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La personnalisation des services est de plus en plus populaire dans le réseau de la santé et des services sociaux. Plutôt que de piger parmi des offres de services existantes, l’usager coconstruit des services selon ses besoins. Or, malgré les avancées dans ce domaine, peu d’approches de personnalisation des services existent pour répondre aux besoins des communautés. Dans ce texte, nous souhaitons contribuer au champ de la personnalisation des services en l’enrichissant d’une perspective communautaire. Vers cet objectif, nous recensons diverses approches employées en santé publique qui tiennent compte des besoins spécifiques des communautés. Nous déclinons ces approches au moyen d’interventions locales pour illustrer comment elles contribuent au développement d’une perspective communautaire à superposer au modèle actuel de personnalisation des services. Nous soutenons que la fonction promotion de la santé en santé publique permet de relier les individus à leur communauté d’appartenance au sein d’un modèle unique de personnalisation des services. Nous pensons que ce modèle intégré de personnalisation des services permettra d’une part, la coproduction de services individuels et communautaires et d’autre part, qu’il favorisera le rapprochement des acteurs des domaines de la santé publique et des services sociaux autour d’un projet commun de développement de communautés productrices de bien-être.

Introduction:In July 2013, a train transporting oil derailed and exploded in Lac-Mégantic, causing major human, environmental, and economic impacts. A community-based survey of people aged 10-25, conducted in 2017, revealed that many young people suffer in silence and report feeling isolated. These observations led to the conclusion that we must make room for young people, and that opportunities for engagement and participation must be provided within the community.Aim:The Public Health Direction of Estrie aimed to identify strategies to promote health and wellbeing for young people living in and around Lac-Mégantic.Methods:A collective reflection half-day was hosted with sixty key stakeholders (school board, other education institutions, health and social services, community sector, municipal/political sector, parents, youth). Throughout the event, participants were invited to build on and learn from accomplishments and experiential knowledge, and develop a common vision of the solutions to be pursued or implemented. All qualitative data sources (verbal and written data from large- and sub-group activities) were analyzed through a content analysis.Results:Several themes (i.e. potential solutions) emerged from the analysis: common venue, diversified activities, communication, collaboration, involvement, support for at-risk youth, intergenerational component, etc. Participants agreed on four priorities for action: 1) creating a gathering place, 2) establishing a Youth Committee, 3) supporting adults working with youth, and 4) fostering a better flow of information.Discussion:Several positive outcomes of the collective reflection half-day were observed, including the mobilization of the participants who greatly appreciated the event, and many promising ideas launched by stakeholders. A social worker is now fully dedicated to supporting youth wellbeing and engagement in Lac-Mégantic. A Youth Committee has been established and projects by and for youth are being implemented. Bottom-up approaches to identify solutions to complex situations are not only effective but also respectful of the local culture.

Social participation is a modifiable health determinant influenced by physical and social aspects of the environment. Little is known about aging women’s and men’s community activities and barriers according to region and population size. This study compared social participation, desire to participate more, and perceived barriers of aging women and men by Canadian region and population size.

L’Organisation mondiale de la Santé (OMS) soutient que les changements climatiques représentent la plus grande menace pour la santé dans le monde au 21e siècle. Ceux-ci influencent négativement plusieurs déterminants sociaux et environnementaux de la santé comme l’accessibilité à la nourriture et la qualité de cette dernière, l’eau et l’air. Blessures, impacts psychosociaux, aggravation de maladies respiratoires, malnutrition, maladies infectieuses, décès : les conséquences sanitaires sont susceptibles d’affecter les populations sur tous les continents. Le Canada se réchauffe deux fois plus rapidement que la moyenne mondiale en raison de sa proximité au pôle Arctique, où le réchauffement est accéléré comparativement à l’équateur (Bush et Lemmen, 2019). Ainsi, le Québec n’est certainement pas à l’abri des changements climatiques. Dans le Sud de la province, les températures moyennes observées ont augmenté de plus d’un degré depuis 1970 et des répercussions se font déjà sentir dans notre environnement. Ce réchauffement, accompagné d’une plus grande variabilité du climat (augmentation du risque d’orages, de tempêtes et d’extrêmes hydrométéorologiques en général), représente un défi grandissant pour les professionnel.le.s de la santé. Dans la région de l’Estrie, les professionnel.le.s de santé publique ont effectué une analyse qui leur ont permis d’identifier quatre principaux problèmes environnementaux associés aux changements climatiques, soit : les vagues de chaleur; les inondations; les tiques à pattes noires; le pollen de l’herbe à poux. Ces problèmes ont des impacts importants sur la santé, c’est-à-dire potentiellement graves ou qui touchent un grand nombre de personnes. Le stress et les pertes (humaines et matérielles) engendrées par ces différents problèmes environnementaux peuvent aussi représenter une source majeure de problèmes psychologiques significatifs pouvant persister dans le temps. De plus, ces impacts sont variables selon les différents contextes sociaux des individus et des communautés, générant des inégalités sociales de santé.

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.

