Thèses sur le sujet « Aide médicale à la Belgique »
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Nguyen, Hoang Khanh. « Alsace et aide médicale au tiers monde ». Université Louis Pasteur (Strasbourg) (1971-2008), 1985. http://www.theses.fr/1985STR1M166.
Texte intégralBordedebat, Catherine. « Le monde maritime : aide médicale et coordination des systèmes opérationnels ». Bordeaux 2, 1992. http://www.theses.fr/1992BOR2M077.
Texte intégralLac, des Cognets Anne-Marie. « L'aide médicale urgente, à la recherche d'une organisation cohérente ? » Paris 9, 1987. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=1987PA090067.
Texte intégralEmergency and aid notion has evolved with time. Almost forty years have been necessary to come toa change from circulars orders to legislation on emergency medical aid and to achieve the generalisation of the so hoped centre 15. How one cane conceive the notion of medical control in the face of so many agents who deal with emergency medical aid especially in paris?
Luyten, Dirk. « OCMW en armenzorg : een sociologische studie van de sociale grenzen van het recht op bijstand / ». Leuven : Katholieke Universiteit, Faculteit der sociale wetenschappen, 1993. http://catalogue.bnf.fr/ark:/12148/cb376045988.
Texte intégralFranche-Ferraris, Valérie. « Réflexion sur l'aide médicale gratuite suite à un stage chez le praticien ». Paris 7, Lariboisière, 1995. http://www.theses.fr/1995PA072061.
Texte intégralDebono, Gilles. « Aide médicale urgente dans le département de l'Hérault et le risque nucléaire ». Montpellier 1, 1991. http://www.theses.fr/1991MON11215.
Texte intégralSchneider, Denis. « Aide médicale : champ d'application et situation dans le département du Bas-Rhin ». Université Louis Pasteur (Strasbourg) (1971-2008), 1985. http://www.theses.fr/1985STR1M039.
Texte intégralDuarte, Kevin. « Aide à la décision médicale et télémédecine dans le suivi de l’insuffisance cardiaque ». Thesis, Université de Lorraine, 2018. http://www.theses.fr/2018LORR0283/document.
Texte intégralThis thesis is part of the "Handle your heart" project aimed at developing a drug prescription assistance device for heart failure patients. In a first part, a study was conducted to highlight the prognostic value of an estimation of plasma volume or its variations for predicting major short-term cardiovascular events. Two classification rules were used, logistic regression and linear discriminant analysis, each preceded by a stepwise variable selection. Three indices to measure the improvement in discrimination ability by adding the biomarker of interest were used. In a second part, in order to identify patients at short-term risk of dying or being hospitalized for progression of heart failure, a short-term event risk score was constructed by an ensemble method, two classification rules, logistic regression and linear discriminant analysis of mixed data, bootstrap samples, and by randomly selecting predictors. We define an event risk measure by an odds-ratio and a measure of the importance of variables and groups of variables using standardized coefficients. We show a property of linear discriminant analysis of mixed data. This methodology for constructing a risk score can be implemented as part of online learning, using stochastic gradient algorithms to update online the predictors. We address the problem of sequential multidimensional linear regression, particularly in the case of a data stream, using a stochastic approximation process. To avoid the phenomenon of numerical explosion which can be encountered and to reduce the computing time in order to take into account a maximum of arriving data, we propose to use a process with online standardized data instead of raw data and to use of several observations per step or all observations until the current step. We define three processes and study their almost sure convergence, one with a variable step-size, an averaged process with a constant step-size, a process with a constant or variable step-size and the use of all observations until the current step without storing them. These processes are compared to classical processes on 11 datasets. The third defined process with constant step-size typically yields the best results
Duarte, Kevin. « Aide à la décision médicale et télémédecine dans le suivi de l’insuffisance cardiaque ». Electronic Thesis or Diss., Université de Lorraine, 2018. http://www.theses.fr/2018LORR0283.
Texte intégralThis thesis is part of the "Handle your heart" project aimed at developing a drug prescription assistance device for heart failure patients. In a first part, a study was conducted to highlight the prognostic value of an estimation of plasma volume or its variations for predicting major short-term cardiovascular events. Two classification rules were used, logistic regression and linear discriminant analysis, each preceded by a stepwise variable selection. Three indices to measure the improvement in discrimination ability by adding the biomarker of interest were used. In a second part, in order to identify patients at short-term risk of dying or being hospitalized for progression of heart failure, a short-term event risk score was constructed by an ensemble method, two classification rules, logistic regression and linear discriminant analysis of mixed data, bootstrap samples, and by randomly selecting predictors. We define an event risk measure by an odds-ratio and a measure of the importance of variables and groups of variables using standardized coefficients. We show a property of linear discriminant analysis of mixed data. This methodology for constructing a risk score can be implemented as part of online learning, using stochastic gradient algorithms to update online the predictors. We address the problem of sequential multidimensional linear regression, particularly in the case of a data stream, using a stochastic approximation process. To avoid the phenomenon of numerical explosion which can be encountered and to reduce the computing time in order to take into account a maximum of arriving data, we propose to use a process with online standardized data instead of raw data and to use of several observations per step or all observations until the current step. We define three processes and study their almost sure convergence, one with a variable step-size, an averaged process with a constant step-size, a process with a constant or variable step-size and the use of all observations until the current step without storing them. These processes are compared to classical processes on 11 datasets. The third defined process with constant step-size typically yields the best results
Libert, Marc. « Habitudes alimentaires et pratique médicale dans deux couvents féminins bruxellois au XVIIIe siècle ». Doctoral thesis, Universite Libre de Bruxelles, 1997. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/212190.
Texte intégralCauvin, Jean-Michel. « Raisonnement médical et aide à la décision en endoscopie digestive ». Rennes 1, 2001. http://www.theses.fr/2001REN1B052.
Texte intégralDucarre, Pierre. « Le service d' aide médicale urgente de la Nièvre : bilan d' activité : perspective d' avenir : le centre 15 ». Clermont-Ferrand 1, 1987. http://www.theses.fr/1987CLF13052.
Texte intégralLaversin, Bertrand. « Formation d'agents de santé afghans par Aide Médicale Internationale Afghanistan, de 1986 à 1992 : description, perspective ». Lille 2, 1993. http://www.theses.fr/1993LIL2M001.
