I set out to make a lighthearted comedy punctuated with some scary moments. I wanted this story to come from a seven-year-old girl's point of view and match fantastic visuals with equally fantastic sounds. I will discuss the entire creative process in this book such as preproduction, writing, direction, cinematography, editing, and the sound design process, as well as many of my own personal experiences on this set and in my life. I have included the influence of unbiased audience members to determine whether or not I was successful in making a competent movie. This entire process, including all of the work done, rests entirely on my audience. I have done my best to include both people who are affluent in film production, as well as those who are not.

Ziel: Die beiden primären Ziele der Diabetes-Therapie sind eine möglichst optimale Einstellung des Blutzuckers sowie der Erhalt einer vergleichsweise guten Lebensqualität. Für beide Therapieziele konnte eine Vielzahl somatischer und psychischer Determinanten identifiziert werden. Relativ wenig Beachtung fand in diesem Kontext jedoch bislang die Bedeutung der therapeutischen Beziehung. Die vorliegende Dissertation untersucht, inwieweit ein unmittelbarer Zusam-menhang zwischen der Behandlungszufriedenheit der PatientInnen und den beiden anvisierten Therapiezielen besteht. Methodik: 650 PatientInnen (475 Insulin-behandelt, 171 nicht Insulin-behandelt) aus einer universitären Poliklinik, 3 Schwerpunktpraxen und 28 hausärztlichen Einrichtungen wurden befragt. Zur Erfassung der therapeutischen Beziehung wurde die Medical Interview Satisfaction Scale (MISS) verwendet, die Lebensqualität wurde mit dem WHOQOL-BREF gemessen und die Beurteilung der Blutzuckereinstellung erfolgte durch HbA1c-Werte. Die Darstellung der Ergebnisse erfolgte getrennt für mit und ohne Insulin behandelte PatientInnen. Ergebnisse: Für keines der beiden Subkollektive konnte ein Zusammenhang zwischen therapeutischer Beziehung und Blutzuckerkontrolle gefunden werden. Hingegen zeigte sich für beide Therapiegruppen eine signifikante Beziehung zu verschiedenen Aspekten der subjektiv wahrgenommenen Lebensqualität. Schlussfolgerungen: Unterschiede in der Blutzuckereinstellung waren mit der gewählten Methodik sowie dem verwendeten Konstrukt (Behandlungszufriedenheit) in dieser naturalistischen Studie nicht aufzuzeigen und ein Einbeziehen weiterer Dimensionen der therapeutischen Beziehung, insbesondere der ärztlichen Perspektive und der jeweiligen Interaktion, erscheint für weitere Untersuchungen wünschenswert. Auch wenn die signifikanten Ergebnisse in der Interaktion mit Lebensqualität z.T. als gemeinsame Kovarianz zu verschiedenen Persönlichkeitsmerkmalen interpretiert werden können, ergeben sich deutliche Hinweise, dass die therapeutische Beziehung ein Einflussfaktor der gesundheitsbezogenen Lebensqualität ist. / Objective: The primary goals in treating Diabetes are maintaining blood glucose levels as close to normal as possible and making a relatively normal quality of life achievable. A multitude of somatic and psychological determinants for both of these goals could be identified. However, relatively little consideration in this context was given to the importance of the doctor-patient-relationship. This study examines, whether a direct relationship between treatment satisfaction and the primary treatment goals exists. Methods: 650 patients (475 insulin-treated, 171 not insulin-treated) from one universitary outpatient centre, 3 specialized treatment facilities and 28 general practitioners were asked. The doctor-patient-relationship was assessed using the Medical Interview Satisfaction Scale (MISS), health-related quality of life was measured by the WHOQOL-Bref and metabolic control by HbA1c values. Results are presented separately for patients treated with and without insulin. Results: For none of the two subgroups a relationship between doctor-patient-relationship and metabolic control was detected. However, significant interactions were found for both collectives regarding different aspects of quality of life. Conclusions: Differences in metabolic control could not be shown using the chosen methods and the construct treatment satisfaction under routine conditions and further dimensions of the doctor-patient-relationship as the physician's perspective and interactional aspects are likely to be included in future studies. Even while the significant results concerning the interaction with quality of life can be interpreted as a common covariance regarding various personality dispositions there are clear indications that the doctor-patient-relationship is a determinant of health-related quality of life.

