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Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-01-15Bitstream added on 2014-06-13T19:38:48Z : No. of bitstreams: 1 cassettari_mr_me_botfm.pdf: 966375 bytes, checksum: 01c8bc47fa4cbaaeadbacf93938286c5 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O envelhecimento tem sido motivo de preocupação e questionamentos constantes dentro de um contexto sócio-econômico e cultural mundial. No Brasil, devido o achatamento da pirâmide demográfica conseqüente ao declive na taxa de mortalidade e também à diminuição na taxa de natalidade, a política de saúde tem sido levada a enfocar atenção integral à saúde do idoso dentro do sistema de saúde brasileiro, mesmo considerando suas limitações. Além disso, há um constante progresso em relação à busca de alternativas para que se melhorem as condições de vida ou de sobrevivência dos idosos. A osteoartrose (OA) em joelhos em indivíduos acima de 60 anos é fator limitante na qualidade de vida dos mesmos, impossibilitando-os de realizar suas atividades de vida diária de forma qualitativa e quantitativa. Sendo assim, nesta pesquisa foi estudada a prevalência de OA de joelho em uma amostra populacional de idosos residentes em Botucatu, São Paulo, com o intuito de possibilitar uma avaliação da sua autonomia em relação a esse aspecto. Para tanto, utilizou-se instrumento validado na literatura e adaptado para a nossa realidade. Foram entrevistados 355 idosos. O processo amostral foi o de sorteio dos idosos para prevalência desconhecida a partir de famílias previamente selecionadas na amostragem sistemática, após atualização do censo do ano de 2002, com a localização das famílias (uma a cada quatro) através do mapa residencial da cidade. Essa população de idosos foi entrevistada três anos após o sorteio e, por este motivo, foi feita a reposição de perdas e óbitos de 80 idosos, estratificados por idade e sexo. Os idosos que na entrevista domiciliar referiram “dor em joelhos” foram encaminhados para exame clínico. Foi encontrado que 64% dos idosos referiram “dor em joelhos” e, destes, 98,6% apresentaram dor ou rigidez... / Aging process has been the cause of world socio-economic and cultural worry and questioning. In Brazil, due to the flattening of the demographic pyramid and the reduction of both mortality and birth rates, the health policy has focused total attention to the elderly health in the Brazilian health system, even considering its limitations. Besides, the search for alternatives to improve the life conditions or survival of the elderly is in constant progress. Knee osteoarthrosis (OA) in people at over 60 years old limits their quality of life, preventing them from doing their daily activities regarding quantity and quality. This work studied the prevalence of knee OA in an elderly population sample of Botucatu, São Paulo, to provide an evaluation of their autonomy considering this aspect. An instrument validated by the literature and adapted to our context was used in this study. Three hundred fifty-five elderly were interviewed. They were raffled for unknown prevalence among previously selected families in the systematic sample, after updated census of 2002; families (one out of four) were located through the residential map of the city. Three years after the raffle the elderly were interviewed, and stratified by sex and age. Eighty patients had to be replaced due to death. Patients who referred to “painful knee” during the home interview were sent to clinical examination. It was found out that 64% of elderly referred to “painful knee”, and, among these, 98.6% had morning pain or rigidity and protokinetic, with much difficulty to do their daily activities. This is an important finding especially concerning the elderly patient who lives alone and needs medical and physiotherapeutic follow-up to improve their quality of life. This result is similar to literature. This situation suggests that the National Health System (SUS) considerers, regarding the risky... (Complete abstract click electronic access below)

Resumo: O envelhecimento tem sido motivo de preocupação e questionamentos constantes dentro de um contexto sócio-econômico e cultural mundial. No Brasil, devido o achatamento da pirâmide demográfica conseqüente ao declive na taxa de mortalidade e também à diminuição na taxa de natalidade, a política de saúde tem sido levada a enfocar atenção integral à saúde do idoso dentro do sistema de saúde brasileiro, mesmo considerando suas limitações. Além disso, há um constante progresso em relação à busca de alternativas para que se melhorem as condições de vida ou de sobrevivência dos idosos. A osteoartrose (OA) em joelhos em indivíduos acima de 60 anos é fator limitante na qualidade de vida dos mesmos, impossibilitando-os de realizar suas atividades de vida diária de forma qualitativa e quantitativa. Sendo assim, nesta pesquisa foi estudada a prevalência de OA de joelho em uma amostra populacional de idosos