Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2008. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-12-05T17:58:48Z No. of bitstreams: 1 dorisfarias.pdf: 822155 bytes, checksum: 2ab08495fca988e8fb2f01a60a84624d (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2012-12-06T04:31:27Z (GMT) No. of bitstreams: 1 dorisfarias.pdf: 822155 bytes, checksum: 2ab08495fca988e8fb2f01a60a84624d (MD5) / Made available in DSpace on 2012-12-06T04:31:27Z (GMT). No. of bitstreams: 1 dorisfarias.pdf: 822155 bytes, checksum: 2ab08495fca988e8fb2f01a60a84624d (MD5) Previous issue date: 2008 / O puerpério é um período vivido e percebido de forma singular pela mulher, exigindo, dos profissionais da saúde, sensibilidade e esforços para que estas se sintam acolhidas e valorizadas como seres únicos e especiais. Assim, este estudo teve como objetivo compreender como a mulher vem vivenciando o seu cuidado no puerpério, alicerçado no referencial teórico de Madeleine Leininger e em autores que abordam esta temática. Trata-se de uma pesquisa qualitativa, desenvolvida com 10 puérperas egressas da Unidade de Internação Obstétrica do Hospital Universitário Dr. Miguel Riet Corrêa - FURG e atendidas na Consulta de Enfermagem. A coleta de dados foi realizada através de entrevistas semi-estruturadas gravadas e transcritas na íntegra, com o devido consentimento esclarecido das participantes. Mediante a Análise Temática dos Dados, a partir de Minayo, emergiram três categorias: Sendo cuidada no puerpério, O cuidado de si no puerpério e Dificuldades encontradas pela mulher no puerpério. Constatei que o puerpério apresenta-se como um período especial na vida da mulher, em que cada uma o vivencia de acordo com seus valores, crenças e costumes. O estudo evidencia o importante papel da família no cuidado à puérpera e a influência cultural que esta exerce sobre a mulher. As alterações ocasionadas no corpo das mulheres durante a gestação, o parto e o puerpério, afetam sua auto-imagem, tornando-as mais vulneráveis emocionalmente. Para algumas mulheres, após o parto, o corpo volta-se para a função materna de amamentar. Com relação às dificuldades enfrentadas pela mulher no puerpério, percebi que ela pode apresentar uma sobrecarga de papéis, com a sensação de perda de controle sobre sua vida, exigindo reorganização do seu cotidiano. O estudo ainda evidenciou a presença de um homem mais participativo na família, mais atento às necessidades da mulher nesse período, mais companheiro e amigo, procurando assumir responsabilidades, compartilhando as demandas de cuidado com a mulher, o trabalho com a casa e os cuidados com o filho. Compreender como as mulheres vivenciam o seu cuidado no puerpério, possibilita à enfermeira, mais facilmente, planejar ações educativas que as instrumentalizem para o seu autocuidado. Acredito que a partir dos conhecimentos mostrados neste estudo, possa contribuir para a produção de um novo olhar para o ser humano puérpera, possibilitando às enfermeiras repadronizarem suas consultas de puerpério, de modo que não dirijam seu olhar apenas para a dimensão biológica da mulher, mas também incorporemseus aspectos subjetivos, valorizando suas crenças e costumes. / Puerperium is a period experienced and realized in a singular way by the woman and it requires sensibility and efforts from the health professionals to these women feel valorized and approached as unique and special beings. Thus, this study aimed to comprehend how the woman is experiencing her care in puerperium and was based on the referential theory by Madeleine Leininger and authors who approach this thematic. It is about a qualitative research developed with 10 mothers who came out from the Obstetric Internment Unit of the Academical Hospital Dr. Miguel Riet Corrêa – FURG and attended in the Nursing Consultation. Data were collected through semi-structured interviews which were completely recorded and transcribed under the participants’ clear consent. Data were analyzed under the Minayo’s proposal denominated Data Thematic Analysis. Results reveled three categories: Woman being cared in purperium, Self care in puerperium and Difficulties found by the woman in purperium. I observed that, puerperium is presented as a special period in woman’s life and it is experienced by her according with her values, beliefs and costumes. The study highlights the family’s important role in caring the mother and the cultural influence that family have on the woman. The alterations occasioned in the woman’s body during pregnancy, birth and in purperium affect her self-image, making her more vulnerable emotionally. For some women, after the birth, the body is ready to breastfeed. In relation to the difficulties faced by the woman in puerperium, I noticed that she can show a roles’ overload, giving her the sensation of loss of controlling her life, requiring reorganization of her daily. The study also evidenced the presence of a more participative and partner man in the family in alert to woman’s needs in this period, and more friendly looking for assuming the responsibilities, sharing the caring demands with the woman, the house and the child. To comprehend how these women experience their care in puerperium, easily makes the nurse able to plan educative actions that prepare them to their self-care. I believe that the knowledge shown in this study can contribute to a new look at mothers, making the nurses able to construct a new pattern for their purperium consultations in a way they no more observe only the biological dimension but also to incorporate the woman’s subjective aspects. / El puerperio es un período vivido y percibido de manera singular por la mujer, exigiendo, de los profesionales de la salud, sensibilidad y esfuerzos para que estas se sientan acogidas y valoradas como seres único y especiales. Por lo tanto, este estudio tuvo como objetivo entender cómo la mujer está vivenciando su atención en el puerperio, se basó en el marco teórico de Madeleine Leininger y autores que abordan esta cuestión. Esta es una investigación cualitativa, realizada con 10 puérperas egresas de la Unidad de Internamiento Obstétrico del Hospital Universitario Miguel Riet Corrêa - FURG y atendidas en la consulta de Enfermería. La colecta de datos fue realizada a través de entrevistas semiestructuradas grabadas y transcritas en su totalidad, con el debido consentimiento de los participantes. Los datos fueron analizados de acuerdo con la propuesta de Minayo, llamado de análisis temático de los datos. Los resultados revelaron 3 categorías: Siendo cuidada en el puerperio, El cuidado de sí mismos en el puerperio y de las dificultades encontradas