Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background - Pregnant women are a vulnerable population. Although regular follow-ups are recommended during pregnancy, not all pregnant women seek care. This pilot study wanted to assess whether the integration of data from administrative health information systems and socio-economic features allows identifying disparities in prenatal care trajectories.Methods - Prenatal care trajectories were extracted from the permanent sample of the French health insurance information system linked to the hospital discharge information system. The records of 2518 women who gave birth without complications in France in 2009 were analyzed. State sequence data analysis was performed to identify homogeneous groups of prenatal care trajectories. Socio-economic data were used to characterize their living environment.Results -We identified three groups of homogeneous prenatal care trajectories: (i) women with relatively high prenatal care consumption (~11 %), (ii) women with no prenatal care (~21 %), and (iii) women with an intermediate level of prenatal care (~66 %). Analysis of the socio-economic data demonstrated the association between disparities in prenatal care trajectories and the women’s living environment. Women with relatively high care consumption generally lived in socio-economically privileged areas (better education levels, employment status and housing conditions) compared with women with few or no prenatal care.Conclusions -Although ecological, our approach demonstrates that data from health administrative information systems could be used to describe prenatal care. However, more individual variables and an improvement of the data quality are needed to efficiently monitor the content and timing of prenatal care. Moreover, state sequence analysis, which was used in this context for the first time, proves to be an interesting approach to explore care trajectories. Finally, the integration of heterogeneous sources of data, including contextual information, might help identifying areas that require health promotion actions toward vulnerable populations, such as pregnant women.
ISSN: 1472-6963

hal-01169792
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01169792
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01169792/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01169792/file/Mining%20care%20trajectories%20using%20health%20administrative.pdf
DOI : 10.1186/s12913-015-0857-5

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: Access to health care is a global public problem. In French Guiana, there exists social inequalities which are specially marked amongst immigrants who make up a third of the population. Health care inequalities are prevalent. The objective of this study was to determine factors associated with why health care amongst the poor population of Cayenne was renounced.Study design The study was cross sectional. It focused on knowledge, attitudes, practices and beliefs of the population living in poor neighborhoods of the Cayenne area. Methods: Populations coming at the Red Cross mobile screening unit in poor urban areas of Cayenne were surveyed from July 2013 to June 2014. Structured questionnaires consisted of 93 questions. Written informed consent was requested at the beginning of the questionnaire. The predictors for renouncing medical care were determined using logistic regression models and tree analysis. Results: Twenty percent of persons had renounced care. Logistic regression showed that renouncement of health care was negatively associated with having no regular physician Adjusted Odds Ratio (AOR)=0.43 (95%CI=0.24-0.79) and positively associated with being embarrassed to ask certain questions AOR=6.81 (95%CI=3.98-11.65) and having been previously refused health care by a doctor AOR=3.08 (95%CI=1.43-6.65) . Tree analysis also showed that three of these variables were linked to renouncement, with feeling shy to ask certain questions as the first branching.Conclusion: Although most people felt it was easy to see a doctor, one in five had renounced health care. The variables identified by the models suggest vulnerable persons generally had previous negative encounters with the health system and felt unwanted or non eligible for healthcare. Health care mediation and welcoming staff may be simple solutions to the above problems which were underscored in our observations.
ISSN: 1472-6963

hal-01288656
https://hal.archives-ouvertes.fr/hal-01288656
https://hal.archives-ouvertes.fr/hal-01288656/document
https://hal.archives-ouvertes.fr/hal-01288656/file/Predictive%20factors%20for%20renouncing%20to%20care%20in%20FG.pdf
PUBMEDCENTRAL : PMC4731954

Éditeur(s) : HAL CCSD
Résumé : International audience
Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines. To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997. The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011. Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3). A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks. The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
ISSN: 2168-6211

hal-01258705
http://hal.univ-brest.fr/hal-01258705
PUBMED : 25621457
DOI : 10.1001/jamapediatrics.2014.3351

Éditeur(s) : HAL CCSD
Résumé : International audience
In this paper we study how to detect anomalies in a distributed manner by using wireless sensor networks (WSN). We focus on a medical context, where existing works generally provide large environments to monitor patients using sensors as simple transducers. Those devices forward sensed health parameters to a main base station. This station collects received data and may perform some computations. In this paper, we perform some distributed tasks on the sensors. We propose a distributed algorithm which allows to raise alarms under some initial rules to alert efficiently medical staff in case of critical situations without needles warnings.
10th IEEE International Symposium on a World of Wireless, Mobile and Multimedia Networks, WOWMOM 2009.
KOS, Greece

hal-00519589
https://hal.archives-ouvertes.fr/hal-00519589

Éditeur(s) : HAL CCSD
Résumé : International audience
The aim of this study is to suggest an automated technique for distributed decision. It is based on protocol population deployed on Wireless Sensor Networks (WSN). This approach is able to help medical staff to detect earlier than usual some diseases on patients. It could be easily adapted for many other fields (fire monitoring, environment supervising, ...) In this context, a patient is equipped with health parameter transducers which are connected to a WSN. This WSN will perform some computations and raise an alarm when some diseases are suspected. The algorithm is distributed, i.e., the decision may be done by any mote dealing with the disease detection. The experimentations show promising results.
a venir
Denver, Colorado, United States

hal-00519597
https://hal.archives-ouvertes.fr/hal-00519597

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
Introduction. - Temocillin is an alternative to treat urinary tract infections with bacteria producing extended spectrum beta-lactamase (ESBL). The objective is to evaluate the use of temocillin in urinary tract infections. Materials and methods. - A systematic review of literature was carried out according to PRISMA criteria. All national and international recommendations have been reviewed regarding the indication of the use of temocillin in urology. Data collection on the use of temocillin in urinary tract infection has been performed from the Cochrane, LILACS and the Medline database. The following keywords were used: temocillin, extended spectrum. beta-lactamase, urinary tract infections, urine, prostate, epididymis, testis, diffusion, pharmacokinetics, pharmacodynamics. The selection was based on the methodology, language of publication (English/French), relevance to the topic and date of publication of the articles collected. The endpoint was to provide exhaustive scientific information allowing urologists to use this antibiotic in febrile urinary infections. Results. - Bacteria producing ESBL has a relatively high susceptible to temocillin, ranging from 61 % to 90 %. These rates would allow its use in probabilistic. The dosage recommended is currently, in the normo-renal patient, 4 g per day by intermittent infusion or continuously after a loading dose of 2g. Some studies argue, particularly in case of difficult clinical situations or obese patients, for administration of high doses (6 g/24 h) rather continuous infusion. There is no evident relationship between high doses and side effects. With an excellent urinary and prostatic diffusion, temocilllin might be recommend for the treatment of ESBL prostatitis. Conclusion. - Temocillin is known to have good urinary and prostatic diffusion. According to our results, this antibiotics is now a reliable alternative for the treatment of documented ESBL urinary tract infections. (C) 2017 Elsevier Masson SAS. All rights reserved.
ISSN: 1166-7087

hal-01659245
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01659245
DOI : 10.1016/j.purol.2017.07.242
PUBMED : 28869169

Éditeur(s) : HAL CCSD
Résumé : International audience
“Affective Computing is computing that relates to, arises from, or deliberately influences emotions” (R.W. Picard, MIT Press, 1997). Specifically, psychosocial equilibrium is now considered as a major issue for both individual and public health. Predicting human emotions via non-intrusive methods is a great challenge triggered by the rise of intelligent assisting systems. In order to determine the emotional state of a subject having a potential psychosocial disorder, it is required to process both neutral and expressive emotions. A computer-engineered method aiming to provide emotional information from videos is proposed. An original approach for affect classification and its interpretation is presented.The database is part of the HUMAINE database, and consists of a large volume of video clips, each displaying individuals, depressed or not, talking with a conversational agent. Both the high-dimensionality of data and its temporal aspect require a pre-training that consists of cleaning, sorting and feature selection, in order to make relevant information usable for further processing by MachineLearning methods. Next step consists in classifying the affective state of subjects according to their positivity or negativity (Russell's model, 1980). By means of six independent classifiers, each running a Support Vector Machine algorithm, separate performances are obtained for each class of emotions. The results reveal an interesting “neutral area phenomenon”, where emotions tend to be harder to be detected.Though more frequent, neutral emotions seem to carry less discriminant information than expressive ones. This issue will be a key for designing a tuning step in further research.
Caribbean Academy Of Science
Deshaies, France

