This study explores the genesis of the presence of the fetus in American culture by examining the evolution of American medical attitudes towards the unborn (1800-1865) in the lead up to the Physicians Crusade Against Abortion in the mid 19th century. Specifically, it analyzes how American allopathic physicians reconciled their denunciation of abortions for reproductive limitation with their approval of abortions for medical reasons, shedding light on how American physicians resolved maternal-fetal conflict. The study begins with an exploration of the medicalization of childbirth in the 18th century and how it created medical concern for the fetus. The forceps could spare the pregnant woman the craniotomy operation (collapse of the fetal skull) and save the fetus. However, not all cases of obstructed labour could be solved with the forceps, and as physicians displaced midwives as the principal birth attendants, they were confronted with the prospect of performing craniotomy on a live fetus. As they dreaded this outcome, they proposed two operations to circumvent it: the Caesarean section and induced premature labour. This shows that medicalization created concern for the fetus, particularly in the later stages of pregnancy. With new embryological research in the 1820s, concern for the fetus was extended to all stages of pregnancy and expressed itself in advice to women to guarantee a healthy child. The publication of Alfred Velpeau’s Principles of Tokology and Embryology was influential because it both normalized the fusion of embryology and obstetrics, and it justified recourse to early abortion in cases of contracted pelvises. Indications for the medical use of abortion began to multiply as a result of this shift, even as physicians denounced clandestine abortion and sought to criminalize it. This study argued the medical ideology of vitalism, as articulated by Xavier Bichat, was key in resolving maternal-fetal conflict in favour of the pregnant woman. Vitalism characterized fetuses as having the same functions as a plant and this lower level of functioning justified the sacrificing of fetal life in certain circumstances. Vitalism also viewed women to as having more sensibility, more cerebral activity, and more social ties. Therefore, women were viewed as the more deserving human being in maternal-fetal conflict.

The introduction of new, innovative technologies within cancer diagnosis is needed, however, the barriers to entering the healthcare market are high, with various regulations and stakeholders to consider. The purpose of this thesis is to research doctors’ attitudes toward the current and emerging methods within cancer diagnosis, with the ultimate objective of providing insights into how companies can affect doctors’ technology acceptance behavior. Understanding of the end-user can facilitate the early involvement of doctors in a company's development process, which can contribute to a successful introduction of a new technology to the healthcare market. This thesis adopts a qualitative single case study approach, where the empirical data was collected through semi-structured interviews. The interviews were conducted with doctors specialized in General Medicine and Obstetrics and Gynecology. The findings reveal that doctors are cautiously positive towards new technologies, but require them to deliver greater benefits compared to their costs, have high performance, and have good usability. In addition, they demand them to be supported by research studies that substantiate their efficacy. Furthermore, a company must build trust by means such as establishing credibility and demonstrating a clear clinical purpose. The thesis also concludes that doctors’ attitudes are influenced by their belief systems and social factors, including the opinions of colleagues or hospital leaders. Finally, the findings suggest that companies should conduct research studies, create resource-sharing collaborations, involve doctors early in the development process, and establish effective communication strategies to influence doctors’ technology acceptance behaviors. / Det finns ett uttalat behov av att introducera innovativa teknologier inom cancerdiagnostik till marknaden, men hälso- och sjukvårdsmarknaden har höga inträdesbarriärer men många regulationer och aktörer att ta hänsyn till. Syftet med denna studie är att fördjupa förståelsen av läkares inställning till existerande och nya teknologier inom cancerdiagnostik. Det yttersta målet är att bidra med insikter rörande hur företag kanpåverka läkares acceptans av nya teknologier. Genom förbättrad förståelse och tidig involvering av slutanvändaren, i detta fall läkarna, kan en introduktion av nya teknologier simplifieras. Denna studie innefattar en kvalitativ, enkel fallstudie, där datainsamlingen skett genom semistrukturerade intervjuer. Dessa intervjuer hölls med läkare med specialisering inom allmänmedicin samt obstetrik och gynekologi. Resultatet visar att läkarna har en försiktigt positiv attityd till nya teknologier, men har höga krav på prestation, användbarhet och nytta-kostnad förhållandet. De kräver även att teknologin stöds av noga utförda forskningsstudier som kan påvisa dess effektivitet och nytta. Studien visar även att företag måste bygga förtroende hos läkarna, genom att exempelvis visa på ett tydligt kliniskt syfte. Vidare visar resultatet att läkarnas attityder influeras av deras trossystem samt sociala faktorer, däribland kollegors och sjukhusledares åsikter och rekommendationer. Slutligen uppmanas företag att genomföra forskningsstudier, etablera samarbeten mellan berörda grupper, involvera läkare tidigt i utvecklingsprocessen, och etablera effektiva kommunikationsstrategier för att påverka läkares acceptans av ny teknologi.

