This thesis is about the relationship between human bodies and instrumental technologies that can be use to measure them. It adopts the position that instruments are technological structures that evoke and manifest particular phenomena of embodied life. However, through their history of association and use in the sciences and scientific medicine, instruments tend to be attached to a particular ontology, that of mechanical objectivity. Embarking from research into the artistic uses of physiological sensor technology in creative practices such as performance and installation art, this thesis asks whether it is possible to use instruments in a way that departs from their association with scientific objectivity. Drawing on philosophers who have developed an understanding of the relationship of instrumental technologies and human bodies as co-constructive, it explores how this model of con-construction might be understood to offer an alternative ontology for understanding the use of instruments in practices outside of science and scientific medicine. The project is therefore suggestive of degrees of freedom and flexibility that are open to exploitation by creative practices in the realm of instrumentation as an alternative to orthodox rationalisations of the value of scientific equipment as authentic, revealing and objective. The major contribution of the thesis is that transfers and synthesises arguments and evidence from the history and philosophy of sciences that serve to demonstrate how the instrumental measurement of human bodies can be considered to be a form of creative practice. It assembles a position based on the work of thinkers from a number of disciplines, particularly philosophy of science, technology, and the medical humanities. These offer examples of ontological frameworks within which the difference between the realm of the instrumental, material, biological, and the objective, and the phenomenal, meaningful and subjective, might be collapsed. Doing this, the thesis sheds light on how physical devices might enter into the interplay of making, mattering and objectifying the immaterial, a realm that it might be considered the role of artists to manifest. Drawing on contemporary, and secondary, accounts of the development of empirical testing in the medical sciences, the thesis agues for the recovery of a romantic account of human physiology, in which the imagination and meaning are active and embodied. It therefore offers to link the bodily and the instrumental through an extended-materialist account in which the physiological, rather than the psychological, is central. Developing a response to constructionist models of the body and instrumentation, the thesis concludes that a model of the poetic may be adopted as a method for understanding the opportunities and imperatives inherent in the avoidance of deterministic approaches to biosignalling technologies. In doing this, the thesis contributes particularly to the creative arts and technology research practices concerned with the use of body sensor technologies in humanistic applications. It complements the existing works by artists in this area that make use of instruments by assembling a number of theoretical readings and interpretations of how instruments work – among them the thermometer, lie detector, and automatograph – which illustrate the argument that that is possible to operate from a theoretical position within which instruments are both material, performative and symbolic.

Introduction Placebos have been used in medical treatments since the dawn of medicine. The placeboeffect is referred to as a beneficial effect of a treatment which cannot be attributed to thepharmacological component of the treatment given. Aim and Method We attempt to understand the current research regarding the placebo effect, its mechanismsand driving factors. We utilize hermeneutics, text-based analytics and argument analysis toanswer our ethical questions regarding the usage of placebo and the placebo effect. Results Classical conditioning and expectation have been accredited as the two most prominentfactors driving a placebo effect. Recent research focuses on identifying minor factorsinfluencing these prominent factors. Through modern imaging techniques researchers haveidentified physiological responses to the placebo effect.We pose four different ways in which a placebo treatment option could be considered ineveryday medicine. We also discuss whether the placebo effect should be used for itsbeneficial effects in all medical treatments, and how this could affect medicine and healthcarepractitioners. Conclusion Current research provides us with substantial evidence that the placebo effect has aphysiological component. It also provides us with explanations as to how this effect can beutilized in every day medical care. The placebo effect can even be utilized without deceivingthe patient which has always been the biggest argument against incorporating it in day to daymedicine. However, there is still lacking evidence of when a placebo effect can be utilized toits full potential which limits its current clinical applications.