Objectif : Un portrait limité de l’endométriose touchant la santé maternelle est actuellement connu. Ce mémoire vise à mettre en lumière une perspective exhaustive et empirique de la problématique de l’endométriose. Cette étude porte sur l’impact de l’endométriose sur la morbidité maternelle sévère chez les femmes enceintes au Québec afin de cibler des recommandations en santé publique. Méthodologie : Une étude de cohorte rétrospective basée sur une population constituée de 2 412 823 accouchements survenus en milieu hospitalier au Québec, Canada entre 1989 et 2019 a été effectuée. La variable d’exposition est l’endométriose confirmée par laparoscopie. L’issue d’intérêt est la morbidité maternelle sévère. L’association entre l’endométriose et le risque de morbidité maternelle sévère, ainsi que les risques associés individuellement aux conditions spécifiques constituant la morbidité maternelle sévère, ont été calculés à partir de modèles de régression log-binomiale. Les associations ont été présentées à partir de rapports de risque (RR) et des intervalles de confiance à 95% (IC95%). Résultats : Au total, 74 587 cas de morbidité maternelle sévère ont été rapportés durant la période de suivi. Les femmes atteintes d’endométriose avaient 1,24 (IC95% 1,20-1,28) fois le risque de morbidité maternelle sévère comparé aux femmes sans l’endométriose. L’endométriose était associée à l’hystérectomie (RR 1,62 ; IC95% 1,36-1,94), l’état septique (RR 1,53 ; IC95% 1,44-1,62) et l’embolie et le choc et de coagulation intravasculaire disséminée (RR 1,27 ; IC95% 1,10-1,47). Conclusion Les femmes enceintes atteintes d’endométriose sont plus à risque de morbidité maternelle sévère, comparativement aux femmes sans l’endométriose. / Objective A limited portrait of endometriosis affecting maternal health is currently known. This thesis aims to highlights an exhaustive and empirical perspective of the problem of endometriosis. This study focuses on the impact of endometriosis on severe maternal morbidity among pregnant women in Quebec in order to target public health guidelines. Methods A population-based retrospective cohort study of 2,412,823 deliveries occurring in hospital settings in Quebec, Canada between 1989 and 2019 was realized. The exposure variable was laparoscopically-confirmed endometriosis. The outcome variable was severe maternal morbidity. The association between endometriosis and the risk of severe maternal morbidity, as well as the individual risks associated with specific adverse outcomes were calculated using log binomial regression models. The associations were presented using risk ratios (RR) and 95% confidence intervals (95% CI). Results A total of 74,587 events of severe maternal morbidity were reported during the follow-up period. Women with endometriosis had 1.24 times (95% CI 1.76-2.12) the risk of severe maternal morbidity compared to women without endometriosis. The most severe maternal morbidity outcomes associated with endometriosis were hysterectomy (RR 1.62; 95% CI 1.36-1.94), sepsis (RR 1.53; 95% CI 1.44-1.62), and embolism, shock and disseminated intravascular coagulation (RR 1.27; 95% CI 1.10-1.47). Conclusion Pregnant women with endometriosis are more at risk of severe maternal morbidity, compared to women without endometriosis

Although several investigations have shown a relationship between increased epicardial adipose tissue (EAT) and atrial fibrillation (AF), the association between EAT and ventricular tachycardia (VT) has not been evaluated. We investigated the association between EAT and post-ablation VT recurrence. In this study, sixty-one consecutive patients (mean age=62.0±13.9) undergoing VT ablation with pre-procedural cardiac magnetic resonance imaging (MRI) were recruited. EAT thickness was measured using cardiac MRI in the right and left atrioventricular grooves (AVGs), RV free wall, anterior, inferior, and superior interventricular grooves (IVGs). During a mean follow-up period of 392.9±180.2 days, post-ablation VT recurrence occurred in 15 (24.6%) patients. EAT thickness was significantly higher in the VT recurrence group than that in the non-recurrent VT at the right (18.7±5.7 vs. 14.1±4.4 mm; p=0.012) and left (13.3±3.9 vs. 10.4±4.1; p=0.020) AVGs. The best cut-off points for predicting VT recurrence were calculated as 15.5 mm for the right AVG (area under ROC curve=0.74) and 11.5 mm for the left AVG (area under ROC curve=0.72). Multivariate Cox regression analysis showed that pre procedural right AVG-EAT (HR: 1.2; 95% CI: [1.06-1.39], p=0.004) was the only independent predictor of VT recurrence after adjustment for covariates. Kaplan–Meier analysis showed a difference for post-ablation VT recurrence between the two groups with right AVG-EAT thickness cut-off value of <15.5 mm versus ≥15.5 mm (log-rank, p=0.003). Based on the finding of this study, we suggested a new possible imaging marker for risk stratification of post-ablation VT recurrence. A higher EAT may be associated with VT recurrence after catheter ablation of VTs.:Epicardial Adipose Tissue Anatomy Embryology Physiology and Pathophysiology Measurement of EAT EAT and heart disorders Future direction VT Catheter Ablation History of VT ablation Catheter ablation for VT in structural and non-structural heart Outcome of VT catheter ablation Predictors of VT recurrence after catheter ablation Objectives of the thesis Publication Summary References

