L’augmentation de la population âgée dans la société indique que les systèmes de soins de la santé font face à de nouveaux défis. Les hauts niveaux d’incapacité qui en résultent peuvent être réduits par les nouvelles technologies, la promotion de la santé ainsi que des stratégies de prévention. Les écrits scientifiques récents soulignent la supériorité des prothèses dentaires implanto-portées par rapport aux prothèses conventionnelles en termes de satisfaction et de qualité de la vie des patients. Cependant, il n'est toujours pas clair si ces avantages ont des effets positifs à long terme sur la santé orale et générale ainsi que sur la qualité de vie des populations âgées. Objectifs, Hypothèses : Notre but était de mesurer l’impact des prothèses mandibulaires retenues par 2 implants sur la qualité de vie associée à la santé bucco-dentaire et générale ainsi que sur la santé orale et la qualité du sommeil des aînés édentés. Nous avons évalué les hypothèses nulles suivantes : il n'y a aucune différence entre les individus portants des prothèses mandibulaires retenues par 2 implants (IODs) et ceux qui portent des prothèses conventionnelles (CDs), par rapport à la qualité de vie reliée à la santé bucco-dentaire et générale, la santé orale et la qualité du sommeil, un an après avoir reçu leurs nouvelles prothèses. Méthodes : Dans cette étude randomisée contrôlée, 255 aînés ont reçu au hasard IODs ou les CDs, les deux types de prothèses étant opposés à des prothèses maxillaires conventionnelles. La qualité de la vie reliée à la santé bucco-dentaire (OHRQoL) et la santé générale subjective ont été mesurées avec les questionnaires Oral Health Impact Profile (OHIP-20) et Short Form-36 (SF-36) en condition pré-traitement et après un an. La qualité du sommeil et la somnolence diurne ont été mesurées à l’aide du questionnaire Qualité de Sommeil de Pittsburg et de l'Échelle de Somnolence Epworth. La santé orale a été évaluée par un examen clinique. Les variables indépendantes étaient le sens de cohérence et le type de prosthèse, ainsi que des variables socio-démographiques. En utilisant des analyses statistiques bi et multi-factorielles, des comparaisons à l’intérieur d’un même groupe et entre deux groupes ont été effectuées. Résultats : Les différences pré et post traitement pour les cotes OHIP étaient significativement plus grandes pour le groupe IOD que le groupe CD (p<0.05). Le type de traitement et la cote pré-traitement étaient des facteurs significatifs à OHRQoL (p < 0.0001). Dans le groupe CD, il y avait une diminution significative par rapport aux cotes de «Physical Component Scores (PCS)», le fonctionnement physique, le rôle physique et la douleur physique entre les données pré-traitement et un an après le traitement, ce qui indique une diminution au niveau de la santé générale subjective. Dans le groupe IOD, une diminution statistiquement non significative a été remarquée par rapport à toutes les cotes des sous-échelles de SF-36, sauf pour la douleur physique. Le modèle final de régression a démontré qu’après ajustement pour les variables âge, sexe, statut marital et type de traitement, la cote totale finale d’OHIP et les données de bases de PCS prédisaient la cote finale de PCS (p < 0.0001). Aucune corrélation significative entre sens de cohérence et OHRQoL n'a été détectée (r =-0.1; p > 0.05). Les aînés porteurs des prothèses conventionnelles avaient presque 5 fois plus de chance d’avoir une stomatite prothétique que ceux portant des prothèses mandibulaires hybrides retenues par 2 implants (p < 0.0001). Les aînés ayant subjectivement une mauvaise santé générale avaient une qualité de sommeil moins bonne que ceux avec une meilleure santé générale subjective (p < 0.05). Les personnes qui avaient une OHRQoL moins bonne étaient presque 4 fois plus somnolentes pendant le jour que celles avec une meilleure OHRQoL (p=0.003, χ2; OR =3.8 CI 1.5 to 9.8). L'analyse de régression a montré que la santé générale subjective et OHRQoL prévoient la qualité du sommeil (p=0.022 et p=0.001, respectivement) et la somnolence diurne (p=0.017 et p=0.005, respectivement). Conclusions: Les résultats de cette étude suggèrent que, chez