Multiple myeloma (MM) is an incurable progressive hematologic malignancy with heterogeneous evolution. It is a disease characterized by abnormal clonal proliferation of plasma cells in the bone marrow producing monoclonal immunoglobulins and causing a number of organ dysfunctions. Most patients relapse after treatment. Therefore, the use of methods of analysis of serum and urinary samples in order to detect as early as possible the presence of monoclonal immunoglobulins, before the occurrence of relapses, may aid in the treatment of patients with MM, improving its quality and prolonging survival. In this study we compared the effectiveness of the techniques of immunofixation (IF) and electrophoresis (EP) in the detection of MM relapses. For this, 52 patients under treatment in the University Hospital of Santa Maria (HUSM) were monitored, being detected the relapse of the disease in nine of these patients. A retrospective analysis of serum proteins of the nine patients, between January 2012 and July 2014, showed that IF was more effective than EP in early detection of relapse, regardless of the present class of immunoglobulins. The precocity of IF in relation to EP in detecting MM relapses in the nine patients studied, ranged from 2.0 to 18.8 months, with a mean of 6.6 months. Thus, we suggest the implementation of IF in the Clinical Analysis Laboratory (CAL) of HUSM to help onco-hematology physicians in the diagnosis and supportive care for patients with MM. / O mieloma múltiplo (MM) é uma neoplasia hematológica progressiva, com evolução heterogênea e ainda incurável. É uma doença caracterizada pela proliferação clonal anormal de plasmócitos na medula óssea produzindo imunoglobulinas monoclonais e ocasionando uma série de disfunções orgânicas. A maioria dos pacientes recidivam após o tratamento. Portanto, a utilização de métodos de análise de amostras séricas e urinárias, que permitam detectar o mais precocemente possível a presença de imunoglobulinas monoclonais, antes da ocorrência das recidivas, pode auxiliar no tratamento de pacientes com MM, melhorando a qualidade e ampliando o tempo de sobrevida dos mesmos. No presente estudo foram comparadas as técnicas de imunofixação (IF) e eletroforese (EF) quanto a sua eficácia na detecção das recidivas do MM. Para isso, foram monitorados 52 pacientes em tratamento junto ao Hospital Universitário de Santa Maria (HUSM), sendo detectada a recidiva da doença em nove destes pacientes. A análise retrospectiva de proteínas séricas dos nove pacientes, no período entre janeiro de 2012 e julho de 2014, mostrou que a IF foi mais eficaz do que a EF em detectar precocemente as recidivas, independentemente da classe de imunoglobulinas presente. Nos nove pacientes recidivados, a precocidade da IF, em relação à EF, na detecção das recidivas do MM variou de 2,0 a 18,8 meses, com um tempo médio de 6,6 meses.