Missbruksproblematik är ett globalt samhällsproblem som kräver insatser, särskilt från verksamheter som socialtjänsten. Missbruk i kombination med psykisk ohälsa är komplextoch utmanande för individen. Det innebär att socialsekreterare, vårdpersonal och behandlare behöver samverka för att uppnå effektiv behandling. Studien syftar till att förstå socialsekreterares och behandlares upplevelser av samverkan, gällande klienter som lider av dubbbelproblematik i form av psykisk ohälsa och missbruk. Detta är en kvalitativ studie som använder sig av sociala representationer, handlingsutrymme och makt som teoretiska utgångspunkter. Genom sju semistrukturerade intervjuer samlades data in för att vidare analyseras utifrån de teoretiska utgångspunkterna i den tematiska analysen.Resultatet visar att de intervjuade socialsekreterarna och behandlarna upplever att samverkan är hjälpsam och nödvändig för personer med missbruk och dubbelproblematik. Trots detta framhålls det svårigheter med samverkan när yrkesverksammas åsikter kring insatser skiljer sig åt. Det framkommer otydligheter gällande ansvarsområden, där socialsekreterare och behandlare upplever att klienter flyttas mellan psykiatrin och socialtjänsten. Det visar även att socialsekreterare upplever hinder inom ansvarsområden vid början av ärendet, medan behandlare uttrycker liknande utmaningar under pågående behandling. Resultatet visar att behandlares handlingsutrymme verkar vara mer flexibelt än socialsekreterares vid val av metoder och strategier. Några faktorer som påverkar socialsekreterarnas handlingsutrymme är ekonomiska ramar, politiska begränsningar och brist på resurser. Avslutningsvis lyfter studien i sin helhet förståelsen för hur samverkan kan påverkas av olika faktorer, men även hur det kan påverka yrkesverksammas möjligheter att hjälpa klienter. / Substance abuse is a global societal issue that requires efforts, especially from social services. Substance abuse in combination with mental illness is complex and challenging for the individual. This means that social secretary, therapists and psychiatry need to cooperate to achieve effective treatment. The study aims to understand social workers and therapist experience of collaboration regarding clients who suffer from co-morbidity in form of mental illness and addiction. This is a qualitative study that utilizes social representations, space for action and power as theoretical foundations. Through seven semi-structured interviews. data is collected and further analyzed based on the theoretical foundations in thematic analyses.The results indicate that the interviewed social workers and therapists perceive collaboration as helpful and necessary for individuals with substance abuse and co-morbidity. Although, it appears difficulties with collaboration when professionals have differing opinions on interventions. Difficulties in collaboration are highlighted regarding responsibilities where social workers feel that clients are shifted between psychiatry and social services. The study's results showed that therapists appear to have more flexible space for action than social workers in choosing methods and strategies. Some factors affecting social workers' space for action are financial constraints, political limitations and lack of resources. In conclusion, the study highlights overall understanding of how cooperation can be influenced by various factors but also how it can impact the roles of professionals.

No description available.

