扬州市邗江区乡镇预防保健体制改革两种模式的比较研究

扬州市邗江区1999年对全区21所乡镇卫生院进行了产权制度改革。改制前3年,实行“医防合一”体制,从2002年起实行“医防分设”体制。文章采用定性调查和定量调查相结合的方法,比较改革前后农村卫生体系和农村预防保键资源、组织机构、服务效率、监督执法力度、农民满意度等方面的变化。研究表明,“医防分设”是必由之路,为进一步改革和完善预防保健体系提供了依据。     

安徽省长期护理保险筹资水平精算研究

老龄化程度加剧,失能人数增加,是我国社会面临的一大难题,长期护理保险制度在该问题的解决中发挥着重要的作用。我国长期护理保险筹资机制存在参保主体覆盖面不足、筹资渠道单一、筹资水平高低不等、筹资激励措施缺乏等问题。文章将安徽省参保对象分为城镇职工和城乡居民,并将失能人群分为轻度、中度、重度三个等级,运用国际劳工组织(International Labour Organization,ILO)精算模型中的人口、收入、成本、结果等子模型测算安徽省长期护理保险筹资水平。结果显示,2019年安徽省城镇职工医疗保险参保人群的缴费率为0.14%,城乡居民每年需要缴纳96.77元。结合安徽省长期护理保险筹资水平与我国筹资机制实践存在的不足进行讨论,为安徽省长期护理保险筹资机制的设计提出优化建议。     

设立国有医药公司降低虚高药价

公立医疗机构对医疗资源的垄断、政府对药品流通市场监管的不到位、广大消费者对相关政策法律及药品知识的无知是造成当前药价虚高的核心原因;在市场经济条件下,政府应该更多地运用经济和法律手段来解决这一问题,由地方政府设立国有医药流通公司,同时运用互联网等媒介扩大消费者对医药信息的了解,从而通过消费者对药品理性选择的市场力量和政府规范市场的法制力量来解决药价虚高这一社会问题。     

家庭托育点管理实践及启示：政策工具的视角

家庭托育点的规范化对婴幼儿健康成长至关重要。通过文献收集和访谈获得既往管理举措和当前试点政策,运用政策工具进行分析和总结,探究管理家庭托育点的背景、对象和措施。结果表明：家庭托育点因经济优势而被纳入管理,现有征求意见稿管理对象偏向小规模邻托,但试点和市场偏向较大收托规模;消防审查依托既有消防验收,师资准入要求偏低,质量监管依靠政府。管理建议：应根据收托规模区分小型和大型家庭托育点开展试点;完善三方协同的管理架构,设定专门空间环境要求,提高师资准入要求,建立综合质量监管。     

以人为本的高校德育新模式

传统的高校德育模式偏重于“道德理论”、“道德知识”和“政治伦理”的灌输,缺乏自身应有的稳定性、逻辑性和科学性,在价值取向上难以摆脱社会本位和政治伦理的倾向。改革高校德育就必须构建“以人为本”的现代高校德育新模式,重视生命关怀,关注学生生命及其生命的生存状况和生存意义,进一步完善德育课程体系,拓宽德育内容,塑造大学生的健康人格和积极向上的人生价值观。     

Nonstandard parental employment schedules and father involvement

This study assesses the impact of nonstandard employment schedules (shift work) on parenting among US fathers of young children in dual-earner couples. The outcomes examined include total caregiving, caregiving without the mother present, and the elements of father involvement proposed by Pleck: positive engagement, warmth, and control. Models with latent variables and with lagged dependent variables are estimated using three waves of nationally representative data from the Early Child Longitudinal Study – Birth Cohort. The results indicate that employment scheduling mainly shapes the context in which involvement takes place. Compared to dual-earner couples who are each employed during the day, fathers in couples in which at least one parent has a nonstandard schedule tend to care for their children more in the mother's absence. To a more limited extent, they also do more caregiving overall. These effects are most conclusively found when the father works during the day and the mother works during the evening, when the mother works during the day but the father works a night, split, rotating, or other shift, and when both parents have nonstandard schedules. Parental work schedules, however, have little impact on father involvement aside from care.     

Early Pregnancy Assessment Services in Australia: What psychosocial support is available? A qualitative study

ProblemWomen commonly experience emotional distress following miscarriage but do not receive the support they need from healthcare providers.BackgroundMiscarriage can result in psychological morbidity; however, appropriate support at the time of a miscarriage can lead to better psychological outcomes. Early Pregnancy Assessment Services (EPASs) are dedicated outpatient services considered the “gold standard” for miscarriage care. Little is known about the psychosocial support EPASs provide in Australia.AimsThe aim of this study was to explore the provision of psychosocial support in Australian EPASs.MethodsSemi-structured interviews were conducted with 29 purposively sampled key-informants from 13 EPASs. Interviews were audio-recorded, transcribed, and thematically analysed.FindingsConsiderable variation was found in how EPASs functioned and their provision of psychosocial support. Many services were co-located with antenatal services, run by doctors with limited experience and most did not offer any psychosocial training to staff specific to EPAS. Referrals for additional support were generally not offered for first trimester miscarriages, and follow-up typically focused on physical management rather than emotional wellbeing. All EPAS staff demonstrated a strong commitment to providing best possible care to women within their own clinical setting and acknowledged the need for improved psychosocial support.ConclusionThis study provides the first exploration of Australian EPASs’ provision of psychosocial support. It has shown that while health care professionals working in EPASs are dedicated to providing the best possible care to women within their clinical setting, psychosocial support is very limited and could be improved.     

An Ecological Understanding of Caregiver Experiences in Palliative Care

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner’s ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.     

Shit is good: Mental health social work with lives of squalor

This paper investigates the phenomenon of three clients living in squalor, all of whom have severe and enduring mental health problems, and are on the caseload of a mental health social work team. By thinking about the clients both individually and as a group, within a psychoanalytic framework, it attempts to understand their squalor in a new way, with particular regard to the transference and countertransference experienced by the practitioner. By making use of social work literature as well as that concerning organisations and community care, it also discusses the impact these clients make on the wider community around them, and examines some of the dilemmas faced by the practitioner. The implications for social work are serious and far-reaching and these are discussed with regard to long-term intervention as well as professional and personal scrutiny.