The objective of this study is to test if the hypothesis of the environmental gerontology theory can be applied to a cross-cultural environment. This study examined the applicability and functionality of the Multiphasic Environmental Assessment Procedure (MEAP), a tool based on the environmental gerontology theory, and assessed the quality of elderly care facilities in Taiwan. Special emphasis was placed in examining the functionality of the MEAP from the cross-cultural standpoint and also in identifying the associations or potential impacting factors of care quality. This is the first study with the application of the MEAP to examine the quality of the two major care facilities in Taiwan. Results of this study provide not only an insight into the characteristics of the elderly care facilities ,and a reference for policy making and regulation, but also valuable data for cross-cultural comparisons. The study employed the MEAP to achieve the stated objectives and further evaluated the differences in the characteristics of the two major elderly care facilities, namely the nursing homes and assisted-living facilities in Kaohsiung city in Taiwan. This cross-sectional research was conducted with questionnaires by 687 employees (excluding foreign workers) and 429 residents in 35 nursing homes and 41 assisted living facilities in Kaohsiung city were interviewed. Participants were selected from residents who were conscious and without cognitive disorder for face-to-face questionnaire interviews. For facilities with ten or more residents, 50% of the eligible residents were selected for this interview. For facilities having less than ten residents, all those qualified residents were interviewed. Results were analyzed on the basis of institutional units rather than the individual basis. Results showed that the MEAP effectively evaluated the associations of the multiple environmental factors with the quality of life of the two major elderly care facilities in Kaohsiung city. Standardized multiple quality indexes mode showed that the assisted-living facilities have better overall quality than nursing homes do. The major findings are: 1.The major residents of elderly care facilities in Kaohsiung city were the socioeconomically less privileged residents, including house wifes, the disabled, and widowed. The service most needed was personal care such as bathing. 2.Based on the MEAP, a total of eight significant variables were compared between nursing homes and assisted living facilities. Among these variables, nursing homes were better in staff resource than that of the assisted living facilities. Assisted-living facilities were better in all other seven variables including functional abilities, activities in community, acceptance of problem behavior, physical amenities, social-recreational aids, and orientational aids and staff facilities. 3.The staff members of both nursing homes and assisted living facilities have better SCES than that of their residents. 4.Compared to assisted living facilities, the nursing homes were superior in staff level and staff resources but inferior in comfort, security, and control. No differences were observed in services, autonomy, rapport and morale. 5.The characteristics of organizational management, such as ownership, type and size, were important impacting factors of care quality. The nonprofit-nursing homes were better scored in six of the eight quality indexes than the ones owned by privately-for-profit. 6.Factors that influenced the quality of the nursing homes include number of workers, number of beds, number of residents, ownership, functional abilities, actively level, activities in community, occupancy rate and type of elderly care facility. 7.Factors that influenced the quality of assisted living facilities include occupancy rate, number of residents, number of workers, activity level and type of elderly care facility. 8.The regression model for the outcome of multiple environmental quality indexes with the structure and process indexes is related in nursing homes. The regression model indicates that the model significantly predicted outcome quality index (morale) (R2 = 49.4%). Both structure quality index (comfort and safety) and process quality index (autonomy and rapport) were significant predicting factors of outcome quality index (morale). Autonomy was a negative predicting factor. 9.Standardized multiple environmental quality index indicated that based on the MEAP, assisted living facilities had a little bit higher quality than that of nursing homes in Kaohsiung city. In conclusion, this study confirmed the hypothesis that the MEAP can be applied effectively to evaluate the quality of elderly care facilities in a cross-cultural environment. However, cultural differences do have an impact on the functionality of the tool. Results of this study indicate that the two major elderly care facilities in Kaohsiung city have relatively similar characteristics, but the assisted living facilities are slightly better in overall quality than that of nursing homes. The major factors that impact the quality of elderly care facilities are the operational characteristics and efficience. Results of this study indicate that the MEAP provides very useful indicators for assessing the quality of elderly care facilities in Taiwan, especially for nursing homes. The MEAP identified more structure and process-related impacting factors than outcome-related impacting factors in this study. Concerning cultural difference, the MEAP could be benefited from some modification in certain measurements, especially in facility atmosphere(SCES), when applied in Taiwan.

