Le brossage des dents, la mastication des aliments et toutes autres activités orales quotidiennes peuvent provoquer une bactériémie transitoire. Cette bactériémie transitoire a le potentiel de causer une endocardite infectieuse en présence de certains facteurs de risque. Les cardiopathies congénitales chez les enfants font partie de ces facteurs de risque. Le contrôle de la plaque dentaire et une bonne santé buccodentaire permettent de réduire le risque d’endocardite infectieuse. Les objectifs du présent projet de recherche visent à évaluer les connaissances des parents d’enfants atteints de cardiopathies congénitales sur l’endocardite infectieuse et son lien avec la santé buccodentaire et de connaître les habitudes d’hygiène orale personnelles et professionnelles adoptées par les enfants atteints de cardiopathies congénitales. Le projet de recherche vise également à évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les enfants atteints de cardiopathies congénitales. La procédure expérimentale implique que tous les parents ou gardiens légaux d’enfants atteints de cardiopathies congénitales, âgés entre 6 et 12 ans qui visitent le service de cardiologie du CHU Sainte-Justine sont sollicités à participer au projet de recherche. Un formulaire d’information et de consentement ainsi qu’un questionnaire sont remis aux parents. Le questionnaire vise à évaluer la connaissance des parents d’enfants atteints de cardiopathies congénitales sur ce qu’est l’endocardite infectieuse et son lien avec la santé buccodentaire ainsi que de connaître les habitudes d’hygiène orale personnelles et professionnelles des enfants atteints de cardiopathies congénitales. L’examen clinique nécessaire au projet de recherche implique le prélèvement d’un indice de plaque Quigley & Hein, Turesky modifié avant et après que l’enfant participant au projet de recherche ait appliqué les instructions d’hygiène orale reçues. L’enfant est assigné à l’une des deux méthodes d’instructions d’hygiène orale avec l’aide d’une table de randomisation. La méthode d’instructions d’hygiène orale du groupe 1 correspond à des instructions transmises par le cardiologue tandis que la méthode d’instructions d’hygiène orale du groupe 2 correspond aux instructions transmises par l’intermédiaire d’un document audio visuel. Des analyses chi-carré et des tests de T pairé ainsi que des analyses de variance univariée (one-way ANOVA) et des analyses de corrélation de Pearson entre le questionnaire et les données cliniques ont été effectuées pour analyser les données recueillies. Les résultats démontrent que les parents d’enfants « à risque élevé » d’effet adverse d’une endocardite infectieuse ne connaissent pas davantage le risque d’endocardite infectieuse d’origine buccodentaire que les parents d’enfants « de moindre risque » (p=0,104). Les résultats démontrent toutefois que les parents d’enfants atteints de cardiopathies congénitales qui connaissent le risque d’endocardite infectieuse et son lien avec la santé buccodentaire adhèrent à des comportements dans le but de maintenir une bonne santé buccodentaire chez leur enfant. Les résultats qui proviennent de l’examen clinique démontrent que l’application des instructions d’hygiène orale faites par le cardiologue et par l’intermédiaire d’un document audio visuel permettent d’observer une différence statistiquement significative (p=0,000) au niveau du contrôle de la plaque dans chacun de ces groupes. Toutefois, aucune différence statistiquement significative (p=0,668) n’a pu être démontrée entre les deux méthodes d’instructions d’hygiène orale. Les parents qui connaissent le lien entre la santé buccodentaire et le risque d’endocardite infectieuse pour leur enfant atteint de cardiopathie congénitale adoptent un comportement pour optimiser la santé buccodentaire de leur enfant. Les instructions d’hygiène orale par l’intermédiaire d’un document audio visuel sont équivalentes aux instructions d’hygiène orale prodiguées par le cardiologue. / Tooth brushing and food chewing are among the oral activities that can cause transient bacteremia. A transient bacteremia can initiate infective endocarditis in patients at risk. Risk factors for infective endocarditis in children include most congenital heart diseases and it has been shown that effective plaque control and good oral hygiene can reduce the risk for infective endocarditis initiated by bacteria of oral origin. The present research objectives were drawn up to evaluate the level of knowledge of parents of children with congenital heart disease on infective endocarditis and its relation to oral health. Our other research objective was to probe the oral hygiene habits of children with congenital heart disease. The efficacy of two oral hygiene instructional methods in children with congenital heart disease was also evaluated. The experimental procedure meant the involvement of all the parents of children with congenital heart disease, between 6 and 12 years old who were visiting the department of cardiology at the CHU Sainte-Justine. They were solicited to participate in the research project and were given an information and consent form. All parents who agreed to participate were given the questionnaire that was used to evaluate the knowledge of parents of children with congenital heart disease on infective endocarditis and its association with oral health. The questionnaire also aimed to know the personal and professional oral hygiene habits of children with congenital heart disease. A clinical exam performed on each child cited the Quigley & Hein, Turesky modified plaque index before and after the utilization of the assigned oral hygiene instructions. Each child was assigned to one of the two oral hygiene instruction groups through a randomization table. The method of oral hygiene instructions of group 1 corresponded to the instructions given by the cardiologist and the method of oral hygiene instructions of group 2 corresponded the to instructions given by an audio visual presentation. Paired T-test and Chi-square analyses, as well as one-way ANOVA analysis and Pearson’s correlation analysis were produced to evaluate the data. The results demonstrated that the knowledge of the association between oral health and infective endocarditis was not superior in parents of children with higher risk of adverse effect from infective endocarditis than in parents of children with a lesser risk (p=0,104). Interestingly enough, parents of children with a congenital heart disease that are knowledgeable about the association will adopt preventive behaviors in order to promote their child’s oral heath and reduce their risk for infective endocarditis. The clinical exam also demonstrated that both oral hygiene instructions methods were effective for plaque control (p=0,000) but no significant statistical difference was found between the two methods (p=0,668). The parents of children with congenital heart disease that are aware of the association between oral health and infective endocarditis demonstrated preventive oral health behaviors to promote oral health in comparison with the parents who lacked the knowledge. The oral hygiene instructions methods given by way of the audio visual presentation was not superior to those given by the cardiologist.