Texte intégralMaigret, Julien. « Evolution de la responsabilité médicale en France et en Belgique : le rapprochement et l'éloignement de deux systèmes voisins ». Paris 8, 2003. http://www.theses.fr/2003PA082351.
Texte intégralTellez, Barbara. « Quel type de prise en charge médicale et psychosociale offrir aux enfants de parent(s) alcoolique(s) ? » Université Louis Pasteur (Strasbourg) (1971-2008), 1991. http://www.theses.fr/1991STR1M095.
Texte intégralRavel, Christiane. « Bilan d' une expérience d' aide médicale dans le cadre du projet "Médecins sans frontières" au Tchad ». Clermont-Ferrand 1, 1987. http://www.theses.fr/1987CLF11016.
Texte intégralBenis, Arriel. « Aide à l'exploration et à la découverte de relations dans des données de la Génomique Médicale Fonctionnelle ». Paris 13, 2009. http://www.theses.fr/2009PA132032.
Texte intégralData Mining is an emerging area in Medical Informatics research field. Nowadays, clinical research protocols are no longer limited to collect only medical data, but they are also regarding to other kinds of data such as genomic data from cDNA microarrays. Currently, the approaches commonly used by biologists in this context simply explore a tiny part of the data based on a priori. Our work is based on automating the analysis process. Firstly, this PhD dissertation focuses on the definition of a data workflow adapted to data that we deal with (bioclinical and genomics data). Secondly, outliers, due to the relative quality of data and sources of errors in analysis are automatically identified thanks to a classification method. Finally, all these results will be presented in an easy way to biologist experts. Experiments related to researches in obesity medicine have been done and allowed to validate our Data Mining process and to discover biomarkers. Evaluations of use and usability have shown the benefits of our approach
Sarrou, Philippe. « Concept de formation d'agents de santé en zone de désertification sanitaire : à partir de l'expérience d'aide médicale internationale afghanistan ». Clermont-Ferrand 1, 1993. http://www.theses.fr/1993CLF1M029.
Texte intégralPauget, Bertrand. « La connaissance relationnelle comme aide à la compréhension de la structuration d'une organisation ». Troyes, 2006. http://www.theses.fr/2006TROY0020.
Texte intégralOur inductive step is based on the study of a network of health of an average agglomeration analyzed in its phase of emergence (2001-2004). The “reseau pole memoire” was created to answer the dissatisfactions of the professionals to the difficulty of assumption of responsibility of patients reached of heavy and recurring diseases such Alzheimer. Gathering different kind of actors, the articulation from the various points of view becomes a crucial element of the structuring of this organization created ex nihilo. We develop the concept of relational knowledge analyzed like a relational filter for the actor and/or the organization allowing to support or limit the structuring. It makes possible to answer our problem: how and in what the tensions between the relational processes and systems cans they be structuring for the organizations? Relational knowledge, sight through model SCIP (Structure/Culture/Identité/Pratique), is a means of determining the ways by the actors to structure their organization. It thus reveals the reasons which those chose a method of construction resulting from the professional bureaucracy rather than that of a reticular organization. In fact why the network of health, little innovating, was built around an actor pivot and of a slightly hierarchical abstract structure
De, Greef Vanessa. « Droit au travail et troubles mentaux : une analyse critique des exclusions et des inclusions par le droit en assurance chômage et en aide sociale ». Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209099.
Texte intégralLes deux premières parties de la thèse comportent une analyse de la réglementation du chômage et de la législation relative au droit à l’intégration sociale. Dans ces deux premières parties, j’ai analysé les conditions d’octroi de l’assurance chômage et du droit à l’intégration sociale et ai examiné dans quelle mesure les allocataires souffrant de troubles mentaux sont accompagnés dans leur recherche d’emploi par les services régionaux de l’emploi et les centres publics d’action sociale (CPAS). Les évolutions qui ont marqué ces domaines au cours des dernières années en Belgique révèlent que loin d’être uniquement un individu totalement exclu du droit au travail, la personne souffrant de troubles mentaux devient progressivement un sujet du droit au travail. Cette transformation de la représentation de la personne souffrant de trouble mentaux est plus marquée dans le domaine de l’assurance chômage, mais influence progressivement les acteurs de l’aide sociale, plus particulièrement en Flandre.
La troisième partie propose une grille d’analyse du caractère idéologique du droit. Dans cette optique, j’ai développé les concepts d’exclusion et d’inclusion juridique qui ont pour but d’analyser l’idéologie des dispositifs de restriction ou d’extension d’un droit fondamental, qu’ils soient explicites (en étant prévu dans un texte juridique) ou implicites (en étant la résultante du silence du texte ou d’une pratique informelle des autorités publiques). Ensuite, j’ai dégagé des deux premières parties de la thèse six dispositifs spécifiques :trois cas d’exclusion juridique de la personne souffrant de troubles mentaux et trois cas d’inclusion juridique. J’ai retracé les justifications qui ont conduit les autorités publiques à élaborer (ou non) certains dispositifs et ce faisant, à diminuer ou à accroître le champ d’application du droit au travail des personnes souffrant de troubles mentaux.
Pour ce faire, je me suis appuyée sur la théorie des justifications du sociologue L. Boltanski et du sociologue et économiste L. Thévenot. L’exploration des justifications a permis de confirmer mon hypothèse :l’évolution des représentations dominantes de la personne souffrant de troubles mentaux reflète l’évolution de son droit au travail. L’analyse idéologique des dispositifs d’exclusion et d’inclusion juridiques a revélé que, malgré sa faible effectivité, le droit au travail est fréquemment mobilisé par les autorités juridiques, en particulier lorsqu’elles évoquent des valeurs d’ « efficacité » ou « d’intérêt général ». Les autorités publiques insistent généralement sur l’accès au travail des personnes souffrant de troubles mentaux et non sur les autres dimensions du droit au travail, telles que le droit à une rémunération ou à des conditions de travail équitables. Mon hypothèse n’a, par contre, pas pu être strictement confirmée dans les domaines où la représentation de la personne souffrant de troubles mentaux est plus effacée. Ce silence juridique ne signifie pas que l’idéologie est absente de ces domaines ;celle-ci ne vise cependant pas à offrir une représentation spécifique de la personne souffrant de troubles mentaux et il est donc plus délicat de l’identifier.