Plasmodium vivax é a espécie de malária humana de maior distribuição geográfica, com 35 milhões de casos por ano. No Brasil, é a espécie mais prevalente, sendo responsável por cerca de 70% dos casos de malária. Diferentemente do P. falciparum, o P. vivax apresenta hipnozoítas, formas que se mantêm em estágio dormente no fígado e que, após um período de tempo variável, por mecanismos ainda desconhecidos, causam novo ataque malárico denominado recaída. Para contribuir para um melhor conhecimento acerca das recaídas causadas por P. vivax, neste trabalho foram analisadas amostras pareadas referentes ao ataque primário e à recaída de 10 pacientes que se infectaram na Amazônia Brasileira. Através da amplificação de um segmento polimórfico do gene que codifica a Proteína de Superfície do Merozoíta 1 (PvMSP1), foi encontrado um índice de 40% de infecções mistas, presentes inclusive durante a recaída, indicando que a ativação de hipnozoítas não é clonal. Em análise mais detalhada deste segmento polimórfico, utilizando técnicas de clonagem e sequenciamento, foi possível verificar que a população de parasitas obtida durante o ataque primário é idêntica àquela que surge nas recaídas. O estudo da resposta IgG específica naturalmente adquirida contra a região C-terminal da PvMSP1, a mais imunogênica da molécula, demonstrou, durante a recaída, um aumento nos títulos acompanhado por uma maturação na afinidade destes anticorpos além de um predomínio de IgG1. / Plasmodium vivax is the most widely distributed human malarial parasite causing an estimated 35 million cases annually. In some parts of the world, including Brazil where it reaches almost 70% of malaria cases, this is the most prevalent species. Unlike P. falciparum, P. vivax has hypnozoites, hepatocyte dormant stages that cause clinical and parasitological relapses. Unfortunately, the molecular basis of relapses remain poorly understood. This work compared paired primary attack and relapse samples obtained from 10 infected patients from the brazilian Amazon Region using a polymorphic segment of the gene encoding the Merozoite Surface Protein 1 (PvMSP1) as a genetic marker. PCR, Southern blot and DNA sequence analysis demonstrated that the parasite population from the primary attack is identical to the one arising during relapses and that the activation of hypnozoites is not clonal; moreover, a large percentage (40%) of mixed infections, were detected. Studies on the naturally acquired human specific IgG response of these patients against the C-terminal region of the PvMSP1 molecule, the most immunogenic region, demonstrated an increase in the titers, affinity maturation and a predominance of the IgG1 subclass during the relapse.

Plasmodium vivax é a espécie de malária humana de maior distribuição geográfica, com 35 milhões de casos por ano. No Brasil, é a espécie mais prevalente, sendo responsável por cerca de 70% dos casos de malária. Diferentemente do P. falciparum, o P. vivax apresenta hipnozoítas, formas que se mantêm em estágio dormente no fígado e que, após um período de tempo variável, por mecanismos ainda desconhecidos, causam novo ataque malárico denominado recaída. Para contribuir para um melhor conhecimento acerca das recaídas causadas por P. vivax, neste trabalho foram analisadas amostras pareadas referentes ao ataque primário e à recaída de 10 pacientes que se infectaram na Amazônia Brasileira. Através da amplificação de um segmento polimórfico do gene que codifica a Proteína de Superfície do Merozoíta 1 (PvMSP1), foi encontrado um índice de 40% de infecções mistas, presentes inclusive durante a recaída, indicando que a ativação de hipnozoítas não é clonal. Em análise mais detalhada deste segmento polimórfico, utilizando técnicas de clonagem e sequenciamento, foi possível verificar que a população de parasitas obtida durante o ataque primário é idêntica àquela que surge nas recaídas. O estudo da resposta IgG específica naturalmente adquirida contra a região C-terminal da PvMSP1, a mais imunogênica da molécula, demonstrou, durante a recaída, um aumento nos títulos acompanhado por uma maturação na afinidade destes anticorpos além de um predomínio de IgG1. / Plasmodium vivax is the most widely distributed human malarial parasite causing an estimated 35 million cases annually. In some parts of the world, including Brazil where it reaches almost 70% of malaria cases, this is the most prevalent species. Unlike P. falciparum, P. vivax has hypnozoites, hepatocyte dormant stages that cause clinical and parasitological relapses. Unfortunately, the molecular basis of relapses remain poorly understood. This work compared paired primary attack and relapse samples obtained from 10 infected patients from the brazilian Amazon Region using a polymorphic segment of the gene encoding the Merozoite Surface Protein 1 (PvMSP1) as a genetic marker. PCR, Southern blot and DNA sequence analysis demonstrated that the parasite population from the primary attack is identical to the one arising during relapses and that the activation of hypnozoites is not clonal; moreover, a large percentage (40%) of mixed infections, were detected. Studies on the naturally acquired human specific IgG response of these patients against the C-terminal region of the PvMSP1 molecule, the most immunogenic region, demonstrated an increase in the titers, affinity maturation and a predominance of the IgG1 subclass during the relapse.

