Negotiating Safety and Wellbeing: The Collaboration Between Faith-Based Communities and Public Health During the COVID-19 Pandemic.

The COVID-19 pandemic led to lockdown measures where congregational faith-based activities were prohibited. With time, the collateral impacts of confinement emerged as priorities, and impositions had to be balanced with the collaboration of the population. In this process, faith-based organizations played a key role in encouraging their congregations to adhere to lockdown measures while fostering their mental wellbeing and resilience. This paper describes the process of establishing a collaborative negotiation among the Montreal Regional Public Health Unit, the police, and the Muslim and Jewish communities, examining the role of mediation in this context. Despite some obstacles, such as communication difficulties and decision-making limitations, the collaborative approach seems to buffer the escalation of intercommunity tension and to promote communities' commitment to physical distancing measures and should be considered in times of pandemic for a more inclusive public health approach.

Pandémie et communautés minoritaires marginalisées : vers une approche inclusive en santé publique?

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.

RéSUMé: La pandémie a mis en lumière la complexité des mesures de santé publique et de leurs effets collatéraux, l'intrication des phénomènes sanitaires, sociaux et politiques sous-jacents, ainsi que leur spécificité pour des communautés minoritaires marginalisées. Fort de cette expérience, le présent commentaire souligne la pertinence d'élaborer des mécanismes de consultation qui tiennent compte de l'ensemble de la population en incluant les groupes minoritaires marginalisés, pour mieux informer les processus décisionnels en temps de pandémie. Dans un contexte de crise fluide, tout processus de consultation doit tenir compte des limites du possible et faire le deuil de l'exhaustivité au profit d'itérations répétées de dialogue, de médiation et de prises de décision au sujet de l'action. Il s'agit de créer des conditions propices à ce que les voix des personnes et groupes plus vulnérables soient entendus par les autorités publiques. Afin de nous préparer aux prochaines crises, il est nécessaire d'ores et déjà de développer des liens forts entre institutions publiques et communautés, tant majoritaires que minoritaires, afin de définir les mécanismes favorisant l'émergence d'une santé publique réellement inclusive, qui tienne compte de la santé physique, mentale et sociale de la population.

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study.

Context: Patients treated with maintenance hemodialysis experience significant symptom burden resulting in impaired quality of life. However, the association of patient reported symptom burden and the risk of healthcare use for patients with end stage kidney disease on hemodialysis has not been fully explored.Objectives: To investigate if higher symptom burden, assessed by the Edmonton Symptom Assessment System-revised (ESASr), is associated with increased healthcare use in patients with end stage kidney disease on hemodialysis.Methods: Prospective, single-center, study of adult patients on HD. Participants completed the ESASr questionnaire at enrollment. Baseline demographic, clinical information as well as healthcare use events during the 12-month following enrollment were extracted from medical records. The association between symptom burden and healthcare use was examined with a multivariable adjusted negative binomial model.Results: Mean (SD) age of the 80 participants was 71 (13) years, 56% diabetic, and 70% male. The median (IQR) dialysis vintage was 2 (1-4) years. In multivariable adjusted models, higher global [incident rate ratio (IRR) 1.02, 95% confidence interval (CI) 1.00-1.04, p = .025] and physical symptom burden score [IRR 1.03, CI 1.00-1.05, p = .034], but not emotional symptom burden score [IRR 1.05, CI 1.00-1.10, p = .052] predicted higher subsequent healthcare use.Conclusions: Our preliminary evidence suggests that higher symptom burden, assessed by ESASr may predict higher risk of healthcare use amongst patients with end stage kidney disease on hemodialysis. Future studies need to confirm the findings of this preliminary study and to assess the utility of ESASr for systematic symptom screening.

Psychosocial Distress and Health Service Utilization in Patients Undergoing Hemodialysis: A Prospective Study.

BACKGROUND: End-stage renal disease is associated with significant morbidity, high-symptom burden, and health care use. Studies have not yet assessed psychosocial distress and health care utilization in this population. OBJECTIVE: This study examines psychosocial distress and its association with hospitalization and emergency room (ER) visits in patients on maintenance hemodialysis (HD). METHODS: The Distress Assessment and Response Tool (DART) was administered to 80 adults on HD in a single treatment center. The DART assessed for anxiety, depression, and social distress. Health care utilization data were extracted prospectively from electronic medical charts. The time between psychosocial distress and hospitalization or ER visits during 12-month follow-up was examined using Cox proportional hazard models. RESULTS: Overall 46% of the sample reported psychosocial distress, with 33% screening above the threshold for depression, 14% for anxiety, and 36% for significant social distress. In multivariable regression adjusting for age, sex, and comorbidity, the presence of psychosocial distress was associated with shorter time to hospitalization (hazard ratio: 2.4 [1.1, 5.0], p = 0.03) during 12-month follow-up. Psychosocial distress was not significantly associated with ER visits in either univariable (hazard ratio: 1.3 [0.7, 2.3], p = 0.5) or multivariable (hazard ratio: 1.4 [0.8, 2.6], p = 0.3) analyses. CONCLUSION: Psychosocial distress is frequent in patients undergoing maintenance HD and is associated with shorter time to hospitalization. Future longitudinal studies should examine if health service use can be reduced through routine distress screening and psychosocial distress intervention.