Magister Public Health - MPH / The increased number of new infections in Uganda necessitates HIV prevention programmes that address risky behaviours especially among heterosexual populations. The AIDS Support Organisation (TASO) is the largest indigenous HIV/AIDS agency serving Uganda and the Great Lakes Region. TASO endeavours to empower sexually active clients to disclose their sero-status to their sexual partners and promotes partner testing for HIV. In spite of these efforts, only 12% of 2,071 sexually active clients in Mulago centre had disclosed by the end of 2006. This study aimed to explore the factors that influence clients’ decisions to disclose their HIV status to their partners in TASO Mulago, Kampala, Uganda. The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be ‘expert’ clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner’s support, having prior knowledge of partner’s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.While strategies like HBHCT and couple counselling have enhanced disclosure among sexual partners on ART living together in stable married relationships (primary), the partners in secondary relationships (cohabiting and steady) especially women, continue to face challenges in disclosure yet their sexual partners are at risk of HIV infection. The study has re-affirmed the fact that while some people living with HIV/AIDS wish to disclose their HIV status to their partners, there are compound factors that make it difficult to disclose. This calls for effective strategies by government, TASO and other agencies to ensure that sexual partners especially in cohabiting and steady relationships are disclosed to in order to reduce their vulnerability to HIV infection.

京都大学 / 0048 / 新制・課程博士 / 博士(人間・環境学) / 甲第18358号 / 人博第671号 / 新制||人||161(附属図書館) / 25||人博||671(吉田南総合図書館) / 31216 / 京都大学大学院人間・環境学研究科相関環境学専攻 / (主査)教授 松井 正文, 教授 加藤 眞, 教授 市岡 孝朗 / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DFAM

Cette thèse propose que les entreprises puissent être maîtres de leur politique de connexion, en se basant sur des objectifs métier et en utilisant la connaissance interne qu’elles ont de leurs usagers et de tâches, et qu’elles les transmettent vers les opérateurs réseau. L’eCAPS (enterprise Context Aware Policy System) proposé permet aux organisations de différencier les activités professionnelles et non-professionnelles engendrées par les usagers BYOD (Bring Your Own Device) et ainsi de mettre en œuvre des politiques de décision pour les ressources, les niveaux de priorité et même le choix du réseau d’accès. En étendant un moteur context‐aware pour évaluer le contexte de risque lié aux requêtes de connectivité, l’entreprise doit pouvoir déterminer les actions relatives aux requêtes de services à haut risque tout en prenant en compte l’impact métier. La solution proposée utilise des extensions des standards 3GPP pour permettre à l’entreprise d’agir comme un MVNO (Mobile Virtual Network Operator) ou un Sponsor de service data. Ainsi, la proposition de la fonctionnalité ‘Defer‐Back’ facilite le transfert d’utilisations personnelles vers l’opérateur de réseau, et ce, en accord avec les souhaits des utilisateurs. Les profils de contexte sont évalués suivant un modèle Business et Risque. Ce modèle calcule les valeurs des attributs de Crédibilité des sources, qui sont estimées en fonction de leur caractéristiques comme la confiance (fiabilité, stabilité des données) , la précision (gestion des erreurs) et la précision (résolution et proximité). Les politiques enterprise sont appliquées via un système de priorité multi‐niveau adaptable, combinant ainsi observations et préférences. Un nouvel algorithme (Cedar: Corroborative Evidential Diminishing Aggregation Rating) est proposé pour définir et agréger une ‘évidence’. Il augmente proportionnellement les attributs concordants et diminue les attributs non‐concordants. Cedar satisfait un grand de besoins et surperforme les méthodes traditionnelles, en particulier en ce qui concerne sa prise en compte de l’incertitude et des conflits. La solution multi‐facette proposée eCAPS donne lieu à un grand nombre d’applications, dont quatre sont décrites dans la thèse. De plus, l’étude de cas présentée ‘MNVO Automotive’ donne un plus de détail sur un cas particulier nécessitant la fusion de politiques parmi plusieurs parties‐prenantes. L’approche proposée, l’Arbre de Crédibilité Cedar’, qui intègre agrégation corroborative et mesure de la crédibilité, devrait avoir un impact significatif dans le domaine, en particulier sur le contexte comportemental et sur le diagnostique / This thesis suggests that the enterprise should determine its own connectivity policies and convey them to the network carrier. This allows selecting service delivery options based on business goals, using corporate internal knowledge of users and tasks. The proposed eCAPS (enterprise Context Aware Policy System) allows organizations to distinguish between business and personal requests that are generated by BYOD (Bring Your Own Device) users. This enables enterprises to make policy decisions about resourcing, priority levels, automatic funding and even choice of access networks. By extending the model to evaluated risks, the enterprise could determine mitigating actions for high risk service requests, moderated by business priorities. The network solution utilizes extended 3GPP interfaces, to enable the enterprise to act as a Mobile Virtual Network Operator (MVNO) or as a Sponsor of data services. The proposed ‘Defer‐Back’ feature facilitates deferring personal usage back to the carrier, to be treated as a personal service. The solution contains a Business and Risk model that determines the profile of each service request. This model computes attributes’ inherent values from the Credibility of their sources, which is estimated by their digital characteristics, such as confidence (reliability, data stability), accuracy (error‐management) and precision (resolution and proximity). Corporate policy is injected via multi‐level customizable prioritization, thus combining observations with preferences. To aggregate the evidential information, a new algorithm (Cedar: Corroborative Evidential Diminishing Aggregation Rating) is proposed, which proportionally augments concordant attributes and decrements discordant ones. Cedar satisfies a challenging range of requirements and outperforms popular methods, especially due to its robustness and logical handling of uncertainty and conflict. The proposed multi‐facet eCAPS solution has many applications, of which four are included. Additionally, a case study of an MVNO Automotive is described, which necessitates joining multistakeholders’ policy. The ‘Cedar Credibility Tree’ approach, with corroborative aggregation and measured Credibility, has far reaching utility, especially in behavioral context and diagnosis