Doctorat en Sciences juridiques
info:eu-repo/semantics/nonPublished
Nony, Patrice. « Aide à la prescription : apport de la méta-analyse, et de l'étude des relations concentration-effet ». Lyon 1, 1998. http://www.theses.fr/1998LYO1T218.
Texte intégralRenaud, Bertrand. « Aide à la décision médicale par les règles de prédiction clinique au service d'urgence : l'exemple de la pneumopathie aigue communautaire ». Paris 6, 2009. http://www.theses.fr/2009PA066543.
Texte intégralThe explonentially increasing amount of medical knowledge compromises its transfer to medical practice and results in suboptimal quality of care. This is of particular interest with regard to emergency medicine. Indeed, in few other domains of medicine is there such variety, novelty, distraction, and chaos, all juxtaposed to a need for expeditious and judicious thinking and in no other area of medicine, is decision density as high. Therefore, emergency medicine is particularly exposed to reveal the cognitive limits of medical decision making. Indeed, medical decision mainly depends on emergency physicians ability to predict patients’ outcome based on data available at presentation. Clinical prediction rules are the best evidence for guiding medical decision. The following text reports several studies conducted by the emergency department team of H Mondor university related hospital about the usefulness of a clinical prediction rule for guiding medical decision making process of patients presenting with a community acquired pneumonia (CAP). First, the European validation of the Pneumonia Severity Index (PSI) that has been intially developped in North America is reported. The second study reports the impact of routine use of the PSI in French emergency departments. Then, we report an evaluation of professional practices consisting in the implemention of a comprehensive strategy that included PSI assessment via the emergency department computerized medical file. Finally, the last two reports present on the one hand the development of a new clinical prediction rule for the severe CAP (REA-ICU: Risk of Early Admission to Intensive Care Unit) and on the other hand a demonstration by recurrence of the actual usefulness of this new rule that could be able to signicantly modify medical practices
Lacroix, Sébastien. « Étude philosophique du renversement juridique canadien concernant l'aide médicale à mourir, à la lumière du débat Hart-Dworkin ». Master's thesis, Université Laval, 2016. http://hdl.handle.net/20.500.11794/27253.
Texte intégralOn February 6th 2015, the Supreme Court of Canada issued an anonymous, unanimous landmark judgment. In Carter v. Canada (Attorney General), the Court recognized that a blanket prohibition of physician-assisted dying violates the constitutional rights of certain individuals. Indeed, a competent adult person should be allowed to seek help from a doctor to end her life if she meets two criteria: clearly consent to the termination of life and have a grievous and irremediable medical condition causing enduring suffering that is intolerable to the said individual. This legal decision constitutes an judicial overrule, because a reverse judgment was made in 1993. In fact, twenty-two years ago, the Supreme Court ruled five to four in favour of the ban on assisted suicide. In Rodriguez v. British Columbia (Attorney General), the majority ruled that the protection of the sanctity of life in all circumstances, both for vulnerable people for capable adults, was reason enough not to invalidate the sections of the Criminal Code concerned with assisted suicide. The majority then feared that any opening to assisted suicide would cause a gradual widening of the eligibility criteria, what many have called the argument of the “slippery slope”. As part of this thesis, the Rodriguez-Carter judicial overrule will be analyzed in light of the debate between H. L. A. Hart and Ronald Dworkin. While the former is known for his defence of a new version of soft positivism, the latter offers a new and innovative theory, named interpretivism. The goal is simple: to establish which of these two theories best explains the Canadian legal overrule regarding physician-assisted dying. The initial hypothesis is that both theories may explain said reversal, but one will do so better than the other.
Lejeune, Aude. « Nul n'est censé être ignoré par le(s) droit(s) : politiques d'accès au droit et à la justice en Belgique et en France ». Cachan, Ecole normale supérieure, 2010. http://www.theses.fr/2010DENS0014.
Texte intégralLegal aid allows access to social and political citizenship. In a context where the transformation of social policies seeks to empower laypeople, lawyers are encouraged to intervene before litigations in order to pass "Iegal consciousness" on laypeople. Through this process, citizcns could be able to defend and promote their rights in everyday life. Beside legal assistance in which disadvantaged people can be assisted by a lawyer in their litigations, legal aid policy offers legal support and expertise in or outside litigation. My PhD dissertation analyses how public authorities and lawyers take in charge legal aid in two countries: Belgium and France. Both terms of comparison have been selected for their historical, legal and cultural proximity. However, they are characterized by very different State and Civil Society traditions. The main focus lies on the relation between the mobilization of law and the institutional contexts in which lawyers provide legal aid. This approach allows me to highlight the formation of innovative social and political mobilizations of law. This process is linked with recent social policies' and, more broadly, public policies' transformations
Le, Maistre Bertrand. « Médecine humanitaire : aide confraternelle franco-roumaine : mission avril-mai 1998 auprès des handicapés physiques de Lugoj ». Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M041.
Texte intégralDelmas, Bénédicte Weltman-Aron. « Découverte de l'Afghanistan au cours d'une mission médicale (Wardak novembre 87-avril 88) ou une autre façon d'exercer la médecine ». Montpellier 1, 1989. http://www.theses.fr/1989MON11206.
Texte intégralCantin, Audrey. « Quelle est la place du soutien psychosocial dans le processus d'aide médicale à mourir au Québec ? » Master's thesis, Université Laval, 2019. http://hdl.handle.net/20.500.11794/34545.
Texte intégralThe Act Respecting End-of-Life Care came into force in Quebec in December 2015. Since that day, a person may, in certain circumstances, apply for medical assistance in dying (MAID). As such, anyone requesting this service has to go through a multistep process. However, as explained in this Act, the main health professionals involved in this process are doctors and the place of social workers is very little discussed and often absent. Therefore, our study aims to answer the following question: What is the role of psychosocial support in the practice of medical aid in dying in Quebec (MAID)? Currently in Quebec, there isn’t any study to our knowledge that is focused on the needs in terms of psychosocial support of a person requesting medical aid in dying. A literature review allowed the study of 273 essays that were filled to the National Assembly of Quebec during the Consultation from the Select Committee on Dying with Dignity. The analytic questioning approach (Paille & Mucchielli, 2012) as allowed the analysis of 20 essays that were selected for our sample because they made recommendations regarding psychosocial support in the MAID. Nonetheless, several observations and recommendations to that effect were not considered during the development of this Act. Based on Kübler-Ross (1969) model known as the five stages of of grief, the results of this study demonstrate the importance of psychosocial support during the medical aid in dying along the continuum care at the end of life, until death. These conclusions highlight the importance of multidisciplinary work in the MAID process, in order to allow optimal support when it comes to the needs of those persons at the end of life, more specifically when assessing the restrictive conditions and decisionmaking. Moreover, the psychosocial support of families during the process is just as important, even after death. Finally, this study highlights the place of social workers in supporting patients and family going through medical aid in dying. -- Keywords: Medical aid in dying, psychosocial support, end-of-life care, five stages of grief of Kübler-Ross
Malmanche, Hélène. « L'engendrement avec tiers donneur : Genre, bioéthique et pratiques transfrontières (France, Belgique) ». Thesis, Paris, EHESS, 2020. http://www.theses.fr/2020EHES0162.
