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Objectives: During the first wave of COVID-19 in Québec, healthcare workers (HCWs) represented 25% of the cases in Montréal. A study was conducted to describe SARS-CoV-2-infected HCWs in Montréal, and certain workplace and household characteristics. Secondary objectives included estimating the associations between having had access to personal protective equipment (PPE) and training, and following self-isolation recommendations, and certain sociodemographic and workplace characteristics. Methods: A cross-sectional study was conducted, based on a stratified random sample, among Montréal HCWs who tested positive for SARS-CoV-2 between March and July 2020. A total of 370 participants answered a telephone-administered questionnaire. Descriptive statistics were conducted, followed by log binomial regressions to estimate the associations. Results: Study participants were mostly female (74%), born outside of Canada (65%), and identified as Black, Indigenous, and People of Colour (BIPOC; 63%). In terms of healthcare positions, most were orderlies (40%) or registered nurses (20%). Half (52%) of the participants reported having had insufficient access to PPE and 30% reported having received no training related to SARS-CoV-2 infection prevention, with large proportions being BIPOC women. Working evening or night shifts decreased chances of having had sufficient access to PPE (OR 0.50; 0.30–0.83). Conclusion: This study describes the profile of the HCWs who were infected during the first wave of the pandemic in Montréal. Recommendations include collecting comprehensive sociodemographic data on SARS-CoV-2 infections and ensuring equitable access to infection prevention and control training and PPE during health crises, particularly those at highest risk of exposure.

Research into social determinants of mental and emotional health problems highlighted the need to understand the cultural factors. Mental health of immigrants is influenced by a variety of cultural, psychological, social, and economic factors. There is some evidence to suggest that South Asian people have higher rates of mental and emotional health problems than the rest of the Canadian population. Limited research also suggests that psycho-social factors are highly likely to be responsible for these high rates of mental health problems. These psychosocial factors may be impeding access and engagement with the services. These socially determined emotional and mental health problems are more likely to respond to psychosocial interventions than biological treatments. Evidence-based psychosocial interventions such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) might offer the way forward. CBT can be offered in a low-cost, low intensity format in a variety of settings, thus addressing the attached stigma. However, these interventions need to be culturally adapted, as these are underpinned by a Western value system. CBT has been culturally adapted and found to be effective in this group elsewhere. This opinion paper describes the need to enhance research on psychosocial determinants of the mental and emotional health problems, status, and the psychosocial determinants of health amongst South Asians in Canada to inform our understanding of the cultural specificity of psychosocial interventions.

BACKGROUND: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. METHODS: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. RESULTS: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. INTERPRETATION: Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

BACKGROUND: Setting priorities is critical to ensure guidelines are relevant and acceptable to users, and that time, resources and expertise are used cost-effectively in their development. Stakeholder engagement and the use of an explicit procedure for developing recommendations are critical components in this process. METHODS: We used a modified Delphi consensus process to select 20 high-priority conditions for guideline development. Canadian primary care practitioners who care for immigrants and refugees used criteria that emphasize inequities in health to identify clinical care gaps. RESULTS: Nine infectious diseases were selected, as well as four mental health conditions, three maternal and child health issues, caries and periodontal disease, iron-deficiency anemia, diabetes and vision screening. INTERPRETATION: Immigrant and refugee medicine covers the full spectrum of primary care, and although infectious disease continues to be an important area of concern, we are now seeing mental health and chronic diseases as key considerations for recently arriving immigrants and refugees.

:Canada received 22,873 asylum seekers in 2006. The screening of specific health problems in this population seems warranted. This study aims to estimate the prevalence of pathologies that were screened at the PRAIDA health service in Montreal, and to identify associations with certain risk factors. :A retrospective study was conducted on the files of patients who were screened between 2000 and 2004. Demographic and clinical information was compiled for computation of prevalence as well as multiple logistic regression analysis. :Of the 289 files reviewed, 56.7% are for male and 43.3% for female patients, with a mean age of 34 years; 53% are Asians and 38% Africans. 59.4% of subjects received a psychiatric diagnosis (mainly depression and post-traumatic stress disorder). The paraclinical work-up showed: 20.3% anaemia, 9% eosinophilia, 29.7% HBcAb+, 5% HBsAg+, 1.5% hepatitis C (RNA+), 2.5% HIV+ and 45.9% TST+. 10.5% of stool samples contained a pathogen, and serologies for strongyloidiasis and schistosomiasis were positive in 17.3% and 3.9% of samples respectively. Significant associations included female gender with anaemia, African origin with rates of HBcAb and TST+, age with HBcAb and hepatitis C positivity, longer length of stay in Canada with eosinophilia and strongyloidiasis, shorter length of stay with HBcAb, and Asian origin with psychiatric disorders. :This study suggests that the prevalence of screened pathologies as part of the PRAIDA health service work-up are high in this population and therefore warrant continuation of their screening until guidelines are constituted. :Le Canada a reçu 22 873 demandeurs d’asile en 2006. Le dépistage de maladies spécifiques semble indiqué dans cette population. Cette étude vise à évaluer la prévalence de pathologies dépistées au service de santé du PRAIDA à Montréal et à identifier des associations avec certains facteurs de risque. :Une étude rétrospective de dossiers de patients ayant été dépistés entre 2000 et 2004 a été réalisée. Des informations démographiques et cliniques ont été compilées, permettant le calcul de prévalences, ainsi que des analyses de régression logistique multiples. :Parmi les 289 dossiers relevés, 56,7 % proviennent d’hommes et 43,3 % de femmes; la moyenne d’âge est de 34 ans; 53 % sont Asiatiques et 38 % Africains. 59,4 % des sujets ont reçu un diagnostic psychiatrique (principalement dépression et syndrome de stress post-traumatique). Le bilan paraclinique a montré les résultats suivants: 20,3 % anémie, 9 % éosinophilie, 29,7 % HBcAc+, 5 % HBsAg+, 1,5 % hépatite C (ARN+), 2,5 % VIH+, 45,9 % TCT+; 10,5 % des selles présentent un germe pathogène, 17,3 % des sérologies sont positives pour strongyloïdose et 3,9 % pour schistosomiase. Les associations significatives sont: anémie et sexe féminin; origine africaine et taux d’HBcAc et de TCT+; âge et taux d’HBcAc et d’hépatite C; longue durée de séjour au Canada et éosinophilie et strongyloïdose; courte durée de séjour et HBcAc; origine asiatique et trouble psychiatrique. :Cette étude suggère que les prévalences des pathologies dépistées au PRAIDA sont élevées et justifient d’en maintenir le dépistage dans cette population jusqu’à ce que des recommandations soient émises.