Les innovations techniques en santé: le processus décisionnel et les limites de la réglementation

Sommaire: Dans nos sociétés, les décisions relatives aux nouveaux équipements techniques en santé sont en général prises au sein d'instances relevant plus ou moins directement du pouvoir gouvernemental (ministères, organismes régionaux, hôpi-taux, etc.). Plusieurs intervenants agissent dans ce milieu public où, comme acteurs du processus décisionnel, ils ont à résoudre diverses incertitudes et è tenir compte d'enjeux politiques, professionnels ou organisationnels. L'influence de ces incertitudes et de ces enjeux sur les décisions dépend aussi beaucoup de la phase (décou-verte, implantation ou diffusion, par exemple) dans laquelle se trouvent les innovations à un moment donné. Cet article tente donc de démontrer la complexité du processus décisionnel dans la mise en place des nouvelles technologies médicales de haute intensité. II met I'emphase sur le rôle et les limites de la réglementation. Abstract: In our society, decisions concerning new technical equipment for health care are in general made by bodies that are more or less directly under government control (ministries, regional bodies, hospitals, etc.). As actors in the decision-making process, these entities are required to clear up many uncertainties and take into account the political, professional or organizational issues. The influence of these uncertainties and issues on decision-making also depends on the stage (for example, discovery, introduction or dissemination) that an innovation has reached at any given moment. This article attempts to illustrate the complexity of the decision-making process as regards the implementation of new advanced medical technologies, and emphasizes the role and the limitations of regulation.     

CUSTODY EVALUATIONS

The procedures used to conduct custody evaluations and the purpose of such reports are currently under review by mental health and legal professionals. This article describes (a) the limitations inherent in clinical assessment and (b) characteristics of the adjudication process which necessarily limit the evaluator's thoroughness and the potential usefulness of evaluations. Given the primitive methods available for assessing families and predicting outcomes, the inability and unwillingness of the courts to process large amounts of clinical data, the conflicting motives surrounding evaluations, and the biases inherent in custody recommendations, the author argues for limited, well-defined, and objectively supported assessment procedures and evaluation criteria.     

Sleep disturbance in adolescents: Sleep quality,sleep habits,beliefs about sleep,and daytime functioning

This study examined the prevalence and correlates of sleep disturbance in adolescents. Two hundred seventy-seven 9th- and 10th-grade students completed a questionnaire on sleep quality, sleep habits, beliefs about sleep, and daytime mood and functioning. Based on their responses, subjects were classified as good sleepers (66%), occasional poor sleepers (23%), and chronic poor sleepers (11%). Occasional and chronic poor sleepers reported being significantly more depressed, without energy, tense, moody, and irritable and less rested and alert than good sleepers. They were also more likely to describe themselves negatively. However, poor sleepers were not consistently more tired than good sleepers. Rather, they tended to be least tired in the evening, the time when most good sleepers reported feeling tired. There were few differences in the sleep habits and beliefs about sleep of good and poor sleepers. All subjects reported shifts in bedtimes and waketimes from weekdays to weekends, with occasional and chronic poor sleepers showing a tendency toward greater shifts, a possible factor contributing to their sleep disturbance. Occasional and chronic poor sleepers also reported more observable behaviors and feelings of stress than good sleepers. The need for early intervention with particular attention to teaching adolescents about good sleep habits and the need for stable bedtimes and waketimes and the possibility of joint intervention on daytime stress and sleeping problems are discussed.     

Adolescent egocentrism-sociocentrism and self-consciousness

A standardized and objectively scored scale of adolescent egocentrism-sociocentrism (AES) and a self-consciousness scale were given to 44 subjects each in the sixth, eighth, tenth, and twelfth grades and college. The AES assesses three components of egocentrism including the personal fable, the imaginary audience, and general self-focuses, as well as sociocentrism and nonsocial subscales. As predicted, the personal fable and imaginary audience declined with age. The self-focus subscale showed a curvilinear relationship with age, while, again as predicted, sociocentrism increased and nonsocial focuses declined. Adolescent egocentrism, as expected, correlated positively with self-consciousness even with age controlled. Implications for the theories of egocentrism and sociocentrism in the adolescent years are discussed.Received his Ph.D. from the University of Minnesota. Major interests are adolescent social cognition and social development.     

The End of Ideology Debate Revisited: An Appraisal of Definitional and Theoretical Issues*

This article deals with the definitional legacy of the end of ideology debate and the problem of defuning ideology. The definitional legacy of the debate is described in terms of assumptions about the characteristics and functions of ideology, and several problematic features are identified. A major argument is that certain theoretical difficulties characterizing the debate were the result of viewing various attributes as definitional properties of ideology rather than hypothetical variables. In an effort to overcome the problematic features of the definitional legacy of the debate, the article recommends the construction of a minimal definition of ideology which converts characteristics and Functions often viewed as a priori elements of ideology into an extensive battery of hypothetical variables.     

Insider Perspectives or Stealing the Words out of Women's Mouths: Interpretation in the Research Process

This article examines the ways in which social class differences between the researcher and female respondents affect data analysis. I elaborate the ways in which my class background, just as much as my gender, affects all stages of the research process from theoretical starting points to conclusions. The influences of reflexivity, power and ‘truth’ on the interpretative process are developed by drawing on fieldnotes and interviews from an ethnographic study of women's involvement in their children's primary schooling. Complexities of social class are explored both in relation to myself as the researcher and to how the women saw themselves. I argue that there is a thin dividing line between the understandings which similar experiences of respondents bring to the research process and the element of exploitation implicit in mixing up one's own personal history with those of women whose experience of the same class is very different. Identification can result in a denial of the power feminist researchers exercise in the selection and interpretation of data. However, researchers are similarly powerful in relation to women from very different class backgrounds to their own, and I attempt to draw out problematic issues around power and ‘truth’ in relation to the middle-class women whom I interviewed. I conclude by reiterating that, from where I am socially positioned, certain aspects of the data are much more prominent than others and as a consequence interpretation remains an imperfect and incomplete process.