Kroniska sjukdomar ökar världen över, i både utvecklings- och industrialiserade länder. Mäniskor som lider av kroniska sjukdomar finner ofta den västerländska medicinen oförmögen att behandla deras sjukdommar, och vänder sig istället till traditionell, komplementär och alternativ medicin [TM/CAM]. TM/CAM har visat sig vara effektiv vid prevention och behandling av kroniska sjukdomar, varför det är av stort intresse att undersöka möjligheten för ökad integration av TM/CAM inom de nationella sjukvårdssystemen. Syftet med denna studie är att undersöka de krafter som främjar respektive förhindrar kommunikation och samarbete mellan utövare av ayurveda, västerländsk och traditionell medicin, samt att se hur detta påverkar integrationen av de medicinska subsystemen på Sri Lanka. Fokus för studien är ett specifikt samarbetsprojekt, “The outcome oriented, evidence informed community health promotion program”, vars mål är att integrera ayurveda och västerländsk medicin inom primärvården. En kvalitativ studie genomfördes under tre månader på Sri Lanka med hjälp av semi-strukturerade intervjuer, deltagande observation samt analys av dokument. Paul Unschulds teori om strukturerad konkurrens, samarbete eller integration användes vid tolkningen av resultaten. Resultaten tyder på att den huvudsakliga formen för samexistens mellan ayurveda och västerländsk medicin på Sri Lanka är strukturerad konkurrens, medan samarbetsprojektet siktar mot att uppnå strukturerat samarbete. Det parallella politiska system som styr samexistenseen mellan ayurveda och västerländsk medicin tycks förhindra integration, medan en ökad professionalisering genom nationella regleringar skapar ökat samarbete och integration. Brist på kunskap om ayurveda bland medicinstudenter förhindrar samarbete. Samtidigt kan inflytandet från västerländsk medicin i den auyurvediska universitetsutbildningen till synes både främja och förhindra samarbete och integration. Genom att höja kompetensen omkring forskningsmetodik och hälsovårdsystem hos ayurvediska läkare kan samarbete främjas. Likaså är forskning utformad med hänsyn till ayurvediska grundprinciper samt närvaro av nyckelpersoner med kompetens inom både ayurveda och västerländsk medicin främjande faktorer för samarbete och integration. / Non-communicable diseases [NCDs] are increasing in both developing and developed countries. Western medicine is not able to offer satisfying solutions and treatments for people suffering from NCDs. TM/CAM have shown promise of effectiveness in the prevention and treatment of NCDs and many people now turn to TM/CAM. Hence it is of great interest to investigate the possibilities of increased integration of TM/CAM in national health care systems. This study was carried out in Sri Lanka, with the aim to investigate the main forces promoting and obstructing cooperation and communication between practitioners of Ayurvedic, Western and traditional medicine, in order to see how this affects integration of the medical subsystems. The focus of this qualitative study was the “Outcome oriented, evidence informed Ayurvedic Community Health Promotion Program”; a collaboration project aiming to integrate Ayurveda and Western medicine in primary health care. Semi-structured interviews, participatory observation and document analysis were carried out during three months in Sri Lanka and the results were analysed using Paul Unschuld’s theory on structured competition, cooperation or integration. The results indicate that the overall coexistence of Ayurveda and Western medicine in Sri Lanka is structured competition, while the collaboration project is aiming for structured cooperation. The results further show that the Sri Lankan parallel political approach to integration can be argued to obstruct integration, while the regulation of Ayurvedic practitioners increases cooperation through professionalization. Education is a main influencing factor for cooperation; lack of CAM-knowledge in medical students obstructs cooperation while westernization of Ayurvedic doctors both promotes and obstructs cooperation and integration. Capacity building, research based on Ayurvedic fundamentals and keypersons with knowledge of both sectors are of importance for increased cooperation and integration to come about.

Background: Knowledge of the relationship between fat free mass (FFM) and strength capacity is not only useful in athlete coaching, but may also be important in developing clinical strategies for evaluating health in general populations. Sufficient skeletal muscle mass and strength are important factors for health and physical function. Bioelectrical impedance analysis (BIA) is a popular and clinically useful tool for assessing body composition. However, being able to simultaneously estimate whole body muscle strength without having to perform additional tests may prove useful in evaluating an individual’s health and physical function. Aim: The primary purpose of this study was to quantify the association between total body fat free mass percentage (TBFFM%) and relative strength in the isometric midthigh pull test (IMTP) and grip strength (GS) test in a healthy general young Swedish population. A secondary purpose was to investigate if there are any sex differences.  Methods: The design for this study was cross-sectional. The studied sample represented a general Swedish population of healthy young adults. Participants were asked to participate in testing on one occasion. Three tests were used for collecting data: BIA for data on FFM and both IMTP and hand dynamometer grip strength test for data on maximal force production. All tests were performed in the movement lab on Halmstad University campus. Statistical analyses were done using Pearson’s correlation and linear regression analysis. Results: Participants for this study consisted of healthy females (n=18) and males (n=17) aged 19-39. The primary findings of this study are that there are strong correlations between TBFFM% and relative strength (r = 0.621) in the IMTP test as well as relative GS (r = 0.705) on a whole-group level. The correlation between TBFFM% and relative GS was slightly stronger. Categorized by sex, we found strong positive correlations between TBFFM% and relative IMTP (r = 0.551) and relative GS (r = 0.596) for the female group and moderately strong correlations for the male group (relative IMTP r = 0.411; relative GS  r = 0.422).On a whole-group level, every unit increase in TBFFM% increases relative strength in the IMTP by 0.538N/kgBW (β = 0.538) and relative GS by 0.015 kg/kgBW (β = 0.015). Conclusion: TBFFM% was strongly associated with both relative IMTP strength and relative GS where the association was stronger for females than for males. TBFFM% values may be indicative of an individual's strength, which could be of value in a research setting.

[ES] La cristalografía de rayos X es una potente técnica para la resolución de la estructura atómica de macromoléculas. La información generada, tiene gran impacto sobre diferentes campos relacionados con la investigación básica y aplicada, como son la biomedicina y diseño de fármacos, al igual que en el desarrollo de aplicaciones nanotecnológicas y biotecnológicas. Esta Tesis se centra en determinadas problemáticas actuales y en las proteínas involucradas en las mismas (TryR, eEF1A2 y CBDP35), siendo éstas sujeto de desarrollo biotecnológico en los campos de la biomedicina, farmacia y de la industria alimentaria, en el que la cristalografía de rayos X juega un papel crucial para dilucidar sus estructuras atómicas y funciones. En consideración a la biomedicina y diseño de fármacos, hemos resuelto la estructura de la Tripanotión reductasa (TryR) de Leishmania infantum en complejo con potentes inhibidores de su actividad oxidorreductasa, con potencial de desarrollo como fármacos. Así, se ha caracterizado la unión y mecanismo de acción de éstos inhibidores. TryR es una reconocida diana farmacológica para el tratamiento de la enfermedad de Chagas, la Tripanosomiasis Humana Africana y la leishmaniosis, ya que desempeña un papel crucial y esencial en el metabolismo redox de los parásitos de la familia Trypanosomatidae. Además, se han analizado los parámetros de cristalización y difracción de novedosos inhibidores de la dimerización de TryR, cuyo diseño racional se basa en la unión a la interfaz de dimerización de la misma. La oncoproteína eEF1A2, involucrada en múltiples funciones celulares y sujeto de numerosas modificaciones post-traduccionales, se une al fármaco anticancerígeno plitidepsina. La cristalografía de rayos X, combinada con experimentos de espectrometría de masas, se han utilizado como herramientas para identificar nuevas modificaciones post-traduccionales y características estructurales en eEF1A2:GDP. Una modificación única, la adición de etanolamina fosfoglicerol (EPG) a aminoácidos conservados (Glu301 y Glu374 en mamíferos), se ha observado aquí por primera vez. El análisis estructural de estos hallazgos facilita la comprensión de las múltiples funciones