Burden of epilepsy in China and its provinces,1990 to 2019:findings from the Global Burden of Disease Study 2019

Background: Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces. Methods: We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019. Results: In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92–1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95% UI: 71.33–133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95% UI: 8.03–98.74%) and 35.72% (95% UI: 0.47–86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95% UI: 1.43–5.66]/100,000), Qinghai (1.80 [95% UI: 1.15–2.36]/100,000), and Yunnan (1.30 [95% UI: 0.88–1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95% UI: 0.39–0.64]/100,000), Zhejiang (0.56 [95% UI: 0.44–0.70]/100,000), and Shanghai (0.57 [95% UI: 0.41–0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased. Conclusions: The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.

Secular trends of asthma mortality in China and the United States from 1990 to 2019

Background:Asthma imposes a large healthcare burden in China and the United States(US).However,the trends of asthma mortality and the relative risk factors have not been comparatively analyzed between the countries.The aim of this study was to compare the mortality and risk factors between China and the US.Methods:The deaths,and mortality rates of asthma in China and the US during 1990–2019 were obtained from the Global Burden of Disease Study 2019.The age–period–cohort model was used to estimate these mortality rates based on a log-linear scale with additive age,period,and cohort effects.The population attributable fractions of risk factors for asthma were estimated.Results:In 1990–2019,the asthma mortality rate was higher in China than in the US.The crude and age-standardized asthma mortality rates trended downward in both China and the US from 1990 to 2019.The decline in mortality was more obvious in China.Mortality gap between the two countries was narrowing.A sex difference in asthma mortality was observed with higher mortality in males in China and females in the US.The age effects showed that mortality increased with age in adults older than 20 years,particularly in the elderly.Downward trends were generally observed in the period and cohort rate ratios in both countries,with China experiencing a more obvious decrease.Smoking and high body mass index(BMI)were the leading risk factors for asthma mortality in China and the US,respectively.Mortality attributable to occupational asthmagens and smoking decreased the most in China and the US,respectively.Conclusions:In 1990–2019,the asthma mortality rate was higher in China than in the US;however,the mortality gap has narrowed.Mortality increased with age in adults.The improvements in asthma death risk with period and birth cohort were more obvious in China than in the US.Smoking,high BMI,and aging are major health problems associated with asthma control.The role of occupational asthmagens in asthma mortality underscores the importance of management and prevention of occupational asthma.

Factors Affecting Catecholamines in Caregivers of Patients with De­mentia

Background:Caregivers of dementia patients have significantly higher levels of serum IL-6 and CRP compared to non-caregivers,and the ac­cumulation of everyday stressors reportedly promotes the induction of inflammatory markers.However,few studies have identified factors that affect catecholamine levels in caregivers who experience a combination of physical and mental stress from caregiving.Purpose:This study aimed to identify physical factors that impact catecholamine levels in caregivers of dementia patients.Methods:Participants were elderly caregivers living together with elderly Alzhei­mer’s-type dementia patients.We performed logistic regression analysis,with levels of adrenaline,noradrenaline,and dopamine(indicators of catecholamine)as dependent variables.Results:Caregiver BMI had a significant impact on adrenaline levels(OR:0.792;95%CI:0.654-0.960)and noradrenaline levels(OR:1.210;95%CI:1.009-1.451),whereas age had a significant impact on dopamine levels(OR:1.162;95%CI:1.019-1.324).Discussion:While caregiver BMI significantly impacted adrenaline and noradrenaline levels,the mechanism underlying these relationships is unclear.One possibility is that obesity(BMI)and a rise in sympathetic nerve activity contributed to hypertension.Our findings suggest that chronic stress in elderly caregivers may potentially impair the dopaminergic activation system in the brain.Conclusion:There is a need to identify factors which increase BMI in caregivers.Future studies aimed at gaining a better understanding of the lifestyle habits of caregiv­ers and intervention studies aimed at reducing their BMI are warranted.

