Los niños que crecen en ambientes de mayor adversidad biopsicosocial presentan mayor riesgo en salud mental y mayor exposición a factores de riesgo. En Chile, el Programa Habilidades para la Vida (P-HpV) de la JUNAEB ha focalizado acciones preventivas en salud mental en las escuelas más vulnerables

Cette thèse a pour objet l’œuvre d’Emma Santos (1943-1983), écrivaine française qui a écrit huit livres au cours de la décennie 1970. L’étude tente de saisir, à partir de son écriture, la notion de « sinthome » élaborée par Jacques Lacan. Aujourd’hui l’œuvre d’Emma Santos, peu lue et encore moins étudiée, reste très liée au contexte de l’éclosion des féminismes et du mouvement antipsychiatrique, et est souvent lue comme un témoignage de femme confrontée à l’expérience de l’enfermement, et de la « folie ». Si nous avons pris en compte l’empreinte de ce contexte dans les ouvrages santosiens, nous avons surtout voulu montrer combien son écriture agit comme un espace vital, au sein duquel peut se mettre en place un travail de cicatrisation d’une blessure physique et psychique. L’un des thèmes récurrents dans les livres est l’accident de voiture qu’elle subit enfant, au cours duquel sa gorge est entaillée : nous suggérons que son écriture agit comme un espace psychique d’accueil de la souffrance, et de cette marque sur le corps. Les problématiques autour desquelles s’articulent notre travail se résument ainsi : comment l’écriture rend-elle possible cette cicatrisation ? En considérant le processus d’écriture que nous avons synthétisé sous le nom de montage, nous pouvons mettre en évidence différents dispositifs récurrents, comme l’autocitation, la réécriture, la répétition. Que peuvent-ils nous révéler et nous apprendre sur la « folie », sur ses assignations, et sur la langue ? L’intuition motrice de cette étude est que la pratique singulière de l’écriture de l’écrivaine lui permet d’appréhender la coupure et ses effets symptomatiques qui la coupent du monde, comme un « sinthome » qui la relie au monde. Or ce concept, analysé à travers le texte santosien, ouvre la voie à une nouvelle appréhension de la langue et de sa loi, et permet de repenser la distinction névrose / psychose ainsi que la différence sexuelle. / This thesis has for object the work of Emma Santos (1943-1983), French writer who wrote eight books during the seventies. The study tries to grasp, from her writing, the notion of « sinthome » devised by Jacques Lacan. Today, the work of Emma Santos, scarcely read and even less studied, stays very connected with the context of the emergence of feminism and the antipsychiatric movement, and is often read as the testimony of a woman confronted with confinement and « madness ». If we have chosen to take into account the influence of this context in the santosien books, we have mainly wanted to show how her writing acts as vital space, in which a work of cicatrization a physical and psychological wound can take place. One of the recurring themes in the books is the car accident she was in as a child, in which she had her throat cut: we suggest that her work acts as a psychic space to host the pain, and this body mark. The following can sum up the problematics organizing our work: how can writing make this cicatrization possible? Considering the writing process that we have synthesized under the name of assembling, we can emphasize different recurring systems, as auto quotation, rewriting, repetition. What can they reveal and teach us about « madness », its definitions, and language? The leading feeling of this study is that the singular writing practice of the writer allows her to apprehend the fracture and its symptomatic effects that alienated her from the world, as a « sinthome » that links her to the world. Thus this concept, analyzed though the santosien work, opens the way to a new apprehension of the language and its law, allowing to rethink the neurosis / psychosis distinction, as well as sexual difference.

Magister Artium - MA / The goal of this research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis. / South Africa

No description available.

To examine evidence-based interventions for nurses to use when supporting cancer survivors self-manage their symptoms. Part I: A systematic review to determine the effect of shared medical appointments (SMAs) on patients with a physical chronic illness (excluding diabetes mellitus), their healthcare providers and the healthcare system. Nine randomized controlled trials were included; one focused on breast cancer survivors. This trial was feasible and showed no difference in outcomes compared to usual care. Part II: A descriptive study to adapt and evaluate the acceptability of an evidence-informed symptom practice guide (SPG) for use by nurses for the assessment, triage, and management of patients experiencing dyspnea due to cancer treatment-related cardiotoxicity. Guided by the CAN-IMPLEMENT© methodology, evidence from seven guidelines on heart failure was added to the original SPG. Eleven participants indicated the adapted SPG was comprehensive and easy to follow, and would be helpful for handling symptom calls from patients.

The first part of this thesis explores the potential role of metacognitive beliefs and strategies in functional somatic symptoms. Current models (for example, Brown, 2004; Deary, Chalder and Sharpe, 2007) and treatments of functional somatic symptoms focus on cognitive models and cognitive behavioural treatments which show modest treatment effects. A metacognitive account is discussed based upon supervisory regulatory executive function theory (SREF; Wells and Matthews, 1994) and research is systematically reviewed which may support such an account. Current research offers limited indirect support for metacognitive factors playing a role in the difficulties of people suffering from functional somatic symptoms. This paper concludes that further research is needed in this promising area. The second part of the thesis describes a cross-sectional correlational study which examines the relationship of somatic symptom reporting in primary care with metacognitive beliefs, finding a significant association for the first time. Fifty patients were recruited from general practice surgeries took part in the study. Support for the novel Metacognitive Health Questionnaire measure was also found. This measure showed significant associations between health specific metacognitive beliefs and body focussed attention, health preoccupation and distress. This measure also showed significant associations with illness behaviours and thought control strategies. Each of these findings is in line with SREF theory. This study provides preliminary support for the role of metacognition in symptom reporting. The third part of the thesis critically evaluated issues salient to the study including methodologically, supervisory, ethical and clinical issues. The interpretations of the literature review and findings of the research paper are limited by the lack of direct findings to support a metacognitive account, and the cross sectional nature of this study. It is hoped that the prospective study which the research study reported forms part, will offer more robust insights into the role of metacognition in symptom reporting, and that future studies will examine this area further.