Texte intégralThe use of medically assisted procreation with third-party donors has been regulated in France by the so-called "bioethics" laws since 1994, which organise gamete and embryo donations by reserving them exclusively for heterosexual couples of fertile age. Because of the restricted access that this framework imposes, and the difficulties in finding a sufficient number of donors to meet the growing needs, many people turn to foreign countries to benefit from sperm, oocyte, embryo or gestation donation. For French men and women, Belgium is the first country of destination for cross-border reproductive care (CBRC).Apprehended in their globality, gamete donations and surrogacy are as much medical practices than kinship practices as they create a new family form: the donor-conceived family. This thesis aims to describe the experience of third-party donor parenthood, both from the point of view of the intended parents who are engaged in CBRC, and from of the practitioners who accompany the construction of this specific kinship. A double survey has been conducted. Firstly, qualitative interviews were conducted with intended parents who had undergone CBRC involving a third-party donor, in three cases: oocyte donation, sperm donation to female same-sex couples, and surrogacy. Secondly, a two-year ethnographic survey in a fertility centre in Belgium welcoming French patients provided information on a medical practice of third-party donor conception. In a context where donor-conceived families are in a situation of "incomplete institution" in France as in Belgium in different ways, this research sheds light on the social change that is taking place through the issue of the institution of emerging norms of this new way of making a family. The results of the survey highlight the processual nature of the acquisition of the places of each protagonist - intended parents, donors, donor-conceived children - from the elaboration of the parental project until after birth; they give an account of the way in which health care professionals accompany this donor conception, through relational work that takes into account all its dimensions, from its biological component to kinship and filiation. Finally, these medical and kinship practices must be placed in the global context of the transformations of the institution of the family, thus opening up the way for social sciences to shed light on the most contemporary bioethical debates
Peter, Christian. « Etude et réalisation d'un appareil d'acquisition automatique de séries de contours tridimensionnels de patients : aide à la radiotherapie et àla chirurgie de reconstruction mammaire en cancerologie ». Vandoeuvre-les-Nancy, INPL, 1991. http://www.theses.fr/1991INPL130N.
Texte intégralDehecq, Caroline. « Aide médicale à la procréation chez les couples sérodifférents dont l'homme est infecté par le VIH en 2002 : état des lieux en France ». Paris 6, 2002. http://www.theses.fr/2002PA060037.
Texte intégralHocquard, Anita. « L'euthanasie volontaire : enquête sur une demande sociale socio-anthropologique ». Paris 1, 1999. http://www.theses.fr/1999PA010543.
Texte intégralWhereas suicide is no longer prohibitted in France since the revolution, a somewhat not inconsiderable part of the population, following the example of what is claim outside its borders, demand the right to die. Better still, the right to be assisted in dying ;. How are we to understand suche a social claim? The question testifies to a further paradox : the individual actually appeals to social solidarity to escape through death the social and its solidarity. After picking out that voluntary death embodies the paradigm of all forms of extinction, decadence and other de-constructions (or ek-stases), the work shows the results of a survey that was led with the members of the association for the right to die with dignity. The qualitative and quantitative treatment of three thousand questionnaires allows us to draw up the sociological profile of this population. Following the exploitation of this material, further thought must be given to the right (what is licit vs what is due) and therfore, the power it calls upon (the bio-powel) or those it fights (the medical power, the therapeutic fury and the technics of emergency care). But could not the euthanasiac vindication be the visible side of a concealed necessity to disappear? This hypothesis is invalidated through the examination of health coast and the social and economical burden entailed by old age. Similary, if the claim may seem to amount to a denial of death, (through shortening the dying process) a close examination appears to avert as it were, not death itself but the blemish epitomized by the indiscernable state between life and death. Above the repeatedly acknowledged fear of decay induces a reflection on shame and intimacy (the social preservation of secret). Euthanasia is always requested in the name of (social) dignity. The claimants might henceforth socially comes out of society. This sacrifical-like reciprocical action ; thus opens onto genuine + allagmatics ; in which life and death, the individual and its society are exchanged
Galopin, Alexandre. « Modélisation ontologique des recommandations de pratique clinique pour une aide à la décision à niveaux d'abstraction variables ». Thesis, Paris 6, 2015. http://www.theses.fr/2015PA066202/document.
Texte intégralClinical practice guidelines (CPGs) are elaborated according to evidence-based medicine principles in order to improve healthcare quality. However, even when they are integrated into clinical decision support systems, recommendations are poorly implemented by physicians. Indeed, CPGs are often criticized for their lack of flexibility, and their inability to handle the singularity of patients encountered in clinical practice. In particular, CPGs are usually elaborated for a single pathology whereas patients usually suffer from multiple pathologies and comorbidities. We have proposed a method based on an ontological reasoning to enable the reconciliation of single-pathology CPGs to support the flexible management of patients with multiple pathologies. Knowledge bases are made of decision rules that formalize the content of single-pathology CPGs. Patient criteria are organized by a domain ontology, which allows the generation of a generalization-ordered graph of clinical patient profiles. The ontological reasoning allows to reason at different levels of abstraction to process clinical cases described with different levels of completeness. This method has been implemented in a decision support system called GO-DSS, and applied to the management of patients suffering from both arterial hypertension and type 2 diabetes, on the basis of CPGs produced by the VIDAL company (VIDAL Recos). The prototype and its user interfaces have been qualitatively evaluated by a sample of users including both computer scientists with medical knowledge and physicians with computer skills
Tantchou, Yakam Josiane Carine. « Comment naissent les politiques verticales de santé en Afrique ? : réinterroger le passé et le présent à partir de la lutte contre la trypanosomiase et la tuberculose au Cameroun ». Paris, EHESS, 2006. http://www.theses.fr/2006EHES0238.
