Le diabète de type 2 (DT2) est devenu de plus en plus une maladie métabolique chronique fréquente, associée à de nombreuses complications micro et macro-vasculaires. Les patients diabétiques ont environ deux fois plus de risque de mort subite d'origine cardiaque (MSC) que ceux normaux. Les interventions pharmacologiques (anti-plaquettaires, anti-hypertenseurs, anti-diabétiques et hypolépimiants) nous semblent les candidats les plus efficaces, accessibles et économiques pour prévenir cet événement à long terme, par contre leurs effets sur la MSC n'ont pas été bien connus. Nous visons à estimer leur impact sur la santé publique et à optimiser leur utilisation chez les DT2, grâce à des études d'analyse, de synthèse et de modélisation.Ce travail inclut trois étapes: premièrement, de construire un score de risque permettant de prédire le risque de MSC dans le DT2 en utilisant les bases de données INDANA. Deuxièmement, d'effectuer des méta-analyses/revues systématiques de différentes stratégies thérapeutiques afin d'estimer leurs effets sur le risque de MSC. Enfin, de simuler différentes stratégies sur une population virtuelle réaliste (PVR) des diabétiques français et d'intégrés les résultats obtenus sur cette plate-forme pour estimer le risque de MSC avec et sans traitements. Cette simulation permet d'estimer leurs bénéfices absolus, par le nombre d'événements prévus (Number of Events Prevented, NEP) et le nombre de patients à traiter pour prévenir une MSC (Number Needed to Treat, NNT). Nous avons construit un score incluant 7 facteurs de risque de MSC chez les patients atteints d'hypertension artérielle (+/- diabète) et collecté les meilleures estimations sur l'effet des médicaments. Notre simulation sur la PVR générée a suggéré que chez 10% des patients ayant le risque de MSC prédit le plus haut, la co-prescription de l'inhibiteurs de l'enzyme de conversion-l'aspirine-l'empagliflozine permettait de prévenir une MSC sur 57 individus traités dans les 5 ans. Le chiffre correspondant pour toute la PVR était 135. Nous concluons que cette approche pourrait aider à mieux transposer les résultats des essais cliniques à la pratique ; et à faciliter la décision clinique aux niveaux populationnel et individuel / Type 2 diabetes (T2D) has increasingly become a common metabolic condition, associated with numerous micro and macro-vascular complications. Diabetic patients are at about two-time higher risk of sudden cardiac death (SCD), compared to non-diabetic ones. Pharmacologic intervention (anti-platelet, anti-hypertensive, lipid lowering, and to a lesser extent, anti-diabetic agents) appear to be the most efficient and economic candidate to prevent this event at long term, yet treatment effects have not well addressed. We aimed to optimize their use and estimate their impact on public health via analysis, synthesis and modeling studies.This work engaged three phases: First, to construct a risk score to predict SCD risk in T2D from the INDANA database. Second, to perform the meta-analyses/systematic reviews of different therapeutic strategies in order to estimate their effects on SCD risk. Finally, to simulate therapeutic strategies on a generated French diabetic realistic virtual population (RVP) of T2D, by estimating the occurrence of SCD with and without treatments, thus their absolute benefits, through the Number of Events Prevented (NEP) due to treatment, and the Number of patients Needed to be Treated to prevent one SCD (NNT).We built a 7-risk factor to predict 5-year risk of SCD in patients with hypertension (+/-diabetes) and collected the best evidence on drugs’ effects. Integrating and simulating altogether on a generated French diabetic RVP suggested that for every 57 individuals of the 10% highest predicted SCD risk, the co-prescription of angiotensin converting enzyme inhibitor-aspirin-empagliflozin could prevent one SCD in 5 years. For the whole population, the corresponding number was 135. In perspectives, this approach could help better transposing clinical trial results into practice and facilitating clinical decision at both public health and individual levels

