No abstract

Following the seminal work of Esping-Andersen, many studies have identified a variety of welfare regimes in Western Europe and North America. This study examines a set of quantitative social indicators, using hierarchical cluster analysis, in order to identify such regimes, which display specific arrangements between markets, the state and families in the production and distribution of the resources required for the well-being of people. Indeed, these empirical analyses reveal the existence of the three regimes originally identified by Esping-Andersen - social-democratic, liberal, and conservative - to which one must add, as many authors had pointed out, a fourth, distinct from the latter, the Latin regime. These results pertain whether one turns to data from the 1980s or the 1990s. The data also reveal strong and durable relations of presumably mutual causality between the configuration of social programmes in the various societies under analysis, the social situations which largely result from these social programmes and, lastly, the level of civic participation which leads (or not) people to collective mobilization, which in turn shapes social programmes. The authors' comparative analysis allows them to identify Canada's place in the worlds of welfare capitalism.

The research community is showing increasing interest in the analysis of the care trajectory of people with chronic health problems, especially dementias such as Alzheimer's disease. However, despite this interest, there is little research on the initial phases of the care trajectory. The fact that the first symptoms of dementia are generally noticed by those surrounding the elderly person suggests that the recognition of the disease is intimately linked to interactions not only amongst family members but also amongst friends, neighbours and health professionals. This study focuses on the period beginning with the first manifestations of cognitive difficulties and ending with the diagnosis of Alzheimer-type dementia. Interviews with 60 caregivers in Montreal, Canada were used to reconstruct how older people with Alzheimer-type dementia enter into the care trajectory. Our methods consisted of the analysis of social networks, social dynamics and action sequences. Our findings are presented in the form of a typology comprised of 5 pathways of entries into the care trajectory that are structured around the following four principles of the Life Course Perspective: family history, linked lives, human agency and organisational effects. We believe that analyses of the initial phases of the care trajectory, such as this one, are essential for the application of effective early detection and intervention policies. They are also central to informing future studies that seek to understand the care experience in its entirety.

Three consecutive randomized open studies have been carried out to determine the optimal dosage of low molecular weight heparin (LMWH) in the prevention of postoperative thrombosis in general surgery (892 patients). All patients undergoing abdominal, gynaecological, thoracic or urological surgery were over 40 years old and presented at least one of the following risk factors for thrombosis: previous thromboembolism, obesity, varicose veins, malignancy (30 per cent), pre-operative hospitalization over 5 days, oestrogen therapy, chronic cardiac disease or bronchitis. Isotopic venous thrombosis and bleeding complications were assessed after subcutaneous administration of a LMWH fragment (LMWH, Enoxaparine) or unfractionated heparin (UH). The three studies compared 3 X 5000 units UH daily with 1 X 60 mg, 1 X 40 mg, 1 X 20 mg LMWH daily. Thromboembolic events rates were not significantly different from group to group (UH: 3.8 per cent, 2.7 per cent, 7.6 per cent respectively compared with LMWH: 2.9 per cent, 2.8 per cent, 3.8 per cent). Bleeding episodes including wound haematoma formation, perioperative blood losses and systemic haemorrhage were not significantly different in patients receiving LMWH or UH. Significant decreases in haematocrit and haemoglobin were only observed in patients receiving 60 mg Enoxaparine (as compared to UH). An analysis using the 'intention to treat' approach gave results consistent with those of an analysis of good compliers. An overview of isotopic thromboses in the three studies gave no evidence of differences amongst the effects of the three doses of LMWH (P = 0.20), and pooling the results of the three studies using the Mantel-Haenszel procedure gave no evidence of a global difference between Enoxaparine and UH (P = 0.54). These results suggest that an optimal dosage of 20 mg/day of Enoxaparine is safe and effective in the prevention of postoperative thrombosis in this population.

Les mots pour le dire, les mots pour le faire : le nouveau vocabulaire du social Numéro 41, printemps 1999 URI : id.erudit.org/iderudit/005057ar

Are the rather generous welfare regimes found in most European countries sustainable; that is, are they competitive in a globalizing economy? Or will they, on the contrary, be crowded out by the more austere and less expensive regimes generally found in liberal Anglo-Saxon countries? We first discuss this issue conceptually, focusing on the notions of institutional competitiveness, social investment, and short-term and long-term productivity. We then briefly present the results of an empirical study of 50 social indicators of policies and outcomes in 20 Organization for Economic Co-operation and Development (OECD) countries during the early 2000s. We conclude that welfare regimes have not been forced to converge through a ''race to the bottom.'' There remain three distinct ways to face the ''trilemma'' of job growth, income inequality, and fiscal restraint: Nordic countries achieve high labor market participation through high social investment; Anglo-Saxon countries attain the same objective through minimal public intervention; while Continental European countries experience fiscal pressures because their social protection schemes are not promoting participation to the same extent.

Ce groupe d'études traitant de l'approche des parcours de vie comme outil d'évaluation de certaines politiques publiques est le produit de plus de un an et demi de recherches et de discussions parmi des chercheurs universitaires et des analystes de politiques. Les six études empiriques de ce numéro spécial ont toutes pour objectif d'élargir la portée de l'approche des parcours de vie en l'appliquant à des domaines liés aux politiques publiques qui, jusqu'à maintenant, n'avaient pas été abordés de cette façon. Ces études portent sur la santé des Autochtones, la participation sociale, les conditions de logement précaires et les expulsions, les trajectoires de revenus et les changements qui marquent le cadre de vie des personnes âgées. Les conclusions majeures qui se dégagent de ce projet de recherche sont les suivantes : 1. Le Canada est à l'avant-garde en matière d'évaluation de politiques publiques grâce à l'approche des parcours de vie, et cet avantage devrait stimuler les chercheurs et les décideurs à aller plus loin encore dans cette voie ; 2. L'approche des parcours de vie est moins axée sur les itinéraires individuels que sur les interactions entre les individus et les institutions sociales, et particulièrement sur les situations (les « scénarios ») où les structures sociales sont sources d'inégalités et où les inégalités sont imprimées dans les parcours de vie eux-mêmes ; 3. L'approche des parcours de vie, utilisée comme moyen de décrire des cheminements marqués par des dépendances et d'expliquer l'influence des forces de gravité sociale et des événements déstabilisants, met l'accent sur les conditions sociales plutôt que sur les choix individuels ; 4. Pour les décideurs politiques, l'approche des parcours de vie est un outil plus pragmatique, parce que plus sensible à la réalité que vivent les acteurs sociaux ; par conséquent, les acteurs sociaux se reconnaissent mieux dans les politiques élaborées grâce à cet outil ; et 5. L'approche des parcours de vie offre aux acteurs sociaux, aux chercheurs et aux responsables de politiques la possibilité de travailler en collaborant plus étroitement. Mots clés : parcours de vie, outils d'évaluation des politiques publiques, choix, inégalités sociales, scénarios, institutions socialesThis set of research studies on the life course as a policy lens springs from research and discussions over more than a year and a half among academic researchers and policy analysts. The six empirical studies in this special issue all rely on the life-course perspective to extend the reach of the perspective into areas with policy relevance that have not been examined previously with a life-course lens. The studies examine aboriginal health, social participation, housing instability and evictions, earnings trajectories, and late-life transitions. Key conclusions overall from the project are that (1) Canada may have an early lead in conceptual thinking on life course as a policy lens, giving us the momentum to push this advantage further;(2) the life-course perspective focuses less on ind...

Fetal fibronectin in cervicovaginal secretions is associated with preterm delivery in both high-risk and low-risk women.