residentes em Botucatu, São Paulo, com o intuito de possibilitar uma avaliação da sua autonomia em relação a esse aspecto. Para tanto, utilizou-se instrumento validado na literatura e adaptado para a nossa realidade. Foram entrevistados 355 idosos. O processo amostral foi o de sorteio dos idosos para prevalência desconhecida a partir de famílias previamente selecionadas na amostragem sistemática, após atualização do censo do ano de 2002, com a localização das famílias (uma a cada quatro) através do mapa residencial da cidade. Essa população de idosos foi entrevistada três anos após o sorteio e, por este motivo, foi feita a reposição de perdas e óbitos de 80 idosos, estratificados por idade e sexo. Os idosos que na entrevista domiciliar referiram "dor em joelhos" foram encaminhados para exame clínico. Foi encontrado que 64% dos idosos referiram "dor em joelhos" e, destes, 98,6% apresentaram dor ou rigidez... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Aging process has been the cause of world socio-economic and cultural worry and questioning. In Brazil, due to the flattening of the demographic pyramid and the reduction of both mortality and birth rates, the health policy has focused total attention to the elderly health in the Brazilian health system, even considering its limitations. Besides, the search for alternatives to improve the life conditions or survival of the elderly is in constant progress. Knee osteoarthrosis (OA) in people at over 60 years old limits their quality of life, preventing them from doing their daily activities regarding quantity and quality. This work studied the prevalence of knee OA in an elderly population sample of Botucatu, São Paulo, to provide an evaluation of their autonomy considering this aspect. An instrument validated by the literature and adapted to our context was used in this study. Three hundred fifty-five elderly were interviewed. They were raffled for unknown prevalence among previously selected families in the systematic sample, after updated census of 2002; families (one out of four) were located through the residential map of the city. Three years after the raffle the elderly were interviewed, and stratified by sex and age. Eighty patients had to be replaced due to death. Patients who referred to "painful knee" during the home interview were sent to clinical examination. It was found out that 64% of elderly referred to "painful knee", and, among these, 98.6% had morning pain or rigidity and protokinetic, with much difficulty to do their daily activities. This is an important finding especially concerning the elderly patient who lives alone and needs medical and physiotherapeutic follow-up to improve their quality of life. This result is similar to literature. This situation suggests that the National Health System (SUS) considerers, regarding the risky... (Complete abstract click electronic access below) / Orientador: Tania Ruiz / Coorientador: Beatriz Funayana Alvarenga Freire / Banca: Paulo José Fortes Villas Boas / Banca: Alberto De Vitta / Mestre

Introdução: As alterações anatômicas do fêmur proximal ou do acetábulo, como as decorrentes das sequelas da epifisiólise do fêmur proximal, da displasia do quadril da doença de Legg-Perthes-Calvé, podem levar ao desenvolvimento da artrose do quadril. No entanto, em torno de 80% dos indivíduos que desenvolvem essa doença têm uma anatomia óssea considerada normal. Ainda assim, surgiu a hipótese que alterações sutis do fêmur proximal ou do acetábulo, denominadas, respectivamente, cam e pincer, poderiam gerar um contato anormal entre essas estruturas ósseas, desencadear lesão condral e, como consequência, a artrose do quadril. Esse mecanismo foi denominado impacto fêmoro-acetabular. No entanto, a comprovação da relação entre o impacto e a artrose do quadril depende da uniformização dos critérios diagnósticos do cam e do pincer, ainda escassa e variável na literatura. Dessa forma, será possível a definição da prevalência e história natura do impacto fêmoro-acetabular e da sua relação com a artrose do quadril. Objetivo: Avaliar a prevalência do impacto fêmoro-acetabular tipo cam e tipo pincer em uma amostra de indivíduos assintomáticos. Pacientes e Métodos: Foram estudados 106 indivíduos assintomáticos (65 homens e 41 mulheres), com idade entre 20 e 40 anos. A condição determinante para a inclusão no estudo foi à ausência de história de dor no quadril ao longo da vida. Foram obtidas radiografias em ântero-posterior e Dünn 45°. A presença de cam foi determinada por um ângulo alfa, arbitrado, de 55° e a presença de pincer, quando observado o sinal da parede posterior e/ou o sinal de crossover. Resultados: Foi observada prevalência de cam de 29%; o sinal do crossover e da parede posterior ocorreram, respectivamente, em 20% e 29% dos indivíduos estudados. Pelo menos uma das imagens de impacto fêmoro-acetabular estava presente em 65% dos indivíduos da amostra. Conclusão: A prevalência encontrada das imagens de impacto