Attitudes et comportements alimentaires des athlètes québécoises pratiquant un sport esthétique à un haut niveau : caractéristiques personnelles et comparaison à un groupe de contrôle

La pratique d’un sport de type esthétique est aujourd’hui considérée par plusieurs (Sundgot-Borgen & Torstveit, 2004; Thompson & Sherman, 2010) comme un facteur de risque à l’adoption d’attitudes et de comportements alimentaires inappropriés à l’égard de l’alimentation et de l’image corporelle (ACIAI) et ultimement au développement d’un trouble des conduites alimentaires (TCA). Les études actuelles portant sur cette problématique rapportent toutefois des résultats contradictoires. De plus, certains aspects méthodologiques associés notamment à l’hétérogénéité des échantillons limitent la portée interprétative de ces résultats. Afin de pallier les limites actuelles des écrits empiriques, cette thèse a pour but de tracer le portrait de la problématique des désordres alimentaires chez les jeunes athlètes québécoises de haut niveau en sport esthétique. Pour ce faire, un échantillon homogène de 145 adolescentes âgées de 12 à 19 ans a été constitué soit 52 athlètes de haut niveau et 93 non-athlètes. Les sports représentés sont le patinage artistique, la nage synchronisée et le ballet. À partir de cet échantillon, deux études sont réalisées. L’objectif de la première étude est de comparer l’intensité des ACIAI et la prévalence des TCA dans les deux groupes à l’aide de deux questionnaires soit le Eating Disorder Examination Questionnaire (EDE-Q) et le Eating Disorder Inventory-3 (EDI-3). Les résultats obtenus suggèrent qu’il n’y a pas de différence significative entre les athlètes et les non-athlètes de l’échantillon en ce qui a trait à l’intensité des ACIAI et à la prévalence des TCA. La deuxième étude est constituée de deux objectifs. Tout d’abord, comparer les deux groupes relativement aux caractéristiques personnelles suivantes : l’insatisfaction de l’image corporelle (IIC), le sentiment d’efficacité personnelle envers l’alimentation normative (SEP-AN) et l’image corporelle (SEP-IC), le perfectionnisme (P), l’ascétisme (As), la dysrégulation émotionnelle (DÉ) et le déficit intéroceptif (DI). De nature plus exploratoire, le second objectif de cette étude est de décrire et de comparer les caractéristiques personnelles qui sont associées aux ACIAI dans chacun des groupes. Afin de réaliser ces objectifs, deux autres questionnaires ont été utilisés soit le Eating Disorder Recovery Self-efficacy Questionnaire-f (EDRSQ-f) et le Body Shape Questionnaire (BSQ). En somme, les analyses indiquent que les athlètes de l’échantillon présentent des niveaux plus faibles de SEP-AN et de DÉ. Ce faisant, elles auraient moins confiance en leur capacité à maintenir une alimentation normative, mais réguleraient plus efficacement leurs émotions que les adolescentes non-athlètes. Une fois l’âge et l’indice de masse corporelle contrôlés, les résultats démontrent également que le SEP-AN et l’IIC contribuent à prédire dans chaque groupe les ACIAI tels que mesurés par la recherche de minceur. Le SEP-AN a aussi été associé dans les deux groupes à l’intensité des symptômes boulimiques. Les modèles obtenus diffèrent cependant quant aux variables prédictives principales. Chez les athlètes de l’échantillon, l’intensité des conduites boulimiques est associée à la DÉ alors qu’elle est davantage liée au DI chez les adolescentes non sportives. Enfin, en plus de discuter et de comparer l’ensemble de ces résultats aux autres travaux disponibles, les apports distinctifs de la thèse et les principales limites des études sont abordés. Des pistes sont également suggérées afin d’orienter les recherches futures et des implications cliniques sont proposées.

