This thesis is a study of patient experience of telehealth services for self-management of chronic disease. It investigates the use of technology-based services to address the social and managerial problem of unsustainable demand for scarce resources by focusing on the understudied patient perspective. Chronic disease care is a ‘wicked problem’ affected by complex interdependencies that are difficult to change, such as rising demand from ageing populations, unhealthy lifestyles, spiralling healthcare costs and economic contraction weakening the financial foundations of healthcare systems. Studies suggest that using technology-based services installed in patient homes can play a part in safely reducing demand for in-clinic appointments and emergency hospitalisations. Conceptualising the research problem involved unpacking extant patient experience concepts. The thesis applies marketing theoretical perspectives to explicitly question the assumptions in the healthcare literature relating to patient experience and argues for application of a service-dominant logic (S-DL) (Vargo & Lusch 2004; 2008; 2016) to address provider-led biases. The perspectival shift enables patient experience to assume patients participate in service experiences as social actors rather than objects. In committing to marketing perspectives, the thesis draws on explanations of consumers agentically experiencing service interactions through resource integration aimed at deriving value from their consumption experiences (Arnould et al. 2006). It also conceptualises telehealth as a self-service technology (SST) (Dabholkar 1996) within a multi-interface, multichannel service context. Using an S-DL approach grounds the study of patient experience in their interactions with various aspects of services based on patient goals and interests. This is consistent with the S-DL’s explanation of value emergence by advocating attention to structure and agency in order to account for value as it is subjectively determined by the patient in context. Applying the S-DL perspective is consistent with the critical realist (Bhaskar 1978) standpoint adopted in the thesis (Löbler 2011; Peters et al. 2013). Critical realism is capable of maintaining consistency between the ontology of patient perspectives of service experiences while accounting for the influence of provider-led social structures. As a philosophical background, critical realism also provides epistemological tools for investigating the interaction of agency and socio-technical structures of healthcare services to explain social change. Its theory of morphogenetic social action (Archer 1995) provides a methodological route to logical conjecture about the generative mechanisms that explain the structure of interactions between patients and providers implicit in service structures even if the actors involved are unaware of them. Therefore, the conceptual framework is philosophically equipped to engage with debates between epistemological approaches in the healthcare literature about the role of individual agency and deterministic service structures. Critical realism also provides analytical tools useful for adducing the potential of telehealth services to disrupt ingrained attitudes and behaviours. The theoretical stance adopted in the thesis suggests that identification of generative mechanisms at the micro level of telehealth service experience can be used to theorise about changes introduced by patient use of telehealth to trigger meso-level structural change, toward transformation of wider healthcare service interactions in different service channels. Transformation is argued to be signalled by the selection of alternatives that challenge the relationship dynamics sustaining ingrained interdependencies that contribute to the problem of unsustainable demand for chronic disease care. An in-depth case study of an NHS telehealth service informed by multiple case studies of experienced telehealth users provides rich empirical data. Employing interviews and participant observations with a heterogeneous sample of 27 complex chronic comorbid adults, data collection took place in patient homes in a large English city over an 18-month study. The findings show telehealth to involve effortful experiences challenging the prevailing view that telehealth is convenient, easy to use, cost-saving for patients, and that it extends the ‘objective’ clinical lens on the patient condition in non-clinical settings. The thesis highlights the relationship between telehealth and wider healthcare service relationships by showing that the outcomes from telehealth use are valued by patients as they compensate for inappropriate functional outcomes and poor relational outcomes that result from full-service interactions. Telehealth is a resource that enables patients to manage service relationships with healthcare services. Patients are shown to regain control over what happens to them through customising clinical decision-making processes. Patient participation in decisions about access to further healthcare resources is argued to be transformative because it makes healthcare interactions patient-led. The core contributions of the thesis are a patient-centred framework improving the construct validity of patient experience and patient value research. By studying disadvantaged and vulnerable consumer experience of SST in a highly institutionalised healthcare service context, it contributes to the SST literature by moving beyond psychology-based focus upon ‘use’ and applying a S-DL to consider the role of ‘experience’. It contributes to the S-DL literature on consumer-provider value misalignment by showing the importance of service channel affordances as opportunities for patients to co-create subjective value. The findings contribute insights into debates about patient choice and autonomy and evidences strategic value from loosely integrated multichannel services in order to counteract effects of misaligned provider and patient value systems. Practical implications include support for continuing telehealth provision, and acknowledgement of non-economic costs of use for patients by ensuring availability of full-service options to provide much-needed support and feedback in response to changing needs. Additional resources are needed to guide users to learn more about clinical measurement and interpretation of vital signs to develop their practical self-management skills. This could improve patients’ ability to derive improved value from their healthcare service interactions. Managers should understand that telehealth is valued by patients because it increases patient autonomy which is missing from full-service experiences. Customisation is an important part of the value that patients derive from using telehealth, enabled by provision of multichannel services. Work is needed to transform organisational culture and values currently focused on clinical outcomes at the expense of the functional and relational outcomes valued by patients.

