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Santé de la femme et pathologie chronique : identification de comorbidités et facteurs de risque ; impact d'une prise en charge gynécologique spécifique : exemple de la mucoviscidose

Abstract : Life expectancy of patients with cystic fibrosis (CF) improved through different types of therapeutic and organizational interventions. As a result, new issues are emerging, such as gynecological management and sexual health in adult women with CF. The main objective of this work was to evaluate the gynecological management of women with CF, to describe their gynecological comorbidities, and to propose means to improve their management and prevention.A first descriptive study conducted in Lyon CF centre, found an insufficient gynecological management (proportion and frequency of women followed, contraceptive coverage and cervical screening). The impact of a gynecological consultation offer in the CF centre was then assessed two years after its implementation, with a significant improvement in gynecological management (according to the same three indicators). Gynecological comorbidities specific to CF were described, including a high frequency of cervical disease due to papillomavirus (HPV) infection (in transplanted, and non-transplanted women). A prospective study was then conducted to better understand the pathophysiological link between CF and cervical disease, exploring the natural history of HPV infection in this specific population. The epidemiological link between CF and cervical disease is also being evaluated through a national-wide study based on french national health insurance data and the French CF Registry. Finally, we have described an insufficient HPV vaccination rate, as well as the barriers to this vaccination in young girls with CF. Sensitization of health care providers and of women on the importance of a regular and specific gynecological management, tailored to the particular context of CF should lead to improved practices
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Submitted on : Wednesday, September 2, 2020 - 1:10:15 AM
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Christine Jablonski. Santé de la femme et pathologie chronique : identification de comorbidités et facteurs de risque ; impact d'une prise en charge gynécologique spécifique : exemple de la mucoviscidose. Santé. Université de Lyon, 2020. Français. ⟨NNT : 2020LYSE1019⟩. ⟨tel-02927780⟩

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