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Bed occupancy ratio reflects the state of the hospital at a given time. It is important for management to keep track of this figure to proactively avoid overcrowding and maintain a high level of quality of care. The objective of this work consists in proposing a decision-aid tool for hospital managers allowing to decide on the bed requirements for a given hospital or network of hospitals on a short-medium term horizon. To that extent we propose a new data-driven discrete-event simulation model based on data from a French university hospital to predict bed and staff requirements. We propose a case study to illustrate the tool’s ability to monitor bed occupancy in the recovery unit given the admission rate of ED patients during the pandemic of Sars-Cov-2. These results give an interesting insight on the situation, providing decision makers with a powerful tool to establish an enlightened response to this situation.

Background Falls are a significant source of morbidity in people aged 65 and over, affecting one in three people in this age group. The scientific evidence indicates that physical activity is the most effective method for preventing falls among seniors. Although public health professionals often use social marketing to design and plan successful interventions, its use to promote physical activity and prevent falls among older people remains low. This article aims to provide a new systematic literature review of social marketing interventions promoting physical activity and targeting people aged 60 and over. Methods Following CRD’s guidance and PRISMA guidelines, we searched between January 2008 and July 2019 for relevant articles in five primary databases using predefined search and inclusion criteria. Two independent reviewers analysed the selected articles to identify evidence of the seven social marketing benchmark criteria, defined by experts in the field as the common elements that contribute to social marketing success. Results The final review included nine studies. Of the studies selected, three specifically targeted over 60-year-olds, whereas the others segmented the population into several age-based subcategories, including over 60-year-olds. Eight studies highlighted positive results for the participants with an increase in participation or an increase in physical activity level. None of the nine studies selected for this systematic review implemented the entire social marketing approach. Conclusion Few published interventions use the seven social marketing criteria. Further research is required to encourage uptake and inclusion in successful social marketing interventions to increase program effectiveness in this target population.

Health preventive medical evaluation programs are strategies commonly implemented as part of national health prevention efforts. Two problems related with the implementation of such strategies are subject profiling and medical test selection. The amount of different types of information that have to be analyzed by physicians in the screening for pathologies and medical test prescription can be overwhelming and significantly increases the complexity of this problem. Two decision-tree-based approaches are proposed in this study for subject profiling and medical test rationing. The proposed models perform well in terms of prediction. Results show that the implementation of these approaches helps to profile consultants into healthy and unhealthy subjects which can be used to ration medical test and design policies for preventive health evaluation programs.

Previous studies have suggested that exercise training improves cardiac autonomic drive in young and middle-aged adults. In this study, we discuss the benefits for the elderly. We aimed to establish whether exercise still increases heart rate variability (HRV) beyond the age of 60 years, and to identify which training factors influence HRV gains in this population. Interventional controlled and non-controlled studies were selected from the PubMed, Ovid, Cochrane and Google Scholar databases. Only interventional endurance training protocols involving healthy subjects aged 60 years and over, and measuring at least one heart rate global or parasympathetic index, such as the standard deviation of the normal-to-normal intervals (SDNN), total frequency power (Ptot), root mean square of successive differences between adjacent NN intervals (RMSSD), or high frequency power (HF) before and after the training intervention, were included. HRV parameters were pooled separately from short-term and 24 h recordings for analysis. Risks of bias were assessed using the Methodological Index for Non-Randomized Studies and the Cochrane risk of bias tool. A random-effects model was used to determine effect sizes (Hedges’ g) for changes, and heterogeneity was assessed using Q and I statistics. Twelve studies, seven of which included a control group, including 218 and 111 subjects, respectively (mean age 69.0 ± 3.2 and 68.6 ± 2.5), were selected for meta-analysis. Including the 12 studies demonstrated homogeneous significant effect sizes for short-term (ST)-SDNN and 24 h-SDNN, with effect sizes of 0.366 (95% CI 0.185–547) and 0.442 (95% CI 0.144–0.740), respectively. Controlled study analysis demonstrated homogeneous significant effect sizes for 24 h-SDNN with g = 0.721 (95% CI 0.184–1.257), and 24 h-Ptot with g = 0.731 (95% CI 0.195–1.267). Meta-regression analyses revealed positive relationships between ST-SDNN effect sizes and training frequency ( $${\text{Tau}}_{\text{res}}^{2}$$ = 0.000; $$I_{\text{res}}^{2}$$ = 0.000; p = 0.0462). This meta-analysis demonstrates a positive effect of endurance-type exercise on autonomic regulation in older adults. However, the selected studies expressed some risks of bias. We conclude that chronic endurance exercise leads to HRV improvements in a linear frequency–response relationship, encouraging the promotion of high-frequency training programmes in older adults.

