Alien Registration- Fleury, Marie C J. (Winthrop, Kennebec County)

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La médecine et la santé au Canada français : un bilan historiographique (1987-2000)

In 1987, historian Jacques Bernier estimated that despite the publication between 1976 and 1986 of a number of prominent papers, the history of medicine and health in French Canada was still in its infancy. Since then, this particular field of study has boomed. The present article examines published studies gathered according to the various themes which have been favoured from 1987 to 2002 and concern the history of medicine and health in French Canada, so as to illustrate the gains of the past sixteen years. In our conclusion, we shall discuss the advancement of the history of medicine and health in French Canada in connection with the various elements suggested by historians Ludmilla Jordonova and Thomas Brown when considering the maturity of a given field of study. We shall identify a number of factors limiting its consolidation.En 1987, l’historien Jacques Bernier signalait que l’histoire de la médecine et de la santé au Canada français, malgré la publication entre 1976 et 1986 de certains écrits importants, était encore au stade de l’enfance. Depuis, ce champ d’étude a connu un essor considérable. Cet article présente une recension des écrits publiés, regroupés selon les thèmes qui ont été privilégiés, au cours des années 1987 à 2002 sur l’histoire de la médecine et de la santé au Canada français, afin d’illustrer les acquis des seize dernières années. En conclusion, nous discuterons du stade d’avancement de l’histoire de la médecine et de la santé au Canada français en lien avec les différents éléments présentés par les historiens Ludmilla Jordonova et Thomas Brown pour juger de la maturité d’un champ d’étude, et identifierons certains facteurs qui en limitent la consolidation

Stratégies d’intégration des services en réseau, régulation et moteurs d’implantation de changement

Les réseaux intégrés de services sont présentés comme l'une des principales voies de solutions pour accroître l'efficience, la pertinence et la cohérence du système de santé dans le contexte actuel d'augmentation de la demande et de contraintes budgétaires. Dans le domaine de la santé mentale, l'intégration s'inscrit aussi dans une tentative de répondre aux besoins multiples de la population cible, plus spécifiquement les personnes souffrant de troubles mentaux graves. Cet article décrit les balises du concept de réseau intégré de services en santé mentale, les principales stratégies qui en favorisent le développement et les modèles de régulation qui permettent leur élaboration. L'article aborde aussi les difficultés et les enjeux de ce mode d'organisation et plus particulièrement les défis liés à l'implantation de changement et de transformation des systèmes.Network of integrated services : regulation and driving force of implementation of change Networks of integrated services are often presented as a major path of solution to increase efficiency, relevance and coherence of health systems especially in the current context of increasing demand and budgetary restraint. In the mental health field, integation also attempts to answer the numerous needs of a targeted population and more specifically, people with serious mental disorders. This article describes the markers of the concept of network of integrated services in mental health, the major strategies favoring development and models of regulation allowing their elaboration. The article discusses difficulties and stakes of this mode of organization and more particularly the challenges linked to implementation of change and transformation of systems.Estrategias de integración de servicios en red, regulación y motores de establecimiento de cambio Las redes integradas de servicios estan presentadas como una de las vias principales de soluciónes para aumentar la eficiencia, la pertinencia y la coherencia del sistema de salud en el contexto actual de aumentación de la demanda y de los limites de los presupuestos. En el campo de la salud mental la integración se inscribe tambien en una tentativa de respuesta a las necesidades multiples de la población, más especificamente las personas que padecen de problemas mentales graves. Este articulo describe las grandes lineas del concepto de la red integrada de servicios en salud mental, las estrategias principales que favorecen el desarrollo y los modelos de regulación cuales permiten su elaboración. El articulo trata tambien las dificultades y las cuestiones relacionadas a este modo de organisación y especificamente los desafios del establecimiento del cambio y de transformación de sistemas.Estratégias de integração das redes de serviços, regulamentação e agentes de implantação de mudanças A integração das redes de serviços é uma das principais soluções para aumentar a eficiência, a pertinência e a coerência do sistema de saúde no contexto atual de aumento da demanda e de problemas orçamentários. Na área da saúde mental, a integração também engloba a tentativa de atender às necessidades do público alvo, principalmente, das pessoas que sofrem de problemas mentais graves. Este artigo descreve algumas linhas básicas do conceito de integração das redes de serviços em saúde mental, as principais estratégias que favorecem o desenvolvimento e os modelos de regulamentação que permitem sua elaboração. O artigo trata também das dificuldades e problemas deste modo de organização e, mais especificamente, dos desafios relacionados com a implantação de mudanças e a transformação dos sistemas

Les organismes communautaires en santé mentale au Québec : rôle et dynamique partenariale

