Ernest Mercier, le pétrole et la France

Ernest Mercier est l’un des patrons les plus influents de l'entre-deux-guerres en France. Ses différentes activités industrielles l'ont conduit à siéger sur de vastes pans de l’économie française, notamment du secteur énergétique. La thèse retrace la carrière pétrolière d'un homme qui a joué un rôle central pour le développement d'une industrie devenue stratégique, mais qui est embryonnaire lorsqu'il rejoint ce secteur après la Première Guerre mondiale. Mercier assiste et assure la création d'une industrie pétrolière nationale. Les obstacles se font légion contre les ambitions pétrolières de la France. Elle se présente bien tard sur un marché étroitement contrôlé par de puissants trusts. La recherche et l'exploitation pétrolière demandent d'importantes ressources, et aucune société française n'a les moyens d'une politique indépendante. Certaines banques se lancent alors dans les affaires de pétrole en s'alliant aux grands trusts internationaux. C'est le cas de Paribas; la gestion de ses avoirs roumains représente la première expérience de Mercier dans ce secteur. L'État s'intéresse aussi au pétrole, il devient un acteur incontournable. Le gouvernement français n'a pourtant pas les moyens de ses ambitions dans le domaine pétrolier. La politique nationale mise en place durant l'entre-deux-guerres doit faire appel à l'épargne privée française. La création d'une compagnie nationale, la Compagnie française des pétroles, en 1924 regroupe ainsi les différentes banques et sociétés intéressées au pétrole. Mercier est personnellement choisi par le président Raymond Poincaré pour mener à bien cette mission. Cette carrière s'articule donc autour d'un fragile équilibre entre milieux privés et gouvernement. Mercier devient rapidement l'intermédiaire incontournable qui régit ces relations. La thèse s'appuie sur les archives bancaires et industrielles, mais aussi sur celles du gouvernement français et de ses différents ministères. Cette analyse de la carrière d'Ernest Mercier permet de retracer les origines du secteur pétrolier français et l'action déterminante d'un homme. Elle expose les mécanismes d'influence d'une puissante banque d'affaires et les conflits d'intérêts qu'engendre l'exploitation pétrolière.

Faiblesse, incoordination et performance motrice du membre supérieur chez le sujet hémiparétique

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women : a short version Cochrane systematic review with meta-analysis

Background Pelvic floor muscle training (PFMT) is a commonly used physical therapy for women with urinary incontinence (UI). Objectives To determine the effects of PFMT for women with UI in comparison to no treatment, placebo or other inactive control treatments. Search Methods Cochrane Incontinence Group Specialized Register, (searched 15 April 2013). Selection Criteria Randomized or quasi-randomized trials in women with stress, urgency or mixed UI (based on symptoms, signs, or urodynamics). Data Collection and Analysis At least two independent review authors carried out trial screening, selection, risk of bias assessment and data abstraction. Trials were subgrouped by UI diagnosis. The quality of evidence was assessed by adopting the (GRADE) approach. Results Twenty-one trials (1281 women) were included; 18 trials (1051 women) contributed data to the meta-analysis. In women with stress UI, there was high quality evidence that PFMT is associated with cure (RR 8.38; 95% CI 3.68 to 19.07) and moderate quality evidence of cure or improvement (RR 17.33; 95% CI 4.31 to 69.64). In women with any type of UI, there was also moderate quality evidence that PFMT is associated with cure (RR 5.5; 95% CI 2.87–10.52), or cure and improvement (RR 2.39; 95% CI 1.64–3.47). Conclusions The addition of seven new trials did not change the essential findings of the earlier version of this review. In this iteration, using the GRADE quality criteria strengthened the recommendations for PFMT and a wider range of secondary outcomes (also generally in favor of PFMT) were reported.

Physical therapy for urinary incontinence in postmenopausal women with osteoporosis or low bone density : a randomized controlled trial

Objective: To assess the effectiveness of 12 weekly physical therapy sessions for urinary incontinence (UI) compared with a control intervention, for reducing the number of UI episodes measured with the 7-day bladder diary, at 3 months and 1 year postrandomization. Methods: A single parallel-group randomized controlled trial was conducted at one outpatient public health center, in postmenopausal women aged 55 years and over with osteoporosis or low bone density and UI. Women were randomized to physical therapy (PT) for UI or osteoporosis education. The primary outcome measure was number of leakage episodes on the 7-day bladder diary, assessed at baseline, after treatment and at 1 year. The secondary outcome measures included the pad test and disease-specific quality of life and self-efficacy questionnaires assessed at the same timepoints. Results: Forty-eight women participated (24 per group). Two participants dropped out of each group and one participant was deceased before 3-month follow-up. Intention-to-treat analysis was undertaken. At 3 months and 1 year, there was a statistically significant difference in the number of leakage episodes on the 7-day bladder diary (3 mo: P = 0.04; 1 y: P = 0.01) in favor of the PT group. The effect size was 0.34 at 1 year. There were no harms reported. Conclusions: After a 12-week course of PT once per week for UI, PT group participants had a 75% reduction in weekly median number of leakage episodes, whereas the control group's condition had no improvement. At 1 year, the PT group participants maintained this improvement, whereas the control group's incontinence worsened.

Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy : a case study

Objective: Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment. Methods: A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program. Results: The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs' tone and elasticity were improved, although some other VVA signs remained unchanged. Conclusions: Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA.