Made available in DSpace on 2010-04-20T20:13:36Z (GMT). No. of bitstreams: 1 72050100744.pdf: 2236930 bytes, checksum: d20ba05362575271eb2ec5c5c07bf93b (MD5) Previous issue date: 2009-03-04T00:00:00Z / A presente tese estuda a dinâmica do jogo regulatório brasileiro e como ela é capaz de proporcionar estabilidade de regras e contratos, apesar da pouca autonomia das agências reguladoras brasileiras em relação aos poderes políticos, contrariando a literatura que deu origem ao modelo regulatório recentemente instalado no Brasil. Buscou-se trazer de volta à discussão das agências o papel da política, negligenciado nos modelos teóricos tradicionalmente aplicados à regulação. Para tanto foram incluídas no modelo analítico abordagens teóricas relacionadas ao controle da burocracia e à teoria principal-agente. Assim, por meio do estudo de três agências reguladoras – Agência Nacional de Telecomunicações (Anatel), Agência Nacional de Energia Elétrica (Aneel) e Agência Nacional de Saúde Suplementar (ANS) – identificamos que a interação entre os diversos atores e instituições envolvidos em cada setor, incluindo os representantes políticos, o Judiciário, os atores setoriais e as regras procedimentais das agências acaba fornecendo ao sistema condições de estabilidade e de garantia dos contratos.

The main aim of this study was to explore the difficulties and limitations preventing social workers from empowering siblings of Autistic Spectrum Disorder (ASD) children. Specific attention was given to social workers in the London Borough of Greenwich, United Kingdom and siblings who were in their middle childhood phase of development. Qualitative, applied research of an explorative and descriptive nature was followed. For the purpose of this study, the researcher conducted unstructured in-depth interviews with social workers and the siblings. Six social workers and four siblings were interviewed for this research study. Themes and categories were developed out of data from the unstructured interviews to which the researcher compared and verified it with already existing literature. Conclusions were drawn and recommendations were made from this research study. / Social Work / M.Diac. (Play Therapy)

Doctorat en philosophie et lettres / info:eu-repo/semantics/nonPublished

Esta tese analisa a trajetória, os desafios e as perspectivas da regulação em saúde suplementar, contextualizados num ambiente de grandes transformações do papel dos Estados nacionais e das relações entre a Economia e a Política no âmbito mundial e no Brasil. As interrelações entre economia e política são a base para importantes mudanças no papel do Estado brasileiro, do arcabouço regulatório e da regulação da saúde suplementar em particular. A tese tem início com o desenvolvimento de uma análise sobre o panorama político e econômico mundial, de modo a identificar suas influências sobre o Brasil e o setor de saúde brasileiro. À luz deste arcabouço analítico, é desenvolvido um detalhamento retrospectivo dos principais normativos que compuseram a regulação em saúde suplementar, editados por intermédio da Agência Nacional de Saúde Suplementar ANS. Para tanto, foi construído um banco de dados que servirá não apenas para a pesquisa da tese, mas para outros trabalhos a serem desenvolvidos posteriormente. O estudo desse material permitiu identificar uma trajetória da saúde suplementar marcada por três diferentes tônicas, que tem se desdobrado a partir da cena das grandes transformações mundiais. As conclusões aqui obtidas sobre a trajetória da regulação foram ainda apreciadas, por meio de pesquisa com todos os atuais e antigos dirigentes da ANS. Adiante, foi realizada uma breve análise dos efeitos produzidos por cada uma das tônicas anteriormente descritas, bem como discutidos os principais desafios que se colocam na ordem do dia na agenda da saúde suplementar no Brasil. É interessante destacar que discussão da perspectiva futura da regulação da saúde suplementar no Brasil se dá sobre um pano de fundo de profundas transformações no plano da política e das relações de hegemonia e poder na esfera global. Por fim, o trabalho aqui apresentado tem a finalidade de contribuir para o desenvolvimento do tema e sugerir aperfeiçoamentos de modo a aprimorar o planejamento, a gestão e a regulação da saúde suplementar, buscando relações público-privadas mais harmoniosas e eficientes no tocante à assistência e promoção da saúde. / This thesis analyzes the trajectory, challenges and prospects of private health insurance regulation in Brazil in a context of changing of hegemony and relationship between economics and politics. This scenario of economy and political change is the basis for the Brazilian State agenda on health regulation. This work analyzes the worlds economic and political landscape in order to identify its influence on Brazil and on the Brazilian healthcare industry. Based on this framework, we develop a retrospective analysis of the major private health insurance regulatory policies enacted by the Brazilian National Health Agency ANS. In this way, a database was built not only for research thesis, but also for later studies. Subsequent analytical study has identified three different waves in the Brazilian regulation trajectory. Results were, then, checked by all current and former ANS directors. This work, also analyses the effects of those three waves and discusses the main challenges of health insurance regulation agenda in Brazil. It is worth noting that discussions of future regulatory policies in Brazil take place on the grounds of critical changes in policy, power and hegemony over the world. Lastly, this work provides contribution to the development of the theme and suggests enhancements to improve planning, management and regulation of health, seeking more harmonious and efficient public-private relations in the field of disease prevention and health promotion.

