Dissertations / Theses on the topic 'Medicial Societies'

This thesis investigates the Medicean ability to present divergent messages to different audiences through the manipulation of art and architecture of the Palazzo Medici. I examine several works of art commissioned and authored by the Medici. First, Donatello’s bronze David, located in the Medici Courtyard, is interpreted through the traditional Christian perspective as seen by the vicini, making the Medici appear pious, reverent, and religiously devout. This work is also interpreted from the amici point of view using ancient and contemporary authors to trace the development of ideas amongst the circle of Classically educated friends of the Medici. Second, Donatello’s bronze Judith and Holofernes, located in the adjacent Medici Garden, is examined in the same way to highlight the divergent message of humility juxtaposed with pride. This exercise shows the Medici had the ability to use one piece of art to set the stage for several different messages. Each type of visitor would view the same piece of art and come away with a different message specifically tailored to them, which allowed the family to increase support for their political faction and maintain their status as de facto rulers of Florence. The Medici family’s success is undisputed amongst scholars, but Cosimo’s use of the Augustan model and his use of the palace as propaganda is a subject that has been left scarcely examined. Much research has been conducted on the exterior due to what is extant, but how those in the Medici faction viewed it is non-existent. This work builds upon F.W. Kent’s position that Renaissance palace were built with several groups in mind. Through this examination of the Medici’s use of polyvalent messaging, a new understanding of the Medici emerges, which shows they were masters of propaganda and can explain why the Palazzo Medici became the model for palaces through Florence, the Italian Peninsula, and eventually greater Europe.

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2009.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 69-73).
Personalized medicine is the science and practice of customizing medical screening and treatment plans for an individual based on his or her genomic profile. Breast cancer is one of the first disease areas to serve as an example of this approach, where most patients have experienced its benefits through the use of genetic tests that provide decision support for health care workers regarding the likely effectiveness of specific drugs and, more broadly, the urgency of particular treatment options (for example, chemoprevention versus prophylactic surgery). Little is known about the diffusion of such personalized approaches to medical practice, particularly the factors shaping the adoption of genetic tests. While numerous medical diffusion studies have been published over the past few decades, most were univariate analyses and did not consider the unique aspects of genetic testing versus drugs. Moreover, they mainly focused on the characteristics and behaviors of physicians, patients, product manufacturers, and social networks, and did not explore the role of potentially important third parties like professional medical societies and patient groups (e.g. disease foundations and patient advocacy organizations). The aim of this thesis was to analyze the relationship between seven attributes of four breast cancer genetic tests and clinical adoption to show that standard diffusion frameworks can be enhanced through previously unstudied dimensions when evaluating personalized medicine-related innovations.
(cont.) We identified four variables that correlated with clinical adoption: 1) regulatory status, 2) inclusion in practice guidelines by professional societies, 3) explicit endorsement by patient groups, and 4) implicit endorsement by patient groups. Our findings indicate that a key overlooked element in the current literature (and potentially overlooked by the firms creating these tests) is the role of patient groups in the diffusion of novel genetic tests, in addition to endorsement from medical professional societies. These findings may add value to strategic decisions made by company executives, investors, payers, health care providers, and patients as they are presented with novel products and development opportunities in the era of personalized medicine.
by Julie Keunhee Yoo.
S.M.

Esta tesina indaga cuestiones conectadas con el Libellus de Medicinalibus Indorum Herbis, un texto médico azteca que constituye la primera descripción de la materia médica americana. El marco médico de los azteca se entraña profundamente con la cultura misma, y se basa en la investigación empírica además de fuentes sociales y religiosas. Aspectos de este marco médico—particularmente sus aportes culturales y botánicos—se presentan todavía en la medicina mexicana folk contemporánea. La época pos-conquista en que el Libellus fue producido constituye un ámbito complejo y agitado, un fundamento que demuestro a través del aparato sociopolítico que dirigió la producción académica de aquella época. Sin embargo, demuestro que la integridad y la originalidad de la materia médica azteca ha prevalecido. El primer capítulo abarca el marco folclórico de la salud y la medicina azteca, además de los aspectos teóricos y logísticos de la etiología, el diagnóstico, y la terapéutica. Con esta base, planteo la cuestión sincrética de la conquista y las intersecciones entre la medicina europea y la medicina nahua. Por el segundo capítulo—que aborda temas de la traducción—demarco y problematizo cuestiones de la autoría, la pluralidad, y el mestizaje lingüístico. A través del tercer capítulo, realizo mi propia traducción del Libellus desde el español al ingles para indagar intensivamente cómo se acerca este proceso de traducción. Luego, al resumirlo y analizarlo, junto las cuestiones teóricas de la traducción y la materia médica azteca con mis propias experiencias como traductora contemporánea.

