Grâce à l’évolution de la technologie à travers le Web, la documentation relative à la santé est de plus en plus abondante et accessible à tous, plus particulièrement aux patients, qui ont ainsi accès à une panoplie d’informations sanitaires. Malheureusement, la grande disponibilité de l’information médicale ne garantit pas sa bonne compréhension par le public visé, en l’occurrence les non-experts. Notre projet de thèse a pour objectif la création d’une ressource de simplification de textes médicaux, à partir d’une analyse syntaxico-sémantique des verbes dans quatre corpus médicaux en français qui se distinguent de par le degré d’expertise de leurs auteurs et celui des publics cibles. La ressource conçue contient 230 patrons syntaxicosémantiques des verbes (appelés pss), alignés avec leurs équivalents non spécialisés. La méthode semi-automatique d’analyse des verbes appliquée pour atteindre notre objectif est basée sur quatre tâches fondamentales : l’annotation syntaxique des corpus, réalisée grâce à l’analyseur syntaxique Cordial (Laurent, Dominique et al, 2009) ; l’annotation sémantique des arguments des verbes, à partir des catégories sémantiques de la version française de la terminologie médicale Snomed Internationale (Côté, 1996) ; l’acquisition des patrons syntactico-sémantiqueset l’analyse contrastive du fonctionnement des verbes dans les différents corpus. Les patrons syntaxico-sémantiques des verbes acquis au terme de ce processus subissent une évaluation (par trois équipes d’experts en médecine) qui débouche sur la sélection des candidats constituant la nomenclature de la ressource de simplification. Les pss sont ensuite alignés avec leurs correspondants non spécialisés, cet alignement débouche sur le création de la ressource de simplification, qui représente le résultat principal de notre travail de thèse. Une évaluation du rendement du contenu de la ressource a été effectuée avec deux groupes d’évaluateurs : des linguistes et des non-linguistes. Les résultats montrent que la simplification des pss permet de faciliter la compréhension du sens du verbe en emploi spécialisé, surtout lorsque un certains paramètres sont réunis. / With the evolution of Web technology, healthcare documentation is becoming increasinglyabundant and accessible to all, especially to patients, who have access to a large amount ofhealth information. Unfortunately, the ease of access to medical information does not guaranteeits correct understanding by the intended audience, in this case non-experts. Our PhD work aimsat creating a resource for the simplification of medical texts, based on a syntactico-semanticanalysis of verbs in four French medical corpora, that are distinguished according to the levelof expertise of their authors and that of the target audiences. The resource created in thepresent thesis contains 230 syntactico-semantic patterns of verbs (called pss), aligned withtheir non-specialized equivalents. The semi-automatic method applied, for the analysis of verbs,in order to achieve our goal is based on four fundamental tasks : the syntactic annotation of thecorpora, carried out thanks to the Cordial parser (Laurent et al., 2009) ; the semantic annotationof verb arguments, based on semantic categories of the French version of a medical terminologyknown as Snomed International (Côté, 1996) ; the acquisition of syntactico-semantic patternsof verbs and the contrastive analysis of the verbs behaviors in the different corpora. Thepss, acquired at the end of this process, undergo an evaluation (by three teams of medicalexperts) which leads to the selection of candidates constituting the nomenclature of our textsimplification resource. These pss are then aligned with their non-specialized equivalents, thisalignment leads to the creation of the simplification resource, which is the main result of ourPhD study. The content of the resource was evaluated by two groups of people : linguists andnon-linguists. The results show that the simplification of pss makes it easier for non-expertsto understand the meaning of verbs used in a specialized way, especially when a certain set ofparameters is collected.

