O atendimento ginecológico de qualidade na adolescência vem se tornando cada vez mais necessário na atualidade devido à ocorrência mais precoce da atividade sexual, com conseqüente aumento das gestações não planejadas, das doenças sexualmente transmissíveis e da probabilidade de câncer de colo uterino. Este estudo teve como objetivo avaliar a consulta ginecológica sob a ótica dos médicos e das adolescentes. Foi desenvolvido um estudo de corte transversal através de questionário estruturado aplicado a 191 ginecologistas filiados à Associação de Ginecologia e Obstetrícia do Estado do Rio de Janeiro e a 418 estudantes do ensino médio de escolas estadual, federal e privada da cidade do Rio de Janeiro. Os médicos responderam questões sobre dados pessoais, qualificação profissional, condutas na consulta ginecológica e sobre a necessidade de capacitação para o atendimento de adolescentes. Para as colegiais foram abordados aspectos sócio-demográficos, comportamento sexual e avaliação da consulta ginecológica. Para a análise dos dados utilizou-se o teste qui-quadrado e o t de student. Os resultados mostraram que não houve diferenças sgnificativas entre as escolares do ensino privado e da escola pública federal que, no entanto, apresentaram características distintas quando comparadas às estudantes da instituição estadual. Estas eram predominantemente da raça negra, com responsáveis de menor escolaridade e tinham piores condições de moradia. Apesar do maior número de parceiros, gestações e de abortamentos, além de histórico de violência sexual, foram à consulta ginecológica em idade mais tardia, devido à dificuldade de acesso a serviços de saúde sexual e reprodutiva. Os três grupos de estudantes manifestaram, em comum, o desejo de que o profissional investisse mais tempo, paciência e disponibilidade no atendimento ginecológico. Quanto aos profissionais, foi constatado que os mais jovens e as do sexo feminino apresentaram atitudes consideradas menos conservadoras na conduta médica. Os participantes informaram como principal obstáculo no atendimento desta faixa etária a maior duração da consulta e ressaltaram a importância de treinamento específico e da realização rotineira do exame colpocitológico. Concluiu-se que há necessidade de criação de estratégias que facilitem o acesso e a adesão deste grupo etário à rotina preventiva ginecológica e à capacitação profissional específica. Este trabalho oferece contribuições para o conhecimento da consulta ginecológica e identifica a necessidade de melhoria na qualidade da assistência prestada a esta faixa etária a fim de reduzir os agravos da atividade sexual precoce e desprotegida na adolescência.

It is widely acknowledged that patients' emotional expressions and doctors' empathic responses play a key role in providing satisfactory healthcare services and improving doctor-patient relationships. While such affective aspect of medical consultation discourse has been studied in different fields of research with the focus of examining medical consultations that occur in face-to-face settings, this area is extremely under-researched in the field of linguistics, particularly in the non-western context and the online space. While online medical consultation (OMC) has ushered in the new era of e-communication around the beginning of this century, discourse-related research on OMC is still in its infancy and studies on the affective dimension of the OMC discourse in non-western sites are, to my best knowledge, apparently absent in the literature. As China has seen a significant increase in the use of OMC platforms, studying OMC discourse in the China context is not only important but vital. With the support of the Chinese government's "Internet Plus Healthcare" policy issued in 2018, the reliance on the online mode of medical consultation will be further strengthened and the future of OMC service in China will remain promising. In order to have a better understanding of the affective aspect of OMC discourse, this thesis explores the online interaction between doctors and e-patients (including patients' caregivers) from a poststructuralist discourse analysis perspective. The data for this study consists of 300 text-based one-to-one instant messaging OMC cases collected from three popular OMC websites used in China. Each OMC case contains e-patients' emotional expression and doctors' empathic response. The data are analysed by the approach of computer-mediated discourse analysis in terms of two dimensions: the textual dimension and the social practice dimension. At the textual level, the study identifies indirect negative emotional acts by e-patients and empathic acts by doctors (which constitute the affective practice); it also examines the interactional discursive features involved in the affective practice. At the social practice level, it explores the discursive positions of e-patients and doctors within the affective practice context and the power relations that are reflected in the identity positionings. This study finds that the text-based OMC affective practice is rich in various types of emotional expressions and different ways of manifesting empathy, some of which are not mentioned in studies on medial consultation discourse. The study also identifies positions that disrupt the traditional or stereotypical roles of doctor and patient. Besides, it presents dynamic power relations, which problematizes the idea that doctors are always the more powerful party and patients are always powerless in medical encounters. This study sheds light on the importance of examining the affective facet of medical consultation from a discourse analytic perspective, when it comes to identifying non-traditional positions and power relations in clinical communication. The study also provides the implication that e-healthcare platforms, especially those with an e-commercialised model for healthcare services, have potential to produce a type of neo-liberal discourse - the e-commercialised medical consultation discourse - in which patients and caregivers, who are acknowledged as the less powerful group in the traditional healthcare activities, are empowered and privileged