This thesis examines welfare provision in rural Oxfordshire after the 1834 Poor Law Amendment Act. The county had little industrial development, remained largely agricultural in nature, and the region had been perceived as a backwater of friendly society development. This thesis rectifies that view and places Oxfordshire as an important component of the movement with its independent nature and early rejection of affiliated order branches that emanated from urbanized and industrialized areas. There is no evidence of impetus given to friendly society formation after the implementation of the new poor law with the general increase in societies continuing. However, the relationship with poor law administration changed. A case study of Stonesfield demonstrates how the friendly society became the heart of village life and was integral to self help and support for the poor. A wider view is taken of welfare provision, with detailed assessment of a range of welfare instruments, such as coal and clothing clubs, soup kitchens, and medical clubs, together with an appraisal of their geographical spread. The range of welfare instruments available is compared to Maslow’s Hierarchy of Need, a model of human motivation. The case study of Whitchurch provides an in-depth assessment of one parish welfare system where after 1834 at least nine stands of welfare were available at all times to the poor who held a degree of selection in what was an increasingly a consumer market. The thesis is underpinned throughout by the use of extensive primary source material.

In 2008, the Organ Donation Taskforce was asked to consider the impact of introducing an opt-out system for organ donation in the United Kingdom. The Taskforce conducted a thorough investigation, which included information gathering from both the public and experts in the field of healthcare, ethics and law and a thorough appraisal of the countries currently operating an opt-out system. Having reviewed this evidence the ODT conceded that whilst the numbers of organs generated may increase under an opt-out system, conversely, because of the way the system actually works, they felt there was a risk that its introduction may cause a backlash amongst the general public resulting in a decrease in organ donations. They based their concerns around fears that such a system would remove the potential for spontaneous acts of goodwill, denying people the opportunity to give a gift, and may deny the opportunity for individuals to determine whether their organs should be donated, thereby precluding choice and the right to self-determination. This might ultimately compromise public trust in the system. This thesis challenges the assumptions made by the Organ Donation Taskforce in respect of introducing an opt-out system. It casts doubt on their claims about compromising privacy interests and then looks to reconcile the potential issues which may arise under an opt-out system; these are preventing the choice to act altruistically and acting in such a way as to undermine public trust. Both of these may result in policy failure. It will advocate a system which addresses the issues raised by the ODT and acts to provide respect for self-determination; this is a soft opt-out system with a combined registry. Such a system would increase the supply of organs for those in need of a transplant, and remain consistent with a society's values in terms of demonstrating respect for individual choice regarding donation.

The scale and severity of cancer, specifically breast cancer, remains significantly different across the spectrum of low-income to high-income countries. This study explores women’s beliefs about breast cancer and associated prevention and health-seeking behaviors in a rural area of Uganda. Through a critical medical anthropological perspective, the study examines the social, cultural, and economic factors that shape women’s understanding of cancer, and breast cancer specifically, and that influence their use of biomedical services. Data were collected over a three-month period through 35 in-depth interviews and two focus groups with 10 women older than 18 years in the rural setting of Nakirebe within Mpigi District, and through five interviews with health care personnel from a private and a government health care facility in Mpigi District. Quantitative and Qualitative data were analyzed using SPSS version 23 and MAXQDA 12.0.2, respectively. Findings suggest that women in this rural setting have limited access to screening and incomplete knowledge about breast cancer, and cancer in general, and internalize fears of a cancer diagnosis. No women were diagnosed with any type of cancer at the time of this study. Common attitudes towards cancer from the women include inevitable death, cancer is caused by contact with artificial substances and/or germs, and cancer causes pain, wounds that never heal, and the removal of body parts. Recommendations for improving cancer control and management in rural Uganda through awareness initiatives and community health outreach programs are presented.

Access to primary medical care and prevention services in Nigeria is limited, especially in rural areas, despite national and international efforts to improve health service delivery. Using a conceptual framework developed by Penchansky and Thomas, this case study explored the perceptions of community residents and healthcare providers regarding residents' access to primary healthcare services in the rural area of Isu. Using a community-based research approach, semistructured interviews and focus groups were conducted with 27 participants, including government healthcare administrators, nurses and midwives, traditional healers, and residents. Data were analyzed using Colaizzi's 7-step method for qualitative data analysis. Key findings included that (a) healthcare is focused on children and pregnant women; (b) healthcare is largely ineffective because of insufficient funding, misguided leadership, poor system infrastructure, and facility neglect; (c) residents lack knowledge of and confidence in available primary healthcare services; (d) residents regularly use traditional healers even though these healers are not recognized by local government administrators; and (e) residents can be valuable participants in community-based research. The potential for positive social change includes improved communication between local government, residents, and traditional healers, and improved access to healthcare for residents.