Made available in DSpace on 2016-04-26T20:27:35Z (GMT). No. of bitstreams: 1 Patricia Caldeira.pdf: 698186 bytes, checksum: e95506b028893165db6ccea5f0671acd (MD5) Previous issue date: 2008-06-30 / The present study investigates the medical activity and procedures to assess responsibility, focusing on the right/duty to inform. Information involves presentation of the product or service, as well as safety, the legitimate expectation of the consumer. Absence, insufficiency or inadequacy of information may motivate the duty to compensate. Evaluation of the doctor s responsibility is proposed, all rules pertaining to general suppliers being applicable to the doctor as well. The objective is to demonstrate the need to protect the consumer with the observance by the supplier, including the doctor, of the duty to give clear, precise and adequate information referring to the service provided, whereas violation of the duty to inform characterizes objective responsibility / O presente trabalho investiga a atividade médica e a forma de apuração da responsabilidade, com foco no direito/dever de informar. A informação envolve a apresentação do produto ou serviço, assim como a segurança, a legítima expectativa do consumidor. A ausência, insuficiência ou inadequação da informação pode ensejar o dever de indenizar. Propõe-se a avaliação da responsabilidade do médico, com base na informação, aplicando-se a ele, todas as regras dirigidas aos fornecedores em geral. O objetivo é demonstrar a necessidade de proteção do consumidor, com a observância pelo fornecedor, inclusive o médico, do dever de prestar informações claras, precisas e adequadas, referentes à prestação do serviço, sendo que a violação do dever de informação enseja a responsabilidade objetiva

Made available in DSpace on 2016-04-28T18:23:27Z (GMT). No. of bitstreams: 1 Ana Maria Rodrigues Alves Kuninari.pdf: 417495 bytes, checksum: 65973ea976a576fe0053d8f3a0602375 (MD5) Previous issue date: 2006-11-27 / The present work aims to reflect on the doctor-patient interaction based on the analysis of the fictional text Domingo a Tarde, a novel by Fernando Namora, written from October 1959 and October 1960. Its action is passed at a public hospital of Lisbon. The purpose of this study is to verify how the utterances multivocal character is esthetically constituted through the narrator's verbal communication with himself, with his friends and with a specific patient, in situations that happen in several spaces and in different times, in the narrative context of the romance. The research is justified because the analyzed work, presenting a graphic literary reconstitution of the doctor-patient interaction, makes available some of the main aspects of this interaction, one to which we can only have access as doctor and/or patient, for the contract implied there in is a private one which no researcher can violate, neither directly nor by means of questionaries interviews and so on. The methodology consisted on the chapters' organization from the perspective of the relation between text and context, from the point of view of dialogical relations: the narrator's memory, the comment that reviews his past, the self-criticism, the metaspeech, from the one hand, and the plot itself, the history, from the other. As analytical category, the work uses reported speech, according to Bakhtin and his Circle: trought the narrator's voice, other voices are recovered through direct, indirect and free indirect speechs. One can perceive that the literary text that constitutes the corpus of the research can be understood as an esthetic representation of social dissymmetries in the doctorpatient interaction (in the social-cultural context and in the historical moment of Domingo à Tarde). Besides, in the literary language of this novel one sees represented the transformation of the professional's posture that humanizes herself - and suffers due to her incapacity of saving and/or to cure incurable sick people -, when evaluating the "other" be the "other" the doctor-narrator himself, that recognizes and identifies in and by the "others" glance, or the other doctors, the patient, the friends, or patients in general / Este trabalho tem o objetivo de refletir sobre a interação médico-paciente, a partir da análise do texto ficcional Domingo à tarde, romance de Fernando Namora, escrito entre outubro de 1959 e outubro de 1960, e ambientado em um hospital público de Lisboa. A finalidade deste estudo é verificar como vai se constituindo, esteticamente, o caráter multivocal dos enunciados, por meio da comunicação linguageira do narrador consigo mesmo, com seus colegas, e com uma paciente específica, em situações que ocorrem em vários espaços e em diferentes tempos, no contexto narrativo daquele romance. A pesquisa se justifica, porque a obra examinada, ao apresentar uma vívida reconstituição literária da complexidade da interação médicopaciente, torna acessíveis alguns importantes aspectos dessa interação a que não se pode ter acesso direto exceto na condição de paciente e/ou médico - dada a natureza sigilosa do contrato entre os participantes, que exclui a presença de um pesquisador, seja diretamente ou na forma de, por exemplo, questionários, entrevistas, etc. A metodologia consistiu na leitura do livro e para a análise mantivemos a sub-divisão em capítulos, utilizada por Namora, de modo a se estabelecer a relação texto/contexto, sob a perspectiva de relações dialógicas: a memória do narrador, o comentário que retoma o seu passado, a autocrítica, o metadiscurso, de um