Anatomical and functional characteristics of the pelvic floor in nulliparous women submitted to three-dimensional endovaginal ultrasonography: case control study and evaluation of interobserver agreement

PURPOSE: To determine anatomical and functional pelvic floor measurements performed with three-dimensional (3-D) endovaginal ultrasonography in asymptomatic nulliparous women without dysfunctions detected in previous dynamic 3-D anorectal ultrasonography (echo defecography) and to demonstrate the interobserver reliability of these measurements. METHODS: Asymptomatic nulliparous volunteers were submitted to echo defecography to identify dynamic dysfunctions, including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional changes (non-relaxation or paradoxical contraction of the puborectalis muscle) in the posterior compartment and assessed with regard to the biometric index of levator hiatus, pubovisceral muscle thickness, urethral length, anorectal angle, anorectal junction position and bladder neck position with the 3-D endovaginal ultrasonography. All measurements were compared at rest and during the Valsalva maneuver, and perineal and bladder neck descent was determined. The level of interobserver agreement was evaluated for all measurements. RESULTS: A total of 34 volunteers were assessed by echo defecography and by 3-D endovaginal ultrasonography. Out of these, 20 subjects met the inclusion criteria. The 14 excluded subjects were found to have posterior dynamic dysfunctions. During the Valsalva maneuver, the hiatal area was significantly larger, the urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during the Valsalva maneuver differed significantly with regard to anorectal junction and bladder neck position. The mean values for normal perineal descent and bladder neck descent were 0.6 cm and 0.5 cm above the symphysis pubis, respectively. The intraclass correlation coefficient ranged from 0.62-0.93. CONCLUSIONS: Functional biometric indexes, normal perineal descent and bladder neck descent values were determined for young asymptomatic nulliparous women with the 3-D endovaginal ultrasonography. The method was found to be reliable to measure pelvic floor structures at rest and during Valsalva, and might therefore be suitable for identifying dysfunctions in symptomatic patients.

IFN-g in human Chagas' disease: protection or pathology?

An apparently paradoxical role for IFN-g in human Chagas' disease was observed when studying the pattern of cytokine production by peripheral blood mononuclear cells (PBMC) obtained from two groups of chagasic patients after specific stimulation with Trypanosoma cruzi-derived antigens. The groups studied were 1) patients treated with benznidazole during the acute phase of Trypanosoma cruzi infection and 2) chronically infected untreated patients. In the treated group, higher levels of IFN-g were produced by PBMC from individuals cured after treatment when compared to non-cured patients. In contrast, in the chronically infected group (not treated) higher levels of IFN-g were produced by PBMC from cardiac patients in comparison with asymptomatic (indeterminate) patients. This apparently paradoxical role for IFN-g in human Chagas' disease is discussed in terms of the possibility of a temporal difference in IFN-g production during the initial stages of the infection (acute phase) in the presence or absence of chemotherapy. The maintenance of an immune response with high levels of IFN-g production during the chronic phase of the infection may favor cure or influence the development of the cardiac form of the disease

Absence-like seizures in adult rats following pilocarpine-induced status epilepticus early in life

Administration of pilocarpine causes epilepsy in rats if status epilepticus (SE) is induced at an early age. To determine in detail the electrophysiological patterns of the epileptogenic activity in these animals, 46 Wistar rats, 7-17 days old, were subjected to SE induced by pilocarpine and electro-oscillograms from the cortex, hippocampus, amygdala, thalamus and hypothalamus, as well as head, rostrum and vibrissa, eye, ear and forelimb movements, were recorded 120 days later. Six control animals of the same age range did not show any signs of epilepsy. In all the rats subjected to SE, iterative spike-wave complexes (8.1 ± 0.5 Hz in frequency, 18.9 ± 9.1 s in duration) were recorded from the frontal cortex during absence fits. However, similar spike-wave discharges were always found also in the hippocampus and, less frequently, in the amygdala and in thalamic nuclei. Repetitive or single spikes were also detected in these same central structures. Clonic movements and single jerks were recorded from all the rats, either concomitantly with or independently of the spike-wave complexes and spikes. We conclude that rats made epileptic with pilocarpine develop absence seizures also occurring during paradoxical sleep, showing the characteristic spike-wave bursts in neocortical areas and also in the hippocampus. This is in contrast to the well-accepted statement that one of the main characteristics of absence-like fits in the rat is that spike-wave discharges are never recorded from the hippocampal fields.

