CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / A confianÃa das mÃes em relaÃÃo à capacidade para cuidar de suas crianÃas à relevante para a promoÃÃo da saÃde das mesmas. Objetivou-se construir uma escala para mensurar a autoeficÃcia materna em prevenir a diarreia infantil, elaborar seus itens e suas dimensÃes, avaliar as propriedades psicomÃtricas de validade e de confiabilidade do instrumento. Tratou-se de um estudo metodolÃgico e de um estudo de desenvolvimento, adotando-se o polo teÃrico, empÃrico e analÃtico para a construÃÃo de escalas, propostos por Pasquali (1997). No polo teÃrico, identificou-se e se aprofundou o construto de interesse prevenÃÃo da diarreia infantil, para tanto se realizou um levantamento bibliogrÃfico, utilizando os descritores âcrianÃaâ, âprevenÃÃo e controleâ, âdiarreiaâ nas bases de dados PubMed, CINAHL, Cochrane e LILACS. A sÃntese de 82 estudos selecionados norteou a operacionalizaÃÃo da primeira versÃo da escala, com 35 itens, e a identificaÃÃo de quatro domÃnios: prÃticas alimentares, ambiente domÃstico, comportamento materno e higiene da crianÃa/infantil. Procedeu-se à anÃlise teÃrica dos 35 itens, submetendo-os à avaliaÃÃo de sete juÃzes, considerados experts na Ãrea do construto, de 30 mÃes, que realizaram a anÃlise semÃntica, e de 31 mÃes, que participaram do prÃ-teste da escala. Realizados os cÃlculos do Ãndice de Validade de ConteÃdo â IVC, e as alteraÃÃes, sugeridas pelos participantes do polo teÃrico, obteve-se o instrumento-piloto composto por 25 itens. No polo empÃrico, a amostra foi de 448 mÃes de crianÃas menores de 5 anos, cadastradas em um dos seis Centros de SaÃde da FamÃlia no qual o estudo foi executado. Efetivou-se a coleta de dados de novembro de 2009 a fevereiro de 2010. Utilizou-se, alÃm do instrumento-piloto da escala com 25 itens, um formulÃrio abordando dados sociodemogrÃficos e dados relacionados à saÃde da crianÃa. No polo analÃtico, encontram-se a validade de construto e de critÃrio, o alfa de Cronbach e o Coeficiente de CorrelaÃÃo Intraclasse â CCIC. A validade de construto, atravÃs da anÃlise fatorial, indicou a necessidade de exclusÃo do item sete e a existÃncia de dois fatores/domÃnios (higiene da famÃlia, com 15 itens, e prÃticas alimentares/gerais, com 9 itens) na Escala de AutoeficÃcia Materna para PrevenÃÃo da Diarreia Infantil â EAPDI. Na validade de construto, procedeu-se ainda a testagem de hipÃteses por comparaÃÃo dos grupos contrastados. Nessa anÃlise, observou-se a correlaÃÃo negativa entre os escores mais elevados da autoeficÃcia materna em prevenir a diarreia infantil e a ocorrÃncia anterior de diarreia na crianÃa (p=0,001), assim como a associaÃÃo entre os escores mais elevados de autoeficÃcia, com mÃes que possuem mais idade (p=0,018). A validade de critÃrio, utilizando-se a validade preditiva, revelou que nÃveis elevados de autoeficÃcia materna configuram-se em fator protetor para diarreia infantil, de acordo com a especificidade e Valor Preditivo Negativo. O alfa de Cronbach da EAPDI foi de 0,84, indicando alta consistÃncia interna. O CCIC, na anÃlise da estabilidade teste-reteste, foi de 0,45, demonstrando a capacidade de aplicaÃÃo da EAPDI mesmo com o passar do tempo. Concluiu-se neste estudo que a escala à confiÃvel, vÃlida e capaz de avaliar a autoeficÃcia materna para a prevenÃÃo da diarreia infantil. / Motherâs confidence in their ability to provide good care to their children has proven to be relevant when it comes to maternal health promotion. This dissertation aims to construct a scale in order to measure maternal self-efficacy for preventing infantile diarrhea, by creating its items and dimensions, as well as evaluating the instrumentâs psychometric aspects (validity and reliability). The following is both a research on methodology and development, having the model proposed by Pasquali on scale elaboration (1997) as our theoretical landmark. In the pre-empirical part, we carefully examined infantile diarrhea prevention as our construct of interest. The bibliographical survey searched for the keywords âchildrenâ, âprevention and controlâ, âdiarrheaâ on the PubMed, CINAHL, Cochrane and LILACS database. The first version of the scale was led by the synthesis of 82 selected papers. It had 35 items and also presented four domains: alimentary habits, domestic environment, mother behavior and child hygiene. The 35 items were evaluated by 30 mothers (who performed the semantic analysis), by 31 other mothers who participated in the scale pre-test and also by seven