Search

Relying on a populace well-educated in family history based in ancestral genealogy, a robust national genomics sector has developed in Québec over the past decade-and-a-half. The same period roughly coincides with a fourfold increase in the number of individuals and organizations in the region self-identifying with a mixed-race form of indigeneity that is counter to existing Indigenous understandings of kinship and citizenship. This paper examines how recent efforts by genetic scientists, working on a multi-year research project on the 'diversity' of the Québec gene pool, intervene in complex settler-Indigenous relations by redefining indigeneity according to the logics of 'Native American DNA'. Specifically, I demonstrate how genetic scientists mobilize genes associated with Indigenous peoples in ways that support regional efforts to govern settler-Indigenous relations in favour of otherwise white settler claims to Indigenous lands.

Improving transfusion chain requires moral support for blood policy and ethics training of different actors. To optimize this support and ethics training, it is important to evaluate and strengthen the ethicality of the mandates of the structures involved in the transfusion chain. To help strengthen audit, this study will examine the use of anticipatory and forward slope of the principle of ethical responsibility in the blood policy in Quebec and Côte d'Ivoire. By elucidating the conditionalities of efficient use of accountability within these transfusion chain, this paper deepens the fundamentals of acting rational, sensible, prudential and therefore responsible to his blood systems and supports, at the same time the ideas of biomonitoring and preventive medicine.

This article proposes the development of an intersectional life course perspective that is capable of exploring the links between structural inequalities and the lived experience of aging among racialized older people. Merging key concepts from intersectionality and life course perspectives, the authors suggest an analytic approach to better account for the connections between individual narratives and systems of domination that impinge upon the everyday lives of racialized older people. Our proposed intersectional life course perspective includes four dimensions: 1) identifying key events and their timing, 2) examining locally and globally linked lives, 3) exploring categories of difference and how they shape identities, 4) and assessing how processes of differentiation, and systems of domination shape the lives, agency and resistance among older people. Although applicable to various forms of marginalization, we examine the interplay of racialization, immigration, labour and care in later life to highlight relationships between systems, events, trajectories, and linked lives. The illustrative case example used in this paper emerged from a larger critical ethnographic study of aging in the Filipino community in Montreal, Canada. We suggest that an intersectional life course perspective has the potential to facilitate a deeper understanding of the nexus of structural, personal and relational processes that are experienced by diverse groups of older people across the life course and into late life., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Food insecurity is steadily increasing in Canada. The objective of this paper is to determine if food capacities and satisfaction of recently enrolled participants in food security interventions are associated with the intervention having either a traditional or an alternative type of approach. Participants having recently accessed traditional (n = 711) or alternative community interventions (n = 113) in the Montreal metropolitan area, Canada, were interviewed with a questionnaire. The categorizing variable was participation in a community organization providing either traditional interventions, aimed to help people cope with the urgent need of food, or alternative interventions, aimed at first assistance, in addition to the creation of long-term solutions such as social integration and skills development. Participants' food and nutrition-related capacities and food satisfaction are studied. Multilevel regression models were used to assess whether participants took part in a traditional or alternative interventions. These interventions do not reach the same population. Relative to participants in alternative food security interventions, participants in traditional interventions demonstrated less capacity for accessing information about food safety and healthiness, and perceived their diet as less healthy. Traditional food security participants also paid less attention to the nutritional properties of food and reported less satisfaction with quantity, variety and taste of the food they accessed. The reasons why individuals who may benefit the most from alternative interventions were unlikely to participate should be investigated. The potential that food security interventions may inadvertently reinforce social inequalities in health should be considered in future intervention research., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: The Québec Incidence Study on situations investigated by child protective services (QIS) has been conducted in 5-year cycles since 1998 in collaboration with all 16 Québec child protection agencies. It provides reliable estimates of the incidence and characteristics of investigated children. The aim of this paper is to discuss major findings from the QIS-2008 and to compare them with the findings from QIS-1998., Methods: Two representative samples of children who were investigated by child protection services during the same three-month time frame in 1998 (N = 4,771) and in 2008 (N = 3,079) were constituted. Caseworkers were asked to complete the QIS data collection form for each sampled child. Annual estimates of the number of children investigated with different characteristics were computed and compared across both cycles. Statistical tests were performed to identify significant differences., Results: While the rate of children investigated increased between 1998 and 2008, the rate of substantiated cases remained stable at 12 and 11 per 1,000 children in the population respectively. Furthermore, substantiated cases in 2008 were less severe than in 1998 along several dimensions, such as co-occurrence, emotional harm and duration., Conclusion: Combined with the stability in the rate of substantiated cases, the decline in the severity of the situations seems encouraging but questions the necessity of a CPS intervention for some of these families. These findings are consistent with the ones reported in other countries, but Québec rates are below the rates estimated for Canada, where substantiated maltreatment almost doubled during the same time frame. Aspects of social policies in Québec may play a role in this situation and need to be examined in future research.

Objectives: In Quebec, three population-based surveys have documented the prevalence of psychological aggression, and minor and severe physical violence toward children. This paper aims to present 1) the results of the 2012 survey with regard to the frequency and annual prevalence of violence, and 2) the trends in all three forms of violence between 1999 and 2012 according to children's age., Methods: The three independent surveys were all conducted through telephone interviews in 1999, 2004 and 2012 by the Institut de la Statistique du Québec and reached a total sample of 9,646 children living with a mother figure. Psychological aggression, and minor and severe physical violence were measured using the Parent Child Conflict Tactics Scales., Results: The results show that repeated psychological aggression, after having increased between 1999 (48%) and 2004 (53%), slightly decreased in 2012 (49%). Minor physical violence decreased steadily between 1999 and 2012, from 48% to 35%, and severe physical violence remained stable (6%). These three forms of violence varied by the age category of the children. Finally, the results show that the co-occurrence of the use of physical and psychological violence remained high in all three surveys., Conclusion: The results are consistent with trends in North America and are discussed in terms of services to support families.

Introduction: doctoral studies in nursing engage a critical reflections about philosophical traditions inherent to knowledge development., Background: critical realism, hermeneutics, postmodernism and poststructuralism refer to philosophical traditions that are generally less explored in nursing, although they are attracting greater attention., Objective: this paper offers an introductory presentation to these traditions as the authors also reflect upon their contribution to nursing knowledge development in., Method: for each tradition, ontological and epistemological properties are presented to provide an overview of their main features. Contributions to nursing knowledge development are then discussed., Results: ontology refers to stratified, fixed and changing, or multiple realities, depending on the philosophical tradition. Likewise, epistemology emphasizes the explanatory power of knowledge, intersubjectivity, or inherent power dynamics., Discussion: the diversity of philosophical traditions represents an asset that can significantly contribute to the advancement of the nursing discipline., Conclusion: clarification of the philosophical dimensions that underlie knowledge development is essential for doctoral nursing students in the process of developing their research projects and future programmes of research.

