Life course changes provoked by chronic disease: A study on everyday life for patients with systemic lupus erythematosus

ObjectiveThis study examined patients with systemic lupus erythematosus (SLE) as a means to explore the impacts of chronic disease on life courses.MethodsA semi-structured in-depth interviews were conducted with nine patients in China in 2017; participants were included based on their having or having had facial butterfly erythema.ResultsThe study focused on both the disease’s impact on the patients’ health and on their daily lives. Four core themes emerged: visible changes in the patient’s bodies, social dilemmas, “the encouragement of disease”, and a new perspective on the relationship between disease and health. One important finding was that the occurrence of a chronic disease did not have only negative repercussions; some patients felt that there were advantages to being sick. Chronic disease resulted in a reworking of daily life. The patients developed a self-referential model of healing.ConclusionThe distinct interpretations of the same disease offered by different patients served to yield a more complete understanding of the disease. People with SLE adjust their thinking about the disease based on personal feelings as well as experiences and pursue a dialogue on their illness based on the disease pattern unique to them. The meaning that disease had for the patients was not limited to negative connotations.     

Variation in oxytocin receptor gene (OXTR) polymorphisms is associated with emotional and behavioral reactions to betrayal

Variations in the gene that encodes the oxytocin receptor (OXTR) have been associated with many aspects of social cognition as well as several prosocial behaviors. However, potential associations of OXTR variants with reactions to betrayals of trust while cooperating for mutual benefit have not yet been explored. We examined how variations in 10 single-nucleotide polymorphisms on OXTR were associated with behavior and emotional reactions after a betrayal of trust in an iterated Prisoner’s Dilemma Game. After correction for multiple testing, one haplotype (C-rs9840864, T-rs2268494) was significantly associated with faster retaliation post-betrayal—an association that appeared to be due to this haplotype’s intermediate effect of exacerbating people’s anger after they had been betrayed. Furthermore, a second haplotype (A-rs237887, C-rs2268490) was associated with higher levels of post-betrayal satisfaction, and a third haplotype (G-rs237887, C-rs2268490) was associated with lower levels of post-betrayal satisfaction.     

Left-sided appendicitis: review of 95 published cases and a case report

AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewe...     

医师对多点执业政策的认知情况研究

背景　医师多点执业政策有利于促进优质医师资源的合理流动,缓解居民“看病难”的问题,但目前医师多点执业注册情况并不十分理想。目的　探讨江苏省医师对医师多点执业政策的认知情况。方法　采用目的抽样法,在苏南、苏中、苏北3个地区分别选取3家不同等级（三级、二级、一级）的医疗机构,然后采取方便抽样法,在9家医疗机构选取符合本研究标准的医师为调查对象。于2017年7-8月,采用自行设计的调查问卷对纳入的医师进行调查。问卷的主要内容包括：医师的基本情况,对医师多点执业的认知情况（包括了解程度、是否赞成、意愿、对多点执业政策前景的看法、认为医师多点执业可能带来的好处、关心的因素、存在的顾虑及愿意采用的多点执业工作形式）。共发放问卷204份,回收有效问卷194份,问卷的有效回收率为95.1%。结果　194例医师中,非常了解/了解/一般了解医师多点执业政策者占93.3%（181/194）;赞成多点执业政策者占78.4%（152/194）;愿意进行多点执业者占70.1%（136/194）;非常看好医师多点执业者占47.4%（92/194）;认为医师多点执业有助于实现自我价值、增加收入来源者分别占80.9%（157/194）、75.3%（146/194）;关心的因素为薪酬、尊重度、工作环境者分别占65.5%（127/194）、62.4%（121/194）、60.8%（118/194）;参加多点执业的顾虑为医疗事故及纠纷难以处理、工作环境的差异者分别占62.4%（121/194）、60.3%（117/194）。选择医生工作室、医联体内部的对口帮扶、注册多点执业单位作为多点执业形式者分别占61.9%（120/194）、53.6%（104/194）、47.9%（93/194）。不同性别、职称、所在医疗机构区域的医师对多点执业了解程度的比较,差异有统计学意义（P<0.05）;不同职称、所在医疗机构区域、所在医疗机构等级的医师对多点执业的赞成情况比较,差异有统计学意义（P<0.05）;不同工龄、职称、所在医疗机构区域的医师对多点执业的意愿比较,差异有统计学意义（P<0.05）;不同性别、学历、职称、所在医疗机构区域的医师对多点执业前景的看法比较,差异有统计学意义（P<0.05）。结论　多数医师了解、赞成并愿意进行多点执业,但仍有顾虑。不同基本情况的医师对多点执业政策的认知情况有差异。     