experts in the construct field. After calculating the Content Validity Index (CVI) and making the proper alterations suggested by the mentioned participators, the pilot test was elaborated, containing itself 25 items. In the empirical part of this paper, the selected sample was formed by 448 mothers of less than 5 years old children. Those women were all registered on one of the six Family Health Centers in which the research took place. Data collection was performed from November of 2009 to February of 2010. A questionnaire on socio-demographic elements and child health aspects was used along with the pilot test. The analytical work involved the construct validity, the criterion validity, Cronbachâs alpha and Intraclass Correlation Coeficient (ICC). Construct validity, through the factor analysis, has indicated the need for exclusion of the item seven and has also shown the existence of two factors/domains (family hygiene, formed by 15 items; and alimentary/general habits, with 9 items) in the Maternal Self-Efficacy for Infantile Diarrhea Prevention Scale (MSIDPS). Regarding the construct validity, hypotheses were tested by contrasting groups comparison. A negative correlation has been observed between the higher maternal self-efficacy for infantile diarrhea prevention scores and the previous occurrence of diarrhea in the child (p=0,001).The higher self-efficacy scores were also associated with older mothers (p=0,018). By using predictive validity, the criterion validity has shown that higher levels of maternal self-efficacy turned out to be a protective factor against infantile diarrhea, according to specificity and to Negative Predictive Value. Cronbachâs alpha of the MSIDPS was 0,84, which indicates high internal consistency. ICC, after test-retest stability analysis, was 0,45, showing the scaleâs applicability throughout time. This dissertation has come to the conclusion that the scale is reliable, valid and capable of evaluating maternal self-efficacy for infantile diarrhea prevention.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-10-11T20:25:05Z No. of bitstreams: 2 Dissertação - Adriane Guimarães de Siqueira Lemos - 2016.pdf: 1850453 bytes, checksum: a94724c58fd1453b42c1204bcf3c529b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2016-10-14T19:53:26Z (GMT) No. of bitstreams: 2 Dissertação - Adriane Guimarães de Siqueira Lemos - 2016.pdf: 1850453 bytes, checksum: a94724c58fd1453b42c1204bcf3c529b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-10-14T19:53:26Z (GMT). No. of bitstreams: 2 Dissertação - Adriane Guimarães de Siqueira Lemos - 2016.pdf: 1850453 bytes, checksum: a94724c58fd1453b42c1204bcf3c529b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-09-19 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / That research, entered in the line Fundamentals of Processes Educational, investigates the vinculation psicology-education in the document Childhoods and Children in Scene: for one Politic of Infantile Education for the Rede Municipal de Goiânia (GOIÂNIA 2014). This is the qualitative research, bibliographic and documental, developed by content analysis procedure conducted from the strict document reading, the seizure of its structure and internal logic, the key concepts, and meanings and meanings of the terms and concepts used, based on the comparison with the appropriate theoretical framework in the literature review. By having for reference studies about the vinculation psychology-education from on one approach criticizes, based on historical analysis this relationship, it was found that it can take in order to hide and justify the unequal social relations and antagonistic and, concomitantly, support the training focused on the demands of the production process. It has been found that the principles identified in the document, the child who elected as centrality, and the emphasis on learning, for the organization and execution of educational processes, corroborates the movement here called webs of psychology-education relationship. The centrality of the child in the document is expressed by joining the Pedagogy of Childhood, the definition of the child as a subject of rights and the prominent place given to life experiences and experiences for the realization of the pedagogical proposal. The emphasis on learning is perceived in the document from the circumstantial teaching place, understanding that learning is a constitutive process and to the child and the subordination of this process to the interests and needs of the