Claims in vapour device (e-cigarette) regulation: A Narrative Policy Framework analysis

BackgroundThe electronic cigarette or e-cigarette (vapour device) is a consumer product undergoing rapid growth, and governments have been adopting regulations on the sale of the devices and their nicotine liquids. Competing claims about vapour devices have ignited a contentious debate in the public health community. What claims have been taken up in the state arena, and how have they possibly influenced regulatory outcomes?MethodsThis study utilized Narrative Policy Framework to analyze the claims made about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the 2016 deeming rule legislation from the United States, and examined the claims and the regulatory outcomes in these jurisdictions.ResultsThe vast majority of claims in the policy documents represented vapour devices as a threat: an unsafe product harming the health of vapour device users, a gateway product promoting youth tobacco uptake, and a quasi-tobacco product impeding tobacco control. The opportunity for vapour devices to promote cessation or reduce exposure to toxins was very rarely presented, and these positive claims were not discussed at all in two of the four documents studied.ConclusionThe dominant claims of vapour devices as a public health threat have supported regulations that have limited their potential as a harm reduction strategy. Future policy debates should evaluate the opportunities for vapour devices to decrease the health and social burdens of the tobacco epidemic.     

脂联素受体的表达与调节

脂联素受体1在骨骼肌中有丰富表达,而脂联素受体2主要在肝中表达。另外,两种脂联素受体也在胰岛β细胞、脂肪组织、单核细胞、巨噬细胞、成骨细胞、心肌组织和胎盘组织中表达。生长激素、胰岛素以及过氧化物酶体增殖物活化受体(PPAR)α、PPARγ和肝X受体激动剂等可影响脂联素受体的表达。研究脂联素受体在不同组织、细胞中的表达与调节可了解其组织特异性作用。     

Sodium salicylate has no effect on cerebrospinal fluid [H+] in dogs with normal acid-base balance

The experiments described here were designed to investigate the possibility that central stimulation of respiration by salicylates may be due to changes in [H⁺] of cerebral fluids. Two groups (n=6 in each) of anesthetized, paralyzed, and mechanically ventilated dogs were studied for 6 hr. Renal pedicles were ligated to maintain blood salicylate level constant. Group II received 150 mg/kg Na salicylate intravenously at 0 hr after samples had been obtained. Group I (control) received equal volume of half-normal saline. Mean plasma salicylate levels were 18.9, 18.4, and 19.6 mg % at 0.5, 3, and 6 hr after administration of Na salicylate. Respective cisternal cerebrospinal fluid (CSF) levels were 3.2, 4.8, and 5.9 mg %. Salicylate-induced hyperthermia was prevented by peritoneal cold dialysis, and a rise in PaCO₂ was prevented by increasing ventilation. During the 6 hr of relatively normal systemic acid-base balance, cisternal CSF mean PCO₂ values were 45.3, 43.6, and 49.3 mm Hg at 0, 3, and 6 hr in the control group; in group II, respective values were 46.9, 45.7, and 47.7 mm Hg. Cisternal CSF [H⁺] were 44.4, 45.2, and 50.5 nEq/L in group I at 0, 3, and 6 hr. Respective values in group II were 45.0, 47.5, and 50.6 nEq/L. These values were similar and statistically insignificant from those in group I. In both groups cisternal CSF [HCO ₃ ⁻ ] fell about 2 and CSF lactate concentration rose about 1 mEq/L at 6 hr. We conclude that at the dose used in the present study, Na salicylate increases metabolic rate but does not significantly influence cisternal CSF [H⁺] up to 6 hr in dogs with normal systemic acid-base balance.     

The Protective Role of Resilience in Attenuating Emotional Distress and Aggression Associated with Early-life Stress in Young Enlisted Military Service Candidates

Early life stress (ELS) may induce long-lasting psychological complications in adulthood. The protective role of resilience against the development of psychopathology is also important. The purpose of this study was to investigate the relationships among ELS, resilience, depression, anxiety, and aggression in young adults. Four hundred sixty-one army inductees gave written informed consent and participated in this study. We assessed psychopathology using the Korea Military Personality Test, ELS using the Childhood Abuse Experience Scale, and resilience with the resilience scale. Analyses of variance, correlation analyses, and hierarchical multiple linear regression analyses were conducted for statistical analyses. The regression model explained 35.8%, 41.0%, and 23.3% of the total variance in the depression, anxiety, and aggression indices, respectively. We can find that even though ELS experience is positively associated with depression, anxiety, and aggression, resilience may have significant attenuating effect against the ELS effect on severity of these psychopathologies. Emotion regulation showed the most beneficial effect among resilience factors on reducing severity of psychopathologies. To improve mental health for young adults, ELS assessment and resilience enhancement program should be considered.     

Swiss popular initiative for a single health insurer… once again!

The article describes a recent Swiss popular initiative, aiming to replace the current system of statutory health insurance run by 61 competing private insurers with a new system run by a single public insurer. Despite the rejection of the initiative by 62% of voters in late September 2014, the campaign and ballot results are interesting because they show the importance of (effective) public communication in shaping the outcome of a popular ballot. The relevance of the Swiss case goes beyond the peculiarities of its federalism and direct democracy and might be useful for other countries debating the pros and cons of national unitary health insurance systems versus models using multiple insurers.After this electoral ballot, the project to establish a public sickness fund in Switzerland seems definitely stopped, at least for the next decade. Insurers, who opposed the initiative, have effectively fed the “fear of change” of the population and have stressed the good outcomes of the Swiss healthcare system.However, the political pressure favoured by the popular initiative opened a “windows of opportunity” and led the federal Parliament to pass a stricter regulation of health insurers, improving in this way the current system.     

Regulation of healthcare and medical imaging in Australia: A narrative review of the evolution,function and impact on professional behaviours

ObjectivesThis review explores the literature about the status and influence of statutory regulation in healthcare with a focus on medical imaging. It summarises the status of regulation in Australia for radiographers and sonographers, with brief reference to the global situation. The role of regulation is explored in terms of its evolution, function and effect on professional behaviours.Key findingsReports of medical errors, sentinel events and professional misconduct in healthcare have raised concern about how health care professionals are regulated. Patient-centric healthcare delivery has changed how people interact with healthcare, contributing to the development of statutory regulation for many healthcare professions.In Australia, the Health Practitioner Regulation National Law (The National Law) 2009, established the National Registration and Accreditation Scheme (NRAS) in order to practice. Not all health care professions are included in the scheme. In medical imaging, radiographers are included but sonographers are a notable exception.Regulation is designed to positively influence practitioners' professional behaviours. The available evidence however is limited, but suggests that under certain circumstances, it can negatively impact practitioners’ professional behaviours.ConclusionStatutory regulation has been implemented to address serious issues highlighted in reports of medical errors and professional misconduct, but it may have unintended consequences on the professional behaviours of practitioners. Limited research means the relationship between statutory regulation of healthcare practitioners and its impact upon professional behaviours remains unclear.Implications for practiceIf statutory regulation of healthcare professionals is to achieve its aim of protecting the public, it is imperative that we understand the impact that it has on professional behaviours. This review highlights that it can negatively impact professional behaviours which may be detrimental to patient's safety.     

MicroRNA在微血管病变调控机制方面的研究进展

Microangiopathy is characterized by capillary basement membrane thickening and microthrombus formation. The process of microangiopathy involves multiple organs and tissues, and seriously endangers the patients’ health and quality of life during the later stage. Recent evidence shows that microRNAs play an important role in the regulatory mechanism of microangiopathy, including inflammatory response, oxidative stress, abnormalities of glucose and lipid metabolism, abnormal activation of the rennin-angiotensin system and so on. The regulatory mechanism has unique features of microangiopathy in different organs. At present, more and more attention has been paid to the roles of microRNAs in the pathogenesis of microangiopathy.