How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

中古道教仙传中的"食桃修仙"母题研究

中古道教仙传中,"食桃修仙"母题的产生有其相应的时代背景和文化背景。在探究该母题产生的基础上,从内外两方面分析了"桃"被仙化的多重原因。就外因而言,桃被仙化与神仙信仰的广泛流传有关。就内因而言,桃被仙化与桃特殊丰富的文化内涵紧密相连。进而以"食王母桃"这一母题为中心梳理"食桃修仙"母题的流变。该母题的流变与桃被赋予的神效和异形密切相关,由此导致"食桃修仙"母题呈现出神异浪漫的美学风格。     

Factors associated with a positive childbirth experience in Brazilian women: A cross-sectional study

BackgroundHaving a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women’s satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women.MethodsThis cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31–37 days after delivery, at the mothers’ homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance.ResultsFollowing hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR = 1.30; 95% confidence interval [95%CI] = 1.06−1.59), understanding the information provided by health professionals during labor and delivery (PR = 1.40; 95%CI = 1.01−1.95), not having reported disrespect and abuse (PR = 1.53; 95%CI = 1.01−2.31), and having had the baby put to the breast within the first hour of life (PR = 1.63; 95%CI = 1.26−2.11). No association was observed with type of delivery or hospital status (public or private).ConclusionsA higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.     

政府动态奖惩机制下绿色建筑供给侧演化博弈研究

从绿色建筑供给侧角度出发，构建消费者效用函数、开发商利润函数和政府与开发商的演化博弈模型，分析消费者绿色偏好、建筑绿色度、成本等因素对建筑价格、需求和利润的影响以及政府动态奖惩政策下系统的演化稳定策略。结果表明：消费者绿色偏好支付系数和建筑绿色度的增大有利于绿色建筑价格、需求和利润的提高，但高成本却使需求和利润降低；政府采用静态补贴与静态税收政策时，博弈系统不存在演化稳定策略，采用动态补贴与静态税收、静态补贴与动态税收、动态补贴与动态税收三种政策组合时，系统存在演化稳定策略；动态补贴与静态税收的政策组合在推动绿色建筑发展方面优于其他政策；开发商开发绿色建筑的概率与补贴上限值呈负相关，与税收上限值呈正相关。     

农地产权结构变迁视域下土地增值收益的公平分享

农地产权结构是搭建土地增值收益分配与宪法秩序有效链接的重要桥梁.从农地产权结构变迁的视角看,我国传统土地增值收益的国有化机制实际在很大程度上符合1982年宪法所确立的社会主义地租国有原则及地利共享秩序.然而,由于宪法土地条款一开始就被注入了地利分配具有倾向性的思想基因,长此以往便忽视了农民作为整体分享土地增值收益的"另一半宪法秩序".新型城镇化背景下,国家进行了"同地同权"、赋权于"民"的农村土地管理制度改革,其实质是宪法秩序的延续而非替代,我国土地增值收益分配的主要机制仍是征地补偿制度.要实现我国土地增值收益的公平分享,必须回到社会主义"国家—集体"一元论的完整地利共享秩序中来,并遵循实质平等的要求,通过以"人的城镇化"为目标对区片综合地价进行限定、采取倾向于农村及农业发展的"土地财政"政策、打破城乡户籍二元制实现城乡一体化发展等方案,推动农民全过程参与、共享土地利益.     

“一带一路”相关文件政策强度与省域经济开放度关系研究——“一带一路”沿线18个省份实证分析

文章的特色和理论意义在于,尝试量化"一带一路"沿线18个省份"一带一路"相关政策文件,以设计政策效力、政策措施与政策保障的评判要点为基础,确定政策措施强度和政策保障强度.细致讨论"一带一路"文件的政策强度与经济开放度提升之间的关系,并讨论该关系在东西部地区的差异以及政策保障强度在政策措施强度与经济开放度关系之中的调节效应.研究发现:政策措施强度能够正向促进省域经济开放度的提升;在经济开放度高于10％的省份中,政策保障强度正向调节政策措施强度与经济开放度提升之间的关系,政策措施强度和政策保障强度之间存在互补关系;政策措施强度中资金融通强度对于沿线省域经济开放度的提升有着最显著的正向影响,政策沟通强度对于沿线省域经济开放度的提升影响不显著;政策措施强度对省域经济开放度的提升存在地区差别,西部地区更注重"一带一路"倡议所带来的机会.建议:"一带一路"沿线省份在政策设计上,不仅要对政策沟通、设施联通、贸易畅通、资金融通和民心相通等内容作出合理规划和布局,还应对保障机制作出可操作性的安排.     

1930年代沪上文坛独特的“新感觉”--南洋华侨作家黑婴的“乡愁”书写

史称“新感觉派”后起之秀的黑婴是唯一一位跻身于1930年代中国主流文坛的南洋华侨作家。这位生于荷印棉兰，长于广东梅县，深造于“魔都”上海的新一代南洋华侨，在“民国时态”浓郁的南洋氛围中登陆沪上文坛。在此跨文化的激烈碰撞与深度融合中，黑婴经由“乡愁”的激发与引领，讲述了新一代南洋华侨青年的苦难、迷惘以及艰难的蜕变。今天看来，这种包含着独特生命体验和丰富历史痛感的文化乡愁，正是南侨作家黑婴在“华文文学”和“海派文学”的脉络之外，贡献给中国现代文学真正而独特的“新感觉”。     

Latin American convergence and divergence towards the mortality profiles of developed countries

It is uncertain whether Latin America and Caribbean (LAC) countries are approaching a single mortality regime. Over the last three decades, LAC has experienced major public health interventions and the highest number of homicides in the world. However, these interventions and homicide rates are not evenly shared across countries. This study documents trends in life expectancy and lifespan variability for 20 LAC countries, 2000–14. By extending a previous method, we decompose differences in lifespan variability between LAC and a developed world benchmark into cause-specific effects. For both sexes, dispersion of amenable diseases through the age span makes the largest contribution to the gap between LAC and the benchmark. Additionally, for males, the concentration of homicides, accidents, and suicides in mid-life further impedes mortality convergence. Great disparity exists in the region: while some countries are rapidly approaching the developed regime, others remain far behind and suffer a clear disadvantage in population health.     

民国时期汉语语文辞书词性标注研究——以《王云五大辞典》为例

民国时期为我国汉语语文辞书古今转型的关键时期,《王云五大辞典》是该时期第一部采用现代汉语语法体系为字词标注词性的白话词典,本文对《王云五大辞典》的词类划分依据和词性标注特点进行了较为系统的剖析,并与其他代表性辞书的词性标注加以对比,总结《王云五大辞典》在词性标注理念的时代创新性,也指出其字词词性标注中存在的不足,供当前的辞书编纂参考借鉴。     

民办幼儿园教师专业素养培训方式实验研究

随着现代教育的发展，提升幼儿园教师专业素养已成为促进学前教育发展的必然要求。以探究民办幼儿园教师专业素养为视角，提出通过干预行为提升教师专业素养水平的构想。实验随机选取成都市某民办幼儿园的20名教师为实验组，再选取与其办园环境、办园背景相似的另一所民办幼儿园的20名教师为对照组，对实验园教师的专业理念与师德、专业知识、专业能力3个维度进行干预。实验结果表明：与对照园相比，实验园教师的专业能力提升显著；与实验园实验前后相比，教师在专业知识、专业能力维度及专业素养总体水平方面均有提升。对教师培训的具体建议为：（1）单一与混合相结合的培训方式对提升民办幼儿园教师专业素养总体水平有现实意义；（2）民办幼儿园教师专业知识的提升需理论培训与自主学习相结合；（3）专家"现场诊断-指导式"培训方式对提升民办幼儿园教师专业能力有显著作用。综上，建议民办幼儿园在了解本园教师专业素养水平的基础上，针对教师专业素养的不同方面，分别采取不同的有效培训方式。