Quebec Institutions Research Articles

Outlooks toward Government Institutions in Quebec

The 2012 Quebec election campaign began with opposition parties claiming that factors such as corruption and false promises (among others) had made Quebecers leery of their government institutions. The time had come to clean house and get the province back on track to good governance and prosperity. In this paper, we employ new data from the Quebec component of the Comparative Provincial Election Project to examine Quebecers’ outlooks toward various government institutions. How confident are Quebecers in their political parties, governments, legislatures and civil service? Is there any evidence to suggest that Quebecers’ views on these specific government institutions are any different across various levels of government? And what accounts for any negativity that Quebecers may feel? More specifically, this analysis considers a variety of plausible explanations, including poor government performance, pervasive cynicism, rising levels of cognitive mobilization, the rise of post-materialist values and declining levels of interpersonal trust, just to name a few.

A Canadian Lens on Facilitating Factors for North American Partnerships

What does it take to develop and maintain effective international education partnerships between institutions in the Canada, Mexico, and United States? This was a driving question for the qualitative study funded by a Fulbright-Enders-Garcia grant examining the relationship between North American partnerships and campus internationalization. Administrators, professors, and students at four institutions in Quebec, Canada and two institutions in Mexico shared institutional documents and their perspectives on North American partnerships and campus internationalization to help eluminate this relationship. This article features a Canadian lens on what factors contribute to effective partnership development with institutions in Mexico and the United States. The qualitative case study approach yields data on the facilitative institutional documents, administrative structures, and supporting mechanisms that exists within a given institution. Through probing interviews with diverse stakeholders, this approach also yields the human dimension—that is the factors that facilitate individual efforts to craft and maintain partnerships. The piece features primarily the internal workings at work on one side of the partnership equation—in this case within the Canadian institutions. Internationalization champions who are initiating new North American partnerships or seeking to maximize the effectiveness of existing international partnerships are the intended audience. It draws illustrations from the case studies to substantiate the argument that through the combination of visionary leadership, facilitative mechanisms, and competent internationalization leaders who are intentionally collaborating successful partner relationships are established and sustained. It is clearly critical in this global era for institutions to develop international partnerships that advance individual research agendas and student global learning. The issue at hand is how might leaders articulate their vision and organize their institutional structures so that these partnerships contribute as well as they might to advancing student global learning. Drawing elements of good practice from each case, this piece offers a structural model for maximizing partnership engagement.

Public Libraries Reading in Quebec: A History of Censorship Freedom

Quebec public libraries have had a complex and eventful history. It was only a half century ago, in 1960, that a public library policy was set up. Between 1760 and 1840, Quebec had a subscription library founded by English- speaking residents, and, after 1840, a parish library for the French-speaking residents. Under the control of the Catholic Church, the parish library was a major phenomenon in the history of public literacy in Quebec. Parish libraries and the public libraries belong to two different ideologies, two different world visions. They were polar opposites. At the beginning of the 1960s, the public library chased out the parish library. The modernization of institutions during what is called the ‘Quiet Revolution’ in the early 1960s radically changed, among other things, public reading policy. The public library has since affirmed its place and influence across the province of Quebec, both in cities and rural areas. Performance indicators for libraries, reinforced by the huge success of the Grande Bibliothèque in Montreal, clearly show that public libraries are now lively and dynamic institutions in Quebec.

La institucionalización de la evaluación del impacto en la salud en Quebec: ¿un modelo factible en España?

Objectives In Canada, the province of Quebec has institutionalized Health Impact Assessment (HIA) by including it in its Public Health Act (PHA). In Spain, the Ministry of Health, Social Policy and Equality is in the process of reforming its PHA, and plans to include HIA in this legislation. This study reviews the factors that have led to the effective implementation of HIA in Quebec and discusses the possible applications of the Quebec model in the Spanish context. Methods Information was gathered through interviews conducted in various public health institutions in Quebec. The Quebec model was compared to the Spanish situation, to identify potential needs associated with the practice of HIA in Spain. Results In Quebec, public health institutions have developed a strategy for effective implementation of HIA. This strategy is based on several measures: creation of a network of ministerial representatives, development of an internal procedure at the Ministry of Health and Social Services to respond to requests, preparation of methodological guidelines, establishment of a research program, strengthening of knowledge transfer mechanisms, and establishment of communication and participation tools. Conclusions HIA legislation does not guarantee its successful implementation. The institutionalization of HIA requires establishing a well-designed structure, as well as the allocation of adequate resources. The Quebec experience offers one model of HIA implementation that could be adapted to our country, taking into account elements of Spanish idiosyncrasies.

