Description de l’évolution du profil socio-cognitif et clinique d’une cohorte d’adolescents diabétiques de type 1 ayant suivi un programme d’éducation thérapeutique

Thèse réalisée en cotutelle entre Aix-Marseille Université et l'Université de Montréal

Effets d'un programme d'exercices aérobie et en résistance, combinés, chez les patients atteints de fibrose kystique, intolérants au glucose ou diabétiques

La fibrose kystique (FK) est une des maladies rares la plus fréquente au Canada avec un âge médian de survie de 50.9 ans. Toutefois, l'amélioration de l’espérance de vie est associée à l'émergence de complications secondaires telles que le diabète associé à la FK (DAFK). Présent chez 25 à 40% des adultes, il augmente de 6 fois le risque de morbidité et de mortalité. Plusieurs études sur des populations atteintes de diabète de type 2 ont démontrés les bienfaits de programmes d’exercices combinés (aérobie et résistance) sur l’amélioration du contrôle glycémique. L’objectif de l’étude visait à déterminer si un programme d’exercices combinés permettait d’améliorer les anomalies de la tolérance au glucose et le contrôle glycémique chez les patients atteints de FK. Méthodologie: 18 adultes atteints de FK, sédentaires avec une intolérance au glucose ont été recrutés pour cette étude (8 hommes, 10 femmes, âge: 33 ± 9.4 ans, FEV1 71.5% pred ± 12.5, IMC 23.57 kg/m2 ± 3,4). Les participants ont été assignés au hasard à un groupe contrôle ou exercice. Les tests suivants ont été réalisés avant et après l’intervention : VO2max, HGPO, mesure de l'endurance et de la force musculaire, ainsi qu’un questionnaire sur la qualité de vie. Résultats: 14 participants ont complété le protocole. Les participants du groupe exercice ont amélioré leur valeur de glycémie plasmatique à la 2e heure de l’HGPO (-2.34 +/- 0.87 mmol/L; p <0.01; CI 99.22%), à la 1re heure de l’HGPO (-2.0 mmol/L; p<0.05) et ont présenté une réduction de 17.2% (p<0.05) de l’aire sous la courbe de glucose. Conclusion: Un programme d'exercices combinés améliore le contrôle glycémique chez les patients atteints de FK. Cette approche thérapeutique non-pharmacologique pourrait offrir une intervention ayant le potentiel de retarder l'apparition de DAFK.

Community Participation in Ecotourism: An Inclusive Development Option for Kerala

