Bridging the gender gap in agricultural development through gender responsive extension and rural advisory services delivery in Ghana

Despite the critical role women play in agricultural development their access to extension and rural advisory services delivery is limited. To improve this situation, an in-depth understanding of the importance of gender-responsive extension delivery is required. A case study of the Agricultural Development and Value Chain Enhancement Program that put in extra efforts to reach more female farmers with extension delivery and other rural advisory services was conducted. The study investigates how gender dynamics interact with the agricultural extension delivery with particular reference to the adoption of improved technologies. A total sample of 592 smallholder farmers were interviewed in selected communities in Northern Ghana. In addition to one-on-one interviews, 18 focus group discussions were also conducted in the surveyed districts. Study findings confirmed that male farmers had more access to agricultural extension delivery than their female counterparts because of their relatively better financial standing, large farm sizes, mobility to access extension and rural advisory service providers outside their communities. The study identified gendered associations with some crop types across all the study districts. However, the gendered extension delivery led to a new sociocultural order that seems to break down the gendered associations with the adoption of improved technologies.     

What Drives For-Profit and Nonprofit Organizations’ Entry into Voucher Markets?

This study investigates a social service voucher program in Korea to examine why local governments rely on external actors, such as for-profit and nonprofit organizations, in provisioning social services and what encourages such market entry in view of the transaction cost theory. The social service voucher program, first introduced in 2007, offers a unique dataset of 1,101 local markets to examine how local governments are willing to stay in control of provisioning the nationwide program while promoting private actor entry. This study finds that local governments with lower fiscal capacities or in markets in which multiple existing organizations operate are more motivated to foster for-profit entry, whereas only existing nonprofit organizations in the market that provide the same services predict nonprofit entry. The implication is that the facilitation of for-profit entry is associated with local governments’ need to manage transaction costs, although this may not be true for nonprofit entry.     

论欧盟金融服务法中的最低限度协调原则

在欧盟金融服务法中,最低限度协调原则是指共同体立法只对各成员国金融监管规则的基本要素进行协调.这一原则尊重了成员国的国家主权,有助于降低金融服务市场一体化的政策成本,并能够充分发挥市场机制的作用以促成最优的监管标准.<欧共体条约>中的特别协调条款是这一原则的直接依据,金融服务指令中的协调条款是其集中体现.最低限度协调原则只适用于符合共同利益的非歧视性限制措施.在其适用范围内,各成员国只能进行执行性立法.该原则的确立和推行是以相互承认为核心、以母国控制为表现形式的一体化模式成功运用的必然结果.晚近的立法实践表明,这一原则有被边缘化的危险.     

医疗权的伦理辩护

为国家设定建立医疗保障体系和高效优质的医疗服务体系以保障和促进人民健康义务的基本人权是医疗权,而不是健康权.合作抵御包括疾病在内的自然的侵害,是人际社会形成的重要根据.现代医疗服务已经成为一种基本的善,一种人之生命的必需.病人的医疗权是病人对分享社会合作成果的一种期待,这种期待具有伦理的正当性,能够得到伦理的辩护.这种作为正当性期待的医疗权本身又要受限于权利秩序中当时的条件和资源.     

和血汤和养精通络汤序贯治疗联合雌孕激素周期治疗人工流产后月经过少30例

目的 观察养血和血、养精通络中药序贯治疗联合雌孕激素周期治疗人工流产后月经过少的临床疗效。方法 将70例人工流产后月经过少患者随机分成中西医结合组（30例,予中药序贯治疗联合雌孕激素周期治疗）、中药组（20例,予中药序贯治疗）和西药组（20例,予雌孕激素治疗）,疗程均为2个月经周期。治疗前后分别观察3组行经时间、子宫内膜厚度和卵泡早期性激素水平。结果 中西医结合组临床疗效以及行经时间和子宫内膜厚度改善程度均明显优于中药组和西药组（P<0.05）。中药组治疗前后性激素水平无明显变化（P>0.05）;而中西医结合组和西药组卵泡刺激素显著降低（P<0.05）,黄体生成素、雌二醇、孕酮均显著升高 （P<0.05）,但两组治疗前后差值比较,差异均无统计学意义 （P>0.05）。结论 养血和血、养精通络中药序贯治疗联合雌孕激素周期治疗人工流产后月经过少能显著提高疗效。     