International audience

Cardiovascular diseases (CVD) are the leading cause of death worldwide. In addition, many studies around the world reveal the existence of a causal relationship between periodontal diseases (PD) and CVD.Thus, to be effective, public health actions aimed at controlling the spread of CVD should not only aim at reducing modifiable cardiovascular risk factors; but also integrate the improvement of oral health into the overall framework of the fight against CVD. The implementation of said actions requires prior identification of the level of exposure of populations through sufficient and precise epidemiological data on the distribution of these cardiovascular risk factors.In Cameroon, some data on the distribution of cardiovascular risk factors among the general population are available, but there isn’t any information on the level of exposure of Cameroonian soldiers to CVD. However, studies around the world have shown that the military population which seemed to be immune to these pathologies is now as exposed as the civilian population, sometimes even more.The general objective of this thesis work was therefore to assess the level of exposure of Cameroonian soldiers to CVD and the link between their cardiovascular risk and their periodontal status. To achieve this general objective, 3 specific objectives have been defined.The first specific objective was to determine the level of exposure of the Cameroonian military to cardiovascular risk factors. On a sample of 566 adults, of whom 295 were soldiers, it was observed that behavioural cardiovascular risk factors were more prevalent in soldiers than in civilians, smoking and excessive alcohol consumption in particular, 13.9% versus 4.4% (p

Fall affects one of three people after 65 years old, and it can lead to serious consequences. Scientific evidence point out that physical exercise is the most efficient way to prevent falls among older adults. However, despite a global consensus about physical activity to prevent falls, many obstacles remain to increase participation. The main point is the subscription to falls prevention programs. About this subject, social marketing has already proven its usefulness. Nevertheless, it has been lightly used in prevention programs for older adults and especially in the physical activity field. Our general question is: Could the use of the social marketing method be effective in promoting and increasing participation in a falls prevention program for older people in France? We have demonstrated through a literature review that social marketing holds a strong potential to promote physical activity for elders. Moreover, the communication campaign development and the market studies that we have conducted indicate that the needs and expectations of the targeted audience should be more considered in prevention programs conception. This thesis work opens the way for social marketing strategies for this specific population in France and confirms that physical activity programs subscription is the main concern of their efficiency., Les chutes touchent une personne sur trois après 65 ans et peuvent avoir de graves conséquences dans cette population. Les preuves scientifiques indiquent que l'activité physique est la méthode la plus efficace pour prévenir les chutes chez les personnes âgées. Pourtant, bien qu'il existe désormais un consensus sur l'utilité de l'activité physique pour prévenir les chutes, de nombreux obstacles à la participation subsistent. L’adhésion aux programmes de prévention des chutes est la question centrale. Le marketing social a montré son utilité dans la construction de programmes de prévention. Cependant, son utilisation dans les programmes de prévention chez les personnes âgées et notamment dans le domaine de l’activité physique reste faible. Notre question générale est : l’utilisation de la méthode du marketing social pourrait-elle être efficace pour promouvoir et augmenter la participation à un programme de prévention des chutes destiné aux personnes âgées en France ? Dans ce contexte, nous avons montré, notamment à travers une revue systématique de la littérature, que le marketing social avait un fort potentiel pour promouvoir l’activité physique chez le sujet âgé. De plus, l’étude de marché que nous avons réalisée ainsi que le développement de la campagne de communication, suggèrent que les besoins et les attentes du public cible doivent être mieux pris en compte dans la conception des programmes de prévention. Ce travail de thèse ouvre la voie pour des stratégies de marketing social pour cette population spécifique en France et confirme que l’adhésion aux programmes d’activité physique reste l’enjeu majeur de leur efficacité.

