Disparities In Resources Research Articles

Exploring two measures of spatial accessibility to organizational resources in a small city

ABSTRACTResearch has documented neighborhood-level disparities in organizational resources. Organizational resources may meet residents’ needs because, as social organization theory suggests, they generate social ties, establish and enforce local norms, and promote social control. However, few studies have examined access to organizational resources in micropolitan cities, which are important for research on place and inequality because of their growing population and poverty. This study presents findings from an assessment conducted in a Midwestern micropolitan city implementing a new community development initiative. We collected data on program delivery locations and assessed spatial accessibility using two measures of organizational resources in neighborhoods: (1) the count of programs and (2) the average distance to all programs from a neighborhood centroid. Findings reveal distinct characteristics of micropolitan geography. Access to resources was not equitably distributed. However, neighborhood socioeconomic disadvantage was not associated with organizational resource access. Implications for assessment and community development efforts are discussed.

Academic disparities and health: How gender-based disparities in schools relate to boys' and girls’ health

RationaleRecent research reveals that, although girls encounter some barriers in school (e.g., in science and math), on balance, boys perform worse academically. Moreover, other research has identified a correlation between exposure to a context characterized by large disparities in performance or resources and a range of negative outcomes, including negative health and well-being, among members of lower status groups. ObjectiveBuilding on these literatures, the present research tests the relationship between gender disparities in academic performance within a school and students' health outcomes. Specifically, we investigated whether boys had worse health when they attended schools where there was a greater disparity between boys' and girls’ academic performance. MethodWe tested this hypothesis in two different samples with different health outcomes. In a sample of healthy eighth graders (Study 1; 159 girls and 81 boys), we assessed two indices of metabolic syndrome, and in a sample of children with asthma (Study 2; 122 girls and 153 boys), we assessed immune function (Th1 and Th2 cytokine production) and self-reported symptoms. Participants in both samples also reported the name of the school that they attended so that we could access publicly available information about the percentage of girls and the percentage of boys in each school who met expectations for their grade level on standardized tests. ResultsIn both samples, the greater the gap in a school between the percentage of girls and the percentage of boys who met expectations for their grade level on standardized tests, the worse boys’ health. This pattern did not emerge among girls. ConclusionResults thus highlight the negative health correlates of academic disparities among members of lower-performing groups.

Structures of Stratification: Advancing a Sociological Debate over Culture and Resources

When theorizing differences in action between structurally unequal groups, sociologists often disagree over the roles that structure, culture, and resources play. It is not uncommon for debates to arise in which structural explanations for unequal outcomes are pitted against cultural ones, with the former pointing to group resource disparities and the latter emphasizing differences in how groups think and do things. In this article, we develop a theoretical approach that conceptualizes culture as an element of social structure and draws on Sewell’s multiplicity of structures and Bourdieu’s habitus to theorize group differences in action as structural. This approach, we argue, advances a structural sociology of stratification that helps counter the tendency for U.S. individualism to promote interpretations of group differences/disparities as having individual-level rather than structural-level sources.

Recent advances in gynecologic radiation oncology.

Radiation has long been a primary treatment modality in locally advanced gynecologic carcinomas and a tool for palliation of metastatic disease. Here we review advances in imaging and radiation technologies and the corresponding clinical evolution of the role for radiation oncology in the treatment of gynecologic malignancies. Advances in MRI are impacting diagnosis, radiation target delineation, planning, treatment delivery, and response assessment. The combination of MRI and PET-computed tomography (PET-CT) has the potential to significantly change treatment recommendations as compared with a single imaging modality. Advances in radiation delivery including intensity modulated radiation therapy (IMRT) and stereotactic ablative radiotherapy (SABR) have expanded the role for radiation in the definitive treatment of high risk and oligometastatic ovarian cancer. Finally, global disparities in oncology resources has led to the development of resource stratified treatment guidelines for gynecologic malignancies. The use of ultrasound for brachytherapy planning may help improve access to this critical treatment modality. As imaging and radiation technologies advance, the indications for radiation in the treatment of gynecologic malignancies continues to evolve. Here we review the changing landscape of radiation oncology in the multidisciplinary management of gynecologic cancers.