Texte intégralThe thesis seek to answers three questions: how can we explain the emergence of selective health programs in Africa? How can we explain the repetitive failures of health policies in Africa ? What justifies the "eagerness" to improve the health of the poor (countries). As answer to the first question, the author notes that selective health policies are not always based on the report of a critical epidemiologic situation. They are often the initiative of actors inserted in power networks, able to mobilize interest and financial resources. The thesis raises the question of "eagerness" to cooperate or improve the health of the poor (countries). Refuting the humanitarian argument, the author uses Michel Foucault analysis of the "racisme d'Etat" and explains this by the desire "de faire vivre pour soi-même". As for the repetitive failures of health policies implemented in some African countries, the author proposes an analysis based on the "biopouvoir", explaining these failures by a deficiency, an absence, a bursting of it
Ramadier, Lionel. « Indexation et apprentissage de termes et de relations à partir de comptes rendus de radiologie ». Thesis, Montpellier, 2016. http://www.theses.fr/2016MONTT298/document.
Texte intégralIn the medical field, the computerization of health professions and development of the personal medical file (DMP) results in a fast increase in the volume of medical digital information. The need to convert and manipulate all this information in a structured form is a major challenge. This is the starting point for the development of appropriate tools where the methods from the natural language processing (NLP) seem well suited.The work of this thesis are within the field of analysis of medical documents and address the issue of representation of biomedical information (especially the radiology area) and its access. We propose to build a knowledge base dedicated to radiology within a general knowledge base (lexical-semantic network JeuxDeMots). We show the interest of the hypothesis of no separation between different types of knowledge through a document analysis. This hypothesis is that the use of general knowledge, in addition to those specialties, significantly improves the analysis of medical documents.At the level of lexical-semantic network, manual and automated addition of meta information on annotations (frequency information, pertinence, etc.) is particularly useful. This network combines weight and annotations on typed relationships between terms and concepts as well as an inference mechanism which aims to improve quality and network coverage. We describe how from semantic information in the network, it is possible to define an increase in gross index built for each records to improve information retrieval. We present then a method of extracting semantic relationships between terms or concepts. This extraction is performed using lexical patterns to which we added semantic constraints.The results show that the hypothesis of no separation between different types of knowledge to improve the relevance of indexing. The index increase results in an improved return while semantic constraints improve the accuracy of the relationship extraction
Borghol, Nada. « Mécanismes épigénétiques et aide médicale à la procréation : évaluation de la maturation in vitro des ovocytes humains et de la fécondation avec des spermatides rondes murines ». Lyon 1, 2006. http://www.theses.fr/2006LYO10083.
Texte intégralBaneyx, Audrey. « Construire une ontologie de la Pneumologie Aspects théoriques, modèles et expérimentations ». Phd thesis, Université Pierre et Marie Curie - Paris VI, 2007. http://tel.archives-ouvertes.fr/tel-00136937.
Texte intégralDans ce contexte, notre réflexion a porté sur la collecte, l'organisation, la représentation et la formalisation des connaissances en médecine, tout particulièrement, dans le domaine de la pneumologie. Nous avons été amenés à considérer le problème dans son ensemble, afin de comprendre les mécanismes qui sous-tendent la constitution de ressources terminologiques et ontologiques à partir de textes. Nous avons également considéré chaque tâche séparément, afin de proposer, pour chaque étape, si ce n'est une solution, au moins un savoir-faire personnel susceptible d'apporter des éléments de réponse. L'objectif principal de cette thèse consiste à mettre au point une ontologie dans le domaine de la pneumologie pour faciliter, d'une part, l'aide au codage médico-économique des pathologies et, d'autre part, la représentation des connaissances pertinentes relatives au patient, dans ce domaine de spécialité. Nos recherches couvrent l'ensemble du cycle de vie d'une ontologie, de la mise au point d'une méthodologie de construction à partir de textes à son utilisation dans un système opérationnel. Nous contribuons aux recherches dans les domaines de l'Ingénierie des connaissances et de l'Informatique médicale.
La méthode de travail adoptée est une démarche expérimentale ascendante qui consiste à partir des problématiques concrètes rencontrées pour aller vers la résolution des questions scientifiques sous-jacentes. Selon cette démarche, nous avons tout d'abord cerné les besoins des pneumologues en termes de représentation des connaissances. Ensuite, nous avons mis au point une méthodologie, destinée à l'ingénieur des connaissances, fondée sur la méthode ARCHONTE définie par B. Bachimont. L'enchaînement des processus d'extraction, de sélection et de choix des candidates termes du domaine ainsi que l'aide fournie par les patrons lexico-syntaxiques pour renseigner les principes différentiels la rende relativement facile d'emploi (ou moins difficile qu'une autre) pour un ingénieur des connaissances. L'ontologie construite compte à ce jour 2260 concepts primitifs. Enfin, nous avons développé un outil de codage semi-automatique proposant deux types de codages : (1) un codage médical qui représente graphiquement les informations pertinentes relatives aux pathologies du patient et qui, à terme, servira de descripteur pour indexer intelligemment les comptes rendus d'hospitalisation ; (2) un codage médico-économique pour lequel nous obtenons un rappel de 80% et une précision de 87%. Nos résultats concernant l'ontologie et l'outil nous encouragent à poursuivre nos recherches et à améliorer les solutions proposées.
Mendes, Nicolas. « Le père et le genre : la paternité en question par l’aide médicale à la procréation pour des hommes transgenres ». Thesis, Paris 10, 2018. http://www.theses.fr/2018PA100102.
