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.     

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.     

类型化视域下自然保护地立法的制度建构

自然保护地在维持生态平衡,实现生态系统服务功能中可以发挥重要作用,但不同类型自然保护地的主导生态系统服务功能供给存在一定差异.《自然保护地法》立法工作须依赖理论上对自然保护地的类型化,并在此基础上建构对应型的规划建设、运营管理等方面的具体制度.因此,基于生态系统服务功能供给的空间差异,可以将当前相互重叠、缺乏体系的自然保护地划分为国家公园、自然保护区、自然公园、自然保护小区等四种类型,搭建"1部基础法律+4部类型化条例(或法律)"的自然保护地法律体系,并可以通过体系化公法、私法制度工具强化自然保护地的有效治理.     

高校哲学社会科学研究评价的本质要求及其制度建设

建设具有中国特色、中国风格、中国气派的哲学社会科学,一直是我国哲学社会科学繁荣发展的根本目的.提升高校哲学社会科学繁荣发展水平,离不开科学有效的哲学社会科学研究评价.坚持党的领导、"二为"方向和"双百"方针是哲学社会科学繁荣发展的根本保障,坚持"质量为本"和"创新至上"是哲学社会科学繁荣发展的必然要求,坚持科学权威和公开透明是哲学社会科学研究评价的现实需要.结合当前高校哲学社会科学研究评价中"量化评价下数量与质量的关系论辩","学术评价与科研管理评价的边界异化"和"学术权力和行政权力的制度规制"三大问题聚讼,文章建议通过强化学术成果质量保障机制、优化学术共同体工作机制、构建学术争鸣长效机制和完善学术成果转化应用机制等制度建设,推动构建科学权威、公开透明的哲学社会科学研究评价体系,以期进一步改善新时代高校哲学社会科学研究评价工作.     

随机需求环境下联产品系统价格与产量决策研究

基于固定比例生产技术和多产品随机需求的情形,研究了联产品制造商的两阶段产量和价格联合优化模型。通过反向倒推的优化求解,得到了联产品制造商的最优产量和价格决策以及变化规律。同时研究了需求服从均匀分布时,需求波动对均衡的影响。研究结果表明,在订货成本较低和一种产品的需求波动性较大时,当另外一种产品的波动增大,则该产品的最优订货量增大,同时价格下降。借助数值仿真,分析了价格敏感度和产出比例对最优决策和利润的影响。结果表明,在给定一种产品的价格敏感度时,另外一种的价格敏感度越大,那么该产品的价格就越低,制造商的订货量就下降。当一种产品的产出比例固定时,另一种产品的产出比例上升时,则该产品的价格下降,制造商的订货量下降,总利润上升。     

网络服务提供者著作权侵权中的双重注意义务

《民法典》侵权责任编对原有通知删除规则进行了科学修正，但事前保护缺位与事后救济程序失范的问题仍然存在。随着网络服务提供者完成角色转型和技术升级，其作为网络侵权风险的控制者和参与者，有必要且有能力承担未通知阶段的主动预防义务和已通知阶段的证明材料审查义务，以弥补著作权保护和用户利益保护的漏洞。双重注意义务应分别与网络服务提供者对侵权危险的预期和控制能力以及材料审查能力相适应。未通知阶段之注意义务以技术措施为主要履行方式，其注意标准的认定应综合考量技术水平、服务类型、内容介入程度、是否直接获取收益等要素，未尽该注意义务仅为过错认定的考量因素而非唯一标准，并不必然导致侵权责任。已通知阶段之注意义务仅限于对提交的证明材料进行形式审查和有限的实质审查，尽到此注意义务的，可以免于承担侵权责任。     

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.     

农户地权诉求视角下农地制度的创新

目前我国农户的地权诉求已经发生了很大的变化，即由地权稳定、自主经营向农地资源的优化配置和高效利用转化。这一变化的内在动力是农户急切希望改变承包地过于细碎化以及改善农业生产经营基本条件。考察我国农地制度的发展史可以发现，我国农地制度变迁的基本逻辑就是农户的地权诉求决定农地制度的发展方向，这一点在当下一些地方的农地制度创新试验和经验中再次得到证明。今后我国农地制度创新必须遵循这一逻辑，根据我国农户地权诉求的变化，实施农户自愿前提下的承包地连片重划,争取国家对承包地重划制度的支持,强化农民集体民主决策制度,地方政府也要给予必要的支持。     

Age limits for participation in child protection court proceedings in Sweden

According to the UN Convention on the Rights of the Child and Swedish legislation, children have the right to participate in child protection proceedings. The aim of this paper is to describe and analyse the notion of age and maturity in child protection proceedings in order to elucidate how these aspects could influence children's rights to participate. We focus on the view of three groups of actors involved in child protection proceedings in Sweden—social workers, lawyers, and laypersons in social welfare boards and administrative courts—and on how children's age and maturity should be taken into consideration in decisions on their participation in court. The analysis is based on survey data. The study found that social workers, laypersons, and lawyers have different views on when children are old enough to have the right to litigate in court. Additionally, there is no consensus on how the maturity of the child can be assessed to inform the decision about participation. More discussion is needed about what competences a child needs to participate in court and to what extent this right should be limited by their age. Importantly, courts and decision‐making proceedings can be made more child friendly.     

Caring for families experiencing stillbirth: Evidence-based guidance for maternity care providers

BackgroundEvidence-based guidance is needed to inform care provided to mothers and families who experience stillbirth. This paper focuses upon how meaningful and culturally appropriate care can be provided to mothers and families from when they are informed that their baby will be stillborn to many years after the experience. Avoidable suffering may be occurring in the clinical setting.AimsTo promote and inform meaningful and culturally appropriate evidence-informed practice amongst maternity care providers caring for mothers and families who experience stillbirth.MethodsA comprehensive systematic review was conducted which primarily synthesised relevant qualitative research studies. An expert advisory group comprised of stillbirth researchers, clinicians, and parents who have experienced stillbirth provided guidance for the review and the development of implications for practice.FindingsGrieving parents want staff to demonstrate sensitivity and empathy, validate their emotions, provide clear, information, and be aware that the timing of information may be distressing. Parents want support and guidance when making decisions about seeing and holding their baby. Sensitivity, respect, collaboration, and information are essential throughout the experience of stillbirth. Culturally appropriate care is important and may require staff to accommodate different cultural practices.ConclusionThe findings of the review and expert consensus inform the provision of meaningful and culturally appropriate care for mothers and families that have experienced stillbirth. Evidence informed implications for practice are provided to guide the actions, communication, and behaviours of maternity care providers.