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

Contexte : Les sujets âgés représentent un groupe d’âge dont la proportion ne cesse d’augmenter. Ainsi, la lutte contre la sédentarité et la pratique d’une activité physique régulière demeure l’une des principales mesures qui devrait être privilégiée chez les seniors. L’objectif principal de ce travail était de déterminer les effets d’un nouveau protocole de réentraînement en endurance sur ergocycle alternatif « le Programme d’Entraînement Personnalisé sur Cycle à charge constante avec Récupération intermittente » (PEP’C-R) sur les paramètres d’endurance et cardio-respiratoires maximaux chez des seniors de plus de 70 ans. Les objectifs secondaires étaient de déterminer les effets du PEP’C-R sur la fonction vasculaire et les performances cognitives. Résultats : le PEP’C-R permet une amélioration significative des paramètres d’endurance et cardio-respiratoires maximaux et permet aussi d’améliorer la fonction vasculaire et les performances cognitives. Conclusion : Les résultats apportés par ce travail permettront de diffuser le PEP’C-R chez les seniors en bonne santé et ceci dans le cadre de la prescription de programmes de réentraînement à l’effort. / Background: Older adults constitute one of the most rapidly growing population groups. Consequently, avoiding an inactive lifestyle and encouraging regular physical activity remains one of the main measures that should be promoted for older adults. The main objective of our study was to determine the effects of a new lightweight protocol including recovery bouts called: “The Intermittent Aerobic Training Program with Recovery bouts” (IATP-R - PEP’C-R in French) for seniors over 70 on maximal cardiorespiratory and endurance parameters. The secondary objectives were to determine the effects of IATP-R on vascular function and cognitive performances. Results: Our results showed that this new “IATP-R” training protocol permits to achieve a significant improvement in both endurance parameters and maximal cardio-respiratory parameters. In addition, the IATP-R permits to improve the vascular function and cognitive performances. Conclusion: The results of this study could be useful to implement this new IATP-R protocol for healthy older adults over 70. This would also be within the framework of prescribing training programs.