fêmoro-acetabular (65%) está acima daquelas relatadas na literatura. É necessária a ampliação do estudo para confirmar os resultados encontrados e a realização de estudos prospectivos bem controlados para avaliar o papel do cam e do pincer no desenvolvimento da artrose do quadril. / Background: Anatomical abnormalities of the proximal femur or the acetabulum, such as those resulting from the consequences of slipped epiphyses of the proximal femur, the hip dysplasia of Legg-Calve-Perthes disease, could lead to the development of hip osteoarthrosis. Nevertheless, around 80% of individuals who develop this condition have a bone anatomy considered normal. Still, the hypothesis arose that subtle alterations of the proximal femur or the acetabulum, called, respectively, cam and pincer, could generate an abnormal contact between these bony structures, triggering chondral lesion and as a consequence, arthritis of the hip. This mechanism has been named femoroacetabular impingement. Nevertheless, evidence of the relationship between the impact and osteoarthritis of the hip depends on the standardization of diagnostic criteria of cam and pincer, still scarce and variable in the literature. Thus it will be possible to define the prevalence and natural history of femoroacetabular impingement and its relationship with hip osteoarthrosis. Aim: To determine the prevalence of cam-type and pincer-type femoroacetabular impingements in asymptomatic subjects. Patients and Methods: Were studied 106 asymptomatic subjects (65 males and 41 females) aged between 20 and 40 years. The determining condition for inclusion in the study was the absence of history of hip pain throughout life. Radiographs were obtained in anteroposterior pelvic view and Dunn 45° view. The presence of cam was determined by an angle alpha, arbitrated, 55 ° and the presence of pincer when the observed the posterior wall and / or crossover signs. Results: A prevalence of 29% of cam, and 20% and 29% of crossover sign and posterior wall sign respectively was found. At least, one of those radiographic signs of femoroacetabular impingement was found in 65% (68) of the cases. Conclusion: In conclusion, the prevalence of images of femoroacetabular impingement (65%) is above those reported in the literature. Increase of the study is necessary to verify the results found, and the performance of well-controlled prospective studies to evaluate the role of the cam and pincer in the development of osteoarthritis of the hip.

Osteoartrozė – viena dažniausių vyresnio amžiaus žmones varginančių ligų. Progresuojanti liga luošina ligonius, labai nukenčia jų gyvenimo kokybė ir yra viena neįgalumo priežasčių. Ligos gydymas reikalauja ypatingos sveikatos apsaugos sistemos dėmesio ir lėšų. Kadangi ligos paplitimas tiesiogiai susijęs su amžiumi, prognozuojama, kad ateityje, didėjant vyresnio amžiaus žmonių skaičiui, sergamumas osteoartroze dar labiau padidės, atitinkamai didės ir gydymo išlaidos. Gydant ligą, kartu su kitais metodais, taikoma kineziterapija. Sergant kelių sąnarių osteoartroze, ligonių mokymas ir kineziterapijos taikymas mažina skausmo intensyvumą ir gerina funkcines galimybes (Dieppe et al, 2001). Tyrimo metodai ir organizavimas. Tyrime dalyvavo sergantieji kelių sąnarių osteoartroze, savanoriškai sutikę dalyvauti. Jiems taikytas ambulatorinės reabilitacijos gydymo kompleksas. Tiriamieji buvo suskirstyti į dvi skirtingo amžiaus grupes: iki 60 metų (n=12) ir virš 60 metų (n=18). Abiem grupėms taikyta tokia pati kineziterapijos programa. Tiriamiesiems skirtos 5 kineziterapijos procedūros po 30 min. Dėl mažo kineziterapijos procedūrų skaičiaus ir tiriamųjų nesistemingo procedūrų lankymo, rekomenduota kineziterapiją atlikti ir savarankiškai, namuose. Vertintas skausmo stiprumas pagal VAS skalę, funkcinė būklė – pagal modifikuotą Keitel indeksą, kelio sąnario lenkimo judesio amplitudė, blauzdos raumenų – tiesėjų jėga – pagal 5 balų Lovett skalę. Visi tyrimai atlikti per pirmą ir pakartoti per... [toliau žr. visą tekstą] / Osteoarthritis is one the most common illnesses amongst elderly people. An ingravescent illness maims patients, exacerbating quality of their lives and therefore this is one of the causes of their physical disability. Treatment of this illness requires a special attention of the health service system and funds. Since pervasion of the illness is directly related with age, there are some predictions that with an increasing number of the elderly people, morbidity of osteoarthritis will increase also; medical costs will be increasing respectively. This illness, together with the other methods, is being cured by the physiotherapy. If the patients suffer of the kneel joints osteoarthritis, patients training and application of the physiotherapy decreases intensity of the pain and improves functional capabilities. (Dieppe et al, 2001). Methods of the research and organization. Volunteers, having knee joint osteoarthritis, attended this research process. They received an ambulatory treatment complex. Exploratory group was divided into two parts: under 60 years (n =12) and over 60 years (n =18). Both groups received the same type of the program – 5 physiotherapy procedures up to 30 minutes. Due to the little number of the procedures and facultative attendance of the patients, there were made recommendations to perform physiotherapy procedures at home. There were evaluated the following facets – pain intensity according to the VAS scale, functional state according to the modified... [to full text]

