Chapitre 6. Révisions des lois de bioéthique et recherche sur l'embryon humain : une analyse psychosociale des États Généraux de la Bioéthique.

Bioethics are widely used in the course of biomedical science’s evolution. It allows to question ethical aspects underlying the setting of new research and clinical intervention techniques. This ethical thinking reflects norms and values socially admitted and question the way new scientific information are integrated to individuals’ system of knowing. Human embryo research, subject to bioethics laws revisions, represents an almost prototypical object of these issues, both lay and scientific. This study aims to study these issues through the context of bioethics revision laws, from users’ comments on Estates-General of Bioethics website, using the social representations theorical frame. A thematic content analysis has been performed. Results shows that embryo status is a structural argument of the debate, and that the opinion on human embryo research results from a set of ethical concerns that come from socially anchored values, accounting for the way individuals define science, biotechnologies and research on the living, that we also find in the bioethics legislation.

Social value, normative features and gender differences associated with speeding and compliance with speed limits.

INTRODUCTION: Among risky driving behaviors, speeding is a main causal and aggravating factor of road crashes and is more frequent among males than females. Research suggests that this gender gap could be explained by gender social norms that lead males to assign more social value to speeding than females. However, few studies have proposed directly investigating gendered prescriptive norms associated with speeding. We propose to address this gap through two studies based on the socio-cognitive approach to social norms of judgment. METHODS: Study 1 (N = 128, within-subject design) investigated the extent to which speeding is subject to social valuation among males, compared to females, through a self-presentation task. Study 2 (N = 885, between-subject design) aimed to identify the dimension of social value (i.e., social desirability, social utility) that both genders associate with speeding, based on a judgment task. RESULTS AND CONCLUSION: Although results of study 1 indicate that both genders devaluate speeding and valuate speed limits compliance, we found that males do so to a lesser extent than females. Results of study 2 further suggest that males less valuate speed limit compliance than females on the social desirability dimension, while no gender difference were found in valuation of speeding on both dimensions of social value. Regardless of gender, results also indicate that speeding is valued more on the social utility than on the social desirability dimension, while speed limit compliance is valued similarly on both dimensions. PRACTICAL APPLICATIONS: Road safety campaigns toward males could benefit to focus more on enhancing the representations of speed compliant drivers, in terms of social desirability, than devaluing the representation of speeding drivers.

Chapitre 6. Révisions des lois de bioéthique et recherche sur l'embryon humain : une analyse psychosociale des États Généraux de la Bioéthique.

Bioethics are widely used in the course of biomedical science’s evolution. It allows to question ethical aspects underlying the setting of new research and clinical intervention techniques. This ethical thinking reflects norms and values socially admitted and question the way new scientific information are integrated to individuals’ system of knowing. Human embryo research, subject to bioethics laws revisions, represents an almost prototypical object of these issues, both lay and scientific. This study aims to study these issues through the context of bioethics revision laws, from users’ comments on Estates-General of Bioethics website, using the social representations theorical frame. A thematic content analysis has been performed. Results shows that embryo status is a structural argument of the debate, and that the opinion on human embryo research results from a set of ethical concerns that come from socially anchored values, accounting for the way individuals define science, biotechnologies and research on the living, that we also find in the bioethics legislation.

Gene editing of the human embryo: tensions and controversies among scientists / Edição genética do embrião humano: tensões e controvérsias de posicionamentos entre cientistas

Objective: This study analyzed the relation between the position of scientists on embryo editing and the different types of knowledge involved. Methods: A lexical analysis of 151 scientific articles in the PubMed and Web of Science databases was conducted using the IRAMUTEQ software. Results: The results showed that gene editing in embryos is presented in two argumentative branches: the first refers to the editing technique and its possibilities; the second discusses the impacts of these techniques on the public arena. The results demonstrate a consensus regarding the potential of editing; however, dilemmas about its effectiveness were also highlighted. Conclusion: The presence of ethical conflicts with embryo editing among the specialists was evidenced especially regarding the birth of genetically modified babies. Therefore, gene editing is marked by conflicts that are not limited only to biological contexts, but that encompasses different aspects of social life.