child. These are principles that historically are linked to the field of ideas psychology-education that tend to naturalization of the child and his formation. / Esta pesquisa, inscrita na linha de Fundamentos dos Processos Educativos, investiga a vinculação psicologia-educação no documento Infâncias e Crianças em Cena: por uma Política de Educação Infantil para a Rede Municipal de Goiânia (GOIÂNIA, 2014). Trata-se de uma pesquisa de natureza qualitativa, bibliográfica e documental, desenvolvida mediante o procedimento de análise do conteúdo realizado a partir da leitura rigorosa do documento, da apreensão da sua estrutura e lógica interna, dos conceitos-chave, e dos significados e sentidos dos termos e conceitos utilizados, tendo por base o cotejamento com o referencial teórico apropriado na revisão bibliográfica. Tendo por referência estudos sobre a vinculação psicologia-educação a partir de uma abordagem crítica, com base na análise histórica dessa relação, verificou-se que ela pode se dar de forma a ocultar e justificar as relações sociais desiguais e antagônicas e, concomitantemente, fundamentar a formação voltada para as demandas do processo produtivo. Verificou-se que os princípios identificados no documento, que elegem a criança como centralidade, bem como a ênfase na aprendizagem, para a organização e efetivação dos processos educativos, corroboram o movimento que aqui se denominou tramas da relação psicologia-educação. A centralidade da criança no documento é expressa pela adesão à Pedagogia da Infância, pela definição da criança como sujeito de direitos e pelo lugar de destaque dado às vivências e experiências para a efetivação da proposta pedagógica. A ênfase na aprendizagem é apreendida no documento a partir do lugar circunstancial do ensino, da compreensão de que a aprendizagem é um processo constitutivo da e para a criança e da subordinação desse processo aos interesses e necessidades da criança. Trata-se de princípios que historicamente ligam-se à ideias do campo da psicologia-educação que tendem à naturalização da criança e da sua formação.

Made available in DSpace on 2016-08-17T13:54:07Z (GMT). No. of bitstreams: 1 Karla Bianca Freitas de Sousa.pdf: 696959 bytes, checksum: 90f9b9166e78ca7c71a150222007b183 (MD5) Previous issue date: 2007-10-31 / The investigation approaches the relationship between graduation and educational practice of teachers from an Infantile Education School of the Municipal School Network in Imperatriz - MA. It focuses on the curriculum and its relationship with the teacher graduation, the childhood historical life and the rising of the infantile education in Europe and in Brazil. It presents the public politics for the infantile education in Brazil and the contributions of infantile development psychology. It involves the graduation space and the theoreticalmethodological presuppositions that validate it as well as child's conceptions, childhood and infantile education that guide the pedagogic praxis. The theoretical base that validate this study is centered on authors like: Silva (2005), Lopes; Macedo (2002), in the field of curriculum, Tanuri (2000), Vilela (2000), Freitas (2001), Oliveira (2000), Barreto (2004) on teacher graduation and Phillipe Àires (1981) Freitas; Kuhlmann Jr. (1991) Kramer (2006), Kishimoto (2005), Campos; Rosemberg; Ferreira (2001), Kramer (1994) and Oliveira (2002) in the extent of childhood and infantile education, among others. The central objective planned for the research consists of analyzing the implications of the teacher graduation on the teachers' pedagogic praxes having as reference, the theoretical-methodological contributions which validate such courses under the educational legislation for infantile education. The adopted methodology is a research with teachers of a school of infantile education, in which the following instruments of collecting data were used: observation in class and semi-structured interview. The study points out for the need of an analysis of the graduation process undergone by the teachers so that they understand the theoreticalmethodological presuppositions which subsidize the organization of the pedagogical work and the construction of a praxes capable of assisting the child's demands in the context of the infantile education. / A investigação aborda a relação formação e prática docente de professoras de uma Escola de Educação Infantil da Rede Municipal de Imperatriz MA. Enfoca o currículo e sua relação com a formação docente, a trajetória histórica da infância e o surgimento da educação infantil na Europa e no Brasil. Apresenta as políticas públicas para a educação infantil no Brasil e as contribuições da psicologia do desenvolvimento infantil. Compreende o espaço de formação e os pressupostos teórico-metodológicos que a fundamentam bem como as concepções de criança, infância e educação infantil que orientam a práxis pedagógica. A base teórica que fundamenta este estudo centra-se nos autores Silva (2005), Lopes; Macedo (2002), no campo do currículo, Tanuri (2000), Vilela (2000), Freitas (2001), Oliveira ( 2000 ), Barreto (2004 ) sobre formação docente e Phillipe Àires (1981) Freitas; Kuhlmann Jr.