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PubMed1993

[Geographic inequality of death in South Asia, Southeast Asia and East Asia].

The geography of mortality in South, Southeast and East Asia presents considerable disparities. The range is particularly large between Japan, where life expectancy is one of the highest in the world and Afghanistan or Cambodia, where it reaches only 40 years approximately. Male overmortality varies extensively from one country to another. Male undermortality still occurs in Bhutan (1.5 years); male overmortality reaches 6.4 years in the two Koreas. As elsewhere, the difference between male and female life expectancy increases with life spans. Various levels of development of the countries under consideration (examined through three variables: income per capita, urbanization and education) do not explain spatial inequality of mortality very well. In order to understand the disparities better, the macro-approach should be supplemented by a micro-approach.

Adult↗
PubMed1993

Malaria and mobility in Thailand.

This paper examines the relationship between malaria transmission and migration in three northern Thai villages. Data and observations indicate that land-poor families forced into swidden farming have greater contact with the primary vectors in Thailand--which breed in small pools in forested areas and shady clearings on hilly scrub terrain. Once infected, migrants from an endemic locus can introduce the parasite into an area with no transmission but potent vectors, thus becoming the cause of explosive epidemics; equally, non-immunes carrying out agricultural activities in or across forest and border areas can themselves be subject to seasonal morbidity. In addition to agricultural activities on clearings near forested areas, clandestine forest activities and cross border traffic contributes to the high prevalence of malaria in Thai border villages. Illegal economic activities--logging, poaching, cattle and goods smuggling--interferes with vector suppression campaigns and prompt detection of infected cases, and ultimately increases human infection not only within the mobile population, but also within the passive population of villages to which the migrants return periodically. Control measures therefore need to take into account the economic pressures which determine a high degree of mobility, the ethnic diversity of the groups which depend on fringe activities for their economic welfare, and the difficult geography of the areas in which they live. As long as economic circumstances forcing human-vector contact receives inadequate attention, better alternatives to current vector control campaigns (which are not effective amongst migrants) are not tried and malaria transmission continues.

Agriculture↗
PubMed1993

On the use of socio-demographic indicators in local health planning: a Canadian non-metropolitan perspective.

This paper argues that the use of socio-demographic indicators to represent actual or potential demand for mental health services needs to be informed by knowledge of local settlement conditions and trends. Following a selective review of the literature on the use of socio-demographic indicators in mental health care planning and on the spatial ecology of mental illness, a case study of a non-metropolitan jurisdiction in southern Ontario, Canada is presented. The results of a regression-based analysis reveal a strong association between the socio-demographic composition of populations and hospitalization rates for mental illness. The pattern of correlates appears to be underlain by residential location processes that 'filter' populations on the basis of age and socio-economic status. It is concluded that, in the absence of this knowledge of local social geography, applications of indicators methodologies run the risk of being 'black boxes'.

Adolescent↗
PubMed1995

Sewers and scapegoats: spatial metaphors of smallpox in nineteenth century San Francisco.

Medical geography is slowly including more social and cultural theory in its analysis of health issues. Yet there is still room for theoretical growth in the discipline, in areas such as historical inquiry, metaphoric landscapes of disease, and the role of disease and its interpretations in the production of place. With the example of four smallpox epidemics in nineteenth century San Francisco, application of these concepts is illustrated. Each successive epidemic in San Francisco brought stronger association of the disease with Chinatown, until an almost complete metonymy of place and disease had occurred by the last decades of the century. The articulation of biased medical theory onto a landscape of xenophobia engendered this metaphorical transformation of Chinatown into a pustule of contagion threatening to infect the rest of the urban body. A less metaphoric mapping of smallpox focused on the sewer. According to 19th-century miasmatic theories of epidemiology, sewers were the most dangerous urban topographical feature. In an increasingly class-stratified city, they undercut attempts of the upper classes to escape disease by carrying smallpox-causing miasmas across class and ethnic boundaries. A reinvigorated sanitation movement was the result. Both reactions to smallpox epidemics had significant influence in shaping San Francisco's landscape, real and symbolic.

Asian↗
PubMed1994

Differences in health and welfare between homeless and homed welfare applicants in Los Angeles County.

