Econometric analysis of employment integration and retention of people with disabilities in Canada

Cette thèse présente trois chapitres sur l'analyse microéconométrique. Dans le premier chapitre, nous étudions l'impact de la discrimination à l'encontre des personnes handicapées sur l'efficacité des politiques publiques (subventions salariales) qui favorisent leur emploi. En effet, au cours des dernières décennies, de nombreux pays ont adopté des politiques importantes pour réduire les inégalités sur le marché du travail entre les personnes vivant avec et sans incapacités avec très peu de succès. Nous sommes convaincus que la présence d'une discrimination importante à l'encontre des personnes avec incapacités peut expliquer l'inefficacité de ces politiques. Pour ce faire, nous développons d'abord un modèle de recherche d'emploi avec appariement et négociation qui tient compte des décisions de participation en présence de discrimination basée sur les goûts des employeurs. Ce modèle nous permet de séparer et d'estimer l'effet de la discrimination de l'effet de la différence de productivité. Nous estimons le modèle en utilisant les données de l'Enquête sur la Dynamique du Travail et du Revenu (EDTR) au Canada. Nos estimations suggèrent que la discrimination de l'employeur est le principal facteur expliquant les inégalités sur le marché du travail entre les personnes handicapées et non handicapées. Nos estimations montrent que 57% des employeurs ont des préjugés envers l'embauche des hommes avec incapacités et 62% pour les femmes avec incapacités. Nous avons ensuite simulé un contrefactuel pour estimer l'impact d'une politique de subvention salariale sur les taux d'emploi en utilisant les paramètres estimés du modèle. Nous constatons que l'effet de la subvention est très faible en présence ou en l'absence de discrimination, et que la subvention compense légèrement l'effet de la discrimination sur l'écart entre les personnes handicapées et non handicapées sur le marché du travail. Cela illustre la mesure dans laquelle les efforts doivent être réorientés afin de réaliser une efficacité significative de nos politiques, étant donné que nous ne trouvons aucune différence de productivité qui puisse expliquer l'écart entre les deux groupes. Le deuxième chapitre analyse l'effet de la flexibilité de l'emploi sur l'absentéisme. En utilisant les données canadiennes de l'Enquête sur la dynamique du travail et du revenu (EDTR), nous exploitons une variante de la méthode des variables instrumentales adaptée aux modèles non linéaires proposée par Terza et al. (2008), qui est la " Two Stage Residual Inclusion " (2SRI), pour analyser l'effet du travail depuis la maison (avoir un certain nombre d'heures de travail depuis la maison) sur le nombre de semaines d'absence du travail dans une année. Nous montrons que les travailleurs ayant une flexibilité de l'emploi (travaillant partiellement ou totalement depuis la maison) sont moins souvent absents pour des raisons de maladie ou d'obligation familiales que ceux qui n'ont pas de flexibilité de l'emploi après contrôle de l'endogénéité. Nos résultats montrent également des effets d'interaction assez significatifs, notamment pour les personnes handicapées. Ceci suggère qu'une politique favorisant la flexibilité de l'emploi permettrait à ces personnes de gérer leur état de santé, de rester sur le marché du travail, et donc de continuer à travailler. Les femmes sont également beaucoup plus sensibles à la possibilité de travailler depuis la maison. Dans le troisième chapitre, nous évaluons l'impact du programme Contrat d'intégration au Travail (CIT) sur le taux d'emploi des personnes ayant des contraintes sévères à l'emploi. Ce programme a été implanté au Québec en avril 2001. Pour ce faire, nous estimons l'effet de la mesure par la méthode de la différence-de-différences tout en introduisant des paramètres d'erreur de classification qui capte les faux-positif et faux-négatif du statut d'emploi. En effet, comme nous n'observons pas directement le statut d'emploi de l'individu dans les données, nous le construisons à partir des entrées, sorties et durées dans les programmes d'aide et de solidarité sociale, ce qui est sujette à des erreurs de classification lorsqu'un chômeur est identifié à tord comme employé ou qu'un employé est identifié à tord comme chômeur. Nous utilisons des données administratives du Ministère du Travail, de l'Emploi et de la Solidarité Sociale (MTESS) du Québec. Nos résultats montrent que rien ne prouve que la mesure CIT, à travers sa composante subvention salariale, a eu un impact positif sur l'emploi des personnes ayant des contraintes sévères à l'emploi, quel que soit le groupe de contrôle utilisé. De plus, les estimations des probabilités d'erreur de classification sont significativement différentes de zéro et vont de 10 à 17 % pour α₀ (chômeur est classé à tort comme employé) et de 3 à 16 % pour α₁ (employé est classé à tort comme chômeur) en utilisant les personnes sans contraintes comme groupe de contrôle. En revanche, si le groupe de contrôle est constitué d'individus soumis à des contraintes d'emploi temporaires, les estimations de ces paramètres sont approximativement doublées. Nous avons testé la robustesse de ces estimations en introduisant délibérément un faux positif de 5%. Le résultat montre que nos estimations sont robustes puisque cela augmente le faux positif d'environ 5%, laissant le faux négatif inchangé.This thesis presents three chapters on microeconometric analysis. In the first chapter, we study the impact of discrimination against people with disabilities on the effectiveness of public policies (wage subsidies) that promote their employment. Indeed, over the past decades, many countries have adopted significant policies to reduce labour market inequalities between people with and without disabilities with very little success. We believe that the presence of significant discrimination against people with disabilities may explain the ineffectiveness of these policies. To do so, we first develop a job search model with matching and bargaining that accounts for participation decisions in the presence of employer's tastes based discrimination against people with disabilities. This model allows us to separate and estimate the effect of discrimination from the effect of productivity difference. We estimate the model using data from the Survey of Labour and Employment Dynamics (SLID) in Canada. Our estimates suggest that employer discrimination is the main factor explaining labour market inequalities between people with and without disabilities. Our estimates show that 57% of employers are prejudiced toward hiring men with disabilities and 62% toward hiring women with disabilities. We then simulated a counterfactual to estimate the impact of a wage subsidy policy on employment rates using the estimated model parameters. We find that the effect of the subsidy is very small in the presence or absence of discrimination, but that the subsidy slightly compensates for the effect of discrimination on the gap between people with and without disabilities in the labour market. This illustrates the extent to which efforts need to be redirected in order to achieve meaningful policy effectiveness, as we find no difference in productivity that can explain the gap between the two groups. The second chapter analyzes the effect of employment flexibility on absenteeism. Using Canadian data from the Survey of Labour and Income Dynamics (SLID), we exploit a variant of the instrumental variables method adapted to non-linear models proposed by Terza et al. (2008), which is the "Two Stage Residual Inclusion" (2SRI), to analyze the effect of working at home (having a certain number of hours of work at home) on the number of workweeks absence in a year. We show that workers with job flexibility (working partially or fully from home) are absent less often than those without job flexibility after controlling for endogeneity. Our results also show fairly significant interaction effects, especially for people with disabilities. This suggests that a policy favouring employment flexibility would allow these individuals to manage their health status, remain in the labour market, and thus continue working. Women are also much more sensitive to the possibility of working from home. In the third chapter, we evaluate the impact of the Employment Integration Contract (EIC) program on the employment rate of people with severe employment constraints. This program was implemented in the province of Quebec in April 2001. To do so, we estimate a probit model using the difference-in-differences method whilst introducing false-positive and false-negative misclassification parameters of employment status. Indeed, as we do not directly observe the employment status of the individual, we construct it from the entries, exits and duration on the social assistance and social solidarity programs, which is subject to misclassification when an unemployed person is classified as an employee or an employee is classified as unemployed. We use administrative data from the Ministère du Travail, de l'Emploi et de la Solidarité Sociale (MTESS) of Québec. Our results show that there is no evidence that the EIC measure, through its wage subsidy component, had a positive impact on the employment of people with severe employment constraints, regardless of the control group used. Moreover, the estimates of the misclassification probabilities are significantly different from zero and range from 10 to 17 percent for α₀ (unemployed is misclassified as employed) and from 3 to 16 percent for α₁ (employed is misclassified as unemployed) using those without constraints as the comparison group. In contrast, if the comparison group consists of individuals with temporary employment constraints, the estimates of these parameters are approximately doubled. We tested the robustness of these estimates by deliberately introducing a false positive of 5%. The result shows that our estimates are robust since this increases the false positive by about 5 percent, leaving the false negative unchanged