The aim of the work presented in this thesis, was to investigate two general hypotheses derived from theories of the development and maintenance of medically unexplained symptoms (MUS) and health anxiety; that individual differences in attention to the body and somatic awareness contribute to the experience of physical symptoms and health anxiety. Three studies (an analogue pilot study, a prospective cohort study with primary care patients, and an analogue study involving a negative mood induction) were conducted to investigate the relationship between attention, somatic awareness, symptom reporting and health anxiety. In the pilot study, enhanced attentional disengagement from neutral material was associated with health anxiety and delayed disengagement from neutral material was associated with symptom reporting. In the primary care study, enhanced disengagement from neutral body-irrelevant material and delayed disengagement from threatening body-relevant material were independently associated with health care utilisation, but not symptom reporting or health anxiety. However, the longitudinal analysis revealed that attentional disengagement was neither a predictor of, or predicted by, health care utilisation. The tendency to experience distortions in somatic awareness was independently associated with symptom reporting, health anxiety and health care utilisation. Longitudinal analysis revealed that symptom reporting and health anxiety were independent predictors of somatic distortion, but that somatic distortion was not a predictor of symptom reporting or health anxiety. The results of a structural equation modeling analysis suggest that a model including both attentional disengagement and the tendency to experience distortions in somatic awareness improves understanding of symptom reporting, health anxiety and health care utilisation. In the negative mood induction study, however, neither attentional disengagement nor the tendency to experience distortions in somatic awareness were significantly associated with symptom reporting or health anxiety. The evidence presented here suggests that complex attentional processes may be associated with health seeking behaviours, possibly via a third unknown variable. This evidence, however, does not support the often-hypothesised general attentional bias for the body as a causative factor in the development of health anxiety or symptom reporting. This research has provided important evidence about attentional differences and how future research might extend the findings reported here. Furthermore, the findings regarding the tendency to experience distortions in somatic awareness provides empirical support for theories that suggest MUS may be associated with a tendency to place greater weight on top-down factors in the creation of somatic awareness (Brown, 2004; Edwards et al., 2013). However, whilst alterations in somatic awareness may be a maintenance factor for symptom reporting and health anxiety, somatic distortion may not be a causative factor in their development.

Chaque sujet doit composer avec le manque en tant que "parlêtre" et "sujet du désir". Le symptôme qui révèle le manque a son lot de souffrances. Celles-ci submergent parfois le sujet dans le trou du réel en le déstabilisant. Comment aider à donner du sens au manque dévoilé par la souffrance dans le symptôme ? Existe-t-il une façon optimale de se positionner face au manque ? Que faire avec le réel ? Le modèle psychanalytique, avec l'expérience du transfert/contre-transfert, donne une réponse et une possibilité de sortie. Dans cette thèse nous soumettrons des pistes pour faire face au manque et au réel inhérent. Lacan nous dit qu'à la fin de l'analyse il peut y avoir un lien inédit avec le symptôme, lien qui consiste à admette le "jouis" qui fonde le "suis", c’est-à-dire à assumer le fait d'avoir un manque qui rendra le sinthome pur. Le sujet se positionnera autrement. Il continuera à aller de l'avant, singulièrement inséré dans son environnement avec une nouvelle conscience, en établissant un maximum de liens optimaux avec les autres et son milieu. Un certain nombre d'études concluent que l'homme n'a pas de but extérieur à lui-même : il serait son propre but. Or le positionnement féminin propose une autre sortie qui ouvre le sujet à l'infini impossible à saisir mais toujours possible à entrevoir. Maître Eckhart l'a illustré en voyant le manque comme une voie de liberté et de réalisation dans cet impossible. Le sujet, libre de sa castration tentera de cerner un bout du réel, encore et encore, mais sans jamais s'en débarrasser. / Each individual has to face its dependence towards the "parlêtre" and the "subject of desire". The symptom that reveals its dependence is painful, and can sometimes overwhelms the subject by projecting him in an abysm of destabilizing reality. How can we help people finding meaning to this dependence now revealed and its painful symptom? Is there an ideal way to take action towards this dependence? What can be done with this reality? The psychoanalytic model, with the transfer/against transfer experience, gives an answer and a possible way to overcome the issue. In this thesis, clues will be given so that one can overcome the dependence and its inherent reality. Lacan tells us that at the end of the analyses, it can be a new link with the symptom, link which consists of admitting the "enjoy" which found the "be", that is to say to assume the fact that the dependence exists which makes the symptom pure. The individual will have a different opinion. He will continue on going forward, well established in his environment with a new consciousness. Some studies suggest that human being has not external goal in relation to himself: he would be his own goal. However the female positioning may open a new way offering the subject to the elusive infinity that we are always able to glimpse but not to grasp. Maître Eckhart illustrates it, showing the lack as a way of freedom and achievement in the suffering situation. The subject, free from his own castration will try again and again to catch a piece of real without ever getting rid of it.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13399号 / 論医博第2223号 / 新制||医||1051(附属図書館) / (主査)教授 今中 雄一, 教授 佐藤 俊哉, 教授 福田 和彦 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23125号 / 人健博第87号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 林 悠, 教授 稲富 宏之, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM