Health-Related Quality of Life in Long-Term Survivors of Relapsed Childhood Acute Lymphoblastic Leukemia

BACKGROUND: Relapses occur in about 20% of children with acute lymphoblastic leukemia (ALL). Approximately one-third of these children can be cured. Their risk for late effects is high because of intensified treatment, but their health-related quality of life (HRQOL) was largely unmeasured. Our aim was to compare HRQOL of ALL survivors with the general population, and of relapsed with non-relapsed ALL survivors. METHODOLOGY/PRINCIPAL FINDINGS: As part of the Swiss Childhood Cancer Survivor Study (SCCSS) we sent a questionnaire to all ALL survivors in Switzerland who had been diagnosed between 1976-2003 at age <16 years, survived ≥5 years, and were currently aged ≥16 years. HRQOL was assessed with the Short Form-36 (SF-36), which measures four aspects of physical health and four aspects of mental health. A score of 50 corresponded to the mean of a healthy reference population. We analyzed data from 457 ALL survivors (response: 79%). Sixty-one survivors had suffered a relapse. Compared to the general population, ALL survivors reported similar or higher HRQOL scores on all scales. Survivors with a relapse scored lower in general health perceptions (51.6) compared to those without (55.8;p=0.005), but after adjusting for self-reported late effects, this difference disappeared. CONCLUSION/SIGNIFICANCE: Compared to population norms, ALL survivors reported good HRQOL, even after a relapse. However, relapsed ALL survivors reported poorer general health than non-relapsed. Therefore, we encourage specialists to screen for poor general health in survivors after a relapse and, when appropriate, specifically seek and treat underlying late effects. This will help to improve patients' HRQOL

Women and citizenship post-trafficking : the case of Nepal

The research for this paper was funded by the Economic and Social Research Council – ESRC Res-062-23-1490: ‘Post Trafficking in Nepal: Sexuality and Citizenship in Livelihood Strategies’. Diane Richardson would like to acknowledge the support provided by the award of a Leverhulme TrustMajor Research Fellowship, ‘Transforming Citizenship: Sexuality, Gender and Citizenship Struggles’ [award MRF-2012-106].This article analyses the relationship between gender, sexuality and citizenship embedded in models of citizenship in the Global South, specifically in South Asia, and the meanings associated with having - or not having - citizenship. It does this through an examination of women's access to citizenship in Nepal in the context of the construction of the emergent nation state in the 'new' Nepal 'post-conflict'. Our analysis explores gendered and sexualized constructions of citizenship in this context through a specific focus on women who have experienced trafficking, and are beginning to organize around rights to sustainable livelihoods and actively lobby for changes in citizenship rules which discriminate against women. Building from this, in the final section we consider important implications of this analysis of post-trafficking experiences for debates about gender, sexuality and citizenship more broadly.Publisher PDFPeer reviewe

What Difference Does a Visit Make? Changes in Animal Welfare Perceptions after Interested Citizens Tour a Dairy Farm

Citizens’ concerns about farm animal welfare are often dismissed on the assumption that they are not well informed about farming practices. We conducted exploratory surveys of interested citizens (n = 50) before and after a self-guided tour of a 500-head dairy farm. ‘Before’ survey questions explored perceptions, concerns, and values about dairy cattle farming and welfare, in addition to a short knowledge-based quiz on dairy cattle husbandry. An ‘after’ survey explored the extent to which these constructs shifted after the tour. Before, most participants correctly answered quiz questions about general feeding and housing practices, but scores were low on questions about specific practices such as cow-calf separation. Participants considered several elements as necessary for a ‘good’ life for dairy cattle: fresh food and water, pasture access, gentle handling, space, shelter, hygiene, fresh air and sunshine, social companions, absence of stress, health, and safety from predators. These elements reflect a diverse conception of animal welfare that incorporates values for physical and mental well-being, natural living, and humane care. The visit had a mixed effect on perceptions of whether dairy cows had a ‘good’ life, improving perceptions for a quarter of participants, worsening perceptions in a third, with no shift in the remaining participants. The visit appeared to mitigate some concerns (e.g., provision of adequate food and water, gentle humane care) while reinforcing or eliciting others (e.g., lack of pasture access, early cow-calf separation). Moreover, animal welfare-relevant values held by participants (e.g., natural living, care) appeared to play an important role in influencing perceptions of farm practices. These results suggest that education and exposure to livestock farming may resolve certain concerns, but other concerns will likely persist, especially when practices conflict with deeply held values around animal care

Astrocytes: biology and pathology

Astrocytes are specialized glial cells that outnumber neurons by over fivefold. They contiguously tile the entire central nervous system (CNS) and exert many essential complex functions in the healthy CNS. Astrocytes respond to all forms of CNS insults through a process referred to as reactive astrogliosis, which has become a pathological hallmark of CNS structural lesions. Substantial progress has been made recently in determining functions and mechanisms of reactive astrogliosis and in identifying roles of astrocytes in CNS disorders and pathologies. A vast molecular arsenal at the disposal of reactive astrocytes is being defined. Transgenic mouse models are dissecting specific aspects of reactive astrocytosis and glial scar formation in vivo. Astrocyte involvement in specific clinicopathological entities is being defined. It is now clear that reactive astrogliosis is not a simple all-or-none phenomenon but is a finely gradated continuum of changes that occur in context-dependent manners regulated by specific signaling events. These changes range from reversible alterations in gene expression and cell hypertrophy with preservation of cellular domains and tissue structure, to long-lasting scar formation with rearrangement of tissue structure. Increasing evidence points towards the potential of reactive astrogliosis to play either primary or contributing roles in CNS disorders via loss of normal astrocyte functions or gain of abnormal effects. This article reviews (1) astrocyte functions in healthy CNS, (2) mechanisms and functions of reactive astrogliosis and glial scar formation, and (3) ways in which reactive astrocytes may cause or contribute to specific CNS disorders and lesions