Enquiring about traumatic experiences in psychosis: A comparison of case notes and self-report questionnaires

Purpose: Studies have found an association between a history of trauma and the presence of psychotic symptoms. Despite the research evidence it appears to be the case that many clinicians are not routinely asking about traumatic experiences. This study aims to ascertain the level of agreement between rates of self-reported trauma and that which is recorded in case notes.

Methods: The study population was drawn from all individuals with a confirmed diagnosis of psychosis, residing within a defined catchment area. Rates of childhood trauma, lifetime trauma and trauma related to the Troubles in Northern Ireland recorded in participants’ case notes were compared to their responses on self-report questionnaires: THQ, CTQ and TREQ.

Results: Relatively high levels of trauma were reported by participants on the self-report measures that were administered. The rates of trauma recorded in case note records were similar to that found in other studies. Also in line with other research were poor levels of agreement between self-report and case note data.

Conclusion: High levels of lifetime, childhood and trauma related to the Troubles in Northern Ireland were found when the individuals in the sample were directly assessed for the purposes of this study. In contrast much lower rates were recorded in patient notes on routine clinical assessment. The results suggest that clinicians do not routinely enquire about trauma histories with this population and as a result, case notes underestimate trauma prevalence.

Formando o cidadão desde o jardim-de-infância: o contributo das práticas de avaliação das aprendizagens dos educadores de infância em colaboração com a família

