West Nile virus (WNV) is an emerging infectious disease that has widespread implications for public health practitioners across the world. Within a few years of its arrival in the United States the virus had spread across the North American continent. This research focuses on the development of a spatially explicit GIS-based predictive epidemiological model based on suitable environmental factors. We examined eleven commonly mapped environmental factors using both ordinary least squares regression (OLS) and geographically weighted regression (GWR). The GWR model was utilized to ascertain the impact of environmental factors on WNV risk patterns without the confounding effects of spatial non-stationarity that exist between place and health. It identifies the important underlying environmental factors related to suitable mosquito habitat conditions to make meaningful and spatially explicit predictions. Our model represents a multi-criteria decision analysis approach to create disease risk maps under data sparse situations. The best fitting model with an adjusted R2 of 0.71 revealed a strong association between WNV infection risk and a subset of environmental risk factors including road density, stream density, and land surface temperature. This research also postulates that understanding the underlying place characteristics and population composition for the occurrence of WNV infection is important for mitigating future outbreaks. While many spatial and aspatial models have attempted to predict the risk of WNV transmission, efforts to link these factors within a GIS framework are limited. One of the major challenges for such integration is the high dimensionality and large volumes typically associated with such models and data. This research uses a spatially explicit, multivariate geovisualization framework to integrate an environmental model of mosquito habitat with human risk factors derived from socio-economic and demographic variables. Our results show that such an integrated approach facilitates the exploratory analysis of complex data and supports reasoning about the underlying spatial processes that result in differential risks for WNV. This research provides different tools and techniques for predicting the WNV epidemic and provides more insights into targeting specific areas for controlling WNV outbreaks.

Orientador: Anderson L.H. Christofoletti / Banca: Sandra Elisa Contri Pitton / Banca: Thiago Salomão de Azevedo / Resumo: Cordeirópolis é uma cidade com aproximadamente 20.000, localizada em meio a Depressão Periférica Paulista, uma das regiões com umidade relativa do ar mais baixas do estado de São Paulo durante a estação de inverno. Por outro lado, a cidade também conta com uma série de problemas socioambientais, como a exploração indiscriminada dos recursos naturais e os baixos níveis educacionais apresentados pela população local, colocando em risco a qualidade de vida dos habitantes. Diante dos fatos, buscou-se estabelecer relações entre os diferentes tipos de tempo atmosférico e as doenças cardiorrespiratórias, considerando que as variações do tempo atmosférico tendem a desencadear uma série de reações no organismo humano, causando ou agravando um emaranhado de sintomas, enfermidades e mudanças no quadro clínico de saúde da população. Também foi possível identificar os grupos de risco e mapear as áreas mais vulneráveis e o local de residência dos pacientes portadores de enfermidades ligadas ao sistema circulatório e respiratório atendidos pelo Programa Saúde da Família, servindo de contribuição para que o poder público possa pensar novas diretrizes que sejam ecologicamente, social e economicamente mais viáveis e justas / Abstract: Cordeirópolis is a small town with approximately 20,000 inhabitants and is located in the midst of the Depressão Periférica Paulista, one of the driest regions of the state of São Paulo during the winter season. On the other hand, the city is among the largest and most important deposits of clay, which explains its economic vocation, aimed mainly to the production of ceramic artifacts and agriculture of sugar cane. Despite being part of the largest ceramic center in Latin America,and although the ceramic industries as well as the sugar industry are the main sources of income of the municipality, the city has a number of socio-environmental problems, such as the indiscriminate exploitation of natural resources and low levels of education provided by the local population, threatening the quality of life for residents. Given the above facts, we sought to establish relationships between different types of weather and cardiopulmonary diseases, considering that variations in the weather tend to trigger a series of reactions in the human body, causing or exacerbating a tangle of symptoms, diseases changes in clinical and population health. By the way, were collected, processed and organized weather data on precipitation, temperature, relative humidity and air quality standard, and was then correlated with the information collected by the Hospital Health System (SIH-SUS), referring to the monthly number of patients hospitalized for some kind of cardiopulmonary disease. Through the questionnaires it was possible to identify risk groups and map the area's most vulnerable and place of residence of patients with diseases related to circulatory and respiratory system served by the Family Health Program, serving as a contribution to the local government can think of new guidelines that are environmentally, socially and economically more viable and fair / Mestre

