La nanosanté : perspective et enjeux sociologiques de l'application des nanotechnologies à la médecine.

Considérée comme le futur de la pratique médicale, la nanomédecine est l’application des nanotechnologies aux soins de santé. Plus qu’un nouveau domaine d’application technologique, la nanomédecine est porteuse d’un nouveau paradigme biomédical qui promeut une conception technoscientifique de la santé. Ce nouveau paradigme regroupe sous le préfixe nano l’ensemble des grandes tendances actuelles de la recherche en santé : la médecine prédictive, la médecine personnalisée et la médecine régénératrice. Centré sur le développement d’innovations visant au contrôle technique des éléments et des processus biologiques fondamentaux, ce nouveau paradigme se développe largement grâce au soutien des gouvernements et aux promesses économiques qu’il soulève. Il se construit à la croisée du scientifique, du politique et de l’économique. Interroger la nanomédecine revient alors à examiner plus largement la forme et les conditions du sens des innovations biomédicales et à soulever les implications de la « technoscientifisation » des soins de santé. L’objectif de cette thèse est de rendre compte de la spécificité et des enjeux sociaux, culturels et politico-économiques caractéristiques du modèle biomédical technoscientifique porté par la nanomédecine à partir de sa conceptualisation sous la forme d’un idéaltype : la nanosanté. Si la nanomédecine renvoie de manière générale aux applications techniques de la nanotechnologie au domaine biomédical, la nanosanté renvoie aux diverses dimensions sociologiques constitutives de ces technologies et à leurs effets sur la santé et la société. Notre modèle de la nanosanté s’organise autour de trois dimensions : la transversalité, l’amélioration et la globalisation. Compte tenu de sa nature synthétique, ce modèle tridimensionnel permet iii d’aborder de front plusieurs questionnements cruciaux soulevés par le développement de la nanomédecine. Il permet d’éclairer le rapport contemporain à la santé et ses implications sur l’identité ; de mettre en lumière la centralité des technosciences dans la conception du progrès médical et social ; de mieux saisir les nouvelles formes globales de pouvoir sur la vie et les nouvelles formes d’inégalité et d’exploitation caractéristiques d’une société qui accorde une valeur grandissante à l’adaptabilité technique de l’humain et à l’économisation de la santé et du corps ; mais aussi de mieux comprendre le sens et les répercussions de l’engagement scientifique, politique et économique dans les innovations moléculaires et cellulaires.

Inclure l’addiction à Internet dans le DSM-V : étude de cas de la biomédicalisation des cyberdépendances

Le domaine de recherche scientifique sur les cyberdépendances présente de multiples définitions de cette pathologie. À partir du matériel empirique issu des débats relatifs à la proposition d'inclure l'addiction à Internet dans le Manuel Diagnostique et Statistique des Troubles mentaux (DSM-V), ce mémoire vise à comprendre les processus sociaux bornant le développement de cette pathologie au regard de la théorie de la biomédicalisation. À cette fin, un premier travail sociohistorique retrace les voies de la biologisation progressive des pratiques sociales de communication en ligne amorcées dès 1980. Un second travail d'analyse de discours systématise ensuite le processus normatif se dégageant des controverses scientifiques liées à son inclusion dans le DSM-V. La recherche menée suggère une interprétation théorique de cet objet située à l'intersection de tendances sociales propres à la société d'information. Le projet d'inclusion révèle la volonté d'une régulation sociale effectuée à partir de la transformation technoscientifique du vivant selon des processus santéistes et néolibéraux. Il donne ainsi à penser les discours scientifiques sur l'addiction à Internet comme avant tout politiques et économiques.