民法典背景下保险人信息提供义务的完善

《保险法》以格式免责条款作为划分保险人信息提供义务强度的标准,存在逻辑缺陷,在实践中引发争议和混乱。《民法典》在格式条款订入规则中扩大了条款提供方提示说明义务范围,借鉴其理念并结合保险合同自身特点,构建以条款重要性、信息获得可能性和利益均衡性为标准的多层次保险人信息提供义务体系更为合理。扩大保险人信息提供义务范围的同时,应降低保险人义务履行之证明标准。保险人提供投保人签署或摘抄含有保险人履行义务内容的声明,可认定保险人已完成信息提供义务的初步举证责任。

Comparison of time trends in the incidence of primary liver cancer between China and the United States: an age-period-cohort analysis of the Global Burden of Disease 2019

Background::China and the United States(US)ranked first and third in terms of new liver cancer cases and deaths globally in 2020.Therefore,a comprehensive assessment of trends in the incidence of primary liver cancer with four major etiological factors between China and the US during the past 30 years with age-period-cohort(APC)analyses is warranted.Methods::Data were obtained from the Global Burden of Disease 2019,and period/cohort relative risks were estimated by APC modeling from 1990 to 2019.Results::In 2019,there were 211,000 new liver cancer cases in China and 28,000 in the US,accounting for 39.4%and 5.2%of global liver cancer cases,respectively.For China,the age-standardized incidence rate(ASIR)consecutively decreased before 2005 but increased slightly since then,whereas the ASIR continuously increased in the US.Among the four etiological factors of liver cancer,the fastest reduction in incidence was observed in hepatitis B virus-related liver cancer among Chinese women,and the fastest increase was in nonalcoholic steatosis hepatitis(NASH)-related liver cancer among American men.The greatest reduction in the incidence of liver cancer was observed at the age of 53 years in Chinese men(-5.2%/year)and 33 years in Chinese women(-6.6%/year),while it peaked at 58 years old in both American men and women(4.5%/year vs.2.8%/year).Furthermore,the period risks of alcohol-and NASH-related liver cancer among Chinese men have been elevated since 2013.Simultaneously,leveled-off period risks were observed in hepatitis C viral-related liver cancer in both American men and women.Conclusions::Currently,both viral and lifestyle factors have been and will continue to play an important role in the time trends of liver cancer in both countries.More tailored and efficient preventive strategies should be designed to target both viral and lifestyle factors to prevent and control liver cancer.

论我国民事诉讼证明责任分配的一般原则

最高人民法院《关于民事诉讼证据的若干规定》第二条第一款确立了我国民事证明责任的一般原则。该原则可以概括为两个命题:一是提出诉讼请求的当事人对权利根据事实承担证明责任,反对诉讼请求的当事人对抗辩事实承担证明责任;二是当事人各自负有证明责任的事实是实体法所规定的要件事实。我国证明责任分配一般原则需要借助于一定的理论方法才能适用于案件,法律要件分类说应当是主要和首选的理论方法,但是不能排除其他理论的运用。关于证明责任分配一般原则的例外亦即举证责任倒置,现行司法解释中关于特殊侵权案件证明责任分配的规定,多数属于证明责任分配一般原则的具体化,只有很少的内容属于一般原则的例外,构成举证责任倒置。

商业秘密侵权诉讼的举证责任分配

商业秘密侵权诉讼中的举证责任分配是一个长期存在的难题。依据2019年修订的《反不正当竞争法》和2020年初达成的《中美经济贸易协议》,在原告和权利人证明部分相关事实后,法律就推定商业秘密具有秘密性,同时被告具有不当行为。这一制度安排减轻了原告的举证负担,但也不合理地加重了弱势被告的负担,会产生过高的社会成本。决策者应当接受民事诉讼领域主流理论的指引,坚持让商业秘密权利人承担证明责任,重申合理的证明标准,为权利人履行举证义务提供更具体的指引。只有这样,才能建立起符合中国长远产业利益的合理的商业秘密诉讼制度。

“事案解明义务”一般化之辨——以美国“事证开示义务”为视角

随着我国民事诉讼模式从"(超)职权主义"向"当事人主义"转型,不负证明责任之一方当事人的事案解明义务逐渐浮出水面。事案解明义务应否一般化是大陆法系国家及地区理论争议的热点问题。作为一般化的样本,美国事证开示义务殊值探究。美国之所以确立一般性事证开示义务,与其诉答机制、具体化义务、证明责任等所具有的特殊性有关。而且,其事证开示义务范围趋向限缩。我国尚不具备确立一般性事案解明义务的必要及可能,但仍可参考其事证开示方法对文书提出命令等予以完善。

