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Some essential features of the pathogenic complex concept formulated by the French geographer Max. Sorre are presented, aiming at integrating epidemiological and geografic studies.
Access to specialty healthcare remains inadequate for many of our rural citizens, a situation attributable to a host of factors ranging from geographic to economic barriers, worsened by the limited numbers of specialists who practice in rural communities. We wish to report our progress in the development of a robust 55-site telehealth network in the Commonwealth of Virginia, designed specifically to enhance access to specialty care not locally available in rural regions of the state. We will review the process by which we developed partnerships with otherwise unaffiliated healthcare facilities, the equipment and telecommunications services used, and the statutory, regulatory, and cultural impediments to the fullest deployment of telehealth facilitated healthcare and education. Through this network, early and timely intervention has saved lives, avoided unnecessary transfer and travel, and initiated previously unavailable screening and education programs in many rural communities.
A sample of 114 isolates of Echinococcus granulosus (Cestoda: Taeniidae) collected from different host species and sites in Argentina has been sequenced for 391 bp from the mitochondrial cytochrome c oxidase subunit I gene to analyze genetic variability and population structure. Nine different haplotypes were identified, 5 of which correspond to already characterized strains. Analysis of molecular variance and nested clade analysis of the distribution of haplotypes among localities within 3 main geographic regions indicate that geographic differentiation accounts for the overall pattern of genetic variability in E. granulosus populations. Significant geographic differentiation is also present when the sheep strain alone is considered. Our results suggest that geographic patterns are not due to actual restricted gene flow between regions but are rather a consequence of past history, probably related to the time and origin of livestock introduction in Argentina.
OBJECTIVES: In this study, data on violent deaths in the Bronx, New York City, from the 1970, 1980, and 1990 censuses were analyzed. METHODS: The incidence and areal density of intentional deaths were mapped by health area. Simple and stepwise regressions between violent death measures and other factors were performed. RESULTS: The incidence of deaths at levels of those in the highest 1970 quintile spread so that by 1990 only 2 areas saw incidences at levels of the lowest 1970 quintile. Overcrowding, socioeconomic status, population, population change, and drug deaths in simple regressions and overcrowding, socioeconomic status, and low-weight births in stepwise regressions correlated significantly with violent death incidence or density. CONCLUSIONS: Understanding the spatiotemporal development of violence can contribute to public policy on violence.
While significant gains have been achieved in understanding and reducing AIDS and hepatitis risks among injection drug users (IDUs), it is necessary to move beyond individual-level characteristics to gain a fuller understanding of the impact of social context on risk. In this study, 6 qualitative methods were used in combination with more traditional epidemiologic survey approaches and laboratory bioassay procedures to examine neighborhood differences in access to sterile syringes among IDUs in 3 northeastern cities. These methods consisted of (1) neighborhood-based IDU focus groups to construct social maps of local equipment acquisition and drug use sites; (2) ethnographic descriptions of target neighborhoods; (3) IDU diary keeping on drug use and injection equipment acquisition; (4) ethnographic day visits with IDUs in natural settings; (5) interviews with IDUs about syringe acquisition and collection of syringes for laboratory analysis; and (6) focused field observation and processual interviewing during drug injection. Preliminary findings from each of these methods are reported to illustrate the methods' value in elucidating the impact of local and regional social factors on sterile syringe access.
The 1979 election of the Conservative Government in Britain was not followed by the demolition of the welfare state. However, a variety of policy initiatives were introduced both to restructure National Health Service (NHS) expenditure, and to facilitate private provision of health services. This article considers the effects of such policies on the existing and future distribution of health care resources. A historical introduction discusses the main thrusts of conservative welfare policy. This is followed by an examination of the current financial situation of NHS authorities, at the regional and sub-regional scales; the political response to the 1983 manpower reductions is also considered. Events in the NHS are then contrasted with the deregulation of the private sector. The emergence and distribution of commercial acute hospitals are examined, as are other initiatives designed to transfer some of the financial burden of welfare provision away from the state. A concluding section compares and contrasts these developments and considers prospects for the future form of health care provision in Britain.