por la mujer en el puerperio. Constate que el puerpero es un período especial en la vida de la mujer, en la que cada una de vivencia de acuerdo a sus valores, creencias y costumbres. El estudio evidencia el importante papel de la familia en el cuidado de la puérpera y la influencia cultural que esta ejerce sobre la mujer. Los cambios causados en el cuerpo de la mujer durante el embarazo, parto y puerperio, que afecta a su auto imagen, lo que los hace más vulnerables emocionalmente. Para algunas mujeres, después del parto, el cuerpo de vuelta a la tarea de amamantar. Cuanto a las dificultades enfrentadas por las mujeres en el puerperio, verifiqué que la misma podrá presentar una sobrecarga de papel, dándole la sensación de pérdida de control sobre su vida, exigiendo la reorganización de su vida cotidiana. El estudio también mostró la presencia de un hombre más participativo y compañero en la familia, más atento a las necesidades de las mujeres en ese período, más compañero y amigo, buscando asumir responsabilidades, compartiendo de las demandas de cuidado con su esposa, hijo y la casa. Entender cómo las mujeres experencian el cuidado en el puerperio, permite a la enfermera, más fácilmente, planificar las actividades educativas que las herramientas para su auto cuidado. Creo que, partiendo del conocimiento demostrado en este estudio podrá contribuir a la producción de una nuevo mirar para los seres humanos puerperios, permitiendo a la enfermera estandardizar sus consultas en el puerperio, de manera que las mismas no vuelven su mirada sólo para las medidas biológicas, sino también la incorporación de los aspectos subjetivos de la mujer.

Orientador: Anibal Faundes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T02:15:48Z (GMT). No. of bitstreams: 1 Viana_FranciscoJoseMachado_D.pdf: 6336629 bytes, checksum: 3497f0e3050f2c437022be217d4d77a0 (MD5) Previous issue date: 2009 / Resumo: Objetivo: Avaliar a efetividade de intervenções que objetivavam aprimorar o atendimento em um serviço de atenção a mulheres em situação de violência sexual e estudar a história de algumas dessas mulheres e os fatores associados ao tipo de violência sofrido. Sujeitos e Método: O estudo baseou-se no acompanhamento durante cinco anos das mulheres atendidas após agressão sexual na Maternidade Odete Valadares de Belo Horizonte, MG. Trata-se de estudo observacional, que em um primeiro estágio constou de uma retrospectiva realizada de 2003 a abril de 2006 e foi prospectivo do mês de maio de 2006 em diante, embasado em dados coletados nas fichas de notificação de violência dos prontuários e por meio de entrevistas realizadas durante o atendimento. Apresenta uma avaliação da efetividade de mudanças realizadas para prolongar o seguimento e para estimular a precocidade da consulta após a violência. Em relação às mulheres atendidas, procurou-se estudar suas características e os fatores associados às características da agressão sexual sofrida por mulheres considerando a via do coito, com as categorias somente vaginal, anal não exclusivo e oral não exclusivo, e número de vias de coito, categorizado em única e múltipla. Os fatores de risco foram características sociodemográficas e circunstâncias da agressão. Resultados: 681 mulheres foram atendidas no período. O retorno após a emergência aumentou de 25,3% para 47,3% após a primeira intervenção, mas não houve aumento na proporção das que continuaram o seguimento por mais de 90 ou 180 dias. A segunda intervenção não teve efetividade para estimular a consulta das mulheres dentro dos três primeiros dias decorridos em relação aos fatores associados ao tipo de agressão. Na análise ajustada, a ocorrência na via pública foi fator de proteção para coito exclusivamente vaginal e de risco para coito anal. Mulheres com mais escolaridade tiveram mais probabilidade de coito apenas vaginal e foi fator de proteção para coito anal. Ser agredida por desconhecido foi fator de risco para sexo oral Conclusão: A avaliação das intervenções para aprimorar o atendimento à mulher em situação de violência sexual na MOV mostra que não é uma tarefa fácil e que se trata de um processo muito dinâmico que precisa de constante avaliação. Algumas características da mulher e das circunstâncias da agressão permitem identificar maior risco de determinado tipo de agressão. O elemento principal é o atendimento solidário e compreensivo destas mulheres por uma equipe bem preparada, mas é preciso uma avaliação permanente das ações realizadas para conseguir o objetivo de prevenir as consequências deletérias da violência sobre a saúde e a vida destas mulheres / Abstract: Objective: To evaluate interventions performed with the purpose of improving the care of women who suffer sexual violence and to identify risk factors for the different types of sexual violence Subjects and Method: This is a prospective, observational study based on the data collected by mean of interviews carried out during the care and registered in the files of the Odete Valadares Maternity hospital of Belo Horizonte, MG. Evaluates de effectiveness of two interventions intending to stimulate and prolong the follow-up after the emergency care and to shorten the period between the aggression and the first visit to the emergency service. For the identification of risk factors for type of violence, the outcomes evaluated were route of penetration with categories, only vaginal, non-exclusive anal and non-exclusive oral, and number of routes of penetration categorized in single or multiple. The risk factors were socio-demographic characteristics and circumstances of the aggression. An unadjusted and adjusted analysis, estimating Odds Ratio was performed. Results: 650 women received care during the period. The return for follow up increased from 25,3% to 47,3% after the first intervention, but the second intervention had no effect over to the percentage of women requesting care during the first 72 hours after the aggression. In relation to of risk factors for type of violence, the adjusted analysis showed that aggression in the streets was protective for exclusively vaginal sex and a risk factor for anal penetration. Women with higher education had greater probability of only vaginal coitus and it was a protective factor for anal sex. Being attacked by an unknown person was a risk factor for oral sex. Conclusion: The evaluation of interventions with the purpose of improving the care of women who suffer sexual violence shows that is not an easy task, but of a very dynamic process requiring constant evaluation and adaptation. Some characteristics of women and the circumstances of the violence allow identifying a higher risk of the various route of penetration during sexual violence. The key element of the care is solidarity and understanding toward the women from a well trained professional team, but a permanent and careful evaluation of the actions taken to achieve the purpose of preventing the negative effects of sexual violence over the health and life of these women is an essential requirement / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

