Chez les personnes âgées, la dépression est un problème important en santé publique, à cause de sa prévalence élevée et de son association avec les incapacités fonctionnelles, la mortalité et l’utilisation des services. La plupart des études ont montré que le manque de relations sociales était associé à la dépression, mais les résultats ne sont pas clairs. Au Québec et au Canada, on possède peu de données sur la prévalence de la dépression chez les personnes âgées et de son association avec les relations sociales. Peu d’études ont examiné le rôle des relations sociales sur l’utilisation des services de santé par les personnes âgées déprimées. Le but de cette recherche était d’examiner le rôle des relations sociales dans la présence de la dépression et dans la consultation chez un professionnel de la santé des personnes âgées déprimées, au Québec. Plus spécifiquement, ce travail visait à : 1) examiner les associations entre les relations sociales et les troubles dépressifs selon la région de résidence; 2) examiner les associations différentielles des relations sociales sur la dépression des femmes et des hommes âgés; 3) examiner le rôle des relations sociales dans la consultation auprès d’un professionnel de la santé des personnes âgées déprimées. Pour répondre à ces objectifs, nous avons utilisé les données de l’enquête ESA (Enquête sur la Santé des Aînés), réalisée en 2005 -2006 auprès d’un échantillon de 2670 personnes âgées résidant à domicile au Québec, qui nous ont permis de rédiger trois articles. Les troubles dépressifs (incluant la dépression majeure et mineure) ont été mesurés, selon les critères du DSM-IV, en excluant le critère de l’altération du fonctionnement social, professionnel ou dans d’autres domaines importants, à l’aide du questionnaire ESA développé par l’équipe de recherche. Les relations sociales ont été mesurées à l’aide de cinq variables : (1) le réseau social; (2) l’intégration sociale; (3) le soutien social, (4) la perception d’utilité auprès des proches et (5) la présence de relations conflictuelles avec le conjoint, les enfants, les frères et sœurs et les amis. Des modèles de régression logistique multiple ont été ajustés aux données pour estimer les rapports de cote et leur intervalle de confiance à 95 %. Nos résultats ont montré des prévalences de dépression plus élevées chez les personnes qui résident dans les régions rurales et urbaines, comparées à celles qui résident dans la région métropolitaine de Montréal. La pratique du bénévolat, le soutien social et les relations non conflictuelles avec le conjoint sont associés à une faible prévalence de dépression, indépendamment du type de résidence. Comparés aux hommes, les femmes ont une prévalence de dépression plus élevée. L’absence de confident est associée à une prévalence de dépression élevée, tant chez les hommes que chez les femmes. La probabilité de dépression est plus élevée chez les hommes veufs et chez ceux qui ne pratiquent pas d’activités de bénévolat, comparativement à ceux qui sont mariés et font du bénévolat. Chez les femmes, aucune association significative n’a été observée entre le statut marital, le bénévolat et la dépression. Cependant, la présence de relations conflictuelles avec le conjoint est associée avec la dépression, seulement chez les femmes. Les relations avec les enfants, les frères et sœurs et les amis ne sont pas associées avec la dépression dans cette population de personnes âgées du Quebec. En ce qui concerne la consultation chez un professionnel de la santé, nos résultats ont révélé que presque la moitié des personnes âgées dépressives n’ont pas consulté un professionnel de la santé, pour leurs symptômes de dépression, au cours des 12 derniers mois. Par ailleurs, notre étude a montré que les personnes âgées qui disposent de tous les types de soutien (confident, émotionnel et instrumental) consultent plus pour leurs symptômes de dépression que ceux qui ont moins de soutien. Comparativement aux hommes mariés, les femmes mariées consultent plus les professionnels de la santé, ce qui laisse supposer que le réseau de proches (épouse et enfants) semble agir comme un substitut en réduisant la fréquence de consultation chez les hommes. Vu la rareté des études canadiennes sur la prévalence de la dépression chez les personnes âgées et les facteurs psychosociaux qui y sont associés, les résultats de ce travail seront utiles pour les cliniciens et pour les responsables des politiques à l’échelle nationale, provinciale et locale. Ils pourront guider des interventions spécifiques, selon la région de résidence et pour les hommes et les femmes âgées, dans le domaine de la santé mentale. / Depression is an important public health problem among the elderly population due to its high prevalence and its association with disability, mortality and use of health services. Most studies have shown that lack of social networks is associated with depression but results are not clear. In Quebec and in Canada, little evidence exists on the prevalence of depression in the elderly population and on its associations with social relationships. Few studies have examined the associations between social relationships and health services utilisation among the depressed elderly patients. The aim of this work was to examine the role of social relationships on the presence of depression and on the consultation with a health