Addressing complex global health challenges, including the burden of noncommunicable diseases (NCDs), will require change in sectors outside of traditional public health. Contemporary regional trade and investment agreements (RTAs) like the Trans-Pacific Partnership (TPP) continue to move further ‘behind-the-border’ into domestic policy space introducing new challenges in the regulation of health risk factors. This dissertation aimed to clarify the pathways through which RTAs influence NCDs, and to explore points along those pathways with the intent of improving the existing evidence base and supporting policy development. This work develops a critical theoretical framework exploring the ideas, institutions, and interests behind trade and investment policy; it also develops a conceptual framework specifying how trade and investment treaty provisions influence NCD rates through the effects of trade and investment on tobacco, alcohol, and ultra-processed food and beverage products, as well as access to medicines and the social determinants of health. Using health impact assessment methodology, three analytical components were designed to examine pathways of influence from RTAs to health outcomes as mediated by the interests of transnational corporations (TNCs). The first component explored the influence of industry during the TPP negotiations and how its health-related interests were reflected in the final TPP text. The second component examined the role of trade and investment liberalisation in health-harmful commodity markets, finding a rise in TNC sales after a period of liberalisation. The third component demonstrated how investor rights and investor-state dispute can challenge the state’s right to regulate if it damages the profits of TNCs, which may threaten effective health regulation, and provides opportunities to strengthen the right to regulate. The work in this dissertation provides support for the thesis that trade and investment policies are a fundamental structural determinant of health and well-being, which are highly influenced by TNCs that guide such policies in the interest of maximising their profits and protections, often to the detriment of public policy and population health. This work identifies the need for more robust health impact assessments of RTAs before future agreements are ratified, as well as an imperative to challenge vested interests that entrench neoliberal policy preferences that have hindered sustainable and equitable development.

HIV/AIDS-related stigma and discrimination (S&D), lack of social support, poverty, and gender inequalities have been identified as factors in the increased prevalence rate of HIV transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite the funding of reduction programs, HIV/AIDS-related S&D remain a major driving force in the increased rate of new HIV cases in Enugu. This study addressed a perceived need for behavioral change intervention approaches that span all societal factors to reduce the HIV infection rate in Enugu Nigeria. The study was guided by Goffman's (1963) social S&D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114 participated in an online survey. The descriptive statistics and a multiple linear regression analysis and comparison revealed a convergent significant relationship between the S&D determinants (social, political, psychological, environmental, and cultural) and HIV/AIDS-related S&D towards WLWHA in Enugu F (4,109) = 45.09, p

No description available.

Introduction/Background: Guidelines from the World Health Organization currently recommend targeting a body mass index (BMI) between 18.5 and 24.9 kg/m2 based on the lowest risk of mortality observed in epidemiological studies. However, these recommendations are based on population observations and do not take into account potential inter-individual differences. We hypothesized that genetic and non-genetic differences in adiposity, anthropometric, and metabolic measures result in inter-individual variation in the optimal BMI. Methods: Genetic variants associated with BMI as well as related adiposity, anthropometric, and metabolic phenotypes (e.g. triglyceride (TG)) were combined into polygenic risk scores (PRS), cumulative risk scores derived from the weighted contributions of each variant. 387,692 participants in the UK Biobank were split by quantiles of PRS or clinical biomarkers such as C-reactive protein (CRP), and alanine aminotransferase (ALT). The BMI linked with the lowest risk of all-cause and cause-specific mortality outcomes (“nadir value”) was then compared across quantiles (“Cox meta-regression model”). Our results were replicated using the non-linear mendelian randomization (NLMR) model to assess causality. Results: The nadir value for the BMI–all-cause mortality relationship differed across percentiles of BMI PRS, suggesting inter-individual variation in optimal BMI based on genetics (p = 0.005). There was a difference of 1.90 kg/m2 in predicted optimal BMI between individuals in the top and bottom 5th BMI PRS percentile. Individuals having above and below median TG (p = 1.29×10-4), CRP (p = 7.92 × 10-5), and ALT (p = 2.70 × 10-8) levels differed in nadir for this relationship. There was no difference in the computed nadir between the Cox meta-regression or NLMR models (p = 0.102). Conclusions: The impact of BMI on mortality is heterogenous due to individual genetic and clinical biomarker level differences. Although we cannot confirm that are results are causal, genetics and clinical biomarkers have potential use for making more tailored BMI recommendations for patients. / Thesis / Master of Science (MSc) / The World Health Organization (WHO) recommends targeting a body mass index (BMI) between 18.5 - 24.9 kg/m2 for optimal health. However, this recommendation does not take into account individual differences in genetics or biology. Our project aimed to determine whether the optimal BMI, or the BMI associated with the lowest risk of mortality, varies due to genetic or biological variation. Analyses were conducted across 387,692 individuals. We divided participants into groups according to genetic risk for obesity or clinical biomarker profile. Our results show that the optimal BMI varies according to genetic or biomarker profile. WHO recommendations do not account for this variation, as the optimal BMI can fall under the normal 18.5 - 24.9 kg/m2 or overweight 25.0 – 29.0 kg/m2 WHO BMI categories depending on individual genetic or biomarker profile. Thus, there is potential for using genetic and/or biomarker profiles to make more precise BMI recommendations for patients.

