Inequitable Provision Research Articles

When I say inclusion in health professions education

There is no unified understanding of the concept of inclusion in the literature. Because of the growing reports of exclusion and marginalization in HPE, and the reports of inequitable health provision in global health, inclusion is currently a widely discussed topic in Health Professions Education (HPE) as well as global health. In this article I explore the concept of inclusion based on the current literature, mainly from the psychological aspect. When I say inclusion, it is not just a sense of belonging, but also the opportunity to participate and contribute meaningfully.

Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives.

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Victoria, Australia. Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Who Does the Public Blame for Inequities in Public Service Provision? Examining the Effect of Contracting and Cost Information in a Survey Experiment

Research assessing blame attribution in third-party governance views public service performance as a function of efficiency and effectiveness but overlooks equity. We address this gap in the literature by asking two questions: (1) Does contracting out lessen the blame assigned to the government for inequitable service provision? and (2) Is the public less critical of inequitable service provision when told it results in greater efficiency? To answer these questions, a survey experiment was conducted using a representative sample of United States residents (n = 1034). The results show that, while the government still bears responsibility for inequitable service provision, contracting out diminishes some of the responsibility placed on the government, shifting it toward the contractor instead. In addition, citizens’ blame attribution patterns do not change when told inequitable service provision results from efforts to improve efficiency, which suggests that the public does not excuse inequitable service provision even when told it saves money. The findings of this study contribute to the understanding of blame dynamics in third-party governance and bring implications to democratic accountability.

Overlooked by the obstetric gaze – how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study

BackgroundDuring the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.MethodsIn this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 – February 2022. The data was analysed using inductive qualitative content analysis.ResultsOur results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women’s difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a ‘key person’ in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.ConclusionsOur study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

The Changing Trend of Primary Medical Care in China From The Perspective of Urban and Rural Areas

As one of the most populous countries in the world, China has consistently grappled with the challenge of uneven distribution and inequitable provision of medical resources between urban and rural areas. Urban regions boast a greater number of medical facilities and healthcare professionals compared to their rural counterparts, exacerbating the issue of insufficient medical resources and inadequate services in rural areas. This disparity not only impacts the health status of rural residents but also perpetuates social inequality between urban and rural communities. With China's ongoing process of urbanization, these disparities in healthcare have become increasingly pronounced. The objective of this study is to examine the evolving trends in China's primary healthcare system from an urban-rural perspective, aiming to gain a better understanding of how medical resources are distributed, access to healthcare services is facilitated, and disparities in medical consumption persist between urban and rural areas. The findings from this study yield several crucial recommendations: Firstly, it is imperative to prioritize enhancing the establishment of primary healthcare facilities in rural areas by significantly increasing both the quantity and quality standards for medical institutions while improving bed availability to meet the pressing needs for adequate healthcare among rural residents. Secondly, measures should be implemented to bridge the gap in distribution between health workers serving urban versus rural populations by incentivizing more professionals to engage in medical work within undeserved regions to ensure timely access for all individuals residing outside major cities. Additionally, both government entities and society at large should encourage increased investment by rural residents into their expenditure on healthcare while simultaneously improving overall levels of medical security coverage as a means of alleviating financial distress. Finally, it is imperative to adapt and optimize the rural industrial structure following the specific circumstances of different regions, thereby enhancing the income of rural residents and augmenting their capacity to allocate resources towards medical and healthcare expenditures.

Exploring the perspectives of underrepresented voices: Perceptions and experiences of uterine cancer for black African, Caribbean, black British, and mixed-black women in the UK to develop strategies for early symptom presentation

