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＂Our childhood is different＂ —— On the changes of children’s life in the 21st century

In the 21st century, China has rushed to the front of the locomotive of science and technology and entered the stage of rapid development.Children are the flowers of the motherland, and the changes of the times and the development of the motherland also change their growing environment.For more than 20 years from the Millennium to the present, the economic level has developed rapidly, and science and technology have been constantly innovated. The countless conveniences and problems that followed have also been projected in children’s childhood life. Over the past 20 years, we have gone from promoting the popularization of education to advocating reducing the burden of education, from worrying about children’s malnutrition to having to face the increasingly serious obesity problem. At the same time, countless questions have been thrown out-do children need cram schools? How should children use the Internet scientifically?How can children have a healthy and happy childhood?

We will focus on the changes in all aspects of children’s lives since the 21st century, find the gratifying development trend, analyze the exposed problems and put forward our suggestions.

I. Education

1. Compulsory education

A century-long plan, education-oriented. China began to implement compulsory education in 1986. In the 21st century, the popularity of education in China has been greatly improved. The enrollment rate of primary school-age children has remained above 99%, while the enrollment rate of primary schools has stabilized at around 98%.Reach the standard of universal compulsory education.

In the process of promoting the implementation and balanced development of compulsory education, all localities are actively adjusting the layout of primary and secondary schools, especially standardizing the layout of rural primary and secondary schools, reducing the number of primary schools and improving the quality of teaching.

Because of the decline in birth rate, the number of primary school students is declining.From 2001 to 2013, the decline rate was as high as 25.4%, and the number of students has rebounded since then. The number of primary schools decreased from 491,300 in 2001 to 160,100 in 2019, with a drop of 67.4%, much higher than the decline in the number of students.

At the same time, the quality of the teaching staff has been continuously improved, the teacher-student ratio has increased significantly, and the national education funding has increased synchronously with the economic development. All changes have proved that,China has entered a new stage of promoting the balanced development of compulsory education and promoting educational equity. The state attaches great importance to basic education and strives to give children a better education so that every child can enter the hall of knowledge.

Step 2 read

Books are the ladder of human progress. In the initial stage of life, reading more books and reading good books are conducive to children’s moral education, enlightenment and history.

Since the 21st century, the number and types of children’s books in China have increased by spurt, and it is no longer hard to find a book.In 2001, there were 7,255 kinds of children’s books, but in 2019, there were 43,712 kinds, about five times as many as in 2001. At present, China publishes more than 40,000 kinds of children’s books every year.The total publishing volume ranks first in the world and has reached a rich enough level.Children in the new century have more reading choices and can draw spiritual food at any time.

In 2009, the "National Reading Survey Report" included "the reading status of minors under the age of 18" in the survey scope for the first time. Comparing the two reports in 2009 and 2019, which were separated by 10 years, we can find that the number of minors aged 0-17 in China.The reading volume and reading rate of books have been greatly improved.. The reading volume of children aged 0-8 increased the most, from 3.85 to 9.54 books per year.Behind the growth of children’s reading figures, school guidance and family companionship are indispensable.

The reading situation of teenagers indicates the future civilization and ideological thickness of a nation to a certain extent.. In this era surrounded by electronic devices, it is necessary for creators and publishers to publish more high-quality books, parents and schools to guide children to develop good reading habits, and the whole society to create a good reading atmosphere.

Since the founding of New China 70 years ago, the strategic position of giving priority to the development of education in China has been gradually strengthened. Facing the new era, we expect China education to lead the realization of the goal of "two hundred years" and realize the Chinese dream of the great rejuvenation of the Chinese nation.Following the development trend of the times, China has been constantly rebuilding, adjusting and reforming the educational mechanism and system, independently exploring China’s educational model, and striving to create a better learning environment for every child and help them grow up.

Second, health

With the arrival of the new century, the flowers of the motherland have taken on a new look.The morphological development level of primary and middle school students in urban and rural areas in China has been continuously improved, and the health problems such as malnutrition that have plagued children in China for decades have been greatly improved, and the physical fitness and health status of Chinese students have generally improved. But at the same time, the worrying obesity rate, myopia rate and lack of sleep time are also increasing.

Step 1 change for the better

Over the past 20 years, the level of morphological development of primary and middle school students in urban and rural areas in China has been continuously improved.At the same time, children’s physiological development has changed, such as accelerated growth rate, improved growth level and early puberty development, especially in urban children. With the development of economy, the improvement of diet level and the change of concept in the new era, the variety of food on children’s table is more abundant.Malnutrition, which has plagued children in China for decades, has greatly improved.

