Thesis (M.S)--State University of New York at Binghamton, Decker School of Nursing, 2007. / Includes bibliographical references.

Thesis (M.B.A.)--Globe University/Minnesota School of Business, 2008. / Includes bibliographical references (leaves 38-41).

ENGLISH ABSTRACT: HIV/AIDS is the leading cause of death in Sub-Saharan Africa. According to 2001 estimates, there are 28.5 million people living with HIV in Africa, comprising more than 70% of the world’s HIV-infected population. HIV/AIDS remains one of the most important social and public health threats in Sub-Saharan Africa. UNAIDS 2006 estimates that 5.5 million people are living with HIV, and almost 1,000 AIDS deaths occur every day in South Africa. South Africa is currently one of the most severely affected countries in the world. Antiretroviral therapy (ART) is currently the only treatment available for HIV. It does not cure HIV infection, but reduces HIV related mortality and morbidity. / AFRIKAANS ABSTRACT: No abstract available

A presente pesquisa teve como objetivo central a reflexão acerca da possibilidade de inserção da psicanálise no trabalho na área da educação, especificamente em escolas públicas da Prefeitura do Rio de Janeiro. O estudo foi instigado pela experiência em instituições educacionais, o que levou ao surgimento de diversas indagações a respeito do campo da educação, englobando não só as questões da práxis psicanalítica na escola, mas também as questões políticas, econômicas, sociais e éticas que atravessam essa instituição e extrapolam o campo da psicanálise. Neste percurso, foi realizado um resgate histórico da educação pública no Brasil, sobretudo na Primeira República, trazendo para a discussão alguns movimentos deste campo, como o escolanovismo e a pedagogia libertária. Ademais, ressaltou-se o papel da psicologia na educação neste mesmo período. A partir disso, procurou-se distinguir a psicanálise da psicoterapia, levando em conta a especificidade teórica, clínica e ética da psicanálise, o que evidencia a revolução discursiva operada por Sigmund Freud. Por fim, objetivou-se situar a questão do sujeito na escola, que pode ser trabalhada a partir de uma diversidade de dispositivos psicanalíticos, sendo fundamental o estabelecimento e manejo da transferência.Concluiu-se ainda que o trabalho institucional está vinculado à clínica uma vez que envolve a escuta e o fazer falar. / The main objective of the research is to discuss about the possibility of insertion of psychoanalysis in the work in the educational field, specifically in public schools in Rio de Janeiro. This study was instigated by the experience in public schools, which led to several questions about psychoanalytic praxis in school, and political, economic, social and ethical matters related to educational institutions that are beyond the psychoanalytic field. It begins with the history of public education in Brazil, especially during the period of First Republic, bringing into discussion some educational movements, as New School and libertarian pedagogies. Moreover, it focuses the role of psychology in education within this same period. From that point, the aim was to make a distinction between psychoanalysis and psychotherapy, indicating the theoretical, clinical and ethical specificity of psychoanalysis that make evident the discursive revolution operated by Sigmund Freud. Finally, it highlights the matter of the subject in the school that can be explored by a diversity of psychoanalytic dispositive, and it is essential to consider the role of transference. To summarize, institutional work is linked with clinic as it does involves listening and talking.

