Submitted by Marilene Donadel (marilene.donadel@unioeste.br) on 2018-06-04T20:40:47Z No. of bitstreams: 1 Josefa_Silva_2018.pdf: 1442831 bytes, checksum: c832866013a29658382e21eb921eeae4 (MD5) / Made available in DSpace on 2018-06-04T20:40:48Z (GMT). No. of bitstreams: 1 Josefa_Silva_2018.pdf: 1442831 bytes, checksum: c832866013a29658382e21eb921eeae4 (MD5) Previous issue date: 2018-02-23 / Introduction: This research aims at analyzing children and adolescents’ profiles under hospitalization conditions for the detoxification program offered by the Western Paraná University Hospital (HUOP). Methodology: This is a qualitative and quantitative research, with an exploratory-descriptive character. As a support for the analysis, the study deals not only with a bibliographical discussion about children and adolescents under psychoactive substances addiction, but also with the legal rulings established by the Statute of Child and Adolescent, and by the guidelines of SUS and Ministry of Health. The present study also adopted the documentary analysis to rescue the history of the implantation of the HUOP Detoxification Program and its activities. This research used a 400 physical-file samples with the patient’s information in order to carry out statistical analyses concerning the program users. All the information was collected on the day the patient was hospitalized by HUOP's on-call social worker, and all questions were answered by the own patient and his / her caregiver. The selected files are from 2007 to 2016, which was chosen because the Detoxification Wing began its operation in March 2007. The studied variables were: age, sex, schooling, school dropout, family income, chronological order of consumption of psychoactive substances, first substance, substances most used, how the substance was obtained, occupation, participation of social programs, family composition, birth order, addicted familiar member, housing conditions, origin, as well as involvement in infractions, compliance with socio-educational measures, sexual behavior, patients who have become pregnant. Results: Most of them were male (76.5%), while females were 23.5%. Their mean age ranged from 8 to 17 years old, and the oldest age group ranged from 15 to 17 years old, whose focus was the 15-year old group. And regarding their schooling degree, it was observed that the users were behind in school degree. 89.9% of them did not have finish the elementary education and 9% had just part of secondary education. At their hospitalization day, more than 60% were out of school. The familiar average income of the studied individual ranged from one to two minimum wages. In order to get information about the characteristics of psychoactive substances used, it was observed that many of them were introduced to both licit and illicit substances by influence of friends, siblings, relatives and even parents. The main reason that led them to try psychoactive substances was curiosity. And as the first psychoactive substance most consumed was alcohol, and almost 50% was followed by tobacco, and then marijuana. All those patients, before hospitalization, used more than one substance, but marijuana was the most consumed (59.2%), followed by crack. We also have the use of psychoactive substances, among parents reaching 70.4%. The use of psychoactive substances by patients was associated with involvement with illegal activities in order to get them. This index reached 92%. They were involved in robbery, prostitution and, mostly, they took part of illicit psychoactive substance trafficking. It was recorded that 18.2% of them complied with socio-educational measures, 17.5% were in compliance as a service measure, 11.0% were under assisted freedom, 2.6% were in compliance with freedom deprivation measures. Regarding the family, it is observed that 70.5% are part of a parental/single-parent family nucleus. And the number of siblings is small. There were two or three children. They had a bad or conflicting relationship with their family, but the greatest conflict was with their father. The major modality of hospitalization was involuntary, in which they are brought by the parents or guardian, followed by compulsory. The greatest majority was admitted at the hospital against their own will and were brought by parents or guardian, followed by the compulsory. 