L’hôpital à l’épreuve de la performance économique : doctrines, instruments et hybridations des valeurs

L’optimisation des administrations publiques est un phénomène bien connu. Les politiques européennes convergent ces dernières années vers les mêmes solutions de réduction budgétaire pour l’ensemble des secteurs. Pensée unique et outils de contrôle semblent être les principaux leviers de cette révolution culturelle en dépit des nombreuses limites que rencontre la mise en œuvre des outils. L’introduction de logiques et d’outils du « new public management » interroge la concurrence de nouvelles valeurs avec celles qui fondent le service public. Or, la responsabilisation des professionnels et gestionnaires concernant l’utilisation de leurs ressources vient bouleverser à la fois les valeurs associées à la place, au rôle de l’hôpital, de même que les pratiques et le cadre des prises en charge.Optimization government is a known phenomenon. European policies converge to the same recent budget reduction solutions for all sectors. Single thought and control tools seem to be the main drivers of this cultural revolution despite many limitations faced by the implementation tools. The introduction of logic and tools of the « new public management » competition asks new values with those based on public service. Empowering professionals and managers regarding the use of their resources disrupts both the values associated with the place, the role of the hospital and practice

Des mutilations faciales handicap d’apparence et travail biographique des personnes atteintes de cancers au visage

Pendant des siècles les épidémies ont constitué les maladies dominantes de nos sociétés, marquant fortement l’imaginaire social. La maladie qui transforme le corps est visible ; la peste, la lèpre, la syphilis, la variole, marquent le corps à l’extérieur. Le corps malade d’antan c’est d’abord un corps devenu pour soi et pour les autres horrible à voir. Dans le cas des cancers, localisés au visage, il en va de même. Si la médecine dispose aujourd’hui de traitements permettant de faire vivre des personnes autrefois condamnées, il arrive que l’apparence du corps soit irrémédiablement marquée. La personne mutilée à la suite d’un cancer au visage doit alors apprendre à composer avec les limitations imposées par son nouvel état. La difformité tend à devenir pour l’individu défiguré une identité. Elle devient un attribut socialement discréditant et est un handicap d’apparence. En intégrant la défiguration à son histoire singulière, grâce au travail biographique et à la réhabilitation prothétique, l’individu défiguré et dévisagé va reconstruire son identité sociale.For centuries epidemics constituted the dominant diseases in our societies, leaving deep marks on the social imagination. A disease that transforms the body is visible : the plague, leprosy, syphilis and smallpox mark the outside of the body. The sick body of yesteryear was first of all a body that had, for oneself and for others, become horrible to look at. The same is true in the case of face cancers. Although medical treatments are available today that allow people to live who would formerly have died, it can happen that the appearance of the body is irreparably affected. A person who is disfigured following face cancer must learn to cope with the limitations imposed by their new state. The deformity tends to become an identity for the disfigured individual. In integrating the disfigurement into their own history, thanks to biographical work and prosthetic rehabilitation, the disfigured and stared-at individual is able to reconstruct their social identity

Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership

<strong>Background: </strong>Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). <p><br /><strong>Purpose: </strong>To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs.</p><p><br /><strong>Results: </strong>In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase.</p><p><br /><strong>Conclusion: </strong>The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements</p

