Durant les années 1990, en France, en Suisse et au Québec, de nouveaux médicaments ont reçu une autorisation de mise sur le marché, dans le cadre de la prise en charge de la dépendance aux opiacés. Vingt cinq ans plus tard, notre thèse interroge les usages qu’en font les personnes en traitement. A partir de la méthode biographique, nous étudions la substitution en terme d’« ajustements ». Les détournements de l’usage prescrit des TSO, étiquetés comme « mésusages » par les pouvoirs publics et un certain nombre de praticiens, apparaissent dès lors comme une modalité d’adaptation et de réappropriation du traitement. En évaluant les convergences et les divergences dans les pratiques et leurs effets, la comparaison de nos trois terrains d’enquête nous permet d’analyser les différents sens associés à la substitution, selon les contextes et les structures de soin au sein desquels l’usager est accueilli. / For a long time, ending drug addiction meant completely stopping any consumption. In the context of harm reduction policies, the introduction of substitution treatments has drastically changed the abstinence paradigm. Ending an addiction has taken a plural meaning, adding complexity to the delimitation already porous between “normal and pathological”. Nowadays stabilizing Methadone maintenance treatment or taking drugs on an irregular basis are perceived as an alternative to abstinence or other forms of recovery. In this thesis, wiitch deals with polysemic uses of substitution treatment, we analyze the attempts and strategies of the adjustment process in entering an addiction centre. The aim of this study is to show the different competencies that people can display in situations of vulnerability. Our interest is to find out how valuable expertise can emerge from the layperson point of view.

<p dir="ltr"><a href="" target="_blank">The goal of this study was to contribute to the research on determinants of caregiving by exploring whether adult children’s health problems shape their involvement in their mothers’ care. Drawing from equity theory and contingent exchange theory (Davey & Eggebeen, 1998; Davey & Norris, 1998; Walster et al., 1978), I proposed that adult children with health problems would be less likely to be their mothers’ primary caregivers but more likely to be their mothers’ secondary caregivers compared to their healthier siblings. Additionally, based on gender role development theories (Chodorow, 1978; Gilligan, 1982; Leaper & Friedman, 2007), I hypothesized that health problems would reduce sons’, but not daughters’, likelihood of serving as their mothers’ primary caregivers. The results of both the quantitative and qualitative analyses revealed that from both the mothers’ and children’s perspectives, adult children with and without health problems were equally as likely to serve as their mothers’ primary or secondary caregivers. Furthermore, the results suggested that daughters were expected to provide care despite their own health obstacles, whereas this expectation was not present for sons. The findings suggested that adult children with health problems are still participants in their mothers’ care and should be included in conversations regarding planning for their mothers’ future care needs and current caregiving arrangements. Additionally, the findings highlighted how providing care comes at a higher cost for children with health problems compared to their healthier siblings. Future research should investigate how additional support to caregivers with health problems may lead to better caregiving outcomes for both the caregivers and care recipients.</a></p>

Submitted by Vasti Diniz (vastijpa@hotmail.com) on 2017-12-27T13:35:13Z No. of bitstreams: 1 arquivototal.pdf: 6153186 bytes, checksum: a8c4706f7510bfbfd12619172e5b49eb (MD5) / Made available in DSpace on 2017-12-27T13:35:13Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 6153186 bytes, checksum: a8c4706f7510bfbfd12619172e5b49eb (MD5) Previous issue date: 2017-02-22 / The adoption of universality, of integrality and equity as foundations of health rights, was evidenced in the 1988 constitutional text, based on the historical construction of a health mentality that resulted in the reformulation of the Health System and the replacement of the Social Security model by the Model Of Social Security in Brazil. However, the notion of Health as a universal right is still an obstacle to the consolidation of health practices of subnational subjects (professionals, managers and users), of the consolidation of “Sistema Único de Saúde” (SUS) - Unified Health System - and of the establishment of the political character of SUS, as a mechanism for access to the improvement of living conditions through health. Thus, the present study sought to investigate the social representations that the professionals of the “Unidades Básicas de Saúde da Família” (UBSF) - Basic Units of Family Health, in Cariri from Paraíba, have regarding the SUS as a political right, based on the constant participation of the subjects and, these representations influence the attention in health practiced by these professionals. In turn, all these elements result in deficient or nonexistent effectiveness of cidadanização, which raises the need to strengthen it through the SUS cidadanização process, understood here as the intensification of participation, especially in SUS management instances. The originality of this work rests on the scarcity of academic research on the Cariri, region of Paraíba, exposes the difficulties to understand the local social reality and the consequent elaboration and execution of public policies for the region, which is made up of 29 municipalities. For the accomplishment of this work, the sample was chosen for convenience of the population formed by professionals that work in 02 UBSF of 05 municipalities of the region with greater quantitative population and offer of health services. Data collected through questionnaire (80), semi-structured interviews (42), and Focal Group (06) were treated with the Survey technique for quantitative data, and the Collective Subject Discourse Analysis for both qualitative data Analyzed in the light of the Theory of Social Representations. The field work points to the non-visualization of SUS as a political right, resulting from struggles and mobilization of society, based on elements such as clientelism and power relations established among the subjects involved in the health care process. The information of the interlocutors also indicates the scarcity or difficulty of continuous training regarding the innovations of health procedures; The lack of knowledge about the universality importance and of healthcare reform as a commodity, expressed in the implementation of health policies and health quality programs, such as the “Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica” (PMAQ-AB) - National Program for Improving Access and Quality of Basic Care. Thus, it is observed that health professionals still work in the perspective of the health insurance model implemented by the “Instituto Nacional de Assistência Médica e Previdência Social” (INAMPS) - National Institute of Medical Assistance and Social Security. / A adoção da universalidade, da integralidade e da equidade como fundamentos dos direitos em saúde se evidenciou no texto constitucional de 1988, a partir da construção histórica de uma mentalidade sanitária que resultou na reformulação do Sistema de Saúde e na concepção de saúde pública com a substituição do modelo de Seguro Social pelo modelo da Seguridade Social no Brasil. Assim, o presente estudo tratou de investigar as representações sociais que os profissionais das Unidades Básicas de Saúde da Família (UBSF) no Cariri Paraibano têm a respeito do SUS enquanto direito político, fundamentado na participação constante dos sujeitos (profissionais, gestores e usuários) e, como estas representações influenciam na atenção em saúde praticada por estes profissionais. Por sua vez, todos estes elementos resultam na deficiente ou inexistente efetivação da cidadania o que suscita a necessidade de reforço da mesma por meio do processo de cidadanização do SUS, entendida aqui como a intensificação da participação, especialmente nas instâncias de gestão do SUS. A originalidade deste trabalho repousa na escassez de pesquisas acadêmicas sobre a região do Cariri Paraibano, expõe as dificuldades para o entendimento da realidade social local e a consequente elaboração e execução de políticas públicas para a região, que é constituída por 29 municípios. Para a realização deste trabalho foi escolhida uma amostra por conveniência da população formada por profissionais que atuam em 02 UBSF de cada um dos 05 municípios pesquisados, totalizando 10 UBSF e seguindo o critério de maior quantitativo populacional e oferta de serviços de saúde. Os dados coletados por meio de questionário (80), entrevistas semiestruturada (42) e Grupo Focal (06) foram tratados com a técnica de Levantamento, para os dados quantitativos, e a Análise de Discurso do Sujeito Coletivo, para os dados qualitativos, ambos analisados à luz da Teoria das Representações Sociais. O trabalho de campo aponta para a não visualização do SUS enquanto Direito Político, resultado de lutas e mobilização da sociedade e para o fato dos profissionais de saúde ainda trabalharem na perspectiva do modelo previdenciário de saúde executado pelo Instituto Nacional de Assistência Médica e Previdência Social (INAMPS). A estes dados acostam-se elementos como o clientelismo e as relações de poder estabelecidas entre os sujeitos envolvidos no processo da atenção em saúde na região do Cariri. As informações dos interlocutores, indicam ainda, a escassez ou dificuldade de capacitação continuada com relação as inovações dos procedimentos em saúde; o desconhecimento da importância balizar da universalidade e da Reforma Sanitária como elementos fundamentais de construção e manutenção do SUS e o choque entre a concepção de saúde enquanto direito e de saúde enquanto mercadoria, expresso na implementação das políticas de saúde e dos programas de qualidade em saúde, a exemplo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB).

En France, le rapport aux moustiques et les politiques de démoustication présentent des histoires et des caractéristiques différenciées d’un territoire à l’autre. Si dans les DFA les moustiques n'ont jamais cessé d'être des facteurs épidémiques, sur le pourtour méditerranéen en revanche, ils ne constituaient plus de risques sanitaires depuis près d'un demi-siècle. Dans les DFA, les opérations de démoustication ont toujours principalement relevé de politiques sanitaires de Lutte Anti-Vectorielle, tandis qu'en métropole furent mises en place des démoustications de confort visant à réduire la nuisance. Mais, à partir de 2004, la situation évolue suite à l’installation durable du moustique vecteur Aedes albopictus sur le littoral méditerranéen et à l’élargissement progressif de son aire de répartition, exposant la métropole à des risques sanitaires jusqu'alors circonscrits aux régions tropicales. Mobilisant les cadres théoriques des sociologies de l’environnement, des risques et de la santé, et s'appuyant sur un corpus réunissant données qualitatives (311 entretiens et observation participante) et quantitatives (1415 questionnaires), cette thèse analyse la recomposition du rapport entre enjeux environnementaux et sanitaires face à la prolifération de moustiques vecteurs. L'analyse porte tout d'abord sur la place et le statut de l’insecte au sein des différentes populations. Puis, l’attention est portée aux caractéristiques socioéconomiques influençant la vulnérabilité individuelle. Ensuite, les attentes et demandes de la population relatives à la démoustication sont questionnées. Enfin, la dernière partie développe une analyse diachronique dans les Alpes-Maritimes. / In France,the human-mosquito relationship and the mosquito control policies show differentiated stories and features from one territory to another.Thus,if in FDA mosquitoes never ceased being epidemic factors,however,on the Mediterranean coast until recently they no longer represented a Health risk.Indeed,in the FDA,since their implementation,mosquito control campaigns have always been conducted for a sanitary purpose through vector control campaigns.Meanwhile,in metropolitan France,aiming to reduce the nuisance,these policies were initially implemented to ensure the inhabitants comfort.But,starting from 2004,following the durable installation of the Asian tiger mosquito on the French Mediterranean coastline and the progressive widening of its distribution area,the context evolves and,from now on,the metropolitan France is potentially exposed to health risks hitherto circumscribed to tropical areas.Mobilising the theoretical frameworks of environmental,health and risks sociologies,and based on a corpus gathering qualitative (311 interviews and direct observations) and quantitative data (1415 questionnaires),this PhD analyses the recombining of the relationship between environmental and health challenges in light of the vector mosquitoes proliferation.It initially focuses on the place and status of the insect within the different populations.Then, the socio-economic factors influencing the individual vulnerability of exposure to the insect are studied.The third part is devoted to the expectations and requests of the inhabitants regarding the public management of the mosquitoes’ proliferation.Finally, a diachronic analysis centered on the Alps-Maritimes region is developed.

<p>This dissertation, broadly, examines how power dynamics manifest during clinical interactions related to vague and gendered medical symptoms, such as pelvic pain. To examine this issue, I approach my research questions through multiple methods including a critical discourse analysis of the medical discourse on pelvic pain, a survey experiment administered to healthcare workers in the US, and a narrative analysis of pelvic pain patient experiences. While the focus of this research is on pelvic pain, the analyses presented here reach far beyond ideas of power dynamics and pelvic pain. Rather, the findings from this research speak to theoretical discussions medical sociologists have been having for decades. Specifically, findings provide new insight on: 1) the limits of evidence-based medicine as a biomedical paradigm, 2) how fundamental causes of health inequality intersect with each other as well as other factors, such as gender, important in predicting health outcomes and 3) how discussions of metamechanisms in fundamental cause theory can inform our understanding of the accumulation of cultural health capital. In providing such insight, this dissertation uses the case of pelvic pain to integrate multiple perspectives and theories in medical sociology to drive the field forward in a way that acknowledges the many ways power is simultaneously constituted in the clinical interaction. From the role of gender, race, and class in power relations, to the ways medical knowledge, discourse, and authority dictate the clinical interaction, this research covers a wide range of sociological theories and concepts. In doing so, this dissertation sheds new light on current understandings of power in the clinical interaction and its relationship to inequitable health outcomes in the US.</p>

This study investigates two central research problems. These are: What are the healing practices of Aeta women? What are the implications of the healing practices of Aeta women in the academic discourse? This inquiry is important for the following reasons: (a) it focuses a reconsidered gaze and empirical lens on the healing practices of Aeta women healers as well as the lessons, insights and perspectives which may have been previously missed; (b) my research attempts not to be 'neutral' but instead be an exercise in participatory action research and as such hopefully brings a new space of decolonization by documenting Aeta women healers’ contributions in the political and academic arena; and (c) it is an original contribution to postcolonial, anti-colonial and Indigenous feminist theories particularly through its demonstration the utility of these theories in understanding the health of Indigenous peoples and global health. There are 12 Aeta women healers who participated in the Talking Circle. This study is significant in grounding both the theory and the methodology while comparatively evaluating claims calibrated against the benchmark of the actual narratives of Aeta women healers. These evaluations subsequently categorized my findings into three themes: namely, identity, agency and representation. This work is also important in illustrating the Indigenous communities’ commonalities on resistance, accommodation, evolution and devolution of social institutions and leadership through empirical example. The work also sheds light on how the members of our Circle and their communities’ experiences with outsider intrusion and imposed changes intentionally structured to dominate them as Indigenous people altered our participants and their communities. Though the reactions of the Aeta were and are unique in this adaptive process they join a growing comparative scholarly discussion on how contexts for colonization were the same or different. This thesis therefore joins a growing comparative educational literature on the contextual variations among global experiences with colonization. This is important since Indigenous Peoples' experiences are almost always portrayed as unique or “exotic”. I can now understand through comparison that many of the processes from military to pedagogical impositions bore striking similarities across various colonial, geographical and cultural locations.

This study investigates two central research problems. These are: What are the healing practices of Aeta women? What are the implications of the healing practices of Aeta women in the academic discourse? This inquiry is important for the following reasons: (a) it focuses a reconsidered gaze and empirical lens on the healing practices of Aeta women healers as well as the lessons, insights and perspectives which may have been previously missed; (b) my research attempts not to be 'neutral' but instead be an exercise in participatory action research and as such hopefully brings a new space of decolonization by documenting Aeta women healers’ contributions in the political and academic arena; and (c) it is an original contribution to postcolonial, anti-colonial and Indigenous feminist theories particularly through its demonstration the utility of these theories in understanding the health of Indigenous peoples and global health. There are 12 Aeta women healers who participated in the Talking Circle. This study is significant in grounding both the theory and the methodology while comparatively evaluating claims calibrated against the benchmark of the actual narratives of Aeta women healers. These evaluations subsequently categorized my findings into three themes: namely, identity, agency and representation. This work is also important in illustrating the Indigenous communities’ commonalities on resistance, accommodation, evolution and devolution of social institutions and leadership through empirical example. The work also sheds light on how the members of our Circle and their communities’ experiences with outsider intrusion and imposed changes intentionally structured to dominate them as Indigenous people altered our participants and their communities. Though the reactions of the Aeta were and are unique in this adaptive process they join a growing comparative scholarly discussion on how contexts for colonization were the same or different. This thesis therefore joins a growing comparative educational literature on the contextual variations among global experiences with colonization. This is important since Indigenous Peoples' experiences are almost always portrayed as unique or “exotic”. I can now understand through comparison that many of the processes from military to pedagogical impositions bore striking similarities across various colonial, geographical and cultural locations.

Made available in DSpace on 2011-05-04T12:36:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / O presente trabalho teve por objetivo examinar os vínculos simbólicos e imaginários que os trabalhadores do maior hospital geral do Estado mantêm com a organização e com seu trabalho, discutindo, a partir desse conhecimento, possíveis dispositivos para o cotidiano da gestão que favoreçam a criatividade e a responsabilização desses trabalhadores para com seu trabalho e com a instituição. Ao apreender o imaginário organizacional e as representações psíquicas dos trabalhadores acerca da organização, tenta-se contribuir para a explicitação dos fatores que condicionam o estabelecimento dos vínculos à organização, interessando-nos mais especificamente a adesão, e identificar quais desafios os vínculos e o imaginário organizacional observado impõem para os processos e dispositivos de gestão. Elegeu-se como estudo de caso o setor de pediatria do hospital, tomando-se como referenciais teóricos para tal estudo a abordagem da Psicossociologia francesa sobre as organizações, e a Psicodinâmica do Trabalho. Na apresentação dos resultados desta investigação, discutem-se os sentidos do trabalho, a partir de uma aproximação do imaginário organizacional, das representações dos trabalhadores sobre o seu trabalho, da sua visão sobre a gestão, e a dinâmica prazer versus sofrimento no trabalho. Na análise dos vínculos que os trabalhadores estabelecem com o trabalho e com a instituição, emergem os desafios para o cotidiano de gestão do hospital. A tão esperada mudança nos nossos serviços de saúde parece não poder prescindir de uma reflexão crítica sobre o que temos hoje, e do reconhecimento quanto à importância da dimensão subjetiva, e intersubjetiva, como determinante dos modos de ser e de agir dos trabalhadores. / This study intends to analyze the imaginary and symbolic links that the workers from the largest hospital in the state remain with the organization and their work, based on this knowledge, a discussion will be made about the possible devices for the daily management to encourage creativity and the responsibility of these workers with their work and with the institution. From the worker’s organizational idea and the psychological representations of workers about the organization, a study about the factors that influence the establishment of links to the organization will be made, focused on the membership, and to identify the challenges that the organizational idea and the links observed are require to the processes and management arrangements. Was selected as a case study the pediatric section of the hospital, using as theoretical reference for this study the approach of the French Psychosociology on organizations, and the psychodynamics of work. In the results of this investigation, is discussed the meaning of the work, from an organizational approach, representation of the workers on their work, their vision on the management, and dynamic pleasure versus pain at work. In the analysis of the links that workers provide with work and with the institution, can be found challenges for the hospital daily management. The long-awaited change in our health services cannot be done without a critical reflection on what we have today, and the importance of the subjective and intersubjective, as a determinant of the ways that the employees are and behave.