La reconnaissance d’autrui comme prérequis à toute forme de consentement et d’assentiment : Une réponse à Verpaelst et Touyz

Commentaire / Commentary

Histoire d'une profession disparue: les puéricultrices du Québec, 1925-1985

Ce mémoire porte sur l’évolution de la profession de puéricultrice au Québec entre 1925 et 1985. Il cherche plus spécifiquement à éclairer les raisons de la disparition de cette profession. Celle-ci prend racine dans le contexte de la lutte contre la mortalité infantile et de la médicalisation croissante de la maternité, ce dernier phénomène connaissant de profondes modifications au cours du XXe siècle. En parallèle, les systèmes de santé et d’éducation québécois connaissent d’importants bouleversements. Comment la profession de puéricultrice évolue-t-elle devant ces changements ? Comment tentera-t-elle de faire sa place dans le monde des spécialistes des soins et de l’enfance ? Par ailleurs, quelle place la société, plus spécifiquement le monde médical et l’État, lui réservera-t-elle au fil du temps et pour quelles raisons ? Qu’est-ce qui explique sa disparition ? Voilà les questions auxquelles ce mémoire cherche à répondre. Afin de bien ancrer les origines de la profession, notre analyse s’est d’abord penchée sur les raisons de la création des premières formations en puériculture et des stratégies de professionnalisation des puéricultrices. Notre recherche s’est ensuite intéressée aux discours des acteurs s’étant prononcés sur le sort des puéricultrices à la suite des grandes réformes des années 1960-1970 ainsi qu’au discours des puéricultrices qui cherchent à s’inscrire dans ce nouveau système de santé étatisé. Nous émettons l’hypothèse que la profession de puéricultrice a été victime de plusieurs facteurs dont les multiples réorganisations du système de santé ainsi que de la compétition entre les professions de la santé, mais plus profondément d’une conception de la maternité qui se modifie considérablement au cours de la période étudiée.

Legislación y atención medicalizada al nacimiento en el ejercicio de la maternidad y la paternidad en Cuba

El nacimiento de un hijo o una hija constituye un momento transcendental en la vida personal y familiar, en el que se desarticulan o consolidan aspectos de la feminidad y la masculinidad. Objetivo: desde esta perspectiva se realizó una investigación con el fin de comprender la formacomo influyen la representación de la maternidad, el sistema médico en el que se inserta la atención al parto y las legislaciones relacionadas con la maternidad en la concepción y en el ejercicio de la maternidad y la paternidad durante el embarazo, el parto y el puerperio. Metodología: se utilizaron varias técnicas cualitativas de investigación (entrevistas y observación participante) a mujeres atendidas en tres hospitales de maternidad de La Habana y sus compañeros (esposos legales o consensuales). Resultados: los hallazgos develan roles de género en los cuales la mujeres la cuidadora por excelencia y la responsable de la reproducción y los hombres son relegados de ella; se refuerzan y consolidan institucionalmente desde lo legislado y desde la atención médica al proceso. Paralelo a esto, deja al descubierto la emergencia de una nueva masculinidad mediante la mayor implicación de los hombres en este proceso, de su mayor inserción en el espacio privado y de la exteriorización de sentimientos asociados con el nacimiento de su bebé. Conclusión: surge la necesidad de generar políticas orientadas a desmontar la cultura patriarcal en aras de construir relaciones de pareja más igualitarias y democráticas en la sociedad cubana.

Nodrizas, madres, médicos: Medicalización de la lactancia en Bogotá 1869-1945

El presente texto realiza un análisis desde la antropología histórica sobre la construcción del concepto de cuerpo de mujer lactante a principios del siglo XX en Colombia. Para esto, se explorara el largo y accidentado proceso en el cual algunos médicos de la época diseñaron saberes (fisiología, bacteriología), herramientas (estadística), leyes y programas sociales (Las gotas de Leche) con la finalidad de convertir la lactancia y el cuerpo de la mujer lactante en un campo exclusivo a la medicina

Factors influencing European consumer uptake of personalised nutrition: results of a qualitative analysis

The aim of this research was to explore consumer perceptions of personalised nutrition and to compare these across three different levels of ‘‘medicalization’’: lifestyle assessment (no blood sampling); phenotypic assessment (blood sampling); genomic assessment (blood and buccal sampling). The protocol was developed from two pilot focus groups conducted in the UK. Two focus groups (one comprising only ‘‘older’’ individuals between 30 and 60 years old, the other of adults 18–65 yrs of age) were run in the UK, Spain, the Netherlands, Poland, Portugal, Ireland, Greece and Germany (N = 16). The analysis (guided using grounded theory) suggested that personalised nutrition was perceived in terms of benefit to health and fitness and that convenience was an important driver of uptake. Negative attitudes were associated with internet delivery but not with personalised nutrition per se. Barriers to uptake were linked to broader technological issues associated with data protection, trust in regulator and service providers. Services that required a fee were expected to be of better quality and more secure. An efficacious, transparent and trustworthy regulatory framework for personalised nutrition is required to alleviate consumer concern. In addition, developing trust in service providers is important if such services to be successful.

