ObjectiveTo explore the current situation， causes， and countermeasures of medical disputes in a tertiary A comprehensive hospital in Xi’an from 2018 to 2023. MethodsA total of 804 medical dispute cases that had been processed in a tertiary A hospital in Xi’an from January 2018 to December 2023 were collected. The occurrence， current characteristics， and cause distribution of medical disputes were retrospectively analyzed. ResultsThe cumulative incidence rate of medical disputes was 4.408/100，000， and the compensation rate was 31.59% （254/804）. The incidence and compensation rate of medical disputes showed an overall increasing trend year by year from 2018 to 2023 （P<0.05）. The proportion of deceased patients in dispute cases in the past 6 years showed an increasing trend annually （χ²=30.396， P=0.011）. Medical dispute cases mainly came from hospitalized patients （65.17%） and patients undergoing surgical treatment （55.35%）， and the top five departments with medical dispute cases were the hepatobiliary surgery department， cardiovascular medicine department， obstetrics and gynecology department， emergency department， and gastroenterology department. The number of in-hospital mediations showed a decreasing trend annually， while the number of people’s mediations showed an increasing trend annually from 2018 to 2023 （χ²=34.523， P<0.001）. The top five causes of medical disputes in this hospital were surgical/operational complications （29.10%）， disease condition assessment/disease diagnosis （10.45%）， diagnosis and treatment plan （9.45%）， diagnosis and treatment effectiveness （8.83%）， and medical insurance reimbursement （7.59%）. ConclusionThe number of medical disputes and compensation cases in comprehensive hospitals is increasing annually， and high-risk departments such as the surgical department and emergency department need to be given high attention. The handling of medical disputes has shown diversification， with people’s mediation gradually taking the dominant position. The causes of medical disputes mainly concentrated on diagnosis and treatment technology， doctor-patient communication， medical insurance， and other aspects. It is necessary to continuously improve the level of clinical diagnosis and treatment technology， strengthen doctor-patient communication， improve the medical insurance system， strengthen hospital connotation management， alleviate doctor-patient conflicts， and builds a harmonious doctor-patient relationship.

Objective: To systematically review the development and changes in mental health policies within the National Outline for Children s Development in China from 1992 to 2030, providing a reference basis for future formulation of mental health policies among children and adolescent in China. Methods: Based on the four editions of the National Outline for Children s Development in China across different periods from 1992 to 2030, word frequency analysis was used to reveal shifts in policy priorities, and an internationally recognized framework for adolescent health policy analysis was applied to conduct a textual review. Results: Word frequency analysis revealed that the term "psychological" appeared 6 times in the National Outline for Children s Development in China (2001-2010) but increased to 20 times in the National Outline for Children s Development in China (2021-2030) (abbreviated as the National Outline of 2021), while the term "health" rose from 4 times in the National Outline for Children s Development Plan in China in the 1990s to 68 times in the National Outline of 2021. The scope of mental health policy interventions expanded to encompass five key areas:health, safety, education, welfare and legal protection. Textual analysis highlighted that the policies of the National Outline for Children s Development in China were demand driven, prioritized vulnerable groups and continuously broadened their coverage, emphasizing sustainability and appropriateness, and monitoring/evaluation mechanisms. By 2023, 42.3% of primary schools and 64.8% of secondary schools employed full time mental health education teachers. However, the National Outline for Children s Development in China lacked direct evidence of children and adolescents participation in policy formulation, and publicly available mental health data disaggregated by age and gender remained limited. Conclusion Mental health policies of children and adolescents in China have evolved from nonexistence to gradual refinement, yet institutionalized channels for youth involvement in policy development and evaluation remain insufficient, and transparency in age and gender specific mental health data needs improvement.

Objective Triple-negative breast cancer(TNBC)poses a significant challenge for treatment efficacy.CD8+T cells,which are pivotal immune cells,can be effectively analyzed for differential gene expression across diverse cell populations owing to rapid advancements in sequencing technology.By leveraging these genes,our objective was to develop a prognostic model that accurately predicts the prognosis of patients with TNBC and their responsiveness to immunotherapy. Methods Sample information and clinical data of TNBC were sourced from The Cancer Genome Atlas and METABRIC databases.In the initial stage,we identified 67 differentially expressed genes associated with immune response in CD8+T cells.Subsequently,we narrowed our focus to three key genes,namely CXCL13,GBP2,and GZMB,which were used to construct a prognostic model.The accuracy of the model was assessed using the validation set data and receiver operating characteristic(ROC)curves.Furthermore,we employed various methods,including Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway,immune infiltration,and correlation analyses with CD274(PD-L1)to explore the model's predictive efficacy in immunotherapeutic responses.Additionally,we investigated the potential underlying biological pathways that contribute to divergent treatment responses. Results We successfully developed a model capable of predicting the prognosis of patients with TNBC.The areas under the curve(AUC)values for the 1-,3-,and 5-year survival predictions were 0.618,0.652,and 0.826,respectively.Employing this risk model,we stratified the samples into high-and low-risk groups.Through KEGG enrichment analysis,we observed that the high-risk group predominantly exhibited enrichment in metabolism-related pathways such as drug and chlorophyll metabolism,whereas the low-risk group demonstrated significant enrichment in cytokine pathways.Furthermore,immune landscape analysis revealed noteworthy variations between(PD-L1)expression and risk scores, Conclusion Our study demonstrates the potential of CXCL13,GBP2,and GZMB as prognostic indicators of clinical outcomes and immunotherapy responses in patients with TNBC.These findings provide valuable insights and novel avenues for developing immunotherapeutic approaches targeting TNBC.

Objective:To explore whether the degree of skeletal muscle atrophy in obese individuals under the influence of colorectal cancer is more severe than that in non-obese individuals.Methods:The clinical data of patients who underwent radical resection of colorectal cancer in our department from Jul 2020 to Dec 2021 was collected. Sixty-four obese patients were included and 64 non-obese patients were matched according to propensity score. At the same time, 51 obese patients were collected from non-tumor patients and matched with 51 non-obese patients. The psoas muscle index (PMI) of included patients was analyzed and compared.Results:The PMI of patients with colorectal cancer was significantly lower than that of corresponding non-tumor patients, regardless of gender and body weight (both P<0.05). The PMI of obese patients with colorectal cancer was significantly lower than that of non-obese patients ( P<0.05). Conclusions:The impact of colorectal cancer on skeletal muscle atrophy in obese individuals is greater than that in normal weight individuals. Therefore, the skeletal muscle status of obese patients with colorectal cancer should be evaluated more comprehensively.

The patient was a 29-year-old male with a history of hemophilia for more than 10 years. After 6 hours of botulinum toxin injection into the masseter muscle, the redness and swelling of the right face gradually worsened, accompanied by local pain, and restricted mouth opening, etc. The hematoma was absorbed and the swelling subsided significantly after the infusion of coagulation factor Ⅸ. Such cases of large-scale hematomas after botulinum toxin injection in hemophiliacs is rarely reported. This article summarized the diagnosis and treatment process of this case and combines with literature review to provide clinical experience for diagnosis, treatment and prevention of similar complications.

The patient was a 29-year-old male with a history of hemophilia for more than 10 years. After 6 hours of botulinum toxin injection into the masseter muscle, the redness and swelling of the right face gradually worsened, accompanied by local pain, and restricted mouth opening, etc. The hematoma was absorbed and the swelling subsided significantly after the infusion of coagulation factor Ⅸ. Such cases of large-scale hematomas after botulinum toxin injection in hemophiliacs is rarely reported. This article summarized the diagnosis and treatment process of this case and combines with literature review to provide clinical experience for diagnosis, treatment and prevention of similar complications.