L’Évaluation d’Impact sur la Santé (EIS) est un instrument de support à la décision, pour juger une politique quant aux effets potentiels sur la santé et leur distribution (équité). C’est encore souvent une approche qualitative.L’objectif principal est de montrer l’utilité de méthodologies statistiques quantitatives multivariées pour enrichir la pratique d’EIS, améliorant la compréhension des résultats par des professionnels non-statisticiens.Les futures réformes des systèmes de santé déplacent le centre d’évaluation des services de santé des fournisseurs aux citoyens (besoins, préférences, équité d’accès aux gains de santé), exploitant big data associant information de soins aux données sociales, économiques et de déterminants de santé. Des méthodologies statistiques et d’évaluation innovantes sont nécessaires à cette transformation.Les méthodes de data mining et data science, souvent complexes, peuvent gérer des résultats graphiques compréhensibles pour amplifier l’usage d’EIS, qui deviendrait ainsi un outil précieux d’évaluation de politiques publiques pour amener les citoyens au centre de la prise de décision. / Health Impact Assessment (HIA) is a decision-making support tool to judge a policy as to its potential effects and its distribution on a population’s health (equity). It’s still very often a qualitative approach.The main aim here is to show the usefulness of applying quantified multivariate statistical methodologies to enrich HIA practice, while making the decision-making process easier, by issuing understandable outputs even for non-statisticians.The future of healthcare reforms shifts the center of evaluation of health systems from providers to people’s individual needs and preferences, reducing health inequities in access and health outcomes, using big data linking information from providers to social and economic health determinants. Innovative statistical and assessment methodologies are needed to make this transformation.Data mining and data science methods, however complex, may lead to graphical outputs simple to understand by decision makers. HIA is thus a valuable tool to assure public policies are indeed evaluated while considering health determinants and equity and bringing citizens to the center of the decision-making process. / A Avaliação de Impacte na Saúde (AIS) é um instrumento de suporte à decisão para julgar política quanto aos seus efeitos potenciais e à sua distribuição na saúde de uma população (equidade). É geralmente ainda uma abordagem qualitativa.O principal objetivo é mostrar a utilidade das metodologias estatísticas quantitativas e multivariadas para enriquecer a prática de AIS, melhorando a compreensão dos resultados por profissionais não-estatísticos.As futuras reformas dos sistemas de saúde deslocam o centro da avaliação dos serviços de saúde dos prestadores para as necessidades e preferências dos cidadãos, reduzindo iniquidades no acesso à saúde e ganhos em saúde, usando big data que associam informação de prestadores a dados sociais e económicos de determinantes de saúde. São necessárias metodologias estatísticas e de avaliação inovadoras para esta transformação.Métodos de data mining e data science, mesmo complexos, podem gerar resultados gráficos compreensíveis para os decisores. A AIS é assim uma ferramenta valiosa para avaliar políticas públicas considerando determinantes de saúde, equidade e trazendo os cidadãos para o centro da tomada de decisão.

La découverte de nouveaux médicaments est un processus complexe qui implique de gros investissements et de longues phases de développement. Le coût des échecs est phénoménal et le taux de succès diminue depuis deux décennies, suggérant que le processus d'innovation-développement tel qu'il est pratiqué aujourd'hui n'est plus adapté aux défis actuels. Dans ce travail de thèse, nous proposons une nouvelle approche, dite descendante « Top-down » qui consiste à inverser le procédé traditionnel. Elle reposera essentiellement sur la conception et l'optimisation de modèles de prédiction, afin de mieux orienter les phases successives du développement et de prédire les résultats de chaque étape avec le maximum de précision. Cette démarche s'appuie sur la conception du modèle d'innovation thérapeutique et de toutes ses composantes, notamment le modèle physiopathologique (modèle simulant l'organisme et l'évolution naturelle de la maladie) le modèle thérapeutique (modèle simulant l'effet du médicament sur la maladie), et le modèle d'effet (modèle qui peut être prédit à partir des modèles précédents et qui permet de simuler l'impact du médicament sur la population traitée à partir de son effet sur chaque individu de la population. Le processus complet de notre stratégie comprend dix étapes : élaboration du modèle physiopathologique, calibration, validation, identification des cibles potentielles, activation du logiciel de modifications séquentielles des cibles, construction de la population virtuelle (réaliste ou non), obtention du modèle d'effet nécessaire pour calculer le nombre d'événements évités (NEE), calcul du NEE par cible, comparaison et choix de la “meilleure” cible / New drug discovery and development is a complex process which requires massive investments over protracted horizons. The cost of failed programs is significant in absolute dollar terms. Decreasing R&D productivity over the past 2 decades suggests that the traditional innovation model