The potential role of benefit and burden finding in school engagement of young leukaemia survivors: an exploratory study.

BACKGROUND: Childhood cancer may radically change the daily lives of young survivors, particularly in school. Depending on the sense they derive from the experience of illness, survivors may go through profound transformations in the way they approach life. METHODS: This exploratory study reports on school engagement of cancer survivors by examining their perceptions of benefits and burdens in relation to their illness. Forty-nine young Quebecers, previously diagnosed and treated for leukaemia, completed a questionnaire measuring their school engagement and participated in an interview focusing on the impact of cancer on their lives. Perceptions with regard to the presence and types of benefits and burdens were described and examined in light of participants' characteristics. An analysis of variance explored whether the presence/absence of benefits and burdens were associated with participants' scores regarding school engagement. RESULTS: Most participants mentioned benefits from having had cancer, and in particular benefits at an interpersonal level. Half of the participants mentioned burdens, mainly of a physical and psychological nature. Significant correlations indicated that (i) the older the survivors were, the more likely they were to report benefits in terms of qualities and strengths of character; (ii) the more time had elapsed since their diagnosis, the more survivors were likely to report psychological types of burdens; and (iii) children from single-parent families reported more frequently having appreciated social or recreational activities compared with children from two-parent families. One main effect indicated that school engagement was greater for survivors who perceived the presence of benefits. An interaction effect revealed that the perception of both benefits and burdens predicts the highest scores of school engagement. CONCLUSIONS: While the results reveal the promising potential that an optimistic yet realistic disposition has in regard to school engagement, more research is necessary to further our understanding of such a disposition.

Living with an impaired elderly person: the informal caregiver's physical and mental health.

Although it is acknowledged that providing an elderly relative with informal assistance can be stressful and burdensome, previous research does not provide clear evidence of the impact of informal caregiving on the physical and mental health of caregivers. The objective of this research was to compare health indicators of coresidents of elderly people who have physical or cognitive impairments with those of two comparison groups: individuals living with a nonimpaired person aged 55 or over and individuals who were not living with a person of that age. Samples were drawn from the Qu/ebec Health Survey database. Although very few differences in physical health were observed between coresidents (n = 292) and individuals in the comparison groups, coresidents systematically presented poorer psychological health indicators. This result supports previous findings related to the low level of psychological well-being of informal caregivers. This suggests that informal caregivers should be regarded as a target population for which health and social services should be carefully planned.

Tenascin may not be required for intestinal villus development.

Tenascin, a large extracellular matrix protein, is subject to complex spatial and temporal patterns of expression in the course of various organogenetic processes including the formation of the small intestinal villus. In the present study, the presence of tenascin was analyzed in human fetal colonic villi, which are transient structures that are programmed to disappear at the time of colonic mucosal remodeling. While the labeling of muscles and peripheral mesenchyme was similar in both segments, surprisingly the colonic villus cores were mostly devoid of tenascin as opposed to those of the small intestine. Western blot analysis revealed that the 220 and 320 kDa forms of tenascin were detected in both segments. However, the 200 kDa form present in small intestinal villi was absent in colonic villi. These data suggest that tenascin under its 200 kDa form is not required for villus formation.

Relationship between tenascin and alpha-smooth muscle actin expression in the developing human small intestinal mucosa.

The expression of tenascin (Tn) and alpha-smooth muscle actin (alpha-SMA) was analyzed in the developing and adult human small intestine by means of double immunofluorescent staining with specific antibodies. By 7 weeks of gestation, the gut anlage has a simple tubular shape and is formed of a stratified undifferentiated epithelium surrounded by a poorly organized mesenchyme. Both Tn and alpha-SMA were found exclusively at the periphery of the tissue, corresponding to the presumptive muscularis propria. By 9 weeks, villus rudiments had formed but Tn and alpha-SMA remained restricted to the muscularis propria. Tn was first detected in the mesenchyme at 11 weeks. By 13 weeks, a preferential distribution of Tn in the subepithelial region of the mesenchyme was readily observed while alpha-SMA was still absent. From this stage to 20 weeks, Tn gradually concentrated in this region that, as determined by alpha-SMA detection, corresponded to the future muscularis mucosa area. As shown by double staining of Tn and alpha-SMA, deposition of Tn also preceded the appearance of the other alpha-SMA-expressing cells in the mucosa. These observations suggest that Tn could have a role in the differentiation of intestinal contractile cells.

Expression of tenascin in the developing human small intestine.

The expression of tenascin (Tn), an extracellular matrix glycoprotein, was analyzed in the human small intestine. Three major oligomeric forms of intestinal Tn (320 kDa, 220 kDa and 200 kDa) were identified in both the fetus and the adult. The intestinal 200 kDa form was not found expressed by intestinal mesenchymal cells in culture. During development, the amounts of the 320 and 220 kDa forms remained relatively constant between 9-20 weeks of gestation as compared to sucrase-isomaltase and a-smooth muscle actin while the 200 kDa immunoreactive component increased substantially during this period of active intestinal morphogenesis. Further experiments by microdissection revealed that the 200 kDa component was the major form of Tn in the intestinal villus. These results suggest that this newly identified 200 kDa form of Tn in the small intestine is predominantly expressed in the villus under a developmentally regulated pattern.

The effect of surfactants on the aggregation state of amphotericin B.

We have studied the effect of two surfactants, one non-ionic, lauryl sucrose (LS) and the other ionic, sodium deoxycholate (DOC), on the aggregation state of amphotericin B (AmB) and its selectivity towards ergosterol and cholesterol. It is shown that the addition of these surfactants has very similar effects on the AmB micelles. Below the critical micellar concentration of the surfactants, mixed micelles with AmB are first formed as a result of the penetration of the surfactant molecules into the AmB micelles. At higher concentrations of the surfactant molecules, the micellar structure is completely destroyed and AmB is found as monomers in solution. When the concentration of the surfactant is further increased, micelles of the surfactant molecules are built up, AmB remaining in monomeric form. However, the critical micellar concentration of LS is modified by the presence of AmB in solution, while that of DOC is not affected, thereby indicating that the interactions of AmB with LS are stronger than those of DOC with AmB. We also show that both surfactants enhance the selectivity of the AmB binding to sterols at exactly the concentrations of the surfactants which induce the monomerization of the antibiotic. It is observed that the maximal selectivity is found at a concentration of the surfactants corresponding to their particular CMC in presence of the antibiotic.

Caring for the elderly: the partnership issue.

The promotion of a partnership set up to assure care for dependent elderly people has become a popular topic amongst health care and social services planners. This paper reviews what seems to be Québec's main assumptions concerning the demands created by the demographic explosion of elderly people, limited financial resources, and the negative impact of institutionalisation. The state's five guidelines for the establishment of sensible health care services for dependent elderly people are also discussed. They include redefining the '65 years or over' criterion that labels someone in this age group as 'a person needing extra care services'; cutting and re-allocating state expenditures; soliciting all eventual partners outside the formal health care network; reformulating the roles and duties of health care professionals, stressing the efficiency of their intervention; and re-asserting the value of an elderly person's family and community networks. An interpretation of the meaning of partnership, based on information in government documents, as well as the conditions that could hinder its development are also discussed. Finally, an overview is provided of the potential effects of a partnership on the target group and the community. This analysis is based on Québec's situation although many of the angles and dilemmas could be applied to other industrialised countries.