Alcance de la implementación en Cataluña de las estrategias de salud reproductiva (2008-2017)

ObjectiveWe analyse how reproductive health strategies have been incorporated into the everyday activities of the services and the resulting transformation of professional and user practices.MethodCartographic research taking a multi-sited ethnographic approach that seeks to reveal the processes of transformation. Data generation techniques featuring participant observation and situated interviews. Discourse analysis of the text corpus using three analytical axes based on three main lines of action promoted by the strategies.ResultsWe identified transformations in: 1) demedicalisation: an increase in midwives’ know-how and autonomy, changes in episiotomy practice and the facilitation of bonding practices; 2) warmth of care: incorporation of women's needs and expectations and improvements in the comfortableness of birth settings, especially in assistance at physiological birth; and 3) participation: actions that foster shared decision-making and the involvement of the persons accompanying women in labour.ConclusionsAbove all, transformation is visible in the incorporation of new attitudes, sensibilities and practices that have developed around the old structures, especially during physiological childbirth. The more technological areas have been less permeable to change. Risk management in decision-making and addressing diversity are identified as areas where transformation is less evident.     

Barriers and facilitators for the implementation of the integrated public policy for alcohol,drug, tobacco,and gambling prevention: a qualitative study

Abstract

In the field of alcohol, drug, tobacco, and gambling studies, empirical research on the barriers and facilitators for public prevention policies has been scarce. Public policy studies show that the implementers of different organizational positions impact on policy implementation. In this paper, the barriers and facilitators for the implementation of an integrated national policy for addiction prevention, as seen from the positions of managers, prevention specialists, and frontline workers, are analyzed on the basis of qualitative interview data. The results indicate that the managers were structurally oriented in their thinking and emphasized local structures as facilitators. All the groups saw prevention as underfunded and undervalued. The specialists were most focused on the official structures and regarded the functioning of the structures as a key facilitator. The frontline workers underlined that their position was a facilitator in itself, offering a unique viewpoint to the localities and to the lives of their clients. A key finding is also the normalcy of gambling that both the specialist and frontline workers regarded as a major barrier. The results show that studying the policy implementation context is important: it makes it possible to understand social and cultural factors that can function as barriers or facilitators.     

从《傅青主女科》探析全面二孩政策下“肝郁不孕”的影响

随着国家二孩政策的全面放开,有相当一部分女性在备孕二孩时面临着不孕的困扰,其中心理因素影响所占的比例日益增高。本文从《傅青主女科 种子门》关于不孕的论述入手,分析了肝郁不孕的机理,强调临证治疗中注重疏肝解郁,及必要的心理疏导治疗,从而提高二孩妊娠率。     

英国价值定价理念对我国医保药品报销政策的启示

本文在梳理英国医保药品报销政策的基础上,通过对价值定价理念的深入研究和理解,系统探讨其在报销政策制定过程中对药品目录遴选、价值测算、支付标准确定、医保基金平衡和报销效益评估的作用机制,并深入思考通过价值定价理念建立起的药物警戒体系与药品报销政策间的衔接机制。在此基础上总结价值定价理念的特点、应用阶段和具体操作方法,以期为我国提供借鉴。     

People don’t live on the care cascade: The life of the HIV care cascade as an international AIDS policy and its implications

ABSTRACT

This article analyses how the HIV care cascade, an analytical tool, has become a policy practice that determines the direction and content of international AIDS policy. It traces the development of the cascade through from its emergence around 2011 to its position framing global AIDS policy by 2018. The article distinguishes between the cascade model as a mapping tool and the care cascade as a policy that aims to end the AIDS epidemic. It then argues that the move from an analytical to a policy tool has important implications, both for the scope of policies and for policy-relevant research. It concludes by considering its implications in determining policy direction. The qualitative research that informs the article is based on published care cascade research and policy documents, and observations of the presentations and discussions at the 2012 and 2018 International AIDS Conferences (IAS). The article uses textual analysis to develop its argument.     

“I'm Leaving”: Factors That Impact Against Medical Advice Disposition Post-Trauma

BackgroundDischarge against medical advice (AMA) is an important, yet understudied, aspect of health care—particularly in trauma populations. AMA discharges result in increased mortality, increased readmission rates, and higher health care costs.ObjectiveThe goal of this analysis was to determine what factors impact a patient's odds of leaving the hospital prior to treatment.MethodsWe performed a retrospective analysis of the National Trauma Data Bank on adult trauma patients (older than 14 years) from 2013 to 2015. Of the 1,770,570 patients with known disposition, excluding mortality, 24,191 patients (1.4%) left AMA. We ascertained patient characteristics including age, sex, race, ethnicity, insurance status, ETOH, drug use, geographic location, Injury Severity Score (ISS), injury mechanism, and anatomic injury location. Multivariate logistic regression models were used to determine which patient factors were associated with AMA status.ResultsUninsured (odds ratio [OR] 2.72; 95% confidence interval [CI] 2.58–2.86) or Medicaid-insured (OR 2.50; 95% CI 2.37–2.63) trauma patients were significantly more likely to leave AMA than patients with private insurance. Compared to white patients, African-American patients (OR 1.06; 95% CI 1.02–1.11) were more likely, and Native-American (OR 0.62; 95% CI 0.52–0.75), Asian (OR 0.59; 95% CI 0.49–0.69), and Hispanic (OR 0.80; 95% CI 0.75–0.85) patients were less likely, to leave AMA when controlling for age, sex, ISS, and type of injury.ConclusionsInsurance status, race, and ethnicity are associated with a patient's decision to leave AMA. Uninsured and Medicaid patients have more than twice the odds of leaving AMA. These findings demonstrate that racial and socioeconomic disparities are important targets for future efforts to reduce AMA rates and improve outcomes from blunt and penetrating trauma.     

Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment

Abstract

We highlight the critical roles that pharmacists have related to sustaining and advancing the changes being made in the face of the current COVID-19 pandemic to ensure that patients have more seamless and less complex access to treatment. Discussed herein is how the current COVID-19 pandemic is impacting persons with substance use disorders, barriers that persist, and the opportunities that arise as regulations around treatments for this population are eased.     

Parliament in action: Drug withdrawals and policy changes in the U.K.

Previous studies on changes in health policies theorize such changes either as crises responses, or as the outcome of longer-term stakeholder conflicts. In this paper, we propose that parliaments function as overlooked, intermediate actors that contribute to translating the interests of stakeholders into policy changes. We study the role of parliament connecting policy makers and stakeholders in the context of drug regulation. Based on three high-profile cases of drug withdrawals between 1991 and 2005 in the United Kingdom (triazolam, rofecoxib, and co-proxamol), we distinguish partisan-political, individual-idiosyncratic, and collective-institutional pathways of parliamentary action on drug withdrawals. Distinguishing direct and indirect actions, we argue that indirect courses of action, including advocacy and educational work, can be just as effective as regular legislative endeavours, under certain conditions.