Global ETD Search

131	Examining the State of Substance Use Treatment among Youth and Adults in the United States Adeniran, Esther Adejoke 01 May 2022 (has links) (PDF) In the United States (US), substance use, misuse, and substance use disorders are significant public health problems. Additionally, the difference between needing substance use treatment (SUT) and receiving treatment is becoming more pronounced. Therefore, the aims of this dissertation include, 1) to synthesize evidence of barriers and facilitators to integrating SUT into mainstream health care (MHC) after the Affordable Care Act was nationally implemented in 2014, 2) to examine the rate of treatment completion and dropout, along with its associated factors, among youth who received Medication-Assisted Opioid Therapy (MAT), 3) to determine the relationship between prior treatment episodes and length of stay (LOS) among adults in residential rehabilitation facilities (RRF) and explore other predictors of LOS and, 4) to determine whether experiencing multiple treatment episodes and being in certain age groups was associated with longer wait period to enter SUT. The literature synthesis involved data from five databases and was informed by PRISMA. Quantitative analysis (aims 2-4) included log-binomial, Poisson, and logistic regression models using the Treatment Episode Data Set-Admissions and Discharges. Andersen’s Behavioral Model for Health Services was the conceptual framework used to inform aims 2-4. For aim 1, several patient, provider, and program/system-level barriers and facilitators were identified, which highlights the need to use a comprehensive approach to improve SUT adoption in MHC. For aim 2, among youth who received MAT, 43.9% completed treatment and 56.1% dropped out. Factors positively associated with treatment completion included MAT use, males, self-help group participation, admission to detoxification and residential/rehabilitation settings, and being in the Midwest/Western US; while minority races (excluding Blacks/African Americans) and being in the South resulted in lower likelihood. For aim 3, the average LOS in RRF was 16.4 days, and having ≥ 1 prior SUT episode (PSUTE) was associated with slightly higher LOS. Some predictors associated with lower LOS included age (18-34 years), males, being employed, private insurance, and being in the Northeast. For aim 4, a longer wait period was identified among clients 25-49 years and those with ≥5 PSUTEs. These factors should be considered to improve SUT use, and future studies should corroborate these findings. Substance Use Treatment Youth Adults United States Treatment Episode Data Set (TEDS) Medication Assisted Opioid Therapy Residential Rehabilitation Facilities Wait period Epidemiology Health Services Research
132	GIS-based Episode Reconstruction Using GPS Data for Activity Analysis and Route Choice Modeling / GIS-based Episode Reconstruction Using GPS Data Dalumpines, Ron 26 September 2014 (has links) Most transportation problems arise from individual travel decisions. In response, transportation researchers had been studying individual travel behavior – a growing trend that requires activity data at individual level. Global positioning systems (GPS) and geographical information systems (GIS) have been used to capture and process individual activity data, from determining activity locations to mapping routes to these locations. Potential applications of GPS data seem limitless but our tools and methods to make these data usable lags behind. In response to this need, this dissertation presents a GIS-based toolkit to automatically extract activity episodes from GPS data and derive information related to these episodes from additional data (e.g., road network, land use). The major emphasis of this dissertation is the development of a toolkit for extracting information associated with movements of individuals from GPS data. To be effective, the toolkit has been developed around three design principles: transferability, modularity, and scalability. Two substantive chapters focus on selected components of the toolkit (map-matching, mode detection); another for the entire toolkit. Final substantive chapter demonstrates the toolkit’s potential by comparing route choice models of work and shop trips using inputs generated by the toolkit. There are several tools and methods that capitalize on GPS data, developed within different problem domains. This dissertation contributes to that repository of tools and methods by presenting a suite of tools that can extract all possible information that can be derived from GPS data. Unlike existing tools cited in the transportation literature, the toolkit has been designed to be complete (covers preprocessing up to extracting route attributes), and can work with GPS data alone or in combination with additional data. Moreover, this dissertation contributes to our understanding of route choice decisions for work and shop trips by looking into the combined effects of route attributes and individual characteristics. / Dissertation / Doctor of Philosophy (PhD) GPS time use diary episode extraction multinomial logit travel behavior mode detection episode reconstruction GIS map-matching route choice path size logit potential path area scale estimation Python ArcGIS activity analysis trip reconstruction smartphone global positioning system geographic information system toolkit work trip shop trip potential activity location land use activity episode travel episode stop episode transferability scalability modularity scripting big data travel survey respondent burden preprocessing multipath error tracking purpose detection segmentation data filter data smoothing fuzzy logic neural network decision tree rule-based algorithm trajectory point road network network dataset gateway shortest path horizontal dilution of precision HDOP commonality factor mode transfer point Halifax Nova Scotia Space-Time Activity Research variance inflation factor shapefile comma-separated values traveling salesman problem data mining branch-and-bound algorithm pedestrian network alternative route observed route route efficiency route attributes distance time heading bearing duration acceleration latitude longitude coordinate overlay analysis intersect shopping module data logger walk likelihood ratio test classification table path generation kappa statistic degrees data collection transportation research automate framework ArcToolbox spatio-temporal navigation positioning trace path spatial data topology horizontal accuracy SPSS Stata spatial resolution temporal resolution household survey trip reporting proximity analysis DMTI Desktop Mapping Technologies Inc. road intersection route overlap left turn right turn location analysis time geography spatial statistics buffer analysis cycling bus transit public transportation GEOIDE AGILE data need raw data urban canyon endpoint data cleaning elevation satellite outliers automatic processing nearest node classifier classification method short trip multi-point
