Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.

Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.

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La qualité méthodologique en recherche clinique est une exigence garantissant la fiabilité des expérimentations médicales, au bénéfice des praticiens comme à celui des patients. Cette thèse a pour objectif de mesurer la qualité des essais thérapeutiques présentés au Comité d’Ethique de la Région Sud-Est II et son évolution sur des périodes pluriannuelles. Deux études transversales exhaustives ont été réalisées. La première a pour objet de mesurer l’impact du Règlement Pédiatrique Européen de 2007 sur l’évolution qualitative et quantitative de essais pédiatriques, compte tenu du faible nombre de recherches dans cette population. La deuxième analyse le niveau de qualité des essais contrôlés randomisés en utilisant le score de Jadad et identifie les éléments qui l’influencent. L'outil de travail est constitué des protocoles détenus par le Comité d’Ethique, et non de publications de la littérature. Le concept de qualité et ses deux composantes, éthique et fiabilité scientifique, a été étudié. Les différents outils proposés par les experts pour mesurer la qualité ont été expertisés, ce qui a permis la sélection de l’échelle méthodologiquement la plus adaptée. Le niveau de qualité observé pour les essais pédiatriques est élevé, mais n’a pas été influencé par le Règlement Européen, qui a pu, cependant, entraîner une progression forte du nombre des essais pédiatriques, pouvant être l’indice d’un développement de la recherche en pédiatrie. Concernant les essais contrôlés randomisés, deux marqueurs sont associés à un haut score qualité des protocoles, identifiés après une analyse multivariée : le caractère multicentrique de la recherche et les essais portant sur les médicaments. / Methodological quality in clinical research is mandatory to ensure the reliability of medical experiments, with benefits for both practitioners and patients. This PhD thesis aims at measuring the quality of therapeutic trials submitted to the Ethics Committee of the South-East Region II, and its evolution over several years. Two comprehensive cross-sectional studies were conducted. The first explore the field of pediatric research, and aims at measuring the impact of the introduction of European Pediatric Regulation in 2007, on the evolution of the quantity and quality of trials in this field, given the low number of research in this population. The second analyzes the quality of randomized controlled trials using the JADAD score and seeks to identify the elements that influence it. These studies were conducted using the protocols submitted to the Ethics Committee, and not from a literature analysis. The concept of quality was first studied based on their ethical and scientific reliability. The various assessing tools proposed by the experts to measure the quality were appraised, which allowed the selection of the most methodologically scale adapted to this study. Conclusion: we show that the level of quality observed for pediatric trials is high, but was not influenced by the introduction of the European Regulation, which could, on the other hand, have led to an important increase in the number of pediatric trials. Regarding randomized controlled trials, a multivariate analysis allowed the identification of two statistically significant markers associated with high quality score of the protocol: the multicentric character of the research, and the drugs trials.

In this thesis presents the results obtained in the treatment of the topic The Creation of an Internal Control System in the select company. The Internal Control System is examined from the perspective of the COSO model which evaluates the quality of the internal control at various levels in the company. On the survey of the disertation are valorized risk areas of the company. There are also proposed individuals suggestions for the solutions of the risk areas including the draft internal regulation. The company was also investigated using Altman's Z-Score model that evaluated its financial health.

