Le système de santé d'aujourd'hui fait appel à de nombreuses technologies de l'information nommées TIS (Technologies de l’Information en Santé). Celles-ci ont donné naissance à de nouvelles formes d’interaction médecin-patient et ont complexifié l'approche thérapeutique dite
« centrée sur le patient ». Les TIS promettent une plus grande efficacité et l’augmentation de la satisfaction des patients par le biais d’une meilleure compréhension de la maladie pour le patient. Or, elles peuvent également devenir des sources de conflit pour le professionnel de la santé, étant donné leur utilisation en dehors des rencontres cliniques ainsi que leur tendance à agir comme des barrières communicationnelles lors des consultations. Cette recherche vise a étudier les critères de design nécessaires à la conception d’un TIS pouvant améliorer la relation médecin-patient et donc, faciliter la communication et améliorer l’alliance thérapeutique. L’étude utilise une approche centrée sur l’utilisateur et vise donc à comprendre les besoins et les attentes des médecins et des patients. En étudiant les nouvelles approches en santé et les TIS, il a été possible de comprendre le contexte et les besoins des utilisateurs en terme de communication. Ces derniers sont primordiaux au processus dit centré sur l’utilisateur. Le faible taux de rétention du discours du médecin devient une barrière communicationnelle importante, tout comme le temps pressurisé. La recherche nous montre que l’ajout d’un outil virtuel de vulgarisation peut, à l’aide de média visuels (tel que des modélisations, des animations 3D et des dessins), grandement aider la relation médecin-patient. / Today’s medical system is using an increasing number of information technologies to help healthcare professionals in their daily practice. Commonly known as HIT (Health Information Technologies), they create new forms of doctor-patient interaction and complexify the therapeutic approach called “patient centered approach”. Their use promises to improve the efficiency of the healthcare system and the overall satisfaction of the patient by improving his understanding of his illness, yet they can also become communication barriers during a consultation and even a source of conflict when used outside a clinical context. This research project aims at studying the design criteria for a Health Information tool that can help improve the doctor-patient relationship. The study uses a user-centered approach and therefore, focuses on understanding the needs and expectations of both doctors and patients. The study of the theoretical and "on the field" therapeutic approach shows that the pressurized time of the consultation, the many communication barriers and the low level of information remembered by patients are problems that can be solved by a HIT. A virtual vulgarization tool that uses multimedia such as 3D animations, 3D models and drawings can considerably help the doctor-patient relationship.

Atualmente o vídeo tem sido considerado por alguns autores o padrão-ouro para ensino de habilidades de comunicação e o vídeo feedback (VF) tem se mostrado eficaz no treinamento de habilidades em várias áreas profissionais. Entretanto, há poucos estudos sobre os efeitos das diferentes metodologias de VF. Este estudo propõe explorar as potencialidades, desafios e efeitos do VF de filmagem de consultas em contexto real, para uma avaliação formativa em habilidades de comunicação, com médicos residentes, em um programa de Atenção Primária. Foi conduzido um estudo pré e pós teste com um grupo controle. A intervenção constituiu-se de sessões de revisão do vídeo em pequenos grupos, na metodologia de entrevista baseada em problemas, com feedback por colegas (peer-feedback) e com um facilitador. Os 54 (cinquenta e quatro) médicos residentes responderam questionários quantitativos e qualitativos e dois avaliadores externos analisaram em vídeo, randomicamente e às cegas, cerca de 200 (duzentas) performances dos residentes com pacientes-simulados, antes e após a intervenção. Para análise dos dados foi usado ANOVA two-way de medidas repetidas e para análise qualitativa foi usado análise temática de Braun e Clarke. A metodologia de VF utilizada para avaliação formativa mostrou ser bem avaliada pelos participantes e com potencial de gerar mudança de atitudes no entrevistador. Na análise qualitativa, as principais potencialidades identificadas na metodologia foram autopercepção e o feedback por pares, e as principais mudanças na prática clínica foram a melhora da comunicação não-verbal, mudanças de comportamento, abordagem mais centrada no paciente e incorporação de prática reflexiva. Houve aumento de escores, entre os tempos, relacionados à decisão compartilhada, aviso de alerta de comunicação de má notícia e disposição para apoio ao paciente. Os desafios foram a dificuldade do facilitador em conectar o vídeo feedback com o referencial teórico e o estresse inicial para gravar-se e assistir-se em vídeo. Observamos que a análise qualitativa dos dados revelou mais informações sobre os efeitos nos participantes que a análise quantitativa. Os dados observados nos resultados qualitativos não tiveram o mesmo impacto nos resultados quantitativos. Devido à dificuldade observada em encontrar instrumentos adequados e validados para avaliar habilidades de comunicação, foi realizada em uma etapa posterior, a tradução e adaptação transcultural para o português falado no Brasil do instrumento Calgary-Cambridge Observation Guide (CCOG), com análise psicométrica. Concluímos que há uma dificuldade nos questionários em mensurar competências atitudinais e aspectos mais subjetivos de comunicação. Sugere-se mais estudos com aprofundamento na definição de parâmetros dos itens subjetivos de avaliação, conforme as competências exigidas para cada fase da formação médica. Concluímos também que para uma metodologia de VF efetiva é importante estimular a autoavaliação com uma prática reflexiva, feedback por pares focado em reforço positivo na busca de estratégias, além de um facilitador cuidadoso em relação a psicologia do aprendiz, com habilidade de conectar o feedback com uma teoria de comunicação abordada previamente. A versão brasileira do CCOG mostrou confiabilidades aceitáveis nos indicadores psicométricos, incluindo no modelo multifacetas de Rasch e assim, um instrumento adequado para auxiliar no ensino e avaliação de habilidades de comunicação no Brasil / Currently, video recordings of medical consultations have become the standard teaching approach to communication skills, and video feedback has shown to be effective in skills training in many professional areas. However, researches on the effects of different video-based feedback methodologies remains scarce. This study proposes to explore the potentials, challenges, and effects of video-based feedback methodology in real contexts for the formative assessment of communication skills of medical residents in a primary health care program. We conducted a pre/post study with a control group. The intervention was video feedback sessions with peer-feedback. Before and after the intervention, medical residents 54 (fifty four) answered quantitative and qualitative questionnaires and two raters blind assessed about 200(two hundred) video-recorded clinical examinations with simulated patients, who also scored the performances. For the data analysis, we used ANOVA two-way and for the qualitative analysis, we used the Braun and Clarke framework for thematic analysis. This video feedback methodology showed to be a well-accepted formative assessment. The main potentialities identified were self-perception and peer-feedback. The main effects in the residents\' medical practice was a better patient-centered approach, with increased scores mainly in good listening, decision-sharing, and patient support. Improvements were reported in non-verbal communication, behavior changes, and incorporation of reflective practices. Some of the challenges were the difficulty of the coordinator to link the video feedback with theoretical references and the initial stress to record and watch oneself in video. During the study, we did not find adequate and validated instruments to assess communication skills, and so in stage 2 we developed the translation and transcultural adaptation to Brazilian Portuguese of the Calgary-Cambridge Observation Guide (CCOG). This study did not find instruments that completely answered the assessment necessities regarding training in clinical communication. Further researches about assessment tools are thus required, as discussion about competence parameters in subjective items in assessment. The qualitative analysis revealed more information about the effects in communication skills than the quantitate analysis. We observed that there is a difficulty in questionnaires assessing attitudinal competences and subjective aspects in communication. We conclude that for an effective video-based feedback it becomes important to promote self-evaluation alongside reflective practices, peer-feedback focused in positive reinforcement and pursuing strategies, and a supervisor attentive to the leaner\'s psychology and able to relate the feedback with a well-defined communication theory. The Brazilian CCOG version showed acceptable reliability in the Rasch model indicators and could be part of a systematic assessment of communication skills in Brazil

In einer repräsentativen Querschnittsuntersuchung wurden 1219 Multiple Sklerose Betroffene in Deutschland zu den Auswirkungen der Multiple Sklerose auf deren Lebenssituation und ihrer Einschätzung der medizinischen Versorgung befragt. Schwerpunkte der Untersuchung, die auf einem integrativen Konzept der Patientenorientierung beruht, waren: Soziale Auswirkungen, Krankheitswahrnehmung, Alltagsbewältigung, Lebensqualität, Patienteninformation, Arzt-Patient-Beziehung, Therapieentscheidung und das ACT Programm in der medizinischen Versorgung. Negative Auswirkungen der Multiple Sklerose auf die untersuchten Lebensbereiche sind nachweisbar, aber die Einschätzung differiert in Abhängigkeit von der konkreten Lebenssituation und der Persönlichkeit. Der Schweregrad der körperlichen Einschränkungen steht nur bedingt in Beziehung zur subjektiven Einschätzung der Auswirkungen. Es bestätigt sich außerdem die besondere Bedeutung des nahen persönlichen Umfeldes als wichtigste Quelle der Unterstützung Multiple Sklerose Betroffener. Professionelle Unterstützung wird nur in geringem Maß in Anspruch genommen. Die Anforderungen der Befragten an die medizinische