Objetivo: O objetivo deste trabalho foi analisar a relação entre o posicionamento dos cientistas sobre a edição de embriões e os diferentes tipos de conhecimento envolvidos nesses debates. Método: Utilizando o software IRAMUTEQ realizou-se uma análise lexical de 151 artigos científicos nas bases de dados PubMed e Web of Science. Resultados: Os resultados demonstraram que a edição genética de embriões se apresenta em dois blocos argumentativos: o primeiro se refere à técnica de edição e suas possibilidades e o segundo discute os impactos dessas técnicas na arena pública. Os achados demonstram consenso sobre as potencialidades da edição, contudo dilemas sobre a sua eficácia foram também destacados. Conclusão: Evidenciou-se a presença de embates éticos sobre a edição de embriões entre os especialistas em relação ao nascimento de bebês geneticamente modificados. Observou-se que a edição genética é marcada por conflitos que não se limitam apenas a contextos biológicos, mas que tangem diferentes aspectos da vida social.

When "the Dream Dies" But the Ideal Persists: Representations of the Couple Relationship and Its Connection To Intimate Partner Violence Experiences.

Intimate partner violence (IPV) is now recognized internationally as a significant problem against which public action is being taken. However, victims commonly disclose little of this violence. The understanding of sociocultural factors that prevent women from talking about their male partner's violence towards them thus appears to be an important issue. Using a qualitative approach, this study examines the representations that women survivors of IPV draw on to give meaning to the couple relationship and the links that these representations maintain with IPV and the help-seeking process. Nineteen women, who had previously experienced abuse from an intimate partner, participated in semi-structured interviews. Despite the experience of violence, an idealized vision of the couple relationship persists among the majority of respondents and conflicts with their experience of violence. This gap between an ideal and lived experience appears to be a major source of suffering for the participants who thus develop different strategies to preserve their ideal. These strategies appear to have the effect of minimizing and concealing violence.

Imagens e representações sociais: a fotolinguagem e photovoice na produção de dados sobre fenômenos de saúde / Imágenes y representaciones sociales: fotolenguaje y fotovoz em la producción de datos sobre fenómenos de salud / Images and social representations: photolanguage and photovoice in data production on health phenomena

RESUMO Objetivo refletir sobre o uso de fotos na apreensão das representações sociais de fenômenos na área da saúde, a partir da aplicação da técnica da fotolinguagem e do método photovoice. Método estudo teórico-reflexivo desenvolvido em duas etapas: de análise da literatura; e análise reflexiva sobre a técnica e o método aplicados, pautados nas representações sociais. Desenvolvimento a análise apontou que as fotos possibilitam captar a zona muda das representações, a dimensão dos afetos, dos símbolos e são parte da estratégia de triangulação metodológica para entendimento das múltiplas dimensões que concorrem para a organização do campo da representação social de fenômenos da área da saúde. Conclusão e implicações para a prática as fotos potencializam a apreensão da dimensão figurativa da representação, essencial na compreensão da elaboração do pensamento social. O uso da fotolinguagem e do photovoice na prática operacional de pesquisa contribui para o avanço do conhecimento nos estudos de representações sociais na área da saúde.

RESUMEN Objetivo Reflexionar sobre el uso de fotografías en la aprehensión de representaciones sociales de fenómenos en el área de la salud, desde la perspectiva de la aplicación de la técnica del fotolenguaje y del método de la fotovoz. Método Estudio teórico-reflexivo desarrollado en dos etapas: análisis de la literatura; y análisis reflexivo sobre la técnica y el método aplicados, basado en las representaciones sociales. Desarrollo El análisis señaló que las fotografías permiten captar la zona muda de las representaciones, la dimensión de los afectos, de los símbolos y forman parte de la estrategia de triangulación metodológica para comprender las múltiples dimensiones que contribuyen a la organización del campo de la representación social de fenómenos en el área de la salud. Conclusión e implicaciones en la práctica Las fotografías intensifican la aprehensión de la dimensión figurativa de la representación, fundamental para comprender la elaboración del pensamiento social. El uso del fotolenguaje y de la fotovoz en la práctica operativa de la investigación contribuye al avance del conocimiento en los estudios de las representaciones sociales en el área de la salud.