The area of the care of a Clubfoot (pes equinovarus congenitus PEC Clubfoot) Diagnosed Child is the topic of this Paper. Currently, the PEC is the second most frequent congenital deformity within orthopaedics. The theoretical part of this Paper deals with a description of the PEC, its diagnostics, cure and a possible risk of relapse. A sub-chapter of the Paper introduces the Achilleus association, which is the only body in the Czech Republic bringing together parents of PEC diagnosed children. The Paper also focuses on nurses and their role(s) in the nursing care of PEC diagnosed children. The empirical part of this Paper covers a research with the following directions: - parental knowledge of PEC diagnosed children care at home; - specifications of the nursing care of PEC diagnosed children; - nurses and their educational role (if fulfilled) in the nursing care of PEC diagnosed children. The research presented in the empirical part of the Paper was based on a semi-structuralized interview and open coding technique. The interviews were conducted with parents of PEC diagnosed children and care providing nurses who also play an important educational role in this matter. The benefit of the Paper, based on collected research data, is to provide a complete overview on the problems relating to the care of PEC diagnosed children. The outcome is supposed to be also presented to appropriate expert public for further consideration. The research outcome presents that the level of parental knowledge of the PEC diagnosed children care at home is very high and that parents provide their children with a quality care. The Paper describes that specifications of the nursing care of PEC diagnosed children are mainly evident in appropriate and consistent education of parents as the homecare is usually a long-term process. Finally, the Paper also shows that nurses in their educational role in the nursing care of PEC diagnosed children do not fulfil their tasks to such an extent that is expected.

No description available.

Cette thèse de doctorat explore les trajectoires de deux types de déviance, celle de joueurs excessifs (N=100) et celle de délinquants (N=172). Le questionnaire utilisé dans chacun des cas possède un important volet destiné à recueillir des renseignements de manière chronologique par différentes thématiques; la méthode des calendriers d’histoire de vie. L’intérêt d’une analyse de calendrier est qu’elle permet de tenir compte des changements ponctuels de comportement et d’évaluer les effets à court terme de la prise en charge des sujets au cours de leur carrière déviante. La démonstration se base sur trois dimensions des trajectoires : l’intensité de l’engagement, les épisodes d’abstinence volontaire et les épisodes de rechutes. Le résultat majeur de ma thèse montre que les circonstances de vie (facteurs dynamiques) rendent bien compte des dimensions des trajectoires alors que les caractéristiques des individus (facteurs fixes ou statiques) ont souvent très peu de force explicative. Une analyse attentive des effets indirects montre la pertinence de continuer à s’intéresser à ces facteurs. En effet, l’impact des caractéristiques dynamiques est souvent conditionnel à certaines variables statiques. Aucune étude, tant américaine que canadienne, ne s’est penchée sur la dynamique des trajectoires de joueurs excessifs. Le troisième chapitre examine les fluctuations mensuelles des sommes englouties dans les jeux de hasard et d’argent. On s’efforce de comprendre ce qui incite les joueurs à dépenser davantage certains mois et moins à d’autres. Une attention particulière est aussi consacrée aux mois où les joueurs cessent de participer aux jeux de hasard et d’argent et aux facteurs qui favorisent cette abstinence provisoire. Le quatrième chapitre se concentre sur les trajectoires de délinquants. Dans ce cas-ci, la performance criminelle, les revenus illégaux mensuels, mesure l’intensité de l’engagement criminel. On s’intéresse dans ce chapitre aux conditions régissant à la fois les épisodes de réussite criminelle et les épisodes concomitants de désistement temporaire. Les mesures « officielles » de récidive (nouvelle condamnation, nouvelle entrée en thérapie) présentent un problème de chiffre noir (les rechutes effectives sont plus nombreuses que les rechutes connues des autorités officielles). L’intérêt du chapitre