<p>Studies concerning social consequences, gastrointestinal and urinary tract symptoms were conducted in a population-based cohort comprising patients with long-standing type 1 diabetes and matched control persons. Three different questionnaires were sent by mail to diabetic patients and control persons. After a mean duration of 28.7±2.6 years, compared to the controls the diabetic patients showed an almost 10 times higher mortality, a lower employment rate and greater need for welfare benefits. These differences were mainly due to diabetic late complications. Education, housing conditions, life-style, civil state, alcohol and smoking habits were similar in the two groups. The prevalence of gastrointestinal symptoms was significantly higher in the diabetic patients than in the controls, and this was found to be attributable to the female diabetic patients. Female diabetic patients had been treated with antibiotics for urinary tract infections more often than controls, they experienced more social problems than controls in daily life because of urinary tract problems and used clamps to prevent wetting more often than did controls. </p><p>Body composition and bone mineral density were evaluated in parts of the cohort with long-standing type 1 diabetes and control persons in another population-based cohort comprising diabetic females aged 16-19 years with type 1 diabetes since childhood and matched controls. Besides a tendency to reduced abdominal fat mass in diabetic males, no difference was observed in fat mass, muscle mass or bone mineral density between the patients with long-standing type 1 diabetes and controls. Significant correlations were found between insulin dosage and whole body fat mass in diabetic females and between serum cholesterol levels and abdominal fat mass in diabetic males. The female adolescents had a higher body mass index than the controls, and their overweight was shown to consist almost entirely of an increased fat mass. The distribution of fat, expressed as abdominal-to-leg ratio, correlated significantly to HbA1c and daily dosage of insulin. Bone mineral density did not differ between the groups. IGF I was significantly lower both in patients with long-standing type 1 diabetes and in the adolescent diabetic females compared with their matched controls.</p>

Studies concerning social consequences, gastrointestinal and urinary tract symptoms were conducted in a population-based cohort comprising patients with long-standing type 1 diabetes and matched control persons. Three different questionnaires were sent by mail to diabetic patients and control persons. After a mean duration of 28.7±2.6 years, compared to the controls the diabetic patients showed an almost 10 times higher mortality, a lower employment rate and greater need for welfare benefits. These differences were mainly due to diabetic late complications. Education, housing conditions, life-style, civil state, alcohol and smoking habits were similar in the two groups. The prevalence of gastrointestinal symptoms was significantly higher in the diabetic patients than in the controls, and this was found to be attributable to the female diabetic patients. Female diabetic patients had been treated with antibiotics for urinary tract infections more often than controls, they experienced more social problems than controls in daily life because of urinary tract problems and used clamps to prevent wetting more often than did controls. Body composition and bone mineral density were evaluated in parts of the cohort with long-standing type 1 diabetes and control persons in another population-based cohort comprising diabetic females aged 16-19 years with type 1 diabetes since childhood and matched controls. Besides a tendency to reduced abdominal fat mass in diabetic males, no difference was observed in fat mass, muscle mass or bone mineral density between the patients with long-standing type 1 diabetes and controls. Significant correlations were found between insulin dosage and whole body fat mass in diabetic females and between serum cholesterol levels and abdominal fat mass in diabetic males. The female adolescents had a higher body mass index than the controls, and their overweight was shown to consist almost entirely of an increased fat mass. The distribution of fat, expressed as abdominal-to-leg ratio, correlated significantly to HbA1c and daily dosage of insulin. Bone mineral density did not differ between the groups. IGF I was significantly lower both in patients with long-standing type 1 diabetes and in the adolescent diabetic females compared with their matched controls.

Arbetet behandlade vilka konsekvenser inom driften (ekonomiska kostnader och teknologi) som rederier kommer att drabbas av när IMO:s barlastkonvention träder i kraft då barlastvattnet måste renas innan inträde i Östersjön. Arbetets syfte var att få fram vilka konsekvenser det blir för rederier när IMO:s barlastkonvention träder i kraft. Resultatet skulle jämföra skillnaden mellan lag och rekommendation då Helsingforskonventionens rekommendationer baseras på IMO:s barlastkonventions krav. En kvalitativ metod valdes för att komma fram till resultatet, i form av en öppen intervjustudie, där fyra olika företag har intervjuats. Syftet med intervjuerna var att se ifall de följde Helsingforskonventionens rekommendationer och vilka konsekvenser det skulle innebära och skulle komma att krävas då Barlastkonventionen träder i kraft. Resultatet visade att kostnaderna kommer att bli omfattande vid installation samt att det kommer att krävas teknologiska åtgärder. Vidare visade undersökningen att inköpskostnaden endast utgör en liten del av fartygets investering och att barlastreningsanläggningar är tämligen underhållsfria. / The task discussed the consequences within the ship’s operation (economical costs and technology) companies will be affected with when IMO’s Ballast Water Convention enters into force and ballast water has to be treated before entrance to the Baltic Sea. The purpose with the task was to find out which consequences companies will be forced with when IMO’s Ballast Water Convention enters into force. The result compares the difference between law and recommendation because HELCOM’s recommendations are based on IMO’s Ballast Water Convention’s laws. A qualitative method has been used, such as an open interview form, where four different companies were interviewed. The purpose with the interviews was to see if the companies followed HELCOM’s recommendations and which consequences it would lead to and would be necessary when the Ballast Water Convention enters into force. The results showed that the costs would be extensive when installation takes place and it will require technical arrangements. The task also shows that the purchase cost only makes a small part of the vessel’s investment and ballast water treatment systems are almost totally maintenance-free.

Declining union memberships are a fact in both Sweden and Finland. At the same time, the autonomous labour market parties and the high membership rates are the most significant factors for the two countries compared to Europe and the rest of the world. These two factors have in turn been developed and strengthened since the beginning of the twentieth century. By autonomous labour market parties I refer to the fact that the labour market parties themselves through collective bargaining are agreeing on the labour market conditions, without interference from the government. This paper is therefore taking it's stance in the question of what happens with the autonomous labour market parties when the membership rates are in decline.   With this in mind, this paper describes the judicial development, the collective agreement and labour market structures, the legal consequences of collective agreements and the opportunities of industrial and sympathy action in both Sweden and Finland. The two countries' systems of labour law have caught some negative attention, hence two of the most discussed cases of recent years are given some attention as well.   The collective judicial conditions are very similar in both Sweden and Finland regarding the labour market main actors' collaboration, the collective agreement structures and legal consequences and the opportunities of industrial and sympathy action. The Finnish regulations regarding industrial action are somewhat more unconstrained compared to the Swedish ones. The Swedish opportunities of sympathy action are on the other hand more intricate and contain more exceptions. The Finnish union density is almost as high as in Sweden, although the Finnish employees are more willing to use industrial action. The labour market structures are relatively similar between the countries and so are the effects of the legislation and traditions surrounding them. The differences