Made available in DSpace on 2014-12-17T15:43:49Z (GMT). No. of bitstreams: 1 MarinaCBML_DISSERT.pdf: 1113411 bytes, checksum: 9a3585d52187487449cbc5cbaece96e8 (MD5) Previous issue date: 2012-12-17 / Background:Low birth weight(LBW) isa risk factor formorbidity, infant and child mortality. In Brazilthe highest percentages oflow birth weightoccur inregionsofbettersocio-economic status. Objective: to know the spatial distributionofrates of lowbirth weight andcorrelation withsocial indicatorsand service. Drawing: ecological, and Brazilian statesas units ofanalysis. Methodologyused thetechnique ofspatial analysis, data from 2009SINASC, IPEAandIBGE. Results:higher rates oflow birth weightare in the statesof the south/southeast,GlobalMoran: 0.267, p=0.02.Clustersofhigh-hightypein the Southeastandlow-lowstates ofthe Amazon region.Conclusion: Thespatial inequalityoflow birth weightreflectsthe socioeconomic conditionsof the states. More developed regionsholdhigher rates oflow birth weight, therefore,the presenceof the serviceandits usedodecrease infant mortalityandincrease theBPN / o baixo peso ao nascer (BPN) ? fator de risco para a morbidade, mortalidade neonatal e infantil. No Brasil os maiores percentuais de baixo peso ao nascer ocorrem em regi?es de melhor situa??o s?cio-econ?mica. Objetivo: conhecer a distribui??o espacial de taxas de baixo peso ao nascer e a correla??o com indicadores sociais e de servi?o. Desenho: ecol?gico, tendo os estados brasileiros como unidades de an?lise. Metodologia: utilizou-se t?cnica de an?lise espacial, dados de 2009 do SINASC, IPEA e IBGE. Resultados: taxas maiores de baixo peso ao nascer est?o nos estados da regi?o sul/sudeste, Moran Global: 0,267, p= 0,02. Aglomerados do tipo alto-alto na regi?o Sudeste e baixo-baixo em estados da regi?o da Amaz?nia Legal. Conclus?o: A desigualdade espacial do baixo peso ao nascer reflete as condi??es socioecon?micas dos estados. Regi?es mais desenvolvidas det?m maiores taxas de baixo peso ao nascer, portanto, a presen?a do servi?o e sua utiliza??o fazem diminuir a mortalidade infantil e aumentar o BPN

Orientador: Magda Adelaide Lombardo / Coorientador: Sandra Elisa Contri Pitton / Banca: José Bueno Conti / Banca: Ana Tereza Cáceres Cortez / Banca: Sílvia Aparecida Guarnieri Ortigoza / Banca: Tânia Maria de Campos Leite / Resumo: Esta pesquisa, realizada no campo da Geografia Médica, tem como objetivo estabelecer interface entre o clima e a saúde. Nessa ótica, buscou-se analisar a variabilidade dos elementos climáticos nas ocorrências de casos de internação por pneumonia, relacionando-os com os fatores de risco dos grupos dos pacientes e riscos socioeconômicos da população em estudo. Tomou-se a cidade de Rio Claro como exemplo de caso, para estimar a associação existente entre os totais diários de internação por pneumonia, obtidos pelo Sistema de Informação Hospitalar (AIH/SUS), e os dados meteorológicos (temperatura, precipitação e umidade), obtidos junto a Estação Metereológica do Centro de Análise e Planejamento Ambiental (CEAPLA) e pelo Laboratório de Análise Metereológica e Climatologia Aplicada da UNESP-campus de Rio Claro-SP no período compreendido entre janeiro de 2000 e dezembro de 2009. Foi evidenciado que o número de ocorrência de internação por pneumonia sofreu acréscimo durante os meses de outono e inverno, época em que foram registradas baixas temperaturas e período de estiagem. Com relação à distribuição espacial, verificou-se que as áreas de concentração de domicílios dos pacientes se localizaram na zona central, onde há uma grande concentração de pessoas e a frota de veículos é mais numerosa, gerando mais poluentes na atmosfera, e nos bairros periféricos, onde as moradias têm menor qualidade de acabamento e a população se torna mais vulnerável. Pelas evidências, foi possível concluir que as condições climáticas têm influência sobre a morbidade respiratória / Abstract: This research made in Medical Geography field aims to establish an interface between climate and health. In this viewpoint, the climatic factor variability had been analyzed on the hospital stay for pneumonia, correlating with the risk factors of risk patient groups and the population's socioeconomic study. The city of Rio Claro, Sao Paulo State, Brazil, had been taken as the geographical study place to estimate the linking between daily totals of hospital stay for pneumonia, got by the Hospital Information System (AIH/SUS), and the meteorological data - temperature, precipitation, moisture - which had been gotten from the Climatology Laboratory of Geography Department, Unesp (Sao Paulo University) - Rio Claro campus and Climatological Station to the Center of Analysis and Environmental Planning (CEAPLA), during the period between January 2000 and December 2009. The number of hospitalization for pneumonia had been increased during autumn and winter months due to the low temperature and dry periods which had been recorded. Related to special distribution, it had been shown that the patient housing area concentration had been located in the central area as well peripheral ones such as Mae Preta and Chervezon. In the central areas there as been a large concentration of people and a high number of vehicles which results in more pollutants in the atmosphere. Therefore, in the peripheral region houses have been presenting low housing finishing, becoming such population more vulnerable to this health problem. However, it is possible to conclude that the climate has influence on respiratory morbidity / Doutor