A presente investigação procura compreender o fenómeno complexo e dinâmico que é a avaliação das aprendizagens das crianças em colaboração com a família na Educação Pré-Escolar (EPE) como forma de potenciar o desenvolvimento de competências pelas crianças. Assim, e recorrendo a um estudo de caso com uma componente de investigação-acção, pretende-se (i) compreender as concepções e práticas de avaliação de aprendizagens na EPE desenvolvidas por um grupo de educadores de uma Instituição Privada de Solidariedade Social da região centro do país e (ii) potenciar, através de formação em contexto que contemple o desenvolvimento de estratégias inerentes a uma avaliação das aprendizagens em colaboração com a família das crianças, o desenvolvimento profissional dos educadores de infância neste âmbito, proporcionando experiências educativas que levem as crianças a desenvolver um conjunto de competências inerentes à nova natureza dos saberes básicos de todos os cidadãos do séc. XXI. Tomando como ideias base da investigação a concepção (i) da criança enquanto cidadão (Prout, 2005; Vasconcelos, 2009) e (ii) da família enquanto primeira e principal educadora das crianças (Steves, Hough & Nurs, 2002), a investigação foi desenvolvida em quatro fases: Fase I – Formulação de um referencial de competências para a EPE inerentes à nova natureza dos saberes básicos do séc. XXI e seu processo de transferibilidade e credibilidade; Fase II – Diagnóstico das concepções dos participantes da investigação sobre avaliação das aprendizagens na EPE e colaboração Instituição/Família; Fase III – Construção e implementação de um programa de formação para educadores de infância; Fase IV – Avaliação do impacte do programa de formação nas concepções e práticas de avaliação das aprendizagens dos educadores de infância. A fase I centra-se na formulação de um referencial de competências transversais para a EPE inerentes à nova natureza dos saberes básicos do séc. XXI (Cachapuz, Sá-Chaves & Paixão, 2004) e no seu processo de transferibilidade e credibilidade através da reflexão/discussão do respectivo referencial com um painel de especialistas e profissionais. Identificaram-se quatro competências transversais a serem desenvolvidas pelas crianças centradas nas dimensões do aprender a aprender, aprender a comunicar e a expressar-se, aprender a ser e estar e aprender a reflectir. A fase II incide no diagnóstico das concepções de avaliação das aprendizagens na EPE e de colaboração Instituição/Família dos 6 educadores de infância, 17 pais e 17 crianças participantes no estudo, recorrendo a entrevistas, à análise documental e à observação de práticas. A análise dos dados recolhidos demonstra que é necessário recuperar um verdadeiro discurso didáctico e educativo da avaliação das aprendizagens, deixando de a conceber como sinónimo de medida e de objectividade e melhorando as práticas de avaliação de VII modo a potenciar o desenvolvimento de competências pelas crianças. A fase III preenche-se na construção e implementação de um programa de formação, creditado e correspondente a 50 horas, para educadores de infância sobre avaliação de competências na EPE em colaboração com a família. O programa de formação foi desenvolvido a partir (i) das concepções diagnosticadas, (ii) dos indicadores da investigação em formação contínua e em avaliação na EPE e (iii) de um modelo de desenvolvimento profissional baseado na reflexão, na observação e supervisão e na investigação-acção (Shön, 1992; Alarcão, 2000; Roldão, 2008; Cadório & Simão, 2011). Os indicadores obtidos demonstram que o programa de formação contribuiu para o enriquecimento profissional dos formandos ao nível da (re)construção de conhecimento, da reflexão constante e colaborativa sobre as práticas de avaliação, da mudança de atitudes e práticas de avaliação das aprendizagens e na compreensão mais profunda da complexidade, diversidade e necessidade de cada criança. Além disso, os indicadores obtidos também evidenciam a importância de uma avaliação das aprendizagens em colaboração com os pais das crianças para o desenvolvimento progressivo das competências transversais para a EPE e, consequentemente, para a obtenção de sucesso educativo. A fase IV consiste na avaliação do impacte do programa de formação nas concepções e práticas avaliativas dos educadores de infância através de, à semelhança da fase II, entrevistas aos 6 educadores de infância, aos 17 pais e às 17 crianças, à análise documental e à observação de práticas. Os resultados obtidos demonstram que o programa de formação teve impacte nas práticas de avaliação das aprendizagens a nível micro (decisões no interior da sala de actividades) e, mais reduzido, a nível meso (decisões a nível institucional). Os educadores de infância integraram nas suas práticas pedagógicas algumas estratégias avaliativas implementadas durante o programa de formação, consciencializando-se da importância da avaliação na EPE se centrar em procedimentos descritivos com enfoque na actividade da criança e na documentação e registo do trabalho realizado no dia-a-dia e do desenvolvimento de competências de cada criança (Gaustad, 1996; Parente, 2002). Contudo, e no que se refere à colaboração dos pais no processo de avaliação das aprendizagens das crianças, o programa de formação não proporcionou qualquer impacte nas práticas avaliativas dos educadores de infância. Apesar dos discursos transparecerem uma consciencialização da importância da família participar e influenciar a tomada de decisões ao longo do processo de avaliação das aprendizagens (Oliveira-Formosinho & Araújo, 2004), não foram tomadas medidas de mudança de práticas neste sentido, permanecendo os pais das crianças como sujeitos passivos neste processo. Uma visão integradora sobre os resultados obtidos ao longo da presente investigação revela a necessidade de se continuar a investigar e a construir novos caminhos na formação contínua dos educadores de infância de modo a recuperar um verdadeiro discurso educativo da avaliação das aprendizagens com impacte nas práticas pedagógicas e onde a família das crianças surja como parceira num trabalho a desenvolver colaborativamente.

