Дисертації з теми "Contexte épidémiologique"
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Aounallah-Skhiri, Hajer. "Mode de vie et santé de l'adolescent en Tunisie dans un contexte de transition épidémiologique." Paris 6, 2010. http://www.theses.fr/2010PA066108.
Повний текст джерелаDamien, Barikissou Georgia. "Evaluation épidémiologique de l’efficacité des stratégies de lutte anti-vectorielle contre le paludisme dans un contexte de lutte intégrée." Thesis, Montpellier, 2015. http://www.theses.fr/2015MONTT044/document.
Повний текст джерелаDespite national and international efforts, malaria remains a major public health in many countries. Health systems are hindered by the lack of information on the actual burden of malaria and the effectiveness of vector control tools. Vector-control measures are a component of integrated malaria control strategies. The objective of our thesis was to evaluate the efficacy and the effectiveness of malaria vector control tools using parasitological and clinical criteria.With a block randomized control trial, we investigated whether the combination of long-lasting insecticidal mosquito nets (LNs) with indoor residual spraying (IRS) or Carbamate-treated Plastic Sheeting (CTPS) conferred better protection against malaria vectors than did LNs alone. The clinical incidence density of malaria was not reduced in the children from the "Universal LN" group (incidence density rate (0.95, 95% CI 0.67–1.36, p=0.79), nor in those from the "Target LN + IRS" group (1.32, 0.90–1.93, p=0.15) or from the "Universal LN + CTPS group (1.05, 0.75–1.48, p=0.77) compared with the reference group "Target LN". The same trend was observed with the prevalence and parasite density of asymptomatic infections. The evaluation of the effectiveness of vector control tools is possible but requires enormous technical, logistic and financial resources. The evaluation of the effectiveness of malaria vector control tools after distribution requires a more flexible epidemiological study. Considering the ethical and financial constraints of the longitudinal study, we validated the use of a case-control study to this purpose. It was conducted primarily among children aged 0-5 years old and then applied to the entire population. Results were spatial dependant when taking into account age and compliance to chemoprophylaxis as confusion factors, use of other vector control tools, sex, and economic status, school level of the mother or the head of the house. In the rural area, the use of LNs provided significant level of protection (40-50%) against clinical cases among children aged 0-5 years old. This significant protection was obtained among all population only if the LNs were associated to IRS. In the urban area, the use of LN was not provided protection against clinical cases but reduce 50% of the risk of Plasmodium falciparum infection in one neighbourhood. The limits of this case-control study may be intrinsic to control measures (lake of coverage, vector resistance to insecticides etc.). The exposure of vector control tools measures may also be subject to bias. Several factors interfering with the success of malaria control were discussed. The first negative factor to the effectiveness of vector control tools was the "no use of LNs". Then follows the immediate environment where the fight against vectors took place. The description of the room where played vector control fighting shows that the space available for all the actors (LNs, IRS, humans and vectors) to play their role properly is quite limited. This space is often poorly enlightened. Similarly the presence of open flames is involved in the degradation of the physical integrity of LNs. The presence of holes on the bed-nets indicates a loss of effectiveness because from a hole index above 100, individuals are highly exposed to the bites of vectors. In addition, An. funestus, one of the main vectors of malaria transmission in the study area, bitted after 6:00 am and provides much of the transmission in outdoor. Finally, the nets can also create personal injury as fire. At the end our work, we conclude that the innovative vector control tools are required to improve malaria vector control. But, operational research seems now essential as the vector control tools used on a large scale have provided good efficacy results in the laboratory. The challenge then is to obtain comparable results in real condition of use and look for effectiveness barriers
Kalantari, Soudabeh. "Étude épidémiologique et clinique des violences vécues par les femmes iraniennes : clinique des violences en contexte conjugal en Iran à Téhéran." Phd thesis, Université Rennes 2, 2012. http://tel.archives-ouvertes.fr/tel-00785574.
Повний текст джерелаWasniewski, Marine. "Apport des outils de détection de l’immunité adaptés au contexte épidémiologique pour le contrôle et la surveillance de la rage animale." Thesis, Paris Est, 2018. http://www.theses.fr/2018PESC1093.