lado, e a própria trama, a história, de outro. Como categoria de análise, foi usado o conceito teórico de discurso relatado, segundo Bakhtin e seu Círculo: pela voz do narrador, outras vozes são recuperadas por meio de discurso direto, discurso indireto e discurso indireto livre. O comentário final é que o texto literário - corpus desta pesquisa, pode ser entendido como representação estética de dessimetrias sociais na interação médico-paciente (no contexto sócio-cultural e no momento histórico de Domingo à tarde). Além disso, na linguagem literária deste romance está representada a transformação de postura do profissional que se humaniza - e sofre por sua incapacidade de salvar e/ou curar, doentes incuráveis -, ao valorizar o outro (seja o outro o próprio médico-narrador, que se reconhece e se identifica no e pelo olhar do outro ; sejam os outros os médicos, a paciente, a colega, ou os doentes)

Made available in DSpace on 2016-07-27T14:21:15Z (GMT). No. of bitstreams: 1 Adriana Regina de Oliveira.pdf: 233420 bytes, checksum: 01118a5386ee3d15f5fd46bf2c35ef85 (MD5) Previous issue date: 2006-10-11 / The purpose of this study was to identify the possible functional categories of smoking patients verbal reports about their difficulties in quitting smoking in an ambulatory context. It was also identified the functional categories of the doctor s role in supplying necessary information to the patient on damages made by the use of cigarettes. For such, it was adopted a descriptive methodology through direct observation of behaviors registered in video to identify possible behavior categories at the moment of the doctor appointment. Three doctors and nine patients from a private hospital ambulatory had participated in this study, being three patients of each participant doctor. The appointments were registered in video and were properly authorized to be used by the patients and doctors. The sessions were transcribed after recorded. After a careful study on these transcriptions, it was initiated the identification of verbal and non verbal categories of smoking patients on smoking behavior, as well as verbal categories of doctor s performance in relation to such patients. Seven categories of patient s verbal actions and eighteen of non-verbal actions were selected. It was also selected five categories referring to doctor s verbal actions. Later on some categories were divided in subcategories. The results had indicated a high frequency in the speech of smoking patients indicating symptoms and illnesses, amongst others. Also, the results had demonstrated that smoking patients reported to doctors their negative emotional situation as a reason to continue making use of tobacco. The data still show that doctors practically do not inform patients about anti-smoking treatments, and they do not encourage them to abandon the addiction. These data was discussed on the extreme importance of doctors role on informing, advising, or encouraging their patients about anti-smoking treatments, since these actions can contribute to improve health and quality of life for many people. Although it is likely that the majority of patients wants to quit smoking, but is not able to, as it was demonstrated in this study. / O objetivo do presente estudo foi identificar as possíveis categorias funcionais dos relatos verbais dos pacientes tabagistas sobre suas dificuldades em abandonar o uso do cigarro em um contexto ambulatorial. Procurou-se também identificar as categorias funcionais da atuação do médico no sentido de fornecer as informações necessárias ao paciente sobre os malefícios do cigarro. Para tal optou-se por uma metodologia descritiva através da observação direta de comportamentos registrados em vídeo para identificar as possíveis categorias comportamentais presentes no momento da consulta médica. Participaram deste estudo três médicos e nove pacientes provenientes do ambulatório de um hospital particular, sendo três pacientes de cada médico participante. As consultas foram registradas em vídeo, após autorização por escrito, dos médicos e pacientes participantes. Após a obtenção do registro em vídeo, todas as sessões foram transcritas. De posse das transcrições e após várias leituras destas, procedeu-se a identificação das categorias verbais e nãoverbais dos pacientes tabagistas sobre o comportamento de fumar, bem como as categorias verbais referentes à atuação dos médicos em relação a tais pacientes. Foram selecionadas sete categorias em relação às ações verbais e 18 das ações nãoverbais dos pacientes, também cinco categorias referentes às ações verbais dos médicos. Posteriormente algumas categorias foram divididas em subcategorias. Os resultados indicaram uma alta freqüência de falas dos pacientes tabagistas indicativas de sintomas e doenças, dentre outras. Os resultados demonstraram que os pacientes tabagistas relataram aos médicos seus estados emocionais negativos como justificativa para continuar fazendo uso do tabaco. Os dados mostram ainda que os médicos praticamente não informaram aos pacientes sobre tratamentos antitabagismo, bem como não os incentivaram a abandonar o vício. Os dados foram discutidos em relação à extrema importância da atuação médica no sentido de informar, aconselhar ou incentivar seus pacientes sobre tratamentos antitabagismo, sendo que estas ações poderão contribuir no sentido de melhorar a saúde e a qualidade de vida de muitas pessoas. Contudo é previsível que a maioria dos pacientes quer abandonar o cigarro, mas não consegue como demonstrou os dados do presente estudo.