Cette thèse s’intéresse aux évolutions de la médecine hospitalo-universitaire, sous l’angle des relations qui s’instaurent entre activités de soins et de recherche des enseignants-chercheurs praticiens hospitaliers (PUPH – MCUPH). Deux questions centrales organisent cette investigation sociologique. D’une part, en quoi l’autonomie historique (acquise au XIXème siècle) du savoir médical plus particulièrement anatomo-clinique et de ses agents est-elle, ou non, remise en cause sous l’effet des réformes bureaucratico-gestionnaires de l’espace dominant de la médecine (celui des CHU) de ces dernières années ? D’autre part, en prenant en compte l’existence d’un univers de la médecine historiquement différencié entre médecine clinique, médecine biologique et santé publique, peut-on dire que l’hégémonie clinique sur les autres sous-espaces de la médecine est atteinte dans ce contexte ? Ce travail revient sur la manière dont l’actualisation de la clinique dans le cadre des restructurations hospitalières constitue un enjeu pour l’élite médicale sur le terrain. Les luttes historiques constitutives du champ concernent en effet la définition même de la médecine clinique, ses frontières, les limites de son objet, ses objectifs, la nature de sa connaissance, ses modes d’interventions, ses conditions de pratiques et ses interactions avec les autres formes de connaissances, notamment scientifiques, essentielles à son essor. Face à l’ampleur que prend depuis les années 1970 les connaissances sociales, économiques et gestionnaires sur la médecine, nous faisons l’hypothèse qu’un processus de routinisation de la légitimité clinique au sein du champ médical tend à s’opérer par la voie de la réforme hospitalière : il s’agit de demander aux médecins de rendre compte de leur pratique et de rendre des comptes sur leur pratique. Autrement dit, de passer d’opérateur à témoin de ce qu’est la médecine, son champ d’intervention et les interrogations sociétales qu’elle porte. Ce sont ainsi les mécanismes de transformation possible de cet ordre des légitimités qu’il s’agit avant toute chose d’interroger, leur construction et leur mode d’intégration au champ. / This thesis is interested in developments in the university hospital medicine, in terms of the relationships that develop between care and research hospital practitioners teacher-researchers (PUPH - MCUPH). Two central questions are organizing this sociological investigation. First, how the historical autonomy (acquired in the nineteenth century) of particular anatomical clinical medical knowledge and its agents is it or not questioned as a result of bureaucratic-managerial reforms of space overlooking medicine (the CHU) in recent years? On the other hand, taking into account the existence of a universe of medicine historically differentiated between clinical medicine, biological medicine and public health, can we say that the clinical hegemony over other sub-areas of medicine reached in this context ? This work comes to how updating of the clinic in the context of hospital restructuring is a challenge for the medical elite field. The constituent historical struggles of the field concerned in fact the very definition of clinical medicine, its borders, the limits of its purpose, objectives, the nature of its knowledge, its modes of action, conditions of practice and its interactions with other forms of knowledge including science, essential to its growth. Given the scale that took since the 1970s social knowledge, economic and managers on medicine, we assume that routinization of clinical legitimacy process within the medical field tends to take place through Hospital Reform: it is asking doctors to report their practice and be accountable for their practice. In other words, to move from operator to witness what the medicine, its field of intervention and societal questions she wears. These are the possible transformation and mechanisms of this kind of legitimacy that it is above all to question, their construction and mode of integration in the field.