Purpose: Social determinants of health (SDoH) and rurality have both been shown to contribute to severe maternal morbidity (SMM). Appalachian communities often embody this compounded risk, but regional SMM is under-explored. This study’s purpose is to explore SMM in rural areas of Appalachian states. Aims: There are two specific aims. 1) Describe the prevalence of rural SMM in Appalachian states. 2) Investigate the relationship between SMM and SDoH, specifically income, education, and care access. Methods: An IRB exempt, descriptive correlational study was conducted. Birth data (2018-2022) were extracted from the CDC WONDER database for 12 Appalachian states. Demographic, income, and education data were obtained from the U.S. Census. Access was measured by March of Dimes (MoD) maternity care categorizations. Descriptive statistics and Pearson’s correlations were conducted in IBM SPSS. Results: Rural SMM rates correlated with poverty (r =.803, p Conclusions: This study describes rural SMM in Appalachian states, showing correlation with poverty, education, and maternity care access. Limited access to care is correlated with a higher SMM burden for rural areas. This points to the need for further exploration into rural SMM, and the interplay of SDoH and geography in relation to maternal health.

No / BACKGROUND: Vitamin D deficiency rickets is associated with skeletal deformities including swollen rib junctions, bowing of the legs, and the flaring and fraying of the wrist and long-bone metaphyses. There is, however, scarce information on the direct effect of rickets on skeletal growth in either present or past populations. AIM: The study investigated the effect of vitamin D deficiency rickets on long-bone growth in two post-medieval skeletal populations from East London (Broadgate and Christ Church Spitalfields). Subsequently, inter-population growth variations in relation to non-specific environmental stress (dental enamel defects), industrialization, urbanization and socio-economic status during infancy (birth to 3 years) and early childhood (3-7 years) were examined. SUBJECTS AND METHODS: Data on long-bone diaphyseal length dimensions and stress indicators of 234 subadults from Anglo-Saxon, late medieval and post-medieval archaeological skeletal samples were analysed using both linear and non-linear growth models. RESULTS: Rickets had no effect on the growth curves for any of the long bones studied. However, pronounced variations in growth between the four populations were noted, mainly during infancy. The diaphyseal length of long bones of Broadgate were significantly smaller-per-age than those of Spitalfields and the other samples up to the age of 4 years, and were associated with a high prevalence of enamel defects during early infancy. CONCLUSION: Socio-economic status, rather than urbanization, industrialization or rickets, was the central factor behind the observed differences in growth among the post-medieval populations. The observed inter-population growth variations were only significant during infancy.

Background: This study examined the association of 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) with postoperative medical complications and one year mortality of elderly patients sustaining a low-energy cervical hip fracture scheduled for surgery. We hypothesized that vitamin D deficiency and CRP in these patients might be associated with an increased 1-year mortality. Methods: The prospective single-center cohort study included 209 patients with a low-energy medial femoral neck fracture; 164 women aged over 50 years and 45 men aged over 60 years. Referring to 1-year mortality and postoperative medical complications multiple logistic regression analysis including 10 co-variables (age, sex, BMI, ASA, creatinine, CRP, leukocytes hemoglobin, 25(OH)D, vitamin D supplementation at follow-up) was performed. Results: Vitamin D deficiency was prevalent in 87 % of all patients. In patients with severe (<10 ng/ml) and moderate (10–20 ng/ml) vitamin D deficiency one year mortality was 29 % and 13 %, respectively, compared to 9 % in patients with > 20 ng/ml 25(OH)D levels (p =0.027). Patients with a mild (CRP 10–39.9 mg/l) or active inflammatory response (CRP ≥ 40 mg/l) showed a higher one year mortality of 33 % and 40 % compared to 16 % in patients with no (CRP < 10 mg/l) inflammatory response (p = 0.002). Multiple logistic regression analysis identified CRP (OR 1.01, 95 % CI 1.00- 1.02; p = 0.007), but not 25(OH)D (OR 0.97, 95 % CI 0.89-1.05; p = 0.425) as an independent predictor for one year mortality. 20 % of patients suffered in-hospital postoperative medical complications (i.e. pneumonia, thromboembolic events, etc.). 25(OH)D (OR 0.89, 95 % CI 0.81–0.97; p = 0.010), but not CRP (OR 1.01, 95 % CI 1.00-1.02; p = 0.139), was identified as an independent risk factor. Conclusion: In elderly patients with low-energy cervical hip fracture, 25(OH)D is independently associated with postoperative medical complications and CRP is an independent predictor of one year mortality.

