A análise pelas técnicas hifenadas CLAE-DAD-EM e CLAE-DAD-EM/EM de extratos foliares de Lychnophora ericoides Mart. levou à identificação de 34 metabólitos secundários diretamente a partir dos extratos vegetais. Destes, 19 foram relatados pela primeira vez na subtribo Lychnophorinae. Uma metodologia para extração e análise destes metabólitos por CLAE-DAD foi desenvolvida, validada e utilizada para determinação de suas variações populacionais e temporais. Perfis metabólicos bem semelhantes, com diferenças quantitativas, mas não qualitativas, foram observados entre os indivíduos de uma mesma população. Entre as cinco populações analisadas, foi observado um metabolismo secundário bem mais diversificado, caracterizado pela presença de lactonas sesquiterpênicas, nas plantas da população de Ibiraci-MG. As concentrações mais elevadas de ácidos cafeoilquínicos foram encontradas no período da seca no cerrado (inverno) e as menores quando a planta se encontrava florida. Os teores de flavonóides foram maiores durante o período de chuvas (verão) e os de C-glicosilflavonas e lactonas sesquiterpênicas se mantiveram estáveis. Variações circadianas significativas de flavonóides e ácidos cafeoilquínicos também foram observadas nas duas populações nas quais estes fatores foram estudados. Foi verificado que o envelhecimento das folhas resulta em uma pronunciada redução no conteúdo de todos os metabólitos secundários e concentrações menores dos metabólitos foram observadas nas folhas dos ramos floridos em relação aos ramos sem flores de um mesmo indivíduo. Finalmente, conclui-se que as variações temporais e populacionais observadas em L. ericoides podem ser determinantes para a intensidade da atividade antiinflamatória e/ou analgésica desta planta, utilizada popularmente para estes propósitos. / The analyses of Lychnophora ericoides Mart. leaves extracts by HPLC-DAD-MS and HPLC-DAD-MS/MS resulted in the identification of 34 secondary metabolites directly from the plant extracts. Nineteen of these metabolites are being reported for the first time in the Lychnophorinae subtribe. A method for the extraction and analyses of these metabolites by CLAE-DAD was developed, validated and employed for the determination of their populational and temporal variations. Very similar metabolic profiles, exhibiting quantitative but not qualitative differences, were found among each population individuals. Among the five studied populations, a more diversified secondary metabolism, characterized by sesquiterpene lactones presence, was observed for the plants collected at Ibiraci-MG. The highest concentrations of caffeoylquinic acids were found in the cerrado dry season (winter), and the lowest when the plants were blooming. The flavoinoid contents were higher during the rainy season (summer), while C-glucosylflavones and sesquiterpene lactones levels remained stable. Significant circadian variations were also detected regarding flavonoids and caffeoylquinic acids in the two populations analyzed on this respect. It was also found a pronounced reduction in the contents of all the secondary metabolites as the leaves get old. Lower levels of all the metabolites were also found for the flowery branches when compared to the non flowery ones in the same individual. Finally, it can be concluded that the temporal and populational variations detected in L. ericoides leaves could highly influence the intensity of the anti-inflammatory and/or analgesic activities of this plant, used in popular medicines for these purposes.

Uno de los principales factores que amenazan a los anfibios es la contaminación del medio por diferentes sustancias químicas, lo que hace necesario incrementar el conocimiento que se tiene del impacto de estos compuestos sobre los anfibios.En la presente Tesis Doctoral se estudió el impacto, en diferentes condiciones experimentales, del cloruro amónio, nitrito sódico y nitrato sódico, de manera aislada o combinada, sobre la rana común, Pelophylax perezi (Seoane, 1885). Además, se intentó proporcionar una visión general de los efectos de la contaminación sobre los anfibios mediante la realización de un meta-análisis.Los resultados obtenidos permiten concluir que la contaminación afectó negativamente a la supervivencia de los anfibios y a otros parámetros subletales. Sin embargo, la contaminación puede conducir la evolución de los anfibios. Finalmente, las condiciones experimentales demostraron tener una gran importancia a la hora de establecer el impacto de un agente estresante sobre los anfibios. / Chemical pollution is one of the major factors threatening amphibians, which makes necessary to perform further studies to assess its impact on amphibians.The present PhD thesis looks at the impact, in different experimental venues, of ammonium chloride, sodium nitrite and sodium nitrate, either isolated or combined, on the Iberian water frog, Pelophylax perezi (Seoane, 1885). Moreover, an overview of pollution effects on amphibianswas provided by conducting a meta-analysis.The results obtained allowed to conclude that pollution negatively affected amphibian survival, as well as other sublethal endpoints. Neverthelesss, pollution may drive the evolution in amphibians. Finally, experimental venues were revealed to show a great relevance when assessing the impact of a stressing factor on amphibians.

Face aux pressions continues que subissent les systèmes de santé, de nombreuses réformes sont perpétuellement en cours pour améliorer le processus de soins et par conséquent, offrir des soins de qualité et accroître le niveau de santé des populations. Les réformes que connaissent actuellement les systèmes de santé visent à optimiser l’impact des services sur la santé de la population en introduisant le concept de la responsabilité populationnelle. Par ailleurs, il existe de plus en plus un consensus sur la nécessité d’établir une relation directe et durable entre les prestataires et la population des territoires desservies pour être en mesure de tenir compte des contextes personnels et sociaux des patients et de leurs familles et pour assurer la continuité des soins dans le temps et d’un service à l’autre. Cette thèse porte sur la Programmation régionale de services ambulatoires (PRSA) de Laval. Elle analyse cette programmation comme une solution innovatrice dans la mise en œuvre de la responsabilisation populationnelle des soins. La stratégie de recherche combine à la fois une revue intégrative de la littérature qui vise à analyser le bien-fondé de la PRSA; une étude quasi-expérimentale pour examiner ses effets; et enfin, une recherche synthétique de cas pour comprendre l’évolution de la PRSA et analyser l’institutionnalisation du changement dans les organisations de la santé. Dans le premier article, nous nous sommes employés à analyser le bien fondé c’est-à-dire la plausibilité des mécanismes causaux présumés. La PRSA est un modèle d’intégration régionale basée sur une approche populationnelle. La stratégie de réseaux intégrés de soins et de case management combinée avec une approche populationnelle telle que mise de l’avant par le PRSA sont trois éléments essentiels en faveur d’une responsabilité populationnelle des soins. À l’aide d’une revue intégrative de la littérature, nous avons démontré qu’il s’agit d’une programmation capable de consolider une intégration régionale en mettant de l’avant une approche populationnelle permettant de bien cibler les besoins des populations du territoire à desservir. Le deuxième article examine les effets populationnels de la PRSA en termes de réduction de la durée moyenne de séjour et de l’augmentation de la rétention régionale. Une approche quasi expérimentale a été utilisée. En ce qui concerne la durée moyenne de séjour, on n’observe aucune diminution pour l’asthme ni pour la démence. Par contre, il est plausible que l’implantation de la PRSA ait permis une diminution de la durée moyenne de séjour pour les maladies coronariennes, les MPOC, l’embolie pulmonaire et le cancer du sein. Pour la rétention régionale, aucun effet n’a été observé pour les MPOC, l’embolie pulmonaire et la démence. Une augmentation de la rétention régionale a été observée pour les maladies coronariennes, l’asthme et le cancer du sein. Cette augmentation pourrait être attribuée à la PRSA. Dans le troisième article, nous avons examiné les facteurs susceptibles d’expliquer l’évolution de la PRSA. En partant du point de vue des responsables de la programmation de la PRSA et les gestionnaires actuels de la programmation de services de la région de Laval, nous avons tenté de mieux cerner les facteurs qui ont provoqué la suspension du déploiement de la PRSA. Les résultats indiquent que les changements fréquents dans les structures dirigeantes du réseau de la santé ainsi que l’interférence de plusieurs autres réformes ont été un obstacle dans le maintien de la PRSA. Dans le contexte actuel des réformes en santé où l’approche de réseaux intégrés de soins et de responsabilité populationnelle sont mises de l’avant, les résultats de cette thèse apportent un éclairage certain sur l’opérationnalisation de ces orientations. / Due to the continuous pressures on the health systems, many reforms are perpetually implemented to improve care process and consequently the quality of care in order to increase public’s health level. The ultimate goal of this health system’s reform is to optimize the services impact on population’s health by introducing the populational responsibility concept; an approach based on the conviction that health is collective, therefore necessary to maintain and develop. In addition, there are more and more consensus on the necessity to establish a direct and durable relationship between care providers and communities. Thus, a way to be able to consider the patient’s personal and social contexts along with his family, and to ensure continuous care. This thesis, based on the Regional Programmation of ambulatory services (PRSA) of Laval, analyzes this program as an innovative solution concerning the introduction of populational approach in healthcare. The research strategy combines an integrated literature review, which analyses the pertinence of the PRSA; a quasi-experimental study, to examine its effects; and finally, a synthetic research that allows grasping the PRSA’s evolution and to analyze the institutionalization of change in healthcare organizations. In the first article, we analyse the pertinence of the PRSA’s model or, in other words, the plausibility of the causal relation that is presumed by this model. The PRSA is a regional model that combines integrated healthcare networks, case management and a populational approach to achieve populational responsibility. We showed, based on an integrated literature review, that this program has indeed the potential to secure a regional integration using a populational approach to well assess its population’s needs. The second article analyses the PRSA’s populational effects in terms of length of stay (LOS) and regional retention. A quasi-experimental design was used. For the length of stay, no decrease could be noted for asthma or dementia. On the other hand, the PRSA’s implementation may have contributed to decrease the LOS for heart disease, chronic obstructive pulmonary disease (COPD), pulmonary embolism and breast cancer. Concerning the regional retention of patients, no significant changes were seen for COPD, pulmonary embolism and dementia though effects were observed for heart disease, asthma and breast cancer. Finally, in the third article, we look at the reasons that lead PRSA’s suspension. Based on the PRSA’s manager and the current services programs managers in Laval, we tried to get a better understanding of the factors that delayed the PRSA’s implementation. The results indicate that the frequent healthcare system leading structures reorganizations and the interference of several other reforms in the past years were obstacles in the PRSA’s implementation. Considering the current context, in which health care system is going through several reforms and where the network approach and the populational responsibility are valued, the results of this thesis bring a valuable contribution to the comprehension and the implementation of these concepts.

Made available in DSpace on 2015-03-26T13:37:39Z (GMT). No. of bitstreams: 1 texto completo.pdf: 546542 bytes, checksum: c9dbde18124d512955d3a032831ab07f (MD5) Previous issue date: 2008-07-31 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / In most experiments dealing with biological control of plant diseases, plant growth-promoting rhizobacteria (PGPR) are delivered by seed microbiolization while bacterial phylloplane residents are delivered by spraying. In this work aimed to test several procedures for delivering the biocontrol agent Pseudomonas putida to tomato plants, as well as to study populational tendencies of the biocontrol agent in plant surfaces and to make attempts to establish correlations among populational tendencies and efficiency of biological control. The bacterium Pseudomonas putida (isolate UFV- 0073), autochthonous in tomato phylloplane, was previously selected for the biocontrol of tomato aerial part diseases. Four deliver modes were tested, as follow: 1- seed microbiolization (OD540 = 0,3) followed by planting; 2 - spraying tomato phylloplane with bacterial live propagules (OD540 = 0,3); 3 microbiolization and spraying seedlings with the antagonist (treatments 1 and 2) and 4 - spraying tomato phylloplane with the supernate obtained from bacterial culture (OD540 = 1.0). Results indicated that for the pathosystem tomato - Xanthomonas campestris pv. vesicatoria the most efficient deliver mode was to spray tomato phylloplane with propagule suspension of the antagonist while for its counterpart tomato- Pseudomonas syringae pv. tomato pathosystem, the best deliver modes were to spray the phylloplane with culture supernates and seed microbiolization along with phylloplane spray with a propagule suspension. In order to study populational tendencies for the biocontrol agent UFV-0073 in tomato phylloplane, a semi-selective culture medium was developed and tested based on the constitutive multiple resistance to antibiotics exhibited by the aforementioned isolate of P. putida. Under greenhouse conditions, measurement of population tendencies as a function of time indicated a population decrease in the sense that at day 0, the population was estimated as 8,92 x 107 CFU/g of leaf tissue and in day 5 this population went down to 4,13 x 105 CFU/g of leaf tissue, what means a population 215 times smaller that the original one. On the other hand, under field conditions, the populational tendency did decrease but in a slower rate and presented a tendency to equilibrium, with up and down population peaks in terms of recovered bacteria. So, at 0 day , the population was estimated as being 4,62 x 106 CFU/g leaf fresh weight and nine days after deliver it was 9,91 x 105 UFC/g, what means five times smaller than the population at 0 day. Last but not least, it was established a correlation between populational tendencies of the P. putida in the phylloplane and biocontrol of tomato bacterial speck (P. syringae pv. tomato), when results indicated that the biocontrol was effective up to the fifth day after deliver. This work provides a better understanding about the best deliver mode of P. putida while biocontrol agent for tomato diseases in the aerial parts as well as about time intervals for delivering the biocontrol agent under investigation. / Na maioria dos experimentos sobre controle biológico de fitopatógenos já descritos, Rizobactérias Promotoras de Crescimento em Plantas (PGPR s) são dispensadas por microbiolização de sementes e bactérias residentes do filoplano são dispensadas por pulverização da parte aérea da cultura. Procurou-se verificar, se outras formas de dispensa do agente de biocontrole são igualmente eficientes aos métodos clássicos de dispensa. Objetivou-se testar várias formas de dispensa do agente de biocontrole Pseudomonas putida no filoplano do tomateiro, estudar sua dinâmica populacional no filoplano e correlacionar a dinâmica populacional com o biocontrole de doenças da parte aérea da cultura. O isolado Pseudomonas putida (UFV-0073), autóctone do filoplano de tomateiro, foi selecionado para o controle biológico de doenças da parte aérea da cultura. Foram testadas quatro formas de dispensa do agente de biocontrole em plantas de tomate: 1- sementes microbiolizadas DO540nm= 0,3 e logo em seguida semeadas; 2-atomização do filoplano do tomateiro com a cultura bacteriana DO540nm= 0,3; 3- a aplicação dos tratamentos 1 e 2 conjuntamente e 4- atomização do filoplano com o sobrenadante DO540nm= 1,0. Para o patossistema tomateiro e Xanthomonas campestris pv. vesicatoria, a melhor forma de dispensa foi a pulverização do filoplano com propágulos do agente de biocontrole. No patossistema Pseudomonas syringae pv. tomato e plantas de tomate, as melhores formas de dispensa do agente de controle biológico foram a pulverização do filoplano com o sobrenadante da cultura e a microbiolização de sementes associada à pulverização do filoplano com propágulos do isolado. Para o estudo da dinâmica populacional do agente de biocontrole UFV-0073, no filoplano foi desenvolvido e testado um meio semi-seletivo tirando partido da resistência múltipla constitutiva a antibióticos. Em condições de casa-de-vegetação, houve uma tendência de queda na população do antagonista. No dia 0 (zero), a população do antagonista foi de 8,92 x 107 UFC/g de tecido foliar e no quinto dia após a dispensa sua população foi de 4,13 x 105, ou seja, 215 vezes menor do que a população inicial. Em condições de campo, a queda populacional do agente de biocontrole foi mais branda, revelando uma tendência ao equilíbrio, com alternância entre aumento e queda da quantidade de bactérias recuperadas. No dia zero, a população foi de 4,62 x 106 UFC/g de tecido foliar, nove dias após a dispensa a população passou a 9,91 x 105 UFC/g, cerca de 5 vezes menor do que a população inicial. Por fim, foi correlacionada a dinâmica populacional com o biocontrole de P. syringae pv. tomato, quando os resultados indicaram que o biocontrole foi efetivo até o quinto dia após a dispensa do agente de controle biológico no filoplano do tomateiro. Estudos dessa natureza são necessários para se estabelecer qual a melhor forma de dispensa e qual o intervalo entre as aplicações com o agente de biocontrole, quando realizadas pulverizações visando ao controle biológico de doenças. São necessários mais estudos com o agente de biocontrole, testando o controle contra outros patógenos e em condições de casa-devegetação e no campo.

