Home-based therapy programmes for upper limb functional recovery following stroke

Background: With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. Objectives: To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. Search methods: We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. Selection criteria: Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended ADL and motor impairment of the arm. Data collection and analysis: Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. Main results: We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. Primary outcomes: we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). Secondary outcomes: no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). Authors' conclusions: There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care

Premature ovarian failure and ovarian autoimmunity

Premature ovarian failure (POF) is defined as a syndrome characterized by menopause before the age of 40 yr. The patients suffer from anovulation and hypoestrogenism. Approximately 1% of women will experience menopause before the age of 40 yr. POF is a heterogeneous disorder with a multicausal pathogenesis involving chromosomal, genetic, enzymatic, infectious, and iatrogenic causes. There remains, however, a group of POF patients without a known etiology, the so-called "idiopathic" form. An autoimmune etiology is hypothesized for the POF cases with a concomitant Addison's disease and/or oophoritis. It is concluded in this review that POF in association with adrenal autoimmunity and/or Addison's disease (2-10% of the idiopathic POF patients) is indeed an autoimmune disease. The following evidence warrants this view: 1) The presence of autoantibodies to steroid-producing cells in these patients; 2) The characterization of shared autoantigens between adrenal and ovarian steroid-producing cells; 3) The histological picture of the ovaries of such cases (lymphoplasmacellular infiltrate around steroid-producing cells); 4) The existence of various autoimmune animal models for this syndrome, which underlines the autoimmune nature of the disease. There is some circumstantial evidence for an autoimmune pathogenesis in idiopathic POF patients in the absence of adrenal autoimmunity or Addison's disease. Arguments in support of this are: 1) The presence of cellular immune abnormalities in this POF patient group reminiscent of endocrine autoimmune diseases such as IDDM, Graves' disease, and Addison's disease; 2) The more than normal association with IDDM and myasthenia gravis. Data on the presence of various ovarian autoantibodies and anti-receptor antibodies in these patients are, however, inconclusive and need further evaluation. A strong argument against an autoimmune pathogenesis of POF in these patients is the nearly absent histological confirmation (the presence of an oophoritis) in these cases (< 3%). However, in animal models using ZP immunization, similar follicular depletion and fibrosis (as in the POF women) can be detected. Accepting the concept that POF is a heterogenous disorder in which some of the idiopathic forms are based on an abnormal self-recognition by th

De l'aspect du temps, représentation et expression du temps passé en anglais et en français (étude contrastive dans une perspective traductologique)

Cette étude est fondamentalement une approche linguistique des problèmes de traduction liés au prétérit et à l imparfait en contexte spécifique. Elle se compose de trois grandes parties. La première s intéresse à la distinction entre aspect lexical et aspect grammatical. Cette distinction se fonde essentiellement sur la définition que donne G. Guillaume de la lexigénèse. La deuxième partie analyse le signifé de puissance de l imparfait et du prétérit ainsi que leurs effets de sens respectifs. Dans la troisième et dernière partie sont introduits quatre concepts clefs visant à justifier la traduction du prétérit simple par l imparfait ou le passé simple, ceux de perfectivité verticale, horizontale, intégrale et transitive. Sont également répertoriés plusieurs critères favorisant l emploi de la forme perfective et imperfective du prétérit, tels que l image temporelle du verbe, le concept philosophique de esse est percipi / percipi est esse, le principe de la deixis ad occulos, etc. Cette étude peut être enfin globalement considérée comme une réflexion sur le principe d orthonymie dans le processus de traduction.This study is basically a linguistic approach to the translation of the English preterite and the French imparfait, primarily in a specific context. It falls into three major parts. The first one focuses on the distinction between lexical and grammatical aspect. This distinction is mainly based on G. Guillaume s definition of the concept of lexigenesis. The second part analyses the potential significate of the imparfait and of the preterit and their related sense effects. In the last and third part, four key concepts are introduced to account for the translation of the simple past into either the imparfait or the passé simple, those of vertical, horizontal, integral and transitive perfectivity. Various criteria are also listed favouring the use of the perfective or the imperfective form of the preterit, such as the temporal contour of the verb, the philosophical concept of esse est percipi / percipi est esse, the deixis ad occulos principle, etc. Lastly, this study can be considered as an overall reflection on the principle of orthonymy underlying the translating process at large.TOULON-BU Centrale (830622101) / SudocSudocFranceF