Affluent Areas Research Articles

Exploring residential relocation– differences between newcomers and settled residents in health, travel behaviour and neighbourhood perceptions

This study explores whether people who have recently moved to an area differ from longer-term residents in their health, travel behaviour, and perceptions of the environment. Using a large, representative sample from the UKHLS, Newcomers demonstrate significantly lower mental and physical health, reduced car commuting, and a higher likelihood of liking their neighbourhood. Area deprivation, urbanicity, household income, and age emerge as influential moderators with i.e. Newcomers in affluent areas experiencing lower physical health than Settled Residents, and rural Newcomers expressing less neighbourhood satisfaction. Our findings highlight that Newcomers' perceptions of their environment diverge and environmental influences vary among population segments, potentially impacting related health behaviours such as active travel. Furthermore, residential relocation introduces Newcomers with distinct characteristics into areas, affecting the context in which potential population health interventions aiming to influence health behaviours operate. This necessitates a deeper understanding of what influences reactions to the environment as well as ongoing adaptation of environmental interventions to respond to changing contexts within the same location over time.

Socioeconomic Deprivation and Invasive Breast Cancer Incidence by Stage at Diagnosis: A Possible Explanation to the Breast Cancer Social Paradox.

In this study, we assessed the influence of area-based socioeconomic deprivation on the incidence of invasive breast cancer (BC) in France, according to stage at diagnosis. All women from six mainland French departments, aged 15+ years, and diagnosed with a primary invasive breast carcinoma between 2008 and 2015 were included (n = 33,298). Area-based socioeconomic deprivation was determined using the French version of the European Deprivation Index. Age-standardized incidence rates (ASIR) by socioeconomic deprivation and stage at diagnosis were compared estimating incidence rate ratios (IRRs) adjusted for age at diagnosis and rurality of residence. Compared to the most affluent areas, significantly lower IRRs were found in the most deprived areas for all-stages (0.85, 95% CI 0.81-0.89), stage I (0.77, 95% CI 0.72-0.82), and stage II (0.84, 95% CI 0.78-0.90). On the contrary, for stages III-IV, significantly higher IRRs (1.18, 95% CI 1.08-1.29) were found in the most deprived areas. These findings provide a possible explanation to similar or higher mortality rates, despite overall lower incidence rates, observed in women living in more deprived areas when compared to their affluent counterparts. Socioeconomic inequalities in access to healthcare services, including screening, could be plausible explanations for this phenomenon, underlying the need for further research.

Household carbon monoxide (CO) concentrations in a large African city: An unquantified public health burden?

Carbon monoxide (CO) is a poisonous gas produced by incomplete combustion of carbon-based fuels that is linked to mortality and morbidity. Household air pollution from burning fuels on poorly ventilated stoves can lead to high concentrations of CO in homes. There are few datasets available on household concentrations of CO in urban areas of sub-Saharan African countries. CO was measured every minute over 24 h in a sample of homes in Nairobi, Kenya. Data on household characteristics were gathered by questionnaire. Metrics of exposure were summarised and analysis of temporal changes in concentration was performed. Continuous 24-h data were available from 138 homes. The mean (SD), median (IQR) and maximum 24-h CO concentration was 4.9 (6.4), 2.8 (1.0–6.3) and 44 ppm, respectively. 50% of homes had detectable CO concentrations for 847 min (14h07m) or longer during the 24-h period, and 9% of homes would have activated a CO-alarm operating to European specifications. An association between a metric of total CO exposure and self-reported exposure to vapours >15 h per week was identified, however this were not statistically significant after adjustment for the multiple comparisons performed. Mean concentrations were broadly similar in homes from a more affluent area and an informal settlement. A model of typical exposure suggests that cooking is likely to be responsible for approximately 60% of the CO exposure of Nairobi schoolchildren. Household CO concentrations are substantial in Nairobi, Kenya, despite most homes using gas or liquid fuels. Concentrations tend to be highest during the evening, probably associated with periods of cooking. Household air pollution from cooking is the main source of CO exposure of Nairobi schoolchildren. The public health impacts of long-term CO exposure in cities in sub-Saharan Africa may be considerable and should be studied further.