The inferences obtained from the study are presented in coherent area-specific levels so as to understand the ecotourism and its sub-sector areas for the researchers and policy makers about the issues, importances and potentialities of the sector. An analysis of the tourism sector in Kerala has shown tremendous growth both in terms of tourist arrivals and in terms of revenue generation from direct and indirect sources. The foreign tourist visitors in Kerala in 2014 was 9,23,336 which shows 7.60 percent increase from the last year and the domestic tourist visitors were 1,16,95,411 which again shows 7.71 percent increase, is a clear evidence of its potential. In 2014 the industry contributed revenue of 24885.44 crores from direct and indirect sources giving rise to an increase of 12.11 percent from the last year. A dichotomy of tourists and ecotourists shows that tourists in the ecotourism destinations come to 42.6 percent of the total, shows the scope, significance and its potential. Correlation of zone-wise tourist arrivals based on the ecotourism destinations highlights the fact that with only 19 of the 64 destinations that come in the central zone are the most preferred centres (around 54 percent) for the domestic as well as foreign tourists. The north zone encompassing 6 districts with rich biodiversity shows that the tourists‟ arrival patterns exhibit less promising results. Though the north zone has 31 ecotourism destinations of the state receives only 6.19 percent of the foreign visitors. The ecotourism activities in the state are primarily managed by the Eco-Development Committees (EDCs) and the Vana Samrakshana Samithies (VSS) under the Forest Development Agency of Kerala. Social class-wise categorization of membership shows that 13142 families have membership in 190 EDCs with SC (28 percent), ST (33 percent) and other marginalised communities (39 percent). But this in the VSS shows that 400 VSS have 59085 members actively engaged in ecotourism activities and social category of the VSS makes clear that majority are from the other marginalized fringe households with 62 percent where as the participation of SC is 12 percent and ST is 26 percent. An evaluation of the socio-economic and demographic matrix of the community members involved in ecotourism activities brings out region specific differences. About 75.70 percent of the respondents are males and the rest are females. Majority of the respondents (about 60 percent) are in the age group of 20 to 40 years, followed by the age group of 40-50 (20 percent). The average age of respondents in the three zones is between 35 and 37 years. The majority of the respondents are married, a few are unmarried. Average family size is 4-5 members and differences are identified among zones. Average number of adults per household is 3 and child per household is 2. Majority have an education of 10th class and below i.e. about 60 percent of the sample have only basic school education like primary, secondary and high school (i.e. up to SSLC but not passed) level. About 18 percent are SSLC passed, 10 percent are undergraduates whereas 6 percent constitute respondents having qualification of graduation and above. Majority of the „graduates and above‟ are from south and central zone. Inter-zone differences in educational profile are also identified with lesser number of „graduates and above‟ are identified in the north zone compared to the other two zones. Investigating into the income and livelihood options of the respondents gives insight about the prominence of ecotourism as an employment and livelihood option for the community members, as more than 90 percent of the respondents have cited tourism sector as their main employment option. Most (49.30 percent) of respondents get 100 percent income from tourism related activities, followed by 37.30 percent of community members have income between 75-99 percent from tourism whereas the rest (13 percent) have less than 74 percent of their income from tourism and there exists difference between zones and percentage of income. Financial habit shows that about 49.7 percent hold active bank accounts, 61 percent have savings behaviour and 73.8 percent have indebtedness. Analysis about the ownership of house brings to light that 37 percent of respondents live in their own house followed by 25.7 percent in government funded/provided house and 21 percent in their parent‟s house and 3.5 percent in rented house. About 12 percent of the respondents have other kinds of accommodation facilities such as staff quarters, etc. But in the case of north zone majority i.e. 52 percent primarily depend on the government funded house indicating the effectiveness of government housing programme. Standard of living measured in SLI frameworks shows that majority of the respondents have medium SLI values (42.3 percent); the remaining 47.7 percent have low SLI and 10 percent have high SLI. The community members have been benefitted immensely from forest and its resources. Since the ecotourism destinations are located amidst the wildlife settings, majority of them depend on forest for their livelihood. The information on the tourist‟s demographic characteristics like age, sex, educational qualification and annual income show that the age category of domestic and foreign tourists falls below the age group of less than 35 years (about 65 percent), whereas only 16 percent of tourists are aged above 46 years. The age group below 25 years consists of more international tourists (31.3 percent) compared to the proportion of domestic tourists (12.5 percent). Male-female ratio shows that the males constitute 56 percent of the sample and females with 44 percent. The factors determining the impact of ecotourism programmes in the community was evaluated with the aid of a factor analysis with 12 selected statements. The worries and concerns of the community members about the impact of ecotourism on the environment are well understood from this analysis. It can be drawn that environment protection and the role of ecotourism in improving the income and livelihood options of the local communities is the most important factor concerning the community members.

Factors associated to avascular necrosis of the femoral head and non-union in patients younger than 65 years old with displaced femoral neck fractures treated with reduction and internal fixation.

Pocos estudios han evaluado el tratamiento de las fracturas desplazadas de cuello femoral en pacientes menores de 65 años de edad, y no han sido claramente definidos los factores de riesgo para necrosis avascular o no-unión dentro de este rango de edad. Para determinar los factores asociados a la necrosis avascular de la cabeza femoral (AVN) y no-unión en pacientes menores de 65 años de edad con fracturas desplazadas del cuello femoral tratados con reducción y fijación interna, se realizó un estudio retrospectivo de 29 fracturas desplazadas del cuello femoral en 29 pacientes consecutivos tratados en una sola institución. La influencia de la edad, la energía del trauma, tipo de reducción, y el tiempo entre la fractura y el tratamiento en desarrollo de la AVN y no-unión fueron evaluados. Los pacientes que desarrollaron NAV fueron significativamente mayores y sufrieron un trauma de más baja energía que en los casos sin AVN. Ninguna variable fue asociada con la no-unión. La regresión logística determinó que sólo la edad se asoció de forma independiente a NAV. La edad es un buen predictor para el desarrollo de NAV, con un C-estadístico de 0.861, y un mejor corte-determinado en 53,5 años. Conclusión: Los pacientes de entre 53,5 y 65 años presentan un riesgo más alto de NAV. La artroplastia primaria se debe considerar en este subgrupo.

Presión arterial en preescolares de la localidad de Usaquén en Bogotá

Introducción: La hipertensión arterial es un problema de salud pública tanto en países industrializados como en vía de desarrollo. Su prevalencia en la infancia viene en aumento por lo que es relevante determinarla en niños preescolares a nivel local. Objetivo: Determinar la prevalencia de hipertensión arterial en niños de tres a cinco años de una cohorte de 14 hogares infantiles del ICBF de la localidad de Usaquén en Bogotá. Materiales y métodos: Se realizó un estudio de corte transversal analítico, utilizando la base de datos de un ensayo aleatorizado y controlado del año 200913, y se evaluaron las cifras de tensión arterial de acuerdo a sexo, edad, talla y su correlación con el IMC con un nivel de confianza del 95% y precisión del 1%. Se calcularon las medias, desviaciones estándar, percentiles y prevalencia. Resultados: Se obtuvo una muestra de 1035 casos, encontrándose una prevalencia de 4,5% de HTA sistólica, 10,4% de diastólica, ambas en estadio I; teniendo en cuenta tanto sistólica como diastólica, fue de 11,6% en estadio I. Se determinaron los valores de presión arterial sistólica y diastólica en cuartiles de acuerdo a edad, sexo y talla. El coeficiente de correlación entre el IMC y los niveles de presión arterial sistólica y diastólica fueron de 0.0992 y 0.0362 respectivamente. Conclusión: La prevalencia de HTA general fue de 11,6%, predominando la diastólica en estadio I en niños preescolares. No se encontró correlación entre el IMC y las cifras de tensión arterial sistólica y diastólica.

Primary Prevention and Screening Strategies for Colorectal Cancer: Which Strategy Should Take?

Objective: To explore and define the utility of different strategies for primary prevention (ASA, diet, physical activity) and strategies of screening test (FOBT, sigmoidoscopy, colonoscopy, etc.) for colorectal cancer. Data source: Databases consulted were MEDLINE (1966 to 2006), DARE (1980 to 2006), Cochrane Central Register of Controlled Trials, Cochrane Collaboration’s Registry of Clinical Trials, Cochrane Database of Systematic Reviews and LILACS. Study selection: Studies such clinical trial, cohort and case-control studies of the effectiveness of tests for screening and primary prevention adenoma and colorectal cancer were identified by two reviewers. Data Extraction: The extraction of data and its evaluation is done in most of the process so paired. Limitations: Not strictly complies with the methodology of a systematic review and therefore reproducibility is questionable, the conclusions of this study should be extrapolated with caution. Conclusions: The major strategy of screening on the effectiveness of early detection of premalignant lesions or cancer is colonoscopy every 5 years, however it is necessary to evaluate this measure cost-effectiveness studies. For primary prevention, aspirin and cyclooxygenase-2 inhibitors reduce the incidence of colorectal adenomas. Aspirin can reduce colorectal cancer incidence. However, these medications may be associated with a significant risk of cardiovascular events and gastrointestinal bleeding. The balance between risks and benefits must be evaluated in future studies.

Transcutaneous electrical nerve stimulation and primary dysmenorrhea: a case report

Primary dysmenorrhea is pelvic pain during the menstrual cycle. The A delta and C fibers aresensitized by the increased release of prostaglandins and leukotrienes, thus causing pain. TransElectric Nerve Stimulation (TENS) is a physiotherapeutic strategy that mitigatespain sensation. Objective: The aim of this paper is to present six cases of women in childbearingage who were diagnosed with primary dysmenorrhea and received transcutaneous electricnerve stimulation. Materials and methods: A type of study, case report, was conducted with sixwomen between 15 and 25 years of age with medical diagnosis of primary dysmenorrhea. Weassessed pain intensity utilizing the visual analogue pain scale and located the pain by usinga pain test map. Results: Pain intensity decreased in all treated women. Conclusion: Transcutaneouselectric nerve stimulation (TENS) is a physiotherapeutic strategy that mitigates painsensation. We conclude that high frequency TENSis a safe noninvasive modality to achievereduction of pain in primary dysmenorrhea.