Introdução: a busca por qualificação e desenvolvimento tecnológico é um indicador de prosperidade de uma nação. A educação é um componente fundamental para o progresso econômico e social. Mesmo países em desenvolvimento, como o Brasil, colaboram continuamente com o progresso da ciência e da tecnologia mundial por meio da produção de conhecimento e aperfeiçoamento profissional. A pós-graduação estrito senso abre o caminho para esta escalada evolutiva. Mesmo com as dificuldades econômicas, a pós-graduação em níveis de mestrado e doutorado tem viabilizado este progresso. Embora muito tenha sido feito para alavancar o alastramento de programas de pós-graduação, ainda há uma carência de meios para avaliar e para mensurar a evolução dos egressos. Esta é a motivação deste estudo, que objetiva compreender a trajetória e a contribuição dos Doutores formados pelo Programa de Pós-Graduação em Medicina: Ciências Medicas (PPGCM), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). Objetivo: Construir um índice de desempenho acadêmico e inserção profissional dos doutores egressos do Programa de Pós-Graduação em Medicina: Ciências Médicas, Faculdade de Medicina, UFRGS. Método: Realizou-se um estudo transversal. Foram coletados dados dos alunos egressos de doutorado do Programa de Pós-Graduação em Medicina: Ciências Médicas, no período compreendido de 1987 a 2014. A estratégia usada para localizar os membros desta amostra foi o nome dos egressos obtido nos registros do PPGCM. A partir destes, foram acessados currículos modelo Lattes, disponível na base de dados de aceso público do Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq). Visando proteger os dados dos egressos, foram extraídos apenas os dados pertinentes a sua origem, curso de graduação e de mestrado, produção intelectual, inserção acadêmica e a posição profissional. Resultados: foram analisados 324 doutores egressos. Deste total, 221 eram graduados em Medicina. Para obtenção do efeito independente no índice de produção qualificada o escore do mesmo foi ajustado usando um modelo de regressão linear múltipla hierárquico. O coeficiente de determinação (R2) demonstra que a proporção variância explicada pelas variáveis incluídas no modelo foi de 99%. As variáveis com maior contribuição na construção deste índice foram: graduação em medicina, vínculo laboral em universidade pública, exercer atividade como orientador em nível de doutorado ou de mestrado, ser bolsista de produtividade em pesquisa do CNPq e possuir registro do índice H no Currículo Lattes. Conclusão: Os resultados demonstram que os egressos produzem conhecimento qualificado, atestado pela sua disseminação em jornais de circulação internacional, formação de recursos humanos. No global conclui-se que os egressos em nível de doutorado do PPGCM possuem capacidade para interagir e criar parcerias em seu ambiente de trabalho e repassar o conhecimento, bem como para fomentar o conhecimento na área das ciências médicas com relevância regional, nacional e internacional. / Introduction: the search for qualification and technological development is a prosperity indicator of a nation. Education is a fundamental component of economic and social progress. Even though the Brazil is a developing country, our nation continuously collaborates with world science and with technological advances in the production of knowledge. In addition, the Brazil contributes to professional development. The graduation provides the way for this progressive knowledge pool. Despite the economic difficulties, graduates in doctoral levels have taken part in this advancement. Although much has been done to stimulate the creation of master and doctoral programs, there is an insufficient assessment of what happens to the graduates. Aim: To assess the track and the contribution of Doctors formed by the Graduate Program in Medicine Medical Sciences (PPGCM), Medicine School, Universidade Federal do Rio Grande do Sul (UFRGS). Methods: We conducted a cross-sectional study. Data were collected from doctoral graduate students of the PPGCM from 1987 to 2014. The strategy used to locate the graduate students was their names