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Biomedical subjects

R Pineault

Publications and source records attributed to R Pineault.

At least 37 records · Page 2Linked to original sources
PubMed1993

The reform of the Quebec health care system: potential for innovation?

The recent reform of the health care system in Quebec can be viewed as the result of a continuous process that originated with the first reform launched in the early 70s. The reform focuses on three elements: decentralization, citizen participation, and outcome-centered management. The context in which the reform is being launched contains both favorable conditions and obstacles to its successful implementation.

Community Health Services↗
PubMed1992

[Psychosocial factors influencing the intention of women infected with HIV to have a child: study of 12 cases].

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 III, their fear of transmitting the infection and the idea of losing a child to AIDS.

Adult↗
PubMed1991

Structural and political models of analysis of the introduction of an innovation in organizations: the case of the change in the method of payment of physicians in long-term care hospitals.

This article presents the results of a study on the introduction of sessional fees remuneration for physicians working in Quebec long-term care hospitals. More generally, this research was concerned with the determinants of the capacity of an organization to implement an innovation. Both a political and a structural model of analysis were empirically probed. We found strong support for the political model and moderate support for the structural model. This article contributes to the understanding of the relative contribution of structural and political determinants in the implementation of changes in organizations.

Family Practice↗
PubMed1991

Characteristics of physicians practicing in alternative primary care settings: a Quebec study of local community service center physicians.

Since the early 1970s, there have been two primary care networks in Quebec: the traditional one characterized by private practice remunerated on a fee-for-service basis, and the public one comprising 15 percent of physicians and characterized by salaried practice within publicly funded local community health service centers (CLSCs). Using data collected on 616 Quebec generalists, 333 in private practice and 283 in CLSCs, we compared physicians' profiles in both networks. In contrast to their colleagues in private practice, CLSC physicians are younger, more often women, and more often graduates of innovative primary care training programs. They are more sensitive to the biopsychosocial nature of health problems and to giving patients an active role in their care. Significant differences were also observed in physicians' self-reported clinical practices, more so for women than for men. The study suggests that alternative primary care settings attract physicians that are more preventive and socially oriented. As a result, they may contribute to the emergence of a more comprehensive type of medical practice in health care delivery systems.

Adult↗
PubMed1990

Effects of patient, physician and hospital characteristics on the likelihood of vaginal birth after previous cesarean section in Quebec.

Repeat cesarean section is a major factor contributing to the rising cesarean section rate. Although vaginal birth after a previous cesarean section (VBAC) is advocated in most cases, it has not yet been adopted as widespread policy. In a case-control study we compared 400 women in Quebec who underwent VBAC with 1600 women who had a repeat cesarean section from 1985 to 1987 in an attempt to identify factors that favour vaginal delivery. Using both simple and multiple logistic regression analyses we examined the effect of independent variables linked to the patients (two variables), the attending physicians (seven) and the hospitals (two) on the dependent variable (type of birth) with the use of odds ratios. We found that the physician characteristics related to type of practice and the degree of hospital specialization were significant factors in predicting the type of delivery. Women who gave birth vaginally were more likely than those who had a repeat cesarean section to be attended by a physician with a specialized practice and to give birth in a hospital providing an intermediate or high level of care. This suggests that VBAC is still perceived as a high-risk option and is managed by only a minority of specialized obstetricians.

Adult↗
PubMed1990

Content and methods of studies on the prevention and treatment of mental disorders in selected psychiatric journals.

Studies on psychiatric treatments published in 1986 were reviewed in five major psychiatric journals (Am. J. Psychiatry, Can. J. Psychiatry, Arch. Gen. Psychiatry, Am. J. Orthopsychiatry and Am. Acad. Child Psychiatry). Articles on prevention and treatment represent only 27% of the total of titles (194 out of 731 articles). The studies reviewed focus mostly on the treatment of adults, on psychoses, on the short term effect of treatment and on the effect of treatment rather than its process. Almost no information is published on the evaluation of the process or on the cost of treatment. Studies are for the most part original, but they tend to be studies without controls rather than randomized or non-randomized controlled trials. Interpretation of results rely essentially on statistical significance and almost no attention is paid to the evaluation of impact, in epidemiological terms, of the cause-effect relationship and to the clinical relevance of observed differences. Psychiatrists who read only a few major journals of psychiatry should get more information on therapeutic and preventive interventions in comparison to other components of clinical work and to clinical course of disease.