Made available in DSpace on 2016-03-15T19:26:47Z (GMT). No. of bitstreams: 1 Jorge Ivan Correa Junior.pdf: 2934959 bytes, checksum: 2d19143b4a7c2946468164647e634e0f (MD5) Previous issue date: 2009-09-09 / Since the first brazilian shopping center founded in 1966, in 2008 there were 377 shopping centers operating in Brazil, totaling R$ 64.4 billion in revenues and provided more than 8.5 million square meters of GLA (gross leaseble area), according to ABRASCE. Capting attention in economic and social scenarios, this sector has received consistent national and foreign investment in recent years, besides the support of government agencies such as BNDES. To investigate the population evolution of the brazilian shopping center, this work adopted the principal of the demography of firms, wich is based on the Organizational Ecology theoretical background, and has as one of its interests of study the influence of organizational density over the firms population development. This approach is called Density Dependence Theory, the density measured by the number of organizations within (population density) and also by the aggregate supply of the population (mass density). According to this theory, the density of a population directly influences their rates of founding (borning) and failure (closing) of orgabizations, indicating that the higher the number of organizations in a population, the greater are the founding rates of new organizations over time, this rate increasing under decreasing rates until a possible stabilization. Moreover, the greater the mass density, the lower the rate of founding of new organizations in the population, even with the total number of organizations decreasing. Adopting a quantitative approach, using econometric models based on method of estimators to populational growth relating the birth rates with the populational density performed in different industries and countries, this study investigated the evolution of the density in the brazilian shopping centers from 1966 to 2008. The conclusion of this study confirms the effects provided by the theory of density dependence in the relationship between density and rates of organizational founding population of shopping centers. / Tendo sido fundado em 1966 o primeiro shopping center brasileiro, em 2008 existiam 377 shopping centers em operação no Brasil, totalizando R$64,4 bilhões previstos de faturamento e mais de 8,5 milhões de metros quadrados de ABL (área bruta locável), segundo a ABRASCE. Com destaque no cenário econômico e social, este setor recebeu consistentes investimentos nacionais e estrangeiros nos últimos anos, além do apoio de órgãos governamentais, como o BNDES. Para investigar a evolução da população de shopping centers brasileiros, o presente trabalho adotou os princípios da demografia de empresas, que tem como base teórica a Ecologia Organizacional e traz como um de seus interesses o estudo da influência da densidade organizacional na evolução da população de empresas. Essa abordagem é chamada de Teoria de Dependência de Densidade, sendo a densidade medida pelo número de organizações que a compõe (densidade populacional) e também pela oferta agregada da população (densidade de massa). Segundo essa teoria, a densidade de uma população influencia diretamente suas taxas de fundação (nascimento) e fracasso (encerramento) organizacionais, indicando que quanto maior o numero de organizações em uma população, maior a taxa de fundação de novas organizações ao longo do tempo, essa taxa aumentando a taxas decrescentes até uma possível estabilização. Além disso, quanto maior a densidade de massa, menor a taxa de fundação de novas organizações na população, mesmo com o número total de organizações decrescendo. Adotando abordagem quantitativa, com o uso de modelos econométricos baseados no método de estimadores para crescimento populacional que relacionam a taxa de fundação com a densidade populacional realizados em diferentes indústrias e países, este trabalho investigou a evolução da densidade na população brasileira de shopping centers desde 1966 até 2008. A conclusão deste trabalho confirma os efeitos previstos pela teoria da dependência de densidade na relação entre a densidade organizacional e as taxas de fundação da população brasileira de shopping centers.

