Treatment of multiple sclerosis--2. Application of a new immunological basic research is close]

Multiple sclerosis (MS) is a demyelinating, central nervous system disease, of putative autoimmune pathogenesis. Although no effective pharmacological therapy has been available for this often disabling disease until recently, several studies have now confirmed that subcutaneous or intramuscular administration of beta-interferon may reduce the frequency and severity of relapses in relapsing MS, and may also inhibit disease progression. Studies are under way to determine the possible efficacy of beta-interferon during the progressive phase of the disease. Three beta-interferon formulations are currently available in Sweden. Another drug, glatiramer acetate, also shown to have some effect on the disease course, is expected to be registered for use in Sweden shortly.     

Is befriending by trained volunteers of value to people suffering from long-term mental illness?

People who suffer from long term mental illness may be vulnerable to loneliness and isolation when living in community settings. Befriending by volunteers may be an effective way of combating such problems and helping clients to develop social networks. The findings of a small scale project to evaluate the views of people suffering from long term mental illness of an organized befriending scheme are reported. Nine subjects who suffer from severe mental illness were interviewed, all subjects felt befriending was helpful to them, and 67% of subjects thought it had improved their confidence when in social situations. Subjects who lived alone indicated a preference to see volunteers at home, whilst those who lived with carers preferred support in going out socially. The value of befriending schemes as part of community care services for this needy client group are discussed.     

In vitro intercellular adhesion molecule-1 expression on brain endothelial cells in multiple sclerosis

To investigate the origin of intercellular adhesion molecule-1 (ICAM-1) and its expression on brain endothelial cells, we studied the expression in vitro of ICAM-1 on human brain endothelial cells after incubation of T cells from patients with multiple sclerosis (MS) using a histochemical technique and flow cytometry. We determined soluble forms of ICAM-1 (ICAM-1) in the supernatants after mixtures of brain endothelial cells and T cells from patients with MS using an enzyme-liked immunosorbent assay. Flow cytometric analysis showed that a number of ICAM-1-positive cells were significantly increased after incubation of brain endothelial cells with T cells from patients with acute relapsing MS during an exacerbation as compared with those of controls (P < 0.01). Patients with acute relapsing MS during an exacerbation and chronic progressive MS exhibited higher levels of ICAM-1 in the supernatants of mixtures with brain endothelial cells and lymphocytes than those of controls (P < 0.001 and P < 0.01, respectively). These results suggest that lymphocytes from patients with acute relapsing MS during an exacerbation lead to an increased expression of ICAM-1 on the brain endothelial cells and add to evidence involving this adhesion molecule in the pathogenesis of MS.     

Autoimmunity to myelin oligodendrocyte glycoprotein in rats mimics the spectrum of multiple sclerosis pathology

Multiple sclerosis is a chronic inflammatory disease characterized by perivenous inflammation and focal destruction of myelin. Many attempts have been undertaken previously to create animal models of chronic inflammatory demyelinating diseases through autoimmunity or virus infection. Recently, however, a new model of myelin oligodendrocyte glycoprotein (MOG) induced autoimmune encephalomyelitis became available, which, in a very standardized and predictable way, leads to chronic (relapsing or progressive) disease and widespread CNS demyelination. In the present study we actively induced MOG-experimental autoimmune encephalomyelitis (EAE) in different inbred rat strains using different immunization protocols. The pathology found in our models closely reflects the spectrum of multiple sclerosis (MS) pathology: Classical MS as well as variants such as optic neuritis, Devic's disease and Marburg's type of acute MS are mimicked in rats immunized with MOG antigen. Furthermore we demonstrate, that by using the proper strain/sensitization regime, subforms of MS such as for instance neuromyelitis optica can be reproducibly induced. Our study further supports the notion, that incidence and expression of the disease in this model, alike the situation in multiple sclerosis, is determined by genetic and environmental factors.     

Stages of Change Among Chinese People With Mental Illness: A Preliminary Study.

