Diabetes mellitus is a frequent endocrinopathy in dogs. Exogenous insulin and nutritional management are the mainstays of therapy. High carbohydrate and fibre diets have been traditionally recommended for canine diabetes mellitus. However, recent studies in healthy and diabetic dogs have challenged the use of these traditional diabetic diets. In addition, dietary carbohydrate content was found to be the main determinant of postprandial blood glucose concentrations over 1.5 hours in healthy dogs. Increasing carbohydrate content increased blood glucose concentration. In a search of the literature, no studies in dogs were found comparing the effects on postprandial plasma glucose, insulin, triglyceride and free fatty acid concentrations of a traditionally recommended high carbohydrate and fibre diabetes diet with a moderate carbohydrate and fibre diet, or a commercially-available maintenance diet. Although fasting plasma triglyceride concentrations are commonly used for diagnosis and management of canine hyperlipidemia, a review of the literature found that in human beings, it may not to be predictive of the highest postprandial concentration. Importantly, in overweight and obese dogs with postprandial plasma triglyceride concentrations >5 mmol/L (>445 mg/dL), it was found there was a 6 fold increase in risk of laboratory evidence of exocrine pancreatic disease. However, there are limited studies on the effect of maintenance diets on postprandial plasma triglyceride concentrations in dogs, and no reference intervals determined for a triglyceride meal challenge test in healthy dogs. For the dietary studies in this thesis, animal welfare was of paramount importance, and minimally invasive peripheral venous catheterization and blood collection techniques were needed to collect 4 mL blood samples over 13 hours in conscious dogs. A search of the literature found no studies evaluating the reliability of using peripheral catheterization via the cephalic vein for the collection of larger blood volumes (for example, 4 mL). The aims of this thesis were firstly, to investigate the influence of three diets with varying carbohydrate and fibre content on postprandial plasma glucose, insulin, triglyceride and free fatty acid concentrations in healthy dogs over 12 hours; secondly, to develop a triglyceride meal challenge test and associated reference intervals; and finally, to evaluate a minimally invasive catheterization and blood collection technique for reliability in collecting the blood volumes required for these studies. For the studies in this thesis, twelve healthy dogs were fed each of three diets for three weeks in a three period cross-over design. For the meal response test at the end of each three-week period, 10 blood samples were collected over 13 hours. Reference intervals for fasting and postprandial triglyceride concentrations at single and multiple time points after eating a standard meal were determined in healthy dogs. Associations between fasting and postprandial triglyceride concentrations, and time to measure highest postprandial triglyceride concentration were also evaluated. Blood volume obtained, resistance on aspirating the blood sample, and methods used to improve blood flow during collection were recorded for the 358 samples collected. The results of the studies in this thesis demonstrated that a moderate carbohydrate diet resulted in lower peak and postprandial glucose concentrations compared with a traditional diabetic diet (CHO 55 %ME) and a maintenance diet (CHO 45 %ME). Fasting triglyceride concentrations were found not to be predictive of peak postprandial triglyceride concentrations. The highest triglyceride concentration measured at 2, 5, and 6 hours after eating had the closest agreement with peak postprandial triglyceride concentration. Glucose, insulin and triglyceride concentrations in some dogs were significantly above baseline concentrations at 12 hours after eating each of the diets. Of 358 blood samples collected, 93 % achieved the required 4 mL volume, while the remaining samples were greater than 1.5 mL, and 87 % were obtained with minimal resistance. It was concluded that the moderate carbohydrate and fibre test diet warrants evaluation in diabetic dogs. It was found that when following the same protocol, blood samples should be collected 2, 5, and 6 hours after eating to determine the highest postprandial plasma triglyceride concentration. For future nutritional studies, dogs may need to be fasted for at least 12 hours, and analytes measured over at least 12 hours after feeding to evaluate fasting and postprandial plasma analyte concentrations. Finally it was demonstrated that percutaneous catheterization of the cephalic vein using a 20-gauge catheter allows for successful collection of multiple 4 mL blood samples over 13 hours in conscious dogs. This thesis presents new information for future nutritional studies in healthy and diabetic dogs by suggesting that there may be no glycemic benefit feeding the high carbohydrate and fibre diet compared with a moderate carbohydrate and fibre diet. A triglyceride meal challenge test was developed to assist the diagnosis of canine hyperlipidemia. Finally, a minimally invasive method for obtaining serial blood samples was evaluated and described. These findings are expected to help in designing future studies in the nutritional management in healthy dogs, and dogs with diabetes mellitus and hyperlipidemia.

Contexte : Le management de la présentation foetale en siège est complexe car la littérature scientifique est contrastée. Objectif : Mettre en évidence les effets des attitudes et des interventions professionnelles sur le vécu des femmes. Méthodes : Cinq recherches quantitatives et qualitatives, incluant 311 participantes, ont été menées à la maternité des Hôpitaux Universitaires de Genève. Résultats : Les femmes doivent souvent faire un deuil par anticipation de l'accouchement idéalisé. Elles sont très motivées à tenter de corriger la malposition foetale. 69% des participantes ont recours aux médecines alternatives et complémentaires pour se soigner. 68% des participantes ont qualifié la tentative de version céphalique externe (VCE) de « forte à insupportable. Un accompagnement par hypnose ne réduit pas l'intensité de la douleur, comparé à un accompagnement par une sage-femme (échelle visuelle analogique : 6,0 vs 6,3 /10 respectivement, p=0.25). Pour le choix du mode d'accouchement les femmes ont rapporté des conflits décisionnels majeurs. L'information médicale est souvent perçue en faveur de la césarienne élective. Le sentiment de contrôle, les émotions et les premiers instants avec le nouveau-né sont perçus différemment selon le mode d'accouchement, en défaveur de la césarienne en urgence. Conclusion : Un processus émotionnel et décisionnel inattendu et souvent difficile est associé au diagnostic de siège. Développer des outils d'aide à la décision pour la femme, et des techniques de relation d'aide pour les professionnels faciliteraient ces processus. La prise en charge de la douleur durant la tentative de VCE est indispensable / Context: Management of breech remains complex due to divergence of practices and recommendations reported in the literature. Objective: To highlight the effects of health professionals' interventions on women's experiences. Methods: Five research studies qualitative were conducted at the University Hospitals of Geneva, including a total of 311 participants. Two studies used a method with interviews and thematic analysis, two used a quantitative method with a statistical analysis, and one used a mixed methods' design. Results: Breech diagnosis often requires anticipating a disappointment of an idealized childbirth. Women demonstrate a strong motivation to try to turn their fetus. 69% of women use complementary and alternative medicine (CAM) for their treatment. 68% of participants qualified external cephalic version (ECV) as "strong to unbearable". An accompaniment by a hypnotist compared to a midwife did not decrease pain intensity (visual analogic scale: 6.0 vs 6.3/10, respectively; p=.25). For the choice of breech delivery mode, women reported strong decisional conflicts. Medical information is often perceived in favour of a planned caesarean. Feelings of control, emotions and the first moments with the newborn are perceived differently and, notably, negatively in the case of emergency ceasarean section. Conclusion: A difficult emotional and decision-making process is associated with term breech. Use of CAM should be considered by professionals. Developing tools to assist women, and relationship techniques for professionals could facilitate these processes. Reduction of pain during ECV is necessary

De fato, por não existir um levantamento antropométrico de crianças com síndrome de Down no Brasil, foi realizado em São Paulo um estudo biométrico prospectivo que permitiu a elaboração de curvas antropométricas avaliando taxas de peso, estatura e perímetro cefálico elaboradas por tabelas e gráficos com valores lapidados de 4 percentis de dois grupos etários de ambos os sexos divididos de 0-24 meses e de 2-8 anos respectivamente.o estudo considerou e excluiu, quando pertinente, fatores ambientais ou genéticos paralelos que eventualmente pudessem interferir nas variáveis avaliadas. A ampla revisão bibliográfica e a comparação dos dados antropométricos permitiram enfatizar a importância de curvas padrões nacionais para estatura, peso e perímetro cefálico de crianças com síndrome de Down, facilitando o diagnóstico diferencial entre outros comprometimentos clínicos, auxiliando na intervenção clínico-Iaboratorial, na prevenção e acompanhamento médico. / Considerint that there is any anthropometrical evaluation in children with Down\'s syndrome in Brazil, the objective of this prospective biometric investigation was to construct anthropometrical curves for weight, stature and cephalic perimeter in children with Down\' s syndrome living in São Paulo urban area. Ali measurements were obtained from January 1980 to December 1999. Ali height or cephalic perimeter values 10% below or above and weight values 16% below or above of the 1st and 3rd quartile were excluded. Tables for each sex during 0-24 months and 2-8 years were presented in mean, standard deviations, percentiles and quartiles and graphics were presented in percitiles. Environmental and genetic factors associated that could interfere in development were identified and the proband excluded from the sample. The employing of a national pattem curve of stature, weight and cephalic perimeter for individuaIs with Down\' s syndrome would be useful in differential diagnosis among other clinical disorders associated to this genetic malformation providing better clinical intervention and prevention of comorbidity.