[pt] Esta dissertação apresenta os resultados de pesquisa sobre um modelo para incorporação de requisitos ergonômicos na indústria calçadista em prol da saúde dos diabéticos. Pretende-se que o modelo aqui apresentado beneficie, por extensão, a pacientes atingidos por outras patologias que também geram problemas neuropáticos e vasculares periféricos (pacientes com problemas renais, hipertensos, indivíduos afetados por complicações decorrentes do tabagismo, etc). Através de entrevistas semi-estruturadas, formulários e questionários foram obtidas informações junto diferentes grupos envolvidos diretamente com a problemática do Pé Diabético. A análise destes dados demonstrou que grande parte dos modelos de calçados, encontrados nas lojas do Rio de Janeiro, propicia traumas repetitivos aos pés de pessoas com problemas de neuropatia diabética sensitiva nos pés (ou sensibilidade comprometida nos pés por causa do diabetes, que ocorre quando as células nervosas da região deixam de conduzir as informações relativas aos estímulos sensitivos da forma adequada) devido a problemas de projetação/design (palmilha mal projetada, costuras internas salientes ou solados duros demais). E, uma vez que diabéticos tendem a ter lenta cicatrização em virtude de deficiente circulação periférica gerada pela doença, qualquer ferida torna-se mais do que um simples problema passageiro, torna-se um perigo real à saúde. Este estudo revelou-se interdisciplinar, na medida em que seu campo permeou outras áreas do saber para conjugar informações relacionadas à problemática do Pé Diabético. Trabalhou-se aqui com o seguinte problema: diabéticos são prejudicados pela maioria dos calçados produzidos para o mercado brasileiro, que não levam em consideração questões ergonômicas, físicas, ou mesmo cognitivas relacionadas ao diabetes no momento de sua produção. / [en] This dissertation presents the results of a research that lead to a theoretical model proposing the integration of ergonomic requirements at shoes´ industry in order to increase the healthiness of people with diabetic feet. It´s expected that the model here presented benefits, by extension, also patients injured by other pathologies that causes neuropathycs or vascular peripheryc problems: patients with kidney problems, hypertensives, people affected by complications caused by tobacco addiction, etc. Formularies, questionnaires, and semi structured interviews supported the data collection that was done. Different groups were interviewed, all of them directed related with the diabetic feet problem. The data analysis presented evidences that most part of the shoes available in Rio de Janeiro might be able to cause repetitive traumas to neuropathyc feet of diabetic problem (lack of sensibility at the feet, because of the diabetes, happens when nervous stop conducting information related to sensitive stimulation in a healthy way), because of projetation/design (midsoles not well developed, thick internal sews or too hard outsoles). And, once diabetics are predisposed to have deficient peripheryc circulation any wound might become more then just a simple problem, might become a real danger. The study here presented reassured its interdisciplinaryti once extended its exploratory field to other areas with the purpose of merging related information regarding diabetic feet. The following problem guided this research: Diabetics are damaged by most part of the shoes produced for the internal market, because they don´t take in consideration ergonomic, cognitive or physical issues regarding diabetes during production.

Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)-United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

La dysbiose est une cause importante dans la survenue de maladies, favorisant la prolifération de pathogènes ou induisant l’inflammation. L’étude de ce phénomène est devenue possible grâce aux approches d’analyse génomique (AG) associé avec d’autres techniques. L’entérocolite nécrosante (ECN) et l’infection du pied diabétique (IPD) demeurent deux maladies associées à la dysbiose dans lesquels différents bactéries ont été décrites, notamment C. butyricum dans l’ECN, E. coli et S. aureus dans l’IPD. Dans le cadre de l’ECN, C. butyricum demeure l’espèce la plus fréquente chez les ECN. L’identification clusters liés géographiquement et en fonction du temps. Le portage asymptomatique est suggéré par une similarité génomique des souches patients et contrôles. La prédiction d’un gène de β-hémolysine ainsi leur effet cytotoxique sur les cellules Jurkat avait été observé. De même, sur les cellules Caco-2 malgré le KO du gène de β-hémolysine. En se basant sur l’analyse physico-chimique du surnageant bactérien, nous avons suggéré que la fraction cytotoxique est protéique. La purification de la fraction cytotoxique a permis de trouver une protéine codant pour PspC family possédant un domain conservé commun avec celui de la toxine A/B. L’inactivation du gène codant pour cette protéine n’a pas supprimé l’effet cytotoxique, suggérant la présence d’une combinaison gènes. En parallèle, nous avons ciblé l’impact de C. neonatale par qRPC spécifique rpoB. Cette espèce était plus fréquente chez les patients, ainsi de clones géographiques ont été identifiées. Enfin, des SNPs ont été observés dans des gènes de virulence dans le cas des E. coli et S. aureus isolés de l’IPD. / Dysbiosis remains a main cause during the establishment of several diseases, by promoting bacterial translocation, leading to inflammation process. Specific microorganisms were involved in the pathogenesis of dysbiosis-associated diseases, notably necrotizing enterocolitis (NEC) and diabetic foot (DF). This was possible by the implication of whole-genome analysis (WGA) in association with other techniques. In case of NEC, C. butyricum was significantly associated with in NEC; tested on a South-East French cohort. Geographical and/or temporal clusters were identified, thus genomic relationship between NEC-associated isolates and controls, suggesting the presence of asymptomatic carriage. Genes encoding for β-hemolysin was detected and C. butyricum supernatant exhibited cytotoxic effect on Jurkat cells. Cytotoxic effect was also presented on Caco-2 cells. Supernatant of β-hemolysin-mutant C. butyricum showed enterotoxic effect. Basing on physico-chemical data, we assumed that the evaluated fraction was a protein. Proteomics analysis revealed that PspC family was the cytotoxic protein. This protein owned a glucan-binding domain, shared by C. difficile toxin A/B. The KO of PspC gene was enterotoxic, suggesting by this the existence of a combination of genes. In parallel, a specific rpoB-based qPCR was developed to identify C. neonatale. We found that, C. neonatale was more prevalent in NEC than in controls. Although co-identified in association with C. butyricum. C. neonatale clones were distinguished especially in strains isolated from the same hospital. Regarding to DF infection, SNPs were identified within S. aureus and E. coli genomes, especially in virulent genes.