133	Des soins de qualité pour la dépression en première ligne : une contribution à l’amélioration de l’état de santé de la population québécoise Duhoux, Arnaud 04 1900 (has links) Contexte De nombreuses études, utilisant des indicateurs de qualité variés, ont démontré que la qualité des soins pour la dépression n’est pas optimale en première ligne. Peu de ces études ont examiné les facteurs associés à la réception d’un traitement adéquat, en particulier en tenant compte simultanément des caractéristiques individuelles et organisationnelles. L'association entre un traitement adéquat pour un épisode dépressif majeur (EDM) et une amélioration des symptômes dépressifs n'est pas bien établie dans des conditions non-expérimentales. Les objectifs de cette étude étaient de : 1) réaliser une revue systématique des indicateurs mesurant la qualité du traitement de la dépression en première ligne ; 2) estimer la proportion de patients souffrant d’EDM qui reçoivent un traitement adéquat (selon les guides de pratique clinique) en première ligne ; 3) examiner les caractéristiques individuelles et organisationnelles associées à l’adéquation du traitement pour la dépression ; 4) examiner l'association entre un traitement minimalement adéquat au cours des 12 mois précédents et l'évolution des symptômes dépressifs à 6 et 12 mois. Méthodes La littérature sur la qualité du traitement de la dépression a été examinée en utilisant un ensemble de mots-clés (« depression », « depressive disorder », « quality », « treatment », « indicator », « adequacy », « adherence », « concordance », « clinical guideline » et « guideline ») et « 360search », un moteur de recherche fédérée. Les données proviennent d'une étude de cohorte incluant 915 adultes consultant un médecin généraliste, quel que soit le motif de consultation, répondant aux critères du DSM-IV pour l’EDM dans la dernière année, nichés dans 65 cliniques de première ligne au Québec, Canada. Des analyses multiniveaux ont été réalisées. Résultats Bien que majoritairement développés à partir de guides de pratique clinique, une grande variété d'indicateurs a été observée dans la revue systématique de littérature. La plupart des études retenues ont utilisé des indicateurs de qualité rudimentaires, surtout pour la psychothérapie. Les méthodes utilisées étaient très variées, limitant la comparabilité des résultats. Toutefois, quelque soit la méthode choisie, la plupart des études ont révélé qu’une grande proportion des personnes souffrant de dépression n’ont pas reçu de traitement minimalement adéquat en première ligne. Dans notre échantillon, l’adéquation était élevée (> 75 %) pour un tiers des indicateurs de qualité mesurés, mais était faible (< 60 %) pour près de la moitié des mesures. Un peu plus de la moitié de l'échantillon (52,2 %) a reçu au moins un traitement minimalement adéquat pour la dépression. Au niveau individuel, les jeunes adultes (18-24 ans) et les personnes de plus de 65 ans avaient une probabilité moins élevée de recevoir un traitement minimalement adéquat. Cette probabilité était plus élevée pour ceux qui ont un médecin de famille, une assurance complémentaire, un trouble anxieux comorbide et une dépression plus sévère. Au niveau des cliniques, la disponibilité de la psychothérapie sur place, l'utilisation d'algorithmes de traitement, et le mode de rémunération perçu comme adéquat étaient associés à plus de traitement adéquat. Les résultats ont également montré que 1) la réception d'au moins un traitement minimalement adéquat pour la dépression était associée à une plus grande amélioration des symptômes dépressifs à 6 et à 12 mois; 2) la pharmacothérapie adéquate et la psychothérapie adéquate étaient toutes deux associées à de plus grandes améliorations dans les symptômes dépressifs, et 3) l'association entre un traitement adéquat et l'amélioration des symptômes dépressifs varie en fonction de la sévérité des symptômes au moment de l'inclusion dans la cohorte, un niveau de symptômes plus élevé étant associé à une amélioration plus importante à 6 et à 12 mois. Conclusions Nos résultats suggèrent que des interventions sont nécessaires pour améliorer la qualité du traitement de la dépression en première ligne. Ces interventions devraient cibler des populations spécifiques (les jeunes adultes et les personnes âgées), améliorer l'accessibilité à la psychothérapie et à un médecin de famille, et soutenir les médecins de première ligne dans leur pratique clinique avec des patients souffrant de dépression de différentes façons, telles que le développement des connaissances pour traiter la dépression et l'adaptation du mode de rémunération. Cette étude montre également que le traitement adéquat de la dépression en première ligne est associé à une amélioration des symptômes dépressifs dans des conditions non-expérimentales. / Background Numerous studies, using a variety of quality indicators, highlight an important gap in the quality of care for depression in primary care. Few of these studies examined factors associated with receiving adequate treatment, particularly with a simultaneous consideration of individual and organizational characteristics. The association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The objectives of this study were to i) systematically review indicators used to measure the quality of depression treatment in primary care, ii) estimate the proportion of primary care patients with a MDE who receive adequate treatment, iii) examine the individual and organizational characteristics associated with the receipt of minimally adequate treatment for depression, iv) examine the association between receiving minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6 and 12 months. Methods The literature on the quality of depression treatment was reviewed using a set of keywords (depression, depressive disorder, quality, treatment, indicator, adequacy, adherence, concordance, clinical guideline and guideline) and « 360search », a federated search engine. Data were obtained from a cohort study including 915 adults consulting a general practitioner (GP), regardless of the motive of consultation, meeting DSM-IV criteria for previous-year MDE, and nested within 65 primary care clinics in Quebec, Canada. Multilevel analyses were conducted. Results Though mostly based on recommendations from clinical practice guidelines, a great variety of indicators were observed. Most studies used rudimentary indicators to measure the quality of depression treatment, especially for psychotherapy. Studies also differed greatly with respect to the methods used, thus limiting the comparability of results. However, whatever the chosen method, most studies reveal that a large proportion of people with depression do not receive minimally adequate treatment in primary care settings. In our sample, adherence to guidelines was high (> 75 %) for one third of the quality indicators that were measured but was low (< 60 %) for nearly half of the measures. Just over half of the sample (52.2 %) received at least one minimally adequate treatment for depression. At the individual level, young adults (18-24) et older people (>65) had a lower probability of receiving at least one minimally adequate treatment. This probability was higher for people with a family physician, a supplementary insurance coverage, a comorbid anxiety disorder and a more severe depression. At the clinic level, the availability of psychotherapy on-site, the use of treatment algorithms, and the mode of remuneration perceived as adequate were associated with more adequate treatment. Results also showed that i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months. Conclusions Our findings suggest that interventions are needed to increase the quality of depression treatment in primary care. These interventions should target specific populations (i.e. the younger adults and the elderly), enhance accessibility to psychotherapy and to a regular family physician, and support primary care physicians in their clinical practice with patients suffering from depression in different ways such as developing knowledge to treat depression and adapting mode of remuneration. This study also shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions. Dépression Épisode dépressif majeur Santé mentale Qualité des soins Indicateur de qualité Adéquation du traitement Guide de pratique clinique Analyse multiniveaux Soins de première ligne Depression Major depressive episode Mental health Quality of care Quality indicator Adequacy of treatment Clinical guideline Multilevel analysis Primary care
