Health / Disease

Inadequate pregnancy monitoring for pregnant migrant women without medical insurance (PMWMI) exposes them to severe complications during childbirth and consequences for the health of their child (e.g. preterm delivery, low birth weight, etc.). This scoping review aims to identify existing interventions globally to improve access to perinatal care for PMWMI. It will also highlight the strengths, weaknesses as well as the costs of these interventions.

Cette étude documente l’utilisation des services sociaux et de santé québécois par les hommes immigrants. Plus précisément, elle dresse dans un premier temps un portrait de l’état de santé physique et de l’état de bien-être psychologique de ces hommes. Elle examine ensuite leurs trajectoires d’utilisation (ou de non-utilisation) des services et explore à la fois les obstacles qu’ils rencontrent lorsqu’ils cherchent à accéder à des services et les éléments qui, en contrepartie, leur en facilitent l’utilisation. Finalement, elle se penche sur les attentes et les perceptions des hommes immigrants vis-à-vis de ces services. De manière transversale, une attention particulière est portée à l’impact de la pandémie de COVID-19 et des mesures de confinement sur ces différents sous-thèmes, l’entièreté de la collecte de données ayant été effectuée en contexte pandémique

A cross-jurisdictional pan-Canadian environmental scan was conducted to identify provincial, territorial, and federal financial supports available to families with children living with neurodisabilities. In partnership with the organization Childhood Disability LINK, flowchart-styled pathway documents were developed for each financial support identified, mapping out the processes required to access each support. A critical analysis was completed as it relates to structural barriers, accessibility of program information and geographic discrepancies. The results revealed that, despite almost universal availability of programs to support families of children living with neurodisabilities, significant barriers and inequity remain. This included considerable variation in access to financial support based on geographic and jurisdictional discrepancies, absence of adequate and accurate information about programs, and minimal support provided to families in the application process. We argue that the barriers and discrepancies identified were an inherent result of the Canadian federalist fragmentation of the delivery of social care and financial support programs for children living with neurodisabilities. A more unified response by Canadian provincial, territorial, and federal governments is clearly needed to take positive steps to address the consequences of federalist fragmentation and respond to the structural barriers and geographic discrepancies identified by this study. 

Objectives

High mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD.

Design

Cross-sectional study.

Setting

The current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC).

Participants

A large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC.

Primary and secondary outcome measures

Participants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions.

Results

Overall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms.

Conclusions

Results indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.

Ambivalence toward pregnancy is an important predictor of early pregnancy as documented in diverse Western societies. Inuit women from Nunavik, a northern region of Quebec, Canada, experience a high rate of early pregnancy, yet no study has explored their attitudes toward pregnancy. Grounded in a participatory approach, this study aimed to explore ambivalence toward pregnancy, among other pregnancy-related attitudes, and identify themes underlying ambivalence among young Inuit women from Nunavik. We conducted semi-structured interviews with 15 women aged 16 to 20 years, who became pregnant during the year preceding the interview. We used an inductive approach to analyse the data. Eleven participants were identified as ambivalent toward pregnancy while three were characterised as having a favourable attitude, and one as unfavourable. Four themes related to ambivalence were identified: the value of childbearing/motherhood; the use of contraceptives; the likelihood of becoming pregnant; and the ideal age to become pregnant. A better understanding of young women’s attitudes toward pregnancy could contribute to the development of culturally relevant programmes to more effectively support adolescents, pregnant adolescents and young mothers, and to lead to better care.

Background: Migrants commonly maintain transnational ties as they relocate and settle in a new country. There is a growing body of research examining transnationalism and health. We sought to identify how transnationalism has been defined and operationalized in migrant health research in high income countries and to document which populations and health and well-being outcomes have been studied in relation to this concept.

Methods: We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI). We searched nine electronic databases; no time restrictions were applied. Studies published in English or French in peer-reviewed journals were considered. Studies were eligible if they included a measure of transnationalism (or one of its dimensions; social, cultural, economic, political and identity ties and/or healthcare use) and examined health or well-being.

Results: Forty-seven studies, mainly cross-sectional designs (81%), were included; almost half were conducted in the United States. The majority studied immigrants, broadly defined; 23% included refugees and/or asylum-seekers while 36% included undocumented migrants. Definitions of transnationalism varied according to the focus of the study and just over half provided explicit definitions. Most often, transnationalism was defined in terms of social connections to the home country. Studies and measures mainly focused on contacts and visits with family and remittance sending, and only about one third of studies examined and measured more than two dimensions of transnationalism. The operationalization of transnationalism was not consistent and reliability and validity data, and details on language translation, were limited. Almost half of the studies examined mental health outcomes, such as emotional well-being, or symptoms of depression. Other commonly studied outcomes included self-rated health, life satisfaction and perceived discrimination.

Conclusion: To enhance comparability in this field, researchers should provide a clear, explicit definition of transnationalism based on the scope of their study, and for its measurement, they should draw from validated items/questions and be consistent in its operationalization across studies. To enhance the quality of findings, more complex approaches for operationalizing transnationalism (e.g., latent variable modelling) and longitudinal designs should be used. Further research examining a range of transnationalism dimensions and health and well-being outcomes, and with a diversity of migrant populations, is also warranted.

Highlights
Poor Ebola virus disease (EVD) knowledge is associated to risky rumors, misconceptions, and inappropriate practices.

A large proportion of participants did not have sufficient knowledge on EVD transmission, prevention and treatment methods.

More than half of participants had misconceptions about EVD and were not aware of appropriate practices.

Results will facilitate the development of education programs that should equip them to prevent the spread of the EVD.

In the past decade there has been an increase in focus on the concept of deservingness and how it plays out in debates around health care for migrant populations with precarious legal status. This study uses latent class analysis to identify subtypes of attitudes regarding asylum seeker access to health care and endorsement of support for asylum seeker access to care among 4066 employees of health care institutions in Montreal and Toronto, Canada. Authors identified four classes of attitudes towards asylum seeker access to care named ‘Favorable,’ ‘Opposed,’ ‘Ambivalent/Reactive,’ and ‘Unconcerned/Status quo’. The odds of endorsing access to health care depended on the individual’s class membership of asylum seeker attitude. Although there are segments of the population that overwhelmingly endorse, or reject, asylum seeker access to care, there are important variants in opinions and beliefs. Interventions are needed to engage professionals more ambivalent or opposed to asylum seeker access to care.

Vaccination is a common painful procedure for children. Parents’ concern regarding vaccination pain is a significant driver of vaccine hesitancy. Despite the wealth of evidence-based practices available for managing vaccination pain, parents lack knowledge of, and access to, these strategies. Knowledge translation (KT) tools can communicate evidence-based information to parents, however little is known about what factors influence parents’ use of these tools. A two-page, electronic KT tool on psychological, physical, and pharmacological vaccination pain management strategies for children, was shared with parents as part of a larger mixed methods study, using explanatory sequential design, exploring factors related to uptake of this KT tool. The aim of this qualitative study was to understand what influenced parents’ perceptions of the relevance of the KT tool, as well as their decision as to whether to use the tool.

C’est avec une petite larme au coin de l’oeil que METISS (Migration et Ethnicité dans les Interventions en Santé et en Services sociaux) vous fait ses adieux. Eh oui! Après 28 ans de recherche et de partenariat, l’équipe ferme boutique.

Pour clore cette époque en beauté, nous vous présentons avec beaucoup de fierté une toute dernière publication, les toutes dernières « Entre-vues », qui retracent trois décennies de recherche, d’innovation et de collaboration autour de la thématique de la diversité dans les services sociaux et de santé. Des fondements sur lesquels on peut s’appuyer pour nous propulser vers l’avenir, mais un document à consulter avec un brin de nostalgie tout de même.

Le Centre intégré universitaire de santé et de services sociaux du Centre-Ouest-de-l’île-de-Montréal (CCOMTL) salue l’initiative du Secrétariat aux aînés (SA) du ministère de la Santé et des Services sociaux (MSSS) de réitérer l’importance de la lutte contre la maltraitance envers les personnes aînées et est fier de contribuer à cette consultation dans le cadre des travaux d’élaboration du prochain plan d’action 2022- 2027. Le Centre de santé et de services sociaux Cavendish – Centre affilié universitaire, maintenant intégré au CCOMTL depuis 2015, a contribué à l’élaboration et à la mise en œuvre de plusieurs mesures phares des plans d’action précédents. Ces initiatives témoignent de l’engagement continu du gouvernement du Québec, du ministère de la Santé et des Services Sociaux (MSSS) et de son Secrétariat aux ainés à répondre aux préoccupations de la population en continuant à lutter contre la maltraitance et à favoriser la bientraitance envers les personnes aînées dans tous les milieux.
Dans cette continuité, et en vertu de la mission universitaire du CCOMTL en gérontologie sociale, nous avons à cœur d’unir l’expertise et les savoirs issus de la recherche à ceux de la pratique afin d’alimenter la réflexion sur les futures actions du gouvernement. Le modèle unique de collaboration entre nos équipes cliniques, nos centres de recherche et d’expertise et nos partenaires communautaires nous permet d’être à l’affut des besoins des personnes aînées, de développer des connaissances et des pratiques fondées sur les données scientifiques et les meilleures pratiques afin de répondre à ces besoins. Le présent mémoire réunit ainsi la perspective de chercheurs et praticiens-chercheurs du Centre de recherche et d’expertise en gérontologie sociale (CREGÉS) et d’intervenants de la Ligne Aide Abus Aînés (LAAA). Nous avons aussi invité des chercheurs de notre Institut universitaire au regard des communautés ethnoculturelles (IU-SHERPA) à contribuer en vertu de leur expertise en lien avec les personnes aînées issues de l’immigration. Pour la rédaction de ce mémoire, nous avons adopté une conceptualisation large de la maltraitance permettant de faire ressortir les diverses réalités sociales qui sont couramment négligées ou tout simplement ignorées dans le discours public et qui reflète bien les perspectives complémentaires des instances participantes que nous présentons brièvement ci-dessous.

The question of how workers’ compensation systems should account for language barriers is of increasing importance given Canada’s growing linguistic diversity. This study is the first to empirically examine, based on interviews with injured workers and key informants, return-to-work policies and practices through the lens of language barriers. By comparing two jurisdictions, Quebec and Ontario, the study highlights similarities and differences in language accommodation and return-to-work policies and practices that shape the experiences of injured workers with language needs. It argues that gaps in this regard, which are more pronounced in Quebec, contribute to poor return-to-work outcomes for these workers in both provinces.

This paper addresses the well-being of children in Switzerland, Canada and Estonia, as they experienced the lockdown imposed by governments after the state of international public health emergency, declared by the World Health Organization on 30 January 2020. Suspension of school or starting with distance learning, cessation of extracurricular activities, closure of playgrounds, parks, shopping centres and loss of daily contacts with friends completely transformed children’s lives. The surveys conducted by the authors in individual ways, were all inspired by their membership to the Children’s Understandings of Well-Being network and involved the participation of 403 children aged 7–17 years old (229 girls and 174 boys). They present the emerging trends from the children’s narratives focusing on their experience of the lockdown in relation to family life, school life, contacts with friends, and in relation to space, time and self. During the lockdown leisure activities and hobbies, followed by life with friends and school life challenged relational well-being the most, while family life opened up new perspectives and generational solidarity. Staying at home and decreased physical activity impacted on the physical health of children, missing direct contacts with friends and teachers put social relations to test, fear of the virus decreased feeling safe and secure, and the lockdown restricted participation in society. The findings underline the relational nature of their well-being. More in-depth studies are needed to highlight the widening of inequalities and the balance between protection and participation of children.

La modernisation du régime de santé et sécurité du travail représente un besoin vital dans un contexte d’expansion du travail atypique, de l’accentuation des conditions de travail précaires et de l’émergence de l’économie de plateforme. Une modernisation inclusive et exhaustive de
la réglementation entourant les conditions du travail et le régime de sécurité et santé du travail est nécessaire. Cela permettra d’éviter la prolifération de zones grises du travail et l’accroissement d’un vide juridique, et par conséquent, d’empêcher la réduction de la protection des travailleurs et travailleuses les plus vulnérables, dont les immigrants, les réfugiés et les personnes sans statut représentent une partie significative. Personne ne doit être exclu d’une telle démarche. La pandémie nous démontre que le travail précaire des travailleurs et travailleuses (im)migrants les expose à des risques potentiellement fatals de santé et sécurité au travail (Côté, Dubé & Frozzini, 2020, 2021; Tremblay, 2020). Dans cet avis sur les changements proposés par le Projet de loi 59, nous abordons deux grandes catégories de lacunes dans le Projet de loi:

(1) La protection de travailleurs et travailleuses atypique (secteurs du travail
domestique, des agences de placement, de l’économie à la demande et du
télétravail); et

(2) L’accessibilité des mesures de prévention et d’indemnisation en matière de santé et sécurité du travail pour les travailleurs et travailleuses (im)migrants.

The perception of epidemic risk has been associated with the production of narratives in which figures such as villains and heroes emerge. This article critically analyzes social media users’ construction of heroic figures during the 2013–2016 Ebola epidemic. We used international Twitter and Facebook comments as our raw material, collected by key word extraction. A thematic analysis resulted in a descriptive typology of three heroic figures: the martyr, the warrior, and the saviour. Our analysis showed that heroic status (highly associated with willingness to take high risks on behalf of others) was mostly conferred on common individuals and ‘insiders’ living in the Ebola-afflicted communities – often deemed ‘unsung’ – rather than the foreigners frequently heroised in previous crises. We deconstruct this heroisation dynamic, showing that it is a socially strategic move because it is embedded in a potential instrumentalization of heroes. First, this production of ‘everyday heroes’ may encourage the involvement of lay people in the epidemic response, by conveying that anyone can become a health hero. Second, we show that this heroisation process maintains the status quo by encouraging adherence to biomedical discourses, and by individualising the narrative and neglecting the structural changes needed to address the epidemic. Finally, we caution against discourses that seem socially ‘progressive’ but may be used as a smokescreen to hide discriminatory dynamics, and we recommend changes in communication strategies.

The ‘Developmental Origins of Health and Disease’ hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase ‘preconception to early childhood’ lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years.

La télésanté connait un essor fulgurant en ce contexte de pandémie. Or, en cette période d’insécurité mondiale, la santé préventive reprend ses droits. En période de déconfinement, la discipline et la cohésion sociale peuvent se relâcher. Cette enquête sociale vise à décrire un programme d’intervention à distance, réalisé en partenariat avec des locataires de logement communautaire, des infirmières et des étudiantes pour soutenir la littératie en santé au temps de la COVID-19. Le Programme de déconfinement en toute sécurité vise à renforcer les mesures préventives et de soutien avec des groupes en contexte de vulnérabilités économiques et sociales à l’aide de la télésanté. Les infirmières ont développé des pratiques cliniques et psychosociales et renforcé la littératie en santé, soutenant les mesures de santé publique post-COVID-19, surveillant l’éclosion de nouveaux foyers et apaisant les souffrances issues du confinement. À l’aide de cibles de performance des systèmes de santé et d’une perspective de justice sociale, nous avons documenté les défis, les leviers et les menaces à l’usage des pratiques à distance en prévention. Vecteur d’une approche intégrée, la télésanté préventive peut cibler simultanément, la lutte contre les maladies non transmissibles et transmissibles et les inégalités. La pandémie de COVID-19 renvoie à un nouvel équilibre des enjeux qui exige un accompagnement et des pratiques de santé communautaire engagées et critiques.

This brief report explored trends of cigarette smoking among Syrian newcomers in the first two years of resettlement in Canada. 1794 adult Syrian refugees were surveyed about their physical and mental health, and smoking behaviours. Results were analyzed using descriptive statistics, Wilcoxon signed-rank tests, and logistic regressions. Almost 27% of the sample reported cigarette smoking (50% light smokers and 50% moderate/heavy smokers). Light smokers increased and moderate/heavy smokers decreased in the number of cigarettes smoked from year 1 to year 2. Moderate/heavy smokers were more likely to be male and reported higher post-traumatic stress scores, while light smokers reported higher depression scores. Only 14.3% of smokers recalled receiving advice from health care providers in Canada regarding their smoking habits. Healthcare providers should provide tailored advice to everyone who is an active smoker with a specific emphasis on those who have concurrent health issues.

The combined forces of economic globalization and international migration have resulted in specific challenges to palliative care systems. The COVID-19 pandemic has and is still greatly affecting elder populations as well as those across the age continuum living with long-standing chronic conditions or with pre-existing diverse unmet needs. While health promotion and palliative care may appear to be conceptually opposing fields, we argue that palliative care can and should fit under the umbrella of the health promotion continuum. This commentary seeks to discuss the importance of linguistic literacy and communication imperatives in the context of access to palliative care, given the broad, diversified and sensitive scope of care. While the pandemic has demonstrated that the public health responses of migrant host societies are deeply intertwined with policies as well as local rules and constraints, the promotion and provision of safe, timely and appropriate palliative care can be achieved through a sensitive assessment of differential contexts of diversity. The pandemic has painfully illustrated the need for a strong, respectful and equitable working partnership within the professions as well as with the civic society in order for the palliative needs of those exposed to a sustained risk not to be forgotten.

There has been much talk about decolonizing global health lately. The movement, which has arisen in various communities around the world, suggests an interesting critique of the Western dominant model of representations. Building upon the ‘decolonial thinking’ movement from the perspective of Francophone African philosophers, we comment on its potential for inspiring the field of global healthinterventions. Using existing literature and personal reflections, we reflect on two widely known illustrations of global health interventions implemented in sub-Saharan Africa – distribution of contraceptives and dissemination of Ebola virus prevention and treatment devices – featuring different temporal backdrops. We show how these solutions have most often targeted the superficial dimensions of global health problems, sidestepping the structures and mental models that shape the actions and reactions of African populations. Lastly, we question the ways through which the decolonial approach might indeed offer a credible positioning for rethinking global health interventions.

In January 2010, Haiti was hit by a terrible earthquake that pushed thousands of people to migrate. Many of them chose to settle in Quebec, Canada. Years after the earthquake, many Haitians continue to migrate to the Quebec province. Several studies however have shown that this population’s socioeconomic status is lower than the provincial average. Given the potential multiple stressors that affect Haitian migrants in Quebec, there are concerns about their health status.

Located at the intersection of international migration studies and global health, this paper offers an in-depth qualitative investigation of Haitian migrants’ representations of both their situation and self-perceived health in Montreal, Quebec. Our perspective on migrant health was inspired by the World Health Organisation’s framework on the social determinants of health and recent studies in the field of migrant health. We collected and analysed qualitative data from 23 key informants (i.e., 12 women and 11 men, aged 21-76 years old) from diverse socioeconomic backgrounds. The analysis of the data from these people’s narratives revealed the importance of structural determinants such as social position, and intermediate determinants such as living and working conditions. Our analysis also highlighted several interrelations between those determinants. Specifically, participants reported coping with issues related to migrant status, income, occupation, language, and racism, and challenging living and working conditions, and stress. This study underscored the importance of social support brought by relatives, friends, as well as community-based organisations and religious practices.

Our findings were coherent with available literature looking at the determinants of health of racialized and migrant minorities in other high-income regions of the world. Our conclusive remarks featured reflections on three cross-cutting issues and their practical implications for policy and practices.

Access to quality drinking water is a fundamental right. Despite Canada’s wealth of fresh water, many First nations, including the Anishinaabeg, regularly face inequitable access to quality drinking water, a situation that has health, spiritual and cultural consequences. These injustices are a direct result of colonization and the unequal relationship between the Canadian government and First Nations, which has greatly contributed to restricting the traditional role of Anishinaabeg women as water protectors, despite their spiritual and identity connection to water. Nevertheless, these women have shown resilience, which is reflected in a number of initiatives to raise awareness, mobilize and advocate for water protection. In this article, we seek to show that an ecological and sanitary issue, such as the availability of quality drinking water for Indigenous peoples in Canada, is part of a power struggle, past and present, with the federal government and the provinces. Our article aims more specifically at : 1) showing the importance of the lack of availability of drinking water for Indigenous nations ; 2) describing the traditional role of Anishinaabeg women as water protectors ; 3) situating the water issue in its colonial context ; and 4) exploring the various mobilizations led by Indigenous women in response to this historical and political problem.

This commentary aims to provide a glimpse into some of the early and continuing impacts of the COVID-19 pandemic on our global and public health projects: research in low-resourced settings; research with vulnerable populations, such as asylum seekers, Indigenous communities, children, and mental health service users; and research with healthcare professionals, frontline workers, and health planners. In the early context of restrictions caused by COVID-19, this commentary highlights our research setbacks and challenges, and the ways in which we are adapting research methodologies, while considering ethical implications related to the pandemic and their impacts on conducting global and public health research. As we learn to become increasingly aware of some of our limitations in the face of the pandemic, some positives are also worth highlighting: we are mobilizing our training and research skills to participate in COVID-19 projects and to disseminate knowledge on COVID-19, including through papers such as this one. However, we do acknowledge that these opportunities have not been equitable. Each thematic section of this commentary concludes with key recommendations related to research in the early and continuing context of the COVID-19 pandemic that we believe to be applicable to early- and not-so-early-career researchers working in the global and public health fields.

The pandemic has highlighted the complexity of public health measures and their side effects, the intricacy of the underlying health, social and political phenomena at play as well as their specificity for marginalized minority communities. Based on this experience, this commentary suggests that it would be relevant in the future to develop consultation mechanisms that take into account the entire population, including marginalized minority groups, in order to better inform decision-making processes in times of pandemic. In a context of fluid crisis, any consultation process must take into account the limits of what is possible and mourn the comprehensiveness in favour of repeated iterations of dialogue, mediation and decision-making. This means creating conditions favourable to the consideration of the most vulnerable people and groups’ voices by public authorities. In order to prepare for the next crises, it is necessary to develop strong links between public institutions and communities, both of majorities and minorities, in order to define the mechanisms favouring the emergence of truly inclusive public health, taking into account the physical, mental and social health of the population.

Objectives: We describe the knowledge translation strategies in two projects and share lessons learned about knowledge sharing and uptake.

Methods: To generate findings for dissemination: (1) the Republic of Côte d’Ivoire (RCI) project relied on a multiple case study design to document barriers and facilitators to implementing a community-led prevention strategy targeting Ebola virus disease; and (2) the Tunisia project used several designs to assess a mental health training’s effectiveness, and a case study design to explore contextual factors that may influence anticipated outcomes.

Results: To share findings with participants, the RCI project relied on workshops and a pamphlet, and the Tunisia project relied on a structured half-day dissemination workshop and research summary. Facilitators that may have encouraged sharing and using findings include involving champions in dissemination activities, ongoing collaboration, and developing/implementing context-specific knowledge sharing strategies. Barriers include omitting to assess strategies, limited consideration of a wider audience, and the exclusion of a knowledge translation training component.

Conclusions: Our experiences might be useful to contexts involved in global and public health research that wish to address the “know-do gap.”

To help primary care teams improve patient-centered care, we elicited health and life goals of immigrants with a chronic disease. We conducted an exploratory study of the (1) acceptability of home visits by volunteers to collect health information and (2) content of health and life goals within a primary care program for immigrants with chronic disease. Pairs of trained community volunteers visited 23 patients in their homes and asked them to identify three life goals and three health goals. We conducted content analyses of written notes. Health goals were related to disease prevention and symptom control, family well-being, own quality of life, own or family members’ work and/or financial situation. Life goals concerned family well-being, their own quality of life, work/financial situation and health. Given the limited time health professionals have with their patients, trained community volunteers could be important members of primary care teams caring for immigrants.

What factors influence the impact of the crisis associated with COVID-19 on Montreal cultural communities?

Our study indicates that certain groups in cultural communities are made vulnerable by the intersection of multiple economic and social factors, in particular:

• Precarious financial situation;
• Employment in a position at high risk of exposure to COVID ;
• Precarious migration status or lack of status;
• Lack of medical insurance;
• Being allophone;
• Low literacy;
• Being targeted by racism.

These factors may contribute to high levels of infection and psychosocial distress in certain multiethnic, low-income neighbourhoods in Montreal.
Public health policies must take into account the combined impact of these economic, linguistic, sociocultural and migratory factors.

1. Collect data on COVID’s social determinants
2. Facilitate community collaboration and consultation
3. Improve access to health information and guidelines through a multilingual communication
4. Promote access to health and psychosocial services
5. Provide universal access to financial support measures
6. Ensure that COVID-related workplace health and safety measures are respected
7. Guarantee food security
8. Prevent evictions linked to the pandemic
9. Promote family well-being
10. Strengthen intercommunity relations and act against racism

What factors influence the impact of the crisis associated with COVID-19 on  Montreal cultural communities?

Our study indicates that certain groups in cultural communities are made  vulnerable by the intersection of multiple economic and social factors, in  particular :

• Precarious financial situation;
• Employment in a position at high risk of exposure to COVID ;
• Precarious migration status or lack of status;
• Lack of medical insurance;
• Being allophone;
• Low literacy;
• Being targeted by racism.