"Funding Long-Term Care in Canada: Issues And Options" (Adams and Vanin 2016) is a well-argued paper that grounds its recommendations in learnings from other jurisdictions that have tried to enact major reforms to the funding approach for long-term care (LTC). In particular, the paper considers the experience in both the UK and Quebec. The paper correctly highlights the significant difficulty of implementing large structural reforms to deal with LTC funding challenges. This is not a surprising result. Structural reform in healthcare has proven challenging even when the problems being addressed are immediate and large in scale, let alone for those that will manifest themselves in increments over many years or even decades in the future. The authors are correct, in my view, to focus on the art of the possible and to seek ways to set Canada on a path towards addressing the coming challenges around LTC, rather than proposing a big-bang fix.

In 2006, a University Hospital in Quebec decided to implement the Health Promoting Hospital project (HPH). A study was conducted on the internal context of the HPH Project implementation, and more particularly on one of its dimensions, the “health promoting workplace”. Compatibility is an important factor of the internal context, but has been rarely studied. The objective of this paper is to examine whether there are any organizational practices compatible with those of a health promoting workplace for nurses. A questionnaire was administered, interviews were conducted with strategic actors and a document analysis was performed.The results show various levels of compatibility with the criteria of a health promoting workplace. Thus, compatibility was very high for criteria related to the development of a learning and efficient organization, the strategies to ensure a healthy and safe workplace, and healthy lifestyles. However, poor compatibility was observed for criteria related to the adoption of a health promotion policy and no compatibility was observed for nurses’ participation in the decision-making process.The study identified strengths and weaknesses in the “Health Promoting Workplace” Subproject implementation process. It also emphasized the importance of the adaptation of tools to local conditions. In this case, it is the WHO assessment tool for hospitals wishing to assess their health promotion practices and to stimulate their development.

Empirical data on the processes underlying knowledge brokering (KB) interventions, including their determining factors and effects, remain scarce. Furthermore, these interventions are rarely built on explicit theoretical foundations, making their critical analysis difficult, even a posteriori. For these reasons, it appeared relevant to revisit the results of a qualitative evaluation undertaken in the province of Quebec in parallel with a Canada-wide randomized controlled trial (RCT) evaluating various KB strategies in public health. This paper looks critically at the theoretical foundations of the KB interventions in light of two conceptual models: (1) the dissemination model underlying the KB interventions used in the Canadian trial and (2) a systemic KB model developed later. This critical analysis sheds light on the processes involved in KB interventions and the factors influencing their implementation and effects. The conclusions of the critical analysis are consistent with the systemic model, in which interpersonal contact is an essential condition for effective KB interventions. This analysis may advance knowledge in the field by enhancing our understanding of the role of knowledge brokers as essential mediators in KB processes and outcomes., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This paper examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public health care system with free physician and hospital services. Using the Canadian National Population Health Survey from 1994 to 2003 and implementing a difference-in-differences estimation strategy, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization. Findings from quantile regressions suggest that there was a large improvement in the health status of less healthy individuals. Further analysis by pre-policy drug insurance status and the presence of chronic conditions reveals a marked increase in the probability of taking medication and visiting a general practitioner among the previously uninsured and those with a chronic condition., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Preventive healthcare (PH) programs and services aim at reducing the likelihood and severity of potentially life-threatening illness by early detection and prevention. The effectiveness of these programs depends on the participation level and the accessibility of the users to the facilities providing the services. Factors that impact the accessibility include the number, type, and location of the facilities as well as the assignment of the clients to these facilities. In this paper, we study the impact of system-optimal (i.e., directed) choice on the design of the preventive healthcare facility network under congestion. We present a model that simultaneously determines the location and the size of the facilities as well as the allocation of clients to these facilities so as to minimize the weighted sum of the total travel time and the congestion associated with waiting and service delay at the facilities. The problem is set up as a network of spatially distributed M/G/1 queues and formulated as a nonlinear mixed integer program. Using simple transformation of the nonlinear objective function and piecewise linear approximation, we reformulate the problem as a linear model. We present a cutting plane algorithm based exact (𝜖-optimal) solution approach. We analyze the tradeoff between travel time and queuing time and its impact on the location and capacity of the facilities as well as the allocation of clients to these facilities under a directed choice policy. We present a case study that deals with locating mammography clinics in Montreal, Canada. The results show that incorporating congestion in the PH facility network design substantially reduces the total time spent by clients. The proposed model allows policy makers to direct clients to facilities in an equitable manner resulting in better accessibility.

Background: The use of medication is at the heart of primary care, but is also the cause for major health concerns. It is therefore important to examine the prescription of medication process., Objective: This study identifies the barriers and facilitators perceived by community pharmacists and primary care physicians concerning the adoption of a nationwide electronic prescribing (e-prescribing) network in the province of Quebec, Canada., Methods: We used purposive sampling to identify the most intensive users of the e-prescribing network. We conducted phone and in-person interviews. Interviews were transcribed, and we analysed their content with NVivo, using the clinical adoption framework (CAF) for the codification of the data.Results We interviewed 33 pharmacists, 2 pharmacy technicians, 11 physicians and 3 clinic managers. Adoption of the e-prescribing network was fairly low. The respondents underlined adaptation of their work environment, openness to change and perception of benefits as facilitators to the adoption of the network. However, important barriers were perceived, including system quality issues and paper prescriptions being the only legal document in the prescribing process. Even if respondents recognised that the e-prescribing network can offer substantial benefits to the prescribing process, issues still persisted and raised barriers to the full use of such a network, especially in a context where different local information systems are connected within a nationwide e-prescribing network., Conclusions: This study, based on the CAF, provides a better understanding of the factors related to the adoption of a nationwide e-prescribing network connecting primary care clinics and community pharmacies.

Introduction: Even in countries with universal healthcare systems, excess mortality rates due to physical chronic diseases in patients also suffering from serious mental illness like schizophrenia is such that their life expectancy could be lessened by up to 20 years. The possible explanations for this disparity include: unhealthy habits (i.e. smoking; lack of exercise); side-effects of psychotropic medication; delays in the detection or initial presentation leading to a more advanced disease at diagnosis; and inequity of access to services. The main objective of this paper is to explore the feasibility and acceptability of patient partnership for developing an interactive guide to improve access to primary care providers for chronic diseases management and health promotion among patients with severe mental illnesses., Methods: A participatory action research design was used to engage patients with mental illness as full research partners for a strategy for patient-oriented research in primary care for persons with schizophrenia who also have chronic physical illnesses. This strategy was also developed in partnership with a health and social services centre responsible for the health of the population of a territory with about 100,000 inhabitants in East-end Montreal, Canada. A new interactive guide was developed by patient research partners and used by 146 participating patients with serious mental illness who live on this territory, for them to be better prepared for their medical appointment with a General Practitioner by becoming more aware of their own physical condition., Results: Patient research partners produced a series of 33 short videos depicting signs and symptoms of common chronic diseases and risk factors for the leading causes of mortality and study participants were able to complete the corresponding 33-item questionnaire on an electronic touch screen tablet. What proved to be most relevant in terms of interactivity was the dynamic that has developed among the study participants during the small group learning sessions, a training technique designed for healthcare professionals that was adapted for this project for, and with patient partners., Conclusion: This research has shown the feasibility and acceptability of patient partnership and patient-oriented research approaches to the R&D process of a new medical tool and intervention for patients with serious mental illness, and its acceptability for addressing inequity of this disadvantaged population in terms of access to primary care providers.