(1991 ) Kramer ( 2006 ), Kishimoto (2005), Campos; Rosemberg; Ferreira ( 2001), Kramer (1994) e Oliveira (2002) no âmbito da infância e da educação infantil, dentre outros. O objetivo central traçado para a pesquisa consiste em analisar as implicações da formação docente na práxis pedagógica das professoras tendo como referência, os aportes teórico-metodológicos que fundamentam tais cursos face à legislação educacional para a educação infantil. A metodologia adotada é uma pesquisa com professoras de uma escola de educação infantil, na qual foram utilizados os seguintes instrumentos de coleta de dados: observações em classe e entrevista semiestruturada. O estudo aponta para a necessidade de uma análise do processo de formação vivenciado pelas professoras a fim de que compreendam os pressupostos teóricometodológicos que subsidiam a organização do trabalho pedagógico e a construção de uma práxis capaz de atender às demandas da criança no contexto da educação infantil.

Introduction and rationale: Clinical experience with infants presenting with feeding difficulties and increasing referrals of infants with colic led to this study. There is uncertainty whether the speechlanguage therapist should play a role in the management of this condition. Despite extensive clinical research into the multiple factors related to the condition, the etiology of infantile colic has not yet been established. Suck- swallow-breathing coordination (SSBC), which is key to successful feeding, has not yet been investigated as a factor in this condition. Goals: The goal of the study was to give a comprehensive description of the symptoms and the SSBC of a group of young infants with colic. Sub-goal 1 was to compile a list of symptoms based on a description by parents of infants with infantile colic, which could be used to compare symptoms of a group of infants with the condition to a group without the condition. Sub-goal 2 was to describe SSBC, in a group of infants with the condition, by conducting a clinical assessment. Sub-goal 3 was to compare SSBC in a group of infants with colic to a group without the condition of the same age. Method: A descriptive survey design and interview guide was used in Phase 1. The parents of 60 infants with colic participated in this study. A correlation research design (Phase 2) and the List of symptoms for Infantile Colic (compiled in Phase 1) as well as the Assessment Protocol for SSBC (compiled in Phase 2) were used. A new research group of 50 participants with infantile colic and a control group of 28 participants with the condition, whose ages correlated with those of the research group, was selected. An interview was conducted with the parents of all participants. SSBC was clinically assessed in all the participants. Results: Parental description of infantile colic resulted in a comprehensive list of 27 symptoms. Audible swallowing of air and a feeding duration of more than 20 minutes were described more by parents than found in the literature. Statistically significant differences were found when the postural control and SSBC of the research group were compared with the control group. The difficulties with SSBC differed across the age categories of the participants. Conclusion: The study indicated that infantile colic is related to a disturbance in postural control and components of SSBC, and infants with the condition have subtle feeding difficulties. The speech-language therapist therefore has a role to play in the clinical assessment of infantile colic and the development of treatment strategies. / Dissertation (MA)--University of Pretoria, 2014. / lk2014 / Speech-Language Pathology and Audiology / MA / Unrestricted