This article opens up an important but overlooked chapter in the political and diplomatic history of Florence, as well as that of fifteenth-century Franco-Italian relations more broadly. In late 1461, the city of Florence elected ambassadors to go to France to congratulate King Louis XI on his accession to the throne. Intended as a purely ceremonial mission, the Florentine diplomat Piero de' Pazzi ignored his commission and pursued policies that explicitly promoted French interests in Italy. By doing so, Piero sought to improve the standing of his own family, both domestically and abroad, at the expense of the Medici regime in Florence and the anti-French Italian League that the Medici supported. This article offers for the first time a full investigation of a surprisingly early example of tensions between the Medici and the Pazzi, tensions that famously erupted in the Pazzi Conspiracy of 1478.

Healthcare providers increasingly recognize the importance of collaboration among stakeholders in cost-effective healthcare delivery. While collaborative relationships offer great advantages, little research has addressed their relevance in an international development aid context, particularly in sub-Saharan Africa. The region is a major recipient of international development support, yet health indicators on HIV/AIDS, malaria, tuberculosis, and child and maternal mortality indicate the health of the region is among the weakest worldwide. This sequential mixed method, descriptive study of a USAID-funded community health program in Ghana examined the nature of collaboration among six stakeholders and impact of this collaboration on effectiveness of program implementation. Stakeholder and resource dependence theories provided conceptual frameworks for analysis. Data were collected through surveys and interviews of officers of participating organizations (POs) and community health officers (CHOs). Surveys were analyzed using means, standard deviations, and t tests, while coding and themes determination were adopted for the interview data analysis. Results from both sources were integrated. Findings indicate both POs and CHOs perceived human relationship factors as more critical than physical resources. Collaboration, shared decision making, and frequency of communication in the relationship were perceived to substantially improve CHO skills and rural healthcare quality. Recommendations include active development of strong trust and dialogue in future relationships. These results could have important implications for positive social change by identifying the bases for collaborative success in providing impoverished rural communities with cost-effective and quality healthcare to address critical community health needs.

This study explored the origins, evolution and influence of the tradition of San Lázaro as it currently pertains to the Cuban-American Santeria community in Miami. The main argument of the study is that in the context of the contemporary religious culture of Santeria in Miami, San Lázaro is a hybrid spirit. Many manifestations of healing entities have come to merge in the person of this spirit. Though practitioners identify with specific manifestations of this spirit, the processes of transmigration have blurred the lines of deep-rooted faiths and created a fusion of meanings from disparate traditions, making San Lázaro an ambivalent personality. San Lázaro’s ambivalence is the very quality that makes him such an important Orisha. As a deity whose personalities demonstrates the combination of a diversity of qualities, including those that contradict each other, San Lázaro is deployed in a very broad range of healing context, making him a versatile Orisha. This study clarified the contrasting qualities this deity embodies and traces the socio-historical context in which the deity acquires the layers of meanings it is currently associated with. Drawing on interviews with Lázaranian worshipers [Lázarenos] in Miami and engaging in Bourdieu’s concept of Habitus, the study provided a window into the nature of the tradition of San Lázaro and how its usage is linked with the African heritage of the worshipers.

Com objetivo de analisar criticamente os tipos histológicos propostos na classificação da Sociedade Brasileira de Patologia para o adenocarcinoma gástrico, estudamos os tipos histológicos e o perfil imuno-histoquímico de mucinas em 272 adenocarcinomas gástricos operados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A casuística pode ser dividida em 237 tumores únicos, 4 tumores múltiplos e 31 tumores com mais de um tipo histológico. Foram avaliados idade, gênero, localização, aspecto, estadiamento tumoral, padrões de expressão de mucinas intestinais pelos marcadores MUC2 e CD10 e gástricas por MUC5AC e MUC6. A coexistência de focos de padrão pouco diferenciado e de padrão gástrico em adenocarcinoma gástrico com mais de um aspecto e em casos com mais de um tumor e a ausência de tal concomitância com o padrão intestinal favorece sua compreensão como padrões independentes. As variáveis histológicas \"favoráveis\" predominaram nos adenocarcinomas gástricos de padrão intestinal, seguido dos de padrão tubular gástrico. Estes representam o cerne para estudos futuros por compreender o tipo túbulo-papilífero cujos aspectos clínicos se assemelham aos intestinais, o tipo tubular com expressão de mucina incaracterística e o tipo microtubular pela primeira vez individualizado, com aspectos morfológicos menos favoráveis e expressão imuno-histoquímica própria da mucosa gástrica. Os adenocarcinomas mucinosos mostraram marcante dicotomia quer nos aspectos clínicomorfológicos, quer no padrão de expressão de mucinas. Os dados indicam a necessidade de compreendê-los como entidades díspares. O tipo histológico foi detectado em casos com apresentação precoce, mas representa a maior fração daqueles avançados Borrmann IV exibindo predomínio de mucinas gástricas. O mucinoso muconodular só foi detectado em estadios avançados e co-expressou mucinas de intestinais e gástricas. O padrão pouco diferenciado diferiu distinto dos demais tanto pelos dados clínico-morfológicos, como pela escassa expressão de mucinas.
Aiming at a critical assessment of the histological types proposed at the classification of Brazilian Society of Pathology for gastric adenocarcinoma, we studied herein the histological and immunohistochemical profile of mucins in 272 gastric adenocarcinoma surgical samples from Hospital das Clínicas University of São Paulo School of Medicine. The casuistic can be divided into 237 single tumors, 4 multiple tumors and 31 tumors with more than one histological type. We evaluated age, gender, tumor location and appearance, tumor staging, the expression patterns of intestinal mucins by the markers MUC2 and CD10 and for gastric tumor by MUC5AC and MUC6 markers. The coexistence of foci of poorly differentiated pattern and foci of gastric pattern in gastric adenocarcinoma with more than one pattern and in cases with more than one tumor and the absence of such concurrence with the intestinal pattern, lead to its understanding as independent patterns. Favorable histological variables prevailed in gastric adenocarcinomas of intestinal pattern, followed by the gastric tubular pattern. These represent the core for future studies to include: the tubulo-papilary type, whose clinical features resemble the intestinal types, the tubular type with uncharacteristic mucin expression and the microtubulat type, individualized for the first time in the present study, with less favorable morphological aspects and immunohistochemical expression of the gastric mucosa itself. Mucinous adenocarcinomas have shown a stricking dichotomy in both clinical and morphological aspects, as in the expression pattern of mucins. Data indicate the need to understand them as disparate entities. The mucocelular type (signet ring cells) was detected in cases found inearly tumor stages, but includes the highest fraction of advanced tumors, Borrmann IV with predominant expression of gastric mucins. Muconodular type was only detected in advanced stages and co-expressed intestinal and gastric mucins. The poorly differentiated cases were frankly distinct from the other types, by both clinical and morphological data, and by the scarcity of mucin expression.

