American Indians are distinct in their current geographic isolation and history of exclusionary policies enacted against them. Citizenship and territorial policies from the 1700s through the early 1900s have manifested in the distinctive status of many American Indian communities as sovereign nations, a classification that no other ethnic group in the United States can claim. However, as a result of political and geographic isolation, disparities in heath and economic development have been an ongoing problem within these communities. Among the most distinctive health disparities are in infant mortality and obesity-related complications. This project will focus on South Dakota, a state that was late in its application of assimilationist policies, yet today is home to some of the least healthy reservation communities in the United States. An investigation into the making of reservation healthcare delivery systems and patterns of prenatal care utilization will hopefully reveal patterns of health and economic characteristics that predispose infant mortality. / Master of Science

Bisher wurden die Einzugsgebiete der Gesundheitszentren mit den administrativen Grenzen des Sektors, in dem das Gesundheitszentrum liegt, gleichgesetzt. Das Hauptanliegen dieser Arbeit ist es, die tatsächlichen Einzugsgebiete zu erfassen und bisher verwendete methodische Ansätze auf ihre Eignung zu testen, Einzugsgebiete für Gesundheitszentren möglichst realistisch zu modellieren. Darüber hinaus sollen Gründe für räumliche Unterschiede in der Inanspruchnahme von Gesundheitszentren ermittelt werden. Fragenbögen, die mit Patienten in den Gesundheitszentren ausgefüllt wurden, sowie aus Registrierungsbüchern erfasste Daten geben Aufschluss über die räumlichen Unterschiede bei der Inanspruchnahme und dienen als Referenzdaten für die weiteren Analysen. Die Studie zeigt, dass keine der getesteten Methoden dazu geeignet ist, die Einzugsgebiete zufriedenstellend zu modellieren. Ein selbst entwickelter Ansatz, der verschiedene Methoden kombiniert, liefert bezüglich der Bevölkerung nur zweitbeste Ergebnisse nach Thiessen Polygonen, während für keine der Methoden die Grenzen mit den Grenzen übereinstimmen, die für die tatsächliche Nutzung ermittelt wurden. / Until now catchment areas of health centers are considered as the administrative boundaries of the sector where the health center is situated. The main objective of this study is to determine the actual catchment areas of health centers in Huye District (Southern Province, Rwanda) and to test approaches used in other studies in a geographical information system for an improved estimation of catchment areas. Furthermore reasons for disparities in health center utilization are to be revealed. Questionnaires filled with patients at health centers as well as data retrieved from registration books aim to give information about spatial disparities in health center utilization and serve as evaluation basis for further analysis. The study shows that none of the tested methods is able to predict catchment areas or the population to be served in a satisfying accuracy. An own approach that combines different methods gives only second best results after Thiessen polygons regarding the served population while for none of the methods the boundaries match well the catchment areas as they are defined by the data.

Made available in DSpace on 2016-04-25T20:22:03Z (GMT). No. of bitstreams: 1 Valencio Manoel.pdf: 7169342 bytes, checksum: 65f3ead043d0e9977eb4e9d160f955ba (MD5) Previous issue date: 2008-03-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present thesis has objective to carry through studies of Medical Geography of the Heath, in three cities of the African continent, located in Angola: Benguela, Lobito and Commune of the Catumbela, in the period of 1615 the 1940. This research about in such a way promotes quarrel of the Theory of the Pathogenic Complex of the Malaria ( elaborated for the French geographer Max Sorre), as well as, through the re reading of the European colonized, that considers the Malaria in the colonies a regional- cultural problem. I display the application of a Medical Geography imperialist occidental person, who almost sends the extinguishing of the local Medicine. It has a recurrent fight in these Kingdoms, to inside determiner the great epidemics of Malaria of its territorial occupation. In century XX, although the biotechnological advances, still take advantage the receptive and the vulnerability of the Malaria. It has crisis of the Angolan Public Health. In a retrospect of the description social process, in the above described period, I search an assay of relative form, a proposal of reconstruction of the relations between the man, the environment, and the pathological complexity of the Malaria in the Republic of Angola / A presente tese tem como objetivo realizar estudos da Geografia Médica e da Saúde, em três cidades do continente africano, localizados em Angola: Benguela, Lobito e Comuna da Catumbela, no período de 1615 a 1940. Esta pesquisa promove uma discussão acerca da Teoria do Complexo Patogênico da Malária (elaborada pelo geógrafo Francês Max Sorre), como também, através da re leitura da Antropogeografia (de Friedrich Ratzel). Neste contexto, relato o olhar do colonizador europeu, que considerava a Malária nas colônias um problema regional cultural. Exponho a aplicação de uma Geografia Médica imperialista ocidental, que remete a quase extinção da Medicina local. Há uma luta recorrente nestes reinos, para exterminar as grandes epidemias de Malária dentro da sua ocupação territorial. No século XX, apesar dos avanços bio-tecnológicos, ainda prevalece a receptividade e a vulnerabilidade da Malária. Há crise da Saúde Pública angolana para controlar epidemias, com a ausência de uma Geografia da Saúde. Numa retrospectiva do processo histórico social, no período acima descrito, busco um ensaio de forma relativa, uma proposta de reconstrução das relações entre o homem, o meio ambiente, e a complexidade patológica da Malária na República de Angola