professional by the elderly patient with depression, in Québec. More specifically, this work aimed at examining if: 1) the associations between social relationships and depression varied in rural and urban areas; 2) the associations between social relationships and depression were different in men and in women and 3) assessing the role of social relationships in the consultation of a health professional by the elderly patients with depression. To attain these objectives we have written three articles using data from the ESA survey, conducted in 2005-2006 on a representative sample of 2670 community dwelling people over 65 in Quebec. Depressive disorders (including major and minor depression) were measured by the DSM-IV criteria using the ESA questionnaire developed by the research team which excludes the criteria on limitations of social functioning. Social relationships were measured by aspects of social networks (marital status and diversity of ties), engagement in community social activities (religious attendance, frequenting social centers, and volunteerism), social support and perception of usefulness and presence of conflict in the relationships with spouse, children, siblings and friends. Multiple logistic regressions were adjusted to estimate odds ratios and their 95 % confidence intervals. Prevalence of depression was higher among those living in urban and rural areas of Quebec compared with metropolitan Montreal. Volunteerism, social support and not having conflict with the spouse were associated with lower frequency of depression independently of the area of residence. Women had higher prevalence of depression compared with men. Lack of a confident was associated with higher frequency of depression both in men and in women. Men who were widows and those who were not involved in volunteer work had higher odds of depression than men in other marital situations and men who were volunteering. Marital status and volunteer work were not associated with depression in women. However, conflict in marriage was associated with depression in women. Relationships with children, siblings and friends are not associated with depression in this population of elderly people from Quebec. Concerning consultation with a health professional for symptoms of depression, we have shown that approximately half of those depressed elderly, both among men and among women, have not consulted for their symptoms in the last 12 months. Consultation is associated with high levels of support, but the immediate network (spouse and siblings) seems to act as a substitute for depressed elderly men, reducing their frequency of consultation. Given the scarcity of Canadian studies on depression prevalence among the elderly population, these results on depression and its associated factors provide important information for clinicians and decision makers for planning and targeting of services by area of residence and for both men and women.

Cette recherche s’intéresse aux processus communicationnels utilisés dans les comités d’éthique clinique (CEC) en Amérique du nord dans leur fonction de consultation. Selon la littérature, les CEC bénéficieraient de «pay closer attention to group process [as an] effective communication in a HEC is essential to a committee’s function» (Berchelmann and Blechner 2002 p.143). Or, très peu de données sur les dynamiques de groupe et les modes de communication en CEC sont disponibles. Ce travail cherche à savoir si l’approche dialogique peut être utile au soutien des discussions de groupe des CEC. Dans un premier temps, une revue de littérature rend compte, à partir de son historique, de l’état actuel des CEC. Sont ensuite explorées et analysées, dans leurs avantages et leurs limites, les diverses méthodes utilisées afin de mener les discussions dans le cadre des consultations. Dans un deuxième temps, les barrières communicationnelles qui affectent potentiellement les CEC sont identifiées. Par la suite, afin d’améliorer le processus de communication (et diminuer l’effet des barrières), une nouvelle piste de solution est proposée : le dialogue tel que développé par le milieu organisationnel. Le dialogue est alors conceptualisé et mis en lien avec les besoins des CEC en matière de communication. Bien que le dialogue propose plusieurs contributions avantageuses pour les CEC et leurs membres, certaines contraintes réduisent sa faisabilité d’une façon globale dans le contexte particulier des CEC. Par contre, en l’utilisant comme formation complémentaire, le dialogue permet le développement de l’individu et du groupe et demeure une approche intéressante et utile pour les CEC qui éprouvent des difficultés systémiques et comprennent les implications de sa démarche. / This research focuses on communication processes used in hospital ethics committees (HECs) in North America in their consultation role. According to the literature, HECs would benefit if they ―pay closer attention to group process [as an] effective communication in a HEC is essential to a committee’s function‖ (Berchelmann and Blechner 2002 359 p.143). However, very little data on group dynamics and modes of communication are available. This thesis explores whether the dialogical approach may be useful to supporting group discussion in HECs. The first part of this thesis presents a literature review and history to situate the current state