hal-01408029
https://hal.univ-antilles.fr/hal-01408029

Éditeur(s) : HAL CCSD Awwa American Water Works Association
Résumé : International audience
A three-year study was conducted on the occurrence of disinfection by-products (DBPs) - trihalomethanes (THMs), haloacetic acids (HAAs), and haloacetonitriles - in drinking water of regions of Europe where epidemiology studies were being carried out. Thirteen systems in six countries (i.e., Italy, France, Greece, Lithuania, Spain, United Kingdom) were sampled. Typically chlorinated DBPs dominated. However, in most of Catalonia (Spain) and in Heraklion (Greece), brominated DBPs dominated. The degree of bromine incorporation into the DBP classes was in general similar among them. This is important, as brominated DBPs are a greater health concern. In parts of Catalonia, the reported levels of tribromoacetic acid were higher than in other parts of the world. In some regions, the levels of HAAs tended to be peaked in concentration in a different time period than when the levels of THMs peaked. In most epidemiology studies, THMs are used as a surrogate for other halogenated DBPs. This study provides exposure assessment information for epidemiology studies. © 2016 American Water Works Association.
ISSN: 0003-150X

hal-01406069
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01406069
DOI : 10.5942/jawwa.2016.108.0152

Résumé : Ce travail est l'expression d'une volonté de chercheurs, de la Carabe d'améliorer les connaissances scientifiques méso- et micro-météorologiques appliquées aux milieux insulaires sous influence des alizés et de développer la recherche dans ces domaines.On sait que le phénomène météorologique le plus remarquable impactant les îles de la Caraïbe reste le cyclone tropical. Mais d'autres phénomènes, a des échelles inferieures, telles que les pluies intenses, les houles, la dégradation de la qualité de l'air ont une importance aigüe en termes de risques naturels ou de risques sur la sante. Ces exemples attestent la nécessité d'utiliser des méthodes de descente d'échelle pour exploiter l'information météorologique et/ou climatique de grande échelle et dériver des scenarios locaux et régionaux appliques aux territoires insulaires. Ce défi est important car l'attente d'analyses scientifiques pertinentes dans ces domaines est grande.Les travaux présentés dans ce mémoire ont pour principaux objectifs la simulation numérique puis l'analyse des mécanismes méso- et micro-échelles qui induisent des circulations locales diurnes et nocturnes sur l'archipel de la Guadeloupe à l'aide de codes numériques météorologiques éprouves car largement utilises en recherche et en prévision opérationnelle.Ils constituent donc la première étude de modélisation numérique à haute résolution en basse atmosphère, par descente d'échelle dynamique, pour des intervalles d'espace compris entre 1 km et 111 m sur cet archipel.Le modelé atmosphérique Weather Research and Forecasting ARW V3.4 (WRF ARW), non-hydrostatique, a été utilise pour l'ensemble des simulations pour modéliser la troposphère depuis l'échelle globale à l'échelle de la turbulence.Trois situations météorologiques classiques réelles d'une durée de 48 heures, correspondant à 80 % des situations météorologiques observées dans la zone, alizes soutenus (AS), alizes moyens (AM), alizes faibles (AF) ont été examinées. Ces situations sont caractérisées par les valeurs du nombre de Froude local suivantes : 0,82 (AS), 0,41 (AM) et 0,21 (AF). Six domaines de modélisation ont été sélectionnés pour effectuer les descentes d'échelle dynamiques : D01 (maille de 27 km), D02 (maille de 9 km), D03 (maille de 3 km), D04 (maille de 1 km), D05 (maille de 333 m) et D06 (maille de 111 m) avec soixante-dix niveaux verticaux. Les quatre premiers domaines (D01 à D04) couvrent l'archipel de la Guadeloupe et sont utilisés en mode méso-échelle à l'aide d'un schéma d'ensemble de couche limite planétaire YSU. Les domaines D05 (couvrant l'île de la Basse-Terre et le centre de l'archipel) et D06 (couvrant la zone littorale et rurale du Petit Cul-de-Sac Marin et la zone urbaine de l'agglomération pointoise) sont utilisés en mode Large Eddy Simulation avec une fermeture de la turbulence 