Mitochondrial disorders are considered to be the most common cause of metabolic abnormalities in the paediatric neurology population (Zeviani et al., 1996). These authors reported that the phenotypes observed in 25-30% of the paediatric patients in their neurology clinics were due to a mitochondrial aetiology. The genetic aetiology in an equivalently affected paediatric population in South Africa is currently unknown. This study investigated the possibility that reported mutations could account for the mitochondrial phenotypes observed in the South African population. It focussed on the most frequent paediatric mitochondrial disorders namely: Leigh Syndrome (LS), mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS), and myoclonic epilepsy and ragged red muscle fibres (MERRF). A clinically well characterised group of 25 patients with mitochondrial disorders was included in this study. The molecular analysis of the mitochondrial genome was initially based on a restriction fragment length polymorphism (RFLP) screening strategy for the ten most common mitochondrial DNA (mtDNA) mutations associated with the above¬mentioned three disorders. However, during the study the mutation analysis strategy was modified to a sequencing strategy as this provided more information than the RFLP approach. The modified sequencing strategy extended the study to incorporate fifteen additional mtDNA mutations, associated with other mitochondrial disorders, and individuals included in the study were thus investigated for the presence of 25 mtDNA mutations. Moreover, the modified strategy provided additional information of the regions encompassing the reported mutations. A single patient was observed to harbour the reported A3243G MELAS mutation. This mutation was noted to be heteroplasmic in the proband and two of her maternal relatives. None of the other 24 reported mutations were observed in this patient population. One novel mtDNA alteration in the tRNALeu(UUR) gene was observed in a single patient, although the pathogenicity of this mutation remains to be investigated. Novel and reported polymorph isms, some of which are associated with specific haplogroups, were also observed when comparing sequencing data against the Cambridge reference sequence. The data generated during this study contributed towards the understanding of the uniqueness of the South African population in the global context. This was apparent from the fact that only one of the reported mutations was observed in our patient population who were clinically well characterised and displayed phenotypes similar to those reported internationally. Results form this study underlined the complexity of mitochondrial disorders and argues in favour of whole mitochondrial genome sequence information to be used for diagnostic purposes. Moreover, the results confer with the hypothesis that novel mitochondrial mutations may account for the majority of mitochondrial phenotypes observed in the South African population. / Dissertation (MSc (Human Genetics))--University of Pretoria, 2007. / Genetics / unrestricted

La malnutrition infantile et maternelle est un enjeu mondial qui affecte des millions d’enfants et de femmes, surtout dans les pays en développement. Le Projet d’appui à l’amélioration nutritionnelle au Bénin, réalisé par l’Association des personnes rénovatrices des technologies traditionnelles et la Fondation Paul Gérin-Lajoie, mise sur l’éducation nutritionnelle pour aborder cet enjeu. Le but de cette recherche est de faire une évaluation procédurale de ce projet afin de constater si sa mise en œuvre est pertinente relativement à la situation nutritionnelle des villages du Mono. La logique du minimum evaluation procedure a été respectée. Ainsi, plutôt que d’évaluer les résultats, ce sont les services offerts et l’utilisation de ces services par les bénéficiaires qui sont évalués. Grâce à la recherche menée sur le terrain, il est démontré que le projet répond partiellement aux besoins nutritionnels locaux, puisque les initiatives mises en œuvre dans le cadre du PAAN ne permettent pas de répondre adéquatement aux problèmes nutritionnels locaux (retard de croissance, insuffisance pondérale, carences, etc.). Cette recherche démontre aussi que, dans le cadre de projets nutritionnels, la mise en œuvre d’activités d’éducation nutritionnelle n’est pas suffisante. En plus de prendre en considération les ressources (agricoles, nutritives, sanitaires et financières) disponibles, le projet doit être en complémentarité avec les services offerts par les autres acteurs présents sur le terrain. La recherche a néanmoins permis de constater que les attentes des bénéficiaires du PAAN semblent être atteintes.

