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No. of bitstreams: 2 Tese - Christine Garrido Marquez - 2016.pdf: 6917394 bytes, checksum: 526d6b5f8053bab6b76ca9985fe07da9 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-10-28 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / This research integrates the project of Public Policy and Education of Children in Goiás: history, concepts, projects and practices developed by the Center of Studies and Research of Childhood and its Education in Different Contexts (NEPIEC) which is inserted in the research line: Education, Teaching Professionalization, Educational Work of the Postgraduate Program in the School of Education of the Federal University of Goiás. Propositions of multisectoral policies and integrated development of Early Childhood of the World Bank for developing countries have been investigated, which involve interconnected actions in education, health, nutrition, social protection (child protection and social assistance) and basic sanitation, in order to understand how this process has been set up in Brazil as of the 1990s. A documentary and literature research was carried out and we propose as reference of analysis historical and dialectical materialism. The starting point being a survey called State of the Art on the studied subject, in order to map out the academic and scientific production in the field, to enable a look at the production, observing the evolution of research, its features, focus and gaps. Presenting the multiple aspects of the organizational structure of the World Bank and its development policy propositions on Early Childhood supported in the six Education Sectoral Documents and the eight publications produced from 1974 to 2014 by the International Organization, which were formulated to instruct the political debate with governments, development partners and civil society in developing countries, including Brazil. The strategic entry points of investment have been analyzed, classified into four themes based on: 1) programs based on Early Childhood Development Centers focusing on school readiness; 2) residential programs based on behavioral change in relation to health, nutrition and child care; 3) communication / media campaigns aimed at families with young children on child health, nutrition and overall development; and, 4) conditional cash transfer for families with small children. It is concluded that the World Bank since its inception in 1944, besides project financing, policy-making, technical assistance to governments, also plays an important role in the meeting, synthesis and dissemination of knowledge about the specific development issues covering its extensive practice area, including the development of Early Childhood, services in the area and around the world. Since the seventies, the World Bank references the relevance of the adoption of multisectoral and integrated programs designed for Early Childhood, with the theoretical support based on the political theory of human capital, which seeks the reproduction and accumulation of capital, as opposed to a project that aims to guarantee full rights the children in Brazil. / Esta pesquisa integra o projeto Políticas Públicas e Educação da Infância em Goiás: história, concepções, projetos e práticas, desenvolvido pelo Núcleo de Estudos e Pesquisas da Infância e sua Educação em Diferentes Contextos (NEPIEC) e está inserida na Linha de Pesquisa: Formação, Profissionalização Docente, Traballho Educativo do Programa de Pós-Graduação em Educação da Faculdade de Educação da Universidade Federal de Goiás. Investigamos as proposições de políticas multissetoriais e integradas de Desenvolvimento da Primeira Infância do Banco Mundial para os países em desenvolvimento, os quais envolvem ações interligadas no campo da educação, saúde, nutrição, proteção social (proteção à criança e assistência social) e de saneamento básico, a fim de compreender como este processo tem se configurado no Brasil, a partir dos anos de 1990. Foi realizada uma pesquisa documental e bibliográfica e propomos como referencial de análise o materialismo histórico e dialético. A metodologia de pesquisa abrange a constituição do Estado da Arte acerca da temática em estudo, com o propósito de mapearmos as produções acadêmicas e científicas na área, possibilitando um olhar sobre a produção, observando a evolução das pesquisas, suas características, foco e as lacunas existentes. Apresentamos os múltiplos aspectos da estrutura organizacional do Banco Mundial e as suas proposições políticas de Desenvolvimento da Primeira Infância apoiadas nos seis Documentos Setoriais de Educação e nas oito publicações produzidas no período de 1974 a 2014 pela referida Organização Internacional sobre a temática, as quais foram formuladas para instruir o debate político com governos, parceiros de desenvolvimento e a sociedade civil dos países em desenvolvimento, inclusive com o Brasil. Analisamos os pontos de entrada estratégicos de investimento, classificados em quatro eixos temáticos baseados em: 1) programas baseados em Centros de Desenvolvimento da Primeira Infância com foco na prontidão escolar; 2) programas domiciliares baseados na mudança de comportamento em relação à saúde, à nutrição e aos cuidados parentais; 3) campanhas de comunicação/mídia destinadas a família com crianças pequenas sobre saúde infantil, nutrição e desenvolvimento global; e, 4) transferência condicionada de renda para famílias com crianças pequenas. Com base na pesquisa realizada, conclui-se que o Banco Mundial desde sua criação, em 1944, além do financiamento de projetos, formulação de políticas, da assistência técnica a governos, desempenha um papel relevante na reunião, síntese e disseminação do conhecimento sobre os temas específicos de desenvolvimento que abrangem sua extensa área de atuação, inclusive sobre o desenvolvimento da primeira infância e serviços na área em todo o mundo. Desde os anos setenta, o Banco Mundial referencia a relevância da adoção de programas multissetoriais e integrados dirigidos à primeira infância, tendo como base de sustentação teórica das políticas a teoria do capital humano, que busca a reprodução e a acumulação do capital, em contraposição a um projeto que objetive a garantia dos direitos plenos da criança no Brasil.

Le XVIe siècle est souvent perçu comme un temps de massacres motivés par les haines confessionnelles, une litanie de carnages et d’exactions à laquelle succéderait, à partir des années 1650 une culture de la reddition honorable, une guerre réglée et limitée caractérisée par une nette amélioration du sort des vaincus. Une humanisation de la guerre se donnerait à lire au travers d’une codification des procédures de capitulation et de reddition des places. Ce travail, suivant les pistes ouvertes par l’anthropologie historique, questionne cette vision caractéristique d’une déréalisation de la guerre pour montrer que la reddition honorable émerge précocement et ne constitue jamais qu’un idéal toujours soumis aux intérêts des belligérants. Mobile de la clémence, l’intérêt est également celui de la rigueur. Tout au long des XVIe et XVIIe siècles, la reddition reste un risque pour l’honneur et la vie des vaincus. Cette histoire de la reddition entend déconstruire le mythe déréalisant de la «guerre en dentelles» pour rappeler que les guerres du règne de Louis XIV ne sont pas le théâtre d’une limitation de la violence. / The XVIth century is often perceived as an era of religious driven massacres, a litany of carnage and exactions directly followed, from 1650 onward, by reversing habits of honourable capitulation, a closely regulated and restricted warfare characterized by a great improvement in the fate of the defeated. A humanization of the war would show through a codification of the surrending procedures and the transfer of forteresses. This essay investigates this derealizing vision of warfare, based on historical anthropology’s theoretical leads. It shows that honourable capitulation come about earlier on as an ideal led by the interest of belligerent parties. These interests appear as a major motive for both leniency and rigorousness. All along the XVIth and XVIIth cent., capitulation stands as a risk for the honor and life of the losers. This history of capitulation intends to deconstruct the derealizing myth of chivalrous and limited warfare, to recall the fact that wars under the reign of Louis XIV often led to repeated acts of unleashed violence.