Teses / dissertações sobre o tema "Santé publique – Administration – Chine"
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Tang, Lingyue. "Being both a doctor and a state employee : grassroots medical professionals in contemporary China". Electronic Thesis or Diss., Paris, Institut d'études politiques, 2023. http://www.theses.fr/2023IEPP0049.
Texto completo da fonteThe development of grassroots healthcare systems is a key element of China’s current healthcare reform. This study focuses on a group that has often been overlooked in previous research - grassroots medical professionals. They hold a unique dual identity, being both professionals and state employees, setting them apart from conventional professional paradigms and urban doctors. Through in-depth fieldwork in central China, including interviews, participant observations, and a comprehensive analysis of online media, this research reveals that different institutional designs and social contexts result in different practice conditions for medical professionals in three-tiered primary medical institutions, as well as varying degrees of attachment to medical institutions and local governments. As the ultimate bearers of a hierarchical chain of control, they are subject to constant state intervention, including supervision, inspection, and technological management, which severely erode their professional autonomy. Beyond their daily medical and administrative duties, grassroots medical professionals also undertake a substantial number of political tasks, and the tension between their dual identity varies in different types of tasks. The transformation of medical professionals’ dual identity is dynamic, driven not only by the needs of the state, but also influenced by the complex interactions of multiple interest groups, and even, in some cases, medical personnel have become a figurative extension of state power to penetrate rural society. Moreover, this study, through a meticulous analysis of healthcare policies from local experiments to central directives and their subsequent local execution, also illuminates the logic of political functioning and the mechanisms for responding to health crises in China
Wang, Li Qiang. "L'administration locale de chine : le cas de Dongcheng". Paris 1, 1998. http://www.theses.fr/1998PA010310.
Texto completo da fonteThis stuty seeks to apply the principle of integration to a local Chinese administration, in order to identify the essential means used by this administration, making use of integration axes, to depict their interactions. The principle of integration guided this study, it enabled us to devise a new scheme of Chinese administration organization. We found that the chinese administration encountered two major difficulties in its process of integration, which were firstly the impossibility of exerting a centralized power in this vast country, and secondly the impossibility of applying the same rules everywhere. This observation allowed us to hypothesize that directed autonomy ; is a fundamental principle of China's local administration system. Indeed, during the process of integrating china, the means of integration uses by the administration are determined mostly by the two above-mentioned factors. They have given rise to a special integration system in China. Both Chinese traditions and foreign experiences have played a role in designing the means of integration by civil servants. Our present study shows how, in dongcheng district, these means of integration are used by civil servants, in the administrative structure, the administrative legislation and the operation of this system
Zhu, Guobin. "La réforme de la fonction publique et son évolution en droit chinois : vers l'établissement d'un nouveau régime". Aix-Marseille 3, 1994. http://www.theses.fr/1994AIX32016.
Texto completo da fonteThe aim of this thesis is to study the important events during the reform of chinese civil service system from nineteen seventy eight to the promulgation of the first general statute relative to the state civil servants in nineteen ninety three. It is composed of three parts. The preliminary part discusses the general background concerning the political institutions, the dominant ideology and the evolution of the system. The first part aims at the study of the important changes of reform between nineteen seventy eight and nineteen eighty seven. The main themes are about the new political orientation as regards cadres and personnel, the devolution of administration and new managements systems and procedures set up during this period. The second part specially deals with the establishment of a new regime of civil service in china. It lays emphasis on the elaboration and the promulgation of the first general statute of the state civil servants ; it also treats the experimental application of this new regime. The general statute now with the title of provisional ordinance relative to the state civil servants is published as an annexe at the end of this thesis
Shen, Jun. "Introduction du régime de responsabilité administrative du service public en droit chinois : un vecteur vers l'équilibre entre l'intérêt général et l'intérêt particulier". Aix-Marseille 3, 2008. http://www.theses.fr/2008AIX32036.
Texto completo da fonteCabestan, Jean-Pierre. "L'administration chinoise de 1979 à 1987 : réformes et résistances". Paris 1, 1988. http://www.theses.fr/1988PA010281.
Texto completo da fonteBetween the 3rd plenum of the 11th central committee and the 13th congress of the chinese communist party, the administration of the people's republic of china has deeply evolved. However, reforms decided by deng xiaoping and his followers insisted much more on the renewal of personnel - and particularly of leading personnel - than on the rationalization of government struc- tures. Many pre- cultural revolution institutions were certainly re-established (central party secretariat, local gouvernments, discipline inspection commis- sions, ministry of control). Two new institutions set up by the reformists cer- tainly favored some rejuvanation (cp advisory commissions) and a relative modernization (general amditing office) of party and state apparatus. Never- theless, chinese administration still complies with the same old rules. Legal norms are almost non-existent the implementation of decisions remains the outcome of a permanent bargaining among organs and between the centre and the provinces. The reformists therefore were chiefly eager to promote cadres ready to carry out their policy. But in many respects the chinese civil servant remains therefore omnipotent and corrupt
Dab, William. "La décision en santé publique : valeur décisionnelle de la surveillance épidémiologique dans les situations d'urgence et de crise de santé publique". Montpellier 1, 1992. http://www.theses.fr/1992MON1T002.
Texto completo da fonteVandenberghe, Michel. "Les médecins inspecteurs de santé publique : une conversion identitaire et une transformation de l'action publique dans le champ de la santé". Lille 1, 2001. https://pepite-depot.univ-lille.fr/LIBRE/Th_Num/2001/50377-2001-3-4.pdf.
Texto completo da fonteGimbert, Virginie. "L'état sanitaire en question : les administrations à l'épreuve des risques". Cachan, Ecole normale supérieure, 2006. http://www.theses.fr/2006DENSA004.
Texto completo da fonteFeng, Shuji. "Les Mingongs et la réforme politique en Chine". Toulouse 1, 2012. http://www.theses.fr/2012TOU10020.
Texto completo da fonteThe relationship between the citizenship of peasant-worker (In Chinese : Mingong) and the political reform of the current China has been discussed. The Mingongs appeared at the same time with the reform of 1978. They are the elite of the Chinese countryside. They have been contributing much to the modern Chinese society. Floating between the countrysides and the cities, they belong to a special society which is marginalized by both the countryside and city. In general, they have been exploiting heavily and living in the miserable conditions. More and more Mingongs have been becoming the criminals. Their children, following them to enter cities or stay alone in the countryside, can not get enough care and help to grow up well. As part of the future of China, they are in danger. The society of Mingong is a dangerous society. Explosion is bad to everyone. China is a huge country and an old country. Unlike the leaders of the high level or the intellectuals of the middle-class, the amount of Mingong is shocking and impossible to ignore. They will definitely push the political reform of China strongly. If the leaders of the high level and the intellectuals of the middle-class control and help them well, the people's republic of China may reach democracy in peace its own way. The world needs to be patient to see the election, participation and supervision in politics appear in China. But first at all, there needs to appear a society of qualified citizen in China
Liao, Hehui. "Les situations locales engendrées par les bouleversements actuels de l’espace régional pékinois". Paris 10, 2012. http://www.theses.fr/2012PA100023.