cinq est de miser sur une analyse autorévélée des rechutes et du « moment » où ces rechutes se produisent. Le deuxième objectif de cette étude est de comparer les épisodes de rechutes dans ces deux trajectoires de déviance. La logique de ce chapitre suit celles des précédents, on s’intéresse à la dynamique qui entoure ces épisodes, on se demande si elle est similaire au sein des deux trajectoires déviantes. / This thesis explores the trajectories of two types of deviance, that of excessive gamblers (N = 100) and of persistent offenders (N = 172). The questionnaire used in each case has an important component to collect information chronologically on different themes; the life history calendar method. The interest of a calendar analysis is that it takes into account the specific changes in behaviour and evaluates the short-term effects during their deviant careers. The demonstration is based on the three dimensions of the trajectories: the intensity of the commitment, the episodes of voluntary abstinence and relapse episodes. The major result of my thesis demonstrates that the circumstances of life (dynamic factors) have a greater influence on the dimensions of the trajectories, whereas the individual characteristics (fixed or static factors) often have very little explanatory power. A careful analysis of the indirect effects illustrates the relevance of maintaining an interest in these factors. Indeed, the impact of dynamic characteristics is often conditional on certain static variables. No study, either American or Canadian, has examined the dynamic trajectories of excessive gamblers. The second chapter examines the monthly fluctuations of amounts spent on gambling and games of chance. We attempted to understand what motivates gamblers to spend more certain months and less at others. Particular attention is also devoted to the months when the players cease to gamble, and the factors that promote this provisional abstinence. The third chapter focuses on the trajectories of persistent offenders. Here, the criminal performance (illegal monthly income), measure the intensity of the criminal commitment. In this chapter, we are interested in the conditions that favour both the success of criminal episodes and episodes of temporary desistance. The “official” measures of recidivism (new conviction, new admission into therapy) present a problem when it comes to unrecorded events; the actual relapses outnumber the relapse known by the official authorities. The interest of chapter four is to focus on an auto-revealed analysis of relapse and of the “moment in time" when these relapses occur. The second objective of this study is to compare the relapse episodes between the two trajectories. The logic of this chapter follows that of the preceding ones, we are interested in the dynamics surrounding these episodes and we wish to see if it is similar in both deviant trajectories.

La maladie de Crohn (MC) a une incidence élevée dans la population pédiatrique en Amérique du Nord et cette incidence est en augmentation. L’évolution naturelle de la MC est mal comprise. L'évolution du délai à la rémission au fil des ans et les causes influençant le délai à la rémission sont très limitées dans la littérature. Peu de facteurs de risque sont identifiés dans la littérature pour prédire les rechutes de la maladie chez les enfants. Le premier objectif de cette étude était de décrire les variations du phénotype clinique, des caractéristiques endoscopiques, histologiques et de laboratoire de la MC pédiatrique au cours de la dernière décennie et de décrire les variations saisonnières de la présentation de la maladie au moment du diagnostic. Le deuxième objectif était de décrire le délai à la rémission chez les enfants atteints de MC ainsi que son évolution au cours de la dernière décennie et de déterminer les facteurs associés au délai à la rémission. Le troisième objectif de l’étude était de décrire le taux de rechutes chez les enfants atteints de la MC, son évolution au cours de la dernière décennie et de déterminer les facteurs de risque associés à la rechute de la maladie. Les patients éligibles étaient âgés de 4 à 18 ans et diagnostiqués entre 2009 et 2019. Toutes les caractéristiques cliniques, endoscopiques, histologiques et de laboratoire des patients, ainsi que leurs traitements, ont été recueillis à partir de leurs dossiers médicaux. Des analyses de survie et des modèles de régression linéaire ont été utilisés pour évaluer l'impact de ces facteurs sur le délai à la rémission et des analyses de survie et des modèles de régression de Cox ont été utilisés pour évaluer l'impact de ces facteurs sur le risque de rechute. 