This study examines the impact of the transition from diploma to degree on the initial education and training of three para-professions in England; chiropody, occupational therapy (OT) and radiography. It focuses on the nature of and reasons for changes to their initial professional education and training and the potential impact of these changes on their professionalisation. The study adopted a multiple method approach; a historical review, which included documentary sources and interviews with key informants, aimed at identifying how and why these three para-professions wanted to achieve all-graduate entry, and the use of case studies to explore the differences between the diploma and degree courses. It is concluded that the achievement of all-graduate entry for these para-professions was an unintended consequence of the policies of the then government. As a result of the achievement of all-graduate entry changes were made to the respective diploma courses of these para-professions. The extent of these changes were related to the level of control and influence that the professional bodies exercised over the diploma courses. All the degree courses shared the following features: the development of autonomous, reflective practitioners who are life-long learners, an emphasis on theory rather than practice, and emphasis on propositional knowledge and the study of research methods. Although the degree courses for these para-professions achieved approval from HEIs it is argued that degree education is a contested concept. It is apparent that the para-professionals believed that the achievement of all-graduate entry would improve their professional status. However, it is evident from the study findings that it served to maintain rather than enhance their social status and market position. Changes to the initial education and training of these para-professionals were the results of the para-professionals having to respond to prevailing social, political and economic circumstances. If they had not taken this action it is suggested that their social status and market position may have been adversely affected.

Orientador: Anamarli Nucci / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T09:41:22Z (GMT). No. of bitstreams: 1 Ramos_MargotGuarieiro_M.pdf: 985606 bytes, checksum: 434d1760ad15f7e85ae84d37db9d1523 (MD5) Previous issue date: 2006 / Resumo: Charcot-Marie-Tooth (CMT) está entre as neuropatias hereditárias mais comuns, com prevalência mundial de 1:2.500 indivíduos. Constitui-se de doenças geneticamente heterogêneas, caracterizadas por atrofia e fraqueza distais dos membros inferiores, podendo estender-se para os membros superiores. Objetivos: elaborar protocolos de exame podiátrico exeqüível em nosso meio. Aplicá-los e utilizar o Escore de Neuropatia para CMT para avaliação das disfunções e sua documentação em uma amostra de pacientes do Ambulatório de Doenças Neuromusculares. Descrever o fenótipo do conjunto dos pacientes estudados. Métodos: realizou-se avaliação clínico neurológica dos pacientes, teste do suporte lateral dos pés e preencheu-se o Escore de Neuropatia para CMT. Dois protocolos de avaliação podiátrica foram elaborados, com os respectivos escores. A parte comum a ambos consistiu na avaliação da impressão plantar e da função dos plantiflexores. A parte diferencial constituiu-se na utilização de goniometria para avaliação do ângulo do tornozelo e do calcanhar em um e utilização de fotos digitalizadas para leitura dos mesmos ângulos em outro. Resultados: participaram 20 pacientes com CMT, entre 7 e 53 anos (média e mediana de 29 anos), 50% de cada sexo, 90% com CMT de herança autossômica dominante. Atrofia peroneal ocorreu em 65% dos pacientes e atrofia dos músculos