Texto completo da fonteThe gradualism of Chinese reform and the dualism of economic systems are the products of a compromise between the old political systems and the new economic systems. This thesis is devoted to the observation of social and individual repercussions stemming from the present upheavals in the urban region of Beijing. We selected ten human groups on ten pieces of land: the first five groups are "losers" and the other five groups are "winners", at least materially. The "losers" have different fates in accordance with their status: precarious workers because of the bankruptcy of many public enterprises, peasants deprived of their allowance confronted with the urbanization of their lands, the peasant workers deprived of their social rights on the places where they work, etc. The material "winners", emergent middle class, undergo a moral crisis coming from an interference of values and purposes. In the urban maelstrom, losers and winners are faced with the complicity between house developers and local governments, the complicity between traffickers and large-scale enterprises, etc. The law is hardly respected, and the not-independence of judicial system is no doubt one of the principal problems of China today
Moro, François. "L'administration du système de santé : les effets de la création de l'agence régionale de santé". Thesis, Montpellier 1, 2014. http://www.theses.fr/2014MON10002/document.
Texto completo da fonteThe administration of the health care system was deeply changed with the introduction of health agencies. The implementation of the ARS in 2009 contributes to unify the health action at the local level, what was missing under the influence of the ARH. The introduction of the ARS solely expresses a supposed simplification of the health care system, at the confluence of a classic health agency and of a local administration of the State. This new agency appears then as an unprecedented territorial agency what is proved by its intervention on the health care system. The appropriation of regulating instruments by this agency, which can be embodied in the contract, shows a renewal in health action. The ARS carries out a local regulation of health system which is original. This reform of health action is far away from being completed. Relationships between the ARS and public health institutions reveal this partial efficiency. The addition of functions awarded to the ARS harms the readability and the efficiency of its intervention on the health care system. The ARS has to be self-sufficient to become the main regulator of the health care system
Decostanzi, Arthur. "Le service public de santé de proximité". Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0495.
Texto completo da fonteThe realization of this right is guaranteed by the intervention of public authorities, which must act in the organization of the provision of care, as well as by the existence of social security mechanisms that allow access to healthcare that is not limited by social or geographical factors. The French system is today subject to strong tensions and uncertainties: growing inequalities in access to healthcare, compartmentalization in the organization of the health system, or the ageing of the population and the development of chronic diseases. The health system must evolve around a local public health service that is the only one able to satisfy the general interest of health protection. This objective requires a better structuration and coordination of healthcare activities between the different providers serving users in order to satisfy the requirement of equal access to quality care, transversal cooperation tools are designed to break with existing silos. The implementation of such a public service requires a clear and rational management capable of take into account territorial disparities. The emergence of regional health agencies in a territorialization phenomenon must be accentuated to meet the challenges of proximity. The regulatory means implemented still have to be renewed to respond to the challenge of health protection, the capacity of self-organisation left to the initiative of liberal professionals must be transformed into collaboration with all health providers, health administrations, health insurance, local authorities and users. All these measures permit the satisfaction of the essential trilogy of public services: equality, continuity, mutability
Qiao, Jing. "La réforme de l'administration chinoise face aux rites confucéens". Paris 1, 2005. http://www.theses.fr/2005PA010298.
Texto completo da fonteLefébure, Alessia. "Transformer la culture administrative par les marges : l’introduction en Chine du Master in Public Administration (MPA)". Thesis, Paris, Institut d'études politiques, 2016. http://www.theses.fr/2016IEPP0011/document.
Texto completo da fonteChanging nothing to change everything: innovation and continuity in the reforms of Chinese administrative training — At the end of the Maoist era, the Communist Party of China (CPC) attempted to create a more highly‑skilled bureaucracy to achieve economic development in a stable political context. Reforms concerned not just recruitment, management and civil service organization, but also the training of officials in order to improve their skills. The introduction of the Master of Public Administration (MPA) in 1999 enhanced the scientific character of administrative knowledge while pre‑existing selective mechanisms were retained. The MPA supports the country’s modernization by enabling the State‑Party to undertake continuous reform of public administration. It allows as well the emergence of a new ethos and a community of vision among the new generation of civil servants, whose competences are adjustable to several possible political scenarios
Zhang, Qi. "L'adaptation des entreprises d'état chinoises à l'ouverture économique : conditions institutionnelles et adaptations stratégiques". Lille 1, 2007. https://pepite-depot.univ-lille.fr/LIBRE/Th_Num/2007/50374-2007-Zhang.pdf.
Texto completo da fonteDurand, Audrey. "Simulation et apprentissage Monte-Carlo de stratégies d'intervention en santé publique". Thesis, Université Laval, 2011. http://www.theses.ulaval.ca/2011/28698/28698.pdf.
Texto completo da fonteDecision makers in public health system, such as the one in the province of Quebec, have a growing need for assessment tools to support their decisions on the interventions to implement. This master’s thesis proposes a generic simulator optimized for public health issues, while being extensible to other areas. It details the software architecture and all the features that make it a tool of choice for decision makers. It also presents the optimization of existing intervention strategies using Monte Carlo reinforcement learning. This includes the proposal of a new algorithm for selecting actions when learning on populations of individuals evolving in parallel. We conclude with the application of this infrastructure to two public health issues : diabetic retinopathy, that has already been the subject of work by other researchers, and osteoporosis, a current application that has been validated by health care specialists.
Paparrigopoulou, Patrina. "Le contrôle du service public de santé en France et en Angleterre". Paris 1, 1990. http://www.theses.fr/1990PA010258.
Texto completo da fonteThe speciality of the sanitary sector of the public health services affects the administrative control in two ways, on the one hand by the imposition of a certain type of organisation and on the other hand by its influence on the extent of the control. That two public services being compared although phenomenally different, nevertheless present common rules of organisation and control
Gnessien, Banou-Florence. "Réflexion sur les fondements d'une politique sanitaire dans un pays en développement : le Burkina Faso". Perpignan, 1995. http://www.theses.fr/1995PERP0208.
Texto completo da fonteSanitary conditions in burkina faso which is placed among the less advanced countries on earth, are not the most enviable. As a matter of fact, they result in a high mortality rate, especially among children, and by a low life expectancy, both things mainly due to low hygiene in the environment, to the lack of drinking water and to malnutrition. In any case, the observations which seemingly can be derived from these facts are : that the health policy implemented by the state of burkina faso, despite numerous efforts undertaken in this domain, still remains largely embryonic (first part of the thesis), and in the present context of economic crisis which has called for the drastics remedies of the fmi, the perspective does not seem to be any more optimistic. Unless a new approach to the health policy were to be considered (second part of the thesis), the watchword of the oms, "health for everyone by the year 2000", would still be a remote objective in burkina faso
Mahyaoui, Youssef. "Etude juridico-économique de la contractualisation dans le système de soins". Paris 7, 2003. http://www.theses.fr/2003PA077224.
