Objectives: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. Methods: We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. Results: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001). Conclusions: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.

L’objectif du travail de cette thèse est la contribution au développement de nouvelles techniques dans le domaine dessystèmes de détection sans marqueur pour une utilisation dans trois domaines vitaux de la santé en utilisant des capteursinnovants et peu coûteux. Pour la réalisation de nos objectifs nous avons eu recours principalement à de l’électroniqueembarquées et du traitement du signal en utilisant le capteur Kinect. Des résultats encourageants ont été obtenus et sontprésentés tout au long de cette thèse. Dans la première partie de ce travail, nous présentons un nouveau système desurveillance visuelle sans marqueur en temps réel pour détecter et suivre les personnes âgées et surveiller leurs activitésdans leur environnement intérieur en utilisant un réseau de capteurs Kinect. Le système identifie également l’événementde chute des personnes âgées sous surveillance. Dans la deuxième partie nous utilisons également le capteur Kinectmais cette fois ci pour la détection sans marqueur des mouvements de la tête d’un patient lors d’un examen utilisant LaTomographie par Emission de Positons (CT/PET) du cerveau. Ce travail est basé sur la compensation de la dégradationde l’image TEP due aux mouvements de la tête du patient. Pour nos essais un cobaye dit « fantôme » a été réalisé,les résultats sur le fantôme sont prometteur ce qui a donné lieu à un test sur un vrai patient volontaire. Les résultatsfinaux montrent l’efficacité de ce nouveau système. La troisième partie du travail présente la mise en oeuvre d’un nouveausystème intelligent pour contrôler un fauteuil roulant électrique par des mouvements spéciaux de la tête toujours sansmarqueur. Un algorithme adapté est conçu pour détecter en continu les degrés des mouvements du visage en utilisant lecapteur Kinect. Fautes de fauteuil roulant électrique, le système a été testé sur un véhicule radio commandé. / The objective of the work of this thesis is the contribution in developing novel technical methods in the field of marker-lesssensing systems for use in three vital health areas by using new inexpensive sensors. Several scientific areas are involvedin achieving our objective such as; electronics and signal processing by using the Kinect sensor. Encouraging results wereachieved as presented throughout this thesis. In the first part of this work we present a new real-time marker-less visualsurveillance system for detecting and tracking seniors and monitoring their activities in the indoor environment by usingnetwork of Kinect sensors. The system also identifies the fall event with the elderly. In the second part, we present anew approach for a marker-less movement detection system for influential head movements in the brain Positron EmissionTomography imaging (CT/PET) by employing the Kinect sensor. This work addresses the compensation of the PET imagedegradation due to subject’s head movements. A developed particular phantom and volunteer studies were carried out.The experimental results show the effectiveness of this new system. The third part of the work presents the design andimplementation of a new smart system for controlling an electric wheelchair by special mark-less head movements. Anadaptable algorithm is designed to continuously detect the rotation degrees of the face pose using the Kinect sensor inreal-time that are interpreted as controlling signals through a hardware interface for the electric wheelchair actuators.

Natural health products (NHPs) are attractive due to the public’s perception that they are natural and safe but there is wide variety of risks associated with these products. Post-market surveillance is the key to control hazards produced from NHPs. A set of activities are involved in post-market surveillance designed to assure the safety, efficacy and quality of products after being launched into the market. Although post-market surveillance is an efficient tool to preserve the safety of users from adverse reactions of NHPs but there are various challenges associated with performing post-market surveillance specifically for NHPs. This research project is focused on defining a framework for performing post-market surveillance for NHPs and on identifying best practices in its application. An international comparative analysis was undertaken to formulate best practices by reviewing existing frameworks for post-market surveillance of NHPs in Australia, Germany, New Zealand, United Kingdom and United States. Evidence-based best practices are compared with the Canadian post-market surveillance framework to identify key gaps in the Canadian system. Recommendations are provided for bridging each gap, and making the Canadian NHPs surveillance system, strong according to the international standards of best practices.

Natural health products (NHPs) are attractive due to the public’s perception that they are natural and safe but there is wide variety of risks associated with these products. Post-market surveillance is the key to control hazards produced from NHPs. A set of activities are involved in post-market surveillance designed to assure the safety, efficacy and quality of products after being launched into the market. Although post-market surveillance is an efficient tool to preserve the safety of users from adverse reactions of NHPs but there are various challenges associated with performing post-market surveillance specifically for NHPs. This research project is focused on defining a framework for performing post-market surveillance for NHPs and on identifying best practices in its application. An international comparative analysis was undertaken to formulate best practices by reviewing existing frameworks for post-market surveillance of NHPs in Australia, Germany, New Zealand, United Kingdom and United States. Evidence-based best practices are compared with the Canadian post-market surveillance framework to identify key gaps in the Canadian system. Recommendations are provided for bridging each gap, and making the Canadian NHPs surveillance system, strong according to the international standards of best practices.