Submitted by Maike Costa (maiksebas@gmail.com) on 2016-02-04T11:42:39Z No. of bitstreams: 1 arquivototal.pdf: 1420681 bytes, checksum: 445c35c359c93e2ce0feea223f65ed14 (MD5) / Made available in DSpace on 2016-02-04T11:42:39Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1420681 bytes, checksum: 445c35c359c93e2ce0feea223f65ed14 (MD5) Previous issue date: 2013-04-05 / This work addresses the controversies within Medicine about health practices considered scientific or not. This research will address the process of health-disease from a social-anthropological perspective. It is considered as empirical cut the prohibition (assigned by the National Health Surveillance Agency- ANVISA) directed at health professionals, the use of therapeutic method called Auto-Hemotherapy (AH), such as technical reclaim legitimacy while legal medical knowledge . Different methodological tools were used, such as: documentary research, interviews, reports on television media (among others). This practice constitutes the use of autologous blood (blood of individual in treatment), punctured the blood stream and applied immediately in the muscle of the practitioner. I try to understand of legitimizing practices that are now considered scientific, sometimes illegitimate. The conclusion of this research concerns to once again, the Social Sciences and Biomedicines debate on new directions for studies about the processes of health-disease. / Este trabalho aborda as controvérsias dentro da biomedicina acerca de práticas de saúde consideradas científicas ou não. A presente pesquisa irá abordar os processos de saúde-doença a partir de uma perspectiva socioantropológica. Considera-se como recorte empírico a proibição (atribuída pela Agência Nacional de Vigilância Sanitária – ANVISA) direcionada aos profissionais da área da saúde, do uso de um método terapêutico denominado Auto-Hemoterapia (AH), à Medida que tal técnica reclama legitimação enquanto conhecimento médico legal. Foram utilizadas variadas ferramentas metodológicas, tais como: pesquisa documental, entrevistas, reportagens em mídia televisiva (entre outras). Esta prática constitui da utilização de sangue autólogo (sangue do próprio indivíduo em tratamento), puncionado da corrente sanguínea e aplicado imediatamente no músculo do sujeito praticante. Procuro entender o processo de legitimação de práticas que são consideradas ora científicas, ora ilegítimas. A conclusão desta pesquisa diz respeito à necessidade de uma vez mais, as Ciências Sociais e as Biomedicinas debaterem sobre novos rumos para os estudos em torno dos processos de saúde-doença.

Depuis quelques années, la recherche clinique s’est imposée comme un outil de la lutte contre le cancer à part entière, allant dans certaines situations jusqu’à se positionner comme une alternative aux soins. En cancérologie les essais précoces, qui correspondent à la première phase de recherche clinique, soulèvent des questions particulières quant à la manière dont ils se coordonnent avec les soins standards. C’est donc au niveau de cette interface entre soins et recherche que cette thèse se positionne pour étudier le fonctionnement des essais précoces. La question de l’accès aux essais est ainsi centrale dans la mesure où c’est elle qui va structurer les différentes formes de coordination. Pour traiter cette problématique, nous proposons un modèle d’analyse structurale des trajectoires de soins autour de la notion de configuration qui permet de croiser les dynamiques propres aux patients, aux médecins et aux institutions de santé. A partir de cela, nous avons pu distinguer trois mécanismes d’inclusion mobilisés par les unités investigatrices et sur lesquels repose la sélection des patients susceptibles de participer à un essai : l’accès, l’engagement et les appariements. Ceci nous a permis d’analyser la réorganisation de l’accès aux essais, confrontée à l’évolution de la recherche clinique en cancérologie et des changements institutionnels qui l’accompagnent.Cette thèse s’appuie sur un travail de terrain alliant données quantitatives (questionnaires, analyse de bases de données) et qualitatives (entretiens, observations) qui a été mené dans deux des principales unités réalisant des essais précoces en France. / For some years, clinical research has been perceived as an ally to fight against cancer. In drug development process, early phase trials are the first test on human of a new therapeutics’ agent. Because in oncology those early phases enroll patient with therapeutic failure – without any treatment or option left –, they brings specific issues on how care pathway links to clinical research. We focus on how patient join such trials and frame it as a coordination problem to determine how early phase trial works between medical and research activities. The concept of configuration steers to a structural analysis of care pathways considering all at one dynamics of patients, physicians and health institutions. It especially focuses on three inclusion’s mechanisms connecting research units to patients: access, commitment and matching. Each of them is described and formalized as a specific model. Separating those mechanisms help to highlights changes over time. Lately, this configuration has evolved with the introduction of genomic trials and institutional changes.This thesis combines quantitative (survey, data analysis) and qualitative (interviews, observations) data collected in two main French early phase unit.