Introdução: As alterações anatômicas do fêmur proximal ou do acetábulo, como as decorrentes das sequelas da epifisiólise do fêmur proximal, da displasia do quadril da doença de Legg-Perthes-Calvé, podem levar ao desenvolvimento da artrose do quadril. No entanto, em torno de 80% dos indivíduos que desenvolvem essa doença têm uma anatomia óssea considerada normal. Ainda assim, surgiu a hipótese que alterações sutis do fêmur proximal ou do acetábulo, denominadas, respectivamente, cam e pincer, poderiam gerar um contato anormal entre essas estruturas ósseas, desencadear lesão condral e, como consequência, a artrose do quadril. Esse mecanismo foi denominado impacto fêmoro-acetabular. No entanto, a comprovação da relação entre o impacto e a artrose do quadril depende da uniformização dos critérios diagnósticos do cam e do pincer, ainda escassa e variável na literatura. Dessa forma, será possível a definição da prevalência e história natura do impacto fêmoro-acetabular e da sua relação com a artrose do quadril. Objetivo: Avaliar a prevalência do impacto fêmoro-acetabular tipo cam e tipo pincer em uma amostra de indivíduos assintomáticos. Pacientes e Métodos: Foram estudados 106 indivíduos assintomáticos (65 homens e 41 mulheres), com idade entre 20 e 40 anos. A condição determinante para a inclusão no estudo foi à ausência de história de dor no quadril ao longo da vida. Foram obtidas radiografias em ântero-posterior e Dünn 45°. A presença de cam foi determinada por um ângulo alfa, arbitrado, de 55° e a presença de pincer, quando observado o sinal da parede posterior e/ou o sinal de crossover. Resultados: Foi observada prevalência de cam de 29%; o sinal do crossover e da parede posterior ocorreram, respectivamente, em 20% e 29% dos indivíduos estudados. Pelo menos uma das imagens de impacto fêmoro-acetabular estava presente em 65% dos indivíduos da amostra. Conclusão: A prevalência encontrada das imagens de impacto fêmoro-acetabular (65%) está acima daquelas relatadas na literatura. É necessária a ampliação do estudo para confirmar os resultados encontrados e a realização de estudos prospectivos bem controlados para avaliar o papel do cam e do pincer no desenvolvimento da artrose do quadril. / Background: Anatomical abnormalities of the proximal femur or the acetabulum, such as those resulting from the consequences of slipped epiphyses of the proximal femur, the hip dysplasia of Legg-Calve-Perthes disease, could lead to the development of hip osteoarthrosis. Nevertheless, around 80% of individuals who develop this condition have a bone anatomy considered normal. Still, the hypothesis arose that subtle alterations of the proximal femur or the acetabulum, called, respectively, cam and pincer, could generate an abnormal contact between these bony structures, triggering chondral lesion and as a consequence, arthritis of the hip. This mechanism has been named femoroacetabular impingement. Nevertheless, evidence of the relationship between the impact and osteoarthritis of the hip depends on the standardization of diagnostic criteria of cam and pincer, still scarce and variable in the literature. Thus it will be possible to define the prevalence and natural history of femoroacetabular impingement and its relationship with hip osteoarthrosis. Aim: To determine the prevalence of cam-type and pincer-type femoroacetabular impingements in asymptomatic subjects. Patients and Methods: Were studied 106 asymptomatic subjects (65 males and 41 females) aged between 20 and 40 years. The determining condition for inclusion in the study was the absence of history of hip pain throughout life. Radiographs were obtained in anteroposterior pelvic view and Dunn 45° view. The presence of cam was determined by an angle alpha, arbitrated, 55 ° and the presence of pincer when the observed the posterior wall and / or crossover signs. Results: A prevalence of 29% of cam, and 20% and 29% of crossover sign and posterior wall sign respectively was found. At least, one of those radiographic signs of femoroacetabular impingement was found in 65% (68) of the cases. Conclusion: In conclusion, the prevalence of images of femoroacetabular impingement (65%) is above those reported in the literature. Increase of the study is necessary to verify the results found, and the performance of well-controlled prospective studies to evaluate the role of the cam and pincer in the development of osteoarthritis of the hip.