Versorgung sind sehr hoch. Negative Bewertungen der medizinischen Betreuung zeigen sich sowohl bei kritischeren Befragten und als auch bei ausgeprägten Autonomiebedürfnis. Die befragten Multiple Sklerose Betroffenen nutzen überwiegend objektive Informationsquellen als allgemeine Informationsbasis und zur Therapieentscheidung. Subjektives Erfahrungswissen wird meist nur ergänzend herangezogen. Veränderungsbedarf besteht in der medizinischen Versorgung im Bezug auf die Integration kritischerer, informierterer, selbstbewussterer Multiple Sklerose Betroffene und in Bezug auf den Zugang zu den vorhandenen Informations-, Unterstützungs- und Beratungsangeboten. / In a representative study 1219 people with multiple sclerosis in Germany were asked about the impacts of multiple sclerosis on their living situation and their estimation of the medical supply. Main topics were: social impacts, perception of the disease, coping with everyday life, quality of life, patient information, doctor-patient-relationship, shared decision making and the ACT programme as tool in the medical supply. Negative impacts on all analysed areas of the living situation could be proved, but the estimation differs in dependence on the specific living situation and the personality. Unlike the physical disability isn''t a predictor of the individual estimation of the impact. People with multiple sclerosis get their main support by relatives and friends. Professional services are rarely used in relation to the aid by the individual social environment. People with multiple sclerosis have very high expectations on the medical supply. The estimation of the situation is relatively negative if the people are more critical as well as if they have a great need for autonomy. The interrogated people with multiple sclerosis use basically and for their therapy decision mostly objective, medical information. Most of them use subjective knowledge based on experiences only additionally. Medical supply should be optimised by better integrating people with multiple sclerosis who are more critical or self confident as well as better informed. Usability and access of the existing offers to inform, support and counsel people with multiple sclerosis have to be improved.

Submitted by PPG Direito (ppgdir@pucrs.br) on 2018-06-04T13:38:03Z No. of bitstreams: 1 Andrei_Ferreira_de_Arau?jo_Lima_DIS.pdf: 2336908 bytes, checksum: 566fe92260d6a118f2a36da3cfd3cc73 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-06-11T13:15:40Z (GMT) No. of bitstreams: 1 Andrei_Ferreira_de_Arau?jo_Lima_DIS.pdf: 2336908 bytes, checksum: 566fe92260d6a118f2a36da3cfd3cc73 (MD5) / Made available in DSpace on 2018-06-11T13:29:04Z (GMT). No. of bitstreams: 1 Andrei_Ferreira_de_Arau?jo_Lima_DIS.pdf: 2336908 bytes, checksum: 566fe92260d6a118f2a36da3cfd3cc73 (MD5) Previous issue date: 2018-03-27 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / This work is the result of an interdisciplinary study between the Science of Law and Bioethics. It aims to understand the ethical and legal limits of the possible right to die, specifically euthanasia. In order to achieve that goal, we will investigate the conflict and the conformation between the fundamental right to life, to human dignity and the autonomy of the will, taking into account both doctrine and national and international jurisprudence. The main reason for the reincorporation of the subject of euthanasia into the medical and legal debate (both academic and jurisprudential) refers to the fast-moving and efficient evolution of medical science, developing treatments that can prolong the patient?s life, possibly, depending on the sickness, forever. In face of this reality, one can perceive the alteration of certain paradigms of Bioethics, such as the breaking of the paternalistic relationship between doctor and patient, the principle of beneficence according to what would be best for the patient, and the removal of unreasonable obstinacy, based on the autonomy of the will and in human dignity. In this scenario, the patients? rights are increasingly debated and new contour to the state?s duty to protect life are being given, especially when in conflict with the dignity and autonomy of the patient. In this scenario, it?s debated a possible right to die with dignity. This right promotes numerous questions, especially concerning the ethical and legal limits in cases of euthanasia, requiring the establishment of clear criteria, having as a basic principle the maximum protection of the patient?s dignity. It is emphasized that, in spite of the varied forms of assisted death, as well as the recent incorporation of ortotan?sia (term in Portuguese used for terminal patients who decline useless treatments and have their right to die granted) as legal conduct in medical ethics in Brazil, the work seeks to solve questions related to euthanasia. First classifying it, in order to avoid any form of semantic confusion. In the following points it will be discussed as a possible establishment of legal criteria as well as the practical developments, taking into account both the medical deontology and the patient?s fundamental rights. / O presente trabalho de disserta??o ? fruto de um estudo interdisciplinar entre a Ci?ncia do Direito e a Bio?tica, buscando