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.     

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.     

Squashed dreams and rare breeds: ableism and the arbiters of life and death

The week beginning 29 June 2015 is not just historic for the closure of the Independent Living Fund in the United Kingdom, but for me was the week they decided that my life is not worth investing in; they being NHS England, NICE and, with them, the Department of Health. They chose not to support the enzyme replacement therapy that has been not only keeping me alive, but giving me a quality of life – enabling me to return to finish my Disability Studies PhD exploring how Christian leaders explain disability, where ethics have become the main topic, and to rebuild my career – or so I thought.     

历史变局、国家兴衰与发展之路——三次千年变局叠加下的中国特色社会主义发展道路

每当先进的发展制度开始取代落后的发展制度时，整个世界格局就会进入重大的转换阶段。在中国五千年的发展历史中，有两次重大的历史变局完全改变了中国历史发展轨迹并深远地影响了当前中国的发展模式。新时代下的中国作为前两次历史变局影响的客体，曾经既是先进发展制度取代落后发展制度的受益者，也经历过作为落后发展制度主体而被先进发展制度冲击的过程。目前世界正处于第三次先进发展制度与落后发展制度交替的历史变局阶段，作为第三次重大历史变局的主体，在三次千年历史变局叠加的背景下，能否有效地认识、适应并改造利用前两次历史变局的经验与教训，构建系统性、科学性、可行性、领先性的中国特色社会主义制度，将决定中国在本次历史变局中能否顺利成为先进发展制度的主体从而实现民族复兴。     

The relationship between lifetime health trajectories and socioeconomic attainment in middle age

A large literature demonstrates the direct and indirect influence of health on socioeconomic attainment, and reveals the ways in which health and socioeconomic background simultaneously and dynamically affect opportunities for attainment and mobility. Despite an increasing understanding of the effects of health on social processes, research to date remains limited in its conceptualization and measurement of the temporal dimensions of health, especially in the presence of socioeconomic circumstances that covary with health over time. Guided by life course theory, we use data from the British National Child Development Study, an ongoing panel study of a cohort born in 1958, to examine the association between lifetime health trajectories and socioeconomic attainment in middle age. We apply finite mixture modeling to identify distinct trajectories of health that simultaneously account for timing, duration and stability. Moreover, we employ propensity score weighting models to account for the presence of time-varying socioeconomic factors in estimating the impact of health trajectories. We find that, when poor health is limited to the childhood years, the disadvantage in socioeconomic attainment relative to being continuously healthy is either insignificant or largely explained by time-varying socioeconomic confounders. The socioeconomic impact of continuously deteriorating health over the life course is more persistent, however. Our results suggest that accounting for the timing, duration and stability of poor health throughout both childhood and adulthood is important for understanding how health works to produce social stratification. In addition, the findings highlight the importance of distinguishing between confounding and mediating effects of time-varying socioeconomic circumstances.     

Teaching technologies for immigrant children: an exploratory study of elementary school teachers in Russia*

ABSTRACT

Educational institutions are an important setting where psychological, pedagogical, sociocultural, and language adaptation of immigrant children occurs. A number of teaching strategies, practices, approaches, and methods have been described in the literature. In the Russian context, such strategies have been called ‘technologies’. The purpose of the present exploratory study was to describe teaching technologies used by teachers in Russia when working with immigrant students in elementary schools. Responses of forty-five elementary school teachers to open-ended questions describing technologies they use when teaching children with migration backgrounds were analyzed using content analysis. Findings suggest that Russian elementary school teachers used ethno-cultural group, communicative technologies, games, individualized instruction, and differentiated teaching. Many approaches mentioned can be used inclusively with groups of immigrant and non-immigrant students. Importantly, while teachers supplemented classroom instruction with additional Russian language lessons, none mentioned specific techniques for teaching Russian as a non-native language. These findings are discussed in relation to teaching strategies described in the international literature focused on migrant students. Finally, implications for further research are discussed.     

Inference and optimal design of multiple constant-stress testing for generalized half-normal distribution under type-II progressive censoring

The generalized half-normal (GHN) distribution and progressive type-II censoring are considered in this article for studying some statistical inferences of constant-stress accelerated life testing. The EM algorithm is considered to calculate the maximum likelihood estimates. Fisher information matrix is formed depending on the missing information law and it is utilized for structuring the asymptomatic confidence intervals. Further, interval estimation is discussed through bootstrap intervals. The Tierney and Kadane method, importance sampling procedure and Metropolis-Hastings algorithm are utilized to compute Bayesian estimates. Furthermore, predictive estimates for censored data and the related prediction intervals are obtained. We consider three optimality criteria to find out the optimal stress level. A real data set is used to illustrate the importance of GHN distribution as an alternative lifetime model for well-known distributions. Finally, a simulation study is provided with discussion.     

精神回溯与意象精研的本质书写--林雪诗歌评论

林雪是当代汉语诗歌的重要诗人，她“在心为志，发言为诗”，诗风大气沉郁。她近期的诗歌，情怀与思辨相互倚重、酵化，介入生活与提炼心性同步发力，题材多样，手法多变，情感收放自如，气韵放达从容。她对现实的观照，对时空的架构，对存在的开掘，都呈现出一种新的气象。她自觉地从先期女性主义诗写中觉醒，到如今的清澈中隐显尘世的味蕾，对生活细节和感念触觉的精妙镂刻，以及对世道人心的专注和细致打量。     

哲学家的私人生活与其哲学的解读

在哲学史研究中，对哲学家之哲学的解读与其私人生活的考察之间是否存在本质性的关联，是一个颇为耐人寻味却又不易回答的问题。而且，正像对“哲学”这一概念的本质主义理解是不可能的一样，这个问题也不存在一个本质主义的解答。不过，借助两种哲学类型的区分以及哲学史研究过程的三阶段划分，我们能够相对具体而又深入地来分析和讨论这一问题。     

自杀和生命的意义——来自脑科学研究的解读

生命本身是一个随机事件，并不具有高尚的意义。进化的结果使人类可通过工作、家庭和人际关系等给予自己的生命以意义感。当我们的生活方式使脑内奖赏系统获得刺激，就会带来生命具有意义的感受，这种感受给人带来更好的生存机会。生存的欲望是一切生物体最具特征的属性，一些精神疾病患者缺乏这种欲望。自杀主要发生于精神疾病患者，它并非是基于自由意志的行为。抗精神病治疗和适当的社会交往可以预防自杀。由于不同个体有着不同的大脑，人们的生活方式就应该去适应各自大脑的特征。只要人们的生活方式不对他人造成过多的伤害，政府就应该允许和保护人们自由地按照各自的方式生活。