It is widely acknowledged that patients' emotional expressions and doctors' empathic responses play a key role in providing satisfactory healthcare services and improving doctor-patient relationships. While such affective aspect of medical consultation discourse has been studied in different fields of research with the focus of examining medical consultations that occur in face-to-face settings, this area is extremely under-researched in the field of linguistics, particularly in the non-western context and the online space. While online medical consultation (OMC) has ushered in the new era of e-communication around the beginning of this century, discourse-related research on OMC is still in its infancy and studies on the affective dimension of the OMC discourse in non-western sites are, to my best knowledge, apparently absent in the literature. As China has seen a significant increase in the use of OMC platforms, studying OMC discourse in the China context is not only important but vital. With the support of the Chinese government's "Internet Plus Healthcare" policy issued in 2018, the reliance on the online mode of medical consultation will be further strengthened and the future of OMC service in China will remain promising. In order to have a better understanding of the affective aspect of OMC discourse, this thesis explores the online interaction between doctors and e-patients (including patients' caregivers) from a poststructuralist discourse analysis perspective. The data for this study consists of 300 text-based one-to-one instant messaging OMC cases collected from three popular OMC websites used in China. Each OMC case contains e-patients' emotional expression and doctors' empathic response. The data are analysed by the approach of computer-mediated discourse analysis in terms of two dimensions: the textual dimension and the social practice dimension. At the textual level, the study identifies indirect negative emotional acts by e-patients and empathic acts by doctors (which constitute the affective practice); it also examines the interactional discursive features involved in the affective practice. At the social practice level, it explores the discursive positions of e-patients and doctors within the affective practice context and the power relations that are reflected in the identity positionings. This study finds that the text-based OMC affective practice is rich in various types of emotional expressions and different ways of manifesting empathy, some of which are not mentioned in studies on medial consultation discourse. The study also identifies positions that disrupt the traditional or stereotypical roles of doctor and patient. Besides, it presents dynamic power relations, which problematizes the idea that doctors are always the more powerful party and patients are always powerless in medical encounters. This study sheds light on the importance of examining the affective facet of medical consultation from a discourse analytic perspective, when it comes to identifying non-traditional positions and power relations in clinical communication. The study also provides the implication that e-healthcare platforms, especially those with an e-commercialised model for healthcare services, have potential to produce a type of neo-liberal discourse - the e-commercialised medical consultation discourse - in which patients and caregivers, who are acknowledged as the less powerful group in the traditional healthcare activities, are empowered and privileged

Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING / Bibliography: leaves 150-158. / by Ramesh Shrikrishna Patil. / Ph.D.

Abstract not available

Les Jeux Sérieux (Serious Games) sont des jeux vidéo qui sont conçus avec un objectif premier qui n'est pas le divertissement. Les jeux sérieux sont de plus en plus utilisés dans le domaine de la santé en tant qu'outil éducatif dans le cadre de la formation à la médecine, ou pour aider au rétablissement des patients. Dans cette thèse, nous nous intéressons à la conception d'un jeu sérieux pour la formation des médecins généralistes, en nous intéressant tout particulièrement à l'apprentissage des compétences communicationnelles et interpersonnelles qui jouent un rôle très important dans le métier de médecin, et qui sont assez peu présentes dans les programmes des cursus de formation. Nous nous intéressons en particulier aux méthodologies de conception d'un tel jeu qui doit délivrer un contenu utilitaire tout en équilibrant apprentissage et divertissement. Afin de mener ce travail, nous présentons dans la première partie de la thèse une analyse des méthodes existantes de conception de jeux sérieux en étudiant en particulier les mécanismes permettant de motiver le joueur ainsi que les principaux design patterns de conception. Nous expliquons en quoi les jeux sérieux nécessitent une architecture particulière dont la principale caractéristique est de séparer clairement les concepts nécessaires à l'apprentissage de ceux liés à l'aspect ludique. Nous proposons ensuite une modélisation de la consultation médicale qui en plus de rendre compte du processus métier auquel elle correspond, permet de représenter les différents éléments nécessaires à l'implémentation algorithmique d'un moteur de dialogue entre un joueur et un patient virtuel. Cette modélisation utilise les ontologies pour décrire les connaissances impliquées et nous montrons comment un scénario de consultation médicale peut se décrire en termes d'instances de ces ontologies. Ces ontologies incluent quatre niveaux qui décrivent le profil du patient, le résultat de consultation, le scénario et la phrase. Cette description est accessible aux experts formateurs qui disposent donc d'un outil leur permettant de définir les objectifs pédagogiques que le joueur-apprenant doit atteindre au cours de la simulation. Ces analyses sont enfin appliquées au cas de la consultation médicale et nous décrivons l'architecture d'un jeu que nous avons conçu appelé AgileDoctor. Ce jeu a pour objectif de permettre à un apprenant de jouer le rôle d'un médecin qui mène des consultations médicales en accueillant des patients aux profils divers. / Serious games are games designed for a primary purpose other than pure entertainment. More and more, serious games are developed and used in the health area as educational tools dedicated to medical knowledge training, or helping with the recovery of the patients. Communication and interpersonal skills for general practitioners in medical consultation play an important role in providing high-quality health care and establishment of good doctor-patient relationship. However, specific trainings on communication skills for doctors and medical school students are often overlooked. Comparing to traditional training approaches by using role-playing and standardized patients, an educational tool in form of a game can maximize the variety of scenario, reduce the limitation and enhance learner's motivation. For the above purposes, in this thesis we are interested in the design of a serious game for training general practitioners, in particular on communication skills learning. We are particularly interested in design methodologies of such a game, which is able to deliver a utility content while balancing learning and entertainment. To conduct this work, firstly we present an analysis of existing methods of serious games design by studying the mechanisms to motivate the player as well as the main design patterns. We explain how serious games require a special architecture in the design phase whose main characteristic is to clearly separate the concepts necessary for learning to those associated with the fun aspect. We then propose a model of medical consultation based on our analyses of identification of key concepts in the medical consultation process. This model is used to represent the different elements required for algorithmic implementation of a dialogue engine between a doctor and a patient. Our modeling uses ontologies to describe involved domain knowledge and show how a medical consultation scenario can be described in terms of instances of these ontologies. The proposed ontologies include four levels which describe the patient's profile, the result of consultation, the scenario and the phrase respectively. This description is available to the trainers and domain experts by using the authoring tool thus allows them to define the educational objectives for the player-learner during the simulation process. Finally these models are implemented and applied to the case of medical consultation. We represent the architecture of a serious game that we've designed called AgileDoctor. This game aims to enable a learner to play the role of a doctor who conducts medical consultations facing the patients of various profiles.

