Intra-country Differences Research Articles

Cross-sectional HIV and HCV cascades of care across the regions of Ukraine between 2019 and 2020: findings from the CARE cohort.

Eastern Europe is facing major HIV and hepatitis C (HCV) epidemics, with many people living with HIV (PLHIV) and HIV/HCV coinfection living in Ukraine. Despite the previous progress towards care quality improvement, the ongoing war in Ukraine is disrupting HIV and HCV care. We described an HIV cascade of care (CoC) in PLHIV from two clinical sites and an HCV CoC for anti-HCV-positive PLHIV from six sites in Ukraine, enrolled in the CARE cohort between 1 January 2019 and 1 June 2020. The cross-sectional HIV CoC and HCV CoC are described at study enrolment. Of 1028 PLHIV, 1014 (98.6%, 95% confidence interval [CI] 97.7-99.3) were on antiretroviral therapy (ART), and 876 (86.4% of those on ART, 95% CI 84.1-88.4) were virologically suppressed. Of 894 participants on ART >6 months, 90.8% (95% CI 88.7-92.6) were virologically suppressed (HIV-RNA <200 copies/ml). Of 2040 anti-HCV-positive PLHIV, 417 (20.4%, 95% CI 18.7-22.3) were ever tested for HCV-RNA prior to enrolment, ranging from 4.9% to 54.4% across sites, and 13.5% were currently HCV-RNA positive. One hundred and eighteen persons (7.3% of ever chronically infected) had received HCV treatment, and 25 persons (1.6% of ever chronically infected) were cured, with variations across sites (0%-7.5%). The site diagnosing 54.4% of people with chronic HCV was the only one providing free RNA testing for all anti-HCV-positive persons, while the intra-country differences in treatment coverage were driven by the number of available direct-acting antiviral (DAA) courses. Over 98% of PLHIV in care in both CARE sites in Ukraine were receiving ART, and the target of 90% virally suppressed was achieved in persons >6 months on ART. Only one of six HIV/HCV study sites tested over 50% anti-HCV-positive PLHIV for HCV-RNA and treated over 25% of eligible persons. While free HCV-RNA testing and DAA treatment are paramount to achieving HCV elimination targets, they remained a challenge in Ukraine in 2019-2020. The extent of the HIV and HCV care disruption during the war will be further assessed in the CARE cohort and compared with the pre-war findings.

Challenges in family policy research

In the third millennium, family policies have become the most dynamic part of welfare state policies in developed countries and the forerunners of welfare state development in developing countries. They remain, however, an important dimension of social policy diversification, among both developed and developing countries. Degree and patterns of overall welfare state development, labour market conditions, demographic characteristics, family and gender cultures, political legacies and political cultures – all these factors contribute to shaping which and how family issues are framed as policy-relevant issues. The author addresses some of the research challenges that lie ahead in family policy research, namely: (1) the conceptual and methodological challenges deriving from the enlargement of research, both national and comparative, across an increasingly diversified spectrum of countries; (2) the dual challenge of the diversification of family forms and of international mobility; (3) the interaction between the labour market and family policies and their impact on social class differences; (4) the differential impact of social policies across the social spectrum and diversified family forms; and (5) the multilevel making and governance of family policies and the impact on intra-country differences. According to the author, these challenges are also the consequence of the intersectional character of family policies.

Institutional Distance versus Intra-Country Differences: Capturing and Leveraging the Diversity Within

The field of international business (IB) largely focuses on the inter-country institutional differences, however, very little focus and attention have been given to the social interactions of sub-cultural groups within the country. Could we be overlooking greater opportunities for understanding differences across the diversity within countries? This article aims to provide insights and practical suggestions on: (1) How does leveraging intra-country diversity affect firm performance outcomes globally? (2) Why understanding intra-country diversity is important to the field of IB? and (3) How can IB scholars, managers, and educators engage further as a discipline to explore strategies that achieve more diverse and equitable societal and economic outcomes?

Intercountry and intracountry variations in opinions of palliative care specialist physicians in Germany, Italy, Japan and UK about continuous use of sedatives: an international cross-sectional survey

ObjectivesTo explore intercountry and intracountry differences in physician opinions about continuous use of sedatives (CUS), and factors associated with their approval of CUS.SettingsSecondary analysis of a questionnaire study.ParticipantsPalliative care physicians...