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Det finns många läkare som arbetar deltid, sjukskrivs eller byter jobb på grund av ett påfrestande arbetsmiljö. Syftet med min studie är att identifiera läkarens upplevelse av arbetsrelaterad stress inom vårdcentral. Metoden som valdes är en kvalitativ metod där jag använder halvstrukturerade intervjuer. Två kategorier och fyra subkategorier av upplevelse av arbetsrelaterad stress hos läkare identifierades: faktorer som påverkar stress i arbetet, egna strategier för stresshantering, tidsbrist, ledarskap, brister i organisatorisk och social arbetsmiljö, upplevelse av krav och förväntningar. Informanterna upplevde att deras stress orsakades av brister i den organisatoriska och sociala arbetsmiljön. Läkarens arbete kan förstås påverkas negativt av upplevd stress. Arbetsrelaterad stress kan påverka negativt läkarens bedömningsförmåga vilket ställer patienterna i risk för felbedömningar. / There are many doctors who work part-time, are laid off or change jobs because of a stressful work environment. The purpose of my study is to identify the physician's experience of work-related stress in a health center. The method chosen is a qualitative method where I used semi-structured interviews. Two categories and four subcategories of high of work-related stress were identified: factors affecting stress at work, own strategies for stress management, lack of time, leadership, deficiencies in organizational and social work environment, demands and expectations. It was found that the respondents experienced stress was caused by problems in the organizational and social work environment. The physician's work can be adversely affected by high stress. Work-related stress can adversely affect the physician's judgment, which puts patients at risk of misjudgment.

<p>This investigation is a pilot survey whose main purpose is to investigate with work evaluation and attitude analysis whether the orthopedists and surgeons work can be equaled, why the wages differences exists between women and men, and also which preventive measures the organization can use to even out the wages differences between the genders. In relation with the investigation I have applied the reflexive way of thinking to establish which difficulties come up in the work of gender-equality.</p><p>The result’s from work evaluation displays that the works are equivalent but the salaries are not, which can depend on value discrimination,gender discrimination and the organization theory.</p><p>Wages differences between women and men depend on, according to the informers, partly by historical explanation and partly by the old directors who was allowed to retain regular salary when they</p><p>post transformed. The common point of view is that men have a larger work experience and therefore a higher salary.</p><p>The managements attitude towards gender-equality issues is of absolute importance in order to achieve and bring a change within the organization.</p><p>The measure positive special treatment is proposed to be used as an improving method to achieve (gender)equality between the posts and to even out the wages difference between the sexes.</p><p>To establish whether or not gender discrimination exist in the investigated organization there needs to be done a whole lot supplementary studies like a complete wage (salary) mapping which includes all supplements and more interviews among the organizations all occupation groups.</p> / <p>Utredningen är en pilotstudie vars huvudsyfte är att via arbetsvärderingsanalysen och attitydundersökningen undersöka om ortopeders och kirurgers arbete kan jämställas, varför löneskillnader mellan kvinnor och män finns, samt vilka åtgärder organisationen kan använda för att jämna ut lönerna mellan könen. I samband med undersökningen har jag också valt att tillämpa det reflexiva tankesättet för att undersöka vilka som svårigheter uppstår i samband med jämställdhetsarbetet.</p><p>Resultatet från arbetsvärderingen visar att det handlar om likvärdiga arbeten men inte lika löner, vilket kan ha sin förklaring i värdediskriminerings-, genus- och organisationsteorin. Löneskillnaderna mellan kvinnor och män beror, enligt informanterna, dels på historiska förklaringar och dels på de gamla cheferna som har fått behålla sin ordinarie lön i samband med omplacering. Den allmänna synen är att män har längre arbetslivserfarenhet och därför högre lön.</p><p>Ledningens inställning till jämställdhetsfrågor har vidare vistas vara helt avgörande för att förändringsarbetet inom organisationen skall kunna genomföras.</p><p>Åtgärden positiv särbehandling har föreslagits som en metod för att uppnå jämställdhet mellan befattningarna och för att jämna ut löneskillnaderna mellan könen. För att undersöka om könsdiskriminering föreligger inom den undersökta organisationen behövs en del kompletterande studier såsom en komplett lönekartläggning som inkluderar alla tillägg och fler intervjuer bland organisationens samtliga yrkesgrupper.</p>