intrínsecos das mãos em 50%; rigidez da articulação subtalar em 20%; pés cavos em 90%; dedos em martelo em 85%; hipertrofia dos nervos periféricos em 40%. No escore de Neuropatia para CMT encontrou-se pontuação mínima de 9 e máxima de 30. Os protocolos podiátricos resultaram em escores sem diferenças estatísticas significantes. A avaliação do ângulo do tornozelo pelo método da goniometria demonstrou pé eqüino grave em 57,5% dos membros inferiores e pelas fotos digitalizadas em 50%. Setenta e cinco por cento (75%) dos pés tinham inversão do calcanhar. A avaliação da impressão plantar diagnosticou 70% de pés cavos. Houve déficit da flexão plantar em 60% dos pacientes. Conclusões: dois escores podiátricos por métodos diferentes foram elaborados, ambos factíveis e com resultados similares. A aplicação do Escore de Neuropatia para CMT mostrou 1 paciente com incapacidade leve, 10 (50%) com incapacidade moderada e 9 (45%) com incapacidade grave. O fenótipo de atrofia peroneal com pés eqüinos graves e inversão dos calcanhares foi predominante. Palavras-chave: Charcot-Marie-Tooth, avaliação podiátrica, Escore de Neuropatia para CMT / Abstract: Charcot-Marie-Tooth (CMT) is a genetically heterogeneous group of peripheral neuropathies presenting world prevalence of 1:2.500. Atrophy and weakness of the distal lower limbs are common clinical features and these signs may extend to the upper limbs. Objectives: to elaborate reliable protocols for podiatric exams, apply them and make use of the CMT neuropathy score in a sample of outpatients of the Neuromuscular Disorders Unit at Unicamp Hospital. To describe patients phenotypes by using the mentioned tools. Methods: patients were clinically examined and test block was realized. CMT neuropathy score was fulfilled. Two protocols of podiatric evaluation were produced, resulting in two distinct scores. Both protocols had the evaluation of footprint and plantarflexors functions in common and have used different means to assess ankle and heel angles. One of them has used goniometry to assess those angles and the other has made use of digitalized photos to do the same measurement. Results: 20 CMT patients from 7 to 53 years old (being both the average age and the median value 29) were studied - 50% males and 50% females, 90% with dominant autosomal CMT. Peroneal atrophy was observed in 65% of the patients and atrophy of intrinsic hand muscles in 50%; subtalar rigidity in 20%; pes cavus in 90%; claw of toes in 85%; peripheral nerves hypertrophy in 40%. CMT neuropathy score ranged from the minimal score of 9 and the maximal of 30. There were no significant statistical differences in the results of both podiatric protocols. The evaluation of the ankle angle by goniometry showed severe footdrop in 57,5% of the lower limbs and when the digital photos were used - 50%. Seventy-five per cent (75%) of the feet showed heel inversion. Footprint method diagnosed 70% of pes cavus. Plantarflexors failure was seen in 60% of patients. Conclusions: by using different methods, two podiatric scores were elaborated - both reliable and presenting similar results. CMT neuropathy score classified 1 patient with mild disability, 10 (50%) with moderate and 9 (45%) with severe. The predominant phenotype was peroneal atrophy associated with severe footdrop and heel inversion. Key words: Charcot-Marie-Tooth, podiatric evaluation, CMT neuropathy score / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Ziel der Untersuchung war eine umfassende und vergleichbare Datengrundlage über den Einfluss verschiedener hauptsächlich orthopädischer Beschlagsmodifikationen auf die Ausrichtung der Zehenknochen, Druckverteilungsmuster und die individuelle Fußung unter Berücksichtigung