Introductio: Cardiovascular Risk Factors (CVRF) prevalence is unknown in Ecuadorian workers. Objetives:1.To estimate the prevalence of CVRF: overweight, obesity, physical inactivity, high blood pressure (HBP), central obesity, dyslipidemia history, tobacco use, alcohol and low Fruit (F) and Vegetable (V) intake. 2.To establish the relationship between obesity, overweight with central obesity with age, sex, marital status and education. 3.To determine the relationship between obesity with other CVRF. 4.To establish the association between central obesity with age, sex, marital status, and level of education. 6.To find out the relationship between Body Mass Index (BMI) with Physical Activity (PA) levels and PA autoefficacy. 7.To explore PA and F/V intake behaviors. 8.To determine the relationship between PAs Stages of Change (SOC) with PA levels and PA autoefficacy. 9.To determine the relationship between BMI with PA SOC and SOC F/V (action and maintenance). 10.To determine the relationship between SOC action and maintenance PA and F/V consumption with sex, age, marital status and education in workers from Ecuadorian private enterprise in 2006. Materials/ methods: transversal study. Through a medical story the following information is collected 1.Sociodemographic factors, hypertension and dyslipidemia stories, tobacco and alcohol use; 2.Anthropometry: waist circunference, waist/hip ratio and BMI; 3.PA levels are measured by International Physical Activity Questionnaire; 4.The F/V intake and PA SOC behaviors are measured in accordance with the Trans Theoretical Model; 5.Autoefficacy and PA barriers are measured by questionnaire. Descriptive statistics, chi- cuadrado test and factorial analysis of multiple correspondences are used.Results:The prevalence of CVRF are: 87.9% low F and V intake, 65.3% physical inactivity, 50% excess of weight (40.8% overweight, 9.4% obesity), 36.4% alcohol, 25.6% central obesity, 14.8% tobacco use, 14% high blood pressure and 6.9% dyslipidemia history. Overweight is higher in men (p<0.001), married (p=0.000), with primary education (p=0.024) and increase with age (p<0.000). Overweight, central obesity and high body fat percentage are associated with hypertension (p <0.000). Hypertension coexisted with obesity (38.4%) and overweight (15%) (p=0,00). Hypertension is associated with overweight and central obesity (p< 0.000). Overweight is associated with tobacco use (p=0,000), dyslipidemia history (p<0.000), high percentage of body fat (p=0,000) and central obesity (p=0,000). Central obesity increase with age and it is more prevalent in women. An association between F and V intake SOC and F and V intake is found. The 83% of subjects who accomplished WHO F and V intake recommendation are classified in SOC maintenance. Whereas the majority of subjects who did not accomplished WHO F and V intake recommendation have low F and V intake SOC (precontemplation y contemplation). A significative association between physical activity SOC with PA levels is observed (p=0.000). Sedentary subjects are classified mainly in PA SOC contemplation, whereas active and very active subjects are in PA SOC maintenance. Lack of time is the most common barrier to practice PA. PA autoefficacy levels are associated with BMI. Lower PA autoefficacy is associated with obesity. Women eat more F/V. Conclusions: High CVRF prevalence is found (low F/V intake, physical inactivity, excess of weight, alcohol use, central obesity, tobaco use and HBP). Obesity is associated with other FRCV. Being obese and lack of time are barriers for PA practicing. The PA SOC are associated with PA levels. The F/V SOC are associate with F/V comsumption. Research findings were used for designing and implementing "Estar bien es cuestión de equilibrio" (lifesytle promotion) Program in the Ecuadorian private company under investigation.It is important to implement a CVRF prevention and management program in this company. / Introducción: Se desconoce prevalencia de ECV y Factores de Riesgo Cardiovascular (FRCV) en trabajadores ecuatorianos. Objetivos:1.Estimar prevalencia de FRCV: exceso de peso, inactividad física, hipertensión arterial (HTA), obesidad central, historia de dislipidemias, uso de tabaco, alcohol y baja ingesta de Frutas (F) y Verduras (V). 2.Identificar asociación entre exceso de peso con edad, sexo, estado civil y nivel de educación. 3.Determinar asociación entre exceso de peso con otros FRCV. 4.Identificar asociación entre obesidad central con edad, sexo, estado civil y nivel de educación. 5.Determinar relación entre exceso de peso y niveles Actividad Física (AF). 6.Identificar asociación entre ECC ingesta de F y V con cumplimiento recomendación consumo F/V. 7.Determinar niveles de autoeficacia para realizar AF. 8.Investigar relacion entre IMC con autoeficacia para realizar AF. 9.Correlacionar IMC con Estados de Cambio de Comportamiento (ECC) acción y mantenimiento para AF y consumo F/V. 10.Identificar asociación entre ECC para realizar AF con niveles AF y autoeficacia AF.11.Identificar asociación entre ECC acción y mantenimiento AF y consumo F/V con sexo, edad, estado civil y nivel educativo en trabajadores de empresa privada Ecuatoriana 2006. Materiales/métodos: estudio descriptivo transversal. Mediante historias clínicas se recaba:1.Factores sociodemográficos, historia de dislipidemias e HTA, uso de tabaco y alcohol 2.Presión arterial. 3.Antropometría: circunferencia de cintura, ratio cintura/cadera e IMC; 4.Nivel de AF mediante Cuestionario Internacional de Actividad Física; 5.Modelo Trans Teorético determina ECC para realizar AF e ingesta F/V; 6.Autoeficacia y barreras para realizar AF. Se utiliza estadística descriptiva, razón de verosimilitudes, test chi- cuadrado y análisis factorial de correspondencias múltiples. Resultados: Prevalencia FRCV: 87.9% baja ingesta de F/V, 65.3% inactividad física, 50% exceso de peso (sobrepeso 40.8% y obesidad 9.4%), 36.4% consumo alcohol, 25.6% obesidad abdominal, 14.8% uso de tabaco, 14% HTA y 6.9% historia de dislipidemias. El sobrepeso es mayor en hombres (p<0.001), casados (p=0.000), con educación primaria (p=0.024) y aumenta con edad (p<0.000). Obesidad central se incrementa con la edad, es mayor en mujeres y en menor nivel educativo. Exceso de peso, obesidad central y alto porcentaje de grasa corporal estan asociados con HTA (p<0.000). La HTA coexiste con obesidad (38.4%) y sobrepeso (15%) (p=0,00). La obesidad se asocia con: uso de tabaco (p=0,000), historia de dislipidemias (p<0.000), alto porcentaje de grasa corporal (p=0,000), HTA (p<0.001) y obesidad central (p=0,000). Existe asociación entre consumo de F y V y ECC ingesta de F/V. El 83% de sujetos que cumplen con recomendación ingesta F/V están en ECC mantenimiento. La mayoría de sujetos que no cumplen con recomendación ingesta F/V están en ECC precontemplación y contemplación. Existe una asociación significativa entre ECC para practicar AF con niveles AF (p=0.000). Los sujetos sedentarios se ubican principalmente en ECC contemplación, mientras que individuos activos y muy activos se ubican en ECC mantenimiento.La falta de tiempo es la barrera más común para prácticar AF. Obesos tienen poca o ninguna auto eficacia para realizar AF. Conclusiones: Altas prevalencias de FRCV (baja ingesta de F/V, inactividad física, exceso de peso, alcohol, obesidad central, uso de tabaco e HTA). Sobrepeso es más prevalente en hombres. Obesidad se asocia con otros FRCV. ECC para realizar AF se correlaciona con niveles AF. ECC ingesta F/V se correlaciona con consumo de F/V. Resultados de esta investigación permitieron diseñar e implementar un programa de promoción estilos vida saludable "Estar bien es cuestión de equilibrio" en empresa investigada. Se sugiere implementar programa prevención y manejo de FRCV.La actuación preventiva en empresas requiere un conocimiento previo de FRCV de los trabajadores facilitando una planificación eficaz.