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A hiperestesia dentinÃria à um fenÃmeno sensorial complexo e de difÃcil soluÃÃo na clÃnica odontolÃgica. Apesar da grande diversidade de tratamentos propostos, ainda nÃo existe uma terapia considerada ideal para eliminar essa situaÃÃo desconfortÃvel. Esta dissertaÃÃo, constituÃda por dois artigos cientÃficos, teve por objetivos: (1) revisar criticamente a literatura disponÃvel sobre os principais aspectos relacionados à etiologia e ao tratamento da hiperestesia dentinÃria; (2) avaliar clinicamente a eficiÃncia de agentes anti-hiperestÃsicos no tratamento da hiperestesia dentinÃria. No estudo 1, a literatura cientÃfica pertinente ao assunto foi analisada atravÃs dos resultados de investigaÃÃes clÃnicas e laboratoriais pesquisadas usando a base de dados medline e busca manual de referÃncias citadas em artigos cientÃficos. No estudo 2, um total de 164 dentes, provenientes de 30 pacientes com diagnÃstico de hiperestesia dentinÃria moderada ou severa, foi dividido aleatoriamente em trÃs grupos e avaliado clinicamente de acordo com o tratamento administrado: aplicaÃÃo de laser de arseniato de gÃlio-alumÃnio (AsGaAl), aplicaÃÃo de gel de oxalato de potÃssio a 3% e aplicaÃÃo de gel placebo. As aplicaÃÃes dos tratamentos foram realizadas em intervalos semanais, durante o perÃodo de quatro semanas consecutivas e o grau de sensibilidade foi mensurado para cada dente atravÃs de uma escala visual analÃgica em resposta aos estÃmulos tÃtil (sonda exploradora) e evaporativo (jato de ar) antes da primeira aplicaÃÃo (baseline), imediatamente apÃs e trÃs meses apÃs a Ãltima aplicaÃÃo dos tratamentos. Os dados foram submetidos à anÃlise estatÃstica pelo teste de Kruskal-Wallis (p=0,05) e o grau de reduÃÃo da hiperestesia dentinÃria foi avaliado para cada um dos perÃodos observacionais em relaÃÃo ao baseline. A anÃlise crÃtica apresentada no artigo 1 mostrou que a literatura apresenta diversos tipos de tratamento para a hiperestesia dentinÃria, que variam desde procedimentos simples, que podem ser executados pelo prÃprio paciente, atà procedimentos complexos, que envolvem a combinaÃÃo de diferentes terapias. Os resultados do artigo 2 demonstraram que a aplicaÃÃo dos tratamentos propostos, inclusive o placebo, proporcionou reduÃÃo estatisticamente significante, imediata e mediata, da sensibilidade em resposta aos estÃmulos tÃtil e evaporativo (p<0,05). No entanto, nÃo houve diferenÃa estatisticamente significante entre os trÃs grupos estudados, independentemente do estÃmulo aplicado, tanto na avaliaÃÃo imediata quanto na mediata (p>0,05). Em conclusÃo, os resultados desses estudos indicam que o conhecimento acerca do mecanismo de ocorrÃncia da hiperestesia dentinÃria e dos agentes anti-hiperestÃsicos disponÃveis à indispensÃvel para a elaboraÃÃo de um tratamento eficiente. AlÃm disso, concluiu-se que os trÃs tratamentos utilizados no estudo clÃnico sÃo eficientes para a reduÃÃo da hiperestesia dentinÃria e que existe grande influÃncia do efeito placebo na reduÃÃo da sensibilidade dolorosa / Dentinal hypersensitivity is a complex sensorial condition which can cause considerable concern in the dental office. Despite the large number of different proposed kinds of treatment, there is no product or therapy reported in literature that could be considered ideal to eliminate this uncomfortable situation. The aim of this study, comprised by two manuscripts, was: (1) to critically review the literature related to the main evidences about the etiology and the management of dentinal hypersensitivity; (2) to evaluate the clinical performance of different dentine desensitizers in the treatment of dentinal hypersensitivity. In study 1, the scientific literature related to the issue was analyzed through the results of laboratory and clinical investigations searched using medline and manual tracing of references cited scientific papers. In study 2, a total of 164 teeth, from 30 patients with clinical diagnosis of moderate or severe dentinal hypersensitivity, were randomly divided into three groups and clinically evaluated according to the desensitizing treatment under study: gallium-aluminun-arsenide (GaAlAs) laser therapy, 3% potassium oxalate application and placebo gel application. Treatment sessions were performed at seven-day intervals for four consecutive weeks and the degree of sensitivity in response to tactile (probe) and evaporative (air blast) stimuli was assessed according to a visual analogue scale at baseline, immediately after and three months after the last treatment session. Data scores were submitted to Kruskal-Wallis statistical analysis (p=0.05) and were analyzed by dentinal hypersensitivity reduction for each observational moment in relation to baseline. The critical review presented in study 1 showed that the reviewed literature points out several treatment modalities ranging from simple procedures, which can be performed by the patient him/herself, to complex procedures that involve the combination of therapies. The results of study 2 demonstrated that the treatment of dentinal hypersensitivity performed with both active and control groups produced statistically significant reduction of pain in response to evaporative and tactile stimulation immediately after and three months after treatment (p<0.05). No significant differences among the three groups could be detected in both immediate and mediate evaluations irrespective of the applied stimulus (p>0.05). In conclusion, the results of these studies suggest that knowledge about the available desensitizing products and the factors involved in the mechanism of the dentinal hypersensitivity is indispensable in order to perform an effective treatment. Besides, it could be concluded that the three treatments performed in the clinical study were effective for treating dentinal hypersensitivity and that the placebo effect plays an important role in sensitivity reduction