unterschiedlicher klinisch relevanter Bodeneigenschaften zu generieren und mit Standardbeschlägen, sowie dem Barhuf zu vergleichen.:1 Einleitung 1 2 Literaturübersicht 3 2.1 Anatomie der distalen Gliedmaße des Pferdes 3 2.1.1 Knochen und Gelenke 3 2.1.2 Sehnen und Bänder 6 2.1.3 Der Huf und seine Segmente 10 2.1.3.1 Definition des Hufs 10 2.1.3.2 Der Hufbeinträger 10 2.1.3.3 Segmente des Hufs 11 2.2 Biomechanische Grundlagen 13 2.2.1 Allgemeine Betrachtungsweisen der Biomechanik 13 2.2.2 Die Statik der distalen Gliedmaße des Pferdes 15 2.2.3 Kinetische Betrachtung der distalen Gliedmaße des Pferdes 17 2.3 Analysemethoden biomechanischer Prozesse der distalen Gliedmaße des Pferdes 19 2.3.1 Statische Analysemethoden 20 2.3.1.1 Röntgen 20 2.3.2 Kinetische Analysemethoden 22 2.3.2.1 Druckmessung 22 2.4 Lahmheit und deren Ursachen im Bereich der distalen Gliedmaße 23 2.4.1 Definition des Begriffes Lahmheit und deren Erkennung 24 2.4.2 Risikofaktoren für die Entstehung von Lahmheit 25 2.5 Orthopädischer Beschlag 27 2.5.1 Erkrankungen der distalen Gliedmaße mit Beschlagsindikation 27 2.5.2 Beschlagsmodifikationen 28 2.5.2.1 Beschlagsmodifikationen der dorsopalmaren Ebene 29 2.5.2.2 Beschlagsmodifikationen der mediolateralen Ebene 34 2.5.3 Der Einfluss unterschiedlicher Bodeneigenschaften auf die Wirkung orthopädischer Beschlagsmodifikationen 36 3 Wissenschaftliche Originalarbeiten 38 3.1 Modifying the Surface of Horseshoes: Effects of Eggbar, Heartbar, Open Toe, and Wide Toe Shoes on the Phalangeal Alignment, Pressure Distribution, and the Footing Pattern 38 3.2 Modifying the Height of Horseshoes: Effects of Wedge Shoes, Studs, and Rocker Shoes on the Phalangeal Alignment, Pressure Distribution, and Hoof-Ground Contact During Motion 51 3.3 Modifying Horseshoes in the Mediolateral Plane: Effects of Side Wedge, Wide Branch, and Unilateral Roller Shoes on the Phalangeal Alignment, Pressure Forces, and the Footing Pattern 63 4 Diskussion 73 4.1 Material und Methoden 73 4.1.1 Röntgenuntersuchung 73 4.1.2 Druckmessung 75 4.1.3 Kombination von Röntgenuntersuchungen und Druckmessungen zur Beurteilung biomechanischer Fragestellungen 78 4.2 Die Veränderungen der Zehenknochenausrichtung nach Applikation von orthopädischen Beschlagsmodifikationen 79 4.3 Die Veränderungen des Druckverteilungsmusters unter Hufeisen und Huf nach Applikation von orthopädischen Beschlagsmodifikationen 81 4.4 Der Effekt von orthopädischen Beschlagsmodifikationen auf die individuelle Fußung 84 4.5 Schlussfolgerungen und Ausblick86 5 Zusammenfassung 88 6 Summary 90 7 Literaturverzeichnis 93 / Aim of this study was to establish comprehensive and comparable data groundwork on the influence of a variety of modified horseshoes on the alignment of the bone of the equine distal limb, pressure distribution and individual footing patterns, while considering different practically relevant flooring materials, in comparison to data acquired with standard horseshoes and barefoot examinations.:1 Einleitung 1 2 Literaturübersicht 3 2.1 Anatomie der distalen Gliedmaße des Pferdes 3 2.1.1 Knochen und Gelenke 3 2.1.2 Sehnen und Bänder 6 2.1.3 Der Huf und seine Segmente 10 2.1.3.1 Definition des Hufs 10 2.1.3.2 Der Hufbeinträger 10 2.1.3.3 Segmente des Hufs 11 2.2 Biomechanische Grundlagen 13 2.2.1 Allgemeine Betrachtungsweisen der Biomechanik 13 2.2.2 Die Statik der distalen Gliedmaße des Pferdes 15 2.2.3 Kinetische Betrachtung der distalen Gliedmaße des Pferdes 17 2.3 Analysemethoden biomechanischer Prozesse der distalen Gliedmaße des Pferdes 19 2.3.1 Statische Analysemethoden 20 2.3.1.1 Röntgen 20 2.3.2 Kinetische Analysemethoden 22 2.3.2.1 Druckmessung 22 2.4 Lahmheit und deren Ursachen im Bereich der distalen Gliedmaße 23 2.4.1 Definition