Made available in DSpace on 2014-06-11T19:28:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2002-10-12Bitstream added on 2014-06-13T19:16:57Z : No. of bitstreams: 1 dalcol_dml_me_assis.pdf: 581229 bytes, checksum: 9165d6ce3f114b512edbae3ab956dcdc (MD5) / O presente trabalho tem como objeto o conceito de angústia na perspectiva aberta pelo fundador da psicanálise - S.Freud. Seu objetivo é o estudo da elaboração desse conceito ao longo da sua obra, desde suas origens - quando se encontra, nos casos clínicos, com o fenômeno de angústia - , sua revisão no meio da obra, entre 1915 e 1917, até sua conceituação final da angústia como sinal de alarme. Visa discutir as conseqüências dessa conceituação para o tratamento psicanalítico e faz algumas considerações sobre a angústia na cultura contemporânea. Realiza-se mediante um método que consiste em fazer um levantamento da origem e das mudanças da teoria, procurando apontar os impasses com os quais Freud se deparou na sua clínica e na elaboração do saber, identificando as conclusões a que chegou. Estabelece três períodos do desenvolvimento da elaboração do conceito de angústia na obra freudiana: as origens (1886-1900); período intermediário (1900-1920); última fase (1920-1933). Apresenta e discute as conseqüências para a clínica psicanalítica (tratamento) das descobertas que Freud fez sobre a angústia ao longo de sua investigação, principalmente do seu conceito final como sinal de alarme do perigo que o desejo inconsciente representa para o ego. Conclui que a angústia é um paradoxo porquanto indica, clinicamente, ao mesmo tempo, uma aproximação ao desejo inconsciente e um alerta do ego para colocar em curso medidas de afastamento. A implicação clínica reside em que o praticante da clínica psicanalítica deve acolher a angústia e levar o paciente a acolhê-la pela verdade inconsciente que ela aponta, a saber, que o sujeito é marcado pela perda, tendo isso implicações na sua vida... / The object of this work is the concept of angst within the open perspective of the founder of psychoanalysis, S. Freud. It elaborates on the concept of angst from its origins, found in his clinical cases together with the angst phenomenon, during its review, between 1915 and 1917, until its final conceptualization as a sign of distress. The consequences of this conceptualization to the psychoanalytical treatment and considerations on the subject of angst in the contemporary culture are also presented. The method used to carry out this study included a survey of the origins and changes of the theory, as well as the setbacks faced by Freud both in his clinical work and during the development of the knowledge based on his conclusions. Three phases were established for the develoment of the Freudian concept of angst: the origins phase (1886 to 1900), the intermediate phase (1900 to 1920) and the last phase (1920 to1933). The consequences of his conceptualization to the psychoanalysis clinical treatment, mainly his final conceptualization of the phenomenon as a sign of distress, and the dangers that the unconscious desire causes to the ego are also discussed. It concludes that angst is a paradox which indicates, clinically, an approximation to the unconscious desire and an alert for the ego to use withdrawal measures.Clinical implications involve the acceptance of angst by the clinician and his patient of the unconscious truth it reveals ,i.e., that the subject suffers from a loss which brings consequences to his life... (Complete abstract, click electronic access below)

L’autisme considéré d’abord comme une maladie d’ordre psychique est appréhendé aujourd’hui comme Trouble envahissant du développement (TED), et plus récemment comme Trouble du spectre autistique (TSA) dans le DSM 5 (Diagnostic and Statistical Manual of mental Disorders). L'imposition des critères de ce manuel, l’émergence des sciences cognitives et la recherche en génétique et en neurobiologie font que l’autisme est considéré comme un « handicap » qui relève plus d’une « éducation spécialisée» que d’un traitement psychiatrique ou psychologique. La clinique psychanalytique est mise en cause depuis quelques années par les instances de santé publique et les médias dans le traitement de l’autisme. Pour la psychanalyse lacanienne, l’autisme n’est pas un « handicap » mais une position subjective de l’être et un mode de jouissance singulier, suivant la proposition d’Eric Laurent du retour de la jouissance sur un bord, laquelle peut être traitée à partir d’une clinique du réel qui utilise les objets, la parole et le corps. Dans cette thèse, nous étudions l’autisme avec pour fil conducteur la clinique et ses effets. Nous nous penchons sur les premiers travaux psychiatriques et psychanalytiques, sur l’enseignement de Lacan ainsi que sur les concepts élaborés par certains de ses élèves. Nous traitons principalement d’une pratique clinique en institution, la « pratique à plusieurs », issue de cet enseignement. Nous exposons en dernier deux témoignages de sujets autistes, qui ont pu appareiller leur jouissance et s’ouvrir au lien social à partir de leurs propres inventions sans pour autant sortir de l’autisme. / Considered first and foremost as a mental illness, autism is nowadays being approached as a Pervasive Developmental Disorder (PDD) and, more recently still, as a disorder on the Autism Spectrum, as presented in the fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders). The imposition of criteria from this manual, the emergence of the cognitive sciences, alongside research in genetics and neurobiology, have led to autism being considered as a “disability” that would fall more under the remit of “specialized education” than that of psychiatric or psychological treatment. The psychoanalytic clinic has for some years now been called into question as a treatment for autism, by public healthcare bodies and the media alike. From the perspective of Lacanian psychoanalysis, autism is not a “disability”, but a subjective position of Being and a singular mode of jouissance, in line with Éric Laurent’s assertion that it entails a return of jouissance in a rim, a jouissance that may be treated by means of a clinic of the real that uses objects, speech, and the body. In this thesis, we study autism from the angle of the clinic and its effects. We draw on the early psychiatric and psychoanalytic texts, on Lacan’s teaching, and on concepts developed by some of his students. We look chiefly at a clinical practice specific to institutions, so-called “multi-person practice”, which was derived from the aforementioned teachings. Lastly, we present two studies of autistic subjects who were able to transform their jouissance into an apparatus and turn towards a social bond on the basis of their own specific inventions, without, however, leaving their autism behind.

