Quebec Program Research Articles

Impact of interventions to improve HPV vaccination acceptance and uptake in school-based programs: Findings of a pilot project in Quebec

ContextVaccination coverage against human papillomavirus (HPV) in school-based programs in Quebec, Canada, is suboptimal despite more than a decade of introduction. Three interventions to improve HPV vaccine acceptability and coverage in school-based programs were developed, implemented as part of a multicomponent strategy and evaluated. MethodSixty-four (64) schools were recruited, of which 32 received the interventions (pilot schools), and 32 received usual vaccination activities (control schools). Two approaches were used to assess the impact of the interventions. Pre-post questionnaires were completed by parents in both pilot and control schools. Quantitative analyses of vaccination coverage using the Quebec immunization registry were conducted. ResultsParticipating parents (n = 989 in the pre-intervention survey and n = 772 in the post-intervention one) were generally aware of HPV and HPV vaccination. Most parents were confident about vaccination, had little or no hesitation and had decided to have their child vaccinated. Parents in the pilot schools were less concerned about vaccine safety than those in the control schools after the interventions. Parents in the pilot schools were also more likely to have decided to have their child vaccinated. A statistically significant difference of 7.4 % in HPV vaccine coverage between pilot and control schools was observed (82.9 % vs 75.5 %, p <0.0001). ConclusionAlthough school-based programs offer equitable access to vaccination and minimize access barriers, it remains crucial to identify effective interventions to improve vaccine uptake further and reach the WHO cervical cancer elimination goal. Our multicomponent strategy appears to have positively impacted HPV vaccine acceptability and coverage and could be adapted to other contexts where vaccination is delivered in school-based programs.

School-based vaccination program against HPV and Hepatitis B: A longitudinal analysis of vaccine coverage between 2015 and 2021 in Quebec

BackgroundHPV vaccination prevents cancers, including 90% of cervical cancer. Since 2008, a school-based HPV vaccination program has been implemented in Quebec, but vaccine coverage is suboptimal. The COVID-19 pandemic disrupted school-based vaccination programs. This study aimed to assess variation in HPV vaccination coverage in the school-based program between 2015 and 2022 in Quebec and to identify sociodemographic characteristics associated with non-vaccination. MethodsHPV vaccine coverage data were extracted from the Quebec Immunization Registry for students in Grade 4 and matched to the 2016 Canadian census sociodemographic data. Descriptive analysis was conducted to explore individual-level vaccine coverage according to sociodemographic data. A Generalized Estimating Equations model assessed the independent association between non-vaccination and students’ sociodemographic characteristics. ResultsHPV vaccine coverage (at least one dose) was 84% in 2018–2019 and 85% in 2019–2020. A decrease was observed during the pandemic. In 2020–2021, the HPV vaccine coverage (at least one dose) was 52% (at the end of the school year) and rose to 84% with intense catch-up activities. In 2021–2022, the coverage was slightly lower than before the pandemic (81%). Factors in the dissemination area were statistically significantly associated with non-vaccination: material (p-value = 0.0001) and social deprivation index (p-value = 0.0048), the proportion of immigration (p-value < 0.0001), and the language spoken at home (English (p-value = 0.0318), other than French or English (p-value = 0.0001). ConclusionSchool-based vaccination programs offer equitable access to vaccination, and our analysis showed that some groups have consistently lower vaccine acceptance and uptake. Strategies to improve HPV vaccine coverage should target children living in areas with a higher proportion of immigrants, non-French speakers, and people from underprivileged backgrounds. Although it is too early to assess the full impact of COVID-19 on school-based programs in Quebec, it remains important to ensure that catch-up strategies are implemented for missed doses.

The annual costs of participation in the Sport-études programs in Quebec

In Canada, organized sports practice for youth is influenced by households’ socioeconomic status. However, few studies have examined the socioeconomic accessibility to competitive youth sport. The purpose of this study was to identify the annual costs of participation in the Sport-études programs in Quebec and to situate them with reference to disposable income and leisure spending of Quebec households. Employing a telephone survey, information was collected from 77% of the 580 available programs (N = 448). Programs costing between $2000 and $4999 represented 51.6% of all programs, and programs costing $5000 or more represented 38.9% of all programs. When examined with reference to household disposable income and leisure spending, the cost of participation in Sport-études programs likely exerts financial pressure on some households and renders the programs inaccessible for others.

