Tesi sul tema "Récidive (médecine) – Facteurs de risque"
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Olié, Valérie. "La maladie veineuse thromboembolique : étude des facteurs de risque de récidive". Phd thesis, Université Paris Sud - Paris XI, 2011. http://tel.archives-ouvertes.fr/tel-00719318.
Noboa, Maria Soledad. "La prise en compte des facteurs temps dépendants dans l'évaluation du risque de récidive de la maladie veineuse thromboembolique". Brest, 2008. http://www.theses.fr/2008BRES3073.
Gilmer, Catherine. "Etude des différents facteurs intervenant sur les récidives des troubles bipolaires". Bordeaux 2, 1991. http://www.theses.fr/1991BOR23025.
Ligier, Fabienne. "Adolescence et tentative de suicide : devenir, soutien social, facteurs de risque et prévention de la récidive suicidaire". Thesis, Université de Lorraine, 2016. http://www.theses.fr/2016LORR0184/document.
Background: Suicide attempt (SA) concerns 8% to 10% of adolescents and SA recurrence within the year 14% to 20% of adolescents. SA of young patients may have implications over the long term on an academic/professional level, as well as on an affective and psychic level. Objectives: 1) To describe psychosocial outcomes of SAers and the weight of recurrence on these outcomes, 2) to study the impact of losing contact with caregivers during the year following SA, and 3) to study how young SAers use means of communication, and perceive social support they receive and their health-related quality of life. Methods: Three researches were carried out on adolescent SAers. 1) 309 SAers were evaluated at time of SA and 10 years after SA, 2) study of the correlation between a loss of contact with caregivers and SA recurrence occurring between 1 to 10 years after the initial SA of 249 young patients, 3) how 58 SAers use means of communication, and perceive social support they receive and their health-related quality of life. Results: As an adult, the psychosocial situation of young SAers is impaired, especially for those who have a recurrence of SA during the year after index SA. The risk of recurrence increases in the ten years following index SA for early SAers, and in the year following index SA when contact has been lost with caregivers. SAers preferentially use SMS to “keep in touch” with relatives and they assess on a less positive note than peers their social support and health-related quality of life. Perspectives: We developed a monitoring device based on SMS sending in order to prevent SA recurrence which will be assessed through a randomized controlled clinical trial
Gauthier, Victoria. "Étude du pronostic des accidents vasculaires cérébraux et des syndromes coronaires aigus en population : étude réalisée à partir du registre des AVC de Lille et des trois registres français des syndromes coronaires aigus". Electronic Thesis or Diss., Université de Lille (2022-....), 2023. http://www.theses.fr/2023ULILS004.
Cardiovascular diseases are an important cause of morbidity and mortality. The monitoring of epidemiological indicators of stroke and Acute Coronary Syndromes (ACS) through population registers plays an important role in the evaluation of public policies. In addition, as acute-phase care progresses rapidly over time, it is essential to be able to monitor its evolution, to estimate the potential impact of new treatments in real life. Our objective was to characterize the prognosis of strokes and ACS in the population and it was organized according to 3 axes.In a first study, we studied lethality after stroke in the Lille stroke registry. Lethality at 28 days, in subjects aged >=35 years, was 48% after hemorrhagic stroke, 3% after large artery atherosclerosis or lacunar stroke and varied from 15 to 20% for the other subtypes of ischemic strokes. In the acute phase, the time between the onset of symptoms and first contact with the care services was exceeded in 40% of patients, not allowing revascularization. Age, severity and stroke etiology were the main predictors of 28-day case fatality. The higher lethality observed in women compared to men was mainly explained by their advanced age. AF, an underdiagnosed and undertreated comorbidity found in 57% of cardioembolic strokes, was also a risk factor associated with lethality.In a second work we studied the evolution of the management and the lethality of ACS in the French registers of ACS between 2006 and 2016. In patients aged 35-74, residing in one of the 3 geographical areas monitored by MONICA registries and hospitalized for an ACS, the lethality was 8% at 28 days. These rates varied by type of ACS (9% after STEMI, 6% after NSTEMI at 1 year), but did not differ between men and women. On the therapeutic level, our results showed a more qualitative than quantitative evolution with an improvement in the effectiveness of management in the acute phase and prescriptions related to new generation therapies. However, while the characteristics of the events tend to converge between men and women, a slight deficit in management was still observed in women compared to men.In a third part, we focused on patients who had survived their incident event to study the risk of recurrence after an ACS in the French ACS registers. The recurrence rate after an incident ACS remained high (~20% over 9 years), mainly the year following the incident event (6.7%) and did not depend on the type of the first event (STEMI/NSTEMI/UA), or sex. Impaired LVEF and complications from the incident event were major risk factors for recurrence. Recurrence rates decreased between 2009 and 2017.In conclusion, acute vascular events remain diseases with a serious prognosis whose etiology and physiopathological mechanism are an important and independent source of prognostic variability. It is important to continue improving the management of women for whom the progression is not as optimal as for men and to pay particular attention to the severity factors of stroke and ACS. Thus, by providing precise epidemiological indicators, the continuous recording of acute vascular events in a geographically defined territory, has enabled the monitoring of the state of vascular health in the population and has enabled us to study the prognosis of strokes and ACS according to the precise characteristics of the event
Fabry, Valérie. "Les deuxièmes tumeurs malignes de l'enfant : à propos de 14 observations". Bordeaux 2, 2001. http://www.theses.fr/2001BOR23008.