ObjectivesThe uterine cancer (UC) mortality rate in the UK is significantly higher for women who belong to a Black ethnic group compared to those from other ethnic groups. This study aimed to understand the views and experiences of UC amongst Black ethnic minority women in the UK, with a focus on awareness and presentation of red-flag symptoms. MethodsWomen of Black African, Caribbean, Black British and Mixed-Black ethnicity were purposefully recruited to participate in focus groups and individual semi-structured interviews. ResultsTwenty women from different regions in England participated in the study. Reflexive thematic analysis of the data led to the identification of three main themes: 1) Healthcare inequities; 2) Support and sense making with other Black women; and 3) Knowledge dissemination, mobilisation, and empowerment. Perceptions of inequitable healthcare provision and distrust influenced how participants, and their peer networks, approached seeking assistance from healthcare professionals. Concerns were also raised about culturally insensitive information resources, including issues of language, literacy, and representation, all of which served as potential barriers for women within Black ethnic minority groups. ConclusionsThe deficiency of targeted knowledge mobilisation and specific UC information aimed at Black ethnicity women living in the UK, reportedly contributes to the dissemination of misconceptions and an atmosphere of apprehension around a UC diagnosis. The insights from this study highlight the significance of designing culturally sensitive strategies to promote informed decision-making and empower the dissemination of accurate health knowledge amongst Black women.

Evaluation of variation in special educational needs provision and its impact on health and education using administrative records for England: umbrella protocol for a mixed-methods research programme

IntroductionOne-third of children in England have special educational needs (SEN) provision recorded during their school career. The proportion of children with SEN provision varies between schools and demographic groups, which...

Women’s contested mobility and equity in Indian urban environment: case of public toilets in Pune, Maharashtra

ABSTRACT Public toilet facilities in an urban setting are an essential infrastructure that guarantees every citizen’s right to sanitation in the public realm. This paper contends on the fragility of urban infrastructure in addressing women’s needs focusing on public toilet facilities in Indian cities. We argue that the deficit and inequitable provision of urban public toilets in Indian cities restricts women’s participation in the public realm and perpetuates social inequality, with Pune, India, as the case. The spatial features of 124 public toilet facilities in 15 wards were examined in light of gender-responsive guidelines under the Swachha Bharat Mission. Various contextual, psychosocial, and technological factors influencing toilet use behavior were identified with semi-structured in-depth interviews with 45 women in three different life stages using the Integrated Behavioural Model for Water, Sanitation, and Hygiene. The analysis provided a nuanced understanding of various spatial and psychosocial aspects governing women’s public toilet use in Pune. Analysis showed that various initiatives for improving sanitation adopted an androcentric vision in designing public toilets discounting women’s equitable participation in the public realm. The finding delineates a spatial paradigm on providing inclusive public toilets contributing to women’s mobility and equity in the Indian urban environment.

Be the Solution: How Anesthesiologists Can Address Health Equity and Show Leadership to the C-Suite

Article| June 2023 Be the Solution: How Anesthesiologists Can Address Health Equity and Show Leadership to the C-Suite Sunil Eappen, MD, MBA Sunil Eappen, MD, MBA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2023, Vol. 87, 1–8. https://doi.org/10.1097/01.ASM.0000938776.16244.db Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Sunil Eappen; Be the Solution: How Anesthesiologists Can Address Health Equity and Show Leadership to the C-Suite. ASA Monitor 2023; 87:1–8 doi: https://doi.org/10.1097/01.ASM.0000938776.16244.db Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: health equity, leadership Addressing health equity is a top priority for many, if not all, health care systems. Anesthesiologists can have a powerful leadership role in addressing this complex issue. ASA's Be the Solution: Sell Your C-Suite on the Value and Leadership of Anesthesiologists program features guidance and resources on this critical issue that you can share with your health care executives (asamonitor.pub/3ybWw4A). This involves detailing your leadership throughout the perioperative process, including managing surgical patients with high comorbidities and developing pathways that improve care for all patients. But have you considered the broader role you can have in the equity equation? Anesthesiologists can be instrumental by ensuring and valuing a diverse workforce, using interpreter services appropriately, tackling the inequitable provision of epidurals and pain medication, and addressing the much higher maternal mortality among Black women, for example. To resolve these issues and overcome these hurdles, anesthesiologists – and all health... You do not currently have access to this content.

Impact of the COVID-19 pandemic on perceived access and quality of care in German people with parkinsonism.

