Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Research4Life——发展中国家可开放获取的四个生命科学研究信息源

论文详尽介绍了Research4Life项目及其旗下的四个生命科学研究信息源———医药卫生研究网际获取(HINAR-I)、全球农业研究在线获取(AGORA)、环境研究在线获取(OARE)、发展与创新研究信息在线获取(ARDI),供发展中国家的高校、科研院所、政府部门、地方非政府组织、医院和公立图书馆参考。

Life History Research in Education

Life history research,as one of the most powerful research methods in sociology,brings some re-freshened air into interpretive research.In this paper,the development of life history research,from modernism to postmodernism,from life story to life history,is firstly illustrated.Then the process of conducting life history research is analyzed specifically,which is followed by its unique strengths.Finally,its issues,its general issues and its special issues in Chinese context,are critically examined.

Research and Practice on the Training Mode of Innovative and Entrepreneurial Talents in Colleges and Universities:A Case Study of Academic Association of"Federation of Life Science Research and Innovation"

Taking the academic association of the Federation of Life Science Research and Innovation of the College of Life Science and Biotechnology of Heilongjiang Bayi Agricultural University as the research platform,it is necessary to organically combine personalized education with the cultivation of innovative and entrepreneurial ability.On the basis of unified teaching ideas,we should pay attention to the individual differences of educational objects,eliminate the disadvantages of traditional education,and break the conventional"spoon-feeding"teaching mode.It is necessary to shift from only paying attention to one-way indoctrination to paying attention to the cultivation of students'innovative quality,and to enhance students'interest in scientific research and practical ability of innovation and entrepreneurship through the rich scientific research activities of academic associations.

Impact of endoscopy-based research on quality of life in healthy volunteers

AIM:To study the impact of an endoscopy-based long-term study on the quality of life in healthy volunteers(HV).METHODS:Ten HV were included into a long-term prospective endoscopy-based placebo-controlled trial with 15 endoscopic examinations per person in 5 different drug phases.Participants completed short form-36(SF-36) and visual analog scale-based questionnaires(VAS) for different abdominal symptoms at days 0,7 and 14 of each drug phase.Analyses wereperformed according to short-and long-term changes and compared to the control group.RESULTS:All HV completed the study with duration of more than 6 mo.Initial quality of life score was comparable to a general population.Analyses of the SF-36 questionnaires showed no significant changes in physical,mental and total scores,either in a short-term perspective due to different medications,or to potentially endoscopic procedure-associated long-term cumulative changes.Analogous to SF-36,VAS revealed no significant changes in total scores for pathological abdominal symptoms and remained unchanged over the time course and when compared to the control population.CONCLUSION:This study demonstrates that quality of life in HV is not significantly affected by a longterm endoscopy-based study with multiple endoscopic procedures.

Progress in Research of Nutrition and Life Expectancy

Life expectancy is an important indicator to evaluate the social development of a country. Health and longevity can not only improve people＇s life quality but also ensure them to have more time to pursue their life goal. A one-year increase in life expectancy during ＇China＇s Twelfth Five-Year Economic and Social Development Plan＇ period has been used as an indicator to evaluate whether the goal of improving people＇s living standards continuously is met. Nutrition is one of the important factors affecting people＇s health. Both malnutrition and overnutrition are risk factors for disease and death. Many studies of the relationship between nutrition and life expectancy have been conducted in the world, and the results of them are quite valuable for China to improve people＇s life expectancy by targeted nutrition intervention strategy. This paper summarizes the progress in research of nutrition and life expectancy in the world.

Research on spirit and culture of the elderly life under the multiple responsibility

With the transformation of population age structure and the extension of life expectancy, China has entered a rapid aging period. With development of social economy and the social security systcn~ the elderly spiritual and cultural needs is becoming more and more importantly. To the government, enterprise, society community, family and themselves, enriching the spirit and culture of the elderly life is a higher level of challenge.