O efeito placebo tem sua origem atrelada aos estudos ligados às ciências médicas e farmacológicas e, basicamente, consiste na capacidade de produtos inertes produzirem efeitos por meio do seu uso ou consumo. Esse efeito passou a fazer parte do escopo do Marketing em 2005, quando estudos mostraram a capacidade do preço gerar modificações sobre o desempenho de um produto. A ideia do efeito placebo desencadeado pelo preço dos produtos está ancorada no fato das crenças globais, que associam preço baixo a produtos de má qualidade, anteciparem as expectativas do consumidor acerca da resposta do produto e, a partir disso, alterarem o seu desempenho. Nessa mesma linha, o estereótipo do país de origem também se apresenta como uma crença global, em que produtos oriundos de países com estereótipo negativo são associados a produtos inferiores e de má qualidade. Sendo assim, esta pesquisa analisou a ocorrência do efeito placebo desencadeado pelo país de origem do produto, analisando, ainda, a interação da força das expectativas e do preço do produto na geração deste efeito. Para tanto, três estudos experimentais foram operacionalizados. O primeiro estudo apresentou as testagens iniciais sobre o efeito placebo gerado pelo país de origem e mostrou que o país de origem com estereótipo negativo é capaz de gerar um efeito placebo negativo sobre o desempenho do produto. Não foi identificado, no entanto, a ocorrência de efeito placebo gerado pelo estereótipo positivo do país de origem. No segundo estudo, analisou-se o efeito placebo do país de origem em cenário de alta e baixa expectativa. Como resultado, obteve-se, em cenário de baixa expectativa, a ocorrência de efeito placebo negativo gerado pelo estereótipo negativo do país de origem. Já em cenário de alta expectativa, os resultados indicam que o fortalecimento das expectativas eliminou o efeito placebo negativo e, além disso, promoveu a ocorrência de um efeito placebo positivo gerado pelo estereótipo positivo do país de origem. O último estudo observou a interação do país de origem e do preço do produto sobre a geração de efeito placebo. Os resultados mostram que, em cenário de preço baixo, há efeito placebo negativo gerado pelo país de origem com estereótipo negativo, mas não foi observada a ocorrência de efeito placebo positivo gerado pelo estereótipo positivo do país de origem. Já, em cenário de preço alto, não se observou a ocorrência de nenhum efeito placebo, nem positivo, nem negativo. Ou seja, o preço elevado do produto foi capaz de anular o efeito placebo negativo gerado pelo estereótipo negativo do produto, mostrando a capacidade do preço em compensar os efeitos negativos causados pelo país de origem com imagem desfavorável. Com base nisso, os achados desta tese contribuem para o avanço teórico dos estudos sobre efeito placebo em Marketing, uma vez que adicionam o país de origem como um elemento gerador deste tipo de efeito e, ao analisar a interação do país de origem com o fortalecimento das expectativas e o preço do produto, confirmam as bases conceituais sobre a relação entre esses elementos. Além disso, seus achados, em termos gerenciais, podem promover reflexões por parte das organizações que compõem o seu mix de produtos com bens importados e também que operaram no exterior e fazem investimentos externos diretos em diversas partes do mundo. / The placebo effect has its origin linked to studies related to medical and pharmacological sciences and basically consists in the ability of inert products to produce effects through its use or consumption. This effect became part of the Marketing scope in 2005 when studies showed the ability of pricing to generate changes on the performance of a product. The idea of the placebo effect triggered by product price is anchored on the fact that global beliefs, which associate low price to low quality products, anticipate consumer expectations about the response of the product and, from there, change its performance. Along the same line, the stereotype of the country of origin also presents itself as a global belief in that products from countries with negative stereotypes are associated with inferior and bad quality products. Thus, this research analyzed the occurrence of the placebo effect triggered by the country of origin of the product, also analyzing the interaction of the strength of expectations and of product price in the generation of this effect. For this purpose, three experimental studies were operationalized. The first study presented initial testings on the placebo effect generated by the country of origin and showed that the country of origin with negative stereotypes is able to generate a negative placebo effect on product performance. However, the occurrence of the placebo effect generated by positive stereotypes in the country of origin was not identified. In the second study, the placebo effect of the country of origin in a scenario of high and low expectations was analyzed. As a result, in a scenario of low expectations, the occurrence of a negative placebo effect generated by the negative stereotype of the country of origin was obtained. However, in a scenario of high expectations, results indicate that the strengthening of the expectations eliminated a negative placebo effect and in addition, promoted the occurrence of a positive placebo effect generated by the positive stereotype of the country of origin. The last study observed the interaction of the country of origin and the price of the product upon the generation of the placebo effect. The results show that in a scenario of low price, there is a negative placebo effect generated by the country of origin with a negative stereotype, but the occurrence of a positive placebo effect generated by the positive stereotype of the country of origin was not observed. However, in a scenario of high prices, there was no occurrence of a placebo effect, whether positive or negative. In other words, the high price of the product was able to cancel the negative placebo effect generated by the negative stereotype of the product, showing the capacity of the price to compensate for the negative effects caused by the country of origin with an unfavorable image. Based on this, this thesis’ findings contribute to the theoretical progress on the studies about the placebo effect in Marketing, once the country of origin is added as a generating element of this type of effect, and when analyzing the interaction of the country of origin with the strengthening of expectations and the price of the product, the conceptual foundations about the relationship between these elements are confirmed. Moreover, its findings in management terms can promote reflections by organizations that compose the product mix with imported goods and also that operate overseas and make foreign direct investments in various parts of the world.

