Cette thèse a pour objectif d’explorer la relation entre les caractéristiques socio-culturelles et les politiques de reconstruction post-séisme dans les zones rurales de Azad Jammu et du Cachemire, au Pakistan. L’objet principal est d’examiner les pratiques architecturales traditionnelles : dhajji-dewari et la composition sociale de la communanuté pendant et après la reconstruction. Différents processus sont analysés: comment les aspects socio-culturels des sociétés rurales sont affectés par les politiques de reconstruction? Comment les politiques sont touchées par les aspects socio-culturels des commmunautés? Comment la combinaison des deux influence le processus final?Ce travail de thèse part du constat que 80% des 600 000 bâtiments endommagés ou détruits lors du séisme du 8 octobre 2005 au Cachemire, étaient des maisons rurales provisoires (Katcha). Il s’agit d’examiner jusqu’où le Programme de Reconstruction de Logement Rural (RHRP) qui a concerné quelque 100 000 maisons dhajji, a réduit ou augmenté la vulnérabilité de la zone pour l'avenir. Ce programme a été initié à partir de l’expérience de précédents programmes de reconstruction post-tremblements de terre, qui ont été d’une grande utilité pour les experts. Il restait à analyser les erreurs commises ou répétées par les différents acteurs pendant les phases d’élaboration, de validation, de mise en œuvre, et de suivi des politiques de reconstruction. Les principaux résultats de la thèse couvrent trois thèmes relatifs aux différentes étapes de la reconstruction : la durabilité de la reconstruction ; la réduction de la vulnérabilité de la reconstruction ; les résultats qui n’entrent pas dans les catégories “durabilité” et “vulnérabilité” selon les experts du Cachemire rural. La satisfaction des communautés est l’indicateur principal permettant d’évaluer les principaux résultats. L'étude conclut que la non-prise en compte des aspects socioculturels des communautés pendant la reconstruction peut augmenter la vulnérabilité du scénario de post-reconstruction. Le suivi du programme de reconstruction consiste à évaluer les tendances liées aux maisons en construction. En présentant par des illustrations les détails architecturaux de ces maisons reconstruites, l’écart avec les recommandations est évalué. Après que quelques années, les populations oublient les impacts du séisme et leurs besoins immédiats dictent leurs priorités de décision. Il est suggéré qu'à la fin du programme de reconstruction, la présence des autorités dans la zone reconstruite permette d’assister les populations dans leurs besoins actuels et futurs, et de contrôler le développement des constructions non conformes. / This thesis is aimed at exploring the relation of socio-cultural characteristics and policies with post-quake reconstruction of rural areas of Azad Jammu & Kashmir, Pakistan. The primary concern of the study is limited to examine the traditional architectural practice ; dhajji-dewari and social composition of the community during and after reconstruction. It is analyzed that how the socio-cultural aspects of rural communities are affected by the policies, how policies are affected by the socio-cultural aspects of the community and how both of these can influence the final product. The thesis was rooted in the fact that 80% of the 600,000 damaged/destroyed buildings during 8th October, 2005 Kashmir earthquake were rural temporary (Katcha) houses. It was hence to be investigated that how far the Rural Housing Reconstruction Program (RHRP) has reduced (or increased) the vulnerability of the area for future. The impact of any policy launched during this program was not limited to few housing units rather more than 0.1 million dhajji houses could be affected through this. The rural Kashmir reconstruction was commenced with the in-hand knowledge of several previous post-quake reconstruction programs and was appreciated widely by experts. It was yet to be explored that which mistakes were committed/repeated by the stakeholders during policy making, delivery, implementation and post implementation phases. Covering the phases of policy making, delivery and implementation, the major findings of the thesis are categorized into three sections ; the sustainability generating aspects of reconstruction, vulnerability enhancing dimensions of reconstruction, and, those outcomes of reconstruction which are not yet categorized under ”sustainability” or ”vulnerability” by the experts focusing particularly rural Kashmir. Community satisfaction is given primary focus to rate different outcomes.The study concludes that ignoring socio-cultural aspects of the community during reconstruction may lead to vulnerability in post-reconstruction scenario. Considering the post implementation phase, the current trends are observed by examining under-construction houses. By pictorially presenting the architectural details of these houses it is examined that deviations from guidelines are in practice. People start forgetting the disaster impacts after few years and their immediate needs drive their decision priorities. It is suggested that after reconstruction program ends up, some authorities must be present in the reconstructed area to guide people for their current requirements and future needs and also to control the spread of non compliant construction.