63.9% had already took part of some treatment before hospitalization in this Wing. The mother is the main person who most come with their sons and daughters to the hospital. Sexual behavior was more associated with risk, with early onset of sexual activity, whose practice is with different partners, including prostitution. Thus, there were forty girls from 400 sampling charts, and from those ones, twelve had already become pregnant at least once. / Introdução: Esta pesquisa tem como objetivo a análise do perfil das crianças e adolescentes em condição de internação no programa de desintoxicação, oferecido pelo Hospital Universitário do Oeste do Paraná (HUOP). Metodologia: O estudo consiste em uma pesquisa qualitativa e quantitativa, de caráter exploratório-descritivo. Como suporte para a análise, o estudo trata não só da discussão bibliográfica sobre crianças e adolescentes em situação de uso de substâncias psicoativas, como também da normatização jurídica, prevista pelo Estatuto da Criança e Adolescente, e das diretrizes do SUS e do Ministério da Saúde. O presente estudo, também, adotou a análise documental para resgatar a história da implantação do Programa de Desintoxicação do HUOP e suas atividades. Para efetuar análises estatísticas sobre os usuários do programa, a pesquisa utilizou uma amostra de 400 prontuários físicos, contendo informações referentes aos pacientes. Todas as informações contidas nos prontuários físicos são coletadas no dia do internamento do paciente, pela assistente social de plantão do HUOP, e todas as perguntas são respondidas pelo próprio paciente e seu responsável. Os prontuários escolhidos são do período de 2007 a 2016, e esse período foi escolhido pelo fato de a Ala de Desintoxicação ter seu início de funcionamento em março de 2007. As variáveis estudadas foram idade, sexo, escolaridade, evasão escolar, renda familiar, experimentação, ordem cronológica de consumo de substâncias psicoativas, primeira substância, substâncias de maior uso, modo de obtenção da substância, ocupação, participação de programas sociais, composição familiar, ordem de nascimento, membro familiar com dependência, condições das moradias, procedência, bem como envolvimento em atos infracionais, cumprimento em medidas socioeducativas, comportamento sexual, pacientes que já engravidaram. Resultados: A maioria era do sexo masculino, com um percentual de 76,5%, enquanto o sexo feminino era de 23,5%. A média de idade dos pacientes variou entre oito e 17 anos, sendo que a maior faixa etária é dos 15 aos 17 anos, concentrando-se na faixa etária dos 15 anos. Quanto ao grau de escolaridade, observouse que os usuários apresentavam algum grau de atraso escolar, 89,9% dos usuários possuíam o ensino fundamental incompleto e 9% tinham o ensino médio incompleto, e no dia do internamento mais de 60% estavam fora da escola. A renda média dos familiares da população estudada é de um a dois salários mínimos. Quanto às características do uso das substâncias psicoativas, constatou-se que muitos iniciaram o uso destas, tanto lícitas como ilícitas, por influência de amigos, irmãos, parentes e até mesmo dos pais. O maior motivo que levou à experimentação das substâncias psicoativas foi a curiosidade. E, como a primeira substância psicoativa mais consumida foi o álcool, com quase 50% seguido pelo tabaco, evoluído para a segunda, que foi a maconha. Todos, antes do internamento, faziam uso de mais de um tipo de substância, só que a mais consumida era a maconha, com 59,2%, seguida pelo crack. Há também o uso de substâncias psicoativas entre os pais, chegando a 70,4%. O uso dessas substâncias pelos pacientes estava associado ao envolvimento com atividades ilegais para consegui-las, chegando a 92%. Havia o envolvimento em roubo, prostituição e, sobretudo, a adesão ao tráfico de substâncias psicoativas ilícitas. E 18,2% cumpriram medidas socioeducativas, 17,5% estavam em cumprimento de medida de prestação de serviço, 11,0%, em liberdade assistida, 2,6% estavam em cumprimento de medidas com privação da liberdade. Com relação à família, observa-se que 70,5% fazem parte de um núcleo familiar parental/monoparental. E o número de irmãos é pequeno, de dois a três filhos. O relacionamento dos pacientes com a família é uma relação ruim ou conflituosa com algum membro, sendo o pai com quem ocorrem os maiores conflitos. A maior modalidade de internação foi a involuntária, em que são trazidos pelos pais ou responsável, seguida pela compulsória. E 63,9% já tinham recorrido a algum tratamento antes da internação na ala. A mãe é a principal pessoa que mais acompanha os filhos nos internamentos. O comportamento sexual esteve mais associado ao de risco, com início precoce de atividade sexual, cuja prática é com parceiros diferentes, inclusive se prostituindo. E, da amostra dos 400 prontuários, 40 eram meninas, e, destas, 12 já tinham engravidado uma ou mais de uma vez.

