Votre recherche

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.

Objective To assess the association between flooding/repeat flooding and: (1) psychological morbidity (anxiety, depression, post-traumatic stress disorder (PTSD)) and (2) health-related quality of life (HRQoL) at 6 months post-flooding. Design Cross-sectional analysis of data from the English National Study of Flooding and Health. Setting Cumbria, England. Participants Questionnaires were sent to 2500 residential addresses at 6 months post-flooding; 590 people responded. Outcomes Probable depression was assessed using the Patient Health Questionnaire, probable anxiety using the Generalised Anxiety Disorder scale and probable PTSD using the short-form PTSD checklist (PCL-6). HRQoL was assessed using the EQ-5D-5L. Mental health outcomes were analysed using logistic regression; HRQoL dimensions using ordinal regression; and summary index/Visual Analogue Scale scores using linear regression. Results One hundred and nineteen participants had been flooded, over half of whom were experiencing a repeat flooding event (54%; n=64). Mental health outcomes were elevated among flooded compared with unaffected participants (adjusted OR for probable depression: 7.77, 95% CI: 1.51 to 40.13; anxiety: 4.16, 95% CI: 1.18 to 14.70; PTSD: 14.41, 95% CI: 3.91 to 53.13). The prevalence of depression was higher among repeat compared with single flooded participants, but this was not significant after adjustment. There was no difference in levels of anxiety or PTSD. Compared with unaffected participants, those flooded had lower EQ-5D-5L index scores (adjusted coefficient: −0.06, 95% CI: −0.12 to −0.01) and lower self-rated health scores (adjusted coefficient: −6.99, 95% CI: −11.96 to −2.02). There was, however, little difference in HRQoL overall between repeat and single flooded participants. Conclusions Interventions are needed to help minimise the impact of flooding on people’s mental health and HRQoL.

Aim: The aim of the study was to investigate the health effect on and adaptation of the elderly affected by floods in the Lat Krabang District, Bangkok, Thailand in 2011.Methods: A cross-sectional descriptive study was conducted. Data were collected from 290 elderly participants who were affected by the floods using questionnaires.Results: The elderly participants had previous experience with flooding, but the massive flooding in 2011 was the most severe compared to any other experiences in the past. Physical health effects included muscle pain (35.2%), athlete’s foot (28.3%), and skin rash (23.1%). The psychological health effects (24.3%) encountered included insomnia, constant stress and tension, attention deficit, and discontentment. Most elderly (89.3%) decided not to relocate thinking they could still live at home, but they were concerned about the safety of their property. In regards to preparation for the flood, they prepared consumer goods, medication, and emergency kits. In addition, they kept abreast with news on television and public announcements in the community. They also helped clear the drainage system and prepared contact information of children, relatives, and government offices in case they needed assistance. Finally, to reduce possible damage to the property, they moved their belongings to high places, built sandbag walls, raised the house level, and prepared a water pump.Conclusion: The 2011 Thailand floods had adverse effects on physical and psychological health of the elderly people. To ensure better management for this vulnerable group, plans to respond to possible disasters need to be devised by relevant agencies to reduce flood-related health impacts.

Dans le cadre de la mise en œuvre du Plan d’action 2013-2020 sur les changements climatiques du Québec, le ministère de la Santé et des Services sociaux du Québec a mandaté l’Institut national de santé publique du Québec afin de mener une étude exploratoire portant sur les impacts psychosociaux vécus chez les travailleurs à la suite de quatre événements météorologiques extrêmes qui s’accentueront avec les changements climatiques, soit les vagues de chaleur, les inondations, les tempêtes et les feux de forêt. Cette étude exploratoire visait à examiner brièvement la littérature et les connaissances de différents acteurs-clés afin de proposer par la suite des projets de recherche plus importants et qui répondent aux besoins et aux enjeux des milieux de travail et de la santé publique au Québec. Elle a mis en évidence que les événements météorologiques extrêmes étudiés peuvent entraîner des impacts psychosociaux chez les travailleurs, mais les connaissances sur ces impacts varient grandement selon l’événement. Les impacts psychosociaux chez les travailleurs ont été plus documentés dans la littérature scientifique pour les tempêtes et l’ont été de façon moins importante pour les inondations et les feux de forêt et négligeable pour les vagues de chaleur. Les travailleurs des services de la première ligne (comme les intervenants municipaux, les policiers, les pompiers, et les professionnels de la santé qui interviennent auprès des sinistrés, le personnel des services de travaux publics, etc.) et les agriculteurs font partie des populations de travailleurs qui ont été les plus étudiées. Les impacts psychologiques négatifs comme de l’épuisement, de la fatigue, de la détresse psychologique, de l’anxiété, de la colère et de la tristesse ont été plus souvent rapportés dans la littérature que les impacts sociaux. Il existe des facteurs de risque organisationnels (ex. : surcharge de travail, le manque de formation, de ressources matérielles, de personnels disponibles) et personnels (ex. : le fait d’être sinistré, le manque de contact avec les membres de la famille), communs à plusieurs événements et types de travailleurs, et qui peuvent aggraver les impacts psychosociaux vécus chez les travailleurs. Il existe aussi des facteurs de protection (ex. : reconnaissance ou gratitude, résilience individuelle, soutien social et efficacité collective). Il est important de consulter des acteurs clés pour bonifier les connaissances de la littérature scientifique. Dans le cadre de cette étude, les consultations avec des acteurs clés ont permis d’identifier de nouveaux travailleurs vulnérables, d’en apprendre davantage sur les caractéristiques de certains événements météorologiques extrêmes et de réaliser que les impacts psychosociaux vécus à la suite de ceux-ci pouvaient être positifs. L’acquisition de connaissances sur les impacts psychosociaux vécus chez les travailleurs à la suite des inondations est un des sujets qui répond aux besoins et aux enjeux des milieux de travail et de la santé publique au Québec.<br/><br/>

In this editorial, the authors (and guest editors) introduce the Special Issue titled Understanding Game-based Approaches for Improving Sustainable Water Governance: The Potential of Serious Games to Solve Water Problems. The authors take another look at the twelve contributions, starting from the subtitle question: what is the potential? The authors summarize the insights and give directions for future research.