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Aim: There are currently no prospective studies evaluating the long- term outcomes of non- surgical root canal treatments beyond 5 years, both in terms of treatment success and tooth preservation, and identifying factors predictive of treatment outcome. The aim of the present work was therefore to fill this gap by assessing these outcomes over time and identifying predictive variables based on systematic data collection over a 25- year period. Methodology: Data concerning the treatments (N = 2500) were systematically collected since 1990. Information was recorded among clinical, technical, radiographic and patient- related characteristics, i.e., approximately 150 variables for each treatment. The data were analysed regarding both treatment success and tooth preservation by multivariable Cox proportional hazards model, and survival curves were generated. The statistical significance level was set at 0.0125. Results: In total, 56.4% of the treatments could be followed over time (0– 25 years, mean = 6.5 years, median = 5 years). Survival probability decreased almost linearly for treatment success, with about 85% after 5 years and 60% after 20 years, and for tooth preservation, with about 90% at 5 years and 50% at 20 years. The variables significantly associated with treatment failure were: pre- operative pain (Hazard Ratio— HR = 1.56 [95% CI 1.23– 1.97]), persistent pain (HR = 2.63 [95% CI 1.44– 4.80]), good operator rating of treatment prognosis (HR = 0.46 [95% CI 0.36– 0.58]), size of periapical bone radiolucency (HR = 1.88 [95% CI 1.67– 2.11]), and tooth type (p = .0006). For tooth extraction, they were: combined endodontic- periodontal lesion (HR = 3.37 [95% CI 1.88– 6.05]), pre- existing complication before treatment (HR = 1.67 [95% CI 1.26– 2.21]), good operator rating of treatment prognosis (HR = 0.45 [95% CI 0.33– 0.60]), clinical failure of root canal treatment (HR = 2.78 [95% CI 1.98– 3.89]) and tooth type (p = .0012). Conclusion: Root canal treatment success

Infectious diseases in sub-Sahara African pregnant women remain public health concerns. Malaria and curable sexually transmitted infections (STI) are the most common and severe infections causing poor pregnancy outcomes despite the several control programs implemented. Their coinfections could be frequent and more severe in pregnant women. The overall objective of our thesis was to contribute to improving the control of these co-infections through describing their prevalence, identifying risk groups, determining their impact on the pregnancies, and identifying the effective strategies for their control. We analyzed retrospectively captured routine data and we carried out a cross-sectional study in rural settings of Burkina Faso. We found that malaria and curable STI coinfections are frequent in pregnant women but are underdiagnosed in routine care in rural peripheral health facilities. Pregnant women who received no IPT-SP presented more frequently with coinfections. Malaria and curable STIs considered separately were more frequent in students. Miscarriages and stillbirth were associated with symptomatic coinfections contrary to low birth weight, and preterm births. Our findings have shown for the first time the severe impact of malaria and curable STI co-infections in pregnant women. IPT-SP should be reinforced in pregnant women. Health education should be set up for young girls to prevent complications in teenagers’ pregnancies., (MED - Sciences médicales) -- UCL, 2022

Background: Cervical cancer contributes to 6%–29% of the cancers in India. Although the Government of India in 2010 integrated cancer screening within the National Programme for the prevention of Non-communicable Diseases, only 22% of women aged 15–45 years had undergone examination of the cervix by 2016. This prompts the question regarding the organisation of the program's implementation and service delivery and regarding challenges that may explain poor screening uptake. Methods: Semi-structured interviews were held with program managers and implementers in seven districts of three selected States of India. The data analysis looked at program content, the organisation of screening delivery, and the challenges to the implementation of the program, considering six theoretically derived dimensions of public health capacity: leadership and governance, organisational structure, financial resources, workforce, partnerships, and knowledge development. Results: Participants perceive the existing capacities across the six domains as insufficient to implement the CCS program nationwide. A context specific implementation, a better coordination between the program and district health facilities, timely remuneration, better maintenance of data and a strong monitoring system are possible solutions to remove health system related barriers

Nowadays, clinical pathology has becoming a central medical discipline in the health care ecosystem and blood sampling is an unavoidable step. Lab testing results influence about 70% of medical decisions. In response to the economic pressure on health care accentuating the need for rationalization in many countries, clinical pathology laboratories must act and implement measures to reduce costs while ensuring that they maintain and respect highest quality standards. Therefore, to target the effective actions to be implemented, it is necessary to identify and define the reasons explaining the observed increase in the budgets devoted to laboratory tests. A whole literature appealing to the notion of "Right order" is available and is a source of inspiration for many authors. What are the concepts behind these words? What does it mean to “What does right order mean”? As part of an analytical approach to review the literature, a search for tools to optimize the prescription of clinical biology will make it possible to establish recommendations for implementing, developing and perpetuating a strategy of “prescribing correctly” with prescribers. An in-depth analysis of the context of use of these tools is thus in order to understand their adaptation and the essential conditions for their implementation in an academic context. Eventually, it will be necessary to define the elements to be introduced into an information management tool (EMR – Electronic Medical Record) to support the learning of “right order” and, through this, achieve the defined objective. Throughout the process, the emphasis is placed on respecting the freedom of the prescriber, who remains the sole judge of the relevance of his ordering act in relation to the particular context of each patient., (SP - Sciences de la santé publique) -- UCL, 2022