No description available.

Avec l’avènement de l’Empire romain au cours du premier siècle avant notre ère le Levant devient le théâtre d’un cosmopolitisme où maintes cultures hétéroclites vont coexister. Ce nouveau système a Rome comme Caput Mundi. Des voies vont être tracées par l’armée jusqu’au fin fond de l’empire pour relier le monde à sa capitale. Les fouilles préventives récentes (depuis 2005) à Berytus (Beyrouth) et à Botrys (Batroun) ont mis au jour une quantité considérable de données inédites sur l’homme et sur les populations qui vivaient dans la région durant les quatre siècles de l’Empire romain et jusqu’au début du Christianisme. À partir d’une étude archéo‐anthropologique de huit ensembles funéraires (n=290) provenant de la Colonia Julia Augusta Felix Berytus et de la ville de Botrys qui contrairement à Berytus n’a pas le statut de colonia romana, ce travail propose de contribuer à l’histoire de ces deux villes. Notre but est d’appréhender les populations du passé d’après l’étude du squelette, les caractéristiques biologiques, les rituels et les pratiques funéraires ainsi que l’organisation des espaces sépulcraux. Cette étude révèle en premier lieu un cosmopolitisme culturel et biologique illustré par la variabilité des pratiques funéraires et par la diversité biologique des deux ou plusieurs groupes qui ont dû coexister à la Colonia Julia Augusta Felix Berytus. Par contre, les données bio-culturelles de Botrys évoquent quant à elles, une cité moins cosmopolite, moins diversifiée sur les plans anthropologiques et culturels. En effet, la ressemblance des modes d’inhumation, du traitement du corps, du mobilier funéraire et la structuration de l’espace funéraire et l’homogénéité biologique sont incontestables à Botrys. En revanche, les analyses comparatives entre Berytus et Botrys ont mis en évidence une hétérogénéité biologique existante à plusieurs échelles entre les individus des deux villes. Cependant cette distance est brisée par l’homogénéité du corpus féminin des deux villes pour la période qui s'étend du IIème au IVème siècle de notre ère. / During the first century B.C., with the rise of the Roman Empire, the Levant became the scene of cosmopolitanism where many heteroclite cultures would coexist. The new cosmopolitan society had Rome as its capital (Caput Mundi), and roads drawn up by the army linking the rest of the empire to its capital. Recent rescue excavations (since 2005) in Berytus (Beirut) and Botrys (Batroun) have revealed a considerable amount of unpublished data on populations who lived in the region during the four centuries of the Roman Empire until the early centuries of Christianity. Following an archaeo-anthropological approach, this thesis presents an assessment of eight funerary sites (n= 290) from the cities of Colonia Julia Augusta Felix Berytus and Botrys. Significantly, Botrys, unlike Berytus, did not have the status of a Roman colony. This research seeks to contribute to the history of these two cities. The purpose is to understand the populations of the past through the study of the skeletons, rituals and funerary practices as well as the organisation of funerary spaces. This study primarily reveals a cultural and biological cosmopolitanism illustrated by variability in funerary practices and in biological characteristics. These results suggest that at least two different groups or more coexisted in the Colonia Julia Augusta Felix Berytus. On the contrary, the biocultural data of Botrys skeletons reveal a less cosmopolitan city with less diversity shown on different anthropological and cultural levels. Indeed, the similarity of funerary practices, body treatments, grave goods and the organisation of the funerary space and biological homogeneity are indisputable in Botrys. Comparative analysis between Berytus and Botrys highlighted an existing biological heterogeneity at different scales between individuals of both cities. However, this diversity is contradicted by the homogeneity of the females of both cities during the 2th and the 4th century A. D. / أصبح المشرق خلال القرن الاول قبل الميلاد، مع صعود الامبراطورية الرومانية، مسرحاً عالمياً تتفاعل فيه ثقافات مختلفة. ثقافات لطالما ميزت المشرق بسبب الغزوات واختلاط الشعوب منذ العصر الحجري الحديث. النظام العالمي الجديد جعل روما "عاصمة العالم" أو كما يقال باللاتينية Caput Mundi وبذلك رسم الجيش الروماني الطرق الى مختلف أصقاع الامبراطورية لتؤدي الى روما. كشفت الحفريات الوقائية و الإنقاذية الأخيرة في بيروت والبترون عن معطيات جديدة تخص الشعوب التي عاشت في المنطقة خلال القرون الأربعة من الإمبراطورية الرومانية وحتى بدايات المسيحية. تقدم رسالة الدكتوراه هذه دراسة عن الإنسان وعلاقاته مع الموت. وباتباع منهج أثري-أنثروبولوجي ستقدم تقييماً لثمان مواقع مدفنية في كولونيا جوليا أوغوستا فيليكس بيريتوس Colonia Julia Augusta Felix Berytus ومدينة البترون (ع=٢٩٠ ) والتي على عكس بيريتوس )بيروت) لم تحمل صفة مستوطنة رومانية .تقدم هذه الدراسة في المقام الأول الاطار الثقافي والبيولوجي والمشروحين بتعدد الطقوس المدفنية والاختلاف البيولوجي لمجموعتين او اكثر من المجموعات التي تعيش في كولونيا جوليا أوغوستا فيليكس بيريتوس. في المقابل المعطيات البيولوجية الثقافية في البترون تدل على أنها مدينة أقل تنوعاً ولا تحوي تنوعات انثروبولوجية وثقافية كبيرة. لذلك فإن التطابق في طرق الدفن وتحضير الموتى وأمكنة الدفن والتجانس البيولوجي هي مسائل لاجدال فيها بالنسبة للبترون. وبالمقارنة مابين بيروت والبترون من الواضح عدم التجانس البيولوجي الموجود على أكثر من صعيد فيما بين سكان المدينتين.ولكن هذا التباين مابين المدينتين مخترق من قبل تشابه الإناث في كلا المدينتين من القرن الثاني الى القرن الرابع ميلادي.