Повний текст джерелаRabies is a deadly zoonosis that can affect wild and domestic mammals as much as humans. About 70,000 human deaths are reported each year, mostly in children from developing countries. Dogs, which are the major reservoir and source of the RABV species, account for 98-99% of these deaths. Currently, fourteen species of Lyssavirus, mainly circulating in chiroptera, are officially recognized. Vaccination, combined with sanitary measures, remains the best tool for preventing and controlling the disease. To date, only serology has allowed to control the effectiveness of rabies vaccination, as the production of neutralizing antibodies is the first evidence of protective immunity. Studies based on viral seroneutralisation, including my own studies, have highlighted the influence of various factors. Some of them have led to recommend modifications of vaccine protocols. They also contributed to monitor the effectiveness of individual or group vaccination field programmes and to improve these programmes. Seroneutralisation tests are also used in the context of the epidemiological surveillance of unvaccinated animal populations. I first successfully adapted these tests to lyssaviruses of interest in France. In a second step, their implementation in chiropters in France provided information on the circulation of EBLV-1 and EBLV-2 species, (only on a serological basis for the latter). This survey also allowed to highlight, within a specific colony, a phenomenon of serological transition over time, which should deserve to be studied further. However, seroneutralisation tests are difficult to be implemented in countries where rabies is very prevalent, mainly because of limited resources. My work, which recommends the use of an ELISA test as an alternative method, contributed to questioning the dogma of the necessary use of seroneutralisation tests. This test, coupled with a blood sampling system adapted to the field, should improve the monitoring of the effectiveness of vaccination campaigns for both wildlife and domestic animals, including in enzootic countries, where the quality of the blood samples cannot be guaranteed. Humoral immune response assessment tools are very valuable tools for the control and surveillance of animal rabies all around the world. My work, complementary to those carried out by other teams, has helped to make the priority objective of international organizations possible, i.e. the eradication of canine rabies in the world by 2030. However, further works are needed to improve the available tools and to propose more adapted ones, in order to achieve all the goals of eradication, for both canine and sylvatic rabies
Charters, Kathleen Anne. "Putting health behaviour theory into context and context into health behaviour theory. : COVID-19 through the health psychology looking glass." Electronic Thesis or Diss., Paris, EHESS, 2024. http://www.theses.fr/2024EHES0042.
Повний текст джерелаThe COVID-19 pandemic highlighted the importance of health protective behaviours in reducing disease spread and subsequent health burden. Understanding the psychological determinants motivating behavioural engagement is therefore critical in an epidemic and pandemic setting. At the time of the pandemic outbreak, relatively little research attention had focused on the dynamics of human behavioural response to an unfolding, constantly evolving epidemic threat. This doctoral research therefore sought to address this gap in the literature firstly by investigating existing theory in the COVID-19 context, and secondly by expanding upon existing theory to account for the epidemic setting, thereby putting health behaviour theory into context and context into health behaviour theory. To this end, the first part of the doctoral research investigated two health behaviour issues of concern to researchers and health authorities: unrealistic optimism and risk compensation. Findings from the first repeated cross-sectional study (N=12,378), conducted at pre-, early and peak first-wave epidemic stages (February–April 2020) in France, Italy, Switzerland and the United Kingdom, indicated that people across all four countries became increasingly unrealistically optimistic over time and that this was associated with behavioural disengagement. Results of the second study (N=14,003) during the initial eight months of the vaccine rollout in France (February–September 2021), suggested risk compensation occurred towards the end of the vaccine rollout, particularly towards avoidance of social gatherings among those with a completed vaccination schedule.As results from these initial studies suggested that the epidemic setting influenced risk appraisal and adherence to mitigation measures, and addressing a gap in the literature due to the paucity of research in this area, the second part of the doctoral study explored the effect of the epidemiological context on behaviour and the social cognitive pathways involved. Seventeen bi-monthly surveys were conducted over nine months (March–November 2020, N=34,016). Multilevel analysis revealed that there was an association between the epidemiological context and protective behaviour, with time serving to moderate the effect of incidence on behaviour. Further pathway analysis indicated that the effect of the epidemiological context on behaviour was only partially mediated by social cognitive variables. Surprisingly, with the exception of perceived social norms, which made the greatest mediational contribution, social cognitions commonly and repeatedly found to predict behavioural response contrastingly contributed little to mediating the epidemiological context–behaviour relationship. Implications for theory, future research, public health policy and practice are discussed. Above all, these research findings highlight the need to nurture theory by examining, testing and expanding upon it in different contexts. Through its extension of extant theory to an epidemic of an emerging infectious disease, COVID-19, the current investigation explored the underlying layers of influence and possible causal mechanisms involved in the complex and dynamic psychological process of risk appraisal and behavioural engagement. By putting theory into context and context into theory, this doctoral research sought to nourish and advance theory, thereby making a significant contribution to the field of health behaviour research
Imounga, Laure Manuella. "Contexte sanitaire et situation épidémiologique de la Guyane vis-à-vis des cancers : comparaisons infrarégionales, nationales, internationales et Spécificités Gastric cancer incidence and mortality in French Guiana: South American or French ? Incidence and mortality of cervical cancer in French Guiana: temporal and spatial trends." Thesis, Guyane, 2020. http://www.theses.fr/2020YANE0013.
