Some results and prospects of the activities of the working group on "The Geography of Health" under the aegis of the International Geographical Union.
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Rapid industrialization has transformed the agricultural economy of Puerto Rico, creating employment opportunities and raising standards of living. Success, however, is marred by widespread pollution that outstrips the infrastructural capacity necessary for the preservation of environmental quality and of human health. The result today is a landfill crisis, a heritage of toxic dumps, and an advancing tide of pollution. Rivers and reservoirs are nearly ubiquitously affected and groundwaters, long thought to be naturally protected, show evidence of increasing contamination. Limestone aquifers are at particular risk. Public awareness and inter-sectoral political leadership are urgently needed to reverse the trend towards environmental deterioration.
Interactive spatial data analysis involves the use of software environments that permit the visualization, exploration and, perhaps, modelling of geographically-referenced data. Such systems are of obvious value in epidemiological research, both of an environmental and geographical nature. There is an increasing number of such software environments available on a variety of platforms and operating systems. This paper considers the use of the proprietary Geographical Information System, ARC/INFO, in a spatial analysis context, showing how the spatial analytic tools that may be added to it can be exploited by geographical epidemiologists; such tools include those for modelling possible raised incidence of disease around suspected sources of pollution. The paper also reviews the use of systems such as S-Plus and XLISP-STAT, statistical programming environments to which spatial analysis functions or libraries may be added. The use of INFO-MAP, a system designed to aid in the teaching of interactive spatial data analysis, is also highlighted. The various software environments are illustrated with reference to examples concerned with: clustering of childhood leukaemia in part of Lancashire, England; Burkitt's lymphoma in Uganda; larynx cancer in Lancashire; and childhood mortality in Auckland, New Zealand.
Multiple sclerosis (MS) shows uneven geographic distribution globally as well as within countries. In epidemiological studies we have previously demonstrated that there is a high-risk focus for MS in the southern Ostrobothnian region of western Finland. In genetic studies we recently identified haplotypes that associate with MS specifically in patients originating from southern Ostrobothnia suggesting a founder effect. Such haplotypes can be used as molecular tools for tracing common ancestry between patients in different geographic locations. In addition to providing clues to the historical origin, such a genetic archeological approach should help narrow the size of the shared haplotype, thus facilitating the identification of etiological variants and possibly define a superfamily of MS patients with common pathogenetic mechanisms.
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The prevalence of health problems and malnutrition in Bolivia is exceptionally high, even in comparison to other underdeveloped countries. This study analyzes the relationship between a two measures of child health--height-for-age and weight-for-age z-scores--and a set of physical and cultural determinants of child nutrition, including mother's characteristics, household assets and access to public services. The ultimate aim is to identify the most important determinants of child health and to measure the relative impact of each factor on the height and weight z-scores. A sequential strategy was adopted in order to estimate a two-equation linear model with correlated error terms. A major finding points to geographical and cultural variables as main causes of nutritional status and highlights the role of mother's anthropometrical characteristics. This study uses data on over 3000 children gathered from a Demographic and Health Survey (DHS).
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This research is part of the SPIn-Eco project for the Province of Siena, Italy, and applies an environmental accounting method to a region with reference to its population, human activities, natural cycles, infrastructures and other settings. This study asserts that the consumption of resources due to the human economy is a source of great concern because of the load it places on the biosphere. Environmental resources locally used, whether directly or indirectly, from both renewable energy fluxes and storage of materials and energies, are investigated. In this paper emergy analysis is presented and applied to the Province of Siena and to each of its municipalities, in order to evaluate the main flows of energy and materials that supply the territorial system, including human subsystems, with reference to their actual environmental cost. Therefore, the behaviour of the whole system and the interactions between natural and human agents were studied; in other words, the attitudes of the territorial systems toward resource use as revealed by their patterns of emergy consumption were observed. Once expressed in units of the same form of energy through the emergy evaluation, categories of resource consumption and systems of varying scales and organization are compared. Furthermore, indexes of environmental performance based on emergy are calculated. Flows of energy and materials are assessed, and their intensities, which vary throughout the area of the Province, are then visualized on maps.
There has recently been much debate about the influence of social capital on health outcomes. In particular it has been suggested that levels of social capital vary from place to place and that such variations may account for previously unexplained between-place variations in health outcomes. As yet few studies exist of the influence of small-area variations in social capital on health outcomes. One reason for this is the difficulty of obtaining indicators for small areas such as electoral wards in England, and we describe a method used to derive what we term 'synthetic estimates' of aspects of social capital by linking coefficients produced from multi-level analyses of national survey datasets to census data. We produce estimates for electoral wards in England and apply these in multi-level models of our response variable, the probability of survival of individuals surveyed in the Health and Lifestyle Survey of England. We report various combinations of models incorporating individual attributes, health-related behaviours, area measures of deprivation, and area measures of social capital. Our overall conclusion is that we find little support, at this spatial scale, for the proposition that area measures of social capital exert a beneficial effect on health outcomes.
This study uses hospital discharge data, death certificates and medical examiner data for New Jersey for 1999-2001 to investigate whether fatal and non-fatal self-injury exhibit similar geographic patterns. Findings show that the demographic characteristics of individuals committing fatal and non-fatal self-injury are quite different. Furthermore, attempted and completed suicides have a somewhat different geographical pattern. Municipality-level determinants of suicide and non-fatal self-injury were estimated in two separate models. While measures of isolation such as low population density and high proportions of households with only one member were predictive of completed suicides, non-fatal self-injury was related to unemployment and median age. Both types of self-injury were more common in municipalities which lost population between 1990 and 2000, and where divorce rates were high. Population-based suicide prevention efforts should be aided by the knowledge that although there are some similarities in the spatial pattern of completed and attempted suicides, there are some important differences in significant determinants.
Our aim was to assess the accessibility of potential liver recipients to cadaveric organs and the ability of transplant teams to realize recipients needs in Poland in 2004. Our calculations revealed that in Poland the number of cadaveric liver transplants was two to three times lower than in other countries and is insufficient to meet the needs, also the number of referred potential liver recipients is two to three times lower than expected.
The Andes of South America contain one of the richest avifaunas in the world, but little is known about how this diversity arises and is maintained. Variation in mitochondrial DNA and morphology within the speckled hummingbird (Adelomyia melanogenys) was used to elucidate the phylogeographic pattern along an Ecuadorian elevational gradient, from the coastal cordillera to the inland Andean montane region. We examined sequence, climatic/remote sensing and morphological data to understand the effects of topography and ecology on patterns of variation. Populations on either side of the Andes are genetically divergent and were separated during a period that corresponds to the final stages of Andean uplift during the Pliocene. Despite isolation, these two populations were found to be morphologically similar suggesting a strong effect of stabilizing selection across ecologically similar Andean cloud forests, as assessed using climatic and remote sensing data. In contrast, little genetic divergence was found between coastal and west-Andean individuals, suggesting recent interruption of gene flow between these localities. However, coastal populations were found to inhabit different habitats compared to Andean populations as shown by climatic and remote sensing variables. Furthermore, coastal individuals had significantly longer bills compared to their montane relatives, indicative of differential directional selection and the influence of habitat differences in shaping phenotypic variation. Results highlight the role of both isolation and ecology in diversification in Ecuadorian montane regions, while suggesting the two may not always act in concert to produce divergence in adaptive traits.
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