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Increasing emphasis is given on involving patients in health technology assessment (HTA). While this is mainly done at the level of regional and national HTA agencies, this tendency is also emerging in local HTA units. In this study, we provide the results of a survey conducted in local HTA units in the province of Quebec, Canada. The aim of the survey was to provide an overview of local HTA unit practices to involve patients, users, caregivers, and citizens in their process, their interest in doing so, and their information needs for this.
The survey was conducted in 2017 with a response rate of eleven units over a possibility of twelve.
Three units out of eleven (27.3 percent) never involved patients or members of the public in their processes and all indicated that they will involve them in the next few years. The three most important needs for support identified in the HTA units were in: recruiting and selecting patients; integrating experiential knowledge; and knowing and implementing the best methods and practices for partnership.
Patient involvement in local HTA units is quickly evolving and that is why they urgently need tools to involve more effectively patients and members of the public in their process.
The chapter identifies three rules of law which ground the general right to conscientious exemption in Canadian law. The primary source of this right is to be found in anti-discrimination statutes and the duty of reasonable accommodation that case law has read into them. This rule of law is the most extensive. It arises in each Canadian jurisdiction; it binds public and private persons; and it arises in a variety of contexts, including employment and provision of goods and services. The right to freedom of conscience and religion under the Canadian and Quebec Charters also gives rise to a general right to conscientious exemption which applies to public bodies but not to private persons. Depending on which exercise of public power is concerned (administrative action or law of general application) the legal analysis will differ. Administrative bodies’ refusal to grant an exemption cannot be unreasonable. Legislative measures cannot infringe that right disproportionately.
By taking a historical perspective on the higher education and the housing sectors in Quebec, we demonstrate how the political cleavage around the national question has had long-term effects on the dynamic of contention in these two sectors. At a general level, the presence of this cleavage has favoured the adoption of institutional arrangements related to funding that have allowed the reproduction of social protest over time. Nevertheless, the institutional arrangements vary from one sector to another: in the case of higher education, Bill 32, adopted in 1983, facilitated the division of the student movement into two branches and, to some extent, its dynamism; in the case of housing, the AccèsLogis program and the contribution au secteur, implemented in 1997, ensured the selection of claims for social housing and favoured the grouping that leads this issue. In both cases, the national question is at the heart of the process that led to the adoption of these policies.
In their much-quoted typology of Western media systems, Hallin and Mancini (2004) associate Canada's media system with what they call the “Liberal model,” given its strong professionalization and limited politicization. They also hypothesize the existence of a more professional and more politicized media subsystem in Quebec. This article tests their hypothesis with data from a 2018 survey of 209 experts across Canada. The findings do not support the hypothesis of a media subsystem in Quebec. However, they show a diversity of ideological and political orientations among news media organizations, which has important empirical and theoretical implications for the study of political communication in Canada.
One reform considered for increasing voter turnout rates is to lower the voting age to 16 years old. Advocates of such a reform argue that young people would vote for the first time while they are still in school and living with their parents, which would provide a social context that is supportive of their electoral participation. However, opponents argue that 16- and 17-year-olds are not mature enough to take part in elections. Using data from a 2018 Quebec election survey that included a subsample of individuals aged 16 and 17, this study provides mixed evidence for both arguments.
The story of Catholic Canada is not simply a binary of French and English. Rather, there were a number of groups, including significant populations of Scottish Catholics, in the Maritime provinces and Upper Canada (modern Ontario). This chapter takes as its starting point the regional nature of Canadian history and examines the development of distinctively (and distinct) Irish Catholic communities in the Maritime provinces and Upper Canada/Ontario.