Construction Cycle and Quality Controls for Training Transfer Evaluations in Livelong Learning Programs in Quebec and Switzerland

The Construction Cycle and Quality Controls for Training Transfer Evaluations (CCQCTTE) is an assessment method that results of collaboration between University of Quebec in Montreal (UQAM) Canada and the University of Teacher Education of State of Vaud (HEP Vaud) Switzerland. The main objective of CCQCTTE project is to design and field test a method for building high quality training transfer assessments (level 3 of Kirkpatrick’s model). In relation with this goal, we defined five sub-objectives: easy way of use; implementation of best practices; cyclical quality approach; taking into account of transfer factors; diagnostic feedbacks. CCQCTTE consists of eight steps: 1) analysis of the training objectives and of the factors influencing the transfer; 2) assessment design; 3) items writing; 4) information about the assessment; 5) collection of transfer data; 6) processing of results; 7) feedbacks and 8) macro-regulation. The end product of the first step is a table of specifications and a list of transfer factors. Once the evaluation plan is defined in step two, we can move on to step three of item development. During the fourth step, all the stakeholders are informed. During step five data collection takes place in the training environment and in the workplace. Data are processed to extract information during step six. The seventh step concerns elaboration and sending of personalized feedback to the trainees and the stakeholders. Finally, the eighth and final step is a “macro-regulation” that consists of learning from all the previous steps in order to improve future transfer assessments cycles. During the first-year, we made a preliminary field testing and the second-year, a series of main field tests of the CCQCTTE. During the third year, the method was implemented in Montreal and in Lausanne. The three years international CCQCTTE project has made it possible to develop the method during construction of several transfer assessments for lifelong training programs. We highlighted a real added value of step 8 that transforms the cycle in a kind of spiral of quality. In terms of limitation, we note that step 1 “Analysis” remains time-consuming and that it is difficult to start without the accompaniment of an experienced expert of the CCQCTTE. As part of this paper, we will describe the CCQCTTE method and its quality approach, the circumstances in which it was developed and field tests results.

Patient characteristics associated with enrolment under voluntary programs implemented within fee-for-service systems in British Columbia and Quebec: a cross-sectional study.

Background:There is a paucity of information on patient characteristics associated with enrolment under voluntary programs (e.g. incentive payments) implemented within fee-for-service systems. We explored patient characteristics associated with enrolment under these programs in British Columbia and Quebec.Methods:We used linked administrative data and a cross-sectional design to compare people aged 40 years or more enrolled under voluntary programs to those who were eligible but not enrolled. We examined 2 programs in Quebec (enrolment of vulnerable patients with qualifying conditions [implemented in 2003] and enrolment of the general population [2009]) and 3 in BC (Chronic disease incentive [2003], Complex care incentive [2007] and enrolment of the general population [A GP for Me, 2013]). We used logistic regression to estimate the odds of enrolment by neighbourhood income, rural versus urban residence, previous treatment for mental illness, previous treatment for substance use disorder and use of health care services before program implementation, controlling for characteristics linked to program eligibility.Results:In Quebec, we identified 1 569 010 people eligible for the vulnerable enrolment program (of whom 505 869 [32.2%] were enrolled within the first 2 yr of program implementation) and 2 394 923 for the general enrolment program (of whom 352 380 [14.7%] were enrolled within the first 2 yr). In BC, we identified 133 589 people eligible for the Chronic disease incentive, 47 619 for the Complex care incentive and 1 349 428 for A GP for Me; of these, 60 764 (45.5%), 28 273 (59.4%) and 1 066 714 (79.0%), respectively, were enrolled within the first 2 years. The odds of enrolment were higher in higher-income neighbourhoods for programs without enrolment criteria (adjusted odds ratio [OR] comparing highest to lowest quintiles 1.21 [95% confidence interval (CI) 1.20–1.23] in Quebec and 1.67 [95% CI 1.64–1.69] in BC) but were similar across neighbourhood income quintiles for programs with health-related eligibility criteria. The odds of enrolment by urban versus rural location varied by program. People treated for substance use disorders had lower odds of enrolment in all programs (adjusted OR 0.60–0.72). Compared to people eligible but not enrolled, those enrolled had similar or higher numbers of primary care visits and longitudinal continuity of care in the year before enrolment.Interpretation:People living in lower-income neighbourhoods and those treated for substance use disorders were less likely than people in higher-income neighbourhoods and those not treated for such disorders to be enrolled in programs without health-related eligibility criteria. Other strategies are needed to promote equitable access to primary care.