Antimicrobial resistance in outpatient Escherichia coli urinary isolates in Dakar, Senegal.

International audienceBACKGROUND: Data regarding the evolution of antimicrobial resistance are needed to suggest appropriate empirical treatment of urinary tract infections (UTI) in developing countries. To assess the antimicrobial susceptibility of Escherichia coli, the predominant pathogen in community-acquired UTI, a prospective multicenter study was carried out in Dakar, Senegal. METHODOLOGY: From February 2004 to October 2006, 1010 non-duplicate E. coli strains were collected from four centres. Antimicrobial susceptibility testing was performed using disk diffusion method according to the recommendations of the CA-SFM (2004). RESULTS: Most of the isolates were resistant to amoxicillin (73.1%), amoxicillin-clavulanic acid (67.5%), cephalothin (55.8%), and trimethoprim/sulfamethoxazole (68.1%). Extended spectrum beta-lactamase was detected in 38 strains. The overall resistance rates to nalidixic acid, norfloxacin and ciprofloxacin were 23.9%, 16.4% and 15.5%, respectively. Most of the strains were susceptible to gentamicin, nitrofurantoin and fosfomycin (respective susceptibility rates, 93.8%, 89.9%, and 99.3%). During this period, a significant decrease in sensitivity was observed for cephalothin, fluoroquinolones and trimethoprim/sulfamethoxazole (p<0.001). CONCLUSIONS: These data suggest that trimethoprim/sulfamethoxazole may no longer be used as empirical treatment for community-acquired UTI in Dakar. In order to preserve the activity of fluoroquinolones for future years, alternatives such as fosfomycin or nitrofurantoin should be considered