In the early 1950s, both the publication of the first Diagnostic and Statistical Manual (DSM-I) and the advent of psychopharmacology - particularly the development of chlorpromazine (Thorazine - RP4650) - set the stage for models of psychiatric thought, research and practice that remain dominant today. It was during this pivotal period, in 1955, that the Département de psychiatrie de l'Université de Montréal was founded by a cohort of young researchers newly arrived from well-known universities in France and the northeastern United States. This influential group quickly became staunch critics of the province's religion-based asylum system and lobbied for a government review that culminated into the 1962 Commission d'étude des hôpitaux psychiatriques (popularly known as the Bédard Report). What followed in Quebec between 1965 and 1975 was the secularization of psychiatric institutions and widespread deinstitutionalization. This paper illuminates cultural changes and intellectual shifts that have been overlooked in historical studies of post-war psychiatry by exploring the expansion of such "anti-psychiatry" schools of thought in Quebec in this period.

Based on an overview of the recent history of professional roles in autism diagnosis and support in the province of Quebec, this paper supports the view that hearing what autistic people say, combined with interdisciplinary, but hierarchically ruled task sharing in clinical settings, and to a pacific confrontation between scientific and clinical demands, prevents the high jacking of autism for corporatist or ideological purposes.

Organizational evaluation capacity (EC) has received significant attention in the evaluation research literature in the past decade. Much of the focus has been on defining organizational evaluation capacity, which can be thought of as the competencies and structures required to conduct high-quality evaluation studies (capacity to do), as well as the organization's ability to integrate evaluation findings into its decision-making processes (capacity to use). This paper seeks to contribute to this growing body of knowledge through a multiple case study of EC across three different organizations (e.g., non-profit, provincial government and federal government, herein named sectors); the novelty of this particular study is that each case study is based on the use of a common measurement tool developed by Bourgeois, Toews, Whynot and Lamarche (2013). The cross-case analysis presented in the paper reveals that evaluation capacity tends to be higher, both in terms of capacity to do and capacity to use, in organizations that have developed systematic mechanisms to institute an evaluation culture within their walls. Interestingly, however, we also found that capacity to use does not first require capacity to do, as evidenced in the non-profit organization under study., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: In terms of health and social services, the territory of the province of Quebec is covered by four large 'integrated university health networks,' which are involved in the coordination of care delivery and medical training. The francophone components of the public mental health system for Montreal are thus primarily linked to the Integrated University Health Network of University of Montreal. In 2010, the Faculty of Medicine of the University of Montreal has included in its development strategy a firm commitment to the development and implementation of the 'patient partner expertise' in research, training and care in order to make this expertise no less than the brand of the Faculty. This commitment applies to all medical specialties that are taught at University of Montreal, including in psychiatry. More recently, the Institut universitaire en santé mentale de Montréal (IUSMM) has endorsed a new clinical vision that promotes full citizenship, which implies that service users and carers are considered as full partners with a specific expertise to be fully deployed. The objective of this paper is to examine, from an ethical point of view, the challenges that may be associated with involving such lay persons in various levels of mental health care planning and delivery, and in research., Methods: This study is mainly based on a review of the institutional processes that are in place at the IUSMM to promote service users' participation in care planning and delivery, and in research. The focus is on the practicalities and conditions for the exercise of such an active participation, as some questions and concerns emerged through a series of interviews with different stakeholders. These issues are addressed and discussed through the lenses of the ethical values that were formalized at IUSMM., Results: Despite a firm institutional commitment at IUSMM to implement its new citizenship-oriented clinical vision through greater service users' involvement, little is known about the possible negative impacts of their participation, on themselves and for regular employees. There is a consensus on the symbolic value of recognizing the potential of service users as contributors, as a peer workers or peer research assistants. This is an historic advance compared to a time when they were considered only as more or less passive recipients of services or as a simple research subjects. Some risk factors were nonetheless identified: isolation, emotional fatigue, possible relapse, insecurity, sometimes tensed relations with health or research professionals and misunderstanding. In organizational terms, among the pitfalls, the study highlighted the need for more cautious preparatory steps, guidance and support for service users and for professionals as well, and the importance of a global and integrated governance strategy., Conclusion: This study points to three main recommendations to better anticipate and manage possible risks associated with more or less improvised service users' active participation, as lay persons, in complex planning and service delivery and in research. The first would be directed towards professionals for them to reflect on the quality of the doctor-patient relationship in their facility as to see how service users can help to improve this relationship, but among a variety of stakeholders and without being the sole responsible for such an improvement, or for the lack of improvement thereof. The second recommendation would propose to draw an objective evaluative assessment of participatory approaches at the organizational level, promoting a real return of experience and in light of the issues raised by these practices. The third would recommend an update of the organizational ethical values when introducing practices that change the current paradigms of the provision of care and services and of research.

This paper reports the results of a study on the identification and management of violence on a psychiatric ward and in the psychiatric emergency of a Quebec hospital. The purpose of this exploratory and descriptive study was to examine patients' and nurses' perceptions and strategies for identifying and managing patient aggression and violence. Results show that the type of setting influences the way aggressive behaviour issues are perceived and managed. The types of behaviours deemed aggressive or risky also vary between the two units. Moreover, patients and nurses are similarly described by all participants as susceptible to being violent and to being a victim of violence. Prevention of aggression and violence remains a significant challenge in psychiatric nursing, where administrative and environmental constraints, the growing complexity of clinical profiles, divergent interprofessional approaches to care, and collective feelings of apprehension and vulnerability interact.