The aims of this thesis are to investigate the factors influencing treatment fidelity of health behaviour change (HBC) interventions. The thesis will focus on HBC interventions delivered by practice nurses (PNs) and health care assistants (HCAs) to patients within general practice, although the findings will be explored within the context of the wider treatment fidelity literature. The thesis comprises five studies, focussed on exploring, enhancing and assessing fidelity of delivery and receipt of HBC interventions. Through developing an enhanced understanding of these areas of treatment fidelity, the thesis will also make recommendations for strategies to enhance and assess fidelity of delivery and receipt of future HBC interventions. Study one is a meta-synthesis of qualitative studies that explored the views and experiences of nurses who had delivered HBC interventions with a focus on how this can inform future delivery of HBC interventions. Study two is an Interpretative Phenomenological Analysis of PNs’/HCAs’ experiences of helping patients to change their health behaviours within the context of their routine care, and before and after delivery of an intervention to facilitate increased walking. Study three reports a quantitative assessment of delivery of intervention techniques to facilitate increased walking, as specified in an intervention protocol, by PNs/HCAs. Study four explores PNs’/HCAs’ views and experiences of the factors that influenced their delivery of the walking intervention. Study five investigates treatment receipt, by exploring patients’ understanding of, and experiences of receiving the walking intervention. The key findings from this research are that delivery and receipt of HBC interventions within general practice are influenced by a range of factors that include the providers’ confidence and skills, the patients’ expectations and/or engagement with the intervention and the general practice within which the intervention is delivered. A number of these factors are difficult to influence and so research teams need to develop a range of strategies to enhance delivery and receipt of HBC interventions. These may include appropriate preparation for providers to deliver the intervention, the provision of a simple intervention resource to support delivery of the intervention and the development of strategies to enhance patients’ understanding of intervention techniques.

This thesis stems from a large, international research project funded in the UK by the Economic and Social Research Council (ESRC) (RES-000-22-2003) and led by Dr. Emma Rich and Professor John Evans at Loughborough University between 2007 and 2009. The study investigated how new health imperatives and associated curriculum initiatives were operationalized within and across eight schools located in a county in the Midlands region of England. The schools were chosen to reflect a variety of socio-cultural settings in the UK, and specifically those that were typical of the Midlands county in which the study took place. The research findings formed part of a three-way international collaboration with parallel studies conducted in Australia (led by Professor Jan Wright) and New Zealand (led by Associate Professor Lisette Burrows) and revealed, among other significant findings, that whilst some young people are deeply troubled by obesity discourse, others are emboldened by it. In pursuit of this key finding, this PhD study departs from the aforementioned project through detailed case study exploration of the emplacement , enactment and embodiment of health policy in three of the eight UK schools from the ESRC-funded study, focusing specifically on the class and cultural mediations of health imperatives in each setting and the various ways these can affect a young person s developing sense of self (particularly the relationships they develop with their own weight/size). Young people are considered to be body subjects (Blackman, 2012) whose embodiments are assembled, performed and enacted in situ. I therefore speak of troubled , insouciant and emboldened bodies as categories which reflect the fundamentally agentic, contingent, relational and fluid nature of young people s embodiment in time, place and space. Hence, whilst highlighting the deleterious and indeed ubiquitous effects of some health education programmes on some young people s relationships with their weight/size, key findings presented in this thesis offer nuance and complexity to the notion of the neoliberal body (Heywood, 2007; Rizvi and Lingard, 2010; Rose, 1999) through exploration of the ways in which contemporary health imperatives also have potential to privilege and empower some young people. The thesis concludes with a discussion of the implications of these findings for policy makers, educators and researchers whose work concerns young people s health and well-being.

