Deprived Regions Research Articles

Evaluating mutual impacts of Agricultural Growth and Inequality in Iran's Rural area divided to Provinces with Amenity and Deprived: Simultaneous Equations of Panel Data Approach

Purpose- Income distribution inequity in low income societies spreads poverty faster therefore it is essential to indicate the relation between economic growth and income distribution in low income societies like rural societies which gain income through agricultural activities. On the other hand, recent studies show that societies amenity or deprivation is effective on the relation between growth and income distribution. So the aim of this study is to indicate the relation between rural income distribution and Iran agricultural sector growth dividing to regions with amenity or deprived. Design/methodology/approach - Due to economic literature income distribution and economic growth has interactional effect on each other and the relation between them is different in regions with amenity and deprived. To explain the relation between rural income distribution and agricultural sector growth in this study two equations are introduced, the first equation analyzes the effective factors on agricultural sector growth and the second equation examine the factors determining rural income inequality. These equations are estimated by provincial data divided to regions with amenity and deprived during 2008-2016 and simultaneous equations approach of panel data is used. Finding-The results show that, in low amenity and deprived provinces agricultural sector growth reduces the inequality while agricultural sector growth has no significant effect on inequality in provinces with amenity. Also inequality increase lead to economic growth in deprived regions, but in regions with amenity the effect of inequality on growth is not significant. Besides, the results of estimation imply that government's expenditure in provinces increase rural income inequality and development expenditure only in deprived and low amenity provinces cause rural income inequality decrease and in other rural is not significant on inequality index. Practical implications- Based on the results of this study and in order to reduce rural income inequality and the growth of agricultural sector, it is necessary to consider the distribution of public facilities and infrastructure in order to enjoy deprived and low amenity rural regions.

Rethinking lifestyle and middle‐class migration in “left behind” regions

AbstractSo‐called “left behind” regions have gained infamy for working‐class discontent. Yet a concurrent phenomenon has gone unremarked: middle‐class lifestyles in peripheral places. This article examines how middle‐class migrants (defined by economic, social, and cultural capital) to peripheral regions envisage and enact their aspirations. Against presumed migration trajectories to growing urban centres or for better‐paid employment, we argue that seeming moves down the “escalator” reveal how inequalities between regions offer some migrants opportunities to enact middle‐class lifestyles affordably. We present a qualitative case study of West Wales and the Valleys, predominantly rural and post‐industrial and statistically among Europe's most deprived regions. Drawing from interviews with EU and UK in‐migrants alongside long‐term residents, we illustrate how three dimensions of quality of life—material, relational, subjective—are mobilised in middle‐class placemaking amidst peripherality. We demonstrate how spatial inequalities and career trade‐offs offer affordable material access to lifestyle and how middle‐class aspirations enable migrants to subjectively transform peripherality into enchantment.

Growth rules for the repair of Asynchronous Irregular neuronal networks after peripheral lesions.

Several homeostatic mechanisms enable the brain to maintain desired levels of neuronal activity. One of these, homeostatic structural plasticity, has been reported to restore activity in networks disrupted by peripheral lesions by altering their neuronal connectivity. While multiple lesion experiments have studied the changes in neurite morphology that underlie modifications of synapses in these networks, the underlying mechanisms that drive these changes are yet to be explained. Evidence suggests that neuronal activity modulates neurite morphology and may stimulate neurites to selective sprout or retract to restore network activity levels. We developed a new spiking network model of peripheral lesioning and accurately reproduced the characteristics of network repair after deafferentation that are reported in experiments to study the activity dependent growth regimes of neurites. To ensure that our simulations closely resemble the behaviour of networks in the brain, we model deafferentation in a biologically realistic balanced network model that exhibits low frequency Asynchronous Irregular (AI) activity as observed in cerebral cortex. Our simulation results indicate that the re-establishment of activity in neurons both within and outside the deprived region, the Lesion Projection Zone (LPZ), requires opposite activity dependent growth rules for excitatory and inhibitory post-synaptic elements. Analysis of these growth regimes indicates that they also contribute to the maintenance of activity levels in individual neurons. Furthermore, in our model, the directional formation of synapses that is observed in experiments requires that pre-synaptic excitatory and inhibitory elements also follow opposite growth rules. Lastly, we observe that our proposed structural plasticity growth rules and the inhibitory synaptic plasticity mechanism that also balances our AI network both contribute to the restoration of the network to pre-deafferentation stable activity levels.

