Hégémonie du modèle de l'autisme: carrefour epistémologique entre médecine, familles et politique [Hegemonic model of autism: epistemological crossroads between medicine, family and politics].

The aim of this article is to make a contribution to the regional reflection with regard to autism spectrum disorders (ASDs) at a key moment in which the authorities are requested by the users, professionals in the fields of health, pedagogy and education to put forward a structured answer to a multitude of expressed needs. The question for the creation of a competence pole of an academic tertiary level is posed in order to advise in the best possible way the families who do not know how to orient themselves in the maze and contradictions of the proposed solutions and to help the professionals who are submerged by an ever increasing demand of services exceeding the means of the existing institutions and who cannot justify their choices among the various existing theoretical and scientific models.

Smoking trends in Switzerland, 1992-2007: a time for optimism?

Objective To assess trends in smoking status according to gender, age and educational level in the adult Swiss population. Methods Four national health interview surveys conducted between 1992 and 2007 in representative samples of the Swiss population. Results The prevalence of current smokers increased between 1992 and 1997, decreasing thereafter. In 2007, the prevalence of current smokers (32.0% of men and 23.8% of women) was lower than in 1992 (38.4% and 26.7%, respectively). Whereas the prevalence of current + former smoking decreased from 64.5% in 1992 to 59.3% in 2007 among men, it was similar among women during the same period (44.0% in 1992 and 43.9% in 2007). The prevalence of current + former smokers decreased from 47.2% in 1992 to 46.3% in 2007 in the lower education group (no education + primary), from 54.8% to 52.9% in subjects with secondary level education, and from 55.4% to 48.7% in subjects with university level education. The prevalence of current smokers decreased in all age groups. Finally, the amount of cigarette equivalents smoked per day decreased, but the amount of non-cigarette tobacco (alone or in combination with cigarettes) increased for both sexes. Conclusion The prevalence of smoking has been decreasing in the Swiss population, for both sexes and for most age groups and educational levels between 1992 and 2007. The health effects of the change in type of tobacco products consumed await further investigation.

Socioeconomics status and quality of care in a population-based sample of swiss diabetic patients

Introduction: Low socioeconomic status (SES) is associated with higher prevalence of diabetes and worse outcomes; it has also been shown to be associated with worse quality of care. We aimed to explore the relationship between SES and quality of care in the Swiss context. Methods: We used data from a population-based survey including 519 adult diabetic patients living in the canton of Vaud. Self-reported data on patients' and diabetes characteristics, indicators of process and outcomes of care and quality of life were collected. Dependent variables included 6 processes of care (PoC) received during the last 12 months (HbA1C, lipid, microalbuminuria, fundoscopy, feet examination and influenza vaccination) and selected clinical outcomes (blood pressure, LDL, HbA1C, diabetes-specific (ADDQoL) and generic quality of life (SF-12)). Regression analyses were performed to assess the relationship between education and income, respectively, and quality of care as measured by PoC and clinical outcomes. Adjustment was made for age, gender and comorbidities. Results: Mean age was 64.5 years, 40% were women; 19%, 56% and 25% of the patients reported primary (I), secondary (II) and tertiary (III) education. Fundoscopy was the only PoC significantly associated with education, with III education patients more likely to get the exam than those with primary education (adjOR 1.8, 95% CI 1.0-3.3). Use of composite indicators of PoC showed that compared to patients with primary education, patients with III education were more likely to receive ≥5/6 PoC (adjOR 1.9, 95% CI 1.1-3.4), and that those with II or III education were more likely to receive 4/4 PoC (adjOR 1.9, 95% CI 1.0-3.3; adjOR 2.1, 95% CI 1.1-4.1, respectively). Quality of life was the only clinical outcome significantly associated with education, with II and III education patients reporting better quality of life compared to primary education patients, as measured by the ADDQoL (β 0.6, 95% CI 0.3-1.0, β 0.6, 95% CI 0.2-1.0, respectively) and the physical component score of the SF-12 (β 2.5, 95% CI 0.2-4.8, β 3.6, 95% CI 0.9-6.4, respectively). No associations were found between income and quality of care. Conclusion: Social inequalities have been demonstrated in Switzerland for global health indicators. Our results suggest that similar associations are found when considering quality of care measures in individuals with diabetes, but only for a few indicators.