Texto completo da fonteMesnaoui, Abderrahmane. "Les bureaux municipaux d'hygiène au Maroc". Montpellier 1, 1989. http://www.theses.fr/1989MON10020.
Texto completo da fonteMallea, Patrick. "Performance durable en santé et territoire : méthode d'anticipation et d'évaluation des vulnérabilités pour les agences régionales de santé (MAEVA)". Phd thesis, École Nationale Supérieure des Mines de Paris, 2010. http://pastel.archives-ouvertes.fr/pastel-00566253.
Texto completo da fonteBahafa, Sanaa. "Impact de l'évolution des réformes hospitalières, des principes tutélaires et des outils de régulation sur le management des établissements de santé". Paris 8, 2014. http://www.theses.fr/2014PA084063.
Texto completo da fonteIn 2013, to manage an health institution is not "a sinecure ". The freedom of making a decision by the managers is limited by the laws, the decrees and the orders imposed and multiple. The new hospitable reform " law of July 21st, 2009 : Hospital Patient Health Territory ", the principles of supervisory agencies and the regulation tools have impacted the organization of health institutions, as : the introduction of the new mutations in the management field, the techniques and the medical practices as well as the expectations and needs of the users. In front of these new requirements, the director has a real autonomy and flexibility within the framework of managing his institution? In this context, the director of the health institution has an essential role : on one hand, he is the addressee of the reforms, which so modified his intervention perimeter and which involved a reflection on its positioning within the institution. On the other hand, he is " the spokesman" and the catalyst to accompany the implementation of these tutelary and regulatory requirements. The implementation of the new processes of hospitable restructuring requires, certainly, a conduct of change. However, the difficulty to setting it up consists, not in a bad application of texts, but rather in the difficulty to adhere and imply the actors. It is from these reports that our study suggests deepening the impact of reforms, of the principles of supervisory agencies and the regulation tools on the managerial practices of a director of institution and so defining what is the strategy to be adopted. Our analysis consists, on one side, in deepening the sanitary organization of health institutions and on the other side, to realize an inventory of fixtures to approach under a pragmatic angle our theoretical study. At the end of the analysis, some tracks of improvement are proposed
Yordanov, Yassen. "Un modèle systémique d'analyse de changement dans les organisations : le cas de l'analyse de l'implantation du projet PATH de l'OMS Europe en France". Nantes, 2012. https://archive.bu.univ-nantes.fr/pollux/show/show?id=2e92db68-796f-4d27-990a-c7318c165995.
Texto completo da fonteThe hospitals are interested more and more in the programs of improvement of the hospital performance, in order to satisfy the double requirement of efficiency, on one hand and of efficacy and quality of care for the patients, on the other hand. The decision to undertake strategic, structural, cultural and technical transformations in hospitals depends not only of the will to satisfy this double requirement, but also on their capacity to implement and to institutionalize the innovative hospital performance practices. The object of the thesis consists in deepening the understanding of the stakes bound to the process of introduction of the change in the health care organizations. The theoretical contributions include a detailed understanding of the systematic processes which take place in the health care organizations and their relations with the environment during the implementation of a strategic change. So, the results show that the collective capacities of acceptance and implementation of a hospital performance innovation influence as much the process of structuring of the collective action for the change as the degree of use of the innovation
Wang, Qian. "Aspects socio-économiques et éco-épidémiologiques de l'échinococcose alvéolaire dans les communautés pastorales tibétaines en république populaire de Chine". Phd thesis, Université de Franche-Comté, 2005. http://tel.archives-ouvertes.fr/tel-00390145.
Texto completo da fonteDhaene, Gwénaël. "Le partenariat public-privé dans les secteurs de la santé : mise en perspective juridique et performance globale". Thesis, Paris 1, 2013. http://www.theses.fr/2013PA010309.
Texto completo da fonteThe decision makers in the health sector are faced with increasing challenges and new stakes that they need to address. A wide range of push factors from new techniques and care to a higher demand for quality and accessibility of care as well as dramatic budget cuttings and constraints are driving and often trigger a new approach to health systems. Private sector involvement in public service, whether through for-profit or non-profit stakeholders, complements existing models such as traditional procurement or concessions instruments. These new models aim at innovative collaborations between public and private sectors through restructuring and strengthening health services, underpinned by risk and expertise sharing mechanisms. These PPP bring added value through long-term contracting and often a private financing of infrastructures and equipment. Public managers are in this case empowered to focus on their core public service missions while entrusting their private contractors/partners with a variety of tasks from design to financing, building, operating and maintaining the infrastructures. The overall aim of these new flexible contractual instruments is to help improving the services performance. Raising interest amongst public decision makers as well as other stakeholders, these complex legal arrangements require an assessment of the sustainability of the PPP approach towards health issues. The expected value for money which PPP are supposed to bring in also demands that a thorough evaluation be carried out. Besides, operational recommendations shall be drawn up for the benefit of those public managers looking at making the best of their partnership instruments
Capgras, Jean-Baptiste. "Le programme de médicalisation des systèmes d'information (1982-2009) : anamorphose et métamorphoses d'un dispositif de gestion". Lyon 3, 2009. https://scd-resnum.univ-lyon3.fr/in/theses/2009_in_capgras_j-b.pdf.
Texto completo da fonteThe “programme de medicalisation des systemes d’information” (PMSI) is the information system tracking the inpatient activity of the French hospitals. It is used by the Health Ministry to allocate budget for short inpatient stay only. The allocation of this budget, corresponding to nearly 50 billion euros today (equivalent to nearly 3% of France’s GDP), is tightly connected to the historical development, tribulation and evolution of the PMSI. Based on the “theory of activity” developed by Y. Engestrom and the concept of “situation de gestion” (managerial context) defined by J. Girin, we develop a comprehensive understanding of this “management system”. This study was conducted looking at the implementation of the PMSI both within hospitals and regulatory agencies. Our study demonstrates that the PMSI is first a true “management system” tool. Second our study develops a new concept called “management system” that relies on a grid framework to analyze activity systems with instruments. The PMSI is the results of an anamorphosis whose final aim was to allocate financial budgets (design for use). This achievement led to a main application (“forme pivot”): the “Tarification à l’activité” (DRG payment). This resulted in improving the completeness of the data/information collected. It has now evolved (metamorphosed) for multiple applications (design by use)
Fellah, Lazhar. "Étude exploratoire du système de prévention algérien : déterminisme et problématique". Bordeaux 4, 1998. http://www.theses.fr/1998BOR40038.