Η λεπτομερής περιγραφή και ανάλυση των ιζημάτων υφαλοκρηπίδας, ηλικίας Ολιγοκαίνου στο νησί της Λήμνου μας έδωσε τη δυνατότητα να κατασκευάσουμε την στρωματογραφική στήλη των αποθέσεων που μελετήθηκαν και να την χωρίσουμε σε τέσσερις κύκλους ιζηματογένεσης, με αυξανόμενο κοκκομετρικό μέγεθος προς τα πάνω. Ειδικότερα, ο πρώτος κύκλος ιζηματογένεσης και στρωματογραφικά κατώτερος έχει συνολικό πάχος 36,5 μέτρα και αποτελείται από 6 στρώματα ιλυολίθων πάχους 33 μέτρων μέσα στα οποία παρεμβάλλονται μικρού πάχους ψαμμιτικοί ορίζοντες. Ο κύκλος αυτός κλείνει με εναλλαγές ψαμμιτικών και πηλιτικών στρωμάτων σε αναλογία 1:1 συνολικού πάχους 3,5 μ., όπου τα ψαμμιτικά στρώματα έχουν πάχος από 1-5εκ. Ο δεύτερος κύκλος ιζηματογένεσης με συνολικό πάχος 13μ. αποτελείται από ιλυόλιθους στη βάση, πάχους 7μ., με μικρού πάχους παρεμβολές ψαμμιτών που περνάνε σε εναλλαγές ψαμμιτών και ιλυολίθων συνολικού πάχους 6μ., σε αναλογία 1:1 και πάχος ψαμμιτών από 1-7 εκ. Ο τρίτος κύκλος ιζηματογένεσης συνίσταται από 4 στρώματα ιλυολίθων, συνολικού πάχους 15 μέτρων και μια ακολουθία εναλλαγών ψαμμιτών με ιλυόλιθους συνολικού πάχους 17,5 μ. Ο τέταρτος και τελευταίος κύκλος ιζηματογένεσης αποτελείται από ένα στρώμα ιλυολίθου με σπάνια παρουσία άμμου πάχους 10 μέτρων, ο οποίος κλείνει με εναλλαγές ψαμμιτών και ιλυολίθων, συνολικού πάχους 7 μέτρων και πάχος ψαμμιτών από 1-25 εκ. Η γεωχημική ανάλυση 77 δειγμάτων στο σύνολο της ακολουθίας έδειξε ότι τα μελετηθέντα ιζήματα περιέχουν από 0%-1,15% TOC με μέση τιμή 0,34%. Γενικά, το περιεχόμενο σε οργανικό άνθρακα χαρακτηρίζεται από έντονη διακύμανση σε όλη την στρωματογραφική στήλη. Τα αποτελέσματα της ανάλυσης του CaCO3 στα ίδια δείγματα έδειξαν ότι το ποσοστό του ανθρακικού ασβεστίου κυμαίνεται από 1,37-42,52% με μέση τιμή 16,95%, με έντονη διακύμανση όπως και το οργανικό υλικό. Η σύγκριση των αποτελεσμάτων έδειξε τόσο αρνητική όσο και θετική συσχέτιση των ποσοστών TOC- CaCO3. Η ερμηνεία των συγκρίσεων αυτών συνδέθηκε είτε με τις οξειδωτικές ή αναγωγικές συνθήκες που επικρατούσαν στο περιβάλλον ιζηματογένεσης είτε με τον ρυθμό ιζηματογένεσης και τους ρυθμούς βύθισης ή ανύψωσης της λεκάνης ιζηματογένεσης. / The detailed description and analysis of shelf sediments of Oligocene on Lemnos island enabled us to construct the stratigraphic column of the studied deposits as well as to divide it into four sedimentary cycles, with increasing the grain size upwards. Specifically, the first sedimentary cycle which is the lowest of the stratigraphic column has a total thickness of 36.5 meters and consists of 6 mudstone layers, 33 meters thick with thin sandstone layers at some positions. The cycle ends with alternations of sandstones and mudstones at a ratio of 1:1 with a total thickness of 3.5 m, where the sandstone layers are 1-5cm thick. The second sedimentary cycle has a total thickness of 13m., it consists of mudstones at its base, 7m. thick with thin sandstone layers passing to sandstone and mudstone alternations with a total thickness of 6m., with a ratio of 1:1 and thickness of sandstones 1-7 cm. The third sedimentary cycle consists of 4 mudstone layers of 15 meters total thickness and alternations of sandstones and mudstones with a total thickness of 17.5 m. The fourth and upper at the stratigraphic column sedimentary cycle consists of a mudstone layer with rare sand, 10 meters thick, which ends with alternations of sandstones and mudstones, with a total thickness of 7 meters and sandstones 1-25 cm thick. The geochemical analysis of 77 samples throughout the stratigraphic column showed that the studied sediments contain from 0% -1,15% TOC with an average of 0.34%. Generally, the content of organic carbon is characterized by an intense fluctuation throughout the stratigraphic column. The results of the analysis of CaCO3 at the same samples showed that the percentage of calcium carbonate ranges from 1.37 to 42.52% with an average of 16.95%. The comparison of the results showed both negative and positive correlation between TOC-CaCO3 rates. The interpretation of these comparisons was associated with either acidic or alkaline conditions of the sedimentary environment or with the sedimentation rate and the rise / sink rates of the sedimentary basin.

The term sedentary refers to a distinct class of activities which involve sitting or reclining and which do not cause an increase in energy expenditure above resting levels. Observational studies have reported positive associations between both sedentary time and the number of hours spent sitting per day, with risk for a number of health outcomes that are independent of moderate to vigorous physical activity (MVPA). The total time spent sitting can be amassed in different patterns (long and short bouts) and different types (watching TV, driving, working at a computer) that may have differential associations with health outcomes as well as different confounders that have yet to be properly explored. Further, limitations in current measures used to quantify sedentary behaviour and the possibility of residual confounding, mean that it is unclear whether the posture of sitting itself represents a risk to health or whether sitting is actually a proxy for low energy expenditure. This thesis aimed to examine; the associations between five separate sitting types with health risk, the prevalence of sitting behaviour in England, and the biological mechanisms which might underpin the observed negative health consequences of sitting. Using data from the Whitehall II cohort study the first four studies of this thesis examined prospective associations between sitting at work, TV viewing, non-TV leisure time sitting, total leisure time sitting (TV and non-TV leisure sitting combined) and total sitting from work and leisure, with four health outcomes; mortality, cardiovascular disease, type II diabetes and obesity. No association between any of the sitting indicators with risk for mortality or incident cardiovascular disease was found. TV viewing and total sitting were associated with an increase in risk for type II diabetes following adjustment for sociodemographic covariates and MVPA, but were attenuated following further adjustment for body mass index. None of the five sitting indicators were associated with incident obesity but being obese prior to the measurement of sitting was associated with the number of reported hours of daily TV viewing. The final study of this thesis examined the acute effect of sustained versus interrupted sitting on glucose and insulin metabolism. Interrupting sitting with repeated short bouts of light intensity walking significantly improved insulin sensitivity while repeated short bouts of standing did not. Sitting is a prevalent behaviour in English adults and varies by socio-demographic characteristics. Previously reported associations between sitting time and health risk may be confounded by light intensity physical activity and obesity. The absence of an effect of repeated standing bouts (a change in posture without a change in energy expenditure) suggests that promoting reductions in sitting without also promoting increases in movement are not likely to lead to improvements in metabolic health. New measures of sedentary behaviour are required that can be used in population studies, and can discriminate between the posture of sitting, standing and very low levels of physical activity of a light intensity. This would permit further studies that are needed to clarify the precise nature of the association between sitting and health.

Whilst high levels of cardiorespiratory fitness and physical activity may protect against cardiometabolic risk factor clustering, evidence suggests these outcomes are below optimal in English youths. Adolescence is a key stage in health behaviours development, and thus represents an opportunity for interventions aiming to improve the cardiometabolic health, fitness and activity levels of this population. Recently, there has been growing interest in the efficacy of low-volume high-intensity interval training (HIT) as a time efficient way of improving health and fitness outcomes in adults. Contrastingly, the effects of low-volume HIT in adolescents remains relatively unknown. The first aim of this programme therefore was to develop a novel school-based low-volume HIT intervention. The second was to determine the effectiveness of this model for improving the cardiometabolic health, cardiorespiratory fitness and physical activity levels of adolescents. Study one examined adolescents’ views towards high-intensity exercise, and the proposed low-volume HIT intervention. This data was used to design the novel low-volume HIT model. In Study 2, participants’ heart rate and perceived exertion responses to three prototype prescriptions of low-volume HIT, based on boxing, dance and football were examined. Here, it was indicated that these activities were capable of eliciting a high-intensity training response (~90% of maximum heart rate). Study 3 incorporated the main intervention, which examined the effect of a 10-week multi-activity low-volume HIT intervention (named Project FFAB [Fun Fast Activity Blasts]) on various health and fitness outcomes in adolescents. Here, beneficial effects were detected in the intervention participants compared to the controls for triglycerides, waist circumference, lipid accumulation product and daily moderate-to-vigorous physical activity. Study 4 assessed the fidelity of the intervention, and found that this had been largely upheld. Collectively therefore, it appears that Project FFAB represents a viable strategy for improving aspects of cardiometabolic health and physical activity levels in adolescents.

