Who Should Make Care Arrangement for Older Adults? Heteronormative Family Responsibility in Japan

In Japan, despite the greater availability of public care services upon implementation of national long-term care insurance, families are still considered as primarily responsible to make care arrangement for older adults. My aim in this study was to explore (hetero)normative ideas about families that underlie Japan’s institutionalized practices of elder care. In doing so, I focused on care managers, who are certified care practitioners helping families to make care arrangement, and whether they would count older adults’ same-sex partners as legitimate family members to participate in such arrangement. Data were collected from 1,580 care managers working for officially designated in-home care providers across the nation. Preliminary analysis revealed that although most care managers believed the voices of same-sex partners should be preferably reflected in the process of care arrangement, they also thought that these partners could not participate in such process without permission from older adult’s “blood relatives” (e.g., siblings).

Gallbladder perforation with liver abscess; laparoscopic cholecystectomy converted to open: a case report

Gallbladder disease affects more than 20 million people in the United States. Acute cholecystitis is a clinic entity characterized by the inflammation of the vesicular wall that is usually manipulated by abdominal pain, right hypochondrial sensitivity and fever. The technique of choice for the diagnosis of cholecystitis is abdominal ultrasound; gallbladder perforation is a rare complication of acute cholecystitis (2%-11%). The presence of perivesicular abscesses is infrequent, its prevalence varies between 2.1% and 19.5%. Clinical record was reviewed of a 73 years old woman who attended a second level public care unit, with a clinical picture of acute chronic lithiasis cholecystitis, who underwent surgery consisting of open converted laparoscopic cholecystectomy with a finding of vesicular perforation with liver abscess, it was initiated with laparoscopic approach, it was not possible to identify anatomical structures, so it was decided to convert to open surgery. Cholecystectomy and abdominal lavage are usually sufficient in the treatment of gallbladder perforation.

Imposed volunteering: Gender and caring responsibilities during the COVID-19 lockdown

This article contributes to the sociology of care-relational justice by identifying, conceptualising and unpacking ‘imposed volunteering’ as a mechanism that shapes societal caring arrangements. Contemporary societies allocate care work disproportionately to women, ethnic minorities and working-class citizens, which exacerbates social inequalities. Distribution of caring responsibilities is a political question but often not recognised as such, because it is deeply immersed in everyday routines. Our study uses the context of the COVID-19 pandemic to dissect the distribution mechanisms that became unusually palpable when the lockdown of public welfare provision in Denmark relocated some forms of care work from professionals to volunteers. With the term imposed volunteering, we conceptualise the feeling of being coerced into taking on new caring responsibilities, which some women – and men – experienced during the lockdown. Drawing on a national, representative survey, we document that, compared to men, women carried out significantly more voluntary care work and organised voluntary work through informal personal networks rather than through formal civil society organisations to a significantly higher degree. We unpack the experience of imposed volunteering as it unfolded during the lockdown through qualitative case studies, and clarify how relational and institutional factors, such as gendered expectations and the sense of personal obligation, imposed volunteering. Our study illuminates the importance of public care, reciprocal caring relationships and care for carers, and demonstrates why the mobilisation of care work volunteers must take gendered implications into account if it is to be consistent with democratic commitments to justice, equality and freedom for all.

An economic evaluation of an intervention to increase demand for medical male circumcision among men aged 25–49 years in South Africa

Background Studies estimate that circumcising men between the ages of 20–30 years who have exhibited previous risky sexual behaviour could reduce overall HIV prevalence. Demand creation strategies for medical male circumcision (MMC) targeting men in this age group may significantly impact these prevalence rates. Objectives The objective of this study is to evaluate the cost-effectiveness and cost-benefit of an implementation science, pre-post study designed to increase the uptake of male circumcision for ages 25–49 at a fixed MMC clinic located in Gauteng Province, South Africa. Methods A health care provider perspective was utilised to collect all costs. Costs were compared between the standard care scenario of routine outreach strategies and a full intervention strategy. Cost-effectiveness was measured as cost per mature man enrolled and cost per mature man circumcised. A cost-benefit analysis was employed by using the Bernoulli model to estimate the cases of HIV averted due to medical male circumcision (MMC), and subsequently translated to averted medical costs. Results In the 2015 intervention, the cost of the intervention was $9445 for 722 men. The total HIV treatment costs averted due to the intervention were $542,491 from a public care model and $378,073 from a private care model. The benefit-cost ratio was 57.44 for the public care model and 40.03 for the private care model. The net savings of the intervention were $533,046 or $368,628 - depending on treatment in a public or private setting. Conclusions The intervention was cost-effective compared to similar MMC demand interventions and led to statistically significant cost savings per individual enrolled.