Texto completo da fontePrevention in health care is not a glorious subject even though it is regularly mentioned in official speeches and seems to be of a great financial interest, so far as expenses for public health are concerned. In developing countries, the health care systems are copied from developed countries, without taking into account the pathologies of local populations. These systems are based on a curative approach where in the hospital is the main structure, consuming the most important share of the resources involved. This research analyses the algerian health care system of prevention in the ligth of economic theory. But prevention is an ambiguous concept and health too specific to be studied with the classical economic tools of supply and demand. In the first part of this work, we outline the exogenous factors in the determination of health states, the interest of a multidisciplinary approach of health cares problems going beyong the pure medical aspect (chapter i). Such an approach is different from the organization and functioning of a curative system (chapter ii). The second part is devoted to the problems related the elaboration, the coordination and evaluation of prevention programs which have some specific aspects in developing countries (chapter iii). It also presents the implementation of priority programs for particularly vulnerable groups of population, the development of information, education and the organization of a community participation in a strategy of health care promotion (chapter iv). The results of a program against tuberculosis show that a combination of preventive and curative appraoches can yield a good cost-efficiency ratio (chapter v)
Bahrami, Stéphane. "Essais sur la qualité des soins : approches en économie et en santé publique". Thesis, Paris 9, 2013. http://www.theses.fr/2013PA090073.
Texto completo da fonteThis work takes the perspectives of economics and public health to study issues related to the quality of hospital care.The first chapter introduces the concept of quality of care in economics and public health. We show that the two fields use similar definitions of the concept but explore differing and complementary approaches towards its regulation.Fixed price competition between hospitals, as implemented by a prospective payment system, should lead to an improvement of care quality, provided that the demand for care is increasing with quality. The second chapter evaluates the sensitivity to quality of demand for hospital care in France, using ranking lists published by the lay media as a measure of information on quality available to potential patients. We estimate changes in hospital demand caused by ranking lists on a panel of hospitals located in the Paris area, for several pathologies. We find a sizeable and significant demand shift towards hospitals belonging to the top list in the forprofit sector for one pathology. No effect is observed for non-profit hospitals, or for other pathologies in the for profit sector. Competition for quality may thus not be a feasible regulation approach for French public hospitals.The third chapter provides evidence regarding the cost of hospital infection control strategies targeting antimicrobial resistant bacteria. We estimated the burden and costs associated with two types of strategies, relying on targeted screening or on general hygiene promotion strategies, in two multinational controlled clinical trials, in surgical and intensive care units.Our results highlight the variability of costs associated with broad, non-specific hygiene promotion interventions, and, for interventions which were found to be effective by the clinical trials, costs that are consistent with the hypothesis that these interventions are costeffective
Barlagiannis, Athanasios. "Hygiène publique et construction de l'Etat grec, 1833-1845 : la police sanitaire et l'ordre public de la santé". Thesis, Paris, EHESS, 2017. http://www.theses.fr/2017EHES0044.
Texto completo da fonteThis study is about the organization of public hygiene in the kingdom of Greece between 1833, when prince Otto of Bavaria ascends to the throne, and 1845, when the political and epidemiological frontiers of the kingdom are traced by a complete system of lazarettos and sanitary offices. We will firstly analyze the structures of sanitary prevention in the interior of the country (vaccinators, public health doctors, municipal doctors) as well as at its frontiers, and then we will focus on the measures against contagious diseases (such as the plague and smallpox) and against miasmas. We are also interested in examining the main diseases that determine the mortality of the period under scrutiny and the medical theories that explain the applicable sanitary measures. At the same time, we will review some of the aspects of the classical distinction of Erwin Ackerknecht between contagionism and miasmatic theory. Finally, we will study the difficult formation of an official group of medical professionals. The interest in public hygiene imposes the study of the biological construction of the state and, subsequently, of the state itself. Public hygiene defines the threats which it tries to prevent, and it creates and secures the collectivity. In the Police State of the cameralist king Otto, these developments are controlled by the bureaucracy, the administration, the public force and the science of medical police. Its purpose is to construct and order the public space, the space of state action, which is natural as well as social. This action of ordering imposes the centralization of health and at the same time it normalizes the natural elements and the social forces so that they can coordinate without resistance; in other words, the action of ordering pacifies. Medical police controls these processes by reconfiguring the ties that bind individuals with each other and with the geography, the nature and their diseases
He, Siyue. "Le rôle des institutions dans la participation publique des grands projets: une étude comparative entre le barrage des Trois Gorges en Chine et le projet de la Romaine au Québec". Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38273.
Texto completo da fonteShi, Silu. "Les structures administratives territoriales de l'Etat en Chine". Thesis, Paris 1, 2017. http://www.theses.fr/2017PA01D053.
Texto completo da fonteIn the traditional image, China is a typically centralized unitary country, such a concept, even in the era of Mao Zedong, is not very precise, because at that time, China has even experienced at least three cycles of decentralisation/centralisation. So, through the reform and open by Deng Xiaoping, China has formed contrasting relations between central and local. Deng Xiaoping has adopted decentralization through administrative measures to decentralize the power and transfer “interests” to the local government, so that, the local government has a major initiative, in particular, in the development of the economy. Thus, the non-institutional decentralization leads the local government to become de facto an administrative entity which controls resources and power in the name of the central government. So the local government is not just obeying the central government like before. Behind this change is the emergence and the driving force of local interests. With a deep decentralization, the local governments have received much more discretionary power, especially in the local affairs and at the same time, through the control of resources and powers, the local governments have the “bargain chip” to negotiate with the central government, so that they could express local interests and influence the decisions of the central government. In order to maintain central authority, the central government has adopted a selective centralization for this de facto centralization, so as to achieve a balance between the central government and the local government. However, the non-institutional decentralization mainly through negotiation to achieve a balance between the two preceding ones, seems to be an approach that is still not stable, so that the search for a normativity of relations between central and local has become a long-term goal
Gossement, Arnaud. "Le principe de précaution". Paris 1, 2001. http://www.theses.fr/2001PA010332.
Texto completo da fonteCohen, Michel. "Le service public hospitalier existe-t-il encore ?" Nice, 1997. http://www.theses.fr/1997NICE0024.
Texto completo da fonteEbang, Ondo Emmanuel. "Perception de l'hôpital public et offre de soins de santé au Gabon : analyse des enjeux des interactions entre personnels et usagers du centre hospitalier de Libreville (CHL)". Paris, EHESS, 2012. http://www.theses.fr/2012EHES0461.
Texto completo da fonteIn the study of the dysfunctions of the national systems of health in sub-Saharan africa, the difficult current relations between patients (users and hospital staff(personnel)) must be understood by their integration with a historical heritage relating to colonial medicine. The problem of the perception of the public hospital in Gabon try to analyze at the same time the difficult relationships and the various stakes which cross the everyday life of the care in hospital life in Libreville. Since the middle of the years 1980, more and more gabonese' patients meet enormous diificulties to look after itself in the public hospitals. How the populations (medical staff and patients) of Libreville represent then the care in the CHL, the greatest medical formation of Gabon? In addition, why the patients continue to visit this public hospital in spite of its dysfunctions and its bad reputation near its users? A fine and descriptive ethnography of the "General Hospital" of Libreville enabled us to analyze the practices, the speeches, logics of actors and other issues which are played around the taking care of the patients. The gabonese' hospital, although being a modern place of vexercise of the biomedical practice, is presented in the form of a "social microcosm" reflecting the social inequalities, the relations of being able, the importance of the money and the acquaintances, the extent of the practices of corruption, the weight of the popualr representations on sorcery and illness, the religious beliefs and many other characteristics defining the gabonese society of today
Dakey, Yawovi Ségla Kpéli. "Le développement des compétences dans le processus de prise en charge globale des personnes âgées au sein des établissements médico-sociaux : le cas des maisons de retraite". Versailles-St Quentin en Yvelines, 2009. http://www.theses.fr/2009VERS028S.
