An Explanation of Punctuated Policy Change: Nursing Policy in the Post-Pandemic Landscape.

As the United States (U.S.) moves toward the post-pandemic landscape, there remains a heightened need to increase the nursing workforce. The population continues to age, chronic illnesses are further exacerbated, and the highlight of the shortage of nurses weighed heavier while navigating care during Covid-19. This article examines nursing workforce improvement policies in a policy system where outcomes are either predicated by incremental decision-making or by punctuated changes. Punctuated Equilibrium Theory (PET) is posited to explain nursing policy trends and outcomes. Covid-19 created a punctuation in the healthcare system, leading to the "great resignation," the increase of travel nurses, and nurses working remotely via tele-health tools. What remains is the impact on nurse staffing policy and what will be done to provide nursing services moving into the future.

Comprehensive sexuality education for the most disadvantaged young people: findings from formative research in Ethiopia.

Comprehensive sexuality education (CSE) seeks to improve young people's knowledge, attitudes and practices in relation to sexual and reproductive health, sexual and social relationships, and dignity and rights. In Ethiopia, young people with disabilities and young women involved in sex work are particularly vulnerable to sexual violence and poor sexual health, yet face stigma and accessibility challenges that continue to exclude them from information, support and services. Because they are often out of school, these groups are also often excluded from programmes that are largely delivered in school settings. This paper explores the challenges faced by these groups of young people in accessing inclusive and age-appropriate sexual and reproductive health knowledge and services in the Ethiopian context and the implications for delivering CSE. The research included literature review, mapping analysis and interviews with young people from those two groups and with service providers and programme implementers. Our findings indicate that young people with disabilities and young women involved in sex work face myriad barriers to accessing information and services that support positive and healthy sexuality, relationships and rights. However, changes over the past decade to national and regional governance structures and a political environment in which CSE has become increasingly contested have generated siloed approaches to the provision of sexual and reproductive health information and services, and poor linkages to complementary services including violence prevention and social protection. It is vital that efforts to implement comprehensive sexuality education are informed by these challenges in the wider policy environment.

Theory and Practice of Policy Change: Current Situation and Countermeasures of Village-level Health Human Resource Distribution in Field Research in H District of Beijing / 中国医学伦理学

【Objective:】 To explore the current situation and problems of village-level health human resource allocation based on the theory of policy change, and to help rural revitalization and healthy rural construction from the perspective of "consolidating the basic level foundation as fundamental policy". 【Methods:】 a) Information census method. A round-the-box survey on the distribution of health human resources at village-level in 14 rural towns and villages in H district was conducted. b) In-depth interview method. Based on the principle of information saturation, three township and villages clinics and community stations were selected for field observation, and in-depth personal interviews were conducted with key insiders. 【Results:】 The health policy environment changed significantly with the spatiotemporal changes. "Hollow village" and "inverted village" coexisted. The change of registered population and permanent resident population accelerated, old village doctors and new village doctors continued on the same hand, village clinics and community station were in "double track" of management progress. With the change of internal and external environment of the above-mentioned policies, the allocation of health human resources at village level needs to be studied urgently. 【Discussion:】 Under the dual function of external and internal environment, the policy change is inevitable. The health human resource distribution at village-level should be integrated with the system in terms of policy. The career development mechanism is connected up and down. Team construction revolves around suitable and applicable for batch training.

Is a Pleasant Policy Environment Conducive to Green Growth of Central China?

Improving the pleasantness of the policy environment in Central China stimulates economic growth, but it also contains higher risks of pollution. Based on the data of 80 cities in Central China from 2006 to 2018, the entropy method was used to estimate the pleasantness of policy environment in the region. How the policy environment has changed and whether the pleasant policy environment in the region is conducive to green growth were empirically studied. The results show the following: (1) The current attempts to improve the pleasantness of the policy environment in Central China is not conducive to green growth of the region. (2) Improving the pleasantness of the policy environment has indirect negative impacts on green growth through widening the development gap between prefecture-level cities and provincial capitals, as well as encouraging foreign trade; meanwhile, it also has an indirect positive impact through stimulating industrial diversification. The policy environment does not indirectly affect green growth through affecting technological innovation. (3) The policy environment in Central China will have a heterogeneous effect on the green growth of cities from the perspective of spatial heterogeneity and heterogeneity of city characteristics. In this paper, policy implications are proposed.

Exploring the relationship between the alcohol policy environment and nondiscrimination laws: Implications for binge drinking disparities among LGB adults in the United States.

