WorldCat Identities

Fougère, Bertrand (1983 - ...).

Works: 34 works in 47 publications in 2 languages and 68 library holdings
Roles: Opponent, Other, Author, Thesis advisor
Publication Timeline
Most widely held works by Bertrand Fougère
Effet de l'aide informelle sur l'adaptation du logement chez des personnes âgées vivant à domicile by Sophie Robin( )

2 editions published in 2018 in French and held by 3 WorldCat member libraries worldwide

Informal help is an important factor for home support for elderly people in situation of loss of autonomy. We can wander if there is an influence of informal help on the decision to make modifications of the home. This study aimed to highlight an effect of informal help from children on the likelihood of home adaptation. We used data of the Survey of Health, Ageing and Retirement in Europe (SHARE). The econometric model was defined as the effect of the intensity of informal help from children, number of hours per month, on the likelihood of home adaptation, in controlling sociodemographic characteristics. The model was estimated through a regression method by probit. Due to a reverse causality between the informal help and the likehood of home adaptation, we used an instrumental variable to control endogeneity of informal help. The results highlight an effect of substitution between the informal help and the likehood of home adaptation. Sensitivity analyses confirm robustness of the results, that the model was estimed with a other sample or using an other instrumental variable. Otherwise, results suggest a substitution less important for people with a more severe loss of autonomy. In conclusion, these results are in favor of a strengthening of policies encouraging the creation of supportive environments for loss of autonomy, especially through home adaptation
État des lieux du dépistage et de la prise en charge en soins primaires du fardeau des aidants de patient atteint de la maladie d'Alzheimer ou maladie apparentée par le médecin généraliste : enquête auprès des aidants by Véronique Payen( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Background: Patients with Alzheimer disease are mainly supported by family caregivers. This caregiver role can be felt as a burden. The general practitioner has a crucial role in screening and taking care of the burden felt by caregivers. The main objective: Describe the screening and management of the burden felt by caregivers of patient with Alzheimer's disease or a related dementia by the primary care general practitioner. Method: Quantitative cross-sectional declarative questionnaire study administered between October 2019 and March 2020 to family caregivers of Alzheimer's disease patients in two French departments (Indre-et-Loire and Cher). Recruitment was carried out by the local outpatient and hospital networks and by local patient associations. Results: 67 questionnaires were analyzed. 75% (n=49/65) of caregivers stated that their general practitioner was aware that they were a caregiver. The general practitioner was more aware of the role of the caregiver when he also followed the patient with dementia (93%, n=37/40 versus 48%, n=12/25). When the general practitioner was aware of this caregiver role, the help mainly offered were the search for psychological difficulties (52%, n=24/46), as well as information on Alzheimer's disease (66%, n=31/47). The majority of caregivers (56%, n=35/62) considered their general practitioner as a resource. Conclusion: In order to complement and improve screening and caregiver burden management in ambulatory care, a reflexion is needed; especially when the general practitioner of the ill patient and the caregiver are different
Le bilan de médication partagé : ressenti des médecins généralistes by Benjamin Maino( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Il s'agit d'une étude qualitative par entretiens semi-dirigés, réalisée auprès de médecins généralistes d'Indre et Loire. Le dispositif des bilans de médication partagés a un peu plus d'un an et aucune étude ne s'est intéressée au ressenti des médecins généralistes vis-à-vis de cette nouvelle mission des pharmaciens. Le recrutement s'est effectué par réseau ou « effet boule de neige ». L'objectif de cette étude est d'évaluer le ressenti des médecins généralistes d'Indre et Loire vis-à-vis de cette nouvelle mission des pharmaciens d'officine. Le bilan de médication partagé est un dispositif encore méconnu des médecins généralistes. La collaboration entre médecin et pharmacien est ambivalente, car ce dernier est à la fois reconnu comme professionnel du médicament par les médecins, mais ils se disent prêts à ne collaborer qu'avec les pharmaciens qu'ils reconnaissent comme bons professionnels de santé. Il est tout de même noté au cours de cette étude que les médecins ne sollicitent pas assez les pharmaciens, qui pourtant pourraient être des alliés de choix dans la prise en charge des patients via le bilan de médication partagé. Ces résultats semblent sensiblement identiques à ceux d'autres études menées sur les nouvelles missions des pharmaciens
