The primary and secondary objectives of the Early Developmental Stages of Substance Abuse Study (EDSP) are described along with a detailed description of the overall design, special design features and instruments used. The EDSP is a 5-year prospective study with three waves of assessments. Special design features are the linkages with family genetic investigations as well as neuroendocrinological stress tests in high-risk subjects. Overall, 3,021 adolescents and young adults aged 14–24 years are included. The response rate for the baseline investigation was 71%. Diagnostic assessments were made by using a modified lifetime (baseline) and 12-month change version of the WHO-CIDI, adjusted for DSM-IV. Modifications refer to a more detailed quantitative assessment of symptoms and substance use variables as well as the inclusion of questions to assess course of disorders and subthreshold diagnostic conditions.

Anhand einer prospektiven epidemiologischen Verlaufsstudie an einer repräsentativen Bevölkerungsstichprobe von ursprünglich 14- bis 17jährigen Jugendlichen (N=1395) werden die Häufigkeit und die Verlaufsmuster des Konsums, des Mißbrauchs und der Abhängigkeit von Cannabis untersucht. Die Jugendlichen wurden persönlich mit Hilfe eines Interviews befragt, wobei als diagnostisches Instrument das M-CIDI mit seinen DSM-IV Algorithmen verwendet wurde. Die Ergebnisse aus der Basiserhebung ergaben, daß 1995 etwa 20% aller 14- bis 17jährigen - in der Mehrzahl wiederholt - Cannabis probiert hatten und 6% der Population einen regelmäßigen Gebrauch aufweisen. Die Einjahres-Inzidenz (= Auftreten neuer Fälle) für den Cannabisgebrauch der nun 15- bis 19jährigen betrug zum Zeitpunkt der Nachuntersuchung 20,1% für die Männer und 16,3% für die Frauen. Für den regelmäßigen Gebrauch wurden Inzidenzraen von 12% (Männer) und 8,4% (Frauen) ermittelt. Die Stabilität des Konsumverhaltens zwischen der Basis- und der Nachuntersuchung war relativ hoch un stieg mit höherem Initialkonsum an. Angesichts der hohen Gebrauchsrate von 32,4% bei den 15- bis 19jährigen bei der Nachuntersuchung ergab sich im Vergleich zu anderen psychotropen Substanzen eine relativ niedrige Prävalenz für Mißbrauch und Abhängigkeit (4%). Das Vorliegen einer Diagnose bei der Erstuntersuchung weist allerdings eine relativ hohe Stabilität über die Nachuntersuchungskette auf. / The paper examines the prevalence, incidence and stability patterns of cannabis use and dependence in a prospective epidemiological study of a random community sample of adolescents, aged 14 to 17 years (N=1395) at time 1. Assesments are based on personal interviews by trained clinical psychologists using the computerized DSM-IV lifetime and 12-month change version of the M-CIDI. Results indicate that in 1995 every fifth person aged 14 to 17 years had used cannabis at least once and 6% reported regular use. The 12-month incidence rates (i.e. proportion of the sample reporting first cannabis use in the last year) among subjects, 15 to 19 years of age at time 2, was high, with 20,1% of males and 16,3% of females reporting first use. The incidence of regular use was 12,0% (males) and 8,4% (females). The stability of consumption patterns from time 1 to time 2 was high. Increasing with higher initial consumption. Given the reexamined samples overall high cannabis consumption rates of 32,4%, the prevalence of clinically manifest DSM-IV abuse and dependence was low in comparison to other psychologic drugs (4%). However there was remarkable diagnostic stability over time in this age group of those with an initial diagnosis at time 1 receiving a diagnosis again at time 2.

No description available.