les aînés édentés, des prothèses mandibulaires hybrides retenues par deux implants amènent une amélioration significative de la qualité de vie reliée à la santé bucco-dentaire et maintiennent la sensation d’une meilleure santé physique. Des prothèses hybrides implanto-portées peuvent contribuer à la santé orale en réduisant les traumatismes infligés à la muqueuse orale et en contrôlant la stomatite prothétique. Les aînés édentés dont le niveau de qualité de vie reliée à la santé bucco-dentaire est bas, peuvent aussi avoir des troubles de qualité du sommeil. / The global greying of society indicates that health care systems face new challenges. High levels of disability can be reduced through new technologies, health promotion and preventive strategies. Recent literature has underlined the superiority of mandibular implant overdentures over conventional dentures for patient satisfaction and quality of life. However, it is still not clear whether this benefit has any long-term positive effects on oral and general health, as well as on the quality of life of elderly populations. Objectives, Hypotheses: We aimed to measure the impact of mandibular two-implant overdentures on the general and oral health quality of life, as well as on oral health and sleep quality of edentulous elders. We tested the null hypothesis that there is no difference in the general and oral health quality of life, as well as, on oral health and sleep quality of those wearing mandibular two-implant overdentures (IODs) and those who wear conventional dentures (CDs), one year following prosthesis delivery. Methods: In this randomized controlled trial, 255 elders randomly received IODs or CDs, both opposed by conventional maxillary dentures. OHRQoL and perceived general health were measured with the Oral Health Impact Profile (OHIP-20) and the Short Form-36 (SF-36) at baseline and after one year. Sleep quality and daytime sleepiness were measured with the Pittsburg Sleep Quality global score and the Epworth Sleepiness Scale. Clinical exams were conducted to evaluate oral health. Independent variables included sense of coherence and prosthesis type, as well as socio-demographic variables. Between and within group comparisons were performed using bivariate and multivariate statistical tests. Results: Pre/post treatment differences in OHIP scores were significantly greater for the IOD than the CD group (p<0.05). Type of treatment and pre-treatment scores were significant contributors to OHRQoL (p<0.0001). In the CD group, there was a statistically significant decrease in physical component scores (PCS), physical functioning, role physical and bodily pain from baseline to one year follow up, indicating decreased perceived general health. In the IOD group, no statistically significant decrease was seen in SF-36 subscale scores from baseline to one year, except for bodily pain. The final regression model demonstrated that, after controlling for age, sex, marital status and type of treatment, the OHIP total final and the PCS baseline scores predict PCS final scores (p<0.0001). No significant correlation between sense of coherence and OHRQoL was detected (r= -0.1; p> 0.05). Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant retained overdentures (p < 0.0001). Elders with low perceived general health had poorer sleep than those with high perceived general health (p<0.05). Those with low oral health related quality of life were almost 4 times sleepier during the day than those with high OHRQoL (p=0.003, χ2; OR =3.8 CI 1.5 to 9.8). Regression analysis showed that perceived general health and OHRQoL predict sleep quality (p=0.022 and p=0.001, respectively) and daytime sleepiness (p=0.017 and p=0.005, respectively). Conclusions: The results of this study suggest that, in edentulous elders, mandibular two-implant overdentures provide significant improvement in oral health related quality of life and maintain perceived physical health. Implant overdentures may contribute to oral health by reducing oral mucosa trauma and control denture stomatitis. Edentulous elders whose oral health related quality of life is low may also have poor sleep quality.