des Begriffes Lahmheit und deren Erkennung 24 2.4.2 Risikofaktoren für die Entstehung von Lahmheit 25 2.5 Orthopädischer Beschlag 27 2.5.1 Erkrankungen der distalen Gliedmaße mit Beschlagsindikation 27 2.5.2 Beschlagsmodifikationen 28 2.5.2.1 Beschlagsmodifikationen der dorsopalmaren Ebene 29 2.5.2.2 Beschlagsmodifikationen der mediolateralen Ebene 34 2.5.3 Der Einfluss unterschiedlicher Bodeneigenschaften auf die Wirkung orthopädischer Beschlagsmodifikationen 36 3 Wissenschaftliche Originalarbeiten 38 3.1 Modifying the Surface of Horseshoes: Effects of Eggbar, Heartbar, Open Toe, and Wide Toe Shoes on the Phalangeal Alignment, Pressure Distribution, and the Footing Pattern 38 3.2 Modifying the Height of Horseshoes: Effects of Wedge Shoes, Studs, and Rocker Shoes on the Phalangeal Alignment, Pressure Distribution, and Hoof-Ground Contact During Motion 51 3.3 Modifying Horseshoes in the Mediolateral Plane: Effects of Side Wedge, Wide Branch, and Unilateral Roller Shoes on the Phalangeal Alignment, Pressure Forces, and the Footing Pattern 63 4 Diskussion 73 4.1 Material und Methoden 73 4.1.1 Röntgenuntersuchung 73 4.1.2 Druckmessung 75 4.1.3 Kombination von Röntgenuntersuchungen und Druckmessungen zur Beurteilung biomechanischer Fragestellungen 78 4.2 Die Veränderungen der Zehenknochenausrichtung nach Applikation von orthopädischen Beschlagsmodifikationen 79 4.3 Die Veränderungen des Druckverteilungsmusters unter Hufeisen und Huf nach Applikation von orthopädischen Beschlagsmodifikationen 81 4.4 Der Effekt von orthopädischen Beschlagsmodifikationen auf die individuelle Fußung 84 4.5 Schlussfolgerungen und Ausblick86 5 Zusammenfassung 88 6 Summary 90 7 Literaturverzeichnis 93

Background: Government policy has placed greater emphasis upon health professional students gaining practical experience in real-world environments. Given the fairly new inception of the role of clinical educator in podiatry there is a paucity of research in the area of practice placement in podiatry. Research aims: Within an action research framework, the first phase focused upon exploring the capacity of clinical educators to engage with the role of mentoring, alongside the factors that might impact upon that capacity. The second phase of the project investigated the impact of a teaching tool within the placement area when utilised by clinical educators and students. Methods: The pilot study utilised established questionnaire development methods to create a survey and scale to measure clinical educators’ capacity to engage with the role. The second phase of the project used a range of qualitative data collection methods analysed using framework analysis to analyse the utility of the teaching and learning tool. Findings: Phase I resulted in a 70-item scale measuring the capacity of clinical educators to engage with the role of clinical educator and the identification of four independent variables predictive of a significant proportion of the variability of the dependent variable, capacity to engage with clinical education. Phase II confirmed the utility of the teaching and learning tool to support clinical educators and students during the placement period. An inductive placement model, explanatory of the super-complexity of the environment where the clinical educator endeavours to monitor, modify and manage the placement scope, was developed. Conclusions: In an area where research is currently scant, this study contributed to practice-based education in podiatry and to current understanding of how clinical educators undertake this complex and responsible role. This is an important area for research given the influence clinical educators have to shape and guide the next generation of podiatry professionals.

