Oggi, l'Italia è un paese multietnico. Dietro i movimenti migratori non vi sono però solo dati statistici, ma persone con culture e storie personali diverse, con cui gli operatori a contatto con gli immigrati devono confrontarsi. Ciò ha condotto alla nascita della mediazione linguistico-culturale, un settore sorto nella fase più acuta del fenomeno dell'immigrazione, gli anni Novanta, per rispondere alle esigenze specifiche di assistenza medica e legale degli immigrati. L'intento del presente lavoro di ricerca è quello di studiare l'interazione verbale e non verbale tra medico o infermiere e paziente straniero nel contesto della mediazione linguistica-culturale in una struttura socio-sanitaria. All'interno dell'interazione verbale si analizzeranno le teorie della cortesia linguistica applicate a un contesto socio-sanitario multietnico. Si andrà a verificare se esiste una lingua di mediazione, se la lingua inglese funge da lingua franca nell'interazione verbale medico o infermiere e paziente straniero e se esistano strategie empatiche comunicative verbali e non verbali comunemente utilizzate in corsia dal personale ospedaliero. Si studierà inoltre come l'analisi della conversazione, in particolare l'analisi delle strategie empatiche comunicative verbali e non verbali, possa essere utilizzata a fini didattici e pedagogici nella formazione linguistica e interculturale di studenti di medicina nel nuovo contesto sociosanitario multiculturale. / Italian society has undergone massive transformation, arising today as a true multiethnic society. Migration movements are not simply a phenomenon of statistical data but involve people from different cultures and personal backgrounds. Immigration is behind the onset of community interpreting in Italy at the beginning of the '90s. Community interpreters catered for all medical and legal needs of immigrants. Today, it is common practice in Italy that doctors and nurses interact with immigrant patients. The aim of the thesis is to study verbal and non-verbal strategies of communication between doctors or nurses and immigrant patients in this new multiethnic medical environment. The study will examine strategies of politeness theory, whether English is a lingua franca in the doctor or nurse and immigrant patient interaction and whether there are empathic verbal and non-verbal strategies of communication commonly used in the hospital ward by doctors and nurses. The study will also examine how conversational analysis, in particular the analysis of empathic verbal and non-verbal strategies of communication can be used for didactic and pedagogical purposes so as to prepare medical students linguistically and culturally to interact with their future patients in this new multiethnic medical environment.

Arbetsuppgifterna på ett fartyg kan innefatta hård fysisk påfrestning samt arbete i mörker, påhög höjd och i slutna utrymmen vilket betyder att sjöfolk måste vara lämpliga för tjänstgöringen.De nationella reglerna för medicinsk lämplighet för sjöfolk skiljer sig trots att deninternationella standarden är densamma för alla. Syftet med denna rapport är att åskådliggöraskillnaderna mellan regelverken om läkarintyg för sjöfolk i de skandinaviska länderna ochundersöka historien bakom de svenska föreskrifterna.Vår slutsats är att det skulle gagna Sverige att återinföra Sjömansläkare, som troligtvis är merkompetenta än en icke specialiserad läkare vad gäller tjänstbarhetsbedömning för sjömän.Systemet med sjömansläkare är fortfarande i bruk och fungerar väl i både Danmark ochNorge.Slutligen sammanfattas rapporten av författarnas egna reflektioner kring ämnet i relation tillresultatet. Förslag till vidare forskning återfinns i slutet. / The duties onboard any ship include moments of hard physical labour, work in darkness, aloftand within enclosed spaces which means that a seafarer must be fit for duty. The nationalrequirements for medical fitness of seafarers differ between countries, although they are allbased on the same international standard. The aim of this report is to compare the differencesbetween the regulations concerning medical certificates for seafarers in the Scandinaviancountries and to investigate the history of the Swedish regulations.We conclude that Sweden would benefit from the reintroduction of the old system ofSeaman’s Doctors, who presumably are more competent than a doctor not specialized injudging the fitness of a seafarer. This system is still in operation and working well in bothDenmark and Norway.Finally this report consists of the authors’ own reflexions regarding the medical examinationsand certificates for seafarers. We also include a few suggestions for further research.