Biaxial seismic behaviour of reinforced concrete columns

A análise dos efeitos dos sismos mostra que a investigação em engenharia sísmica deve dar especial atenção à avaliação da vulnerabilidade das construções existentes, frequentemente desprovidas de adequada resistência sísmica tal como acontece em edifícios de betão armado (BA) de muitas cidades em países do sul da Europa, entre os quais Portugal. Sendo os pilares elementos estruturais fundamentais na resistência sísmica dos edifícios, deve ser dada especial atenção à sua resposta sob ações cíclicas. Acresce que o sismo é um tipo de ação cujos efeitos nos edifícios exige a consideração de duas componentes horizontais, o que tem exigências mais severas nos pilares comparativamente à ação unidirecional. Assim, esta tese centra-se na avaliação da resposta estrutural de pilares de betão armado sujeitos a ações cíclicas horizontais biaxiais, em três linhas principais. Em primeiro lugar desenvolveu-se uma campanha de ensaios para o estudo do comportamento cíclico uniaxial e biaxial de pilares de betão armado com esforço axial constante. Para tal foram construídas quatro séries de pilares retangulares de betão armado (24 no total) com diferentes características geométricas e quantidades de armadura longitudinal, tendo os pilares sido ensaiados para diferentes histórias de carga. Os resultados experimentais obtidos são analisados e discutidos dando particular atenção à evolução do dano, à degradação de rigidez e resistência com o aumento das exigências de deformação, à energia dissipada, ao amortecimento viscoso equivalente; por fim é proposto um índice de dano para pilares solicitados biaxialmente. De seguida foram aplicadas diferentes estratégias de modelação não-linear para a representação do comportamento biaxial dos pilares ensaiados, considerando não-linearidade distribuída ao longo dos elementos ou concentrada nas extremidades dos mesmos. Os resultados obtidos com as várias estratégias de modelação demonstraram representar adequadamente a resposta em termos das curvas envolventes força-deslocamento, mas foram encontradas algumas dificuldades na representação da degradação de resistência e na evolução da energia dissipada. Por fim, é proposto um modelo global para a representação do comportamento não-linear em flexão de elementos de betão armado sujeitos a ações biaxiais cíclicas. Este modelo tem por base um modelo uniaxial conhecido, combinado com uma função de interação desenvolvida com base no modelo de Bouc- Wen. Esta função de interação foi calibrada com recurso a técnicas de otimização e usando resultados de uma série de análises numéricas com um modelo refinado. É ainda demonstrada a capacidade do modelo simplificado em reproduzir os resultados experimentais de ensaios biaxiais de pilares.

A consultoria num Agrupamento TEIP II : contributos para a compreensão do seu processo

Tese de mestrado, Educação (Supervisão e Orientação da Prática profissional), Universidade de Lisboa, Instituto de Educação, 2012

Enhancing Student Learning Experiences in Sport Psychology Modules Using Practical Activities

The University of Worcester states in its most recent strategic plan (2013 – 2018) a set of enduring values that guide and direct the activities of the institution. The first listed, and perhaps the most important value is the striving to be “an outstanding university at which to be a student”. This is further supplemented by values such as “to inspire our students to reach their full potential through excellent, innovative teaching, scholarship and research” (University of Worcester 2013: p.4). One of the many ways in which the institution strives to provide this outstanding educational experience is through regular engagement, both formal and informal, with students at a number of points in each semester. Regular experiences of collating formal and informal feedback has led to the identification of a common theme amongst Higher National Diploma (HND) students in the Institute of Sport and Exercise Sciences (ISES), where they consistently request ‘more practicals’. The ISES modules however are designed to incorporate a high degree of interaction, practical activities and tasks. This is especially important for those studying at HND level as research suggests differences in learning preferences exist when compared to undergraduate students, the former preferring a more tactile style of learning (Peters et al. 2008). Using an introductory Sport Psychology HND module as an example, practical activities and tasks are fully embedded in the taught sessions to enable contextual links to be made between the learning outcomes and their subsequent use. Examples of these include: a. interviewing athletes to produce a performance profile (Butler & Hardy 1992); b. completing psychometric instruments such as the Competitive State Anxiety Inventory-2 (CSAI-2) to measure competitive anxiety in sport (Martens et al. 1990) and demonstrate data collection and construct measurement; c. performing relaxation interventions on the students to demonstrate how specific techniques (in this instance, decreasing somatic anxiety) might work in practice; d. demonstrating how observational learning facilitates skill acquisition by creating experimental conditions that the students participate in, in teaching a new skill. Nevertheless owing to the students' previously stated on-going requests for more practical activities, it became evident that assumptions about what students consider an effective means of experiential or active learning in the context of sport-related disciplines of study needed to be investigated. This is where the opportunity to undertake an action research project arose, this being a practical method commonly employed in pedagogical enquiry to aid reflection on teaching and assessment practice for the purposes of working towards continuous improvement.