Studies of homelessness have rarely addressed the differences between homed and homeless groups. Such differences may have significant impacts for subgroups of the homeless population, especially the mentally disabled homeless. This paper examines the characteristics of a sample of homed and homeless welfare applicants (N = 372) in Los Angeles County based on a recent survey conducted by the Department of Public and Social Services. First, a social geography of the homed and homeless is presented. Second, an analysis of these survey data indicates that these two populations differ in terms of demographic characteristics, types of employment, and access to institutional and social support. These results suggest that greater institutional and social support, labor market access, and stable and affordable housing resources are all necessary elements in policy which prevents and ameliorates homelessness.

Adaptation, Psychological↗
PubMed1994

Britain's regional mortality: a legacy from disaster in the Celtic periphery?

Are the differences in Britain's contemporary regional mortality partly a legacy from the disasters which befell nineteenth-century peasant populations? The rise of Britain's industrial cities was linked with recruitment from populous but vulnerable peasant economies in the (largely Celtic) north and west of the British Isles, and in Glasgow this was linked with exceptionally high mortality. Three ways of accounting for the first of these linkages, between industrial cities and peasant migration, are considered, drawing on analyses of rural Malthusian pressures, of the industrial labour market, and of cultural divisions on the Celtic periphery. These accounts all predict a particular urban and regional geography of mortality which is confirmed in nineteenth-century data. Different accounts also suggest somewhat different durations for this pattern, and preliminary exploration of readily available data on secular change in relevant areas up to 1971 show that Malthusian explanations are unlikely to account for much of the effect, while the economic and cultural structures described are worth exploring further. Alternative explanations of regional or ethnic mortality cannot all be ruled out at this stage but discussions of contemporary regional mortality differences need to take into account the history of the peasant populations in the former British Isles as a whole.

Adolescent↗
PubMed1994

Social science education as a component of medical training.

The broad view of health espoused by the World Health Organization is now generally accepted by medical educators. Implicit in the new paradigm is a recognition of multiple determinants of health and of shifting divisions of professional responsibilities among providers. As a consequence, the importance of social and behavioural science education as a foundation to medical training is increasingly appreciated. At the same time medical programmes are under pressure to contend with the explosion of knowledge in basic biomedical and life sciences and with technological innovation. Curricula are being submerged in facts, causing medical schools to look for innovative teaching models that feature more flexible approaches to the diverse body of knowledge supporting professional practice. Independent learning methods are being explored and revised teaching programs are being organized around coordinating themes, such as aging, human development and environmental health. Future programmes must be designed to encourage multiprofessional approaches while fostering awareness of the important interplay between health care (both curative and preventive) and social/behavioural science. Within the curriculum students should be offered options that include sociology, child growth and development, gerontology, medical anthropology, psychology, medical geography, health economics, political science and related subthemes. More important than the inclusion of any specific discipline is the creation of an environment in which future physicians may be exposed to critical thinking across a wide range of themes that characterize the social and cultural context for medical practice. Such enquiry is also likely to drive a closer relationship between medical schools and their parent universities within which the social science expertize resides.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗
PubMed1994

Contradictions in women's health care provision: a case study of attendance for breast cancer screening.

Breast cancer screening facilities operated by the Ontario Breast Screening Program (OBSP) have recently been added to the existing geography of diagnostic mammography facilities in hospitals and private clinics in Eastern Ontario. While diagnostic facilities require a physician's referral for access, the new centres offer mammograms by self-referral. Other work has shown the utilization of mammography screening services to be quite low despite widespread acceptance of early diagnosis through mammographic screening as the best method to lower breast cancer mortality. Major findings are that spatial variation does exist in attendance rates in the townships and census tracts surrounding the screening centre. At the regional level, physician referral patterns and the presence of local diagnostic mammography units appear to affect the uptake of screening at the Kingston facility. The individual level analysis confirms the importance of the primary care physician's referral with two-thirds of the client sample indicating that they were referred for screening by their family physician. The sample of clients are also very mobile women who have comparatively greater access to financial resources than other women of screening age. The results of ecological and individual level analyses of attendance at OBSP's Kingston Centre reveal contradictions in the provision of this service. Spatially, the centres follow a location pattern of a much higher order health facility yet women are expected to include screening as part of their routine care. Attenders at the Centre were found to be of higher socioeconomic status, married and have access to a private automobile. The finding that the primary care physician's referral is an important prerequisite for attendance raises questions about the feasibility of providing health care for women which encourages individual responsibility for health within the existing paternalistic health care system.