Embora sejam grandes os progressos com a promulgação da Constituição de 1988, que garante constitucionalmente a saúde como direito de todos e dever do Estado, esse direito não tem sido assegurado no mesmo nível e com a mesma qualidade de atenção, em especial, para a população negra. Depois de uma revisão sobre a história a influência das teorias racialistas e de gênero como categoria de análise na medicina, discute-se uma síntese da história recente das práticas médicas no Brasil e a reflexão critica sobre essas práticas centradas no tecnicismo. O objetivo deste estudo, parte da linha de pesquisa Pesquisa Psicossocial da Desigualdade: Relações Étnico-raciais, foi descrever que sentidos e significados médicos e médicas conferem aos temas médico-sociais na sua trajetória e formação, especialmente como concebem os determinantes sociais de gênero e raça Foram entrevistados 25 médicos (13 médicos e 12 médicas) que orientam e são preceptores de alunos da residência médica em um hospital universitário. O roteiro abordava o perfil sócio-demográfico e sua trajetória profissional; o seu nível de conhecimento e contato com os determinantes sociais (pobreza, gênero, cor/raça, nacionalidade, religião dos diferentes grupos populacionais) durante a formação acadêmica; que fatores consideravam relevantes para uma boa relação médico-paciente; seu conhecimento sobre Direitos Humanos e os princípios do Sistema Único de Saúde; as experiências na relação médico-paciente e de cuidado. Depois de um aquecimento propiciado pela situação da entrevista, entre os resultados, o estudo permitiu observar como os médicos entrevistados reconhecem alguns marcadores sociais da diferença que se transformam em desigualdade, os lugares sociais diferentes para homens e mulheres, brancos, amarelos e negros, lugares de maior ou menor privilégio e de obstáculo para o sucesso técnico. As diferenças e desigualdade de gênero foram mais fáceis de serem explicitadas e os entrevistados articulavam um repertório levemente maior para o tema. Todos os entrevistados, em algum momento, usaram o discurso sobre o instintivo e natural, e a maior parte deles compreende o masculino e o feminino de um modo muito conservador, com problemas para encontrar definições para perguntas supostamente simples. No caso da desigualdade racial, observamos que houve uma polarização: de um lado a negação das desigualdades entre brancos e não brancos, do outro temos a valorização da identidade branca, compondo bem com o racismo à brasileira. O contexto social foi associado à pobreza mais que qualquer outro indicador da desigualdade social. Cenas de racismo e sexismo institucional foram frequentes. Os poucos entrevistados que tinham uma noção mais sofisticada sobre gênero e raça eram aqueles que contaram com a oportunidade de desenvolver uma atividade de extensão, a iniciação científica ou que tiveram uma formação mais generalista, mais social. A trajetória trilhada na faculdade contribui, portanto, para a formação / Brazil\'s 1988 Constitution grants health as a human right to all and a duty of the State. Although great progress has been made since its enactment, this right has not been ensured at the same level and with the same service quality, particularly with regard to Afro-Brazilians. With close attention to history and the influence of racial and gendered theories, this article discusses the recent history of medical practices in Brazil and provides critical reflection on those practices that are centered on technique. The main purpose of this study, a part of the Psycho-social research on inequality: ethnic-racial relations research line, is to describe the meanings and significance that doctors give to medical social issues in their education. Special attention is given to their conception of the social determinants of gender and race. Twenty-five doctors (13 men and 12 women) were interviewed. All of them mentor medical students pursuing their residency at a University Hospital. The interviews script centered on their socio-demographic profile, their professional path and the degree of knowledge or contact with social determinants (poverty, gender, race/color, nationality, religion of the different population groups) during their academic formation, the factors they considered as relevant to a good doctor-patient relationship, their knowledge of Human Rights and the principles of the Sistema Único de Saúde (SUS) and their experiences in the care and doctor-patient relationships. Among its results, the study shows how the interviewed doctors recognize several social markers of difference that convert into inequity, the different social places for men and women, the white, the people of Asian descent and the black, places of greater or lower privilege and obstacle for technical success. The gender differences and inequalities were more easily explained and respondents articulated a slightly larger repertoire for the topic. All of the interviewees, at some moment, used the discourse on the instinctive and the natural, and most of them have a very conservative comprehension of the feminine and the masculine, and encountered problems in finding definitions for apparently simple questions. With regards to racial inequality, there was a polarization: on the one hand, the denial of inequalities among the white and the non white, on the other, a consistent evaluation of white identity, linked to the Brazilian racism. The social context was associated with poverty rather than any other indicator of social inequality. Evidence of racism and sexism were frequently observed in the interviews. The few interviewees that had a more sophisticated notion of gender and race were those who had had the chance to develop an extracurricular activity, the scientific initiation, or those who had had a more generalist and social education. Thus, the experience acquired during university contributes to the formation of their notions of social determinants in health

