Service Personalization as a Response to Noncompliance with Routine Childhood Vaccination

Governmental reaction to citizens’ noncompliance with policy is often portrayed as a retrospective enforcement effort, in which incentives and information serve as the main mechanisms to change citizens’ noncompliant behavior. This study suggests that government may adapt existing policy arrangements to encourage compliance rather than enforce implementation. Such responses recognize that noncompliance is an ongoing decision‐making process rather than a single event, with scope for government intervention at different points. Drawing on toddlers’ nonvaccination in Israel as a test case, findings indicate that to minimize noncompliance and its public health implications, officials have responded by personalizing the standardized service. Personalization is a pragmatic response that recognizes that hesitant parents may be amenable to modified interventions as an alternative to complete exit. Nevertheless, personalization challenges the very notion of a public health intervention based on a standard protocol and raises new dilemmas around where private responsibilities end and public ones begin.     

Strategic planning through a participatory learning and action framework: a Kenyan study

This paper reflects on the use of a participatory learning and action (PLA) framework in a strategic planning process (SPP) at a primary school in rural Kenya. Successes and challenges are discussed, focusing on the barriers to fully implementing the PLA framework. Additionally, lessons learnt and ways forward for participatory SPPs are outlined. The PLA framework allowed the project stakeholders to engage in a planning process that gave participants a voice in the process. Although PLA methodology faces shortcomings, the application of this model is a step towards making community development more sustainable.     

Fatal Fentanyl Patch Misuse in a Hospitalized Patient with a Postmortem Increase in Fentanyl Blood Concentration

Opioid‐related mortality happens, even in healthcare settings. We describe serial postmortem fentanyl blood concentrations in a hospital inpatient who fatally abused transdermal fentanyl. This is a single‐patient case report. A 42‐year‐old man with lymphoma was started on transdermal fentanyl therapy while hospitalized for chronic abdominal pain. The patient was last seen awake 1.3 h prior to being found apneic and cyanotic. During the resuscitation attempt, a small square‐shaped film was removed from the patient's oropharynx. Femoral blood was collected 0.5 and 2 h postmortem, and the measured fentanyl concentration increased from 1.6 to 14 ng/mL. Study limitations include potential laboratory or collection errors and missing data. (i) Providers must be vigilant for signs of fentanyl patch abuse. (ii) Postmortem blood concentrations are not static postmortem, likely secondary to decreasing pH, increased aqueous solubility, and tissue redistribution, and are therefore unlikely to accurately represent antemortem blood concentrations.     

Buddhism,Mindfulness, and Transformative Politics

This article examines whether the American cultural phenomena of the practice of Buddhism or the Buddhism-derived technique of mindfulness are likely to be helpful to the political left. It summarizes the central teachings of the ancient Buddhist texts, with particular focus on the issues of mindfulness and politics. It also reviews the political history of Buddhist countries. The author argues that although modern Buddhism has shed its historical embrace of absolutist monarchy in favor of republicanism, and although there is some ideological overlap between Buddhism and the American Left, Buddhism in America is too small a movement for it to be of much significance for progressive politics. Mindfulness appears to be capable of becoming a much larger phenomenon, but its separation from its Buddhist origins makes it also unlikely to be strategically important for the Left.     

The Day I Will Never Forget: an interview with Kim Longinotto

The documentary filmmaker Kim Longinotto talks to Catherine Fowler about her latest film The Day I Will Never Forget (2003) about female genital mutilation (FGM) in Africa. Longinotto’s films have consistently interrogated our understanding of womens’ place in the world, and her latest film is no exception. She discusses how she found her subjects: Fardohsa, a midwife who has been campaigning against FGM, a group of girls who have (successfully) taken their parents to court in order to prevent FGM being practised, and Fouzia, a girl of nine who reads a poem that she wrote the day after she was circumcised, asking her mother to explain why she put her daughter through such a painful experience. Longinotto also discusses the ethical issues raised by her filming of a circumcision of two sisters, and the wider issues that her film engages: the powerless position of women in African societies, the confusion of religion and culture in discussions of FGM, and the impact of saying ‘no’ to this practice.