Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review.

INTRODUCTION: In 2014, the health authorities of the Eastern Townships (Québec, Canada) commissioned an evaluation of the mental health admission system for adults (GASMA) to identify the best GASMA organizational or structural elements and optimize the mental health services continuum. METHODS: To develop better services, seven indicators (ie, accessibility to services, integration of levels of services, user satisfaction, guidance and management time, evaluation tools, professional composition, and interprofessional collaboration) were examined through four evaluation questions. A three-step systematic and multisource evaluation was realized. A systematic review of the scientific and gray literature was performed. This evaluation also included key informant opinions to contextualize results from this review. RESULTS: Results from 91 scientific articles, 40 gray literature documents, and 10 interviews highlighted determinants and barriers associated with the examined indicators. From these results, 24 preliminary recommendations were formulated and discussed in a steering committee. These recommendations were then weighted and validated. This served to formulate three final recommendations. CONCLUSION: To optimize the regional mental health services continuum, stakeholders should (1) implement a single-window access for adults with mental health needs, (2) develop alternative services based on users' needs, and (3) test the effectiveness of new methods, initiatives, and tools.

[Evaluation of implementation of a local consultation model in health and social services]. / Évaluation de l'implantation d'un modèle de concertation local en santé et services sociaux.

OBJECTIVE: To adapt the supply of services to the needs of the community, a local health authority has developed a consultative model in health and social services. This approach, based on shared governance and various health promotion strategies, identifies targets, develops actions, and measures the effects of these actions. This study evaluates the implementation of this consultative model from three dimensions : describe (1) implementation of the model, (2) how user experience was taken into account to prioritize and draw up action plans, (3) favourable and unfavourable implementation conditions. METHODS: A qualitative methodology based on four data sources was used (i.e. individual interviews, focus groups, observations, analysis of reports). Content analysis was conducted on the individual interviews and focus groups. The observations and analysis of reports contributed to enhance the evaluation process. RESULTS: Valorisation of experienced-based knowledge, citizen participation, shared leadership, support from institutions or stakeholders, and the dynamism of discussion tables were favourable to implementation. Time, language, cumbersome procedures, staff instability, the recent reform of the Quebec network and inherent elements of discussion tables were unfavourable conditions. CONCLUSION: The model allows actions adapted to health and social needs of a local population and increases the sense of belonging to a community. Further efforts are required to preserve the relevance, flexibility, and dynamism of this model in a context of restructuring of the Quebec health and social services network.

Energy Conservation and the Promotion of Legionella pneumophila Growth: The Probable Role of Heat Exchangers in a Nosocomial Outbreak.

OBJECTIVE To determine the source of a Legionella pneumophila serogroup 5 nosocomial outbreak and the role of the heat exchanger installed on the hot water system within the previous year. SETTING A 400-bed tertiary care university hospital in Sherbrooke, Canada. METHODS Hot water samples were collected and cultured for L. pneumophila from 25 taps (baths and sinks) within wing A and 9 taps in wing B. Biofilm (5) and 2 L water samples (3) were collected within the heat exchangers for L. pneumophila culture and detection of protists. Sequence-based typing was performed on strain DNA extracts and pulsed-field gel electrophoresis patterns were analyzed. RESULTS Following 2 cases of hospital-acquired legionellosis, the hot water system investigation revealed a large proportion of L. pneumophila serogroup 5 positive taps (22/25 in wing A and 5/9 in wing B). High positivity was also detected in the heat exchanger of wing A in water samples (3/3) and swabs from the heat exchanger (4/5). The outbreak genotyping investigation identified the hot water system as the source of infections. Genotyping results revealed that all isolated environmental strains harbored the same related pulsed-field gel electrophoresis pattern and sequence-based type. CONCLUSIONS Two cases of hospital-acquired legionellosis occurred in the year following the installation of a heat exchanger to preheat hospital hot water. No cases were reported previously, although the same L. pneumophila strain was isolated from the hot water system in 1995. The heat exchanger promoted L. pneumophila growth and may have contributed to confirmed clinical cases. Infect. Control Hosp. Epidemiol. 2016;1475-1480.

Combination of Heat Shock and Enhanced Thermal Regime to Control the Growth of a Persistent Legionella pneumophila Strain.

Following nosocomial cases of Legionella pneumophila, the investigation of a hot water system revealed that 81.5% of sampled taps were positive for L. pneumophila, despite the presence of protective levels of copper in the water. A significant reduction of L. pneumophila counts was observed by culture after heat shock disinfection. The following corrective measures were implemented to control L. pneumophila: increasing the hot water temperature (55 to 60 °C), flushing taps weekly with hot water, removing excess lengths of piping and maintaining a water temperature of 55 °C throughout the system. A gradual reduction in L. pneumophila counts was observed using the culture method and qPCR in the 18 months after implementation of the corrective measures. However, low level contamination was retained in areas with hydraulic deficiencies, highlighting the importance of maintaining a good thermal regime at all points within the system to control the population of L. pneumophila.

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.