Introdução: As alterações anatômicas do fêmur proximal ou do acetábulo, como as decorrentes das sequelas da epifisiólise do fêmur proximal, da displasia do quadril da doença de Legg-Perthes-Calvé, podem levar ao desenvolvimento da artrose do quadril. No entanto, em torno de 80% dos indivíduos que desenvolvem essa doença têm uma anatomia óssea considerada normal. Ainda assim, surgiu a hipótese que alterações sutis do fêmur proximal ou do acetábulo, denominadas, respectivamente, cam e pincer, poderiam gerar um contato anormal entre essas estruturas ósseas, desencadear lesão condral e, como consequência, a artrose do quadril. Esse mecanismo foi denominado impacto fêmoro-acetabular. No entanto, a comprovação da relação entre o impacto e a artrose do quadril depende da uniformização dos critérios diagnósticos do cam e do pincer, ainda escassa e variável na literatura. Dessa forma, será possível a definição da prevalência e história natura do impacto fêmoro-acetabular e da sua relação com a artrose do quadril. Objetivo: Avaliar a prevalência do impacto fêmoro-acetabular tipo cam e tipo pincer em uma amostra de indivíduos assintomáticos. Pacientes e Métodos: Foram estudados 106 indivíduos assintomáticos (65 homens e 41 mulheres), com idade entre 20 e 40 anos. A condição determinante para a inclusão no estudo foi à ausência de história de dor no quadril ao longo da vida. Foram obtidas radiografias em ântero-posterior e Dünn 45°. A presença de cam foi determinada por um ângulo alfa, arbitrado, de 55° e a presença de pincer, quando observado o sinal da parede posterior e/ou o sinal de crossover. Resultados: Foi observada prevalência de cam de 29%; o sinal do crossover e da parede posterior ocorreram, respectivamente, em 20% e 29% dos indivíduos estudados. Pelo menos uma das imagens de impacto fêmoro-acetabular estava presente em 65% dos indivíduos da amostra. Conclusão: A prevalência encontrada das imagens de impacto fêmoro-acetabular (65%) está acima daquelas relatadas na literatura. É necessária a ampliação do estudo para confirmar os resultados encontrados e a realização de estudos prospectivos bem controlados para avaliar o papel do cam e do pincer no desenvolvimento da artrose do quadril. / Background: Anatomical abnormalities of the proximal femur or the acetabulum, such as those resulting from the consequences of slipped epiphyses of the proximal femur, the hip dysplasia of Legg-Calve-Perthes disease, could lead to the development of hip osteoarthrosis. Nevertheless, around 80% of individuals who develop this condition have a bone anatomy considered normal. Still, the hypothesis arose that subtle alterations of the proximal femur or the acetabulum, called, respectively, cam and pincer, could generate an abnormal contact between these bony structures, triggering chondral lesion and as a consequence, arthritis of the hip. This mechanism has been named femoroacetabular impingement. Nevertheless, evidence of the relationship between the impact and osteoarthritis of the hip depends on the standardization of diagnostic criteria of cam and pincer, still scarce and variable in the literature. Thus it will be possible to define the prevalence and natural history of femoroacetabular impingement and its relationship with hip osteoarthrosis. Aim: To determine the prevalence of cam-type and pincer-type femoroacetabular impingements in asymptomatic subjects. Patients and Methods: Were studied 106 asymptomatic subjects (65 males and 41 females) aged between 20 and 40 years. The determining condition for inclusion in the study was the absence of history of hip pain throughout life. Radiographs were obtained in anteroposterior pelvic view and Dunn 45° view. The presence of cam was determined by an angle alpha, arbitrated, 55 ° and the presence of pincer when the observed the posterior wall and / or crossover signs. Results: A prevalence of 29% of cam, and 20% and 29% of crossover sign and posterior wall sign respectively was found. At least, one of those radiographic signs of femoroacetabular impingement was found in 65% (68) of the cases. Conclusion: In conclusion, the prevalence of images of femoroacetabular impingement (65%) is above those reported in the literature. Increase of the study is necessary to verify the results found, and the performance of well-controlled prospective studies to evaluate the role of the cam and pincer in the development of osteoarthritis of the hip.