Análisis de la ayuda oficial al desarrollo. estudio de caso: programa conjunto de UNICEF y UNFPA sobre la mutilación genital femenina en Kenia (2008-2012)

El interés de este estudio de caso es analizar el Programa Conjunto de UNFPA y UNICEF sobre MGF/E en Kenia bajo la luz de los postulados poscolonialistas. Partiendo de la idea de que la MGF es una manifestación de las desigualdades de género, se argumenta que el PC reproduce la imagen de la mujer keniana como una víctima del poder masculino. A partir de esta imagen se deslegitima el orden cultural de los grupos que siguen esta tradición, afectando las lógicas de unidad y cohesión de la sociedad. El análisis de este tipo de dinámicas permite comprender mejor los procesos de intervención de las organizaciones internacionales sobre las estructuras sociales de actores frágiles del sistema internacional.

Trauma craneoencefálico severo en la UCIP del Hospital de la Misericordia, 2010-2013

El Trauma Craneoencefálico (TCE) infantil constituye un motivo frecuente de consulta en Urgencias y supone la primera causa de muerte en niños, llegando a ser hasta del 50% en trauma severo. En Colombia se conocen cifras de TCE por algunos estudios descriptivos, pero no existen reportes en Bogotá ni específicamente en TCE severo. Objetivo: Caracterizar el trauma craneoencefálico severo pediátrico en la Unidad de Cuidado intensivo del Hospital de la Misericordia entre los años 2010 y 2013. Materiales y métodos: Un estudio descriptivo retrospectivo fue realizado en el Hospital de la Misericordia mediante revisión de las historias clínicas de los pacientes que ingresaron a la Unidad de Cuidado Intensivo pediátrico con diagnóstico de trauma craneoencefálico severo entre el año 2010 al 2013. Resultados: Se incluyeron 63 pacientes (71,4% hombres) con una edad mediana de 4 años (RIQ 2-8). La mayoría de los traumas fueron originados por caída o accidente de tránsito (79,4%). La principal lesión fue fractura de cráneo (79%). Casi la mitad de los pacientes sufrieron algún tipo de secuela neurológica al egreso (47,1%). La mayoría de los pacientes que murieron (19%) sufrieron choque hipovolémico (83,3%) y presentaron trauma asociado (66,7%). Conclusión: Las características y epidemiología del trauma craneoencefálico en nuestra población muestran claras similitudes con lo reportados en otras series de la literatura mundial y de Colombia, excepto por la mortalidad, que se esperaba más alta al estudiar solo pacientes con TCE severo.

100 ideas for teaching primary mathematics.

Es un recurso para los profesores y personal de apoyo que quiere completar y mejorar el programa de estudios de matemáticas de primaria, aunque aquí predominan los conceptos de números. Todas las ideas expuestas se han utilizado con éxito en las clases y las actividades y juegos fomentan la colaboración en parejas o en grupos entre los niños.

Primary succession in man-made wetlands: biodiversity, structure and dynamics of macrofaunal assemblages

Man-made wetlands are often created to compensate for the loss or degradation of natural wetlands, but little is known about the processes taking place in these artificial environments, especially at the community level. Throughout this thesis, we have assessed the phenomena of primary succession over different time (short-, mid- and long-term) and spatial scales (local, regional, interregional levels), applying different approaches (taxonomic and functional) and subject groups (invertebrates and amphibians). Our main findings regarding time scales show a 3-phase successional pattern in Mediterranean man-made wetlands’ communities, where at the short term (1 year) colonization processes dominate; at mid term perspectives (2 to 7 years) succession signs begin to be conspicuous, and later on (≥ 10 years) parameters such as species richness reach an asymptote. At that moment, some biological strategies dominate, and biodiversity surrogates indicate that communities are indistinct between man-made and natural wetlands. Regarding spatial effects, we corroborated that both local and regional factors affect the establishing communities. Particularly, the low hydrological stability of the Mediterranean region has enhanced biological traits favoring resilience and resistance to disturbances when comparing Mediterranean and cold temperate aquatic communities. Even within the Mediterranean region, low levels of hydrological stability have significant effects on the successional dynamics. In these cases, local communities are highly nested within regional natural ones, and so are not able to make net contributions to regional richness. We also showed the influence of the regional pool of recruiters over local communities, both in the case of invertebrates and amphibians. Especially for the latter group, man-made Mediterranean temporary ponds (MTPs) can play an important role in their conservation.