<p>The purpose with this essay is to explore the social changes in relation to changes in mortality for the two largest ethnic groups in Estonia; ethnic Estonians and the Russian minority. Since this is a geographical essay, my purpose is also to explore these changes in relation to the country’s internal geography. As these changes appear over time in space, the content is partly rooted in a time geographical point of view. It is also rooted in a regional geographical point of view, since I have been comparing the mentioned changes between different areas in Estonia (with considerations on developments abroad).</p><p>Two different development lines can be seen as a consequence of the social changes taking place in the 1990s. While the ethnic Estonians situation has improved, the Russian minority’s situation has instead declined regarding to social existence and health. As a result the mortality has increased enormously for the Russian minority. The ethnic Estonians had also a mortality increase in practically all studied causes of death in all studied areas, but this increase wasn’t as high as for the Russian minority. Nevertheless, when comparing two different counties with each other as well as with the country as whole, the pattern seems to be more complicated. The Russians living in the western county of Läänemaa, have been affected more favourably by the social change than those living in the north-eastern county of Ida-Virumaa. Except for mortality by alcohol poisoning, the Russians living in Läänemaa had a much lower mortality increase than those living in Ida-Viruma and even compared with the country as whole.</p><p>It seems as those Russians living in the western parts of Estonia have been affected more favourably than those living in the north-eastern parts. These structures are very much depending on the history, since most of the Russians living in the north-eastern area immigrated during the Soviet era, while the western parts had a much earlier immigration of Russians. Considering the time and place of the Russian immigration, one can divide the Russian minority in two groups; those in the west, and those in the east.</p>

The purpose with this essay is to explore the social changes in relation to changes in mortality for the two largest ethnic groups in Estonia; ethnic Estonians and the Russian minority. Since this is a geographical essay, my purpose is also to explore these changes in relation to the country’s internal geography. As these changes appear over time in space, the content is partly rooted in a time geographical point of view. It is also rooted in a regional geographical point of view, since I have been comparing the mentioned changes between different areas in Estonia (with considerations on developments abroad). Two different development lines can be seen as a consequence of the social changes taking place in the 1990s. While the ethnic Estonians situation has improved, the Russian minority’s situation has instead declined regarding to social existence and health. As a result the mortality has increased enormously for the Russian minority. The ethnic Estonians had also a mortality increase in practically all studied causes of death in all studied areas, but this increase wasn’t as high as for the Russian minority. Nevertheless, when comparing two different counties with each other as well as with the country as whole, the pattern seems to be more complicated. The Russians living in the western county of Läänemaa, have been affected more favourably by the social change than those living in the north-eastern county of Ida-Virumaa. Except for mortality by alcohol poisoning, the Russians living in Läänemaa had a much lower mortality increase than those living in Ida-Viruma and even compared with the country as whole. It seems as those Russians living in the western parts of Estonia have been affected more favourably than those living in the north-eastern parts. These structures are very much depending on the history, since most of the Russians living in the north-eastern area immigrated during the Soviet era, while the western parts had a much earlier immigration of Russians. Considering the time and place of the Russian immigration, one can divide the Russian minority in two groups; those in the west, and those in the east.

Cardiovascular diseases (CVDs) are the leading cause of death and disability around the world. The purpose of this thesis is to investigate the impact of socio-environmental determinants of CVDs at the neighbourhood scale in order to inform actionable interventions, which may lead to large-scale reductions in preventable CVDs. Drawing on 2411 surveys carried out in Toronto, Canada, this thesis employs multilevel models to estimate the magnitude of socio-environmental influences on the risk of CVD while adjusting for individual-level risk factors. To advance current research methodology, strategies and innovations were developed to 1) improve the characterization of neighbourhoods by empirically testing a full range of socio-environmental influences; 2) account for non-residential exposures by including a combined analysis of work and home contexts; 3) account for variations in the duration of exposure through the use of time-weighted models; 4) deal with problem of spatial data aggregation by developing and testing a novel method of neighbourhood zone design, and 5) account for the spatial scales of different socio-environmental determinants by modeling at multiple scales. The thesis demonstrated that land use decisions are inextricably public health decisions. It found that living in neighbourhoods with inadequate access to food stores and areas for physical activity, burdened by violent crimes and fast food restaurants, and over-dependent on automobiles (leading to air pollution), with a high level of noise may significantly increase the risk of CVDs, over and above individual-level risks. The thesis also found that working in neighbourhoods that are socio-economically disadvantaged or have high-traffic may significantly increase CVD risk. The thesis developed and demonstrated novel methods to reduce the measurement error of neighbourhood exposures through 1) the use of “amoeba buffers” to improve neighbourhood zone design to better reflect participants’ local neighbourhoods and 2) the use of duration of exposure weights to adjust for individual differences in the time spent across different contexts. Finally, it found that the significance of socio-environmental factors depends on the scale of data aggregation; thus, investigation of multiple scales may be required to identify the relevant scale that matches the specific contextual factor in future research.

