Different disparities of gender and race among the thrombotic thrombocytopenic purpura and hemolytic-uremic syndromes

Thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS) represent multiple disorders with diverse etiologies. We compared the gender and race of 335 patients enrolled in the Oklahoma TTP-HUS Registry across 21 years for their first episode of TTP or HUS to appropriate control groups. The relative frequency of women and white race among patients with TTP-HUS-associated with a bloody diarrhea prodrome and the relative frequency of women with quinine-associated TTP-HUS were significantly greater than their control populations. The relative frequency of women and black race among patients with idiopathic TTP and TTP-associated with severe ADAMTS13 deficiency was significantly greater than their control populations. The relative frequency of black race among patients who had systemic lupus erythematosus (SLE) preceding TTP was significantly greater than among a population of patients with SLE, and the relative frequency of black race among patients with other autoimmune disorders preceding TTP was significantly greater than their control population. No significant gender or race disparities were present among patients with hematopoietic stem cell transplantation-associated thrombotic microangiopathy, TTP associated with pregnancy, or TTP associated with drugs other than quinine. The validity of these observations is supported by the enrollment of all consecutive patients across 21 years from a defined geographic region, without selection or referral bias. These observations of different gender and race disparities among the TTP-HUS syndromes suggest the presence of different risk factors and may serve as starting points for novel investigations of pathogenesis.

Accessibility as a determinant of environmental dynamics in socio-economic disparities in mainland Southeast Asia

Access and accessibility are important determinants of people’s ability to utilise natural resources, and have a strong impact on household welfare. Physical accessibility of natural resources, on the other hand, has generally been regarded as one of the most important drivers of land-use and land-cover changes. Based on two case studies, this article discusses evidence of the impact of access to services and access to natural resources on household poverty and on the environment. We show that socio-cultural distances are a key limiting factor for gaining access to services, and thereby for improved household welfare. We also discuss the impact of socio-cultural distances on access to natural resources, and show that large-scale commercial exploitation of natural resources tends to occur beyond the spatial reach of socio-culturally and economically marginalised population segments. We conclude that it is essential to pay more attention to improving the structural environment that presently leaves social minority groups marginalised. Innovative approaches that use natural resource management to induce poverty reduction – for example, through compensation of local farmers for environmental services – appear to be promising avenues that can lead to integration of the objectives of poverty reduction and sustainable environmental stewardship.

The Role of Small and Medium-sized Centers for Territorial Development in Switzerland

This paper describes the role of small and medium-sized urban centers in Switzerland. Switzerland is a highly urbanized country where small and medium-sized urban centers play an important role in ensuring a balanced national urban system. Besides the four largest metropolitan regions （Zurich, Geneva, Basel and Bern）, small and medium-sized towns function as central places for a wider, often extensive hinterland. They provide opportunities for living and working and they connect rural and mountain regions to national and international networks. Using secondary statistics and a case study, the paper shows that small and medium-sized urban centers are home to significant concentrations of export-oriented industries. Firms in these value-adding secondary sectors are rooted in these places and benefit from strong local embeddedness while also being oriented towards global markets. Small and medium-sized urban centers also profit from their strong local identities. While these places face various challenges, they function as important pillars in creating a balanced regional development pattern. Swiss regional development policy follows the goal of polycentric spatial development and it employs various instruments that aim to ensure a balanced urban system.

Disparities in bone density measurement history and osteoporosis medication utilisation in Swiss women: results from the Swiss Health Survey 2007

BACKGROUND Although factors associated with the utilisation of bone density measurement (BDM) and osteoporosis treatment have been regularly assessed in the US and Canada, they have not been effectively analysed in European countries. This study assessed factors associated with the utilisation of BDM and osteoporosis medication (OM) in Switzerland. METHODS The Swiss Health Survey 2007 data included self-reported information on BDM and OM for women aged 40 years and older who were living in private households. Multivariable logistic regression analysis was used to identify sociodemographic, socioeconomic, healthcare-related and osteoporosis risk factors associated with BDM and OM utilisation. RESULTS The lifetime prevalence of BDM was 25.6% (95% CI: 24.3-26.9%) for women aged 40 years and older. BDM utilisation was associated with most sociodemographic factors, all the socioeconomic and healthcare-related factors, and with major osteoporosis risk factors analysed. The prevalence of current OM was 7.8% (95% CI: 7.0-8.6%) and it was associated with some sociodemographic and most healthcare-related factors but only with one socioeconomic factor. CONCLUSIONS In Swiss women, ever having had a BDM and current OM were low and utilisation disparities exist according to sociodemographic, socioeconomic and healthcare-related factors. This might foster further health inequalities. The reasons for these findings should be addressed in further studies of the elderly women, including those living in institutions.

Reducing liver cancer disparities: a community-based hepatitis-B prevention program for Asian-American communities

OBJECTIVES: Several Asian-American groups are at a higher risk of dying of liver diseases attributable to hepatitis-B infection. This culturally diverse community should be well informed of and protected against liver diseases. The present study assesses the knowledge of hepatitis B before and after a hepatitis-B educational program and determines the infection status of an Asian community. METHODS: Nine Asian communities of Montgomery County, MD, enrolled in the hepatitis-B prevention program between 2005 and 2006. They attended culturally tailored lectures on prevention, completed self-administered pre- and posttests, and received blood screening for the disease. RESULTS: More than 800 Asian Americans participated in the study. Knowledge of prevention was improved after educational delivery. The average infection rate was 4.5%, with Cambodian, Thai, Vietnamese, Chinese and Korean groups having higher infection rates. The age group of 36-45 had the highest percentage of carriers (9.1%). CONCLUSION: Many Asian groups, particularly those of a southeast Asian decent, were subject to a higher probability of hepatitis-B infection. At an increased risk are first-generation Asian immigrants, groups with low immunization rates and those aged 36-45. The findings provide potential directions for focusing preventive interventions on at-risk Asian communities to reduce liver cancer disparities.

A spatial-temporal approach to surveillance of prostate cancer disparities in population subgroups

BACKGROUND: Prostate cancer mortality disparities exist among racial/ethnic groups in the United States, yet few studies have explored the spatiotemporal trend of the disease burden. To better understand mortality disparities by geographic regions over time, the present study analyzed the geographic variations of prostate cancer mortality by three Texas racial/ethnic groups over a 22-year period. METHODS: The Spatial Scan Statistic developed by Kulldorff et al was used. Excess mortality was detected using scan windows of 50% and 90% of the study period and a spatial cluster size of 50% of the population at risk. Time trend was analyzed to examine the potential temporal effects of clustering. Spatial queries were used to identify regions with multiple racial/ethnic groups having excess mortality. RESULTS: The most likely area of excess mortality for blacks occurred in Dallas-Metroplex and upper east Texas areas between 1990 and 1999; for Hispanics, in central Texas between 1992 and 1996: and for non-Hispanic whites, in the upper south and west to central Texas areas between 1990 and 1996. Excess mortality persisted among all racial/ethnic groups in the identified counties. The second scan revealed that three counties in west Texas presented an excess mortality for Hispanics from 1980-2001. Many counties bore an excess mortality burden for multiple groups. There is no time trend decline in prostate cancer mortality for blacks and non-Hispanic whites in Texas. CONCLUSION: Disparities in prostate cancer mortality among racial/ethnic groups existed in Texas. Central Texas counties with excess mortality in multiple subgroups warrant further investigation.

Territorial Cohesion through Spatial Policies: An Analysis with Cultural Theory and Clumsy Solutions

The European Territorial Cohesion Policy has been the subject of numerous debates in recent years. Most contributions focus on understanding the term itself and figuring out what is behind it, or arguing for or against a stronger formal competence of the European Union in this field. This article will leave out these aspects and pay attention to (undefined and legally non-binding) conceptual elements of territorial cohesion, focusing on the challenge of linking it within spatial policies and organising the relations. Therefore, the theoretical approach of Cultural Theory and its concept of clumsy solution are applied to overcome the dilemma of typical dichotomies by adding a third and a fourth (but not a fifth) perspective. In doing so, normative contradictions between different rational approaches can be revealed, explained and approached with the concept of ‘clumsy solutions’. This contribution aims at discussing how this theoretical approach helps us explain and frame a coalition between the Territorial Cohesion Policy and spatial policies. This approach contributes to finding the best way of linking and organising policies, although the solution might be clumsy according to the different rationalities involved.