The main purpose of this dissertation is to elucidate the problem of assessing and providing alternative medical technologies. The purpose is divisible into three parts: To investigate the bases of assessment for the acceptance of an alternative medical technology; 2. To investigate the professional and ethical problems connected with the practice of alternative medical technologies and find out whether the views of laymen and physicians differ with regard to the provision of treatments which are not in accordance with science and proven experience; 3. To investigate the interest physicians have shown in alternative medicine and the motives for this interest. These investigations are based partly on a study of the literature on alternative medicine dealing with the effects of the following alternative medical technologies: manipulation therapy, acupuncture, reflexio (zone) therapy, homoeopathy and magnetic therapy, and partly on empirical research into the attitudes expressed by doctors and patients towards non-scientific treatments. The results of these studies show that the acceptance of empirical data cannot be separated from the scientific paradigm within which the investigation has been planned. The documentation of the effect of alternative medical technologies is often empirically insufficient and based, in many instances, on so-called ”personal experience”. The interest shown by accredited physicians in alternative medicine is often motivated by the fact that certain complaints brought to them by their patients cannot be rectified by academic medical methods. The study also shows that physicians have professional interests which the patient is not prepared to respect in the same way as the physician is prepared to respect the right of a patient to refuse to undergo life-saving medical treatment. The main conclusion is that alternative medicine is a heterogeneous field where the interest expressed can be interpreted as a crisis phenomenon and an indication of the need for the assessment of alternative medicine as well as academic medicine. Laymen perceive the ethical and professional problems connected with the practice of alternative medicine relatively differently when compared to physicians. The possibility of scientific co-operation between practitioners of alternative medicine and academic medicine is difficult due to the fact that alternative medicine and academic medicine relate to different scientific paradigms. Clinical co-operation in the case of individual patients, on the other hand, is likely to occur. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1991, härtill 6 uppsatser</p> / digitalisering@umu

The placebo effect, a beneficial effect attributable to a treatment containing no specific properties for the condition being treated, has been demonstrated in a variety of medical conditions. This thesis includes four studies aimed at increasing our knowledge on the neurobiology of placebo. Study I, a review of the placebo neuroimaging literature, suggested that the anterior cingulate cortex (ACC) may be a common site of action for placebo responses. However, because placebo neuroimaging studies in clinical disorders are largely lacking, the clinical relevance of this needs further clarification. The subsequent three empirical studies were thus designed from a clinical perspective. Using positron emission tomography (PET) these studies investigated the underlying neurobiology of sustained placebo responses in patients with social anxiety disorder (SAD), a disabling psychiatric condition that nonetheless may be mitigated by placebo interventions. Study II demonstrated that serotonergic gene polymorphisms affect anxiety-induced neural activity and the resultant placebo phenotype. In particular, anxiety reduction resulting from placebo treatment was tied to the attenuating effects of the TPH2 G-703T polymorphism on amygdala activity. Study III further compared the neural response profile of placebo with selective serotonin reuptake inhibitors (SSRIs), i.e the first-line pharmacological treatment for SAD. A similar anxiety reduction was noted in responders of both treatments. PET-data further revealed that placebo and SSRI responders had similar decreases of the neural response in amygdala subregions including the left basomedial/basolateral (BM/BLA) and the right ventrolateral (VLA) sections. To clarify whether successful placebo and SSRI treatments operate via similar or distinct neuromodulatory pathways, study IV focused on the connectivity patterns between the amygdala and prefrontal cortex that may be crucial for normal emotion regulation. In responders of both treatment modalities, the left amygdala (BM/BLA) exhibited negative coupling with the dorsolateral prefrontal cortex and the rostral ACC as well as a shared positive coupling with the dorsal ACC. This may represent shared treatment mechanisms involving improved emotion regulation and decreased rumination. This thesis constitutes a first step towards better understanding of the neurobiology of placebo in the treatment of anxiety, including the neural mechanisms that unite and segregate placebo and SSRI treatment.