134	Étude comparative du fonctionnement dans la communauté des jeunes adultes schizophrènes et de leurs pairs sans psychopathologie Roy, Laurence 01 1900 (has links) La schizophrénie est un trouble mental qui touche environ un pour cent de la population et dont les symptômes et troubles associés affectent la capacité des individus à fonctionner dans la communauté. Dans la dernière décennie, des services spécialisés dans la détection et l’intervention précoce dès le premier épisode psychotique ont été implantés dans plusieurs pays. Or, ces services ont surtout ciblé, jusqu’ici, la réduction des symptômes et de la demande de soins. Les difficultés fonctionnelles des jeunes adultes schizophrènes justifient que les services qui leur sont destinés misent également sur la réadaptation et l’amélioration du fonctionnement dans la communauté. Les besoins, priorités et préférences de cette population, ainsi que l’impact des particularités développementales du jeune âge adulte sur leur fonctionnement, sont méconnus. Cette étude propose de documenter le fonctionnement dans la communauté des jeunes adultes schizophrènes au stade du premier épisode psychotique et de le comparer à celui de leurs pairs sans psychopathologie. L’utilisation d’un modèle théorique de réadaptation, le modèle de Compétence, permet de conceptualiser le fonctionnement sous l’angle de la relation personne-environnement. Ce projet s’inscrit dans une approche de recherche synthétique ; le devis préconisé est une étude de cas multiples avec l’utilisation de méthodes mixtes (qualitatives et quantitatives), selon un modèle concurrent de triangulation (Creswell & Plano Clark, 2007). Les résultats mettent en lumière des différences entre les deux groupes dans les domaines des relations sociales et conjugales, du cheminement académique et de l’indépendance résidentielle et financière. Les données qualitatives, analysées selon le modèle de la théorisation ancrée (Glaser & Strauss, 1967), permettent de comprendre les processus sociaux impliqués dans l’accomplissement des tâches développementales au jeune âge adulte, ainsi que les conditions personnelles et systémiques sous-jacentes. Les résultats soulignent l’importance d’adapter les services résidentiels aux particularités développementales, de favoriser le soutien aux études et d’inclure les amis et les pairs dans la réadaptation des personnes touchées. Cette thèse permet à la fois d’identifier les besoins et priorités de cette population, de donner une voix aux jeunes adultes schizophrènes dans l’élaboration des services qui leur sont destinés et d’examiner les enjeux méthodologiques reliés à l’utilisation d’un devis mixte en recherche clinique. / Schizophrenia is a mental health disease that affects approximately one percent of the population and whose symptoms and associated deficits hinder community functioning in affected individuals. Over the last decade, specialized services in early detection and intervention of first-episode psychosis have been implemented in many countries. So far, these services have primarily targeted symptoms and use of psychiatric care as outcomes. The significant functional difficulties experienced by young adults with schizophrenia call for a shift in emphasis towards rehabilitative strategies. No study has documented the needs, preferences and priorities of this population in terms of rehabilitation services and of the influence of developmental characteristics of young adulthood on functional outcome. This study aims to examine community functioning of young adults with schizophrenia after the first episode of psychosis and to compare it with community functioning of their unaffected peers. Community functioning is conceptualized from the perspective of person-environment interaction through the lens of the Model of Competence. A multiple case study is used within the canvas of a synthetic research approach. A concurrent, mixed methods design (qualitative and quantitative) is implemented for triangulation purposes (Creswell & Plano Clark, 2007). Results indicate salient differences between the clinical and comparison groups in the areas of social and conjugal relationships, academic achievement as well as financial and residential independence. Qualitative data analyzed through a grounded theory approach (Glaser & Strauss, 1967) highlight the social processes through which young adults achieve developmental tasks. Personal and systemic conditions that constraint and facilitate processes are recognized. The results have implications for psychiatric practices. First, residential services should be adapted to the developmental characteristics of this age group. Second, supported education should be valued and implemented as a key service for young adults with schizophrenia. Third, friends and members of the social network should be included as early and intensively as possible in the rehabilitation process. Overall, this study leads to methodological innovations in the use of mixed methods in clinical research, to identification of needs and priorities in the design of rehabilitation strategies and to the recognition of the voices and input of young adults with schizophrenia. Développement humain Jeune âge adulte Méthodes mixtes Premier épisode psychotique Psychiatrie Réadaptation Relation personne-environnement Santé mentale Schizophrénie Evidence-based practices First-episode psychosis Human development Mental health Mixed methods Person-environment interaction Psychiatry Rehabilitation Schizophrenia Young adulthood