"Civilization of its spirit, barbarism of its body."It has always been the goal pursued by school education. According to the results of previous national surveys on students’ physique and health released by the Ministry of Education, students’ physique and health in China have generally improved. In 2019, the excellent and good rate of students aged 6-22 nationwide reached 23.8%, which was significantly higher than in previous years. At the same time, the level of students’ vital capacity has risen in an all-round way, and the quality of primary and secondary school students’ flexibility, strength, speed and endurance has improved.

In recent 20 years, the improvement of students’ physique and health level is attributed to the joint action of economic development, policy guidance and home-school coordination.

2. There are still problems

Due to the profound changes in the dietary structure and lifestyle of children and adolescents in recent years, coupled with the heavy academic burden and the popularity of electronic products,The rate of overweight and obesity among children in China is rising rapidly, which has become an important public health problem threatening the physical and mental health of children in China.

At the same time,The myopia rate of children in China is also the highest in the world for a long time. The formation of "a big country with glasses" cannot be ignored.In recent years, the detection rate of poor eyesight among primary and middle school students in China remains high. From 2000 to 2014, the detection rate of poor eyesight in all age groups has increased, and it shows a trend of increasing with age. The main reasons for the rising incidence of myopia among teenagers are premature contact with electronic products in infancy, early time for teenagers to "touch the internet", increased time for using electronic products, and insufficient time for sleep and exercise.The key age stages of myopia prevention and control are kindergartens and primary schools.

In view of the increasingly serious situation of myopia among adolescents, the Ministry of Education, the Health and Health Commission and other departments attach great importance to the prevention and control of myopia among children and adolescents, and cooperate with many parties to promote related work, and have achieved certain results.In 2020, the overall myopia rate of children and adolescents in China is 52.7%, which is 0.9 percentage points lower than that in 2018, basically achieving the prevention and control goal of the Comprehensive Prevention and Control Plan for Myopia of Children and Adolescents, which is 0.5 percentage points lower every year.However, there is still a long way to go to get rid of the "myopic country" hat.

Since the new century, the social emphasis on education has invisibly increased the learning pressure for children.In the new century, children’s learning burden is heavier, sleep time is reduced, and homework time is seriously exceeded.

To this end, the state also attaches great importance to and tries to solve it.From 2004, when the Ministry of Education officially put forward the policy of "reducing the burden" to 2021, how to reduce the burden without reducing the quality has always been a hot issue in society.

Since the 1990s, China has formulated a series of policies to reduce the burden, but studentsThe school time shows a trend of decreasing first and then increasing, which seems to reflect the game between increasingly fierce educational competition and burden reduction.

At the same time, the school has lightened students’ schoolwork burden, and parents have added a new burden to their children after class. In addition to the homework that must be completed in class, the time spent by children on extracurricular tutoring has increased greatly, and extracurricular learning and tutoring have come from behind and become the main burden for students. Comparing the time for children to finish homework with the length of sleep, it is not difficult to find that,After-school study has seriously squeezed the sleep time of children..

Children’s health is an important cornerstone of national health. Since the beginning of the 21st century, children’s growing environment has changed dramatically. While some chronic diseases have been solved, new problems have emerged. The state has been paying close attention to children’s health status, and timely issued guiding policies and opinions to protect children’s healthy growth.

Third, entertainment

Every child’s most hopeful moment should be when the school bell rings. It was the most carefree time, whether it was playing with friends in twos and threes after school, lingering in a snack bar filled with snacks, or trying the Internet in a novel way … The entertainment time in childhood will definitely leave traces in children’s hearts.

1. Internet

After the Millennium, children met the wave of internet popularization.In 1994, the Internet was connected to China, and then it developed with irresistible momentum. From 2002 to 2020, the number of netizens in China increased from 59 million to 989 million, and the internet penetration rate increased from 4.6% to 70.4%, especially in the two time periods of 2006-2010 and 2015-2020.

The constantly updated electronic equipment provides more options for their after-school entertainment.The Internet and electronic equipment have left a strong impression in the post-00′ s life and reflected the characteristics of the times.

In 2010, the Internet penetration rate in China has just exceeded 1/3, and children have little access to the Internet. At that time, only 13.5% of children were under the age of 6, while as many as 43.7% opened the door to the information world after the age of 10. Ten years later, the situation has changed dramatically. The proportion of children under the age of 6 who touch the internet has doubled, while the number of people who use the internet after the age of 10 has been greatly reduced to 13.6%. This shows that most "post-00" students skillfully shuttled between major websites as early as primary school.

Internet has become an inseparable part of children’s lives, and the problem of how to guide minors to use the Internet scientifically is also in front of everyone.Thanks to the joint efforts of the state, schools and parents, the entertainment function of the Internet has weakened in recent years, while the educational function has been significantly enhanced, and online education has developed rapidly during the epidemic. At the same time, in the new era, children’s single online time is becoming more and more reasonable, but the online frequency is greatly increased and the overall online time is prolonged.More scientific and technological inventions in the future will also bring about changes in children’s lifestyles. How to foster strengths and avoid weaknesses and use them scientifically? The general trend of the times gives the direction.

