ObjectiveTo understand patients’ cognition of third-party mediation model for medical disputes, analyze the factors influencing the trust of patients on third-party mediation, and propose recommendations for building third-party mediation mechanisms. MethodsFrom November 2013 to April 2014, we referred past literature to design a relevant questionnaire on the cognition of third-party mediation for medical disputes. Patients who had reached the end of the treatment were surveyed by random cluster sampling. The raw data were put into the computer for statistical analysis by SPSS 18.0. ResultsAfter giving out 500 questionnaires, we acquired 486 effective questionnaires. The result showed that 61.52% of the patients knew of third-party mediation; 55.35% of the patients considered that thirdparty mediation should be set in and supervised by the court or judicial administrative department; if the mediation failed, 57.41% of the patients chose to resolve the dispute through legal channels, and 67.90% of the patients tended to confirm the force of mediation conclusion by arbitration; 70.58% of the patients considered that mediators should have professional background of medicine and law; 73.05% of the patients tended to take conclusions of forensic identification as the basis for mediation; 64.81% of the patients were biased to take Tort Liability Act as the basis for determining the compensation; 53.70% of the patients believed that financial allocations could solve the fund problems of third-party mediation, while 38.48% of the patients thought the funds should be provided by insurance companies; 91.15% of the patients thought the medical institutions should purchase medical liability insurance, and 54.32% of the patients thought insurance companies should not intervene the process of meditation. Conclusions Government should provide financial allocations to ensure the funds of third-party mediation. Besides, medical insurance should be brought in as a supplement. Medical institutions should purchase medical liability insurance to solve problems caused by medical disputes. Third-party mediation should be set in and supervised by the court or the judicial administrative department. Mediators should have professional background of medicine and law. Conclusions of forensic identification should be the basis for third-party mediation.
Objective To explore the causal relationship between DNA copy number and the risk of Alzheimer disease (AD) using Mendelian randomization (MR) methods, as well as to investigate the potential mediating effects of immune cells. Methods The data related to 731 immune cell types, DNA copy number and AD from the Genome-Wide Association Study database were collected. A bidirectional MR analysis was conducted to explore the causal relationship between DNA copy number and AD, primarily using the inverse-variance weighted method and MR-Egger method. Additionally, a two-step mediation analysis was performed to identify potential mediating immune cells. Results A total of 134 single-nucleotide polymorphisms were included for bidirectional MR analysis. The MR methods results showed a negative causal relationship between DNA copy number and the risk of AD (P<0.05), while the reverse analysis showed no statistical significance. Sensitivity analysis confirmed the robustness of these results. The mediation analysis indicated that the immune cell phenotype (HVEM on CD45RA-CD4+) partially mediated the causal relationship between DNA copy numbers and the risk of AD, with a mediation effect proportion of 4.6%. Conclusion An increase in DNA copy numbers may reduce the risk of AD, and immune cells partially mediate this causal relationship.
Objective To explore the mediating role of activities of daily living and sleep duration in the relationship between pain and depressive symptoms in lung cancer patients undergoing chemotherapy, and to provide suggestions for improving the well-being of cancer patients. Methods Using convenience sampling, middle-aged and elderly lung cancer patients receiving postoperative chemotherapy at the First Affiliated Hospital of Soochow University were selected as the study subjects between January and December 2024. Data were collected using a general information questionnaire, the Numerical Pain Rating Scale, the Center for Epidemiological Studies Depression Scale, and the activities of daily living Scale. Results A total of 252 patients were included. The depression score of lung cancer chemotherapy patients was (20.05±15.73) scores. Pain was positively correlated with activities of daily living and depression (P<0.001) and negatively correlated with sleep duration (P<0.001). The mediating effects of activities of daily living and sleep duration between pain and depression were significant, with simple mediating effects of 0.252 [95%CI (0.044, 0.494)] and 0.127 [95%CI (0.010, 0.281)], respectively. The chain mediating effect was 0.039 [95%CI (0.002, 0.105)]. The total mediating effect value was 0.418, accounting for 33.2% of the total effect. Conclusions The incidence of depression is high among middle-aged and elderly lung cancer patients undergoing chemotherapy. Activities of daily living and sleep duration play a chain mediating role between pain and depression. The mental health of lung cancer chemotherapy patients should be emphasized at different levels. Multi-faceted psychological interventions and emotional support should be implemented to effectively improve their depressive symptoms and enhance their well-being.
Objective To investigate the prevalence characteristics of psychotic-like experiences (PLE) in adolescents and to explore the mechanisms through which sleep quality, anxiety, and depression affect PLE, with a specific focus on testing the parallel mediating roles of anxiety and depression in the relationship between sleep quality and PLE. Methods Students from three grades of high schools in Zhongshan City of Guangdong Province were selected in May 2024. Assessments were conducted using the Community Assessment of Psychic Experiences, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7. Parallel mediation analysis was performed using Structural Equation Modeling. Results A total of 4009 students were surveyed. Among them, there were 1963 male students and 2046 female students. The average age was (16.83±1.08) years old. PLE was widespread among adolescents and their distribution was significantly influenced by demographic characteristics and multi-dimensional risk factors. PLE was positively associated with sleep quality, anxiety, and depressive symptoms (P<0.01). The mediation model showed that sleep quality not only directly and positively predicted PLE (β=0.115, P<0.001), but also had a significant indirect impact on PLE through the mediating paths of anxiety (β=0.560, P<0.001) and depression (β=0.623, P<0.001). Both anxiety (β=0.359, P<0.001) and depression (β=0.277, P<0.001) could predict PLE, but the effect of anxiety was stronger. The effect decomposition indicated that the total indirect effect far exceeded the direct effect. Both the mediating paths of “sleep quality → anxiety → PLE” and “sleep quality → depression → PLE” were significant. Conclusions PLE among adolescents is influenced by multi-dimensional risk factors and is closely related to sleep and emotional problems. Sleep quality not only directly predicts PLE, but more importantly, indirectly affects PLE through the parallel mediating paths of anxiety and depression, with the “sleep quality → anxiety → PLE” path having a stronger effect. Measures such as improving sleep and anxiety can be selected as potential entry points to interrupt the development path of PLE, which is conducive to early identification and intervention of PLE in adolescents.