No Brasil, a transmissão dos quatro sorotipos do vírus dengue ao homem ocorre através da picada da fêmea infectada de Aedes aegypti, também considerado vetor principal de outros arbovírus, como chikungunya e Zika. Além dessa espécie, o Aedes albopictus é considerado vetor potencial desses arbovírus. Populações brasileiras de Ae. aegypti e Ae. albopictus demonstraram a capacidade de realizar alguns repastos sanguíneos em diferentes hospedeiros dentro de um único ciclo de oviposição, o que chamamos de discordância gonotrófica. Paralelamente, a vigilância do DENV a partir de sua detecção em fêmeas de Ae. aegypti e Ae. albopictus que nunca se alimentaram de sangue é essencial para uma melhor compreensão da dinâmica de transmissão vertical desse agente etiológico. O objetivo desse estudo foi avaliar a paridade, a presença de sangue no estômago e o desenvolvimento ovariano de fêmeas de Ae. aegypti e de Ae. albopictus coletadas no Parque Esporte para Todos da Universidade de São Paulo - Cidade Universitária e na Faculdade de Saúde Pública da Universidade de São Paulo, bem como detectar DENV em fêmeas dessas espécies, oriundas de ovos coletados no Parque Municipal do Piqueri, São Paulo. Fêmeas de Ae. aegypti e Ae. albopictus capturadas tiveram o abdômen e ovários avaliados, através da técnica de dissecção. A investigação do RNA viral foi feita através de Transcrição Reversa seguida da Reação em Cadeia da Polimerase (RT-PCR). Foram encontrados 27% e 34% de fêmeas de Ae. aegypti e Ae. albopictus paridas, respectivamente, bem como 77% e 60% de fêmeas de Ae. aegypti e Ae. albopictus, respectivamente, com sangue no estômago. Foi constatado que 36% das fêmeas de Ae. aegypti estavam em discordância gonotrófica, enquanto essa taxa para Ae. albopictus foi de 27%. A transmissão vertical não foi detectada nas populações estudas. O campus da Faculdade de Saúde Pública e o Parque dos Esportes mostraram-se favoráveis para a manutenção e longevidade das duas espécies estudas. Apesar da transmissão vertical natural não ter sido detectada em nosso estudo, a investigação desse fenômeno é essencial para a compreensão da dinâmica de transmissão de arbovírus na natureza. / In Brazil, the transmission of the four serotypes of the dengue virus to human is transmitted out through the bite of the infected female of Aedes aegypti, it is also considered a vector of the main etiological agents of other arboviruses, such as chikungunya and Zika. In addition, Aedes albopictus is considered a potential arbovirus vector. Brazilian populations of Ae. aegypti and Ae. albopictus have already demonstrated an ability to perform some blood supply in different hosts within a single oviposition cycle, which we call gonotrophic discordance. At the same time, surveillance of the DENV from its detection in Ae. aegypti and Ae. albopictus that has never fed on blood is essential for a better understanding of the dynamics of vertical transmission of etiologic agent. The objective was to evaluate the parity, the presence of blood in the stomach and the ovarian development of Ae. aegypti and Ae. albopictus collected in the Parque Esporte para todos of Universidade de São Paulo - Cidade Universitária and Faculdade de Saúde Pública of Universidade de São Paulo, as well as detecting DENV in females of these species, from eggs collected in the Parque Municipal do Piqueri, São Paulo. Females of Ae. aegypti and Ae. albopictus captured, from the results obtained, through the technique of dissection. The investigation of the virus was done through Reverse Transcription followed by Polymerase Chain Reaction. We found 27% and 34% of Ae. aegypti and Ae. albopictus parous, 77% and 60% of Ae. aegypti and Ae. albopictus, respectively, with blood in the stomach. It was found that 36% of Ae. aegypti was in gonotrophic discordance, while that rate for Ae. albopictus was 27%. Vertical transmission was not detected in the selections studied. The campus of the Faculdade de Saúde Pública and the Parque Esporte para todos were favorable to the maintenance and longevity of the two species studied. Vertical nature transmission was not detected in our study, an investigation is an essential event for understanding the transmission of arbovirus data in nature.