654 patients ont été inclus dans cette étude de cohorte rétrospective. Le nombre de nouveaux diagnostics annuels de MC a augmenté au fil des ans et les patients diagnostiqués entre 2015 et 2019 avaient un âge au diagnostic plus bas (OR 2.53, IC à 95% [1.29; 4.98]), plus de maladies périanales (OR: 2.30, IC à 95% [ 1.52; 3.48]), plus de granulomes (OR: 1.61, IC à 95% [1.17; 2.22]), mais moins d’éosinophiles (OR: 0.35, IC à 95% [0.25; 0.48]) et moins d’infiltrat lympho-plasmocytaire chronique (OR: 0.56, IC à 95% [0.36; 0.86]) comparé aux patients diagnostiqués entre 2009 et 2014. Il y avait moins de diagnostics de MC chez les enfants en hiver. Les patients diagnostiqués à l'automne avaient une activité de la maladie plus faible (score PCDAI), moins de retard de croissance et des maladies digestives moins diffuses. Les MC diagnostiquées au printemps et à l’été avaient des taux d'hémoglobine plus faibles et des taux de vitesse de sédimentation plus élevés associées à plus d’atteintes articulaires et plus d'érythème noueux. La localisation colique était significativement plus fréquente l’été et l’automne. Il n'y a pas eu de changement dans le délai à la rémission au cours de la dernière décennie. Le sexe féminin chez les adolescents (coefficient de regression bêta ajusté (aβ) = 31.8 jours, p=0.02), l'atteinte du tube digestif supérieur (aβ= 46.4 jours, p=0.04), la maladie périanale (aβ= 32.2 jours, p=0.04), les signes d'inflammation active sur les biopsies (aβ= 46.7 jours, p=0.01) et l’exposition aux 5-ASA oraux lors de la phase d'induction (aβ= 56.6 jours, p=0.002) étaient associés à un délai à la rémission plus long. À l’inverse, l'utilisation d'antibiotiques (aβ= -29.3 jours, p=0.04), l’augmentation des éosinophiles sur les biopsies (aβ= -29.6 jours, p=0.008) et l'utilisation de la nutrition entérale exclusive comme traitement d'induction avec les anti TNF-alpha (aβ= -36.8 jours, p=0.04) étaient associés à un délai à la rémission plus court. Il y a eu une diminution du taux de rechute au cours de la dernière décennie : 69.59% chez les patients diagnostiqués entre 2009 et 2014 et 47.76% chez les patients diagnostiqués entre 2015 et 2019 (p<0.0001). Le sexe féminin (hazard ratio ajusté (aHR) = 1.51, p=0.0009), les scores PCDAI (aHR= 1.02, p=0.04) et SES-CD élevés (aHR= 1.03, p=0.03) au diagnostic, l'atteinte du tube digestif supérieur (aHR= 1.59, p=0.0003), l’utilisation des 5-ASA oraux (aHR= 1.91, p=0.0003), l’usage d'agents immunomodulateurs par rapport aux biologiques (methotrexate aHR= 1.91, p=0.0006; thiopurines aHR= 2.06, p<0.0001), la présence de granulomes (aHR= 1.27, p=0.04) et l’augmentation des éosinophiles sur les biopsies (aHR= 1.34, p=0.02), des niveaux élevés de protéine C-réactive (aHR= 1.01, p<0.0001) et de calprotectine fécale (aHR=1.09, p<0.0001) pendant la rémission clinique et de faibles taux sériques d'infliximab en post-induction (aHR pour les niveau moyen d’infliximab inférieur à 7ug/mL = 2.48, p=0.005) étaient indépendamment associés à la rechute. Le phénotype de la maladie a changé au fil des ans et des tendances saisonnières dans la fréquence et la gravité des diagnostics existent, suggérant des hypothèses étiologiques telles que la carence en vitamine D en hiver, les colites bactériennes saisonnières, les processus de réactivation virale et les changements dans la composition du microbiote. Plusieurs résultats de l'étude sont originaux et ceux-ci ont apporté de nouvelles connaissances et certains pourraient être intégrés dans les lignes directrices de prise en charge de la MC pédiatrique afin d’améliorer la qualité de vie des patients, soit obtenir une rémission rapide et durable. / Crohn's disease (CD) has a high incidence in the pediatric population in North America. The etiology of CD remains unknown and the disease incidence has been increasing. The natural evolution of CD is misunderstood, especially in the pediatric population. The trends of time-to-remission over the years and the influencing factors are very limited in the literature. Few risk factors are identified in the literature to predict relapses of the disease in children. The first part of this study was to describe the trends in the clinical phenotype, endoscopic, histological, and laboratory characteristics of pediatric CD during the last decade and to describe the seasonal variation of disease presentation at diagnosis. The secondary part of this study was to describe the time to remission in children with CD as well as its evolution over the past decade and to determine factors associated with time to remission. The third part of the study was to describe the rate of relapses in children with CD, its evolution over the past decade and to determine risk factors associated with relapse of the disease. Eligible patients were aged from 4 to 18 years and diagnosed between 2009 and 2019. All clinical, endoscopic, histological, laboratory and treatment data were collected from their medical records. Survival analyses and linear regression models were used to assess the impact of those factors on time to remission. Likewise, survival analyses and Cox regression models were applied to assess the impact of those risk factors on relapse. A total of 654 patients were included in this retrospective cohort study. The number of new diagnoses per year increased over the decade. Patients diagnosed between 2015 and 2019 had a lower age at diagnosis (OR 2.53, 95% CI [1.29; 4.98]), more perianal diseases (OR: 2.30, 95% CI [1.52; 3.48]), more granulomas (OR: 1.61, 95% CI [1.17; 2.22]), but less eosinophils (OR: 0.35, 95% CI [0.25; 0.48]) and less chronic lympho-plasma cells infiltrate (OR: 0.56, 95% CI [0.36; 0.86]) on ileo-colonic biopsies compared to patients diagnosed in 2015-2019. There were fewer diagnoses of CD in children in winter. Patients diagnosed in fall had lower PCDAIs and less failure to thrive. CD diagnosed in spring and summer had lower hemoglobin levels and higher erythrocyte sedimentation rate levels. In addition, arthritis and erythema nodosum were more frequent in spring and summer. Colonic location was significantly more frequent in summer and fall. There was no change in the time to clinical remission over the past decade. Female sex in adolescents (adjusted bêta regression coefficient (aβ)= 31.8 days, p=0.02), upper digestive tract involvement (aβ= 46.4 days, p=0.04) perianal disease (aβ= 32.2 days, p=0.04), presence of active inflammation on biopsies (aβ= 46.7 days, p=0.01) and oral 5-ASA exposure (aβ= 56.6 days, p=0.002) were all associated with longer time to clinical remission. However, antibiotic exposure (aβ= -29.3 days, p=0.04), increased eosinophils on biopsies (aβ= -29.6 days, p=0.008) and combination of exclusive enteral nutrition and TNF-alpha inhibitors as induction therapy (aβ= -36.8 days, p=0.04) were associated with shorter time to clinical remission. There has been a decrease in the relapse rate over the past decade : 69.6% in patients diagnosed between 2009 and 2014 and 47.8% in patients diagnosed between 2015 and 2019 (p<0.0001). Female sex (adjusted hazard ratio (aHR) = 1.51, p=0.0009), high PCDAI (aHR= 1.02, p=0.04) and SES-CD (aHR= 1.03, p=0.03) scores at diagnosis, upper digestive tract involvement (aHR= 1.59, p=0.0003), exposure to oral 5-ASA (aHR= 1.91, p=0.0003), use of immunomodulatory agents compared to TNF-alpha inhibitors (methotrexate aHR= 1.91, p=0.0006; thiopurines aHR= 2.06, p<0.0001), presence of granulomas (aHR= 1.27, p=0.04) and increased eosinophils on biopsies (aHR= 1.34, p=0.02), high levels of C-reactive protein (aHR= 1.01, p<0.0001) and fecal calprotectin (aHR=1.09, p<0.0001) during clinical remission and low serum infliximab levels during maintenance (aHR for mean serum infliximab level under 7ug/mL = 2.48, p=0.005) were all significantly associated with relapse in patients. The disease phenotype has changed over the years and important trends in the frequency and severity of diagnoses exist according to the diagnosis period within a year, suggesting etiological hypotheses such as vitamin D deficiency in winter, seasonal bacterial and viral colitis and academic stress. Many of the results of the study are original and brought new knowledge while confirming certain statements which had not obtained consensus in recent studies of expert opinions and some could be incorporated into management guidelines of pediatric CD to short time to remission and avoid relapse in patients.