Background: Historically the identification of ACL injuries upon initial presentation is low and considerable diagnostic delays have been reported. However, specific evidence on the individual elements of, and factors which influence delay, is lacking. Aims: The overarching aim was to provide a comprehensive picture of delay to diagnosis and specialist consultation, including factors which influence delay. An additional aim was to determine whether the approach to examining acute knee injuries varied as a consequence of varying patient presentation or experience of the assessing clinician. Methods: Study 1: Cross -sectional survey. Study 2: Non-participant direct observation methodology. Results: Data from 194 patients were analysed in the survey. Only 15.5% of patients were given a correct diagnosis of ACL rupture at the initial consultation. Median delay to diagnosis was 67.5 days (IQR= 15 to 178 days) and specialist consultation 108 days (IQR= 38 to 292 days). The factors most influential on delay were whether a follow-up appointment was arranged after attending A&E, whether the site of attendance operated an acute knee clinic and whether MRI was performed. The direct observation study showed wide variation in approach to injury assessment. Specialist clinicians performed the most comprehensive examination. A&E clinicians were more likely to assess for bony, neurovascular and gross tendon injuries as opposed to ligamentous or meniscal injury. Conclusions: The diagnostic rate of ACL injury at initial presentation remains low. Considerable delays to diagnosis and specialist consultation are apparent following ACL injury, the majority of which is attributable to health system delay.

Esta pesquisa-intervenção parte das interrogações disparadas na bifurcação de duas experiências de trabalho: como trabalhadora do setor de saúde de uma instituição pública de ensino superior e também como apoiadora institucional em uma das cidades da região metropolitana de Porto Alegre. Busca-se analisar as narrativas referentes às experiências de intervenções realizadas na interface saúde-gestão junto às equipes de servidores de uma instituição pública de nível superior a fim de compreender a relação saúde-clínica-gestão que se expressa nesse processo de trabalho. A partir dessa investigação, as perspectivas teórico-metodológicas da Clínica da Atividade e do Apoio Institucional são exploradas para articular as conexões entre ambas e com a Análise Institucional, subsidiando um debate entre o Sistema Único de Saúde – SUS – e as experiências do Subsistema Integrado de Atenção à Saúde do Servidor – SIASS. O percurso metodológico desse estudo adota a cartografia como estratégia na produção de dados e, como ferramentas, são utilizados os registros do diário de campo e da realização de duas rodas de conversa com servidores da Pró-Reitoria responsável pela gestão de pessoas, tematizando a experiência de intervir com as diferentes equipes da Universidade. George Canguilhem, Yves Clot, Michel Foucault, Gilles Deleuze, Félix Guattari, Gastão Wagner Campos, Emerson Elias Merhy e outros autores brasileiros contemporâneos da saúde coletiva são interlocutores dessa investigação, que parte do conceito de intercessores, para travar esse diálogo, permitindo nos conduzir à discussão acerca da dimensão clínica presente no apoio institucional. Dessa forma, concluiu-se que é no plano constituído pelas infidelidades do meio e pelas imprevisibilidades nos modos de subjetivação, que se produz a atividade de apoio ao trabalho – através das rodas de conversa cotidianas e seus diferentes arranjos. O duplo lugar servidora-pesquisadora ajudou a colocar em análise as instituições academia e clínica, apontando a possibilidade de um exercício de apoio que as articulem em busca da produção de saúde. / This intervention research lies on the interrogations that emerged from two work experiences: as a worker in the health department of a public university in Brazil, as well as an institutional supporter on one of the cities around Porto Alegre. This study intends to analyze the narratives concerning the experience of health-management interventions made on teams of a public university in order to understand how health, clinic and management are related in this work process. From this analysis, the theoric-methodological perspectives of Clinical Activity and Institutional Support are exploited to articulate the connections between them and amongst the institutional analysis, supporting a debate between the Brazilian Public Health System - SUS - and the experiences of the Servants Health Subsystem - SIASS. The methodological approach of this study adopts the cartography as a strategy to produce data and, such as tools, the field diary research and two rounds discussions with the department responsible for managing people, thematising the experience of intervetion with different teams from the University. George Canguilhem, Yves Clot, Michel Foucault, Gilles Deleuze, Félix Guattari, Gaston Wagner Campos, Emerson Elias Merhy and other contemporary brazilian authors are partners on this research, which is based on the concept of intercessors leading the discussion towards the clinical dimension presented in institutional support. Thus, it was concluded that the work of supporting work is formed by the context that combines infidelities of the environment and the unpredictability of the modes of subjectivity - through the everyday rounds discussions and its different arrangements. The double function servant-researcher could analise both clinic and academic institutions, enabling support experience towards occupational health.