Adult mortality in children exposed to state care: systematic review and meta-analysis of prospective cohort studies

SummaryBackgroundRemoval from family of origin to placement in state care is a highly challenging and increasingly prevalent childhood experience. The purpose of this report was to synthesise published and unpublished prospective evidence on adult mortality in people with a history of state care in early life.MethodsFor this systematic review and meta-analysis, we searched PubMed and Embase from their inception to May 31st 2021, extracting standard estimates of association and variance from qualifying studies. We augmented these findings with analyses of unpublished individual-participant data from the 1958 and 1970 Birth Cohort Studies (total N = 21,936). Study-specific estimates were aggregated using random-effect meta-analysis. The Cochrane Risk of Bias Tool was used to assess study quality. This review is PROSPERO-registered (CRD42021254665).FindingsWe identified 209 potentially eligible published articles, of which 11 prospective cohort studies from the UK, Sweden, Finland, the USA, and Canada met the inclusion criteria (2 unpublished). In 2,273,998 individuals (10 studies), relative to those without a care history in childhood, those who were exposed had 2.5 times the risk of total mortality in adulthood (summary rate ratio; 95% confidence interval: 2.58; 1.96 to 3.39), study-specific estimates varying between 1.53 and 5.77 (I2=92%). Despite some attenuation, this association held following adjustment for other measures of early life adversity; extended into middle- and older-age; was stronger in higher quality studies; and was of equal magnitude according to sex and geographical region. There was a suggestion of sensitive periods of exposure to care, whereby individuals who entered public care for the first time in adolescence (3.54; 2.00 to 6.29) experienced greater rates of total mortality than those doing so earlier in the life course (1.69; 1.35 to 2.12). In five studies capturing 1,524,761 individuals (5 studies), children in care had more than three times the risk of competed suicide in adulthood (3.37; 2.64 to 4.30) with study-specific estimates ranging between 2.42 and 5.85 (I2=68%). The magnitude of this relationship was weaker after adjustment for multiple covariates; in men versus women; and in lower quality studies.InterpretationThe excess rates of total and suicide mortality in children exposed to state care suggest child protection systems and social policy following care graduation are insufficient to mitigate the effects of the adverse experiences of care itself and the social disadvantage that preceded it.FundingNone.Research in contextEvidence before this studyExposure to state care during childhood has emerging links with an array of unfavourable social, psychological, and behavioural characteristics in early adulthood. We searched PubMed and Embase from their inception to May 31st 2021 for studies examining whether care is also related to elevated rates of adult mortality. While we identified a series of relevant studies, there was no synthesis of this evidence. Few studies utilised a prospective design such that the assessment of care was made in childhood, so avoiding biases of distant retrospective recall. There was also a lack of clarity regarding: the role of confounding factors; the influence of the timing of care entry on mortality; whether the impact of care extended into middle-age and beyond; and, as has been hypothesised, if men with a care history have a greater vulnerability than women.Added value of this studyWe conducted a systematic review to synthesis evidence on adult mortality risk in children placed in state care. Drawing also on unpublished resources to complement the findings of published studies, a total of 10 studies consistently showed that exposure to state care in childhood was associated with more than a doubling in the risk of total mortality. This association, while attenuated, held following statistical adjustment for other early life risk factors, including other adversities; extended into later adulthood such that it did not exclusively occur immediately following graduation from care; was stronger in better designed studies; and was of equal magnitude in men and women. There was also a suggestion of sensitive periods of exposure to care, whereby individuals who entered public care for the first time in adolescence experienced greater rates of total mortality in adulthood than those doing so earlier in the life course. The magnitude of the association between childhood care and adult risk of completed suicide (5 studies) were somewhat higher than for total mortality. This relationship was not completely explained by control for other early life risk factors; and the magnitude was somewhat weaker in lower quality studies, and in men versus women. There were too few studies to explore the impact of care on other causes of mortality.Implications of all the available evidenceIn recent years there has been a secular rise in the prevalence of children in state care in western societies. This excess mortality risk in this group did not appear to be attributable to other measures of adversity, suggesting that, in the countries studied, child protection systems and social policy following care graduation are insufficient to mitigate the effects of the adverse experiences of care itself and the unfavourable events that preceded it.

Healthcare Activism

What is the role of civil society and activists in defining and defending the collective good in healthcare, especially in cases where that good seems to be heavily shaped by market dynamics? Presenting conceptual and empirical studies from a variety of healthcare contexts and theoretical perspectives, this book volume addresses this vital question by drawing together multi-disciplinary scholarship from science and technology studies, sociology, organization studies, marketing, and public health. The volume maps three major changes in healthcare over the past decades: the advent of personalized medicine, the marketization of public care systems, and the digitalization of healthcare services. It illustrates the extent to which these are interlinked to produce a seemingly unstoppable move toward individualization in healthcare, highlights the tensions and challenges arising from these interlinkages, and traces how activists react to these tensions to argue for and defend the common good. The volume thus sketches a multi-faceted picture of healthcare activism in the twenty-first century as civil society responds to these dynamics at the crossroads of markets and morals, economic and social justifications, individual and collective, and digital and non-digital worlds. Importantly, the volume also starts to sketch potential solutions for heightening patient voices and broadening participation in healthcare markets in a post-Covid-19 world.

A Childs’ Right to Family Life when Placed in Public Care; an Analysis of Whether Current Norwegian Practice is in Systematic Contradiction to Human Rights

Based on both ECHR and CRC being incorporated into Norwegian law and underpinning the Child Welfare Act, this study aimed to clarify whether the current Norwegian practice is in systematic contradiction to human rights. The article is based on 94 Norwegian care orders comprising 117 children from newborn to 16 years old and analysis whether the child and parents’ right to contact are safeguarded in the care orders. Contradictions and dilemmas between Conventional rights and Norwegian practice are addressed. The article’s contribution presents analytical results, which describe the County Social Welfare Boards’ practice when issuing care orders. The result reinforces the suspicion that current Norwegian practice may be in systematic contradiction to human rights.

LAYANAN INFORMASI PADA RUMAH SAKIT MAMAMI KOTA KUPANG BERBASIS WEBS

Kupang City is municipality city and East Nusa Tenggara Capital city at once. Its glowing population, from time to time, causing varied problems, as such, in creasing pollution, limitedness resources, infrastructures and economic growth, thus generate broad impact, without exception, public healt threatening. Mamami Hospital is a prevate ownership healty mean in Kupang city,runing public trasition healt service, by general practioner, medical specialis on tooth , child, midwife service,internal disease, surgical operation, ophthaltmologist, tediarticiant, public care healt reference. Mamami Hospital, estimated, faces to potential problems, first, of its ignorance healt care information by a large member of Kupang‘s population, and second, possesses no available and accurate data on its patiens recording on digital device. Personally to thanks every one, the owner especeally, who received me to practice my digital device application skill at Mamami Hospital, writer would like to contributed a public information for mamami hospital. Further information on method of this research, researcher uses discription, bibliography observation and interview. Based on above finding, writer apprently suggest Mamami Hospital’s, agent to answer its need to cultivate in their relationsip with patients by public health information from digital device. This public information facilitate them to communicate each other on their need.

Managing Work and Care: Does Employing a Live-in Migrant Care Worker Fill the Gap? The Example of Taiwan

This article uses Taiwan as an example to examine how families manage work and care when the government and workplace provide limited support. Many Taiwanese households employ live-in migrant care workers to negotiate care responsibilities and adults’ paid jobs. Based on interviews with employers of live-in migrant care workers and workers, the findings demonstrate that daughters-in-law and occasionally daughters and sons become employers of live-in migrant care workers because of the limitation of public care services and lack of support they receive in seeking to combine paid work and family care responsibility. Even after employing migrant workers, women retain greater care responsibility in daily practices than their husbands. Hiring live-in migrant care workers also imposes risks to all parties involved in the processes of organising, coordinating, and providing care due to the uncertainty of care quality and the nature of care work.

Assisted reproduction in Spain, outcome and socioeconomic determinants of access

Research question We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.