This research project addresses the following: how topical talk operates in the organisation and management of MSE interactions; and how topical talk operates in the co-ordination of specific service requests and service provisions. It draws on a corpus of audio-recorded and transcribed interactions between general practitioners and persons seeking general medical services in suburban clinics in Brisbane, Australia. The corpus comprised a total of 67 medical service events (henceforth MSEs), audio-taped with the full informed consent of the participants. Many contemporary medical sociological accounts of the operation of topical talk in MSEs, typified by the work of Mishler (1981, 1984) and Waitzkin (1991), remain anchored to the 'professional dominance' thesis (Freidson 1970a; 1970b), arguing for the fundamental conflict between two perspectives - lay and professional. Topical talk has been formulated as one expression of this conflict in 'doctor-centred' communicative 'styles' (Byrne and Long 1976; Silverman 1987). Within such accounts, familiar interactional patterns in MSEs, including the content and structure of topics, have been theorised as instruments of power and control whereby the dominance of specialised medical knowledge and expertise are established and maintained. Mishler's (1984) characterisation of the conflict between a biomedically oriented 'voice of medicine' used by professional physicians (henceforth GPs) and a 'voice of the lifeworld' used by persons seeking medical services (henceforth Ps) is an expression of the 'professional dominance' thesis. The voices are characterised as attesting to a fundamental, theoretically problematic, asymmetry of power relations between GPs and Ps, thereby reinforcing the ideological status of professionals in general and the medical profession in particular. Further, recommendations regarding correctives to 'professional dominance' centre on advice GPs to attend to the primacy of Ps' talk on their experiences of illnesses rather than apparently 'ignoring' or transforming these topics into biomedical accounts of disease. This research project critiques this formulation of topical talk and the traditional theoretical and empirical bases on which it has drawn. This critique arises from the application of ethnomethodological approaches to the study of MSEs. Such approaches, as outlined in Chapters 2 and 3, are characterised by a number of conceptual and analytic premises: First, particular social structural features of social activities and the institutional contexts within which activities occur should not be assumed to be the primary criteria for judging the import and adequacy of situated action. Second, the parties to situated social events mutually constitute those events in the real world. Third, issues of agency are collaborative situated accomplishments such that the management of everyday social activities is accomplished by the people involved who show one another the rationalities of their actions as they assemble the familiar scenic features of those same institutional events (Garfinkel 1967; Sacks 1992a, 1992b). These assumptions have been applied in ethnomethodological analyses of social action, including the analysis of professional service encounters that have critiqued the 'professional dominance' thesis (Eglin and Wideman 1986; Sharrock 1979). The novelty of this study is the analysis of the operation of topic organisation as a phenomenon of order. This study also draws on recommendations within Ethnomethodology (Hester & Eglin 1997b; Watson 1997) that sequential and categorial organisations are mutually informative in the analysis of the rationality of situated social action. One of the particular contributions of this thesis is that it not only jointly applies both conversation analysis and membership categorisation analysis but also extends this recommendation to the inclusion of topic analysis as was originally provided for by Sacks (1992a , 1992b) and Garfinkel and Sacks (1970). Within this study a model of analysis has been constructed that has enabled the analytical consideration of four dimensions of social organisation: local sequential, extended sequential, topical and categorial organisations. The theoretical and empirical concepts of ethnomethodogical analysis have thus been developed and extended within this project. The central findings of this study are that in institutional service events, the 'service topic' is both significant and consequential, and that persons constitute themselves as bona fide incumbents of the categories GP or P by attending to their actions as topically organised. The local adequacy of any particular interactional move (such as questioning-answering, greetings, the design of a topic proposal, etc) is shown to be referenced to the service topic. This study found no evidence of potential or actual "struggles" between the 'voice of the life-world and the voice of medicine'. Rather, this study finds routine recognition on the part of both Ps and GPs of the centrality of the service topic and, thereby, the service task, and no evidence of orientation to distinctive biographical contributions staged in competition with biomedically relevant service topics. It is found that Ps' biographical references were made in the context of an assembled service topic such that particular service tasks, however conventional, were constituted as both relevant and reasonable as medical goods and service for the specific service recipient and provider. At the most general level, it is concluded that the service topic operates as a phenomenon of order in MSEs where order, as defined by Garfinkel and Weider (1992: 202), refers to all of the rationalities evident in the generic features of institutional events and settings, that is, the situated logic and intelligibility as well as the procedures whereby they are constituted as recognisable social events. The thesis concludes with a discussion of the implications of the findings for the theorisation, policy-making, medical education, and practices of GPs and Ps within MSEs. Overall, the significance of this work for researchers into medical interactions is that the relevance of the service topic and its pervasive organisational consequences need to be considered analytically. A major outcome of this thesis is the establishment of a new order of interest within the study of institutional interactions. The project demonstrates the pervasive consequences of service topics and thus provides a step forward in the study of institutional service interactions and ways of theorising their rationality, a step that extends beyond social structural pre-theorisations of power and domination and also beyond interactional accounts of the primary relevance of turn taking structures.