There is a growing public health concern over the effects that sedentary lifestyles are having on the health of young people, particularly in relation to overweight and obesity. This thesis presents five studies which examine the prevalence, incidence and determinants of sedentary behaviour among youth. The rationale for eachs tudy derives from a framework of behaviourale. pidemiology applied to physical activity and health. Study I presents four systematic reviews of literature. The first review presents a descriptive epidemiology of youth sedentary behaviour. The second review presents a summary of empirical correlates of television viewing, the most prevalent sedentary behaviour among young people. 'Me third and fourth reviews present quantitative syntheses of empirical relationships between television viewing and body composition (review 3) and sedentary behaviour and physical activity (review 4). Study 2 examines the prevalence and interrelationships among different sedentary behaviours and physical activity in a cross-nationa(l USA & UK) sample of 2,494 youth ages 11-15. Study 3 uses a qualitative strategy to generate a grounded framework from which to understand the choices young people make about how to spend their free-time. Study 4 adopts a micro-behavioural approach for understandingt he incidence and temporal patterning of sedentary behaviour among 162 adolescents (age 13-16). Study 5 presents an evaluation of a behaviour change theory useful for increasing levels of physical activity and reducing sedentary behaviour. Sedentary behaviour and physical activity do not appear to be two sides of the same coin and appear to have different sets of determinants. This is an important finding becausee fforts to increase levels of physical activity may not reduce levels of sedentary behaviour. While television viewing, video games and computer use are consistent referents in the academic and media panic surrounding youth inactivity, it is unlikely that these behaviours play a substantialr ole in epidemiologic trends of adolescent overweight and obesity. Further study should attempt to examine how contemporary lifestyles contribute to the growing prevalence of overweight and obesity among adolescents.

Background: The sensitivity to drug-induced QT prolongation is highly variable in heart failure (HF) patients. QT interval prolongation can lead to a life-threatening ventricular arrhythmia known as torsade de Pointes (TdP), which can result in sudden cardiac death. Although QT prolongation is a surrogate marker for sudden cardiac death, the extent of drug-induced QT prolongation, and thus TdP, is largely unpredictable. Therefore, developing a biomarker to predict patients’ sensitivity to drug-induced QTc prolongation could have a profound clinical impact. MicroRNA (miR) are recognized as important regulators of cardiovascular function as they shape the transcriptome by targeting mRNAs for repression of translation. Our multidisciplinary research group has demonstrated that miR-362-3p regulates a potassium channel (i.e., hERG) that is the most widely implicated in drug-induced QTc prolongation. The primary objects of this analysis focus on characterizing serum miR-362-3p expression in the circulation as a potential biomarker to predict subject’s susceptibility to ibutilide exposure induced QT-interval prolongation.<div><br></div><div>Methods: The dataset utilized to develop the PK-PD models were collected from a previous clinical study carried out by Tisdale et al. (Tisdale,et al. 2020).A total of 22 adult subjects who met the inclusion and exclusion criteria were enrolled and divided into three groups: a group of patients with heart failure with preserved ejection fraction (HFpEF, n=10), a group of patients with heart failure with reduced ejection fraction (HFrEF, n=2), and ten healthy subjects in the control group who were matched to subjects in the HFpEF group for age and sex. Following a baseline day of triplicate 12-lead ECGs, all subjects received ibutilide 0.003mg/kg intravenously infused over 10 minutes. Serial collection of blood samples to determine serum Ibutilide concentrations (HPLC/MS), serum miR-362-3 expression (qPCR), with triplicate ECG readings were obtained pre-and-post ibutilide administration. To describe ibutilide serum concentration exposure and the9relationship with Fridericia-corrected QT (QTF) intervals, a non-linear mixed effect modeling approach was used along with clinical and demographic data, and serum miR-362-3p expression was evaluated as potential covariates on the PK/PD model.<div><br></div><div>Results: A three-compartment model best described the time course of ibutilide concentrations profile with a proportional residual error. The individual ibutilide concentrations time profile was then used in an indirect response model where ibutilide concentrations are indirectly driving the QT interval prolongation through inhibition of the output (Kout) parameters linked to an indirect response model with zero‐order input parameter best described the ibutilide concentrations QT interval lengthening relationship. The Individual PK/PD parameters using the base model for the Imax and IC50 were 11.4% (9.9%RES) and 0.36(8.4% RES)ng/mL, respectively. Following stepwise forwarding inclusion steps, the final covariate analyses identified circulating miR-362-3p expression associated with a history of myocardial infarction covariate influencing both the Imax and IC50( p<0.05). <div><br></div><div>Conclusions: An indirect response model has been developed to describe the effects of ibutilide concentrations on QT-intervals. Although the semi-mechanistic model could not be developed; serummiR-362-3p expression was identified as a significant predictor for ibutilide-induced QT-interval prolongation. Moreover, the upregulation of serum miR-362-3p expression enhanced IC50 seen after ibutilide administration. The potential use of miR-362-3p as a biomarker warrants further investigation to identify patients at the greatest risk of TdP </div></div></div>

