Reconfiguration du réseau de la Patrick sabourté et et des services sociaux au Québec: la place des regroupements intéretablissements

Sommaire: Depuis le début des années 1990, le système de santé québécois, comme celui des autres provinces, subit de profonds changements. lis se concrétisent sous la forme d'une reconfiguration majeure du système lui-meme, des services qu'il dispense et des structures qui le composent. L'article s'interesse a ce dernier aspect, plus particulierement sous l' angle des regroupements interétablissements. II appert que la Loi sur les services de santé et les services sociaux (1991, chap. 42) a bouleversé la configuration structurelle du réseau en forcant l'unification horizontale de plusieurs types d'établissements, tels les centres d'hébergement de soins de longue durée et les centres de réadaptation. Plus récemment, la décentralisation fonctionnelle accrue au profit des régies régionales de la santé et des services sociaux (rrsss), jumelée à l'annonce de compressions budgétaires sans précédent, a donné un second souffle à cette reconfiguration de structures. Une enquete a été menée a l'hiver 1995. Elle révèle qu'à ce moment, en plus des regroupements deja prévus dans la loi, un peu plus de 110 établissements socio-sanitaires, dont 60 centres hospitaliers, étaient également impliqués dans divers projets de regroupements allant de l'entente de services a la fusion. Depuis le printemps 1995, certaines rrsss étudient l' option des intégrations ou des fusions verticales, qui impliquent des établissements de mission différente. Or, une revue de la littérature démontre que l' efficacité et l' efficience de ces options ne sont pas clairement démontrées dans le secteur des soins de santé et qu'il vaudrait mieux envisager des formes moins contraignantes (partenariats, ententes de services, etc.) permettant de s'apprivoiser avant de songer au mariage. Abstract: Since the early 1990s, the Quebec health-care system, as those in other provinces, has undergone major changes. These changes involved a major reconfiguration of the system itself - its services and its structures. This article describes this reconfiguration and focuses on one particular aspect: the integration of services. The Health and Social Services Act, 1991 (c. 42) created havoc in the configuration of the system by imposing horizontal integration of several types of services, such as those of long-term care facilities and rehabilitation centres. More recently, this growing delegation in favour of the Regional Health and Social Services Boards (rhssbs) together with the announcement of unprecedented budget cuts, has led to further restructuring. A survey carried out during the winter of 1995 showed that 120 health-care establishments, including 60 hospitals, were involved in inter-establishment relationship projects, ranging from service agreements to mergers. Since the spring of 1995, some rhssbs have been studying the option of integration or of vertical mergers, i.e., how to integrate facilities with different services. However, a review of the literature shows that the effectiveness and efficiency of these options has not yet been clearly proven in the health-care sector, and that it would be wiser to consider, as a first stage, less constraining relationships (e.g., partnerships, service agreements, etc.) as a way of testing compatibility before getting involved in permanent partnerships.     

Perceived control and emotional status in abusive college student relationships: an exploration of gender differences

The authors assessed perceived control, dysphoria, hopelessness, self-esteem, and optimism in 280 college students involved in abusive and nonabusive relationships. Women reported higher levels of dysphoria and lower levels of self-esteem and optimism than men. Women in abusive relationships reported more psychological symptoms than men in abusive relationships. After controlling for gender differences in emotional status, participants in abusive relationships showed more psychological symptoms than those in nonabusive relationships. Women showed lower perceived control of relationship conflicts than men. Men experiencing high levels of abuse reported higher perceived control of relationship conflict than females experiencing low levels of abuse. Perceived control was affected more by gender than emotional status, abuse level, and gender-affected emotional status. The authors discuss the results in terms of their implications for future investigations of emotional reactions to abuse.     

Dealing with cross-sectoral policy problems: An advocacy coalition approach to climate and water policy integration in Northeast Brazil

Policy Sciences - The governance of several cross-cutting challenges, such as food security, climate change, and sustainable development, calls for integrative policy approaches. However, efforts...     

Barriers to the strategic adoption of revolutionary manufacturing processes

This research examines the role of strategic barriers to the adoption of revolutionary new manufacturing processes in two American industries—primary textiles and steel. Based on the experiences of these sectors, two general conclusions are reached. First, the factors influencing strategic adoption of revolutionary processes can be classified into three categories: scale, vertical scope, and horizontal scope. Second, different strategic groups experience and encounter different barriers in the adoption of revolutionary technological processes.     

Public opinion on media presence in the courthouse

Very little attention has been devoted to the public's opinion of media coverage of court cases despite extensive research on pretrial publicity (PTP). Following a provincial judgment to restrict media access in Quebec courthouses, a preliminary unpublished study found that the public was largely in support of these restrictions. The present study sought to expand on this finding in a more widely generalizable sample. Subjects were recruited from continuing education classes and completed a questionnaire that assessed their support for restricting journalists in courthouses. Nearly 80% of the 243 participants supported media restrictions. Although participants in the four experimental conditions and one of the control groups were largely in favor of the restrictions, one control group was opposed to the restrictions. The results suggest that the public prefers that journalists have restricted access to courtroom participants, resonating research on PTP and the Supreme Court's decision on the case.     

Dysphoria and Hopelessness Following Battering: The Role of Perceived Control, Coping, and Self-Esteem

Coping, perceived control, dysphoria, hopelessness, and self-esteem in a sample of 100 battered women were assessed. Participants reported dysphoria and low self-esteem, but not hopelessness. High perceived control over current abuse and greater use of drugs, behavioral disengagement, denial, and self-blame as coping mechanisms were associated with increased dysphoria and low self-esteem. High expectations for control over future abuse were associated with decreased dysphoria and hopelessness and increased self-esteem. After controlling for the effects of abuse severity and low self-esteem, self-blame was a unique contributor to dysphoria and high expectations for control of future abuse were unique contributors to hopelessness. Results are discussed in terms of their implications for clinical intervention with battered women.     

Child sexual abuse and adult romantic adjustment: comparison of single- and multiple-indicator measures

This study compared the usefulness of single- and multiple-indicator strategies in a model examining the role of child sexual abuse (CSA) to predict later marital satisfaction through attachment and psychological distress. The sample included 1,092 women and men from a nonclinical population in cohabiting or marital relationships. The single-item measure assessed the presence or absence of CSA. The multiple-indicator measure included items relating to level of force, relationship with perpetrator, number of abusive experiences, and nature of assault. Structural equation modeling indicated that, for research purposes, a dichotomized item provided as much information as a complex measure to predict the relationship between sexual abuse and marital adjustment through attachment representations and psychological distress. However, when analyses were conducted strictly within the CSA victims group, no correlation was found between abuse severity and psychosocial measures. The present results show that in a community sample, CSA may be an important risk factor that develops couple difficulties, regardless of the severity of the trauma.