La politique de santé mentale et la communautarisation des services

Dans cet article, la politique de santé mentale est vue comme un élément charnière de la réforme des « services psychiatriques » amorcée au Québec dans les années 70. Nous y faisons l'hypothèse que le discours communautaire a joué un rôle fondamental dans cette réforme et qu'il en a lui-même été profondément affecté. Dans cette perspective, les effets de la politique et de la réforme sont discutés suivant un double point de vue, celui des formes de la communautarisation des services et celui du destin du discours communautaire dans le cours du processus de réforme.In this article, the mental health policy is viewed as a pivotal element of the "psychiatric services" reform which began in Québec in the seventies. The authors advance the hypothesis that the community approach has played a fundamental role in developing the reform and that it has itself undergone deep changes. As a result, the policy's and the reform's effects are discussed from two angles, namely that of the communitization of services and that of the direction taken by the community approach during the reform process

Ressources alternatives et structures intermédiaires dans le contexte québécois

Au Québec, un consensus semble se dégager ces dernières années sur le besoin de développer des ressources communautaires en santé mentale. Cependant, le concept de ressources communautaires est fragmenté : il y a une distinction à établir, sur le plan conceptuel, entre ressources alternatives et structures intermédiaires. Les deux types de ressources agissent hors les murs des institutions, mais leurs objectifs sont différents de même que les moyens qu'elles proposent pour le soutien dans la communauté des personnes souffrant de problèmes de santé mentale. Les tentatives pour rendre ces concepts opérationnels tendent à avoir pour effet de masquer leurs différences conceptuelles. La nouvelle politique de santé mentale du Québec, adoptée en janvier 1989, parle de "ressources communautaires" seulement et leur donne un mandat qui ne reflète pas la divergence conceptuelle entre les organisations patronnées par le réseau, et celles qui contestent la domination du réseau. Cela peut entraîner une limitation des types de services qui seront offerte au sein de la communauté, dans le contexte de la nouvelle politique.In Québec, a consensus appears to have developed over the last few years around the need to develop community-based resources in mental health. However, the concept of community resources is fragmented: there is a conceptual distinction between Alternative and Intermediary Resources, both of which are located outside the walls of the institution, but which have different objectives, and suggest different means for supporting the mentally disturbed in the community. Attempts to operationalize these concepts have tended to have the effect of masking their conceptual particularity. In this article, the conceptual distinctions - as they have developed in the Québec context - are clarified, and the implications of erasing them are discussed

Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool

Abstract Background The awakening and breathing coordination, delirium, and early mobility (ABCDE) bundle is a multicomponent complex intervention that improves outcomes for critically ill adults yet is inconsistently implemented. Effective interprofessional team function (how the team interacts) is key to ABCDE delivery but little is known about how to measure team interactions. The purpose of our study was to examine the reliability of an observational rating tool to assess team interactions about ABCDE in one ICU. Results We pilot tested and evaluated reliability of an observational rating tool to assess team interactions about ABCDE. Two independent raters used this tool in one medical ICU over 4 weeks during morning rounds. We examined which ABCDE components were addressed, which team members initiated interactions, and which participated in interactions about ABCDE. We evaluated inter-rater reliability using Cohen’s kappa statistic and data from interprofessional team interactions for 23 patients. We demonstrated moderate to substantial reliability for whether breathing, coordination, delirium or early mobility were addressed (k = 0.48–0.78) and slight to fair reliability for which team members initiated interactions about ABCDE (0.18–0.40). Reliability was low for whether Awakening was addressed (k = −0.07) and for which team members initiated interactions about awakening (k = 0.05). Conclusions Our study provides pilot evidence of reliability of an observational rating tool to assess interprofessional team interactions about ABCDE. Future work should further test and modify this tool to gain an understanding of how to use team interactions to improve ABCDE delivery.http://deepblue.lib.umich.edu/bitstream/2027.42/134632/1/13104_2016_Article_2213.pd

Synergistic Embryotoxicity of Polycyclic Aromatic Hydrocarbon Aryl Hydrocarbon Receptor Agonists with Cytochrome P4501A Inhibitors in Fundulus heteroclitus