Conception et évaluation d’un modèle biomécanique, éléments finis, patient-spécifique, du pied humainApplications en podologie, orthopédie et diabétologieLe pied est une des structures les plus complexes du corps humain. Avec 28 os, 33 articulations et une centaine de structures ligamentaires, cette entité poly articulée est le résultat d’une hyperspécialisation ayant contribué à faire de l’homme l’unique primate totalement bipède. Quelque soit le relief, quelque soit le mouvement en cours, le pied transmet au tibia le bon vecteur force afin de finaliser le geste de la manière la plus précise et économe en énergie possible dans l’objectif de préparer l’action des segments sus jacents. Ainsi, en cas de lésion d’une des structures, l’ensemble du complexe pied doit pouvoir s’adapter, si ce n’est pas le cas, les tissus mous, les articulations ou les os seront fragilisés et verront leur fonction propre au sein de ce complexe altérée.Prédire l’adaptation du pied à une modification structurelle, tissulaire, neurologique ou fonctionnelle est un enjeu important dans l’estimation du risque lésionnel.Afin d’initier une réponse à ces problématiques, nous avons décidé au cours de cette thèse de modéliser le pied humain avec des outils mathématiques de simulation biomécanique. Dans un premier temps, un modèle tridimensionnel musculo-squelettique du pied a été reconstruit à partir d’imagerie scanner. Le pied polyarticulé en multicorps rigides obtenu possède des articulations uniquement contraintes par les ligaments et contacts osseux. Les muscles ont été implémentés afin de piloter le modèle en dynamique directe. Enfin, les tissus mous comme les volumes musculaires, le gras et la peau ont été maillés en éléments finis. L’utilisation d’un environnement de programmation multi-physique open source (Artisynth) a permis de coupler la modélisation musculo-squelettique et éléments finis.• L’adaptation du pied au sol en orthostatisme a été évaluée par comparaison des cartographies de pression d’une mise en charge simulée avec la mise en charge réelle du sujet.• Le contrôle moteur du pied en chaine ouverte par l’activation des muscles extrinsèques a été évalué en comparant la cinématique du modèle biomécanique pilotée par électromyographie avec la cinématique capturée en laboratoire sur un mouvement d’abduction – adduction.• Nous avons ensuite cherché à comprendre comment une arthrodèse de cheville modifie la cinématique du pied à la contraction musculaire, l’objectif étant d’aider au réglage chirurgical du geste.• Enfin nous avons utilisé les dernières avancées sur la physiologie de la plaie de pression afin de prédire le risque d’ulcération sur un pied neuroarthropatique diabétique par simulation numérique.Le modèle ainsi que les routines de simulations mis en place nous permettent d’avoir un des modèles les plus aboutis du pied humain utilisant aussi bien des données physiques externes comme les données baropodométriques, les données d’analyse quantifiée du mouvement ou encore les données électromyographiques. Ce modèle permettra par l’intermédiaire d’outils de mesh-matching d’obtenir des modèles patients spécifiques. Les domaines d’applications porteront sur l’aide au geste chirurgical, la prévention des risques d’ulcération, l’analyse avancée des relations entre le pied et le membre inférieur, mais aussi l’aide à la conception de prothèse en orthopédie classique et en mécatronique. / Biomechanical modeling of the human foot. Application to the healthy and pathological subject.The foot is one of the more complex structures of the human body. With 28 bones, 33 joints and a hundred ligamentous structures, this articulated entity is the result of a hyper specialization that makes humans the only obligate bipedal primates. Whatever the terrain, whatever the current movement, the foot transmits to the tibia the right force vector to finalize the gesture in the most precise and efficient manner and prepares the action of the lower limb. Thus, in case of injury to one of the structures, the whole foot complex must adapt if it is not the case, soft tissues, joints or bones are fragile and will have their own function within this complex altered .Predicting the foot’s adaptation of a structural, tissue, neurological or functional modification is an important issue in estimating the risk lesion on locomotion, in the design of therapeutic footwear and orthotics of the degenerative foot, but also in the future of this complex in situations where the boundary conditions change like working in microgravity or foot exoskeleton coupling.To initiate a response to these problems, we decided during this thesis to model the human foot with mathematical tools for biomechanical simulation. Initially, a musculoskeletal three-dimensional model of the foot was reconstructed from computed tomography. The multi-articulated foot joints constraints obtained by ligaments and bone contact. The muscles have been implemented to control the model in direct dynamic. Finally, the soft tissues such as muscle volume, fat and skin were meshed into finite elements. Using a multi-physics open source programming environment (Artisynth) allowed to couple musculoskeletal modeling and finite elements.• Adapting the foot on the ground in upright posture was evaluated by comparing the pressure maps at a simulated load setting with the actual loading pressure map of the subject.• The motor control of foot in opened chain by activation of the extrinsic muscles was assessed by comparing the kinematics of the biomechanical model piloted by electromyography with kinematics captured in the laboratory on a movement of abduction - adduction.• We then sought to understand how an ankle arthrodesis alter the kinematics of the foot muscle contraction, with the aim of helping the surgical setting gesture.• Finally, we used the latest advances in the physiology of a pressure ulcer to predict the risk of ulceration on diabetic foot with Charcot neuro arthropathy by numerical simulation.The model and simulation routines in place allow us to have one of the most successful models of the human foot using both external physical data like pedobarographic data, motion analysis data or electromyography data. This model will allow through mesh-matching tool to obtain specific patient models. The fields of applications will focus on assisted surgery, prevention of ulceration, advanced analysis of relations between the foot and the leg, but also will help the prosthesis design in orthopedic and mechatronics.