Objective:To analyze the terminal survey data of hospice care services in a district of Beijing in 2020, and discuss its current situation and existing problems of hospice care services in this district for countermeasures, hence providing reference for the development of hospice care services.Methods:Data were collected from the " Terminal Survey Forms of the Second Batch of Hospice Care Pilot Areas in China in 2020" , which were reported by 4 tertiary hospitals and 5 community health service centers in a district of Beijing. The reporting timeframe ranged from January to December 2020. Text analysis method was used to analyze the hospice care mode, relevant security policies, hospice care team, case diagnosis categories, average hospitalization days and patient cost burden. All the data were subject to descriptive analysis.Results:In 2020, only 4 tertiary hospitals carried out outpatient, consultation and inpatient services of hospice care among the 9 medical institutions in a certain district of Beijing, and none of them carried out home hospice care services. The number of doctors and nurses engaged in hospice care in the four hospitals was 35 and 40 respectively; There were 267 inpatient cases of hospice care, including 121 cases of malignant tumors, accounting for 45.32%; The average hospitalization days of hospice patients (40.0 days) was more than that of the hospital (7.8 days); The average daily hospitalization cost of hospice patients (3 428.7 yuan) was lower than that of the hospital (3 605.6 yuan); Hospice care services had not been included in the scope of medical insurance payment, and the relevant security policies were not perfect.Conclusions:The work of hospice care service in a district of Beijing remains at an initial stage, and the professional team building and supporting policies for hospice care fail to catch up with the demand in this district. The authors suggest to speed up the development of hospice care in primary medical institutions, build a network of " hospital -community-family" levels, enhance training of professionals and technical personnel of hospice care, as well as establish and improve the medical security system, so as to promote the rapid development of hospice care services in this district.

Background Sleep disorders in occupational groups will seriously affect their physical and mental health and work efficiency. Oil workers are a special occupational group, and their working environment factors may lead to occupational stress and job burnout, and the occurrence of sleep disorders. Objective To investigate the current situation of sleep disorders in oil workers and analyze the the effects of occupational stress, job burnout, and their interactions on sleep disorders. Methods From May to November 2019, 2300 oil workers were selected by multi-stage cluster sampling, and their occupational stress, job burnout, and sleep disorders were evaluated using the Effort-Return Imbalance (ERI), the Maslach Burnout Inventory－General Survey, and the Pittsburgh Sleep Quality Index (PSQI). The influencing factors of sleep disorders were analyzed using binary logistic regression, and the effect of the interaction between occupational stress and job burnout on sleep disorders were evaluated after adjusting for selected confounding factors. Results Of the 2300 questionnaires distributed, after excluding invalid questionnaires, a total of 2060 questionnaires were valid and the valid recovery rate was 89.57%. There were 1069 males (51.89%) and 991 females (48.11%), and the average age was (40.89±8.22) years old. The prevalence rate of sleep disorders among the oil workers was 34.76%, and the differences among different gender, age, working age, type of work, shift system, education and marital status groups was statistically significant (P < 0.05); 986 (47.86%) workers experienced occupational stress, and the prevalence rates were higher in males (57.06%), age group ≥45 years (52.63%), technical secondary school and below education group (51.87%) ,working age group > 15 years (50.47%), oil transportation workers (50.95%), shift workers (56.34%), and workers with a monthly income > 4000 yuan (51.70%); 1749 workers (84.90%) experienced job burnout, of which the prevalence rate of moderate burnout was higher (50.68%). Except the subjective sleep quality of oil workers between different occupational stress groups (Z=−1.02, P=0.308), the total score of PSQI and the scores of remaining dimensions were varied among different occupational stress and job burnout groups (P < 0.05). The results of multiple regression analysis found that being females, age ≥ 30 years, working age ≥ 15 years, oil transportation workers, shift work, severe burnout, and occupational stress were associated with an increased risk of reporting sleep disorders (P<0.05); the interaction between occupational stress and severe burnout led to a 11.403-fold increase in the risk of reporting sleep disorders (OR=11.403, 95% CI: 5.107-25.462). Conclusion Oil workers are experiencing poor sleep quality, and occupational stress, job burnout and their interaction would increase the risk of sleep disorders.