are found in the larger gender pay gaps present in Finland. While the differences are also present in Sweden, they are smaller. The similarities are found in the effects of the labour market structures and the labour market main actors' collaboration. Both are contributing to strengthening the present conditions. / Gemensamt för Sverige och Finland är att medlemstalen i de fackliga organisationerna minskar. Samtidigt är det den fackliga autonomin och den höga anslutningsgraden som i jämförelse med Europa och resten av världen är utmärkande för de båda länderna. Dessa två faktorer har i de båda länderna utvecklats och befästs sedan början av 1900-talet. Den fackliga autonomin bygger på att de centrala parterna utan inblandning från staten själva kommer överens om arbetsmarknadens villkor. Uppsatsen utgår därför från den övergripande frågan om vad som händer med den fackliga autonomin när medlemstalen minskar.   Med detta i åtanke redogör uppsatsen för Sveriges och Finlands rättsliga utveckling, deras kollektivavtals- och arbetsmarknadsstrukturer, kollektivavtalens bindningsmekanism och rättsverkningar samt möjligheten till strids- och sympatiåtgärder. De båda ländernas arbetsrättsliga system har heller inte undgått kritik, varför två av de mest omtalade rättsfallen på senare tid också ges en redogörelse.   Sveriges och Finlands kollektiva arbetsrättsliga system är mycket lika, både avseende de centrala parternas samrådsförfaranden, kollektivavtalens bindningsmekanism, rättsverkningar och arbetskonfliktsreglering. Den finska regleringen kring stridsåtgärder är dock något friare, medan den svenska innehåller fler intrikata undantag. De finska arbetstagarna är medlemmar i fackliga organisationer i nästan lika hög grad som de svenska. De finska arbetstagarna är dock betydligt mer benägna att ta till arbetsstrid. Arbetsmarknadsstrukturerna i Sverige och Finland är relativt lika och likaså effekterna av dem. Skillnaden ligger i de stora löneskillnader mellan män och kvinnor som föreligger i Finland. Även i Sverige förekommer det skillnader, om än något mindre. Effekterna, som är liknande i de båda länderna, består i att befintliga särfördelningar av löne- och anställningsvillkor befästs genom rådande arbetsrättsliga reglering och huvudavtalsparternas samrådsförfaranden. / Yhteistä Ruotsin ja Suomen ammattiliitoille on jäsenmäärän supistuminen. Samanaikaisesti ammattiliittojen itsenäisyys ja korkea järjestäytymisaste ovat ominaisia molemmille maille verrattuna Eurooppaan ja muuhun maailmaan. Nämä kaksi tekijää ovat molemmissa maissa kehittyneet ja vahvistuneet 1900-luvun alusta alkaen.   Ammattiyhdistysten itsenäisyys rakentuu sille että keskeiset osapuolet ilman valtiovallan sekaantumista sopivat itse työmarkkinoiden ehdoista. Opinnäytteen lähtökohta on mitä tapahtuu ammattiyhdistysten itsenäisyydelle jäsenmäärän supistuessa.   Opinnäyte selvittää Ruotsin ja Suomen yhteiskuntien oikeudellista kehitystä, työehtosopimus- ja työmarkkinarakennetta, työehtosopimusten sitomismekanismia ja oikeudellisia vaikutuksia sekä mahdollisuuksia työtaistelu- ja myötätuntotoimenpiteisiin. Molempien maiden työoikeudellinen järjestelmä ei ole välttynyt arvostelulta, josta syystä aineisto sisältää selostuksen kahdesta viime aikojen puhutuimmasta oikeustapauksesta.   Ruotsin ja Suomen työoikeudellinen järjestelmä on hyvin samankaltainen sekä keskeisten osapuolten kuulemismenettelyn, työehtosopimusten sitomismekanismin, oikeudellisten vaikutusten että työtaistelujen säätelyn osalta. Suomalainen työtaistelusäätely on jonkunverran vapaampi, ruotsalainen sisältää useita monimutkaisia poikkeuksia. Suomalaiset työntekijät ovat ammattiliitojen jäseniä melkein yhtä usein kuin ruotsalaiset. Suomalaiset työntekijät ovat kuitenkin paljon useammin mukana työtaisteluissa Työmarkkinoiden rakenne Ruotsissa ja Suomessa ovat suhteellisen samanlaisia kuten myös niiden vaikutukset. Erot ovat Suomen suurissa palkkaeroissa miesten ja naisten kesken. Myös Ruotsissa on eroja, joskin pienempiä. Vaikutukset jotka ovat samanlaisia molemmissa maissa, koostuvat vallitsevan jaon palkka- ja palkkaamisehtojen vahvistamisesta vallitsevasta työoikeudellisesta sääntelystä ja pääsopijaosapuolten kuulemismenettelystä.