Made available in DSpace on 2016-04-28T20:56:55Z (GMT). No. of bitstreams: 1 Danielle Girotti Callas.pdf: 1417513 bytes, checksum: 174222034eed79bc40020de0f8a6034b (MD5) Previous issue date: 2015-09-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Considerando a lacuna na bibliografia existente sobre a educação profissional como campo de estudo, esta pesquisa pretende investigar a constituição da profissionalidade e os saberes docentes no eixo tecnológico Ambiente, Saúde e Segurança áreas de Saúde e Bem-estar. Foi realizada uma pesquisa qualitativa com dez docentes, atuantes nos cursos: Técnico em Enfermagem, Técnico em Estética, Técnico em Massoterapia, Técnico em Podologia e Técnico em Segurança do Trabalho, da unidade Jundiaí do Serviço Nacional de Aprendizagem Comercial SENAC (São Paulo), em duas etapas distintas: primeiramente, por meio de entrevistas individuais e, posteriormente, por meio de dois encontros coletivos psicodramáticos, com a presença de seis dos dez participantes, em cada um dos encontros. O quadro teórico está fundamentado nas produções de: Placco e Souza (2006), Imbernón (2011), Tardif (2002), Freire (1983, 2002), Barato (2003, 2004), Shulman (1987) e Moreno (1975, 2008). Os dados nos possibilitam analisar os processos de socialização primária e profissional dos docentes, identificando a constituição da profissionalidade docente como o desenvolvimento do exercício docente, in loco e na relação aluno-docente, de modo processual, gradual e infindável, baseada nas experiências pessoais, escolares e profissionais dos docentes. Outro resultado significativo, na pesquisa, é a relevância da interdependência dos saberes docentes, especialmente os profissionais-experienciais, os pedagógicos, os pessoais e os do profetizar, que se imbricam no desenvolvimento da profissionalidade. Embora não se reconhecendo como profissionais docentes, as falas dos pesquisados nos permitem afirmar que há um desenvolvimento dessa profissionalidade e dos saberes docentes pedagógicos, com o compromisso e a intencionalidade explícitos com a aprendizagem dos alunos e da docência, com o exercício profissional Considering the gap in the literature on vocational education as a field of study, this research aims to investigate the construction of professionality and teaching knowledge in the technical domain of Environment, Health and Safety - fields of Health and Wellness. A qualitative survey was conducted with 10 teachers of the following courses: Nursing Technician, Esthetics Technician, Massage Therapy Technician, Podiatry Technician, and Occupational Safety Technician from the Jundiaí unit of Serviço Nacional de Aprendizagem Comercial (Senac São Paulo), in two distinct stages first, through individual interviews and later, through two group psychodramatic encounters, with six participants per encounter. The theoretical framework is based on the works of: Placco e Souza (2006), Imbernón (2011), Tardif (2002), Freire (1983, 2002), Barato (2003, 2004), Shulman (1987), and Moreno (1975, 2008). The data allowed us to analyze the teachers primary and professional socialization processes and identify the construction of teaching professionality as the development of the teaching practice, both on site and in the student-teacher relation, in a gradual, never-ending process, based on the teachers personal, school, and professional experiences. Another significant result of the research is the relevance of the interdependence of teaching knowledge - especially professional/experiential, educational, personal, and prophetic skills, which interweave in the development of professionality. Although the respondents do not identify themselves as teaching professionals, their reports allow us to state that the educational professionality and teaching knowledge are developed with an explicit commitment and intentionality to the students learning and education, with professional practice and with the enhancement of their educational skills. The perception of the possibility of social change, through education, also