Introduction: The relationship between the onset of smoking and the onset of depression among adolescents has been well document, but the mechanisms underlying the relationship are unclear. This paper uses an empirical method to assess potential intermediate variables in the pathway between changes in depressive symptoms and cigarette smoking in a longitudinal cohort of adolescents., Methods: 837 participants from a cohort in Montreal, Canada who had not smoked and did not have elevated depressive symptoms at baseline were followed for five years from 1999 to 2003. The role of a set of 15 variables previously identified in the literature as potential confounders were systematically evaluated as predictors of exposure and outcome, for attenuation of the association by more than 10%, and for intra-individual change in the variable after onset of exposure., Results: The magnitude of the association between smoking and depressive symptoms was fully attenuated after adjustment for all variables included indiscriminately. A concept map was developed detailing the empirical associations between the variables within this data set. Stress, worry about weight, and worry about parents were identified as intermediate variables for both smoking predicting depressive symptoms and depressive symptoms predicting smoking. Cox regressions with appropriate confounders maintained statistical significance., Conclusion: Cigarette smoking is associated with higher depressive symptoms prior to and after inclusion of empirical confounders. Inclusion of intermediate variables in multivariable models can lead to the erroneous conclusion that there is no association between smoking and depression., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Third spaces are in-between places where teacher-student scripts intersect, creating the potential for authentic interaction and a shift in what counts as knowledge. This paper describes a unique community-university initiative: a third space storefront classroom for postsecondary students in professional education programs, which also functions as a community art studio for the surrounding neighborhood. This approach to professional education requires an innovative combination of theory, methods, and materials as enacted by the professionals involved and performed by the students. This storefront classroom utilizes collaborative and inclusive instructional practices that promote human and community development. It facilitates the use of innovative instructional strategies including art making and participatory dialogue to create a liminal learning space that reconfigures professional education. In researching the effectiveness of this storefront classroom, we share the voices of students who have participated in this third space as part of their coursework to underscore these principles and practices.

The National Trajectory Project examined longitudinal data from a large sample of people found not criminally responsible on account of mental disorder (NCRMD) to assess the presence of provincial differences in the application of the law, to examine the characteristics of people with serious mental illness who come into conflict with the law and receive this verdict, and to investigate the trajectories of NCRMD-accused people as they traverse the mental health and criminal justice systems. Our paper describes the rationale for the National Trajectory Project and the methods used to collect data in Quebec, Ontario, and British Columbia, the 3 most populous provinces in Canada and the 3 provinces with the most people found NCRMD.

Introduction: Contemporary nursing practice requires constant updating of knowledge, especially in regards to research results found in academic or scientific papers., Context: As part of the university curriculum in nursing, students must develop their skills in relation to the understanding and evaluation of research evidence., Objectives: The objective of this study was to explore the appreciation and effects of a new teaching approach, the use of a journal club within a nursing research course, with undergraduate students in nursing sciences., Method: As part of a qualitative exploratory descriptive design, a questionnaire with open-ended questions about their appreciation and perception of the effects of the journal club was administered to the participating students (n = 41) at the end of the course., Results: Participation in the journal club appears to have provided an introduction to the scientific area of nursing, to have improved several skills related to the evaluation of scientific articles and has increased motivation to adopt evidence-based practice., Conclusion: The use of a journal club within an undergraduate research course in nursing was a relevant teaching method that aroused great interest in the undergraduate students in nursing.

Purpose: Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec., Design/methodology/approach: An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis., Findings: The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery., Research Limitations/implications: This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation., Practical Implications: The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes., Originality/value: This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design.

Interprofessional education (IPE) is increasingly recognized as a means to improve practice in health and social care. However, to secure interprofessional learning, it is important to create occasions in prelicensure health and social services curriculum so that students can learn with, from and about each other. This paper presents the process behind the development and implementation of an IPE curriculum in 10 health and social sciences programs by a team of professors from the faculties of medicine, nursing sciences and social sciences at Université Laval in the province of Québec, Canada. The pedagogical approach, description of primary objectives and issues related to its implementation in the curriculum programs are also described and discussed.

Background: Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place., Methods: This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software., Results: Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM., Conclusions: These results provide insights on the type of practical implementation imperatives involved in supporting EIDM.

In adopting a whole-of-society (WoS) approach that engages multiple stakeholders in public health policies across contexts, the authors propose that effective governance presents a challenge. The purpose of this paper is to highlight a case for how polycentric governance underlying the WoS approach is already functioning, while outlining an agenda to enable adaptive learning for improving such governance processes. Drawing upon a case study from Quebec, Canada, we employ empirically developed concepts from extensive, decades-long work of the 2009 Nobel laureate Elinor Ostrom in the governance of policy in nonhealth domains to analyze early efforts at polycentric governance in policies around overnutrition, highlighting interactions between international, domestic, state and nonstate actors and processes. Using information from primary and secondary sources, we analyze the emergence of the broader policy context of Quebec's public health system in the 20th century. We present a microsituational analysis of the WoS approach for Quebec's 21st century policies on healthy lifestyles, emphasizing the role of governance at the community level. We argue for rethinking prescriptive policy analysis of the 20th century, proposing an agenda for diagnostic policy analysis, which explicates the multiple sets of actors and interacting variables shaping polycentric governance for operationalizing the WoS approach to policymaking in specific contexts., (© 2014 New York Academy of Sciences.)

Background: Homelessness and mental disorders constitute a major problem in Canada. The purpose of the At Home/Chez Soi pilot project was to house and provide supports to marginalised groups. Policymakers are in a better position to nurture new, complex interventions if they know which key factors hinder or enable their implementation. This paper evaluates the implementation process for the Montreal site of this project., Methods: We collected data from 62 individuals, through individual interviews, focus groups, questionnaires, observations and documentation. The implementation process was analysed using a conceptual framework with five constructs: Intervention Characteristics (IC), Context of Implementation (CI), Implementation Process (IP), Organizational Characteristics (OC) and Strategies of Implementation (SI)., Results: The most serious obstacle to the project came from the CI construct, i.e., lack of support from provincial authorities and key local resources in the homelessness field. The second was within the OC construct. The chief hindrances were numerous structures, divergent values among stakeholders, frequent turnover of personnel and team leaders; lacking staff supervision and miscommunication. The third is related to IC: the complex, unyielding nature of the project undermined its chances of success. The greatest challenges from IP were the pressure to perform, along with stress caused by planning, deadlines and tension between teams. Conversely, SI construct conditions (e.g., effective governing structures, comprehensive training initiatives and toolkits) were generally very positive even with problems in power sharing and local leadership. For the four other constructs, the following proved useful: evidence of the project's scope and quality, great needs of services consolidation, generous financing and status as a research pilot project, enthusiasm and commitment toward the project, substantially improved services, and overall user satisfaction., Conclusion: This study demonstrated the difficulty of implementing a complex project in the healthcare system. While the project faced many barriers, minimal conditions were also achieved. At the end of the study period, major tensions between organizations and teams were significantly reduced, supporting its full implementation. However, in late 2013, the project was unsustainable, calling into question the relevance of achieving a significant number of positive conditions in each area of the framework.

