The topic of this diploma thesis is based on European study: Childhood Obesity Surveillance Initiative (COSI). It is WHO Europe project. In the Czech Republic is this project lead by Institute of Endocrinology. The goal of this work is to determine childhood obesity prevalence and to monitor prevalence in relation to family and school environment. Obesity in children is an important health problem, accelerating throughout the world with particularly alarming trends in Europe. It causes a wide range of serious health and social consequences and increases the likelihood of morbidity in children and adults such as dyslipidaemia, hyperinsulimia, hypertension, type 2 diabetes, early atherosclerosis etc. Obesity is also strongly associated with orthopaedic problems and mental disorders, therefore, it is very important to monitor obesity prevalence in childhood. The goal of the work is to determine the prevalence of overweight and obesity in 7-year children in the year 2010 (WHO classification and classification method of Czech republic). Another goal is to find a relation of the anthropometric data to environmental factors - identified by parents of children and representatives of schools (socioeconomic characteristics, eating habits, physical activities etc.). In this diploma thesis were measured 2594...

Introduction. Des traitements efficaces permettent la prise en charge des personnes vivant avec le VIH (PVVIH) et la prévention. Cependant, seulement 55% des PVVIH connaissent leur statut et ce taux est encore plus faible pour les pays de l’Afrique de l’Ouest et du Centre (35%). Afin d’accroître l’offre de Conseil et Test pour le VIH (CTV), l’OMS a publié en juillet 2015 un guide consolidé basé sur des études, dont certaines ont été réalisées en Afrique Subsaharienne. Et très peu d’entre elles concernent les pays à faible prévalence du VIH, notamment l’Afrique de l’Ouest francophone. Cette thèse a pour objectif général d’analyser les enjeux et les limites des politiques et programmes de CTV dans les pays africains de basse prévalence VIH, à partir de la situation du Burkina Faso, et de proposer de nouvelles mesures pour développer l’offre de CTV.Méthodes. Deux études ont été conduites. La première portait sur les motivations et les obstacles à la pratique du test VIH. Elle a été menée dans le cadre du projet « Multi-country African Testing and Counselling for HIV » (MATCH) portant sur quatre pays (Burkina Faso, Kenya, Malawi, Ouganda). Au Burkina Faso, l’étude a été conduite en 2008-2009 en milieu urbain (Ouagadougou) et rural (Dédougou) dans des sites sélectionnés selon leur niveau de fréquentation. Des approches quantitatives et qualitatives ont été utilisées.La deuxième étude a été conduite en 2015 auprès des acteurs et des décideurs du CTV au niveau national, et visait à analyser leurs perceptions des directives publiées par l’OMS en 2015. Un outil de collecte des données expliquant les changements a diffusé par voie électronique. Les réponses ont été analysées de manière quantitative et qualitative.Résultats. L’offre du CTV est basée au Burkina Faso sur des documents validés en 2008.L’analyse de l’utilisation du test à l’initiative du client a montré que les femmes étaient les plus nombreuses (58,5%). Cependant les hommes (p=0,02), les 18-34 ans (p=0,01), et les plus scolarisés (p=0,001) semblaient utiliser plus précocement les services.. En analyse multivariée, ces catégories utilisaient plus les campagnes. Les signes ou symptômes liés au VIH motivaient le test chez les femmes (p=0,008), les 35 ans et plus (p<0,001) et les non scolarisés (p<0,001) qui sollicitaient plus le test en sites fixes. L’utilisation du CTV pendant la campagne était associée au désir de connaître le statut (p<0,001), tandis qu’en dehors des campagnes, l'état de santé de l’utilisateur, la maladie ou le décès du partenaire était le principal motif (p=0,001). Aussi 61% des utilisateurs avaient réalisé 2 tests et plus. Dans une analyse multivariée, l’utilisation répétée du CTV par les personnes séronégatives était associée à la scolarisation (au moins le secondaire), au jeune âge et pour les PVVIH à la résidence en milieu urbain.Les prestataires déclaraient être confrontés à des difficultés logistiques et matérielles pour offrir adéquatement le CTV. Il en résultait une faible qualité des services, notamment un conseil post test dispensé partiellement, et une faible référence des PVVIH. Celles-ci avaient un vécu de stigmatisation élevé, soit 46% de stigmatisation interne, 40% dans les relations interpersonnelles et 11% dans les services de santé. Les décideurs et acteurs