needs a radical rethink. The central purpose of this thesis work is to lay the theoretical foundations for a new "topdown" approach to new target identification construed as an alternative to the current bottomup approach based on high throughput screening. In essence, it will consist in the design and optimization of in silico models in order to guide the development of a new drug candidate by predicting the outcomes of each successive phase of the development process. This in silico framework brings together a physiopathological model (to simulate the natural evolution of the disease) with a therapeutic model (to simulate the effects of a drug candidate on disease evolution) and the effect model (to predict the impact of the drug candidate on a population of patients)

Addressing complex global health challenges, including the burden of noncommunicable diseases (NCDs), will require change in sectors outside of traditional public health. Contemporary regional trade and investment agreements (RTAs) like the Trans-Pacific Partnership (TPP) continue to move further ‘behind-the-border’ into domestic policy space introducing new challenges in the regulation of health risk factors. This dissertation aimed to clarify the pathways through which RTAs influence NCDs, and to explore points along those pathways with the intent of improving the existing evidence base and supporting policy development. This work develops a critical theoretical framework exploring the ideas, institutions, and interests behind trade and investment policy; it also develops a conceptual framework specifying how trade and investment treaty provisions influence NCD rates through the effects of trade and investment on tobacco, alcohol, and ultra-processed food and beverage products, as well as access to medicines and the social determinants of health. Using health impact assessment methodology, three analytical components were designed to examine pathways of influence from RTAs to health outcomes as mediated by the interests of transnational corporations (TNCs). The first component explored the influence of industry during the TPP negotiations and how its health-related interests were reflected in the final TPP text. The second component examined the role of trade and investment liberalisation in health-harmful commodity markets, finding a rise in TNC sales after a period of liberalisation. The third component demonstrated how investor rights and investor-state dispute can challenge the state’s right to regulate if it damages the profits of TNCs, which may threaten effective health regulation, and provides opportunities to strengthen the right to regulate. The work in this dissertation provides support for the thesis that trade and investment policies are a fundamental structural determinant of health and well-being, which are highly influenced by TNCs that guide such policies in the interest of maximising their profits and protections, often to the detriment of public policy and population health. This work identifies the need for more robust health impact assessments of RTAs before future agreements are ratified, as well as an imperative to challenge vested interests that entrench neoliberal policy preferences that have hindered sustainable and equitable development.

Chemical (gaseous) emissions from wastewater treatment plants (WWTP) are perceived as odour and can generate undesirable health reactions. These could affect the quality of life to those regularly albeit intermittently exposed, although regular exposure may result in tolerance and loss of recognition of the odour. Consequently, research is necessary to establish the role of Environmental Impact Assessment (EIA) in ensuring that facilities such as WWTP do not pose a threat to local communities, particularly in relation to housing developments for poor communities. The aim of this study was to investigate if the EIA regulations were effectively implemented before building of the Residential Development Proiect (RDP) houses at KwaMathukuza, in Newcastle South Africa. Furthermore, the study intended to determine the impact the (WWTP) has on the health of people who reside close to the site and to establish if the families staying close to the WWTP have any common ailments such as handicapped babies, early deaths within families. Findings would also indicate if RDP houses should be built in close proximity to such sites. Data was collected through a survey of 85 residents living within five kilometers and ten residing beyond five kilometers from the WWTP. The participants were selected randomly. Municipality employees who worked with the WWTP were also sampled together with healthcare givers. Data included information about health of the community, their perception of the