Typologies of caregiving families: family congruence and individual well-being.

Data from 252 female primary caregivers, their husbands, and children living in multigenerational households were used to create family typologies based on the extent of similarity among reports of elder behaviors. Analysis of variance indicates that families characterized by high agreement and those characterized by low agreement were significantly different from one another on a number of dimensions. When the relationship between caregiver-reported stressors and mental health was examined as a function of family typology, results indicate that for high agreement families there were significant correlations between the caregiver's report of the elder's behaviors and her burden; satisfaction with caregiving; relationships with her husband, child, and elder; and depression. Similar relationships characterize data reported by husbands and children in high agreement families. For families characterized by low agreement, the majority of these relationships were not significant.

Coping strategies of people living in multigenerational households: effects on well-being.

Analyses examined whether information about the coping strategies used by family members adds to an understanding about the psychological well-being of individuals. Data from 140 women and their husbands and children who were living in multigenerational households that included a disabled older relative indicated that for the women and children, the best predictors of depression, positive affect, and mastery were their own coping strategies; the coping strategies used by other family members did not add significantly to the predictive equation. For husbands, however, depression was predicted by both their own coping strategies and the coping strategies of their wives. Husbands' positive affect was predicted only by the coping strategies of their wives and children, and their mastery was predicted by their own coping strategies and those of their wives and children.

Understanding the well-being of care receivers.

A model in which the contributions made by older care receivers to their family members predicted personal control and ultimately psychological well-being of older people living in multigenerational households was proposed and tested. Data from 129 people over the age of 60 reveals that physical health predicts the extent to which elders contribute to the family, with those in poorer health giving less help to family members than those in better health. Elder contributions to the family increased the sense of control experienced by the older person. Although personal control increased the overall sense of psychological well-being experienced by the older care receivers, there was no direct relationship between the elder's contributions to the family and their psychological well-being.

Limited effect of sulphasalazine treatment in reactive arthritis. A randomised double blind placebo controlled trial.

OBJECTIVE: To assess the efficacy and safety of sulphasalazine in reactive arthritis. METHODS: Double blind placebo controlled trial of six months duration comparing sulphasalazine 2-3 g per day (n = 37) with matching placebo (n = 42) in adults with active reactive arthritis (age 19-57 years, median 34). Treatment response was evaluated once a month by changes in erythrocyte sedimentation rate (ESR), pain, peripheral arthritis, tender iliosacral joints, entesopathy, extra-articular manifestations, and working ability. RESULTS: 15 patients in the sulphasalazine group and eight in the placebo group withdrew from the study prematurely. Adverse events, primarily gastrointestinal, were the main reason for withdrawal in the actively treated group. Intention-to-treat analyses showed significant improvements over time in both groups in ESR, pain, and number of swollen joints (P < 0.01). Number of days on sick leave decreased significantly in the sulphasalazine group only (P < 0.01). No significant differences between the two groups were present after six months. Among the patients completing the trial according to protocol, persistent complete remission had occurred within two months in five (23%) of the actively treated, but in no placebo treated patients (P = 0.013). CONCLUSIONS: Sulphasalazine seemed to improve only the very short term outcome of reactive arthritis. The possible beneficial effect of the drug should also be weighed against the risk of adverse events. Although these were mainly mild, almost 25% of the patients in the actively treated group gave up treatment for this reason.

Mental health of coresident family caregivers: examination of a two-factor model.

Data were collected from 140 caregivers of elderly relatives, their husbands, and coresident children. Lawton et al.'s (1991) parallel channel hypothesis, which suggests that positive and negative aspects of mental health have differential predictors, was tested. Data from caregivers, their husbands, and children support the hypothesized model, with greater interdependence of psychological process being associated with greater role centrality.

Attachment among adult children and their institutionalized parents.

Structural equation analysis using data from 424 adult children with parents living in long-term care facilities indicated that the attachment experienced by adult children for their institutionalized parents was predicted from child's report of parent's mood and child's sense of guilt regarding his/her parent. Parent's mood was predicted by parent's health, and child's sense of guilt was predicted by the amount of help provided to the parent by the adult child. Results are interpreted in the context of theories of attachment.

Intravenous methylprednisolone pulse therapy in ankylosing spondylitis.

The aim of this double-blind study was to compare the effect of high-dose (1000 mg) and low-dose (375 mg) methylprednisolone pulse therapy administered intravenously once daily for three consecutive days, in active ankylosing spondylitis. Seventeen patients with active ankylosing spondylitis were randomly allocated to high-dose (8 patients) or low-dose (9 patients) regimen. Although there was no placebo group in this study, it is our impression that in patients with active ankylosing spondylitis, both high-dose (1000 mg) and low-dose (375 mg) methylprednisolone pulse therapy given on three consecutive days, is effective as regards pain relief and improvement in spinal mobility. There were no statistically significant differences between the two groups, though there was a trend towards the high dose yielding a greater and longer lasting improvement. No serious adverse reactions were observed.

