[Relationship between preoperative delay in hip fractures, postoperative complications and risk of death]. / Relation entre le délai pré-opératoire pour une fracture de hanche, les complications post-opératoires et le risque de décès.

The objective was to describe the relationship between preoperative delay, postoperative complications, and risk of death at 6 months. The population is constituted of 200 subjects aged 65 years or older who were living at home and treated for a hip fracture in any of three of Québec's hospitals between April, 1st, 1987 and March, 31, 1989. Chi-square or F-test, and linear and logistic regression were used to test the relationship between the variables. Preoperative delays varied from 2 to 403 h (median, 45 h). Variations between hospitals were particularly important; median delay at hospital 1 was 109 h, at hospital 2, 36 h, at hospital 3, 30.5 h. Only 5% of the variance of the delay was explained by the subjects' characteristics before the fracture. The relationships between delay and postoperative complications are not significant. However, the risk of death at 6 months increased with the length of operative delay; the observed increase tends to be linear (p = 0.03). These results suggest first, that surgery for hip fracture had to be consider as an urgency, second, that it could be done 36 hours or less after the arrival at hospital.

[The effect of health care settings on children's immunization status]. / Impact des organisations de services sur l'état vaccinal des enfants.

The objective of this study was to determine the effect of practice settings (CLSC and private office) and family characteristics (mother's age and education, children's rank in families) on children's immunization status and adherence to the immunization schedule. The study population was composed of 209 children born in 1991 and residing in the Regional Municipal County of Montmagny, Quebec. After adjusting for mother's education, those children vaccinated in a private office were at 13.3 times higher risk for incomplete immunization than those vaccinated in a CLSC. A similar but nonsignificant result was obtained regarding adherence to the immunization schedule. The factors likely to account for the results are the first contact and follow-up mechanisms put into place by the CLSC. The effectiveness of such mechanisms seems to be related to their population-based rather than client-oriented responsibility.

Our health paradigm in peril.

Health care systems are rapidly shifting attention from providing health care to producing health, profoundly altering how and which services are provided. To free up individual and collective resources for investment in activities with a greater impact on health, less care will be given. This paper posits that the current model--increased health resources make for better health care make for better health status--is too simplistic a system. Structural problems inherent in this model are being observed as the boundaries of the paradigm are pushed. Resources are limited, and health outcomes are no longer being improved despite the application of large percentages of Gross National Product. A new health paradigm is emerging, one with increased focus on health prerequisites such as housing, minimum decent income, food, education, and good social and physical environment.

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.