Objective: To determine the effect of self-efficacy and outcome expectancy on the readiness for rehabilitation among Chinese people with mental illness. Participants: Fifty-eight men and 62 women with chronic mental illness. Outcome Measures: Change Assessment Questionnaire for People With Severe and Persistent Mental Illness, Task-Specific Self-Efficacy Scale for People With Mental Illness, and Outcome-Expectancy Scale for People With Mental Illness. Results: Chinese people with mental illness can be meaningfully classified into 4 stages of change (SOC) groups: precontemplation, contemplation, ambivalent-conforming, and action-maintenance. SOCs are related to self-efficacy in interpersonal, symptoms management, and help-seeking skills as well as expectations about the benefit of social and coping skills. Conclusion: The SOC concept is useful for tailoring culturally sensitive psychiatric rehabilitation interventions for Chinese people with mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A rearrangement of the CDD gene at the 5'' UTR produces two types of transcripts that contain a natural antisense region

BACKGROUND: Mothers with multiple sclerosis (MS) often face fatigue and episodic exacerbations during their child-rearing years. These problems affect their support of their children, including physical affection. Children, depending on their age and gender, may or may not understand the changes. OBJECTIVES: To increase knowledge about mothers with MS concerning the relationship of fatigue and functional status to the perception of physical affection with their children, their perceptions of physical affection with their children in relation to exacerbation of their symptoms and the age and gender of their children, and the children's perceptions of their mothers' physical affection in relation to the children's age and gender and exacerbations in their mothers' symptoms. METHOD: Thirty-five mothers with relapsing-remitting MS and a child of each mother were studied, using interviews and questionnaires. RESULTS: Functional status and fatigue were not significant predictors of physical affection during an exacerbation. When the mothers' symptoms were stable, perceptions of mothers and children with respect to maternal physical affection were similar. Significant changes were reported in both the mothers' perceptions of their physical affection and the children's perceptions of their mothers' physical affection during exacerbations. There was a significant difference between the perceptions of the mothers and children regarding the magnitude of that change. Mothers significantly underestimated changes in their physical affection. CONCLUSIONS: Physical affection was selected as an important aspect of family functioning that could be affected by characteristics of illness, including exacerbations, fatigue, and functional status. However, fatigue and functional status did not explain the perception of physical affection during an exacerbation.     

Depression in Multiple Sclerosis: A Quantitative Review of the Evidence.

The published literature on depression in multiple sclerosis (MS) is reviewed quantitatively. The authors report mean effect sizes for 20 studies comparing depression scores of MS patients with those of healthy participants (d=1.07) and 21 studies comparing depression scores of MS patients with those of patients who have other chronic conditions (d=-0.14). The confidence interval for the mean overall MS-medical comparison included 0. However, subgroups of patients with chronic fatigue and spinal-neuromuscular conditions were more and less depressed than MS patients, respectively. Results indicate that a majority of MS patients with mild to moderate disability levels are distinguishable from healthy people in terms of depressive symptoms. However, the depression-disease link is complex and not specific to this form of demyelinating illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A replicated prospective investigation of life stress, coping, and depressive symptoms in multiple sclerosis

Life stress and coping responses jointly contribute to psychological adjustment in many chronic illness populations, but their significance in multiple sclerosis (MS) has not been extensively investigated. Physical disability, cognitive status, negative life stress, coping strategies, and depressive symptoms were prospectively assessed in 27 adults with definite or probable MS. Of the original subjects, 22 provided two additional assessments at 6-month intervals. After accounting for cognitive status and physical disability, life stress was positively correlated with current as well as future depressive symptoms; the prospective relationship was replicated within the second pair of prospective data waves. Escape avoidance was the only coping strategy that added to the prediction of future mood symptoms, but this was not replicated. Results suggest that MS-related depressive symptoms are a function of prior disease-related impairment, life stress, and possibly escape avoidance coping.     

The psychosocial impact of multiple sclerosis: Exploring the patient's perspective.