Patients' views on primary care multidisciplinary teams in Scotland: a mixed-methods evaluation.

Expanding primary care multidisciplinary teams (MDTs) was a key component of the 2018 Scottish GP contract, with more than 4700 MDT staff appointed since then. To explore patients' views on primary care MDT expansion in Scotland. A mixed-methods evaluation, which included a postal survey and semi-structured telephone interviews with patients in Scotland. A survey was undertaken of patients who had recently consulted a GP in deprived urban, affluent urban, and remote and rural areas, assessing awareness of five MDT roles and attitudes towards receptionist signposting. In addition, 30 individual interviews were conducted, exploring patients' MDT-care experiences. Of 1053 survey responders, most were unaware of the option of MDT rather than GP consultations for three out of five roles (69% unaware of link worker appointments; 69% mental health nurse; and 58% pharmacist). Reception signposting was less popular in deprived urban areas (34% unhappy versus 29% in remote and rural versus 21% affluent urban; P<0.001), and in patients with multimorbidity (31% unhappy versus 24% in non-multimorbid; P<0.05). Just over two-thirds of interviewees had multimorbidity and almost all reported positive MDT-care experiences. However, MDT care was generally seen as a supplement rather than a substitute for GP care. Around half of patients expressed concerns about reception signposting. These patients were more likely to also express concerns about GP access in general. Both of these concerns were more common in deprived urban areas than in remote and rural or affluent urban areas. MDT care has expanded in Scotland with limited patient awareness. Although patients understand its potential value, many are unhappy with reception signposting to first-contact MDT care, especially those in deprived urban areas living with multimorbidity. This represents a barrier to the aims of the new GP contract.

COVID-19 inequalities in England: a mathematical modelling study of transmission risk and clinical vulnerability by socioeconomic status

BackgroundThe COVID-19 pandemic resulted in major inequalities in infection and disease burden between areas of varying socioeconomic deprivation in many countries, including England. Areas of higher deprivation tend to have a different population structure—generally younger—which can increase viral transmission due to higher contact rates in school-going children and working-age adults. Higher deprivation is also associated with a higher presence of chronic comorbidities, which were convincingly demonstrated to be risk factors for severe COVID-19 disease. These two major factors need to be combined to better understand and quantify their relative importance in the observed COVID-19 inequalities.MethodsWe used UK Census data on health status and demography stratified by decile of the Index of Multiple Deprivation (IMD), which is a measure of socioeconomic deprivation. We calculated epidemiological impact using an age-stratified COVID-19 transmission model, which incorporated different contact patterns and clinical health profiles by decile. To separate the contribution of each factor, we considered a scenario where the clinical health profile of all deciles was at the level of the least deprived. We also considered the effectiveness of school closures and vaccination of over 65-year-olds in each decile.ResultsIn the modelled epidemics in urban areas, the most deprived decile experienced 9% more infections, 13% more clinical cases, and a 97% larger peak clinical size than the least deprived; we found similar inequalities in rural areas. Twenty-one per cent of clinical cases and 16% of deaths in England observed under the model assumptions would not occur if all deciles experienced the clinical health profile of the least deprived decile. We found that more deaths were prevented in more affluent areas during school closures and vaccination rollouts.ConclusionsThis study demonstrates that both clinical and demographic factors synergise to generate health inequalities in COVID-19, that improving the clinical health profile of populations would increase health equity, and that some interventions can increase health inequalities.

Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review

BackgroundChildhood malnutrition in all forms is a major public health issue worldwide. This review systematically examined the prevalence and determinants and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0–18 years old.MethodsEmbase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist.ResultsSeventy-two studies that met the inclusion criteria were included. Undernutrition has decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Anaemia, iron, zinc, and vitamin D deficiencies were the more common forms of MNDs, the prevalence varied by age, region, and socioeconomic group. Population-based surveys reported that 11% and 48% of children aged 0–11 years old were iron and vitamin D deficient, respectively. Zinc deficiency affected almost one-quarter of the children and adolescents. Retinol deficiency was of less concern (< 20%). However, more evidence on MNDs prevalence is needed. Overweight and obesity is now on the rise, affecting one-third of school-aged children. The key determinants of undernutrition included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight and obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers. National nutrition-sensitive programmes also provided nutritional benefits for children’s growth and eating behaviours, but there is a lack of data on childhood obesity.ConclusionThis finding highlights the need for effective double duty actions to simultaneously address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future research is warranted.

