Stress, social support and parental behavior

The present study investigated the relationship between stress, social support and parenting behavior. Eighty-six mothers who had a child enrolled in a daycare center in the Kitchener-Waterloo region volunteered for this study. Participants completed four questionnaires: A Demographic Sheet, the Perceived Stress Scale (Cohen, Kamarck & Mermelstein, 1983), the Interpersonal Support Evaluation List (Cohen and Hoberman, 1983), and the Parent Behavior Scale (which was specifically constructed for this study). The overall support scale and the four subscales (tangible, belonging, appraisal, and self-esteem support) were used to determine whether the perceived availability of social support is directly related to parenting behavior (main effect) or whether it moderates the effects of stress on parenting behavior (buffering effect). The results showed that social support was strongly positively related to Positive Parental Behavior. In addition, stress was strongly associated with Negative Parental Behavior. No stress by support interactions were found; hence, the buffering hypothesis was not supported. However, evidence supporting a two-factor model was found, in that social support correlated with Positive Parental Behavior, but not Negative; and Perceived Stress correlated positively with Negative Parental Behavior but not Positive. Limitations of the study, future recommendations and suggestions and for interventions utilizing social support with parents in overcoming stress are discussed

Primary antibiotic resistance of Helicobacter pylori isolates is twofold more frequent in HIV-positive than HIV-negative individuals: A descriptive observational study

peer reviewedThe antimicrobial susceptibility of Helicobacter pylori strains isolated from HIV-positive individuals is not well characterized. This study aimed to measure the prevalence and long-term trends associated with primary H. pylori antibiotic resistance, evaluate correlations with antibiotic consumption, and compare predictors for H. pylori antibiotic resistance between HIV-positive and HIV-negative individuals. In this longitudinal registry study, we evaluated consecutive adults with and without HIV infection, naïve to H. pylori treatment, who underwent upper gastrointestinal endoscopy and had a positive H. pylori culture, with susceptibility testing available, between 2004 and 2015. Outpatient antibiotic consumption data were based on nationwide aggregated numbers. H. pylori was isolated from gastric biopsies of 3008/8321 patients, 181/477 (37.9%) were HIV-positive and 2827/7844 (36.0%) HIV-negative. Overall cohort mean prevalence of H. pylori primary antibiotic resistance was 11.1% for clarithromycin, 17.8% levofloxacin, and 39.4% metronidazole. The prevalence of H. pylori primary resistance was significantly higher for these three drugs in HIV-positive individuals across the study period. Linear regression showed that the prevalence of clarithromycin and levofloxacin resistance correlated with the country aggregate daily dose consumption of macrolides and quinolones, respectively. Multivariable regression analysis showed that HIV infection is a strong independent risk factor for multiple H. pylori antibiotic resistance. In summary, HIV infection is a risk factor for carrying multi-resistant H. pylori strains and this is correlated with antibiotic consumption. Empirical therapies should be avoided in HIV-positive individuals. These data highlight the need to implement ongoing monitoring of H. pylori antimicrobial susceptibility among HIV-positive individuals. The study is registered at ISRCTN registry, number 13466428: https://www.isrctn.com/ISRCTN13466428

Antireflux Transoral Incisionless Fundoplication Using EsophyX: 12-Month Results of a Prospective Multicenter Study

BACKGROUND: A novel transoral incisionless fundoplication (TIF) procedure using the EsophyX system with SerosaFuse fasteners was designed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single-device insertion. The safety and efficacy of TIF for treating gastroesophageal reflux disease (GERD) were evaluated in a prospective multicenter trial. METHODS: Patients (n = 86) with chronic GERD treated with proton pump inhibitors (PPIs) were enrolled. Exclusion criteria included an irreducible hiatal hernia > 2 cm. RESULTS: The TIF procedure (n = 84) reduced all hiatal hernias (n = 49) and constructed valves measuring 4 cm (2-6 cm) and 230 degrees (160 degrees -300 degrees ). Serious adverse events consisted of two esophageal perforations upon device insertion and one case of postoperative intraluminal bleeding. Other adverse events were mild and transient. At 12 months, aggregate (n = 79) and stratified Hill grade I tight (n = 21) results showed 73% and 86% of patients with >or=50% improvement in GERD health-related quality of life (HRQL) scores, 85% discontinuation of daily PPI use, and 81% complete cessation of PPIs; 37% and 48% normalization of esophageal acid exposure; 60% and 89% hiatal hernia reduction; and 62% and 80% esophagitis reduction, respectively. More than 50% of patients with Hill grade I tight valves had a normalized cardia circumference. Resting pressure of the lower esophageal sphincter (LES) was improved significantly (p < 0.001), by 53%. EsophyX-TIF cured GERD in 56% of patients based on their symptom reduction and PPI discontinuation. CONCLUSION: The 12-month results showed that EsophyX-TIF was safe and effective in improving quality of life and for reducing symptoms, PPI use, hiatal hernia, and esophagitis, as well as increasing the LES resting pressure and normalizing esophageal pH and cardia circumference in chronic GERD patients.Journal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Modulation of high-dose infusional fluorouracil by low-dose methotrexate in patients with advanced or metastatic colorectal cancer : final results of a randomized European Organization for Research and Treatment of Cancer study

Contains fulltext : 22503___.PDF (publisher's version ) (Open Access

Pegfilgrastim reduces the length of hospitalization and the time to engraftment in multiple myeloma patients treated with melphalan 200 and auto-SCT compared with filgrastim