Kurtosis-based projection pursuit analysis to evaluate South American rapadura

Rapadura is an artisanal candy obtained from concentrated sugarcane juice. In this study, a differentiation between South American rapadura producers has been tried using a Kurtosis-based projection pursuit analysis (kPPA) concerning essential minerals, acrylamide, moisture contents, pH, and color. These parameters revealed significant inter- and intra-country differences. Based on the employed measurements, a multivariate exploration with kPPA extracted information from rapadura even though it is a very artisanal product and was effective in separating classes, especially Brazilian and Ecuadorian rapadura, where principal component analysis failed. Moreover, ellipse confidence regions showed significant differences between non-organic and organic rapadura from Colombia and Peru in granulated form. From a chemometric point of view, the application of kPPA can be used in cases when other metrics (as based on the variance) fail and can be useful in the exploratory analysis of complex multivariate chemical data.

Society and territory: making sense of Italian populism from a historical perspective

ABSTRACT Italy is depicted as a populist promised land. Especially within Western Europe, Italy is an outlier in terms of support for and varieties of populist parties. Yet, common explanations of populism do not fully account for the Italian exceptionality, while single-country studies often present time-wise limited focus or anecdotical evidence. This article contributes by providing a novel interpretation of Italian populism since 1945 through a three-step process. First, the Italian populist success is theoretically linked to societal anti-parliamentarism and anti-elitism, whose roots date back to the formation of the unitary state and its institutional weakness. Second, it is argued that traditional intra-country differences in terms of voting behavior still matter when it comes to providing the opportunity structure for populist parties. Finally, a preliminary empirical analysis shows that – in line with expectations – different political traditions across the national territory are likely to determine the success of specific types of populism. The findings are relevant for the generation of new hypotheses about the societal origins of contemporary populist parties.

Integrating general and local context-dependent factors into a framework for analysing business sectors in Bottom-of-the-Pyramid emerging markets

Abstract: &#x0D; Aim: This paper investigates how a framework for analysing business sectors in emerging markets looks like when taking into account the local context-dependent and general factors of The Bottom-of-the-Pyramid (BoP). The BoP segment in emerging markets represents a major growth potential for firms, including multinational enterprises (MNEs) from developed countries. However, the continued lack of success of MNEs in these markets has shown that generic one-size-fits-all strategies for the BoP are not appropriate as BoP contexts differ between countries.&#x0D; Design / Research methods: The sample that was selected for the research includes two non-governmental organizations (NGOs) related to the BoP and eight managers at MNEs with activities in the BoP have been interviewed in a semi-structured manner to collect rich data.&#x0D; Conclusion / findings: By interviewing eight managers at MNEs with activities in the BoP and two NGOs related to the BoP, an additional analysis, BoP-orientation, and further extensions to the original analyses are being presented. This results in an advanced framework for analysing business sectors in emerging markets.&#x0D; Originality / value of the article: Current frameworks for analysing business sectors in emerging markets do take into account inter-country differences but fail to recognize intra-country differences, which causes them to fall short on their applicability to the BoP. This paper fills the gap how frameworks for analysing business sectors in emerging markets can be made applicable for the BoP by taking into account both the local context-dependent and general factors of a BoP-market to analyse it for opportunities, threats, and eventually and strategic entry mode.

Ethnic-Based Cultural Differences: Study of Lithuania's Russian Minority

Cultural orientation is conceptualized as a moderator variable of behavior. People of different ethnic groups possess cultural orientations different from those of the majority. Assuming cultural homogene-ity across all people of a given nation-state may lead to neglecting the potentially multi-layered nature of national cultural values. Cultural differences offer guidelines to equip oneself better in personal communication (Yi 2021). This study examines the cultural value orientations of Lithuania’s Russian diaspora, who in 2015 made up of 4.8% national average. The research question was concerned with characteristics of value orientations concerning four dimensions of Hofstede’s cultural value orientation. A total of 193 respon-dents of the target group completed the adopted Yoo, Donthu, and Lenartowicz’s (2011) questionnaire CVSCALE. The study explored ethnic-based intra-country cultural differences and similarities providing a greater understanding of the societal differences in value orientations.