of HECs. The various methods used to conduct discussions in ethics consultations are then explored and analyzed, with regards to their advantages and limitations. The second part of the thesis examines communication barriers that potentially affect HECs, and then proposes a possible solution to improve the communication process (and reduce the effect of barriers), that is, the dialogic approach as developed by the organizational setting. This approach is then conceptualized and linked with the communication needs of HECs. Although dialogue can provide several beneficial contributions to HECs and their members, some contextual constraints reduce its feasibility for a comprehensive application. However, using it as a means of additional training, dialogue enables the development of the individual and the group and remains an interesting and useful approach for HECs facing difficulties, and who are able to understand the systemic implications of this approach.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este é um estudo transversal feito com pacientes mulheres que compareceram ao Setor de Endoscopia Urológica e Urodinâmica do Serviço de Urologia do Hospital Universitário Pedro Ernesto HUPE entre dezembro de 2009 e dezembro de 2012, para a realização de estudo urodinâmico, com encaminhamento médico e agendamento prévio para investigação de queixa de incontinência urinária. O estudo foi realizado nas pacientes do sexo feminino, com idade entre 23 e 86 anos e com queixa de incontinência urinária nao complicada. Os dados utilizados nesse estudo têm três origens: (1) a avaliação primária formada pelo conjunto dos questionário de perda por esforço e ou urgência e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) e história padronizada; (2) avaliação médica, realizada pelo médico residente; e (3) avaliação urodinâmica, resultado do estudo urodinâmico conduzido por médico residente, com supervisão e laudos feitos por um dos professores do serviço. O objetivo do trabalho foi analisar se o uso de métodos mais simples poderia diagnosticar incontinência urinária não complicada sem a necessidade de realizar a avaliação urodinâmica. Os nossos achados mostraram que entre a avaliação primária e a médica há elevada sensibilidade e especificidade além de forte concordância. O estudo urodinâmico tem menor probabilidade de fazer o diagnostico de IUM e maior frequencia de falso negativo. Os nossos achados fortalecem a indicação de uma abordagem primária antes de intervenções mais invasivas e dispendiosas como a avaliação urodinâmica. A realização de uma avaliação simplificada pode fornecer informações suficientes para começar um tratamento medicamentoso e fisioterapêutico. / This cross-sectional study of female patients who attended the Department of Urology and Urodynamic of the Endoscopy Department of Urology, Pedro Ernesto University Hospital HUPE/UERJ between December 2009 and December 2012, for performing urodynamic study with medical referral and scheduling prior to investigation of stress urinary incontinence. The study was conducted in female patients, aged between 23 and 86 years with complaints of urinary uncomplicated incontinence. The data used in this study have three origins: (1) the primary assessment formed by the set of questionnaire and loss effort or urgency and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and standardized history; (2) medical evaluation performed by a resident physician; and (3) urodynamic evaluation, results of urodynamic study conducted by resident physician, with supervision and reports made by one of the Professors of the service. The objective was to analyze whether the use of simpler methods could diagnose uncomplicated urinary incontinence without the need for urodynamic evaluation. Our findings showed that between primary medical evaluation and there is high sensitivity and specificity in addition to strong agreement. The urodynamic study is less likely to make the diagnosis of MUI and higher frequency of false negative. Our findings strengthen the indication of a primary approach before more invasive and costly interventions such as urodynamic evaluation. The realization of a simplified assessment can provide enough to get a drug and physical therapy information.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este é um estudo transversal feito com pacientes mulheres que compareceram ao Setor de Endoscopia Urológica e Urodinâmica do Serviço de Urologia do Hospital Universitário Pedro Ernesto HUPE entre dezembro de 2009 e dezembro de 2012, para a realização de estudo urodinâmico, com encaminhamento médico e agendamento prévio para investigação de queixa de incontinência urinária. O estudo foi realizado nas pacientes do sexo feminino, com idade entre 23 e 86 anos e com queixa de incontinência urinária nao complicada. Os dados utilizados nesse estudo têm três origens: (1) a avaliação primária formada pelo conjunto dos questionário de perda por esforço e ou urgência e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) e história padronizada; (2) avaliação médica, realizada pelo médico residente; e (3) avaliação urodinâmica, resultado do estudo urodinâmico conduzido por médico residente, com supervisão e laudos feitos por um dos professores do serviço. O objetivo do trabalho foi analisar se o uso de métodos mais simples poderia diagnosticar incontinência