Individuals with Smith-Magenis syndrome display profound neurodevelopmental behavioral deficiencies and exhibit food-related behaviors equivalent to Prader-Willi syndrome

Smith-Magenis syndrome (SMS) is a neurodevelopmental disorder associated with intellectual disability, sleep disturbances, early onset obesity and vast behavioral deficits. We used the Behavior Problems Inventory-01 to categorize the frequency and severity of behavioral abnormalities in a SMS cohort relative to individuals with intellectual disability of heterogeneous etiology. Self-injurious, stereotyped, and aggressive/destructive behavioral scores indicated that both frequency and severity were significantly higher among individuals with SMS relative to those with intellectual disability. Next, we categorized food behaviors in our SMS cohort across age using the Food Related Problems Questionnaire (FRPQ) and found that problems began to occur in SMS children as early as 5–11 years old, but children 12–18 years old and adults manifested the most severe problems. Furthermore, we evaluated the similarities of SMS adult food-related behaviors to those with intellectual disability and found that SMS adults had more severe behavioral problems. Many neurodevelopmental disorders exhibit syndromic obesity including SMS. Prader-Willi syndrome (PWS) is the most frequent neurodevelopmental disorder with syndromic obesity and has a well-established management and treatment plan. Using the FRPQ we found that SMS adults had similar scores relative to PWS adults. Both syndromes manifest weight gain early in development, and the FRPQ scores highlight specific areas in which behavioral similarities exist, including preoccupation with food, impaired satiety, and negative behavioral responses. SMS food-related behavior treatment paradigms are not as refined as PWS, suggesting that current PWS treatments for prevention of obesity may be beneficial for individuals with SMS.     

What May we be Learning from So-called Spontaneous Remission in Ethnic Minorities?

This study describes a small-scale attempt to compare people from two populations in an English county who have grown out of alcohol problems without formal assistance from treatment agencies. The populations were the indigenous white population and the ethnic minority population who originated from the Indian sub-continent, although 40% were born in Britain. There may be more spontaneous remitters and less problematic drinkers in need of specialist services than one would expect on the basis of population and consumption levels in the ethnic minority communities. For both white indigenous and ethnic groups, physical health, self-esteem, ability to cope and work were important motivating factors in reduction or cessation of alcohol use. For the ethnic minority group, social networks, including religiously-based ones, family status and honour were important, whereas accommodation and psychological state were more important to the white indigenous sample. Although the study is anecdotal, a case is made to have services for people with alcohol problems which offer treatments and goals consistent with the attitudes and beliefs of the communities of origin of presenters.     

Generalized shared decision making approaches and patient problems. Adapting AHRQ’s SHARE Approach for Purposeful SDM

ObjectiveGeneralized shared decision making (SDM) describes the involvement of patients in choosing options. However, there are many situations in which patients and clinicians make decisions together that don’t focus on choosing between options, e.g. problem-solving dialysis and insulin use while traveling. Poor uptake associated with clinicians’ perception that SDM doesn’t apply to clinical situations they face may reflect the lack of adaptation of generalized SDM approaches to patients’ problems. The Purposeful SDM schema published in 2019 identifies problems for which different kinds of SDM are appropriate.MethodsThe U.S. Agency for Healthcare Research and Quality developed SHARE as a generalized SDM approach. We sought to adapt SHARE to the different problems that patients face using a matrix to relate SHARE steps and Purposeful SDM modes and describe changes in generalized concepts and practices of SDM across these modes.ResultsMany SHARE communicative behaviors applied across modes, although the meaning of SDM terms and practices, e.g. patients involved as problem solvers versus experts, varied substantially.ConclusionAspects of SHARE require adaptation to different patient problems.Practice implicationsSDM in education, practice, and tools may be supported by adapting generalized SDM approaches to patients’ problems.     

我国药物经济学研究的现状和建议

目的:为推进我国药物经济学研究提供理论参考。方法:通过对药物经济学文献进行分析,总结出国内研究现状,探讨存在问题的原因,并提出建议。结果与结论:中国地广人多,共享信息的途径太少;药物经济学研究涉及面广,医药卫生行业的人员对经济学、社会学的知识掌握不够;"以药养医"现象的存在,药物经济学研究成果的推广难免会触及多方经济利益。建议应加强药物流行病学研究,整合研究人员知识结构;深化医药卫生体制改革,破除"以药养医"现象。     

Impulsivity,Sensation-Seeking,and Part-Time Job Status in Relation to Substance Use and Gambling in Adolescents

PurposeAlthough impulsivity, sensation-seeking, and part-time employment have each been linked to risky behaviors in adolescents, their inter-relationships are less well-understood. We examined data from adolescents to assess the following predictions: (1) sensation-seeking would relate closely to substance use and gambling; (2) impulsivity would relate closely to alcohol, drug, and gambling problems; and (3) these relationships would be particularly strong among those holding part-time jobs.MethodHigh-school students (N = 3,106) were surveyed to provide data on impulsivity, sensation-seeking, and part-time job status. Bivariate and logistic regression analyses were conducted to examine relationships with gambling, substance use (i.e., alcohol, cigarettes, and marijuana) and related problems.ResultsBoth impulsivity and sensation-seeking related significantly to substance use and impulsivity to gambling. Impulsivity had stronger associations with drug and gambling problems than sensation-seeking did. Students with paid part-time jobs were more likely to drink alcohol, binge drink, and use marijuana. Sensation-seeking had a particularly strong relationship to heavy cigarette smoking among students with part-time jobs. Conversely, there was little relationship between part-time job status and smoking among low sensation-seekers.ConclusionsThese findings further support the relevance of sensation-seeking, impulsivity, and part-time job status to risky behaviors among adolescents. Sensation-seeking and impulsivity had unique relationships to risky behaviors, in accordance with theory and prior evidence. Impulsive adolescents may be in particular need for interventions to reduce drug use and gambling. Although part-time jobs can be beneficial, parents and caregivers should be mindful of potential negative ramifications of paid work outside the home.     

我国儿科住院医师规范化培训的发展及存在的问题

住院医师规范化培训是培养高素质临床医师的重要途径,是提高医疗水平的重要手段,关乎我国医疗事业的发展。近年来,我国住院医师的规范化培训已经有了长足的发展,但不可否认还存在一定的问题,只有采取相应的对策,我国的医学事业才会有更快更好的发展。     

护理人力资源管理与护士工作满意度之相关性及对策研究

护理人力资源管理是人力资源中的微观管理内容,分析当前我国护理人力资源的管理现状,不难发现还存在着诸多问题,例如：工作压力过大、人员不足、工作满意度低、队伍整体素质水平有待提高等。那么,如何及时有效的运用科学的管理模式解决这些问题,从而提高护士们的工作积极性与能动性,是每一名护理管理人员迫在眉睫的新课题。本文就当前国内医院护理人力资源管理以及护士工作的满意程度现状进行了分析,并提出了有效的完善措施,希望能够为我国护理人力资源的可持续发展提供更为坚实可靠的保障。