论人民法院不是证明责任的主体

“人民法院是证明责任的主体”似乎是顺理成章的“常识”。然而正是这种建立在对“证明责任”概念错误理解之上的“常识” ,导致了一系列法学理论和司法操作上的混乱和本不该有的困惑 ,成了审判方式改革的“瓶颈”。有必要厘定证明责任概念 ,采取有效措施推行真正的证明责任制度 ,并且强化一种诉讼观念 :即 ,承担证明责任的主体不是法院 ,而是当事人或控诉方 !人民法院只是将法律规定的证明责任适用到具体的案件裁判之中而已 ,尽管这也是一种“责任” ,但不是“证明责任”。

论民事证据理念的转变——兼谈民事诉讼证据新规定的发展

与此前的立法与司法解释相比 ,证据新《规定》有了较大的发展 ,我们的民事证据理念也应当有相应的转变。树立法律真实、私法自治的理念 ,全面正确理解举证责任的含义和实质。引入高度盖然性原理与法官心证原则 ,采用直接、言词证人证言方式。

高校教职工个人所得税纳税筹划

介绍了个人所得税中工资、薪金所得、劳务报酬所得、稿酬所得的应纳税额的纳税筹划。根据个人所得税法规定研究了工资、薪金所得中年终奖最佳发放金额,通过案例分析直观地反映出工资、薪金所得、劳务报酬所得、稿酬所得的税负最低方案。从纳税人角度看,合理合法地减轻了纳税人的税收负担,获得最大的税收利益,并且通过纳税筹划能够有助于提高纳税人的纳税意识,实现纳税人经济利益的自我保护。

刑事证明责任倒置相关概念辨析

刑事证明责任与举证责任、刑事证明责任的正置与倒置等相关概念之间的正确区分是分析我国刑事案件证明责任倒置问题的前提。举证责任是证明责任的第一重含义,二者既有联系又有区别;证明责任倒置本属于民事法律的规定,但在刑事法律中存在着证明责任正置与倒置的情况。

妨害举证行为对策研究——以民事诉讼为视角分析

妨害举证行为违反诚实信用原则,有违法律公平、正义的价值追求,并造成诉讼迟延。我国现行对策对这一情况,收效不大。对于妨害举证行为,立法应当设置一个多层次的制裁体系加以规制,其中包括:举证责任倒置,采取一般强制措施,追究刑事责任或几种方法并用的方式。

苏州失地农民老年人养老负担及家庭承载力研究

目的:通过评估养老负担及家庭承载力,了解苏州失地农民老年人家庭养老现况,并探究不同老年人群特征对二者的影响。方法:采用自行设计的问卷对苏州市相城区5650名失地农民老年人的家庭养老状况进行调查,通过打分法和综合指数评价法,从健康相关经济、人力和潜在三个方面分析其养老负担和家庭承载力指数,并利用线性模型进行影响因素分析。结果:苏州失地农民老年人养老负担总指数男性为147.57,女性为141.75(低于平均水平144.55);家庭承载力总指数男性为98.21,女性为95.13(低于平均水平96.61),男性各指数均高于女性。养老负担和家庭承载力总指数随年龄的增长有明显的下降趋势,且两总指数随文化程度的降低而降低。已婚或同居组家庭承载力总指数(98.33)明显高于无伴侣组(88.33)。结论:苏州失地农民老年人的养老负担较轻而家庭承载力较弱,家庭养老状况在不同人群特征的老年人中存在差异。应实施相应的助老政策和开展针对性的养老服务,以提升助老效果。

山西省人口老龄化时空特征分布研究

文章通过老龄化程度、老龄化速度、养老负担和老年人口空间分布四项指标,分析了山西省人口老龄化程度及地区差异后得出以下结论:第一,从1990年至2010年山西省各地区老龄化阶段呈现出从成年型到老年型逐步发展的趋势。第二,山西省人口老龄化的速度越来越快。第三,山西省人口老龄化具有不均衡的空间分布特征,中北部地区和南部的运城老龄化程度较为严重。第四,从老年人口密度指标衡量,2010年山西省大部分地区进入了低中密度地区,太原进入高密度地区,是养老基础设施建设的重点地区。

