Healthcare facilities (HF) may identify catchment areas (CA) by selecting criteria that depend on various factors. These refer to hospital activities, geographical definition, patient covariates, and more. The analyses that were traditionally pursued have a limiting factor in the consideration of only static conditions. Instead, some of the CA determinants involve influences occurring at both temporal and spatial scales. The study of CA in the cancer context means choosing between HF, usually divided into general hospitals versus oncological centers (OCs). In the CA context, electronic health records (EHRs) promise to be a valuable source of information, one driving the next-generation patient-driven clinical decision support systems. Among the challenges, digital health requires the re-definition of a role of stochastic modeling to deal with emerging complexities from data heterogeneity. To model CA with cancer EHR, we have chosen a computational framework centered on a logistic model, as a reference, and on a multivariate statistical approach. We also provided a battery of tests for CA assessment. Our results indicate that a more refined CA model's structure yields superior discrimination power between health facilities. The increased significance was also visualized by comparative evaluations with ad hoc geo-localized maps. Notably, a cancer-specific spatial effect can be noticed, especially for breast cancer and through OCs. To mitigate the data distributional influences, bootstrap analysis was performed, and gains in some cancer-specific and spatially concentrated regions were obtained. Finally, when the temporal dynamics are assessed along a 3-year timeframe, negligible differential effects appear between predicted probabilities observed between standard critical values and bootstrapped values. In conclusion, for interpreting CA in terms of both spatial and temporal dynamics, sophisticated models are required. The one here proposed suggests that bootstrap can improve test accuracy. We recommend that evidences from stochastic modeling are merged with visual analytics, as this combination may be exploited by policy-makers in support to quantitative CA assessment.

This study sought to identify variables associated with help received in terms of information, medication, counselling and total help received (including other needs) among 571 individuals needing health care services for mental health problems. Study participants were randomly selected from an epidemiological survey. Data on help received were collected using the Canadian version of the Perceived Need for Care Questionnaire (PNCQ), and were analyzed using a multinomial logistic regression model. Most help received was in the form of counselling, followed by medication and information. Compared with individuals who received no help, those who reported receiving help for all their needs were more likely to have psychological distress, to be non-verbally aggressive, to consult more healthcare professionals, to be men and to be somewhat older. Compared with individuals who received no help, those who received partial help were more likely to be not addicted to drugs or alcohol, to consult more healthcare professionals, and to be older. Healthcare services should prioritize strategies (e.g., early detection, outreach, public education on mental and addiction disorders) that address barriers to help seeking among youth, as well as individuals addicted to drugs and alcohol or those presenting with aggressive behavior.

The range of Ixodes scapularis is expanding in Ontario, increasing the risk of Lyme disease. As an effective public health response requires accurate information on disease distribution and areas of risk, this study aims to establish the geographic distribution of I. scapularis and its associated pathogen, B. burgdorferi, in northwestern Ontario. We assessed five years of active and passive tick surveillance data in northwestern Ontario. Between 2013 and 2017, 251 I. scapularis were submitted through passive surveillance. The submission rate increased over time, and the proportion infected with B. burgdorferi was 13.5%. Active tick surveillance from 2014 to 2016 found few I. scapularis specimens. In 2017, 102 I. scapularis were found in 10 locations around the city of Kenora; 60% were infected with B. burgdorferi, eight tested positive for A. phagocytophilum, and one for POWV. I. scapularis ticks were found in 14 locations within the Northwestern Health Unit area, with seven locations containing B. burgdorferi-positive ticks. We found abundant I. scapularis populations in the southern portion of northwestern Ontario and northward expansion is expected. It is recommended that I. scapularis populations continue to be monitored and mitigation strategies should be established for rural northern communities.

There are only limited studies on access to COVID-19 vaccines and identifying the most appropriate health centres for performing vaccination in metropolitan areas. This study aimed to measure potential spatial access to COVID-19 vaccination centres in Mashhad, the second-most populous city in Iran.