No description available.

Au cours du Ve millénaire avant notre ère, le Bassin parisien voit l’émergence des premières nécropoles et du monumentalisme funéraire. Associé à la culture de Cerny, ces vestiges offrent un observatoire privilégié des mutations sociales que connaissent les communautés du Néolithique moyen en France. À partir d’une approche archéo-anthropologique, nous livrons ici un bilan complet de la population Cerny, au niveau général, à l’échelle des trois types de site (à structure de type Passy, plats et à sépulture sous dalle), et au niveau de chaque nécropole. Les sites de Passy, Balloy, Gron, Escolives-Sainte-Camille, Vignely (La Noue Fenard et La Porte aux Bergers), Chichery, Orville, Malesherbes (Les Marsaules et La Chaise), qui réunissent l’essentiel des squelettes Cerny mis au jour (n=160), font l’objet de cette étude. Quel que soit le niveau scalaire, le croisement des paramètres biologiques et archéologiques est systématisé et soumis à la décision statistique. Les résultats s’inscrivent dans un cadre interprétatif fiable grâce à de nouvelles datations 14C. Les analyses intra-sites révèlent différentes modalités sélectives des défunts et, parfois, le rassemblement codifié de sépultures en différents loci. Le statut des inhumés et leur fonction sociale jouent un rôle prépondérant dans la structuration des sites. Deux modèles organisationnels, dont un, répété de nécropole en nécropole, illustre une hiérarchisation des statuts à l’intérieur des structures monumentales. La correspondance de ces mêmes statuts en nécropoles plates suggère que l’identité sociale des défunts n’est pas la seule raison d’être du monumentalisme funéraire. Enfin, la dualité du Cerny, traditionnellement rattachée à deux manifestations diachroniques de la culture, doit être reconsidérée. La différenciation typologique évidente entre les longs couloirs de type Passy et les sépultures sous dalles de type Malesherbes, est ici soutenue par une distinction d’ordres funéraire et biologique, indépendamment du facteur chronologique, remettant en question l’unité culturelle du Cerny. / During the 5th millennium B.C., the Paris Basin sees the emergence of the first necropoles and funerary monumentality. Associated with the Cerny culture, these vestiges offer a privileged insight into the social transformations of Middle Neolithic communities in France. Following an archaeo-anthropological approach, we present a full assessment of the Cerny population as a whole, according to the three types of sites (Passy type structures, extended flat sites and slab graves) and with regard to each necropolis. The sites of Passy, Balloy, Gron, Escolives-Sainte-Camille, Vignely (La Noue Fenard and La Porte aux Bergers), Chichery, Orville, Malesherbes (Les Marsaules and La Chaise), which comprise the bulk of Cerny skeletons uncovered (n=160), constitute the object of this study. The cross-referencing of biological and archaeological parameters is systematized and subjected to statistical reasoning, regardless of the scalar value. These results, combined with new 14C dates, provide a reliable interpretive framework. Intrasite analyses reveal different modes of selection of the deceased and, occasionally, codified grouping of burials into separate loci. The rank of the dead and their social status play a predominant role in the structuring of the sites. Two models of organisation, one of which is repeated in every necropolis, illustrate the social stratification operating within monumental structures. The presence of individuals of similar status in flat necropoles suggests that the social identity of individuals is not the raison d'être of monumental graves. Moreover, the duality of the Cerny culture, traditionally seen as two diachronic manifestations of this culture, must now be reconsidered. The clear typological distinction between the long passage tombs of the Passy type and the slab graves of the Malesherbes type is herein upheld on both funerary and biological levels, regardless of chronology, thus calling the Cerny cultural unity into question.