BACKGROUND: Alcohol policies reduce population-level binge drinking; however, they may not reduce binge drinking disparities between different populations. We examined the association between the alcohol policy environment and binge drinking among Lesbian, Gay and Bisexual (LGB) and heterosexual adults in the presence and absence of state laws protecting LGB people from discrimination. METHODS: The 2015-2018 Behavioral Risk Factor Surveillance System (BRFSS) provided information about individual-level binge drinking, sexual identity, and individual-level covariates. The Alcohol Policy Scale (APS) score measures the strength of the alcohol policy environment. Presence of state-level nondiscrimination protections based on sexual orientation came from the Movement Advancement Project. Logistic regression models were used to test whether nondiscrimination statutes modified the association between the alcohol policy environment and binge drinking and whether this interaction differed for LGB and heterosexual adults. RESULTS: Among women, a 10 percentage-point increase in APS score was significantly associated with 7% lower odds of binge drinking in states with inclusive nondiscrimination laws (aOR: 0.93 [95% CI: 0.89-0.97; p = 0.0003]) but was not associated with binge drinking in states without inclusive laws (aOR: 0.98 [95% CI: 0.93-1.03] p = 0.4781). Moreover, binge drinking disparities comparing lesbian/bisexual women with heterosexual women were narrower in states with inclusive nondiscrimination laws. No significant association was found among men. CONCLUSIONS: Binge drinking disparities between lesbian and heterosexual women are negligible in states with inclusive laws and strong alcohol policy environments. Inclusive nondiscrimination laws are an indicator of less structural stigma directed at lesbian and bisexual women.

State-Level Alcohol Environments and Sexual Identity Disparities in Binge Drinking in the Behavioral Risk Factor Surveillance System.

Purpose: Binge drinking disparities by sexual identity are well documented. Stronger alcohol policy environments reduce binge drinking in the general population. We examined whether state-level alcohol policy environments have the same association with binge drinking among lesbian, gay, and bisexual (LGB) adults as among heterosexual adults. Methods: Binge drinking, sexual identity, and demographic characteristics were extracted from the 2015 to 2018 Behavioral Risk Factor Surveillance System. The strength of the alcohol policy environment was measured by using the Alcohol Policy Scale (APS) score. We estimated the association between APS score and binge drinking by using logistic regression and included an interaction term between APS score and sexual identity. Results: The interaction between APS score and sexual identity was not significant, and findings differed between women and men. Among women, a higher APS score was associated with lower odds of binge drinking (adjusted odds ratio [aOR]: 0.96, 95% confidence interval [CI]: 0.94-0.99). Differences in binge drinking by sexual identity remained after adjusting for individual and state-level factors (e.g., the percentage of LGB adults in the state). Compared with heterosexual women, the odds of binge drinking were 43% higher (aOR: 1.43, 95% CI: 1.17-1.75) among lesbian women and 58% higher (aOR: 1.58, 95% CI: 1.40-1.79) among bisexual women. A higher APS score was not associated with binge drinking among men. Conclusion: Stronger state-level alcohol policy environments were associated with lower binge drinking among women. Lesbian and bisexual women were still more likely to engage in binge drinking compared with heterosexual women even in states with stronger alcohol policy environments.

Risk Identification and Evaluation of Clinical Trials of I nnovative Drugs under New Policy Environment / 中国药房

OBJECTIVE：To identify and evaluate the risk factors of innovative drug clinical trials ，and to provide references for the development of risk management and control strategies. METHODS ：Using the method of literature research ，the risk factors of innovative drug clinical trials were obtained ，classified and sorted out ，and the risk evaluation indicators were initially formed. On this basis ，the questionnaire was designed. By means of interview and questionnaire survey ，54 experts were invited from 4 tertiary hospitals and 1 contract research organization to score. SPSS 24.0 software was used to perform principal component analysis on risk event status data. RESULTS & CONCLUSIONS ：The risk evaluation system included 9 first-class indicators such as policy and legal risk ，clinical trial institution risk and trial scheme design risk ，and 31 second-class indicators such as industrial policy，law and regulation changes ，intellectual property risk . According to the analysis ，the risk factors of innovative drug clinical trials mainly included drug and biological sample management risk ，trial scheme design risk ，clinical trial institution risk ，safety report management risk ，ethical review risk ，policy and legal risk ，and subject management risk. Relevant parties in clinical trials need to focus on monitoring various risk factors ，establish dynamic monitoring and control mechanism and implementation guarantee mechanism ，and effectively prevent and control risk ，to promote the smooth implementation of clinical trials.

Grain legume seed systems for smallholder farmers: Perspectives on successful innovations.