Laboratory Life:Twenty Years of Experimental Research with Locals and New Comers in Remote Rural Areas

Through the Latour concept of philosophy of science of laboratory life,the life course of a(geo)ethnographer researcher is analyzed,in order to establish the emotional or more personal dimensions that do not usually appear in research papers,but that have notable relevance in qualitative research.The text is structured in three large parts:A conceptual vision of the new experimental geography;the experimental geo-ethnography in old social,new social and place scenarios;and finally,the most personal and emotional dimension of the research.The first part establishes the geo-ethnographic experimental context and the assumptions in fieldwork,in addition to the geo-ethnographic reconciliation process.In the second part,the main qualitative research problems related to mobility,resistance and dynamics in place are established.Finally,in the third part the research perceptions,the personal experiences,and the emotional dimension of the research in remote rural areas are established.The laboratory life of a researcher,allows one to establish scalar conclusions and rigor in qualitative research.

Patient-centric periodontal research:A pioneering application of patient-reported outcome measures

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

继承与突破:Second Life中的教育问题研究

作为最典型、最流行的多用户虚拟环境(Multi-user Virtual Environment,简称MUVE)系统,SecondLife(第二人生,简称SL)正受到越来越多的教育研究者的关注,Second Life的教育研究已经成为教育技术领域研究热点之一。一方面,SL的教育研究继承了e-Learning尤其是协作虚拟环境(Collaborative Virtual Environ-ment,简称CVE)的研究成果,例如,三大学习理论仍作为SL中学习活动设计的基本指导理论;ADDIE模式仍适用于SL中的教学设计;SL同样面临着CVE的不流畅用户协作问题。另一方面,SL的教育研究又在寻求突破,例如,SL作为学习支持环境呈现独特的功能;SL中用户的个体认知行为和群体交互行为呈现新的特征;传统的多媒体教学设计原理面临新的挑战;联接主义学习观、语言学、社会文化学等成为研究SL的新视角。目前SL的教育研究在国内尚处于起步阶段,研究资料较少。本文主要基于外文文献调查的方法,梳理了国外SL的教育研究脉络,综合介绍了SL中各种教育问题的研究状况和成果,主要内容包括:SL中的学习环境、SL中的学习理论、SL中的教学设计、SL中的学习者、SL的教育实践效果,旨在为国内同行进一步研究SL提供思路、拓宽视野。

Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer

AIM: To compare quality of life (QoL) outcomes in Chinese patients after curative laparoscopic vs open surgery for rectal cancer. METHODS: Eligible Chinese patients with rectal cancer undergoing curative laparoscopic or open sphincterpreserving resection between July 2006 and July 2008 were enrolled in this prospective study. The QoL outcomes were assessed longitudinally using the validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQCR38 questionnaires before surgery and at 4, 8, and 12 mo after surgery. The QoL scores at the different time points were compared between the laparoscopic and open groups. A higher score on a functional scale indicated better functioning, whereas a higher score on a symptom scale indicated a higher degree of symptoms.RESULTS: Seventy-four patients (49 laparoscopic and 25 open) were enrolled. The two groups of patients were comparable in terms of sociodemographic data, types of surgery, tumor staging, and baseline mean QoL scores. There was no significant decrease from baseline in global QoL for the laparoscopic group at different time points, whereas the global QoL was worse compared to baseline beginning at 4 mo but returned to baseline by 12 mo for the open group (P = 0.019, Friedman test). Compared to the open group, the laparoscopic group had significantly better physical (89.9±1.4 vs 79.2±3.7, P = 0.016), role (85.0±3.4 vs 63.3±6.9, P = 0.005), and cognitive (73.5±3.4 vs 50.7±6.2, P = 0.002) functioning at 8 mo, fewer micturition problems at 4-8 mo (4 mo: 32.3±4.7 vs 54.7±7.1, P = 0.011; 8 mo: 22.8±4.0 vs 40.7±6.9, P = 0.020), and fewer male sexual problems from 8 mo onward (20.0±8.5 vs 76.7±14.5, P = 0.013). At 12 mo after surgery, no significant differences were observed in any functional or symptom scale between the two groups, with the exception of male sexual problems, which remained worse in the open group (29.2±11.3 vs 80.0±9.7, P = 0.026). CONCLUSION: Laparoscopic sphincter-preserving resection for rectal cancer is associated with better preservation of QoL and fewer male sexual problems when compared with open surgery in Chinese patients. These findings, however, should be interpreted with caution because of the small sample size of the study.

