Ces 15 dernières années, la recherche sur l'empathie clinique dans le contexte de la médecine somatique s'est développée de manière significative. Cette empathie clinique est donc de mieux en mieux cernée : élaboration de différentes modélisations et identification de ses bénéfices. Aujourd'hui, il reste certains challenges à relever, et notamment celui d'améliorer et de préserver l'empathie clinique au fil de la formation et de la pratique médicales tout en protégeant le bien-être des médecins. Ce travail de thèse a pour objectif de définir l'empathie clinique dans le cadre des maladies chroniques graves : son processus, ses déterminants, ses conséquences et les ressources nécessaires. Ce travail propose trois études successives portant sur des patients (N=15) et des médecins hospitaliers (N=235) selon un design mixte, recueils de données quantitatifs et qualitatifs associés à des analyses de données quantitatives. Ces études cherchent à définir l'empathie, identifier et tester ses antécédents et conséquences, en explorant les vécus des médecins et des patients. Par ailleurs, une quatrième étude longitudinale dite pilote a été mise en place. Les résultats ont mis en évidence la spécificité de l'empathie à une clinique spécifique, ont souligné sa nature majoritairement cognitive et comportementale et son rôle primordial dans la clinique et le bien-être des patients et des médecins. Ce travail propose ainsi une définition empirique qui concilie et enrichit les précédentes tout en développant la connaissance des déterminants de cette compétence clinique dans le cas spécifique des maladies chroniques graves. L'empathie clinique résulte de nombreux éléments tant individuels que situationnels ou encore interindividuels. Alors le développement de l'empathie des médecins auprès des personnes atteintes de maladies chroniques graves ne peut être considéré sans développer des recommandations à destination des institutions, des programmes de formation, et des dispositifs de soutien individuel et collectif. / Over the last 15 years, research on clinical empathy in somatic medicine has increased significantly. This clinical empathy is therefore becoming better understood, which shows by the appearance of various models and benefits on patients and physicians. Today, the challenge is to improve and to maintain clinical empathy through medical training and practice while protecting the well-being of physicians. This thesis' aim is to define clinical empathy in the context of serious chronic diseases: its process, its determinants, its consequences and the resources it needs. This work proposes three sequential studies involving patients (N = 15) and hospital doctors (N = 233). The design is mixed between qualitative and quantitative data and methods. These studies seek to define empathy, identify and test its antecedents and its consequences, exploring both the experiences of physicians and patients. Furthermore, a fourth study, a pilot one, has been conducted. Empathy appears as specific to a clinic. The results emphasize its cognitive and behavioral facets. Clinical empathy has a key role in patients' care and wellbeing but also in physicians' wellbeing. This work proposes an empirical definition that reconciles and enriches the preceding ones. It gives the opportunity to develop knowledge of empathy's determinants in the specific case of serious chronic diseases. Clinical empathy is the result of many individual, situational and inter-individual elements. Therefore, the development of doctors' empathy with patients with severe chronic diseases cannot be considered without developing recommendations to institutions, training programs, and individual and collective supports.