Objetivos: Investigar anomalias dentárias, presença de fissura de lábio e/ou palato e higiene bucal em indivíduos com síndrome de Kabuki (SK) e listar as alterações sistêmicas presentes. Metodologia: Grupo 1: 46 prontuários de indivíduos com SK matriculados no HRAC/USP analisados quanto a presença de fissura de lábio e/ou palato e listadas as alterações sistêmicas presentes (cardiopatias, doenças infecciosas e imunológicas, nefropatias, comprometimento neurológicos e repercussões, aspectos genéticos). Grupo 2: formado por 15 indivíduos com SK matriculados no HRAC/USP submetidos aos exames clínicos para a investigação das alterações bucais (anomalias dentárias, presença de fissura de lábio e/ou palato e avaliação da higiene bucal índice de placa) e doenças sistêmicas existentes. Resultados: Grupo 1 43 (93,47%) indivíduos apresentaram fissura de lábio e/ou palato, 36 apresentaram fissura de palato; 17 (36,95%) indivíduos apresentaram cardiopatia congênita, 36 (76,59%) indivíduos tiveram doenças infecciosas ou imunológicas, 8 (17,39%) indivíduos apresentaram nefropatias, 40 (86,95%) indivíduos tinham deficiência intelectual e 1 (2,77%) indivíduos apresentou cariótipo com alteração. Grupo 2 todos os indivíduos com SK apresentaram fissura de lábio e/ou palato, 11 (73,33%) indivíduos apresentaram anomalias dentárias, todos os indivíduos apresentaram comprometimento da higiene bucal, 5 (33,33%) indivíduos apresentaram cardiopatias congênitas, 12 (80%) tiveram doenças infecciosas ou imunológicas, em um indivíduo foi notada nefropatia, 14 (93,33%) indivíduos demonstraram deficiência intelectual e 1 (6,66%) apresentou cariótipo alterado. Conclusões: Os indivíduos com SK apresentaram anomalias dentárias, fissura de lábio e/ou palato, higiene bucal comprometida, cardiopatias congênitas, doenças infecciosas e deficiência intelectual. / Aim: To investigate dental anomalies, presence of lip and/or cleft palate and dental hygiene in individuals with Kabuki Syndrome (KS) as well as detail their systemic alterations. Methodology: GROUP 1: 46 prontuaries of individuals with KS (patients from HRAC/USP) were analyzed concerning to the presence of lip and cleft palate and their systemic alterations were described (cardiopathies, infectious and immunological diseases, nephropathies, neurological disorders and genetical aspects). GROUP 2: 15 individuals with KS (patients from HRAC/USP) submitted to the clinical examination to investigate buccal alterations (dental anomalies, presence of lip and/or cleft palate and dental hygiene - plaque index) and systemic alterations. Results: Group 1 - 43 (93.47%) individuals showed lip and/or cleft palate, 36 showed cleft palate; 17 (36.95%) individuals showed congenic cardiopathies, 36 (36.95%) individuals showed infectious or immunological diseases, 8 (17.39%) individuals showed nephropathies, 40 (86.95%) individuals had intellectual disability and 1 (2.77%) individuals showed cariotip with alteration. Group 2 - all the individuals with KS showed lip and/or cleft palate, 11 (73.33%) individuals showed dental anomalies, all the individuals showed compromised dental hygiene, 5 (33.33%) individuals showed congenic cardiopathies, 12 (80%) showed infectious or immunological diseases, in only 1 individual nephropathy was observed, 14 (93.33%) had intellectual disabilities and 1 (6.66%) showed a cariotip with alteration. Conclusions: Individuals with KS showed dental anomalies, presence of lip and/or cleft palate, compromised buccal hygiene, congenic cardiopathies, infectious diseases and intellectual disability.