Background: Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS)uptake is infuenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention. Methods: A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models. Results: CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefts contributed most signifcantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specifc barriers. Conclusion: Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their efectiveness by addressing women’s screening attitude, perceived benefts, and emotions as well as reducing context specifc

Background Cervical cancer represents a high burden of disease. Many women in low- and middle-income countries face opposition from their partners and families to undergo cervical cancer screening. Identifying the social, cultural, and psychological factors that underly the opposition to screening by male partners is an important step towards reducing barriers for men to support their wives’ participation in cervical screening. This study explored the role of structural and psychological factors deriving from theoretical models as determinants of Indian men’s opposition to their partners being screened for cervical cancer. Methods A survey among 500 sexually active males was conducted between April 2020 and August 2020 to measure knowledge of cervical cancer and screening, awareness of screening possibilities, attitude towards screening, perceived barriers to screening, and health literacy. Regression analysis was performed to assess which of the potential factors contributed to the intention to support their wives’ screening. Results The majority of participants had very poor knowledge and awareness about cervical cancer and screening procedures, tended towards a negative attitude towards screening, and perceived several structural barriers. Attitude towards the screening procedure and routine participation in general screening significantly predicted their intention to support their wives’ screening for cervical cancer. Education moderated the association between knowledge and awareness and the intention to support their wives’ screening. Conclusion As women often rely on their spouses’ financial and emotional support of cervical screening, there is a need for men to be encouraged to support their wives’ screening participation. Programs to encourage men to support their wives’ cervical screening should focus on their attitude towards screening, educate about cervical cancer and screening procedures, and reduce perceived barriers.

Despite multiple public health interventions, the incidence of malaria in Cameroon among children U5 is not decreasing. Fine-scale analysis helps to better capture the incidence and determinant of disease at local level and therefore, may contribute to more contextualized public health interventions and better resource allocation. Based on the analysis of routinely collected data between 2012 and 2018 in U5, our findings indicate substantial variation in malaria trend, seasonality, and risk in U5 across health districts. Malaria incidence was correlated with maximum temperature and rainfall the month before. The East region has a disproportionately high malaria burden compared to other regions. This first spatiotemporal modelling of clinical data from the whole country provides one-month risk forecasts that can guide preventive action at the health district level in Cameroon. In the future, the optimisation of data should allow a finer analysis at the level of the health areas in Cameroon., (SP - Sciences de la santé publique) -- UCL, 2021

While cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low- and middle-income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns. A comprehensive search and analysis of published intervention and non-intervention (observational) studies that applied at least one health behavior theory to CCS participation. After quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Social-ecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake. Despite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake.

For psychiatric service users, the personal social network offers many resources important for living in the community : social support, purpose and meaning in life, coordination of interventions. Research on the subject has usually described the network using size and composition measures showing that service users have smaller and less diverse networks, which is a disadvantage in terms of health, service use, social integration. However, the availability of network resources also rely on the cohesion of the relationships between network members. Depending on its level of cohesion, the social network generates social control or autonomy and opportunities, with various impacts on the user, including continuity of care. Moreover, the support offered by a person is influenced by his or her relationships with other support persons. This should encourage health professionals to consider the social network to support the individualisation of care., (SP - Sciences de la santé publique) -- UCL, 2021

Background: Managing older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, to fine-tune future interventions for older people, considering the naturalistic context of the ED. Methods: This is a qualitative study of some 450h of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient’s trajectories, in particular those presenting with typically geriatric syndromes. Results: Four themes were developed: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients are unwelcome in EDs. Conclusions: The overall process of care was based on an organ- and flow-centered paradigm, which ignored older people’s specific needs and exposed them to discontinuity of care. Their basic needs were neglected and, when their management slowed the emergency department flow, older people were perceived as unwelcome. Findings of our study can inform the development of interventions about the influence of context and organizational factors.

Most studies of chronic kidney disease (CKD) in Sub-Saharan Africa (SSA) have been conducted in urban settings. They relied on GFR estimated from serum creatinine alone and on the inexpensive, convenient urinary dipstick to assess proteinuria. The dipstick for proteinuria has not been directly compared with the gold standard albumin-to-creatinine ratio (ACR) in a large-sized study in SSA. We hereby assessed the influence of rural versus urban location on the level, interpretation, and diagnostic performance of proteinuria dipstick versus ACR. In a cross-sectional population-based study of CKD in both urban (n = 587) and rural (n = 730) settings in South-Kivu, Democratic Republic of Congo (DRC), we assessed the prevalence, performance (sensitivity, specificity, positive predictive value and negative predictive value) and determinants of a positive dipstick proteinuria as compared with albuminuria (ACR). Albuminuria was subdivided into: A1 (< 30 mg/g creatinine), A2 (30 to 299 mg/g creatinine) and A3 (≥ 300 mg/g creatinine). The overall prevalence of positive dipstick proteinuria (≥ 1+) was 9.6 % (95 % CI, 7.9-11.3) and was higher in rural than in urban residents (13.1 % vs. 4.8 %, p < 0.001), whereas the prevalence of albuminuria (A2 or A3) was similar in both sites (6 % rural vs. 7.6 % urban, p = 0.31). In both sites, dipstick proteinuria ≥ 1 + had a poor sensitivity (< 50 %) and positive predictive value (< 11 %) for the detection of A2 or A3. The negative predictive value was 95 %. Diabetes [aOR 6.12 (1.52-24.53)] was a significant predictor of A3 whereas alkaline [aOR 7.45 (3.28-16.93)] and diluted urine [aOR 2.19 (1.35-3.57)] were the main predictors of positive dipstick proteinuria. ACR and dipstick proteinuria have similar positivity rates in the urban site whereas, in the rural site, dipstick was 2-fold more often positive than ACR. The poor sensitivity and positive predictive value of the dipstick as compared with ACR makes it unattractive as a screening too