Повний текст джерелаThe purpose of this study was to know the epidemiological situation of French Guiana with regard to cancer between 2005 and 2014 in terms of incidence and mortality, to study the evolution of these indicators, to compare them with those of mainland France for 2012 in order to highlight the specificities of French Guiana and then compare them with the Antilles and Latin America.The databases of the French Guiana Cancer Registry and CépiDC-INSERM identified 4,392 new cases and 1,305 cancer deaths in French Guiana between 2005 and 2014 and highlighted an excess incidence and mortality in men. The most frequent and fatal cancers in men over the 2005-2014 period, ranked by mortality were: prostate, lung, stomach, liver, colon-rectum and pancreas. In women, the most frequent and fatal cancers were breast, cervix, colon-rectum, lung, ovary, and cancer of the stomach.The analysis of incidence and mortality of all cancers showed that the epidemiological situation between 2005 and 2014 was more favorable overall in French Guiana than in mainland France in 2012. However, cancers and cancer deaths occur much earlier in French Guiana with younger median age of at diagnosis and at death than in France. In addition, the sex ratio was similar for incidence and lower in French Guiana than in France in terms of mortality, i.e. a smaller gap between men and women in French Guiana which suggests a more unfavorable situation among women in French Guiana than in France. Between 2005 and 2014 * (* 2012 for France), the incidence of all cancers declined in men and slightly increased in women in the two territories. Cancer mortality declined in men and slightly increased in women in French Guiana, while incidence and mortality both declined in mainland France. Certain cancers in French Guiana were on the rise compared to France (lung, colon-rectum, breast, thyroid, multiple myeloma and plasmacytoma).Through the spatial analyzes, we were able to show that French Guiana presented municipal disparities. In comparison with France, certain cancers were over-represented in terms of incidence and mortality (prostate, stomach, cervix, multiple myeloma and plasmacytoma with an inversion of the sex ratio for the latter location). The comparative analysis of these cancers with the West Indies and the countries of Latin America has shown similar epidemiological profiles according to the type of cancer and the region of the world considered. French Guiana often has a profile that resembles Latin America for cervical cancer and gastric cancer.These specificities reflect the many particularities of French Guiana: youth, social inequalities, ethnic composition, climate, greater sedentary lifestyle and obesity, lower consumption of alcohol and tobacco, deficiencies ... all factors that shape the risk of cancer.This study is in line with the requirements of the French Cancer Plan and its results could be used to implement actions for the prevention and therapeutic management of cancers in French Guiana. Further studies on the stage at diagnosis and survival of cancers seem important in order to have a broader overview of the epidemiological situation in French Guiana
Clairet, Anne-Laure. "Gestion des risques médicamenteux dans des contextes spécifiques : typologie et épidémiologie." Thesis, Bourgogne Franche-Comté, 2019. http://www.theses.fr/2019UBFCE020.
Повний текст джерелаThe medical management of a patient is a multidisciplinary process consisting of several stages: prescription, dispensation, administration. Securing the medical management of a patient is essential to control the iatrogenic risk. In France, for all causes, nearly 6.2 serious adverse events occur per 1000 days of hospitalization (9.2 in surgery and 4.7 in medicine), or about one serious adverse event every five days in a hospital ward with 30 beds. Medication errors would be estimated at nearly 60,000 to 130,000 per year, nearly half of which would be preventable.Clinical pharmacy is a health discipline focused on the patient whose exercise aims to optimize the therapeutic management at each stage of the care pathway. For this, clinical pharmacy acts contribute to the security, relevance and efficiency of the use of health products.The objectives of this thesis are to describe the pharmacist's role in the prevention and management of medication errors through the example of two unique care pathways and the management of a patient in a particular care context:- the care pathway of the patient initiating oral anticancer treatment;- the path of care of the elderly subject:o the role of the hospital pharmacist in the care and continuity of the elderly patient's care during acute hospitalization in a geriatric ward;o the training of community pharmacists in the preparation of outpatient medication reports and feedback on their implementation;- the hospitalization of a patient in intensive care unit.This work allows the synthesis of 3 examples related to the complexity of the care of the patients within the care pathways or in particular care contexts:- Acute management of a patient with chronic illness in a medical resuscitation department;- Chronic management of a medical oncology patient during the initiation of oral anticancer treatment;- The hospital and outpatient care of a polyp old patient.Drug risks differ according the type of treatment. Thus, the main risk identified during a first prescription of an oral anticancer drug is the self-medication of the patient. In intensive care, the pharmacist must be expert in order to be able to answer certain problems not seen in other conventional wards. New missions are entrusted to community pharmacists, especially in the care of the elderly.Faced with these new missions of the pharmacist and in view of the expertise required of a pharmacist in specialized care services (oncology, Intensive care unit for example), it is necessary to evolve some university education
Girdary, Laurent. "Analyse géographique de la transition de la dengue suivant les contextes d'habitations en Guadeloupe." Thesis, Antilles-Guyane, 2012. http://www.theses.fr/2012AGUY0565/document.
