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This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain > 3 on VAS and 79 reported VAS > 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain >3 on POM-VAS and 47 patients reported >3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain > 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain > 3. Being cared for by a nurseled or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.

Background: Developmental Coordination Disorder (DCD) describes children with a difficulty to acquire age-specific motor skills. Although there is a significant body of literature addressing developmental and cognitive issues in children with DCD, few studies have actually examined the associations between DCD, physical activity and physical fitness. Therefore, the aim of the present research work was to assess these associations in a series of four successive studies which were set: a) (study 1) to estimate DCD prevalence rates in Greek children and investigate whether these children exhibit different obesity and cardiorespiratory fitness levels than an overseas sample, b) (study 2) to provide evidence on the association between DCD and physical fitness levels, c) (study 3) examine whether a motor skills and exercise training intervention programme affects motor proficiency in a cohort of elementary school children with and without DCD, and d) (study 4) to test the hypothesis that DCD is associated with CVD risk, identify modes of physical activity that mediate such an association and to evaluate the CSAPPA scale as a potential tool for identifying Greek children for DCD. Methods: The total of 574 Greek (Age: 11.46 ± 1.54 years; BMI: 19.96 ± 3.53) children were assessed for anthropometry, physical fitness (flexibility, hand strength, leg explosive power, speed and cardiorespiratory fitness), motor competence (i.e., short form of the Bruininks-Oseretsky Test of Motor Profiency- BOTMP-sf) and subjected to two self assessments for: i) perception of adequacy for physical activity (CSAPPA scale), and ii) children’s participation in physical activity (Participation Questionnaire - PQ). Results: Study 1: Greek children demonstrated significantly higher DCD prevalence rates (p<0.05), higher body fat (p<0.05) and were inferior in both cardiorespiratory fitness (p<0.05) and motor competence (p<0.05) compared to an overseas sample. Study 2: Greek children with DCD demonstrated significantly higher BMI values (p<0.01) and lower leg explosive power (p<0.01), speed (p<0.01) and hand strength (p<0.01) than those without DCD. Study 3: Results showed a significant main effect of time [F(14, 115) = 3.79, p< 0.001; η2 = 0.32] for motor competence (p<0.001) between children with and without DCD. Significant main effects of group (i.e intervention and control groups) [F(42, 351) = 4.01, p< 0.001; η2 = 0.33] were observed for BMI (p<0.01), motor competence (p<0.01), cardiorespiratory fitness (p<0.01), hand strength (p<0.05), leg explosive power (p<0.05), speed (p<0.01), and free time play activities (p<0.05). Study 4: Chi-square comparisons and ANOVA, revealed significantly increased body mass (p<0.05), BMI (p<0.05) and inactivity (p<0.05), as well as significantly decreased cardiorespiratory fitness (p<0.05), motor competence (p<0.05), CSAPPA indices, and participation in free play (p<0.05) in children with DCD. Furthermore, BMI and cardiorespiratory fitness were significantly associated with motor competence (p<0.05) with inactivity as the mediating factor (p<0.05). ROC curve analyses for CSAPPA indicated an optimal cut-off at 62 points. Conclusions: 1) the relatively high DCD and obesity prevalence rates together with the low cardiorespiratory fitness suggest greater health risk for Greek children with the studied condition, 2) children with DCD tend to perform worse in selected physical fitness parameters compared to their normal peers, 3) motor skills and exercise training interventions for children with DCD may improve health and skills related fitness, and 4) inactivity mediates the relationship between DCD and CVD risk in children with DCD. Finally, the CSAPPA scale may serve as a practical and a cost-effective proxy assessment for identifying Greek children with DCD, however as this is not a standardised test for use with children, its use should be treated with caution until further validation work.