<p>This thesis analyse how life-histories are expressed and reformulated in connection to a life crisis of ill health. The study is based on ten interviews with people who in connection with ill health have made use of treatments within both orthodox medicine and complementary medicine and who have also developed various forms of self-treatment. The overall aim is, with a point of departure in the concepts health, healing and trust, to analyse narratives as a practice through which the respondents create identity and a life-context. The signifi cance of constructing the (auto)biography of the healing narrative – a form of narrative and performative act – runs as the main thread through the thesis. This act makes up the practice that is recurrently discussed in several of the thesis’ chapters and is synonymously termed the telling of healing narratives or or to narrate health and healing. The analysis of the narrative’s The analysis of the narrative’s healing main themes is mirrored in the order of the chapters. The study is broadly thematic and structured as a generalised healing process beginning with upheaval, continuing with crisis and social drama, and further to the endeavour of expressing values and judgements in a public context.</p><p>The interview themes of self-treatment and alternative treatment have occasioned the investigation into what an ethno-medical perspective can bring to analyses of people’s experiences of ill health in an everyday medical context. One of the points of having the concept ethno-medicine as a starting point is that every practice or narrative formation is ascribed with a potential for interpretation in its creation of knowledge. Another chapter deals with two themes of identity and life-history construction in the practice of healing narratives – the need for a chronology and reappraised perspectives on body, health and lifestyle. Healing narratives can be understood as a genre of life-historical narratives where life is often described as a linear course of events. A model by the anthropologist Victor Turner on the course and content of social drama is used as a comment to analyses of three respondents’ narratives in another chapter. A drama can be understood as a tragic course of events, based on an accident or an upsetting incident that roughly revolves around event/crisis, chaos and the striving for restoration. The concept of other journals is then used to make visible the everyday medical administrative practice and refers to the documentation used in the form of collected documents, written notes, and diaries. As an unexpected part of healing processes, the necessity of familiarising oneself with rules, laws and health insurance systems in order to be able to claim one’s rights is brought forward.</p><p>The social transformation process of various care practices in society makes up both a context and a commonly occurring theme in the narratives that the thesis is based upon. A modern health culture that gains strength from loosely composed social movements exerts infl uence on all levels of society. With an increased individual responsibility, the need grows to fi nd one’s own healing strategies and to create one’s own life-history in narratives that mirror this transformation in an everyday context. Healing narratives can be seen as a form of evaluation of health-care practices where experiences of treatment and notions of health and cure and healing are concretised.</p>

This thesis analyse how life-histories are expressed and reformulated in connection to a life crisis of ill health. The study is based on ten interviews with people who in connection with ill health have made use of treatments within both orthodox medicine and complementary medicine and who have also developed various forms of self-treatment. The overall aim is, with a point of departure in the concepts health, healing and trust, to analyse narratives as a practice through which the respondents create identity and a life-context. The signifi cance of constructing the (auto)biography of the healing narrative – a form of narrative and performative act – runs as the main thread through the thesis. This act makes up the practice that is recurrently discussed in several of the thesis’ chapters and is synonymously termed the telling of healing narratives or or to narrate health and healing. The analysis of the narrative’s The analysis of the narrative’s healing main themes is mirrored in the order of the chapters. The study is broadly thematic and structured as a generalised healing process beginning with upheaval, continuing with crisis and social drama, and further to the endeavour of expressing values and judgements in a public context. The interview themes of self-treatment