To reduce the duration of neutropenia after conditioning chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT), granulocyte-colony stimulating factors (G-CSF) are commonly administered. We retrospectively evaluated the impact of pegfilgrastim compared to filgrastim on neutrophil engraftment, hospital stay, and supportive measures in patients with multiple myeloma after conditioning with Melphalan 200 (Mel200) followed by APBSCT. Ninety-two APBSCT after Mel200 treatment were performed in 72 patients between January 2006 and December 2009 at our institution. Patients received either single-dose pegfilgrastim (n = 46; 50%), or daily filgrastim (n = 46; 50%) after APBSCT (median duration of filgrastim use, 9 days; range, 3-14 days). Duration of neutropenia grade IV was shorter with pegfilgrastim compared with filgrastim (median, 5 days (range, 3-14 days) versus 6 days (range, 3-9 days), p = 0.0079). The length of hospitalization differed significantly (pegfilgrastim (median, 14.5 days; range, 11-47 days) versus filgrastim (median, 15.5 days; range, 12-64 days), p = 0.024). Pegfilgrastim-treated patients had less red blood cell transfusions (median, 0 transfusions (range, 0-10) versus 0.5 transfusions (range, 0-9), p = 0.00065). Pegfilgrastim was associated with reduced cost of the treatment procedure compared with filgrastim (p = 0.031). Pegfilgrastim appears to be at least equivalent to filgrastim without additional expenditure in myeloma patients treated with Mel200 and APBSCT

Combination ledipasvir-sofosbuvir for the treatment of chronic hepatitis C virus infection: a review and clinical perspective

Marcel Nkuize,1 Thomas Serst&eacute;,1,2 Michel Buset,1 Jean-Pierre Mulkay11Department of Gastroenterology and Hepatology, Saint-Pierre University Hospital, 2Department of Gastroenterology, Pancreatology and Hepatology, H&ocirc;pital Academique Erasme, Universit&eacute; Libre de Bruxelles, Brussels, Belgium Abstract: Chronic hepatitis C treatment has continued to evolve, and interferon-free, oral treatment with direct-acting antiviral agents is the current standard of care. Recently, a new treatment, which is a combination of two direct-acting antiviral agents, ledipasvir 90 mg (anti-NS5A) and sofosbuvir 400 mg (anti-NS5B), has been approved in the US and the European Union for the treatment of chronic hepatitis C viral infection. In Phase III trials among chronic hepatitis C virus genotype 1 monoinfected (treatment-na&iuml;ve, treatment-experienced, and with advanced liver disease or posttransplant) patients and HIV&ndash;hepatitis C virus coinfected patients, the ledipasvir-sofosbuvir fixed-dose combination is associated with a higher rate of sustained virologic response at 12 weeks after therapy has ceased. According to preliminary data, the ledipasvir-sofosbuvir combination also may be effective against hepatitis C genotype 4 virus infection. The ledipasvir-sofosbuvir combination taken orally is generally well-tolerated. Moreover, the combination treatment may suppress the effect of predictive factors of chronic hepatitis C that have historically been known to be associated with treatment failure. Thus, the fixed-dose single-tablet combination of ledipasvir-sofosbuvir offers a new era for the effective treatment of a variety of patients suffering from chronic hepatitis C virus infection.Keywords: ledipasvir, liver disease, ethnicity, DAA, HI

Helicobacter pylori and cancer prone lesions of the stomach

De nos jours, le cancer gastrique reste un problème de santé majeur, malgré la diminution de son incidence. L'histopathogénèse a été décrite dans le modèle de Correa, lequel tient compte des influences environnementales impliquées sur l'évolution de la muqueuse gastrique normale vers une gastrite superficielle, ensuite l'atrophie, la métaplasie intestinale, la dysplasie et finalement le carcinome gastrique. Helicobacter pilori est la cause principale de la gastrite chronique active. Lorsque l'atrophie de la muqueuse progresse, la densité bactérienne de H. pylori diminue et dans la gastrite atrophique sévère, seuls les anticorps sériques anti-Helicobacter pylori constituent le témoin d'une infection antérieure. Le développement d'une gastrite atrophique chronique s'accompagne de la présence d'Helicobacter pylori, d'un pH gastrique élevé et d'un abaissement des taux sériques de béta-carotène. La métaplasie intestinale est également associée à la présence de H. pylori, à une réduction de la consommation de la vitamine C, à des taux faibles de sa concentration dans le suc gastrique, à un pH gastrique élevé, et à un reflux biliaire. Des taux élevés de prévalence d'H. pylori ont été observés chez les patients porteurs d'une dysplasie gastrique ou d'un cancer gastrique superficiel. En revanche, les données relatives au rôle de H. pylori dans le cancer gastrique superficiel de type diffus, demeurent contradictoires. Les mécanismes de l'implication de H. pylori dans la carcinogenèse gastrique incluent l'inflammation induite par H. pylori, l'augmentation de la prolifération cellulaire gastrique, la production de produits inflammatoires mutagènes; H. pylori permet au sel (NaCl) d'augmenter la prolifération cellulaire gastrique; H. pylori inhibe le maintien de la concentration gastrique en vitamine C; l'ammoniaque, produit par l'uréase bactérienne, est capable d'induire une atrophie; enfin la toxine de H. pylori, pour des raisons encore inconnues, constitue un facteur important de la carcinogenèse gastrique. On ignore si les lésions précancéreuses gastriques sont réversibles. L'effet de l'éradication de de H. pylori chez des patients sélectionnés et le rôle de la vaccination à l'échelle de l'ensemble de la population, restent à évalue