2 years' review of pediatric emergencies admitted in the resuscitation room of a Swiss university hospital

Introduction: Paediatric resuscitation is an intense, stressful andchallenging process performed in a specific surrounding. In theresuscitation room (RR), a dedicated pediatric team is not alwaysavailable and its composition varies according to local resources. Aregular review of the children admitted in the resuscitation room andthe assessment of various outcome measures are the basis of qualitycontrol (QC). The epidemiology of Potentially Life ThreateningPaediatric (LTP) emergencies admitted in a Swiss university hospitalhas never been reported. The aims of this study were to review theLTP emergency population with regards to origin, patients'demographics, reason for admission and final diagnosis, treatmentmodalities, critical events and outcome.Methods: A retrospective observational cohort study of prospectivelycollected data was conducted, including all LTP emergencies admittedover a period of 2 years in the RR of a Swiss university hospitalfunctioning as a tertiary level referral centre. Multiple variablesincluding indication for transfer, mode of pre-hospital transportation,diagnosis and the time spent in RR were assessed. Data assessmenttook place 2 years after the implementation of a quality control (QC)team assessing the pediatric resuscitations occurring within theinstitution on a monthly basis.Results: Out of 60 939 pediatric emergencies treated in LausanneUniversity Medical center over 2 years, a total of 277 LTP emergencies(0.46%) were admitted to the RR, including 160 boys and 117 girls,aged 6 days to 15.95 years (mean 6.69 years, median 5.06). The tablebelow illustrates in more details the identified problems, average age,time in hospital and outcome of both surgical and medical groups ofpatients.Conclusions: With the need for health care quality improvement andfinancial restrictions, an excellent knowledge of the characteristics ofLTP emergencies is unavoidable. A thorough understanding of theresuscitation process and humans resources involved can be achievedwith a systematic review of the cases. A dedicated quality control teamevaluating LTP emergencies in a hospital will identify areas forimprovement. A LTP registry at the national level would be of greatvalue in Switzerland.

Information Needs and Concerns of Patients with Inflammatory Bowel Disease: What Can We Learn from Participants in a Bilingual Clinical Cohort?

BACKGROUND: Inflammatory Bowel Disease (IBD) patients are confronted with needs and concerns related to their disease. AIM: To explore information expectations of patients included in a national bilingual IBD cohort in Switzerland (SIBDC). METHODS: This is a mixed-methods study, comprising 1) a semi-narrative survey sent to 1506 patients from the SIBDC and 2) two focus groups conducted with 14 patients to explore and assess the relevance of the survey's findings. Data collected within the framework of the SIBDC was used to characterize survey's responders. RESULTS: 728 patients (48%) replied to the survey: 52.5% females, 56% Crohn's disease (CD), 87% secondary/tertiary level educated, 70% full/part-time employed. On average, 47% of patients sought for information, regardless of the disease stage; 27% of them were dissatisfied with information received at the time of first symptoms. During flares, 43% were concerned about drugs and therapies; in remission, 57% had concerns on research and developments; 27% searched for information linked to daily disease management. Information-seeking increased when active disease, for CD with high levels of perceived stress (OR = 2.47; p = 0.003), and for all with higher posttraumatic stress symptoms. The focus groups confirmed a perceived lack of information about general functioning, disease course, treatments and their risks, extra-intestinal symptoms and manifestations. CONCLUSIONS: Information remains insufficient for IBD patients. Lack of information in specific domains can potentially cause stress and hinder detection of symptoms. Better information should be considered as a potentially important component in improving patients' outcomes in IBD.

Changes of overweight and obesity in the adult Swiss population according to educational level, from 1992 to 2007.

