Mathieu Roy

The body image construct among Western seniors: A systematic review of the literature

Despite numerous body image researches focusing on children, adolescents, young and middle-aged adults, there is a dearth regarding the body image of Western seniors. In this paper, we reviewed this literature using a systematic three-step extraction procedure plus a quality evaluation assessment for each retained article. The results showed that, while body dissatisfaction (BD) and body image distortion (BID) exist at older ages, the importance given to body image as it relates to physical appearance is lower in comparison with younger samples. Associations between body image and physical/mental health were also shown. Various tensions regarding the aging body (appearance vs. health, inside vs. outside, natural vs. unnatural) as well as a double standard of aging were also reported among older women. We conclude that the body image experience of Western seniors has both specificities and similarities with the one of younger populations. We also conclude that some methodological aspects of the literature on body image among older adults need to be addressed in order to move forward with this field of research.

A scoping review of anorexia of aging correlates and their relevance to population health interventions.

Anorexia of aging (AA, i.e., loss of appetite and/or reduction of food intake with aging) is an important public health issue. It leads to unintentional weight loss, which is an independent risk factor for morbidity and mortality among seniors. AA has mainly been studied from a biological perspective and regarded as a normal physiological consequence of aging, rather than a negative health outcome with underlying determinants. Some potentially modifiable correlates have however been found to be associated with this geriatric condition. Here, we conducted a scoping review of the literature to: 1) identify AA correlates, and 2) discuss their relevance to population health interventions. Our results indicate two main categories of AA correlates, namely, physiopathological and non-physiopathological. The first category relates to physiological dysfunctions, pathologies involving (or culminating in) biomarker dysregulation, and polypharmacy. These correlates are difficult to modify, especially through population health interventions. The second category, which contains fewer correlates, includes potentially modifiable public health targets, such as food-related properties, psychological, sociocultural, and environmental issues. We conclude that there are several AA correlates. Some of them are modifiable and could be targeted for development and implementation as appropriate population health interventions to prevent appetite loss and promote maintenance of adequate food intake in aging.

Surveillance of social and geographic inequalities in housing-related issues: the case of the Eastern Townships, Quebec (Canada).

Even though health inequalities are conditioned by many aspects of the environment, much of the existing research focuses on the social environment. This emphasis has the effect to neglect other environmental aspects such as its physical dimension. The physical environment, which is linked to housing conditions, may contribute to the uneven distribution of health. In this study, we examined 19 housing-related issues among a representative sample of 2,000 adults residing in a Quebec (Canada) health region characterized by a mix of rural, semi-rural, and urban areas. The distribution of these issues was examined according to socioeconomic and geographic indicators of social position. Summary measures of inequalities were assessed. Our results showed that the prevalence of nearly all housing-related issues was higher among low-income households compared to more affluent ones. Highly educated individuals showed better housing conditions, whereas different issues tended to cluster in deprived or densely populated areas. To conclude, we observed steep gradients between social class and poor housing conditions. This may explain a substantial part of health inequality on the regional scale. The surveillance of housing-related issues is therefore essential to properly inform and mobilize local stakeholders and to develop interventions that target vulnerable groups on this level.

Seniors' Body Weight Dissatisfaction and Longitudinal Associations With Weight Changes, Anorexia of Aging, and Obesity: Results From the NuAge Study

Objective: We examined longitudinal associations between weight dissatisfaction, weight changes, anorexia of aging, and obesity among 1,793 seniors followed over 4 years between 2003 and 2009. Method: Obesity prevalence (body mass index [BMI] ≥ 30) and prevalence/incidence of weight dissatisfaction, anorexia of aging (self-reported appetite loss), and weight changes ≥5% were assessed. Predictors of weight loss ≥5%, anorexia of aging, and weight dissatisfaction were examined using logistic regressions. Results: Half of seniors experienced weight dissatisfaction (50.6%, 95% confidence interval [CI] = [48.1, 53.1]). Anorexia of aging and obesity prevalence was 7.0% (95% CI = [5.7, 8.3]) and 25.1% (95% CI = [22.9, 27.3]), whereas incidence of weight gain/loss ≥5% was 6.6% (95% CI = [1.3, 11.9]) and 8.8% (95% CI = [3.3, 14.3]). Weight gain ≥5% predicts men’s subsequent weight dissatisfaction (odds ratio [OR] = 6.66, 95% CI = [2.06, 21.60]). No other association was observed. Discussion: Weight dissatisfaction is frequent but not associated with subsequent eating disorders. In men, weight gain predicted weight dissatisfaction. Seniors’ weight dissatisfaction does not necessarily equate weight changes. Due to its high prevalence, it is of public health interest to understand how seniors’ weight dissatisfaction may impact health.

