Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.

Dans la première partie de cette thèse, nous avons mis en place un métamodèle de transmission du paludisme basé sur la modélisation compartimentale susceptible-infecté-résistant (SIR) et prenant en compte les flux de mobilité humaine entre différents villages du Centre Sénégal. Les stratégies d’intervention géographiquement ciblées, s’étaient avérées efficaces pour réduire l’incidence du paludisme aussi bien dans les zones d’intervention qu’à l’extérieur de ces zones. Cependant, des actions combinées ciblant à la fois le vecteur et l’hôte, coordonnées à large échelle sont nécessaires dans les régions et pays visant l’élimination du paludisme à court/moyen terme.Dans la deuxième partie nous avons évalué différentes méthodes d’estimation de la mobilité humaine en l’absence de données individuelles. Ces méthodes incluaient la traçabilité spatio-temporelle des téléphones mobiles ainsi que les modèles mathématiques de gravité et de radiation. Le transport de l’agent pathogène dans l’espace géographique, par la mobilité d’un sujet infecté est un déterminant majeur de la vitesse de propagation d’une épidémie. Nous avons introduit le modèle d’impédance qui minimise l’erreur quadratique moyen sur les estimations de mobilité, en particulier dans les contextes où les ensembles de population sont caractérisés par leurs tailles hétérogènes.Nous avons enfin élargi le cadre des hypothèses sous-jacentes à la calibration des modèles de gravité de la mobilité humaine. L’hypothèse d’une distribution avec excès de zéros a fourni un meilleur ajustement et une meilleure prédictibilité, comparée aux hypothèses classiques n’assumant pas un excès de zéros : Poisson, Quasipoisson. / In the first part of this thesis, we have developed a malaria transmission metamodel based on the susceptible-infected-resistant compartmental modeling framework (SIR) and taking into consideration human mobility flows between different villages in the Center of Senegal. Geographically targeted intervention strategies had been shown to be effective in reducing the incidence of malaria both within and outside of intervention areas. However, combined interventions targeting both vector and host, coordinated on a large scale are needed in regions and countries aiming to achieve malaria elimination in the short/medium term.In the second part we have evaluated different methods of estimating human mobility in the absence of real data. These methods included spatio-temporal traceability of mobile phones, mathematical models of gravity and radiation. The transport of the pathogen through the geographical space via the mobility of an infected subject is a major determinant of the spread of an epidemic. We introduced the impedance model that minimized the mean square error on mobility estimates, especially in contexts where population sets are characterized by their heterogeneous sizes.Finally, we have expanded the framework of assumptions underlying the calibration of the gravity models of human mobility. The hypothesis of a zero inflated distribution provided a better fit and a better predictability, compared to the classical approach not assuming an excess of zeros: Poisson, Quasipoisson.