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A Map of Baseball Nation

A Map of Baseball Nation | National Population Health Grid | Scoop.it

"Fans may not list which team they favor on the census, but millions of them do make their preferences public on Facebook. Using aggregated data provided by the company, we were able to create an unprecedented look at the geography of baseball fandom, going down not only to the county level, as Facebook did in a nationwide map it released a few weeks ago, but also to ZIP codes."


Via Seth Dixon
Brian Altonen's insight:

Some of that red in Texas overlaps with Boston I hear.

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Brian Altonen's curator insight, April 25, 4:51 PM

Anything can be mapped.  

 

This mapping did not fully account for hybridization--for example when a friend in Texas is a Boston Red Sox fan.

Courtney Barrowman's curator insight, April 28, 7:43 AM

unit 1 & 3

Greg Russak's curator insight, April 29, 9:53 AM

Maps and baseball - a good combination!

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Chicago Illness, Full Run of diffusion examples - YouTube

http://youtu.be/qN9CALP2_uw ChicagoIllness Full 7 0808 Teaching Video 0%
Brian Altonen's insight:

There are two versions of the "Chicago Illness" that I developed videos for.  They were designed to present the  value of the NPHG method for disease investigation.   This is one of these two presentations.

 

The other is at https://www.youtube.com/watch?v=GV0s2qeZpAc 

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Ebola and the Present States of Surveillance

Ebola and the Present States of Surveillance | National Population Health Grid | Scoop.it

The Present States of Surveillance - the implementation of GIS and Remote Sensing in Spatial Epidemiology.     

 

A Flowchart used to assign levels of engagement in the Medical GIS process.    

 

Normal Ranks 1 to 9 (1=low; 9=high performance and success; 10 = ideal theoretically rank.     

 

Status, in this illustration is almost 6.   Although this score is based on interviews etc. analyses completed a half year ago  These assignments are based on the forms of software/programming required for each step and its uses, i.e. presentation and/or utilization, levels of spatial math, spatial representation, and analytic tools/methods used.  Note: last month's second review demonstrated considerable progress.     

 

Improvements in accuracy, presentability, complexity, dimensionality, utilization, and predictability are some of the major changes required for each step.     

 

To effectively deal with Ebola, the higher end agencies are working close to levels 7 and 8, and testing at levels 8 and 9.

Brian Altonen's insight:

A reiteration of the value and importance of having an operational (not experimental) GIS in use for regular (ongoing, daily) disease surveillance.      

 

You can bet the quality of GIS use is going to rise considerably in the next year once the epidemic months for Ebola, Chikungunya, MIRS (SARS), Asiatic Flu, Measles, Mumps, Pinta, Dengue, Cholera, Bubonic Plague, Tick-born Fevers, and even Bedbugs has passed.      

 

The real question is how effectively can developmental teams produce GIS's that can be operate locally around the country.     

 

In a survey I developed to query into the value of GIS to epidemiological research and surveillance programs, I found a higher understanding of its applications than expected (40% instead of just 20% familiarity).  But the level of GIS implementation nationally and internationally remains at about 5.5 on a scale from 1 to 10.   [A theoretical '10' can operate hundreds of diseases (300+) nationally, per single sql/report run, per day, with pre-specified groupings based on risk patterns and ecological types. . . which I reviewed elsewhere.]

 

To successfully manage something as ecological, international, fast moving and deadly as Ebola, we need to reach level 9.  Even a level 8 might suffice for now.

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Brian Altonen's curator insight, July 2, 10:19 AM

The circled level is where we need to be for outbreaks like those of Ebola and other foreign born emerging diseases.  Research stations and facilities at major headquarters no doubt have these technologies in place.  Where we are lacking is at the infrastructure level and the lack of engagement in upgrading our software and skillsets.  

 

     In some ways, this reminds critics of what happened due to the natural disasters we experienced over the recent years.  There were a number events we were "unprepared for", resulting in limited recognition, delayed response, and inadequate long term follow up for these events .

 

     The point here is that we should use cases like these as lessons, that very well could prepare us for a repeat in these same events next year, but with worse consequences.  

 

     This year's spatial epidemiological events--ebola, chikungunya, polio in the Middle East, the polio-like condition in California, the measles outbreaks and other immunized diseases in the U.S., and most recently Whooping Cough (is mumps, rubella, or diphtheria next?)-- demonstrate better systems should be put in in place at regional and local levels.  These systems should match the level most of the better standard system in health care are at currently (Levels 6) and be able to progress rapidly to levels 7 and 8 (begin to employ NLCD, grid, DEM, RS, NIR, vector-NDWI, RADAR, LiDAR, live LS or equivalents), and even 9 (prediction/accurate risk assignment) for the most advanced.  

 

     The technology we need to accomplish this goal exists right now.  Only human behaviors can be used to explain why Medical GIS, as a profession, has not reached its fullest potential.

 

     Those companies and health care organizations that start right now will become the local Innovators and Supporters.  Those that wait, but ultimately find a way in are Early Followers.  

 

     Which pack does your company or healthcare group belong to?

 

      I am currently trying to document our participation and rate of implementation, including with this ANONYMOUS survey,

 

     described at:  http://brianaltonenmph.com/biostatistics/gis-in-the-workplace-survey/

 

     and directly accessible at:   https://www.surveymonkey.com/s/HZ7MH7Q

 

 

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Vectors or Victims? Docs Slam Rumors That Migrants Carry Disease

Vectors or Victims? Docs Slam Rumors That Migrants Carry Disease | National Population Health Grid | Scoop.it

"Doctors say they are concerned about false rumors and “hysteria” that the unaccompanied children coming across the border from Mexico into Texas are carrying diseases such as Ebola and dengue fever."  

 

Source:  NBC News.  Maggie Fox. (dated July 9, 2014).  "Vectors or Victims? Docs Slam Rumors That Migrants Carry Disease"    http://www.nbcnews.com/storyline/immigration-border-crisis/vectors-or-victims-docs-slam-rumors-migrants-carry-disease-n152216

 

WELL WHAT ABOUT THE OTHERS.

Brian Altonen's insight:

As is often the case, concerns, fear and even panic arise with some of the worst logic.   The fear may be right and have good reasons for its existence, but unless we consider the alternatives for how else it might apply, we could result in two series of negative historical epidemiology events--ignoring the original claim because it is misapplied, and missing the boat as how to better apply it.  

