Este estudo tem por objetivo a realização de uma exegese (tomando o termo “exegese” no sentido de leitura epistemológica) do artigo de 1970, de Émile Benveniste, intitulado O aparelho formal da enunciação, procurando averiguar em que medida é possível considerá-lo como um texto ao mesmo tempo de síntese e organização da perspectiva enunciativa esboçada pelo linguista no decorrer de seus trabalhos anteriores, e como um texto de “abertura”, ao ampliar o alcance teórico da enunciação em relação à língua e abrir a teoria enunciativa a novas possibilidades de análise. Para tanto, o trabalho se encontra dividido em duas partes: A primeira delas compreende os três primeiros capítulos e se destina ao estabelecimento das bases teórico-metodológicas da exegese, configurando-se, portanto, como uma tentativa de elaboração de operadores de leitura necessários à leitura epistemológica da obra benvenistiana. A segunda parte constitui propriamente a exegese do texto de 1970 e é constituída por dois capítulos, um responsável pelo ponto de vista que vê no texto O aparelho formal da enunciação uma síntese organizadora da teoria enunciativa, ao descrever a enunciação a partir do quadro formal de sua realização, e outro responsável por uma leitura que destaca os aspectos programáticos do texto benvenistiano e elucida os pontos em que se percebe um alargamento da teoria, ao conceber que a língua na sua totalidade está submetida à enunciação. / This study has the objective of performing an exegesis (considering the term “exegesis” in the sense of epistemological reading) of Émile Benveniste‟s article from 1970, titled L’appareil formel de l’énociation, in order to investigate in which extent it is possible to consider it simultaneously as a text of synthesis and organization of the enunciative perspective outlined by the linguist along his previous studies, and as a text of openness, by broadening the theoretical length of énonciation regarding the language (langue) and by opening the enunciative theory to new possibilities of analysis. To this end, this study is divided in two parts: The first part comprises three chapters and is intended to establish the theoretical-methodological basis of the exegesis, figuring, thus, as an attempt to elaborating the necessary reading operators to the epistemological reading of the benvenistian text. The second part constitutes properly the exegesis of the 1970‟s article, and comprises two chapters, one of them responsible for the point of view that sees in the text L’appareil formel de l’énonciation an organizing synthesis of the enunciative theory, by describing énonciation from its formal framework of realization, and the other one responsible for a reading that highlights the prospective aspects of the benvenistian article, and that elicits the points in which is evident a widening of the theory, by considering that language (langue), as a whole, is submitted to énonciation.

Este estudo tem por objetivo a realização de uma exegese (tomando o termo “exegese” no sentido de leitura epistemológica) do artigo de 1970, de Émile Benveniste, intitulado O aparelho formal da enunciação, procurando averiguar em que medida é possível considerá-lo como um texto ao mesmo tempo de síntese e organização da perspectiva enunciativa esboçada pelo linguista no decorrer de seus trabalhos anteriores, e como um texto de “abertura”, ao ampliar o alcance teórico da enunciação em relação à língua e abrir a teoria enunciativa a novas possibilidades de análise. Para tanto, o trabalho se encontra dividido em duas partes: A primeira delas compreende os três primeiros capítulos e se destina ao estabelecimento das bases teórico-metodológicas da exegese, configurando-se, portanto, como uma tentativa de elaboração de operadores de leitura necessários à leitura epistemológica da obra benvenistiana. A segunda parte constitui propriamente a exegese do texto de 1970 e é constituída por dois capítulos, um responsável pelo ponto de vista que vê no texto O aparelho formal da enunciação uma síntese organizadora da teoria enunciativa, ao descrever a enunciação a partir do quadro formal de sua realização, e outro responsável por uma leitura que destaca os aspectos programáticos do texto benvenistiano e elucida os pontos em que se percebe um alargamento da teoria, ao conceber que a língua na sua totalidade está submetida à enunciação. / This study has the objective of performing an exegesis (considering the term “exegesis” in the sense of epistemological reading) of Émile Benveniste‟s article from 1970, titled L’appareil formel de l’énociation, in order to investigate in which extent it is possible to consider it simultaneously as a text of synthesis and organization of the enunciative perspective outlined by the linguist along his previous studies, and as a text of openness, by broadening the theoretical length of énonciation regarding the language (langue) and by opening the enunciative theory to new possibilities of analysis. To this end, this study is divided in two parts: The first part comprises three chapters and is intended to establish the theoretical-methodological basis of the exegesis, figuring, thus, as an attempt to elaborating the necessary reading operators to the epistemological reading of the benvenistian text. The second part constitutes properly the exegesis of the 1970‟s article, and comprises two chapters, one of them responsible for the point of view that sees in the text L’appareil formel de l’énonciation an organizing synthesis of the enunciative theory, by describing énonciation from its formal framework of realization, and the other one responsible for a reading that highlights the prospective aspects of the benvenistian article, and that elicits the points in which is evident a widening of the theory, by considering that language (langue), as a whole, is submitted to énonciation.

Este estudo tem por objetivo a realização de uma exegese (tomando o termo “exegese” no sentido de leitura epistemológica) do artigo de 1970, de Émile Benveniste, intitulado O aparelho formal da enunciação, procurando averiguar em que medida é possível considerá-lo como um texto ao mesmo tempo de síntese e organização da perspectiva enunciativa esboçada pelo linguista no decorrer de seus trabalhos anteriores, e como um texto de “abertura”, ao ampliar o alcance teórico da enunciação em relação à língua e abrir a teoria enunciativa a novas possibilidades de análise. Para tanto, o trabalho se encontra dividido em duas partes: A primeira delas compreende os três primeiros capítulos e se destina ao estabelecimento das bases teórico-metodológicas da exegese, configurando-se, portanto, como uma tentativa de elaboração de operadores de leitura necessários à leitura epistemológica da obra benvenistiana. A segunda parte constitui propriamente a exegese do texto de 1970 e é constituída por dois capítulos, um responsável pelo ponto de vista que vê no texto O aparelho formal da enunciação uma síntese organizadora da teoria enunciativa, ao descrever a enunciação a partir do quadro formal de sua realização, e outro responsável por uma leitura que destaca os aspectos programáticos do texto benvenistiano e elucida os pontos em que se percebe um alargamento da teoria, ao conceber que a língua na sua totalidade está submetida à enunciação. / This study has the objective of performing an exegesis (considering the term “exegesis” in the sense of epistemological reading) of Émile Benveniste‟s article from 1970, titled L’appareil formel de l’énociation, in order to investigate in which extent it is possible to consider it simultaneously as a text of synthesis and organization of the enunciative perspective outlined by the linguist along his previous studies, and as a text of openness, by broadening the theoretical length of énonciation regarding the language (langue) and by opening the enunciative theory to new possibilities of analysis. To this end, this study is divided in two parts: The first part comprises three chapters and is intended to establish the theoretical-methodological basis of the exegesis, figuring, thus, as an attempt to elaborating the necessary reading operators to the epistemological reading of the benvenistian text. The second part constitutes properly the exegesis of the 1970‟s article, and comprises two chapters, one of them responsible for the point of view that sees in the text L’appareil formel de l’énonciation an organizing synthesis of the enunciative theory, by describing énonciation from its formal framework of realization, and the other one responsible for a reading that highlights the prospective aspects of the benvenistian article, and that elicits the points in which is evident a widening of the theory, by considering that language (langue), as a whole, is submitted to énonciation.

