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1.  Isolated locoregional recurrence patterns of breast cancer after mastectomy and adjuvant systemic therapies in the contemporary era 
Oncotarget  2015;6(34):36860-36869.
To evaluate the recurrence patterns in a series of patients who presented with isolated locoregional recurrences (ILRRs) after mastectomy and adjuvant systemic therapies in the contemporary era.
A total of 235 patients who developed ILRRs between 2005 and 2013 were classified into subgroups based on nodal status, hormone receptor status, and biologic subtype. The annual frequency of recurrences, association between biologic subtype and interval to recurrence (ITR), and anatomical distribution were evaluated.
For the entire group, recurrence peaked within the first 3 years after mastectomy, and then decreased significantly with time. Node-positive patients were observed to recur early, and a greater proportion recurred within 5 years (86.7% vs. 72.8%, χ2 = 6.83, P = 0.008) than did node-negative subgroup. Overall, the median ITR was 33.2 (range, 4.5 – 236) months. Biologic subtype specific median ITR were 43.3 (7.9 – 236.0) months for luminal A, 42.2 (6.1 – 143.3) months for luminal B, 23.8 (6.9 – 47.3) months for luminal HER2, 18.2 (6.6 – 117.5) months for HER2, and 21.8 (4.5 – 138.2) months for TNBC, and their difference was statistically significant (χ2 = 7.4, P = 0.001). Among all ILRRs, 51.5% (n = 121) were isolated to regional nodes.
We demonstrates that the time course is consistent with previous description, biologic subtype is associated with ITR, and regional nodes is the most common place for recurrences in this series of patients who developed ILRRs following mastectomy and contemporary adjuvant systemic therapies but without PMRT.
PMCID: PMC4742215  PMID: 26416456
breast cancer; mastectomy; isolated locoregional recurrence; recurrence pattern; biologic subtype
2.  Relationships between actual and desired workplace characteristics and job satisfaction for community health workers in China: a cross-sectional study 
BMC Family Practice  2014;15:180.
Community health workers are the main providers of community health services in China and have been important in the process of health system reform that has been in place since 2009. Therefore, it is critical that healthcare managers and policy decision makers motivate current staff and improve their job satisfaction. This study examined workplace characteristics and their contribution to job satisfaction in community health workers in Heilongjiang Province, China.
A cross-sectional survey of 448 community health workers, from three cities in Heilongjiang province, was conducted between October 1, 2012 and December 31, 2012. Multistage sampling procedures were used to measure socioeconomic and demographic status, job satisfaction, and both actual and desired workplace characteristics. Factor analysis was conducted to determine the main factors contributing to workplace characteristics, and multiple linear regression analysis was performed to assess the key determinants of job satisfaction.
Eight groups of factors were identified as the most important workplace characteristics. These comprised system and policy; fringe benefits; work itself; work relationships; professional development; recognition; work environment; and remuneration. In all cases, all desired workplace characteristics were higher than the associated actual workplace characteristics. The main determinants of job satisfaction were occupation, years worked in health service institution, and five subscales representing the gap between desired and actual workplace characteristics, which were system and policy; fringe benefits; working relationship; professional development; and remuneration.
These findings suggested that managers wishing to enhance job satisfaction should assess workplace characteristics comprehensively and design mechanisms that reduce the gap between actual and desired workplace characteristics.
PMCID: PMC4240823  PMID: 25403924
Actual workplace characteristics; Desired workplace characteristics; Job satisfaction; China
3.  Claims, liabilities, injures and compensation payments of medical malpractice litigation cases in China from 1998 to 2011 
Although China experienced great improvement in their health system, disputes between patients and doctors have increasingly intensified, reaching an unprecedented level. Retrospective analysis of medical malpractice litigation can discover the characteristics and fundamental cause of these disagreements.
We analyzed medical malpractice litigation data from 1998 to 2011 for characteristics of claims via a litigation database within a nationwide database of cases (1086 cases) in China, including claims, liabilities, injures, and compensation payments.
Among the cases analyzed, 76 percent of claims received compensation in civil judgment (640 out of 841), while 93 percent were fault liability in paid judgment (597 out of 640). The average time span between the occurrence of the injury dispute and closure of claims was 3 years. Twenty-two percent of claims (183 of 841) were caused by injury, poisoning, and other external causes. Seventy-nine percent of claims (472 of 597) were contributed to by errors in medical technology. The median damage compensation payment for death was significantly lower than for serious injuries (P < 0.001; death, $13270 [IQR, $7617–$23181]; serious injury, $23721 [IQR, $10367–$57058]). Finally, there was no statistically significant difference in the median mental compensation between minor injury, serious injury, and death (P = 0.836).
The social reasons for the conflict and high payment were catastrophic out-of-pocket health-care expense in addition to the high expectations for treatment in China. There were no distinguishing features between China and other countries with respect to time of suits, facilities, and specialties in these claims. The compensation for damages in different medical injuries was unfair in China.
PMCID: PMC4261607  PMID: 25218509
Claims; Compensation; Medical malpractice; Medical litigation
4.  Work stress, work motivation and their effects on job satisfaction in community health workers: a cross-sectional survey in China 
BMJ Open  2014;4(6):e004897.
It is well documented that both work stress and work motivation are key determinants of job satisfaction. The aim of this study was to examine levels of work stress and motivation and their contribution to job satisfaction among community health workers in Heilongjiang Province, China.
Cross-sectional survey.
Heilongjiang Province, China.
The participants were 930 community health workers from six cities in Heilongjiang Province.
Primary and secondary outcome measures
Multistage sampling procedures were used to measure socioeconomic and demographic status, work stress, work motivation and job satisfaction. Logistic regression analysis was performed to assess key determinants of job satisfaction.
There were significant differences in some subscales of work stress and work motivation by some of the socioeconomic characteristics. Levels of overall stress perception and scores on all five work stress subscales were higher in dissatisfied workers relative to satisfied workers. However, levels of overall motivation perception and scores on the career development, responsibility and recognition motivation subscales were higher in satisfied respondents relative to dissatisfied respondents. The main determinants of job satisfaction were occupation; age; title; income; the career development, and wages and benefits subscales of work stress; and the recognition, responsibility and financial subscales of work motivation.
The findings indicated considerable room for improvement in job satisfaction among community health workers in Heilongjiang Province in China. Healthcare managers and policymakers should take both work stress and motivation into consideration, as two subscales of work stress and one subscale of work motivation negatively influenced job satisfaction and two subscales of work motivation positively influenced job satisfaction.
PMCID: PMC4054641  PMID: 24902730
Public Health
5.  Antimicrobial activity of bacteriocin-producing lactic acid bacteria isolated from cheeses and yogurts 
AMB Express  2012;2:48.
The biopreservation of foods using bacteriocinogenic lactic acid bacteria (LAB) isolated directly from foods is an innovative approach. The objectives of this study were to isolate and identify bacteriocinogenic LAB from various cheeses and yogurts and evaluate their antimicrobial effects on selected spoilage and pathogenic microorganisms in vitro as well as on a food commodity.
LAB were isolated using MRS and M17 media. The agar diffusion bioassay was used to screen for bacteriocin or bacteriocin-like substances (BLS) producing LAB using Lactobacillus sakei and Listeria innocua as indicator organisms. Out of 138 LAB isolates, 28 were found to inhibit these bacteria and were identified as strains of Enterococcus faecium, Streptococcus thermophilus, Lactobacillus casei and Lactobacillus sakei subsp. sakei using 16S rRNA gene sequencing. Eight isolates were tested for antimicrobial activity at 5°C and 20°C against L. innocua, Escherichia coli, Bacillus cereus, Pseudomonas fluorescens, Erwinia carotovora, and Leuconostoc mesenteroides subsp. mesenteroides using the agar diffusion bioassay, and also against Penicillium expansum, Botrytis cinerea and Monilinia frucitcola using the microdilution plate method. The effect of selected LAB strains on L. innocua inoculated onto fresh-cut onions was also investigated.
Twenty percent of our isolates produced BLS inhibiting the growth of L. innocua and/or Lact. sakei. Organic acids and/or H2O2 produced by LAB and not the BLS had strong antimicrobial effects on all microorganisms tested with the exception of E. coli. Ent. faecium, Strep. thermophilus and Lact. casei effectively inhibited the growth of natural microflora and L. innocua inoculated onto fresh-cut onions. Bacteriocinogenic LAB present in cheeses and yogurts may have potential to be used as biopreservatives in foods.
PMCID: PMC3488010  PMID: 22963659
Lactic acid bacteria; Bacteriocins; Bacteriocin-like substance (BLS); Antimicrobials; Fresh-cut onions

Results 1-5 (5)