Τα τελευταία χρόνια σημαντικά βήματα έχουν γίνει σε ότι αφορά στην κατανόηση της γενετικής βάσης. Αυτά τα βήματα αντανακλούν στη ραγδαία ανάπτυξη των εταιρειών που προσφέρουν υπηρεσίες γενετικών τεστ. Η Μοριακή και η Κυτταρογενετική ανάλυση είναι οι κυρίαρχοι τύποι των προσφερόμενων υπηρεσιών γενετικών τεστ, καθώς υπάρχει μια αύξηση στη ζήτηση των φαρμακογενετικών τεστ. Η παρούσα έρευνά μας αποτελεί τη βάση για μια αξιόπιστη κριτική του περιβάλλοντος των γενετικών προσφερόμενων τεστ στην Ελλάδα για να αποκτήσουμε μια καλύτερη κατανόηση για τις προσφερόμενες υπηρεσίες γενετικών τεστ, το στόχο τους, τον τρόπο προώθησής τους, το κόστος τους και την πιστοποίησή τους. Το δομημένο ερωτηματολόγιο μας αποτελείται από 21 ερωτήσεις καλύπτοντας τις διάφορες πτυχές των προσφερόμενων γενετικών τεστ. Στην Ελλάδα υπάρχουν 18 ιδιωτικές εταιρείες που προσφέρουν υπηρεσίες γενετικών τεστ στην Αθήνα και σε άλλες πόλεις. Μόνο 13 από τις 18 εταιρείες ανταποκρίθηκαν και συμμετείχαν στην έρευνα. Από τις απαντήσεις που δόθηκαν τα σημαντικότερα σημεία είναι ότι η μοριακή και η κυτταρογενετική ανάλυση «υπερισχύουν» έναντι των υπολοίπων εξετάσεων και η ζήτηση των φαρμακογενετικών τεστ ολοένα και αυξάνεται. Το κόστος των γενετικών τεστ είναι χαμηλό στην Ελλάδα. Οι εταιρείες είτε συνεργάζονται είτε έχουν γενετικό σύμβολο και ελάχιστες από αυτές έχουν πιστοποίηση για την παροχή των υπηρεσιών γενετικών τεστ. / In recent years, significant advances have been made in our understanding of the genetic bases. These advances are reflected in the rapid development of the genetic testing industry. Molecular genetic and cytogenetic testing were found to be the predominant types of genetic testing services offered although there is an increasing demand for pharmacogenomic testing. Our study provides the basis for a critical appraisal of the genetic testing environment in Greece to acquire a better understanding of the genetic tests offered, the target groups, marketing channels, costs of analysis and accreditation. Our questionnaire included 21 questions on various aspects of genetic testing. We have performed a nationwide survey of 18 private genetic testing laboratories in located in Athens and various other cities in Greece. Only 13 of the 18 private genetic testing laboratories responded to our questionnaire and analysis of their responses indicate that although molecular genetic and cytogenetic testing tend to predominate, the demand for pharmacogenomic testing is growing. Genetic testing costs are fairly low in Greece. Although the majority of private genetic laboratories either employ or collaborate with a genetic counselor, few of them are accredited for the provision of genetic testing services.