Sahmoud, Tarek. "Identification des sujets à haut risque de rechute dans la maladie de Crohn quiescente : construction et étude de stabilité du modèle". Bordeaux 2, 1995. http://www.theses.fr/1995BOR28349.
Demesmaeker, Alice. "La morbi-mortalité par suicide : de l'épidémiologie longitudinale à l'évaluation d'un dispositif de prévention". Electronic Thesis or Diss., Université de Lille (2022-....), 2023. http://www.theses.fr/2023ULILS014.
Patients with a psychiatric disorder have a decreased life expectancy associated with a high rate of suicide and non-psychiatric diseases. In addition, patients who have attempted suicide (SA) are at particular risk for re-attempt and premature death. First, we tried to identify risk factors for re-attempt with novel statistical approaches. Thus, patients with an alcohol use disorder and with an acute alcohol use during their SA, patients with an anxiety disorder, those who had more than 2 SAs and those who consumed benzodiazepines and/or hypnotics had a high risk of re-attempt.Then, we estimated the rate of death by suicide after SA using a meta-analysis. Our results showed a rate of 2.8% at 1 year. Then, we searched for causes of death in the Vigilans cohort. One year after SA, the most common causes of death were suicide and cardiovascular diseases.Finally, we showed an example of an assessment of a suicide prevention program. We evaluated the effectiveness of training gatekeepers in nursing homes. Our results showed an improvement in knowledge about the suicidal crisis and a decrease in the number of SAs after the training.In conclusion, the reduction of the morbidity and mortality of those who have attempted suicide requires a global management: by suicide prevention, but also by the management of non-psychiatric diseases
Vachon, Claudya. "La délinquance sexuelle : facteurs de risque et récidive". Master's thesis, Université Laval, 2021. http://hdl.handle.net/20.500.11794/68747.
Kepka, Sabrina. "Aspects épidémiologiques, diagnostiques et thérapeutiques du pneumothorax non traumatique". Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCE018.
Spontaneous pneumothorax (SP) is usually a benign pathology, when it occurs at a healthy subject. Recurrence is the main risk, in approximately 30% of the cases. Current knowledge concerning physiopathology, associated with the results of clinical trials estimating ambulatory treatment, make reconsider the strategies of initial treatment and prevention of recurrence. Our research on SP have several topics related to epidemiological, diagnostic and therapeutic aspects of initial management in the Emergency Department (ED). This work treats three axis. The first axis corresponds to identification of factors associated with recurrence of primary spontaneous pneumothorax (PSP). If tobacco, gender or use of cannabis are identified as a risk factor of occurrence, their impact on recurrence are not consensual. Then, we conducted a retrospective multicenter study in 14 french ED. In this population of 1491 PSP, among whom respectively 62 and 38% corresponded to a first episod and to a recurrence, no clinical risk factor of recurrence was highl ighted. In spite of methodological limits, in particular in line with its retrospective design, this series represents the most larger never published. The second axis concerns the study of initial treatrnent of PS in 14 ED. Although preliminary studies showed rates of success of more than 70% in case of ambulatory management, in the absence of international consensus and French recommandations, the choice of initial treatment depends on physicians decision. Few data exist on this initial management in real life condition, concerning therapeutic action, material devices used, or speciality of physicians implied. Again, we conducted a second retrospective study with 1849 PS in 14 french ED in France to precise healthcare pathways. The study showed that the management was multidisciplinary, abstention was the frst therapeutic strategy for half of patients and in case of intervention, chest tube was chosen in about 80% of cases. Ambulatory strategy concerned only 239 patients (14%), among whom 230 PSP and 9 secondary PS, mostly in case of abstention. The third axis concerns medical economic evaluation of two treatments strategies of first primary PS : chest tube drainage versus aspiration as first therapeutic action (EXPRED study).The study concerned a serie of 379 patients, randomized in Iwo arms. The results of this multicenter study showed that both strategies are equivalent concerning immediat success estimated on pneumothorax resolution and the rate of recurrence at one year. The medicoeconomic evaluation as a minimization of the costs and with the hypothesis of an equivalence of both strategies with the prospect of the payer, showed that aspiration was a strategy more cost effective than chest tube. Finally, results of these works showed that actually in practice, abstention and chest tube drainage are preferentially chosen for the management of PS in ED in France, compare to ambulatory strategy. Results of EXPRED study and knowledge about risk factors of recurrence can influence future french recommandations. Future research are necessary to identify barriers to implementation of these recommandations, as well asthose relative to adhesion of ambulatory management
Riedi, Géraldine. "Évaluation aux urgences des facteurs de risque pour la récidive suicidaire dans l'année". Toulouse 3, 2012. http://thesesups.ups-tlse.fr/1654/.
