The overall aim of this thesis was to cast light on the new phenomenon of Internet-based medical consultation. This was approached by studies of the use of an Ask the doctor service, by a web survey to the users who sent enquiries to the service, and by a questionnaire to the answering physicians of their respective expericence of the service. Written communication is becoming increasingly important, not only for communication between individuals outwith health care (e.g. by email, SMS and instant messaging), but also between doctors and patients. There is an ongoing shift in the way individuals look for medical information with an increasing number going first to the Internet berfore talking with their physicians. Also, there is an increasing interest from patients in accessing Internet-based services, including text-based consultations with doctors. These consultations can be part of the regular communication between a patient and his/her doctor or be carried out without any previous relationship. Our studies of the latter consultation type emanate from the free of charge Ask the doctor service at a Swedish public health web portal, Infomedica, financed by health authorities. At the Ask the doctor service, the communication has been merely text-based and the individual using the consultation service (here called the enquirer) might have been anonymous. We followed the development of the first four years use of the service (38 217 enquiries), finding that the typical enquirer was a woman aged 21-60 years. Three quarters of the enquirers were women, thus exceeding the gender difference seen in regular health care. The service was used all times of the day and night, seven days a week, and it was most used in densely populated areas as defined from postal codes. The enquiries submitted to the service included a broad variety of medical issues. Most enquirers asked on their own behalf. Almost half of the enquiries concerned a matter not previously evaluated by a medical professional. Only a few were frequent enquirers. The service was used e.g. for a primary evaluation of a medical problem, for getting more information on a medical issue under treatment, and for a second opinion. The most common reasons for turning to a doctor on the Internet were convenience, wish for anonymity and that doctors were experinced too busy. In free text a considerable number of participants expressed discontent and communication problems with a previous doctor as a reason to turn to the Ask the doctor service. Many participants expressed a view of the service as a complement to regular health care, and the majority were satisfied with the answer. Nearly half of the participants in the web survey stated that they received sufficient information in their answer and that they would not pursue their question further. The family physicians answering the enquiries at the Ask the doctor service were stimulated and challenged by the new task, in spite of the limitations caused by the lack of personal meetings and physical examinations. The opportunity to reflect on the answer before replying was appreciated, and the task was regarded as having a high educational value for themselves. The Internet not only allows easy access to medical information but also to medical consultation – to date mostly text-based. It is probable that in the near future an increasing number of doctors will adopt text-based communication via the Internet to be a natural part of their communication with patients. Therefore, training in text-based communication and carrying out Internet consultations should be integrated into the curricula of medical schools and of continuous professional development. Ethical guidelines should be established.

No description available.

Les travaux de recherche de cette thèse contribuent à l'intégration des nouvelles technologies dans la pratique gérontologique, en vue de répondre aux besoins des personnes âgées. Dans la première partie de ce travail et après une présentation générale du domaine, la thèse s'ouvre sur une enquête exploratoire, auprès de professionnels des soins, concernant les besoins des personnes âgées. Cette enquête est suivie par une présentation des réponses à ces besoins, apportées par la télémédecine et les nouvelles technologies. Dans la deuxième partie, nous procédons à une approche bidimensionnelle pour la mise de nouvelles technologies au service des personnes âgées. La première dimension de cette approche concerne la consultation de gérontechnologie clinique. La deuxième dimension aborde trois modèles cliniques d'utilisation des trois technologies suivantes expérimentées dans ce travail : la géolocalisation, la visioconférence et l'actimetrie. La troisième partie, une discussion reprend les nombreuses dimensions de la recherche telle que la sélection de groupe thématique de la Classification Internationale du Fonctionnement, du Handicap et de la Santé (CIF) pour la gérontechnologie, l'attitude des utilisateurs envers les technologies utilisées, les limites à cette utilisation, les services rendus par ces technologies, ainsi qu'une notion éthique. La discussion s'ouvre également sur des proposition concernant : 1) une classification des technologies pour la gérontologie, 2) un modèle clinique générique d'intégration de dispositifs technologiques à la gérontologie, et 3) un centre d'appel médicalisé mettant en ouvre ces nouvelles technologies.