In many high income developed countries, obesity is inversely associated with educational level. In some countries, a widening gap of obesity between educational groups has been reported. The aim of this study was to assess trends in body mass index (BMI) and in prevalence of overweight and obesity and their association with educational level in the adult Swiss population. Four cross-sectional National health interview surveys conducted in 1992/93 (n = 14,521), 1997 (n = 12,474), 2002 (n = 18,908) and 2007 (n = 17,879) using representative samples of the Swiss population (age range 18-102 years). BMI was derived from self-reported data. Overweight was defined as BMI > or = 25 and <30 kg/m(2), and obesity as BMI > or = 30 kg/m(2). Mean (+/- standard deviation) BMI increased from 24.7 +/- 3.6 in 1992/3 to 25.4 +/- 3.6 kg/m2 in 2007 in men and 22.8 +/- 3.8 to 23.7 +/- 4.3 kg/m(2) in women. Between 1992/3 and 2007, the prevalence of overweight + obesity increased from 40.4% to 49.5% in men and from 22.3% to 31.3% in women, while the prevalence of obesity increased from 6.3% to 9.4% in men and from 4.9% to 8.5% in women. The rate of increase in the prevalence of obesity was greater between 1992/3 and 2002 (men: +0.26%/year; women: +0.31%/year) than between 2002 and 2007 (men: +0.10%/year; women: +0.10%/year). A sizable fraction (approximately 25%) of the increasing mean BMI was due to increasing age of the participants over time. The increase was larger in low than high education strata of the population. BMI was strongly associated with low educational level among women and this gradient remained fairly constant over time. A weaker similar gradient by educational level was apparent in men, but it tended to increase over time. In Switzerland, overweight and obesity increased between 1992 and 2007 and was associated with low education status in both men and women. A trend towards a stabilization of mean BMI levels was noted in most age categories since 2002. The increase in the prevalence of obesity was larger in low education strata of the population. These findings suggest that obesity preventive measures should be targeted according to educational level in Switzerland.

I want to quit education: a longitudinal study of stress and optimism as predictors of school dropout intention

Prior research on school dropout has often focused on stable person- and institution-level variables. In this research, we investigate longitudinally perceived stress and optimism as predictors of dropout intentions over a period of four years, and distinguish between stable and temporary predictors of dropout intentions. Findings based on a nationally representative sample of 16e20 year-olds in Switzerland (N ¼ 4312) show that both average levels of stress and optimism as well as annually varying levels of stress and optimism affect dropout intentions. Additionally, results show that optimism buffers the negative impact of annually varying stress (i.e., years with more stress than usual), but not of stable levels of stress (i.e., stress over four years). The implications of the results are discussed according to a dynamic and preventive approach of school dropout.

Influence of socioeconomic factors on delays, management and boutcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Background¦The outcome after primary percutaneous coronary intervention (pPCI) for STElevation¦Myocardial Infarction (STEMI) is strongly affected by time delays. In thepresent study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients from a well-defined region of the French part of Switzerland.¦Method¦A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analyzed for the following socioeconomic factors: level of education, gender, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment by fibrinolysis or patients immediately referred for CABG.¦Therefore, 352 patients were finally included.¦Results¦At one year, there was no difference in mortality amongst the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly higher for patients with a low level of education, Swiss citizens and non-married patients with median differences of 40 minutes, 48 minutes, and 60 minutes, respectively (p<0.05).¦Nevertheless, no difference was found regarding in-hospital management and clinical outcome.¦Conclusion¦This study demonstrates that symptom-to-first-medical-contact time is higher amongst people with a lower educational level, Swiss-citizens, and non-married people. Because of the low mortality rate in general, these differences in time delays did not affect clinical outcomes. Still, primary prevention measures should particularly focus on these vulnerable populations.

Perceptions of aging across 26 cultures and their culture-level associates

College students (N = 3,435) in 26 cultures reported their perceptions of age-related changes in physical cognitive, and socioemotional areas of functioning and rated societal views of aging within their culture. There was widespread cross-cultural consensus regarding the expected direction of aging trajectories with (a) perceived declines in societal views of aging, physical attractiveness, the ability to perform everyday tasks, and new learning; (b) perceived increases in wisdom, knowledge, and received respect; and (c) perceived stability in family authority and life satisfaction. Cross-cultural variations in aging perceptions were associated with culture-level indicators of population aging, education levels, values, and national character stereotypes. These associations were stronger for societal views on aging and perceptions of socioemotional changes than for perceptions of physical and cognitive changes. A consideration of culture-level variables also suggested that previously reported differences in aging perceptions between Asian and Western countries may be related to differences in population structure.

