863 resultados para Determinants of mortality


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

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

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L’hypothyroïdie congénitale par dysgénésie thyroïdienne (HCDT) est la condition endocrinienne néonatale la plus fréquemment rencontrée, avec une incidence d’un cas sur 4000 naissances vivantes. L’HCDT comprend toutes les anomalies du développement de la thyroïde. Parmi ces anomalies, le diagnostic le plus fréquent est l’ectopie thyroïdienne (~ 50% des cas). L’HCDT est fréquemment associée à un déficit sévère en hormones thyroïdiennes (hypothyroïdisme) pouvant conduire à un retard mental sévère si non traitée. Le programme de dépistage néonatal assure un diagnostic et un traitement précoce par hormones thyroïdiennes. Cependant, même avec un traitement précoce (en moyenne à 9 jours de vie), un retard de développement est toujours observé, surtout dans les cas les plus sévères (c.-à-d., perte de 10 points de QI). Bien que des cas familiaux soient rapportés (2% des cas), l’HCTD est essentiellement considérée comme une entité sporadique. De plus, plus de 92% des jumeaux monozygotiques sont discordants pour les dysgénésies thyroïdiennes et une prédominance féminine est rapportée (spécialement dans le cas d’ectopies thyroïdiennes), ces deux observations étant clairement incompatible avec un mode de transmission héréditaire mendélien. Il est donc cohérent de constater que des mutations germinales dans les facteurs de transcription thyroïdiens connus (NKX2.1, PAX8, FOXE1, and NKX2.5) ont été identifiées dans seulement 3% des cas sporadiques testés et furent, de plus, exclues lors d’analyse d’association dans certaines familles multiplex. Collectivement, ces données suggèrent que des mécanismes non mendéliens sont à l’origine de la majorité des cas de dysgénésie thyroïdienne. Parmi ces mécanismes, nous devons considérer des modifications épigénétiques, des mutations somatiques précoces (au stade du bourgeon thyroïdien lors des premiers stades de l’embryogenèse) ou des défauts développementaux stochastiques (c.-à-d., accumulation aléatoire de mutations germinales ou somatiques). Voilà pourquoi nous proposons un modèle «2 hits » combinant des mutations (épi)génétiques germinales et somatiques; ce modèle étant compatible avec le manque de transmission familial observé dans la majorité des cas d’HCDT. Dans cette thèse, nous avons déterminé si des variations somatiques (épi)génétiques sont associées à l’HCTD via une approche génomique et une approche gène candidat. Notre approche génomique a révélé que les thyroïdes ectopiques ont un profil d’expression différent des thyroïdes eutopiques (contrôles) et que ce profil d’expression est enrichi en gènes de la voie de signalisation Wnt. La voie des Wnt est cruciale pour la migration cellulaire et pour le développement de plusieurs organes dérivés de l’endoderme (p.ex. le pancréas). De plus, le rôle de la voie des Wnt dans la morphogénèse thyroïdienne est supporté par de récentes études sur le poisson-zèbre qui montrent des anomalies du développement thyroïdien lors de la perturbation de la voie des Wnt durant différentes étapes de l’organogénèse. Par conséquent, l’implication de la voie des Wnt dans l’étiologie de la dysgénésie thyroïdienne est biologiquement plausible. Une trouvaille inattendue de notre approche génomique fut de constater que la calcitonine était exprimée autant dans les thyroïdes ectopiques que dans les thyroïdes eutopiques (contrôles). Cette trouvaille remet en doute un dogme de l’embryologie de la thyroïde voulant que les cellules sécrétant la calcitonine (cellules C) proviennent exclusivement d’une structure extrathyroïdienne (les corps ultimobranchiaux) fusionnant seulement avec la thyroïde en fin de développement, lorsque la thyroïde a atteint son emplacement anatomique définitif. Notre approche gène candidat ne démontra aucune différence épigénétique (c.-à-d. de profil de méthylation) entre thyroïdes ectopiques et eutopiques, mais elle révéla la présence d’une région différentiellement méthylée (RDM) entre thyroïdes et leucocytes dans le promoteur de FOXE1. Le rôle crucial de FOXE1 dans la migration thyroïdienne lors du développement est connu et démontré dans le modèle murin. Nous avons démontré in vivo et in vitro que le statut de méthylation de cette RDM est corrélé avec l’expression de FOXE1 dans les tissus non tumoraux (c.-à-d., thyroïdes et leucocytes). Fort de ces résultats et sachant que les RDMs sont de potentiels points chauds de variations (épi)génétiques, nous avons lancé une étude cas-contrôles afin de déterminer si des variants génétiques rares localisés dans cette RDM sont associés à la dysgénésie thyroïdienne. Tous ces résultats générés lors de mes études doctorales ont dévoilé de nouveaux mécanismes pouvant expliquer la pathogenèse de la dysgénésie thyroïdienne, condition dont l’étiologie reste toujours une énigme. Ces résultats ouvrent aussi plusieurs champs de recherche prometteurs et vont aider à mieux comprendre tant les causes des dysgénésies thyroïdiennes que le développement embryonnaire normal de la thyroïde chez l’homme.