Intravenous methylprednisolone pulse therapy in ankylosing spondylitis.

For several years the medical treatment of active ankylosing spondylitis (AS) has been NSAID because gold, penicillamine, antimalarials and steroids have been without efficacy. In 1981, Mintz et al reported that methylprednisolone pulse therapy (MPPT) had an excellent effect in patients with AS. Seven patients with active AS and insufficient efficacy of NSAID for three months were treated with one gram methylprednisolone daily given intravenously for three successive days. Mobility and pain were recorded before, during, and after treatment. Significant pain relief and improvement of mobility of the spine for at least six weeks were clearly demonstrated (p less than 0.05). Finger to floor distance and chin manubrium distance improved significantly for at least six months (p less than 0.05). We conclude that intravenous MPPT is a useful treatment in patients with active AS when NSAID is insufficient.

Steroids reduce complement activation in rheumatoid arthritis.

Patients with seropositive, classical rheumatoid arthritis (RA) with severe active disease have raised plasma concentrations of the complement C3 split product C3d. These values display little diurnal or circadian variation in the individual patient. During a 3-month period the variation was within 10 mU/l in 45 patients (ref. range 20-52 mU/l, RA patients up to 120 mU/l.) Six RA patients were treated with steroids on clinical indication, and the plasma C3d, Ritchie index and pain score before and during the treatment (30 mg prednisolone per day) were measured. The variables showed a steady decrease during the next 14 days. Plasma C3d fell 2/3 of the total fall within the first 48 hours, while the serum total haemolytic complement activity, complement C3 and C4 did not change significantly. This shows that the anti-inflammatory effect of steroids is accompanied by a reduction of complement activation.

Early detection of neurogenic bladder dysfunction caused by protruded lumbar disk.

A case of cauda equina compression was suspected from urinary symptoms. The diagnosis was based on the presence of type A contraction on rapid cystometry and prolonged latency of the sacral evoked response. Such findings pointed to the need for myelography. Lumbar laminectomy, with removal of a ruptured intervertebral disk and cauda equina decompression, resulted in return of normal urination and normal cystometry and electromyogram of the perineal muscles.

Histochemistry and acetylcholine receptor distribution in normal and denervated monkey extraocular muscles.

In monkey extraocular muscles (EOM), a battery of histochemical reactions delineates three muscle fiber types, coarse, fine, and granular. Normal EOM are compared with EOM denervated by intracranial oculomotor nerve section. The experimentally denervated EOM fibers did not show the constellation of histologic responses typical of denervated limb muscle, making a diagnosis of a denervation process in EOM muscle very difficult. Although the denervated fine and granular fibers (but not the coarse fibers) develop diffuse extrajunctional acetylcholine receptors (AChR) following experimental denervation, this is not a reliable criterion of denervation because not all of those fibers developed it and they did not show it beyond a 12-week period following nerve section; moreover, myopathic mechanisms have previously been shown capable of provoking diffuse extrajunctional AChR in limb-muscle fibers.

A model for spasm of the anterior cerebral artery.

A model for production of spasm of the anterior cerebral artery in primates is presented. The model consists of injection of 0.35 cc of fresh blood into the chiasmatic cistern through the optic canal after orbital exenteration. Clinical and angiographical follow-up is possible. The clinical appraisal of acute and chronic changes can be accomplished in the awake animal.

Oxygen affinity of haemoglobin and red cell 2,3-diphosphoglycerate in childhood diabetes.

Red cell 2,3-diphosphoglycerate (2,3-DPG) and the oxygen haemoglobin dissociation curve (ODC) were determined in 32 ambulatory, non-acidotic diabetic children and in 49 healthy children. Despite the fact that the diabetic children had, on average, an increased haemoglobin concentration, their erythrocytes contained significantly more 2,3-DPG than normal. Both in diabetic and in healthy children a negative relationship was found between the content of 2,3-DPG and the haemoglobin concentrations. No relationship was present between the plasma glucose and the 2,3-DPG concentration. The concentration of plasma inorganic phosphate (Pi) in the diabetic children was significantly higher than in the control children, and for all children there was a significant relationship between the 2,3-DPG and the Pi. In the diabetics 2,3-DPG was positively correlated to the P50 (7.40) and to the P50 (in vivo ph) of the ODC. However, despite the significant increase in 2,3-DPG among the diabetic children the average P50 (7.40) and P50 (in vivo pH) was not increased as compared with the control children. The inhibitory factor preventing the oxygen affinity from decreasing among the diabetics was strongly correlated to an increase in the mean corpuscular haemoglobin concentration. The result of this study suggests the presence of an increased amount of haemoglobin fraction with high oxygen affinity (haemoglobin Alc) in the red cells of juvenile diabetics.