These factors may contribute to high levels of infection and psychosocial  distress in certain multiethnic, low-income neighbourhoods in Montreal.

Public health policies must take into account the combined impact of these  economic, linguistic, sociocultural and migratory factors.

In our study, almost half of immigrants without health insurance perceived  their health as negative, much higher than reports of negative self-perceived health in previous Canadian studies (8.5% among recent immigrants, 19.8% among long-term immigrants, and 10.6% among Canadian-born). Our study also suggests a high rate of unmet health care needs among migrants with precarious status, a situation that is correlated with poor self-perceived health. There is a need to put social policies in place to secure access

While access to healthcare for permanent residents in Canada is well known, this is not the case for migrants without healthcare coverage. This is the first large-scale study that examines the unmet healthcare needs of migrants without healthcare coverage in Montreal. 806 participants were recruited: 436 in the community and 370 at the NGO clinic. Proportions of individuals reporting unmet healthcare needs were similar (68.4% vs. 69.8%). The main reason invoked for these unmet needs was lacking money (80.6%). Situations of not working or studying, not having had enough food in the past 12 months, not having a medical prescription to get medication and having had a workplace injury were all significantly associated with higher odds of having unmet healthcare needs. Unmet healthcare needs were more frequent among migrants without healthcare coverage than among recent immigrants or the citizens with health healthcare coverage (69%, 26%, 16%). Canada must take measures to enable these individuals to have access to healthcare according to their needs in order to reduce the risk of worsening their health status, something that may have an impact on the healthcare system and population health. The Government of Quebec announced that all individuals without any healthcare coverage will have access to COVID-19 related health care. We hope that this right, the application of which is not yet obvious, can continue after the pandemic for all health care.

• Global health can be anywhere as it often focuses on large-scale health inequities that are rooted in transnational determinants.
• Some global health initiatives and actors aim to find solutions to domestic problems.
• King and Koski’s definition of global health may exacerbate inequities by reserving the right to call oneself a global health researcher to those who are privileged and have access to funding that enables them to travel to other settings.
• An inadequate definition of global health based on a ‘here’ vs ‘somewhere else’ dichotomy could result in less funding for a field already characterised by limited resources.
• The decolonisation of global health requires promoting and valuing reflexivity, critical approaches, equitable partnerships and accountability.

Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still not very formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIR ethics, and to develop the ethical competence in PHIR for which a preliminary framework is proposed.

Objectives
The Ebola virus disease (EVD) is associated with major mental health consequences (e.g., depression, anxiety, PTSD). Studies have shown a need for relevant and effective programs to address mental health consequences associated to EVD. This systematic review aimed to describe programs implemented following EVD outbreaks and to evaluate their effectiveness and relevance in order to provide evidence-based data to improve mental health services.

Methods
We first searched EMBASE, PubMed, PsycINFO, PILOTS, Cochrane Library and MEDLINE for a systematic review on EVD and on MHPSS programs. Then, we searched the grey literature. The search generated 2827 publications. Eleven studies were retained according to the PRISMA statement.

Results
This systematic review revealed that most programs were implemented by international organizations in collaboration with local partners. Many of them were implemented following WHO mhGAP and Psychological First Aid guidelines. Programs were implemented in hospitals, Ebola treatment centres, communities among different categories of individuals exposed to EVD (survivors, health workers and volunteers, other frontline workers, children, adults, etc.). Only two of the identified programs which integrated cultural factors were empirically evaluated. Results from the evaluations showed mental health improvement for both children and adults.

Conclusions
This study provides the first systematic review on MHPSS programs among communities affected by EVD. This study shows the need to increase efforts to systematically document and evaluate the implemented programs. Results also provide preliminary evidence about the value of culturally sensitive MHPSS programs and of the implication of local mental health professionals.

L’immigration constitue une transition ayant des répercussions considérables sur la santé et le bien-être des personnes immigrantes pouvant donner lieu à des virages dans une trajectoire de vie. Le contexte dans lequel ces expériences sont vécues requiert une sensibilité aux dynamiques, aux interactions, aux trajectoires, aux situations de vulnérabilité et aux capacités de résilience qui modulent le recours et l’accès aux services de santé ainsi qu’à la justice. Il est proposé de prendre ancrage dans les expériences des femmes avec divers angles d’analyse. Il s’agira d’illustrer par le biais de trois perspectives les risques auxquels sont exposées les femmes ayant subi l’excision et l’infibulation. Le statut identitaire, notamment une identité de victime, un détachement entre le corps et le vécu seront mis en exergue comme expériences rapportées vers le développement de pratiques sensibles à la complexité des expériences, des approches se voulant réflexives, de qualité et équitables. Des illustrations sur les divergences perçues entre des pratiques et discours professionnels, et l’expérience effective des femmes, issus des communautés de pratique contribueront aux discussions.