FAST-TRIO, étude prospective sur l'impact de l'informatisation exclusive du triage des patients aux urgences du centre hospitalier d'Orléans by Joffrey Mouyna( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction: The overcrowding of emergency department and its consequences are at the heart of current concerns. An adaptation to these flows is necessary in order to optimize patient care.Lean management principles have been applied to the emergency reception service in Orléans in order to improve its efficiency. An exclusive computerization of triage was therefore put in place preceding a structural reorganization project. The triage time by the reception and orientation nurse is an indicator of the quality of care. The main objective of this study was to show that the exclusive computerization of the reception of the ED made it possible to reduce the delay in triage. Our secondary objectives were to show that the exclusive triage computerization made it possible to increase the rate of collection of clinical parameters. Method: We conducted a single-center prospective observational study, from November 1 to December 31, 2018 at the Orléans Regional Hospital Center. The study consisted of two phases: before and after the introduction of the exclusive computerization of triage. We compared the "administrative registration-triage" delay in each of the two groups, before and after the introduction of the exclusive computerization; as well as the rate of collection of the clinical parameters "Respiratory frequency" and "Glasgow score". Results: The study included 1366 patients. The mean triage time was 57 minutes (95% CI, 52- 62) versus 35 minutes (95% CI, 31-39) after the implementation of computerization. We have shown that there is a significant reduction in triage time after the introduction of proprietary computerization. It did not significantly increase the collection rate of the Glasgow score and the respiratory rate. Conclusion: The exclusive computerization of triage at the emergency department reduces the time taken to take charge by the nurse. Through this study it would appear that the principles of lean management are applicable and effective in the organization of emergency services
Épidémiologie des modalités de recours aux urgences des patients venant d'EHPAD : une étude prospective, observationnelle, transversale et multicentrique menée au sein des services des urgences de l'Indre et Loire au cours de l'année 2019 by Clara Vannier( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Context: In 20 years, the number of emergency room visits has continued to grow. At the same time, the population is aging, often with a loss of autonomy leading to the institutionalization of our elders. In this population, visits to the emergency room represent a risk of iatrogeny and psycho-somatic degradation. Material and Methods: We carried out a prospective, multicentric, observational study of the modalities of consulting to the emergency departments of Indre et Loire for patients living in nursing homes. This study took place over 3 one-month periods (winter, spring, summer) in 2019. Results: We included 836 patients. The presentation to emergency departments was higher during the winter period. Approximately 35% of the visits took place during the night period. The average waiting time before medical management was 191.8 minutes [95% CI 172.8- 210.9]. This time was increased over the period 18h-23h59 (242.9 min [95% CI 194.5-291.2]) and in the winter period 278 min [95% CI 237.7-318.2]. The mean length of stay in the emergency department was 539.6 min [95% CI 574.9-739.5], and was longer for patients admitted between 18h and 23h59.58.5% of patients returned to their nursing home without hospitalization. Mortality rate at 90 days was 9.3% overall, and 12.3% during the winter period. Conclusion: Optimizing the management of nursing home residents is a major public health issue. It is essential to improve the collaboration between town and hospital medicine in order to reduce the morbi-mortality of this population
Profil clinique et nutritionnel d'une population gériatrique suivie dans une grande unité de néphrologie : comparaison entre trois cohortes définies par l'âge by Maria Rita Moio( )