Problématique : La collaboration entre infirmières et médecins est un élément crucial lorsque la condition des patients est instable. Une bonne collaboration entre les professionnels permet d’améliorer la qualité des soins par l’identification des patients à risques et l’élaboration de priorités dans le but de travailler à un objectif commun. Selon la vision des patients et de leur famille, une bonne communication avec les professionnels de la santé est l’un des premiers critères d’évaluation de la qualité des soins. Objectif : Cette recherche qualitative a pour objectif la compréhension des mécanismes de collaboration interprofessionnelle entre médecins et infirmières aux soins intensifs. L’étude tente également de comprendre l’influence de cette collaboration sur la communication entre professionnels/ patients et famille lors d’un épisode de soins. Méthode : La collecte de données est réalisée par le biais de 18 entrevues, qui ont été enregistrées puis retranscrites. Parmi les entrevues effectuées deux gestionnaires, six médecins et infirmières, et enfin dix patients et proches ont été rencontrés. Ces entrevues ont été codifiées puis analysées à l’aide du modèle de collaboration interprofessionnelle de D’Amour (1997), afin de déterminer les tendances de collaboration. Pour terminer, l’impact des différentes dimensions de la collaboration sur la communication entre les professionnels/ patient et famille a été analysé. Résultats : Médecins et infirmières doivent travailler conjointement tant avec les autres professionnels, que les patients et leur famille afin de développer une relation de confiance et une communication efficace dans le but d’établir des objectifs communs. Les patients et les familles désirent rencontrer des professionnels ouverts qui possèdent des talents de communicateur ainsi que des qualités interpersonnelles. Les professionnels doivent faire preuve de transparence, prendre le temps de donner des explications vulgarisées, et proposer aux patients et aux familles de poser leurs questions. / Problem : The collaboration between nurses and physicians is a key element when the patient's condition is unstable. Good collaboration between these professionals allows improvement on the quality of care by identifying patients at risk and by establishing priorities so that we work towards the same goal. Patients and their families who experience the Intensive Care Unit improved when the messages provided are coherent, giving the sense of control and decision making back to the patient and their families. Objectif : The goal of this qualitative research is to better understand the mechanisms of collaboration between nurses and physicians during the daily interdisciplinary rounds the Intensive Care Units. It will also attempt to understand the influence of these behaviours on the communication between these professionals, the patients and their families. Method : The data collection is carried out via 18 interviews, which will first be recorded and then retranscribed. The interviews are done with 2 managers, six following with medical staffs and nurses and ten patients and close family members. These interviews have been coded and analyzed using the interprofessional collaboration model of D‟Amour (1997) in order to obtain the collaboration tendencies. Lastly, the impact of the different dimensions of collaboration on the communication between professionals/ patients and families have been analyzed. Results : In order to establish common objectives, all healthcare professionals must work together with the patients and their family to develop a trusting relationship and an effective communication. Patients and their family want to see professionals who are open, possessing communication and interpersonal skills. They must also be transparent, taking the time to provide popularized explanations and offer question periods to the patients and their family.