Introduction: Question of femoroacetabular impingement is very actual. This young concept brings mechanism which leads to early degenerative changes of the hip joint of young and active individuals (athletes). Objectives: To review influence of sport activity on condition of the hip joint of young athletes (players of table tennis) and to determine incidence of femoroacetabular impingement and its clinical significance. Methods: We performed ultrasound and clinical examination and questionnaire with 22 individuals from 2 training groups. Groups vary in age, height, weight, volume of sport activity and how long they do sports. We found out incidence of cam-type impingement and evaluated pain of anterior impingement test, ranges of motions of the hip joint and deep squat. Results: Cam impingement was found in 27 hip joints, 16 in older group, 11 in younger one. In older group there were 12 from 16 impingements painful during anterior impingement test, 4 from 11 in younger one. In older group there were 4 symptomatic individuals, none in younger one. Older group has lower ranges of motion of flexion and internal rotation. 4 individuals did not perform deep squat, all of them with bilateral cam-type impingement. Conclusion: Femoracetabular impingement is frequent among young athletes. It causes...

Made available in DSpace on 2016-04-04T18:29:50Z (GMT). No. of bitstreams: 1 Sergio Fernando Zavarize.pdf: 1703933 bytes, checksum: 03d6f97fa836468089a0e8d7c4c45d5c (MD5) Previous issue date: 2011-02-17 / The low back pain is considered an important public health problem and affects 70% to 80% of the adult population. When chronic, it undertakes the quality of life on many levels. The objective of this study is to evaluate the effects of the creative profile of the quality of life in patients with chronic low back pain. The research has been composed for 158 participants, 105 women and 53 men, between 30 and 80 years old, with chronic low back pain, selected by a medical diagnosis of Lumbar Osteoarthritis and registered for treatment in specialized clinics in the state of S?o Paulo. The instruments used were: a) Scale's creative profile, composed of descriptors adjectives of the creative personality which evaluates five factors: Daring, Traditionalism, Individualism, Intuition and Prudence; b) Assessment Instrument for Quality of Life of the World Health Organization (WHO) - The World Health Organization Quality of Life Assessment - WHOQOL-bref - composed of on general domain and four specific: physical, psychological, social and environmental; c) Visual Analogue Scale (VAS), that self-assess the intensity of pain with scores ranging from zero to ten. d) Supplementary Questionnaire, prepared by the author, consisting of four questions about leisure, strategies of relief and distraction from pain. The results obtained by Multivariate Analysis of Variance (MANOVA) showed, for the quality of life, significant differences on the physical domain for age and in the physical, psychological, social, environmental and general pain (VAS). For the factors of creativity, were found significant differences on Individualism factor for age, sex and pain; Traditionalism for age and pain, Daring and Intuition for age. When we compare the leisure activities, strategies for pain relief, distraction from pain and full creative profile, we found significant positive correlations between leisure, relief strategies, distraction from pain and full of creative profile. Among strategies for relief and distraction from pain, correlations were significantly negative. Comparing, also, the factors of the creative profile with the domains of quality of life, we found significant positive correlations between the factor Daring with the psychological and social factors and Intuition with the physical and environmental. Individualism factor were correlated significantly negative with psychological, social, environmental and general. We conclude that the creative profile has important implications on quality of life of individuals with chronic low back pain. / A dor lombar ? considerada um importante problema de sa?de p?blica que afeta 70% a 80% da popula??o adulta e a lombalgia, quando cr?nica, compromete a qualidade de vida em v?rios n?veis. O objetivo deste estudo foi avaliar os efeitos da criatividade na qualidade de vida em portadores de dor lombar cr?nica. A amostra foi composta por 158 participantes, consistindo em 105 mulheres e 53 homens, de 30 a 88 anos de idade, com dor lombar cr?nica, selecionados mediante diagn?stico m?dico de Osteoartrose Lombar e inscritos em cinco cl?nicas especializadas do interior paulista. Os instrumentos utilizados foram: a) Escala do Perfil Criativo, composta por adjetivos descritores da personalidade criativa e que avalia cinco fatores: Ousadia, Tradicionalismo, Individualismo, Intui??o e