and the curriculum vitae in the CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) CV Lattes Portal, an open public database. Only relevant data to this study were retrieved: origin, undergraduate and master's degree, intellectual production, academic integration and professional position. Results: The study included 324 graduated doctors. Of this total, 221 were graduated in Medicine. A hierarchical multiple linear regression model was used to identify the independent effect of variables on the H-index score. The variables graduation in medicine, to work in a public university and execute activity as the doctoral mentor, CNPq research scholarship, and an H-index record in CV Lattes. Conclusion: Our results show that graduates are qualified for the construction of qualified knowledge disseminated in international scientific journals, human resources training (master and doctor titles), interact and create international collaboration nets, in medical sciences with regional, national and international relevance.

La dynamique professionnelle pour améliorer la qualité du soin montre qu’en dépit des progrès de l’enseignement sur la relation Soigné-Soignant, le temps du verbe médical est encore sacrifié au chevet des Malades. Depuis une vingtaine d’années, en neurologie, l’annonce diagnostique, ce faire-savoir, a surtout été analysée dans le registre des maladies avec atteinte cognitive. Ce travail de thèse se propose d’étudier, d’un point de vue épistémologique, philosophique, et éthique, le conflit des libertés en jeu lors de l’annonce diagnostique d’une maladie incurable paralysante évolutive telle que la Sclérose Latérale Amyotrophique (SLA). Guidée par la confrontation des vécus et des représentations recueillis auprès des Médecins des Centres SLA (38 entretiens), et à travers une enquête de terrain, des Patients et de leurs Proches, au moyen de questionnaires (203 questionnaires d’une quarantaine de questions), notre approche révèle que, dans l’impératif d’une information qui se veut avoir la vertu de conserver le plus longtemps possible l’autonomie du Patient, les angles de vulnérabilités du triangle relationnel Médecin-Patient-Proche s’affrontent dans une sous-estimation de la perception du Proche de son devoir d’engagement. Au travers d’une relecture philosophique des réponses des trois identités concernées, et d’une expérience professionnelle, nous comprenons que l’évolution rationnelle multidisciplinaire de la démarche de soin face à la maladie incurable transforme la clarté de l’information médicale en une injonction morale de présence du tiers. Parce qu’il s’agit d’impuissance, mais en aucun cas d’incapacité, nous proposons que tout Médecin, présent et à venir, apprenne à interroger en toute lucidité la pertinence de ses propositions de soins dés l’instant où il s’est engagé à annoncer l’incurabilité. Pour qu’un nouvel esprit du temps lui soit insufflé, quelle que soit son orientation, l’apprentissage systématique des soins palliatifs lui permettra de rester soucieux de ses choix, dans le clair-obscur des intentions humaines, et de reconnaître ses imperfections tout en se donnant le défi de la collaboration thérapeutique pour accompagner. / The teaching of Doctor-Patient relationship, in particular in making announcement of the diagnosis, makes progress in the Faculties of Medicine. But in practice, communicating the thruth of a disease with fatal issue remains a distressing time because still badly told. Amyotrophic Lateral Sclerosis, a motor neuron disease, is the most pejorative diagnosis to make in Neurology. In the controversy surrounding the time of the announcement of the diagnosis, and, by examining the results of 203 ALS Patients’ and their Caregivers’ questionnaires, we compare with the results of 38 ALS Centre Neurologists’ interviews. Through bringing an epistemological, ethical and philosophical analysis into focus, we argue that, in the rational multidisciplinary of the care in a rapid and incurable disease, the evolution of the clearly medical information changes the Doctor-Patient relationship into a moral injunction of presence for the Caregivers and the families. Only through the training of Doctors and a certain conception of Patient information in palliative care can the harmful consequences of such a trend be limited.