Quality of life (QOL) is an extremely important concept in the promotion of appropriate and successful health care programmes. However, there is a need for conceptual clarity to unravel the complexities of terminology in different medical conditions and the underlying factors that have a direct influence on the quality of life for people with coronary heart disease. The primary objective of this thesis is to propose a theoretical model which specifies the domains of QOL and the interrelationships among these domains. The objectives of the study are four-fold: (1) To examine whether a cardiac rehabilitation programme has a beneficial effect on cardiac heart disease patients; (2) To evaluate the primary components of generic health-related quality of life assessment tools for people with coronary heart disease; (3) To identify the main factors governing disease-specific health-related quality of life assessment tools amongst patients with coronary heart disease; (4) To examine a variety of conceptual models of QOL and to determine their relevance to cardiac patients. First, in order to provide conceptual clarity, a comprehensive review of QOL measures was undertaken. Second, data was collected on a cardiac rehabilitation programme in a county hospital using Short Form-36 (SF-36) and Quality of Life for Myocardial Infarction (QLMI) instruments. This data was analysed using a number of techniques including (l)meta-analysis; (2)discriminant analysis; (3)factor analysis and (4)structural equation modelling. Analysing the data in this way enabled the development and clarification of the specific domains of the quality of life model. Meta-analysis involved pooling the results of several studies, these were then analysed to provide a systematic, quantitative review of the data. The results found that the related studies did not have consistent outcomes to support the positive effects of a cardiac exercise rehabilitation programme on quality of life in coronary patients. Findings from the SF-36 indicate that older people with coronary heart disease gain more pain relief than their younger counterparts. After a cardiac exercise rehabilitation progranune, statistically significant improvements occurred in physical function, social function, role limitation/physical, energy/vitality, body pain, and change in health-related dimensions of quality of life. The first-order five domains model includes the symptom domain, the restriction domain, the confidence domain, the self-esteem domain and the emotion domain. This model represents an appropriate model of quality of life for people with coronary heart disease compared to the three-domain model and the four-domain model. In terms of the second-order QOL model, the five-domain model also has an adequate fit to the data. According to the result of structural equation modelling, three models, including the null model, the alternative model I and the alternative model n, did not fit the data perfectly. However, the construct of full latent variable model gradually increased the fit statistics from the null model to the alternative model I and from the null model to alternative model n. Therefore, it can be concluded that the paths and indicators of the three models need to be further adjusted in order to provide a more appropriate model. Nevertheless, this is a first trial to examine a full model of quality of life for people with coronary heart disease using the structural equation analyses. As such, this study provides a new approach to examining the difference between empirical studies and theoretical approaches.

Com o objetivo de estudar a interação do HAdV-41 com células permissivas, primeiramente foi observada a cinética de infecção do HAdV-41 em células HEK-293, durante 7 dias. A seguir, as culturas foram analisadas por MCVL e por MET. O HAdV-41 apresentou um ciclo replicativo lento com liberação da progênie viral por mecanismo não lítico. A seguir, com o intuíto de verificar a participação da proteina FC do HAdV-41 nas etapas de entrada nas células HEK-293 e CaCo2, obteve-se os dodecaedros recombinantes (DR) em células High five (base-Ad3, base-Ad3+FC-Ad41, base-Ad3+FL-Ad41, baseRGEHS-Ad3+FCAd41 e base-Ad3+FAd3). Esses dodecaedros foram inoculados em células HEK-293 e CaCo2. Após a análise por MCVL, observou-se que a proteína FC talvez não desempenhe função na entrada do DR nas células estudadas. A seguir, uma alíquota do DR base-Ad3+FC-Ad41 foi digerida com a enzima pepsina e analisada por WB. Notou-se que a FC sofreu proteólise. Acredita-se que essa proteólise seja necessária para o reconhecimento de receptores no trato gastro-intestinal. Esses resultados fornecerão subsídeos para o desenvolvimento de vetores de terapia gênica direcionada para o epitélio intestinal e vetores vacinais administrados por via oral. / Our objective was study the interaction between HAdV-41 and permissive cells. First, it was observed the kinetic of infection between HAdV-41 and HEK-293 cells, for 7 days. Second, the cultures were analyzed by CLSM and by TEM. The HAdV-41 showed a slower replicative cycle with release of viral progeny by non-lytic mechanisms. In order to verify the participation of SF protein of the HAdV-41 during the phases of entry in HEK-293 and CaCo2 cells, we producted recombinant dodecahedrons (DR) in high five cells (base-Ad3, base-Ad3+SF-Ad41, base-Ad3+SF-Ad41, baseRGEHS-Ad3+SFAd41 and base-Ad3+FAd3). These decahedrons were inoculated in HEK-293 and CaCo2 cells. After analysis with CLSM, observed that SF protein may not have a role in dodecahedron entry in the cells studied. Next, recombinant dodecahedrons base-Ad3+SF-Ad41 and base-Ad3 were digested with pepsin and analyzed by WB. We observed proteolysis of the SF. We believe that this proteolysis may be necessary for the recognition of receptors in intestinal cells. The results obtained will be the base for the development of gene-therapy vectors directed to intestinal epithelium, as well as orally administered vaccine vectors.