Détermination du débit de filtration glomérulaire au cours de la drépanocytose au Sénégal: Schwartz, Cockcroft et Gault, MDRD, CKD-EPI ou JSCCS ?

La détermination du Débit de Filtration Glomérulaire (DFG) est importante chez les drépanocytaires du fait qu’ils constituent un groupe de patients chez lesquels des atteintes rénales sont fréquemment décrites notamment l’hyperfiltration glomérulaire. Dès lors, à une époque où les calculateurs en ligne proposent simultanément différentes formules de détermination du DFG, il serait important d’évaluer au sein d’une population noire africaine drépanocytaire l’équivalence entre ces formules qui ont été développées et validées sur des populations caucasiennes et afro-américaines à DFG normal ou diminué. Ainsi cette étude avait pour but d’évaluer l’interchangeabilité des différentes formules de détermination du DFG en les appliquant à des drépanocytaires. Des enfants et adultes sénégalais drépanocytaires homozygotes ont été alors recrutés et leur DFG calculé. La fréquence de l’hyperfiltration glomérulaire et celle de l’insuffisance rénale ont été calculées à partir des résultats obtenus avec les formules de Schwartz et du CKD-EPI. La concordance des différentes formules a été évaluée avec la méthode Bland-Altman. Au total 56 adultes et 62 enfants ont été inclus dans l’étude. L’insuffisance rénale a été notée chez 1,78% des adultes et 9,68% des enfants ; l’hyperfiltration glomérulaire chez 66,10% des adultes et 25,8% des enfants. Par rapport aux formules de référence (CKD-EPI, Schwartz), tous les biais relevés étaient significativement différents de zéro à l’exception de celui de Cockcroftet Gault qui était statistiquement nul. Les limites de concordance étaient toutes inacceptablement larges par rapport aux limites attendues à l’exception de celles du CKD-EPI sans ajustement sur la race. Ainsi, la formule de Schwartz n’était pas interchangeable avec celle du JSCCS chez les enfants, tout comme celle du CKD-EPI ne l’était pas non plus avec celles du JSCCS, de Cockcroft, du MDRD ou du CKD-EPI sans ajustement sur la race chez les adultes drépanocytaires. &nbsp; English title: Determination of glomerular filtration rate in sickle cell disease in Senegal: Schwartz, Cockcroft and Gault, MDRD, CKD-EPI or JSCCS? Determination of Glomerular Filtration Rate (GFR) is important in patients living with sickle cell disease (SCD) because they constitute a group of patients where kidney dysfunction is frequently described, in particular glomerular hyperfiltration. Therefore, at a time when online calculators simultaneously propose different formulas to estimate GFR, it would be important to evaluate in a black African population living with SCD the equivalence between these formulas which have been developed and validated on Caucasian and African American populations with normal or decreased GFR. Thus, the aim of this study was to evaluate interchangeability of different GFR formulas in a group of patients living with SCD. Homozygous Senegalese sickle cell children and adults were then recruited and their GFR computed using Schwartz and JSCCS in children, Cockcroft and Gault, CKD-EPI with and without adjustment for ethnicity, MDRD and JSCCS formulas in adults. The frequency of glomerular hyperfiltration and renal failure was computed based on the results generated using Schwartz and CKD-EPI formulas. The agreement between formulas was assessed with BlandAltman method. A total of 56 adults and 62 children were included in this study. Renal failure was observed in 1.78% of adults and 9.68% of children; glomerular hyperfiltration in 66.10% of adults and 25.8% of children. Compared with reference formulas (CKD-EPI, Schwartz), all biases found were significantly different from zero except for Cockcroft and Gault formula bias, which was statistically zero. The limits of agreement were all unacceptably wide compared with the expected limits with the exception of CKD-EPI without adjustment for ethnicity. Thus, Schwartz formula would not be interchangeable with JSCCS formula in children, nor was the CKD-EPI formula interchangeable with the JSCCS, Cockcroft and Gault, MDRD or CKD-EPI without adjustment for ethnicity formulas in adults living with sickle cell anemia

Resurgence of Ebola Virus Disease in Guinea Linked to a Survivor With Virus Persistence in Seminal Fluid for More Than 500 Days.

