Politiques publiques et santé:les dilemmes de I‘évaluation prospective

Sommaire: Depuis le milieu des années 1990, plusieurs gouvernements ont affirmé leur volonté de tenir compte des impacts de leurs actions sur la santé des populations. En juin 2002, le gouvernement du Québec met en vigueur l'article 54 de la Loi sur la santé publique (L.R.Q. chapitre S‐22, 2001). Cet article atteste de l'obligation pour les ministères de tenir dorénavant compte des impacts sociaux, environnementaux et économiques de leurs actions sur la santé. La mise en Oeuvre de cet article suppose l'intégration d'un processus d'évaluation prospective des politiques publiques dans l'appareil gouvernemental, remet en question le fonctionnement vertical des administrations publiques et souligne l'importance d'une gestion stratégique des connaissances dans un monde sans frontières. Dans ce contexte, quatre dilemmes sont soulevés. Les deux premiers dilemmes sont d'ordre interministériel. Ils concernent les relations qu'entretiennent les ministéres entre eux et avec les organismes centraux. Les deux autres dilemmes s'intéressent à la dimension intra organisationnelle, c'est‐à‐dire la maniére dont chaque ministère réagit face aux demandes d'évaluations prospectives de ses politiques ou programmes et répond aux exigences dc l'article 54. Des méthodes qui devraient permettre aux administrations publiques de remédier à ces différents dilemmes sont également présentées. Abstract: Since the mid‐1990s, several governments have declared their commitment to ensuring that the impact of their actions on the health of the population is taken into account. In June 2002 the Quebec provincial government implemented article 54 of the Public Health Act (R.S.Q., chapter 2.2, 2001). This article stipulates the obligation on the part of the government departments to take into account the social, environmental, and economic impacts of their actions on public health in the future. The implementation of this article means integrating a process for the prospective assessment of the government's public policies, and re‐examining the vertical model of operation of public administrations; it also underlines the importance of strategic knowledge management in a world without borders. Four dilemmas are raised within this context. The first two dilemmas are interdepartmental in nature, and involve the relationships the government departments have with each other and with the central agencies. The other two dilemmas fall within the intra‐organizational sphere ‐ that is, the way in which each government department reacts to the demands for the prospective assessment of its public policies or programs, and how each department responds to the requirements of article 54. Processes that should allow the public administrations to solve these various dilemmas are also presented.     

Receipt of preventive dental care among special-needs children enrolled in Medicaid: a crisis in need of attention

Although not widely recognized, tooth decay is the most common childhood chronic disease among children ages five to seventeen. Despite higher rates of dental caries and greater needs, low-income minority children enrolled in Medicaid are more likely to go untreated relative to their higher income counterparts. No research has examined this issue for children with special needs. We analyzed Medicaid enrollment and claims data for special-needs children enrolled in the District of Columbia Medicaid program to evaluate receipt of recommended preventive dental care. Use of preventive dental care is abysmally low and has declined over time. Enrollment in managed care rather than fee for service improves the likelihood that special-needs children receive recommended preventive dental services, whereas residing farther from the Metro is an impediment to receipt of dental care.     

Modus operandi and situational aspects in adolescent sexual offenses against children: a further examination

The relationship between situational factors and the modus operandi of 103 adolescents involved in sexual offenses against children (12 years old or younger) is analyzed. Situational factors taken into account in this study are the location of the crime, the offender-victim relationship, and the presence of deviant sexual fantasies involving the victim prior to the offense. Modus operandi strategies were measured on the basis of participants' responses to Kaufman's Modus Operandi Questionnaire. Results indicate that modus operandi strategies are influenced by situational factors and that the offender's home, when no one else is home, is likely to be the place and the situation for adolescent offenders to adopt manipulative strategies. Suggestions are made regarding future modus operandi studies.     

Modeling the Deviant Y in Criminology: An Examination of the Assumptions of Censored Normal Regression and Potential Alternatives

Many dependent variables of criminological interest have censored distributions. Investigations that use such variables increasingly have turned to the Tobit model, a censored regression technique that is specified based on a latent dependent variable. When used under suitable circumstances, this model provides appropriate estimates. This paper discusses key assumptions of the Tobit model. It then highlights the risk of violating these assumptions and reviews alternative flexible parametric and semiparametric modeling techniques, currently used sparingly in criminology, which researchers may find helpful when assumptions regarding the error terms are untenable. By using an empirical example focused on sentencing outcomes and comparing estimates across analytic methods, this study illustrates the potential utility of simultaneously estimating the Tobit model along with some alternatives.

Ireland and the UN decade for women

The Irish Government has made little or no direct response to the UN decade for Women. The ‘convention on the Elimination of all Forms of Discrimination Against Women’ still has not been signed. This paper considers why the reticence persists and argues that women must insist that the Convention is signed by 1985.     

Hair analysis of opiates in mothers and newborns for evaluating opiate exposure during pregnancy

The increasing interest in toxicological hair analysis as a marker of human exposure to xenobiotics such as illicit substances or therapeutic drugs, has been made feasible by the extension of mass spectrometry, a highly sensitive method of detection. A newborn exposed to drugs in utero can suffer from a varying degree of withdrawal syndrome, a few days after birth. If of opiate origin, the withdrawal syndrome can be treated with morphine, among other therapeutics, but it is not easy to diagnose because of atypical symptoms presented by neonates and especially when maternal drug addiction has not been revealed. To assess and measure toxicological factors linked with the appearance and the severity of this syndrome, maternal and neonatal matrices such as urine, meconium and hair were collected during a protocol approved by the ethical committee. Opiates in particular were measured with GC-MS and potential combined dependences (cannabis, cocaine, amphetamine, LSD and benzodiazepines) and/or substitutive therapeutics (methadone or buprenorphine) were also assessed in 17 mother/neonate couples. Gestational opiate exposure profiles were drawn up and linked with the observed withdrawal syndromes. A withdrawal syndrome seems to appear more frequently after foetal exposure to an association of opiates/substitutive molecules (8 out of 10 withdrawal syndromes observed in this study), although the impact of cocaine and benzodiazepines must also be taken into account. The results obtained in neonatal hair make it possible to affirm foetal drug exposure and are in accordance, for the majority, with the appearance of a neonatal withdrawal syndrome (NWS). Neonatal hair analysis could contribute to assess in utero exposure to opiates, particularly when results in urine and meconium are negative or when these matrices are not available.     

Maternal cigarette smoking during pregnancy and criminal/deviant behavior: a meta-analysis

A growing body of empirical literature has emerged examining the somewhat inconsistent relationship between maternal cigarette smoking (MCS) during pregnancy and children's subsequent antisocial behavior. To systematically assess what existing studies reveal regarding MCS as a criminogenic risk factor for offspring, the authors subjected this body of literature to a meta-analysis. The analysis reveals a statistically significant--yet rather small--overall mean "effect size" of the relationship between MCS and the likelihood children will engage in deviant/criminal behavior. In addition to being rather moderate in size, the MCS-crime/deviance relationship is sensitive to a number of methodological specifications across empirical studies--particularly those associated with sample characteristics. The implications of this modest, and somewhat unstable, relationship are discussed in terms of guidelines for future research on this subject and how existing theoretical perspectives may be integrated to explain the MCS-crime/deviance link.