Loss and grief: The experience of transition to residential aged care

There is growing recognition of the experience of non-death-related loss and grief. One unexplored area of non-death-related loss and grief is associated with older people’s transition from home to residential aged care (RAC). This paper reports findings from a qualitative study that explored the experiences of people living in RAC, carer-relatives of people living in RAC and RAC staff. Using theories of loss and grief, the paper identifies features of the transition to RAC that are associated with unresolved loss and maladaptation to changed circumstances, and the types of support that would mitigate these. Using a series of focus groups with both residents and carer-relatives, as well as staff, the study found that residents and their families need more support to negotiate the multiple, often necessarily hasty decisions and bureaucratic requirements associated with transitioning to RAC, while simultaneously experiencing loss and grief. The types of support that families would welcome from service providers include facilitating shared decision making, valuing family and community carer expertise and providing practical information and assistance to fulfil administrative obligations.     

人工智能背景下医疗法律责任的现实困境与完善路径

医疗人工智能利用深度学习和计算机算法等现代化技术，实现辅助诊疗、医学影像、药物发掘、健康诊疗等功能，是人工智能应用最具前景的领域之一。随着人工智能技术发展，具备自主思维和决策能力的智能机器人医生等人工智能将对现有的医疗法律责任制度带来颠覆性影响。在人工智能背景下，医疗人工智能是否具有独立法律主体地位、传统的医疗过错责任归责能否适用、因果关系如何认定等成为现代民事法律责任制度的严峻挑战，也成为实践中的必答之问。因此，在借鉴欧美人工智能领域的探索经验的基础上，在当前阶段通过修正和完善我国民事法律责任制度，提出针对不同的人工智能侵权情形适用差别化归责原则，并尝试建立人工智能强制保险或储备金制度，设置人工智能监管机构及行业标准，以实现既保障患者合法公平权益，又鼓励人工智能技术有效发展之间的平衡。     

重大公共卫生事件中应如何作为:来自医学人类学哈佛学派的启示

聚焦人类学者在针对重大公共卫生事件的跨学科研究中应该有何作为这一议题,通过借鉴来自医学人类学哈佛学派的民族志洞见和研究经验,为当下2019新型冠状病毒疫情危机中所进行的田野观察和分析,以期获得灵感和启示,并探索有可行性和操作性的研究策略和方法。     

Issue Information

In 2017, the number of applications for care orders in England and Wales was the highest ever recorded at 14,207. This is a significant factor, contributing to the rise in the number of children who are looked after, which is at the highest level since 1985. The authors reflect on the recently published Care Crisis Review 2018, a sector‐led review, which examines the reasons for the rise in care proceedings and the number of children in care. The review sought to identify changes to policy and practice within local authorities and the family justice system, in an attempt to divert cases away from the family courts and to reduce the number of children in care, where it is safe to do so. Whilst the legislative framework is largely effective and the system generally works well, there is insufficient funding and resources to meet the needs of children and their families when they seek help, regardless of whether this is at an early stage or when they are in crisis and most in need of care and protection.     

Informal kin caregivers raising children left behind in rural China: Experiences' feelings' and support

The well‐being of children in informal kinship care and their caregivers is a growing concern globally. This study explored the lived experiences of 23 kin caregivers raising children left behind in rural Northeast China while their migrant parents worked and lived in cities. The findings show that the expected authority and responsibility caregivers carry sometimes conflict with their social role of being children's grandparents. Caregivers' feelings about and understandings of these roles are shaped through their social interactions in local communities. In view of their situation and caregivers' self‐conscious attitudes towards utilizing local resources' future formal service provision and social support should take caregivers' viewpoints into account. These views are embedded in and shaped by their rural living context and relationships with community members who influence caregivers' perceptions and child rearing practices.     

The functional patterns of adolescent mothers leaving foster care: Results from a cluster analysis

Few studies have explored the outcomes of adolescent mothers leaving foster care, especially using person‐oriented methods. The current study employed a cluster analysis to identify unique patterns of functioning among adolescent mothers aged 19 (n = 777). Data from the National Youth in Transition Database and the Adoption and Foster Care Analysis and Reporting System were utilized. Findings revealed five subpopulations characterized by distinct constellations of outcomes at age 19. The largest group (43%) exhibited competent functioning across all the domains studied—its members were connected to school and/or employment and did not experience homelessness, substance abuse referrals, or incarceration during the past 2 years (i.e., “resilient”). A relatively small group (12%) exhibited challenges across all the above‐referenced domains, whereas the remaining groups presented challenges in some domains, but not in others. Follow‐up analyses revealed that adolescent mothers classified as resilient at age 19 had the lowest rates of congregate care placements and the highest rates of nonrelative foster care placements at age 17. Moreover, they had lower placement instability and higher rates of extended foster care as compared with members of the other clusters. Implications for practice, policy, and research are discussed.     

Supporting unaccompanied asylum‐seeking young people: The experience of foster care

Although research on the experiences of unaccompanied asylum‐seeking young people in the UK has grown steadily in recent years, their experience of fostering and of the role played by foster carers in helping their adjustment have been neglected. This paper reports findings from the first UK study into these experiences, describing issues arising from initial assessment and preparation for fostering and the ways in which young people and foster carers adjusted to their lives together. It assesses the progress made by young people during placement, the strategies that appeared helpful to relationship building, and the extent to which young people had become integrated within the wider network of family relationships. Given that most young people first arrive as teenagers, it also considers the ways in which foster carers and social workers helped young people prepare for adult life in the context of uncertainties arising from the asylum process.     

‘Unfit for reform or punishment’: mental disorder and discipline in Liverpool Borough Prison in the late nineteenth century

This article examines how Liverpool Borough Prison, opened in 1855 as one of the largest local prisons in England to adopt the separate system, categorized and dealt with mental distress and disorder amongst its prison population in the late nineteenth century. High prison committal rates in Liverpool, alongside high levels of recidivism, especially among female prisoners, led to severe overcrowding and encouraged a harsh disciplinary regime. Exacerbated by the poor physical and mental condition of the prisoners, this produced a challenging environment for maintaining the separate system of confinement and prisoners’ mental well-being. While official figures for the rates of mental disorder in local prisons are not readily available, Liverpool Prison’s diverse and under-exploited archives and official reports indicate that insanity caused prison officials and visiting justices great concern, and many prisoners were declared unfit for the rigours of prison discipline. Our article explores the implications of the ever more punitive, deterrent and physically taxing penal policy implemented in the late nineteenth century on the minds of prisoners. Despite the heavy toll on prisoners’ mental well-being, such cases were often retained by prison medical officers reluctant to acknowledge the failure of the prison to deter, reform and redeem.     

Care earnings in the United States and 24 European countries: The role of social policy and labour market institutions

Care occupations are gendered and remain relatively poorly paid, particularly in the United States. Prior research on the ‘care penalty’ primarily points to individual, relational, and market-valuation factors in explaining the relative earnings of care workers. This study integrates these explanations with a comparative institutional perspective. Using higher-quality data and methods than previous comparative research in the field—that is, harmonized micro-data from the Current Population Survey and EU-SILC from 2005 to 2016, country and year fixed effects models, and a counterfactual analysis—we find that national variance in labour market and welfare state institutions explains most of the difference in the relative earnings of reproductive care workers between the United States and European countries. Higher rates of collective bargaining coverage, stronger employment protection and welfare state spending contribute to higher relative earnings for reproductive care occupations, and lower relative earnings for high-status nurturant care occupations. Differences in the relative earnings of care workers appear to be mostly a construct of social policy and labour market institutions rather than individual, relational, and market-valuation factors.