gases released from the WWTP as well as EIA meetings and processes related to the construction of the RDP houses. The outcome of this study revealed that EIA regulations were not adequately implemented and that this residential site was unsuitable for the construction of RDP houses. It emerged that the residence regularly experience unpleasant odours released from the WWTP. These could be associated with ill-health of the residents as well as v degradation the environment in general. The study also found that the effect of the WWTP affects even those communities who reside beyond five kilometers from the WWTP. The researcher argues for more stringent mechanisms to ensure that EIA regulations are properly implemented to prevent adverse effects on the communities. / Environmental Sciences / M. Sc. (Environmental Management)

Vård och omsorg är en komplex verksamhet att schemalägga då det ofta medför krävande arbetsschema för medarbetarna samtidigt som hänsyn måste tas till medarbetarnas hälsa, hållbara organisationer samt att det ska vara en god och säker vård som ges till patienterna. Schema är en viktig del för den enskildes vardag och det förekommer olika schemaläggningsmetoder. Syftet med studien är att undersöka effekter av olika schemaläggningsprinciper inom vård och omsorg. Studien genomfördes som en strukturerad integrativ litteraturstudie med inslag av systematisk metod och induktiv ansats. Sökningar genomfördes i databaserna Healthcare Administration Database och Medline som resulterade i 252 artiklar. Efter urval och kvalitetsgranskning kvarstod 16 artiklar av både kvantitativ och kvalitativ metod som ingår i resultatet. Nattarbete ger negativa konsekvenser på hälsan hos medarbetare inom vård och omsorg. Såväl negativa som positiva effekter ses vid schemaläggningsprinciperna skiftarbete, arbete med långa pass eller önskeschema när det gäller effekter på organisatoriska klimatet, hälsoeffekter hos medarbetarna och patientsäkerhet och patientomhändertagande. Skiftarbete påverkar medarbetaren hälsa på ett negativt sätt från flera aspekter. De kan även leda till en obalans mellan arbetsliv och familjeliv samt mindre tid till fritidsaktiviteter. Långa arbetspass kan också ha ett samband med av medarbetaren upplevt värde mellan arbete och privatliv, work life balance. Att som medarbetare lägga önskeschema kan ibland medföra att verksamhetens behov inte tillgodoses. När det gäller negativa effekter av nattarbete kan detta oftast härledas till att dygnsrytmen störs. Ledarens närvaro och stöd kan bidra till bättre förutsättningar för medarbetaren att klara av skiftarbete. Den största utmaningen för arbetsgivaren inom vård och omsorg är att finna den rätta strukturen för att utarbeta ett hälsoschema som tar vara på medarbetarnas hälsa. / Health and care sector is a complex business to schedule as it often entails a demanding work schedule for the employees at the same time as the employees' health, sustainable organizations must be taken into account and it must be good and safe care that is given to the patients. Scheduling is an important part of the individual's everyday life and there are different scheduling methods. The purpose of the study is to investigate the effects of different scheduling principles in health and care. The study was conducted as a structured integrative literature study with elements of systematic method and inductive approach. Searches were performed in the Healthcare Administration Database and Medline databases which resulted in 252 articles. After selection and quality review remained16 articles of both quantitative and qualitative methods that are included in the result remained. Night work has negative consequences for the health of employees in health and care. Both negative and positive effects are seen in the scheduling principles of shift work, work with long shifts or wish lists in terms of effects on the organizational climate, health effects for employees and patient safety and patient care. Shift work affects the employee's health in a negative way from several aspects. They can also lead to an imbalance between work and family life as well as less time for leisure activities. Long work shifts can also have a connection with the value experienced by the employee between work and private life, work life balance. As an employee, laying out a wish list can sometimes mean that the needs of the business are not met. When it comes to the negative effects of night work, this can usually be attributed to the circadian rhythm being disturbed. The manager's presence and support can contribute to a better condition for the employee to cope with shift work. The biggest challenge is to find the right structure to prepare a health scheme that safeguards the employee's health.