2 editions published in 2020 in French and English and held by 3 WorldCat member libraries worldwide

De nombreuses études montrent que la prévalence de la maladie rénale chronique (MRC) augmente avec l'âge, aussi en lien avec la majoration des maladies vasculaires et du diabète. Cette augmentation a été démontrée pour la tranche d'âge 60- 80 ans, avec une réduction de la prévalence après 90 ans, classiquement expliquée comme liée à la mortalité compétitive. Selon les nouvelles recommandations de l'HAS, la nutrition doit faire partie intégrante de la prise en charge de la MRC à partir de ses stades initiaux. La restriction protidique est la base de la prise en charge nutritionnelle de la maladie rénale chronique, mais plusieurs experts considèrent que les patients âgés réduisent spontanément les apports protidiques et, en conséquent qu'une prise en charge ne soit pas nécessaire. L'objectif de ce travail de thèse est d'évaluer l'applicabilité d'une prise en charge diététique de la MRC dans une population gériatrique atteinte d'une maladie rénale sévère. La population étudiée est celle soignée dans l'Unité UIRAV (Unité pour l'Insuffisance Rénale chronique Avancée) du CH Le Mans incluant 298 patients à octobre 2020, avec un âge médian de 74 ans ; les patients inclus dans l'étude sont classifiés comme avec une maladie rénale chronique de stade 3b-5. Les comorbidités ont été évaluées selon l'index de Charlson, dont la médiane est à 7. Pour l'évaluation globale, en incluant aussi l'état nutritionnel, deux échelles fréquemment employées en néphrologie ont été utilisées : MIS (Malnutrition Inflammation Score) et SGA (Subjective Global Assessment). La thèse est ciblée à trois cohortes divisées selon l'âge : OLD entre 70 et 79 ans, OLD-OLD entre 80 et 89 ans et extremely- OLD > 90 ans. Les soins médicaux sont personnalisés, associant une prise en charge néphrologique classique et une nutritionnelle en 4 étapes. 1- correction de la malnutrition, 2- normalisation de l'apport protéique à 0.8 mg/kg/jour, 3- prise en charge visée à ralentir la progression de l'insuffisance rénale et 4- éviter la dialyse. Pour la réalisation des deux dernières étapes, des régimes avec apports protéiques à 0.6 mg/kg/j éventuellement supplémentés avec des alpha-chetoanalogues sont prescrites par une petite équipe de diététiciens, spécifiquement formés. Le premier résultat intéressant regarde les habitudes alimentaires : bien qu'avec une tendance à la réduction avec l'âge, l'apport protidique médian est, dans les trois catégories considérées, de 1.1 g/Kg/j, avec une réduction à 0.9 g/Kg/j (toujours supérieur à la définition actuelle de régime normo protidique, désormais établi à 0.8 g/Kg/j) à un âge supérieur à 90 ans. Après la prise en charge nutritionnelle, on observe, à 6 mois, une réduction des apports à une médiane de 0.9 g/Kg/j, qui se réduit ultérieurement de 0.2 g/Kg/j de protéines pour les sujets suivis pour au moins un an, en ligne avec la réduction progressive des apports. Cette réduction des apports, probablement aussi en tenant compte du fait que moins de 10 % des patients présente un état nutritionnel précaire (SGA : B), et que l'obésité a une prévalence, même dans cette population âgée, de 42%, ne s'accompagne pas à une réduction des principaux paramètres nutritionnels, dont l'albumine. Au contraire, l'albumine plasmatique montre une augmentation de 2 g/l, significative, à 3 mois depuis le début du régime. L'adhérence thérapeutique, établie selon l'analyse des carnets alimentaires, et définie comme apport protidique non supérieure à la prescription plus 20 %, est bonne, à environ 75 % des patients à 3 et 6 mois d'observation. Bien que l'étude, observationnelle et non-interventionnelle, sans une cohorte contrôle, ne permet pas de juger sur l'efficacité dans le but de retarder la dialyse, une efficacité en ce sens est suggérée par le fait que tous les patients suivis en UIRAV qui ont commencé la dialyse ont bénéficié d'une approche incrémentale (début de dialyse en raison d'une ou deux séances par semaine, en lieu des trois séances « classiques »). En conclusion : les patients âgés atteints d'une maladie rénale chronique sévère peuvent bénéficier d'une prise en charge nutritionnelle. Les apports protidiques sont probablement plus importants de ceux classiquement décrits, et la prise en charge ne s'accompagne pas à un risque de malnutrition, au moins à court terme. L'association avec un début incrémental de dialyse, moins traumatique et plus respectueux de la diurèse résiduelle, souligne les avantages potentiels, à étudier ultérieurement à long terme
Évaluation du degré de satisfaction de patients ayant participé à un projet d'évaluation gériatrique en soins premiers by Maxime Renoux( )

