No description available.

No description available.

No description available.

No description available.

No description available.

La maladie de Crohn touche 100 000 personnes en France. Elle est caractérisée par une inflammation chronique de l’intestin, ainsi que par l’alternance de phases de récidive et de rémission. Devant l’imprévisibilité des rechutes, médecins et patients essaient d’identifier des facteurs qui permettraient de les anticiper et ainsi de mieux les contrôler. Néanmoins, aucune étude n’a encore pu clairement mettre en évidence l’étiologie de la rechute dans la maladie de Crohn. Ce travail de thèse a donc pour ambition de définir les facteurs psychosociaux prédictifs de la rechute. Dans une démarche clinique, nous accordons également une importance au vécu subjectif de la maladie et des rechutes. Les travaux portants sur les expériences subjectives de la maladie chronique montrent que diverses représentations cognitives, sociales et fantasmatiques de la pathologie et du corps malade, sont mises au travail permettant aux patients un meilleur ajustement. Le deuxième objectif de ce travail de thèse vise donc une compréhension des enjeux psychiques du vécu de la maladie de Crohn.La double méthodologie mise en place, quantitative et qualitative, s’inscrit dans une perspective longitudinale, prospective et intégrative. Nous avons ainsi pu recueillir des données portant sur les facteurs psychosociaux à travers des questionnaires administrés auprès de 145 sujets adultes en rémission de la maladie de Crohn. Parallèlement nous avons conduit 33 entretiens de recherche ayant fait l’objet d’une analyse de contenu thématique. Le test projectif du Rorschach a également été utilisé afin de mettre en lumière les retentissements psychiques de la maladie lors de 3 études de cas.Les principaux résultats soulèvent l’implication des stresseurs spécifiques à la maladie chronique, des stratégies de coping centrées sur l’émotion et de la qualité de vie dans l’augmentation du risque de rechute dans la maladie de Crohn. Nous avons également pu mettre en évidence plusieurs phénomènes quant au vécu de la pathologie. La rechute parait marquée par des potentialités traumatiques et psychopathologiques qui signent la véritable entrée du sujet dans la maladie. Son vécu ainsi que le vécu de la maladie donne lieu à des remaniements identitaires profonds médiatisés par de forts éprouvés de honte quant à la spécificité des symptômes et par une fantasmatique propre à la zone corporelle atteinte, faisant écho à des angoisses du féminin. L’acquisition de savoirs profanes, un travail d’élaboration autour de la perte et de la qualité des relations entretenues avec le médecin spécialiste paraissent constituer des facteurs permettant de mieux gérer les stresseurs et de s’approprier la maladie. Notre travail amorce une réflexion sur l’accompagnement thérapeutique devant être fondé une prise en charge globale de la souffrance des patients traduite aussi bien à partir des facteurs psychosociaux que du vécu subjectif des patients. / Crohn's disease affects 100,000 people in France. It is characterized by a chronic inflammation of the intestine, as well as alternating phases of recurrence and remission. Given the unpredictability of relapses, doctors and patients try to identify factors that would allow them to be anticipated and thus better controlled. Nevertheless, no study has yet been able to clearly identify the etiology of relapse in Crohn's disease. This thesis work aims to define the psychosocial factors predictive of relapse. In a clinical approach, we also place importance on the subjective experience of illness and relapse. Work on the subjective experiences of chronic disease shows that various cognitive, social and fantasy representations of the pathology and the sick body are put to work allowing patients a better fit. The second objective of this PhD thesis is therefore an understanding of the psychic issues involved in living with Crohn's disease.The dual methodology put in place, quantitative and qualitative, is part of a longitudinal, prospective and integrative perspective. We were able to collect data on psychosocial factors through questionnaires administered to 145 adult subjects in remission of Crohn's disease. At the same time, we conducted 33 research interviews that were the subject of a thematic content analysis. The projective Rorschach test was also used to highlight the psychic repercussions of the disease in 3 case studies.The main findings highlight the involvement of chronic disease-specific stressors, emotion-focused coping strategies, and quality of life in increasing the risk of relapse in Crohn's patients. We have also been able to highlight several phenomena regarding the experience of pathology. The relapse seems marked by traumatic and psychopathological potentialities which sign the real entrance of the subject into the disease. Her experience as well as the experience of the disease gives rise to profound identity re-mediations mediated by strong shame as to the specificity of the symptoms and by a phantasmatic peculiar to the affected body area, echoing anxieties of the feminine. The acquisition of secular knowledge, a work of elaboration around the loss and the quality of the relations maintained with the specialist doctor appear to constitute factors allowing to better manage the stressors and to appropriate the disease. Our study initiates a reflection on the therapeutic accompaniment to be founded a global management of the suffering of the patients translated as well from psychosocial factors as from the subjective experience of the patients.

