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Biomedical subjects

W M Gesler

Publications and source records attributed to W M Gesler.

At least 19 recordsLinked to original sources
PubMed2001

Developing socio-spatial knowledge networks: a qualitative methodology for chronic disease prevention.

Chronic disease is a significant and costly social problem. The burden is even more pronounced in communities with high rates of a particular chronic disease. Assessment of health belief systems and the local geographies of health beliefs can assist community health planners to create cost-effective strategic intervention programs where populations are at high risk for chronic diseases. In this paper, we elaborate the concept of socio-spatial knowledge networks (SSKNs) and demonstrate that SSKNs can be useful in informing the design of health care prevention strategies. In our project, we demonstrate how to identify key socio-spatial information for intervention strategies which will prevent or delay the onset of a particular chronic disease, Type 2 diabetes. Our qualitative framework allows us to determine which sites might be best characterized as socio-spatial knowledge network nodes for sharing diabetes information and which sites might be less suited to such exchange. Our strategy explores cross-cultural similarities, differences, and overlap in a multi-ethnic rural North Carolina context through simple techniques such as mapping social networks and sites in which people share their knowledge and beliefs about diabetes. This geographical analysis allows us to examine exactly where health knowledge coincides with other social support, and where such resources may be improved in a particular community. Knowing precisely what people in a community understand about a chronic disease and its treatment or prevention and knowing where people go to share that information helps to (1) identify strategic locations within a community for future interventions and, (2) evaluate the effectiveness of existing interventions. The geographical approach presented here is one that can serve other communities and health practitioners who hope to improve chronic disease management in diverse local environments.

Aged↗
PubMed2000

The wineglass model: tracking the locational histories of health professionals.

This paper introduces a space-time continuum model to evaluate the effectiveness of programs that encourage recruitment and retention of health professionals. Based on the shape of a wineglass, the model provides a framework to study the locational histories of a cohort of health professionals, both conceptually and quantitatively. A key component of the model is that it measures geographic dispersion over time from a medical school, residency program, or other shared location. Geographic dispersion can be studied in the model through standard deviational ellipses, standard distance, or average distance circles. The model enables analysis through structuration theory, which is used as a guide for analyzing the interplay between human agency (e.g., individual decisions on practice location) and structure (e.g., medical education). Space-time modeling is linked with structuration theory. Variations in the shape of the wineglass reveal how people may be bound by a general structure, yet through lifetime locational decisions may change that structure over space and time. Using data on University of Nebraska alumni, the authors constructed a pilot demonstration to test and confirm the model's potential usefulness. In the pilot demonstration, standard deviational ellipses represented the range of physician locations during each year, overlaid on maps of the US. The pilot demonstration indicated the model's strength in identifying changing mobility over time, while also pointing to concerns about unevenness in data availability from one year to the next. Further application of the wineglass model could be used toward studying the life histories of health professionals. The impact of community-based training on long- or short-term retention, changes in the mobility of male vs female providers, and the career trajectories of people in different health professions or medical schools are only a few examples of potential future applications of the model.

Cohort Studies↗
PubMed1999

Words in wards: language, health and place.

The role of place in medical encounters which involve language is examined using theoretical arguments backed by empirical studies. Links between language and place, health and place and especially language and health are discussed. The language-health link is developed in terms of explanatory models; how language is used in medical encounters; and power, dominance and resistance relationships. Then it is shown how considerations of place enhance knowledge about this link. The paper closes with a set of research questions which focus on the role of place.

Delivery of Health Care↗
PubMed1997

Disease ecology and a reformist alternative: the case of infant mortality.

This paper attempts to shed some light on the recent debate between those who advocate a reformed medical geography and those who respond that reform is not necessary. We show that disease ecology and a reformist alternative display certain tendencies in the ways in which they address issues of health and disease. We use the example of geographic variations in infant mortality rates to show how two non-positivist perspectives from social theory, political economy and humanism, support a reformist viewpoint, while also acknowledging the value of a complementary disease ecology approach. Two concepts, the social construction of health and illness and social relevance, are used to portray the political economy approach; humanism is described in terms of the meaning of individual experience and the importance of place. The paper concludes with a discussion of the respective roles of disease ecology and a reformist approach in models of infant mortality and a summary of the main differences between the two perspectives.

Black or African American↗
PubMed1997

What is rural? A focus on urban influence codes.

Classification of U.S. counties into metropolitan and nonmetropolitan masks a high degree of variation in population size, density, and relationship between urban and rural areas. This article reviews the urban influence county coding system and illustrates how it applies to U.S. counties. The urban influence codes can be useful for analysis of rural health policy.

Abstracting and Indexing↗
PubMed1997

Normative models and healthcare planning: network-based simulations within a geographic information system environment.

