The EU's multi-level system continuously renegotiates the influence of the European institutions on national sovereignty. Social policy has traditionally been the domain of the member states. But is ...it still possible to speak of the political autonomy of the nation-states, or is the European level gaining in importance through social and budgetary policy measures, some of which are restrictive? Jana Windwehr vividly analyzes Europeanization processes within social policy in the context of the euro crisis, using five member states as examples. This makes the book an indispensable contribution to the discussion on national social policy autonomy in the EU multi-level system.
Das EU-Mehrebenensystem verhandelt den Einfluss der europäischen Organe auf die einzelstaatliche Souveränität fortlaufend neu. Sozialpolitik gilt dabei traditionell als Domäne der Mitgliedsstaaten. Kann man jedoch an dieser Stelle noch von politischer Autonomie der Nationalstaaten sprechen oder gewinnt die europäische Ebene durch sozial- wie haushaltspolitische, teils auch restriktive Maßnahmen vielmehr fortlaufend an Bedeutung? Jana Windwehr analysiert Europäisierungsprozesse innerhalb der Sozialpolitik im Kontext der Eurokrise anschaulich am Beispiel von fünf Mitgliedsstaaten. Das Buch wird dadurch zu einem unverzichtbaren Beitrag zur Diskussion um nationale sozialpolitische Autonomie im EU-Mehrebenensystem.
In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for ...women aged between 30 and 60 years. The Netherlands was the first country to switch to hrHPV screening at the national level. We investigated the health impact of this transition by comparing performance indicators from the new hrHPV-based programme with the previous cytology-based programme.
We obtained data from the Dutch nationwide network and registry of histo- and cytopathology (PALGA) for 454,573 women eligible for screening in 2017 who participated in the hrHPV-based programme between 1 January 2017 and 30 June 2018 (maximum follow-up of almost 21 months) and for 483,146 women eligible for screening in 2015 who participated in the cytology-based programme between 1 January 2015 and 31 March 2016 (maximum follow-up of 40 months). We compared indicators of participation (participation rate), referral (screen positivity; referral rate) and detection (cervical intraepithelial neoplasia (CIN) detection; number of referrals per detected CIN lesion).
Participation in the hrHPV-based programme was significantly lower than that in the cytology-based programme (61% vs 64%). Screen positivity and direct referral rates were significantly higher in the hrHPV-based programme (positivity rate: 5% vs 9%; referral rate: 1% vs 3%). CIN2+ detection increased from 11 to 14 per 1000 women screened. Overall, approximately 2.2 times more clinical irrelevant findings (i.e. ≤CIN1) were found in the hrHPV-based programme, compared with approximately 1·3 times more clinically relevant findings (i.e. CIN2+); this difference was mostly due to a national policy change recommending colposcopy, rather than observation, of hrHPV-positive, ASC-US/LSIL results in the hrHPV-based programme.
This is the first time that comprehensive results of nationwide implementation of hrHPV-based screening have been reported using high-quality data with a long follow-up. We have shown that both benefits and potential harms are higher in one screening round of a well-implemented hrHPV-based screening programme than in an established cytology-based programme. Lower participation in the new hrHPV programme may be due to factors such as invitation policy changes and the phased roll-out of the new programme. Our findings add further to evidence from trials and modelling studies on the effectiveness of hrHPV-based screening.
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An accessible built environment is an important catalyst of participation. However, people living with disabilities face daily barriers to in their built environment. Many stakeholders are involved ...in the implementation of accessible built environment for all, such as municipalities. The implementation of such universal accessibility measures is therefore complex for municipal employees. Integration of such measures into regular activities requires individual (employees) and organizational (municipalities) change. Different implementation strategies are helpful to guide municipalities in the creation of tools and to facilitate the operationalization and implementation of the measures. The aim was to explore what are the implementation strategies used by municipalities to implement universal accessibility measures. To answer this question, (1) identified the different strategies used by municipalities in implementing universal accessibility measures, (2) explored the perceived influence of these strategies, and (3) identified facilitators and barriers to the use of the different strategies to implement universal accessibility measures. We conducted a scoping review following the PRISMA-SR guidelines. We analyzed the data according to the type of strategy and to the Consolidated Framework for Implementation Research (CFIR). Of 1328 articles identified by the search strategy, six studies met the inclusion criteria. The strategies were identified as dissemination, process, integration, or capacity-building strategy. Involvement of all stakeholders was the most frequently mentioned facilitator, while lack of awareness was the most reported barrier. The results show that there is no consensus on which implementation strategies are appropriate and effective to use in this context. Also, there are no measures of effectiveness of pre-post design of these strategies. This shows that implementation strategies in municipal context regarding universal accessibility are still in an exploratory phase. However, it is possible to make links with the different implementation domains of the CFIR. We also observed that the identification of facilitators and obstacles to implementation is important to identify needs and to better plan the different stages of implementation.
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The article aims to analyze the planning of the National Policy of Basic Sanitation (NPBS) in the city of Pelotas-RS, problematizing a possible change of political paradigm developed through new ...rhetoric that camouflaged the perpetuation of the development of old policies in Brazil. In order to do so, the aim is to understand the State of Social Welfare model that has developed in the country and the hidden rationality in Brazilian public policies, supporting a relational appreciation of the Municipal Basic Sanitation Plan (MBSP) in the city under study. The development of such analyzes aims not only to understand how the MBSP regulates the execution of the national policy, but also, what are the objectives, values and discourses that are in dispute, in the ongoing transformations, and for what horizon does the reorganization structure of Brazilian social policies
Malaysia is widely credited to have achieved universal health coverage for citizens. However, the accessibility of healthcare services to migrant workers is questionable. Recently, medical fees for ...foreigners at public facilities were substantially increased. Mandatory health insurance only covers public hospital admissions and excludes undocumented migrants. This study explores barriers to healthcare access faced by documented and undocumented migrant workers in Malaysia.
We use qualitative data from 17 in-depth interviews conducted with key informants from civil society organisations, trade unions, academia, medical professionals, as well as migrant workers and their representatives. We interviewed doctors working in public hospitals and private clinics frequented by migrants. Data were analysed using thematic analysis.
We found that healthcare services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector. Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers. Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities. Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent.
We propose instituting migrant-friendly health services at public facilities. We also suggest implementing a comprehensive health insurance to enable healthcare access and financial risk protection for all migrant workers. Non-health sector solutions include the formation of a multi-stakeholder migration management body towards a comprehensive national policy on labour migration which includes health.
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With less than 3200 wild tigers in 2010, the heads of 13 tiger-range countries committed to doubling the global population of wild tigers by 2022. This goal represents the highest level of ambition ...and commitment required to turn the tide for tigers in the wild. Yet, ensuring efficient and targeted implementation of conservation actions alongside systematic monitoring of progress towards this goal requires that we set site-specific recovery targets and timelines that are ecologically realistic. In this study, we assess the recovery potential of 18 sites identified under WWF's Tigers Alive Initiative. We delineated recovery systems comprising a source, recovery site, and support region, which need to be managed synergistically to meet these targets. By using the best available data on tiger and prey numbers, and adapting existing species recovery frameworks, we show that these sites, which currently support 165 (118-277) tigers, have the potential to harbour 585 (454-739) individuals. This would constitute a 15% increase in the global population and represent over a three-fold increase within these specific sites, on an average. However, it may not be realistic to achieve this target by 2022, since tiger recovery in 15 of these 18 sites is contingent on the initial recovery of prey populations, which is a slow process. We conclude that while sustained conservation efforts can yield significant recoveries, it is critical that we commit our resources to achieving the biologically realistic targets for these sites even if the timelines are extended.
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