Uma sistemática de teleconsulta para o processo de programação, verificação e adaptação dos aparelhos de amplificação sonora individuais (AASI) foi desenvolvida e sua eficácia avaliada por meio de um estudo prospectivo, randomizado e cego. Participaram do estudo 50 deficientes auditivos (30 homens; 20 mulheres) candidatos ao uso do AASI, com idades variando entre 39 e 88 anos e média ISO dos limiares audiométricos entre 30 e 68,75dB. Os participantes foram alocados em dois grupos (randomização estratificada): controle (n=25), submetidos aos procedimentos face a face (F) e experimental (n=25) submetidos à teleconsulta (T). O procedimento F foi realizado pelo avaliador 1 em todos os participantes, incluindo: programação do AASI, medidas com microfone sonda (equipamento Unity PC Probe, estímulo speech noise, apresentado em 50, 65 e 80dBNPS) e orientação quanto ao uso e cuidados com o AASI. Para a teleconsulta o participante e um facilitador se posicionaram na sala junto aos equipamentos (ambiente de teste). O avaliador 1 posicionou-se em outra sala (ambiente remoto) com um notebook conectado à LAN USP. Webcams e headsets capturaram áudio e vídeo, transmitidos em tempo real pelo software Polycom PVX (384 kbps), também utilizado para compartilhamento de aplicativos. Por meio desse compartilhamento o avaliador 1 realizava todos os procedimentos diretamente no participante, com auxílio do facilitador. O tempo despendido para as consultas F e T foi cronometrado. Após as consultas o avaliador 2, cego quanto aos grupos, realizou a avaliação de percepção da fala (Hearing in Noise Test - HINT Brasil) para obter o limiar de reconhecimento de fala no silêncio (LRF) e a relação sinal/ruído (S/R) em que os participantes reconheciam 50% das sentenças apresentadas. Aproximadamente um mês após as consultas foi realizada (avaliador 2) a análise do tempo diário de uso do AASI (via datalogging do dispositivo) e do benefício e satisfação em vida diária (questionário International Outcome Inventory for Hearing Aids - IOI-HA). Maior tempo para a programação e verificação e menor tempo para orientação foi observado para o grupo experimental, sendo este estatisticamente significativo (teste t de Student). Não houve diferença entre grupos no tempo total do atendimento em minutos (82,2 controle e 81,3 experimental). A equiparação das medidas com microfone sonda aos respectivos targets foi similar para os dois grupos. Não houve diferença significativa (teste t) entre as médias do LRF no silêncio (56,24 controle e 51,78 experimental) e da relação S/R (4,94 controle e 4,17 experimental), o tempo médio de uso do AASI em horas (7,26 controle e 7,44 experimental) e das pontuações total e dos itens do questionário IOI-HA. Houve correlação (Spearman) positiva forte e significativa entre o tempo de uso do AASI e o tempo de uso informado pelo participante, para ambos os grupos. Para alguns participantes durante a teleconsulta houve interrupção da transmissão de áudio e vídeo que foi prontamente solucionada. Concluiu-se que a teleconsulta é um procedimento eficaz para a realização da programação, verificação do AASI e orientação de usuários quando, por algum motivo, serviços face a face não estiverem disponíveis. / A teleconsultation system for hearing aid (HA) programming, verification and fitting has been developed and its efficacy assessed through a prospective, randomized and blind study. Fifty hearing impaired individuals (30 men; 20 women), HA candidates, in the age range 39 - 88 years and ISO mean of audiometric thresholds between 30 and 68.75dBNA, participated in the study. The participants were divided into two groups (stratified randomization): control (n=25), submitted to face to face procedures (F) and experimental (n=25), submitted to teleconsultation (T). Procedure F was performed by evaluator 1 in all participants: HA programming, probe microphone measures (Unity PC Probe equipment, speech noise stimulus presented at 50, 65 and 80dBSPL) and HA use and care orientation. For the teleconsultation, the participant and a facilitator positioned themselves in the room with the equipment (test environment). Evaluator 1 stayed in another room (remote environment) with a notebook connected to the LAN USP. Webcams and headsets captured audio and video, transmitted in real time by software Polycom PVX (384 kbps), utilized as well for application sharing, through which evaluator 1 performed all the procedures directly in the patient, aided by the facilitator. The time spent for consultations F and T was recorded. Following the consultations, evaluator 2, blind to the groups, performed the speech perception assessment (Hearing in Noise Test - HINT Brazil) so as to obtain the speech reception threshold (SRT) in silence and the signal/noise ratio (S/N) in which the participants recognized 50% of the sentences presented. Nearly a month following the consultations the evaluator 2 carried out the analysis of daily time of HA use (via datalogging of the device) as well as benefit and satisfaction (questionnaire International Outcome Inventory for Hearing Aids - IOI-HA). An statistically significant (Students t test) greater time for the programming and verification and a smaller one for HA orientation were observed for the experimental group. No difference was found between the groups for the total consultation time in minutes (control: 82.2; experimental: 81.3). The real ear measures matching to targets were similar for the both groups. No significant difference was observed (Students t test) between the means of SRT in silence (56.24 control and 51.78 experimental) as well as the S/N ratio (4.94 control and 4.17 experimental), the daily amount HA use in hours (7.26 control and 7.44 experimental) and the IOI scores. For both groups there was a positive, strong and significant correlation (Spearman) between the daily amount of HA use (datalogging) and the reported HA use. For some participants, during the teleconsultation, the transmission of audio and video was interrupted, but readily restored. Conclusion: teleconsultation is an effective procedure for hearing aid programming, verification and fitting when face to face services are not available.

