Le Mirror Effect Plus Protocol (MEPP) dans la rééducation faciale des paralysies de Bell sévères et aigües : une étude longitudinale contrôlée et randomisée

Les effets psychologiques et fonctionnels de la paralysie de Bell (PB) sont dévastateurs, et ce dès l’apparition des symptômes. Or, peu de données existent sur l'efficacité de la rééducation faciale en phase aiguë de PB. C’est pourquoi, dans le cadre de cette thèse, nous avons développé et étudié une rééducation faciale nommée Mirror Effect Plus Protocol (MEPP), qui vise spécifiquement à rééduquer les patients atteints de PB aiguë. Le MEPP a de plus été conçu pour les PB de degré modérée-à-sévère à totale, et dont les séquelles persistent jusqu’à 14 jours, malgré une médication appropriée. De plus, cette thèse a été l’occasion de développer et d’étudier un outil clinique web spécialisé nommé MEPP-website, conçu pour répondre aux manques cliniques à cet égard, et pour faciliter le processus de rééducation. Cette thèse se décline donc en 2 volets. Le premier s’attarde spécifiquement à l’efficacité de la rééducation MEPP, et le deuxième se penche sur les impacts de l’outil MEPP-website. Spécifiquement, l'objectif premier de cette thèse était de valider les effets du MEPP. Les objectifs spécifiques visaient à étudier les effets du MEPP à moyen terme (article 1) et à long terme (article 2), en mesurant la symétrie faciale, les syncinésies faciales, la qualité de vie et les impacts fonctionnels des patients, ainsi que l’intelligibilité de leur parole, perçue par des juges naïfs. Pour ce faire, nous avons recruté 40 participants atteints de PB modérée-à-sévère à totale, qui ont été assignés par randomisation au groupe contrôle (n=20) et au groupe MEPP (n=20). Nous avons suivi tous les patients pendant un an suivant l’apparition de leurs symptômes. À moyen terme, c’est-à-dire 6 mois après l’apparition des symptômes, les premières analyses sur 20 participants (n=10 dans chaque groupe) ne démontraient aucun effet significatif de la rééducation MEPP sur la symétrie faciale et sur les syncinésies, bien qu’une tendance en faveur du groupe MEPP était observée. Après 12 mois, les analyses descriptives sur l’ensemble des participants (n=40) ont démontré une amélioration du groupe MEPP pour toutes les variables étudiées (symétrie, syncinésies, impacts fonctionnels), à l’exception de l’intelligibilité perçue de la parole, ce qui était conforme à notre hypothèse. En effet, nous avions postulé que la PB, même sévère, affecterait peu l’intelligibilité perçue. De plus, une diminution significative des syncinésies et des impacts fonctionnels sur la qualité de vie a été observée dans le groupe MEPP, par rapport au groupe contrôle. Les différences entre les groupes étaient plus marquées un an après l’apparition des symptômes. Dans le cadre du deuxième volet de cette thèse, nous avons développé un outil clinique web spécialisé nommé MEPP-website, afin de soutenir les cliniciens et patients dans leur processus de rééducation faciale, et afin de créer un outil clinique concret, qui pourrait être diffusé gratuitement dans les milieux de pratique. Nous avions donc les objectifs spécifiques suivant : premièrement, de comparer l’expérience utilisateur de participants (n=15, dont 10 patients et cinq cliniciens) utilisant le MEPP-website avec un site générique nommé Webcamtoy©, et deuxièmement, d’étudier objectivement l’adhérence des patients (n=10) au MEPP via une fonctionnalité particulière du MEPP-website (article 3). Les résultats de ce volet du projet ont révélé que tous les participants ayant utilisé à la fois l’outil MEPP-website et le site générique Webcamtoy© avaient jugé que leur expérience utilisateur était significativement meilleure avec le MEPP-website, peu importe l’ordre d’utilisation des outils. De plus, l’observation des données d’adhérence au traitement a démontré qu’environ 40% des patients avaient une adhérence élevée au MEPP, et que l’adhérence semblait meilleure si le MEPP-website avait été utilisé en premier. Les résultats globaux sur cet échantillon démontrent donc des effets prometteurs et durables de la rééducation MEPP, afin de bonifier la fonction faciale et d’améliorer significativement la qualité de vie des patients atteints de PB aigue modérée-à-sévère à totale. De plus, le MEPP-website a permis d’améliorer significativement