Cannabis use and cancer of the head and neck: Case-control study

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• 作者：Sarah Aldington ; Matire Harwood ; Brian Cox ; Mark Weatherall ; Lutz Beckert ; Anna Hansell ; Alison Pritchard ; Geoffrey Robinson ; Richard Beasley
• 关键词：Care network ; Health network ; Representations ; Care actors ; General practitioners ; Perinatal period ; Pregnancy ; Postnatal period ; Psychiatric emergency department ; Follow-up study
• 刊名：Otolaryngology - Head and Neck Surgery
• 出版年：2008
• 出版时间：March 2008
• 年：2008
• 卷：138
• 期：3
• 页码：374-380
• 全文大小：92 K

文摘

The syntagms ""care networks"" and ""health networks"" have lately been reified. One notes a discrepancy between the theoretical development of the ""network"" concept and the accomplishment of this new care organisation in the field. Where does that paradox come from? Is it from reluctance towards change, from a vocabulary problem, or from training? Is it a myth or an experiment that needs to be rediscovered and re-established? We suggest attempting to answer this question by studying the real representation of the term ""network"" based on a study of pregnant women or women in the post-natal period, who presented themselves to the emergency department of a general hospital for a psychiatric motive. The data collection lasted 13 months. The identification of the network actors was based on semi-structured interviews. A standardised diagnostic evaluation was made by the Mini International Neuropsychiatric Interview 5.0.0. French version International Classification of Diseases-10. The depression and anxiety intensity rank was measured by the Hospital Anxiety and Depression scale by Zigmond and Snith. At 6 months stage, semi-open questionnaire was addressed to the women and another to their general practitioner or other intervening persons noted at the initial interview. We built up a sample of 42 women: 21 women in the perinatal period (average age: 28.8 years old, s.d. 6.4), and 21 control women (average age: 32.2 years old, s.d. 10.4). Globally, on arriving at the Emergency department, half of the women were sent by their socio-domestic circle and by their general practitioner. Almost half of the women in the perinatal period were sent by the maternity department. At 6 months, 45 % of the women and 64 % of the general practitioners answered the questionnaires. The psychiatric network was activated for half the cases in both groups. For half of the cases, the general practitioner remains the reference person in assuming care of the women in the perinatal period. As for the control women, general practitioner remains the main intervening person for a third of the cases. Eventually the patient turns out to be the one that decides whether or not to become integrated in one of the care networks. The healthcare network in perinatal psychopathology probably corresponds to a group of treatments that is put in place as long as the psychiatric crisis and the control of its complications lasts. The patient's circle and her general practitioner, as well as the patient, show up as the main participants of the care network. Unfortunately for some patients, one cannot say they are registered in a care network, perhaps because their care consists of a single treatment, which is often weak.