Drug use as a ‘practice of the self’: is there any place for an ‘ethics of moderation’ in contemporary drug policy?

This paper offers a series of critical interrogations of the principles and practice of harm minimisation. This critique draws from Michel Foucault's account of ethics, pleasure and moderation in pointing to some significant gaps and conceptual problems within Australia's National Drug Strategy. I argue that this strategy has had only indirect impacts upon the ways in which illicit drugs are consumed in Australia, and on the behaviour of individual users. Part of this problem lies in the ways in which the cultures and the contexts of illicit drug use have been conceptualised within contemporary drug policy. Following Foucault, I argue that drug use ought to be conceptualised as a distinctive ‘practice of the self’. I argue further that Foucault's work on pleasure and ethics offers important new ways of understanding the changing nature of drug use for young people, as well as providing new conceptual bases for the design and delivery of harm minimisation strategies within those settings and contexts in which drug use takes place.     

中国5岁以下儿童营养不良的社会决定因素研究

目的： 了解中国5岁以下儿童营养不良与社会决定因素的关联程度，为制定进一步改善儿童营养不良的社会政策提供依据。方法： 从中国居民健康和营养调查（China Health and Nutrition Survey, CHNS）1991-2011年的纵向数据中提取2 434名5岁以下儿童，使用世界卫生组织igrowup软件计算儿童营养不良率，使用多因素非条件Logistic回归分析营养不良与社会决定因素的关联。结果： 20年间儿童整体低体重率和生长迟缓率分别下降了64.8%和67.8%，儿童低体重和生长迟缓得到显著改善。消瘦率一直维持在较低水平，女童营养不良率的降低幅度大于男童。非社会经济因素中，母亲身高低、儿童蛋白质摄入不足是营养不良的危险因素。社会决定因素中，居住在西部和中部、居住地城市化水平低、家庭收入低、母亲教育水平低是儿童营养不良的危险因素。结论： 为进一步改善儿童营养不良和缓解儿童健康不公平，需要重视儿童营养不良背后的社会决定因素，完善并实施改善儿童营养相关的社会政策，包括关注孕产妇和儿童的膳食营养、提高家庭生活水平和母亲教育水平、平衡地区间发展差距和资源分配等。     

Stakeholder views on the role of spiritual care in Australian hospitals: An exploratory study

Research increasingly demonstrates the contribution of spiritual care to patient experience, wellbeing and health outcomes. Responsiveness to spiritual needs is recognised as a legitimate component of quality health care. Yet there is no consistent approach to the models and governance of spiritual care across hospitals in Australia. This is consistent with the situation in other developed countries where there is increased attention to identifying best practice models for spiritual care in health. This study explores the views of stakeholders in Australian hospitals to the role of spiritual care in hospitals. A self-completion questionnaire comprising open and closed questions was distributed using a snowball sampling process. Analysis of 477 complete questionnaires indicated high levels of agreement with ten policy statements and six policy objectives. Perceived barriers to spiritual care related to: terminology and roles, education and training, resources, and models of care. Responses identified the issues to inform a national policy agenda including attention to governance and policy structures and clear delineation of roles and scope of practice with aligned education and training models. The inclusion of spiritual care as a significant pathway for the provision of patient-centred care is noted. Further exploration of the contribution of spiritual care to wellbeing, health outcomes and patient experience is invited.     

Local Leaders' Perspectives on Women Veterans’ Health Care: What Would Ideal Look Like?

Background

The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy.

