Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated to hereditary neuropathy with liability to pressure palsies (HNPP) and revealed after influenza AH1N1 vaccination

Neurological complications of AH1N1 vaccination such as Guillain-Barré syndrome were described in the previous years. Several reports suggest that hereditary neuropathies may be a predisposing factor for immune-mediated neuropathies. We report the case of a 54-year-old female who developed chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) 5 weeks after AH1N1 vaccination. She had no previous neurological history, but neurophysiological features led us to suspect an underlying hereditary neuropathy. PMP22 gene analysis showed a typical deletion, confirming the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP). We observed a significant clinical and neurophysiological improvement of the neuropathy after intravenous immunoglobulin treatment. This is, to our knowledge, the first reported case of CIDP potentially triggered by AH1N1 vaccination. This and previous observations suggest that genetic-determined neuropathies could predispose to the occurrence of immune-mediated neuropathies. One must recall the possibility of a superimposed hereditary neuropathy like HNPP in patients with a clinical presentation of CIDP, especially when positive family history or unexpected neurophysiological features are present.Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Project ECHO: A novel tele-mentoring service to aid hepatitis C treatment in difficult-to-access populations

Introduction: Hepatitis C virus (HCV) is now curable with nationally funded direct-acting antivirals; however, its eradication faces many barriers as HCV commonly occurs in difficult-to-access populations (DTAPs), including those with active drug misuse and psychiatric comorbidities. Project ECHO (PE) is a novel “hub and spoke” tele-mentoring program that originated in New Mexico, USA, and was adopted by Liverpool Hospital in July 2016 to empower local clinicians and target DTAPs. Aim: To examine if the PE model can more effectively identify and treat DTAPs with HCV in comparison to a patient cohort treated in an outpatient liver clinic. Methods: This prospective study was approved by the Sydney South West Area Health Service ethics committee. Weekly PE video conference meetings were conducted with local clinicians, including drug and alcohol physicians, sexual health physicians, private methadone prescribers, and community general practitioners. Deidentified HCV cases were presented to a multidisciplinary team of gastroenterologists, nurses, and allied health staff. Information discussed and collected during PE meetings broadly encompassed relevant clinical and biochemical data for formulating treatment plans, psychosocial, and drug-related elements that were considered potential barriers, and treatment outcomes. PE patients were then retrospectively compared with 99 consecutive new HCV patients seen in Liverpool Hospital Liver Clinic since July 2016. Results: Between July 2016 and April 2017, 99 cases of HCV were presented at the PE meetings by local clinicians in the South Western Sydney Local Health District. Thirteen were referred from a sexual health clinic, 68 from various drug health facilities, four from private methadone prescribers, and 14 from GPs. The PE cohort had a greater proportion of female patients (33.3% vs 25.3%) and were younger (median age, 45 years) compared with the liver clinic cohort (median age, 50 years). There were more Indigenous patients in the PE (n = 15) compared with the liver clinic cohort (n = 5). Ongoing substance misuse was prevalent in 43 of 99 PE patients, of whom 31 were active intravenous drug users and 25 had polysubstance misuse, compared with 17 of 99, 12 and 7, respectively, in the liver clinic. Of the 99 PE patients, 73 used opioid substitution therapy, of whom 38 (52.1%) required daily pickups (an indirect indicator of instability), while only 20 clinic patients used opioid substitution therapy, six of whom (30%) required daily pickups. Of the PE patients, 49 have a background of psychiatric illness, with 41 using psychotropic medications, compared with 44 clinic patients who have psychiatric comorbidities, 29 of whom are pharmacologically treated. Cirrhosis was present similarly in PE (13.1%) and liver clinic (18.1%) cohorts. Most were treatment-naive (95.0% and 90.9%, respectively). Genotypes 1, 2, and 3 proportions were similar between PE (44.4%, 6%, and 47.5%, respectively) and liver clinic (39.3%, 6%, and 37.3%, respectively) patients. Genotype 6 was not seen in PE patients, while it comprised 11.1% of liver clinic patients. As of May 2017, 18 of 18 patients in the PE cohort have completed therapy and achieved sustained virological response (SVR), while 46 patients are awaiting completion of treatment. Thirty-two patients did not initiate therapy (13 due to conflicting priorities and 19 were lost to follow-up), and three had treatment ceased early. In contrast, 34/35 liver clinic patients achieved SVR (one relapsed), 44 patients are awaiting completion, and 20 did not initiate therapy (six due to conflicting priorities, eight lost to follow-up, six awaiting future therapies). Conclusion: PE provides an innovative model that facilitates community treatment of HCV in DTAPs who are cared for by other services and differ markedly from those who would attend liver clinics. Furthermore, the teaching approach of PE teleconferencing sessions effectively empowers referring clinicians to become independent prescribers

