Empowerment of Senior Citizens via the Learning of Information and Communication Technology

Most East Asian countries have policies to promote digital inclusion, especially among the children of low-income families and persons with disabilities, for the purposes of social development. However, such efforts and their impact among older people have been rather limited. In Hong Kong, only 7 % of those aged 65 or above were Internet users in 2008, compared with 66.7 % of the general public. Providing computer and Internet training programmes to older people is thus crucial in promoting digital inclusion. This paper discusses the experience and results of training older people to use both a computer and the Internet. Based on findings from an earlier qualitative study, we hypothesise that acquiring knowledge of computers and Internet use will have an empowering effect for older people in terms of increasing self-efficacy and enhancing communication with friends and family members. This paper presents two studies of such empowerment among older people in two non-governmental organisations (NGOs). While older people with little computer knowledge showed some effects of empowerment, at the same time, they also became more aware of the marginalisation and exclusion effects of their limited knowledge of computer and Internet usage. However, among users with some prior experience of using a computer, further training failed to show additional positive empowerment results. The results of the two studies call for a re-examination of the training process and experience of older people as well as integration of such training with other strategies to achieve better results in promoting their social inclusion in the information society.     

Hémorragie surrénalienne bilatérale révélant une hyperhomocystéinémie

Introduction

Bilateral adrenal hemorrhage remains a rare disease. It has several etiologies, and clinical presentation is not specific.

Case report

We report a 45-year old man without known prothrombotic factor who presented with acute left sided abdominal pain left revealing a bilateral adrenal hemorrhage. The diagnostic work-up identified a significant hyperhomocysteinemia associated with a previously undiagnosed homozygous mutation of the 5,10 methylene–tetrahydrofolate reductase gene. The outcome was associated with the occurrence of an adrenal insufficiency.     

Factors associated with bronchiolitis obliterans syndrome and chronic graft‐versus‐host disease after allogeneic hematopoietic cell transplantation

Bronchiolitis obliterans syndrome (BOS) is a form of chronic graft vs. host disease (cGVHD) and a highly morbid pulmonary complication after allogeneic hematopoietic stem cell transplantation (HSCT). We assessed the prevalence and risk factors for BOS and cGVHD in a cohort of HSCT recipients, including those who received reduced intensity conditioning (RIC) HSCT. Between January 1, 2000 and June 30, 2010, all patients who underwent allogeneic HSCT at our institution (n = 1854) were retrospectively screened for the development of BOS by PFT criteria. We matched the BOS cases with two groups of control patients: (1) patients who had concurrent cGVHD without BOS and (2) those who developed neither cGVHD nor BOS. Comparisons between BOS patients and controls were conducted using t‐test or Fisher's exact tests. Multivariate regression analysis was performed to examine factors associated with BOS diagnosis. All statistical analyses were performed using SAS 9.2. We identified 89 patients (4.8%) meeting diagnostic criteria for BOS at a median time of 491 days (range: 48–2067) after HSCT. Eighty‐six (97%) of our BOS cohort had extra‐pulmonary cGVHD. In multivariate analysis compared to patients without cGVHD, patients who received busulfan‐based conditioning, had unrelated donors, and had female donors were significantly more likely to develop BOS, while ATG administration was associated with a lower risk of BOS. Our novel results suggest that busulfan conditioning, even in RIC transplantation, could be an important risk factor for BOS and cGVHD. Am. J. Hematol. 89:404–409, 2014. © 2013 Wiley Periodicals, Inc.     

Multiple myeloma: 2014 Update on diagnosis,risk‐stratification,and management

Disease overview : Multiple myeloma accounts for approximately 10% of hematologic malignancies. Diagnosis : The diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end‐organ damage. If end‐organ damage is not present, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma. Risk stratification : In the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high‐risk myeloma. Patients with t(4;14) translocation are considered intermediate‐risk. All others are considered as standard‐risk. Risk‐adapted intial therapy : Standard‐risk patients can be treated with lenalidomide plus low‐dose dexamethasone (Rd), or a bortezomib‐containing triplet such as bortezomib, cyclophosphamide, dexamethasone (VCD). Intermediate‐risk and high‐risk patients require a bortezomib‐based triplet regimen. In eligible patients, initial therapy is given for approximately 4 months followed by autologous stem cell transplantation (ASCT). Standard risk patients can opt for delayed ASCT if stem cells can be cryopreserved. In patients who are not candidates for transplant, initial therapy is given for approximately 12 to 18 months. Maintenance therapy : After initial therapy, lenalidomide maintenance is considered for standard risk patients who are not in very good partial response or better, while maintenance with a bortezomib‐based regimen should be considered in patients with intermediate or high risk myeloma. Management of refractory disease : Patients with indolent relapse can be treated first with 2‐drug or 3‐drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Am. J. Hematol. 89:998–1009, 2014. © 2014 Wiley Periodicals, Inc.     

Sequential infusion of donor‐derived dendritic cells with donor lymphocyte infusion for relapsed hematologic cancers after allogeneic hematopoietic stem cell transplantation

Donor lymphocyte infusion (DLI) is often given to induce a graft‐versus‐leukemia (GVL) effect after allogeneic hematopoietic stem cell transplantation (HSCT). However, efficacy of DLI is limited in most hematologic cancers. As antigen presenting cells, dendritic cells (DC) bolster immune responses. We conducted a Phase I trial testing the coinfusion of DC followed by DLI. DC were generated by culturing peripheral blood mononuclear cells from HLA matched‐related donors in GM‐CSF and IL‐4 for 7 days, followed by TNF‐α for 3 days. DC were administered intravenously on 3 dose levels (5 × 10⁶; 1 × 10⁷; 5 × 10⁷ cells). DLI (3 × 10⁷ CD3+ cells/kg) was administered intravenously 1 day after the DC. Sixteen patients with hematologic cancers relapsed after HSCT were treated. A maximum tolerated dose for DC was not reached. Two of 16 patients met criteria for DLT within 10 weeks of the infusion: 1 idiopathic respiratory failure, 1 ventricular cardiac arrest. None developed grade III/IV GVHD. One patient developed grade II acute intestinal graft‐vs.‐host disease (GVHD) and 1 chronic GVHD within 6 months of the infusion. Both resolved with corticosteroids. Four of 14 patients evaluable for disease response achieved durable remissions and are alive and cancer free 6.7, 8.4, 8.8, and 10.1 years from infusion. Sequential infusion of donor‐derived DC with DLI is feasible in patients with relapsed hematologic cancers after allogeneic HSCT. Future studies may consider donor DC preloaded with tumor antigens to investigate whether DC infusion could augment the GVL effect. Am. J. Hematol. 89:1092–1096, 2014. © 2014 Wiley Periodicals, Inc.