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Crighton EJ, Ouédraogo AM, Sawada M, Mestre TA. Patterns and determinants of health care utilization among people with Parkinson's disease: A population-based analysis in Ontario, Canada. PLoS One 2024; 19:e0305062. [PMID: 38905210 DOI: 10.1371/journal.pone.0305062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 05/22/2024] [Indexed: 06/23/2024] Open
Abstract
In Ontario, despite the increasing prevalence of Parkinson's disease (PD), barriers to access-to-care for people with Parkinson's disease (PwP) and their caregivers are not well understood. The objective of this study is to examine spatial patterns of health care utilization among PwP and identify factors associated with PD-related health care utilization of individuals in Ontario. We employed a retrospective, population-based study design involving administrative health data to identify PwP as of March 31, 2018 (N = 35,482) using a previously validated case definition. An enhanced 2-step floating catchment area method was used to measure spatial accessibility to PD care and a descriptive spatial analysis was conducted to describe health service utilization by geographic area and specialty type. Negative binomial regression models were then conducted to identify associated geographic, socioeconomic, comorbidity and demographic factors. There was marked spatial variability in PD-related service utilization, with neurology and all provider visits being significantly higher in urban areas (CMF>1.20; p<0.05) and family physician visits being significantly higher (CMF >1.20; p<0.05) in more rural areas and remote areas. More frequent visits to family physicians were associated with living in rural areas, while less frequent visitation was associated with living in areas of low spatial accessibility with high ethnic concentration. Visits to neurologists were positively associated with living in areas of high spatial accessibility and with high ethnic concentration. Visits to all providers were also positively associated with areas of high spatial accessibility. For all outcomes, less frequent visits were found in women, older people, and those living in more deprived areas as years living with PD increased. This study demonstrates the importance of geographic, socioeconomic and individual factors in determining PwP's likelihood of accessing care and type of care provided. Our results can be expected to inform the development of policies and patient care models aimed at improving accessibility among diverse populations of PwP.
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Affiliation(s)
- Eric J Crighton
- Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | | | - M Sawada
- Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
- Laboratory for Applied Geomatics and GIS Science (LAGGISS), Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Tiago A Mestre
- Parkinson Disease and Movement Disorder Clinic, Department of Medicine, Division of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Moscou K, Bhagaloo A, Onilude Y, Zaman I, Said A. Broken Promises: Racism and Access to Medicines in Canada. J Racial Ethn Health Disparities 2024; 11:1182-1198. [PMID: 37285050 PMCID: PMC10246521 DOI: 10.1007/s40615-023-01598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/14/2023] [Accepted: 04/06/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Discriminatory policies, attitudes, and practices have had deleterious impacts on the health of Black, Indigenous, and other racialized groups. The aim of this study was to investigate racism as barrier to access to medicines in Canada. The study investigated the characteristics of structural racism and implicit biases that affect medicines access. METHODS A scoping review using the STARLITE literature retrieval approach and analysis of census tract data in Toronto, Ontario, Canada, were undertaken. Government documents, peer-reviewed articles from public policy, health, pharmacy, social sciences, and gray literature were reviewed. RESULTS Structural racism that created barriers to access to medicines and vaccines was identified in policy, law, resource allocation, and jurisdictional governance. Institutional barriers included health care providers' implicit biases about racialized groups, immigration status, and language. Pharmacy deserts in racialized communities represented a geographic barrier to access. CONCLUSION Racism corrupts and impedes equitable allocation and access to medicine in Canada. Redefining racism as a form of corruption would obligate societal institutions to investigate and address racism within the context of the law as opposed to normative policy. Public health policy, health systems, and governance reform would remove identified barriers to medicines, vaccines, and pharmaceutical services by racialized groups.
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Affiliation(s)
| | | | - Yemisi Onilude
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
| | - Ifsia Zaman
- Simon Fraser University, Burnaby, BC, Canada
| | - Ayah Said
- McMaster University, Hamilton, ON, Canada
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3
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Markowski JH, Wallace J, Ndumele CD. After 50 Years, Health Professional Shortage Areas Had No Significant Impact On Mortality Or Physician Density. Health Aff (Millwood) 2023; 42:1507-1516. [PMID: 37931191 DOI: 10.1377/hlthaff.2023.00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Since 1965, the US federal government has incentivized physicians to practice in high-need areas of the country through the designation of Health Professional Shortage Areas (HPSAs). Despite its being in place for more than half a century and directing more than a billion dollars annually, there is limited evidence of the HPSA program's effectiveness at reducing geographic disparities in access to care and health outcomes. Using a generalized difference-in-differences design with matching, we found no statistically significant changes in mortality or physician density from 1970 to 2018 after a county-level HPSA designation. As a result, we found that 73 percent of counties designated as HPSAs remained physician shortage areas for at least ten years after their inclusion in the program. Fundamental improvements to the program's design and incentive structure may be necessary for it to achieve its intended results.
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Ab Hamid J, Juni MH, Abdul Manaf R, Syed Ismail SN, Lim PY. Spatial Accessibility of Primary Care in the Dual Public-Private Health System in Rural Areas, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3147. [PMID: 36833838 PMCID: PMC9959538 DOI: 10.3390/ijerph20043147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia's dual public-private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development.
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Affiliation(s)
- Jabrullah Ab Hamid
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, Shah Alam 40170, Selangor, Malaysia
| | - Muhamad Hanafiah Juni
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
| | - Rosliza Abdul Manaf
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
| | - Sharifah Norkhadijah Syed Ismail
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
- Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
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Cromley G, Lin J. Examining the impact of COVID-19 vaccination rates on differential access to critical care. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2022; 145:102751. [PMID: 35757493 PMCID: PMC9212364 DOI: 10.1016/j.apgeog.2022.102751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/20/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
The measurement of potential access to health care has focused primarily on what might be called "place-based" access or the differential access among geographic locations rather than between different populations. The vaccination program to inoculate the population against the effects of the COVID-19 virus has created two different at-risk populations. This research examines the impact of COVID-19 vaccination rates on access to critical care for persons fully-vaccinated versus those not fully-vaccinated. In this situation, additional tools are necessary to understand: 1) if there is a significant difference in accessibility between different populations, 2) the magnitude of this difference and how it is distributed across accessibility levels, and 3) how the differences between groups are distributed across the state. A study of access to intensive care unit (ICU) beds by these two populations for the state of Illinois found that although there was a statistically significant difference in access, the magnitude of differences was small. A more important difference was being located in the Chicago Area of the state. The not-fully vaccinated in the Chicago Area had higher than expected spatial access due to the lower need for ICU beds by a higher percentage of fully vaccinated people.