 

NPHG mapping doesn't support the claim that in-migrating from Mexico and lower parts of the Americas  in unlikely to bring in diseases for us to be concerned with. 

 

Ecological fallacy is when you believe your observations and deductions pertain to a much larger area or population.  Such is the case for those arguing these "false rumors."

 

The support for the "possibility" (a term we should even consider removing from this sentence)  that in-migration patterns do not increase the risk of behaviors and disease coming in from other areas, peoples and culture is absurd.  We can try arguing the point that immunizable diseases is not a concern, because we can simply provide these as soon as they come in, although many underprivileged classes in this country also in need of these medicines will most certain fell neglected, and rightfully so (see news video - http://www.ijreview.com/2014/07/155553-cant-go-back-houston-black-woman-drops-epic-rant-obamas-failure-deal-border-crisis/ ).

 

The article is right in stating the concerns about dengue fever are overrated (see video), and my Ebola work is appearing to show that this is also unlikely to be linked to Mexico in-migration, as much as Caribbean or Natural Animal in-migrating patterns.

 

The argument that sufficient quarantine and public health monitoring strategies are in place only holds for those who enter this country legally.  

 

The real indicators here are the presence of in-migrated diseases from countries to the south, such as the most obscurest of ICDs with a well-defined cultural relationship--Chiclero's Ear and Pinta.

 

But we can add more to this if need be.  Vibrio cholera outbreaks from a strain bred in Peru, Brazilian blastomycosis, and venezuelan encephalitis.

 

As I recently demonstrated on one of my ScoopIt! pages about Ebola, the most likely route of entry naturally is via the Caribbean and/or South to Central American route, through the eastern Texas-Mexico border, directed Northnortheastward.  The human in-migration route, more likely, involves major airplanes and airports linked to Africa, for direct transmission, London for indirect.

 

See:

 

Dengue, at https://www.youtube.com/watch?v=eHyehbfOwFo 

 

El Tor cholera at https://www.youtube.com/watch?v=m5tccQopKFE (demonstrates a nidus in the NYC area, due to rule outs and high density of cases, but the major localized cluster in the Southwest)

 

Brazilian Blastomycosis, https://www.youtube.com/watch?v=bPgOWoC1lO8

 

Chiclero's Ear (route very strongly demonstrated), https://www.youtube.com/watch?v=BmLlfLze1Lo

 

Pinta, using an earlier and very unique presentation technique, at https://www.youtube.com/watch?v=KCTueptEHlc

 

Venezuelan Encephalitis, https://www.youtube.com/watch?v=iuKuvqAlZFU

 

Disease distributions in the US for ICDs linked to Middle and South America, https://www.youtube.com/watch?v=dk7z6dbGuj8

 

My coverage of the disease in-migration for numerous parts of the world: https://www.youtube.com/watch?v=zQ60npQzdTk&list=PLWrApErk5bybFfsOWTXWjlwvIM7D4d6-h

 

 

 

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Medical staff warned: Keep your mouths shut about illegal immigrants or face arrest

Medical staff warned: Keep your mouths shut about illegal immigrants or face arrest | National Population Health Grid | Scoop.it
A government-contracted security force threatened to arrest doctors and nurses if they divulged any information about the contagion threat at a refugee camp housing illegal alien children at Lackland Air Force Base in San Antonio, Texas, sources say.
Brian Altonen's insight:

This seems very much counter to what everyone is taught in healthcare.     

 

    Quite a while ago, some years back, my models said there was a path coming into this country via Texas for infectious disease migration.  A large part of this root is dictated by population densities, proximity of urban settings and well used travel routes, mostly by land and water, less frequently by airplane.  The key indicators of such a route existing are the distributions of the rarest diseases from down south in the heart of the U.S..  

 

    For example, pinta and chiclero's ulcer spatial behaviors showed exceptional peaking in seasonal work regions of the country.  The influx of common seasonal host-vector patterns from the south define east coast routes better than midwestern U.S. routes, but nevertheless there are some repeated midwest south to north patterns.  A Brazilian fungal condition and a uniquely ecological vibrio from the coasts of Peru have also demonstrated these patterns, with tendency to travel inland via a midwestern pattern, not a directly northward coastal pattern.

 

    The San Antonio to central Texas and then northward, further northward and then eastward route is implied by these spatial diffusion patterns.

 

   It is very disconcerting when politics and political decisions outweigh preventive health priorities.  These behaviors are perhaps the exact reason for many of the midwestern outbreaks that recur with diphtheria in the Rockies, measles in Indiana and Illinois, and the mumps and whooping cough problems that seem to be growing across this country.     

 

   What next?  Rubella?  Diphtheria? Spinal meningitis?  Polio?     

 

   Are all of these recent outbreaks due mostly to political decisions?! (or indecisiveness?)   

 

    An important thing to note is that the mapping of cases suggests a travel and diffusion process for infectious childhood diseases is already happening . . .   

 

    See    http://www.scoop.it/t/national-population-health-grid/p/4023333942/2014/06/21/california-declares-whooping-cough-epidemic-outbreak-distributions-may-be-predictable-using-nphg     

 

     and     

 

http://sco.lt/7z082L

 

 

 

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Congenital Tuberculosis - YouTube

http://youtu.be/n7sk4N3Hmrw CongenitalTuberculosis 1116
Brian Altonen's insight:

Why is the Hot Spot for Congenital Tb in the Pacific Northwest?

 

.     This was a question I tried to answer a number of years back with my work on culture and disease.  The focus for Pacific NW colleges was the Pacific Rim effect.  My travels all along the  west coast over the years, including up into Vancouver and good old Victoria BC demonstrated to me that there was a migration and commercial behavior very much underresearched for this region.  Congenital TB and a host of culturally-linked, culturally-bound, and culturally-prevalent disease patterns proved spatially that this was a topic in need of further exploration.

 

.     Many of the cultural traditions came to the Northwest by way of missions activities.  The removal of Vietnamese, Cambodians and Laotians to the Pacific NW were due to the Vietnam War, and the relocation of pro-US military leaders from SE Asia to this part of the US.  Hawaii and parts of lower Canada were used in the relocation of a number of Japanese and Indian entrepreneurs in recent decades.  The Hmong, with some of the highest birthrates in the U.S., also came to the NW during this time.