Malaria is one of the leading causes of death for children and women in Sierra Leone. The purpose of this qualitative study was to explore and understand the lived experiences of women from the rural areas of Sierra Leone regarding malaria. A purposive sample of Krio women from the western rural area, aged 21-55 years, spoke English, and had taken care of someone with malaria described their perceptions and lived experiences with the disease in face-to-face interviews. The research questions were based on the health belief model and focused on knowledge, beliefs, and perceptions about malaria prevention and treatment. Interpretative phenomenological analysis was used to identify themes through coding. The findings indicated that (a) lack of doctors, medicines, and medical supplies at government clinics discourages malaria victims from visiting those clinics; (b) the use of traditional herbs is prevalent because of their effectiveness, affordability, easy access, and lack of side effects; (c) women were not aware of recommended comprehensive malaria control measures, which include the continuous use of durable insecticide nets, residual spraying, case management, and artemisinin-based therapy. The results also show that (a) pregnant women should not take prescribed medications to prevent or treat malaria because they harm the fetus, and (b) traditional herbs may be taken with Western medicines to treat severe malaria. Recommendations include: that the government evaluate the efficiency and effectiveness of its current malaria programs in local clinics, and that future studies be undertaken to identify antimalarial properties in commonly accepted local herbs. Changes in policies and practices relating to the prevention and treatment of malaria will serve as building blocks for positive social change to reduce the malaria incidence rate in Sierra Leone.

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Pesquisa exploratória sobre divulgação científica no Brasil, na área de Saúde, cujo objetivo principal foi identificar e analisar as ações de divulgação científica, no período de 2000 a 2016, empreendidas por Sociedades Brasileiras de Especialidades Médicas, cujos especialistas lidam com as doenças responsáveis pelos maiores índices de mortalidade no Brasil, a fim de verificar como estão sendo desenvolvidas essas iniciativas. As Sociedades Brasileiras de Especialidades Médicas, uma vez que constituem o ambiente da pesquisa, são apresentadas em um breve perfil. O quadro teórico é centrado em alguns aspectos da divulgação científica, como seu nascedouro, diferenças da comunicação científica, sendo ressaltada a contribuição da comunicação social para o tema, embora o enfoque da pesquisa seja a Ciência da Informação. É incluída uma questão polêmica, a discussão sobre quem deve assumir a divulgação científica, o pesquisador ou o jornalista, e ressaltada a dimensão social da área, finalizando essa fundamentação a Divulgação Científica no Brasil.A pesquisa empírica reuniu a análise dos portais das Sociedades Científicas selecionadas e entrevistas com diretores e jornalistas dessas instituições. Na primeira parte, os portais das Sociedades indicam riqueza de informações e a ênfase em materiais de prevenção de doenças e campanhas de promoção de saúde. As entrevistas demonstram, de um modo geral, pouca familiaridade com o conceito da Divulgação Científica, embora há esforço e investimento nessas ações. Os resultados em geral indicam que na Saúde e com base nas Sociedades Brasileiras de Especialidades Médicas, a Divulgação Científica avança e está em vias de consolidação, no Brasil.
Exploratory research on scientific divulgation in the area of Health, having as its main objective the identification and the analysis of actions of scientific divulgation, from 2000 to 2016, undertaken by the Brazilian Societies of Medical Specialties. Their experts deal with diseases that account for the highest rates of death in Brazil. The study aimed at verifying how these initiatives are being developed. The Brazilian Societies of Medical Specialties, as long as they make up the research environment, are briefly presented. The theoretical framework focuses on some aspects of scientific divulgation, like its beginnings, differences in scientific communication, enhancing the contribution of social communication in the area, though focusing this research on Information Science. A controversial issue is included: the discussion about who must assume scientific divulgation, researchers or journalists, and highlighting the social dimension in the area, concluding the theoretical foundation with Scientific Divulgation in Brazil. Empirical research gathered analysis from portals of the selected Scientific Societies and interviews with directors and journalists of such institutions. In the first part, Societies' portals indicate a wealth of information and an emphasis on materials to prevent diseases and health-promoting campaigns. The interviews generally demonstrated little acquaintance with the concept of scientific divulgation, although there is effort and there is investment in these actions. Results, in general, indicate that as far as Health is concerned, and based on the Brazilian Societies of Medical Specialties, Scientific Divulgation moves forward and is in the process of consolidation in Brazil.

This dissertation explores the intellectual discourse on race in the early twentieth century, particularly from 1919 to 1958, examining how British and American eugenicists and Caribbean nationalists debated the limits of colonial politics in the British Caribbean using academic and scientific language. These discussions emerged in the aftermath of World War I, the economic crises that led to the Great Depression, the political and labor unrest in the British Caribbean, and consequences of the Second World War. The dissertation’s goal is to examine how residents of the British Caribbean understood, appropriated, and challenged some of the principles of eugenics, particularly those espousing ideas of white superiority. The dissertation has taken great consideration of both private and published sources from white and black intellectuals in the Anglophone Caribbean to document the dissemination of concepts of race, ethnicity, and identity in the region during the interwar period. Additionally, focusing on such critical areas as education and social policies, it explores whether eugenic ideas influenced the twentieth-century governance of British West Indian colonies.

Using the lives of impaired individuals catalogued in the Íslendingasögur as a narrative framework, this study examines medieval Scandinavian social views regarding impairment from the ninth to the thirteenth century. Beginning with the myths and legends of the eddic poetry and prose of Iceland, it investigates impairment in Norse pre-Christian belief; demonstrating how myth and memory informed medieval conceptualizations of the body. This thesis counters scholarly assumptions that the impaired were universally marginalized across medieval Europe. It argues that bodily difference, in the Norse world, was only viewed as a limitation when it prevented an individual from fulfilling roles that contributed to their community. As Christianity’s influence spread and northern European powers became more focused on state-building aims, Scandinavian societies also slowly began to transform. Less importance was placed on the community in favor of the individual and policies regarding bodily difference likewise changed; becoming less inclusive toward the impaired.

This thesis examines the methods used by the Ministerium für Staatssicherheit (MfS), more commonly known as the Stasi, or East German secret police, for extraction of information from citizens of the German Democratic Republic for the purpose of espionage and covert operations inside East Germany, as it pertains to the deliberate brainwashing of East German citizens. As one of the most efficient intelligence agencies to ever exist, the Stasi’s main purpose was to monitor the population, gather intelligence, and collect or turn informants. They used brainwashing techniques to control the people of the GDR, keeping the populace paralyzed with fear and paranoia. By surrounding themselves with a network of informants they prevented actions against the dictatorial communist regime. Using the video testimonies of former prisoners, and former confidential informants who worked closely with and collaborated with Stasi agents, in combination with periodicals and previous historical studies, this work argues that the East German Police State’s brainwashing techniques had long and lasting consequences both for German citizens, and for the psychiatric health of former GDR citizens. The scope and breadth of the techniques and data compiled for use by the Stasi were exhaustive, and the repercussions of their use are still being felt and discovered twenty five years after the fall of the Berlin Wall. This study aims to show the lasting effects brainwashing had on former informants and the Stasi’s victims.

La recerca pren com a punt de partença la consolidació de les formes institucionals d'una tradició mèdica desenvolupada pel govern de la ciutat de Barcelona al llarg dels segles XVI i XVII, enteses com a representació pública dels seus interessos polítics. La guerra de Successió i les reformes introduïdes en aquesta matèria per les autoritats borbòniques escapçaren aquella tradició i no es fonamentaren en cap projecte de renovació científica. La tesi analitza les estratègies desenvolupades, al marge del model professional imposat, pels professionals de la medicina des de mitjan segle, tot centrant l'atenció en l'estudi del projecte i dels seus representants que cercava una nova professionalització de la medicina en el marc d'un nou encaix de la realitat política catalana dintre de la corona espanyola. La recerca planteja alhora la implantació de la medicina universitària a Catalunya a partir de l'estudi de la contractació de professionals per part dels municipis i de les formes associatives urbanes d'auxili mutu en la malaltia i en la mort.
The institutional forms of a medical tradition developed by the city of Barcelona throughout the 16th and 17th centuries are taken as starting point of this research. The war of Succession and the reforms carried out on this matter by the Bourbon authorities not only broke the former tradition but also did not lay its foundations in any project of scientific renewal. This thesis studies the strategies developed, in the margin of the professional model imposed, by the Catalan medical practitioners from the middle of the century, by looking at the project, and its representatives, that searched for a new kind of medical professionalization in the context of a new insertion of the Catalan society into the Spanish crown. This research also poses the question of how university medicine did spread in Catalonia through the study of the municipal engagement of medical practitioners and the urban friendly societies that provided mutual help in times of sickness and death.