D.L. A 790-2008

La qualité de vie liée à la santé (QdV) s’est imposée comme une préoccupation essentielle dans la prise en charge des patients. Elle est devenue un des objectifs majeurs des essais cliniques.Notre revue bibliographique a montré un réel manque de données sur la QdV de la femme enceinte, puisqu’entre 2005 et 2015, elle n’a identifié que 75 articles portant sur cette problématique. Nous avons donc voulu déterminer l’évolution de la QdV chez les femmes enceintes du premier trimestre au 9ème mois, à l’aide du questionnaire EQ5D-3L version française, en différenciant les grossesses physiologiques des grossesses pathologiques, et en comparant cette évolution inter et intra grossesse. A cette fin, nous avons suivi une cohorte de 500 femmes enceintes entre 2015 et 2017 au CHU de Toulouse qui ont complété mensuellement un cahier d’observation en ligne. Après avoir réalisé une régression par morceaux, entre le 4ème et le 8ème mois, la QdV était significativement plus basse pour les grossesses pathologiques et diminuait significativement pour chaque type de grossesse. Ces résultats nous ont amené à nous demander si la QdV de la femme enceinte pouvait avoir un impact sur le mode d’allaitement à la naissance (maternel ou artificiel). A partir de cette même cohorte, où nous avions également recueilli le mode d’allaitement à la naissance, nous n’avons pas montré de lien entre QdV au cours de la grossesse et mode d’allaitement à la naissance, que ce soit lors de l’analyse mensuelle ou lors de l’analyse catégorielle qui était fonction de la QdV au 3ème mois de grossesse et de son évolution au cours de la grossesse / Health Related Quality of life (HRQoL) has emerged as a major concern in the care of patients and has become a major objective of clinical trials.Our literature review showed us a real lack of data on the QoL of the pregnant woman, since between 2005 and 2015, she identified only 75 articles dealing with this problem.We therefore wanted to determine the evolution of QoL in pregnant women from the first trimester to the 9th month using the EQ5D-3L French version, by differentiating physiological pregnancies from pathological pregnancies and comparing this inter and intra pregnancy progression. . We therefore followed a cohort of 500 pregnant women between 2015 and 2017 at Toulouse University Hospital, who completed a monthly online observation form. After performing piecemeal regression, between the 4th and 8th month, QoL was significantly lower for pathological pregnancies and significantly decreased for each type of pregnancy.These results led us to question whether the QoL of the pregnant woman could have an impact on breastfeeding at birth (maternal or artificial). From this same cohort, where we also collected breastfeeding at birth, we did not show a link between QoL during pregnancy and breastfeeding at birth, whether at birth. monthly analysis or categorical analysis that was based on QoL at the 3rd month of pregnancy and its course during pregnancy