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Affiliation(s)
- Gordon Cromley
- Spatial Literacy Center, Dickinson College, Carlisle, PA, USA
| | - Jie Lin
- School of Earth Sciences, Zhejiang University, Hangzhou, Zhejiang, China
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Zhang L. Trap of weights: The reuse of weights in the floating catchment area (FCA) methods to measuring accessibility. F1000Res 2022; 10:751. [PMID: 37124452 PMCID: PMC10130702 DOI: 10.12688/f1000research.51483.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Geographic weights are vital in the floating catchment area (FCA) method of accessibility measurements due to their simulation of spatial barriers in various ways. When modelling population demand, geographical weights with different distance decay coefficients can reflect diverse distance tolerances in facility utilization and could lead to erratic accessibility results. Quantifying accessibility as the sum of weighted supply-demand ratios can alleviate the distance decay coefficient's influence and generate stable geographic patterns. However, the effects of weighted ratios on different FCA models and resources have not been investigated. Methods: To identify impacts of weighted ratios on various FCA variants, this study contrasted the accessibility calculated from the sum of ratios (access) and the sum of weighted ratios (access ratios) within three prevalent FCA models: enhanced two-step FCA (E2SFCA), modified two-step FCA (M2SFCA), and three-step FCA (3SFCA). In addition, the accessibilities of various resources evaluate the stability of the weighted ratios' effect. This study therefore examined the accessibilities to primary schools, job opportunities, and major hospitals in Shanghai. Shanghai is a case study that provides lessons on using big data to measure accessibility in metropolitan areas. Results: Geographic weights can not only mitigate the impact of the distance decay coefficients, but can also eliminate model features, which reduces the performance of the M2SFCA's supply decay and the 3SFCA's population demand adjustment in accessibility results. Moreover, weighted ratios tend to overestimate accessibility in marginal communities that lie within fewer catchments, regardless of the resource type. This tendency can lead to an epistemological trap that creates an inaccurate and counter-intuitive perception of resource distribution in a given area. Conclusions: The results identify a gap between the methodological logic and the empirical perception in accessibility measurements. This study concludes that the use of geographic weights needs to be cautious and epistemologically consistent.
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Affiliation(s)
- Lina Zhang
- Department of Urban and Regional Planning, The Faculty of Spatial Planning, TU Dortmund University, Dortmund, 44149, Germany
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7
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Wang J, Li G, Wang J, Nie Q, Yu Y, Xu T. Modeling of emergency support capacity and optimization of delivery service system for urban living materials under uncertain situations: a case study of Xi'an City during COVID-19 epidemic. COMPUTATIONAL URBAN SCIENCE 2022; 2:47. [PMID: 36589308 PMCID: PMC9789736 DOI: 10.1007/s43762-022-00076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has brought a heavy burden and severe challenges to the global economy and society, forcing different countries and regions to take various preventive and control measures ranging from normal operations to partial or complete lockdowns. Taking Xi'an city as an example, based on multisource POI data for the government's vegetable storage delivery points, logistics terminal outlets, designated medical institutions, communities, etc., this paper uses the Gaussian two-step floating catchment area method (2SFCA) and other spatial analysis methods to analyze the spatial pattern of emergency support points (ESPs) and express logistics terminals in different situations. It then discusses construction and optimization strategies for urban emergency support and delivery service systems. The conclusions are as follows. (1) The ESPs are supported by large-scale chain supermarkets and fresh supermarkets, which are positively related to the population distribution.The spatial distribution of express logistics terminals is imbalanced, dense in the middle while sparse at the edges. 90% of express terminals are located within a 500 m distance of communities, however, some terminals are shared, which restrict their ability to provide emergency support to surrounding residents. (2) In general, accessibility increases as the number of ESPs increases; under normal traffic, as the distance threshold increases, the available ESPs increase but accessibility slightly decreases; with a traffic lockdown, the travel distance of residents is limited, and as ESPs increase, accessibility and the number of POIs covered significantly increase. (3) The spatial accessibility of the ESPs has a "dumbbell-shaped" distribution, with highest accessibility in the north and south, higher around the second ring road, slightly lower in the center, and lowest near the third ring road at east and west. (4) With the goal of "opening up the logistics artery and unblocking the distribution microcirculation", based on "ESPs + couriers + express logistics terminals + residents", this paper proposes to build and optimize the urban emergency support and delivery service system to improve the comprehensive ability of the city to cope with uncertain risks.
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Affiliation(s)
- Jianpo Wang
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China ,Xi’an Public Security Bureau, 710000 Xi’an, China
| | - Gang Li
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China ,grid.412262.10000 0004 1761 5538Shaanxi Key Laboratory of Earth Surface System and Environmental Carrying Capacity, Northwest University, 710127 Xi’an, China
| | - Jiaobei Wang
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China
| | - Qifan Nie
- grid.411015.00000 0001 0727 7545Department of Civil, Construction and Environmental Engineering, The University of Alabama, 35487 Tuscaloosa, AL USA
| | - Yue Yu
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China
| | - Tingting Xu
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China
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8
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Spatial Accessibility of Primary Health Care in Rural Areas in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179282. [PMID: 34501871 PMCID: PMC8431058 DOI: 10.3390/ijerph18179282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to assess the spatial accessibility of basic and universal healthcare (understood as primary healthcare (PHC) facilities) in rural statistical localities in Poland. Data from the National Health Fund, Central Statistical Office, National Register of Geographic Names and OpenStreetMap were used in the research. The research was carried out on the basis of modelled distance from the rural statistical localities to the nearest PHC facility. The methods used included network analysis, characteristics of normal point distribution, Theil index, and spatial autocorrelation. Areas where the greatest shortages of access to PHC facilities occurred were indicated on the basis of the analysis of their clustering density. The average distance from rural statistical localities in Poland to PHC facilities is about 5 km. Slightly more than 70% of the distance values are within one standard deviation of the mean. Better access to the examined healthcare facilities is available in the southern and central parts of Poland, while northern and eastern Poland, as well as the border areas, suffer from lower accessibility. Poor access to PHC occurs first of all at the border of Greater Poland Voivodeship with the Kuyavian-Pomeranian Voivodeship, on the border of the Lodz Voivodeship, in Masovian and Swietokrzyskie Voivodeship, and in the ring surrounding Warsaw, as well as in the Pomeranian Voivodeship. The research findings can be used to develop strategies to improve the accessibility of primary care facilities in rural areas.
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9
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Zhang L. Trap of weights: The reuse of weights in the floating catchment area (FCA) methods to measuring accessibility. F1000Res 2021; 10:751. [PMID: 37124452 PMCID: PMC10130702 DOI: 10.12688/f1000research.51483.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Geographic weights are vital in the floating catchment area (FCA) method of accessibility measurements due to their simulation of spatial barriers in various ways. When modelling population demand, geographical weights with different distance decay coefficients can reflect diverse distance tolerances in facility utilization and could lead to erratic accessibility results. Quantifying accessibility as the sum of weighted supply-demand ratios can alleviate the distance decay coefficient's influence and generate stable geographic patterns. However, the effects of weighted ratios on different FCA models and resources have not been investigated. Methods: To identify impacts of weighted ratios on various FCA variants, this study contrasted the accessibility calculated from the sum of ratios (access) and the sum of weighted ratios (access ratios) within three prevalent FCA models: enhanced two-step FCA (E2SFCA), modified two-step FCA (M2SFCA), and three-step FCA (3SFCA). In addition, the accessibilities of various resources evaluate the stability of the weighted ratios' effect. This study therefore examined the accessibilities to primary schools, job opportunities, and major hospitals in Shanghai. Shanghai is a case study that provides lessons on using big data to measure accessibility in metropolitan areas. Results: Geographic weights can not only mitigate the impact of the distance decay coefficients, but can also eliminate model features, which reduces the performance of the M2SFCA's supply decay and the 3SFCA's population demand adjustment in accessibility results. Moreover, weighted ratios tend to overestimate accessibility in marginal communities that lie within fewer catchments, regardless of the resource type. This tendency can lead to an epistemological trap that creates an inaccurate and counter-intuitive perception of resource distribution in a given area. Conclusions: The results identify a gap between the methodological logic and the empirical perception in accessibility measurements. This study concludes that the use of geographic weights needs to be cautious and epistemologically consistent.