Antioxidant properties of hydroxycinnamic acids: a review of structure- activity relationships

Hydroxycinnamic acids (HCAs) are important phytochemicals possessing significant biological properties. Several investigators have studied in vitro antioxidant activity of HCAs in detail. In this review, we have gathered the studies focused on the structure-activity relationships (SARs) of these compounds that have used medicinal chemistry to generate more potent antioxidant molecules. Most of the reports indicated that the presence of an unsaturated bond on the side chain of HCAs is vital to their activity. The structural features that were reported to be of importance to the antioxidant activity were categorized as follows: modifications of the aromatic ring, which include alterations in the number and position of hydroxy groups and insertion of electron donating or withdrawing moieties as well as modifications of the carboxylic function that include esterification and amidation process. Furthermore, reports that have addressed the influence of physicochemical properties including redox potential, lipid solubility and dissociation constant on the antioxidant activity were also summarized. Finally, the pro-oxidant effect of HCAs in some test systems was addressed. Most of the investigations concluded that the presence of ortho-dihydroxy phenyl group (catechol moiety) is of significant importance to the antioxidant activity, while, the presence of three hydroxy groups does not necessarily improve the activity. Optimization of the structure of molecular leads is an important task of modern medicinal chemistry and its accomplishment relies on the careful assessment of SARs. SAR studies on HCAs can identify the most successful antioxidants that could be useful for management of oxidative stress-related diseases.

A educação tecnológica como disciplina de opção de escola e os novos desafios do professor no ano de transição

Relatório de estágio apresentado à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Ensino da Educação Visual e Tecnológica no Ensino Básico

TRFS: desenvolvimento de um protótipo para simulação microscópica de tráfego

Dissertação para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Vias de Comunicação e Transportes

O Relato financeiro nas IPSS: Estudo de caso de uma IPSS do concelho de Vila Nova de Gaia

Dissertação de Mestrado apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Contabilidade e Finanças, sob orientação de Professora Doutora Ana Maria Alves Bandeira e Professora Doutora Deolinda Meira

Comparison of two osteoporotic fracture management pathways: experience at 1 year

Introduction: Osteoporosis presenting as low-impact fractures to traumatology units is often undiagnosed and under-treated. Results from the Osteocare study in Lausanne (a nurse based intervention, passive pathway) showed that only 19% of patients received management for osteoporosis, and in the literature [1], the rate is between 10-25%. We have evaluated a different management concept, based on the systematic assessment of patients with osteoporotic fractures during and after hospitalization (active pathway). Methods: Inpatients admitted to the Department of Musculoskeletal Medicine for a fragility fracture were identified by a nurse according to a predefined questionnaire and were then clinically evaluated by a doctor. Based on the results, a management plan was proposed to the patients. Patients could choose between follow up either by their GP or by the Centre of Bone Disease of the CHUV. For patients who chose follow-up in our Centre, we assessed their adherence to medical follow-up 1 year inclusion. The results of patients who had been evaluated in our cohort between the 1 November 2008 and the 1 December 2009 were analysed. Results: 573 inpatients received specific management of their osteoporotic fracture over 18 months. The mean age was 77 y (31-99), 81% were women (203 hip fractures, 40 pelvis fractures, 101 arm fractures, 57 vertebral fractures, 63 ankle fractures, and 25 others sites). During the study period, 303 patients received a proposition of a specific treatment. 39 (13%) chose a follow up with the GP, 19 (6%) dead and 245 (81%) preferred a follow up in our Centre. After 1 year, 166 (67%) patients are under follow up in our outpatient clinic. Conclusion: With an active clinical pathway that starts during the hospitalization, consisting on a nursing evaluation followed by a medical consultation by an expert in osteoporosis, the adherence increased from 19% to 67% in terms of follow up. These results lead us to propose a consultation with a doctor experienced in osteoporosis after all osteoporotic fractures.

Impact of an intervention to control risk associated with patient transfer.

QUESTION UNDER STUDY: Hospitals transferring patients retain responsibility until admission to the new health care facility. We define safe transfer conditions, based on appropriate risk assessment, and evaluate the impact of this strategy as implemented at our institution. METHODS: An algorithm defining transfer categories according to destination, equipment monitoring, and medication was developed and tested prospectively over 6 months. Conformity with algorithm criteria was assessed for every transfer and transfer category. After introduction of a transfer coordination centre with transfer nurses, the algorithm was implemented and the same survey was carried out over 1 year. RESULTS: Over the whole study period, the number of transfers increased by 40%, chiefly by ambulance from the emergency department to other hospitals and private clinics. Transfers to rehabilitation centres and nursing homes were reassigned to conventional vehicles. The percentage of patients requiring equipment during transfer, such as an intravenous line, decreased from 34% to 15%, while oxygen or i.v. drug requirement remained stable. The percentage of transfers considered below theoretical safety decreased from 6% to 4%, while 20% of transfers were considered safer than necessary. A substantial number of planned transfers could be "downgraded" by mutual agreement to a lower degree of supervision, and the system was stable on a short-term basis. CONCLUSION: A coordinated transfer system based on an algorithm determining transfer categories, developed on the basis of simple but valid medical and nursing criteria, reduced unnecessary ambulance transfers and treatment during transfer, and increased adequate supervision.

Research in the clinical setting : a qualitative study of the value of play research in the continuing education of occupational therapists.

Occupational therapists have always recognized playas an important part of a child's life. However, until recently play has been viewed as a medium for reaching treatment goals, rather than as an activity that is valuable in and of itself. If occupational therapists think of playas the primary activity or occupation of childhood, then play should be a very important area of focus for paediatric clinicians. In order to assist children to become as independent as possible with play and to have fulfilling play experiences the occupational therapist needs to have a clear understanding of how to assess, set goals which lead towards competence in play, and promote play. Recent play literature has placed importance on play behaviours and looking at the relationship between the child and both the human and nonhuman environment. Believing that play and playfulness can and should be promoted, for children with physical disabilities, requires that therapists learn new assessment and intervention strategies. A new assessment tool, The Test of Playfulness, was developed by Bundy in 1994. It addressed play behaviours and environmental influences. The author, a co-investigator and eight occupational therapists were involved in a playfulness study using this test to compare the playfulness of children with physical disabilities with their able-bodied peers. After the study was completed the author questioned whether or not involvement in the playfulness study was enough of a change agent to bring about transformative learning in order to further the eight occupational therapists' education about play.This study investigated changes in either the therapists' thinking about play or their behaviour in their clinical practice. The study also examined the participants' retention of knowledge about the Test of Playfulness. The eight therapists who had been involved in the playfulness study (participants) were matched with eight therapists who had not been involved (nonparticipants). The therapists were interviewed 9 to 12 months after completion of the playfulness study. They were asked to describe various scenarios of play and open ended prompts were used to elicit the therapists' perceptions of play, good play, the role or value of play, environmental and gender influences on play, play assessment and intervention, and play research, for children with and without disabilities. The participants were also prompted to discuss their experience with the playfulness study. A self-report questionnaire was also completed at the end of the interview. The results of the study demonstrated that: (a) the play research project was a good format for continuing the participants' education about play; (b) their thinking had changed about play; (c) according to self report, they had used this new knowledge in their clinical practice; and (d) the participants remembered the items on the Test of Playfulness and could use them in describing various aspects of play. This study found that participating in a play research project had been an effective method of professional development. It also highlighted the need for increased awareness of the recent literature on play and the developing role of the occupational therapist in the assessment and intervention of play.

À l’écoute du soignant : relation de soins et considérations éthiques dans la pratique des soins psychiatriques communautaires

Un phénomène de résistance au traitement pharmacologique chez les personnes souffrant de maladies psychiatriques graves et persistantes comme la schizophrénie, tel que révélé par la pratique des soins psychiatriques communautaires de première ligne, sert de point de départ pour poser une distinction fondamentale entre les notions de traitement et de soins. Conséquemment, la question du consentement selon qu’il est attribué au traitement ou aux soins suggère des formes de consentement distinctes susceptible d’affecter la façon de faire face à des problèmes particuliers sur le plan de l’éthique. L’analyse conceptuelle d’un certain modèle d’interventions psychiatriques de crise, qui regroupe des travailleurs de la santé et des policiers au sein d’une même équipe de travail, permet de circonscrire des catégories de problèmes éthiques qui conduiront éventuellement à la formalisation d’une approche de résolution de problème. Trois façons d’approcher un problème d’éthique clinique sont proposées sous la forme d’enjeux, de dilemmes, puis de défis éthiques. L’intervention de crise y est catégorisée selon quatre niveaux d’intensité de crise, donnant lieu à une appréciation subjective par le soignant de la capacité de la personne soignée d’établir et de maintenir une relation de soins en situation de crise. Des parallèles entre les soins psychiatriques et les soins palliatifs permettent d’approfondir la question de la souffrance en lien avec la douleur et de distinguer à nouveau les notions de soins et de traitement. La relation de soins est présentée comme une occasion de normaliser les rapports entre soignants et soignés, de valoriser un état de souffrance à l’origine de la rencontre de soins, tout en mettant à profit la dimension relationnelle d’une condition qui appelle à être non pas traitée mais soignée. Ces considérations permettent de dégager une responsabilité nouvelle pour le soignant : celle de se faire le gardien de la relation de soins. Une transition du primum non nocere au primum non excludere : d’abord ne pas exclure est suggérée comme une maxime pour guider la relation de soins vers un consentement aux soins plus authentique.