Objectifs : Examiner les difficultés psychosociales chez des adolescents exposés, âgés entre 14 et 18 ans, dans les neuf (9) mois suivants la tragédie ferroviaire. Comparer les adolescents qui atteignent le seuil clinique du trouble de stress post-traumatique (TSPT) à ceux qui ne l’atteignent pas, en fonction de la sévérité d’exposition, des symptômes de dépression, d’anxiété et autres problématiques associées. Méthode : Les analyses ont été faites auprès d’un échantillon de convenance de 227 jeunes, dont la moyenne d’âge est de 15,96 ans, des niveaux secondaires III, IV et V et vivant dans le secteur de Lac-Mégantic, en Estrie au Québec. Résultats : Près de la moitié (41,5 %) des adolescents rapportent avoir été sévèrement exposés à l’accident ferroviaire et le tiers (29,6 %) présentent un niveau de sévérité du TSPT atteignant le seuil clinique. Il semble y avoir une tendance où les filles sont proportionnellement plus nombreuses à rapporter des symptômes du TSPT, de dépression et d’anxiété comparativement aux garçons. La majorité des adolescents présentent une consommation non problématique de substances psychoactives (SPA), alors que pour 8 %, celle-ci serait à risque ou problématique. Les actes de délinquance, principalement non violents, sont davantage identifiés chez les garçons. Les adolescents qui atteignent le seuil clinique du TSPT ont été plus sévèrement exposés lors de la tragédie et sont davantage dépressifs et anxieux. Aucune relation significative n’est observée entre le TSPT et la consommation de SPA et le nombre d’actes de délinquance. Conclusions : Suite à l’accident ferroviaire, cette étude démontre la proportion importante des adolescents qui souffrent de symptômes du TSPT et de problèmes de santé mentale associés. / Objectives: To examine the psychosocial difficulties in a group of exposed adolescents aged 14 to 18 nine months after the railway accident. Compare adolescents who reach the clinical level of post-traumatic stress disorder (PTSD) to those who do not, depending on range severity of exposure and on symptoms of depression, anxiety and other related issues. Methods: The analyses were conducted on a suitability sample of 227 young people, with an average age of 15.96 years, in secondary levels III, IV and V, and living in the Mégantic sector of the Eastern Townships in the province of Quebec. Results: Almost half (41.5%) of adolescents report being severely exposed to the railway accident and one third (29.6%) has described severe PTSD symptoms reaching the clinical threshold. In addition, there appears to be a tendency for a higher proportion of girls compared to boys to have PTSD problems and depression and anxiety symptoms. The majority of adolescents report a non-problematic use of psychoactive substances, while 8% are at risk or problematic. Delinquency, mainly non-violent, is more common among boys. Adolescents who reach a clinical threshold of PTSD symptoms have been more severely exposed to the tragedy and report feeling more depressed and anxious. There was no significant relationship between PTSD and externalized behaviours. Conclusion: The results of the study highlight the relationship between a traumatic event such as the railway accident and the presence of PTSD symptoms as well as of internalized behaviours in a group of adolescents.

THE ABSTRACT It has been shown recently that workload, stress, and burnout syndrome among the staff of the medical rescue service may be major risk factors in terms of triggering the use of psychoactive substances. Representing what is understandably a delicate issue, substance use among emergency medical staff has not been thoroughly studied in our country. Emergency medical workers' difficult working conditions and the chronic stress they are exposed to, in combination with a lack of support and care on the part of their employers, result in exhaustion and general distress, accompanied by the development of symptoms associated with both physical and mental disorders. This condition may lead to the use of psychoactive substances as a negative coping strategy. Consisting of both theoretical background and case studies, the paper points out the relationship between the chronic effect of stressors pertaining to the job of emergency medical workers and the use of psychoactive substances as a way of coping with and compensating for the implications of work-related stress and fatigue. Thorough case studies are presented to demonstrate the onset and development of addictive behaviour within a wider context, with special emphasis being placed on its association with coping with both acute and chronic occupational...