Genetic studies of gestational duration and preterm birth

The fine control of birth timing is important to human survival and evolution. A key challenge in studying the mechanisms underlying the regulation of human birth timing is that human parturition is a unique to human event — animal models provide only limited information. The duration of gestation or the risk of preterm birth is a complex human trait under genetic control from both maternal and fetal genomes. Genomic discoveries through genome-wide association (GWA) studies would implicate relevant genes and pathways. Similar to other complex human traits, gestational duration is likely to be influenced by numerous genetic variants of small effect size. The detection of these small-effect genetic variants requires very large sample sizes. In addition, several practical and analytical challenges, in particular the involvement of both maternal and fetal genomes, further complicate the genetic studies of gestational duration and other pregnancy phenotypes. Despite these challenges, large-scale GWA studies have already identified several genomic loci associated with gestational duration or the risk of preterm birth. These genomic discoveries have revealed novel insights about the biology of human birth timing. Expanding genomic discoveries in larger datasets by more refined analytical approaches, together with the functional analysis of the identified genomic loci, will collectively elucidate the biological processes underlying the control of human birth timing.     

论我国舆论监督的制度困境

2006年“新华社舌战福建媒体”事件再次凸现我国舆论监督的制度困境，这是目前我国舆论监督难点之所在。要充分发挥我国舆论监督的功能，取决于相关制度困境的突破。为此，就要考察现有的制度框架．外部推动力有多大，以及现有制度对改革要求的承受力。     

药品市场信用监管的博弈分析

药品市场监管实际上是药品监督管理部门与医药市场主体之间的博弈与反复博弈。从贝叶斯规则与医药市场准入监管、囚徒困境与打假维权、医药市场进入阻挠与反限制竞争等方面对医药企业的监管进行博弈分析,药品监督管理部门通过理性博弈可以大大提高医药市场监管的有效性。笔者还通过对医药监管者的监管博弈分析,认为现有监管的滞后性和弱有效性是我国医药市场违规现象层出不穷的主要原因。对监管者实施强有力的监管可以减少违规操作,使药品监管提高资源配置效率,确保医药市场高效、平稳有序运行的目标更容易实现。     

走出生命伦理的两难困境

两难困境是生命伦理的一个重要特征,需要理性面对。这种两难首先是由科技自身的发展所引起的,同时也与文化差异和利益冲突密切相关,其实质是价值选择。走出生命伦理的两难困境,在理念层面要促进科学与伦理的良性互动;在实践层面要切实加强生命伦理委员会建设,但两难困境不会消失。     

Validating, Improving Reliability, and Estimating Correlation of the Four Subscales in the WHOQOL-BREF using Multidimensional Rasch Analysis

Objective: This study examined the construct validity, and improved the test reliability and the estimation accuracy for the correlation between domains of the WHOQOL-BREF using multidimensional Rasch analysis. Method: A total of 13,083 adults were administered the 28-item WHOQOL-BREF Taiwan version, which consists of 4 subscales (domains). The multidimensional form of the partial credit model was used to examine the fit of the 4 subscales. For comparison, each subscale individually was also fitted to the unidimensional partial credit model. Standard item fit statistics and analysis of differential item functioning (DIF) were used to check model-data fit. Results: After excluding 2 overall items and deleting 7 DIF items, the remaining items of each subscale in the WHOQOL-BREF constituted a single construct. The test reliabilities and correlations between domains obtained from the multidimensional approach, (0.82–0.86) and (0.79–0.89), respectively, were much higher than those obtained from the unidimensional approach, (0.67–0.75) and (0.53–0.65), respectively. Conclusion: The 19-item WHOQOL-BREF measures more succinct latent traits than the original design. The multidimensional approach yields not only more accurate estimates for the correlation between domains but also substantially higher reliabilities, than the standard unidimensional approach.     

"三农"问题面临的二难困境

当下中国,三农问题面临着四个方面的二难困境：家庭承包责任制分散经营的现状与土地规模经营的要求的二难困境,农业对技术的需求和技术推广使农民收益甚微的二难困境,农产品结构调整与农民得不偿失的二难困境,农村劳动力绝对过剩与“民工荒”并存的二难困境。三农问题之所以陷入如此二难困境,其根本原因在于人多地少的国情矛盾和城乡二元结构的体制矛盾所形成的一系列约束条件。基于此,有关三农问题的制度安排和政策设计,都必须在这些约束条件下进行。正是在国情矛盾和体制矛盾的制约下,三农问题的解决是一个长期而复杂的过程,解决三农问题必须有新的思路和举措。