ABSTRACT Objective to reflect on the use of photographs in the apprehension of social representations of phenomena in health care by applying the photolanguage technique and the photovoice method. Method a reflective and theoretical study developed in two stages: literature analysis; and reflective analysis on the technique and method applied, based on social representations. Development the analysis pointed out that photographs make it possible to capture the silent zone of representations and the dimension of affections, symbols, as well as that they are part of the methodological triangulation strategy to understand the multiple dimensions that contribute to the organization of the field of social representation of phenomena in health care. Conclusion and implications for the practice photographs enhance apprehension of the figurative dimension of the representation, essential in understanding the elaboration of social thinking. The use of photolanguage and photovoice in the research operational practice contributes to the advancement of knowledge in studies of social representations in health care.

'Adolescents are reckless': Representations at stake in the construction of the relationship of trust in paediatric diabetology.

A total of 10 focus groups were held with adolescents living with diabetes, their parents and health professionals in order to explore their needs in therapeutic education. The analysis showed that the relationship of trust was a central concern for a number of participants. Several adults were divided between a feeling of confidence inspired by the need to empower adolescents to cope with the chronic condition and a sense of distrust inspired by the idea of carelessness and irresponsibility thought to characterize adolescence. Adolescents, for their part, seemed relatively clear-sighted about how they can be perceived, and blamed adults for not trusting them. These findings emphasize the importance of considering the representations at stake in the dynamics of the therapeutic relationship in order to better understand the construction of the relational climate.

Drogas no espaço público: consumo, tráfico e política na imprensa brasileira / Drugs in public space: consumption, trafficking and policy in the brazilian press / Drogas en el espacio público: consumo, tráfico y política en la prensa brasileña

Os fenômenos relacionados ao uso de drogas constituem um campo heterogêneo e polissêmico, a partir do qual se constroem diferentes objetos, identidades e práticas sociais. Este artigo apresenta uma pesquisa documental, baseada na teoria das representações sociais, cujo objetivo foi analisar o campo representacional das drogas em comunicações midiáticas. O material foi composto por 4.516 matérias de um jornal de ampla circulação no Brasil que tinham como tema central questões relacionadas às drogas. Com auxílio do software Iramuteq, realizou-se uma análise lexicométrica visando reconstituir classes lexicais relacionadas a dimensões específicas do campo. Oito classes foram interpretadas, categorizadas e discutidas. Os resultados permitiram identificar três eixos temáticos: regulação sociopolítica do uso, produção e circulação das drogas; uso de drogas, dependência e saúde; polícia e guerra às drogas no Brasil. A discussão evidencia dimensões que conferem sentido a processos político-legais, relações internacionais, movimentos sociais, entretenimento, práticas terapêuticas, políticas públicas, violência, criminalidade e exclusão. Além disso, os fenômenos do campo guardam relação com categorias sociais típicas (e.g., usuários e traficantes); formas de desvio (e.g., dependência e crime); e práticas sociais em saúde e segurança pública (e.g., tratamento e prisão). Compreende-se que os conteúdos difundidos nessas comunicações atuam na criação de quadros simbólicos de referência que podem influenciar a orientação de práticas sociais e tomadas de posição diante dos fenômenos relacionados ao uso de drogas...(AU)

Phenomena related to drug use constitute a heterogeneous and polysemic field, from which different objects, identities and social practices are constructed. This paper presents a documentary research based on Social Representations Theory, whose objective was to analyze the representational field of drugs in media. We analyzed 4516 articles from a newspaper with wide circulation in Brazil that had as its central theme issues related to drugs. Lexicometric analysis was carried out utilizing Iramuteq to reconstruct lexical classes related to specific field dimensions. Eight classes were interpreted, categorized and discussed. The results allowed to identify three thematic axes: socio-political regulation of the use, production and circulation of drugs; drug use, addiction and health; police and drug war in Brazil. The discussion highlights dimensions that give meaning to political-legal processes, international relations, social movements, entertainment, therapeutic practices, public policies, violence, crime and exclusion. Additionally, the phenomena of the field are linked to typical social categories (e.g., drug users and drug dealers); forms of deviance (e.g., addiction and crime); and social practices in public health and public security (e.g., treatment and imprisonment). The contents disseminated by these sorts of communication have a role in the creation of symbolic frames of reference that influence the orientation of social practices and attitudes towards phenomena related to drug use...(AU)