Association between education and quality of diabetes care in Switzerland

PURPOSE: Low socioeconomic status is associated with higher prevalence of diabetes, worse outcomes, and worse quality of care. We explored the relationship between education, as a measure of socioeconomic status, and quality of care in the Swiss context. PATIENTS AND METHODS: Data were drawn from a population-based survey of 519 adults with diabetes during fall 2011 and summer 2012 in a canton of Switzerland. We assessed patients and diabetes characteristics. Eleven indicators of quality of care were considered (six of process and five of outcomes of care). After bivariate analyses, regression analyses adjusted for age, sex, and diabetic complications were performed to assess the relationship between education and quality of care. RESULTS: Of 11 quality-of-care indicators, three were significantly associated with education: funduscopy (patients with tertiary versus primary education were more likely to get the exam: odds ratio, 1.8; 95% confidence interval [CI], 1.004-3.3) and two indicators of health-related quality of life (patients with tertiary versus primary education reported better health-related quality of life: Audit of Diabetes-Dependent Quality of Life: β=0.6 [95% CI, 0.2-0.97]; SF-12 mean physical component summary score: β=3.6 [95% CI, 0.9-6.4]). CONCLUSION: Our results suggest the presence of educational inequalities in quality of diabetes care. These findings may help health professionals focus on individuals with increased needs to decrease health inequalities.

Patterns of Subject Mix in Higher Education Institutions : A First Empirical Analysis Using the AQUAMETH Database

Teaching and research are organised differently between subject domains: attempts to construct typologies of higher education institutions, however, often do not include quantitative indicators concerning subject mix which would allow systematic comparisons of large numbers of higher education institutions among different countries, as the availability of data for such indicators is limited. In this paper, we present an exploratory approach for the construction of such indicators. The database constructed in the AQUAMETH project, which includes also data disaggregated at the disciplinary level, is explored with the aim of understanding patterns of subject mix. For six European countries, an exploratory and descriptive analysis of staff composition divided in four large domains (medical sciences, engineering and technology, natural sciences and social sciences and humanities) is performed, which leads to a classification distinguishing between specialist and generalist institutions. Among the latter, a further distinction is made based on the presence or absence of a medical department. Preliminary exploration of this classification and its comparison with other indicators show the influence of long term dynamics on the subject mix of individual higher education institutions, but also underline disciplinary differences, for example regarding student to staff ratios, as well as national patterns, for example regarding the number of PhD degrees per 100 undergraduate students. Despite its many limitations, this exploratory approach allows defining a classification of higher education institutions that accounts for a large share of differences between the analysed higher education institutions.

Assessing sedimentary evolution by means of Sr-isotope ratios : 3 case studies on the Caribbean plate : (Cretaceous: Nicoya Peninsula, Costa Rica, Tertiary: Hess Rise, and La Désirade, Guadeloupe, France)