Made available in DSpace on 2016-04-26T14:56:49Z (GMT). No. of bitstreams: 1 Valencio Manoel.pdf: 7169342 bytes, checksum: 65f3ead043d0e9977eb4e9d160f955ba (MD5) Previous issue date: 2008-03-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present thesis has objective to carry through studies of Medical Geography of the Heath, in three cities of the African continent, located in Angola: Benguela, Lobito and Commune of the Catumbela, in the period of 1615 the 1940. This research about in such a way promotes quarrel of the Theory of the Pathogenic Complex of the Malaria ( elaborated for the French geographer Max Sorre), as well as, through the re reading of the European colonized, that considers the Malaria in the colonies a regional- cultural problem. I display the application of a Medical Geography imperialist occidental person, who almost sends the extinguishing of the local Medicine. It has a recurrent fight in these Kingdoms, to inside determiner the great epidemics of Malaria of its territorial occupation. In century XX, although the biotechnological advances, still take advantage the receptive and the vulnerability of the Malaria. It has crisis of the Angolan Public Health. In a retrospect of the description social process, in the above described period, I search an assay of relative form, a proposal of reconstruction of the relations between the man, the environment, and the pathological complexity of the Malaria in the Republic of Angola / A presente tese tem como objetivo realizar estudos da Geografia Médica e da Saúde, em três cidades do continente africano, localizados em Angola: Benguela, Lobito e Comuna da Catumbela, no período de 1615 a 1940. Esta pesquisa promove uma discussão acerca da Teoria do Complexo Patogênico da Malária (elaborada pelo geógrafo Francês Max Sorre), como também, através da re leitura da Antropogeografia (de Friedrich Ratzel). Neste contexto, relato o olhar do colonizador europeu, que considerava a Malária nas colônias um problema regional cultural. Exponho a aplicação de uma Geografia Médica imperialista ocidental, que remete a quase extinção da Medicina local. Há uma luta recorrente nestes reinos, para exterminar as grandes epidemias de Malária dentro da sua ocupação territorial. No século XX, apesar dos avanços bio-tecnológicos, ainda prevalece a receptividade e a vulnerabilidade da Malária. Há crise da Saúde Pública angolana para controlar epidemias, com a ausência de uma Geografia da Saúde. Numa retrospectiva do processo histórico social, no período acima descrito, busco um ensaio de forma relativa, uma proposta de reconstrução das relações entre o homem, o meio ambiente, e a complexidade patológica da Malária na República de Angola