Volume 98 Issue 5, pp. 899-1054

ECOLOGY-EPIDEMIOLOGY-BEHAVIOR Increased Surfacing Behavior in Longnose Killifish Infected by Brain-Encysting Trematode. B. L. FREDENSBORG and A. N. LONGORIA - 899 Spatial Structure of Helminth Communities in the Golden Grey Mullet, Liza aurata (Actinopterygii: Mugilidae), From the Western Mediterranean. RAUL MIGUEZ-LOZANO, TRINIDAD V. PARDO-CARRANZA, ISABEL BLASCO-COSTA, and JUAN ANTONIO BALBUENA - 904 Hepatozoon Infection Prevalence in Four Snake Genera: Influence of Diet, Prey Parasitemia Levels, or Parasite Type? BEATRIZ TOME, JOAD P. M. C. MAIA, and D. JAMES HARRIS - 913 ECTOPARASITOLOGY Molecular Identification and Description of the Female of Nothoaspis reddelli (Ixodida: Argasidae) From a Cave in Southeastern Mexico. CARMEN GUZMAN-CORNEJO, RICARDO PAREDES-LEON, MARCELO B. LABRUNA, SANTIAGO NAVA, and JOSE M. VENZAL - 918 Prevalence of Hemoproteus iwa in Galapagos Great Frigatebirds (Fregata minor) and Their Obligate Fly Ectoparasite (01- Jersia spiniJera). IRIS I. LEVIN and PATRICIA G. PARKER - 924 Variable Microsatellite Loci for Population Genetic Analysis of Old World Monkey Lice (Pedicinus sp.). KATLYN SCHOLL, JULIE M. ALLEN, FABIAN H. LEENDERTZ, COLIN A. CHAPMAN, and DAVID L. REED - 930 FUNCTIONAL MORPHOLOGY Ultrastructural Study of Vitellogenesis of Aphallus tubarium (Rudolphi, 1819) Poche, 1926 (Digenea: Cryptogonimidae), an Intestinal Parasite of Dentex dentex (Pisces: Teleostei). SAMUEL GREANI, YANN QUILICHINI, JOSEPHINE FOATA, and BERNARD MARCHAND - 938 IMMUNOLOGY Seroprevalence of Toxoplasma gondii Infection in Domestic Horses in Durango State, Mexico. C. ALVARADO-ESQUIVEL, S. RODRIGUEZ-PENA, I. VILLENA, and J. P. DUBEY - 944 INVERTEBRATE-PARASITE RELATIONSHIPS Excystation Signals Do Not Isolate Gregarine Gene Pools: Experimental Excystation of Blabericola migrator Among 11 Species of Cockroaches. SHELBY M. STEELE, DEBRA T. CLOPTON, and RICHARD E. CLOPTON - 946 LIFE CYCLES-SURVEY A New Sarcocystis Species (Apicomplexa: Sarcocystidae) From the Rock Gecko Bunopus tuberculatus in Saudi Arabi. A. S. ABDEL-BAKI, H. M. ABDEL-HALEEM, and S. AL-QURAISHY - 951 A Retrospective Study of Abattoir Condemnation Due to Parasitic Infections: Economic Importance in Ahwaz, Southwestern Iran. HASSAN BORJI, MOHAMMAD AZIZZADEH, and MEHRAB KAMELLI - 954 Prevalence of Eimeria Infection in Yaks on the Qinghai-Tibet Plateau of China. HUI DONG, CHUNHUA LI, QIPING ZHAO, JING LI, HONGYU HAN, LIANLIAN JIANG, SHUNHAI ZHU, TING LI, CHUNLIN KONG, BING HUANG, and JINZHONG CAI - 958 Prevalence of Coccidial Infection in Dairy Cattle in Shanghai, China. HUI DONG, QIPING ZHAO, HONGYU HAN, LIANLIAN JIANG, SHUNHAI ZHU, TING LI, CHUNLIN KONG, and BING HUANG - 963 Genetic Sequence Data Identifies the Cercaria of Drepanocephalus spathans (Digenea: Echinostomatidae), a Parasite of the Double-Crested Cormorant (Phalacrocorax auritus), with Notes on Its Pathology in Juvenile Channel Catfish (Ictalurus punctatus). MATT J. GRIFFIN, LESTER H. KHOO, SYLVIE M. QUINIOU, MARY M. O\u27HEAR, LINDA M. POTE, TERRENCE E. GREENWAY, and DAVID J. WISE - 967 SYSTEMATICS-PHYLOGENETICS A New Species of Megalobatrachonema (Nematoda: Kathlaniidae) in Fojia bumui (Squamata: Scincidae) From Papua New Guinea. CHARLES R. BURSEY, STEPHEN R. GOLDBERG, and FRED KRAUS - 973 Two New Species of Schizorchis (Cestoda: Anoplocephalidae) From Leporids (Lagomorpha: Leporidae) in China. KUIZHENG CAI, JIALIN BAI, and SHIEN CHEN - 977 The Genus Guerrerostrongylus (Nematoda: Heligmonellidae) in Cricetid Rodents From the Atlantic Rain Forest of Misiones, Argentina: Emended Description of Guerrerostrongylus zetta (Travassos, 1937) and Description of a New Species. MARIA CELINA DIGIANI, JULIANA NOTARNICOLA, and GRACIELA T. NAVONE - 985 A New Microphallid (Digenea) Species From Lontra provocax (Mammalia: Mustelidae) From Freshwater Environments of Northwestern Patagonia (Argentina). VERONICA R. FLORES, NORMA L. BRUGNI, and CARLA M. POZZI - 992 Description of Riouxgolvania kapapkamui sp. n. (Nematoda: Muspiceoidea: Muspiceidae), a Peculiar Intradermal Parasite of Bats in Hokkaido, Japan. HIDEO HASEGAWA, MASAHIKO SATO, KISHIO MAEDA, and YOSHIKO MURAYAMA - 995 A New Species of Choleoeimeria (Apicomplexa: Eimeriidae) From Meller\u27s Chameleon, Trioceros melleri (Sauria: Chamaeleonidae). CHRIS T. McALLISTER - 1001 A New Species of Eimeria (Apicomplexa: Eimeriidae) From the Northern Myotis, Myotis septentrionalis (Chiroptera: Vespertilionidae), in Oklahoma. CHRIS T. McALLISTER, R. SCOTT SEVILLE, and ZACHARY P. ROEHRS - 1003 A New Spirurid (Nematoda) Parasite From Mormoopid Bats in Mexico. JORGE LUIS PERALTA-RODRIGUEZ, JUAN MANUEL CASPETA-MANDUJANO, and JOSE ANTONIO GUERRERO - 1006 THERAPEUTICS-DIAGNOSTICS Resistance of Rhipicephalus microplus to Amitraz and Cypermethrin in Tropical Cattle Farms in Veracruz, Mexico. AGUSTIN FERNANDEZ-SALAS, ROGER IVAN RODRIGUEZ-VIVAS, and MIGUEL ANGEL ALONSO-DIAZ - 1010 RESEARCH NOTES Seroprevalence Study on Theileria equi and Babesia caballi Antibodies in Horses From Central Province of Saudi Arabia. A. D. ALANAZI, M. S. ALYOUSIF, and M. M. HASSIEB - 1015 Influence of Rangelia vitalii (Apicomplexa: Piroplasmorida) on Copper, Iron and Zinc Bloodstream Levels in Experimentally Infected Dogs, ALEKSANDRO S, DA SILVA, RAQUELI T. FRANC;:A, MARCIO M. COSTA, CARLOS B. V. PAIM, FRANCINE C. PAIM, CLARISSA M. M. SANTOS, ERICO M. M. FLORES, TIAGO L. EILERS, CINTHIA M. MAZZANTI, SILVIA G. MONTEIRO, CARLOS H. DO AMARAL, and SONIA T. A. LOPES - 1018 Plagiorchis elegans (Trematoda) Induces Immune Response in an Incompatible Snail Host Biomphalaria glabrata (Pulmonata: Planorbidae). S. P. DAOUST, M. E. RAU, and J. D. McLAUGHLIN - 1021 Prevalence and Intensity of Fish-Borne Zoonotic Trematodes in Cultured Freshwater Fish From Rural and Urban Areas of Northern Vietnam. NGUYEN VAN DE, THANH HOA LE, and K. D. MURRELL - 1023 Details of the Paranephridial System of a Species of Prohyptiasmus (Cyclocoelidae: Hyptiasminae) From an American Coot, Fulica americana (Rallidae) in Oklahoma. NORMAN O. DRONEN, F. AGUSTIN JIMENEZ, and SCOTT L. GARDNER - 1026 Surface Ultrastructure of the Eggs of Malacopsylla grossiventris and Phthiropsylla agenoris (Siphonaptera: Malacopsyllidae). M. C. EZQUIAGA and M. LARES CHI - 1029 Prevalence of Ancylostoma braziliense in Cats in Three Northern Counties of Florida, United States. JANICE L. LIOTTA, KHUANCHAI N. KOOMPAPONG, JOSEPH P. YAROS, JOSEPH PRULLAGE, and DWIGHT D. BOWMAN - 1032 Obtaining an Isolate of Ancylostoma braziliense From Dogs Without the Need for Necropsy. JANICE L. LIOTTA, ALICE C. Y. LEE, SARP AKSEL, IBRAHIM ALKHALIFE, ALEJANDRO CRUZ-REYES, HEEJEONG YOUN, STEPHEN E. BIENHOFF, and DWIGHT D. BOWMAN - 1034 Obtaining an Isolate of Ancylostoma braziliense From Cats Without the Need for Necropsy. JANICE L. LIOTTA, ALICE C. Y. LEE, KHUANCHAI N. KOOMPAPONG, JOSEPH P. YAROS, JOSEPH PRULLAGE, MICHAEL A. ULRICH, and DWIGHT D. BOWMAN - 1037 Prevalence of Ancylostoma braziliense in Dogs From Alachua and Marion Counties, Florida, United States. JANICE L. LIOTTA, HEEJEONG YOUN, SARP AKSEL, STEPHEN E. BIENHOFF, and DWIGHT D. BOWMAN - 1039 Morphological Differentiation of Eggs of Ancylostoma caninum, Ancylostoma tubaeforme, and Ancylostoma braziliense From Dogs and Cats in the United States. ARACELI LUCIO-FORSTER, JANICE L. LIOTTA, JOSEPH P. YAROS, KAITLYN R. BRIGGS, HUSSNI O. MOHAMMED, and DWIGHT D. BOWMAN - 1041 Molecular and Immunological Characterization of a Novel 32-kDa Secreted Protein of Babesia microti. HIDEO OOKA, MOHAMAD A. TERKAWI, SHINUO CAO, GABRIEL ABOGE, YO UN-KYOUNG GOO, YUZI LUO, YAN LI, YOSHIFUMI NISHIKAWA, IKUO IGARASHI, and XUENAN XUAN - 1045 DNA Barcoding of Schistosome Cercariae Reveals a Novel Sub-Lineage within Schistosoma rodhaini From Ngamba Island Chimpanzee Sanctuary, Lake Victoria. C. J. STANDLEY and J. R. STOTHARD - 1049 Host Susceptibility Is Altered by Light Intensity After Exposure to Parasites. MICHELLE L. STEINAUER and KAITLIN M. BONNER - 1052 ANNOUNCEMENT: Change in Editorship - 903 ERRATUM - 91

Avant-propos : Ce que les indicateurs qualité nous disent des politiques publiques et de la profession médicale?

National audienceLe lecteur trouvera rassemblés dans ce dossier cinq travaux qui par-delà leur diversité d’approche examinent des processus dans et par lesquels la qualité se définit et se construit relativement à des instruments, des professions ou des politiques donnés. La qualité recouvre un ensemble hétérogène de dispositifs concrètement à l’œuvre dans le domaine de la santé. L’évaluation de la qualité est aujourd’hui fortement liée aux politiques publiques et se rattache à ces technologies de pilotage à distance par lesquelles les États contemporains orientent, régulent et contrôlent l’activité du secteur public...(Aperçu du texte