1,5 TKE 3D. Le modèle WRF a été forcé toutes les six heures par l'assimilation des champs d'analyses globales du modèle NCEP FNL (1° de résolution). Les simulations effectuées ont permis d'obtenir des champs de variables météorologiques 10-minutes à très hautes résolutions spatiales.Les résultats des simulations méso- et micro-échelles ont été confrontés aux valeurs expérimentales obtenues à l'aide de capteurs places sur des mâts météorologiques (campagne Atmo-Mangrov et réseau de mesure Météo-France). Il s'agissait d'optimiser l'utilisation des couplages de codes numériques tout en conservant la possibilité de les confronter aux observations expérimentales.Les résultats des simulations numériques micro-échelles, des différents cas (AS, AM, AF) sont utilisées pour forcer (c'est-à-dire définir les conditions limites) un modèle lagrangien de dispersion de particules : FLEXPART. Le système couple FLEXPART-WRF a été employé dans le domaine D06 pour étudier la dispersion du panache d'oxydes d'azote émis par la principale usine de production d'électricité de l'île.
The present work expresses the will of Caribbean researchers to improve the meso- and micro-meteorological scientific knowledge of the trade winds influenced island areas, and to develop research in these domains.It is well known that tropical hurricanes remain the most remarkable meteorological phenomena that affect the Caribbean islands. But some other phenomena, of smaller scale, such as intense rainfall events, swells, or air quality degradation, are of extreme importance for natural or health hazards. These examples show the need to use downscaling methods to exploit large scale meteorological or climatic information, and to obtain local and regional scenarios for the island areas. This is an important challenge, as sound scientific studies in these matters are eagerly expected. The aim of the research works exposed in the present dissertation is numerical simulation and analysis of the meso- and microscale mechanisms that induce diurnal and nocturnal local circulations in the Guadeloupe archipelago, using numerical meteorological models that are widely used in research and in operational forecasting.These works represent the first high-resolution (1 km to 111 m) numerical study of the lower atmosphere over the Guadeloupe archipelago. The Weather Research and Forecasting ARW 3.4 (WRF-ARW) model is used to simulate the troposphere from global scale to turbulence scale. Real cases of three typical weather types (80% of cases during a year) are examined during 48 hours : strong trade winds (STW), medium trade winds (MTW) and weak trade winds (WTW). These weather types are characterized by values of the local Froude number : 0.82 (STW), 0.41 (MTW) and 0.21 (WTW). Six domains have been selected for the dynamical downscaling : D01 (grid spacing of 27 km), D02 (grid spacing of 9 km), D03 (grid spacing of 3 km), D04 (grid spacing of 1 km), D05 (grid spacing of 333 m) and D06 (grid spacing of 111 m), including 70 vertical levels. The first four domains (D01 to D04) cover the Guadeloupe archipelago and are used in the meso-scale simulations with the planetary boundary layer scheme YSU (ensemble mean). Domain D05 (covering the Basse-Terre island and the middle of the archipelago) and domain D06 (covering the coastal and rural area of Le Petit Cul-de-Sac Marin and the urban area of Pointe-à-Pitre), are employed in the micro-scale simulation (LES) with the 3D TKE 1.5 order closure scheme. WRF has been 6 hourly reinitialized with the NCEP FNL global analyses (resolution of 1°). These simulations permitted to obtain 10-minutes meteorological variable fields with a very high resolution (111 m).Meso-scale and micro-scale model results have been evaluated with observational data from meteorological stations (field campaign Atmo-Mangrov, French Met Office).Once validated, the micro-scale model outputs have been used for the assimilation of the lagrangian particle dispersion model : FLEXPART. The coupling FLEXPART-WRF has been employed in domain D06, in order to analyze the dispersion of the nitrogen oxide plume emitted by the main power plant of the archipelago.

http://www.theses.fr/2014AGUY0735/document