Facteurs psychosociaux influençant l’intention des femmes infectées par le VIH d’avoir un enfant : étude de douze cas

Cette étude documente les facteurs qui influencent l'intention d'avoir un enfant parmi 12 femmes en âge de procréer infectées par le virus de l'immunodéficience humaine (VIH) dans les trois prochaines années. Trois de ces femmes ont l'intention d'avoir un enfant. Leur intention est influencée par leurs croyances et leurs attitudes positives envers le fait d'avoir un enfant, l'influence positive du conjoint, l'absence des enfants auprès d'elle, la négation de la maladie et l'absence de symptômes dans la famille. Pour les neuf autres femmes, le contexte sociopolitique et économique, la famille déjà complète, le fait d'être séropositive ou d'être malade, la peur de transmettre l'infection et le décès d'enfants sidéens ont influencé leur intention de ne pas avoir d'enfant.This study documents the factors that influenced the decision of 12 women of child-bearing age whether to have a child in the three years following an infection by the human immunodeficiency virus (HIV). Three of the 12 women are intending to have a child, and their intention stems from their beliefs and positive attitudes toward having a child, their partner's positive influence, the absence of their children, their denial of the disease and the absence of symptoms within their family. For the nine other women, the factors that influenced their decision not to have a child include the sociopolitical and economical context, the fact their family is complete, the fact they are seropositive or ill, their fear of transmitting the infection and the idea of losing a child to AIDS

Les urgences psychiatriques dans la région du Montréal métropolitain : quelques différences entre les hommes et les femmes

Le thème du présent numéro vise à caractériser la situation des femmes à l'égard de certains aspects de la santé mentale. C'est une occasion de présenter certaines données d'une recherche sur les urgences psychiatriques effectuée dans la région du Montréal métropolitain. Cet article comporte trois parties. Dans une première partie, on décrira d'une manière générale les patients considérés comme « urgences psychiatriques » dans la région de Montréal, selon certaines caractéristiques socio-démograhiques et économiques et ensuite selon les différents types de détresse psychiatrique. Dans une deuxième partie, un portrait plus détaillé de la clientèle de l'urgence psychiatrique sera brossé en mettant en relief les différences entre la clientèle féminine et la clientèle masculine. Enfin, dans une troisième et dernière partie, seront présentées des données relatives à une dimension importante de l'intervention médicale en psychiatrie d'urgence, à savoir les premières décisions prises par les professionnels de la santé de service à l'urgence en réponse à cette demande.This article presents a general description of the clientele requiring emergency psychiatric services in the Greater Montreal area, with a particular emphasis on the differences between the characteristics of the female and of the male clientele of these emergency services (demographic variables, diagnosis, treatment and disposition variables)

Analyse descriptive des urgences psychiatriques dans la région du Montréal métropolitain

Cet article résume la première partie d'une recherche descriptive sur les urgences psychiatriques dans la région métropolitaine de Montréal. Tout d'abord, nous exposons le contexte dans lequel se situe l'étude et les objectifs poursuivis ; dans un deuxième temps, nous effectuons une brève description des principaux aspects méthodologiques de la recherche. Dans un troisième temps, nous présentons les données relatives au nombre d'urgences psychiatriques et à la répartition de cete demande de soins selon les centres hospitaliers du Montréal métropolitain. Un second article traitera des principales caractéristiques de la clientèle psychiatrique qui requiert les ressources d'urgence : âge, sexe, état civil, catégories socio-professionnelles, types de détresse psychiatrique, profils d'utilisation antérieure, etc.In. September 197S1, a research team from the Department of Health Administration of the University of Montreal, completed a research study on psychiatric emergencies financed by the Planning section of Quebec's Ministry of Social Affairs. The purpose of this research was on the one hand, to measure the importance of psychiatric problems in the emergency services of hospital centers in Montreal's metropolitan region (22 institutions) and, on the other hand, to describe the characteristics of patients who have access to these emergency services for the purpose of psychiatric treatment.This article summarizes the first section of this research study. Firstly, the authors explain the problem underlying the study, as well as the objectives pursued. Subsequently, a brief description of the research is made, according to its major methodological features. Finally, in the third section, data relative to the number of psychiatric emergencies and to the distribution of this care demand in Montreal's hospital centers, are presented.A second article will deal with the main characteristics of the psychiatric clientele requiring emergency resources i.e. age, sex, marital status, socio-professional categories, types of emotional distress, profiles of past-utilization of services (etc.)