Background and objectives: Risk factors for suicide and deliberate self-harm are the subject of many studies in the epidemiology of suicidal behaviour. However few studies have focused on the recurrence of suicidal behaviours after hospitalization in the emergency department for a deliberate self-harm. The aim of this study is to identify specific risk factors for repeated deliberate self-harm among patients admitting following a deliberate self-harm by acute intoxication to assess and orient in an optimal way after patients' suicidal act. Methods: A prospective year study was conducted with 606 patients admitted to the Emergency Room as a result of self-poisoning. The assessment, in the emergencies, fell on the intensity of suicidal intent with the Beck Suicidal Intent Scale (SIS), the level of alexithymia with the Toronto Alexithymia Scale-20 (TAS 20), the intensity of depression with the The Beck Depression Inventory-13 (BDI), the level of hopelessness with the Beck Hopelessness Scale, the level of alcohol dependence with the Alcohol Use Disorders Identification Test (AUDIT), and other psychiatric disorders with the Mini International Neuropsychiatric Interview (M. I. N. I. ). For each subject included, emergency admissions for suicidal behaviour, regardless of the modality, were informed with the computerization of medical data in the year following the date of inclusion, and have created the variable "relapse" and" multiple recurrences ". Results: Among the 606 participants, 418 women (69%) and 188 men (31%), mean age 38 years (SD= 13. 2), 140 (23. 1%) readmitted in the year after the evaluation and 61 (10. 1%) were readmitted more than 2 times. Antipsychotic and anxiolytic treatment, addiction to alcohol and marital status "single" were significant independent predictors of recurrence at 1 year. Antipsychotic and anxiolytic treatment and addiction to alcohol were significant independent predictors multiple recurrence. Conclusion: Upon an initial ER admission as a result of self-poisoning, it is important to evaluate specific factors, such as alcohol abuse, that could subsequently lead to repeated deliberate self-harm. In view of improving the targeting and referral of patients towards structures that can best respond to their needs
Comte, Eric. "Les réhospitalisations des personnes agées : fréquence, circuits des réhospitalisations, facteurs de risque". Saint-Etienne, 1995. http://www.theses.fr/1995STET6225.
Sadoun, Catherine. "Ostéoporose : épidémiologie, facteurs de risque, traitements". Paris 5, 1995. http://www.theses.fr/1995PA05P116.
Bigras, Jacques. "La prédiction de la récidive chez les délinquants sexuels". Thèse, Université de Sherbrooke, 2007. http://savoirs.usherbrooke.ca/handle/11143/2757.
Arsenault, Benoît. "Facteurs de risque en émergence des maladies cardiovasculaires : de l'épidémiologie au métabolisme". Thesis, Université Laval, 2009. http://www.theses.ulaval.ca/2009/26342/26342.pdf.
Benchehida, Nassim. "Notion de typologie homéopathique : prévention des principaux facteurs de risque athérogène". Aix-Marseille 2, 1989. http://www.theses.fr/1989AIX20087.
Bendifallah, Sofiane. "Prédiction et modélisation du risque dans le cancer de l'endomètre de stade précoce". Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066319.
With the abundance of new options in diagnostic and treatment modalities, a shift in the medical decision process for endometrial cancer has been observed. The emergence of individualized medicine and the increasing complexity of available medical data have lead to the development of prediction models. In endometrial cancer, those clinical models (algorithms, nomograms, and risk scoring systems) have been reported, for stratifying and subgrouping patients, with various unanswered questions regarding such things as the optimal surgical staging for lymph node metastasis as well as the assessment of recurrence and survival outcomes. Through this manuscript we developed the question of the risk stratification for recurrence at the population level and the probability of lymph node involvement estimation at an individual level in early stage endometrial cancer. This double approach was adopted with the aim to illustrate the interest of these tools in clinical practice. At the population level, we proposed: i) a comparison of the main international clinicopathological classifications ii) a new clinicopathological classification based on a pathological predictor iii) two risk stratification systems for recurrence and lymph node metastasis. At the individual level we developed: i) a reproducible methodology for external validation of predictive models, ii) a specific clinic pathological nomogram for lymph node metastasis. In the future, the emerging field of molecular or biochemical markers research may substantially improve the predictive approach for preventive and curative strategies in endometrial cancer
Masson, Philippe. "Etude des facteurs de risque de calcification rénale chez l'enfant broncho-dysplasique". Bordeaux 2, 1992. http://www.theses.fr/1992BOR23016.
Thiam, N'Deye Aissatou. "Soutien social général ou au travail et risque de récidive après un premier infarctus : étude prospective de 6 ans". Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27105/27105.pdf.