Forced migration and extended time spent migrating may lead to prolonged marginalization and increased risk of HIV. We conducted a population-based cohort study to examine whether secondary migration status, where secondary migrants resided in a transition country prior to arrival in Ontario, Canada and primary migrants arrived directly from their country of birth, modified the relationship between refugee status and HIV. Unadjusted and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated using log-binomial regression. In sensitivity analysis, refugees with secondary migration were matched to the other three groups on country of birth, age and year of arrival (+/− 5 years) and analyzed using conditional logistic regression. Unmatched and matched models were adjusted for age and education. HIV prevalence among secondary and primary refugees and non-refugees was 1.47% (24/1629), 0.82% (112/13,640), 0.06% (7/11,571) and 0.04% (49/114,935), respectively. Secondary migration was a significant effect modifier (p-value = .02). Refugees with secondary migration were 68% more likely to have HIV than refugees with primary migration (PR = 1.68, 95% CI 1.06, 2.68; APR = 1.68, 95% 1.04, 2.71) with a stronger effect in the matched model. There was no difference among non-refugee immigrants. Secondary migration may amplify HIV risk among refugee but not non-refugee immigrant mothers.

While a series of changes in the approaches to FGM/C health research and intervention have historically taken place, there has been an increased implementation of sexual health interventions for women with FGM/C over more than a decade. These interventions derive from health research data, but their epistemology and praxis are also informed by cultural representations of the clitoris and what it means to be ‘healthy’. This is the case, notably, for genital reconstructive surgeries, which are performed globally in spite of a lingering inconclusiveness regarding their general efficacy, Summary drawing from research in Ivory Coast and Canada, from the results of the Quebec Ministry of Health and Social Services- commission ED training module on FGM/C, as well as from the author’s clinical practice in mental health working with women with FGM/C, this presentation aims to illuminate the multifarious ethical underpinnings of such sexual health interventions. The overarching goal of this presentation is to share best practices in sexual health interventions in order to afford compassionate care, grounded in a reflexive and ethical professional practice.

Introduction : La « démence » est généralement vue comme un syndrome caractérisé par le déclin d’une ou de plusieurs capacités cognitives, comme la perte de mémoire. Toutefois, perte de mémoire ne signifie pas pour autant démence. La plus fréquente des démences est la maladie d’Alzheimer dont la fréquence augmente avec le grand âge. En anthropologie de la santé, les maladies et leur expression représentent des construits socio-culturels qui ne sont pas reconnus et interprétés de la même façon par tout le monde. Par ailleurs, le contexte migratoire est source de difficultés dans le domaine de la démence. Cet article vise à discuter les liens entre vieillesse, démence et recherche d’aide dans ce contexte.
Méthode : Nous nous appuyons sur une étude qualitative exploratoire. Dix entrevues semi-structurées ont été réalisées avec des femmes et des hommes nés en Haïti et qui ont ensuite immigré au Québec. Ces entrevues nous ont permis de discuter du statut des aînés, du sens donné à la perte de mémoire et de la recherche d’aide.
Résultats : Les entrevues révèlent une pluralité des représentations à propos des pertes de mémoire et de la maladie d’Alzheimer. Elles mettent en lumière une diversité de croyances, d’attitudes et de valeurs traduisant une variabilité culturelle et sociale au sein d’une même communauté. La prise en compte du contexte permet de comprendre tantôt la transformation, tantôt la continuité des représentations et des conduites vis-à-vis des pertes de mémoire.
Conclusion : La démence ne semble pas être un phénomène qui est abordé facilement au sein de la communauté haïtienne du Québec. Au final, cette étude révèle un manque d’information à ce propos.

La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families.

Objectif
Évaluer les stratégies d’interventions dans la lutte contre le choléra à Uvira dans la perspective de les
renforcer
Matériel et méthodes.
L’étude a été évaluative recourant à des entrevues avec des acteurs impliqués dans la lutte contre le choléra et à la revue documentaire. Elle concerne la période de 2013 à 2016. Les données quantitatives relatives aux nombres de nouveaux cas et des décès ont été analysées à l’aide d’Excel. L’analyse des données qualitatives a été faite par thème en fonction des questions de recherche et au regard de la stratégie nationale de lutte contre le choléra en RDC.

Résultats
La corrélation entre les stratégies de lutte contre le choléra mises en place par les acteurs et les stratégies nationales de lutte contre le choléra reste relativement très faible dans la zone de santé. Des inadéquations entre ces deux groupes de stratégies sont ainsi relevées au cours de l’étude. Les effets positifs des différentes interventions mises en œuvre se traduisent par la diminution du nombre des nouveaux cas de choléra de 28% entre 2014 (1839 cas) et 2015 (1316 cas) et une certaine stagnation depuis 2016 autour de 1392 cas par an. L’efficacité des interventions est perçue efficace par seulement par 25% des membres de la  communauté contre 62% des agents des organisations; les effets des interventions sont estimés durables par 38% des membres de la communauté contre 68 % des agents des organisations et 34% des membres de la communauté (68% des agents des organisations) pensent que la participation communautaire est sollicitée lors des interventions de lutte contre le choléra. Par contre, la grande majorité des membres de la communauté (87%) et des agents des organisations (99%) jugent pertinentes les interventions de lutte contre le choléra au cours de l’étude. La faible implication de la communauté dans les actions de lutte contre le choléra et le caractère urgentiste des interventions sont fortement fustigés.