Texto completo da fonteThe ageing of the population and the growing number of very old people in loss of autonomy, represents, a real social problem. In France, retirement homes (EHPAD) are the main actors in the public policies implemented to face these demographic trends. This thesis aims at providing a framework of comprehension and guidelines for the development of professional competencies of nursing staff in retirement homes (EHPAD). In this context it is tackling the practices of work and organization which can contribute to the learning and the development of competencies, through an exploratory research which is based on case studies, the analysis of social representations of the actors and the analysis of the concrete situations of care of the elderly. Our results and analysis showed professional practices in shift with the systems of thoughts and beliefs of nurses and in addition, the complexity of the care to the elderly and ethical problems involved in this care. On the conceptual level, our research enabled us to build a model to analyze and evaluate the practices of development of competencies in the process of care of the very old people. If this model could be applied only to retirement homes in France, an investigation carried out in USA enabled us to collect information on some foreign practices of care of old people and provides a perspective to our research
Rimbert-Pirot, Anne-Gaëlle. "Analyse du processus de territorialisation de l'action publique : construction d'un territoire et appropriation d'un outil pour agir collectivement : cas des programmes territoriaux de santé". Electronic Thesis or Diss., Aix-Marseille, 2015. http://www.theses.fr/2015AIXM1099.
Texto completo da fonteThis research focuses on public policy territorialisation. While administrative territories, such as health territories, are imposed via a top-down process, a bottom-up approach is also recognised as being necessary. Here, local stakeholder and user needs are identified and understood meaning that territory specificities are recognised, local public actions are adapted, social inequalities are tackled and access to care is facilitated. This work focuses on the construction process of one such territory by public and local actors. In order to increase knowledge the objective is to study this process in relation to the procedure of territory building by local stakeholders and the ownership of a public policy tool which will lead to collective action. The first section is theoretical and presents the links between the three research areas: territrialisation, territory construction and appropriation of a tool. The second part presents the epistemological and methodological choices and the case study. Focus is placed on the deployment of a public policy tool, in this case a territorial health programme, in two health territories. The third part presents an analysis of the results which include interviews and observation. Finally, the fourth section places the results in perspective. The dimensions of constructed territory are reconsidered so as to offer a model articulating the dichotomy between prescribed territory and emergent territory while taking into consideration the specificities of a public tool for regionalisation
Vlassis, Ioannis. "Évolution du système de santé en Grèce : 1974-2008 : émergence et marginalisation récente d'une nouvelle structure administrative prometteuse". Thesis, Montpellier 3, 2011. http://www.theses.fr/2011MON30005/document.
Texto completo da fonteHealth System as a fundamental institution of the welfare state aids in securing and improving the level of welfare and quality of life of the population. The addressees are the members of or the whole community. Therefore, it is made clear that it is important to study the health policies and public administration, whose role is dominant. The content of the Health System, the administration models and the resources available define the policies of the states and are differentiated as opposed to the rest. The combination of welfare policies and the Health System is affected by the economical and social condition of each country. The longitudinal evolution of the Health System from 1974 to 2008 is the main pillar of our study. The subject will be approached through all the explanatory reports of the laws of the Greek republic. The primary sources will be processed and information related to the content of the study will be drawn. [...]
Leprêtre, Pascal. "Principe de précaution et droit sanitaire : cas français". Paris 13, 2004. http://www.theses.fr/2004PA131028.
Texto completo da fonteIn termes of the french law of 2 february 1995, the precautionary principle is that "according to wether the absence of certainty, considering technical and scientific knowledge of the moment, does not have to delay the effective and proportioned measure adoption, aiming to warn a serious and irreversible damage risk to the environment, to an economically acceptable cost". The thesis has for object to evaluate in the sector of the health, modes of application and the function of the principle of precaution, especially in its reports with the right of the health and more generally with the sanitary democracy. Become judicial principle of constitutional value, it contributes to delimit a new field of the right of the responsibility. The thesis tends to justify that the principal of precaution addresses to the collective and individual mastery of risks. Making this, this new forms responsibility will have to possess a conceived particular regime on the basis of a prejudice and causality risk, and will make place to a new makes justificatory, the social risk acceptability
Gay, Renaud. "L'Etat hospitalier : réformes hospitalières et formation d'une administration spécialisée en France : (années 1960 - années 2000)". Thesis, Université Grenoble Alpes (ComUE), 2018. http://www.theses.fr/2018GREAH014.
Texto completo da fonteThe « neoliberal statization » of French hospital system is a well-established paradox that our research reexamines through two ways. The first one is historical. It consists in studying managerial reformism which emerged in the 1960s, whereas most investigations are focused on policies implemented after the 1980s. The second one is organizational. The statization is to be understood less as proliferation of norms and procedures in hospitals than as the formation and the stabilization of public specialized organizations. At the intersection of the policy analysis and the sociology of administration, this study focuses on how hospital reforms can contribute to the definition, the consolidation and the recognition of a political-administrative center in a sociohistorical perspective. Our main hypothesis is that hospital reforms crystallize three interconnected processes which underpin the institutionnalization of a specialized administrative organization called the Hospital State. Firstly, reforms support the redistribution and concentration of administrative prerogatives on hospitals within one single organization (process of monopolization). Secondly, they help increase the capacities of this organization that in turn strengthen its autonomy from other agents (process of autonomization). Thirdly, they generate and rely on specialized knowledge that justifies state interventions (process of legitimation). Our historical observation of reform activities leads to outline three temporal sequences. These reveal an uneven continuity of these processes and their unequal articulation depending on historical periods. If reforms contribute to forging a relative autonomous Hospital State, its organizational boundaries and its principles of legitimation are far from being stabilized. Our investigation is based on various materials : records from administrative and private organizations ; interviews with minister’s advisers, senior civil servants and experts of the Ministry of Health ; grey literature (administrative and expert reports, ministerial publications) ; national newspapers and professional journals ; parliamentary debates ; biographies of supervisory staff members at the Ministry of Health
Lenay, Olivier. "Régulation, planification et organisation du système hospitalier : la place des outils de gestion dans la conception des politiques publiques". Paris, ENMP, 2001. http://www.theses.fr/2001ENMP1018.