This thesis is aimed at exploring the relation of socio-cultural characteristics and policies with post-quake reconstruction of rural areas of Azad Jammu & Kashmir, Pakistan. The primary concern of the study is limited to examine the traditional architectural practice ; dhajji-dewari and social composition of the community during and after reconstruction. It is analyzed that how the socio-cultural aspects of rural communities are affected by the policies, how policies are affected by the socio-cultural aspects of the community and how both of these can influence the final product. The thesis was rooted in the fact that 80% of the 600,000 damaged/destroyed buildings during 8th October, 2005 Kashmir earthquake were rural temporary (Katcha) houses. It was hence to be investigated that how far the Rural Housing Reconstruction Program (RHRP) has reduced (or increased) the vulnerability of the area for future. The impact of any policy launched during this program was not limited to few housing units rather more than 0.1 million dhajji houses could be affected through this. The rural Kashmir reconstruction was commenced with the in-hand knowledge of several previous post-quake reconstruction programs and was appreciated widely by experts. It was yet to be explored that which mistakes were committed/repeated by the stakeholders during policy making, delivery, implementation and post implementation phases. Covering the phases of policy making, delivery and implementation, the major findings of the thesis are categorized into three sections ; the sustainability generating aspects of reconstruction, vulnerability enhancing dimensions of reconstruction, and, those outcomes of reconstruction which are not yet categorized under "sustainability" or "vulnerability" by the experts focusing particularly rural Kashmir. Community satisfaction is given primary focus to rate different outcomes.The study concludes that ignoring socio-cultural aspects of the community during reconstruction may lead to vulnerability in post-reconstruction scenario. Considering the post implementation phase, the current trends are observed by examining under-construction houses. By pictorially presenting the architectural details of these houses it is examined that deviations from guidelines are in practice. People start forgetting the disaster impacts after few years and their immediate needs drive their decision priorities. It is suggested that after reconstruction program ends up, some authorities must be present in the reconstructed area to guide people for their current requirements and future needs and also to control the spread of non compliant construction.

Un problème préoccupant du suivi des patients diabétiques en République Démocratique du Congo (RDC) demeure ceux perdus de vue qui ne cessent d’augmenter. En effet, beaucoup de patients négligent la gestion de leur maladie pour plusieurs raisons, parmi lesquelles les croyances religieuses. En général, les religions promeuvent la vie et consolident sa protection. Certaines croyances religieuses, cependant, confortent des comportements démissionnaires et irresponsables au regard de la santé. La présente recherche vise à comprendre le rôle des connaissances et des facteurs religieux sur l’autogestion du diabète. Une enquête qualitative descriptive par entretiens semi-dirigés a été réalisée à Kinshasa auprès de 23 fidèles diabétiques et ainsi qu’au moyen de trois groupes de discussion impliquant des leaders religieux de ces églises. Cette étude a démontré une connaissance erronée et insuffisante de la maladie et à l’influence des croyances religieuses sur la gestion du diabète. Les participants identifiaient le diabète comme une maladie grave, curable par des prières et par des plantes traditionnelles dictées par Dieu. Ils manifestaient un déni de la maladie, ce qui influençait leurs habitudes de vie (c’est-à-dire leur régime alimentaire et leur activité physique). Se disant détenir le pouvoir de guérison, les chefs religieux pouvaient interrompre le traitement médical et acceptaient que leurs fidèles diabétiques se rendent à l’hôpital uniquement pour vérifier leur taux de glycémie. Notre étude implique que les réseaux d’affiliation religieuse et d’entraide devraient être ciblés par les stratégies de sensibilisation contre la désinformation, afin de réduire les complications et les décès dus au diabète à Kinshasa en particulier et en République Démocratique du Congo en général. / An important problem in the follow-up of diabetic patients in the Democratic Republic of Congo (DRC) remains the lost to follow-up which continues to increase. Many patients neglect the management of their disease for several reasons including religious beliefs. In general, religions promote life and consolidate its protection. Certain religious beliefs, however, reinforce resigning and irresponsible behaviors regarding health. The current research aims to understand the role of knowledge and religious factors in the self-management of diabetes. A descriptive qualitative study by semi-structured interviews was carried out in Kinshasa among 23 diabetic patients and three focus groups of religious leaders from prophetic churches. This study suggests an incorrect and insufficient knowledge of the disease, and the influence of religious beliefs on diabetes management. Participants identified diabetes as a serious disease that was curable by prayers and by traditional plants dictated by God. They displayed a denial of the disease which influenced their lifestyle (i.e., diet and physical activity). Claiming to have the ability to heal, religious leaders could interrupt medical treatment and only allowed their diabetic patients to go to the hospital to check their blood sugar levels. Our study implies that religious affiliation and mutual aid networks should be targeted by advocacy strategies against disinformation to reduce complications and deaths from diabetes in Kinshasa and in the Democratic Republic of Congo.

