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The People's Republic of China has experienced since the late 70s unprecedented economic development. That is, on the one hand, coupled with the many positive aspects, on the other, but also brought some negative things. One of them was the increasing regional disparities and the related problems of poverty, which are the main subject of this thesis. Regional disparity is dealt through the provinces of Sichuan, Hunan and Liaoning, each of them represents one Chinese region. By comparing socio-economic development of these provinces it is found that the differences in their economic levels are greater than the differences in social level. But the important thing is that these differences in the last years are not deepening and there is a gradual narrowing of the gap between the East and the rest of the country. This is due not only to economic growth but also adopted government programs.

This thesis is concerned with regional disparities in The Czech and Slovak Republics. The theoretical part is therefore related to the definition of the region, regional policy and regional disparities. Implied are different concepts, classification, and the methods of measurement and evaluation of regional disparities. In the practical part of this thesis, regions of the Czech and Slovak Republics are evaluated from the ecomical point of view using Bennet method. Finally there is comparison of selected regions between the two countries.

This diploma thesis deals with existing regional disparities in Germany with focus on differences between north and south regions at NUTS I level. The main goal is to divide analysed regions into clusters of similar regions using cluster analysis and prove the existence of regional disparities between north and south of Germany. Regional differences are determined using a group of selected regional disparity indicators that reflect different aspects of economy and life in German regions. The aim is also to analyse the development trend of regional disparities in years 2006-2016 using β and δ convergence models. Results are subsequently interpreted from an economic point of view.

As obesity becomes a growing concern in the United States, bariatric surgery is also growing in popularity, leading patients to regain control of their health and resolve many chronic conditions associated with morbid obesity, such as Type II diabetes mellitus (DM II), heart disease, and hypertension (HTN)[1–7]. On average, bariatric surgery patients lose 50% excess weight within the first two years following a Roux-en-Y gastric bypass, sleeve gastrectomy, or laparoscopic gastric banding[4–6,8–11], leading to problematic excess skin, most commonly located at the abdomen, but also found on the arms, thighs, buttocks, groin, and other areas of the body[12]. While survey-based studies have found approximately 90% of bariatric surgery patients develop excess skin[13], other studies have shown only 11-12% of patients undergo excess skin removal following bariatric surgery[14,15]. This study conducted a retrospective review of patients undergoing massive weight loss (MWL) (defined as at least 50% excess weight loss or 100 lb weight loss) at one year follow up after bariatric surgery at one large academic medical center in Massachusetts. The goal was to identify which step in the pursuit of excess skin removal created the largest barrier to entry and whether patient demographics (age, sex, type of bariatric surgery, payor, weight loss at one year, and highest level of education) played a role in creating a healthcare disparity in the patients undergoing excess skin removal. Patients were identified through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Through chart review, patients were followed from bariatric surgery to first complaint of excess skin to plastic surgery consultation for excess skin removal to undergoing excess skin removal. Of 370 patients who experienced a MWL within the first year after bariatric surgery, 36.2% (134) of patients complained of excess skin at bariatric surgery follow up and were referred to a plastic surgeon at the same academic institution for a plastic surgery consultation. Of patients who complained of excess skin, 37.3% (50) attended a plastic surgery consultation. Finally, 48% (24) of patients who attended a plastic surgery consultation underwent excess skin removal at the same academic institution. Of patients who complained of excess skin, 17.9% of patients underwent excess skin removal. Demographics of patients were tracked to determine whether certain demographics had a higher barrier to entry in pursuing excess skin removal. No healthcare disparity based on: patient age at time of bariatric surgery, race, highest level of education, type of bariatric surgery, or payor was found. It is important to note that this study was performed at a single Massachusetts academic institution, and the final number of patients undergoing excess skin removal was relatively small (n=24). A higher-powered study with a larger group of patients from multiple bariatric surgery programs could be more telling in identifying whether a healthcare disparity exists. Regardless of patient demographic, 82.1% of patients who complained of excess skin did not undergo excess skin removal, so there may be a societal or insurance-driven gap in understanding the importance and need for these procedures in bariatric surgery patients that should be studied further.

Background: Obesity has been generally understudied in Asian Americans. It is important to identify subgroups of Asian Americans at high risk of obesity to help develop targeted interventions for those subgroups. This study aimed to examine the disparities in obesity among Asians (i.e., Chinese, Filipino, Japanese, Korean, and Vietnamese) living in California. Methods: A sample of Adult Americans in California (n = 47,970) including Asian American adults (n = 3810) aged 18 years or older were obtained from the 2013–2014 California Health Interview Survey (the U.S. nation’s largest state cross-sectional health survey). Body mass index was calculated using self-reported height and weight. Weight status was determined using the WHO Asian BMI cut points in 4 categories: < 18.5 kg/m2 (underweight), 18.5–22.9 kg/m2 (normal weight), 23–27.5 kg/m2 (overweight), and ≥ 27.5 kg/m2 (obese). Multiple logistic regression analyses were used to estimate odds ratio (OR) and 95% confidence interval (CI) after adjustment for covariates. Results: Overall, the prevalence of Asians was 23.3% for obesity and 40.0% for overweight. The obesity prevalence was higher in Asians who were males, aged 45–64 years old, had higher family income, were current smokers, never got married, had lower education level, had an insufficient level of physical activity, and had more frequent consumption of fast foods. After adjusting for other factors, compared to Whites, being Hispanics and Blacks were associated with higher odds of obesity (OR = 1.47, 95%CI = 1.31–1.65; OR = 2.04, 95%CI = 1.65–2.53, respectively); being Chinese, Korean, and Vietnamese were associated with lower odds of obesity (OR = 0.28, 95%CI = 0.18–0.45; OR = 0.14, 95%CI = 0.04–0.46; OR = 0.28, 95%CI = 0.14–0.58, respectively). Compared to Chinese, being Japanese and Filipino were associated with higher odds of obesity (OR = 2.75, 95%CI = 1.52–4.95; OR = 2.90, 95%CI = 1.87–4.49, respectively). Conclusions: The prevalence of adult obesity was high among Asian Americans in California. Ethnic/racial disparities in obesity among Asian Americans in California were observed in 2013–2014. Compared to Whites, being Chinese, Korean, Vietnamese were associated with lower odds of obesity. Among Asians, compared to Chinese, being Japanese and being Filipino were associated with higher odds of obesity. These findings can help design better interventions to reduce racial and ethnic disparities in obesity, especially for Asian Americans.

Purpose of review This article describes methodological challenges, gaps, and opportunities in US transgender health research. Recent findings Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of sex affirmation (e.g., hormones and surgical interventions), and inconsistent use of definitions across studies hinder evidence-based care for transgender people. Systematic high-quality observational and interventiontesting studies may be carried out using several approaches, including general population-based, health systems-based, clinic-based, venue-based, and hybrid designs. Each of these approaches has its strength and limitations; however, harmonization of research efforts is needed. Ongoing development of evidencebased clinical recommendations will benefit from a series of observational and intervention studies aimed at identification, recruitment, and follow-up of transgender people of different ages, from different racial, ethnic, and socioeconomic backgrounds and with diverse gender identities. Summary Transgender health research faces challenges that include standardization of lexicon, agreed upon population definitions, study design, sampling, measurement, outcome ascertainment, and sample size. Application of existing and new methods is needed to fill existing gaps, increase the scientific rigor and reach of transgender health research, and inform evidence-based prevention and care for this underserved population.

Purpose: There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status. Methods: Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population. Results: In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups. Conclusion: This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

Purpose: Transgender (TG) persons are overrepresented in prison settings and in the U.S. veteran population. Health disparities studies of large populations of transgender people involved with the criminal justice system have not been published to date. Methods: We studied a large cohort of TG veterans who received care in Veterans Health Administration (VHA) facilities during 2007-2013 (n = 4,793) and a 3:1 matched control group of veterans without known TG identification (n = 13,625). Three hundred twenty six (n = 138 TG, 188 non-TG) had received VHA services in programs designed to address the needs of justice involved (JI) veterans. We linked patients in each of the three groups to their medical and administrative data. Results: TG veterans were more likely to be justice involved than controls (2.88% vs. 1.38%; P < .0001). Compared to non-TG JI veterans, TG JI veterans were more likely to have a history of homelessness (80% vs. 67%; P < .05) and to have reported sexual trauma while serving in the military (23% vs. 12%; P < .01). Significant health disparities were noted for TG JI veterans for depression, hypertension, obesity, posttraumatic stress disorder, serious mental illness, and suicidal ideation/attempts. Conclusion: These data suggest that TG veterans experience a number of health risks compared to non-TG veterans, including an increased likelihood of justice involvement. TG veterans involved with the criminal justice system are a particularly vulnerable group and services designed to address the health care needs of this population, both while incarcerated and when in the community, should take these findings into account in the development of health screenings and treatment plans.

Memory-trace theories of remembering suggest that performance in delayed matching-to-sample (DMTS) procedures depends on a memory trace that degrades with time. By contrast, the theory of direct remembering suggests that increasing the delay between sample and comparison stimuli in DMTS procedures is functionally equivalent to decreasing the disparity between sample stimuli. The present dissertation tested this assumption by assessing the degree to which changes in the frequency of reinforcement for correct choices biased the distribution of choice responses in a conditional-discrimination procedure. Seven pigeons responded under a temporal-discrimination procedure in which temporal sample-stimuli were categorized as being of either short or long duration by a response to a corresponding comparison key. In the sample-stimulus disparity condition, the disparity between the sample stimuli (difference between the short and long samples) was manipulated. In the retention-interval condition, the delay between sample offset and presentation of the comparison stimuli was manipulated. Importantly, the same general procedure was used across conditions, facilitating conclusions regarding functional equivalence of the two manipulations. The theory of direct remembering suggests that the relation between sensitivity of behavior to changes in reinforcer frequency and discriminability (accuracy) should be similar in the sample-stimulus disparity and retention-interval condition. The results showed that discriminability decreased with both the sample-stimulus disparity and retention-interval manipulations. Overall estimates of sensitivity were similar to those obtained previously. There was, however, no difference in the estimates of sensitivity as a function of discriminability during either the sample-stimulus disparity or retention-interval conditions; sensitivity was independent of discriminability. These results are in contrast to most previous reports, and are interpreted in terms of the use of temporal-sample stimuli in the current experiment. Further analyses of the choice-response data showed that the effects of variation in reinforcer ratios differed across conditions as a function of trial type and trial difficulty. These results suggest the need for careful consideration of behavioral outcomes at several levels of analysis when assessing functional equivalence of experimental manipulations. The potential benefits and hindrances of characterization of behavioral outcomes in terms of functional equivalence are discussed.