135	Des soins de qualité pour la dépression en première ligne : une contribution à l’amélioration de l’état de santé de la population québécoise Duhoux, Arnaud 04 1900 (has links) Contexte De nombreuses études, utilisant des indicateurs de qualité variés, ont démontré que la qualité des soins pour la dépression n’est pas optimale en première ligne. Peu de ces études ont examiné les facteurs associés à la réception d’un traitement adéquat, en particulier en tenant compte simultanément des caractéristiques individuelles et organisationnelles. L'association entre un traitement adéquat pour un épisode dépressif majeur (EDM) et une amélioration des symptômes dépressifs n'est pas bien établie dans des conditions non-expérimentales. Les objectifs de cette étude étaient de : 1) réaliser une revue systématique des indicateurs mesurant la qualité du traitement de la dépression en première ligne ; 2) estimer la proportion de patients souffrant d’EDM qui reçoivent un traitement adéquat (selon les guides de pratique clinique) en première ligne ; 3) examiner les caractéristiques individuelles et organisationnelles associées à l’adéquation du traitement pour la dépression ; 4) examiner l'association entre un traitement minimalement adéquat au cours des 12 mois précédents et l'évolution des symptômes dépressifs à 6 et 12 mois. Méthodes La littérature sur la qualité du traitement de la dépression a été examinée en utilisant un ensemble de mots-clés (« depression », « depressive disorder », « quality », « treatment », « indicator », « adequacy », « adherence », « concordance », « clinical guideline » et « guideline ») et « 360search », un moteur de recherche fédérée. Les données proviennent d'une étude de cohorte incluant 915 adultes consultant un médecin généraliste, quel que soit le motif de consultation, répondant aux critères du DSM-IV pour l’EDM dans la dernière année, nichés dans 65 cliniques de première ligne au Québec, Canada. Des analyses multiniveaux ont été réalisées. Résultats Bien que majoritairement développés à partir de guides de pratique clinique, une grande variété d'indicateurs a été observée dans la revue systématique de littérature. La plupart des études retenues ont utilisé des indicateurs de qualité rudimentaires, surtout pour la psychothérapie. Les méthodes utilisées étaient très variées, limitant la comparabilité des résultats. Toutefois, quelque soit la méthode choisie, la plupart des études ont révélé qu’une grande proportion des personnes souffrant de dépression n’ont pas reçu de traitement minimalement adéquat en première ligne. Dans notre échantillon, l’adéquation était élevée (> 75 %) pour un tiers des indicateurs de qualité mesurés, mais était faible (< 60 %) pour près de la moitié des mesures. Un peu plus de la moitié de l'échantillon (52,2 %) a reçu au moins un traitement minimalement adéquat pour la dépression. Au niveau individuel, les jeunes adultes (18-24 ans) et les personnes de plus de 65 ans avaient une probabilité moins élevée de recevoir un traitement minimalement adéquat. Cette probabilité était plus élevée pour ceux qui ont un médecin de famille, une assurance complémentaire, un trouble anxieux comorbide et une dépression plus sévère. Au niveau des cliniques, la disponibilité de la psychothérapie sur place, l'utilisation d'algorithmes de traitement, et le mode de rémunération perçu comme adéquat étaient associés à plus de traitement adéquat. Les résultats ont également montré que 1) la réception d'au moins un traitement minimalement adéquat pour la dépression était associée à une plus grande amélioration des symptômes dépressifs à 6 et à 12 mois; 2) la pharmacothérapie adéquate et la psychothérapie adéquate étaient toutes deux associées à de plus grandes améliorations dans les symptômes dépressifs, et 3) l'association entre un traitement adéquat et l'amélioration des symptômes dépressifs varie en fonction de la sévérité des symptômes au moment de l'inclusion dans la cohorte, un niveau de symptômes plus élevé étant associé à une amélioration plus importante à 6 et à 12 mois. Conclusions Nos résultats suggèrent que des interventions sont nécessaires pour améliorer la qualité du traitement de la dépression en première ligne. Ces interventions devraient cibler des populations spécifiques (les jeunes adultes et les personnes âgées), améliorer l'accessibilité à la psychothérapie et à un médecin de famille, et soutenir les médecins de première ligne dans leur pratique clinique avec des patients souffrant de dépression de différentes façons, telles que le développement des connaissances pour traiter la dépression et l'adaptation du mode de rémunération. Cette étude montre également que le traitement adéquat de la dépression en première ligne est associé à une amélioration des symptômes dépressifs dans des conditions non-expérimentales. / Background Numerous studies, using a variety of quality indicators, highlight an important gap in the quality of care for depression in primary care. Few of these studies examined factors associated with receiving adequate treatment, particularly with a simultaneous consideration of individual and organizational characteristics. The association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The objectives of this study were to i) systematically review indicators used to measure the quality of depression treatment in primary care, ii) estimate the proportion of primary care patients with a MDE who receive adequate treatment, iii) examine the individual and organizational characteristics associated with the receipt of minimally adequate treatment for depression, iv) examine the association between receiving minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6 and 12 months. Methods The literature on the quality of depression treatment was reviewed using a set of keywords (depression, depressive disorder, quality, treatment, indicator, adequacy, adherence, concordance, clinical guideline and guideline) and « 360search », a federated search engine. Data were obtained from a cohort study including 915 adults consulting a general practitioner (GP), regardless of the motive of consultation, meeting DSM-IV criteria for previous-year MDE, and nested within 65 primary care clinics in Quebec, Canada. Multilevel analyses were conducted. Results Though mostly based on recommendations from clinical practice guidelines, a great variety of indicators were observed. Most studies used rudimentary indicators to measure the quality of depression treatment, especially for psychotherapy. Studies also differed greatly with respect to the methods used, thus limiting the comparability of results. However, whatever the chosen method, most studies reveal that a large proportion of people with depression do not receive minimally adequate treatment in primary care settings. In our sample, adherence to guidelines was high (> 75 %) for one third of the quality indicators that were measured but was low (< 60 %) for nearly half of the measures. Just over half of the sample (52.2 %) received at least one minimally adequate treatment for depression. At the individual level, young adults (18-24) et older people (>65) had a lower probability of receiving at least one minimally adequate treatment. This probability was higher for people with a family physician, a supplementary insurance coverage, a comorbid anxiety disorder and a more severe depression. At the clinic level, the availability of psychotherapy on-site, the use of treatment algorithms, and the mode of remuneration perceived as adequate were associated with more adequate treatment. Results also showed that i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months. Conclusions Our findings suggest that interventions are needed to increase the quality of depression treatment in primary care. These interventions should target specific populations (i.e. the younger adults and the elderly), enhance accessibility to psychotherapy and to a regular family physician, and support primary care physicians in their clinical practice with patients suffering from depression in different ways such as developing knowledge to treat depression and adapting mode of remuneration. This study also shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions. Dépression Épisode dépressif majeur Santé mentale Qualité des soins Indicateur de qualité Adéquation du traitement Guide de pratique clinique Analyse multiniveaux Soins de première ligne Depression Major depressive episode Mental health Quality of care Quality indicator Adequacy of treatment Clinical guideline Multilevel analysis Primary care
