Introduction : le devenir des personnes âgées est un sujet majeur d'actualité, l'importance d'une refonte du système d'aides et de services en adéquation avec les besoins et les volontés de la population est connue, et cette refonte est en cours. Il n'empêche que l'opinion des personnes âgées est encore demandée trop souvent tardivement lorsque la perte d'autonomie est déjà avancée et que les prises en charge peuvent alors se faire dans la précipitation. Le médecin traitant apparaît le plus souvent comme le premier intervenant face au sujet de la perte d'autonomie, surtout lorsqu'il a assuré le suivi de son patient sur de longues années. La présente étude s'interroge donc sur l'implication des personnes âgées en bonne santé par rapport à une potentielle perte d'autonomie future ; elle se concentre en particulier sur leurs représentations et leurs ressentis face à cette situation. Elle s'intéresse ensuite à l'approche de ce sujet avec leur médecin traitant et cherche à connaître les attentes des patients vis-à-vis de ce professionnel. Méthode : il s'agit d'une étude qualitative, ayant permis de réaliser 15 entretiens semi-dirigés, individuels, de patients âgés en bonne santé, à partir de l'âge de 65 ans ; les critères d'inclusion étaient l'absence d'aide à domicile et l'autonomie dans le quotidien. Le recueil et les entretiens se sont faits dans trois cabinets de médecins traitants. Chaque patient a été interrogé dans la salle de consultation habituelle de son médecin. Résultats : les comportements des personnes âgées dites en bonne santé sont variés autour de leur implication sur une perte d'autonomie future : anticipation extrême, tabou du sujet mais plan d'avenir tracé, déni et refus du sujet avec souhait d'attendre le dernier moment pour agir... Des ressentis sont aussi mentionnés autour de leurs expériences de la perte d'autonomie, de la prévention du vieillissement, de la notion d'être utile jusqu'à la fin de sa vie, et du rôle joué par le conjoint et la famille dans la perte d'autonomie. D'autre part, il est mis en évidence que le sujet n'est que rarement abordé avec le médecin traitant, en amont de la perte d'autonomie. Les attentes sont nombreuses envers le médecin traitant mais concernent souvent une perte d'autonomie déjà effective et ne se rattachent qu'au rôle « de soin » du médecin traitant. Discussion : une différence notable entre santé ressentie par le patient âgé et santé réellement constatée par le médecin est mise en avant. Deux catégories principales de personnes apparaissent, découlant de facteurs variés comme le tempérament, le sexe, la santé et l'autonomie réelles, le rejet ou non d'une dépendance. Enfin plusieurs hypothèses sont avancées sur un lien possible entre un âge moins avancé et une implication plus importante dans l'anticipation d'une future perte d'autonomie. La recherche, par les médecins traitants, de signes de fragilité mais surtout la prévention de la perte d'autonomie sont majeures et semblent non suffisantes actuellement. Les raisons de la difficulté à aborder le sujet en médecine générale sont nombreuses. Il s'agit toujours d'un sujet tabou, méconnu. Le rôle du médecin traitant semble être d'éveiller une réflexion chez le patient sur son devenir, pour que ce sujet revienne plus facilement dans les consultations futures et que le médecin puisse y apporter une aide adaptée. Une recherche sur les moyens d'allier prévention de la perte d'autonomie et médecine générale pourrait ouvrir de nouvelles perspectives d'avenir.

Le terme promotion de la santé en Afrique, près de 30 ans après l'adoption de la Charte d'Ottawa, continue d'avoir des connotations complètement hors du sens que lui confère cette charte. Cela n'est pas étonnant quand on sait que la notion de santé dans ce contexte africain équivaut à la lutte contre la maladie à travers les soins de santé dispensés par des professionnels de la santé dans des formations sanitaires et les hôpitaux. L'évolution que connait le continent depuis quelques décennies est de donner un peu plus de place à la communauté à travers les relais communautaires dans une participation communautaire vidée de son contenu, car le pouvoir n'est jamais passé entre les mains des communautés.C'est au vu de tout ceci que le présent ouvrage à sa raison d'être pour expliquer les fondements de l'autonomisation communautaire et de la promotion de la santé avec leur importance pour la région africaine en proie aux mauvais indicateurs de santé comparativement aux autres régions du monde.

"Your Mindful Compass" takes us behind the emotional curtain to see the mechanisms regulating individuals in social systems. There is great comfort and wisdom in knowing we can increase our awareness to manage the swift and ancient mechanisms of social control. We can gain greater flexibility by seeing how social controls work in systems from ants to humans. To be less controlled by others, we learn how emotional systems influence our relationship-oriented brain. People want to know what goes on in families that give rise to amazing leaders and/or terrorists. For the first time in history we can understand the systems in which we live. The social sciences have been accumulating knowledge since the early fifties as to how we are regulated by others. S. Milgram, S. Ashe, P. Zimbardo and J. Calhoun, detail the vulnerability to being duped and deceived and the difficulty of cooperating when values differ. Murray Bowen, M.D., the first researcher to observe several live-in families, for up to three years, at the National Institute of Mental Health. Describing how family members overly influence one another and distribute stress unevenly, Bowen described both how symptoms and family leaders emerge in highly stressed families. Our brain is not organized to automatically perceive that each family has an emotional system, fine-tuned by evolution and "valuing" its survival as a whole, as much as the survival of any individual. It is easier to see this emotional system function in ants or mice but not in humans. The emotional system is organized to snooker us humans: encouraging us to take sides, run away from others, to pressure others, to get sick, to blame others, and to have great difficulty in seeing our part in problems. It is hard to see that we become anxious, stressed out and even that we are difficult to deal with. But "thinking systems" can open the doors of perception, allowing us to experience the world in a different way. This book offers both coaching ideas and stories from leaders as to strategies to break out from social control by de-triangling, using paradoxes, reversals and other types of interruptions of highly linked emotional processes. Time is needed to think clearly about the automatic nature of the two against one triangle. Time and experience is required as we learn strategies to put two people together and get self outside the control of the system. In addition, it takes time to clarify and define one's principles, to know what "I" will or will not do and to be able to take a stand with others with whom we are very involved. The good news is that systems' thinking is possible for anyone. It is always possible for an individual to understand feelings and to integrate them with their more rational brains. In so doing, an individual increases his or her ability to communicate despite misunderstandings or even rejection from important others. The effort involved in creating your Mindful Compass enables us to perceive the relationship system without experiencing it's threats. The four points on the Mindful Compass are: 1) Action for Self, 2) Resistance to Forward Progress, 3) Knowledge of Social Systems and the 4) The Ability to Stand Alone. Each gives us a view of the process one enters when making an effort to define a self and build an emotional backbone. It is not easy to find our way through the social jungle. The ability to know emotional systems well enough to take a position for self and to become more differentiated is part of the natural way humans cope with pressure. Now people can use available knowledge to build an emotional backbone, by thoughtfully altering their part in the relationship system. No one knows how far one can go by making an effort to be more of a self-defined individual in relationships to others. Through increasing emotional maturity, we can find greater individual freedom at the same time that we increase our ability to cooperate and to be close to others.

The essential guide by one of America's leading doctors to how digital technology enables all of us to take charge of our health A trip to the doctor is almost a guarantee of misery. You'll make an appointment months in advance. You'll probably wait for several hours until you hear "the doctor will see you now"-but only for fifteen minutes! Then you'll wait even longer for lab tests, the results of which you'll likely never see, unless they indicate further (and more invasive) tests, most of which will probably prove unnecessary (much like physicals themselves). And your bill will be astronomical. In The Patient Will See You Now, Eric Topol, one of the nation's top physicians, shows why medicine does not have to be that way. Instead, you could use your smartphone to get rapid test results from one drop of blood, monitor your vital signs both day and night, and use an artificially intelligent algorithm to receive a diagnosis without having to see a doctor, all at a small fraction of the cost imposed by our modern healthcare system. The change is powered by what Topol calls medicine's "Gutenberg moment." Much as the printing press took learning out of the hands of a priestly class, the mobile internet is doing the same for medicine, giving us unprecedented control over our healthcare. With smartphones in hand, we are no longer beholden to an impersonal and paternalistic system in which "doctor knows best." Medicine has been digitized, Topol argues; now it will be democratized. Computers will replace physicians for many diagnostic tasks, citizen science will give rise to citizen medicine, and enormous data sets will give us new means to attack conditions that have long been incurable. Massive, open, online medicine, where diagnostics are done by Facebook-like comparisons of medical profiles, will enable real-time, real-world research on massive populations. There's no doubt the path forward will be complicated: the medical establishment will resist these changes, and digitized medicine inevitably raises serious issues surrounding privacy. Nevertheless, the result-better, cheaper, and more human health care-will be worth it. Provocative and engrossing, The Patient Will See You Now is essential reading for anyone who thinks they deserve better health care. That is, for all of us.

Most women who die from cervical cancer, particularly in developing countries, are in the prime of their life. They may be raising children, caring for their family, and contributing to the social and economic life of their town or village. Their death is both a personal tragedy, and a sad and unnecessary loss to their family and their community. Unnecessary, because there is compelling evidence, as this Guide makes clear, that cervical cancer is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively. Unfortunately, the majority of women in developing countries still do not have access to cervical cancer prevention programmes. The consequence is that, often, cervical cancer is not detected until it is too late to be cured. An urgent effort is required if this situation is to be corrected. This Guide is intended to help those responsible for providing services aimed at reducing the burden posed by cervical cancer for women, communities and health systems. It focuses on the knowledge and skills needed by health care providers, at different levels of care.

Report presents a series of analyses and recommendations for fostering the role of culture for sustainable development. Drawing on a global survey implemented with nine regional partners and insights from scholars, NGOs and urban thinkers, the report offers a global overview of urban heritage safeguarding, conservation and management, as well as the promotion of cultural and creative industries, highlighting their role as resources for sustainable urban development. Report is intended as a policy framework document to support governments in the implementation of the 2030 Agenda for Sustainable Urban Development and the New Urban Agenda.

Emphasising the multi-disciplinary nature of palliative care the fourth edition of this text also looks at the individual professional roles that contribute to the best-quality palliative care.