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work stems from a project developed under the Teaching and Learning of Mathematics and their Philosophical, Historical and Epistemological Foundations research scope of the Graduate Program in Mathematics Education and Physics Teaching at the Federal University of Santa Maria. Based on the assumptions of the Historic-Cultural Theory and the Theory of Activity, as well as authors who address the training of teachers who teach mathematics, we define as main objective to investigate the formation of teachers who teach Mathematics in the early years of Elementary school, from discussions about the Decimal Numbering System in the context of a working group of Guiding Studies of Pacto Nacional pela Alfabetização na Idade Certa (PNAIC) Program. How collected data procedure, we adopted a questionnaire applied to Guiding Studies of this Program belonging to Santa Maria (RS) polo; follow-up of continuing education presential meetings that boarded the Decimal Numbering System in one of the working groups and we realize reflective sessions with guiding studies teachers of this working group. While the questionnaire answers served to bring indicative of these teachers think about Decimal Numbering Decimal and your teaching, the data of continuing education meetings and reflective sessions were systematized in four analysis sections the teacher as subject in your formation; the math knowledge as promotor of subject development; pedagogical intentionality as element of teacher organization, e; the share as promotor of comprehension of complexity of pedagogical activity with the goal of build episodes (Moura,1992) to verify the extent to which the Guiding Studies presents quality change in your formation process. We conclude that formation space, such as offered by PNAIC, may constitute as Learning spaces of Teaching for evolved teachers, since that develop forming activities that provide access to math knowledge as a result of logic-historic process; provide discussions about Teaching organization focusing in Learning of student and favor the collective development of group, in order that knowledge appropriation occurs from the social to the individual. / Este trabalho decorre de um projeto desenvolvido no âmbito da linha de pesquisa Ensino e Aprendizagem da Matemática e seus Fundamentos Filosóficos, Históricos e Epistemológicos do Programa de Pós-Graduação em Educação Matemática e Ensino de Física da Universidade Federal de Santa Maria. Com base nos pressupostos da Teoria Histórcio-Cultural e da teoria da Atividade, assim como em autores que abordam a formação de professores que ensinam Matemática, delimita-se como objetivo principal investigar a formação de professores que ensinam Matemática nos anos iniciais do Ensino Fundamental, a partir de discussões sobre o Sistema de Numeração Decimal, no contexto de um grupo de trabalho de Orientadoras de Estudos do programa Pacto Nacional pela Alfabetização na Idade Certa (PNAIC). Como procedimento de coletada de dados foram adotados um questionário aplicado a Orientadores de Estudos desse programa, pertencentes ao polo de Santa Maria (RS); o acompanhamento dos encontros de formação continuada presenciais que abordaram o Sistema de Numeração Decimal em um dos grupos de trabalho e a realização de sessões reflexivas com professores Orientadores de Estudos desse grupo de trabalho. As respostas dos questionários serviram para levantar indicativos do que estes professores pensam sobre o Sistema de Numeração Decimal e o seu ensino. Os dados dos encontros de formação e das sessões reflexivas foram sistematizados em quadro unidades de análise - o professor como sujeito de sua formação; o conhecimento matemático como promotor de desenvolvimento do sujeito; a intencionalidade pedagógica como elemento da organização do ensino; e o compartilhamento como promotor da compreensão da complexidade da atividade pedagógica com o intuito de constituir episódios (Moura, 1992) para verificar em que medida os Orientadores de Estudos apresentaram mudanças de qualidade nos seu processo de formação. Concluímos que espaços de formação, como os oportunizados pelo PNAIC, podem se constituir como espaços de aprendizagem da docência para os professores envolvidos, em especial, se desenvolverem atividades formadoras que proporcionem o acesso ao conhecimento matemático como decorrência de um processo lógico-histórico; promoverem discussões sobre a organização do ensino com enfoque no aprendizado do aluno e favorecerem o desenvolvimento coletivo do grupo, a partir da compreensão do papel fundamental das relações sociais no desenvolvimento do indivíduo.