<p>Declining union memberships are a fact in both Sweden and Finland. At the same time, the autonomous labour market parties and the high membership rates are the most significant factors for the two countries compared to Europe and the rest of the world. These two factors have in turn been developed and strengthened since the beginning of the twentieth century. By autonomous labour market parties I refer to the fact that the labour market parties themselves through collective bargaining are agreeing on the labour market conditions, without interference from the government.</p><p>This paper is therefore taking it's stance in the question of what happens with the autonomous labour market parties when the membership rates are in decline.</p><p> </p><p>With this in mind, this paper describes the judicial development, the collective agreement and labour market structures, the legal consequences of collective agreements and the opportunities of industrial and sympathy action in both Sweden and Finland. The two countries' systems of labour law have caught some negative attention, hence two of the most discussed cases of recent years are given some attention as well.</p><p> </p><p>The collective judicial conditions are very similar in both Sweden and Finland regarding the labour market main actors' collaboration, the collective agreement structures and legal consequences and the opportunities of industrial and sympathy action. The Finnish regulations regarding industrial action are somewhat more unconstrained compared to the Swedish ones. The Swedish opportunities of sympathy action are on the other hand more intricate and contain more exceptions. The Finnish union density is almost as high as in Sweden, although the Finnish employees are more willing to use industrial action. The labour market structures are relatively similar between the countries and so are the effects of the legislation and traditions surrounding them. The differences are found in the larger gender pay gaps present in Finland. While the differences are also present in Sweden, they are smaller. The similarities are found in the effects of the labour market structures and the labour market main actors' collaboration. Both are contributing to strengthening the present conditions.</p> / <p>Gemensamt för Sverige och Finland är att medlemstalen i de fackliga organisationerna minskar. Samtidigt är det den fackliga autonomin och den höga anslutningsgraden som i jämförelse med Europa och resten av världen är utmärkande för de båda länderna. Dessa två faktorer har i de båda länderna utvecklats och befästs sedan början av 1900-talet.</p><p>Den fackliga autonomin bygger på att de centrala parterna utan inblandning från staten själva kommer överens om arbetsmarknadens villkor. Uppsatsen utgår därför från den övergripande frågan om vad som händer med den fackliga autonomin när medlemstalen minskar.</p><p> </p><p>Med detta i åtanke redogör uppsatsen för Sveriges och Finlands rättsliga utveckling, deras kollektivavtals- och arbetsmarknadsstrukturer, kollektivavtalens bindningsmekanism och rättsverkningar samt möjligheten till strids- och sympatiåtgärder. De båda ländernas arbetsrättsliga system har heller inte undgått kritik, varför två av de mest omtalade rättsfallen på senare tid också ges en redogörelse.</p><p> </p><p>Sveriges och Finlands kollektiva arbetsrättsliga system är mycket lika, både avseende de centrala parternas samrådsförfaranden, kollektivavtalens bindningsmekanism, rättsverkningar och arbetskonfliktsreglering. Den finska regleringen kring stridsåtgärder är dock något friare, medan den svenska innehåller fler intrikata undantag. De finska arbetstagarna är medlemmar i fackliga organisationer i nästan lika hög grad som de svenska. De finska arbetstagarna är dock betydligt mer benägna att ta till arbetsstrid. Arbetsmarknadsstrukturerna i Sverige och Finland är relativt lika och likaså effekterna av dem. Skillnaden ligger i de stora löneskillnader mellan män och kvinnor som föreligger i Finland. Även i Sverige förekommer det skillnader, om än något mindre. Effekterna, som är liknande i de båda länderna, består i att befintliga särfördelningar av löne- och anställningsvillkor befästs genom rådande arbetsrättsliga reglering och huvudavtalsparternas samrådsförfaranden.</p> / <p>Yhteistä Ruotsin ja Suomen ammattiliitoille on jäsenmäärän supistuminen. Samanaikaisesti ammattiliittojen itsenäisyys ja korkea järjestäytymisaste ovat ominaisia molemmille maille verrattuna Eurooppaan ja muuhun maailmaan. Nämä kaksi tekijää ovat molemmissa maissa kehittyneet ja vahvistuneet 1900-luvun alusta alkaen.</p><p> </p><p>Ammattiyhdistysten itsenäisyys rakentuu sille että keskeiset osapuolet ilman valtiovallan sekaantumista sopivat itse työmarkkinoiden ehdoista. Opinnäytteen lähtökohta on mitä tapahtuu ammattiyhdistysten itsenäisyydelle jäsenmäärän supistuessa.</p><p> </p><p>Opinnäyte selvittää Ruotsin ja Suomen yhteiskuntien oikeudellista kehitystä, työehtosopimus- ja työmarkkinarakennetta, työehtosopimusten sitomismekanismia ja oikeudellisia vaikutuksia sekä mahdollisuuksia työtaistelu- ja myötätuntotoimenpiteisiin. Molempien maiden työoikeudellinen järjestelmä ei ole välttynyt arvostelulta, josta syystä aineisto sisältää selostuksen kahdesta viime aikojen puhutuimmasta oikeustapauksesta.</p><p> </p><p>Ruotsin ja Suomen työoikeudellinen järjestelmä on hyvin samankaltainen sekä keskeisten osapuolten kuulemismenettelyn, työehtosopimusten sitomismekanismin, oikeudellisten vaikutusten että työtaistelujen säätelyn osalta. Suomalainen työtaistelusäätely on jonkunverran vapaampi, ruotsalainen sisältää useita monimutkaisia poikkeuksia. Suomalaiset työntekijät ovat ammattiliitojen jäseniä melkein yhtä usein kuin ruotsalaiset. Suomalaiset työntekijät ovat kuitenkin paljon useammin mukana työtaisteluissa Työmarkkinoiden rakenne Ruotsissa ja Suomessa ovat suhteellisen samanlaisia kuten myös niiden vaikutukset. Erot ovat Suomen suurissa palkkaeroissa miesten ja naisten kesken. Myös Ruotsissa on eroja, joskin pienempiä. Vaikutukset jotka ovat samanlaisia molemmissa maissa, koostuvat vallitsevan jaon palkka- ja palkkaamisehtojen vahvistamisesta vallitsevasta työoikeudellisesta sääntelystä ja pääsopijaosapuolten kuulemismenettelystä.</p>

Violence – especially violence against children – is one of the biggest problems in the world and in Lithuania as well. The consequences of violence are very painfull, it’s physical, moral and material damage is tremendous. In spite of that our society is still unable properly to solve this problem. The worrying fact is that quite a big number of children undergo violence not only at home or in the street, but also at school. The responsible authorities should pay more attention to this fact and should make every effort to prevent that. In order to organize prevention first of all we need objective, reliable and full information about the fact of violence and it’s spreading in school. The purpose of this paper is: a) to analize the atitude towards violence in school by schoolchidren themselves (what boys and girls think about that); b) to clear up the scale of violence among the teenagers of different sexes; c) to disclose the attitude of the schollchildren of different sexes towards the prevention of violence. In order to find out the attitude of the most interested group the main method of research was chosen as questionnaire. During the research the hypothesis was corroborated : the teenagers of juniour age at school undergo violence, their safety and the kind of violence depend on sex.

Cette recherche porte sur les conséquences sociales, au Québec, de la maladie cœliaque et des allergies alimentaires. Elle vise à expliquer et comprendre comment la maladie cœliaque et les allergies alimentaires influencent les relations sociales, les activités sociales et les perceptions des personnes qui vivent avec ces conditions, ainsi que celles de leurs proches. Pour ce faire, des entrevues semi-dirigées ont été effectuées auprès de 11 participants qui étaient soit cœliaque, allergique ou membre de l’entourage. Durant ces entrevues, il a été question de diagnostic, d’accidents alimentaires, d’accessibilité, d’activités amicales, de la réaction et de l’adaptation de la famille, de perceptions et de relations amoureuses. Une comparaison, entre les expériences des cœliaques et des allergiques, est réalisée suite à la description celles-ci. Les données d’entrevues ont été analysées avec le concept d’habitus de Bourdieu (1980), les concepts d’agency et de règles de Giddens (1979), les concepts d’exclusion et d’identité ainsi qu’avec les différentes définitions de la maladie et une échelle de gravité des perceptions. De cette recherche, on notera que les perceptions de la maladie sont différentes chez les cœliaques et les allergiques. La maladie cœliaque tend à être moins prise en charge par les professionnels de la santé et être considérée avec moins de sérieux, par les cœliaques et la population générale, que les allergies alimentaires. Les deux conditions amènent une modification de l’habitus et une période d’adaptation. Par contre, cet exercice semble être plus difficile et complexe pour les cœliaques que les allergiques, dû à l’âge où la condition est découverte. Dépendant de la souplesse de l’habitus individuel et de groupe, la confrontation à cette reformulation de l’habitus se produira plus ou moins bien. Dans le cas où la confrontation prend une tangente négative, il en découlera une désapprobation sociale ou un déni personnel qui mènera à l’exclusion. La littérature indique généralement que la qualité de vie des cœliaques et des allergiques diminue progressivement avec le temps, entraînant des conséquences négatives au niveau social, émotif et physique. Mes participants semblent, toutefois, bien vivre avec leur condition respective puisqu’ils profitent d’un bon support de la part de leur entourage. / This research is about the social consequences, in Québec, of the celiac disease and food allergies. Its aim is to bring an explanation and a better understanding of how celiac disease and food allergies influence the social relations, the social activities and the perceptions of the people that are living with those conditions and their close relations. With this aim in mind, semi-directed interviews were carried out with 11 participants that were either celiac, allergic or near relations. During these interviews, diagnostic, food accidents, accessibility, activities with friends, the family’s reaction and adaptation, perceptions and relationships were the main topics that were discussed. The experiences of the people living with celiac disease (CD) or food allergies (FA) were compared following their description. The data stemming from the interviews was analysed by using Bourdieu’s habitus concept (1980), Giddens’s concepts of agency and rules (1979), concepts of exclusion and identity as well as the definitions of sickness, illness and disease and a gravity scale of perceptions. From this research will be noticed that perception of illness is different for the people living with CD than those living with FA. CD tends to be taken less in charge by health professionals and to be taken with less seriousness, by people living with CD and the general population, than FA are. Both conditions lead to a modification of habitus and an adaptation phase. Nevertheless, these changes seem to be harder to deal with and more complex for people living with CD than for people living with FA because of the age period where the condition was revealed. Depending on the flexibility of the individual and group habitus, the confrontation to the recasting of habitus will go more or less well. If the confrontation is more on the negative side of the spectrum, social disapproval or personal denial will take place, leading to exclusion. The literature generally shows that the quality of life for people living with CD and FA gradually diminishes over time, bringing negative social, emotional and physical consequences. My participants, however, are apparently living well with their respective conditions because they benefit from a good support of their peers.

Les modèles kainate et pentylènetétrazole représentent deux modèles d’épilepsie du lobe temporal dont les conséquences à long terme sont différentes. Le premier est un modèle classique d’épileptogénèse avec crises récurrentes spontanées tandis que le second se limite aux crises aigües. Nous avons d’abord caractérisé les différents changements survenant dans les circuits excitateurs et inhibiteurs de l’hippocampe adulte de rats ayant subi des crises à l’âge immature. Ensuite, ayant observé dans le modèle fébrile une différence du pronostic lié au genre, nous avons voulu savoir si cette différence était aussi présente dans des modèles utilisant des neurotoxines. L’étude électrophysiologique a démontré que les rats KA et PTZ, mâles comme femelles, présentaient une hyperactivité des récepteurs NMDA au niveau des cellules pyramidales du CA1, CA3 et DG. Les modifications anatomiques sous-tendant cette hyperexcitabilité ont été étudiées et les résultats ont montré une perte sélective des interneurones GABAergiques contenant la parvalbumine dans les couches O/A du CA1 des mâles KA et PTZ. Chez les femelles, seul le DG était légèrement affecté pour les PTZ tandis que les KA présentaient, en plus du DG, des pertes importantes au niveau de la couche O/A. Les évaluations cognitives ont démontré que seuls les rats PTZ accusaient un déficit spatial puisque les rats KA présentaient un apprentissage comparable aux rats normaux. Cependant, encore une fois, cette différence n’était présente que chez les mâles. Ainsi, nos résultats confirment qu’il y a des différences liées au genre dans les conséquences des convulsions lorsqu’elles surviennent chez l’animal immature. / Kainate and pentylenetetrazole models represent two animal models of temporal lobe epilepsy in which long-term consequences differ. The first model is a classical model of epileptogenesis with spontaneous recurrent seizures while the second one is limited to acute seizures. We wanted to characterize the difference in changes which occur in excitatory and inhibitory systems of the hippocampus of adult males and females having suffered an episode of status epilepticus during the immature stage of life. Besides having noticed a difference between genders in the febrile model, our second objective was to see if this difference was also present in models using neurotoxins. Electrophysiology recordings indicated that KA and PTZ rats (both male and female) showed a hyperactivity of NMDA receptors in CA1, CA3 and DG pyramidal cells. Anatomical modifications causing hyperactivity were studied and results show a selective loss of specific GABA interneurons PV in the O/A layer of CA1 region of the hippocampus in KA and PTZ male rats. However in female rats, only the DG layer was slightly affected in PTZ while female KA presented losses in both DG and O/A layers. Cognitive evaluation indicated that only PTZ rats showed a spatial impairment since KA rats had a similar learning pattern as controls. However, once again, that difference was observed only in males and not in females. In summary, our results confirmed that there is a difference between genders regarding brain damages after having suffered an episode of status epilepticus during the immature stage.

Le sujet de l’avortement provoqué demeure encore tabou au Togo et la compréhension du phénomène reste incomplète. La présente étude vise à dresser un portrait complet de ses divers aspects dans la capitale togolaise, qui a connu une baisse importante de la fécondité au cours des dernières années. À partir des données des Enquêtes démographiques et de santé (EDS) de 1988 et 1998, et de celles de l’Enquête sur la planification familiale et l’avortement provoqué (EPAP) de 2002, l’étude montre que le recours à l’avortement est à la hausse à Lomé, bien que l’estimation de son ampleur dépende de la méthode utilisée. Plus de 32 % des femmes ayant déjà été enceintes ont déclaré avoir avorté au moins une fois. Toutefois, l’avortement est plus fréquent chez les jeunes, qui y ont recours de manière plus précoce et plus rapprochée que leurs aînées. En contribuant ainsi à la régulation des naissances, l’avortement réduit la fécondité de 10 à 12 %. En utilisant les données de l’EPAP, réalisée auprès de 4755 femmes âgées de 15-49 ans, nous avons aussi étudié le recours à l’avortement comme une séquence d’étapes débutant par l’exposition au risque de grossesse jusqu’au recours à l’avortement, en passant par une absence de pratique contraceptive et le fait qu’une grossesse qui survient soit déclarée « non désirée ». L’ethnie et la génération sont associées à certaines étapes de la séquence alors que la religion, la parité, le statut matrimonial et le niveau d’instruction sont associés aux quatre étapes. Ainsi, le risque élevé d’avorter chez les femmes instruites découle en fait de leur risque élevé à toutes les étapes. En étant moins à risque de grossesse, les femmes qui ont au moins deux enfants sont plus susceptibles que les nullipares, d’utiliser une contraception moderne, de déclarer une grossesse comme non désirée et d’avorter. Si plusieurs grossesses non désirées surviennent aux âges jeunes, c’est surtout le caractère « hors union » de la grossesse qui fait qu’elle est considérée comme « non désirée » et interrompue. En outre, les femmes qui ont déjà avorté ou utilisé une contraception sont plus enclines à recourir à un avortement. Les résultats montrent également que le partenaire soutient souvent la femme dans la décision d’avorter et s’acquitte des coûts dans la majorité des cas. Malgré le fait qu’ils soient illégaux, plus de 40 % des avortements sont pratiqués à Lomé dans des centres de santé, par un membre du personnel médical, et à l’aide du curetage ou de l’aspiration. Mais, la moitié de ces avortements (22 %) avait été tentée au préalable par des méthodes non médicales. Plusieurs avortements ont aussi lieu soit à domicile (36 %), soit chez des tradi-thérapeutes (24 %), grâce à des méthodes non médicales. Par ailleurs, près de 60 % des avortements ont entraîné des complications sanitaires, conduisant la majorité des femmes à une hospitalisation. Sur le plan psychologique et relationnel, nous avons montré que la plupart des avortements ont entraîné des regrets et remords, de même que des problèmes entre les femmes et leurs parents. Les parents soutiennent en fait peu les femmes dans la décision d’avorter et interviennent rarement dans le paiement des coûts. L’étude a enfin révélé que la loi sur l’avortement est peu connue. Cependant, être âgée de 25 ans ou plus, en union ou très instruite, connaître des méthodes contraceptives, le recours d’une parente ou amie à l’avortement sont associés, toutes choses égales par ailleurs, à une plus grande chance de connaître la loi. L’analyse, en appuyant des déclarations des professionnels de la santé et des femmes, montre que malgré sa forte prévalence à Lomé, le recours à l’avortement demeure largement stigmatisé. Les quelques professionnels et femmes qui se sont prononcés en faveur de sa légalisation pensent que celle-ci permettrait de « réduire les avortements clandestins et risqués ». En fait, ce sont les femmes les plus instruites, âgées de 25 ans ou plus, utilisant la contraception, ayant déjà avorté ou connaissant quelqu’un l’ayant fait, qui sont plus aptes à approuver la légalisation de l’avortement. Celles qui appartiennent aux églises de type « pentecôtiste », plus sévères quant aux relations sexuelles hors mariage, sont par contre moins susceptibles que les catholiques d’avoir une telle attitude positive. / Induced abortion remains a taboo topic in Togo and the understanding of the phenomenon is still incomplete. This study aims to provide more complete portrait of its various aspects in the Togolese capital city, Lomé, where an important decrease in fertility has occurred during recent years. Using data from the 1988 and 1998 Demographic and Health Surveys (DHS) and from the 2002 Survey on Family Planning and Induced Abortion (EPAP), results clearly show that induced abortion prevalence has increased in Lomé, although the estimate of its magnitude depends on the method used. Overall, more than 32 % of ever-pregnant women declare having had at least one abortion. However, abortion is more common among young women, who make use of it at an earlier age and more frequently than older women. The intensity of abortion should then reduce fertility by 10 to 12 %. Using data from EPAP, conducted among 4755 women aged 15-49, we approached the abortion as a sequence of stages beginning with exposure to a pregnancy, going through a lack of contraceptive use and a declaration of a pregnancy as “unwanted” by the woman, and ending with abortion. While ethnicity and generation influence certain stages leading to the abortion, women’s religion, marital status and age, educational attainment and parity have significant association with all four stages. Thus, the expected high risk of abortion among educated women results from their higher likelihood at all stages. Even if they are less at risk of a pregnancy, women who have at least two children are more likely to use modern contraception, to declare a pregnancy as unwanted and to end it through abortion, compared to childless women. Even if several unwanted pregnancies occur at younger ages, it is mainly the “out of wedlock” character of the pregnancy that leads it to be considered as unwanted and to be interrupted. In addition, women who had a previous abortion or who used contraception are more likely to resort to abortion. The study also shows that the partner often supports the woman in the abortion decision-making process, and, in most cases, he pays the related costs. Even though they are clandestine, more than 40 % of abortions in Lomé are performed in healthcare centers by medical staff, and by using curettage or aspiration. However, in half of these cases (22 %), abortions had been previously attempted using non-medical methods. Probably to keep the abortion secret, many abortions also take place either at home (36 %) or through traditional therapists (24 %) using non-medical abortion methods. Consequently, almost 60 % of abortions resulted in health complications, leading the majority of women to hospitalization. On the psychological and relational side, we find that most women who have had abortions express regrets and remorse, and also commonly speak of problems between themselves and their parents. In fact, parents are rarely involved in the abortion decision-making and almost never pay the abortion fees. Finally, this study shows that the abortion law is barely known in Lomé. However, being older than 24 years, in a relationship or highly educated, having knowledge of contraceptive methods, having a relative or a friend who had an abortion are associated, other factors being equal, to a better knowledge of the law. By supporting qualitative statements from health professionals and women, the analysis illustrated that, despite its high prevalence in Lomé, abortion remains widely stigmatized. The few professionals and women, who are in favour of its legalization, believe that this would “reduce illegal and unsafe abortions”. Opinion on the legalization of abortion, which remains a sensitive and little studied topic, is influenced by women’s characteristics, especially their religion. In fact, women attending “Pentecostal churches”, which are less tolerant of sexual relations outside marriage, are less likely than Catholics to approve the legalization of abortion. The most educated and older women, those who use contraception, who had an abortion or know someone who had an abortion, are also more likely to have such positive attitude.

Thesis (PhD)--Macquarie University, Macquarie Graduate School of Management, 2001. / Bibliography: leaves 288-310. / Introduction -- Introduction to research problem and methodology -- Study context -- Theoretical framework - Review of the literature -- Study design and methods -- Study sites, surgical procedures, and labour input to surgical production -- New intra-operative artefacts: goals, choices and consequences -- Conclusion. / Surgical technologies since the late 1980s have undergone substantial innovations that have involved ...the adoption of new machines, instruments, and related surgical materials... referred to throughtout this thesis as intra-operative artefacts... typically represents a commitment of substantial financial resources by the hospitals concerned. However, little is documented about the process whereby the decisions are made to adopt new intra-operative artefacts, and no previous research appears to have explored the work-related consequences of new intra-operative artefact adoption within operating theatre services. This thesis explores the reasons why new intra-operative artefacts are adopted, how the decisions are made, who are the participants in the decsion process and what are the expected and actual organisational consequences of new intra-operative artefact adoption. / Electronic reproduction. / xii, 347 leaves, bound : / Mode of access: World Wide Web. / Also available in print form