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-11-18T12:40:23Z No. of bitstreams: 1 Elisete da Silva Gil_.pdf: 3137524 bytes, checksum: 45e1fc30d2d9066d065eb024bc0fae4b (MD5) / Made available in DSpace on 2016-11-18T12:40:23Z (GMT). No. of bitstreams: 1 Elisete da Silva Gil_.pdf: 3137524 bytes, checksum: 45e1fc30d2d9066d065eb024bc0fae4b (MD5) Previous issue date: 2016-09-29 / Nenhuma / Consultório na Rua (CR) é uma proposta do Ministério da Saúde que tem por objetivo atuar de forma resolutiva perante as necessidades da População em Situação de Rua, desenvolvendo ação integral in loco, com abordagens ampliadas que buscam possibilitar o acesso a serviços de saúde, assistência social, entre outros. A equipe de Consultório na Rua (eCR) realiza suas atividades de forma itinerante, desenvolvendo ações na rua, em instalações específicas e em unidades móveis. O objetivo desta dissertação foi propor um Programa de Educação Permanente em Saúde para o Consultório na Rua Pintando Saúde, do Grupo Hospitalar Conceição, em Porto Alegre/RS. Esta pesquisa trata-se de um estudo qualitativo, descritivo e exploratório, realizado no CR Pintando Saúde. Os participantes foram os 13 profissionais que integraram a eCR no período da coleta de dados: outubro de 2015 a agosto de 2016. A coleta de dados foi realizada em duas etapas: (1) observação de campo acompanhando a eCR nas abordagens e nos atendimentos aos usuários (na rua e nos serviços de saúde); (2) grupo focal com a eCR. Como resultados emergiram duas categorias: (1) fragilidades e desafios no cotidiano do trabalho no CR; (2) estratégias para superar as fragilidades e os desafios do trabalho no CR. O Programa de Educação Permanente em Saúde para os profissionais do Consultório na Rua foi elaborado considerando as necessidades referidas pela eCR e dividido em três propostas: o Grupo de Estudos Pintando Saúde, I Fórum do Consultório na Rua Pintando Saúde e Seminário de Apresentação Semestral de Pesquisas Concluídas em 2017. As considerações apresentadas abordam estratégias para superar a invisibilidade da população em situação de rua, melhorias institucionais importantes para a equipe e articulação do CR com a rede de serviços socioassistenciais a essa população. / The Street Doctor´s Office (SDO) is a proposal from the Ministry of Health which aims to provide solution to the needs of homeless people. Through the development of full in loco actions, with wide approaches that seek to grant access to health services, social assistance, among other services, the Street Doctor´s Office team (SDOt) performs its activities itinerantly, with actions on street, in special facilities and in mobile units. The objective of this essay was to suggest a Health Permanent Education Program to the “Pintando Saúde” Street Doctor´s Office, of the Conceição Hospital Group, in Porto Alegre/RS. This is a qualitative, descriptive and exploratory study, conducted at Pintando Saúde SDO. The participants were the very professionals of the SDOt that is being studied. The gathering of information was performed in two stages: 1st) field observation, along with the SDO in its approaches and services to the population (on street and health services); 2nd) focal group with the SDOt. There came up two categories of results: Frailties and challenges on daily work at the SDO; Strategies to overcome the work frailties and challenges at the SDO. The Health Permanent Education Program for the workers of the Street Doctor´s Office has been created according to the needs mentioned by the SDOt. Divided in three proposals: Pintando Saúde Studies Group, 1st Pintando Saúde Street Doctor´s Office Forum and Six-monthly Seminar of Presentation of Researches Conducted in 2017. The presented considerations demonstrate strategies to overcome the invisibility of homeless people, important institutional improvements for the team and the doctor´s office articulation with the socio-assistance services network to this population.

