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Whether COVID-19-related experienced stress influenced lifestyle habits remains to be thoroughly evaluated among university students. This study examined the relationship between COVID-19-related experienced stress and subsequent lifestyle habits among undergraduate students. This cross-sectional study included 708 undergraduate students from Université Laval (Québec, Canada) participating in the Expériences Pandémiques (ExPan) cohort. Data on COVID-19-related experienced stress and lifestyle were self-reported using a questionnaire completed between February and April of 2022. A stress index (SI) was computed by summing scores associated with 31 situational statements related to the pandemic (e.g., not being able to see friends, dealing with job loss). A healthy lifestyle score (HLS) ranging from zero to seven was calculated based on seven lifestyle habits: moderate-to-vigorous physical activity, sleep quality, fruit and vegetable intake, tobacco and electronic cigarette use, alcohol consumption, cannabis use, and hard or sedative-hypnotic drugs use. In multivariable-adjusted models, a negative association between the SI and the HLS was found (β 10% increment SI = -0.23, 95% CI = -0.30, -0.16 HLS point; P  < 0.0001). The SI was also negatively associated with sleep quality, and fruit and vegetable consumption, while being positively associated with at-risk alcohol consumption, cannabis use, and hard or sedative-hypnotic drug use. Subgroup analyses suggested a negative relationship between the SI and HLS among participants who did not receive academic accommodations (e.g., additional time for evaluations, personal notetaker), but not those who received such accommodations. This study suggests that COVID-19-related experienced stress was negatively associated with healthy lifestyle habits in this cohort of undergraduate students., Competing Interests: The authors declare there are no competing interests.

The Beach Center Family Quality of Life Scale (Beach Center FQOL) is used to evaluate and develop family-centered intervention services. However, its use with families of children with autism spectrum disorder (ASD) and in non-English speaking populations requires further investigation. The present study sought to assess the psychometric properties of a French translation of this scale on 452 parents of children aged 5 and under who were recently diagnosed with ASD. The resulting Satisfaction and Importance scales presented excellent internal consistency at the scale level and acceptable internal consistency at the subscale level. Theoretical model positing 5 dimensions of FQOL generally fit the data acceptably. Satisfaction ratings were found to be sensitive to changes and were negatively correlated with parenting stress.

Background: The goal of this study was to identify measures to facilitate access to the Quebec Breast Cancer Screening Program for women with activity limitations, considering the barriers to screening uptake in that population., Methods: The study was carried out in three stages. First, 124 semi-structured interviews were conducted in five regions of Quebec with five groups of key informants. The content analysis lead to the identification of 64 proposals, which were submitted to 31 experts through a two-round Delphi survey process. Finally, consultations were held with 11 resource people to determine which decision-making levels (local, regional, provincial) could play a key role in implementing the proposals., Results: A strong consensus (≥80%) was achieved for 25 proposals seen as highly relevant and feasible., Discussion: The implementation of such proposals could substantially improve access to screening, given the prevalence of activity limitations in the age group targeted by the program.

This paper reports results from a case study on household food insecurity needs and the interventions that address them. It aimed at comparing households' perceptions on food insecurity experience and vulnerability to those of other stakeholders: community workers, programme managers and representatives from donor agencies. Semi-structured interviews with 55 households and 59 other stakeholders were conducted. Content analysis was performed, using a framework encompassing food sufficiency, characterization of household food insecurity and vulnerability of households to food insecurity. Overall, the results draw attention to a gap between households and the other stakeholders, where the later do not seem always able to assess the realities of food-insecure households. Other areas of divergences include: characteristics of food insecurity, relative importance of various risk factors related to food insecurity and the effectiveness of the community assistance to enhance the households' ability to face food insecurity. These divergent perceptions may jeopardize the implementation of sustainable solutions to food insecurity. Training of stakeholders for a better assessment of households' experience and needs, and systematic evaluation of interventions, appear urgent and highly relevant for an adequate response to households' needs. Collaboration between all stakeholders should lead to knowledge sharing and advocacy for policies dedicated to poverty reduction.