y regulaciones de eEF1A2. La adquisición de una muestra conformacionalmente homogénea de eEF1A2:GTP, necesaria para la unión a la plitidepsina, ha sido evaluada en ensayos de cristalización del complejo terciario de eEF1A2: GTP: plitidepsina. Con respecto al dominio de unión a la pared celular de la endolisina PlyP35 codificada por el fago P35 de Listeria monocytogenes (CBDP35), hemos resuelto la estructura cristalina de CBDP35 en un complejo con ácido teicoico natural de L. monocytogenes serovar 1/2a. Esta estructura es el primer módulo de unión a la pared celular en complejo con ácidos teicoicos jamás dilucidado. El análisis estructural reveló los principales determinantes para la unión de la pared celular bacteriana, en particular, el mecanismo molecular del reconocimiento de N-acetil-d-glucosamina, una decoración de carácter glicosídico en ácidos teicoicos de serovares patógenos de L. monocytogenes. Estos hallazgos arrojan luz sobre el desarrollo biotecnológico de nuevas herramientas en la industria alimentaria y las terapias derivadas de fagos para detectar y tratar infecciones bacterianas. / [CA] La cristal·lografia de raig X és una potent tècnica per a la resolució de l'estructura atòmica de macromolècules. La informació generada té gran impacte sobre diferents camps relacionats amb la investigació bàsica i aplicada, com són la biomedicina i disseny de fàrmacs, igual que en el desenvolupament d'aplicacions nanotecnológiques i biotecnològiques. Aquesta Tesi es centra en determinades problemàtiques actuals i en les proteïnes involucrades en les mateixes (TryR, eEF1A2 i CBDP35), sent estes subjecte de desenvolupament biotecnològic en els camps de la biomedicina, farmàcia i de la indústria alimentària, en el que la cristal·lografia de raig X juga un paper crucial per a dilucidar les seues estructures atòmiques i funcions. En consideració a la biomedicina i disseny de fàrmacs, hem resolt l'estructura de la Tripanotión reductasa (TryR) de Leishmania infantum en complex amb potents inhibidors de la seua activitat oxidorreductasa, amb potencial de desenrotllament com a fàrmacs. Així, s'ha caracteritzat la unió i mecanisme d'acció d'estos inhibidors. TryR és una reconeguda diana farmacològica per al tractament de la malaltia de Chagas, la Tripanosomiasi Humana Africana i la leishmaniosi, ja que exerceix un paper crucial i essencial en el metabolisme redox dels paràsits de la família Trypanosomatidae. A més, s'han analitzat els paràmetres de cristal·lització i difracció de nous inhibidors de la dimerizació de TryR, el disseny racional dels quals es basa en la unió a la interfície de dimerización de la mateixa. L'oncoproteína eEF1A2, involucrada en múltiples funcions cel·lulars i subjecte de nombroses modificacions posttraduccionals, s'unieix al fàrmac anticancerigen plitidepsina. La cristal·lografia de raig X, combinada amb experiments d'espectrometria de masses, s'han utilitzat com a ferramentes per a identificar noves modificacions posttraduccionals i característiques estructurals en eEF1A2:GDP. Una modificació única, l'addició d'etanolamina fosfoglicerol (EPG) a aminoàcids conservats (Glu301 i Glu374 en mamífers), s'ha observat ací per primera vegada. L'anàlisi estructural d'estes troballes facilita la comprensió de les múltiples funcions i regulacions d'eEF1A2. L'adquisició d'una mostra conformacionalmente homogènia d'eEF1A2:GTP, necessària per a la unió a la plitidepsina, ha sigut avaluada en assajos de cristal·lització del complex terciari d'eEF1A2: GTP: plitidepsina. Respecte al domini d'unió a la paret cel·lular de l'endolisina PlyP35 codificada pel fago P35 de Listeria monocytogenes (CBDP35), hem resolt l'estructura cristal·lina de CBDP35 en un complex amb àcid teicoico natural de L. monocytogenes serovar 1/2a. Esta estructura és el primer mòdul d'unió a la paret cel·lular en complex amb àcids teicoicos mai dilucidat. L'anàlisi estructural va revelar els principals determinants per a la unió de la paret cel·lular bacteriana, en particular, el mecanisme molecular del reconeixement de N-acetil-d-glucosamina, una decoració de caràcter glicosídico en àcids teicoicos de serovares patògens de L. monocytogenes. Estes troballes fan llum sobre el desenrotllament biotecnològic de noves ferramentes en la indústria alimentària i les teràpies derivades de fagos per a detectar i tractar infeccions bacterianes. / [EN] X-ray crystallography is a powerful technique for atomic structure resolution of macromolecules. The information generated impacts different fields involving basic and applied research on biomedicine and drug design and the development of nanotechnology and biotechnological applications. This dissertation focuses on current problematics and the target proteins involved (TryR, eEF1A2 