Made available in DSpace on 2014-12-17T15:43:48Z (GMT). No. of bitstreams: 1 GenycleaSO_DISSERT.pdf: 2009007 bytes, checksum: 19a6d4fcd41f06f499ef6b4431291aa7 (MD5) Previous issue date: 2012-12-17 / In Brazil, despite the decline in infant mortality in recent decades it still has high rates going against recommended by WHO. Being the largest percentage of infant mortality rate composed of neonatal deaths. Objective: A study was conducted to analyze the spatial distribution of neonatal mortality and its correlation with the biological, socioeconomic and maternal and child health care in the Brazilian states in the period from 2006 to 2010. Method: The study made thematic maps and correlation (LISA) for verification of spatial dependence and multiple linear regression models. Results: Was found that there is no spatial autocorrelation for neonatal mortality in the Brazilian states (R = 0.002, p = 0.48). Most of variables were correlated (r> 0.3, p <0.05) with neonatal mortality, forming clusters in the North and Northeast, with the highest rates of teenage mothers, low household income per capita, lower prenatal appointments and beds of Neonatal Intensive Care Unit. The number of Neonatal UCI beds remained independent effect after regression analysis. Conclusion: The study concludes that regional inequalities in living conditions and especially the access to maternal and child health services contribute to the unequal distribution of neonatal mortality in Brazil / No Brasil, apesar do decl?nio da mortalidade infantil nas ?ltimas d?cadas esta ainda possui altas taxas indo de encontro ao preconizado pela OMS. Sendo o maior percentual da taxa de mortalidade infantil composto pelos ?bitos neonatais. Objetivo: Realizou-se um estudo para analisar a distribui??o espacial da mortalidade neonatal e sua correla??o com os fatores biol?gicos, socioecon?micos e de aten??o ? sa?de materno-infantil nos estados brasileiros, no per?odo de 2006 a 2010. Desenho: ecol?gico, utilizando os estados brasileiros e o Distrito Federal como unidades de an?lise. M?todo: Foram constru?dos mapas tem?ticos e de correla??o (LISA) para verifica??o de depend?ncia espacial e modelos de regress?o linear m?ltipla. Resultados: Verificou-se que n?o h? autocorrela??o espacial para mortalidade neonatal nos estados brasileiros (I =0,002; p=0,48). A maioria das vari?veis estavam correlacionadas (r >0,3, p<0,05) com a mortalidade neonatal, formando clusters em estados do Norte e Nordeste, com maiores taxas de m?es adolescentes, renda domiciliar per capta baixa, menor realiza??o de consultas de pr?-natal e de leitos de UTI Neonatal. O n?mero de leitos de UTI Neonatal manteve efeito independente ap?s a an?lise de regress?o. Conclus?o: As desigualdades regionais das condi??es de vida e principalmente de acesso aos servi?os de sa?de materno-infantil contribuem para a distribui??o desigual da mortalidade neonatal no Brasil

Two disease regions existed on the Oregon Trail. Asiatic cholera impacted the Platte River flood plain from 1849 to 1852. Dysentery developed two endemic foci due to the decay of buffalo carcasses in eastern and middle Nebraska between 1844 and 1848, but later developed a much larger endemic region west of this Great Plains due to the infection of livestock carcasses by opportunistic bacteria. This study demonstrates that whereas Asiatic cholera diffusion along the Trail was defined primarily by human population features, topography, and regional climate along the Platte River flood plain, the distribution of opportunistic dysentery along the Trail was defined primarily by human and animal fitness in relation to local topography features. By utilizing a geographic interpretation of disease spread, the Asiatic cholera epidemic caused by Vibrio cholerae could be distinguished from the dysentery epidemic caused by one or more species of Salmonella or Campylobacter. In addition, this study also clarifies an important discrepancy popular to the Oregon Trail history literature. "Mountain fever," a disease typically associated with Rocky Mountain Spotted Fever, was demonstrated to be cases of fever induced by the same bacteria responsible for opportunistic dysentery. In addition, several important geographic methods of disease interpretations were used for this study. By relating the epidemiological transition model of disease patterns to the early twentieth century sequent occupance models described in numerous geography journals, a spatially- and temporally-oriented disease model was produced applicable to reviews of disease history, a method of analysis which has important applications to current studies of disease patterns in rapidly changing rural and urban population settings.