This thesis is concerned with the health-related effects of perspective-taking in response to a narrative health campaign. To begin, the thesis outlines the health promotion strategies currently in use (i.e., statistical vs. narrative), presents research discussing their relative effectiveness, and considers the potential for perspective-taking to influence the impact of narrative health campaigns (Chapter 1). The thesis then defines two types of perspective-taking, cognitive and emotional, and explores the processes underlying these (Chapter 2). Each type of perspective-taking is then considered in the context of the health promotion literature (Chapter 3). It was proposed that, whereas cognitive perspective-taking should have a relatively straightforward and positive effect on the impact of narrative health campaigns, the effects of emotional perspective-taking should be more variable. Seven studies were conducted to test this basic premise and identify mediators and moderators of the observed effects. In Chapter 4, two studies are presented that aim to establish the effects of perspective-taking on health-related outcomes (Studies 1 & 2). A broadly consistent pattern was observed across these studies: encouraging cognitive perspective-taking led to more positive health-related outcomes than did encouraging emotional perspective-taking. Having established the basic effect, two studies are presented in Chapter 5 that explore a potential mediator: perspective-takers’ self-efficacy concerning a health promoting behaviour (chlamydia testing: Studies 3 & 4). These studies found a consistent indirect effect of perspective-taking on intentions to get tested for chlamydia through self-efficacy: encouraging cognitive perspective-taking increased participants’ perceived self-efficacy relative to encouraging emotional perspective-taking, which in turn positively predicted intentions to get tested in the future. The three studies presented in Chapter 6 explore potential moderators of the effects of perspective-taking (Studies 5-7). Specifically, these studies test whether the relative effects of perspective-taking are moderated by features of the relationship between the perspective-taker and a target presented in a narrative health campaign. The broad pattern observed across these studies suggests that the perception of a shared categorisation (or social identity) between the perspective-taker and target moderates the effect of perspective-taking on health-related outcomes. Specifically, the final study, Study 7, demonstrated that encouraging cognitive perspective-taking in response to a narrative health campaign leads to more positive health-related effects than encouraging emotional perspective-taking when perspective-takers’ personal (unshared) identity is made salient; however, these effects are attenuated (and potentially even reversed) when a social (or shared) identity is made salient. Considered as a whole, the research presented in this thesis represents the first empirical examination of the relative health-related effects of different types of perspective-taking in response to a narrative health campaign. The research demonstrates that perspective-taking is an important factor in determining whether or not narrative health promotion campaigns are likely to be effective. However, it also makes clear that the processes through, and conditions under, which cognitive and emotional perspective-taking can help to ensure the effectiveness of narrative health campaigns are not yet fully understood. Nevertheless, the studies presented herein successfully identify several such conditions and mechanisms ready for further study. Theoretical and practical implications, alongside limitations and more specific suggestions for further research are discussed.