Le taux de mortalité chez les patients à risque d’arythmies cardiaques menaçantes à la vie a été considérablement réduit grâce au défibrillateur cardiaque implantable (DCI). Toutefois, des préoccupations uniques face au DCI, y compris les chocs que l’appareil peut déclencher, sont susceptibles de provoquer des symptômes d'anxiété et une limitation perçue des activités chez les porteurs de DCI. Ces réactions émotives et modifications de comportement peuvent affecter l’acceptation du patient envers le DCI. Cette étude pilote randomisée avec groupe contrôle (n=15 /groupe) visait à examiner la faisabilité et l'acceptabilité d'une intervention infirmière individualisée de même que ses effets préliminaires sur l’anxiété, le fonctionnement dans les activités de la vie quotidienne et l’acceptation du DCI auprès de nouveaux porteurs de DCI. L'intervention infirmière, basée sur la théorie du Human Caring et teintée d’une approche cognitive comportementale, ciblait les préoccupations individuelles face au DCI. À partir des préoccupations identifiées, l’infirmière intervenait en mettant l'accent sur les croyances contraignantes du patient, qui pouvaient mener à de l’anxiété et des comportements d'évitement. Après randomisation, les patients du groupe intervention (GI) ont participé à un premier entretien en face-à-face avant le congé hospitalier. Subséquemment, deux entretiens se sont faits par téléphone, à environ 7 et 14 jours suite au congé hospitalier. Les résultats soutiennent la faisabilité et l’acceptabilité du devis de l’étude et de l’intervention évaluée. De plus, ils soulignent le potentiel de l’intervention à diminuer les sentiments anxieux chez les participants du GI. Les résultats de cette étude pilote offrent des pistes de recherches futures et permettront de guider la pratique clinique. / Patients with an implantable cardiac defibrillator (ICD) decrease their risk of mortality related to life threatening arrhythmias. However, multiple concerns about this device exist, including ICD shocks, which may result in increased anxiety and a perceived limitation in performing everyday activities. These emotional reactions and behavioral changes may have a negative impact on the acceptance of the device. The purpose of this randomized pilot study with a group control (n=15 / group), was to verify the feasibility and acceptability of an individualized nursing intervention aiming to decrease anxiety, improve performance in everyday activities and device acceptance in patients with newly implanted ICDs. Based on Human Caring theory and a cognitive behavioral approach, this intervention addressed each patient’s unique concerns. From the identified concerns, the nurse intervened focussing on the patient’s dysfunctional beliefs that can lead to anxiety and avoidance behavior. After randomization, the first encounter for the experimental group (EG) was face-to-face before hospital discharge. Subsequently, two encounters were made via telephone, 7 and 14 days after discharge. The results support the feasibility and acceptability of the study design and the intervention evaluated. In addition, they emphasize the potential of the intervention to reduce symptoms of anxiety among the participants of the EG. The results of this pilot study may provide directions for future research and help guide clinical practice.

La relation entre le risque de décès par cancer du poumon et l’exposition au radon est aujourd’hui établie, notamment à partir des études conduites chez les mineurs d’uranium. Mais de nombreuses interrogations persistent sur les risques de cancers extra-pulmonaires et de maladies non-cancéreuses, et sur l'impact sur la santé des autres expositions radiologiques professionnelles. L’objectif général de cette thèse est de contribuer à l’estimation des risques radio-induits aux faibles débits de dose au travers de l'analyse des risques de décès par cancer du rein et par Maladie de l'Appareil Circulatoire (MAC) chez les mineurs d’uranium.Les analyses du risque de décès par cancer du rein ont été réalisées au sein de la cohorte française des mineurs d'uranium (n=5 086 ; période de suivi : 1946-2007), la cohorte post-55 (n=3 377 ; période de suivi : 1957-2007) et la cohorte allemande de la Wismut (n=58 986; période de suivi : 1946-2003) au sein desquelles sont respectivement répertoriés 24, 11 et 174 décès par cancer du rein. L’exposition au radon et à ses descendants à vie courte (exprimée en Working Level Month WLM), aux poussières d’uranium (kBqh.m-3) et aux rayonnements gamma (mSv) a été estimée individuellement et la dose absorbée au rein a été calculée. La relation dose-réponse a été affinée par rapport à l'analyse classique en considérant deux types de réponse : le risque instantané de décès par cancer du rein (analyse classique, Cause-specific Hazard Ratio (CSHR) estimé avec le modèle de Cox) et sa probabilité d'occurrence au cours du suivi (Subdistribution Hazard Ratio (SHR) estimé avec le modèle de Fine & Gray). Un excès de mortalité par cancer du rein était observé dans la cohorte française (SMR = 1,62 IC95%[1,04; 2,41]), mais pas dans la cohorte post-55. Dans la cohorte de la Wismut, un déficit de mortalité par cancer du rein était observé (0,89 [0,78; 0,99]). Pour ces trois populations, aucune relation n'a pu être mise en évidence entre les expositions radiologiques (ou la dose au rein) et le risque de décès par cancer du rein (ex : CSHRWismut_radon/100WLM=1,023 [0,993; 1,053]), ni