Texte intégralThis study allows a first reflection on the fatherhood of transgender men who have used sperm donation with medically assisted procreation. Twenty years ago, the first French sperm bank offered to accompany the request of heterosexual couples which transgender men. To this day only one study about these couples has been published but focused on the development of their children. A reflection on the fatherhood of these men born as women and who are now fathers appears to be necessary. To study this new situation, we have reviewed the psychoanalytic concepts of identity brought to us by Freud and Lacan, and the concept of gender brought to us by the Gender Studies. Also, fatherhood is discussed with the anthropological approach on structure of kinship. The gamete’s donation is addressed in relation to the clinical concept of transmission and the bioethical questioning that it rises. From a psychoanalytical paradigm, we admit a relationship with the phenomenological approach. A quantitative tool (the Five Minute Speech Sample) was adapted in its analysis method to answer: how does a person born as a women and now living as a man will define his fatherhood when benefitting of anonymous sperm insemination in medically assisted procreation? We analyzed the free speech of sixteen transgender men to build a representation of fatherhood in these specific experiences. Points of tension have allowed to identify three sets of disquiets’ signs. Some of them can be encountered in the process toward this specific kind of fatherhood. Being aware of these disquiets’ signs could help us accompany more appropriately people in the quest of their transgender lives
Romdhane, Samira. « Les nouvelles technologies de l'assistance médicale à la procréation (amp) et la qualité des gamètes et des embryons : évaluation de l'épigénome ». Phd thesis, Université Claude Bernard - Lyon I, 2010. http://tel.archives-ouvertes.fr/tel-00838798.
Texte intégralArteau, Joanie. « Le recours à l'aide médicale à mourir au Québec : l'expérience occultée des proches ». Master's thesis, Université Laval, 2019. http://hdl.handle.net/20.500.11794/34970.
Texte intégralThe aim of this exploratory qualitative research is to document the overall experience of relatives of the patient during the process of medical assistance in dying (MAID), focussing particularly on the social environment. It aims to 1) describe the accompaniment provided by medical team to relatives during MAID’s process; 2) explore the relatives’ relationships and interactions between them during MAID’s process; 3) describe the relatives’ perceptions about MAID’s process and 4) explore the relatives specific MAID’s mourning process. Data was collected from semi-structured and free style individual interviews with seven relatives who accompanied a person in a MAID demand process. Giorgi’s (1997) phenomenological data analysis method was used to codify and interpret qualitatively relatives’ sayings. The results were highlighted according to the chosen theoretical perspective, the Bronfenbrenner’s (2005) bioecological model. The results of this study suggest that relatives’ accompaniment is mainly supported by the medical team, such as doctors and nurses, and that the position of social workers and their potential psychosocial support or interventions is not clearly established in this process. Relatives were generally satisfied with their global experience during the MAID process, but they specify that this end-of-life care need to be improved, especially regarding the psychosocial support of families. Finally, relatives’ grief does not seem different from grief of a conventional death, except that their process seems for some of them to be accelerated or facilitated. Keywords: medical aid in dying, medical assistance in dying, euthanasia, relatives, caregivers, family, palliative care, end-of-life care, psychosocial support
Dony, Marianne. « La responsabilité des pouvoirs publics en cas d'intervention dans une entreprise en difficulté ». Doctoral thesis, Universite Libre de Bruxelles, 1990. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/213118.
Texte intégralFisher, Evan. « Humanitarian presence. Locating the global choices of Doctors Without Borders ». Thesis, Université Paris sciences et lettres, 2020. http://www.theses.fr/2020UPSLM024.
Texte intégralThis dissertation is a monograph of the nongovernmental organisation (NGO) Doctors Without Borders (MSF). It is based on an ethnographic inquiry into the operations of this medical humanitarian NGO as they take place. Observing members of MSF providing healthcare to migrants in Paris and to inhabitants of a slum in Nairobi, evaluating and planning projects in their headquarters, we see them tinker together the sometimes-incompatible goals of a seemingly simple humanitarian mission: medical assistance to the vulnerable around the world. Our pragmatist approach consists in arguing that analysis of international aid must account for how humanitarians find a way to hold together the ambiguities, and even the contradictions, of this claimed mission in the ambivalent effects humanitarian aid in practice. To this end, we ask how MSF selects those it seeks to assist around the world. Our response entails close description of the instrumentation of triage: the problematic processes of elaborating and using tools that support the reflexive choice of beneficiaries around the globe. We then make three analytical gestures, allowing us to contribute to ongoing discussions in anthropology on global assemblages, global spaces, and global health. First, we show how the processes of bordering, territorializing, and scaling that triage instruments support, participate in producing humanitarian locations: humanitarian space, the field, medical platforms, and headquarters. Second, analysing the ways triage instruments script for those humanitarians claim to assist, we argue that MSF gains humanitarian agency in the ways it relates to humanitarian beneficiaries: the tact and tactics of care, the reciprocal recognition of beneficiaries in their need and of MSF’s need to help, the acceptance of responsibility for this vulnerability coupled with an attempt to transfer responsibility to public health care systems. Third, accounting for these instruments in terms of humanitarian technologies of intervention, we demonstrate how MSF makes timely interventions into governing bodies and the bodies of the governed. Together, our description of aid as it takes place and our analysis of the problems associated with humanitarian locations, beneficiaries, and technologies of intervention constitute what we call MSF’s humanitarian presence. This humanitarian presence indicates the ways MSF exists, in their global physical extension, in the health care they practice, in their nongovernmental politics and their ethics of attention. This concept supports critique by indicating, first, the multiple and incompatible goods that are to inhere in humanitarian aid, and second, those specific instances when MSF has failed to do so
Romdhane, Samira. « Les nouvelles technologies de l’assistance médicale à la procréation (amp) et la qualité des gamètes et des embryons : évaluation de l’épigénome ». Thesis, Lyon 1, 2010. http://www.theses.fr/2010LYO10143/document.
Texte intégralAssisted reproductive technologies particularly the induction of ovulation, oocytes in vitro maturation, and prolonged embryo culture require in vitro manipulation of gamete and embryos at critical times of their maturation and development. In consequence, they may interfere with epigenetic reprogramming and affect particularly demethylation and remethylation of imprinted genes. To evaluate such a risk, we have determined the methylation profile of KvDMR1, the region that regulates KCNQ1OT1 imprinted gene, in human oocytes retrieved from stimulated or unstimulated cycles, at different phases of their maturation in vivo or in vitro. Our results show that the timing of establishment of the methylation profile of KvDMR1 covers the maturation phase of oocyte growth, in vivo and in vitro, and that hyperstimulation likely recruits young follicles epigenetically immature. Analysis of the methylation profile of H19DMR (DMR of IGF2/H19) in atypical ICSI embryos and corresponding sperm suggests that imprinting disorders are not responsible of embryo developmental failure prior the blastocyst stage
Horn, Ruth. « Le débat sur l'euthanasie et les pratiques en fin de vie en France et en Allemagne : une étude comparative ». Paris, EHESS, 2009. http://www.theses.fr/2009EHES0076.