136	L’itinérance chez une cohorte de jeunes adultes avec premier épisode psychotique : étude comparative à 2 ans de l’impact de l’itinérance sur l’évolution fonctionnelle et symptomatique Lévesque, Isabelle Sarah 10 1900 (has links) No description available. itinérance jeunes itinérants troubles mentaux sévères psychose premier épisode psychotique schizophrénie toxicomanie évolution fonctionnelle évolution symptomatique psychiatrie homelessness homeless youth severe mental disorders psychosis first-episode psychosis schizophrenia substance-related disorders outcome psychiatry
137	Avaliação longitudinal de alterações microestruturais cerebrais estado-dependentes em indivíduos com primeiro episódio psicótico, associadas à atividade da enzima fosfolipase A2 / Longitudinal evaluation of state-dependent microstructural brain abnormalities in first-episode psychosis patients, associated to the activity of phospholipase a2 enzyme Serpa, Mauricio Henriques 10 March 2017 (has links) INTRODUÇÃO: Os transtornos mentais psicóticos são condições frequentes na população geral e estão associados a grande morbidade e disfuncionalidade. Apesar disso, as bases fisiopatológicas destes transtornos ainda estão em investigação. Estudos neuropatológicos post-mortem e de neuroimagem in vivo sugerem haver comprometimento da microestrutura de substância branca (SB) cerebral nestas condições clínicas, associado a alterações da conectividade cerebral. No entanto, nenhuma investigação prévia de neuroimagem avaliou especificamente se tais anormalidades microestruturais podem ser dependentes do estado clínico do paciente, i.e., se tais alterações podem variar de acordo com a fase da doença. Outra linha de investigação biológica em psicoses aponta para alterações na atividade da fosfolipase A2 (PLA2), uma enzima essencial a diversas funções na homeostase cerebral, incluindo manutenção de membrana celular, mielinização e atividade inflamatória. Estudos prévios sugerem haver relação entre alterações na atividade desta enzima e as fases da esquizofrenia. Entretanto, não há estudos translacionais que tenham avaliado como tais alterações se relacionam com anormalidades microestruturais de SB em pacientes psicóticos. OBJETIVOS: Investigar a hipótese de que alterações de microestrutura de SB presentes em pacientes em fase aguda do primeiro episódio psicótico (PEP) sejam potencialmente reversíveis após estabilização clínica; investigar também possíveis alterações estado-dependentes da atividade de PLA2 no PEP; e examinar interações entre manifestações clínicas, microestrutura de SB cerebral e atividade de PLA2 na fisiopatologia do PEP. METODOLOGIA: Pacientes em PEP não afetivo foram avaliados em dois períodos no tempo: durante a fase aguda da doença (T0); após remissão estável de sintomas (T1). Um grupo controle de voluntários saudáveis (CS) também foi avaliado longitudinalmente. Para investigar alterações de microestrutura de SB estado-dependentes, análises voxel-a-voxel de mapas cerebrais de índices de anisotropia (fractional anisotropy, FA) e difusividade (trace, TR) foram conduzidas, assim como o cálculo de correlações entre tais índices de DTI, variáveis clínicas e atividade de PLA2. A atividade dos três principais subgrupos de PLA2 em plaquetas foi estimada através de um método radioenzimático. RESULTADOS: 25 pacientes PEP e 51 CS foram avaliados em T0, com coleta de dados clínico-demográficos, ressonância magnética (RM) e amostra de sangue. Destes, 21 PEP e 36 CS realizaram a segunda aquisição de RM. No baseline (T0), os pacientes PEP apresentaram redução difusa de FA (p < 0,05, FDR), afetando principalmente SB fronto-límbica e fascículos associativos, projetivos e comissurais. As análises longitudinais demonstraram que a remissão clínica se associou a aumentos de FA em tratos de SB acometidos em T0 (p < 0,001, não corrigido), além de robustas correlações inversas entre aumentos de FA e redução sintomas ao longo do tempo (p < 0,05, FDR). As análises de PLA2 não demostraram efeitos estado-dependentes ou correlações consistentes com os índices de DTI. CONCLUSÃO: Alterações da microestrutura de SB afetando tratos cerebrais essenciais para a integração de informação perceptual, cognição e emoções são detectáveis logo após o início do PEP e podem ser parcialmente revertidas em relação direta com a remissão de sintomas psicóticos agudos. Nossos achados reforçam a visão de que anormalidades de SB de tratos cerebrais são um componente neurobiológico central nos transtornos psicóticos agudos, e que a recuperação de tal patologia de SB pode levar à melhora clínica. Por outro lado, a atividade de PLA2 não parece ter associação direta com o estado de doença ou moderar as alterações microestruturais dinâmicas de SB aqui observadas. Estudos com amostras maiores e com um maior número de avaliações ao longo do tempo são necessários para confirmar e ampliar os resultados aqui apresentados / INTRODUCTION: Psychotic disorders are frequent conditions in the general population and are associated to severe morbidity and functional impairment. Notwithstanding, the pathophysiological basis of such disorders is still under investigation. Post-mortem neuropathologic investigations and in vivo neuroimaging studies have pointed to the occurrence of abnormalities in the microstructure of brain white matter (WM) in such clinical conditions, which are associated to changes in brain connectivity. However, no previous neuroimaging investigation has specifically examined whether such microstructural abnormalities would be state-dependent, i.e., whether such changes could relate to the illness phase. Another field of biological investigation in psychosis points to changes in the activity of phospholipase A2 enzyme (PLA2), which is essential to several functions implicated in brain homeostasis, such as the maintenance of cellular membrane, myelination and inflammatory activity. Previous studies suggest the existence of a relationship between changes on PLA2 activity and schizophrenia phase. Nonetheless, no translational study to date has examined the potential interplay between PLA2 activity and WM microstructural abnormalities in psychotic patients. OBJECTIVES: To investigate the hypothesis that WM microstructural changes observed in patients during the acute first-episode psychosis (FEP) are potentially reversible following clinical remission; to investigate possible state-dependent changes in PLA2 activity in FEP; and to examine interactions between clinical manifestations, brain WM microstructure and PLA2 activity in the pathophysiology of FEP. METODOLOGY: Patients with non-affective FEP were evaluated in two time points: during the acute phase (T0) and following sustained remission (T1). A control group of healthy volunteers (HC) was also longitudinally