Modification of outcomes by lowering ischemic events after reconstruction of extracranial vessels (MOLIERE): An internet-based prospective study to evaluate and improve the effectiveness of carotid endarterectomy

Independent audits have been proposed to improve carotid endarterectomy (CEA) effectiveness. This study used the online registry Modification of Outcomes by Lowering Ischemic Events after Reconstruction of Extracranial Vessels (MOLIERE) to evaluate the effectiveness of CEA in the Province of Quebec. The concept of MOLIERE is that surgeon involvement in a prospective manner is a prerequisite for them to evaluate, compare, and improve their practice. All Quebec surgeons who performed CEA were invited to participate in this study sponsored by the Société des sciences vasculaires du Québec, the Canadian Society for Vascular Surgery and the Association des chirurgiens vasculaires du Québec. Surgeons prospectively entered data for 60 variables relevant to CEA in an online, secure, and confidential database between May 24, 2004, and May 31, 2005. Patient inclusion had to occur before surgery. After the study was completed, charts of all CEAs performed in each participating center were reviewed to validate the results of MOLIERE. For each participating institution, results of CEA that were not entered in the registry were also reviewed. A total of 279 patients (mean age, 69 years; range, 46-91 years) undergoing a CEA were enrolled in MOLIERE by 23 surgeons from 10 institutions in Quebec; 157 (56%) were symptomatic, and 122 (44%) were asymptomatic. Carotid endarterectomies were performed with patch angioplasty in 252 (89%), primary closure in 24 (9%), and by eversion in six (2%). Follow-up at 30 days was achieved for all patients. The 30-day stroke or death rates for symptomatic and asymptomatic patients were 3.2% (5 of 157, 95% confidence interval [CI], 1.2%-7.4%) and 0%. Validation was excellent for patients who were entered in the registry, with no additional deaths or strokes than those reported by the surgeons. The validation process revealed that participating surgeons entered 66% (279 of 424) of their patients in the registry. Indications and stroke or death rates (SDRs) for those patients who were not entered in the registry were not statistically different (symptomatic, 54% [79 of 145]; SDR of 1.3% [1 of 76] for symptomatic and 1.5% [1 of 66] for asymptomatic). In participating institutions, 11 surgeons did not participate. The SDRs for patients operated on by nonparticipating surgeons were higher but not statistically different than rates for patients operated on by participating surgeons (3.7% [5 of 136] vs 1.7% [7 of 424], P = .16). There was a trend toward higher stroke rate for patients operated on by nonparticipating surgeons (3.7% [5 of 136] vs 1.2% [5 of 424], P = .056). Mean postoperative length of stay was statistically higher for patients operated on by nonparticipating surgeons (4.7 vs 3.4 days, P = .046). The SDRs were adequate for all surgeons in participating centers, with 95% CI within accepted standards for symptomatic and asymptomatic patients. MOLIERE is the first Canadian online prospective registry allowing surgeons to audit CEA results. The SDRs for participating surgeons were valid and within standards. Scientific vascular societies played a key role in supporting this project. Such audits allow surgeons and medical stroke experts to examine the appropriateness and results of CEAs in their institutions to improve them. The future of MOLIERE is in validation of its concept, increased participation by surgeons, and integration of a multidisciplinary approach.