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Introduction: Vulnerable European Union citizens (vulnerable EU citizens) are those who come to Sweden from EU member states. In Sweden the term “vulnerable EU citizens” is associated with the word “beggars”, which in turn is associated with Roma people. By November 2015 the number of vulnerable EU citizens in Sweden was estimated to be 4 700. The majority of these were from Romania. Roma as citizens of an EU member state have the right to reside in EU countries in accordance with the EU’s freedom of movement rights concept for up to but no longer than three months. However, to obtain the right for residence after three months, proof of financial resources and health insurance are required. Lacking these resources, vulnerable EU citizens have subsequently lost their right for residence and therefore became undocumented. They often find themselves in the same situation as undocumented migrants from outside the EU, having poor health outcomes and limited access to health care. In my study I aim to explore access to health care for vulnerable EU citizens in Umeå, a city in eastern Sweden. Methods: A qualitative design methodology has been applied in this thesis. Those contacted for this study were; Doctors of the World, Health on Equal Terms, Staff for planning and control Västerbotten Region, University Hospital of Umeå and representatives of vulnerable EU citizens’ community from Romania in Umeå. Seven in-depth interviews were collected with professionals and volunteers from these organisation/institutions and members of vulnerable EU citizens’ community. Questions were asked about their experience and knowledge regarding access to health care for vulnerable EU citizens. Data was analyzed using qualitative content analysis. Results: Three main categories and one final theme were developed during data analysis. The first category “Difficult to access health care for vulnerable EU citizens in Sweden without European Health Insurance” elaborates the dependence of vulnerable EU citizens’ access to health care on having health insurance, specifically European Health Insurance and National Health Insurance. It also describes what kind of access to health care vulnerable EU citizens have in Sweden. The second category “Decision about how much access to health care provide for vulnerable EU citizens lies on medical personnel” discusses the situation of health care personnel when they treat vulnerable EU citizens in hospitals. The third category “Organisations, Doctors of the World and Health on Equal Terms, mediate connection between vulnerable EU citizens and hospitals, so they can have their right to health fulfilled” elaborates about the role the organisation plays when vulnerable EU citizens are in need of health care. After grouping categories and looking at the data from more interpretive, abstracted higher level, the final theme was created “Lack of attention from the national and international levels to the situation of vulnerable EU citizens’ access to health care”. Conclusion: This study highlights the difficulty for vulnerable EU citizens to access health care in Umeå if they do not have European Health Insurance. Being treated as undocumented migrants is the only way they have access to emergency services. Health care personnel feel insecure when treating vulnerable EU citizens, because there are no clear guidelines when vulnerable EU citizens can be treated as undocumented migrants as well as what is included in the clause “the care that cannot wait”. Because of this situation, vulnerable EU citizens sometimes are not able to receive the medical help they need. Organisations, Doctors of the World and Health on Equal Terms, help to mediate the connection between vulnerable EU citizens and hospitals which helps them to access the health care and fulfille their right to health. Lack of attention from the national as well as international governments to this situation is found to be important factor influencing vulneralbe EU citizens’ access to health care

This study examined Angolan culture as an influence to accessing modern scientific health care with the aim to develop health information brochures to inform the population of the advantages of scientific medicine. The quantitative approach with an exploratory and descriptive design was applied in this study, using a questionnaire to collect data from 100 respondents by means of a convenience sample. The findings indicated that most of the respondents were aware of what caused disease and illness in terms of modern knowledge, preferred to access government hospitals and also that government health care services were more affordable than some of the other alternatives. However, the study also found that a small section of the respondents believed in the powers and advantages of witch doctors, thus confirming that certain cultural issues still influenced the selection of assistance when health care and treatment is required. Recommendations were made through which health education could be distributed. / HEALTH STUDIES / Chemistry / MA (HEALTH STUDIES) / MSC (Chemistry)

This research work is set out to investigate healing practised in Africa today. There are many ways of healing in African; others are classified as foreign because they came out of Africa especially from European influence while others are considered local or traditional. The research shall dig out the influence of what is known as foreign methods or approaches of healing in Africa today and what African healing can learn from other methods of healing practised today. There shall be contemporary stories and facts about the situation of healing today and relevant statistics where necessary. The research also comes out with appropriate suggestions on how to combat contemporary illnesses of today. This includes what should be improved and how. This work covers the whole of Africa. / Philosophy & Systematic Theology / M.Th. (Systematic Theology)

This study was carried out as part of efforts to better understand the factors that impinge on childbirth service delivery and to develop guidelines to help improve the quality and safety of childbirth services in Ghana. The objectives were to: assess the factors that influence client-centredness; explore women’s and health professional’s views of and experiences with client-centred childbirth services; and develop guidelines to assist improve client-centred childbirth services in hospitals. The fixed mixed methods design comprising both quantitative and qualitative methods was employed. Structured questionnaire and exit interviews were used to gather data from 754 women who delivered in the hospitals. Furthermore, in-depth interviews were used to examine the experiences of women, doctors and midwives. STATA MP Version 13 was used to analyse the data by generating frequencies, chi-square and binary logistic regression results. Qualitative data analysis was analysed through data reduction, data display and generation of themes and categories. The process of developing the guidelines comprised: drafting based on the findings of the study and additional literature review, and a number of reviews by senior health professionls to build consesnsus on the content. With a response rate of 97.8%, the results indicated average performance. A number of the items examined under demographic characteristics, ante-natal, labour and postnatal care were significantly associated with the experience of excellent client-centred care. These included: number of weeks pregnant before delivery; health professional who assisted with delivery; mode of delivery; labour pain management; and length of stay after delivery. On the whole, the findings of the quantitative study were support by that of the structured interviews. Most of the themes from in-depth interviews with women were had to do with the relationship between health care provider and clients. Issues of support during childbirth; decision-making and informed choice; and continuity were raised. Themes deduced from the doctors’ and midwives’ interviews demonstrated a fair understanding of principles of client-centred care and delineated relational as well as client, health care worker and organisational factors that facilitate or limit effective implementation of client-centred care. The findings of the studies were used to develop guidelines to help improve services. It is recommended that the Ministry of Health, Ghana adopt the guidelines and provide the enabling environment for its effective implementation. / Health Studies / D. Litt. et Phil. (Health Studies)

