Spatial distribution of gambling exposure and vulnerability: an ecological tool to support health inequality reduction.

OBJECTIVES: Recent research by Public Health has redefined harmful gambling, shifting the focus from problematic people with irresponsible behaviour to 'gamblogenic' environments. The aim of this research was to support this alternative perspective with concrete ecological tools for characterizing harmful environments. Studies that analyse the spatial distribution of gambling show that people living in the most disadvantaged areas have greater access to gambling and are more affected by the harms of gambling. Despite their quality methodology and usefulness, the scope of geographic access measures has been partially limited. These measures have been mostly structured around a single form of gambling, focus on only one dimension of accessibility (density or proximity) and few of them take into account the risks associated with each type of the game. The main goal of our research was to propose an innovative method to characterize gambling environments in Quebec and address social inequality with respect to gambling exposure. This article more specifically describes the method we used to address the aforementioned shortcomings by developing the gambling exposure index (GEI), a more comprehensive ecological index of all games-weighted by their relative level of risk-to which populations are exposed. STUDY DESIGN: The study design is a cross-sectional ecological study. METHODS: The methodological approach was carried out in three stages. A GEI was operationalized and is composed of three dimensions: A dimension of spatial accessibility to gambling sites, a dimension of density of gambling places and a dimension of relative risk associated with different types of game. The two-step floating catchment area (2SFCA) method was used to combine these three dimensions into an overall GEI index. Data were retrieved from a geocoded directory of all gambling sites from Loto-Québec and other commercial databases. The relative risk of each type of game has been expressed by prevalence rates for those specific games in a Quebec population prevalence survey. A vulnerability to gambling index (VGI) was produced based on 6 socio-economic proxies of problem gambling from the 2016 Canadian census. The six variables were weighted and aggregated at the dissemination area (DA) level. Spatial and descriptive statistical analyses were conducted to explore the relationship between VGI and GEI and to identify areas that are highly vulnerable and have a high gambling exposure. RESULTS: The findings of our analysis reveal widespread geographic exposure to gambling and a significant positive linear relationship between the GEI and the VGI. In many areas, increased accessibility to gambling is significantly associated with a higher vulnerability to gambling. Our findings demonstrate that in 1328 DAs in Quebec, there is a particularly unequal and potentially harmful geographical distribution of gambling, exposing 9% of the population which are theoretically vulnerable to gambling to an increased presence of gambling. CONCLUSION: This research applied a spatial analytical approach to assess the association between environments, gambling and vulnerability. The GEI and VGI at the DA level can serve as a monitoring tool for policy-makers regarding gambling exposure in the most vulnerable sectors and contribute to prevention and intervention strategies better adapted to the population. The general findings raise the ethical implications of increased marketing development in vulnerable neighbourhoods. As the GEI takes into account both the environmental determinants and the relative risk of games, it is in contributing to the shift in public and scientific discourse, redefining the subject from problematic people to problematic games and environments.

[Refugees, migrants, language barrier: opinion of physicians on translation aids]. / Réfugiés, migrants, barrière de la langue: opinion des praticiens sur les moyens d'aide à la traduction.

When the patient and caregiver do not share a common language, an interpreter is not always the best solution, and in any case, one cannot be present for every visit, especially in the case of an emergency. According to a questionnaire that was sent to all of the physicians who are members of a health care network for asylum seekers in the Swiss canton of Vaud (n = 169), it appears that 45% of practitioners found a telephone translation service to be a practical solution, and 58% would like medical glossaries with phonetic pronunciation and visual illustrations made available. With a response rate of 91%, it is estimated that these two types of services would be used as often as qualified interpreters, if they were made available. Other translating aids are also proposed.

Reproductive outcome in patients with diminished ovarian reserve.

OBJECTIVE: To compare reproductive outcome between women with normal ovarian reserve and women with abnormal ovarian reserve. DESIGN: Retrospective. SETTING: Tertiary care center. PATIENT(S): Nine thousand eight hundred and two patients who had basal follicle-stimulating hormone (FSH) concentrations measured as part of an infertility evaluation. INTERVENTION(S): Monitoring of early pregnancy. MAIN OUTCOME MEASURE(S): Pregnancy loss rates, live birth rates. RESULT(S): Of 1,034 patients with diminished ovarian reserve (DOR) (FSH > or =14.2 IU/L), 28 (2.7%) conceived. Twenty of these pregnancies (20/28; 71.4%) were lost in the first trimester. Pregnancy loss rates in women with DOR were 57.1% in women <35 years old, 63.5% in women 35-40 years old, and 90.0% in women >40 years old. These rates of pregnancy loss were significantly higher compared to age-matched patients with normal ovarian reserve. CONCLUSIONS(S): Women with DOR have exceedingly high rates of pregnancy loss, regardless of age. Women with diminished ovarian reserve should be counseled that, in addition to a low probability of conception, live birth rates are poor.