Virtual Consultation in Dermatology: Access Inequalities According to Socioeconomic Characteristics and the Place of Residence.

Virtual consultation has been implemented as a tool to improve the cooperation and coordination between primary care and other specialties. However, in its use in dermatology, inequities have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource. We conducted a cross-sectional study. The study population was individuals living in Aragón, a region in the north-east of Spain, who were users of the Aragon Health Service in 2021. To explore the differences in individual and area characteristics, between patients with virtual and non-virtual dermatology consultation, we performed bivariate analyses. To analyse the use of virtual consultation in dermatology, a multilevel methodology stratified by sex was developed. We analysed 39,174 dermatology visits, with 16,910 being virtual (43.17%). The rates of virtual consultation were higher in urban areas and the most affluent areas, for older persons, chronic complex patients and people with more advantageous socioeconomic positions. The best multilevel model conducted showed inequalities by socioeconomic position and area of residence. There are individual and area inequalities in the use of teledermatology. As this tool should improve equity of access, teledermatology interventions must address and adapt to the needs of the local patient population.

Age and co-morbidities as independent risk factors of infections leading to hospital admission in the last year of life among the elderly: A retrospective registry-based study.

The immune system declines with age, but the impact of chronological age may be affected by sex, co-morbidities, and sociodemographic factors. The article aims to study infections associated with hospital admission in the elderly in their last year of life and the impact of age, sex, co-morbidities, and sociodemographic factors. A retrospective study based on registry data covering all care visits in Stockholm Region, Sweden, for 7 years was conducted. All deceased subjects with at least one hospital admission with infection as the main diagnosis in the last year of life were compared with subjects with no such admission. Subjects were categorized into three different age-groups 65-79, 80-89, and 90 years and above. Co-morbidity was measured by the Charlson Comorbidity Index (CCI) and sociodemographic factors were assessed using the 'Mosaic-system'. Subjects living in nursing homes were analyzed separately. Uni- and multivariable logistic regressions were conducted. Of the 55,238 subjects in the study population, 14,192 (26%) had at least one hospital admission due to infection in the last year of life. The risk of having a severe infection increased with age, adjusted odds ratio (OR): 1.30 (1.25-1.36), and 1.60 (1.52-1.69) for the age-groups 80-89 and ≥ 90 compared to the age-group 65-79. The most important factor for infection was a high co-morbidity score; adjusted OR: 1.75 (1.68-1.82). Male sex and living in a less affluent area were weaker risk factors for infections. Chronological age and co-morbidities are independent risk factors of infections associated with hospital admission in the last year in life while male sex and sociodemographic factors have less impact.

A spatial examination of alcohol availability and the level of disadvantage of schools in Ireland

BackgroundThe availability of alcohol is a major factor in underage drinking and according to the alcohol harm paradox, those living in more deprived communities are more susceptible to the negative consequences of alcohol use, despite drinking the same or less than those from more affluent areas. Alcohol availability within the vicinity of the home or school normalises alcohol for schoolchildren. For the first time in the Republic of Ireland, this study examines the number of premises licensed to sell alcohol within 300 m of all schools in Ireland and differences in this number between disadvantaged and non-disadvantaged schools.MethodsUsing publicly available data from the Department of Education and Revenue, the addresses of all schools (n = 3,958) and all premises with at least one liquor licence (n = 14,840) were geocoded and analysed using the Geographic Information System software, Quantum GIS (QGIS). Schools were identified by their disadvantaged classification using the HP Pobal Deprivation Index and the number of liquor licences within 300 m of each school type was examined. To test for significant differences between schools’ level of disadvantage, a combination of Mann-Whitney U tests, Kruskal-Wallis tests and Dunn-Bonferroni tests were used.ResultsThere was a mean of two licenced premises within 300 m of all schools in Ireland, but when disadvantaged schools were compared to non-disadvantaged schools, there was a significantly higher number of licenced premises around disadvantaged schools (p < .001). Primary schools are further classified according to their level of disadvantage and the results indicated that those schools classified as the most disadvantaged had a significantly greater number of liquor licences within 300 meters (p < .001). There was no significant difference in density of licenced premises when comparing disadvantaged secondary schools with non-disadvantaged secondary schools (p = .705).ConclusionIreland is considering increasing alcohol availability through the Sale of Alcohol Bill, 2022. However, this analysis indicates already problematic numbers of licenced premises within close proximity of schools in Ireland. It is essential that the harms associated with alcohol availability are considered, especially for those living and attending school in disadvantaged communities, where higher numbers of licenced premises were identified.