Contexte. Chez l’homme, la mise en bouche d’un aliment est l’étape ultime de la chaîne alimentaire et le début du processus de dégradation et de digestion. Avec l’âge la santé orale évolue et peut parfois rendre l’acte alimentaire difficile.Objectif. L’objectif de cette étude est de déterminer les facteurs (salivaire, dentaire, musculaire) impactant sur les dimensions physiologiques (faculté à former un bol alimentaire, libération et perception de la flaveur) de l’acte alimentaire et/ou la prise alimentaire et la corpulence des séniors. Ceci permettra de d’identifier des techniques culinaires permettant d’adapter la texture des aliments aux problèmes bucco-dentaires.Matériel et méthode. 108 séniors (>65 ans) vivant à domicile et ne présentant pas de pathologie chronique ont été recrutés et caractérisés sur la base des dimensions suivantes : santé orale (examen clinique), auto-évaluation de la santé orale, perceptions sensorielles, faculté à former un bol alimentaire, comportement alimentaire, état de santé général. En parallèle, des techniques culinaires permettant d’améliorer la texture de la viande ont été testées. Leur efficacité a été évaluée via des mesures rhéologiques et la perception du confort en bouche par les séniors eux-mêmes.Résultats et conclusion. L’analyse multidimensionnelle des données montre que les facteurs de santé orale (dentition, salivation, force musculaire) jouent des rôles différents dans les processus de mastication et de prise alimentaire chez les personnes âgées. De plus, l’étude du confort en bouche a permis de sélectionner des techniques culinaires optimisant la tendreté et la jutosité de la viande. Ces résultats permettront de développer une offre alimentaire adaptée aux troubles oraux survenant avec l’âge. / Context. In human, oral food intake is the ultimate stage of food supply chain and the beginning of food disintegration and the digestion process. During aging, the oral health changes and sometimes eating food can be a real challenge as food can be hard to masticate, humidify or swallow.Objective. The aim of the present study is to determine which oral factors (salivary, dental, tongue strength) have an impact on physiological – ability to form a food bolus – and psychological – pleasure to eat – dimensions of food oral processing in order to select culinary techniques and help elderlies maintaining an appropriate protein intake in spite of the occurrence of poor oral health.Material and method. Resting and stimulated salivary flow, oral status, the ability to form a food bolus, the pleasure induced by food consumption and the nutritional status were measured on 108 elderly people (65-92 years old, living at home, with no acute pathology at the time of the study). In parallel, culinary technics that aimed at improving meat texture were developed and evaluated throughout physical measurements and oral comfort assessment by the elderly volunteers.Results and conclusion. Multivariate analysis highlighted the fact that oral factors (salivary, dental, muscular) play different roles in food oral processing and eating behavior in elderly people. Moreover, the assessment of oral comfort on the culinary technics showed that some technics improve significantly meat tenderness and juiciness. Those results will help the development of food offer tailored to elderly people with or without oral health impairments.

En France, l'usage des bases de données médico-administratives dans le cadre épidémiologique est récent comparativement à d'autres pays d'Europe, du fait notamment de leur complexité, liée à leur développement initial mené dans une optique comptable. Les travaux menés ont porté sur l'apport de ces bases de données à l'étude de la prise en charge et de la morbidité évitable dans l'asthme et dans l'ostéoporose. Dans un premier temps, nous avons montré que ces bases de données permettaient au travers d'algorithmes d'identifier des nourrissons asthmatiques et leurs exacerbations, et que la prise en charge de ces nourrissons n'était pas optimale en France, avec une forte consommation d'antibiotiques et de corticoïdes oraux. Nous avons prolongé ces recherches par la description de la prise en charge des asthmatiques enfants/adolescents et adultes, et les constats ont été les mêmes. Une surconsommation des traitements de crise a pu être mise en évidence, ainsi que des sous-groupes de patients à risque d'exacerbation sévère. Ces résultats nous ont amené à nous intéresser tout particulièrement à l'adhésion aux traitements de fond. Dans une étude menée sur 5 000 patients asthmatiques, le taux de couverture par un traitement de fond était en moyenne de 51%, et seuls 24% des patients avaient un taux de couverture supérieur ou égal au taux minimal recommandé (80%). Enfin, concernant l'ostéoporose, nous nous sommes attachés à décrire la prise en charge des patients ostéoporotiques sur une période de 6 ans, en nous concentrant particulièrement sur les changements de stratégies thérapeutiques / Anglais In France, the use of claims data in the epidemiological context is recent compared to other European countries, in particular because of their complexity, linked to their initial development for accounting purposes. This work was focused on the contribution of these databases to study disease management and unmet needs