Introdução: Os transtornos mentais que ocorrem na comunidade e em culturas diversas são temas de grande interesse frente às constantes transformações sociais no mundo. A mudança do foco de pesquisa para os transtornos freqüentes na comunidade possibilitou aperfeiçoamentos metodológicos e desenvolvimento de instrumentos sensíveis para a sua detecção. A inclusão da variável cultural no estudo da psiquiatria, por sua vez, questiona o universalismo psicopatológico, a taxonomia ocidental e o diagnóstico de síndromes culturalmente específicas. Uma amostra desta visão psiquiátrica, ancorada na questão cultural e de transtornos da comunidade, são as pesquisas envolvendo neurastenia, um transtorno neurótico comum entre os chineses. O presente trabalho é um estudo observacional e transversal dos transtornos mentais comuns entre os indivíduos chineses da comunidade. Objetivo: Avaliar a psicopatologia não-psicótica dos chineses residentes na cidade de São Paulo, através de instrumentos padronizados. Material e Método: Os sujeitos da comunidade (n = 211), chineses e seus descendentes, preencheram um questionário de auto-avaliação e foram entrevistados por pesquisadores treinados. Os instrumentos utilizados foram: Chinese Health Questionnaire (CHQ-12), Escala de Sintomas Físicos, Escala de Eventos Vitais, Inventário de Depressão de Beck (BDI), Inventário de Ansiedade Traço-Estado (IDATE) e Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Os dados foram analisados através de estatística descritiva, análise univariada (testes de qui-quadrado, Fisher e t de Student), análise multivariada (regressão logística), análise da curva ROC, análise fatorial exploratória (CHQ-12) e análise de correlação. Resultados: A probabilidade dos indivíduos pontuar alto no CHQ-12 ou ser casos prováveis de transtornos mentais comuns associou ao fato de ser do sexo feminino (OR = 2,31; IC95%: 1,12–4,75) e fluentes em chinês mandarim (OR = 3,37; IC95%: 1,68–6,78). Além disso, aqueles sujeitos com queixas físicas (OR = 4,20; IC95%: 1,70–10,40), relato de eventos-vitais no último ano (OR = 4,91; IC95%: 1,51–16,00) e pontuação alta no BDI (OR = 1,29; IC95%: 1,20–1,41) também tiveram maior chance de apresentar transtornos. O coeficiente de consistência interna &#61537; de Cronbach do CHQ-12 foi de 0,71 e a correlação item-total variou de 0,25 a 0,55, mostrando boa fidedignidade e homogeneidade deste instrumento. Adotando SCAN como critério-padrão, o melhor ponto de corte de CHQ-12 foi 2/3. Os seguintes indicadores de validade foram calculados a partir deste critério: sensibilidade 75%, especificidade 71%, valor preditivo positivo 55%, valor preditivo negativo 86% e taxa de classificação incorreta 28%. A curva ROC foi utilizada para avaliar a capacidade discriminante do instrumento, tendo uma área sob a curva de 0,728. O questionário CHQ-12 também se correlacionou significativamente com Escala de Sintomas Físicos (p < 0,005), Escala de Eventos Vitais (p < 0,005), BDI (p < 0,0005) e IDATE (p < 0,05). Na análise fatorial exploratória, três dimensões psicopatológicas explicaram 47,8% da variância total do CHQ-12. O conteúdo sintomatológico avaliado por este instrumento pode ser descrito como tridimensional, contendo fator somático, depressivo e de preocupação. As entrevistas do SCAN (n = 25) geraram diagnósticos de distimia, depressão e insônia não orgânica (CID-10). Os item-grupos “mau funcionamento subjetivo" (p < 0,005) e “características especiais de depressão" (p < 0,005) predominaram no perfil sintomatológico dos casos positivos de SCAN. Conclusão: Os transtornos mentais comuns predominantes na comunidade chinesa de São Paulo são os transtornos neuróticos, muito sugestivos de neurastenia. Os sujeitos chineses da comunidade apresentam uma psicopatologia própria, semelhante àquela dos indivíduos do seu país de origem. O CHQ-12 é um instrumento de rastreamento