Grain legumes are nutritionally important components of smallholder farming systems in sub-Saharan Africa and Asia. Unfortunately, limited access to quality seed of improved varieties at affordable prices due to inadequate seed systems has reduced their contribution to improving nutrition and reducing poverty in these regions. This paper analyses four seed systems case studies: chickpea in Ethiopia and Myanmar; cowpea in Nigeria; and tropical grain legumes in Nigeria, Tanzania and Uganda highlighting outcomes, lessons learned, and the enabling factors which supported the successful innovations. All four case studies highlighted at least some of the following outcomes: increased adoption of improved varieties and area planted; increased productivity and income to farmers; improved market access and growth; and significant national economic benefits. Important lessons were learned including the value of small seed packets to reach many farmers; the value of innovative partnerships; capacity building of value chain actors; and continuity and coherence of funding through Tropical Legumes projects II and III and the recently funded Accelerated Varietal Improvement and Seed Delivery of Legumes and Cereals in Africa (AVISA) project. Successful adoption of innovations depends not just on the right technologies but also on the enabling environment. The case studies clearly showed that market demand was correctly identified, establishment of successful partners and institutional linkages overcame constraints in production and delivery of improved seed to smallholders, and fostered conducive policies supported national seed systems. All were integral to seed system viability and sustainability. It is hoped that these examples will provide potential models for future grain legume seed systems efforts. In addition, the analysis identified a number of areas that require further research.

The Influence of the Early Childhood Education and Care Environment on Young Children's Physical Activity: Development and Reliability of the PLAYCE Study Environmental Audit and Educator Survey.

(1) Background: Participation in physical activity is crucial for the healthy growth and development of young children. More robust measurement of environmental influences on children's physical activity in early childhood education and care (ECEC) settings may help resolve inconsistencies in the literature. This study evaluated the reliability of an environmental audit and educator practice survey for assessing ECEC physical, policy, and social environments related to young children's physical activity. (2) Methods: A convenience sample of 20 ECEC centres participated in this PLAYCE (Play Spaces and Environments for Children's Physical Activity) sub-study. Trained auditors conducted audits and educators completed surveys, two weeks apart. Test-retest reliability of the survey (n = 32), inter-rater (n = 20 pairs) and intra-rater reliability (n = 38) of the audit was assessed using intra-class correlation coefficients (ICCs), Kappa statistics and percent agreement. (3) Results: Intra-rater and inter-rater reliability ICCs for outdoor equipment, spaces and features were good to excellent (ICC = 0.70-0.94), while ratings for indoor equipment, media and spaces varied from fair to excellent (ICC = 0.46-0.78). The majority of items were rated by Kappa as moderate or above for intra-rater, inter-rater and survey test-retest reliability. (4) Conclusions: The PLAYCE Study instruments provide reliable measures of ECEC physical activity environments which can help to better understand influences on young children's physical activity.

U.S. alcohol treatment admissions after the Mental Health Parity and Addiction Equity Act: Do state parity laws and race/ethnicity make a difference?

BACKGROUND: The U.S. Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark federal policy aimed at increasing access to substance use treatment, yet studies have found relatively weak impacts on treatment utilization. The present study considers whether there may be moderating effects of pre-existing state parity laws and differential changes in treatment rates across racial/ethnic groups. METHODS: We analyzed data from SAMHSA'S Treatment Episode Data Set (TEDS) from 1999 to 2013, assessing changes in alcohol treatment admission rates across states with heterogeneous, pre-existing parity laws. NIAAA's Alcohol Policy Information System data were used to code states into five groups based on the presence and strength of states' pre-MHPAEA mandates for insurance coverage of alcohol treatment and parity (weak; coverage no parity; partial parity if coverage offered; coverage and partial parity; strong). Regression models included state fixed effects and a cubic time trend adjusting for state- and year-level covariates, and assessed MHPAEA main effects and interactions with state parity laws in the overall sample and racial/ethnic subgroups. RESULTS: While we found no significant main effects of federal parity on alcohol treatment rates, there was a significantly greater increase in treatment rates in states requiring health plans to cover alcohol treatment and having some pre-existing parity. This was seen overall and in all three racial/ethnic groups (increasing by 25% in whites, 26% in blacks, and 42% in Hispanics above the expected treatment rate for these groups). Post-MHPAEA, the alcohol treatment admissions rate in these states rose to the level of states with the strongest pre-existing parity laws. CONCLUSION: The MHPAEA was associated with increased alcohol treatment rates for diverse racial/ethnic groups in states with both alcohol treatment coverage mandates and some prior parity protections. This suggests the importance of the local policy context in understanding early effects of the MHPAEA.

