Medical GIS Guide
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Medical GIS Guide
Recommended tools , resources, and methods. Examples of what can be done, what should be done, and what has been done.
Curated by Brian Altonen
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American Journal of Gastroenterology - Abstract of article: Emergency Department Burden of Constipation in the United States from 2006 to 2011

The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print. www.amjgastro.com, *2007 Journal Citation Report (Thomson Reuters, 2008)
Brian Altonens insight:

When will the map of these results be published?

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Sixth Oregon college student stricken by meningococcal disease

Sixth Oregon college student stricken by meningococcal disease | Medical GIS Guide | Scoop.it
By Shelby Sebens PORTLAND, Ore. (Reuters) - A sixth University of Oregon student has contracted the potentially deadly meningococcal disease amid an outbreak that erupted in January, and more cases could emerge, public health officials said on Thursday. Health officials said a 20-year-old college sophomore who lives off campus has been confirmed as having contracted meningococcemia, a bacterial precursor to meningitis that can also lead to damaging blood infections. The student, who has not been named, was in stable condition and was expected to recover, according to Lane County Public Health officer Patrick Luedtke. Five other students have contracted meningococcal disease since January, including an 18-year-old freshman, Lauren Jones, who died.
Brian Altonens insight:

This is something we should consider to be a ruminating disease, awaiting for more opportunities.  During my 17 years of living in Oregon (1985 to 2002), the meningitis issue, which mostly erupting in students at OSU, was a recurring topic in local health news.    Immunizations are available for preventing these outbreaks.   

 

But as I have show in numerous postings, Oregon and Washington are the two states with the greatest number of families and young adults against the use of vaccines to prevent disease.  These students I knew who developed the disease were born in the 70s, their parents, like myself, were born 20 - 25 years earlier.  These parents (unlike myself) were adamant about not vaccinating their children (exposing me of course).    

 

Again, population density and regional culture define the locations of the lowest immunization rates, an outcome that will not be realized until the local insurance companies learn to map their data for the first time.  (I mapped population health in Oregon for the last 8 years I was there.)    Evidence for this is apparent in the article--Lane County is where recurring cases have been seen over the past several decades in the Oregon meningococcal outbreak histories.      

 

But it is not the county that is the center for this problem, because it is where OSU is located.  Portland State University, University of Portland, Lewis & Clark, and a host of other colleges and universities around the state have similar student centered community health settings, and should also experience these meningococcal outbreaks.   

 

Lane County is where this disease prevails.  Perhaps due to climate and topography, but more likely due to its Woodstock-like culture, where naturalism and natural medicine have their major followings (look up the good old Country Fair for an example).  The history of naturopathy in this state (with an accredited, active ND program 4 yr school) plays a major role in the history of vaccine refusal for this state and its neighbor Washington (also with an ND school).  The late 1960s started this modern anti-vaccine movement, when the states with naturopaths defined the vaccines as a surgical like process, outlawing it briefly as a practice that could be offered by naturopaths.   

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simpleNewz - Brian Altonen, MPH, MS RSS Feed for 2014-12-19

simpleNewz - Brian Altonen, MPH, MS RSS Feed for 2014-12-19 | Medical GIS Guide | Scoop.it
Latest discussion topics on Brian Altonen, MPH, MS Forum
Brian Altonens insight:

A couple of months ago some outside agencies began publishing my criticisms on the lack of GIS in managed care and regionalized PBM and health insurance programs.  Critiques are never really respected much by the profession they are directed towards.  It's even worse when the critic is a part of that program . . . many out there in healthcare are against change, except for a change that means we stop the current PPACA program.  

 

This is a promotion of my widely agreed with criticism on how limited we are in our potential for health improvement and financial savings currently.  If these programs were in place for 3 years, we would now be experiencing the benefits of more appropriate, accurately targeted health care services and activities.

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Michigan disease outbreaks spark backlash

Michigan disease outbreaks spark backlash | Medical GIS Guide | Scoop.it

Measles in Michigan--Today and 120 years ago.  Anti-vaccination trend irks parents, especially in Traverse City where outbreaks occur.  Statistics on current antivaccine trands in Michigan (top figure and lower left).  Geography of the 1896 outbreak that struck Michigan (lower right), from the State of Michigan Department of Health Annual Report.

Brian Altonens insight:

A series of interesting spatial epidemiology questions can be generated from this news.    

 

The first is 'is this a continuation of the Disneyland' outbreak or a new outbreak with different roots?'   

 

The second, 'could certain parts of the diffusion process in Michigan mimic their beahvioral patterns during the outbreak in 1896?'  We have the map to follow up on this question with.   

 

Thirdly, 'can we relate the Michigan introduction and diffusion process to human behaviors in the adjacent country of Canada?  