compreender quais s?o os limites ?ticos e jur?dicos relativos a um poss?vel direito ? morte, especificamente ? eutan?sia. Para tanto, se investigar? o conflito e a conforma??o entre os direitos fundamentais ? vida, ? dignidade e ? autonomia, levando em considera??o tanto a doutrina quanto a jurisprud?ncia nacional e internacional. Elucida-se que o principal motivo para a reincopora??o da tem?tica da eutan?sia no debate m?dico e jur?dico (tanto em n?vel acad?mico quanto jurisprudencial), se refere ? r?pida e eficaz evolu??o da ci?ncia m?dica, desenvolvendo tratamentos que possam prolongar a vida de um paciente, por vezes, de modo ad eternum. Frente a essa realidade, se percebe a gradativa altera??o de determinados conceitos da Bio?tica, como a quebra da rela??o paternalista entre m?dico e paciente, o princ?pio da benefic?ncia de acordo com o que seria melhor para o paciente, e o afastamento da obstina??o irrazo?vel, todos calcados na autonomia da vontade e na dignidade da pessoa humana. Nesse cen?rio, os direitos dos pacientes s?o cada vez mais debatidos e o dever de prote??o da vida por parte do Estado passa a receber novos contornos, impondo-se limites ? dimens?o objetiva do direito fundamental ? vida, podendo prevalecer, em casos espec?ficos, a dimens?o subjetiva desse mesmo direito. Dessa rela??o entre vida, dignidade e autonomia, fala-se em um poss?vel direito ? morte digna. Contudo, restam in?meras quest?es quanto aos limites desse direito, tanto em um sentido ?tico quanto jur?dico, pois por mais que se conclua pela exist?ncia de um direito ? morte, necess?rio ser? o estabelecimento de crit?rios, limitando a autonomia dos pacientes, tendo como norte a prote??o m?xima de sua dignidade. Frisa-se que, em que pesem as mais variadas formas de morte assistida, bem como a recente incorpora??o da ortotan?sia como conduta legal na ?tica m?dica brasileira, o trabalho buscar? resolver quest?es relacionadas ? eutan?sia. Primeiro classificando-a, de modo a evitar qualquer forma de confus?o sem?ntica, para nos pontos seguintes estabelecer os crit?rios jur?dicos, bem como os desdobramentos pr?ticos calcados na deontologia m?dica.

Embora sejam grandes os progressos com a promulgação da Constituição de 1988, que garante constitucionalmente a saúde como direito de todos e dever do Estado, esse direito não tem sido assegurado no mesmo nível e com a mesma qualidade de atenção, em especial, para a população negra. Depois de uma revisão sobre a história a influência das teorias racialistas e de gênero como categoria de análise na medicina, discute-se uma síntese da história recente das práticas médicas no Brasil e a reflexão critica sobre essas práticas centradas no tecnicismo. O objetivo deste estudo, parte da linha de pesquisa Pesquisa Psicossocial da Desigualdade: Relações Étnico-raciais, foi descrever que sentidos e significados médicos e médicas conferem aos temas médico-sociais na sua trajetória e formação, especialmente como concebem os determinantes sociais de gênero e raça Foram entrevistados 25 médicos (13 médicos e 12 médicas) que orientam e são preceptores de alunos da residência médica em um hospital universitário. O roteiro abordava o perfil sócio-demográfico e sua trajetória profissional; o seu nível de conhecimento e contato com os determinantes sociais (pobreza, gênero, cor/raça, nacionalidade, religião dos diferentes grupos populacionais) durante a formação acadêmica; que fatores consideravam relevantes para uma boa relação médico-paciente; seu conhecimento sobre Direitos Humanos e os princípios do Sistema Único de Saúde; as experiências na relação médico-paciente e de cuidado. Depois de um aquecimento propiciado pela situação da entrevista, entre os resultados, o estudo permitiu observar como os médicos entrevistados reconhecem alguns marcadores sociais da diferença que se transformam em desigualdade, os lugares sociais diferentes para homens e mulheres, brancos, amarelos e negros, lugares de maior ou menor privilégio e de obstáculo para o sucesso técnico. As diferenças e desigualdade de gênero foram mais fáceis de serem explicitadas e os entrevistados articulavam um repertório levemente maior para o tema. Todos os entrevistados, em algum momento, usaram o discurso sobre o instintivo e natural, e a maior parte deles compreende o masculino e o feminino de um modo muito conservador, com problemas para encontrar definições para perguntas supostamente simples. No caso da desigualdade racial, observamos que houve uma polarização: de um lado a negação das desigualdades entre brancos e não brancos, do outro temos a valorização da identidade branca, compondo bem com o racismo à brasileira. O contexto social foi associado à pobreza mais que qualquer outro indicador da desigualdade social. Cenas de racismo e sexismo institucional foram frequentes. Os poucos entrevistados que tinham uma noção mais sofisticada sobre gênero e raça eram aqueles que contaram com a oportunidade de desenvolver uma atividade de extensão, a iniciação científica ou que tiveram uma formação mais generalista, mais social. A trajetória trilhada na faculdade contribui, portanto, para a formação / Brazil\'s 1988 Constitution grants health as a human right to all and a duty of the State. Although great progress has been made since its enactment, this right has not been ensured at the same level and with the same service quality, particularly with regard to Afro-Brazilians. With close attention to history and the influence of racial and gendered theories, this article discusses the recent history of medical practices in Brazil and provides critical reflection on those practices that are centered on technique. The main purpose of this study, a part of the Psycho-social research on inequality: ethnic-racial relations research line, is to describe the meanings and significance that doctors give to medical social issues in their education. Special attention is given to their conception of the social determinants of gender and race. Twenty-five doctors (13 men and 12 women) were interviewed. All of them mentor medical students pursuing their residency at a University Hospital. The interviews script centered on their socio-demographic profile, their professional path and the degree of knowledge or contact with social determinants (poverty, gender, race/color, nationality, religion of the different population groups) during their academic formation, the factors they considered as relevant to a good doctor-patient relationship, their knowledge of Human Rights and the principles of the Sistema Único de Saúde (SUS) and their experiences in the care and doctor-patient relationships. Among its results, the study shows how the interviewed doctors recognize several social markers of difference that convert into inequity, the different social places for men and women, the white, the people of Asian descent and the black, places of greater or lower privilege and obstacle for technical success. The gender differences and inequalities were more easily explained and respondents articulated a slightly larger repertoire for the topic. All of the interviewees, at some moment, used the discourse on the instinctive and the natural, and most of them have a very conservative comprehension of the feminine and the masculine, and encountered problems in finding definitions for apparently simple questions. With regards to racial inequality, there was a polarization: on the one hand, the denial of inequalities among the white and the non white, on the other, a consistent evaluation of white identity, linked to the Brazilian racism. The social context was associated with poverty rather than any other indicator of social inequality. Evidence of racism and sexism were frequently observed in the interviews. The few interviewees that had a more sophisticated notion of gender and race were those who had had the chance to develop an extracurricular activity, the scientific initiation, or those who had had a more generalist and social education. Thus, the experience acquired during university contributes to the formation of their notions of social determinants in health

L'oncogénétique, l'étude des prédispositions héréditaires au cancer, constitue une discipline médicale dynamique, faisant l'objet de nombreuses innovations, tant technologiques que thérapeutiques. Les progrès scientifiques en oncogénétique rendent le recours aux tests génétiques à la fois moins coûteux, plus rapide et plus efficace, ce qui soulève ou réactualise paradoxalement de nombreux enjeux éthiques et psychosociaux tels que la capacité des patients à formuler un consentement éclairé ou le risque de dérives liées à des mésusages des tests génétiques. Face à ces changements, nous avons choisi d’explorer la façon dont est mobilisée l'expérience vécue ou projetée dans la mise en sens des enjeux éthiques et psychosociaux liés aux innovations technologiques et thérapeutiques en oncogénétique. Ce travail de recherche, résolument ancré en psychologie sociale, s'inscrit dans une approche critique des questions de santé où sont interrogés à la fois les besoins, attentes et contraintes des professionnels et usagers du système de soins, et les relations de pouvoir qui s'exercent tant au niveau interindividuel qu'au niveau plus large des politiques de santé. C'est grâce à la notion d'expérience vécue ou projetée que nous avons cherché à comprendre la façon dont les individus font sens de leur monde, et plus particulièrement des évolutions qui touchent l'oncogénétique. L'expérience, nécessairement sociale et socialement construite, est multidimensionnelle, nous proposons d'investiguer plus particulièrement trois de ces dimensions : - une dimension pratique centrée sur l’étude des relations soignants-patients, - une dimension de connaissances étudiée au travers de la négociation des connaissancesexpertes et du savoir de sens commun grâce à la théorie des représentations sociales, - et enfin une dimension émotionnelle envisagée sous l'angle des phénomènes de partage social des émotions et de régulation émotionnelle.Afin de répondre à ces objectifs, deux études complémentaires reposant sur des méthodologies qualitatives ont été mises en place dans une perspective de triangulation des données. La première étude a visé à investiguer la mise en sens des pratiques professionnelles ainsi que la façon dont les soignants se projettent dans un champ disciplinaire en pleine transition et dans leurs pratiques futures. Nous avons mené des entretiens semi-directifs auprès de 27 professionnels en oncogénétique (oncogénéticiens