Self-Efficacy of Physical and Health Education Student Teachers in the Quebec Context

Abstract Pre-service training is a critical period for establishing the beliefs of future teachers in their ability to successfully assume their responsibilities as teachers. One of the goals of teacher education programs would therefore be to cultivate a high sense of competence among students. For this purpose, a scale to measure the perception of self-efficacy (PSE) among Quebec physical and health education trainees during teaching has been developed and empirically validated. Teacher trainees (n = 232) enrolled in 3rd and 4th year in the Bachelor of Education in Physical and Health Education (PHE) in four different university programs in Quebec participated in the study. Subsequent exploratory and quasi-confirmatory factor analyses led to the development of an instrument with 19 items divided into three factors, explaining 66.10 % of the total variance. The convergent and divergent measures of validity are satisfactory, as are those of the reliability of the three scales (upper lower limit: .78 to .93). Finally, the RMSR, CFI, RMSEA and NNFI indices show an excellent goodness of fit of the model obtained.

ANTI-RACIST EDUCATION IN SOCIAL WORK: AN EXPLORATION OF REQUIRED UNDERGRADUATE SOCIAL WORK COURSES IN QUEBEC

Social workers play a vital role in helping service users navigate structural barriers and oppressions. Anti-racist social work education trains future social workers to apply critical thinking to the ways in which societal practices of racist exclusion and domination threaten the integrity of racialized individuals and communities. However, inclusion of anti-racist curricula in Schools of Social Work (SSWs) is largely dependent on each individual institution and their course offerings. This study explored the extent to which anti-racist practice is included across social work programs in Quebec through conducting a review of required undergraduate courses. Our results reveal that, among the nine universities that offer Bachelor of Social Work programs across Quebec, only one SSW offered a course that explicitly addressed race. Five out of the nine SSWs include a mandatory course with implicit mention of race under broader terms such as “anti-oppression,” “inequality,” or “intercultural practice.” These findings raise important considerations for social work education in Quebec and the development of anti-racist practitioners across the profession.

Co-Design to Support the Development of Inclusive eHealth Tools for Caregivers of Functionally Dependent Older Persons: Social Justice Design.

BackgroundeHealth can help reduce social health inequalities (SHIs) as much as it can exacerbate them. Taking a co-design approach to the development of eHealth tools has the potential to ensure that these tools are inclusive. Although the importance of involving future users in the development of eHealth tools to reduce SHIs is highlighted in the scientific literature, the challenges associated with their participation question the benefits of this involvement as co-designers in a real-world context.ObjectiveOn the basis of Amartya Sen’s theoretical framework of social justice, the aim of this study is to explore how co-design can support the development of an inclusive eHealth tool for caregivers of functionally dependent older persons.MethodsThis study is based on a social justice design and participant observation as part of a large-scale research project funded by the Ministry of Families as part of the Age-Friendly Quebec Program (Québec Ami des Aînés). The analysis was based on the method developed by Miles and Huberman and on Paillé’s analytical questioning method.ResultsA total of 78 people participated in 11 co-design sessions in 11 Quebec regions. A total of 24 preparatory meetings and 11 debriefing sessions were required to complete this process. Co-designers participated in the creation of a prototype to support the search for formal services for caregivers. The majority of participants (except for 2) significantly contributed to the tool’s designing. They also incorporated conversion factors to ensure the inclusiveness of the eHealth tool, such as an adequate level of digital literacy and respect for the caregiver’s help-seeking process. In the course of the experiment, the research team’s position regarding its role in co-design evolved from a neutral posture and promoting co-designer participation to one that was more pragmatic.ConclusionsThe use of co-design involving participants at risk of SHIs does not guarantee innovation, but it does guarantee that the tool developed will comply with their process of help-seeking and their literacy level. Time issues interfere with efforts to carry out a democratic process in its ideal form. It would be useful to single out some key issues to guide researchers on what should be addressed in co-design discussions and what can be left out to make optimal use of this approach in a real-world context.

Introducing cell-free DNA noninvasive testing in a Down syndrome public health screening program: a budget impact analysis

BackgroundNon-invasive prenatal testing (NIPT) using cell-free fetal DNA in maternal plasma is a high accurate test for prenatal screening for Down syndrome. Although it has been reported to be cost effective as a contingent test, evidence about its budget impact is lacking.ObjectiveTo evaluate, using computer simulations, the budget impact of implementing NIPT as a contingent test in the Quebec Program of screening for Trisomy 21.MethodsA semi-Markov analytic model built to simulate the budget impact of implementing NIPT into the current Quebec Trisomy 21 public Prenatal Screening, Serum Integrated prenatal screening (SIPS). Comparisons were made for a virtual population similar to that of expected Quebec pregnant women in 2015 in terms of size and age. Data input parameters were retrieved from a thorough literature search and in government databases, especially data from Quebec Program of screening for Trisomy 21. The 2015–2016 fiscal year budget impact was estimated from the Quebec healthcare system perspective and was expressed as the difference in the overall costs between the two alternatives (SIPS minus SPS + NIPT).ResultsOur study found that, at a baseline cost for NIPT of CAD$ 795, NIPT as a second-tier test offered to high-risk women identified by current screening program (SIPS + NIPT) may be affordable for Quebec health care system. Compared to the current screening program, it would be implemented at a neutral cost, considering a modest annual savings of $ 80,432 (95% CI $ 79, $ 874–$ 81,462). Results were sensitive to the NIPT costs and the uptake-rate of invasive diagnostic tests.ConclusionIntroducing NIPT as a contingent test in the Quebec Trisomy 21 screening program is an affordable strategy compared to the current practice. Further research is needed to confirm if our results can be reproduced in other healthcare jurisdictions.

INTRODUCTION TO SPECIAL ISSUE

This special issue aims to explore Canadian pedagogical and curricular practices in child and youth care and youth work preservice education with an emphasis on empirical and applied studies that centre students’ perspectives of learning. The issue includes a theoretical reflection and empirical studies with students, educators, and practitioners from a range of postsecondary programs in Quebec, Ontario, Alberta, and British Columbia. The empirical articles use various methodologies to explore pedagogical and curricular approaches, including Indigenous land- and water-based pedagogies, ethical settler frontline and teaching practices, the pedagogy of the lightning talk, novel-based pedagogy, situated learning, suicide prevention education, and simulation-based teaching. These advance our understanding of accountability and commitment to Indigenous, decolonial, critical, experiential, and participatory praxis in child and youth care postsecondary education. In expanding the state of knowledge about teaching and learning in child and youth care, we also aspire to validate interdisciplinary ways of learning and knowing, and to spark interest in future research that recognizes the need for education to be ethical, critically engaged, creatively experiential, and deeply culturally and environmentally relevant.

Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada.

This commentary explores public health (PH) investments in Quebec and underlines the challenge of tracking PH resources across Canada. We analyzed governmental data to compare investments across all health and social programs in Quebec from 2004–2005 to 2017–2018. The province’s PH budgets suffered from disproportionately low investments and abrupt cuts. These cuts were the largest among all health programs in 2015–2016 (− 7.1%). PH budgets did not keep up with inflation and, in constant dollars, have declined over the last decade. Furthermore, their evolution over the span of 14 years significantly differed from other health programs. On average, programs providing direct services experienced overall budget increases of 81%, whereas PH budgets had the lowest increase of all such programs at only 46%. PH suffers from serious erosion of its capacity. Unfortunately, there is a dire lack of comparable data for provincial, national, and international PH budgets, which further complicates the monitoring of PH erosion. We contend that systematic tracking of PH budgets remains profoundly inadequate across Canada. We recommend (1) regular, comprehensive, and publicly reported analyses of PH budgets; (2) in-depth comparisons of PH investments across Canadian jurisdictions; and (3) a strong PH systems and services research agenda for Canada.