Clostridium difficile-associated diarrhoea rates and global antibiotic consumption in five Quebec institutions from 2001 to 2004

A massive outbreak of a new Clostridium difficile clone affected the province of Quebec between 2002 and 2004. There are several theories as to the exact cause of the emergence of this new clone, including the overuse of some classes of antibiotics. Antibiotic prescription is associated with C. difficile-associated diarrhoea (CDAD), but which class has the highest risk is still the subject of debate. We analysed the global antibiotic consumption patterns in five institutions in Quebec, three in the area affected by the 2002–2004 CDAD outbreak and two in non-affected areas. We showed that there is no correlation between the type and amount of antibiotics used at the institution level and the magnitude of the outbreak. Deficient infection control measures likely led to the rapid spread and dissemination of this newly characterised clone within some parts of Quebec.

Commentary on “Seven Institutionalized Children and Their Adaptation in Late Adulthood: The Children of Duplessis”: Les Enfants de Duplessis: Perspectives on Trauma and Resiliency

J.C. Perry and his colleagues have previously published reports of a systematic study of 81 adults (41 women and 40 men), a small sampling of the thousands of children reportedly raised in Quebec institutions from birth under the auspices of the Catholic Church. As adults, they had been contacted and interviewed using structured and semi-structured instruments to explicate the spectrum of traumatic exposures, attachments, childhood strengths, social and occupational functioning, psychiatric symptoms, and the pattern of defense mechanisms. These studies provided evidence that these individuals had been exposed to severe and continuing childhood trauma including excessive punishment, neglect, the witnessing of violence, and emotional, verbal, physical, and sexual abuse. They reportedly exhibited “moderate difficulties” in social and occupational functioning, higher levels of psychiatric symptomatology, self-reported illnesses, somatic symptoms, and neurotic inhibitions relative to controls. The authors selected seven of these adults for further analysis, and their personal case histories are provided to illustrate their life experiences. It’s not clear how they selected their seven, but they did so, and they provide the empirical data derived from the larger systematic study. Unfortunately, the personal data is sparse, and there is an absence of nuance and knowledge of the individual’s inner life and thus we are left to infer from superficial data. We are told that Justine and Leonard had few childhood strengths and little if any attachment figures. Justine as a young girl was without early attachment figures and had a damaged sense of self efficacy. She was told that she was “stupid” and “mentally retarded. She used her sensual–sexual feelings (warm urine, physical abuse, repeated sexual abuse by a janitor) as a way of experiencing some sense of relatedness, suggestive of a masochistic self-object phenomenon. Justine refers to the physical abuse as “it’s so stupid, being hit so much, I had no choice but to like it. She yearns for something beyond the self and imagines being killed by her son and living with her son, in heaven. We don’t know if the son is real or fantasy. Leonard also had few early attachments, and his personal narrative is presented as an individual experiencing profound social isolation, yearning for relatededness, but impoverished in his ability Psychiatry 69(4) Winter 2006 328

Seven Institutionalized Children and Their Adaptation in Late Adulthood: The Children of Duplessis (Les Enfants de Duplessis)

War, societal and familial upheaval, disease, and natural disasters have resulted in orphaned children throughout time. One societal response to providing care for orphans has been institutionalization or the orphanage. We studied a sample of adults, known as les enfants de Duplessis or Duplessis's children, who were raised in Quebec institutions from birth onward and followed up in late adulthood. Systematic study indicated a high prevalence of adverse outcomes and found high levels of gross psychological trauma and adversity which, moderated by the childhood strengths of the individuals, had adverse effects on adult outcome (Sigal, Perry, Rossignol, & Ouimet, 2003; Perry, Sigal, Boucher, Paré, & Ouimet, 2005a; Perry, Sigal, Boucher, Paré, Ouimet, Norman, & Henry, 2005b). This report describes the experiences of seven individuals in the institutions and their subsequent life history and current functioning. The individual cases reflect a wide range of childhood strengths and experiences of trauma and other adversity in relationship to adult caretakers. While the group overall appears to have had seriously diminished functioning in late adulthood, several individuals had positive outcomes. We hope that by highlighting the potentially adverse effects of institutional rearing on subsequent development into late adulthood, these stories may inform those concerned with the care of orphans.

