Integrated Place-Based Primary Interventions: Levers and Tensions Related to Multilevel Governance for Community Integrated Pathways, A Multiple Case Study

Integrated Place-Based Primary Interventions (IPPIs) are considered an innovative response to the challenges and complex issues faced in disadvantaged areas where traditional institutional services have difficulty reaching people in vulnerable situations. IPPIs are an innovative approach to the delivery of in services, conceived as an original community-based local care and service pathways. However, these intervention practices require adaptive modes of governance. In this article, we explore how and to what extent the mode of governance of IPPIs influences the performance of community-integrated pathways. To this end, using a qualitative exploratory multiple-case study design (observation and semi-structured interviews), we describe 4 IPPIs in 3 territories in Quebec. This includes an examination of the levers of action and tensions related to their governance and the performance levels of the community-integrated pathways. We conclude that collaborative and shared multilevel governance, despite its demanding nature, appears to contribute to the longevity of the actions and benefits of IPPIs and could prevent their relevance from being questioned.

Factors Associated with Complicated Grief Following a Railway Tragedy

On July 6, 2013, a train with 72 crude oil tank cars derailed in the heart of Lac-Mégantic, a small municipality of 6,000 inhabitants located in Québec (Canada). This tragedy killed 47 people. Technological disasters are rarely studied in bereavement research, and train derailments even less. The goal of this article is to increase our understanding of the bereavement consequences of technological disasters. Specifically, we aim to identify the factors that lead to the experience complicated grief and distinguish from the protective factors. A representative population-based survey was conducted among 268 bereaved people, three and a half years after the train accident. Of these, 71 people (26.5%) experienced complicated grief. People with complicated grief (CG) differ significantly from those without CG in terms of psychological health, perception of physical health, alcohol use and medication, as well as social and professional relationships. Hierarchical logistic regression analysis identified four predictive factors for CG: level of exposure to the disaster, having a negative perception of the event, as well as having a paid job and low-income increase the risk of CG. The importance of having health and social practitioners pay attention to these factors of CG are discussed along with future directions for research.

Stressed and distressed: how is the COVID-19 pandemic associated with sexual frequency, sexual satisfaction, and relationship satisfaction?

BACKGROUND

The Canadian government's response to the ongoing COVID-19 pandemic included the implementation of several restrictive measures since March 2020. These actions sought to decrease social contact and increase physical distancing, including that within universities. Such constraints were required to impede the transmission of the virus; however, concerns remain about their impact on the sexual and intimate relationships of university employees and students.

AIM

This study examined the associations between COVID-19-related stress and sexual frequency, sexual satisfaction, and relationship satisfaction, also testing the mediating role of psychological distress.

METHODS

The models were tested with Canadian data collected from university employees and students in 2 phases: the first wave in April-May 2020 (T1; n = 2754) and the second wave in November-December 2021 (T2; n = 1430), 18 months afterward. Participants completed self-report questionnaires online. Path analyses were performed to test the associations of the mediation models.

OUTCOMES

The principal outcomes included psychological distress determined via the Patient Health Questionnaire-4, relationship satisfaction measured via the Dyadic Adjustment Scale, and sexual satisfaction and sexual frequency ascertained through a single item each.

RESULTS

Overall, COVID-19-related stress was associated with higher psychological distress, which in turn was related to lower sexual frequency, sexual satisfaction, and relationship satisfaction. Similar results were obtained with T1 and T2 data, indicating the mediating effect of psychological distress.

CLINICAL IMPLICATIONS

These findings increase scholarly comprehension of the negative associations between stress/distress and sexual and romantic relationships. Sexuality and close relationships are vital to the quality of human life; thus, targeted interventions should be developed to reduce COVID-19-related stress and its impact on sexual and romantic relationships to mitigate the long-term influences of this unique global challenge.

STRENGTHS AND LIMITATIONS

To our knowledge, this study is the first to use a large sample size and replicate findings in 2 waves. Nonetheless, it is limited by the use of cross-sectional data. Longitudinal studies with the same participants are mandated to better understand the evolution of these outcomes.

CONCLUSION

COVID-19-related stress and psychological distress were found among participating university students and employees and were associated with lower sexual satisfaction, sexual frequency, and intimate relationship satisfaction. These results were observed at the early onset of the pandemic and 18 months afterward, suggesting that the stress generated by the pandemic were not mere reactions to the onset of the pandemic but persisted over time.

[End-of-life support experiences at home during the Covid-19 pandemic: Issues and challenges]

Objective The aim of this text is to describe the challenges and issues associated with family caregivers during the experience of caring for a person at the end of life at home, in the context of a pandemic. This support situation, already normally demanding, turned out to be more difficult and complicated than usual due to the many challenges and issues associated, in particular, with the health restrictions imposed at the time. Here, we present an analysis of comments gathered from family caregivers during the pandemic. Method Testimonials from caregivers were drawn from a research study entitled COVIDEUIL. The qualitative component of this study included many rich comments drawn from the voices of PPA and collected by questionnaire. For the present article, the focus was on qualitative data relating to the end-of-life situation at home of a loved one. This theme was documented by analyzing the responses of 71 caregivers. These people described, sometimes in detail, the particular circumstances surrounding their loved one's final days and death. Results PPAs report various issues in end-of-life care at home during the pandemic. Some results are similar to studies already carried out, including fatigue and the benefits of outside help, while others are perhaps more amplified, including the lack of support from caregivers, isolation, and the absence of continuity in services, due to the pandemic context. Testimonies show that home care requires physical and mental availability on the part of PPAs; the burden is imposing. In some cases, financial resources have been invested to pay for home care services. Moreover, formal and informal help remains an important element in maintaining home care until the end, otherwise it is compromised and institutional care becomes necessary. Conclusion For PPAs who were able to provide end-of-life care at home for their loved one at the end of life, various challenges were reported. In short, if end-of-life care at home is to be a safe and satisfying experience, PPAs must receive adequate support, and care must be tailored to the needs of the person being cared for. Support at the end of life at home is part of a long process of assistance and care provided by PPAs. The formal assistance offered should follow the evolution of the dyad's journey-PPA and cared-for person. End-of-life care at home is likely to increase as the population ages. As such, care and services must be orchestrated and adapted from the moment the diagnosis is announced. The Observatoire québécois de la proche aidance will certainly be able to assess the impact of the national policy on PPAs and measure the effects on their health, well-being and quality of life (art. 40) (ministère de la Santé et des Services sociaux, 2021a).

Respiratory and Otolaryngology Symptoms Following the 2019 Spring Floods in Quebec

BACKGROUND

Although floods may have important respiratory health impacts, few studies have examined this issue. This study aims to document the long-term impacts of the spring floods of 2019 in Quebec by (1) describing the population affected by the floods; (2) assessing the impacts on the respiratory system according to levels of exposure; and (3) determining the association between stressors and respiratory health.

METHODS

A population health survey was carried out across the six most affected regions 8-10 months post-floods. Data were collected on self-reported otolaryngology (ENT) and respiratory symptoms, along with primary and secondary stressors. Three levels of exposure were examined: flooded, disrupted and unaffected.

RESULTS

One in ten respondents declared being flooded and 31.4% being disrupted by the floods. Flooded and disrupted participants reported significantly more ENT symptoms (adjusted odds ratio (aOR): 3.18; 95% CI: 2.45-4.14; aOR: 1.76; 95% CI: 1.45-2.14) and respiratory symptoms (aOR: 3.41; 95% CI: 2.45-4.75; aOR: 1.45; 95% CI: 1.10-1.91) than the unaffected participants. All primary stressors and certain secondary stressors assessed were significantly associated with both ENT and respiratory symptoms, but no "dose-response" gradient could be observed.

CONCLUSION

This study highlights the long-term adverse effects of flood exposure on respiratory health.

Sociographie des ritualités funéraires en temps de pandémie: des rites empêchés aux rites appropriés

COVID-19 has led to unprecedented health and social measures in several countries, including major restrictions on funeral rituals. These restrictions concerned pre-mortem, peri-mortem and post-mortem rites. Based on a longitudinal study of 955 French-speaking Canadians bereaved of a loved one during the pandemic, this article describes the reality of these impediments. Through an analysis of the quantitative and qualitative data collected, it is possible to identify the gap between desired and realized funeral rituals during the first year of the COVID-19 pandemic. The results show important hindrances to the various desired rituals, yet some ritual and symbolic creativity by the bereaved.

[Influence of spirituality on health status in times of pandemic]

Spirituality is a health protection factor recognised in the scientific literature. However, few studies have evaluated its impact on French-speaking populations, in secularised societies and even fewer in the context of a pandemic. It is therefore interesting to highlight significant relationships between spiritual quality of life and health.

Psychological, Physical and Behavioral Health of Adults, 3 Years After Exposure to a Train Derailment

In July 2013, a train derailment profoundly disrupted the tranquility of the population of Lac-Mégantic for months and even years. In 2016, we conducted a representative population-based survey among 387 people from Lac-Mégantic and 413 from other municipalities with the aim to document psychological and physical health of adults exposed to the disaster. This article examines differences between 3 groups of respondents: those who were highly, moderately or not exposed to the train accident. Khi Square analyses, odds ratios and logistic regressions were used to examine differences between the 3 groups of respondents (high, moderate and no exposure). Results show that the level of exposure to this technological disaster is strongly associated with psychological suffering, post-traumatic growth, physical heath, drinking patterns, and use of prescribed and non-prescribed drugs. We can explain these results by the nature and cause of the event as well as its consequences.

