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Does help help? The adaptive consequences of obtaining help from professionals and social networks.

This study reports on a longitudinal analysis of changes in adaptation associated with seeking help on a representative sample of Chicago area adults who had experienced one of three transitions or four crises during the interval between 1972 and follow-up 1976--77 interviews. For each event, respondents are classified into three groups according to their help-seeking behavior: those who went to professionals, those who went only to their social networks, and those who had the event but sought no help. Nine measures of adaptation are used: symptoms of anxiety and depression and strains and stresses in four role areas. Statistical controls equate the groups on demographic characteristics, perceived stress, personal resources, access to help, and elapsed time since the event. There are no consistent statistical significant differences among the groups. No evidence is found that help-seeking has positive adaptive consequences. The findings are not likely to result from an inadequate sample, outcome measures, or statistical controls, but could result from insufficient information on the kind, quality, and duration of the help provided.

Adaptation, Psychological

Role of antigen-specific T cell help in the generation of in vivo antibody responses. I. Antigen-specific T cell help is required to generate a polyclonal IgG1 response in anti-IgD antibody-injected mice.

A system in which injection of mice with an antibody to mouse IgD that they recognize as foreign stimulates a large, T cell-dependent IgG response was used to study whether Ag-specific T cell help is required to stimulate polyclonal (non-Ag-specific) IgG production in vivo. Igha x Ighb allotype heterozygous mice were injected with a conjugate of a foreign Ag coupled to a mAb specific for one of the two IgD allotypes expressed in these mice. This conjugate cross-links mIgD on B cells that express the recognized allotype. These cells process the conjugate and present the foreign Ag to Ag-specific T lymphocytes, which become activated. Thus, B cells of the recognized allotype can be stimulated by cross-linking of their mIgD, Ag-specific T cell help, non-Ag-specific cytokines, and non-Ag-specific contact with activated T cells. In contrast, B cells that express the Igh allotype not recognized by the Ag-anti-IgD antibody conjugate (bystander B cells) can be stimulated in this system only by non-Ag-specific cytokines and non-Ag-specific contact with activated T cells. Although both recognized and bystander B cells in conjugate-injected mice demonstrated substantial increases in size and Ia expression, only the recognized B cells were induced to synthesize DNA and to make a substantial polyclonal Ig response. Bystander B cells still failed to secrete IgG when mice were injected with an anti-IgD-Ag conjugate specific for the other Igh allotype as well as a mAb that cross-linked IgD of the bystander B cell allotype. These observations demonstrate that although non-Ag-specific cytokine and contact-mediated T cell help are sufficient to induce B cells to increase in size and Ia expression in anti-IgD antibody-injected mice, Ag-specific T cell help is required to stimulate the generation of an IgG response in these mice.

Animals

Role of antigen-specific T cell help in the generation of in vivo antibody responses. II. Sustained antigen-specific T cell help is required to induce a specific antibody response.

The injection of mice with a goat or rabbit antibody to mouse IgD stimulates a large polyclonal IgG response, approximately 10% of which is specific for antigenic determinants on the anti-IgD antibody molecule. The large goat IgG (GIgG)-specific antibody response in mice injected with goat antibody to mouse IgD requires that GIgG-specific B cells undergo much greater clonal expansion than B cells specific for other Ag. One possible explanation for the greater clonal expansion of GIgG-specific B cells is that B cells that lack GIgG specificity can only be stimulated with GIgG-specific T help during the relatively short time that anti-IgD binds to, and is processed and presented by, these B cells before they cease to express membrane mIgD. In contrast, GIgG-specific B cells can continue to bind, process, and present GIgG through mIgM after they lose mIgD. To test the hypothesis that extended stimulation with Ag-specific T help is required to generate a specific antibody response, we determined time requirements for Ag-specific T cell help for the development of such a response. Mice were injected with rabbit antibody to mouse IgD plus one or more daily injections of FITC conjugated to a F(ab')2 fragment of rabbit IgG (FITC-(Fab')2), which has a short in vivo half-life, and IgG1 anti-FITC antibody production was analyzed. In this system, each additional injection of FITC-F(ab')2 extends the period during which FITC-specific B cells can process this Ag and present it to rabbit IgG-specific T cells. Each additional injection of FITC-F(ab')2 stimulated a several-fold increase in IgG1 anti-FITC antibody levels, and injections on 5 consecutive days were required to induce a maximal anti-FITC response. These observations provide evidence that sustained Ag-specific T cell help is required to stimulate the degree of B cell clonal expansion that characterizes a specific antibody response.

Animals

Helping one another: a speculative history of the self-help movement.

The Independent Living Movement represents a direct challenge to current notions of rehabilitation (see the article by Gerben DeJong in this issue). It is a unique challenge, spearheaded not by new technical advances but by a new social awareness, and not from within by medical personnel but from without by lay groups. In another sense, however, it is but the latest evolution of an old theme in American life--the notion of self-help. This paper traces the history of self-help, to illuminate the problems and prospects of the Independent Living Movement.

History, 19th Century

Helping the hypertensive patient to help himself.

The control of blood pressure in patients with hypertension is an important challenge in everyday medical practice. It can do much to reduce complications, but too often we fall short of our therapeutic goals. Much more can be done to help our patients help themselves if physicians, along with their paramedical staffs and their patients, make the effort. The results are gratifying in terms of motivation and successful long-term control of the blood pressure and the risks associated with hypertension. This paper outlines objectives and practical approaches to patient education and self-care of this common medical problem.

Blood Pressure Determination