presque toutes les composantes de l’expérience utilisateur des participants lors de la rééducation faciale, par rapport à l’utilisation de Webcamtoy©. La création d’un tel outil spécifique à la rééducation MEPP permet de créer un pont tangible entre recherche et clinique, et de faciliter l’appropriation du MEPP dans les milieux cliniques.Psychological and functional impacts of Bell’s Palsy (BP) are devastating as soon as symptoms occur. However, little data exists supporting early facial rehabilitation in the acute phase of BP. This is why, as part of this thesis, we developed and studied a form of facial rehabilitation called Mirror Effect PLUS Protocol (MEPP). The MEPP aims to rehabilitate patients suffering from acute and moderate-to-severe to total BP, and whose sequela persist more than 14 days, even in the context of an appropriate medication intake. Also, this thesis has been an opportunity to develop and study an accompanying web tool called MEPP-website, that was conceived to respond to clinical needs for rehabilitation and facilitate the MEPP process. Thus, this thesis consists of two parts. The first one is specifically interested in the efficacy of the MEPP, and the second one considers the impacts of the MEPP-website. Specifically, the first goal of this thesis was to validate effects of the MEPP. Specific objectives were to study mid-term effects (article 1) and long-terms effects (article 2) of the MEPP, measuring facial symmetry, synkinesis, self-reported quality of life and functional impacts in patients, as well as perceived speech intelligibility as measured by naïve listeners. To do so, we recruited 40 participants with moderate-to-severe to total PB, who were randomly assigned to the control group (n=20) or to the MEPP group (n=20). Every patient was followed-up until one-year post-onset of BP. At mid-term or six months post-onset, the first analyses on 20 patients (n= 10 in each group) demonstrated no effect of the MEPP rehabilitation on facial symmetry and synkinesis, though a tendency toward a better evolution was observed in favor of the MEPP group. After 12 months, descriptive analyses on the complete cohort (n= 40) demonstrated a stronger improvement of the MEPP group for every tested variable (symmetry, synkinesis, functional impact), except for perceived speech intelligibility, which confirmed our hypothesis. Indeed, we had postulated that BP, even if severe, would have little impact on intelligibility. Also, a significant reduction of synkinesis and of self-reported functional impacts was observed in the MEPP group, compared to the control group. Differences between the groups were bigger one-year post-onset. For the second part of this thesis, we developed a clinical webtool specialized for the MEPP, in order to support clinicians and patients in their rehabilitation process, and also in order to create a concrete clinical webtool that would be freely available in clinical settings. Our specific objectives were as follows: first, we wanted to compare the user experience of participants (n=15, 10 patients and 5 clinicians) using both the MEPP-website and a generic website called Webcamtoy© during facial therapy, and second, to measure patients’ compliance (n=10) to MEPP thanks to the functionality of the MEPP-website (article 3). Results of this part of the project revealed that every participant who used both the MEPP-website and the generic website Webcamtoy© rated their user experience as significantly better with the MEPP-website, no matter the order of use. Also, descriptive data about compliance to treatment demonstrated that approximately 40 percent of the patients had a high compliance to the MEPP, and that compliance tended to be better when the MEPP-website was used first. The general results of this sample of participants demonstrate promising and long-lasting effects of the MEPP, to improve facial function and to significantly improve quality of life of patients suffering from moderate-to-severe to total acute BP. Moreover, the MEPP-website allowed for the significant improvement of almost all components of user experience of participants during facial rehabilitation compared to the use of Webcamtoy©. The creation of such a clinical web tool specific for the MEPP was appreciated by users and will facilitate its adoption in clinical settings