et conseillers en génétique). Les données recueillies ont fait l'objet d'une analyse interprétative phénoménologique (IPA) adaptée à un large échantillon sur les données recueillies, en nous appuyant sur le logiciel d'aide à l'analyse N-Vivo. La seconde étude avait pour objectif d'explorer la co-construction des représentations liées aux nouveaux usages de l'oncogénétique, ainsi que d'étudier l'impact de la l'expérience vécue sur la compréhension des enjeux éthiques liés àl'oncogénétique. Dix focus groups, reposant principalement sur la résolution de dilemmes éthiques, ont été réalisés auprès de 18 femmes ayant l'expérience d'au moins une consultation en oncogénétique et 21 femmes n'ayant pas d'expérience similaire, toutes recrutées par le biais de la plateforme Les Seintinelles, qui constitue une communauté d'intérêt autour du cancer. Une analyse inspirée de l'IPA a été réalisée sur les données ainsi recueillies avec appui sur le logiciel N-Vivo.Notre recherche a permis de souligner le caractère résolument social de la recherche de prédispositions génétiques en oncologie. L’oncogénétique est définie socialement autour de deux de ces objectifs : permettre de mettre en place des mesures de prévention destinées aux individus porteurs d’une mutation génétique, et donner une explication à une histoire familiale de cancer..... / Genetic testing for cancer, which aims to identify hereditary predispositions to cancer, is a dynamic medical field, where many technological and therapeutic innovations emerge. Scientific progress allows genetic testing to be both less expensive, faster and more efficient, which paradoxically raises new ethical and psychosocial issues, such as the patient’s ability to give informedconsent, or the risk of misuses of genetic testing. These changes led us to explore how lived experience is mobilized in the process of making sense of the ethical and psychosocial issues related to innovations in the field of genetic testing of cancer. This research, anchored in social psychology, is based on a critical approach of health issues, which questions the needs, expectations and constraints of health professionals and patients, and the power relationships that take place both at the interindividual level and, on a larger scale, within health policies. Based on the theoretical notion of lived experience, we aimed to understand how individuals make sense of their world, and more particularly of innovations in the field of genetic testing. Lived experience, necessarily social and socially constructed, has many dimensions, among which we chose to investigate the following three: - A practical dimension, based on the study of doctor patient-relationship, - A knowledge dimension, investigated through the negotiation of expert knowledge and common sense thanks to the social representations theory, - And an emotional dimension, based on the study of the phenomena of emotion regulation and social sharing of emotions.Based on the principles of methodological and data triangulation, our exploration was based on two complementary qualitative studies. The first study aimed to investigate sense making processes related to professional activities and how health professionals working in genetic testing for cancer imagine their future and the future of genetic testing. We led 27 semi-structured interviews with genetic counsellors and clinical geneticists. An Interpretative Phenomenological Analysis (IPA) was performed analyze the data gathered, with the assistance of N-Vivo software. The second study aimed to explore the co-construction of representations related to new uses to genetic testing of cancer, and to investigate the impact of lived experience on the understanding of ethical issues related to genetic testing. We led ten focus groups, based mostly on the resolution of ethical dilemmas, with 18 women who attended at least one genetic counselling consultation, and 21 women who did not have a similar experience. All women were recruited thanks to the online collaborative research platform “Les Seintinelles”, which constitutes a cancer related community of interest.This research allowed us to highlight the social nature of genetic testing of cancer. This medical field is defined by two main goals: allowing carriers of genetic predisposition to undergo preventive measures, and making sense of a family history of cancer. Genetic counselling professionals report a high level of personal involvement in their work and emotion regulation strategies acquired on purpose and based on a strict division between their personal and professional life. The acknowledgement oftheir professional skills and the perceived quality of their relationships with their patients contribute highly to the work-related satisfaction of genetic testing professionals. The doctor-patient relationship is structured by an ideal of non-directivity, which can be questioned by the need to accompany and protect the patients, who are considered as vulnerable. Because of the risks of misuses of genetic testing, the strict legislation related to these practices in France is most often considered as valuable.Clinical geneticists and genetic counsellors are considered the most likely to provide genetic testing within an ethical framework.

Embora sejam grandes os progressos com a promulgação da Constituição de 1988, que garante constitucionalmente a saúde como direito de todos e dever do Estado, esse direito não tem sido assegurado no mesmo nível e com a mesma qualidade de atenção, em especial, para a população negra. Depois de uma revisão sobre a história a influência das teorias racialistas e de gênero como categoria de análise na medicina, discute-se uma síntese da história recente das práticas médicas no Brasil e a reflexão critica sobre essas práticas centradas no tecnicismo. O objetivo deste estudo, parte da linha de pesquisa Pesquisa Psicossocial da Desigualdade: Relações Étnico-raciais, foi descrever que sentidos e significados médicos e médicas conferem aos temas médico-sociais na sua trajetória e formação, especialmente como concebem os determinantes sociais de gênero e raça Foram entrevistados 25 médicos (13 médicos e 12 médicas) que orientam e são preceptores de alunos da residência médica em um hospital universitário. O roteiro abordava o perfil sócio-demográfico e sua trajetória profissional; o seu nível de conhecimento e contato com os determinantes sociais (pobreza, gênero, cor/raça, nacionalidade, religião dos diferentes grupos populacionais) durante a formação acadêmica; que fatores consideravam relevantes para uma boa relação médico-paciente; seu conhecimento sobre Direitos Humanos e os princípios do Sistema Único de Saúde; as experiências na relação médico-paciente e de cuidado. Depois de um aquecimento propiciado pela situação da entrevista, entre os resultados, o estudo permitiu observar como os médicos entrevistados reconhecem alguns marcadores sociais da diferença que se transformam em desigualdade, os lugares sociais diferentes para homens e mulheres, brancos, amarelos e negros, lugares de maior ou menor privilégio e de obstáculo para o sucesso técnico. As diferenças e desigualdade de gênero foram mais fáceis de serem explicitadas e os entrevistados articulavam um repertório levemente maior para o tema. Todos os entrevistados, em algum momento, usaram o discurso sobre o instintivo e natural, e a maior parte deles compreende o masculino e o feminino de um modo muito conservador, com problemas para encontrar definições para perguntas supostamente simples. No caso da desigualdade racial, observamos que houve uma polarização: de um lado a negação das desigualdades entre brancos e não brancos, do outro temos a valorização da identidade branca, compondo bem com o racismo à brasileira. O contexto social foi associado à pobreza mais que qualquer outro indicador da desigualdade social. Cenas de racismo e sexismo institucional foram frequentes. Os poucos entrevistados que tinham uma noção mais sofisticada sobre gênero e raça eram aqueles que contaram com a oportunidade de desenvolver uma atividade de extensão, a iniciação científica ou que tiveram uma formação mais generalista, mais social. A trajetória trilhada na faculdade contribui, portanto, para a formação / Brazil\'s 1988 Constitution grants health as a human right to all and a duty of the State. Although great progress has been made since its enactment, this right has not been ensured at the same level and with the same service quality, particularly with regard to Afro-Brazilians. With close attention to history and the influence of racial and gendered theories, this article discusses the recent history of medical practices in Brazil and provides critical reflection on those practices that are centered on technique. The main purpose of this study, a part of the Psycho-social research on inequality: ethnic-racial relations research line, is to describe the meanings and significance that doctors give to medical social issues in their education. Special attention is given to their conception of the social determinants of gender and race. Twenty-five doctors (13 men and 12 women) were interviewed. All of them mentor medical students pursuing their residency at a University Hospital. The interviews script centered on their socio-demographic profile, their professional path and the degree of knowledge or contact with social determinants (poverty, gender, race/color, nationality, religion of the different population groups) during their academic formation, the factors they considered as relevant to a good doctor-patient relationship, their knowledge of Human Rights and the principles of the Sistema Único de Saúde (SUS) and their experiences in the care and doctor-patient relationships. Among its results, the study shows how the interviewed doctors recognize several social markers of difference that convert into inequity, the different social places for men and women, the white, the people of Asian descent and the black, places of greater or lower privilege and obstacle for technical success. The gender differences and inequalities were more easily explained and respondents articulated a slightly larger repertoire for the topic. All of the interviewees, at some moment, used the discourse on the instinctive and the natural, and most of them have a very conservative comprehension of the feminine and the masculine, and encountered problems in finding definitions for apparently simple questions. With regards to racial inequality, there was a polarization: on the one hand, the denial of inequalities among the white and the non white, on the other, a consistent evaluation of white identity, linked to the Brazilian racism. The social context was associated with poverty rather than any other indicator of social inequality. Evidence of racism and sexism were frequently observed in the interviews. The few interviewees that had a more sophisticated notion of gender and race were those who had had the chance to develop an extracurricular activity, the scientific initiation, or those who had had a more generalist and social education. Thus, the experience acquired during university contributes to the formation of their notions of social determinants in health