L’objectif de cette thèse est de répondre à trois questions de recherche, peu explorées dans la littérature. Le but de notre premier essai est d’examiner la relation entre le développement financier islamique et la croissance économique, en utilisant un échantillon de 15 pays sur une période allant de 2000 vers 2009. Les résultats de l’estimation du modèle à effet fixe, variable instrumentale et GMM en différence montrent que le développement financier islamique a un impact positif sur la croissance économique. Les résultats du modèle semi-paramétrique prouvent que l’impact du développement financier islamique sur la croissance économique puisse être non linéaire. Notre deuxième essai s’intéresse à étudier l’effet de la crise des subprimes de 2007-2008 sur les banques islamiques portant sur 70 banques, réparties entre 43 banques classiques et 27 banques islamiques pendant la période 2005-2009. Les résultats prouvent qu’il n’y a pas de différence significative en termes d’effet de la crise sur la solidité des banques islamiques et conventionnelles. Dans notre troisième essai, nous nous s’intéressons à analyser la volatilité des indices boursiers islamiques par rapport à leurs consorts conventionnels. Cinq indices islamiques ont fait l’objet de cette étude ainsi que leurs consorts conventionnels. L’étude couvre la période : 2/02/2009-12/02/2014. Les résultats du test de Granger détectent différentes relations causales. Ainsi, Les résultats du modèle Garch montrent que quatre parmi les cinq indices islamiques sont moins volatiles que leurs consorts conventionnels tandis qu’un seul indice islamique est plus volatile que son consort conventionnel. / This dissertation contains three essays on different issues on mergers and acquisitions, left unexplored or unresolved by the existing literature. The first study examine the relationship between Islamic finance development and economic growth in a panel of 15 MENA and Sout-est-asia countries over the 2000-2009 period, using a variety of econometric methods and four standard measures of Islamic financial development. The study identifies two sets of findings. First, fixed effects estimation, panel-data-instrument variables regressions and GMM-difference estimator reveal that the relationship between Islamic financial development and economic growth is positive. The semiparametric panel model shows that there is evidence of nonlinearity in the data. The second study, assess empirically the effect of the 2007-2008 subprime financial crisis on Islamic banks using a sample of 27 Islamic banks and 43 conventional banks during the period from 2005 to 2009. Using the Z-score as indicator of bank stability the results of our regression analysis show that there is no difference in terms of the effect of the financial crisis on the soundness of Islamic bank and their conventional counterparts. The third study aims to examine the volatility of Islamic stock index compared to their conventional counterparts. Five major Islamic stock indexes have been the subject of our third study as well as their conventional counterparts. Covering a time period from 12/02/2009 to 12/02/2014. The application of Granger causality tests detected different causalities during the period, between the returns series under study. Employing Generalized Autoregressive Conditional Heteroskedastic (GARCH), our results indicate that, four among five Islamic stock indexes were less volatile than their conventional counterparts. But, one Islamic index are more volatile than their conventional counterpart.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O contingente de idosos iniciando tratamento de diálise vem aumentado de maneira importante desde o ano de 2000, conforme mostrado pelo United States Renal Data System. Dados nacionais demonstram que cerca de 31,5% dos pacientes em diálise tem idade acima de 65 anos, segundo o Censo Brasileiro de Diálise de 2011. Estes dados alertam para a importância no cuidado da saúde do idoso em diálise. O cuidado nutricional desse grupo merece especial atenção, uma vez que já foi demonstrado que a prevalência de desnutrição energético-proteica nos pacientes idosos em diálise é significantemente maior do que a de adultos jovens em diálise. Nesse sentido, faz-se importante desenvolver estudos com instrumentos que avaliem o estado nutricional desse grupo. Os questionários de avaliação subjetiva global de 7 pontos (ASG-7p) e o malnutrition inflammation score (MIS) têm sido bastante empregados em estudos incluindo pacientes em diálise. Contudo, estes instrumentos estão originalmente na língua Inglesa, e para o seu uso em nosso meio, é necessário a tradução por meio da adaptação transcultural. Porém, até o momento, não há estudos que tenham realizado a tradução transcultural desses questionários para a língua Portuguesa. Deste modo, o objetivo deste estudo foi realizar a adaptação transcultural para o português de dois instrumentos de avaliação do estado nutricional em pacientes idosos em tratamento crônico de hemodiálise (HD). O estudo é do tipo observacional e seccional. A adaptação transcultural consistiu na