and CBDP35) that are in sight for biotechnological development in the biomedical, pharmaceutical and food industry fields, in which X-ray crystallography plays a crucial role in the elucidation of their atomic structures and functions. Attaining to biomedical and drug design problematics, we have solved the structure of Leishmania infantum TryR in complex with potent oxidoreductase inhibitors prone to further development as anti-trypanosomal drugs, thereby characterizing their binding and mechanism of action. This protein is a long recognized drug target for the treatment of Chagas disease, Human African Trypanosomiasis and leishmaniasis, as it plays a crucial and essential role in the redox-metabolism of the Trypanosomatidae parasites. Moreover, the crystallization and diffraction parameters of novel TryR dimerization disruptors have been assayed for inhibitors which have been rationally designed to bind the dimerization interface of TryR. The "moonlighting" oncoprotein eEF1A2 is known to be highly post-translationally modified and to bind the anticancer drug plitidepsin. X-ray crystallography, combined with mass-spectrometry experiments, have been used as tools to identify novel post-translational modifications and structural features in eEF1A2:GDP. A unique modification, namely the addition of ethanolamine phosphoglycerol (EPG) to conserved glutamic residues (Glu301 and Glu374 in mammals), has been here observed for the first time. Structural analysis of these findings facilitate the understanding of eEF1A2's multiple functions and regulations. The acquirement of a conformationally homogenous eEF1A2:GTP sample, necessary for plitidepsin binding, has been has been assayed for eEF1A2:GTP:plitidepsin complex crystallization. Regarding the cell wall binding domain of Listeria monocytogenes phage-encoded endolysin PlyP35 (CBDP35), we have solved the crystal structure of CBDP35 in complex with natural Listeria serovar 1/2a teichoic acid. This structure is the first cell wall binding module in complex with teichoic acids ever elucidated. Structural analysis revealed the main determinants for bacterial cell-wall binding, in particular, the molecular mechanism of N-acetyl-d-glucosamine recognition, a glycosidic moiety in teichoic acids of pathogenic serovars of L. monocytogenes. These findings shed light upon the biotechnological development of new tools in the food industry and phage-derived therapies to detect and treat bacterial infections. / Agradecer al Ministerio de Educación, Cultura y Deporte por haberme proporcionado el contrato FPU (FPU14/03190) que me ha permitido desarrollar esta Tesis Doctoral en el Instituto de Química-Física “Rocasolano” del Consejo Superior de Investigaciones Científicas (IQFR-CSIC), así como la financiación otorgada para poder realizar mi estancia predoctoral en el laboratorio del Prof. Hammershmidt, en Greifswald, Alemania (EST17/00751). / Carriles Linares, AÁ. (2019). STRUCTURAL BIOMEDICINE: CHARACTERIZATION OF THE STRUCTURAL BASIS IN PROTEIN-DRUG RECOGNITION IN DIFFERENT HUMAN DISEASES [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/130844 / TESIS

No / Cytochrome P450 (CYP) is one of the most important drug-metabolizing enzyme families, which participates in the biotransformation of many endogenous and exogenous compounds. Quantitative analysis of CYP expression levels is important when studying the efficacy of new drug molecules and assessing drug-drug interactions in drug development. At present, chemical probe-based assay is the most widely used approach for the evaluation of CYP activity although there are cross-reactions between the isoforms with high sequence homologies. Therefore, quantification of each isozyme is highly desired in regard to meeting the ever-increasing requirements for carrying out pharmacokinetics and personalized medicine in the academic, pharmaceutical, and clinical setting. Herein, an absolute quantification method was employed for the analysis of the seven isoforms CYP1A2, 2B6, 3A4, 3A5, 2C9, 2C19, and 2E1 using a proteome-derived approach in combination with stable isotope dilution assay. The average absolute amount measured from twelve human liver microsomes samples were 39.3, 4.3, 54.0, 4.6, 10.3, 3.0, and 9.3 (pmol/mg protein) for 1A2, 2B6, 3A4, 3A5, 2C9, 2C19, and 2E1, respectively. Importantly, the expression level of CYP3A4 showed high correlation (r = 0.943, p < 0.0001) with the functional activity, which was measured using bufalin-a highly selective chemical probe we have developed. The combination of MRM identification and analysis of the functional activity, as in the case of CYP3A4, provides a protocol which can be extended to other functional enzyme studies with wide application in pharmaceutical research.

This thesis is concerned with plants, chronic illness and medicine in Oku, Northwest Region, Cameroon. I focus on patient strategies to obtain effective medical outcomes, and on how such outcomes may be obtained through seeking traditional medicine in Oku. I argue that biomedical notions of efficacy do not appropriately represent the central and diverse roles that plants play in traditional medicine nor do they correctly represent how people in Oku evaluate the efficacy of plant-based traditional medicine. I argue instead that efficacy must be understood in terms of the emic concept of power. This power is understood to be located in the Oku landscape, which is still uniquely forested and said to embody powerful ancestral spirits. With plants as the primary tangible material of power, and traditional doctors in Oku as those who claim exclusive rights to manipulate and disperse such power, I discuss traditional medicine in Oku as a system wherein power from the natural landscape is drawn upon to challenge harmful powers feared to derive from the social arena. Using the pragmatic and phenomenological approaches, I show how patients evaluate the efficacy of a medical treatment based on their bodily experiences, and how their actions, as revealed in their therapeutic trajectories, reveal their satisfaction or dissatisfaction with a given diagnosis and/or therapy. I discuss how enduring illness generates and exacerbates bodily, treatment-outcome, social, and psychological uncertainties. In this context, effective outcomes can be understood as those which address and limit these uncertainties and anxieties while offering ways to imagine hopeful prognoses. This thesis then outlines the major sources of uncertainty, people’s responses to such uncertainties, and what people might achieve in terms of limiting uncertainties by seeking traditional medicine in Oku.

Avhandlingen undersöker ett centralt steg inom vetenskapliga praktiker: hur laboratorieprov översätts till data som anses giltiga och användbara av forskargemenskapen. Baserat på ett multilokalt fältarbete bestående av observationer och intervjuer i laboratorier för genetisk forskning, visas i avhandlingen hur laboratoriepersonalens yrkesskicklighet, samt normer och ideal om vetenskaplig forskning, formade deras praktiker av att producera giltiga data. Eftersom maskiner var väsentliga i forskningen undersöker avhandlingen också de former av agens som människor och maskiner ansågs bidra med till produktionen av giltiga data; giltighet tolkades som reproducerbarhet av forskarna. Med hjälp av representationsbegreppet och Latours begrepp om inskriptioner och immutable mobiles analyserar avhandlingen arbetet med att förvandla laboratorieprov till giltiga data som en tvåstegsprocess. Proven omvandlades först till rådata som sedan tolkades till data. Personalens huvudsakliga ansträngningar fokuserade i det första steget på att uppnå säkra resultat genom att bekämpa osäkerhet i material och metoder. I det andra steget var det viktigaste att eliminera subjektivitet och att göra objektiva tolkningar av rådatan. Laboratoriepersonalens yrkesskicklighet och användning av maskiner var viktiga verktyg för att eliminiera osäkerhet och subjektivitet. Säkra och objektiva resultat, dvs giltiga data, förväntades uppnås med hjälp av maskiner. Med användning av bl a Barad’s begrepp agential realism analyserar avhandlingen de olika förståelser av människor och maskiner som formade forskarnas praktiker och möjliggjorde skapandet av giltiga data. / This dissertation explores a central step in scientific practices: how samples are turned into data that is considered valid and useful by the research community. Based on multi-sited fieldwork, with observations and interviews at laboratories involved in genetic research, the study focuses on how the laboratory staff’s professional skill, norms, and ideals of scientific research formed their practices of making valid data. As machines were essential for this research, the study also investigates the forms of agency that humans and machines were seen as contributing to the making of valid data; validity being interpreted as reproducibility by the scientists involved. Drawing upon notions of representations as well as Latour’s concepts of inscriptions and immutable mobiles, the study analyzes the practices of transforming samples into valid data as a two-step process. The samples were first turned into raw data, which was subsequently interpreted as data. During the first step, the staff’s central concern was to battle uncertainty in materials and procedures and establish certainty of results, whereas in the second step it was of vital importance to eliminate subjectivity and make objective interpretations of the raw data. Central tools for eliminating uncertainty and subjectivity were the laboratory staff’s professional skill and the use of machines. Certainty and objectivity of results, i.e. valid data, were expected to occur with the help of machines. Drawing upon e.g. Barad’s framework of agential realism, the study analyzes the various understandings of notions of humanness and machineness which shaped scientists’ practices and made the creation of valid data possible.