Regional disparity of medical resources and its effect on age-standardized mortality rates in Korea

The progress in medical resources and technologies has played an important role in improving people’s health. Various indicators can be used to measure the health level of a country. The mortality rate is a clinical result of health and medical sectors that quantitatively displays the state or change in health levels. The effectiveness of medical resources can be quantitatively determined with the changes in mortality rate and can represent the health level of a region. In this study, 16 cities and provinces in Korea for the years from 2001 to 2014 are set as spatial and temporal scopes. Doctors, medical personnel, specialists, and number of operations are introduced as human medical resources. The number of hospital beds and number of medical facilities represent physical resources, while the high-end medical equipment represents technical advancements. The result from panel analyses indicated that all medical resources considered in this study reduce age-standardized mortality rate, with medical facilities having the greatest influence, followed by specialists, then by high-end medical equipment. These results can be interpreted to suggest that medical resources and regional economic characteristics compositely have reducing effect on mortality rate.

Assessing Spatial Accessibility to Medical Resources at the Community Level in Shenzhen, China.

Spatial accessibility to medical resources is an integral component of universal health coverage. However, research evaluating the spatial accessibility of healthcare services at the community level in China remains limited. We assessed the community-level spatial access to beds, doctors, and nurses at general hospitals and identified the shortage areas in Shenzhen, one of the fastest growing cities in China. Based on hospital and population data from 2016, spatial accessibility was analyzed using several methods: shortest path analysis, Gini coefficient, and enhanced 2-step floating catchment area (E2SFCA). The study found that 99.9% of the residents in Shenzhen could get to the nearest general hospital within 30 min. Healthcare supply was much more equitable between populations than across communities in the city. E2SFCA scores showed that the communities with the best and worst hospital accessibility were found in the southwest and southeast of the city, respectively. State-owned public hospitals still dominated the medical resources supply market and there was a clear spatial accessibility disparity between private and public healthcare resources. The E2SFCA scores supplement more details about resource disparity over space than do crude provider-to-population ratios (PPR) and can help improve the efficiency of the distribution of medical resources.

Strengthening district healthcare in rural Africa: a cross-sectional survey assessing difficulties in pulse oximetry use and handoff practices

Background: Rural hospitals in sub-Saharan Africa suffer from numerous disparities in resources and practices, and subsequently patient care is affected.Methods: In order to assess current practices and opportunities for improvement in pulse oximetry use and patient-care handoffs, a cross-sectional survey was administered to clinicians at a referral level hospital serving a large rural area in Shinyanga, Tanzania.Results: Respondents (n=46) included nurses (50%), medical doctors (48%), and clinical officers (2%). A response rate of 92% was achieved, and 81% of clinicians acknowledged routine difficulties in the use of current devices when obtaining pulse oximetry. Although 83% of respondents reported using a written handoff at shift change, information reporting was inconsistent and rarely included specific management guidance.Conclusions: Further research is needed to elucidate handoff practices in developing settings, but there is a large opportunity for novel point-of-care devices and tools to improve both pulse oximetry use and patient care handoffs in rural Africa.

Has the Rise of Financial Viability Assessment in the British Planning System Reinforced the Asymmetry in Relationship between the Property Industry, Local Authorities, and the Communities that They Serve?

Financial viability assessment was first introduced to the UK planning system through paragraph 173 of the 2012 National Planning Policy Framework (NPPF). It was described by Colenutt, et al. (2015) to have inevitably shifted the balance of power and influence between the property industry, local authorities and communities that they serve. This paper aims to demonstrate that the shift in power and influence has predominantly favoured the property industry in the following ways. Firstly, the test for economic viability has provided developers and landowners with the means to challenge and even undermine the affordable housing agenda and priorities of planning authorities and communities. Secondly, confidentiality clauses allowed the property industry to hide the full contents of their financial viability assessments from public review resulting in the unequal access to information. Thirdly, the introduction of viability assessment to the planning system disadvantaged local planning authorities because of their disparity in technical resources and knowledge-gap from private property developers. The lack of expertise from planning authorities and communities curtailed their ability to interpret, let alone, contest viability assessments. However, this paper concludes that while viability assessments gave developers and landowners the incentives and opportunities to exert greater influence over planning, it did not intend to reinforce the asymmetry between the property industry, local authorities and communities. Ultimately, it was the government’s limited guidance and failure to establish a standardized valuation methodology that contributed to this imbalance.