The understanding of sedimentary evolution is intimately related to the knowledge of the exact ages of the sediments. When working on carbonate sediments, age dating is commonly based on paleontological observations and established biozonations, which may prove to be relatively imprecise. Dating by means of strontium isotope ratios in marine bioclasts is the probably best method in order to precisely date carbonate successions, provided that the sample reflects original marine geochemical characteristics. This requires a precise study of the samples including its petrography, SEM and cathodoluminescence observations, stable carbon and oxygen isotope geochemistry and finally the strontium isotope measurement itself. On the Nicoya Peninsula (Northwestern Costa Rica) sediments from the Piedras Blancas Formation, Nambi Formation and Quebrada Pavas Formation were dated by the means of strontium isotope ratios measured in Upper Cretaceous Inoceramus shell fragments. Results have shown average 87Sr/86Sr values of 0.707654 (middle late Campanian) for the Piedras Blancas Formation, 0.707322 (Turonian-Coniacian) for the Nambi Formation and 0.707721 (late Campanian-Maastrichtian) for the Quebrada Pavas Formation. Abundant detrital components in the studied formations constitute a difficulty to strontium isotope dating. In fact, the fossil bearing sediments can easily contaminate the target fossil with strontium mobilized form basalts during diagenesis and thus the obtained strontium isotope ratios may be influenced significantly and so will the obtained ages. The new and more precise age assignments allow for more precision in the chronostratigraphic chart of the sedimentary and tectonic evolution of the Nicoya Peninsula, providing a better insight on the evolution of this region. Meteor Cruise M81 dredged shallow water carbonates from the Hess Rise and Hess Escarpment during March 2010. Several of these shallow water carbonates contain abundant Larger Foraminifera that indicates an Eocene-Oligocene age. In this study the strontium isotope values ranging from 0.707847 to 0.708238 can be interpreted as a Rupelian to Chattian age of these sediments. These platform sediments are placed on seamounts, now located at depths reaching 1600 m. Observation of sedimentologic characteristics of these sediments has helped to resolve apparent discrepancies between fossil and strontium isotope ages. Hence, it is possible to show that the subsidence was active during early Miocene times. On La Désirade (Guadeloupe France), the Neogene to Quaternary carbonate cover has been dated by microfossils and some U/Th-ages. Disagreements subsisted in the paleontological ages of the formations. Strontium isotope ratios ranging from 0.709047 to 0.709076 showed the Limestone Table of La Désirade to range from an Early Pliocene to Late Pliocene/early Pleistocene age. A very late Miocene age (87Sr/86Sr =0.709013) can be determined to the Detrital Offshore Limestone. The flat volcanic basement had to be eroded by wave-action during a long-term stable relative sea-level. Sediments of the Table Limestone on La Désirade show both low-stand and high-stand facies that encroach on the igneous basement, implying deposition during a major phase of subsidence creating accommodation space. Subsidence is followed by tectonic uplift documented by fringing reefs and beach rocks that young from the top of the Table Limestone (180 m) towards the present coastline. Strontium isotope ratios from two different fringing reefs (0.707172 and 0.709145) and from a beach rock (0.709163) allow tentative dating, (125ky, ~ 400ky, 945ky) and indicate an uplift rate of about 5cm/ky for this time period of La Désirade Island. The documented subsidence and uplift history calls for a new model of tectonic evolution of the area.

The Tertiary structural and thermal evolution of the central Alps - Compressional and extensional structures in an orogenic belt

The Western Alpine Are has been created during the Cretaceous and the Tertiary orogenies. The interference patterns of the Tertiary structures suggest their formation during continental collision of the European and the Adriatic Plates, with an accompanying anticlockwise rotation of the Adriatic indenter. Extensional structures are mainly related to ductile deformation by simple shear. These structures developed at a deep tectonic level, in granitic crustal rocks, at depths in excess of 10 km. In the early Palaeogene period of the Tertiary Orogeny, the main Tertiary nappe emplacement resulted from a NW-thrusting of the Austroalpine, Penninic and Helvetic nappes. Heating of the deep zone of the Upper Cretaceous and Tertiary nappe stack by geothermal heat flow is responsible for the Tertiary regional metamorphism, reaching amphibolite-facies conditions in the Lepontine Gneiss Dome (geothermal gradient 25 degrees C/ km). The Tertiary thrusting occurred mainly during prograde metamorphic conditions with creation of a penetrative NW-SE-oriented stretching lineation, X(1) (finite extension), parallel to the direction of simple shear. Earliest cooling after the culmination of the Tertiary metamorphism, some 38 Ma ago, is recorded by the cooling curves of the Monte Rosa and Mischabel nappes to the west and the Suretta Nappe to the east of the Lepontine Gneiss Dome. The onset of dextral transpression, with a strong extension parallel to the mountain belt, and the oldest S-vergent `'backfolding'' took place some 35 to 30 Ma ago during retrograde amphibolite-facies conditions and before the intrusion of the Oligocene dikes north of the Periadriatic Line. The main updoming of the Lepontine Gneiss Dome started some 32-30 Ma ago with the intrusion of the Bergell tonalites and granodiorites, concomitant with S-vergent backfolding and backthrusting and dextral strike-slip movements along the Tonale and Canavese Lines (Argand's Insubric phase). Subsequently, the center of main updoming migrated slowly to the west, reaching the Simplon region some 20 Ma ago. This was contemporaneous with the westward migration of the Adriatic indenter. Between 20 Ma and the present, the Western Aar Massif-Toce culmination was the center of strong uplift. The youngest S-vergent backfolds, the Glishorn anticline and the Berisal syncline fold the 12 Ma Rb/Sr biotite isochron and are cut by the 11 Ma old Rhone-Simplon Line. The discrete Rhone-Simplon Line represents a late retrograde manifestation in the preexisting ductile Simplon Shear Zone. This fault zone is still active today. The Oligocene-Neogene dextral transpression and extension in the Simplon area were concurrent with thrusting to the northwest of the Helvetic nappes, the Prealpes (35-15 Ma) and with the Jura thin-skinned thrust (11-3 Ma). It was also contemporaneous with thrusting to the south of the Bergamasc (> 35-5 Ma) and Milan thrusts (16-5 Ma).

Tertiary Himalayan structures and metamorphism in the Kulu Valley (Mandi-Khoksar transect of the Western Himalaya) - Shikar-Beh-nappe and crystalline nappe

The Crystalline Nappe of the High Himalayan Crystalline has been examined along the Kulu Valley and its vicinity (Mandi-Khoksar transect). This nappe was believed to have undergone deformation related only to its transport towards the SW essentially during the `'Main Central Thrust event''. New data has led to the conclusion that during the Himalayan orogeny, two distinctive phases, related to two opposite transport directions, characterize the evolution of this part of the chain, before the creation of the late NE-vergent backfolding. The first phase corresponds to an early NE-vergent folding and thrusting, creating the Tandi Syncline and the NE-oriented Shikar Beh Nappe stack, with a displacement amplitude of about 50 km. Two schistosities, together with a strong stretching lineation are developed at a deep tectonic level under amphibolite facies conditions (kyanite-staurolite-garnet-two mica schists). At a higher tectonic level and in the southern part of the section (Tandy Syncline and southern Kulu Valley between Kulu and Mandi) one or two schistosities are developed in the greenschist facies grade rocks (garnet-biotite and biotite schists). These structures and the associated Barrovian type metamorphism are all related to the NE-verging Shikar Beh Nappe. The creation of the NE-verging Shikar Beh Nappe may be explained by the reactivation of a SW dipping listric normal fault of the N Indian flexural passive margin, during the early stages of the Himalayan orogeny. In the second phase, the still hot metamorphic rocks of the Shikar Beh Nappe were folded and thrust towards the SW (mainly along the MBT and the MCT with a displacement in excess of 100 km) onto the cold, low-grade metamorphic rocks of the Larji-Kulu-Rampur Window or, near Mandi, on the non-metamorphic sandstones of the Ganges Molasse (Siwaliks). Sense of shear criteria and a strong NE-SW stretching-lineation indicate that the Crystalline Nappe has been overthrusted towards the SW. Thermometry on synkinematically crystallised garnet-biotite and garnet-hornblende pairs reveals the lower amphibolite facies temperature conditions related to the Crystalline Nappe formation. From the muscovite and biotite Rb-Sr cooling ages, the Shikar Beh Nappe emplacement occurred before 32 Ma and the southwestward thrusting of the Crystalline Nappe began before 21 Ma. Our model involving two opposite directions of thrusting goes against the conventional idea of only one main SW-oriented transport direction in the High Himalayan Crystalline Nappes.