2. pocket money

Every child has a treasure-piggy bank.With the development of economy, the consumption level of children in China has also improved obviously, and children’s wallets are "bulging" day by day.

However, the increase in the amount of discretionary money does not seem to have caused children to fall into a frenzy of consumption. From 2005 to 2015, except for the snack consumption, which increased by 2%, other consumption showed a downward trend.Children in the new era have a strong sense of saving.51.5% people have made the choice of saving money, and the proportion has been soaring in recent years. In contrast, only 16.6% of the "post-90 s" children choose to save pocket money. Although "post-00" people’s awareness of deposit has increased, their awareness of donation has declined.This shows that with the development of the times, children’s self-awareness and individual awareness are constantly strengthened. How to help children establish a correct view of money and cultivate the values of "everyone for me and I for everyone" still needs further efforts.

Since the reform and opening up, children’s social environment has been actively improved and optimized, but there are still many problems, especially in children’s recreational life, which plays an important and special role in children’s growth. Science and technology are changing with each passing day, and policies should also keep up with the ever-changing reality.The mixed voice of appeals, cheers and controversies urges us to sum up past experience and study the current situation in order to have a better future.

The children’s development policy formulated by the national government is the policy and code of action to promote children’s development, which determines the direction of children’s development in a country.In the World Declaration on the Survival, Protection and Development of Children, the United Nations pointed out: "The happiness of children needs a higher level of policy action."

China government attaches great importance to children’s survival, health and development, pays close attention to the constantly developing actual situation and emerging new problems, improves children’s policies with the times, and formulates forward-looking national policies to promote the development of children’s cause. Through the actions of the government and society, the basic system and action system for protecting children’s rights have been established. From the education problems of hundreds of millions of children to myopia and internet addiction prevention, the state has propped up a huge "umbrella" for all aspects of children’s lives, protecting the seedlings of the motherland from growing sturdily.

Basic education has been fully popularized, but excessive training has also brought a heavy burden. The rapid development of the Internet has changed the traditional way of learning and entertainment, and contributed a large number of diverse cultural resources. However, like Pandora’s box, it has also caused many problems such as "Internet addiction" and "myopia rate". Education, diet, electronic equipment …All aspects of rapid development allow children to enjoy abundant material conditions that children have never had before, and also create conditions for them to fully release their potential, so that children can stand higher and see farther, but at the same time they are confined to a test paper, a screen and an unhealthy body.

In a blink of an eye, "post-90s" has become the backbone of the society, and "post-00" has gradually entered the threshold of adulthood, and the childhood of "post-10s" and "post-20s" continues. The times follow their own trajectory and rush to a more colorful future at a high speed. The "red" and "black" left on the way are all splashed with ink in children’s childhood. From the different childhood trajectories of "post-90s" to "post-00s", we can sum up the gratifying development trend, guide the future development of children, and even sum up the problems and hidden dangers, intervene and solve them as soon as possible, so as to better implement the principle of giving priority to children.

In order to give children a healthy and happy childhood, China has made many beneficial attempts, and children’s living standards have been greatly improved. We should also learn from setbacks, face problems squarely and try to solve them. There is still a long way to go …

Note: the age definition of "children"

Article 1 of the 1989 Convention on the Rights of the Child stipulates that a minor is anyone under the age of 18. Minors are children. The Law of People’s Republic of China (PRC) on the Protection of Minors promulgated in 1991 defines the age of minors, that is, children, as 0-18 years old (excluding 18 years old). This time, we define the age of "children" as 0-17 (one year old), which is consistent with the international standards and the policy documents issued by the China government. In this article, we will mainly focus on school-age children aged 6-14.

Data source:

[1] http://www.stats.gov.cn/, National Bureau of Statistics

[2] China Press and Publication Research Institute "China National Reading Survey Report"

[3] National Physical Fitness Monitoring Center "National Physical Fitness Monitoring Bulletin"

[4]CNNIC Statistical Report on Internet Development in China (2002-2020)

[5] The Ministry of Youth Rights and Interests of the Central Committee of the Communist Youth League, China Internet Network Information Center (CNNIC) and China Youth New Media Association jointly issued "The Status of Internet Use for Minors in 2020".

[6] The Institute of Journalism and Communication of China Academy of Social Sciences, the School of Journalism and Communication of China Academy of Social Sciences, and Social Science Literature Publishing House jointly published "Blue Book for Teenagers: Report on Internet Use of Minors in China (2021)".

[7] The "National Survey on Learning Stress of Primary and Secondary School Students" was released by the artificial intelligence education platform for primary and secondary schools.

[8] Announcement of the Ministry of Education on the results of the national survey on students’ physique and health in 2005

http://www.moe.gov.cn/srcsite/A17/moe_943/moe_947/200705/t20070522_80580.html

[9] Announcement of the Ministry of Education on the results of the 2010 national survey on students’ physique and health

http://www.moe.gov.cn/srcsite/A17/moe_943/moe_947/201108/t20110829_124202.html

[10] Wang Xiuping: "40 years of children’s development in China", China Social Sciences Press, 2020.

[11] Song Yanhui, Zhang Shengqin: "The Changing Trend of Internet Use of Minors (2009 ~ 2013)", Social Science Literature Publishing House, 2014.

[12] Zhang Xudong, Sun Hongyan, Zhao Xia: From "After 90" to "After 00": Investigation Report on Children’s Development in China, China Youth Research, 2017(2)

　

References:

People’s Daily reports: 70 years of educational reform and development is magnificent | Celebrating 70 years of achievements, 2019.

　

Team member: School of Journalism and Information Communication, Huazhong University of Science and Technology Xu Xinyan Li Ning Zhou Ji Zhao Xiangjing

Instructor: Xu Di, School of Journalism and Information Communication, Huazhong University of Science and Technology

(Cover drawings, fonts and some materials come from the butter camera material library &Canva can be painted, and the copyright belongs to the original creator. If there is any infringement, please contact to delete it.)

New issue of Reading ｜ Wang Yifang： Welfare of Disease

Original Wang Yifang reading magazine

editorial comment/note

Diseases, especially malignant diseases, are hard to avoid in everyone’s life. The author advocates that when this happens, we should still be optimistic, and at this moment, the society should be equipped with a channel of "hospice care" to effectively improve the quality of life of patients. This is an appeal for "hospice care", which is a relatively missing part of our national medical system and deserves attention from all sides.

Welfare of disease

Wen | Wang Yifang

(The third issue of Reading in 2024)

When talking about the welfare of diseases, people will naturally bypass the disease itself and point to the miracle of modern medical care or the increasingly perfect insurance system. In fact, without disease and suffering, medical benefits will not be born automatically, and the love and care parallel to medical benefits will be eclipsed. This is clearly a kind of "paper clip effect" welfare. The initial port can be traced back to the independent reflection and collective response of diseases. If we glance into the deep well of philosophy, it is a reflection and awe of patients’ subjectivity.

Hospice Care (Source: stchristophers.org.uk)

It was an American community doctor who first made me understand this bitter philosophy. More than 20 years ago, I visited the United States. On the way, I suffered from a bad cold, fever, cough and sore throat, and I was sore all over. So, I hurried to choose a doctor for treatment. The general practitioner, who was nearly half a century old, enthusiastically accepted me. After some consultation, he didn’t prescribe medicine for me. His belief was that the common cold didn’t need to take medicine, and he humorously told me that "take medicine for seven days, don’t take medicine for a week", just take a full rest and strengthen nursing. He explained the reasons in detail. The common cold symptoms are serious but not dangerous, and it is a self-healing disease, except It also urged the patient to review his lifestyle. More interestingly, he also talked to me about "Aesthetics of cold". Although the course of a cold is not long, the patient’s identity has shaped the image of the sick and weak who are cared for, cared for and loved, won an opportunity to feel sorry for themselves (be kind to themselves), and allowed relatives and friends to fully express their love (care for others). Sure enough, during my week of illness, I was cared for by my colleagues and friends, and my heart was full of love. This also reminds me of the deep association of disease welfare. It seems that the word "welfare" can be divided and analyzed. Happiness is a blessing and a benefit. However, in the concept of China people, happiness and misfortune are interdependent, with mutual interests and full of dialectics.

Perhaps it is too common to talk about a cold, and it is not easy to attract people’s attention. If you change a cold into a tumor and change it into a malignant cancer, will you feel the same? Obviously, the mood will be heavier and more shattered. If readers inadvertently type "aizheng" on the keyboard, there will be "being punished" on the computer screen at the same time as "cancer", which means that cancer equals being punished. In susan sontag’s Metaphor of Disease, cancer is labeled as a modern devil, ranking first in the disease spectrum and death spectrum. Nearly ten million people die of malignant tumors every year in the world. For such a number one malignant disease, people avoid it, sigh, and talk about welfare. Isn’t it deliberate to find a flat? Actually, there are two sides to everything, and so are tumors. First of all, tumor is just a "different fruit" that grows after the loopholes in human immune system appear, just like the "crooked melon and cracked jujube" in nature, which is closely related to the aging process of human beings. However, a few days ago, an academic report by Academician Cheng Shujun made me feel refreshed. The report cited a group of elderly people who were over 80 years old. They were complacent and enjoyed their life, but in the autopsy, they found that 60% of the deceased had "prostate cancer", which they didn’t know before their death. This is the so-called "lazy cancer" phenomenon. Its natural growth cycle is long, even exceeding the natural life span, but it only proliferates slowly without making a mess. Therefore, a familiar oncologist often teases patients with slow progress of prostate cancer: "Congratulations, you have snail cancer." As for cancer, Academician Fan Daiming, who is the chairman of China Anti-Cancer Association, has some strange ideas. In his eyes,Cancer cells are the "revolutionary party" in the body. In the process of aging, weakness, atrophy, degradation, and even exhaustion and decline, cancer cells are changing locally, inspiring a new atmosphere of proliferation, expansion, prosperity and transfer. This is clearly a retrograde force of "rejuvenation". The problem lies in their "crazy" growth and breaking the internal ecology, which leads to physical harm.