This thesis is an ethnographic analysis of a Continuing Care Retirement Community (CCRC) in the American Midwest. I examine salient aspects of American culture, and how persons in the American Midwest understand relationships and themselves in the context of eldercare, and particularly, how issues of personhood and kinship are conceptualised in a long-term care facility. Rather than focusing exclusively on just the labour of caregivers, or how the residents in the CCRC receive care, my study is grounded in the interaction and relations that obtain during specific regimes of caregiving. Because the exigencies of ageing are met with certain exigencies of care, this study touches upon three dominant themes that make sense of the tensions that emerge when principles and practices do not square up. The first theme deals with how ageing and care are constituted, and made relational to one other. Secondly, I demonstrate that in the CCRC where I conducted fieldwork, ageing is constructed as a process and institutionalised, resulting in a distinctive way in which space and time are dealt with and unravelled from their inextricability. The resulting consequences affect not just the older residents and the CCRC staff, but also impacts how caregiving takes on specific forms and meanings. Thirdly, I investigate how formal (professional) caregivers and care receivers produce a type of social relation, which cannot be understood alone by conventional studies of kinship and economic relations. Ultimately, this thesis sets the frame for future debate on the ontological commitments involved in eldercare, and how the segregation of care and of the elderly in society relate to wider social norms regarding ageing and marginality.

Il est admis qu’avoir une mauvaise santé est une des causes principales de pauvreté,particulièrement dans les pays à faible et moyen revenus. Une des raisons de ce constat est une absence de protection financière. L’objectif de cette thèse est de discerner le rôle que l'assurance maladie pourrait jouer dans l'organisation du système de protection financière de la santé. La thèse se compose de deux parties. La première partie aborde les problèmes liés au financement de santé d’un point de vue global. Le chapitre 1 apporte des discussions théoriques sur trois thèmes: 1) les spécificités des risques de la consommation médicale qui rendent la gestion du risque par l’assurance maladie privé difficile, 2) le rôle du gouvernement et du marché dans la répartition des ressources de santé. 3) les options pour l'organisation du financement de la santé. Le chapitre 2 présente une comparaison statistique sur la performance des systèmes de financement de la santé entre des pays à contextes socio-Économique différents. Les discussions sont menées autour de trois aspects du financement de la santé: la disponibilité des ressources,l'organisation du financement de la santé, et la couverture de la protection financière. La deuxième partie qui comporte trois chapitres étudie l'évolution du système de financement de la santé dans un pays donné: la Chine. Le chapitre 3 présente l'histoire du système de financement de la santé en Chine depuis 1950. Il nous aide à comprendre les défis dans le financement de la santé suscités par la réforme économique. Le chapitre 4 porte sur une étude empirique de la répartition de la charge financière de la santé en Chine dans les années 1990. Il illustre les résultats directs de la baisse du financement public et de l'augmentation des paiements directs sur le bienêtre de la population. Le chapitre 5 présente la réforme de l'assurance maladie lancée par le gouvernement depuis la fin des années 1990. L'objectif est d'estimer l'impact de la mise en oeuvre du nouveau système rural d’assurance médical (NRMCS) sur les activités et la structure financière de ces hôpitaux. Une analyse d'impact est réalisée sur un échantillon de 24 hôpitaux dans la préfecture de Weifang, au Nord de la Chine. Nous concluons que le système d'assurance maladie permet un partage des responsabilités financières entre prestataires de services, patient consommateurs et acheteurs de services. Elle inclut à la fois les agents publics et privés dans la contribution au financement de santé, ce qui rend chaque partie plus responsable vis-À-Vis de son comportement en raison des risques qu'il doit assumer du fait de la consommation médicale.Cependant, il est nécessaire de noter que l’assurance maladie sociale n’est qu’une option parmi d’autres systèmes de financement de la santé. La mise en oeuvre de ce système exige un certain niveau de développement socio-Économique. L’assurance maladie ne conduit pas systématiquement à une meilleure performance du financement de la santé si elle n'est pas accompagnée de réformes quant au paiement au fournisseur ou au système de prestation de services. L'engagement du gouvernement et des capacités institutionnelles sont également des facteurs clés pour le bon fonctionnement du système. / It has been widely recognized that poor health is an important cause of poverty, especiallyamong the low- and middle- income countries. One of the reasons is the absence of publicfinancial protection against the medical consumption risk in these countries. This Phd dissertationis dedicated to discern the role that health insurance could play in the organization of healthfinancial protection system. The dissertation is composed of two parts. The first part discusses theproblems linking to the financing to medical consumption from a global point of view. Chapter 1brings theoretical discussions on three topics: 1) the specialties of medical consumption risks andthe difficulties in using private health insurance to manage medical consumption risks. 2) Therole of government and market in the distribution of health resources. 3) The options for theorganization of health financing system. Chapter 2 conducts a statistical comparison on theperformance of health financing systems in the countries of different social-Economic background.The discussion is carried out around three aspects of health financing: the availability of resources,the organization of health financing, and the coverage of financial protection. The second part ofthe dissertation studies the evolution of heath financing system in a specific country: China. Threechapters are assigned to this part. Chapter 3 introduces the history of Chinese health financingsystem since 1950s. It helps us to understand the challenges in health financing brought byeconomic reform. Chapter 4 carries out an empirical study on the distribution of health financingburden in China in the 1990s. It illustrates the direct results of the decline of public financing andincrease of direct payment. Chapter 5 presents health insurance reform that launched by thegovernment since the end of 1990s. An impact analysis is conducted on an original dataset of 24township hospitals in Weifang prefecture in the north of the China. The objective is to estimatethe impact of the implementation of New Rural Medical Cooperation System (NRMCS) on theactivities and financial structure of township hospitals. At last, we conclude that social healthinsurance (SHI) permits a sharing of health financial responsibilities between the service provider,the patient-Consumer, and the service purchaser. It can not only involve both public and privateagents into the collection of funds for health financing system, but also make each party moreaccountable due to the risks they bear from the result of medical consumption. Meanwhile it isnecessary to note that SHI is just one option among others to organize health financing system.The implementation of SHI requires a certain level of social-Economic development. SHI does notsystematically bring better performance on health financing if it is not accompanied by thereforms on provider payment or on service delivery system. Government commitment andinstitutional capacity are also key factors for the good function of the system.