Genetic and environmental factors interact to determine the individual vulnerability to develop ethanol dependence. The neurobiological mechanisms underlying these processes are not fully understood. Endogenous opioid peptides have been suggested to contribute. Brain opioids mediate ethanol reward and reinforcement via actions on the mesocorticolimbic dopamine system. This thesis focuses on environmental factors and investigates the impact of the early-life environment on adult voluntary ethanol consumption. The possible involvement of opioid peptides in environmental influences on adult ethanol consumption was examined using an experimental animal model. Maternal separation with short 15 min separations (MS15) was used to simulate a safe environment whereas prolonged 360 min separations (MS360) simulated an unsafe environment. Control rats were subjected to normal animal facility rearing (AFR). The separations were performed daily from postnatal day 1 to 21. Long-term ethanol consumption was registered using a two-bottle or a four-bottle free-choice paradigm in adult male and female ethanol-preferring AA (Alko, Alcohol), ethanol-avoiding ANA (Alko, Non-Alcohol) and non-preferring Wistar rats. In addition, analyses of immunoreactive Met-enkephalin-Arg6Phe7 (MEAP), dynorphin B (DYNB) and nociceptin/orphanin FQ (N/OFQ) peptide levels were performed after maternal separation as well as after voluntary ethanol drinking. In male rats, MS15 was related to lower ethanol consumption and these rats preferred lower concentrations, whereas MS360 was associated with an increased risk for higher consumption and/or preference for higher ethanol concentrations. Differences in basal opioid levels were observed in MS15 and MS360 rats. Furthermore, the ethanol-induced effects on opioid peptides in adults were dependent on the early environment. Female rats, on the other hand, were less affected or unaffected by maternal separation both in terms of ethanol consumption and neurobiological effects. Taken together, voluntary ethanol drinking, preference for low or high ethanol concentrations and opioid peptides in brain areas related to reward and reinforcement, motivation and stress were influenced by postnatal maternal separation in a sex dependent manner. The early environment thus had profound impact on the adult brain and the individual propensity for high ethanol drinking. A deranged endogenous opioid system contributed to these effects and may act as a mediator for long-term environmental influence on voluntary ethanol consumption.

Les amibes sont des organismes unicellulaires eucaryotes, de 10 à 300 µm, pouvant vivre sous forme parasite ou évoluer librement dans les sols et les milieux aquatiques ou encore adopter l’une ou l’autre forme en fonction de l’environnement. Certaines amibes libres sont hautement pathogènes pour les animaux et l’homme, en particulier Naegleria fowleri qui se développe dans les eaux naturellement chaudes à des températures comprises entre 27 et 45°C. Cette espèce est responsable d'une encéphalite généralement mortelle, la méningo-encéphalite amibienne primitive (MEAP), dont un cas a été recensé en Guadeloupe en 2008. Un enfant de 9 ans ayant contracté la maladie est décédé quelques jours après un bain dans les eaux chaudes de Dolé, sur la commune de Gourbeyre. Notre travail de Thèse à l’Institut Pasteur, en collaboration avec l’ARS, a permis d’initier un programme de recherche sur ces amibes pathogènes très peu connues sur notre territoire, afin de mieux évaluer le risque lié aux baignades dans les sources géothermales de la Guadeloupe. Nous avons développé et mis au point une méthode de détection et de dénombrement des amibes faisant appel à la biologie moléculaire qui est aujourd’hui appliquée en routine au sein de notre laboratoire. Depuis Janvier 2011, un suivi mensuel a révélé la présence des amibes thermophiles et de l’amibe pathogène dans presque tous les sites analysés (Ravine Chaude, Bains de La Lise et Bain du Curé à Pigeon, Bains Jaunes, Bain de Dolé, Bain de Capes, Bain des Amours, Bain de la rivière Grosse-Corde, Chute du Carbet, Bain de Morphy et Bain chaud de Matouba), à l’exception des eaux chaudes soufrées et/ou salées de Sofaïa et de l’Anse Thomas à Bouillante. Le séquençage des produits de PCR obtenus et déposés dans Genbank nous a permis de confirmer l’appartenance de cette souche de N. fowleri, au type 3 Euro-américain, identique