Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Phénoménologie de l’humour

Dans cet article, nous dressons un inventaire des phénomènes qu’une théorie de l’humour devrait expliquer. La première partie fait valoir que l’humour est une propriété qui s’attache à certains événements mentaux, plutôt qu’à certains objets du monde (les blagues, par exemple). Nous signalons l’une des conséquences de ce fait : les blagues, prises isolément, ne sont pas un phénomène universel. Nous suggérons également que, même s’il se peut que certaines formes de rire soient déclenchées par des situations qui n’ont rien d’humoristique, il existe un lien spécial entre le rire dit « de Duchenne » et un certain type de stimulation cognitive propre à le déclencher. Nous poursuivons en montrant que le sentiment d’allégresse associé au rire (sentiment qui constitue pour nous un aspect crucial du rire) est un phénomène psychologique qui se prête à une approche « hétérophénoménologique ». L’hétérophénoménologie est une phénoménologie qui envisage les états subjectifs en tant que données à expliquer, mais pas nécessairement en tant qu’interprétations valides des phénomènes psychologiques qui les sous-tendent. Selon nous, ce sentiment d’allégresse lié à l’humour est étroitement lié à un autre sentiment : le sentiment du cocasse qui nous saisit face à des phénomènes incongrus. Les liens qui unissent ces deux émotions sont riches d’enseignements pour toute théorie de l’humour. La dernière partie passe en revue, en plus des divers cahiers des charges dressés par des théories de l’humour antérieures, quelques découvertes issues de ces travaux et de certains autres.In this article, we develop an inventory of the explananda that any complete theory of humor should account for. In the first chapter, we argue that humor is a property of events in the mind, rather than objects in the world (such as jokes), and we point out that a result of this is that individual jokes are not universal. We also suggest that while some varieties of laughter may be triggered by situations that are not humorous in any sense, a special connection exists between Duchenne-type laughter and the certain type of cognitive stimulation that usually elicits it. Then we argue that the feeling of mirth — perhaps the most central aspect of humor — is a psychological phenomena that should be explored by means of a “heterophenomenological” approach — one that uses subjective states as data to be explained, but not necessarily as valid interpretations of the underlying psychological phenomena. And we comment that this feeling (“funny” — humorous) is closely related to another feeling: “funny” — odd — a relationship worth exploring in any theory of humor. In the second chapter, we catalogue the findings of these explorations and others, in addition to those further explananda highlighted by previous theories of humor

Rires

Rire, mais comment et pourquoi? Le rire peut être formel, joyeux, méprisant, nerveux ou embarrassé... Il peut être aussi un moyen de dédramatiser des situations de violence, de prendre contact ou de garder ses distances avec l’autre et, surtout, de montrer son intégration à une communauté. Universel qui n’appartiendrait qu’aux êtres humains, le rire nécessite de comprendre les intentions de celui qui vous fait face, d’être un acteur social à part entière. Les auteurs de ce nouveau numéro de la revue Terrain s’attachent à décrire cette pratique dans différents contextes culturels, esquissant les contours d’une véritable anthropologie du rire

A short history of evolutionary theory Uma breve história da teoria evolutiva

The history of the Theory of Evolution has been told a number of times by historians, philosophers, professors, writers, scientists and so on. However, many of these versions differ from or even contradict one another. In this article, the history of the Theory of Evolution is retold according to a dialectical-materialistic perspective. It analyzes the historical contradictions between Darwinian evolution theory and Mendel's model, the background that led to the synthetic theory of evolution, the debate carried out by classic schools and the result of synthesis, as well as the still current debate between Neutralism and Selectionism. Finally, it also discusses the interpretative model used ("an idiosyncratic dialectic materialism"), mainly in relation with Popper's and Kuhn's models.<br>A história da teoria evolutiva tem sito contada inúmeras vezes por historiadores, filósofos, professores, escritores, cientistas etc. Contudo, muitas destas versões diferem entre si ou mesmo se contradizem. Neste trabalho, a história da teoria evolutiva é recontada a partir de uma perspectiva materialista dialética. São analisadas as contradições históricas entre a teoria evolutiva darwiniana e o modelo mendeliano, o caminho para a teoria sintética da evolução, o debate entre as escolas clássica e do balanco que sucedeu a síntese, bem como o debate, ainda atual, entre neutralismo e selecionismo. Ao final, o modelo interpretativo utilizado ("um materialismo dialético idiossincrático") é discutido, principalmente, em relação aos modelos popperiano e kuhniano