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

A conspectus over these years is sought using brief reviews of: McGlashan's edited volume of 1972; Pyle's study of some non-infectious diseases and needed facilities in Chicago (1971); Shannon and Dever on the geography of health care delivery (1974); series of bench-mark reviews edited by Hunter (1974); a special issue of Economic Geography edited by Pyle (1976); Howe's 1977 World Geography of Human Diseases; McGlashan's edited booklet on Australian mortality studies; Learmonth's introductory book on medical geography in 1978; and finally Pyle's much more advanced textbook of 1979. A table is used to compare national approaches to medical geography, and some current topics that may offer pointers to the future are noted.

The inter-relationships between asthma morbidity series in different parts of the State of Tasmania and the local, daily, meteorological factors were examined using spectral techniques. In addition to hospital morbidity series of 6 years length, volunteer asthmatics in 4 areas provided comparative series for 19 months. Biometeorological indices of wind chill, discomfort etc. were calculated for each day and used for analysis in addition to single weather elements.

Each morbidity index by geographic region and sex was analysed with each meteorological element/construct. For each pair first the individual spectra were calculated to demonstrate the dominant frequencies in their respective time series and then the co-spectrum between each pair of spectra was computed to assess the degree of coherence, or correlation between their frequency components. An examination of the coherence between the series provided evidence against the existence of cyclical meteorotropic behaviour in any of the study areas. Periodic fluctuations were seen to exist in the morbidity spectra but these were not related to any of the weather parameters that were investigated.

The effect of colonization on the infestation by intestinal parasites was examined in the subtropical lowlands of Bolivia. High frequency of parasite carriers indicates the close parasite-human relationship in this area. But the variation in the extent of infestation among colonies shows the modification of this relationship by the development of cultivation and/or adjustment for living facilities which were influenced by differential colonizing processes in terms of the time elapsing since initial settlement, the type of colonization and the origin of the colonists.

In order to clarify the geographical factors affecting the remarkable ubiquity of schistosomiasis japonica in Japan, topographical and edaphic conditions, as well as change of agricultural landuse of the habitats of the snails were investigated.

• 1.

  1. The landforms were classified into the following three types, with reference to the topography of flood areas. They are (1) lower deltaic plains, (2) lower alluvial fans and (3) upper alluvial fans. Many of the endemic land surface are of the first types.

• 2.

  2. From the results of cultural experiments of the snails on various kinds of soils, it was realized that the soil restricted the distribution of habitats and that the soils adequate for the fecundity and breeding of snail egg were surface materials of grey, grey-brown or brown lowland soil with the texture of sandy loam or loam and with humus content of about 2.6%.

• 3.

  3. The effects of agricultural development on the decrease of schistosomiasis cases were clarified by examining changes in the land use of the Kofu Basin, the most infected area.

• 4.

  4. A medical geographical province map of the Kofu Basin was compiled by synthesis of snail distribution and its controlling factors.

The mortality rate for cerebrovascular disease has been the leading cause of death in Japan since 1951 followed by malignant neoplasm and cardiovascular disease. Both cerebro- and cardiovascular diseases are currently responsible for about 40% of all causes of death in Japan, emerging as the most important disease problem.

The purpose of this study is to examine the geographic variations in standardized mortality ratio (SMR) for these diseases on a county-by-county basis across Japan during 1969–1974 and to investigate environmental factors which might be associated with these diseases.

Environmental data such as the food expenditures, latitude and longitude in each county were obtained from the reliable sources. In order to study the association between these environmental factors and the disease, the counties were divided into two groups: one group consists of counties with the SMR more than 120 and significant at 5% level (high SMR group) and the other, those with the SMR less than 80 and significant at 5% level (low SMR group). The environmental conditions were then compared between these two groups.

Cerebral haemorrhage and cerebral infarction accounted for approximately 80% of all cerebrovascular diseases deaths in Japan in 1978. The SMR for cerebral haemorrhage and cerebral infarction in males is high in the northeast and low in the southwest but the most striking clustering of elevated SMR occurs in the Tohoku Region. The patterns for females for these diseases are similar. The geographic patterns for ischaemic heart disease are less pronounced than those for cerebral infarction and haemorrhage, while the maps of hypertensive heart disease show higher SMR in the southern part of the country and Kanto areas.