Widespread contamination of aquatic systems with polycyclic aromatic hydrocarbons (PAHs) has led to concern about effects of PAHs on aquatic life. Some PAHs have been shown to cause deformities in early life stages of fish that resemble those elicited by planar halogenated aromatic hydrocarbons (pHAHs) that are agonists for the aryl hydrocarbon receptor (AHR). Previous studies have suggested that activity of cytochrome P4501A, a member of the AHR gene battery, is important to the toxicity of pHAHs, and inhibition of CYP1A can reduce the early-life-stage toxicity of pHAHs. In light of the effects of CYP1A inhibition on pHAH-derived toxicity, we explored the impact of both model and environmentally relevant CYP1A inhibitors on PAH-derived embryotoxicity. We exposed Fundulus heteroclitus embryos to two PAH-type AHR agonists, β-naphthoflavone and benzo(a)pyrene, and one pHAH-type AHR agonist, 3,3′,4,4′,5-pentachlorobiphenyl (PCB-126), alone and in combination with several CYP1A inhibitors. In agreement with previous studies, coexposure of embryos to PCB-126 with the AHR antagonist and CYP1A inhibitor α-naphthoflavone decreased frequency and severity of deformities compared with embryos exposed to PCB-126 alone. In contrast, embryos coexposed to the PAHs with each of the CYP1A inhibitors tested were deformed with increased severity and frequency compared with embryos dosed with PAH alone. The mechanism by which inhibition of CYP1A increased embryotoxicity of the PAHs tested is not understood, but these results may be helpful in elucidating mechanisms by which PAHs are embryotoxic. Additionally, these results call into question additive models of PAH embryotoxicity for environmental PAH mixtures that contain both AHR agonists and CYP1A inhibitors

Use of relevailles : relevailles and intersectoral collaborations : brief report.

In the interest of population-based responsibility, health and social services establishments (HSSEs) are expected to establish more working partnerships with organismes communautaires Famille (OCF – community-based family organizations). Some OCFs offer a service called ‘relevailles,’ which consists of providing a home-visiting postnatal support program that adapts to the needs of each family, in order to listen, encourage, inform, and support day-to-day organization. The use and impacts of this service, as well as the collaborations surrounding its implementation in local networks of services provided by health and social services establishments, remain largely unknown

Evaluation of intersectoral collaborations : "Relevailles" and intersectoral collaborations. Brief Report.

HIGHLIGHTS • In 3 of the 4 cases, the key actor in the collaborative network was the OCF coordinator/liaison officer. • All the networks were vulnerable to the departure of a key actor. • Collaborative networks did not include any perinatal assistants. • 35 of the 37 HSSE actors involved in collaborative networks belonged to a local community services centre (CLSC), even when there was a birthing hospital or birthing centre in the HSSE. • Five determinants contributed to or constrained intersectoral collaborations between OCFs and HSSEs. • Sufficiency of resources, knowledge of the partner organization, and complementarity/flexibility in the delivery of services were determinants of collaborations. • Six modes of OCF/HSSE collaboration were identified. • There are few formal mechanisms for collaboration between organizations. • Disagreements/misunderstandings on the mechanisms for sharing information about families occurred between organizations and even within organizations. • Some parents perceived links between OCFs and CLSCs as falling into two modes of collaboration, namely 1) activating the request/recourse to partner organization services and 2) coordinating the services provided to families

Évaluation des collaborations intersectorielles : relevailles et collaborations intersectorielles : rapport bref.

Dans une optique de responsabilité populationnelle, les établissements de santé et de services sociaux (ÉSSS) sont appelés à travailler davantage en partenariat avec les organismes communautaires Famille (OCF). Certains OCF offrent un service de relevailles qui consiste à offrir un soutien postnatal à domicile qui s’adapte aux besoins de chaque famille, afin d’écouter, d’encourager, d’informer et de soutenir l’organisation du quotidien. L’utilisation et les impacts de ce service demeurent largement méconnus, de même que les collaborations entourant sa mise en œuvre à même les réseaux locaux de services des établissements de santé et de services sociaux

Utilisation des relevailles : relevailles et collaborations intersectorielles : rapport bref