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This research work was to study the level of awareness of consumers about health insurance concept and market, consumer perceptions about health insurance providers, schemes and various factors that influence buying decision of health insurance. There is need to bring entire age group – high risk and low risk under health insurance cover. Widening the cover of health insurance calls for indepth understanding of consumer thinking and extensive marketing efforts based on that. Hence the study of consumer perceptions and the impact of different contributing factors on consumer purchase decision assume significance to the marketer. Understanding the consumer thinking on health insurance will also be of relevance to governmental/non governmental agencies, as affordable health care to all is a policy objective of the government and new schemes are being launched in this area.

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The study is focused on education of tribes particularly the problem of high dropout rate existing among the tribal students at school level. Scheduled Tribe is one of the marginalized communities experiencing high level of educational deprivation. The analysis of the study shows that the extent of deprivation existing among STs of Kerala is much higher compared to that of other communities. The present study covered tribes of three tribal predominant districts of Kerala such as Idukki, Palakkad and Wayanad. Out of the 35 tribal communities in the State, 17 of them are concentrated in these districts. Tribes concentrated in Idukki include Muthuvans, Malai Arayan, Uraly, Mannan and Hill Pulaya. The present study analyzed dropouts situation in tribal areas of Kerala by conducting Field Survey among dropout and non-dropout students at school level. High dropouts among STs persist due to many problems which are of structural in nature. Important problems faced by the tribal students that have been analyzed, this can be classified as economic, social, cultural and institutional. It is found that there exists high correlation between Income and expenditure of the family with the well-being of individuals. Significant economic factors are poverty and financial indebtedness of the family. Some of the common cultural factors of tribes are Nature of Habitation, Difference in Dialect and Medium of Instruction etc. Social factors analyzed in the study are illiteracy of parents, migration of family, family environment, motivation by parents, activities engaged in for helping the family and students’ lack of interest in studies. The analysis showed that all these factors except migration of the family, are affecting the education of tribal students. Apart from social, economic and cultural factors, there are a few institutional factors which will also influence the education of tribal students. Institutional factors analyzed in the study include students’ absenteeism, irregularity of teachers, attitude of non-tribal teachers and non-tribal students, infrastructure facilities and accessibility to school. The study found irregularity of students and accessibility to school as significant factors which determine the dropout of the students.

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Households in much of the tropics depend for their livelihoods on the variety and continued production of food and other products that are provided by their own farms. In such systems, maintenance of agrobiodiversity and ensuring food security are important for the well being of the population. The enset-coffee agroforestry homegardens of Southern Ethiopia that are dominated by two native perennial crops, Coffee (Coffea arabica L.) and Enset (Enset ventricosum Welw. Cheesman), are examples of such agricultural systems. This study was conducted in Sidama administrative zone of Southern Ethiopia to determine the factors that influence the diversity and composition of crops in the systems. Data were collected from 144 sample homegardens selected from four districts. Stepwise multiple regression analysis was used to relate indices of crop diversity and area share of major crops with the physical and socioeconomic factors. The study revealed that socioeconomic factors, mainly proximity to markets, affected negatively crop species richness. The production area of the main crops enset and coffee decreased with increasing proximity to market and road while that of maize and khat increased. At household level, farm size had a significant effect on area share of enset and coffee. As farm size increased the share of the cash crop, coffee increased but that of the staple, enset declined. Enset, which is the backbone of the system in terms of food security, is declining on small farms and the share of monoculture maize system is increasing. The trend towards declining agrobiodiversity, and reduction in the production area of the main perennial crops and their gradual replacement with monoculture fields could make the systems liable to instability and collapse. As these sites are high potential agricultural areas, intensification can be achieved by integrating high-value and more productive crops, such as fruits, spices and vegetables, while maintaining the integrated and complex nature of the systems.