Submitted by Eunice Novais (enovais@uepg.br) on 2018-08-30T17:43:30Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Claudiane Ayres P.pdf: 1202728 bytes, checksum: 2b48ec7440eb9f77288374dd442bfe90 (MD5) / Made available in DSpace on 2018-08-30T17:43:30Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Claudiane Ayres P.pdf: 1202728 bytes, checksum: 2b48ec7440eb9f77288374dd442bfe90 (MD5) Previous issue date: 2018-02-27 / A pressão intracraniana (PIC) tem variações determinadas pelos ciclos respiratórios e cardíacos, portanto, acredita-se que lesões cardiovasculares podem ocasionar modificações na PIC. As doenças cardiovasculares (DCVs) estão dentre as principais causas de morte nos países desenvolvidos e em desenvolvimento e frequentemente, para o seu tratamento, torna-se necessário a realização de cirurgia cardíaca. Porém, pacientes submetidos a tais procedimentos desenvolvem complicações relacionadas a disfunções cardiopulmonares. A fim de minimizar as complicações decorrentes da cirurgia, a fisioterapia, como parte da reabilitação cardiopulmonar é capaz de controlar os sintomas respiratórios e melhorar a função cardiovascular, atuando através de exercícios aeróbicos e respiratórios. Este trabalho teve como objetivo monitorar a PIC, a força muscular respiratória e os sinais vitais de pacientes pré- e pós- cirurgia cardíaca e comparar os efeitos de dois protocolos de fisioterapia na recuperação da força muscular respiratória. Participaram do estudo 48 pacientes. Observou-se que as DCVs podem alterar a PIC de pacientes acometidos por tais patologias. Independente do protocolo utilizado, a realização da fisioterapia como parte da reabilitação cardiorrespiratória é benéfica para a recuperação cardiopulmonar dos pacientes submetidos à cirurgia cardíaca. / Intracranial pressure (ICP) has variations determined by respiratory and cardiac cycles, therefore, it is believed that cardiovascular lesions may cause changes in ICP. Cardiovascular diseases (CVDs) are among the leading causes of death in developed and developing countries, and it is often necessary to perform cardiac surgery for their treatment. However, patients submitted to such procedures develop complications related to cardiopulmonary dysfunctions. In order to minimize the complications resulting from surgery, physical therapy as part of cardiopulmonary rehabilitation is able to control respiratory symptoms and improve cardiovascular function by acting through aerobic and respiratory exercises. The objective of this study was to monitor ICP, respiratory muscle strength and vital signs of pre- and post-cardiac surgery patients, and to compare the effects of two physiotherapy protocols on respiratory muscle strength recovery. 48 patients participated in the study. It has been observed that CVDs can alter ICP in patients affected by such pathologies. Regardless of the protocol used, the performance of physiotherapy as part of cardiorespiratory rehabilitation is beneficial for the cardiopulmonary recovery of patients undergoing cardiac surgery.

L’objectif est de tester les associations de marqueurs inflammatoires et lipidiques avec la survenue de cardiopathies ischémiques chez la personne âgée non institutionnalisée. Les analyses sont menées dans une étude cas cohorte dans le cadre de l’étude des 3 Cités. Elle inclut 199 sujets ayant développé un premier évènement coronaire sur 4 ans de suivi et 1086 sujets sans antécédents cardiovasculaires (sous cohorte). Un premier travail suggère que la protéine C-réactive (CRP-US) est un marqueur de risque indépendant des évènements coronaires (risque relatif standardisé du log de la CRP-US=1,27 ; IC95%=1,08-1,64) mais n’améliore pas la prédiction du risque coronaire. Le second travail démontre une hétérogénéité dans l’association des lipides classiques et des apolipoprotéines avec les évènements coronaires selon la prise et la nature du traitement hypolipémiant à l’inclusion. Le troisième travail indique que les apolipoprotéines AI et B100 mais pas le non-HDL cholestérol améliorent significativement la prédiction du risque coronaire sur la base d’indice de reclassification. / The aim was investigate associations of inflammatory and lipids markers with occurrence of ischaemic heart disease (IHD) in community dwelling elderly subjects. Within the Three City Study, a case cohort study was used including 199 subjects with first coronary events over 4 years and 1086 participants free from prevalent cardiovascular disease (random sample). The first paper showed that C-reactive protein was independently associated with IHD (standardized hazard ratio of log CRP-US=1.27; CI95%=1.08-1.64) but did not improve IHD risk prediction beyond usual risk factors. The second paper showed heterogeneity in the association between lipids and apolipoproteins with IHD depending on the use and the type of lipid-lowering therapy (statins or fibrates). Using imputations and reclassification metrics, the third paper suggests that apolipoproteins AI and B100 added significant predictive information beyond usual risk factors for IHD risk prediction.