strengthens and deepens the respondents educational vision / Considerando a lacuna na bibliografia existente sobre a educação profissional como campo de estudo, esta pesquisa pretende investigar a constituição da profissionalidade e os saberes docentes no eixo tecnológico Ambiente, Saúde e Segurança áreas de Saúde e Bem-estar. Foi realizada uma pesquisa qualitativa com dez docentes, atuantes nos cursos: Técnico em Enfermagem, Técnico em Estética, Técnico em Massoterapia, Técnico em Podologia e Técnico em Segurança do Trabalho, da unidade Jundiaí do Serviço Nacional de Aprendizagem Comercial SENAC (São Paulo), em duas etapas distintas: primeiramente, por meio de entrevistas individuais e, posteriormente, por meio de dois encontros coletivos psicodramáticos, com a presença de seis dos dez participantes, em cada um dos encontros. O quadro teórico está fundamentado nas produções de: Placco e Souza (2006), Imbernón (2011), Tardif (2002), Freire (1983, 2002), Barato (2003, 2004), Shulman (1987) e Moreno (1975, 2008). Os dados nos possibilitam analisar os processos de socialização primária e profissional dos docentes, identificando a constituição da profissionalidade docente como o desenvolvimento do exercício docente, in loco e na relação aluno-docente, de modo processual, gradual e infindável, baseada nas experiências pessoais, escolares e profissionais dos docentes. Outro resultado significativo, na pesquisa, é a relevância da interdependência dos saberes docentes, especialmente os profissionais-experienciais, os pedagógicos, os pessoais e os do profetizar, que se imbricam no desenvolvimento da profissionalidade. Embora não se reconhecendo como profissionais docentes, as falas dos pesquisados nos permitem afirmar que há um desenvolvimento dessa profissionalidade e dos saberes docentes pedagógicos, com o compromisso e a intencionalidade explícitos com a aprendizagem dos alunos e da docência, com o exercício profissional e com o aperfeiçoamento de suas práticas pedagógicas. A percepção de possibilidade de transformação social, por meio da docência, também reforça e aprofunda a visão educacional dos pesquisados

Dans le contexte de l’augmentation de l’espérance de vie et de l’obésité ainsi qu’avec les changements environnementaux et culturels, la prévalence du diabète est à la hausse ainsi que ses complications inhérentes tels l’ulcération plantaire diabétique (UPD), l’amputation au membre inférieur (AMI) et les risques d’infection associés. Une façon efficiente de gérer ces complications est la prise en charge en équipe multidisciplinaire (ÉMD) et les soins de pieds intégrés en incluant plusieurs professionnels, dont le podiatre. Dans l’optique d’améliorer les résultats pour la santé de cette population, cette thèse a pour objectifs de développer de nouvelles connaissances pour la compréhension du rôle du podiatre et de ses interventions, réalisées en contexte seul ou en ÉMD, dans la prise en charge de l’UPD et de l’AMI ainsi que d’explorer spécifiquement une nouvelle possibilité de matériel pour la prévention de la colonisation bactérienne des UPDs principalement associée à Staphylococcus aureus. Les travaux de recherche s’insèrent dans une approche intégrative faisant appel aux domaines théorique, pratique et expérimental utilisant différentes approches méthodologiques telles la revue systématique avec méta-analyse, l’étude cohorte comparative et l’étude expérimentale in vitro. Cela a conduit à trois articles scientifiques; les deux premiers traitent spécifiquement des effets des interventions du podiatre en approche d’ÉMD sur les résultats pour la santé (données sur l’UPD, l’AMI et l’utilisation des ressources dans le système de la santé) et le dernier concerne l’effet antibactérien d’un produit potentiel pour la gestion locale des infections des UPDs. Une analyse intégrée des travaux de recherche a permis une perspective des résultats à l’aide du cadre de référence pour la prévention et gestion des maladies chroniques et du cadre d’analyse pour les résultats pour la santé, en relation avec les connaissances