Ce travail aborde la question du renseignement militaire de la guerre de succession d’Autriche (1740) au traité de Paris (1763). Le renseignement militaire est d’abord replacé dans la réflexion stratégique de la période qui l’évoque peu tout en soulignent paradoxalement l’importance pour les armées. Les différentes sources de l’information militaire constituent la seconde partie. L’espion d’armée, figure méconnue de la période joue un rôle quotidien auprès des armées d’Ancien Régime. Situé à la marge de la société civile et de la sphère militaire, attiré par le gain mais aussi par le goût de l’aventure, une reconnaissance sociale ou incité par un patriotisme naissant, l’espion prend des risques pour satisfaire un commanditaire. La troisième partie s’intéresse au secret militaire, difficile à préserver et dévoilé dans une logique de réseau, à différentes échelles et selon des organisations plus ou moins complexes. L’espion s’inscrit dans un rapport personnel avec un supérieur dont il est le « client ». L’étude s’intéresse dans un dernier temps à la transmission et la protection du renseignement obtenu. Les risques sont divers (interception postale mais surtout espions ennemis). La conclusion pose la question de l’efficacité du renseignement militaire, peu décisif du fait des contraintes logistiques et de la méfiance généralisée sur les informations et sur les acteurs qui les collectent. Dans une période de structuration de l’armée et de centralisation du pouvoir politique, le renseignement militaire oppose un fonctionnement décentralisé. La nécessité d’une information fiable entraîne une militarisation des civils, transformant ces derniers en auxiliaires de renseignement. / This work tackles the question of the military intelligence from the war of Austrian succession (1740) to the treaty of Paris (1763). The military intelligence is initially replaced in the strategic thinking of the period which evokes it little while paradoxically highlighting its importance for the armies. The various sources of military information are the second part. The army Spy, unrecognized figure of the period, plays a daily role within the armies of the Ancien Regime. Located at the margins of society and the military sphere, attracted by profit but also by the sense of adventure, social recognition or induced by a nascent patriotism, the spy takes risks to satisfy a sleeping partner. The third part focuses on the military secret, hard to preserve and unveiled in logic of networks, at different scales and in a more or less complex organizations. The spy takes part of a personal relationship with a supervisor whom he is the "client." The study examines in a final time the transmission and protection of information obtained. The risks are varied (postal interception but especially enemy spies). The conclusion raises the question of the effectiveness of the military information, not very decisive because of the logistic constraints and widespread distrust about information and the actors who collect them. In a period of structuring of the army and centralization of political power, military intelligence is in contrary a decentralized operation. The need for reliable information leads to a militarization of civilians, transforming them into auxiliary information.

Dire qu’il n’est pas possible de séparer la religion de la politique avant le XVIIIe siècle, c’est énoncer un lieu commun. Mais comment étudier l’influence des représentations religieuses sur la politique ? Si depuis Marc Bloch et Ernst Kantorowicz de nombreuses études ont été publiées sur la légitimation religieuse du pouvoir temporel, les autres dimensions de la politique, c’est à dire le développement et la réalisation de politiques, ont souvent été négligées. Ainsi, l’historiographie sur la Guerre de Trente Ans et la politique étrangère française sous Louis XIII distingue d’un côté des acteurs motivés religieusement et de l’autre des acteurs motivés politiquement et, de ce fait, ne peut appréhender de manière satisfaisante les débats politiques du XVIIe siècle.En examinant l’impact de la Réforme catholique sur le calcul politique, cette thèse de doctorat propose une démarche qui rassemble la religion et la politique dans toutes ses dimensions. Ce faisant, elle tente de développer de nouveaux récits de l’histoire politique. Les questions du parti dévot, de la Fronde, du caractère de la Guerre de Trente Ans et de l’échec de la monarchie polonaise sont reconsidérées. En outre, elle cherche à donner une vue d’ensemble de la Réforme catholique et de ses conséquences politiques. Une grande attention est accordée à l’émergence de nouveaux cultes politico-religieux favorisant la construction étatique, et en particulier au patronage marial étatique. / Common wisdom says that it is not possible to dissociate religion from politics before the 18th century. But how is it possible to study the influence of religious patterns on political action? Since Marc Bloch and Ernst Kantorowicz, a great deal of scholarly work has been written on religious legitimization of political power, yet the other dimensions of politics - the development of policies and the struggles around it - have been somewhat neglected. Historiography about the Thirty Years’ War or French foreign policy under Louis XIII still postulates a dichotomy between religiously and politically motivated actors and, because of this, fails to analyse properly the political debates of the 17th century. Examining the influence of Catholic reform on political calculation in the first half of 17th century, the doctoral thesis proposes a way bridging religion and politics in all its dimensions, and in so doing develops new narratives of political history. The questions of the resistance to war in France, of the Fronde, of the character of the Thirty Years’ War, and of the failure of the Polish monarchy are re-considered. Furthermore, this work provides a general view of Catholic reform and of its impact on political life. It pays particular attention to the new religious-political cults propelling state construction, and especially to the State Marian patronage.

Physiological signals, which are controlled by the autonomic nervous system (ANS), could be used to detect the affective state of computer users and therefore find applications in medicine and engineering. The Pupil Diameter (PD) seems to provide a strong indication of the affective state, as found by previous research, but it has not been investigated fully yet. In this study, new approaches based on monitoring and processing the PD signal for off-line and on-line affective assessment (“relaxation” vs. “stress”) are proposed. Wavelet denoising and Kalman filtering methods are first used to remove abrupt changes in the raw Pupil Diameter (PD) signal. Then three features (PDmean, PDmax and PDWalsh) are extracted from the preprocessed PD signal for the affective state classification. In order to select more relevant and reliable physiological data for further analysis, two types of data selection methods are applied, which are based on the paired t-test and subject self-evaluation, respectively. In addition, five different kinds of the classifiers are implemented on the selected data, which achieve average accuracies up to 86.43% and 87.20%, respectively. Finally, the receiver operating characteristic (ROC) curve is utilized to investigate the discriminating potential of each individual feature by evaluation of the area under the ROC curve, which reaches values above 0.90. For the on-line affective assessment, a hard threshold is implemented first in order to remove the eye blinks from the PD signal and then a moving average window is utilized to obtain the representative value PDr for every one-second time interval of PD. There are three main steps for the on-line affective assessment algorithm, which are preparation, feature-based decision voting and affective determination. The final results show that the accuracies are 72.30% and 73.55% for the data subsets, which were respectively chosen using two types of data selection methods (paired t-test and subject self-evaluation). In order to further analyze the efficiency of affective recognition through the PD signal, the Galvanic Skin Response (GSR) was also monitored and processed. The highest affective assessment classification rate obtained from GSR processing is only 63.57% (based on the off-line processing algorithm). The overall results confirm that the PD signal should be considered as one of the most powerful physiological signals to involve in future automated real-time affective recognition systems, especially for detecting the “relaxation” vs. “stress” states.