The polls of the 2018 Quebec election forecast a close race between the two leading parties. The result, a clear victory of the Coalition Avenir Québec (CAQ) over the Parti libéral du Québec (PLQ), was clearly at odds with the polls. We argue that when the polls get it wrong, it is important to determine whether there was a polling miss, in which the discrepancy is due to changing voter behaviour, or a poll failure, in which the problem stems from polling methodology. Our post-election poll shows that changing voter behaviour—last-minute shifts and the vote of non-disclosers—explains most of the discrepancy. These movements varied by region. We conclude that the Quebec 2018 election was among the worst polling misses in history but not necessarily a major poll failure.
In 1975, the Bourassa government received legal advice that the James Bay Northern Quebec Agreement exceeded provincial jurisdiction. Legal counsel advised the constitutionality of the Agreement be secured through formal constitutional amendment. No such amendment was sought. Based on authorized access to Premier Bourassa’s archived dossier on the Agreement’s negotiation, this article sets out the following: 1) why the provincial government sought to encroach on federal jurisdiction; 2) the strategic means employed to insulate the Agreement from s. 91(24) litigation; and 3) provincial negotiators’ views on how judges would approach the Agreement going forward. This article confirms theoretical expectations about when governments might coordinate to transgress federalism’s division of powers: a high probability that courts would find a transgression occurred, and a high political cost should governments not coordinate on a transgression strategy.
How has English-speaking Canadian political science conceived of the relationship between Quebec and Canada? Why has an issue that has been considered central for more than three decades become less attractive, if not marginal, within the discipline? The aim is to examine, from this example, the overlapping relationship between science and politics. The intent is also to show that Canadian political science has examined the Quebec/Canada relationship from four different angles: 1) its interest in Quebec politics was part of the urgency of the moment, based on a crisis that challenged the foundations of the political system; 2) it questioned the legitimacy of the sources of the dispute, namely the compatibility between the new expressions of Quebec nationalism with the presumed principles on which the Canadian political community had been founded; 3) Quebec nationalism also encouraged a reflection on the existence (or not) of “English Canada” as a sociological and political reality; 4) the combination of the first three factors caused the prescriptions for getting out of, or resolving, the crisis to evolve over time, to the point of rendering research on this issue obsolete.
In this paper I critically review language policies aiming at the integration of immigrants into French minorities in Canada, and use recent survey data to trace the impact of these policies on adult Francophone immigrants’ integration experiences outside of Quebec. An analysis of the intersections between these language policies and the integration trajectories shows interesting, but also worrying trends which are discussed in this paper. While these policies arguably aim at the maintenance of linguistic status quo, both nationally and locally, through reinforcing the existing balance of power between English and French communities, and through leveling asymmetries in French minority settings, they simultaneously work at facilitating but also impeding immigrant integration; as such, they are at times embraced, and at others resisted on immigrants’ pathways.
Despite surface-level changes to the Heritage Languages Program in Ontario, heritage language instruction continues to exist at the margins of school life in Ontario. Public deliberations over this policy have led to intense, racialized conflict among stakeholders. At their most fundamental level, these conflicts have centred on who has – or should have – the power (or the “right”) to determine linguistic and cultural practices within publicly funded schools. To address this question, the chapter builds on my previous work sketching out a political-economy perspective on language policy analysis. Most salient is this theory’s insight that, while capitalism relies on human labour to create all profit and value, it has no internal system for reproducing that labour in the first place. I situate language socialization within this contradiction. When speakers of minoritized and/or racialized languages make demands for access to their languages in the public sphere (be it at work, at school, etc.) they directly challenge this separation between production and social reproduction. Understanding this contradiction moves us beyond searching for better metaphors for framing language policy, and towards concrete political strategies for undermining language-based oppression.