We report on an Ebola virus disease (EVD) survivor who showed Ebola virus in seminal fluid 531 days after onset of disease. The persisting virus was sexually transmitted in February 2016, about 470 days after onset of symptoms, and caused a new cluster of EVD in Guinea and Liberia

Learning Ordinal Embedding from Sets

Ordinal embedding is the task of computing a meaningful multidimensional representation of objects, for which only qualitative constraints on their distance functions are known. In particular, we consider comparisons of the form “Which object from the pair (j,k) is more similar to object i?”. In this paper, we generalize this framework to the case where the ordinal constraints are not given at the level of individual points, but at the level of sets, and propose a distributional triplet embedding approach in a scalable learning framework. We show that the query complexity of our approach is on par with the single-item approach. Without having access to features of the items to be embedded, we show the applicability of our model on toy datasets for the task of reconstruction and demonstrate the validity of the obtained embeddings in experiments on synthetic and real-world datasets

Profile of HLA-B27-positive enthesitis/spondylitis-related arthritis in Senegal, West Africa

Abstract Background Enthesitis/spondylitis-related arthritis (ERA) is a type of juvenile idiopathic arthritis (JIA) frequently associated with HLA-B27. In sub-Saharan Africa, HLA-B27-positive ERA hasn’t been the subject of a specific study. Objectives We aimed to describe the clinical features, disease activity, functional disability and treatment of HLA-B27-positive ERA at diagnosis in Senegal and compare the findings to other populations. Methods We conducted a retrospective study by reviewing the medical records of patients diagnosed with ERA with an age of symptom onset < 18 years according to the 2019 PRINTO provisional criteria for ERA from January 2012 to December 2022. We collected demographic, clinical, paraclinical and therapeutic data. Disease activity score was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional disability was assessed using Bath Ankylosing Spondylitis Functional Index (BASFI). Results A total of 31 patients with HLA-B27-positive ERA were included. Twenty of 31 (64.5%) were males. Twenty-seven (87%) were Fula (ethnicity). The median age at symptom onset and at diagnosis was 12 years and 19 years, respectively. Seven patients had a family history of Spondyloarthritis. Peripheral arthritis and enthesitis were the most common presenting features at disease onset. Peripheral arthritis was present in 29 (93.5%) and located in the lower limbs in 27/29 (93.1%) patients. Heel enthesitis was present in 26 (83.8%) patients. Axial involvement was present in 27 (87%) patients, dominated by low back pain and sacroiliac pain/ buttock pain in 24 (88.8%) and 22 (81.5%) patients, respectively. Seven (22.5%) patients had anterior uveitis. The ESR and CRP were elevated in 65.5% and 57.1% of cases, respectively. On imaging, sacroiliitis was found in 22 patients. The mean BASDAI was 5.5/10 (77.2% of patients had a high active disease; BASDAI ≥ 4/10). The mean ASDAS-ESR/CRP was 3.8. The mean BASFI was 5.4/10 (80% of patients had high functional disability; BASFI ≥ 4/10). Twenty-seven (87%) patients were treated with methotrexate and non-steroidal anti-inflammatory drugs. After 6 months of treatment, mean BASDAI was 3/10 and mean BASFI was 2.5/10. Conclusion In our study, HLA-B27-positive ERA was found in our Senegalese cohort mainly in adolescents of the Fula ethnic group. 22 (70.9%) patients developed ankylosing spondylitis at adulthood. The disease was very active at the time of diagnosis with significant functional disability. Treatment was mainly based on methotrexate and NAISDs

A Tangled Threesome: Circadian Rhythm, Body Temperature Variations, and the Immune System

International audienceThe circadian rhythm of the body temperature (CRBT) is a marker of the central biological clock that results from multiple complex biological processes. In mammals, including humans, the body temperature displays a strict circadian rhythm and has to be maintained within a narrow range to allow optimal physiological functions. There is nowadays growing evidence on the role of the temperature circadian rhythm on the expression of the molecular clock. The CRBT likely participates in the phase coordination of circadian timekeepers in peripheral tissues, thus guaranteeing the proper functioning of the immune system. The disruption of the CRBT, such as fever, has been repeatedly described in diseases and likely reflects a physiological process to activate the molecular clock and trigger the immune response. On the other hand, temperature circadian disruption has also been described as associated with disease severity and thus may mirror or contribute to immune dysfunction. The present review aims to characterize the potential implication of the temperature circadian rhythm on the immune response, from molecular pathways to diseases. The origin of CRBT and physiological changes in body temperature will be mentioned. We further review the immune biological effects of temperature rhythmicity in hosts, vectors, and pathogens. Finally, we discuss the relationship between circadian disruption of the body temperature and diseases and highlight the emerging evidence that CRBT monitoring would be an easy tool to predict outcomes and guide future studies in chronotherapy