<p>The aim of this thesis was to explore the impact of physical, sexual and emotional violence against women of reproductive age and the level of controlling behaviour in marriage on child health and survival in two different cultural settings: Bangladesh and Nicaragua. </p><p>Data were acquired from four quantitative community-based studies. In two studies, a cohort including a prospective two year follow-up of 3164 mother-infant pairs in rural Bangladesh was investigated. A third study was a case-referent study in Nicaragua including mothers of 110 cases of under-five deaths and 203 referents, and in a forth study an other cohort of 1048 rural Bangladeshi women and their 2691 children was followed until 5 years of age. </p><p>Maternal exposure to any form of violence, including physical, sexual, emotional, and controlling behaviour was independently associated with lower body size at birth, increased risk of stunting and under-weight at 24 months of age, slower growth velocity during the first two years of life and a higher incidence of diarrhoeal episodes and respiratory tract infections. In the Nicaraguan setting, the children of women who experienced any history of physical violence had a two-fold increase in risk of death before the age of 5 years, and those whose mothers experienced both physical and sexual violence had a six-fold increase in risk of death. In Bangladesh, an association between violence against women and under-five mortality was found among daughters of educated mothers who were exposed to severe physical violence or a high level of controlling behaviour in marriage. In all four studies, lifetime violence experience among participating mothers was high (37-69%), and the timing was less relevant than the exposure to violence <i>per se</i>. </p><p>In conclusion, this investigation revealed that violence against women severely affects child health and survival. The findings are especially relevant in a context of high level of child under-nutrition, morbidity and under-five mortality. Efforts for protecting women from all forms of violence are needed as part of the interventions for improved child health.</p>

Rationnelle. La ventilation mécanique invasive (VI) s’accompagne lorsqu’elle se prolonge, d’une augmentation de la morbimortalité. Jusqu’à 64% des enfants hospitalisés aux soins intensifs sont ventilés et peu de données épidémiologiques existent afin d’estimer précocement la durée du support ventilatoire. Objectifs. Déterminer l’incidence et les facteurs de risque précoces de ventilation mécanique invasive prolongée aux soins intensifs pédiatriques. Méthode. Nous avons conduit une étude descriptive rétroélective sur un an. Tous les épisodes de VI aux soins intensifs du Centre hospitalier universitaire Sainte Justine de Montréal ont été inclus. Les facteurs de risque de VI prolongée (≥ 96 heures) ont été déterminés par régression logistique. Résultats. Parmi les 360 épisodes de VI, 36% ont duré ≥ 96 heures. Les facteurs de risques de ventilation prolongée en analyse multivariée sont : âge <12 mois, score de PRISM ≥ 15 à l’admission, pression moyenne dans les voies aériennes ≥13 cm H2O au jour 1 de ventilation, utilisation de la sédation intraveineuse continue au jour 1 de ventilation et ventilation non invasive avant intubation. Conclusion. La VI prolongée survient chez environ un tiers des patients ventilés. Les patients de moins de 12 mois semblent être plus à risque que les enfants plus âgés et devraient bénéficier de stratégies différentes pour diminuer leur durée de ventilation mécanique. La sévérité de la maladie, l’agressivité du support ventilatoire, l’utilisation d’une sédation continue au premier jour de ventilation sont également des facteurs à considérer dans les études visant à diminuer la durée de support ventilatoire. / Rationale. Invasive mechanical ventilation is associated, if prolonged, with higher morbidity and mortality. Up to 64% of children hospitalized in pediatric intensive care units (PICU) require invasive ventilation but little epidemiological data are available on children requiring prolonged acute invasive mechanical ventilation. Objectives. To determine the incidence rate and early risk factors for prolonged acute invasive mechanical ventilation in children. Methods. We conducted a retrolective longitudinal cohort study over a one-year period. All consecutive episodes of invasive mechanical ventilation in the PICU of Sainte-Justine Hospital were included. Risk factors for prolonged (≥ 96 hours) versus short (< 96 hours) ventilation were determined by logistic regression. Results. Among the 360 episodes of invasive ventilation, 36% had a length ≥ 96 hours. Following multivariate analysis, significant risk factors for prolonged acute invasive mechanical ventilation were: age <12 months, PRISM score ≥ 15 at admission, mean airway pressure ≥13 cm H2O on day one, use of continuous intravenous sedation on day one and use of non-invasive ventilation prior to intubation. Conclusion. Prolonged acute mechanical ventilation occurs in approximately one third of ventilated children. Younger children (aged <12 months) may be different from older patients and may require different strategies to decrease the duration of mechanical ventilation. Severity of illness, the aggressiveness of ventilatory support required and the use of continuous intravenous sedation on the first day of ventilation are also risk factors to consider in trials aimed at reducing mechanical ventilation duration.

