我国婴幼儿托育服务标准规范体系的现状及其优化研究

近年来,我国婴幼儿托育服务标准规范建设进程较快,当前体系框架已初步建立。但由于长期以来标准规范建设比较缓 慢、推进机制不健全等客观因素制约,当前婴幼儿托育服务在通用基础标准规范方面整体滞后,婴幼儿安全照护和权益保障标准 规范方面仍存短板,监管和人员标准规范方面较弱等问题。根据托育标准规范体系现状,结合托育服务发展需求,当前亟需建立 托育服务标准规范体系的协同推进工作机制,加快通用基础标准规范研制,促进服务提供标准规范的健全,补足支持保障标准规 范的短板,进而完善标准规范框架体系,推动各类标准规范的兼容,进而为婴幼儿托育服务高质量发展提供支持和保障。     

安徽省长期护理保险筹资水平精算研究

老龄化程度加剧,失能人数增加,是我国社会面临的一大难题,长期护理保险制度在该问题的解决中发挥着重要的作用。我国长期护理保险筹资机制存在参保主体覆盖面不足、筹资渠道单一、筹资水平高低不等、筹资激励措施缺乏等问题。文章将安徽省参保对象分为城镇职工和城乡居民,并将失能人群分为轻度、中度、重度三个等级,运用国际劳工组织(International Labour Organization,ILO)精算模型中的人口、收入、成本、结果等子模型测算安徽省长期护理保险筹资水平。结果显示,2019年安徽省城镇职工医疗保险参保人群的缴费率为0.14%,城乡居民每年需要缴纳96.77元。结合安徽省长期护理保险筹资水平与我国筹资机制实践存在的不足进行讨论,为安徽省长期护理保险筹资机制的设计提出优化建议。     

Institutional Ethnography and Experience as Data

Experience, as concept, is contested among feminists as to its epistemological status, thus its usefulness in knowledge claims. Institutional ethnography (Smith 1987) is a feminist methodology that nonetheless relies fundamentally on people's experience. Not as Truth, nor the object of inquiry, but as thepoint d'appui for sociological inquiry. This article offers a demonstration of institutional enthnography using observational and interview data that show experience as methodologically central to a trustworthy analysis. A moment in the work lives of nursing assistants in a long-term care setting is captured by a participant observer. The analysis produces two lines of argument. One is methodological; it is argued that nursing assistants' experiences are an entry into the social relations of the setting that, when mapped and disclosed, make those experiences understandable in terms of the ruling arrangements permeating both the organization and their own experiences. The other argument is substantive; the inquiry uncovers how a quality improvement' strategy in a long term care hospital in Canada is reorganizing caregivers' values and practices toward a market orientation in which care appears to be compromised. Use of experience as data in this approach holds the analysis accountable to everyday/everynight actualities in a lived world.     

Homework and domestic work

This study assesses two competing theories about the extent to which homework—paid work in the home—helps integrate work and domestic roles for men and women. Contrasting male and female homeworkers with their counterparts working outside the home, it supports some aspects of both the resource and role overload theories, but predominantly the role overload perspective. Homeworkers, especially in the working class, experience less interference between job and family life, but perform more housework and child care. They have no more leisure time nor greater marital satisfaction than those working outside the home, but receive more family assistance with their paid jobs, suggesting that they combine tasks from their first and second shifts. Working at home does not break down gender roles in domestic life. Despite time saved from commuting, male homeworkers perform no more housework than comparable men working outside the home. Thus, the gender division of unpaid household labor is not simply a matter of resources or spatial logistics.An earlier version was presented at the meetings of the Eastern Sociological Society, Providence, Rhode Island, April 1991.     

临床共情的基本路径研究

目的：开展临床共情基本路径研究,调查共情基本路径执行现状,为共情临床实践提供建议。方法：利用自行设计的调查问卷,采用分层随机抽样方法,对江苏省8所公立医院825名临床工作者和在这些医疗机构就诊的807例患者的临床共情基本路径现状进行调查和分析,对医务工作者和患者共情的认知状况进行比较。结果：在临床共情基本路径中的神态、情绪、倾听、微笑环节,医务工作者与患者的认知存在偏差;在耐心、专注、语言、告知、解释环节临床工作者均表现不佳。结论：临床工作者各路径环节表现不佳,需结合临床共情路径的内涵和实施方法,促进临床共情实践的实现和发展。     

精准扶贫与老年贫困消减

精准扶贫是针对以往粗放型扶贫方式提出的扶贫方略。 提高扶贫效率,实现社会公平是精准扶贫的核心要件。 老年贫困人口是贫困群体的主体,要低成本、高效率地消减老年贫困问题,要更多地依靠社会保障制度建设,即更多地依靠制度性力量,更多地依赖市场力量。 只有建立和完善与我国社会发展阶段相契合的“ 普惠+特惠冶 的基本社会保障制度,才能真正实现老年人口精准扶贫的政策初衷,从而提升社会的效率与公平。     

农村老年人日常生活家庭照料与社会照料关系研究——基于多层回归模型的分析

文章利用中国健康与养老追踪调查 2011—2012 年的基线调查数据,运用多层回归模型,通过分析社会照料对农村老年人家庭照料获得的影响,探讨家庭照料与社会照料的关系。 回归估计结果显示,个人层次上的年龄、居住状况、失能情况和社区层次上的老龄补贴、经济状况对农村老年人获得家庭照料有不同程度的影响,而代表社会照料的变量在统计上均不显著。 回归估计结果说明,社会照料并不能对缺位的家庭照料起到补充作用,更不会起到替代作用,两者呈现一种非此即彼的“无关系”。 文章的政策启示是,打破家庭照料与社会照料的壁垒,构建一个“流动”的老年照料体系。     

Nonstandard parental employment schedules and father involvement

This study assesses the impact of nonstandard employment schedules (shift work) on parenting among US fathers of young children in dual-earner couples. The outcomes examined include total caregiving, caregiving without the mother present, and the elements of father involvement proposed by Pleck: positive engagement, warmth, and control. Models with latent variables and with lagged dependent variables are estimated using three waves of nationally representative data from the Early Child Longitudinal Study – Birth Cohort. The results indicate that employment scheduling mainly shapes the context in which involvement takes place. Compared to dual-earner couples who are each employed during the day, fathers in couples in which at least one parent has a nonstandard schedule tend to care for their children more in the mother's absence. To a more limited extent, they also do more caregiving overall. These effects are most conclusively found when the father works during the day and the mother works during the evening, when the mother works during the day but the father works a night, split, rotating, or other shift, and when both parents have nonstandard schedules. Parental work schedules, however, have little impact on father involvement aside from care.     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下，发现就医惯性的存在；并运用集中指数分解法发现，卫生服务的利用存在不公平，偏向于富人，而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

An Ecological Understanding of Caregiver Experiences in Palliative Care

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner’s ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.