National Disparities Research Articles

Patents, Standards and Borders: Addressing National Disparities among Holders of Standard-Essential Patents

Today’s technology product markets are inherently international. The global character of technology markets underscores the importance of technical interoperability standards in global supply chains and commerce. This paper considers the impact of patents on international technical standardization activities. In particular, it assesses the impact that patents have on individual firm behavior and intra-firm dynamics in the context of international standard-setting and evaluates available options to reduce disparities between large patent holders and firms from less-developed economies.

Editorial: Institutional Determinants of Social Inequalities.

Editorial: Institutional Determinants of Social Inequalities.

National disparities in minimally invasive surgery for rectal cancer.

Social and racial disparities have been identified as factors contributing to differences in access to care and oncologic outcomes in patients with colorectal cancer. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS), both laparoscopic and robotic, across different racial, socioeconomic and geographic populations of patients with rectal cancer. We utilized the American College of Surgeons National Cancer Database to identify patients with rectal cancer from 2004 to 2011 who had undergone definitive surgical procedures through either an open, laparoscopic or robotic approach. Inclusion criteria included only one malignancy and no adjuvant therapy. Multivariate analysis was performed to investigate differences in age, gender, race, income, education, insurance coverage, geographic setting and hospital type in relation to the surgical approach. A total of 8633 patients were identified. The initial surgical approach included 46.5% open (4016), 50.9% laparoscopic (4393) and 2.6% robotic (224). In evaluating type of insurance coverage, patients with private insurance were most likely to undergo laparoscopic surgery [OR (odds ratio) 1.637, 95% CI 1.178-2.275], although there was a less statistically significant association with robotic surgery (OR 2.167, 95% CI 0.663-7.087). Patients who had incomes greater than $46,000 and received treatment at an academic center were more likely to undergo MIS (either laparoscopic or robotic). Race, education and geographic setting were not statistically significant characteristics for surgical approach in patients with rectal cancer. Minimally invasive approaches for rectal cancer comprise approximately 53% of surgical procedures in patients not treated with adjuvant therapy. Robotics is associated with patients who have higher incomes and private insurance and undergo surgery in academic centers.

The Contribution of National Disparities to International Differences in Mortality Between the United States and 7 European Countries

This study examined to what extent the higher mortality in the United States compared to many European countries is explained by larger social disparities within the United States. We estimated the expected US mortality if educational disparities in the United States were similar to those in 7 European countries. Poisson models were used to quantify the association between education and mortality for men and women aged 30 to 74 years in the United States, Belgium, Denmark, Finland, France, Norway, Sweden, and Switzerland for the period 1989 to 2003. US data came from the National Health Interview Survey linked to the National Death Index and the European data came from censuses linked to national mortality registries. If people in the United States had the same distribution of education as their European counterparts, the US mortality disadvantage would be larger. However, if educational disparities in mortality within the United States equaled those within Europe, mortality differences between the United States and Europe would be reduced by 20% to 100%. Larger educational disparities in mortality in the United States than in Europe partly explain why US adults have higher mortality than their European counterparts. Policies to reduce mortality among the lower educated will be necessary to bridge the mortality gap between the United States and European countries.

National disparities and cyclical dynamics in Italy (1892–2007): was the Mezzogiorno a sheltered economy?

The paper presents the evolution of national disparities in Italy in a cyclical perspective, comparing GDP per capita growth rates in the Centre-North and South from 1892 to 2007. The aim is to evaluate the pro-cyclical pattern of macro-area divergences and to measure, with a non-parametric analysis, the degree of the Southern regions (Mezzogiorno) dependence on the whole country. A performance indicator for national growth is used to determine whether the South can be defined as a sheltered economy. Our results show that peripheral regions as a whole had different degrees of dynamism during the period considered and that the South can be defined as unequivocally sheltered only when national policies switched from industrialization and investments into simple transfers. In other periods, including recent times, national disparities do not show pro-cyclical patterns, supporting the conclusion that the Mezzogiorno has been exposed to market conditions and its economy has not always been dependent on external factors.

Racial disparities in operative outcomes after major cancer surgery in the United States.

Numerous studies have recorded racial disparities in access to care for major cancers. We investigate contemporary national disparities in the quality of perioperative surgical oncological care using a nationally representative sample of American patients and hypothesize that disparities in the quality of surgical oncological care also exists. A retrospective, serial, and cross-sectional analysis of a nationally representative cohort of 3,024,927 patients, undergoing major surgical oncological procedures (colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, pneumonectomy, pancreatectomy, and prostatectomy), between 1999 and 2009. After controlling for multiple factors (including socioeconomic status), Black patients undergoing major surgical oncological procedures were more likely to experience postoperative complications (OR: 1.24; p < 0.001), in-hospital mortality (OR: 1.24; p < 0.001), homologous blood transfusions (OR: 1.52; p < 0.001), and prolonged hospital stay (OR: 1.53; p < 0.001). Specifically, Black patients have higher rates of vascular (OR: 1.24; p < 0.001), wound (OR: 1.10; p = 0.004), gastrointestinal (OR: 1.38; p < 0.001), and infectious complications (OR: 1.29; p < 0.001). Disparities in operative outcomes were particularly remarkable for Black patients undergoing colectomy, prostatectomy, and hysterectomy. Importantly, substantial attenuation of racial disparities was noted for radical cystectomy, lung resection, and pancreatectomy relative to earlier reports. Finally, Hispanic patients experienced no disparities relative to White patients in terms of in-hospital mortality or overall postoperative complications for any of the eight procedures studied. Considerable racial disparities in operative outcomes exist in the United States for Black patients undergoing major surgical oncological procedures. These findings should direct future health policy efforts in the allocation of resources for the amelioration of persistent disparities in specific procedures.

On the ‘How Many Europes’ Debate: Varieties of Service Economies

AbstractThis paper shapes and identifies the varieties and dynamics of service economies in the EU 25. By adopting a neo‐Schumpeterian and evolutionary approach it contributes to enrich previous research dealing with national disparities from the perspective of services economic structures. Communalities across countries and time are detected and discussed at different levels of analysis. A wide set of models across the European region is found from an aggregated perspective. Moreover, the paper analyses the key dimensions explaining the different service models at sectoral level: structural change, knowledge and innovation, internationalisation and competition restrictions. The main result shows that structural composition of countries plays a prominent role, while heterogeneity is driven by dissimilarities in knowledge bases and innovative efforts across Europe.

The sanitation access to developing Asia: India's performance over 2001 and 2011

Purpose – The purpose of this paper is to shed light on India's performance in sanitation over the last decade as it strives to meet the Millennium Development Goal target. Design/methodology/approach – In doing so, both qualitative and quantitative analyses are employed. The latter method includes a regression analysis. Income and income inequality variables have been included in the analysis. Findings – Whilst India has made progress towards achieving access to sanitation for its people, the nation continues to perform relatively poorly to its neighbours and on a comparative global basis. At the national level, substantial rural-urban and income disparities are linked to a reduced level of sanitation access. Both forms of analysis support the view that income inequality in India is directly related to a lack of sanitation facilities. Research limitations/implications – The study is based on secondary data gathered from WHO and UNICEF sources. These are national data gathered by these agencies in two periods. These are aggregated data. Practical implications – The study has major practical implications in policy formation in the area of sanitation access to both rural and urban India. The state level data analysed by the study will also be useful to make policies at disaggregated level. India, indeed, needs to improve the conditions on an urgent basis. Even in South Asia standard, this nation is behind from almost all other nations of the region. Social implications – The social implications are to make people particularly poor aware about the sanitation issue lack of which contributes to health hazards and gestro condition for children and old. The sanitation related diseases contribute to huge loss of working hours in both rural and urban communities. Originality/value – The study contributes original ideas and demonstrates with a simple regression analysis how sanitation depends on income and income inequality of the poor.

INSTITUTIONAL VS. SECTORAL DIMENSION OF INNOVATION STRATEGIES OF FIRMS

In light of the controversy of the dispute about the role of national institutions in shaping innovation strategies of firms, and in light of the lack of explicitness of the notion of innovation strategy within the dispute, this paper aims at ascertaining if national institutional subjection of a firm is fateful in shaping its innovation strategy. The sample companies represented two distinct sets of institutions – Lithuanian vs. Swiss, and two distinct sectors – laser producers vs. contact centres. Warm-house conditions were ensured to eliminate other potentially disruptive factors. Following methods were used to analyse the data: exploratory case study, correlation analysis, test of difference, cluster analysis, and cross-tabulation. The survey highlighted the most important, with regard to national and sectoral disparities, characteristics of innovation strategy.

