129 resultados para Étude prospective randomisée


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Objective To investigate the association between periodontitis and mortality from all causes in a prospective study in a homogenous group of 60- to 70-year-old West European men. Methodology A representative sample of 1400 dentate men, (mean age 63.8, SD 3.0 years), drawn from the population of Northern Ireland, had a comprehensive periodontal examination between 2001 and 2003. Men were divided into thirds on the basis of their mean periodontal attachment loss (PAL). The primary endpoint, death from any cause, was analysed using Kaplan-Meier survival plots and Cox's proportional hazards model. Results In total, 152 (10.9%) of the men died during a mean follow-up of 8.9 (SD 0.7) years; 37 (7.9%) men in the third with the lowest PAL (<1.8 mm) died compared with 73 (15.7%) in the third with the highest PAL (>2.6 mm). The unadjusted hazard ratio (HR) for death in the men with the highest level of PAL compared with those with the lowest PAL was 2.11 (95% CI 1.42-3.14), p < 0.0001. After adjustment for confounding variables (age, smoking, hypertension, BMI, diabetes, cholesterol, education, marital status and previous history of a cardiovascular event) the HR was 1.57 (1.04-2.36), p = 0.03. Conclusion The European men in this prospective cohort study with the most severe loss of periodontal attachment were at an increased risk of death compared with those with the lowest loss of periodontal attachment.

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Management of dyspepsia remains a controversial area. Although the European Helicobacter pylori study group has advised empirical eradication therapy without oesophagogastroduodenoscopy (OGD) in young H pylori positive dyspeptic patients who do not exhibit alarm symptoms, this strategy has not been subjected to clinical trial.

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Increased plasma levels of cellular adhesion molecules (CAMs) have been shown to be predictors of all cause mortality in individuals with chronic renal failure 12 and patients with end-stage renal disease receiving haemodialysis 3. In renal transplant recipients the predictive value of CAMs has not been well characterised. The aim of this study was to assess the relationship between CAMs and all-cause mortality during prospective follow-up of a renal transplant cohort.

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The cerebral cortex contains circuitry for continuously computing properties of the environment and one's body, as well as relations among those properties. The success of complex perceptuomotor performances requires integrated, simultaneous use of such relational information. Ball catching is a good example as it involves reaching and grasping of visually pursued objects that move relative to the catcher. Although integrated neural control of catching has received sparse attention in the neuroscience literature, behavioral observations have led to the identification of control principles that may be embodied in the involved neural circuits. Here, we report a catching experiment that refines those principles via a novel manipulation. Visual field motion was used to perturb velocity information about balls traveling on various trajectories relative to a seated catcher, with various initial hand positions. The experiment produced evidence for a continuous, prospective catching strategy, in which hand movements are planned based on gaze-centered ball velocity and ball position information. Such a strategy was implemented in a new neural model, which suggests how position, velocity, and temporal information streams combine to shape catching movements. The model accurately reproduces the main and interaction effects found in the behavioral experiment and provides an interpretation of recently observed target motion-related activity in the motor cortex during interceptive reaching by monkeys. It functionally interprets a broad range of neurobiological and behavioral data, and thus contributes to a unified theory of the neural control of reaching to stationary and moving targets.

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Two prospective controllers of hand movements in catching-both based on required velocity control-were simulated. Under certain conditions, this required velocity control led to overshoots of the future interception point. These overshoots were absent in pertinent experiments. To remedy this shortcoming, the required velocity model was reformulated in terms of a neural network, the Vector Integration To Endpoint model, to create a Required Velocity Integration To Endpoint model. Addition of a parallel relative velocity channel, resulting in the Relative and Required Velocity Integration To Endpoint model, provided a better account for the experimentally observed kinematics than the existing, purely behavioral models. Simulations of reaching to intercept decelerating and accelerating objects in the presence of background motion were performed to make distinct predictions for future experiments.

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OBJECTIVES:: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed. DESIGN:: Prospective, randomized, and blinded. PARTICIPANTS:: In Study 1, experienced laparoscopic surgeons (n = 195) and in Study 2 laparoscopic novices (n = 30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only. RESULTS:: Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32- 42%). The correlation observed between the VR and real-world task performance was r > 0·96 (Study 2). CONCLUSIONS:: VR simulation training offers a powerful and effective platform for training safer skills.

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Postpartum depression has been associated with parenting stress, impacting attachment and child development. However, the relation between antenatal depression or anxiety and postpartum parenting stress has not been investigated. We studied the effect of antenatal depression and anxiety and treatment with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors (antidepressants [ADs]) on postpartum parenting stress.

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Our intent was to investigate the neurodevelopment of HIV-uninfected children exposed to combination highly active antiretroviral therapy in pregnancy compared with children not exposed to highly active antiretroviral therapy but with similar socioeconomic backgrounds.

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In a prospective study of 36 children who were extremely low birthweight (ELBW: <1000 g) preterm infants and 36 matched full-term controls, differences were found in somatization at age 4 1/2 years. Only children who had been extremely premature, and thereby experienced prolonged hospitalization and repeated medical intervention in infancy, had clinically high somatization scores on the Personality Inventory for Children. The combination of family relations at age 4 1/2 years, neonatal intensive care experience, poor maternal sensitivity to child cues in mother-child interaction observed at age 3 years, and child avoidance of touch or holding at age 3, predicted somatization scores, prior to school entry. Due to the known higher incidence of actual medical problems among children with a history of extreme prematurity, the high somatization ELBW children were compared with the normal somatization ELBW children. There were no differences in prevalence of actual medical problems between the 2 ELBW groups, and the importance of maternal factors in relation to somatization was confirmed. Child temperament at age 3, but not personality at 4 1/2, was related to somatization. The etiology of recurrent physical complaints of no known medical cause appears to be a multi-dimensional problem. Non-optimal parenting may contribute to the development of inappropriate strategies for coping with common pains of childhood, or of chronic pain patterns, in some children who have experienced prolonged or repeated pain as neonates.