Cardiovascular diseases (CVDs) are the leading cause of death and disability around the world. The purpose of this thesis is to investigate the impact of socio-environmental determinants of CVDs at the neighbourhood scale in order to inform actionable interventions, which may lead to large-scale reductions in preventable CVDs. Drawing on 2411 surveys carried out in Toronto, Canada, this thesis employs multilevel models to estimate the magnitude of socio-environmental influences on the risk of CVD while adjusting for individual-level risk factors. To advance current research methodology, strategies and innovations were developed to 1) improve the characterization of neighbourhoods by empirically testing a full range of socio-environmental influences; 2) account for non-residential exposures by including a combined analysis of work and home contexts; 3) account for variations in the duration of exposure through the use of time-weighted models; 4) deal with problem of spatial data aggregation by developing and testing a novel method of neighbourhood zone design, and 5) account for the spatial scales of different socio-environmental determinants by modeling at multiple scales. The thesis demonstrated that land use decisions are inextricably public health decisions. It found that living in neighbourhoods with inadequate access to food stores and areas for physical activity, burdened by violent crimes and fast food restaurants, and over-dependent on automobiles (leading to air pollution), with a high level of noise may significantly increase the risk of CVDs, over and above individual-level risks. The thesis also found that working in neighbourhoods that are socio-economically disadvantaged or have high-traffic may significantly increase CVD risk. The thesis developed and demonstrated novel methods to reduce the measurement error of neighbourhood exposures through 1) the use of “amoeba buffers” to improve neighbourhood zone design to better reflect participants’ local neighbourhoods and 2) the use of duration of exposure weights to adjust for individual differences in the time spent across different contexts. Finally, it found that the significance of socio-environmental factors depends on the scale of data aggregation; thus, investigation of multiple scales may be required to identify the relevant scale that matches the specific contextual factor in future research.

The primary objective of this thesis is to differentiate between the risk factors for pre-and post-monsoon cholera epidemics in rural Bangladesh by analyzing the complex interaction between select environmental, cultural/behavioral, and socioeconomic variables over space and time. In rural Bangladesh, cholera epidemics correspond with the annual monsoon: the first, and smallest, occurs between March and June, while the larger cholera peak occurs between September and December. The differences between the spatial and temporal patterns of seasonal cholera are analyzed, and the risk factors are calculated for pre-and post-monsoon cholera epidemics. The theoretical approach that underlies this medical geographical study is disease ecology, which espouses that risk of disease is caused by an interaction between people and their environment. This thesis is structured around a holistic understanding that human-environment interactions are inseparable. In Bangladesh, the monsoon season typically starts between May and June. The 1992 and 1993 cholera peaks occurred just before the monsoon in April and March respectively, while the 1994 cholera peak occurred between April and June. In 1992 and 1993 cholera incidence increased in the post-monsoon period, and peaked in October. The 1994 post-monsoon cholera peak occurred in November. There is a regular temporal pattern to cholera, as the peaks followed a seasonal pattern with the smaller epidemic occurring in the pre-monsoon period and the larger epidemic occurring in the post-monsoon period. This study shows that there are different risks associated with pre-monsoon cholera epidemics and post-monsoon cholera epidemics. The two main risk factors associated with cholera incidence pre-monsoon were bari population (i.e., crowding) and a house located within the flood controlled area. These two variables were even more strongly associated with post-monsoon cholera incidence to a greater degree, along with a number of other variables including water use, sanitation practices, and socioeconomic status.

Ghana is identified among the developing countries with high maternal mortality ratio in Africa. This study unpacked the Demographic and Health Survey data by examining the maternal health indicators at the district level using GIS methods. Understanding the geographic patterns of antenatal care, place of delivery, and skilled birth attendants at the small scale will help to formulate and plan for location-specific health interventions that can improve maternal health care behavior among Ghanaian women. Districts with high rates and low rates were identified. Place of residence, Gini-Coefficient, wealth status, internet access, and religious affiliation were used to explore the underlying factors associated with the observed patterns. Economic inequality was positively associated with increased use of maternal health care services. The ongoing free maternal health policy serves as a cushion effect for the economic inequality among the districts in the Northern areas. Home delivery is common among the rural districts and is more prominent mostly in the western part of Northern Region and southwest of Upper West. Educating women about the free maternal health policy remains the most viable strategy for positive maternal health outcomes and in reducing MMR in Ghana.