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Despite decreasing cardiovascular disease mortality rates, these diseases are still the most common cause of death in a number of economically advanced countries, including the Czech Republic. This thesis deals with prevalence of myocardial infarction (the most common forms of ischemic heart disease) and selected risk factors of this disease, using the database of the international project SHARE (The Survey of Health, Aging and Retirement in Europe). The first part describes the development of mortality on circulatory system diseases and the risk factors of myocardial infarction are discussed in the context of the literature. The empirical part of this work analyzes the infarction prevalence and the relationship between infarction prevalence and risk factors in SHARE respondents, both in the group of respondents from European countries and in the subset of respondents from the Czech Republic, using the binary logistic regression method. The analysis showed, among other things, that the main risk factor for myocardial infarction of SHARE respondents was low physical activity among respondents in European countries, so did male respondents in the Czech Republic. In the group of Czech women, the main risk factor was underweight. Out of the social determinants, the impact of education attained in both...

La complexité qui traverse l'épidémiologie sociale et la médecine légale du vivant est de celle que l'on cherche à saisir par la variété des observations et par l'intrication de points de vue et d'échelles différentes - l'individu, le groupe, la société. Les méthodes du biomédical sont encore peu adaptées au traitement de la complexité, à sa représentation qui ne soit pas normative, statistique. Il existe un ensemble d'approches non statistiques, " non classiques ", qui puissent traiter simultanément un grand nombre de dimensions et qui permettent de réduire la complexité apparente en dégageant des objets d'étude spécifique. Nous présentons ici les principes et l'utilisation des techniques de reconnaissance de forme dans le cadre de l'épidémiologie sociale, en les appliquant à la recherche d'une typologie de recours aux soins, sur la base des données de la cohorte SIRS. Nous expliquons en quoi ces approches ont leur place, épistémologiquement et techniquement parlant, aux côtés des méthodes expérimentales classiques type essais randomisés contrôlés. Nous exposons également un autre moyen de réduire la complexité des données, tout en en préservant les qualités topologiques. Nous introduisons en médecine légale la notion de dimension intrinsèque, plus petite dimension nécessaire et suffisante à la description des données, et de techniques non linéaires de réduction de la dimension. Nous en appliquons les principes au cas de l'intégration de sources d'information multiples pour l'estimation de l'âge chez les adolescents migrants. Enfin, nous discutons les avantages et limites de ces approches ainsi que les perspectives qu'elles ouvrent à ces deux disciplines complémentaires. / Social epidemiology and clinical legal medicine are hybrid objects that articulate several fields, accounting for social and interpersonal relationships. The complexity that characterizes them both is investigated through different viewpoints, scales and dimensions: the individual scale, the group scale and the society scale. The techniques used in biomedicine are not designed to properly deal with such a complexity, in a non-normative way. A wide range of alternative non-statistical, “non-classical” methods exist that can process simultaneously various dimensions so that we can reduce the apparent complexity of data while discovering scientific objects. Here, we present the principles and the use of clustering techniques, applied to social epidemiology. We applied different clustering techniques on data from the SIRS cohort to build a typology of healthcare utilization in the Paris metropolitan area. From an epistemological and technical viewpoint, we explain why these methods should take place beside other recognized but limited techniques such as randomized controlled trials. We introduce another but complementary kind of complexity reduction technique. The concept of intrinsic dimension is explained – the littlest dimension needed to describe properly data – and nonlinear dimensionality reduction techniques are applied in clinical legal medicine. With these tools, we explore whether the integration of multiple information sources is relevant in age estimation of living migrants. Finally, we discuss the pros and cons of these methods, as well as the opportunities they may create for both fields of social epidemiology and clinical legal medicine.

