Care policies in practice: how discourse matters for policy implementation

This article puts public policy research in dialogue with gender and politics studies to enhance our understanding of the implementation of care policies. Care policies present interesting problems of implementation because of the multiplicity of aims, values, inequalities, actors and levels of governance involved. Nonetheless, previous research shows two important gaps: 1) the neglect of discursive factors in studies of implementation; and 2) the lack of attention to implementation processes in the analysis of care policies. This article suggests a general framework to address these issues which considers discourse as a transversal factor connecting actors and institutions engaged in policy implementation. The articles in this special issue demonstrate that including discourses in the analysis of care policy implementation makes visible the influence of gender+ norms and the dynamic and contentious processes surrounding them in a variety of institutional arenas, levels, and national contexts

Influence of hydroxychloroquine blood levels on adhesion molecules associated with endothelial dysfunction in patients with systemic lupus erythematosus

Background Patients with SLE have an endothelial dysfunction (ED), which is considered the earliest marker of cardiovascular (CV) disease. Endothelial cell activation induced by proinflammatory cytokines is defined by the endothelial expression of cell-surface adhesion molecules, such as vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) and E-selectin. The aim of this study was to investigate whether serum endothelial adhesion molecule levels are influenced by blood hydroxychloroquine (HCQ) levels in SLE. Methods Consecutive patients with SLE taking a stable dose of HCQ were investigated. At study entry and 6 months later HCQ blood levels were quantified by tandem mass spectrometry. Serum levels of P-selectin, E-selectin, ICAM-1 and VCAM-1 were also measured using a Luminex 200 instrument. Comparison of endothelial soluble adhesion molecules in groups with different HCQ blood levels was performed by t-test. Results 83 patients with SLE were enrolled. Correlation were demonstrated between mean blood HCQ concentrations and endothelial soluble adhesion molecules (E-selectin, ICAM-1 and VCAM-1). Moreover, serum levels of ICAM-1 and VCAM-1 were significantly lower in the patients with SLE with HCQ blood levels >500 ng/mL (83.67 +/- 52.8 ng/mL vs 158.81 +/- 125.1 ng/mL and 8.9 +/- 2.2 ng/mL vs 10.4 +/- 2.3 ng/mL). Serum levels of E-selectin were nearly significantly lower in the patients with SLE with HCQ blood levels >500 ng/mL (64.7 +/- 30.2 ng/mL vs 71.6 +/- 42.2 ng/mL, p=0.06). No significant difference in concentration of P-selectin was detected. Conclusions In the present study, there was a trend towards higher adhesion molecules levels with lower HCQ blood levels in patients with SLE. Further longitudinal studies will determine whether changes in endothelial biomarkers reflect decreased clinical CV events