Susan sontag and Henri Cartier-Bresson were filmed in 1972 (Source: Beijing News)

Metaphor of Disease, by susan sontag, translated by Cheng Wei, Shanghai Translation Publishing House, 2020 (Source: dangdang.com).

Unfortunately, the balance technology of connivance-controlling the growth of cancer cells has not yet come out, and more patients are tortured by crazy and barbaric growth of cancer cells and die young. This is the harsh cancer world. If so, it is obviously inappropriate for me to explore the welfare of diseases under the cruel aesthetic situation. But it’s not that no one dares to think and say. Susan sontag, who has suffered from cancer twice, is such a brave man who dares to face up to the suffering of cancer. She tells the world that it is the existence of cancer that reveals people’s "dual nationality", that is, they are citizens of the health kingdom and the disease kingdom, rather than absolutely healthy people or patients. Everyone is so-called "healthy with illness". Even if they do not suffer from such a malignant disease as cancer, they may be patients with one disease or another but not diagnosed, or linger in "disease" Don’t fantasize that after a serious illness, you should rely on high consumption and high technology mastered by a famous doctor to save yourself from danger, but you should always maintain a good lifestyle, avoid all kinds of risk factors, intervene in time when you are sick at the end of the disease, and refuse the evil disease from the "Xiao Qiang".

However, with the development of modern medicine, it seems that human beings have no magic to resist all sufferings, including cancer that makes the body and mind tremble. The dice of suffering in God’s hands will eventually be thrown out. The arrival of evil diseases is the fate of life, and someone needs to bear it. With the advent of the age of longevity, the probability of suffering from cancer and other malignant diseases is still rising, even young people are not spared, and they need to be psychologically prepared to meet the malignant diseases. The talented boy who died young wrote proudly, especially in dealing with cancer: "God is going to send a golden tumor to a person, and to whom?" He is afraid that timid people can’t support it, and he is afraid that strong people will bear it flatly, so he will give it to an optimistic person, and those who are optimistic and have no aftertaste will just give it to me. I am beyond everything! " In the face of human suffering, we really need a superman who chews pain like this and then transcends it. Nevertheless, modern medicine should also design a spiritual soothing journey of "arrival of love" and "redemption of suffering" for cancer and other malignant diseases besides coming back to life, so that they can "step on thorns, feel no pain, have tears to shed, and are not sad" (Bing Xin: Send a Letter to a Little Reader), which can be regarded as an ultimate pursuit for cancer patients in pain. It is a set of "holistic pain" for cancer patients, highlighting the value of care and creating a dignified and quality survival and life plan. This scheme, once known as palliative care, began in 1967, marked by the British nurse Sanders.Dame Cicely Saunders established a hospice ward in St Christopher’s Hospital in south London, which started the modern hospice movement. Julia M. Addington-Hall, Saunders’ successor and the current director of the hospice care unit of St. Christopher’s Hospital, co-authored with Irene Higginson, and Li Xiaomei, Zhu Ping, Li Fan and Liu Duanluan led 46 elite colleagues in the hospice care industry in China to jointly translate (to adapt to the multidisciplinary and interdisciplinary characteristics of the book) the book palliative care for non-cancer patients. It describes the difficult course of hospice care concept and action advocated by Saunders from initial germination to worldwide popularity, and also describes the difficult butterfly change of hospice palliative care from exclusive service for cancer patients to universal benefit for all chronic patients (such as heart, lung, liver and kidney failure, severe blood diseases, gradual freezing and other neurodegenerative diseases, AIDS, serious and rare diseases of children and adolescents). After reading this book, people will deeply feel that the opening, construction and perfection of modern hospice and palliative medical system are the greatest medical benefits born of cancer and chronic diseases.

British nurse Saunders who established the hospice ward (Source: stchristophers.org.uk)

Palliative care for non-cancer patients, by Julia and Irene, translated by Li Xiaomei and Zhu Ping, Science Press, 2023 (Source: dangdang.com).