An all-of-society approach is foundational for increasing disaster resilience and creating adaptive capacity in the face of disasters and climate change. Youth participation within disaster risk reduction (DRR) and disaster risk management (DRM) is an inclusive strategy to engage youth in an all-of-society approach. While this is an emerging and fast-growing area of study, ingraining social inclusion in practice is slow. Through a series of four articles, this dissertation describes two separate qualitative studies exploring youth participation in DRR and DRM through the youth perspective. Participatory research methodologies dismantle power dynamics inherent in traditional research, and they are well-suited for research on youth participation. As such, our first study used Photovoice methodology to explore youth perceptions of youth capabilities in disasters, and to understand their experiences of the COVID-19 pandemic. Examples of youth participation initiatives in DRR are scattered, necessitating exploration of the process of participation in diverse contexts and types of disaster events. We conducted the second study using case study methodology to explore facilitators of - and barriers to - youth contributions towards DRR efforts in the context of local flooding, tornado, and pandemic events in Ottawa, Ontario, Canada. This dissertation provides insight on how to promote youth resilience, capacity, and strengths in disasters. Based on these findings, we argue that a paradigm shift in DRR towards an asset-based approach is essential to implement youth participation in practice. An asset-based approach aligns with the capability-oriented worldview in youth participation literature and theories. The complexity arises in attempting to apply asset-based lessons from the literature into the traditionally needs-based orientation of DRR policy and DRM practice. More research is needed to document youth actions in DRR and to determine asset indicators to evaluate implementation efforts. This dissertation begins an important conversation around applying an asset-based approach to youth participation in DRR through the perspectives of youth.

Utilizing the longitudinal component of the National Population Health Survey (NPHS) (1994/1995-2000/2001), designed to collect comprehensive information on the health status of the Canadian population and related socio-demographic information, differences in health status between immigrants and non-immigrants (i.e., native-born individuals) were explored. Specifically, the analysis investigated how chronic conditions influence the health of immigrants, the role of stress and mental health upon immigrant health status, and the influence and role of previously underrepresented variables such as age and arrival cohorts on foreign-born health status. The conceptual approach of this project draws upon a 'population health' perspective, which suggests that the most influential determinants of human health status are non-medical in nature, but rather can be identified as the social and economic characteristics of individuals. Analysis was completed through the use of ordinary least squares stepwise regression and logistic stepwise regression in association with descriptive stochastic methodologies. Analysis of the mental health and stress variables suggests that, contrary to what has been expressed in literature in the past, both immigrants and the native-born do not perceive stress, distress, or depression to be major problems or health concerns in their lives. Furthermore, the analysis indicated, as was expected, that older immigrants are at greater risk of developing more chronic conditions relative to younger groups, and that arrival cohorts, the period in which an immigrant entered the nation, do exert a considerable influence on the health status of the foreign-born. Surprisingly, this analysis indicates that the Healthy Immigrant Effect (HIE), which proposes that recent immigrants, regardless of country of birth, tend to be in better health than the Canadian-born population upon entering the nation, may be more apparent than real, especially when investigating mental health and stress conditions amongst the foreign-born. / Thesis / Master of Arts (MA)