L’idée qui traverse l’ensemble de la thèse est la possibilité de la rencontre de deux mouvements : Psichiatria democratica et la psychothérapie institutionnelle, de deux psychiatres Basaglia et Tosquelles, rencontre entre médecin et patient ; rencontre entre patient psychotique et le monde, monde étant compris comme la société mais aussi le groupe de soin.La réflexion est basée sur des points « d’accrochage » entre différents discours : psychanalytique, historique, sociologique, philosophique ou phénoménologique à travers un axe central : celui de la relation possible entre médecin et patient au-delà d’une logique institutionnelle close. La pratique de la rencontre, à travers leurs protagonistes : opérateurs, usagers, patients etc… Ne peut, de fait, être comprise qu’à travers les concepts qui la fondent : l’inconscient, le transfert, la pulsion, etc. Elle est, comme on l’entendra ici, un rencontre transférentielle lieu de relations interpersonnelles qui doivent savoir s’adapter à la singularité de chacun. / The main theory of the thesis is the possibility of two psychiatrical movements meeting at a crossroad: Italian "psichiatria democratica" and French "psychothérapie institutionnelle". In the study their two founders, the psychiatrists Basaglia and Tosquelles are compared as well as the relation between psychiatrist and patient and patient and world (as society but also as group of care). The observation is focused on common grounds among different disciplines, psychoanalytic, historical, sociological, philosophical and phenomenological, over a central axis: the relationship between physician and patient outside the logic of closed institutional clinics. The setting of this intellectual encounter of operators, users and patients can only be understood through the concepts that underlie it: the unconscious, the transfer, the impulse. Lastly our “encounter” is, as we'll understand it here, a transferential encounter. It is a network of interpersonal relations that must adapt to each other actor’s singularity and individuality.

Questions explored in this study were: (a) Is learner centeredness related to teacher role stress and/or career commitment; (b) If so, can learner centeredness explain variance in teachers' role stress and/or career commitment; (c) Is the discrepancy between teacher and student perceptions of teacher practices related to teacher role stress and/or career commitment; and (d) if so, can this discrepancy explain variance in teachers' role stress and/or career commitment? The current need to provide every child with qualified and committed teachers in the face of a growing, national teacher shortage supported the significance of the research. The study was based on open systems theory (Thompson, 1996). An open system consists of inputs, process, and outputs, as well as feedback loops connecting these three components. All systems adjust to changes in their search for equilibrium (Katz & Kahn, 1966; Thompson, 1996). The xiii changes inherent in the shift toward learner centeredness can be expected to disrupt role expectations and lead to role stress for teachers (Connor, 1992; Fullan, 1991). A related construct, career commitment, is critical to sustaining teachers through the stresses of change (Firestone & Pennell, 1993). Middle school teachers (N = 318) in three northeast Florida counties completed four surveys that measured their learner centeredness, role stress, career commitment, and demographic background. In addition, 60% of the sample (N = 192) had one class complete a survey about teacher practices. A total of 4,539 students completed this survey. Findings from Pearson product-moment correlations suggested that teachers who were more learner centered in their beliefs and practices experienced less role stress (role insufficiency, role ambiguity, and role boundary) and higher levels of career commitment (career identity, career resilience, and career planning) than teachers who were less learner centered. With strength~ of relationships ranging from low to moderate, it appears that learner centeredness offers measurable benefits to teachers. In addition, findings from stepwise multiple regression suggested that learner-centeredness was a predictor of role stress and career commitment in teachers. The variance that was explained by learner-centered beliefs and practices ranged from 19% to 25% for role stress (role insufficiency, role ambiguity, and role boundary) and career commitment (career identity, career resilience, and career planning). Thus, teachers may be able to influence some of their own role stress and commitment to the profession through their beliefs and practices. Using Pearson product-moment correlations, a low relationship was found between the discrepancy between teacher and student perceptions of xiv teacher practices and two dimensions of role stress, role ambiguity and role boundary. In addition, discrepancy was related to career commitment: The relationship to career identity was negative but low, while the relationship to career planning was negative but moderate. Finally, results of multiple regression indicated slight predictive value of discrepancy for role stress and career commitment. The variance that was explained by discrepancy ranged from 3% to 11% for role stress (role boundary and role ambiguity) and career commitment (career identity and career planning). An open systems model was developed to show the influence of learner-centered beliefs, practices, and discrepancy on teachers' role stress and career commitment. Tentative suggestions for practice, as well as recommendations for further study, concluded the dissertation. Focus was placed on the need for continued research of the complex issues that impact teachers' resilience.