MDG Hunger Target: Analysis of Cereal Production System and the Evaluation of Cereal Production Potential in Africa

The contradiction between Africa’s GDP growth and poverty has raised much debate in the scientific community, which casts much doubt on Africa’s prospect in achieving MDG (Millenium Development Goals) hunger target. To better tackle this issue, we resort to grey system theory for solution. Firstly, by grey relational analysis (GRA), we aim to find out the relationship between the population undernourished (PU, the major index of MDG hunger target), and cereal production (CP). Then we establish a grey system composed of 8 factors, to identify the major ones in affecting cereal production. Through GRA and grey prediction model GM(1,1), the grey relations between each set of 2 factors out of the 8, as mentioned above, are analyzed and predicted. Next, we evaluate the short-term performance of Africa in reaching MDG hunger target by utilizing GM(1,1) as well. Finally, long-term continental and national cereal productions are forecasted by GM(1,1) from 2021 to 2051, based on data 1961-2011, which can serve as a signifier for Africa’s CPP (cereal production prediction) and the corresponding potential in cutting down PU in the long run. The results from this study suggest that PU and CP are related so that we could cut down PU by promoting CPP, that different factors is likely to show different extents of projected relativeness with cereal production in the future, and that the national disparities of cereal production in Africa are inclined to rise, although the majority of African countries may be able to enjoy a remarkable boost in cereal production prediction. Most importantly, 38% of Africa countries show encouraging signs in achieving MDG hunger target on the national level, indicating that we need to be very cautious in believing in Africa’s ability of achieving it on the whole continent. Finally, several methods and suggestions in eradicating hunger and promoting cereal production are come up with.

National disparities in laparoscopic colorectal procedures for colon cancer

Racial disparity in the treatment of colorectal cancer (CRC) has been cited as a potential cause for differences in mortality. This study compares the rates of laparoscopy according to race, insurance status, geographic location, and hospital size. The 2009 Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) database was queried to identify patients with the diagnosis of CRC by the International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariate logistic regression was performed to look at age, gender, insurance coverage, academic versus nonacademic affiliated institutions, rural versus urban settings, location, and proportional differences in laparoscopic procedures according to race. A total of 14,502 patients were identified; 4,691 (32.35 %) underwent laparoscopic colorectal procedures and 9,811 (67.65 %) underwent open procedures. The proportion of laparoscopic procedures did not differ significantly by race: Caucasian 32.4 %, African-American 30.04 %, Hispanic 33.99 %, and Asian-Pacific Islander 35.12 (P = 0.08). Among Caucasian and African-American patients, those covered by private insurers were more likely to undergo laparoscopic procedures compared to other insurance types (P ≤ 0.001). The odds of receiving laparoscopic procedure at teaching hospitals was 1.39 times greater than in nonteaching hospitals (95 % confidence interval [CI] 1.29-1.48) and did not differ across race groups. Patients in urban hospitals demonstrated higher odds of laparoscopic surgery (2.24, 95 % CI 1.96-2.56) than in rural hospitals; this relationship was consistent within races. The odds of undergoing laparoscopic surgeries was lowest in the Midwest region (0.89, 95 % CI 0.81-0.97) but higher in the Southern region (1.14, 95 % CI 1.06-1.22) compared with the other regions. Nearly one-third of all CRC surgeries are laparoscopic. Race does not appear to play a significant role in the selection of a laparoscopic CRC operation. However, there are significant differences in the selection of laparoscopy for CRC patients based on insurance status, geographic location, and hospital type.

Laicidad y libertad religiosa en la jurisprudencia de la Corte Europea de Derechos Humanos: una convivencia necesaria y difícil

La regulación jurídica de las relaciones entre el Estado y las Iglesias, o entre el Estado y el fenómeno religioso, está íntimamente relacionada en los países europeos con la historia nacional de cada país. Por este motivo, el Tribunal Europeo de Derechos Humanos, una jurisdicción necesariamente comprometida con la integración de las diferencias nacionales, ha sido especialmente respetuoso con el «margen de apreciación nacional» de las autoridades estatales a la hora de regular la gestión del pluralismo religioso. Ahora bien, esto no ha impedido la afirmación por parte del TEDH del valor objetivo de la libertad religiosa, ni la asunción de la laicidad del Estado, como un elemento consustancial al sistema democrático, y por lo tanto, como un valor integrante del orden público europeo. El hecho de que la laicidad haya sido erigida en uno de los valores de la Convención exige plantearnos cuáles son los contornos jurídicos de este principio. En definitiva, de qué laicidad estamos hablando. En este artículo, se defenderá que, dentro del ámbito del Convenio, y tomando en consideración la importancia objetiva de la libertad religiosa, la laicidad ha de entenderse como un principio indeclinable dentro del Estado de Derecho, pero también en un sentido de mínimos, y por lo tanto, en ningún caso asimilable, a los concretos perfiles que adquiere este principio en ordenamientos como el francés o el turco, donde, según circunstancias históricas y sociales, el principio de laicidad legitima determinadas ingerencias en la manifestación del derecho a la libertad religiosa.&lt;br /&gt;

Giants all around — apart from the squid

Giants all around — apart from the squid

Pay-For-Performance Programs to Reduce Racial/Ethnic Disparities: What Might Different Designs Achieve?