 

.     The persistence of congenital Tb suggests that some of this migration is still quite active, as descendants of earlier families removed to North America  to follow in their elders' footsteps.   Whereas in the first years it was the elders with TB that drew most of our attention in Pacific NW epidemiology and public health, it is now this persistence of congenital TB that should lead us to be concerned, especially since the hottest spot in the country for congenital TB remains the Pacific NW, where refusals to immunize are also the highest in this country, and where Pacific Rim migration influences continue to impact the public health for this region.

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Australian Disease In-migration Patterns - YouTube

Recently I pointed out the fact that the furthest distance a disease has to travel to infect the heart of the United States is the distance from Western Australia to Chicago, Illinois. The fact that some history of Australian zoonotic disease patterns exists for the United States indicates that there is no longer a true geographic barrier to international disease migration around the world.

 

The distance from Western Australia to Chicago is about 10,500 miles as the crow flies. Demographic isolation is impossible due to commerce, unlike the pre-world war 2 years in United States history. See the video on the history of Australian disease immigration in totum at http://m.youtube.com/watch?v=IejZIYTCz5U Another at http://m.youtube.com/watch?v=dk7z6dbGuj8

Brian Altonen's insight:

This is one of a series of combination studies of disease migration to the US from other parts of the world. These videos are in general available at the sites with the rotating map videos. This is a product of my NPHG National Population Health Grid Mapping Project.  Links for related pages and/or videos:  

 

Vectored diseases:  https://www.youtube.com/playlist?list=PLWrApErk5byYIE4u0cyvuYt4PWjbhaLuw

 

Foreign Born  Diseases:  https://www.youtube.com/playlist?list=PLWrApErk5byYEazOlIoMZkXEKfE8fIL3T

 

More - https://www.youtube.com/playlist?list=PLWrApErk5byZnE0bWUqdfH4CYVmnETLg6

 

Worm Ecology:  https://www.youtube.com/playlist?list=PLWrApErk5bybRr7QngCgYpyRTykazJk0Y

 

Or peruse any of the dozens posted, starting with this listing:  

https://www.youtube.com/user/altonenb/videos

 

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Fact Sheets | Chikungunya virus | CDC

Fact Sheets | Chikungunya virus | CDC | National Population Health Grid | Scoop.it
Chikungunya is a viral disease transmitted by the bite of infected mostquitoes.
Brian Altonen's insight:

Chikungunya

Fact sheet N°327
Updated March 2014

Accessed at: http://www.who.int/mediacentre/factsheets/fs327/en/

 

[BEGIN QUOTE, with some returns and enumeration added]  


Key facts

 

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.


The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.


There is no cure for the disease. Treatment is focused on relieving the symptoms.


The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.


Since 2004, chikungunya fever has reached epidemic proportions, with considerable morbidity and suffering.


The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in a localized outbreak in north-eastern Italy.

 

WHO response


WHO responds to chikungunya by:

1)  formulating evidence-based outbreak management plans;

2)  providing technical support and guidance to countries for the effective management of cases and outbreaks;

3)  supporting countries to improve their reporting systems;

4)  providing training on clinical management, diagnosis and vector control at the regional level with some of its collaborating centres;

5)  publishing guidelines and handbooks for case management, vector control for Member States.

 

[END QUOTE]


Main Links: (for most recent news and updates) 

 

CDC Page:  http://www.cdc.gov/chikungunya/index.html

 

COMMUNICABLE DISEASE THREATS REPORT

http://www.ecdc.europa.eu/en/publications/Publications/communicable-disease-threats-report-26-april-2014.pdf

 

 

For more information (by month)

 

Chikungunya now an epidemic in the Caribbean.  May 01, 2014.  At 

http://www.jamaicaobserver.com/news/Chikungunya-now-an-epidemic-in-the-Caribbean

 

St Lucia records first case of Chikungunya Disease.   April 2, 2014.  At 

http://www.cbn4news.com/2014/04/02/st-lucia-records-case-chikungunya-disease/

 

Chikungunya Virus Spreading Quickly in the Caribbean.  March 4, 2014.  At 

http://blog.sermo.com/2014/03/04/chikungunya-virus-spreading-quickly-in-the-caribbean/

 

Frances Robles.  Virus Advances through East Caribbean.  Feb. 8, 2014.  The New York Times.   At

http://www.nytimes.com/2014/02/09/world/americas/virus-advances-through-east-caribbean.html?_r=0

 

Scott Harrah, Epidemiology, Public Health News, UMHS News.  Chikungunya Virus Threatens Caribbean.  January 23, 2014.  Posted on The UMHS Pulse.

At https://www.umhs-sk.org/blog/no-mosquito-borne-chikungunya-reported-in-st-kitts-nevis-but-tropical-disease-threatens-parts-of-caribbean/Caribbean-Medical-Schools

 

Charles Simmins.  Paradise Invaded by Chikungunya Virus.  At

http://voices.yahoo.com/new-illness-spreading-throughout-eastern-caribbean-12506433.html

 

Yale scientist: Chikungunya outbreak may become a major U.S. public health problem.  Dec. 20, 2013.  At 

http://news.yale.edu/2013/12/20/yale-scientist-chikungunya-outbreak-may-become-major-us-public-health-problem

 

 

Google Search for CDC report related news items on this subject:  https://www.google.com/search?q=chikungunya+virus+in+the+Caribbean&oq=chikungunya+virus+in+the+Caribbean&aqs=chrome..69i57.1321j0j8&sourceid=chrome&es_sm=93&ie=UTF-8#q=chikungunya+virus+CDC+report++2014&tbm=nws

 

 

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Latest Videos « CBS Dallas / Fort Worth

Latest Videos « CBS Dallas / Fort Worth | National Population Health Grid | Scoop.it

A Central Texas county is dealing with its worst outbreak of rabies in more than a decade.

Coryell County had 26 cases of the disease in animals last year and officials have determined at least three already in 2014.

Most of the cases involve skunks - 21 of them last year.

Brian Altonen's insight:

For the news video on this story, go to CBS Local News for Dallas-Fort Worth at http://dfw.cbslocal.com/video/10106206-ten-year-old-recovers-from-rabid-skunk-bite/  ;

 

At my Youtube site I posted a number of videos on zoonotic disease, including that depicting the distribution of rabies.

 

For the Rabies 3D map image above in the lower right corner, see--Rabies, IP, at    https://www.youtube.com/watch?v=WFdWszKEYJ4&list=PLWrApErk5byYvO6ZHvDzgzmPqOGs1WI9B

 

This Youtube site also has Foreign Zoonotic Diseases as an aggregate to demonstrate the national overall foreign born disease pattern.  Ratbite Fever, Boutoneusse Fever, North Asian Tick Fever, Quennsland Tick Typhus, and many more. 