No Brasil, a transmissão dos quatro sorotipos do vírus dengue ao homem ocorre através da picada da fêmea infectada de Aedes aegypti, também considerado vetor principal de outros arbovírus, como chikungunya e Zika. Além dessa espécie, o Aedes albopictus é considerado vetor potencial desses arbovírus. Populações brasileiras de Ae. aegypti e Ae. albopictus demonstraram a capacidade de realizar alguns repastos sanguíneos em diferentes hospedeiros dentro de um único ciclo de oviposição, o que chamamos de discordância gonotrófica. Paralelamente, a vigilância do DENV a partir de sua detecção em fêmeas de Ae. aegypti e Ae. albopictus que nunca se alimentaram de sangue é essencial para uma melhor compreensão da dinâmica de transmissão vertical desse agente etiológico. O objetivo desse estudo foi avaliar a paridade, a presença de sangue no estômago e o desenvolvimento ovariano de fêmeas de Ae. aegypti e de Ae. albopictus coletadas no Parque Esporte para Todos da Universidade de São Paulo - Cidade Universitária e na Faculdade de Saúde Pública da Universidade de São Paulo, bem como detectar DENV em fêmeas dessas espécies, oriundas de ovos coletados no Parque Municipal do Piqueri, São Paulo. Fêmeas de Ae. aegypti e Ae. albopictus capturadas tiveram o abdômen e ovários avaliados, através da técnica de dissecção. A investigação do RNA viral foi feita através de Transcrição Reversa seguida da Reação em Cadeia da Polimerase (RT-PCR). Foram encontrados 27% e 34% de fêmeas de Ae. aegypti e Ae. albopictus paridas, respectivamente, bem como 77% e 60% de fêmeas de Ae. aegypti e Ae. albopictus, respectivamente, com sangue no estômago. Foi constatado que 36% das fêmeas de Ae. aegypti estavam em discordância gonotrófica, enquanto essa taxa para Ae. albopictus foi de 27%. A transmissão vertical não foi detectada nas populações estudas. O campus da Faculdade de Saúde Pública e o Parque dos Esportes mostraram-se favoráveis para a manutenção e longevidade das duas espécies estudas. Apesar da transmissão vertical natural não ter sido detectada em nosso estudo, a investigação desse fenômeno é essencial para a compreensão da dinâmica de transmissão de arbovírus na natureza. / In Brazil, the transmission of the four serotypes of the dengue virus to human is transmitted out through the bite of the infected female of Aedes aegypti, it is also considered a vector of the main etiological agents of other arboviruses, such as chikungunya and Zika. In addition, Aedes albopictus is considered a potential arbovirus vector. Brazilian populations of Ae. aegypti and Ae. albopictus have already demonstrated an ability to perform some blood supply in different hosts within a single oviposition cycle, which we call gonotrophic discordance. At the same time, surveillance of the DENV from its detection in Ae. aegypti and Ae. albopictus that has never fed on blood is essential for a better understanding of the dynamics of vertical transmission of etiologic agent. The objective was to evaluate the parity, the presence of blood in the stomach and the ovarian development of Ae. aegypti and Ae. albopictus collected in the Parque Esporte para todos of Universidade de São Paulo - Cidade Universitária and Faculdade de Saúde Pública of Universidade de São Paulo, as well as detecting DENV in females of these species, from eggs collected in the Parque Municipal do Piqueri, São Paulo. Females of Ae. aegypti and Ae. albopictus captured, from the results obtained, through the technique of dissection. The investigation of the virus was done through Reverse Transcription followed by Polymerase Chain Reaction. We found 27% and 34% of Ae. aegypti and Ae. albopictus parous, 77% and 60% of Ae. aegypti and Ae. albopictus, respectively, with blood in the stomach. It was found that 36% of Ae. aegypti was in gonotrophic discordance, while that rate for Ae. albopictus was 27%. Vertical transmission was not detected in the selections studied. The campus of the Faculdade de Saúde Pública and the Parque Esporte para todos were favorable to the maintenance and longevity of the two species studied. Vertical nature transmission was not detected in our study, an investigation is an essential event for understanding the transmission of arbovirus data in nature.