studied. In order to investigate state-dependent WM microstructure changes, voxelwise analyses of brain maps of anisotropy (fractional anisotropy, FA) and diffusivity (trace, TR) indexes were conducted, as well as correlations between such DTI metrics, clinical variables and PLA2 activity. The activity of the three main PLA2 subgroups was assessed in platelets using a radioenzymatic method. RESULTS: 25 FEP and 51 HC were evaluated at T0 (clinical and demographic data, MRI scanning, and blood collection). Out of these, 21 FEP and 36 HC also underwent a second MRI acquisition. At baseline (T0), FEP patients presented widespread reduction of FA (p < 0.05, FDR), affecting mainly fronto-limbic WM and associative, projective and commissural fasciculi. Longitudinal analyses showed that clinical remission was associated with FA increase in WM tracts that were affected at T0 (p < 0.001, uncorrected), besides robust inverse correlations between FA increase and symptoms reduction over time (p < 0.05, FDR). PLA2 analyses failed to show state-dependent effects or consistent correlations to DTI indexes. CONCLUSION: WM changes affecting brain tracts critical to the integration of perceptual information, cognition and emotions are detectable soon after the onset of FEP and may partially reverse in direct relation to the remission of acute psychotic symptoms. Our findings reinforce the view that WM abnormalities are a key neurobiological feature of acute psychotic disorders, and that recovery from such WM pathology can lead to amelioration of symptoms. In the other hand, it seems that PLA2 activity has no direct relationship to the disease state or modulatory effects on the dynamic WM changes observed herein. Studies with larger samples and with more time points evaluations are necessary to confirm and expand the findings reported herein Brain Diffusion magnetic resonance imaging Encéfalo Esquizofrenia Estudos longitudinais First-episode psychosis Fosfolipases A2 Fosfolipídeos Imagem por ressonância magnética Longitudinal studies Magnetic resonance imaging Phospholipase A2 Phospholipids Primeiro episódio psicótico Psychotic disorders Schizophrenia Substância branca Transtornos psicóticos White matter
138	Avaliação longitudinal de alterações microestruturais cerebrais estado-dependentes em indivíduos com primeiro episódio psicótico, associadas à atividade da enzima fosfolipase A2 / Longitudinal evaluation of state-dependent microstructural brain abnormalities in first-episode psychosis patients, associated to the activity of phospholipase a2 enzyme Mauricio Henriques Serpa 10 March 2017 (has links) INTRODUÇÃO: Os transtornos mentais psicóticos são condições frequentes na população geral e estão associados a grande morbidade e disfuncionalidade. Apesar disso, as bases fisiopatológicas destes transtornos ainda estão em investigação. Estudos neuropatológicos post-mortem e de neuroimagem in vivo sugerem haver comprometimento da microestrutura de substância branca (SB) cerebral nestas condições clínicas, associado a alterações da conectividade cerebral. No entanto, nenhuma investigação prévia de neuroimagem avaliou especificamente se tais anormalidades microestruturais podem ser dependentes do estado clínico do paciente, i.e., se tais alterações podem variar de acordo com a fase da doença. Outra linha de investigação biológica em psicoses aponta para alterações na atividade da fosfolipase A2 (PLA2), uma enzima essencial a diversas funções na homeostase cerebral, incluindo manutenção de membrana celular, mielinização e atividade inflamatória. Estudos prévios sugerem haver relação entre alterações na atividade desta enzima e as fases da esquizofrenia. Entretanto, não há estudos translacionais que tenham avaliado como tais alterações se relacionam com anormalidades microestruturais de SB em pacientes psicóticos. OBJETIVOS: Investigar a hipótese de que alterações de microestrutura de SB presentes em pacientes em fase aguda do primeiro episódio psicótico (PEP) sejam potencialmente reversíveis após estabilização clínica; investigar também possíveis alterações estado-dependentes da atividade de PLA2 no PEP; e examinar interações entre manifestações clínicas, microestrutura de SB cerebral e atividade de PLA2 na fisiopatologia do PEP. METODOLOGIA: Pacientes em PEP não afetivo foram avaliados em dois períodos no tempo: durante a fase aguda da doença (T0); após remissão estável de sintomas (T1). Um grupo controle de voluntários saudáveis (CS) também foi avaliado longitudinalmente. Para investigar alterações de microestrutura de SB estado-dependentes, análises voxel-a-voxel de mapas cerebrais de índices de anisotropia (fractional anisotropy, FA) e difusividade (trace, TR) foram conduzidas, assim como o cálculo de correlações entre tais índices de DTI, variáveis clínicas e atividade de PLA2. A atividade dos três principais subgrupos de PLA2 em plaquetas foi estimada através de um método radioenzimático. RESULTADOS: 25 pacientes PEP e 51 CS foram avaliados em T0, com coleta de dados clínico-demográficos, ressonância magnética (RM) e amostra de sangue. Destes, 21 PEP e 36 CS realizaram a segunda aquisição de RM. No baseline (T0), os pacientes PEP apresentaram redução difusa de FA (p < 0,05, FDR), afetando principalmente SB fronto-límbica e fascículos associativos, projetivos e comissurais. As análises longitudinais demonstraram que a remissão clínica se associou a aumentos de FA em tratos de SB acometidos em T0 (p < 0,001, não corrigido), além de robustas correlações inversas entre aumentos de FA e redução sintomas ao longo do tempo (p < 0,05, FDR). As análises de PLA2 não demostraram efeitos estado-dependentes ou correlações consistentes com os índices de DTI. CONCLUSÃO: Alterações da microestrutura de SB afetando tratos cerebrais essenciais para a integração de informação perceptual, cognição e emoções são detectáveis logo após o início do PEP e podem ser parcialmente revertidas em relação direta com a remissão de sintomas psicóticos agudos. Nossos achados reforçam a visão de que anormalidades de SB de tratos cerebrais são um componente neurobiológico central nos transtornos psicóticos agudos, e que a recuperação de tal patologia de SB pode levar à melhora clínica. Por outro lado, a atividade de PLA2 não parece ter associação direta com o estado de doença ou moderar as alterações microestruturais dinâmicas de SB aqui observadas. Estudos com amostras maiores e com um maior número de avaliações ao longo do tempo são necessários para confirmar e ampliar os resultados aqui apresentados / INTRODUCTION: Psychotic disorders are frequent conditions in the general population and are associated to severe morbidity and functional impairment. Notwithstanding, the pathophysiological basis of such disorders is still under investigation. Post-mortem neuropathologic investigations and in vivo neuroimaging studies have pointed to the occurrence of abnormalities in the microstructure of brain white matter (WM) in such clinical conditions, which are associated to changes in brain connectivity. However, no previous neuroimaging investigation has specifically examined whether such microstructural abnormalities would be state-dependent, i.e., whether such changes could relate to the illness phase. Another field of biological investigation in psychosis