Los fenómenos relacionados con el consumo de drogas constituyen un campo heterogéneo y polisémico, a partir del cual se construyen diferentes objetos, identidades y prácticas sociales. Este artículo presenta una investigación documental basada en la teoría de las representaciones sociales con el objetivo de analizar el campo representativo de las drogas en comunicaciones mediáticas. El material se compuso por 4516 artículos de un periódico de amplia circulación en Brasil que tenían como tema central cuestiones relacionadas con las drogas. Con el apoyo del software Iramuteq, se llevó a cabo un análisis lexicométrico para reconstruir clases léxicas relacionadas con dimensiones específicas del campo. Ocho clases fueron interpretadas, categorizadas y discutidas. Los resultados permitieron identificar tres ejes temáticos: la regulación sociopolítica del uso, producción y circulación de drogas; el uso de drogas, adicción y salud; la policía y la guerra a las drogas en Brasil. La discusión resalta las dimensiones que dan sentido a los procesos político-legales, las relaciones internacionales, los movimientos sociales, el entretenimiento, las prácticas terapéuticas, las políticas públicas, la violencia, el crimen y la exclusión. Además, los fenómenos del campo están vinculados a categorías sociales típicas (por ejemplo, usuarios de drogas y traficantes de drogas); formas de desviación (por ejemplo, adicción y crimen); y prácticas sociales en salud pública y seguridad pública (por ejemplo, tratamiento y encarcelamiento). Se entiende que los contenidos diseminados en estas comunicaciones actúan en la creación de marcos de referencia simbólicos que pueden influir en la orientación de las prácticas y actitudes sociales frente a los fenómenos relacionados con el consumo de drogas...(AU)

Parental disclosure of positive BRCA1/2 mutation status to children 10 years after genetic testing.

The disclosure of genetic information is an important issue in cancer prevention. This study based on a French national cohort of BRCA1/2 mutation carriers (GENEPSO-PS cohort, N=233) aimed to assess the prevalence of parental disclosure of genetic information to children 10 years after genetic testing, with a focus on gender differences. Most participants (n = 193, 131 women) reported having children. A total of 72.0% of offspring had received genetic information (88.8% for adult offspring, p < .001), with no differences according to the gender of the mutation-carrying parent. While female carriers disclosed genetic information more often than male carriers (54.1% versus 38.3%, p = .029), they did so irrespective of the gender of their offspring. Moreover, female carriers who had developed incident cancer after genetic testing disclosed genetic information more frequently than unaffected female carriers (70.7% versus 48.5%, p = .005). A multivariate analysis confirmed the effects of both gender and cancer on disclosure to offspring. The same results were obtained when the analysis was restricted to adult offspring. This study reveals high rates of disclosure of positive BRCA1/2 mutation status to children 10 years after genetic testing, irrespective of the gender of the carrier/offspring. However, female carriers disclosed genetic information more frequently than male carriers.

What makes decision-making difficult for oncologists faced with critical situations? The socio-affective side of the physician-patient relationship.

The aim of this qualitative study based on a Social Representations approach was to explore experienced oncologists' representations of difficult decision-making situations. In total, 22 semi-structured interviews with oncologists were conducted and analysed by performing a thematic content analysis. The thematic content analysis brought to light the main medical problem involved such as uncertainty, the lethal nature of cancer and physicians' specialties, as well as the psychosocial ones, such as patients' non-medical characteristics and the patient-physician relationships. This analysis also showed the painful tensions experienced by specialists in the context of decision-making situations when the medical arguments conflict with the psychosocial ones. These findings suggest that in order to understand more clearly the complex processes involved in difficult medical decision-making situations, studies on physicians' expertise should include the socio-affective climate involved in each patient-physician relationship.

Uptake of genetic counseling among adult children of BRCA1/2 mutation carriers in France.