culturalmente sensível, que apresenta evidências de confiabilidade e validade para ser aplicado em outras populações de chineses. / Introduction: Community and culturally specific mental disorders have attracted much interest lately as a consequence of the constant social changes in the world. The shift of research focus to community-specific disorders has permitted methodological improvements and the development of tools for their detection. The inclusion of the cultural variable in the study of psychiatry questions psychopathological universality, Western taxonomy, and the diagnosis of culturally specific syndromes. The research of neurasthenia, a common neurotic disorder among the Chinese, is an example of the psychiatric approach based on cultural issues and on community disorders. This is an observational and transversal study of the common mental disorders among Chinese individuals in the community. Objective: to assess the non-psychotic psychopathology of the Chinese who live in the city of São Paulo, using standardized instruments. Materials and Methods: Individuals of the community (n = 211), Chinese and their descendants, filled out a self-evaluation questionnaire and were interviewed by trained researchers. The instruments used were: Chinese Health Questionnaire (CHQ-12), Physical Symptom Scale, Life Event Scale, Beck Depression Inventory (BDI), Trait-State Anxiety Inventory (STAI), and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data were analyzed with descriptive statistics, univariate analysis (chi-square, Fisher and Student’s t tests), multivariate analysis (logistic regression), ROC curve analysis, exploratory factor analysis (CHQ-12), and correlation analysis. Results: The likelihood of an individual scoring high in CHQ-12 or having a probable common mental disorder is associated to the fact of being female (OR = 2.31; 95% CI: 1.12–4.75) and fluent in Mandarin Chinese (OR = 3.37; 95% CI: 1.68–6.78). Moreover, those with physical complaints (OR = 4.20; 95% CI: 1.70–10.40), reporting life events in the previous year (OR = 4.91; 95% CI: 1.51–16.00) and scoring high in BDI (OR = 1.29; 95% CI: 1.20–1.41) also had a greater likelihood of presenting disorders. CHQ-12’s Cronbach’s &#61537; coefficient of internal consistency was 0.71 and the item-total correlation ranged from 0.25 to 0.55, showing that this instrument is reliable and homogeneous. Using SCAN as a standard criterion, the best cut-off point for CHQ-12 was 2/3. The other validity indicators were calculated based on that criterion: sensitivity 75%, specificity 71%, positive predictive value 55%, negative predictive value 86%, and misclassification rate 28%. ROC curve was used to evaluate the discriminating capacity of the instrument, having an area under the curve of 0.728. CHQ-12 questionnaire also correlated significantly with the Physical Symptom Scale (p < 0.005), Life Event Scale (p < 0.005), BDI (p < 0.0005), and STAI (p < 0.05). In the exploratory factor analysis, three psychopathologic dimensions explained 47.8% of the total variance of CHQ-12. The symptomatological content evaluated by this instrument may be described as three-dimensional, including somatic, depressive and preoccupation factors. SCAN interviews (n = 25) led to diagnoses of dysthymia, depression and non-organic insomnia (ICD-10). The item-groups “poor subjective functioning" (p < 0.005) and “special features of depression" (p < 0.005) prevailed on the symptomatological profile of SCAN-positive cases. Conclusion: the most common mental disorders in São Paulo’s Chinese community are the neurasthenia-like neurotic disorders. The individuals of the Chinese community presented a unique psychopathology, resembling that of their country of origin. CHQ-12 is a culturally sensitive screening instrument, which seems to be reliable and valid enough to be used in other Chinese populations.

