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PubMed1984

Spatial patterns of hospital utilization: the impact of distance and time.

Although the impact of the physical proximity of health care facilities on utilization in rural areas is well established, its effect in metropolitan areas is still subject to question. This paper develops a spatial demand model of hospital choice to empirically estimate the impacts of distance and time on hospital utilization patterns. With a cross-product ratio estimation approach, the effects of physical access are estimated after controlling for spatial irregularities owing to the distribution of hospitals and population in metropolitan areas. The empirical results suggest that distance and time factors strongly influence hospital choice, even in metropolitan areas where alternatives are widely available, and that their effects vary across service classifications and hospitals.

Catchment Area, Health↗
PubMed2006

Content and distribution of arsenic in soils, sediments and groundwater environments of the southern Pampa region, Argentina.

The health of a large rural population in the southern Pampa (Argentina) is at risk owing to newly detected areas where As-groundwater exceeds 0.01 mg/L standard (WHO (1995) Guidelines for drinking water quality, 2nd edition. pp 43-45). Currently, devitrification of volcanic glass is invoked to interpret the origin of arsenic in the aquifers hosted in a sequence of pampean loess (Plio-Pleistocene) juxtaposed with postpampean loess (Holocene). Our data suggest that arsenic is not specifically associated with volcanic glass and that other minerals contribute to As-release into groundwater. The goals were (1) to understand As-groundwater spatial variability, (2) to explore soils/sediments/water relationships and to identify the probable As-provenance. Comparable As concentrations of the light and the heavy sand fractions suggest that though detrital glass is a major light constituent, other existing primary minerals are As-bearers that contribute to As-release into groundwater. Grouping of materials according to their As-content indicated spatial variability in the sedimentary distribution pattern leading to differences in the frequencies of occurrence of As-bearing minerals. Phreatic waters were Ca + Mg bicarbonate and devoid of As in the intake areas (Ventania System) and Na-carbonate but As-rich towards the discharge (Atlantic coast and local depressions). As-groundwater reflects a patchy distribution within the pampean landscape. A correspondence between As-high groundwater, EC >1 dSm, CO(3)H(-), alkaline pH and a longer water residence time do exist triggering As extraction from the loess sand fraction and desorption from charged fine particles which lead to As-toxicity towards groundwater discharge.

Argentina↗
PubMed1990

The third world goes to town: will U.S. policy catch up?

"Third World cities are growing so fast that in the 21st century over half the world's population will be urban. This shift will need to be recognized by all aid donors, and particularly by the USA. Sustainable development will be possible only if Third World governments--central and local--can be assisted to meet the challenge of this massive rural to urban transition."

Americas↗
PubMed1998

An analysis of the geographical distribution of severe malaria in children in Kilifi District, Kenya.

BACKGROUND: Although malaria is known to be a major cause of child mortality and morbidity throughout sub-Saharan Africa there are few detailed studies of malaria mortality rates and incidence of severe malarial disease in defined communities. We have studied the geographical pattern of admissions to hospital with severe malaria and the stability of this pattern over time in Kilifi District on the Kenyan Coast. METHODS: Over a 2-year period all children under 5 years of age with severe malaria admitted to the district hospital and living in a rural study population of about 50,000 people were identified. Annual censuses were carried out in the study area, and all households were mapped using a hand-held satellite navigation system. The resulting databases were linked using a geographical information system (GIS). RESULTS: Using methods originally developed for the study of the geographical distribution of childhood leukaemia we assessed the spatial pattern of hospital admission rates for severe malaria. As expected, admission rates were significantly higher in children with easier access to the hospital. For example, those living more than 25 km from the hospital had admission rates which were about one-fifth of those for children living within 5 km of the hospital. Those living more than 2.5 km from the nearest road had admission rates that were about half of those for children living within 0.5 km of a road. We also investigated short-term local fluctuations in severe malaria and found evidence of space-time clustering of severe malaria. CONCLUSIONS: Hospital admission rates for severe malaria are higher in households with better access to hospital than in those further away. The finding of space-time clusters of severe malaria suggests that it would be of value to conduct case-control studies of environmental, genetic and human behavioural factors involved in the aetiology of the disease.

Animals↗
PubMed2000

Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan.

Following reports of frequent deaths associated with jaundice and chronic liver disease among adults in a periurban community of Karachi, Pakistan, an investigation was conducted to evaluate the relationship between injections and viral hepatitis infections, to identify the reasons why patients received frequent injections, and to observe the injection practices employed in clinics. Two hundred and three adult patients were interviewed as they left each of the 18 area clinics. Practitioners were interviewed and three consecutive injections were observed at each clinic. Eighty-one per cent of patients received an injection on the day of the interview. Of the 135 patients who provided a serum sample, 59 (44%) had antibodies against hepatitis C virus and 26 (19%) had antibodies against hepatitis B virus. Patients who received more injections were more likely to be infected with hepatitis C. If oral and injected medications were equally effective, 44% of patients preferred injected medication. None of the practitioners knew that hepatitis C could be transmitted by injections. Non-sterile syringes and needles that had been used earlier in the day on other patients were used for 94% of the observed injections. Interventions to limit injections to those which are safe and clinically indicated are needed to prevent injection-associated infections in Pakistan and other low-income countries.