A análise pelas técnicas hifenadas CLAE-DAD-EM e CLAE-DAD-EM/EM de extratos foliares de Lychnophora ericoides Mart. levou à identificação de 34 metabólitos secundários diretamente a partir dos extratos vegetais. Destes, 19 foram relatados pela primeira vez na subtribo Lychnophorinae. Uma metodologia para extração e análise destes metabólitos por CLAE-DAD foi desenvolvida, validada e utilizada para determinação de suas variações populacionais e temporais. Perfis metabólicos bem semelhantes, com diferenças quantitativas, mas não qualitativas, foram observados entre os indivíduos de uma mesma população. Entre as cinco populações analisadas, foi observado um metabolismo secundário bem mais diversificado, caracterizado pela presença de lactonas sesquiterpênicas, nas plantas da população de Ibiraci-MG. As concentrações mais elevadas de ácidos cafeoilquínicos foram encontradas no período da seca no cerrado (inverno) e as menores quando a planta se encontrava florida. Os teores de flavonóides foram maiores durante o período de chuvas (verão) e os de C-glicosilflavonas e lactonas sesquiterpênicas se mantiveram estáveis. Variações circadianas significativas de flavonóides e ácidos cafeoilquínicos também foram observadas nas duas populações nas quais estes fatores foram estudados. Foi verificado que o envelhecimento das folhas resulta em uma pronunciada redução no conteúdo de todos os metabólitos secundários e concentrações menores dos metabólitos foram observadas nas folhas dos ramos floridos em relação aos ramos sem flores de um mesmo indivíduo. Finalmente, conclui-se que as variações temporais e populacionais observadas em L. ericoides podem ser determinantes para a intensidade da atividade antiinflamatória e/ou analgésica desta planta, utilizada popularmente para estes propósitos. / The analyses of Lychnophora ericoides Mart. leaves extracts by HPLC-DAD-MS and HPLC-DAD-MS/MS resulted in the identification of 34 secondary metabolites directly from the plant extracts. Nineteen of these metabolites are being reported for the first time in the Lychnophorinae subtribe. A method for the extraction and analyses of these metabolites by CLAE-DAD was developed, validated and employed for the determination of their populational and temporal variations. Very similar metabolic profiles, exhibiting quantitative but not qualitative differences, were found among each population individuals. Among the five studied populations, a more diversified secondary metabolism, characterized by sesquiterpene lactones presence, was observed for the plants collected at Ibiraci-MG. The highest concentrations of caffeoylquinic acids were found in the cerrado dry season (winter), and the lowest when the plants were blooming. The flavoinoid contents were higher during the rainy season (summer), while C-glucosylflavones and sesquiterpene lactones levels remained stable. Significant circadian variations were also detected regarding flavonoids and caffeoylquinic acids in the two populations analyzed on this respect. It was also found a pronounced reduction in the contents of all the secondary metabolites as the leaves get old. Lower levels of all the metabolites were also found for the flowery branches when compared to the non flowery ones in the same individual. Finally, it can be concluded that the temporal and populational variations detected in L. ericoides leaves could highly influence the intensity of the anti-inflammatory and/or analgesic activities of this plant, used in popular medicines for these purposes.

No description available.

La perte au suivi diminue grandement l’efficacité des interventions de prévention de la transmission mère-enfant du VIH en Afrique subsaharienne. Devrait-on donc choisir des traitements courts ou longs de pTME? Nous avons mené une revue systématique des études sur l’efficacité de traitements avec et sans composante anténatale et évalué l’impact de la perte au suivi sur leur efficacité. Nous avons trouvé qu’après ajustement pour la perte au suivi, les traitements avec composante anténatale ont encore une efficacité plus élevée à prévenir la TME. Les intervenants ne devraient pas craindre l’utilisation de traitements plus longs auprès de populations à risque de perte au suivi. Plus d’études sont nécessaires pour déterminer comment les interventions peuvent être adaptées au virage dans la pTME. / Loss to follow-up greatly decreases efficiency of MTCT interventions in sub-Saharan Africa. Should we therefore choose shorter pMTCT treatments over longer ones? We conducted a systematic review of studies on the efficiency of pMTCT treatments with or without an antenatal component. We found that after adjustment, treatments with an antenatal component still had a higher efficiency at decreasing MTCT despite loss to follow-up. Healthcare providers shouldn’t fear using longer treatments amongst populations at high risk of loss to follow-up. More studies are needed to determine how current interventions can be better adapted to the turnaround in pMTCT interventions.

