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This thesis starts from the observation that a credit portfolio is subject to several risks, mainly due to the credit quality of the borrower and his behavior toward his credit lines (drawdown or prepayment). It turns out that the observed risks are dynamic and depend on various factors, both micro and macroeconomic. Our goal in one hand is to understand the articulation of these risks in order to efficiently manage them in the current time, in the other hand, we want to have a forward looking vision of these risks with respect to the changes in the economic conditions in order to have a pro-active management. To address our objectives, we have articulated our research on three axes that have resulted in three chapters in the form of articles.(i) Analysis of changes in the credit ratings with respect to risk factors. The use of factor migration models allowed us to reproduce some stylized facts mentioned in academic literature and to identify some others. We have also estimated the business cycle between2006 and 2014, which manages to capture the crises of 2008 and 2012.(ii) Design of a cash-_ow model that considers the changes in borrowers' behavior under the influence of their micro and macroeconomic environments. We prove the influence of the credit ratings, business cycle, estimated recovery rates and short-term interest rates on the utilization rates of a credit line. This model also provides risk measures such as Cash Flow-at-Risk and Stressed Cash Flow-at-Risk on credit portfolio using Monte Carlo simulations.(iii) Discussion on the Willingness-to-Pay (WTP) of an ambiguity neutral decision maker (DM) in order to reduce the risk in presence of ambiguity over probabilities. We show that the introduction of ambiguity through several ambiguity sources modifies the welfare level of all ambiguity-neutral and risk-averse DM when ambiguity and risk interact, Cette thèse de doctorat part du constat qu'un portefeuille de crédit est soumis à plusieurs risques qui proviennent principalement de la qualité de crédit de l'emprunteur et de son comportement de tirage et de pré-paiement sur ses lignes de crédit. Il s'avère que les risques observés sont dynamiques et dépendent de facteurs divers, autant micro que macro-économiques.Nous avons eu la volonté de comprendre l'articulation de ces risques pour avoir une gestion efficace de ceux-ci dans le présent, mais aussi une vision prospective si les conditions économiques changent, cela pour une gestion pro-active. Pour traiter cette problématique, nous avons articulé nos recherches autour de trois axes qui ont abouti à trois chapitres sous forme d'articles.(i) Analyse des changements des notations de crédit en fonction des facteurs de risque.L'utilisation des modèles de migration multi-factoriels nous a permis de reproduire des faits stylisés cités dans la littérature et d'en identifier d'autres. Nous reconstituons aussi le cycle économique entre 2006 et 2014 qui réussit à capter les crises de 2008 et 2012.(ii) Conception d'un modèle de cash-flow qui tient compte de l'évolution des comportements des emprunteurs sous l'influence de leurs environnements micro et macro-économiques.Nous prouvons l'influence de la notation de crédit, du cycle économique, du taux de recouvrement estimé et du taux d'intérêt court terme sur les taux d'utilisation. Ce modèle permet aussi d'obtenir des mesures de risque comme le Cash Flow-at-Risk et le Stressed Cash Flow-at-Risk sur des portefeuilles de crédit grâce à des simulations de Monte Carlo.(iii) Réflexion sur la Disposition-à-Payer (DAP) d'un décideur neutre à l'ambiguïté pour réduire le risque en présence d'incertitude sur les probabilités. Nous montrons que la présence de plusieurs sources d'ambiguïté (possiblement corrélées) change le bien-être d'un décideur averse au risque bien que celui-ci soit neutre à l'ambigüité

The aim of this study was to present the results of diabetic retinopathy screening using a nonmydriatic fundus camera in the upper Rhine (France).The screening period took place from September 2004 to December 2007. Patients came to three referring medical centers (Altkirch, Mulhouse, Thann) and all had three fundus photographs on both eyes without pupillary dilatation. The data were stored on a website. The photographs were then analyzed by the team of experts from the Department of Ophthalmology of the Mulhouse General Hospital. The results were sent to the general practitioner with treatment guidelines. The campaign was evaluated at the end of the screening period using a questionnaire.In this study, 1050 diabetics patients were screened: 18% had diabetic retinopathy; of these 1.5% had proliferative or serious nonproliferative diabetic retinopathies and 74.2% mild nonproliferative forms. The mean value of hemoglobin A1C was 9.3% (+/-2.55), the patients' mean age of patients was 61.5 (+/-14.3) years, and the mean onset of diabetes was 16.6 (+/-7.9) years before screening. After screening, 70% of the patients consulted an ophthalmologist. Ninety percent of the referent practitioners received the results of the screening.The diabetic retinopathy screening campaign in the upper Rhine provided a real benefit in terms of public health and prevention of diabetic retinal complications.