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

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

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

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

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Should Helicobacter pylori be eradicated before starting a long term proton pump inhibitor treatment for reflux oesophagitis ? : Esophagitis : new acquisitions

Helicobacter pylori (HP) a été retrouvé au niveau de l'œsophage, uniquement sur un épithélium de type gastrique dans l'oesophage de Barrett, et presque exclusivement chez des patients porteurs d'une contamination gastrique par HP. L'infection de l'oesophage de Barrett par HP n'a aucune influence sur sa sévérité, ses complications ou son histoire naturelle. La contamination gastrique par HP n'est pas un facteur de risque de reflux gastro-oesophagien et au contraire la présence de HP au niveau gastrique, l'inflammation de la partie fundique et la gastrite atrophique pourraient jouer un rôle protecteur contre l'oesophagite par reflux. L'éradication de HP chez les patients porteurs d'un ulcère duodénal expose ceux-ci à un risque de développement d'oesophagite par reflux. HP influence l'efficacité du traitement antisécrétoire: les inhibiteurs de pompe à protons et la ranitidine procurent une réduction de l'acidité gastrique supérieure chez les sujets contaminés par HP par rapport aux sujets HP négatifs. Au cours d'un traitement par inhibiteur de pompe à protons, on constate un déplacement de HP de l'antre vers le fundus. Les traitements prolongés par inhibiteur de pompe à protons provoquent une gastrite atrophique chez les sujets positifs pour Helicobacter pylori, ce qui constitue un argument majeur en faveur de l'éradication de HP chez les patients soumis à une inhibition sécrétoire acide de longue durée