Beyond the Transatlantic Divide: The Multiple Authorities of Standards in the Global Political Economy of Services

This paper explores the plurality of institutional environments in which standards for the service sector are expected to support the rise of a global knowledge-based economy. Despite the careful wording of the World Trade Organization (WTO), a whole range of international bodies still have the capacity to define technical specifications affecting how services are expected to be traded on worldwide basis. The analysis relies on global political economy approaches to extend to the area of service standards the assumption that the process of globalization is not opposing states and markets, but a joint expression of both of them including new patterns and agents of structural change through formal and informal power and regulatory practices. It analyses on a cross-institutional basis patterns of authority in the institutional setting of service standards in the context of the International Organisation for Standardisation (ISO), the European Union, and the United States. In contrast to conventional views opposing the American system to the ISO/European framework, the paper questions the robustness of this opposition by showing that institutional developments of service standards are likely to face trade-offs and compromises across those systems and between two opposing models of standardisation.

Styles de vie, besoins de santé et utilisation des services de soins des adolescents porteurs d'affections chroniques

Résumé Contexte et objectifs Le premier volet a comme objectif d'évaluer la prévalence de l'affection chronique (AC) parmi les adolescents en Suisse, de décrire leurs comportements (loisirs, sexualité, conduites à risque) et de les comparer aux adolescents non porteur d'AC afin d'évaluer l'impact de l'AC sur leur bien-être. Le second volet a comme objectif d'explorer leur réseau de soutien, leur mode d'adaptation et leur perception de la prise en charge dont ils bénéficient par les équipes soignantes. Chacun des objectifs est traité dans un article : - « Chronic illness, life style and emotional health in adolescence: results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland » Eur J Pediatr (2003) 162: 682-689 - « Adolescents porteurs d'affections chroniques: la parole aux patients » Med Hyg 2004 ; 62 : 2224-9. Méthode Première partie: les données ont été obtenues par analyse secondaire de l'enquête sur la santé des adolescents en Suisse, réalisée en 1993-1994 auprès d'un échantillon de 9268 jeunes de 15 à 20 ans (6% de la population visée), à l'aide d'un questionnaire auto administré de 100 questions environ. Le programme SPSS a été utilisé pour effectuer les analyses bi- et multi-variées. Seconde partie: la commission d'éthique de la Faculté de médecine de l'Université de Lausanne a donné son accord permettant la réalisation d'un focus group (discussion en petit groupe) de 12 jeunes. Ils ont participé à une discussion de 2 heures, conduite par un modérateur entraîné à cette méthode. Résultats Premier volet : 11.4% des filles et 9.6% des garçons se déclarent porteurs d'une AC. 25% des filles porteuses d'une AC (versus 13% de non porteur; p=0.007) et 38% des garçons porteurs d'une AC (versus 25% de non porteur; p=0.002) déclarent ne pas utiliser la ceinture de sécurité quand ils conduisent. 6.3% des filles (versus 2.7% ; p= 0.000) disent avoir conduit en étant ivres. 43% des filles (versus 36% ; p= 0.004) et 47% des garçons (versus 39% ; p=0.001) sent fumeurs de cigarettes. 32% des garçons (versus 27% p=0.02) rapportent avoir consommé du cannabis. 17% des filles (versus 13°h ; p=0.013) et 43% des garçons (versus 36% ; p= 0.002) disent boire de l'alcool. Le fait d'être porteur d'AC a aussi des conséquences psychologiques : 7.7% des filles (versus 3.4% ; p= 0.000) et 4.9% des garçons (versus 2% ; p=0.000) ont effectué un tentamen durant les 12 mois précédents. Deuxième volet: Sur oui peuvent-ils compter ? Avant tout sur eux-mêmes, puis sur leurs parents ou leurs amis. Les pairs, l'équipe soignante, les autres malades et les enseignants ont chacun des rôles à jouer à des moments précis de l'évolution de l'AC. Leurs modes d'adaptation: prendre du recul, faire preuve d'humour et demander de l'aide à leurs proches. Ils s'évadent dans l'écriture, les pensées ou la musique. Demande aux médecins une prise en charge globale qui permette une compréhension de l'ensemble de leurs besoins plutôt que focalisée seulement sur leur AC. Le respect, la possibilité d'un soutien et d'explications précises leur paraissent importants. Conclusions Les conduites dites à risque ne sont pas moins fréquentes chez les adolescents porteurs d'AC que chez leurs pairs Elles peuvent être expliquées par le besoin de tester leurs limites tant sur le plan des consommations que du comportement. Une prévention et une attention spécifiques des équipes soignantes sont nécessaires. Un réseau social diversifié paraît nécessaire aux jeunes souffrant d'AC. Les médecins devraient avoir une vision globale de leur patient, les aider à se situer dans le monde de l'adolescence, leur permettre de nommer leurs émotions et anticiper les questions difficiles à poser. Abstract The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; interval to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey Introduction on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P = 0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P= 0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. Conclusion: Experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

Structure et processus dans une « Agence de développement de réseaux locaux de services de santé et de services sociaux » [Document électronique] : des problèmes et un diagnostic?