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Affiliation(s)
- Lina Zhang
- Department of Urban and Regional Planning, The Faculty of Spatial Planning, TU Dortmund University, Dortmund, 44149, Germany
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10
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Rumble DD, O'Neal K, Overstreet DS, Penn TM, Jackson P, Aroke EN, Sims AM, King AL, Hasan FN, Quinn TL, Long DL, Sorge RE, Goodin BR. Sleep and neighborhood socioeconomic status: a micro longitudinal study of chronic low-back pain and pain-free individuals. J Behav Med 2021; 44:811-821. [PMID: 34106368 DOI: 10.1007/s10865-021-00234-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/03/2021] [Indexed: 02/08/2023]
Abstract
Individuals with chronic low back pain (cLBP) frequently report sleep disturbances. Living in a neighborhood characterized by low-socioeconomic status (SES) is associated with a variety of negative health outcomes, including poor sleep. Whether low-neighborhood SES exacerbates sleep disturbances of people with cLBP, relative to pain-free individuals, has not previously been observed. This study compared associations between neighborhood-level SES, pain-status (cLBP vs. pain-free), and daily sleep metrics in 117 adults (cLBP = 82, pain-free = 35). Neighborhood-level SES was gathered from Neighborhood Atlas, which provides a composite measurement of overall neighborhood deprivation (e.g. area deprivation index). Individuals completed home sleep monitoring for 7-consecutive days/nights. Neighborhood SES and pain-status were tested as predictors of actigraphic sleep variables (e.g., sleep efficiency). Analyses revealed neighborhood-level SES and neighborhood-level SES*pain-status interaction significantly impacted objective sleep quality. These findings provide initial support for the negative impact of low neighborhood-level SES and chronic pain on sleep quality.
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Affiliation(s)
- Deanna D Rumble
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA.
| | | | - Demario S Overstreet
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA
| | - Terence M Penn
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA
| | - Pamela Jackson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edwin N Aroke
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew M Sims
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Annabel L King
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA
| | - Fariha N Hasan
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA
| | - Tammie L Quinn
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA
| | - D Leann Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert E Sorge
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237B, Birmingham, AL, 35294, USA
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11
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Home-Based Locational Accessibility to Essential Urban Services: The Case of Wake County, North Carolina, USA. SUSTAINABILITY 2020. [DOI: 10.3390/su12219142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accessibility is an important concept in urban studies and planning, especially on issues related to sustainable transportation planning and urban spatial structure. This paper develops an optimization model to examine the accessibility from single family homes to major urban facilities for services or amenities using geographical information systems. The home-based accessibility to facilities is based upon the point to point direct distance from sampled homes to sampled facilities. Descriptive statistics about the accessibility, such as min/max, mean/median, and standard deviation/variance were computed. Variations of accessibility for a range of categories by home price and year built were also examined. Multivariate linear regression models examining the housing value with respect to home-facility accessibility by facility types were implemented. The results show that desirable urban facilities, which are also more frequently used for livability, enjoy better accessibility than undesirable urban facilities. The home-based accessibility’s positive or negative associations with home price along with year built and/or residential lot size exist for most facilities in general, and by confirming to the literature, the home-facility accessibility in particular does strongly impact home values as evidenced by fair to excellent R2 values. Accordingly, this research provides evidence-based recommendations for sustainable urban mobility and urban planning.
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12
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Disparities in Geographical Access to Hospitals in Portugal. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2020. [DOI: 10.3390/ijgi9100567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.
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13
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Zhao P, Li S, Liu D. Unequable spatial accessibility to hospitals in developing megacities: New evidence from Beijing. Health Place 2020; 65:102406. [PMID: 32877867 PMCID: PMC7456595 DOI: 10.1016/j.healthplace.2020.102406] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/11/2020] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Abstract
The increasing inequality in spatial accessibility to hospitals in developing countries has been attracting attention from researchers and politicians. The situation seems to be worse in growing megacities where more than 10 million people live and rapid urban sprawl has caused serious problems with the supply of health and public transport services. The recent global COVID-19 pandemic calls for particular attention to be afforded to the matter of equal access to basic medical facilities and services for people across different neighborhoods. Although some studies have already been undertaken into the subject of health-focused inequality in the cities of developing countries, the spatial inequity in hospital accessibility has rarely been discussed to date. In this paper, I aim to provide new evidence by considering Beijing as a case study. With the results of my analysis, I show that low-income neighborhoods have experienced lower levels of accessibility not only to high-tier hospitals (secondary and tertiary hospitals) but also to primary healthcare services (primary hospital and neighborhood clinics). The rate at which high-income neighborhoods access secondary and tertiary hospitals is approximately 4 times and 1.5 times as high as that of low-income neighborhoods. Low-income face nearly twice the travel time of those from high-income neighborhoods to reach the nearest primary hospital or neighborhood clinics. Suburban neighborhoods have less access to medical services than neighborhoods that are located in the central urban areas. It seems that the rapid urban sprawl has been worsening spatial inequality in the context of access to medical services in the growing megacity of Beijing. Equal access to healthcare services should be prioritized in future policy discussions, especially in relation to the urban growth management of megacities in developing countries in order to ensure that fair and inclusive urbanization processes are undertaken. Equal access to healthcare services would also be widely beneficial in the context of managing the COVID-19 pandemic.
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Affiliation(s)
- Pengjun Zhao
- College of Urban and Environmental Sciences, Peking University, PR China.
| | - Shengxiao Li
- College of Urban and Environmental Sciences, Peking University, PR China.
| | - Di Liu
- College of Urban and Environmental Sciences, Peking University, PR China.
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14
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Yitshak-Sade M, Lane KJ, Fabian MP, Kloog I, Hart JE, Davis B, Fong KC, Schwartz JD, Laden F, Zanobetti A. Race or racial segregation? Modification of the PM2.5 and cardiovascular mortality association. PLoS One 2020; 15:e0236479. [PMID: 32716950 PMCID: PMC7384646 DOI: 10.1371/journal.pone.0236479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 07/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Many studies have identified an inequitable distribution of exposure to PM2.5 (particulate matter less than 2.5 microns) by race. We investigated the association of PM2.5 and cardiovascular mortality considering both the decedents' race and neighborhood racial composition as potential modifiers. METHODS We obtained geocoded cardiovascular mortality records of all black and white decedents from urban block-groups in Massachusetts between 2001 and 2011 (n = 130,863). We examined the association between PM2.5 and cardiovascular mortality, and assessed effect modification by three types of racial modifiers: decedents' race, census block-group percent black and white, and two novel measures of racial segregation. The Racial Residential Segregation (RRS) quantifies the concentration of non-Hispanic blacks and whites in each block-group. The Index of Racial Dissimilarity measures dissimilarity in non-Hispanic black and white racial distribution between the smaller census block-group and larger tract. RESULTS We found a 2.35%(95%CI: 0.92%;3.79%) increase in mortality for each 10μg/m3 increase in two-day average exposure to PM2.5. The effect was modified by the block-group racial composition, with higher risks in block-groups with the highest percentage of black residents (interaction p-value = 0.04), and in block-groups with the lowest RRS (i.e. higher black to white resident ratio, interaction p-value = 0.072). Racial dissimilarity did not modify the associations. CONCLUSION Current levels of PM2.5 are associated with increased cardiovascular deaths in Massachusetts, with different risks between areas with different racial composition and segregation. This suggests that pollution reductions in neighborhoods with the highest percentage of non-Hispanic blacks would be most beneficial in reducing cardiovascular mortality and disparities.