A presente tese teve por objetivo compreender as repercussões da condição da criança autista, na vida familiar e conjugal dos pais. Interrogamo-nos, ainda, acerca da utilização da entrevista clínica não-dirigida, seguindo o modelo da consulta terapêutica. Utilizamos também dados de prontuário como recurso auxiliar para obtenção de informações da criança e de seus pais. Participaram deste estudo cinco casais (dez participantes), pais de crianças autistas, cujo filho tinha sido diagnosticado recentemente, tendo iniciado as atividades em uma instituição para tratamento educacional especializado, localizada em um município do interior do Estado de São Paulo. O critério de inclusão empregado foi a participação de ambos os membros do casal nas entrevistas. Tratou-se de uma pesquisa de metodologia clínico-qualitativa, em que a Psicanálise foi a teoria de referência, especialmente a abordagem de Donald W. Winnicott. Além disso, apoiamo-nos nos estudos da Psicanálise familiar e de casal, para a análise do material clínico. O estudo pormenorizado das entrevistas estimulou reflexões a partir de três núcleos temáticos levantados: parentalidade e o lugar ocupado pela criança na dinâmica familiar; interface entre parentalidade e conjugalidade; a entrevista como um espaço de holding aos pais, diante da experiência de sofrimento vivenciado. De acordo com as narrativas dos casais, os resultados apontaram que pais e mães foram afetados pela problemática da criança, assim como a relação conjugal foi suplantada pela necessidade iminente de cuidados com o filho autista. Emergiram sentimentos de impotência frente à precariedade dos serviços de saúde, tanto em termos materiais como humanos. Observou-se que, como a descoberta do diagnóstico era recente, muitas angústias surgiram, principalmente por parte das mães, com referência ao tratamento institucional. Dentre elas, estavam as incertezas sobre o atendimento, a problemática da medicação e a inclusão escolar. O reconhecimento dessa condição do filho alterava a autoestima dos pais, levando-os a oscilarem entre momentos de crença e de descrença em face do desenvolvimento do filho, predominando sentimentos ambivalentes de desamparo e de esperança. Cada casal utilizou o setting proposto de forma singular e única, configurando-o de acordo com suas necessidades. Percebemos que a situação da entrevista favoreceu a criação de uma demanda que estava latente, tendo sido adotada como um espaço de escuta e de holding aos pais. Predominou um sentimento de urgência concernente à criança autista que tomava o lugar da vida conjugal e do cuidado com os outros filhos, quando existiam. Diante da complexidade das situações e da variedade de temas emergentes, verificamos que alguns casais puderam se questionar sobre a criação do filho, todavia, manifestaram-se pouco sobre o tipo de conjugalidade construída. Acreditamos que o modelo da consulta terapêutica representa uma proposta ampla e flexível de atendimento aos pais que pode ajudá-los no alívio de suas angústias. Preconizamos que essa modalidade possa servir como um dispositivo de atenção à saúde mental, nos serviços relacionados à problemática em questão / The objective of this thesis is to comprehend the impact of the condition of autistic children on family life and the conjugal relationship of the parents. We also explore the use of the clinical, non-directed interview, following the model of therapeutic consultation. We use data from medical records as an additional resource to obtain information about the child and its parents. Five couples (ten participants), parents of autistic children, whose child had recently been diagnosed and had commenced activities in an educational institution for specialist educational treatment, located in a municipality in the interior of the state of Sao Paulo, participated in this study. The inclusion criterion was the participation of both members of the couple in the interviews. This was a clinical-qualitative study in which psychoanalysis was the theory of reference, especially the approach of Donald W. Winnicott. In addition, we rely on studies of psychoanalysis of families and of couples for the analysis of the clinical material. The detailed study of the interviews prompted reflections on three core themes that emerged: parenting and the space occupied by children in family dynamics; the interface between parenthood and the conjugal relationship; the interview as a holding space for parents on the experience of suffering. According to the narratives of the couples, the results indicated that fathers and mothers were affected by the childrens problem and the conjugal relationship has been superseded by the urgent need to care for the autistic child. Feelings of powerlessness in the face to the precariousness of Health Services, in both material and human terms, emerged. It was observed that, as the discovery of the diagnosis was recent a lot of anguish has arisen, principally for mothers, in relation to institutional treatment. Among them were the uncertainties about the service, the issue of medication and of school inclusion. The recognition of the child\'s condition altered the self-esteem of parents causing them to oscillate between moments of belief and disbelief in the face of the development of the child, predominantly ambivalent feelings of helplessness and hope. Each couple used the setting proposed in a singular and unique way, according to their needs. We perceived that the interview situation favored the creation of a demand that was latent and this was taken as a listening and holding space for the parents. A feeling of urgency prevailed concerning the autistic child, who took the place of the conjugal relationship and the care of other children, when they existed. Given the complexity of the situations and the variety of emerging themes, we found that some couples might question the creation of the child, however, reveal little about the type of conjugal relationship construction. We believe that the model of therapeutic consultation represents a comprehensive and flexible proposal for the assistance of parents which can help to alleviate their anguish. We advocate that this method can serve as a means of care for mental health in the services related to the issue in question