Adult↗
PubMed2001

Landscape affects the host-seeking patterns of Culex tarsalis (Diptera: Culicidae) in the Coachella Valley of California.

Effective arbovirus transmission requires that the principal vertebrate hosts and vectors have frequent contact. Vegetation and other landscape features used by roosting or nesting birds at night dictate their exposure to nocturnally active host-seeking Culex tarsalis Coquillett and therefore to western equine encephalomyelitis and St. Louis encephalitis viruses. Precipitin tests on 645 Cx. tarsalis that were collected resting and host-seeking near the Salton Sea in Coachella Valley, CA, indicated that passeriform birds (64%) and rabbits (25%) were the most frequent bloodmeal hosts and that the percentage of females feeding on birds varied temporally as an inverse fuction of mosquito abundance. Blood meals were not taken from communally roosting water birds. The spatial distribution of host-seeking females then was investigated by deploying dry ice baited traps within seven sites representative of habitats found along the Salton Sea. Mosquito catch was greatest at traps within elevated vegetation such as Tamarisk, mesquite, cattails, and orchards and lowest at traps positioned at snags over water, sand bars, open fields, and within housing in a small rural community. These data indicate that host-seeking Cx. tarsalis females congregated at specific landscape features that were not necessarily associated with large concentrations of potential bloodmeal hosts.

Animals↗
PubMed2006

The geographic distribution of melanoma incidence in Massachusetts, adjusted for covariates.

BACKGROUND: The aims of this study were to determine whether observed geographic variations in melanoma cancer incidence in both gender groups are simply random or are statistically significant, whether statistically significant excesses are temporary or persistent, and whether they can be explained by risk factors such as socioeconomic status (SES) or the percent of the population residing in an urban rather than a rural area. Between 1990 and 1999, 4774 female and 5688 male melanomas were diagnosed in Massachusetts residents. Cases were aggregated to census tracts and analyzed for deviations from random occurrence with respect to both spatial location and time. RESULTS: Thirteen geographic areas that deviated significantly from randomness were uncovered in the age-adjusted analyses of males: five with higher incidence rates than expected and eight lower than expected. In the age-adjusted analyses of females, six areas with higher incidence rates and eight areas with lower than expected incidence rates were found. After adjustment for SES and percent urban, several of these areas were no longer significantly different. CONCLUSION: These analyses identify geographic areas with invasive melanoma incidence higher or lower than expected, the times of their excess, and whether or not their status is affected when the model is adjusted for risk factors. These surveillance findings can be a sound starting point for the shoe-leather epidemiologist.

Age Factors↗
PubMed1990

Population density and cancer mortality differentials in New York State, 1978-1982.

Patterns of cancer mortality within five population density quintiles in Upstate New York (New York State, exclusive of New York City), were investigated between 1978 and 1982. Sex-specific standardized mortality ratios (SMRs) were calculated within each population density quintile for all cancer deaths combined and for site-specific cancer deaths based on cancer mortality patterns exhibited by the general population of New York State, exclusive of New York City. Areas with the highest population density demonstrated a 12% excess of cancer deaths among males and a 6% excess among females. In contrast, areas with the lowest population density exhibited lower cancer mortality, among both males (9% less) and females (7% less). Males demonstrated a significant linear relationship between increasing population density and deaths for all cancer sites combined and for cancers of the oral cavity and pharynx, oesophagus, stomach, colon, gallbladder, pancreas, lung, prostate, and kidney. Among females, a significant linear relationship was observed between increasing population density and deaths for all cancer sites combined and for deaths due to cancers of the stomach, colon, liver and breast. Deaths due to cancers of the rectum, malignant melanomas of the skin, and cervix also exhibited unusual patterns of mortality across the population density quintiles. These data are most useful in generating hypotheses for further studies to define specific aetiological factors operating within population density groupings. Population density, as measured in this investigation, may represent a surrogate measure for other factors which are related to cancer morbidity and cancer mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1999

Multilevel modelling of the geographical distributions of diseases.

"Multilevel modelling is used on problems arising from the analysis of spatially distributed health data. We use three applications to demonstrate the use of multilevel modelling in this area. The first concerns small area all-cause mortality rates from Glasgow where spatial autocorrelation between residuals is examined. The second analysis is of prostate cancer cases in Scottish counties where we use a range of models to examine whether the incidence is higher in more rural areas. The third develops a multiple-cause model in which deaths from cancer and cardiovascular disease in Glasgow are examined simultaneously in a spatial model. We discuss some of the issues surrounding the use of complex spatial models and the potential for future developments."

Cause of Death↗
PubMed1991

Population mobility in Java: in search of theoretical explanation.

"Given the current status of studies of population mobility in Java, this paper will attempt to construct a framework of analysis that can capture the interaction between macro socio-economic process and population mobility in Java. This paper thus first examines the theoretical approaches to population mobility in general. Second, it critically reviews the history of the movement of people in Java. A considerable literature on Indonesia makes it possible to reconstruct the broad socio-economic processes that have been associated with Javanese mobility since colonial times. Third,...this paper attempts to demonstrate the utility of such a framework of analysis through an examination of the links between rural households, labour flows, and the housing construction industry in Bandung, West Java."

Asia↗