Spädbarnskolik är ett vanligt hälsoproblem. När ett barn lider av kolik är detta oftast påfrestande för barnets föräldrar. Dessa föräldrar upplever ofta oro, trötthet och en känsla av hjälplöshet, vilket kan påverka relationen mellan barnet och föräldrarna negativt och öka barnets skrikande. Känslor av frustration och ilska, vilka kan upplevas av trötta och stressade föräldrar, ökar risken för att föräldrar ska skaka eller ta hårt i barnet, vilket kan leda till att barn får allvarliga skador. BHV-sjuksköterskor är viktiga aktörer inom barnahälsovården och det är av stor vikt att de effektivt hjälper och stödjer föräldrar till barn med kolik. Syftet med denna studie är att undersöka vilket stöd och vilken hjälp föräldrar till barn med kolik önskar sig från BHV-sjuksköterskor. Denna studie utfördes som en systematisk litteraturstudie. För studien valdes nio vetenskapliga artiklar ut. De utvalda artiklarna är från Sverige, Norge, USA och Sydafrika. Bland de utvalda artiklarna är sju artiklar med kvalitativ metod och två har utförts med blandad metod med kvalitativa intervjuer och deskriptiv statistik. Samtliga utvalda artiklar belyser föräldraperspektivet, med avseende på spädbarnskolik. Studiens resultat visar att förståelse och stöd från vårdpersonal har stor betydelse för föräldrar, för att de ska kunna klara av att hantera den svåra kolikperioden. Föräldrar önskar ofta att sjuksköterskor erbjuder systematisk rådgivning och systematisk uppföljning samt att barnets tillstånd undersöks noggrant. Flertalet föräldrar är även intresserade av att få information om metoder med bristande evidens. Det framgick i studien att sjuksköterskor kan misslyckas med att hjälpa familjer med kolik på grund av att sjuksköterskor kan se annorlunda på kolikproblemet än föräldrarna själva eller att föräldrar kan ifrågasätta sjuksköterskors kompetens vad gäller kolikhantering. Ett annat hinder kan vara att föräldrarnas förmåga att acceptera stöd kan vara försämrad på grund av bland annat social isolering. Resultaten av denna studie tyder även på att kolikdiagnosen kan upplevas både som positiv och negativ av föräldrar och att när spädbarnskolik ibland normaliseras av vårdpersonal kan detta upplevas som negativt av föräldrar. En viktig poäng som framgick i studien, är att föräldrar till barn med kolik har olika behov och kan uppskatta olika typer av stöd och av andra vårdinsatser. Utifrån studiens resultat är det viktigt att sjuksköterskor och annan vårdpersonal alltid lyssnar på föräldrar, bemöter föräldraperspektivet och anpassar alla vårdinsatser utifrån föräldrars individuella behov.