The single parent family in an inner city context is confronted with a problematic life situation. The demands, which are brought about by single parenthood as well as residence in an inner city environment, often lead to inappropriate parenting. The single parent child is often disrupted on an emotional and social level as a result. In many cases the child handles this disruption inappropriately. The single parent family has a need for resources in the community in order to ensure the continuous emotional, social, psychic and physical well being of its separate members. Involvement in gestalt group work can already be regarded as such an important resource available to the single parent child. Through this research study an investigation was made into the efficiency of a gestalt group work programme in the empowerment of the single parent child to handle the negative experiences of the single parent situation, such as feelings of guilt, anger, confusion, fear, inadequacy, loss, and sorrow and depression. Gestalt group work offers an opportunity to the child to share feelings and experiences regarding the single parent situation within the group context and to receive support from the therapists and other group members. This process strengthens the child’s inner self and the child is empowered to self-support. A complete and refined gestalt group work programme was developed and evaluated from the findings of a literature study and empirical study. The process of intervention research was followed during the empirical study. Data was obtained from seven single parent children in their late middle childhood years in an inner city context and their single parents. The combined quantitative-qualitative approach was used for this purpose according to the dominant-less-dominant model of Creswell. The single-systems design was used to test the effectiveness of the programme. The quantitative findings were obtained by self-developed questionnaires for the child respondents and their single parents, before and after the gestalt group work programme. The qualitative findings were obtained by unstructured observation during the gestalt group work sessions. According to the integration of the quantitative and qualitative findings, the conclusion can be made that the gestalt group work programme brought about an improvement in the child respondents’ emotional and social levels of functioning and their appropriate handling of feelings. The findings obtained, suggest that the developed gestalt group work programme can be implemented with confidence with single parent children in their late middle childhood years in an inner city context. Further research on the development and evaluation of a gestalt group work programme, specifically presented to the single parents, in order to guide and support them in the handling of their experiences of the single parent situation, is strongly suggested. / Thesis (DPhil (Social Work))--University of Pretoria, 2005. / Social Work and Criminology / unrestricted

Le régime juridique de l'Enfant Associé aux Forces et Groupes Armés âgé de plus de quinze ans auteurs d'infractions graves est incohérent. En effet, il permet à son titulaire d'obtenir le statut de combattant, sans que pour autant sa responsabilité ne soit automatiquement engagée en cas de commission d'infractions graves. Cette situation s'explique par le fait que la communauté internationale est divisée sur sa nature juridique: il est perçu en tant que victime ou criminel. Cette incertitude a pour conséquence de créer de l'insécurité juridique car il ne sais pas au préalable quel sort lui sera réservé par la Justice. Cette réalité profite au recruteur qui le pousse à commettre les crimes les plus graves. L'enfant se sent ainsi tout-puissant. Toutefois, à l'issue du conflit, il risque d'être rejeté par sa communauté l'identifiant en tant que bourreau. Sa réinsertion est donc compromise. Afin de pallier cette situation, une harmonisation de l'âge du combattant devrait être envisagée afin de clarifier son régime de responsabilité. En attendant, le stand minimal est de quinze ans. S'il n'est pas considéré comme étant trop jeune pour prendre les armes, il doit être aussi en capacité de rendre des comptes. Mais comment ? À travers la Justice Transitionnelle de manière générale et plus précisément par la création d'un Tribunal Spécial pour Enfants Auteurs d'Infractions Graves qui a pour fonction de juger ceux qui ont le plus au degré de responsabilité dans la commission des crimes. Pour les autres, il est envisagé la valorisation de mécanismes de Justice Restauratrice qui répondent à leurs besoins, à celles de leurs victimes et de leur communauté tout entière. / The legal justice mechanism of the Child Associated with Armed Forces and Groups of more than fifteen years old of serious offenders is inconsistent. In fact, this kid's allowed to obtain the combatant status even if he never assumes automatically his responsibilities when he commits serious offences. It's because the international community is divided and considers him as a victim or a criminal. This uncertainty creates the effect of legal insecurity since he doesn't know how he'll be treated by Justice. This situation benefits to his recruiter who encourages him to commit the most serous crimes. The child feels almighty. But at the end of the conflict, he may probably rejected by this community who considers him as an executioner. So, his reintegration is compromise. To rectify this situation, harmonizing the age of the fighter should be a solution to clarity his accountability status. For the moment, fifteen years old appears as minimum standard. If the child isn't so youth to take arms, he can bear his accountability. But how? Whith Transitional Justice in general and more specifically the creation of a Special Court for Serious Violations which judge those who have the highest level of responsibility in the commission of the crime. For the others, we propose Restorative Justice that meet their needs, those of their victims and their entire community.