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A Better Explanation: How the Unvaccinated Put the ‘Herd’ at Risk

A Better Explanation:  How the Unvaccinated Put the ‘Herd’ at Risk | Medical GIS Guide | Scoop.it
A measles outbreak in California has scientists concerned about the disease making a resurgence. Why do health officials track vaccinations so closely? WSJ’s Jason Bellini has #TheShortAnswer.
Brian Altonens insight:

The current herd of non-vaccinated kids has a very traceable history.  I brought this up quite recently in a couple of LinkedIn conversations.    


When we don't know a cause, we often simply make things up. That is what some authors are trying to do, to find an explanation for the events now taking place in the U.S., a behavior I have been able to trace to its routes, in literature and by face to face conversations with some of the initiators of this movement in the Pacific NW, Canada, and Kansas, several decades ago.

 

The major transition to antivaccination can be directly traced to the mid-20th century post-Korean War medical political licensure events that took place, specific to the licensure of non-allopaths.  The first major event took place in Utah, due to a part of the LDS philosophy for the time.  Its most important growth occurred in Oregon by 1957, a consequence of 10 years of change in the medical profession and the proper licensure and definition for "drugless" physicians, who were then the osteopaths, chiropractors, "physotherapists," "mechanotherapy physicians", several unique physical therapy trained MDs, and naturopaths.  

 

My Chronology page for this study, from research performed back in the 1990s, and posted several times on several personal sites, was most recently posted in 2009 at my personal blog site:  http://brianaltonenmph.com/6-history-of-medicine-and-pharmacy/naturopathy-1895-present/naturopathy-a-chronology/  ;

 

I will post more on this important piece of US medical history shortly.

 

******************************

 

[QUOTE]

 

1956

 

The availability of the Polio Vaccine by mid 1950s put the question of naturopathy back up front. The Attorney General concluded “a naturopath cannot prescribe drugs or perform surgery as part of the practice of naturopathy.” [See Attorney General’s Opinion, 55-101, pp. 191-195, Biennial Report Atty. General, June 30, 1956.] 

 

[END QUOTE]

 

********************************

 

RELATED QUOTE:

 

The availability of the Polio Vaccine by mid 1950s put the question of naturopathy back up front. Therefore, the questions asked of the Attorney General were:

 

“Is naturopathy actually a legal classification?”

 

“May a naturopath engage in the administration of drugs and surgery?”

 

“Which professions are allowed to give shots (vaccines)?”

 

[Attorney General’s Opinion, 55-101, pp. 191-195, Biennial Report Atty. General, June 30, 1956.]

 

The Attorney General concluded “a naturopath cannot prescribe drugs or perform surgery as part of the practice of naturopathy.” (p. 3) 

 

Source:  http://brianaltonenmph.com/6-history-of-medicine-and-pharmacy/naturopathy-1895-present/the-utah-council-and-senate-review-1956-7/summary-of-utah-study-findings-notes/ ;

*********************************

 

Also see:

 

The Oregon Anti-vaccine Movement (based on the Thimerosal incident and the state's 1986 Vaccine Act):  http://www.sciencebasedmedicine.org/naturopaths-and-the-anti-vaccine-movement-if-you-cant-dazzle-em-with-real-science-baffle-em-by-getting-a-law-passed/ ;

 

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LINKS

 

One of my pages:

 

http://brianaltonenmph.com/2014/06/25/heres-to-pop-culture-the-anti-vaccine-movement-gives-diseases-a-new-life/ ;

 

Articles

 

How the Unvaccinated Put the Herd at Risk.  https://search.yahoo.com/search;_ylt=AuEWupWRGNP.GVvvhTHJrwqbvZx4?p=measles+outbreak+2015&toggle=1&cop=mss&ei=UTF-8&fr=yfp-t-901&fp=1 ;

 

Officials Predict More Measles Cases After 5 Babies Are Diagnosed In Illinois.  FEBRUARY 06, 2015 8:54 AM ET.  

http://www.npr.org/blogs/thetwo-way/2015/02/06/384265117/officials-predict-more-measles-cases-after-5-babies-are-diagnosed-in-illinois

 

The Largest Measles Outbreak In Recent U.S. History Wasn't At Disneyland.  AP | By ALICIA CHANG.  Posted: 02/05/2015 12:23 pm EST Updated: 02/05/2015 12:59 pm EST    http://www.huffingtonpost.com/2015/02/05/amish-measles-outbreak_n_6622742.html ;

 

Measles Outbreak Will Likely Spread, CDC Director Warns

Read Latest Breaking News from Newsmax.com .  