OBJECTIVES: Network analysis to integrate patient, transportation and hospital characteristics for healthcare planning in order to assess the role of geographic information systems (GIS). A normative model of base-level responses of patient flows to hospitals, based on estimated travel times, was developed for this purpose. DATA SOURCES/STUDY SETTING: A GIS database developed to include patient discharge data, locations of hospitals, US TIGER/Line files of the transportation network, enhanced address-range data, and U.S. Census variables. The study area included a 16-county region centered on the city of Charlotte and Mecklenburg County, North Carolina, and contained 25 hospitals serving nearly 2 million people over a geographic area of nearly 9,000 square miles. STUDY DESIGN: Normative models as a tool for healthcare planning were derived through a spatial Network analysis and a distance optimization model that was implemented within a GIS. Scenarios were developed and tested that involved patient discharge data geocoded to the five-digit zip code, hospital locations geocoded to their individual addresses, and a transportation network of varying road types and corresponding estimated travel speeds to examine both patient discharge levels and a doubling of discharge levels associated with total discharges and DRG 391 (Normal Newborns). The Network analysis used location/allocation modeling to optimize for travel time and integrated measures of supply, demand, and impedance. DATA COLLECTION/EXTRACTION METHODS: Patient discharge data from the North Carolina Medical Database Commission, address-ranges from the North Carolina Institute for Transportation Research and Education, and U.S. Census TIGER/Line files were entered-into the ARC/INFO GIS software system for analysis. A relational database structure was used to organize the information and to link spatial features to their attributes. PRINCIPAL FINDINGS: Advances in healthcare planning can be achieved by examining baseline responses of patient flows to distance optimization simulations and healthcare scenarios conducted within a spatial context that uses a normative model to integrate characteristics of population, patients, hospitals, and transportation networks. Model runs for the defined scenarios indicated that a doubling of the 1991 patient discharge levels resulted in an areal constriction of the service areas to those zip codes immediately adjacent to the hospitals, thereby leaving substantial areas unassigned to hospitals during the allocation process, but that doubling the demand for obstetrics care (DRG 391) resulted in little change in the pattern of accessibility to care as indicated by the size, orientation, and pattern of the service areas. CONCLUSIONS: The GIS-Network system supported "what if" simulations, portrayed service areas within a spatial context, integrated disparate data in the execution of the location/allocation model, and used estimated travel time along a transportation network instead of Euclidean distance for calculating accessibility. The results of the simulations suggest that the GIS-Network system is an effective approach for exploring a variety of healthcare scenarios where changes in the supply, demand, and impedance variables can be examined within a spatial context and where variations in system trajectories can be simulated and observed.

Computer Communication Networks↗
PubMed1992

Therapeutic landscapes: medical issues in light of the new cultural geography.

Employing an expanded meaning of the concept of landscape taken from the 'new' cultural geography, this paper explores why certain places or situations are perceived to be therapeutic. Themes from both traditional and recent work in cultural geography are illustrated with examples from the literature of the social science of health care. The themes include man-environment relationships; humanist concepts such as sense of place and symbolic landscapes; structuralist concepts such as hegemony and territoriality; and blends of humanist concerns, structuralist concerns, and time geography. The intention of this broad overview is to bring some particularly useful concepts developed in cultural geography to the attention of social scientists interested in matters of health and to stimulate research along new lines.

Culture↗
PubMed1988

The place of chiropractors in health care delivery: a case study of North Carolina.

Three perspectives on the place of DCs in the United States health care delivery system were derived from the social science literature; system status, cultural congruence, and utilization patterns. North Carolina was used as a case study site to examine these perspectives from a geographical point of view. It was found that DCs were located in smaller places than MDs. DC/population ratios were associated with white populations and higher incomes, but were not associated with those aged 18-64, rural populations, and religious groups that used touch in healing. DCs were located in more rural and lower income areas than were MDs.

Adolescent↗
PubMed1988

Locational and population factors in health care-seeking behavior in Savannah, Georgia.

The use of regular sources of health care by a sample of residents of Chatham County, Georgia was examined through an analysis of the interactions among distance, sociodemographic, locational, and activity-space factors. Health care facilities were concentrated near downtown Savannah. Distance from home to regular source of care was a relatively more important factor for inner-city residents than for suburban or urban fringe residents. There were no clear differences by race, sex, age, occupation, or length of stay at present residence in the relative importance of distance. Strong associations were found between distance-to-care measures and measures of daily-activity spaces. Urban ecological structure appeared to play a more important role in health care-seeking behavior than did the personal characteristics of individuals in this small metropolitan area.

Adolescent↗
PubMed1984

Client characteristics at Kissy Mental Hospital, Freetown, Sierra Leone.