The thesis "Marketing of Elderly People" follow up on the issue of marketing focused on the generation aged over fifty years. Describes the specifics of this generation in the context of the consumer behavior. In the practical part of the thesis is conducted marketing research dedicated to consumables behavior of seniors in regard to Internet commerce. For marketing research was used questionnaire. Analysis of the results obtained information on the relationship of seniors to Internet trading, which is largely the domain of the younger generation already online.

Cette thèse étudie théoriquement et empiriquement les interrelations entre la santé de la population, la dégradation de l'environnement et le développement économique, ses conséquences pour les pays en développement, et fournit certaines réponses en termes de politique économique. Elle est subdivisée en deux parties. La première partie s’intéresse à la relation entre l’environnement, la santé, et les inégalités. Elle analyse dans un premier temps l’hypothèse selon laquelle la dégradation de l'environnement pourrait être considérée comme un canal supplémentaire par lequel les inégalités de revenu affectent les taux de mortalité infantile et juvénile (chapitre 2). Nos travaux théoriques et empiriques montrent que les inégalités de revenu affectent négativement la qualité de l'air et de l'eau, et cela à son tour dégrade la santé de la population. Par conséquent, la dégradation de l'environnement peut être considérée comme un canal non négligeable à travers lequel les inégalités de revenu influence l’état de santé. Il est ensuite démontré que les émissions de dioxyde de soufre (SO2) et celles des micro-Particules (PM10) sont en partie responsables des grandes disparités dans la mortalité infantile et juvénile au sein des pays pauvres (chapitre 3) .En outre, nos résultats soutiennent l’idée selon laquelle les institutions démocratiques jouent un rôle de protection sociale en atténuant cet effet pour les classes de revenu les plus pauvres et ainsi réduisent les inégalités de santé provoquées par la pollution. La deuxième partie évalue le lien entre la santé, l'environnement et la croissance économique. Le Chapitre 4 évalue l'effet de la santé (charge globale de la maladie, maladies transmissibles et paludisme) sur la croissance économique. Ce chapitre montre que les indicateurs de santé, lorsqu'ils sont correctement mesurés par l'écart entre l'état de santé actuel et une situation de santé idéal où toute la population vit à un âge avancé, indemne de maladie et d'invalidité, et lorsqu’ils sont convenablement instrumentés, ont un impact négatif significatif sur la performance économique. Les conséquences de ces interactions sur la convergence économique des pays pauvres vers leur état régulier, sont théoriquement et empiriquement analysées dans le dernier chapitre. Il en ressort que la dégradation de l'environnement réduit la capacité des pays pauvres d'atteindre leur état régulier, renforçant ainsi notre argument théorique selon lequel l’amélioration de la qualité de l'environnement joue un rôle considérable dans le processus de convergence économique. En outre, la dégradation de la qualité de l'air et de l'eau affecte négativement la performance économique, et l'état de santé demeure un canal important par lequel la dégradation de l'environnement agit sur la croissance économique même si elle n'est pas le seul. L’hypothèse de la courbe environnementale de Kuznets (EKC) est également vérifiée. / This dissertation investigates theoretically and empirically the interrelationships among population’s health,environmental degradation and economic development, its consequences for developing countries, and someeffective policy responses. The first part explores the association between health, environment, and inequalities. Itfirstly analyzes whether environmental degradation could be considered as an additional channel through whichincome inequality affects infant and child mortality (chapter 2). Theoretical and empirical investigations show thatincome inequality affects negatively air and water quality, and this in turn worsens population’s health. Therefore,environmental degradation is an important channel through which income inequality affects population health. Then,it is shown that sulphur dioxide emission (SO2) and particulate matter (PM10) are in part responsible for the largedisparities in infant and child mortalities between and within developing countries (chapter 3). In addition, we foundthat democratic institutions play the role of social protection by mitigating this effect for the poorest income classesand reducing the health inequality it provokes. The second part is devoted to the link among health, environment,and economic growth. The effect of health (global burden of disease, communicable disease, and malaria) oneconomic growth is assessed in Chapter 4. This chapter shows that health indicators, when correctly measured by thegap between current health status and an ideal health situation where the entire population lives to an advanced age,free of disease and disability, and when accurately instrumented have significant impact on economic performance.The consequences of these interrelationships on the convergence of poor countries towards their steady state aretheoretically and empirically investigated in the last Chapter (chapter 5). It is found that environment degradationreduces the ability of poor countries to reach their own steady state, reinforcing our argument according to whichenvironment quality improvement plays a considerable role in economic convergence process. Moreover, thedegradation of air and water quality affects negatively economic performance, and health status remains an importantchannel through which environment degradation affects economic growth even if it is not alone. The EnvironmentalKuznets Curve (EKC) hypothesis is also verified.

This research concentrates on the development of an intervention model for the sexually abused latency aged child. The focus is on short term, structured individual therapy. The importance of this model is linked to the underlying theoretical basis that it provides as well as the guidelines suggested for therapy. Intervention research was used as research methodology. This methodology implies a combined quantitative and qualitative approach. The first part (Chapters 2, 3&4) addresses the problem analysis and information gathering linked to the development of a theoretical basis for the intervention model. The latency years as developmental stage is discussed and suggestions are made as to which this information can be used during the planning and conducting of intervention. The reasons for the child’s vulnerability to become a sexual abuse victim are explained. The different forms of sexual abuse are indicated and it is argued that one child can be abused by another. The social environments where sexual abuse might occur are described as well as the possible consequences that sexual abuse holds for the victim. The second part of this research (Chapters 5&6) is related to the design of the intervention model, the conducting of a pilot test and the refining of the intervention. The key elements of abused focused therapy, cognitive behavioural therapy and movement therapy is outlined. These approaches serve as theoretical background for the formulation of the principles of the intervention model. The areas of focus during intervention are described. In Chapter 7 an outline of the intervention program is described. This programme can be viewed as a practical application of the intervention model. A detailed description of every therapy session is provided. The intervention program was tested on three children from the Jakaranda Children’s Home in Pretoria. Chapter 8 indicates the results of the empirical research as well as the interpretation thereof. The focus of this chapter is on the results as referring to the changes in the respondent’s experience of compliance, relationships, security and anxiety. The research results clearly shows that the three respondents were helped by the intervention and that they were no longer overwhelmed by their experience of the sexual abuse. The study is concluded in Chapter 8 with some remarks in summary and proposals for further research. / Thesis (DPhil (Social Work))--University of Pretoria, 2005. / Social Work and Criminology / unrestricted

Contexte: Le retard de croissance intra-utérin (RCIU) désigne l’incapacité du fœtus à atteindre son potentiel de croissance déterminé génétiquement en raison de diverses causes. Il est défini le plus souvent par un poids de naissance inférieur au 10ème percentile pour l’âge gestationnel sur les courbes néonatales. Ce travail de thèse a comme objectif de répondre aux questions non-résolues sur la définition et les conséquences du RCIU dans le contexte de la grande prématurité: (1) Quelle est la meilleure définition du RCIU à utiliser pour identifier les enfants à risque ? (2) Quels sont les risques de mortalité et de morbidités néonatales respiratoires et neurologiques associés au RCIU et existe-t-il des interactions avec les pathologies de la grossesse responsables de cette naissance très prématurée ? (3) Quel est l’impact du RCIU sur le devenir neuro-développemental à 2 ans, en particulier chez les enfants nés extrêmement prématurément ? Méthodes: Nous avons utilisé deux sources de données. L’étude MOSAIC (Models for OrganiSing Access to Intensive Care for Very Preterm Babies in Europe) est une étude européenne en population qui porte sur l’ensemble des naissances survenues entre 22 et 31 semaines d’aménorrhée en 2003 dans dix régions européennes. Les enfants ont été suivis jusqu’à la sortie d’hospitalisation (population d’étude : 4525 enfants). La deuxième source est une cohorte d’enfants nés avant 27SA qui ont été hospitalisés dans le service de réanimation néonatale à l'hôpital de Port-Royal de 1999 à 2008 et qui ont eu un examen pédiatrique et une évaluation selon l’échelle de Brunet-Lézine qui inclut quatre domaines du développement global de l’enfant : la motricité globale, la motricité fine, le langage et l’interaction sociale (445 enfants admis, 268 enfants suivis à 2 ans). Résultats: Dans les deux populations, les risques de décès et de dysplasie broncho-pulmonaire étaient plus élevés pour les enfants ayant un poids de naissance <10éme percentile des courbes néonatales, mais également pour des enfants avec un poids plus élevé (entre le 10éme et le 24éme percentile des courbes néonatales ou <10ème percentile des courbes fœtales). Par contre, il n’y avait pas