Disparities In Demand Research Articles

Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study.

Over 200 health information exchanges (HIEs) are currently operational in Japan. The most common feature of HIEs is remote on-demand viewing or searching of aggregated patient health data from multiple institutions. However, the usage of this feature by individual users and institutions remains unknown. This study aims to understand usage of the on-demand patient data viewing feature of large-scale HIEs by individual health care workers and institutions in Japan. We conducted audit log analyses of large-scale HIEs. The research subjects were HIEs connected to over 100 institutions and with over 10,000 patients. Each health care worker's profile and audit log data for HIEs were collected. We conducted four types of analyses on the extracted audit log. First, we calculated the ratio of the number of days of active HIE use for each hospital-affiliated doctor account. Second, we calculated cumulative monthly usage days of HIEs by each institution in financial year (FY) 2021/22. Third, we calculated each facility type's monthly active institution ratio in FY2021/22. Fourth, we compared the monthly active institution ratio by medical institution for each HIE and the proportion of cumulative usage days by user type for each HIE. We identified 24 HIEs as candidates for data collection and we analyzed data from 7 HIEs. Among hospital doctors, 93.5% (7326/7833) had never used HIEs during the available period in FY2021/22, while 19 doctors used them at least 30% of days. The median (IQR) monthly active institution ratios were 0.482 (0.470-0.487) for hospitals, 0.243 (0.230-0.247) for medical clinics, and 0.030 (0.024-0.048) for dental clinics. In 51.9% (1781/3434) of hospitals, the cumulative monthly usage days of HIEs was 0, while in 26.8% (921/3434) of hospitals, it was between 1 and 10, and in 3% (103/3434) of hospitals, it was 100 or more. The median (IQR) monthly active institution ratio in medical institutions was 0.511 (0.487-0.529) for the most used HIE and 0.109 (0.0927-0.117) for the least used. The proportion of cumulative usage days of HIE by user type was complex for each HIE, and no consistent trends could be discerned. In the large-scale HIEs surveyed in this study, the overall usage of the on-demand patient data viewing feature was low, consistent with past official reports. User-level analyses of audit logs revealed large disparities in the number of days of HIE use among health care workers and institutions. There were also large disparities in HIE use by facility type or HIE; the percentage of cumulative HIE usage days by user type also differed by HIE. This study indicates the need for further research into why there are large disparities in demand for HIEs in Japan as well as the need to design comprehensive audit logs that can be matched with other official datasets.

DEMAND DRIVEN UNIVERSITY EDUCATION PROVISION: IMPLICATIONS FOR EQUITY AND QUALITY

The established link between higher education attainment and individual socio-economic prosperity explains to a large extent the continued increase in private and social investment in education. It is the driver of growth in established higher education institutions and in the number of students enrolled. Many research reports on the status of education reveal the intensity in efforts to address issues underlying the poor quality of education. It is generally agreed that universities are entrusted with the task of generating knowledge of appropriate quality, and to making this knowledge availability to a wide population in order to support national economic competitiveness. But the issue of forces driving demand for higher education and their capacity to distort access to opportunities stand out. As nations endeavour to expand access to higher education, challenges of inadequate resource provision constrain access to opportunities for students with certain unique attributes. Overall national socio-economic development requires that education provision be inclusive to cover students with unique characteristics including the marginalised. Participation of those with attributes defined vulnerabilities should be a pre-requisite to quality assessments. This paper therefore examines university education demand trends in Kenya and how they related to students’ characteristics. Descriptive survey designs were used. A sample of 524 respondents was drawn from among the twenty-two public and eighteen private chartered universities. Data was analysed using frequency tables and percentages, and means; hypotheses were tested using ANOVA, with all statistical tests done at α=0.05 level of significance. Results showed that overall demand for education was on the increase in public universities, but declining in private universities. Disparities in demand by gender were observed with more males accessing university places. Consequences of increased demand for university education included high workloads for lecturers, and congested facilities. These findings are important to educators, education planners, institution managers who are charged with devising mechanisms and processes that address issues of quality and equity in demand for university education.

Need of Standardization of Ayurveda Formulations

Standardization of herbal formulations is a process of setting some standard parameters which are essential for assuring the quality of the herbal formulations and it should be reproducible at any time of stability period of that formulations. Today many people all over the world experiencing the side effects of Modern medicine are shifting towards the traditional medical systems, among them most widely accepted is Ayurveda. Increased demand of herbal medicines, along with disparity in demand and supply of raw materials and profit mindedness of pharmaceutical agencies, has resulted substandard and unsafe products. The adulteration and substitution of drugs, methods of collection, storage and preservation of raw drugs, controversial opinions regarding formulations in classical text books, addition of preservatives and improper purification of toxic herbal and mineral drugs are the main problems that leading to the production of substandard and unsafe products. Authorities like WHO and Govt. of India has taken steps to standardize the individual drugs and formulations. Ministry of AYUSH have given the standard parameters for different types of preparations and few of the individual formulations are standardized in Ayurvedic pharmacopoeia of India. As the general population uses Ayurvedic medicines mainly as polyherbal formulations, standardization of each formulations is a need of hour for ensuring the quality medicines that leading to the global acceptance of Ayurveda.

Disparities in demand for COVID-19 hospital care in the United States: Insights from a longitudinal hierarchical study.

Background and aimsThis study examined disparities in hospitalization for COVID‐19 within the U.S. by racial and ethnic groups, health insurance status, and social support structure.MethodsUsing publicly available ecological case and contextual data from July 2020 to April 2021, a longitudinal hierarchical model for the 51 U.S. states was constructed.ResultsRacial/ethnic disparities were observed, such as that hospitalization rates were higher in states with a higher percentage of Black (β = .002, P = .009) and American Indian or Alaska Native persons (β = .003, P = .03). Conversely, lack of health insurance was related to a lower hospitalization rate (β = −.005, P = .002), and so was a stronger social support system (β = −.015, P = .05).ConclusionThese differences suggest disparities in COVID‐19 incidence, symptom severity, and demand for hospital care. Understanding how they contribute to geographic differences in hospitalization can help guide public health decisions and resource allocation to address COVID‐19‐related health inequalities.

Analyse comparative des inégalités d’utilisation des services prénatals entre 2004 et 2011 au Cameroun

Maternal mortality in Cameroon is worrying when it is compared to general mortality statistics. The maternal mortality ratio increased from 669 in 2004 against 782 in 2011, an increase of almost 17%. The 2004 and 2011 Demographic and Health Surveys (DHS) also showed that the systematization of antenatal care consultations and the reduction of disparities in the utilization of prenatal health services have an important role in reducing maternal mortality. This study attempts to understand the dynamics of inequalities linked to the demand for antenatal care as well as its determinants between 2004 and 2011. The mother, child and of the newborn health data from the 2004 DHS and 2011 have been used. The design of these two surveys was an area sampling, the two-stage sampling. The target population for this study was women of reproductive age [15-49years of age] who had had at least one live birth in the five years preceding the survey. In order to solve the problem, the concentration curve method, a multiple component analysis and a multilevel analysis were used. The study showed that disparities in demand for antenatal services did exist in 2004 and 2011. However, the level of these disparities remained the same during the two reference periods. In addition, the determinants of these disparities are theregion of residence, the level of education of the woman andthe level of education of the husband, the level of well-being of the woman and the sex of the household head. This study shows that the structure has not changed in terms of factors influencing these disparities but, the way in which this influence is operationalized is different between the year 2004 and the year 2011.

Demand for Family Planning Satisfied With Modern Methods in Urban Malawi: CHAID Analysis to Identify Predictors and Women Underserved With Family Planning Services.

Introduction: Family planning progress under the SDGs is measured with a novel indicator, demand for family planning satisfied with modern methods (mDFPS), which provides a better indication of modern contraceptive coverage than unmet need and contraceptive prevalence rate. Yet, few studies have examined the predictors of mDFPS and the sub-groups of women with unsatisfied mDFPS in urban Saharan Africa. The objective of this study was to examine the predictors of mDFPS in urban Malawi and to identify the sub-groups of urban women underserved with modern contraceptives.Methods: The study analysed data from the 2015–16 Malawi Demographic and Health survey. The sample was comprised of 2,917 women in urban Malawi who had a demand for family planning services. We used a Chi-square (χ2) Automatic Interaction Detector (CHAID) model to address the study objectives.Results: The results show that the number of living children a woman had was the most significant predictor of mDFPS. Women with one or more children, who were of Chewa, Lomwe, or Tumbuka ethnic origin and who resided in the central region had the highest mDFPS (87%). On the other hand, women with no children, and who were not exposed to FP information on television, had the lowest mDFPS (41%). Among women in union, ethnicity was the best predictor of mDFPS. Ngoni, Yao, and other ethnic minority women in union who were aged 15–19 and 40 years and above and those who were Catholic, SDA/Baptist, or Muslim had the lowest mDFPS (36%).Conclusion: This study demonstrates significant intra-urban disparities in demand for FP satisfied with modern contraceptives in Malawi. There is a need for policymakers and reproductive health practitioners to recognise these disparities and to prioritise the underserved groups identified in this study.