03 Feb 2015 08:33 AM.  By Clyde Hughes.  

http://www.newsmax.com/TheWire/measles-outbreak-cdc-us/2015/02/03/id/622326/  ;

 

Measles Outbreak in U.S.: Top 5 Conspiracy Theories.  Published 7:13 pm EST, February 4, 2015 Updated 7:19 pm EST, February 4, 2015 Comment By Sam Prince 

http://heavy.com/social/2015/02/measles-vaccine-vaccination-conspiracy-theories/ ;

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Measles outbreak: Debate among moms over vaccinations turns ugly

Measles outbreak: Debate among moms over vaccinations turns ugly | Medical GIS Guide | Scoop.it
One online support group for mothers bans all talk of measles and vaccinations after members threaten each other with violence, even death
Brian Altonens insight:

Today's tally:  155 cases.  New Jersey may be added to the list.

 

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Five babies at suburban Chicago daycare center have measles

Five babies at suburban Chicago daycare center have measles | Medical GIS Guide | Scoop.it
By Mary Wisniewski CHICAGO (Reuters) - Five babies at a suburban Chicago daycare center have been diagnosed with measles, adding to a growing outbreak of the disease across the United States, Illinois health officials said on Thursday. Officials are investigating the cluster of measles cases at KinderCare Learning Center in Palatine, said a statement from the Illinois and Cook County health departments. All the children are under 1 year old and would not have been subject to routine measles vaccination, which begins at 12 months. Public health officials have reported that more than 100 people across the United States have been infected with measles, many of them traced to an outbreak that began at the Disneyland theme park in Anaheim, California, in December.
Brian Altonens insight:

From the west or the east?  Or perhaps a new route from the north?  Or another cause of in-migration?  And when do you think it will cross the Canadian border?

 

The chief sociocultural problem on the west coast is belief in natural therapy or naturopathy; the lack of immunization by these groups allowed some hot spots to develop.  

 

Canada has several regions devoted to natural health.  The Vancouver BC region has many of the graduates from the U.S. (NCNM, Portland, and John Bastyr College, Seattle) and the Boucher Institute of Naturopathic Medicine (http://www.binm.org/ ) in New Westminster, and the Canadian College of Naturopathic Medicine in Toronto (http://www.ccnm.edu/   ).  Plus its big following in Ottawa.

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Measles - Past and Recent Applications of GIS

Measles -  Past and Recent Applications of GIS | Medical GIS Guide | Scoop.it

Just how committed are we to our field?  We are not committed enough to require the peers that are younger than us to have to retrace the history of our profession on their own, relearn things we never learned or kept to memory, things we never made a part of our profession.  

 

These early 20th century maps symbolized this problem to me.  On my own, I relearned the use of spider diagrams in mapping about 20 years ago.  But this method of spatial analysis had already been in place in the early 1900s.  The lower map sort has a buffer zone approach.  Theissen polygons should have been included as well on this 1950s map.  

 

The problem is these spatial concepts for understanding disease have been forgotten, due to this left hemispheric society we live in and the over certainty some of our past teachers felt, as though they were the best.  The other reason for this problem most commonly states within the medical school setting is that we have "too much to learn, too much to read, too much to do."   We should feel lucky that some of the best surgeons of today never followed that belief.

Brian Altonens insight:

The above spider diagram for Michigan reminds me of the issue in upper New York State right now.  A train with the contagion linked to measles made its way to the border of the U.S. at Niagara Falls.  A spider diagram of this regions cases, if any should erupt, would mimic the past research of the writer  and cartographer  of this  early 20th century borderland event.     

 

I have seen evidence for the same problems with border crossing in the images I produced for childhood prostitution down at the Tex-Mex junction, certain tropical environmental diseases in the heart of farming country in the United States, a Brazilian born fungus or two overlapping with the distribution great west coast coccidiomycosis, Arizona fever demonstrating more outbreaks far from the state with its name, and Cuban culture and environment diseases or diagnoses erupting where we might expect them to be.  

 

Where is the hotspot for mushroom grower's lung in this country?  Answer--a very small town in the midwest.   Where and when do bird grower's lung cases develop and why--which two shipping ports carrying in the parrots of Africa, or worse.  South American horse diseases, do they travel the Bovine Tuberculosis routes or do they have a route of their own due to the way commerce regulates the passage of these disease hosts.

 

Measles made its way to California recently from the same part of the Americas.  A Spider Diagram would be interesting to see, if we really want to know the truths about how contagion gets around.

 

**************************************************

 

The following are GIS sites or articles related to Measles and GIS.