L'objectif de notre thèse est d'évaluer le rôle de l'alcool et autres substances psychoactives dans la survenue et la gravité des traumatismes dus aux Accidents de la Voie Publique (AVP) en Côte d'Ivoire. Nous avons initié un recueil de données sur 893 victimes tuées ou blessées suite à un AVP, et admises aux urgences ou à l'Institut de Médecine Légale d'Abidjan. Ces données hospitalières ont été couplées aux données policières et aux résultats d'analyses toxicologiques. La méthode de dosage de l'alcoolémie par CPG-FID a démontré qu'elle répond parfaitement aux critères de performances analytiques recommandés en termes de fidélité, d'exactitude, de linéarité, de stabilité et de limite de quantification. Les niveaux d'alcoolémie chez les victimes au moment de l'AVP, sont élevés et compatibles avec un profil d'alcoolisation excessive. Plus de 75% des conducteurs alcoolisés ont une alcoolémie supérieure à 1g/L. Les prévalences d'alcoolémie au-delà de 0,8g/L sont de 41% chez les conducteurs de véhicules légers 4 roues, 35% chez les 2-roues, 17% chez les piétons et 13% chez les passagers. L'usage des autres substances psychoactives est moins fréquent chez les victimes (11%) et souvent associé à une alcoolémie supérieure à 0,8g/L. L'évaluation du risque de blessures graves (NISS9+) en fonction du degré d'alcoolisation suggère que les victimes avec une alcoolémie modérée ont un risque de blessures graves plus élevé en comparaison avec les victimes sobres (OR = 7,7; IC95% : 2,5-24,2). Au terme de cette thèse, nous proposons une procédure fiable de dosage de l'alcoolémie chez les victimes d'AVP et des mesures concrètes pour la prévention des traumatismes par AVP en Côte d'Ivoire / We implemented a data collecting process including 893 victims who died or were injured following a RTA, and were admitted to the Emergency Room or to the Forensic Institute in Abidjan. This hospital-based data was linked with police data and toxicological testing. The method developed in our laboratory for blood alcohol determination using GC-FID demonstrated a good compliance with analytical performance requirements in terms of repeatability, accuracy, linearity, stability and limit of quantification. Blood alcohol levels found in victims at the time of the RTA were compatible with an excessive alcohol intake. More than 75% of drivers with a positive alcohol test had a blood alcohol concentration greater than 1g/L. Prevalence of alcohol above 0.8g/L reaches 41% in light four-wheel drivers, 35% in two-wheel riders, 17% in pedestrian and 13% in passengers. The prevalence of psychoactive drugs was lower (11%) compared to alcohol and usually associated with blood alcohol level greater than 0.8g/L. The assessment of the risk of serious injury (NISS9+) associated to the level of blood alcohol content suggest that victims showing a moderate blood alcohol level are more at risk to sustain serious injury compared to sober victims (OR = 7.7; IC95% : 2.5 – 24.2). In conclusion, we make some practical proposals to strengthen and for facilitating the application of the current law concerning driving under the influence of alcohol. We also make recommendations for prevention of road traffic injuries in the Ivory Coast

La consommation et la consommation problématique de substances psychoactives sont des phénomènes répandus à l’adolescence qui ont suscité beaucoup d’intérêt dans les pays occidentaux au cours des dernières décennies. La recherche a souligné la nécessité d’établir un modèle examinant les effets conjoints du groupe de pairs et de la famille sur ces phénomènes. Deux grandes lignées théoriques émergent de la littérature, soit les courants de la socialisation et de la sélection. De plus, de nombreuses études ont tenté d’expliquer la fréquente cooccurrence de ces phénomènes avec la symptomatologie dépressive, généralement associée à un pronostic plus lourd. Toutefois, la nature et le sens de cette association demeurent peu clairs. Une clarification des mécanismes en jeu est nécessaire afin de pouvoir mieux orienter les efforts de prévention et d’intervention. Le premier objectif de cette thèse est de contribuer à clarifier l’étiologie de la consommation problématique à l’adolescence, en examinant comment elle s’articule avec certains facteurs familiaux, comportementaux et affectifs, et avec l’association à des amis déviants et consommateurs, en testant conjointement deux modèles de médiation compétitifs. Le deuxième objectif est de clarifier l’association entre ces différentes dimensions et la symptomatologie dépressive, en testant l’effet modérateur des symptômes dépressifs dans la chaîne médiatrice proposée. Le troisième objectif est de spécifier les particularités pouvant exister entre les garçons et les filles en testant l’effet modérateur du sexe sur cette même chaîne médiatrice. Les données utilisées proviennent d’une cohorte de l’échantillon longitudinal de la Stratégie d’Intervention Agir Autrement (SIAA) comprenant