Understanding the Internet Digital Divide: An Exploratory Multi-Nation Individual-Level Analysis

As evidenced in the digital divide literature, various and diverse sets of indicators and analytical techniques have been applied that have contributed to different purposes. Some investigations try to measure the gap of digital divide, while others have attempted to explain its determinants. However, certain facets are yet to be addressed in the literature. This study uses an individual-level multi-nation approach to study both developed and developing nations with the aim of identifying factors of digital divide that separate the digitally deprived and the intense users of internet. This unique research examines the two extreme sides of the inequality—citizens with no access to the internet and frequent users of the internet. We empirically test conventional (e.g., age, education, and income) and novel (e.g., income perception, media channels, and religion) factors. We find some interesting significant results that are later outlined in the study

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Essays on the digital divide

The digital divide is a phenomenon that is globally persistent, despite rapidly decreasing costs in technology. While much of the variance in the adoption and use of information communication technology (ICT) that defines the digital divide can be explained by socioeconomic and demographic variables, there is still significant unaccounted variance that needs to be explained if the world\u27s population is expected to be brought more fully into the digital age. The present research addresses this need with three cross-country studies. Study 1 primarily investigates the time individuals spend with traditional media sources as a likely explanation for their frequency of internet access and use across multiple time periods. Study 2 explores the influence of Schwartz-like human values on individuals\u27 frequency of personal computer use and Study 3 employs gender attitudes as a predictor of PC use behavior across countries that vary in the cultural dimension of gender egalitarianism. Overall, analyses in each study reveal varying support of the proposed hypotheses. Each study is approached with a multinational perspective and is theoretically justified and tested empirically at an individual-level. In Study 1, the displacement hypotheses is adopted from the mass communication literature to rationalize how traditional media systems associate with internet access and use. Also the knowledge gap hypothesis is utilized to explain why the predictors that are commonly tested in empirical digital divide research can logically explain disparities in ICT adoption and use. In addition, Study 1 tests whether the predictive power of common digital divide variables holds across eleven nations and five time periods. I used data from the European Social Survey, which measures individual attitudes, beliefs, and behavioral patterns in more than 30 countries every two years starting in 2001. Results from Study 1 provide empirical support for socioeconomic status and age as predictors of ICT access and use disparities across countries and time periods. The number of countries with a significant and negative association between age and internet use was consistent across time periods but there was an increase in the number of countries with a significant and positive association between age and traditional media system use in the same time periods. Gender and use of traditional media sources were found to contribute to both access and use divides; however, their association with ICT access and use decreased across time periods. In Study 2, the theoretical framework and methodology of Johnson and Jackson (2009) was utilized to factor analyze data from the World Values Survey (WVS) that captures the universal human values developed by Schwartz (1992). The confirmatory factor analysis resulted in a two-factor measurement model that was used to examine how each factor--interdependent values and independent values--associates with citizens\u27 personal computer use behavior across seven countries. For most nations, the assertions put forth in this study that citizens who associate more with interdependent values are less likely to be frequent PC users and those who associate with independent values are more likely to be frequent PC users were partially supported. For Study 3, biosocial theory from social psychology was adopted to propose a possible explanation for the disparities of ICT use behavior between males and females. It was posited that disparities in PC use behavior by gender is associated with traditional gender attitudes. To begin, data from the World Values Survey that captures gender attitudes was analyzed to develop a single factor of citizens\u27 attitudes towards traditional gender roles. Second, three sample countries were selected using House et al.\u27s (2004) GLOBE Project\u27s rank of nations based on gender egalitarianism scores to test the hypothesized model. The analysis provides support for the tenet that disparities in PC use behavior vary as a function of citizens\u27 gender attitudes when compared across countries with different gender egalitarian culture scores. More specifically, results indicate that traditional gender attitudes may be partially responsible for the gender divide. Each study provides a discussion and concludes with limitations, contributions, and future research directions