Objectives: The aim of the study was (i) to describe the needs of food-insecure households and their assessment of community programmes, as expressed by households and perceived by stakeholders; and (ii) to examine the similarities and differences between households' and stakeholders' perceptions in Quebec City area., Design/setting/subjects: A semi-structured interview and sociodemographic questionnaire with fifty-five households and fifty-nine stakeholders (community workers, managers, donor agencies). The transcriptions were subjected to content analysis and inter-coder reliability measurement., Results: The respondents' perceptions converge towards three main categories of needs: needs specific to food security, conditions necessary for achieving food security and related needs. There was agreement on the necessity of better financial resources, although the impact of financial resources alone may be uncertain in the opinion of some stakeholders. Different perceptions of needs and of their fulfilment by community programmes emerge between both groups. Despite households found positive aspects, they complained that quality of food and access were major needs neglected. Their account suggests overall a partial fit between the programmes and food security needs; even a combination of programmes (e.g. collective kitchens, purchasing groups, community gardens) was insufficient to adequately meet these needs. In contrast, most stakeholders perceived that the household's primary need was a basic amount of food and that the households were satisfied with programmes., Conclusions: It is urgent to evaluate the overall effect of community programmes on specific aspects of household food insecurity. The results emphasise that community programmes alone cannot bring about social change needed to prevent food insecurity.

Background: Aggressive behaviours represent major obstacles to the integration into society of individuals with intellectual disability (ID) and pose significant management issues for carers., Methods: The present study assessed the prevalence and severity of five types of aggressive behaviours in 3165 adult men and women with ID receiving services from three rehabilitation agencies in Québec by surveying their carers using the Modified Overt Aggressive Scale., Results: The 12-month prevalence of aggressive behaviour was 51.8%: 24% property damage, 37.6% verbal, 24.4% self-oriented and 24.4% physical aggression, and 9.8% sexually aggressive behaviour, most of which being mild in severity. Only 4.9% of individuals displayed aggressive behaviour leading to injury of the victim. Few gender differences were observed., Conclusions: The capacity to document and assess the types as well as the severity of aggressive behaviour is thus critical, not only to better understand the correlates of various types of behaviours but also to orient intervention programmes whether they be prevention, assessment, monitoring or management of aggressive behaviour.

Objective: It has been suggested that the measurement of strength is inappropriate in patients with stroke, in large part because of the presence of abnormal synergy patterns. The aim of the present study was to characterize force production during multi-joint maximal exertion involving different combinations of activation between shoulder and elbow flexors and extensors., Design: Cross-sectional study., Setting: Rehabilitation centre., Subjects: A convenience sample of 16 chronic hemiparetic stroke subjects., Main Outcome Measures: Maximal torques in flexion and extension at the shoulder and the elbow were measured using static dynamometers (single-joint condition). In addition, the maximal forces produced at the wrist were measured in four directions in the sagittal plane requiring different torque combinations between shoulder and elbow flexors and extensors (multi-joint condition)., Results: No difference was found across directions for the ratios of maximal forces (paretic/nonparetic) in the multi-joint condition (p = 0.227; mean ratios (+/- SD) for each direction ranging from 0.59+/-0.23 to 0.68+/-0.27), suggesting that the ability to produce force did not change as a function of the required torque combination. In addition, relative torques (% of the maximal torque in the single-joint condition) exerted during the multi-joint exertions were similar on the paretic and the nonparetic side., Conclusions: These results do not support the assumption that force production is limited by abnormal synergy patterns between flexors and extensors at the shoulder and the elbow in hemiparetic patients.

Article 8 of the Act Respecting the Protection of Persons Whose Mental State Presents a Danger to Themselves or to Others (Québec, 1997) introduced a new legal framework requiring a linkage between police departments and crisis intervention services to prevent involuntary hospitalizations. Through telephone interviews, observation sessions, and documentary analysis, the authors studied the implementation of article 8 in 16 Québec administrative regions. Results pertain to organizational consequences for the health and police sectors and methods of collaboration between the two sectors. They cast light on the difficulties of implementing article 8 and suggest conditions for the success of initiatives aimed at reducing unjustified recourse to the legal system and hospitalization in cases of persons with mental health problems.