Profils individuels et dynamiques interactionnelles des parents et des enfants à risque d’aliénation parentale dans un contexte d’une rupture conjugale litigieuse

L’aliénation parentale (AP) est un phénomène connu des intervenants sociolégaux œuvrant auprès des familles éclatées chez lesquelles on retrouve un haut niveau de conflits parentaux. Ce phénomène est peu étudié empiriquement et sa définition et les balises l’entourant demeurent à ce jour non circonscrites et suscitent confusion et controverse. Cette recherche n’a pas comme objectif de trancher sur ce qui est ou n’est pas de l’aliénation parentale, mais porte plutôt sur l’étude du phénomène de Détérioration du lien parent-enfant (DLPE), qui inclut une rupture complète du lien comme dans les cas d’AP, lors de séparations conjugales litigieuses. Cette thèse doctorale a pour objectif principal d’élargir notre compréhension sur les différents facteurs qui interagissent et qui mettent en place une situation familiale de DLPE. Le présent ouvrage est composé de quatre articles, dont trois sont empiriques. Le premier article est une synthèse critique des écrits théoriques et empiriques permettant de dégager les différents facteurs, conduites ou contextes individuels et relationnels associés à une DLPE. Il ressort que la plupart des écrits proviennent de comptes rendus cliniques. De plus, peu d’auteurs abordent ce phénomène dans une perspective systémique incluant une vision multifactorielle de cette situation. Plusieurs aspects demandent à être étudiés davantage : les caractéristiques individuelles, les comportements inappropriés des acteurs et les dynamiques familiales. En définitive, il importe d’établir les facteurs de résilience. Les articles 2, 3 et 4 ont été réalisés suite à une analyse qualitative de 17 dossiers d’expertise psychosociale de familles séparées en litige autour des accès des enfants. Le second article a pour objectif d’apporter un éclairage fouillé sur les structures de personnalité des parents impliqués dans de tels litiges. Il se dégage de cette analyse que les parents contribuent différemment à la dynamique familiale en fonction de leur profil de personnalité. Quatre profils parentaux ont émergé et permettent de discerner en quoi les parents aux conduites aliénantes se distinguent des parents dénigrés au niveau des profils de personnalité et en quoi la personnalité de ces parents est respectivement différente selon qu’ils maintiennent ou pas la relation avec leur enfant. L’analyse approfondie des profils parentaux a permis de formuler certains facteurs de risque et de protection relatifs à la structure de la personnalité des parents à risque d’une DLPE. Le troisième article a pour objectif d’évaluer par une lecture psychodynamique les différentes caractéristiques individuelles des enfants dans l’optique d’établir des pistes pouvant élucider pourquoi un enfant est résistant à une DLPE ou, au contraire, ne l’est pas. L’analyse qualitative fouillée des dossiers d’expertise a permis d’extraire différents facteurs de risque et de protection d’une DLPE chez ces enfants. Le quatrième article cherche à modéliser les différents facteurs de risque ou, au contraire, qui atténuent le risque de DLPE. Trois trajectoires dénotant une dynamique de DLPE ont émergé. Une modélisation systémique reprend l’ensemble des facteurs (dynamiques personnelles et relationnelles, contexte familial, système sociojuridique, personnes tierces et temps) émergeant de l’analyse et leur déploiement spécifique à chaque trajectoire.