In the initial hospice ward, there were mainly patients with advanced cancer, who suffered from physical and mental pain, shivering in the eyes of death and crying to the sky. The focus of palliative care is no longer to exterminate cancer cells, but to dispel physical and mental pain, gain insight into the end-of-life counseling of death, and improve the dignity and quality of life. People often say that the highest state of life is "come crying (be born) and go laughing (die)", but it is not easy to really be on the cliff of life and death without shaking your feet. In the late stage of cancer, it is a narrow road to meet death. just visiting, who heard the footsteps of death approaching, must pierce the window paper as soon as possible, so that patients and their relatives can accept the unexpected encounter of death. Montaigne, a French writer who was tortured to death by lithiasis, once said heroically: It is better to stop and invite death to drink a cup of bitter wine than to be chased by death.

Ten years ago, the authoritative website of British Medical Journal published a wonderful article entitled "Death from cancer is the best death". The author is Richard Smith, the former editor-in-chief of the journal. Compared with the mentality of ordinary people talking about cancer discoloration (in essence, talking about death discoloration), his views are shocking. Because compared with sudden death without saying goodbye, cancer death may be more elegant, and it is a death benefit exclusively for cancer patients. From diagnosis to death, there is at least three months, and most people have a buffer period of more than one year. It is a prepared death, and there is enough time to arrange their last time, wave goodbye to my relatives, say goodbye in heaven and reflect on life. Leave your last words to your family and friends, and maybe you will have time to go to your favorite place, read some favorite poems, listen to your favorite music, and make all the preparations for the last moment. In Smith’s view, romantic death is love, morphine (powerful analgesic) and good wine, instead of forcing ambitious oncologists to waste a lot of money trying to cure cancer, which will make cancer death worse. The most terrible death is the kind of life that depends on modern medical technology, the kind of endless lingering. In the name of Hippocrates, doctors created one of the most exquisite and elegant tortures for human beings: the delay of slow illness and slow death.

Richard smith, former editor-in-chief of British Medical Journal.

Hospice palliative care, also known as hospice care, is a shift of attention, concern, care and clinical work focus between doctors and relatives, from coping with diseases to coping with pain, including symptomatic solutions to physical pain: pain relief, cough relief, antiemesis, itching relief, spasmolysis and asthma relief, nursing of fever, swelling reduction, skin bedsore and oral ulcer, improvement of weak nutrition, and community situation and emergency situation. The list of work is detailed in the book, which is not only of guiding value to occupational medical care, but also of guiding significance to the family members (that is, non-professional caregivers) who are taking care of at home. It also introduces the life care of the whole person’s pain and the spiritual comfort method of parting. At this time, although life cannot be healed, life can be respected, inquired and cared for, giving new meaning to life. The transfer of hospice care purpose brings about the change and adjustment of ideas. The object of intervention is not just a simple body, but a whole person; Intervention means are not just medicine, injections and surgery, but stories and narratives, music and drama, life review and reconstruction of life meaning. Clinical thinking is no longer confined to the intervention of biotechnology, but extends to life care, individual dignity and quality of life. What is worth cherishing is the discussion of ethical topics in hospice care, especially the problem of fairness and justice in the allocation of medical resources, and the detailed discussion of social, cultural and psychological projection of various symptoms in hospice care and cross-cultural care, which not only broadens the field of vision, but also closely follows the practice, and the content is not empty or informal.

Undoubtedly, cancer is only one of many chronic diseases. Human beings have entered the era of chronic diseases because of their super longevity. Its basic feature is that medicine and medical treatment are experiencing unprecedented incompetence, powerlessness, ineffectiveness and helplessness. First of all, more and more chronic diseases are treated, and the war model of diagnosis and treatment fails. The pathogenic factors (enemies) are not limited to external bacteria and viruses, but more are internal life stalls, immune out of control, dysfunction, psychological disorder, loss of value, weightlessness of soul, and life out of focus-frustration. It is necessary to get out of the trenches and put down fighting thinking; Secondly, the course of chronic diseases is getting longer and longer, and the alternative model of diagnosis and treatment (technical survival) encounters the dilemma of high cost, low quality of life, maintenance of physical function and mental decline; Third, the disease is becoming more and more difficult, and the medical performance is declining (ineffective medical treatment is obvious): quick cure and quick recovery to slow cure and slow recovery, and then to no cure and no recovery, from quick death (sudden death) to slow death (relying on a complicated life support system to survive), and then to neither death nor life (unconscious, dignified and quality-free survival); Fourthly, the body-mind-society-spirit representation of the disease is becoming more and more stereoscopic, and the role of the doctor is changing silently, from the rescuer to the companion, comforter and witness, bidding farewell to the obsession of never giving up, moving towards the acceptance and openness of death, ending the dependence and moving towards a good death (a good death); Fifth, psychological, social and spiritual weights are getting heavier and heavier, and medical intervention is turning, from drugs and scalpels to language, picture books (life and death narration) and music (looking back at youth and looking forward to heaven) to realize psychological comfort (consciousness) and spiritual comfort (liberation); Sixth,The purpose of medicine is changing quietly, from safety and well-being to tranquility, serenity and settlement, concluding the legacy of love, turning cold death into warm love arrival, and realizing both life and death in farewell, love, apology, thanks and love.

Hospice care at St. Christopher’s Hospital (Source: stchristophers.org.uk)

Hospice care at St. Christopher’s Hospital (Source: stchristophers.org.uk)

Regarding the evolution of the concept of hospice care in the era of chronic diseases, there are some basic principles worth spreading and letting the world know and agree. First of all, the irreversible process of life failure and death can only be alleviated by any medical intervention, but it can’t be cured. There is a huge gap between it and the reversible disease, the psychological expectation that it can regain vitality and reach rehabilitation through intervention. The pathological features of aging and the end of life are the degeneration of organs, tissues and cells, rather than alienation and disproportionation, which are mainly manifested in functional degeneration, behavioral withdrawal and intellectual degeneration, leading to disorder, disability, amnesia, loss of emotion and will, loss of personality and dignity. Modern medicine prides itself on the failure of the war model of etiology control and the substitute model of functional improvement, and the palliative, tranquil and palliative medical model appears. Secondly, there is a huge gap between physical pain and the core of human pain. Pain is not pain, and pain relief is not soothing. The primary intervention of hospice care is full analgesia (symptomatic treatment). Its advanced intervention is caring: attention, concern, concern and empathy, which is the psychological decompression of the concentration of talking and listening. You say it, I am listening carefully, and I have had this pain experience … Advocating a dialogue between doctors and patients on pain experience. Thirdly, healing is not dignity, and the primary goal of hospice care is to pursue etiological improvement, while the advanced goal is to safeguard the life dignity of patients and help patients and their families rediscover the meaning of life. Fourthly, in the end-stage palliative care, the dual-track paradigm of technology and humanities and the simple paradigm of technical intervention are judged. Here, treatment is no longer killing and repairing.It is caring and caring, and its primary vision is to focus on disinfection and repair. Etiology, pathogenesis and symptomatic treatment can eliminate the cause and restore disability, but they cannot cope with dementia, frustration, disqualification and disrespect. The advanced vision of treatment is to focus on the improvement of the whole person’s situation and quality of life, and to implement the whole person’s care and care. Fifth, there are many cognitive biases in the end-stage physical and mental intervention. Psychological intervention is not spiritual comfort, the former is the relief of psychological symptoms and the dilution of negative psychological motivation, and the latter is spiritual comfort and the ultimate care. Sixth, there are also cognitive misunderstandings in the process and meaning of death. Physical death is not the whole person’s death (which can’t cover sociological death), and mortuary is not the end of life journey. The early task of death counseling is to face the warning and interpretation of death crisis, and the later task is to recognize the meaning of death, maintain tension between refusing death and accepting death, controlling death and excessive intervention, and help patients and their families to be open-minded about life and death and conclude a legacy of love. Finally, communication between doctors and patients in palliative care is not doctor-patient communication. Communication training only increases the affinity of communication between doctors and patients and nurses through language improvement, while communication training expands the depth and abundance of communication between doctors and patients and nurses through empathy training, integrates into patients’ life and life experience, and improves the quality of life.