Intensification of university–industry relationships and its impact on academic research

This paper analyses the intensification of university–industry relationships and its impact on university research. The paper consists of recent follow-up research to an international comparative research project conducted in the 1990s. It deals specifically with the Quebec (Canada) situation. Twenty-eight in-depth interviews were conducted in the winter of 2003 with university researchers and an additional five interviews with technology transfer officers. The interviews were conducted in six francophone higher education institutions in Quebec. With regard to university–industry relationships, the interviews revealed that university researchers in scientific and technological fields conducted innovation-oriented research, which benefits their graduate students and the institution itself. Freedom of publication is somewhat conditioned by intellectual property constraints. Thus, a majority of university researchers adopt an “entrepreneurial ethos” which they find compatible with their academic values. The intensification of university–industry relationships may also have latent dysfunctional effects with regard to conflicts of interest, as some university researchers have created start-up companies which act both as research funding sources and as beneficiaries of research results. Thus, intellectual property and conflict of interest issues evolve in a grey zone and are often sources of stress and tension for researchers. However harsh some disputes may become over these issues, they are resolved, at least in the context analysed in this research, in ways that satisfy both the researcher and the institutions.

C difficile—C’est Difficile?

C difficile—C’est Difficile?

Personal Strengths and Traumatic Experiences Among Institutionalized Children Given Up at Birth (Les Enfants de Duplessis???Duplessis??? Children)

We examined childhood and early adult strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions into early adulthood. A follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included retrospective assessments of childhood experiences. Most participants reported multiple early adverse experiences, including, in descending order, unfair rules and excessive punishment, physical abuse, emotional neglect, witnessing violence, verbal abuse, physical neglect, sexual abuse, and serious illness. Adverse experiences were mainly due to lay caretakers, not peers or nuns. Twelve childhood strengths, such as self-protectiveness and athletic talent, were scored at each of four age periods, yielding a median score equivalent to one strength at each period. Over half had significant childhood attachments, but of limited intimacy. Childhood variables correlated with their respective variables in later adulthood. Overall, these older adults reported a high prevalence of adverse or traumatic childhood experiences, counterbalanced by modest levels of individual strengths and attachment relationships. Institutionalization of children--if unavoidable--must build in effective safeguards against adverse experiences.

Personal Strengths and Traumatic Experiences Among Institutionalized Children Given Up at Birth (Les Enfants de Duplessis???Duplessis??? Children)

In a companion article, we retrospectively examined the childhood strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions. This article examines the relationship of their early experiences to functioning and symptoms in later adulthood. The same follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included assessments of their current symptoms and functioning. The mean adult Social and Occupational Functioning Score (57.8; 95% CI, 54.7-61.0) indicated moderate difficulty. Psychiatric symptoms were significantly higher than in a matched population survey sample from Quebec. Mean overall defensive functioning indicated a neurotic (inhibited) level. Total trauma and childhood strengths predicted adult outcomes, but childhood strengths moderated the effects of trauma. Institutionalization of children--if unavoidable--must build in effective safeguards against adverse experiences, especially among children with few strengths, and foster children's strengths to avoid impaired adult outcomes.

Extending Employment beyond Retirement Age: The Case of Health Care Managers in Quebec

Baby boomers in public agencies are getting ready to retire and there are concerns about retaining the existing workforce apart from recruiting younger managers. Recent studies of workplace patterns of older workers have shown that the workforce of older workers should no longer be seen as a unidirectional journey to retirement. Older workers may value bridge employment or even prefer to extend their working lives. The motives for deciding to leave the workplace permanently can be related to unmet expectations, the desire for change, and the need to enjoy a new phase of life. Based on a survey conducted on 402 older managers working in health care institutions in Quebec, this study sheds light on the new alternatives to traditional early retirement that organizations will have to take into account while considering the preferences and intentions of employees who are approaching retirement.