"La Survivance" Discourses and the Curriculum in French-Speaking Communities in North America, 1840-1960

A comparative study of the cultural resistancecurriculum artfully integrated in the English Program of Studies bypatriotic teachers who taught in Franco-American and Canadianbilingual schools before 1960 disclosed that the French curriculumwas based on the Quebec Program of Studies. As a result, lasurvivance discourses concealed in the French textbooks werefounded on a defensive form of nationalism which blended languageand faith. This paper provides examples illustrating the kinds ofla survivance discourses selected by textbook writers to incite youngFrancophones to continue their ancestors' battles to protect anddefend their linguistic, religious, and educational rights. Forinstance, discourses referring to French Canadians as victims ofEnglish Protestant fanatics, as champions of Christian democraticliberties, and as progressive people.

Two Birds With One Stone: Estimating Population Vaccination Coverage From a Test-negative Vaccine Effectiveness Case-control Study.

Vaccination program evaluation includes assessment of vaccine uptake and direct vaccine effectiveness (VE). Often examined separately, we propose a design to estimate rotavirus vaccination coverage using controls from a rotavirus VE test-negative case-control study and to examine coverage following implementation of the Quebec, Canada, rotavirus vaccination program. We present our assumptions for using these data as a proxy for coverage in the general population, explore effects of diagnostic accuracy on coverage estimates via simulations, and validate estimates with an external source. We found 79.0% (95% confidence interval, 74.3%, 83.0%) ≥2-dose rotavirus coverage among participants eligible for publicly funded vaccination. No differences were detected between study and external coverage estimates. Simulations revealed minimal bias in estimates with high diagnostic sensitivity and specificity. We conclude that controls from a VE case-control study may be a valuable resource of coverage information when reasonable assumptions can be made for estimate generalizability; high rotavirus coverage demonstrates success of the Quebec program.

The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting.

BackgroundSeven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation.MethodsThe knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis.Results and discussionStrengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event.ConclusionThe results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1514-0) contains supplementary material, which is available to authorized users.

Assessment of percutaneous renal access skills during Urology Objective Structured Clinical Examinations (OSCE).

The first objective was to assess percutaneous renal access (PCA) skills of urology postgraduate trainees (PGTs) during the Objective Structured Clinical Examinations (OSCEs). The second objective was to determine whether previous experience with percutaneous nephrolithotomy (PCNL) improved performance. After obtaining ethics approval, we recruited PGTs from two urology programs in Quebec between postgraduate years (PGY-3 to PGY-5). Each trainee was asked to answer a short questionnaire regarding previous experience in endourologic procedures. After a 3-minute orientation on the PERC Mentor simulator (Simbionix, Cleveland, OH), each trainee was asked to perform task 4, where they had to correctly access all of the renal calyces and pop the balloons in a normal left kidney model. We collected and analyzed data from the questionnaire and the performance report generated by the simulator. In total, 13 PGTs participated in this study. PGTs had performed a median of 200 (range: 50-1000) cystoscopies, 50 (range: 10-125) TURBTs, 30 (range: 0-100) TURPs, 5 (range: 0-50) laser prostatectomies, and 50 (range: 2-125) ureteroscopies prior to this OSCE. PGTs with previous PCNL experience (8/13) had performed a mean of 18.6 ± 6.3 PCNLs. PGTs with previous PCNL experience performed significantly better in terms of shorter fluoroscopy time (10 ± 1.5 vs. 5.1 ± 0.7 min; p = 0.04), fewer attempts required for successful puncture of the pelvi-calyceal system (PCS) (21 ± 2.3 vs. 13 ± 1.8; p = 0.02), and had significantly lower complications in terms of fewer infundibular injury (7.4 ± 1.5 vs. 2 ± 0.4; p = 0.004) and fewer PCS perforations (11 ± 1.7 vs. 4.5 ± 1.2; p = 0.01). It is feasible to use the PERC Mentor simulator during OSCEs to assess PCA skills of urology PGTs. PGTs who had previous PCNL experience performed significantly better with fewer complications.