in asthma and osteoporosis. First, we showed that it was feasible, through algorithms, to identify in these data infants with asthma and their exacerbations, and we noted that management of these infants was not optimal, with high use of antibiotics and oral corticosteroids. We extended this research by describing the treatment of asthmatic children/adolescents and adults, with similar findings. Overuse of reliever therapy was observed, beyond the identification of subgroups at risk of serious exacerbation. These results led us to focus on adherence to controller therapy. In a study including 5,000 asthma patients, the coverage by controller therapy was 51%, and only 24% of patients had a higher coverage than the recommended minimum (80%). Finally, regarding osteoporosis, we described the treatment of osteoporotic patients over 6 years, with a particular focus on treatment switches

Afin d’évaluer la qualité alimentaire et l’efficacité métabolique des aliments mixtes combinant différentes sources protéiques végétales ou des sources protéiques végétales/animales, deux aliments de base, les pâtes alimentaires et les gels laitiers, ont été choisis comme vecteurs et ont été enrichis par des farines ou des protéines de légumineuses. La structure de la fraction protéique des aliments mixtes a été étudiée à l’échelle moléculaire. La relation entre cette structure et la digestibilité in vitro et in vivo des protéines a été évaluée. L’effet de la formulation et/ou du procédé de fabrication de ces aliments mixtes sur le métabolisme protéique in vivo a été étudié chez des rats jeunes en croissance et des rats âgés. Le changement de la formulation des pâtes alimentaires, c'est à dire l’incorporation de trois farines de légumineuses différentes (féverole, lentille ou pois cassé), génère des modifications de structure du réseau protéique influençant la digestibilité des protéines. Les études animales montrent que la qualité alimentaire des pâtes enrichies en légumineuses est comparable à celle d’une protéine animale comme la caséine et ce, quel que soit le type de légumineuses utilisé. La rétention protéique corporelle et la synthèse protéique musculaire des rats âgés, consommant des régimes iso- protéiques à base de pâtes alimentaires enrichies en légumineuses ou de caséine, sont comparables. Elles restent cependant inférieures à celles induites par les protéines solubles du lait. L’utilisation de gels laitiers enrichis en protéines de féverole chez le rat a révélé un effet de la formulation et du procédé de gélification sur la digestion et la rétention protéiques. La digestibilité in vivo des protéines est plus élevée chez les rats consommant le régime contenant le gel fermenté mixte composé de protéines de caséine et de féverole comparativement à son homologue de même composition mais acidifié par voie chimique. La rétention protéique est encore améliorée chez les rats ayant consommé le régime contenant le gel fermenté composé de protéines de caséine, de féverole et de lactosérum. Ces aliments enrichis en légumineuses, riches en protéines, équilibrés en acides aminés indispensables commencent à être disponibles sur le marché. Ils pourraient être proposés à la population âgée notamment dans des situations physiopathologiques impliquant une perte de protéines corporelles. / In order to assess food quality and metabolic efficiency of mixed foods combining different vegetable protein sources or vegetable-animal protein sources, two staple foods, pasta and dairy gels, were selected as vectors and enriched with flour or protein extracted from legumes. The protein structure of the mixed feeds was studied at a molecular level. The relationship between this structure and the in vitro and in vivo digestibility of proteins was evaluated. The effect of the formulation and / or manufacturing process of these mixed foods on protein metabolism in vivo has been studied in growing young rats and aged rats. The change of the pasta formulation, ie the incorporation of three different leguminous flours (faba beans, lentils or split peas), generates structural modifications of the protein network influencing the digestibility of the proteins. Animal studies show that the nutritional quality of pasta enriched with legumes is comparable to that of an animal protein such as casein, regardless of the type of legume used. Body protein retention and muscle protein synthesis in aged rats, consuming iso-protein diets based on legume-enriched pasta or casein, are comparable. However, they remain lower than those induced by soluble milk proteins. The use of faba bean protein-enriched milk gels has shown an effect of the formulation and gelation process on protein digestion and retention. In vivo digestibility of proteins is higher in rats consuming the mixed fermented gel diet composed of casein and faba bean proteins compared to its counterpart of the same composition but chemically acidified. Protein retention is further improved in rats fed with a diet containing fermented gel composed of casein proteins, faba beans and whey. These legume-enriched foods, rich in protein, balanced in essential amino acids are beginning to be available on the market. They could be offered to the elderly population, especially in physiopathological situations involving a loss of body proteins.