La sclérose en plaques (SEP) est une maladie neuro-inflammatoire du système nerveux central. Les causes sont multifactorielles impliquant à la fois une prédisposition génétique et l'influence de facteurs environnementaux. Dans environ 85% des cas, les patients sont atteints de poussées correspondants à la survenue de signes neurologiques, suivis d'une phase de rémission partielle ou totale. De nombreux travaux avancent l'hypothèse selon laquelle le taux de poussées varie au gré des saisons, survenant plus fréquemment au printemps et en été. Cette fluctuation temporelle a soulevé la question de l'influence de paramètres dépendants de la saison tels que l'ensoleillement et le statut en vitamine D, le niveau de mélatonine ou encore la pollution atmosphérique. Etant donné cette variation de la pollution de l'air, nous avons cherché à explorer l'impact à court terme des particules fines (PM10), benzène (C6H6), dioxyde d'azote (NO2), monoxyde de carbone (CO) et de l'ozone troposphérique (O3), sur le risque de déclenchement de poussée, indépendamment des saisons "chaude" (1er avril au 30 septembre) et "froide" (1er octobre au 31 mars). Ce travail s'est appuyé sur les données de patients issus du réseau ville-hôpital alSacEP. Nous avons sélectionné 424 patients atteints de SEP à début rémittent et ayant connu un total de 1 783 poussées (2000-2009). Les niveaux journaliers de pollution, produits grâce au modèle physique déterministe ADMS-Urban, ont été modélisés sur une base horaire pour chaque IRIS de la communauté urbaine de Strasbourg par l'actuelle AASQUA ATMO Grand Est. De plus, une enquête individuelle menée dans le cadre de cette étude auprès de l'ensemble des patients (PT) a permis de collecter (par questionnaire téléphonique ou auto-questionnaire sur internet) des informations personnelles socio-économiques (SES) et du mode de vie pour 188 d'entre eux (PS). Enfin, le niveau SES des IRIS a été estimé à l’aide d’un indice de défaveur social - construit à partir des données du recensement de l’INSEE. Nous avons observé une influence saisonnière délétère à court terme de la pollution (3 jours précédant la poussée) sur le risque de poussée en PT, notamment de l'O3 en saison "chaude" et des PM10 et NO2 en saison "froide". Nos résultats suggèrent également que le contexte SES puisse exacerber ces associations, notamment chez les patients résidant dans les quartiers défavorisés lors d'exposition aux PM10, NO2, C6H6 et CO ("froide") et ceux résidant dans les quartiers favorisés et défavorisés lors de l'exposition à l'O3 ("chaude"). Enfin, nous avons observé chez la PS que le niveau d'éducation faible, le revenu familial moyen, la consommation de cigarette et le manque d'activité physique régulière sont les catégories SES et du mode de vie les plus associées avec le risque de poussée lors de l'exposition à la pollution de l'air. Ce travail montre la nécessité d'étudier les expositions environnementales au cours de la SEP selon une approche holistique intégrant des facteurs individuels et contextuels. / Multiple sclerosis (MS) is a neuro-inflammatory disease of the central nervous system (CNS). Causes are multifactorial enrolling both genetic predisposition and influence of environmental factors. In 85% of cases, patients experience relapse corresponding to the occurrence of neurologic signs, followed by a phase of partial or total remission. Several studies put forth the hypothesis that relapses rate varies across season, mainly occurring during spring and summer. This temporal fluctuation raised the question of season-dependent parameters influence such as sunlight exposure and vitamin D, melatonin level or ambient air pollution. Considering this variation of air pollution, we explored the short-term impact of fine particles (PM10), benzene (C6H6), nitrogen dioxide (NO2), carbon monoxide (CO) and ground-level ozone (O3), on the risk of relapse triggering, separately for "cold" (i.e., October-March) and "hot" (April-September) season. This work has drawn from data of patients provided by the alSacEP network. We