André-Pierre Contandriopoulos

Quality of life of subjects with occupational asthma

BACKGROUND The aim of the study was to assess the quality of life in subjects with occupational asthma after removal from exposure to the offending agent by comparison with a group of subjects paired for clinical and functional indices in order to show the separation between the two groups of subjects with a hypothesized different quality of life and relate the impairment in quality of life to anthropometric, clinical, and functional variables. METHODS A previously described asthma quality of life questionnaire (Juniper EF, et al. Thorax 1992;47:76-83) was administered to two groups of subjects in a prospective manner. Information on the clinical and functional severity of asthma was obtained from each subject. Two groups of subjects were assessed: group 1, 134 subjects with occupational asthma who were seen more than 2 years after the diagnosis was confirmed, and group 2, 91 subjects who were seen in specialized asthma clinics of tertiary care hospitals for treatment of nonoccupational asthma and matched with 91 of the 134 subjects with occupational asthma from group 1 according to need for medication and (when available), baseline forced expiratory volume in 1 second (FEV1), and level of bronchial responsiveness. RESULTS A statistically significant difference was seen in the four domains (asthma symptoms, limitation of activities, emotional dysfunction, environmental stimuli) and in the total score of the quality of life questionnaire between the two groups of matched subjects; the mean difference in the total score was 0.6 on a scale of 1 (no limitation or none of the time) to 7 (severe limitation or all the time). A weak but statistically significant correlation between the total score and several indices (FEV1, bronchial responsiveness and asthma severity) was generally obtained. CONCLUSION The quality of life of subjects with occupational asthma is slightly less satisfactory than that of subjects paired for clinical and functional indices, although the magnitude of the difference is small; and quality of life is weakly correlated with clinical and functional indices.

Accreditation: a tool for organizational change in hospitals?

Examines the dynamics of change that operated following preparations for accreditation. The study was conducted from May 1995 to October 2001 in a university hospital center in France after the introduction in 1996 of mandatory accreditation. An embedded explanatory case study sought to explore the organizational changes: a theoretical framework for analyzing change was developed; semi-structured interviews, focus groups, and questionnaires addressed to the hospitals professionals were used and documents were collected; and qualitative and quantitative analyses were carried out. Professionals from clinical and medico-technical departments participated most. Preparations for accreditation provided an opportunity to reflect non-hierarchically on the treatment of patients and on the hospitals operational modalities by creating a locus for exchanges and collegial decision making. These preparations also led to giving greater consideration to results of exit surveys and to committing procedures to paper, and were a key opportunity for introducing a continuous quality program.

Avaliando a institucionalização da avaliação

O artigo aborda os desafios em torno da necessidade de conceber e implantar uma cultura de avaliacao. Sao discutidas as relacoes e diferencas entre pesquisa avaliativa, avaliacao normativa e tomada de decisao. A analise mostra que a capacidade de institucionalizacao da avaliacao como instrumento para melhorar o sistema de saude e paradoxal, pois supoe que a informacao produzida contribua para uma racionalizacao dos processos de decisao. Postula-se que o grau em que os resultados de uma avaliacao sao levados em conta pelas instâncias decisorias varia de acordo com a credibilidade, fundamentacao teorica e pertinencia das avaliacoes. Observa-se que atores que ocupam diferentes posicoes nao conseguem chegar a um consenso quanto a pertinencia dos resultados produzidos pela avaliacao. Para fazer com que a avaliacao esteja no cerne das estrategias de transformacao do sistema de saude, sugere-se criar condicoes para um julgamento avaliativo verdadeiramente critico, com a implementacao de estrategias que favorecam a formacao e o aprendizado, o debate, a reflexao e a abertura de novas frentes de intervencao. Institucionalizar a avaliacao implica antes de tudo se questionar a capacidade da avaliacao de produzir as informacoes e julgamentos necessarios para ajudar as instâncias decisorias a melhorar o desempenho do SUS.

Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast

At the beginning of the 1990s, health service reforms were implemented in public health institutions in most African countries South of the Sahara. In the Ivory Coast, the imposition of user fees for public services was adopted in 1994. Such fees require each person to have adequate financial resources in order to access modern health care services. Many poor people--despite their poverty--are able to access modern health care services that have become quite expensive. The factor that allows this access lies within the solidarity of parents, friends or members of a social network. In Africa, illness is a social phenomenon and a state of illness is negative. The sick human being is one who cannot fully participate in community life. The treatment of a sick person is, then, an act, which is tied to the systems of life, which are produced and maintained collectively. Once the causes of illness are identified and consequences evaluated, it is the entire family or group that participates in the finances which bring about treatment. In this study, we show the role of social capital in the processes of financial solidarity for access to modern health care services that now require payment. Our investigation provides valuable insights on the role of social capital with respect to social strategies and community financing mechanisms for the acquisition of modern health care in Africa.

A comparative trial of home and hospital psychiatric treatment: financial costs.

The financial costs of community-based treatment, stressing home treatment, were compared with the cost of hospital-based treatment during one year. Of 155 patients destined to receive inpatient treatment, 76 were randomly assigned to home treatment, 79 to hospital treatment; the two groups were similar as to important social, demographic, and clinical characteristics. The principal differences between the two treatments concerned the focus of treatment, the locale of treatment, the degree to which continuity of treatment was maintained, and the roles of the respective treatment staffs. Manpower and operating costs, measured in dollars, were estimated in two ways. Either way, hospital-based treatment was more expensive during the year: 64.1% more expensive (

Gender and the social context of smoking behaviour

3,250 vs.

Paradoxes of French accreditation

1,980 per patient) in the first instance, 108.9% more expensive (

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

6,750 vs.

Occurrence and risk factors of oral candidiasis treated with oral antifungals in seniors using inhaled steroids

3,230 per patient) in the second. With two exceptions during the first month of treatment, the proportions of patients and families receiving either treatment who incurred other costs of treatment were low, and the differences between groups were not significantly different. A higher proportion of patients and families receiving home-based treatment defrayed the cost of the patients psychotropic drugs; second, a higher proportion of families of patients receiving hospital-based treatment defrayed transportation costs. The proportions of patients and families incurring costs of the consequences of illness were low, and the differences between treatment groups were not significant. We compared this study with similar studies, discussed the generalizability of the results of this study and similar studies, and identified issues for future research.

Cost Utility of Chemotherapy and Best Supportive Care in Non-Small Cell Lung Cancer

This paper examines the relative effect of both individual and societal factors that impinge directly on smoking behaviour of women and men. The societal factors are cigarettes price, tobacco control legislation, newspaper coverage of tobacco issues, overall economic factors, and social milieu characteristics. Three Canadian provinces are studied, from 1978 to 1995. A repeated cross-section design is used. Data are derived from national surveys and official documents. Results show that smoking occurs in social contexts within which the price of cigarettes appears to have a significant negative impact on the prevalence of smoking and the quantity of cigarettes smoked by men, but no effect on either the prevalence of smoking or the amount smoked by women. More comprehensive and restrictive no-smoking legislation and legislation on youth access to tobacco influence negatively the prevalence of smoking both for men and women. However, these laws do not have the same effects on the number of cigarettes smoked by women and men. Newspaper articles on the other hand, negatively influence smoking prevalence for women and men. As differences are observed in the responsiveness of men and women to tobacco control policies, policymakers and practitioners need to keep in mind that tobacco control policies have to be tailored to the broader context of the lives of women and men. Future work needs also to be done to clarify the interrelationships between social influences on smoking such as price, laws and media, and the relationships between these and intrapersonal and interpersonal factors, as well as other social and cultural factors.