L'impact des mécanismes de fédéralisme exécutif sur le déficit fédératif canadien

Le Canada accuse un déficit fédératif en ce sens où il existe des écarts importants entre le fonctionnement de la fédération canadienne et les caractéristiques du système fédéral élaborées par les spécialistes du fédéralisme. Les deux ordres de gouvernement, censés être coordonnés et indépendants, sont, au Canada, hiérarchisés, laissant au gouvernement central un pouvoir nettement supérieur à celui des États provinciaux. Celles-ci, qui devraient avoir une autonomie financière et les ressources suffisantes pour gérer adéquatement leurs sphères de compétence, se retrouvent souvent à la remorque du gouvernement fédéral pour obtenir des transferts de paiement et instaurer des plans d'action. Les institutions politiques fédérales laissent très peu de place à la participation des États provinciaux dans la prise de décision centrale. De plus, les minorités nationales sont souvent exclues ou sous-représentées lors des débats politiques. Comme mécanismes de relations intergouvernementales, les Conférences des premiers ministres et le Conseil de la fédération pourraient jouer un rôle déterminant dans l'atténuation du déficit fédératif canadien. Pourtant, peu institutionnalisées, mal utilisées et surtout mal conçues, ces instances ne font que reproduire les lacunes de la fédération canadienne. Après avoir établi ce qu'est le principe fédéral et en avoir extrait les principaux éléments, et après avoir étudié le fonctionnement des Conférences des premiers ministres et du Conseil de la fédération, ce mémoire traite de l'impact qu'ont ces derniers sur le déficit fédératif canadien, c'est-à-dire sur les lacunes existant dans la fédération canadienne lorsqu'elle est mise en relation avec les théories du fédéralisme.\ud _____________________________________________________________________________

Providing internet-based audiological counselling to new hearing aid users

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

A qualitative investigation of decision making during help-seeking for adult hearing loss

Objective: The Any Qualified Provider framework in the National Health Service has changed the way adult audiology services are offered in England. Under the new rules, patients are being offered a choice in geographical location and audiology provider. This study aimed to explore how choices in treatment are presented and to identify what information patients need when they are seeking help with hearing loss. Design: This study adopted qualitative methods of ethnographic observations and focus group interviews to identify information needed prior to, and during, help-seeking. Observational data and focus group data were analysed using the constant comparison method of grounded theory. Study sample: Participants were recruited from a community Health and Social Care Trust in the west of England. This service incorporates both an Audiology and a Hearing Therapy service. Twenty seven participants were involved in focus groups or interviews. Results: Participants receive little information beyond the detail of hearing aids. Participants report little information that was not directly related to uptake of hearing aids. Conclusions: Participant preferences were not explored and limited information resulted in decisions that were clinician-led. The gaps in information reflect previous data on clinician communication and highlight the need for consistent information on a range of interventions to manage hearing loss

Associations Between Hearing Performance and Physiological Measures - An Overview and Outlook

The current paper summarises the research investigating associations between physiological data and hearing performance. An overview of state-of-the-art research and literature is given as well as promising directions for associations between physiological data and data regarding hearing loss and hearing performance. The physiological parameters included in this paper are: electrodermal activity, heart rate variability, blood pressure, blood oxygenation and respiratory rate. Furthermore, the environmental and behavioural measurements of physical activity and body mass index, alcohol consumption and smoking have been included. So far, only electrodermal activity and heart rate variability are physiological signals simultaneously associated with hearing loss or hearing performance. Initial findings suggest blood pressure and respiratory rate to be the most promising physiological measures that relate to hearing loss and hearing performance

Clinical validation of a public health policy-making platform for hearing loss (EVOTION): protocol for a big data study

INTRODUCTION: The holistic management of hearing loss (HL) requires an understanding of factors that predict hearing aid (HA) use and benefit beyond the acoustics of listening environments. Although several predictors have been identified, no study has explored the role of audiological, cognitive, behavioural and physiological data nor has any study collected real-time HA data. This study will collect ‘big data’, including retrospective HA logging data, prospective clinical data and real-time data via smart HAs, a mobile application and biosensors. The main objective is to enable the validation of the EVOTION platform as a public health policy-making tool for HL. METHODS AND ANALYSIS: This will be a big data international multicentre study consisting of retrospective and prospective data collection. Existing data from approximately 35 000 HA users will be extracted from clinical repositories in the UK and Denmark. For the prospective data collection, 1260 HA candidates will be recruited across four clinics in the UK and Greece. Participants will complete a battery of audiological and other assessments (measures of patient-reported HA benefit, mood, cognition, quality of life). Patients will be offered smart HAs and a mobile phone application and a subset will also be given wearable biosensors, to enable the collection of dynamic real-life HA usage data. Big data analytics will be used to detect correlations between contextualised HA usage and effectiveness, and different factors and comorbidities affecting HL, with a view to informing public health decision-making. ETHICS AND DISSEMINATION: Ethical approval was received from the London South East Research Ethics Committee (17/LO/0789), the Hippokrateion Hospital Ethics Committee (1847) and the Athens Medical Center’s Ethics Committee (KM140670). Results will be disseminated through national and international events in Greece and the UK, scientific journals, newsletters, magazines and social media. Target audiences include HA users, clinicians, policy-makers and the general public. TRIAL REGISTRATION NUMBER: NCT03316287; Pre-results

