Social health protection in Cambodia: Challenges of policy design and implementation

The Government of Cambodia is implementing ambitious reform initiatives to improve the country's social health protection system. In January 2018, it was announced that the Health Equity Fund (HEF), which is fully subsidized by a joint government‐donor initiative for the reimbursement of user fees for the poor at public health facilities, is to be expanded to some segments of informal workers belonging to associations, as well as to commune and village chiefs. Since 2017, the National Social Security Fund (NSSF) has provided social health insurance for formal economy workers in enterprises with eight employees or more. In January 2018, it was expanded to civil servants and all employees regardless of the size of the enterprise. However, this article highlights that the new ambitious reforms are not accompanied by careful planning as regards funding, service delivery, human resources and institutional design. This article therefore aims to examine key policy issues and challenges for Cambodia's ambitious reform of its social health protection system in terms of resource generation, population coverage, strategic purchasing and governance.     

Everything for the Children: Orphans Growing Up in Informal Adoptive Families in China

Most orphaned children in China are cared for by their extended families or become state wards under the guardianship of child welfare institutions. Some exceptions are children who are found and cared for by families in the community, without a formalized adoption or foster relationship. In some locations, institutions now accept guardianship for these children and support the informal adoptive family to continue to care for them. This article examines the outcomes for these children as they became young adults by comparing these 12 children raised within the system as they approach or have approached young adulthood (now aged 16–40 years-old). Some of the participants were either informally adopted or lived in institutional care. The results of this study found that the family environment was more conducive to the young people’s wellbeing as they approached or entered adulthood. The participants raised in informal care appeared to be treated similar to the biological children in these families. When the institution formalized the state guardianship responsibility, it also meant the families had state resources for support to protect the children’s rights to economic security, education, health care, and social participation. This practice by the institution supported the addition of informal adoption, as one step closer to permanency than foster care. Future implications include considering this option to help promote the family system assisting these children, families, and the state.     

参加医疗保险对农村居民健康的影响——基于CHARLS 2015数据的实证分析

基于CHARLS 2015数据,采用倾向得分匹配法实证分析参加医疗保险对农村居民健康的影响。研究发现:参加医疗保险对农村居民的日常活动能力和自评健康影响不显著,参加医疗保险对农村居民认知能力具有显著的正向影响。据此提出,应进一步提升社会医疗保险保障水平、扩大社会医疗保险保障范围、促进商业医疗保险有序发展、推进"三医"高效协同联动等,以充分发挥医疗保险的健康保障功能,从而进一步提升参加医疗保险对农村居民健康的正向影响。     

“四史”教育融入高校思政课教学的五维逻辑进路

历史照亮过去，历史启迪未来。以党史、新中国史、改革开放史、社会主义发展史为核心内容的“四史”教育，是以历史为基础的思想政治教育。从党史、新中国史、改革开放史、社会主义发展史中挖掘思想政治理论课教育资源，对高校传承红色基因、落实立德树人根本任务具有重要的指导意义。以庆祝中国共产党成立100周年为契机，将“四史”教育融入高校思想政治理论课教学，必须遵循相应的逻辑理路：树立正确党史观、坚定理想信念的价值追求是融入的逻辑立场；强化大历史观、理解党的伟大贡献是融入的逻辑方法；坚持内在统一性、把握“四史”教育的整体性逻辑是融入的基本前提；抓住侧重点、精准对接各门大学生思想政治理论课程是融入的逻辑核心；坚持实践逻辑、引导大学生从“四史”中汲取智慧和力量是融入的根本遵循。     

Midwives’ views of caseload midwifery – comparing the caseload and non-caseload midwives’ opinions. A cross-sectional survey of Australian midwives.

BackgroundMidwife-led continuity of care has substantial benefits for women and infants and positive outcomes for midwives, yet access to these models remains limited. Caseload midwifery is associated with professional satisfaction and lower burnout, but also impacts on work-life boundaries. Few studies have explored caseload midwifery from the perspective of midwives working in caseload models compared to those in standard care models, understanding this is critical to sustainability and upscaling.AimTo compare views of caseload midwifery – those working in caseload models and those in standard care models in hospitals with and without caseload.MethodsA national cross-sectional survey of midwives working in Australian public hospitals providing birthing services.FindingsResponses were received from 542/3850 (14%) midwives from 111 hospitals – 20% worked in caseload, 39% worked in hospitals with caseload but did not work in the model, and 41% worked in hospitals without caseload. Regardless of exposure, midwives expressed support for caseload models, and for increased access to all women regardless of risk. Fifty percent of midwives not working in caseload expressed willingness to work in the model in the future. Flexibility, autonomy and building relationships were positive influencing factors, with on-call work the most common reason midwives did not want to work in caseload.ConclusionsThere was widespread support for and willingness to work in caseload. The findings suggest that the workforce could support increasing access to caseload models at existing and new caseload sites. Exposure to the model provides insight into understanding how the model works, which can positively or negatively influence midwives’ views.     

