Thesis (doctoral)-Freie Universität, Berlin, 2004. / Includes bibliographical references (p. 350-399) and index.

This study used narrative inquiry to answer the question “What are the stories of older adults who choose not to share information with health care professionals?” The study explored the experiences of older adults who did not share information with health care professionals (HCPs), who they defined as doctors. A thematic analysis of five participants’ stories revealed three themes: Illusions of Care, describing the participants’ experiences with doctors before they chose not to share information; The Last Straw, revealing the final incident that caused participants to choose not to share information; and The Mask of the Non-sharing Older Adult, describing how participants interacted with their doctors after they decided not to share information. Relationship development between older adults and their doctors, sensitive topics, issues and perceptions of ageing, and structure of the health care system contribute to the complex issue of older adults not sharing information. The decision not to share information with health care professionals may adversely affect the health and health care of older adults.

Submitted by Eduardo Sanchez Palma (edsanpa7@hotmail.com) on 2017-01-17T17:31:17Z No. of bitstreams: 1 17012017 MPA PALMA.pdf: 6332936 bytes, checksum: 491bc558997174d0785b04d3518b6105 (MD5) / Approved for entry into archive by Fabiana da Silva Segura (fabiana.segura@fgv.br) on 2017-01-17T17:35:15Z (GMT) No. of bitstreams: 1 17012017 MPA PALMA.pdf: 6332936 bytes, checksum: 491bc558997174d0785b04d3518b6105 (MD5) / Made available in DSpace on 2017-01-17T17:53:34Z (GMT). No. of bitstreams: 1 17012017 MPA PALMA.pdf: 6332936 bytes, checksum: 491bc558997174d0785b04d3518b6105 (MD5) Previous issue date: 2017-01-09 / A maioria dos investidores se vê esmagada por uma vasta quantidade de informações, muitas vezes de natureza abstrata. Além disso, o formato padrão utilizado para comunicar os riscos é, geralmente de difícil compreensão e de pouca ajuda na tomada da decisão de investimento, pois a mencionada padronização, raramente leva em consideração os diferentes níveis de conhecimento dos investidores sobre finanças (Sachse, Jungermann, & Belting, 2012, v. 33, p. 438, tradução nossa). Alinhada a isso, a presente pesquisa utiliza questionário baseado na Teoria do Paradigma Psicométrico, para investigar as percepções de risco entre especialistas e investidores leigos sobre seis produtos financeiros. Baseado no elevado conhecimento sobre investimentos que possuem, os Certified Financial Planners foram escolhidos como grupo de controle para comparar as percepções de risco da categoria profissional melhor remunerada no Brasil, qual seja a dos médicos da Grande São Paulo (IBRE, 2009). Testes t para diferença de médias foram feitos para avaliar as percepções entre gêneros e os cinco construtos de risco, respectivamente, relacionados à volatilidade, ao desconhecimento, a desconfiança, a adversidade e as falhas regulatórias; os testes mostraram que são distintas as percepções de risco entre CFPs e médicos, com resultados muitas vezes contrários aos indicados pela literatura, assim como a maior percepção de risco entre as mulheres somente para os construtos relacionados às falhas regulatórias e desconfiança nos consultores de investimento, instituições financeiras e órgãos reguladores. O estudo mostra, ainda, que estão negativamente correlacionadas as percepções do benefício/retorno com os construtos desconfiança e falhas regulatórias somente entre os médicos, e que há diferenças de percepção importantes para o Tesouro Direto e PGBL/VGBL entre as duas categorias profissionais. Dentre os resultados encontrados destacam-se as diferentes percepções de risco sobre os construtos falhas da regulamentação e desconfiança, sugerindo que iniciativas de educação voltadas ao investidor podem não surtir o efeito esperado em razão de serem patrocinadas exatamente por instituições vistas com suspeição pelos investidores. O estudo conclui atribuindo à comunicação o papel determinante do sucesso na relação com o investidor e a necessidade que ela seja construída a partir das percepções de risco e níveis de familiaridade com investimentos dos consumidores. / Most individual investors may be overwhelmed by this vast amount of information and by its abstract nature. Furthermore, this way of informing about risk might be hardly helpful when making a particular investment decision, because this kind of standardized information neglects different levels of experience and financial literacy of the clients (Sachse, Jungermann, & Belting, 2012, v. 33, p. 438). Aware of this, this research paper will use a questionnaire in Psychometric Paradigm Theory to investigate risk perceptions among specialists and lay investors of six financial products. Certified Financial Planners were selected as the control group to assess how risk perceptions of the best-paid category in Brazil, compounded by physicians in São Paulo Metropolis (IBRE, 2009). T Tests about average differences were taken to assess gender perceptions and the five risk constructors associated with volatility, lack of knowledge, mistrust, adversity and regulatory failures; tests showed that risk perceptions are different between CFPs and physicians, with some results contradicting literature, as well as a greater perception of risks among women only to risk constructs related to regulatory failures and mistrust in investment advisors, financial institutions and regulatory bodies. The study also shows that correlations between benefit/return and constructs distrust and regulatory failures are negative only among physicians, and that there are significant perceptual differences about Tesouro Direto and PGBL/VGBL among the two professional categories. Different risk perceptions about the lack of regulation, as well as distrust, suggest that investor education initiatives may not have the expected effect, since they are sponsored by the same institutions of which investors are suspicious. Finally, the study says consumer perceptions of risk and their level of familiarity with investments are crucial, and attributes to communication the role for determining success in the relationship with investors.