L’augmentation de la population âgée dans la société indique que les systèmes de soins de la santé font face à de nouveaux défis. Les hauts niveaux d’incapacité qui en résultent peuvent être réduits par les nouvelles technologies, la promotion de la santé ainsi que des stratégies de prévention. Les écrits scientifiques récents soulignent la supériorité des prothèses dentaires implanto-portées par rapport aux prothèses conventionnelles en termes de satisfaction et de qualité de la vie des patients. Cependant, il n'est toujours pas clair si ces avantages ont des effets positifs à long terme sur la santé orale et générale ainsi que sur la qualité de vie des populations âgées. Objectifs, Hypothèses : Notre but était de mesurer l’impact des prothèses mandibulaires retenues par 2 implants sur la qualité de vie associée à la santé bucco-dentaire et générale ainsi que sur la santé orale et la qualité du sommeil des aînés édentés. Nous avons évalué les hypothèses nulles suivantes : il n'y a aucune différence entre les individus portants des prothèses mandibulaires retenues par 2 implants (IODs) et ceux qui portent des prothèses conventionnelles (CDs), par rapport à la qualité de vie reliée à la santé bucco-dentaire et générale, la santé orale et la qualité du sommeil, un an après avoir reçu leurs nouvelles prothèses. Méthodes : Dans cette étude randomisée contrôlée, 255 aînés ont reçu au hasard IODs ou les CDs, les deux types de prothèses étant opposés à des prothèses maxillaires conventionnelles. La qualité de la vie reliée à la santé bucco-dentaire (OHRQoL) et la santé générale subjective ont été mesurées avec les questionnaires Oral Health Impact Profile (OHIP-20) et Short Form-36 (SF-36) en condition pré-traitement et après un an. La qualité du sommeil et la somnolence diurne ont été mesurées à l’aide du questionnaire Qualité de Sommeil de Pittsburg et de l'Échelle de Somnolence Epworth. La santé orale a été évaluée par un examen clinique. Les variables indépendantes étaient le sens de cohérence et le type de prosthèse, ainsi que des variables socio-démographiques. En utilisant des analyses statistiques bi et multi-factorielles, des comparaisons à l’intérieur d’un même groupe et entre deux groupes ont été effectuées. Résultats : Les différences pré et post traitement pour les cotes OHIP étaient significativement plus grandes pour le groupe IOD que le groupe CD (p<0.05). Le type de traitement et la cote pré-traitement étaient des facteurs significatifs à OHRQoL (p < 0.0001). Dans le groupe CD, il y avait une diminution significative par rapport aux cotes de «Physical Component Scores (PCS)», le fonctionnement physique, le rôle physique et la douleur physique entre les données pré-traitement et un an après le traitement, ce qui indique une diminution au niveau de la santé générale subjective. Dans le groupe IOD, une diminution statistiquement non significative a été remarquée par rapport à toutes les cotes des sous-échelles de SF-36, sauf pour la douleur physique. Le modèle final de régression a démontré qu’après ajustement pour les variables âge, sexe, statut marital et type de traitement, la cote totale finale d’OHIP et les données de bases de PCS prédisaient la cote finale de PCS (p < 0.0001). Aucune corrélation significative entre sens de cohérence et OHRQoL n'a été détectée (r =-0.1; p > 0.05). Les aînés porteurs des prothèses conventionnelles avaient presque 5 fois plus de chance d’avoir une stomatite prothétique que ceux portant des prothèses mandibulaires hybrides retenues par 2 implants (p < 0.0001). Les aînés ayant subjectivement une mauvaise santé générale avaient une qualité de sommeil moins bonne que ceux avec une meilleure santé générale subjective (p < 0.05). Les personnes qui avaient une OHRQoL moins bonne étaient presque 4 fois plus somnolentes pendant le jour que celles avec une meilleure OHRQoL (p=0.003, χ2; OR =3.8 CI 1.5 to 9.8). L'analyse de régression a montré que la santé générale subjective et OHRQoL prévoient la qualité du sommeil (p=0.022 et p=0.001, respectivement) et la somnolence diurne (p=0.017 et p=0.005, respectivement). Conclusions: Les résultats de cette étude suggèrent que, chez les aînés édentés, des prothèses mandibulaires hybrides retenues par deux implants amènent une amélioration significative de la qualité de vie reliée à la santé bucco-dentaire et maintiennent la sensation d’une meilleure santé physique. Des prothèses hybrides implanto-portées peuvent contribuer à la santé orale en réduisant les traumatismes infligés à la muqueuse orale et en contrôlant la stomatite prothétique. Les aînés édentés dont le niveau de qualité de vie reliée à la santé bucco-dentaire est bas, peuvent aussi avoir des troubles de qualité du sommeil. / The global greying of society indicates that health care systems face new challenges. High levels of disability can be reduced through new technologies, health promotion and preventive strategies. Recent literature has underlined the superiority of mandibular implant overdentures over conventional dentures for patient satisfaction and quality of life. However, it