Prevalência de obesidade em adolescentes do distrito de Viseu

RESUMO - Introdução: A prevalência de obesidade apresenta valores preocupantes em todas as idades e é reconhecida pela Organização Mundial da Saúde como um importante problema de saúde pública. Diversos estudos mostram que a sua prevalência tem aumentado significativamente nas últimas décadas, particularmente nos países industrializados. O objectivo da presente investigação foi calcular a prevalência de excesso de peso e de obesidade em adolescentes do distrito de Viseu. Métodos: Realizámos um estudo transversal onde avaliámos os alunos de vinte e seis das quarenta e oito escolas públicas do terceiro ciclo e secundário do distrito de Viseu, frequentadas por um total de 23 895 alunos, do 7.o ao 12.o ano. A recolha dos dados foi efectuada através de um questionário auto-aplicado e respondido pelos alunos em sala de aula. Dos 8768 questionários distribuídos recolhemos 7644 (87,2%). Foram excluídos da análise os questionários sem informação para o sexo e para a idade. Ficámos com uma amostra global de 7563 adolescentes, sendo 4117 (54,4%) do sexo feminino. O excesso de peso e a obesidade foram avaliados utilizando o índice de massa corporal (IMC) calculado pela razão entre o peso auto declarado em quilogramas e o quadrado da altura, em metros, também auto declarada (kg/m2). Definimos excesso de peso para valores compreendidos entre o percentil 85 e 95, obesidade para um percentil superior ou igual a 95, e excesso de peso e obesidade para um percentil superior ou igual a 85. Resultados: No total da amostra, a prevalência de excesso de peso é de 13,7%, superior no sexo masculino (16,0% vs. 11,6%). A prevalência de obesidade é de 3,4%, superior no sexo masculino (4,2% vs. 2,8%). A prevalência de excesso de peso e obesidade é de 17,1%, superior no sexo masculino (20,2% vs. 14,4%). Os concelhos situados a norte do distrito de Viseu apresentam prevalências superiores, de excesso de peso (15,9% vs. 13,0%, OR = 1,3; IC95% 1,1-1,5), de obesidade (4,5% vs. 3,6%, OR = 1,3; IC95% 1,0-1,7) e de excesso de peso e obesidade (19,1% vs. 15,7%, OR = 1,3; IC95% 1,1-1,4). A prevalência de excesso de peso e obesidade é superior entre os adolescentes com o índice de aglomeração superior a um. Conclusões: Regista-se uma elevada prevalência de excesso de peso e de obesidade, superior no sexo masculino, com diferenças geográficas significativas.

A Multicenter Randomized Clinical Trial of Primary Anastomosis or Hartmann's Procedure for Perforated Left Colonic Diverticulitis With Purulent or Fecal Peritonitis.

OBJECTIVES: : To evaluate the outcome after Hartmann's procedure (HP) versus primary anastomosis (PA) with diverting ileostomy for perforated left-sided diverticulitis. BACKGROUND: : The surgical management of left-sided colonic perforation with purulent or fecal peritonitis remains controversial. PA with ileostomy seems to be superior to HP; however, results in the literature are affected by a significant selection bias. No randomized clinical trial has yet compared the 2 procedures. METHODS: : Sixty-two patients with acute left-sided colonic perforation (Hinchey III and IV) from 4 centers were randomized to HP (n = 30) and to PA (with diverting ileostomy, n = 32), with a planned stoma reversal operation after 3 months in both groups. Data were analyzed on an intention-to-treat basis. The primary end point was the overall complication rate. The study was discontinued following an interim analysis that found significant differences of relevant secondary end points as well as a decreasing accrual rate (NCT01233713). RESULTS: : Patient demographics were equally distributed in both groups (Hinchey III: 76% vs 75% and Hinchey IV: 24% vs 25%, for HP vs PA, respectively). The overall complication rate for both resection and stoma reversal operations was comparable (80% vs 84%, P = 0.813). Although the outcome after the initial colon resection did not show any significant differences (mortality 13% vs 9% and morbidity 67% vs 75% in HP vs PA), the stoma reversal rate after PA with diverting ileostomy was higher (90% vs 57%, P = 0.005) and serious complications (Grades IIIb-IV: 0% vs 20%, P = 0.046), operating time (73 minutes vs 183 minutes, P < 0.001), hospital stay (6 days vs 9 days, P = 0.016), and lower in-hospital costs (US $16,717 vs US $24,014) were significantly reduced in the PA group. CONCLUSIONS: : This is the first randomized clinical trial favoring PA with diverting ileostomy over HP in patients with perforated diverticulitis.