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Affiliation(s)
- Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Kevin J. Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Jaime E. Hart
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Brigette Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Kelvin C. Fong
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- School of Forestry & Environmental Sciences, Yale University, New Haven, CT, United States of America
| | - Joel D. Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Francine Laden
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Antonella Zanobetti
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Saunders MR, Ricardo AC, Chen J, Anderson AH, Cedillo-Couvert EA, Fischer MJ, Hernandez-Rivera J, Hicken MT, Hsu JY, Zhang X, Hynes D, Jaar B, Kusek JW, Rao P, Feldman HI, Go AS, Lash JP. Neighborhood socioeconomic status and risk of hospitalization in patients with chronic kidney disease: A chronic renal insufficiency cohort study. Medicine (Baltimore) 2020; 99:e21028. [PMID: 32664108 PMCID: PMC7360239 DOI: 10.1097/md.0000000000021028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with chronic kidney disease (CKD) experience significantly greater morbidity than the general population. The hospitalization rate for patients with CKD is significantly higher than the general population. The extent to which neighborhood-level socioeconomic status (SES) is associated with hospitalization has been less explored, both in the general population and among those with CKD.We evaluated the relationship between neighborhood SES and hospitalizations for adults with CKD participating in the Chronic Renal Insufficiency Cohort Study. Neighborhood SES quartiles were created utilizing a validated neighborhood-level SES summary measure expressed as z-scores for 6 census-derived variables. The relationship between neighborhood SES and hospitalizations was examined using Poisson regression models after adjusting for demographic characteristics, individual SES, lifestyle, and clinical factors while taking into account clustering within clinical centers and census block groups.Among 3291 participants with neighborhood SES data, mean age was 58 years, 55% were male, 41% non-Hispanic white, 49% had diabetes, and mean estimated glomerular filtration rate (eGFR) was 44 ml/min/1.73 m. In the fully adjusted model, compared to individuals in the highest SES neighborhood quartile, individuals in the lowest SES neighborhood quartile had higher risk for all-cause hospitalization (rate ratio [RR], 1.28, 95% CI, 1.09-1.51) and non-cardiovascular hospitalization (RR 1.30, 95% CI, 1.10-1.55). The association with cardiovascular hospitalization was in the same direction but not statistically significant (RR 1.21, 95% CI, 0.97-1.52).Neighborhood SES is associated with risk for hospitalization in individuals with CKD even after adjusting for individual SES, lifestyle, and clinical factors.
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Affiliation(s)
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jinsong Chen
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Amanda H. Anderson
- Center for Clinical Epidemiology and Biostatistics
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Michael J. Fischer
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VAMC, Chicago, IL
| | | | | | - Jesse Y. Hsu
- Center for Clinical Epidemiology and Biostatistics
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Denise Hynes
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
- College of Public Health and Human Sciences, Oregon State University, and US Department of Veterans Affairs, Portland, OR
| | - Bernard Jaar
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - John W. Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Panduranga Rao
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Harold I. Feldman
- Center for Clinical Epidemiology and Biostatistics
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
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Shah T, Milosavljevic S, Bath B. Geographic availability to optometry services across Canada: mapping distribution, need and self-reported use. BMC Health Serv Res 2020; 20:639. [PMID: 32650762 PMCID: PMC7350740 DOI: 10.1186/s12913-020-05499-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services. METHODS Optometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population 'need' subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ±0.5SD from the mean was considered as a cut-off. Three classes: low (< - 0.5SD), moderate (- 0.5 to 0.5SD), and high (> 0.5SD) were used for demonstrating distribution of each variable across health regions. RESULTS A total of 5959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services. CONCLUSION This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to "supply" and "need" factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.
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Affiliation(s)
- Tayyab Shah
- School of Rehabilitation Science, University of Saskatchewan, Suite 3400, 3rd Floor, 104 Clinic Pl, Saskatoon, Saskatchewan S7N 2Z4 Canada
- School of Geography, Earth Science, and Environment, University of the South Pacific, Suva, Fiji
| | - Stephan Milosavljevic
- School of Rehabilitation Science, University of Saskatchewan, Rm 3410, Health Sciences Building, 104 Clinic Place PO Box 23, Saskatoon, Saskatchewan S7N 2Z4 Canada
| | - Brenna Bath
- School of Rehabilitation Science and Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Rm 1340 - E wing - Health Sciences Building, 104 Clinic Place PO Box 23, Saskatoon, Saskatchewan S7N 2Z4 Canada
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Paez A, Higgins CD, Vivona SF. Demand and level of service inflation in Floating Catchment Area (FCA) methods. PLoS One 2019; 14:e0218773. [PMID: 31246984 PMCID: PMC6597094 DOI: 10.1371/journal.pone.0218773] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 06/11/2019] [Indexed: 12/19/2022] Open
Abstract
Floating Catchment Area (FCA) methods are a popular tool to investigate accessibility to public facilities, in particular health care services. FCA approaches are attractive because, unlike other accessibility measures, they take into account the potential for congestion of facilities. This is done by 1) considering the population within the catchment area of a facility to calculate a variable that measures level of service, and then 2) aggregating the level of service by population centers subject to catchment area constraints. In this paper we discuss an effect of FCA approaches, an artifact that we term demand and level of service inflation. These artifacts are present in previous implementations of FCA methods. We argue that inflation makes interpretation of estimates of accessibility difficult, which has possible deleterious consequences for decision making. Next, we propose a simple and intuitive approach to proportionally allocate demandand and level of service in FCA calculations. The approach is based on a standardization of the impedance matrix, similar to approaches popular in the spatial statistics and econometrics literature. The result is a more intiuitive measure of accessibility that 1) provides a local version of the provider-to-population ratio; and 2) preserves the level of demand and the level of supply in a system. We illustrate the relevant issues with some examples, and then empirically by means of a case study of accessibility to family physicians in the Hamilton Census Metropolitan Area (CMA), in Ontario, Canada. Results indicate that demand and supply inflation/deflation affect the interpretation of accessibility analysis using existing FCA methods, and that the proposed adjustment can lead to more intuitive results.
