Follow-up care and surveillance are essential components of colorectal cancer survivorship. However, the relative contribution of healthcare experiences to quality of life in cancer survivorship is poorly understood.This study explores associations between colorectal cancer survivors’ healthcare experiences and quality of life.Cross-sectional survey study.Participants were recruited from medical oncology and colorectal cancer surgery departments in three hospitals, and twenty-one cancer support centres providing psycho-social care to cancer patients and survivors in Ireland.304 colorectal cancer survivors between 6 and 60 months post-diagnosis.Participants completed a cross-sectional questionnaire, including the Functional Assessment of Therapy–Colorectal Cancer Survey and the Patient Continuity of Care Questionnaire. Multivariate logistic regression analysis was undertaken to identify associations between quality of life outcomes and healthcare-related variables including continuity of care, access to care, information needs and perceptions of support from health and advocacy services.Most participants (80%) had access to a named healthcare professional and were more frequently satisfied with support received in hospital (95%) compared to primary care (76%) or community (61%) settings. More than two-thirds of participants reported unmet information needs (68%) or social difficulties (66%). 40% reported some dissatisfaction with continuity of care. Greater social difficulty was consistently associated with poorer quality of life in all domains (OR range: 2.9–9.7). Lower satisfaction with continuity of care predicted poorer physical (OR=2.6), social (OR=2.1), functional (OR=2.9) and overall quality of life (OR=2.0). Unmet information needs (OR=2.9) and absence of access to a named nurse (OR=3.8) were associated with lower levels of emotional well-being. Survivors who were living with active malignant disease (OR=3.8), had undergone reversal of a temporary ostomy (OR=4.0) or had accessed advocacy-led cancer support were more likely to experience lower quality of life overall (OR=2.6).Colorectal cancer survivors relied on oncology professionals for cancer-related support and experienced quality of life issues and unmet needs, which were not addressed by oncology, primary care or advocacy professionals. This study suggests there is scope to optimise the contribution of primary care, community care and advocacy services to cancer survivorship care; these services were often overlooked or provided insufficient support when accessed by survivors. The recurring associations between quality of life outcomes and continuity of care and social difficulties suggest these may be meaningful variables to target in the development of interventions to improve survivors’ quality of life in the context of healthcare.
Many of the molecular components constituting the exocytotic machinery responsible for neurotransmitter release have been identified, yet the precise role played by these proteins in synaptic transmission, and their impact on neural function, has not been resolved. The mouse mutation coloboma is a contiguous gene defect that leads to electrophysiological and behavioral deficits and includes the gene-encoding SNAP-25, an integral component of the synaptic vesicle-docking/fusion core complex. The involvement of SNAP-25 in the hyperactive behavior of coloboma mice, which can be ameliorated by the indirect dopaminergic agonist, amphetamine, has been demonstrated by genetic rescue using a SNAP-25 transgene. Coloboma mice also exhibit increased recurrent inhibition, reduced theta rhythm by tail-pinch and reduced long-term potentiation in the hippocampal dentate gyrus that, as the hyperkinesis seen in these mutants suggests, may reflect impaired monoaminergic modulation. We sought to identify neurophysiological correlates of the rescued hyperactivity within hippocampal synaptic circuitry of SNAP-25 transgenic coloboma mutant mice. In contrast to the differences between coloboma and wild-type mice, there was no significant difference in the duration or amplitude of theta rhythmic activity (4–6 Hz) induced by tail-pinch (10 s), afferent-evoked field potentials, or paired-pulse responses recorded in the dentate gyrus of SNAP-25 transgenic coloboma and wild-type mice. Amphetamine (3.0 mg/kg, i.p.) produced disinhibition of dentate paired-pulse responses in both SNAP-25 transgenic and wild-type mice but increased inhibition in non-transgenic coloboma mice. These findings support the hypothesis that alteration of monoaminergic neurotransmission, which can be reversed by the indirect agonist, amphetamine, is particularly sensitive to alterations in the expression of SNAP-25.
