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Saib, Mahdi-Salim. "Construction d'une méthode de caractérisation des inégalités territoriales, environnementales et sociales de santé". Thesis, Amiens, 2015. http://www.theses.fr/2015AMIE0003/document.
Pełny tekst źródłaThe objective of this thesis is to explore spatial indicator crossing-analysis techniques in order to characterize the accumulation and the interrelations of the territorial, environmental and social health (TESHI).This analysis implies to set up integrated approaches based on data representativeness, techniques adapted to specificities of aggregated data, and relevant modeling of the characterized phenomena. A specific aspect of this work is the development of a tool allowing the integration of spatial phenomena at different levels (local, regional and loco-regional). In this project, a pilot study is presented on the Picardy region. The tool has been tested for the analysis of TESHI, thus validating the methodology feasibility and the adaptation of approaches implemented while providing additional keys of interpretation to the relative limits of direct appropriation of the results by the managers
Lalloué, Benoit. "Méthodes d'analyse de données et modèles bayésiens appliqués au contexte des inégalités socio-territoriales de santé et des expositions environnementales". Thesis, Université de Lorraine, 2013. http://www.theses.fr/2013LORR0205/document.
Pełny tekst źródłaThe purpose of this thesis is to improve the knowledge about and apply data mining techniques and some Bayesian model in the field of social and environmental health inequalities. On the neighborhood scale on the Paris, Marseille, Lyon and Lille metropolitan areas, the health event studied is infant mortality. We try to explain its risk with socio-economic data retrieved from the national census and environmental exposures such as air pollution, noise, proximity to traffic, green spaces and industries. The thesis is composed of two parts. The data mining part details the development of a procedure of creation of multidimensional socio-economic indices and of an R package that implements it, followed by the creation of a cumulative exposure index. In this part, data mining techniques are used to synthesize information and provide composite indicators amenable for direct usage by stakeholders or in the framework of epidemiological studies. The second part is about Bayesian models. It explains the "BYM" model. This model allows to take into account the spatial dimension of the data when estimating mortality risks. In both cases, the methods are exposed and several results of their usage in the above-mentioned context are presented. We also show the value of the socio-economic index procedure, as well as the existence of social inequalities of infant mortality in the studied metropolitan areas
Padilla, Cindy. "Inégalités sociales de santé et expositions environnementales. Une analyse spatio-temporelle du risque de mortalité infantile et néonatale dans quatre agglomérations françaises". Thesis, Université de Lorraine, 2013. http://www.theses.fr/2013LORR0192/document.
Pełny tekst źródłaIn France, existence of social health inequalities (SHI) has well established. Infant and neonatal mortality are recognized as indicators of the health status of a population. In spite of numerous risk factors already identified, a part of these inequalities remain unexplained, environmental nuisances are suspected. The thesis objectives were to analyze by a spatial and temporal approach, the contribution of exposure to nitrogen dioxide to social inequalities in infant and neonatal mortality in France between 2000 and 2009. We conducted an ecological type epidemiological study using the French census block as the geographical unit in the metropolitan areas of Lille, Paris, Lyon, and Marseille. All cases collected in the cities hall were geocoded using address of parent's residence. Socioeconomic data estimated from the 1999, 2006 national census were used in a composite index which encompasses multiple dimensions to analyze global deprivation. Average nitrogen dioxide concentrations were modeled by the air quality monitoring networks. Generalized additive models allowed to take into account spatial autocorrelation and generate maps using smoothing on longitude and latitude while adjusting for covariates of interest. Using an innovative approach, results highlight the existence of socio-spatial, environmental or cumulate inequalities in infant and neonatal mortality. These results are city-specific, they vary according to the period and the health event demonstrating the difficulty to generalize these observations at the national level
Lalloué, Benoît. "Méthodes d'analyse de données et modèles bayésiens appliqués au contexte des inégalités socio-territoriales de santé et des expositions environnementales". Phd thesis, Université de Lorraine, 2013. http://tel.archives-ouvertes.fr/tel-00943004.
Pełny tekst źródłaLetellier, Noémie. "Déterminants sociaux et professionnels de la cognition". Thesis, Montpellier, 2019. http://www.theses.fr/2019MONTT044.
Pełny tekst źródłaCognitive aging is a slow and progressive process influenced by many individual and contextual factors, including working conditions and residential environment characteristics. However, the impact of these environmental exposures on cognition remains largely under-studied. The main objective of this thesis is to study the role of social and occupational determinants on cognition, in the general French population. The implementation in 2012 of the Constances cohort allows us to study this issue on a population aged 45 to 70 years (~70,000 participants) in cross-sectional, while the 3C cohort (9,294 participants) allows us to analyze from a social perspective a population aged over 65 years followed since the 2000s. We have observed in these two different populations, an effect of socio-economic characteristics living environment on cognitive performances and risk of dementia, independently of individual socio-economic level and many other individual characteristics. In Constances, we have shown that cognitive performances is early associated with occupational exposure to chemicals (solvents and formaldehyde), regardless of individual characteristics and working conditions. These results suggest that living environments, socio-economic and/or work environment, have an impact on cognitive performances level and dementia, and can be a source of social health inequalities in cognitive aging
Bouhadj, Laakri. "Développement d'outils de gestion pour la prise en compte des enjeux de santé dans les opérations d'aménagement urbain : atténuation des vulnérabilités et renforcement de la résilience des systèmes territoriaux". Electronic Thesis or Diss., Université de Lille (2022-....), 2023. http://www.theses.fr/2023ULILS046.
Pełny tekst źródłaThe design of our cities and regions is crucial for our health and well-being. It notably impacts the quality of our living environment, the air we breathe, the water we drink, our access to green spaces, healthcare services, and employment opportunities (OMS & ONU, 2021). Indeed, our health are influenced by numerous factors that go beyond the scope of pathology alone. The focus of this thesis is to develop a decision support tool that local actors can use to better consider health in urban planning and development plans, documents, and projects.The first objective of the thesis is to characterize the environmental and social health inequalities (ESHI) at the sub-municipal level within the perimeter of the European metropolis of Lille's Territorial Coherence Scheme. A literature review and thematic workshops involving local and regional stakeholders were organized, and a methodological framework was proposed for constructing spatialized composite indices of vulnerability and resilience. Furthermore, a methodology for analyzing the profiles of territory categories resulting from the joint interpretation of the two indices was developed.The second objective is to support and promote the consideration of health issues in urban development projects by proposing an experimental approach applied to two development projects. The in-depth analysis of environmental health issues in the two neighborhoods, along with the contribution of the working group composed of the two project teams and field observations, helped to better understand the factors of vulnerability and resilience present in these neighborhoods. It also enabled the evaluation of the impact of the development project on these neighborhoods and the proposal of a theoretical modeling of improvement prospects for the two development proposals.The obtained results highlight the importance of considering not only the vulnerability and resilience factors of territories but also the spatial dimension. Dividing the European metropolis of Lille's Territorial Coherence Scheme into homogeneous zones would facilitate understanding the dynamics of ESHI at a fine scale. The use of composite indices at the scale of a development project brings to light the issue of transversality and the impact of all involved dimensions. At this scale, composite indices provide an overall vision of the issues within a neighborhood, they also reveal the limitations of development policies for reducing ESHI
El, Arbi Ahmed Salem. "Etalement urbain et inégalités sociales et environnementales : cas de Nouadhibou - Mauritanie". Thesis, Le Mans, 2013. http://www.theses.fr/2013LEMA3002.
Pełny tekst źródłaFurther to the consequences of important periods of drought (1960s, 1970 and 1980), thenomadic / rural world was emptied of his inhabitants who came suddenly to settle down in thelarge Mauritanian urban centers. These socio-spatial changes transformed deeply theMauritanian society, consisting of Arabic speakers (Arab-Berber called Bîdhanes and thefreed people or ex-slaves called Haratines) and African languages speakers (Fulanis, Wolofs,Soninké and Bambara). In terms of town planning and availability of basic social services, thecities of the country were not prepared for a successful inclusion of the new migrants. As aconsequence, the expansion of the Mauritanian cities was characterized by a fast developmentand by striking socio-spatial disparities. The Mauritanian coast counts only two cities:Nouakchott (capital of the country) and Nouadhibou (the economic capital) which underwentmore anthropological pressure than the other cities in the country, because they offer moreemployment opportunities and access to urban services. Our main hypothesis is that the socialinequality to the lands’ access is at the origin of the uncontrolled urban growth ofNouadhibou. What is the reaction of the populations in front of the uneven access to the landsof Nouadhibou? What are the social and environmental inequalities produced by the processof Nouadhibou’s urban growth? Who lived mainly in the unplanned (“spontaneous”) districtsand the suburbs of Nouadhibou? Our approach consists in tracking the urban evolution ofNouadhibou to measure and characterize the scale of its urban growth, identify its causes aswell as the social and environmental inequalities which are associated to it. We used firstlysatellite pictures and mathematical analyses to measure the urban growth. Then we hadinterviews with families living in various urban zones of the city, based on two approaches,quantitative (160 households) and qualitative (15 households). We created a databasecontaining indicators that measure the undergone disparities, and described the daily real-lifeexperience of the inhabitants. The collected data were analyzed with Shinx V5 software andused for the realization of about ten thematic maps on Map Info.The results of our study show that the social inequalities of access to the urban lands, via theprocess of allocation, are striking in Nouadhibou. Only 93 lands were attributed between 1975and 1984 in spite of increased needs in housing (at the beginning of 1980s, half of thehabitations were spontaneous). Between 1990 and 2002, 92,96 % of the granted lands wereattributed by competent authorities, often in strange and opaque conditions. The genesis of thespontaneous districts (Kebba) reflects the forces of opposition created by the inhabitants toface this type of social inequality. The process of land regularization of the spontaneousdistricts (started in 1985), consisting in rehousing the inhabitants in new urban zones, led toan excessive urban growth. Realization of the urban infrastructures did not follow the processof growing, which is at the origin of social (problem of transport and access to schools, lackof pharmacies…) and environmental inequalities (difficulty of access to the drinkable waterand to electricity, absence of garbage’s collection services…), especially in suburbs.Haratines, who lived previously in the extremities of the Moorish nomadic camps, represent62 % (of our sample) of the spontaneous districts inhabitants and 73 % of the familiesconsulted in the new suburbs of El Weva, where the urban growth of Nouadhibou occurredduring the last years
De, Spiegelaere Myriam. "Prévention et inégalités sociales de santé chez l'enfant et l'adolescent". Doctoral thesis, Universite Libre de Bruxelles, 1999. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/211965.
Pełny tekst źródłaDourgnon, Paul. "Evaluation des politiques publiques et inégalités sociales d'accès aux services de santé". Phd thesis, Université Paris Dauphine - Paris IX, 2013. http://tel.archives-ouvertes.fr/tel-00912417.
Pełny tekst źródłaJusot, Florence. "Revenu et mortalité : analyse économique des inégalités sociales de santé en France". Paris, EHESS, 2003. http://www.theses.fr/2003EHES0114.
Pełny tekst źródłaThis thesis proposes an empirical analysis of the impact of income and income inequalities on mortality in France. In order to introduce income in the fields of mortality analysis in France, this analysis is based on a case-control study constructed with two fiscal databases, the Wealth at Death Survey" and the "Taxable Income Survey". The determinants of the probability of dying in 1988 to the characteristics of people surviving in 1990. A first analysis, based on age at death distribution, shows that the survival function increases with income. The results of the case-control study show a continous impact of income on mortality, controlled for occupation. The results suggest a specific risk related to poverty and a strong protective effect of higher incomes. A multilevel analysis shows that the intra-regional level of household income inequality is positively correlated to the probability of dying, after control for regional health care supply. This thesis suggests that both individual socioeconomic status and socioeconomic environment are essential determinants of mortality in France
Manneville, Florian. "Comportement alimentaire, activité physique, sédentarité et inégalités sociales de santé à l’adolescence". Thesis, Université de Lorraine, 2020. http://www.theses.fr/2020LORR0128.
Pełny tekst źródłaBackground: During adolescence, the higher the socio-economic status (SES), the better the health status is and reflects the existence of social inequalities in health. These inequalities could be explained by the unequal distribution of lifestyles such as physical activity (PA), sedentary behaviour (SB) and dietary behaviour (DB) according to adolescents’ SES. The associations between lifestyles and social inequalities in health are unclear among adolescents. Objectives: This thesis aimed to analyze the associations between lifestyles and social inequalities in health during adolescence through three objectives: 1) to describe lifestyles and their distribution according to adolescents’ SES, 2) to evaluate the effectiveness of a public health intervention on the reduction of social inequalities in health among adolescents, and 3) to measure and quantify the mediating effects of lifestyles on social inequalities in health among adolescents. Methods: To address these objectives, data from two trials aimed at preventing overweight and obesity among adolescents were used: PRALIMAP (PRomotion de l’ALImentation et de l’Activité Physique) and PRALIMAP-INES (PRALIMAP-INEgalités de Santé). PA, SB were measured using the International Physical Activity Questionnaire and DB using a food frequency questionnaire. SES was defined using the Social Position Index of Students and the Family Affluence Scale. Statistical analyses included linear, mixed and logistic regression models and an analysis of latent transitions. Results: Low SES adolescents had lower levels of PA and less adapted DB than high SES ones. Overall, DB was not associated with adolescents’ SES. Social inequalities in weight and quality of life were highlighted. There was no evidence that a universal intervention could reduce social inequalities in weight. Mediating effects of behaviours in the association between SES and health status were suggested. Conclusions: These results underline the importance of taking SES into account in order to reduce social inequalities in health among adolescents. Behaviours appear to be important levers to reduce social inequalities in health
Charreire, Hélène. "Santé périnatale et territoire urbain : Analyse géographique des inégalités sociales de santé en Seine-Saint-Denis". Paris 11, 2007. http://www.theses.fr/2007PA11T077.
Pełny tekst źródłaPierron, Annabelle. "Promotion de la santé des mères et des nouveau-nés : réduire les inégalités sociales de santé". Thesis, Université de Lorraine, 2019. http://docnum.univ-lorraine.fr/ulprive/DDOC_T_2019_0259_PIERRON.pdf.
Pełny tekst źródłaIntroduction. It has been shown that the beginning of life is the key period in the genesis of social inequalities in health: support for parenthood is one of the major levers for limiting or even reducing these inequalities. The objective of this dissertation is to develop a conceptual framework establishing the conditions for the success of interventions, policies and organizations to support parenthood in order to limit social inequalities in health for mothers and children in the perinatal period. Methods. The research has two components: a systematic literature review and a realistic evaluation. -Systematic review: this was a systematic review of reviews published between 2009 and 2016 in English or French. 21 reviews meeting the AMSTAR criteria were selected. They were analysed with regard to their consideration of social inequalities in health, according to PRISMA-equity. - Realistic evaluation: The process consisted of three steps: 1) development of a first theory based on the results of the review. 2)multiple case study. Two cases were investigated: the border territories of the steel industry of Longwy in Lorraine and Esch-sur-Alzette in Luxembourg. They were selected for their geographical proximity and the particularly vulnerable and unequal nature of the populations living there. The data collected came from several sources, including a documentary corpus, questionnaires and interviews. The analysis focused on the consideration of social inequalities in health in practices. 3) a synthesis explaining how interventions work based on the mechanisms at play in their real context. Results. The synthesis of the reviews clearly revealed the limitations of current knowledge on health equity in the area of parental support. Parenting education programs, most often offered only to mothers and especially to the most disadvantaged, rarely take into account social gradients in health. In addition, the publications come mainly from Anglo-Saxon cultures; there is little data on the subject in the context of European policies. The case study made it possible to provide in-depth details of the intervention levers, contexts and elements of mechanisms from the point of view of the various stakeholders. The synthesis made it possible to propose a medium-level theory explaining that the mechanisms of proportionate universalism, coordination of actors and consideration of parental needs are effective in fighting social inequalities in health when the levers for action are macro-social. Conclusion. Based on two complementary methods of investigation, this work has made it possible to build a theory that constitutes avenues for research and action
Cousteaux, Anne-Sophie. "Le masculin et le féminin au prisme de la santé et de ses inégalités sociales". Phd thesis, Institut d'études politiques de paris - Sciences Po, 2011. http://tel.archives-ouvertes.fr/tel-00661611.
Pełny tekst źródłaGuillaume, Elodie. "Organisation collective du dépistage des cancers et réduction des inégalités sociales de santé". Thesis, Normandie, 2017. http://www.theses.fr/2017NORMC413/document.
Pełny tekst źródłaIn accordance with the WHO's observation, there are differences in health between different population groups in France, as elsewhere, which result from the social conditions in which people are born, grow, live, work and age.In France, the reduction of social inequalities in health is a political priority, notably through successive cancer plans, with cancers being the main pathologies that provide inequalities. These plans have led to the introduction of organized screening for colorectal cancer and breast cancer, for which social and territorial inequalities of participation as well as non-adherence factors are well documented and constitute potential targets for interventions. This thesis aims to provide new knowledge and evidence to guide the policies and organization of cancer screening based on evidence, particularly for the reduction of social inequalities and territorial. She presents two studies. PRADO is an interventional study with a collective randomization unit (Grouped Islets for Statistical Information (IRIS)) multicentric, stratified on the urban / rural character and precariousness of IRIS and conducted in two parallel groups (Intervention vs Control), from 2011 to 2013 in Picardy. In the intervention arm, in addition to the usual modalities of organized screening for colorectal cancer, a screening assistant contacted by telephone those who did not carry out the screening test in the two previous round. The study showed that this intervention has increased participation and identified the conditions under which this type of intervention could reduce social inequalities. The second study evaluates the interest of a mobile radiography (the mammobile) in organized breast cancer screening. A retrospective analysis of the Orne device on five screening rounds shows that this device makes it possible to reduce the social and territorial inequalities of participation in screening. The principle of proportional universalism, the multilevel and intersectorial nature of intervention, the application of the principle of literacy and respect for informed choice appear as the foundations of a public health policy aimed at reducing social inequalities in the cancer field. The optimal mode of evaluation of these so-called complex interventions remains a major research issue
Villeval, Mélanie. "Evaluation et transférabilité des interventions de réduction des inégalités sociales de santé : un programme de recherche interventionnelle". Thesis, Toulouse 3, 2015. http://www.theses.fr/2015TOU30233.
Pełny tekst źródłaSocial inequalities in health are particularly elevated in France. Decreasing these inequalities has been on the political agenda since 2009. However, knowledge is sparse regarding possible interventions which would contribute to their decrease. Many local-level interventions are implemented, but most often they are not described, not evaluated, nor transferred. This thesis is embedded within the field of population health intervention research. The first part of the thesis focusses on deconstructing the archetypal vision of the intervention within the field of public health, wherein it is considered to be a sequential, technical programme. A systemic approach to interventions is then described. Different levels of intervention are described, from individual health education to Health Impact Assessment (HIA), aiming at addressing social determinants of health. By relying on a critique of the randomised controlled trial, alternative evaluation approaches are detailed, based on a literature review in the field of " programme evaluation " still relatively under developed in France. The second part of the thesis is centred on the results of research on intervention transferability, based on the AAPRISS (Apprendre et Agir Pour réduire les Inégalités Sociales de Santé) programme. A description model has been developed, based on a distinction between the " key functions " of an intervention (that is standardisable and transferable key elements), and their implementation, that can vary across contexts. It has been developed from different prevention projects included within the AAPRISS programme. It relies on the hypothesis that a better description of interventions, relying on a distinction between transferable and adaptive elements, constitutes a useful step to the evaluation and potential transfer of an intervention. The model is built on a knowledge co-construction between project leaders and researchers. In the last part of the thesis, the model is applied to the AAPRISS meta-programme itself. Knowledge exchange and co-construction dynamics on which it relies are analysed. The complexity and multiplicity of the determinants of health and SIH call for revisiting existing programmes more than for the creation of a new programme to reduce SIH
Saint-Pol, Thibaut de. "Corpulence et genre en Europe : le poids des inégalités d'apparence et de santé". Paris, Institut d'études politiques, 2008. http://www.theses.fr/2008IEPP0023.
Pełny tekst źródłaThis sociology thesis apprehends the body through weight, and more precisely, through the body mass index (BMI), which allows to appreciate the complexity of the connection between the weight of individuals and the social characteristics which distinguish them. The study of weight and body shape, which are socially determined, is a way of shedding light on the stakes that the body incarnates and conceals. This is done by making use of data from nine major quantitative surveys. This research shows the importance of gender in the apprehension of weight differences. Differences between social classes are stronger for women. The relation of women to their bodies and to thinness is more constrained than that of men, body shape reflecting mainly beauty for women and force for men. For the latter, under-weight, devalued, plays a symmetrical role to overweight for women. The study of the French situation within a European framework shows its singularity. The increasing prevalence of obesity is associated with an increase in social inequalities which particularly affects women. Besides, the link between obesity and poverty, in France, is stronger among them. But whatever their sex, obese people suffer from the consequences of their weight both in terms of health, work integration and self-perception. Women are more sensitive to the aesthetic dimension and men to the medical dimension, but these two aspects mix. Health inequalities are associated with inequalities in appearance and are both produced by and producing economic and social inequalities
Dolcerocca, Marie-Amélie. "Inégalités sociales et territoriales et éducation thérapeutique du patient : le cas de la Corse". Electronic Thesis or Diss., Corte, 2022. http://www.theses.fr/2022CORT0016.
Pełny tekst źródłaRecent research on therapeutic education shows a real interest in taking intoaccount levels of health literacy and empowerment in learning situations in order tostrengthen them. This research work seeks to highlight the triangulation betweenempowerment, health literacy and therapeutic education in order to understand, throughbiographical research, access to care and TPE for people with diabetes. The results show thatthe use of the life story is an enlightening element on the emergence of health literacy andexperiences related to powerlessness and empowerment. In addition, taking into account theelements of health literacy and empowerment, as a process and strategy of educationalintervention, in the workshops makes it possible to tend towards the autonomist aimexpected from therapeutic education. These allow us to see the value of a clinical use ofquestionnaires associated with people's life stories. This biographical work is transferable tothe Therapeutic Education associated with the questionnaires in order to help the healthprofessionals in the proposals made on a case-by-case basis to the chronically ill persons
Legleye, Stéphane. "Inégalités de genre et inégalités sociales dans les usages de drogues en France". Phd thesis, Université Paris Sud - Paris XI, 2011. http://tel.archives-ouvertes.fr/tel-00716697.
Pełny tekst źródłaRenahy, Emilie. "Recherche d'information en matière de santé sur Internet : déterminants, pratiques et impact sur la santé et le recours aux soins". Paris 6, 2008. http://www.theses.fr/2008PA066087.
Pełny tekst źródłaBonnefond, Céline. "L'analyse des inégalités sociales et spatiales dans le processus d'émergence de la Chine". Thesis, Bordeaux 4, 2013. http://www.theses.fr/2013BOR40039/document.
Pełny tekst źródłaThe rapid emergence of China has been accompanied by a significant increase in inequalities, resulting in profound changes affecting both the economic and social structures of China. The purpose of this doctoral thesis is to provide a better understanding of the diversity of these transformations, by combining macro and microeconomic analyses, together with economic and sociological approaches. Firstly, this research mobilizes provincial data in order to give a general overview of the level of regional disparities and of the spatial concentration of wealth. The recent decline in regional disparities can, among other things, be explained by the existence of growth spillover effects between Chinese provinces. Subsequently, the study is supplemented by the use of household survey data. The analysis of income polarization in rural and urban areas allows to highlight some shifts in its distribution, emphasizing in particular the constitution of population clusters in intermediate income ranges. An intensive investigation on the Chinese urban middle class is thereafter conducted so as to identify its members on an income-based definition, and to underline the heterogeneity of this category regarding employment and education. Finally, based on the example of food consumption and social attitude towards body weight, the vanguard role of middle class in the nutrition transition is highlighted. To conclude, the Chinese middle class appears to be a central category to ensure the further development of China
Sow, Mamadou Mouctar. "Politiques de soutien au revenu, Pauvreté et Inégalités de santé à la naissance: Une comparaison Bruxelles-Montréal". Doctoral thesis, Universite Libre de Bruxelles, 2021. https://dipot.ulb.ac.be/dspace/bitstream/2013/332018/3/Manuscrit.pdf.
Pełny tekst źródłaDoctorat en Santé Publique
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Audet, Mélisa. "Inégalités sociales de santé et pratiques préventives de femmes ménopausées considérées en surpoids : l’influence des conditions d’existence". Thèse, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/9912.
Pełny tekst źródłaRamel, Viviane. "Les technologies numériques en santé face aux inégalités sociales et territoriales : une sociologie de l’action publique comparée". Thesis, Bordeaux, 2020. http://www.theses.fr/2020BORD0053.
Pełny tekst źródłaThe link between digital health and equity is seldom studied, even less are the policies which tackle both issues, and this despite governments being urged to implement health-and-equity-in-all-policies strategies. This thesis has studied whether and how governments and health systems’ stakeholders address this linkage. Specifically, this piece of population health interventional and political science research has been based upon a qualitative study design and comparative public policy analysis of territories from four countries (France, Canada, Spain & England) since 2015. Data were gathered from official and various stakeholders’ documents and through interviews with key stakeholders in e-health and health equity fields. Digital health policy has been institutionalized to varying degrees in the four so-called developed countries focussed on. However, equity in digital health issue has not been placed on the political agenda, although it is acknowledged that digital health use can increase social health inequalities (SHI), in terms of unfair access, use, understanding and adoption of technologies. In the four territories, when (rarely) dealt with, digital inclusion is tackled through a set of instruments, by actors involved in several fora which coproduce public interventions on digital health, SHI and digital inclusion. Each mode of instrumentation of public action is affected by previous local institutions, along with actors’ interests and preconceptions about the issues involved. Our study proposes a conceptual framework for public action and policy implementation as regards digital health and equity in four territories. This study has been designed to be useful for analyzing policies in other settings and for suggesting strategies that could be directly implemented in the field
Schlegel, Vincent. "La fabrique sociale du patient autonome : développer et mettre en oeuvre l'éducation du patient diabétique en France". Thesis, Paris, EHESS, 2020. http://www.theses.fr/2020EHES0122.
Pełny tekst źródłaFor more than ten years, therapeutic patient education programs have been rationally organizing the acquisition of skills and knowledge by people with a chronic disease, with autonomy being described as the goal of this process. Focusing on educational programs dedicated to people with diabetes, this thesis aims to understand what the medical institution does when it seeks to produce an "autonomous patient" and how it proceeds to do so. The research is based on different kind of materials: a corpus of written sources (diabetes textbooks, books and articles on patient education, dedicated journals), data from observations conducted during three therapeutic education programs for people with diabetes between December 2017 and May 2019 and lastly interviews (73 overall) with pioneers in patient education, professionals in charge of conducting the programs, and patients who participated in them. The thesis first uncovers the historical conditions that enabled the medical institution to invest in patient education. In spite of its recognition as "programs" and growing support from public authorities, all studied programs show signs of weakness that complicate their daily implementation. Nonetheless, they are contributing to a new way of governing patients’ conducts that is based on pedagogy rather than coercion. Whether or not based on hospitalization, educational programs adopt a school-based mode of socialization, breaking with the simple transmission of information within the doctor-patient relationship. By learning to consider long-term complications of diabetes as predictable and avoidable events, people with diabetes are encouraged to manage their disease by adjusting their daily behavior in a preventive perspective, which presupposes some learning beforehand. However, such a perspective is based on a socially situated relationship to health. The thesis thus sheds light on the influence of educational programs on social health inequalities, particularly significant in the case of diabetes. Working class patients have to make the greatest efforts to comply with medical recommendations made during programs, while they are also the least likely to benefit from the learning process, due to their lower exposure to the school form. Self-management of the disease then appears to be not only the product of institutional socialization, but also an ideal that is more easily achievable for patients who possess enough cultural, social and economic resources
Tardieu, Émilie. "Soutenir l'équité en santé dans les actions de santé publique : conditions d'utilisation d'un outil visant à la prise en compte des inégalités sociales de santé". Master's thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/26465.
Pełny tekst źródłaMurcia, Marie. "Rôle des facteurs psychosociaux au travail sur les troubles de la santé mentale et leur contribution dans les inégalités sociales de santé mentale". Thesis, Paris 11, 2012. http://www.theses.fr/2012PA11T085/document.
Pełny tekst źródłaPsychosocial work factors are a public health and occupational health issue and are the object of special prevention policies. However, the etiological role of these factors on mental health need to be developed, particularly studies using diagnostic interviews, rarely used in this context. Moreover, the role of these factors in the explanation of social inequalities in mental health is still unknown. The objectives of this PhD thesis are to study the etiological role of psychosocial work factors on mental disorders, measured using a diagnostic interview, and to evaluate the contribution of these factors to social inequalities in mental health.The data from two surveys were used: Samotrace (regional survey based on 6056 employees) and SIP (national survey based on 7709 workers). The main feature for Samotrace was the use of validated questionnaires to measure psychosocial work factors, and for SIP it was the use of a diagnostic instrument to measure depressive and anxiety disorders. Multivariate analyses were conducted, including logistic regression analysis. Interaction tests and the bootstrap method were also used. All analyses were carried out separately for men and women.Low decision latitude, overcommitment and emotional demands were found to be risk factors for depressive and anxiety disorders, for both genders. Other risk factors were observed according to gender or mental health outcome studied (job insecurity, high psychological demands, ethical conflict, low reward). Few social inequalities in mental health were observed except for self-reported health; manual workers being more likely to report poor health. Occupational factors reduced social inequalities in health by 76% and more, according to gender and occupation studied. Among occupational factors, psychosocial work factors played a substantial role, particularly low decision latitude, and to a lesser extent (according to occupation and gender): low social support, low reward, night work, work-life imbalance, physical violence and bullying.Prevention actions focussing on identified risk factors, including emergent psychosocial work factors, should be considered and a better implementation at workplace would be necessary. Improving knowledge on social inequalities of mental health may lead to adequate preventive actions targeting the most exposed social or occupational groups. As our studies were cross-sectional, our results should be confirmed by forthcoming prospective studies
Gaborit, Emilie. "Sanitarisation de l'école et scolarisation de la santé : socio ethnographie de la mise en oeuvre et de l'appropriation du programme "bien manger et bouger dès l'école maternelle" en Haute-Garonne et en Ariège". Thesis, Toulouse 3, 2015. http://www.theses.fr/2015TOU30190.
Pełny tekst źródłaNutrition today holds a central place in the area of public health. Considered as a major State of population health determinant, it is at the heart of government programs, in particular, three programs national health nutrition that occurred from 2001 to 2015. They focus their objectives on primary prevention, screening and early nutritional support. In a comprehensive focus, this thesis work analyses the implementation of a program of preventive health care for young children through the prism of food and physical activity. In a comprehensive focus, this thesis work analyses the implementation of a program of preventive health care for young children through the prism of food and physical activity. This program, entitled Eating well and moving from nursery school is carried by a health institution, CPAM. It comes to understand how this program is implanted in other institutions that are the school and family-based education models and modes of socialization more or less distant concerns health or, at least, treating them differently. The entry by implementation to wonder about conditions and effects of the approximation of these two social worlds that are education and health. Thus, through the example of the nutritional program that we compare in two departments, Haute-Garonne and Ariège, the process of 'sanitizing' social worlds is asked to understand and analyze influence of the local stage on public action through the instruments and mobilized knowledge. We also analyze implementation of health educations system in different contexts, that of nursery schools with a specific mode of education and thus seize "schooling" of health via 'work directors' program. In addition, it is aimed at children whose modes of socialization family and school socially differentiated influence understanding and ownership of the program and induce differentiation and inequality in terms of nutritional knowledge. This work, which is at the crossroads of a sociology of public action and a sociology of childhood and education involves the implementation of a methodology for the ethnographic type corresponding to a participant observation of interventions, supplemented by biographical with 'work directors' interviews, families and early childhood professionals (teachers, ATSEM, etc.). In this thesis, we deconstruct in a first step the downward representation of public health by comparing the program and its variations on two departments and giving a central place to the actors and instruments of public action. Thus, the domination of the health world on other social worlds is nuanced and the idea of homomedicus by the analysis of the modalities of cooperation between CPAM and school. Finally, granted instead to the child in the program reveals early accountabilities forms to young public at the going work to assign a role of "missionary" within the family sphere
Birouste, Guilhem. "Les usages médicaux du social : Médecine générale et inégalités". Thesis, Montpellier 1, 2014. http://www.theses.fr/2014MON10030/document.
Pełny tekst źródłaFrance is characterized by a good overall health status and high social inequalities in the health sector. The renewed interest in health inequalities is the opportunity to question a unique definition focused on results at the expense of processes, in a country where policies on tackling inequalities are based on the health care system. General practice has a particular position in this system, as a new academic speciality, which still needs to figure out how to define itself. It is described simultaneously as a heath care system gatekeeper, a public health officer or an advocate for inter-individual relationship and holistic care. While medicine is based on scientific evidence, it is also a prudential profession as it considers singular situations, generating uncertainty in practice. Among singular sources, social characteristics of both patients and doctors have to be considered. However, in their practice, physicians experience a diversity of social. Sometimes a barrier to the professional activity and considered external to the medical world, sometimes considered as part of scientific evidences by epidemiology, it could also be considered as a component of the individual construction of the patient on which the physician can rely, with the potential to lead to a moralization of behaviours and identities. The physician's social characteristics are often omitted, as if doctors were neutral or mere representatives of science. It is however in the interaction between these two worlds that social determinants of health inequalities can be found, and it seems that a physician could only provide good care to patients sharing the same similarities
Saengkanokkul, Pakpoom. "Le système de santé en Thaïlande et l'origine des inégalités en matière de santé : une analyse politico-économique". Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCF013/document.
Pełny tekst źródłaThis thesis uses a political economy frame to analyze Thailand’s health system and its inequalities in health. After identifying the political actors of the health care system and the ideologies on which they are based, it examines the way in which the policies put in work have affected the health and the distribution of health. In Thailand, national trilogy "Nation-Buddhism-King" impregnated the whole political pattern, including health system. It also influenced political agents and political decision-makers in building the Thai social protection system. Influenced by utilitarianism and nationalism, the Ministry of Health had prioritized efficiency, rather than equality, and improved population health in order to increase economic growth. Due to Buddhism, some technocrats have launched health promotion policies based on the concept of Karma that reinforced individual responsibility for health, but ignored social inequalities that affected health-risk behaviors. Royal charities have provided health care for marginalized groups for long times, but many patients still were left untreated. Thanks to these actors, many health indicators were improved, but, at the same time, it increased health disparities between rich and poor, rural areas and urban areas, as between Bangkok and the poorest regions, North and Northeast. In 2001, Thai Rak Thai party launched a new health insurance program providing basic health care for all Thais. Although many reports confirmed the good results of a policy that reduced some inequalities and improved health care access for the poor, it raised the opposition from several stake-holders groups. This new program, based on equal opportunities and the right to health, unintentionally challenged the old policies and the old ideologies in health care justice. As a result, conflicts in health system as well as political instability as a whole constrained the development of new health policies for the next generations
Martin, Marie. "Evaluation psychocognitive des représentations des patients sur le traitement de l’information du médecin et de l’accompagnateur au dépistage dans le cadre de la communication préventive du cancer colorectalprise de décision, profils interactifs et réduction des inégalités sociales de santé : prise de décision, profils interactifs et réduction des inégalités sociales de santé". Caen, 2014. http://www.theses.fr/2014CAEN1021.
Pełny tekst źródłaDespite the establishment of an organized colorectal cancer screening in France, participation remains low (1/3), particularly for people affected by social inequalities in health. The physician-patient communication is of paramount importance, especially during the exchange when the CRC screening test, the Hemoccult-II ®, is presented. Inspired by the "patient navigator" program (Freeman, 1995), our team has developed the PRADO project: its objective is to assess the impact of the patient navigator on the increasing participation in this screening, in a context of social inequalities in health. Its role is to provide personalized support to the beneficiary to overcome these obstacles. The psychological study, included in this project, explore the cognitive, behavioural, relational and emotional mechanisms on which the patient navigator can intervene. This doctoral work, integrated to the project, studies the patient's representations of their communication with the physician versus the patient navigator, in terms of cognitive psychology. Our focus is on the processing of medical information by the patient, in order to an informed decision-making. The results suggest that the doctor retains a favoured interlocutor position and that the patient navigator is credited as a third resource. The intervention of the patient navigator is indeed complementary to the physician's, provided that the preliminary interview with the physician has made a good first impression
Feyaerts, Gille. "Social Impact Assessment :analyse d'un outil d'aide à la décision pour la lutte contre la pauvreté et les inégalités sociales de santé: Etude des conditions nécessaires à la fonction d'apprentissage conceptuel de l'outil dans le contexte bruxellois". Doctoral thesis, Universite Libre de Bruxelles, 2018. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/269187.
Pełny tekst źródłaDoctorat en Sciences de la santé Publique
info:eu-repo/semantics/nonPublished
Pierre, Aurélie. "Assurance maladie complémentaire : régulation, accès aux soins et inégalités de couverture". Thesis, Paris Sciences et Lettres (ComUE), 2018. http://www.theses.fr/2018PSLED031/document.
Pełny tekst źródłaThis thesis deals with the place of private health insurance in the overall health insurance scheme in France, focusing on social inequalities and on solidarity between healthy individuals and sick patients. It particular, it addresses the role of private health insurance on access to health care, mutualization of health expenditure, and welfare. The results of this thesis reveal the key role of private health insurance to access to care postponed over time for financial reasons. However, our results also show that generalizing complementary health insurance in the current health insurance scheme does not allow pursuing equity goals nor increasing welfare. They finally reveal that the mutualization induced by private health insurance appears relatively weak, compared to the one induced by public health insurance. They therefore encourage a change in the role of private health insurance in funding medical care
Marqué, Gwen. "Développement d’une planification équitable des soins pour lutter contre les inégalités territoriales : l’expérience française". Thesis, Lille 1, 2013. http://www.theses.fr/2013LIL12007/document.
Pełny tekst źródłaThe health of the French population is among the best in the world. However, inequalities characterize our health system. The latest amendments to the health care system may increase. Thus, DGRs, new pricing method should be associated with a control system. For this, the RAWP model provides useful analytic grid. First, at the local level, an experiment needs analysis, use and provision of care for a population of a territory allows us to show that we can detect problems of access care and reorganize supply. Experience from 2006 to 2011 the Nord-Pas-de-Calais region offers a first approach to target setting activities as needed, but the volume of care increases. Second, support for the development of a national approach to the volume control regions of France based on a comparative analysis of healthcare consumption adjusted by age and sex-adjusted mortality is one of the results of this thesis. This helped to develop a systemic model of regulation of national, regional and local care.Finally, to open the discussion to the level of health territories, a typology of health territories of France was carried from the main factors in the model (health status, use and provision of care) and socioeconomic factors the population, and those related to the care pathway. The analysis shows that there are three types of areas of health and therefore to adapt the control strategy: "Attractive-overproducing", "all healing" and "sub-dependent consumers."
Castra, Laurent. "Typologie des arrêts cardiaques au regard des inégalités sociales et territoriales de santé en Ile-de-France : application au registre national des arrêts cardiaques (RéAC)". Thesis, Lille 2, 2018. http://www.theses.fr/2018LIL2S025/document.
Pełny tekst źródłaCardiac arrest (CA) is considered a major public health problem. Preventing cardiac arrest and subsequent deaths and optimizing their management are objectives shared by both emergency professionals and public health policy makers. At a time when territorialization is taking into account the needs of populations, very few studies have been devoted to the variations in incidence induced by the geographical location of cardiac arrests and the socio-economic characteristics of patients. The objective of this thesis is to identify, based on data from the national register of cardiac arrests RéAC, in the three departments of the inner suburbs of Ile-de-France, clusters of municipalities with a high or low incidence of cardiac arrest, and then to characterize them based on the socio-economic factors that can be associated with them. Equipment and Methods: We studied cardiac arrest data from the three departments of Ile-de-France that make up the inner suburbs of the Paris region. We have worked on a total of 123 municipalities. Data on cardiac arrests were extracted from the French register of cardiac arrests RéAC. Socio-economic data were collected for each of these municipalities from the Institut National de la Statistique et des Etudes Economiques (INSEE). In terms of methods, we used a statistically twofold approach, combining Bayesian methods to study geographical variations in the incidence of cardiac arrest and CT statistics to identify clusters of communes according to the incidence level of cardiac arrest. Finally, we characterized and compared these clusters of municipalities according to socio-economic factors
Bertin, Mélanie. "Impact des inégalités sociales et de la pollution atmosphérique sur le risque d'issues défavorable de grossesse dans la cohorte mère-enfant PELAGIE : rôle du contexte urbain-rural". Thesis, Rennes 1, 2015. http://www.theses.fr/2015REN1B010/document.
Pełny tekst źródłaPregnancy is a sensitive and critical period for the development of the child and the health of adults-to-be. The biological and physiological adaptation of the body dealing physical and psychosocial stressors during this period may exert its effects in adulthood (and possibly over several generations). This delayed toxicity presupposes intrinsically the need to study the effects of exposure to environmental risk factors during fetal life using a holistic approach involving risk factors at both the micro (individual characteristics) and the macro level (physical and psycho-social context). Given the heterogeneity of the Breton territory in which this work was conducted, we explored whether the impact of social inequalities and the physical environment (air pollution) on birth outcomes (fetal growth and the risk of prematurity) could be modified according to an urban or rural place of residence. This work was based on data collected as part of the Breton mother-child cohort PELAGIE, which had included 3421 pregnant women between 2002- 2006. The anthropometric parameters and gestational age at birth were measured by medical personnel at delivery. We defined urban and rural areas according to the definition of “urban units” from the National Census Bureau (INSEE). The annual concentrations of air pollution (nitrogen dioxide (NO2)) were estimated using a land-use regression modeled at a 100 m scale and developed as part of an European project. Finally, neighbourhood deprivation was estimated using a composite index developed at census blocks level and whose use was legitimated over both urban and rural areas. Neighbourhood deprivation was associated with an increased risk of infants with fetal growth restriction, only for women living in rural areas. We also observed an increased risk of preterm birth associated with NO2 concentrations > 16.4 μg.m-3, only among women residing in urban areas. The associations between air pollution and fetal growth, although sex-specific, did not seem on the other hand, to vary significantly according to the urban-rural spectrum. This work confirms the need to explore the influence of both social and environmental inequalities on intrauterine development, and to assess the role of place-based factors, such as the urban-rural context, in shaping these inequalities
Coindard, Guillaume. "Le vécu du diagnostic et de la phase thérapeutique initiale par les personnes atteintes de pathologies cancéreuses : quels rôles pour la médecine générale au prisme des inégalités sociales de santé ?" Thesis, Paris 10, 2019. http://www.theses.fr/2019PA100050.
Pełny tekst źródłaThe general practitioner is the main actor in the organisation of primary care, as defined by the laws in force, both nationally and internationally. However, its role in the care of cancer patients remains both fluctuating, depending mainly on the social position of the patients, and difficult to identify, both in terms of time and context. A series of studies have been carried out to try to better understand the role of the general practitioner in the initial management of cancer, i.e. from the diagnostic period to the therapeutic phase itself. An initial qualitative study of 83 people with cancer (PWC) identified the main ways in which the health care system was used and what roles the general practitioner could play in these situations. A second qualitative component with health professionals, including general practitioners, clarified these roles, while a quantitative component was conducted to describe from cancer patient records the modalities of using a general practitioner. The trajectories of PWC were all the more marked by endurance logics as they were socially disadvantaged or from working class backgrounds. We also observed how the difficulties related to the patient's work were burdened by intersectionality logics. From a complete absence in the trajectories of some PWCs to a major role for others, the discovery of cancer and follow-up during the initial therapeutic phase, defining the role that the general practitioner can play requires an analysis of the entire spectrum of possible interventions, of which heterogeneity remains the rule. Nevertheless, during the two main phases, the peri-diagnostic phase and the initial therapeutic phase, the general practitioner is defined by the practice of interface medicine. This interface is temporal, making it possible to support the PWC in the biographical rupture particularly heavy with consequences in cancer pathology. But it is also spatial, being able to support the PWC in referring to the oncology care team, then when anti-cancer treatments are used, to the professionals in charge of this specificity. Like any interface, it is only visible to PWCs when it is crossed and remains in the shadows before and after, at home and in hospital. The issue then becomes that of communication, or how the general practitioner is able, through his knowledge, skills, posture and words, to forge sufficiently strong links to help the patient in his quest for recovery and in his work of physical, psychological and social reconstruction
Letoux, Charlène. "Trajectoires d’adolescents en obésité dans le Nord et Pas-De-Calais comme reflets du processus des inégalités et de la stigmatisation". Thesis, Lille, 2021. http://www.theses.fr/2021LILUA005.
Pełny tekst źródłaOur study reports on how inequality and stigmatization may be visible, constructed and intertwined throughout the trajectory of obese adolescents enrolled in a therapeutic patient education program (TPE). We are helping to provide a new perspective on the issue of implementation and reception of medical norms transmitted during TPE programs by adopting an analysis in terms of disease "trajectories" to analyze different points of view: professionals, adolescents and parents. The study of social interactions involved in social relations, especially class and gender, is honored and allows us to focus on the social dimension of behaviors. We question the differences between the expected or prescribed roles and the roles actually adopted, the strategies of negotiation or resistance between the actors in order to bring out the normative expectations that affect the patients to the point of sometimes revealing a symbolic violence. We also adopt a sociohistorical approach with the aim of retracing the path of norms, by proposing an extension of the notion of "trajectory of illness" by that of "collective trajectory" (Carricaburu, 1999). We include in this research the study of obesity shaping historically conducted by medicine and public health policies that constitute the management conditions, common to the different actors and influencing interactions on the medical scene. Based on the Fat studies perspective, this work made it possible to understand corpulence as a new variable allowing an innovative sociological analysis of discourses, practices and social organization. This work is based on a mixed and multi-site qualitative survey: an analysis of corpus of medical and public health discourse, 38 semi-directive interviews with professionals specialized in the therapeutic education of adolescent obesity (endocrinologist, nutritionist, nurse, sports medicine educator, psychologist, etc.), 21 biographical interviews with adolescents and parents, as well as about 100 observations within FTE programs (specialized centers, hospital centers and health networks)
Verboux, Dorian. "Variabilités des pratiques et inégalités d’accès aux soins en France : le cas de la cancérologie". Thesis, Paris Est, 2016. http://www.theses.fr/2016PESC0065/document.
Pełny tekst źródłaThis thesis addresses several issues: on the one hand we focus on medical practice variations; one the other hand we examine determinants of social and spatial inequalities in access to care for individuals with cancer.In recent years, high practice variations are noted by health public authorities. The first chapter wonders about the determinants of variations in the use of prostatectomy as prostate cancer management. Results indicate a strong positive influence of supply-side factors in both régions and départements.Reducing social inequalities in access to care is also achieved thanks particular scheme as the LTI system. The second chapter focuses on the determinants of health care utilization, i.e. GP and specialist physicians. For those, we differentiate between visits related (or not) to LTI conditions. Concerning GP visits, individuals with lower socio-economic status tend to have greater GP visits. Regarding specialist visits, results point out a clear influence of financial factors, especially for non LTI-related visits.Finally, since 2004 organized breast cancer screening program invites all women 50-74 to be screened. The aim of this chapter is to examine the potential influence of supplied-side factors (GP and specialist physician density) on the use of organized cancer screening in France between 2005 and 2012. Results show that a higher GP density is associated with higher screening rates. On the contrary, a higher specialist density tends to diminish the participation rate to organized screening. Results also underline the presence of a spatial effect which means that neighboring behavior in terms of cancer screening has an impact on the cancer screening rate in the observed area
Schieber, Anne-Cécile. "Étude de la relation patient-médecin généraliste : quel éclairage sur les inégalités sociales de santé ? : analyse des données épidémiologiques et des productions interdisciplinaires issues du projet INTERMEDE". Toulouse 3, 2014. http://thesesups.ups-tlse.fr/2418/.
Pełny tekst źródłaThe work produced in this dissertation aims to understand mechanisms' communication at play during the interaction between a patient and his - or her - general practitioner (GP) which could contribute to social inequalities in health. It uses the qualitative and quantitative data of the project INTERMEDE. The epidemiological analysis reveal the influence of the gender concordance/discordance between patients and GPs on their disagreement on the advice given during the consultation, and the role played by a social distance perceived by the physician on their disagreement on patients' perceived health status. The interdisciplinary analysis have been conducted within an innovate methodology inspired from the Delphi technique. It led to a core of shared knowledge, revealing the convergence of different disciplinary approaches
Kudjawu, Yao Cyril. "Délais d’accès au traitement des patients atteints de cancers en France et impact des inégalités sociales de santé : étude à partir des bases de données médico-administratives". Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS023/document.
Pełny tekst źródłaBackground: timeliness of cancer treatment is an important aspect of health quality. Care centers are expected to treat a growing number of patients with cancer. Our objectives were to examine treatment times from diagnosis to first-course therapy for patients with colon (CC), rectum-anus (RC), and lung (LC) cancers and assess factors associated with time to-treatment and the impact of deprivation index.Methods: using the international classification of diseases and medical procedures codes, from national hospital discharge database which has been crossed with long term illness data and French deprivation Index information, we selected patients newly diagnosed for CC, RC or LC in 2009-2010 who had undergone treatment.Results: We included 15,694, 6,623 and 14,596 patients diagnosed and treated for CC, RC and LC respectively. Median times from endoscopy to: 1) surgery in patients with a surgical treatment pathway for CC, RC, and LC were 22 (Q25 = 14; Q75 = 34), 97 (Q25 = 34; Q75 = 141), and 44 (Q25 = 26; Q75 = 82) days, respectively; 2) to chemotherapy for patients with a non-surgical treatment pathway, for CC, RC, and LC were 36 (Q25 = 21; Q75 = 59), 40 (Q25 = 27; Q75 = 59), and 33 (Q25 = 22; Q75 = 49) days respectively; 3) to radiotherapy in RC and LC patients were 53 (Q25 = 39; Q75 = 78) and 88 (Q25 = 46; Q75 = 162) days respectively; 4) to first treatment, irrespective of pathway and treatment combination for CC, RC and LC were 23 (Q25 = 14; Q75 = 35), 43 (Q25 = 27; Q75 = 74), and 34 (Q25 = 22; Q75 = 50) days respectively.Time to first treatment vary across regions. It was longer in most northern regions and in overseas districts and shorter in Île-de-France, southern, eastern and sometimes in western regions for the three cancers. In multilevel analysis, Age and status of the first care center were significantly associated to time to first treatment in CC patients. Similar factors, including Deprivation index, were significantly associated to time to first treatment in RC and LC patients. The time to first treatment increased with age. It was higher in public hospitals compared to private hospitals and low in patients with low deprivation index compared to patients with high deprivation index. Conclusion: To our knowledge, this is the first study based on medico-administrative database describing time to first treatment after endoscopy in patients suffering from cancers in France. The results, which will complement those from cancer registry data and regional networks of cancerology, could inform decision-making policies on the implementation of guidelines on timeframes for cancer treatment access
Le, Guyader-Peyrou Sandra. "Rôle des inégalités sociales dans la prise en charge et la survie des lymphomes non hodgkiniens en population générale". Thesis, Bordeaux, 2017. http://www.theses.fr/2017BORD0622/document.
Pełny tekst źródłaDue to the addition of innovative treatment, survival of non-Hodgkin lymphoma (NHL) increased during the last decade. Nevertheless, disparities persist, suggesting the role of certain factors as socio-economic factors and disparities in the access or the quality of healthcare.Between 2002 and 2008, 1798 Diffuse Large B-cell (DLBCL) and follicular lymphomas werediagnosed in 3 hematological malignancies specialized registries (Basse-Normandie, Côted'Or and Gironde). Important territorial disparities between the 3 registries areas were observed regarding the place of care, the delay of treatment initiation or the survival whatever the age while there was no association with the deprivation score (EDI).The survival improved during the study period. This positive trend could be explained by the use of immunotherapy as 1st line therapy. The geographical area where the patient was diagnosed, the medical specialization (onco-hematology vs others departments) are independently associated with a better 5-years survival whatever the age.Finally, the improvement of the survival in elderly (especially 75-84 years) could be explained by better work up (higher TEP scan use leading to "upstaging") and thus to use more aggressive therapies. Also, the travel time was associated with the place of care and the survival, with a poorer prognosis for patients living more than 15 min from the closest reference center. Despite therapeutic advances, various non biological factors can affect the prognosis ofpatients with lymphomas. The notion of lymphoma-specific expertise seems to be essential to achieve optimal DLBCL care management and reopen the debate of centralization of NHLpatients care in hematology/oncology departments
Bocquier, Aurélie. "Contribution à la compréhension des liens entre statut socio-économique et comportements de santé". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0713.
Pełny tekst źródłaThis thesis aimed to contribute to current scientific knowledge about the social differentiation of health behaviours in France and to a better understanding of the mechanisms underlying this differentiation. We focused on the role of specific sociocognitive factors (perceptions and beliefs) based on theories derived from the sociology of risk and the sociology of deviance. This work used data from the 2010 Baromètre cancer survey and the 2016 Baromètre santé survey to examine health behaviours related to primary prevention of some cancers (alcohol consumption and sun protection) and infectious diseases (childhood vaccinations). People of low socioeconomic status were more prone to relativize the alcohol-related risks of cancer and to have substantially less knowledge about sun health and more “false beliefs” about sun protection than people of high socioeconomic status. This knowledge and these false beliefs were significant mediators of the positive association between socioeconomic status and sun-protection behaviours. In the field of vaccination, we found a higher prevalence of vaccine hesitancy among parents who had at least passed the “bac”. This association was partly explained by their lower level of trust in health authorities and mainstream medicine than among the least educated group and by their greater commitment to making “good” health-related decisions. From a public health perspective, these results furnish avenues for designing health promotion interventions that take into account the social context in which people’s health behaviours are embedded to improve both effectiveness and equity
Braud, Rosane. "Construction d'une catégorie de "migrants" dans les actions de lutte contre les inégalités face au diabète en France : analyse des configurations contemporaines des rapports sociaux inégalitaires". Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCC089/document.
Pełny tekst źródłaThis research questions the emergence, the uses and the direction of the resort to a category of “migrants”, in the French politics and the actions to reduce social inequalities in front of diabetes mellitus. The sociohistory of the emergence of the question about the diabetes of the "migrants", shows how the medical literature can, by pointing different risk factors according to the social groups, participate in the construction of categories of patients. The led analysis underlines the mixture between ethnic, racial and genetically groups, at the origin of the differentialist narrative about the causes of the diabetes. This reading is today mobilized by the public authorities to organize a specific distribution of health preventive care of diabetes and its complications. In health relation, the analysis of the practices, and in particular the therapeutic patient education, underlines that differential treatments exists, but all have no expected effects. The culturalist view making behavior of patients the main cause of their health condition, can impact the medical course, and also, increase the social inequalities. Guided by the directives of public health, the analysis of the margins of action of the professionals and patients, allows to see that these politics aim less to act on the social determinants of health inequalities that to order the individuals to reach the equality by adopting the majority social groups behaviors
Jullien, Clémence. "Du bidonville à l’hôpital : anthropologie de la santé de la reproduction au Rajasthan (Inde)". Thesis, Paris 10, 2016. http://www.theses.fr/2016PA100146.
Pełny tekst źródłaSince the 2000s, the Indian government’s long-neglected reproductive health sector has been a subject of growing concern, especially in the northern part of the country. Mortality rates remain high, calling India’s superpower image into question; the sex ratio imbalance keeps growing despite legislative measures to correct it; and, despite a significant dip in the fertility rate, the country now has a population of over one-billion-two-hundred-million inhabitants. Drawing on one-and-a-half years of ethnographic fieldwork in a public hospital and several slums in Jaipur, this study analyses the reactions of women and their families to the techniques of persuasion and decision-making power used by hospital staff and NGO workers who institutionalise maternal health. The study also shows how health programmes meant to secure universal access to care paradoxically reinforce existing stereotypes and tend to make vulnerable patients even more aware of socioeconomic inequalities in their daily lives. Through the lens of women’s experiences, reproductive health appears to be a sensitive node where religious and social tensions of caste and class get expressed and crystallised. Thus, reproductive health is not confined to maternal and child healthcare; it includes core issues of discrimination toward young girls, the limited decision-making power of women, and ambivalence about contraception among women. While often presented in the guise of progress and the national interest, the institutionalisation of reproductive health actually maintains social disparities within Indian society
Lebel, Alexandre. "Une approche intégrée pour la définition d'unités de voisinage dans le contexte d'une étude sur les inégalités sociales de la santé dans la région de Québec". Thesis, Université Laval, 2005. http://www.theses.ulaval.ca/2005/22503/22503.pdf.
Pełny tekst źródłaIosti, Pauline. "Les inégalités urbaines d’accès aux soins : une étude croisée des logiques d’organisation de l’offre et des trajectoires individuelles de recours aux soins dans la métropole de São Paulo". Thesis, Lyon, 2020. http://www.theses.fr/2020LYSE3039.
Pełny tekst źródłaInequalities in access to health care are generally studied through the territorial planning of the health care offer or through the socio-economic vulnerability of populations. However, recent works have contributed to renewing this theme by looking at health care utilization practices at an individual scale and using a longitudinal approach, with a special attention to urban areas. This work seeks to contribute to this renewed analysis of inequalities in access to health care. On the one hand, the purpose of this research is to examine the constraints induced by the spatial configuration of the health care systems and by the urban organization in emerging countries. On the other hand, it questions the way in which these constraints are bypassed or, on the contrary, reproduced in the individual trajectories of access to health care of urban populations. Two neighbourhoods of the municipality of São Paulo were studied, using a qualitative methodology combining non-participant observation and semi-structured interviews with health professionals and users of the public system. Two main results emerge from this thesis. Firstly, it shows the mixed effects of the organization of health care provision on inequalities in access to health care. Indeed, the organization of primary health care makes it possible to respond to local health needs, but the territorialization of care and the lack of a complex offer create significant constraints, particularly for the most vulnerable populations. Secondly, this study highlights the way in which prior social inequalities are reflected in individual health practices. Thus, individual trajectories show an unequal fluidity that illustrates the unequal capacity of individuals to act on these trajectories, in order to put them in line with their health care projects. Finally, it contributes to the identification of inequalities between urban populations in relation to the right to the city and to what the city has to offer
As desigualdades no acesso à atenção à saúde são um tema de estudo geralmente abordado, em geografia, pelo prisma do planeamento territorial da oferta ou da vulnerabilidade socioeconómica das populações. Porém, trabalhos recentes têm contribuído para a renovação deste tema, analisando as práticas de utilização da atenção à saúde à uma escala individual, com uma perspectiva longitudinal e com um novo interesse nas áreas urbanas. Esta tese procura contribuir para esta análise renovada das desigualdades no acesso à atenção à saúde. Ela estuda, por um lado, os obstáculos induzidos pela configuração espacial dos sistemas de saúde e pela organização das metrópoles dos países emergentes, e, por outro lado, a forma como estes obstáculos estão contornados ou, pelo contrário, reproduzidos nas trajetórias individuais de utilização da atenção à saúde das populações urbanas. Dois bairros do município de São Paulo foram estudados, utilizando uma metodologia qualitativa que combina observação não participativa e entrevistas semiestruturadas com profissionais de saúde e usuários do sistema público. Dois resultados emergem deste estudo. Primeiramente, ele mostra os efeitos mistos da organização da atenção nas desigualdades de acesso à saúde: a organização da atenção básica responde em parte às necessidades de saúde locais, mas a territorialização dos serviços de saúde e a carência da oferta complexa criam grandes obstáculos, particularmente para as populações as mais vulneráveis. Esta tese também revela que as desigualdades sociais se traduzem nas práticas de saúde individuais: as trajetórias de utilização da atenção estão desigualmente fluidas, o que reflete a capacidade desigual dos indivíduos à atuar sobre essas trajetórias para as alinhar com os planos de cuidados deles. Por fim, este estudo contribui para a identificação de desigualdades entre as populações urbanas no respeito ao direito à cidade e ao que a cidade tem para oferecer
Si, hassen Wendy. "Relations entre les indicateurs socio-économiques, les événements de vie et les comportements alimentaires d’adultes français". Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCD042.
Pełny tekst źródłaStrong health inequalities remain between socio-economically advantaged individuals and those of lower socioeconomic position. Diet appears to be an important modifiable factor, which contributes to health inequalities. Although social disparities in nutrition have been well documented, the independent influences of the different socioeconomic indicators on diet – in particular its behavioural dimensions – have not been deeply investigated. In addition, the pathways underlying these disparities are still poorly understood. Among individual determinants, there is a lack of knowledge regarding effects of life course on dietary behaviours.The objective of this Ph.D. thesis was to investigate the associations between socioeconomic factors and dietary behaviours, expressed in terms of nutrient intakes and snacking practices. The influence of occupational life events on dietary behaviours was also assessed.The results showed that individuals with high socioeconomic position (PSE) had higher intakes of recommended nutrients (fibre, vitamin C, folate, magnesium, etc.). Education appears to be a major determinant of dietary intakes and modifies the associations between income and dietary intakes. Although individuals with low socioeconomic position are less likely to snack, the nutritional quality of their snacks is lower. Moreover, retirement was associated with unhealthier dietary intakes (overall diet quality, lipids, sodium, saturated fatty acids,...), particularly in men with the lowest income before retirement (decrease in intake of dairy products and increase in intake of lipids).The results underline the importance of socioeconomic determinants and life events on dietary behaviours. The identification of life periods and events leading to changes in dietary behaviours enables on one hand to improve knowledge regarding pathways underlying socioeconomic inequalities in health related to nutrient and food intake, and on the other hand to determine target populations for interventions. Adapting nutritional public interventions among social subgroups of the population and throughout the entire life is key to improve dietary behaviours
Diallo, Amadou Bassirou. "Four essays on the links between poverty, inequality and health with empirical application to developing countries : Africa compared to the rest of the world". Clermont-Ferrand 1, 2009. http://www.theses.fr/2009CLF10004.
Pełny tekst źródłaIn this dissertation, we are mainly interested in the interactions between poverty and one of its greatest dimensions, namely health. More specifically, we will focus on their inequalities: does poverty inequality have more effect on poverty that health level? Does health inequality matter to poverty? Poverty and health are two related concepts that both express human deprivations. Health is said to be one of the most important dimensions of poverty and vice-versa. That is, poverty implies poor health because of a low investment in health, a bed environment and sanitation and other living conditions due to poverty, a poor nutrition (thus, a greater risk of illness), a limited access to, and use of, health care, a lower health education and investment in health, etc. Conversely, poor health leads inevitably to poverty due to high opportunity costs occasioned by ill-health such as unemployment or limited employability (thus a loss of income and revenues), a lower productivity (due to loss of strength, skills and ability), a loss of motivation and energy (which lengthen the duration of job search), high health care expenditures (or catastrophic expenditures), etc. But what the degree of correlation and the direction of the causality between these two phenomena? Which causes which? This is a classic problem of simultaneity that gas become a great challenge for economists. Worst, each of these phenomena (health and poverty) has many dimensions
Ancian, Julie. "Des grossesses catastrophiques. Une sociologie des logiques reproductives dans les mises en récit judiciaires et biographiques de néonaticide". Thesis, Paris Sciences et Lettres (ComUE), 2018. http://www.theses.fr/2018PSLEH123.
Pełny tekst źródłaThe term infanticide covers diverse realities too long understood in an undifferentiated way. Among them, neonaticide refers to the murder of a newborn within twenty-four hours of birth. In countries with a high access to contraception and abortion, this behavior – formerly associated with birth control – has become marginal. This research proposes a sociological approach to the practice of neonaticide based on its narratives by the courtrooms and by the authors themselves in France (2005-2015). The investigation led to a series of in-depth interviews with five women prosecuted for these acts and to observe five trials in criminal courts. These materials were supplemented by interviews with lawyers and magistrates, court files and a corpus of press articles covering 75 cases judged over the same period. Courtrooms narratives reveal the essentialist approach to motherhood and procreation, which weighs on the intelligibility efforts made by professionals. The analysis of women's life stories, their socialization processes, their intimate partner and family situations and their resources, makes it possible to identify the obstacles encountered in implementing effective contraception or accessing abortion. By apprehending neonaticide as the ultimate means to avoid a birth deemed catastrophic, this study moves away from the individualizing interpretation imposed by the judicial treatment and documents the reproductive agency of women