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Affiliation(s)
- Antonio Paez
- School of Geography and Earth Sciences, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Christopher D. Higgins
- Department of Land Surveying and Geo-Informatics & Department of Building and Real Estate, 11 Yuk Choi Rd, Hung Hom, Hong Kong
| | - Salvatore F. Vivona
- Department of Computer Science, University of Toronto, 214 College Street, Toronto, ON, M5T 3A1 Canada
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Addressing the Health and Wellness Needs of Vulnerable Rockaway Residents in the Wake of Hurricane Sandy: Findings From a Health Coaching and Community Health Worker Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:137-145. [DOI: 10.1097/phh.0000000000000545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Ludden TM, Taylor YJ, Simmons LK, Smith HA, de Hernandez BU, Tapp H, Furuseth OJ, Dulin MF. Using Community-Based Participatory Research to Develop Geospatial Models Toward Improving Community Health for Disadvantaged Hispanic Populations in Charlotte, NC. J Prim Prev 2018; 39:171-190. [PMID: 29484532 DOI: 10.1007/s10935-018-0505-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hispanic immigrant communities across the U.S. experience persistent health disparities and barriers to primary care. We examined whether community-based participatory research (CBPR) and geospatial modeling could systematically and reproducibly pinpoint neighborhoods in Charlotte, North Carolina with large proportions of Hispanic immigrants who were at-risk for poor health outcomes and health disparities. Using a CBPR framework, we identified 21 social determinants of health measures and developed a geospatial model from a subset of those measures to identify neighborhoods with large proportions of Hispanic immigrant populations at risk for poor health outcomes. The geospatial model included four measures-poverty, English ability, acculturation and violent crime-which comprised our Hispanic Health Risk Index (HHRI). We developed a Primary Care Barrier Index (PCBI) to determine (1) how well the HHRI correlated with a statistically derived composite measure incorporating all 21 measures identified through the CBPR process as being associated with access to primary care; (2) whether the HHRI predicted primary care access as well as the statistically-derived composite measure in a statistical model; and (3) whether the HHRI identified similar neighborhoods as the statistically derived composite measure. We collapsed 17 of the 21 social determinants using principal components analysis to develop the PCBI. We determined the correlation of each index with inappropriate emergency department (ED) visits, a proxy for primary care access, using logistic generalized estimating equations. Results from logistic regression models showed positive associations of both the HHRI and the PCBI with the use of the ED for primary care treatable conditions. Enhanced by the knowledge of the local community, the CBPR process with geospatial modeling can guide the multi-tiered validation of social determinants of health and identify neighborhoods that are at-risk for poor health outcomes and health disparities.
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Affiliation(s)
- Thomas M Ludden
- Department of Family Medicine, Atrium Health, Charlotte, NC, 28207, USA.
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, Charlotte, NC, 28203, USA
| | - Laura K Simmons
- Urban Institute, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA
| | - Heather A Smith
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA
| | | | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, NC, 28207, USA
| | - Owen J Furuseth
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA
| | - Michael F Dulin
- Department of Family Medicine, Atrium Health, Charlotte, NC, 28207, USA
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20
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Comparing alternative methods to measuring pedestrian access to community pharmacies. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2017. [DOI: 10.1007/s10742-017-0173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Determining geographic accessibility of family physician and nurse practitioner services in relation to the distribution of seniors within two Canadian Prairie Provinces. Soc Sci Med 2017; 194:96-104. [DOI: 10.1016/j.socscimed.2017.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/30/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
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Fox M, Thayer Z, Wadhwa PD. Acculturation and health: the moderating role of socio-cultural context. AMERICAN ANTHROPOLOGIST 2017; 119:405-421. [PMID: 28966344 PMCID: PMC5617140 DOI: 10.1111/aman.12867] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 02/04/2017] [Indexed: 12/25/2022]
Abstract
Acculturation represents an important construct for elucidating the determinants and consequences of health disparities in minority populations. However, the processes and mechanisms underlying acculturation's effects on health are largely undetermined and warrant further study. We integrate concepts from anthropology and statistics to describe the role of sociocultural context as a putative modifier of the relationship between acculturation and health. Sociocultural context may influence the extent to which exposure to host culture leads to internalization of host cultural orientation, and may influence the extent to which acculturation leads to stress and adoption of unhealthy behaviors. We focus on specific aspects of sociocultural context: (1) neighborhood ethno-cultural composition; (2) discrimination; (3) discrepancy between origin and host environments; (4) discrepancy between heritage and host cultures; (5) origin group, host group, and individual attitudes towards assimilation; (6) variation in targets of assimilation within host community; (7) public policy and resources; (8) migration selection bias. We review and synthesize evidence for these moderation effects among first- and later-generation immigrants, refugees, and indigenous populations. Furthermore, we propose best-practices data-collection and statistical-analysis methods for this purpose, in order to improve our understanding of the complex, multilevel aspects of the relationship between acculturation and health.
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Affiliation(s)
- Molly Fox
- Department of Anthropology, UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Zaneta Thayer
- Department of Anthropology, Dartmouth College, Hanover, NH, USA
| | - Pathik D. Wadhwa
- Department of Psychiatry & Human Behavior, Health and Disease Research Program, UC Irvine, Irvine, CA, USA
- Department of Obstetrics & Gynecology, Health and Disease Research Program, UC Irvine, Irvine, CA, USA
- Department of Epidemiology, Health and Disease Research Program, UC Irvine, Irvine, CA, USA
- Department of Development, Health and Disease Research Program, UC Irvine, Irvine, CA, USA
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Apparicio P, Gelb J, Dubé AS, Kingham S, Gauvin L, Robitaille É. The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues. Int J Health Geogr 2017; 16:32. [PMID: 28830461 PMCID: PMC5568316 DOI: 10.1186/s12942-017-0105-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/16/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The potential spatial access to urban health services is an important issue in health geography, spatial epidemiology and public health. Computing geographical accessibility measures for residential areas (e.g. census tracts) depends on a type of distance, a method of aggregation, and a measure of accessibility. The aim of this paper is to compare discrepancies in results for the geographical accessibility of health services computed using six distance types (Euclidean and Manhattan distances; shortest network time on foot, by bicycle, by public transit, and by car), four aggregation methods, and fourteen accessibility measures. METHODS To explore variations in results according to the six types of distance and the aggregation methods, correlation analyses are performed. To measure how the assessment of potential spatial access varies according to three parameters (type of distance, aggregation method, and accessibility measure), sensitivity analysis (SA) and uncertainty analysis (UA) are conducted. RESULTS First, independently of the type of distance used except for shortest network time by public transit, the results are globally similar (correlation >0.90). However, important local variations in correlation between Cartesian and the four shortest network time distances are observed, notably in suburban areas where Cartesian distances are less precise. Second, the choice of the aggregation method is also important: compared with the most accurate aggregation method, accessibility measures computed from census tract centroids, though not inaccurate, yield important measurement errors for 10% of census tracts. Third, the SA results show that the evaluation of potential geographic access may vary a great deal depending on the accessibility measure and, to a lesser degree, the type of distance and aggregation method. Fourth, the UA results clearly indicate areas of strong uncertainty in suburban areas, whereas central neighbourhoods show lower levels of uncertainty. CONCLUSION In order to accurately assess potential geographic access to health services in urban areas, it is particularly important to choose a precise type of distance and aggregation method. Then, depending on the research objectives, the choices of the type of network distance (according to the mode of transportation) and of a number of accessibility measures should be carefully considered and adequately justified.