Traffic-related air pollution harms health, so whilst it would be advantageous to improve air quality, the socioeconomic impact of air pollution mitigation in Scotland is not fully understood. Evidence from research literature, current regulatory and policy directives and a socioeconomic analysis are required to assess the true health impact. This thesis presents the first health and socioeconomic analysis of traffic-related air pollution and health for Scotland. A critique of the literature was undertaken to determine the evidence base and the strength of evidence in terms of association and causation, between air pollution and ill health. The evidence was subsequently applied in epidemiological studies of Scottish residents, to assess the actual impact on health in Scotland. The perception of barriers and incentives for change were investigated to understand behavioural influences. Recent policy development in Scotland was reviewed, and a socioeconomic analysis of a proposed air pollution strategy in Scotland, was undertaken. The evidence from 30 cohort studies and nine literature reviews demonstrated a link between poor air quality, mortality and respiratory ill health, but the results for other health conditions were inconsistent. The links were associative rather than causal and therefore might be attributable to other factors other than air pollution. Furthermore, epidemiological studies on Scottish populations did not show health effects from traffic-related air pollution. The socioeconomic analysis suggested that an initial investment of between £27m and £44m to introduce Low Emission Zones (LEZ), and an effective active travel programme, might result in a saving of £38m in terms of Years of Life Lost (YLL) and reduction in sickness absence. It is unlikely that the Clean Air For Scotland Strategy will deliver improved air quality and health without substantial investment, better alignment of planning, and a greater public engagement to support public and active transport options.

The purpose of this study is to examine teachers’ experiences of power relations as psychological violence and the impact it has on their health. This study, using a qualitative approach, thus investigates the association between power relations and the dimensions thereof and how it manifests as psychological violence. In turn, it may have detrimental effects on the health of the teacher and the whole teaching-learning process. Based on the findings, recommendations for this - and future research - are proposed. Open-ended phenomenological interviews were used to collecct the qaulitative data. Eleven participants indicated their willingness to be individually interviewed for the study. The qualitative findings indicated that teachers experience power relations as psychological violence, it is experienced severely and emanates mostly from colleagues in management positions. The most prevalent and severe forms of power relations as psychological violence as experienced by teachers include being subjected to power abuse from principals; being subjected to autocratic management styles and management’s power abuse through the abdication of responsibility. The most severe physical health consequenses as experienced by teachers include feeling tired and experiencing physical ill health. It further emerged that the most severe phychological health consequenses were experienced in the form of feelings of helplessness and feeling emotional or wanting to cry. Teachers’ lack of work productivity and motivation were the most severe behavioural consequense because of the experience of power abuse as psychological violence. Teachers’ personal and family relations and teachers withdrawing socially were the most evident social consequense due to negative experiences. The findings from the study indicated that teachers experience power relations as psychological violence in various forms and that it is highly prevalent. The research results have shown that teachers identified many dimensions of power relations, such as management styles, the perception or experience of someone’s power or “weak point”, possessing no power or status, female teachers being treated in a subordinate manner and racial or cultural differences of others as a contributer to abuse power in relationships at school. This study contributes towards the power relations and psychological violence literature in general and in particular, teachers’ experiences in South Africa. In the light of the findings the study recommends that teacher support programmes should be put in place in order to address the experience of power relations as psychological violence. It further recommends that teachers and students studying to become teachers should be provided with information about power relations as psychological violence to create awareness. / Thesis (MEd (Educational Psychology))--North-West University, Potchefstroom Campus, 2013

The purpose of this study is to examine teachers’ experiences of power relations as psychological violence and the impact it has on their health. This study, using a qualitative approach, thus investigates the association between power relations and the dimensions thereof and how it manifests as psychological violence. In turn, it may have detrimental effects on the health of the teacher and the whole teaching-learning process. Based on the findings, recommendations for this - and future research - are proposed. Open-ended phenomenological interviews were used to collecct the qaulitative data. Eleven participants indicated their willingness to be individually interviewed for the study. The qualitative findings indicated that teachers experience power relations as psychological violence, it is experienced severely and emanates mostly from colleagues in management positions. The most prevalent and severe forms of power relations as psychological violence as experienced by teachers include being subjected to power abuse from principals; being subjected to autocratic