Prud?ncia; b) Instrumento de Avalia??o da Qualidade de Vida da Organiza??o Mundial de Sa?de (OMS), Whoqol-bref, composto por um dom?nio geral e quatro espec?ficos: f?sico, psicol?gico, social e meio ambiente; c) Escala Visual Anal?gica (E.V.A.) a qual permite uma auto-avalia??o da intensidade da dor em n?vel de 0 a 10. d) Question?rio Complementar elaborado pelo autor, composto por quatro perguntas sobre lazer, estrat?gias de al?vio e de distra??o da dor. Os resultados obtidos pela An?lise da Vari?ncia Multivariada (MANOVA) apresentaram, para a qualidade de vida, diferen?as significativas no dom?nio f?sico para idade e nos dom?nios f?sico, psicol?gico, social, ambiental e geral para a dor (E.V.A.). Para os fatores de criatividade, foram encontradas diferen?as significativos no fator Individualismo para idade, sexo e dor; Tradicionalismo para idade e dor; Ousadia e Intui??o para idade. Ao serem comparadas as atividades de lazer, estrat?gias de al?vio da dor, distra??o da dor e total do perfil criativo, encontrou-se correla??es significativamente positivas entre o lazer, estrat?gias de al?vio, distra??o da dor e total do perfil criativo. Entre as estrat?gias de al?vio e distra??o da dor, as correla??es foram significativamente negativas. Comparando-se, ainda, os fatores do perfil criativo com os dom?nios de qualidade de vida, foram encontradas correla??es significativamente positivas entre o fator Ousadia com os dom?nios psicol?gico e social e do fator Intui??o com o f?sico e ambiental. O fator Individualismo apresentou correla??es significativamente negativas com os dom?nios psicol?gico, social, ambiental e geral. Conclui-se, portanto, que o perfil criativo tem implica??es importantes na qualidade de vida de indiv?duos com dor lombar cr?nica.

L'Osteoarthrose (OA) est la maladie articulaire la plus répandue avec un impact socio-économique croissant en raison du vieillissement de la population, de l’augmentation de l'obésité et surtout de l'absence d'un traitement efficace. En effet, l’OA est caractérisée par la dégradation inéluctable du cartilage articulaire, l'apoptose des chondrocytes, un remodelage osseux sous-chondral et une inflammation de la synovie. La matrice extracellulaire (MEC) du cartilage est constituée de collagènes et de protéoglycanes (PG) eux-mêmes composés de glycosaminoglycanes (GAG) liés à un corps proteique, présents dans l'ECM ou à la surface cellulaire. Les GAG sont des chaînes polysaccharidiques linéaires sulfatées comprenant les Héparine/Héparan Sulfate (Hep/HS), Chondroitin Sulfate (CS) et Keratan Sulfate (KS). L'acide hyaluronique (AH) est un GAG non sulfaté particulier, non associé à un corps proteique. Dans le cartilage, l'un des principaux composants de la MEC est l'aggrécan, un CS/KS PG qui forme des aggrégats par interaction avec de l’AH. Au cours du vieillissement, des changements dans la qualité des PG ouvrent la voie à l’OA et les études depuis 60 ans se concentrent sur les aggrécans et le catabolisme des CS. En effets, les niveaux d'expression des CS, la taille de leurs chaînes, leurs profils de sulfatation évoluent, affectant les propriétés mécaniques de la MEC. Cependant, les traitements actuels de visco-supplémentation à base d’injections locales de CS ont démontré leur limite puisque la réparation du cartilage n'est pas induite. Même si ils sont rares dans le cartilage adulte, les HSPG sont associés aux chondrocytes et leurs rôles a été démontrée lors du développement osseux. Or les HS sont des régulateurs de l’homéostasie très importants car ils peuvent lier et réguler l'activité de protéines liant l'héparine (HBP) (facteurs de croissance, cytokines, chimiokines, morphogènes), les protégeant contre la protéolyse et potentialisant leur liaison à leurs récepteurs. Tous ces effets sont contrôlés par les profils de sulfatation complexes des chaînes d’HS.Dans ce contexte les objectifs de cette thèse sont de caractériser l'évolution de la signature chimique et de la fonctionnalité des HS au cours de l’OA. En collaboration avec les Rhumatologistes et Orthopédistes de l’Hopital Henri Mondor, une évaluation quantitative des HS dans des échantillons de cartilage humain contrôle versus OA a été corrélée à la gravité des dommages. Grace à la plateforme glycomic du CRRET, des modifications dans les profils de sulfatation des disaccharides de HS ont été observées et confirmées par des analyses de l'expression des enzymes de la biosynthèse des GAG. Ces caractéristiques structurales ont été corrélées à des changements fonctionnels de l’affinité des GAG pour des HBP, telles que FGF-2, VEGF et PTN. Enfin, les GAG OA ont des capacités différentes à moduler les propriétés (prolifération, adhésion, phénotype) de cellules souches mésenchymateuses, chondrocytes, fibroblastes et cellules endothéliales. Ces résultats démontrent que des modifications des structures et fonctions