2 editions published in 2017 in French and held by 3 WorldCat member libraries worldwide

Introduction: given the current demographie situation, the primary care must consider the frailty concept. The "Frailty and Alzheimer's disease prevention into Primary care" project introduced a geriatrie evaluation nurse or a trained resident in primary care in order to evaluate previously detected frai!people. Our study evaluates patient's opinion about their evaluation. The secondary objective was to compare the nurses group and thal of the trained residents. Methods: this is an observational descriptive study performed in the Occitanie area on a population of 271 elderly patients. Gathering of the infonnations was performed through a phone survey. Results: a total of 133 questionnaires were filled in. Most of the surveyed elderly patients gave a positive opinion about their evaluation in primary care. 42% (n=52) would have refused the evaluation in the hospital. 91% (n=31) gave a positive opinion about their personalized plan of care. The results of the cornparisons do not give statistically significant differences between both groups. Discussion: patient's feedback is very encouraging. They were favorable to the development of the geriatrie evaluation into primary care and to the generalization of the project to other territories. New studies must be carried out in order to evaluate the medico-economic effect of this kind of care model
Evaluation de la pertinence des transferts aux services d'urgences des personnes résidant en établissement d'hébergement pour personnes âgées dépendantes by Simon Thummel( )

2 editions published in 2020 in English and held by 3 WorldCat member libraries worldwide

Background: France is experiencing a steady increase in the number of residents living in nursing homes (NHs). Each year, 50% of these residents are hospitalized. Half of them in emergency department (ED). A part of these transfers to EDs are unjustified and not without consequences. The first aim of our study is to evaluate the proportion of inappropriate NH residents' transfers to EDs. Methods/design: An observational, prospective, cross-sectional and multicentric study was conducted between January and August 2019 in the 6 EDs of Indre-et-Loire county during 3 inclusion periods. A multidisciplinary expert panel determined the inappropriateness of each transfer to EDs. The results are expressed in gross values and in %. Expert agreement is assessed by Fleiss' kappa statistical measure. Results: 836 patients were included. Transfers were deemed inappropriate in 12 to 35% of cases and appropriate in 53 to 81% of cases according to the experts. Fleiss' Kappa score on the concordance of the different experts' answers concerning the relevance of transfers is slight with k = 0.28 with a significant p-value (p<0.0001). Conclusions: Too many transfers of NH residents to EDs remain inappropriate. There is a disparity of results among the experts reflecting a limitation of our study related to the subjective nature of relevance. In a society where demographic projections predict a continuing aging population and where EDs are regularly saturated, it would be interesting to identify and prevent factors predisposing to ED transfers and to consider a geriatric emergency pathway
Epidémiologie des infections aux urgences chez les patients octogénaires hospitalisés : étude de cohorte rétrospective by Matthieu Coulongeat( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction: Bacterial infections in octogenarian are very polymorphic in their clinical presentation and poorly described in the literature. Our study aimed to describe the epidemiology and clinical presentations of infections needing antibiotics for octogenarians hospitalized from Emergency Medical Services (EMS). Method: This study is an observational monocentric retrospective cohort from University Hospital of Tours. All patients ≥ 80 years hospitalized from EMS during the first 3 days of each month of 2018 have been included. Infections needing antibiotics have been awarded by 3 experts (geriatric, infectious disease and emergency specialists). A consensus was sought for every discordant patients. Clinical, biological and radiological variables have been described. Univariate analysis has been conducted with a choice of p<0.05 for significance. Results: During the recruitment period, 444 out of 619 patients have been hospitalized and included. Experts agreed on antibiotic indication at the first step for 353 patients (79.5%), with a consensus obtained for remaining patents. One hundred fourteen patients (25.9%) had antibiotic indication against 327 patients without antibiotic indication. Main infections were: pulmonary (55; 48.2%), urinary (29; 25.4%) and digestive (12; 10.5%). The majority of patients (299; 67.8%) had polymorphic clinical presentation in EMS with main pulmonary (212; 48.1%), cardiologic (169; 38.3%) and skin symptoms (150; 34%). In univariate analysis, antibiotics indication was associated with fever (OR 10 [5.6-18]), chills (OR 7.5 [2.8-20]), pulmonary signs (OR 3.72 [2.35-5.9]), CRP > 10 mg/L (OR 12.8 IC95% [5.77-28.6]) and abnormal radiologic findings (OR 13.8 [7.8-24.4]). Falls and autonomy loss were negatively associated (OR 0.4 [0.2-0.7]). Conclusion: This study shows the difficult identification of bacterial infections in EMS because of atypical clinical presentation in elderly patients. It highlights the interest of multidisciplinary approach in these cases
Évaluation du degré de satisfaction des médecins généralistes ayant participé à un projet d'évaluation gériatrique en soins primaires by Aricie Daure( Book )