Connections Between Cultures: Using Empirical Distributions for Measuring Cultural Differences

The past few decades have seen an explosion in the interest in cultural differences and their impact on many aspects of business management. A noticeable feature of most academic studies and practitioner approaches is the predominant use of national boundaries and group-level averages as delimiters and proxies for culture. However, this largely ignores the significance that intra-country differences and cross-country similarities can have for identifying psychological phenomena. This article argues for the importance of considering intra-cultural variation for establishing connections between two different cultures. It uses empirical distributions of cultural values that occur naturally within a country, thereby making intracultural differences interpretable and actionable. For measuring cross-country differences, the Gini/Weitzman overlapping index and the Kullback-Leibler divergence coefficient are used as difference measures between two distributions. The properties of these measures in comparison to traditional group-level mean-based distance measures are analyzed, and implications for cross-cultural and international business research are discussed.

Child welfare removal of infants: Exploring policies and principles for decision-making in Nordic countries

This descriptive policy analysis examines the position of infants’ rights in the family service orientated child welfare systems of Denmark, Finland, Norway and Sweden when being placed in out-of-home care. Its focus is on the contexts of, and legal procedures for, removing babies from home into public care. Children under the age of one year are taken into public care mainly through voluntary and emergency measures. Analysis of the development over a decade displays big intra-country differences in the prevalence of infant removal, varying from 2 per 1000 to 8 per 1000. The scant prevalence of public policy, practice guidelines and research indicates that infant removal is in some ways an anomaly, an unspoken leaf in the Nordic child welfare systems, whereas the Nordic welfare states otherwise extensively support families with young children through universal interventions. The findings invite to a re-examination of the rights of infants and their specific needs in the welfare states in order to establish responsive and efficient child protection systems.

Prostate cancer in Asia: design of a patient registry to inform real-world treatments, outcomes, and quality of life.

BackgroundThe incidence of prostate cancer (PC) in Asian countries is increasing for reasons that are not clear. Data describing how PC is diagnosed and treated are fragmented across Asia, with marked intercountry and intracountry differences in outcome and knowledge gaps in clinical diagnostic and treatment practices. To address these knowledge gaps, we have established a PC disease registry with the aim of providing a comprehensive picture of PC diagnosis, prognosis, treatment and outcome, population characteristics, and comorbidities in real-world clinical practice in Asia.MethodsThis is a multinational, multicenter, longitudinal, and observational registry of PC patients presenting to participating tertiary-care hospitals in eight Asian countries (www.clinicaltrials.gov NCT02546908. Registry Identifier: NOPRODPCR4001). Approximately 3500-4000 eligible patients with existing or newly diagnosed high-risk localized PC (cohort 1), nonmetastatic biochemically recurrent PC (cohort 2), or metastatic PC (cohort 3) will be consecutively enrolled and followed-up for 5 years. An enrollment cap of 600 patients each will be applied to cohorts 1 and 2. Disease status is collected at enrollment, and outcome variables captured at 3-monthly intervals include diagnostic/staging, treatments including reason for change, laboratory results, comorbidities, and concomitant medications. Treatments and survival outcomes will be captured real time until study end. Patient-reported quality-of-life will be measured every 6 months, and medical resource utilization summarized at study end. Data analysis will include exploratory analyses of potential associations between multiple risk factors and socioeconomic variables with disease progression and evaluation of various treatments for PC including novel therapies on clinical outcome and health-related quality-of-life outcomes.Results3636 men with PC were enrolled until July 2018; 416 in cohort 1, 399 in cohort 2 and 2821 in cohort 3.DiscussionA total of 3636 patients were enrolled until July 2018. The prospective disease registry will provide comprehensive and wide-ranging real-world information on how PC is diagnosed and treated in Asia. Such information can be used to inform policy development for best practice and direct clinical study design evaluating new treatments.

Explaining subnational parliamentary scrutiny powers: A fuzzy-set analysis of German Landtage

ABSTRACTWhile the European Union’s Lisbon Treaty has important implications for regional parliaments with legislative competences, most studies have focused on cross-country differences or examined the activities of regional parliaments at the EU level. This contribution shows the existence of substantial intra-country differences in the formal scrutiny rights of regional parliaments. We analyse how German regional parliaments (Landtage) have addressed the challenge of controlling their governments in EU affairs. Using fuzzy-set comparative qualitative analysis, we find that institutional and partisan factors (vote share in the second chamber, economic potential, and conservative governments) explain the differences found among German Landtage particularly well. Landtage with otherwise weak parliamentary prerogatives were successful in using the reform momentum to strengthen their rights in the field of EU policy. Combined with the party political salience of EU policy-making, the integration process has thus empowered formally weaker Landtage.