OBJECTIVE: Genetic counseling in at-risk families is known to improve cancer prevention. Our study aimed to determine the rate of uptake of genetic counseling among adult children of BRCA1/2 mutation carriers and to identify the potential psychosocial factors associated with uptake of genetic counseling. METHODS: A self-reported questionnaire was mailed to 328 BRCA1/2 mutation carriers 10 years after BRCA1/2 test disclosure. Of the 233 carriers who returned the questionnaire (response rate = 71%), 135 reported having children over age 18 years and were therefore included in the analysis. Generalized estimating equations models were used to identify the factors associated with uptake of genetic counseling among adult children of mutation carriers. RESULTS: Data were gathered for a total of 296 children (46% male, 54% female). The vast majority were informed about the familial mutation (90.9%) and 113 (38%; 95% CI, 32%-44%) underwent genetic counseling. This percentage exceeded 80% in women over 40 years. In the multivariate model, female sex, advanced age, mutation in the father, diagnosis of cancer in the mutation-carrying parent after genetic testing, and good family relationships were all factors associated with higher uptake of genetic counseling. CONCLUSIONS: Adult children of BRCA1/2 mutation carriers in France do not undergo genetic counseling sufficiently often. Further studies should be conducted on the psychosocial factors that hinder the uptake of genetic counseling among adult children of BRCA1/2 mutation carriers.

Understanding health behaviour changes in response to outbreaks: Findings from a longitudinal study of a large epidemic of mosquito-borne disease.

RATIONALE: Although greater attention has been recently given to the ecological determinants of health behaviours, we still do not know much about the behavioural changes induced by the spread of infectiousdiseases. OBJECTIVE: In this study, we took advantage of a large epidemic of chikungunya, an emerging mosquito-borne disease, in French Guiana to examine the dynamic interaction between risk-related perceptions and behaviours that occurs in response to a disease outbreak. In particular, we tested empirically the assumption that both risk perceptions and health behaviours were elastic with respect to prevalence of chikungunya. METHODS: A representative sample of French Guianan (N=434) was interviewed in January 2015 just after the peak of the epidemic, and again 2 months later. Participants were asked about their perceptions of the threat, as well as their engagement in a range of protective behaviours promoted by the regional health authorities to control the spread of the disease. RESULTS: The surveys showed that (1) the frequency of some health behaviours - those related to visible control methods - significantly increased with the subjective and objective prevalence of the disease, (2) perceived risk of infection for oneself tended to decrease considerably over time, and (3) the risk reappraisal hypothesis failed to account for this paradoxical trend in the people's response to the risk of contracting the disease. CONCLUSION: These findings suggest that people may fail to adjust their risk perceptions, and to a lesser extent their health protective behaviours, to the course of an epidemic. Notably, the prevalence elasticity of preventive action found in previous studies of behavioural response to infectious diseases differed substantially according to the type of intervention (personal versus environmental methods). This paradoxical trend may be attributed to risk habituation effects, which seem to vary significantly according to the social visibility of thepreventive actions.

Exploring the link between stigma and social representations among people with and without schizophrenia in the French context.

We explored the representations that individuals associate with schizophrenia in the French context, as well as the relationships between their own representations and the representations they attribute to other French people. Data were collected from individuals in the general population (N = 98) and those with schizophrenia (N = 59). Using a verbal association technique, participants produced words spontaneously based on the inductor word "schizophrenia". The instruction invited them to respond on their own behalf, but also "as the French would in general". Prototypical and similarity analyses were carried out. Results indicated that the representations of participants from the general population were associated with a vocabulary relative to schizophrenia as an illness and with stigmatizing stereotypes, such as madness, dangerousness and split personality when they expressed themselves on their own behalf, as well as psychopathy and confinement when they imagined how French people express themselves regarding schizophrenia. Participants with schizophrenia who had a clear view of the general population's stereotypes mostly referred to negative experiences and emotions such as loneliness, suffering and fear. These findings underline the value of considering the representations associated with schizophrenia in designing awareness campaigns, but also in clinical care for people with schizophrenia.

Representations and experiences of well-being among diabetic adolescents: Relational, normative, and identity tensions in diabetes self-management.

