江苏省卫生医疗地理信息系统的设计

卫生医疗事业事关人民群众身体健康、生命保障,是人类生活的重要基础设施之一.卫生医疗工作中的大部分信息与空间位置分布有关,利用GIS技术将卫生医疗数据通过统一的地理信息平台进行管理,将为卫生医疗管理部门的工作带来极大便利.     

Ecological bias in studies of the short-term effects of air pollution on health

There has been a great deal of research into the short-term effects of air pollution on health with a large number of studies modelling the association between aggregate disease counts and environmental exposures measured at point locations, for example via air pollution monitors. In such cases, the standard approach is to average the observed measurements from the individual monitors and use this in a log-linear health model. Hence such studies are ecological in nature being based on spatially aggregated health and exposure data. Here we investigate the potential for bias in the estimates of the effects on health when estimating the short-term effects of air pollution on health. Such ecological bias may occur if a simple summary measure, such as a daily mean, is not a suitable summary of a spatially variable pollution surface. We assess the performance of commonly used models when confronted with such issues using simulation studies and compare their performance with a model specifically designed to acknowledge the effects of exposure aggregation. In addition to simulation studies, we apply the models to a case study of the short-term effects of particulate matter on respiratory mortality using data from Greater London for the period 2002–2005. We found a significant increased risk of 3% (95% CI 1–5%) associated with the average of the previous three days exposure to particulate matter (per 10 μg m⁻³ PM₁₀).     

2D Monte Carlo versus 2D Fuzzy Monte Carlo health risk assessment

Risk estimates can be calculated using crisp estimates of the exposure variables (i.e., contaminant concentration, contact rate, exposure frequency and duration, body weight, and averaging time). However, aggregate and cumulative exposure studies require a better understanding of exposure variables and uncertainty and variability associated with them. Probabilistic risk assessment (PRA) studies use probability distributions for one or more variables of the risk equation in order to quantitatively characterize variability and uncertainty. Two-dimensional Monte Carlo Analysis (2D MCA) is one of the advanced modeling approaches that may be used to conduct PRA studies. In this analysis the variables of the risk equation along with the parameters of these variables (for example mean and standard deviation for a normal distribution) are described in terms of probability density functions (PDFs). A variable described in this way is called a second order random variable. Significant data or considerable insight to uncertainty associated with these variables is necessary to develop the appropriate PDFs for these random parameters. Typically, available data and accuracy and reliability of such data are not sufficient for conducting a reliable 2D MCA. Thus, other theories and computational methods that propagate uncertainty and variability in exposure and health risk assessment are needed. One such theory is possibility analysis based on fuzzy set theory, which allows the utilization of incomplete information (incomplete information includes vague and imprecise information that is not sufficient to generate probability distributions for the parameters of the random variables of the risk equation) together with expert judgment. In this paper, as an alternative to 2D MCA, we are proposing a 2D Fuzzy Monte Carlo Analysis (2D FMCA) to overcome this difficulty. In this approach, instead of describing the parameters of PDFs used in defining the variables of the risk equation as random variables, we describe them as fuzzy numbers. This approach introduces new concepts and risk characterization methods. In this paper we provide a comparison of these two approaches relative to their computational requirements, data requirements and availability. For a hypothetical case, we also provide a comperative interpretation of the results generated.     

Policy at the margins: developing community capacity in a rural Health Action Zone

The imperative to engage with communities and employ a community development approach is an integral part of the national agenda under New Labour. However, a large part of the literature and experience that informs contemporary policy and practice draws on the urban realm. This paper draws on the evaluation of a rural Health Action Zone to explore the extent to which national policy can facilitate local approaches to community health development within a rural context. Despite avowed support for innovation and evidence-based learning, it finds a continued emphasis on consensual tactics, low-cost solutions and traditional methods of ranking deprivation.     

