Approaches to medical geography: an historical perspective

Landscapes on Prevention Quality Indicators: A Spatial Analysis of Diabetes Preventable Hospitalizations in Portugal (2016-2017)

Preventable hospitalizations due to complications of diabetes mellitus (DM), represented by the related prevention quality indicators (PQI), are ambulatory care-sensitive conditions that can be prevented and controlled through effective primary health care (PHC) treatment. It is important to reduce mortality and promote the quality of life to diabetic patients in regions with higher hospitalization rates. The study aims to analyze the results of the DM age-sex-adjusted PQI, by groups of health centers (ACES), distributed in the Portuguese territory. The most representative PQI at a national level were identified, and the trends were mapped and analyzed. Also, it presents the ACES with the highest age-adjusted rates of avoidable hospitalizations for DM. The absolute number of preventable hospitalizations for all DM complications in Portugal has decreased by 20%, thus passing from the rate of 79 in 2016 to 65.2/100,000 inhabitants in 2017. Despite the improvement in results for PQI 03, 20 of 48 ACES that were above the national 2017 median rate in 2016, achieved better results the following year, and for the overall preventable diabetes hospitalizations (PQI 93) only 11 out 39, revealing the need for further studies and PHC actions to improve the diabetic quality of life.

Ethnobotany and herbal medicine in modern complementary and alternative medicine: An overview of publications in the field of I&C medicine 2001-2013

ETHNOPHARMACOLOGICAL RELEVANCE

Ethnobotanical knowledge and traditional medicinal practices from different parts of the world are of global importance and documentation of ethnobotanical, and ethnopharmacological data is a key prerequisite for further research in the area of herbal medicine and its implementation in clinical practice.

AIMS

An attempt was made to evaluate the scientific output of research related to ethnobotany and herbal medicine in journals indexed in the subject area "Integrative and Complementary Medicine" in the period 2001-2013, in order to ascertain research trends in both subdisciplines.

MATERIALS AND METHODS

All articles related to ethnobotany and herbal medicine, extracted from journals included in the field of I&C Medicine and published in the period 2001-2013, have been analyzed for general bibliometric data, and specific data: ethnobotanical data (geographic, floristic, pharmacological, sociological and other relevant data) and phytotherapeutic data (type of applied herbal medicine, plant species studied, pharmacological activity of studied plant species and disease and disorder type studied on a particular model).

RESULTS

In the studied period, the number of articles dealing with ethnobotany and herbal medicine increased 6.3-fold. Articles related to ethnobotanical studies documented medicinal flora from 81 countries, either giving an overview of overall medicinal flora, or presenting the ethnomedicinal aspect of the use of plants for the treatment of ailments typical to the studied area. Additionally, the authors provided significant information on the methods of use and herbal preparations. In herbal medicine studies, plants, traditional plant remedies, herbal medicinal products and active herbal compounds were tested for many of pharmacological activities (146), with the curative activity emerging as most frequently tested. Out of 39 model systems, most of the studies were carried out under controlled in vitro conditions (4589 articles), followed by rat in vivo (2320), human in vivo (1285), mouse in vivo (955), and on agents of pathogenic diseases (887); more than 800 medical disorders were treated.

CONCLUSIONS

The study revealed the regions most studied for new records of floristic and ethnomedicinal diversity, the most frequently studied plant species, and the most promising therapeutic indications for the integration of herbal remedies in the curative process, as ascertained from the selected bibliographic databases.

[The spatial dimension in health studies: a historical trajectory]

Focusing on concepts taken from critical geography, this article re-examines the spatial notions that were incorporated by the public health field between the late eighteenth and mid-twentieth centuries. Based on a review and systematization of intellectual production within the field of medical geography, this time span is broken into periods. We begin with a presentation of Finke's work (1792) and then move on to analyze the nineteenth century, when geography and medicine became scientific disciplines. The concept of space as a physical environment, with human action abstracted out, took hold within geography, while the biological-individual paradigm prevailed within the field of medicine. The text discusses the implications of the public health field's decision to embrace the geographic notions of determinism, type of life, and human ecology, and describes the contributions of Max Sorré and Pavlovsky. It also looks at the International Geographical Union's 1952 creation of a Commission on the Medical Geography of Health and illness and analyzes the emergence and coalescence of the 'new geography'.