Understanding policy persistence—The case of police drug detection dog policy in NSW,Australia

BackgroundSignificant research attention has been given to understanding the processes of drug policy reform. However, there has been surprisingly little analysis of the persistence of policy in the face of opposition and evidence of ineffectiveness. In this article we analysed just such a case – police drug detection dog policy in NSW, Australia. We sought to identify factors which may account for the continuation of this policy, in spite of counter-evidence and concerted advocacy.MethodsThe analysis was conducted using the Advocacy Coalition Framework (ACF). We collated documents relating to NSW drug detection dog policy from 1995 to 2016, including parliamentary records (NSW Parliament Hansard), government and institutional reports, legislation, police procedures, books, media, and academic publications. Texts were then read, coded and classified against the core dimensions of the ACF, including subsystem actors and coalitions, their belief systems and resources and venues employed for policy debate.ResultsThree coalitions were identified as competing in the policy subsystem: security/law and order, civil liberties and harm reduction. Factors that aided policy stability were the continued dominance of the security/law and order coalition since they introduced the drug dog policy; a power imbalance enabling the ruling coalition to limit when and where the policy was discussed; and a highly adversarial policy subsystem. In this context even technical knowledge that dogs infringed civil liberties and increased risks of overdose were readily downplayed, leading to only incremental changes in implementation rather than policy cessation or wholesale revision.ConclusionThe analysis provides new insights into why the accumulation of new evidence and advocacy efforts can be insufficient to drive significant policy change. It poses a challenge for the evidence-based paradigm suggesting that in highly adversarial policy subsystems new evidence is unlikely to generate policy change without broader subsystem change, such as reducing the adversarial nature and/or providing new avenues for cross-coalition learning.     

Why France is making eight new vaccines mandatory

France is one of the countries with the highest prevalence of vaccine hesitancy in the world. In an attempt to raise vaccination coverages, the French government made on January 1, 2018 eight more vaccines mandatory in addition to the three required until then. The process that led to this policy choice is of particular interest. We describe how vaccines became contentious in France and how French authorities came to view mandatory vaccination as the solution to the rise in vaccine hesitancy. In a bold move, French public health authorities turned to a new type of institutional device grounded in the ideal of democracy and public participation to political decision-making: “a citizen consultation”. This consultation anchored the idea that legal coercion could be the solution to France’s crisis with vaccines. Time will tell whether the French extension of mandatory vaccination will reduce tensions around vaccines.     

新形势下我国科技期刊稿源变化趋势——面向作者和科技期刊编辑的问卷调查与分析

【目的】 分析科技评价体系改革和国家大力扶持期刊发展新形势下我国科技期刊稿源动态变化趋势,助力国内科技期刊加速发展。【方法】 针对作者和科技期刊编辑分别设计了“国内科技期刊作者投稿意愿调查”和“2020年国内科技期刊稿源情况调查”问卷,利用问卷星提供的问卷设计和问卷发放(借助科研、期刊交流微信群)、统计分析等功能完成问卷调查。【结果】 大多数(86.2%)期刊2020年的投稿量比2019年增加,但增加1倍以上的期刊仅占6.4%;大部分期刊稿件平均质量有所提高(49.4%)或基本持平(47.0%)。绝大多数作者比较认可中国科技期刊,但同时对期刊发文速度、审稿质量、传播力度等有越来越高的要求,对期刊服务能力、品牌特色有越来越多的期待。【结论】 科技评价体系改革和国家扶持期刊发展为中国科技期刊发展带来了机遇和挑战,面对作者投稿国内期刊意愿的变化,我国科技期刊应该采取更加积极的应对措施,稳步扩大出版量、优化出版流程以承载更多回流的优秀稿件。     

浙江省德清县县域医共体改革措施与效果分析

目的：分析浙江省德清县县域医共体改革措施及阶段性成效。方法：定性访谈了解医共体整合措施，定量分析医共体建设前后（2016-2018年）各级医疗机构医疗服务利用数据及医共体部分绩效考核数据。结果：医共体在组织、管理、功能、服务方面进行整合，并取得阶段成效：医保基金在县域内支出率有所增加；乡镇卫生院卫生人员数量、医疗收入有所提高，乡镇卫生院住院病人人均医药费有所降低。结论：医共体取得初期成效，应开展以患者健康结局指标为主的长期追踪调查，全面系统评估医共体；保留基层医疗机构地位、功能定位不变；探索实行医共体"总额预付、结余奖励"制度，将医共体发展成以患者健康为中心、基于利益共享机制、分工合作的责任利益共同体。