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Affiliation(s)
- Philippe Apparicio
- Centre Urbanisation Culture Société, Institut National de la Recherche Scientifique, 385 Sherbrooke Street East, Montréal, QC H2X 1E3 Canada
| | - Jérémy Gelb
- Centre Urbanisation Culture Société, Institut National de la Recherche Scientifique, 385 Sherbrooke Street East, Montréal, QC H2X 1E3 Canada
| | - Anne-Sophie Dubé
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Montréal, P.O. Box 6128, Downtown Station, Montréal, QC H3C 3J7 Canada
| | - Simon Kingham
- GeoHealth Laboratory, Department of Geography, University of Canterbury, Private Bag 4800, Christchurch, 8140 New Zealand
| | - Lise Gauvin
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Montréal, P.O. Box 6128, Downtown Station, Montréal, QC H3C 3J7 Canada
| | - Éric Robitaille
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Montréal, P.O. Box 6128, Downtown Station, Montréal, QC H3C 3J7 Canada
- Institut National de Santé Publique du Québec, 190 Boulevard Crémazie Est, Montréal, QC H2P 1E2 Canada
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Shah TI, Milosavljevic S, Bath B. Measuring geographical accessibility to rural and remote health care services: Challenges and considerations. Spat Spatiotemporal Epidemiol 2017; 21:87-96. [DOI: 10.1016/j.sste.2017.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/08/2017] [Accepted: 04/18/2017] [Indexed: 11/25/2022]
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Bauer J, Müller P, Maier W, Groneberg DA. Orthopedic workforce planning in Germany - an analysis of orthopedic accessibility. PLoS One 2017; 12:e0171747. [PMID: 28178335 PMCID: PMC5298336 DOI: 10.1371/journal.pone.0171747] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
Abstract
In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the 'official degree of care provision'. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.
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Affiliation(s)
- Jan Bauer
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Germany
| | - Peter Müller
- Public Health Foundation (‘Stiftung Gesundheit’), Hamburg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, Neuherberg, Germany
| | - David A. Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Germany
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Shah TI, Bell S, Wilson K. Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas. PLoS One 2016; 11:e0168208. [PMID: 27997577 PMCID: PMC5172578 DOI: 10.1371/journal.pone.0168208] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods. METHODS This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations. RESULTS The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs. CONCLUSIONS The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.
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Affiliation(s)
- Tayyab Ikram Shah
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Scott Bell
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathi Wilson
- Department of Geography, University of Toronto Mississauga, Mississauga, Ontario, Canada
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Hussein M, Diez Roux AV, Field RI. Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area. J Urban Health 2016; 93:1027-1045. [PMID: 27718048 PMCID: PMC5126022 DOI: 10.1007/s11524-016-0085-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neighborhood socioeconomic status (SES), an overall marker of neighborhood conditions, may determine residents' access to health care, independently of their own individual characteristics. It remains unclear, however, how the distinct settings where individuals seek care vary by neighborhood SES, particularly in US urban areas. With existing literature being relatively old, revealing how these associations might have changed in recent years is also timely in this US health care reform era. Using data on the Philadelphia region from 2002 to 2012, we performed multilevel analysis to examine the associations of neighborhood SES (measured as census tract median household income) with access to usual sources of primary care (physician offices, community health centers, and hospital outpatient clinics). We found no evidence that residence in a low-income (versus high-income) neighborhood was associated with poorer overall access. However, low-income neighborhood residence was associated with less reliance on physician offices [-4.40 percentage points; 95 % confidence intervals (CI) -5.80, -3.00] and greater reliance on the safety net provided by health centers [2.08; 95 % CI 1.42, 2.75] and outpatient clinics [1.61; 95 % CI 0.97, 2.26]. These patterns largely persisted over the 10 years investigated. These findings suggest that safety-net providers have continued to play an important role in ensuring access to primary care in urban, low-income communities, further underscoring the importance of supporting a strong safety net to ensure equitable access to care regardless of place of residence.
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Affiliation(s)
- Mustafa Hussein
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Robert I Field
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Nichols M, Nemeth LS, Magwood G, Odulana A, Newman S. Exploring the Contextual Factors of Adolescent Obesity in an Underserved Population Through Photovoice. FAMILY & COMMUNITY HEALTH 2016; 39:301-309. [PMID: 27536935 DOI: 10.1097/fch.0000000000000118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Obesity, a global health epidemic, requires targeted interventions to promote sustainable health behavior change; yet, prior efforts have not yielded significant improvements in obesity rates. Using Photovoice as a data collection approach, this community-engaged research study partnered with a weight management program to understand participants' perspectives on access to physical activity and nutritious food. Twelve adolescent-parent dyads participated. Barriers, facilitators, and opportunities for change were identified and categorized through adolescent photographs, interviews, and participant focus groups, according to the social ecological model. A community-engaged research approach can identify areas to increase health promotion and prevention efforts regarding physical activity and nutrition.
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Affiliation(s)
- Michelle Nichols
- Colleges of Nursing (Drs Nichols, Nemeth, Magwood, and Newman) and Medicine (Dr Odulana), Medical University of South Carolina, Charleston
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Dasgupta S, Kramer MR, Rosenberg ES, Sanchez TH, Sullivan PS. Development of a comprehensive measure of spatial access to HIV provider services, with application to Atlanta, Georgia. SPRINGERPLUS 2016; 5:984. [PMID: 27429893 PMCID: PMC4932000 DOI: 10.1186/s40064-016-2515-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/06/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND No existing measures of HIV care access consider both spatial proximity to services and provider-related characteristics in a single measure. We developed and applied a tool to: (1) quantify spatial access to HIV care services (supply) and (2) identify underserved areas with respect to HIV cases (demand), by travel mode, in Atlanta. METHODS Building on a study of HIV care engagement, data from an HIV care provider database, and HIV case counts by zip code tabulation area (ZCTA) from AIDSVu.org, we fit a discrete choice model to estimate practice characteristics most salient in defining patient care access. Modified spatial gravity modeling quantified supply access based on discrete choice model results separately for travel by car and by public transportation. Relative access scores were calculated by ZCTA, and underserved areas (defined as having low supply access and high HIV case count) were identified for each travel mode. RESULTS Characteristics retained in the final model included: travel distance, available provider-hours, availability of ancillary services, and whether Ryan White patients were accepted. HIV provider supply was higher in urban versus suburban/rural areas for both travel modes, with lower supply access if traveling by public transportation. Underserved areas were concentrated in south and east Atlanta if traveling by public transportation, overlapping with many areas of high poverty. Approximately 7.7 %, if traveling by car, and 64.3 %, if traveling by public transportation, of Atlanta-based persons with diagnosed HIV infection resided in underserved areas. CONCLUSION These findings highlight underserved areas in south and east Atlanta if traveling by public transit. Conceptualizing access to medical services spatially and by travel mode may help bridge gaps between patient needs and service availability and improve HIV outcomes.
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Affiliation(s)
- Sharoda Dasgupta
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Michael R. Kramer
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Eli S. Rosenberg
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Travis H. Sanchez
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Patrick S. Sullivan
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
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Lankila T, Näyhä S, Rautio A, Rusanen J, Taanila A, Koiranen M. Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland. Public Health 2015; 131:82-91. [PMID: 26715323 DOI: 10.1016/j.puhe.2015.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 08/26/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the role of distance in public primary health service use in rural and urban local residential areas (1 km² grids) among the young adults of the Northern Finland Birth Cohort 1966 (N = 4503). STUDY DESIGN Cross-sectional study of a cohort born in Northern Finland in 1966. METHODS Use of local health centres was surveyed by postal questionnaire in 1997, and distance from study subjects' home to health centre was calculated along road network. The crude and adjusted incidence rate ratios (IRR) and their 95% confidence intervals were calculated for distance, predisposing and illness-level variables. Distance-related health inequity indices were calculated. RESULTS The IRRs indicated 1.5-fold higher rate of health centre visits among subjects living farther than 10 km compared to subjects living within 2 km from health centre in urban areas. In rural areas, IRRs indicated no significant association with distance and health centre use. No distance-related inequity in the use of health centre services was found. CONCLUSIONS Distance does not seem to be major barrier in health service use among these 31-year old adults. However, closer study of some groups, such as the rural unemployed, might be valuable.