urinária não complicada sem a necessidade de realizar a avaliação urodinâmica. Os nossos achados mostraram que entre a avaliação primária e a médica há elevada sensibilidade e especificidade além de forte concordância. O estudo urodinâmico tem menor probabilidade de fazer o diagnostico de IUM e maior frequencia de falso negativo. Os nossos achados fortalecem a indicação de uma abordagem primária antes de intervenções mais invasivas e dispendiosas como a avaliação urodinâmica. A realização de uma avaliação simplificada pode fornecer informações suficientes para começar um tratamento medicamentoso e fisioterapêutico. / This cross-sectional study of female patients who attended the Department of Urology and Urodynamic of the Endoscopy Department of Urology, Pedro Ernesto University Hospital HUPE/UERJ between December 2009 and December 2012, for performing urodynamic study with medical referral and scheduling prior to investigation of stress urinary incontinence. The study was conducted in female patients, aged between 23 and 86 years with complaints of urinary uncomplicated incontinence. The data used in this study have three origins: (1) the primary assessment formed by the set of questionnaire and loss effort or urgency and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and standardized history; (2) medical evaluation performed by a resident physician; and (3) urodynamic evaluation, results of urodynamic study conducted by resident physician, with supervision and reports made by one of the Professors of the service. The objective was to analyze whether the use of simpler methods could diagnose uncomplicated urinary incontinence without the need for urodynamic evaluation. Our findings showed that between primary medical evaluation and there is high sensitivity and specificity in addition to strong agreement. The urodynamic study is less likely to make the diagnosis of MUI and higher frequency of false negative. Our findings strengthen the indication of a primary approach before more invasive and costly interventions such as urodynamic evaluation. The realization of a simplified assessment can provide enough to get a drug and physical therapy information.

Si les mutations technologiques questionnent l’exercice classique des droits d’action collective, elles renforcent également leur nécessaire existence. La transformation de l’environnement de travail, par l’introduction de nouvelles technologies dans les entreprises et par l’utilisation de ces dernières comme outils de travail ou de communication, invite à repenser l’exercice de ces droits. D’une part, les technologies peuvent servir d’instruments à l’action collective. Elles sont alors susceptibles de prolonger le pouvoir d’agir de ceux qui les utilisent en leur offrant la possibilité d’agir différemment, de communiquer ou de faire pression sur l’entreprise autrement. D’autre part, l’introduction dans l’entreprise des technologies, la mise en place de nouveaux modes d’organisation du travail au moyen des technologies et l’utilisation de ces dernières, emportent un certain nombre de risques pour la communauté de travail. La mise en œuvre des droits d’action collective vise alors à prévenir ces risques et, le cas échéant, à réagir lorsque le risque se réalise. La création de nouvelles communautés de travail, qui n’auraient pu exister sans les technologies, nécessite encore que soient exercés des droits d’action collective pour défendre les intérêts de leurs membres. Il n’en reste pas moins que le régime juridique applicable à l’action collective ne permet pas forcément de répondre à tous ces enjeux. Explorant la manière dont s’appliquent les droits d’action collective dans un environnement exposé aux mutations technologiques, cette étude propose également des pistes d’évolution du droit applicable à l’action collective que les mutations technologiques mettent à l’épreuve. / If technological mutations challenge the classic exercise of collective action rights, they also reinforce their necessary existence. The transformation of the working environment, by the introduction of new technologies in companies and the use of them as working or communication tools, leads to rethink the exercise of these rights. On one hand, technologies can be used as instruments for collective action. Then, they are likely to extend the power of those who use them by offering them the opportunity to act differently, to communicate or to put pressure on the company differently. On the other hand, the introduction of technologies into the company, the implementation of new ways of organizing the work through technologies and the use of them, introduce risks for the working community. Therefore, the implementation of the rights of collective action aims to prevent these risks and, if necessary, to react when the risk is realized. The creation of new working communities, which could not have existed without the technologies, still requires that rights of collective action be provided to defend the interests of their members. Nonetheless, the legal regime for collective action does not necessarily meet all of these issues. While exploring the way in which collective action rights apply in an environment exposed to technological mutations, this thesis also proposes avenues of evolution of the law applicable to collective action that technological mutations put to the test.