is still not clear whether this benefit has any long-term positive effects on oral and general health, as well as on the quality of life of elderly populations. Objectives, Hypotheses: We aimed to measure the impact of mandibular two-implant overdentures on the general and oral health quality of life, as well as on oral health and sleep quality of edentulous elders. We tested the null hypothesis that there is no difference in the general and oral health quality of life, as well as, on oral health and sleep quality of those wearing mandibular two-implant overdentures (IODs) and those who wear conventional dentures (CDs), one year following prosthesis delivery. Methods: In this randomized controlled trial, 255 elders randomly received IODs or CDs, both opposed by conventional maxillary dentures. OHRQoL and perceived general health were measured with the Oral Health Impact Profile (OHIP-20) and the Short Form-36 (SF-36) at baseline and after one year. Sleep quality and daytime sleepiness were measured with the Pittsburg Sleep Quality global score and the Epworth Sleepiness Scale. Clinical exams were conducted to evaluate oral health. Independent variables included sense of coherence and prosthesis type, as well as socio-demographic variables. Between and within group comparisons were performed using bivariate and multivariate statistical tests. Results: Pre/post treatment differences in OHIP scores were significantly greater for the IOD than the CD group (p<0.05). Type of treatment and pre-treatment scores were significant contributors to OHRQoL (p<0.0001). In the CD group, there was a statistically significant decrease in physical component scores (PCS), physical functioning, role physical and bodily pain from baseline to one year follow up, indicating decreased perceived general health. In the IOD group, no statistically significant decrease was seen in SF-36 subscale scores from baseline to one year, except for bodily pain. The final regression model demonstrated that, after controlling for age, sex, marital status and type of treatment, the OHIP total final and the PCS baseline scores predict PCS final scores (p<0.0001). No significant correlation between sense of coherence and OHRQoL was detected (r= -0.1; p> 0.05). Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant retained overdentures (p < 0.0001). Elders with low perceived general health had poorer sleep than those with high perceived general health (p<0.05). Those with low oral health related quality of life were almost 4 times sleepier during the day than those with high OHRQoL (p=0.003, χ2; OR =3.8 CI 1.5 to 9.8). Regression analysis showed that perceived general health and OHRQoL predict sleep quality (p=0.022 and p=0.001, respectively) and daytime sleepiness (p=0.017 and p=0.005, respectively). Conclusions: The results of this study suggest that, in edentulous elders, mandibular two-implant overdentures provide significant improvement in oral health related quality of life and maintain perceived physical health. Implant overdentures may contribute to oral health by reducing oral mucosa trauma and control denture stomatitis. Edentulous elders whose oral health related quality of life is low may also have poor sleep quality.

The present thesis concerns people with Usher syndrome (USH) and their health. People with USH have a congenital hearing loss of various degrees and an eye disease with a progressive course; for some, the balance is also affected. Three clinical groups have been identified 1, 2 and 3, and 13 genes have currently been identified. USH is the most common cause of deafblindness. Clinical knowledge and the limited research that exists have shown that people with deafblindness can experience difficulties in everyday life. Depression, anxiety and social withdrawal have been described. The general aim of the present thesis was to describe the health of people with USH. The empirical material employed was based on an extensive survey in which people with USH answered two questionnaires concerning health, anxiety, depression, social trust, work, health-care, financial situation, and alcohol and drug use. The focus of the present thesis is on general health, physical health and psychological health, social trust and finance. Three studies in the present theses focus on USH1, 2 and 3, respectively; finally, the fourth study provides an in-group comparison of people with USH. The results of studies I and III are compared with a crosssection of the Swedish population. The results revealed poor physical and psychological health, a lack of social trust and a strained financial situation regardless of clinical diagnosis. The discussion stresses the importance of taking a biopsychosocial approach when describing the health of people with USH, in which previous research is lacking. Additional research should focus on the mechanisms at different levels that affect people with USH and their health from a life- course perspective. Furthermore, research should include a salutogenic perspective to explore the resources and strengths of people with USH.