We explore representations of well-being in adolescents with Type 1 diabetes in order to better understand their expectations and needs in therapeutic patient education. In total, 28 interviews were performed and then submitted to thematic content analysis and lexicometric analysis. Results show the intervention of psychosocial processes in the relationship that adolescents maintain with well-being and self-management. More specifically, we observed that well-being is impacted by areas of tension between the expectations of adolescents and the therapeutic objectives expressed by health professionals. These tensions should be taken into account in the conception, implementation, and evaluation of therapeutic education programs.

Ser enfermeira intensivista: elementos identitários presentes no campo das representações sociais / Being an intensive care nurse: identity elements present in the field of social representations / Ser enfermera intensivista: elementos de identidad presentes en el campo de las representaciones sociales

Objetivo: identificar os aspectos identitários presentes nas representações sociais de enfermeiras sobre as práticas de cuidar do cliente hospitalizado na terapia intensiva. Método: estudo de campo, qualitativo, descritivo-explicativo, apoiado na teoria das representações sociais e no conceito de identidade social. Após aprovação do projeto pelo Comitê de Ética em Pesquisa, realizaram-se entrevistas com 21 enfermeiros atuantes na assistência de uma unidade de terapia intensiva de um hospital federal, com uso de um roteiro semiestruturado de questões, cujos dados foram submetidos à análise de conteúdo temática. Resultados: evidenciam-se aspectos de identificação social e valorização do endogrupo, e de comparação social e estereotipização do exogrupo, quais sejam: os modos de usar as tecnologias, o delineamento da figura típica do paciente, bem como os atributos do enfermeiro ideal, o sentido do trabalho, o relacionamento intra e interequipes. Conclusão: recomenda-se reorganizar o campo da representação social a partir de intervenções sob elementos da identidade.

Objective: to recognize the identity aspects present in the social representation of nurses about the care practices for the client hospitalized in intensive therapy. Method: field study, qualitative, descriptive and explanatory, based on the theory of social representations and on the social identity concept. After approval by the Research Ethics Committee, interviews were carried out with 21 nurses working in the assistance of an intensive care unit in a federal hospital, using a semi-structured guide. Data were submitted to the content analysis. Results: social identification and enhancement of the group itself, and social comparison and stereotyping of the outside group are evidenced, which are: the ways of using the technologies, the delineation of the typical patient figure, as well as the attributes of the ideal nurse, the sense of work, the intra and intercompany relationship. Conclusion: it is recommended the reorganization of the field of social representation from interventions under identity elements.

Objetivo: reconocer los aspectos de identidad presentes en la representación social de las enfermeras sobre las prácticas de cuidado para el cliente hospitalizado en terapia intensiva. Método: estudio de campo, cualitativo, descriptivo y explicativo, basado en la teoría de las representaciones sociales y en el concepto de identidad social. Después de la aprobación del Comité de Ética en Investigación, se realizaron entrevistas con 21 enfermeras que trabajaban en la asistencia de una unidad de cuidados intensivos en un hospital federal, utilizando una guía semiestructurada. Los datos fueron sometidos al análisis de contenido. Resultados: se evidencia la identificación social y la mejora del grupo en sí, y la comparación social y los estereotipos del grupo externo, que son: las formas de usar las tecnologías, la delineación de la figura típica del paciente, así como los atributos de la enfermera ideal. el sentido del trabajo, la relación intra e intercompañía. Conclusión: se recomienda la reorganización del campo de la representación social a partir de intervenciones bajo elementos de identidad.

Social Dominance Orientation and Discrimination against People with Schizophrenia: Evidence of Medicalization and Dangerousness Beliefs as Legitimizing Myths.