Depuis l’apparition du CHSCT en 1982, la représentation élue du personnel a connu de profondes évolutions. Délégués du personnel, comités d’entreprise et CHSCT ont dû s’adapter à la considérable extension des notions de santé et de sécurité. L’intégration de l’impératif de protection de la santé mentale des travailleurs dans le Code du travail a bouleversé le champ de compétences du CHSCT. La prévention des risques psycho-sociaux s’est rapidement invitée au centre de ses préoccupations, élargissant d’autant l’obligation de consultation mise à la charge de l’employeur. Des projets et mesures qui initialement nécessitaient la seule consultation du comité d’entreprise doivent dorénavant être également soumis à l’avis du CHSCT. Dans cette procédure de double consultation l’employeur est guidé par le principe de spécialité qui transforme le comité d’entreprise en simple chambre d’enregistrement des avis de l’instance spécialisée. De l’expansion du CHSCT naissent redondances et lourdeurs. Une réforme doit être envisagée. Transformation de l’instance spécialisée en commission du comité d’entreprise ou redistribution des compétences de chacun : l’alternative offerte impose la discussion. / Since the emergence of the CHSCT (health, safety and working conditions committee) in 1982, the elected representation of employees has profoundly changed. Employee representatives, works councils and the CHSCT have had to adapt to the considerable extension of the concepts of health and safety. The integration of the requirement to protect the mental health of workers in the Labour Code has radically altered the scope of competence of the CHSCT. The prevention of psychosocial risks quickly invited itself as the centre of its concerns, thereby extending the consultation obligation borne by the employer. Projects and measures that initially only required the consultation of the works council are now also subject to the prior opinion of the CHSCT. In this procedure of double consultation the employer is guided by the principle of specialty that turns the works council in a mere rubber stamp of the opinion of the specialized committee. The expansion of the CHSCT has caused reiterations and cumbersomeness. A reform must be considered. Transformation of the specialized body in a committee of the works council or redistribution of powers of each : the alternative offered requires discussion.

Introduction: Les survivants d’unité de soins intensifs (SI) présentent souvent des incapacités physiques et neuropsychologiques en raison de l’alitement prolongé et des traitements agressifs reçus dans ce type d’unité. La mobilisation précoce en position debout est une intervention prometteuse pour prévenir ces incapacités et amorcer la récupération de celles- ci. Les activités impliquant la mobilisation en position debout produiraient des bienfaits supplémentaires par rapport aux interventions de mobilisation au lit. Cependant, la mobilisation en position debout comportent des risques plus importants pour la sécurité des patients aux SI, par rapport aux mobilisations au lit. Il n’existe pas de synthèse de l’ensemble des critères de sécurité qui sont utilisés dans les études où les patients de SI ont participé à des mobilisations en position debout. De plus, il n’existe pas de recommandations sur les critères les plus pertinents à utiliser par l’équipe multidisciplinaire pour mobiliser en position debout les patients aux SI. Objectifs: 1- Recenser les critères de sécurité utilisés dans les études dans lesquelles des patients adultes aux SI ont participé à des activités de mobilisation en position debout. 2- Consulter un panel de professionnels de la santé expérimentés en SI afin qu’ils puissent sélectionner et proposer les critères de sécurité les plus pertinents et faisables en clinique à partir des critères recensés dans la littérature. Méthode: Une recension systématique a été réalisée pour déterminer quels critères de sécurité ont été utilisés dans les études où des patients adultes aux SI ont participé à des activités de mobilisation en position debout. Suite à cette recension, l’équipe de recherche a produit une liste synthèse de critères de sécurité utilisés dans la littérature. Un panel local de professionnels de la santé expérimentés en SI a été consulté par la méthode Delphi en trois rondes pour sélectionner et proposer les critères de sécurité les plus pertinents et faisables à partir de la liste synthèse de critères extraits de la littérature. Ce panel local incluait des physiothérapeutes, infirmières, inhalothérapeutes et médecins. Résultats: Soixante-deux articles ont été inclus dans la recension. De ces articles, 381 différents critères à respecter pour assurer