à celui détecté lors de l’accident de 2008 (Moussa et al. 2013). Le nombre d’amibes pathogènes retrouvées varie de 2 à 30 amibes/litre selon les bains, sans dépasser la limite de 100 amibes/litre recommandée par les autorités sanitaires. En dépit de ces faibles concentrations, une surveillance régulière des bassins est nécessaire. Sur l’ensemble de l’année 2011-2012, l’espèce pathogène N. fowleri a été la plus fréquemment rencontrée par rapport aux espèces non pathogènes N. lovaniensis et Hartmanella sp. Ces données de surveillance ont amené l’ARS et les communes concernées à organiser une campagne de sensibilisation à destination des populations locales et touristiques, reposant sur l’installation de panneaux de prévention à proximité des principaux sites où N. fowleri a été retrouvée.La présence régulière de N. fowleri tout au long de l’année dans la plupart des bains chauds et notamment dans les bains les plus fréquentés, a orienté notre travail sur la recherche de l’origine de leur contamination. Nous avons découvert que les sources géothermales ne sont pas contaminées à leur émergence, mais que les amibes proviennent de la terre en amont des bassins. Ce résultat qui montre que le sol est le réservoir naturel des amibes, nous a permis de proposer aux collectivités un moyen de lutte efficace en canalisant l’eau depuis l’émergence jusqu’au bassin, sans passer par le sol. / Amoebas are eukaryotic unicellular organisms, measuring from 10 to 300 µm, being able to live under a parasite form or to evolve freely in soils and aquatic media. They can even adopt either form depending of the environment. Some free living amoebas are highly pathogenic for animals and humans, especially Naegleria fowleri which develops in naturally hot waters at temperatures between 27 and 45°C. This species is responsible for an encephalitis generally lethal, the primary amoebic meningoencephalitis (PAM), a case of which occured in Guadeloupe in 2008. A 9-year-old child having contracted the disease, died a few days after a bath in the hot waters of Dolé, in Gourbeyre. Our Thesis at the Institut Pasteur of Guadeloupe, in association with the ARS, initiated a research program on these pathogenic amoebas poorly known in our territory, to better estimate the risk to contract the disease while bathing in geothermal recreational waters of Guadeloupe. We developed and worked out a method of detection and enumeration of amoebas using the molecular biology, which is currently applied in routine in our laboratory. Since January, 2011, a monthly monitoring of the baths revealed the presence of thermophilic free living amoebas and pathogenic amoeba in almost all the analyzed sites (Ravine Chaude, La Lise, Bain du Curé à Pigeon, Bains Jaunes, Bain de Dolé, Bain de Capès, Bain des Amours, Bain de la rivière Grosse-Corde, Chutes du Carbet, Morphy and the hot bath of Matouba), with the exception of sulphurated and/or salty hot waters of Sofaïa and the Anse-Thomas in Bouillante. The sequencing of the PCR products obtained were deposited in Genbank and confirmed that the Guadeloupean N. fowleri belonged to the Type-3 Euro-American, identical to that detected in the patient in 2008 (Moussa et al. 2013). The number of pathogenic amoebas varied from 2 to 30 amoebas / liter according to the baths, without exceeding the limit of 100 amoebas / liter recommended by the health authorities. In spite of this rather low concentration the baths require a regular surveillance. On the full year 2011-2012, the pathogenic species N. fowleri was the most frequently encountered species followed by N. lovaniensis and Hartmanella sp. These data of the surveillance led the ARS and the municipalities concerned to organize an awareness campaign destinated to the local and tourist population, based on the installation of prevention panels near the main sites where N. fowleri was found. The regular presence of N. fowleri during the year in most of the hot baths, especially the most frequented ones, leads us to look for the origin of their contamination. We discovered that geothermal springs are not contaminated at their emergence, but that amoebas come from the soil upstream the baths. This result which shows that soil is the natural reservoir of amoebas, allowed us to propose to the authorities effective means of prevention by installing pipes to carry the water from the emergence to the bath, without touching the soil.