actuelles sur la problématique. Cette thèse a contribué à l’avancement des connaissances pour la gestion des UPDs en ÉMD incluant le podiatre et a démontré que cette pratique clinique peut avoir des répercussions sur l’UPD et l’AMI. Elle démontre également l’importance d’optimiser la prise en charge ii en ÉMD incluant le podiatre. Elle a proposé l’aspect novateur d’un matériel biomédical, la cellulose phosphorylée avec l’argent ionisé, ayant le potentiel d’être impliqué dans la prise en charge de l’infection locale de l’UPD puisque les résultats préliminaires sur ses capacités antibactériennes, dans les conditions de laboratoire, ont un effet comparable à des produits de même nature actuellement proposés par l’industrie. Somme toute, que ce soit une UPD qui résulte en une AMI ou non, avec ou sans infection, ce qui importe concrètement, c’est d’en diminuer le nombre et de contribuer à la qualité de vie de ces personnes atteinte de diabète. Les professionnels de la santé, dont les podiatres, doivent donc agir selon les meilleurs pratiques en ÉMD et les décideurs doivent mobiliser les ressources nécessaires. / In the context of increasing life expectancy and obesity rates as well as environmental and cultural changes, the prevalence of diabetes is on the rise, as are its inherent complications such as diabetic foot ulceration (DFU), lower extremity amputation (LEA) and higher infection risks. An efficient way to manage these complications is a multidisciplinary team (MDT) approach along with integrated foot care involving several professionals, including the podiatrist. In order to improve health-related outcomes for these persons, the objectives of this thesis are, first, to develop new knowledge to further understand the role of the podiatrist and his interventions, performed alone or in MDT context, in the management of DFU and LEA, and second, to specifically explore the possibility of new material for the prevention of bacterial colonization of UPDs, mainly associated with Staphylococcus aureus. These research projects adopt an integrated approach involving theoretical, practical and experimental domains and uses different methodological approaches such as systematic review with meta-analysis, comparative cohort study and in vitro experimental study. It has led to three scientific articles; the first two specifically address the effects of podiatrist interventions in the MDT approach on health-related outcomes (data on DFUs, LEAs and the usage of healthcare resources) and the last concerns the antibacterial efficacy of a potential material for local infection management. An integrated analysis of the research projects provides perspective on the results through the use of the framework for prevention and management of chronic diseases and the analytical framework for health-related outcomes, in relation with the latest scientific evidences on this issue. This thesis contributes to the advancement of knowledge for the management of DFUs in MDT approach including podiatrists and demonstrates that this type of clinical management can have significant impacts on LEAs, including decreasing rates of major and total LEAs and improvement of healing time and rate of DFUs. It also establishes the importance of optimizing MDT with the podiatrist. Furthermore, it puts forward the potential of an innovative biomedical material, phosphate cellulose fibers with ionic silver, to be involved in the management of local DFU infection, due to its antibacterial properties which, under laboratory conditions, have an effect comparable to similar products currently offered by the industry. In sum, what truly matters is that whether or not a DFU, with or without infection, results in LEA, the aim is to reduce the number of its occurrences and to contribute to the quality of life of the people it affects. Health professionals including podiatrists must therefore act according to best practices in MDT approach and decision-makers must mobilize the necessary resources.

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