Trends in health resource disparities in primary health care institutions in Liaoning Province in Northeast China

BackgroundThe allocation of health resources in primary health care institutions (PHCI) is crucial to health reform. China has recently implemented many reform measures emphasizing the provision of primary health care services, with equity as one of the major goals. The aim of this study was to analyze the quantity, quality, and distribution of health resources in Liaoning Province from 2005 to 2017.MethodsData were drawn from the annual financial report from 2005 to 2017 and information from the Liaoning Province Department of Statistics. Numbers of beds and physicians were used as indicators of health resources. Capital assets per bed, value of medical equipment per bed, operational space per bed, and number of physicians with different educational levels were used as indicators of quality of health resources. Concentration indices (CI) and Gini coefficients were calculated.ResultsThere was a steady rise in health resources in PHCI. From 2005 to 2017, the quality of health resources improved. The CI of beds showed an overall downward trend, indicating an improvement in the disparity among PHCI. There was a similar trend in the CI of fixed assets per bed. The Gini coefficients of physicians overall and physicians with different educational levels were almost always < 0.3, showing preferred equity status. There was a decreasing trend in the Gini coefficients of PHCI physicians with bachelor’s degrees or higher and physicians with associate’s degrees. The proportion of health resource of PHCI in health system increased from 2005 to 2009, before decreasing from 2009 to 2017 and the percentage of physicians overall and physicians with bachelor’s degrees or higher in PHCI declined after 2011.ConclusionsThere was an improvement in the quantity and quality of health resources in PHCI from 2005 to 2017. The distribution of health resource allocation in PHCI also improved. The findings revealed that the measures for the improvement of PHCI physicians’ educational level has been successful and the measures taken by the government in health reform to strengthen the primary health care system have not been successful.

Spatial Disparity in Food Environment and Household Economic Resources Related to Food Insecurity in Rural Korean Households with Older Adults.

Different contextual factors of a household and a community, such as access to resources and transportation, may influence the level of food insecurity. The objective of this study was to identify how food environmental factors and economic resources were related to food insecurity in Korean older adults residing in different contexts of rural areas. Face-to-face interviews with 248 older adults residing in land (n = 149) and mountain (n = 99) rural areas were performed. In both areas, risk of food insecurity was increased for households with limited community food accessibility measured by having difficulties in food purchasing due to food stores far from home. There were discrepancies in factors related to increased risks of food insecurity between households in land and mountain areas. The experience of reducing food expenditure resulting from burden of heating costs during the winter in households in a mountain area whereas the percent proportion of housing fee and household cook’s physical disability in households residing in the land area were found to be factors associated with increased risks of food insecurity. For households residing in mountain areas, the risk of food insecurity was decreased when economic resources measured by average monthly income for the last one year was increased and there was farming or home gardening activity. Such spatial disparity might affect household food insecurity in rural areas. In addition, food environmental factors and economic resources may affect household food insecurity differently according to the diverse contexts of rural areas. Better understanding of spatial challenges in food insecurity faced by seniors in a large rural area would help prepare programs or policy change to strengthen and improve their food environments.

Implementing personalized medicine in diabetic kidney disease: Stakeholders' perspectives.

The promise of personalized medicine to deliver “the right treatments at the right time to the right person” is the next frontier in healthcare. However, to implement personalized medicine in chronic diseases such as diabetes mellitus and diabetic kidney disease (DKD), a number of different aspects need to be taken into account. Better risk stratification and more precise options for treatment need to be developed and included in clinical practice guidelines. A patient's unique psychological, social and environmental situation also drive disease progression and outcomes. Appraising the cost effectiveness of precision medicines is necessary, not just as the cost of new therapies, but also the cost of diagnosis with novel methodologies and averted complications. As the prevalence of DKD grows worldwide to epidemic proportions, challenges such as global disparities in resources, access to healthcare and prevalence need to be addressed. This review considers these issues to achieve the short and longer‐term goals of implementing personalized medicine in clinical practice.

Job Negotiations in Academic Medicine: Building a Competency-Based Roadmap for Residents and Fellows

Negotiation skills are critical to career success, yet many physicians feel ill-equipped to negotiate for professional opportunities. Enhancing competencies in this arena may be especially critical for women and underrepresented minorities to reduce disparities in compensation and resources that begin upon entry into the workforce as junior faculty. This perspective offers a comprehensive overview of negotiation strategies and the job search process for individuals finishing medical training and seeking first-time employment. First, we extrapolate lessons from clinical medicine to provide a negotiation roadmap for residents and fellows. We use both a clinical and an employment scenario to illustrate the concept of principled negotiation in which negotiating partners elicit each other's values and interests and identify options for mutual gain. We then describe approaches to seeking and negotiating job opportunities and discuss typical timelines for these activities. We supply a list of professional needs to consider before a negotiation begins and introduce the concept of a best alternative to negotiated agreement to help ensure essential requirements are met in a final employment offer. Finally, we explore the utility of third-party assistance and published benchmarks and offer best practices for negotiating.

Reducing Resource Disparity in Healthcare Resource Allocation of Laboratories in Countries with Limited Resources by Empowering Policy-Making and Implementation

In resource constraint settings of developing countries like India, inadequate importance and consideration to resource (re)allocation approach causes resource disparity issues. The Indian public health care system has focused on developing rural primary health centres (PHCs) to reduce rural–urban resource disparity and pressure on urban health care facilities. However, all the resources as recommended in national standards for PHCs’ functioning are not completely available in PHCs. Local-level decision-makers are not provided with a policy framework to (re)allocate resources. This study states that empowering local-level decision makers with the ability to (re)allocate resources to reduce resource disparity is critical. The study proposes a new framework for minimizing resource disparity with resource allocation optimization. The study suggests a strategy to improve implementation of policies like the National Rural Health Mission and the National Health Policy. The 42 PHCs in rural areas of Osmanabad District (India) with 23 laboratory technicians (LTs) as resources are considered as a case study to assess the proposed method. The study optimization model showed that reallocating 6 of 23 LTs to different PHCs would reduce disparity in LT workload (from 57.62% to 30.54%) and LT access (from 116.4% to 49.3%). The disparity reduction highlights the impact of resource reallocation according to the proposed framework.

Characterizing the spatial mismatch between intimate partner violence related healthcare services and arrests in Miami-Dade County, Florida

BackgroundRoutine screening and intervention for intimate partner violence (IPV) in healthcare settings constitutes an important secondary prevention strategy for identifying individuals experiencing IPV early and connecting them with appropriate services. Considerable variation in available IPV-related healthcare services exists and interventions are needed to improve the quality of these services. One way to prioritize intervention efforts is by examining the level of services provided in communities most at risk relative to local incidence or prevalence of IPV. To inform future interventions, this study examined the spatial relationship between IPV-related healthcare services and IPV arrests in Miami-Dade County, Florida, and identified predictors of the observed spatial mismatch.MethodsSurvey data collected in 2014 from 278 health facilities pertaining to IPV services were geocoded, computed into a density layer, and aggregated at the census tract level to create a population-based normalized comprehensiveness score (NCS) as a proxy for IPV-related healthcare resources. IPV arrests from 2011 to 2015, collected from the county court, were geocoded and summarized by census tracts to serve as a proxy for IPV prevalence. These measures were combined into a resource disparity score (RDS) that compared relative service density to relative arrest rates, where positive RDS represented over-resourced neighborhoods and negative RDS corresponded to under-resourced neighborhoods. We used correlation analyses and a two-phase spatial modeling approach to evaluate correlates of NCS and RDS.ResultsA spatial lag model did not yield an association between NCS and IPV arrests, demonstrating a spatial mismatch, which we visualized using a Geographic Information System (GIS). A spatial error model revealed that the percentage of white non-Hispanic residents was positively associated with RDS, while percent black non-Hispanic, median age, ethnic heterogeneity, and economic disadvantage were negatively associated with RDS.ConclusionsThese findings underscore the need to further evaluate the adequacy of IPV-related healthcare resources for secondary prevention relative to local IPV arrest rates, particularly within economically disadvantaged neighborhoods. Our approach demonstrates the utility of GIS for identifying potential priority regions for IPV prevention efforts and resource allocation.