Neste trabalho, a decomposição por via úmida em sistema fechado assistida por radiação micro-ondas (MW-AD) e a decomposição por via úmida em sistema fechado assistida por radiação micro-ondas e ultravioleta (MW-UV) foram avaliadas para amostras comerciais de biodiesel para posterior determinação de Ba, Co, Cr, Cu, Mn, Mo, Ni, Pb, Sr, V e Zn por espectrometria de massa com setor eletromagnético com plasma indutivamente acoplado (SF-ICP-MS). A MW-AD empregando ácido diluído foi primeiramente avaliada sendo possível a decomposição de até 700 mg de biodiesel com HNO3 7 mol L-1 e 2 mL de H2O2 30% (m/m). As soluções finais apresentaram teor de carbono residual (RCC) de 8,7% e acidez residual (RA) de 4%. Posteriormente, com o objetivo de obter maior eficiência de decomposição, o método MW-UV foi avaliado para a decomposição de biodiesel. Com o emprego deste método até 950 mg de amostra foram decompostas com HNO3 7 mol L-1 e soluções finais com RCC de 17,4% e RA de 19,3% foram obtidas. As soluções finais, para ambos os métodos, foram adequadas para a determinação de elementos traço por SF-ICP-MS. Possíveis interferências na etapa de determinação dos analitos, causadas pela presença de carbono residual, foram estudadas através do emprego de padrão interno 115In e de ensaios de recuperação de analito para monitorar a formação de espécies poliatômicas no plasma. Os resultados obtidos mostraram a necessidade da utilização de padrão interno, sendo o instrumento operado no modo de baixa resolução para a determinação da maioria dos analitos, com exceção de 52Cr, para o qual o instrumento foi operado no modo de média resolução. A exatidão dos métodos propostos foi avaliada mediante a análise de material de referência certificado, obtendo-se resultados concordantes, com nível de confiança de 95% (teste t-student), com os valores certificados para a maioria dos elementos. Ensaios de adição de analito também foram feitos para a avaliação da exatidão e recuperações de 92 à 109% foram obtidas. Os limites de detecção (LD) obtidos para o método MW-UV foram inferiores aos obtidos para MW-AD, na faixa de 0,08 a 6,9 ng g-1 e 1,0 a 14 ng g-1, respectivamente. / In this work, the microwave-assisted digestion (MW-AD) and microwave-assisted ultraviolet digestion (MW-UV) were evaluated for commercial biodiesel samples for subsequent determination of Ba, Co, Cr, Cu, Mn, Mo, Ni, Pb, Sr, V and Zn by sector field inductively coupled plasma mass spectrometry (SF-ICP-MS). Using the MW-AD method with diluted acid up to 700 mg of biodiesel were digested with 7 mol L-1 HNO3 and 2 mL of 30% (w/w) H2O2. Final solutions presented residual carbon content (RCC) of 8.7% and residual acidity (RA) of 4%. In order to improve the digestion efficiency, the MW-UV method was evaluated for biodiesel digestion. Using MW-UV method up to 950 mg of sample were digested with 7 mol L-1 HNO3 and the final solutions with RCC of 17.4% and RA of 19.3% were obtained. The final solutions obtained for both methods were suitable for the determination of trace elements by SF-ICP-MS. Interferences in the determination step were studied using 115In as internal standard and analyte recovery to monitor the formation of polyatomic species in the plasma. The low resolution mode was used for the determination of almost of the analytes with the exception of 52Cr that was determine using medium resolution mode. Accuracy of the investigated methods were evaluated by analysis of certified reference material and the values obtained were in agreement with 95% confidence level (t-student test) with the certified values for all elements. Analyte recovery was also performed to evaluate the accuracy and recoveries of 92 to 109% were obtained. The limits of detection (LOD) obtained by the MW-UV method were lower than MW-AD method and are in the range of 0.08 to 6.9 ng g -1 and 1.0 to 14 ng g -1, respectively.

Práce se zabývá systémem Strukturální politiky Evropské unie v období 2000-2006, porovnává předpoklady ziskových a neziskových organizací pro čerpání prostředků ze strukturálních fondů Evropské unie a analyzuje dosavadní zkušenosti neziskových organizací v této oblasti. Součástí práce jsou návrhy a doporučení k nápravě zjištěných problémů a nedostatků.