La responsabilisation du patient dans un contexte de télésoins à domicile

Sommaire: La volonté de transformation du système de santé est propice à une recrudescence du discours public sur la responsabilisation du patient. Les technologies d'information et de communication (tic ) sont régulièrement envisagées comme moyens pouvant permettre au patient d'exercer un rôle accru dans la prise en charge des questions de santé. Ce texte vise à cerner le sens de la responsabilisation dans un contexte de télésoins à domicile. L‘étude d'un service de suivi à domicile met en lumière l'un des quatre paradigmes d'interprétation de la responsabilisation du patient: le paradigme professionnel qui est orienté vers l'habilitation en matière de santé. Par une double lecture représentant les approches sociologique et psychologique, cette étude montre les possibilités et les limites d'une technologie de télésoins à domicile par rapport à six principales variables: accès aux connaissances; développement d'une réflexion argumentée; influence sur l'action ou la décision; compétence perçue; contrôle perçu; et intériorisation des buts. Les résultats permettent d'observer le haut niveau d'exigence que représenterait une initiative visant l’émergence de patients informés et compétents. Surtout des patients “experts” dans une vision de la responsabilisation fondée sur la reconnaissance du caractère holistique des connaissances, du principe d'autonomie de pensée et du potentiel d'influence du patient sur une variété de décisions. En conclusion, sont précisées les implications qu'ont ces résultats sur la gestion du système public de santé. Abstract: The willingness to transform the health care system is conducive to a new wave of public discourse on patient empowerment. Information and communications technologies (ict ) are regularly considered as means that allow the patient to exercise increased control in addressing health issues. This text aims at examining this phenomenon within the tele‐homecare context. The study of a follow‐up home‐care service highlights one of the four paradigms of the interpretation of patient empowerment: the professional paradigm that is health empowerment‐oriented. By using both a sociological and a psychological approach, the study identifies the possibilities and limitations of tele‐homecare technology, based on six major variables: access to knowledge, development of critical thinking, personal impact on action or decision, perceived competency, perceived control, and internalization of goals. The results show the high level of requirements needed for an initiative that would produce informed, competent and, most importantly, “expert” patients according to a vision of empowerment based on the recognition of the holistic nature of knowledge, the principle of autonomous thinking, and the patient's potential impact on a variety of decisions. In conclusion, the article defines the implications of these results in terms of the management of the public health system.     

Anthropological Measurement of the Juvenile Clavicle Using Multi‐Detector Computed Tomography—Affirming Reliability

Currently, there is no standardized protocol for multi‐detector computed tomography (MDCT) measurement of juvenile remains. Using 33 juvenile clavicles, this paper investigates a protocol to allow MDCT measurements, comparable or supplemental with traditional osteometric measurements, to be acquired for application to previously published algorithms. The results illustrate that there is no significant difference between MDCT measurements and those taken by direct osteometric methods. By presenting such a protocol, this paper takes the first steps toward validation of the process of conversion from measurement of dry juvenile bone to MDCT compatibility and allows the forensic world to take a step forward in standardizing the way MDCT is used for forensic practice. This paper assesses the limitations and potential applications of this virtual approach and offers some suggestions for where further work might progress the conversion of these new approaches into legally admissible anthropological techniques of age estimation.     

Are We There Yet? Religion,Secularization and Liberal Democracy in Israel

Secularism and liberalism are often perceived as interlinked and associated with the process of modernization and liberal democracy. Yet recent studies of Israel cast doubts on this linkage as in spite of a rapid secularization of some parts of the public sphere anti-liberal and ethnocentric attitudes remain entrenched, encouraging some to call Israel a ‘non-liberal democracy’. This article seeks to explain these contradictions by, first, arguing that religion remains instrumental to the national discourse and to practices of demarcating boundaries and, second, that ethnic groups hold different perceptions of religion and attach different importance to religious rituals. Finally, secularization, as the Israeli case demonstrates, remains within the confines of a national discourse, differs between ethnic groups, and advances only with a limited commitment to religious freedom, to toleration associated with liberalism and, consequently, to a liberal democracy.     

Book reviews

Social Policy Research, Martin Bulmer (ed.), London, Macmillan, 1978, pp. 373, £5.95.

Making Budgets, James N. Danziger, Sage Publications, 1978, pp. 255, £8.50 cloth edition and £4.25 paperback.

Universality, Selectivity and Effectiveness in Social Policy, Bleddyn Davies (in association with Mike Reddin), Heinemann, London, 1978, pp. viii &; 264, £9.50.

Implementation in a Bureaucracy, Control in a Bureaucracy, Andrew Dunsire, Oxford, Martin Robertson, 1978, pp. Vol.1260, Vol. II 263, £15 each.

Planning the Social Services, N. Falk and J. Lee, Saxon House, Farnborough, 1978, pp. x &; 113, £7.50.

Policy Analysis: A Political and Organisational Perspective, W. I. Jenkins, London, Martin Robertson, 1978, pp. 278, £8.95.

Interactions and Interventions in Organizations, Iain L. Mangham, John Wiley &; Sons, 1978, pp. 150, price not known.     

Hard choices in hard times: Valence voting in Germany (2009)

Recent studies of voting behavior in Anglo-American elections have demonstrated the clear superiority of the valence model over its rivals for explaining how people cast their ballots. In this paper we test the portability of the valence model in a particularly challenging setting the 2009 German Parliamentary elections. Although there are reasons to think that a spatial model might outperform the valence model, we find that the valence model outperforms it with results similar to previous findings in other political settings.