Living with a person who has Parkinson's disease: the spouse's perspective by stage of disease. Parkinson's Study Group.

The objective of this study was to examine the experience of spouses caregiving for their spouse with Parkinson's disease (PD) and to determine whether their experiences differed by stage of disease. By using a cross-sectional design and mail questionnaire data from 380 spouse caregivers across 23 sites of the Parkinson Study Group, key caregiver variables were examined by stage of PD. Three categories of variables--caregiver role strain (10 measures), caregiver situation (four measures), and caregiver characteristics (four measures)--were analyzed by using t tests with Bonferroni correction. Specific types and amounts of role strain accumulated as the disease progressed, and they differed significantly between stages (p < 0.05). In the caregiving situation, the mean number of caregiving tasks tripled by stage 4/5. Negative changes in lifestyle plus decreases in predictability in caregivers' lives increased significantly in late-stage disease (p < 0.05). Caregiver characteristics of physical health and preparedness did not significantly differ across stages of disease. Depression was significantly higher by stage 4/5. Mutuality, the positive quality of the relationship as perceived by the caregiving spouse, declined beginning at stage 2. Caregiver strain is experienced across all stages of PD and accumulates significantly as the disease progresses. This study defines types and amounts of strain by stage of disease, which will be helpful in designing formal intervention trials to provide more effective help for spouse caregivers.

The nurse's role in clinical trials.

Parkinson's disease (PD) is a chronic and progressive degenerative disorder of the central nervous system characterized by tremor, rigidity, slowness of movement (bradykinesia) and postural abnormalities. The cause is unknown, but the pathology shows that dopamine is profoundly reduced in the basal ganglia of patients with PD. When dopamine is replenished by the administration of levodopa, most of the symptoms of parkinsonism are reduced significantly. Levodopa is considered to be the most reliable and effective symptomatic drug treatment for keeping patients autonomous and functionally independent for as long as possible.

Factors associated with tuberculin reactivity among the foreign-born in Montreal.

Because tuberculosis among the foreign-born is of increasing importance in North America, it has recently been recommended that newly arriving immigrants be tuberculin tested and preventive therapy given to all those with significant reactions. The factors affecting the prevalence of tuberculin reactions were assessed in a community-based tuberculin survey among foreign-born schoolchildren and young adults. Of 1,198 foreign-born who were tuberculin tested, 32.4% had significant tuberculin reactions. False-positive tuberculin reactions due to sensitivity to purified protein derivative (PPD)-B (for Mycobacterium avium) were uncommon and those due to BCG vaccination of importance only among immigrants from countries with low tuberculosis rates. Tuberculin reactions of 10+ mm were associated with tuberculosis rates in the country of origin (p less than or equal to 0.001), age when immigrated (p less than or equal to 0.001), bacillus Calmette-Guérin (BCG) vaccination (p less than or equal to 0.01), and residence in poorer neighborhoods in Montreal (p less than or equal to 0.001), but not with number of years resident in Canada. The booster phenomenon, seen in 16% of those undergoing two-step testing, was most strongly associated with prior BCG vaccination (p less than or equal to 0.001) and also with tuberculosis rates in the country of origin (p less than or equal to 0.08), age of immigration (p less than or equal to 0.01), and number of years resident in Canada (p less than or equal to 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Sustained release antiparkinson agents: controlled release levodopa.

The rationale for sustained release oral levodopa preparations is to deliver levodopa in the areas of maximal intestinal absorption in a slow and predictable way, leading to stable plasma levodopa levels and brain dopamine levels, therefore resulting in a lengthened duration of action. Sinemet CR is the prototype of such preparations, with demonstrated efficacy in decreasing periods of akinesia in parkinsonian patients with mild to moderate motor fluctuations. Total doses of levodopa are raised 10 to 30% because of the lowered bioavailability; diphasic dyskinesias may increase at the end of the day. Tolerance is good in de novo patients and studies are in progress to establish if early treatment with Sinemet CR delays the onset or attenuates the severity of motor fluctuations as compared to standard Sinemet.

The Mississauga "saga".

At approximately seven minutes to midnight on Saturday, November 10, 1979, a Canadian Pacific Railway (CPR) train travelling from Windsor to Scarborough, Ontario, was derailed in an industrial area in the centre of Mississauga in Peel County (near Toronto). The accident was attributed to an overheated axle bearing on a propane tank car. The resultant fire which ignited the gas created a huge column of fire that lit up the sky. Firefighters noticed the flames from their stations. The nine fire stations in Mississauga were alerted and the first units arrived on the scene at 2355 hrs. (In 15 minutes, 55 firefighters were on the scene, and within the next half hour there were 110). This was the start of what was to result in the largest peace-time evacuation in recorded history. What follows is an account of the events that took place during the tense days that followed, and includes information available as of 17 December 1979.