ont trouvé la plupart des directives de 2015 pertinentes, mais sont pessimistes sur leur faisabilité.Conclusion. Ce travail a identifié les limites du CTV au Burkina Faso et donne des éléments significatifs pour les pays africains de basse prévalence. Dans un contexte de raréfaction des ressources, l’accès équitable au CTV nécessite l’identification de stratégies innovantes. Le renforcement des capacités des prestataires pour une offre globale de services de qualité est nécessaire. La lutte contre la stigmatisation devrait être intensifiée. La prise en compte des avis des experts permettra la révision des documents nationaux et leur adaptation selon les directives OMS. / Background. Treatments are effective for people living with HIVAIDS (PLWHA) care and prevention. However, only 55% of PLWHA are aware of their status. This rate is lower in Central and West Africa (35%). In July 2015, WHO published new guidelines on HIV testing. In Sub-Saharan Africa, there are many studies which results are used to define policies and guidelines on HIV testing at the international level. Few of them are implemented in low HIV prevalence countries, notably French-Speaking West Africa. The overall objective of this thesis is to analyze the challenges and limitations of HIV testing and counselling (HTC) policies and programs in low prevalence countries, over the situation in Burkina Faso and propose new measures to increase the access to HTC services.Methods. Two studies have been conducted. The first one was carried out in the « Multi-country African Testing and Counselling for HIV » (MATCH) project which was implemented in four countries (Burkina Faso, Kenya, Malawi, Uganda). It aimed to analyze the motivations and barriers to HTC services practices by users, non-users and providers. In Burkina Faso, the study was carried out in Urban (Ouagadougou) and rural (Dédougou) areas in 2008-2009. In each locality, study sites (client initiated testing and provider initiated testing sites) were chosen, given the level of utilization. Quantitative and qualitative methods were used. The second study was conducted in 2015, with HTC providers and decision makers at national level. The objective was to analyze their perceptions on WHO 2015 guidelines. A data collection tool explaining the changes introduced in the guidelines has been designed and transmitted via electronic means. Their opinions were analyzed.Results. Guidelines for HTC in Burkina Faso were from 2008. In client initiated testing sites, there were more women (58.5%). However, men (p=0.02), 18-34 years old (p=0.01), and the more educated ones (p=0.001) appeared to have used early services. In multivariate analysis, those categories used often campaigns. Women (p=0.008), 35 years of age and over (p<0.001) and less educated people (p<0.001) sought more often the test in fixed sites. The use of HTC services during campaigns is associated with the desire to know one's HIV status (p<0.01), while outside of campaigns, the health status of the user, the illness or the partner's death was the main concern (p=0.001). Campaigns are associated with the hope of knowing one’s HIV status (p<0.001). There were 61% of users who were repeat testers (2 or more tests). In a multivariate analysis, repeat testing for HIV negative people was associated with higher education, young age and for PLWHA living in urban areas. HTC Providers declared that they faced logistic and material challenges. It resulted in a low quality of services, in particular post-test counselling sessions that were partially done and a low effective reference of PLWHA towards care services. HIV stigma was found to be very high (46% of PLWHA faced internal stigma, 40% of interpersonal stigma, and 11% in health services). Decision-makers and providers have found most of the 2015 guidelines relevant, but were pessimist about their feasibility.Conclusion. This work has identified limitations of HTC at the individual, community, health services and institutional levels in Burkina Faso, and provides significant elements for African low prevalence countries. Given the scarcity of resources, there is a need for innovative strategies for equitable access to HTC, in order to attract more men, and test earlier women, less educated and 34 years or older. Strengthening the capacity of service providers to include a comprehensive range of quality services is necessary. All the aforementioned should be supplemented by the fight against stigma. Paying attention to national HTC experts’ opinion will help for national guidelines review and adapt them to WHO guidelines.

