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Abstract: The professional claims and struggles involved in the design of non-traditional health care places are rarely problematized in applied health research, perhaps because they tend to fade away once the new design is implemented. This paper offers insights into such professional tensions and their impact on health care delivery by examining the design of two dialysis service delivery models in Quebec, Canada. The satellite units were hosted in two small hospitals and staffed by recently trained nurses. The mobile unit was a bus fitted to accommodate five dialysis stations. It was staffed by experienced nurses and travelled back and forth between a university teaching hospital and two sites. In both projects, nephrologists supervised from a distance via a videoconferencing system. In this paper, we draw mainly from interviews with managers (mostly nurses) and physicians (n=18), and from on-site observations. Nephrologists, medical internists, and managers all supported the goal of providing “closer-to-patient” services. However, they held varying opinions on how to best materialize this goal. By comparing two models involving different clinical and spatial logics, we underscore the ways in which the design of non-traditional health care places opens up space for the re-negotiation of clinical norms. Instead of relatively straightforward conflicts between professions, we observed subtle but inexorable tensions within and beyond professional groups, who sought to measure up to “ideal standards” while acknowledging the contingencies of health care places. [Copyright &y& Elsevier]

Abstract: This paper addresses two questions: (1) Can people''s perceptions of problems and social cohesion in the neighbourhood be considered as contextual variables; and (2) are these perceptions related to people''s health? Data come from a general health survey carried out in 2004 among 1634 individuals living in three localities of the region of Québec City, namely a downtown, a suburban and a rural area, which were further subdivided into 34 smaller spatial units, hereafter called neighbourhoods. The survey included questions on individuals’ perception of problems (social and environmental) and social cohesion (attraction to neighbourhood, neighbouring and psychological sense of community) in the neighbourhood, as well as questions on self-rated health, long-term disability and self-mastery. A first set of logistic multilevel models was performed to ascertain the existence of neighbourhood variations in the perception of problems and social cohesion, after accounting for individual attributes. A second set of multilevel models was carried out to examine the association between perceived problems and social cohesion in the neighbourhood and people''s health. Results show that, after accounting for individual attributes, the perception of problems and social cohesion varies significantly by neighbourhood and/or localities and can be considered as contextual variables. Furthermore, these perceptions of place appear to be significant predictors of people''s health. [Copyright &y& Elsevier]