Introduction. The pneumonia pattern in young children may vary across different catchment areas. Therefore, this study aims to analyze the predictive factors for toddlers with an Acute Respiratory Infection (ARI) developing into pneumonia in the catchment area of Banjar Regency, Indonesia. Methods. A case-control design, with 300 respondents, consisting of 106 cases and 194 controls. A questionnaire of interviews with mothers/caregivers of toddlers. Forty-one indicators data were analyzed using multiple logistic regression with backward stepwise regression to arrive at the final model. Results. The predictive factors for toddlers with pneumonia were the child's age (P-value .070), child development (P-value .007), breastfeeding (P-value .051), family income (P-value .026), and location of houses along the river (P-value .025). Conclusion. A prediction index for toddler pneumonia has been compiled, which can be applied to improve the health of lower middle-class toddlers requiring more government attention.

In cervical cancer, high frequencies of regulatory T cells (Tregs) and immunosuppressive PD-L1+CD14+ antigen-presenting cells dominate the microenvironment of tumor-positive lymph nodes (LN+). It is unknown whether this is restricted to LN+ or precedes metastasis, emanating from the primary tumor and spreading through tumor-draining lymph nodes (TDLNs). To investigate immunosuppression in the lymphatic basin of cervical tumors, all dissected TDLNs of five cervical cancer patients (in total 9 LN+ and 74 tumor-negative lymph nodes (LN-)) were analyzed for FoxP3+ Tregs, CD8+ T cells, HLA-DR+- and PD-L1+ myeloid cells by immunohistochemistry.Tregs and PD-L1+ cells were found to form an immunosuppressive cordon around metastatic tumor cells. Importantly, whereas high HLA-DR+- and PD-L1+ cell rates were strongly associated with LN+, elevated Treg levels and decreased CD8+ T cell/Treg ratios were found similar in LN+ and adjacent LN-, as compared to LN- at more distant anatomical localizations. These data suggest that delineated fields of Treg-associated immune suppression in anatomically co-localized TDLNs enable metastasis by creating metastatic niches. This may be of importance for decision-making regarding (surgical) intervention in cervical cancer. Future efforts should include the implementation of immunotherapeutic regimens to overcome this immune suppression, establish loco-regional control and halt systemic tumor spread.

Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies.

Reactive case detection (RACD) for malaria is a strategy that may be used to complement passive surveillance, as passive surveillance fails to identify infections that are asymptomatic or do not seek care. The spatial and seasonal patterns of incident (index) cases reported at a single clinic in Chongwe District were explored.

With the continuous aging of society, the demand among elderly citizens for care facilities is increasing. The accessibility of elderly care facilities is a significant indicator for evaluating whether the layout of urban elderly care facilities is reasonable, and research on the spatial accessibility of related facilities has become an important academic issue in recent years. In this paper, based on the lack of accurate measurement in calculating the spatial accessibility of existing elderly care facilities, we improve the mathematical model based on the two-step floating catchment area method (2SFCA) and introduce the probability function of the elderly population's choice, taking into account the influence of institutional capacity and service quality. In terms of the catchment radius, the calculation accuracy is improved by using the shortest distance along the route combined with the real road network instead of choosing the Euclidean distance. In addition, specific travel thresholds are set for the travel characteristics of the elderly. An evaluation model of the accessibility of urban elderly care facilities is constructed with the help of ArcGIS software to evaluate and analyze the accessibility of the current layout of urban elderly care facilities in Xi'an, China. The results show that the improved 2SFCA model is more effective in evaluating the spatial accessibility of elderly care facilities and has higher accuracy than the previous calculation model, which provides a methodological basis and academic reference for the specific planning of urban elderly care facilities.

A comprehensive understanding of the spatial distribution and dynamic changes of soil properties are the basis for sustainable land management. Topography and land use types are key factors affecting soil property variability. This study analyzed the effects of land use types and landscape locations on soil properties, based on data from 111 points of surface soil (0⁻20 cm) in the Zhujiagou catchment on the Loess Plateau of Northwest China. Soil properties include clay, silt, bulk density (BD), soil organic matter (SOM), total nitrogen (TN) and total phosphorus (TP). Land use types include slope farmland (SFL), terrace farmland (TFL), check-dam farmland (CDL), woodland (WL), shrub land (SL) and grassland (GL). Landscape locations include crest (CT), upper slope (US), middle slope (MS), lower slope (LS) and flat valley (FV). Topographical attributes were divided into primary and secondary (or compound) attributes. Correlation analyses were carried out between soil properties and terrain attribute, and multiple-linear regression models were established to estimate soil properties using land use types and topographic attributes as independents. Results indicated that significant differences in soil properties existed between six land use types, except for bulk density. Higher values of clay, silt, SOM and TN occurred in soils from check-dam farmland, but lower values in soils from shrub land. Significant differences among landscape positions were observed for clay, BD, SOM and TN. Clay, SOM and TN contents on flat valley (FV) positions were higher than those of other positions. Different correlations were found between soil properties and terrain attributes. The regression models explained 13% to 63% of the variability of the measured soil properties, and the model for Clay had the highest R² value, followed by TN, silt, BD, SOM and TP. Validation results of the regression models showed that the model was precise for soil bulk density, but the variation was large and a high smoothing effect existed for predicted values of other soil properties. For TP, the predicted result was poor. Further observations suggested that land use was the dominant factor affecting soil chemical properties. But for soil physical properties, especially for BD, topography was the dominant factor.

Achieving high Mass Drug Administration (MDA) coverage and drug uptake are pivotal in the efforts to eradicate onchocerciasis. The present study investigated the extent and predictors of ivermectin MDA coverage and uptake from the individual and healthcare providers' perspectives. The extent of ivermectin distribution and uptake, and the predictors of distribution and uptake were investigated in endemic communities in the Ashanti Region of Ghana.

Women cancer survivors, especially those in rural areas, with high levels of depression may be acutely susceptible to pain due to the ways they think, feel, and behave. The current study seeks to elucidate the relationship between symptoms of depression and pain severity in women cancer survivors, by examining the putative mediators involved in this relationship, specifically their self-efficacy for managing their health, how overwhelmed they were from life's responsibilities, and relational burden.

To conduct a pilot population-based study within a general practice catchment area to determine whether the incidence of breast cancer was increased in the Ashkenazi population.

Studies suggest that certain black and Asian minority ethnic groups experience poorer outcomes from COVID-19, but these studies have not provided insight into potential reasons for this. We hypothesised that outcomes would be poorer for those of South Asian ethnicity hospitalised from a confirmed SARS-CoV-2 infection, once confounding factors, health-seeking behaviours and community demographics were considered, and that this might reflect a more aggressive disease course in these patients.

Poor spatial accessibility to hospital services is associated with higher morbidity and mortality rates among people living with disability. Improved methods to evaluate spatial accessibility are needed. This study measured the potential spatial accessibility of people living with disability by applying four configurations of the two-step floating catchment area (2SFCA) method to recommend the best model for use in health services research.

The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a "care strategy" specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria.

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services.

Evaluation of soil redistribution rates and influence on crop yield in agricultural catchments is very important information, which can provide a scientific basis for arrangement of soil and water conservation measures and sustainable crop production. In recent decades, the soil erosion has greatly aggravated in the Mollisol region of Northeast China due to unreasonable land management, which in turn has reduced crop yield. The objectives of this study were to investigate the spatial distribution of soil redistribution and the relationship between crop yield and soil redistribute at a catchment of the Chinese Mollisol region. A total of 176 soil samples were collected based on a 200 m by 200 m grid and 4 yr of corn (Zea mays L.) yields were measured. The 137Cs trace technique and Zhang Xinbao's mass balance model indicated that the soil redistribution rates ranged from -7122.25 to 5471.70 t km-2 yr-1 and averaged -830.10 t km-2 yr-1. Soil erosion dominated in the research area. The corn yields for four years ranged from 43.24 to 136.19 kg km-2 and averaged 90.42 kg km-2. The spatial distribution of soil redistribution rates and corn yield showed a similar ribbon and plaque characteristics at the catchment. An equation between corn yield and soil redistribution rates was fitted and showed that there was a significant negative correlation between corn yield and soil erosion rates, while there was no relationship between the corn yield and soil deposition rates. Therefore, effective soil and water conservation measures are urgently needed to increase crop yield and realize sustainable land-use management.

Soil erosion has become a serious problem in recent decades due to unhalted trends of unsustainable land use practices. Assessment of soil erosion is a prominent tool in planning and conservation of soil and water resource ecosystems. The Universal Soil Loss Equation (USLE) was applied to Nyabarongo River Catchment that drains about 8413.75 km² (33%) of the total Rwanda coverage and a small part of the Southern Uganda (about 64.50 km²) using Geographic Information Systems (GIS) and Remote Sensing technologies. The estimated total annual actual soil loss was approximately estimated at 409 million tons with a mean erosion rate of 490 t·ha(-1)·y(-1) (i.e., 32.67 mm·y(-1)). The cropland that occupied 74.85% of the total catchment presented a mean erosion rate of 618 t·ha(-1)·y(-1) (i.e., 41.20 mm·y(-1)) and was responsible for 95.8% of total annual soil loss. Emergency soil erosion control is required with a priority accorded to cropland area of 173,244 ha, which is extremely exposed to actual soil erosion rate of 2222 t·ha(-1)·y(-1) (i.e., 148.13 mm·y(-1)) and contributed to 96.2% of the total extreme soil loss in the catchment. According to this study, terracing cultivation method could reduce the current erosion rate in cropland areas by about 78%. Therefore, the present study suggests the catchment management by constructing check dams, terracing, agroforestry and reforestation of highly exposed areas as suitable measures for erosion and water pollution control within the Nyabarongo River Catchment and in other regions facing the same problems.

Detection of viruses in the environment is heavily dependent on PCR-based approaches that require reference sequences for primer design. While this strategy can accurately detect known viruses, it will not find novel genotypes or emerging and invasive viral species. In this study, we investigated the use of viromics, i.e., high-throughput sequencing of the biosphere's viral fraction, to detect human-/animal-pathogenic RNA viruses in the Conwy river catchment area in Wales, United Kingdom. Using a combination of filtering and nuclease treatment, we extracted the viral fraction from wastewater and estuarine river water and sediment, followed by high-throughput RNA sequencing (RNA-Seq) analysis on the Illumina HiSeq platform, for the discovery of RNA virus genomes. We found a higher richness of RNA viruses in wastewater samples than in river water and sediment, and we assembled a complete norovirus genotype GI.2 genome from wastewater effluent, which was not contemporaneously detected by conventional reverse transcription-quantitative PCR (qRT-PCR). The simultaneous presence of diverse rotavirus signatures in wastewater indicated the potential for zoonotic infections in the area and suggested runoff from pig farms as a possible origin of these viruses. Our results show that viromics can be an important tool in the discovery of pathogenic viruses in the environment and can be used to inform and optimize reference-based detection methods provided appropriate and rigorous controls are included. IMPORTANCE Enteric viruses cause gastrointestinal illness and are commonly transmitted through the fecal-oral route. When wastewater is released into river systems, these viruses can contaminate the environment. Our results show that we can use viromics to find the range of potentially pathogenic viruses that are present in the environment and identify prevalent genotypes. The ultimate goal is to trace the fate of these pathogenic viruses from origin to the point where they are a threat to human health, informing reference-based detection methods and water quality management.