Qualitative study on the impacts of policy exterior environment on rural doctors'ranks in Beijing / 中华医院管理杂志

Objective To study the impact of policy external environmental changes on rural doctors'ranks,and to find out the adaptability between the two.Methods The purposeful sampling method was used to study 84 people of district H in Beijing by means of both field observation and individual in -depth interviews from July to August in 2016.The data acquired was analyzed by qualitative method, and interview results were categorized and analyzed by citing typical expressions of the respondents.In October 2016,rural doctors from 260 village clinics in 14 townships in district H were subject to a basic information survey,by means of general description.Results The changes of village governance model, strength of personal relationship made in adaptation between health policy and policy environment,retained the practice of senior village doctors.These people,though low in competence,were advantageous as being locals(237 of them being in the same village)and for their familiarity with health conditions, namely family disease history and diet habits,of local villagers.At the same time,health policies were not adaptive to the policy environment,as village committees tend to ignore management of doctors.12 of the 21 village leaders were not involved in the management.Conclusions Development of rural doctors ranks is highly challenging as making policies friendly to external policy environment, and the constraints of such environment on health policies deserves more attention.

Current status of rural grassroots health service provision in Beijing suburb / 中华全科医师杂志

Objective To survey the current status of the rural primary medical service supply in Beijing suburb,and to discuss the relationship between policy environment and rural primary medical service.Methods A purposeful sampling method was adopted to select Beijing Huairou District as the study site.In July to August 2016 a questionnaire survey was conducted among 260 village doctors from 260 village clinics in 14 townships;21 village clinics were site visited;21 village leaders,21 village doctors,and 42 villagers were invited for in-depth interview.The impact of policy environment on the provision of =basic health service at the village level was analyzed.Results The facilities of the 260 village clinics basically met the needs,but the service quality was still insufficient.The basic situation of village clinics:174 villages (66.9％) were funded by the "1 486" project,164 (63.1％) village clinics were located in the center of the village.In 173 village clinics (66.5％) the legal representatives were village leaders,but 11 (52.4％) village officials thought that rural doctors should be the legal persons.The mean age of 260 village doctors were (62.7 ± 8.9) years.Among 260 village doctors,168 (64.6％) were working more than 40 years,149 (57.3％) had secondary medical education,72 (27.7％) had no medical professional qualification;247 (95％) held practice certificates of rural doctors and only 3 (1.2％) held medical license;244 (93.8％) village doctors took subsidy from the government.The continuing education was organized monthly by the township health centers.The source of training teachers was township health centers (247,95.0％).The teaching form was mainly audio-visual education (191,73.5％);the content was based on general medicine (245,94.2％).The top 5 basic medical service items provided by village clinics were the diagnosis and differential diagnosis of common diseases,family visits,measurement of blood pressure,respiratory and pulse rates,body weight,height and vision,and intramuscular injection.Most village doctors (199,76.5％) provided night-time medical service.For the medical care needs,22 (52.4％) villagers said they were basically satisfied.The most satisfying aspect was the service attitude,and the most unsatisfactory aspect was the equipment and facilities.The management function of village committee was mainly in personnel recruitment (231,89.5％),daily supervision (218,84.5％) and performance assessment (113,43.8％).The assessment of service quality was conducted by the township health service centers,particularly in public health service.Conclusions The current status of rural primary medical service still cannot fully meet the needs of rural residents.In order to upgrade the quality of rural primary medical service to meet the health needs of villagers,it is necessary to improve the internal policy environment,such as villager autonomy,socio-economic development and so on.

Strengthening the policy environment for health research in the Philippines: Insights from a preliminary analysis of existing policies

@#<p><strong>BACKGROUND AND OBJECTIVE:</strong> Research plays an important role in generating new knowledge that could improve health outcomes when translated into action. As such, there must exist a supportive research policy environment that facilitates the provision of necessary resources and sustainably ensures an appropriate number of skilled researchers buttressed by institutions. These, in turn, are envisioned to provide facilities, information systems, financial grants, and avenues for career development and collaboration. This study aims to analyze factors in the current policy environment that makes health research possible in the Philippines.</p><p><strong>METHODS:</strong> Qualitative exploratory design was used to characterize the Philippine health research environment. Guided by Adamchak's framework on policy environment, a content review of 39 policy documents (1991 to 2018) by the four core agencies of the Philippine National Health Research System was conducted. Seven elements of the policy environment were described.</p><p><strong>RESULTS:</strong> The policies analyzed in this study mainly addressed the legal, political, cultural, economic, and ecological elements of the policy environment. Policies that support the demographic and technological elements are lacking, in that these leave out details that are essential for capacity building and use of research output. A cross-cutting effort to resolve gaps may be necessary.</p><p><strong>CONCLUSION:</strong> Several factors continuously affect the environment in which policy is developed. There is room for improvement in terms of showcasing the government's regulatory quality and independence from political pressure. Equal attention must also be paid to human capital development, innovation partnerships, and mechanisms to improve knowledge impact, absorption, and utilization.</p>

Teasing apart "the tangled web" of influence of policy dialogues: lessons from a case study of dialogues about healthcare reform options for Canada.