Ce mémoire de maîtrise porte sur le concept d’identité organisationnelle, appliqué au milieu des organisations humanitaires. Le contexte mondial actuel dans lequel évoluent ces organisations leur impose de revoir certaines de leurs valeurs et façons de faire. En effet, les équipes des ONG sur le terrain sont confrontées à des conflits de plus en plus nombreux et complexes, qui remettent en question l’identité de leur organisation. Cette recherche vise à dresser un portrait du travail des employés de l’organisation Médecins Sans Frontières (MSF) lors de missions humanitaires, alors que ceux-ci doivent justifier et négocier la présence de l’organisation auprès de la population et des autorités locales. En nous basant sur le concept de sensemaking développé par Karl E. Weick, nous présentons une analyse narrative des récits de mission de cinq employés de MSF. Cette analyse permet d’étudier comment, au quotidien, les employés d’une ONG le terrain sont impliqués dans des négociations où l’identité organisationnelle est continuellement menacée et remise en question. / This thesis focuses on the concept of organizational identity, applied to humanitarian organizations. The actual international context is forcing these organizations to review some of their core values and procedures. Consequently, their teams on the field are confronted with more and more conflicts and complex situations where the organisation’s identity is at stake. The aim of this research is to produce a better understanding of the work that employees of Doctors Without Borders (MSF) do on the field during a mission, especially when they have to justify and negotiate the presence of their organisation with the local populations and authorities. Based on Karl E. Weick’s concept of sensemaking, we present a narrative analysis of fieldwork stories we collected by conducting interviews with five MSF employees. Not only does this analysis help us understand the roles employees have to play on the field, but it also provides insight into the different situations when organizational identity is being negotiated.

À partir de l’étude de deux romans européens et de deux des Amériques, la présente thèse de doctorat examine la manière dont la maladie contagieuse sert de métaphore à la crise. Elle poursuit un triple objectif. Au niveau individuel, on démontre le rôle actif de chacun face à la maladie, puisque tant les médecins que les malades font appel à l’inventivité afin de lutter contre le fléau. Au niveau social, on prouve que la contagion sert d’argument pour stigmatiser et discriminer l’Autre que l’on considère comme menaçant. Au niveau politique, on souligne l’importance d’un compromis individuel et collectif dans la gestion des risques car les fictions illustrent les effets catastrophiques lorsque les États sont incapables d’assurer la protection de la santé des populations (vols, pillages, recherche prétendue de coupables et mise à mort des innocents). / The aim of this doctoral thesis is to examine how the contagious disease serves as a metaphor to the crises by comparing two novels from Europe and two from North and South America. It pursues a triple objective. First, we demonstrate, at the individual level, that each person plays an active role when confronted with a disease, both doctors and patients fight against the plague through inventiveness and resourcefulness. Second, we prove, at a social level that contagion can be used as an argument to stigmatize and to discriminate those who are considering threatening. At a political level, we emphasize the importance of individual and collective compromises when facing the risk. The novels illustrate the catastrophic consequences when states are unable to manage risk and to protect populations from danger. Some of these consequences might be: thefts, looting, scapegoat designation and killing innocent people.

Made available in DSpace on 2016-04-26T20:24:15Z (GMT). No. of bitstreams: 1 Luiz Fernando Picorelli de Oliveira Mouta.pdf: 1297486 bytes, checksum: f43cf0962b266b49b35bbaa2e2e903fc (MD5) Previous issue date: 2016-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The article 170 of the Constitution makes it clear that the State did not opted for a model of total abstinence or full intervention, seeking the constitution to guarantee the role of private enterprise supervised by the government, in order for the economy to become an effective instrument to ensure its purpose, specifically the principle of the human dignity. The State, as a normative and regulating agent, perform the oversight, incentive and planning functions. On the other hand, social rights are rights that are guaranteed by various means, including the regulation of economic relations, giving everyone the benefits of life in society. Such rights, the right to health, is everyone's right and it is also a duty of the state, guaranteed through social and economic policies. To ensure the right to