Donor conception and disclosure : an anthropological study

The study, carried out within an infertility support group, concern disclosure of donor conception and its possible effects upon our constructions of conception, kinship and identity. It also examines perceptions of rights, information and its access or denial, knowledge/power, secrecy and the medicalization of reproduction.

Atenção ao usuário em um centro de referência HIV/Aids: perspectiva de profissionais e usuários

We study the health care focused on care in an intercessor and dialogical relationship with the User, which involves the construction of therapeutic projects essential to the quality of the treatment of the user in health services, and it is necessary individual and collective actions. It is intended to acknowledge and analyze the perception of social subjects, users and professionals on the treatment given to a user of a Specialized Outpatient Service (Serviço Ambulatorial Especializado SAE) in STD/HIV/AIDS state reference in Natal, RN. The study is structured in a transdisciplinary vision of science and knowledge, theoretical and methodological principles that give meaning to the expression of the institutional features of care and health care reconnecting them to the social context. As a research strategy we seek the expressions of 56 subjects of social research, which agreed to participate in the sample, from a symbolic map of the attention, coupled with the techniques of observation and semi-structured interview. For the analysis of the results, five categories of analysis were established: the meaning of the service, care perception, process of communication and interaction, treatment perception and organization and evaluation of the service. It is argued that the attention and care are developed in a technical health care assistance to the disease, focusing on attention based on treatment, on diagnostic and drug therapy of antiretroviral drugs, reflecting the traditional biomedical paradigm of attention to the disease. This is also the mode of organization of practical actions in daily SAE: the therapy proves to be fragmented in several specialties, vertical and feeds the same model, generating tension and overload for professionals; showing impersonal care focused on structured and informative technology, unrelated to an interactive dialogic. From the speech of the subjects, the SAE is understood as the place of confrontation with the disease, but also enables greater elaboration of the illness by meeting their peers. Living with HIV and AIDS is living with concern, apprehension and fear, but mainly with the stigma, prejudice and exclusion, which require that the disease is kept in secret. There is a movement of forces and power, expressed in the knowledge-power of those who dominate the technical and administrative capabilities, devices that concentrate the maintenance of the medicalization of care, rapid consultations and with little attention, making it difficult to interact with and listen to, combined with structural failures, organizational and inadequate management of the service. We conclude that there are dimensions that are not considered in the internal dynamics of the care service multiple forms, characterized by care conflicting models, marked by individual interventions related to the disease. The subject is not considered together with his speech as technical discourse is imposed and care production based on material technology is observed

Estudo representacional da participação familiar nas atividades dos centros de atenção psicossocial no município de Natal-RN

Comprehending social representations of users relatives of Psychosocial Care Centers (CAPS) from Natal-RN, about their participation in the activities of these services, was the purpose of this study. The research instrument used was a semi-structured interview, led to 28 relatives of users of East and West CAPS II, East and North CAPS-ad, involved in the Relative Therapeutic Group, in Relative Meeting, in the Assembly of Users, Technicians and Relatives, according to the therapeutic schedule of each health services, between August to November 2007. Data obtained in family and users identification were characterized with the aid of charts and boards in absolute and/or percentage values. The discursive material from the guide from interviews was submitted to the informational resource ALCESTE (Analyse Lexicale par Contexte d'un Ensemble of Segments of Texte), and analyzed on the basis of the Theory of Social Representations and Central Nucleus Theory. Most of the relatives were women, married, aged over 50 years, who participated for more than two years in CAPS activities, and a coexistence of more than 11 years with the user. From the classification system of ALCESTE were selected categories, identified by: Category 1, Treatment Improvements and Expectations; Category 2, Living User Before and After; Category 3, Activities Relevance, Contradictions and Suggestions; Category 4, Guidelines -- Psychopharmacology and Medicalization; Category 5, Family Participation and Activities; and Category 6, Therapeutic Conditions Thanks, Tips and Vulnerability. The social representation of the family exists in the desire for change, identifying that we need to promote change by the continuity of therapeutic activities and overcome the detected inconsistencies, targeted by strengthening and by the stability of improvements in living and health conditions of users, experienced in CAPS treatment. The central nucleus had corresponded to positive changes in health and living conditions of users, and the peripheral elements were constituted by family conducts before and during treatment, and the expectations of changes in activities, especially in workshops. Despite this family participation be considered important, it still does not meet conditions to promote the inclusion of family, under an emancipating point of view, capable of causing in subject the hope for autonomy, initiative, individual and collective growths, a closer and active involvement in therapeutic activities, in workshops and discussions