Assistive technology needs, access and coverage, and related barriers and facilitators in the WHO European region: a scoping review

Purpose: Globally, assistive technology (AT) is used by over 1 billion people, but the prevalence of needs and access to AT in specific countries or regions is largely unknown. This scoping review summarises the evidence available on the prevalence of needs, access and coverage of AT in the World Health Organisation European Region and the barriers and facilitators to its use. Methods: Relevant publications were identified using a combination of two strategies: 1) a systematic search for AT publications in five scientific literature databases; and 2) consultations with 76 of the Region's AT experts. Result: The search strategies yielded 103 publications, 62 of them identified by the systematic search. The included publications were predominantly from six countries, and 18 countries were unrepresented. Information on AT use for specific functional impairments was present in 57 publications: AT for hearing impairment in 14 publications; vision in 12; mobility, 12; communication, 11; self-care, 6; and cognition, 2. AT needs for vision and hearing impairment were more likely to be met (1–87% and 5–90%, respectively) compared with communication and cognition impairments (10–60% and 58%, respectively). The barriers and facilitators to AT access described were linked to accessibility, affordability and acceptability. Conclusion: Data on AT prevalence and coverage are limited in both quantity and quality. Agreed-upon definitions of functional impairment and assistive product categories and standards for data collection are needed to facilitate data comparisons and to build a more representative picture of AT needs and coverage. Implications for rehabilitation: Comprehensive and disaggregated data concerning the prevalence of needs and coverage of AT is needed to enable the development of responsive policies and actions. The literature available on the prevalence of needs and coverage of AT in the WHO European Region is primarily focussed on a small subset of countries and comparisons between studies are limited due to the use of different data collection strategies. Evidence concerning barriers and facilitators to AT access across countries is more consistent and can be organised across the key themes of accessibility, affordability and acceptability of AT. There is a need for consensus among multiple AT actors on standardised definitions for functional impairment and assistive product categories and standards for data collection to enable a more representative picture to be built of AT needs and coverage across the WHO European Region and globally

Motivational engagement in first-time hearing aid users: a feasibility study

Objective: To assess (1) the feasibility of incorporating the Ida Institute’s Motivation Tools into a UK audiology service, (2) the potential benefits of motivational engagement in first-time hearing aid users, and (3) predictors of hearing aid and general health outcome measures. Design: A feasibility study using a single-centre, prospective, quasi-randomized controlled design with two arms. The Ida Institute’s Motivation Tools formed the basis for motivational engagement. Study sample: First-time hearing aid users were recruited at the initial hearing assessment appointment. The intervention arm underwent motivational engagement (M+, n = 32), and a control arm (M-, n = 36) received standard care only. Results: The M+ group showed greater self-efficacy, reduced anxiety, and greater engagement with the audiologist at assessment and fitting appointments. However, there were no significant between-group differences 10-weeks post-fitting. Hearing-related communication scores predicted anxiety, and social isolation scores predicted depression for the M+ group. Readiness to address hearing difficulties predicted hearing aid outcomes for the M- group. Hearing sensitivity was not a predictor of outcomes. Conclusions: There were some positive results from motivational engagement early in the patient journey. Future research should consider using qualitative methods to explore whether there are longer-term benefits of motivational engagement in hearing aid users

Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference?

<p>Abstract</p> <p>Background</p> <p>The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD) network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community.</p> <p>Methods</p> <p>Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF). We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study.</p> <p>Results</p> <p>On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08) of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r²= 0.25; p < 0.001). At the end of the study, 35% (95% CI: 31% to 40%) of elders with needs living in the ISD area had at least one unmet need, compared to 67% (95% CI: 62% to 71%) in the other area. In general, unmet needs were highest for bathing, grooming, urinary incontinence, walking outside, seeing, hearing, preparing meals, and taking medications.</p> <p>Conclusions</p> <p>In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.</p