Analyse de l’implantation de l’approche S’occuper des enfants : Pour donner parole aux jeunes placés en familles d’accueil

Comme au Royaume-Uni, en Australie et dans un projet pilote au Québec, les Sociétés d’aide à l’enfance de l’Ontario sont en train d’implanter l’approche S’occuper des enfants (SOCEN) et son outil, le Cahier d’évaluation et de suivi (CÉS), pour évaluer les besoins des jeunes placés. En raison de la relative nouveauté de cet outil, il est important de cerner les perceptions qu’en ont des cliniciennes qui l’utilisent et leurs superviseures. À cet effet, 20 entrevues en profondeur ont été menées à l’hiver 2004. Les intervenantes interrogées soutiennent que le CÉS aide à mieux cerner les besoins des jeunes et que leurs plans d’intervention sont plus détaillés. Cependant, cet outil comporte certaines contraintes. Le contexte bureaucratique dans lequel il s’insère en complexifie davantage l’usage. Les intervenantes ouvrent donc des pistes pour se réapproprier cet outil clinique.In the same manner as in the United Kingdom and Australia, and under a pilot-project basis in Quebec, Ontario’s Children’s Aid Societies are in the process of adopting the Looking After Children (LAC) approach and its corresponding tool, the Assessment and Action Record (AAR), in order to evaluate the needs of children in care. As the AAR is relatively new, it is important to determine the views of the social workers using it, as well as those of their supervisors. Accordingly, 20 in-depth interviews were conducted during the winter of 2004. The participants affirm that the AAR helps them to better determine the needs of children in care and leads to improvements in the structure of care plans. All the same, in the context of children in care, the AAR presents administrative constraints. The participants therefore propose ways to adapt this clinical tool

The perception of affective touch in Parkinson's disease and its relation to small fibre neuropathy.

Affective touch sensation is conducted by a sub-class of C-fibres in hairy skin known as C-Tactile (CT) afferents. CT afferents respond maximally to gentle skin stroking at velocities between 1-10 cm/sec. Parkinson's disease (PD) is characterised by markedly reduced cutaneous C-fibres. It is not known if affective touch perception is influenced by C fibre density and if affective touch is impaired in PD compared to healthy controls. We predicted that perceived pleasantness to gentle stroking in PD would correlate with C afferent density and that affective touch perception would be impaired in PD compared to healthy controls. Twenty-four PD patients and 27 control subjects rated the pleasantness of brush stroking at an optimum CT stimulation velocity (3cm/sec) and two sub-optimal velocities (0.3cm/sec & 30cm/sec). PD patients underwent quantification of C-fibre density using skin biopsies and corneal confocal microscopy. All participants rated stroking velocity of 3cm/sec as the most pleasant with significantly lower ratings for 0.3cm/sec and 30cm/sec. There was a significant positive correlation between C-fibre density and pleasantness ratings at 3cm/sec and 30cm/sec but not 0.3cm/sec. Mean pleasantness ratings were consistently higher in PD patients compared to control subjects across all three velocities. This study shows that perceived pleasantness to gentle touch correlate significantly with C-fibre density in PD. The higher perceived pleasantness in PD patients compared to controls suggests central sensitisation to peripheral inputs, which may have been enhanced by dopamine therapy. This article is protected by copyright. All rights reserved

Impact of Quantitative Assessment of Parkinson's Disease-Associated Symptoms Using Wearable Technology on Treatment Decisions.

We read with interest the report by Santiago et al. [1], demonstrating that clinician decision making regarding the management of motor symptoms of Parkinson’s disease (PD) can be enhanced by home-based, continuous objective measurement. Within the UK National Health Service, we have also been using the Parkinson’s Kinetigraph (PKG) since 2015. Similar to the Santiago cohort, in routine care, physicians target PKG use in patients they believe continuous objective measurement will improve the value of clinical encounters. With support from Parkinson’s UK, we have carried out an evaluation of utility across seven centers from the Parkinson’s Excellence Network, comprising a mix of local services and regional specialist neuroscience centers led by consultant neurologists, geriatricians or Parkinson’s nurse specialists

Management of fracture risk in Parkinson's:A revised algorithm and focused review of treatments

IntroductionFalls and fractures are a cause of substantial morbidity in Parkinson's. Despite an excess risk of both falls and osteoporosis, people with Parkinson's perceive that they are less likely to fracture than their peers, despite actually being at higher fracture risk. Recognising this increased risk, in 2014 we published an algorithm to guide management of fracture risk in this high-risk population. Recently, the National Osteoporosis Guideline Group (NOGG) published new guidance revising the 10 year fracture probability intervention thresholds for those over 70 years old to 20.3% for major osteoporotic fracture and 5.4% for hip fracture.MethodsIn light of the new guidance, we have reappraised the use of two fracture prediction tools, Qfracture and FRAX, and have updated the algorithm to guide the management of bone health and fracture risk in people with Parkinson's.ResultsWe outline the treatment options available with particular consideration given to Parkinson specific factors that influence treatment choices.ConclusionThis guidance is relevant to all healthcare specialist managing Parkinson's including neurologists, geriatricians and primary care practitioners

<i>TP53</i> Arg72Pro, mortality after cancer, and all-cause mortality in 105,200 individuals

AbstractRs1042522 (Arg72Pro) is a functional polymorphism of TP53. Pro72 has been associated with lower all-cause mortality and lower mortality after cancer. We hypothesized that TP53 Pro72 is associated with lower mortality after cancer, lower all-cause mortality, and with increased cancer incidence in the general population in a contemporary cohort. We genotyped 105,200 individuals aged 20–100 years from the Copenhagen General Population Study, recruited in 2003–2013, and followed them in Danish health registries. During follow-up 5,531 individuals died and 5,849 developed cancer. Hazard ratios for mortality after cancer were 1.03 (95% confidence interval:0.93–1.15) for Arg/Pro and 0.96 (95% CI:0.79–1.18) for Pro/Pro versus Arg/Arg. Hazard ratios for all-cause mortality were 0.99 (95% CI:0.93–1.04) for Arg/Pro and 1.09 (95% CI:0.98–1.21) for Pro/Pro versus Arg/Arg. Risk of cancer specific mortality, cardiovascular mortality, and respiratory mortality were not associated with Arg72Pro genotype overall; however, in exploratory subgroup analyses, genotype-associated risks of malignant melanoma and diabetes were altered. Considering multiple comparisons the latter findings may represent play of chance. The TP53 Arg72Pro genotype was not associated with mortality after cancer, all-cause mortality, or cancer incidence in the general population in a contemporary cohort. Our main conclusion is therefore a lack of reproducing an effect of TP53 Arg72Pro genotype on mortality.</jats:p

Dystonia Associated with Idiopathic Slow Orthostatic Tremor

Background: We aimed to characterize the clinical and electrophysiological features of patients with slow orthostatic tremor. Case Report: The clinical and neurophysiological data of patients referred for lower limb tremor on standing were reviewed. Patients with symptomatic or primary orthostatic tremor were excluded. Eight patients were identified with idiopathic slow 4–8 Hz orthostatic tremor, which was associated with tremor and dystonia in cervical and upper limb musculature. Coherence analysis in two patients showed findings different to those seen in primary orthostatic tremor. Discussion: Slow orthostatic tremor may be associated with dystonia and dystonic tremor