Introdução: Os transtornos mentais que ocorrem na comunidade e em culturas diversas são temas de grande interesse frente às constantes transformações sociais no mundo. A mudança do foco de pesquisa para os transtornos freqüentes na comunidade possibilitou aperfeiçoamentos metodológicos e desenvolvimento de instrumentos sensíveis para a sua detecção. A inclusão da variável cultural no estudo da psiquiatria, por sua vez, questiona o universalismo psicopatológico, a taxonomia ocidental e o diagnóstico de síndromes culturalmente específicas. Uma amostra desta visão psiquiátrica, ancorada na questão cultural e de transtornos da comunidade, são as pesquisas envolvendo neurastenia, um transtorno neurótico comum entre os chineses. O presente trabalho é um estudo observacional e transversal dos transtornos mentais comuns entre os indivíduos chineses da comunidade. Objetivo: Avaliar a psicopatologia não-psicótica dos chineses residentes na cidade de São Paulo, através de instrumentos padronizados. Material e Método: Os sujeitos da comunidade (n = 211), chineses e seus descendentes, preencheram um questionário de auto-avaliação e foram entrevistados por pesquisadores treinados. Os instrumentos utilizados foram: Chinese Health Questionnaire (CHQ-12), Escala de Sintomas Físicos, Escala de Eventos Vitais, Inventário de Depressão de Beck (BDI), Inventário de Ansiedade Traço-Estado (IDATE) e Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Os dados foram analisados através de estatística descritiva, análise univariada (testes de qui-quadrado, Fisher e t de Student), análise multivariada (regressão logística), análise da curva ROC, análise fatorial exploratória (CHQ-12) e análise de correlação. Resultados: A probabilidade dos indivíduos pontuar alto no CHQ-12 ou ser casos prováveis de transtornos mentais comuns associou ao fato de ser do sexo feminino (OR = 2,31; IC95%: 1,12–4,75) e fluentes em chinês mandarim (OR = 3,37; IC95%: 1,68–6,78). Além disso, aqueles sujeitos com queixas físicas (OR = 4,20; IC95%: 1,70–10,40), relato de eventos-vitais no último ano (OR = 4,91; IC95%: 1,51–16,00) e pontuação alta no BDI (OR = 1,29; IC95%: 1,20–1,41) também tiveram maior chance de apresentar transtornos. O coeficiente de consistência interna &#61537; de Cronbach do CHQ-12 foi de 0,71 e a correlação item-total variou de 0,25 a 0,55, mostrando boa fidedignidade e homogeneidade deste instrumento. Adotando SCAN como critério-padrão, o melhor ponto de corte de CHQ-12 foi 2/3. Os seguintes indicadores de validade foram calculados a partir deste critério: sensibilidade 75%, especificidade 71%, valor preditivo positivo 55%, valor preditivo negativo 86% e taxa de classificação incorreta 28%. A curva ROC foi utilizada para avaliar a capacidade discriminante do instrumento, tendo uma área sob a curva de 0,728. O questionário CHQ-12 também se correlacionou significativamente com Escala de Sintomas Físicos (p < 0,005), Escala de Eventos Vitais (p < 0,005), BDI (p < 0,0005) e IDATE (p < 0,05). Na análise fatorial exploratória, três dimensões psicopatológicas explicaram 47,8% da variância total do CHQ-12. O conteúdo sintomatológico avaliado por este instrumento pode ser descrito como tridimensional, contendo fator somático, depressivo e de preocupação. As entrevistas do SCAN (n = 25) geraram diagnósticos de distimia, depressão e insônia não orgânica (CID-10). Os item-grupos “mau funcionamento subjetivo” (p < 0,005) e “características especiais de depressão” (p < 0,005) predominaram no perfil sintomatológico dos casos positivos de SCAN. Conclusão: Os transtornos mentais comuns predominantes na comunidade chinesa de São Paulo são os transtornos neuróticos, muito sugestivos de neurastenia. Os sujeitos chineses da comunidade apresentam uma psicopatologia própria, semelhante àquela dos indivíduos do seu país de origem. O CHQ-12 é um instrumento de rastreamento culturalmente sensível, que apresenta evidências de confiabilidade e validade para ser aplicado em outras populações de chineses. / Introduction: Community and culturally specific mental disorders have attracted much interest lately as a consequence of the constant social changes in the world. The shift of research focus to community-specific disorders has permitted methodological improvements and the development of tools for their detection. The inclusion of the cultural variable in the study of psychiatry questions psychopathological universality, Western taxonomy, and the diagnosis of culturally specific syndromes. The research of neurasthenia, a common neurotic disorder among the Chinese, is an example of the psychiatric approach based on cultural issues and on community disorders. This is an observational and transversal study of the common mental disorders among Chinese individuals in the community. Objective: to assess the non-psychotic psychopathology of the Chinese who live in the city of São Paulo, using standardized instruments. Materials and Methods: Individuals of the community (n = 211), Chinese and their descendants, filled out a self-evaluation questionnaire and were interviewed by trained researchers. The instruments used were: Chinese Health Questionnaire (CHQ-12), Physical Symptom Scale, Life Event Scale, Beck Depression Inventory (BDI), Trait-State Anxiety Inventory (STAI), and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data were analyzed with descriptive statistics, univariate analysis (chi-square, Fisher and Student’s t tests), multivariate analysis (logistic regression), ROC curve analysis, exploratory factor analysis (CHQ-12), and correlation analysis. Results: The likelihood of an individual scoring high in CHQ-12 or having a probable common mental disorder is associated to the fact of being female (OR = 2.31; 95% CI: 1.12–4.75) and fluent in Mandarin Chinese (OR = 3.37; 95% CI: 1.68–6.78). Moreover, those with physical complaints (OR = 4.20; 95% CI: 1.70–10.40), reporting life events in the previous year (OR = 4.91; 95% CI: 1.51–16.00) and scoring high in BDI (OR = 1.29; 95% CI: 1.20–1.41) also had a greater likelihood of presenting disorders. CHQ-12’s Cronbach’s &#61537; coefficient of internal consistency was 0.71 and the item-total correlation ranged from 0.25 to 0.55, showing that this instrument is reliable and homogeneous. Using SCAN as a standard criterion, the best cut-off point for CHQ-12 was 2/3. The other validity indicators were calculated based on that criterion: sensitivity 75%, specificity 71%, positive predictive value 55%, negative predictive value 86%, and misclassification rate 28%. ROC curve was used to evaluate the discriminating capacity of the instrument, having an area under the curve of 0.728. CHQ-12 questionnaire also correlated significantly with the Physical Symptom Scale (p < 0.005), Life Event Scale (p < 0.005), BDI (p < 0.0005), and STAI (p < 0.05). In the exploratory factor analysis, three psychopathologic dimensions explained 47.8% of the total variance of CHQ-12. The symptomatological content evaluated by this instrument may be described as three-dimensional, including somatic, depressive and preoccupation factors. SCAN interviews (n = 25) led to diagnoses of dysthymia, depression and non-organic insomnia (ICD-10). The item-groups “poor subjective functioning” (p < 0.005) and “special features of depression” (p < 0.005) prevailed on the symptomatological profile of SCAN-positive cases. Conclusion: the most common mental disorders in São Paulo’s Chinese community are the neurasthenia-like neurotic disorders. The individuals of the Chinese community presented a unique psychopathology, resembling that of their country of origin. CHQ-12 is a culturally sensitive screening instrument, which seems to be reliable and valid enough to be used in other Chinese populations.