Background: Effective information exchange is an asset to effective lung cancer care. Although a considerable body of evidence informs the approaches to ‘diagnostic bad news delivery’, the exchange of information that takes place between patients with cancer and professionals with whom they interact thereafter is less well documented. Information exchange has an influential role throughout the lung cancer care continuum, providing patients and professionals with details relative to the cancer diagnosis and the subsequent choices to be made in its management. Information on disease extent, treatment and related side-effects, rehabilitation and prognosis are judged by patients as the most prominent for them. Despite awareness of the specific categories relevant to information exchange needs, there is little evidence available exploring the information exchange process, per se, within cancer generally and even less within the lung cancer context. Aim: To investigate information exchange processes during lung cancer consultations, specifically exploring information content which is both exchanged and not exchanged. Design: Qualitative, multiple case study design. Methods: A case centred on a patient with lung cancer. Within the case were the patients, the health professionals they consulted with and accompanying companions. Seven cases were recruited, which included 12 companions. Data were collected in outpatient clinics between 2010 and 2011. Data were digital recordings of consultations; debrief interviews immediately post-consultation and later in-depth patient interviews. All interviews were transcribed and analysed for pattern matching and coding. Findings: Analysis of categorical data indicated cases were typical of the Scottish lung cancer population across all demographic domains, accept age and performance status. The preliminary analysis showed across cases, almost universal satisfaction with the level and content of information exchange for the main a priori categories of diagnosis, treatment and treatment outcome. Substantive analysis revealed that information content across the a priori categories was influenced by the presence of the accompanying companion. Within the clinical consultation, companion influence on information exchange was shown to be mediating, moderating or neutral. A key finding which emerged showed companion accompaniment to be a negotiated process, with three identifying levels of accompaniment. Non-negotiated companion presence at the clinic was associated with influential and expert companions who significantly moderated the content, direction and flow of information exchange, using the constructs of companion control, companion agenda and companion as expert. Persuasive influences further shaped non-negotiated accompaniment and were identified as demographic characteristics and relationship alliances. Patient and professional perspective regarding companion accompaniment was shown to be discordant. Conclusions: The level of negotiated companion presence at lung cancer clinics has direct implications for clinical care. There needs to be greater understanding among professionals of ways in which information exchange can be influenced by companions.

This prospective descriptive study describes the referral patterns to the Red Cross War Memorial Children's Hospital. The study was conducted from 1st July to 31st December 1987 and entailed the collection of all referral letters presented (9288) to the hospital and the analysis of a sample of these letters (4702). The results indicated: * The patients are similar in terms of age and sex to those attending the Outpatients Department except that relatively fewer referred patients are Black. * The private sector, i.e. general practitioners, is the largest referral agency followed by Day Hospitals. * Most patients were ref erred to the Outpatients Department without an appointment. * Of the specialist clinics, the surgical clinics, i.e. Ophthalmology and Ear, Nose and Throat Clinics, were utilised the most. * The majority of patients (84,90%) were not admitted. * The contact made by the hospital with referral agents was poor (only in 30,30%). * The quality of information in referral letters was generally poor and did not contribute to patient care. Recommendations are made to the hospital and relevant health authorities.