2020 NICE guideline update: Good news for pregnant women with type 1 diabetes and past or current gestational diabetes.

In December 2020, the National Institute for Health and Care Excellence (NICE) reviewed the evidence and updated their recommendations on intermittently scanned (commonly known as Flash) and Continuous Glucose Monitoring (CGM) during pregnancy for women with type 1 diabetes (1). The NICE guidelines now recommend offering CGM to all pregnant women with type 1 diabetes to help them meet their pregnancy glucose targets and improve neonatal outcomes. Their evidence review, based on the CONCEPTT randomised trial (2) and a Swedish observational study (3) found that, compared to capillary glucose monitoring, CGM resulted in more women achieving their blood glucose targets, fewer caesarean sections and fewer neonatal intensive care admissions.

P094 Incidence of clinically diagnosed Paget’s disease of bone: evidence of a continuing decline

Abstract Background/Aims Evidence from the UK suggest that the incidence of Paget's disease of bone declined during the latter half of the last century with a decline also in the incidence of clinically apparent disease. We aimed to characterise the recent incidence of clinically diagnosed Paget’s disease of bone in the UK by age and sex among those aged >18 years and, to determine whether the incidence has changed from 1999-2015. Methods Incident cases of Paget’s disease during 1999-2015 were identified from the first recorded diagnostic code for Paget’s disease in the UK Clinical Practice Research Datalink (CPRD) database. Crude incidence was calculated for each year from 1999 to 2015 and, to account for changes in the distribution of age and sex over time within the CPRD, direct age- and sex-standardised incidence rates were calculated for each year. This was done by multiplying the crude incidence in each age-sex stratum by the age-sex stratum weight of the 1999 population of those at risk of developing Paget’s disease. We looked also at the incidence of disease by quintile of index of multiple deprivation and geographic region. Using Poisson regression, we looked at the influence of deprivation and geography on occurrence of the disease after adjustment for age and sex. Results In total 3,592 incident cases of Paget’s disease were identified between 1999 and 2015. Overall the incidence increased with age and at all ages was greater in men than women. In men, and women, respectively, incidence increased from 0.074 and 0.037 per 10,000 per year at the age of 45-49 years to 6.3 and 3.7 per 10,000 per year at age of 85 years and older. When stratified by year, the age- and sex-standardised incidence fell from 0.75/10,000 person years in 1999 to 0.20/10,000 person years in 2015. Crude incidence (1999-2015) was slightly higher in those living in the most deprived areas (0.53/10,000 person years) compared to those in least deprived areas (0.43/10,000 person years). After adjustment for age and sex, compared to those in the highest quintile of index of multiple deprivation, those in the lowest quintile of index of multiple deprivation had over a 30% increased risk of disease. There was evidence also of geographic variation in the occurrence of disease with the highest incidence in the North West of England. Conclusion The incidence of clinically diagnosed Paget’s disease has continued to decrease since 1999. The reason for the decline remains unknown, though the rapidity of change points to an alteration in one or more environmental determinants. Disclosure M.J. Cook: None. S.R. Pye: None. W.G. Dixon: None. T.W. O'Neill: None.

Incidence of Paget's disease of bone in the UK: evidence of a continuing decline.