Introduction.

Le Rwanda a connu de nombreuses difficultés au cours des deux dernières décennies :la situation économique précaire, les guerres civiles, le régime politique défaillant, l’instabilité de la sous-région des Grands Lacs, la pandémie du VIH/SIDA ;tous ces bouleversements ont plongé le pays dans l’extrême pauvreté. Au lendemain de la guerre et du génocide, le ministère de la Santé avec l’appui de différents partenaires a canalisé tous ses efforts dans la reconstruction du système de santé. Une meilleure participation communautaire à la gestion et au financement des services de santé était un des objectifs retenus dans cette reconstruction du système de santé. Pour ce faire, le ministère de la Santé, en partenariat avec le PHR (Partnership for health reform) a mis en place des mutuelles de santé « pilote » dans trois districts sanitaires (Byumba, Kabgayi et Kabutare) sur les 39 districts que compte le pays. L’objectif du ministère de la Santé était de généraliser ce système d’assurance maladie après une évaluation de ce projet pilote. Cette initiative de mise en place des mutuelles s’est heurtée au début de sa mise en œuvre à différents problèmes :le faible taux d’adhésion, les problèmes de gestion de la mutuelle, une faible implication des autorités de base dans la sensibilisation, une mauvaise qualité de soins dans certaines formations sanitaires, une utilisation abusive des services par les mutualistes, etc. Malgré ces problèmes d’autres initiatives de mise en place de mutuelles de santé ont vu le jour et continuent de s’implanter ici et là dans les districts sanitaires du pays. Dans le souci de renforcer cette réforme de financement alternatif par les mutuelles de santé, nous avons évalué l’impact des mutuelles sur l’accessibilité aux soins et le renforcement de la participation communautaire aux services de santé et nous avons proposé des voies stratégiques susceptibles d’améliorer le fonctionnement des mutuelles de santé.

Méthodologie

Pour atteindre ces objectifs de recherche, nous avons combiné trois approches différentes :la recherche qualitative qui a permis d’une part, d’analyser le processus de mise en place des mutuelles de santé au Rwanda et d’autre part, de recueillir les opinions des bénéficiaires de services de santé sur ce processus. Ensuite la recherche quantitative nous a permis d’étudier les caractéristiques des membres et non-membres des mutuelles et l’utilisation des services de santé ;enfin la recherche action nous a permis d’expérimenter les axes stratégiques susceptibles de renforcer le développement des mutuelles de santé.

Cette approche méthodologique utilisée tout au long de notre travail de terrain a mené à une « triangulation méthodologique » qui est une combinaison de diverses méthodes de recherche. Dans chacune des méthodes citées, nous avons utilisé une ou plusieurs techniques :analyse de documents, observations et rencontres avec des individus ou des groupes, analyse et compilation des données de routine.

Résultats

Les résultats clés sont synthétisés selon les trois types de recherche que nous avons menés.

1. Processus de mise en place des mutuelles de santé au Rwanda et opinions des bénéficiaires

Dans les trois districts pilotes (Byumba, Kabgayi et Kabutare), les mutuelles de santé prennent en charge le paquet minimum d’activités complet offert au niveau des centres de santé. À l’hôpital de district elles couvrent :la consultation chez un médecin, l’hospitalisation, les accouchements dystociques, les césariennes et la prise en charge du paludisme grave. Pour bénéficier de ces soins une cotisation de 7,9 $ EU ($ des États-Unis) par an pour une famille de sept personnes est demandée, puis 1,5 $ EU par membre additionnel et 5,7 $ EU pour un célibataire. Le ticket modérateur est de 0,3 $ EU pour chaque épisode de maladie et la période d’attente d’un mois avant de bénéficier des avantages du système de mutualisation.

Des entretiens en groupes de concertation (focus groups) nous ont permis de confirmer que la population connaît l’intérêt des mutuelles de santé et qu’elle éprouve des difficultés pour réunir les fonds de cotisations pour adhérer aux mutuelles.