BACKGROUND: The knowledge exchange literature suggests that policy dialogues are intended to enhance short-, medium- and long-term capacities of individuals, organizations and health systems to use evidence to inform policy-making. Key features of effective dialogues have been suggested, but the linkages between these features and the realization of improved capacities for evidence-informed policy-making among dialogue attendees and the subsequent influence on policy-making activities are not well understood. METHODS: We conducted a qualitative case study of a series of four policy dialogues that were convened in Canada among national, provincial and regional stakeholders on topics pertaining to healthcare financing and funding in 2011. Data sources included videos of participant perspectives captured during or immediately following each event and follow-up key informant interviews among dialogue participants held 4 years later in 2015. Three conceptual frameworks pertaining to (i) policy dialogues and capacities for evidence use, (ii) factors shaping policy-making across the policy cycle and (iii) factors shaping implementation of evidence guided the thematic analysis. We then synthesized the findings across the three frameworks. RESULTS: The results suggest the potential benefits of policy dialogues described in the literature were developed among the participants at these dialogues. Informants elaborated on how dialogue features influenced their capacities to use evidence, the ideas, interests and institutions during the agenda-setting and policy formulation stages of policy-making and how implementation was affected by characteristics of policy options, individuals, organizations, the external environment and processes. CONCLUSIONS: We present a conceptual framework that furthers our understanding of the potential influence of policy dialogues on the content and mechanisms of policy development and illustrate pathways of influence on various stages of the policy cycle from agenda setting through formulation and implementation. The framework highlights important factors for consideration in designing and evaluating policy dialogues and in supporting post-dialogue knowledge exchange efforts.

Survey and analysis on policy environment of non-public hospitals / 中国卫生政策研究

In this paper, 172 non-public hospitals have been investigated covering east, central and western regions with structured and semi-structured questionnaire and group interviews. We found that the health insurance policies were the most concerned policies by non-public hospitals, accounting for 26.5% of the total. We also found that non-public hospitals from different areas, levels profit nature have different policy expectations, for example Eastern regional institutions wanted to make a breakthrough of the planning policies, the central region wanted to change the health personnel policy, while the western region is considered to be limited by land policy. Tertiary hospitals were more concerned about research projects and land policy, and secondary hospitals were more concerned about access policy. There were 44.8% of the surveyed institutions considered that regulatory policywasmore stringent public hospitals and public hospitals, and there were no difference between profit and non-profit hospitals. According to the survey results, this paper puts forward suggestion that we should implement more targeted policies, purchasing more services from non-public hospitals and enhanced supervision. Considering the survey results research team puts forward sensitive advice as: provide preferential policies in according with different kinds of institutions reinforce purchasing service and enhance non-public hospitals supervision.

Difficult position of scientific literature novelty assessment and its way out / 中华医学图书情报杂志

After the position and difficulties of traditional scientific literature novelty assessment were described, the changing policy environment of scientific literature novelty assessment and its effect on its developmen were ana-lyzed, with suggestions put forward for the reform of scientific literature novelty assessment, including seeking poli-cy support and taking advantage of the opportunity, deep mining and optimizing explanation, dividing team and in-tegrating resources, taking measures in light of the situation and transforming service.

Investigations into non governmental hospitals in Guangdong / 中华医院管理杂志

Objective To find out about the current state of development and existing problems in non governmental hospitals and to explore their development direction by collecting quantitative and qualitative data. Methods Investigations in the form of questionnaires were made into all the non governmental hospitals province wide and a descriptive analysis was made of the data collected. Results Non governmental hospitals in the province witnessed fast development, and yet they were generally small scaled, lacked actual strength, and were unevenly distributed, claiming only 3% of the market share; they paid special attention to the unique features of specialties and employed flexible operational modes, and yet they were still confronted with such problems as insufficient support policies from the government and personnel instability. Conclusion There is still a long way to go before the monopoly of state run hospitals is broken, diversified modes of hospital running are developed, and fair and orderly competition is formed so as to enhance the vitality of medical institutions. Administrative departments of health should fully realize the role and social functions of non governmental hospitals and actively lead their development in a healthy direction with sound policies.