本論文以台灣1995年3月實施全民健康保險為分水嶺，1985-2010年的醫療環境為脈絡、同時間的《聯合報》為研究樣本，檢視醫生的實際勞動過程與勞動條件，相較新聞傳媒論述的落差。 因年代演進、健保前後的報紙再現確實不同，新聞與投書最大的迥異之處出現於財團化，醫病關係與醫療糾紛，醫療極限與去專業化，情緒勞動，因健保更為負面的醫德，及健保體制爭議等的分析類目上，呈現醫師的媒體形象隨時間遞嬗變動。無論是否包含個案，從報導數目來看，可以發現中期、後期醫病關係惡化，醫療糾紛增加，醫學知識去專業化與有限性；健保下的負面形象初實施便有、後期卻越形明顯，可謂與財團化同步。新聞數量、論述，與消費主義社會、醫療環境、政策之演變高度正相關。不過，媒體長期以來多忽略體制變革牽涉個體醫師的「勞動過程與勞動條件」問題，醫師團體凝聚的勞動意識則直至最近才逐漸被喚醒與展現在媒體上。 媒體在醫療議題中扮演的角色，確有出現變化，然，不是晚一步，就是極少報導。在歷時性或個案新聞中，台灣媒體對於醫師身體勞動、情緒勞動之變遷，商品化醫療服務與健康權利有所衝突，以及結構、資本主義之變因與影響，均再現與詮釋不甚全面。 / This thesis investigates how the United Daily News(UDN) represented the doctor’s labor process in Taiwan between 1985 and 2010, taking 1995 as the watershed when the National Health Insurance (NHI) was implemented, prior to and after which the working conditions of medical people have experienced substantial changes. As such, the UDN did register differences in its treatment of related events accordingly. The current study has focused upon issues related to conglomeration, doctor-patient relationship and medical malpractice, limits of medicine and deprofessionalization, emotional labor, negative medical ethics, as well as health care system debates etc.. Images and discourses of doctors in the media have changed across two period of time. It becomes clear that since 1995 the doctor-patient relationship has been getting worse, while medical negligence increased and deprofessionalization of medicine multiplied. In addition, with the introduction of NHI, there were more medical ethics violation and capitalists have made more gains with medicalconglomeration. Another factor contributing to the increase of medical news is the arrival of a consumerist society, and simultaneous changes of medical environment and policy. Although there is such a transformation of Taiwan’s health system, the media has however failed to represent adequately the doctor’s changing labor process and conditions. The UDN has not covered such topic until very recently in the wake of several protests arising out of worsening medical environment. In conclusion, Taiwan’s media has paid insufficient attentions to various significant issues, doctors’ physical labor and their emotional labor, commodified medical services and its conflicts with universal rights of health are among the most eye-catching.

The purpose of this project was to evaluate the effectiveness of a practice-based dermoscopy training program for dermatology healthcare providers in order to improve their technique of performing clinical skin exams for the early detection of melanomas. The overall incidence of melanoma continues to rise. More than 75% of all skin cancer deaths are from melanoma. Advanced melanoma spreads to lymph nodes and internal organs and can result in death. One American dies from melanoma almost every hour (American Cancer Society [ACS], 2009). Early diagnosis and excision are essential to reduce morbidity and to improve patient survival. This one-group before-and-after study design utilized a convenience sample of three dermatology healthcare providers (DHPs). The primary investigator conducted a retrospective review of the pathology logs for each provider. The time frame for the review was a three-month period in 2010, which represented the same time frame that the study was conducted in 2011. The DHPs participated in a four-hour training workshop that included pattern analysis recognition using dermoscopy. Following the workshop, each DHP was given a DermLite 3Gen DL100 to use in practice when performing clinical skin examinations. All DHPs completed a data collection sheet to document their pattern of decision making with and without a DermLite. The outcome of interest was the use of dermoscopy by DHPs to demonstrate an increased detection of melanoma when compared to naked-eye examination. The outcome was evaluated 12 weeks postworkshop training. There were 120 evaluations made with the DermLite as compared to the naked eye. The overall agreement was 0.52, AC1 coefficient (95% CI) was 0.36 (0.30, 0.42), p < .001, and kappa coefficient (95% CI) was 0.27 (0.20, 0.43), p < .001. Overall, the risk of lesion under exam being suspicion for skin cancer was higher on 27.5% (33 out of 120) of the evaluations and lower on 20.8% (25 out of 120) evaluations. The risk of lesion was evaluated the same on 51.7% (62 out of 120) of the evaluations. This is an indication of “Poor” agreement between the two methods. The diagnosis and disposition made using DermLite compared to naked-eye results for both coefficients provided an “Intermediate to Good” agreement between the two methods in assigning diagnosis and disposition. This indicates that there is no difference between DermLite and naked-eye evaluations. More studies are needed in order to provide better evidence on the value of dermoscopy in clinical practice at the Dermatology and Laser Center. Future projects should be more explicit regarding the methods used and lesion selection in order to better understand the benefits of dermoscopy.