Background The occurrence of musculoskeletal disorders in coal mine workers remains high, and psychological factors are one of the important factors. Objective To explore the occupational stress level, mental health status, and prevalence of work-related musculoskeletal disorders (WMSDs) of coal miners in Xinjiang, and to analyze the effects of occupational stress and mental health on WMSDs. Methods From August 2018 to August 2019, 1300 workers of 4 coal mines were selected by cluster sampling method. Musculoskeletal Disorders Questionnaire, Effort-Reward Imbalance (ERI) Scale, Self Reporting Inventory (SCL-90) were used to investigate the prevalence of WMSDs, occupational stress, and mental health. Results A total of 1177 valid questionnaires were collected, with a valid rate of 90.5%. The prevalence rate of WMSDs was 66.4%, the positive rate of occupational stress was 50.2%, and the positive rate of psychological symptoms was 53.4%. The M (P₂₅, P₇₅) ERI score was 1.0 (0.9,1.2), and the M (P₂₅, P₇₅) SCL-90 score was 138.0 (117.0,184.0). The prevalence rate of WMSDs in ≥3 sites was 45.0% in the occupational stress group and 46.0% in the positive psychological symptoms group. The results of binary logistic regression analysis showed that reporting occupational stress (OR=1.835, 95%CI: 1.380-2.440) and positive psychological symptoms (OR=1.461, 95%CI: 1.083-1.969) were positively associated with the prevalence of WMSDs; those being female (OR=2.393, 95%CI: 1.544-3.709), aged≥30 years (OR_30-＜40=2.344, 95%CI: 1.507-3.645; OR_40-＜50=2.395, 95%CI: 1.541-3.723; OR_50-60=5.115, 95%CI: 2.872-9.111), with length of service>15 years (OR=2.283, 95%CI: 1.537-3.392), and being coal diggers (OR=1.591, 95%CI: 1.070-2.365) showed higher risks of reporting WMSDs; those with education level at high school and above (OR_{high school}=0.399, 95%CI: 0.279-0.571; OR_{college and above}=0.220, 95%CI: 0.157-0.310), and monthly income>8000 yuan (OR=0.364, 95%CI: 0.227-0.582) showed lower risks of reporting WMSDs. The results of structural equation model showed that in model 1 with mental health as the intermediate variable, occupational stress and mental health directly affected WMSDs, and the standardized path coefficients (β) were 0.10 and 0.25 respectively; ERI also directly affected mental health with a β of 0.20. In model 2 with WMSDs as the intermediate variable, ERI and WMSDs directly affected mental health, and the β values were 0.16 and 0.25 respectively; ERI also directly affected WMSDs with a β of 0.16. Conclusion The prevalence rate of WMSDs in selected coal mine workers is high, and occupational stress and mental health affect the occurrence of WMSDs.

Background The highly prevalent of occupational stress and job burnout of coal miners seriously affect their physical and mental health. Objective To investigate the levels of occupational stress and job burnout in coal mine workers, and to analyze the mediating effect of work-family conflict between these two conditions. Methods A total of 1500 coal miners were included by random cluster sampling method from February to October 2019. The levels of occupational stress, work-family conflict, and job burnout of the study participants were evaluated using the Effort-Reward Imbalance Inventory scale (ERI), the Work-Family Conflict Scale, and the Chinese version of the Burnout Scale, and compared among coal miners with different demographic characteristics. Partial correlation analysis was used to find the correlations between indicators; SPSS AOMS 26.0 software was used to analyze the potential mediating effect among occupational stress, work-family conflict, and job burnout in the coal miners in Xinjiang. Results The study included 1247 male coal miners with a valid questionnaire return rate of 83.13%. The M (P₂₅, P₇₅) score of job burnout was 55.00 (47.00, 62.00). Except for gender and monthly income, the differences of job burnout scores among coal miners grouped with selected demographic characteristics were statistically significant (P<0.05). The M (P₂₅, P₇₅) scores of ERI and work-family conflict of coal miners were 1.01 (0.85, 1.21) and 51.00 (44.00, 57.00) respectively, and the differences of ERI and work-family conflict scores among different job types were statistically significant (P<0.05). ERI values were positively correlated with burnout (r_s=0.212), emotional exhaustion (r_s=0.188), and depersonalization (r_s=0.244) scores (all P<0.01); work-family conflict scores were positively correlated with burnout (r_s=0.382), emotional exhaustion (r_s=0.360), depersonalization (r_s=0.370), and reduced sense of accomplishment (r_s=0.105) scores (all P<0.01). The regression results showed a significant positive effect of occupational stress on job burnout and work-family conflict (b=7.117, b=8.347, P<0.001), and a mediating effect of work-family conflict on the association between occupational stress and job burnout, with a mediating effect value of 0.249 (50.92% of the total effect of 0.489, P=0.002). Conclusion Work-family conflict may act as a mediating role between occupational stress and job burnout in coal miners, which suggests an indirect effect on occurrence of job burnout.