主观抽象证明责任的内核边界与适用空间

主观抽象证明责任本质在于要求当事人积极适时、全面完整地提供证据。未提供任何证据、提供证据有缺漏,都是违反主观抽象证明责任的表现。在我国立法规范与司法实务中,都有主观抽象证明责任的体现,只是从主观抽象证明责任视角解释问题的现象并不多见。主观抽象证明责任具有其内在的独立价值意义,其中一条即存在一个排除证据共通适用的重要公理。可证性审查正是一种契合主观抽象证明责任本质、保证证据调查必要性的案件处理技术,有利于保障主观抽象证明责任在实务中的运用空间。

网络服务提供者网络著作权侵权证明责任研究

通过对网络服务提供者进行界定,区分提供信息内容服务的网络服务提供者和提供技术服务的网络服务提供者,前者承担直接侵权责任,后者承担间接侵权责任和替代责任;进一步分析网络服务提供者直接侵权责任、间接侵权责任、替代责任的责任认定和侵权责任构成要件,以此来作为证明责任分配的基础。由此认为:第一,直接侵权责任构成要件包括行为、过错、损害和因果关系四要件,网络服务提供者仅就“合法来源”承担证明责任。第二,间接侵权责任构成要件包括行为、过错、损害和因果关系四要件,网络服务提供者就“过错”要件承担证明责任。第三,替代侵权责任构成要件包括行为、损害和因果关系,网络服务提供者不承担证明责任。第四,网络服务提供者就合理使用规则的两个判断要件承担证明责任。

管理规模和住房负担对公积金流动性的影响研究

选取我国83个城市2014~2017年的数据,研究管理规模和住房负担对公积金流动性的影响。结果表明:住房公积金流动性呈现出地区差异分化且不同城市之间差距严重等特征;全样本分析中,管理规模程度越高则公积金流动性压力越小,住房负担越重则公积金流动性压力越大;在分样本分析中,东部地区及一、二线城市的公积金流动性压力主要源于过高的住房负担,而中、西部地区及三、四线城市管理规模的提高会进一步降低城市的公积金流动性压力。

Genetic background of idiopathic neurodevelopmental delay patients with significant brain deviation volume

Background:Significant brain volume deviation is an essential phenotype in children with neurodevelopmental delay(NDD),but its genetic basis has not been fully characterized.This study attempted to analyze the genetic factors associated with significant whole-brain deviation volume(WBDV).Methods:We established a reference curve based on 4222 subjects ranging in age from the first postnatal day to 18 years.We recruited only NDD patients without acquired etiologies or positive genetic results.Cranial magnetic resonance imaging(MRI)and clinical exome sequencing(2742 genes)data were acquired.A genetic burden test was performed,and the results were compared between patients with and without significant WBDV.Literature review analyses and BrainSpan analysis based on the human brain developmental transcriptome were performed to detect the potential role of genetic risk factors in human brain development.Results:We recruited a total of 253 NDD patients.Among them,26 had significantly decreased WBDV(<-2 standard deviations[SDs]),and 14 had significantly increased WBDV(>+2 SDs).NDD patients with significant WBDV had higher rates of motor development delay(49.8%[106/213]vs.75.0%[30/40],P=0.003)than patients without significant WBDV.Genetic burden analyses found 30 genes with an increased allele frequency of rare variants in patients with significant WBDV.Analyses of the literature further demonstrated that these genes were not randomly identified:burden genes were more related to the brain development than background genes(P=1.656e^(-9)).In seven human brain regions related to motor development,we observed burden genes had higher expression before 37-week gestational age than postnatal stages.Functional analyses found that burden genes were enriched in embryonic brain development,with positive regulation of synaptic growth at the neuromuscular junction,positive regulation of deoxyribonucleic acid templated transcription,and response to hormone,and these genes were shown to be expressed in neural progenitors.Based on single cell sequencing analyses,we found TUBB2B gene had elevated expression levels in neural progenitor cells,interneuron,and excitatory neuron and SOX15 had high expression in interneuron and excitatory neuron.Conclusion:Idiopathic NDD patients with significant brain volume changes detected by MRI had an increased prevalence of motor development delay,which could be explained by the genetic differences characterized herein.