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.

The public relations field is rapidly adopting two-way symmetrical communications as a way to achieve excellence and win-win solutions for multiple publics. This paper focuses on activism and industry public relations approaches involving a group of expert physicians in Houston and the medical devices industry. After exploring two-way symmetrical communications and the Excellence Theory of Public Relations, the paper explores these physicians’ viewpoints and provides an overview of the medical device industry. The discussion then provides public relations suggestions for the physicians to symmetrically approach the industry to create change. Next, the paper recommends how the medical device industry can respond to work with the physicians and to prevent possible public relations damage and crisis. The paper concludes by expressing the importance of applying symmetrical communications methods to solve challenges and create win-win solutions. / text

Effective doctor-patient communication is critical to improving health outcomes. Good communication improves emotional health, symptom resolution, functional and physiologic status, and pain control. Conversely, ineffective communication leads to misdiagnosis, inappropriate treatment poor adherence, misuse of health services, and high patient stress. In the U.S., Hispanics are the fastest growing minority. Despite the high burden of illness among this population, Hispanics are less likely than other minorities to regularly see a health professional. This is explained in part because Hispanics navigate a health system designed for the majority, experience a mismatch between cultural values and health beliefs, and have limited English proficiency. These communication challenges contribute to health disparities among the Hispanic population living in the U.S. Despite the importance of doctor-patient communication, few communication interventions that focus on improving patient skills have been tested in this population. Therefore, the purpose of this study was to evaluate whether a patient communication intervention tailored for female Hispanic patients could be practically implemented in a practice setting. The first aim focused on adapting existing communication skills training tools for a Hispanic population. The second aim assessed the feasibility of implementing the training tool in a federally qualified health center in a US-Mexico border community. The third aim explored the extent to which trained patients were able to integrate the information provided. Results indicate that it is feasible to implement communication training when delivered by clinical staff. Patient follow-up revealed that patients valued training on how to communicate with their doctor the most. Moreover, it is feasible to sustain the intervention when it is aligned with the priorities of the clinical site. Patient communication training in medically underserved rural areas could improve barriers to improved health outcomes in communities with a high prevalence of Hispanic patients. Future funding is needed to further test, dissemination of communication training programs.

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In master study is analyzed the problem of code of doctor’s ethics in legal dimension. The relevance of doctor’s ethics is highlighted by the new viewpoints in Lithuanians’ lives, often not corresponding with the old understanding of ethics, which is natural for Lithuanian mentality. The objective of the research is to research the role of doctor’s ethics code in the formation of medical practice and while growing the society’s interest in the quality of doctor-patient relation and to analyze the interaction between Lithuania’s doctor’s ethics principles and law that fine-tunes health care in Lithuania. IN study was made the research with the purpose to analyze the interaction between the principles of doctor’s ethics code and the principles of Lithuania’s law that fine-tunes the health care. The results of the research show that the set of analyzed pieces of legislation does not guarantee the universal definition of doctor’s ethics norms and. For this reason the relevance of doctor’s ethics code exists.