Learning in Health Care Organizations and Systems

This article presents, through the example of health care systems, a theoretically founded analysis of learning processes in the context of reform implementation. Following a critical assessment of the two most prominent approaches to knowledge management—mechanistic and organic—we propose another approach, which consists in coordinating the learning of interdependent actors. The potential of this approach is illustrated through an empirical case study of the implementation of a Quebec program to combat cancer.

Challenge for Change: Activist Documentary at the National Board of Canada (review)

Reviewed by: Challenge for Change: Activist Documentary at the National Board of Canada Malek Khouri (bio) Thomas Waugh, Michael Brendan Baker, and Ezra Winton, editors. Challenge for Change: Activist Documentary at the National Board of Canada. McGill-Queen’s University Press. xxiv, 574. $105.00, $34.95 The work of the ‘program/institution’ Challenge for Change/Societe nouvelle (CFC/SN), initiated in 1967 by the National Film Board of Canada (NFB), is the subject of this critical and first-rate collection of original and reprinted articles by an interdisciplinary group of twenty-six journalists, writers, film-makers, film scholars, and historians. The collection is edited by Thom Waugh, a leading Canadian scholar of alternative and activist cinemas, along with two young scholars of political documentary and the NFB, Michael Brendan Baker and Ezra Winton. [End Page 762] The (CFC/SN) program ran until 1980 and gained an international reputation for its originality and influence. Over 200 documentary films were made during this period (sixty of them for the Quebec program Societe nouvelle), ranging in scope from issues of marginalization and poverty to classism, racism, and sexism, among others. Films of this unique program were mostly conscious of their activist function and nature, and many of the film-makers were largely cognizant of their role as ‘organic intellectuals’ and activists. As such, luminary Canadian film-makers such as Colin Low, Peter Pearson, Bonnie Klein (her daughter writer/activist Naomi Klein writes the book’s foreword), George Stoney, Anne Claire Poirier, and Maurice Bulbulian, along with many others, were well positioned to fashion a new and re-energized kind of documentary cinema, a cinema that is equally attentive to learning from its subjects as much as learning about them. In the end, many of the CFC/SN films assumed an empowering function in the struggles and dreams of their subjects. Equally important, the program represented a watershed moment in Canadian film-making history, which witnessed the incorporation of new portable video techniques with those of well-established 16mm and even 8mm cinema. Just as digital film-making and new media technology today have complemented various forms of social, political, and environmental forms of activism, Challenge for Change similarly benefited from increased interest in less obtrusive film-making technology of the 1960s and 1970s to get itself closer to its subject, itself in the middle of exploding social and political struggles of the day. Despite the huge body of work that was produced under the Challenge for Change banner and the pioneering status and defining impact of this program on the history of social change oriented media, the wide-casting volume at hand is in fact the first and most comprehensive historical and analytical collection to be published dealing with this critically acclaimed NFB project. Equally important, the book effectively and uniquely challenges us to revisit the CFA/SN project and experience with an eye at present-day resourcefulness, on the level of the changing dynamics of social and political activism as well as on the level of the utility of new and more demographically accessible technical ingenuity. The CFA/SN films enriched and impacted the discourse on social and political change in Canada and around the world, and the scholarship of the three editors is certainly reflected in the rich, well-balanced, and nuanced structure of the book. Challenge for Change incorporates five interactive parts each with a distinct task: one part emphasizes thematic and conceptual goals of the program as published in the program’s own publicity material and literature; other parts focus on films that directly engage political activism; specific film-makers and films; and theoretical appraisals of the CFA/SN project and its significance. The [End Page 763] final part presents an interview with Katerina Cizek and an article by Vijaya Mulay, two luminary women film activists. The book refocuses much-needed attention on the NFB and its programs and their fate today. It comes at a time when this institution is under greater than ever financial and political pressure wielded by a conservative economic elite bent on marginalizing alternative discourse. The end result is an essential chronicle of one of the most pioneering moments in film history. Malek...