de lien entre les complications neurologiques et le faible poids, ni d’interaction avec les pathologies de la grossesse. Le RCIU était associé à un risque élevé du retard neurocognitif à deux ans d’âge corrigé chez les extrêmes prématurés, surtout dans le domaine de la motricité fine et de l’interaction sociale mais pas dans le domaine du langage et de la motricité globale. Nous n’avons pas trouvé d’association entre le RCIU et le risque d’infirmité motrice cérébrale à deux ans d’âge corrigé. Conclusions: L’utilisation du 10ème percentile des courbes néonatales n’est pas adaptée pour identifier l’impact du RCIU chez les grands prématurés ; l’utilisation de multiples seuils ou de courbes de croissance fœtale est nécessaire. Le RCIU accroit les risques de mortalité et de dysplasie broncho-pulmonaire, mais n’est pas associé aux lésions cérébrales sévères ; ces associations sont observées dans différents contextes périnatals (pathologies vasculaires et infectieuses, et naissances à des âges gestationnels très précoces). Le RCIU représente un facteur pronostic défavorable pour le neuro-développement à moyen terme. Nos résultats soulèvent de nouvelles questions sur le suivi adapté pour les enfants ayant un RCIU après leur sortie de l’hôpital et aussi sur les éventuels mécanismes biologiques pouvant expliquer les liens entre le RCIU avec une morbidité respiratoire et certains domaines du développement neurocognitif à moyen terme. / Background: Intrauterine growth restriction (IUGR) refers to the inability of the fetus to achieve its genetically determined growth potential due to various causes. Most often, it is defined by a birth weight less than the 10th percentile for gestational age using neonatal growth curves. This thesis aims to answer unresolved questions about the definition and consequences of IUGR in the context of very preterm birth: (1) what is the best definition of IUGR for identifying children at risk? (2) What are the risks of mortality and neonatal respiratory and neurological morbidity associated with IUGR and are there interactions with the underlying pregnancy complications responsible for the very preterm birth? (3) What is the impact of IUGR on neurodevelopmental at 2 years, especially for children born extremely preterm ? Methods: We used two data sources. The MOSAIC study (Models for Organising Access to Intensive Care for Very Preterm Babies in Europe) is a European population-based study that included all births occurring between 22 and 31 weeks of gestation in 2003 in ten European regions. The children were followed until hospital discharge (study population = 4525 infants). The second source is a cohort of children born before 27 weeks of GA who were hospitalized in the neonatal intensive care unit at the Port Royal Hospital from 1999 to 2008 and had a pediatric examination and Brunet-Lézine (BL) neurodevelopmental assessment at 2 years of corrected age (445 children in the cohort, 268children followed at 2 years). The BL assessment includes four areas of child development: gross motor, fine motor, language and social interaction skills. Results: In both populations, the risk of death and bronchopulmonary dysplasia were higher for children with a birth weight <10th percentile of neonatal growth curves but also for children with a higher birth weight (between the 10th and the 24th percentile of neonatal growth curves or <10th percentile of fetal growth curves). In contrast, there was no link between neurological complications and low birth weight and no interactions with pregnancy complications. IUGR was associated with neurocognitive delay among extremely preterm children evaluated at two years of corrected age, especially for fine motor and social interaction skills, but not for language and gross motor skills. We did not find any association between IUGR and the risk of cerebral palsy at two years of corrected age. Conclusions: The use of the 10th percentile of neonatal growth curves is not suitable for identifying the impact of IUGR in very preterm infants; using higher thresholds or fetal growth curves is necessary. IUGR increased the risks of mortality and bronchopulmonary dysplasia, but was not associated with severe brain damage; these associations are observed in multiple clinical contexts (vascular and infectious pregnancy complications, and births at very early gestational ages). IUGR is a risk factor for poor medium-term neuro-development. Our results raise new questions about the appropriate surveillance for children with IUGR after discharge from the hospital and also about possible biological mechanisms that could explain the relationship between IUGR and respiratory morbidity and neurocognitive development.