plus de 3000 jeunes fréquentant des écoles de milieux majoritairement défavorisés du Québec, qui ont été suivis pendant leur secondaire (2003-2007). Lorsque testés séparément, le modèle de socialisation (Patterson) se reproduit dans notre échantillon, mais pas le modèle de sélection (Brown). Lorsque testés simultanément, les modèles structurels de régressions croisées suggèrent toutefois qu’aucun des liens postulés par les modèles ne semble se reproduire, au profit de liens médiateurs de stabilité, à l’exception d’un lien de médiation proposé par le modèle de Patterson chez les garçons. Les analyses de modération (multi-groupes) suggèrent que le sexe a bien un effet modérateur, le contrôle comportemental parental semblant particulièrement important dans l’étiologie des comportements problématiques des garçons, alors que les conflits familiaux semblent plus centraux pour les filles. Les analyses de modération suggèrent également un effet modérateur par les symptômes dépressifs, mais alors qu’il était attendu que ces symptômes exacerberaient les liens à l’étude, il apparaît qu’au contraire, aucun des liens ne se révèle significatif dans le groupe des dépressifs. Cette étude suggère donc que la symptomatologie dépressive et la consommation problématique se présentent conjointement dans un profil plus global de risque. À notre connaissance, cette thèse est la première à s’intéresser spécifiquement au rôle modérateur des symptômes dépressifs sur les liens existant entre les différentes dimensions à l’étude. Les résultats soulignent l’importance d’une intervention psychosociale précoce auprès des jeunes à risque et aux prises avec des symptômes dépressifs, en ciblant des aspects spécifiques pour les garçons et pour les filles. / Psychoactive substance use and problem substance use are common phenomena in adolescence. They have generated a sustained interest in Western countries in the past few decades. Research has highlighted the necessity of a model examining the joint effects of peer group and family on these phenomena. Two major theoretical trends have emerged from the literature, namely socialization and selection processes. Moreover, many studies have attempted to explain the observed comorbidity of these phenomena with depressive symptomatology, which is generally associated with a heavier prognostic. However, the nature and direction of this association remain unclear. Clarifying the underlying mechanisms is necessary to guiding prevention and intervention efforts. The first objective of this thesis is to contribute to clarify the nature of the etiology of problem substance use in adolescence. It examines how problem substance use revolves around familial, behavioral and affective factors and with substance using and deviant friend affiliations. To do so, it tests two competitive mediation models. The second objective of this thesis is to clarify the association between these different dimensions and depressive symptomatology by testing the moderator effect of depressive symptoms on the proposed mediation sequence. The third and last objective is to identify the particularities that may exist between boys and girls by testing the moderator effect of gender on the same mediation sequence. This work was carried out using a cohort from the New Approaches, New Solutions (NANS) longitudinal dataset, which comprises more than 3000 students attending school in mostly disadvantaged areas of Quebec who were followed throughout high school (2003-2007). The analyses carried out in this thesis provide empirical support to the socialization model but not to the selection model when both models are tested separately. However, when tested simultaneously, the structural crosslagged models provide no empirical support to the mediation associations predicted by both models, in favor of stability mediation associations, except for one association suggested by Patterson’s model for boys. Moderation analyses (multigroups) suggest indeed that gender has a moderator effect. Parental behavioral control appears particularly important in the etiology of problematic behaviors in boys, while familial conflicts seem more central for girls. Moderation analyses also suggest a moderator effect of depressive symptoms, but while it was expected that these symptoms would exacerbate the studied associations, none of the associations actually remained significant in the depressive group. This study therefore suggests that depressive symptomatology and problem substance use appear together in a more global profile of risk. To our knowledge, this thesis is the first to take a specific interest in the moderation effect of depressive symptoms on the associations between the different dimensions under study. The results underscore the importance of an early psychosocial intervention with adolescents at risk and with adolescents struggling with depressive symptoms, while targeting specific aspects for boys and girls.

