Essays on Violence, Health and Family Dynamics

[eng] Violence is a pervasive societal challenge with profound economic implications. The experience of violence can have durable impacts on the life-outcomes of victims: their health; labor market opportunities, educational attainment - but also on their descendants and their peers, thereby contributing to the transmission of inequality and large costs for society. Violence's toll goes beyond its immediate, negative effects on victims. Episodes of collective violence (wars, conflicts, colonization) can also have durable effects on long-run development and societies. The experience of violence is, in addition, not random. Economically, socially and politically disadvantaged communities are much more likely to experience violence, whether it be collective - through political repression, wars, labor coercion... - or inter-personal (e.g gender-based violence or racial violence). The experience of violence is, therefore, highly intertwined with the transmission of inequality. The general goal of my thesis is to contribute to a better understanding of the causes and consequences of violence against minorities, with a particular focus on the expression of violence in the familiar setting. I use both historical and contemporary data and adopt a multifaceted approach: both in terms of the events of violence studied (institutional or interpersonal), the targeted minority (racial or gender), and the context (historical or contemporary). The first section focuses on the lingering effects of institutional violence in a historical setting: New World Slavery. I focus on the French Caribbean islands of Guadeloupe and Martinique, and study the determinants of violence during Slavery (Chapter 2) and its lingering effects on the immediate descendants of former slaves (Chapter 3). The work presented in this section is the fruit of a large scale digitization effort of handwritten administrative archives (nearly 50,000 pages) on enslaved individuals and their descendants. To collect this new data, I built an optical character recognition pipeline tailored for French Handwritten Archives, which I present in Chapter 4. Given the persistent effects of violence, investigating the efficiency of current policies in identifying and protecting victims of violence is of primary importance. The second section turns a contemporary context, and focuses on state's responses to systemic violence against women and children during the COVID-19 pandemic (Chapter 5). Both sections focus on two potential drivers of violence in the familiar setting: intergenerational transmission of trauma, and exogenous stressful shocks. These two sections are also complementary in their approach to the problem of violence. While the first section focuses on the mechanisms through which violence has lingering effects, the second section focuses on the efficiency of institutional responses to intra-familial abuse. The health dimension is also highly present in all chapters: either as consequence of violence, using mortality as outcome of interest in Chapter 2 and 3; or as a cause of violence - the COVID-19 health shock - and institution of interest (the health sector) in Chapter 5

COVID-19 and help-seeking behavior for intimate partner violence victims

Using detailed data at the local level on the number of calls to the domestic violence emergency hotline in Spain, we study the effect of the COVID-19 outbreak and the quarantine measures imposed on the help-seeking behavior of intimate partner violence victims. Our analysis focuses on Spain, which is one of the European countries that was most affected by the COVID-19 pandemic and, as a consequence, implemented one of the strictest quarantine policies in Europe. We find that the implementation of the lockdown policy was associated with a 41 percentage point increase in the number of calls to the emergency hotline compared to the pre-policy period. This effect was stronger during the strict confinement period but persisted in the medium term, after quarantine was lifted. Using detailed mobile phone data to measure mobility levels, we document stronger effects in provinces whose effective mobility reduction was more intense. Our results are crucial from a policy perspective, as many countries are faced with a second wave of the pandemic

Imaging of tumour response to immunotherapy.

A wide range of cancer immunotherapy approaches has been developed including non-specific immune-stimulants such as cytokines, cancer vaccines, immune checkpoint inhibitors (ICIs), and adoptive T cell therapy. Among them, ICIs are the most commonly used and intensively studied. Since 2011, these drugs have received marketing authorisation for melanoma, lung, bladder, renal, and head and neck cancers, with remarkable and long-lasting treatment response in some patients. The novel mechanism of action of ICIs, with immune and T cell activation, leads to unusual patterns of response on imaging, with the advent of so-called pseudoprogression being more pronounced and frequently observed when compared to other anticancer therapies. Pseudoprogression, described in about 2-10% of patients treated with ICIs, corresponds to an increase of tumour burden and/or the appearance of new lesions due to infiltration by activated T cells before the disease responds to therapy. To overcome the limitation of response evaluation criteria in solid tumors (RECIST) to assess these specific changes, new imaging criteria-so-called immune-related response criteria and then immune-related RECIST (irRECIST)-were proposed. The major modification involved the inclusion of the measurements of new target lesions into disease assessments and the need for a 4-week re-assessment to confirm or not confirm progression. The RECIST working group introduced the new concept of "unconfirmed progression", into the irRECIST. This paper reviews current immunotherapeutic approaches and summarises radiologic criteria to evaluate new patterns of response to immunotherapy. Furthermore, imaging features of immunotherapy-related adverse events and available predictive biomarkers of response are presented