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This article analyzes the contemporary transformation of the medicalization of pain relief in the organization of the perinatal care system in Quebec. The consequences of this transformation are analyzed specifically through the common recourse to epidural anesthetics to relieve women's pain during childbirth. Relying on 6 months of ethnographic fieldwork, 26 semi-structured interviews and 24 life history interviews, I discuss the relevance of the concepts of medicalization and demedicalization for a theoretical analysis of this transformation. By taking into account in the analysis the three levels of medicalization suggested by Conrad and Schneider (conceptual, interactional and institutional), I argue that the expertise related to the relief of pain during childbirth is transferred from health professionals to women through a naturalization of women's competences process. Beyond the notion of social control, I revisit the use of the concept of medicalization to analyze how pain during childbirth could be simultaneously the subject of a double and continuous process of demedicalization and of medicalization. I conclude that the transformations of the Quebec perinatal system cannot be completely part of a demedicalization process but rather part of a form of medicalization where the different levels of medicalization are modulated. [ABSTRACT FROM AUTHOR]

Introduction: The capacity for teams and organizations to evolve and to thrive in ever‐shifting environments is attributed to their collective intelligence. Collectively, intelligent team could prevent repetition of past mistakes and can help organizations and people work more efficiently. Researchers aimed to find a framework or a tool that could help explain collective intelligence in primary healthcare organizations. Methods: The framework was developed iteratively following a three‐step process based on the Pragmatic utility concept analysis, each step fetching data from both literature and the team's expertise: (i) finding an existing framework, (ii) developing an initial framework, (iii) testing and refining the framework. Results: A broad literature search led researchers to focus more specifically on two interrelated frameworks, both concepts were created within the educational field. We first adapted these concepts to healthcare teams, then to the increasing interdisciplinarity of primary healthcare teams. We also subdivided the framework into clinical or organizational domain. Finally, we performed a secondary analysis from existing data of a larger project that aimed to evaluate seven primary care teams in Quebec. Conclusions: This first attempt to conceptualize collective intelligence in a way that is specific to primary healthcare teams helps identify strengths and areas in which teams could potentially improve. From a theoretical perspective, the framework facilitates understanding of the concept of collective intelligence in primary healthcare teams. Our current results show a strong potential for this tool, but other tests and systematic validations are to be expected in order to better link collective intelligence and team performance. [ABSTRACT FROM AUTHOR]

Introduction: Mental illness accounts for about one-third of the world's disability, a burden that many health systems cannot adequately respond to. Up to 70% of mental health (MH) patients are followed-up in primary health care (PHC) settings. To bridge the treatment gap, the World Health Organization developed mhGAP, a guidance package for integrated management of priority MH disorders in lower-income countries. Other countries have developed their own evidence-based interventions. Objectives: Overviewing countries' strategies towards integrating MH services into PHC, their outcomes and challenges. Methods: Review of literature using PubMed search terms "mental health primary care", MeSH terms "Primary Health Care", "Mental Health Care" and "organization and administration", published in the last 5 years, in English. Results: 25 of 602 articles were selected. The mhGAP programme has seen successful integration in pilot district-level programs, but wider implementation has stalled due to stigma and lack of clinical engagement, resources, MH specialists, and policy support. The Quebec MH reform promoted integrated service networks, improving accessibility and quality of care (QoC). A Norwegian-Russian long-standing collaboration initiative has significantly improved treatment for anxiety and depression (A&D), with 58% reliable recovery rate. A Danish collaborative care intervention provided high-quality treatment of moderate A&D. In Peru, a similar initiative allowed early detection, referral, and treatment of MH patients attending PHC services. Conclusions: Comprehensive, integrated and responsive collaborative care models are a cost-efficient strategy to improve QoC for many MH conditions across diverse populations. MH-PHC integration initiatives have seen varying degrees of success. However, several barriers impact wider implementation and scale-up. [ABSTRACT FROM AUTHOR]