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Objectives: The objectives of this study were to compare behaviour problems and competencies, at home and school, in 7-year-old children with congenital heart disease with a sibling control group, to examine the prospective determinants of outcome from infancy, and to explore whether any gains were maintained in our sub-group of children who had participated in a previous trial of psychological interventions in infancy.
Methods: A total of 40 children who had undergone surgery to correct or palliate a significant congenital heart defect in infancy were compared (Child Behavior Checklist) with a nearest-age sibling control group (18 participants). Comparisons were made between sub-groups of children and families who had and had not participated in an early intervention trial.
Results: Problems with attention, thought and social problems, and limitations in activity and school competencies, were found in comparison with siblings. Teacher reports were consistent with parents, although problems were of a lower magnitude. Disease, surgical, and neurodevelopmental functioning in infancy were related to competence outcomes but not behaviour problems. The latter were mediated by family and maternal mental health profiles from infancy. Limited, but encouraging, gains were maintained in the sub-group that had participated in the early intervention programme.
Conclusions: The present study is strengthened by its longitudinal design, use of teacher informants, and sibling control group. The patterns of problems and limitations discerned, and differential determinants thereof, have clear implications for interventions. We consider these in the light of our previously reported intervention trial with this sample and current outcomes at the 7-year follow-up.

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Cette communication a pour objectif de présenter et d’analyser les résultats d’une enquête portant sur l’accord sujet-verbe en français contemporain. Dans le domaine de l’accord sujet-verbe, bien que dans la plupart des cas le locuteur n’ait pas le choix de l’accord – c’est–à-dire qu’il n’y a qu’un accord possible – il existe néanmoins des contextes dans lesquels on peut trouver une variation entre l’accord singulier et le pluriel (cf. Corbett 2006 ; Grevisse 1993 ; Riegel et al 1994). Cette variation est souvent liée à une discordance entre le nombre syntaxique et le nombre sémantique. C’est le cas de certaines expressions de quantité, comme dans les exemples suivants : Singulier : « On a affaire à une minorité qui fait la loi à l’université » (Ouest France, 23-24 mai 2009, p.13) Pluriel : « Un petit millier de producteurs allemands, français et belges se sont déplacés, hier, à Bruxelles […] » (Ouest France, 26 mai 2009, p.3) Cette variation nous offre plusieurs pistes de recherche : dans une perspective linguistique, elle peut nous aider à mieux comprendre comment interagissent les différents facteurs linguistiques qui ont une influence sur l’accord, et dans une perspective sociolinguistique, elle représente un nouveau domaine à explorer pour l’étude sociolinguistique de la variation grammaticale en français, ce qui reste jusqu’à présent relativement peu étudiée. Nous traitons dans cette communication de la perspective sociolinguistique, c'est-à-dire les facteurs externes tels que l’âge, le sexe, et le niveau d’éducation du locuteur qui jouent un rôle dans l’accord sujet-verbe avec les expressions de quantité. Nous considérons en particulier la variation sexolectale : dans un premier temps, nous examinons les résultats de quelques études précédentes de la variation morphosyntaxique en français contemporain par rapport à l’influence du sexe du locuteur. Nous en concluons que les Principes élaborés par Labov (1990) pour décrire la variation sexolectale en anglais semblent être moins valables pour le cas du français de la France ; ou bien, qu’ils ne s’appliquent pas de façon simpliste. Dans un deuxième temps, nous présentons les résultats de nôtre étude, et nous voyons que pour nôtre projet aussi, les résultats pour la variation sexolectale ne s’expliquent pas facilement dans le cadre des Principes de Labov (1990).

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Dans cet article, nous évaluons le rôle du cotexte (les facteurs internes ou linguistiques) et du contexte (les facteurs externes ou sociaux, et la situation de l’interaction) dans l’accord sujet-verbe induit par les expressions de quantité en français contemporain. Dans l’emploi de ces expressions, par exemple la majorité, le reste etc., il existe une variation entre l’accord singulier et le pluriel, qui est liée à une discordance entre le nombre syntaxique et le nombre sémantique de l’expression. Dans un premier temps, nous présentons la méthodologie d’une première enquête dont le but était d’identifier les principaux facteurs internes et externes qui ont une influence sur les accords de ce type. Dans un deuxième temps, nous présentons les résultats pour les facteurs sociaux avant d’en tirer quelques conclusions pour l’étude principale.

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BACKGROUND AND OBJECTIVE: To compare the use of subconjunctival and peribulbar anesthesia for trabeculectomy. PATIENTS AND METHODS: Sixty patients undergoing trabeculectomy were prospectively randomized to receive either peribulbar or subconjunctival anesthesia. Peribulbar anesthesia consisted of a 3-ml inferior and a 1-ml superior injection of a 1:1 mixture of 2% mepivacaine, 0.75% bupivacaine, and hyaluronidase. Subconjunctival anesthesia consisted of a 1- to 2-ml injection of the same mixture without hyaluronidase in the superotemporal quadrant. Intraoperative pain, presence of eye movements, and complications during surgery were evaluated. RESULTS: The frequency and intensity of pain was statistically similar between the two groups. All episodes of pain (20% in the subconjunctival group and 6.6% in the peribulbar group) were rated as mild. Eye movement was more common in the subconjunctival group than in the peribulbar group, but it was controlled by verbal command and did not interfere with the procedure. No clinically significant complications occurred during surgery. CONCLUSION: Subconjunctival anesthesia is an effective alternative to peribulbar anesthesia for trabeculectomy.