Introduction Numerous preventive programmes have emerged, and need to be investigated to determine their effects on the normal population. Earlier studies have shown a decrease in depressive symptoms, positive effects on children’s disruptive behaviour problems, and an improvement in parental competence. About a fifth of the parents in previous studies had problem-oriented (targeted) reasons for enrolment, whereas the rest of the parents had general (universal) reasons. The results of those studies suggest that the programmes are cost effective in terms of Quality-Adjusted Life Years. Aim Four sub-studies were performed, and their aims were to investigate the effect of parental training programmes (PTPs) in a naturalistic setting on parents’ mental health in the general population, to investigate how PTPs affect parents’ sense of parental competence, to investigate how PTPs affect parental stress and analyse the parents open questions about the PTPs, and to investigate the feasibility and to measure the effect on depression, anxiety, and social problems of two preventive school programmes for pupils in grade 7. Method In a longitudinal quantitative study in a real-world setting, 279 parents from the general population in northern Sweden participated in five PTPs. A comparison group of 702 parents without intervention was included. Simultaneously, a community sample of 59 pupils in grade 7 participated in two preventive school programmes. Both studies were conducted from 2010 to 2013. Parents were assigned to professionally supported interventions that included 5-10 two-hour sessions. Respondents filled in a web-based questionnaire with the General Health Questionnaire (GHQ), the Parents Sense of Competence (PSOC) for parents who had children aged 0-17 years, and the Swedish Parenthood Stress Questionnaire (SPSQ) for parents who had children aged 0-10 years. The intervention groups’ results were compared to comparison group of 702 parents from northern Sweden that had not participated in any parental training programme. In the school study, one of the preventive programmes was an ongoing programme called “Life-Skills”, and the other was an implemented Canadian programme called “Choosing Healthy Actions and Thoughts” (CHAT). The pupils completed a test battery including the Sense of Coherence (SOC), the Children’s Depression Inventory (CDI), and the Youth Self-Report (YSR) instruments. Follow up of the parental programme study was done six months after the post-intervention measure, and follow up of the school study was at one year. Results The improvements in GHQ were statistically significant for the mean of the 279 parents in the intervention group compared to the mean of a comparison group of the 702 parents who did not receive any intervention. This suggests that evidence-based PTPs enhance parental well-being even for parents without problems. The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders. In the SPSQ, the intervention group was smaller due to the fact that the instrument was not validated for children over the age of 10 and one of the parental training groups was only for parents of teenagers. A reduction of stress in the sub-scale of health problems was detected, but no other subscale showed the intervention to have a significant effect when controlling for confounding variables. In the school study, both programmes had good feasibility according to the stake- holders and had several positive mental health outcomes over time. Compared to Life-Skills, CHAT had more significant positive effects on reducing anxious/depressive symptoms and girls experienced significant positive effects on reduced anxious/depressive behaviour, while boys reduced their aggressive behaviours. Conclusions Earlier studies indicate that PTPs enhance perceived parental competence among referred parents. The present study shows that PTPs applied in the general population might also enhance perceived parental benefits such as improved health and satisfaction, suggesting that PTPs can be an important preventive strategy to enhance parenthood. The results suggest that parents who feel a need to increase their parenting competence might participate in PTPs based on lower scores than the comparison control group both before and after the intervention. The school-based programme shows that schools may be a suitable arena for preventive programmes because there was a significant short-term improvement in depression symptoms. Further studies need to explore how parents’ participation in PTPs affects children’s mental health in the general population in quantitative longitudinal studies in real-word settings. There is also a need for bigger studies and RCTs on school preventions and on how children’s health develops naturally in the population.

