Towards integrated governance for water, health and social–ecological systems: The watershed governance prism

This article proposes a shift toward the integrated governance of watersheds as a basis for fostering health, sustainability and social–ecological resilience. The authors suggest that integrated watershed governance is more likely when different perspectives, including health and well-being, are explicitly understood, communicated, and sought as co-benefits of watershed management. A new conceptual device – the watershed governance prism – is introduced in relation to the multiple facets of governance that characterize contemporary water resources management and examined as an integrative framework to link social and environmental concerns with the determinants of health in the watershed context. The authors assess the diagnostic and communicative potential of such a framework, discussing its utility as a concise depiction of multiple, interacting policy priorities and as a guide to integrate different research and policy domains into the governance of water, health and social–ecological systems.     

Is there a Human Health Hazard from Microcystins in the Drinking Water Supply?

Microcystins are cyclic heptapeptide toxins produced by a range of cyanobacterial genera. These cyanobacteria occur naturally in drinking water reservoirs subject to eutrophication, and in rivers and natural lakes. Because of the diversity of organisms, the toxins occur, from oligo‐mesotrophic lakes in North Temperate latitudes, to hypertrophic tropical ponds. The toxins are responsible for numerous cases of injury and death of domestic animals, and human poisoning from drinking water. The initial poisoning includes hepatic cell death. This leads to secondary effects from liver deficiency, including jaundice and photosensitisation. The toxic effects are largely due to inhibition of phosphatase enzymes, acting to regulate protein phosphorylation. The consequences include structural damage, apoptosis and, at lower concentrations, cell cycle effects and tumour promotion. As there is no clear evidence for direct carcinogenesis by microcystins, they are classed as non‐carcinogenic toxins in drinking water. Guideline Values for safe drinking water are derived from data for subchronic rodent toxicity, using the No Observed Adverse Effect Level (the highest dose giving no toxicity). To this dose are applied uncertainty factors, to calculate a Tolerable Daily Intake. On the basis of a standard bodyweight and water consumption the Guideline Value is determined for drinking water. For microcystin‐LR the WHO have set a provisional Guideline Value of 1 μg/L for drinking water.     

The determinants of primary health care utilization: a comparison of three rural clinics in Southern Honduras

Primary health care utilization is poorly understood in many parts of the developing world. This is especially true in rural places, such as Santa Lucia, Intibuca, Honduras, where there are only three primary health care facilities servicing almost 12,000 people, and generally speaking access to care is limited. This study examines the factors that can be used to explain primary health care utilization, and aims to improve the understanding of patient utilization behavior. A better understanding of utilization can be used by health service planners to improve primary health care delivery in this and similar locations. The findings of this research indicate that utilization can be explained, to a large extent, by factors relating to economic status and walking time to clinic. These findings are consistent with findings from prior research. In addition, a home territory variable is used to examine spatial variations of utilization behavior. This variable has not been considered in previous utilization research, and is found to be a very significant determinant of health facility utilization in the study area.     

《卫生宝鉴》中治疗脾胃病方剂用药规律

目的：基于数据挖掘分析《卫生宝鉴》中治疗脾胃病方剂的用药规律。方法：运用中医传承辅助平台（TCMISS）V2.5,采用频次统计、关联规则和聚类分析等数据挖掘方法,对《卫生宝鉴》中所载脾胃病的用药规律进行分析。结果：共收集处方151首,中药168味。频次≥17次的中药有21味,排前5位的依次是陈皮、白术、炙甘草、木香、干姜;温性中药使用频次最高,其次是寒性、平性中药;辛味药出现最多,其次是苦味、甘味药;排前5位的中药归经依次是脾、胃、肺、大肠、心经;频次≥14次的中药组合24个,对药物组合进行关联规则分析得到中药组合17个;聚类分析得到新方聚类的中药组合5组,对应新方组合5组。结论：通过中医传承辅助平台分析得出,《卫生宝鉴》中所载治疗脾胃病的处方注重甘辛温补、健脾消滞,慎用苦寒药,该研究结果可为临床治疗脾胃病开发新药物提供一定的参考     

Geographical accessibility and Kentucky's heart-related hospital services

Cardiovascular diseases (CVDs) are a leading cause of mortality in the US. Rates of mortality vary spatially and demographically, influenced not only by individual patient characteristics but also by levels of accessibility to hospital services and facilities. In 2000, Kentucky ranked third in the nation for heart-related deaths. The purpose of this paper is to assess geographical accessibility and service utilization related to ambulatory care sensitive CVDs in Kentucky. This study utilizes the Kentucky Hospital Discharge Database to evaluate service utilization and the Compressed Mortality File to examine mortality related to CVDs. A spatial statistical comparison of the geographical distribution of service usage and travel time to hospitals assists in assessing the relationship between accessibility and health. Our findings suggest that the distribution of utilization and mortality is geographically variable. People living in rural areas travel further to services; populations residing more than 45 min from health facilities are more likely to be socially and economically marginalized. Spatial clustering of high rates of hospital utilization occurs in areas with lower accessibility.     

