[Patients' intervention in a therapeutic education program dedicated to systemic lupus: definitions, setting and benefits]. / Intervention des patients dans l'animation d'un programme d'éducation thérapeutique dédié au lupus systémique : définitions, mise en place et bénéfices.

PURPOSE: Though recommended, participation of patients with specific expertise in therapeutic education programs (TEP) is rare. This work reports the experience of a national reference centre for rare systemic diseases. PATIENTS AND METHODS: Involvement of "expert patients" (EP) has been planned from the development of a TEP dedicated to systemic lupus: patients' roles and required expertise have been defined and linked to the pedagogical tools. Such patients have been recruited during individual interviews and called to participate to specific pedagogical training. EP intervention have been evaluated by questionnaire to EP and health care providers. RESULTS: Three EP's functions have been identified: sharing experiences, giving "tips and tricks" and promoting dialogue. EP's interventions has been organised into a hierarchy (from sharing to co-animation). Among 298 patients enrolled in the TEP, 25 (8.4%) have been identified as possible EP. Eight of them (32%) benefited from a specific training of 12 hours. Among these patients, two (25%) regularly participate to the education sessions. For EP as well as for health care providers, EP's intervention seems beneficial (visual scale scores of 7.5 and 9.5, respectively). CONCLUSIONS: Though difficult to organise, EP's intervention in TEP dedicated to rare systemic diseases seems useful and would earn to be increase.

[Effects of Parkinson's disease on quality-of-life patients' spouses: a qualitative survey]. / Impact de la maladie de Parkinson sur la qualité de vie des conjoints de patients. Une étude qualitative.

INTRODUCTION: Spouses play a major role as care givers for their partners with Parkinson's disease. This de facto part of family nursing turns out to be so demanding that they often feel isolated. While spouses may have access to financial and technical aids, but no specific psychological support is available to assist them in coping with the difficulties they have to face. Supporting and educating spouses thus appears today to be a real need. METHODS: Wishing to create an appropriate support program responding to the needs and expectancies of spouses of Parkinson's disease, we conducted a study designed to measure the effects of Parkinson's disease on spouses' quality-of-life and identify the priority needs in terms of information and support. This study included the spouses of 14 patients who participated in semi-directive individual interviews and a focus group. RESULTS: The data collected shows that spouses experience great disarray when faced with the disease. Their perception of Parkinson's disease has a strong anxiogenic effects. Caring for their spouse on a day to day basis creates a permanent atmosphere of stress with an insecure feeling generating tensions and major frustrations. Most of the spouses do not allow themselves any break and are overwhelmed with ambivalent feelings. They experience a kind of hostility towards their spouse and at the same time feel guilty for their attitude and also for their helplessness. The disease also leads to an impoverishment of the couples' social network, due to reduced autonomy and fear of other people's way of looking at them. CONCLUSION: Our study confirms the usefulness of organizing an educational support program for these spouses who often feel very lonely and helpless when confronted with their partner's disease.

Leukocyte migration inhibition in bacillus Calmette-Guérin vaccinated healthy adults and in tuberculosis assayed by a rapid photoelectric procedure.

A sensitive photoelectric method was used for reading migrations of human peripheral blood leukocytes from agarose microdroplets. Its rapidity enabled the use of a wide range (12 logs) of in vitro concentrations of antigen. Inhibition of migration of leukocytes (LMI) of healthy subjects having had BCG vaccination in childhood was found to occur in two zones of PPD concentrations, one high, from 10(-1) to 1000 micrograms/ml with a peak at 100 micrograms/ml, and one low, from 10(-8) to 10(-2) micrograms/ml. While three-fifths of subjects showed high zone LMI, in one-fifth it was bizonal and in another fifth observed only in the low zone. In patients with active pulmonary tuberculosis LMI, prior to all treatment, was reduced, absent, or replaced by enhanced migration, particularly in the low zone or in both zones. One and a half to four months after treatment LMI was found to be bizonal, enhanced migration having disappeared. These observations suggest the participation of two cell populations with widely different sensitivity to PPD in LMI in tuberculous and BCG vaccinated subjects and the presence of migration stimulatory lymphokine(s) during active tuberculosis.

[A case of acquired immunodeficiency syndrome (AIDS) in a homosexual]. / A propos d'une observation de syndrome immuno-déficitaire acquis (SIDA) chez un homosexuel.

There is increasing number of cases of acquired immune deficiency syndrome (AIDS) and in France there have been about 100 cases. The authors report one case who died within 10 months. The patient presented a Pneumocystis carinii pneumonia, extensive peri-anal herpes, gastro-intestinal candidiasis and, in the final stage, severe diarrhoea. In the context of this case, the authors review the principal manifestations of this new clinical entity.