Повний текст джерелаAt present, dengue fever has become the arbovirose the most wide-spread worldwide with 40 % ofthe exposed population, 2,5 billion people. The disease is endemie in all the continents excepted Europe even though the fust cases ofautochthonoustransmissionwere observedinmetropolitanFranceandCroatiain2010.Because oftherecentincrease of its incidence, dengue fever is now a major public health problem in the tropical countries and a threat for the other countries in the worldwide. Due to its mode oftransmission, the disease is closely linked to the environment. Urbanization is an important factor ofthe emergence or the re-emergence of dengue in the tropical countries. This study aims to analyze the links between health and environment domains, which correspond to the epidemiological situation of the dengue and the evolution ofthe urbanization in Guadeloupe.Information about suspect and confirmed cases of dengue were collected. The incidence of suspect and confirmed cases has been estimated, then represented at two different administrative boundaries: communes and sections. Environmental factors including the physical and socio-demographic variables were taken into account to the definition, the identification and the analyze ofevolution of the housing patterns during the studied period. Two methods were used: Il Raster" consisting of a regular analysis based on squares units and "Vector" based on the administrative limits of sections. These classifications allowed to describe the distribution ofthe different housing patterns ofGuadeloupe and to estimate indicators for the analyzing of sanitary data. The results highlight a worsening ofepidemiological situation ofthe dengue over the time in the department. Major outbreaks occurred in 2001,2005/2006 and 2007. The north Basse-Terre, the Pointe-à-Pitre urban area as weIl as the whole coast (frOID the city of Gosier to Saint-François) ofthe southeast ofGrande-Terre were the most affected regions by the increase ofincidence of dengue. Concerning the housing classes, eight different patterns were identified: tourist, natural, intermediate, agricultural, residential, rural, suburban and urban. The intermediate class corresponds to buffer regions between the other patterns. The difference between the agricultural and rural contexts lies in the predominance ofagricultural surface for the first one while the rural context is characterized by the inhabited farmland. The evolution over time of spatial extend ofthese patterns was described in relation with incidence. Results showed that the housing patterns are statically associated with the incidence ofdengue in Guadeloupe. In particular, the touristic, residential and rural patterns have a high positive association with dengue incidence
Venier, Anne-Gaëlle. "Pseudomonas aeruginosa en réanimation : épidémiologie et facteurs de risque d’acquisition." Thesis, Bordeaux 2, 2011. http://www.theses.fr/2011BOR21851/document.
Повний текст джерелаDespite major advance in techniques and reinforcement of infection control measures, Pseudomonas aeruginosa remains frequent in intensive care unit (ICU) and is responsible for severe hospital-acquired infections. Several patient and pathogen-specific risk factors have been associated with acquisition of P. aeruginosa in ICUs Nevertheless those risk factors were identified in monocentric studies which rarely took in account the context of cares. If individual risk factors for P. aeruginosa acquisition have appeared to be predominant since then, the role of contextual variables seems to have been underestimated. This thesis provides insight into the epidemiology of P. aeruginosa in ICU, identifies individual and contextual risk factors for P. aeruginosa infection and P. aeruginosa acquisition and emphasizes the interest of contextual variables which gives new perspectives to P. aeruginosa prevention
Signoli, Michel. "Etude anthropologique de crises démographiques en contexte épidémique : aspects paléo et biodémographiques de la Peste en Provence." Aix-Marseille 2, 1998. http://www.theses.fr/1998AIX2651U.
Повний текст джерелаHamada, Sophie Rym. "Analyse de la prise en charge des patients traumatisés sévères dans le contexte français : processus de triage et processus de soin." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS572.