Mindfulness and Other Psycho-Social Resources Protective Against Mental Illness and Suicidality Among Gay Men.

Background: There is considerable evidence of health disparities among gay men characterized by higher levels of stress and distress. Psycho-social resources have been linked to numerous positive health outcomes and shown to act as buffers in the stress-distress pathway.Methods: With data from the 3rd Geneva Gay Men's Health Survey carried out in 2011 using time-space sampling (n = 428), a relatively elaborate profile of 14 psycho-social resources—including mindfulness—is presented. Using their original scores, latent class analysis created an index variable dividing the respondents into meaningful groups. Psycho-social resources—the index variable as well as each resource individually—were then compared to two recent outcomes—i.e., serious mental illness in the past 4 weeks and short-term disability in the past 2 weeks—using a series of logistic regression models, controlling for all other psycho-social resources and socio-demographic confounders. To assess their potential role as buffers, a similar series of logistic regression models were erected using victimization and three outcomes—i.e., major depression, suicidal ideation, and suicide attempt—in the past 12 months.Results: According to the latent class analyses, (1) 5.1% of this sample had a low level of psycho-social resources (i.e., one standard deviation (SD) below the group means), (2) 25.2% a medium-low level, (3) 47.4% a medium level (i.e., at the group means), and (4) 22.2% a high level of psycho-social resources (i.e., one SD above the group means). Psycho-social resources appeared to strongly protect against recent mental morbidity and buffer against the impact of victimization on major depression and suicidality in the past 12 months, reducing the adjusted odds ratios below statistical significance. The explained variance and the individual psycho-social resources which remained independent in the models differed for each outcome.Conclusions: There may be disparities in several psycho-social resources among gay men, and as strong compensatory and protective factors, they may explain in part the well-established disparities in stress and distress in this population. While multiple psycho-social resources should be promoted in this population, gay men under 25 years should receive particular attention as all three disparities are most pronounced in this age group.

The hope of a better life? Exploring the challenges faced by migrant Roma families in Ireland in relation to children’s education

ABSTRACTDrawing on data obtained from the first Irish national needs assessment of Roma this article examines the circumstances impinging on the education of Roma children in Ireland. The findings suggest that Roma children in Ireland are among the most disadvantaged of their peers, with a significant proportion enduring living conditions which most people would not imagine exist in contemporary Ireland. These findings provide insight into the stark disparities in material resources and social status which shape the experience of education.

Spatial accessibility of primary health care in China: A case study in Sichuan Province

Access to primary health care is considered a fundamental right and an important facilitator of overall population health. Township health centers (THCs) and Community health centers (CHCs) serve as central hubs of China's primary health care system and have been emphasized during recent health care reforms. Accessibility of these hubs is poorly understood and a better understanding of the current situation is essential for proper decision making. This study assesses spatial access to health care provided by primary health care institutions (THCs/CHCs) in Sichuan Province as a microcosm in China. The Nearest-Neighbor method, Enhanced Two-Step Floating Catchment Area (E2SFCA) method, and Gini Coefficient are utilized to represent travel impedance, spatial accessibility, and disparity of primary health care resources (hospital beds, doctors, and health professionals). Accessibilities and Gini Coefficients are correlated with social development indexes (GDP, ethnicity, etc.) to identify influencing factors. Spatial access to primary health care is better in southeastern Sichuan compared to northwestern Sichuan in terms of shorter travel time, higher spatial accessibility, and lower inequity. Social development indexes all showed significant correlation with county averaged spatial accessibilities/Gini Coefficients, with population density ranking top. The disparity of access to primary health care is also apparent between ethnic minority and non-minority regions. To improve spatial access to primary health care and narrow the inequity, more township health centers staffed by qualified health professionals are recommended for northwestern Sichuan. Improved road networks will also help. Among areas with insufficient primary health care, the specific counties where demographics are dominated by older people and children due to widespread rural-urban migration of the workforce, and by ethnic minorities, should be especially emphasized in future planning.

