107159 research outputs found
Sort by
Economic development and inequality of opportunity: Kuznets meets the Great Gatsby?
Get PDFAccording to the Kuznets hypothesis, inequality first tends to increase and then decrease as a country develops. Whether borne out empirically, this inverted-U Kuznets curve, as a stylized ‘fact’, has shaped the discourse on economic development and income inequality for decades. In this paper we investigate whether a similar relationship holds between national income per capita and inequality of opportunity: the inequality associated with inherited individual circumstances such as gender, ethnicity, and family background. As, empirically, inequality of opportunity is positively correlated with income inequality (a relationship known as the ‘Great Gatsby’ curve), the relationship between inequality of opportunity and ‘development’ is expected to display the same inverted-U shape. We suggest that the existence of a Kuznets inequality of opportunity curve can be the result of a ‘triangular’ relationship between development, income inequality, and inequality of opportunity. We then draw on the newly published Global Estimates of Opportunity and Mobility database to shed new light on this ‘triangular’ relationship, primarily in a cross-sectional context
Small countries face specific challenges in health workforce sustainability, but policy responses are a testbed for resilience for all countries
No full textWhile countries across Europe are facing challenges in building and sustaining a health workforce, small countries (official population of under 2 million people) face specific challenges that go beyond resource constraint. Limited population size constrains training capacity, specialist care provision, and career development opportunities, making these systems highly vulnerable to workforce shortages. Experiences in Cyprus, Luxembourg, North Macedonia, and the Caribbean Netherlands illustrate these dynamics. Cyprus and Luxembourg have expanded in-country medical education and postgraduate training to reduce the need for training abroad. In contrast, North Macedonia trains sufficient health professionals but struggles with outmigration. Island territories face additional logistical and geographic barriers. The Caribbean Netherlands rely on rotations and cross-border care for many healthcare services. Small countries are like a microscope that magnifies both the problems and the policy responses and may thus serve as a testbed for all health systems confronting workforce challenges. Small country experiences underscore the need for collaborative solutions to respond to the health workforce crisis, including enhanced training opportunities, mitigation of migration risks and improved retention. Ensuring resilience of the health workforce in the face of demographic and mobility pressures requires effective planning and integrated strategies addressing remuneration, working conditions, and professional development across all roles and sectors
Assessment of oral anticancer medicines in pediatric patients before the Research to Accelerate Cures and Equity (RACE) Act, 2007-2021
No full textObjective To assess the relationship between availability of pediatric labeling information as well as on-label pediatric safety information and the use of oral targeted anticancer medications (OTAMs) by pediatric patients. Study design We identified all OTAMs first approved by the Food and Drug Administration from January 1, 2007, to September 31, 2021, and assessed their use by children with cancers on the basis of claims data in Optum's deidentified Clinformatics Data Mart from January 1, 2007, to September 31, 2021. Results Over the study period and across cancer types, 3.8% of patients with childhood cancer received at least 1 OTAM. The majority of OTAMs used (29.4% in 2008 and 51.7% to 88.6% in other years) did not have an indication for the diagnosed pediatric cancers. First OTAM treatment episodes lasted longer (ie, discontinuations happened later) for drugs with pediatric cancer indications and safety information compared with those without the information during the episode of use. From 2007 to 2021, median standard costs of 30-day supplies of OTAMs for patient
The problem with rapport in interview-based studies
Get PDFRapport is an orienting principle in qualitative research. It is a capacious concept which, in practice, is deployed by researchers in a wide variety of ways. Despite its definitional ambiguity, in interview-based studies, researchers often link rapport to obtaining more open and honest – and thus high-quality – data. While rapport has been critiqued in the ethnographic tradition, these critiques have not extended to the particularities of interview-based studies. I offer two critiques of rapport as an orienting principle in interview-based studies. First, I question the assumption that rapport is an unmitigated methodological positive and consider instances when it may not be particularly useful or may even be detrimental to data collection. Second, I argue that the privileged position rapport occupies as an ideal-type of researcher-participant relationship risks foreclosing other types of researcher-participant relationships. The overemphasis on rapport may serve to harm data transparency and epistemic accountability. I argue for de-centering rapport as an orienting principle for interview-based studies
Effects of housing demolition on health and medical utilization: evidence from China