2 editions published in 2016 in French and held by 3 WorldCat member libraries worldwide

Introduction: In response to demographic challenges, primary care facilities need to get familiar with the concept of frailty. The " Frailty and Alzheimer's disease prevention into Primary care " project introduced a geriatric evaluation nurse or a trained resident in primary care facilities in order to evaluate previously detected frail patients. Our work aimed at evaluating the general practitioner opinion following geriatric evaluation in a primary care facility. Material and methods: This is an observational descriptive study performed in the Midi-Pyrénées region on a population of 26 general practitioners. Gathering of the information was performed through an online survey. Results: General practitioners estimated that most of the patients benefiting from a primary care geriatric evaluation would have declined hospital evaluation. 92 % (n = 24) of the surveyed general practitioners gave a strongly positive or positive opinion regarding detection of previously unidentified health issues and improvement of patient care following this evaluation. 42% of the general practitioners found establishing the personalized plan of cares difficult or very difficult. 73% of the general practitioners estimated to have a better understanding of frailty after the evaluation. Discussion: General practitioners feedback was very positive and promising for the future. This geriatric evaluation in primary care facilities could be developed and extended into new regions as long as the appropriate modifications are performed
Exploration des représentations et préférences organisationnelles d'une évaluation gériatrique : étude qualitative auprès de personnes âgées by Caroline Grivaux( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction: In 2004, in France, frailty concerned 15.5% of people aged 65 and over living at home. The comprehensive geriatric assessment (EGG) and the interventions that result from it, contribute to the reversibility of the fragile state and therefore to prevent the loss of functional independence. Its organizational modalities are diverse, their characteristics having a direct impact on the participation of older people, so they must be adapted to their wishes and needs. Objective: The main objective was to explore the preferences of older people regarding the organizational modalities of EGG. The secondary objective was to explore their representations concerning an approach to prevent loss of autonomy. Material and Methods: This was a qualitative study conducted from semi-structured, individual interviews with people aged 70 or over, who have never benefited from EGG. The participants were recruited by their general practitioners, practicing in the French departments of Indre and Indre-et-Loire. Results: Participants' preferences depended on their prevention experience and care habits. The approach had to be included in the continuity of their health pathway, preserving the care network, especially their physician, and respecting their usual procedures for seeking care. The participants expressed the wish to cooperate actively, defining their priorities and objectives through a dialogue with professionals and their relatives. Conclusion: The participants wanted an EGG that matches their care habits, a personalized, concerted approach with the professionals they know, the cooperation of their family caregivers and the gradual and targeted inclusion of new professionals