and alternative treatment have occasioned the investigation into what an ethno-medical perspective can bring to analyses of people’s experiences of ill health in an everyday medical context. One of the points of having the concept ethno-medicine as a starting point is that every practice or narrative formation is ascribed with a potential for interpretation in its creation of knowledge. Another chapter deals with two themes of identity and life-history construction in the practice of healing narratives – the need for a chronology and reappraised perspectives on body, health and lifestyle. Healing narratives can be understood as a genre of life-historical narratives where life is often described as a linear course of events. A model by the anthropologist Victor Turner on the course and content of social drama is used as a comment to analyses of three respondents’ narratives in another chapter. A drama can be understood as a tragic course of events, based on an accident or an upsetting incident that roughly revolves around event/crisis, chaos and the striving for restoration. The concept of other journals is then used to make visible the everyday medical administrative practice and refers to the documentation used in the form of collected documents, written notes, and diaries. As an unexpected part of healing processes, the necessity of familiarising oneself with rules, laws and health insurance systems in order to be able to claim one’s rights is brought forward. The social transformation process of various care practices in society makes up both a context and a commonly occurring theme in the narratives that the thesis is based upon. A modern health culture that gains strength from loosely composed social movements exerts infl uence on all levels of society. With an increased individual responsibility, the need grows to fi nd one’s own healing strategies and to create one’s own life-history in narratives that mirror this transformation in an everyday context. Healing narratives can be seen as a form of evaluation of health-care practices where experiences of treatment and notions of health and cure and healing are concretised.

No description available.

L’information des patients est devenue un enjeu de santé publique et une composante essentielle de la relation médecin patient. De nombreux auteurs s’accordent à dire que l’information écrite est un complément indispensable à l’obligation d’information orale car elle améliore la qualité des soins et l’adhérence du patient à sa prise en charge. Malgré l’existence de nombreuses Fiches d’Information Patient (FIP), le médecin a du mal à se les approprier. Elles sont souvent non validées, peu lisibles, difficiles à stocker, sans références, sources ni dates de rédaction. La première étape de notre travail a consisté à proposer une méthode pour élaborer des fiches d’information du patient (FIP) et à partir d’elle, 125 FIP concernant des motifs de consultation les plus fréquents en soins primaires. Une étude observationnelle réalisée dans 26 cabinets de médecine générale auprès de 350 patients, a montré d’une part que les patients sont demandeurs de FIP et qu’elles sont appréciées des patients. Et d’autre part, que la compréhension des maladies aiguës est plus limitée que celles des maladies chroniques ou situations de prescription chez les patients à faible niveau scolaire. Une étude interventionnelle randomisée en clusters réalisée dans 24 cabinets de médecine générale auprès de 400 patients, nous a permis de montrer que les FIP permettaient aux patients d’améliorer leur niveau de connaissances sur les pathologies et de modifier positivement leur comportements de santé, y compris pour les patients à faible niveau scolaire. Néanmoins, il n’était pas possible de comparer ces résultats à ceux de la littérature, les protocoles de recherche étant trop hétérogènes (critères de jugement spécifiques d’une situation clinique donnée).Pour surmonter cette difficulté, nous basant sur une « revue des revues » de la littérature, nous avons proposé un modèle théorique décrivant les modalités d’action des FIP au cours de la consultation, à partir duquel nous avons élaboré trois scores génériques utilisables pour tout type de consultation : un score de Communication Médecin Malade (CMM), un score de satisfaction et un score d’adhérence globale. Une fois les propriétés psychométriques de ces scores validés, nous avons étudié leurs déterminants. En situation aiguë, le seul déterminant de la CMM était la qualité de l’information reçu (quoi et que faire multipliant la probabilité d’une bonne communication par 11.9), les caractéristiques du patient n’influençant pas la CMM. L’adhérence globale est déterminée par le type de pathologie (paramètre