No full textBackground: China’s fast economic growth has been accompanied by rapid urbanization and urban renewal. Millions of households have experienced housing demolition and relocation (“chaiqian”) to vacate the land for urban renewal and infrastructure projects. Housing demolition can be a major life disruption and place a considerable burden on both mental and physical health. Meanwhile, replacement housing, provided as compensation for demolition, can improve housing quality and access to care, thus improving health. Methods: Using data from the China Family Panel Studies and an event study model with a staggered difference-in-differences framework, we examined the effects of housing demolition on individuals’ medical utilization in the year of demolition, as well as two and four years afterward. Medical utilization was measured as whether an individual uses medical services (incurring medical expenditure) and the amount of medical expenditure if using medical services. We also explored the effects of housing demolition on health measures, namely self-rated health and mental health status, as potential mechanisms through which housing demolition affects medical utilization. Results: Overall, housing demolition did not affect whether an individual used medical services. However, conditional on using medical services, housing demolition increased the amount of medical expenditure by approximately 1,639 CNY (234 USD) two years after demolition. We did not find evidence that housing demolition is associated with self-rated health or mental health status. Moreover, we found urban-rural heterogeneity in the effects of housing demolition. Rural residents have a higher likelihood of using medical services and higher medical expenditure two years after demolition, while urban residents have a lower likelihood of using medical services four years after demolition. 3 Conclusions: Our findings highlight the importance of housing as a social determinant of health and contribute to the growing literature on development-induced displacement. The increased medical expenditure after housing demolition calls for a multidimensional evaluation of compensation for housing demolition. The compensation should consider both the loss of property itself and other associated adverse impacts, such as on health and medical care, to fully offset the burden of housing demolition, especially for rural residents who are particularly vulnerable after housing demolition
Acupuncture as adjunctive treatment for schizophrenia: a systematic review and meta-analysis
Get PDFBackground Schizophrenia spectrum disorders significantly impair functioning and quality of life. While antipsychotic medications are the cornerstone of treatment, many patients experience persistent symptoms and adverse effects. The potential benefits of acupuncture as adjunctive treatment remain uncertain. Methods Nine databases including MEDLINE, EMBASE, and CENTRAL were searched through 15 January 2025. Randomised controlled trials comparing acupuncture plus antipsychotics versus antipsychotics alone in patients with schizophrenia spectrum disorders were included. The primary outcome was overall symptom scores (PANSS/BPRS). Secondary outcomes included adverse events, negative and positive symptom scores, response rates, social function, and quality of life. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, a random-effects model was applied for meta-analysis, and evidence certainty was evaluated using GRADE. Results Fifty-five studies with 4256 participants were included. Acupuncture plus standard-dose antipsychotics improved overall symptoms compared to antipsychotics alone (SMD −1.11, 95 % CI −1.52 to −0.70; 34 studies, 2819 participants; low certainty), but not versus sham acupuncture (MD −0.89, 95 % CI −2.72–0.95; 2 studies, 91 participants; low certainty). Adverse events were reduced versus antipsychotics alone (RR 0.44, 95 % CI 0.33–0.59; 7 studies, 862 participants; moderate certainty). Acupuncture plus low-dose antipsychotics showed little to no difference versus standard-dose antipsychotics alone (SMD −0.47, 95 % CI −1.56–0.61; 8 studies, 532 participants; very low certainty). Conclusions Acupuncture combined with standard-dose antipsychotics may provide pragmatic benefits, though lack of superiority over sham acupuncture indicates uncertainty about specific effects. High-quality trials are needed to establish definitive clinical recommendations
The ‘shades of grey’ in research integrity—researchers admit to questionable research practices that they do not perceive to be serious
Get PDFResearch misconduct practices like fabrication, falsification and plagiarism (FFP) are serious deviations from good research conduct, which have attracted attention in the literature due to the damage they can bring to science and society. However, less is known about the grey zone of researchers’ behaviours that deviate from responsible research conduct but do not fall under serious research misconduct practices. These are known as questionable research practices (QRPs), and they are believed to pose a no less serious threat to research integrity and science. Despite increasing research on the topic, the extent of the problem in different research fields and contexts is unknown. Using a sample of researchers working in Portuguese universities in six main fields of research (n = 1573), we report on QRPs that researchers admit to and how serious they perceive them to be, and on predictors of engagement in QRPs. We find that QRPs are widespread across all fields of research and seniority levels. Yet, younger, more prolific researchers, and those dismissing the seriousness of QRPs admitted to more QRPs. This suggests that some groups are at higher risk of misconduct and that there is a need for studying the motivations behind more susceptible groups to engage in QRPs
Global estimates of opportunity and mobility: a database
Get PDFThis paper describes a new public-access online database containing internationally comparable estimates of inequality of opportunity for seventy-two countries, covering two-thirds of the world’s population. The estimates were computed directly from the unit-record microdata for 196 household surveys, using a suite of machine-learning tools selected to minimize the omitted variable and overfitting biases discussed in the literature. Overall, differences in opportunities account for substantial shares of total income inequality (with the mean of our preferred estimate being 40.9%), but there is substantial variation across countries, with estimates ranging from 18.9% in Denmark (2011) to 76.7% in South Africa (2017). The latest US estimate of 41.6% places it among the most opportunity unequal highincome countries. We also find strong support for the existence of a positive association between income inequality and relative inequality of opportunity, analogous to the “Great Gatsby Curve” for mobility and inequality. Similarly, there is evidence of an inverted-U “Opportunity Kuznets curve”. The database is available at www.geom.ecineq.org