This study examined subjective patient experiences of the psychosocial consequences of multiple sclerosis (MS). Fifty patients were interviewed regarding the effects MS had on their lives and interpersonal relationships. These statements were collated and administered with a 5-point Likert scale to 94 MS patients. The responses were subjected to factor analysis. Three areas of subjective patient experience of the psychosocial consequences of MS emerged: demoralization, benefit-finding, and deteriorated relationships. Of particular interest was benefit-finding, which included a deepening of relationships, enhanced appreciation of life, and an increase in spiritual interests. Although benefit-finding was related to adaptive coping strategies such as positive reappraisal and seeking social support, it was unrelated to depression and was related to higher levels of anxiety and anger. These findings indicate that benefit-finding is a substantial and poorly understood part of the illness experience for MS patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spirituality and practice. Stories, barriers and opportunities. Interview by Laurence A. Savett

What are "spiritual matters?" Are "spiritual matters" the same as "religious matters?" What is spiritual inquiry? Are such questions appropriate for those of us in the caring professions, other than clergy, to consider? If we accept that role, how far should we go? When should we call for help? Whom should we call? We convened a gathering of a hospital chaplain, a social worker, a hospice nurse and a physician to discuss many of the dimensions of spirituality and then to apply their personal and professional paradigms of care to a discussion of an actual case. This article is a record of that conversation. It is actually several articles in one, for it deals with their own views of the meaning of spirituality, the degree to which their spirituality has impact on their practice, what they see as the merit of spiritual matters in the caring professions, barriers to collaboration among their professions and to addressing these issues with patients, and boundaries beyond which one should not go. One way to read this conversation is to include yourself; that is, to reflect on the points the participants make and the ways in which you might integrate their insights into your personal practice. We hope that you find this task worthwhile and that it provokes further thought and discussion. The discussion began with participant introductions.     

Faculty-student mentoring. A father's chronic sorrow: a daughter's perspective

Chronic sorrow often affects not only an individual who has a chronic illness or disability but the family members as well. This is the story of how chronic sorrow affected the life of a man diagnosed with prostate cancer and the family members who lived through it with him. It is told in the first person by his daughter not only as a tribute to her father, but also as a prospective learning experience for anyone involved with an individual moving through a chronic or terminal illness or disability. It integrates theory, research, and personal experience in an effort to understand this common human response to a chronic or terminal illness.     

Combined effect of HLA-DRB1*1501 and interleukin-1 receptor antagonist gene allele 2 in susceptibility to relapsing/remitting multiple sclerosis

Susceptibility to multiple sclerosis (MS) is associated with HLA-DRB1*1501. Many reports have suggested associations with other loci but these results remain unconfirmed. We studied the IL-1 receptor antagonist (IL-1ra) gene polymorphism and the HLA-DR and DQ allele frequencies by DNA-based methods in both the primary chronic progressive form (PP MS) and the relapsing/remitting form (R/R MS). The frequency of DRB1*1501 and IL-1ra allele 2 were significantly higher in R/R MS. Association was more marked in the female sex and in patients with benign forms of R/R MS. On the other hand DR4 subtypes carrying a Val at position 86 in the DR beta chain were increased in PP MS. The present study indicates that MS is genetically heterogeneous and shows a combined effect of HLA-DR and IL-1ra genes in susceptibility to the R/R form of the disease.     

Axonal dysfunction and disability in a relapse of multiple sclerosis: longitudinal study of a patient

In a 6-year longitudinal study of a patient with relapsing progressive multiple sclerosis (MS), we used proton magnetic resonance spectroscopy to assess N-acetylaspartate (NAA) from a large central brain volume to evaluate the relationship between this marker of neuronal integrity and clinical disability. During the follow-up period, there was one major relapse and its subsequent partial remission. Changes in the brain NAA to creatine ratio correlated strongly with clinical disability (Spearman rank coefficient = -0.73, p < 0.001). We interpret this as evidence that axonal dysfunction or loss contributes to functional impairment of patients with MS. Because the NAA signal in the large volume of interest originated predominantly from white matter that appeared normal on conventional MRI, these results also suggest that some degree of axonal dysfunction may be widespread in acute, severe relapses.     

Responses of A and B subjects to normal, neurotic, schizophrenic, and ambiguous communications.

Investigated the initial reactions of 20 A and 20 B undergraduates to "encounter situations" in which they were asked for help by 4 hypothetical patients communicating in normal, neurotic, schizophrenic, or ambiguous styles. For each patient communication, Ss responded to the following questions: (a) "What might he mean?" (b) "What might he be feeling?" (c) "How would you feel in this situation?" (d) "What do you think you would do?" Results indicate that (a) A's more frequently interpreted patient communications symbolically than did B's; and (b) A's exhibited greater congruence than B's, as indicated by their greater use of feeling words in describing their reactions to the hypothetical patients. Results were related to previous A-B findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social learning influences on menstrual symptoms and illness behavior.