Abstract Sparsely populated Finland is an interesting area for studying the effects of population density and distance on health. Previous studies indicate health problems in rural and remote areas. Aim is to study the importance of local residential area to health of young adults: how the residential area is associated with health, what is the role of geographical distance and how health is associated with moving. Study utilises the 31-year follow-up data from the Northern Finland Birth Cohort 1966 study, initially including all children born in the provinces of Oulu and Lapland in 1966. Local residential area is defined with 1 km² population density grid data. Distances to municipality centre or health centre are calculated using Finnish road network data (Digiroad). Perceived health in rural and urban areas is studied with ordinal logistic regression; body mass index (BMI) and overweight in relation to distance to municipality’s centre and population density using a generalised additive model. Role of distance in health centre use and distance-related inequity are studied with negative binomial regression and concentration indices, and health’s association with moving in multinomial logistic regressions. Poor perceived health increased from densely to sparsely populated areas. Among rural men adverse psychosocial and lifestyle factors were behind the associations, among women reasons for poor health in scattered settlement areas remained unclear. BMI and overweight increased at distances greater than 5 kilometres from municipality centre and with decreasing population density. No barrier effects of distance or distance-related inequity in the health centre use was found. Dissatisfaction with life and history of morbidity were associated with rural-urban moves, activity limiting illness with rural-rural moves, and frequent use of health services with all urban moves. Geographical distance was not a major barrier in health service use among young adults. Individual’s health status was linked with moving and may be relevant for rural-urban health inequalities. Local health variations within small administrative areas can be identified by grid-based data, indicating the need of customised interventions. Urban sprawl may affect people’s bodyweight, also urging health-based planning of residential areas. Longitudinal perspective would improve predictive value of findings. / Tiivistelmä Harvaan asuttu Suomi on kiinnostava alue väentiheyden ja etäisyyden terveysvaikutusten tutkimiselle. Aiempien tutkimusten mukaan maaseutumaisilla ja syrjäisillä alueilla on monia terveysongelmia. Tutkimuksen tarkoituksena on selvittää asuinympäristön merkitystä nuorten aikuisten terveydelle: miten asuinympäristö on yhteydessä terveyteen, mikä rooli etäisyydellä on ja miten terveys on yhteydessä muuttamiseen. Aineistona on Pohjois-Suomen syntymäkohortti 1966:n 31-vuotisseuranta-aineisto, sisältäen alkujaan kaikki vuonna 1966 Oulun ja Lapin läänissä syntyneet lapset. Asuinympäristö määritettiin 1 km2 väestöruutuaineiston avulla. Etäisyydet kunta- ja terveyskeskuksiin laskettiin Suomen tie- ja katuverkkotietokantaa (Digiroad) käyttäen. Koettua terveyttä tutkittiin maaseutu-kaupunkijatkumolla ordinaalisella logistisella regressiolla; painoindeksin (BMI) ja ylipainon yhteyttä kuntakeskusetäisyyteen ja väentiheyteen yleistetyllä additiivisella mallilla. Terveyspalvelujen käyttöä ja käytön oikeudenmukaisuutta etäisyyden suhteen tutkittiin negatiivisella binomiregressiolla ja konsentraatioindekseillä, ja terveyden yhteyttä muuttamiseen multinomiaalisella logistisella regressiolla. Huono koettu terveys lisääntyi kaupunkikeskustoista haja-asutusalueille. Maalla asuvien miesten huono koettu terveys selittyi psykososiaalisilla ja terveyskäyttäytymistekijöillä; naisilla syy huonoon koettuun terveyteen haja-asutusalueella jäi epäselväksi. BMI ja ylipainoisten osuus alkoivat kasvaa kuntakeskusetäisyyden ylittäessä viisi kilometriä ja väentiheyden vähetessä. Etäisyys ei vähentänyt terveyskeskuspalvelujen käyttöä, eikä etäisyyteen liittyvää epäoikeudenmukaisuutta havaittu. Elämään tyytymättömyys ja elämänaikainen sairastavuus olivat yhteydessä maaseutu-kaupunkimuuttoihin, haittaava sairastavuus maaseudun sisäisiin muuttoihin ja terveyspalvelujen käyttö kaikkiin kaupunkimuuttoihin. Maantieteellinen etäisyys ei estänyt nuorten aikuisten terveyspalvelujen käyttöä. Yksilön terveys oli yhteydessä muuttamiseen, millä voi olla merkitystä myös terveyden alue-eroille. Ruutuaineiston avulla voidaan löytää terveyseroja hallinnollisten alueiden sisältä, mikä kannustaa toimenpiteiden räätälöintiin eri alueille. Kaupunkirakenteen hajautuminen voi vaikuttaa yksilön painoon, joten terveysnäkökulma tulisi huomioida aluesuunnittelussa. Pitkittäinen tutkimusote parantaisi löydösten ennustavuutta.