Dans une optique de responsabilité populationnelle, les établissements de santé et de services sociaux (ÉSSS) sont appelés à travailler davantage en partenariat avec les organismes communautaires Famille (OCF). Certains OCF offrent un service de relevailles qui consiste à offrir un soutien postnatal à domicile qui s’adapte aux besoins de chaque famille, afin d’écouter, d’encourager, d’informer et de soutenir l’organisation du quotidien. L’utilisation et les impacts de ce service demeurent largement méconnus, de même que les collaborations entourant sa mise en œuvre à même les réseaux locaux de services des établissements de santé et de services sociaux. BUT ET OBJECTIFS But : Évaluer les services de relevailles offerts par quatre OCF et les collaborations intersectorielles qu’ils partagent avec les ÉSSS en vue de consolider les services en période postnatale. Objectifs spécifiques : 1) Évaluer le profil d’utilisation des relevailles offertes par les OCF en termes de continuité, de productivité et de globalité; 2) Explorer les variations d’utilisation des relevailles en fonction des caractéristiques organisationnelles des OCF, des caractéristiques des familles utilisatrices et des besoins exprimés lors de l’inscription aux relevailles. FAITS SAILLANTS • Les OCF desservent une clientèle aux statuts socio-économiques variés présentant principalement des besoins de répit et de soutien pour s’occuper du bébé. Notons que 64 % ont plus d’un enfant, que l’âge moyen du bébé à l’inscription est de 3,6 mois et que 46 % des parents sont informés du service par un professionnel de la santé. • La classification des activités de relevailles en 4 profils permet de situer la spécificité du service et la globalité des tâches réalisées à domicile par les assistantes périnatales. Cela ouvre à une meilleure complémentarité avec le secteur de la santé. • En moyenne, il y a 89 jours entre la première et la dernière visite de relevailles avec un nombre moyen de 9,2 visites par famille. La continuité relationnelle très élevée est un atout pour le développement de liens de confiance. • Malgré un nombre limité d’assistantes périnatales par OCF, la productivité ramenée au plan de la famille se situe autour de 4 visites par mois. • L’utilisation des relevailles est principalement associée aux caractéristiques, prises individuellement, des organisations et à celles des familles. Aucune des variables étudiées ne permet de prédire l’utilisation des relevailles

Retombées auprès des familles utilisatrices : relevailles et collaborations intersectorielles : rapport bref.

Dans une optique de responsabilité populationnelle, les établissements de santé et de services sociaux (ÉSSS) sont appelés à travailler davantage en partenariat avec les organismes communautaires Famille (OCF). Certains OCF offrent un service de relevailles qui consiste à offrir un soutien postnatal à domicile qui s’adapte aux besoins de chaque famille, afin d’écouter, d’encourager, d’informer et de soutenir l’organisation du quotidien. L’utilisation et les impacts de ce service demeurent largement méconnus, de même que les collaborations entourant sa mise en œuvre à même les réseaux locaux de services des établissements de santé et de services sociaux

Intergenerational Transmission of Multiple Problem Behaviors: Prospective Relationships between Mothers and Daughters

Much of the research examining intergenerational continuity of problems from mother to offspring has focused on homotypic continuity (e.g., depression), despite the fact that different types of mental health problems tend to cluster in both adults and children. It remains unclear whether mothers with multiple mental health problems compared to mothers with fewer or no problems are more likely to have daughters with multiple mental health problems during middle childhood (ages 7 to 11). Six waves of maternal and child data from the Pittsburgh Girls Study (n = 2,451) were used to examine the specificity of effects of maternal psychopathology on child adjustment. Child multiple mental health problems comprised disruptive behavior, ADHD symptoms, depressed mood, anxiety symptoms and somatic complaints, while maternal multiple mental health problems consisted of depression, prior conduct problems and somatic complaints. Generalized Estimating Equations (GEE) was used to examine the prospective relationships between mother’s single and multiple mental health problems and their daughter’s single and multiple mental health problems across the elementary school-aged period (ages 7–11 years). The results show that multiple mental health problems in the mothers predicted multiple mental health problems in the daughters even when earlier mental health problem of the daughters, demographic factors, and childrearing practices were controlled. Maternal low parental warmth and harsh punishment independently contributed to the prediction of multiple mental health problems in their daughter, but mediation analyses showed that the contribution of parenting behaviors to the explanation of girls’ mental health problems was small