This thesis examines the missionary work of the Italian Capuchin Lorenzo da Brindisi. Renowned in his own day as a preacher, Bible scholar, missionary, chaplain, and diplomat, as well as vicar general of his Order, Lorenzo led the first organised, papally-commissioned Capuchin mission among the non-Catholics of Bohemia in the Holy Roman Empire from 1599 to 1602, and returned there, again under papal mandate, from 1606 to 1613. This thesis examines Lorenzo’s evangelistic and polemical activities in Central Europe in order to shed light on some of the ways the Capuchins laboured in religiously divided territories to confirm Catholics in their faith and to win over heretics. The introduction explains, principally, the thesis’s purpose and the historiographical background. Chapter one provides a brief biographical sketch of Lorenzo’s life followed by details of his afterlife. Chapter two examines his leading role in establishing the Capuchins’ new Commissariate of Bohemia-Austria-Styria in 1600, and specifically its first three friaries in Prague, Vienna, and Graz. Chapter three treats his preaching against heresy. Chapter four focuses on how Lorenzo, while in Prague, involved himself directly in theological disputations with two different Lutheran preachers. The first dispute, with Polykarp Leyser, took place in July 1607, and dealt with good works and justification. The second, with a Lutheran whose name is not known for certain, and which occurred in August 1610, concerned Catholic veneration of the Virgin Mary. Chapter five analyses the Lutheranismi hypotyposis, Lorenzo’s literary refutation of Lutheranism following additional contact with Polykarp Leyser in 1607. The conclusion considers briefly the effectiveness of Lorenzo’s apostolate and closes with a review of the thesis as a whole.

L’objet de ce mémoire est de s’interroger sur la co-construction et la négociation de l’identité organisationnelle par la parole dans les interactions quotidiennes. Cette étude a été menée sur une organisation du monde de l’humanitaire, Médecins Sans Frontières (MSF) et plus précisément sur une mission réalisée dans la région du Nord- Kivu en République Démocratique du Congo. Les données ont été collectées en employant la méthode du vidéo shadowing, encore appelée vidéo filature, une approche consistant à suivre et filmer des acteurs dans leurs interactions du quotidien, et particulièrement, dans notre cas, le chef de mission. La méthodologie utilisée pour analyser les enregistrements vidéo a, par la suite, été inspirée de l’analyse de conversation et de l’ethnométhodologie. Les concepts phares sur lesquels se base cette recherche sont la « ventriloquie » et la « présentification », deux concepts en communication organisationnelle développés par François Cooren de l’École de Montréal. Plus précisément, nous nous sommes attachés à montrer comment les acteurs de MSF cultivent l’identité et l’image de leur organisation à travers des « conversations identitaires». Nous avons ainsi pu observer et analyser comment les acteurs de l’organisation agissent par le biais de la parole pour construire et établir l’identité de leur organisation, et à travers cela, leur propre identité. / The purpose of this thesis is to examine the co-construction and the negotiation of organizational identity through speech in everyday interactions. This study focused on a humanitarian organization, Médecins Sans Frontières (MSF), and more specifically on a mission carried out in the North-Kivu in the Democratic Republic of Congo. Data were collected by using shadowing, that is, by filming MSF actors in their daily interactions, particularly in our case, a head of mission. These data were analyzed, in turn, by using conversation analysis. The methodology used to analyze the video recordings was inspired by conversation analysis and ethnomethodology. The key concepts of this research are « ventriloquism » and « presentification », both developed by François Cooren of the Montreal School of Organizational Communication. Specifically, our analyses show how MSF actors cultivate the identity and image of their organization through « identity conversations ». In other words, it is through these conversations that MSF actors construct and establish the identity of their organization, as well as their own identity.

The thesis deals teologic comparison of two patristic commentaries of the Sermon on the Plain from Gospel of Luke - by saint Ambrose and by saint Cyril of Alexandria. Both autors are excerpts from their commentaries of Gospel of Luke. At first are outlined life and literary work of both authors and later an analysis of both texts from the point of view of selected principal theological topics is made. After that the two theological views are compared to the Sermon on the Plain, outlining the initial idea of both autors.