Value of quality of life analysis in liver cancer: A clinician's perspective

Health related quality of life(HRQOL) is increasingly recognized as an important clinical parameter and research endpoint in patients with hepatocellular carcinoma(HCC). HRQOL in HCC patients is multifaceted and affected by medical factor which encompasses HCC and its complications, oncological and palliative treatment for HCC, underlying liver disease, as well as the psychological, social or spiritual reaction to the disease. Many patients presented late with advanced disease and limited survival, plagued with multiple symptoms, rendering QOL a very important aspect in their general well being. Various instruments have been developed and validated to measure and report HRQOL in HCC patients, these included general HRQOL instruments, e.g., Short form(SF)-36, SF-12, Euro Qo L-5D, World Health Organization Quality of Life Assessment 100(WHOQOL-100), World Health Organization Quality of Life Assessment abbreviated version; general cancer HRQOL instruments, e.g., the European Organisation for Research and Treatment of Cancer(EORTC) QLQ-C30, Functional Assessment of Cancer Therapy(FACT)-General, Spitzer Quality of Life Index; and liver-cancer specific HRQOL instruments, e.g., EORTC QLQ-HCC18, FACT-Hepatobiliary(FACT-Hep), FACT-Hep Symptom Index, Trial Outcome Index. Important utilization of HRQOL in HCC patients included description of symptomatology and HRQOL of patients, treatment endpoint in clinical trial, prognostication of survival, benchmarking of palliative care service and health care valuation. In this review, difficulties regarding the use of HRQOL data in research and clinical practice, including choosing a suitable instrument, problems of missing data, data interpretation, analysis and presentation are examined. Potential solutions are also discussed.

Systematic review of health-related quality of life after esophagectomy for esophageal cancer

This study is aimed to assess the long-term healthrelated quality of life （HRQL） of patients after esophagectomy for esophageal cancer in comparison with established norms, and to evaluate changes in HRQL during the different stages of follow-up after esophageal resection. A systematic review was performed by searching medical databases （Medline, Embase and the Cochrane Library） for potentially relevant studies that appeared between January 1975 and March 2011. Studies were included if they addressed the question of HRQL after esophageal resection for esophageal cancer. Two researchers independently performed the study selection, data extraction and analysis processes. Twenty-one observational studies were included with a total of 1282 （12-355） patients. Five studies were performed with short form-36 （SF-36） and 16 with European Organization for Research and Treatment of Cancer （EORTC） QLQ c30 （14 of them also utilized the disease-specific OESI8 or its previous version OES24）.The analysis of long-term generic HRQL with SF-36 showed pooled scores for physical, role and social function after esophagectomy similar to United States norms, but lower pooled scores for physical function, vitality and general health perception. The analysis of HRQL conducted using the Global EORTC C30 global scale during a 6-mo follow-up showed that global scale and physical function were better at the baseline. The symptom scales indicated worsened fatigue, dyspnea and diarrhea 6 mo after esophagectomy. In contrast, however, emotional function had significantly improved after 6 mo. In conclusion, short- and long-term HRQL is deeply affected after esophagectomy for cancer. The impairment of physical function may be a long-term consequence of esophagectomy involving either the respiratory system or the alimentary tract. The short- and long-term improvement in the emotional function of patients who have undergone successful operations may be attributed to the impression that they have survived a near-death experience.

Health-related quality of life in patients that have undergone liver resection:A systematic review and meta-analysis

BACKGROUND Mortality after hepatectomy has decreased,and the quality of various surgical approaches to hepatectomy have been evaluated.Various assessments of quality of life(QOL)after hepatectomy have been developed and investigated in different clinical settings.AIM To conduct a systematic review and meta-analysis to examine two clinical topics:Laparoscopic hepatectomy vs open hepatectomy,and preoperative QOL status vs postoperative QOL status.METHODS A systematic literature search was performed using PubMed and MEDLINE,including the Cochrane Library Central.The following inclusion criteria were set for inclusion in this meta-analysis:(1)Studies comparing preoperative QOL and postoperative QOL;and(2)Studies comparing QOL between laparoscopic hepatectomy and open hepatectomy.RESULTS A total of 8 articles were included in this meta-analysis.QOL was better after laparoscopic hepatectomy than after open hepatectomy.CONCLUSION The outcomes of evaluations of QOL after hepatectomy can depend on the type of questionnaire used,the timing of the assessment,and the etiology of the hepatic disease.