O efeito placebo tem sua origem atrelada aos estudos ligados às ciências médicas e farmacológicas e, basicamente, consiste na capacidade de produtos inertes produzirem efeitos por meio do seu uso ou consumo. Esse efeito passou a fazer parte do escopo do Marketing em 2005, quando estudos mostraram a capacidade do preço gerar modificações sobre o desempenho de um produto. A ideia do efeito placebo desencadeado pelo preço dos produtos está ancorada no fato das crenças globais, que associam preço baixo a produtos de má qualidade, anteciparem as expectativas do consumidor acerca da resposta do produto e, a partir disso, alterarem o seu desempenho. Nessa mesma linha, o estereótipo do país de origem também se apresenta como uma crença global, em que produtos oriundos de países com estereótipo negativo são associados a produtos inferiores e de má qualidade. Sendo assim, esta pesquisa analisou a ocorrência do efeito placebo desencadeado pelo país de origem do produto, analisando, ainda, a interação da força das expectativas e do preço do produto na geração deste efeito. Para tanto, três estudos experimentais foram operacionalizados. O primeiro estudo apresentou as testagens iniciais sobre o efeito placebo gerado pelo país de origem e mostrou que o país de origem com estereótipo negativo é capaz de gerar um efeito placebo negativo sobre o desempenho do produto. Não foi identificado, no entanto, a ocorrência de efeito placebo gerado pelo estereótipo positivo do país de origem. No segundo estudo, analisou-se o efeito placebo do país de origem em cenário de alta e baixa expectativa. Como resultado, obteve-se, em cenário de baixa expectativa, a ocorrência de efeito placebo negativo gerado pelo estereótipo negativo do país de origem. Já em cenário de alta expectativa, os resultados indicam que o fortalecimento das expectativas eliminou o efeito placebo negativo e, além disso, promoveu a ocorrência de um efeito placebo positivo gerado pelo estereótipo positivo do país de origem. O último estudo observou a interação do país de origem e do preço do produto sobre a geração de efeito placebo. Os resultados mostram que, em cenário de preço baixo, há efeito placebo negativo gerado pelo país de origem com estereótipo negativo, mas não foi observada a ocorrência de efeito placebo positivo gerado pelo estereótipo positivo do país de origem. Já, em cenário de preço alto, não se observou a ocorrência de nenhum efeito placebo, nem positivo, nem negativo. Ou seja, o preço elevado do produto foi capaz de anular o efeito placebo negativo gerado pelo estereótipo negativo do produto, mostrando a capacidade do preço em compensar os efeitos negativos causados pelo país de origem com imagem desfavorável. Com base nisso, os achados desta tese contribuem para o avanço teórico dos estudos sobre efeito placebo em Marketing, uma vez que adicionam o país de origem como um elemento gerador deste tipo de efeito e, ao analisar a interação do país de origem com o fortalecimento das expectativas e o preço do produto, confirmam as bases conceituais sobre a relação entre esses elementos. Além disso, seus achados, em termos gerenciais, podem promover reflexões por parte das organizações que compõem o seu mix de produtos com bens importados e também que operaram no exterior e fazem investimentos externos diretos em diversas partes do mundo. / The placebo effect has its origin linked to studies related to medical and pharmacological sciences and basically consists in the ability of inert products to produce effects through its use or consumption. This effect became part of the Marketing scope in 2005 when studies showed the ability of pricing to generate changes on the performance of a product. The idea of the placebo effect triggered by product price is anchored on the fact that global beliefs, which associate low price to low quality products, anticipate consumer expectations about the response of the product and, from there, change its performance. Along the same line, the stereotype of the country of origin also presents itself as a global belief in that products from countries with negative stereotypes are associated with inferior and bad quality products. Thus, this research analyzed the occurrence of the placebo effect triggered by the country of origin of the product, also analyzing the interaction of the strength of expectations and of product price in the generation of this effect. For this purpose, three experimental studies were operationalized. The first study presented initial testings on the placebo effect generated by the country of origin