强制医疗保障性制度的困境与出路

强制医疗的制度体系在精神病鉴定、保护性约束、法律监督、案件审理、判决执行等诸多环节存在问题。精神病鉴定制度存在鉴定启动权的官方垄断、鉴定人责任不够明确、鉴定人中立性存疑、鉴定羁押制度缺失等问题;临时约束性保护措施存在临时措施名不副实、缺乏程序正义的公正外观、滥用措施缺乏法律责任、适用标准相对较低等问题;法律监督缺乏针对性的制度与合理的奖惩机制;辩护权保障不足,法律援助生成较晚;法院审理程序与普通案件审理程序有重大差异;法院强制医疗的决定缺乏有效执行的保障。困境成因是多元的、复杂的,既有主观上认识能力、价值取向、部门利益等因素,也有客观上精神病复杂性、资源稀缺、法治环境欠佳等限制。国家只有真正重视精神病人的权利保护,提供制度的物质基础,投入大量资源才有条件健全各项制度,从而保障强制医疗制度的有效运行。     

全面二孩政策背景下婴幼儿照料对女性工资收入的影响研究

照料孩子往往使职业女性遭受"生育工资惩罚",全面二孩政策是否会加重这种"惩罚"?研究基于广东省的问卷数据,得出如下结论:在孩子0—3岁时母亲的照料时间付出会对其工资产生负向影响;相比于一孩母亲,照料孩子的时间付出对二孩母亲工资的负向影响更强;对婴幼儿照料的支持有助于提高母亲的工资;综合考量规模优势、幼儿早教、健康卫生等因素,托幼机构照料是几种照料方式中最优的。为降低母亲照料孩子的代价并提高全面二孩政策的实施效果,研究建议:政府应大力发展低龄幼儿托育机构,建立托育服务基本保障体系,并出台政策支持不同社会主体提供多层次的托育服务,以满足家庭不断增长的托育需求。     

OECD 国家和中国生育产假政策的比较

生育保护假期制度是保障育龄妇女权益的重要手段,OECD国家将产假期限、工作保护和津贴补助三者有机结合,创设的陪产假和育婴假制度极大地促进了性别平等,帮助受雇者平衡工作与家庭的冲突,提升了生育保护水平。当前中国面临着二孩政策全面放开后生育率不如预期乐观的情况,如何走出低生育率陷阱成为亟需解决的问题。通过对OECD国家和中国现有的产假制度进行比较,研究为完善我国生育产假政策提供建议。     

美国管理式医疗的发展历程及对国内医保的借鉴

从理论和实证的研究表明,管理式医疗曾被当作美国医疗保险改革的典范,甚至有人尊其为有效降低医疗费用和成本的灵丹妙药。在有效控制节节攀升的医疗服务费用方面,管理式医疗确实达到了非常好的效果。但是,医疗服务需要关注的不仅是费用,还有医疗服务的质量、服务的可及性以及临床医疗的长远发展等方面。而美国管理式医疗的发展历程生动地诠释了普通民众需要的不仅仅是廉价的医疗服务这一现实。     

Evaluation and applicability of Alere iCup DX 14 for rapid postmortem urine drug screening at autopsy

Performing point‐of‐care urine drug screen testing at autopsy by a forensic pathologist may provide an early indication of the presence of analytes of interest during autopsy. An evaluation for the screening of 14 classes of common drugs of abuse in postmortem urine by the point‐of‐care screening device, Alere iCup DX 14, is presented. One hundred ninety postmortem urine samples were screened with the iCup occurring at autopsy by the forensic pathologist. Positive and negative results obtained from the screening kit were evaluated against confirmatory test results obtained using routine forensic toxicology analyses that employed LC‐MS/MS and GC‐MS to detect a combination of over 85 common drugs of abuse and medications. Sensitivity for each respective iCup drug class ranged from 66% (buprenorphine) to 100% (methadone, tricyclic antidepressants). Specificity for each respective iCup drug class ranged from 89% (benzodiazepines) to 100% (amphetamines, barbiturates, buprenorphine, 3,4‐methylenedioxymethamphetamine, methadone). Positive predictive values ranged from 44% (benzodiazepines) to 100% (amphetamines, barbiturates, buprenorphine, methylenedioxymethamphetamine, methadone), while negative predictive values ranged from 96% (methamphetamine) to 100% (barbiturates, methadone, tricyclic antidepressants). A high false‐positive rate was yielded by the benzodiazepine class. The lack of fentanyl screening in the point‐of‐care device is a significant limitation considering its prolific prevalence in forensic casework. The results obtained in the study should be acknowledged when considering the use of the Alere iCup DX 14 in the context of postmortem casework to help indicate potential drug use contemporaneously with autopsy and when requiring such preliminary results prior to the release of a final forensic toxicology report.     