A Life-skills-based HIV/AIDS Prevention Education for Rural Students of Primary Schools in China:What Changed? What Have We Learned?

Objective To evaluate a four-hour life-skills-based HIV/AIDS prevention curriculum among 5th grade students in rural primary schools of Hainan province.Methods The study included two stages.Stage one （September 2006-May 2007） was a pre-post-quasi experimental design;a total of 2 413 students aged 9 to 14 years from fifth grade classes of nine primary schools completed a baseline survey （1 720 students were in the intervention group,693 in the control group）,and over 98% of them took part in a short survey.The experimental curriculum was provided to the intervention group.At stage two （September 2008）,a cross-sectional questionnaire was administered to 6 923 students in 7th grade classes of eight middle schools in the same study sites.There were 1 437 students in the intervention group when the curriculum was conducted.Results Students tended to score higher in areas of HIV/AIDS related knowledge and attitudes,if they were younger than average,lived in the county seat,had access to the internet,and their parents had completed higher levels of education.Path analysis showed that,after controlling for characteristics such as family and community factors,the total effects of curriculum on knowledge in the short-term model increased remarkably compared with the baseline,and maintained major contributions to knowledge in the mid-term model.The positive effect of knowledge on attitudes was significantly improved in the short-term model as well.Conclusion A life-skills based curriculum can improve HIV/AIDS related knowledge and self-perceived level of life-skills among primary school students in rural areas in a short time,and these positive effects can still be observed at least 2 years post participation in the curriculum.

Deciphering the Quality of Life among Tuberculosis Patients under RNTCP in Karnataka, India

Background: The Tuberculosis (TB) disease has immense impact on physical, psychological, economic and social well-being of an individual. It is desired that the patient with any kind of TB disease should lead a respectable and happier life during their course of TB treatment. Currently, the quality of life (QOL) is an important indicator to assess the well-being of a person and there is paucity of such information among TB patients. Hence, we conducted to assess and compare the QOL of Revised National TB Control Programme registered Drug sensitive TB patients, Drug resistant TB patients and general population of Gadag district in Karnataka, India. Methods: A cross-sectional study was conducted in Gadag district, Karnataka from March 2017 through March 2018 among drug sensitive, drug resistant TB patients and general population. A Non-probability purposive sampling was adopted to select the samples that were matched for age, gender and ward. The select patients were administered WHO QOL-BREF questionnaire by trained personnel. Data were analyzed using SPSS version 12 analysis software. Results: The scores obtained for the four domains of QOL were (a) physical health: 69.62 + 18.29 (b) Psychological: 66.96 + 18.62 (c) Environment: 60.99 + 15.05 and (d) Social relationships: 53.5 + 19.93. Conclusions: The drug resistant TB patients have poor QOL when compared to drug sensitive and general population.

Patient involvement in lung foundation research: A seven year longitudinal case study

Patient involvement in health research is getting more accepted over the years. Until recently scientists and medical professionals were the sole assessors of quality and relevance of research proposals. In the Netherlands, as in other European and North American countries, emancipatory, political and democratic developments stimulated the emergence of patient involvement as a new “voice” in the appraisal of research. A time-series cross sectional longi-tudinal case study was used to describe and analyse a seven year period since the introduction of the patients’ perspective in the Long-fonds research cycle. Longfonds, the Lung Foundation in the Netherlands (LFN) was formerly called “Astma Fonds”. The study was conducted using an actors-interaction model against the background of the dynamics in society. The introduction of patient involvement resulted in a paradigm shift. The scientific and societal relevance of research proposals are now being reviewed by all parties in a more ef- fective and efficient way. Patients, now involved in the review procedure of research funding, are trained and equipped with an appraisal tool for societal relevance from a patients perspective. Scientific relevance and societal relevance are evaluated separately and balanced in the re- search funding application approval process. Societal relevance is being evaluated by a pa- tient advocates group. The results show how a government initiative and an approach by a patient organisation have led to more patient involvement in lung research. It requires “believers” both to initiate and continue the work and to promote the lessons learned inside and outside the patient organisation. As this depends on devoted individuals, the continuity of patient involvement remains vulnerable. This seven year study offers valuable insight in patient involvement against the background of the changeing health discourse.