Si hier les guérisseurs revendiquaient uniquement le besoin de reconnaissance, aujourd’hui, ils se battent plutôt pour que la reconnaissance qui leur a été accordée par l’État soit capable d’intégrer les conceptions africaines de la maladie et des thérapies ; de les protéger au même titre que les biomédecins dans l’exercice de leur profession ; de protéger les malades en cas de préjudices moral et physique. Ils craignent que la reconnaissance [accordée] ne soit pas reconnue juridiquement par une loi camerounaise qui régule leurs pratiques de soins. Dans la mesure où, sans une reconnaissance juridique et institutionnelle, il leur est impossible de se maintenir dans l’espace [public] de sociabilité thérapeutique ; de changer, à partir de la position illégitime, leurs conditions de praticiens précaires, et surtout leur relation aux usagers de soins [les mères] et aux biomédecins. Dans cette perspective, on se demande quelles sont les modalités d’intéressement ou de désintéressement mutuel qui permettent aux guérisseurs – affaiblis institutionnellement – et aux biomédecins – fortement reconnus – d’évoluer vers une réciprocité de perspectives. L’étude cherche à identifier les modes d’arrachement à l’affaiblissement institutionnel, en s’intéressant, d’un côté, aux processus de capacitation et de renforcement de la légitimité ; et de l’autre, à l’impact de ce renforcement, d’abord, sur la redéfinition des objets et figures de la rencontre et de la reconnaissance, et ensuite, sur la reconfiguration de l’espace de soins et du profil du thérapeute camerounais contemporain. Pour répondre à cet objectif, nous avons sollicité le cadre théorique de la sociologie des épreuves d’inspiration pragmatiste [Thévenot, Boltanski, Gennard et Cantelli] et de l’anthropologie capacitaire [Ricœur]. Les observations de consultations en Maisons de Soins [chez les guérisseurs] et au Centre Mère et Enfant [Hôpital pédiatrique] et les entretiens individuels effectués à Yaoundé [Cameroun] ont engendré une réflexion sur le sens que donnent les mères, guérisseurs et biomédecins au fait de rencontrer ou de refuser de rencontrer un soignant. L’analyse des données recueillies inscrit la rencontre dans l’axe de la reconnaissance capacitaire [des compétences], permettant ainsi d’envisager une pluralité de figures de la reconnaissance et de la rencontre. Elle indique aussi que si la formation à l’identité professionnelle biomédicale constitue pour les guérisseurs une tactique de renforcement de leur légitimité, l’inscription en médecines africaines de certains biomédecins [résistants ou non conformistes] les prédisposent à une résistance institutionnelle aux normes biomédicales ; ce qui permet de nuancer, au regard de la pluralisation et de la diversification des rationalités en jeu, la compréhension du caractère monolithique des institutions. Il en résulte une réflexion sur le brouillage des frontières entre les médecines africaines et la biomédecine, ce brouillage ayant alors comme conséquences, entre autres, une possible fragmentation ou morcellement de ces médecines en termes de «biomodernisation» des médecines africaines et de «traditionalisation» de la biomédecine en contexte africain. / If yesterday the need for recognition was the core claim among traditional health practitioners, today, their quest resides in the recognition not only of their practice but also of the African conceptions of diseases and therapies; in their protection as profesionnals (such as biomedical health practictioners); in the protection of patients in case of moral or physical prejudices. The traditional health practitioners fear that their recognition will not extend to or be sanctioned by Cameroonian law, which regulates their care practices. Without legal and institutional recognition, it is impossible for these practitioners to remain in the social care space; to change, from their illegitimate position, their condition of precarious practitioners, and especially their relationship to biomedical health practitioners. Thus, what are the modalities of mutual interestedness or disinterestedness that allow traditional [institutionally weakened] and biomedical practitioners [strongly recognized] to evolve towards reciprocity of perspectives? The study is seeking to identify modes of wrenching from the institutional weakening, focusing, on one hand, on empowerment and reinforcing processes of healers’ legitimacy; and on the other hand, to the impact of empowerment on the redefinition of objects and figures of encounter and of recognition, on the reconfiguration of social care space and the profile of the therapist. To achieve this objective, we have sought the reference framework of sociology of proofs and the anthropology of capacity of Ricœur. The observations of consultations in «Maisons de Soins» and to the «Centre Mère et Enfant» and interviews have led to a reflection on the interpretation associated by mothers, traditional and biomedical health practitioners to what it means to consult or refuse to consult traditional healer or biomedical practitioner. The analysis of data situates the encounter in the axis of capacity of recognition, allowing us to consider multiple figures of recognition and of encounter. It shows that if the adoption of the biomedical professional identity constitutes for traditional health practitioners a tactic of reinforcement of their legitimacy, the integration in African medicines of some biomedical health practitioners predispose them to an institutional resistance to biomedical norms; making it possible to nuance the comprehension of the monolithic character of institutions, given pluralization and diversification of rationalities at stake. This results in a reflection on blurring of frontiers of African medicines and biomedicine, thus giving place to a possible fragmentation of these medicines in terms in terms of biomodernization of African medicines and traditionalization of biomedicine.

No description available.

This thesis explores how scientists within the controversial scientific field of gene  transfer make their research doable. Based on in-depth interviews with gene transfer scientists and key individuals from different regulatory agencies and advisory boards in Sweden and the U.S.A., the study focuses on how scientists describe and reason about how they handle the various problems that confront them as they work in a technically advanced and highly controversial field of research. Drawing upon Clarke and Fujimura’s concepts of situatedness and doability, Latour’s concepts of enrollment and translation, Strauss’concepts of articulation work and alignment as well as Gieryn’s concept of boundary-work, the study analyzes how doable problems are constructed within gene transfer, from basic science to clinical application on human subjects. Doable problems were constructed by enrolling allies on different levels, translating interests and creating alignment of interests and activities of the allies enrolled. The study covers how scientists handle questions of funding, research cooperation and choice of scientific material as well as the ethical complications involved in gene transfer research and its applications. For the U.S. scientists an essential part of creating doable problems consisted of boundary-work in relation to regulatory demands and interventions, something that did not concern the Swedish scientists to the same extent. Gene transfer, due to its controversial character, has raised public fears and concerns. Using Goffman’s concept of frames, the study also analyzes how gene transfer scientists attempt to gain public acceptance by framing gene transfer as an ordinary kind of therapy, while simultaneously heralding it as a revolutionary new technology, in order to obtain the external funding necessary for an expensive and extensive research. / Avhandlingen undersöker hur forskare inom det kontroversiella forskningsfältet genterapi gör sin forskning möjlig. Utifrån djupintervjuer med genterapiforskare samt med nyckelpersoner inom  regleringsmyndigheter och rådgivande organ i Sverige och USA visas i avhandlingen hur forskare beskriver och resonerar kring hur de hanterar olika problem som uppstår i deras arbete inom ett vetenskapligt avancerat och mycket kontroversiellt forskningsfält. Med hjälp av Clarke och Fujimura’s begrepp situatedness och doability, Latour’s begrepp enrollering och översättning, Strauss’ begrepp articulation work och alignment samt Gieryn’s begrepp gränsarbete analyserar avhandlingen forskarnas arbete med att konstruera utförbara problem inom genterapiforskning, från grundforskning till klinisk tillämpning på människor. Detta sker genom enrollering av allierade på olika nivåer, genom översättning av olika aktörers intressen samt genom att dessa enrollerade allierades verksamheter och intressen läggs i linje med forskarnas egna. Avhandlingen tar upp hur forskarna hanterar olika praktiska problem, som finansiering, forskningssamarbete och val av forskningsmaterial, samt hur de bemöter de olika etiska problem som genterapiforskningen och dess tillämpning innebär. Avhandlingen visar även på en viktig skillnad mellan de intervjuade amerikanska och svenska forskarna. I USA måste forskarna hantera en stark reglering av deras arbete, något som inte berör de svenska forskarna på samma sätt; de amerikanska forskarna måste därvid använda olika former av gränsarbete i sina relationer till reglerande myndigheter. Genterapins osäkra och kontroversiella karaktär har orsakat rädsla och oro hos allmänheten. Avhandlingen analyserar genterapiforskarnas försök att skapa samhällelig acceptans för sin forskning genom att ge den en inramning som en etablerad form av medicinsk behandling. Detta sker i viss motsättning till en parallell inramning av genterapi som en ny och revolutionerande teknologi, något som sker i syfte att erhålla den nödvändiga finansieringen för en kostnadskrävande och omfattande forskning.