Coping Alone: Examining the Prospects of Adolescent Victims of Child Abuse Placed in Foster Care

The ability of a young person to cope effectively with stressful life events appears to be associated with their previous experiences and relationships. Young people in foster care who have histories of child abuse, therefore, may find they cannot cope effectively with the situation they find themselves in. This paper attempts to highlight the problems they face. A group of 21 young people were interviewed and were asked to complete the Frydenberg and Lewis Adolescent Coping Scales. Their social workers provided information on their past history both in care and prior to coming in to care. It emerged that the young people who had experienced physical and/or sexual abuse were significantly (p < 0.02) more likely to be/have been involved in problem, or Crisis, foster placements. Additionally these young people displayed less adaptive coping strategies than the young people who had not been abused. The most significant differences indicated that the victims of abuse were more likely to try and cope with stressful situations by themselves, while the other foster adolescents were significantly (p < 0.004) more likely to find support from their friends. Case studies, with reference to the teenager's own accounts, help to illustrate how a history of abuse can complicate the already difficult fostering processes, and can also affect the long-term coping abilities of the victims. The consequences of these issues are discussed.     

PSYCHIATRIC HOSPITAL CAPACITY,HOMELESSNESS, AND CRIME AND ARREST RATES*

As a result of developments in pharmacology, stricter standards for involuntary commitment, and changes in public expenditures, there has been a dramatic decline in the capacity of public psychiatric hospitals to maintain America's most severely mentally ill. Psychiatric deinstitutionalization has led to an increased presence of persons with mental illness in urban areas, many “falling through the cracks” of community‐based services. This is hypothesized to have contributed to homelessness, crime, and arrests. Individual‐level research has documented disproportionate and increasing numbers of mentally ill persons in jails and prisons. It has also found higher rates of violence and arrest among persons with mental illness compared to the general population. This study takes a macro‐level social control approach and examines the relationships between psychiatric hospital capacity, homelessness, and crime and arrest rates using a sample of eighty‐one U.S. cities. I find that public psychiatric hospital capacity has a statistically significant negative effect on crime and arrest rates, and that hospital capacity affects crime and arrest rates in part, through its impact on homelessness. In addition, I find no crime‐reducing effect of private and general psychiatric hospital capacity.     

Equity,access, and outcomes: The status of the art

A rationale for including analyses of outcome in evaluation of the impact and equity of changes in health care policy for the poor is presented. We first discuss problems in defining equity in and access to health care. Equity in access to health care requires equality of access only to those services that are believed to be efficacious. Three cost-containment strategies (restrictions in eligibility, coinsurance, and capitation) are then examined, and their limitations are discussed. Finally, directions for future research focusing on outcomes are suggested. Rather than using access to care to assess outcome, outcome is viewed as the framework for assessing access and equity.     

对当前幼儿园保育工作问题及对策的思考

当前,幼儿园保育工作中存在着重视力度小、保育员队伍不健全、保育工作质量难以保证等诸多问题.针对这一现状,全园上下要树立起正确的保育观,通过优化管理,建设稳定、合理的保育员队伍,注重保育员的业务学习,全面提高保育工作质量,从而为幼儿的全面发展创造最佳的保育条件.     

浅论强化村级医疗卫生网络建设

村级医疗卫生网络机构是县级医疗卫生体系中的最基层网络组织,是解决农民看病难、看病贵问题的有效途径。结合玉屏自治县的调查情况,对其发展状况、存在的问题进行了详细的分析,提出了加强组织建设、加大财政投入、改善村医待遇、加强教育培训等五个方面的对策。