Le brossage des dents, la mastication des aliments et toutes autres activités orales quotidiennes peuvent provoquer une bactériémie transitoire. Cette bactériémie transitoire a le potentiel de causer une endocardite infectieuse en présence de certains facteurs de risque. Les cardiopathies congénitales chez les enfants font partie de ces facteurs de risque. Le contrôle de la plaque dentaire et une bonne santé buccodentaire permettent de réduire le risque d’endocardite infectieuse. Les objectifs du présent projet de recherche visent à évaluer les connaissances des parents d’enfants atteints de cardiopathies congénitales sur l’endocardite infectieuse et son lien avec la santé buccodentaire et de connaître les habitudes d’hygiène orale personnelles et professionnelles adoptées par les enfants atteints de cardiopathies congénitales. Le projet de recherche vise également à évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les enfants atteints de cardiopathies congénitales. La procédure expérimentale implique que tous les parents ou gardiens légaux d’enfants atteints de cardiopathies congénitales, âgés entre 6 et 12 ans qui visitent le service de cardiologie du CHU Sainte-Justine sont sollicités à participer au projet de recherche. Un formulaire d’information et de consentement ainsi qu’un questionnaire sont remis aux parents. Le questionnaire vise à évaluer la connaissance des parents d’enfants atteints de cardiopathies congénitales sur ce qu’est l’endocardite infectieuse et son lien avec la santé buccodentaire ainsi que de connaître les habitudes d’hygiène orale personnelles et professionnelles des enfants atteints de cardiopathies congénitales. L’examen clinique nécessaire au projet de recherche implique le prélèvement d’un indice de plaque Quigley & Hein, Turesky modifié avant et après que l’enfant participant au projet de recherche ait appliqué les instructions d’hygiène orale reçues. L’enfant est assigné à l’une des deux méthodes d’instructions d’hygiène orale avec l’aide d’une table de randomisation. La méthode d’instructions d’hygiène orale du groupe 1 correspond à des instructions transmises par le cardiologue tandis que la méthode d’instructions d’hygiène orale du groupe 2 correspond aux instructions transmises par l’intermédiaire d’un document audio visuel. Des analyses chi-carré et des tests de T pairé ainsi que des analyses de variance univariée (one-way ANOVA) et des analyses de corrélation de Pearson entre le questionnaire et les données cliniques ont été effectuées pour analyser les données recueillies. Les résultats démontrent que les parents d’enfants « à risque élevé » d’effet adverse d’une endocardite infectieuse ne connaissent pas davantage le risque d’endocardite infectieuse d’origine buccodentaire que les parents d’enfants « de moindre risque » (p=0,104). Les résultats démontrent toutefois que les parents d’enfants atteints de cardiopathies congénitales qui connaissent le risque d’endocardite infectieuse et son lien avec la santé buccodentaire adhèrent à des comportements dans le but de maintenir une bonne santé buccodentaire chez leur enfant. Les résultats qui proviennent de l’examen clinique démontrent que l’application des instructions d’hygiène orale faites par le cardiologue et par l’intermédiaire d’un document audio visuel permettent d’observer une différence statistiquement significative (p=0,000) au niveau du contrôle de la plaque dans chacun de ces groupes. Toutefois, aucune différence statistiquement significative (p=0,668) n’a pu être démontrée entre les deux méthodes d’instructions d’hygiène orale. Les parents qui connaissent le lien entre la santé buccodentaire et le risque d’endocardite infectieuse pour leur enfant atteint de cardiopathie congénitale adoptent un comportement pour optimiser la santé buccodentaire de leur enfant. Les instructions d’hygiène orale par l’intermédiaire d’un document audio visuel sont équivalentes aux instructions d’hygiène orale prodiguées par le cardiologue. / Tooth brushing and food chewing are among the oral activities that can cause transient bacteremia. A transient bacteremia can initiate infective endocarditis in patients at risk. Risk factors for infective endocarditis in children include most congenital heart diseases and it has been shown that effective plaque control and good oral hygiene can reduce the risk for infective endocarditis initiated by bacteria of oral origin. The present research objectives were drawn up to evaluate the level of knowledge of parents of children with congenital heart disease on infective endocarditis and its relation to oral health. Our other research objective was to probe the oral hygiene habits of children with congenital heart disease. The efficacy of two oral hygiene instructional methods in children with congenital heart disease was also evaluated. The experimental procedure meant the involvement of all the parents of children with congenital heart disease, between 6 and 12 years old who were visiting the department of cardiology at the CHU Sainte-Justine. They were solicited to participate in the research project and were given an information and consent form. All parents who agreed to participate were given the questionnaire that was used to evaluate the knowledge of parents of children with congenital heart disease on infective endocarditis and its association with oral health. The questionnaire also aimed to know the personal and professional oral hygiene habits of children with congenital heart disease. A clinical exam performed on each child cited the Quigley & Hein, Turesky modified plaque index before and after the utilization of the assigned oral hygiene instructions. Each child was assigned to one of the two oral hygiene instruction groups through a randomization table. The method of oral hygiene instructions of group 1 corresponded to the instructions given by the cardiologist and the method of oral hygiene instructions of group 2 corresponded the to instructions given by an audio visual presentation. Paired T-test and Chi-square analyses, as well as one-way ANOVA analysis and Pearson’s correlation analysis were produced to evaluate the data. The results demonstrated that the knowledge of the association between oral health and infective endocarditis was not superior in parents of children with higher risk of adverse effect from infective endocarditis than in parents of children with a lesser risk (p=0,104). Interestingly enough, parents of children with a congenital heart disease that are knowledgeable about the association will adopt preventive behaviors in order to promote their child’s oral heath and reduce their risk for infective endocarditis. The clinical exam also demonstrated that both oral hygiene instructions methods were effective for plaque control (p=0,000) but no significant statistical difference was found between the two methods (p=0,668). The parents of children with congenital heart disease that are aware of the association between oral health and infective endocarditis demonstrated preventive oral health behaviors to promote oral health in comparison with the parents who lacked the knowledge. The oral hygiene instructions methods given by way of the audio visual presentation was not superior to those given by the cardiologist.