 

See also:

Central Texas County Reports Jump in Rabies Cases.

 http://www.kbtx.com/health/headlines/Central-Texas-County-Reports-Jump-in-Rabies-Cases-246960511.html

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CDC reports biggest measles outbreak since 1996

CDC reports biggest measles outbreak since 1996 | National Population Health Grid | Scoop.it

Twenty-first century outbreaks : complacency and 'non-compliance' make for bad preventive health practices.

Brian Altonen's insight:

The recent measles outbreaks in New York, as detailed in the CDC's page devoted to reviewing this growing problem

( http://www.cdc.gov/measles/  ;), is one of numerous examples of epidemiologic problems arising due to past and present preventive health practices.  

 

Mumps is a growing concern for the same reasons as measles, except mumps is already not unusual for children to experience in this country, if compared with measles.  It is the adults born in the late 1950s and early 1960s that we should be most concerned about, due to the questionable long term value of the vaccine administered during those early years. 

 

Likewise, rubella and diphtheria also have occasional cases arising in this country, enough to make some of us question to validity of the "herding effect theory" so often used as a means to console ourselves as these occasional outbreaks continue to recur.

 

I first posed this epidemiological preventive health question several years ago when I for the first time produced by maps of national case histories for immunizable and immunized diseases, maps on where the cases demonstrate these occasional outbreaks, maps on the relationship between population density and these outbreaks, and maps on the distribution of parents refusing immunizations for their children.  These maps when evaluated together defined just two places where the nidus for potential outbreaks prevail.  One of these two is where the measles epidemic outbreaks are no recurring (see also my links at  http://brianaltonenmph.com/2014/02/14/population-density-immunization-refusal-potential-outbreak/ ;).

 

My very first video on this growing public health problem, produced several years ago, is presented at - - http://es.pinterest.com/pin/568790627908930198/

 

This video depicts where EMR tells us the history of these diseases exist in this country, in recent decades for the time this video was produced, using a small grid analysis technique that I developed.

 

For those of you who might remember, my display of my mapping of polio cases nearly two months back -- 

 

http://www.scoop.it/t/episurveillance/p/4017873532/2014/03/18/has-polio-like-virus-spread-outside-california-wtsp-com

 

-- produced quite a reaction worldwide (much more internationally than from U.S. epidemiologists), mostly in favor of what this presentation has been able to tell us.

 

The following are links for yet more support for my findings:

 

The 2013 outbreaks, according to CDC: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm

 

Notes from the field about measles for most recent months, CDC:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a6.htm?s_cid=mm6316a6_e

 

CDC page on Mumps outbreaks (since the MMR vaccine against measles is also against mumps and rubella):  http://www.cdc.gov/mumps/outbreaks.html

 

The Mumps outbreak in Illinois, the April 22, 2014 report:  http://abclocal.go.com/wls/story?section=news/local/illinois&id=9513170 ;  

and http://www.10tv.com/content/stories/2014/04/21/columbus-mumps-outbreak.html

and in NY and New Jersey:  http://www.thedailybeast.com/articles/2014/04/19/third-u-s-mumps-outbreak-this-year-happens-in-new-jersey.html

 

Or you can use this search for more:

 

https://www.google.com/search?q=mumps+outbreak&oq=Mumps&aqs=chrome.2.69i59l2j0l4.2648j0j4&sourceid=chrome&es_sm=93&ie=UTF-8#q=mumps+outbreak&tbm=nws

 

 

 

 

 

 

 

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Measles outbreak: Why is Canada worse hit than the U.S.?

Measles outbreak: Why is Canada worse hit than the U.S.? | National Population Health Grid | Scoop.it
It's an inescapable reality: As long as measles is infecting children in other parts of the world, Canada is going to have occasional outbreaks.
Brian Altonen's insight:

Where do we stand with regard to susceptibility to Canadian born disease patterns, and how does Canada's safety fare with relation to our own refusal to engage in infectious disease prevention practices like immunization?

Measles is one of those diseases that has recurred regularly in United States history in terms of small outbreaks.

Due to today's transportation patterns and the  tendency for our lives to be heading in an international direction, economically or socially, we exposure ourselves to the risks that other countries have to face almost on a daily basis.  If anything is a surprise, it is the fact that we have managed to maintain our sterility from the other nations abroad which we consider to be "less healthy".

Unhealthy habits are a human trait, and they exist in the U.S. as much as they exist in other countries.  Notice on the above map the kernel density risk areas don't stop at the U.S. border.  Even without the same details about Canadian immunization habits and practices, we can still impact Canada as much as we impact ourselves due to human behaviors.  Vice versa is the case as well.

Recent events with measles demonstrate that the two highest risk regions in the U.S. are close enough to Canada to impact the north as well.  Likewise, Canadian public health issues are just a few hours trip away from the U.S.  This means that the public health problems in these parts of the U.S. must be concerns that Canadian public health professionals need to consider.  We should also be paying more attention to how people behave across the border with regard to OUR public health practices. 

The southern border possess some risks as well, that follow the Central Plains states northward.  Less conspicuous than the Pacific Northwest, or the New York centered high risk regions, the midwestern south-north map of travel has links to numerous other potential disease migrations as well, internationally or nationally.

This is a very good reason to be mapping the national disease history.  If you were asked what routes might a disease from Canada or Mexico come into this country, and subsequently influence your healthcare program in the very near future, and triple the costs for some programs, what routes might you propose?

These questions apply to immunizable disease patterns, international infectious diseases, zoonotic diseases, genetic disease traits, behavioral and culturally bound diagnoses.

ICDs have very specific flow patterns that now can be easily mapped, monitored, and used to predict and test for probably health risk problems in the future.  All of this can be done at the most basic managed care level.

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States rebel against powerful new painkiller

States rebel against powerful new painkiller | National Population Health Grid | Scoop.it

"BARRE, Vt. (AP) — State officials around the country are rebelling over a powerful new painkiller that law enforcement and public health authorities fear could worsen the nation's deadly scourge of heroin and prescription drug abuse..  


On Thursday, Vermont Gov. Peter Shumlin announced an emergency order that would make it harder for doctors to prescribe Zohydro, an extended-release capsule that contains up to five times the amount of narcotic hydrocodone previously available in pills. 