Objective: To evaluate the accessibility to a Montreal low-threshold methadone program (Relais-Méthadone). This program is aimed at a marginalized population of heroin addicts who are injection drug users (IDU)., Method: The data (n = 141 clients) were collected during the first year of the program implementation with questionnaires administered by the programme workers., Results: Analysis of the characteristics of the clients revealed that the program does reach the target population. The program's clientele is characterized by long-time and frequent heroin use, unstable lifestyles, and the presence of numerous behaviours that put them at high risk for HIV transmission. The retention of clients in the program is very high (88%) within the first 30 days., Interpretation: These results demonstrate the importance and value of flexible intervention programs in reaching a marginalized clientele exposed to the HIV virus, who would not have access to regular programs characterized by restrictive selection criteria and limited availability.

This article questions the effectiveness of a managerial tool in changing a health-care system. The process of implementing regional planning and its impact on creating integrated service networks is examined, using a case study and a multi-dimensional analytic model. This model highlights the influence of contextual, structural, cultural and dynamic factors on forming networks. The regional planning developed in the province of Québec (Canada), aimed at a major transformation of the mental health-care system. In each district, organizations working with people who have serious mental disorders were mobilized to plan and implement a more coordinated, continuous and diversified supply of services, under the direction of a regional health body. This study outlines the limitations of regional planning as a tactic for transforming the system. It recommends instead developing more diversified integration strategies to further the process of forming integrated service networks within a complex system. In conclusion, a brief discussion deals with the difficulties related to the study of systemic change implementation.

Organizing services in an integrated network as a model for transforming healthcare systems is often presented as a potential remedy for service fragmentation that should enhance system efficiency. In the mental health sector, integration is also part of a diversified response to the multiple needs of the clients, particularly people with serious mental health disorders. The authors describe how the notion of integrated service networks came to serve as a model for transforming the mental health system in Quebec, and they propose a frame of reference for this notion. They also address the challenges and issues raised by this mode of service organization in the mental health sector and more generally in a context of transforming healthcare systems.

This article presents the results of the Quebec validation of the Satisfaction With Life Domains Scale: This scale was developed in the United States for the general population and adapted for severely mentally ill individuals. Two hundred and sixty six individuals from the general population and 245 severely mentally ill persons participated in this study. Factor analysis allowed the identification of four sub-scales for the clinical population and five for the general population. The scale (alpha = 0.90) and the sub-scales (alpha between 0.60 et 0.84) show excellent internal consistencies and the test-retest reliability was good (r = 0.73). Moreover, analysis of the variance and the discriminant analysis allow to acknowledge that the sub-scales have a high discriminating power; they allow to distinguish the general population from welfare recipient and people suffering from psychosis. The overall results suggest that l'Echelle de satisfaction des domaines de vie have good psychometric properties and can be considered as a valid instrument for assessing subjective quality of life in descriptive or evaluative studies.

In this article, the mental health policy is viewed as a pivotal element of the "psychiatric services" reform which began in Québec in the seventies. The authors advance the hypothesis that the community approach has played a fundamental role in developing the reform and that it has itself undergone deep changes. As a result, the policy's and the reform's effects are discussed from two angles, namely that of the communitization of services and that of the direction taken by the community approach during the reform process.

This article presents the results of a three-year survey of the activities of two case managers following 25 homeless women with substance abuse problems. The case managers' activity record indicated that a great deal of the case managers' energy was devoted to providing direct, concrete services. More than half the clients received four weekly contacts, for an average total of two hours/client/week. Furthermore, direct support accounted for 42.2% of all contacts reported by the case managers, suggesting that, although case managers fill many different functions, establishing and maintaining a significant relationship with the participants constituted a major part of their work. The study confirms that a high staff-to-client ratio is required to respond to the multiple needs of this population.