Este levantamento retrospectivo teve por objetivos verificar quais animais de companhia foram levados para atendimento odontológico, avaliar quais foram as afecções mais freqüentes na cavidade oral destes animais, avaliar o grau de conscientização dos proprietários e a metodologia de preenchimento dos prontuários. As 3055 fichas cadastradas em um período de 44 meses foram analisadas de forma seqüencial. Os dados coletados foram espécie, raça, sexo, idade, peso, realização de consulta prévia ao tratamento, afecção presente, realização ou não de tratamento após consulta e retorno após um ano. As moléstias foram divididas em doença periodontal grave, moderada e leve, gengivite, fratura dental e qual dente foi acometido, presença de pelo menos um dente com lesão de reabsorção odontoclástica dos felinos, presença de complexo gengivite-estomatite-faringite nos felinos, fraturas em mandíbula e maxila, neoplasias benignas e malignas, persistência de dentes decíduos e alterações específicas dos sagüis, roedores e lagomorfos domésticos. Após o levantamento, as informações obtidas foram analisadas estatisticamente pelo teste de Qui-quadrado para avaliar a correlação de cada afecção com variáveis como faixa etária, sexo, e tamanho do animal. Das 3055 fichas avaliadas, 2300 foram de caninos, 588 de felinos, 99 de chinchilas, 41 de sagüis, 17 de porquinhos da índia, 9 de coelhos e uma de hamster. Para os cães e gatos, a afecção periodontal foi a de maior freqüência, acometendo 71,4% dos cães e 74% dos gatos. Observou-se correlação estatisticamente significante entre a doença periodontal e tamanho e idade do animal. A doença periodontal é mais freqüente em animais de mais idade (acima de 7 anos) e de porte pequeno (abaixo de 10 quilogramas), enquanto a gengivite ocorre mais em animais mais jovens ou com mais de trinta quilogramas. A persistência de dentes decíduos esteve freqüente em 11,6% dos cães, acometendo de forma estatisticamente significante os animais com menos de dez quilogramas. As fraturas dentais estavam presentes em 20,4% dos cães e 30,6% dos gatos, sendo que em ambas as espécies, os caninos foram os dentes que mais fraturaram. Entre os felinos, 41% apresentaram pelo menos um dente com lesão de reabsorção odontoclástica e 11,7%, complexo gengivite-estomatite-faringite. As neoplasias benignas e malignas acometeram 11,05% dos cães e 9,18% dos felinos, sendo que o melanoma, o carcinoma e os epúlides foram os mais freqüentes no cão e o carcinoma foi a principal neoformação nos felinos. Para os roedores e lagomorfos, as pontas dentárias e o desalinhamento oclusal foram as alterações mais vistas. Nos sagüis, a doença periodontal e as fraturas de dentes caninos estiveram presentes em 43,9% e 56,1% dos casos, respectivamente. Dos cães e gatos que fizeram consulta, 79% realizaram tratamento e apenas 5% retornaram após um ano de tratamento. Pôde-se concluir que além dos cães e gatos, outras espécies são encaminhadas ao atendimento odontológico; que existem outras afecções, além da doença periodontal, que acometem a cavidade oral dos animais domésticos; que a saúde oral ainda não é prioridade para os proprietários e que as anotações realizadas durante a rotina de atendimento podem apresentar falhas / The aim of this retrospective survey was to evaluate which pet had been taken for dental consultation, to evaluate which had been the most frequent disease, to try to perceive the degree of awareness of the owners and to evaluate the fulfilling of the dental charts. The 3055 files registered during a period of 44 months were analyzed of sequential form. The collected data were species, race, sex, age, weight, accomplishment of previous consultation to the treatment, present disease, accomplishment or not of treatment after consultation and return after one year. The diseases were divided in severe, moderate or slight periodontitis, gengivitis, dental fracture, presence of at least one tooth with resorptive lesion, presence of gingivitis stomatitis faringitis complex, benign and malignant tumors, jaws fractures, deciduous tooth persistence, presence of carie and specific alterations of the marmosets, rodents and domestic lagomorfs. After the survey, the informations were analyzed statistical by Qui-square test in order to evaluate the correlation of each ilness with variable as age, sex and size of the animal. From the 3055 evaluated files, 2300 were dogs, 588 were cats, 99 were chinchillas, 41 were marmosets, 17 were Indian pig, 9 were rabbits and one was hamster., The prevalence of periodontitis in dogs and cats was 71,4% of dogs and 74% of the cats, occurring significant correlation between size and age of the animal. The periodontal disease is more frequent in older and smaller animals, while the gengivitis occurs more in younger animals or with more than thirty kilograms. The persistence of deciduous was frequent in 11,6% of the dogs been significant for the animals with less than ten kilograms. The dental fractures were present in 20,4% of the dogs and 30,6% of the cats, the canine teeth had been the more fractured. Between the cats, 41% had presented at least a tooth with resorptive lesion and 11.7% with gengivitis-estomatitis-faringitis complex The benign and malignant tumors were present in 11.05% of the dogs and 9.18% of the cats. The melanoma, the carcinoma and epulides were most frequent in the dog and carcinoma was the main tumor in cats. For the rodents and lagomorfos, the dental tips and malocclusions were the more frequent diseases. In the marmoset, the periodontal illness and the fractures tooth had prevalence of 43,9% and 56,1% of the cases, respectively. Dogs and cats that had made consultation, 79% had carried through treatment and only 5% returned for treatment after one year. It can be concluded that beyond the dogs and cats, other species are referred to a dental clinic; that other diseases exist, beyond the periodontal illness, that occurred in the domestic animals; that the oral health is priority to the owners yet and that the charts of the attendance may have imperfections