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa.

This thesis explores the provision of services for people with multimorbidity in general practice. It considers 3 broad research questions: how services are organised; why they are configured in this way; and the impact this organisation has on service delivery. At present, there is no formalised system for managing multimorbidity in general practice. Current arrangements reflect the wider organisation of care for chronic conditions which typically involves managing individual chronic conditions. The needs of people with multimorbidity are often complex and require a number of services from several providers. Coordinating these services is challenging, not least because of the fragmented system within which professionals and providers are situated. Different clinical, managerial and funding arrangements complicate this situation, creating as it does a number of parallel work streams. Effective healthcare for people with multimorbidity requires different providers to work collaboratively to promote linkage across professional and service boundaries. Information flows and administration play an important role in promoting continuity and coordination within and across work streams that span primary, secondary and tertiary care. In some instances, inefficiencies in services can be linked to the lack of integrative working between the clinical and administrative aspects of care. At present, fragmented systems are perpetuated by the lack of a whole systems approach that would align clinical, managerial and financial aspects of service provision across organisations. This thesis demonstrates that, services in general practice are increasingly determined by factors external to it. Most notably the division of care across multiple providers and the financial and contractual arrangements which require an organisation of services that promotes a division of labour and a routinsation, aimed at optimising the daily through put of patients. If the present and future needs of people with multimorbidity are to be effectively met, changes to the way services are provided in general practice must be considered as part of a whole system of healthcare, whereby collaborations between different professionals and services are intentionally organised and actively managed. Although the evidence base for managing multimorbidity is limited, there is a growing recognition that in terms of improving outcomes for people with multimorbidity, improving clinical care alone is not as effective as simultaneously improving the organisation or design of services across the whole system of provision.

- / -

Σκοπός της παρούσης εργασίας είναι να παρουσιάσει τα ηλεκτρομαγνητικά, ηλεκτρικά και μαγνητικά πεδία που δέχεται ο άνθρωπος στην καθημερινότητά του, είτε αυτά παράγονται από φυσικές πηγές όπως είναι ο ήλιος, είτε από τεχνητές πηγές όπως είναι οι ηλεκτρικές συσκευές, η κινητή τηλεφωνία, το ηλεκτρικό δίκτυο κ.ά. Επίσης, παρουσιάζονται οι τρόποι υπολογισμού της έκθεσης του ανθρώπου στα πεδία αυτά και τα πιθανά προβλήματα που παρουσιάζονται στην υγεία του ανθρώπου εξαιτίας της έκθεσης. / Nowadays, human is continually exposed to electromagnetic fields, which are produced by nature or artificial sources which has discovered himself. However, the issue that troubles people is whether their health is affected by these fields or not. In this question have been trying to get answers the scientists, international and governmental organizations by carrying out measurements and scientific researches in order to define the impacts of electromagnetic fields on human’s health and determine the exposition limits to these fields. The target of this work is to present the electromagnetic, electric and magnetic fields which human receives in his daily routine, whether are produced by natural sources like sun or artificial sources like household appliances, mobile phones, electricity etc. Furthermore, are being displayed ways of estimation of human’s exposure to these fields and probable repercussions in human’s health owing to this exposure. In chapter two, there is an extensive reference to basic rudiments of fields and their main sources. In addition, are being defined typical magnitudes which are used in specification of electromagnetic fields and human’s exposure to these. In chapter three, are displayed the basic facts of ionizing radiation and its impacts on human. It is mostly presented the main source of ionizing radiation which is ultraviolet radiation of sun and problems which are produced. In chapter four, there is an extensive reference to fields which are produced by household appliances used in people’s houses and how are affect their health. 7 In chapter five, are being presented the basic facts of conveyance and distribution main of Γ.Δ.Ζ and at the same time are defined the impacts which the fields produce when they are near inhabitable areas. In chapter six, are mentioned the problems which can cause mobile phones and generally mobile telephony network which exists in the country through the fields which they produce. In chapter seven, there is a reference to the several types of radar which are used and their results. Whereas, in the next chapter there is a reference to the use of electromagnetic fields in medicine and are being presented radiation doses which we receive through examinations and other problems which can cause. Furthermore, are being presented the exposure limits which take effect in our country and European Union and also the way of analysis of exposure to multiple sources. In chapter eleven, there is a reference to macroscopic and microscopic analysis of exposure to electromagnetic fields. In the last chapter, there are being presented the ways of measurement of human’s exposure to electromagnetic fields with frequency up to 300 GHz.