Résumé: Les progrès réalisés dans le domaine médical ont permis un prolongement de l’espérance de vie, l’amélioration de la qualité de vie des patients; ce qui implique aussi des changements dans des domaines comme l’assurance-vie. Le principe de la tarification en assurance-vie est basé sur la comparaison du risque (probabilité) de décès d’un individu candidat à une police d’assurance à celui d’une population de référence la plus proche possible du candidat. C’est ainsi que l’analyse de la littérature médicale est devenue un outil indispensable dans la sélection des risques. L’assurance-vie est présente en Afrique subsaharienne depuis environ deux cents ans, mais les assureurs ne disposaient pas jusqu'à nos jours d’outils de tarification spécifiques au contexte africain. A notre connaissance notre travail est le premier effort de ce type à s’intéresser à ce sujet. Son objectif est d’élaborer un outil de tarification qui tiendra compte des aspects spécifiques de la mortalité et de la morbidité sur le continent africain. Dans une première partie nous avons conduit une revue de la littérature médicale disponible sur différents problèmes de santé; dans une seconde étape nous avons identifié les facteurs de risque de morbidité et de mortalité afin de proposer une sélection des risques pour une tarification. Les résultats montrent que les études de mortalité, et principalement les cohortes de suivi à long terme sont rares en Afrique subsaharienne; la majorité des études sont de courte durée et en plus elles enrôlent un nombre restreint de patients. Ces insuffisances ne permettent pas une analyse actuarielle approfondie et les résultats sont difficiles à extrapoler directement dans le domaine de la tarification. Cependant, l’identification des facteurs d’aggravation de la mortalité et de la morbidité permettra un ajustement de la tarification de base. Le sujet noir africain présente un profil de mortalité et de morbidité qui est sensiblement différent de celui du sujet caucasien, d’où la nécessité d’adapter les outils de tarification actuellement utilisés dans les compagnies d’assurance qui opèrent en Afrique subsaharienne. L’Afrique au sud du Sahara a besoin aujourd’hui plus que jamais de données épidémiologiques solides qui permettront de guider les politiques sanitaires mais aussi servir au développement d’une sélection des risques adaptés au contexte africain. Ceci passera par la mise en place d’un réseau coordonné de santé publique, un système de surveillance démographique fiable et un suivi continu des mouvements de la population. Pour atteindre un tel objectif, une collaboration avec les pays développés qui sont déjà très avancés dans de tels domaines sera nécessaire. / Abstract: Progress in medical research has prolonged life expectancy, improved patient quality of life; these changes translate in such domain as life insurance underwriting. The principle of underwriting in life insurance is based on the comparison of the probability of death of an individual candidate for an insurance policy to the probability of death of a reference population closed to the candidate. A review and analysis then becomes an of the medical literature become an indispensable tool for risk selection. Life insurance has been present in sub-Saharan Africa for approximately two hundred years, but up to date the insurers do not have specific underwriting tools which are adapted to the African context. This work is the first one in our knowledge to explore risk selection for Life insurance in Africa. Its purpose is to elaborate underwriting tools which will take into account specific aspects of mortality and morbidity in sub-Saharan Africa. First, we made a literature review of all available medical publications on different health problems; then, in a second step, we sorted out the risk factors for both morbidity and mortality, in order to suggest algorithms for underwriting risk selection. It appeared rapidly that mortality studies, and mainly long-term follow-ups, are scarce in sub-Saharan Africa. When they exist, they are of short duration, and enrol a limited number of patients. This makes our analysis and extrapolation of risk difficult for underwriting purposes. However identification of morbidity and mortality factors is important to allow some basic underwriting. The black African has a mortality and morbidity profile which are appreciably different from the one of a Caucasian subject. Consequently it will be important to adapt the underwriting tools used for underwriting life insurance in sub- Saharan Africa. Sub-Saharan Africa needs more than ever solid epidemiological data, and health policies implementation for the development of risk selection in insurance medicine. These changes mean the implementation of a coordinated public health network, a reliable demographic monitoring system and a continuous follow-up of the population’s migration. To reach such objectives, the collaboration with developed countries which are already very advanced in these fields will be very useful.