To characterize the incidence of clinically diagnosed Paget's disease of bone in the UK during 1999-2015 and to determine variations in the incidence of disease by age, sex, geography and level of deprivation. Incident cases of Paget's disease occurring between 1999 and 2015 were identified from primary care records. Overall crude incidence and incidence stratified by age and sex was calculated each year from 1999 to 2015. Direct age- and sex-standardized incidence was also calculated. We used Poisson regression to look at variations in incidence by deprivation and UK region. A total of 3592 incident cases of Paget's disease were identified between 1999 and 2015. Incidence increased with age and at all ages was greater in men than women. In women and men, respectively, crude incidence increased from 0.037 and 0.074/10000 population per year among those 45-49 years of age to 3.7 and 6.3/10000 population per year among those ≥85 years. The overall standardized incidence decreased from 0.75/10000 person-years in 1999 to 0.20/10000 person-years in 2015. After adjustment for age and sex, incidence was >30% higher in the most- compared with least-deprived quintile of deprivation. There was evidence of geographic variation, with the highest incidence in the North West of England, which persisted after adjustment for age, sex and level of deprivation. The incidence of clinically diagnosed Paget's disease has continued to decrease since 1999. The reason for the decline in incidence remains unknown, although the rapidity of change points to an alteration in one or more environmental determinants.

Impact of demand response on escalating energy access with affordable solar photovoltaic generation in the Global South

Globally, three-quarter of a billion people live without electricity. Besides, hundreds of million use a solar lantern for less than 4 h a day. Most of the access-deprived are in the Global South, predominantly in Sub-Saharan Africa and South Asia. The United Nations framed the seventh Sustainable Development Goal to improve access. Solar photovoltaic powered mini-grids are increasingly extending better service to deprived regions. However, poor load-factor and expensive storage adversely affect viability. Also, these mini-grids do not support infrequent large loads to avoid further loss of load-factor. Electric cooking is efficient and non-polluting; water treatment facilities can save millions from contaminant and pathogen by providing clean water. Besides, both electric cooking and water treatment are less expensive than alternatives. But mini-grids frequently do not support these. Indeed, the presence of sustained productive loads favourably influences the mini-grid economy. This study investigates the role of critical household loads to deliver similar bearing on the mini-grid economy. Results underscore realisation of desirable impact with household collaboration under a demand-response program. Collaborative consumption can lower initial investment by 62% and reduce the unit energy cost to $0.23. Also, cooperation improves the mini-grid load factor and promotes viability. Additionally, fast deployment needs during and after Covid-19 remains inherently supported while mitigating the pandemic induced financial stress of both consumer and mini-grid operator. This study of 88 nation-states underscores that demand response in a mini-grid can not only improve affordability for all consumers, but it can also bring 186 million people within affordable access.

Factors influencing home blood pressure monitor ownership in a large clinical trial

Home blood pressure monitor (HBPM) ownership prevalence and the factors that influence it are unclear. This study aimed to investigate factors associated with HBPM ownership among participants in the Treatment in Morning versus Evening (TIME) hypertension study. This study is a sub-analysis of the TIME study, a randomised trial investigating the effect of day-time versus night-time dosing of antihypertensive medication on cardiovascular outcomes in adults with hypertension. As part of the TIME study online registration process, participants were asked to indicate whether they owned an HBPM. A multivariable logistic regression model was constructed to determine factors associated with HBPM ownership. Of 21,104 randomised participants, 11,434 (54.2%) reported owning an HBPM. The mean age of all participants at enrolment was 67.7 ± 9.3 years, 12,134 (57.5%) were male, and 8892 (42.1%) reported a current or previous history of smoking. Factors associated with an increased likelihood of reporting HBPM owned include being male (OR:1.47; 95% CI 1.39–1.56) or residing in a less deprived socioeconomic region (IMD Decile 6–10) (OR:1.31; 95% CI 1.23–1.40). Participants with a history of diabetes mellitus (OR:0.74; 95% CI:0.64–0.86) or current smokers, compared to non-smokers, (OR:0.71; 95% CI:0.62–0.82) were less likely to report owning an HBPM. This study has identified important patient factors influencing HBPM ownership. Further qualitative research would be valuable to identify and explore potential patient-level barriers to engagement with self-monitoring of blood pressure.