Cette thèse examine le gouvernement de la sexualité de deux populations adolescentes (10-19 ans) confrontées au VIH, à savoir les adolescents en population générale et les adolescents nés avec le VIH, dans la société nord thaïlandaise contemporaine. Pour ce faire, entre les mois de mai 2009 et de janvier 2012, des observations directes et participantes ont été conduites durant des actions collectives d’éducation pour la santé sexuelle destinées à ces deux populations adolescentes. Des entretiens semi-dirigés ont également été menés auprès des « adultes » et « adolescents » présents durant ces actions. Les résultats de cette thèse montrent comment les « adultes » agissant auprès des adolescents en population générale tendent à percevoir la sexualité de ces derniers comme le reflet d’une pathologisation de la société. En outre, ils révèlent de quelle manière les « adultes » intervenant auprès des adolescents nés avec le VIH tendent à appréhender la sexualité de ces derniers comme la preuve de leur normalisation. Ces résultats mettent également en lumière les difficultés éprouvées par les « adultes » à parler ouvertement de la sexualité avec les adolescents en population générale. Ils dévoilent aussi les barrières rencontrées par les « adultes » pour parler de manière explicite de leur statut infectieux avec les adolescents nés avec le VIH. Ils indiquent par quels mécanismes les différents éducateurs enquêtés peinent à établir des relations égalitaires avec leurs cadets. / This thesis investigates the governing of sexuality of two adolescent populations (10-19 years old) encountered HIV in Chiang Mai in contemporary Northern Thai society. These include adolescents among the general population and adolescents born with HIV. In doing so, direct and participant observations were conducted in the course of collective actions associated with sexual health education and dedicated to those adolescent populations from May 2009 to January 2012. In-depth interviews were also led among “adults” and “adolescents” participating in these activities. The results of this thesis show how “adults” interacting with adolescents among the general population tend to perceive sexuality of these adolescents as reflecting the society’s pathologization. They reveal how “adults” interacting among adolescents born with HIV demonstrate the tendency to comprehend these adolescents’ sexuality as evidence of their normalization. The results also highlight the difficulty experienced by “adults” in speaking openly about sexuality with adolescents among the general population. Furthermore, they expose the obstacles encountered by “adults” when openly discussing about the infectious status of adolescents born with HIV. Finally, the thesis indicates why the various educators who were investigated experienced difficulty in establishing equal relationships with the younger ones.