Sonication of removed breast implants for improved detection of subclinical infection.

BACKGROUND: Capsular fibrosis is a severe complication after breast implantation with an uncertain etiology. Microbial colonization of the prosthesis is hypothesized as a possible reason for the low-grade infection and subsequent capsular fibrosis. Current diagnostic tests consist of intraoperative swabs and tissue biopsies. Sonication of removed implants may improve the diagnosis of implant infection by detachment of biofilms from the implant surface. METHODS: Breast implants removed from patients with Baker grades 3 and 4 capsular contracture were analyzed by sonication, and the resulting sonication fluid was quantitatively cultured. RESULTS: This study investigated 22 breast implants (6 implants with Baker 3 and 16 implants with Baker 4 capsular fibrosis) from 13 patients. The mean age of the patients was 49 years (range, 31-76 years). The mean implant indwelling time was 10.4 years (range, 3 months to 30 years). Of the 22 implants, 12 were used for breast reconstruction and 10 for aesthetic procedures. The implants were located subglandularly (n = 12), submuscularly (n = 6), and subcutaneously (n = 4). Coagulase-negative staphylococci, Propionibacterium acnes, or both were detected in the sonication fluid cultures of nine implants (41%), eight of which grew significant numbers of microorganisms (>100 colonies/ml of sonication fluid). CONCLUSIONS: Sonication detected bacteria in 41% of removed breast implants. The identified bacteria belonged to normal skin flora. Further investigation is needed to determine any causal relation between biofilms and capsular fibrosis.

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.

OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for postoperative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B), targeting a blood glucose < 150 mg/dL after initial stabilization (2C); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); and a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSIONS: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.

Some go without a cigarette: characteristics of cannabis users who have never smoked tobacco.

OBJECTIVES: To estimate the prevalence of youth who use cannabis but have never been tobacco smokers and to assess the characteristics that differentiate them from those using both substances or neither substance. DESIGN: School survey. SETTING: Postmandatory schools. PARTICIPANTS: A total of 5263 students (2439 females) aged 16 to 20 years divided into cannabis-only smokers (n = 455), cannabis and tobacco smokers (n = 1703), and abstainers (n = 3105). OUTCOME MEASURES: Regular tobacco and cannabis use; and personal, family, academic, and substance use characteristics. RESULTS: Compared with those using both substances, cannabis-only youth were younger (adjusted odds ratio [AOR], 0.82) and more likely to be male (AOR, 2.19), to play sports (AOR, 1.64), to live with both parents (AOR, 1.33), to be students (AOR, 2.56), and to have good grades (AOR, 1.57) and less likely to have been drunk (AOR, 0.55), to have started using cannabis before the age of 15 years (AOR, 0.71), to have used cannabis more than once or twice in the previous month (AOR, 0.64), and to perceive their pubertal timing as early (AOR, 0.59). Compared with abstainers, they were more likely to be male (AOR, 2.10), to have a good relationship with friends (AOR, 1.62), to be sensation seeking (AOR, 1.32), and to practice sports (AOR, 1.37) and less likely to have a good relationship with their parents (AOR, 0.59). They were more likely to attend high school (AOR, 1.43), to skip class (AOR, 2.28), and to have been drunk (AOR, 2.54) or to have used illicit drugs (AOR, 2.28). CONCLUSIONS: Cannabis-only adolescents show better functioning than those who also use tobacco. Compared with abstainers, they are more socially driven and do not seem to have psychosocial problems at a higher rate.