Prévention en médecine générale : approche néo-institutionnelle des systèmes de santé français et québécois

The aim of this paper is to highlight the potential of the French and the Quebec health systems for prevention in general practice. We use a neo-institutional approach of health system, an approach that emphasizes the importance of institutions and health organizations to understand the provision of preventive medicine. The institutional weakness of the prevention in France, strengthened by organizational rules unsuited, lead the French system to be inappropriate to the development of preventive activities in general practice. The Quebec system seems more favourable since prevention is highly institutionalized. However, the potential of Quebec organizations varies.institutions;organisations;primary care;prevention;public health

La relation chômage-santé : une étude prospective. Présentation sommaire et premiers résultats d’une recherche

Les auteurs ont entrepris en 1984 une importante étude sur les multiples interrelations entre le chômage et la santé. La méthodologie retenue est prospective, longitudinale, avec groupe contrôle. Ils présentent d'abord une synthèse des travaux effectués puis exposent les résultats obtenus jusqu'à maintenant. Ces résultats vont dans le sens des quatre hypothèses posées a priori. Cependant, ces résultats ne sont pas définitifs. L'analyse se poursuit.In 1984, the authors undertook a major study on the multiple interrelations between unemployment and health. Tlie methodology in use is prospective, longitudinal, with a control group. Their presentation consists of a synthesis of work carried out so far followed by corresponding results. These results are in compliance with the four hypotheses developed through a priori reasoning. However, these results are not definitive. The analysis continues

A model and typology of collaboration between professionals

Abstract Background: The new forms of organization of healthcare services entail the development of new clinical practices that are grounded in collaboration. Despite recent advances in research on the subject of collaboration, there is still a need for a better understanding of collaborative processes and for conceptual tools to help healthcare professionals develop collaboration amongst themselves in complex systems. This study draws on D'Amour's structuration model of collaboration to analyze healthcare facilities offering perinatal services in four health regions in the province of Quebec. The objectives are to: 1) validate the indicators of the structuration model of collaboration; 2) evaluate interprofessional and interorganizational collaboration in four health regions; and 3) propose a typology of collaboratio

Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

<p>Abstract</p> <p>Background</p> <p>The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care.</p> <p>Objectives</p> <p>In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The <b>goal </b>of the present research project is to track the <it>evolution </it>of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance.</p> <p>Methods/Design</p> <p>This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC.</p> <p>Discussion</p> <p>The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes.</p

International changes in end-of-life practices over time: a systematic review.

BACKGROUND: End-of-life policies are hotly debated in many countries, with international evidence frequently used to support or oppose legal reforms. Existing reviews are limited by their focus on specific practices or selected jurisdictions. The objective is to review international time trends in end-of-life practices. METHODS: We conducted a systematic review of empirical studies on medical end-of-life practices, including treatment withdrawal, the use of drugs for symptom management, and the intentional use of lethal drugs. A search strategy was conducted in MEDLINE, EMBASE, Web of Science, Sociological Abstracts, PAIS International, Worldwide Political Science Abstracts, International Bibliography of the Social Sciences and CINAHL. We included studies that described physicians' actual practices and estimated annual frequency at the jurisdictional level. End-of-life practice frequencies were analyzed for variations over time, using logit regression. RESULTS: Among 8183 references, 39 jurisdiction-wide surveys conducted between 1990 and 2010 were identified. Of those, 22 surveys used sufficiently similar research methods to allow further statistical analysis. Significant differences were found across surveys in the frequency of treatment withdrawal, use of opiates or sedatives and the intentional use of lethal drugs (X 2  > 1000, p < 0.001 for all). Regression analyses showed increased use of opiates and sedatives over time (p < 0.001), which could reflect more intense symptom management at the end of life, or increase in these drugs to intentionally cause patients' death. CONCLUSION: The use of opiates and sedatives appears to have significantly increased over time between 1990 and 2010. Better distinction between practices with different legal status is required to properly interpret the policy significance of these changes. Research on the effects of public policies should take a comprehensive look at trends in end-of-life practice patterns and their associations with policy changes