Possible etiologies for tropical spastic paraparesis and human T lymphotropic virus I-associated myelopathy

The epidemiology of tropical spastic paraparesis/human T lymphotropic virus I (HTLV-I)-associated myelopathy (TSP/HAM) is frequently inconsistent and suggests environmental factors in the etiology of these syndromes. The neuropathology corresponds to a toxometabolic or autoimmune process and possibly not to a viral disease. Some logical hypotheses about the etiology and physiopathology of TSP and HAM are proposed. Glutamate-mediated excitotoxicity, central distal axonopathies, cassava, lathyrism and cycad toxicity may explain most cases of TSP. The damage caused to astrocytes and to the blood-brain barrier by HTLV-I plus xenobiotics may explain most cases of HAM. Analysis of the HTLV-I/xenobiotic ratio clarifies most of the paradoxical epidemiology of TSP and HAM. Modern neurotoxicology, neuroimmunology and molecular biology may explain the neuropathology of TSP and HAM. It is quite possible that there are other xenobiotics implicated in the etiology of some TSP/HAMs. The prevention of these syndromes appears to be possible today.

Different stress modalities result in distinct steroid hormone responses by male rats

Since both paradoxical sleep deprivation (PSD) and stress alter male reproductive function, the purpose of the present study was to examine the influence of PSD and other stressors (restraint, electrical footshock, cold and forced swimming, N = 10 per group) on steroid hormones in adult Wistar male rats. Rats were submitted to chronic stress for four days. The stressors (footshock, cold and forced swimming) were applied twice a day, for periods of 1 h at 9:00 and 16:00 h. Restrained animals were maintained in plastic cylinders for 22 h/day whereas PSD was continuous. Hormone determination was measured by chemiluminescent enzyme immunoassay (testosterone), competitive immunoassay (progesterone) and by radioimmunoassay (corticosterone, estradiol, estrone). The findings indicate that PSD (13.7 ng/dl), footshock (31.7 ng/dl) and cold (35.2 ng/dl) led to lower testosterone levels compared to the swimming (370.4 ng/dl) and control (371.4 ng/dl) groups. However, progesterone levels were elevated in the footshock (4.5 ng/ml) and PSD (5.4 ng/ml) groups compared to control (1.6 ng/ml), swimming (1.1 ng/ml), cold (2.3 ng/ml), and restrained (1.2 ng/ml) animals. Estrone and estradiol levels were reduced in the PSD, footshock and restraint groups compared to the control, swimming and cold groups. A significant increase in corticosterone levels was found only in the PSD (299.8 ng/ml) and footshock (169.6 ng/ml) groups. These changes may be thought to be the full steroidal response to stress of significant intensity. Thus, the data suggest that different stress modalities result in distinct steroid hormone responses, with PSD and footshock being the most similar.

Sleep pattern and learning in knockdown mice with reduced cholinergic neurotransmission

Impaired cholinergic neurotransmission can affect memory formation and influence sleep-wake cycles (SWC). In the present study, we describe the SWC in mice with a deficient vesicular acetylcholine transporter (VAChT) system, previously characterized as presenting reduced acetylcholine release and cognitive and behavioral dysfunctions. Continuous, chronic ECoG and EMG recordings were used to evaluate the SWC pattern during light and dark phases in VAChT knockdown heterozygous (VAChT-KDHET, n=7) and wild-type (WT, n=7) mice. SWC were evaluated for sleep efficiency, total amount and mean duration of slow-wave, intermediate and paradoxical sleep, as well as the number of awakenings from sleep. After recording SWC, contextual fear-conditioning tests were used as an acetylcholine-dependent learning paradigm. The results showed that sleep efficiency in VAChT-KDHET animals was similar to that of WT mice, but that the SWC was more fragmented. Fragmentation was characterized by an increase in the number of awakenings, mainly during intermediate sleep. VAChT-KDHET animals performed poorly in the contextual fear-conditioning paradigm (mean freezing time: 34.4±3.1 and 44.5±3.3 s for WT and VAChT-KDHET animals, respectively), which was followed by a 45% reduction in the number of paradoxical sleep episodes after the training session. Taken together, the results show that reduced cholinergic transmission led to sleep fragmentation and learning impairment. We discuss the results on the basis of cholinergic plasticity and its relevance to sleep homeostasis. We suggest that VAChT-KDHET mice could be a useful model to test cholinergic drugs used to treat sleep dysfunction in neurodegenerative disorders.