tradução para a língua Portuguesa da ASG-7p e MIS pelo método da retrotradução, avaliação da equivalência semântica, confiabilidade e validade de construto. Para tanto, 101 pacientes idosos em HD foram avaliados. Ambos questionários apresentaram alto grau de similaridade semântica. A consistência interna apresentou um valor de α de Cronbach para a ASG-7p de 0,72 (satisfatório) e para o MIS de 0,53 (não satisfatório). A ASG-7p apresentou discreta reprodutibilidade intra-avaliador e moderada reprodutibilidade interavaliador; e para o MIS tanto a reprodutibilidade inter quanto intra-avaliador foi indicativo de forte reprodutibilidade. Referente à validade de construto, ao avaliar o estado nutricional pela ASG-7p notou-se que os pacientes classificados como bem nutridos apresentaram medidas de peso corporal, adequação da dobra cutânea tricipital, percentual de gordura corporal, circunferência da panturrilha e creatinina sérica significantemente maiores do que de pacientes desnutridos. Para o MIS, ao comparar os grupo de bem nutridos com o de desnutridos, a albumina sérica, ângulo de fase, percentual de gordura corporal, a adequação da força de preensão manual e da dobra cutânea tricipital e a circunferência da panturrilha apresentaram diferença significante entre os grupos. Em conclusão, os questionários ASG-7p e MIS traduzidos para o português podem ser utilizados na população de idosos em HD. / The contingency of elderly starting dialysis has substantially increased, according to the United States Renal Data System. Data from Brazil show about 31.5% of dialyzed patients are older than 65 years, according to the Brazilian Dialysis Census from 2011. These data show the importance of health care of elderly patients on dialysis. The nutritional status of this group requires attention, since it has been shown a high prevalence of protein-energy waisting in elderly patients on dialysis. Therefore, it is important to develop studies investigating instruments to assess the nutritional status of this group. The 7 point subjective global assessment (7p-SGA) and the malnutrition inflammation score (MIS) have been widely used in studies including patients on dialysis. However, these instruments are originally in English and the use of them in Brazil requires the translation to Portuguese through cross-cultural adaptation. Thus, the aim of this study is to performe the cross-cultural adaptation to Portuguese of 7p-SGA and MIS to assess the nutritional status of elderly patients on hemodialysis (HD). The study design is observational and cross-sectional. 7p-SGA and MIS were translated to Portuguese by back-translation methodology. In addition, the semantic equivalence, reliability and construct validity were performed. Therefore, 101 elderly patients on hemodialysis were evaluated. Both questionnaires showed a high degree of semantic similarity. The internal consistency showed a value of Cronbach's α for the 7p-SGA of 0.72 (satisfactory) and for the MIS of 0.53 (unsatisfactory). The 7p-SGA showed mild intrarater reliability and moderate interrater reliability. For MIS a strong interrater and intrarater reliability was observed. Regarding the construct validity, for 7p-SGA, patients classified as well nourished had body weight, triceps skinfold thickness adequacy, body fat percentage, calf circumference and serum creatinine significantly higher than those classified as malnourished. For MIS, when comparing the group of well nourished with malnourished, serum albumin, phase angle, body fat percentage, handgrip and triceps skinfold thickness adequacy and calf circumference were significantly different between the groups. Conclusion: The questionnaires 7p-SGA and MIS translated to portuguese can be applied to asses the nutritional status of elderly patients on HD.

Background: The relationship between erectile dysfunction and risk factors of atherosclerosis has been confirmed by a number of previous investigations. There are also plausible pathophysiological mechanisms explaining the observed association. One of the tested hypotheses in our work was the assumption that risk factors of atherosclerosis would be more prevalent in men with erectile dysfunction than in controls selected from the representative sample of the Czech population. Our work did not confirm this hypothesis. Most likely explanation can be greater representation of younger-middle aged men in our group than in the Czech post-Monica study in which the age distribution was equal. On the other hand authors of the Czech post-Monica study admit worse compliance in younger participants of their survey. Nevertheless, the risk factors of atherosclerosis occur very frequently in males with erectile dysfunction. Results: In our group mean cardiovascular risk calculated according to the SCORE chart was 3.39% (±3,39). In the Czech post-MONICA study conducted between 2007 and 2008 the mean SCORE risk reached 2.47%. There was a trend, though not statistically significant, towards direct relationship between the severity of ED and the SCORE CVD risk. Asymptomatic atherosclerosis was detected in 56.25% of our study...