Aged↗
PubMed1996

Analyzing perceived limiting long-term illness using U.K. Census Microdata.

The 1991 Census of England, Wales and Scotland is an improvement on previous censuses in providing fine-grained detail on the geography of limiting long-term illness. Another innovation of the 1991 Census is the release of a Sample of Anonymized Records (SARs). These provide a considerable sample of detailed data on individuals at the sub-regional level. This paper explores individual and geographical variations in morbidity through a multilevel analysis of the SARs. Geographical differences in morbidity are found even after allowing for age, sex, ethnicity, housing tenure, social class and car ownership.

Adult↗
PubMed1996

Access and utilization: a continuum of health service environments.

Birch and Abelson [1] argue that non-income based barriers might explain differences in utilization of health services within and between income groups. Databases which contain utilization data rarely allow for the modelling of geographic variation. In the Ontario Health Survey (OHS), individual observations are georeferenced at the Public Health Unit (PHU) scale, but PHUs cannot easily be used because of the large coefficients of variation. To overcome this problem, a cluster analysis is performed to create a service environment variable, which reflects differences in service availability, population size and rurality. Utilization of health services is then modelled as a logistic regression equation where the independent variables are age, sex, service environment and income to test the Birch and Abelson argument. This argument is then extended by controlling for age, health and income status. Based on the modelling results, the importance of geography to access and utilization is assessed.

Adolescent↗
PubMed1991

The Three Rivers Regatta accident: an EMS perspective.

The Three Rivers Regatta accident occurred on August 7, 1988 when a Formula I racing craft collided with shore, injuring 24 spectators. The authors retrospectively examined the prehospital-based response for this multiple-casualty incident that used emergency medical service (EMS) physicians and 32 paramedics stationed at water and land-based posts to triage and evacuate 24 patients in 32 minutes. Patients were transported to 5 hospitals including 4 Level I trauma centers; this was accomplished in 53 minutes. The EMS response was unique in a number of respects. This was a prehospital-based rescue with the entire triage and stabilization phase accomplished by River Rescue units that transported paramedic divers, EMS physicians, and trauma supplies for 30 patients. Also of significance was the inordinate proportion of pediatric patients that accounted for 50% (12/24) of the cases. Successful medical care was the result of planning based on "Daily Routine Doctrine" or escalation of existing treatment protocol; adequate supplies, personnel and transport adapted to local geography and patient population; communications, including all services--EMS, police, and fire; and prehospital physician input to ensure correct triage order and patient disposition.

Accidents↗
PubMed1989

Risk lesions in cirrhosis and development of hepatocellular carcinoma: an autopsy study.

Non-neoplastic morphologic changes in various types of cirrhosis were evaluated in relationship to the presence or absence of hepatocellular carcinoma (HCC), using autopsy livers from Hokuriku (Japan) and Los Angeles (USA). Macronodular cirrhosis was closely related to HCC in B-viral cirrhosis, alcoholic cirrhosis and cirrhosis of uncertain type. Liver cell dysplasia was most frequently seen in cases with and without HCC in B-viral cirrhosis but was significantly more frequent with HCC in cases of alcoholic cirrhosis and cirrhosis of uncertain type. Nodular bulging activity within regenerative nodules was closely related to HCC in alcoholic cirrhosis. A positive relationship between HCC and Mallory bodies was found in non-alcoholic cirrhosis. These data suggest that patients with macronodular cirrhosis, liver cell dysplasia, nodular bulging activity and Mallory bodies may have an increased risk of developing, or having HCC dependent on the etiology of cirrhosis. The geography and race differences had some relationship to the incidence of HCC.

Autopsy↗
PubMed2006

Residency training as technology matures a survey of radiology residents' training experiences.

RATIONALE AND OBJECTIVES: The aim of the study is to assess radiology resident training experience in cardiac magnetic resonance imaging (MRI), positron emission tomography (PET), obstetrical (OB) ultrasound (US), carotid US, and barium esophagram. MATERIALS AND METHODS: One hundred eighteen radiology residents completed surveys. Surveys assessed resident year of residency training, hospital size, program affiliation with an academic institution, state, performance of the examinations listed, number of examinations performed per week, and number of weeks spent on rotations for each modality. The study was approved by the institutional review board and was Health Insurance Portability and Accountability Act (HIPAA) compliant. t-Test and chi-square test were performed, and results were analyzed for statistical significance. RESULTS: Most (94 respondents; 80%) respondents were third-year residents, 101 residents (86%) stated their program was affiliated with an academic institution, 92 residents (78%) performed cardiac MRI, 104 (88%) performed PET, 84 (71%) performed OB US, 71 (60%) performed carotid US (one did not respond), and all performed esophagrams (although one did not respond). Only performance of cardiac MRI and PET correlated positively with a larger average hospital size (P < .01). Residents at an academically affiliated program were significantly more likely to perform cardiac MRI (P < .05). Geographic region significantly affected likelihood of performance of cardiac MRI only. CONCLUSION: Such factors as hospital size, academic institution affiliation, and geography affect radiology resident training, particularly for such maturing applications as cardiac MRI and PET. This information may be useful in attempts to standardize radiology residency training.

Diagnostic Imaging↗
PubMed2005

Social science research in malaria prevention, management and control in the last two decades: an overview.

In the recent past, considerable progress has been made in understanding how human behavior and social organization, macro- and micro-level economic processes, and health and political systems affect responses to malaria at global, national, community, household, and individual levels. Advances in malaria-related social, behavioral, economic, evaluation, health systems, and policy (social science) research have resulted in improvements in the design and implementation of malaria prevention, management and control (PMC) strategies. Indeed, the past two decades chronicle dramatic advances in the implementation of evidence-based interventions, drawn not only from biomedical but also from social science research. Malaria awareness-raising, advocacy, case management, and prevention efforts have reaped the benefits of social science research and as a result, many programs are implemented and evaluated in a more effective manner than in the past. However, the pace at which findings from social science research are integrated into program and policy implementation is unsatisfactory. Additionally, examples remain of programs that fail to utilize findings from social science research and as a result, achieve minimal results. Furthermore, there is a sizeable body of knowledge that is underutilized and which, if assimilated into programs and policies, could accelerate progress in malaria PMC. Examples include information on meaningful community participation, gender, socio-economic status, and health systems. Regrettably, although social science input is necessary for almost all interventions for malaria management and control, the numbers of scientists working in this area are dismal in most of the key disciplines-medical anthropology; demography; geography and sociology; health economics and health policy; social psychology; social epidemiology; and behavior-change communication. Further, skills of program workers charged with implementation of interventions and strategies at country level are most often inadequate. The Special Program for Research and training in tropical diseases (TDR) and the multi-lateral initiative on malaria (MIM) have remained in the forefront of capacity building for this area of research, but additional efforts are needed to bring more applied social scientists into the fold. Their skills are necessary to ensure that social science findings get to program planners and implementers in a useful form that allows for more rapid and appropriate integration of the results into malaria PMC programs and policies. A re-thinking of the current focus within capacity building efforts is proposed.

Communication↗
PubMed2022

Genetic structure correlates with ethnolinguistic diversity in eastern and southern Africa.

African populations are the most diverse in the world yet are sorely underrepresented in medical genetics research. Here, we examine the structure of African populations using genetic and comprehensive multi-generational ethnolinguistic data from the Neuropsychiatric Genetics of African Populations-Psychosis study (NeuroGAP-Psychosis) consisting of 900 individuals from Ethiopia, Kenya, South Africa, and Uganda. We find that self-reported language classifications meaningfully tag underlying genetic variation that would be missed with consideration of geography alone, highlighting the importance of culture in shaping genetic diversity. Leveraging our uniquely rich multi-generational ethnolinguistic metadata, we track language transmission through the pedigree, observing the disappearance of several languages in our cohort as well as notable shifts in frequency over three generations. We find suggestive evidence for the rate of language transmission in matrilineal groups having been higher than that for patrilineal ones. We highlight both the diversity of variation within Africa as well as how within-Africa variation can be informative for broader variant interpretation; many variants that are rare elsewhere are common in parts of Africa. The work presented here improves the understanding of the spectrum of genetic variation in African populations and highlights the enormous and complex genetic and ethnolinguistic diversity across Africa.