Military staff are repeatedly exposed to stressful and unpleasant traumatic life events. These can cause psychological injury, leading to mental and emotional stress. The stigma of mental health problems in military settings runs deeper than in civil society. Being admitted with mental health problems while serving can be a career stopper, but at times can also be associated with cowardice or malingering. It is the primary responsibility of the military to maintain and promote high military/combat readiness among staff. The change in focus of modern military forces, such as the Botswana Defence Force (BDF), with units being deployed more often, places greater demands on troops. Such operations call for increased training exercises, planning sessions and equipment inspections. Training emphasizes discipline and integrity as the core values of the BDF. These form a foundation for healthy and successful coping strategies. The morale of employees is the starting point for measuring their wellness. Morale in the military is embedded in the fitness programs. These are biased towards military training, creating physical fitness, mental alertness and the qualities of military preparedness. The programs are normally involuntary, mandated through the commander, and form part of a soldier‘s military duties. Military recreation, morale and welfare programs were introduced as a way to provide soldiers with the opportunity to relax and rejuvenate. Recreation serves as a powerful tool for achieving an optimal experience, motivating people to change and improve their health and wellness. The problem identified for this study was that members of the BDF were exposed to situations in a military context, as well as in their personal lives, which caused stress. It was postulated that BDF members had little knowledge or the resources to utilize appropriate recreation-related coping strategies. The study aimed primarily to explore the use of sport and recreation activities in military settings as means to reduce and manage stress. To achieve this goal, it was necessary first to determine the current sport and recreation participation of BDF staff members, then to assess their existing stress levels, their overall psychological well-being, and any dysfunctional behaviours resulting from stress. On the basis of these findings, a Therapeutic Recreation Stress Management Intervention Model was proposed, designed to reduce stress and promote the psychological well-being of BDF members. A survey was carried out using a questionnaire. Descriptive statistics were used to summarize the collected data, offering a basic description of the data through frequency distributions, measures of central tendency, variances and relationships. Inferential statistics were used to draw conclusions from the data collected, giving the various factors. The results revealed that the BDF was a male-dominated institution, recruiting soldiers between the ages of 18 and 44, most of whom had some level of education. Most of the staff members came from the lower ranks and had experienced one or more deployments since being recruited into the military. The results further indicated that BDF staff members participated in sport and recreation activities, reflecting an active and healthy lifestyle, with satisfactory levels of involvement. Analysis of stress responses revealed that members experienced stress and that this was related not just to operational or non-operational military stressors but also to personal stressors resulting from their social, financial or emotional conditions. Members of the BDF did not receive the necessary social support from family members and friends to cope with these stressors. The findings on stress in relation to sport and recreation participation revealed that BDF members were intrinsically motivated to embrace healthy lifestyles which could contribute to lower levels of stress. This could even lead to a decrease in stress, supporting the literature which indicates that engaging in physical activities, as part of living a healthy lifestyle, might lead to a reduction in stress levels. The results on the stress-coping measures used by BDF members revealed that recreation activities were deliberately used to cope with stress. Although physical exercise was used as a way of coping with stress, sedentary recreation activities were more prevalent among BDF members. Positive stress-coping measures were adopted by respondents, contrary to the findings of previous studies which indicated that military staff adopted dysfunctional behaviour as a coping measure (e.g. excessive drinking) that formed part of the military culture. The stress-coping abilities of BDF members differed in terms of personal and military demographics from those of previous studies, posting a new contribution to military literature. The results further revealed that BDF members were not sufficiently skilled in coping with stress during military training. This study concluded that the Botswana Defence Force is no different from other military forces, experiencing operational and non-operational stress, as well as personal stress, which need to be addressed. Recommendations were made for further research on stress in military contexts and further guidelines were suggested to the BDF on the use of sport and recreation, together with more specific therapeutic recreation, as ways to reduce stress. A Therapeutic Recreation Stress Management Intervention Model was recommended for further testing in the BDF, as well as in other military forces. / Thesis (DPhil)--University of Pretoria, 2013. / gm2014 / Biokinetics, Sport and Leisure Sciences / unrestricted