points to changes in the activity of phospholipase A2 enzyme (PLA2), which is essential to several functions implicated in brain homeostasis, such as the maintenance of cellular membrane, myelination and inflammatory activity. Previous studies suggest the existence of a relationship between changes on PLA2 activity and schizophrenia phase. Nonetheless, no translational study to date has examined the potential interplay between PLA2 activity and WM microstructural abnormalities in psychotic patients. OBJECTIVES: To investigate the hypothesis that WM microstructural changes observed in patients during the acute first-episode psychosis (FEP) are potentially reversible following clinical remission; to investigate possible state-dependent changes in PLA2 activity in FEP; and to examine interactions between clinical manifestations, brain WM microstructure and PLA2 activity in the pathophysiology of FEP. METODOLOGY: Patients with non-affective FEP were evaluated in two time points: during the acute phase (T0) and following sustained remission (T1). A control group of healthy volunteers (HC) was also longitudinally studied. In order to investigate state-dependent WM microstructure changes, voxelwise analyses of brain maps of anisotropy (fractional anisotropy, FA) and diffusivity (trace, TR) indexes were conducted, as well as correlations between such DTI metrics, clinical variables and PLA2 activity. The activity of the three main PLA2 subgroups was assessed in platelets using a radioenzymatic method. RESULTS: 25 FEP and 51 HC were evaluated at T0 (clinical and demographic data, MRI scanning, and blood collection). Out of these, 21 FEP and 36 HC also underwent a second MRI acquisition. At baseline (T0), FEP patients presented widespread reduction of FA (p < 0.05, FDR), affecting mainly fronto-limbic WM and associative, projective and commissural fasciculi. Longitudinal analyses showed that clinical remission was associated with FA increase in WM tracts that were affected at T0 (p < 0.001, uncorrected), besides robust inverse correlations between FA increase and symptoms reduction over time (p < 0.05, FDR). PLA2 analyses failed to show state-dependent effects or consistent correlations to DTI indexes. CONCLUSION: WM changes affecting brain tracts critical to the integration of perceptual information, cognition and emotions are detectable soon after the onset of FEP and may partially reverse in direct relation to the remission of acute psychotic symptoms. Our findings reinforce the view that WM abnormalities are a key neurobiological feature of acute psychotic disorders, and that recovery from such WM pathology can lead to amelioration of symptoms. In the other hand, it seems that PLA2 activity has no direct relationship to the disease state or modulatory effects on the dynamic WM changes observed herein. Studies with larger samples and with more time points evaluations are necessary to confirm and expand the findings reported herein Encéfalo Esquizofrenia Estudos longitudinais Fosfolipases A2 Fosfolipídeos Imagem por ressonância magnética Primeiro episódio psicótico Substância branca Transtornos psicóticos Brain Diffusion magnetic resonance imaging First-episode psychosis Longitudinal studies Magnetic resonance imaging Phospholipase A2 Phospholipids Psychotic disorders Schizophrenia White matter
139	Étude comparative du fonctionnement dans la communauté des jeunes adultes schizophrènes et de leurs pairs sans psychopathologie Roy, Laurence 01 1900 (has links) La schizophrénie est un trouble mental qui touche environ un pour cent de la population et dont les symptômes et troubles associés affectent la capacité des individus à fonctionner dans la communauté. Dans la dernière décennie, des services spécialisés dans la détection et l’intervention précoce dès le premier épisode psychotique ont été implantés dans plusieurs pays. Or, ces services ont surtout ciblé, jusqu’ici, la réduction des symptômes et de la demande de soins. Les difficultés fonctionnelles des jeunes adultes schizophrènes justifient que les services qui leur sont destinés misent également sur la réadaptation et l’amélioration du fonctionnement dans la communauté. Les besoins, priorités et préférences de cette population, ainsi que l’impact des particularités développementales du jeune âge adulte sur leur fonctionnement, sont méconnus. Cette étude propose de documenter le fonctionnement dans la communauté des jeunes adultes schizophrènes au stade du premier épisode psychotique et de le comparer à celui de leurs pairs sans psychopathologie. L’utilisation d’un modèle théorique de réadaptation, le modèle de Compétence, permet de conceptualiser le fonctionnement sous l’angle de la relation personne-environnement. Ce projet s’inscrit dans une approche de recherche synthétique ; le devis préconisé est une étude de cas multiples avec l’utilisation de méthodes mixtes (qualitatives et quantitatives), selon un modèle concurrent de triangulation (Creswell & Plano Clark, 2007). Les résultats mettent en lumière des différences entre les deux groupes dans les domaines des relations sociales et conjugales, du cheminement académique et de l’indépendance résidentielle et financière. Les données qualitatives, analysées selon le modèle de la théorisation ancrée (Glaser & Strauss, 1967), permettent de comprendre les processus sociaux impliqués dans l’accomplissement des tâches développementales au jeune âge adulte, ainsi que les conditions personnelles et systémiques sous-jacentes. Les résultats soulignent l’importance d’adapter les services résidentiels aux particularités développementales, de favoriser le soutien aux études et d’inclure les amis et les pairs dans la réadaptation des personnes touchées. Cette thèse permet à la fois d’identifier les besoins et priorités de cette population, de donner une voix aux jeunes adultes schizophrènes dans l’élaboration des services qui leur sont destinés et d’examiner les enjeux méthodologiques reliés à l’utilisation d’un devis mixte en recherche clinique. / Schizophrenia is a mental health disease that affects approximately one percent of the population and whose symptoms and associated deficits hinder community functioning in affected individuals. Over the last decade, specialized services in early detection and intervention of first-episode psychosis have been implemented in many countries. So far, these services have primarily targeted symptoms and use of psychiatric care as outcomes. The significant functional difficulties experienced by young adults with schizophrenia call for a shift in emphasis towards rehabilitative strategies. No study has documented the needs, preferences and priorities of this population in terms of rehabilitation services and of the influence of developmental characteristics of young adulthood on functional outcome. This study aims to examine community functioning of young adults with schizophrenia after the first episode of psychosis and to compare it with community functioning of their unaffected peers. Community functioning is conceptualized from the perspective of person-environment interaction through the lens of the Model of Competence. A multiple case study is used within the canvas of a synthetic research approach. A concurrent, mixed methods design (qualitative and quantitative) is