A survey was made of the manpower employed, facilities available and utilization of radiology in countries in tropical Africa and Southeast Asia. The data obtained are compared with those from industralized societies in temperate climates. The level of use of radiographic services varied by a factor as high as 40. The differences between the level of radiology manpower available could be over a hundredfold and for x-ray technologists, many hundred times. The concentration of services in capital cities is characteristic of many tropical societies. Measures to improve radiologic health care in tropical countries, with particular emphasis on rural areas, are discussed. The main need is for availability of radiodiagnosis close to the primary care level in rural areas to deal with the important clinical problems of trauma, chest infections, and obstetrics. Simplification of equipment and employment of technicians with short training can help relieve maldistribution of services.
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Psychological notions are required to explain geographical patterns. Mapping and statistical analysis for years 1971, 1973, 1974 and half of 1975 revealed that attempted suicide occurs commonly in the area surrounding the central business area of urban Hobart and also in the older housing department areas. Physical patterns and social structure are related in a tangible way for the expression of suicidal behaviour in a spatial pattern.
Outward Na+ - K+ cotransport in erythrocytes from essential hypertensive Caucasian subjects was found to be excessively low (Co -) compared to normotensives (Co +) carefully selected for their negative family history of hypertension. Since the frequency of essential hypertension varies widely among different populations and is particularly high in certain coloured peoples, we compared erythrocyte Na+ - K+ cotransport in normotensive and hypertensive subjects in Paris (France) and in Abidjan (Ivory Coast) to seen whether defective cotransport was related to high blood pressure in the African group as well. Of the 66 French unselected normotensives investigated, 26 (39%) were Co - whereas 14 of the 18 Ivory Coast unselected normotensives (79%) were Co -. 64 (80%) of the 80 essential hypertensives examined in France were Co -, but the proportion of Co - subjects among the Ivory Coast hypertensives was even higher. In addition, both hypertensives and normotensives in the African groups often had undetectable outward Na+ effluxes, a rare finding in the French subjects. We suggest that the high incidence of abnormal Na+ - K+ cotransport in the Ivory Coast series may reflect a genetic propensity to hypertension in this population, and that consequently, Na+ - K+ erythrocyte cotransport measurements might prove useful in defining geographic variations in hypertension.
People in different cultures are taught to think differently. How we gather information, process, rationalise, justify and communicate our ideas is culturally determined. Europe is divided between the pragmatic, inductive thinking of North Sea cultures and the rationalist thinking of the rest of the continent. Westerners and Asians have different mental skills and capacities deriving from the nature of written and spoken language, the relative importance of learning by rote or investigation and the social environment. Western children are expected to ask questions and test ideas for themselves, while in Asia it is unacceptable to question anyone senior in age or authority, including teachers. Westerners base thinking on reason; Asians base thinking on harmony. Whenever people of different cultures work together, different ways of thinking create barriers to understanding and communication. This applies to many spheres of work, including the medical profession.
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Based on the data of the census of 1970, a map of the rates of gene migrations in the rural population of Central Asia and Kazakhstan was drawn. The corrected average value for 35 populations of oblasts (administrative regions) and autonomous republics was m = 0.0606 +/- 0.0102. The estimate obtained from the mapped data was 0.0799 +/- 0.0014, which is 1.2-fold higher than similar values for Europe. The relationship between the rate of gene migration m, the genetically effective population size Ne, and the density of elementary populations in the studied area Pp was analyzed by means of correlation and regression analyses. The following relationship was obtained: m = A/Ne + BPp, where A > 0 and B < 0. This was accounted for by the fact that the migration flow is mainly directed to the less densely populated rural areas. Given that the region was chosen somewhat artificially, studying gene migrations in Central Asia and Kazakhstan as separate historical, geographic, and genetic subregions of northern Eurasia might be a better approach.
Ritual circumcisions can be classified into types according to the circumstances in which they are performed. Spiritual circumstances which express a community identity, usually religious and surrounded by a complex significance related to numerous myths, especially biblical and African. Non-religious circumcisions, particularly well illustrated by the USA model, comprise, apart from controversial medical and scientific reasons, a real social dimension and also reflect a desire for community membership. Regardless of the circumstances, surgeons may sometimes be asked to perform circumcision and should be aware of the significance of this procedure.