Dans un contexte où plusieurs sphères de la vie ne se rapportant pas directement aux questions de santé (la performance sportive et intellectuelle, la contraception et l’apparence physique) sont aujourd’hui médicalisées, nous croyons qu’il importe d’examiner les critères permettant de légitimer l’intervention médicale sur le vieillissement. Dans ce mémoire, nous faisons l’hypothèse que l’approche naturaliste en philosophie de la médecine réussirait à rendre compte de la distinction entre le normal et le pathologique à partir de critères naturels et objectifs, permettant ainsi de rendre unanime la prise en charge médicale et de surpasser un certain relativisme des valeurs. Pour la vérifier, nous étudions dans ce mémoire trois propositions, chacune reposant sur trois champs d’études distincts : l’épidémiologie, la physiologie et la biologie évolutive. Premièrement, nous analysons le critère de l’inévitabilité, proposé par les architectes des études longitudinales américaines sur le vieillissement et repris aujourd’hui en gériatrie, définissant le vieillissement normal comme tout changement lié à l’âge considéré comme inévitable et le plus fréquemment observé. Notamment fondée sur l’épidémiologie, nous concluons, d’une part, que cette approche ne sait faire l’impasse sur le rôle des valeurs grâce aux critiques de Canguilhem et Sedgwick, et, d’autre part, qu’elle s’éloigne de la notion de facteurs de risque caractéristique de l’épidémiologie qui tend à remettre en question le dualisme normal/pathologique. Ensuite, nous pensons que la théorie biostatistique (BST) de Christopher Boorse constitue une approche naturaliste plus prometteuse que la précédente. Cependant, le vieillissement constitue un cas limite pour la BST puisqu’il résulte davantage d’une transition épidémiologique que de l’évolution. En effet, Boorse ne veut pas faire reposer ses notions de design et de classes de référence sur des changements environnementaux soudains, voulant plutôt que le fonctionnement normal relève d’un design significatif de l’histoire évolutive d’une espèce. Plus récemment, Boorse, suivant indirectement la proposition de Caplan, tend à considérer le vieillissement comme pathologique puisqu’il ne présenterait aucune fonction sélectionnée. Finalement, nous pensons que la position d’Arthur Caplan voulant que le vieillissement soit pathologique faute de fonction sélectionnée reprend quelques erreurs de l’adaptationnisme méthodologique en confondant l’explication de l’origine évolutive d’un trait et sa fonction. Nous analysons ainsi la proposition de Caplan à l’aune des différentes théories de la fonction biologique, des débats en biologie de l’évolution sur le vieillissement et des critiques de l’adaptationnisme. En conclusion, nous pensons qu’il est difficile de soutenir une position naturaliste de la distinction entre le vieillissement normal et le vieillissement pathologique. Une telle compréhension dichotomique semble au final moins prometteuse qu’une notion continuiste fondée, par exemple, sur les facteurs de risque. Nous proposons une étude plus approfondie des perspectives continuistes et de la possibilité que le vieillissement soit une exaptation, présentant des avantages au niveau écosystémique. Si cette hypothèse s’avérait valide, alors nous pourrions objectivement limiter l’intervention biomédicale en vue de prolonger la vie au nom d’une santé écosystémique. / Is aging a normal or a pathological process? To affirm the former leads to another question: how can we distinguish normal aging from its pathological deviations? This question is important since several domains in society, which are not directly concerned with matters of health and disease, are nevertheless subjected to medical intervention. Athletic and intellectual performance, or contraception and physical appearance, for instance, are all in the remit of medical interventions based on values such as productivity, youth, and fear of death. Naturalism in philosophy of medicine asserts that the distinction between health and disease can be based on natural criteria alone. With the prospect of delineating the scope of legitimate medical interventions, naturalism also hopes to avoid cultural relativism where health and disease are seen as context-dependant value judgments. This dissertation focuses on three approaches, each based on a different scientific field, namely: epidemiology, physiology and evolutionary biology. First, I consider the criterion of inevitability used in geriatrics and developed in the context of two of the most significant longitudinal studies of aging in North America. According to these studies, normal aging boils down to inevitable physiological change through time, which is based on statistical mean in an aging population. This kind of assumption has been notably criticized by the French philosopher George Canguilhem, and I conclude that it ultimately rely on value judgment. Secondly, I introduce the Biostatistical Theory (BST) of Christopher Boorse. In this naturalist theory, Boorse considers old age as a reference class of uniform functional design. According to the BST, a normal function is a statistically typical contribution of a part or process to their individual survival and reproduction. Yet, aging and old age are borderline cases for the BST because they are mostly the result of the twentieth-century epidemiological transition. For Boorse, the design and reference class need to be evolutionarily significant, and not based on sudden environmental changes. More recently, Boorse tends to consider aging as pathological, indirectly following Arthur Caplan’s assumption, because it has no selected functions. Finally I argue that Caplan’s assumption reprises methodological adaptationism which confuses the explanation of the evolutionary origin of a trait and its function. To support it, I analyze his arguments in light of the functional theories, the debates around the evolution of aging and the criticism of adaptationism. I assume from there the possibility that aging is an exaptation, having a function at other levels of biological organization namely at the ecosystem level. For example, ecosystem health could objectively delineate the premises of biomedical intervention to postpone aging and death. I generally conclude that a naturalist approach of normal and pathological aging is hard to defend. I think that digging deeper into a continuist approach could prove fruitful, while the notion of risk factor in epidemiology could open new ways to understand health and disease in aging.

L'objectif de ce mémoire est de montrer comment Gadamer parvient à apporter une légitimation philosophique à la vérité des sciences humaines sans recourir aux critères méthodologiques de la science moderne. Comme ces critères ne permettent pas de reconnaître le statut gnoséologique de certaines expériences que nous faisons, comme l'expérience esthétique ou l'expérience de notre appartenance à l'histoire, il est nécessaire de se questionner si celles-ci appartiennent, malgré cela, au champ de la connaissance ou si elles doivent en être exclues. Dans la mesure où les sciences humaines prennent en charge une part de ces expériences, en tant qu'héritières de la tradition humaniste, il est à se demander ce qui justifie leur prétention à la vérité. Selon une perspective herméneutique, Gadamer s'efforce de sonder les modalités propres au savoir des sciences humaines, ce qui l'amène à renouer avec la philosophie pratique d'Aristote, qui lui sert de modèle épistémologique pour penser la vérité de l'expérience humaine dans sa globalité. En s'inspirant aussi de l'analytique heideggérienne de la temporalité du Dasein, Gadamer parvient à fournir aux sciences humaines un fondement dans « les choses elles-mêmes », permettant ainsi d'en démontrer la pertinence autant sur le plan cognitif qu'existentiel.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Chronic respiratory diseases (CRDs) include chronic diseases involving the airways and other structures of the lung. In the current circumstance of Vietnam, people are exposed to numerous risk factors of CRD, such as heavy smoking, high frequency of pulmonary tuberculosis, chronic helminthiasis, allergic factors, migration and urbanization (the last associated with traffic-related pollution). The phenotype diagnoses should take into account the risk factors of each individual besides the clinical features, while the differential diagnoses mostly depend on the available techniques in each healthcare center. Our aim was to improve the differential diagnoses of the 3 most frequent CRDs: chronic obstructive pulmonary disease (COPD), asthma and COPD – asthma overlap syndrome (ACOS), in Vietnam. In the first part, we evaluated the prevalence of the allergen sensitization among patients with CRD, in regard to the urban and rural area in the South of Vietnam. House dust mites and cockroach droppings were the most frequent sensitizer. Compared with participants born in the urban setting, those born in the rural environment were less frequently sensitized and this protective effect disappeared in the case of migration from rural to urban areas. In the second part, we evaluated skin prick test as a method to screen dust mite sensitization in CRD in southern Vietnam. The data suggested that, in the present circumstance, skin prick test can be used to screen mite sensitization. In the third part, we evaluated the risk of mite sensitization in the native and migrant population, in regard to several environmental factors. Consistently with the hygiene hypothesis, compared to urban, exposure to high endotoxin concentration in rural was a protective factor against allergic sensitization. We reported for the first time that this effect was reversible among the migrants from rural to urban setting in association with lower endotoxin exposure. In the fourth part, we have defined asthma, COPD and ACOS based on clinical symptoms, cumulative smoking and airway expiratory flow with reversibility, on one side, and the age-related of the different phenotypes, on the other side. We hypothesized that the cumulative exposure to noxious particles should increase the age-related prevalence of COPD, while due to the immunosenescence process, the prevalence of IgE-mediated asthma should decrease with age, and ACOS prevalence being not related to age due to the combined mechanisms.  In conclusion, we showed in the South of Vietnam that:1) mites and cockroach allergens were the most frequent sensitizer in chronic respiratory diseases;2) the skin prick test to mite has been validated to screen mite sensitization;3) associated with a reduced level of endotoxin level, migration from rural to the urban setting was a risk factor of mite sensitization in chronic respiratory diseases;4) based on the clinical symptoms, spirometric values, and cumulative smoking, the diagnosis of asthma, COPD and ACOS have been made and their prevalence were 25, 42 and 33%, respectively. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Given the clear development of the educational mismatch phenomenon in our advanced economies, it seems interesting to investigate the effects of such phenomenon on the labour market. Based on available databases, this thesis gets into the research area of new working organizations and their effects on firm performance in a broader sense, by relying on a double stance. From the firm’s point of view, it analyses how educational mismatch impacts firm productivity (Chapter 2) and profitability (Chapter 3), according to different working environments. Chapter 2 provides first evidence on whether the direct relationship between educational mismatch and firm productivity varies across working environments, materialized as a socially responsible environment and a challenging environment. The results show that corporate social responsibility creates a working environment that fosters the positive impact of over-education on productivity, suggesting that socially responsible firms are more able than others to take advantage of the surplus knowledge of their over-educated workers. When investigating the role of a challenging environment, our results show that over-educated workers are more productive in firms that (i) require higher skills, (ii) rely on high-technological/knowledge processes, and (iii) operate in a more uncertain economic context, these three environments materializing a challenging situation. Chapter 3 reveals a profit-ability profile in the form of an inverted L with, at firm level, under-education being associated with a negative impact on profits, whereas higher levels of normal and over-education are associated with positive returns for firms. It also underlines caveats of relying on human capital hypothesis since increasing educational norms is associated with productivity gains that outpace hikes in labour costs, with the returns, in the case of Belgium, being captures by firms in the form of higher profits. Finally, it shows that in the particular context of high-tech industries, over-education could be a profitable strategy because hiring above educational norms leads to higher levels of profitability.From the workers’ point of view, this thesis analyses the wages impacts of educational mismatch by deepening and expanding the educational mismatch phenomenon to the skills mismatch phenomenon. Chapter 4 investigates the impact of educational and skills mismatches on workers’ wages by relying on three mismatch situations: (i) the apparent matching, where a worker is found to be properly educated but over-skilled; (ii) the apparent over-education, where a worker is found to be over-educated but properly skilled; and (iii) the genuine over-education, where a worker is found to be over-educated and over-skilled. Beside these considerations, this chapter also analyses whether the origin of the worker may influence the wage response to educational and skills mismatches. The results show that all specifications of over-education and over-skilling impact wages negatively, with the highest penalties for genuine over-education. When investigating differences between native and immigrant workers, the results suggest that immigrants suffer from a slightly higher pay penalty than natives. European immigrant and native workers thus do not seem to be that differently impacted by mismatches in terms of education and/or skills. / Doctorat en Sciences économiques et de gestion / info:eu-repo/semantics/nonPublished