Introduction - Quel est le modèle de suivi à long terme adapté aux attentes et besoins des jeunes adultes guéris d’un cancer dans l’enfance ? Méthode - Cette étude a pour objectif d’évaluer l’impact sur la santé de jeunes adultes guéris d’un cancer pédiatrique d’un modèle de suivi associant auto-questionnaire et consultation médicale. De jeunes adultes ayant eu un cancer entre 1987 et 1992 en Rhône-Alpes-Auvergne ont été vus en consultation médicale et psychologique de Suivi A Long Terme (SALTO), précédée et suivie d’un auto-questionnaire. De plus, la capacité d’adaptation de leur système nerveux autonome (SNA) a été évaluée afin de déterminer les caractéristiques des sujets dont le SNA était altéré. Résultats - 207 jeunes adultes ont rempli un questionnaire pré-consultation et 197 ont déclaré avoir de nombreuses séquelles, en moyenne 3,4 séquelles, ce qui a été confirmé par l’observation médicale faite chez les 150 consultants (2,6 séquelles observées/sujet). Après la consultation, près de 70% des sujets ont modifié leur nombre de séquelles déclarées. Aucune caractéristique particulière n’a pu être clairement mise en évidence quant aux personnes ayant une capacité de régulation du SNA altérée mais une relation significative a été établie entre SNA altéré et observation d’une séquelle cardiovasculaire (P=0,049). Une enquête de satisfaction a montré une opinion très favorable à la consultation SALTO. Environ 80% des sujets présentant un trouble psychiatrique au moment de la consultation ne bénéficiaient d’aucun suivi psychologique.Conclusion - Un suivi à long terme des jeunes adultes guéris d’un cancer dans l’enfance est nécessaire, faisable et répond à une demande réelle / Introduction - What is the model of long-term follow-up adapted to the expectations and needs of youngadults cured of a childhood cancer? Method – The aim of this study was to estimate the impact of a long-term follow-up care (LTFU) associated self-questionnaire and medical consultation, on the health of young adult survivors of childhood cancer. Young adults with childhood cancer between 1987 and 1992 in Rhône-Alpes-Auvergne were seen during a LTFU medical and psychological consultation (SALTO), which was preceded and followed by a self-questionnaire. Furthermore, the capacity of adaptation of their autonomous nervous system (ANS) was estimated to determine the characteristics of the subjects whose ANS was altered. Results - 207 young adults completed a questionnaire before consultation and 197 of them declared having sequalae, on average each self-reported 3.4 late effects, which was confirmed by a medical observation made at 150 consultations (mean 2.6 observed late effects/subject). After the consultation, about 70 % of the subjects modified their number of self-reported late effects. No particular characteristic was clearly highlighted in people with an altered capacity of ANS regulation but a significant relationship was established between altered ANS and cardiovascular complication (P=0,049). A satisfaction survey showed a very favorable opinion about the SALTO consultation. Approximately 80% of the subjects presenting a psychiatric disorder at the time of the consultation had received no psychological follow-up at this time. Conclusion - Long-term follow-up of young adult survivors of a childhood cancer is necessary, feasible and answers a real need

La perte au suivi diminue grandement l’efficacité des interventions de prévention de la transmission mère-enfant du VIH en Afrique subsaharienne. Devrait-on donc choisir des traitements courts ou longs de pTME? Nous avons mené une revue systématique des études sur l’efficacité de traitements avec et sans composante anténatale et évalué l’impact de la perte au suivi sur leur efficacité. Nous avons trouvé qu’après ajustement pour la perte au suivi, les traitements avec composante anténatale ont encore une efficacité plus élevée à prévenir la TME. Les intervenants ne devraient pas craindre l’utilisation de traitements plus longs auprès de populations à risque de perte au suivi. Plus d’études sont nécessaires pour déterminer comment les interventions peuvent être adaptées au virage dans la pTME. / Loss to follow-up greatly decreases efficiency of MTCT interventions in sub-Saharan Africa. Should we therefore choose shorter pMTCT treatments over longer ones? We conducted a systematic review of studies on the efficiency of pMTCT treatments with or without an antenatal component. We found that after adjustment, treatments with an antenatal component still had a higher efficiency at decreasing MTCT despite loss to follow-up. Healthcare providers shouldn’t fear using longer treatments amongst populations at high risk of loss to follow-up. More studies are needed to determine how current interventions can be better adapted to the turnaround in pMTCT interventions.