Predictive Factors of Spiritual Quality of Life during the COVID-19 Pandemic: A Multivariate Analysis

COVID-19 has led to the implementation of various social and sanitary measures, impacting populations' quality of life. Aims: Documenting the spiritual quality of life (SQoL) of university employees and students in Quebec, Canada. A survey of 2,202 employees and students was conducted using health measurement tools, including the short version of the WHOQoL-SRPB. We ran a multiple linear regression to determine which variables promote the SQoL. SQoL was very low (2.92/5). Positive mental health, religion, and age are the main predictors of the SQoL. Some dimensions of spirituality contribute more than others to the respondents' quality of life and health during the COVID-19 pandemic.

Psychological impacts of the 2019 Quebec floods: findings from a large population-based study

Background

During Spring 2019, many regions in Quebec (Canada) experienced severe floods. As much as 5,245 households were flooded and 7,452 persons were evacuated, causing extensive material and human damages. A large population-based study was therefore conducted to examine medium-term effects of this natural disaster on health and well-being.

Methods

Six to eight months post-floods, households located in the flooded zones (in one of the 6 Quebec regions the most severely affected) were randomly invited to participate to a telephone or a web-based survey (response rate=15.3%). Several psychological health outcomes were examined, including psychological distress (based on the 6-item Kessler Scale, score 0-24) and post-traumatic stress (based on the 15-item Impact of Event Scale, score 0-75). These outcomes were compared among 3 levels of exposure using Chi-square test: flooded (floodwater in ≥ 1 liveable room), disrupted (floodwater in non-liveable areas, loss of utilities, loss of access to services, or evacuation), and unaffected.

Results

Of the 3,437 participating households, 349 (10.2%) were flooded and 1230 (35.8%) were disrupted (but not flooded) during the 2019 floods. A steep gradient was observed for moderate/severe symptoms of post-traumatic stress (score ≥ 26) according to the level of exposure to flooding (unaffected: 3.0%; disrupted: 14.6%; flooded: 44.1%; p < 0.0005). For psychological distress (score ≥ 7), the baseline level (i.e. unaffected group) was 7.3% while it reached 15.0% and 38.4% in the disrupted and the flooded groups, respectively (p < 0.0005).

Conclusions

This study is among the largest to examine the psychological impacts of flooding. The magnitude of effects observed in flooded households is consistent with the literature and calls for stronger social and economic measures to support flood victims. Such support should help coping with initial stress, but also alleviating secondary stressors classically observed in post-flood settings.

Key messages

Psychological impacts of floods may persist for several months and may be observed in both flooded and disrupted people. Stronger social and economic measures are needed to better support flood victims, not only in the short but also in the longer term.

A Salutogenic Approach to Disaster Recovery: The Case of the Lac-Mégantic Rail Disaster

In July 2013, a train carrying crude oil derailed in Lac-Mégantic (Canada). This disaster provoked a major fire, 47 deaths, the destruction of 44 buildings, a massive evacuation, and an unparalleled oil spill. Since 2013, Public Health has undertaken several actions to address this challenging situation, using both quantitative and qualitative methods. Community-based surveys were conducted in Lac-Mégantic in 2014, 2015 and 2018. The first two surveys showed persistent and widespread health needs. Inspired by a salutogenic approach, Public Health has shifted its focus from health protection to health promotion. In 2016, a Day of Reflection was organized during which a map of community assets and an action plan for the community recovery were co-constructed with local stakeholders. The creation of an Outreach Team is an important outcome of this collective reflection. This team aims to enhance resilience and adaptive capacity. Several promising initiatives arose from the action plan-all of which greatly contributed to mobilize the community. Interestingly, the 2018 survey suggests that the situation is now evolving positively. This case study stresses the importance of recognizing community members as assets, rather than victims, and seeking a better balance between health protection and health promotion approaches.

Medium-Term Effects of a Train Derailment on the Physical and Psychological Health of Men

In July 2013, the derailment of a train caused the death of 47 people and the destruction of Lac-Mégantic's downtown area (Canada). Three years after this event, a population survey was conducted among a representative sample of 800 adults, including 282 men. Several significant differences were observed among respondents of a survey based on their level of exposure to this tragedy, including their physical (changes in physical health) and psychological health (post-traumatic stress disorder, mood and anxiety disorders, psychological distress, signs of depression, consultation of social workers and psychologists) as well as their use of prescribed (anxiolytics and antidepressants) and nonprescribed drugs. Such results can be explained by the nature, magnitude, and cause of the event.

Seniors Who Experienced the Lac-Mégantic Train Derailment Tragedy: What Are the Consequences on Physical and Mental Health?