Integration of teacher education into the Swiss higher education system

The integration of specific institutions for teacher education into the higher education system represents a milestone in the Swiss educational policy and has broad implications. This thesis explores organizational and institutional change resulting from this policy reform, and attempts to assess structural change in terms of differentiation and convergence within the system of higher education. Key issues that are dealt with are, on the one hand, the adoption of a research function by the newly conceptualized institutions of teacher education, and on the other, the positioning of the new institutions within the higher education system. Drawing on actor-centred approaches to differentiation, this dissertation discusses system-level specificities of tertiarized teacher education and asks how this affects institutional configurations and actor constellations. On the basis of qualitative and quantitative empirical data, a comparative analysis has been carried out including case studies of four universities of teacher education as well as multivariate regression analysis of micro-level data on students' educational choices. The study finds that the process of system integration and adaption to the research function by the various institutions have unfolded differently depending on the institutional setting and the specific actor constellations. The new institutions have clearly made a strong push to position themselves as a new institutional type and to find their identity beyond the traditional binary divide which assigns the universities of teacher education to the college sector. Potential conflicts have been identified in divergent cognitive normative orientations and perceptions of researchers, teacher educators, policy-makers, teachers, and students as to the mission and role of the new type of higher education institution. - L'intégration dans le système d'enseignement supérieur d'institutions qui ont pour tâche spécifique de former des enseignants peut être considérée comme un événement majeur dans la politique éducative suisse, qui se trouve avoir des conséquences importantes à plusieurs niveaux. Cette thèse explore les changements organisationnels et institutionnels résultant de cette réforme politique, et elle se propose d'évaluer en termes de différentiation et de convergence les changements structurels intervenus dans le système d'éducation tertiaire. Les principaux aspects traités sont d'une part la nouvelle mission de recherche attribuée à ces institutions de formation pédagogique, et de l'autre la place par rapport aux autres institutions du système d'éducation tertiaire. Recourant à une approche centrée sur les acteurs pour étudier les processus de différen-tiation, la thèse met en lumière et en discussion les spécificités inhérentes au système tertiaire au sein duquel se joue la formation des enseignants nouvellement conçue et soulève la question des effets de cette nouvelle façon de former les enseignants sur les configurations institutionnelles et les constellations d'acteurs. Une analyse comparative a été réalisée sur la base de données qualitatives et quantitatives issues de quatre études de cas de hautes écoles pédagogiques et d'analyses de régression multiple de données de niveau micro concernant les choix de carrière des étudiants. Les résultats montrent à quel point le processus d'intégration dans le système et la nouvelle mission de recherche peuvent apparaître de manière différente selon le cadre institutionnel d'une école et la constellation spécifique des acteurs influents. A pu clairement être observée une forte aspiration des hautes écoles pédagogiques à se créer une identité au-delà de la structure binaire du système qui assigne la formation des enseignants au secteur des hautes écoles spéciali-sées. Des divergences apparaissent dans les conceptions et perceptions cognitives et normatives des cher-cheurs, formateurs, politiciens, enseignants et étudiants quant à la mission et au rôle de ce nouveau type de haute école. - Die Integration spezieller Institutionen für die Lehrerbildung ins Hochschulsystem stellt einen bedeutsamen Schritt mit weitreichenden Folgen in der Entwicklung des schweizerischen Bildungswesens dar. Diese Dissertation untersucht die mit der Neuerung verbundenen Veränderungen auf organisatorischer und institutioneller Ebene und versucht, die strukturelle Entwicklung unter den Gesichtspunkten von Differenzierung und Konvergenz innerhalb des tertiären Bildungssystems einzuordnen. Zentrale Themen sind dabei zum einen die Einführung von Forschung und Entwicklung als zusätzlichem Leistungsauftrag in der Lehrerbildung und zum andern die Positionierung der pädagogischen Hochschulen innerhalb des Hochschulsystems. Anhand akteurzentrierter Ansätze zur Differenzierung werden die Besonderheiten einer tertiarisierten Lehrerbildung hinsichtlich der Systemebenen diskutiert und Antworten auf die Frage gesucht, wie die Reform die institutionellen Konfigurationen und die Akteurkonstellationen beeinflusst. Auf der Grundlage qualitativer und quantitativer Daten wurde eine vergleichende Analyse durchgeführt, welche Fallstudien zu vier pädagogischen Hochschulen umfasst sowie Regressionsanalysen von Mikrodaten zur Studienwahl von Maturanden. Die Ergebnisse machen deutlich, dass sich der Prozess der Systemintegration und die Einführung von Forschung in die Lehrerbildung in Abhängigkeit von institutionellen Ordnungen und der jeweiligen Akteurkonstellation unterschiedlich gestalten. Es lässt sich bei den neu gegründeten pädagogischen Hochschulen ein starkes Bestreben feststellen, sich als neuen Hochschultypus zu positionieren und sich eine Identität zu schaffen jenseits der herkömmlichen binären Struktur, welche die pädagogischen Hochschulen dem Fachhochschul-Sektor zuordnet. Potentielle Konflikte zeichnen sich ab in den divergierenden kognitiven und normativen Orientierungen und Wahrnehmungen von Forschern, Ausbildern, Bildungspolitikern, Lehrern und Studierenden hinsichtlich des Auftrags und der Rolle dieses neuen Typs Hochschule.