Elevated blood pressure prevalence in children did not follow the increase in overweight: results from a school-based study in a rapidly developing country, 1998-2006

Background: Blood pressure (BP) is strongly associated with body weight and there is concern that the pediatric overweight epidemic could lead to an increase in children's mean BP. Objectives: We analyzed BP trends from 1998 to 2006 among children of the Seychelles, a rapidly developing middle-income country in Africa. Methods: Serial school-based surveys of weight, height and BP were conducted yearly between 1998-2006 among all students of the country in four school grades (kindergarten, 4th, 7th and 10th years of compulsory school). We used the CDC criteria to define "overweight" (BMI _95th sex-, and age-specific percentile) and the NHBPEP criteria for "elevated BP" (BP _95th sex-, age-, and height specific percentile). Methods for height, weight, and BP measurements were identical over the study period. The trends in mean BMI and mean systolic/diastolic BP were assessed with linear regression. Results: 27,703 children aged 4-18 years (participation rate: 79%) contributed 43,927 observations on weight, height, and BP. The prevalence of overweight increased from 5.1% in 1998-2000 to 8.1% in 2004-2006 among boys, and from 6.1% to 9.1% among girls, respectively. The prevalence of elevated BP was 8.4% in 1998-2000 and 6.9% in 2004-2006 among boys; 9.8% and 7.8% among girls, respectively. Over the 9-years study period, age-adjusted body mass index (BMI) increased by 0.078 kg/m2/year in boys and by 0.083 kg/m2/year in girls (both sexes, P_0.001). Age- and height-adjusted systolic BP decreased by -0.37 mmHg/year in boys and by -0.34 mmHg/year in girls (both sexes, P_0.001). Diastolic BP did not change in boys (-0.02 mmHg/year, P: 0.40) and slightly increased in girls (0.07 mmHg/year, P: 0.003). These trend estimates were altered modestly upon further adjustment for BMI or if analyses were based on median rather than mean values. Conclusion: Although body weight increased markedly between 1998 and 2006 in this population, systolic BP decreased and diastolic BP changed only marginally. This suggests that population increases in body weight are not necessarily associated with corresponding rises in BP in children.

Videolaryngoscopy improves intubation condition in morbidly obese patients

Résumé : Contexte clinique et objectifs: l'intubation oro-trachéale peut être plus difficile chez les patients obèses morbides (index de masse corporelle BMI > 35 kg/m2) que chez les patients non-obèses. Récemment, de nouveaux instruments permettant une intubation assistée au moyen d'une caméra ont été développés. Notre expérience pratique avec la vidéolaryngoscopie nous a conduit à l'hypothèse que celle-ci pourrait améliorer la vision laryngoscopique chez cette population spécifique et de ce fait faciliter l'intubation. Le but de cette étude était donc d'évaluer le bénéfice du vidéolaryngoscope sur le grade de laryngoscopie chez le patient obèse morbide. Résultats : le grade laryngoscopique fut abaissé de manière significative avec le vidéolaryngoscope comparé à la vision directe avec un laryngoscope standard. Lorsque le grade laryngoscopique était plus grand que 1 à la laryngoscopie directe, il fut dans la grande majorité des cas (93% des patients) abaissé avec le vidéolaryngoscope. Chez les 7 % restant, le grade laryngoscopique resta identique. Conclusions : chez le patient obèse morbide, l'utilisation du vidéolaryngoscope améliore de manière significative la visualisation du larynx et de ce fait facilite l'intubation. Une application systématique de ce procédé pourrait donc permettre de réduire l'incidence d'une intubation difficile ainsi que ses conséquences chez cette population de patients. Summary : Background and objective: Tracheal intubation may be more difficult in morbidly obese patients (body mass index >35 kgM-2) than in the non-obese. Recently, new video-assisted intubation devices have been developed. After some experience with videolaryngoscopy, we hypothesized that it could improve the laryngoscopic view in this specific population and therefore facilitate intubation. The aim of this study was to assess the benefit of a videolaryngoscope on the grade of laryngoscopy in morbid obesity. Methods: We studied 80 morbidly obese patients undergoing bariatric surgery. They were randomly assigned to one of two groups. One group was intubated with the help of the videolaryngoscope and in the control group the screen of the videolaryngoscope was hidden to the intubating anaesthesiologist. The primary end-point of the study was to assess in both groups the Cormack and Lehane direct and indirect grades of laryngoscopy. The duration of intubation, the number of attempts needed as well as the minimal SPO2 reached during the intubation process were measured. Results: Grade of laryngoscopy was significantly lower with the videolaryngoscope compared with the direct vision (P < 0.001). When the grade of laryngoscopy was higher than one with the direct laryngoscopy (n = 30), it was lower in 28 cases with the videolaryngoscope and remained the same only in two cases (P < 0.001). The minimal SPO2 reached during the intubation was higher with the videolaryngoscope but it did not reach statistical significance. Conclusions: In morbidly obese patients, the use of the videolaryngoscope significantly improves the visualization of the larynx and thereby facilitates intubation.