Texte intégralThe objective of this thesis is to understand how the moral question of euthanasia emerges and is dealt with in society. It takes France and Germany as case studies of this; two countries in which euthanasia is prohibited and which have similar legislation on the issue. We suppose that each society has its own specificities in terms of practical, social and political norms that affect the ways in which they deal with these issues. This thesis thus seeks to understand how requests for the right to die emerge in society, through both the debate (analysis of documents) and the practices (ethnographic work in three French and two German hospitals) that elucidate it. It does so however without attempting to solve the moral question of euthanasia. In spite of the differences observed between these two countries, the central issue at stake in their respective debates is the question of the individual’s autonomy to choose the conditions in which he or she wishes to die
Gabarro, Céline. « L’attribution de l’aide médicale d’Etat (AME) par les agents de l’Assurance maladie : entre soupçon de fraude, figures de l’étranger et injonctions gestionnaires ». Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCC167/document.
Texte intégralIn this dissertation, we address the issue of healthcare access for undocumented immigrants through the study of State Medical Aid (referred to as AME – Aide Médicale d’Etat) – a healthcare coverage specifically dedicated to them. Based on an ethnographic study carried out on both sides of the counter at Health Insurance Offices (referred to as CPAM - caisses primaires d’Assurance maladie), we question the impact of an increasingly managerial approach to healthcare and of CPAM occupational mutations on AME attribution. We show how a rhetoric of suspicion developed in this administration, towards foreigners in particular. Event though this rhetoric is institutionalized, we shall see how it can also be individually reappropriated, in a context where the meaning of labor is strongly called into question, and where professional identities are undermined. While all agents share a common discourse on the fight against social fraud, they nevertheless use this logic in different ways. As a result, agents may distinctively promote a managerial expertise, a social expertise, or a system gatekeeper expertise. Finally, this dissertation shows how the use of a suspicion rhetoric does not necessarily produce a rigorist reading of AME, even if the latter dominates. On the contrary, it may also call on a social or managerial perspective – given the specificity of AME and its separate processing – that may facilitate healthcare access for undocumented immigrants
Marissal, Claudine. « La protection sanitaire du jeune enfant en Belgique, 1890-1940 : question sociale, enjeux politiques et dimension sexuée ». Doctoral thesis, Universite Libre de Bruxelles, 2007. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210609.
Texte intégralCette thèse étudie le mouvement de protection sanitaire du jeune enfant et la médicalisation de la maternité dans une perspective de genre. À travers une analyse des discours de ses promoteurs et des principes d'organisation des oeuvres, elle montre combien les enjeux politiques, sociaux, démographiques et sexués ont durablement influencé l'organisation de la protection infantile et maternelle. Elle apporte de nouvelles réflexions sur la dimension sociale de l'éducation maternelle. Elle met par ailleurs en exergue le rôle essentiel joué par les femmes, aux côtés des médecins, dans la gestion des oeuvres de l'enfance et analyse le statut et les relations de pouvoir qui se sont tissées entre les médecins, les dames patronnesses, les travailleuses sociales et les représentants de l'État. Les investissements sociaux féminins sont analysés sous l'angle de leur autonomie, de leur visibilité et de leur portée émancipatrice. Ce faisant, cette thèse montre de quelle manière les œuvres de l'enfance ont favorisé, de manière assez paradoxale, une transgression des modèles sexués en favorisant un questionnement sur la condition maternelle et l'intervention des femmes dans la sphère publique et politique.
Doctorat en Histoire, art et archéologie
info:eu-repo/semantics/nonPublished
Mvoulana, Amed. « Vers un ophtalmologiste "augmenté" : analyse d'images rétiniennes pour l'aide au diagnostic précoce du glaucome ». Thesis, Université Gustave Eiffel, 2022. http://www.theses.fr/2022UEFL2007.
Texte intégralOcular diseases are at the core of major public health issues. One of them, glaucoma, requires early screening to ensure effective treatment of affected patients, and prevent irreversible visual damages. The advent of so-called computer vision and deep learning approaches has led to a paradigm shift in the field of ophthalmology, providing unprecedented support in diagnostic and therapeutic choices. In this thesis, we propose new methods for the development of intelligent systems dedicated to the early detection of glaucoma from retinal images. In particular, we aim at deploying of mobile-based computer-aided diagnosis systems, for remote screening. Firstly, we proposed a method aiming at analyzing the optic nerve head, featured by morphological changes in the presence of glaucoma. Based on a precise algorithm for segmenting the structures of the optic disc and the cup within it, the method extracts clinically relevant measures such as the cup-to-disc ratio, the inferior-superior-nasal-temporal (ISNT) sectors and the neuroretinal rim area. A clinical protocol based on ophthalmic references is drawn to screen for glaucoma, and give indications about the stages of development of the neuropathy (early, moderate or advanced glaucoma). Although very accurate screening, with a performance rate of 94% on the evaluation base (DRISHTI-GS1), this method has highlighted the need to improve generalizability, particularly in the presence of glaucomatous nerve heads without excavation (false negatives) or large healthy nerve heads (false positives). Secondly, we proposed a method based on deep learning algorithms, allowing an automated interpretation of healthy or glaucomatous retinas. This work exploits state-of-the-art convolutional neural networks (VGG-16, ResNet50, Inception-v3, MobileNet and DenseNet121), and proposes an efficient transfer learning method to adapt these networks to the glaucoma screening. These models achieve an AUC of more than 0.97, however, this comparative study has identified the needs for developing efficient models for deployment in clinical conditions: 1) a consistent retinal image dataset in terms of size, inter-class balance, diagnostic reliability and clinical variability, 2) interpretable and explainable models, allowing specialists to understand and discuss the screening result.In this sense, we propose in a third step a method exploiting recent advances in semi-supervised learning, for the generation of synthetic retinal images. The proposed algorithm, BAGAN (for Balancing GAN), allows to produce from a reference image dataset (REFUGE), a new dataset filling the inter-class imbalance potentially responsible for diagnostic bias, while meeting the criteria of image quality and clinical diversity. We have demonstrated the relevance of such dataset in the further development of semi-supervised diagnosis algorithms. Finally, a brand new interface, available on desktop and mobile platforms, has been designed for ophthalmologists and health professionals. Smart and intuitive, it integrates various functionalities based on the developed algorithms, and allows real-time screening to contribute to the improvement of eye health care
Khoueiry, Rita. « Empreinte parentale et Aide Médicale à la Procréation : evaluation de l’impact de différents facteurs sur la mise en place et/ou le maintien du marquage différentiel des gènes soumis à empreinte dans des ovocytes et des embryons humains issus de l’AMP ». Thesis, Lyon 1, 2009. http://www.theses.fr/2009LYO10344.