Cette étude présente un portrait global des 371 organismes communautaires en santé mentale (OCSM) subventionnés par l’État québécois durant l’année 2003-2004, et fait état de leur dynamique partenariale avec les réseaux communautaire, institutionnel et intersectoriel. Les auteurs abordent la diversité des OCSM à partir des dimensions suivantes : période de fondation de l’organisme, type et étendue du territoire couvert, type et nombre de services offerts, profil financier, regroupements et associations, tables de concertation et relations partenariales. L’étendue du territoire, l’importance du budget et la participation à une table de concertation locale et à des comités de travail apparaissent être des conditions qui favorisent la formalisation des relations organisationnelles.This study presents a global picture of the 371 government funded community-based mental health organizations (OCSM) and provides a description of the partnerships developed with community, institutional and inter-sector networks. The authors examine the diversity of the mental health community organizations based on the following characteristics: date of foundation, type and extent of territory, type and number of services offered, financial statement; participation in associations, participation in steering committees and models of partnership. The surface area of the territory, the size of the budget as well as involvement in steering committees appear to be enabling factors favouring the development of relations between organizations.Este estudio presenta una semblanza global de los 371 organismos comunitarios de salud mental (OCSM) subvencionados por el Estado quebequense durante el año 2003-2004, y pone en evidencia su dinámica de asociación con las redes comunitaria, institucional e intersectorial. Los autores abordan la diversidad de los OCSM a partir de los aspectos siguientes: período de fundación del organismo, tipo y extensión del territorio cubierto, tipo y cantidad de servicios ofrecidos, perfil financiero, reagrupamientos y asociaciones, mesas de concertación y relaciones de asociación. La extensión del territorio, la importancia del presupuesto y la participación en una mesa de concertación local y en comités de trabajo parecen condiciones que favorecen la formalización de las relaciones organizacionales.Este estudo apresenta um perfil global dos 371 organismos comunitários em saúde mental (OCSM) subvencionados pelo Estado quebequense durante o ano 2003-2004, e relata sua dinâmica de parceria com as redes comunitária, institucional e intersetorial. Os autores abordam a diversidade dos OCSM a partir das seguintes dimensões: período de fundação do organismo, tipo e abrangência do território coberto, tipo e quantidade de serviços prestados, perfil financeiro, agrupamento e associações, comitês consultivos e relações de parceria. A abrangência do território, a importância do orçamento e a participação em um comitê consultivo local e em comitês de trabalho demonstram ser condições que favorecem a formalização das relações organizacionais

GCP: Gossip-based Code Propagation for Large-scale Mobile Wireless Sensor Networks

Wireless sensor networks (WSN) have recently received an increasing interest. They are now expected to be deployed for long periods of time, thus requiring software updates. Updating the software code automatically on a huge number of sensors is a tremendous task, as ''by hand'' updates can obviously not be considered, especially when all participating sensors are embedded on mobile entities. In this paper, we investigate an approach to automatically update software in mobile sensor-based application when no localization mechanism is available. We leverage the peer-to-peer cooperation paradigm to achieve a good trade-off between reliability and scalability of code propagation. More specifically, we present the design and evaluation of GCP ({\emph Gossip-based Code Propagation}), a distributed software update algorithm for mobile wireless sensor networks. GCP relies on two different mechanisms (piggy-backing and forwarding control) to improve significantly the load balance without sacrificing on the propagation speed. We compare GCP against traditional dissemination approaches. Simulation results based on both synthetic and realistic workloads show that GCP achieves a good convergence speed while balancing the load evenly between sensors

Médecins omnipraticiens : pratiques et intégration des soins en santé mentale au Québec