Conclusion
L’élimination du choléra en tant que problème de santé publique fait face à plusieurs défis dont le plus important semble être l’accès durable à plus de ressources par tous les acteurs, principalement l’État. L’implication plus visible des autorités politico-administratives est souhaitée.

This study aimed to analyze main groups accused on social media of causing or spreading the 2014–2016 Ebola epidemic in West Africa. In this analysis, blame is construed as a vehicle of meaning through which the lay public makes sense of an epidemic, and through which certain classes of people become “figures of blame”. Data was collected from Twitter and Facebook using key word extraction, then categorized thematically. Our findings indicate an overall proximate blame tendency: blame was typically cast on “near-by” figures, namely national governments, and less so on “distant” figures, such as generalized figures of otherness (“Africans”, global health authorities, global elites). Our results also suggest an evolution of online blame. In the early stage of the epidemic, blame directed at the affected populations was more prominent. However, during the peak of the outbreak, the increasingly perceived threat of inter-continental spread was accompanied by a progressively proximal blame tendency, directed at figures with whom the social media users had pre-existing biopolitical frustrations. Our study proposes that pro-active and on-going analysis of blame circulating in social media can usefully help to guide communications strategies, making them more responsive to public perceptions.

Immigration status and unemployment may intersect on the health outcomes of men and women. This study aimed to identify intersections between unemployment and immigration in inflammatory, metabolic and nutritional blood markers and assess gender differences.

Methods
We used Canadian Health Measures Survey data on 2493 participants aged 18 to 65. Outcomes were chronic inflammation (high-sensitivity C-reactive protein (hsCRP) and fibrinogen), nutritional (albumin and hemoglobin), and metabolic blood markers (glycosylated hemoglobin, blood glucose, total and high density lipoprotein (HDL) cholesterol). Multivariate linear regressions were used to assess the associations between each biomarker, unemployment and immigrant status, controlling for age, education, province, smoking, physical inactivity and body mass index and testing for multiplicative interactions between unemployment, immigrant status and gender.

Results
Unemployment was associated with higher inflammation (hsCRP and fibrinogen) in Canadian born men; Canadian born employed women showed higher hsCRP values compared with corresponding employed men. Unemployed immigrant women presented the highest values of hsCRP while employed immigrant women had the lowest hsCRP. Unemployment was associated with higher glucose; immigrant status was associated with higher glucose and glycosylated hemoglobin. Unemployed immigrants had significantly lower levels of hemoglobin and albumin than employed immigrants, and Canadian-born citizens regardless of their employment status. Some of these associations were attenuated after adjustment by body mass index, physical inactivity and smoking.

Conclusion
Blood biomarkers unveil intersections among unemployment, immigration and gender. This study provides evidence on biological pathways of unemployment on the likelihood of common chronic diseases, inflammation and potential malnutrition with some increased vulnerabilities in unemployed immigrants, and particularly in unemployed immigrant women.

Pour intervenir auprès des travailleurs immigrants, les professionnels de la santé et les intervenants en santé et en sécurité du travail ont des contacts directs avec eux, soit en personne, soit par téléphone. Ces interlocuteurs étant issus d’horizons culturels variés, leurs rencontres, dites interculturelles, peuvent mettre en relief des perspectives très différentes. Or, on ne peut traiter un travailleur ayant subi une lésion professionnelle sans tenir compte d’une multitude de facteurs qui influencent ses valeurs et la représentation qu’il se fait de lui-même (identité personnelle, organisation sociale, éducation, classe sociale, genre, religion ou idéologie, etc.). Ces variables peuvent présenter d’importants écarts de représentations culturelles entre les individus et être une source de malentendus, d’incompréhension ou de désaccords qui doivent absolument être pris en considération. Pour que ces rencontres favorisent un retour réussi au travail, il importe d’encourager le développement de la compétence interculturelle des intervenants dans les organisations. Ce document a été conçu pour servir d’instrument de réflexion visant à favoriser le développement de telles compétences.

Québec’s labour market has changed significantly in the past few years, notably with the slower growth of the labour force, an aging population, higher education levels among workers and an increasing proportion of immigrants in the workforce.
In its recent work on occupational rehabilitation, the IRSST has taken a particular interest in workers in vulnerable situations, including immigrant workers. Immigrant workers are considered a more vulnerable population due to, among other things, their proportionately higher-than-average presence in sectors characterized by less favourable working conditions and higher exposure to the risk of occupational injuries. Language and cultural barriers sometimes compound these factors.
The content of this document derives from a study titled The Notion of Ethnocultural Belonging in Rehabilitation Research and Intervention: Knowledge Summaries (published in 2012) and a study (completed in 2017) on the rehabilitation and return-to-work trajectories of immigrant workers with an occupational injury. This study highlighted the role of the health professionals and OHS practitioners involved, their intervention strategies and interactions, and the issues specific to intercultural encounters, while underscoring the impact of the organizational context on these aspects

Synthèse du symposium du 28 novembre 2018.