Capturing how age-friendly communities foster positive health, social participation and health equity: a study protocol of key components and processes that promote population health in aging Canadians

BackgroundTo address the challenges of the global aging population, the World Health Organization promoted age-friendly communities as a way to foster the development of active aging community initiatives. Accordingly, key components (i.e., policies, services and structures related to the communities’ physical and social environments) should be designed to be age-friendly and help all aging adults to live safely, enjoy good health and stay involved in their communities. Although age-friendly communities are believed to be a promising way to help aging Canadians lead healthy and active lives, little is known about which key components best foster positive health, social participation and health equity, and their underlying mechanisms.This study aims to better understand which and how key components of age-friendly communities best foster positive health, social participation and health equity in aging Canadians. Specifically, the research objectives are to:1)Describe and compare age-friendly key components of communities across Canada2)Identify key components best associated with positive health, social participation and health equity of aging adults3)Explore how these key components foster positive health, social participation and health equityMethodsA mixed-method sequential explanatory design will be used. The quantitative part will involve a survey of Canadian communities and secondary analysis of cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The survey will include an age-friendly questionnaire targeting key components in seven domains: physical environment, housing options, social environment, opportunities for participation, community supports and healthcare services, transportation options, communication and information. The CLSA is a large, national prospective study representative of the Canadian aging population designed to examine health transitions and trajectories of adults as they age. In the qualitative part, a multiple case study will be conducted in five Canadian communities performing best on positive health, social participation and health equity.DiscussionBuilding on new and existing collaborations and generating evidence from real-world interventions, the results of this project will help communities to promote age-friendly policies, services and structures which foster positive health, social participation and health equity at a population level.

The relevance of positive approaches to health for patient-centered care medicine

Over the last centuries, the field of medicine has evolved from a disease-oriented model where individuals were seen as simple hosts for diseases, to a patient-centered approach where health professionals actively try to engage their patients in treatment decision-making. This deep change in models of care acknowledges that patients are important actors in health fulfillment. Even though this change in models of care was a major step forward for medical practices and treatment success, patient-centered care medicine (PCCM) has brought its own limitations. In this brief comment, the concept of PCCM will be defined and the benefits of this model of care will be highlighted. The limitations inherent to PCCM will also be summarized. A discussion on how PCCM can move forward will be undertaken using evidence-based knowledge on positive approaches to health. Finally, an encompassing perspective (i.e. the salutogenic perspective) will il lustrate how the PCCM model of care can help to operationalize major health conceptual frameworks worldwide.

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.

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.

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.

A Media Analysis of Canadian Disasters: How are Capability and Vulnerability Framed?

being a major threat in Israel. In particular, studies performed thus far suggest that Israeli preparedness behavior does not adhere to classical correlates of preparedness behavior, such as perception of likelihood or severity. This makes behavioral prediction models inapt in describing preparedness patterns among the Israeli population. Methods: A cross-sectional study based on an Internet survey was performed in 2016. The sample included 385 participants from a diverse socio-demographic background representing the different sectors of Israeli society. The questionnaire included a preparedness index, measurement of the sense of preparedness, Trait Anxiety Inventory, Life Orientation Test, Behavioral Inhibition System (BIS) & Behavioral Activation System (BAS) Scales, and ego defenses. Results: The results suggest that optimistic and rational individuals report significantly greater levels of preparedness, whereas people scoring high on the trait anxiety scale, and those with a tendency to use denial coping mechanisms, report significantly lower levels of preparedness. In addition, the BIS was found to be significantly, negatively associated with reported preparedness. See Table 1. Conclusion: The results of the current study suggest that trait anxiety and optimism appear to be substantially associated with preparedness behavior, and the latter can serve as a predictor of said behavior. Motivating preparedness behavior could draw inspiration from the results of our study.