Le défi

This speech was given by the Prime Minister at the closing banquet of the Conference on the Reform of Federal Institutions in Quebec on March 30, 1984. He suggested that Reform is desirable because Canadian Federalism is capable of evolution and renewal. Canada needs institutions in which a national consensus on its fundamental options can be developed frankly and openly. The federal government's representativeness and its authority to speak and act in the name of all regions and of all Canadians must be strengthened. The proposed reform of the Upper House conducted by the Special joint Committee on Senate Reform indicates that provinces and regions should be represented adequately, not the provincial governments. These governments, because regional interests were not perceived to be adequately represented within the federal institutions, have had a tendency to present themselves as the only legitimate representatives of the regions. The idea of a second chamber elected directly by the people would enhance the independence and authority of senators in their role as regional representative. Mr. Trudeau indicates that the institutionalization of federal-provincial conferences ought to be looked at with the aim of harmonizing the policies of the two orders of government. This should establish coordination and effective management in areas of shared jurisdiction.

Les premières institutions municipales au Québec ou « machines à taxer »

The first general municipal institutions in Quebec were adopted by the Special Council in 1840 when Governor Sydenham found that the Act of Union did not make provision for them. These institutions included local corporations — parishes and townships — and regional corporations — the districts. Parishes and townships had very few powers. Districts had limited powers on local matters. All municipal corporations had little autonomy and were under the strict control of the Governor. Nevertheless, their creation was bound to lead to more important and more autonomous municipal institutions. French Canadians were opposed to these institutions, partly because they seemed to belong to the set of post-Rebellion measures such as the union of the two Canadas and the setting up of the Special Council, and partly because the new municipal corporations had the power to levy taxes. Their opposition succeeded in paralysing these institutions, which were replaced by new ones in 1845.

Improving the psychosocial work environment

This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit. Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers. The study participants were health care workers in a long-term care unit (n = 60). The participatory organizational intervention was based on a contract and carried out by a work team. Work constraints were identified, and an action plan implemented, The effectiveness of the intervention was evaluated by pre- and postintervention questionnaires: the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire and Psychiatric Symptom Index. There was a significant increase in reward (P < or = 0.01) and a significant decrease in Effort-Reward Imbalance (P < or = 0.01) following the intervention. Absenteeism rates decreased from 8.26% to 1.86% over the study period, but in the rest of the institution remained the same. However, there was a significant decrease in social support from supervisors (P < 0.05) at post-test. Participation by health care workers and action plans targeting problematic aspects of the psychosocial work environment are key elements in interventions to improve their health. However, such interventions present challenges, such as the involvement of managers, involvement of all relevant participants, and re-establishment of trust within work teams. Recognition and respect must be re-established, and supervisors must engage with health care workers and give support at all stages of the intervention.

Adecuación de las restricciones físicas y farmacológicas en los ancianos institucionalizados: estudio comparativo en Québec y la Suiza Romanda, con implicaciones en nuestro medio

Objective a) to examine intra- and inter-country variability in the use of physical restraints and psychotropic medication in institutionalised people older than 65 in Quebec and in Romande, Switzerland, and b) to study the applicability of the results to future studies in Spain. Material and method data were collected through PLAISIR, an information system on persons institutionalised in Quebec and French-speaking Switzerland used for financing and planning, resource allocation and management, utilisation control and quality assurance. Data were obtained from all new admissions to 179 institutions in Quebec (n =8183) and to 250 institutions in Switzerland (n =7592) in 1998. Physical restraints were classified into fixed and mobile. Daily and weekly uses of psychotropic medication were coded by defined daily doses. The prevalence of the use of physical restraints and psychotropic medication were estimated and an index of the appropriateness of the use of each was calculated by an indirect adjustment method. A logistic regression model on the use of both types of restriction based on residents’ health and functional status was calculated to estimate expected values of use. Results the rate of dependency was high in residents of both regions. Approximately 80% of residents in French Switzerland and 90% of those in Quebec were dependent for activities of daily living. Intra- and inter-country variability in the use of restrictions is high: psychotropic medication was more often used in French Switzerland (78%) than in Quebec (67%), while physical restraints were more often used in Quebec (76%) than in French Switzerland (40%). The appropriateness of use varied widely within both regions and cannot be fully explained by the characteristics of the residents. Conclusions the high variability in the use of physical restraints and psychotropic medication may be a result of the absence of standards of quality and/or legislation both in Quebec and in French Switzerland. This research illustrates a method that could be useful to investigate the prevalence and appropriateness of the use of these restriction methods in Spain.