Spherulitic concretions are very rare among carbonate concretions that generally consist of micritic carbonate. The occurrence of spherulitic concretions in Cambro-Ordovician black shales of unknown stratigraphic age on a mid-channel island in the St Lawrence Estuary in Quebec is a new example in addition to only three hitherto reported occurrences of spherulitic carbonate concretions. Their origin is still poorly understood. These concretions occur in close association with, and show various transitions to, cone-in-cone structure. The spherules, measuring 0.5 to 12 mm in diameter, consist of intergrown fine fibres of ferroan calcite and quartzine, pointing to the formation of the concretions below the sulfate-reduction zone. A phenomenological theory of spherulitic crystallization relates the thickness δ of an impurity-rich layer in front of impurity-rejecting growing crystals to the impurity-diffusion coefficient D and the growth velocity G of the crystal by δ = D/G. In spherulite-forming environments, extremely small values of δ (in the order of <10−4 cm) in conjunction with cellulation lead to spherulitic fibre growth. The theory of spherulitic crystallization is here applied to sedimentary deposits for the first time. The intimate association of calcite and quartzine in the concretions requires a chemical change from alkaline to acidic conditions, which occurs below the carbonate-reduction zone owing to the dissolution of sponge spicules or radiolarians. The transition from spherulite to the silica-free cone-in-cone structure occurs when the silica reservoir that acted as an impurity is exhausted in the crystallization process.
A leader from Quebec boosts the fortunes of the Liberal party in that province. This, in turn, has helped make Quebec the veto player in twentieth-century Canadian elections and the Liberals the “natural” governing party. Although Quebec is no longer as critical as before, a leader from the province still makes a big difference. Full impact from the pattern requires more than one election to unfold. Patterns outside Quebec are similar, if fainter: the Liberal party is not punished for choosing a Quebecker and may even be helped. The early success of the pattern moved the Liberals to alternate between Quebec and non-Quebec leaders, such that the party is now led by a Quebecker more often than not. Maintaining alternation has never been easy and is only getting harder.
Proponents of restrictions on the wearing of religious symbols in public institutions in Quebec have often framed their support in the language of liberalism, with references to “gender equality”, “state neutrality” and “freedom of conscience”. However, efforts to account for support for restrictions on minority religious symbols rarely mention liberalism. In this article, we test the hypothesis that holding liberal values might have different attitudinal consequences in Quebec and the rest of Canada. Our findings demonstrate that holding liberal values is associated with support for restrictions on the wearing of minority religious symbols in Quebec, but it is associated with opposition to such restrictions in the rest of Canada. Moreover, this difference between Quebec and the rest of Canada in the relationship between liberal values and support for restrictions on minority religious symbols can explain Quebecers' greater support for restrictions.
Drawing on the literature on federalism and public policy, the present article explores the recent politics of two highly-similar and closely integrated Canadian public pension programs created in the mid-1960s: the Canada Pension Plan (CPP) and the Quebec Pension Plan (QPP). This article argues that the parallel evolution of CPP/QPP can be understood by examining how the unique jurisdictional arrangements for the CPP/QPP interacted with other factors to generate by these linked programs have led to the emergence of specific federalism policy dynamics, while muting or foreclosing other potential policy dynamics. As shown, governments have engaged in a process of ‘collusive benchmarking’ that has limited the scope of the available policy options. Differing demographic trends in Quebec and the ‘Rest of Canada’ have strained but also reinforced this policymaking dynamic in recent years. Simultaneously, intergovernmental race to the top dynamics have facilitated the recent push for both CPP and, later, QPP expansion.
This article investigates the extent to which provincial political parties made use of social media in their strategy, organization and communication in order to achieve their electoral goals during the Quebec 2012 general election. Using data from a series of 19 interviews conducted with online strategists and campaign directors from the five leading parties active in the 2012 election, we identify the strategic objectives these organizations followed when developing their social media campaigns. The strategists' narratives reveal that social media became a central component of electioneering and that parties were carrying out, in various forms, hybrid campaigns that combined traditional and emergent communication technologies and employed both old and new types of organizational principles.