Objetivos: Investigar anomalias dentárias, presença de fissura de lábio e/ou palato e higiene bucal em indivíduos com síndrome de Kabuki (SK) e listar as alterações sistêmicas presentes. Metodologia: Grupo 1: 46 prontuários de indivíduos com SK matriculados no HRAC/USP analisados quanto a presença de fissura de lábio e/ou palato e listadas as alterações sistêmicas presentes (cardiopatias, doenças infecciosas e imunológicas, nefropatias, comprometimento neurológicos e repercussões, aspectos genéticos). Grupo 2: formado por 15 indivíduos com SK matriculados no HRAC/USP submetidos aos exames clínicos para a investigação das alterações bucais (anomalias dentárias, presença de fissura de lábio e/ou palato e avaliação da higiene bucal índice de placa) e doenças sistêmicas existentes. Resultados: Grupo 1 43 (93,47%) indivíduos apresentaram fissura de lábio e/ou palato, 36 apresentaram fissura de palato; 17 (36,95%) indivíduos apresentaram cardiopatia congênita, 36 (76,59%) indivíduos tiveram doenças infecciosas ou imunológicas, 8 (17,39%) indivíduos apresentaram nefropatias, 40 (86,95%) indivíduos tinham deficiência intelectual e 1 (2,77%) indivíduos apresentou cariótipo com alteração. Grupo 2 todos os indivíduos com SK apresentaram fissura de lábio e/ou palato, 11 (73,33%) indivíduos apresentaram anomalias dentárias, todos os indivíduos apresentaram comprometimento da higiene bucal, 5 (33,33%) indivíduos apresentaram cardiopatias congênitas, 12 (80%) tiveram doenças infecciosas ou imunológicas, em um indivíduo foi notada nefropatia, 14 (93,33%) indivíduos demonstraram deficiência intelectual e 1 (6,66%) apresentou cariótipo alterado. Conclusões: Os indivíduos com SK apresentaram anomalias dentárias, fissura de lábio e/ou palato, higiene bucal comprometida, cardiopatias congênitas, doenças infecciosas e deficiência intelectual. / Aim: To investigate dental anomalies, presence of lip and/or cleft palate and dental hygiene in individuals with Kabuki Syndrome (KS) as well as detail their systemic alterations. Methodology: GROUP 1: 46 prontuaries of individuals with KS (patients from HRAC/USP) were analyzed concerning to the presence of lip and cleft palate and their systemic alterations were described (cardiopathies, infectious and immunological diseases, nephropathies, neurological disorders and genetical aspects). GROUP 2: 15 individuals with KS (patients from HRAC/USP) submitted to the clinical examination to investigate buccal alterations (dental anomalies, presence of lip and/or cleft palate and dental hygiene - plaque index) and systemic alterations. Results: Group 1 - 43 (93.47%) individuals showed lip and/or cleft palate, 36 showed cleft palate; 17 (36.95%) individuals showed congenic cardiopathies, 36 (36.95%) individuals showed infectious or immunological diseases, 8 (17.39%) individuals showed nephropathies, 40 (86.95%) individuals had intellectual disability and 1 (2.77%) individuals showed cariotip with alteration. Group 2 - all the individuals with KS showed lip and/or cleft palate, 11 (73.33%) individuals showed dental anomalies, all the individuals showed compromised dental hygiene, 5 (33.33%) individuals showed congenic cardiopathies, 12 (80%) showed infectious or immunological diseases, in only 1 individual nephropathy was observed, 14 (93.33%) had intellectual disabilities and 1 (6.66%) showed a cariotip with alteration. Conclusions: Individuals with KS showed dental anomalies, presence of lip and/or cleft palate, compromised buccal hygiene, congenic cardiopathies, infectious diseases and intellectual disability.