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Affiliation(s)
- T Lankila
- Department of Geography, University of Oulu, PO Box 3000, 90014, Oulu, Finland; Center for Life Course Epidemiology and Systems Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
| | - S Näyhä
- Center for Environmental and Respiratory Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
| | - A Rautio
- Centre for Arctic Medicine, Thule Institute, University of Oulu, PO Box 7300, 900014, Oulu, Finland.
| | - J Rusanen
- Department of Geography, University of Oulu, PO Box 3000, 90014, Oulu, Finland.
| | - A Taanila
- Center for Life Course Epidemiology and Systems Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland; Unit of General Practice, Oulu University Hospital, PO Box 5000, 900014 Oulu, Finland.
| | - M Koiranen
- Center for Life Course Epidemiology and Systems Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
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Vora KS, Yasobant S, Patel A, Upadhyay A, Mavalankar DV. Has Chiranjeevi Yojana changed the geographic availability of free comprehensive emergency obstetric care services in Gujarat, India? Glob Health Action 2015; 8:28977. [PMID: 26446287 PMCID: PMC4596889 DOI: 10.3402/gha.v8.28977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/26/2015] [Accepted: 09/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public-private partnership program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India. METHODS Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA) method. RESULTS Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance. CONCLUSIONS This paper demonstrates how GIS could be useful for evaluating programs especially those focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for programmatic planning, particularly for optimizing resource allocation.
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Affiliation(s)
| | - Sandul Yasobant
- Indian Institute of Public Health - Gandhinagar, Ahmedabad, India
| | - Amit Patel
- School of Policy, Government, and International Affairs, George Mason University, Fairfax, VA, USA
| | - Ashish Upadhyay
- Indian Institute of Public Health - Gandhinagar, Ahmedabad, India
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Polo G, Acosta CM, Ferreira F, Dias RA. Location-allocation and accessibility models for improving the spatial planning of public health services. PLoS One 2015; 10:e0119190. [PMID: 25775411 PMCID: PMC4361743 DOI: 10.1371/journal.pone.0119190] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 01/29/2015] [Indexed: 11/24/2022] Open
Abstract
This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA) model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.
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Affiliation(s)
- Gina Polo
- Laboratory of Epidemiology and Biostatistics. Department of Preventive Veterinary Medicine and Animal Health. University of São Paulo, São Paulo, Brasil
| | - C. Mera Acosta
- Institute of Physics. University of São Paulo, São Paulo, Brasil
| | - Fernando Ferreira
- Laboratory of Epidemiology and Biostatistics. Department of Preventive Veterinary Medicine and Animal Health. University of São Paulo, São Paulo, Brasil
| | - Ricardo Augusto Dias
- Laboratory of Epidemiology and Biostatistics. Department of Preventive Veterinary Medicine and Animal Health. University of São Paulo, São Paulo, Brasil
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Fransen K, Neutens T, De Maeyer P, Deruyter G. A commuter-based two-step floating catchment area method for measuring spatial accessibility of daycare centers. Health Place 2015; 32:65-73. [PMID: 25638791 DOI: 10.1016/j.healthplace.2015.01.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/03/2014] [Accepted: 01/05/2015] [Indexed: 11/25/2022]
Abstract
This paper puts forward a commuter-based version of the two-step floating catchment area (2SFCA) method, which has gained acceptance in studies on spatial health care accessibility. Current implementations of the 2SFCA method are static in that they consider centroid-based night-time representations of the population. The proposed enhancement to the 2SFCA approach addresses this limitation by accounting for trip-chaining behavior. The presented method is illustrated in a case study of accessibility of daycare centers in the province East Flanders in Belgium. The results show significant spatial differences in accessibility between the original and commuter-based version of the 2SFCA (CB2SFCA). They highlight the importance of giving heed to more complex travel behavior in cases where the need for detailed accessibility calculations is apparent.
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Affiliation(s)
- Koos Fransen
- Department of Industrial Engineering, Ghent University, Valentin Vaerwyckweg 1, 9000 Ghent, Belgium; Department of Geography, Ghent University, Krijgslaan 281 S8, 9000 Ghent, Belgium.
| | - Tijs Neutens
- Department of Geography, Ghent University, Krijgslaan 281 S8, 9000 Ghent, Belgium.
| | - Philippe De Maeyer
- Department of Geography, Ghent University, Krijgslaan 281 S8, 9000 Ghent, Belgium.
| | - Greet Deruyter
- Department of Industrial Engineering, Ghent University, Valentin Vaerwyckweg 1, 9000 Ghent, Belgium; Department of Geography, Ghent University, Krijgslaan 281 S8, 9000 Ghent, Belgium.
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Yasaitis LC, Bubolz T, Skinner JS, Chandra A. Local population characteristics and hemoglobin A1c testing rates among diabetic medicare beneficiaries. PLoS One 2014; 9:e111119. [PMID: 25360615 PMCID: PMC4215926 DOI: 10.1371/journal.pone.0111119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Proposed payment reforms in the US healthcare system would hold providers accountable for the care delivered to an assigned patient population. Annual hemoglobin A1c (HbA1c) tests are recommended for all diabetics, but some patient populations may face barriers to high quality healthcare that are beyond providers' control. The magnitude of fine-grained variations in care for diabetic Medicare beneficiaries, and their associations with local population characteristics, are unknown. METHODS HbA1c tests were recorded for 480,745 diabetic Medicare beneficiaries. Spatial analysis was used to create ZIP code-level estimated testing rates. Associations of testing rates with local population characteristics that are outside the control of providers--population density, the percent African American, with less than a high school education, or living in poverty--were assessed. RESULTS In 2009, 83.3% of diabetic Medicare beneficiaries received HbA1c tests. Estimated ZIP code-level rates ranged from 71.0% in the lowest decile to 93.1% in the highest. With each 10% increase in the percent of the population that was African American, associated HbA1c testing rates were 0.24% lower (95% CI -0.32--0.17); for identical increases in the percent with less than a high school education or the percent living in poverty, testing rates were 0.70% lower (-0.95--0.46) and 1.6% lower (-1.8--1.4), respectively. Testing rates were lowest in the least and most densely populated ZIP codes. Population characteristics explained 5% of testing rate variations. CONCLUSIONS HbA1c testing rates are associated with population characteristics, but these characteristics fail to explain the vast majority of variations. Consequently, even complete risk-adjustment may have little impact on some process of care quality measures; much of the ZIP code-related variations in testing rates likely result from provider-based differences and idiosyncratic local factors not related to poverty, education, or race.