The study evaluated the risk of recurrent coronary heart disease (CHD) after the exposure to a low general social support (GSS) or to a low work social support (WSS). The cohort was 972 women and men recruited from Quebec’s hospitals. The events looked for were a fatal CHD, a non-fatal myocardial infarction and an instable angina. During the six-year follow-up, 206 events had been found. Cox regression was used for analyzing the data. Our results showed a significant moderate association between the chronically exposure to GSS and the risk of recurrent CHD [adjusted hazard ratio: 1.66 (1.08 - 2.57)]. No association was observed between the exposure to WSS and the risk of recurrent CHD. Therefore, our study shows that the exposure to GSS (not to WSS) is associated to the risk of recurrent CHD. These results confirm those of previous studies.
Bordier, Philippe. "Modèle statistique de prédiction de la resténose avec les facteurs cliniques, biologiques et angiographiques avant angioplastie coronaire". Bordeaux 2, 1992. http://www.theses.fr/1992BOR23113.
Brureau, Laurent. "Cancer de la prostate en Guadeloupe : Facteurs de risque génétique et environnementaux de survenue et de récidive après prostatectomie radicale". Thesis, Antilles, 2015. http://www.theses.fr/2015ANTI0018/document.
Prostate cancer is the most common tumor pathology in West Indies. Our study aims to study risk factors of occurrence and recurrence.To carry out this study, we used the patients included in the case-control study called Karuprostate and a cohort of patients after radical prostatectomy.The main results and conclusions of my work are:a) The study of genetic factors related to the metabolism of xenobiotics and the risk of prostate cancer occurrence in Guadeloupe. The exact number (CNV) gene encoding the glutathione S transferases GSTT1 and GSTM1 were determined in 629 incident cases of prostate cancer and 622 controls. Men having 2, 3 or more copies of GSTT1 have a significantly increased risk of prostate cancer. Similarly men with 3, 4, 5 or more copies of GSTM1 and GSTT1 combined have an increased risk of disease occurrence.b) The study of genetic factors related to estrogen metabolism and the risk of prostate cancer occurrence in Guadeloupe. Five polymorphisms (SNP 3 on CYP17, CYP1B1 and COMT as well as size and UGT1A1 polymorphisms on CYP19) were studied and compared in 498 incident cases and 565 controls. Individuals with the AA genotype COMT have a significantly decreased risk of prostate cancer occurrence. No significant association was found with other studied polymorphisms. A study of 150 incident cases of prostate cancer and 150 controls from a population of Congo-Zaire was the subject of these same genotyping, with the same results.c) The influence of environmental exposure to persistent pollutants with hormonal properties of biochemical recurrence of prostate cancer after radical prostatectomy. The plasma concentrations of chlordecone, DDE (the main metabolite of DDT) and PCBs were measured in 340 subjects with prostate cancer who underwent radical prostatectomy. The exhibition (preoperative) to chlordecone was found associated with a significant increased risk of biochemical recurrence. Conversely, the increasing concentrations of DDE were found associated with a significantly decreased risk of biochemical recurrence. No association was found between exposure to PCB153 and recurrence of the disease.d) The clinical and histological risk factors of recurrence of prostate cancer were studied in 964 patients who underwent radical prostatectomy with a médian follow-up of 4.8 years. Diabetes, PSA, advanced clinical stage, high Gleason score, a high percentage of prostate biopsy, advanced pathological stage, the presence of positive margins are predictors of biochemical recurrence after radical prostatectomy.Our results show that the occurrence and recurrence of prostate cancer are Under influence of genetic and environmental factors. The specific genetic and environmental context in Guadeloupe may partly explain the high incidence of prostate cancer.In addition, further work will incorporate other genes in the future. The next ambitious project is the creation of a prospective cohort of all patients with all prostate cancer stages
Kroger, Edeltraut. "Facteurs de risque occupationnels et environnementaux de la démence : l'étude sur la santé et le vieillissement au Canada". Thesis, Université Laval, 2008. http://www.theses.ulaval.ca/2008/25437/25437.pdf.
Garrelon, Jean-Luc. "Facteurs de risque de fistule anastomotique après résection rectale pour cancer". Bordeaux 2, 1996. http://www.theses.fr/1996BOR23065.
Boullé, Gildas. "Les maladies parodontales : un facteur de risque additionnel pour les accouchements prématurés?" Thesis, Université Laval, 2005. http://www.theses.ulaval.ca/2005/22725/22725.pdf.
Kayibanda, Jeanne Françoise. "La surveillance et les facteurs de risque associés au VIH au Rwanda". Thesis, Université Laval, 2011. http://www.theses.ulaval.ca/2011/28514/28514.pdf.
Thériault, Sébastien. "Prédiction précoce du risque de diabète gestationnel : développement de modèles combinant facteurs cliniques et marqueurs biochimiques". Thesis, Université Laval, 2014. http://www.theses.ulaval.ca/2014/30778/30778.pdf.