la sécurité lors des mobilisations en position i debout aux SI ont été extraits. Ces critères recensés ont été catégorisés selon qu’ils étaient liés aux systèmes cardiovasculaire, respiratoire, neurologique, musculosquelettique ou qu’ils étaient de nature générale. De plus, ils comprenaient deux types de critères soit, les critères à respecter avant de débuter la mobilisation (critères d’initiation) et les critères pour décider s’il faut mettre fin à la mobilisation pour des raisons de sécurité (critères d’arrêt). On note une hétérogénéité dans la formulation et les valeurs seuils des critères recensés (ex. : critère d’arrêt: saturation périphérique d’O2 inférieure à 85% versus inférieure à 88%). De l’ensemble des critères recensés, l’équipe de recherche a produit une liste-synthèse de 34 critères de sécurité qui couvraient l’ensemble des catégories et des types de critères. Un panel local de douze cliniciens expérimentés en SI (tous en provenance de la province de Québec, au Canada) a statué par consensus que 34 critères de sécurité étaient pertinents et de 31 faisables. De ces critères retenus par le panel, 28 provenaient de la liste-synthèse des critères recensés et 6 ont été proposés par les panélistes eux-mêmes. Conclusion: Les critères à respecter pour assurer la sécurité des patients lors de mobilisation en position debout aux SI sont décrits dans la littérature actuelle. Un panel local de cliniciens expérimentés en SI a permis de mettre en évidence 34 critères de sécurité pertinents et 31 faisables à respecter lors de la mobilisation debout aux SI, dont 28 provenaient de la littérature recensée. / Introduction: Survivors of intensive care units (ICU) often present physical and neuro- psychological impairments following the frequently prolonged bed rest and aggressive resuscitation treatments inherent to care received in these units. Early weight-bearing mobility in a standing position is a promising method to limit the extent of, and initiate recovery from these impairments. Activities that incorporate the standing position seem to be more beneficial than other bedside interventions. However, for ICU patients, activities performed in a standing position may be riskier. No existing report incorporates all of the safety criteria used in the ICU studies in which ICU patients were mobilized in a standing position. Moreover, there are no existing recommendations related to the most relevant and feasible safety criteria for weight-bearing in ICU patients. Purpose: 1- To determine the safety criteria needed to mobilize in a weight-bearing standing position critically ill adult patients in the ICU. 2- Identifying safety criteria, and selecting and ranking the most relevant and feasible ones from the literature by a panel of local experienced ICU clinicians. Methods: A systematic review determined which safety criteria were used in adult ICU patient studies addressing mobilization in a standing position. From this systematic review, we extracted an overview and listed safety criteria. Then, local experienced ICU clinicians were consulted with three Delphi method rounds aiming to achieve consensus on the most relevant and feasible criteria. The panel included physiotherapists, nurses, intensivists and respiratory therapists. Results: Sixty-two articles were included in the review, yielding 381 different safety criteria for adult ICU patient mobilization in a weight-bearing standing position. These criteria were categorized into cardiovascular, respiratory, neurological, musculoskeletal and general safety items. They were also subdivided into criteria to be respected before mobilization (initiation criteria) and criteria suggesting stopping a mobilization for safety reasons (termination criteria). A wide variety in the definitions and cut-off values for certain criteria (ex. termination criteria of peripheral oxygen saturation below 85% versus below 88%) were iii identified. A synopsis listing of 34 criteria, selected by the research team from all extracted criteria to represent the criteria categories and types, was presented to a group of 12 local experienced ICU clinicians (all from the province of Quebec, Canada). Consensus was reached as to the relevance of 34 and feasibility of 31 safety criteria. Among them, 28 were from the literature-based synopsis and six criteria were proposed by the panelists. Conclusion: The literature provides safety criteria needed to mobilize ICU patients in a weight-bearing position. A panel of local experienced ICU clinicians helped establish a list of 34 relevant and 31 feasible safety criteria for safety mobilization of ICU patients in standing position among witch 28 originating from the literature review.