Cet article examine le profil sociodémographique des médecins omnipraticiens (MO), leur rôle dans la prise en charge des troubles mentaux (transitoires/modérés, graves/persistants) dans les différents territoires (urbain, semi-urbain ou rural) du Québec, et si la pratique clinique et de collaboration de ces derniers est orientée vers une intégration des services de santé mentale. Cette étude transversale est basée sur 398 MO représentatifs de l’ensemble des MO du Québec qui répondaient à un questionnaire. L’étude révèle que les MO jouent un rôle central en santé mentale. Le profil sociodémographique et de pratique diffère selon les territoires. Les types de territoire et le degré de gravité du trouble mental influencent la propension des MO à intégrer les soins de santé mentale. Enfin, les MO pratiquent majoritairement en silo, mais soutiennent un renforcement de l’intégration des services de santé mentale. Les auteurs concluent que pour favoriser l’intégration des services de santé mentale, des incitatifs plus proactifs devraient être soutenus par les élites politiques et adaptés en fonction de la gravité des cas et des milieux. La pénurie des ressources, particulièrement frappante en milieu rural et l’insuffisance de mécanismes d’aide à la décision clinique, réduisent néanmoins les relations interprofessionnelles et limitent sérieusement l’intégration du dispositif de soins.This article examines the socio-demographic profile of general practitioners (GPs), their role in the management of (transient/moderate, severe/chronic) mental health disorders in different areas (urban, semi-urban, and rural) of Quebec as well as if their clinical practice and collaboration are oriented towards integration of mental health services. This crosswise study is based on 398 GPs representative of all Quebec GPs who answered a questionnaire. The study shows that GPs play a central role in mental health. According to territories, they have different socio-demographic and practice profiles. The types of territory and the degree of severity of mental health illnesses influence the propensity of GPs to integrate mental health care. Finally, GPs practiced mostly in silo, but they support greater integration of mental health services. The authors conclude that to improve mental health services integration, more proactive incentives should be favoured by political elites, adapted to the severity of the case and environments (urban, semi-urban or rural). However, the shortage of resources that is particularly striking in rural areas as well as inadequate mechanisms for clinical decision, reduce inter-relations and seriously limit the integration of healthcare.Este artículo examina el perfil sociodemográfico de los médicos generales (MG), su papel en el cuidado de los trastornos mentales (transitorios/moderados, graves/persistentes) en los diferentes territorios (urbano, semiurbano o rural) de Quebec, y si la práctica clínica y colaboración de estos últimos se orienta hacia una integración de los servicios de salud mental. Este estudio transversal se basa en 398 MG representativos del conjunto de MG de Quebec que respondieron un cuestionario. El estudio revela que los MG desempeñan un papel central en salud mental. El perfil sociodemográfico y de práctica difiere según los territorios. Los tipos de territorio y el grado de gravedad del trastorno mental influyen en la propensión de los MG a integrar los cuidados de salud mental. Finalmente, los MG practican en su mayoría por separado, pero están en favor de un refuerzo de la integración de los servicios de salud mental. Los autores concluyen que para favorecer la integración de los servicios de salud mental, los incentivos más proactivos deberían ser apoyados por las élites políticas y adaptados en función de la gravedad de los casos y de los medios. La penuria de los recursos, particularmente alarmante en el medio rural y la insuficiencia de mecanismos de ayuda a la decisión clínica, reducen sin embargo las relaciones interprofesionales y limitan seriamente la integración del dispositivo de cuidados.Este artigo examina o perfil sociodemográfico dos médicos generalistas, seu papel no tratamento dos transtornos mentais (transitórios/ moderados, graves/persistentes) nos diferentes territórios (urbano, semi-urbano ou rural) do Quebec, e se sua prática clínica e de colaboração é orientada para uma integração dos serviços em saúde mental. Este estudo transversal é baseado em 398 médicos generalistas representativos de todos os médicos generalistas do Quebec que responderam a um questionário. O estudo revela que os médicos generalistas representam um papel central em saúde mental. O perfil sociodemográfico e de prática difere segundo o território. Os tipos de território e o grau de importância do transtorno mental influenciam a propensão dos médicos generalistas a integrar os cuidados de saúde mental. Finalmente, os médicos generalistas praticam principalmente sozinhos, mas apóiam um reforço da integração dos serviços de saúde mental. Os autores concluem que para favorecer a integração dos serviços de saúde mental, os incentivos mais proativos deveriam ser apoiados pelas elites políticas e adaptados em função da importância dos casos e dos meios. A escassez de recursos, principalmente em meio rural e a insuficiência de mecanismos de ajuda à decisão clínica, reduzem as relações interprofissionais e limitam gravemente a integração do dispositivo de cuidados

Divergent modes of integration: the Canadian way

<p><strong>Introduction: </strong>The paper highlights key trajectories and outcomes of the recent policy developments toward integrated health care delivery systems in Quebec and Ontario in the primary care sector and in the development of regional networks of health and social services. It particularly explores how policy legacies, interests and cultures may be mitigated to develop and sustain different models of integrated health care that are pertinent to the local contexts.<strong></strong></p><p><strong>Policy developments: </strong>In Quebec, three decades of iterative developments in health and social services evolved in 2005 into integrated centres for health and social services at the local levels (CSSSs). Four integrated university-based health care networks provide ultra-specialised services. Family Medicine Groups and network clinics are designed to enhance access and continuity of care. Ontario's Family Health Teams (2004) constitute an innovative public funding for private delivery model that is set up to <strong>enhance the capacity of primary care and to facilitate patient-based care</strong>. Ontario's Local Health Integration Networks (LHINs) with autonomous boards of provider organizations are intended to coordinate and integrate care.<strong></strong></p><p><strong>Conclusion: </strong>Integration strategies in Quebec and Ontario yield clinical autonomy and power to physicians while simultaneously making them key partners in change. Contextual factors combined with increased and varied forms of physician remunerations and incentives mitigated some of the challenges from policy legacies, interests and cultures. Virtual partnerships and accountability agreements between providers promise positive but gradual movement toward integrated health service systems.<strong></strong></p