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

This mauscript is intended to review past contributions on the seasonality of suicide. Historically, many social scientists have offered arguments both for and against seasonal aspects of suicide. Studies of geographical variations also reflect variable conclusions. Some works in this area have studied urban-rural differences, while others have examined the differences between male and female suiciderelated behavior. Studies of attempted suicide offer some leads to understanding seasonal aspects of this problem, but many are hampered by the use of limited samples. Clearly, much must be accomplished in future analyses of the seasonal geography of suicide.

This study is directed toward an examination of the difference in the utilization of medical care services between areas of residence.

It is hypothesized that observed differences in utilization between specified areas of residence may be due entirely to the difference in population characteristics and, further, those characteristics may be non-manipulable. From this, it can be determined whether policy action designed to change utilization can be successful and, if so, which direction it should take.

Data used in this study is a 10,000 sub-sample taken from the 1970 Health Interview Survey (HIS). Dental visits per person per year, physician visits per person per year, and short stay hospital days per person per year are used as measures of use of service in separate analyses. p]The findings indicate that the difference in dental service utilization can be explained (statistically) by the difference in the educational levels of the residents of the areas. This suggests that changes in utilization can be effected by adopting programs designed to equalize educational levels between areas. For physician visits, the findings indicate that the difference in utilization between areas can be explained (statistically) by the difference in the sex of the residents of the areas. This suggests that changes in utilization are not possible or would only result from inappropriate use. For hospital days, the findings indicate that the difference in utilization between areas can be explained (statistically) by the difference in the limitation of activity due to chronic conditions (need) of the residents of the areas. This suggests that changes in utilization in the short run are not possible or would only result from inappropriate use. Long run changes could be affected by changes in medical technology that would impact on the amount of need in the populations.

The importance of these findings lie in the implication that differences in utilization between areas of residence may persist in spite of policy action that is directed at equalizing the availability of services between areas.

The Chandigarh Dun is a classic example of what Jaques M. May termed an “ecological niche”. While Chandigarh Dun is a relatively small region with respect to others in India, it nonetheless displays an impressive diversity of diseases related to the rather unique ecology and culture of a physiographic cul de sac. Infectious diseases predominate health problems, and they can be associated with physiographic conditions, the settlement morphology, and behavioral aspects of the people. Such diseases of major importance as malaria, typhoid fever, hookworm disease, and endemic goitre can be associated with the overall geomorphological setting, soils and vegetation, microclimatic conditions, and surface and sub-surface hydrology. Within the Dun, these and other major diseases display a spatial association with pathogenic, geogenic and cultural factors. On the basis of current knowledge of disease ecological problems, four zones, each with somewhat distinct combinations of disease and ecological associations, have been identified.

A measure of potential years of life lost (PYLL) is used to compare causes of death among several Southeast Asian countries to determine their positions in the epidemiologic transition. PYLL reduces the relative importance of degenerative diseases that affect older people and is easily calculated. The transition is already well advanced in Southeast Asia. The perspective of the needs for research and health programs may be lagging vital developments.

Available medical systems and forms of treatment in Pakistan range from traditional medicine to religious healers, homeopathic dispensaries, aryuvedic infirmaries, tibbi medical establishments, modern hospitals and specialized clinics. Traditional medicine and religious healers are more common in the rural areas, while more modern forms of treatment are characteristic of urban areas.

Modern hospitals and clinics offer the broadest range of diagnostic and treatment techniques in a wide range of specialities. Homeopathy is practiced either as a “hobby” without charges or as a service with minor charges. This system is based on the doctrine of similic similibus curante, which implies that disease can be cured by drugs which produce the same pathological effects symptomatic of a disease in a healthy person. The aryuvedic system is so old that Sanskrit is used in prescriptions. Most practitioners of Aryuvedic medicine, known as Vaids, either left Pakistan after 1947 or have adopted other professions. The tibbi, or unani system of medicine has been practiced since the early Greek period, with extensions developed by Persians, Arabs, and Mughals, and is now a part of the Muslim culture in Pakistan.

This paper is an attempt to examine the medical geography of these varied forms of treatment in Pakistan. Sind Province, situated at the southern extremity of Pakistan on the mouth of the Indus, has been selected as an area for some comparisons.

After a brief survey of the regional environments of mainland South Asia. the case is made for a retrospect to the medical geography of the late colonial period as a bench-mark survey against which may be measured both progress and problems since Independence. Examples of two-variable maps plotting both mean incidence and year-to-year variability of mortality from various causes are taken from a longer study of inter-war British India. The role of the three great epidemic diseases then—cholera, plague and smallpox—is contrasted with the more endemic patterns of malaria and dysentery, and a synthetic map of “disease regions” is presented and discussed. Development in the independent countries is likely to be crucial in future improvement in health conditions, and actual progress in disease prevention in India is discussed in relation to demographic and developmental problems.

Based on limited information for incidence and mortality from one population based registry (Singapore) and a number of hospital registries there are important differences in cancer incidence between Southeast Asian countries. Cancers of the oral cavity, pharynx, and liver have high incidence throughout the region; cancer of the nasopharynx in Chinese. Cancers of the oesophagus and stomach have high relative incidence in Burma and in Singapore, and cancer of the lung in Singapore. Cancer of the uterine cervix is the most important female cancer in the region except in the Philippines and Singapore. Cancer of the breast has its highest Southeast Asian incidence in the Philippines and its lowest in Singapore. The importance of cancer as a cause of illness and death is increasing in Southeast Asia as a function of its changing age structure and the continued improvement in conditions that extend life expectancy and suppress communicable diseases.