Do mothers and fathers moderate the influence of each other's self-efficacy beliefs and parenting behaviors on children's externalizing behavior?

The aim of the current study was to test first the validity of the social learning model, in which children’s externalizing behavior (EB) is considered to be related to problematic parenting, and second, whether and to what extent mothers and fathers moderate the influence of each other’s parenting on children’s EB. Two models were tested with a set of longitudinal prospective data collected from 419 mothers and 419 fathers. The first model tested the relations between parental self-efficacy beliefs at 4 years of age, parenting behaviors at age 5 and child’s EB at age 6. The second model tested the moderating effect of parenting behavior displayed by one parent on the way in which the other parent’s concurrent beliefs and subsequent behaviors impact on their child’s EB. The results mainly supported the first model, in particular the bidirectional relations between parents’ controlling behavior and children’s EB. The second model did not fit the data well. The existence of a moderating role of the other parent’s behavior was only demonstrated for the relation between mothers’ or fathers’ controlling behaviors and children’s EB. Very similar results were found for mothers and fathers. The results are discussed for their research and clinical implications

Child-Oriented or Parent-Oriented Focused Intervention: Which is the Better Way to Decrease Children’s Externalizing Behaviors?

Research has tried to identify risk factors that increase the likelihood of difficulties with externalizing behavior. The relations between individual or environmental factors and externalizing behavior have been especially documented. Child-oriented and parent-oriented interventions have been designed in order to decrease externalizing behavior in preschoolers. To date, however, research has largely been compartmentalized. It is therefore not known whether child-oriented or parent-oriented intervention is more effective in reducing externalizing behavior. The aim of the current study was to answer this question by comparing two 8-week child with two 8-week parent-oriented group programs sharing a common experimental design. This was done in a pseudo-randomized trial conducted with 73 3–6-year-old children displaying clinically relevant levels of externalizing behavior who were assigned to one of the four interventions and 20 control participants who were allocated to a waiting list. The results indicate that the four programs focusing on a specific target variable, i.e. social cognition, inhibition, parental self-efficacy beliefs, or parental verbal responsiveness, are all effective in reducing externalizing behavior among preschoolers. Their effectiveness was moderated neither by their orientation toward the child or the parent nor by their content, suggesting that several effective solutions exist to improve behavioral adaptation in preschoolers. A second important highlight of this study is that, thanks to comparable effect sizes, brief focused programs appear to be a reasonable alternative to long multimodal programs, and may be more cost-effective for children and their families.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Self-efficacy beliefs amongst parents of young children : validation of a self-report measure

The self-efficacy belief (SEB) concept is discussed in the context of parenting. A questionnaire, the Echelle Globale du Sentiment de Competence Parentale (EGSCP), assessing several domain-specific SEBs and three related cognitive constructs, was developed with 705 French-speaking parents of 3- to 7-year-old children. The EGSCP displayed good psychometric properties. Age-related differences and differences between mothers and fathers illustrated the questionnaire's discriminative properties. Relations were also found between EGSCP and several criterion variables: support, satisfaction, self-esteem and stress, childrearing behavior, and children's social competence and behavior. The refinement of the SEB concept in the parenting context provides a more comprehensive view of both mothers' and fathers' cognition. The empirical and clinical implications of this are discussed