Social politics in a transoceanic world in the early Cold War years

This article argues that those termed 'liberals' in the United States had the opportunity in the late 1940's to use overseas case studies to reshape the ramshackle political agenda of the New Deal along more specifically social democratic lines, but hat they found it impossible to match interest in the wider world with a concrete programme to overcome tension between left-wing politics and the emerging anti-totalitarianism of the Cold War. The American right, by contrast, conducted a highly organised publicity drive to provide new meaning for their anti-statist ideology in a post-New Deal, post-isolationist United States by using perceived failures of welfare states overseas as domestic propaganda. The examples of Labour Britain after 1945 and Labour New Zealand both provided important case studies for American liberals and conservatives, but in the Cold War it was the American right who would benefit most from an ideologically driven repackaging of overseas social policy for an American audience.

Metrics for solar wind prediction models: Comparison of empirical, hybrid, and physics-based schemes with 8 years of L1 observations

Space weather effects on technological systems originate with energy carried from the Sun to the terrestrial environment by the solar wind. In this study, we present results of modeling of solar corona-heliosphere processes to predict solar wind conditions at the L1 Lagrangian point upstream of Earth. In particular we calculate performance metrics for (1) empirical, (2) hybrid empirical/physics-based, and (3) full physics-based coupled corona-heliosphere models over an 8-year period (1995–2002). L1 measurements of the radial solar wind speed are the primary basis for validation of the coronal and heliosphere models studied, though other solar wind parameters are also considered. The models are from the Center for Integrated Space-Weather Modeling (CISM) which has developed a coupled model of the whole Sun-to-Earth system, from the solar photosphere to the terrestrial thermosphere. Simple point-by-point analysis techniques, such as mean-square-error and correlation coefficients, indicate that the empirical coronal-heliosphere model currently gives the best forecast of solar wind speed at 1 AU. A more detailed analysis shows that errors in the physics-based models are predominately the result of small timing offsets to solar wind structures and that the large-scale features of the solar wind are actually well modeled. We suggest that additional “tuning” of the coupling between the coronal and heliosphere models could lead to a significant improvement of their accuracy. Furthermore, we note that the physics-based models accurately capture dynamic effects at solar wind stream interaction regions, such as magnetic field compression, flow deflection, and density buildup, which the empirical scheme cannot.

Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.

The effects of adding picoxystrobin, azoxystrobin and nitrogen to a triazole programme on disease control, flag leaf senescence, yield and grain quality of winter wheat

The effect of adding strobilurins to a triazole (epoxiconazole) fungicide programme on the quality of a range of wheat cultivars was assessed in field experiments in three successive years. Strobilurin was applied at just flag leaf emergence (azoxystrobin) or at the start of stem extension (azoxystrobin or picoxystrobin) and again at flag leaf emergence or at flag leaf emergence and again at ear emergence (azoxystrobin). All strobilurin treatments reduced disease levels, delayed senescence of the flag leaf and consistently increased yields, thousand grain weight and specific weight. Reductions in Hagberg falling number were observed, even by fungicide applications at the start of stem extension, but effects were small compared to the variation among cultivars. Application of fungicide (triazole or strobilurin) before ear emergence increased the amount of blackpoint, but this was partly countered by applying azoxystrobin at ear emergence. The effect of fungicide on protein concentration differed over seasons and cultivar. Where they occurred. small reductions in protein concentration could be compensated for by extra application of nitrogen as foliar urea at anthesis. Foliar urea (40 kg N ha(-1)) applied at anthesis also improved Hagberg failing number and reduced blackpoint in one of the growing seasons. In one season, the effect of foliar urea at anthesis was compared with applications of granular fertiliser at flag leaf emergence. The granular treatment produced grain with more concentrated protein, while the later, foliar application produced higher specific weights. (C) 2003 Elsevier Science Ltd. All rights reserved.