The purpose of this study is to investigate the right to confidentiality in the context of HIV/AIDS through an interdisciplinary lens. This study indicates that whilst confidentiality is important and should be preserved in order to protect persons living with HIV/AIDS against stigmatisation, discrimination and victimisation, this should be balanced by other equally important interests, such as the protection of public health and individual third parties who may be affected by the intentional or negligent infection of others with HIV. As the consideration of the legal issues relating to confidentiality and privacy cannot be divorced from the social context in which HIV/AIDS plays out in South African communities, the study will examine, amongst others, the victimisation, discrimination and stigmatisation experienced by persons living with HIV/AIDS, followed by a critical exploration of the present legal and ethical framework governing privacy and confidentiality, including medical confidentiality, as well as the duty to disclose a positive HIV-status, in the context of HIV/AIDS. Possible limitations on the right to privacy in this context are also examined, which include, amongst others, a consideration of making HIV/AIDS notifiable diseases in South Africa. The study suggests that it is imperative that legal interventions aimed at curbing the spread of HIV will need to be mindful of the unique social, cultural and economic forces that impact on the duty to disclose a positive HIV-status to partners and other affected third parties. Insights gained from philosophical theories relating to Africanism, individualism, communitarianism and utilitarianism are valuable tools in facilitating a clearer understanding of relevant social and cultural factors that keep South African society locked in the present stalemate with regard to the disclosure of HIV status. / Public, Constitutional, and International law / LLD

This study, quantitative determinants of need and demand for primary health care in the District of Columbia (DCPC), analysed data over a twenty-year period from 1985 to 2004, on need and demand for primary care using standard and epidemiologically innovative statistical measures for physician distributions and socio-demographic characteristics in the District of Columbia (DC). The study attempted to answer the question: Using U.S census-based small area aggregations, Census Tract Groupings (CTGs), that are not zip-code areas or legislative/political boundaries, can a multivariate predictive model be developed using physician distributions, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits shortages? Primary care visits shortages and priority scores (PCPS) were calculated, analysed and presented for CTGs in the District of Columbia from 1985 to 2004. Results indicated that the abundant supply of DC-based physicians – indicated by decreasing population per physician ratios of 239 (1985) to 146 (2004) – appear to be a long-term trend. As raw physician counts increased, the ratio of satisfied visits to demand decreased, from 2.62 (1985) to 1.80 (in 2004). This result appears to indicate that, due to inequities in distribution of primary care physicians in DC’s small areas, the increasing numbers of primary care physicians were by themselves, not sufficient to address the city’s overall primary care visits need. Epidemiological profiles and physician distribution analytical methods appear to be useful for small area analysis of urban primary care shortage areas and for setting priorities. Physician rates per 1,000 pop may be a necessary but not sufficient statistic for estimating urban primary health care needs / Health Studies / D. Litt. et Phil. (Health Studies)