Tested the hypothesis that the sick role and modeling during childhood contribute to the way people react to bodily sensations relevant to illness, using data from 351 nursing students (aged 18–39 yrs) on how their mothers reacted to menstrual symptoms and cold symptoms during their adolescence and how their mothers behaved when they themselves had menstrual symptoms. 198 of the students' mothers answered the same questions. Students who had been encouraged to adopt a sick role for menses or whose mothers modeled menstrual distress reported significantly more menstrual symptoms, clinic visits, and disability days for these symptoms as adults. Those encouraged to adopt a sick role for colds or who lived with a chronically ill person reported more clinic visits and disability days for nongynecological symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic activity of malononitrilamides (MNA 279 and MNA 715) on acute and chronic, relapsing, experimental, allergic encephalomyelitis (EAE)

Due to their immunosuppressive mode of action, we examined the therapeutic effects of the malononitrilamides MNA 279 and MNA 715 in acute EAE, and two models of chronic relapsing EAE in Lewis rats and Biozzi mice. In the first model, sensitization of adult Lewis rats with guinea pig spinal cords results in an acute clinical episode of severe EAE, and by day 15 all animals had died. Treatment of these sensitized rats with the MNAs was most effective in delaying and reducing the onset of clinical symptoms, and mortality of acute EAE was prevented in a dose-dependent manner. The protection afforded by the two MNAs was long-lasting and no subsequent relapse was observed. Similarly, in the chronic relapsing disease, aged Lewis rats were immunized with rabbit myelin basic protein, and all untreated animals developed a disease with up to three relapses. The second and third episodes were both milder and shorter in duration than the first. All animals treated with the MNAs survived the first attack, which also was delayed. Pathological signs were reduced and relapses did not occur. Inhibition of chronic relapsing EAE in aged Lewis rats was observed, even when the MNA-treatment was started after the first appearance of clinical symptoms. All treated animals recovered completely and mortality was prevented. Also in the second model of chronic relapsing EAE in Biozzi AB/H mice, MNA treated animals showed only one acute and delayed episode and no further relapses. All these results qualify both MNA 279 and MNA 715 as powerful immunosuppressants with therapeutic potential in human multiple sclerosis (MS).     

Tick-borne diseases in Texas: a 10-year retrospective examination of cases

The occurrence of Rocky Mountain spotted fever, human monocytotropic ehrlichiosis, tularemia, tick-borne relapsing fever, and a southern erythema migrans-like illness (Lyme/Lyme-like disease) is determined by the geographic distribution and seasonal activity of the particular vector tick(s). The flulike signs and symptoms early in the course of spotted fever rickettsiosis, ehrlichiosis, tularemia, and relapsing fever are nonspecific and do not readily suggest a particular diagnosis. Laboratory diagnosis, particularly during the acute stage of illness, often is elusive. Empiric treatment with doxycycline can be lifesaving for Rocky Mountain spotted fever and ehrlichiosis. This article provides insight into the significance of each of these tick-transmitted diseases in Texas.     

Health promotion and schizophrenia: the year 2000 and beyond

The health promotion needs of persons with schizophrenia have not been emphasized as a result of historical stigma, the effort required to stabilize symptoms, the relapsing nature of the disease, and the helplessness felt by caregivers. Family members and individuals with schizophrenia experience shame, grief, guilt, fear, and isolation, all of which render them less able to be proactive. Health promotion strategies that change attitudes, build self-esteem, increase insight into the illness, modify behavior, provide sources of income and access to medical care, and support companionship are necessary while research efforts seek a cure for this historically misunderstood illness.     

Appraising the menopause Web. Five top sites worth exploring

When a focus group exploring the influence of feminism on students' lives became a hermeneutic evaluation, we understood students' lived experience, gained a retrospective view of students' developing feminist voice, and learned how feminist education influenced students' personal and professional lives. Nurse educators in programs espousing phenomenological, practice-driven, dialogic education are encouraged to integrate hermeneutic evaluation strategies so faculty-student groups can make courses and curricula relevant and meaningful.