En 2015, les pathologies cardiovasculaires étaient responsables de 18 millions de décès par an dans le monde, ce qui en fait la principale cause de mortalité liée aux maladies non-transmissibles. Il a été mis en évidence que des changements de comportements multiples en termes d’activité physique, d’alimentation, de consommation de tabac, et d’observance médicamenteuse, représentaient des moyens efficaces de prévenir l’émergence de cardiopathies chez des populations générales, et des rechutes après un accident cardiaque. En psychologie sociale et de la santé, la compréhension des déterminants des comportements de santé s’est principalement appuyée sur deux approches : l’approche socio-cognitive et l’approche duale. Bien que ces modèles aient identifié plusieurs prédicteurs du comportement, ils sont porteurs de limites qui les rendent difficilement applicables au cadre du changement de comportements multiples. D’une part, ces approches proposent des déterminants spécifiques à un comportement, ce qui ne permet pas de comprendre ce qui détermine l’adoption de plusieurs comportements simultanément. D’autre part, ils ne prennent pas en compte la nature des comportements de santé. Or, les comportements diffèrent sur un certain nombre de caractéristiques, et les comportements pathogènes peuvent s’opposer aux comportements salutogènes, générant alors un conflit chez l’individu. Dans le cadre des changements de comportements multiples, une mauvaise gestion de ce conflit pourrait expliquer la prévalence des comportements pathogènes. Ce travail doctoral a investigué le rôle de deux processus de réduction du conflit pertinent dans le cadre du changement de comportements multiples : les cognitions compensatrices et le contrôle de soi. Plus précisément, ils ont cherché à évaluer (1) dans quelle mesure le mécanisme inter-comportemental des cognitions compensatrices pouvait perturber la formation d’intention envers des comportements de santé ; et (2) si le contrôle de soi était un déterminant aspécifique permettant l’émergence de plusieurs comportements de santé. Nous avons répondu à ces questionnements à travers quatre études empiriques décrites dans trois manuscrtis. Le premier a évalué le rôle délétère des cognitions compensatrices (en dissociant celles-ci selon la nature des comportements) sur la formation d’intentions envers différents comportements de santé, chez des individus atteints de cardiopathies. Les résultats ont montré que ces croyances peuvent avoir des effets négatifs sur les intentions à certains niveaux d’auto-efficacité et de risques perçus. Le deuxième manuscrit présente une étude qui a évalué dans quelle mesure le modèle du contrôle de soi, auquel nous avons intégré une mesure de l’état de la capacité de contrôle de soi, prédisait les comportements de santé. Nos résultats montrent des processus globalement différenciés selon le type de comportement : activité physique/sédentarité, alimentation équilibrée/déséquilibrée, et consommation de tabac. Plus précisément, ils suggèrent que l’effort de contrôle de soi prédirait les comportements pathogènes, et que l’état de la capacité de contrôle de soi prédirait les comportements salutogènes. Le troisième manuscrit a cherché à confirmer ces résultats chez deux populations, l’une d’étudiants, l’autre d’individus atteints de cardiopathies, en testant le modèle du contrôle de soi en contexte naturel et dans un devis longitudinal. Bien que des différences dans les patterns de résultats soient observés selon la population, les résultats semblent confirmer le rôle de l’effort de contrôle de soi sur les comportements pathogènes (sédentarité et alimentation déséquilibrée), et de la capacité de contrôle de soi sur les comportements salutogènes (activité physique). L’ensemble de ces résultats ouvrent la voie vers la construction d’interventions ciblant ces deux composants du modèle du contrôle de soi, afin d’améliorer l’adhérence aux comportements de santé chez des populations cardiaques. / In 2015, cardiovascular diseases caused 18 million deaths per year worldwide, which makes it the leading cause of death attributed to non-communicable diseases. Multiple health behaviors change in terms of physical activity, diet, tobacco consumption, and medication adherence represent one of the best ways to prevent cardiovascular diseases emergence on global population, and to prevent relapses on individual with cardiovascular diseases. To understand behaviors determinants, social and health psychology relies on two conceptual frameworks: socio-cognitive models and dual-process theories. These models identified several behavioral determinants, but two reasons could make their application difficult in the multiple health behavior change framework. First, these approaches proposed behavior-specific determinants that do not permit to understand what determines the simultaneous adoption of several behaviors. On the other hand, they do not consider behaviors characteristics. However, behavior characteristics could be different and unhealthy behaviors could confront healthy behaviors, and thus generate conflicts on an individual. Within the multiple health behavior change process, poor conflict-coping strategies could explain unhealthy behavior prevalence. This doctoral work has investigated role of two processes of conflict reduction within multiple health behavior change: compensatory health beliefs, and self-control. Specifically, they evaluated (1) to what extent compensatory health beliefs, a between-behavior belief, could harm intentions toward healthy behaviors; and (2) if self-control could be an unspecific determinant of multiple health behavior change. We conducted four empirical studies merged in three manuscripts to answer these questions. The first manuscript evaluated compensatory health beliefs harmful influences (by dissociating them according with behaviors nature) on intentions formation process toward several health behaviors, within individual with cardiovascular diseases. Results showed that these beliefs could harm intentions depending on certain self-efficacies and risks perception levels. The second manuscript presented a study that investigated to what extent the self-control model, with a measure of state self-control capacity, predicted health behaviors. Results highlighted different prediction patterns depending on behaviors domain: physical/sedentary activity, healthy/unhealthy diet, tobacco consumption. More precisely, results suggest that self-control effort predicted unhealthy behaviors, and state of self-control capacity predicted healthy ones. The third manuscript attempted to confirm these results on two populations. The first one was composed of students, and the second one was composed of individual with cardiovascular diseases, by testing self-control model on ecological context and with a longitudinal design. Despite differences within predictions patterns, depending on the population observed, results confirmed the role of self-control effort on unhealthy behaviors (sedentary time and unhealthy diet), and of state self-control capacity on healthy behavior (physical activity). Taking together, all these results pave the way to the development of interventions on these two self-control model components, in order to improve health behaviors adherence of individual with cardiovascular diseases.