Paper 1: This study focused on personal education plans for children in care and the related research around individual education plans. Children in care have been identified by the government and local authorities as a vulnerable group, at risk of failing to fully access education (DCSF, 2010). This paper examines the role of the educational psychologist in supporting children in care. There are three aims; 1. to explore the current role and work of educational psychologists in supporting children in care across local authorities, and within one local authority, 2. to generate, a more in-depth understanding of educational psychologists’ practice regarding children in care. 3. to use the analysis to formulate a framework that will inform an intervention to enhance the personal education plan process. Mixed methods were used to investigate the current role and view of educational psychologists and those involved in the personal education plan (PEP) process. The methods included online surveys, hardcopy questionnaires and semi structured interviews, which produced both qualitative and quantitative data. The findings of this research suggest that EPs most often work with Children in Care in school, and this seems to involve consultations, planning and reviewing meetings at a multiagency level. This study reports that EPs are not often involved in the PEP process but that most EPs have an understanding of the purpose of PEPs. A summary of the distinct contribution EPs believe they have to offer children in care has been presented, and the findings could provide EPs with improved role clarity in the future. A number of themes were also identified that would support the PEP process and a framework has been created that has the potential to enhance the process. Paper 2 - Collaborative Consultation: Background: Children in care (CiC) have consistently underperformed educationally, compared to other children. Personal Education Plans (PEP) were introduced to address this issue. This study aims to implement a PEP intervention (based on a framework from Paper 1) to enhance the educational experience of the child and explore the distinct contribution of the educational psychologist (EP). Method: Action Research was used to structure an intervention and gather the pre and post evaluation data in four case studies. The intervention consisted of an assessment of the child; there were three collaborative consultations with those involved in the PEP and attending the PEP meeting. Data collected include child assessments, notes from consultations, pre and post questionnaires and post semi-structured interviews with the professional. Results: The findings suggest the intervention had a positive impact on the PEP process and how those completing the PEP felt about the process. Changes to the child’s independent functioning could not be attributed to the intervention. The analysis developed and supports the finding in the framework from Paper 1. Conclusion: The revised framework offers a guideline to produce a consistent PEP process across all Local Authorities. Recommendations about the use of assessment and introducing psychological theories through consultation prior to the PEP are provided.

Le comité d’entreprise, institution représentative du personnel chargée d’assurer « une expression collective des salariés » dans l’entreprise a une mission sociale et culturelle d’une part, économique et professionnelle d’autre part. En matière économique ses attributions ont été marquées par de profonds changements depuis sa création en 1945. A l’origine, le comité était doté d’une mission de coopération avec l’employeur, abandonnée en 1982 au profit d’une mission de contrôle de la décision patronale. Le législateur et le juge ont conféré à ce contrôle des moyens toujours plus importants, ceux-ci restant cependant sans conséquence sur la décision finale. Le premier objectif de cette thèse est de déterminer la nature de ce contrôle atypique coexistant avec l’autre forme de participation des salariés qu’est la représentation syndicale. Une autre évolution, plus diffuse, se perçoit dans les attributions économiques du comité d’entreprise depuis le début du XXIème siècle : celle d’un possible retour à l’idée de coopération, initié par le droit de l’Union européenne qui se réfère à cette notion pour définir la relation entre représentants des travailleurs et direction. Le deuxième objectif de cette étude est d’identifier les éléments de notre droit caractérisant cette évolution. Celle-ci semble emprunter deux voies distinctes : d’une part, un accroissement du dialogue entre l’employeur et le comité quand ce dernier devient acteur de la négociation collective ; d’autre part, une négociation sur les attributions économiques, qui aboutit à l’inclusion du comité dans un processus global de concertation tout en permettant son association plus en amont de la décision patronale. / A Works Council is a company institution designed to express the workers ’collective wishes. Its mission is social and cultural as well as professional and economic. Its economic roles have been marked by some major changes since its introduction in 1945.Originally the Council was entrusted with a mission of cooperation with the management which gave way to monitoring the management’s decisions in 1982. Though new laws and court decisions have contributed to giving the Council an increasing importance in that respect, it has no sway over final decisions.The first objective of this research is to determine the exact nature of this atypical function in relation with another form of workers ’participation: the Workers ’Union. Another more subtle evolution can be perceived in the Council’s economic roles since the beginning of the 21st century: by referring to the notion of cooperation the European Union law has made it possible to restore the Council’s mission to define the relations between the workers’ representatives and the management.The second objective of this work is to identify the elements in our present French Labour Regulations characterizing this evolution, which appears to be twofold. On the one hand the dialogue between the management and the Council is enhanced when the latter takes an active part in joint negotiations. On the other hand negotiating on the Council’s economic roles has led to its involvement in the global process of consultations with the possibility of being associated earlier with the management’s final decisions.