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Poor adaptation to climate change is a major threat to sustainable rice production in Nigeria. Determinants of appropriate climate-change adaptation strategies used by rice farmers in Southwestern Nigeria have not been fully investigated. In this study, the determinants of climate change adaptation strategies used by rice farmers in Southwestern Nigeria were investigated. Data were obtained through Focus Group Discussions (FGDs) and field survey conducted in the study areas. Data obtained were analyzed using descriptive and inferential statistical tools such as percentage and regression analysis. The major climate change adaptation strategies used by the respondents included; planting improved rice variety such as Federal Agricultural Research Oryza (FARO) (80.5 %), seeking early warning information (80.9 %), shifting planting date until the weather condition was favourable (99.1 %), and using chemical fertilizer on their farms in order to maintain soil fertility (20.5 %). The determinants of climate change adaptation strategies used by the farmers, included access to early warning information (β=43.04), access to fertilizer (β=5.78), farm plot size (β=–12.04) and access to regular water supply (β=–24.79). Climate change adaptation required provision of incentives to farmers, training on drought and flood control, and the use of improved technology to obtain higher yield.

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This paper estimates a translog stochastic production function to examine the determinants of technical efficiency of freshwater prawn farming in Bangladesh. Primary data has been collected using random sampling from 90 farmers of three villages in southwestern Bangladesh. Prawn farming displayed much variability in technical efficiency ranging from 9.50 to 99.94% with mean technical efficiency of 65%, which suggested a substantial 35% of potential output can be recovered by removing inefficiency. For a land scarce country like Bangladesh this gain could help increase income and ensure better livelihood for the farmers. Based on the translog production function specification, farmers could be made scale efficient by providing more input to produce more output. The results suggest that farmers’ education and non-farm income significantly improve efficiency whilst farmers’ training, farm distance from the water canal and involvement in fish farm associations reduces efficiency. Hence, the study proposes strategies such as less involvement in farming-related associations and raising the effective training facilities of the farmers as beneficial adjustments for reducing inefficiency. Moreover, the key policy implication of the analysis is that investment in primary education would greatly improve technical efficiency.

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We use a large firm level data set to investigate the determinants of foreign direct investment(FDI) in Colombia. We estimate econometric models for the determinants of the probabilitythat a firm receives FDI, as well as for the factors that help to explain the foreign share in afirm’s capital. The results show that firms listed on the stock market, involved in foreign tradeactivities, and operating in sectors with greater capital intensity are more likely to be recipientsof FDI. Also, the probability of a firm receiving FDI is directly related to its size.

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Resumen basado en el de la publicaci??n

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This study tries to understand what needs to be done to improve value perceptions and wine usage (1) Change the Portuguese wine and enotourism industry profile to adjust to huge competitive marketplace because it is still production-based; more sales than marketing oriented and the market data are less important then production and sales ones; (2) Enhance strongly the relationship between the wine and enotourism company and final consumers by “management synergies”; high “innovativeness to market”;“marketing research” and by an effective brand strategy. In this line, this paper provides an overview about strategic factors that determine the Portuguese wine and enotourism decision making process. The results of this research enable the essential features of a consumer profile of purchase and consumption to be obtained with respect to: (1) the structure of attributes - intrinsic and extrinsic - that Portuguese still wine consumers best recognise and value in determining its quality, (2) the motivational structures that encourage and guide them in their decision making process when purchasing and consuming wine and enotourism services, (3) the anticipated effect of interaction between different situations of consumption with different price bands.

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To identify the causes of population decline in migratory birds, researchers must determine the relative influence of environmental changes on population dynamics while the birds are on breeding grounds, wintering grounds, and en route between the two. This is problematic when the wintering areas of specific populations are unknown. Here, we first identified the putative wintering areas of Common House-Martin (Delichon urbicum) and Common Swift (Apus apus) populations breeding in northern Italy as those areas, within the wintering ranges of these species, where the winter Normalized Difference Vegetation Index (NDVI), which may affect winter survival, best predicted annual variation in population indices observed in the breeding grounds in 1992–2009. In these analyses, we controlled for the potentially confounding effects of rainfall in the breeding grounds during the previous year, which may affect reproductive success; the North Atlantic Oscillation Index (NAO), which may account for climatic conditions faced by birds during migration; and the linear and squared term of year, which account for nonlinear population trends. The areas thus identified ranged from Guinea to Nigeria for the Common House-Martin, and were located in southern Ghana for the Common Swift. We then regressed annual population indices on mean NDVI values in the putative wintering areas and on the other variables, and used Bayesian model averaging (BMA) and hierarchical partitioning (HP) of variance to assess their relative contribution to population dynamics. We re-ran all the analyses using NDVI values at different spatial scales, and consistently found that our population of Common House-Martin was primarily affected by spring rainfall (43%–47.7% explained variance) and NDVI (24%–26.9%), while the Common Swift population was primarily affected by the NDVI (22.7%–34.8%). Although these results must be further validated, currently they are the only hypotheses about the wintering grounds of the Italian populations of these species, as no Common House-Martin and Common Swift ringed in Italy have been recovered in their wintering ranges.