A Meaningful Life for Older Persons Receiving Municipal Care—Unit Leaders’ Perspectives

Introduction: In Sweden, new national guidelines for elderly care have been introduced containing core values and local guarantees of dignity that highlight the need for dignity, well-being and the organisation of the older person’s daily life, so it is perceived as meaningful. Unit leaders play a crucial role in health care organisations when guidelines are to be implemented. Aim: The aim was therefore to describe unit leaders’ experiences about what constituted a meaningful daily life for older persons receiving municipal care and the opportunities and obstacles that might exist. Method: Repeated interviews using reflective conversations with nine leaders were performed and analysed with qualitative content analysis. Results: Unit leaders felt a shared vision regarding a meaningful life was needed. Daily routines and habits that promoted independence, a feeling of community together with familiarity with the job, and got the little extra from knowledgeable staff were important. The historical collective paradigm in elderly care needed to be abandoned in favour of one promoting more individualism. Fundamental was the courage to ask the older person what was important and dared to follow through to “Give power to the older person to decide what care to be given”. Conclusion: Organisational conditions affect unit leaders’ ability to succeed in the implementation of the work. Further studies are required regarding the nature of the support that the unit leaders need to succeed in their work.

Roles of mutual help of local community networks in community health activities: Improvement for the quality of life of older people in Thailand

Objectives: This study aimed to describe work and activities of community networks focusing on the improvement of the quality of life (QOL) of older people in Thailand.The understanding of the work can help enhancing the community development and strengthening of local communities and their networks.Methods: Qualitative methods including in-depth interview,observation,and focus group discussion were employed to the study.64 participants participated to the study and were recruited from 4 key actors within the community.Content analysis was used to analyze the obtained data.This study was conducted in 6 local administrative organizations (LAOs) which selected from the outstanding areas of the project.Each LAO represents one sub-district of the regions of Thailand namely;(1) the upper north,(2) the lower north,(3)the upper eastern,(4) the lower eastern,(5) the central and (6) the south.Results: The findings of this study were categorized into three main themes: (1) Social capital including people in the community,social groups,and organizations,(2) Mutual help/collaboration activities composed of six sets of activities related to social capitals working on the improvement of QOL of older people,and (3) Impacts of the mutual help/collaboration activities on older people and local communities who help to improve of QOL of older people.Conclusion: The findings are important features for the community development.These themes should be recommended for community nurses,health related groups and organizations for the improvement of QOL of older people in the community.

Patient Life Experience and Activity of Daily Living before and after Total Knee Arthroplasty

Background: As the population ageing, more patients suffer from joint disease. Joint replacement surgery performed in Taiwan is about 10,000 to 20,000 cases yearly. Aims: The purpose of this study is to realize Total Knee Arthroplasty (TKA) patients’ views about life experiences and difficulty in daily life before and after the surgery. Methods: In this study, in-depth interview with interview guideline was used to analyze patients’ experience by using a qualitative research method, and questionnaires were used to collect quantity data. Results: 1) A total of 20 participants were recruited. Average age was 75.15 (SD = 6.468). Eighteen of the participants were female and the other two were male. The majority of participants indicated that their home facilities were convenient or very convenient. 2) Motivations of the participants to undergo TKA were joint pain, limited joint range of motion, and weakness in legs. Participants’ expectations after surgery were no more pain and ease in walking, and able to manage daily life. 3) Depending on the time after surgery, joint pain and walking ability had improved to some extent. The joint range of motion increased, but kneeling remained difficult, and the participants’ mood and exercise capacity were improved. Conclusions: The finding can be as a reference for clinical practitioner to provide preoperative education for total knee arthroplasty patients.