RESUME Contexte La maladie rénale chronique (MRC) constitue un problème mondial majeur de Santé publique. Son ampleur réelle en Afrique demeure inconnue. Malgré, les progrès réalisés dans lidentification et la prévention de la MRC et le traitement de la phase terminale de la maladie, ces domaines restent un grand défi en Afrique Sub-saharienne à cause du manque cruel des ressources nécessaires. Objectif Ce travail a pour objectif de cerner lépidémiologie de la MRC à Kinshasa en vue délaborer des stratégies de dépistage précoce et de prévention adaptées. Le but ultime est de contribuer à la réduction de la morbidité et la mortalité rénales mais aussi cardiovasculaires. Méthodes : Le présent travail est une revue synthétique de 4 études menées à Kinshasa : Une étude documentaire des 412 cas réalisée aux Cliniques Universitaires de Kinshasa (CUK), durant la période allant de Janvier 2001 à Décembre 2004 pour identifier le profil épidémiologique et clinique des patients atteints de la MRC. Les résultats de cette étude ont motivé le besoin dévaluer lampleur de la maladie dans la population et dans les structures de santé existantes. Il en a résulté trois études. Une étude épidémiologique de type transversal effectuée à partir de 503 ménages sélectionnés de manière aléatoire selon un plan de sondage à plusieurs degrés dans 10 des 35 Zones de santé composant Kinshasa, capitale de la République Démocratique du Congo (RDC). Une seconde étude, aussi de type transversal, réalisée à partir de 527 patients à risque de MRC, fréquentant neuf Centres de santé (CS) de niveau primaire et quatre hôpitaux de référence de la ville de Kinshasa. Une campagne de dépistage de la protéinurie et des facteurs de risque de la MRC chez 3.018 sujets. Résultats : Lanalyse des données enregistrées en milieu hospitalier a montré : Une augmentation annuelle progressive et inquiétante des proportions (60,6%, 65,9%, 67,4% et 70,5%) de la MRC admises aux CUK quasi exclusivement au stade terminal de la maladie nécessitant une prise en charge rapide par la dialyse péritonéale. Malheureusement, 11% seulement pouvaient accéder à ce traitement onéreux. La majorité des malades à prédominance masculine (sexe ratio 2,2/1) décèdent prématurément à un âge moyen (45,8±14,5 ans), à un moment de leur vie où ils sont encore économiquement très productifs. Les causes probables de la MRC chez ces patients sont la glomérulonéphrite chronique (37%), lhypertension artérielle (27%) et le diabète sucré (26%). Les études transversales dans la population générale et les institutions de santé traditionnelles de la ville de Kinshasa ont mis en évidence les caractéristiques épidémiologiques suivantes: La prévalence globale (tous les stades confondus) de la MRC est de 12% dans la population générale, mais 3% seulement sont conscients de leur état de rein. Celle de linsuffisance rénale chronique (IRC) estimée par le débit de filtration glomérulaire (DFGe) < 60 ml/min/1,73 m² est de 8%. Cette MRC touche particulièrement les adultes (52±15 ans). Les facteurs de risque potentiels de la MRC, liés à des maladies non transmissibles (MNT) sont en progression comparativement aux études antérieures. Ces facteurs sont lhypertension (28%), le diabète sucré (12%) et lobésité (15%). Dans les Centres de santé de Kinshasa, la prévalence globale de la MRC méconnue parmi les sujets à risque est le triple de celle rapportée dans la population générale de la même ville. Parmi cette population malade, les proportions de la MRC atteignent 44% chez les hypertendus, 39% chez les diabétiques ; 16% chez les obèses et 12% chez les sujets infectés par le Virus de limmunodéficience humaine (VIH). 82% des diabétiques avaient une glycémie à jeun non contrôlée (> 126 mg/dl) et 78% dhypertendus navaient pas une pression artérielle sous la cible la moins stricte, cest à dire contrôlée à moins de 140/90 mmHg. Les déterminants identifiés de lIRC ont été lhypertension (OR ajusté 3,3), le diabète sucré (OR 2) et la protéinurie (OR 2,9). Les principaux déterminants de DFGe < 60 ml/min/1,73 m² chez les diabétiques étaient lâge et la durée du diabète sucré. Les résultats de la campagne de dépistage de la protéinurie et des facteurs de risque de la MRC ont révélé ce qui suit : La prévalence de la protéinurie a été de 17%. Les autres facteurs de risque de la MRC identifiés chez les sujets en bonne santé apparente ont été: lhypertension (37%), le diabète sucré (9%), lobésité (11%) et le syndrome métabolique (5%). Pour identifier un cas de protéinurie, il est nécessaire de dépister 4 diabétiques, 5 hypertendus, 4 sujets avec syndrome métabolique, 5 sujets âgés de plus de 50 ans et 9 personnes ne présentant aucune des conditions susmentionnées. Les déterminants majeurs de la protéinurie étaient lâge > 50 ans (OR ajusté 1,4), le diabète sucré (OR 1,3), le surpoids (OR 1,2) et le niveau socio-économique bas (OR 1,4). Conclusion : Ces études établissent pour la toute première fois dans une population africaine la forte prévalence de la MRC et ses facteurs de risque notamment lhypertension, le diabète sucré, lobésité, lâge > 50 ans et linfection à VIH. La maladie affecte ladulte encore jeune comparée aux Etats-Unis où elle prédomine à la vieillesse. Nos études ont montré aussi à la fois la forte prévalence de la protéinurie chez les sujets sans facteurs de risque traditionnels précités, le déficit du dépistage précoce de la MRC et de prise en charge des facteurs de risque dans le système de santé traditionnel favorisant la référence tardive et/ou les décès prématurés, ainsi que les limites malheureuses par manque de moyens de la prise en charge de la maladie au stade tardif. Ces études plaident pour la nécessité dun renforcement de la capacité du personnel soignant dans le domaine de détection précoce et de prise en charge des MNT dont la MRC. Elles montrent également quun dépistage annuel de masse de la population de la protéinurie et des facteurs de risque de la MRC est faisable et pourra, nous lespérons, constituer la base dune élaboration dune politique nationale de prévention. Mots-clé : diabète sucré, équation (Cockcroft & Gault, MDRD), hypertension artérielle, maladie rénale chronique, prévalence, protéinurie. SUMMARY Background Chronic kidney disease (CKD) is a worldwide public health problem. Little is known about its burden in Africa. Despite the advances in identification and prevention of CKD and management of end stage renal disease (ESRD), sub-Saharan Africa has been left far behind regarding these advances. This is because of the scarcity of necessary resources. Objective This work was designed to ascertain the epidemiologic knowledge of CKD in Kinshasa in order to define suitable baseline preventive strategies. It would aims ultimately, to reduce the morbidity and mortality from renal disease and related cardiovascular events. Methods: This current work summarises results of 4 studies undertaken in Kinshasa: A retrospective cross sectional study of 412 cases which was done in the Academic hospital of Kinshasa (AHK), from January 2001 to December 2004 to identify the epidemiologic and clinical profile of patients with CKD. The results of this study motivated us to investigate the extent of the burden of CKD in the population and the existing structures of healthcare. Thus, three further studies were carried out; In an epidemiologic cross sectional study, 503 adult residents in 10 of the 35 health zones of Kinshasa, the capital of the DRC were studied in a randomly selected sample; In a second study of higher risk subjects, 527 people in primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or who were infected by HIV; Finally, a mass screening for proteinuria and CKD risk factors was conducted in Kinshasa which involved 3,018 subjects. Results: The analysis of the data recorded in health care had showed: An overwhelmingly annual increasing proportion of CKD (60.6%, 65.9%, 67.4% and 70.5%) in AHK, unfortunately for the majority at stage 5, in other words at ESRD. Tragically enough, only 11% of them could be treated by peritoneal dialysis depending on their financial resources. The majority of the patients are young males (sex ratio 2.2/1) undergoing premature death (45.8±14.5). The probable causes of CKD in these subjects were chronic glomerulonephritis (37%), hypertension (27%) and diabetes mellitus (26%). The cross-sectional studies in the general population and the traditional structures of health care (HC) of the city of Kinshasa highlighted the following: The overall prevalence of CKD is 12% in the general population, but only 3% of those with CKD were aware of their condition. The prevalence of chronic renal failure (CRF) (eGFR < 60 ml/min/1.73 m ²) is 8%; CKD affects particularly young adults (52±15 years); Risk factors for CKD considered in this study, including hypertension (28%), diabetes (12%) and obesity (15%), are increasing compared to the former studies. In HC, the overall prevalence of undiagnosed CKD among at-the risk subjects is three times higher the prevalence of CKD in the general population of the same city. In those with the at-risk conditions, the % of CKD was: 44% in the hypertensive, 39% in the diabetics; 16% in the obese and 12% in those who were infected by the human immunodeficiency virus (HIV). 82% of those with history of diabetes had fasting serum glucose levels (> 126 mg/dl), and 78% of those with a history of hypertension did not have blood pressure controlled to less than 140/90 mmHg. The strongest determinants of CRF or CKD 3+ were: hypertension (adjusted OR 3.3), diabetes (OR 2) and proteinuria (OR 2.9). The principal determinants of eGFR < 60 ml/min/1.73 m² in the diabetic patients were age and the duration of diabetes. The results of the campaign of early detection for proteinuria and CKD risk factors revealed that: The prevalence of proteinuria was 17%. The other CKD risk factors identified were: hypertension (37%), diabetes (9%), obesity (11%) and metabolic syndrome (5%). To identify 1 case of proteinuria, one would need to screen 4 persons with diabetes, 5 persons with hypertension, 4 subjects having metabolic syndrome, 5 subjects aged ≥ 50 years and 9 people without any of the conditions mentioned above. The strongest determinants of proteinuria were age > 50 years (adjusted OR 1.4), diabetes (OR 1.3) and overweight (OR 1.2) and low socioeconomic status (OR 1.4). Conclusion: This work documents for the first time in Africa the high prevalence of CKD and its risk factors mainly hypertension, diabetes, obesity and HIV infection. CKD affects younger people in DRC, in contrast to the United States, where CKD is more prevalent in older. Our work also shows the high prevalence of proteinuria among subjects with neither diabetes nor hypertension, the deficit of the early detection and management of CKD risk factors in the traditional health care system leading to late referral or premature deaths, and the limits of renal replacement treatment. They also show that an annual mass screening of the population for proteinuria and CKD risk factors is feasible and will, it is hoped, provide the basis for building a nationwide prevention strategy. Key words: chronic kidney disease, diabetes mellitus, equation (Cockcroft &Gault, MDRD), arterial hypertension, prevalence, proteinuria.