Abstract IA010: Neighborhood socioeconomic status and outcomes of patients with endometrial cancer

Abstract Cancer disparities manifest a particularly intricate interplay between incompletely understood genomic risks, biologic susceptibility, and access to quality care. Disparate access to quality cancer care is often a reflection of a complex relationship between social, historical, and environmental factors that influence a patient’s surroundings, however large observational studies rarely quantify these contextual elements beyond individual or area-level income and education. The well-established racial and socioeconomic inequities in uterine cancer outcomes remain one of the widest amongst all cancer types, with an approximate 20% difference in 5-year survival between Black and White patients, which remains unchanged over the past 15 years. Racial disparities persist even when controlling for more advanced stage at presentation, the occurrence of more aggressive tumor subtypes and quality of treatment. When controlling for age, time period of diagnosis, region of the country, urban or rural setting, treating facility type, socioeconomic status, education, insurance, comorbidity index, pathologic stage, histology, lymphadenectomy and adjuvant treatment, African American patients still have lower overall survival than White patients (HR 1.21, 95% CI 1.16-1.26). There continues to be a concerted call for further explanation of the socioeconomic factors that contribute to these racial disparities. To date, few epidemiologic studies of uterine cancer have utilized markers that are more representative of the complex interplay of various social and environmental factors that influence health outcomes. Some studies have examined area level poverty and uterine cancer treatment and outcomes, finding that living in more vulnerable neighborhoods was associated with poor survival, delays in care, and inadequate treatment. However, these studies do not take into account the interplay of neighborhood poverty and how race, or experience of racism, may affect this relationship. Given the complex and insidious nature of racism in the United States, we have further explored how neighborhood poverty may affect uterine cancer outcomes taking into account the race of patients studied. Preliminary data from New York state suggests that neighborhood socioeconomic vulnerability is associated with worse treatment and survival for patients with uterine cancer, and this was best seen in White patients living outside of major metropolitan areas. The greatest Black/White survival disparities are seen in the wealthiest neighborhoods in New York City. Black women with advanced stage endometrial cancer living in affluent areas have no significant survival advantage over those living in vulnerable neighborhoods. Citation Format: Charlotte Gamble. Neighborhood socioeconomic status and outcomes of patients with endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr IA010.

COVID-19 vaccine uptake in Skåne county, Sweden, in relation to individual-level and area-level sociodemographic factors: a register-based cross-sectional analysis

ObjectivesBetter understanding of societal factors associated with COVID-19 vaccination can have important implications for public health policy to increase uptake.MethodsThis study investigated sociodemographic determinants of COVID-19 vaccine uptake with ≥2...

What makes elites more or less egalitarian? Variations in attitudes towards inequality within the economic, political and cultural elites in Chile

Abstract This article investigates how the type of elite to which a person belongs and their intergenerational contextual experiences are associated with attitudes towards inequality among elite individuals. We propose that membership of the economic elite and access to private schools, higher education business schools and affluent residential areas may contribute to the development of views that favour inequality. Using unique survey data collected in 2018 from a sample of 416 individuals belonging to Chile’s economic, political and cultural elites, we construct an additive score to measure attitudes towards inequality. Results of our regression analyses indicate that individuals belonging to the economic and political elite are more tolerant of inequality than members of the cultural elite. Moreover, intergenerational experiences at both private schools and higher education business schools significantly contribute to the formation of attitudes that favour inequality. These contextual experiences also relate to significant attitudinal variations within all elite groups.

The economic impact of general vs. targeted lockdowns: New insights from Italian municipalities

In response to COVID-19, most governments implemented either general or geographically targeted lockdowns. While the contractionary effects of general lockdowns have been well-documented, this paper is the first to contrast the economic impacts of the two approaches in a quasi-experimental setting. To this aim, we construct a high-frequency database combining unique information from mobile devices and administrative data across Italian municipalities. Using difference-in-differences approaches, our results confirm that general lockdowns considerably reduced mobility and employment, but we also find that localised measures only led to modest declines in mobility with minimal additional impact on employment. Focusing on the distributional consequences, we show that economic activity decreased less in wealthier communities with a higher capacity for telework. Moreover, short-time work schemes, serving as automatic stabilizers, predominantly benefited affluent areas. We conclude that an optimal policy mix involves targeted lockdown measures, complemented by adequate social policies and infrastructure investment.

Neighborhood Deprivation and Symptoms, Psychological Distress, and Quality of Life Among Head and Neck Cancer Survivors

Socioeconomic deprivation is associated with increased risk of poor health and quality-of-life (QOL) outcomes in head and neck cancer (HNC) survivors. However, there are few data on how neighborhood deprivation affects patient-reported outcome measures (PROMs) in HNC survivors. To investigate whether neighborhood socioeconomic deprivation is associated with symptom burden, psychological distress, and QOL among HNC survivors. This cross-sectional study used prospectively collected data from patients seen in a university-affiliated multidisciplinary HNC survivorship clinic between September 2018 and September 2021 who received radiotherapy for squamous cell carcinoma of the oral cavity, oropharynx, and larynx or hypopharynx. Neighborhood socioeconomic deprivation, measured using the Area Deprivation Index (ADI). The PROMs pertaining to symptom burden and severity of psychological distress were measured using the Neck Disability Index, Insomnia Severity Index, the 10-item Eating Assessment Tool, the Generalized Anxiety Disorder 7-item scale, and the 8-item Patient Health Questionnaire. Physical and social-emotional QOL were obtained using the University of Washington QOL questionnaire. Multivariable linear regression analysis adjusting for individual-level sociodemographic, comorbidity, and treatment characteristics investigated the association between ADI and PROMs. A subgroup analysis was performed to compare the lowest (most affluent areas: ADI, 0%-20%) and highest (most deprived areas: ADI, 80%-100%) ADI quintiles. A total of 277 patients were included in the final analysis (mean [SD] age, 64.18 [9.60] years; 215 [77.6%] male). Cancer sites were the oral cavity (52 [18.8%]), oropharyngeal area (171 [61.7%]), and larynx or hypopharynx (54 [19.5%]). Multivariable analysis showed that for every 1-point increase in ADI, social-emotional QOL changed by -0.14 points (95% CI, -0.24 to -0.05 points), anxiety increased by 0.03 points (95% CI, 0.01-0.06 points), and neck disability worsened by 0.05 points (95% CI, 0.01-0.10 points). Compared with patients in the most affluent areas, those in the most deprived areas had significantly lower physical (-15.89 points; 95% CI, -25.96 to -2.31 points; Cohen d = -0.83) and social-emotional (-13.57 points; 95% CI, -22.79 to -3.49 points; Cohen d = -0.69) QOL and higher depression (2.60 points; 95% CI, 0.21-4.40 points; Cohen d = 0.52), anxiety (3.12 points; 95% CI, 1.56-4.66 points; Cohen d = 0.61), insomnia (3.55 points; 95% CI, 0.33-6.41 points; Cohen d = 0.54), and neck disability (5.65 points; 95% CI, 1.66-9.55 points; Cohen d = 0.66) scores. In this cross-sectional study, a higher ADI score was associated with higher risk of increased psychological distress, higher symptom burden, and decreased QOL after treatment among HNC survivors. These findings suggest that proactive, patient-centered interventions are needed to address these disparities.

Interplay of socio-economic and environmental factors in shaping urban plant biodiversity: a comprehensive analysis

Urban environments are dynamic landscapes shaped by a multitude of factors, including environmental conditions and socio-economic influences. This study systematically investigates how various factors shape urban plant diversity in Haikou City, Hainan Province, China, focusing on 30 key drivers including socio-economic aspects, biophysical conditions, landscape elements, and management practices. Our research methodology involved a comprehensive analysis of these factors’ impact on six types of urban plant species: spontaneous, native spontaneous, exotic spontaneous, cultivated, native cultivated, and exotic cultivated. Conducted in urban areas with varying population densities and landscape features, our sampling approach aimed to understand the species’ distribution patterns. We discovered significant correlations between plant species diversity and specific environmental and socio-economic variables. Our results indicate that spontaneous species are prevalent in densely populated areas with strong social ties, whereas areas rich in tree and shrub cover see fewer such species. Native cultivated species favor more serene, less urbanized landscapes, while exotic cultivated species are predominantly found in economically affluent areas with diverse vegetation. These findings offer valuable insights for urban planning and biodiversity conservation, emphasizing the need for customized greening strategies that align with local environmental and social contexts. By adopting such tailored approaches, urban planners can more effectively manage landscapes, enrich green spaces, and foster biodiverse, sustainable ecosystems. This research not only enhances our understanding of urban plant biodiversity but also lays the groundwork for future studies and policy-making, promoting harmonious integration of diverse plant life within urban settings.

Real-world Trends, Rural-urban Differences, and Socioeconomic Disparities in Utilization of Narrow versus Broad Next-generation Sequencing Panels.

We identified socioeconomic and rurality disparities in the use of genomic tests and trial matching by panel size, which may have implications for equal access to targeted therapies. The lack of association between large panel tests and clinical trial matching by socioeconomic status, suggests a potential health equity impact, while removing barriers in access to large panels for rural patients may improve access to trials. However, further research is needed.

(239) Stem Cell Therapy for Erectile Dysfunction Across States – Fact or Fiction?

Abstract Introduction While conventional treatments exist for erectile dysfunction (ED), the growing interest in alternative therapies has brought stem cell therapy to the forefront. Stem cells, with their regenerative potential, hold promise for addressing a wide range of diseases, including ED. However, the overall efficacy and potential risks of stem cell therapy for ED remain uncertain. Despite the limited evidence, an increasing number of clinics in the US offer these treatments. This study aims to analyze businesses marketing stem cell therapies and public interest in them. Objective To quantify data in the treatment of erectile dysfunction (ED) with stem cell therapy as marketed by U.S. companies. By querying Google trends, this study provides a novel epidemiological tool for geographically mapping search intent in relation to stem cell use and ED. Methods Google trends were extracted to trace stem cell related search intents combined with ED related searches within past 5 years in U.S. Weather related searches are predicted to remain consistent across time, thus were implemented as a control of Google searches. In addition, data collected regarding stem cell search trends were regressed on state GDP to correlate the degree to which price influences those interested in the novel treatment. The derived data was then implemented into a nationwide heat map to determine which states harbor the most interest (Figure 1). Individual Income Tax Statistics- Zip Code Data (SOI) were used to further explore correlation of public interest with individual’s annual income in the top 4 searched states. Results From the available patient websites, there were 6 practicing clinics within the U.S. that offer stem cells for ED, with out-of-pocket expenses averaging $5000 to $10000 per treatment. The types of stem cells advertised on these websites included umbilical derived, adipose derived, bone marrow derived and blood derived stem cells. Using the heat map, states with the highest search intents were in Florida, California, Massachusetts, New York, and Arizona. While stem cell average search intent exponential increase was observed over the past 5 years relative to platelet rich plasma (PRP), it was not as high as that of low-intensity shockwave therapy increase: stem cell= 11.3 Arbitrary Units (A.U), shockwave= 35.4 A.U, and PRP= 10.8 A.U. Using linear regression, a correlation of r = 0.132 was observed between a higher State GDP per capita and a higher search intent (Figure 2). Furthermore, SOI was analyzed for the highly searched states to explore the specific search interest for the public with corresponding zip codes of an annual income &amp;gt; $200,000. In Arizona, for example, a conspicuously great number of individuals who make &amp;gt;$200,000 annually demonstrated an even increasing higher correlation regarding interest in stem cell treatment for ED. Conclusions With different sites offering such therapy across the US, there is a growing interest in stem cells and other regenerative therapies for ED with the affluent areas having more interest in these therapies, likely due to the high cost of treatment Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