management styles and management’s power abuse through the abdication of responsibility. The most severe physical health consequenses as experienced by teachers include feeling tired and experiencing physical ill health. It further emerged that the most severe phychological health consequenses were experienced in the form of feelings of helplessness and feeling emotional or wanting to cry. Teachers’ lack of work productivity and motivation were the most severe behavioural consequense because of the experience of power abuse as psychological violence. Teachers’ personal and family relations and teachers withdrawing socially were the most evident social consequense due to negative experiences. The findings from the study indicated that teachers experience power relations as psychological violence in various forms and that it is highly prevalent. The research results have shown that teachers identified many dimensions of power relations, such as management styles, the perception or experience of someone’s power or “weak point”, possessing no power or status, female teachers being treated in a subordinate manner and racial or cultural differences of others as a contributer to abuse power in relationships at school. This study contributes towards the power relations and psychological violence literature in general and in particular, teachers’ experiences in South Africa. In the light of the findings the study recommends that teacher support programmes should be put in place in order to address the experience of power relations as psychological violence. It further recommends that teachers and students studying to become teachers should be provided with information about power relations as psychological violence to create awareness. / Thesis (MEd (Educational Psychology))--North-West University, Potchefstroom Campus, 2013

Made available in DSpace on 2011-05-04T12:42:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Este trabalho foi concebido a partir da reflexão e discussão sobre as principais oportunidades para a abordagem integrada de Saúde Pública e Meio Ambiente, considerando o atual cenário energético mundial, a introdução de novas tecnologias de produção e a necessidade de construção de uma referência conceitual e prática que considere a interação entre Saúde, Meio Ambiente, Responsabilidade Social das Empresas e Desenvolvimento Sustentável. Considerando os inúmeros desafios para o controle dos impactos ambientais e de saúde, através da gestão efetiva de responsabilidade social de empresas potencialmente poluidores, particularmente da indústria de petróleo e energia, essa tese tem como principal objetivo discutir como os aspectos de saúde podem ser incorporados ao licenciamento ambiental do setor petróleo. Para isso foi utilizada uma abordagem metodológica exploratória, por meio de exaustivo levantamento bibliográfico na literatura científica e institucional deáreas empresariais e governamentais responsáveis pela obtenção e concessão de licenças ambientais. A partir da seleção e análise de documentação oficial, particularmente dos estudos e relatórios de impacto ambiental (EIA/RIMA) de empreendimentos nacionais de exploração, produção e refino do petróleo, avaliousea existência de evidências e oportunidades para a inserção de questões de saúde nos respectivos projetos de investimento desse setor. Como ferramenta de avaliação dessas questões nos EIA/RIMA dos empreendimentos selecionados, foi utilizada uma adaptação de uma matriz de análise validada para o setor hidrelétrico, cujas categorias analíticas foram baseadas nos parâmetros estabelecidos para os estudos de avaliação de impacto ambiental pela Resolução CONAMA 1/86 e nos principais aspectos da metodologia de Avaliação de Impactos à Saúde (AIS). Como resultado, a matriz empregada mostrou-se um instrumento metodológico com grande potencial para orientar a incorporação dos aspectos desaúde no processo de licenciamento ambiental, instrumentalizando a Avaliação de Impacto Ambiental (AIA) e subsidiando a tomada de decisão, contribuindo, portanto, para uma gestão socioambiental mais proativa do setor petróleo. / This work was conceived from the discussion about the main opportunities for the integrated approach of Public Health and Environment, considering the current world energy scenario, the introduction of new production technologies and the need for a more comprehensive conceptual reference among Health, Environment, Social Responsibility and Sustainable Development. Considering the several challenges for effective management of the environmental and health impacts, particularly caused by oil industry, strategic for the development and economical growth of our country, the main objective of this thesis is discuss how the health aspects could be incorporated to the environmental licensing of this sector. An exploratory methodological approach was used, starting from an exhausting bibliographical research in scientific and institutional literature, produced by companies and government areas related with the environmental licenses. The health evidences and opportunities in the main official documents, particularly studies and reports of the environmental impacts (EIA/RIMA, in portuguese) of national enterprises of oil exploration, production and refining, was evaluated. An adapted matrix, validated for the hydroelectric sector, was used like a tool for assessment of health subjects in the selected RIMA. The analytical categories of this matrix were based on the established parameters for the studies of environmental impact assessment of CONAMA Resolution 1/86, and on the main aspects of Health Impact Assessment (HIA) methodology. As result, this matrix was considered like an important instrument with great potential to guide the incorporation of the health aspects in the environmental licensing, supporting the Environmental Impact Assessment (EIA) and decision makers, contributing to a proactive social and environmental management of the petroleum industry.