Les résultats d’un nombre croissant d’études montrant l'effet préventif du traitement antirétroviral(TARV) sur la transmission du VIH ont jeté les bases de travaux de modélisation suggérant que ledépistage universel et répété du VIH, associé à l'initiation immédiate d’un TARV chez les personnesséropositives, pourraient infléchir l'épidémie de VIH, en particulier en Afrique sub-saharienne. On nesait pas encore si cette stratégie, qui consiste à Tester et Traiter Universellement (TTU), est réalisableau niveau populationnel, compte tenu des contraintes et du niveau requis de prise en charge du VIH quisont sans précédent.L'objectif de cette thèse était d'explorer les conditions de mise en oeuvre d’une stratégie TTU à largeéchelle. Sur la base des protocoles d'études communautaires menées en Afrique subsaharienne, nousavons caractérisé la diversité des approches TTU. Dans le cadre de l'une de ces études, l'essai ANRS12249 TasP mené dans une zone rurale d’Afrique du Sud, nous avons décrit les expériences etperceptions des travailleurs de la santé vis-à-vis de la stratégie TTU et étudié les trajectoires de soinsdes personnes vivant avec le VIH.Les résultats rapportés dans cette thèse mettent en évidence que les stratégies TTU englobent une variétéd'interventions de prise en charge du VIH, rendant complexe l'évaluation de leur impact sur l'épidémie.Les analyses des opinions des travailleurs de santé et des comportements des patients exposés à unestratégie TTU ont également permis de souligner le potentiel de la stratégie à faire évoluer les pratiquesprofessionnelles et l’accès aux soins des patients. L’ensemble de ce travail permet de mieux appréhenderles efforts nécessaires pour assurer un impact maximal d’une stratégie TTU sur la santé des populationsen Afrique subsaharienne. / Increasing evidence of the preventive effect of antiretroviral treatment (ART) on HIV transmission havelaid the foundations for mathematical models to suggest that universal and repeated HIV testing,combined with immediate initiation of ART among those diagnosed HIV-positive could curtail the HIVepidemic, especially in sub-Saharan Africa. It is still unknown if this strategy, labelled as “UniversalTest and Treat” (UTT), could be workable at population level, given the unprecedented HIV servicesuptake rates that it requires.The objective of this thesis was to explore the terms of large-scale UTT implementation. Based on theprotocols of community-based trials conducted in sub-Saharan Africa, we characterized the diversity ofUTT approaches. Within the framework of one of those studies, the ANRS 12249 TasP trial, conductedin rural South Africa, we described the perceptions of health care workers regarding UTT and studiedthe care trajectories of people living with HIV from care referral to viral suppression.The findings reported in this thesis highlight that UTT strategies encompass a variety of healthinterventions, challenging the assessment of their impact on the HIV epidemic. Analyses of health careworkers opinions and patients’ behaviours when exposed to UTT underlined the potential of the strategyto change professional practices and patients’ access to care. Overall this work provides some insightson the efforts needed to allow the maximal public health impact of UTT in sub-Saharan Africa.

Historically, the Jewish faith has used alcohol in rituals and religious holidays in which adolescents are permitted to fully participate and this exposure to alcohol may influence attitudes and beliefs about underage drinking among Jewish adolescents. The purpose of this study was to determine if there was a relationship between the Jewish religion and attitudes toward alcohol among Jewish adolescents. The theoretical frameworks, on which this study was based, were the social bond theory and the social development theory. Each of these theories indicates that community is important to the individual. Using a cross sectional study design, 160 adolescents participated in a survey that was administered by paper during a free period or lunchtime. ANOVA and linear regression were used to determine if there was a relationship between religion, gender, age, and attitudes toward alcohol. According to study findings, there was no significant relationship between religious affiliation or religious service attendance and attitudes towards the use of alcohol. However, there was a significant relationship between gender and attitudes against drinking and between age and the positive attitudes for drinking. These findings may spur positive social change at the community level. Yeshivas may review with Jewish adolescents the distinction between using alcohol for rituals/ceremonies and using alcohol socially, and the consequences of underage drinking. Future studies should include more participants in the different sects and denominations to get a more complete picture of the Jewish community.

Background: Childhood excess weight and family food insecurity are food-system related public health problems that exist in Canada. Since both relate to issues of food accessibility and availability, which have elements of “place”, they may share common risk factors in the local environment that are amenable to intervention. In this area of research, the literature derives mostly from a US context, and there is a dearth of high quality evidence, specifically from longitudinal studies. Objectives: The main objectives of this thesis were to examine the adjusted associations between the place factors: material deprivation, social deprivation, social cohesion, disorder, and living location, with change in child BMI Z-score and with change in family food insecurity status in a Canadian cohort of children. Methods: The Québec Longitudinal Study of Child Development was used to meet the main objectives of this thesis. Response data from six collection cycles (4 – 10 years of age) were used in three main analyses. The first analysis examined change in child BMI Z-score as a function of the place factors using mixed models regression. The second analysis examined change in child BMI Z-score as a function of place factors using group-based trajectory modeling. The third and final analysis examined change in family food insecurity status as a function of the place factors using generalized estimating equations. Results: Social deprivation, social cohesion and disorder were strongly and positively associated with family food insecurity, increasing the odds by 45-76%. These place factors, on the other hand, were not consistently associated with child weight status. Material deprivation was not important for either outcome, except for a slight positive association in the mixed models analysis of child weight status. Living location was not important in explaining family food insecurity. On the other hand, it was associated with child weight status in both analyses, but the nature of the relationship is still unclear. Conclusions: Results do not suggest that addressing similar place factors may alleviate both child excess weight and family food insecurity. More high quality longitudinal and experimental studies are needed to clarify relationships between the local environment and child weight status and family food insecurity.

Background: Childhood excess weight and family food insecurity are food-system related public health problems that exist in Canada. Since both relate to issues of food accessibility and availability, which have elements of “place”, they may share common risk factors in the local environment that are amenable to intervention. In this area of research, the literature derives mostly from a US context, and there is a dearth of high quality evidence, specifically from longitudinal studies. Objectives: The main objectives of this thesis were to examine the adjusted associations between the place factors: material deprivation, social deprivation, social cohesion, disorder, and living location, with change in child BMI Z-score and with change in family food insecurity status in a Canadian cohort of children. Methods: The Québec Longitudinal Study of Child Development was used to meet the main objectives of this thesis. Response data from six collection cycles (4 – 10 years of age) were used in three main analyses. The first analysis examined change in child BMI Z-score as a function of the place factors using mixed models regression. The second analysis examined change in child BMI Z-score as a function of place factors using group-based trajectory modeling. The third and final analysis examined change in family food insecurity status as a function of the place factors using generalized estimating equations. Results: Social deprivation, social cohesion and disorder were strongly and positively associated with family food insecurity, increasing the odds by 45-76%. These place factors, on the other hand, were not consistently associated with child weight status. Material deprivation was not important for either outcome, except for a slight positive association in the mixed models analysis of child weight status. Living location was not important in explaining family food insecurity. On the other hand, it was associated with child weight status in both analyses, but the nature of the relationship is still unclear. Conclusions: Results do not suggest that addressing similar place factors may alleviate both child excess weight and family food insecurity. More high quality longitudinal and experimental studies are needed to clarify relationships between the local environment and child weight status and family food insecurity.

Durkheim’s socioeconomic hypothesis of suicide has been a popular theory to test for sociologists. However the results have been mixed, offering very little cumulative sociological knowledge. Previous theory and research have found that there are contradictory results in the direction of the income regression coefficients used to study the relationship between income and suicide rates depending on if a time-series or a cross-sectional approach has been used. It has been hypothesised that the contradictory results are caused by a specification bias, namely failing to account for lagged income, which is influencing the direction of the regression coefficients. The aim of this study is to investigate the effect of income on the Swedish municipalities’ suicide rates by replicating a study published in The American Journal of Sociology by Carl B. Barnes from 1975, in which he argued that the effect of income on the suicide rate is always negative. This cross-sectional analysis is based on municipality data on male, female and overall suicide in 2002 to 2004 from the Swedish Centre for National Prevention of Suicide and Mental Ill-Health at Karolinska Institutet among the working-age population (25-64 years). Control variables are the hypothesised lagged variable causing the specification bias, education, and three other possible contributing factors to suicide; unemployment, alcohol consumption and divorce. The results of the correlation and regression coefficients show that there is a negative effect of income on suicide for those aged 25 to 64 years when the other variables are held constant for both sexes; however the male results are not statistically significant. These results speak against the socioeconomic hypothesis of suicide, but generally confirm earlier findings of a negative relationship between median income and suicide. Low education is positively related to the suicide rate for males but there is no such relationship for female suicide. The findings also confirm alcohol consumption as an important factor in explaining the suicide rate. Unemployment and divorce show mixed results for the male and female suicide rates. The female unemployment rates are negatively related to suicide while male unemployment rates are not significant, on the other hand the divorce rates show a strong positive association with the female suicide rate and a negative association with the male suicide rate.

Gender inequality is the root cause of the differences in mental disorders prevalence between men and women. The aim of this thesis was to examine social inequalities in mental health, focusing on gender as a critical determinant of mental health and mental illness. In the first chapter, the ways mental health is shaped by gender and other social determinants are discussed. Gender-based discrimination, traditional gender roles, unequal distribution of power and lack of control over life events are the most common risk factors for higher prevalence of mental disorders in women. In the empirical part of this thesis the European countries were grouped based on indicators related to women's mental health. The typology was developed using factor and cluster analyses. Subsequently, logistic regression analysis investigated associations between prevalence of depression and various social determinants of mental health in respondents of the Survey of Health, Ageing and Retirement in Europe (SHARE). The results suggest that risk factors for common mental disorders are gender specific.

Background: Childhood excess weight and family food insecurity are food-system related public health problems that exist in Canada. Since both relate to issues of food accessibility and availability, which have elements of “place”, they may share common risk factors in the local environment that are amenable to intervention. In this area of research, the literature derives mostly from a US context, and there is a dearth of high quality evidence, specifically from longitudinal studies. Objectives: The main objectives of this thesis were to examine the adjusted associations between the place factors: material deprivation, social deprivation, social cohesion, disorder, and living location, with change in child BMI Z-score and with change in family food insecurity status in a Canadian cohort of children. Methods: The Québec Longitudinal Study of Child Development was used to meet the main objectives of this thesis. Response data from six collection cycles (4 – 10 years of age) were used in three main analyses. The first analysis examined change in child BMI Z-score as a function of the place factors using mixed models regression. The second analysis examined change in child BMI Z-score as a function of place factors using group-based trajectory modeling. The third and final analysis examined change in family food insecurity status as a function of the place factors using generalized estimating equations. Results: Social deprivation, social cohesion and disorder were strongly and positively associated with family food insecurity, increasing the odds by 45-76%. These place factors, on the other hand, were not consistently associated with child weight status. Material deprivation was not important for either outcome, except for a slight positive association in the mixed models analysis of child weight status. Living location was not important in explaining family food insecurity. On the other hand, it was associated with child weight status in both analyses, but the nature of the relationship is still unclear. Conclusions: Results do not suggest that addressing similar place factors may alleviate both child excess weight and family food insecurity. More high quality longitudinal and experimental studies are needed to clarify relationships between the local environment and child weight status and family food insecurity.