Texte intégralEpigenetic modifications, particularly DNA methylation of imprinted genes are sensible to environment. Techniques of assisted reproduction require in vitro manipulation of gamete and embryos and currently superovulation of patients. These technologies may interfere with eprogramming and maintenance of methylation at imprinted genes. To evaluate such a risk, we have determined the methylation profile of KvDMR1, the region that regulates KCNQ1OT1 imprinted gene, in human oocytes retrieved from stimulated or unstimulated cycles, at different phases of their maturation in vivo or in vitro. Our results show that the timing of establishment of the methylation profile of KvDMR1 covers the maturation phase of 199 oocyte growth, in vivo and in vitro, and that hyperstimulation likely recruits young follicles epigenetically immature. Analysis of the methylation profile of KvDMR1 and H19DMR (DMR of IGF2/H19) in ICSI embryos suggests that imprinting disorders are not responsible of embryo developmental failure prior the blastocyst stage
Ben, Souissi Souhir. « Vers une nouvelle génération d'outils d'aide à la décision s'appliquant à la prévention des risques lors de la prescription des antibiotiques : combinaison des technologies Web sémantique et de l'aide multicritère à la décision ». Thesis, Valenciennes, 2017. http://www.theses.fr/2017VALE0027/document.
Texte intégralMotivated by the well documented worldwide spread of adverse drug events that are associated to antibiotics usage, as well as the increased danger of antibiotic resistance (caused mainly by inappropriate prescribing and overuse), we propose a general architecture for recommendation systems adapted for this kind of context and we develop a specific system for antibiotic prescription (PARS). The type of context that our architecture covers is characterised by highly risky decisions or decisions with high stakes. Such a system cannot be based on machine learning, since there are no available training data sets or case bases. However, rules of good practice and expert knowledge are available, therefore our system should be able to model and implement them. The proposed solution is intended to be used by a decision maker who must adapt his/her decision both to each subject’s specific needs and characteristics, as well as to different types of evolution. Our approach is based on the combination of semantic technologies with MCDA (Multi-Criteria Decision Aids). The decision support process involves two steps. First, by taking into account the specific application domain, the approach evaluates the relevance of each alternative (action) in order to satisfy the needs of a given subject. The first level of the decision support model aims to select all the alternatives that have the potential to fulfill the subject’s needs. Subsequently, the second level consists of evaluating and sorting the selected alternatives in categories according to their adequacy to the characteristics of the subject. We propose an approach that exploits the knowledge schemes of semantic web technologies (ontologies) and that structures the recommendation rules into a suitable sorting method: the MR-Sort with Veto. By doing so, our solution is able to link and match heterogeneous knowledge sources expressed by experts. In collaboration with the EpiCURA Hospital Center, we have applied this approach in the medical domain and more specifically in the prescription of antibiotics. The system’s recommendations were compared with those expressed in the guidelines currently in use at EpiCURA. The results showed us that PARS allows for a better consideration of the sensitivity of the patients to the adverse effects of antibiotics. Moreover, by taking into account the additional characteristics of the patients, the model is able to adapt to contextual changes (such as new antibiotics, side effects and development of resistant micro-organisms)
Biquet, Jean-Marc. « Patient safety in medical humanitarian action : medical error prevention and management ». Thesis, Lyon, 2020. http://www.theses.fr/2020LYSE1038.
Texte intégralPatient safety is recognized for some 20 years as one of the essential elements of healthcare quality and has become an integral part of healthcare systems. It encompasses regulations, tools and strategies that affect all sectors of medicine. Today, research and implementation in the area of patient safety pertain above all to healthcare systems in the most developed countries whereas two thirds of estimated safety incidents occur in low- or mid-income countries.An exploratory phase aiming at developing the research strategy confirmed that patient safety, per se, and the detection and management of medical errors have not yet been translated into the humanitarian assistance sector in a structured and adapted way. In order to understand the reasons for this gap this thesis aims to understand what the current status and perspectives of patient safety in medical humanitarian action are. An initial phase explored developments in the knowledge of safety and risk management and the current state of knowledge and the main developments in patient safety and especially medical error management were explored. Follows an analysis of the characteristics of medical action as carried out by medical humanitarian organisations.The second part of the thesis is centred on semi-directive discussions with medical and paramedical personnel active within six medical humanitarian organisations to understand the knowledge, attitudes and practises with regards to patient safety and medical error management. 39 interviews were done with international medical and paramedical staff with minimum 2 years of experience in the humanitarian sector. It appears clearly that, while there may not yet be a structured approach in the sector regarding patient safety and, specifically, medical error management, this clearly corresponds to an expectation on the part of the humanitarian personnel interviewed.This research, to our knowledge the first of its kind, demonstrates the eagerness of the medical and paramedical staff engaged in humanitarian action to commit to an internal cultural revolution towards a safer healthcare provision, even in precarious situations. Catching up the delays in adopting adapted patient safety and medical error management policies would reinforce the accountability to the vulnerable populations assisted by these organisations and save more lives, the essence of humanitarian purpose
Münch-Mertz, Eveline. « La Médecine cantonale ou médecine des pauvres au XIXe siècle, 1825-1870 : l'exemple haut-rhinois ». Université Marc Bloch (Strasbourg) (1971-2008), 2003. http://www.theses.fr/2003STR30063.
Texte intégralThis study is concerned with the establishment of medical care for the poor provided on a district (canton) level in nineteenth century france and focuses specifically on the haut-rhin county (département). Inspired by liberal, philanthropic and even romantic trends, the aim of this form of medical practice was to provide free and professional health care for the poor in urban and rural districts under the supervision of the county administration, implemented by appointed poor law medical officers and practitioners. This organisation was part of a larger network of private or public institutions whose aim it was to relieve the suffering of the poor whose expectations in this matter are largely unknown. Despite the limits of medicine as a science at the time, a pervading scepticism and financial difficulties, nineteenth century organised medical care for the poor foreshadows the structure of modern medical aid providing quality health care for all and easy access to the medical practitioner