Syfte med studien var att belysa skolsköterskors erfarenheter av hälsosamtal med nyanlända elever som kommit till Sverige tillsammans med sina familjer. En kvalitativ design med induktiv ansats och semistrukturerade intervjuer tillämpades. Totalt inkluderades sju skolsköterskor från olika skolor i Västernorrlands län och i Stockholms län. Intervjumaterialet bearbetades genom innehållsanalys. Resultatet av studien visade på ett tema "Att vara mer än bara skolsköterska" med tre huvudkategorier; "Att utmanas i sin yrkesroll som skolsköterska i hälsosamtalet" "Att berikas i sin yrkesprofession i samband med hälsosamtalet" "Att inte räcka till i hälsosamtalet som skolsköterska" Vidare bildades 14 stycken subkategorier. Samtliga skolsköterskor betonade att mötet med nyanlända elever i samband med hälsosamtal innebar att vara mer än bara skolsköterska, baserat på både positiva och negativa faktorer. Hälsosamtal med nyanlända elever innebar olika typer av utmaningar som ofta var relaterade till avsaknad av riktlinjer, kunskapsbrist, tidsbrist och resursbrist. Trots de utmaningar som framkom i studien uppgav skolsköterskorna att de hankade sig fram. Vidare uppgav skolsköterskorna att de berikades i sin yrkesroll i samband med hälsosamtalet vilket skapade en känsla av tillfredsställelse och ett engagemang av att vilja hjälpa och finnas där för dessa elever på ett djupare plan. De beskrev också en känsla av att inte räcka till i hälsosamtalet med eleven, vilket väckte känslor som osäkerhet, frustration och maktlöshet hos skolsköterskorna samt påverkade deras professionella förhållningssätt. Alla deltagare i studien var överens om att det saknades riktlinjer för bemötande av nyanlända elever på gymnasienivå och att det fanns kunskapsluckor hos skolsköterskorna gällande kulturella skillnader. Deltagarna efterfrågade också handledning i arbetet med nyanlända elever. / The aim of this study was to investigate and disclose the experiences that school nurses encounter, in regard to health consultations, with newly arrived foreign students. The study had a qualitative design and was composed of semi structured interviews with an applied inductive approach. In total, seven interviews were performed with separate school nurses from the counties of Västernorrland and Stockholm. The interview material was processed through a content analysis. The results from the study indicated a theme of " being more than a school nurse" was composed of three main constituents; "To be challenged in one´s profession as a school nurse in health consultations" "To be enriched in one's profession in regard to health consultations" "To be inadequate in the health consultations as a school nurse" Based on both positive and negative factors, all school nurses affirmed that the meeting with the newly arrived foreign students, in regard to health consultations, resulted in being more than a school nurse. Health consultations with the students involved different types of challenges that consisted of inadequate guidelines, knowledge, time and resources. In spite of the challenges posed by the findings in this report, the school nurses asserted that they inched forward. The school nurses argued that they were enriched in their role in relation to the health consultations, which resulted in a sense of satisfaction and a commitment of wanting to help and be there for these students on a deeper level. The nurses reported a feeling of being inadequate during the consultations with the students, which brought forth feelings of insecurity, frustration and helplessness with the nurses. They reported that even their professional disposition had been affected. All participants in this study agreed that current high school health consultation guidelines were inadequate and confirmed that they lacked some knowledge in regard to cultural differences. The participants also requested guidance in their work involving newly arrived foreign students.

Abstract The background to this study was, firstly, the shortage of doctors in the remote areas in Finland and secondly, the possibilities to use new IT-technology to the organization of health care services. The aim was to find out whether it is possible to organize consultations between GPs and patients as remote work through the use of videoconferencing equipment. In literature the results of the studies on teleconsultations in remote areas have been positive in many specialties from the point of view of operating the system, patient satisfaction and costs. However few studies of teleconsultations are available in the area of general practice. The aims of this study were to identify the technical solutions what teleconsultation requires and to report on the implementation of the solutions and process of the teleconsultations. Two hypotheses were to be tested in the study: first that patients treated in the traditional way were more satisfied than teleconsultation patients: the second was that while a sizeable patient group could be treated remotely, teleconsultation would prove to be more expensive than the traditional consultation. The teleconsultation part of the study was organized so, that the patient and a trained nurse were in Puolanka Health Center and the GP in the city of Kajaani (100 kilometers away). The videoconferencing system worked on the LAN in the Kainuu area. The study group consisted of two random groups, 508 patient visits were treated as remote work and 490 visits were treated in the traditional way in Puolanka Health Center. In addition to the diary of technical problems and the patient satisfaction questionnaires the measures of the study were the analysis of success in the consultation and the account of the return consultations in the remote group. A part of consultations were videotaped and the success in transfer of information was analysed from those tapes. The cost of the consultation was calculated, and sensitivity analysis was used to examine the cost of teleconsultations for diabetic patients. The results indicated that with a local area network it is possible to build a well functioning, reasonably priced teleconsultation system. The patients were equally satisfied with the teleconsultation