Modéliser le processus d’appropriation du feed-back en évaluation du potentiel pour en optimiser les retombées positives auprès des candidats

L’appropriation du feed-back a fait l’objet de plusieurs modèles théoriques en contexte d’évaluation de la performance, notamment par Ilgen, Fisher et Taylor (1979) qui suggèrent un modèle explicitant comment un feed-back en vient à susciter des changements comportementaux. Ce modèle a été repris dans divers domaines de recherche, sans pour autant être adapté en fonction du contexte spécifique dans lequel le feed-back était transmis. Cette thèse propose un modèle d’appropriation du feed-back inspiré des travaux d’Ilgen et al. (1979), mais reflétant les spécificités de l’évaluation du potentiel. Le modèle comporte trois étapes qui sont l’appropriation cognitive (composée de l’acceptation et de la conscientisation), l’intention d’agir dans le sens du feed-back et l’appropriation comportementale. La présente thèse se décompose en trois articles poursuivant les objectifs suivants : (1) Proposer un modèle théorique de l’appropriation du feed-back adapté au contexte de l’évaluation du potentiel. (2) Valider une mesure de l’appropriation cognitive combinant l’acceptation et la conscientisation. (3) Tester empiriquement le modèle d’appropriation du feed-back en contexte d’évaluation du potentiel. Le premier article vise d’abord à circonscrire les fondements de l’évaluation du potentiel et à définir l’appropriation du feed-back. Sur la base de ces informations, le modèle d’Ilgen et al. (1979) est ensuite revu et modifié. Les liens entre les différentes étapes du modèle sont subséquemment étayés par des théories et des études empiriques. L’article se conclue par une réflexion sur les retombées théoriques et pratiques du modèle revisité. L’objectif du second article consiste à développer et valider une mesure de l’appropriation cognitive incluant deux dimensions, à savoir l’acceptation et la conscientisation. Pour ce faire, deux études ont été menées auprès de candidats ayant reçu un feed-back suite à une évaluation du potentiel. Des analyses factorielles exploratoires (N = 111), puis des analyses factorielles confirmatoires (N = 178) ont été réalisées en ce sens. Chaque dimension de l’appropriation cognitive a également été mise en relation avec des variables critères afin de recueillir des éléments de preuve appuyant la validité de l’instrument. La majorité des indices obtenus confirment la présence des deux dimensions pressenties et des constats sont tirés sur la base de ces résultats. Le troisième article vise à vérifier empiriquement les liens anticipés entre les composantes du modèle d’appropriation du feed-back détaillé dans le premier article. Les deux premières étapes du modèle, soit l’appropriation cognitive et l’intention d’agir, ont été mesurées via un questionnaire complété immédiatement après le feed-back par 178 candidats. Ces derniers ont été sollicités trois mois plus tard afin de compléter un second questionnaire portant sur la dernière étape, l’appropriation comportementale, et 97 d’entre eux y ont répondu. Les résultats d’analyses par équations structurelles supportent le modèle et une discussion sur la portée de tels résultats s’en suit.