Introduction : Ces dernières années, les auteurs se sont attachés à créer une théorie générale de la problématique de la relation d’aide afin de mettre en évidence l’importance de la place occupée par les familles auprès du sujet âgé souffrant de la maladie d’Alzheimer. Il peut toutefois être intéressant de replacer l’aidant dans sa singularité de sujet affecté par d’autres questionnements que ceux relatifs à l’aide, afin de déterminer les facteurs influençant son vécu. Problématique : Dans quelle mesure la personnalité, les représentations du vieillissement, le lien de parenté et la qualité des relations passées vont influencer le vécu du rôle d’aidant principal d’un parent ou conjoint âgé en perte d’autonomie psychique, que ce dernier réside à domicile ou en institution ? Objectifs : Dans un premier temps, ce travail a pour objectif, d’établir les relations entre les différentes dimensions du vécu de l’aidant familial (difficultés, satisfactions et stratégies). Il se propose ensuite d’étudier l’influence sur ce vécu du lien de parenté et de l’entrée en institution d’une part, et de la personnalité (modèle en Cinq dimensions) et des représentations de la vieillesse d’autre part. Méthodologie : Pour ce faire, nous avons mené une étude auprès de 113 participants, dont 80 enfants et 33 conjoints. La première moitié accompagnait un proche à son domicile, la seconde en institution. Dans une première partie de l’étude, les participants ont rempli un questionnaire sociodémographique accompagné d’échelles évaluant la qualité des relations passées (QRASA), le fardeau (ZBI), les difficultés (CADI), satisfactions ressenties (CASI) et stratégies utilisées (CAMI) dans la relation d’aide, la personnalité (NEO PI-R) et la dépression (BDI). Dans un second temps, dix-sept participants ont été vus en entretien semi-directif afin d’appréhender qualitativement leur expérience d’aidant, les relations qu’ils entretiennent avec la personne accompagnée ainsi que leurs représentations de la vieillesse. Résultats : Les résultats de cette étude montrent que les difficultés, satisfactions ressenties et stratégies utilisées dans la relation d’aide sont liées entre elles, créant un équilibre nécessaire pour que l’aidant familial puisse investir son rôle. Cet équilibre est influencé aussi bien par des facteurs situationnels (lieu de résidence de la personne malade), relationnels (qualité des relations avec la personne accompagnée) que personnels (personnalité et représentations liées au vieillissement). Conclusion : Les implications en termes d’accompagnement et de prévention auprès de cette population sont discutées. / Introduction: Over the past years, authors have proposed a general theory of the caregiving relationship in order to highlight the importance of the place occupied by the families, who have an elderly relative suffering from Alzheimer's disease. However, it may be interesting to consider the caregiver with all his specificities, and as an individual affected by other problems than only the caregiving. We wonder to what extent the personality of a caregiver, the representations of the ageing process, the family relationship and the quality of the past relationships can influence the experience of caregiving. The studied caregivers were children or spouses of a patient losing his psychic autonomy, living at home or in an institution. Methods: We realized a study with 113 subjects (80 children and 33 spouses of an Alzheimer’s patient). Half of the patients were living at home and the other half in an institution. First, all caregivers filled a socio-demographic questionnaire and different clinical scales, assessing: the quality of the passed relationships (QRASA) ; the burden (ZBI) ; the difficulties (CADI ), satisfactions (CASI ) and strategies they used (CAMI) in the caregiving situations ; the personality (NEO PI-R) and the depression (BDI ). Second, 17 subjects have been seen in a semi-structured interview in order to qualitatively assess their experience of the caregiving, the past and present relationship they have with their parent or spouse. Results: The results of this study showed that the difficulties, the satisfactions which are experienced, and the strategies which are used in the caregiving relation are linked together. A balance between these variables is required for the family caregiver to invest his role. This balance is influenced by situational factors (the place where the patient lives), relational factors (the quality of the present and past relationship with the patient) as well as personal factors (personality and representations linked to the ageing process). Conclusion: The implications in terms of support and prevention for this population of caregivers are discussed.