 

OnLine GIS:

 

My Number One recommended site: EHealthMap.com, has:

 

Measles in Canada?!?!   https://healthmap.wordpress.com/2014/04/01/measles-in-canada/

 

The Influence of Anti-vaccine Movements.  https://healthmap.wordpress.com/tag/measles/ 

 

See also:

 

Measles Then and Now in Illinois: An Open Data Comparison of Measles Cases Before Vaccine Availability with Current Measles Vaccine Status.  [An excellent ESRI ArcGIS generated site]

http://www.arcgis.com/apps/Compare/storytelling_compare/index.html?appid=788fa9d294cb472bacc0785f8e95a67b

 

INFORMATION SITES:

 

Healthy wealthy and GIS.  By Mushahid M. Khan, Sr. Assistant Editor.  mushahid@geospatialmedia.net

- See more at: http://geospatialworld.net/Magazine/MArticleView.aspx?aid=30744#sthash.pkOPlKYD.dpuf 

 

I rank this a 3 out of 10--informative but riddled with culturally biased misconceptions and outright errors, unfortunately, he missed NY's Valentine Seaman's story, i.e. the box "First ever disease map" bears the phrase:  "In 1854, London suffered a severe cholera outbreak. No one knew how it spread from one person to the other. Some physicians believed that cholera spread through miasmas, bad air and bad smells but Dr John Snow thought otherwise" in a side notes box tells me the writers are fairly untrained and eurocentered in the history of this profession.  The modern stuff is okay, but the chief editor here needs to be more humble about himself and make better use of true experts.

 

GIS and Public Health [Book]

 By Ellen K. Cromley, Sara McLafferty .  https://books.google.com/books?id=QhYbartcBn4C&pg=PA251&lpg=PA251&dq=GIS+and+Measles&source=bl&ots=pASnXfY95e&sig=fhaJ3HmL_S26iQU9HEiV24lw9Lk&hl=en&sa=X&ei=Tw_SVOrTJYP7ggTznYHwBw&ved=0CB0Q6AEwADgK#v=onepage&q=GIS%20and%20Measles&f=false

 

 

ARTICLES:

 

[Classroom style preseentation/essay].  Spatial Diffusion: Conceptualizations and Formalizations

Kathleen Hornsby.  http://www.spatial.maine.edu/~max/KEH_i21.html 

 

[Saudi Arabia, essay]  The application of Geographic Information Systems (GIS) to illustrate geographical distribution of notifiable diseases in KSA, during the 1990s. 

http://www.saudigis.org/FCKFiles/File/SaudiGISArchive/1stGIS/Papers/4.pdf

 

[Rhode Island, US, refereed article]  ANANDA SANKAR BANDYOPADHYAY, MBBS, MPH; UTPALA BANDY, MD.  

Emerging Global Epidemiology of Measles and Public Health Response to Confirmed Case in Rhode Island.  https://www.rimed.org/rimedicaljournal/2013/02/2013-02-41-health-measles.pdf 

 

[Turkey, refereed article]  N ULUGTEKIN, S ALKOY , DZ SEKER.  Use of a Geographic Information System in an Epidemiological Study of Measles

in Istanbul.  The Journal of International Medical Research

2007; 35: 150 – 154

 

related article/item . . . 

 

A.O. Dogru and N.N. Ulugtekin, Istanbul Technical University, Cartography Division, Istanbul, Turkey;  S. Alkoy,  Abant Izzet Baysal University, Bolu Izzet Baysal Faculty of Medicine, Departmant of Public Health, 14280, Golkoy, Bolu, Turkey.  GIS APPLICATIONS ON EPIDEMIOLOGY WITH CARTOGRAPHIC PERSPECTIVE IN TURKEY.  http://icaci.org/files/documents/ICC_proceedings/ICC2007/documents/doc/THEME%2026/Oral%202/Dogru_et_all_GIS%20Applications%20on%20Epidemiology%20with%20Cartograp.doc 

 

 

[Ireland, refereed article]  G Fitzpatrick, M Ward, O Ennis, H Johnson, S Cotter, M J Carr, B O’Riordan, A Waters, J Hassan, J Connell, W Hall, A Clarke, H Murphy, M Fitzgerald.  USE OF A GEOGRAPHIC INFORMATION SYSTEM TO MAP CASES OF MEASLES IN REAL-TIME DURING AN OUTBREAK IN DUBLIN, IRELAND, 2011.  Eurosurveillance, Volume 17, Issue 49, 06 December 2012

Surveillance and outbreak reports.  http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20330 

 

POWERPOINTS:

 

[Alberta, Canada]. Powerpoint: Dr. Vivien Suttorp .  