A networked research program for aluminum production and transformation

In response to increasing needs and new opportunities, a provincewide network of Quebec institutions of higher learning, R&D agencies, and technology users has been set up to carry out research in aluminum production, fabrication, and transformation technologies, and to help channel the expertise and resources into large projects with more efficiency in terms of generating synergy and funding, cutting-edge research, qualified personnel training, and technology transfers. It is a unique experience in collaborative, multipartite, university-based R&D which, in addition to a comprehensive, far-reaching research program, emphasizes the various aspects of dispersed inter-institutional coordination, resource sharing, synergy creation, joint graduate training, diversification of funding, and intellectual property.

Policy Communities and Policy Divergence in Canada: Agro-Environmental Policy Development in Quebec and Ontario

AbstractDespite what would appear to be pressures for policy convergence in Canada due to growing continental integration and market competitiveness, agro-environmental policies in the provinces of Quebec and Ontario have become increasingly divergent over the past decade. Quebec's policies are comprehensive, coercive in approach and intrusive in the production process; those in Ontario, while comprehensive, rely more on industry self-regulation and shy away from intruding significantly into farming practices. Three institutional factors help explain this policy divergence. First, Quebec's main environmental act enabled the Ministry of the Environment to participate in the agro-environmental policy community's “subgovernment,” while the Ministry of the Environment in Ontario remained in the “attentive public.” Second, the agricultural policy network in Ontario took on many attributes of closed bipartite corporatism during the 1990s, thereby enhancing the power potential of Ontario's farmers. Third, path dependence related to policy feedback predisposed Ontario to self-regulatory approaches, but favoured strong statist policies in Quebec. The combination of these institutional differences creates distinct negotiation settings in the two provinces. Consequently, in Ontario, policy discussions tend to focus on wealth generation to the exclusion of distributive justice, while in contrast, Quebec's institutions focus more on distributive issues, perhaps at the expense of aggregate value creation.

Intravenous diazepam for psychiatric reactions following open-heart surgery.

The present study, based on a series of 79 consecutive unselected patients undergoing open-heart surgery with extracorporeal circulation at the Quebec Institute of Cardiology, was undertaken to determine the occurrence and severity of postoperative psychiatric complications, to discuss some of the factors involved in their pathogenesis, and to test the effectiveness of intravenous diazepam in their prevention and control. The 79 patients were divided into two groups: a control group of 37 subjects and a treatment group of 42 subjects. In the treatment group only, the usual postoperative analgesic medication was completed by intravenous doses of diazepam 2.5 to 5 mg. six times a day given between the doses of narcotics. Both groups were comparable as to the age, sex, height, weight, anaesthetic risk, degree of hypothermia, bypass time, duration of anaesthesia, and type of cardiac lesion. Our results are as follows: (a) The incidence of psychiatric complications was 35.1 per cent (13 cases) in the control group and 4.7 per cent (two cases) in the treatment group, (b) There were eight minor and five major reactions in the control group in comparison to two minor and no major disturbances in the treatment group, (c) Postoperative mechanical ventilatory support was carried out more frequently in the treatment group (92.0%) than in the control group (62.1%), yet the occurrence of psychiatric reactions was 5.1 per cent in the treatment group as compared to 56.5 per cent in the control group. It is concluded that the postoperative use of intravenous diazepam as an adjunct to the usual analgesic medication has markedly reduced the incidence and severity of psychiatric complications after intracardiac surgery with cardiopulmonary bypass. In the treatment group, the use of intravenous diazepam has resulted in better patient behaviour, and an improved patient-nurse and patient-doctor relationship. Because of the amnesic properties of this drug, the I.C.U. is no longer described as a “torture chamber” to prospective patients.