In the hospice care unit, doctors and nurses have to deal with all kinds of complicated difficulties at the end of their lives. Traditional medicines, needles and scalpels are of course important, but they also need the devotion of humanity and the nourishment of humanity, including companionship, witness, comfort and settlement. Among them, companionship and witness are the advanced circumstances of care. Doctors and nurses are not only present, but also their personality charm brings hope and human light to patients and experiences "being with angels" (tasting divinity). Medical care witnesses the existence of a weak life and the suffering of a vicious disease. "I know that you are suffering, I can touch and feel your suffering, and I can pay attention to and understand how difficult it is for you now." It is not difficult to imagine that patients and elders are often trapped in emotional loneliness, language loneliness and meaning loneliness because of the sharp contraction of social relations, and feel that they will become "lonely souls and wild ghosts", and they will live without belief support. At this time, they need more determined eyes, loving language and body language to secretly deliver life energy (empowerment). Comfort in palliative care is often a miraculous force, just like the spring breeze blowing the body and mind, which is carried out at four levels: first, physical comfort, such as hugging and touching the forehead, managing the living situation, trimming the margins (haircut, shaving, bathing, changing underwear), recovering life confidence and identity and dignity; The second is language comfort: intimate words, private words, life course review and dignity therapy; Third, psychological comfort, dissolve the psychological knot, and call back distant family ties; Fourth, spiritual comfort, life education, suffering, death counseling, dignity and belief therapy, and reconciliation with nature and the world after death. Undoubtedly,Care at the end of life is a systematic project that constantly updates its connotation, and needs multiple coordination and support. First, it is the four-all cognition of peaceful care, that is, to establish the thinking of caring for the whole family, community, general practitioner, team and whole process; Secondly, it is the support of blood and affection to overcome the companionship fatigue of "no dutiful son before a long hospital bed"; Third, the social and emotional support beyond consanguinity (empathy and empathy), to maximize the mobilization of social workers and volunteers to participate in hospice care; Fourth, the professional value support of hospice care team, such as constructing continuous professional behavior driven by virtue and bioethics, overcoming empathic exhaustion and job burnout; Fifth, caring financial support, overcoming the utilitarian thinking of curative effect. At present, patients and their families generally have the psychology of giving up without hope of healing, unwilling to spend money to improve their dignity and quality of life, and long-term care consumes limited health insurance and medical resources, which is difficult to guarantee continuously; Sixth, social care financing: internationally, there is a dichotomy, that is, medical insurance and long-term care insurance are operated separately, and the resources for etiological treatment are gradually transferred to caring resources for hospice care.

Hospice care in China (source: baidu. com)

Hospice care in China (source: baidu. com)

In all fairness, China’s hospice care is still in a difficult climbing stage, with technical and resource bottlenecks easily broken and concept and system bottlenecks hard to get rid of. Nowadays, not only patients with terminal cancer have not fully entered the hospice palliative medical channel, but also dare not expect non-cancer patients to enjoy the welfare of hospice care. However, the frame and road map of hospice and palliative care carefully described by Julia and Irene are very detailed, and the road signs and objectives are very clear, which undoubtedly adds confidence and strength to our future journey of hospice and palliative care. I think that as long as the whole society really pays attention to death as the "terminal welfare" of life, there will be showers of wealth and wisdom coming simultaneously, which will moisten the hospice and ease the medical cause and make it a towering tree.

Let’s hope that this day will come soon.

(palliative care for non-cancer patients, by Julia and Irene, translated by Li Xiaomei and Zhu Ping, presided by Li Fan and Liu Duanmao, Science Press, 2023).

　

Original title: The New Issue of Reading | Wang Yifang: Welfare of Diseases

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Baseball home runs are increasing or partly due to global warming.

In recent years, the number of home runs in American baseball games has increased obviously, which is rumored by baseball circles to be related to the rising temperature. American researchers recently used data to speak, confirming that this statement has some truth. They estimate that global warming has helped major league baseball batters hit an average of about 50 more home runs each year.

Home run refers to the attack method that the batter runs through the first, second and third bases in turn and returns to home plate safely after hitting the ball from the other side. It is a very wonderful climax moment in the baseball game. According to NBC, from the beginning of American professional baseball in the late 19th century to 1993, there was only one season when each team hit more than one home run per game. Since 1994, only four seasons have not seen such a "grand occasion". In the history of professional baseball league, the top four seasons of home runs all appeared in 2017 and later years.

Researchers at Dartmouth College in the United States said in a peer-reviewed paper published in the latest issue of Bulletin of American Meteorological Society that they analyzed 100,000 games and more than 200,000 balls played by Major League Baseball from 2010 to 2019, and combined with weather conditions, stadium and other factors, they found that the probability of hitting a home run increased by 1.8% when the temperature rose by 1 degree Celsius.

According to data from the National Oceanic and Atmospheric Administration, the average temperature in June, July and August in the United States has increased by 1.1 degrees Celsius in the past 40 years.

According to researchers, the physics behind the relationship between temperature and home run is simple: when the temperature rises, molecules move faster and farther away from each other, thus reducing the air density, reducing the flying resistance of baseball and making it fly farther.

However, according to researchers’ estimates, from 2010 to 2019, climate warming made about 500 home runs, accounting for only 1% of all home runs. In contrast, non-climatic factors have a greater impact. Allen Nathan, a physicist at the University of Illinois, believes that the biggest factors are the ball itself and the stitching, as well as the batter’s physical quality, pitching angle and speed.

The researchers found that the impact of climate warming on home runs also varies from venue to venue. Home runs are more likely to occur in outdoor venues during the day than in dome stadiums where games are held at night.

The researchers also established a model to estimate the impact of different degrees of warming on home runs. Under the worst-case scenario, by 2050, there will be about 192 home runs in the United States every year, and by 2100, the number will increase to about 467. In a milder situation closer to the current climate change, by 2050, climate warming will promote about 155 home runs every year, and by 2100, this number will increase to about 255.

Source: CCTV news client