Environmental geochemistry and health of fluorine in Chinese coals

Fluorine is one of the potential hazardous trace elements in coal. Fluorine may be released into atmosphere mostly during coal combustion process. When the coal is burning indoors without any controlling methods (chimney), the fluorine will pollute the room and is absorbed by food fired (dried) over stoves. Now many people have suffered from fluorosis due to coal burning indoors in Southwest China. In this paper, the concentration, distribution, mode of occurrences and impact factors of fluorine in Chinese coals are analyzed. The environmental impacts and typical features of fluorosis are studied. It is concluded that the value of fluorine in Chinese coals ranges from 20 to 300 mg/kg, and with average value of 122 mg/kg from 5,603 coal samples. It is higher than the average value of the world coals (80 mg/kg). In provincial coalfields of the SW China, the content of F is highest and many people have been affected due to coal combustion indoors.     

‘The health event’: Everyday, affective politics of participation

This paper is about a single event: a conference (A.K.A. ‘the health event’) held in the English East Midlands in July 2005, at which findings from a policy-led research project regarding young people’s health needs were fed back to research participants. The paper foregrounds some of the everyday work, happenings, emotions, conversations and materialities which were fundamentally constitutive of ‘the health event’ and, thus fundamentally constituted the moments of affirmative, politically-charged participation which could and did happen therein. Thus the paper bears witness to the sorts of practices, minutiae and highs and lows which are surely fundamentally constitutive of participation, policy and politics per se, but which (despite the growing visibility of nonrepresentational theories) are typically absent from salient accounts of participation, Children’s Geographies and Post-medical Geographies.     

Interactive spatiotemporal modelling of health systems: the SEKS–GUI framework

This paper describes the spatiotemporal epistematics knowledge synthesis and graphical user interface (SEKS–GUI) framework and its application in medical geography problems. Based on sound theoretical reasoning, the interactive software library of SEKS–GUI explores heterogeneous (spatially non-homogeneous and temporally non-stationary) health attribute distributions (disease incidence, mortality, human exposure, epidemic propagation etc.); expresses the health system’s dependence structure using (ordinary and generalized) spatiotemporal covariance models; synthesizes core knowledge bases, empirical evidence and multi-sourced system uncertainty; and generates a meaningful picture of the real-world system using space–time dependent probability functions and associated maps of health attributes. The implementation stages of the SEKS–GUI library are described in considerable detail using appropriate screens. The wide applicability of SEKS–GUI is demonstrated by reviewing a selection of real-world case studies. An erratum to this article can be found at     

Preliminary evidence of a link between surface soil properties and the arsenic content of shallow groundwater in Bangladesh

The extremely heterogeneous distribution of As in Bangladesh groundwater has hampered efforts to identify with certainty the mechanisms that lead to extensive mobilization of this metalloid in reducing aquifers. We show here on the basis of a high-resolution transect of soil and aquifer properties collected in Araihazar, Bangladesh, that revealing tractable associations between As concentrations in shallow (< 20 m) groundwater with other geological, hydrological, and geochemical features requires a lateral sampling resolution of 10–100 m. Variations in the electromagnetic conductivity of surface soils (5–40 mS/m) within a 500 m × 200 m area are documented with 560 EM31 measurements. The results are compared with a detailed section of groundwater As concentrations (5–150 μg/L) and other aquifer properties obtained with a simple sampling device, “the needle-sampler”, that builds on the local drilling technology. By invoking complementary observations obtained in the same area and in other regions of Bangladesh, we postulate that local groundwater recharge throughout permeable sandy soils plays a major role in regulating the As content of shallow aquifers by diluting the flux of As released from reducing sediments.     

Groundwater quality in parts of Central Ganga Basin, India

 This paper deals with the drinking water quality of the Ganga-Kali sub-basin which occupies 1300 km² over parts of Aligarh and Etah districts. Water samples were collected from shallow and deep aquifers and were analyzed for major ions and trace elements. The analytical data were interpreted according to published guidelines. Chemical analysis shows that the groundwater in the basin is alkali bicarbonate type. Trace element studies of water from the shallow aquifer show that the concentration of toxic metals Fe, Mn, Cd, Pb, and Cr⁺⁶ are above permissible limits which may present a health hazard. The water from the deep aquifer is comparatively free from contamination. The aquifers are subject to contamination due to sewage effluents and excessive use of fertilizers and pesticides in agriculture. Received: 7 December 1998 · Accepted: 2 March 1999