GP training in affluent practices in Scotland: the experiences of GP trainees and implications for their future practice

ABSTRACT UK general practice faces workforce challenges. The pandemic, and cost-of-living crisis are felt hardest by our most deprived communities. The Scottish Government is keen to tackle Scotland’s high drugs-related deaths. The perceptions and experiences of GP specialist trainees who have trained in deprived communities are already known. This qualitative study explored the perceptions and experiences of trainees from affluent practices and how this training may affect their future career. One-to-one in-depth interviews were conducted and analysed using grounded theory methods. Seven participants were interviewed. Five themes were constructed: training practice choices, perceptions of working in deprived areas, unmet learning needs for working in deprived areas, other sources of deprivation exposure and future working intentions. Most did not choose their training practice because of its affluence. They perceived that working in a deprived area would have challenges: less staff, higher rates of pathology, communication challenges, poorer patient health literacy. Addiction care was a significant unmet learning need. Most lacked confidence to work in deprived areas, and were likely to work in their training practice or similar, upon completion of training. This research has implications for ensuring equity of GP workforce provision and whether GP Specialty Training fulfils its intention of producing ‘a GP who is capable of working independently in a variety of primary care settings’. Those training in highly-affluent settings may not feel able to meet this aim. Training providers should consider this limited experience and whether rotations, involving affluent and deprived area practices, would prepare future GPs to work with a range of socioeconomic populations.

The geographies of local austerity policies: a quantitative analysis of local budgets in France

ABSTRACT The literature acknowledges the variety of local austerity policies, but has paid less attention to their geographical diversity. This paper questions the theorisation of space in this literature and investigates the relationships between local austerity policies and the diversity of local spatial systems. By combining two fiscal and socio-economic classifications of French municipalities, it provides a comprehensive and fine-grained mapping of local austerity for an entire country. Our findings demonstrate that austerity occurs in a wide range of local spatial systems and highlight numerous instances of mundane austerity that exist between affluent areas and those most severely impacted by austerity.

Economic Burden of Induced Laryngeal Obstruction in Adolescents and Children.

Diagnosing pediatric induced laryngeal obstruction (ILO) requires equipment typically available in specialist settings, and patients often see multiple providers before a diagnosis is determined. This study examined the financial burden associated with the diagnosis and treatment of ILO in pediatric patients with reference to socioeconomic disadvantage. Adolescents and children (<18 years of age) diagnosed with ILO were identified through the University of Madison Voice and Swallow Outcomes Database. Procedures, office visits, and prescribed medications were collected from the electronic medical record. Expenditures were calculated for two time periods (1) pre-diagnosis (first dyspnea-related visit to diagnosis), and (2) the first year following diagnosis. The Area Deprivation Index (ADI) was used to estimate patient socioeconomic status to determine if costs differed with neighborhood-level disadvantage. A total of 113 patients met inclusion criteria (13.9 years, 79% female). Total pre-diagnosis costs of ILO averaged $6486.93 (SD = $6604.14, median = $3845.66) and post-diagnosis costs averaged $2067.69 (SD = $2322.78; median = $1384.12). Patients underwent a mean of 3.01 (SD = 1.9; median = 2) procedures and 5.8 (SD = 4.7; median = 5) office visits prior to diagnosis. Pharmaceutical, procedure/office visit, and indirect costs significantly decreased following diagnosis. Patients living in neighborhoods with greater socioeconomic disadvantage underwent fewer procedures and were prescribed more medication than those from more affluent areas. However, total expenditures did not differ based on ADI. Pediatric ILO is associated with considerable financial costs. The source of these costs, however, differed according to socioeconomic advantage. Future work should determine how ILO diagnosis and management can be more efficient and equitable across all patients. Laryngoscope, 134:3384-3390, 2024.