This study aims to investigate how municipalities respond to citizen input in consultation reports – a necessary and often mandatory documentation in the Swedish planning process. More specifically, building on the political-philosophical debate on deliberation as a democratic ideal, this study explores how local authorities' response to citizen input is structured and designed in these reports, and to what extent citizen input is recognized. By approaching a model for logics and considerations within sorting processes, I also seek to understand how local authorities motivate and explain their stances. More specifically, I examine whether considerations – made within a so called selective sorting – emphasize what ispossible, legal and/or proper to implement. The study is mainly based on a qualitative content analysis of consultation reports from three Swedish municipalities. The results of this study highlight, among other things, that the structure and design of the response from the local authorities depend on the structure and design of the input. Further, almost fifty percent of the total number of responses studied are rejected, where a vast majority of the few approvals given are weak/vague. Even though local authorities from all three municipalities motivate their stances based on what is possible, legal and proper, there are some general patterns. In total, almost half of all positions are justified on the basis of what is considered proper to implement, while approximately a fifth are justified on the basis of what is legal. Further, I have drawn attention to two more specific ways in which municipalities seem to motivate and explain their positions. These ways are defined as two categories that I have chosen to call aesthetics and external expertise.

This book examines the long -term consultation partnership involving a federal agency, a group of American Indian tribes, and a team of anthropologists. This book highlights the history, evolution, dynamics, and results of the consultation relationship between the U.S. Department of Energy Nevada Operations Office (DOE/NV) and 20 tribes and organizations composed of ethnic Numic-speaking Western Shoshone, Southern Paiute, and Owens Valley Paiute -Shoshone people. A team of applied anthropologists currently affiliated with the Bureau of Applied Research in Anthropology at the University of Arizona in Tucson (UofA), and a team of archaeologists from the Desert Research Institute (DRI), a unit of the University and Community College System of Nevada in Reno and Las Vegas, Nevada, respectively, have provided technical assistance and contract consulting services to the Indian tribes and the DOE/NV, first on the Yucca Mountain Site Characterization Office (YMSCO) and, in the past decade, on the Nevada Test Site (NTS). During the early stages of the consultation relationship, the culturally affiliated Indian and pan-Indian entities unified themselves into a single indigenous organization, the Consolidated Group of Tribes and Organizations, or CGTO, for the purpose of defending their collective interests in the lands and resources comprising the NTS in south –central Nevada. Since 1994, this new Indian organization has consulted with the DOE/NV on an increasingly wider range of issues that affect Indian cultural, religious, and resource values on and around the NTS. The book also examines these cultural and religious values regarding traditional lands and resources, and the cultural significance of resources, objects, places, and landscapes within the boundaries of this facility that have been affected by DOE/NV mission activities. The consultation relationship was initiated, and continues into the present, as a result of the implementation of a series of federal environmental laws and regulations that require consultation with American Indian tribal governments when activities conducted with federal funds, in federal facilities, or both, have the potential to adversely impact traditional American Indian resources and cultural practices. Most notable among these is the American Indian Religious Freedom Act (AIRFA), which was passed by the United States Congress in 1978. Prior to that time, cultural resources were managed mainly in accordance with the provisions set forth in Sections 106 and 110 of the National Historic Preservation Act.

Communication between the patient and healthcare professional is pivotal in enabling effective self-care management to occur (Street et al., 2009) which in turn leads to improved health outcomes (Kravitz et al., 1993). However, there is little published data exploring the most effective tools for evaluating whether these communication skills occur and what particular attributes enhance the process (Goodchild, Skinner & Parkin, 2005; Heisler et al., 2003; Parkin & Skinner, 2003). This study aims to identify patient-centred communication skills occurring in consultations and to explore their link with a tool-recording agreement on reported decisions made. Quantitative analysis was conducted on 86 dietetic consultations across four outpatient diabetes services. Audio recordings from 20 of these were qualitatively analysed. Greater agreement on reported decisions correlated significantly with level of empathy demonstrated (t = .283, p = .0005). In consultations featuring agreement, dietitians expressed more empathy (p = .02), used more active listening skills, asked significantly more exploratory questions on self-care practices (U = 18.5, p = .007), provided significantly more supportive/collaborative information-giving exchanges (U = 11, p = .003) and were more likely to set an agreed agenda at the start of consultations. In contrast, consultations featuring disagreement had low levels of empathy, fewer active-listening skills and exploratory questions, significantly greater numbers of persuasive information-giving exchanges (U = 17, p = .007) and more recommending exchanges. Generally, agendas were not set. In conclusion, recording patient/healthcare professional agreement on reported decisions made during a consultation is a simple tool that can indicate the presence of patient-centred communication skills. Active-listening skills allow expressions of empathy that facilitate patient involvement and interactive dialogue. The measure of agreement should be used frequently as a marker of effective dietetic consultations and to provide further data on the relationship between patient-centred communication and implementation of behaviour change for improved health outcomes.