Si hier les guérisseurs revendiquaient uniquement le besoin de reconnaissance, aujourd’hui, ils se battent plutôt pour que la reconnaissance qui leur a été accordée par l’État soit capable d’intégrer les conceptions africaines de la maladie et des thérapies ; de les protéger au même titre que les biomédecins dans l’exercice de leur profession ; de protéger les malades en cas de préjudices moral et physique. Ils craignent que la reconnaissance [accordée] ne soit pas reconnue juridiquement par une loi camerounaise qui régule leurs pratiques de soins. Dans la mesure où, sans une reconnaissance juridique et institutionnelle, il leur est impossible de se maintenir dans l’espace [public] de sociabilité thérapeutique ; de changer, à partir de la position illégitime, leurs conditions de praticiens précaires, et surtout leur relation aux usagers de soins [les mères] et aux biomédecins. Dans cette perspective, on se demande quelles sont les modalités d’intéressement ou de désintéressement mutuel qui permettent aux guérisseurs – affaiblis institutionnellement – et aux biomédecins – fortement reconnus – d’évoluer vers une réciprocité de perspectives. L’étude cherche à identifier les modes d’arrachement à l’affaiblissement institutionnel, en s’intéressant, d’un côté, aux processus de capacitation et de renforcement de la légitimité ; et de l’autre, à l’impact de ce renforcement, d’abord, sur la redéfinition des objets et figures de la rencontre et de la reconnaissance, et ensuite, sur la reconfiguration de l’espace de soins et du profil du thérapeute camerounais contemporain. Pour répondre à cet objectif, nous avons sollicité le cadre théorique de la sociologie des épreuves d’inspiration pragmatiste [Thévenot, Boltanski, Gennard et Cantelli] et de l’anthropologie capacitaire [Ricœur]. Les observations de consultations en Maisons de Soins [chez les guérisseurs] et au Centre Mère et Enfant [Hôpital pédiatrique] et les entretiens individuels effectués à Yaoundé [Cameroun] ont engendré une réflexion sur le sens que donnent les mères, guérisseurs et biomédecins au fait de rencontrer ou de refuser de rencontrer un soignant. L’analyse des données recueillies inscrit la rencontre dans l’axe de la reconnaissance capacitaire [des compétences], permettant ainsi d’envisager une pluralité de figures de la reconnaissance et de la rencontre. Elle indique aussi que si la formation à l’identité professionnelle biomédicale constitue pour les guérisseurs une tactique de renforcement de leur légitimité, l’inscription en médecines africaines de certains biomédecins [résistants ou non conformistes] les prédisposent à une résistance institutionnelle aux normes biomédicales ; ce qui permet de nuancer, au regard de la pluralisation et de la diversification des rationalités en jeu, la compréhension du caractère monolithique des institutions. Il en résulte une réflexion sur le brouillage des frontières entre les médecines africaines et la biomédecine, ce brouillage ayant alors comme conséquences, entre autres, une possible fragmentation ou morcellement de ces médecines en termes de «biomodernisation» des médecines africaines et de «traditionalisation» de la biomédecine en contexte africain. / If yesterday the need for recognition was the core claim among traditional health practitioners, today, their quest resides in the recognition not only of their practice but also of the African conceptions of diseases and therapies; in their protection as profesionnals (such as biomedical health practictioners); in the protection of patients in case of moral or physical prejudices. The traditional health practitioners fear that their recognition will not extend to or be sanctioned by Cameroonian law, which regulates their care practices. Without legal and institutional recognition, it is impossible for these practitioners to remain in the social care space; to change, from their illegitimate position, their condition of precarious practitioners, and especially their relationship to biomedical health practitioners. Thus, what are the modalities of mutual interestedness or disinterestedness that allow traditional [institutionally weakened] and biomedical practitioners [strongly recognized] to evolve towards reciprocity of perspectives? The study is seeking to identify modes of wrenching from the institutional weakening, focusing, on one hand, on empowerment and reinforcing processes of healers’ legitimacy; and on the other hand, to the impact of empowerment on the redefinition of objects and figures of encounter and of recognition, on the reconfiguration of social care space and the profile of the therapist. To achieve this objective, we have sought the reference framework of sociology of proofs and the anthropology of capacity of Ricœur. The observations of consultations in «Maisons de Soins» and to the «Centre Mère et Enfant» and interviews have led to a reflection on the interpretation associated by mothers, traditional and biomedical health practitioners to what it means to consult or refuse to consult traditional healer or biomedical practitioner. The analysis of data situates the encounter in the axis of capacity of recognition, allowing us to consider multiple figures of recognition and of encounter. It shows that if the adoption of the biomedical professional identity constitutes for traditional health practitioners a tactic of reinforcement of their legitimacy, the integration in African medicines of some biomedical health practitioners predispose them to an institutional resistance to biomedical norms; making it possible to nuance the comprehension of the monolithic character of institutions, given pluralization and diversification of rationalities at stake. This results in a reflection on blurring of frontiers of African medicines and biomedicine, thus giving place to a possible fragmentation of these medicines in terms in terms of biomodernization of African medicines and traditionalization of biomedicine.