La prévention du suicide est une activité importante pour les professionnels de la santé et particulièrement pour les infirmières . Or, le processus d’évaluation du risque suicidaire n’est pas effectué de façon systématique d’un milieu de soins à un autre auprès d’une population adulte. De plus, il y a peu d’information sur ce processus d’évaluation du risque suicidaire auprès des enfants de moins de 12 ans. C’est un sujet difficile à aborder et à comprendre dans une société où l’accent est mis sur grandir en santé. Cette étude vise à décrire, comprendre et schématiser le processus d’évaluation du risque suicidaire auprès des enfants de moins de 12 ans selon une perspective infirmière en santé mentale. Le modèle humaniste des soins infirmiers-UdeM constitue la toile de fond de cette étude compte tenu de sa vision centrée sur la Personne , ses relations interpersonnelles significatives, son expérience de santé ainsi que les significations qu’elle lui accorde. Pour atteindre le but de notre étude, une approche par théorisation ancrée inspirée de Strauss et Corbin (1998) a été retenue. L’échantillon a été obtenu à l’aide d’entrevues semi-structurées avec des infirmières (n=11) provenant de cinq régions administratives différentes au Québec ainsi qu’à l’aide de questionnaires socio-démographiques, d’outil de collecte de données utilisées par les infirmières ainsi que de notes de terrain. Une analyse comparative continue à travers une triple codification a permis de proposer une schématisation spécifique au processus d’évaluation du risque suicidaire auprès des moins de 12 ans en santé mentale. Les principaux résultats indiquent qu’il y a deux phases à ce processus d’évaluation. La première phase est centrée sur comprendre le sens de la détresse chez l’enfant et la deuxième phase consiste à assurer la sécurité de l’enfant et de sa famille. Dans chacune des phases, nous avons remarqué l’importance de la relation interpersonnelle entre l’infirmière, d’un côté, et l’enfant et ses parents, de l’autre. Plus précisément, certaines caractéristiques de l’infirmière (tempérament, croyances et perceptions, expériences antérieures, formation) en relation avec celles de l’enfant et de sa famille (propos ou comportements suicidaires, conception de la mort, dynamique familiale ainsi qu’attitudes, perceptions et croyances des parents) s’inter-influencent de manière à produire des effets positifs ou négatifs sur l’ensemble du processus de cette évaluation. L’environnement, soit l’organisation des soins (fonction occupée par l’infirmière, acuité des soins, ressources humaines disponibles et collaboration interprofessionnelle), affecte également le processus. De plus, le processus d’évaluation du risque suicidaire chez l’enfant implique pour l’infirmière de prendre en compte le développement de l’enfant qu’elle rencontre, que ce soit lorsqu’elle tente de comprendre le sens de sa détresse ou lorsqu’elle cherche à assurer sa sécurité. Ainsi, l’infirmière doit être vigilante afin de maintenir une posture d’empathie et non se laisser envahir par les émotions qu’une telle évaluation peut engendrer. Cette étude permet d’approfondir la compréhension du processus d’évaluation du risque suicidaire auprès des moins de 12 ans afin d’aider les professionnels de la santé travaillant en prévention du suicide auprès des jeunes à comprendre ce qui est vécu pour mieux intervenir. / Suicide prevention is an important aspect of the work of any healthcare professional, especially for nurses working in mental healthcare settings. However, suicide risk assessment is not conducted systematically, varying from one setting to another. Furthermore, there is no information to our knowledge on this type of risk assessment process with children under 12 years old. This topic is particularly difficult to explore and to understand in a society where children are expected to grow to be healthy and happy. The aim of this study is to describe, understand and schematize nurses’ suicide risk assessment process with children under12 in a mental health setting. The background of this study is the humanistic model in nursing – UdeM. Centered on the Person, this model takes into account their significant interpersonal relationships, their subjective experience of care and its meaning. Strauss et Corbin’s (1998) approach in grounded theory was used to conduct this study. Using theoretical sampling, data was obtained through 11 semi-structed interviews with nurses working in five different administrative regions in the province of Quebec, nurses’ documents, socio-demographic questionnaires, and field notes. A constant comparative analysis of the data across triple coding allowed a better understanding and a schematization of the nurses’ suicide risk assessment process with children. The process includes two main phases relating to nurses’ actions. These two phases are: (1) Understanding the meaning of the child’s distress, and (2) Ensuring the child and their family’s safety. The different elements involved in each phase are not exclusive to one phase or the other. In fact, characteristics of nurses (temperament, beliefs and perceptions, past experiences) interact with those of the child and his or her family (suicidal ideations or behaviors, level of understanding of the concept of death, mental health state, family dynamics and attitudes, parents’ perceptions and beliefs ). This interaction can produce both positive and negative impacts. The environment (health and services organization) where this interaction occurs can also impact on the whole assessment process. Our findings reveal that for both phases of the assessment process with children, nurses have to take in account the developmental aspect of the child and must be careful to maintain their empathic posture, so they are not overwhelmed by emotions. Doing so will help lessen the level of emotional intensity for the nurse during the whole process. A better understanding of this process can help nurses and other professionals improve their interventions with children presenting a suicidal risk as well as their parents and in the long term, contribute to suicide prevention.