Ce cas décrit la structure organisationnelle en place dans une régie régionale de la santé et des services sociaux, ainsi que le processus de prise de décision pour un dossier particulier : la mise en oeuvre d'un programme d'interruption volontaire de grossesses dans la région. L'objectif est d'illustrer comment la structure organisationnelle peut influencer (positivement ou négativement) la façon de traiter les dossiers et les résultats qui en découlent. [Auteurs]

Supervised injection services : what has been demonstrated? : a systematic literature review

BACKGROUND: Supervised injection services (SISs) have been developed to promote safer drug injection practices, enhance health-related behaviors among people who inject drugs (PWID), and connect PWID with external health and social services. Nevertheless, SISs have also been accused of fostering drug use and drug trafficking. AIMS: To systematically collect and synthesize the currently available evidence regarding SIS-induced benefits and harm. METHODS: A systematic review was performed via the PubMed, Web of Science, and ScienceDirect databases using the keyword algorithm [("SUPERVISED" OR "SAFER") AND ("INJECTION" OR "INJECTING" OR "SHOOTING" OR "CONSUMPTION") AND ("FACILITY" OR "FACILITIES" OR "ROOM" OR "GALLERY" OR "CENTRE" OR "SITE")]. RESULTS: Seventy-five relevant articles were found. All studies converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney. CONCLUSION: SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence.

Conclusion : les usages possibles et contestables des normes et des institutions dans l'internationalisation des services

The conclusion of this volume on technical standards in the regulation of services reviews the authors' contributions to understanding the relation between tertiarisation, internationalisation and standardisation from three distinct perspectives : theoretical, institutional, and sectorial. It argues that conventional views on conditions for standardisation and internationalisation of service activities are overly restrictive, making them dependent on sectorial and institutional specificity. In emphasizing the possible and contestable uses of service standards, the volume opens a critical debate on service offshoring, underlining the social and historical constructions of its transnational logic.

Savoir s'assurer : économie politique internationale des normes de services et mondialisation du marché de la (ré)assurance

The significance of the insurance industry in the functioning of the world economy is often underestimated, with premiums reaching 7.5 % of world gross domestic product (GDP), three times as much as worldwide military expenses. Insurance services mutualise risks in such a way as they provide a form of private governance that complements or makes up for guarantees otherwise supplied by the State. This case study of international standards developed for the insurance market provides evidence that deviates from conventional accounts considering service standards as heavily dependent of national environments and industry specificities. The chapter examines the relationship between tertiarisation, internationalisation and standardisation of contemporary economies by highlighting the complementarity between institutionalist approaches of the French regulation school and international political economy scholarship shedding light on the polarisation in the possible use of standards, notwithstanding thesectoraland institutional specificities of the activities concerned.

Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts.

Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.

European Council of Legal Medicine (ECLM) accreditation of forensic pathology services in Europe.

Forensic experts play a major role in the legal process as they offer professional expert opinion and evidence within the criminal justice system adjudicating on the innocence or alleged guilt of an accused person. In this respect, medico-legal examination is an essential part of the investigation process, determining in a scientific way the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological, or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards, i.e., it should be independent, effective, and prompt. Ideally, the investigations should be conducted by board-certified experts in forensic medicine, endowed with a solid experience in this field, without any hierarchical relationship with the prosecuting authorities and having access to appropriate facilities in order to provide forensic reports of high quality. In this respect, there is a need for any private or public national or international authority including non-governmental organizations seeking experts qualified in forensic medicine to have at disposal a list of specialists working in accordance with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal, the National Association of Medical Examiners (NAME) has elaborated an accreditation/certification checklist which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, European Council of Legal Medicine (ECLM) board decided to set up an ad hoc working group with the mission to elaborate an accreditation/certification procedure similar to the NAME's one but taking into account the realities of forensic medicine practices in Europe and restricted to post-mortem investigations. This accreditation process applies to services and not to individual practitioners by emphasizing policies and procedures rather than professional performance. In addition, the standards to be complied with should be considered as the minimum standards needed to get the recognition of performing and reliable forensic pathology service.