This study examines the effects of deinstitutionalization policies on psychiatric hospitalization rates over a thirty-year period. It is based on a retrospective study of successive hospitalizations in severely disabled patients. The data indicate that in any five-year period these patients still spend over 20% of their time in hospital. For patients who have stayed for a total of more than one year every five years in hospital, the average length of stay has been decreasing far less rapidly in the last fifteen years than it had previously. Patients who were first admitted after 1971 spent proportionally as much time in hospital as those whose first stay was earlier. These results show that the groups primarily affected by deinstitutionalization are those who were first hospitalized prior to the 1970s and those who are the heaviest hospital users. However, the data from the patients admitted since the seventies seem to reveal that the process of change may have reached its limits.

This paper reports an evaluation study of a pilot project held in a "CLSC" (Local Community Health Centre) located in a rural community. The intervention design is based on multidisciplinary teams created to meet specific local community needs. Mental health intervention is part of a community-based approach open to all kinds of requests for support. Practitioners in the field give support not only to the individual with a mental health problem, but also to existing self-help networks in the community. The intervention is also designed to change the relationship between a professional, seen as the one who provides services, and a client, defined as a consumer. The term "client" gains a wider meaning, and collaborative work with informal self-help networks induces a closer relationship between the community and the practitioner. The practitioner is more open to local community values and adjusts his or her practice to match variable contexts. The evaluation study has expanded knowledge of this type of intervention design, on its impact upon service demand, intervention modalities, and service management and organization. This project was coupled with a similar project in an urban environment and was financed by the Health and Social Services Ministry in Québec.

Based on data collected during the assessment phase of setting up the crisis centre L'Autre Maison, this article aims to present the services offered by the centre and to examine its integration with other resources within the community. Secondly, the article proceeds with a detailed analysis of the nature of crises that motivated clients to resort to the centre, which allows the authors to confirm the essentially social nature of these crises. Following a presentation of the results, the authors enter a broader discussion on: 1) the training received by personnel that works in the area of crisis intervention; 2) the organization of mental health services; and 3) the prevention programs focused on avoiding the oncoming of a crisis.

From 1965 to 1985, 76 patients were admitted to Sacré-Coeur Hospital, Montreal, with a diagnosis of penetrating chest trauma (PCT). The majority were under the age of 30 years and almost two thirds suffered gunshot wounds. Sixty-seven (88.1%) sustained a lateral or thoracic (T) injury and in nine (11.8%) the lesion was central or mediastinal (M). In the first group (T), 53.7% were treated surgically with thoracotomy, laparotomy, and chest tube (CT) insertion or both; 46.2% were managed conservatively. In the second group (M) the pericardium or the heart was involved, eight patients (88.8%) were managed surgically without the use of extracorporeal circulation and one patient was observed only. Eight (11.9%) died in the thoracic group; all survived in the mediastinal group, for an overall mortality of 10.5%. Shock was associated with increased morbidity and mortality in the thoracic group (T) and infection was the most frequent complication for the entire group of patients under study. There has been a steady increase in the total number of PCT at our hospital during the last two decades suggesting an increase in crime and violence in our urban surroundings.

A study conducted in a Montreal area psychiatric institution focuses on the impact of chronic patients on in-patients services delivery system. This article shows a disarticulation of the system, from the first to the second line and within the second line. The authors suggest that when the length of stay is extended beyond a certain time frame, it becomes increasingly difficult to reconcile continuity and complementarity of services: by congesting the system, chronic psychiatric population is decreasing the accessibility of services.

This article, written following a survey of staff in a psychiatric hospital, analyzes how the trend toward deinstitutionalization has influenced institutional practice. Interviews reveal that intervenors support the objective of social reintegration, even if they find it a source of contradictions. In their daily activities, the staff are concerned mainly with improving their patients' quality of life, but this concern is also accompanied by the apprehension of encouraging dependency on the institution. Thus intervenors experience difficulty in focusing their practice on a system of representation capable of reconciling the ideal of rehabilitation with the characteristics of their clientele. Recognizing the paradoxes associated with work in the institutional setting does, however, make it possible to start a process of clarification that is likely to support intervenors and improve the quality of their relationship with chronic psychiatric patients.