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Affiliation(s)
- Laura C. Yasaitis
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America
- * E-mail:
| | - Thomas Bubolz
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Jonathan S. Skinner
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
- Department of Economics, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Amitabh Chandra
- The John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America
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Allan DP. Catchments of general practice in different countries--a literature review. Int J Health Geogr 2014; 13:32. [PMID: 25174719 PMCID: PMC4150420 DOI: 10.1186/1476-072x-13-32] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/04/2014] [Indexed: 11/25/2022] Open
Abstract
The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus. Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area. This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK. Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the allocation of resources so that opportunities for good health outcomes for all groups within society, especially those who have been systematically denied equitable access, are maximised.
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Affiliation(s)
- Donald P Allan
- Discipline of Public Health, School of Health Sciences, Faculty of Medicine, Nursing & Health Sciences, Flinders University, Health Sciences Building, Registry Road, Bedford Park, SA 5042, Australia.
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Maass R, Lindstrøm B, Lillefjell M. Exploring the relationship between perceptions of neighbourhoodresources, sense of coherence and health for different groups in a norwegian neighbourhood. J Public Health Res 2014; 3:208. [PMID: 25170510 PMCID: PMC4140378 DOI: 10.4081/jphr.2014.208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 12/05/2022] Open
Abstract
Background Health and conditions for health are unevenly distributed across neighbourhoods. Within a salutogenic perspective, neighbourhood-resources can be internalised, and become generalised resistance resources. This paper aims to examine whether the neighbourhood could be a supportive arena for health-promotion, and for whom. Design and Methods A cross-sectional study, based on register data from the population-survey in Malvik, Norway, (N=865) was conducted. Using multiple regression analysis, total sample and sub-group analyses (men/women, low/high earners, employed/unemployed) of 5 independent neighbourhood-measures (overall satisfaction, neighbourhood Social Capital, satisfaction with availability and quality of neighbourhood-resources, and neighbourhood participation) on Sense of Coherence (SOC) and health respectively were obtained. Results Overall satisfaction (β=0.153) and neighbourhood social capital (β=0.134) emerged as the most consistent partial correlates of SOC across groups. In turn, SOC was the strongest coefficient for health-outcomes (β=0.238). Neighbourhood participation had more consistent correlations with health than SOC across groups. Group-differences became visible in proportions of explained variance in SOC (varying from 7 to 23.7%) and health (varying from 6.7 to 20.6%), and in the relative importance of neighbourhood-variables. Satisfaction with quality of neighbourhood-resources was significantly related to SOC in non-workers (β=0.451) and low-earners (β=0.261), and health-outcomes in women (β=0.143). Conclusions Health might be promoted in the neighbourhood mainly through strengthening SOC, and deprived groups, especially non-workers, may benefit most from health-promotion in the neighbourhood. Findings suggest that high satisfaction with quality can contribute to better health-outcomes for groups with weaker average SOC. The proposed theoretical framework is only partly supported. Significance for public health The creation of health-promoting settings has been outlined as one of the main strategies ahead by the Ottawa-charter. Findings from this study suggest that health can be promoted through the neighbourhood, both through strengthening Sense of coherence (SOC), and providing resources for health-promotion. It is suggested that the neighbourhood might be of benefit for promoting health in groups which might be otherwise hard to reach, such as people outside the work-force. Moreover, investigating the relationships between various perceptions of neighbourhood-resources and SOC/health across groups allows for developing strategies for positive change, including improving quality of neighbourhood-resources, and facilitating neighbourhood participation.
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Affiliation(s)
| | - Bengt Lindstrøm
- Research Centre for Health Promotion and Resources and Department of Social Work and Health Sciences, Norwegian University of Science and Technology , Trondheim Norway ; Department of Social Work and Health Sciences, Norwegian University of Science and Technology , Trondheim Norway
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Delamater PL. Spatial accessibility in suboptimally configured health care systems: a modified two-step floating catchment area (M2SFCA) metric. Health Place 2013; 24:30-43. [PMID: 24021921 DOI: 10.1016/j.healthplace.2013.07.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 07/20/2013] [Accepted: 07/30/2013] [Indexed: 11/30/2022]
Abstract
The floating catchment area (FCA) family of metrics employ principles from gravity-based models to incorporate supply, demand, and distance in their characterization of the spatial accessibility of health care resources. Unlike traditional gravity models, the FCA metrics provide an output in highly interpretable container-like units (e.g., physicians per person). This work explores two significant issues related to FCA metrics. First, the Three Step Floating Catchment Area is critically examined. Next, the research shows that all FCA metrics contain an underlying assumption that supply locations are optimally configured to meet the needs of the population within the system. Because truly optimal configurations are highly unlikely in real-world health care systems, a modified two-step floating catchment area (M2SFCA) metric is offered to address this issue. The M2SFCA is built upon previous FCA metrics, but allows for spatial accessibility to be discounted as a result of the suboptimal configuration of health care facilities within the system. The utility of the new metric is demonstrated through simulated data examples and a case study exploring acute care hospitals in Michigan.
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Affiliation(s)
- Paul L Delamater
- Department of Geography, Michigan State University, East Lansing, MI, USA.
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Health inequalities and regional specific scarcity in primary care physicians: ethical issues and criteria. Int J Public Health 2013; 59:449-55. [PMID: 23880912 DOI: 10.1007/s00038-013-0497-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/24/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES A substantial body of evidence supports the beneficial health impact of an increase in primary care physicians for underserved populations. However, given that in many countries primary care physician shortages persist, what options are available to distribute physicians and how can these be seen from an ethical perspective? METHODS A literature review was performed on the topic of primary care physician distribution. An ethical discussion of conceivable options for decision makers that applied prominent theories of ethics was held. RESULTS Examples of distributing primary care physicians were categorised into five levels depending upon levels of incentive or coercion. When analysing these options through theories of ethics, contrasting, and even controversial, moral issues were identified. However, the different morally salient criteria identified are of prima facie value for decision makers. CONCLUSIONS The discussion provides clear criteria for decision makers to consider when addressing primary care physician shortages. Yet, decision makers will still need to assess specific situations by these criteria to ensure that any decisions they make are morally justifiable.
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Bissonnette L, Wilson K, Bell S, Shah TI. Neighbourhoods and potential access to health care: The role of spatial and aspatial factors. Health Place 2012; 18:841-53. [DOI: 10.1016/j.healthplace.2012.03.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/13/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
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Harrington DW, Wilson K, Bell S, Muhajarine N, Ruthart J. Realizing neighbourhood potential? The role of the availability of health care services on contact with a primary care physician. Health Place 2012; 18:814-23. [PMID: 22503325 DOI: 10.1016/j.healthplace.2012.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/02/2012] [Accepted: 03/26/2012] [Indexed: 11/16/2022]
Abstract
Access to health services research has traditionally focused on demographic, socioeconomic, and need-based factors, resulting in a relative lack of knowledge regarding place-based determinants. Further, much of what we know comes from international, national, and regional study. This study analyzes survey data (n=1635) to explore the relationship between neighbourhood-level potential access (i.e., availability) and realized access (i.e., use) in two Canadian cities. Controlling for predisposing, enabling and need factors, living in a well-served neighbourhood was a significant predictor of realized access, particularly in Saskatoon. This suggests that the relationship between potential and realized access may be modified by place-based factors.
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Affiliation(s)
- Daniel W Harrington
- Department of Geography, University of Toronto Mississauga, 3359 Mississauga Rd N, WG Davis Bldg, Mississauga, Ontario, Canada L5L 1C6.
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