients and the clinical, biological and radiological data were determined. Results. 86 patients were included in the study [G₁: SpO₂ >95% (n=51) and G₂: SpO₂ ≤95% (n=35)]. Compared to G₁, G₂ was older (48±14 vs. 61±12 years, p=0.0001), included more patients aged ≥ 50 years (37.2 vs. 80.0%, p=0.0001), having an arterial-hypertension (21.6 vs. 45.7%, p=0.0180), a cancer (0.0 vs. 14.3%, p=0.0054), an anemia (25.6 vs. 56.3%, p=0.0069), a leukocytosis (4.7 vs. 21.9%, p=0.0236), a biological inflammatory syndrome (82.5 vs. 100%, p=0.0142), a hyper-uremia (7.0 vs. 37.5%, p=0.0185), a hyper-creatininaemia (4.7 vs. 18.8%, p=0.0356), a tissue damage (41.0 vs. 66.7%, p=0.0341), a diffuse ground-glass opacity (52.0 vs. 71.4%, p=0.0397), band condensations (30.0 vs. 54.3%, p=0.0244), a severe extension (2.0 vs. 25.7%, p=0.0008), and included fewer patients who complained from diarrhea (49.0 vs. 22.9%, p=0.0145), having a nodular ground-glass (66.0 vs. 40.0%, p=0.0177) and a slight extension (78.0 vs. 40.0%, p=0.0004). Conclusion. Criteria associated with low SpO₂ in hospitalized COVID-19 patients were advanced age, a history of arterial-hypertension and cancer, high frequencies of certain biological abnormalities or radiological signs. The diarrhea symptom, the radiological appearance of nodular ground glass, and a slight extension of the radiological lesions appear as protective elements.     

Prise en charge des diabétiques. Etude comparative de deux structures de santé contrastées

Background:

The proportion of total Tunisian with Diabetes reached 15.5% in 2016. The objective of this study was to analyze diabetic''s management in contrasted health care settings.

Methods:

Mixed methodology (quantitative and qualitative) with explanatory design was used in contrasted health care structures (a primary health center (PHC) and the National Institute of Nutrition and Food Technologies (INNTA)). Interviews with health providers and patients were than condcuted in both centers to explain quantitative findings.

Results:

Quality of care assessement was performed among 100 patients in the PHC and 96 in the hospital. Glycemic control was reached in less than 30 % of the cases in both centers. Although clinical evaluation was better in the PHC, conducting ECGs, measuring of HbA1c  and  LDL-Ch were far from being optimal. The qualitative study did supply some hypotheses explaining these gaps: treatments shortage and lack of laboratory assessments specifically pointed in PHC settings, potentially lower its attractiveness, thus compounding overcrowding and stressful working conditions in hospitals. These last points as well as poor communication and overloaded clinics in hospital were major sources of providers and patient dissatisfaction.

Conclusion:

This study made it clear that primary health care is a cornerstone in diabetes management. However, it is crucial to strengthen primary health care centers by operational technical support (laboratory equipements and quality information system) as well building capacities of health professionals in information, education and communication.     

40 ans des Soins de Santé de Base en Tunisie d'Alma Ata à Astana. Il est temps de revitaliser la première ligne des soins

In order to readjust the national policy of Basic Health Care (SSB) to the declaration of Primary Health Care (SSP) of Astana (2018), 40 years after that of Alma Ata (1978), this paper summarizes the lessons learned from the international and national experience of PHC / SSB and presents the originator lines of the roadmap of the second version of SSB in Tunisia. WHO and Unicef have identified four lessons from PHC policy: 1. Political leadership, prioritizing primary care. 2. Sufficient funding to ensure the availability of basic services and their access by the population served. 3. Health personnel specifically trained in primary care, with decent working conditions. 4. A support strategy for the quality of care, based on financial and moral motivation. In Tunisia, the history of SSBs has memorized images of successes such as the organization of simulation sessions for the preparation of the “oral rehydration solution”, “mobile teams” of home visits, “deadlines” for monitoring vaccination and “school social action units” for multisectoral management of the problem of school backwardness. The "Think Tank" groups, having reflected on the perspectives of SSBs in Tunisia, came up with a roadmap made up of four fundamental axes. 1. Creation of a National Health Insurance Fund (CNAS), affiliated with the Ministry of Health, and promoting prevention and health promotion. 2. Focus on non-communicable diseases, both young and old. 3. Establishment of a periodic health assessment, stratified by sex and age, guiding health behaviors and "self-care" skills. 4. The development of “nursing homes”, providing continuous care, by multi-functional and multidisciplinary teams. Thus, the reform of the SSB policy of Tunisia, by referring to the Astana declaration and the cumulative national expertise, is essential to revitalize the first line of care and ensure the Tunisian population a "health for all", leaving no one behind”.     

Access to health care for asylum seekers in the European Union--a comparative study of country policies

BACKGROUND: The aim of our article is to characterise and compare current standards of health care provision for asylum seekers in the 25 European Union (EU) countries in order to identify the needs and potential for improving access to health care for asylum seekers. METHODS: The study is based on an e-mail survey performed between April and June 2004. The questionnaire was concerned with asylum seekers' access to medical screening upon arrival, and their general access to health care services on April 1, 2004. The questionnaire was sent to ministries and NGOs responsible for asylum seekers' health care in the 25 EU countries. A total of 60% of the ministries and 20% of the NGOs responded. We received answers from 24 out of the 25 countries. RESULTS: Medical screening was provided to asylum seekers upon arrival in all EU countries but Greece. The content of screening programs, however, varied as well as whether they were voluntary or not. We found legal restrictions in access to health care in 10 countries. Asylum seekers were only entitled to emergency care in these countries. A number of practical barriers were also identified. Legal access to health care changed during the asylum procedure in some countries. Access to specialised treatment for traumatised asylum seekers existed in most countries. CONCLUSION: Health policies towards asylum seekers differ significantly between the EU countries and may result in the fact that the health needs of asylum seekers are not always adequately met.     

Stuff you think you can handle as a parent and stuff you can’t’. Understanding parental health‐seeking behaviour when accessing unscheduled care: A qualitative study

BackgroundUnscheduled health care constitutes a significant proportion of health‐care utilization. Parental decision making when accessing unscheduled care for their children is multifaceted and must be better understood to inform policy and practice.DesignNineteen semi‐structured interviews and one focus group (n = 4) with parents of children younger than twelve in Ireland were conducted. Participants had accessed unscheduled care for their children in the past. Data were thematically analysed.ResultsParents accessed unscheduled care for their children after reaching capacity to manage the child''s health themselves. This was informed by factors such as parental experience, perceived urgency and need for reassurance. Parents considered the necessity to access care and situated their health‐seeking behaviour within a framework of ‘appropriateness’. Where parents sought unscheduled care was largely determined by timely access, and inability to secure a general practitioner (GP) appointment often led parents to access other services. Parents expressed a need for more support in navigating unscheduled care options.ConclusionsBetter resources to educate and support parents are required, and structural issues, such as accessibility to GPs, need to be addressed to enable parents to better navigate the unscheduled health system and manage their children''s health. The discourse around ‘appropriate’ and ‘inappropriate’ access to health care has permeated parental decision making when accessing unscheduled health care for their children. What constitutes appropriate access should be examined, and a shift away from this framing of health‐seeking behaviour may be warranted.Patient or Public ContributionThere was no explicit patient or public involvement. All authors hold experience as users of the health system.     

“It reflects the society in which we live,except now everything is accentuated”: youth,social inequities,and the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has been an extraordinary moment of uncertainty and rapid transformation. The effects lockdowns had on youths’ mental and physical health, as well as the challenges they posed for young peoples’ learning, were of great concern. It quickly became clear that government responses to COVID-19, in particular regarding the social determinants of health, were not equally experienced across all social groups. This paper adopts an interdisciplinary lens at the intersection of health and education and uses Max Weber’s lifestyle theory to analyze the inequitable experience of the COVID-19 pandemic. We examine most directly social inequities in education during the first wave of COVID-19 and explore long-term effects on youths’ educational opportunities, health, and well-being.MethodsWe use focus group materials collected from our Spring 2020 study. This study explored how youth were differentially experiencing the pandemic. Participants included 18 youth between the ages of 13 and 18 (11 girls, 7 boys). Participants were stratified by private and public secondary schools and we ran focus groups in which experiences of the pandemic were discussed.ResultsOur results show (1) clear differences in early access to education for youth who attended public and private institutions in Quebec during the COVID-19 pandemic; (2) access to the internet and computers offset learning opportunities for students across Quebec throughout the COVID-19 pandemic; and (3) few of the differences experienced during the pandemic were based on youth’s behaviours, or life choices, but rather stemmed from differences in material and structural opportunities, based largely, but not solely, on what type of school the youth attended (public or private).ConclusionThe way in which the COVID-19 pandemic was handled by the Quebec education system deepened existing social inequities in education between private and public school attendees. Given the importance of education as one of the main determinants of health, particularly during transition periods such as adolescence, we must ensure that future policies do not repeat past mistakes.