SOURCE: "States rebel against powerful new painkiller"

Associated Press By BETH GARBITELLI. April 4, 2014 3:52 PM

At http://news.yahoo.com/states-rebel-against-powerful-painkiller-173429680.html?vp=1

Brian Altonen's insight:

The approval of Zohydro for use as a single opiate remedy has turned many states against this recent recommendation for a new painkillers.  The problem is its recipe--it is a single painkiller without the ingredients that often limit consumption due to liver toxicity--and due to its purity, which gives it a high street value.


The following five video maps produced by NPHG demonstrate the distribution of three drug use behaviors and two  medical consequences suffered by newborns, when drug abuse behaviors are practiced during the latter months of pregnancy:

  

Opium Abuse IP  https://www.youtube.com/watch?v=x7nym6TuTNs

Hallucinogens Abuse IP  https://www.youtube.com/watch?v=h6SRAVTZgnA

Cannabis Abuse IP  https://www.youtube.com/watch?v=ZKO6W5FZmL0

Fetal Exposure to Narcotics  https://www.youtube.com/watch?v=cdcs1rPtJk8

Crack Baby Syndrome https://www.youtube.com/watch?v=f22tnbV3JME

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Regionalism and Public Health in the Pacific Northwest

Regionalism and Public Health in the Pacific Northwest | National Population Health Grid | Scoop.it
PART V The Pacific Northwest In the course of my review of regional health patterns in the US as these may be predicted or defined by demographics and population health statistics, I found that the...
Brian Altonen's insight:

To illustrate the value of mapping for a single program, several hundred ICDs, emergency visit codes, V-codes, clinical practices, and patient preventive care behaviors were mapped nationally, and then related to the Pacific Northwest findings common to Seattle and Portland.  

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A number of most popular public health issues for the region were evaluated, such as STDs, hepatitis (all 3), street drug use, behavioral health trends, teen age prostitution, low income housing, child abuse, childhood sexual abuse, spouse abuse, poor nutrition, immunization refusal, religious refusal of care, tuberculosis due to the Pacific Rim influence, congenital tuberculosis in newborns, Hawaiian Island culturally-linked disease patterns, etc. etc..

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Two of the important outcomes of this project were a comparison of national and regional statistics for:

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1) homelessness (for play listing in Youtube  https://www.youtube.com/playlist?list=PLWrApErk5byYk0dUG4wr84OH7xo8pTKZ3  ) and

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2)  young adult suicides ( https://www.youtube.com/watch?v=mtYbKbja6ZU&index=9&list=PLWrApErk5byY6uhXRzd0wYy2OuuCZI-zW   ;).  

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The krigged map of young adult suicides demonstrated the highest peak in the country, based on counts, prevalence evaluations, and density analysis of claims filed  ( https://www.youtube.com/watch?v=xEX4ekL3NnA&feature=youtu.be ;)

 

The Pacific Northwest also stood out for homeless population density, but was the weakest of the five peak areas in the U.S. based on EMRs ( https://www.youtube.com/watch?v=f-0kaHI1VI8&feature=youtu.be ;)

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Congenital Tuberculosis demonstrated its greatest peak in the region between Portland and Seattle (  https://www.youtube.com/watch?v=QkB-NK-oYqQ&feature=youtu.be ;)

 

A peak in Low Birthweight Babies is seen for this region as well (  https://www.youtube.com/watch?v=PiJIYT5aEDc&list=PLWrApErk5byY6uhXRzd0wYy2OuuCZI-zW ;)

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My full 2010 report for this Medical GIS study (5 parts) begins at http://brianaltonenmph.com/gis/population-health-surveillance/production-examples/regions-and-health/

 

 

 

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The history of disease mapping in the United States -- Valentine Seaman, 1797 (1804) and the Black Plague of New York City

The history of disease mapping in the United States -- Valentine Seaman, 1797 (1804) and the Black Plague of New York City | National Population Health Grid | Scoop.it

The first published maps of disease in the United States were produced by New York City physician and medical school professor Valentine Seaman.  He used maps to describe the yellow fever outbreak that took place in lower New York in 1797, with the hope of defining this epidemic as either a local outbreak due to marshlands, wind and weather, or the result of the import of this disease as a form of contagion brought up from the West Indies.   

Brian Altonen's insight:

A number of the most famous and most historically important epidemiology and disease ecology maps are presented, reviewed and analyzed in detail, beginning at http://brianaltonenmph.com/gis/historical-disease-maps/ ;  

 

This and many other historically important disease maps are also reviewed at the Princeton University site

http://libweb5.princeton.edu/visual_materials/maps/websites/thematic-maps/quantitative/medicine/medicine.html

 

Available for review for the first time at Princeton University's site is the map from  'De noxiis paludum effluviis, eorumque remediis: Libri duo'   (On the noxious effluvia of marshes and their remedies), Rome: Typis Jo. Mariae Salvioni . . . , by Italian physician Giovanni Maria Lancisi, 1717. 

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The Immigration Problem We’re Not Talking About

The Immigration Problem We’re Not Talking About | National Population Health Grid | Scoop.it

These are the distribution of immunizable diseases (ID) in the U.S., based on a review of EHR/EMRs for ICD defined infectious diseases.  These numbers do not always indicate true cases, for ICDs are entered into medical records for "rule out" cases.  The other stragglers in such rare IDs as small pox are presumable mistakes.  Some cases of unusual claims may be noted in the EHR/EMR as "a history of . . . "   The point of these maps is to demonstrate several patterns.  

 

First, the popular density pattern typical of mumps, measles, rubella (diphtheria as well, although recent outbreaks were noted in the diphtheria data for the midwest that had to be corrected for).  

 

Second, the in-migration population density routes, in the NY-NJ-CT-PA ports area, but especially the route heading from south to northnorthnortheast from San Antonio.  

 

Third, the cluster formed around the great lakes region for poliomyelitis.  Culturally-based over-documentation has been considered a cause, as well as behaviors linked to the proximity of this region to Canada.

 

Finally, the occasional scattering of claims for rare diseases, in particular small pox (n = 1 or 2, max), which may be even due to data entry errors.

Brian Altonen's insight:

This importation of immunizable disease has been an ongoing dilemma with illegal immigration patterns.  

 

The recent changes in policy that enables immigration could leave the U.S. in one of its most potentially deadly states ever, in terms of loss or reductions in US population health.  