Excess intake of salt and insufficient intake of animal proteins which were observed in the high SMR group seem to play an important role as risk factors of cerebrocardiovascular diseases in Japan.

The authors studied the changing pattern of geographical distribution of medical facilities and population density in a suburban district of Tokyo. The data sources are the population census in Japan of 1965, 1970 and 1975, and a survey of medical institutions by the TAMA Medical Association in 1978. The district was divided into 215 unit cells by the Standard Mesh System (Japan Grid Reference System). We used the quantitative geographical method in order to analyse the development of medical facilities from the viewpoint of planning theory. According to the results, the tendency towards increase in number and sorts of medical facilities had been close to the development of the population density in the district as in the theoretical pattern of market development. However, details of the process and the tendency are slightly different from it. The authors also discuss the present situation concerning planning of medical care delivery system in Japan.

Against a background of a potential oversupply of medical practitioners, this study develops a method of quantifying the hinterland and population served by each practice centre. Allowance is made for varying age and sex demands for medical service and demonstrates a seven-fold variation in workload per doctor in rural Tasmania. The need for means to correct the inertia inherent in this geographic maldistribution is emphasised.

Maps of age adjusted death rates (AADRs) of each health district (HD) in Rio Grande do Sul, the southernmost state of Brazil, for ischemic heart disease, cerebrovascular disease, malignant neoplasm of all sites, esophagus, stomach, colon, lung and breast from 1970 to 1976 are presented. Geographic distribution patterns of these diseases show a strong geographic dependency indicating that environmental factors are important in the etiology of these diseases. Higher AADRs from malignant neoplasms were observed in stock farming areas of the state and from ischemie heart disease and cerebrovascular disease in coast and stock farming areas. AADR from esophagus cancer for males of the state was the highest in the world and for females, it was also one of the highest group. Stomach cancer mortality rate per 100,000 population was about 14.4 through the period of examination and it was about 2.5 times of that of colon cancer in spite of a large quantity of beef consumption. The rank order of AADRs in the world from cancer of digestive tract, from esophagus to rectum, was compared with the rank order of AADRs for the state. This showed a step-down pattern declining from upper to lower tract, and AADR from colon cancer was the same as that of Japan, one of the low risk countries for colon cancer. Higher AADRs from esophagus and stomach cancer might be due to very hot “mate-tea” (infusion of Ilex paraguayensis A. St. Hil.) and a large salt intake, especially in stock farming areas. Rapid increase of AADRs from lung and breast cancer were also observed and they showed a similar geographic distribution. Further studies on the environmental factors associated with AADRs from above mentioned diseases are needed.

In cities where a mixed free-enterprise and public supply system operates, the spatial distribution of health care services and access opportunities of potential consumers to services typically fails to satisfy equity criteria. The pattern of distribution and consumer use of general practitioner (GP) services in metropolitan Adelaide, Australia, are examined. Various theories and models are discussed aimed at furnishing explanations of the spatial behaviour of both facility providers and users. These include traditional location theories, theory of demand for semi-public goods, and behavioural models of user choice. A method of spatial analysis at a disaggregated level of scale to investigate the degree of congruence between potential demand for GP services and likely levels of satisfaction from the available supply of GP services in Adelaide is presented and its planning implications discussed.

The mortality map shows a spatial distribution of the death phenomena over a certain period of time and facilitates analysis of factors which influence disease. In constructing a mortality map, it is desirable from the geographical point of view to make each areal unit as small as possible so that we can compare it with other regions with different characters. On the other hand, since the number of deaths in each region decreases as each areal unit becomes smaller, the comparison of the level of mortality rate among the regions is known to become more difficult owing to the influence of random errors. Therefore the areal unit has to be fairly large from the statistical point of view. Those two demands conflict with each other. In practice it is necessary to set up appropriate areal units to make a good compromise between those two conflicting demands. In this paper, this problem is discussed in terms of statistical theory.