‘Sometimes,it's easier to write the prescription’: physician and patient accounts of the reluctant medicalisation of sleeplessness

The medicalisation of sleep is a rich and growing area of sociological interest. Previous research suggests that medicalisation is occurring within the context of physician office visits, but the inner workings remain unclear. This study is the first to provide perspectives on the office visit interaction from both sleepless patients (n = 27) and the physicians (n = 8) who treat them. Analyses of semi‐structured qualitative interviews reveal that sleep‐related conversations are typically patient‐initiated in routine office visits. Physicians and patients conceptualised insomnia as a symptom of another issue (depression), an everyday problem of living (stress) or the result of a natural life process (aging). Lack of sleep was not necessarily linked to daytime impairment. Even though sleep aids were routinely requested and prescribed, patients and physicians consistently expressed attitudes of reluctance toward the use of sedative hypnotics. I call this a case of ‘reluctant medicalisation’ and highlight the liminal space between pathology and normalcy inhabited by patients and physicians. I also build on recent work acknowledging the dynamics between macro and micro levels of medicalisation and illustrate the influence of multilevel ‘engines’ (consumerism, biotechnology, managed care and physicians) in patients’ and physicians’ accounts. A virtual abstract of this paper can be viewed at: https://youtu.be/7uLHOJPHF0I     

影响护理不良事件发生因素的质性研究

目的探讨护理不良事件发生的相关因素。方法采用深度访谈法,收集15例个案资料,进行现场录音和速记,并运用Colaizzi分析程序进行分析。结果提炼出6个主题,分别为护理人员因素、管理因素、物品因素、环境因素、患者因素、多种因素相互作用。结论对护理不良事件应进行多因素分析,并采取多种措施,以降低护理不良事件的发生率。     

Prevalence of hyperuricemia among Beijing post-menopausal women in 10 years

ObjectivesThe objective of this study was to explore the trend and risk factors of the prevalence of hyperuricemia among post-menopausal women in Beijing over a ten years period.MethodThis research was based on two cross-sectional surveys in post-menopausal women in Beijing. A total of 1881 post-menopausal women were included. Subjects answered a questionnaire and underwent a physical examination and blood test. Serum uric acid >357 μmol/L was diagnosed as hyperuricemia, and another diagnosis criterion (serum uric acid >416 μmol/L) was applied in these women.ResultsSerum uric acid levels and hyperuricemia prevalence increased remarkably in the 10-year period. The prevalence of hyperuricemia increased more than 2-fold after being adjusted by age. Multivariate logistic regression models revealed hyperuricemia associated with age, education level, urban residents, alcohol consumption, hypertension, obesity, and dyslipidemia. With the increasing number of traditional cardiovascular risk factors (including hypertension, obesity, diabetes, and dyslipidemia), the risk of hyperuricemia increased significantly, and the accumulative effect of the factors on the risk of hyperuricemia was determined.ConclusionThe prevalence of hyperuricemia was high and exhibited a remarkable, increasing trend in Beijing community-based, post-menopausal women. Better management of relative factors could help to prevent further increases in the burden of hyperuricemia in post-menopausal women in this region.     

How to conduct research of rare autoimmune diseases

Rare autoimmune diseases are difficult to conduct researches in spite of present era with advanced scientific progress. Research using genetic approach is a promising way since genetic findings implicate causality of diseases. Still, there are multiple obstacles preventing genetic studies of rare diseases. Here, we list up the problems and propose solutions for them with detailed examples. The biggest problem is that it is difficult to collect a substantial number of DNA samples from patients with rare diseases. We propose to collaborate not only with academic institutions and hospitals but with patients’ groups. Detailed examples include studies about Takayasu arteritis (TAK), relapsing polychondritis, and systemic sclerosis. In TAK, we identified IL12B, a key gene which seems to play a central role in the disease. After getting evidence of IL12p40 encoded by IL12B as a possible therapeutic target by showing similarities of the genetic background between TAK and ulcerative colitis, we performed a pilot clinical study of ustekinumab, a monoclonal antibody against IL12p40 for patients with refractory TAK and obtained good response. This is a good example of how genetic findings in a rare disease lead to development of new therapeutic option.     

Impaired quality of life after bicycle trauma

IntroductionBicycle crashes often affect individuals in working age, and can impair quality of life (QoL) as a consequence. The aim of this study was to investigate QoL in bicycle trauma patients and to identify those at risk of impaired QoL.Patients and methods173 bicycle trauma patients who attended a level I trauma centre from 2010 to 2012 received Hadorn's QoL questionnaire six months after their crash. Medical data was collected from the patient's records. Univariate ordinal logistic regression was used to investigate the association between QoL and other factors.Results148 patients returned the questionnaire (85.5%). The majority had only mild or minor injuries (85.1%; n = 126). However, 72.1% (n = 106) still suffered from pain or other physical symptoms more than six months after their bicycle crash. Patients with a Glasgow Coma Scale (GCS) ≤13 or an Injury Severity Score (ISS) >15 experienced impaired emotions/outlook on life (p-values 0.003 and 0.045, respectively). Physical suffering was reported by patients with a GCS ≤13 and in those with injuries to the cervical spine (p-values 0.02 and 0.025, respectively). Patients with an ISS >15 or facial fractures experienced limitations in daily activities (p-values 0.031 and 0.025, respectively).ConclusionsMore than 70% of bicycle trauma patients suffered physically more than six months after their crash, even though only 15% were severely injured. Risk factors for an impaired QoL were cervical spine injuries or facial fractures, a GCS ≤13 and an ISS >15.