avec sa probabilité d'occurrence au cours du suivi (ex : SHRWismut_radon /100WLM=1,012 [0,983; 1,042]).L’étude du risque de décès par MAC dans la cohorte française a montré une augmentation significative du risque de décès par MAC (n=442, CSHR/100WLM=1,11 [1,01; 1,22]) et par Maladie CérébroVasculaire (MCeV, n=105, CSHR/100WLM=1,25 [1,09; 1,43]) avec l’exposition au radon. Une enquête cas-témoins nichée au sein de la cohorte a été mise en place pour recueillir dans les dossiers médicaux les facteurs de risque classiques de MAC (surpoids, hypertension, diabète...) pour 313 mineurs (76 décès par MAC (dont 26 par Cardiopathie Ischémique (CI) et 16 par MCeV) et 237 témoins). Pour les trois expositions radiologiques, la relation exposition-risque a été analysée au sein d'une pseudo-cohorte (obtenue en pondérant les observations par l'inverse de la probabilité de sélection, n=1 644 pseudo-individus) avec le modèle de Cox, en ajustant sur les différents facteurs de risque. L’association entre les expositions radiologiques et le risque de décès par MAC, CI ou MCeV n'était pas significative (ex : CSHRMAC_radon/100WLM=1,43 [0,71; 2,87]). La prise en compte des facteurs de risque ne modifiait pas sensiblement cette association.L'absence de relation dose-réponse significative suggère que l'excès de mortalité par cancer du rein chez les mineurs français serait induit par d'autres facteurs, non-disponibles pour cette analyse. La faible variation des coefficients avec l'ajustement sur les facteurs de risque de MAC dans l'enquête cas-témoins nichée soutient l'hypothèse de l'existence d'une augmentation du risque de MCeV dans la cohorte française associée à l’exposition au radon. La poursuite du suivi de la cohorte permettra d'affiner ces résultats. / The relation between lung cancer risk and radon exposure has been clearly established, especially from the studies on uranium miner cohorts. But the association between radon exposure and extrapulmonary cancers and non-cancer diseases remains not well known. Moreover, the health risks associated with the other mining-related ionizing radiation exposures are still under consideration. The aim of this thesis is to contribute to the estimation of the radio-induced health risks at low-doses through the analysis of the kidney cancer and Circulatory System Disease (CSD) mortality risks among uranium miners.Kidney cancer mortality risk analyses were performed from the French cohort of uranium miners (n=5086; follow-up period: 1946-2007), the post-55 cohort (n=3,377; follow-up period: 1957-2007) and the German cohort of the Wismut (n=58,986; follow-up period: 1946-2003) which included 24, 11 and 174 deaths from kidney cancer, respectively. The exposures to radon and its short-lived progeny (expressed in Working Level Month WLM), to uranium ore dust (kBqh.m-3) and to external gamma rays (mSv) were estimated for each miners and the equivalent kidney dose was calculated. The dose-response relation was refined considering two responses: the instantaneous risk of kidney cancer mortality (corresponding to the classical analysis, Cause-specific Hazard Ratio (CSHR) estimated with the Cox model) and its occurrence probability during the follow-up (Subdistribution Hazard Ratio (SHR) estimated with the Fine & Gray model). An excess of kidney cancer mortality was observed only in the French cohort (SMR = 1.62 CI95%[1.04; 2.41]). In the Wismut cohort, a decrease of the kidney cancer mortality was observed (0.89 [0.78; 0.99]). For these three cohorts, the occupational radiological exposures (or the equivalent kidney dose) were significantly associated neither with the risk of kidney cancer mortality (e.g. CSHRWismut_radon/100WLM=1.023 [0.993; 1.053]), nor with its occurrence probability during the follow-up (e.g. SHRWismut_radon /100WLM=1.012 [0.983; 1.042]).CSD mortality risk analyses in the French cohort showed a significant increase of the risks of mortality from CSD (n=442, CSHR/100WLM=1.11 [1.01; 1.22]) and from CerebroVascular Disease (MCeV, n=105, CSHR/100WLM=1.25 [1.09; 1.43]) with radon exposure. A case-control study nested in the French cohort was set up to collect the information related to CSD risk factors (overweight, hypertension, diabetes...) from the medical records of 313 miners (76 deaths from CSD (including 26 from Ischemic Heart Disease (IHD) and 16 from MCeV) and 237 controls). For the three radiological exposures, the exposure-risk relation was analyzed in a pseudo-cohort (n=1,644 pseudo-individuals, obtained from the weighting of the observations by their inverse selection probability) with the Cox model, adjusted for the CSD risk factors. The association between the radiological exposure and the risk of mortality from CSD, IHD or MCeV was not significant (e.g. CSHRCSD_radon/100WLM=1.43 [0.71; 2.87]). The adjustment for CSD risk factors did not substantially change the exposure-risk relation.The lack of a significant dose-response relation suggests that the excess of kidney cancer mortality among the French uranium miners may be induced by other risk factors, unavailable for this study. The small change of the coefficients observed after adjustment for CSD risk factors in the nested case-control study supports the assumption of the existence of the MCeV mortality risk increase associated with radon exposure in the French cohort of uranium miners. Future analyses based on further follow-up updates should allow to confirm or not these results.