as with the traditional consultation. The transfer of information in teleconsultations was good enough to make reliable diagnoses. It is estimated that three out of four from a random population in general practice could be treated in teleconsultation. Although it is about 30% more expensive to treat patients by teleconsultation than by the traditional method, the advantages of the teleconsultation model are that it enables an efficient transfer of information and know-how regardless of distance, and that it enhances considerably the traditional scope of health care services. / Tiivistelmä Tutkimuksen lähtökohtana oli syrjäisten alueiden lääkäripula ja toisaalta telelääketieteen mukanaan tuomat mahdollisuudet järjestää palveluja uudella tavalla. Tarkoituksena oli selvittää, voidaanko lääkärin vastaanottopalveluita tuottaa etätyönä videoneuvottelujärjestelmää käyttäen. Kirjallisuuden mukaan tulokset monien erikoisalojen televideokonsultaatioista olivat myönteisiä toimivuuden, potilastyytyväisyyden ja kustannusten näkökulmista: mutta perusterveydenhuollon tutkimuksia etävastaanotosta ei löytynyt. Tutkimuksen tavoitteena oli selvittää millaisia teknisiä ratkaisuja etävastaanotto vaatii ja kuvata valitun järjestelmän toimivuus sekä etävastaanottotapahtuman kulku. Hypoteesissa oletettiin tavallisella vastaanotolla hoidettujen olevan hieman etä-vastaanotolla käyneitä tyytyväisempiä ja että merkittävä osa potilasjoukosta voidaan hoitaa etätyönä sekä että etävastaanottokäynti on kalliimpi kuin tavallinen vastaanottokäynti. Tutkimus toteutettiin siten, että etävastaanottotilanteessa potilas oli hoitajan kanssa Puolangan terveyskeskuksessa ja lääkäri Kajaanissa. Yhteys hoidettiin videoneuvottelujärjestelmällä, joka käytti Kainuun atk-alueverkkoa. Tutkimusjoukko koostui kahdesta satunnaistetusta ryhmästä, joista 508 vastaanottokäynnin ryhmä hoidettiin etätyönä ja toinen 490 käynnin ryhmä tavallisella vastaanotolla Puolangan terveyskeskuksessa. Mittareina käytettiin teknisten ongelmien päiväkirjaa ja potilastyytyväisyyskyselyä, vastaanoton onnistumisen arviointia ja etävastaanoton uusintakäyntien tarpeen selvitystä. Tiedon siirtymisen onnistumista tutkittiin siten, että analysoitiin joukko videonauhoitettuja vastaanottoja, laskettiin vastaanottokäyntien kustannukset ja tarkasteltiin herkkyysanalyysien avulla etävastaanottomallilla toteutetun diabetesetävastaanoton kustannuksia. Tuloksien mukaan on mahdollista rakentaa toimiva, kohtuuhintainen etävastaanottojärjestelmä, kun käytetään alueellista atk-verkkoa. Potilaat olivat vähintään yhtä tyytyväisiä etävastaanottoon kuin tavalliseen. Tiedon siirtyminen etävastaanotolla on riittävän hyvä luotettavien päätelmien tekemiseksi. Noin kolme neljäsosaa valikoimattomasta perusterveydenhuollon potilasjoukosta voitiin hoitaa etätyönä. Lääkärin oma arvio vastaanoton onnistumisesta oli kuitenkin parempi perinteisessä vastaanotossa ja etävastaanotolla jouduttiin määräämään hieman enemmän laboratoriokokeita. Kun etävastaanottomallia käytetään korvaamaan tavanomainen vastaanottotapa ilman toiminnallisia ja organisatorisia muutoksia, se on noin 30 % kalliimpi kuin tavanomainen. Etävastaanottomalli kuitenkin mahdollistaa tehokkaan tiedon ja osaamisen siirtymisen välimatkasta riippumatta ja luo edellytykset uudenlaisille tavoille organisoida terveydenhuollon palveluita.

This study examines different meanings attached to and practices adopted during Swedish local consultation processes on offshore wind power projects. It analyses the role played by those processes in a democratic planning context, as well as the ways in which they are implemented. It also identifies overarching process models. The study is informed by theories on democracy, planning, participation, communication, and media. The empirical material comprises three case studies, each examining experiences of local consultation processes for wind power projects that led to differences in local reception. Methodologically, the study triangulates analyses of semi-structured interviews, documents and news articles. The results show that, in a Swedish context, the role of local consultation processes is to create legitimacy and trust in the process and planning decisions. The complex dynamics become evident in the different forms of participation, knowledge generation, and communication employed during the consultation. This is shown to be the result of various democratic and planning attitudes to locally-situated interests and knowledge, which in turn lead to differing views on local understanding for and acceptance of project proposals. The study develops three schematic models that correspond to different types of consultation processes. An important conclusion is that the content and form of local consultation processes depends on the agency of several actors on different scales. They are not simple pre-designed by project planners, but the result of a far more complex interaction between a host of local actors, including officials, local media, and local communities. The categorisation of different local consultation processes could contribute to awareness about the implications of various ways of working with large-scale projects from local perspectives. / I den här avhandlingen undersöks lokala förankringsprocesser med ett särskilt fokus på havsbaserade vindkraftsprojekt. Diskussionen uppehåller sig vid frågor om förankringsprocessens roll i en svensk planeringskontext, samt hur olika utformningar av processen kan påverka det lokala mottagandet. Studien visar att förankringsprocesser ytterst handlar om legitimitet och tillit. I praktiken förekommer en stor variation, komplexitet och dynamik i lokala förankringsprocesser. Det yttrar sig bland annat genom olika former av deltagande, kunskapsbyggande och kommunikation. Centralt i resonemangen är demokratiska och planeringsmässiga förhållningssätt till platsbundna intressen och kunskaper. På så sätt tydliggörs skillnader i synen på förståelse och lokal acceptans avseende ett projektförslag. Genom studien urskiljs också tre schematiska förankringsmodeller som belyser sådana skillnader. Förståelse för lokala förankringsprocesser har betydelse inte minst avseende påverkan på lokal acceptans för storskaliga projekt.