Texto completo da fonteCarlucci, Sarah. "La trasferibilità delle autorizzazioni e concessioni amministrative". Electronic Thesis or Diss., Toulon, 2021. http://www.theses.fr/2021TOUL0140.
Texto completo da fonteThe research aims to investigate the problems relating to the transfer of administrative acts between private subjects, especially with attention to activities related to health services, where it is difficult to find a balance between conflicting interests,The subjective change in the legal relationship between the Public Administration and the holder of the administrative act, which is replaced by a new beneficiary, must be read as a legal act ontologically linked to the contextual transfer, inter vivos or mortis causa, of the subjective legal situation that justifies the legitimate interest in being the holder of the favorable administrative act. Indeed, the transfer of a commercial activity loses its legal, economic and social significance if the buyer or the universal successor cannot benefit from the administrative act necessary to effectively carry out the activity. But, if the private subject is clearly in favor of a free transferability of the administrative act, it is also necessary to take into account the public interests protected by the administrative act, interests present both at the time of issue of the act and at the moment of the transfer of the authorized activity.Currently, administrative jurisprudence continues to consider administrative acts as strictly personal, stating that it is not possible to transfer an administrative act to a new beneficiary because it is issued in consideration of the person who benefits from it. However, if it is clear that we cannot speak of the transferability of those administrative acts that depend on strictly individual qualities, there seems to be no valid obstacle to the transfer of an act issued exclusively or mainly by reason of the objective activity to which it refers. The transferability of an administrative act in which the economic potential and the presence of technical prerequisites are more important than personal qualities could therefore be recognized, without threatening the public interest, which remains protected by the fact that the transfer of the administrative act is not a simple marketing between private subjects, but it is a legal act that can exercise its effects after issuing a specific authorization by the competent public administration. This administrative intervention is read by the jurisprudence as the issue of a new authorization but we believe that it must be interpreted and regulated as a preventive check only of the subjective elements required by law, because if there is a contextual transfer of the commercial company, such as an organization of resources, the compliance of the activity with the qualitative and quantitative criteria predetermined by the public administration has already been verified at the time of the issue of the administrative act : it would rather be necessary to subject the activity to subsequent periodic effective checks carried out by the competent administrations, aimed at verifying the compliance with the conditions set out in the transferred administrative act.Transfers of administrative acts are operations that involve significant legal risk, which should be understood and analyzed to best manage it. The aim of the research is to examine whether there are general and common criteria that can be used to solve theoretical and practical problems related to the transfer of administrative acts, with reference to private commercial activities and public service activities
Naud, François-Xavier. "L'État et la prévention sanitaire au dix-neuvième siècle". Bordeaux 4, 2004. http://www.theses.fr/2004BOR40003.
Texto completo da fonteWang, Qian. "Aspects socio-économiques et éco-épidémiologiques de l'échinococcose alvéolaire dans les communautés pastorales tibétaines en République populaire de Chine". Besançon, 2004. http://www.theses.fr/2004BESAA002.
Texto completo da fonteMultivariate analysis of data from 7,138 subjects revealed that increasing age, in all communities, "non-preventing flies from food" in herdsmen communities, "residence in Ganzi county", "number of dogs kept" and "ownership of fox skin" in farmers' communities, "female gender", "drinking water from streams" and "playing with dogs" in urban communities were risk factors for Alveolar Echinococcosis in the respectiye populations. Questionnaires on husbandry practices, transects to detect small mammal indices and measure the extent of fenced pastures, and assessment of dog infection confirmed our hypothesis that oyergrazing in common pastures was significantly associated with the extent of fenced pastures in the winter settlements and appeared to increase the density of small mammals that may serve as reservoir for the parasite, which might in tum promote maintenance and transmission of E. Multilocularis, through dog infection, in the Tibetan pastoralist communities of Sichuan, PR China
Li, Lingwei. "Les places respectives de la médecine chinoise et de la médecine occidentale dans le droit chinois entre 1840 et 1982". Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0276/document.
Texto completo da fonteFor millennia, Chinese medicine has been of some renown. However, during the period going from the first opium war of 1840 to the promulgation of the constitution of 1982, this medicine has slowly declined. This change is mainly due to the radical mutation of Chinese society on its whole, and to its increasing confrontation with western culture and medicine. Successive political regimes have tried to set up diverse health systems, which they modernized or westernized, in order to remedy the delicate health situation and relieve some burden from existing institutions. They either openly supported Western medicine, even to the point of wanting to abolish its Chinese counterpart, or tried to stimulate some form of collaboration between the two medicines. Based on this history of clashes and forced cohabitation, and on the specific aspects of each of them, it seems a sound goal to proceed to a deeper collaboration between these two medicines, to help and manage public health more efficiently. Indeed, this collaboration could in itself better the current health system, would stimulate medical activity, could reduce healthcare costs and finally should improve global health and wellbeing of the Chinese population. But of course, it is first and foremost a pressing duty to enhance the current status of existence and state of development of Chinese traditional medicine
Rimbert-Pirot, Anne-Gaëlle. "Analyse du processus de territorialisation de l'action publique : construction d'un territoire et appropriation d'un outil pour agir collectivement : cas des programmes territoriaux de santé". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM1099/document.
Texto completo da fonteThis research focuses on public policy territorialisation. While administrative territories, such as health territories, are imposed via a top-down process, a bottom-up approach is also recognised as being necessary. Here, local stakeholder and user needs are identified and understood meaning that territory specificities are recognised, local public actions are adapted, social inequalities are tackled and access to care is facilitated. This work focuses on the construction process of one such territory by public and local actors. In order to increase knowledge the objective is to study this process in relation to the procedure of territory building by local stakeholders and the ownership of a public policy tool which will lead to collective action. The first section is theoretical and presents the links between the three research areas: territrialisation, territory construction and appropriation of a tool. The second part presents the epistemological and methodological choices and the case study. Focus is placed on the deployment of a public policy tool, in this case a territorial health programme, in two health territories. The third part presents an analysis of the results which include interviews and observation. Finally, the fourth section places the results in perspective. The dimensions of constructed territory are reconsidered so as to offer a model articulating the dichotomy between prescribed territory and emergent territory while taking into consideration the specificities of a public tool for regionalisation
Blaise, Pierre J. "Culture qualité et organisation bureaucratique, le défi du changement dans les systèmes publics de santé: une évaluation réaliste de projets de qualité en Afrique". Doctoral thesis, Universite Libre de Bruxelles, 2004. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/211123.
Texto completo da fonteDepuis une quinzaine d'années en Afrique, cercles de qualité, audits cliniques, cycles de résolution de problèmes et autres 'projets qualité' ont été mis en oeuvre dans les services publics de santé pour améliorer la qualité des soins. Ces projets ont souvent mis l'accent sur des approches participatives, la résolution locale de problèmes et le changement, bousculant les pratiques managériales traditionnelles. A court terme, les évaluations montrent l'amélioration des résultats de programmes ou d'activités. Mais la pérennité de la dynamique reste largement à prouver. Le véritable aboutissement d'un programme d'assurance qualité devrait être apprécié à l'aune de sa capacité à mettre la préoccupation pour la qualité au cœur du management et du fonctionnement du système, et ce de façon continue. C'est en effet la vision moderne de l'assurance qualité déclinée dans les approches du management de la qualité totale, de l'amélioration continue de la qualité ou de l'organisation apprenante.
