The shift from inpatient care to outpatient care in Switzerland since 2017: Policy processes and the role of evidence

The shift from inpatient care to the ambulatory sector is a central aspiration of European health systems. Despite demonstrated benefits, health reforms have struggled to realize their potential. In this context, we discuss recent hospital sector reforms in Switzerland and analyze the content, process, and role of evidence in the recent introduction of policies to substitute inpatient care with ambulatory care. The prevailing payment system incentivized hospitals to provide unnecessary and costly inpatient services, but federal reform on tariff structures was deemed politically unfeasible. Instead, driven by the pressure to contain costs, cantonal and federal health authorities began to deny reimbursement for selected inpatient procedures in 2017. These regulatory measures were effective in reducing inpatient admissions and health care costs. This case study illustrates that clear, simple messages about hospital sector reform can raise awareness of the need for change. However, the evidence used in the policy process was limited and not critically reviewed. Stakeholders used long-standing international comparisons of inpatient substitution potential to legitimize policies, but not to develop them. The analysis restates the importance of inter- and intranational comparative analyses and institutions such as health observatories and suggests aligning health system governance more proactively with international developments.     

云南省弥渡县新型农村合作医疗补偿机制研究

目的 调查云南省弥渡县新型农村合作医疗运行2年来的补偿机制，了解补偿方案与具体补偿情况的关系，为新型农村合作医疗的推广提供借鉴。方法 收集县、乡两级合作医疗管理机构有关补偿情况的记录。并利用现有资料、通过个人访谈及集中小组访谈等方法了解试点的基本情况、补偿情况以及卫生服务情况等。结果 （1）实际补偿水平（29．32％）高于全国平均水平；（2）群众看病首选县级医疗机构。占全部参加合作医疗并就诊人群的60％以上；（3）补偿基金报销基本正常。结论 应鼓励群众参与，加大对乡镇卫生院的投入，引导村民到乡镇级医疗机构就医，以合理有效地利用卫生资源。     

Agentive and communitarian play in early childhood

Play has long been recognised as a vehicle by which significant developmental advances occur during early childhood. Children use play to explore their relationships, their psychosocial skills, and their environment, and through their experiences, they begin to adopt specific capacities and values that have an impact on future socio-emotional and academic outcomes. To understand more fully the factors that contribute to well-being in early childhood, we explored footage of a full ‘day in the life’ of a 5-year-old boy in transition to kindergarten, and we conducted interviews with him, his parents, and teacher. We identified agentive and communitarian strivings to be significant sources of his thriving and primary elements of many episodes of play during his filmed day. Previous research indicates that the development of strong agentive and communitarian skills and values is related to positive psychosocial outcomes. The current case study explores our participant's agentive and communitarian behaviours as exemplified through episodes of play, and the ways in which these skills and values are encouraged and supported by his caregivers. Implications regarding the role of parents and educators in the facilitation of agentive and communitarian skills are discussed.     

以人为本 以才兴业 为食品药品科学检验提供人才支撑

目的 加强人才队伍建设，推动科学检验工作。方法 分析省级食品药品检验机构人才队伍的现状，介绍陕西省食品药品检验所通过选才、育才、聚才等一系列举措，加强人才队伍建设的具体实践。结果与结论 通过加快推进事业单位人事制度改革，进一步健全培养机制，强化培养措施，为科学检验提供有力的人才支撑。     

Structural risk and limits on agency among exotic dancers: HIV risk practices in the exotic dance club

This paper provides longitudinal examination of women’s health and sexual risk trajectories in US exotic dance clubs, which represent an important commercial setting for the economic mainstreaming of sexual services and an important target for public health programmes. Between July 2014 and May 2015, two semi-structured interviews (at baseline and at three months) were conducted with 24 female exotic dancers who had recently started working in in Baltimore City, USA. Results from a constant comparative analysis point to the interrelationship between the structures of the club setting, including the social context, and women’s agentic practices concerning their sexual health. Study findings highlight the centrality of the interrelationship between individual- and structural-level experiences in influencing dancers’ risk behavior. Findings point to the need for interventions to empower women both individually and collectively so as to provide the foundation for longer-term structural change.     

Innovation in Chemistry,Manufacturing, and Controls—A Regulatory Perspective From Industry

This review describes the landscape of novel modalities such as cell and gene therapies, viruses, other novel biologics, oligomers, and emerging technologies, including modern analytics. We summarize the regulatory history and recent landmark developments in some major markets and examine specific chemistry, manufacturing, and controls (CMC) challenges, including suggestions for exploration of potential science-based approaches in support of regulatory strategy development from an industry perspective. In addition, we evaluate the economic factors contributing to patient access to innovation and discuss the impact of regulation. There is a desperate need for a consistent form of regulation where global approaches to regulatory strategies can be harmonized, and specific CMC challenges can be dealt with using the appropriate science and risk-based tools. Although these tools are well described in current guidance documents, the specifics of applicability to complex novel modalities can still result in differing regulatory advice and outcomes. The future goals for efficiently regulating innovative modalities and technologies could be aided by more regulatory harmonization, regulatory education, and industry cooperation through consortia, enabling industry to supply key information to regulators in a transparent yet well-defined manner, and utilizing mutually understood risk-benefit analyses to produce drugs with appropriate safety, efficacy, and quality characteristics.     

Older rehabilitees’ life-course agency in Finnish gerontological rehabilitation

Aims: This study investigates gerontological rehabilitation sessions of Finnish rehabilitees in the framework of life-course agency from the perspectives of temporal orientation and agency. Methods: The research data were obtained by non-participatory observation in 11 individual goal-setting sessions between 11 rehabilitees and their personal counsellors. The data were analysed in accordance with data-driven, qualitative content and narrative analysis, with an emphasis on the life-course agency approach. Results: Four temporal orientations of older rehabilitees were identified in the rehabilitation sessions: (i) timeless, (ii) past, (iii) present, and (iv) life course. For each temporal orientation, the rehabilitees displayed different kinds of agency. Fractured agency was intertwined with the timeless orientation, frozen agency was related to the past orientation, practical agency to the present orientation, and transitional agency emerged in relation to the life-course orientation. Conclusions: The article contributes to the discussion of how older adults’ rehabilitation should be reformed within the Finnish context. The study suggests that a person-centred gerontological rehabilitation process should be conceptualized in terms of an agency-based approach with a personally constructed and temporally embedded life-course perspective. This kind of conceptualizing could promote empowered cooperation and innovative interventions with flexible schedules in the rehabilitation processes of older adults.