Fragile and conflict affected states: report from the Consultation on Collaboration for Applied Health Research and Delivery

Fragile and Conflict Affected States present difficult contexts to achieve health system outcomes and are neglected in health systems research. This report presents key debates from the Consultation of the Collaboration for Applied Health Research and Delivery, Liverpool, June, 2014

Rééducation orthophonique post myoplastie d’allongement du temporal : une étude de trois patients

La myoplastie d’allongement du temporal est une chirurgie qui vise à restaurer le sourire chez les patients ayant une paralysie faciale périphérique irréversible. Le muscle temporal est détaché dans sa partie haute et rattaché à la commissure labiale. À la suite de la chirurgie, une rééducation orthophonique est nécessaire pour atteindre un sourire fonctionnel. Cette rééducation vise à automatiser le sourire pour le rendre spontané, ainsi qu’à optimiser le sourire pour rendre le mouvement de la commissure opérée symétrique à celui du côté sain. Parmi les moyens utilisés dans cette rééducation, un logiciel reproduisant l’hémiface saine permet de créer un effet-miroir, en offrant un biofeedback visuel positif aux patients. Les objectifs de la présente étude de cas multiples étaient 1) de mesurer les effets de la rééducation orthophonique après la myoplastie d’allongement du temporal et 2) de mesurer l’adhérence au traitement. Trois patients présentant une paralysie faciale périphérique droite secondaire à une résection de tumeur et ayant subi une myoplastie d’allongement du temporal ont été recrutés. Ces patients ont tous été évalués avant la chirurgie, ainsi qu’avant et après la rééducation, à l’aide de l’échelle Sunnybrook. Les résultats ont confirmé qu’à la suite de la rééducation orthophonique, le sourire des trois patients avait progressé.Compte tenu des résultats prometteurs obtenus avec cette rééducation, il serait intéressant d’en valider l’efficacité sur un plus grand nombre de patients.Lengthening temporalis myoplasty is a surgical procedure to restore the smile in patients with irreversible facial nerve paralysis. The temporalis muscle is detached from its upper end and attached to the labial commissure. Following surgery, facial rehabilitation by speech-language pathologists is necessary to achieve a functional smile. More specifically, this rehabilitation aims to automate the smile to make it spontaneous, as well as to optimize the smile to make the movement of the commissure operated on symmetrical to that of the healthy side. Among the means used in this rehabilitation, a software program reproducing the healthy hemiface allows for the creation of a “mirror effect” by giving the patients positive visual biofeedback. The objectives of this multiple case study were (a) to measure the effects of facial rehabilitation after lengthening temporalis myoplasty and (b) to measure adherence to treatment. Three patients with right facial nerve paralysis secondary to tumour resection that had lengthening temporalis myoplasty were enrolled. These patients were all assessed before surgery, and before and after rehabilitation, using the Sunnybrook scale. The results confirmed that following facial rehabilitation, the smiles of the three patients had improved. Given the promising results obtained from this rehabilitation, it would be interesting to validate its effectiveness on a larger number of patients

Health care workers in conflict and post-conflict settings: Systematic mapping of the evidence

Background Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict. Objective The aim of this study was to systematically identify and map the published evidence on HCWs in conflict and post-conflict settings. Our ultimate aim is to inform researchers and funders on research gap on this subject and support relevant stakeholders by providing them with a comprehensive resource of evidence about HCWs in conflict and post-conflict settings on a global scale. Methods We conducted a systematic mapping of the literature. We included a wide range of study designs, addressing any type of personnel providing health services in either conflict or post-conflict settings. We conducted a descriptive analysis of the general characteristics of the included papers and built two interactive systematic maps organized by country, study design and theme. Results Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings. For conflict settings, the most studied counties were Iraq (15%), Syria (15%), Israel (10%), and the State of Palestine (9%). The most common types of publication were opinion pieces in conflict settings (39%), and primary studies (33%) in post-conflict settings. In addition, most of the first and corresponding authors were affiliated with countries different from the country focus of the paper. Violence against health workers was the most tackled theme of papers reporting on conflict settings, while workforce performance was the most addressed theme by papers reporting on post-conflict settings. The majority of papers in both conflict and post-conflict settings did not report funding sources (81% and 53%) or conflicts of interest of authors (73% and 62%), and around half of primary studies did not report on ethical approvals (45% and 41%). Conclusions This systematic mapping provides a comprehensive database of evidence about HCWs in conflict and post-conflict settings on a global scale that is often needed to inform policies and strategies on effective workforce planning and management and in reducing emigration. It can also be used to identify evidence for policy-relevant questions, knowledge gaps to direct future primary research, and knowledge clusters