Pay-for-performance (P4P) programs may have unintended effects on racial/ethnic disparities. We used patient-level quality scores from the Hospital Quality Alliance and ranked hospitals by overall quality and by racial/ethnic disparities. We then modeled the effects of different P4P designs on national disparity scores. The models using overall quality to rank hospitals resulted in modest reductions in national disparity scores, although these were smaller than the reductions that were found from programs using disparities to rank hospitals. These results suggest that many hospitals treat Whites and minorities equitably. Nevertheless, in order to maximize both improvements in quality and reductions in national disparities, P4P programs should consider an approach that considers both overall quality and reductions in disparities when setting incentives.

The Developing Role of Systems of Competences in Public Health Education and Practice

In recent decades there have been attempts in many professions to define the competences of their practitioners. Over the last quarter century attempts have been made to apply this to public health; initiatives in several countries have been devised to meet the perceived needs of public health education and training (e.g., the United States), of public health practice (e.g., the United Kingdom), etc. The achievements and some of the failings of US and UK initiatives are reviewed. Since 2006 The Association of Schools of Public Health in the European Region (ASPHER) has been working on a system of public health competences suited and adapted to the needs of both public health education and training, and practice. After much work and several stages of development, a third series of competence lists (for public health practitioners generally, for MPH-related education, and for employment purposes) will soon be published. ASPHER believes that for sustainability of a competences project, the competences proposed must be seen as relevant by all public health practitioners and stakeholders, including those engaged in education and training, service work, and public health research. Accordingly, all these stakeholders need to be involved in the preparation of lists of competences. Sustainability will also require an ongoing system and structure for permanent review of existing public health competences, and of the need for definition of new ones. Possible directions towards the achievement of this are indicated. A generally accepted system of core competences could contribute most to the establishment of a clearly identifiable public health profession across Europe, equipped to address current and future health needs of its peoples. All three experiences described share similar challenges, and on a continuing basis these will of necessity need to be addressed in the future: the assessment of whether competences have been achieved or not; the evaluation of whether lists of competences are genuinely appropriate both to population health challenges and to the development and management of systems of intervention as experienced in practice; identification of appropriate means to take account of geographical, regional and national disparities within one common competence system.

Les antipsychotiques injectables à action prolongée: Avis d'experts de l'Association des médecins psychiatres du Québec

To present points of agreement and disagreement about antipsychotics. Since the appearance of 2nd generation long-acting antipsychotics (LAA), and given the high frequency of noncompliance with antipsychotics in psychotic disorders, LAAs have attracted more interest in psychiatric literature. However,their use is suboptimal, globally, and is also subject to significant national disparities. ln this context,the Association des médecins psychiatres du Québec (AMPQ) has asked for a review of the evidence concerning LAA efficiency and tolerance, and has called for consensual c1inical reflection on the benefits and obstacles of prescribing them, as weil as potential solutions, including administrative and judiciary dimensions. The AMPQ established an expert committee, from 4 Quebec universities, which was responsible for preparing the review paper. The committee intended to appropriately provide c1inicians with the different aspects of LAA use. The committee produced a qualitative and selective review. Mean LAA prescription rates observed in Canada are around 6% and data to confirm this are scarce. A 15% to 25% rate could be suggested. The committee has submitted the Quebec long-acting antipsychotic algorithm (QAAPAPLE, derived from the French acronym) as a result of the consensus reached by the 4 university psychiatry departments.