In this paper, I will show how applying a spatially explicit context to an existing environmental health surveillance framework is vital for more complete surveillance of disease, and for disease prevention and intervention strategies. As a case study to test the viability of a spatial approach to this existing framework, the risk of human exposure to Lyme disease will be estimated. This spatially explicit framework divides the surveillance process into three components: hazard surveillance, exposure surveillance, and outcome surveillance. The components will be used both collectively and individually, to assess exposure risk to infected ticks. By utilizing all surveillance components, I will identify different areas of risk which would not have been identified otherwise. Hazard surveillance uses maximum entropy modeling and geographically weighted regression analysis to create spatial models that predict the geographic distribution of ticks in Texas. Exposure surveillance uses GIS methods to estimate the risk of human exposures to infected ticks, resulting in a map that predicts the likelihood of human-tick interactions across Texas, using LandScan 2008TM population data. Lastly, outcome surveillance uses kernel density estimation-based methods to describe and analyze the spatial patterns of tick-borne diseases, which results in a continuous map that reflects disease rates based on population location. Data for this study was obtained from the Texas Department of Health Services and the University of North Texas Health Science Center. The data includes disease data on Lyme disease from 2004-2008, and the tick distribution estimates are based on field collections across Texas from 2004-2008.

This thesis addresses three interrelated challenges of disease mapping and contributes a new approach for improving visualization of disease burdens to enhance disease surveillance systems. First, it determines an appropriate threshold choice (smoothing parameter) for the adaptive kernel density estimation (KDE) in disease mapping. The results show that the appropriate threshold value depends on the characteristics of data, and bandwidth selector algorithms can be used to guide such decisions about mapping parameters. Similar approaches are recommended for map-makers who are faced with decisions about choosing threshold values for their own data. This can facilitate threshold selection. Second, the study evaluates the relative performance of the adaptive KDE and spatial empirical Bayes for disease mapping. The results reveal that while the estimated rates at the state level computed from both methods are identical, those at the zip code level are slightly different. These findings indicate that using either the adaptive KDE or spatial empirical Bayes method to map disease in urban areas may provide identical rate estimates, but caution is necessary when mapping diseases in non-urban (sparsely populated) areas. This study contributes insights on the relative performance in terms of accuracy of visual representation and associated limitations. Lastly, the study contributes a new approach for delimiting spatial units of disease risk using straightforward statistical and spatial methods and social determinants of health. The results show that the neighborhood risk map not only helps in geographically targeting where but also in tailoring interventions in those areas to those high risk populations. Moreover, when health data is limited, the neighborhood risk map alone is adequate for identifying where and which populations are at risk. These findings will benefit public health tasks of planning and targeting appropriate intervention even in areas with limited and poor-quality health data. This study not only fills the identified gaps of knowledge in disease mapping but also has a wide range of broader impacts. The findings of this study improve and enhance the use of the adaptive KDE method in health research, provide better awareness and understanding of disease mapping methods, and offer an alternative method to identify populations at risk in areas with limited health data. Overall, these findings will benefit public health practitioners and health researchers as well as enhance disease surveillance systems.

Health and reducing disparities in health between and within countries are among the principal global sustainable development objectives for the period 2016-2030. The incidence of Occupational Diseases (OD) is characterized by very distinct differentiation, both regional and sectoral, and has considerable dynamics in time and place. Given that Czechia is at the top among all EU member states in terms of employment in the automotive industry and production of new vehicles, new research on OD in the automotive industry acquires importance. The Ph.D. Thesis is conceived as an ecological correlation study focusing on the study of the determinants of OD in automotive industry. Its own core work is to analyze 32,646 cases of OD (in the past 20 years) and a set of data from a survey of 247 companies of the automotive industry (employing nearly 110,000 employees, i.e. 78 % of the economically active population working in this sector). In the present work are used available data from routine statistics, data from registers and basic sanitation data from a questionnaire survey. The study innovatively links research of Global production networks and medical-geographical approach. At the end of the Ph.D. Thesis, specific outcomes for praxis and discusses possible topics for further research in this area are...