inflexible) et par la qualité de la CMM. Enfin, la satisfaction, bien que tout autant liée à l’infrastructure, à l’équipe paramédicale et à l’équipe médicale, est également améliorée par une CMM de bonne qualité. En situation aiguë, la CMM est donc primordiale et impacte sur les indicateurs santé usuels que sont la satisfaction et l’adhérence des patients.Enfin, nous avons évalué avec ces nouveaux outils l’impact de 6 FIP sur la CMM, l’adhérence globale du patient et la satisfaction dans deux services d’urgences auprès de 324 patients. Cette étude interventionnelle avant-après nous a permis de montrer que les FIP améliorent: la CMM, la satisfaction vis-à-vis des professionnels de santé, le comportement des patients (qui respectent mieux les modalités de prises des médicaments et reconsultent moins dans les services d’urgences pour une même pathologie) et le comportement des médecins (qui prescrivent moins médicaments et davantage d’examens complémentaires). En situation aiguë, un outil simple pour améliorer la CMM est l’usage de FIP délivrée en complément de l’information orale.La CMM est un critère de jugement fondamental qu’il conviendra à l’avenir d’utiliser plus souvent, notamment pour évaluer les interventions thérapeutiques non pharmacologiques en plein essor, et pour lesquelles la communication est probablement un déterminant majeur de l’efficacité. / Patient information has become a public health issue and an essential component of Doctor-Patient communication (DPC). Many authors agree that written information is an indispensable complement to the obligatory oral information, since it improves the quality of care and the patient adherence. Despite the existence of numerous Patient Information Leaflets (PILs), physicians have difficulty appropriating them; they are often not validated, hard to read, difficult to store, without references, sources and dates of writing. The first step in our work was to propose a methodology for developing PILs and from there, design 125 PILs for the most common reasons for consultation in primary care. An observational study carried out in 26 general practice offices with 350 patients showed that patients appreciate PILs. On the other hand, the understanding of Acute Conditions (AC) is more limited than that of chronic diseases or prescription situations, particularly patients with a low school level. A cluster randomized interventional study performed in 24 general practice offices with 400 patients showed that PILs allowed patients to improve their knowledge about pathologies and modify their health behaviors positively, independently of their level of education. Nevertheless, the heterogeneity of the research protocols made it impossible to compare our results with those of the literature.To overcome this scientific hurdle and continue our work on the assessment of PILs, we performed a review of the literature on the subject, constructed a theoretical model describing the various effects of PILs and created three generic scales usable for evaluating the impact of PILs on any type of condition (scales of Doctor-Patient Communication, satisfaction and overall adherence). An observational study carried out in 2 Emergency Departments (ED) allowed us to validate the 3 scores, assess the psychometric properties and elucidate their determinants. In the context of AC, the only determinant of the DPC was the quality of the information received (both information "what to do" and "when to reconsult" have an adjusted Odds Ratio 11.9. Characteristics of the patient did not influence the DPC score. The overall adhesion is determined by the type of pathology (inflexible parameter) and by the quality of the DPC. Finally, although satisfaction was strongly associated with the hospital infrastructure and the attitude of the paramedical and medical staff, a high DPC score multiplied the probability of having a good satisfaction score. In a context of emergency consultations, the DPC is paramount and has an impact on the usual health indicators: satisfaction and adherence.Finally, a before-after intervention study conducted in two ED showed that PILs improve DPC, satisfaction with healthcare professionals, and adherence to medication regimens. PILs decrease the number of reconsultations for the same pathology, in particular return to the ED. They reduce the number of drug prescriptions given by the doctor in favor of complementary examinations and specialized advice. In a context of AC, a PIL given by the doctor improves DPC, the patient’s satisfaction with healthcare professionals and improves both the doctor’s and the patient’s behaviors.The DPC is a fundamental outcome that will need to be measured more frequently in the future, including in acute situations.