[pt] A tese tem o objetivo de desenvolver um estudo acerca do trauma e de seus efeitos sob uma perspectiva dinâmica e não meramente econômica, como tem sido o caso de muitos estudos no campo da psicanálise até os dias de hoje, tendo como referência a observação clínica de atendimentos psicanalíticos prestados a policiais militares na cidade do Rio de Janeiro. Assim, além das noções de Schreck (susto) e de excesso de estímulo pulsional apresentados por Freud em 1920 para explicar o trauma a partir de uma invasão energética do aparato psíquico, incluiremos nesta pesquisa o papel do supereu, cuja imposição de gozo – masoquista – a serviço da pulsão de morte pode levar à compulsão à repetição do trauma. O trauma, que deve ser entendido como um esfacelamento das fantasias sexuais, faz com que as referências subjetivas estruturantes caiam por terra, processo que leva à sensação de aniquilamento psíquico, daí a idéia de que resta um corpo estranho no psiquismo. Identificado com o morto, o que gera um estado depressivo que ameaça a sobrevivência do sujeito traumatizado, ele pode se encontrar num estado melancólico ou até num estado paranóico, sem que seja um psicótico; visto que a ação superegóica de castigar e espezinhar o eu, que pode inclusive levá-lo a completar a ação não finalizada (morte), pode ser atribuída a um Outro (perseguidor), quando em realidade, esta ameaça é interna, como será mostrado em alguns casos clínicos. / [en] The thesis has the objective of developing a study concerning trauma and its effects under a dynamic perspective and not merely economical, as it has been the case of many studies in the field of the psychoanalysis since now, taking as reference the clinical observation in psychoanalytic services rendered to the Military Policemen in the city of Rio de Janeiro. Besides the notions of Schreck (fright) and of an excess of energy invasion presented by Freud in 1920 to explain the trauma, we will include in this research the role of the superego, whose imposition of a masochist enjoyment at the service of the death drive can lead to the compulsion to repetition of the trauma. If we understand trauma as the shattering of the sexual fantasies, it causes the subjective references to dismount, a process that leads to the sensation of psychic annihilation. That is the reason of the idea that a strange body remains in the psyche. Identified with the dead, a position that generates a depressive state that endangers the subject s survival, he can fall in a melancholic state or even in a paranoid state, without being a psychotic; because the action of the superego of punishing and trampling on the ego, taking him to complete the inconcluded action (death), can be attributed to a pursuing Other, when, in reality, this threat is internal, as it will be shown in some clinical cases.