Rural community well-being: models and application to changes in the tobacco-belt in Ontario, Canada

In this paper we develop a model of changes in rural community well-being. The model conceptualizes four interrelated dimensions of rural community well-being: physical, psychological, social, and economic. The model recognizes that a range of external forces (political, economic, etc.) exert pressures on rural communities, of which changes in well-being are one outcome. The paper then applies the model to changes which occurred in the tobacco growing region of southern Ontario, Canada. It is argued that this region was impacted by a variety of forces, some general to farming, others specific to tobacco farming, particularly between 1979 and the early 1990s. The empirical application is based on a personally administered farm survey (n=63) conducted between July 1996 and January 1997 and agricultural census data for the years 1981, 1986, 1991, and 1996. The paper concludes by suggesting that the model provides a useful framework for analysing the forces and changing conditions of other rural communities, not only in Canada, but beyond.     

Lessons from the past for sustainability transitions? A meta-analysis of socio-technical studies

To break away from techno-institutional lock-in in climate change and in other sustainability problems, many have focused on innovation in technological ‘niches’. The destabilisation of the incumbent ‘regime’ has been neglected and external ‘landscape’ pressures under-analysed. With this in mind, this article examines the factors of regime destabilisation and forms of regime resistance in past technological transitions in energy and transport. It analyses 23 energy (electricity, heat & chemicals) and 11 transport (drive chain, networks, fuels & land planning) transitions pre-1990. Furthermore, in order to properly frame these results and make any “lessons from the past” applicable to the present, this article includes an assessment of current sustainability trends.The key lessons from past energy transitions are that regime outsiders with the right ideology and influence on the market can destabilise the energy sector, which has traditionally had strong incumbents. As incumbents are weakened, past transport transitions show that further change may come from emphasising the Health and Lifestyle benefits of sustainability transitions.     

Exploring the asylum-migration nexus in the context of health professional migration

The current global migration regime is extremely complex and characterised by a polarisation of flows. Increasing numbers of individuals fleeing conflict regimes and seeking asylum are faced with restrictive immigration regimes whilst at the same time, highly skilled migrants are welcomed and encouraged to contribute to developed economies. This paper explores the asylum-migration nexus that has emerged as a result of restrictive immigration policy by drawing upon a survey of 300 health professionals in the UK. First, the empirical lens of health professionals fleeing conflict regions is employed to map the contours of the asylum-migration nexus. Second, the implications of highly selective asylum flows to Europe, in terms of economic and social characteristics, are considered. The paper concludes by highlighting concerns that Western refugee policy regimes are worryingly failing to fully meet moral obligations to protect individuals seeking asylum whilst also inadvertently supporting brain drain flows.     

There and back again: Epiphany, disillusionment, and rediscovery in political ecology

This paper reviews the experience of discovering, abandoning, and rediscovering elements of the work of political ecologist Piers Blaikie from the period spanning 1992-2006. In the process, we analyze the cyclic fate of critical ideas in the field of political ecology, including especially the “chain of explanation,” during a tumultuous period where materialist and constructivist theorists encountered one another. The paper concludes with a specific discussion of the power of traditional tools in political ecology for addressing current socio-ecological crises, specifically HIV/AIDS in southern Africa.     

The need for psychiatric care in England: a spatial factor methodology

To ensure health resources are equitably distributed, composite indices of population morbidity or “health need” are often used. Measures of the dimensions of population morbidity (e.g. socioeconomic deprivation) relevant to health need are typically not directly available but indirectly measured through census or other sources. This paper considers measurement of latent population morbidity constructs using both health outcomes (e.g. hospital admissions, mortality) and observed area social and demographic indicators (e.g. census data). The constructs are allowed to be spatially correlated between areas, as well as correlated with one another within areas. The health outcomes may depend both on the latent constructs and on other relevant covariates (e.g. bed supply), with some covariates possibly measured only at higher (regional) scales. A case study considers variations in psychiatric admissions in 354 English local authority areas in relation to two latent constructs: area deprivation and social fragmentation.      

城市旅游开发规划进展评述

在总结国内旅游开发规划工作经验的基础上,从理论和实践两方面探讨了综合与整体规划,配套建设,滚动开发的操作模式以及当前旅游开发重点等,强调要突出旅游文化背景和旅游形象策划,并归纳了旅游开发规划需要研究的一系列问题。