Lymphatic vessel function in atherosclerosis

L'athérosclérose est une maladie inflammatoire chronique caractérisée par l'accumulation de cholestérol dans la paroi artérielle et associée à une réponse immunitaire anormale dans laquelle les macrophages jouent un rôle important. Récemment, il a été démontré que les vaisseaux lymphatiques jouent un rôle primordial dans le transport inverse du cholestérol (Martel et al. JCI 2013). L’objectif global de mon stage de maîtrise a été de mieux caractériser la dysfonction lymphatique associée à l’athérosclérose, en étudiant de plus près l’origine physiologique et temporelle de ce mauvais fonctionnement. Notre approche a été d’étudier, depuis l’initiation de l’athérosclérose jusqu’à la progression d’une lésion athérosclérotique tardive, la physiologie des deux constituants principaux qui forment les vaisseaux lymphatiques : les capillaires et collecteurs lymphatiques. En utilisant comme modèle principal des souris Ldlr-/-; hApoB100+/+, nous avons pu démontrer que la dysfonction lymphatique est présente avant même l’apparition de l’athérosclérose, et que cette dysfonction est principalement associée avec un défaut au niveau des vaisseaux collecteurs, limitant ainsi le transport de la lymphe des tissus périphériques vers le sang. De plus, nous avons démontré pour la première fois l’expression du récepteur au LDL par les cellules endothéliales lymphatiques. Nos travaux subséquents démontrent que ce défaut de propulsion de la lymphe pourrait être attribuable à l’absence du récepteur au LDL, et que la dysfonction lymphatique observée précocement dans l’athérosclérose peut être limitée par des injections systémiques de VEGF (vascular endothelial growth factor) –C. Ces résultats suggèrent que la caractérisation fonctionnelle de la capacité de pompage des vaisseaux collecteurs serait une condition préalable à la compréhension de l'interaction entre la fonction du système lymphatique et la progression de l'athérosclérose. Ultimement, nos travaux nous ont amené à considérer de nouvelles cibles thérapeutiques potentielles dans la prévention et le traitement de l’athérosclérose.

Étude des liens entre l’orientation mentale paternelle et le développement des manifestations morales à l’âge préscolaire

Essai présenté à la Faculté des arts et des sciences en vue de l’obtention du doctorat en psychologie (D.Psy.)

Marketing orientation of small Firms- a study with reference to Trivandrum district

The small business has attracted very little attention of the historians in the ancient times, or public mind inspite of the fact that its impact on the various civilisations has been phenominal. Even in recent times economists considered the small firms as inappropriate, obselate and anacronistic as it cannot assimilate the full potential of technological change in the production system. But today everybody agrees that the small business has a definite role in shaping the human destiny and enhancing the quality of life in any society. In a developing country like India small firms are necessary to generate employment for millions, high standared of personal choice to consumers, provide competition and act as a check to monopoly power; further the small firms provide an important source of innovation and in turn it paves the way for entrepreneur development in the society. In many countries the small enterprises played a significant role in the growth and development of their economic system. Italy and Japan are quoted as classic examples . In India, too, with the abundance of labour and scarce capital resources small firms have been promoted and protected by the government. But one must say that the small firm owners/managers in India have been shy in developing a market orientation in themeselves. Due to this many firms failed and closed. The alarming rate of sickness among the small firms in India may be attributed to the lack of market driven/customer orientation approach among the owner/managers of small business. So the study on the market oreintation of the small firms has never been in the mind of marketing experts and academicians. Thus, an attempt is made to enquire into them systematically and scientifically. For the study, Trivandrum district in Kerala has been selected. The data for the study has been collected by the help of a schedule which has been prepared after consulting the relevant literature and after consultation with experts in the field, academicians and practising managers.

“Improved Feature Extraction and Classification Techniques for Multispectral Brain Magnetic Resonance Images”

Magnetic Resonance Imaging (MRI) is a multi sequence medical imaging technique in which stacks of images are acquired with different tissue contrasts. Simultaneous observation and quantitative analysis of normal brain tissues and small abnormalities from these large numbers of different sequences is a great challenge in clinical applications. Multispectral MRI analysis can simplify the job considerably by combining unlimited number of available co-registered sequences in a single suite. However, poor performance of the multispectral system with conventional image classification and segmentation methods makes it inappropriate for clinical analysis. Recent works in multispectral brain MRI analysis attempted to resolve this issue by improved feature extraction approaches, such as transform based methods, fuzzy approaches, algebraic techniques and so forth. Transform based feature extraction methods like Independent Component Analysis (ICA) and its extensions have been effectively used in recent studies to improve the performance of multispectral brain MRI analysis. However, these global transforms were found to be inefficient and inconsistent in identifying less frequently occurred features like small lesions, from large amount of MR data. The present thesis focuses on the improvement in ICA based feature extraction techniques to enhance the performance of multispectral brain MRI analysis. Methods using spectral clustering and wavelet transforms are proposed to resolve the inefficiency of ICA in identifying small abnormalities, and problems due to ICA over-completeness. Effectiveness of the new methods in brain tissue classification and segmentation is confirmed by a detailed quantitative and qualitative analysis with synthetic and clinical, normal and abnormal, data. In comparison to conventional classification techniques, proposed algorithms provide better performance in classification of normal brain tissues and significant small abnormalities.