Diarrheal disease risk in Matlab, Bangladesh

The objective of this research project is to assess risk for diarrheal disease in rural Bangladesh by analyzing the complex and dynamic interaction of biological, socioeconomic, cultural/behavioral and environmental factors over time and space. Risk factors of cholera and non-cholera water diarrheal disease are calculated to compare the relative importance of risk for several independent variables. Diarrheal disease data were collected for people who were hospitalized at the International Centre for Diarrhoeal Disease Research (ICDDR) hospital from January 1, 1992 to December 31, 1994. Using laboratory and hospital records, cases were assigned to one of two diarrhea disease categories (cholera or non-cholera watery diarrhea) that were used as dependent variables in the analysis stage of the research. Age-matched individuals were randomly chosen from the community to be controls. Information was collected for independent variables that were hypothesized to be related to watery diarrhea. This information was collected by administering questionnaires, obtaining secondary data from the ICDDR's demographic surveillance system records and community health worker record books and calculating variables using a geographic information system database. Sanitation and water availability and use are extremely important in the effort to reduce secondary cholera and non-cholera, watery diarrhea transmission. Water use and availability variables were more important for non-cholera watery diarrheal risk than for cholera but nevertheless they were important for both. Socioeconomic status is an important indirect cause of both of these diseases because poverty is the root cause of many of the other variables, such as lack of sanitation and clean water. Flood-control was related to both types of diarrhea but it is not understood why. Since the Bangladesh Flood Action Plan will continue to build and maintains flood-control embankments, it is important to investigate whether there is a pattern to this relationship throughout the country and to investigate why the relationship exists.

[Geographic differences in mortality from digestive tumors in Spain, 1980-1984]

The purpose of this study is to analyze the geographical distribution of eight gastrointestinal (GI) cancer sites in Spain, during the 1980-1984 period. Data for deaths attributed to each cancer site were obtained from Spain's National Institute for Statistics (INE). Standardized Mortality Ratios (SMR) were calculated for each GI cancer site, using the International Classification of Diseases (ICD) 9th revision. Statistical tests were performed to determine whether SMR's were statistically significant. The mortality distribution for cancers of the oropharynx and oesophagus showed a similar pattern, which might suggest some common risk factor in their etiology. Stomach cancer presented high SMR's in the northern central areas (Meseta). Colon, rectum and pancreas cancer sites emerged with irregular patterns though high SMR's were more often observed in developed areas within the country.

Display of small-area variation in health-related data: a methodology using resistant statistics

Health care planning requires characterization of the population to be served. Examination of available demographic and epidemiologic data is one early step in this process. However, aggregate data for the entire geographic area of concern often fail to reveal important differences among geographically defined sub-populations--differences that influence the form an effective delivery system should take. We present a methodology based on exploratory data analysis (EDA) techniques that we have found useful in examining health-related data for our ambulatory care catchment area. Our examples use three population characteristics that have major implications for health care planning for the elderly: 1970-1980 change in population aged 65+; the percent of the population aged 65+ below poverty level; and the percent of single-person households among households with one or more persons aged 65+. With these data for the 25 municipalities of Middlesex County, New Jersey, we illustrate a two-step process: (1) the construction of stem-and-leaf displays that permit examination of a data distribution for asymmetry, concentrations around specific values, gaps in values, and outliers; and (2) the use of the median, the fourth-spread, and other information from the stem-and-leaf display in the systematic selection of data value classes to be given distinct shadings on a map of the selected geographic area. Discussion emphasizes the usefulness of graphic display of data in detecting similarities and unusual data values. Comparison of maps based on the EDA techniques and maps based on several traditional methods of value classing for the same data illustrates the influence of classing choices on the interpretation of cartographic displays of health-related data.