p. 1-110 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-07T19:58:59Z No. of bitstreams: 1 888888888888888.pdf: 457498 bytes, checksum: 26eab977e9e482aef8f7d65b783c3bba (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-13T13:53:23Z (GMT) No. of bitstreams: 1 888888888888888.pdf: 457498 bytes, checksum: 26eab977e9e482aef8f7d65b783c3bba (MD5) / Made available in DSpace on 2013-05-13T13:53:23Z (GMT). No. of bitstreams: 1 888888888888888.pdf: 457498 bytes, checksum: 26eab977e9e482aef8f7d65b783c3bba (MD5) Previous issue date: 2006 / As LER/Dort são síndromes de repercussões importantes para a saúde do trabalhador e para os sistemas previdenciários e de saúde brasileiros e têm origem nas lesões osteoarticulares cuja complexidade segue o curso histórico das profundas modificações ocorridas no trabalho e nas relações de trabalho. Objetiva-se conhecer a experiência de adoecimento sob a ótica do ?corpo incapacitado? nas perspectivas fenomenológica, social e política, apoiando-se nos pressupostos da ?experiência de enfermidade? e nas ?narrativas da doença?. Para construir esses enredos, utilizou-se a ?análise temática? de entrevistas em profundidade com trabalhadores sob regime de benefício pela Previdência Social brasileira. A trama foi tecida partindo do auto-reconhecimento dos trabalhadores sobre sua condição antes do adoecimento, seguindo pelas percepções iniciais da incapacidade, bem como as estratégias mais incipientes de enfrentamento até ações mais pragmáticas de resistência, passando pelas construções metafóricas que apontam para processos legitimadores da invalidez. Sentidos e significados foram extraídos dessas experiências, denotando também processos macrossociais imbricados nos sentidos da vida prática, requerendo uma visão holística, dialeticamente integrada a estratégias que valorizem mais a abordagem intersubjetiva sobre a incapacidade em LER/Dort. / Salvador

No description available.

Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced. This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment. The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded. The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated. An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.

To explore attributions about chronically ill peers, 545 older adolescents ages 17-26 read a short vignette describing a brief social encounter with a hypothetical peer suffering from a medical condition, and then responded to a series of questionnaires to assess their perceptions of that peer. Nine measures intended to assess perceptions of ill peers were developed and empirically validated. Test-retest reliability and internal consistency was moderate to good for all measures. Component structure of the Peer Acceptance Questionnaire (PAQ), Peer Acceptance Questionnaire ?? 3rd Person (PAQ-F), and Perceived Similarity Questionnaire (PSQ) were also evaluated. Principal components analysis yielded a 2-factor structure of Openness and Egalitarianism for both the PAQ and PAQ-F. A 6-factor structure of (a) Familial/Spiritual, (b) General Health, (c) Social, (d) Behavioral, (e) Physical, and (f) Educational was suggested for the PSQ. Results indicated an interaction between illness type and behavior on acceptance ratings, such that behavior potentiated the effect of illness type on acceptance. In addition, vignette characters with contagious illnesses were rated less favorably than those with noncontagious illnesses, and vignette characters displaying typical behavior were rated more favorably than either withdrawn or aggressive vignette characters. Illness-specific knowledge, ratings of perceived similarity, and ratings of assigned blame predicted acceptance ratings, whereas illness-specific knowledge and acceptance ratings predicted ratings of assigned blame. Finally, significant differences were observed between first- and third-person ratings of both acceptance and assigned blame.