Heterogeneity in treatment effects across diverse populations

Differences in patient characteristics, including age, sex, and race influence the safety and effectiveness of drugs, biologic products, and medical devices. Here we provide a summary of the topics discussed during the opening panel at the 2018 Johns Hopkins Center for Excellence in Regulatory Science and Innovation symposium on Assessing and Communicating Heterogeneity of Treatment Effects for Patient Subpopulations: Challenges and Opportunities. The goal of this session was to provide a brief overview of FDA-regulated therapeutics, including drugs, biologics and medical devices, and some of the major sources of heterogeneity of treatment effects (HTE) related to patient demographics, such as age, sex and race. The panel discussed the US Food and Drug Administration's role in reviewing and regulating drugs, devices, and biologic products and the challenges associated with ensuring that diverse patient populations benefit from these therapeutics. Ultimately, ensuring diverse demographic inclusion in clinical trials, and designing basic and clinical research studies to account for the intended patient population's age, sex, race, and genetic factors among other characteristics, will lead to better, safer therapies for diverse patient populations.     

Developing and testing a mobile application for breastfeeding support: The Milky Way application

BackgroundSupporting women to continue breastfeeding is a global challenge. The Milky Way Program is an effective face to face intervention to increase breastfeeding rates up to six months postpartum. The sustainability and access to the Milky Way Program could be enhanced by transforming it into a mobile application allowing women to access relevant information from their own place at a convenient time.AimTo explore the process of transforming the Milky Way Program into an acceptable and usable mobile health application.MethodStakeholders including multidisciplinary researchers and end-users designed the application based on the Milky Way Program by using Persuasive System Design principles. A mixed-method approach was used in the development and evaluation process. Seven women were recruited through convenience sampling to pilot test the application. The women’s feedback was collected through an online survey six weeks after birth and individual interviews at four months postpartum.FindingsWomen in the pilot study reported that the breastfeeding application was well designed, easy to use, interactive, reassuring and evidence-based with credible sources of information.ConclusionThe Persuasive System Design model combined with end-user engagement can feasibly inform the development of an acceptable and usable mobile health application for breastfeeding based on a proven clinical intervention. Further rigorous testing is required to evaluate the effectiveness of the application on breastfeeding initiation and duration.     

Women’s reports of satisfaction and respect with continuity of care experiences by students: Findings from a routine,online survey

BackgroundPre-registration midwifery students in Australia undertake a minimum of ten continuity of care experiences with childbearing women. However, women are rarely asked to formally evaluate this care by students.AimTo evaluate data from a routine, web-based survey of women about having a midwifery student provide a continuity of care experience.MethodsAll women (n = 886) recruited by a midwifery student for a continuity of care experience during a 12 month period received an email inviting them to complete an online survey. The survey included personal details, experiences of care, and two scales on Respect and Satisfaction.ResultsA response rate of 57% (n = 501) was achieved. On average students attended six antenatal visits (mean = 5.83) and had six postnatal contacts with women. Most students attended labour and birth (92.6% n = 464). Most women rated overall satisfaction with care by their student as ‘better than they had hoped’. Positive correlations were found between number of antenatal visits and postnatal contact with students on both levels of satisfaction and respect felt by women. Women felt more satisfied when their midwifery student attended labour and birth.ConclusionsThe online survey was feasible and provided valid and reliable feedback from women about their student during a continuity of care experience. Women valued having an ongoing relationship with a student during pregnancy, labour and birth, and postpartum. Pre-registration midwifery education programs should continue to privilege relationship-based care and national standards should support the effective integration of continuity of care experiences.     

Digital crime,trauma, and abuse: Internet safety and cyber risks for adolescents and emerging adults in the 21st century

ABSTRACT

The shift in the technology landscape has altered the technology ecosystem of adolescents and emerging adults in the 21^st century. Yet, with greater use of digital gadgets comes greater mental health risks that technological advancement brings. This study provides a narrative review of contemporary cyber risks faced by adolescents and emerging adults. In particular, this review will cover dangers and effects of cyber-bullying, social media, cyber-dating violence, sextortion, sexting, revenge porn, online dating, catfishing, and scammers, with an emphasis to raise awareness and encourage proactive efforts dedicated to address these social concerns as the digital era continues to evolve.     

福利多元主义视角下城市“老漂族”精神赡养问题研究——以广州市三个典型社区为例

本研究聚焦渐趋普遍的“老漂族”群体异地养老现象,关注其精神健康。以福利多元和精神赡养理论为分析框架,对广州市三个老年流动人口较集中地区的“老漂族”进行问卷调查及访谈,通过多元线性回归分析政府、家庭、社区、市场等主体的服务供给对“老漂族”异地养老精神需求产生的影响,剖析“老漂族”异地精神赡养的需求和供给现状。本文的主要结论是,目前的养老福利托底政策和市场补充供给的不足给“老漂族”带来异地养老尤其是精神赡养上一定的困难,建议更多地发挥家庭、社区和社会组织的作用,提倡养老资源供给模式应将物质服务和精神扶助结合起来,实现养老渠道多样化、社会福利供给主体多元化,形成多元供给主体之间的协调与互补,共同支撑起能够惠及“老漂族”异地精神赡养的养老服务体系。