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

A number of available films on disease ecology and health care delivery are useful for leaching medical geography. Twenty-five films are described and rental information provided here.

This paper seeks to provide a framework for understanding differential access to medical care for the population of the Eastern Township and to suggest ways to achieve equality of access. The framework is provided by a behavioral model of utilization of health services which suggests a sequence of predisposing, enabling and illness variables. These variables determine the number of times people will visit a physician. The model is rendered operational by using a path analysis technique. The data comes from a survey of the rural population in the Eastern Township conducted during the summer of 1978. The results suggest that services are generally equitably distributed because age and level of illness are the principal determinants of the number of services people receive. However, the inequality of access which does exist could be reduced by providing people who have no regular source of medical care with a personalized entry into the health service system.

The seasonal variation in mortality in the more northern latitudes has generally been neglected by both epidemiologists and medical geographers. Among Alaskans, for whom mortality data are available, different racial groups (white versus non-white) are seen to have different seasonal mortality patterns. White patterns generally resemble those seen in temperate climates. For nonwhites April and October are particularly prominent months both for total mortality and for selected causes of death. This pattern may be attributable to a number of geographic or cultural factors which need to be evaluated further. This pattern may have implications for the planning of native health care in Alaska.

The outcome of pregnancy may be improved by a woman's early and regular attendance at an ante-natal clinic. The objective of this study was to examine whether ‘satellite’ ante-natal clinics located in peripheral housing estates are able, by virtue of their location, to improve the attendance levels of the local residents as compared with the central hospital clinic.

A comparison of the attendance records of four groups of women, two attending ‘satellite’ clinics and two attending the central clinic, indicates that distance to the clinic may be an important determinant of the level of attendance. The study further shows that the distance effect was small in comparison with three socio-cultural factors examined in the study—the employment status of the woman's husband, and the woman's age and parity, especially parity.

The regularity of attendance exhibited a similar pattern of relationships with the studied factors as did the time to the first attendance though on a much reduced scale. It is possible that once contact is established the clinic exerts a certain amount of control on the woman's behaviour.

The purpose of this paper is to adduce pointers towards the underlying aetiology of cancer. Seasonal patterns of stomach cancer mortality were regionally and chronologically examined. Japan was considered at a national level. Two Tohoku regions (the Pacific facing and the Sea of Japan sub-regions). the Kansai region and the Kyushu region of Japan were chosen within Japan. At an international scale, Japan. England and Wales and the United States were compared. The following results were obtained: (1) A small autumn peak appeared throughout Japan. (2) There was no regional difference among the four Japanese regions. All of these regions had a small autumn peak. (3) In England and Wales and the United States there was hardly any variation of mortality between the seasons. Japan seemed to be showing a similar trend. On the basis of the above results some environmental factors were suggested as contributing to the seasonal pattern of stomach cancer.

Based on the distribution of undoctored household members reported in a mail-out survey, a heuristic location-allocation algorithm was used to determine facility locations and associated user allocations for primary care health centers being established in the Lansing, Michigan area.

Beyond simply identifying desirable health care center locations, the analyses showed that four facilities, rather than the originally proposed five, would yield more tenable and equitable utilization levels. The allocation results also indicated a preferable sequence for facility development based on differences in expected utilization. Subsequent location-allocation analyses based on expected future health services need did not appreciably affect the locational findings.

Since 1974 the number of abortions in New York City's borough of Manhattan has exceeded the number of births within its resident population.Manhattan's rate of abortions has been nearly twice that of the other city boroughs during the decade of the 1970's. Most investigations of abortion have focused on the attitudes of individual abortion patients as a means of explaining the growing number of pregnancy terminations in New York and throughout the United States. This study seeks to place this earlier research in ecological perspective by examining the social conditions in Manhattan associated with its spatial concentration of induced abortions. Data from the City Health Department and the U.S. Census were combined to describe abortion rates and status of women among New York's 339 health areas. A factor analysis of this data base using a varimax solution revealed that the most prominent areas of abortion usage cluster among populations of well-educated, professionally employed women living in communities on Manhattan's East Side and Greenwich Village. Single marital status and high population turnover were also found to covary with abortion. Results of this analysis suggest that the attitudes found among abortion patients in previous studies may be fostered by the compendium of pressures from single parenthood, upward mobility and short-term social relationships

This paper presents simple and inexpensive methods of recognizing patterns of epidemicity of varying intensity in geographical areas, and of testing for clusters. These methods are designed for available data which are reported on a county (or other geographical unit) basis. The methods are based on a simulated distribution of county “adjacencies”. An interesting pattern of the incidence of sudden infant death syndrome is recognized.

In view of increasing requirements for health care and climbing costs that reflect scarcer resources, it is necessary that new health care delivery facilities and medical personnel training programs be carefully planned. Care must be taken not to concentrate efforts on progress in medical science technology exclusively. Basic problems exist in the delivery of health care, e.g. maldistribution of physicians by specialty and geographic location and inequitable patterns of availability of health care facilities and personnel. A number of techniques have been used by health planners to forecast the need for, demand for and supply of health manpower at a specific time and place. The basic models for estimating these requirements include those based on: (1) professionally defined criteria, (2) current utilization rates of comprehensive pre-paid group plans, (3) medical personnel to population ratios, and (4) economic systematics. Some of these models address need (quantity of medical care that ought to be consumed to be as healthy as medical technology permits); others focus on supply and demand (actual use of medical services by consumers as a function of age, income, education, travel costs, and other social, economic and demographic variables).

After a review of the available models, it was felt that the economic types were most useful because they allow for the simulation of change in the health care environment and accommodate “what if” questions, thereby allowing for the consideration of contingencies in the environment. One example of a significant change in the health care environment in the United States would be the decrease or elimination of foreign medical graduates; FMG's accounted for 47% of the newly licenced physicians in the U.S. in 1974.

The economic model presented in this study was used to assess the supply of and demand for primary care physicians, particularly family practitioners in metropolitan northern Virginia. The demonstration of the model reveals its great flexibility b.y presenting four alternative situations for each of the study years 1978, 1988 and 1993. The statement of demand for family practitioners in this region was incorporated as a major phase of a feasibility study by the Medical College of Virginia for a family practice residency program at the Mount Vernon Hospital.