Cet article présente une étude diachronique portant sur le changement de la norme de prononciation québécoise entre 1970 et 2008 sur la base d'un corpus de quatre heures et trente minutes de journaux télévisés de Radio-Canada, 52 à 58 minutes d'enregistrements ayant été prises en compte tous les dix ans durant cette période. L’étude compare la perspective sociolinguistique externe sur la norme (de prononciation) à la perspective interne de la phonétique sur cette même norme en se basant sur une analyse quantitative de deux traits de prononciation particulièrement saillants du français québécois : l'affrication de /t, d/ ainsi que la réalisation antériorisée de /ɑ̃/. Les résultats indiquent – du moins pour ces deux traits de prononciation – un changement significatif partant du standard de prononciation parisien et débouchant sur un standard québécois, les changements les plus frappants pouvant être observés entre les années 1970 et 1990.
Studies have investigated the potential protective effects that diet may have on late-life depression incidence. This disorder can, however, affect the person’s food intake, widely known as the reverse causality hypothesis of depression. To test this hypothesis, we compared mean nutrient intakes from three 24-h recalls during the year depression was detected (Geriatric Depression Scale ≥11 or antidepressant medication) with intakes from 1 year earlier among community-dwelling older adults (67–83 years) followed up annually in the 4-year Québec Longitudinal Study on Nutrition and Aging, who were free of depression and cognitive impairment at baseline. Participants (n 158, 64·4 % female) who became depressed and had data available for all follow-up years were matched by age group and sex with non-depressed participants. General linear mixed models were adjusted for percentage changes in physical activity, functional autonomy and stressful life events reported at the time of positive screening. A significant group effect for the dietary intake of all three B-vitamins was observed, as depression cases had consistently lower dietary intakes than controls (P<0·01). Over time, intakes of dietary vitamin B12 declined within depressed participants in bivariate analysis, but there was no time×group effect for any nutrient tested in the multivariate analyses. Intakes of energy, protein, saturated fat and total dietary fibre did not change in cases v. controls. Among community-dwelling older adults, declines in dietary vitamins B6, B12 and folate may precede depression incidence. To help preventative efforts by programmes and practitioners, longitudinal cohorts of longer duration should investigate the extent of the decline in dietary intakes relative to the time of depression.
Objectives: The aim of this study was to present the experience of a Canadian hospital-based health technology assessment (HTA) unit that performed the traditional functions of the HTA process along with many other activities to facilitate the choice of smart pumps.
Methods: A rapid literature review was initiated, but little evidence was found. Moreover, the evidence provided was too far from our hospital context. To help our decision makers, we offered them a list of various services based on the skills of our HTA unit staff.
Results: To involve our HTA unit in the choice of the new smart pumps led to a strong collaboration between hospital services. After a rapid review on smart pumps, we proceeded to establish the clinical needs, followed by an evaluation of technical features. To ascertain clinical needs, we participated in the establishment of a conformity list for the tender, a failure and mode-effect analysis, an audit on the use of actual smart pumps, and simulation exercises with nurses and doctors to evaluate the ease of use and ergonomics. With regard to technical tests, these were mainly conducted to identify potential dysfunction and to assess the efficiency of the pump. This experience with smart pumps was useful for evidence-based procurement and led to the formulation of a nine-step process to guide future work.
Conclusions: HTA units and agencies are faced with rapid development of new technologies that may not be supported by sufficient amount of pertinent published evidence. Under these circumstances, approaches other than evidence-based selection might provide useful information. Because these activities may be different from those related to classic HTA, this widens the scope of what can be done in HTA to support decision making.
Bigamy has been a crime against morality since the earliest days of New France. Of the 385 cases identified in our study of bigamy in Quebec (1763–1960), although priests were often called on to attest to the validity of a marriage or the morality of their parishioners, very few of them played the role of informer. Rather, they turned to the criminal courts only when they were unable to quell a scandal by their own methods. It is apparent that not only did the Catholic Church prefer to handle this offence against monogamous marriage by itself, but most importantly, given the small number of cases taken before the criminal courts, it continued to exercise its monopoly over the institution of matrimony during the first half of the twentieth century, even though the civil authorities sometimes flouted canon law. At the individual level, we would note that the institution of marriage remained fundamental throughout the period studied.