Over the last two decades, several studies have revealed the presence of olfactory disorders (OD) following moderate and severe traumatic brain injuries (TBI). Specifically, previous authors have shown that, following a TBI, several patients had quantitative (hyposmia/anosmia) and qualitative (parosmia) loss of sense of smell in important proportions. For moderate and severe TBI, the presence of such disorders, following trauma, is usually due to a coup-contrecoup mechanism responsible for the shearing of olfactory nerves penetrating the cribriform plate or to contusions or secondary hemorrhages within the olfactory bulb and cortical olfactory areas. Since these types of TBI cause obvious lesions, it was relatively simple to understand the nature of such disorders as well as identify the patients at risk of developing olfactory losses. A close follow-up of these patients is necessary since different studies have demonstrated associations between OD following TBI and long-term development of mood (depression, anxiety). Patients developing OD following moderate to severe TBI exhibited more symptoms of anxiety and depression for several weeks following the trauma, when compared to patients without OD. On the other hand, there are only three studies that have investigated the presence of OD and their consequences in patients with mild traumatic brain injury (mTBI), even though they represent nearly 85% of TBI. Moreover, due to the presence of several methodological flaws (choice of invalid evaluation tools, omission of a control group) a great heterogeneity regarding the proportion of mTBI patients who develop OD after the trauma, is found within the literature. So, the studies included in this thesis aim to give, with the establishment of a valid and controlled methodology, the very first idea of the proportion of patients with mTBI who will develop quantitative and qualitative OD. In addition, the predictive value of OD following mTBI on the development of anxiety and depressive symptoms and general health, is also covered in the manuscript. The first study aimed to assess the presence of olfactory disorders within the first 24 hours and one year after the mTBI. The results of this cross-sectional study demonstrated that, in the acute phase, more than half of the patients with mTBI exhibited a partial loss of their sense of smell (hyposmia). In fact, when compared to an orthopedic control group, the proportion of mTBI patients with OD following their accident was significantly higher. When evaluated one year after their mTBI, the patients did not have OD and no significant difference was found between control and mTBI groups. However, when comparing mTBI patients with OD (OD+) to those who did not present OD (OD-) at baseline, we found that OD+ mTBI patients reported significantly more anxiety and post-concussion symptoms, when evaluated one year following their trauma. The second study of this thesis aimed to deepen the results of the previous one, with the help of a larger group of patients, a longitudinal design as well as the implementation of new tools in order to evaluate a broader spectrum of post-concussive symptoms. In this study, olfaction and mood of patients with mTBI were evaluated 1 and 6 months following the trauma. The results show that, when compared to a group of control participants, a significantly high proportion of mTBI patients report a distortion of their olfaction (parosmia), 1 and 6 months following the trauma. In addition, the hierarchical regression analyzes indicate that, within the mTBI group, the presence of baseline parosmia significantly increases the value of the predictive model for the development of depression and anxiety. In conclusion, these two studies provided a much more accurate picture of the actual proportion of mTBI patients at risk of developing post-traumatic OD. Indeed, due to the numerous methodological controls applied, these results paint a more realistic portrait of the short and long term presence of OD following mTBI. Thus, these two projects have revealed alarming proportions, going far beyond what is recorded in the restricted literature available to date. In addition, it appears that baseline presence of qualitative OD following mTBI is a significant predictor of the development of symptoms of anxiety and depression. / Au cours des deux dernières décennies, plusieurs études ont révélé la présence de troubles olfactifs suite à des traumatismes crâniens (TCC) modérés et sévères. Spécifiquement, les précédents auteurs ont montré que, suite à leur TCC, plusieurs patients présentaient des pertes quantitative (hyposmie, anosmie) et qualitative (parosmie) de leur odorat. Dans le cas des TCC de types modérés et sévères, la présence de tels troubles est généralement causée par l’effet de coupcontre coup provoquant des lésions du nerf olfactif pénétrant dans la lame criblée de l’ethmoïde ainsi que par des contusions et des hémorragies au niveau du bulbe olfactif et des régions corticales traitant les stimuli olfactifs. En effet, puisque ces types de TCC provoquent des lésions assez apparentes, il a été facile de comprendre la nature de tels troubles ainsi que d’identifier les patients à risque de développer des pertes olfactives. Un suivi de ces patients est d’autant plus nécessaire puisque différentes études ont démontré des associations entre les pertes olfactives suite au TCC et la chronicisation de troubles de l’humeur (dépression, anxiété) et cognitifs. En effet, il a été démontré que, les patients développant des troubles olfactifs suite à un TCC modéré/sévère, présentaient davantage de symptômes d’anxiété et de dépression plusieurs semaines suite au trauma, lorsque comparés à des patients n’ayant pas de troubles olfactifs. En revanche, il n’y a que trois études qui ont, jusqu’à aujourd’hui, étudié la présence de troubles olfactifs et leurs conséquences auprès de patients ayant subi un traumatisme craniocérébral léger (TCCL), malgré le fait qu’ils représentent près de 85% des patients TCC. De plus, dû à la présence de plusieurs faiblesses méthodologiques dans les précédentes études (choix d’outils d’évaluation non valides, omission de groupe contrôle) une grande hétérogénéité, en ce qui a trait à la proportions de patient TCCL vivant avec un trouble olfactif, est retrouvée dans la littérature. Ainsi, les études composant le présent ouvrage visent