Cette thèse amorce une réflexion approfondie sur les représentations populaires de la maladie et du pluralisme thérapeutique eu égard à la tradition, la religion et aux spécificités sociologiques de la société sénégalaise. Sa singularité repose sur le fait de mettre en exergue les composantes sociales et culturelles à l’œuvre, dans la prise en charge de la maladie du paludisme dans la communauté wolof du Sénégal. Cette recherche analyse la maladie comme le révélateur d’une conflictualité sociale et des rapports sociaux complexes entre les individus, les familles, les thérapeutes, les ethnies, où dominent des idéologies et des manières d’agir à la fois opposées et complémentaires. C’est dans la conception que les communautés se font de la maladie, que réside l’explication de la fusion culturelle qui est au firmament de la société et de l’humain, qui est perçu ici comme étant un complexe triadique fait de l’esprit, de l’âme et du corps / This thesis begins a reflection on popular representations of disease and therapeutic pluralism with regard to tradition, religion and sociological specificities Senegalese society. Its uniqueness lies in the fact to highlight the social and cultural work in the management of malaria illness in the community Wolof of Senegal. This research analyzes the disease as the developer of a social conflict and complex social relationships between individuals, families, therapists, ethnicity, dominated ideologies and ways of acting both opposite and complementary. This is the design that communities are the disease, lies the explanation of cultural fusion is the firmament of human society and which is seen here as a triadic complex due to the spirit, soul and body