included 424 patients affected with remitting MS onset who experienced 1,783 relapses over the 2000-2009 period. Daily level of air pollution was modeled through ADMS-Urban software at the census block scale of the Strasbourg metropolitan area (AASQA ATMO Grand Est). Furthermore, an individual survey was conducted among all the patients (PT) in order to collect individual socioeconomic (SES) and lifestyle features. Finally, the census block SES position was estimated using a composite deprivation index - created from the INSEE census data. A short-term (3 days preceding the relapse) seasonal adverse effect was observed in PT, in particular during exposure to O3 in "hot" season and PM10 and NO2 in "cold" season. Results also suggest that the SES context might exacerbate these associations, in particular among patients who were living in deprived neighborhood with exposure to PM10, NO2, C6H6 and CO ("cold) and those who were living in most well-of and deprived places with exposure to O3 ("hot"). Finally, we observed among Ps that low education level, average family income, smoking and lack of physical activity are more associated with the risk of relapse triggering when patients were exposed to air pollution. This work shows the need to investigate environmental exposure such as air pollution along the SEP course using a holistic approach integrating individual and contextual factors.

This research traces the developments in Europe that led to a rush for foreign missions i different parts of the world, with specific reference to South Africa. It describes the operations of the Swiss missionaries in South Africa from 1873 to 1975. This study also evaluates the motives for the evangelization of the African masses, and contradictions th existed in the relations that missionaries had with proselytes during the period under review. The sterling contributions of black evangelists in this period are demonstrated. It cannot be denied that the Swiss missionaries did a lot of good to the indigenous populac of South Africa-the importance of their services at Lemana Training Institution (1906) and Elim Hospital (1899) are indelibly inscribed in our historiography. They should also applauded for their response to the plight of the Shangaans, who had for reasons unkno to the researcher been by-passed by other missions during the "scramble for mission fields". But the missionaries also had their shortcomings, for instance their failure to ind the state to remove capital punishment from the statute books. They may nonetheless stil continue to be used by the present government of South Africa to assist in carrying the social transformation process forward. / Educational Studies / M. Ed. (History of Education)

This research traces the developments in Europe that led to a rush for foreign missions i different parts of the world, with specific reference to South Africa. It describes the operations of the Swiss missionaries in South Africa from 1873 to 1975. This study also evaluates the motives for the evangelization of the African masses, and contradictions th existed in the relations that missionaries had with proselytes during the period under review. The sterling contributions of black evangelists in this period are demonstrated. It cannot be denied that the Swiss missionaries did a lot of good to the indigenous populac of South Africa-the importance of their services at Lemana Training Institution (1906) and Elim Hospital (1899) are indelibly inscribed in our historiography. They should also applauded for their response to the plight of the Shangaans, who had for reasons unkno to the researcher been by-passed by other missions during the "scramble for mission fields". But the missionaries also had their shortcomings, for instance their failure to ind the state to remove capital punishment from the statute books. They may nonetheless stil continue to be used by the present government of South Africa to assist in carrying the social transformation process forward. / Educational Studies / M. Ed. (History of Education)