globalement à évaluer, à l’aide d’une méthodologie valide et contrôlée, la réelle proportion de patients ayant subi un TCCL qui développeront un trouble olfactif. De plus, un regard sera posé sur les capacités prédictives de la présence de troubles olfactifs suite au TCCL sur le développement, à long terme, de symptômes anxieux et dépressifs. La première étude visait à évaluer la présence de troubles olfactifs dans les premières 24 heures et un an suite au TCCL. Les résultats de cette étude transversale, à caractère exploratoire, ont démontré que, en phase aiguë, plus de la moitié des patients ayant subi un TCCL présentaient une perte partielle de leur odorat (hyposmie). En effet, lorsque comparée à un groupe de patients contrôle, ayant subi une blessure orthopédique, la proportion de patients TCCL ayant un trouble olfactif suite à leur accident s’est révélée significativement plus élevée. Lorsqu’évalués un an suite à leur TCCL, les patients ne présentaient plus de troubles olfactifs et aucune différence significative ne fut retrouvée entre les patients TCCL et orthopédique. Cependant, lorsque nous avons comparé les patients TCCL qui, à l’évaluation initiale, présentaient un trouble olfactif (OD+) à ceux qui n’en présentaient pas (OD-) à l’évaluation initiale, nous avons trouvé que les patients TCCL OD+ rapportaient significativement plus de symptômes anxieux et post-commotionnels, lorsqu’évalués un an suite à leur trauma. La deuxième étude de cet ouvrage visait à approfondir les résultats de la précédente, à l’aide d’un plus grand groupe de patients, d’un devis longitudinal ainsi que l’implantation de nouveaux outils d’évaluation permettant d’évaluer un plus large spectre de symptômes post-commotionnels. Dans cette étude, l’olfaction et l’humeur des patients ayant subi un TCCL furent évaluées 1 et 6 mois suite au trauma. Les résultats montrent que, lorsque comparé à un groupe de participants contrôles, une proportion significativement élevée de patients TCCL rapporte avoir remarqué une distorsion de leur olfaction (parosmie), 1 et 6 mois suite au trauma. De plus, les analyses de régression hiérarchique indiquent qu’au sein du groupe de patients TCCL, la présence de parosmie au premier temps de mesure (court-terme) augmente significativement la valeur du modèle de prédiction de la présence de symptômes dépressifs et anxieux à long terme. En somme, ces deux études ont permis de dresser un portrait beaucoup plus précis de la réelle proportion de patients TCCL qui risquent de développer un trouble olfactif. En effet, grâce aux divers contrôles méthodologiques que nous avons appliqués, les présents résultats permettent de peindre un portrait plus réaliste de la présence, à court et long-terme, de troubles olfactifs suite à un TCCL. Ainsi, ces deux projets ont mis en lumière des proportions allant bien au-delà de ce qui est recensé dans le peu de littérature disponible à ce jour. De plus, il semble que la présence initiale de troubles olfactifs suite au TCCL soit un prédicteur significatif du développement des symptômes d’anxiété et de dépression des patients.

This study investigated the subjective well-being of female strippers. The effect that certain variables namely, self-esteem, general health, self-efficacy, perceived social support and sense of coherence had on subjective well-being and the independent components of subjective well-being, namely life satisfaction and positive and negative affect, were investigated. The sample consisted of 75 female strippers and was a consequence of a combination of purposive and convenience non-probability sampling. These women were employed at Teazers - a chain of strip clubs in Gauteng, South Africa. Information was gathered through self-reported questionnaires with quantifiable scales. The results of the regression models showed that life satisfaction depends on perceived social support, but positive and negative affect depends on self-esteem and general health. If life satisfaction and positive and negative affect is combined into a measurement of subjective well-being, 6.7% of the total variance in subjective well-being is uniquely explained by self-esteem. / Psychology / M. Sc. (Psychology)

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Title: The effect of physiotherapy on balance in multiple sclerosis Objectives: The aim of this study is to compare efficacy between ambulatory individual physiotherapy and complex inpatient rehabilitation in people with multiple sclerosis on balance and subjective evaluation of general health. In ambulant program to compare effect of different physiotherapeutic methods (Motoric program activating therapy, Manual physiotherapy correction, Reflex Locomotion according to Vojta). Methods: A combined design of study. Ambulant program has randomised assessor blind design, in which subjects were divided into one of the three groups of ambulatory physiotherapy. A clinical study without control arm design is used in case of comparison between complex and ambulatory program. Results were analysed in 45 patients with multiple sclerosis (25 subjects of ambulatory program, 20 subjects of complex program). Subjects of the ambulatory program were divided into one of the three groups of ambulatory physiotherapy (Motoric program activating therapy, Manual physiotherapy correction, Reflex Locomotion according to Vojta), in which they absolved during two months 20 therapies (2-3 times per week, length 60 minutes). Subjects of complex program underwent complex inpatient rehabilitation with duration about 21 days. The...

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal