What Difference Does Difference Make? The Persistence of Inequalities in Healthcare Delivery

Scholars across many disciplines have amassed a mountain of research documenting how social differences along lines of race, class, gender, and sexuality shape how those who need medical attention are cared for in the US healthcare system. Here, we aim to succinctly review a selection of studies that have considered the many ways both patients' and healthcare providers' social identities can impact care delivery. After establishing how these differences influence patient–provider interactions and patient diagnosis, treatment, and outcomes, we argue that a critical sociological perspective can help us to better understand why these inequities persist despite decades of research calling attention to them. Specifically, we suggest that research guided by symbolic interactionist and intersectional frameworks can generate more comprehensive analyses of inequality in healthcare delivery and help researchers delve deeper into the complex interactional processes undergirding disparities in care provision. We conclude by highlighting recent work that illustrates the value of this approach.     

Inclusions and exclusions in law: experiences of women with disability in rural and war-affected areas in Sri Lanka

Broad and inter-disciplinary inquiry into disability is at a nascent stage in Sri Lanka. This paper looks at the intersectionality of disability and gender in the specific contexts of ‘the rural’ and the armed conflict-affected areas of the country, particularly the interaction with the law. In-depth interviews and focus group discussions were conducted among rural women with disabilities in the North Central and Eastern provinces, including women who acquired disabilities resulting from the internal conflict. Legal literacy, administrative discretion in disability-related welfare programmes, and transitional justice and reconciliation emerged as the most prominent themes in the interviews. We analyse these issues using a rights framework in an attempt to highlight some of the vulnerabilities of women with disability in the rural and war-affected contexts. The paper also reflects on a few instances where those vulnerabilities have been overcome through collective action.     

Carry on Shrinking?: The Bankruptcy of Urban Policy in Detroit

Much attention has recently been focused on the bankruptcy of the City of Detroit in 2013 and the reasons for the largest municipal fiscal melt down in US history. Contrary to a view gaining currency, which dismisses Detroit as the product of exceptional forces and largely calls it the architect of its own collapse, this article argues the case that Detroit conveys more general lessons for European cities struggling with decline, not least of which is the need for interventionist regional planning to avoid predictable but avoidable urban distress. The article briefly reviews the well-documented decline of the city of Detroit measured against population, economic, fiscal and image impacts. It considers five current misreadings of the reasons for Detroit's predicament and implicit signposts for European practice before concluding with an assessment of what has been hailed as the shoots of yet another possible renaissance in the originally proclaimed Renaissance City over 40 years ago.     

Exact calculation of power and sample size in bioequivalence studies using two one‐sided tests

The number of subjects in a pharmacokinetic two‐period two‐treatment crossover bioequivalence study is typically small, most often less than 60. The most common approach to testing for bioequivalence is the two one‐sided tests procedure. No explicit mathematical formula for the power function in the context of the two one‐sided tests procedure exists in the statistical literature, although the exact power based on Owen's special case of bivariate noncentral t‐distribution has been tabulated and graphed. Several approximations have previously been published for the probability of rejection in the two one‐sided tests procedure for crossover bioequivalence studies. These approximations and associated sample size formulas are reviewed in this article and compared for various parameter combinations with exact power formulas derived here, which are computed analytically as univariate integrals and which have been validated by Monte Carlo simulations. The exact formulas for power and sample size are shown to improve markedly in realistic parameter settings over the previous approximations. Copyright © 2014 John Wiley & Sons, Ltd.     

Letter to the editor by the authors of Exact Calculation of Power and Sample Size in Bioequivalence Studies Using Two One‐sided Tests,Pharmaceutical Statistics,DOI: 10.1002/pst.1666

This article reflects the views of the authors and should not be construed to be those of the US Food and Drug Administration. Copyright © 2015 John Wiley & Sons, Ltd.     

He Said What? Guided Cognitive Reframing About the Co‐Resident Father/Stepfather–Adolescent Relationship

We studied young adolescents' seeking out support to understand conflict with their co‐resident fathers/stepfathers, and the cognitive and affective implications of such support‐seeking, phenomena we call guided cognitive reframing. Our sample included 392 adolescents (M_age = 12.5, 52.3% female) who were either of Mexican or European ancestry and lived with their biological mothers and either a stepfather or a biological father. More frequent reframing was associated with more adaptive cognitive explanations for father/stepfather behavior. Cognitions explained the link between seeking out and feelings about the father/stepfather and self. Feelings about the self were more strongly linked to depressive symptoms than cognitions. We discuss the implications for future research on social support, coping, guided cognitive reframing, and father–child relationships.     

Educational Attainment by Life Course Sexual Attraction: Prevalence and Correlates in a Nationally Representative Sample of Young Adults

Researchers know relatively little about the educational attainment of sexual minorities, despite the fact that educational attainment is consistently associated with a range of social, economic, and health outcomes. We examined whether sexual attraction in adolescence and early adulthood was associated with educational attainment in early adulthood among a nationally representative sample of US young adults. We analyzed waves I and IV restricted data from the National Longitudinal Study of Adolescent Health (n = 14,111). Sexual orientation was assessed using self-reports of romantic attraction in waves I (adolescence) and IV (adulthood). Multinomial regression models were estimated and all analyses were stratified by gender. Women attracted to the same-sex in adulthood only had lower educational attainment compared to women attracted only to the opposite-sex in adolescence and adulthood. Men attracted to the same-sex in adolescence only had lower educational attainment compared to men attracted only to the opposite-sex in adolescence and adulthood. Adolescent experiences and academic performance attenuated educational disparities among men and women. Adjustment for adolescent experiences also revealed a suppression effect; women attracted to the same-sex in adolescence and adulthood had lower predicted probabilities of having a high school diploma or less compared to women attracted only to the opposite-sex in adolescence and adulthood. Our findings challenge previous research documenting higher educational attainment among sexual minorities in the US. Additional population-based studies documenting the educational attainment of sexual-minority adults are needed.     

Bottom Up and Top Down? Community Development in Post‐Soviet Armenia: The Social Fund Model

The main objective of this article is to discuss the effectiveness of bottom‐up, community‐driven approaches in promoting community participation and building local capacity within the post‐Soviet social, institutional and political context of Armenia. In exploring this issue, the article examines the nature of local participation and social relations in rural communities in Armenia and the impact of the World Bank‐supported Armenia Social Investment Fund (ASIF) project on the existing forms of local social organization. One of the objectives of the ASIF project was to promote the participation of local communities in their own economic and social development. The research finds that the project did not change the existing patterns of local social organization and had no significant impact on the nature of participation in the beneficiary communities. Bottom‐up, capacity‐building interventions that mainly focus on changing patterns of interpersonal social relations may not be effective in fostering sustainable civic institutions without changes in the nature of a country's governance.     

Providing mental health services to older people living in rural communities

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional wellbeing and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.