In- and out-patient data from the only Western mental health institution in Sierra Leone, Kissy Mental Hospital in Freetown , were analyzed using basic epidemiological techniques. Although it could not be proved conclusively with the available data, the educational and occupational levels of the patients appear to be far above that of the general population. Very possibly females are also underserved by the hospital. Contrasts between the two patient populations show that in-patients were more seriously ill, older, more likely to be male, more likely to be single, less educated, less likely to have social support, more likely to express Western ideas about the causes of mental illness and have more previous Western treatment, than out-patients. The literature on mental illness suggested the examination of possible associations among diagnosis, illness beliefs and types of previous treatment as response variables and several patient characteristics as explanatory variables. Out-patients who were older and those with lower status occupations had more severe illnesses. Married in-patients and out-patients with higher educational and occupational status had more Western as opposed to native beliefs about the cause of mental illness than their counterparts. More previous Western rather than native treatment was reported by in-patients who were older, from certain tribes, or had Western beliefs and by younger out-patients. Points of agreement and disagreement of study results with findings from Africa and the United States are discussed.

Adult↗
PubMed1984

Geographical patterns of heart disease in the Northeastern United States.

A 49-county region surrounding the urban corridor from New York through New Jersey to Philadelphia was the focus of an investigation of the spatial patterns of mortality from four types of heart disease: major cardiovascular, acute ischemic, chronic ischemic and cerebrovascular. The data used were age-adjusted mortality rates for white males and white females for the period 1968-1972. Central to the research was interest in the existence of county clusters with similar rates, high and low risk areas and possible associations of mortality rates with environmental and socioeconomic conditions. The tasks completed in this first phase of a projected multi-phase project led to the identification of four country clusters within the region. High major cardiovascular rates appear to make the Southern New Jersey cluster a high risk zone. In contrast, a Central Corridor cluster has relatively low rates for all the diseases. No clear pattern was in evidence for the Northwestern Periphery cluster. Finally, a stark contrast between acute and chronic ischemic rates appeared in the Urban Spur. The next step in this research will be to search for either consistency or deviation from these patterns in the 1973-1976 period. A risk factor data set will be created to analyze the patterns in greater detail.

Female↗
PubMed1983

A categorical data analysis of contacts with the Family Health Clinic, Calabar, Nigeria.

The relationships of population, environmental and accessibility variables to registration and attendance by mothers of children under 6 at the Family Health Clinic in Calabar, Nigeria are investigated. The technique used to analyze the data collected is categorical data analysis which proceeds in two stages, variable selection to reduce the variable set and fitting a log-linear model to the reduced set. Details of the statistical procedures used are provided to indicate how categorical data analysis can be used as a valuable tool of analysis in medical geographical studies that employ count or frequency data. It was found that younger mothers and Ibibio women registered more often at the clinic than did their counterparts. However, if the relatively sparse data on fathers is accepted, the association between age and registration is found to be spurious and a model can be substituted which shows younger fathers and fathers who spoke a non-Efik/Ibibio language to be associated with higher clinic registration of mothers. It was further found that for registered mothers the probability of a clinic visit was decreased by mother's age, increased by distance given no travel cost, unaffected by distance given some travel cost, increased by travel cost given a short distance to the clinic and decreased by travel cost given a longer distance from the clinic. These results are discussed in relation to population characteristics such as socio-economic status, clinic procedures such as health worker activities, transportation availability in Calabar, the spatial ecology of the city and local environmental conditions.

Adult↗
PubMed1978

The interactive effects of induced abortion, inter-pregnancy interval and contraceptive use on subsequent pregnancy outcome.

Prior induced abortion and outcome of the next pregnancy are investigated, allowing for two intervening and potentially confounding variables: 1) length of interval between the termination of the first pregnancy and the conception of the next (inter-pregnancy interval) and 2) the utilization of contraception during this interval. Results show that non-contracepting (susceptibility) intervals which immediately precede a subsequent pregnancy are significantly shorter following an induced abortion than those following a spontaneous abortion or delivery. A life table analysis of all susceptibility intervals confirmed this finding. To investigate outcome of subsequent pregnancy as influenced by preceding pregnancy outcome, inter-pregnancy interval and contraceptive use in the interval, a categorical linear model has been developed. Among non-contraceptors, the model indicates no differences in proportions of succeeding adverse outcomes (spontaneous abortion or low birth weight) regardless of inter-pregnancy interval and whether or not the preceding pregnancy had been terminated by an induced abortion. For the contraceptive users, however, proportions of adverse outcomes increased with length of inter-pregnancy interval, and, within each interval category, proportion of adverse outcomes was higher when the preceding pregnancy had terminated in an induced abortion.

Abortion, Induced↗