La mise en œuvre d’activités de prévention de la consommation de substances psychoactives (SPA) (tabac, alcool et cannabis) en milieu scolaire est une stratégie couramment utilisée pour rejoindre un grand nombre de jeunes. Ces activités s’inspirent, soit de programmes existant, soit d’innovations dictées par le contexte d’implantation ou l’existence de données de recherche. Dans un cas comme dans l’autre, l’évaluation de ces programmes représente la meilleure voie pour mesurer leur efficacité et/ou connaître comment ceux-ci sont implantés. C’est cet impératif qui a motivé une commission scolaire du Québec a recommandé l’évaluation de l’Intervention en Réseau (IR), un programme développé en vue de retarder l’âge d’initiation et de réduire la consommation problématique de SPA chez les élèves. Ce programme adopte une approche novatrice avec pour principal animateur un intervenant pivot (IP) qui assure le suivi des élèves de la 5e année du primaire jusqu’en 3e secondaire. Inspiré des modèles en prévention de la santé et de l’Approche École en santé (AES), le rôle de l’IP ici se démarque de ceux-ci. Certes, il est l’interface entre les différents acteurs impliqués et les élèves mais dans le cadre du programme IR, l’IP est intégré dans les écoles primaires et secondaires qu’il dessert. C’est cet intervenant qui assure la mobilisation des autres acteurs pour la mise en œuvre des activités. Cette thèse vise à rendre compte de ce processus d’évaluation ainsi que des résultats obtenus. L’approche d’évaluation en est une de type participatif et collaboratif avec des données quantitatives et qualitatives recueillies par le biais de questionnaires, d’entrevues, de groupes de discussion, d’un journal de bord et de notes de réunions. Les données ont été analysées dans le cadre de trois articles dont le premier concerne l’étude d’évaluabilité (ÉÉ) du programme. Les participants de cette ÉÉ sont des acteurs-clés du programme (N=13) rencontrés en entrevues. Une analyse documentaire (rapports et journal de bord) a également été effectuée. Cette ÉÉ a permis de clarifier les intentions des initiateurs du programme et les objectifs poursuivis par ces derniers. Elle a également permis de rendre la théorie du programme plus explicite et de développer le modèle logique, deux éléments qui ont facilité les opérations d’évaluation qui ont suivi. Le deuxième article porte sur l’évaluation des processus en utilisant la théorie de l’acteur-réseau (TAR) à travers ses quatre moments du processus de traduction des innovations (la problématisation, l’intéressement, l’enrôlement et la mobilisation des alliés), l’analyse des controverses et du rôle des acteurs humains et non-humains. Après l’analyse des données obtenues par entrevues auprès de 19 informateurs-clés, les résultats montrent que les phases d’implantation du programme passent effectivement par les quatre moments de la TAR, que la gestion des controverses par la négociation et le soutien était nécessaire pour la mobilisation de certains acteurs humains. Cette évaluation des processus a également permis de mettre en évidence le rôle des acteurs non-humains dans le processus d’implantation du programme. Le dernier article concerne une évaluation combinée des effets (volet quantitatif) et des processus (volet qualitatif) du programme. Pour le volet quantitatif, un devis quasi-expérimental a été adopté et les données ont été colligées de façon longitudinale par questionnaires auprès de 901 élèves de 5e et 6e année du primaire et leurs enseignants de 2010 à 2014. L’analyse des données ont montré que le programme n’a pas eu d’effets sur l’accessibilité et les risques perçus, l’usage problématique d’alcool et la polyconsommation (alcool et cannabis) chez les participants. Par contre, les résultats suggèrent que le programme pourrait favoriser la réduction du niveau de consommation et retarder l’âge d’initiation à l’alcool et au cannabis. Ils suggèrent également un effet potentiellement positif du programme sur l’intoxication à l’alcool chez les élèves. Quant au volet qualitatif, il a été réalisé à l’aide d’entrevues avec les intervenants (N=17), de groupes de discussion avec des élèves du secondaire (N=10) et d’une analyse documentaire. Les résultats montrent que le programme bénéficie d’un préjugé favorable de la part des différents acteurs ayant participé à l’évaluation et est bien acceptée par ces derniers. Cependant, le roulement fréquent de personnel et le grand nombre d’écoles à suivre peuvent constituer des obstacles à la bonne marche du programme. En revanche, le leadership et le soutien des directions d’écoles, la collaboration des enseignants, les qualités de l’IP et la flexibilité de la mise en œuvre sont identifiés comme des éléments ayant contribué au succès du programme. Les résultats et leur implication pour les programmes et l’évaluation sont discutés. Enfin, un plan de transfert des connaissances issues de la recherche évaluative est proposé. / Implementation of school-based substance use prevention activities is a widespread strategy to reach out to a significant number of young people. These activities are based either on existing programs or innovations dictated by the context of implantation or the existence of research data. In one case or another, evaluation of these programs is the best way to measure their effectiveness and/or to know how they operate. It is this need that motivated a school board in Quebec to recommend the evaluation of the Intervention Network (IR), a program developed to delay the age of substance use onset and to reduce problematic use of substances among students. This program takes an innovative