Equity in the Distribution of Health Resources: A Case Study in Southeast Iran

Background: Equity in the distribution of equipment and resources in the health sector constitutes one of the main dimensions of justice, improving health status and increasing people's satisfaction. Objectives: The current study aimed at determining how health resources and bed are distributed in the poorest region of Iran. Methods: The current retrospective, cross-sectional study was performed in Sistan and Baluchistan Province, as the poorest region of Iran, in 2020. Data were collected using a standard checklist from all five health centers affiliated to Zahedan University of Medical Sciences (ZAUMS). Excel and STATA software were used for data analysis; the Gini index was also calculated. Results: The Gini index for the distribution of midwives and rural health workers was equitable (0.216 and 0.287, respectively). The distribution of urban healthcare providers, nutrition and psychology counselors, and active beds in ZAUMS were 0.675, 0.545, 0.454, and 0.526, respectively. The distribution of general practitioners, based on the Gini index (0.492), was not fair. Also, the distribution of specialists and nurses was unfair (Gini index: 0.494 and 589, respectively). Conclusions: The distribution of most resources in the poorest region of Iran was not fair. Unfair distribution and disparities can affect population health status in the future. Then, it is suggested that health policymakers and managers pay more attention to deprived regions.

A mixed methods approach to the social assessment of transport infrastructure projects

In this paper, we propose a mixed methods quantitative and qualitative approach to capture fully the measurable and less tangible social impacts of transport projects on local people and communities. The approach was used to assess the potential social impacts of a strategic road by-pass project case study in a deprived region of Wales in the UK. The project specifically aimed to stimulate local economic growth and regeneration in the local areas it serves. In a ‘before and after’ case study, we combined fine-grained, GIS-based spatial analysis of secondary datasets with qualitative participative exercises with the local residents of the five communities living adjacent to the road, and interviews with professional local stakeholders. This mixed methods approach significantly enhanced understanding of both the social benefits and disbenefits of the road project. It helped to reveal local concerns that would not otherwise have been apparent from secondary dataset analysis alone. The qualitative studies were also successful in bringing to the table new ‘hard to reach’ voices that had not been heard through the formal consultation and public engagement process. The study revealed that the social benefits accruing to local people from the project could have been significantly enhanced, whilst a number of its locally occurring negative social impacts could have been avoided had social assessment been employed earlier in the decision processes concerning its routing and design. Recommendations to improve the practice and uptake of social assessments at the option appraisal, project design mitigation and post evaluation stages of transport projects are included in the paper.

Sociodemographic inequalities in patients' experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017.

ObjectiveYounger people, minority ethnic groups, sexual minorities and people of lower socioeconomic status report poorer experiences of primary care. In light of NHS ambitions to reduce unwarranted variations in care, we aimed to investigate whether inequalities in patient experience of primary care changed between 2011 and 2017, using data from the General Practice Patient Survey in England.MethodsWe considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience: overall experience, doctor communication, nurse communication, access and continuity of care. We used linear regression to explore whether the magnitude of inequalities changed between 2011 and 2017, using mixed models to assess changes within practices and models without accounting for practice to assess national trends.ResultsWe included 5,241,408 responses over 11 survey waves from 2011–2017. There was evidence that inequalities changed over time (p < 0.05 for 27/30 models), but the direction and magnitude of changes varied. Changes in gaps in experience ranged from a 1.6 percentage point increase for experience of access among sexual minorities, to a 5.6 percentage point decrease for continuity, where experience worsened for older ages. Inequalities in access in relation to socio-economic status remained reasonably stable for individuals attending the same GP practice; nationally inequalities in access increased 2.1 percentage points (p < 0.0001) between respondents living in more/less deprived areas, suggesting access is declining fastest in practices in more deprived areas.ConclusionsThere have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.

Visual motion processing recruits regions selective for auditory motion in early deaf individuals

In early deaf individuals, the auditory deprived temporal brain regions become engaged in visual processing. In our study we tested further the hypothesis that intrinsic functional specialization guides the expression of cross-modal responses in the deprived auditory cortex. We used functional MRI to characterize the brain response to horizontal, radial and stochastic visual motion in early deaf and hearing individuals matched for the use of oral or sign language. Visual motion showed enhanced response in the ‘deaf’ mid-lateral planum temporale, a region selective to auditory motion as demonstrated by a separate auditory motion localizer in hearing people. Moreover, multivariate pattern analysis revealed that this reorganized temporal region showed enhanced decoding of motion categories in the deaf group, while visual motion-selective region hMT+/V5 showed reduced decoding when compared to hearing people. Dynamic Causal Modelling revealed that the ‘deaf’ motion-selective temporal region shows a specific increase of its functional interactions with hMT+/V5 and is now part of a large-scale visual motion selective network. In addition, we observed preferential responses to radial, compared to horizontal, visual motion in the ‘deaf’ right superior temporal cortex region that also show preferential response to approaching/receding sounds in the hearing brain. Overall, our results suggest that the early experience of auditory deprivation interacts with intrinsic constraints and triggers a large-scale reallocation of computational load between auditory and visual brain regions that typically support the multisensory processing of motion information.

Digital labour platforms in Pakistan: institutional voids and solidarity networks

PurposeWhile digital labour platforms are being increasingly studied across the Global South, the existing literature does not conceptualise the theoretical link between such platforms and socio-economic development. This paper theorises such a link drawing on the notion of institutional voids defined, as in Khanna and Palepu (2010), as “the absence of intermediaries to efficiently connect buyers and sellers” in an economy. We frame digital labour platforms as means to fill institutional voids, seeking to create “development” in the form of earning opportunities in contexts of deprivation.Design/methodology/approachWe draw on an interpretive case study of an online work training project in a deprived region of Pakistan, where members of marginalised communities were trained to become freelancers for global digital labour platforms. We use the notion of market-enabling institutions aimed at filling institutional voids as a lens to study the project's declared goals, examining the extent to which these were met in practice for the workers who participated in the training.FindingsOur analysis reveals three types of market-enabling institutions–credibility enhancers, aggregators and distributors, and transaction facilitators–through which digital labour platforms seek to fill institutional voids. However, workers' narratives reveal that institutional voids are only partially filled by these platforms, and their perpetuation results in diverse forms of power asymmetries leveraged by clients and owners of the platforms. We also observe the formation of solidarity networks among workers, networks that are intra-familial and societal rather than characterised by formal unionisation.Originality/valueThe paper offers a novel perspective to theorise the link between digital labour and socio-economic development. Applying such a perspective in a Global South context, it also finds the limits of the digital platforms' institutional void-filling potential, highlighting the emergence of power asymmetries and the emerging formation of worker solidarity networks.

Association of peripheral artery disease and chronic limb-threatening ischemia with socioeconomic deprivation in people with diabetes: A population data-linkage and geospatial analysis.

The association between the prevalence and geographical distribution of peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI) in patients with diabetes in the context of socioeconomic deprivation is not well understood. We undertook a retrospective cohort study of 76,307 people with diabetes admitted as a hospital inpatient in a large Scottish health administrative area. Utilising linked health records, we identified diagnoses of PAD and/or CLTI and their distribution using small area cartography techniques according to multiple deprivation maps. Spatial autocorrelation techniques were applied to examine PAD and CLTI patterning. Association between crude inpatient prevalence-adjusted outcome rates and exposure to social deprivation were determined. We found crude prevalence-adjusted rates of 8.05% for PAD and 1.10% for CLTI with a five- to sevenfold difference from the least to most deprived regions. Statistically significant hot spots were found for PAD (p < 0.001) and CLTI (p < 0.001) in the most deprived areas, and cold spots for PAD (p < 0.001) but not CLTI (p = 0.72) in the least deprived areas. Major health disparities in PAD/CLTI diagnoses in people with diabetes is driven by socioeconomic deprivation.

Estimation of the Potentially Avoidable Excess Deaths Associated with Socioeconomic Inequalities in Cancer Survival in Germany.

Simple SummaryIn this study, we estimate the number of avoidable deaths attributable to socioeconomic inequalities in cancer survival in Germany. We used data from epidemiological cancer registries. The German Index of Multiple Deprivation (GIMD) 2010 was used to assess deprivation on a municipality level. Results show that summed over the 25 cancer sites, 4100 annual excess deaths (3.0% of all excess deaths) could have been avoided each year in Germany during the period 2013–2016 if relative survival were in all regions comparable with the least deprived regions. Colorectal, oral and pharynx, prostate, and bladder cancer contributed the largest numbers of avoidable excess deaths. We also observed that cancer incidence was generally higher in more deprived areas. Our analyses demonstrate the importance of cancer prevention and of survival improvements in more deprived regions.Many countries have reported survival inequalities due to regional socioeconomic deprivation. To quantify the potential gain from eliminating cancer survival disadvantages associated with area-based deprivation in Germany, we calculated the number of avoidable excess deaths. We used population-based cancer registry data from 11 of 16 German federal states. Patients aged ≥15 years diagnosed with an invasive malignant tumor between 2008 and 2017 were included. Area-based socioeconomic deprivation was assessed using the quintiles of the German Index of Multiple Deprivation (GIMD) 2010 on a municipality level nationwide. Five-year age-standardized relative survival for 25 most common cancer sites and for total cancer were calculated using period analysis. Incidence and number of avoidable excess deaths in Germany in 2013–2016 were estimated. Summed over the 25 cancer sites, 4100 annual excess deaths (3.0% of all excess deaths) could have been avoided each year in Germany during the period 2013–2016 if relative survival were in all regions comparable with the least deprived regions. Colorectal, oral and pharynx, prostate, and bladder cancer contributed the largest numbers of avoidable excess deaths. Our results provide a good basis to estimate the potential of intervention programs for reducing socioeconomic inequalities in cancer burden in Germany.

Inequalities in health-related quality of life: repeated cross-sectional study of trends in general practice survey data.

After decades of steady progress, life expectancy at birth has stalled in England. Inequalities are also rising, and life expectancy has fallen for females living in the most deprived areas. However, less attention has been given to trends in other measures of population health, particularly health-related quality of life (HRQoL). To examine trends and inequalities in HRQoL in England between 2012 and 2017. The authors used nationally representative survey data on 3.9 million adults to examine HRQoL (measured by EQ-5D-5L overall score, plus each of the five health domains - mobility, selfcare, usual activity, pain/discomfort, and anxiety/depression). The study explored trends across time, and inequalities by sex, age, and deprivation. Although HRQoL seemed steady overall between 2012 and 2017, there is evidence of increasing inequality across population subgroups. There was a rise in sex disparity over time, the female-male gap in EQ-5D-5L increased from -0.009 in 2012 to -0.016 in 2017. Trends for the youngest females and those living in the most deprived areas were of the greatest concern. Females in the most deprived regions suffered a 1.3% decrease in HRQoL between 2012 and 2017, compared with a 0.5% decrease for males. The key contribution to the decline in HRQoL, particularly in females, was a 1.5% increase in reported levels of anxiety/depression between 2012 and 2017. Developing interventions to address these worrying trends should be a policy priority. A particular focus should be on mental health in younger populations, especially for females and in deprived areas.

Impact of Financial Inclusion on Income Generation and Savings in Mountain Regions: A Case Study of Rural Households of Uttarakhand

The major drive for financial inclusion started in the country mainly from year 2014 after the launch of Jan Dhan Yojana which focused mainly towards empowering dwellers of resource deprived and underdeveloped regions. Economic empowerment of such deprived sections is possible only when they are provided with ample opportunities for income generation in various economic activities. The prominent aim of financial inclusion is to facilitate residents of such deprived regions by reaching out to them and delivering them facilities so that they could identify and work on their capabilities to generate employment and income earning opportunities. The economically deprived and vulnerable population, through it, could be secured, from falling in the trap of poor informal level activities. These low-level informal activities are not suitable for them and for their overall development in the long run. Financial inclusion thus helps them in getting out of the poverty trap and hence acts as one of the important facility or an instrument which could help in a larger achievement of the goal of the development of residents of such deprived regions. Keeping these aspects in consideration the present study aims to understand the impact of financial inclusion on two important variables i.e. income generation and enhancement of savings among the residents of Mountain regions of the state which also represents the deprived and underdeveloped regions. The study was conducted in three mountain districts of the state and the results of the study shows that financial inclusion has helped in income generation in these regions but the impact of it has been different among different caste categories. Further the study shows that financial inclusion worked to enhance the income generation with larger benefits to households having higher levels of income. The study also depicts the positive impact of financial inclusion on savings but with noticeable variations in its impact on different caste groups.

Achieving Equitable Access to Medicines and Health Services: A COVID-19-time Recalled Matter.

In the 21st century, while some people seek to use artificial intelligence for health services delivery, others have to surrender their health rights to meet basic needs. The gradient in health has become more pronounced in the COVID-19 crisis considering discrepancies in disease prevalence, geographical accessibility, availability, affordability, quality/safety of health services, and human resources. Through PubMed, GoogleScholar, Scopus, WHO, OECD, and UN databases, the English documents and global statistics were collected. Determining the role of health equity-related factors and introducing mechanisms to maintain regional and international justice in health, specifically during the COVID-19 pandemic, were among the core concepts of this paper. Social determinants of health (SDH), interregional and intraregional bodies are the main drivers of discrimination in health services. Governments should relish chief health strategists’ role in possessing legitimacy, accountability, direction, transparent performance, fairness, and good governance in one word. Improving health literacy and telemedicine, providing income support, and reforming insurance where needed, are other national mechanisms to amend inequity. Among interregional issues, what is concerning is the matter of sanctions on access to health services, which is against the Universal Declaration of Human Rights. Shortage of vital medications, ventilators, test kits, COVID-19 vaccines, pharmaceutical raw materials, foreign currency, decreased national currency value, purchasing power parity, and quality/safety of health services resulted from such oppression. The article also provides practical suggestions, paving the way for re-establishing global solidarity and developing health justice in deprived regions.

Physical Impact Assessment of Sturgeon Farming Using a GIS-Based Approach (Case Study: Southeast Part of the Caspian Sea, Iran)

This study assessed and predicted the environmental impacts of sturgeon farming in three pre-determined spatial alternatives on the southeastern coast of the Caspian Sea, Iran. In Fact, the present study is a theoretical research that has developed a GIS-based mathematical matrices method to evaluate the environmental impacts of the sturgeon farming project. In this case, after preparing maps related to environmental factors and project activities, weight determination of interaction impacts was performed based on these maps. The results showed that spatial option number 1 (near the Gomishan Shrimp Farming Center) is the best place to establish a sturgeon farm and will have the least negative impact on the environment. The use of maps and the information obtained from them increases the accuracy of the impact assessment process. The present study also emphasized that GIS is a powerful and effective tool for managing and monitoring the environment and the decision-making process. This study also predicted that the expansion of aquaculture on the southeastern coast of the Caspian Sea will create jobs and reduce poverty in this deprived region.

Women's autonomy in healthcare decision-making and healthcare seeking behaviour for childhood illness in Ghana: Analysis of data from the 2014 Ghana Demographic and Health Survey.

The capacity of women to decide on their healthcare plays a key role in their health. In this study, we examined the association between women's healthcare decision-making capacity and their healthcare seeking behaviour for childhood illnesses in Ghana. We used data from the 2014 Ghana Demographic and Health Survey. A total sample of 2,900 women with children less than 5 years was used for the analysis. Data were processed and analysed using STATA version 14.0. Chi-square test of independence and binary logistic regression were carried out to generate the results. Statistical significance was pegged at 95% confidence intervals (CIs). We relied on the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement in writing the manuscript. Out of the 2,900 women, approximately 25.7% could take healthcare decisions alone and 89.7% sought healthcare for childhood illnesses. Women who decided alone on personal healthcare had 30% reduced odds of seeking healthcare for childhood illnesses compared to those who did not decide alone [AOR = 0.70, CI = 0.51-0.97]. With age, women aged 45-49 had 69% reduced odds of seeking healthcare for childhood illnesses compared to those aged 25-29 [AOR = 0.31, CI = 0.14-0.70]. Women from the Northern and Upper West regions had 72% [AOR: 0.28, CI: 0.11-0.70] and 77% [AOR: 0.23, CI: 0.09-0.58] reduced odds of seeking healthcare for childhood illnesses respectively, compared to those from the Western region. Ghanaian women with autonomy in healthcare decision-making, those who were older and those from the Northern and Upper West regions were less likely to seek healthcare for childhood illness. To reduce childhood mortalities and morbidities in Ghana, we recommend educating women such as those who take healthcare decisions alone, older women and women from deprived regions like the Northern and Upper West regions on the need to seek healthcare for childhood illnesses.