[Training of field professionals in Switzerland health prevention projects]. / Formation des acteurs de terrain à la gestion de projets de prévention en Suisse.

Following various difficulties during prevention programs, an interdisciplinary training course in project management was set up for professionals working in the field. Sessions devoted to theoretical aspects alternated with workshops aimed at problem-solving strategies. The intention of the course was to equip the participants with relevant operational tools. The twenty-seven participants came from twelve different professional backgrounds. Fourty-two hours of training were given over a period of nine months. Two physicians specialized in public health accompanied the course throughout, seven invited speakers joined the group for occasional sessions. The evaluation was positive for the teaching methods used and the variety of subjects covered. The analysis of practical experiences has proved to be a powerful learning tool and a vehicle for interdisciplinary exchanges. The course has highlighted the isolation of the professionals in the field, the absence of common points of reference and the resulting difficulties in communication and collaboration. This experience has clearly shown the need for a well-defined standard model in project management and for intensive training of the professionals in the field.

[Physicians' role in prevention and health promotion policy: canton reports on health status]. / La place des médecins dans les politiques de prévention et de promotion de la santé: à propos des rapports cantonaux sur l'état de santé.

With the example of a study on population health in the Swiss cantons Jura and Neuchâtel, the paper proposes a mechanism for priority setting of problems that could be acted upon preventively. Concepts are reviewed: public health needs as defined by epidemiology, supply of preventive activities, demands expressed by the population and different stakeholders. The role of general practitioners is stressed, not only as preventive services suppliers, but also as actors of priority setting.

[Health status of the populations of the Jura and Neuchatel cantons: evaluation and recommendations for prevention and health promotion]. / L'état de santé des populations des cantons du Jura et de Neuchâtel: bilan et recommandations en matière de prévention et de promotion de la santé.

A recent study on population health in two Swiss cantons (Jura and Neuchâtel) makes it possible to determine the relative importance of various problems and to set priorities in preventive activities. Attention is focused on traffic accidents (first cause of death among children and young adults up to 25 years) and their link with alcohol consumption, on suicide (first cause of death among adults 26-40 years old), on lung and breast cancer. For general practitioners, essential preventive activities appear as follows: screening of depression and risk of suicide, of alcohol and tobacco addiction; counselling on addictions (brief intervention); recommending mammography to all women above 50.

[Reasons for the hospitalization and length of stay of a homeless population in Montreal]. / Motifs d'hospitalisation et durées de séjour d'une population d'itinérants de Montréal.

OBJECTIVE: To compare the hospitalization experience of a homeless population with that of the residents of a low socioeconomic area. METHODS: The homeless hospitalization records (n = 245) were compared with the records of the 3,553 residents of the Département de Santé Communautaire of Saint-Luc Hospital territory who were admitted to the same hospital. RESULTS: The homeless population is mainly composed of young men. Mental health diagnoses are more frequent while cardiovascular and the obstetrical diagnoses are more rarely seen. Homelessness is associated with an 11.2 increased risk of organic psychosis, a 6.1 risk increase of functional psychosis and a 3.8 risk increase of personality disorders, neurosis and substance abuse. Obstetrical diagnoses are 20 times less frequent among homeless women while the cardiovascular risk did not seem to be affected in our sample. The lengths of stay are similar.

[Perception of environmental threats by children and adolescents]. / La perception des menaces environnementales par les enfants et les adolescents.

Surveys conducted in Europe and North America over the last 30 years have shown that children and adolescents were particularly worried about the possibilities of nuclear war and unemployment. A study carried out in Montreal among young people of primary or high school level assessed their concerns about the future and inquired about what their priorities would be if they were political leaders. One hundred and twenty young people answered a questionnaire administered by a classmate. Results indicate that worries about environmental issues predominate. In comparison with previous surveys, this study suggests a recent change in the young generation from concerns about nuclear war to worries over ecological problems.