La ligne directrice de notre recherche est de questionner l'évidence d'une distinction disciplinaire entre la sociologie et l'histoire. Vue l'étendue du sujet, nous avons adopté une posture exploratoire en suivant deux pistes. La première consiste à interroger un critère de distinction courant et selon lequel la sociologie serait davantage explicative alors que l'histoire serait essentiellement descriptive. À la lumière d'une mise en débat des positions de Durkheim et Weber pour la sociologie et de celles de l'histoire traditionnelle et des Annales pour l'histoire, nous avons noté une tendance à la diversité des conceptions disciplinaires qui semblent confirmée par certains travaux de recherche des auteurs discutés. Constatant un décalage entre les discours de définition disciplinaire et les recherches à proprement parler, la seconde piste d'exploration s'attarde à l'analyse des disciplines à l'oeuvre. À travers une sélection de trois études d'histoire et trois études de sociologie, nous avons cherché à identifier ce qui pourrait être considéré comme des fondements d'une distinction disciplinaire. Loin de fournir une ligne de démarcation claire, les oeuvres analysées semblent plutôt indiquer que l'histoire et la sociologie participent à une pratique analytique commune guidée par un processus d'interrogation complexe. Nous avançons que l'analyse des distinctions disciplinaires devrait se poursuivre par la recherche de postures interrogatives propres à chacune de l'histoire et de la sociologie. / The guideline of our research is to question the obviousness of a disciplinary dictinction between sociology and history. The subject being too broad, we have adopted an explorative approach wich follows two main tracks. The first one questions a common way of distinguishing sociology from history according to the idea that the first would be mainly explanatory while the latter would be essentially descriptive. We have confronted Durkheim's and Weber's main ideas about sociology, and brought together the debate around history which took place in France between the "histoire traditionnelle" and the "Annales" school. In doing so, we have noted a variety of ways of conceiving each discipline and that seems to be corroborated by some of these author's research work. We have also noticed a gap between disciplinary definitions and the academic research as such. Therefore, the second track of our exploration was the analysis of the "disciplines at work". By selecting three studies in history and three others in sociology, we have tried to identify some elements on wich a disciplinary distinction can be based. Far from revealing a clear boundary, the studies seemed rather to show that history and sociology take part in a common analytical practice guided by a complex process of inquiry. In that sense, we argue that the analysis of the disciplinary distinctions should carry on by a search for inquiry stances that may be specific to each of history and sociology.

Doctorat en philosophie et lettres / info:eu-repo/semantics/nonPublished

Doctorat en philosophie et lettres / info:eu-repo/semantics/nonPublished

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Doctorat en philosophie et lettres / info:eu-repo/semantics/nonPublished