Les pneumonies chez l’enfant de moins de 5 ans restent à l’heure actuelle un enjeu majeur de santé publique. Afin d’étudier les agents étiologiques des pneumonies chez les enfants de moins de 5 ans dans les pays à revenu faible ou intermédiaire, une étude cas-témoins a été réalisée entre 2010 et 2014 dans cette population par le réseau Global Approach for Biological Research on Infectious Epidemics in Low Income Countries (GABRIEL). Notre travail s’est attaché à décrire la distribution des sérotypes de Streptococcus pneumoniae retrouvés dans la population de l’étude, d’évaluer la prévalence du virus infuenza et d’évaluer l’effet du virus sur la gravité de la pneumonie, et enfin d’étudier la fréquence des co-détections bactériennes et virales au niveau nasopharyngé ainsi que leur effet sur le risque de pneumonie. Les résultats montraient que la majorité des sérotypes pneumococciques retrouvés étaient inclus dans le vaccin pneumococcique conjugué 13-valent (PCV13) et suggèraient que les souches de S. pneumoniae retrouvées au niveau nasopharyngé et au niveau sanguin étaient identiques chez un même individu atteint de pneumonie. L’importance du virus influenza, et particulièrement d’influenza A H1N1 a été soulignée. Enfin, de nombreuses co-détections nasopharyngées de microorganismes étaient observées chez les cas mais aussi chez les témoins. Leur pathogénicité semblait différer selon les espèces et pourrait dépendre des interactions avec le microbiome du tractus respiratoire. Les résultats suggèraient que la mise en œuvre de campagnes de vaccination par PCV13 pourrait être efficace dans les pays étudiés. Néanmoins, de nouvelles études précisant le rôle des co-détections entre bactéries et virus dans la physiopathologie de la pneumonie sont nécessaires pour guider les décisions de santé publique de façon optimale / Pneumonia remains a public health issue in children under 5 years old. In order to study the etiological agents of pneumonia in this population, a case-control study was carried out between 2010 and 2014 by the Global Approach for Biological Research on Infectious Epidemics in Low Income Countries (GABRIEL) Network in 9 study sites located in 8 low or middle-income countries. The objectives of the present work were to describe the distribution of Streptococcus pneumoniae serotypes, to assess the burden of influenza virus and its effect on the severity of pneumonia, and to study bacterial/viral co-detection in nasopharyngeal samples and their effect on the risk of pneumonia. Results showed that most of S. pneumoniae serotypes detected were included in the pneumococcal 13-Valent conjugate vaccine (PCV13) and confirmed the assumption that the isolate carrying or causing disease in an individual were of the same serotype. The importance of the burden of influenza virus in pneumonia cases, and particularly A H1N1 influenza, was highlighted. Finally, numerous nasopharyngeal co-detections were found both in pneumonia cases and in control subjects. Pathogenicity of microorganisms differs between species and might depend of the interactions with the microbiome of the respiratory tract. Results suggested that the implementation of PCV13 vaccination policies might be effective in the study population. Nevertheless, further studies focused on the most important co-detections of micro-organisms are needed to improve the understanding of their role in the pathogenesis of pneumonia and to guide appropriate public health interventions