Alimentation infantile et changements climatiques : une opportunité prometteuse.

The method of infant feeding has consequences for the production of greenhouse gases (GHG) as well as for the risks to infants posed by climate change. Breastfeeding can reduce the carbon footprint associated with the use of commercial infant formula by nearly 50% while reducing its water footprint and waste. It is also an excellent way of coping with emergencies associated with climate change, such as water shortages, since breastfed children are better protected than those fed with formula. To ensure that the protection offered by breastfeeding can be realized, we present elements that can help decision-makers seize a promising opportunity: improve infant feeding support for women and families.

RéSUMé: Le mode d'alimentation infantile a des répercussions sur les émissions de gaz à effets de serre (GES) de même que sur les risques que posent les changements climatiques pour les nourrissons. L'allaitement peut réduire de près de 50 % l'empreinte carbone associée à l'utilisation des préparations commerciales pour nourrissons (PCN) et diminuer leur empreinte hydrique et les déchets associés. C'est aussi une excellente façon de faire face aux situations d'urgence associées aux changements climatiques, telles les difficultés d'accès à l'eau, puisque l'enfant allaité est mieux protégé que celui alimenté avec des PCN. Pour s'assurer que la protection offerte par l'allaitement puisse se concrétiser, nous présentons des éléments pouvant aider les décideurs à saisir une opportunité prometteuse : améliorer le soutien à l'alimentation infantile pour les femmes et les familles.

Health impacts of the July 2010 heat wave in Québec, Canada.

BACKGROUND: One of the consequences of climate change is the increased frequency and intensity of heat waves which can cause serious health impacts. In Québec, July 2010 was marked by an unprecedented heat wave in recent history. The purpose of this study is to estimate certain health impacts of this heat wave. METHODS: The crude daily death and emergency department admission rates during the heat wave were analyzed in relation to comparison periods using 95% confidence intervals. RESULTS: During the heat wave, the crude daily rates showed a significant increase of 33% for deaths and 4% for emergency department admissions in relation to comparison periods. No displacement of mortality was observed over a 60-day horizon. CONCLUSIONS: The all-cause death indicator seems to be sufficiently sensitive and specific for surveillance of exceedences of critical temperature thresholds, which makes it useful for a heat health-watch system. Many public health actions combined with the increased use of air conditioning in recent decades have contributed to a marked reduction in mortality during heat waves. However, an important residual risk remains, which needs to be more vigorously addressed by public health authorities in light of the expected increase in the frequency and severity of heat waves and the aging of the population.

An open source web application for the surveillance and prevention of the impacts on public health of extreme meteorological events: the SUPREME system.

BACKGROUND: Every year, many deaths or health problems are directly linked to heat waves. Consequently, numerous jurisdictions around the world have developed intervention plans that are employed during extreme heat events; beyond their emergency sections, these plans generally include preventive measures to be implemented each year. Over the last five years, local and regional information systems have been implemented in a few Canadian cities for surveillance purposes. However, until recently, no such systems existed at the provincial level. In the context of the Government of Quebec's 2006-2012 Action Plan on Climate Change, a real-time integrated system for the surveillance and monitoring of extreme heat events has been implemented on a provincial level. The system is a component of a broader approach that would also monitor the public health impacts of all types of extreme meteorological events. RESULTS: After conducting a detailed needs analysis, the Quebec National Institute for Public Health developed and implemented an integrated web application leveraging open source software for the real-time Surveillance and Prevention of the impacts of Extreme Meteorological Events on public health, called the SUPREME system. Its first field use involved heat waves. This decision-support system is based on open source software and is composed of four modules: (1) data acquisition and integration, (2) risk analysis and alerts, (3), cartographic application, and (4) information dissemination - climate change and health portal. The system is available to health specialists through a secure web information portal and provides access to weather forecasts, historic and real-time indicators (including deaths and hospital admissions), alerts and various cartographic data used for conducting prevention activities and launching emergency measures. CONCLUSIONS: The SUPREME system was implemented and used during the summer of 2010. It served as an important decision-making tool during the July 2010 heat wave in the province of Quebec, Canada. Planned improvements for 2011 include the integration of data related to other risk factors for other extreme events to the system. The next steps will be to provide access to the application to other groups of specialists that are involved in the prevention, monitoring, or analysis of extreme meteorological events and their effects on community health and well-being.

[The decentralized training program and the retention of general practitioners in Quebec's Lower St. Lawrence Region]. / Le Programme d'enseignement décentralisé et la rétention des médecins omnipraticiens dans la région du Bas-Saint-Laurent au Québec.

OBJECTIVE: To assess the effect of decentralized training programs, financial incentives, and physicians' origins on whether general practitioners continue to practise in an area. DESIGN: Our data were obtained from the physician database maintained by the Bas-Saint-Laurent Regional Department of Health and Social Services and from responses to a mailed questionnaire completed by physicians in the study. SETTING: The Lower St. Lawrence Region of Quebec. PARTICIPANTS: General practitioners who practised in the area between 1985 and 2003. METHOD: We used the Cox proportional hazards model of survival analysis to ascertain which variables were related to retaining physicians in the area. RESULTS: The adjusted probability of physicians remaining in Bas-Saint-Laurent after being exposed to the area through rural rotations had an odds ratio of 2.12 (P = .15). The probability of remaining in the area climbed to an odds ratio of 4.5 (P < .01) for physicians originally from the Bas-Saint-Laurent region. Financial incentives appeared to make little difference to whether physicians were retained in the area. CONCLUSION: The most promising strategies for retaining rural general practitioners are recruiting candidates from rural areas and exposing medical students to rural practice through decentralized training.

Men's Help-Seeking Attitudes in Rural Communities Affected by a Natural Disaster.

The article describes a mixed methods study of help-seeking in men living in the Chilean Central Valley, following exposure to a major earthquake event in 2010. The results identify that, within the sample, positive attitudes toward help-seeking correlated with younger age, higher education levels, above-average incomes, and stable personal relationships. It appears that education plays a significant role in shaping such positive attitudes, particularly by influencing views of gender roles and help-seeking. Conversely, older men's reticence toward seeking help appeared linked to negative perceptions of available services and the influence of traditional notions of masculinity. The study concludes that adapting interventions and service offers to men's needs in rural contexts must include an ecosystemic analysis of their reality and incorporate an understanding of masculinity socialization processes.

Excess Mortality in Istanbul during Extreme Heat Waves between 2013 and 2017.

Heat waves are one of the most common direct impacts of anthropogenic climate change and excess mortality their most apparent impact. While Turkey has experienced an increase in heat wave episodes between 1971 and 2016, no epidemiological studies have examined their potential impacts on public health so far. In this study excess mortality in Istanbul attributable to extreme heat wave episodes between 2013 and 2017 is presented. Total excess deaths were calculated using mortality rates across different categories, including age, sex, and cause of death. The analysis shows that three extreme heat waves in the summer months of 2015, 2016, and 2017, which covered 14 days in total, significantly increased the mortality rate and caused 419 excess deaths in 23 days of exposure. As climate simulations show that Turkey is one of the most vulnerable countries in the Europe region to the increased intensity of heat waves until the end of the 21st century, further studies about increased mortality and morbidity risks due to heat waves in Istanbul and other cities, as well as intervention studies, are necessary.