and showed that the country of origin with negative stereotypes is able to generate a negative placebo effect on product performance. However, the occurrence of the placebo effect generated by positive stereotypes in the country of origin was not identified. In the second study, the placebo effect of the country of origin in a scenario of high and low expectations was analyzed. As a result, in a scenario of low expectations, the occurrence of a negative placebo effect generated by the negative stereotype of the country of origin was obtained. However, in a scenario of high expectations, results indicate that the strengthening of the expectations eliminated a negative placebo effect and in addition, promoted the occurrence of a positive placebo effect generated by the positive stereotype of the country of origin. The last study observed the interaction of the country of origin and the price of the product upon the generation of the placebo effect. The results show that in a scenario of low price, there is a negative placebo effect generated by the country of origin with a negative stereotype, but the occurrence of a positive placebo effect generated by the positive stereotype of the country of origin was not observed. However, in a scenario of high prices, there was no occurrence of a placebo effect, whether positive or negative. In other words, the high price of the product was able to cancel the negative placebo effect generated by the negative stereotype of the product, showing the capacity of the price to compensate for the negative effects caused by the country of origin with an unfavorable image. Based on this, this thesis’ findings contribute to the theoretical progress on the studies about the placebo effect in Marketing, once the country of origin is added as a generating element of this type of effect, and when analyzing the interaction of the country of origin with the strengthening of expectations and the price of the product, the conceptual foundations about the relationship between these elements are confirmed. Moreover, its findings in management terms can promote reflections by organizations that compose the product mix with imported goods and also that operate overseas and make foreign direct investments in various parts of the world.

O efeito placebo tem sua origem atrelada aos estudos ligados às ciências médicas e farmacológicas e, basicamente, consiste na capacidade de produtos inertes produzirem efeitos por meio do seu uso ou consumo. Esse efeito passou a fazer parte do escopo do Marketing em 2005, quando estudos mostraram a capacidade do preço gerar modificações sobre o desempenho de um produto. A ideia do efeito placebo desencadeado pelo preço dos produtos está ancorada no fato das crenças globais, que associam preço baixo a produtos de má qualidade, anteciparem as expectativas do consumidor acerca da resposta do produto e, a partir disso, alterarem o seu desempenho. Nessa mesma linha, o estereótipo do país de origem também se apresenta como uma crença global, em que produtos oriundos de países com estereótipo negativo são associados a produtos inferiores e de má qualidade. Sendo assim, esta pesquisa analisou a ocorrência do efeito placebo desencadeado pelo país de origem do produto, analisando, ainda, a interação da força das expectativas e do preço do produto na geração deste efeito. Para tanto, três estudos experimentais foram operacionalizados. O primeiro estudo apresentou as testagens iniciais sobre o efeito placebo gerado pelo país de origem e mostrou que o país de origem com estereótipo negativo é capaz de gerar um efeito placebo negativo sobre o desempenho do produto. Não foi identificado, no entanto, a ocorrência de efeito placebo gerado pelo estereótipo positivo do país de origem. No segundo estudo, analisou-se o efeito placebo do país de origem em cenário de alta e baixa expectativa. Como resultado, obteve-se, em cenário de baixa expectativa, a ocorrência de efeito placebo negativo gerado pelo estereótipo negativo do país de origem. Já em cenário de alta expectativa, os resultados indicam que o fortalecimento das expectativas eliminou o efeito placebo negativo e, além disso, promoveu a ocorrência de um efeito placebo positivo gerado pelo estereótipo positivo do país de origem. O último estudo observou a interação do país de origem e do preço do produto sobre a geração de efeito placebo. Os resultados mostram que, em cenário de preço baixo, há efeito placebo negativo gerado pelo país de origem com estereótipo negativo, mas não foi observada a ocorrência de efeito