health for all, it was created the Unified Health System. However, in reality, the Unified Health System was not able to avoid the large concentration of establishments, structure and health professionals in the South and Southeast regions, to the detriment of other areas of the country. This was compounded by the State's abstention when it comes to planning and regulation of the medical profession, which is predominantly carried out by the Federal Medical Council and Regional Medical Councils. The "More Doctors" program, established by Law nº. 12 871 2013, aims to expand health supply in the country by creating new courses, setting new standards for medical education in the country and the promotion in the priority areas of medical improvement of Unified Health System in primary care area in health. Therefore, the "More Doctors" program, despite some flaws, is constitutional from the perspective of economic order, since it preserves the right to health by legitimate state intervention in the economic domain, and it is in line with the principle of reduction social and regional inequalities and the principle of human dignity / O artigo 170 da Constituição deixa claro que não se optou por um modelo de total abstenção ou de total intervenção do Estado, buscando a Constituição garantir a atuação da iniciativa privada, fiscalizada pelo poder público, para que a economia torne um instrumento apto a garantir os seus princípios-fins, mais especificamente o princípio da dignidade da pessoa humana. O Estado, ainda como agente normativo e regulador, desempenhará as funções de fiscalização, incentivo e planejamento. Por outro lado, os direitos sociais são direitos por diversos meios, dentre eles a regulação das relações econômicas, atribuir a todos os benefícios da vida em sociedade. Um desses direitos, o direito à saúde, é direito de todos e dever do Estado, garantido mediante políticas sociais e econômicas. Para garantir o direito à saúde a todos, foi criado o Sistema Único de Saúde (SUS). Entretanto, na prática, o SUS não foi capaz de evitar a grande concentração de estabelecimentos, estrutura e profissionais de saúde nas regiões Sul e Sudeste, em detrimento das demais áreas do país. Isto foi agravado pela abstenção do Estado no que tange ao planejamento e à regulação da profissão médica, que é predominantemente realizada pelo Conselho Federal e Conselhos Regionais de Medicina. O programa Mais Médicos , instituído pela Lei nº. 12.871 de 2013, tem por objetivo expandir a oferta de saúde no país, mediante a criação de novos cursos, estabelecimento de novos parâmetros para a formação médica no País e a promoção nas regiões prioritárias do SUS de aperfeiçoamento de médicos na área de atenção básica em saúde. Desta feita, o programa Mais Médicos , apesar de algumas falhas, é constitucional sob a ótica da ordem econômica, uma vez que preserva o direito à saúde, mediante a intervenção legítima do Estado no domínio econômico, estando em consonância com o princípio da redução das desigualdades sociais e regionais e o princípio da dignidade da pessoa humana

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2018-01-30T23:00:25Z No. of bitstreams: 1 disserta??o VERS?O FINAL PDF.pdf: 2988819 bytes, checksum: aee6403751f41f9de88d75a037db2c94 (MD5) / Made available in DSpace on 2018-01-30T23:00:25Z (GMT). No. of bitstreams: 1 disserta??o VERS?O FINAL PDF.pdf: 2988819 bytes, checksum: aee6403751f41f9de88d75a037db2c94 (MD5) Previous issue date: 2017-04-11 / Funda??o de Amparo ? Pesquisa do Estado da Bahia - FAPEB / Study on the work process in the Family Health Strategy, after the implantation of the more doctors program. It presents as guiding questions: how does the work process in the Family Health Strategy occur after the implantation of the More Doctors Program in a municipality in Bahia? How are the constituent elements of the health work process presented in the Family Health Strategy in a municipality in Bahia? What are the facilities, difficulties and challenges after the implantation of the More Doctors Program for the work process in the Family Health Strategy in a municipality in Bahia? The general objective is to analyze the work process in health in the Family Health Strategy, after the implantation of the more doctors program in a municipality of Bahia; And specific objectives: to describe the constitutive elements of the health work process in the Family Health Strategy in a municipality of Bahia; To discuss the facilities, difficulties and challenges encountered in the teamwork of the Family Health Strategy after the implantation of the more doctors program in a municipality in Bahia. This is a case study with a qualitative approach,whose project was submitted to the Research Ethics Committee of the UEFS and approved according to opinion number: 1.530.791. The data collection, carried out from June to July 2016, occurred through a semi-structured interview with twelve health workers and