implemented for triangulation purposes (Creswell & Plano Clark, 2007). Results indicate salient differences between the clinical and comparison groups in the areas of social and conjugal relationships, academic achievement as well as financial and residential independence. Qualitative data analyzed through a grounded theory approach (Glaser & Strauss, 1967) highlight the social processes through which young adults achieve developmental tasks. Personal and systemic conditions that constraint and facilitate processes are recognized. The results have implications for psychiatric practices. First, residential services should be adapted to the developmental characteristics of this age group. Second, supported education should be valued and implemented as a key service for young adults with schizophrenia. Third, friends and members of the social network should be included as early and intensively as possible in the rehabilitation process. Overall, this study leads to methodological innovations in the use of mixed methods in clinical research, to identification of needs and priorities in the design of rehabilitation strategies and to the recognition of the voices and input of young adults with schizophrenia. Développement humain Jeune âge adulte Méthodes mixtes Premier épisode psychotique Psychiatrie Réadaptation Relation personne-environnement Santé mentale Schizophrénie Evidence-based practices First-episode psychosis Human development Mental health Mixed methods Person-environment interaction Psychiatry Rehabilitation Schizophrenia Young adulthood
140	Parcours d'entrée en vie féconde des femmes au Burkina Faso : une analyse séquentielle Vergara Marroquin, Daniel 08 1900 (has links) Alors que dans les sociétés de l’Afrique de l’Ouest, le mariage représente traditionnellement le point de départ de la séquence des événements démographiques associés à la formation de la famille, aujourd’hui cette séquence s’est complexifiée. Suite à l’effritement des modes traditionnels du passage à l’âge adulte, les jeunes citadins reportent leur mariage, le contexte de l’initiation sexuelle est plus fréquemment prénuptial et le nombre de naissances hors mariage semble augmenter. Peu d’études se sont penchées sur l’analyse de la séquence de ces événements sous l’angle du parcours individuel. L’objectif central de ce mémoire est d’explorer, de décrire et d’expliquer les changements survenus dans les parcours d’entrée en vie féconde des femmes durant leur jeunesse en utilisant comme unité d’analyse l’entièreté des parcours. Utilisant les données EDS du Burkina Faso, nous synthétisons en parcours, sous forme des séquences d’épisodes, les calendriers du premier rapport sexuel, de la première union et de la première naissance. Avec l’analyse séquentielle, nous identifions quatre catégories de parcours : nuptial, sexualité prénuptiale, maternité prénuptiale et célibataires. La méthode permet également une catégorisation plus fine des parcours et une visualisation de modèles de transitions. Nous analysons ensuite l’association entre les caractéristiques individuelles et les parcours suivis grâce à des modèles multinomiaux. Nos résultats confirment l’augmentation des parcours non nuptiaux auprès des jeunes. De plus, ils montrent qu’un niveau de scolarité plus élevé augmente la probabilité de suivre un parcours non-traditionnel, notamment chez les femmes urbaines, le milieu de socialisation à l’enfance ayant aussi un effet sur le choix du parcours. / In West African societies, marriage has traditionally represented the first step of the sequence of demographic events regarding the formation of the family. Currently, this sequence has become more complex. Following the erosion of traditional patterns of entrance into adulthood, urban youth tend to delay marriage, to increasingly engage in premarital sex while premarital births among youth seem to rise. Our study considers demographic life courses of entry into reproductive life as individual sequences of states. The main purpose of this study is to explore, describe and explain changes in young women’s sequences of entry in reproductive life using individual sequences as the unit of analysis. Using data from the 2003 Demographic and Health Survey of Burkina Faso, we synthesize the timing of first sexual intercourse, first union and first birth into sequences. Using Sequence Analysis methods, we identify four main categories of entrance in reproductive life: marital, premarital sex, premarital childbearing and singles. These methods allow a finer classification and a visualization of complete sequences and their transition patterns. We then analyze the association between individual characteristics and the sequence that women follow. Our results confirm that non-traditional sequences rise among younger generations. We also show that while women’s years of instruction increase, the probability of starting a sequence by premarital sex rises and the probability of starting a sequence by a marriage falls dramatically. Finally the childhood place of residence seems to moderate these effects by increasing the probability to follow a non-traditional sequence for urban women. / En las sociedades del Africa subsahariano el matrimonio representa tradicionialmente el inicio de la secuencia de eventos demográficos asociados a la formación de la familia, pero esta secuencia ha sufrido transformaciones. Como consecuencia de la erosión de los modelos tradicionales del paso a la edad adulta, los jovenes citadinos tienden a retardar el casamiento, el contexto de la primera relación sexual es cada vez mas prenupcial y los nacimientos prenupciales han aumentado. Pocos estudios han analizado la secuencia estos eventos bajo la perspectiva del curso de vida individual. El objetivo central de este estudio es explorar, describir y explicar los cambios en la secuencia de la entrada a la vida fecunda empleando las secuencias de episodios completas como las unidades de análisis. Utilizando los datos de la EDSBF-2003, sintetizamos en secuencias individuales los calendarios de la primera relación sexual, de la primera unión y del primer nacimiento. A traves del análisis secuencial, identificamos cuatro tipologías: nupcial, sexualidad prenupcial,maternidad prenupcial y solteras. Obtenemos una clasificación mas fina de las secuencias al visualizar distintos modelos de transición. Empleando un modelo multinomial analizamos la asociación entre las características de los individuos y las secuencias. Nuestros resultados confirman que las secuencias no nupciales ganan terreno en las generaciones mas jóvenes. Además, un nivel de escolaridad mas elevado aumenta la probabilidad de empezar una secuencia con una relación sexual. El medio de socialización en la infancia modera estos efectos, ya que las mujeres urbanas tienen una probabilidad mas elevada que las rurales de seguir una secuencia no nupcial. Entrée en vie féconde Entrance into reproductive life Analyse séquentielle Sequence analysis Parcours Lifecourse Burkina Faso Burkina Faso Initiation sexuelle First sexual intercourse Première naissance First birth Première union First union Afrique de l'ouest West Africa Épisode Episode Classification Classification Séquence Sequence Modèle de transition Transition patterns

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