Cardiovascular diseases (CVD) are the leading cause of death worldwide. In addition, many studies around the world reveal the existence of a causal relationship between periodontal diseases (PD) and CVD.Thus, to be effective, public health actions aimed at controlling the spread of CVD should not only aim at reducing modifiable cardiovascular risk factors; but also integrate the improvement of oral health into the overall framework of the fight against CVD. The implementation of said actions requires prior identification of the level of exposure of populations through sufficient and precise epidemiological data on the distribution of these cardiovascular risk factors.In Cameroon, some data on the distribution of cardiovascular risk factors among the general population are available, but there isn’t any information on the level of exposure of Cameroonian soldiers to CVD. However, studies around the world have shown that the military population which seemed to be immune to these pathologies is now as exposed as the civilian population, sometimes even more.The general objective of this thesis work was therefore to assess the level of exposure of Cameroonian soldiers to CVD and the link between their cardiovascular risk and their periodontal status. To achieve this general objective, 3 specific objectives have been defined.The first specific objective was to determine the level of exposure of the Cameroonian military to cardiovascular risk factors. On a sample of 566 adults, of whom 295 were soldiers, it was observed that behavioural cardiovascular risk factors were more prevalent in soldiers than in civilians, smoking and excessive alcohol consumption in particular, 13.9% versus 4.4% (p, Les maladies cardiovasculaires (MCV) constituent la première cause de mortalité mondiale. Par ailleurs, de nombreux travaux de par le monde révèlent l’existence d’une relation de causalité entre les maladies parodontales (MP) et les MCV.Ainsi, pour être efficaces, les actions de santé publique visant à lutter contre l’expansion des MCV devraient non seulement viser la réduction des facteurs de risque cardiovasculaires (FDRCV) modifiables ; mais aussi intégrer l’amélioration de la santé buccale dans le cadre global de lutte contre les MCV. La mise en place des dites actions requiert au préalable l’identification du niveau d’exposition des populations grâce à des données épidémiologiques suffisantes et précises sur la distribution de ces FDRCV. Au Cameroun, des données existent sur la distribution des FDRCV au sein de la population générale, mais aucune information n’existe sur le niveau d’exposition des militaires camerounais aux MCV. Pourtant, des travaux à travers le monde ont montré que la population militaire qui semblait à l’abri de ces pathologies se trouve aujourd’hui autant exposée que la population civile, parfois même plus.L’objectif général de ce travail de thèse était donc de d’évaluer le niveau d’exposition des militaires camerounais aux MCV et le lien qui existe entre leur risque cardiovasculaire et leur statut parodontal. Pour atteindre cet objectif général, 3 objectifs spécifiques ont été définis.Le premier objectif spécifique était de déterminer le niveau d’exposition des militaires camerounais aux FDRCV. Sur un échantillon de 566 adultes dont 295 étaient militaires, il a été observé que les FDRCV comportementaux étaient plus prévalents chez les militaires que chez les civils, le tabagisme et la consommation excessive d’alcool notamment, 13,9% versus 4,4% (p < 0,001) et 61,7% versus 14,8% (p < 0,001) respectivement.Le second objectif spécifique était de décrire le statut parodontal de la population militaire camerounaise. Sur 857 personnels militaires examinés, il a été observé que 68,6% souffraient de gingivite et 13,7% de parodontite.Le troisième objectif spécifique était de déterminer le lien qui existe entre les paramètres parodontaux des militaires camerounais et leurs profils de risque cardiovasculaire. Au sein d’un échantillon de 205 militaires, il a été observé que le tabagisme était associé à la parodontite, OR : 4, 44 [1,73-11,43]. Et qu’une hygiène buccale inadéquate était associée à un profil de risque cardiovasculaire élevé, mauvaise/bonne, OR : 3,96 [1,07-14,57] et moyenne/bonne, OR : 3,44 [1,11-10,66].En conclusion, les militaires camerounais sont particulièrement exposés à des facteurs de risque cardiovasculaires et parodontaux comportementaux. Ils devraient par conséquent modifier leur hygiène de vie, notamment en réduisant la consommation de tabac et d’alcool et en améliorant la qualité de leur hygiène buccale. Par ailleurs, les programmes nationaux de lutte contre les maladies non transmissibles (MNT) devraient intégrer la promotion de la santé bucco-dentaire, de même qu’il serait souhaitable que des programmes spécifiques destinés aux forces de défense soient mis en œuvre.

Although there is abundant literature on the link between physical activity and cognitive aging, several of these studies aroused questions about the choice of tools to assessed physical activity, the collection of physical activity, and methods of statistical analyses. In this context, we studied the link between physical activity, dementia, and cognitive functions in the elderly, by analyzing the different types of physical activity through questionnaires specific to the elderly, while keeping the greatest statistical power thanks to models adapted to longitudinal data. Our results have highlighted the difficulty of quantifying physical activity in the elderly and analyzed all the physical activities specific to the elderly and not only sports. The results obtained on the link between physical activity and cognitive aging allow us to question the choice of the most relevant indicators that should be used, but especially the place of lifestyle activities (domestic and transport). Our work contributes to the debate on the implementation of prevention policies on dementia and wider on aging and the autonomy of the elderly which must be preserved., Bien qu’il existe une abondante littérature sur le lien entre l’activité physique et le vieillissement cognitif, plusieurs de ces travaux suscitent cependant des interrogations sur le choix des outils d'évaluation de l'activité physique, le recueil de l'activité physique et les méthodes d’analyses statistiques. Dans ce contexte, nous avons étudié le lien entre l'activité physique, la démence et les fonctions cognitives chez les personnes âgées, en analysant les différents types d'activité physique grâce à des questionnaires spécifiques aux personnes âgées, tout en gardant la plus grande puissance statistique grâce aux modèles appropriés aux données longitudinales. Nos résultats ont mis en exergue la difficulté à quantifier l'activité physique chez les personnes âgées et l'importance d'évaluer l'ensemble des activités physiques propres aux personnes âgées et pas uniquement sportives. Les résultats obtenus sur le lien entre l'activité physique et le vieillissement cognitif permettent de s'interroger sur le choix des indicateurs les plus pertinents qui doivent être utilisés, mais surtout sur la place des activités du mode de vie (domestiques et de transports). Nos travaux contribuent au débat sur la mise en place des politiques de prévention sur la démence et plus largement sur le vieillissement et l'autonomie de la personne âgée qui doit être préservée.