ninefamily health unit users analyzed; document analysis; and systematic observation. The empirical material was analyzed using the content analysis technique proposed by Bardin (2011).The care model is centered on the care of the community through clinical procedures and consultations to the detriment of activities aimed at health promotion. The actions developed are based on ministerial programs and the fragmentation of care, where each worker performs his actions individually, with few moments of interaction between the teams, especially the Oral Health Teams. Regarding the implantation of the program more doctors, no changes were found in the work process of other health workers, but the adaptation of foreign physicians to a biological health system.However, it was noticed the recognition of the community and the majority of the workers regarding the differentiated care of the doctors of the program who started to stay in the family health unit full-time, having only an employment relationship. Also, difficulties were not recognized that prevented care on behalf of the language of doctors. Among the difficulties, it should be noted that the program has not yet contributed to the advancement of the family health unit infrastructure, being found problems regarding the lack of materials, instruments and inputs important for the continuity of work, as well as the of the users, for the accomplishment of educative activities in detriment to the assistencialist practices. In this sense, the great challenge is the reformulation of the health work process, so that the core of the professional activity is centered on the users, breaking the paradigm of individualized actions, with a view to strengthening teamwork. / Estudo sobre o processo de trabalho na Estrat?gia Sa?de da Fam?lia, ap?s a implanta??o do programa mais m?dicos. Apresenta como perguntas norteadoras: como se d? o processo de trabalho na Estrat?gia Sa?de da Fam?lia, ap?s a implanta??o do Programa Mais M?dicos em um munic?pio da Bahia? De que forma s?o apresentados os elementos constitutivos do processo de trabalho em sa?de na Estrat?gia Sa?de da Fam?lia em um munic?pio da Bahia? Quais as facilidades, dificuldades e desafios ap?s a implanta??o do Programa Mais M?dicos para o processo de trabalho na Estrat?gia Sa?de da Fam?lia em um munic?pio da Bahia? O objetivo geral ? analisar o processo de trabalho em sa?de na ESF, ap?s a implanta??o do programa mais m?dicos em um munic?pio da Bahia; e objetivos espec?ficos: descrever os elementos constitutivos do processo de trabalho em sa?de na Estrat?gia Sa?de da Fam?lia em um munic?pio da Bahia; discutir as facilidades, dificuldades e os desafios encontrados no trabalho em equipe da Estrat?gia Sa?de da Fam?lia ap?s a implanta??o do programa mais m?dicos em um munic?pio da Bahia. Trata-se de um estudo de caso de abordagem qualitativa, cujo projeto foi submetido ao Comit? de ?tica em Pesquisa da UEFS e aprovado conforme parecer n?mero: 1.530.791. A coleta de dados, realizada no per?odo de junho a julho de 2016, ocorreu por meio de entrevista semiestruturada com doze trabalhadores de sa?de e nove usu?rios das USF analisadas, an?lise de documentos; e observa??o sistem?tica. O material emp?rico foi analisado utilizando-se a t?cnica de an?lise de conte?do proposta por Bardin (2011). O modelo de aten??o ? centrado no atendimento a comunidade por meio de procedimentos e consultas cl?nicas em detrimento de atividades voltadas para a promo??o da sa?de. As a??es desenvolvidas, baseiam-se em programas ministeriais e na fragmenta??o do cuidado, onde cada trabalhador executa suas a??es individualmente, com poucos momentos de intera??o entre as equipes, principalmente as Equipes de Sa?de Bucal. Sobre a implanta??o do programa mais m?dicos, n?o foram encontradas mudan?as no processo de trabalho dos demais trabalhadores de sa?de e sim a adapta??o dos m?dicos estrangeiros a um sistema de sa?de biologicista. No entanto, notou-se o reconhecimento da comunidade e da maioria dos trabalhadores quanto ao atendimento diferenciado dos m?dicos do programa que passaram a ficar nas USF em per?odo integral, possuindo apenas um v?nculo empregat?cio. Tamb?m n?o foram reconhecidas dificuldades que inviabilizassem o atendimento por conta do idioma dos m?dicos. Dentre as dificuldades, destaca-se que o programa ainda n?o contribuiu para o avan?o da infraestrutura das USF, sendo encontrados problemas quanto a falta de materiais, instrumentos e insumos importantes para a continuidade do trabalho, assim como na valoriza??o, tanto dos demais trabalhadores quanto dos usu?rios, para a realiza??o de atividades educativas em detrimento ?s pr?ticas assistencialistas. Nesse sentido, o grande desafio ? a reformula??o do processo de trabalho em sa?de, de maneira que o cerne da atua??o profissional esteja centrado nos usu?rios, rompendo o paradigma de atua??es individualizadas, com vistas ao fortalecimento de um trabalho em equipe.