Humans↗
PubMed1989

An integrative framework for health-related research.

Research on the manifold aspects of health and health-care delivery, economics and administration has expanded rapidly in recent years and now engages a number of disciplines. The array of theories, methods, and analytical strategies derived from such diverse sources frequently impedes effective communication between investigators and sometimes renders it impossible. We propose a conceptual framework that encompasses all health-related research and demonstrates the relationships and interfaces between the various disciplines involved. The framework emerges from a classification of health-related research into studies of health states or health interventions followed by consideration of the level of analysis (e.g. cell, individual, community) employed and the purpose of each study (development, description, explanation, or evaluation).

Delivery of Health Care↗
PubMed1989

Do conventional and innovative medical schools recruit different students?

A mail questionnaire was used to survey the social and demographic characteristics, educational background, attitudinal profiles and expected career choice of 243 first-year students enrolled in three US medical schools. The aim was to determine whether different types of schools selected different types of students. Two schools were considered as conventional whereas one school was considered as innovative both in its admission policies and in its curriculum which emphasizes a biopsychosocial approach to health care. The survey achieved an 84% response rate. The results showed no difference in students' career expectations. Students recruited in the innovative school, however, differed from students recruited in the conventional schools with regard to their social and demographic characteristics, educational background and attitudinal profiles. This study suggests that as some medical schools are innovating in their curriculum and admission policies, new types of medical students are entering medicine. Implications of these results are discussed.

Adult↗
PubMed1988

[The use of large morbidity data bases in the evaluation of health services].

The major developments of recent years in computer sciences have led to the creation of large morbidity data bases. Although these data sets are not compiled expressly for research, they serve researchers if certain precautions are taken. These concern definition of the study population, unit of analysis, record linkage and both reliability and validity of the data.

Canada↗
PubMed1987

Quality of care in public health well child clinics: a neglected issue.

The process of well child care in public health clinics was evaluated using a peer review approach based on explicit criteria formulated by the peers themselves. The criteria defined what should be done in order to ensure good preventive care during a client-provider encounter. The data from this study suggest that the traditional goals of public health are being pursued, but that a broader spectrum of preventive care, including attention to the child's psychosocial development, is still lacking.

Child↗
PubMed1987

The influence of medical school programs on physicians' attitudes toward universal access to medical care.

The extent to which medical education influences physicians' attitudes toward the issue of universal access to medical care was studied. Data were obtained from a survey of graduates from three medical schools with differing orientations. The first school could be described as traditional and highly research-oriented; the second as also traditional but more middle-of-the-road in its curriculum content; and the third as more social and primary care-oriented. Our results indicated that graduates from the more socially-oriented medical school were significantly more positive in their attitudes about the universality of the medical care issue than were graduates of the more traditional medical schools. The medical school effect vanished completely, however, when differences in personal characteristics among the three groups of graduates, namely, sex and interest in social sciences, were taken into account. Such findings support the hypothesis that the medical school effect can be explained to a greater extent by differences in medical student recruitment than by differences in medical school curricula. They also limit the expectations of those who advocate changes in medical curricula as a mean of inducing more favorable attitudes toward progressive medical care approaches in tomorrow's physicians.

Attitude of Health Personnel↗
PubMed1987

[The relation between unemployment and health : a prospective study : brief presentation and preliminary results of a study.].

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.

English Abstract↗
PubMed1987

[Diarrheal diseases treated at the health center of Kalaa-Kebira (Sousse-Tunisia)].

Diarrheal diseases of children constitute a public health problem in Tunisia because of their frequency as well as their association with malnutrition. A national programme for diarrheal diseases control was instituted in 1980. This study focuses on a local health center (the PMI of Kalaa-Kebira in an effort to assess the magnitude of diarrheal diseases of children in 1985, and to see to what extent goals and recommendations of the national programme have been attained.

Anti-Bacterial Agents↗