Spastische Bewegungsstörungen kommen in einer Vielzahl von Krankheitsbildern, unter anderem im Kindesalter, vor. Die Krankheit betrifft die motorische Funktionalität der Muskulatur und kann zu teilweise erheblichen Einschränkung der Beweglichkeit führen. Es gibt ein multimodales Behandlungskonzept in der Therapie von Spastik bei Kindern. Seit den 1990er Jahren hält zunehmend der Einsatz einer intrathekalen Baclofentherapie Einzug. Besonders wenn die meisten anderen Therapieversuche erschöpft sind, ist der Einsatz einer intrathekalen Pumpe ein erfolgsversprechender Therapieansatz. Bei dieser Arbeit handelt es sich um eine retrospektive Analyse eines Patientenguts an der Poliklinik für Kinder- und Jugendmedizin des Universitätsklinikums Leipzig mit bereits implantierter Pumpe zur intrathekalen Baclofentherapie. Sie beschreibt eine Nutzen- Risiko- Analyse anhand einer statistischen Dateninterpretation unter Einbezug der subjektiven Bewertung durch die Eltern und Physiotherapeuten der Patienten, die mittels Fragebögen ermittelt wurde. Hierbei werden unter anderem deren Ängste und Sorgen in Bezug auf den Erfolg beziehungsweise Misserfolg des invasiven Eingriffs einer Operation, als auch deren postoperativen Aufwand der Pumpenbefüllung und –kontrolle im Vergleich zu vorherigen Maßnahmen erfasst. Der Fragebogen der Physiotherapeuten soll die Stärken und Schwächen des Kindes auf physischer Ebene und den Erfolg der Tonussenkung erfassen. Bei den in der Untersuchung einbezogenen Kindern war eine Pumpenimplantation zwischen April 2005 und November 2015 erfolgt. Zuvor fand stets eine Wirkkontrolle mittels Lumbalkatheter statt, um eine intrathekale Wirkung des Baclofens zu verifizieren.

La prévalence de l’obésité infantile est en augmentation constante et constitue un enjeu majeur de santé publique, justifiant la mise en place de stratégies de modification des modes de vie. L’obésité infantile est associée à des complications métaboliques et vasculaires, en relation avec le statut inflammatoire et stress oxydant, mais aussi à une insuffisance en vitamine D (VD). Ainsi, l’objectif général de ce travail de thèse a consisté à évaluer les effets de différents types de prises en charge chez des adolescents obèses hospitalisés pour perte de poids avec la comparaison de différentes modalités d’exercice et l’étude d’une supplémentation en vitamine D (VD). Nous avons comparé la fonction microvasculaire de 29 adolescents obèses par comparaison avec 16 adolescents normo-pondérés et déterminer les effets d’une prise en charge de 3 mois associant diète et exercice soit modéré continu (MCT) soit intensif intermittent (HIIT) sur les paramètres de santé et la fonction microvasculaire chez 29 adolescents obèses. Les deux modalités de prise en charge (diète et MCT ou diète et HIIT) ont été aussi efficaces pour la perte de poids et de masse grasse et pour l’amélioration de la condition physique. Les paramètres de la fonction microvasculaire n’ont pas été modifiés, seules les valeurs de perfusion basale ont eu tendance à augmenter quel que soit le groupe suggérant un possible phénomène d’angiogénèse.Les objectifs de l’étude VIDADO, étude interventionnelle randomisée contrôlée en double aveugle,ont été de vérifier l’effet additionnel/synergique d’une supplémentation en VD 1) sur les paramètres cardiométaboliques, 2) sur l’amélioration de la compliance artérielle et la diminution de l’épaisseur de l’intima-média de la carotide et 3) sur la fonction vasculaire macro- et microcirculatoire chez les adolescents obèses. Des adolescents obèses ont été randomisés en 2 groupes : l’un supplémenté enVD (n = 13) et l’autre non (n = 13). À l'inclusion, l'insuffisance en 25(OH)D était très élevée chez les adolescents obèses (73%) que chez les 23 adolescents normo-pondérés (22%). Tous les facteurs cardiométaboliques des adolescents obèses étaient altérés par rapport au normo-pondérés. Le diamètre carotidien et l’épaisseur de l’intima-média étaient respectivement plus faible et plus élevé chez des adolescents obèses. Les résultats de la macrocirculation ont montré une préservation de lafonction endothéliale et de la fonction musculaire lisse chez les adolescents obèses. Au