ED Sociétés, Politique, Santé Publique
Heterogeneity in care pathways and inequalities in access to care during the acute and post-acute phases of ST-elevation myocardial infarction
by Emilie LESAINE (Bordeaux Population Health Research Center)
The defense will take place at 14h00 - Salle de conférence Université de Bordeaux, CARF : centre d'appui à la recherche et de formation, 146 rue Léo Saignat 33000 Bordeaux
in front of the jury composed of
- Florence SAILLOUR-GLENISSON - Praticienne hospitalière - Université de Bordeaux - Directeur de these
- Frederic LAPOSTOLLE - Professeur des universités - praticien hospitalier - Assistance Publique – Hôpitaux de Paris - Rapporteur
- Sandrine CHARPENTIER - Professeure des universités - praticienne hospitalière - CHU de Toulouse - Rapporteur
- Pierre COSTE - Professeur - Université de Bordeaux - Examinateur
- Marie MOITRY - Praticienne hospitalière - CHU Strasbourg - Examinateur
- Jérome WITTWER - Professeur - Université de Bordeaux - Examinateur
ST-segment elevation myocardial infarction (STEMI) is a cardiovascular emergency whose prognosis closely depends on the timeliness and quality of care. Reducing delays between symptom onset and revascularization is a major prognostic challenge, supporting the implementation of structured care pathways. However, despite international guidelines and dedicated STEMI networks, care remains heterogeneous with opportunities for improvement. In the French context, STEMI care pathways remain insufficiently documented. Important gaps remain, particularly in the characterization of critical points in the care pathway where management may be suboptimal, as well as in the understanding of the social and geographic factors that influence these processes. Furthermore, the impact of a health crisis on the organization and functioning of these pathways remains poorly understood. A better understanding of the mechanisms underlying variations in patient management is essential to guide health policy. This PhD research aims to help address these gaps by leveraging comprehensive observational data from the REANIM and ACIRA registries in the Aquitaine region over the period 2017–2021. Its objectives are to characterize care pathways for patients with STEMI, from symptom onset to cardiac rehabilitation, to analyze the social and territorial determinants of health affecting critical points of these pathways in France, and to assess the resilience of the STEMI network during the COVID-19 pandemic. The results identified three critical breakpoints that may compromise optimal STEMI patient management: - Initial contact with the emergency medical services, reported by only three-quarters of patients; - Medical dispatch decisions, with mobile intensive care unit activation in only three-quarters of patients who contacted the emergency medical services; - Access to cardiac rehabilitation, limited to one-third of patients who underwent percutaneous coronary intervention within one year following an acute coronary syndrome. In addition, marked social and territorial inequalities were observed in access to care for STEMI patients in France, both in the acute and post-acute phases, despite universal health coverage. During the acute phase, patients living in socioeconomically deprived areas, as well as specific groups—particularly women, older adults, and residents of peri-urban areas—experienced less timely and less optimal access to care. In the post-acute phase, access to cardiac rehabilitation within three months after STEMI was partly driven by geographic factors, particularly the distance between patients' homes and specialized facilities. The analysis of the first wave of COVID-19 provides original insights into the resilience of STEMI care pathways, demonstrating the healthcare system's ability to maintain overall quality of care during a health crisis, including for the most vulnerable populations. These findings open important perspectives for both public health action and research. They highlight the value of combining complementary approaches to analyze care pathways, the relevance of existing ecological variables for studying social and territorial health inequalities, and the need to develop mixed-methods approaches to better understand the mechanisms underlying inequalities in access to care.
Teaching dance in preschool: between emotions and well-being
by Laetitia ROSMANN (Laboratoire Cultures, Education, Sociétés)
The defense will take place at 14h00 - Salle A Université de Bordeaux, Faculté des STAPS, Campus Rocquencourt, Bâtiment R2 "Rougier", 12 avenue Camille Jullian, 33607 Pessac
in front of the jury composed of
- Florence DARNIS - Maîtresse de conférences émérite - INSPÉ de l'académie de Bordeaux - Site de Gironde - Directeur de these
- Sophie NECKER - Maîtresse de conférences - Université de Lille - Examinateur
- Eric DUGAS - Professeur des universités - Université de Bordeaux - Examinateur
- Fabien BACRO - Maître de conférences - Université de Nantes UFR Psychologie UR 4638 Laboratoire de Psychologie des Pays de la Loire - Rapporteur
- Gaëlle ESPINOSA - Professeure des universités - Université de Lorraine Campus Lettres et Sciences Humaines à Nancy - Rapporteur
- Pascal LEGRAIN - Professeur émérite - Université de Bordeaux - Campus de Pessac - Examinateur
Subjective well-being, defined by Diener (1984) as a cognitive and affective evaluation of one's own life, is now recognised as an important lever in academic success. However, this dimension seems to have been little explored in nursery school children. This thesis is part of an interactionist approach to development, according to which learning, language and subjective well-being are constructed through interactions between the child and the school environment. Two complementary objectives are pursued here. The first is to adapt and validate an existing subjective well-being scale (Guimard et al., 2014) for 5- to 6-year-old pupils by incorporating a motor dimension. The second is to study the mechanisms by which a collaborative approach – between a primary school teacher and a researcher – of the design-based research type (Brown, 1992) influences both motor skills acquisition in dance and subjective well-being at school. This programme combines creative dance, an album about emotions (joy, anger and fear) and work in pairs. It creates a space for physical and verbal expression supported by the teacher. A mixed methodology was implemented, combining a well-being questionnaire, a grid for analysing motor skills in dance and a comprehensive analysis of exchanges within the pairs, combined with individual interviews. The results show a moderate effect of the programme on the children's well-being and a significant effect on the pupils' motor skills in dance. The qualitative analysis highlights the role of language interactions in dyads and metaphorical language in the construction of movement, as well as the influence of evaluative gaze on the pupils' emotional experience. These results contribute to a better understanding of the links between physical activity, social interactions and subjective wellbeing in nursery school. Keywords: creative dance – nursery school – positive emotions – language interactions – subjective well-being