Half of those who start smoking die as a result. People of lower socio-economic status are over-represented among smokers. Socially and economically underprivileged individuals are more likely to use tobacco, smoke for longer, experience relapses when they try to quit smoking, and die prematurely. Tobacco control policies have been implemented but do not seem to have decreased socio-economic inequalities in smoking. This thesis attempts to demonstrate the extent to which peer effects in schools contribute to buffering smoking denormalization and increasing socio-economic inequalities in smoking. Acceptance of smoking in low-SES groups, and social capital based on academic performance and smoking mitigate the effects of denormalization strategies and protect smokers from stigmatization. It may, therefore, be possible to create school tobacco policies that take adolescents’ SES into account and change the smoking climate without contributing to the stigmatization of individual smokers., (SP - Sciences de la santé publique) -- UCL, 2020

Many caregivers of geriatric patients are spouses who are old themselves. In many aspects, their mental, social and physical health may be at the core of successful caregiving. If the caregiver faces any health issue, this could lead to undesired care breakdown. In this context, this thesis aimed at assessing the health of older spousal caregivers with clinical and biological markers. In summary, our clinical and laboratory based investigations showed a relatively good health among these older caregivers. They are at an increased risk of being frail but few of them are frail, consistent with the idea that you have to be in good health to remain caregiver. The difficulties encountered by the spousal caregivers involved primarily disruption of their activities and feeling of social isolation. However, a large majority of the older spousal caregivers found caregiving as a source of self-fulfilment. This dimension takes into account the desire and the pleasure to give care. This thesis has also supported the role of protective factors against the caregiver’s burden., (SP - Sciences de la santé publique) -- UCL, 2019

Through this thesis, we have explored the potential of the learning organization concept to create an organizational dynamic towards creativity and excellence in health organizations. Ministries of health can benefit from applying these attributes to meet the challenge of universal health coverage. This thesis helped to provide a state of knowledge on this concept through a structured review and allowed to examine its feasibility in the context of countries like Morocco to guide health policies with organizational learning processes. The results of this research showed the positive benefit the Ministry of Health can make by adopting the attributes of a learning organization. The adaptation of the analytical framework allowed us to facilitate reflection on a vision of what can be the adoption and application of this concept in the particular context of Morocco., (SP - Sciences de la santé publique) -- UCL, 2019

As self-management support is a cost-effective way to enable patients to take an active role in managing their own condition and to address the chronic disease burden, there is a need for contextually appropriate self-management support tools. This study explored the feasibility of using a contextually adapted self-management care-plan booklet for diabetes and hypertension for use in medical consultations in a middle-income country. Focus groups and individual interviews with patients and health care providers were conducted in three primary health care facilities. Four relevant focus areas for feasibility studies were used as the lens for data analysis: acceptability, demand, implementation, practicality. The study revealed a high acceptance of the care-plan booklet by both patients and providers. Patients reported that the booklet increased their knowledge of their conditions. They also indicated that they would share the booklet with friends and families and expressed the need to use it with their providers. Providers mentioned that community health workers and health promoters could play an important role in implementing the tool. The findings of this study contribute to the knowledge base needed for the development and adoption of the self-management component of the South African integrated chronic diseases model. The care-plan booklet can be used to stimulate the interaction between patients, providers and/or family and friends.

Since 2010, the World Health Organization has successively recommended initiating antiretroviral therapy in all infants, children and finally adults with the human immunodeficiency virus. These treatments, administered for life and sometimes since birth, present many challenges in terms of adherence, side effects and resistance for patients, families and caregivers. The main objective of this thesis is to compare the long-term immunovirological evolutions of two cohorts of South African children who initiated their antiretroviral treatments before the age of one and after the age of two respectively. Our results allow us to conclude that patients who initiated their treatments earlier in life show better immunological results but more resistance mutations for some classes of antiretrovirals (NRTI and NNRTI). The introduction of resistance monitoring in clinical practice and access to new antiretrovirals should be considered in order to contain the HIV epidemic by 2030 and to respect the objectives of UNAIDS., (MED - Sciences médicales) -- UCL, 2019