Le taux de mortalité chez les patients à risque d’arythmies cardiaques menaçantes à la vie a été considérablement réduit grâce au défibrillateur cardiaque implantable (DCI). Toutefois, des préoccupations uniques face au DCI, y compris les chocs que l’appareil peut déclencher, sont susceptibles de provoquer des symptômes d'anxiété et une limitation perçue des activités chez les porteurs de DCI. Ces réactions émotives et modifications de comportement peuvent affecter l’acceptation du patient envers le DCI. Cette étude pilote randomisée avec groupe contrôle (n=15 /groupe) visait à examiner la faisabilité et l'acceptabilité d'une intervention infirmière individualisée de même que ses effets préliminaires sur l’anxiété, le fonctionnement dans les activités de la vie quotidienne et l’acceptation du DCI auprès de nouveaux porteurs de DCI. L'intervention infirmière, basée sur la théorie du Human Caring et teintée d’une approche cognitive comportementale, ciblait les préoccupations individuelles face au DCI. À partir des préoccupations identifiées, l’infirmière intervenait en mettant l'accent sur les croyances contraignantes du patient, qui pouvaient mener à de l’anxiété et des comportements d'évitement. Après randomisation, les patients du groupe intervention (GI) ont participé à un premier entretien en face-à-face avant le congé hospitalier. Subséquemment, deux entretiens se sont faits par téléphone, à environ 7 et 14 jours suite au congé hospitalier. Les résultats soutiennent la faisabilité et l’acceptabilité du devis de l’étude et de l’intervention évaluée. De plus, ils soulignent le potentiel de l’intervention à diminuer les sentiments anxieux chez les participants du GI. Les résultats de cette étude pilote offrent des pistes de recherches futures et permettront de guider la pratique clinique. / Patients with an implantable cardiac defibrillator (ICD) decrease their risk of mortality related to life threatening arrhythmias. However, multiple concerns about this device exist, including ICD shocks, which may result in increased anxiety and a perceived limitation in performing everyday activities. These emotional reactions and behavioral changes may have a negative impact on the acceptance of the device. The purpose of this randomized pilot study with a group control (n=15 / group), was to verify the feasibility and acceptability of an individualized nursing intervention aiming to decrease anxiety, improve performance in everyday activities and device acceptance in patients with newly implanted ICDs. Based on Human Caring theory and a cognitive behavioral approach, this intervention addressed each patient’s unique concerns. From the identified concerns, the nurse intervened focussing on the patient’s dysfunctional beliefs that can lead to anxiety and avoidance behavior. After randomization, the first encounter for the experimental group (EG) was face-to-face before hospital discharge. Subsequently, two encounters were made via telephone, 7 and 14 days after discharge. The results support the feasibility and acceptability of the study design and the intervention evaluated. In addition, they emphasize the potential of the intervention to reduce symptoms of anxiety among the participants of the EG. The results of this pilot study may provide directions for future research and help guide clinical practice.