Problems of allometric scaling analysis: examples from mammalian reproductive biology.

Biological scaling analyses employing the widely used bivariate allometric model are beset by at least four interacting problems: (1) choice of an appropriate best-fit line with due attention to the influence of outliers; (2) objective recognition of divergent subsets in the data (allometric grades); (3) potential restrictions on statistical independence resulting from phylogenetic inertia; and (4) the need for extreme caution in inferring causation from correlation. A new non-parametric line-fitting technique has been developed that eliminates requirements for normality of distribution, greatly reduces the influence of outliers and permits objective recognition of grade shifts in substantial datasets. This technique is applied in scaling analyses of mammalian gestation periods and of neonatal body mass in primates. These analyses feed into a re-examination, conducted with partial correlation analysis, of the maternal energy hypothesis relating to mammalian brain evolution, which suggests links between body size and brain size in neonates and adults, gestation period and basal metabolic rate. Much has been made of the potential problem of phylogenetic inertia as a confounding factor in scaling analyses. However, this problem may be less severe than suspected earlier because nested analyses of variance conducted on residual variation (rather than on raw values) reveals that there is considerable variance at low taxonomic levels. In fact, limited divergence in body size between closely related species is one of the prime examples of phylogenetic inertia. One common approach to eliminating perceived problems of phylogenetic inertia in allometric analyses has been calculation of 'independent contrast values'. It is demonstrated that the reasoning behind this approach is flawed in several ways. Calculation of contrast values for closely related species of similar body size is, in fact, highly questionable, particularly when there are major deviations from the best-fit line for the scaling relationship under scrutiny.

Immersioultraäänitutkimuksen kehittäminen

Teräksenvalmistajilta edellytetään jatkuvasti panostusta laadun ja laadunvarmistuksen kehittämiseen. Teräksen laatu ja puhtaus korostuvat varsinkin silloin, kun terästä käytetään vaativiin käyttökohteisiin, kuten autoteollisuuden tarpeisiin. Ultraäänitarkastusmenetelmää käytetään laadun-varmistuksessa teräksen sisävikojen etsimiseen. Ultraäänitarkastuksessa lähetetään suuritaajuuksista ääntä kappaleeseen. Ääni etenee materiaalissa ja heijastuu erilaisista epäjatkuvuuskohdista. Luotaimeen palaavaa ääntä analysoimalla saadaan tietoa teräksestä ja sen sisävioista. Ultraäänitarkastuksen ongelmana on vian tyypin määrittäminen hankaluus sekä herkkyys tutkittavan materiaalin aineominaisuuksille. Työn tavoitteena oli immersioultraäänitarkastuksen kehittäminen sovellettuna teräksenvalmistajan tarpeisiin. Materiaalin aineominaisuuksista tutkittiin seostuksen vaikutusta. Teräslajit tarkastettiin valssitilaisena, karkaistuna ja normalisoituna. Lisäksi tutkittiin kappaleen pinnankarheuden ja -muodon vaikutusta tarkastukseen. Vikatyyppien tunnistamisen mahdollisuuksia ultra-äänitarkastuksessa selvitettiin käyttäen FFT- taajuusanalyysiä. Erilailla lämpökäsitellyillä teräslajeilla näytti eniten tuloksiin vaikuttavan terästen raekoko. Valssitilaisilla teräksillä raekoko on suuri, jolloin ultraääni vaimenee voimakkaasti teräksessä. Huomattavaa kuitenkin oli, että mikäli lämpö-käsittelyillä ei teräksen raekokoa saada juuri pienennettyä, ei myöskään vaimeneminen vähene. Tämän vuoksi lämpökäsittely ei välttämättä ole aina tarpeellinen valmisteltaessa ultraääninäytteitä. Fourier’n taajuusanalyysissä huomattiin olevan eroavaisuuksia verrattaessa huokosista ja sulkeumista palaavien kaikujen taajuusspektrejä. Näiden tulosten perusteella näyttäisi olevan mahdollista käyttää FFT- menetelmää ultraääni-tarkastuksessa vikojen luokitteluun.