Méthode
La définition, la mesure et le management de la qualité en santé se révèlent être beaucoup plus qu'une simple procédure technique: c'est un processus social dans un système complexe dont l'étude requiert une approche méthodologique appropriée (Chapitre 1). Notre objectif est d'explorer dans quelle mesure les projets qualité ont permis aux systèmes de santé d'adopter les principes du management de la qualité.
Nous proposons de conduire une 'évaluation réaliste' de projets qualité en Afrique (Chapitre 2). Conceptualisée par Pawson et Tilley (1997) dans le domaine des sciences sociales, l'évaluation réaliste ('realistic evaluation') est une approche méthodologique de la famille des theory based evaluations. Au-delà du constat d'un effet produit par une intervention, l'évaluation réaliste cherche à comprendre ce qui marche, pour qui, dans quelles circonstances et comment. Alors que les résultats issus de la 'grounded theory', de la recherche action et d'autres méthodes de recherche sur les systèmes de santé restent très liés à un contexte, l'évaluation réaliste génère des théories intermédiaires ('middle range theories') qui permettent d'étendre la validité des interprétations au-delà d'un contexte particulier. Construite autour d'études de cas menées dans des contextes multiples et variés, l'évaluation réaliste met en effet l'accent sur l'interaction entre le contexte et la logique d'une intervention.
Résultats
Afin de construire une théorie initiale, nous comparons les systèmes de santé Européens et Africains à l'aide des configurations organisationnelles de Mintzberg (chapitre 3). Nous mettons ainsi en évidence le rôle joué par la nature bureaucratique ou professionnelle de la configuration des organisations de santé dans les résistances à l'introduction des principes du management de la qualité.
Nous menons ensuite une série d'études de cas au Niger, en Guinée, au Maroc et au Zimbabwe pour étudier cette interaction. Dans une première série comparative de trois études de cas (Chapitre 4), nous mettons en évidence la tension qui existe entre la logique de commande et de contrôle des organisations bureaucratiques et la logique de l'assurance qualité valorisant la prise d'initiative de changement par des équipes non hiérarchisées. Nous explorons ensuite cette tension dans trois études de cas distinctes au Zimbabwe et au Maroc. Laissées à la merci des contraintes bureaucratiques, les initiatives locales pour améliorer la qualité apparaissent dépendantes de la capacité des acteurs à développer des stratégies de contournement (Chapitre 6). Faute de quoi elles doivent réduire fortement leurs ambitions à moins qu'elles ne bénéficient d'un soutien émanant d'une institution située hors de la ligne hiérarchique mais reconnue légitime (Chapitre 5). Les systèmes publics de santé de ces pays, conçus comme des organisations bureaucratiques structurées autour de relations hiérarchiques de commande et de contrôle tolèrent une démarche qualité, valorisant l'innovation, la créativité, la prise d'initiative locale et le travail en équipes non hiérarchisées, à la condition qu'elle se déroule à l'abri d'un projet. Force est de constater que ces dimensions clé de la culture qualité n'ont pas fondamentalement ni durablement imprégné des pratiques de management restées bureaucratiques. L'émergence d'une véritable 'culture qualité', un produit attendu de l'introduction de projets qualité, ne semble pas s'être produite au niveau organisationnel (Chapitre 7).
Nous procédons ensuite à la synthèse 'réaliste' de l'ensemble de nos études de cas (Chapitre 8). Nous en tirons les leçons sous la forme d'un enrichissement progressif de notre théorie initiale. Nous pouvons alors formuler une théorie améliorée, toujours intermédiaire et provisoire, dérivée de nos théories intermédiaires successives.
Discussion
Notre discussion s'organise autour de deux thèmes (chapitre 9).
Dans une première partie, nous discutons le potentiel et les limites de nos résultats et de l'approche réaliste de l'évaluation. Nous montrons que nos résultats sont des théories provisoires et incomplètes, deux caractéristiques d'une middle range theory. En dépit de ces limites, l'approche réaliste est potentiellement très riche pour interpréter les effets d'interventions dans des systèmes complexes. Elle se situe dans une perspective d'aide à la décision pour orienter l'action sur le terrain plutôt que dans une perspective de genèse de lois universelles. Elle représente une avancée méthodologique particulièrement pertinente pour la recherche sur les systèmes de santé dans un monde turbulent où de multiples initiatives se télescopent.
Dans une deuxième partie, nous discutons les conséquences de nos résultats pour le futur de l'assurance qualité dans les systèmes de santé. Les projets qualité étudiés ne parviennent pas à changer une culture organisationnelle bureaucratique qui compromet pourtant leur pérennisation. Nous envisageons alors les stratégies susceptibles de permettre à la culture qualité de s'épanouir et au contexte organisationnel d'évoluer en conséquence. Décentralisation et nouveau management public, en vogue hier et aujourd'hui, montrent leurs limites. Il faut probablement trouver un équilibre entre trois idéaux-types décrits par Freidson: l'idéal-type bureaucratique, malmené par les stratégies de débrouille locale, l'idéal-type du marché, valorisant l'initiative, et l'idéal-type professionnel, émergent mais encore embryonnaire en Afrique. Finalement, à côté des mécanismes du contrôle et de la compétition, un troisième mécanisme régulateur devrait prendre toute sa place: la confiance.
Introduction
For nearly two decades in Africa, quality circles, clinical audits, problem solving cycles and other quality projects have been implemented in public health services to improve quality of care. Challenging traditional managerial practices, these projects usually emphasized participatory approaches, local problem solving and change. At short term, evaluation shows improvement in programs and activities output. However the capacity to put quality at the heart of system's management should be considered as the genuine achievement of a quality assurance program. Did quality projects contribute to the adoption of quality management principles by health systems ?This is the question addressed in the present thesis.
Method
Our methodology belongs to the realistic evaluation paradigm conceptualized by Pawson and Tilley and focuses on the interaction between an intervention mechanism and its context in order to understand what works, for whom, in what circumstances and how ?Based on case studies in various contexts in Niger, Guinea, Morocco and Zimbabwe, we build a middle range theory, that explains organizational behavior towards quality management.
Results
Based on Mintzberg's models, we show the role of health care organizational configuration in resisting to quality management principles. We then explore the tension between the bureaucratic organization's command and control approach and the quality assurance approach promoting initiative and change through team work. Local initiative had to develop coping strategies to overcome bureaucratic constraints. Failing to do so, ambitions had to be reduced unless there was support from an external, yet legitimate institution. Public health systems of these countries, structured as command and control hierarchical organizations, allowed innovation, creativity, local initiative and non hierarchical relationships as long as they developed within the boundaries of a project. However, these key characteristics of a quality culture did not permeate routine management. The quality culture shift expected from quality projects does not seem to have happened at organizational level.
