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.     

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。     

Pathways from workplace flexibility to turnover intention: Role of work–family conflict,family–work conflict,and job satisfaction

This study examined the prevalence of workplace flexibility and the mechanisms that allow workplace flexibility to influence turnover intentions through work–family and family–work conflicts and job satisfaction among low‐wage workers in South Korea. Participants included 250 low‐wage workers whose monthly salary was less than 2 million Korean won (approx. $1,900). The study results indicate that low‐wage workers have limited access to workplace flexibility and that workplace flexibility plays a significant protective role in reducing their turnover intention, indirectly by decreasing work–family conflicts and enhancing job satisfaction. This article also discusses the implications of these findings for labor policy and social work practice.     

Impact of older adults' mobility and social participation on life satisfaction in South Korea

South Korea has been experiencing rapid population aging. In an aging society, the need for healthy lives is greater. Two of the fundamental factors to enable independent and active life for the elderly are mobility and social participation. The purpose of this study was to examine the relationship between older adults’ mobility, social participation, and quality of life in South Korea. We used data from the 2017 National Survey of Older Koreans conducted by the Ministry of Health and Welfare and the Korea Institute for Health and Social Affairs and applied hierarchical regression. The major finding was that older adults’ mobility had a positive impact on their life satisfaction. After controlling for older adults’ mobility, social participation was positively associated with life satisfaction regardless of the place of residence. The findings of this study not only make a valuable contribution to further research on mobility and social participation but also provide new insight into improving older adults’ quality of life.     

Leader-employee congruence of expected contributions in the employee-organization relationship

Employees' expected contributions can be incongruent with those of their leader. We examine the congruence effect of leaders' and employees' expected contributions on job satisfaction. Results of cross-level polynomial regressions on 947 employees and 224 leaders support the congruence effect. When expected contributions are congruent, employees are more satisfied with their job. Our findings suggest that employees enjoy high challenges, as long as these challenges are in harmony with the expected contributions of their leaders. Employees are less satisfied with their jobs both when their expected contributions were higher than their leaders' and when their expected contributions were lower than those of their leaders. Beyond the relevance of having high expected contributions, the findings highlight the crucial role played by the congruence of expected contributions of leaders and employees.     

陶渊明的诗化人格

作家的人格是其作品风格的内在因素 ,往往决定着其作品的风格。我们在研究作品风格的时候 ,不能不关注作家的人格。只有对作家的人格进行全面深入的审视 ,才能更准确地理解和把握其作品的风格。探讨陶渊明的人格魅力及其特征 ,是深入研究陶渊明作品风格的至关重要的途径。从陶渊明的作品中 ,从他的言行中 ,我们可以领悟到他的情趣和胸襟 ,领悟到一种具体的人格。陶渊明自然率真平和旷达的个性特征构筑了他的诗化人格 ,即未经世俗异化的高尚贞洁的人格。这种人格的内在思想根源是自然化迁的宇宙观和委运自然的人生观。这种人格的外在表现形式是他任真自得和固穷守节的行为方式。他的作品中常见的酒与菊、孤松、孤云与归鸟等艺术形象组成了陶渊明诗化人格的象征系列     

关于研究生教育若干问题的思考

研究生教育是高等教育结构中的高层次教育。文章围绕创建科学的研究生教育体系问题 ,从自主招生、导师队伍建设、学位授权点、学术监控以及办学理念等方面进行了探讨     

The Best and Worst Times of Life: Narratives and Assessments of Subjective Well-Being by Anamnestic Comparative Self Assessment (ACSA) in the Eastern Cape,South Africa

The Anamnestic Comparative Self Assessment (ACSA) measure of subjective well-being (SWB) aims to reduce the problems of cultural bias and relativity to external standards by allowing people to define the endpoints or ‘anchors’ of the measurement scale. In medical terminology anamnestic denotes ‘based on memory’. The ACSA uses subjects’ memories of the best and worst periods in their lives to define the anchors of the scale. They then assess their current quality of life relative to these personal anchors. The South African pilot study tested the match between self-assessment of SWB with ACSA and the conventional single-item measures of life satisfaction and happiness used in the South African Quality of Life Trends Study and analysed the narratives of the best and worst times of life. The quota sample of 46 consisted of 26 residents of Makana district in the Eastern Cape Province, South Africa, and 20 patients undergoing treatment in the local TB hospital. Mean SWB ratings with all three measures of life satisfaction, happiness and ACSA were between 5 and 6 on a 0–10-point scale. Ratings on all three scales were positively correlated. However, on ACSA the TB patients rated their current SWB 1.84 points lower than the community respondents, suggesting a greater sensitivity of this measure. It was observed that the starting points of the life stories produced by respondents to define the anchor periods for ACSA were related to their current assessment of SWB. A typology was developed that combined the starting point of the life stories with current SWB. The majority of community respondents matched the ‘Achiever’ type who scored positively on ACSA (i.e., above the mid-point of the scale) and whose life stories started with the worst period of their lives and proceeded to the best period. The TB patients were the only respondents to represent the ‘Survivor’ type whose morale had recovered after misfortune in life. ‘Survivors’ started their narratives with the best period in their lives, then moved to the worst (often health-related) one, and gave positive ACSA ratings. Based on the qualitative analysis of narratives, it is concluded that ACSA is a sensitive measurement instrument and therefore particularly useful for monitoring the effects of treatments and social interventions in longitudinal studies. However, further research is required to verify its cross-cultural validity.

流动人口婚姻满意度实证分析

利用"流动人口的婚姻家庭调查研究"课题收集的数据,从流动人口对婚姻生活的满意度和对配偶的满意度来描述流动人口的婚姻满意度状况,并对流动人口各方面的婚姻满意度随结婚年数的发展变化趋势进行分析。通过建立多视角多因素的综合解释模型,对流动人口婚姻满意度的影响因素进行回归分析,结果表明,夫妻关系维系因素、冲突解决方式、婚恋意愿、权利模式等是流动人口婚姻满意度的主要影响因素。