La variabilité spatiale et temporelle des biomarqueurs entre tumeur primitive et métastase est une question clé à une époque où une meilleure individualisation des thérapeutiques est vivement attendue par les cliniciens, les chercheurs et les patients. Le projet de la thèse est de préciser les profils moléculaires différentiels entre tumeur primitive et métastases. Des échantillons conservés congélation issus de deux cohortes de patients ont été considérés : cancer bronchique non à petites cellules (15 patients) et cancer colorectal (13 patients, dont 11 patients avec contrôle de tissus sains). Ces prélèvements ont été analysés par séquençage haut débit et en expression génique afin d'étudier l'hétérogénéité tumorale lors de la progression métastatique et ainsi que les voies potentiellement impliquées dans le processus métastatique.Une forte conservation des profils génomiques est observée à la première progression métastatique pour les gènes récurrents des cancers bronchiques non à petites cellules et des cancers colorectaux. Si les études d'expression génique ne permettent pas de mettre en évidence de profil spécifique de la métastase, elles apportent des éléments utiles sur la conservation de certaines voies importantes dans les processus oncogéniques, identifient des gènes d'intérêt particulier dans l'étude de la progression métastatique et soulignent l'impact de l'effet tissu pour les analyses d'expression. / The question of spatial and temporal variability of biomarkers in solid tumors is a key issue in an era where personalized therapy is strongly advocated by clinicians, researchers and patients. The purpose of the work is to compare molecular profiles of primary tumor and matched metastasis in order to precise tumor heterogeneity during metastatic progression and to investigate pathways potentially involved in the metastatic process.Frozen samples from two cohorts of patients were considered: non-small cell lung cancer (15 patients) and colorectal cancer (13 patients, 11 patients with healthy control tissues). These samples were analyzed by high-throughput sequencing and gene expression. Highly conserved genomic profiles were observed in the first metastatic progression for known recurrent genes in non-small cell lung cancer and colorectal cancer. If gene expression studies do not highlight specific profile of metastasis, they provide useful data on the conservation of some important oncogenic pathways; identify genes of interest in the study of metastatic progression and highlight the putative impact of the effect of healthy tissue for expression analysis.

