血清Ⅰ型胶原吡啶交联终肽、骨钙素在肿瘤骨转移中的应用

目的探讨骨胶原吸收指标血清Ⅰ型胶原吡啶交联终肽（ICTP）和骨形成指标血清骨钙素（OC）二者在肿瘤骨转移的应用价值。方法收集我院肿瘤科经病理确诊的肺癌患者血清65例,乳腺癌患者血清36例,通过影像学诊断,将其分为骨未转移组和骨转移组两组。并征集我院健康体检人群41例作为健康对照组,分别定量测定血清ICTP、OC和碱性磷酸酶（ALP）浓度。结果血清ICTP在肺癌和乳腺癌骨转移组[（27．80±11．14）μg／L和（122.33±34．92）μg／L]均显著高于骨未转移组[（8．95±3．81）μg／L和（8．40±4．59）μg／L],差异有统计学意义（P〈0．01）,骨未转移组较健康对照组[（5．16±1．76）μg／L]亦有极显著性差异（P〈0．01）,血清OC值在乳腺癌骨转移组[（69．31±36．17）ng／mL]亦显著高于骨未转移组[（15．54±6．09）ng／mL],差异有统计学意义（P〈0．01）,而肺癌骨未转移组血清OC值较健康对照组以及肺癌骨转移组较肺癌骨未转移组差异均无统计学意义（P〉0．05）。血清ICTP在诊断肺癌和乳腺癌骨转移中是特异性高、敏感度较好的指标,血清OC在诊断肺癌骨转移中单独使用敏感度不够,意义不大,但在诊断乳腺癌骨转移时特异度和敏感度均较好。两者联合诊断乳腺癌骨转移的敏感度为96．3％,特异度为96．7％,联合诊断肺癌骨转移的敏感度为80．3％,特异度为84．2％。结论可根据需要单独或联合应用血清ICTP和OC,作为除影像学外诊断肿瘤骨转移有用的实验室诊断指标。     

COVID-19: A year later: The National Collaborating Centre for Healthy Public Policy in times of COVID-19: Building skills to “Build Back Better”

This article, the second in a series on the six National Collaborating Centres for Public Health, focuses on the National Collaborating Centre for Healthy Public Policy (NCCHPP), a centre of expertise, and knowledge synthesis and sharing that supports public health actors in Canada in their efforts to develop and promote healthy public policy.The article briefly describes the NCCHPP’s mandate and programming, noting some of the resources that are particularly relevant in the current coronavirus disease 2019 (COVID-19) context. It then discusses how the NCCHPP’s programming has been adapted to meet the changing needs of public health actors throughout the pandemic. These needs have been strongly tied to decisions aimed at containing the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and mitigating its immediate impacts in various societal sectors since the beginning of the crisis. Needs have also gradually emerged related to how public health is expected to help inform the development of public policies that will allow us to “build back better” societies as we recover from the pandemic. The article concludes by discussing the orientation of the NCCHPP’s future work as we emerge from the COVID-19 crisis.     

中医思维：中医药文化自信的内在逻辑

中医思维传承中国古代哲学的辩证思维传统,以独特的视角、方式和方法研究人类健康、生命及其疾病现象,表现出中华民族特有的原创思维特征。传承中医思维是坚定中医药文化自信的历史逻辑,创新中医思维是坚定中医药文化自信的理论逻辑,养成中医思维是坚定中医药文化自信的实践逻辑。中医药院校必须改革创新培养路径,培养出具有中医思维自觉的“铁杆”中医人才。     

论大学生中医药文化自信教育

中医药文化自信是中华民族文化自信的重要组成部分。中医药的创新与转化是中医药文化自信的持续动力源泉。培养中医药文化自信是新时代立德树人根本任务的重要抓手、人才培养的首要任务、党的政治建设的具体体现,是高校的职能、教师的责任和大学生的本分。新时代需要培养大学生的中医药文化自觉,形成大学生的中医药文化认同,树立乃至坚定大学生的中医药文化自信。中医药文化价值取向和中医思维是中医药文化自信的主导与内核,是达成中医药文化自信最重要、最核心的组成要素。高校应以中医药文化价值取向为目标,以中医思维培养为关键,积极有效地探讨大学生中医药文化自信教育的多样化路径和方法。     

The changing cultural and economic dynamics of polygyny and concurrent sexual partnerships in Iringa,Tanzania

Polygyny has been identified both as a ‘benign’ form of concurrency and as the cultural basis of concurrent partnerships that are considered important drivers of the HIV epidemic in sub-Saharan Africa. This paper investigates the changing cultural and economic dynamics of polygyny in concurrency in Iringa, Tanzania, a region with traditions of polygyny and high prevalence of HIV. Our analysis of focus group discussions, in-depth interviews and key informant interviews indicate that contemporary concurrent partnerships differ from regional traditions of polygyny. Whereas in the past, polygyny reflected men's and their kin group's wealth and garnered additional prestige, polygyny today is increasingly seen as a threat to health, and as leading to poverty. Nevertheless, participants evoked the social prestige of polygyny to explain men's present-day concurrency, even outside the bounds of marriage, and despite continued social prohibitions against extramarital affairs. Difficult economic conditions, combined with this prestige, made it easier for men to engage in concurrency without the considerable obligations to wives and children in polygyny. Local economic conditions also compelled women to seek concurrent partners to meet basic needs and to access consumer goods, but risked greater moral judgement than men, especially if deemed to have excessive ‘desire’ for money.     

When people with dementia are perceived as witches. Consequences for patients and nurse education in South Africa

Aims and Objectives

To explore and describe the link between culture and dementia care with the focus on the influence of the belief in dementia as witchcraft and people with dementia as witches.

Background

In South Africa, especially in townships and rural areas, dementia is often perceived as connected to witchcraft rather than to disease. Persons labelled as witches—mostly older women—may be bullied, ostracised, beaten, stoned, burned, even killed.

Method

One strand of findings from a larger international study is presented with in‐depth qualitative interviews of one close family member and seven nurses caring for patients with severe dementia in nursing homes in Tshwane in South Africa. A hermeneutic analytic approach was used.

Results

Two main themes are found, namely “Belief in witchcraft causing fear of persons with dementia” and “Need of knowledge and education.” Fear of and violence towards people with dementia are based on the belief that they are witches. Some of the nurses had also held this belief until they started working with patients with dementia. There is a great need for education both among healthcare workers and the populace.

Discussion

The “witch” belief prevents seeking professional help. As nursing homes tend to be private and expensive, professional dementia care is virtually unattainable for the poor. Dementia needs a more prominent place in nursing curricula. Nurses as educators need to know the local culture and language to be accepted in the various communities. They need to visit families affected by dementia, give awareness talks in churches, schools and clinics and facilitate support groups for carers of people with dementia in the local language.

Conclusion

Improved nurses’ education in gerontology and geriatric care is needed. Trained specialist nurses may work as mediators and help eradicate the witchcraft beliefs connected to severe dementia.     

Irritable bowel syndrome in Asia: Pathogenesis,natural history,epidemiology, and management

Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom‐based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross‐cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.