The role of diabetes specialist nurses in delivering diabetes consultations has been recognised for more than a decade, particularly since the publication of the Standards for Specialist Education and Practice by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) in 2001. However, evidence on how the consultation is delivered, together with patients’ experiences, is somewhat limited. This study examined diabetes specialist nurses’ and patients’ consultation experiences in primary care. It also investigated the process and outcome of these diabetes consultations. This research utilised a sequential mixed methods single approach design in which qualitative was followed by quantitative investigation. In the qualitative stage, 7 diabetes specialist nurses and 7 patients were interviewed separately, followed by observations of 7 nurse-patient consultations. The data from the interviews were analysed thematically, whereas the data from nurse patient consultations were examined though conversation analysis (CA). The investigation continued quantitatively, where the questionnaires were developed based on the qualitative findings and adaptation of the Consultation Quality Index (CQI-2). Following on from a pilot study, the questionnaires were sent to adult patients with diabetes (n=150) and 40 completed questionnaires were returned for statistical analysis. The qualitative and quantitative findings were then merged in a matrix diagram to reveal holistic findings on consultation experiences. The thematic analysis of patients’ interviews produced five themes which were: ‘I don’t like living with diabetes’, ‘Daily problems’, ‘Coping with my diabetes’, ‘How the nurses approach me’ and ‘My expectations toward the diabetes specialist nurses’ . In contrast, the themes from the nurses focused not only on the diabetes consultation but also care management issues: ‘Current problems’, ‘My expectations towards the patients’, ‘Consultation approaches’, ‘Personal development’ and ‘Team working’. Details on the sequence and scope of consultations were obtained from conversation analysis which highlighted the approaches commonly used by the diabetes specialist nurses. The statistical analysis showed associations between partnership and empathy (P=0.01), empathy and outcome (P= 0.005), information giving and consultation time (P= 0.05). The integration of qualitative and quantitative findings suggested ‘Consultation stages’ as a theme, and also four themes related to consultation experiences: ‘Day to day hurdle’, ‘Knowing each other’, ‘Shared expectations’and ‘Working together’. This study has identified the value and processes of the nurse-patient consultation in diabetes care from a nursing context. In general, the patients experienced their consultations with the DSNs positively. They highlighted key personal characteristics of the nurses. Similarly, the nurses considered their role in delivering consultation as crucial. Some challenges were evident including patients’ behaviours, the diabetes knowledge of other health care professionals and the lack of administrative support. The association between the nurses’ empathetical approaches and the patients’ outcomes needs further investigation.

The collaborative management arrangements in place for Nunavut’s National Parks demonstrated a shifting trend in Canadian resource management, where Indigenous people are increasingly involved in the governance of traditional lands. This work considered the arrangement in place for Auyuittuq National Park, Nunavut, by exploring the effect that differential discourse had on policy formation and implementation. To focus the research on a single management issue youth engagement was selected for consideration. Employing a qualitative case study strategy of inquiry, data was collected by conducting 50 interviews and 7 focus groups in the park adjacent community of Pangnirtung. The project findings indicated that the Parks Canada Agency’s discourse maintained a dominant position within the management process, such that many of the youth engagement strategies implemented did not account for Inuit cultural practices. As a consequence of this omission, many of the implemented methods were unintuitive to the community, and in some cases served as a barrier to youth participation. / October 2016