La consultation est présente dans plusieurs domaines, tels que la psychologie, les ressources humaines, la gestion, l’éducation, l’informatique, et la comptabilité (Bordeleau, 1998; Lescarbeau, Payette et St-Arnaud, 2003; Stern et Tutoy, 2003). Plusieurs entreprises font régulièrement appel à des consultants pour les aider à résoudre un problème, à optimiser un processus ou à former leurs employés. Les individus font également appel aux consultants pour les aider à clarifier leurs objectifs ou à établir un plan d’action pour les atteindre. Ces consultants jouent parfois un rôle de conseiller, d’expert, d’accompagnateur, de coach, de psychothérapeute. Ils aident leurs clients en analysant leurs besoins, en faisant preuve d’écoute, en les aidant à trouver des solutions, à développer un plan d’action ou à acquérir de nouvelles compétences. Toutefois, les mandats de consultation n’ont pas tous le succès escompté et plusieurs facteurs semblent nécessaires pour réussir. L’introduction de la thèse présente la recherche effectuée sur les caractéristiques personnelles des consultants efficaces, car c’est un aspect que le consultant peut développer par l’entremise de l’expérience, de la formation, de la supervision ou du coaching. De plus, étant donné le petit nombre de recherches trouvées sur le sujet, il semblait pertinent et avant-gardiste de s’y attarder davantage. Les résultats sont présentés dans deux articles, l’un présentant les résultats de la recherche documentaire et l’autre présentant les résultats de la recherche exploratoire effectuée. D’abord, le premier article partage les résultats de la recension documentaire sur la consultation, sur l’efficacité de la consultation et les caractéristiques personnelles des consultants qui y sont liées. Six catégories de caractéristiques des consultants liées à l’efficacité en consultation ont émergé des analyses : les caractéristiques sociodémographiques, les habiletés interpersonnelles et intellectuelles, les traits de personnalité, les comportements et les connaissances. Il est à noter que la documentation expose surtout des descriptions basées sur les expériences des auteurs, quelques études de cas et peu de recherches empiriques ou exploratoires. Le second article présente les résultats d’une recherche exploratoire sur les caractéristiques personnelles des consultants liées à leur perception d’efficacité en consultation. Cette étude a été effectuée pour pallier au manque de recherches trouvées sur le sujet. Elle visait à répondre à deux questions : 1. Quelles sont les caractéristiques de personnalité et sociodémographiques des consultants en lien avec a) l’efficacité globale en consultation et b) chacun des critères de cette efficacité? 2. Quelle est la puissance prévisionnelle des caractéristiques de personnalité et sociodémographiques à l’endroit de a) l’efficacité globale en consultation et de b) chacun des critères de cette efficacité? Au total, 135 consultants provenant de quatre cabinets et deux associations de professionnels, de quatre pays différents, ont participé à la recherche. Il a été possible de mesurer deux catégories de caractéristiques des consultants efficaces identifiées dans le premier article : les traits de personnalité (Hogan et Hogan, 2007) et les caractéristiques sociodémographiques, par l’entremise de questionnaires auto-rapportés. De plus, les consultants ont évalué les critères d’efficacité utilisés et atteints dans leurs consultations (Roy, 2008). Ainsi, en analysant les résultats, il est important de considérer qu’ils reflètent la perception de ce que les consultants estiment important pour leur efficacité. L’article présente ces résultats de manière détaillée suite aux analyses corrélationnelles et de régression qui ont été effectuées. La sensibilité interpersonnelle, le fait d’apprécier les interactions sociales et d’être proactif socialement, la sociabilité, l’intérêt à avoir une diversité d’expériences et de contacts, l’ambition, le leadership, la vitesse de passage à l’action, le fait d’être préoccupé par l’opinion des autres et la confiance en autrui s’avèrent liés à la perception d’efficacité globale en consultation, ainsi qu’à plusieurs des critères relatifs à la satisfaction du consultant et à la conduite de son intervention. Pour terminer, la discussion de ce second article, de même que la conclusion de la thèse, font des liens entre ces résultats et la documentation, présentent les apports et limites de la recherche, ainsi que des pistes de recherche futures. / Consultation is an important part of the professional practice in several fields such as psychology, human resources, management, education, informatics and accounting (Bordeleau, 1998; Lescarbeau, Payette et St-Arnaud, 2003; Stern et Tutoy, 2003). Several businesses regularly hire consultants to help them resolve problems, improve a process or train their employees. Individuals also contact consultants to help them clarify their objectives and make an action plan. These consultants can play an expert, partner, coach or psychotherapeutic role. They help their clients by analysing their needs, listening to them, finding solutions, making an action plan or acquiring new skills. Yet the degree of success of the mandates may vary and several factors may affect success. The introduction focus is on the personal characteristics of the effective consultants, because the consultants may improve it by training, coaching, supervision and experience. Moreover, this research is useful and original since only a small amount of studies were found on this topic. The results are presented in two articles, one more theoretical and the other presenting the exploratory research results. The first article presents the literature results on consultation, effectiveness and the personal characteristics of consultants that are related to it. Six categories of consultant characteristics emerged from the analysis: interpersonal and intellectual skills, behaviours, knowledge, socio-demographic and personality characteristics. The literature is based on authors’ descriptions, case studies and a small amount of empirical and exploratory studies. The second article presents exploratory research results on personal characteristics of the consultants related to consultants’ perception of effectiveness. This study was conducted to address the lack of research found on the subject. It was designed to answer two questions: 1) What personality and socio-demographic consultant characteristics are related to a) consultation global effectiveness b) each effectiveness criteria? 2) What is the predictive power of personality and socio-demographic characteristics in relation to a) consultation global effectiveness b) each effectiveness criteria? In total, 135 consultants from four firms and two professional associations participated in the study. It was possible to measure two categories of the consultant characteristics identified in the first article: personality (Hogan et Hogan, 2007) and socio-demographic characteristics, through two self-reported questionnaires. Moreover, the consultants evaluated the effectiveness criteria used and achieved in their consultation (Roy, 2008). Thus, analysing the results, it is important to say that they reflect consultants’ perception of what they consider important for their effectiveness. The article presents these results in detail following correlational and regression analyses that were performed. Personality traits such as interpersonal sensitivity, love for social interactions, being socially proactive, sociability, interest in a variety of experiences and contacts, ambition, leadership, being action oriented, being concerned about the opinion of others, and trust in others seem to be related to the perception of the overall effectiveness as well as to several consultation criteria related to the satisfaction of the consultant and the conduct of its intervention. Finally, the discussion of this second article, as well as the thesis conclusion, make links between these results and the literature results, present the contributions and limits of the research, as well as future research directions.