En partant d’une description des nombreux changements de la pratique médicale depuis quelques décennies, la thèse étudie divers aspects constitutifs du malaise du médecin. L’accroissement de la puissance médicale qu’a permis la technoscience est analysée et remise dans un contexte plus large où les technologies de l’information ont une grande place. L’augmentation considérable des connaissances pose un problème de maîtrise de la science médicale. La multiplicité des observations fait qu’il y a discordance de certaines d’entre elles avec les théories médicales largement acceptées. De cette manière, le gain d’efficacité est associé à une perte de la cohérence du discours médical. Le rôle du médecin disparaît derrière la technique, qui semble pouvoir, seule, rendre tous les progrès accessibles. Le médecin devient alors un simple distributeur de services et, à ce titre, développe parfois des offres de pratiques sans fondement, voire dangereuses.<p>Le pouvoir du médecin est évoqué, et se ramène in fine à la fourniture d’un diagnostic et d’une explication de sa maladie au patient. Le rôle des explications particulières que donne le médecin au malade est exploré à la lumière d’une conception narrative et évolutive de la vie humaine. Le rôle du médecin apparaît alors comme d’aider le patient à réécrire a posteriori le fil d’une histoire qui apparaît initialement comme interrompue par la maladie.<p>Le rôle social de maintien de l’ordre de la pratique médicale est alors évoqué. Ensuite, par une approche descriptive du phénomène religieux, on montre que la médecine du XXIe siècle a les caractéristiques d’un tel phénomène. Entités extrahumaines, mythes, rites, tabous, prétention à bâtir une morale, accompagnement de la vie et de la mort, miracles, promesse de salut, temples, officiants sont identifiés dans la médecine « classique » contemporaine. Seule la fonction de divination de l’avenir d’un homme précis est devenue brumeuse, la technoscience permettant régulièrement du « tout ou rien » là où auparavant un pronostic précis (et souvent défavorable) pouvait être affirmé.<p> L’hypothèse que la médecine est devenue une religion du XXIe siècle est confrontée à des textes de S. Freud, M. Gauchet et P. Boyer. Non seulement ces textes n’invalident pas l’hypothèse, mais la renforcent même. Il apparaît que le fonctionnement de l’esprit humain favorise l’éclosion de religions et donc la prise de voile de la médecine. La dynamique générale de la démocratisation de la société montre que la médecine est une forme de religion non seulement compatible avec une société démocratique, mais est peut-être une des formes accomplies de celle-ci, où chaque individu écrit lui-même sa propre histoire.<p>Le danger qu’il y a, pour le patient comme pour le médecin, si ce dernier accepte de jouer un rôle de prêtre, est ensuite développé. Enfin, la remise dans le cadre plus général de l’existence humaine, l’évocation de la dimension de révolte de la médecine, de son essentielle incomplétude, l’acceptation d’une cohérence imparfaite permettent au médecin de retrouver des sources de joie afin de, peut-être, ne tomber ni dans un désinvestissement blasé, ni dans un cynisme blessant.<p><p>From a description of the many changes medical practice has undergone for a few decades, the work goes on to study many sides of the modern doctor’s malaise. The gain of power made possible by technoscience is put on a larger stage where information technologies play a major role. The abundance of knowledge makes health literacy more difficult. the great number of observations makes discrepancies with general theories more frequent. The gain in power is associated with a loss of coherence of the medical speech. The doctor’s role vanishes behind technology that seems to be the only access to all medical progresses. Doctors becomes mere service providers and go on to offer unvalidated or even harmful services on the market.<p>Modern medical power resumes into the explanations and diagnosis given to the patient. The role of medical explanations is explored through an evolutive and narrative vision of human life. The duty of the doctors then appears to allow a new narration of the self that bridges the gap disease introduced into the patient’s life.<p>The role of medicine in maintaining social order is mentioned. Through a sociological approach of the religious phenomenon, one can see that XXIst century medicine is such a phenomenon. Medicine knows of extrahuman entities, myths, rites, taboos, miracles, temples; priests are present in modern mainstream medicine. Some want to derive objective moral values from medicine, and it brings companionship to man from birth to death. The only departure from old religions was the weakened ability to predict the future of an individual patient: for some diseases for which survival was known to be very poor, the possibilities are now long-term survival with cure, or early death from the treatment. <p>The hypothesis that medicine is a religion is confronted to texts from Freud S. Gauchet M. and Boyer P. Not only do they not invalidate the hypothesis, but they bring enrichment to it. Brain/mind dynamics is such that the appearance of religions is frequent, and makes the transformation of medicine into a religion easier. Society’s democratisation confronted to religion’s history shows that medicine is the most compatible form of religion within a truly democratic society, where each individual writes his own story.<p>To become a priest brings some dangers for the patient, but also for the doctor. These dangers are discussed. This discussion is put into the larger context of human life. The revolt dimension of medicine is discussed, as is its never-ending task. Their acceptance, as that of a lack of total logical coherence can open the possibility for the doctor to enjoy his work, without being neither unfeeling nor cynical.<p> / Doctorat en philosophie et lettres, Orientation bioéthique / info:eu-repo/semantics/nonPublished

This thesis explores the significance of John Keats's medical Notebook, and his time at Guy's Hospital (October 1815 – March 1817), for the poet's career. As a primary contribution, it offers a new transcription of Keats's medical Notebook (Appendix 1). The transcription reproduces Keats's text and indicates the layout of his notes, but is neither a facsimile, nor a new edition: the visual form of Keats's notes is not reproduced, nor do I offer critical annotations; commentary follows in subsequent chapters. The achievements, limitations and influence of the only edition of Keats's medical Notebook — Maurice Buxton Forman's from 1934 — are the subject of the first chapter, which also considers accounts of Keats's medical career in Keats biography and criticism. Chapter two focuses on the poems Keats wrote while at Guy's to show that the two aspects of his life — medicine and poetry — were mutually influential. Chapter three considers Keats's medical notes in comparison to a fellow-student's, indicating how some characteristics of Keats's note-taking prefigure aspects of his mature poetry. Chapter four finds Endymion suffused with medical knowledge and imagery, and argues that this was a vital aspect of the poem's depiction of passion. Chapter five suggests that the publication of Keats's 1820 volume was greatly influenced by questions of health, medicine, and disease; concerns reflected by the poems in it, which also reveal the extent of Keats's continued awareness of, and interest in, contemporary medical thought. In sum, the thesis argues that the origins of Keats's poetic achievement can be traced in his medical Notebook and ‘hospital' poems, and that the ability to infuse his poetry with medical knowledge was a vital component of Keats's poetic power and achievement.

No description available.

In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.

This thesis concluded that offering physicians an appropriate Web-based transcription service should be well received and improve their medical record management and patient care.