There is a growing body of evidence indicating that anxiety, stress and mental ill-health are becoming more prevalent in modern Western societies. At the same time, climate change and mass extinction have now taken root in a period of the earth’s history that has been labelled, ‘the Anthropocene’ and/or ‘Capitalocene’. Some academics have related these various issues to a ‘crisis of perception’ and a general nature-culture perceptual misalignment. This thesis/play is a deconstruction and (re)construction of human-environment conceptions in relation to mental health and wellbeing. More precisely, it is an attempt to map ‘the spread mind’ in ‘environ(mental) health’ (Mcphie, 2014a). (Intra-)Act 1 is an exploration of the performativity of particular Euclidean concepts as well as post-Enlightenment environmental and psychotherapeutic paradigms, with a particular emphasis on those that purport an innate connection with nature. The act also (re)views models that measure mental health as an objectified or subjectified essence within an anthropocentrically idealised self. By taking this approach, I highlight the distinct move in Western culture from an ontology of immanence to one of transcendence. (Intra-)Act 2 invites you to think with a post-qualitative collaborative action (re)search, using psychogeography and rhizoanalysis to map the temporal assemblages of six people-environments (a multiplicity), each with a specific diagnosed mental health concern, in order to explore how mental health and wellbeing is a distributed process. (Intra-)Act 3 and the assemblages present the rhizoanalyses in the form of (re)presentational experimentation including, Brechtian playwriting and assemblages of mental health. By thinking with a troika of emerging contemporary process-relational ontologies, I propose an alternative post-psychotherapeutic pathway for how we might conceive of mental health and wellbeing. This attempt emphasises the intra-relational co-production of material agency and is (re)presented in this study as a process distributed of the environment. This is not a conclusion.

Increasingly, war and armed conflict are having devastating effects on the psychological and social well-being of civilian survivors throughout the world. There is a serious shortage of practitioners and culturally-appropriate models for assisting victims of psychological trauma with their healing and recovery. Educational settings, be they formal or nonformal, are appropriate places for psychotherapeutic interventions. This dissertation focuses on the intentional use of a nonformal educational setting for psychosocial healing of those exposed to war-induced trauma. A participatory education program designed to teach Central American community mental health workers the basic concepts and techniques of trauma treatment also served as a healing environment for the trainees. Individual psychological trauma as well as war-related intra-group conflict were addressed. Using an integrative model of healing and recovery, the intervention combined cognitive, emotional, spiritual, social, and physical approaches. The educational setting provided a larger interactional framework for the social contextualization of intrapsychic wounds, thus supporting healing. The case illustrates the importance of self-care for professionals and para-professionals working with the psychologically traumatized, which is rarely mentioned in the literature. This is a qaulitative study that combines a literature review on the nature of trauma and recovery, a case study with Central American community mental health workers, interviews with practitioners, and personal experience. The literature review takes into consideration cultural and Latin American perspectives, the importance of community-based approaches, and the linkage of individual and social dimensions. It includes a critique of posttraumatic stress disorder as a conceptual framework. The inquiry examines the viability of intentional incorporation of psychosocial healing into an educational setting, and indicates which components of participatory nonformal education best lend themselves to interfacing with psychological healing. Findings from both the literature and case study point to a need to question long-held assumptions of psychotherapy when working with trauma survivors. Self-care, safe container-building, peer support, mentoring, and a heightened role for para-professionals are recommended. The training and preparation of community mental health workers is seen as an effective response to the proliferation of war-related trauma.

Cette thèse amorce une réflexion approfondie sur les représentations populaires de la maladie et du pluralisme thérapeutique eu égard à la tradition, la religion et aux spécificités sociologiques de la société sénégalaise. Sa singularité repose sur le fait de mettre en exergue les composantes sociales et culturelles à l’œuvre, dans la prise en charge de la maladie du paludisme dans la communauté wolof du Sénégal. Cette recherche analyse la maladie comme le révélateur d’une conflictualité sociale et des rapports sociaux complexes entre les individus, les familles, les thérapeutes, les ethnies, où dominent des idéologies et des manières d’agir à la fois opposées et complémentaires. C’est dans la conception que les communautés se font de la maladie, que réside l’explication de la fusion culturelle qui est au firmament de la société et de l’humain, qui est perçu ici comme étant un complexe triadique fait de l’esprit, de l’âme et du corps / This thesis begins a reflection on popular representations of disease and therapeutic pluralism with regard to tradition, religion and sociological specificities Senegalese society. Its uniqueness lies in the fact to highlight the social and cultural work in the management of malaria illness in the community Wolof of Senegal. This research analyzes the disease as the developer of a social conflict and complex social relationships between individuals, families, therapists, ethnicity, dominated ideologies and ways of acting both opposite and complementary. This is the design that communities are the disease, lies the explanation of cultural fusion is the firmament of human society and which is seen here as a triadic complex due to the spirit, soul and body

Le travail de cette thèse s’interroge sur les réponses à apporter en terme d’organisation de l’offre médico-technique et de sa juste répartition sur les territoires en particulier pour les patients âgés poly-pathologiques. Il part de l’hypothèse qu’il existe un espace pour des concepts de petits établissements de santé ambulatoires pluridisciplinaires, dotés d’un petit plateau médico-technique, qui permettraient de participer à fluidifier et optimiser les parcours de soins. La méthode a consisté d’une part à étudier des structures plus petites de proximité en Allemagne, les MVZ, avec une expérience plus ancienne que celle dont nous disposons en France avec les MSP ou les Centres de Santé, et d’autre part à analyser les données PMSI pour faire émerger à la fois l’existence de groupes homogènes de co-morbidités et de groupes homogènes de parcours de soins. Les résultats sont constructifs, à la fois dans l’analyse par les sciences des réseaux et par l’automatisation de représentations de parcours de soins complexes. Ils ont permis de faire émerger des patterns représentatifs de groupes, d’en caractériser la consommation de soins, en matière de dispositifs médicaux et de ressources humaines, de quantifier les distances parcourues cumulées et les coûts cumulés par les patients selon leur lieu d’habitation et les institutions de santé auxquelles elles sont adressées. Nous en tirons des éléments pour la définition et la labellisation de nouvelles structures de santé de proximité satellites d’hôpitaux plus importants. Ce travail représente une avancée particulièrement utile, à la fois conceptuelle et pratique, pour les études de données de santé complexes des personnes âgées. / This work questions the answer to be given in terms of organization of the health technical offer and its fair distribution in the territories especially for the elderly patients with multimorbidities. It is based on the assumption that there is space for a concept of small multi-disciplinary outpatient health facilities, with a small health-technical platform, which would help to streamline and optimize care pathways. The method consisted on the one hand to study in Germany smaller community interdisciplinary health care center (the MVZ) in operation for a longer time than the the French multidisciplinary médical care centers. And on the other hand it analyzed the national heath data to reveal both the existence of comorbidités related groups and homogeneous care pathways related groups. The results are positive, both in network science analysis and in the automation of representations of complex care pathways. They made it possible to create representative patterns of groups, to characterize the consumption of care, in terms of medical devices and human resources, to quantify the cumulative distances traveled and the costs accumulated by patients according to their place of residence and the health institutions to which they are sent. We get addition elements for the definition and labeling of small community health centers, satellite of larger hospitals. This work represents a particularly useful step, both conceptual and practical, for complex health data studies of elderly.

Health is an organising principle of contemporary neoliberal citizenship, particularly evident in the political rhetoric of individual responsibility articulated around the privatisation of public health and welfare systems. The popular culture of these political technologies is expressed via the discourses of self-help and self-care, exemplified by the commercial success of consumer health magazines, and the responsibilising strategies of public health interventions. This thesis investigates the contemporary function of health magazines by examining both the content and the context of reader letters published between 1997 and 2000 in six Sydney-based 'commercial' and 'community' publications, and incorporating interviews with magazine editors. The three commercial magazines address the health media 'publics' of women (Good Medicine), men (Men's Health) and alternative health consumers (Nature & Health), whereas the three community publications address the 'counterpublics' of people living with HIV/AIDS (Talkabout), sex workers (The Professional) and illicit drug users (User's News). Despite their different social contexts, these six magazines are all exemplary of the advanced liberal health imperatives of Australian popular culture, although the community magazines also empower audiences to facilitate social change. Reader letters are approached via the interpretive lens of cultural studies, in which the specific local characteristics of each text is seen to have wider global implications. Each magazine's letters are positioned within a complex cultural, political and economic context that includes the rise of consumer culture, the social function of narrative disclosures, the increased validation of exhibitionism and the gendered politics of health and medicine. This research advocates for interdisciplinary dialogue between media/cultural studies, health/medical sociology and political theory, suggesting that health magazine reader letters can help to identify the role of popular and alternative media in constructing ideals of 'citizenships' within advanced liberalism.