L'objectif est de tester les associations de marqueurs inflammatoires et lipidiques avec la survenue de cardiopathies ischémiques chez la personne âgée non institutionnalisée. Les analyses sont menées dans une étude cas cohorte dans le cadre de l'étude des 3 Cités. Elle inclut 199 sujets ayant développé un premier évènement coronaire sur 4 ans de suivi et 1086 sujets sans antécédents cardiovasculaires (sous cohorte). Un premier travail suggère que la protéine C-réactive (CRP-US) est un marqueur de risque indépendant des évènements coronaires (risque relatif standardisé du log de la CRP-US=1,27 ; IC95%=1,08-1,64) mais n'améliore pas la prédiction du risque coronaire. Le second travail démontre une hétérogénéité dans l'association des lipides classiques et des apolipoprotéines avec les évènements coronaires selon la prise et la nature du traitement hypolipémiant à l'inclusion. Le troisième travail indique que les apolipoprotéines AI et B100 mais pas le non-HDL cholestérol améliorent significativement la prédiction du risque coronaire sur la base d'indice de reclassification.

Les cardiopathies congénitales cyanogènes (CCC) sont des malformations cardiaques qui entraînent une désaturation en oxygène à la naissance. Des progrès majeurs réalisés ces vingt dernières années dans la prise en charge médico-chirurgicale des nouveau-nés atteints de CCC ont permis de considérablement améliorer la survie et le pronostic cardiaque à long terme de cette population. Cependant, ces enfants sont exposés à un risque accru d’accidents neurologiques dû au caractère cyanogène de la cardiopathie et à certaines techniques de chirurgie à cœur ouvert. En conséquence, les troubles neurocognitifs font partie des principales morbidités résiduelles. Malgré l’augmentation exponentielle du nombre de patients qui atteignent dorénavant l’âge adulte, à ce jour très peu d’études ont investigué le devenir neuropsychologique des adultes opérés de CCC. Cette thèse a pour objectif principal d’évaluer le devenir neuropsychologique et psychosocial d’adultes ayant été opérés à cœur ouvert en période néonatale pour corriger une CCC. L’évaluation, qui repose sur des outils validés, est menée auprès de 67 patients âgés de 18 à 31 ans. Les résultats mettent en évidence qu’une proportion substantielle de patients présente des troubles cognitifs et émotionnels susceptibles de réduire leur qualité de vie et d’entraver leur réussite scolaire et leur insertion professionnelle. Ce travail offre des résultats pionniers concernant le devenir à long terme de cette population. D'autres études sont nécessaires pour mieux comprendre la trajectoire développementale des adultes opérés de CCC afin de mettre en place des stratégies préventives et thérapeutiques adaptées aux besoins de cette population. / Cyanotic congenital heart diseases (CHD) are heart defects which cause oxygen desaturation at birth. In the last twenty years, the major progress in the medical and surgical care of newborns with cyanotic CHD has resulted in a considerable improvement of the survival and the long-term cardiac prognosis of this population. However, these children are at an increased risk of neurological injuries due not only to the cyanotic nature of their CHD but also to certain open-heart surgery techniques. Consequently, neurocognitive disorders are among the major remaining morbidities in this population. Despite the exponential increase in the number of patients who can now reach adulthood, to date very few studies have investigated the neuropsychological outcomes of adults with cyanotic CHD. The main objective of the present thesis is to evaluate the neuropsychological and psychosocial outcomes of adults who had undergone an open-heart surgery during the neonatal period in order to correct a cyanotic CHD. The assessment, based on validated tools, is conducted among 67 patients aged from 18 to 31 years. The results show that a substantial proportion of patients with TGA presents a number of cognitive deficits and emotional impairments which may reduce their quality of life and hinder their academic success and their professional integration. This thesis offers original results on the long-term neuropsychological and psychosocial outcomes of this population. Further studies are needed so as to better understand the developmental trajectory of adults with cyanotic CHD in order to develop preventive and therapeutic strategies adapted to the specific needs of this population.