Background: This protocol builds on the development of a) a framework that identified the various supports (i.e. positions, activities, interventions) that a healthcare organisation or health system can implement for evidence-informed decision-making (EIDM) and b) a qualitative study that showed the current mix of supports that some Canadian healthcare organisations have in place and the ones that are perceived to facilitate the use of research evidence in decision-making. Based on these findings, we developed a web survey to collect cross-sectional data about the specific supports that regional health authorities and hospitals in two Canadian provinces (Ontario and Quebec) have in place to facilitate EIDM., Methods/design: This paper describes the methods for a cross-sectional web survey among 32 regional health authorities and 253 hospitals in the provinces of Quebec and Ontario (Canada) to collect data on the current mix of organisational supports that these organisations have in place to facilitate evidence-informed decision-making. The data will be obtained through a two-step survey design: a 10-min survey among CEOs to identify key units and individuals in regard to our objectives (step 1) and a 20-min survey among managers of the key units identified in step 1 to collect information about the activities performed by their unit regarding the acquisition, assessment, adaptation and/or dissemination of research evidence in decision-making (step 2). The study will target three types of informants: CEOs, library/documentation centre managers and all other key managers whose unit is involved in the acquisition, assessment, adaptation/packaging and/or dissemination of research evidence in decision-making. We developed an innovative data collection system to increase the likelihood that only the best-informed respondent available answers each survey question. The reporting of the results will be done using descriptive statistics of supports by organisation type and by province., Discussion: This study will be the first to collect and report large-scale cross-sectional data on the current mix of supports health system organisations in the two most populous Canadian provinces have in place for evidence-informed decision-making. The study will also provide useful information to researchers on how to collect organisation-level data with reduced risk of self-reporting bias.

This paper proposes a multimodal approach to study safety at intersections by simultaneously analysing the safety and flow outcomes for both motorized and non-motorized traffic. This study uses an extensive inventory of signalized and non-signalized intersections on the island of Montreal, Quebec, Canada, containing disaggregate motor-vehicle, cyclist and pedestrian flows, injury data, geometric design, traffic control and built environment characteristics in the vicinity of each intersection. Bayesian multivariate Poisson models are used to analyze the injury and traffic flow outcomes and to develop safety performance functions for each mode at both facilities. After model calibration, contributing injury frequency factors are identified. Injury frequency and injury risk measures are then generated to carry out a comparative study to identify which mode is at greatest risk at intersections in Montreal. Among other results, this study identified the significant effect that motor-vehicle traffic imposes on cyclist and pedestrian injury occurrence. Motor-vehicle traffic is the main risk determinant for all injury and intersection types. This highlights the need for safety improvements for cyclists and pedestrians who are, on average, at 14 and12 times greater risk than motorists, respectively, at signalized intersections. Aside from exposure measures, this work also identifies some geometric design and built environment characteristics affecting injury occurrence for cyclists, pedestrians and motor-vehicle occupants., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Rabies is endemic throughout arctic areas including the region of Nunavik, situated north of the 55th parallel of Québec, Canada, and raises public health concerns. The aim of this paper is to provide a descriptive overview of the temporal and regional distributions of three important components of arctic rabies in Nunavik from 1999 to 2012, following a "One Health" approach: animal rabies tests and confirmed cases, dog vaccination, and human consultations for potential rabies exposures. Forty-four cases of rabies, involving mainly arctic and red foxes, were confirmed in animals during this period. The mean number of dogs vaccinated per 1,000 inhabitants was highly variable and lower in the Hudson region than the Ungava region. 112 consultations for potential rabies exposure were analyzed, of which 24 were exposure to a laboratory confirmed rabid animal. Children less than 10 years of age were the age group most commonly exposed. The median time between potential exposure and administration of the first post-exposure prophylaxis dose was four days. This study confirms that the risk of human exposure to rabid animals in Nunavik is present and underlines the need to follow a "One Health" approach to prevent rabies in humans in similar contexts worldwide.

The purpose of this study was to better understand why change initiatives succeed or fail in long-term care organizations. Four case studies from Québec, Canada were contrasted retrospectively. A constipation and restraints program succeeded, while an incontinence and falls program failed. Successful programs were distinguished by the use of a change strategy that combined "let-it happen," "help-it happen," and "make-it happen" interventions to create senses of urgency, solidarity, intensity, and accumulation. These four active ingredients of the successful change strategies propelled their respective change processes forward to completion. This paper provides concrete examples of successful and unsuccessful combinations of "let-it happen," "help-it happen," and "make-it happen" change management interventions. Change managers (CM) can draw upon these examples to best tailor and energize change management strategies in their own organizations., (© The Author(s) 2013.)

Dissolved organic carbon (DOC) is a recognized indicator of natural organic matter (NOM) in surface waters. The aim of this paper is twofold: to evaluate the impact of geophysical characteristics, climate and ecological zones on DOC concentrations in surface waters and, to develop a statistical model to estimate the regional variability of these concentrations. In this study, multilevel statistical analysis was used to achieve three specific objectives: (1) evaluate the influence of climate and geophysical characteristics on DOC concentrations in surface waters; (2) compare the influence of geophysical characteristics and ecological zones on DOC concentrations in surface waters; and (3) develop a model to estimate the most accurate DOC concentrations in surface waters. The case study involved 115 catchments from surface waters in the Province of Quebec, Canada. Results showed that mean temperatures recorded 60 days prior to sampling, total precipitation 10 days prior to sampling and percentages of wetlands, coniferous forests and mixed forests have a significant positive influence on DOC concentrations in surface waters. The catchment mean slope had a significant negative influence on DOC concentrations in surface waters. Water type (lake or river) and deciduous forest variables were not significant. The ecological zones had a significant influence on DOC concentrations. However, geophysical characteristics (wetlands, forests and slope) estimated DOC concentrations more accurately. A model describing the variability of DOC concentrations was developed and can be used, in future research, for estimating DBPs in drinking water as well evaluating the impact of climate change on the quality of surface waters and drinking water., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Institutional altruism in the form of a public-sector intervention and support for victims and social altruism generated by mutual aid and solidarity among citizens constitute a coming together in a crisis. This coming together and mutual support precipitate a decrease in crime rates during such an event. This paper presents an analysis of daily fluctuations in crime during the prolonged ice storms in Quebec, Canada, in January 1998 that provoked an electrical blackout. Of particular interest are the principal crisis-related influences on daily crime patterns. A first series of analyses examines the impact of altruistic public-sector mobilisation on crime. A significant decline in property crime rates was noticed when cheques were distributed to crisis victims in financial need in Montérégie, and hence they were attributable to public intervention (institutional altruism). Moreover, the rate of social altruism (financial donations), which was more substantial in adjoining rather than distant regions, was inversely proportional to crime rates., (© 2014 The Author(s). Disasters © Overseas Development Institute, 2014.)