des HS pourraient être impliquées dans l'évolution de l'homéostasie du cartilage vers des processus pathologiques au cours de l’OA. Ce projet se positionne clairement comme une recherche fondamentale et translationnelle qui permettra d'acquérir des connaissances sur les mécanismes régulant les interactions cellules/matrice au cours de l'OA. De plus, les outils développés au cours de ce projet ont permis de réaliser 2 projets collaboratifs sur l'hypertension artérielle pulmonaire et une pathologie éosophagique. Enfin, ces données confirment l'intérêt d’identifier de nouvelles cibles glycaniques basées sur la chimie des HS. Cela permettra de proposer une nouvelle stratégie thérapeutique basée sur des composes à même de contrôler les profils de sulfatation de la MEC, dans le but d'améliorer les propriétés de cellules souches thérapeutiques endogènes ou exogènes, associées. / Osteoarthritis (OA) is the most prevalent joint disease with increasing socio-economic impact due to population aging, obesity , and absence of an efficient medical treatment that can repair cartilage. OA is characterized by degradation of articular cartilage, hypertrophy and apoptosis of chondrocytes, subchondral bone remodeling and joint synovial inflammation. Cartilage extracellular matrix (ECM) consists of collagens, glycoproteins and proteoglycans (PGs) that are composed of Glycosaminoglycans (GAGs) linked to core proteins, presents in the ECM or at the cell surface. GAGs are linear polysaccharidic sulfated chains including Heparine/Heparan Sulfate (Hep/HS), Chondroitin Sulfate (CS) and Keratan Sulfate (KS) families. Hyaluronic acid (HA) is a particular un-sulfated GAG no associated to core protein. In cartilage, one of the major ECM component is aggrecan, a CS/KS PG that form aggregate through HA interaction. During the aging process, changes in PGs quality pave the way for OA and studies are focus on aggrecans and CS catabolism since 60 years. CS expression levels, chain size, sulfation patterns evolved during OA, affecting the mechanical properties of ECM. However, treatments based on visco-supplementation with CS local injections have demonstrated their limit since cartilage repair is not induced. Even if rare in adult cartilage, HSPG are present associated to chondrocytes also and their relevance was demonstrated mainly during bone development. HS chains are very important homeostatic regulators because they are able to bind and regulate the activity of several heparin binding proteins (HBP) (growth factors, cytokines, chemokines, morphogens), protecting them against proteolysis and potentiating their binding to their receptors. These interactions provide a stock of regulatory factors that can be release by selective degradation of the HS chains too. All these regulatory effects are mediated through the complex sulfation/acetylation pattern of HS chains but no data are available on this aspect during OA.In this context, the goals of this Thesis were to characterize the evolution of HS chemical signature and functionality during OA. In collaboration with Rheumatology and Orthopedic clinical teams from Henri Mondor Hospital, a quantitative evaluation of HS and CS amount in control versus OA human cartilage samples was correlated to the structural damage severity. According to the tools of the CRRET’s lab glycomic platform, structural changes on HS and CS sulfated disaccharides compositions was observed using HPLC, confirmed by RQ-PCR analyzes of the expression of enzymes involved in GAG biosynthesis. These structural features were correlated to functional changes on HBP affinities, such as FGF-2, VEGF and PTN, through ELISA based competition assay. Finally, GAGs from OA have different abilities to modulate properties (adhesion proliferation, phenotype…) of Mesenchymal Stem Cells, chondrocytes, fibroblast and endothelial cells. These results clearly make the proof that modifications of HS structures and functions could be involved in the evolution of cartilage homeostasis and pave the way for altered pathological processes during OA. This project is clearly positioned as a fundamental and translational research that will permit to gain knowledge on the mechanisms regulating cartilage cells/matrix interactions during OA. All these results are summarized in 2 scientific and 1 review articles. Moreover, all the tools developed during this project have permit to realize 2 collaborative projects and associated articles on Pulmonary Hypertension and Eosophagic pathology also. Finally, all these data confirmed the interest of the team to identify new glycanic targets based on HS chemistry. This will permit to propose new therapeutic strategy based on HS compounds associated to endogenous or exogenous therapeutic stem cells, with the aim of improving cell properties according to HS ability to control sulfation panels of ECM.