L’analyse critique du processus de mise en place des mutuelles dans les trois districts pilotes nous a permis de conclure que les autorités locales et les leaders d’opinions étaient peu impliqués dans le processus de mise en place des mutuelles et que la sensibilisation était insuffisante. L’appui au processus de mise en place par le PHR a été jugé insuffisant en termes de temps (18 mois) et de formation de cadres locaux qui devraient assurer la poursuite de ce projet. Les défaillances évoquées ont alerté le ministère de la Santé, qui a mis en place un comité de mise en place et de suivi des mutuelles de santé. Depuis ce temps, on observe une émergence des initiatives mutualistes. Le pays compte actuellement 21 % de la population totale qui possède une certaine couverture (partielle ou totale) d’assurance maladie.

2. Caractéristiques des membres et non-membres des mutuelles de santé et utilisation des services de santé par la communauté

Il a été constaté que la répartition selon le sexe, l’état civil et le statut professionnel des membres et non-membres de la mutuelle les caractéristiques ne diffèrent pas significativement entre les adhérents et les non-adhérents à la mutuelle de santé (p > 0,05). Parmi les membres, les proportions des ménages avec revenus élevés sont supérieures à celles observées chez les non-membres (p < 0,001). Quant à la « sélection adverse » que nous avons recherchée dans les deux groupes (membres et non-membres de la mutuelle), nous avons constaté que l’état de morbidité des membres de la mutuelle ne diffère pas de celui des non-membres (p > 0,05). Les personnes qui adhèrent à la mutuelle de santé s’y fidélisent au fil des années (> 80 %) et fréquentent plus les services de santé par rapport aux non-membres (4 à 8 fois plus pour la consultation curative et 1,2 à 4 fois plus pour les accouchements). Les non-membres ont tendance à fréquenter les tradipraticiens et à faire l’automédication. Bien que les mutualistes utilisent plus les services de santé que les non-mutualistes, ils dépensent moins pour les soins.

3. Axes stratégiques développés pour renforcer les mutuelles de santé

Pour mettre en place les stratégies de renforcement des mutuelles de santé, cinq types d’actions dans lesquelles nous avons joué un rôle participatif ont été menés.

D’abord la stratégie initiée pour faire face à l’exclusion sociale :il s’agit de l’entraide communautaire développée dans la commune de Maraba, district sanitaire de Kabutare. Ce système d’entraide, nommée localement ubudehe (qui signifie « travail collectif » en kinyarwanda), assure un appui aux ménages les plus pauvres selon un rythme rotatoire préalablement établi en fonction du niveau de pauvreté.

Une autre stratégie est celle du crédit bancaire accordé à la population pour pouvoir mobiliser d’un seul coup le montant de cotisation. Cette stratégie a été testée dans le district sanitaire de Gakoma. Un effectif de 27 995 personnes, soit 66,1 % du total des membres de la mutuelle de ce district ont souscrit à la mutuelle de santé grâce à ce crédit bancaire.

Les autorités politiques et des leaders d’opinions ont été sensibilisés pour qu’ils s’impliquent dans le processus de mise en place des mutuelles dans leurs zones respectives. Il a été constaté que les leaders d’opinions mobilisent plus rapidement et plus facilement la population pour qu’elle adhère aux mutuelles de santé, que les autorités politiques. Cette capacité de mobiliser la population est faible chez les prestataires de soins.

Certaines mesures ont été proposées et adoptées par les mutuelles de santé pour éviter les risques liés à l’assurance maladie. Il s’agit de l’adhésion par ménage, par groupe d’individu, par association ou par collectivité ;l’exigence d’une période d’attente avant de bénéficier des avantages des mutualistes ;l’instauration du paiement du ticket modérateur pour chaque épisode de maladie ;les supervisions réalisées par les comités de gestion des mutuelles de santé et les équipes cadres de districts ;l’utilisation des médicaments génériques ;le respect de la pyramide sanitaire et l’appui du pouvoir public et/ou partenaire en cas d’épidémie. Ces mesures ont montré leur efficacité dans l’appui à la consolidation des mutuelles de santé.

Enfin, l’« Initiative pour la performance » est la dernière stratégie qui a été développée pour renforcer les mutuelles de santé. Elle consiste à inciter les prestataires à produire plus et à améliorer la qualité de services moyennant une prime qui récompense leur productivité. Les résultats montrent que les prestataires de services ont développé un sens entrepreneurial en changeant leur comportement vis-à-vis de la communauté. Certaines activités du PMA (paquet minimum d’activités) qui n’étaient pas offertes ont démarré dans certains centres de santé (accouchement, stratégies avancées de vaccination, causeries éducatives, etc.). Des ressources supplémentaires ont été accordées aux animateurs de santé, aux accoucheuses traditionnelles et aux membres de comités de santé qui se sont investis plus activement dans les activités des centres de santé. L’intégration des services a été plus renforcée que les années précédentes.

Conclusions

Les mutuelles de santé facilitent la population à accéder aux soins de santé et protègent leurs revenus en cas de maladies.