Integrating protected areas into climate planning

Though protected areas have grown considerably over the last 130 years, there are several troubling trends, including national and regional disparities, ecological gaps, a decline in the growth of new protected areas, and problems with ineffective management. At the same time, society increasingly expects protected areas to provide an expanded array of benefits, including climate mitigation, resilience and adaptation. This poses three main questions for policy makers. The first question is where new protected areas should be located in order to maximise climate change resilience, adaptation and mitigation. Planners can incorporate climate change into ecological gap assessments (e.g. by incorporating climate-related data and carbon sequestration into their algorithms), as well as consider basic climate-related design features in the layout of new protected areas. The second question is how protected areas should be managed to maximise climate change resilience, mitigation and adaptation. Planners can explicitly include climate-related issues in their management plans, management effectiveness assessments, threat assessments, monitoring, research and capacity-building programs. The third is what factors and policies are necessary to enable protected areas to maximise climate resilience, adaptation and mitigation. Planners can better integrate protected area planning into sectoral planning such as transportation, energy and invasive species; assess and communicate the full economic value of protected areas in addressing climate-related issues such as national food and water security; and ensure that protected areas are an integral part of climate adaptation planning. Although there are potential tradeoffs between managing protected areas for biodiversity and for climate, the overwhelming societal, economic and ecological benefits of protected areas make them a natural and cost-effective investment.

Regional disparities in child mortality within China 1996-2004: epidemiological profile and health care coverage.

China was one of the 68 "countdown" countries prioritized to attain Millennium Development Goals (MDG 4). The aim of this study was to analyze data on child survival and health care coverage of proven cost-effective interventions in China, with a focus on national disparities. National maternal and child mortality surveillance data were used to estimate child mortality. Coverage for proven interventions was analyzed based on data from the National Health Services Survey, National Nutrition and Health Survey, and National Immunization Survey. Consultations and qualitative field observations by experts were used to complement the Survey data. Analysis of the data revealed a significant reduction in the overall under-5 (U5) child mortality rate in China from 1996 to 2007, but also great regional disparities, with the risk of child mortality in rural areas II-IV being two- to sixfold higher than that in urban areas. Rural areas II-IV also accounted for approximately 80% of the mortality burden. More than 60% of child mortality occurred during the neonatal period, with 70% of this occurring during the first week of life. The leading causes of neonatal mortality were asphyxia at birth and premature birth; during the post-neonatal period, these were diarrhea and pneumonia, especially in less developed rural areas. Utilization of health care services in terms of both quantity and quality was positively correlated with the region's development level. A large proportion of children were affected by inadequate feeding, and the lack of safe water and essential sanitary facilities are vital indirect factors contributing to the increase in child mortality. The simulation analysis revealed that increasing access to and the quality of the most effective interventions combined with relatively low costs in the context of a comprehensive approach has the potential to reduce U5 deaths by 34%. China is on track to meet MDG 4; however, great disparities in health care do exist within the country. It is therefore necessary to specifically target rural areas II-IV. Many causes of child mortality can be prevented or averted through the provision of basic health care. However, the leading predisposing factor contributing to child mortality in China is the insufficient coverage and poor quality of maternal and child health care services. Based on these data, we recommend that the government put more effort to ensure the health of the Chinese people, particularly in terms of providing the most vulnerable populations, i.e., children from the poorest areas and households, with access to good quality essential health care services.

Growth, unemployment and labour market institutions: evidence from a cross-section of EU regions

The responsiveness of unemployment to growth is an issue of ongoing political and academic interest. Economic growth is supposed to be the key to increase labour demand and reduce unemployment. Departing from Okun's law, most research on the unemployment intensity of growth has focused on national disparities and the role of labour market institutions. Empirical evidence at the regional level is scarce. We investigate differences in regional labour market responsiveness and their potential determinants for a cross section of European regions. The data set covers the NUTS 2 regions in the EU15 for the period 1980 to 2002. Following a spatial modelling approach interaction among neighbouring labour markets is taken into account. Our findings point to substantial differences in labour market effects of output growth among European countries and regions. Both national labour market institutions and regional characteristics, such as structural change explain a significant part of these disparities.

Embedding the drivers of emission efficiency at regional level — Analyses of NAMEA data

This paper provides new empirical evidence on regional–national disparities in environmental efficiency, based on analyses of NAMEA data referring to Italy and the Lazio region, where Rome is the main city. Shift-share analyses provide evidence on the drivers of environmental efficiency and on sector specificity. Our evidence shows that although the region around Rome has achieved higher environmental performance compared to Italy mainly thank to its being less industry based, some critical points in the energy sector and in some services should be taken into account in shaping the future development of the region. In addition, the use of regional NAMEA for econometric investigations of emission efficiency drivers at national level shows that though north south disparities favour northern and richer regions, in accordance with development oriented dynamics, environmental hot spots driven by specialisation and efficiency related issues also appear in some northern industrial regions. Further, the role of public ad private R&D is of main relevance in enhancing emission on economic value ratios. Environmental, industrial and sector-oriented policy making may derive valuable information from the evidence provided by our study, that highlights how analytical exploitation of NAMEA offers rich array of insights for regional policy making.