The purpose of this study was to investigate and describe the experience of infertility of African women, men and family member. It is hoped that this description will contribute to a deeper understanding of the psychosocial difficulties involved in the area of infertility and ofthe ways in which people respond to the situation of infertility. A qualitative research approach was used, and in particular social constructivist-interpretive research and feminist research approaches. The sample consisted of39 participants: 19 women, 10 men, and 10 family members faced with infertility. The research orientation was field-based, concerned with collecting data using the technique of in-depth semi-structured interviews. Each participant was interviewed individually. The interviews were recorded on tape, transcribed in their full length and translated into English. Data were analysed on the basis of the interpretive feminist approach. Analysis of individual cases and crosscase analysis were employed. The findings suggested a contextual definition of infertility, for example, for some, having had an ectopic pregnancy or a miscarriage meant that they did not fit into the definition of infertility. The findings revealed that for many African women and men, blood ties still defined the family and the persona. Thus, failure to have a blood child resulted in courtship and marital break up, extramarital relationships, polygamy, and divorce and remarriage. Infertility had serious psychosocial consequences for both the infertile individuals and their families. Participants experienced repeated periods of existential crisis, which began at different points for different participants. Analysis of gender differences indicated similarities in the experience of the crisis, but differences in terms of expression and ways of responding to the crisis. Family dynamics within the context of infertility were coloured by ambivalent feelings, resentment, insensitivity, and miscommunication, but also affection, and social support. Traditional and modern medical health systems offered the possibility of finding explanations and treatment, but there was further strain from the negative experiences with the health care system. The findings in this study suggested the need for policy reformulation, for psychosocial intervention as part of the treatment plan, and for future research on the outcome of using various coping strategies. / Psychology / D. Phil. (Psychology)

This article samples possible uses of psychoanalysis in law from the academic work of Joseph Goldstein and Jay Katz. Both start to recognize the importance of psychoanalysis to provide a serious and courageous attention to the non-rational dimensions of the human being, we should be aware in the world of law. Starting from this premise, the author explores two possible uses of psychoanalysis in law: one represented by Goldstein, focuses on using «psychoanalytic premises to resolve legal disputes», for example by providing psychoanalytic information to determine the best interests of the child in cases of custody, while the other, represented by Katz, who seeks to «create an awareness of conflict where all of the actors had previously been locked in a mutually reinforcing fantasy that no conflict existed», as it occurs in doctor-patient relationship, in order to rethink standards that had been set by law under an illusion of objectivity and rationality. The article explores these two approaches through examples, linking two perspectives adopted by Freud throughout his academic work and taking a preferred position by the position of Katz. / El presente artículo muestras los posibles usos del psicoanálisis en el derecho a partir del trabajo académico de Joseph Goldstein y Jay Katz. Ambos parten de reconocer la importancia del psicoanálisis para prestar una atención seria y valiente a las dimensiones no racionales del ser humano, de las que debemos ser conscientes en el mundo del derecho. Partiendo de dicha premisa, el autor explora dos posibles usos del psicoanálisis en el derecho. Uno, representado por Goldstein, se centra en utilizar «premisas psicoanalíticas para resolver conflictos jurídicos», como, por ejemplo, al aportar información psicoanalítica para determinar el interés superior del niño en casos de tenencia. Mientras tanto, el otro, representado por Katz, busca «concientizar acerca de un conflicto en casos donde los todos actores se habían dedicado a reforzar mutuamente su fantasía de que no existía conflicto alguno» entre sujetos de una relación, como ocurría en la relación médico-paciente, con la finalidad de repensar estándares que habían sido fijados por el derecho bajo una ilusión de objetividad y racionalidad. El artículo explora estas dos aproximaciones a través de ejemplos, vinculándolas a dos perspectivas adoptadas por Freud a lo largo de su trabajo académico y tomando una postura preferente por la mirada de Katz.

Atualmente o vídeo tem sido considerado por alguns autores o padrão-ouro para ensino de habilidades de comunicação e o vídeo feedback (VF) tem se mostrado eficaz no treinamento de habilidades em várias áreas profissionais. Entretanto, há poucos estudos sobre os efeitos das diferentes metodologias de VF. Este estudo propõe explorar as potencialidades, desafios e efeitos do VF de filmagem de consultas em contexto real, para uma avaliação formativa em habilidades de comunicação, com médicos residentes, em um programa de Atenção Primária. Foi conduzido um estudo pré e pós teste com um grupo controle. A intervenção constituiu-se de sessões de revisão do vídeo em pequenos grupos, na metodologia de entrevista baseada em problemas, com feedback por colegas (peer-feedback) e com um facilitador. Os 54 (cinquenta e quatro) médicos residentes responderam questionários quantitativos e qualitativos e dois avaliadores externos analisaram em vídeo, randomicamente e às cegas, cerca de 200 (duzentas) performances dos residentes com pacientes-simulados, antes e após a intervenção. Para análise dos dados foi usado ANOVA two-way de medidas repetidas e para análise qualitativa foi usado análise temática de Braun e Clarke. A metodologia de VF utilizada para avaliação formativa mostrou ser bem avaliada pelos participantes e com potencial de gerar mudança de atitudes no entrevistador. Na análise qualitativa, as principais potencialidades identificadas na metodologia foram autopercepção e o feedback por pares, e as principais mudanças na prática clínica foram a melhora da comunicação não-verbal, mudanças de comportamento, abordagem mais centrada no paciente e incorporação de prática reflexiva. Houve aumento de escores, entre os tempos, relacionados à decisão compartilhada, aviso de alerta de comunicação de má notícia e disposição para apoio ao paciente. Os desafios foram a dificuldade do facilitador em conectar o vídeo feedback com o referencial teórico e o estresse inicial para gravar-se e assistir-se em vídeo. Observamos que a análise qualitativa dos dados revelou mais informações sobre os efeitos nos participantes que a análise quantitativa. Os dados observados nos resultados qualitativos não tiveram o mesmo impacto nos resultados quantitativos. Devido à dificuldade observada em encontrar instrumentos adequados e validados para avaliar habilidades de comunicação, foi realizada em uma etapa posterior, a tradução e adaptação transcultural para o português falado no Brasil do instrumento Calgary-Cambridge Observation Guide (CCOG), com análise psicométrica. Concluímos que há uma dificuldade nos questionários em mensurar competências atitudinais e aspectos mais subjetivos de comunicação. Sugere-se mais estudos com aprofundamento na definição de parâmetros dos itens subjetivos de avaliação, conforme as competências exigidas para cada fase da formação médica. Concluímos também que para uma metodologia de VF efetiva é importante estimular a autoavaliação com uma prática reflexiva, feedback por pares focado em reforço positivo na busca de estratégias, além de um facilitador cuidadoso em relação a psicologia do aprendiz, com habilidade de conectar o feedback com uma teoria de comunicação abordada previamente. A versão brasileira do CCOG mostrou confiabilidades aceitáveis nos indicadores psicométricos, incluindo no modelo multifacetas de Rasch e assim, um instrumento adequado para auxiliar no ensino e avaliação de habilidades de comunicação no Brasil / Currently, video recordings of medical consultations have become the standard teaching approach to communication skills, and video feedback has shown to be effective in skills training in many professional areas. However, researches on the effects of different video-based feedback methodologies remains scarce. This study proposes to explore the potentials, challenges, and effects of video-based feedback methodology in real contexts for the formative assessment of communication skills of medical residents in a primary health care program. We conducted a pre/post study with a control group. The intervention was video feedback sessions with peer-feedback. Before and after the intervention, medical residents 54 (fifty four) answered quantitative and qualitative questionnaires and two raters blind assessed about 200(two hundred) video-recorded clinical examinations with simulated patients, who also scored the performances. For the data analysis, we used ANOVA two-way and for the qualitative analysis, we used the Braun and Clarke framework for thematic analysis. This video feedback methodology showed to be a well-accepted formative assessment. The main potentialities identified were self-perception and peer-feedback. The main effects in the residents\' medical practice was a better patient-centered approach, with increased scores mainly in good listening, decision-sharing, and patient support. Improvements were reported in non-verbal communication, behavior changes, and incorporation of reflective practices. Some of the challenges were the difficulty of the coordinator to link the video feedback with theoretical references and the initial stress to record and watch oneself in video. During the study, we did not find adequate and validated instruments to assess communication skills, and so in stage 2 we developed the translation and transcultural adaptation to Brazilian Portuguese of the Calgary-Cambridge Observation Guide (CCOG). This study did not find instruments that completely answered the assessment necessities regarding training in clinical communication. Further researches about assessment tools are thus required, as discussion about competence parameters in subjective items in assessment. The qualitative analysis revealed more information about the effects in communication skills than the quantitate analysis. We observed that there is a difficulty in questionnaires assessing attitudinal competences and subjective aspects in communication. We conclude that for an effective video-based feedback it becomes important to promote self-evaluation alongside reflective practices, peer-feedback focused in positive reinforcement and pursuing strategies, and a supervisor attentive to the leaner\'s psychology and able to relate the feedback with a well-defined communication theory. The Brazilian CCOG version showed acceptable reliability in the Rasch model indicators and could be part of a systematic assessment of communication skills in Brazil