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de Maître en droit (LL.M.)" / L'introduction des OGM dans le domaine agricole soulève diverses préoccupations. Qu'il s'agisse du type d'agriculture ou des aliments que nous privilégions pour l'avenir, de la sauvegarde des écosystèmes et des patrimoines culturels, des questions de justice, d'équité et d'éthique, les choix de société que suscitent les OGM sont nombreux. Notre argumentation est à l'effet que, seul un processus démocratique offrant aux citoyens la possibilité d'exprimer leurs préoccupations, commentaires et opinions sur le développement des aliments transgéniques est en mesure de permettre une prise de décision éclairée des autorités quant à ces choix de société. Les gouvernements de nombreux pays démontrent par ailleurs leur volonté d'ouvrir le dialogue avec le grand public sur les enjeux que suscitent ces nouvelles technologies. Notre étude analyse différents modèles de participation du public aux décisions portant sur les OGM au sein de trois pays, la France, la Suisse et le Canada. Nous avons organisé ces modèles en les classant sous trois rubriques : les instruments de la démocratie directe, l'implication de membres de la société dans les processus d'évaluation, les débats publics. Nous constatons alors que malgré les efforts des autorités pour démocratiser les prises de décisions en cette matière, de nombreux facteurs, tels la logique technicienne dans laquelle s'inscrivent les décisions ainsi que les lacunes inhérentes au régime représentatif, ne permettent pas une véritable prise en compte de l'opinion des citoyens. Il s'agit donc de s'interroger sur la pertinence et l'opportunité d'utiliser le référendum afin de traiter des questions associées aux OGM. / The introduction of GMOs into agri-business has brought forth many public concems, such as the type of agriculture or the kind of foods we choose for our future, the safekeeping of our ecosystems and our cultural heritage, or matters of justice linked to ethics and equity. Our argumentation is that only a democratic process that offers to the citizens the possibility to express their views and concems on the development of GMOs will allow the authorities to make enlightened decisions on these matters. Moreover, many govemments have already shown interest in opening communication lines with the general public on the stakes created by these new technologies. This study analyzes different forms of public participation in the decision-making process conceming GMOs in three different countries, France, Switzerland and Canada. These models have been divided into three categories : the instruments of direct democracy, participation of different members of society in the evaluation processes, and public debates. We note that in spite of the efforts of the govemments to democratize decisionmaking in these matters, many factors such as technical reasoning into which decisions are inscribed as weIl as the inherent gaps of the representative model, prevent from taking the opinions of citizens into consideration. Therefore, we should ask ourselves about the relevance and the convenience of using the referendum to treat the concems associated with GMOs.

Les restructurations occupent plus que jamais le devant de l'actualité. En effet, il ne se passe pas une semaine sans que les médias ne relayent un nouveau plan de restructuration aux conséquences souvent désastreuses sur l'emploi. S'il est vrai que les restructurations sont également présentes en période de croissance économique, elles prennent un relief tout particulier en temps de crise ; c'est à ce moment là qu'elles vont véritablement se révéler. Elles représentent un phénomène complexe qui engendre de nombreuses conséquences économiques, financières et humaines. A partir de ce constat, il paraît évident qu'une stratégie doit être mise en place afin de les anticiper et de sécuriser au mieux l'emploi en France. Le dialogue social est alors privilégié pour atteindre cet objectif. La procédure d'information-consultation des représentants du personnel et la négociation collective peuvent-elles contribuer à la mise en place d'une stratégie d'anticipation collective des restructurations ? Sans se vouloir exhaustive, cette étude tente d'apporter des éléments de réponse à la question soulevée. / Company reorganizations have now become burning issues. Every single week, the media report a new reorganization project whose consequences on employment are disastrous. Of course, reorganizations also take place in times of economic prosperity, however, they take a new dimension in times of crisis when they do reveal themselves. They represent a complex phenomenon which generates a lot of economic, financial and human difficulties. Once this observation made, it seems obvious that a relevant strategy must be put in place to anticipate reorganizations and secure employment in France as best as possible. Social talks are then favoured so as to reach this objective. Can this process of information-consultation of the staff representatives added to collective negotiation talks lead to a better strategy of anticipation of reorganizations? Without being exhaustive, this study tries to bring some possible answers to this question.

in English The topic of this thesis is the regulation of employees' right to transnational information and consultation within Community-scale undertakings or Community-scale Groups of undertakings. Firstly, the right to information and consultation at the national level and the forms of employees' representation in the Czech Republic are introduced. Then the thesis explains the respective European directives and describes relevant cases of the Court of Justice of the EU, followed by a detailed analysis of the Czech legislation in the Labour Code. The next chapter focuses on the German transposition of this regulation. Eventually, the last chapter is a research on the operation of active European Works Councils in practice in the European Union and in the Czech Republic. The purpose of the thesis is to provide a comprehensive overview of the regulation of information and consultation procedures at transnational level and to introduce its operation in practice.