Image guided critical screw placement precision in the cervical spine : important or incidental? : results of a series of 91 consecutive cases using OVEM

Study design: A retrospective study of image guided cervical implant placement precision. Objective: To describe a simple and precise classification of cervical critical screw placement. Summary of Background Data: "Critical" screw placement is defined as implant insertion into a bone corridor which is surrounded circumferentially by neurovascular structures. While the use of image guidance has improved accuracy, there is currently no classification which provides sufficient precision to assess the navigation success of critical cervical screw placement. Methods: Based on postoperative clinical evaluation and CT imaging, the orthogonal view evaluation method (OVEM) is used to classify screw accuracy into grade I (no cortical breach), grade la (screw thread cortical breach), grade II (internal diameter cortical breach) and grade III (major cortical breach causing neural or vascular injury). Grades II and III are considered to be navigation failures, after accounting for bone corridor / screw mismatch (minimal diameter of targeted bone corridor being smaller than an outer screw diameter). Results: A total of 276 screws from 91 patients were classified into grade I (64.9%), grade la (18.1%), and grade II (17.0%). No grade III screw was observed. The overall rate of navigation failure was 13%. Multiple logistic regression indicated that navigational failure was significantly associated with the level of instrumentation and the navigation system used. Navigational failure was rare (1.6%) when the margin around the screw in the bone corridor was larger than 1.5 mm. Conclusions: OVEM evaluation appears to be a useful tool to assess the precision of critical screw placement in the cervical spine. The OVEM validity and reliability need to be addressed. Further correlation with clinical outcomes will be addressed in future studies.

Recueil de lettres et de pièces originales, et de copies de pièces indiquées comme telles dans le dépouillement qui suit.