Abstract P123: The Introduction of Prehospital ECGs into a Provincial System of STEMI Care: Impact on Treatment Delays and the Process of Care

Background: Timely reperfusion therapy is associated with improved clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). To improve treatment delays in Quebec (Canada), the Health Ministry set a goal of implanting prehospital ECG programs in all healthcare regions by the end of 2010. Objective: To investigate treatment delays and processes of care associated with the introduction of prehospital ECG programs in Quebec. Methods: All acute care Quebec hospitals that treated at least 30 acute myocardial infarctions (AMI) (n=82) participated in a systematic 6-month evaluation in 2008-9. Charts, prehospital ECGs and first in-hospital ECGs of all patients with a final diagnosis of AMI who presented to an emergency room with appropriate symptoms were reviewed to identify STEMI. Results: Of 1878 patients with STEMI who either received fibrinolysis or were sent for primary angioplasty (PPCI), 1118 (60%) came by ambulance. Of ambulance patients, 148 (13%) had a prehospital ECG. For 68% of these patients, there was an alert from the ambulance to the first emergency room. The prehospital ECG was transmitted to the first emergency room for 52% (77/148) of patients but a second in-hospital ECG was performed for 95% (141/148) of patients. The majority (61%) of patients with prehospital ECGs were brought directly to a PPCI center. However, almost 25% were brought to a non-PPCI center and then transferred to a PPCI center. In-hospital treatment delays were shorter in prehospital ECG patients without a substantial increase in the prehospital delay. However, even with a prehospital ECG, transferred patients experienced long delays to treatment. Conclusion: These findings suggest that the potential for improving times to treatment by implanting ECG programme depends on modifying the continuum of STEMI care. Specifically, the avoidance of unnecessary and time-consuming inter-hospital transfers should be the primary goal of a prehospital ECG program. Prehospital and in-hospital treatment delays in STEMI patients who presented by ambulance Type of reperfusion treatment Prehospital Delay First medical contact to triage Median (10-90 percentile) In-hospital Delay Triage to treatment Median (10-90 percentile) With prehospital ECG Without prehospital ECG With prehospital ECG Without prehospital ECG Fibrinolysis n=195 38 min (20-56) 28 min (18-50) 19 min (14-55) 29 min (13-73) Direct admission PPCI n=417 30 min (21-51) 29 min (19-45) 57 min (32-95) 78 min (43-170) PPCI with transfer n=506 28 min (17-48) 27 min (18-47) 97 min (69-172) 109 min (75-207)

Obstacles à l’implantation d’un programme de boire contrôlé dans le contexte organisationnel des services en dépendance

Abstract: Implementation is a primary step in disseminating innovation because, without successful implementation, even the most effective program cannot show results. Many barriers were reported in the implementation evaluation of Alcochoix+, a Quebec program for managing alcohol consumption intended for non-dependent excessive drinkers. In addition to barriers already identified in the literature, such as lack of advertising, staff turnover, and financial resource problems, the results of this study point out a more specific barrier: a lack of understanding of the program’s underlying approach. Moreover, the relative importance attributed to the barriers seems to change over time. These results illustrate the importance of conducting implementation studies for new programs.

Déterminants psychosociaux d’utilisateurs de drogues d’utiliser une seringue neuve

Background A limited number of injection drug users are hard to reach through needle-exchange programs. They obtain their injection material from drug-using peers. This dependence on others can make them more at risk of contracting HIV through sharing non-sterile syringes. The aim of this study is to identify determinants of the intention to systematically resort to use of a new syringe by injection drug users rarely or never involved in needle-exchange programs in Quebec. Methods A cross-sectional survey was conducted in Québec city by means of a questionnaire measuring variables from the theory of planned behavior and past behavior. Participants ( n = 97) were recruited by acquaintances who kept regular contacts with the local needle-exchange programs. Multiple linear regression was used to identify the psychosocial determinants of the intention, and beliefs underlying those determinants were identified using multiple logistic regression. Results Half of participants reported using a new syringe for each injection in the last month. In multivariate analyses, this past behavior together with theory of planned behavior constructs explained 70% of the variation in participants intent to use a new syringe for each injection (control beliefs: β = 0.39; past behavior: β = 0.27; attitude: β = 0.21; perceived behavioral control: β = 0.20; subjective norm: β = 0.12). In logistic regression, six important beliefs were identified. Conclusion This study resulted in the development of a predictive model of intention to use always a new syringe for each injection among a population of injection drug users in Quebec. Study results could serve as the foundation for the development of interventions to promote this behavior.