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.     

Emotional and temperamental correlates of Type A in children and adolescents

Emotional and behavioral correlates of Type A behavior in children and adolescents were examined in 184 fifth-, seventh-, and ninth-grade students, classified as high or low Type A, using self-report, teacher ratings (fifth grade only), and structured interview procedures. Measures included the Hunter-Wolf A-B Rating Scale, Behavioral Symptoms of Stress Inventory, Dimensions of Temperament Survey, Desire for Control Scale, Eysenck Personality Inventory, and the Multiple Affect Adjective Checklist. High Type A children reported significantly more stressed-related behaviors, higher levels of depression, anger, anxiety, and cognitive disorganization, and greater reactivity than Low Type A. No differences were found on measures of temperament (activity level, attention span, adaptibility, and rhythmicity), desire for control, or introversion-extroversion. Females, in general, reported significantly more behavioral stress symptoms. However, no other gender differences were found. Possible reasons for reported differences between Type A children and adults are discussed, along with gender differences in behavioral symptoms. Need for multiple measures of Type A across situation is considered along with need for controlled longitudinal studies of Type A components and the influence of contexts.Received Ph.D. from Stanford. Research interests: Adolescent problems, stress.Received Ph.D. from Stanford. Research interests: Type A, anger/hostility; AIDS prevention.Received Ph.D. from Stanford. Research interests: child & family problems, stress disorders.Received Ph.D. from Stanford. Research interests: psychoneuroimmunology.Received Ph.D. from Stanford. Research interests: pain disorders, stress.Received Ph.D. from Stanford.Received Ph.D. from Stanford. Research interests: anxiety and phobic disorders.     

Development of interest and enjoyment in adolescence. Part I. Attentional capacities

The first part of this two-part article argues that significant changes in both the capacity and the content of attention emerge in adolescence. Part I reviews evidence from behavioral and biological studies that the capacity for interested attention develops from late childhood into adolescence.     

The role of group interest,identity, and stigma in determining mental health policy preferences

Public attitudes toward mental health present an interesting puzzle. While mental health is one aspect of general health and well-being, it receives less support for government spending increases than does health care. One explanation lies with the stigma that is attached to mental illness. This stigma produces more negative attitudes on policy issues related to persons with mental illness such as government spending for mental health. However, group identification, as defined by personal experience or a family member who has experienced a mental illness, may have a strong effect on these attitudes. Using data from the 1996 General Social Survey's module on mental health. I examine this and other hypotheses and find evidence that group identification increases the likelihood of increased support for government spending for mental health. These robust findings exist even in quantitative models, which include politically relevant variables and measure identification with mental illness in two different ways. These findings suggest that mental health is policy for the few because those most supportive of government spending increases are persons who share the common identity of experiencing mental illness.     

Ethics revisited in a society in transition: the case of the former East Germany

Since 1990, the German government has been demanding from the civil servants of the former East Germany a new adaptability and creativity that was never promoted in the GDR bureaucracy. The article analyses the change of ethics in the former East Germany after 1990. It looks at the development of the German civil service, discusses the economic disparity between East and West, and examines the ethical tradition in the former socialist country. It uses the case of the selection in 2001 of the city of Leipzig by BMW as the location of a new manufacturing plant as an illustration of the new goal‐oriented activities of the present Eastern bureaucracy. More than 250 European cities were competing for the new plant, which will create over 10,000 jobs. The level of performance of the Leipzig bureaucracy in the BMW case reveals the new efficiency and professionalism of the former Eastern civil service. In addition to Leipzig, virtually all the local and state administrations from the former East Germany have developed a sense of the necessities of the time, including globalization. Copyright © 2002 John Wiley & Sons, Ltd.     

A Longitudinal Study of Self-Esteem: Implications for Adolescent Development

This study used a cluster analytic approach to identify self-esteem trajectories among adolescents over a four-year period from sixth to tenth grades (N = 1,160). Four self-esteem trajectories were identified that replicated previous research: (1) consistently high, (2) moderate and rising, (3) steadily decreasing, and (4) consistently low. Female adolescents were more likely to be in the steadily decreasing self-esteem group while male adolescents were more likely to be in the moderate and rising group. African American and white youth were equally distributed across groups. Using repeated measures analysis, we found that youth with consistently high and moderate and rising self-esteem reported developmentally healthier outcomes in Grade 10 than youth in the other two clusters. Outcomes included susceptibility to peer pressure, school grades, and alcohol use. Implications of these results for studying self-esteem and developmental change more generally are discussed.