Medicalizing beliefs about schizophrenia (biogenetic causes and psychiatric labels) are connected to the belief that people with schizophrenia are dangerous and to discriminating intentions towards them. In this research, we draw on the Social Dominance theory and we examine these beliefs as legitimizing myths that are connected to the individuals' social dominance orientation (SDO) and that legitimize discrimination. In total, 238 Humanities students participated in the current research (Mage = 20.4; SD = 3.03; 107 male and 131 female). A vignette presenting a person with schizophrenia symptoms that offered no labels or explanations about the depicted person's condition was presented to research participants. A structural equation modeling analysis was carried out, in order to confirm our hypotheses in accordance with social dominance theory. Participants' social dominance orientation (SDO) was associated with higher endorsement of medicalizing (ß = .16, p < .01) and dangerousness beliefs (ß = .22, p < .001). In turn, medicalizing beliefs were connected to dangerousness (ß = .21, p < .001) and higher discriminating intentions, both for desired social distance (ß = .15, p < .05) and for deprivation of sociopolitical rights (ß = .14, p < .05). Dangerousness was highly associated with both these measures (ß = .28, p < .001 and ß = 43, p < .001 respectively) while SDO was not significantly associated with discriminating intentions. Our model showed good fit to the data. This study confirms the role of SDO in schizophrenia stigma and the fact that ideological and power factors underpin the stigma of schizophrenia.

Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey.

BACKGROUND: French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. OBJECTIVES: This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. METHODS: In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. RESULTS: We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists. CONCLUSION: Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.

Social dominance orientation and discrimination against people with schizophrenia: evidence of medicalization and dangerousness beliefs as legitimizing myths

Medicalizing beliefs about schizophrenia (biogenetic causes and psychiatric labels) are connected to the belief that people with schizophrenia are dangerous and to discriminating intentions towards them. In this research, we draw on the Social Dominance theory and we examine these beliefs as legitimizing myths that are connected to the individuals' social dominance orientation (SDO) and that legitimize discrimination. In total, 238 Humanities students participated in the current research (Mage = 20.4; SD = 3.03; 107 male and 131 female). A vignette presenting a person with schizophrenia symptoms that offered no labels or explanations about the depicted person's condition was presented to research participants. A structural equation modeling analysis was carried out, in order to confirm our hypotheses in accordance with social dominance theory. Participants' social dominance orientation (SDO) was associated with higher endorsement of medicalizing (β = .16, p < .01) and dangerousness beliefs (β = .22, p < .001). In turn, medicalizing beliefs were connected to dangerousness (β = .21, p < .001) and higher discriminating intentions, both for desired social distance (β = .15, p < .05) and for deprivation of sociopolitical rights (β = .14, p < .05). Dangerousness was highly associated with both these measures (β = .28, p < .001 and β = 43, p < .001 respectively) while SDO was not significantly associated with discriminating intentions. Our model showed good fit to the data. This study confirms the role of SDO in schizophrenia stigma and the fact that ideological and power factors underpin the stigma of schizophrenia

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Analyzing the presentation and the stigma of schizophrenia in French newspapers.

PURPOSE: It has been suggested that the stigmatizing presentation of people with schizophrenia by newspapers is an example of structural stigma. In this study, we explore how French newspapers contribute to the stigma of people with schizophrenia. METHODS: All the articles of eight major newspapers (four national and four regional) that include the term schizophr* and that were published in 2015 were therefore analyzed using a coding scheme that we developed inductively. RESULTS: This analysis showed that among the identified themes, 40.4% of the articles used the term schizophrenia metaphorically and 28.3% referred to dangerousness. The first concerned mostly national newspapers, while the second were mostly published by regional newspapers. A more selective analysis was also carried out on these major themes in order to investigate how the "us" against "them" distinction is created and how negative stereotypes are associated with this distinction. In the case of the metaphorical use of the term, schizophrenia was presented as a "split personality" disorder and the label used in order to devalue the political opposition. Schizophrenia was presented either as a deterministic cause of dangerousness or as a potential cause of crime. In either case, the question of control was clearly present in these articles. CONCLUSIONS: These results are discussed in terms of the "us" against "them" distinction as a double process of stigmatization of people with schizophrenia and of reinforcement of one's own identity and security.

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

BACKGROUND: The contribution of patients' non-medical characteristics to individual physicians' decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non-medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. DESIGN: Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. RESULTS: In the final sample of patients' records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. LIMITATIONS: The design of the study made it difficult to draw definite cause-and-effect conclusions. CONCLUSION: The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients' attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.