Discussion
We first discuss the potential and limitation of realistic evaluation which appear particularly relevant for complex health systems research. We then discuss consequences of our results on the future of quality assurance in health systems. Since quality projects fail to transform a bureaucratic organizational culture, which in turn undermines their sustainability, alternative strategies must be sought to promote quality culture and relevant organizational change. Decentralization and new public management show their limitations. We suggest a balance between three ideal-types described by Freidson: The bureaucratic ideal-type, challenged by local coping strategies, the market ideal-type, which is fashionable today and promote initiative, and the professional ideal-type, emerging and promising, yet still embryonic in Africa.
Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
Ma, Jingjing. "La gestion, l'utilisation, la consommation et la représentation de l'eau en Chine". Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCB195/document.
Texto completo da fonteWe will analyze this topic based on four major scales of observation: macrosocial, mesosocial, microsocial and micro individual. Firstly, in order to understand the context of drinking-water usage and management, we will present the environmental context and the geopolitical importance of water at the international level. We will then demonstrate China's development following a "water crisis" at the national level. Finally, we will present the regional-level example of Guangzhou, along with the solutions to and conflicts within this crisis on a macrosocial scale. "Water management", in terms of quantity and quality, continues to be a particularly important issue on the national and international stage. Secondly, we will examine the changes in the quality and management of running water in Guangzhou. In this second section, we will first show that running water in the region has become undrinkable due to severe pollution stemming from rapid urbanization. On a mesosocial level, we can observe the reactions of and cooperation between various segments of the public and private sector with respect to the production and distribution of running water. In the third section, we will examine the issue on the microsocial scale. Here, we will be focusing on water usage in individuals' daily lives, especially in the context of food and eating habits. We will first describe the changing role and diversity of water usage in the modern urban Chinese household, from historic usage of well-water to various types of commercially produced water. How do individuals select their preferred water source(s) based on the available options? How do they use and transform the meaning of water within the domestic realm? Next, we will analyze the forms of consumption and the representations of drinking water (including running water as well as other types of non-alcoholic water beverages, both flavored and unflavored) within Chinese households in four major Chinese cities: Beijing, Shanghai, Guangzhou, and Chengdu on the microsocial scale and micro individual. In this section, we outline the differences between the habits of more traditional Chinese, adherents of the Chinese philosophy of qi, yin, and yang, and those of more modern, non-traditional Chinese, as well as those in between the two extremes. This section also explores the relationships inherent in Chinese society though the lens of water consumption. Lastly, we address the issue of flavor, especially sugar in non-alcoholic drinks, by outlining the forms, practices, representations, and management of the body in relation to sugar and sweet drinks
Mariotti, Ludovic. "La réforme "Hôpital, patients, santé et territoires" : Une recomposition de l’action publique locale en trompe l’œil ? : Une analyse par les instruments au prisme du secteur médico-social en région Provence-Alpes-Côte d'Azur". Thesis, Montpellier, 2015. http://www.theses.fr/2015MONTD032.
Texto completo da fonteThe 2009 reform “Hôpital, patients, santé, territoires” (HPST) made the « Agence Régionale de Santé » the leading health organism on a regional level. By using an instrument approach, our thesis exanimates the reality of this role during its application. This question echoes a more global issue: namely, who are health policies decided by, on a local level?By investigating the health field within the PACA region, through the lenses of the medico-social area, our work demonstrate that the instruments supposedly in the hands of the ARS are only barely so. Each instrument, whether it finds its origins in the old healthcare planning ideal or in a more liberal ideology, let us discover a distribution of competences different from what is legally intended
Leckie, Christine. "Déterminer les conditions de pertinence de la norme ISO 9001 pour l'assurance de la qualité des soins : cas d'experimentation". Lyon 2, 2001. http://theses.univ-lyon2.fr/documents/lyon2/2001/leckie_c.
Texto completo da fonteThis thesis focuses on the convergences between the quality insurance of the ISO 9001 norm and the care quality insurance of health organisations. The problem is placed in the referential context of two frameworks. That of public health and the management of health systems of the European Health policy of the WHO in the 21 st century, including accreditation. Thus the public health fuction of management is explained. Centred on health results, the cost-effectiveness relation, quality crtiteria based on scientific proofs, its objectives are the improvement of public health and sanitary safety. That of management sciences, including the evolution of the conceptions and pratices of quality, thus the certification. The search for convergence between these frameworks of reference and an experimentation, brings out the conditions of pertinence of the ISO 9001 norm, version 2000 for the care quality insurance. For the health organisations, it is about : 1. Defining the characteristics and levels of acceptance of their basic service (individual and collective health programmes) and peripheral service (care quality insurance programme) relating to public health ; 2. Considering the programmes as critical and major processes of a quality system oriented process, by applying the principles of the ISO 9001 referential to them ; 3. Their strategy, their quality policy, complimentary norms and legal exigencies, their stand concerning care management models, and the tractability of their quality system. Finally, regarding the configuration of this system, the contributions of socio-economic diagnosis and quality system audit are shown
Kada, Amine. "Une exploration des messages Twitter émis par les gouvernements en temps de COVID-19". Master's thesis, Université Laval, 2021. http://hdl.handle.net/20.500.11794/70311.
Texto completo da fonteGovernments are increasingly turning to social media platforms such as Twitter to disseminate public health information to the public, as evidenced during the COVID-19 pandemic. The purpose of this paper is to gain a better understanding of Canadian government and public health officials' use of Twitter as a dissemination platform during the pandemic, and to explore the public's engagement with and sentiment towards these messages. We examined the account data of 93 Canadian public health and government officials during the first wave of the pandemic (December 31, 2019 – August 31, 2020). Our objectives were to: 1) determine the engagement rates of the public with Canadian federal and provincial/territorial governments and public health officials' Twitter posts, 2) illustrate the evolution of the Canadian public discourse during the pandemic's first wave by a hashtag trends and 3) provide insights on the public's reaction to the Canadian authorities' tweets through sentiment analysis. To address these objectives, we extracted Twitter posts, replies and associated metadata available during the study period in both English and French. Our results suggest members of the public demonstrated increased engagement with federal officials' Twitter accounts as compared to provincial/territorial Twitter accounts. Hashtag trends analyses illustrated the topic shift in the Canadian public discourse, which initially focused on COVID-19 mitigation strategies and evolved to address emerging issues such as COVID-19 mental health effects. Additionally, we identified 11 sentiments in response to officials' COVID-19 related posts. This study illustrates the potential to leverage social media to understand public discourse during a pandemic. We suggest that routine analyses of such data can provide real-time recommendations to government and public health officials on public sentiments during a public health emergency and can provide useful insights on the accounts/actors with which members of the public are most engaged, which can be leveraged to disseminate key messages.