Outbreaks in Rural Communities with Low Immunization Rates. 

  http://www.health.alberta.ca/documents/WCIF2014-PPT25-Suttorp-Outbreaks.pdf 

 


[India conference, Powerpoint]. Kapil Goel, A. Khera, R. Gera, A. Shrivastava, J. P. Narain, K. F. Laserson, L. S. Chauhan. Evaluation of Progress Towards Measles Elimination in Karnataka, 2008-2012. India EIS Conference, November 2013. http://www.ncdc.gov.in/writereaddata/linkimages/drkapil8623026931.pdf

 

[U Texas Powerpoint].  Stephen C. Waring, Univ. of Texas, School of Public Health, Houston. Communicable Diseases Following Natural Disasters: A Public Health Response. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=29&cad=rja&uact=8&ved=0CFQQFjAIOBQ&url=http%3A%2F%2Fwww.ncdc.gov.in%2Fwritereaddata%2Flinkimages%2Fdrkapil8623026931.pdf&ei=WxDSVPmhKsP2ggS7iIK4Cw&usg=AFQjCNGsx0Vf4VHbRzW-AbEdSRy88VKZng&sig2=ogLX_6NJiGB441ju9gZSZQ

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Charted: One unvaccinated person undermines the efforts of everyone else

Charted: One unvaccinated person undermines the efforts of everyone else | Medical GIS Guide | Scoop.it

HERD IMMUNITY THEORY--NEGATED BY A SINGLE MEASLES CASE.  The math says that 90% vaccination rates should be enough. Here's the simple reason it's not.

Brian Altonens insight:

I have been stating this for a while.     

 

In October 2013, my criticisms about our dependency on the "Herd Immunity" belief  drew major criticisms by a number of major public health leaders in the world.  Why not criticize me?  They have a lot to lose once their fences (no longer walls) lose their strength with protecting conformists from non-conformists, as they continue to exercise their personal human rights.  

 

The majority, if not the overwhelming super majority (95%) of doctors and leaders in public health have been too dependent on traditional programs, relying upon unchanging traditions and philosophies that have been in place for decades.   For some reason, technology and science and the theories behind how each of these enable medicine to grow, endure a different life than societal, population and culture based ideologies.  Science can undergo abrupt change; what we believe in people however does not.  How stubborn we are!

 

Well, today's "society" isn't at all like society was in 1960 to 1970, when a number of new ideologies were developing.  People themselves now are very different, and any philosophy related to people can only be valid for a generation or two, only until their promoters have grown to "adult age".  

 

The medicine practiced in the late 1960s is obviously too "outdated" to practice in today's hospitals and clinics; after all, it wasn't anything close to perfect in the first place.     

 

Neither are today's medical philosophies and theories "perfect" and "absolutely correct".  When you believe they are,  you have stopped yourself from growing within the medical profession.     

 

The Herd Immunity theory went extinct decades ago.  The moment a perfectly safe herd of people became an endangered species, its future was defined.  All of this due to rapid population growth and our ever changing social environment, a revolution in process that medicine can barely keep up with. 

 

 

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Has Culture Defined A Hudson Valley Measles Nidus ?

Has Culture Defined A Hudson Valley Measles Nidus ? | Medical GIS Guide | Scoop.it
State Health Department: Measles Vaccination Remains Vital to Protecting Against Highly Contagious Disease ALBANY, N.Y. (September 21, 2012) - In light of confirmation of a measles case in a school...
Brian Altonens insight:

"Nidus" is a mid 19th century term used by medical geographers used to describe what we today might call potential hot spots for disease.  A nidus is the "nest", where the first cases develop and from there spread to other locations either radially or along specific kinds of routes such as along a waterway, through a valley, by following a particular assemblage of plants and animals.   Medical geographers in the mid-19th century had perfected this way of understanding disease development, to such an extent that they could use such unusual physiographic features as aspect of a hillside and the slope of that location to define where the disease might fester, due to the "animalcules" or microbes that lives there naturally.  (Unlike what common teachings like to profess, bacteria was the first small organism we related to diseases.)

 

Since the 1980s, there have been at least four outbreaks of measles in the valley, and they share certain common population, travel, and business or economics features.  And they represent a classic example of the hierarchical diffusion process (see my page on this -  http://wp.me/Puh6r-5TT ;).

 

Three of the articles and discussions of these four cases have one town or village as a common source for the cases.  The case that emerged just a day or so ago is somewhat to the north, associated with the local railways system returning a student to his/her college setting.  The case from two or three years aback also involved schools in some way and local international travel--in that case it was the school that allowed 50% of its students to not be vaccinate, per their personal belief or faith.   The association of the Rhinebeck-Bard-Tivoli cases with those in New Paltz across the river also shared university-international travel or foreign students features.

 

The fourth location to the south is where the first recent mention of this problem returned to the local newspapers, down by the Palisade Mall in lower New York.

 

See also See also: http://www.skepticalraptor.com/skepticalraptorblog.php/measles-case-confirmed-york-state-school/  

 

Now, it is easy and at times too easy to draw these comparisons between regions and see similarities.  Culture itself for example is not the cause for this part of the valley showing a tendency to be a nidus.  Statistically, I might call it a covariate.  The main factor in this migration of measles into the eastern U.S. is the population health behavior features, and the fact that the Hudson valley has  a unique behavioral feature--programs that bring together many people who demonstrate a strong support of personal beliefs, personal rights to chose, and "alternative forms of medical beliefs or thinking."  

 

We all have the right to be "different".  If only we knew how our differences influence the right of others to live a secure life, without fear of that terrible Scarlet letter coming close to our kids, elders, or family members engaged in critical quality of life related health care.  In this case, cultural diversity works against the continued survival of these different communities.  There are some rules that must be followed by all cultures, no matter what sacrifice of personal rights may be required.

 

We map physical and human geography all of the time when we research spatial epidemiology.  Small scale area analyses may be used to define specific natural ecosystems or niduses required for west nile to develop in this region (I posted my example of successfully using this technique in 2002 and 2003, a while back).  We can also use small area analyses to identify niches of unhealthy communities or shared communal settings.

 

One has to wonder, how much of this type of cultural analysis of disease (if any) is engaged in locally? 

 

In the past few days, a comparable social behavioral pattern has emerged recently in Minnesota as well (http://www.startribune.com/lifestyle/health/290151131.html  ).

 

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WHO says cash crunch, rains could thwart Ebola efforts

WHO says cash crunch, rains could thwart Ebola efforts | Medical GIS Guide | Scoop.it
By Stephanie Nebehay GENEVA (Reuters) - Halting the spread of Ebola in West Africa will depend on mobilising funds and aid workers before the rainy season hits in April-May, otherwise it could up to take a year, the World Health Organization (WHO) warned on Friday. "It is a programme that can stop transmission if we have the money and the people, and we don't have either," Dr. Bruce Aylward, WHO assistant director-general in charge of the Ebola response, told a news briefing before a special session of WHO's Executive Board on Sunday. The number of Ebola cases week-on-week has declined for each of the past four weeks in hard-hit Guinea, Liberia and Sierra Leone, which is promising, he said after a tour of the region.
Brian Altonens insight:

It's called "disease ecology", the main reason GIS is such an effective surveillance tool.  We can manage the ecology of diseases based on natural ecology traditions, accompanied by the more common studies that focus on human ecology (demographics and population health) traditions.  

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Measles outbreak casts spotlight on anti-vaccine movement

Measles outbreak casts spotlight on anti-vaccine movement | Medical GIS Guide | Scoop.it

"LOS ANGELES (AP) — A major measles outbreak traced to Disneyland has brought criticism down on the small but vocal movement among parents to opt out of vaccinations for their children."  

 

The Anti-vaccine movement actually first made the news as a future public health issue back in 1996, when there was  a measles outbreak, and in 2005 when this movement began making the news due to support by celebrities.

Brian Altonens insight:

Since October 2013 I have been documenting the various news items related to immunized disease outbreaks.  For those of you familiar with my work, I developed this project as a result of some maps I produced demonstrating the highest number of immunization refusals clustered around one of my former abodes in the Pacific Northwest.  In the past 15 months, 120 of my pages or postings have been devoted to topics on communicable diseases, disease in-migration by immigration, and disease re-emergence.   The bulk of the articles, news events, etc., that I uncovered for this research (excluding the Ebola) focused on the successful introduction of foreign diseases into this country by immigrants and travelers.  MMRs and the refusal to vaccinate your child were the next two hot topics, followed by Polio and DTaP vaccine related stories or conditions.

 

The full listing of my postings on this topic are at my NationalPopulationHealthGrid site: 

 

http://wp.me/P3qi2r-1r

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1865 - 1870 - Mapping Public Health in Manhattan

1865 - 1870 - Mapping Public Health in Manhattan | Medical GIS Guide | Scoop.it

 The responsibility of sanitary and safety officers in New York City during the late 1860s and 1870s resulted in some of the first 3D maps of public health surveillance.  There were a number of reports generated detailing the health of the rapidly growing New York City.  For the first time, public health officials paid close attention to the safety of living in tenement houses, shacks builts in alleys, and the placement of public latrines in alleys adjacent to older well pumps still used or next to city water supply settings.  The top images are of 27th and 3rd in NYC.  The lower image is of slaughterhouse stables set up on Sixth Street; the slaughterhouse for this facility was probably next door.  Pure white, tiled rooms were popular sets ups for these facilities by the turn of the century.  Slaughterhouses were often responsible for producing epidemics of listeria, salmonella outbreaks, and spinal meningitis and encephalitis, both often referred to as erysipelas.

Brian Altonens insight:

This is a detailed study of the sanitation report for New York city, for a time when building use was mismatched with development plans for the neighborhood.  A number of small area maps and illustrations were provided in these reports, which I relate to contemporary overviews and streetside views of the same sites, obtained from Google maps.  The five story slaughterhouse is a prime example of how mismatched the land use patterns were back then, agriculture-farming industries were confronted by our growing urbanization problem.  

 

 

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Medical GIS - Administration, Use, Barriers, and Benefits

Medical GIS - Administration, Use, Barriers, and Benefits | Medical GIS Guide | Scoop.it

Numerous benefits are linked to applying GIS to managed care.  The most important of benefit is reducing long term potential cost, through the employment of more effective preventive care strategies.   The cost of implementing GIS has been a major concern.  There are free GIS systems out there, but HIPAA concerns become a limiter at these sites.  Instead, health and medical mapping can be done without adding a high cost GIS to your system, and even without a GIS, depending upon your data quality and software products.  

Brian Altonens insight:

This survey was developed in preparation for dissertation work on the current state of GIS use in Managed Care.  The Utilization of GIS by healthcare systems is the focus.  This survey can be accessed at    

https://www.surveymonkey.com/s/HZ7MH7Q   . | | .                

 

A more recently published survey, devoted specifically to Managed Care application (the focus of the dissertation), has also been posted; at      https://www.surveymonkey.com/s/V5THRFQ 

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Study uses real-time Twitter data to understand vaccine refusal

Study uses real-time Twitter data to understand vaccine refusal | Medical GIS Guide | Scoop.it
A multi-institutional team of researchers has initiated a study which will draw in part on Twitter analyses to better understand vaccine refusal, George Washington University announced in a press release.
“People really do tweet about everything, and conversations about vaccines are no exception,” David Broniatowski, PhD, assistant professor in the School of Engineering and
Brian Altonens insight:

It will be interesting to see the main reasons that are cited for this rebelliousness.

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Weather triggers early mosquito season

Weather triggers early mosquito season | Medical GIS Guide | Scoop.it
Watch the video Weather triggers early mosquito season on Yahoo News . The West Nile Virus hit the Valley hard last year and this year abatement crews haven't had much of a break.
Brian Altonens insight:

Is it possible to predict the newer vectored diseases to come via the southwest.  With most of the these diseases mapped, we should be able to establish a list of priorities when it comes to monitoring the southwestern States.  Will the likely route be via Pacific Rim and Hawaii? from southsoutheast Baja area? or from eastsoutheastern central Mexico?  Will anything from South America reach us?  What might follow the malaria or typhoid? Venezuelan encephalitis?  Brazilian Blastomycosis?  Russian Scrub Typhus?  Omsk Fever?

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California warns against intentional measles exposures

California warns against intentional measles exposures | Medical GIS Guide | Scoop.it
By Dan Whitcomb LOS ANGELES (Reuters) - California health officials on Monday warned parents against intentionally exposing their children to measles, which could worsen an outbreak in the state. In response to media inquiries about so-called measles parties, the California Department of Public Health (CDPH) said it did not have information on the parties or their frequency. "CDPH strongly recommends against the intentional exposure of children to measles as it unnecessarily places the exposed children at potentially grave risk and could contribute to further spread," said department spokeswoman Anita Gore.
Brian Altonens insight:

Imagine what could happen if your parents told you to never worry about diseases again.  They argue that this is because where you live, a place where the "purity" of your community makes you exempt from the natural laws, the same laws that dictate disease patterns.  

 

The thinking here might also include notion that you will be rewarded for this by being allowed to live a long life as a result of this lifestyle.  That is where the imagination of utopianism kicks in, and your child naturally believes it.

 

So a few minutes later, when your kid sites down at the breakfast table, prays 'thanks' for the food at hand, and then goes on with the day's life, does that kid ever wonder or learn about the technology your household bears.  From where did it arise?  Whom did you purchase it from.  Your local and neighborning communities no doubt.  Only isolationists could effectively melt their own spoons and forks, turn their clays into pottery dishware and cookware, melt the iron needed to make their ovens, sinks and pipeware.    

 

No matter how communal some groups try to be, most people use electricity, have a telephone, require a stove or worst yet a microwave.  Even the most natural of thinkers still need to power the waterpump that feeds their pipes and inside toilets.  That pitchfork that was used to toss hay at the horse probably did not come from an iron mine beneath your neighbor's property.  These products come from stores.  The need for transportation is because you have to go to that store, and expose yourself to the outside every now and then.   You can and soon will catch and spread some sort of infectious disease, be it the cold or flu, measles or mumps, stds or a unique E. coli strain.  

 

California's utopians, when it comes to health, are dreamers of a life that cannot be experienced without risking serious consequences.  Even if they stay away from the public as much as possible, can they prevent others coming there from infecting others each time they come in?