Magister Legum - LLM / Indigenous peoples constitute at least 5000 distinct peoples with a population of more than 370 million, living in 70 different countries. These peoples are typically subjected to a number of human rights violations (being excluded from decision-making processes and forced to assimilate into dominant groups, among others). The plight of these peoples has recently received worldwide attention. In 1989, the international community adopted the Convention on Indigenous and Tribal Peoples (Convention 169) to protect the rights of these peoples. In 2007 the UN adopted a Declaration on Indigenous peoples’ Rights. Attention is now focused on implementing indigenous peoples’ rights at the domestic level. Cameroon is not yet a party to Convention No.169 and so cannot be bound under the Convention to protect the rights of its indigenous peoples. Cameroon often denies any duty in this regard. However, Cameroon is party to core human rights instruments like the International Covenant on Civil and Political Rights, International Covenant on Economic, Social and Cultural Rights, International Convention on the Elimination of all forms of Racial Discrimination and the African Charter on Human and Peoples Rights and Freedom. Cameroon also voted in favour of the adoption of the UN Declaration on Indigenous Peoples Rights. These international human rights instruments, with the exclusion of the Declaration, are not specifically dedicated to indigenous peoples’ rights. Given this situation, two questions arise: is Cameroon bound by any international legal obligation to protect the rights of its indigenous peoples; and if so, is Cameroon implementing the basic international law principles relating to indigenous peoples’ rights. Using an in-depth study and analysis of various international human rights treaties to which Cameroon is a party, this research will explore the grounds on which Cameroon, though not a party to Convention 169, can be held bound to protect the rights of its indigenous peoples (chapter 2). This research present the situation of the indigenous peoples in Cameroon and provide a brief overview of the legislative and policy measures taken by the government which in some way provide entry points for the protection of the rights of the indigenous people in Cameroon (chapter 3). A critical analysis of these measures highlights some areas of success but also work that remains to be done to ensure that the rights of Cameroon’s indigenous peoples are fully protected (chapter 4). The study concludes with a number of recommendations for further study and legal reform (chapter 5).

Ce travail propose une analyse de la mobilisation citoyenne autour du projet de LGV Bordeaux-Toulouse sur une période de dix ans. La mise en place du débat public par la CNDP en 2005 constitue une étape permettant à la population de prendre connaissance de l'existence d'un projet LGV. Ce premier débat public n'engage aucun tracé précis, l'enjeu est essentiellement de statuer sur l'opportunité d'une LGV entre Bordeaux et Toulouse. Progressivement, une mobilisation se structure. Cependant, nous montrons que la mobilisation n'est pas homogène tout au long du tracé et dépend du contexte local. Il n'y a que dans le Bordelais où les citoyens se mobilisent et participent au débat public organisé par la CNDP pour contester le projet LGV. En 2009, le maître d'ouvrage, RFF, met en place un nouveau dispositif participatif : la concertation dite " GPSO " (Grand Projet du Sud-Ouest). L'enjeu de cette nouvelle procédure participative vise, cette fois-ci, l'élaboration d'un tracé précis. La proposition d'un tracé par le maître d'ouvrage contribue à généraliser la contestation relative à la LGV au-delà du Bordelais. En effet, lors du débat public de 2005 la question de l'opportunité du projet a été tranchée, ce que remettent en cause les groupes civiques de Bordeaux à Toulouse. Dans le Lot-et-Garonne, notamment, de nombreuses associations d'opposants voient le jour et s'organisent en collectif, la Coordination 47. Ces associations se structurent et s'entendent pour proposer un projet alternatif. Contrairement au maître d'ouvrage qui souhaite la création de nouvelles voies, la Coordination 47 défend, quant à elle, la possibilité de réhabiliter les voies existantes. La Coordination 47 s'engage alors dans d'importantes actions de sensibilisation de la population afin de favoriser la participation des citoyens à l'enquête publique qui se déroule en 2014. Les militants ont obtenu gain de cause : la participation du " public " a été soutenue et la commission d'enquête a rendu un avis défavorable. A ce jour, le gouvernement n'a pas encore rendu sa décision. / This work proposes an analysis of the mobilization citizen around the project of "LGV Bordeaux-Toulouse" over a period of ten years. The implementation of the public debate by CNDP in 2005 establishes a stage allowing the population to acquaint with the existence of a project LGV. This first public debate engages no precise plan, the stake is essentially to rule on the opportunity of a LGV between Bordeaux and Toulouse. Gradually, a mobilization forms itself. However, we show that the mobilization is not homogeneous throughout the plan and depends on the local context. There are that in the "Bordelais" only the citizens mobilize and participate in the public debate organized by CNDP to dispute the LGV project. In 2009, the project owner, RFF, sets up a new participative procedure: the said dialogue "GPSO" (Big Project of the Southwest). The stake in this new participative procedure aims, this time, at the elaboration of a precise plan. The proposal of a plan by project owner contributes to generalize the contesting relative to the LGV beyond the "Bordelais". Indeed, during the public debate of 2005 the question of the opportunity of the project was cut, what question the civic groups from Bordeaux to Toulouse. In Lot-et-Garonne, in particular, a lot of opponents associations are born and get organized in collective, the Coordination 47. These associations form themselves and get on to propose an alternative project. Contrary to the project owner who wishes the creation of new ways, the Coordination 47 defends the possibility of rehabilitating the existing ways. The Coordination 47 makes a commitment then in important awareness-raising activities of the population to favor the participation of the citizens in the public inquiry which takes place in 2014. The activists were proved right: the participation of the "public" was supported and the commission of inquiry returned an unfavorable opinion. To date, the government has not taken its decision yet.