 

This is a deliberate exposure, with increases in prevention practices engaged in within the local encampments used as the primary reason we are allowing this to happen.    

 

So the key questions are . . .  

 

Will the possible influx of more international diseases like Chikungunya  compromise this security even more?    

 

Will its impact on local communities outside the national border compromise the security of the borderlands even more?  

 

Could there be an influx on individuals that we cannot control?  

 

And do we really know where all of the carriers or potential carriers are?  

 

The following video on the once geographically bound and fortunately mostly non-contagious Chiclero's ulcer (place of origin - Yucatan peninsula) indicates a very effective in-migration of its carriers to the northern latitudes of the U.S. https://www.youtube.com/watch?v=BmLlfLze1Lo 

 

My video on these immunizable diseases and where they were noted in US EMR/EHR documents is at https://www.youtube.com/watch?v=W1d8fBxz5V4&feature=youtu.be ;

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Why Americans Should Worry About the Ebola Outbreak, by Samantha Cowen, TakePart Live

Why Americans Should Worry About the Ebola Outbreak, by Samantha Cowen, TakePart Live | National Population Health Grid | Scoop.it

The influx of African born epidemiologic culture, traditions, influence, and genetics.  There are two culturally distinct in-migration African routes.  The traditional commercial routes evident since slavery, and the more recent increasingly used Islamic in-migration routes.  

Brian Altonen's insight:

A simple comparison of sickle cell versus infibulation practices over the past decade reveals how these medical diagnoses make their way into this country.  This is reviewed extensively on these ScoopIt! pages and in numerous others posted in other web locations.  

 

This topic is reviewed extensively as part of the NPHG mapping program.

 

http://nationalpopulationhealthgrid.wordpress.com/

http://nationalpopulationhealthgrid.wordpress.com/applications/3-sociocultural-disease-clusters/

http://www.pinterest.com/altonenb/nphg-the-news/

 

It remains a topic poorly reviewed by the majority of healthcare programs being developed.  

 

In the video linked to on the news page --

Why Americans Should Worry About the Ebola Outbreak --

(if you can ignore the overly "flowery" pop culture interpretation it provides)

virus hunter Anne Rimoin talks about the Ebola outbreak in West Africa and how it could affect the U.S.

Romoin talks about outbreaks like Ebola, such as the 2003 Monkey Pox outbreak due to pet animals importation

 

See  CDC review and recommendations:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5223a1.htm and http://www.cdc.gov/ncidod/monkeypox/factsheet2.htm ;

 

and article

CMAJ. Jul 8, 2003; 169(1): 44–45.  "Monkeypox outbreak among pet owners" by James Maskalyk

--  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164943/ ;).  


For my partial listing of the numerous diseases this issue brings up, see http://brianaltonenmph.com/gis/global-health-mapping/foreign-disease-intrusion/ ;

 

Youtube search on  MonkeyPox videos:  https://www.youtube.com/results?search_query=monkeypox

 

My NPHG videos on

 

Monkey Pox -- http://youtu.be/1amd_QP3YHU ;

 

Ebola -- https://www.youtube.com/watch?v=RfvUQfYLlvM 

 

Yakatopox -- https://www.youtube.com/watch?v=RiSHvXsc5-s&list=UUN1qTQzREkH6ratg-pg2_fg

 

Korean Hemorrhagic Fever -- https://www.youtube.com/watch?v=XlRl-D5sG-w&list=UUN1qTQzREkH6ratg-pg2_fg&index=119

 

Crimean or Congo Fever -- https://www.youtube.com/watch?v=YWuMBOdB08k&index=123&list=UUN1qTQzREkH6ratg-pg2_fg

 

 

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Suicide, z versus z-squared - YouTube

National Population Health Grid-mapping Project. New GIS Technology for Medicine, Conference educational materials. Demonstration of the value of using Z-squared instead of Z or true data values when implementing a new preventive care program.

Brian Altonen's insight:

It sounds really simple.  Your company wishes the  develop a program that targets underserved populations by setting up a new clinic and contacting the neighborhoods where the least amount of health care activities are engaged in by all of the family members.

 

The way we traditionally do this is we look at something like zip code and street addresses, towns and even hamlets if we have that information, and then we look at whatever services we already have in place for the most needed neighborhoods and where a new office may have to be rented in order to set up a new clinic.

 

Ideally, this is what we might do, until we see the tables and graphs in front of us and haven't an idea of where to start.  All you need to do is map out that data, adjust it according to the whims and wishes of your managers or quality assurance teams, and then produce a 3D map of your results.  If those results are not easy to interpret, meaning the hot spots don't stand out the way you'd like, all you need to do with your visual is square those z values, and the most needed places in communities are easy to spot.

 

So why don't we do this?  In a way it appears to be too much common sense at play here, and historically it has been the traditional of spatial health projects to focus on the large area evaluations for reasons of simplicity and, as some might argue, HIPAA compliance.  However, for internal work, there is no reason not to produce maps that explain exactly where the boost in services is needed.  In periurban and rural settings, a zip code tract could mean a 5 or 10 mile difference in locating your new clinic, meaning that you could miss the most needed houses and families.

 

I used suicide z versus z-squared to point out where the most aggressive suicide prevention programs need to be wet up in the United States.  These are the regions where the most people take their lives, no matter what their normalized incidence rates are.  In most of the V- and E-codes and many ICDs with high social significance or meaning, prevalence/incidence rates suppress the information we have about where the best services need to be provided.  

 

For managed care programs, this same method can also be used to evaluate costs and savings.  Any statistic can be analyzed using 3D NPHG techniques.  best of all, no GIS is required, if that's the reason a managed care program is simply not implementing GIS as a part of its healthcare management program.

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California declares whooping cough epidemic - Outbreak distributions may be predictable using NPHG

California declares whooping cough epidemic - Outbreak distributions may be predictable using NPHG | National Population Health Grid | Scoop.it
California is declaring whooping cough to be an epidemic after 800 cases were reported in the last two weeks. Learn how whooping cough spreads.
Brian Altonen's insight:

My controversial 3.75 minute NPHG presentation on the distribution of immunizable diseases is at :  https://www.youtube.com/watch?v=UBUPd8LPdrQ&list=UUMJaJTXo6VmoTW2yktQiZrA&index=24

 

 

My 3D videomap on the distribution of refusals to immunize children is at:  https://www.youtube.com/watch?v=LyqSJQOqSHU&index=21&list=UUMJaJTXo6VmoTW2yktQiZrA

 

The Playlist for this several year old site is found at:  https://www.youtube.com/playlist?list=UUMJaJTXo6VmoTW2yktQiZrA

 

 

 

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'Joe the Plumber' an out-of-touch gun 'extremist,' says Sandy Hook principal's daughter

'Joe the Plumber' an out-of-touch gun 'extremist,' says Sandy Hook principal's daughter | National Population Health Grid | Scoop.it

NPHG results, overlain on top story.  