Introduction: Les troubles respiratoires du sommeil (TRS), qui représentent une préoccupation croissante pour la santé, ont des effets significatifs sur la santé, le comportement et la performance académique chez l’enfant. Les malformations craniofaciales, l’hypertrophie adéno-amygdalienne et l'obésité, représentent des facteurs de risque importants dans le développement de cette condition. Les symptômes des TRS ont été étudiés dans une étude prospective chez les enfants et adolescents durant leur traitement orthodontique dans un milieu universitaire. Cette étude a cherché à décrire la prévalence et les facteurs de risque principaux des TRS, ainsi que l'impact des différentes interventions orthodontiques sur les symptômes TRS. Matériel et méthodes: dans une étude cohorte prospective, un groupe de 168 sujets âgés de 12 à 21 ans ont été soumis, quatre ans après la prise de données initiale, à un examen craniofacial en plus d'être administré des questionnaires qui ont recueilli des données sur la situation socio-démographique, le bruxisme et les troubles d’ATM, le sommeil et le comportement diurne, et les facteurs neuropsychologiques. Résultats: l'indice de masse corporelle a été augmenté mais est demeurée dans la même catégorie aux deux moments de l'enquête. Il ya eu une augmentation du serrement des dents et des symptômes de l'ATM, une diminution de la taille des amygdales, et une augmentation de la somnolence diurne. La prévalence des TRS n'a pas changé entre l’étude initiale et l’étude de suivi. Aucune intervention orthodontique s'est avérée avoir un effet cliniquement significatif sur les voies aériennes supérieures. Conclusions: la prévalence des symptômes TRS était constante par rapport aux valeurs de base pour la population étudiée, mais a augmenté si rapportée à la population générale. Les traitements orthodontiques ne montrent aucun effet sur les TRS. Mots-clés : apnée du sommeil, craniofacial, prévalence, ronflement, traitement orthodontique, voies aériennes supérieures / Introduction: Sleep-disordered breathing (SDB), a growing health concern, has significant effects on a child’s health, behaviour, and scholastic performance. Craniofacial malformations, along with adenotonsillar hypertrophy and obesity, represent important risk factors in the development of this condition. SDB symptoms in children and adolescents followed for orthodontic treatment in a university setting have been investigated in this prospective study. The aims of this study were to describe the prevalence and main risk factors of SDB and the impact of different orthodontic interventions on the SDB symptoms. Materials and methods: in a prospective cohort study, four years following an initial evaluation, a group of 168 subjects aged 12-21 years underwent a craniofacial examination in addition to being administered self-completed questionnaires that collected information on socio-demographic and psychosocial factors, bruxism and temporo-mandibular joint (TMJ) disorders, sleep and daytime behaviour, and neuropsychological factors. Results: Body mass index (BMI) was slightly increased but remained in the same category at the two time points of investigation. There was an increase in tooth clenching and TMJ symptoms, a decrease in tonsils’ size, and an increase in daytime sleepiness. Prevalence of SDB did not change between baseline and follow-up studies. No orthodontic treatment intervention proved to have any clinically significant impact on the upper airway. Conclusions: SDB symptoms prevalence was constant when compared to the baseline values for the studied population, but increased if reported to the general population. Regular orthodontic treatment didn’t show any effect on SDB symptoms. Keywords : craniofacial, orthodontic treatment, prevalence, sleep apnea, snoring, upper airway

The incidence of human papillomavirus (HPV) -associated oropharyngeal tumors is steadily increasing therefore, information about the prevalence of oral HPV and its risk factors is very important for future screening and early diagnosis of the disease. This thesis addresses three topics. The first topic is to evaluate the prevalence of oral HPV in a healthy population and to investigate risk factors for oral HPV infection, given that these data are almost completely absent in Central Europe. A statistically significantly higher rate of positivity (8.8%) of oral HPV infection was found in the group of older unvaccinated probands than in younger partially vaccinated volunteers (2.0%). The seropositivity rate of anamnestic HPV antibodies was comparable in both groups. None of the analyzed risk factors were significantly associated with oral HPV positivity. The second topic of the thesis is the dynamics of HPV specific antibodies in patients with head and neck cancer and their prognostic significance. In patients with cervical cancer, a decrease in HPV E6 / E7-specific antibodies is associated with a better prognosis. Another goal of the dissertation was to assess the importance of anamnestic antibodies and antibodies against oncoproteins E6 and E7 in long-term follow-up 2-14 years after the end of...