Africa, Southern↗
PubMed2026

CanVar-UK: A collaborative platform for germline interpretation in cancer susceptibility genes.

Germline variants in cancer susceptibility genes (CSGs) are typically inherited rather than arising de novo. Hence, wide cascade testing of families across geographies is common, meaning consistency in variant classification is particularly critical. Variant interpretation requires collation of variant-level data from diverse sources, as well as assembly of comprehensive clinical data, often necessitating sharing of information between genomic testing centers. Here, we describe CanVar-UK, a freely accessible web platform bespoke designed to support interpretation of germline CSG variants. CanVar-UK contains variant-level data for over 1.1 million single-nucleotide variants (SNVs), comprising all possible coding SNVs in 116 established CSGs. The data sources with which variants are annotated include in silico scores from 11 clinically relevant tools, population allele frequencies from gnomAD v4.1, case counts from multiple cohorts, including National Health Service (NHS) clinical laboratory testing, variant-level readouts from 47 selected functional and splicing datasets across 19 CSGs, genetic epidemiology studies, and live linkage to existing consensus classifications in the ClinVar database. The diagnostic discussion forum is only available to registered diagnostic scientist users. Through this, a variant-tagged email message can be dispatched in real time across the diagnostic forum community of >1,500 users, with all exchanges and classifications captured and stored in the platform. Already widely used by NHS diagnostic clinical scientists in the UK, CanVar-UK has a rapidly growing international diagnostic user base (>800 UK and >600 non-UK registered users). Survey of the NHS diagnostic user community illustrates the wide-ranging utility of CanVar-UK within their clinical workflows for interpretation of germline CSG variants.

Journal Article↗
PubMed2004

The effect of moving to a new hospital facility on the prevalence of methicillin-resistant Staphylococcus aureus.

BACKGROUND: The influence of hospital design on nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) is unknown. Our hospital's relocation to a new building with radically different ward design allowed us to study this question. Our old hospital facility had open bay wards and intensive care units, and few poorly located sinks for handwashing (bed:sink ratio 4:1). Our new hospital facility had optimized hand-washing geography and distribution of ward beds into mostly single or double rooms (bed:sink ratio 1.3:1). METHODS: We compared the prevalence of MRSA in the 2 institutions by obtaining nasal swabs from all patients on 8 selected wards and intensive care units at 2 time points both before and after the move. In addition, passive surveillance rates of MRSA for all hospitalized patients for 2 years both before and after the move were compared. Hand hygiene practices, although unrelated to the study periods, were directly observed. RESULTS: Eight of 123 patients cultured before the move were MRSA positive, compared to 5 of 138 patients cultured after the move (P=NS). MRSA prevalence determined by passive surveillance of all hospitalized patients before and after the move was also unchanged. An insignificant increase in the frequency of hand-hygiene performance following the move (20% to 23%) was observed. CONCLUSION: Radical facility design changes, which would be permissive of optimal infection control practices, were not sufficient, by themselves, to reduce the nosocomial spread of MRSA in our institution.

Analysis of Variance↗
PubMed2003

The crisis in orthodontic education: goals and perceptions.

A crisis in orthodontic education exists today because of a shortage of qualified people seeking to pursue careers in academic orthodontics; 35% of orthodontic graduate programs in the United States report having at least 1 vacant faculty position. Previous studies have identified several factors that contribute to the current shortage. The purpose of this study was to quantify and compare real and perceived differences in income, workload, and other qualitative characteristics between academic and private practice orthodontists. Orthodontic faculty, private practitioners, and residents were surveyed, and their answers were compared statistically. Faculty annual income was less than one half that of private practitioners matched by experience and geography. Faculty reported working an average of 25% more hours per week, and income per hour for full-time faculty was less than one third that of their private-practice colleagues. In addition, faculty perceived that they experienced more stress, encountered more bureaucracy, received less respect, and had a more difficult time achieving board certification than did private practitioners. Despite these findings, both faculty and private practitioners reported high levels of satisfaction in their respective jobs. Orthodontic residents were better attuned to the differences between academics and private practice than were faculty or private practitioners themselves. Residents perceived that it would take an average of 67% longer to pay off their educational debt in a faculty position than in private practice. It is in the best interest of orthodontics to resolve the crisis in education if it is to maintain its well-respected status among dental and medical specialties.

Adult↗