Follow-up care and surveillance are essential components of colorectal cancer survivorship. However, the relative contribution of healthcare experiences to quality of life in cancer survivorship is poorly understood.This study explores associations between colorectal cancer survivors’ healthcare experiences and quality of life.Cross-sectional survey study.Participants were recruited from medical oncology and colorectal cancer surgery departments in three hospitals, and twenty-one cancer support centres providing psycho-social care to cancer patients and survivors in Ireland.304 colorectal cancer survivors between 6 and 60 months post-diagnosis.Participants completed a cross-sectional questionnaire, including the Functional Assessment of Therapy–Colorectal Cancer Survey and the Patient Continuity of Care Questionnaire. Multivariate logistic regression analysis was undertaken to identify associations between quality of life outcomes and healthcare-related variables including continuity of care, access to care, information needs and perceptions of support from health and advocacy services.Most participants (80%) had access to a named healthcare professional and were more frequently satisfied with support received in hospital (95%) compared to primary care (76%) or community (61%) settings. More than two-thirds of participants reported unmet information needs (68%) or social difficulties (66%). 40% reported some dissatisfaction with continuity of care. Greater social difficulty was consistently associated with poorer quality of life in all domains (OR range: 2.9–9.7). Lower satisfaction with continuity of care predicted poorer physical (OR=2.6), social (OR=2.1), functional (OR=2.9) and overall quality of life (OR=2.0). Unmet information needs (OR=2.9) and absence of access to a named nurse (OR=3.8) were associated with lower levels of emotional well-being. Survivors who were living with active malignant disease (OR=3.8), had undergone reversal of a temporary ostomy (OR=4.0) or had accessed advocacy-led cancer support were more likely to experience lower quality of life overall (OR=2.6).Colorectal cancer survivors relied on oncology professionals for cancer-related support and experienced quality of life issues and unmet needs, which were not addressed by oncology, primary care or advocacy professionals. This study suggests there is scope to optimise the contribution of primary care, community care and advocacy services to cancer survivorship care; these services were often overlooked or provided insufficient support when accessed by survivors. The recurring associations between quality of life outcomes and continuity of care and social difficulties suggest these may be meaningful variables to target in the development of interventions to improve survivors’ quality of life in the context of healthcare.
This paper addresses the effects of economic transition policies on forestry in China. The effects of de-collectivization and market liberalization on the forest land area and timber harvest are studied using panel data from four provinces covering the period 1978–1995. Fixed effects ordinary least squares models for forest land cover and annual harvests per hectare are estimated, allowing for differences across provinces and prefectures in northern and southern China. The results show that land tenure reform in general has had a positive effect on forest land expansion, but the absolute size of the effects varies from province to province. The positive impact of the reform on timber harvesting has not taken place at the cost of forest land cover. The claim that market liberalization leads to over-harvesting of forest resources in developing countries is not supported by our results.
The diagnosis of acute myeloid leukaemia and related neoplasms in adults is challenging as this requires the integration of clinical findings, morphology, immunophenotype, cytogenetics, and molecular genetic findings. Lack of familiarity with rare subtypes of acute leukaemia hinders the diagnosis. In this review, we will describe diagnostic findings of several rare acute myeloid leukaemias and related neoplasms that primarily occur in adults including information on presentation, morphology, immunophenotype, genetics, differential diagnosis, and prognosis. Leukaemias discussed include blastic plasmacytoid dendritic cell neoplasm, acute myeloid leukaemia with t(6;9) (p23;q34.1); DEK-NUP214, acute myeloid leukaemia with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM, acute myeloid leukaemia with BCR-ABL1, acute leukaemias of ambiguous lineage, acute myeloid leukaemia with mutated RUNX1, pure erythroid leukaemia, acute panmyelosis with myelofibrosis, and acute basophilic leukaemia. Case studies with morphological features of the nine subtypes of acute myeloid leukaemia and related neoplasms have been included, and additional evidence available since publication of the 2016 World Health Organization Classification has been added to each subtype.