No Significant Effect of Maternal Perception of the Food Environment on Reproductive Success or Pup Outcomes in C57BL/6J Mice.

ObjectivePrior work concerning maternal perception of the food environment suggests that perceived disparities in food resources resulted in reduced pup mass and dam reproductive success. We attempted to replicate this result with increased sample size and additional measures.MethodsFemale C57BL/6J mice (n=160; 3 weeks old) were randomized to either subject or peer and were pair-housed in partitioned cages with olfactory and visual contact. After a 6-week maturation period on an energy-rich cafeteria diet, cages were randomized to Control (subject and peer fed pelleted diet) or Treatment (subject fed pellets, peer fed cafeteria diet), and subjects were bred. After weaning, one pup from each sex per litter was reared to five months.ResultsTreatment did not affect the number of births, pup size at birth or proportion of pups surviving to weaning (p>0.09). Treatment did not affect dam body or fat mass at parturition (p>0.22) but these measures were higher in some Treatment dams at weaning (p<0.05). Smaller female pups were weaned from Treatment dams pregnant on the first breeding attempt (p=0.01), but no other pup effects were observed (p>0.07).ConclusionsExposure to food-environment disparity in this study did not replicate previous findings or affect pup growth after weaning.

High-level talent flow and its influence on regional unbalanced development in China

Brain drain has long been a concern. However, little is known about the brain drain within a country. China is a developing country which is experiencing not only overseas brain drain but also a domestic cross-regional and cross-departmental flow. In this study, we investigate the flow of high-level talent (HLT) given the background of constructing world-class universities and disciplines (WCUDs) in China and its dynamic mechanisms, and then we discuss its potential implications. The results show that over the past four decades, eastern China has been a net-inflow area, and the northeastern and midwestern regions saw a net outflow. The eastern region shows more internal regional flow. Furthermore, a large amount of HLT has flowed from scientific research institutes to colleges and universities (CUs). Regional socioeconomic gaps, imperfect systems and inadequate management are the main reasons for the flow of HLT. Regional HLT flow is not as serious as expected, but irrational flow will probably aggravate the already interregional disparity in educational resources and human capital accumulation as well as regional unbalanced development. Therefore, some measures should be taken to fight irrational high-level talent flow.

DEMOGRAPHIC RESOURCES OF DISTRICTS IN THE REPUBLIC OF SERBIA: CLUSTER ANALYSIS APPROACH

Bearing in mind how important demographic resources are for the socio-economic development of specific administrative-territorial units, the objective of this paper is to classify the districts in the Republic of Serbia according to the available demographic resources and to create an adequate typology of demographic areas, based on the comparison of values of relevant indicators of demographic and educational resources. These values were calculated using 14 demographic and educational variables, based mainly on the data from last census in 2011. For this purpose, hierarchical and non-hierarchical procedures of cluster analysis, as a method of multivariate statistical analysis, were used. The resulting typology and categorization clearly confirm the presence of unfavorable demographic tendencies and pronounced territorial disparities of demographic resources at the district level in the Republic of Serbia. More specifically, approximately 80% of the 25 analyzed districts belong to the type of demographically endangered areas, which are characterized by weak and very weak demographic resources. The obtained "snapshot" of the current demographic situation together with created typology of districts can serve as a useful source for understanding and monitoring of complex demographic phenomena and processes as well as for the definition of measures of population and regional development policies aimed at mitigating the effects of an alarming demographic situation.