Multimodal Accessibility to Primary Health Services for the Elderly: A Case Study of Naples, Italy

In Europe, the share of people aged 65 years and above is expected to increase exponentially, and in 2050, for the first time in human history, the number of older people will be larger than the number of children under the age of 15. Aging is associated with increased vulnerability and dependence on medical care services. For these reasons, providing access to health services to people aged 65 years and over is crucial. From the perspective of social equity, everyone should have the opportunity to access healthcare services equally, but due to economic and geographical issues, achieving this level of equity is challenging. The aim of this study was to fill the gap between scientific and actual practices using an accessibility measure to evaluate urban accessibility to primary healthcare services and to support decision-makers to better allocate resources in local restructuring of welfare policies. The accessibility measure was designed considering both the land use and the transportation components, the local healthcare supply system, and a multimodal transportation network. The methodology was applied to the city of Naples considering Local Health Agency (ASL) healthcare services to the elderly. The ASL is the largest health agency in Europe, consisting of 17 buildings serving nearly 200,000 elderly. The results show that the entire elderly neighborhood population suffers from poor accessibility to primary health services, especially in the city suburbs, and that the methodology could be effectively applied to urban planning strategies to achieve a high quality of life for elderly people. Due to poor dialogue between the authorities, this could help to improve the decision-making process through the lens of social equity.

Generativity and Other Buffers of Death Awareness in First Responders with PTSD

Background and ObjectivesAnxiety buffer disruption theory (ABDT) is an application of terror management theory to posttraumatic stress disorder (PTSD). ABDT predicts that posttraumatic stress reactions occur when buffers of awareness of death, such as meaning in life, self-esteem, and social intimacy, fail to suppress overwhelming death-anxiety. In this study, we hypothesized that generativity may also serve as an effective buffer of awareness of death and PTSD. Design The present study investigated the presence of anxiety buffering disruption in first responders with a spectrum of posttraumatic stress via a mediation path model of self-report measures of PTSD symptoms, anxiety buffer variables, and death-though accessibility. MethodsTo investigate the role of anxiety buffering in PTSD, a sample of 986 first responders completed self-report measures of PTSD symptoms and anxiety buffer variables in randomized order, and a death-thought accessibility measure following random assignment to mortality salience (n = 290) or control (n = 302) conditioning. Results and ConclusionWhile results indicate PTSD symptoms have a small relation to increased awareness of death, results indicate anxiety buffering variables did not mediate the relation between PTSD symptoms and awareness of death. Nonetheless, generativity and meaning in life, self-esteem, and social support were significant predictors of lower levels of PTSD.

An International Comparison of Equity in Accessibility to Jobs: London, São Paulo, and the Randstad

We analyze the impact of different accessibility measures on the interpretation of associated equity analysis using the Gini coefficient and the (pseudo) Palma ratio, and the impact of the method of assigning zonal accessibility on Gini estimation results using four different alternatives. Two types of potential accessibility measures (zonal and person-based) and two ratios of potential jobs to potential population (intra-modal and multi-modal) are estimated for car and transit in the Netherlands' Randstad region, Greater London, and São Paulo relying on network data, schedule-based data, and speed profiles. Gini results are heavily influenced by the accessibility indicator and the method of assignment. The Palma ratio is also influenced by the choice of accessibility indicator, with the person-based potential accessibility measure tending to show greater inequity.

Representing Accessibility: Evidence from Vehicle Ownership Choices and Property Valuations in Singapore

This paper compares the relative performance of different measures of accessibility in relevant models. Specifically, the authors formulated three measures of accessibility: gravity-based accessibility, an aggregate measure of potential; trip-based accessibility, a disaggregate, utility-based measure of the value of travel alternatives; and activity-based accessibility, a theoretically richer disaggregate, utility-based measure of the value of alternative activities (including travel). These accessibility measures were used as explanatory variables in household vehicle ownership models and real estate market price models, comparing the explanatory power of each accessibility measure in each model as expressed by the confidence in the coefficient estimates and captured by the models’ goodness-of-fit statistics. It was found that trip-based accessibility best represents preferences for accessibility in both vehicle ownership decisions and property valuations. This supports the theoretical value of disaggregate, utility-based accessibility measures over aggregate, potential-based measures. The fact that trip-based measures perform better than activity-based accessibility measures underscores several empirical and technical limitations. Finally, the authors noted that accurately representing accessibility preferences requires congruence between the granularity of the accessibility measure and that of the explained behavior. This emphasizes the importance of understanding what accessibility measures actually capture and ensuring that they align with the analysis purpose.