Il lavoro si propone di rendere conto del ruolo dell’associazionismo di auto-mutuo aiuto (self-help) nel contesto del modello di welfare regionale lombardo, il “quasi mercato”. Questa forma associata vive una nuova stagione di sviluppo e dimostra di essere una delle risposte possibili ai recenti mutamenti dei sistemi di welfare, soprattutto in un contesto socio-demografico caratterizzato dall’invecchiamento della popolazione, dalla riduzione dei componenti delle famiglie e dal prevalere di malattie croniche e di disabilità. L’associazionismo di auto-mutuo aiuto si dimostra una delle risorse emergenti della società civile, capace di trasformare soggetti passivi e marginalizzati in cittadini attivi e responsabili; è più difficile capire quale sia il suo ruolo all’interno della governance locale, in termini di partecipazione. La ricerca presenta un quadro complesso, in cui il self-help riesce a promuovere innovazioni capaci di divenire risorse per il territorio locale, ma anche una certa incapacità di essere valorizzate presso le istituzioni locali, in ragione della fragilità istituzionale di cui soffre ancora questo tipo di associazionismo. / Purpose of the present study is to explain the role played by self-help associations within the Lombardia regional welfare model, the so-called ‘quasi-market’. Such associative forms are undergoing a whole new deal of development and prove to be one of the possible answers to the recent changes typical of the welfare systems, especially in a socio-demographic context characterized by ageing processes, decrease in the number of family members, prevailing of chronic diseases and disabilities. Self-help associations prove to be one of the resources emerging from civil society, able to transform passive subjects into active and responsible citizens. However, it is still difficult to understand what role they play in the local governance, in terms of participation. Major finding of the research is a complex picture, where self-help associations are able, on the one hand, to encourage innovations able in their turn to become resources for the local communities; on the other hand, they still show a certain inability to be fully appreciated by the local institutions because of the institutional fragility that still characterize these specific associations.

This project is a study of the way that people use language actively to achieve certain ends in communication, the way that they organise their spoken discourse to construct, convincingly, the state of their lives, both ‘internal’ and ‘external’. It does this primarily through an analysis of the systematic properties of the descriptive, communicative and interpretative skills which members use in the accomplishment of the meanings central to everyday existence. More specifically, this project is a study of verbal accounts of, and doctor-patient interaction relating to, clinical depression. The project begins from the premise that most social studies of depression and its diagnosis have been subject to the same problematic treatment of language as a ‘transparent medium’ as the psychiatric frames upon which the modern clinical understanding of depression in the UK is itself based. I aim, in view of this, to demonstrate how hitherto neglected elements in the social analysis of the condition can be revealed with the application of an alternative methodology, a methodology which treats talk-in-interaction as a dynamic and constructive phenomenon rather than a neutral conduit for the passage of information. The empirical data takes the form of a set of General Practitioners from a single practice in the North West talking freely about depression and their experiences of diagnosing it, and actual consultations between these GPs and their patients. Drawing upon Wittgenstein, Ethnomethodology, Discursive Psychology and, particularly, Conversation Analysis this project examines the ways in which doctors and patients construct, negotiate and manage ‘depressive’ meanings in the course of medical interaction, always holding tightly to Wittgenstein’s maxim that practice gives words their significance.

Durant les années 1990, en France, en Suisse et au Québec, de nouveaux médicaments ont reçu une autorisation de mise sur le marché, dans le cadre de la prise en charge de la dépendance aux opiacés. Vingt cinq ans plus tard, notre thèse interroge les usages qu’en font les personnes en traitement. A partir de la méthode biographique, nous étudions la substitution en terme d’« ajustements ». Les détournements de l’usage prescrit des TSO, étiquetés comme « mésusages » par les pouvoirs publics et un certain nombre de praticiens, apparaissent dès lors comme une modalité d’adaptation et de réappropriation du traitement. En évaluant les convergences et les divergences dans les pratiques et leurs effets, la comparaison de nos trois terrains d’enquête nous permet d’analyser les différents sens associés à la substitution, selon les contextes et les structures de soin au sein desquels l’usager est accueilli. / For a long time, ending drug addiction meant completely stopping any consumption. In the context of harm reduction policies, the introduction of substitution treatments has drastically changed the abstinence paradigm. Ending an addiction has taken a plural meaning, adding complexity to the delimitation already porous between “normal and pathological”. Nowadays stabilizing Methadone maintenance treatment or taking drugs on an irregular basis are perceived as an alternative to abstinence or other forms of recovery. In this thesis, wiitch deals with polysemic uses of substitution treatment, we analyze the attempts and strategies of the adjustment process in entering an addiction centre. The aim of this study is to show the different competencies that people can display in situations of vulnerability. Our interest is to find out how valuable expertise can emerge from the layperson point of view.