Nutrient cycling and nutrient use efficiency in urban and peri-urban agriculture of Kabul, Afghanistan

Like elsewhere also in Kabul, Afghanistan urban and peri-urban agriculture (UPA) has often been accused of being resource inefficient and unsustainable causing negatives externalities to community health and to the surroundings. These arise from the inappropriate management and use of agricultural inputs, including often pesticides and inter-city wastes containing heavy metal residues and pathogens. To address these concerns, parallel studies with the aims of quantification of carbon (C), nitrogen (N), phosphorus (P) and potassium (K) horizontal and vertical fluxes; the assessment of heavy metal and pathogen contaminations of UPA produce, and an economic analysis of cereal, vegetable and grape production systems conducted for two years in UPA of Kabul from April 2008 to October 2009. The results of the studies from these three UPA diverse production systems can be abridged as follows: Biennial net balances in vegetable production systems were positive for N (80 kg ha-1 ), P (75 kg ha-1) and C (3,927 kg ha-1), negative for K (-205 kg ha-1), whereas in cereal production systems biennial horizontal balances were positive for P (20 kg ha-1 ) and C (4,900 kg ha-1) negative for N (-155 kg ha-1) and K (-355 kg ha-1) and in vineyards corresponding values were highly positive for N (295 kg ha-1), P (235 kg ha-1), C (3,362 kg ha-1) and slightly positive for K (5 kg ha-1). Regardless of N and C gaseous emissions, yearly leaching losses of N and P in selected vegetable gardens varied from 70 - 205 kg N ha-1 and 5 - 10 kg P ha-1. Manure and irrigation water contributed on average 12 - 79% to total Inputs of N, P, K and C, 10 - 53% to total inputs of C in the gardens and fields. The elevated levels of heavy metal and pathogen loads on fresh UPA vegetables reflected contamination from increasing traffic in the city, deposits of the past decades of war, lacking collection and treatment of raw inter-city wastes which call for solutions to protect consumer and producer health and increase reliability of UPA productions. A cost-revenue analysis of all inputs and outputs of cereal, vegetable and grapes production systems over two years showed substantial differences in net UPA household income. To confirm these results, more detailed studies are needed, but tailoring and managing the optimal application of inputs to crop needs will significantly enhance farmer’s better revenues as will as environmental and produce quality.

Contradictions within the Modern Food System: Nutritional Disbalance across the Globe, Its Main Drivers and Possible Ways Out

Contemporary food production, given the degree of technology being applied in it and the present state of scientific knowledge, should be able to feed the world. Corresponding statistics show that in fact the volumes of modern food production confirm this statement. Yet, the present nutritional situation across the globe leaves much to be desired: on the one hand the numbers of undernourished and malnourished people are still high and even growing in some regions, and on the other hand there is an increasing number of overweight and obese people who are experiencing (or are at risk of) adverse health impacts as consequences. The question arises how this situation is possible given the present state of food production and knowledge, and also in terms of nutrition basics when talking about the latter. When arguing about the main causes of the present situation with nutrition across the globe, it is the modern food system with its distortions that is often criticised with emphasis placed on inappropriate food distribution as one of the key problems. However it is not only food distribution that shapes inequalities in terms of food availability and accessibility – there is a number of other factors contributing to this situation including political influences. Each of the drivers of the present situation might affect more than one part and have outcomes in different dimensions. Therefore it makes sense to apply a holistic approach when viewing the modern food system, embracing all the elements and existing relationships between them for this will facilitate taking appropriate actions in order to target the desired outcome in the best possible way. Applying a systematic approach and linking various elements with corresponding interactions among them allows for picturing all the possible outcomes and hence finding the way for a better solution on global level – a solution to the present problem with nutritional disbalance across the globe.