Introduction:Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors.Aim:To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a conceptual framework and performance measurement indicators for public health emergency preparedness (PHEP), to ensure knowledge generated is relevant and useful to the field.Methods:The iKT approach was initiated by identifying a research question based on priorities from the field. The two phases of the study used participatory research methods as well as active engagement with potential end users at key study milestones. The Structured Interview Matrix (SIM) facilitation technique for focus groups and an expert panel using Delphi methodology were used to define the PHEP framework and performance measurement indicators, respectively. An advisory committee was assembled consisting of potential end-users of the research, in senior positions in applied and decision-making roles.Results:iKT was an essential component for this applied public health project, contributing to and enhancing the relevance of the knowledge generated. iKT contributed to the following: broad national engagement and interest in the study, successful recruitment in both phases, and engagement with decision-makers. This multi-dimensional participatory approach successfully generated knowledge that was important to the field demonstrated by relevance to practice and policy in jurisdictions across Canada. Furthermore, the approach fostered building resilience in local and national communities through collaboration.Discussion:The iKT approach was essential to generating knowledge that is relevant and useful to the field, mainly to promote health system preparedness and resilience. Future research to study the implementation of knowledge will be important to continue addressing the knowledge-to-action gap in health emergency management research.

Emergencies and disasters impact population health. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared. There is a knowledge gap in that existing frameworks lack consideration for complexity relevant to health systems and the emergency context. The objective of this study is to describe the essential elements of a resilient public health system and how the elements interact as a complex adaptive system.

Introduction:In July 2013, a train carrying 72 cars of crude oil derailed in the town of Lac-Mégantic (Eastern Townships, Quebec, Canada). This disaster provoked a major conflagration, explosions, 47 deaths, the destruction of 44 buildings, the evacuation of one-third of the local population, and an unparalleled oil spill. Notwithstanding the environmental impact, many citizens of this town and in surrounding areas have suffered and continue to suffer substantial losses as a direct consequence of this catastrophe.Problem:To tailor public health interventions and to meet the psychosocial needs of the community, the Public Health Department of Eastern Townships has undertaken repeated surveys to monitor health and well-being over time. This study focuses on negative psychosocial outcomes one and two years after the tragedy.Methods:Two cross-sectional surveys (2014 and 2015) were conducted among large random samples of adults in Lac-Mégantic and surrounding areas (2014: n = 811; 2015: n = 800), and elsewhere in the region (2014: n = 7,926; 2015: n = 800). A wide range of psychosocial outcomes was assessed (ie, daily stress, main source of stress, sense of insecurity, psychological distress, excessive drinking, anxiety or mood disorders, psychosocial services use, anxiolytic drug use, gambling habits, and posttraumatic stress symptoms [PSS]). Exposure to the tragedy was assessed using residential location (ie, six-digit postal code) and intensity of exposure (ie, intense, moderate, or low exposure; from nine items capturing human, material, or subjective losses). Relationships between such exposures and adverse psychosocial outcomes were examined using chi-squares and t-tests. Distribution of outcomes was also examined over time.Results:One year after the disaster, an important proportion of participants reported human, material, and subjective losses (64%, 23%, and 54%, respectively), whereas 17% of people experienced intense exposure. Participants from Lac-Mégantic, particularly those intensely exposed, were much more likely to report psychological distress, depressive episode, anxiety disorders, and anxiolytic drug use, relative to less-exposed ones. In 2015, 67% of the Lac-Mégantic participants (76% of intensely exposed) reported moderate to severe PSS. Surprisingly, the use of psychosocial services in Lac-Mégantic declined by 41% from 2014 to 2015.Conclusion:The psychosocial burden in the aftermath of the Lac-Mégantic tragedy is substantial and persistent. Public health organizations responding to large-scaling disasters should monitor long-term psychosocial consequences and advocate for community-based psychosocial support in order to help citizens in their recovery process.

Canada regularly faces environmental public health (EPH) disasters. Given the importance of evidence-based, risk-informed decision-making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster management. In-depth interviews were conducted with 23 leaders in disaster management from Canada, the United States, the United Kingdom, and Australia, and were complemented by other qualitative methods. Three topics were examined: governance, knowledge creation/translation, and related barriers/needs. Data were analyzed through a four-step content analysis. Six critical success factors emerged from the analysis: blending the best of traditional and modern approaches; fostering community engagement; cultivating relationships; investing in preparedness and recovery; putting knowledge into practice; and ensuring sufficient human and financial resources. Several promising knowledge-to-action strategies were also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources. There is no single roadmap to incorporate EPH expertise and research into disaster management. Our findings suggest that preparation for and management of EPH disaster risks requires effective long-term collaboration between science, policy, and EPH practitioners at all levels in order to facilitate coordinated and timely deployment of multi-sectoral/jurisdictional resources when and where they are most needed.

Emergencies and disasters typically affect entire communities, cause substantial losses and disruption, and result in a significant and persistent mental health burden. There is currently a paucity of evidence on safe and effective individual- and community-level strategies for improving mental health before, during, and after such events. In October 2018, the World Health Organization (WHO) Centre for Health Development (WHO Kobe Centre) convened a meeting bringing together leading Asia Pacific and international disaster research experts. The expert meeting identified key research needs in five major areas, one being “Psychosocial management before, during, and after emergencies and disasters”. Experts for this research area identified critical gaps in observational research (i.e., the monitoring of long-term psychological consequences) and interventional research (i.e., the development and evaluation of individual- and community-level interventions). Three key research issues were identified. First, experts underscored the need for a standardized and psychometrically robust instrument that classified the mental health/psychosocial risk of people within both a clinical and community setting. Then, the need for a standardization of methods for prevention, screening, diagnosis, and treatment for affected people was highlighted. Finally, experts called for a better identification of before, during, and after emergency or disaster assets associated with greater community resilience.