Contient : 1 Lettre du roi « CHARLES [IX]... à monseigneur Du Bouchaige,... Escript à Longpont, le IXme jour de may 1561 » ; 2 Arrêt du conseil pour la justification de Louis de Bourbon, prince de Condé. « Du huictiesme jour de mars, l'an mil cinq cens soixante et un ». Copie ; 3 Lettre de « LOYS DE BOURBON [prince DE CONDE]... à... monseigneur le prince de Protez,... Escript à St Germain en Laye... may 1563 » ; 4 Lettre de « FRANÇOIS DE MONTMORENCY » à Louis de Bourbon, duc de Montpensier. « De Paris, ce quinzeme jour de janvier 1564 ». Copie ; 5 Lettre de « LOUIS DE BOURBON, duc DE MONTPENSIER », à François de Montmorency. « D'Argenton, ce IIIIe jour de fevrier 1564 » ; 6 Lettre de « HENRY [DE FRANCE, duc D'ANJOU]... à monseigneur le conte Du Bouchaige,... Escript au camp de Chinon, le XIIIme jour de janvier 1569 » ; 7 Lettre du roi « CHARLES [IX]... à monseigneur le conte Du Bouchaige,... Escript à Chaalons, le XXVe jour de janvier 1569 » ; 8 Lettre d'« ANTOYNE [DE BOURBON, roi de Navarre]... à... madame la vidame d'Amyens... Escript à St Germain en Laye, le VIIe jour de decembre 1561 » ; 9 Lettre de « JEHANNE [D'ALBRET, reine de Navarre]... à ma cousine » ; 10 Lettre de « LOYS DE BOURBON,... à monseigneur [le] conte Du Bouchaige,... De Champigny, ce XXIIIme jour de juing 1568 » ; 11 Lettre de GASPARD DE COLIGNY, amiral DE « CHASTILLON,... à monsieur... Du Bouchage,... De La Rochelle ce XVIIIe jour d'avril 1571 » ; 12 Lettre d'« E[MMANUEL] PHILIBERT [duc DE SAVOIE]... De Thurin, ce XVme jour d'apvril 1576 » ; 13 Lettre de « CHASTILLON,... à monsieur... Du Bouchage,... De Chastillon, ce XXXe jour d'octobre 1571 » ; 14 Lettre de Mme « J. D'ANTREMONT,... à monsieur le conte Du Bouchaige,... A Chastillon, ce dernier octobre 1571 » ; 15 Lettre de Mr « DE PRYE,... à monseigneur le conte Du Bouchaige,... De Monpoupon, ce vendredi matin » ; 16 Lettre de « NANÇAY,... à monsieur... le conte Du Bouchage,... De Bloys, ce XXIXme jour de septambre » ; 17 Lettre de « NANÇAY,... à monsieur le conte Du Bouchage,... Du camp de Nieul devant La Rochelle, le XXXe mars 1573 » ; 18 Lettre d'ANNE DE « MONTMORENCY,... à... madame Du Bouchaige,... De St Germain en Laye, ce XXIXe jour de jung » ; 19 Lettre de « NANÇAY,... à monsieur... le conte Du Bouchaige,... De Blois, ce Ve may 1572 » ; 20 Lettre d'ANNE DE « MONTMORENCY,... à... madame la vidasme d'Amyens... De Fontainebleau, ce XVIIIe fevrier 1560 » ; 21 Lettre d'« ANTHOINETTE DE BOURBON,... [duchesse DE GUISE]... à... madame la vidasme d'Amyens... De Joinville, ce Xme jour de juillet 1563 » ; 22 Lettre d'« ANTHOINETTE [DE BOURBON, duchesse DE GUISE]... à... madame la vidasme d'Amiens... De Joinville, ce XVme jour de febvrier 1560 » ; 23 Commission du roi « CHARLES [IX]... à noz amez et feaux Mes Jehan Chastellier, seigneur de Millieu,... Robert de Montdoucet,... Françoys Pain », sur le fait des finances. « Donné à Amboise, le XVIIe jour de febvrier, l'an de grace mil cinq cens soixante et douze ». Copie ; 24 Lettres patentes du roi « CHARLES » IX, rétablissant dans la ville de Metz la profession exclusive du culte catholique. « Donné à Metz, le sixiesme jour d'avril, l'an de grace mil cinq cens soixante et neuf » ; 25 Lettre de « LOYSE DE PIENES,... à madame la vidame d'Amyens, douairiere... De Joinville, ce IIIe jour de may 1562 » ; 26 Lettre d'ANNE DE « MONTMORENGY,... à mon nepveu d'Authon,... D'Escouen, ce XVIIIe jour d'aoust 1561 » ; 27 Lettre de « NANÇAY,... à monsieur... le conte Du Bouchage,... De Victry, ce Ve novembre 1573 » ; 28 « Traicté de l'alliance des Suisses par le roy Charles neufviesme... Faict et passé en la... ville de Fribourg... decembre XV.C. soixante et quatre ». Copie ; 29 « Ordonnances des cent suisses de la garde du roy... translatté par GUILLEAUME TOUGUINER, dit FREULIOF, truchement du roy et protenseigne des cent suisses... du langage d'allemant en françois. Faict le seiziesme jour de janvier 1567 » ; suivies d'une note de « Guilleaume Touguiner » relative aux divers grades et fonctions occupés par lui. Copie ; 30 Lettre de « CLAUDE DE LORRAINE [duc D'AUMALE]... à monseigneur de Nancé, cappitaine des gardes du corps du roy... De Nancy, ce XVIme jour d'octobre 1571 » ; 31 Lettre de « LOYS DE BOURBON [duc DE MONTPENSIER]... à... monseigneur le comte Du Bouchage,... De Champigny, ce XXXme et penultime jour de decembre 1577 » ; 32 Lettre de « JOYEUSE,... à monseigneur... le conte Du Bouchaige,... A Thoulouse, le XVII febvrier » ; 33 Lettre de « JOYEUSE,... à monsieur... le conte Du Bouchaige,... Au camp de Montbron, se XIIII may » ; 34 « Pasqun des troubles advenuz au royaume de France en l'année mil cinq cens soixante sept jusques en l'année mil cinq cens soixante huyct » ; 35 Brevet de capitaine gouverneur du Mont-St-Michel, accordé par le roi Henri III à Anne de Joyeuse, sur la requête du titulaire, le comte Du Bouchage. 27 février 1579. Copie ; 36 « Coppie de lectre de monsieur le duc DE MONTPENCIER,... LOYS DE BOURBON,... à monseigneur de St Moris,... De Mortaing, ce XXVIIe jour de jung 1573 » ; 37 « Coppie de lectre du roy... CHARLES [IX]... à monsieur de Sainct Moris,... cappitaine du Mont Sainct Michel... Escript à Monceaulx, le XVIe jour de jung 1573 » ; 38 « Coppie de lectre de la royne mere... CATERINE [DE MEDICIS]... à monseigneur de St Moris,... Escript à Monceaulx, le XIIIe jour de jung 1573 » ; 39 « Coppie de lectre de monsieur DE MATIGNON,... à monseigneur... de Sainct Moris,... A Thorigny, le VIIe d'aoust 1573 » ; 40 « Nouvelles » du « camp de Dompfront... Ce lundi matin 24 may 1574 ». Copie