Évolution du risque cardiométabolique sur une période de quatre ans : étude chez des adultes béninois (Afrique de l’Ouest)

Les objectifs de l’étude de l’évolution du risque cardiométabolique (RCM) sur une période de quatre ans (2006-2010) chez des adultes béninois consistaient à: • Examiner les relations entre l’obésité abdominale selon les critères de la Fédération Internationale du Diabète (IFD) ou l’insulino-résistance mesurée par le Homeostasis Model Assessment (HOMA) et l’évolution des autres facteurs de RCM, • Examiner les liens entre les habitudes alimentaires, l’activité physique et les conditions socio-économiques et l’évolution du RCM évalué conjointement par le score de risque de maladies cardiovasculaires de Framingham (FRS) et le syndrome métabolique (SMet). Les hypothèses de recherche étaient: • L’obésité abdominale telle que définie par les critères de l’IDF est faiblement associée à une évolution défavorable des autres facteurs de RCM, alors que l’insulino-résistance mesurée par le HOMA lui est fortement associée; • Un niveau socioéconomique moyen, un cadre de vie peu urbanisé (rural ou semi-urbain), de meilleures habitudes alimentaires (score élevé de consommation d’aliments protecteurs contre le RCM) et l’activité physique contribuent à une évolution plus favorable du RCM. L’étude a inclus 541 sujets âgés de 25 à 60 ans, apparemment en bonne santé, aléatoirement sélectionnés dans la plus grande ville (n = 200), une petite ville (n = 171) et sa périphérie rurale (n = 170). Après les études de base, les sujets ont été suivis après deux et quatre ans. Les apports alimentaires et l’activité physique ont été cernés par deux ou trois rappels de 24 heures dans les études de base puis par des questionnaires de fréquence simplifiés lors des suivis. Les données sur les conditions socioéconomiques, la consommation d’alcool et le tabagisme ont été recueillies par questionnaire. Des mesures anthropométriques et la tension artérielle ont été prises. La glycémie à jeun, l’insulinémie et les lipides sanguins ont été mesurés. Un score de fréquence de consommation d’« aliments sentinelles » a été développé et utilisé. Un total de 416 sujets ont participé au dernier suivi. La prévalence initiale du SMet et du FRS≥10% était de 8,7% et 7,2%, respectivement. L’incidence du SMet et d’un FRS≥10% sur quatre ans était de 8,2% et 5%, respectivement. Le RCM s’était détérioré chez 21% des sujets. L’obésité abdominale définie par les valeurs seuils de tour de taille de l’IDF était associée à un risque plus élevé d’insulino-résistance: risque relatif (RR) = 5,7 (IC 95% : 2,8-11,5); d’un ratio cholestérol total/HDL-Cholestérol élevé: RR = 3,4 (IC 95% : 1,5-7,3); mais elle n’était pas associée à un risque significativement accru de tension artérielle élevée ou de triglycérides élevés. Les valeurs seuils de tour de taille optimales pour l’identification des sujets accusant au moins un facteur de risque du SMet étaient de 90 cm chez les femmes et de 80 cm chez les hommes. L’insulino-résistance mesurée par le HOMA était associée à un risque élevé d’hyperglycémie: RR = 5,7 (IC 95% : 2,8-11,5). En revanche, l’insulino-résistance n’était pas associée à un risque significatif de tension artérielle élevée et de triglycérides élevés. La combinaison de SMet et du FRS pour l’évaluation du RCM identifiait davantage de sujets à risque que l’utilisation de l’un ou l’autre outil isolément. Le risque de détérioration du profil de RCM était associé à un faible score de consommation des «aliments sentinelles» qui reflètent le caractère protecteur de l’alimentation (viande rouge, volaille, lait, œufs et légumes): RR = 5,6 (IC 95%: 1,9-16,1); et à l’inactivité physique: RR = 6,3 (IC 95%: 3,0-13,4). Les sujets de niveau socioéconomique faible et moyen, et ceux du milieu rural et semi-urbain avaient un moindre risque d’aggravation du RCM. L’étude a montré que les relations entre les facteurs de RCM présentaient des particularités chez les adultes béninois par rapport aux Caucasiens et a souligné le besoin de reconsidérer les composantes du SMet ainsi que leurs valeurs seuils pour les Africains sub-sahariens. La détérioration rapide du RCM nécessité des mesures préventives basées sur la promotion d’un mode de vie plus actif associé à de meilleures habitudes alimentaires.