Estimating maximum fine-fraction organic carbon in UK grasslands

Publication history: Accepted - 24 November 2021; Published - 27 January 2021.Soil organic carbon (SOC) sequestration across agroecosystems worldwide can contribute to mitigate the effects of climate change by reducing levels of atmospheric CO2. Stabilisation of organic carbon (OC) in the fine soil fraction (<20 μm) is considered an important long-term store of SOC, and the saturation deficit (difference between measured OC and estimated maximum OC in the fine fraction) is frequently used to assess SOC sequestration potential following the linear regression equation developed by Hassink (1997). However, this approach is often taken without any assessment of the fit of the equation to the soils being studied. The statistical limitations of linear regression have previously been noted, giving rise to the proposed use of boundary line (BL) analysis and quantile regression (QR) to provide more robust estimates of maximum SOC stabilisation. The objectives of this work were to assess the suitability of the Hassink (1997) equation to estimate maximum fine-fraction OC in UK grassland soils of varying sward ages and to evaluate the linear regression, boundary line and quantile regression methods to estimate maximum fine-fraction OC. A chronosequence of 10 grasslands was sampled, in order to assess the relationship between sward age (time since the last reseeding event) and the measured and predicted maximum fine-fraction OC. Significantly different regression equations show that the Hassink (1997) equation does not accurately reflect maximum fine-fraction OC in UK grasslands when determined using the proportion of the fine soil fraction (<20 μm, %) and measured finefraction OC (g C per kg soil). The QR estimate of maximum SOC stabilisation was almost double that of the linear regression and BL analysis (0.89 0.074, 0.43 0.017 and 0.57 0.052 gC per kg soil, respectively). Sward age had an inconsistent effect on the measured variables and potential maximum fine-fraction OC. Fine-fraction OC across the grasslands made up 4.5% to 55.9% of total SOC, implying that there may be either high potential for additional C sequestration in the fine fraction of these soils or that protection in aggregates is predominant in these grassland soils. This work highlights the need to ensure that methods used to predict maximum fine-fraction OC reflect the soil in situ, resulting in more accurate assessments of carbon sequestration potential.This research has been supported by SRUC’s postgraduate studentship programme and the Global Academy of Agriculture and Food Security, University of Edinburgh. Funding has also been provided by Business Environment, Industry and Strategy (grant no. TRN1133); Ricardo-AEA; and the Rural & Environment Science & Analytical Services Division of the Scottish government

Genome wide analysis of gene dosage in 24,092 individuals estimates that 10,000 genes modulate cognitive ability

International audienceGenomic copy number variants (CNVs) are routinely identified and reported back to patients with neuropsychiatric disorders, but their quantitative effects on essential traits such as cognitive ability are poorly documented. We have recently shown that the effect size of deletions on cognitive ability can be statistically predicted using measures of intolerance to haploinsufficiency. However, the effect sizes of duplications remain unknown. It is also unknown if the effect of multigenic CNVs are driven by a few genes intolerant to haploinsufficiency or distributed across tolerant genes as well. Here, we identified all CNVs > 50 kilobases in 24,092 individuals from unselected and autism cohorts with assessments of general intelligence. Statistical models used measures of intolerance to haploinsufficiency of genes included in CNVs to predict their effect size on intelligence. Intolerant genes decrease general intelligence by 0.8 and 2.6 points of intelligence quotient when duplicated or deleted, respectively. Effect sizes showed no heterogeneity across cohorts. Validation analyses demonstrated that models could predict CNV effect sizes with 78% accuracy. Data on the inheritance of 27,766 CNVs showed that deletions and duplications with the same effect size on intelligence occur de novo at the same frequency. We estimated that around 10,000 intolerant and tolerant genes negatively affect intelligence when deleted, and less than 2% have large effect sizes. Genes encompassed in CNVs were not enriched in any GOterms but gene regulation and brain expression were GOterms overrepresented in the intolerant subgroup. Such pervasive effects on cognition may be related to emergent properties of the genome not restricted to a limited number of biological pathways

Effectiveness of mass media campaigns to reduce alcohol consumption and harm: a systematic review

Aims: To assess the effectiveness of mass media messages to reduce alcohol consumption and related harms using a systematic literature review. Methods: Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. Drink driving interventions and college campus campaigns were ineligible. Studies quality were assessed, data were extracted and a narrative synthesis conducted. Results: Searches produced 10,212 results and 24 studies were included in the review. Most campaigns used TV or radio in combination with other media channels, were conducted in developed countries and were of weak quality. There was little evidence of reductions in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low. Recall of campaigns was high. Conclusion: Mass media health campaigns about alcohol are often recalled by individuals, have achieved changes in knowledge, attitudes and beliefs about alcohol but there is little evidence of reductions in alcohol consumption

Vitamin D and Its Role During Pregnancy in Attaining Optimal Health of Mother and Fetus

Despite its discovery a hundred years ago, vitamin D has emerged as one of the most controversial nutrients and prohormones of the 21st century. Its role in calcium metabolism and bone health is undisputed but its role in immune function and long-term health is debated. There are clear indicators from in vitro and animal in vivo studies that point to vitamin D’s indisputable role in both innate and adaptive immunity; however, the translation of these findings to clinical practice, including the care of the pregnant woman, has not occurred. Until recently, there has been a paucity of data from randomized controlled trials to establish clear cut beneficial effects of vitamin D supplementation during pregnancy. An overview of vitamin metabolism, states of deficiency, and the results of recent clinical trials conducted in the U.S. are presented with an emphasis on what is known and what questions remain to be answered