Le paludisme, la tuberculose et les infections respiratoires aiguës constituent un enjeu majeur de santé publique à Madagascar, les deux premières de ces maladies faisant l’objet de programmes nationaux de lutte largement inspirés et financés par des organisations internationales. Les méthodes diagnostiques, thérapeutiques et de prévention recommandées officiellement dans le système de santé conventionnel sont standardisées et reposent sur un corpus de connaissances scientifiques solidement établi. Parmi d’autres maladies, elles font explicitement partie des cibles des objectifs du développement durable (ODD). Pour les atteindre, les nations unies recommandent la mise en œuvre d’une Couverture Sanitaire Universelle (CSU). Madagascar a adopté les ODD et s’est engagé dans la voie de la mise en œuvre d’une CSU. Ces travaux sur le paludisme, la tuberculose et les infections respiratoires aiguës ont été menés dans le cadre de cette thèse de sociologie, en utilisant une approche qualitative (auprès de 83 individus) et quantitative (auprès d’environ 26.000 personnes interrogées, par enquêtes en populations), sur plusieurs terrains de Madagascar, impliquant des soignants, des soignés et des acteurs institutionnels. L’acceptation et la mise en œuvre des méthodes de prise en charge des maladies dépendent de facteurs logistiques et organisationnels, mais aussi des croyances et pratiques adoptées par les individus, les familles et les groupes sociaux ou professionnels. En pratique, les obstacles sont nombreux sur la voie d’un accès effectif des populations aux soins contre les maladies ciblées par les ODD et la CSU, y compris celles faisant déjà l’objet de programmes de lutte verticaux et soutenus internationalement. Les éléments représentatifs des zones étudiées dans cette thèse apportent un éclairage qui peut être utile pour la mise en œuvre d’une CSU à l’échelle du pays. Ils révèlent aussi les défis, pas seulement financiers, qui restent à surmonter. / Malaria, tuberculosis and acute respiratory infections constitute a major public health issue in Madagascar, the first two of which are the subject of national control programs largely inspired and financed by international organizations. The diagnostic, therapeutic and preventive methods recommended officially in the conventional health system are standardized and are based on a solid corpus of scientific knowledge. Among other diseases, they are explicitly targeted by the universal sustainable development goals (SDG). To reach them, the United nations recommend the implementation of an universal health coverage (UHC). Madagascar has adopted the SDG and is committed to the implementation of a UHC. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDG and UHC, including those already covered by vertical and internationally supported control programs. These works on malaria, tuberculosis and acute respiratory infections were carried out within the framework of this sociological thesis, using a qualitative methods (among 83 individuals) and quantitative methods (with about 26,000 people interviewed), by population surveys, on several fields in Madagascar, involving caregivers, cared population and institutional actors. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDGs and UHC, including those already covered by vertical and internationally supported control programs. The representative elements of the studied zones of Madagascar presented in this thesis provide an insight that could be useful for the implementation of a CSU across the country. They also reveal the challenges, not just financial, that remain to be overcome.

L'utilisation des coefficients aérodynamiques pour caractériser le comportement d'un objet en vol libre demeure un sujet de recherche parmi les plus complexes et les plus étudiés dans le domaine de la balistique extérieure. La présente étude analyse l'identification des coefficients aérodynamiques à partir de données obtenues lors d'essais en vol libre. Elle vise à modéliser, définir ainsi que maîtriser les techniques d'identification de paramètres les plus adaptées au problème qu'est la détermination des coefficients aérodynamiques. Le travail de thèse a été dédié au développement d'une procédure d'identification pour la détermination des coefficients aérodynamiques à partir de mesures de vol libre et a été testée pour deux cas d'application : un corps de rentrée dans l'atmosphère et un projectile stabilisé par empennage. Cette procédure nécessite plusieurs étapes telles que la description du comportement d'un objet en vol libre sous la forme d'un modèle non linéaire en représentation d'état, la description polynomiale des coefficients aérodynamiques en fonction du nombre de Mach et de l'incidence, les analyses d'identifiabilité a priori et a posteriori suivies de l'estimation des paramètres. De plus, dans le but d'augmenter la probabilité que les coefficients caractérisent l'aérodynamique de l'objet pour l'ensemble des conditions d'essais et d'améliorer la précision des coefficients estimés, une stratégie "multiple fit" a été appliquée. Cette approche fournit une base de données de coefficients aérodynamiques, qui sont déterminés à partir de plusieurs séries de mesures analysées simultanément, afin de décrire le spectre le plus complet du mouvement de l'objet / The use of aerodynamic coefficients for the characterization of the behaviour of an object in flight remains one of the oldest and most emergent research project in the field of exterior ballistic. The present study investigates the identification of the aerodynamic coefficients based on measured data, gathered during free flight tests from different measurement techniques. This project deals with topics as modelling, defining and mastering parameter identification techniques best suited to the problem of the aerodynamic coefficients determination. In the frame of this study, an identification procedure was developed for the aerodynamic coefficients determination based on free flight measurements and was tested for two application cases: a re-entry space vehicle and a fin stabilized reference projectile. This procedure requires several steps such as the description of the behaviour of the vehicle in free flight as a nonlinear state-space model representation, the polynomial descriptions of the aerodynamic coefficients as function of Mach number and incidence, the a priori and a posteriori identifiability analyses, followed by the estimation of the parameters from free flight measurements. Moreover, to increase the probability that the coefficients define the vehicle’s aerodynamics over the entire range of test conditions and to improve the accuracy of the estimated coefficients, a multiple fit strategy was considered. This approach provides a common set of aerodynamic coefficients that are determined from multiple data series simultaneously analyzed, and gives a more complete spectrum of the vehicle’s motion