The objective of this study was to contribute evidence regarding the use of the SF6D and HUI3 in persons with neurological conditions. The data of 776 individuals from the LINC Study was analyzed. The mean utility score of the HUI3 was 0.47 (95% CI 0.45, 0.49) and SF6D was 0.62 (95% CI 0.62, 0.63). Even though the SF6D and HUI3 were sensitive to a variety of HRQoL domains relevant to persons with neurological conditions, they showed only marginal agreement (ICC of 0.41) with a mean utility difference of 0.15 (95% CI 0.13, 0.17). Discordance varied systematically with HRQoL status and was consistent regardless of the participant or impairment characteristics present. Despite sharing a common purpose, the substantial and clinically important differences found between the SF6D and HUI3 cast doubt on whether the utility estimates produced by these instruments are directly comparable or universally valid.

BACKGROUND: Multi drug resistant Tuberculosis (MDR-TB) is a serious public health concern in many parts of the world. As per the WHO- 2010 global report on Surveillance and response 3.6% of all incident TB cases globally are multidrug resistant. In this regard, there is an increasing demand for timely, reliable and comprehensive drug susceptibility testing (DST) as MDR-TB surveillance is being geared up. The intent of this analysis is to determine whether there is a need to continue routine confirmatory DST testing at CDC in addition to just sending the isolates for genotyping. Analysis is done by measuring the discordance between the results of laboratory DST at CDC and the local labs drug type, drug testing concentrations, and study sites. METHODS: The data for this analysis was provided by the Tuberculosis Trials Consortium (TBTC), CDC. Data for this analysis was collected over nearly two decades (1993-2011), gathered from 7 clinical trials. Discordance between the local and CDC lab DST results was measured using Kappa statistic. Sensitivity and specificity analysis was done by taking the CDC DST lab results as the gold standard. Discordance levels were calculated by local sites and baseline drug resistance for each antibiotic in each study was measured. RESULTS: Average Kappa values for inter rater agreement for all the studies was 0.6444 whereas the overall level of discordance across all studies is 7.786%. Drug resistance at baseline was highest for Isoniazid and Streptomycin (except Study 23 and 22). CONCLUSION: Though the current results show few DST result discordances between local and CDC labs, it is better to continue to send isolates to the centralized lab (CDC) in view of the worldwide threat of drug resistant TB epidemic, the recommendations of the current literature and the benefits of reliable confirmatory testing services and availability of other molecular diagnostic methods.

Thèse (M.Ps.)--Université Laval, 2003. / Bibliogr. Publié aussi en version électronique.

As has been reported in Canadian research on the experiences of Francophone patients and Francophone health professionals, active offer is not common or well performed in the Ontario healthcare system (Bernier, 2009; Boileau, 2016; Bouchard & Desmeules, 2013; Drolet et al., 2014; Hien & Lafontant, 2013). This descriptive quantitative research explored the self-reported awareness and implementation of the active offer concept during clinical placements by English language program 4th year undergraduate nursing students. A total of 69 participants were recruited in April 2017 to complete a paper or online-based survey. The survey consisted of questions on French language abilities, awareness of the patient safety risk of language discordance, communication experiences with Francophone patients and opinions of the role of the nurse, healthcare organizations and universities in the implementation of active offer. The participating nursing students reported little knowledge and training for implementing active offer during clinical settings. Despite the lack of preparation, the majority of them (92%) reported caring for a Francophone patient at least once with 25% doing that eight times or more during their clinical placements. More than 84% reported finding a way to communicate with Francophone patients in French, by speaking to them in French themselves or by asking Francophone colleagues, a professional interpreter or the patients’ family to interpret for them. Study recommendations include training nursing students during their undergraduate studies about the patient safety risks of language discordance, active offer and how to implement it. All English program nursing students should also be taught how to access and work with a professional interpreter. Those with French language skills should be encouraged to take healthcare specific language training. New research should be done to explore communication between English language program nursing students and Francophone patients to identify if it is safe and adequate from both the student and the patient’s point of view.