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This qualitative process evaluation study aimed to identify the primary processes of a psycho-educational group for caregivers of persons with dementia, in order to better understand intervention outcomes. Semi-structured interviews were conducted with 30 participants recruited from the experimental group of a randomised controlled trial. At pre-test, participants reported their expectations of the group. At post-test, they described their group experience, the most/least helpful aspects of the intervention, their most useful learning and their responses during a recent episode of disturbing behaviour by their relative. Results showed that the group delivered both educational and support processes. Support processes complemented educational processes. Participants learned coping strategies, with reframing playing a more important role than problem-solving or seeking social support. Daughters benefited more than spouses from educational processes. This study of group processes contributes to our understanding of the reported reduction in frequency of disturbing behaviours and of the change in caregivers' behaviours.

To report on an uncommon association of agranulocytosis in primary Sjögren's syndrome (SS).The clinical, haematological, and immunological features of seven patients with primary SS associated with a chronic (6 months) agranulocytosis, and the outcome of the patients, were analysed.Patients were white women with an unexplained agranulocytosis. They all had non-erosive arthritis and three had a thrombocytopenia or Evan's syndrome. In three patients, transient or durable expansion of T lymphocytes was present in the peripheral blood or in the bone marrow, but evolved independently from neutrophil counts. There was no paroxysmal nocturnal haemoglobinuria clone or antibodies to neutrophil surface antigens. In vitro bone marrow culture was normal (four patients) or showed a decrease in colony forming unit-granulocyte monocyte (CFU-GM) and colony forming unit-erythroblast (CFU-E) (one patient). Serum levels of soluble Fas ligand (sFasL) were normal, and granulocyte-colony stimulating factor (G-CSF) concentrations were either normal or raised. One patient was treated with steroids associated with intravenous immunoglobulins and achieved a lasting response. Two other patients were treated with steroids and methotrexate, with poor efficacy. Short courses of subcutaneous G-CSF produced a transient and mild response in all three patients. Complete recovery of the neutrophils occurred temporarily during pregnancy in two patients. After a mean follow up of 34.8 months (range 6-139) all patients were alive and none developed serious infections.A subset of patients with primary SS and non-destructive arthritis may develop a chronic but well tolerated agranulocytosis that is usually poorly responsive to steroids and oral methotrexate.

Most earlier group interventions for caregivers of demented persons lacked a theoretical basis to guide the intervention process and focused on providing information and practical advice and encouraging the expression of feelings. This article presents the process of a group intervention with emphasis on its conceptual framework, components and characteristics. As caregivers are exposed to numerous daily stressful demands, the intervention's conceptual framework was derived from Lazarus and Folkman's transactional theory of stress and coping and Folkman's Coping Effectiveness Training Program. The central aim of the intervention was to improve the ability of caregivers to cope with the stressful demands at the core of caring for a demented person, rather than to focus on information and the task-oriented aspects of caring. The two components of the intervention deal with the cognitive appraisal of stressors and coping strategies, with a view to determining which strategies are most appropriate on the basis of the changeability of stressors. Three coping strategies were proposed: problem solving (problem-focused coping to deal with changeable stressors), reframing (emotion-focused coping to manage the emotional response to unchangeable stressors), and seeking social support (problem- or emotion-focused coping). The most salient characteristics of this group intervention were its intensity (15 meetings) and its focus on the caregivers' daily reality, which provided concrete reference points for the discussion of conceptual notions.

We report a case of a child who developed Hemolytic Uremic Syndrome in whom two Shiga-like toxin (SLT)-producing Escherichia coli strains of different serotypes and genotypes, were simultaneously isolated from stools. In addition, one of these strains represented a new toxin producing serotype. Strain 1 belonged to serotype O157: H7, biotype D, produced SLT II and was susceptible to all antibiotics tested. This strain hybridized with gene probes for SLT II, fimbrial adhesion (EHEC factor) and attaching and effacing factor (eae). Strain 2 belonged to serotype 025: K2: H2, produced SLT II and had a multiresistant antibiotic susceptibility pattern. This strain hybridized with the EHEC gene probe but not with SLT I, SLT II and eae gene probes. Free fecal SLT II cytotoxin was detected in stools of the child and his father, suggesting that the infection may have been acquired from a household contact.

The effects of maleic acid on the gluconeogenic capacity and energy metabolism of rat kidney cortex were studied.In vitro maleic acid inhibits glucose production from various substrates by rat kidney cortex slices. Of the substrates tested, inhibition of gluconeogenesis was much greater with pyruvate, lactate andα-ketoglutarate than with glycerol, succinate, fumarate and malate. Subcutaneous injection of maleic acid produced a dose-dependent effect on aminoaciduriain vivo and on gluconeogenic capacity of slices prepared from the kidney cortices. The content of adenine nucleotides and adenylate kinase activity of kidney cortex of the maleic acid injected rats were significantly decreased. While no ultrastructural alteration of the glomeruli was demonstrable with any of the doses of maleic acid injected, electron microscopic changes of the tubules were dose-dependent, and correlated well with the degree of aminoaciduria and inhibition of gluconeogenic capacity of kidney cortex slices. Vesiculation of mitochondrial cristae found in the proximal, as well as distal convoluted tubular cells, may be associated with impairment of energy metabolism and, in turn, the reduced renal gluconeogenic capacity of the kidney cortex and the amino aciduria of maleic acid nephropathy.

After overnight fasting, a water overload test(470ml/m2 for 2.5 hours)was done in 11 normal children(N) (7males, 4females) and 22 insulin-dependent diabetic children (D) (9males, 13females) ranging from 1 to 14 years of diabetes. Insulin was not administered. During the test, urine was collected every 30min. for uALB determination. GFR was meassured by DTPA99Tc technique. Radioimnuneassays for uALB and glucagon determination. KAL and PRE-KAL stearase activity was meassured by substrate S2266 hydrolisis. Blood glucose concentration was 75.0±5.Qmg% in N and 197.0±21.0mg% in D. At 150 min., uALB in N, was 3784±0.87pg/min/1.73m2. The mean plus 3 D.S. was considered as the maximal normal valor: 12.00pg/min/1.73m2. In 13 D, uALB was 4.60±0.83μg/min/1.73m2 and was considered not having nephropathy. In 6 D, uALB was: 38.00±15.70μg/min/1.73m2 and considered as an expression of nephropathy. Urine collection of 24 hours did not show any difference in uALB between N and N. GFR was 101.0±8.3ml/min/1.73m2 in N and 144.0±8.0 in D (p