Introduction: In July 2013, a train derailment caused the death of 47 people and destroyed the downtown area in the city of Lac-Mégantic (Quebec, Canada). This tragedy had several impacts on this small community. Method: Three years after this disaster, we used a representative population-based survey conducted among 800 adults (including 265 seniors aged 65 or above) to assess the physical and mental health of seniors. Results: Several differences were observed in seniors' physical and mental health based on their level of exposure to the tragedy. Nearly half of seniors highly exposed to the train derailment (41.7%) believe that their health has deteriorated in the past 3 years. The majority of seniors highly exposed to the train derailment (68.7%) also show symptoms of posttraumatic stress disorders. Seniors highly or moderately exposed to the tragedy were also more likely to have found positive changes in their personal and social life as compared with nonexposed seniors. Discussion: A technological disaster such as a train derailment still had negative impacts on seniors' physical and mental health 3 years later. Conclusion: Public health authorities must tailor prevention and promotion programs to restore health and well-being in this population.

Men's Help-Seeking Attitudes in Rural Communities Affected by a Natural Disaster

The article describes a mixed methods study of help-seeking in men living in the Chilean Central Valley, following exposure to a major earthquake event in 2010. The results identify that, within the sample, positive attitudes toward help-seeking correlated with younger age, higher education levels, above-average incomes, and stable personal relationships. It appears that education plays a significant role in shaping such positive attitudes, particularly by influencing views of gender roles and help-seeking. Conversely, older men's reticence toward seeking help appeared linked to negative perceptions of available services and the influence of traditional notions of masculinity. The study concludes that adapting interventions and service offers to men's needs in rural contexts must include an ecosystemic analysis of their reality and incorporate an understanding of masculinity socialization processes.

Looking for capacities rather than vulnerabilities: The moderating effect of health assets on the associations between adverse social position and health

To increase capacities and control over health, it is necessary to foster assets (i.e. factors enhancing abilities of individuals or communities). Acting as a buffer, assets build foundations for overcoming adverse conditions and improving health. However, little is known about the distribution of assets and their associations with social position and health. In this study, we documented the distribution of health assets and examined whether these assets moderate associations between adverse social position and self-reported health. A representative population-based cross-sectional survey of adults in the Eastern Townships, Quebec, Canada (n = 8737) was conducted in 2014. Measures included assets (i.e. resilience, sense of community belonging, positive mental health, social participation), self-reported health (i.e. perceived health, psychological distress), and indicators of social position. Distribution of assets was studied in relation to gender and social position. Logistic regressions examined whether each asset moderated associations between adverse social position and self-reported health. Different distributions of assets were observed with different social positions. Women were more likely to participate in social activities while men were more resilient. Resilience and social participation were moderators of associations between adverse social position (i.e. living alone, lower household income) and self-reported health. Having assets contributes to better health by increasing capacities. Interventions that foster assets and complement current public health services are needed, especially for people in unfavorable situations. Health and social services decision-makers and practitioners could use these findings to increase capacities and resources rather than focusing primarily on preventing diseases and reducing risk factors.

Medium-Term Health of Seniors Following Exposure to a Natural Disaster

The article aims to describe the medium-term impacts of a major earthquake event (Chile, February 27, 2010) on 26 seniors. The authors adopted a qualitative study approach. Data obtained using the Impact of Event Scale-Revised (IES-R) show the presence of manifestations of posttraumatic stress in the majority of respondents. In addition, data collected in interviews demonstrated a progressive deterioration of the health of respondents over a period of 4 years following the disaster. Seniors are particularly vulnerable to the effects of material loss, emotional stress, and postdisaster health complications. These impacts are exacerbated by low economic status. Furthermore, broader research is necessary involving elderly living in poverty who have survived natural disasters and others without such experiences, in order to better identify and differentiate between health complications associated with exposure to disaster events and those linked more strictly with natural aging processes.

The "Lac-Mégantic tragedy" seen through the lens of the EnRiCH Community Resilience Framework for High-Risk Populations

SETTING

On July 6, 2013, a train carrying oil derailed in downtown Lac-Mégantic (Quebec, Canada), causing major human, environmental, and economic impacts. We aim to describe, and learn from, public health strategies developed to enhance community resilience following the train derailment though the lens of the EnRiCH Community Resilience Framework for High-Risk Populations.

INTERVENTION

Annual population-level surveys were conducted in Lac-Mégantic and surrounding areas to assess the long-term impacts of the disaster. Findings suggested that a solid upstream investment towards the development of adaptive capacity was needed. A "Day of Reflection" bringing together local stakeholders and citizens was organized, inspiring the elaboration of an innovative action plan. Leaders advocated for funding to support its implementation, leading to a substantial investment from the provincial government. Through a wide range of actions, the plan aims to bring psychosocial services closer to people, stay connected with the community, and foster community engagement.

OUTCOMES

Several lessons have been identified. After a disaster, there needs to be a balanced focus between the gaps/needs and strengths/capacities of a community. Moreover, public health actors must collaborate closely, all along the continuum of the upstream-downstream paradigm, with local organizations and citizens.

IMPLICATIONS

This unique experience, supported by an empirically-based framework, suggests that three vital ingredients are required for success in recovering from a disaster: (1) fostering community strengths and valuing citizen participation, (2) a strong political commitment to support upstream actions, and (3) a public health team able to support these actions.

Associations Between Resilience, Community Belonging, and Social Participation Among Community-Dwelling Older Adults: Results From the Eastern Townships Population Health Survey

OBJECTIVE

To examine the associations between resilience, community belonging, and social participation, and the moderating effect of resilience on the association between community belonging and social participation among community-dwelling older adults.

DESIGN

Cross-sectional; secondary analyses of the Eastern Townships Population Health Survey.

SETTING

Community.

PARTICIPANTS

A sample (N=4541) of women (n=2485) and men (n=2056) aged ≥60 years was randomly selected according to area. Most participants had <14 years of schooling, owned their dwelling, were retired, had 1 or 2 chronic conditions, and did not have depressive symptoms.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-reported data on age, education, depressive symptoms, social participation, community belonging, and resilience were collected by phone interviewer-administered questionnaire. A social participation scale measured frequency of participation in 8 community activities. A 4-point Likert scale ranging from "very strong" to "very weak" estimated sense of belonging to the local community. Social participation and sense of belonging questions came from Statistics Canada surveys. Resilience was assessed with the 10-item Connor-Davidson Resilience Scale, capturing the ability to cope with adversity.

RESULTS

Controlling for age, education, and psychological distress, greater resilience and community belonging were associated with greater social participation among women (R²=.13; P<.001) and men (R²=.09; P<.001). The association between community belonging and social participation varied as a function of resilience, especially in men. Greater community belonging further enhanced social participation, especially among women (P=.03) and men (P<.01) with greater resilience (moderator effect).

CONCLUSIONS

Resilience moderates the association between community belonging and social participation among community-dwelling older women and, especially, men. Interventions targeting social participation should consider the potential impact of resilience on improving community belonging. Future studies should investigate why resilience moderates associations between community belonging and social participation, and how to enhance resilience among older adults.

Chilean Men Exposed to the Major Earthquake in 2010

The article presents the results of a study involving 18 men, 4 years after one of South America's most powerful natural disasters: An earthquake occurring off the coast of Chile in February 2010. Participants reported having developed new psychological health problems in the months following the catastrophe. The manifestations most frequently reported by participants were the presence of depressive and stress symptoms, as well as sleep disorders. The majority of participants registered scores of 33 and above on the Impact of Event Scale-Revised, indicating that they were suffering from posttraumatic stress. Furthermore, although the majority of interviewed men reported having suffered psychological or physical health problems following the disaster, only a small minority had sought help from professional health services. The article develops insights into the men's social interactions and underlines the importance of supporting further research on red health topics, in particular the help-seeking behavior of men following exposure to natural disasters.

The public health response during and after the Lac-Mégantic train derailment tragedy: a case study

On July 6^th 2013, a train derailment occurred in the small town of Lac-Mégantic, Quebec, Canada, causing a major human and environmental disaster. In this case study, we comprehensively describe and analyze actions taken by the Public Health Department of the Eastern Townships, in close collaboration with community-based organizations, during both the impact phase emergency response and the post-impact recovery operations that continued for months. Due to the complexity of the event, public health actions needed to be broadly diversified. Preventive measures targeted chemical, physical, biological, and psychosocial hazards in the short-, medium- and long-term. Our analyses yielded valuable lessons that will improve and inform our response to future events while serving as a basis for developing a conceptual framework for public health emergency preparedness.

Nurses joining family doctors in primary care practices: perceptions of patients with multimorbidity

BACKGROUND

Among the strategies used to reform primary care, the participation of nurses in primary care practices appears to offer a promising avenue to better meet the needs of vulnerable patients. The present study explores the perceptions and expectations of patients with multimorbidity regarding nurses' presence in primary care practices.

METHODS

18 primary (health) care patients with multimorbidity participated in semi-directed interviews, in order to explore their perceptions and expectations in regard to the involvement of nurses in primary care practices. Interviews were audio-recorded and transcribed. After reviewing the transcripts, the principal investigator and research assistants performed thematic analysis independently and reached consensus on the retained themes.

RESULTS

Patients with multimorbidity were open to the participation of nurses in primary care practices. They expected greater accessibility, for both themselves and for new patients. However, the issue of shared roles between nurses and doctors was a source of concern. Many patients held the traditional view of the nurse's role as an assistant to the doctor in his or her various duties. In general, participants said they were confident about nurses' competency but expressed concern about nurses performing certain acts that their doctor used to, notwithstanding a close collaboration between the two professionals.

CONCLUSION

Patients with multimorbidity are open to the involvement of nurses in primary care practices. However, they expect this participation to be established using clear definitions of professional roles and fields of practice.

Purification and partial characterization of vitellogenin from shorthead redhorse (Moxostoma macrolepidotum) and copper redhorse (Moxostoma hubbsi) and detection in plasma and mucus with a heterologous antibody

Vitellogenin (VTG), the egg yolk precursor protein, was purified from plasma of estradiol-3-benzoate (E2B)-treated male shorthead redhorse (Moxostoma macrolepidotum) and immature copper redhorse (Moxostoma hubbsi) by a two-step chromatographic procedure without precipitation. Intact VTGs appeared as dimers with apparent molecular masses, determined by gel filtration, of approximately 425 kDa (copper redhorse) and approximately 450 kDa (shorthead redhorse). In native polyacrylamide gel electrophoresis (PAGE), dimeric redhorse VTGs appeared as a 520 kDa band. Both VTGs were reduced to a single monomer of approximately 150 kDa in sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) under reducing and nonreducing conditions, indicating that monomers are not linked by disulfide bonds in the dimer form. The purified proteins were characterized as phospholipoglycoproteins. Isoelectric focusing of both VTGs revealed components with isoelectric points ranging from 5.3 to 6.0, suggesting charge heterogeneity. The amino acid composition of both VTGs contains a high proportion of nonpolar amino acids and was similar to those of other teleosts. An antibody developed against carp (Cyprinus carpio) VTG showed cross-reactivity with VTG from both redhorse species. Using this antibody, VTG was detected in plasma and surface mucus of E2B-treated redhorse. This is the most extensive report on purification and characterization of vitellogenin from catostomidid species.

Vivre en résidence pour aînés : le format est-il la formule?

Le présent article discute des liens qui existent entre quatre caractéristiques organisationnelles des résidences pour aînés et le bien-être psychologique des personnes âgées. Afin d'identifier ces liens, 238 personnes âgées vivant dans onze résidences privées sans but lucratif ont été interviewées. Les résultats démontrent que deux des quatre caractéristiques organisationnelles sont associées au bien-être psychologique des personnes âgées, que celles-ci soient peu ou très vulnérables. Ces variables sont le niveau de service et la perception subjective qu'ont les aînés de leur niveau de contrôle sur le processus décisionnel, qualifié ici de perception du contrôle environnemental. Les résultats de la présente recherche démontrent l'importance d'offrir aux personnes âgées vivant en résidences privées divers milieux de vie dont les caractéristiques varient en fonction des capacités et des besoins des aînés.

Les sinistrés des inondations de 1996 au Saguenay : problèmes vécus et séquelles psychologiques

Les inondations de juillet 1996 ont touché une partie importante de la population du Saguenay. Des désastres de cette nature soumettent les personnes sinistrées à des expériences psycho-émotionnelles particulièrement difficiles à vivre entraînant généralement des séquelles psychologiques. À partir d'une recherche de type qualitatif portant sur l'analyse clinique de 30 histoires de cas, cette étude exploratoire permet de brosser un tableau de l'impact de ce désastre dans la vie des personnes touchées et d'en évaluer les conséquences sur leur santé psychologique. Les résultats indiquent que ce désastre a grandement bouleversé la vie des individus sinistrés entraînant de nombreuses difficultés et une détérioration de leur santé mentale, rendue évidente par l'apparition de problèmes et troubles psychologiques sérieux.

L’état de santé psychologique et physique des sinistrés des inondations de juillet 1996 : étude comparative entre sinistrés et non sinistrés

En juillet 1996, le Saguenay-Lac-St-Jean a vécu l'une des plus grandes catastrophes naturelles dans l'histoire du Québec. Cet article présente les résultats d'une recherche visant à comparer, deux ans après les inondations, l'état de santé physique et psychologique de sinistrés (n = 177) à celui de non-sinistrés (n = 168). Les résultats indiquent que les sinistrés, indépendamment de leur sexe, présentent un bien-être psychologique ainsi qu'un état de santé physique post-désastre différents des non-sinistrés. Les victimes des inondations sont, entre autres, beaucoup plus nombreux que les non-sinistrés à considérer que leur état de santé est mauvais ou moyen et à déclarer l'apparition de nouveaux problèmes de santé ou l'exacerbation de problèmes existants. Les sinistrés présentent également plus de manifestations de stress post-traumatiques et de plaintes somatiques, ont des niveaux plus élevés de dépression, d'anxiété et de dysfonctionnement social que les non-sinistrés. Toutefois, aucune différence significative entre les répondants n'est relevée en ce qui concerne la dépression sévère. Les résultats obtenus corroborent ceux d'autres études. Après une catastrophe naturelle ou technologique impliquant des dommages matériels importants aux biens individuels, les sinistrés sont plus affectés que les non-sinistrés au plan de leur état de santé psychologique et physique.

[Access to health care: perceptions of patients with multiple chronic conditions]

OBJECTIVE

To explore access to health care for patients presenting with multiple chronic conditions and to identify barriers and factors conducive to access.

DESIGN

Qualitative study with focus groups.

SETTING

Family practice unit in Chicoutimi (Saguenay), Que.

PARTICIPANTS

Twenty-five male and female adult patients with at least four chronic conditions but no cognitive disorders or decompensating conditions.

METHODS

For this pilot study, only three focus group discussions were held.

MAIN FINDINGS

The main barriers to accessing follow-up appointments included long waits on the telephone, automated telephone-answering systems, and needing to attend at specific times to obtain appointments. The main barriers to specialized care were long waiting times and the need to get prescriptions and referrals from family physicians. Factors reported conducive to access included systematic callbacks and the personal involvement of family physicians. Good communication between family physicians and specialists was also perceived to be an important factor in access.

CONCLUSION

Systematic callbacks, family physicians' personal efforts to obtain follow-up visits, and better physician-specialist communication were all suggested as ways to improve access to care for patients with multiple chronic conditions.

Multimorbidity and quality of life in primary care: a systematic review

Background

Many patients with several concurrent medical conditions (multimorbidity) are seen in the primary care setting. A thorough understanding of outcomes associated with multimorbidity would benefit primary care workers of all disciplines. The purpose of this systematic review was to clarify the relationship between the presence of multimorbidity and the quality of life (QOL) or health-related quality of life (HRQOL) of patients seen, or likely to be seen, in the primary care setting.

Methods

Medline and Embase electronic databases were screened using the following search terms for the reference period 1990 to 2003: multimorbidity, comorbidity, chronic disease, and their spelling variations, along with quality of life and health-related quality of life. Only descriptive studies relevant to primary care were selected.

Results

Of 753 articles screened, 108 were critically assessed for compliance with study inclusion and exclusion criteria. Thirty of these studies were ultimately selected for this review, including 7 in which the relationship between multimorbidity or comorbidity and QOL or HRQOL was the main outcome measure. Major limitations of these studies include the lack of a uniform definition for multimorbidity or comorbidity and the absence of assessment of disease severity. The use of self-reported diagnoses may also be a weakness. The frequent exclusion of psychiatric diagnoses and presence of potential confounding variables are other limitations. Nonetheless, we did find an inverse relationship between the number of medical conditions and QOL related to physical domains. For social and psychological dimensions of QOL, some studies reveal a similar inverse relationship in patients with 4 or more diagnoses.

Conclusions

Our findings confirm the existence of an inverse relationship between multimorbidity or comorbidy and QOL. However, additional studies are needed to clarify this relationship, including the various dimensions of QOL affected. Those studies must employ a clear definition of multimorbidity or comorbidity and valid ways to measure these concepts in a primary care setting. Pursuit of this research will help to better understand the impact of chronic diseases on patients.

The blue copper ceruloplasmin induces aggregation of newly differentiated neurons: a potential modulator of nervous system organization

Ceruloplasmin (CP) is a copper-dependent ferroxidase. It regulates iron metabolism and is involved in inflammation, angiogenesis, and protection against oxidative stress. CP also modulates K(+) channel activity in neuroblastoma cells and affects cardiodynamics of isolated hearts. Considering the presence of CP in the nervous system and the importance of iron ions and K(+) channels in neuronal activity, we postulated a role of CP in neuronal development. This hypothesis was tested using the P19 mouse embryonal carcinoma cell line, a model of neuronal differentiation. Addition of CP to the culture medium of newly differentiated P19 neurons induced cell aggregation within 24 h. This effect was concentration-dependent half-maximal at 50 nM, and not associated with necrosis, apoptosis or changes in secretory function. Deglycosylated CP was aggregative but not denatured CP, copper salts, His(2)Cu complex, or other copper enzymes or serum proteins. CP-induced aggregation was less pronounced with aging neurons and seemed not to involve K(+) channels. Immunocytofluorescence analysis demonstrated that digoxigenin-labeled CP bound to P19 neurons and the proportion of responding neurons decreased with aging. The interaction of digoxigenin-labeled CP with neurons was half-maximal at 120 nM by enzyme-linked immunosorbent assay and displaced by unlabeled CP. Our data indicate a specific aggregative action of CP on young neurons in vitro, possibly involving CP receptors. A potential developmental role of CP in nervous system organization is thus demonstrated.

Protocol to prevent shoulder-hand syndrome after stroke

OBJECTIVE

To determine the effectiveness of a protocol designed to restrict passive movement of affected upper extremity on the incidence of shoulder-hand syndrome (SHS) after stroke.

DESIGN

Before-and-after trial: follow-up duration of subject group and historical control group 231.6 and 257.2 days, respectively.

SETTING

Rehabilitation medicine department in a hospital in Japan.

PARTICIPANTS

SUBJECTS

81 stroke patients treated with the protocol from 1994 to 1996 who were followed for at least 4 months from the onset of stroke; controls: 71 stroke patients treated without the protocol from 1991 to 1994 who were followed for same length of time.

INTERVENTION

Use of a set protocol for controlled passive movement by trained therapists and restriction of passive movement by the patients for 4 months after stroke. The SHS criterion used to detect early signs of SHS has not yet been validated. Corticosteroids were given to all subjects diagnosed with SHS.

MAIN OUTCOME MEASURES

Swelling index, SHS diagnostic criteria applied in physical exam, Brunnstrom stage, and sensory disturbance evaluations.

RESULT

The incidence of SHS in the subject group was 18.5% (n = 15), whereas the incidence of SHS in the control group was 32.4% (n = 23). The difference between the 2 groups was statistically significant (chi(2) = 3.885, p < .05).

CONCLUSION

The protocol helped to prevent development of SHS.

Use of orthoses lowers the O(2) cost of walking in children with spastic cerebral palsy

PURPOSE

The aim of this study was to assess the effects of hinged ankle foot orthoses (AFO) on the metabolic and cardiopulmonary cost of walking and gross motor skills of children with cerebral palsy (CP).

METHODS

Ten habitual users of hinged AFO with spastic diplegic CP (9.01 yr +/- 2.10) participated in the study. Expired gas and heart rate (HR) were measured during sitting and with AFO on and off during steady state treadmill walking at three speeds: 3 km.h(-1), comfortable walking speed (CWS), and 90% of their fastest walking speed (FWS). Comfortable and fastest ground walking speed and Gross Motor Function Measure scores were also assessed with AFO on and off and analyzed with ANOVA. Because not all children could walk at all speeds on the treadmill, an ANOVA was performed on data for children who walked at 3 km.h(-1) and CWS (N = 8 for HR; N = 9 for pulmonary ventilation and metabolic variables) and a t-test on data at 90% of FWS (N = 9 for HR; N = 8 for pulmonary ventilation and metabolic variables).

RESULTS

When children wore their AFO net oxygen uptake (L.min(-1), absolute--sitting values) was significantly (P < 0.05) reduced by 8.9% at 3 km.h(-1) and by 5.9% at 90% of FWS. Net pulmonary ventilation (L.min(-1)) was significantly (P < 0.05) lower with AFO on by 10.3% but only at 3 km.h(-1). AFO did not affect net HR (beats.min(-1)) nor the respiratory exchange ratio at any speed, nor any physiologic variable at CWS, nor gross motor skills.

CONCLUSIONS

Use of hinged AFO reduces the oxygen and ventilatory cost of walking in children with spastic diplegic CP.

[Disaster victims of the 1996 Saguenay floods: problems experienced and psychological consequences.]

The July 1996 Saguenay floods affected an important part of the region's population. Disasters of this nature subject victims to particularly difficult psycho-emotional experiences. From a qualitative study of the clinical analysis of 30 case history, this exploratory research describes the impact of this disaster on the lives of the victims and evaluates the consequences on their psychological health. Results indicate that this disaster has greatly disrupted the lives of victims entailing several problems as well as a deterioration of their mental health translating into serious psychological problems and disorders.

[Psychological and physical health of the July 1996 disaster victims: A comparative study between victims and non-victims.]

In July 1996, the Saguenay-Lac-St-Jean region suffered one of the greatest natural disasters in Québec's history. This article presents results of a study aiming at comparing, two years after the flood, the physical and psychological health condition of victims (n=177) to that of non-victims (n=168). The results indicate that victims, - regardless of their gender - present a psychological well-being as well as a post-disaster physical health that is different from non-victims. Disaster victims are much more numerous than non-victims in considering that their health is bad or average and in witnessing new health problems or the exacerbation of existing problems. Victims also present more manifestations of prosttraumatic stress and somatic complaints, have higher levels of depression, anxiety and social dysfunction than non-victims. However, no significant difference between subjects was revealed concerning severe depression. Results obtained corroborated that of other studies. After a natural or technological disaster involving important material damages to individual belongings, victims are more affected than non-victims concerning their psychological and physical health.

[Redefining habitat and mental health of flood victims.]

During the July 1996 floods in the Saguenay area, many families lost everything : house, land and personal belongings. This disturbing situation forced many victims to let go of their home. A review of the literature has allowed to conclude that individuals develop profound feelings towards their homes and that its destruction entails disorganization as well as negative thoughts threatening their psychological equilibrium. With the objective of identifying the consequences of this disaster on the concept of home and mental health of victims, an exploratory study was realized during winter 1998 with 69 subjects having lost all their belongings. The data collected confirmed what has been raised in the scientific literature : many individuals have been profoundly scarred by this disaster on both levels of concept of home and psychosocial health. Two years following the disaster, nostalgia and disappointment are still present for most individuals who have been unable to find a new environment where they truly feel at home.

[Housing for the elderly : is the format the formula?]

This article discusses the existing links between four organizational characteristics of residency for the elderly as well as their psychological well-being. In order to identify these links, we have interviewed 238 elderly living in private housing facilities. Results show that two of the four organizational characteristics are associated with the psychological well-being of the elderly, vulnerable or not. These variables are the level of service and subjective perception the elderly have of their level of control on decision making qualified here as perception of environmental control. The results of this research shows the importance of offering different living environments with various characteristics which takes into consideration the capacities and the needs of the elderly.