niveau de la microcirculation, ils présentaient des valeurs plus faibles de la conductance vasculaire cutanée en réponse aux doses d’ACh et de SNP. La concentration de 25 (OH) D n'était corrélée ni avec les données vasculaires ni à aucun marqueur inflammatoire. Après l’intervention de 3 mois, tous les adolescents obèses du groupe supplémenté ont atteint des taux adéquats de 25 (OH) D> 50 nmol,contre seulement 46% pour le groupe placebo. L’intervention a permis d’améliorer les facteurs cardiométaboliques, le statut inflammatoire et les performances physiques, mais la supplémentation en VD n’a pas eu d’effet supplémentaire. Les adolescents obèses ont présenté des réductions significatives de l’épaisseur intima-media tandis que la compliance artérielle carotidienne a augmenté sans différence entre les 2 groupes. A noter, les concentrations sériques delta 25OHD (%)étaient seulement corrélées négativement avec les valeurs delta de l’épaisseur intima-media (%). La conductance vasculaire cutanée en réponse aux doses d’ACh et de SNP a pu être améliorée dans leseul groupe supplémenté. La variation du statut en 25(OH)D était significativement corrélée avec la variation de la conductance vasculaire cutanée en réponse aux doses d’ACh et de SNP pour les deux groupes. Les résultats de cette thèse semblent prometteurs pour mettre en place des stratégies sur les modes de vie, dont l’intérêt de sessions d’activités physiques adaptées intensives et intermittentes. / The increasing prevalence of early childhood overweight and obesity raises major public healthissues with considerable risk consequences, especially on vascular health. Childhood obesity isassociated with early signs of vascular dysfunction and with vitamin D (VD) deficiency statusand cardiometabolic abnormalities. The main aim of the thesis was to study the effects ofdifferent programs of intervention in adolescents obese.The first study aimed to determine the effects of a lifestyle intervention including 3 months ofmoderate continuous training (MCT) or high-intensity interval-training (HIIT), on healthrelatedparameters and microvascular function in 29 obese adolescents. At baseline, obeseadolescents had higher peak microcirculatory response. After 3 months, peak microcirculatoryfunction remained unchanged after MCT and HIIT. Only basal cutaneous blood flow increasedwhatever the modality of exercise.The second study (VIDADO), double-blind, randomized, placebo-controlled clinical study,aimed to analyze the cardiometabolic and vascular effects of VD supplementation in a lifestyleprogram submitted to obese adolescents. Twenty-six obese adolescents (OA) and twenty-threenormal-weight (NW) were enrolled and matched on age, gender and puberty stage. OAfollowed a 3-month weight-loss program combining a reduced caloric diet and interval trainingphysical activity and were randomized into two groups: a VD supplemented (4000 IU/d) (n=13)group (OS) and non-supplemented (n=13) one (ONS).At inclusion, 25(OH)D concentration was lower in OA than in NW. At baseline, VDinsufficiency (25(OH)D levels < 50 nmol/L) was higher in OA (73%) than in NW (22%). Allcardiometabolic factors of OA were impaired in comparison with NW. After the 3-monthlifestyle intervention, all OS achieved adequate 25(OH)D levels > 50 nmol against only 46%for ONS. Intervention led to improve the cardiometabolic factors, inflammatory status andphysical performance, but VD supplementation did not have an additional effect. OA displayedhigher IMT but lower carotid compliance than controls. After three months, the changes of IMTwere negatively correlated with the changes of 25(OH)D in OA displaying VD insufficiency atbaseline. OA displayed preserved macrocirculation function but altered microcirculationfunction with decreased vascular conductance increase responses to ACh and SNP. Interventionled to improve ACh and SNP vascular conductance only in the VD-supplemented group. Thedelta change of 25(OH)D was significantly correlated with delta changes of peak ACh and peakSNP.In conclusion, these results may yield promising interventional program including intensive,intermittent exercise and vitamin D supplementation.

No description available.