Повний текст джерелаIn France, the third most frequent cause of disability adjusted life years lost is trauma, an observation that makes trauma a public health challenge. However, investment in trauma care and specific research fails to meet this challenge and to acknowledge the associated societal and economic impact.The purpose of this research was to explore the core of the pathway of a major trauma patient and bring to light key issues and question and to find answers. The data used in this research were mainly extracted from a regional and national trauma registry, the Traumabase®. The registry collects epidemiological, clinical, paraclinical and therapeutic variables for patients with severe trauma admitted to participating trauma centres. The first project focused on the effects of triage on patients with severe trauma following a road traffic accident in the Ile de France region. Patients who were initially under triaged and then transferred to regional trauma centres did not have a worse prognosis than patients who were transported directly. The emergency medical system as a whole ensured that they would have an equivalent outcome. A population analysis carried out by a probabilistic data chainage using the accident records of the National Road Safety Observatory made it possible to approach the undertriage rate leading to death in the region (0.15%) and to reveal that 60% of deaths occurred before any hospital admission. The second project developed a pragmatic pre-alert tool based on simple, clinical prehospital criteria to predict acute hemorrhage in trauma patients. This tool is meant to increase the performance of the receiving hospital trauma team of these critically sick patients and activate a specific hemorrhage pathway. The study identified five variables (shock index>1, mean blood pressure <70mmHg, capillary hemoglobin <13g/dL, unstable pelvis and intubation). If two or more variables were present, the tool identified patient with acute hemorrhage and the corresponding pathway should be activated. This tool requires prospective validation and assessment of its impact on care provision and patient outcome.The third research project focused on a therapeutic component of trauma induced coagulopathy. The study attempted to quantify the effect of fibrinogen concentrate administration at the early phase of traumatic hemorrhagic shock (first 6 hours) on 24 hours all-cause mortality using a causal inference approach (propensity score and double robust estimator). The research did not demonstrate any impact on mortality (observed risk difference: -0.031, 95% confidence interval [-0.084; 0.021]); a lack of power might be responsible for this result
Joly, Pierre. "Estimation de la fonction de risque dans un contexte général de troncature et de censure : application à l'estimation de l'incidence de la démence." Bordeaux 2, 1996. http://www.theses.fr/1996BOR28397.
Повний текст джерелаAhmed, Ammar Abdo. "Influence des comportements à risque sur l'épidémiologie du VIH à Djibouti et mise en place d'un système d'alerte précoce aux épidémies dans un contexte de ressources limitées." Phd thesis, Université Pierre et Marie Curie - Paris VI, 2009. http://tel.archives-ouvertes.fr/tel-00813143.
Повний текст джерелаBelhadj, Ihssen. "Ingénierie des connaissances pour l’épidémiologie et l’aide à la décision en santé publique : Analyse des besoins potentiels et expérimentations dans le contexte du registre français des maladies rénales." Thesis, Paris 13, 2014. http://www.theses.fr/2014PA132068.
Повний текст джерелаExpressing terms referring to pathological conceptualization is an important issue toward the development of clinical research and public health decision support systems. From the context of the French Registry of End Stage Renal Disease, requirements for disease terms representation are anlysed highlighting the acute and hidden problem of statistical continuity in disease data and knowledge representation. The underpinned assumption relies on the idea of ensuring terminological continuity through agenerative method of building Ontology Based Terminological systems. Rather than looking at all the terms that are necessary to describe a domain, we focused solely on the modeling of basic and definitional knowledge about disease. A set ontological rules for diseases hierachies were defined. Eperiments have been designed and implemented taking advantage of GC formalism and a logic programming toll called prolog-GC. The results confimed that such method allow performing two major activities that are carried out in the conventional building process of medical terminologies : refinement of disease terms granularity and consistency improvement. Terminological continuity needs to be considered as major criteria in disease terminological building. Generative approaches helps to improve the terminological continuity as imposes to create news terms of the bases of existing ones formal definitions
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.
Повний текст джерелаMancini, Julien. "Information et participation de patients dans divers contextes de décision en cancérologie." Aix-Marseille 2, 2008. http://www.theses.fr/2008AIX20683.
Повний текст джерелаBenmarhnia, Tarik. "Vulnérabilité à la chaleur dans le contexte des changements climatiques." Thesis, Paris 11, 2015. http://www.theses.fr/2015PA11T003/document.
Повний текст джерелаClimate change is one of the biggest public health threats in the 21th century. An increase in temperatures will lead to an increase in mortality attributable to temperature. In addition, some populations and territories are particularly vulnerable to the impact of increases in heat. It is thus necessary to identify these populations and territories as well as examine future heat-Related health impacts in order to recommend equity-Oriented policies today and in the future. The general objective of this thesis is to document current and future heat-Related vulnerability factors in the context of climate change. In order to address this general objective, the thesis involved four components: a) to conduct a systematic review and a meta-Analysis to assess the heterogeneity in the heat-Mortality associations with respect to individual and contextual population characteristics; b) to identify whether and how the magnitude of mean temperature effects on all-Cause mortality were modified by chronic air pollution exposure, social deprivation, and a combination of these two dimensions; c) to develop a method to quantify the climate change impacts on heat-Related mortality using climate modeling; d) to assess historical and future social disparities in years of life lost caused by ambient temperature in Montreal and Paris, and compare these estimates as well as the impact of climate change on social disparities between the two cities. This thesis highlights which populations are more vulnerable to heat and shows that several differences exist with regard to guidelines from international public health institutions for the identification of vulnerable populations. This thesis also identified chronic air pollution exposure as a new vulnerability factor in heat-Related mortality and that it has a double interaction with social deprivation. Furthermore, in this thesis a novel method to quantify future heat-Related mortality was developed which emphasized the strong evidence of an increase in heat-Related mortality under climate change. This method was then applied to estimate the increase in daily years of life lost social disparities in both Montreal and Paris under climate change which showed that this increase would be greater in Montreal compared to Paris in the future. Thus, this thesis which used a variety of epidemiologic methods has clarified which populations are particularly vulnerable to heat impacts and challenges guidelines for the identification of vulnerable populations from international public health institutions. It has also highlighted the climate change impacts on health inequalities and aims to reorient equity-Focused policies
Esnault, Olivier. "Diversité des agents pathogènes de l’abeille dans le Sud-Ouest de l’Océan Indien dans un contexte d’invasion récente de Varroa destructor et mortalités associées." Thesis, La Réunion, 2018. http://www.theses.fr/2018LARE0044/document.
Повний текст джерелаThe honeybee (Apis mellifera) is a key species in its native range for both ecosystem services offerred and for bee products. However, its populations are subject to various biotic stressors responsible for significant mortalities. In the South-West Indian Ocean region the endemic bee subspecies is A. m.unicolor. However, no studies had been carried out on its pathosphere and it is only since 2010 where the ectoparasite Varroa destructor invaded some of these islands, threatening this subspecies, that first studies were conducted. In this thesis work, we carried out a general inventory of the health of honeybee herds through descriptive epidemiological surveys in the majority of islands: Réunion, Mauritius, Rodrigues, Madagascar and Seychelles. We were able to show quite similar epidemiological facies between islands, characterized by a dominance of Nosema ceranae especially in small islands (80-100%) and the presence of 3 viruses: BQCV (4-89%), CBPV (2- 51% except in Rodrigues) and DWV (4-40% except in Reunion). Other pathogens have only been found in certain territories such as Aethinatumida, Braula pretoriensis, Acarapis sp. or Melissococcus plutonius. The analysis of the genetic diversity carried out on the 3 viruses showed a proximity of viral strains within the SOOI. Surveys conducted in a context without varroa showed good colony health with no clinical signs. The observed mortalities concerned only the territories invaded by varroa: Madagascar, Mauritius, Reunion. Varroa therefore appears to be the main cause of acute colony mortality in the area long before other pathogens or environmental causes. Its impact on bee populations and ultimately on native ecosystems will be evaluated in future years
Kamega, Aymric. "Outils théoriques et opérationnels adaptés au contexte de l'assurance vie en Afrique subsaharienne francophone - Analyse et mesure des risques liés à la mortalité." Phd thesis, Université Claude Bernard - Lyon I, 2011. http://tel.archives-ouvertes.fr/tel-00654549.
Повний текст джерелаMatukala, Nkosi Thomas. "Relation entre statut socio-économique et incidence du cancer du poumon dans le contexte d’une étude cas-témoins montréalaise." Thèse, 2010. http://hdl.handle.net/1866/3807.
Повний текст джерелаSeveral studies have reported that socioeconomic status (SES) is inversely associated with the risk of lung cancer. This thesis investigates different aspects of the relationship between SES and lung cancer risk in order to improve our understanding of the factors influencing the risk of this disease. Its overall objective is to explore associations between SES and risk of lung cancer according to: 1) different indicators of SES, 2) types of adjustments for smoking, and 3) potential intermediate risk factors of the association between SES and lung cancer. Data from a large case-control study conducted in Montreal between 1996 and 2002, and assessing the role of environmental factors in the etiology of lung cancer, were used. The sample analyzed consisted of 1,203 cases (738 men and 465 women) diagnosed in 1996-1997 across 18 major hospitals in the Greater Montreal and 1,513 controls (899 men and 614 women). Controls, recruited randomly from the electoral list, were frequency-matched to cases by age, sex and electoral district. The subjects were interviewed to collect information on a wide range of factors, including socio-economic and demographic characteristics, smoking and occupational history, and diet. Additional data collection was conducted specifically for this thesis. Indeed, property value assessments were obtained from the public database of the City of Montreal using the participants’ addresses provided at the time of interview. The first article compares how different indices of financial availability, i.e., an index based on residential values, the median income from census data, and the selfreported household income, each recoded into 5 categories, classified study participants. When compared to the self-reported household income, very good concordance was observed for the residential value index and the census income (73% and 64%, respectively). The weighted kappa was higher when comparing selfreported household income with the residential value index (Kappap=0.36, IC 95%: 0.31-0.40) than with the census income (Kappap=0.22, IC 95%: 0.17-0.27). The choice of the financial availability index, resides, however, on the study objectives and feasibility aspects in the study population. The second article describes associations between the three indices of financial availability and the risk of lung cancer. The strong associations observed initially with crude models disappeared after adjustment for the multiple dimensions of smoking. Smoking therefore played an important role in the relationship between SES and risk of lung cancer. Finally, potential intermediate risk factors of the association between three different dimensions of SES - education, income, occupational class - were studied. The results suggest that the three potential intermediate risk factors examined, i.e., smoking, intake of carotenoid-containing fruit and vegetables, and occupational exposures, had an independent mediating effect on the relationship between SES and lung cancer. The most important mediator was smoking, followed by diet, and, to a much lesser extent, occupational exposures. Future studies on the relationship between SES and lung cancer risk would benefit from considering various SES indicators when possible, and should apply a detailed adjustment for the different smoking dimensions. A better understanding of the various intermediate risk factors is essential for formulating preventive measures for lung cancer.
Ripoche, Marion. "Estimer le risque associé aux maladies vectorielles dans un contexte d’émergence : cas de la maladie de Lyme et du virus du Nil occidental au Québec." Thèse, 2017. http://hdl.handle.net/1866/20742.
Повний текст джерелаPirkle, Catherine M. "Measuring and evaluating quality of care in referral maternities in Mali and Senegal in the context of overlapping interventions." Thèse, 2012. http://hdl.handle.net/1866/9891.
Повний текст джерелаIn this thesis, we describe the results of a research project that aimed to measure and evaluate quality of care in referral hospitals in Mali and Senegal. In these countries, hospital maternal mortality is high and linked, in part, to inadequate medical practice. This research was conducted as part of the QUARITE cluster randomized trial that assessed whether the program, ALARM International, could reduce facility maternal mortality. ALARM was implemented from 2008 to 2010 and consisted of the training of local health professionals and the use of maternal death reviews. At the same time as QUARITE was ongoing, programs for the prevention of maternal to child transmission of HIV (PMTCT) were scaled- up; these can also improve obstetrical quality of care. Thus, we evaluated the effects of both programs (ALARM and PMTCT) on quality of care. We began with a systematic review of the literature to evaluate the capacity of a criterion-based clinical audit to measure the quality of obstetrical care (article 1). This type of audit verifies if the care provided meets criteria indicative of best clinical practices, according to the literature and expert opinion. Our review demonstrates that this tool has been used in a variety of low- and middle-income settings, but the way it has previously been employed leaves doubts as to its validity (article 1). We thus developed a criterion based clinical audit specific to the West African context and approved by national and international expert obstetricians. Using patient medical records, with this instrument we evaluated obstetrical care provided during labour and delivery. Quality of care was calculated based on the percentage of care criteria met. Applied to different sites and by different auditors, our instrument demonstrated concordant results and provided a valid image of the quality of obstetrical care provided at hospitals in the region (article 3). Nonetheless, the audit experience raised concerns about the implications of poor medical recordkeeping and archiving on quality of care (article 2). We used the criterion-based clinical audit to review over 800 medical records at 32 QUARITE hospitals (16 intervention and 16 control hospitals) in order to evaluate the effects of the ALARM intervention. We demonstrated that the ALARM program contributes to better obstetrical quality of care, especially during the first clinical examination and postpartum monitoring of women treated at intervention hospitals (article 4). Finally, we used this instrument to evaluate the effects of PMTCT programs on obstetrical quality of care (article 5). Our work demonstrated that certain components of a PMTCT program, specifically training of healthcare professionals and supplementary nutritional services, are associated with better obstetrical care. In all, this research identified several mechanisms that can be targeted by quality improvement interventions in West Africa.
Pirkle, Catherine. "Measuring and evaluating quality of care in referral maternities in Mali and Senegal in the context of overlapping interventions." Thèse, 2012. http://hdl.handle.net/1866/9891.
Повний текст джерелаIn this thesis, we describe the results of a research project that aimed to measure and evaluate quality of care in referral hospitals in Mali and Senegal. In these countries, hospital maternal mortality is high and linked, in part, to inadequate medical practice. This research was conducted as part of the QUARITE cluster randomized trial that assessed whether the program, ALARM International, could reduce facility maternal mortality. ALARM was implemented from 2008 to 2010 and consisted of the training of local health professionals and the use of maternal death reviews. At the same time as QUARITE was ongoing, programs for the prevention of maternal to child transmission of HIV (PMTCT) were scaled- up; these can also improve obstetrical quality of care. Thus, we evaluated the effects of both programs (ALARM and PMTCT) on quality of care. We began with a systematic review of the literature to evaluate the capacity of a criterion-based clinical audit to measure the quality of obstetrical care (article 1). This type of audit verifies if the care provided meets criteria indicative of best clinical practices, according to the literature and expert opinion. Our review demonstrates that this tool has been used in a variety of low- and middle-income settings, but the way it has previously been employed leaves doubts as to its validity (article 1). We thus developed a criterion based clinical audit specific to the West African context and approved by national and international expert obstetricians. Using patient medical records, with this instrument we evaluated obstetrical care provided during labour and delivery. Quality of care was calculated based on the percentage of care criteria met. Applied to different sites and by different auditors, our instrument demonstrated concordant results and provided a valid image of the quality of obstetrical care provided at hospitals in the region (article 3). Nonetheless, the audit experience raised concerns about the implications of poor medical recordkeeping and archiving on quality of care (article 2). We used the criterion-based clinical audit to review over 800 medical records at 32 QUARITE hospitals (16 intervention and 16 control hospitals) in order to evaluate the effects of the ALARM intervention. We demonstrated that the ALARM program contributes to better obstetrical quality of care, especially during the first clinical examination and postpartum monitoring of women treated at intervention hospitals (article 4). Finally, we used this instrument to evaluate the effects of PMTCT programs on obstetrical quality of care (article 5). Our work demonstrated that certain components of a PMTCT program, specifically training of healthcare professionals and supplementary nutritional services, are associated with better obstetrical care. In all, this research identified several mechanisms that can be targeted by quality improvement interventions in West Africa.
Naimi, Ashley I. "Associations between area-level unemployment, body mass index, and risk factors for cardiovascular disease in an urban area." Thèse, 2009. http://hdl.handle.net/1866/2837.
Повний текст джерелаINTRODUCTION: Little is known about whether area-level unemployment is independently associated with individual-level Cardiovascular Disease (CVD) in an urban setting. Furthermore, it is unclear whether this relationship differs by sex. This thesis examined the direction and magnitude of the association between area-level unemployment (ALU) and Body Mass Index (BMI) and a marker for CVD risk, and whether this association differs by sex. METHODS: A sample of 342 individuals from the Montreal Neighbourhood Survey of Lifestyle and Health (MNSLH) self-reported behavioural and socioeconomic information. A registered nurse collected biochemical and anthropometric data. ALU was operationalised within a 250 m radius buffer centered on individual residence using a Geographic Information System (GIS). Generalized Estimating Equations were used to determine if body mass index (BMI), and a cumulative score for total cardiometabolic risk (TCR) representing elevated values for total cholesterol, triglycerides, high-density lipoprotein cholesterol, and glycosylated hemoglobin, were associated with ALU. RESULTS: After adjustment for age, gender, smoking status, behavioural, and socioeconomic covariates, living in an area in the upper ALU quartiles was associated with an elevated BMI [Q4 beta = 2.1 kg/m2 (95% CI: 1.02-3.20)] and greater TCR [Q4 RR = 1.82 (95 % CI: 1.35-2.44); Q3 RR = 1.66 (95% CI: 1.33-2.06)] relative to the 1st quartile. Sex-by-ALU interaction revealed a 1.99 kg/m2 (95% CI: 0.00-4.01) difference in BMI and 1.39-fold (95% CI: 1.06-1.81) greater TCR Score for women compared to men. CONCLUSIONS: Area-level unemployment is associated with greater CVD risk in men and women but associations are stronger among women.