P213 The epidemiological features of herpes simplex virus cases in a cork sti clinic

IntroductionHerpes simplex virus (HSV) is the leading cause of genital lesions worldwide. The transmission of sexually transmitted infections (STI’s) and human behaviour are intrinsically linked. A clear understanding of the characteristics that increase the risk of acquiring these infections is vital for STI control. European evidence lists large intracountry and intercountry differences in the epidemiology of genital herpes across EuropeMethodsRetrospective chart review, examining demographic, behavioural and diagnostic data of patients who attended a Cork STI clinic from 2011 to 2015 inclusive. Multivariate logistic regression models were used to study the epidemiological features of patients with a genital HSV infection (n=296) in comparison to a control group of patients with negative screen (n=307).ResultsFemales (OR3.942, P&lt;0.001) and those aged between 25 to 30 years (OR: 8.397, P&lt;0.001) had increased odds of acquiring genital HSV. Subjects of non-Irish ethnicity (P=0.032) and females who engaged in sexual intercourse younger than 17 years of age were more likely to present with the infection (OR: 7.427, P&lt;0.01). Alcohol and drug use were not significant predicting factors of HSV infection. High number of sexual partners was not associated with increased risk of the infection. Consistent condom use was very low in all subjects.DiscussionPublic health campaigns directed at young people, especially those engaging in sexual activity at a young age and non-Irish ethnic groups, may be beneficial. Increased distribution of condoms to at risk age groups should be considered. It is relevant to public policy design that classic risk taking behaviours were not associated with increased risk of genital HSV infection.

Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: findings from health facility surveys in six sub-Saharan countries.

Introduction: Despite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi-country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic-level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART. Methods: Health facilities (n = 156) were sampled within 10 surveillance sites: Nairobi and Kisumu (Kenya), Karonga (Malawi), Agincourt and uMkhanyakude (South Africa), Ifakara and Kisesa (Tanzania), Kyamulibwa and Rakai (Uganda) and Manicaland (Zimbabwe). Structured questionnaires were administered to in-charge staff members of HIV testing, prevention of mother-to-child transmission (PMTCT) and ART units within the facilities. Forty-one indicators influencing uptake and patient retention along the continuum of HIV care were compared across sites using descriptive statistics. Results: The number of facilities surveyed ranged from six in Malawi to 36 in Zimbabwe. Eighty percent were government-run; 73% were lower-level facilities and 17% were district/referral hospitals. Client load varied widely, from less than one up to 65 HIV testing clients per provider per week. Most facilities (>80%) delivered services or interventions that would support patient retention in care such as delivering free services, offering PMTCT within antenatal care, pre-ART monitoring and adherence counselling. Many facilities under-delivered in several areas, however, such as targeted testing for high-risk groups (21%) and mobile testing (36%). There were also intra-site and inter-site differences, including in the delivery of Option B+ (ranging from 6% in Kisumu to 93% in Kyamulibwa), and nurse-led ART initiation (ranging from 50% in Kisesa to 100% in Karonga and Agincourt). Only facilities in Malawi did not require additional lab tests for ART initiation. Stock-outs of HIV test kits and antiretroviral drugs were particularly common in Tanzania. Conclusions: We identified a high standard of health facility performance in delivering strategies that may support progression through the continuum of HIV care. HIV testing policy and practice was particularly weak. Inter- and intra-country differences in quality and coverage represent opportunities to improve the delivery of comprehensive services to people living with HIV.

Fertility Transitions in Ghana and Kenya: Trends, Determinants, and Implications for Policy and Programs

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)

Green segmentation: a cross-national study

Purpose– Understanding and defining the characteristics of environmentally conscious or concerned consumers has received attention from academic researchers, commercial sector, and policy makers. The purpose of this paper is to identify distinct market segments in three countries (China, Germany, and Turkey) based on several “green” attitude and behavior variables.Design/methodology/approach– A survey was administered in three countries, yielding a total of 1,415 valid survey responses.Findings– Four clusters, ranging from the “greenest” to the “least green” segment, were identified and characterized for each country. Inter- and intra-country similarities and differences are discussed. Existence of cross-national segments was confirmed.Research limitations/implications– There is a potential gap between actual behavior and reported behavior.Practical implications– The segment profiles can be valuable to firms, particularly to those competing in multinational markets. By delineating areas of similarity among international diversity, enterprises can develop effective global marketing strategies.Social implications– Understanding market segments in this respect is critical for policy makers who try to focus their policies that seek to promote green consumption.Originality/value– This is the first study that uses cross-national data for segmenting the market based on “green” criteria, to the authors’ knowledge. Methodologically, the paper uses techniques and instruments that have not been used in this context before.

Is China uniform? Intra-country differences in the takeoff of new products

Multi-national corporations (wrongly) introduce new products in China rather late. Such a strategy arises because research treats all of China as one monolithic country, thus, finding that takeoff occurs quite late. However, for large or multi-ethnic countries, intra country diversity may be quite high, rivaling or exceeding that among inter country differences of some continents (e.g., Europe). This study examines the takeoff of new products among provinces of China based on data of 30 Chinese provinces on 10 categories over 34 years. Rooted in the theory of institutions and product network externalities, this study tests the drivers of new product takeoff using a discrete time hazard model. The major results are as follows: First, time to takeoff varies dramatically across provinces in China. Second, the average time to takeoff varies substantially between products with strong and weak network externalities. Third, time to takeoff is converging across provinces. Fourth, the intra-country differences in time-to-takeoff are explained by economic institutional variables: economic wealth, trade openness, education, media and transportation infrastructure; and product characteristics: network externalities and year of introduction. Fifth, the vast differences in takeoff of new products across provinces suggest that a waterfall strategy within China might be more profitable.

Is China Uniform? Intra-Country Differences in the Takeoff of New Products

Multi-national corporations (wrongly) introduce new products in China rather late. Such a strategy arises because research treats all of China as one monolithic country, thus, finding that takeoff occurs quite late. However, for large or multi-ethnic countries, intra-country diversity may be quite high, rivaling or exceeding that among inter country differences of some continents (e.g., Europe). This study examines the takeoff of new products among provinces of China based on data of 30 Chinese provinces on 10 categories over 34 years. Rooted in the theory of institutions and product network externalities, this study tests the drivers of new product takeoff using a discrete time hazard model. The major results are as follows: First, time to takeoff varies dramatically across provinces in China. Second, the average time to takeoff varies substantially between products with strong and weak network externalities. Third, time to takeoff is converging across provinces. Fourth, the intra-country differences in time-to-takeoff are explained by economic institutional variables: economic wealth, trade openness, education, media and transportation infrastructure; and product characteristics: network externalities and year of introduction. Fifth, the vast differences in takeoff of new products across provinces suggest that a waterfall strategy within China might be more profitable.

Institutional open access at home and outward internationalization

While voluminous research has focused on the impact of host country institutions on foreign entrants, the rise of outward internationalization of firms from emerging economies is challenging this research stream. Limited work has been done to investigate a crucial question: How do home country institutions influence firms from emerging economies to engage in outward internationalization? Inspired by North's insights on institutional open access, we develop an institution-based framework highlighting intra-country (sub-national) regional differences within a large emerging economy. Specifically, we argue that greater institutional open access in a particular region of a home country—in the areas of legal environment openness and financial market openness—leads to greater outward internationalization of local firms headquartered in that region. Further, tenure of that region's governor moderates such relationships in different ways. Our multilevel analysis with 5239 observations (company-years) finds that institutional open access is indeed behind some Chinese firms’ outward internationalization.

Natural Disaster and Democratic Legitimacy

Can natural disasters undermine democratic legitimacy? This article maps a causal pathway from natural disaster damage to shifts in opinion and behavioral tendencies in less established democracies. It theorizes citizens who suffer damage in such contexts will tend toward lower evaluations of democratic institutions, lower support for democratic values and practices, and stronger dispositions toward action. These expectations are tested with national survey data collected following Chile’s 2010 earthquake and tsunami by analyzing intracountry differences in damage with matching techniques and regression analyses. Results are consistent with expectations, with important implications for Chile and other less established democracies.