Job tenure for people with severe mental disorders (e.g., schizophrenia) remains a stumbling-block to their work integration. However, the length of job tenure can vary according to the workplace (e.g., provided resources) and the work context (e.g., regular market, social firms). This gap can be explained in part by diverse organisational components, particularly the implementation of work accommodations, which is related to the disclosure of the mental disorder in the workplace. Indeed, in the scientific literature, the principal reason associated with disclosure is in regards to requesting work accommodations. The main objective of this paper is to increase our understanding of the relationships between these three concepts - disclosure of a mental disorder, work accommodations and natural supports, and job tenure - by reviewing the specialized literature and presenting the work of the authors of this paper. To do so, the authors will address the following questions: How do we define 'disclosure' of a mental disorder in the workplace and what are the strategies to consider before disclosing? What is the decision-making process related to disclosure in the workplace? How are the three concepts - disclosure of the mental disorder in the workplace, work accommodations and job tenure - intertwined? Finally, how can employment specialists facilitate the work integration of people with severe mental disorders by considering the three concepts mentioned above? Results from a review of the literature show that disclosure of a mental disorder is a dialectical process that goes beyond the question: to tell or not to tell? In fact, it is not a single binary decision. Several components are associated with the disclosure concept, and can be summarized by the questions: What, how, when and to whom to disclose his/her mental condition? Reasons for disclosing his/her mental disorder in the workplace are numerous, characterized by personal, interpersonal and work environmental factors, on one hand. On the other hand, disclosure has potential consequences, both positive (e.g., to obtain work accommodations) and negative (e.g., stigma). A decision-making process takes place when people with a severe mental disorder think about the possibility of disclosing their mental condition in the workplace - a complex decisional process involving the need to evaluate different aspects (i.e. individual, interpersonal and work environmental factors). Also, the literature supports the fact that requiring work accommodations is often related to the disclosure of the mental disorder, when natural supports in the workplace are not available. The literature is scarce regarding the correlations between the concepts of disclosure, implementation of work accommodations and job tenure; however, a more recent study demonstrated this significant relationship, in which the supervisor and co-worker supports are crucial. Employment specialists or counselors recognise the importance of planned disclosure as a means to obtain access to work adjustments in the workplace and to prevent stigma. The employment specialist working in supported employment programs for instance, could adopt with his/her clients a plan for managing the pros and cons of disclosure of the mental disorder in the workplace; this plan is entitled: Managing personal information. It consists of several steps - for example, to collect details of any sensitive information such as diagnosis, to identify work restrictions with the client, to have a common agreement (employment specialists and clients together) on terms to describe work restrictions - to help clients feel empowered and more confident as productive and valued workers. This plan allows employment specialists to work through the disclosure concept, often negatively connoted, and to adopt a more normalising strategy. Furthermore, additional tools for supporting the management of personal information plan could be used such as the Decision-Making About Disclosure Scale, the Barriers to Employment and Coping Efficacy Scale, and the Work Accommodation and Natural Support Scale, to name a few. To conclude, job tenure for people with severe mental disorders is not a pious vow, several pragmatic ingredients for intervening on this issue are now available., (Copyright © 2014. Published by Elsevier Masson SAS.)

Purpose: In multiple sclerosis (MS), the use of preference-based measures is limited to generic measures such as Health Utilities Index Mark 2 and 3, the EQ-5D and the SF-6D. However, the challenge of using such generic preference-based measures in people with MS is that they may not capture all domains of health relevant to the disease. Therefore, the main aim of this paper is to describe the development of a health state classification system for MS patients. The specific objectives are: (1) to identify items best reflecting the domains of quality of life important to people with MS and (2) to provide evidence for the discriminative capacity of the response options by cross-walking onto a visual analog scale of health rating., Methods: The data come from an epidemiologically sampled population of people with MS diagnosed post-1994. The dataset consisted of 206 items relating to impairments, activity limitations, participation restrictions, health perception and quality of life. Important domains were identified from the responses to the Patient Generated Index, an individualized measure of quality of life. The extent to which the items formed a uni-dimensional, linear construct was estimated using Rasch analysis, and the best item was selected using the threshold map., Results: The sample was young (mean age 43) and predominantly female (n = 140/189; 74%). The P-PBMSI classification system consisted of five items, with three response levels per item, producing a total of 243 possible health states. Regression coefficient values consistently decreased between response levels and the linear test for trend were statistically significant for all items. The linear test for trend indicated that for each item the response options provided the same discriminative ability within the magnitude of their capacity. A scoring algorithm was estimated using a simple additive formula. The classification system demonstrated convergent validity against other measures of similar constructs and known-groups validity between different clinical subgroups., Conclusion: This study produced a health state classifier system based on items impacted upon by MS, and demonstrated the potential to discriminate the health impact of the disease.

This paper deals with the lack of interest shown by family medicine residents in Quebec (Canada) in home follow-up or monitoring of the elderly. By collecting and analyzing data from sixteen family medicine residents before and after their first experience of home follow-up, and from four medical supervisors, we found that residents experience a rapid loss of interest in this practice over a very short period. We show that this lack of interest stems first from the difficulty of applying the principle of patient-centered care, wherein medical interventions must meet the needs of the elderly in their entirety. Secondly, residents complain that they have to deal with many administrative tasks. They call for implementation of professional features to better integrate services such as case management.

Purpose. This paper aims to summarize the current situation regarding the role of families of persons with mental disorders within the mental health system in Quebec.Methods. We made a research in the most recent and pertinent papers or books regarding: 1) the history of the family involvement in the mental health system in Quebec; 2) the present situation of these families and the models that we can see and 3) identify in recent governmental or research documents recommendations regarding a greater empowerment of the families in the mental health system.Results. The research provides a historical perspective to the roles occupied by families. First the family was described as a causal agent; the work of the psychoanalyst Freud described the family unit as a source of conflicts in the areas of affect and sexual dynamics, and which results in the appearance of psychiatric symptoms. Later, this view of a causal agent came both from the point of view of genetic and from expressed emotions. In the 70's new perspectives such as general systems theory (von Bertalanffy, 1968), described the family as responsive to mental disorder of one of its members rather than a responsible agent. With the deinstitutionalization movement, the family was perceived as a source of solutions for persons with mental illness, but also as persons who can live some burden. This subject became well described and a several studies reported about adverse effects of caring for a person with mental disorder on the health, well-being and feeling of caregiver burden. In the 90's, some government action plans called for the relationship between the family and the health system as a partnership. Also, families want to be involved in decisions about care and to be informed about the diagnosis and treatment options. ( Lefley et Wasow, 1993)A new model developed by FFAPAMM that identifies three main roles enables to contextualize the current role in the current system. This model, called CAP lists and describes three roles of families that, if they are dependent on the past, continue to mingle in our time. These roles are:Accompanist: the role imposed by being near a person with mental illness (Fradet, 2012). As an accompanist, the family needs to establish relationships with health professionals. Accompanists want to be considered by stakeholders and be respected in their desire to share information and participate in decisions.Client: this is the role that derives from the accompanist when the caregiver receives care services for its psychological or physical problems related to the fact support a sick person.Partner: it is relative to the involvement (or not) the role of family members in the organization of care. It is a role of participation and decision-making. In this context, we also speak of participation in the consultation mechanisms.Recommendations from a Quebec research project and a report of the Commission on Mental Health of Canada will consider a future where the needs and aspirations of families will be taken into account in mental health general services, short term health care, community mental health services. There are also some guidelines regarding education for professionals about the needs of families and about changing politics.Conclusion. There exists in all associations of families of person with mental disorders, training on topics such as how to behave towards different mental disorders or aggressiveness near reached. A project of the Douglas Institute has hired a family member to the emergency room to help families better manage this often difficult time and to facilitate communication with stakeholders. Another project called "Learning to come closer without aggression" has helped more than 200 family members undergo training inspired by the Omega approach, which helps them better manage their own behavior in situations of aggression with their loved one.

This paper presents a relevant approach to predict the indoor radon potential based on the combination of the radiogeochemical data and the indoor radon measurements in the Quebec province territory (Canada). The Quebec ministry of health asked for such a map to identify the radon-prone areas to manage the risk for the population related to indoor radon exposure. Three radiogeochemical criteria including (1) equivalent uranium (eU) concentration from airborne surface gamma-ray surveys, (2) uranium concentration measurements in sediments, (3) bedrock and surficial geology were combined with 3082 basement radon concentration measurements to identify the radon-prone areas. It was shown that it is possible to determine thresholds for the three criteria that implied statistically significant different levels of radon potential using Kruskal-Wallis one way analyses of variance by ranks. The three discretized radiogeochemical datasets were combined into a total predicted radon potential that sampled 98% of the studied area. The combination process was also based on Kruskal-Wallis one way ANOVA. Four statistically significant different predicted radon potential levels were created: low, medium, high and very high. Respectively 10 and 13% of the dwellings exceed the Canadian radon guideline of 200 Bq/m(3) in low and medium predicted radon potentials. These proportions rise up to 22 and 45% respectively for high and very high predicted radon potentials. This predictive map of indoor radon potential based on the radiogeochemical data was validated using a map of confirmed radon exposure in homes based on the basement radon measurements. It was shown that the map of predicted radon potential based on the radiogeochemical data was reliable to identify radon-prone areas even in zones where no indoor radon measurement exists., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The importance of children and youth mental health is increasingly recognized. This rapidly developing field cannot be conceptualized as an extension of adult services to a younger age group and its developmental and organizational specificities are the object of debate. Reviewing recent literature in this domain and some preliminary information about the Quebec Mental Health Plan implementation, this paper addresses some of the questions which structure this debate in Quebec.Quebec mental health plan has put at the forefront collaboration among disciplines and partnership among institutions. In spite of having produced significant improvement in the field, discontinuities in services, which interfere with an ecosystemic model of care, persist. Recent studies suggest that the organisational climate which surrounds youth mental health services has a direct impact on the quality of services and on youth health outcomes. A flexible management structure, which engages clinicians and health workers, favors empowerment, minimizes work stress and facilitates partnership, is needed to foster successful interdisciplinary and intersectorial collaboration. This collaboration is the cornerstone of youth mental health services.

Objective: One of the four main chapters of the consultation document proposed by the Québec Ministère de la santé et des services sociaux (Health and Social Services), in preparation for the National Forum on the Mental Health Action Plan 2014-2020, is dedicated to the full exercise of citizenship. This paper reports the dialogue that took place between the CEO of a university mental health institute and a group of service users, in order to participate in the consultation process regarding the full exercise of citizenship., Method: Since May 2013, a dozen service users have gathered in the Projet citoyen at the Research Centre of Institut universitaire en santé mentale de Montréal (IUSMM). The Projet citoyen is a culturally adapted transposition, in Québec, of the Citizens Project that is in place in New Haven, Connecticut. One of the key components of both the Projet citoyen and the Citizens Project interventions is a group training regarding citizenship. Participants discuss what it means for them to be full citizens and they support each other in achieving personal or collective goals. To assess progress made in such matters, a new Citizenship Measurement has been developed by the Yale Program for Recovery & Community Health, and translated into French. This Mesure de la citoyenneté is in the process of being validated; peer research assistants conducted data collection by asking 178 people who use the mental health services of Quebec to complete the French Mesure de la citoyenneté. The preliminary results of a statistical analysis were used to structure the dialogue between the IUSMM CEO and the participants of the Projet citoyen., Results: Three sub-scales emerged from preliminary statistical analysis (clusters). Colleagues of the Projet citoyen were invited, through a focus group conducted by one of them, to give evocative labels to these sub-scales. Regarding the first one, we felt that it was about asking ourselves what we can bring to others' lives, wondering how we, as members of the community, can make a difference for a more inclusive civic cohabitation. The label "contribution to the community" was chosen. For the second sub-scale, personal and social spheres emerged as both being essential to the achievement of full citizenship. These spheres must be respected in complementarity. Hence we chose the label: "personal and social integrity." Finally, the third sub-scale seemed to combine items that have the common elements of respecting human rights, respecting the person, and respecting the autonomy of the person. "Rights and freedom of choice" was chosen as a label for that sub-set. The IUSMM CEO immersed herself in the Projet citoyen and as her dialogue with the participants deepened around these features, a sense of mutual respect and friendliness got stronger. Participants were pleasantly surprised to see that an influential CEO can be sensitive and comfortable expressing this sensitivity, even with her emotions while interacting with service users as they are exercising their own citizenship as research colleagues., Conclusion: This case study illustrates a way of triangulating qualitative and quantitative data sets generated from a participatory-action research project for which people who use mental health services have been active research partners throughout. A mobilizing effect was found among participants of the Projet citoyen who become multipliers once back in their respective communities and neighborhoods. This effect can also affect a senior manager. The ISUMM CEO was inspired to relay and communicate this innovative thinking on the full exercise of citizenship as a governmental priority in mental health. It could thus be recommended to implement and network some Projets citoyens in other educational, research and clinical settings. This would provide opportunities for service users to contribute to the community - here, the scientific community. It would exemplify respect for personal and social integrity by channeling the expression of the lived experience into an instrument of change. These Projets citoyens would advocate for the rights and freedom of choice of service users as partners, in action, of a citizenship-oriented mental health system.

Objective: Implementation of routine Screening for Distress constitutes a major change in cancer care, with the aim of achieving person-centered care., Method: Using a cross-sectional descriptive design within a University Tertiary Care Hospital setting, 911 patients from all cancer sites were screened at the time of their first meeting with a nurse navigator who administered a paper questionnaire that included: the Distress Thermometer (DT), the Canadian Problem Checklist (CPC), and the Edmonton Symptom Assessment System (ESAS)., Results: Results showed a mean score of 3.9 on the DT. Fears/worries, coping with the disease, and sleep were the most common problems reported on the CPC. Tiredness was the most prevalent symptom on the ESAS. A final regression model that included anxiety, the total number of problems on the CPC, well-being, and tiredness accounted for almost 50% of the variance of distress. A cutoff score of 5 on the DT together with a cutoff of 5 on the ESAS items represents the best combination of specificity and sensitivity to orient patients on the basis of their reported distress., Significance of Results: These descriptive data will provide valuable feedback to answer practical questions for the purpose of effectively implementing and managing routine screening in cancer care.

Communities of practice (CoPs) are among the professional development strategies most widely used in such fields as management and education. Though the approach has elicited keen interest, knowledge pertaining to its conceptual underpinnings is still limited, thus hindering proper assessment of CoPs' effects and the processes generating the latter. To address this shortcoming, this paper presents a conceptual model that was developed to evaluate an initiative based on a CoP strategy: Health Promotion Laboratories are a professional development intervention that was implemented in local public health organizations in Montreal (Quebec, Canada). The model is based on latest theories on work-group effectiveness and organizational learning and can be usefully adopted by evaluators who are increasingly called upon to illuminate decision-making about CoPs. Ultimately, validation of this conceptual model will help advance knowledge and practice pertaining to CoPs as well as professional and organizational development strategies in public health., (Copyright © 2014 Longwoods Publishing.)

Purpose: The aim of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change., Design/methodology/approach: The authors conducted an in-depth longitudinal case study (2005-2008) of a healthcare organisation in the province of Quebec, Canada. Data collection consisted of real-time observations of senior managers (n = 87), interviews (n = 24) with decision-makers and secondary data analysis of documents., Findings: The paper reports on the extent to which entrepreneurial healthcare organisations can be a driving force in the creation of a new practice. The authors analyse the development of a diabetes reference centre by a healthcare organisation acting as an institutional entrepreneur that illustrates the conceptualisation of an innovation and the mobilisation of resources to implement it and to influence other actors in the field. The authors discuss the case in reference to three stages of change: emergence, implementation and diffusion. The results illustrate the different strategies used by managers to advance their proposed projects., Research Limitations/implications: This study helps to better understand the dynamics of mandated change in a mature field such as healthcare and the roles played by organisations in this process. By adopting a proactive strategy, a healthcare organisation can play an active role and strongly influence the evolution of its field., Originality/value: This paper is one of only a few to analyse strategies used by healthcare organisations in the context of mandated change.

Alternative successional trajectories (AST) may result in multiple climax states within an ecosystem when disturbances affect colonization history. In the boreal forest, ungulates have been proposed to drive AST because, under herbivore pressure, preferred species may go extinct and apparent competition may benefit browsing-resistant species. Over a 15-year period following logging, we tested whether deer herbivory altered plant species composition and whether the competitive advantage of resistant species was maintained following herbivore removal. We compared exclosures built immediately after logging with delayed exclosures built eight years later on Anticosti Island, Quebec, Canada. Although the palatable tree Betula papyrifera (paper birch) and some palatable herbs recovered in delayed exclosures, we observed legacies in both tree and herb cover. Woody regeneration in delayed exclosures was dominated by Picea glauca (white spruce), and Poaceae (grasses) were abundant in the field layer. Given that only early-successional species recovered, whereas late-successional broadleaf species and Abies balsamea (balsam fir) remained rare, succession may follow an AST after a limited browsing period during early succession.

Université de Montréal implemented an interprofessional education (IPE) curriculum on collaborative practice in a large cohort of students (>1,100) from 10 health sciences and psychosocial sciences training programs. It is made up of three one-credit undergraduate courses (CSS1900, CSS2900, CSS3900) spanning the first 3 years of training. The course content and activities aim for development of the six competency domains identified by the Canadian Interprofessional Health Collaborative. This paper describes the IPE curriculum and highlights the features contributing to its success and originality. Among main success key factors were: administrative cooperation among participating faculties, educators eager to develop innovative approaches, extensive use of clinical situations conducive to knowledge and skill application, strong logistic support, close cooperation with health care delivery organizations, and partnership between clinicians and patients. A distinguishing feature of this IPE curriculum is the concept of partnership in care between the patient and caregivers. Patients' representatives were involved in course planning, and patients were trained to become patients-as-trainers and cofacilitate interprofessional discussion workshops. They give feedback to students regarding integration and application of the patient partnership concept from a patient's point of view.

Understanding the main values and beliefs that might promote humanized birth practices in the specialized hospitals requires articulating the theoretical knowledge of the social and cultural characteristics of the childbirth field and the relations between these and the institution. This paper aims to provide a conceptual framework allowing examination of childbirth practices through the lens of an organizational culture theory. A literature review performed to extrapolate the social and cultural factors contribute to birth practices and the factors likely overlap and mutually reinforce one another, instead of complying with the organizational culture of the birth place. The proposed conceptual framework in this paper examined childbirth patterns as an organizational cultural phenomenon in a highly specialized hospital, in Montreal, Canada. Allaire and Firsirotu's organizational culture theory served as a guide in the development of the framework. We discussed the application of our conceptual model in understanding the influences of organizational culture components in the humanization of birth practices in the highly specialized hospitals and explained how these components configure both the birth practice and women's choice in highly specialized hospitals. The proposed framework can be used as a tool for understanding the barriers and facilitating factors encountered birth practices in specialized hospitals.

Although breastfeeding is beneficial to the health of babies born into poverty, rates have remained consistently low among this group. This paper presents findings from a study conducted with poor French Canadian women, who were exposed to breastfeeding promotion. Analysis of 31 qualitative interviews suggests that the 'good mother' imperative in context of poverty and the western hypersexualization of breasts acted as major deterrents to breastfeeding. Poor mothers, lacked access to the power required to negotiate these barriers in their social space. Public health should prioritize the transformation of social and public spaces when promoting breastfeeding to poor mothers., (© 2013 Elsevier Ltd. All rights reserved.)

Recent years have witnessed important public investments in physicians' compensation across Canada. The current paper uses data from Quebec to assess the impact of those investments on the volumes of services provided to the population. While total physician compensation costs, average physician compensation and average unit cost per service all rose extremely fast, the total number of services, number of services per capita and average number of services per physician either stagnated or declined. This pattern is compatible with the economic target income hypothesis and raises important policy questions., (Copyright © 2013 Longwoods Publishing.)

This paper attempts to go deeper into the topic of social competency of physicians who provide primary care to populations living in poverty in Montreal. Adaptability as well as the ability to tailor practices according to patient expectations, needs and capabilities were found to be important in the development of the concept of social competency. The case of paternalism is used to demonstrate how a historically and socially contested medical approach is readapted by players in certain contexts in order to better meet patient expectations. This paper presents data collected in a qualitative study comprising 25 semi-supervised interviews with physicians recognized by their peers as having developed exemplary practices in Montreal's impoverished neighbourhoods., (Copyright © 2013 Longwoods Publishing.)