Le modèle de mise en place des mutuelles de santé au Rwanda est de caractéristique dirigiste :à partir des autorités (politiques, sanitaires ou leaders d’opinions). Il ne serait pas le plus adéquat dans la participation communautaire, mais plutôt adapté à un contexte politique de reconstruction d’un pays.
Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished

Despite the ongoing investments in programs to increase sexual health awareness among young adults globally, many youths remain vulnerable to sexually transmitted diseases (STDs). Two-thirds of all STDs occur among youths engaging in high-risk sexual behaviors, which put young adults at higher risk of STDs and can result in serious consequences including infertility. Additionally, the social consequences of STD affect families and communities. While a need exists for increased public awareness of STDs among young adults, extant intervention and prevention activities should be informed by a cultural perspective, including the integration of community and government roles. The purpose of this social ecological study was to investigate the perceptions of STDs and the potential factors responsible for the increased frequency of STDs based on the lived experiences of 20 young adults with STDs in Akwa Ibom State, Nigeria. Through a qualitative approach using a phenomenological research design, this study employed semi-structured interviews, and the resultant data were analyzed and coded. The findings indicated that college-aged students increasingly engaged in sexually risky behavior with multiple sexual partners for financial gain and power. Additionally, while institutions promoted abstinence as an effective strategy to reduce STD infections, the findings indicated a strong relationship between the phenomenon and individual interconnectedness with the larger society. Because the sexual behavior of young adults in Akwa Ibom State, Nigeria, is influenced at multiple ecological levels, effective and sustaining culturally appropriate STD interventions must involve the larger society including young adults in all stages of intervention development and implementation.

This dissertation investigates how Jewish women social scientists relationally established their gendered-racialized subjectivities and theories about race-gender-sexuality-class through their portrayals of black women’s sexuality and family structures in the African Diaspora: the U.S., Brazil, South Africa, Swaziland, and the U.K. The central women in this study: Ellen Hellmann, Ruth Landes, Hilda Kuper, and Ruth Glass, were part of the same “political generation,” born in 1908-1912, coming of age when Jews of European descent experienced an ambivalent and conditional assimilation into whiteness, a form of internal colonization. I demonstrate how each woman’s familial origin point in Europe, parental class and political orientations, were important factors influencing her later personal/professional networks and social science theorizing about women of color. However, other important factors included the national racial context, the political affiliations of her partners, her marital status and her transracial fieldwork experiences. One of the main problems my work addresses is how the internal colonization process in differing nations within the Jewish diaspora differently affected and positioned Jewish social scientists from divergent class and political affiliations. Gendering Aamir Mufti’s primarily male-oriented argument, I demonstrate how Jewish internal divergences serve as an example that highlights the lack of uniformity within any “identity” group, and the ways that minority groups, like Jews, use measures of “abnormal” gender and sexuality, to create internal exiled minorities in order to try to assimilate into the majority colonizing culture. My dissertation addresses three problems within previous studies of Jewish social scientists by creating a gendered analysis of the history of Jews in social science, an analysis of Jewish subjectivity within histories of women (who were Jewish) in social science, and a critique of the either-or assumption that Jewishness necessarily equated with a “radical” anti-racist approach or a “colonizing” stance toward black communities. The data collection followed a mixed methods approach, incorporating archival research, ethnographic object analysis, site visits in Brazil and South Africa, consultations with library, archive and museum professionals, and interviews with scholars connected to the core women in the study.

We investigate the origins of mathematical societies and journals. We argue that the origins of today’s professional societies and journals have their roots in the informal gatherings of mathematicians in 17th century Italy, France, and England. The small gatherings in these nations began as academies and after gaining government recognition and support, they became the ancestors of the professional societies that exist today. We provide a brief background on the influences of the Renaissance and Reformation before discussing the formation of mathematical academies in each country.

Traditional medicine, unlike western medicine, is not merely concerned with physical illness, but it is used for various purposes. For instance: It can be used for lkuthwala' (the process whereby a person consults a traditional doctor for the medicine that will make a person very rich). The practice of 'ukuthwala' has numerous disavantages, especially because of the price that is paid in return of the wealth accumulated. The price is usually a human sacrifice, depending on what version of Ukuthwala' a person has opted for. Traditional medicine can also be used for witchcraft (ukuthakatha),for protection against evil spirits (ukuqinisa) , for making someone love you, for job opportunities, and for inspiration of the army. It can be either used for good or evil purposes. The dissertation looks at both versions by strongly drawing examples from Zulu novels. Other issues raised in this study is the importance of religion and cosmology, culture, magic, as well as spiritual healing, in association with traditional medicine. The Africans believe in the spirit world. They believed that for people to communicate with 'Mvelinqangi ' (God) there should be 'amadlozi' (the ancestors), who should intercede with God on their behalf. Usually, they call a sangoma' (medium) or 'inyanga' (medicine-man) to perform the religious ritual, or he would just instruct the elder person in the family how to carry out the procedure of communicating with the ancestors (Canonici, 1996). Traditional medicine has its own professional ethics. These ethics are also discussed in the research.
Thesis (M.A.)-University of Natal, Durban, 2000.