Background: Childhood asthma has increased worldwide, although recent studies report a prevalence plateau in some western countries. Aims: To investigate the prevalence of asthma and the associated risk factor patterns from ages 7-8 to 11-12 with special emphasis on the hereditary component, and further to study prevalence trends at age 7-8 from 1996 to 2006 and the possible determinants of these trends. Methods: The studies involved two cohorts from Kiruna, Luleå and Piteå: one previously identified cohort of 3430 children age 7-8 followed by yearly questionnaires until age 11-12 with 97% yearly participation. Skin-prick tests for allergic sensitisation were performed at ages 7-8 and 11-12 in subsets of 2148 and 2155 children respectively (88% of invited). In 2006 a new cohort of 7-8-year-olds was identified and examined identically. 2585 (96% of invited) and 1700 (90% of invited) participated in the questionnaire and skin-prick tests, respectively. The questionnaire included questions about symptoms of asthma, allergic rhinitis and eczema, and possible risk factors. Results: In the 1996 cohort, from age 7-8 to 11-12 the prevalence of physician-diagnosed asthma increased (5.7%-7.7%, P&lt;0.01) while current wheeze decreased (11.7%-9.4%, P&lt;0.01), and 34.7% reported ever wheee at ≥one occasion. Remission was 10% of which half relapsed during the study. Remission was significantly lower among sensitised children. The strongest risk factors for current asthma at ages 7-8 and 11-12 were allergic sensitisation (OR 5) and family history of asthma (OR 3). Several other significant risk factors, e.g. respiratory infections, damp house and low birth weight, had lost importance at age 11-12. At age 7-8, parental asthma was a stronger risk factor (OR 3-4) than parental rhinitis or eczema (OR 1.5-2). Sibling asthma had no independent effect. Biparental asthma had a multiplicative effect (OR 10). Maternal and paternal asthma was equally important, regardless of the child’s sex and sensitisation status. From 1996 to 2006 the prevalence of current wheeze and asthma at age 7-8 did not increase (P=0.13, P=0.18), while lifetime prevalence of ever wheeze and physician-diagnosed asthma increased (P&lt;0.01, P=0.01). Symptoms of rhinitis and eczema were unchanged, despite 45% increase (P&lt;0.01) in allergic sensitisation. For current asthma the adjusted population attributable fractions of sensitisation and parental asthma increased (35%-41%, 27%-45%). This was however balanced by decreased exposure to infections, maternal smoking and home dampness, resulting in stable asthma prevalence. Stratification by sex revealed that current wheeze increased in boys (P&lt;0.01) but tended to decrease in girls (P=0.37), seemingly due to symptom persistence in males. Several asthma indices followed this pattern. The boy-to-girl ratio in exposure to all studied risk factors increased, which may explain the sex-specific prevalence trends in wheeze. Conclusions: The prevalence of current asthma and wheeze did not increase statistically significantly. However, the risk factor pattern has changed considerably since 1996, which will presumably affect the clinical features of childhood wheeze in this region. Sex-specific trends in wheeze can be explained by changes in exposure, and trends in risk factors should be explored parallel to prevalence trends.

BACKGROUND:This paper examines the individual factors that influence prevalence rates of canine heartworm in the contiguous United States. A data set provided by the Companion Animal Parasite Council, which contains county-by-county results of over nine million heartworm tests conducted during 2011 and 2012, is analyzed for predictive structure. The goal is to identify the factors that are important in predicting high canine heartworm prevalence rates.METHODS:The factors considered in this study are those envisioned to impact whether a dog is likely to have heartworm. The factors include climate conditions (annual temperature, precipitation, and relative humidity), socio-economic conditions (population density, household income), local topography (surface water and forestation coverage, elevation), and vector presence (several mosquito species). A baseline heartworm prevalence map is constructed using estimated proportions of positive tests in each county of the United States. A smoothing algorithm is employed to remove localized small-scale variation and highlight large-scale structures of the prevalence rates. Logistic regression is used to identify significant factors for predicting heartworm prevalence.RESULTS:All of the examined factors have power in predicting heartworm prevalence, including median household income, annual temperature, county elevation, and presence of the mosquitoes Aedes trivittatus, Aedes sierrensis and Culex quinquefasciatus. Interactions among factors also exist.CONCLUSIONS:The factors identified are significant in predicting heartworm prevalence. The factor list is likely incomplete due to data deficiencies. For example, coyotes and feral dogs are known reservoirs of heartworm infection. Unfortunately, no complete data of their populations were available. The regression model considered is currently being explored to forecast future values of heartworm prevalence.

Introduktion: Grundläggande för operationssjukvård är att kunna använda sina händer för att utföra god specialistsjukvård och omvårdnad av patienten. Att drabbas av eksem på händer, handleder, underarmar eller urtikaria till följd av kontaktallergi kan medföra att händernas funktion påverkas. Syfte: Syftet med studien var att undersöka prevalensen av självrapporterade handeksem, urtikaria och möjliga riskfaktorer hos verksamma operationssjuksköterskor och kirurger samt identifiera statistiska samband hos respondenterna. Metod: Studien genomfördes med kvantitativ metod. Data samlades in via elektroniska enkäter. Sammanlagt samlades 150 enkäter in. För statistisk bearbetning och analys användes ett statistiskt dataprogram. Resultat: Förekomst av eksem på händer, handleder eller underarmar vid något tillfälle självrapporterades av 44% av respondenterna, varav 24% upplevt eksem de senaste två åren. Uppkomst av urtikaria på händer, handleder eller underarmar vid något tillfälle självrapporterades av 28,7% respondenter. En högre andel av de som självrapporterat eksem och urtikaria hade också åtminstone en övrig allergi. Konklusion: I studien framkom att nästan var femte personal på operationsavdelningar inom Region Östergötland hade haft handeksem någon gång under de senaste två åren. Denna siffra är i enighet med tidigare forskning, dock är bortfallet i denna undersökningsgrupp för stort för att kunna generalisera resultatet. / Introduction: To be able to use your hands to carry out perioperative care and nursing is fundamental. To suffer from eczema on your hands, wrists, forearms or urticaria as a consequence of contact allergy, can affect the function of the hands. Aim: The aim of the study was to research the prevalence of self-reported hand eczema, urticaria and risk factors among working operating room nurses and surgeons in the region of Östergötland and to identify statistical relations among the respondents. Method: The study was carried out with a quantitative method. Data was gathered through electronic questionnaires. A total of 150 questionnaires were collected. For statistical processing and analyse, a statistic computer program were used. Result: Prevalence of eczema on hands, wrists and forearms at any time were self-reported among 44% of the respondents, and 24% had experienced eczema during the last two years. Experience of urticaria on hands, wrists and forearms at any time were reported by 28,7% respondents. A greater amount of the respondents who self-reported eczema and urticarial also described at least one additional allergy. Conclusion: The study showed that almost every fifth personnel on the surgical ward in the region of Östergötland, had self-reported hand eczema at some time during the two last years. Former research has shown similar data, but the number of non-respondents were too high to be able to generalize the result of this study.

Over the past 20 years there has been a clear shift in Peru’s mortality profile towards non-communicable diseases. As part of this transition, childhood overweight and obesity (O&O) has become a growing public health concern. In order to address this challenge, context-specific information is needed concerning prevalence, associated factors and culturally appropriate interventions. To this end, I conducted a mixed methods study using a socio-ecological framework to investigate childhood overweight and obesity in Peru. This study found a prevalence of 19.2% overweight and 8.6% obesity among children aged seven to eight in a pro-poor cohort in Peru. Factors associated with being overweight in this cohort included: a high socioeconomic status, living in metropolitan Lima, an O&O mother, being male and being an only child or having only one sibling. The quantitative analysis highlighted the prevalence in O&O in this population and revealed a number of relationships explored in more depth via interviews and focus group discussions. The qualitative component of this research explored these associations amongst a sub-sample of children, parents and teachers in three distinct geographical regions in Peru. My qualitative research showed that parents, teachers and children are aware of the health implications of childhood overweight and obesity and that they have a sophisticated understanding of the many factors that influence its aetiology. Participants also had many suggestions for ways to address this issue in their community. This information was complemented by a systematic review and meta-analysis of the evidence of childhood O&O interventions that took place in Latin America published between 1990 and 2011. A combination of diet, physical activity and pharmaceutical strategies have shown modest effect on BMI reduction in O&O children, but more evidence is needed for effective population-level prevention strategies. The findings highlight the need for comprehensive, multi-level interventions. Notable intervention components include: kiosco reform, junk food taxation, creation of recreational space and enhancement of school-based physical activity programmes. To accomplish this, communities need to be mobilised and work together with school administration, municipal and national government.