Acompanhando o crescimento e o desenvolvimento da criança : uma intervenção integrada entre enfermagem e família

The accompanying the growth and development of the child is the guiding line of basic health measures directed at this public, acting within the scope of health monitoring and inferring positively in the rate of infant morbidity and mortality, which are still a preoccupation worldwide and in Brazil. However, mostly, this practice is based on the biomedical model of care, individualized, with emphasis on the medicalization and complaints, favoring the passivity of users. Given this issue, aim to develop accompanying the growth and development of the child in a Basic Unit Family Health, through a collective approach of medical care next to a health team, especially nurses and caregivers. This is a qualitative study, with the research-action method. Involved the four nurses and twenty-six of children's caregivers of the area of Basic Unit Family Health of Cidade Nova, in Natal, in the period from February to July 2010. The results were analyzed following the direction of the thematic analysis of Freire. In the situation analysis of the current reality of the accompanying the growth and development the children in the Basic Unit Family Health, through participant observation and applying a questionnaire to the nurses, we realize that despite these professionals have a knowledge tied to the paradigm of health promotion, in practice the monitoring of child is done through individual consultations in outpatient room, based on complaints brought by caregivers, with little solvability in actions employed. Given the need for change in medical care model, we decided jointly, in the focal group, for the collective monitoring of children's the growth and development, featuring then this proposal to the multidisciplinary team, discussing the participation of professional categories and planned collectively the actions. In the implementation stage of collective action, we contemplate the execution by the caregivers of anamnesis and physical examination, recording data in the Child Health Handbook and discussion of clinical findings, under the supervision of nurses and facilitators. In the evaluation, we found that this collective accompanying strategy allowed to caregivers learn new knowledge, exchange experiences, assistance in home care, beyond reduce the waiting time for medical care and creating opportunity of more time for debate about the children‟s health situation, differing of ambulatory care. As difficulties, we face with a high rate of defaulters (53.8%), lack of motivation and passivity of the users, little participation of other health professionals and nurses' involvement in other activities, technical and bureaucratic in the moment of care. Thus, we note also a strong rooting of individual clinical model on the way of thinking and acting of nurses and caregivers

Para uma crítica da medicalização na educação

Este artigo analisa criticamente o processo crescente de medicalização da vida cotidiana e suas expressões contemporâneas no campo da educação escolar à luz dos pressupostos da Psicologia Histórico-Cultural, buscando desvelar o processo de produção dos fenômenos do não aprender e não se comportar na escola, bem como os fatores que determinam sua identificação por profissionais da saúde e da educação como sintomas de doenças e transtornos. Dentre as muitas disfunções comumente associadas ao desempenho escolar de crianças na atualidade, são destacados e analisados o TDAH e o TOD. As análises desenvolvidas ao longo do texto indicam que a compreensão da medicalização como um desdobramento inevitável do processo de patologização dos problemas educacionais exige um trabalho intelectual crítico e o desenvolvimento de novos posicionamentos de psicólogos, educadores e profissionais da saúde em relação à sociedade, à educação e ao desenvolvimento humano.

O cuidado em saúde mental na atenção básica: uma cartografia

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Transtornos mentais no Hospital Geral: percepções elaboradas por enfermeiros

Pós-graduação em Enfermagem (mestrado profissional) - FMB