Breastfeeding preterm infant from the delivery ward via nicu to home

The aim of this study was to examine how to support breastfeeding of preterm infants immediately after birth in the delivery ward, during their hospital stay in a neonatal intensive care unit (NICU), and at home after hospital discharge. Specifically, the role of early physical contact, maternal breastfeeding attitude, and an internet-based peer support group were investigated. The delivery ward practices concerning the implementation of early physical contact between a mother and her infant admitted to a NICU were examined by a structured survey in two hospitals. An Internet-based, breastfeeding peer-support intervention for the mothers of preterm infants was developed and tested in a randomized controlled design with one year follow-up. The main outcomes were the duration of exclusive and overall breastfeeding, expressing milk, and maternal attitude. In addition, the perceptions of mothers of preterm infants were investigated by analyzing the peer-support group discussions with a qualitative approach. The implementation of early physical contact was different between the two hospitals studied and was based more on hospital routines than the physiological condition of the infant. Preterm infants, who were born before a gestational age (GA) of 32 weeks, were hardly ever allowed to have early contact with their mothers. Both, a higher GA and early physical contact predicted earlier initiation and increased frequency of breastfeeding in the NICU. A maternal breastfeeding-favorable attitude predicted increased frequency of breastfeeding in the NICU and also a longer duration of overall breastfeeding. The actual duration of breastfeeding was, however, shorter than the mothers intended in advance. The internet-based, peer-support intervention had no effect on the duration of breastfeeding, expressing milk, or maternal attitude. The participating mothers enjoyed the possibility of sharing their experiences of preterm infants with other mothers in similar situations. Some of the mothers also experienced being given useful advice for breastfeeding. Based on the mothers’ discussions, a process of breastfeeding preterm infants was created. This included some paradoxical elements in the NICU where, for example, breast milk was emphasized over breastfeeding and support in the hospital varied. Hospital discharge was a critical point, when the mothers faced breastfeeding in reality. Over time, the mothers assimilated their breastfeeding experience into part of being a mother. The care practices related to early physical contact in delivery wards need to be re-evaluated to allow more infants to have a moment with the mother. Maternal attitude could be screened prenatally and attitude-focused interventions developed. Breastfeeding support in the NICU should be standardized. Internet-based breastfeeding peer-support intervention was feasible but additional research is needed.

An examination of existential faith in the writtings of Søren Kierkegaard

This thesis takes seriously the proposition that existentialism is a lived philosophy. While Descartes' proof for the existence of God initially sparked my interest in philosophy, the insights of existentialism have allowed me to appropriate philosophy as a way of life. I apply the insights of Kierkegaard's writings to my spiritual and philosophy development. Philosophy is personal, and Kierkegaard's writings deal with the development of the person in his aesthetic, ethical and religious dimensions. Philosophy is a struggle, and this thesis, reveals the existential struggle of the individual in despair. The thesis argues that authentic faith actually entails faith. The existential believer has this faith whereas the religious believer does not. The subjectively reflective existential believer recognizes that a leap of faith is needed; anything else, is just historical, speculative knowledge. The existential believer or, the Knight of Faith, realizes that a leap of faith is needed to become open in inwardness to receive the condition to understand the paradoxes that faith presents. I will present Kierkegaard's "Analogy of a House" which is in essence, the backbone of his philosophy. I will discuss the challenge of moving from one floor to the next. More specifically, I will discuss the anxiety that is felt in the very moment of the transition from the first floor to the second floor. I will outline eight paradoxes that must me resolved in order for the individual to continue on his journey to the top floor of the house. I will argue that Kierkegaard's example of Abraham as a Knight of Faith is incorrect, that Abraham was in fact not a Knight of Faith. I will also argue that we should find our own exemplars in our own lives by looking for Knight of Faith traits in people we know and then trying to emulate those people. I will also discuss Unamuno's "paradoxical faith" and argue that this kind of faith is a strong alternative to those who find that Kierkegaard's existential faith is not a possibility.

Childlessness in a child-centered environment : the experiences of voluntarily childless female teachers /

In the literature on voluntary childlessness there is a lack of research on the types of occupations held by women who choose not to mother and how their fertility choice influences their occupational experiences. At the same time, the experience ofwomen with regard to the childfree choice has not been adequately addressed in contemporary feminist literature. In the field of education, much has been written about the association between mothering and teaching. Thus, childfree teachers become particularly interesting since they made seemingly paradoxical choices in that they chose not to bear and rear children yet they chose an occupation in which they are surrounded by and responsible for the daily care of many children. To gain an understanding of the work-related experiences of childfree women, in-depth interviews were conducted with 7 voluntarily childless female elementary school teachers from Southern Ontario. In addition, a focus group interview in which 3 of the 7 childfree teachers participated was conducted. Findings revealed that these women's "choice" to be childless was the result of complex circumstances and multiple motivations. Also, despite their decision to forgo the traditional female role of mother, these women held surprisingly conventional beliefs with regard to family and gender roles. In addition, these childfree women at times identified themselves as mother-like when teaching, yet at other times distanced themselves as teachers from mothers. Finally, results showed that these women experienced both direct and indirect pronatalist pressures outside as well as inside the workplace as a result of their childfree status.

Kierkegaard : the temporality of becoming a self

Introduction In Difference and Repetition, Deleuze compares and contrasts Kierkegaard's and Nietzsche's ideas of repetition. He argues that neither of them really give a representation of repetition. Repetition for them is a sort of selective task: the way in which they determine what is ethical and eternal. With Nietzsche, it is a theater of un belie f. ..... Nietzsche's leading idea is to found the repetition in the etemal return at once on the death of God and the dissolution of the self But it is a quite different alliance in the theater of faith: Kierkegaard dreams of alliance between a God and a self rediscovered. I Repetition plays a theatrical role in their thinking. It allows them to dramatically stage the interplay of various personnae. Deleuze does give a positive account ofKierkegaard's "repetition"; however, he does not think that Kierkegaard works out a philosophical model, or a representation of what repetition is. It is true that in the book Repetition, Constantin Constantius does not clearly and fully work out the concept of repetition, but in Sickness Unto Death, Kierkegaard gives a full explanation of the self and its temporality which can be connected with repetition. When Sickness Unto Death is interpreted according to key passages from Repetition and The Concept of Anxiety, a clear philosophical concept of repetition can be established. In my opinion, Kierkegaard's philosophy is about the task of becoming a self, and I will be attempting to show that he does have a model of the temporality of self-becoming. In Sickness Unto Death, Kierkegaard explains his notions of despair with reference to sin, self, self-becoming, faith, and repetition. Despair is a sickness of the spirit, of the self, and accordingly can take three forms: in despair not to be conscious of having a self (not despair in the strict sense); in despair not to will to be oneself; in despair to will to be oneself2 In relation to this definition, he defines a self as "a relation that relates itself to itself and in relating itself to itself relates to another.''3 Thus, a person is a threefold relationship, and any break in that relationship is despair. Despair takes three forms corresponding to the three aspects of a self s relation to itself Kierkegaard says that a selfis like a house with a basement, a first floor, and a second floor.4 This model of the house, and the concept of the stages on life's way that it illustrates, is central to Kierkegaard's philosophy. This thesis will show how he unpacks this model in many of his writings with different concepts being developed in different texts. His method is to work with the same model in different ways throughout his authorship. He assigns many of the texts to different pseudonyms, but in this thesis we will treat the model and the related concepts as being Kierkegaard's and not only the pseudonyms. This is justified as our thesis will show this modelremains the same throughout Kierkegaard's work, though it is treated in different ways by different pseudonyms. According to Kierkegaard, many people live in only the basement for their entire lives, that is, as aesthetes ("in despair not to be conscious of having a self'). They live in despair of not being conscious of having a self They live in a merely horizontal relation. They want to get what they desire. When they go to the first floor, so to speak, they reflect on themselves and only then do they begin to get a self In this stage, one acquires an ideology of the required and overcomes the strict commands of the desired. The ethical is primarily an obedience to the required whereas the aesthetic is an obedience to desire. In his work Fear and Trembling (Copenhagen: 1843), Johannes de Silentio makes several observations concerning this point. In this book, the author several times allows the desired ideality of esthetics to be shipwrecked on the required ideality of ethics, in order through these collisions to bring to light the religious ideality as the ideality that precisely is the ideality of actuality, and therefore just as desirable as that of esthetics and not as impossible as the ideality of ethics. This is accomplished in such a way that the religious ideality breaks forth in the dialectical leap and in the positive mood - "Behold all things have become new" as well as in the negative mood that is the passion of the absurd to which the concept "repetition" corresponds.s Here one begins to become responsible because one seeks the required ideality; however, the required ideality and the desired ideality become inadequate to the ethical individual. Neither of them satisfy him ("in despair not to will to be oneself'). Then he moves up to the second floor: that is, the mystical region, or the sphere of religiousness (A) ("despair to will to be oneself). Kiericegaard's model of a house, which is connected with the above definition ofdespair, shows us how the self arises through these various stages, and shows the stages of despair as well. On the second floor, we become mystics, or Knights of Infinite Resignation. We are still in despair because we despair ofthe basement and the first floor, however, we can be fiill, free persons only ifwe live on all the floors at the same time. This is a sort of paradoxical fourth stage consisting of all three floors; this is the sphere of true religiousness (religiousness (B)). It is distinguished from religiousness (A) because we can go back and live on all the floors. It is not that there are four floors, but in the fourth stage, we live paradoxically on three at once. Kierkegaard uses this house analogy in order to explain how we become a self through these stages, and to show the various stages of despair. Consequently, I will be explaining self-becoming in relation to despair. It will also be necessary to explain it in relation to faith, for faith is precisely the overcoming of despair. After explaining the becoming of the self in relation to despair and faith, I will then explain its temporality and thereby its repetition. What Kierkegaard calls a formula, Deleuze calls a representation. Unfortunately, Deleuze does not acknowledge Kierkegaard's formula for repetition. As we shall see, Kierkegaard clearly gives a formula for despair, faith, and selfbecoming. When viewed properly, these formulae yield a formula for repetition because when one hasfaith, the basement, firstfloor, and secondfloor become new as one becomes oneself The self is not bound in the eternity ofthe first floor (ethical) or the temporality of the basement (aesthete). I shall now examine the two forms of conscious despair in such a way as to point out also a rise in the consciousness of the nature of despair and in the consciousness that one's state is despair, or, what amounts to the same thing and is the salient point, a rise in the consciousness of the self The opposite to being in despair is to have faith. Therefore, the formula set forth above, which describes a state in which there is not despair at all, is entirely correct, and this formula is also the formula for faMi in ^elating itself to itself and in willing to be itself, the self rests transparently in the power that established it.

Evaluation of a professional development curriculum in movement education and adapted physical activity for invisible disabilities : a critical cross-case analysis

Movement education and adapted physical activity are content areas not addressed in pre-service education or in-service training for Ontario practitioners working with individuals with disabilities in physical environments. Consequently, physical activity is often overlooked by service providers in programming and intervention for exceptional young learners. A formative evaluation, multiple-case study design was employed in this research in which a purposeful sample of expert practitioners performed a guided, descriptive evaluation of a three-day professional development workshop curriculum designed to supplement these areas lacking in professional preparation within their respective cohorts. Case-by-case and comparative analyses illustrated the inherent assumptions and societal constraints which prioritize the structure of professional development within the education system and other government organizations providing services for school-aged persons with disabilities in Ontario. Findings, discussed from a critical postmodern perspective, illustrate the paradoxical nature of Western values and prevailing mind/body dichotomy that guide professional practice in these fields.

The Political Economy of St. Catharines' Illicit Taxi Trade

The global restructuring of production has led to increasingly precarious working conditions around the world. Post-industrial work is characterized by poor working conditions, low wages, a lack of social protection and political representation and little job security. Unregulated forms of work that are defined as “irregular” or “illegal”, or in some cases “criminal,” are connected to sweeping transformations within the broader regulated (formal) economy. The connection between the formal and informal sectors can more accurately be described as co-optation and, as a subordinate integration of the informal to the formal. The city of St. Catharines within Niagara, along with much of Ontario’s industrial heartland, has been hard hit by deindustrialization. The rise of this illegal service is thus viewed against the backdrop of heavy economic restructuring, as opportunities for work in the manufacturing sector have become sparse. In addition, this research also explores the paradoxical co-optation of the growing illicit taxi economy and consequences for racialized and foreign credentialed labour in the taxi industry. The overall objective of this research is to explore the illicit cab industry as not only inseparable from the formal economy, but dialectically, how it is as an integrated and productive element of the public and private transportation industry. Furthermore the research examines what this co-optation means in the context of a labour market that is split by race.

Le sommeil des personnes atteintes de schizophrénie : résultats d’études par questionnaire, polysomnographie et analyse spectrale de l’EEG en sommeil paradoxal

Les personnes atteintes de schizophrénie peuvent présenter un sommeil anormal même lorsqu’elles sont stables cliniquement sous traitements pharmacologiques. Les études présentées dans cette thèse ont pour but de mesurer le sommeil afin de mieux comprendre les dysfonctions des mécanismes cérébraux pouvant être impliqués dans la physiopathologie de la schizophrénie. Les trois études présentées dans cette thèse rapportent des résultats sur le sommeil dans la schizophrénie à trois niveaux d’analyse chez trois groupes différents de patients. Le premier niveau est subjectif et décrit le sommeil à l’aide d’un questionnaire administré chez des personnes atteintes de schizophrénie cliniquement stables sous traitements pharmacologiques. Le deuxième niveau est objectif et évalue le sommeil par une méta-analyse des études polysomnographiques chez des patients atteints de schizophrénie ne recevant pas de traitement pharmacologique. Le troisième niveau est micro-structurel et utilise l’analyse spectrale de l’électroencéphalogramme (EEG) afin de caractériser le sommeil paradoxal de patients en premier épisode aigu de schizophrénie avant le début du traitement pharmacologique. La première étude montre que, lorsqu’évaluées par un questionnaire de sommeil, les personnes atteintes de schizophrénie cliniquement stables sous traitements pharmacologiques rapportent prendre plus de temps à s’endormir, se coucher plus tôt et se lever plus tard, passer plus de temps au lit et faire plus de siestes comparativement aux participants sains. Aussi, tout comme les participants sains, les personnes atteintes de schizophrénie rapportent un nombre normal d’éveils nocturnes, se disent normalement satisfaites de leur sommeil et se sentent normalement reposées au réveil. La deuxième étude révèle qu’objectivement, lorsque les études polysomnographiques effectuées chez des patients non traités sont soumises à une méta-analyse, les personnes atteintes de schizophrénie montrent une augmentation du délai d’endormissement, une diminution du temps total en sommeil, une diminution de l’efficacité du sommeil et une augmentation de la durée des éveils nocturnes comparativement aux participants sains. Les patients en arrêt aigu de traitement ont des désordres plus sévères au niveau de ces variables que les patients jamais traités. Seulement les patients jamais traités ont une diminution du pourcentage de stade 2 comparativement aux participants sains. La méta-analyse ne révèle pas de différence significative entre les groupes en ce qui concerne le sommeil lent profond et le sommeil paradoxal. La troisième étude, portant sur l’analyse spectrale de l’EEG en sommeil paradoxal, montre une diminution de l’amplitude relative de la bande de fréquence alpha dans les régions frontales, centrales et temporales et montre une augmentation de l’amplitude relative de la bande de fréquence bêta2 dans la région occipitale chez les personnes en premier épisode de schizophrénie jamais traitées comparativement aux participants sains. L’activité alpha absolue est positivement corrélée aux symptômes négatifs dans les régions frontales, centrales et temporales et négativement corrélée aux symptômes positifs dans la région occipitale. L’activité beta2 absolue ne montre pas de corrélation significative avec les symptômes positifs et négatifs de la schizophrénie. Ces résultats sont discutés suivant la possibilité que des dysfonctions au niveau des mécanismes de la vigilance seraient impliquées dans la physiopathologie de la schizophrénie.

L'expérience du dévoilement telle que perçue par des femmes vivant avec le VIH nées au Québec

Le dévoilement de sa séropositivité représente une préoccupation quotidienne des femmes vivant avec le VIH, complexifié par la stigmatisation. L'état des connaissances demeure très fragmenté : les études révèlent des patterns (à qui les femmes dévoilent et à quelle fréquence), les raisons pour dévoiler ou non, les conséquences positives et négatives ainsi que les facteurs liés au dévoilement, limitant une compréhension globale du phénomène. Inspirée de la toile de fond de Parse (1998, 2003), cette présente étude visait à décrire et à mieux comprendre l'expérience du dévoilement, telle que perçue par des femmes vivant avec le VIH nées au Québec. La méthode phénoménologique a été privilégiée afin de recueillir des données auprès de sept participantes, par la tenue d’une entrevue semi structurée. L’analyse des données a reposé sur deux activités de recherche proposées par van Manen (1997), soit la réflexion et l’écriture, permettant d’identifier les sept thèmes suivants : 1) Se respecter tout en considérant les confidents ; 2) Ressentir l’appréhension; 3) Exercer un contrôle pour assurer une protection; 4) S’engager délibérément dans une démarche de révélation-dissimulation; 5) S’exposer au contexte social stigmatisant empreint d’exclusion; 6) Souffrir intérieurement; 7) Bénéficier des retombées positives de sa décision. Ces thèmes ont contribué à la formulation de l’essence du phénomène étudié soit : vivre l’ambivalence d’une démarche paradoxale de révélation-dissimulation, au cœur d’une souffrance profonde intensifiée par la stigmatisation, tout en s’enrichissant des bienfaits recueillis. Il est permis de croire que ces résultats puissent avoir des retombées positives pour guider la pratique infirmière autour du soutien aux femmes dans leur expérience de dévoilement.

Le travail d'enseignant en milieu carcéral

Jusqu’à maintenant, la prison a surtout été analysée à partir du point de vue des détenus et celui des surveillants comme si le vécu de l’enfermement et la relation détenus-surveillants étaient les seuls points de vue permettant d’en apprendre sur ce qu’elle est et d’en saisir le fonctionnement. Nous pensons, pour notre part, que d’autres points de vue sont possibles, voire même souhaitables. C’est le cas, notamment, de celui des enseignants qui exercent leur métier en prison. Bien que théoriquement en mesure d’offrir un complément intéressant aux fonctions de dissuasion et de réinsertion sociale que la prison remplit difficilement à elle seule, le projet éducatif carcéral constitue une activité plus ou moins marginalisée qui est ramenée au niveau des autres activités pénitentiaires. Au premier chef, c’est à la prison que nous sommes tentés d’en imputer la responsabilité et, de fait, elle y est pour quelque chose. D’abord conçue pour neutraliser des criminels, il lui est difficile de les éduquer en même temps. Mais cette marginalisation, nous le verrons, n’est pas le seul fait de la prison. Elle tient aussi beaucoup au mandat qu’ils se donnent et à la façon dont les enseignants se représentent leur travail. S’étant eux-mêmes défini un mandat ambitieux de modelage et de remodelage de la personnalité de leurs élèves délinquants détenus, prérequis, selon eux, à un retour harmonieux dans la collectivité, les enseignants déplorent qu’on ne leur accorde pas toute la crédibilité qui devrait leur revenir. Cette situation est d’autant plus difficile à vivre, qu’à titre de travailleurs contractuels pour la plupart, ils sont déjà, aux yeux du personnel correctionnel, objets d’une méfiance qui sera d’autant plus grande que, pour effectuer leur travail, ils doivent se faire une représentation du délinquant et du délit peu compatibles avec celles qui prévalent dans le milieu. C’est ainsi qu’à la marginalisation comme fait organisationnel se superpose une auto-marginalisation, incontournable, qui est le fait des enseignants eux-mêmes et qui se traduit par leur attitude de réserve à l’égard de la prison. La chose est d’autant plus paradoxale que le mandat que se donnent les enseignants, bien qu’ils s’en gardent de le dire, correspond tout à fait au projet correctionnel. Mais la prison, davantage préoccupée par la gestion du risque que par la réinsertion sociale des détenus, n’a d’intérêt pour l’éducation en milieu carcéral que dans la mesure où elle permet une socialisation à l’idéologie pénitentiaire et contribue à consolider la paix à l’intérieur des murs avec la complicité des enseignants eux-mêmes. Du reste, ces derniers ne sont pas dupes et lui en font grief, encore qu’il soit permis de nous demander si on ne lui reproche pas, plus simplement, de ne pas leur donner toute la place qu’ils croient leur revenir et de les laisser suspendus dans le vide carcéral.