 

Can a conclusion about how prevent a recurrence ever be decided upon?

Brian Altonen's insight:

Several years ago, due to the Columbine incident still on my mind, I tried to review a number of behavioral, psychological, mental health, psychiatric, neurological, temperamental, poverty-linked, SES, emergent code, abuse related, and even physical causes that could be linked to human behaviors, which in turn might lead to the use of guns as part of a killing spree.  

 

Not to my surprise, I found nothing conclusive.  But the distribution of potential indicators often talked about was enough to make that light go on in my head about about how to research such a social issue.

 

The recent event involving 'Joe the Plumber' and, at first the victims in Newtown, Ct., and now the victims in Santa Barbara, California, is nothing for us in healthcare programs to take lightly.  

 

Because we have all of this data available to us, we can in theory review it to search for hidden patterns, spatial and temporal relationships that provide us with new insights into where the copycats are likely to be found.  Or better stated, we can use spatial analyses to define where the antagonists of this copycat behavior might exist in society, and where they are going to have their greatest impact on human behavior, emotional response, and overall population health and public safety concerns.

 

NPHG will not predict where the next shots will be fired.  But it does provide us with the insights needed to understand this country as a whole and quite locally, no matter how diverse people can be, in their psychiatric state, as well as their belief system and cultural upbringing.

 

 

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NPHG - Developmental & Genetic Diagnoses Spatial Patterns - YouTube

NPHG - Developmental & Genetic Diagnoses Spatial Patterns - YouTube | National Population Health Grid | Scoop.it

In January of this year, one of the first break-throughs in genetic  disease therapy was announced in the press.  A study published in The Lancet  (http://www.ncbi.nlm.nih.gov/pubmed/24439297) reviewed a novel form of gene therapy developed by researchers for treating choroideremia and adult-onset macular degeneraton patients, common causes for adult age onset of blindness (see Gene Therapy Trial Shows Promise for Type of Blindness at http://www.ox.ac.uk/media/news_stories/2014/140116.html ;   ;

Ricki Lewis. See Gene Therapy News: Brain, Skin and Eye.  At http://blogs.plos.org/dnascience/2014/01/23/gene-therapy-news-brain-skin-eye/ ;  

Loren Grush.  Gene therapy improves vision in patients with form of incurable blindness.  Fox News.  http://www.foxnews.com/health/2014/01/16/gene-therapy-improves-vision-patients-with-form-incurable-blindness/

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Sanfilippo syndrome Type A, Breast Cancer, Schizophrenia and even obesity are now being researched for this new form of pharmacotherapy. 

Brian Altonen's insight:

With gene therapy just around the corner from becoming an acceptable form of treatment for many health conditions, there is this growing need to merge population health research and disease mapping with the another form of “mapping” common to medicine—human genome mapping.
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As part of the National Population Health Grid mapping project, a number of very rare genetic conditions were evaluated spatially in the United States to determine if clustering patterns could be demonstrated that could provide us with insights into genetic disease patterns.   This evaluation of NPHG demonstrated that ICD mapping can in fact provide us with very useful findings when it comes to developing genetic disease education programs.  

 

In the maps above, a particular form of blindness shows well defined clusters of cases in certain parts of the United States.  This ability to view the entire country and then zoom in to a particular region suspected of clustering makes this tool very useful both regionally and nationally.  One can now focus on the neighborhood or even block area to produce more  effective education and intervention programs.  For rare genetic conditions, this method supplements the standard epidemiological methods already in place and helps to determine if a cluster may be important statistically, or not.

 

Numerous diagnoses are monitored and better managed using this new spatial health technique.

 

Numerous diagnoses are monitored and better managed using this spatial health technique, including everything from cystic fibrosis, blindness, epilepsy, sickle cell, hemophilia, etc.,  to schizophrenia, diabetes, breast cancer, and adult obesity, and even inherited forms of age-related chorea, parkinsonism, and even Alzheimer’s disease. 

 

This need for higher resolution population health genetics spatial surveillance is demonstrated by the growing number of new form of gene therapy arising in upcoming years.  “Cures” such as injectable adiponectin gene therapy for obesity (http://www.genetherapynet.com/), enzyme replacement therapy for Sanfilippo syndrome Type A (http://www.fiercebiotech.com/press-releases/lysogene-raises-165-m-series-led-sofinnova-partners-and-co-led-innobio-and) and aged-related macular degeneration (AMD) prevention (http://lifescientist.com.au/content/molecular-biology/news/gene-therapy-on-trial-for-eye-disease-1085223190) are just a few examples of how fully researching your population health for the need for such products enables more fully tested and agile medications to be developed in a more timely manner.

 

Ricki Lewis. See Gene Therapy News: Brain, Skin and Eye.  At http://blogs.plos.org/dnascience/2014/01/23/gene-therapy-news-brain-skin-eye/

 

Loren Grush.  Gene therapy improves vision in patients with form of incurable blindness.  Fox News.  http://www.foxnews.com/health/2014/01/16/gene-therapy-improves-vision-patients-with-form-incurable-blindness/

 

Gene therapy trial shows promise for type of blindness.  (with video) http://www.ox.ac.uk/media/news_stories/2014/140116.html

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Local Team Support versus Allegiance in Baseball

Local Team Support versus Allegiance in Baseball | National Population Health Grid | Scoop.it

I used this Upshot/NY Times mapping tool available on the internet to evaluate counties for highest level of local team support, and longest distance allegiance to teams based on distance and percent support or allegiance to a distant team.  

Brian Altonen's insight:

The above map I produced can be reviewed more closely at   

http://www.pinterest.com/pin/568790627911028333/

 

No county could be located that had a 100% score for local team support.  

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Allegiance or devotion to a former home or distant team was found in several expected places such as Florida (NY'ers winter paradise) and the Boston Red Sox-NY Yankees border in upstate NY.

 

Unexpectedly, Utah also has its own major followings for each of these teams.  South Carolinians on the other hand were split between NY and Atlanta.  

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The best scoring local support that I could find (and by "local", I mean from the diamond to the neighboring teams' territorial edges) was Boston Red Sox (86%), followed by St. Louis Cardinals (85%).  [However, territorial area was not evaluated!!]

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This interactive mapping tool, (for now, April 30th 2014), can be found at http://www.nytimes.com/interactive/2014/04/24/upshot/facebook-baseball-map.html#4,43.328,-74.795

 

 

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A Map of Baseball Nation

A Map of Baseball Nation | National Population Health Grid | Scoop.it

"Fans may not list which team they favor on the census, but millions of them do make their preferences public on Facebook. Using aggregated data provided by the company, we were able to create an unprecedented look at the geography of baseball fandom, going down not only to the county level, as Facebook did in a nationwide map it released a few weeks ago, but also to ZIP codes."


Via Seth Dixon
Brian Altonen's insight:

Some of that red in Texas overlaps with Boston I hear.

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Brian Altonen's curator insight, April 25, 4:51 PM

Anything can be mapped.  

 

This mapping did not fully account for hybridization--for example when a friend in Texas is a Boston Red Sox fan.

Courtney Barrowman's curator insight, April 28, 7:43 AM

unit 1 & 3

Greg Russak's curator insight, April 29, 9:53 AM

Maps and baseball - a good combination!

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Mapping Child Neglect and Abuse in this Country - another form of Inequality

Mapping Child Neglect and Abuse in this Country - another form of Inequality | National Population Health Grid | Scoop.it

These maps depict 9 very common items found in an EMR that can be used to monitor several different forms of child abuse, ranging from poor prenatal/postpartum care, to poor parenting, neglect, and abuse, to numerous mental health/poor preventive health behaviors. 

Brian Altonen's insight:

There are easily 50 basic metrics that can be evaluated for small and large areas in order to define the least health places for kids to be born and raised.

The metrics include V-codes, E-codes, accident frequencies, very specific fractures and dislocations, drug abuse history, and numerous socially defined child neglect inducing activities and behaviors.

There is no single ICD or condition or behavior that will define where the worst cases prevail.  But there are patterns that can be produced by mapping the right features taken from the EMRs.  These patterns tell us where different groups of behavior take place, and sometimes even the reasons they prevail in one region of the state or urban region and are not prevalent elsewhere.

The above maps demonstrate how complex child neglect and abuse are as a single topic of concern for community health workers.  Defining the war to monitor you 50, 75, 100 or even 150 different indicators for abuse is the best way to manage and better understand this particular public health problem our nation faces.

Poverty isn't the only reason neglect and abuse happen.    Eliminating inequality in this nation will not make child neglect or abuse go away. 

The more people who are insured and who receive adequate healthcare in this country, the more unwed parents, couples and families we can monitor to better understand this growing problem.

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From Human Genome Project to GIS

From Human Genome Project to GIS | National Population Health Grid | Scoop.it

In managed care, spatial disease patterns and what have learned due to the human genome project could soon be coming face to face due to the recent HIT/EMR changes.  Are we ready for this?

Brian Altonen's insight:

What impacts will the spatial analysis of genetic disease have for our future?

Mapping the human genome provides us with insights into the causes and even possible treatments for diseases that remain incurable.

What happens once we apply the results of these studies to manage care and public health?

A number of controversies will no doubt arise about the appropriate use of this data.  

The denial of health insurance coverage or the sudden increase in a cost for coverage could be the least of these issues.  

We have culture, race, ethnicity and even socioeconomics to contend with in the future.

Every health insurance program or healthcare population has the same issues to contend with regarding genetic and inherited disease patterns.  

For the first time, HIT and EMR enable us to map out genetic disease in such detail, that we are more likely to determine the cause for syndromes before an actual "cure" can be found (if any exists). 

At the clinical level, mapping the human genome  genetically and spatially will produce significant advancements in the field.  

At the business or insurance company level, their ability to responsibly manage this new skill has yet to be tried and tested.  

 

In a recent study of high cost medications, I found a handful of people on medications that cost between $1M and $6.5M  per year, just for the medication, not including any treatment that was also needed  (for more, see Minnesota's Million Dollar Miracles -Factor IX medicine costs more than 1 million dollars per year.  - http://www.minnesotamedicine.com/PastIssues/PastIssues2006/April2006/FeatureApril2006.aspx).   

These are the patients most at risk for spatial HIT/EMR data that are "misapplied" or "mismanaged".  

 

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NPHG - the Sixth Sense in Managed Care

NPHG - the Sixth Sense in Managed Care | National Population Health Grid | Scoop.it
Managed Care Organizations benefit from GIS software's use of patient demographics and market and provider data to make better decisions regarding Medicaid, disease management & utilization.
Brian Altonen's insight:

In some of my past discussions with student about population health monitoring, I referred to a successful GIS that is already operating and managing several hundred metrics or more per month as our "sixth sense."
Even when nothing appears in the forefront about health matters, viewing the images you are used to seeing every day  can often bring about new attention whenever a new health problem is surfacing, and its appearance on the map suddenly changes.
This is the major reason GIS works better for population health analyses and surveillance than any other method out there that is predominantly word or table based.
On a single page, single screen, one can review several dozen outcomes in just a few seconds.  This rapid processing is what enables us to utilize these methods as a 'sixth sense" approach to analyzing population health.

 

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Retracted autism study an 'elaborate fraud,' British journal finds

Retracted autism study an 'elaborate fraud,' British journal finds | National Population Health Grid | Scoop.it
A now-retracted British study that linked autism to childhood vaccines was an "elaborate fraud" that has done long-lasting damage to public health, a leading medical publication reported Wednesday.
Brian Altonen's insight:

How did the refusal to vaccinate children get so out of hand in the U.S.?  

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This whole problem began when an article  was published in 1998 that provided falsified results to support its claim.  

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The Jan. 5, 2011 news story and related video describing this event are at:  http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/

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According to a krigged analysis of the distribution of these behaviors, the two niduses for this social pattern are the tristate area near Manhattan (high density), and the Pacific Northwest (statistically significant z-axis values).  

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A third nidus for this human behavior is surfacing in southern California.  

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A number of secondary sites defining potential entry points are in the Great Lakes region, in Florida, and in the southern (Houston) Texas area.

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