The role of self-presentation in adolescent health risk behaviours

Self-presentation has been identified as playing a key role in the perfonnance of various potentially hazardous health behaviours such as substance abuse, eating disorders and reckless behaviours (Leary, Tchividjian, & Kraxberger, 1994; Martin & Leary, 2001; Martin, Leary, & O'Brien, 2001). The present study investigated the role of selfpresentation on adolescent health-risk behaviours. Specifically, this study examined the prevalence of adolescent identified health-risk behaviours rooted in self-presentational motives in youths aged 13-18 years. The current study also identified the specific images associated with these behaviours desired by youth, and the targets of these behaviours. Also, the relationship between these behaviours, and several trait measures (social physique anxiety, public-self consciousness, fear of negative evaluations, selfpresentational efficacy) of self-presentation were examined. Finally, the gender differences in health risk behaviours and self-presentational concerns were examined. Participants in the present study were 96 adolescent students, 34 male and 62 female, recruited from various private schools across Southern Ontario. Students ranged in age from 13 to 18 years for both males (M age = 15.81 years, SD = 1.49) and females (M age = 14.89 years, SD = 1.17) and ranged from grades 8 through 13. Results of the current study suggested that Canadian adolescents between the ages of 13 and 18 years participated in health risk behaviours for self-presentational purposes. Drinking alcohol, skipping school, and performing stunts and dares were identified as the most common health risk behaviours performed for self-presentational purposes by both males and females. Appearing fun and cool were the most commonly reported desired images while appearing brave and mature were the least reported. The most desired target group cited was same sex friends, followed by other sex friends. Trait measures of self-presentational concerns identified females as being higher in public self-consciousness, and social physique anxiety than males. Males were found to be higher in self-presentational efficacy than females. The total number of health risk behaviours was predicted by selfpresentational efficacy and social physique anxiety for males, and social physique anxiety for females. Findings of the current study suggest that Canadian adolescents' health risk behaviours are rooted, in part, in self-presentational motives. Thus far, an educational approach to health interventions has been favoured and/or adopted by teachers, health promoters, and educators (Jessor, 1992). Implications of the current study suggest that although educational interventions are beneficial in presenting the associated risks with certain activities and/or behaviours, one reason this type of approach may be ineffective in changing adolescent behaviour over the long run is that it does not address the strong and prominent influences of interpersonal motives on health damaging behaviour. It is evident that social acceptance and public image are of importance to adolescents, and the desire to make the "right" impression and to achieve peer approval and acceptance often override health and safety concerns (Jessor, 1992). Thus, a self-presentational approach focusing on changing the images associated with the behaviours may be more successful at deterring adolescent health risk behaviours.

What children value : a scale to guide health promotion programs

Objective. Physical activity is important for the health of all human beings. Although it is important to develop good health promotion programs for children to increase participation in physical activity, to date there appear to be no programs based on what kids value beyond health and physical activity itself. This study proposed to create a scale with strong content and face validity that could uncover what any given population of children value in life regardless of their participation in physical activity and that experts feel could be related to physical activity. These findings will allow the development of targeted health promotion programs to increase children's participation in regular physical activity. Method In this study, a combination of qualitative and quantitative approaches was used. Data were gathered from seven experts in the field, sixty-seven children in grades three to five, five parents, and three teachers. From these data response groupings were created and sent to four experts to be given single word names. The resulting nine theme names were re-worked into "child-friendly" language. Four children were then asked to discuss theme names to see if they liked and understood them. The next step involved asking children and experts to rank order the nine themes, the children in general and the experts in terms of relevance to physical activity. From these results, possible versions of the scale were then created using the combined expert/children rankings. Each version was examined for content validity. Two versions of a scale resulted. These were sent to experts, parents, teachers and children in order to determine which one they liked better and to suggest any foreseeable problems. Once this information was collected, a beta (final prototype) version of the scale was created. Results. Nine common theme names were created from the response groupings. All four children agreed that they did understand and like each of the nine theme names. Experts and teachers agreed that full coverage of the content had been achieved. Children suggested a single wording change from "Being Accepted" to "Being Included". Five themes were selected for inclusion. The beta version of the scale included 12 forced choice statements, the first ten comparing all themes against one another followed by two anchor statements. Conclusion. At the outset it was recognized that it is essential to know what children think is important in their lives in order to serve as potential benefits in the development of effective physical activity promotion programs. This study developed a scale which could be used to determine what a population of children feel is important in order to focus health promotion programs for physical activity. The scale has strong face and content validity.

Adolescent sexuality : an investigation into the relation between sexuality and self-concept /

The present study explored the connections among adolescents' sense of self, sexuality, and perceptions of risk. Such an exploration may help educators to further understand why adolescents engage in risk-taking behaviours such as unprotected sex. The study involved secondary analysis on the data collected from the Youth Lifestyle Choices - Community University Research Alliance 2000 (YLC - CURA) Youth Resilience Questionnaire (YRQ). Participants were 300 male and female students in Grades 9, 1 1 and OAC. Data analyses involved both descriptive and inferential statistics (correlational and multivariate analysis). Chi-square analyses were performed on the open-ended self-description question. Separate analyses were conducted on gender and age (grade levels). Correlational analyses revealed that adolescents with a more positive sense of self were more likely to perceive sexual involvement as a relatively high-risk behaviour. Specifically, results found that male adolescents were less likely than females to perceive sex to be risky. Results are discussed in relation to previous research in the area of selfcognitions and risk-taking sexual behaviour. Results are also discussed in terms of educational implications in that the current results may provide the beginnings of a framework for more holistic sexual education programs.

Predictors of academic achievement and social competence in adolescence : facilitation, inhibition and general cognitive processing /

The relevance of attentional measures to cognitive and social adaptive behaviour was examined in an adolescent sample. Unlike previous research, the influence of both inhibitory and facilitory aspects of attention were studied. In addition, contributions made by these attentional processes were compared with traditional psychometric measures of cognitive functioning. Data were gathered from 36 grade 10 and 1 1 high school students (20 male and 16 female students) with a variety of learning and attentional difficulties. Data collection was conducted in the course of two testing sessions. In the first session, students completed questionnaires regarding their medical history, and everyday behaviours (the Brock Adaptive Functioning Questionnaire), along with non-verbal problem solving tasks and motor speed tasks. In the second session, students performed working memory measures and computer-administered tasks assessing inhibitory and facilitory aspects of attention. Grades and teacher-rated measures of cognitive and social impulsivity were also gathered. Results indicate that attentional control has both cognitive and social/emotional implications. Performance on negative priming and facilitation trials from the Flanker task predicted grades in core courses, social functioning measures, and cognitive and social impulsivity ratings. However, beneficial effects for academic and social functioning associated with inhibition were less prevalent in those demonstrating a greater ability to respond to facilitory cues. There was also some evidence that high levels of facilitation were less beneficial to academic performance, and female students were more likely to exceed optimal levels of facilitory processing. Furthermore, lower negative priming was ''S'K 'i\':y-: -'*' - r " j«v ; ''*.' iij^y Inhibition, Facilitation and Social Competence 3 associated with classroom-rated distraction and hyperactivity, but the relationship between inhibition and social aspects of impulsivity was stronger for adolescents with learning or reading problems, and the relationship between inhibition and cognitive impulsivity was stronger for male students. In most cases, attentional measures were predictive of performance outcomes independent of traditional psychometric measures of cognitive functioning. >,, These findings provide support for neuropsychological models linking inhibition to control of interference and arousal, and emphasize the fundamental role of attention in everyday adolescent activities. The findings also warrant further investigation into the ways which inhibitory and facilitory attentional processes interact, and the contextdependent nature of attentional control.associated with classroom-rated distraction and hyperactivity, but the relationship between inhibition and social aspects of impulsivity was stronger for adolescents with learning or reading problems, and the relationship between inhibition and cognitive impulsivity was stronger for male students. In most cases, attentional measures were predictive of performance outcomes independent of traditional psychometric measures of cognitive functioning. >,, These findings provide support for neuropsychological models linking inhibition to control of interference and arousal, and emphasize the fundamental role of attention in everyday adolescent activities. The findings also warrant further investigation into the ways which inhibitory and facilitory attentional processes interact, and the contextdependent nature of attentional control.