La maladie d'Alzheimer, figure archétypique de la "mauvaise" vieillesse, et véritable désordre dans I'univers de la personne, implique de nombreux acteurs et particulièrement les accompagnants familiaux. Pour soulager ce qui est souvent désigné comme un "fardeau", de nombreuses initiatives sont prises dans le domaine des gérontechnologies. Conçues pour répondre aux besoins des personnes âgées,elles représentent un axe de recherche et de développement - scientifique et industriel - en plein essor. Cependant, peu de ces technologies sont réellement insérées dans le quotidien des personnes âgées et beaucoup de projets stagnent à un stade embryonnaire ou, édités sous forme de prototypes. Elles peuvent également être considérées comme salvatrices mais lorsque la "technologie" ne fonctionne plus, mal ou reste à l'état de prototype, le monde construit autour de la personne atteinte de la maladie bascule dans les désillusions. L'approche anthropologique est intéressante pour comprendre les mécanismes d'appropriation de l'espace en maison de retraite. Les lieux aident à la construction de la personnalité et de l'identité de chacun et, pas l'approche du "lieu anthropologique" [Augé,1992a], les accompagnants peuvent se rendre compte des capacités effectives des personnes. Ces compétences doivent aider à la construction d'outils gérontechnologiques pertinents. / Alzheimer's disease is most often regarded as the bad ageing disorder. It wreaks havoc in the physical and psychological lives of individuals concerned, and requires the support and help of numerous persons, in particular family caregivers. In order to reduce this burden many initiatives have been taken in the field of gerontechnology. Research and development in gerontechnologies are presently booming, both scientifically and industrially. Although these technologies were originally conceived to respond to the elderly's needs, few of them have actually been implemented in the aging persons' environment. Many projects stagnate at the conceptual level, others do not go beyond the building of a prototype. Nonetheless, sometimes these technologies arouse great hopes. When, however, they function badly or not at all, or when they are not developed beyond the prototype stage, disillusionment slowly destroys all the hope that patients and caregivers had invested in these technologies. M. Augé's anthropological approach helps us understand how people lay claim to public space, in a retirement home, for example. Places and spaces help shape each individual's personality and identity. Using the "lieu anthropologique" (anthropological place or space) [Augé, l992a] caregivers can more easily get to know the elderly's effective capacities in this domain. These skills should be analyzed in order to improve the construction of pertinent gerontechnological tools.

Selon l’OMS, le dépistage organisé s’appuie sur la participation volontaire des sujets qui sont recrutés dans la population, dans le cadre de campagnes de dépistage. En France, deux dépistages sont organisés par les pouvoirs publics : le dépistage du cancer du sein et le dépistage colorectal. L’objectif de cette thèse était d’étudier sous l’angle éthique et médicolégal, les programmes français de dépistage organisé des cancers.Les valeurs éthiques applicables aux programmes nationaux de dépistage font l’objet de recommandations européennes et sont déclinées en France, dans des cahiers des charges annexés aux textes juridiques mettant en œuvre les programmes de dépistage. D’autres textes de portée plus générale encadrent cette pratique en France.Détaillé dans un rapport publié par l’INCa, l’analyse éthique du programme de dépistage organisé du cancer du sein pointe la nécessité d’optimiser l’information des patientes et de renforcer la place et le rôle d’un professionnel de santé référent, de l’entrée dans le dépistage jusqu’à la sortie éventuelle vers la filière de soins.L’étude des préférences des médecins généralistes dans l’organisation du dépistage du cancer colorectal montre que les questions relatives à l’information du patient et aux modalités de recueil de son consentement, ainsi qu’au suivi des patients, jouent une véritable influence sur leur adhésion au programme, au regard du risque médicolégal. / According to WHO, organized screening is based on the voluntary participation of subjects who are recruited into the population through screening campaigns. In France, two are organized by the government: breast cancer screening and colorectal cancer screening. The aim of this thesis was to study by an ethical and forensic approach, the French organized programs for cancer screening.Ethical values of national screening programs are subject to European recommendations. In France, they are available in documents attached to the legal texts implementing screening programs. Some others texts more general, frame this practice in France.Detailed in a report published by INCa, the ethical analysis of organized screening program for breast cancer points the need to optimize patients’ information and to strengthen the position and role of the referring health professional, from the entry in the screening to the eventual output to the care.The study of GPs’ preferences in the organization of screening for colorectal cancer shows that issues related to patient information and procedures for collecting of consent, as well as patient monitoring, play a real impact on their adherence to the program, in terms of forensic risk.