Due to the heterogeneous clinical presentation, people with Parkinsonism (PwP) develop individual healthcare needs as their disease progresses. However, because of limited health resources during the COVID-19 pandemic, many patients were put at risk of inadequate care. All this occurred in the context of inequitable healthcare provision within societies, especially for such vulnerable populations. This study aimed to investigate factors influencing satisfaction and unmet need for healthcare among PwP during the COVID-19 pandemic in Germany. Analyses relied on an anonymous online survey with a 49-item questionnaire. We aimed at describing access to health services before and during the early stages of the pandemic. To this end, a generalized linear model was used to derive significant predictors and a stepwise regression to subsummarize the main factors of perceived inadequate care. In total, 551 questionnaires showed that satisfaction with Parkinsonism-related care decreased significantly during the pandemic (p < 0.001). In particular, factors such as lower educational level, lower perceived expertise of healthcare providers, less confidence in remote care, difficulties in obtaining healthcare, and restricted access to care before the pandemic but also lower densities of neurologists at residence and less ability to overcome barriers were indicative of higher odds to perceive unmet needs (p < 0.05). The results unveil obstacles contributing to reduced access to healthcare during the COVID-19 pandemic for PwP. These findings enable considerations for improved provision of healthcare services to PwP.

' Like I said about culture. You don't talk about mental health' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals.

There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP). A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame. Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.

Models of Care and Relationships with Care Homes: Cross-Sectional Survey of English General Practices.

The Enhanced Health in Care Homes framework for England sets out standards for how primary care should work with care homes. How care home staff and General Practitioners work together and the quality of their working relationships are core to resident healthcare. This study explored the current models of care and relationships between General Practitioners' practices and care homes. Sixty-seven respondents from 35 practices were recruited in the East of England and completed a semi-structured online survey. Responses were analysed using descriptive statistics. Free text responses were interpreted thematically. The number of care homes that practices supported ranged from 0-15. Most reported having designated General Practitioners working with care homes and a good working relationship. Despite the national rollout of the Enhanced Health in Care Homes framework, two-thirds reported no recent changes in how they worked with care homes. There is a shift towards practices working with fewer care homes and fewer accounts of fractured working relationships, suggesting that residents' access to primary care is improving. The continuing variability suggests further work is needed to ensure it is driven by context, not inequitable provision. Future work needs to address how policy changes are changing work practices and residents' health outcomes.

Right to the city and community facility planning for elderly: The case of urban renewal district in Hong Kong

The concept of right to the city has attracted increasing attention in urban planning area. However, many cities are far from providing equitable resources. The questions of what is, who has the right, and how it has been affected during urban renewal process have not been fully examined. Although access to public services is widely recognized as an important right, whether elderly’s right to community facilities in urban renewal district has been addressed sufficiently still remains questionable. This study builds a conceptual framework to understand the factors affecting elderly’s right to community facilities in an urban renewal district. Through focus group meetings held in three neighborhoods in Kwun Tong district and spatial analysis, elderly’s perception and the provision of community facilities were ascertained. The findings reveal how inequitable provision of community facilities, gentrification caused by transit-oriented development mode and insufficient mobility services have affected elderly’s right to access community facilities and deprived their rights. Urban renewal, as an important urban planning strategy, has not effectively remedied the inequality in access to public goods. The study recommends strategic planning policies to enhance equitable right to the city in the planning for building a more age-friendly community in urban renewal district.

Pakistan’s Health-Care System: A Case of Elite Capture

Pakistan currently ranks 154 out of 189 countries on the UNDP’s Human Development Index. In this paper, we use a ‘political settlements analysis’ to understand how the distribution of political, economic and social power explains this ranking and the inequity in Pakistan’s health system. We investigate elite power struggles over the last seven decades to explain how ad hoc policy-making, instability, patronage politics and rent-seeking have led to a maldistribution of resources, lack of oversight, and inequitable access and service provision for a burgeoning population. We argue that these factors have had two consequences: the privatisation of health care, and the opening up of a considerable sphere of influence to the donor community to direct state policy. Despite promising ongoing reform efforts, we conclude that Pakistan’s health system will remain hamstrung by the constraints of a political settlement in which elites with short-term horizons bargain for influence rather than developing an inclusive, consensus-based approach to improving governance outcomes for citizens.

