Social science & medicine. Part D, Medical geography最新文献

It is frequently stated—and more frequently assumed—that the dispersed settlement of a rural population results in isolation and a substantial physical separation from modern-sector health services. This study shows that for three large departments in western Guatemala—Sololá, Tolonicapán, and San Marcos—the vast majority of persons have reasonably good physical access to health services, even taking bad roads and slow travel times into account. Furthermore, the Ministry of Health has strategically located its facilities in congruence with rural market centers, and virtually the entire population visits these market centers with great regularity. Analysis of 1800 actual patient visits, however, shows that Ministry facilities have minuscule geographic drawing power, that is, the vast majority of patients come only very short distances. The question is raised: Why? Although no definitive answer is provided here, the most plausible explanation is simply that the health posts—which are understaffed by poorly trained personnel and badly under-equipped—do not cure very well, and thus people are not highly motivated to use them. Improving levels of utilization depends on improving the quality of delivered services, not building more health posts or overcoming supposed ‘cultural barriers’.

Disease hazards help explain why much of Latin America's humid tropics remains sparsely inhabited. Recent agricultural colonization, occupation of new lands by peasant farmers, has been fostered partially by amelioration of some of the former threats. But landscape modification by colonists also has created new disease hazards. The continual arrival of settlers and the periodic nature of much ‘migration’ to colonization zones provide ideal conditions for the introduction and re-introduction of infectious diseases. Migration itself produces stress that may contribute to health problems. In the central Andean countries, the migrants to lowland settlement areas may be adapted biologically to high altitudes. Furthermore, cultural practices brought from different ecological zones often prove maladaptive in the lowlands. Finally, health care delivery among low-income colonists far from urban centers is difficult and expensive.

The American hospital industry has recently been experiencing the steady evolution of multihospital arrangements (various types of individual facilities under consolidated or cooperative management structures). The type that exhibits the most integrated structure is the multihospital system, here defined as two or more acute care hospitals owned, leased, or contract-managed by a corporate office. This paper examines some large-scale spatial dimensions of the 267 multihospital systems and their 1400 owned and leased hospitals listed in the American Hospital Association's 1980 Directory of Multihospital Systems. Multihospital systems are divided into two broad categories according to the kind of controlling organization, i.e. investor-owned and not-for-profit, and into another two categories according to their geographical dispersion: intrastate (in which all hospitals as well as the main corporate office are located in a single state) and interstate.

The geographical distribution of out-of-hospital cardiac arrest has not been studied but is of importance both epidemiologically and programmatically, for the planning of pre-hospital emergency care. In this study, 525 cardiac arrests in Seattle are sampled and the census tract of their occupance noted. A predictive model is developed to explain the geographical distribution of the cardiac arrest cases. The regression model indicates a high degree of statistical explanation (R² = 0.94), based upon 5 independent variables. Using population alone as an independent variable, the model is only marginally less powerful (R² = 0.91). The study concludes that such a prediction model is of use in the geographical allocation of emergency units based upon response time minimization.

The assignment of service-dependent elderly people to appropriate treatment settings has three phases: assessment of client need; identification of appropriate treatment setting; and placement of the client in that setting. Optimal placement depends upon successfully matching the external and internal treatment setting needs of the client. In analysis of an extended sequence of assignment by the Assessment and Placement Service (APS) of Hamilton-Wentworth (in the Province of Ontario), a highly consistent pre-placement assessment procedure ensured the allocation of a client to an appropriate treatment setting. Staff of the ‘host’ treatment setting overwhelmingly endorsed the placement. There was evidence of minor misjudgements in certain assessment categories, but overall consistency levels were high. A significant minority (14%) of clients were dissatisifed with their placements. General characteristics which influenced client attitude included dislike of being institutionalized, isolation from friends and community, and absence of a rewarding social environment within the treatment setting. The physical setting of, and services offered at, the treatment settings were favourably regarded. The study sample included 33 clients, who were more functionally competent than the general APS population.

Regional and social disparities in rates of infant mortality have recently been highlighted as a major source of concern. Social class gradients in infant mortality have been shown to have been persistent over the past few decades, despite the introduction of the National Health Service. Relatively little is known, however, about the persistence or otherwise of geographical gradients in infant mortality. This paper describes the relative change in infant mortality in the United Kingdom by local authority areas between 1949–1951 and 1970–1972, using a typology of change derived from the results of a linear regression analysis. It is shown that the overall intensity of spatial inequality has changed very little over the period. At the same time, however, the relative position of some areas has deteriorated significantly, while that of others has significantly improved.

Numerous empirical investigations have shown the impact or facility location upon rates of mental health care service utilization to be substantial but complex. Following a brief discussion of the conceptual basis of distance decay effects in utilization, the role of diagnosis as a modifier of such effects is explored through analysis of data for a mental health care catchment area in central Ontario. The results produced demonstrate clearly the importance of diagnosis; the strength of distance decay effects is negatively correlated with the severity of diagnosis. This points toward the severe constraint imposed by assumptions on the uniformity of observations (patients) and on their response to facility location

A comparison of data from nearly 260 regions in Western Europe during the period from 1969 to 1977 reveals regional differences of 11.0 years in life expectation at birth for males as well as females (from 73.6 to 62.6 years for males and from 79.2 to 68.5 years for females). The causes of these differences are still inadequately explored: however, it appears that male mortality is often relatively higher in the regions that are most highly urbanized and where mining and heavy industry or dockyards are concentrated. In contrast, the populations of predominantly agricultural regions appear to enjoy a higher life expectation.