approach with a patient navigator (PN) as the main implementation actor who keeps track of students from grade 5th to 9th. Inspired by such models in the fields of health prevention and the Healthy Schools Approach (HSA), the role of the PN here differs from those fields. S/he serves as an interface between the various stakeholders and students but in the IR program, the PN is integrated in primary and secondary schools involved in the program. The PN is also the one who ensures mobilization of other actors for the implementation of the program activities. This thesis aims to provide an account of the evaluation process and the results obtained. The evaluation approach is participatory and collaborative and combines both quantitative and qualitative data collected through questionnaires, interviews, focus groups, a logbook and meeting notes. Data were analyzed in the framework of three articles, the first being an evaluability assessment (EA) of the program. Participants of this EA are key-informants involved in the program implementation (n=13). A document review (report, logbook) was also conducted. The EA was helpful to clarify the intentions and objectives of the initiators of the program. It helped provide explicit information on the program theory and develop the logic model, two elements that facilitated subsequent evaluation operations. The second article is a process evaluation that uses Actor-Network Theory (ANT) as analytical framework, through the four moments of innovation translation (problematization, interessment, enrollment and mobilization of allies), controversies analysis, and the role of human and non-human actors. After analysis of the 19 interviews and available documents, results showed that the program implementation phases adequately follow the four moments of the ANT, that management of controversies by negotiation and support was needed for the mobilization of some human actors. This process evaluation also highlighted the role of non-human actors in the implementation process. The last article is a combined evaluation of the effects (quantitative component) and the process (qualitative component) of the program. For the quantitative component, a quasi-experimental design was used and data were collected longitudinally by questionnaires from 901 students of 5th and 6th grades and their teachers from 2010 to 2014. Data analysis indicated that the program had no effect on the accessibility and perceived risk, problematic use of alcohol and use of both alcohol and cannabis among participants. On the other hand, results suggest that the program could help reduce the level of consumption and delay the age of onset of alcohol and cannabis. These results also suggest a potentially positive effect of the program on alcohol intoxication among students. As for the qualitative component, stakeholder interviews (N = 17) and focus groups with high school students (N = 10) were conducted. Program documents were also analyzed. Results of this second process evaluation showed that the program is highly viewed and positively appreciated by the different actors involved in the program. However, frequent staff turnover and the number of schools to follow can be obstacles to the smooth running of the program. Nevertheless, the leadership role and support from the principals, teacher’s collaboration, the quality of the PN and flexibility in the implementation process are identified as factors contributing to the success of the program. All the results and their implication for program implementation and evaluation are discussed. Finally, to ensure greater access to the results, this thesis concludes with a plan for transferring knowledge drawn from the evaluation research.

En raison de la diffusion incontrôlée sur le e-commerce, la sécurité et l’alternative légale aux stupéfiants habituels, les nouvelles substances psychoactives (NPS), d’apparition récente (2008), sont au cœur des phénomènes récents d’addiction et de décès mal expliqués. Au-delà des différents défis dans nos sociétés (prévention, législation), la capacité d’identifier les NPS dans des échantillons biologiques pour caractériser leur utilisation, présente de nombreux challenges analytiques. L’objectif principal de cette thèse a été de collecter des échantillons biologiques (sang, urine, cheveux) provenant de cas d’exposition à des NPS et d’y caractériser les substances présentes à l’aide de méthodes analytiques originales, dans le but d’enrichir les librairies de spectres de masse et d’améliorer, en conséquence, la détection de la consommation de NPS. En particulier, il s’agissait d’augmenter la fenêtre de détection de la prise de NPS en se focalisant sur les métabolites qui sont, le plus souvent, les produits majeurs d’élimination. Le développement analytique, par chromatographie liquide ultra haute performance couplée à la spectrométrie de masse en tandem (UHPLC-MS/MS), a demandé plusieurs mois d’optimisation afin d’obtenir une méthode robuste, exhaustive et sensible. Actuellement, la librairie de spectres MS comporte 114 NPS et est mise à jour régulièrement. A la suite de ce développement, ma thèse a porté sur l’étude de cas d’intoxication vus au service des urgences du CHU de Strasbourg, mais aussi en médecine légale, avec des situations de décès et d’identification de produits inconnus provenant de saisies (poudres et cristaux). Il a également été nécessaire de développer des outils analytiques complémentaires, tels que la caractérisation de métabolite(s) par étude sur microsomes hépatiques humains (HLMs), et l’utilisation de la spectroscopie par résonance magnétique nucléaire (RMN) afin d’identifier avec certitude certains composés et de déterminer leur degré de pureté. Les outils analytiques développés et la stratégie mise en place ont permis la rédaction de 18 publications, ainsi que l’agencement de nombreuses collaborations. / Due to the uncontrolled spread on the Internet and their legal alternative to usual drugs, the new psychoactive substances (NPS), recently appeared (2008), are at the center of recent phenomena of addiction and badly explained deaths. Beyond different challenges in our societies (prevention, legislation), the ability to identify NPS in biological samples, in order to characterize their use, presents many analytical challenges. The main objective of this thesis was to collect biological samples (blood, urine, hair) from cases of exposure to NPS and to characterize the substances present using original analytical methods, in order to enlarge the libraries of mass spectra and improve, as a result, the detection of NPS consumption. In particular, it was intended to increase the detection sensitivity of NPS intake by focusing on the metabolites that are often the major products of elimination. This analytical development, by ultra-high liquid chromatography coupled with tandem mass spectrometry (UHPLC-MS/MS), required several months of optimization in order to obtain a robust, exhaustive and sensitive method. At present, the mass spectra database has 114 NPS and is regularly updated. Thereafter, ma thesis focused on the study of cases of intoxication observed in the emergency department of Strasbourg, but also in legal medicine with situations of deaths and identification of unknown products collected from seizures (powders and crystals). It has also been necessary to implement complementary analytical tools, such as the characterization of metabolites by human liver microsomes (HLMs), and the use of nuclear magnetic resonance (NMR) spectroscopy to accurately identify the compounds and establish their purity degrees. The analytical tools developed, and the strategy adopted, allowed the writing of 18 publications, as well as the setting up of numerous collaborations.

Objective: This research aimed at reviewing the information provided by the online drug misuse communities with reference to the available evidence-based literature on the novel psychoactive substances. Methodology: Among hundreds of novel psychoactive substances, four groups (phenethylamines, tryptamines, piperazines and miscellaneous) were selected for the study. Various website drug fora were identified by Google and Yahoo search engines using a set of specific key words. The methods consisted of extracting and analysing qualitative data from the identified website fora. This was also supplemented by critical reviewing the existing evidence-based literature search for each of the selected psychoactive compounds. Results: The combined search results identified 84 unique website fora from which qualitative data were extracted for thirty novel psychoactive substances and organised into technical folders. This data extracted from online communities has thrown some light on factors such as the mode of purchase, subjective experiences, reasons for use, combinations, legislation, mechanisms of action in the CNS, side effects, toxicity and its management. This would enable the clinicians to be obtain full history when assessing and would inform better treatment choices. Conclusions: A range of novel psychoactive substances have been made recently available across the globe. The sale is easily achieved through the Internet. New legislations are made to control some recreational substances whilst newer substances appear. Furthermore, the distributors sell the backlog of products even after controlling of the substance has occured and hence are liable to potentiating criminal investigations. It is here suggested as well that the 'genuinity' of each onlince susbtance is questionable. Evidence-based literature is scant for the vast majority of these substances. Accidental overdoses are common occurences and some of the potential life-threatening clinical situations include sympathomimetic toxidrome and serotonin syndrome. Benzodiazepines appear to help with agitation and neuropsychiatric manifestations. Better levels of international cooperation and rapid share of available information may be needed to tackle the emerging problem of the novel psychoactive substances.

The aim of this thesis is to draw attention to the serious problem of drug addiction among adolescents who are abusing addictive substances or marijuana. This increasingly important issue is discussed a lot, but very often neglected by the society. This thesis provides definitions and characteristics of individual drugs and their effects on adolescents. The need for prevention and treatment of adolescent clients is emphasized, alongside with the family support, which is often crucial. In the practical part, the author of the thesis focuses on organizations that are critically important in this field. These organizations focus on prevention, counseling services, social inclusion and treatment facilities (inpatient and outpatient services), etc. Their characteristics and methods of client treatment are described. Furthermore, in this work the author presents a survey that confirms the findings of some detailed quantitative research papers. The main findings are that drug abuse is a major problem of this century and also a burden on society, especially on the adolescents themselves. The solution is very complicated and time consuming, but everyone can contribute by not being indifferent to this problem.