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The purpose of this study was to investigate and describe the experience of infertility of African women, men and family member. It is hoped that this description will contribute to a deeper understanding of the psychosocial difficulties involved in the area of infertility and ofthe ways in which people respond to the situation of infertility. A qualitative research approach was used, and in particular social constructivist-interpretive research and feminist research approaches. The sample consisted of39 participants: 19 women, 10 men, and 10 family members faced with infertility. The research orientation was field-based, concerned with collecting data using the technique of in-depth semi-structured interviews. Each participant was interviewed individually. The interviews were recorded on tape, transcribed in their full length and translated into English. Data were analysed on the basis of the interpretive feminist approach. Analysis of individual cases and crosscase analysis were employed. The findings suggested a contextual definition of infertility, for example, for some, having had an ectopic pregnancy or a miscarriage meant that they did not fit into the definition of infertility. The findings revealed that for many African women and men, blood ties still defined the family and the persona. Thus, failure to have a blood child resulted in courtship and marital break up, extramarital relationships, polygamy, and divorce and remarriage. Infertility had serious psychosocial consequences for both the infertile individuals and their families. Participants experienced repeated periods of existential crisis, which began at different points for different participants. Analysis of gender differences indicated similarities in the experience of the crisis, but differences in terms of expression and ways of responding to the crisis. Family dynamics within the context of infertility were coloured by ambivalent feelings, resentment, insensitivity, and miscommunication, but also affection, and social support. Traditional and modern medical health systems offered the possibility of finding explanations and treatment, but there was further strain from the negative experiences with the health care system. The findings in this study suggested the need for policy reformulation, for psychosocial intervention as part of the treatment plan, and for future research on the outcome of using various coping strategies. / Psychology / D. Phil. (Psychology)

This article samples possible uses of psychoanalysis in law from the academic work of Joseph Goldstein and Jay Katz. Both start to recognize the importance of psychoanalysis to provide a serious and courageous attention to the non-rational dimensions of the human being, we should be aware in the world of law. Starting from this premise, the author explores two possible uses of psychoanalysis in law: one represented by Goldstein, focuses on using «psychoanalytic premises to resolve legal disputes», for example by providing psychoanalytic information to determine the best interests of the child in cases of custody, while the other, represented by Katz, who seeks to «create an awareness of conflict where all of the actors had previously been locked in a mutually reinforcing fantasy that no conflict existed», as it occurs in doctor-patient relationship, in order to rethink standards that had been set by law under an illusion of objectivity and rationality. The article explores these two approaches through examples, linking two perspectives adopted by Freud throughout his academic work and taking a preferred position by the position of Katz. / El presente artículo muestras los posibles usos del psicoanálisis en el derecho a partir del trabajo académico de Joseph Goldstein y Jay Katz. Ambos parten de reconocer la importancia del psicoanálisis para prestar una atención seria y valiente a las dimensiones no racionales del ser humano, de las que debemos ser conscientes en el mundo del derecho. Partiendo de dicha premisa, el autor explora dos posibles usos del psicoanálisis en el derecho. Uno, representado por Goldstein, se centra en utilizar «premisas psicoanalíticas para resolver conflictos jurídicos», como, por ejemplo, al aportar información psicoanalítica para determinar el interés superior del niño en casos de tenencia. Mientras tanto, el otro, representado por Katz, busca «concientizar acerca de un conflicto en casos donde los todos actores se habían dedicado a reforzar mutuamente su fantasía de que no existía conflicto alguno» entre sujetos de una relación, como ocurría en la relación médico-paciente, con la finalidad de repensar estándares que habían sido fijados por el derecho bajo una ilusión de objetividad y racionalidad. El artículo explora estas dos aproximaciones a través de ejemplos, vinculándolas a dos perspectivas adoptadas por Freud a lo largo de su trabajo académico y tomando una postura preferente por la mirada de Katz.