Danielle Maltais

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

BackgroundMany 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.MethodsMedline 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.ResultsOf 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.ConclusionsOur 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 public health response during and after the Lac-Mégantic train derailment tragedy: a case study

On July 6th 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.

Chilean Men Exposed to the Major Earthquake in 2010: Investigation of the Impacts on Their Health

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.

Conséquences des inondations de juillet 1996 sur la conception du chez-soi et la santé biopsychosociale des préretraités et retraités

In July 1996, major floods destroyed several houses occupied by pre-retirees (ages 50–59) and retirees (ages 60 and over). Faced with the task of relocating and rebuilding a new home, several of those older adults lived through difficult post-traumatic adaptation periods. The data collected during in-depth interviews with 31 aging people clearly show that the biopsychosocial health of pre-retirees and retirees, as well as their conception of home were greatly disturbed. The floods also had significant consequences on their behaviour, character and beliefs. A list of recommendations from the victims interviewed to individuals, workers and different government departments shows the need to take into account the emotional distress of victims in implementing emergency measures.

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

SettingOn 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.InterventionAnnual 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.OutcomesSeveral 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.ImplicationsThis 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.RésuméContexteLe 6 juillet 2013, un train transportant du pétrole déraillait au centre-ville de Lac-Mégantic (Québec, Canada), causant des impacts majeurs sur le plan humain, environnemental et économique. Notre objectif est de décrire les stratégies de santé publique développées pour favoriser la résilience communautaire suivant la tragédie ferroviaire et d’en tirer des leçons, à travers la lentille du « EnRiCH Community Resilience Framework for High-Risk Populations ».InterventionDes enquêtes populationnelles ont été réalisées annuellement à Lac-Mégantic et les environs pour examiner les conséquences à long terme de la catastrophe. Les résultats suggèrent qu’un important effort en amont était nécessaire afin de développer la capacité d’adaptation. Une journée de réflexion rassemblant des partenaires locaux et des citoyens a été organisée, inspirant l’élaboration d’un plan d’action innovant. Les leaders ont plaidé pour l’obtention d’un financement afin de soutenir son implantation, ce qui a mené à un investissement substantiel du gouvernement du Québec. À travers un large éventail d’actions, le plan vise à rapprocher les services psychosociaux de la population, rester connecté avec la communauté et promouvoir la mobilisation communautaire.RetombéesPlusieurs leçons ont été tirées. Après une catastrophe, on doit porter une attention à la fois sur les lacunes/besoins et les forces/capacités de la communauté. De plus, les acteurs de santé publique doivent collaborer étroitement, autant en amont qu’en aval, avec les organisations locales et les citoyens.ImplicationsCette expérience unique, soutenue par un cadre fondé sur des données empiriques, suggère que trois composantes sont essentielles au succès du rétablissement post-catastrophe: (1) la valorisation des forces de la communauté et de la participation citoyenne, (2) un engagement politique fort pour soutenir les actions en amont, et (3) une équipe de santé publique capable de soutenir ces actions.