OBJETIVO: Analisar as freqüências de malformações congênitas detectadas ao nascimento no Rio Grande do Sul, enfocando especialmente aquelas passíveis de Diagnóstico Pré-Natal através do Estudo Morfológico Fetal, para sugerir, ao final, uma rotina mínima de exame ultra-sonográfico fetal. MÉTODOS: Inicialmente realizou-se um estudo descritivo de base populacional dos bancos de dados oficiais do Rio Grande do Sul referentes aos defeitos congênitos no estado. Foi delimitado o período de 2001 a 2005, sendo incluídos todos recém-nascidos vivos que foram registrados ao nascimento como portadores de uma ou mais anomalias congênitas na Declaração de Nascidos Vivos. Foram incluídos também os nascidos vivos falecidos com menos de um ano, com causa mortis atribuída a um defeito congênito e os óbitos fetais cuja Declaração de Óbito registrou defeitos congênitos. Para fins deste estudo, foram analisados 25 defeitos ou grupos de defeitos, levando em conta suas prevalências relatadas na literatura, gravidade, possibilidade de diagnóstico pré-natal ou no exame do recém-nascido. A seguir foram estudadas as possibilidades de Diagnóstico Pré-Natal dos principais defeitos congênitos através da ultra-sonografia, tendo como base na literatura atual e buscando-se elaborar uma rotina mínima de exame fetal. RESULTADOS: Os 25 defeitos ou grupos de defeitos representaram 81,74% do total dos 6.236 recém nascidos com defeitos identificados no nascimento. No período de 2001-2005 nasceram no estado 765.230 bebês, com média anual de 153.046. A ocorrência geral de defeitos diagnosticados no nascimento no período foi de 0,81%, sendo relatadas as freqüências específicas daqueles 25 defeitos. Identificou-se que 787 casos de defeitos congênitos que faleceram no 1º ano de vida não foram diagnosticados ao nascimento. Calculou-se que para cada caso de cardiopatia diagnosticado no nascimento cerca de 3 casos não foram percebidos e faleceram no 1º ano de vida. Estes cálculos foram expressivos também para trissomias do 13 e 18 (3:1) e sistema nervoso central (1,28:1). CONCLUSÕES: A análise das freqüências de defeitos congênitos no Rio Grande do Sul mostrou que 25 defeitos ou grupo de defeitos representam mais de 80% do total das ocorrências no estado. Alguns defeitos congênitos registrados ao nascimento no Campo 34 da Declaração de Nascidos Vivos parecem estar subestimados, especialmente aqueles cujo diagnóstico necessita de exames especializados, como as cardiopatias congênitas. Este estudo sugere que com a avaliação ultra-sonográfica de 18 planos da anatomia fetal se pode rastrear a maioria dos defeitos congênitos do nosso meio. / OBJECTIVE: To analyze the frequency of congenital defects detected at birth in Rio Grande do Sul, focusing mainly on those that can be diagnosed prenatally by a Fetal Morphological Ultrasound Study, and finally, to suggest a minimum routine for fetal ultrasonographic examination. METHODS: Initially a population-based descriptive study was performed of the Rio Grande do Sul (RS) state official database referring to congenital defects in the state. The period from 2001 to 2005 was delimited, and all livebirths recorded in the Declaration of Livebirths as having one or more congenital anomalies were included. Babies born alive who died at less that one year of age were also included if their cause of death was attributed to a congenital defect, and the fetal deaths when the Death Declaration recorded congenital defects. For the purposes of this study, 25 defects or groups of defects were analyzed, taking into account their prevalence reported in the literature, severity, possibility of prenatal diagnosis or diagnosis during the examination of the newborn. Next the possibilities of Prenatal Diagnosis of the main congenital defects by ultrasound were studied based on the current literature and trying to create a minimum routine for a fetal examination. RESULTS: The 25 defects or groups of defects were 81.74% of the total of 6,236 newborns with defects identified at birth. During the 2001-2005 period, 765,230 babies were born in the state, with an annual mean of 153,046. The overall occurrence of defects diagnosed at birth during the period was 0.81%, and the specific frequencies of those 25 defects were reported. It was found that 787 cases with congenital defects that died in the first year of life were not diagnosed at birth. It was calculated that for each case of cardiopathy diagnosed at birth, about 3 cases were not perceived, and died during the 1st year of life. These calculations were also important for trisomies 13 and 18 (3:1) and the central nervous system (1.28:1). CONCLUSIONS: The analysis of frequencies of congenital defects or groups of defects that represents more than 80% of them. Some congenital defects recorded in the Declaration of Livebirths at field number 34 seams to be underestimates, like the congenital cardiopathies. This study suggest that with the ultrasonographic evaluation of 18 planes of fetal anatomy the majority of congenital defects can be traced.