Evaluation de l'accessibilité des thérapeutiques spécifiques de l'AVC chez les sujets de 65 ans ou plus by Anaïs Elana( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Stroke is a condition whose prevalence increases with age. Ischemic stroke accounts for 80% of total strokes. They are the cause of serious complications, with a risk of incidental depen-dence and major impairment of quality of life. This risk of adverse health events can be con-trolled by addressing vascular risk factors (e.g., hypertension) as primary prevention and se-condary prevention through the use of treatments such as thrombolysis and mechanical throm-bectomy, which have altered the natural history of stroke over the past decade. However, there is under-prescribing in the elderly. Our hypothesis is that advancing age is a factor associated with access to this therapy. The main objective of this work is to determine the proportion of people aged 65 years and older, hospi-talized at the CHU of Martinique who have had access to thrombectomy and/or thrombolysis. Secondary objectives are to determine patient characteristics and factors associated with the prescription of thrombectomy and/or thrombolysis in stroke patients hospitalized. Material and Method : Monocentric, observational, retrospective study including subjects aged 65 years and older hospitalized during the year 2018, at the CHU of Martinique for ischemic stroke within 6 hours of onset of 1st symptoms. Result : 233 patients were recruited based on data from the CHU of Martinique, with an 82% MRI rate. In terms of stroke management, the population's thrombolysis and thrombectomy rates are 34% and 9% respectively. The thrombolysis rate is comparable in each age group. There is an insignificant increase (p to 0.059) in the thrombectomy rate (14%) in the 75-84 age group compared to the other two age groups 65-74 (4%) and over 85 (7%). Conclusion : ur study showed no association between age and access to thrombolysis and thrombectomy
Influence du confinement sur la relation entre les équipes soignantes des EHPAD et les proches du patient durant l'épidémie COVID-19 : du point de vue des équipes soignantes by Marine Roger( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Contexte : En France, en réponse à la propagation de l'épidémie de COVID-19 début 2020, un confinement a été mis en place impliquant une restriction des contacts humains et des déplacements au strict nécessaire. Les EHPAD ont connu durant cette période une réorganisation majeure du fait de la fragilité des personnes âgées qu'ils ont en charge. Dans les EHPAD, la relation triangulaire entre soignants, proches et patients, est un facteur déterminant dans la prise en soin de ces derniers. Objectif : Explorer l'influence du confinement lors de l'épidémie de COVID-19 sur la relation entre les équipes soignantes des EHPAD et les proches des résidents. Méthode : Enquête qualitative par entretiens semi-dirigés de 14 professionnels des équipes soignantes de quatre EHPAD du Loir- et-Cher en Juin 2020. Enregistrement des entretiens, retranscription intégrale et analyse thématique de contenu avec émergence d'une théorie. Résultats : Le lien entre les équipes soignantes et les familles a été particulièrement impacté par le confinement. Les modalités de communication avec les familles ont changé (exemple de la visiotéléphonie). Une réorganisation majeure des équipes soignantes a été mise en place pour faire face à ce virus inconnu (nouveaux protocoles sanitaires, changement de fonctions, charge de travail plus importante et amplification des collaborations). Un renforcement de la relation de confiance a été perçu, avec une reconnaissance accrue des familles envers le travail des soignants. Cela a fait soutien aux équipes durant cette période difficile pour eux. De nombreux facteurs ont modifié la relation avec les proches des résidents avec une influence plus ou moins forte et plus ou moins positive : compréhension par les familles des mesures barrières, cohésion des équipes, charge de travail, image véhiculée par les médias, crainte d'une judiciarisation. Le doute subsistait sur la poursuite de cette reconnaissance dans le temps. Conclusion : Cette période a renforcé le lien entre les proches du patient et les équipes soignantes mais avec certaines limites. Il sera intéressant d'étudier l'évolution de ce lien dans le temps et ce qui aurait pu être amélioré durant cette gestion de crise
Etat des lieux de la connaissance, de l'utilisation et de la perception de la PTA 37 par les médecins généralistes d'Indre et Loire by Emilien Bech( )

1 edition published in 2020 in French and held by 2 WorldCat member libraries worldwide