Diverses publications soulignent l'augmentation de l'espérance de vie et avec elle, le vieillissement mondial de la population. Ce processus se poursuivra à l'avenir, ainsi que son influence sur l’incidence et la prévalence de l'incapacité. Chez les personnes âgées, l’incapacité, les maladies chroniques et leur association constituent un sujet important dans le domaine de la santé publique en raison de l'effet qu'ils ont sur la demande des services de santé. Le but de ce mémoire est d’examiner quelle est la contribution respective des maladies chroniques et de l'incapacité dans l'utilisation des services de santé chez les personnes âgées et de leur interaction. Il s’agit de savoir si l'association entre la maladie chronique et l'utilisation des services de santé est modifiée par l’incapacité prenant en compte les caractéristiques de l'individu et son environnement. Ce travail est basé sur le modèle comportemental proposé par Andersen et Newman et le modèle du processus d’incapacité de Verbrugge et Jette. Pour répondre à l’objectif, nous utilisons les données du projet de recherche “ FRéLE ” (Fragilité, une étude longitudinale de ses expressions), réalisé durant la période 2010 -2013 auprès d’un échantillon de 1643 personnes âgées vivant dans la communauté au Québec. L’incapacité est évaluée à l’aide de deux indicateurs : les AVQ et les AVD. Les maladies chroniques sont mesurées par l’indice fonctionnel de comorbidité (IFC). La dépression est évaluée selon les critères de l’échelle de dépression gériatrique (EDG). L’état cognitif est mesuré par l'évaluation cognitive de Montréal (MoCA). Les facteurs de prédisposition comportent l’âge, le sexe, l’ethnicité et le niveau scolaire. Les facteurs facilitateurs incluent le revenu et le réseau social, ce dernier étant mesure par la présence ou non d’une personne de soutien et son lien avec la personne âgée. Divers modèles de régression sont adoptés pour identifier les facteurs statistiquement significatifs du modèle comportemental d’Andersen et Newman et du modèle du processus d’incapacité de Verbrugge et Jette. Nos résultats ont montré que, si le rôle des prédicteurs de l’utilisation varie en fonction du type de services de santé utilisé, l’utilisation s’accroît principalement avec le nombre de maladies chroniques. En ce qui concerne l’interaction entre la maladie chronique et l’incapacité, nos résultats ont révélé que l’interaction n’est statistiquement significative pour aucun des services analysés. Compte tenu de la diversité et les besoins de la population âgée, caractérisée par une prévalence élevée de maladies chroniques et d'incapacités, l’étude des facteurs impliqués dans l'utilisation des services de santé sera utile pour la mise en œuvre d’une offre de services, plus conforme aux besoins de cette population / Several publications emphasize the increase in life expectancy and, as a result, the global aging of the world’s population. This process will continue into the future, and will influence disability trends. In the elderly, disability, chronic diseases, and the association of both conditions are important topics in public health due to effect that they have on elderly people’s demand of health services. This paper aimed to examine the contribution and interaction of chronic disease and disability on health services demand among the elderly. In addition, the paper aimed to determine if the association between chronic disease and health services demand is modulated by disability considering the characteristics of the individual and its environment. This work is based on the behavioral model proposed by Andersen & Newman and the disability process model proposed by Verbrugge & Jette. In order to respond to the objective, we use the data of the research project "FRèLE" (frailty, a longitudinal study of its expressions), held between 2008-2013 with a sample of 1643 elderly people living in the community of Quebec. Disability is assessed with two indicators: IADL and ADL. Chronic diseases are measured by the Functional Comorbidity Index (IFC). Depression is evaluated according to the criteria of the Geriatric Depression Scale (GDS). Cognitive status is measured by the Montreal Cognitive Assessment (MoCA). Predisposing factors include age, gender, ethnicity and educational level. The enabling factors include income and social network, which is measured by the presence or absence of a support person and their relationship with the elderly person. Several regression models were adopted to identify statistically significant factors in the behavioral model of Andersen and Newman as well as the model of disablement proposed by Verbrugge and Jette. Our results showed that health care service use predictors vary according to the type of health care services seek by the elderly. However, health care service use mainly increases according to the number of chronic diseases. In terms of the assessed health services, we found non-significant levels of interaction between chronic disease and disability. Given the variety of health care needs that elderly people have, characterized by a high prevalence of chronic diseases and disability, the study of the different factors involved in health services demand will be useful for the implementation of a service offering, more consistent with the needs of this population