This project aims to develop an early risk-prediction tool for gestational diabetes (GDM). This is a case-control study from a prospective cohort including 7929 pregnant women recruited between 2005 and 2010 in the Quebec City metropolitan area. External validation of four predictive models proposed in the literature allowed the identification of clinical variables (including past history of GDM, body mass index and family history of diabetes) performing particularly well for the prediction of GDM requiring insulin therapy. An original model combining some of these clinical variables with three readily available biochemical markers (HbA1c, SHBG and hsCRP measured between 14 and 17 weeks of gestation) yielded area under the ROC curve of 0.90 and sensitivity of 72% at a false-positive rate of 10%. This project allowed the identification of predictive factors for GDM available early in pregnancy, which could improve the management of high risk women.
Mathieu, Romain. "Prédiction du risque de récidive du cancer de prostate à partir d'une caractérisation multimodale". Thesis, Rennes 1, 2017. http://www.theses.fr/2017REN1B013.
Objective: The aim of this work was the prediction of prostate cancer recurrence based on a multimodal characterization of this cancer including pathological markers, tissue biomarkers, and quantitative parameters from Magnetic Resonance Imaging (MRI), and to propose a method to assess correlations between these factors. Material and methods: The prognostic values of the new ISUP groups, the lymphovascular invasion, the expressions of Ki67, Survivin et Caveolin-1 were assessed in large multicentric and international cohorts of patients with prostate cancer treated with radical prostatectomy. A review of the literature investigated the use and the performance of radiomics and texture analysis to predict prostate cancer recurrence. The prognostic value of MRI features including Haralick’s texture features to predict biochemical recurrence after prostate cancer radiotherapy was assessed in a retrospective cohort of 83 patients. In a preliminary study including eight patients, a method to correlate in-vivo observations from pre-operative imaging with biological findings from radical prostatectomy using quantitative analysis was proposed. Résultats: Our studies confirmed the new ISUP groups, the lymphovascular invasion, the expressions of Ki67, Survivin and Caveolin-1 were associated with adverse pathologic features and prostate cancer recurrence after radical prostatectomy. However, these factors did not add clinically relevant information to established models. Our review of the literature revealed radiomics was promising for tumor identification and characterization but that few studies assessed its prognostic value. We demonstrated T2-w Haralick’s features were predictors of biochemical recurrence after prostate cancer radiotherapy. With a mean error of 4.90mm, our method to register prostate whole mount histology to in-vivo MRI resulted in the construction of classifiers to predict the presence of tumor, Gleason score, and Ki67 expression. Conclusion : Our work confirm the prognostic value of different markers from tissue, pathological pre-operative imaging analyses. Our method of registration and correlation of these markers leads to promising preliminary results that justify further evaluation with larger cohorts of patients
Helmer, Catherine. "Aspects épidémiologiques des dém̀ences et de la maladie d'Alzheimer : facteurs de risque et pronostic". Bordeaux 2, 2000. http://www.theses.fr/2000BOR28900.
Dementia represents a major Public Health problem which care is deficient for the moment. However, several possibilities exist to face this problem. It is necessary to develop the prevention of this disease acting on its factors. We analysed the effect of several potential risk factors of dementia and Alzheimer's disease (marital status, profession, tobacco, diabetes). Some of these factors provide tracks of prevention ; others could allow to develop actions of prevention. It is of prime importance to continue analysing the risk factors of this disease on which it will be possible to act, with a particular interest for the vascular factors. In addition to prevention, it is also necessary to improve the care of the demented persons and their relatives,, as soon as the disease is diagnosed and at every stage of its evolution. Assessment of the needs of the demented population is required to improve the care, which implicates to know better the consequences of the disease. We present here the analysis of the consequences of dementia in term of mortality, carried out by using biostatistic models allowing to take into account the specific methodological difficulties of this analysis. The other major consequences of the dementia, in particular the disability and institutionalisation, will have also to be taken into account. After the phase of observation, it will be necessary to promote the intervention studies, as well in the field of prevention as in the field of care
Abou, Chakra Claire Nour. "Développement d’outils de prédiction des complications et des récidives de l’infection à Clostridium difficile". Thèse, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/9911.
Abstract : A significant increase in Clostridium difficile infection (CDI) unfavourable outcomes was observed since 2002 and was associated with the emergence of the strain NAP1/BI/R027. Identifying patients at high risk of developing complications (cCDI) and recurrences (rCDI), and predicting these outcomes early in the course of illness could improve clinical decision-making. The main objectives of this research were to: i) identify risk factors for cCDI and rCDI, and ii) develop and validate a clinical prediction rule for cCDI using predictors measured within 48h of CDI diagnosis. Methods: Adult in patients with confirmed CDI diagnosis in 10 acute care hospitals, were enrolled in a prospective cohort. Data at enrolment were collected : demographics, underlying illnesses, past medical and drug history (two months prior to CDI), clinical signs, blood tests, and C. difficile strain type. A follow-up was completed on day 30 and 90 after enrolment. Risk factors were identified by multivariate logistic regression and survival analyses. Split-sample technique was used for training and validation sets. Several predictive models were derived and assessed in both sets by AUC/ROC, prediction error (PE), and performance parameters. A predictive score was built using the optimal predictive model. Results: A total of 1380 patients were enrolled and 96% had 90 days follow -up. cCDI was observed in 8% and rCDI in 26%. R027 was identified in 52% of patients. Age ≥80 years, heart rate >90/min, respiratory rate >20/ min, white cell count <4 or ≥20 × 109/L, albumin <25 g/L, blood urea nitrogen >7 mmol/L, and C-reactive protein (CRP) ≥150 mg/L were independently associated with cCDI. Age ≥65 years, increased CRP, expos ure to macrolides/clindamycin, R 027, and prolonged hospital stay were associated with rCDI. A sub-group of 1038 complete cases was used for predictive modelling. In the training set, the optimal model with 6% PE and AUC 0.84 included age≥80, WBC≥12x10 [superscript 9]/L, BUN>7 mmol/L, and serum albumin <26 g/L. A predictive score was built with minimum 0 and maximum 17 points. A score >10 points showed 50% sensitivity (95%CI, 28-72), 85% specificity (81-89), 17% (7-27) positive predictive value, and 96% (94-99) negative predictive value. Conclusion: Through a large multicenter prospective cohort and multiple modelling approached, independent risk factors of complications and recurrence of CDI were identified. We derived a predictive score that included easily available meas ures at the bedside and showed acceptable performance. At time of CDI diagnosis, these predictors could be used by clinicians to identify patients at higher risk and adjust for the most optimal treatment that could prevent unfavourable outcomes.
Lachance, Philippe. "Corrélation entre certains polymorphismes génétiques et l'expression de certains facteurs de risque de maladie coronarienne". Thesis, Université Laval, 2009. http://www.theses.ulaval.ca/2009/26472/26472.pdf.
Dion, Roy Véronique. "Facteurs de risque d'athérosclérose menant à la maladie coronarienne : l'évaluation du risque cardiométabolique chez de jeunes adultes apparemment en santé par la mesure du tissu adipeux abdominal avec imagerie par résonance magnétique". Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/29150/29150.pdf.
Faure, Nathalie. "Toxicité rénale des produits de contraste iodés : facteurs de risque et prévention". Bordeaux 2, 1998. http://www.theses.fr/1998BOR2P066.
Mahé, Isabelle. "Problématique des antithrombotiques chez le sujet âgé en médecine interne". Paris 5, 2003. http://www.theses.fr/2003PA05P628.
The management of antithrombotic therapy in elderly patients is a growing question : indications are diseases increasing with age, bleeding complications are most often observed in elderly. But findings of clinical trials about antithrombotic therapies not always fit with the therapeutic problematic of elderly patients who are at both increased thrombotic and haemorrhagic risk. In order to increase the benefit to risk ratio of antithrombotic therapy, several ways of research have been developed about the choice and the management of antithrombotic therapies (aspirine, low molecular weight heparins) in thrombo-embolic diseases (atrial fibrillation, venous thrombosis : prevention and treatment) in older patients recruited in internal medicine
Kodio, Belco. "Niveaux, causes et facteurs de risque de la mortalité maternelle en milieu rural au Sénégal : 1984-1998". Bordeaux 2, 2001. http://www.theses.fr/2001BOR28849.
Objective : To assess the magnitude of maternal mortality, their causes and risk factor in rural Senegal. Methods : The study has been carried out in three rural sesttings under continuous demographic surveillance since several years. A total of 317, 110 and 44 deaths of women in reproductive age (15-44 years) has been recorded in Niakhar (1984-87), Bandafassi (1988-97) and Mlomp (1985-98), respectively. Information on each death has been summarised in a confidential verbal autopsy file. The maternal origin of the death, the obstetrical origin of maternal deaths and their essential cause have been independently attributed by two obstetricians and a medical epidemiologist. Maternal mortality measures were based on 87 maternal deaths in Niakhar, 33 in Bandafassi and 10 in Mlomp. A case-control study in Niakhar allowed to identify certain risk factors. Results : Almost a third of the deaths of the women in reproductive age was linked to a maternal cause. The maternal mortality ratio reached 852 deaths for 100,000 live births in Bandafassi, 516 in Niakhar and 436 in Mlomp. Almost two-thirds were directly related to pregnancy or delivery (direct obsteric deaths) and 10 % were indirect obstetric deaths. Haemorrhage was the leading cause of direct deaths and abortion the last frequent cause. A Young or old age, more than six pregnancies, history of abortion or still birth, delivery in a health facility and during the rainy season were identified as risk factors. Matrimonial status and antenatal care were not associated with maternal death. Conclusion : Maternal mortality remains high, although lower than WHO estimates for Senegal. The five main causes of maternal death were found. The role of malaria in maternal mortality should be more deeply investigated, particularly its role in eclampsia. The feasibility of confidential enquiries on maternal deaths has been demonstrated in Senegal
Ould, El Joud Dahada. "Epidémiologie des dystocies en Afrique de l'Ouest : incidence, facteurs de risque et prédictivité". Paris 11, 2001. http://www.theses.fr/2001PA11T027.
Objectives: (1) to measure the incidence of dystocia in 6 West African countries (6 cities and 1 rural area) (2) to identify risk factors of dystocia and study their interrelationships with the goal to potentially use them for the identification of high risk pregnant women during antenatal consultations (3) to assess their usefulness as predictors of dystocia during pregnancy (4) to study the consequences of dystocia, in particular uterine rupture (5) to suggest practical recommandations in view of reducing maternai mortality in West Africa. Methods: The MOMA study is a prospective population-based study that allowed the follow up of 20,326 West African pregnant women. The analysis of dystocia’s risk factors was done only on those deliveries performed in health facilities because of the likelyhood of diagnostic and recall biases in case of home deliveries. Overall, 16,318 deliveries have been analysed here. Uterine rupture was studied on all the deliveries (20. 326). Results: The incidence of dystocia in our study was 18. 3% [95% CI: 17,7-18,9]. After multivariate analysis (stepwise logistic regression), the significant risk factors were: short stature, scarred uterus and nulliparity. However, their positive predictive values were very low in univariate and multivariate analysis. One major consequence of dystocia: uterine rupture is studied. Conclusion: Dystocia, which occurs mainly during delivery, has a high incidence in West Africa. Its consequences are often dramatic, both for the fetus and the mother. No studied risk factor, even in combination, allowed to predict dystocia. Therefore, all pregnant women must be considered at risk of dystocia. Efforts should be put on the detection of dystocia during Jabor (partograph) and the quality of emergency obstetric care. Emergency obstetric care must be made available to all pregnant women. This goal is achievable in most major West African cities. The possibility of performing in good conditions C-sections must be increased even in rural areas. On the other hand, women with a scarred uterus must be told to deliver in a health facility with available and accessible emergency obstetric care
Hamdi, Leila. "Recherche de facteurs de risque immunologiques associés au Lymphome Hodgkinien de l'enfant". Phd thesis, Université Paris Sud - Paris XI, 2013. http://tel.archives-ouvertes.fr/tel-01011174.
Leone, Nathalie. "Fonction ventilatoire, asthme et facteurs de risque cardiométabolique". Phd thesis, Université Paris Sud - Paris XI, 2014. http://tel.archives-ouvertes.fr/tel-00965432.
Sow, Mariama. "Récidives d'infections à Campylobacter ou Salmonella dans les ménages de la Montérégie, 2001 à 2007". Mémoire, Université de Sherbrooke, 2012. http://hdl.handle.net/11143/5571.
Semjen, François. "Insuffisance rénale aigue͏̈ post-traumatique traitée par hémofiltration veinoveineuse continue : facteurs de risque et pronostic". Bordeaux 2, 1996. http://www.theses.fr/1996BOR23058.
Diallo, Bassirou Labico. "Épidémie du VIH en Guinée : Prévalence, Facteurs de Risque Associés et Tendances 2001 à 2007 dans les Principaux Groupes à Haut Risque – Éléments de Classification". Thesis, Université Laval, 2011. http://www.theses.ulaval.ca/2011/28142/28142.pdf.
Objectives: To estimate HIV prevalence, its associations with potential risk factors, and trends from 2001 to 2007, and to describe vulnerability among commercial sex-workers (CSWs) as well as among their potential clients who were truck-drivers, military army and miners from all over the country of Guinea, West Africa. Methods: 339 CSWs and 954 potential clients in 2001, 598 and 3401 respectively in 2007 were interviewed then tested for HIV over all the country. Data were analysed by multivariate log-binomial regression. Results: Among CSWs, HIV prevalence (40.7% in 2001 and 34.5% in 2007; p=0.15) was associated with illiteracy [(Prevalence Ratio noted PR)=1.41; p=0.02 in 2001 and PR=1.28; p=0.03 in 2007) and with sexually transmitted diseases [ (STDs); PR=1.89; p=0.001 in 2001]. HIV prevalence among potential clients (varying from 4.5% to 7.0% in 2001 and from 5.2% to 6.4% in 2007) was positively associated once at least, with sexually transmitted diseases (STDs), alcohol consumption, declaring paying sexual partners and negatively, with reported capacity of restraining from risky sexual intercourse. Trends of indicators analysed were together not favourable for controlling epidemic with the exception of those observed among among CSWs. Conclusion: HIV prevalence was very high and strongly concentrated among CSWs and their potential clients, relatively to data obtained observed in the general population of Guinea. Sexually active networks were also observed, as well as more vulnerable sub-groups among illiterate CSWs and among potential clients who were alcohol consumers, or who declared STD symptoms. Reinforcement of prevention targeting specific sub-groups is needed.
Rochefort, Lucie. "Étude exploratoire d'une approche globale d'intervention en contrôle du tabagisme pour les adolescents selon l'âge et le genre". Thesis, Université Laval, 2008. http://www.theses.ulaval.ca/2008/25715/25715.pdf.
Pham, Thiên-Ly. "Evaluation ultrasonore de l'os cortical par transmission axiale : une approche multiparamétrique". Paris 6, 2010. http://www.theses.fr/2010PA066505.
Messier, Valérie. "La séroprévalence des zoonoses au Nunavik : surveillance, identification des facteurs de risque et intervention". Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27743/27743.pdf.
Bouhali, Tarek. "L'adiponectine, un modulateur du risque de maladie coronarienne athérosclérotique dans l'hypercholestérolémie familiale". Thèse, Université Laval, 2006. http://constellation.uqac.ca/468/1/24822437.pdf.
Lecarpentier, Julie. "Étude des facteurs modificateurs du risque de cancer du sein des femmes à risque génétique élevé". Phd thesis, Université Paris Sud - Paris XI, 2012. http://tel.archives-ouvertes.fr/tel-00910388.
Barry, Hassane. "Profil coronarien de la population guadeloupéenne : évaluation rétrospective à partir de 250 coronarographies réalisées au CHU de Pointe-à-Pitre". Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M068.
Amigou, Alicia. "Etude des facteurs de risque des leucémies de l'enfant". Phd thesis, Université Paris Sud - Paris XI, 2013. http://tel.archives-ouvertes.fr/tel-00954463.
Bridet, Lionel. "Facteurs prédictifs de survenue de carcinome hépato-cellulaire sur cirrhose post-virale C". Bordeaux 2, 1999. http://www.theses.fr/1999BOR23088.
Laroche, Mélissa. "Lien entre la prééclampsie et les facteurs de risque cardiovasculaire : étude de gènes impliqués dans le processus inflammatoire et associés au syndrome métabolique". Thesis, Université Laval, 2009. http://www.theses.ulaval.ca/2009/26217/26217.pdf.
Preeclampsia (PE), a pregnancy complication characterized by increased blood pressure and proteinuria, is associated with significant maternal and neonatal mortality and morbidity worldwide. Recent studies suggest that women who suffered from PE are at increased risk of long term cardiovascular diseases (CVD) and that the link between these two entities could be explained by the metabolic syndrome (MS). As inflammation appears to be a major element involved as much in PE than in MS and CVD, our research aimed to investigate the potential association between genetic variations in candidate genes involved in the inflammatory process and PE risk in a study sample that included 307 women who suffered from PE and 603 matched controls. In this regard, we analysed known polymorphisms of interleukin-1α (IL-1α; 4845G>T), interleukin-6 (IL-6; -174C>G), interleukin-10 (IL-10; -1082A>G, -2849G>A), TNF-α (TNF-α; -308G>A, -857C>T) and TNF-α receptors (TNFRІ 36A>G, TNFRІІ 676T>G) genes. Our results suggest the presence of a dose-effect of the combination of genes involved in the inflammatory process on the risk of PE.
Gil-Jardiné, Cédric. "Facteurs de risque, dépistage et prévention des syndromes post-traumatiques à la suite d'un passage aux urgences". Thesis, Bordeaux, 2019. http://www.theses.fr/2019BORD0211.
Worldwide, tens of millions of people suffer minor injuries and many are admitted to emergency departments (ED). This represents approximately 5 million ED admissions in France and nearly 40 million in Europe each year. For several years, studies have suggested that up to 20% of these patients will suffer for months from chronic symptoms initially described in mild traumatic brain injury (MTBI) and referred to as "post-concussion syndrome" (PCS). Today, these symptoms have been identified as non-specific to TCL and most authors use the term "Post-Concussion-Like Symptoms" (PCLS). Such a combination of symptoms can lead to a significant deterioration in the quality of social and family life or delay the return to work or school. In France, if the results described in the literature are representative of the entire population, up to one million people could be affected by this currently poorly identified public health problem.The different objectives of this work were as follows:- to identify the factors associated with the development of "Post-Concussion like symptoms" at a distance from an emergency room visit,- to develop a tool to assess the level of risk of developing these symptoms for patients managed in emergency departments- to identify interventions that could be offered to emergencies as a means of prevention.- to assess the value of implementing interventions in the ED to prevent these symptoms from occurring.We found in SOFTER 1 that PCLS were associated with stress at the ED discharge. Then, after creating a risk assessment tool, we showed that it is possible to conduct EMDR sessions during ED stay. The effectiveness of this intervention appeared to be influenced by many factors such as patients' socio-economic conditions, stress level and psychologists' experience.Thus, results currently available suggested that ED could be a place to identify and manage fragile patients at risk of developing PCLS. The opportunity offered by ED visit could have a significant impact in terms of public health and could be a powerful community health tool to combat health inequalities