Association of Demographic and Geospatial Factors With Treatment Selection for Laryngeal Cancer

Guidelines for many head and neck cancers, especially laryngeal cancers, allow for multiple treatment options. Currently, inequitable provision of surgery may contribute to outcome disparities. However, the role of geospatial factors remains understudied. To assess the association between US geospatial factors and treatment selection for patients with laryngeal cancer. In this retrospective cohort study, patients diagnosed with laryngeal squamous cell carcinoma between January 1, 2004, and December 31, 2014, were identified from the Surveillance, Epidemiology, and End Results database. Adjusted odds ratios (aORs) for surgical treatment were generated from multivariable, hierarchical models to assess associations with oncologic, demographic, and county variables. Outlier US counties with the highest and lowest aORs were described. Data analysis was performed from April 29 to September 11, 2020. County of residence. The aORs for surgical treatment were generated from multivariable, hierarchical models. Outlier counties with the highest and lowest aORs are described. The cohort includes 21 289 patients (mean [SD] age, 63.6 [11.2] years; 17 214 [80.9%] male) in 598 counties. Most counties had no otolaryngologist (365 [61.0%]) or radiation oncologist (434 [72.6%]). Surgery rates varied from 7.1% to 85.7% among counties with at least 10 cases. After oncologic variables were controlled for, factors independently associated with surgical treatment included patient age (aOR [95% CI], 0.94; 0.91-0.98 per 10 years), marital status (single versus married: aOR [95% CI], 0.87 [0.79-0.97]), and county social deprivation index (aOR [95% CI], 0.98 [0.97-1.00 per 5 points]) but not physician number (≥2 otolaryngologists: aOR [95% CI], 0.91 [0.75-1.11] vs ≥1 radiation oncologist: aOR [95% CI], 0.91; 0.75-1.11). The 5% of counties most likely to provide surgery (aOR, >1.23) were nearly all large metropolitan areas (2593 patients [93.3%]) and treated a disproportionately large number of patients (2778 [13.1%]). The 5% of counties least likely to provide surgery (aOR, <0.79) were also mostly large metropolitan areas (1676 patients [91.2%]) and treated a disproportionately large number of patients (1838 [8.6%]). Patients in counties least likely to provide surgery had inferior survival compared with those most likely to provide surgery (adjusted hazard ratio, 1.16; 95% CI, 1.00-1.35). These findings suggest that sociodemographic factors contribute to the wide variety in surgical treatment practices by county. The largest metropolitan counties were often outliers regarding their adjusted odds of surgical treatment. This finding is concerning for the counties least likely to provide surgery where survival is inferior.

Clinical practices of speech-language pathologists working with 12- to 16-year olds in Australia

Purpose: The current landscape of speech-language pathology (SLP) services for 12- to 16-year olds in Australia remains largely unchartered. Implementing the Speech Pathology 2030 vision necessitates mapping current services, and gaps in services, provided by speech-language pathologists (SLPs). However, the last survey of Australian SLPs’ practices with young people was conducted in 2005. The aim of this study was to bridge the service delivery information gap. Method: Ninety-six SLPs working with 12- to 16-year olds in Australia completed an anonymous online survey consisting of binary choice, multiple choice, and Likert scale questions. A theoretical approach to service delivery based on response to intervention models underpinned question design. Result: SLP clinical practices remain traditional, following an impairment/diagnostic model. Additionally, there is an inequitable provision of SLP services across states/territories of Australia, according to whether or not there is government provision for SLP services in public schools. Conclusion: The results suggest a need for standard government provision of SLP services across Australia to ensure equity of access. These findings inform our understanding of contemporary assessment and intervention practices of SLPs working with 12- to 16-year olds in Australia.

When Authenticity Goes Missing: How Monocultural Children’s Literature Is Silencing the Voices and Contributing to Invisibility of Children from Minority Backgrounds

The importance of recognising, valuing and respecting a child’s family, culture, language and values is central to socially just education and is increasingly articulated in educational policy worldwide. Inclusive children’s literature can support children’s human rights and contribute to equitable and socially just outcomes for all children. However, evidence suggests many educational settings provide monocultural book collections which are counterproductive to principles of diversity and social justice. Further, that educators’ understandings and beliefs about diversity can contribute to inequitable provision and use of diverse books and to inequitable outcomes of book sharing for many children. This paper reports on a larger study investigating factors and relationships influencing the use of children’s literature to support principles of cultural diversity in the kindergarten rooms of long day care centres. The study was conducted within an ontological perspective of constructivism and an epistemological perspective of interpretivism informed by sociocultural theory. A mixed methods approach was adopted, and convergent design was employed interpret significant relationships and their meanings. Twenty-four educators and 110 children from four long day care centres in Western Australia participated. Data were collected through semi-structured interviews, video-based observations, field notes, document analysis and a book audit. This study firstly identified that current book collections in kindergarten rooms of long day care centres promote mono-cultural viewpoints and ‘othering’ of minority groups through limited access to books portraying inclusive and authentic cultural diversity. Secondly, that educators had limited understandings of the role of literature in acknowledging and valuing diversity and rarely used it to promote principles of diversity, resulting in a practice of “othering” those from minority group backgrounds. The key challenges which emerged from the study concerned beliefs, understanding and confidence of educators about diversity and inclusion, and the impact of these on their approaches to promoting principles of diversity through the use of children’s books. This research contributes to discussion on the value of children’s literature in achieving international principles of diversity. These findings have important social justice implications. The outcomes of this study have implications for educators, policy makers, early childhood organisations and those providing higher education and training for early childhood educators.

COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper.

BackgroundThe COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future.AimsTo discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership.Methods & ProceduresThe relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors.Main ContributionThe main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge.Conclusions & ImplicationsThe immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper addsWhat is already known on the subject ENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high‐risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID‐19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research. What this paper adds to existing knowledge This study provides a discussion of the threats and opportunities from the COVID‐19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership. What are the potential or actual clinical implications of this work? The COVID‐19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post‐COVID era.

Charity Density and Social Need: A Longitudinal Perspective

The distribution of charitable organizations in an equitable and socially just manner is a long-standing policy concern in the United Kingdom and many other jurisdictions. Geographic variations are important as they are linked to potentially inequitable service provision and opportunities for participation in voluntary activities. This study links large-scale administrative data on charities registered in England and Wales with local authority-level measures of material deprivation for 5 U.K. census years (1971–2011). Count and spatial regression models show evidence of nonlinear associations between charity density and social need, and changes in the shape of this distribution over time. In general, charity density is highest in the least deprived local authorities but this varies across different types of organizations and census years. These results provide important new insights into the evolving relationship between charity density and social need, and demonstrate the value of adopting more advanced, longitudinal statistical approaches for studying this phenomenon.

Regional analysis of UK primary care prescribing and adult service referrals for young people with attention-deficit hyperactivity disorder.

Approximately 20% of children with attention-deficit hyperactivity disorder (ADHD) experience clinical levels of impairment into adulthood. In the UK, there is a sharp reduction in ADHD drug prescribing over the period of transition from child to adult services, which is higher than expected given estimates of ADHD persistence, and may be linked to difficulties in accessing adult services. Little is currently known about geographical variations in prescribing and how this may relate to service access. To analyse geographic variations in primary care prescribing of ADHD medications over the transition period (age 16-19 years) and adult mental health service (AMHS) referrals, and illustrate their relationship with UK adult ADHD service locations. Using a Clinical Practice Research Datalink cohort of people with an ADHD diagnosis aged 10-20 in 2005 (study period 2005-2013; n = 9390, 99% diagnosed <18 years), regional data on ADHD prescribing over the transition period and AMHS referrals, were mapped against adult ADHD services identified in a linked mapping study. Differences were found by region in the mean age at cessation of ADHD prescribing, range 15.8-17.4 years (P<0.001), as well as in referral rates to AMHSs, range 4-21% (P<0.001). There was no obvious relationship between service provision and prescribing variation. Clear regional differences were found in primary care prescribing over the transition period and in referrals to AMHSs. Taken together with service mapping, this suggests inequitable provision and is important information for those who commission and deliver services for adults with ADHD.