placebo positivo gerado pelo estereótipo positivo do país de origem. Já, em cenário de preço alto, não se observou a ocorrência de nenhum efeito placebo, nem positivo, nem negativo. Ou seja, o preço elevado do produto foi capaz de anular o efeito placebo negativo gerado pelo estereótipo negativo do produto, mostrando a capacidade do preço em compensar os efeitos negativos causados pelo país de origem com imagem desfavorável. Com base nisso, os achados desta tese contribuem para o avanço teórico dos estudos sobre efeito placebo em Marketing, uma vez que adicionam o país de origem como um elemento gerador deste tipo de efeito e, ao analisar a interação do país de origem com o fortalecimento das expectativas e o preço do produto, confirmam as bases conceituais sobre a relação entre esses elementos. Além disso, seus achados, em termos gerenciais, podem promover reflexões por parte das organizações que compõem o seu mix de produtos com bens importados e também que operaram no exterior e fazem investimentos externos diretos em diversas partes do mundo. / The placebo effect has its origin linked to studies related to medical and pharmacological sciences and basically consists in the ability of inert products to produce effects through its use or consumption. This effect became part of the Marketing scope in 2005 when studies showed the ability of pricing to generate changes on the performance of a product. The idea of the placebo effect triggered by product price is anchored on the fact that global beliefs, which associate low price to low quality products, anticipate consumer expectations about the response of the product and, from there, change its performance. Along the same line, the stereotype of the country of origin also presents itself as a global belief in that products from countries with negative stereotypes are associated with inferior and bad quality products. Thus, this research analyzed the occurrence of the placebo effect triggered by the country of origin of the product, also analyzing the interaction of the strength of expectations and of product price in the generation of this effect. For this purpose, three experimental studies were operationalized. The first study presented initial testings on the placebo effect generated by the country of origin and showed that the country of origin with negative stereotypes is able to generate a negative placebo effect on product performance. However, the occurrence of the placebo effect generated by positive stereotypes in the country of origin was not identified. In the second study, the placebo effect of the country of origin in a scenario of high and low expectations was analyzed. As a result, in a scenario of low expectations, the occurrence of a negative placebo effect generated by the negative stereotype of the country of origin was obtained. However, in a scenario of high expectations, results indicate that the strengthening of the expectations eliminated a negative placebo effect and in addition, promoted the occurrence of a positive placebo effect generated by the positive stereotype of the country of origin. The last study observed the interaction of the country of origin and the price of the product upon the generation of the placebo effect. The results show that in a scenario of low price, there is a negative placebo effect generated by the country of origin with a negative stereotype, but the occurrence of a positive placebo effect generated by the positive stereotype of the country of origin was not observed. However, in a scenario of high prices, there was no occurrence of a placebo effect, whether positive or negative. In other words, the high price of the product was able to cancel the negative placebo effect generated by the negative stereotype of the product, showing the capacity of the price to compensate for the negative effects caused by the country of origin with an unfavorable image. Based on this, this thesis’ findings contribute to the theoretical progress on the studies about the placebo effect in Marketing, once the country of origin is added as a generating element of this type of effect, and when analyzing the interaction of the country of origin with the strengthening of expectations and the price of the product, the conceptual foundations about the relationship between these elements are confirmed. Moreover, its findings in management terms can promote reflections by organizations that compose the product mix with imported goods and also that operate overseas and make foreign direct investments in various parts of the world.

BAKGRUND: Placebo som begrepp har förändrats över tid – från medeltidens betydelse ”jag skall göra gott” till en overksam substans som används i randomiserade kontrollerade studier. Tidigare forskning visar att placeboeffekt kan skapas genom förväntans- och betingningsmekanismer, som via hjärnan startar processer i kroppen som kan lindra symptom som exempelvis smärta och illamående. Placeboeffekter har ansetts förekomma vid upp till 90 procent av sjuksköterskans åtgärder, men forskningen som belyser dess potential inom omvårdnad är bristfällig. SYFTE: Att undersöka hur placeboeffekten skulle kunna användas vid omvårdnadsåtgärder. METOD: En litteraturstudie med induktiv ansats. RESULTAT: Placebo kan skapas genom bemötande, behandlingsritualer och vårdmiljö. Vårdpersonal kan använda placeboeffekten för att stödja patientens behandling, för att individanpassa vården och stärka relationen mellan patient och personal. SLUTSATS OCH FÖRSLAG PÅVIDARE FORSKNING: Många omvårdnadsåtgärder som kan bidra till att skapa placeboeffekter går att använda utan etiska konflikter, medan andra delar kräver merforskning och etiska riktlinjer innan de är genomförbara i klinisk praxis. Vidare forskning bör fokusera på klinisk miljö och knyta samman omvårdnadsforskning med andra forskningsområden. Individuella skillnader i placeborespons och vårdpersonalens syn på användning av placebo är några områden som behöver fördjupas inom omvårdnadsforskning. / BACKGROUND: The concept placebo has changed over time – from the Middle Ages denotation of "I shall please" - into an inactive substance used in randomized controlled trials. Previous research shows that a placebo effect can be created through expectation and conditioning-mechanisms, which in turn trigger brain processes that can alleviate symptoms such as pain and nausea. Up to 90 percent of a nurse's actions have been considered to create placebo effects, but research that highlights its potential in nursing care is scarce. AIM OF STUDY: Examine how the placebo effect could be used in nursing interventions. METHOD: A literature study with inductive approach. RESULTS: Placebo effects can be created through verbal and non-verbal treatment, treatment rituals and by altering the context of the healthcare setting. Healthcare professionals can use the placebo effect to strengthen or replace active treatments. CONCLUSION AND SUGGESTIONS FOR FURTHER RESEARCH:Several nursing interventions that initiate a placebo effect can be used without ethical conflicts, while others require more research and ethical guidelines before being viable in clinical practice. Individual differences regarding placebo response, and healthcare professionals' views of the use of placebo, are some areas that need further research.

Bakgrund: Kommunikationen mellan sjuksköterska och patient är betydande för den mellanmänskliga relationen som i sin tur är grunden för omvårdnad. Forskning visar att kommunikationen mellan sjuksköterska och patient kan främja hälsa och lindra lidande. Evidens om hur kommunikation påverkar hälsan genom placebo- eller noceboeffekt är relativt outforskat eftersom resultat är svåra att mäta. Placebo rör inte enbart “sockerpiller” utan omfattar olika former av psykologisk stimulans som aktiverar fysiologiska processer. Syfte: Syftet var att sammanställa evidens för vilka kommunikativa åtgärder sjuksköterskan kan tillämpa för att öka placeboeffekt samt minska noceboeffekt. Metod: Litteraturöversikt baserad på elva kvantitativa artiklar. Resultat: Hälsofrämjande kommunikativa åtgärder kan sammanfattas med ett positivt ordval, en varm kommunikationsstil och fysisk beröring. Kommunikation som främjar placeboeffekt minskar patientens puls, blodtryck, ångest och smärta samt ökar själveffektivitet, belåtenhet, tro på sin egen prestationsförmåga samt förväntan på behandlingsresultat. Fysisk beröring som separat åtgärd håller även patientens oxytocin-nivå stabil och ger ett ökat fysiskt och psykiskt välbefinnande samt fysisk och psykisk komfort. Konklusion: När sjuksköterskan är medveten om sitt sätt att kommunicera med patienten kan det öka placeboeffekten och främja hälsa genom att välja en varm kommunikationsstil, ge fysisk beröring samt att välja positiva ord. / Background: The communication between nurse and patient is significant for the interpersonal relationship, which is the basis for nursing. Research shows that communication can promote health and relieve suffering. Evidence on how communication affects health through a placebo or nocebo effect is relatively unexplored because results are difficult to measure. Placebo is not just about "sugarpills" but includes various forms of psychological stimuli that activate physiological processes. Aim: The purpose was to compile evidence about communicative measures nurses can utilize to increase the placebo effect and reduce the nocebo effect. Method: A literature review based on eleven quantitative articles. Findings: Health-promoting communicative measures can be summed up with a choice of positive words, a warm communication style and physical touch. Communication that promotes the placebo effect reduces patients' heart rate, bloodpressure, anxiety and pain and even increases self-efficacy, satisfaction and belief in their own performance ability and expectations of treatment results. Physical touch as a separate measure also keeps the patient's oxytocin level stable and provides increased physical and mental well-being and comfort. Conclusion: When nurses are aware of their way of communicating with patients, they can increase the placebo effect and promote health by choosing a warm communication style, providing physical touch and choosing positive words