中医药干预对78例进展期胃癌生存期影响的单因素和多因素分析

目的 为多学科协作时代评价中医干预对进展期胃癌的临床价值及治疗时机选择提供依据。方法 回顾性分析78例进展期胃癌患者的临床资料,采用Kaplan-Meier法计算1年、3年生存率,采用单因素分析（Log-rank检验）观察相关因素对生存期的影响,对单因素分析有统计学意义的影响因素进行多因素分析（Cox回归分析）。结果 单因素分析显示,年龄、性别对进展期胃癌生存期的影响无统计学意义（P＞0.05）,根治手术、足程化学治疗、TNM分期、中医干预、中医干预时机及中药服用时间对生存期的影响均具有统计学意义（P＜0.05）;多因素分析显示,根治手术、足程化学治疗、TNM分期、中医干预、中药服用时间对进展期胃癌生存期的影响均具有统计学意义（P＜0.05）,其中TNM分期是进展期胃癌生存期的独立危险因素,而根治手术、足程化学治疗以及中医干预为其保护因素。结论 中医干预可以提高进展期胃癌患者的生存期,且长时间中医干预有利于患者长期生存。     

基于糖皮质激素给药阶段辨证治疗原发性肾病综合征31例

目的 在不同的激素治疗阶段,观察中医辨证治疗原发性肾病综合征（primary nephrotic syndrome, PNS）的增效减毒作用。方法 将62例PNS患者随机分为治疗组和对照组,每组31例。对照组给予泼尼松治疗,按首始量、减量、维持量规范用药。在对照组治疗的基础上,治疗组在不同的激素治疗阶段,分别采用解毒祛湿益肾养阴、清热利湿益气养阴、补益脾肾的中医治法。在不同的激素治疗阶段,分别观察并比较两组的疾病疗效、中医证候疗效、尿蛋白疗效及不良反应发生率,以及24 h尿蛋白定量、血浆白蛋白（albumin, ALB）、三酰甘油（triglyceride, TG）、总胆固醇（total cholesterol, TC）和肾功能。结果 在激素减量阶段,治疗组中医证候总有效率和尿蛋白完全缓解率均显著高于对照组（P<0.01）,向心性肥胖、精神兴奋、痤疮、血糖升高、肝功能受损的发生率均显著低于对照组（P<0.05）;在激素维持量阶段,治疗组疾病总缓解率、中医证候总缓解率和尿蛋白完全缓解率均显著高于对照组（P<0.01）,以及向心性肥胖、精神兴奋、痤疮的发生率均显著低于对照组（P<0.05）。在激素减量和维持量阶段,治疗组在升高血浆ALB,降低24 h尿蛋白和血浆TG、TC水平方面均显著优于对照组（P<0.05,或P<0.01）。结论 在不同的糖皮质激素给药阶段,中医辨证论治能够显著提高糖皮质激素治疗PNS的效果,减轻其不良反应,具有增效减毒的作用。     

我国地方政府间公共服务协商提供的得与失——基于长三角地区的探索

由于生产要素的跨区域流动以及政府某些行为的外部效应,地方政府辖区间衍生了大量公共服务协作提供问题。这些问题依靠单个地方政府往往难以解决,必须寻求毗邻地区地方政府的集体协商与合作治理。地方政府间公共服务协商提供是指由各地方政府、部门或其他社会参与者构成的协商主体,围绕一定的合作议题,运用一定的协商手段,协商提供公共服务。长三角地区地方政府间公共服务合作走在全国前列,探索其协商提供公共服务所取得的经验,可为其他地区提供参考。     

Chapter 13: Group Therapy for Birth Parents of Children in Foster Care

Psychological impairments render many biological parents of children placed in treatment foster care incompetent to meet child-rearing tasks. Service agreements identify and address critical areas of dysfunctioning but do not engage parents in a broader inventory of their parental functioning and dysfuntioning. A group method provides mutual support, exploration, and a positive child-rearing model. A clinical assessment of parenting that highlights ongoing developmental needs of nurturance and empathy, limit setting, structure, role modeling, reality testing, and separation and individuation is used to promote progress. Parents gain insight into their own overall impairments, origin of impairments, and compensatory techniques. Parents recognize broader responsibility for parenthood enhancing reunification efforts.     

One Small Step at a Time: Implementing Continuous Quality Improvement in Child and Youth Mental Health Services

Continuous quality improvement (CQI) is increasingly being adopted by health care, including child and youth mental health services. As part of the commitment to ongoing quality improvement, child and youth mental health teams in the Fraser region in British Columbia undertook CQI projects over a one year period (2007–2008). The projects covered a range of domains and service features and staff gained experience in developing projects. Patience, management support and ongoing dialogue were key elements in the implementation of CQI. Three projects are highlighted to illustrate how teams developed their own unique projects and the outcomes.