Context: To meet the challenges of coordinating careers and care, various support methods for primary care professionals have been developed by the State, in particular support mechanisms for coordinating complex careers structured around a Territorial Support Platform (PTA). Although they constitute support modalities, General Practitioners (GPs) are not necessarily familiar with them and do not always use them. The main objective was to carry out an inventory of the knowledge, use and perception of GPs in Indre-et-Loire about the PTA 37 which has become Appuisanté 37. Method: This is a quantitative study carried out using an anonymous online questionnaire of 24 questions at most, between July 6 to August 21, 2020, with GPs practicing on January 1, 2020 in Indre-et-Loire. Results: Out of 90 MGs questioned, 60% knew of its existence and 34% had requested it. GPs living in rural areas, university internship supervisors or members of a CPTS were more familiar with its existence. GPs solicited PTA 37 primarily for elderly patients with loss of autonomy and social and family isolation. 93% of GPs were experiencing difficulties when managing a "complex situation" with a high frequency in their daily practice. 90% of GPs found PTA 37 useful in their professional practice, especially for improving coordination, helping to find the right provider, overall assessment of the situation and saving time. 38% felt that all their expectations were met by the PTA 37 but 29% wanted it to be more responsive and quick in its actions. Conclusion: PTA 37 is useful for general practitioners in the case of medico-social complexity, it provides assistance in finding concrete solutions and facilitating the support and care of patients. There is a major stake in making its structure and objectives better known
Influence de l'âge et du tabac sur les mécanismes génotoxiques et épigénétiques précoces de cancérogénèse broncho-pulmonaire en réponse à la pollution particulaire urbaine by Bertrand Fougère( )

1 edition published in 2014 in French and held by 2 WorldCat member libraries worldwide

Recently recognized as carcinogenic to human by IARC, air pollution and fine particulate matter (PM₂.₅) can be inhaled and could be retained into the lung or reach the systemic circulation. This can cause or worsen many diseases for which the elderly are often more sensitive. The PhD objective corresponds to the identification of the mechanisms of action involved in the modulation of carcinogenic potential of PM₂.₅, in connection with age or smoking status. PM₂.₅ were collected in Dunkerque, a French seaside city characterized by important industrial activities and heavy motor vehicle traffic. In order to estimate the influence of age, blood lymphocytes sampled from 90 patients from age classes (25-30, 50-55 and 75-80 years old) were ex vivo exposed to PM₂.₅ during 72 hours, before evaluation of telomerase activity and gene expression modulation of P16INK4A and MGMT. PM₂.₅ modulated telomerase activity and telomeres length in all age groups without any influence of age. P16INK4A gene expression increased significantly with age after exposure to PM₂.₅. Age could enhance MGMT gene expression after exposure to particles by decreasing the level of promoter methylation in the oldest group. Regarding the role of smoking status, 26 broncho-alveolar lavage were performed in smoker and non-smoker people. Macrophages were cultured with bronchial epithelial BEAS-2B cells before PM₂.₅ exposure (3 or 15µg/cm²; 72h). The telomerase activity and telomere length vary after exposure and the tobacco modify these parameters in BEAS-2B cells and alveolar macrophages. Methylation of P16INK4A and MGMT genes promoters and their expression are not modified in BEAS-2B cells. In alveolar macrophages, particles lead to a decrease of methylation of P16INK4A gene promoter. The smoking status seems also to increase methylation and to down-regulate expression of these two genes. In conclusion, it seems that the studied PM₂.₅ sample can induce ex vivo modifications described in the initiation and promotion of lung carcinogenesis. The age and smoking status may modulate the toxic effects of particles. Since lung cancer symptoms appear only at an advanced stage, our results could help in proposing new biomarkers of carcinogenesis allowing an early diagnosis to improve survival
Interventions against disability in frail older adults: Lessons learned from clinical trials by Bertrand Fougère( )

1 edition published in 2017 in English and held by 2 WorldCat member libraries worldwide

Precision Medicine: The Future Management of Geriatric Conditions by Bertrand Fougère( )

1 edition published in 2018 in English and held by 2 WorldCat member libraries worldwide

Ready-meal consumption in older people: association with obesity and dietary intake by Groupe DSA MAPT( )

1 edition published in 2018 in English and held by 2 WorldCat member libraries worldwide

Rapid Screening for Frailty and Sarcopenia in Daily Clinical Practice by Bertrand Fougère( )

1 edition published in 2018 in English and held by 2 WorldCat member libraries worldwide

Omega-3 fatty acid levels in red blood cell membranes and physical decline over 3 years: longitudinal data from the MAPT study by MAPT Study Group( )

1 edition published in 2017 in English and held by 2 WorldCat member libraries worldwide

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Alternative Names
Bertrand Fougère wetenschapper

French (25)

English (8)