Rice Bran Oil- A Silver Lining to Indian Edible Oil Economy: A Review

Edible oil is an integral part of everyday cooking, due to remarkable gain in vegetable oil consumption in India over the past few decades. Accomplishing edible oil requirement of the ever-growing population is a formidable task before the country. On the contrary, annual compound growth rate of major edible oilseeds in India is declining. This phenomenal disparity in demand and supply of vegetable oil in the country is tending to bother through profuse investment on overseas purchase. At this point of time, in order to meet on-growing demand of edible oil, rice bran oil can be the available option before the country. India being the major producer of rice, yields significant amount of bran which contain upto 24% edible grade superior quality vegetable oil. It essentially contains 48.48% oleic acid, 35.26% linoleic acid, 14.54% palmitic acid, 8.15% free fatty acid besides contain good number of antioxidants such as tocopherols, tocotrienols and oryzanol. Therefore, rice bran oil became the integral part of oil market in India and abroad. Inspite of its benefits, it has not been fully exploited. If its potentiality is harnessed completely, rice bran oil could emerge as silver lining of Indian edible oil economy.

Need based approach: a perspective for sustainable housing

Population growth and urbanisation have been causing tremendous stress on urban housing. Over the years, housing construction has emerged as an industry and became a major contributor to pollution, environmental issues and resource depletion. There is a threat of exhausting resources with respect to housing construction. A quick glance at the housing scenario, it can be observed that there is a huge disparity in demand and supply of housing, which is more evident across the less affordable classes of society. While there is shortage in supply for the urban poor, there is over utilisation of resources to satisfy the requirements of those who could spend beyond their affordability confines. This need to be addressed with respect to the resource allocation and such an attempt requires an understanding of human requirement for housing beyond the basic desires and needs. Various studies in social science and economics have put forward theories to explain the human needs, which can be found useful in understanding the housing needs also. This paper attempts to understand such theories and frameworks on human needs and develop a sustainable approach to refine the housing requirements across different socio cultural and economic categories. Based on the studies, a broad framework is proposed categorizing human housing needs into normative, comparative, felt and expressed which can be analysed based on personal economic and socio cultural attributes. Such a framework shall help the society address the conditions of imbalance in a broader standpoint with long-term benefits.

Gaps between supply and demand of acute myocardial infarction treatment in Mexico.

To analyze acute myocardial infarction (AMI) admissions and in-hospital mortality rates and evaluate the competence of the Ministry of Health (MOH) hospitals to provide AMI treatment. We used a mixed-methods approach: 1) Joinpoint analysis of hos-pitalizations and in-hospital mortality trends between 2005 and 2017; 2) a nation-wide cross-sectional MOH hospital survey. AMI hospitalizations are increasing among men and patients aged >60 years; women have higher mortal-ity rates. The survey included 527 hospitals (2nd level =471; 3rdlevel =56). We identified insufficient competence to diagnose AMI (2nd level 37%, 3rd level 51%), perform pharmacological perfusion (2nd level 8.7%, 3rd level 26.8%), and mechanical reperfusion (2nd level 2.8%, 3rd level 17.9%). There are wide disparities in demand, supply, and health outcomes of AMI in Mexico. It is advisable to build up the competence with gender and age perspectives in order to di-agnose and manage AMI and reduce AMI mortality effectively.