Impact on Policy Responses to Food Price Crisis and Rural Food Security in Sri Lanka

In Sri Lanka policy responses have direct impacts on rural dwellers. Over 80% of Sri Lanka’s population live in rural areas and 90% of them represent low income dwellers. Their production system may be hampered by fragmented landholding, poor economics of scale, low investment levels resulting from poor financial services as well as inappropriate or limited technology. They are vulnerable to price hikes of basic foods and food security issues due to fragmented landholding and poor financial services. Policy measures to reduce the transmission of higher international prices in domestic markets exist to protect the food security of the vulnerable population. This paper will discuss the food policy and strategies implemented by the government and outside to the above facts this paper also describes the effectiveness of the policies forwarded by the government. The objective of this study is to analyse the impact of policy responses to the food price crisis and rural food security in Sri Lanka. Outside of the above facts this study also treats the impact of policies and decisions on the nutritional condition of rural dwellers. Furthermore this study is to analyse the fluctuation of buying power with the price hikes and the relation of above facts with issues like malnutrition. This paper discusses why policy makers should pay greater attention to rural dwellers and describes the multiple pathways through which food price increases have on rural people. It also provides evidence of the impact of this crisis in particular, through hidden hunger, and discusses how current policy responses should adjust and improve to protect the rural dwellers in the short and long term.

Loss of wobble uridine modification in tRNA anticodons interferes with TOR pathway signaling

Previous work in yeast has suggested that modification of tRNAs, in particular uridine bases in the anticodon wobble position (U34), is linked to TOR (target of rapamycin) signaling. Hence, U34 modification mutants were found to be hypersensitive to TOR inhibition by rapamycin. To study whether this involves inappropriate TOR signaling, we examined interaction between mutations in TOR pathway genes (tip41Δ, sap190Δ, ppm1Δ, rrd1Δ) and U34 modification defects (elp3Δ, kti12Δ, urm1Δ, ncs2Δ) and found the rapamycin hypersensitivity in the latter is epistatic to drug resistance of the former. Epistasis, however, is abolished in tandem with a gln3Δ deletion, which inactivates transcription factor Gln3 required for TOR-sensitive activation of NCR (nitrogen catabolite repression) genes. In line with nuclear import of Gln3 being under control of TOR and dephosphorylation by the Sit4 phosphatase, we identify novel TOR-sensitive sit4 mutations that confer rapamycin resistance and importantly, mislocalise Gln3 when TOR is inhibited. This is similar to gln3Δ cells, which abolish the rapamycin hypersensitivity of U34 modification mutants, and suggests TOR deregulation due to tRNA undermodification operates through Gln3. In line with this, loss of U34 modifications (elp3Δ, urm1Δ) enhances nuclear import of and NCR gene activation (MEP2, GAP1) by Gln3 when TOR activity is low. Strikingly, this stimulatory effect onto Gln3 is suppressed by overexpression of tRNAs that usually carry the U34 modifications. Collectively, our data suggest that proper TOR signaling requires intact tRNA modifications and that loss of U34 modifications impinges on the TORsensitive NCR branch via Gln3 misregulation.

Changes of traditional farming systems and their effects on land degradation and socio-economic conditions in the Inle Lake region, Myanmar

At many locations in Myanmar, ongoing changes in land use have negative environmental impacts and threaten natural ecosystems at local, regional and national scales. In particular, the watershed area of Inle Lake in eastern Myanmar is strongly affected by the environmental effects of deforestation and soil erosion caused by agricultural intensification and expansion of agricultural land, which are exacerbated by the increasing population pressure and the growing number of tourists. This thesis, therefore, focuses on land use changes in traditional farming systems and their effects on socio-economic and biophysical factors to improve our understanding of sustainable natural resource management of this wetland ecosystem. The main objectives of this research were to: (1) assess the noticeable land transformations in space and time, (2) identify the typical farming systems as well as the divergent livelihood strategies, and finally, (3) estimate soil erosion risk in the different agro-ecological zones surrounding the Inle Lake watershed area. GIS and remote sensing techniques allowed to identify the dynamic land use and land cover changes (LUCC) during the past 40 years based on historical Corona images (1968) and Landsat images (1989, 2000 and 2009). In this study, 12 land cover classes were identified and a supervised classification was used for the Landsat datasets, whereas a visual interpretation approach was conducted for the Corona images. Within the past 40 years, the main landscape transformation processes were deforestation (- 49%), urbanization (+ 203%), agricultural expansion (+ 34%) with a notably increase of floating gardens (+ 390%), land abandonment (+ 167%), and marshlands losses in wetland area (- 83%) and water bodies (- 16%). The main driving forces of LUCC appeared to be high population growth, urbanization and settlements, a lack of sustainable land use and environmental management policies, wide-spread rural poverty, an open market economy and changes in market prices and access. To identify the diverse livelihood strategies in the Inle Lake watershed area and the diversity of income generating activities, household surveys were conducted (total: 301 households) using a stratified random sampling design in three different agro-ecological zones: floating gardens (FG), lowland cultivation (LL) and upland cultivation (UP). A cluster and discriminant analysis revealed that livelihood strategies and socio-economic situations of local communities differed significantly in the different zones. For all three zones, different livelihood strategies were identified which differed mainly in the amount of on-farm and off-farm income, and the level of income diversification. The gross margin for each household from agricultural production in the floating garden, lowland and upland cultivation was US$ 2108, 892 and 619 ha-1 respectively. Among the typical farming systems in these zones, tomato (Lycopersicon esculentum L.) plantation in the floating gardens yielded the highest net benefits, but caused negative environmental impacts given the overuse of inorganic fertilizers and pesticides. The Revised Universal Soil Loss Equation (RUSLE) and spatial analysis within GIS were applied to estimate soil erosion risk in the different agricultural zones and for the main cropping systems of the study region. The results revealed that the average soil losses in year 1989, 2000 and 2009 amounted to 20, 10 and 26 t ha-1, respectively and barren land along the steep slopes had the highest soil erosion risk with 85% of the total soil losses in the study area. Yearly fluctuations were mainly caused by changes in the amount of annual precipitation and the dynamics of LUCC such as deforestation and agriculture extension with inappropriate land use and unsustainable cropping systems. Among the typical cropping systems, upland rainfed rice (Oryza sativa L.) cultivation had the highest rate of soil erosion (20 t ha-1yr-1) followed by sebesten (Cordia dichotoma) and turmeric (Curcuma longa) plantation in the UP zone. This study indicated that the hotspot region of soil erosion risk were upland mountain areas, especially in the western part of the Inle lake. Soil conservation practices are thus urgently needed to control soil erosion and lake sedimentation and to conserve the wetland ecosystem. Most farmers have not yet implemented soil conservation measures to reduce soil erosion impacts such as land degradation, sedimentation and water pollution in Inle Lake, which is partly due to the low economic development and poverty in the region. Key challenges of agriculture in the hilly landscapes can be summarized as follows: fostering the sustainable land use of farming systems for the maintenance of ecosystem services and functions while improving the social and economic well-being of the population, integrated natural resources management policies and increasing the diversification of income opportunities to reduce pressure on forest and natural resources.

Whither Japan's Economy?

The Japanese economy entered a long recession in spring 1997. Its economic growth has been much lower than in the US and the EU despite large fiscal stimulus packages, a monetary policy which has brought interest rates to zero since 1999, injections of public money to recapitalize banks, and programs of liberalization and deregulation. How could all these policies have failed to bring the Japanese economy back on a sustainable growth path? This paper argues that the failure of Japan's efforts to restore a sound economic environment is the result of having deliberately chosen inappropriate and inadequate monetary and fiscal instruments to tackle the macroeconomic and structural problems that have burdened the Japanese economy since the burst of the financial bubble at the beginning of the 90s. These choices were deliberate, since the "right" policies (in primis the resolution of the banking crisis) presented unbearable political costs, not only for the ruling parties, but also for the bureaucratic and business elites. The misfortunes of the Japanese economy during the long recession not only allow us to draw important economic policy lessons, but also stimulate reflections on the disruptive role on economic policies caused by powerful vested interests when an economy needs broad and deep structural changes. The final part of the paper focuses on ways to tackle Japan's banking crisis. In particular, it explores the Scandinavian solution, which, mutatis mutandis, might serve Japanese policy-makers well.

The single principle of compositional data analysis, continuing fallacies, confusions and misunderstandings and some suggested remedies

In any discipline, where uncertainty and variability are present, it is important to have principles which are accepted as inviolate and which should therefore drive statistical modelling, statistical analysis of data and any inferences from such an analysis. Despite the fact that two such principles have existed over the last two decades and from these a sensible, meaningful methodology has been developed for the statistical analysis of compositional data, the application of inappropriate and/or meaningless methods persists in many areas of application. This paper identifies at least ten common fallacies and confusions in compositional data analysis with illustrative examples and provides readers with necessary, and hopefully sufficient, arguments to persuade the culprits why and how they should amend their ways

Adherencia a la quimioterapia y radioterapia en pacientes oncológicos : una revisión de la literatura

Objetivo: Realizar una revisión de la literatura sobre la adherencia a la quimioterapia y a la radioterapia para el cáncer, por los altos costos biopsicosociales y culturales que acarrean y que están relacionados con bajas tasas de adherencia. Método: se realizó una búsqueda de la literatura en bases de datos especializadas utilizando las palabras clave. Resultados: Se definió adherencia encontrándose múltiples significados y confusión conceptual, se presentan las tasas nacionales en Colombia y mundiales de deserción del tratamiento oncológico, los factores biológicos, psicológicos y socioculturales que pueden aumentar y disminuir la probabilidad de adherencia al tratamiento oncológico y los métodos y técnicas de evaluación e intervención de la adherencia a este tratamiento. Conclusiones: La adherencia es un constructo multifactorial y multideterminado, ampliamente estudiado en tratamientos no oncológicos (p.e. SIDA) y la inespecificidad de las intervenciones psicológicas para abordar la no adherencia y promover la adherencia a tratamientos oncológicos es evidente.

Adherencia a criterios de pertinencia de revascularización coronaria del colegio americano de cardiología, servicio de hemodinamia Fundación Cardioinfantil- Bogotá 2011

Titulo: Adherencia a criterios de pertinencia de revascularización coronaria del colegio americano de cardiología 2009, en el servicio de hemodinámica de la fundación cardioinfantil Bogotá 2011. Introducción: La enfermedad cardiovascular es la principal causa de morbimortalidad a nivel mundial, teniendo mayor prevalencia enfermedad coronaria. Existen guías especificas para el manejo de esta enfermedad sin embargo su aplicación se entorpece por factores diversos. Este estudio quiere evaluar la adherencia, en el laboratorio de hemodinamia de la Fundación Cardioinfantil, a las guías de pertinencia de intervencionismo coronario de la ACCF (American college of cardiology foundation). Objetivo General: Evaluar el nivel de adherencia a criterios de pertinencia de revascularización coronaria del colegio americano de cardiología 2009, en el servicio de hemodinámia de la fundación cardioinfantil Bogotá 2011. Métodos: Se revisaron 200 historias clínicas pacientes con diagnóstico de síndrome coronario agudo, llevados a intervención coronaria, según características de pacientes , intervención, y nivel de adherencia se clasifico la intervención como apropiada, incierta e inadecuada . Resultados: De la población analizada, el 71% (n=142) de las intervenciones fueron clasificados como apropiadas, 20% (N=40) como inapropiadas y 8,5% (n=17) como inciertas. Los desenlaces y complicaciones no tuvieron asociación estadísticamente significativa (p> 0,005) con la adherencia a los criterios de pertinencia. Conclusiones: Respecto a la literatura existente el número de intervenciones inapropiadas es mayor en la FCI, comparado con estudios practicados en América Latina y Norte América, sin embargo una adherencia del 80 %, ubica a esta institución en un adecuado nivel de adherencia.