Regional Disparities in Demand for Education: A Microeconometric Analysis for Pakistan

Regional Disparities in Demand for Education: A Microeconometric Analysis for Pakistan

Evaluation of the Intensive Care Unit Resources and Utilization in Two Governmental Hospitals in Tripoli, Libya

The growing population in Tripoli is projected to have a sustained increase in the demand for health services, especially in-service areas with limited resources such as intensive care units (ICUs). Currently, ICUs in the city of Tripoli routinely operate at or near full capacity and have a limited ability to accommodate the next critically ill patient. This disparity in demand and supply makes a substantial strain on our health care system. In response to this rising problem, the current study aimed to investigate the ICU capacity in the two largest hospitals in Tripoli, Libya. This is a retrospective observational study that conducted to compare ICU capacities and admission in the Medical intensive care unit (MICU) and surgical intensive care unit (SICU) of Tripoli Medical center (TMC) and Alkhadra hospital (AH) in Tripoli city of Libya. ICUs capacity and admissions were assessed and recorded in data collection sheet that includes; type of ICU, number of available ICU beds, number of available functional monitors, number of available functional mechanical ventilators, number of patients admitted to the ICU, and number of ICU nurse. In TMC, MICU occupied with 4 beds, 4 monitors, 3 mechanical ventilators (MV), 5 patients admitted, and 13 nurses. Whereas SICU engaged with 4 beds, 5 monitors, 5 MV, 13 patients admitted and 15 nurses. While MICU at AHT was occupied with 4 beds, 4 monitors, 1 MV, and 4 admitted patients with 1 nurse care, SICU at CHT was comprised of 3 beds, 3 monitors, 0 MV, and 3 patients with 1 nurse stuff. We concluded that facilities at both MICU and SICU at Alkhadra hospital of Tripoli were less efficient than MICU and SICU at Tripoli Medical centre. Both ICUs at AHT had not enough beds, observation equipment, and nursing staff to take care of patients. However, facilities of both ICUs at TMC were also not sufficient.

Closing the Poor-Rich Gap in Contraceptive Use in Rwanda: Understanding the Underlying Mechanisms.

Evidence suggests that as Rwanda has strengthened its family planning program, disparities in contraceptive use by socioeconomic status have narrowed. However, the changes in these gaps, and the mechanisms that underlie them, are not well understood. Data from the 2005, 2010 and 2015 Rwanda Demographic and Health Surveys on 19,028 in-union women aged 15-49 were analyzed to examine trends in socioeconomic disparities in contraceptive use. Descriptive statistics and multivariate regression with interaction terms were used to identify changes in these disparities, as well as to describe trends in desired fertility, and in types and sources of contraceptives used. Between 2005 and 2015, the prevalence of modern contraceptive use rose from 11% to 48%. In the regression analysis, interaction terms indicated that prevalence increased to a lesser extent among women who were wealthy, had a least a secondary education or lived in urban areas than among those who were poor, were uneducated or lived in rural areas (odds ratios, 0.5-0.7). In parallel, declines in desired fertility were greater among women with no education than among those with at least a secondary education (by 0.7 vs. 0.5 children); among the poorest than the richest women (by 1.0 vs. 0.5 children); and among rural than urban residents (by 0.9 vs. 0.4 children). The shrinking of gaps in contraceptive use by socioeconomic status coincided with narrowing of disparities in demand for children and with improvements in family planning services, suggesting that disadvantaged populations may have especially benefited from public programs to increase contraceptive access.

Assessing Urban and Rural Infrastructure Development in Agrarian India Towards Sustainability Planning and Management

India a largely agrarian economy has got majority of population in rural area. It is now transforming to industrial and service economy. As in most countries, India’s towns and cities also make a major contribution to the country’s economy. With less than 1/3rd of India’s people, its urban areas generate over 2/3rd of the country’s GDP and account for 90% of government revenues. This probably is the outcome of Urbanization in India which is expanding rapidly as better as increasing numbers of people migrate to towns and cities in search of privileged social and economic services such as education, health care, sanitation, housing, transportation and business opportunities when compared with rural infrastructure services in India. It marks disparity in demand and supply of urban infrastructure and difficulty in management of infrastructure as a development resource. Distribution of socio economic activities in urban and rural India proportionately may result in terms of balance in infrastructure development planning and management in India. The paper marks the discussion for assessment of Urban and Rural Infrastructure development in context of agrarian India towards sustainability planning and management.

A simplified ground thermal response model for analyzing solar-assisted ground source heat pump systems

Ground source heat pump systems that are installed in areas with heating or cooling dominant seasons, or in buildings with utilization characteristics that lead to a disparity in demand, often encounter challenges related to ground thermal imbalance. This imbalance can lead to long-term ground temperature changes and may cause premature system failure. This paper focuses on combining a ground source heat pump system with a solar thermal array, with the goal of eliminating the effect of ground thermal imbalance, and minimizing system lifetime cost. A thermal mass ground heat transfer model is combined with a time-stepping model to analyze the system for a variety of solar array sizes. The details associated with this modelling technique are presented, and case studies are provided to illustrate the results of the calculations for three different buildings. It is shown that increasing the solar array size can offset ground thermal imbalances, but increasing the array size also results in a larger initial system cost. An economic analysis is then carried out to determine the system lifetime cost as a function of this solar array size, and an optimal array size from an economic perspective was found. The result of the study shows that hybridizing a ground source heat pump system with a solar array produces a viable system from a technical and economic standpoint, can be used to avoid premature system failure, and can reduce system lifetime cost.

Comparative Analysis of Disparity in Demand for Fresh Fish between Rural and Urban Households in Cameroon

The past decades have exhibited changes in the consumption of fresh fish. In developing countries, factors affecting fish consumption are different between urban and rural households. This study comparatively analyses the disparity in demand for fresh fish between rural and urban households in Cameroon. Using random sampling, data on the weekly consumption of fresh fish were collected between April and May 2015; 30 households lived in rural localities while 30 lived in urban areas of Buea Municipality. Consumer’s income, the price of fresh fish, family size, gender and age of consumers represented parameters of interest. These were analyzed using the independent sample t-test. Results revealed that the availability, the income level and price affected fish consumption of rural dwellers while price, taste, income and affordability determined the consumption patterns of urban dwellers. The study equally revealed that the higher the price of fresh fish, the higher the demand for its closed substitutes and the higher the size of the household, the higher the quantity demanded. Gender, education and marital status did not affect the quantity demanded; family size and age negatively influenced consumers’ decision to buy while consumers’ income and price of fresh fish positively influenced consumers’ weekly and monthly expenditure on fresh fish. The study proposes that more information be provided to consumers regarding the numerous nutritional benefits of fresh fish for both rural and urban dwellers. Also, policy makers and marketers need to improve the availability of fresh fish in rural and semi-urban settings.

The evolution of the board interlock network following Sarbanes-Oxley

We examine the impact of the passage of Sarbanes-Oxley (SOX) on the evolution of the board interlock network for Fortune 300 firms during the 1998–2006 period using a stochastic actor-oriented model. Placing particular emphasis on director accountability and board independence, SOX created considerable disparity in demand and supply in the labor market for corporate directors. We examine whether the regulatory change may have led firms to draw more on socially embedded processes of board interlock partner selection such as reciprocity, transitivity, and multiplexity after SOX. We find that after the passage of SOX, a firm’s tendency to reciprocate board interlock ties has been reinforced. Similarly, firms appear to have relied more on their existing alliance partners to fill their board seats in the post-SOX period.

Orthotopic heart transplantation with concurrent aortic valve replacement and coronary artery bypass grafting

We report a case of successful orthotopic heart transplantation of a donor heart with normal ventricular function, 2-vessel coronary artery disease, and a bicuspid aortic valve, which required concurrent aortic valve replacement and coronary artery bypass grafting. In confronting the disparities in demand and supply, we must consider the so-called marginally acceptable heart for either critically ill recipients or those who may be disadvantaged on the waiting list.

Socio-economic deprivation and admission rates to secure forensic psychiatry services

Annual admission rates from the North-East Thames Region to maximum- and medium-secure forensic psychiatry services demonstrated a highly significant correlation with social deprivation measured at district health authority level using the Jarman UPA 8. There were specific associations with the number of unemployed persons, overcrowded households, and persons from ethnic minorities in the districts studied. There was a 10-fold difference in treated prevalence rates across the region, indicating that certain purchasing authorities may be seriously underfunded to meet the needs of their catchment area populations for secure forensic psychiatry services. Further research is required into the nature of the association between admissions to these services and social deprivation. It is readily apparent that a new formula is required for the allocation of resources in the face of such wide disparities in demand from different geographical locations.