 

 California has diseases migrating across its borders right now that behave according to their natural laws, not according to any community's religious law.   Vibrio lives off the shores of southern California.  Brazilian and Columbia fungal infections routinely make their way into this region from people escaping the communities down south.  Measles made its way into Disneyland along a route closely hugging Fray Juan Bautista de Anza's trail.  Nature's mosquitos, ticks, fowls, raptors and mammals routinely make it possible for any pathogen to cross into this utopian setting unseen, undetected.  Perhaps the microbes responsible for Venezuelan Encephalitis, Trench and Omsk Fever, or Russian borne Tick Late-summer Fever are the next pathogens to arrive.

 

Now add to this the intentional exposures of kids to measles that we see in California.  For measles, the more this happens, the more likely it becomes for the rarest of complications of measles are going to erupt.  SSPE is the worst of these complications.  It does not occur as a consequence of the initial Measles experience.  It happens when the organism remaining in the body, dormant a short while, behaves like the pathogens of HIV, chicken pox, tuberculosis or rheumatic fever.   It sits there in the body, migrates through various organs, and for the measles virus, once it reaches the liver, becomes capable of crossing into the nervous system.  

 

So a few to ten years later, the child who suffered a simple case of measles years earlier, in just a few months to a year becomes severely disabled, paralyzed and cognitively gone.  Now it is the child who is suffering the consequence of parents' utopian thinking.

 

Parental responsibility is lost the moment a parent decides to allow the child to take this risk, due to no choice made by the child.

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'Melanie's Marvelous Measles' children's book gets scathing Amazon reviews

'Melanie's Marvelous Measles' children's book gets scathing Amazon reviews | Medical GIS Guide | Scoop.it
Amazon commenters are destroying a children's book about measles.
Brian Altonens insight:

The following is a note written by the author/publisher of this book, reviewed by Yohana Desta on her page, which this link sends you to.  

 

"[I wrote this book] ...to educate children on the benefits of having measles and how you can heal from them naturally and successfully. Often today, we are being bombarded with messages from vested interests to fear all diseases in order for someone to sell some potion or vaccine, when, in fact, history shows that in industrialized countries, these diseases are quite benign and, according to natural health sources, beneficial to the body. Having raised three children vaccine-free and childhood disease-free, I have experienced many times when my children's vaccinated peers succumb to the childhood diseases they were vaccinated against. Surprisingly, there were times when my unvaccinated children were blamed for their peers' sickness. Something which is just not possible when they didn't have the diseases at all."

 

This points out an interesting problem that healthcare faces.  Two completely different constructs of the same disease or malady.  Now, cultural beliefs play a major role in health, mostly along the lines of psychology, human behavior, and mental health as they relate to disease.  You cannot for example argue that because you are in the U.S., that your are less likely to suffer from a mosquito bite than those natural to the mosquito setting.  Your upbringing doesn't change the way your body reacts to something, your physical make up does.  

 

Your physical make up can also influence how you personally react to poison ivy, as much as the mumps, chicken pox or measles.  But being from a particular country and culture does not exclude you from experiencing the problems other countries can suffer from a disease.  If you really believe this nonsense, go see if you are exempt from catching AIDs due to HPV or measles due to your fullbred, healthy San Francisco vegan diet.   

 

There is a myth that this book feeds upon.  Those most gullible to these false beliefs are its consumers.  

 

All ads need numbers to make themselves seem worthy.  The mention of three children starts off that marketing strategy.  I bought my last car due to its mpg.  

 

Adding exaggeration by stating how "many times" something incredible has happened, when it most likely happened there just as much as it did anywhere else in the country,only adds to the personal appeal you are now feeling as the reader.   You have now succumbed to the bait.  

 

next, you are told the incredible--that the diseases your kids were actually vaccinated against are the reasons the children became ill--the vaccine doesn't work.  A redirecting of the flu vaccine problem, to apply to all vaccines.  ,

 

This is like saying you also believe you saw the neighbor's cow actually jump over the moon.  

 

And you did see that cow jump probably.  But it was your imagination that took off, more than the cow.

 

P.S. One critic asked 'Why isn't this book published in Braille?"  She is right, kids who experience measles can become blind like her daughter.  Is the possibility of blindness due to measles simply denied, or outrightly prejudiced against by the author of the book, "Stephanie Messenger"?

 

For more, see:

 

'Melanie's Marvelous Measles' Children's Book Gets Scathing Amazon Reviews by Wochit 0:56 mins

https://screen.yahoo.com/melanies-marvelous-measles-childrens-book-172531891.html

 

Stephanie Messenger's Vaccination Story.  http://www.dilutedthinking.com/hln_story.php

 

There's a lot of public distrust in this movement:

 

http://reasonablehank.com/2011/12/13/stephanie-messenger-childhood-infectious-disease-advocate/

 

VACCINES OR ATTEMPTED MURDER?.  http://uncensored.co.nz/category/health/vaccines-diseases/

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Subacute Sclerosing Panencephalitis: More Cases of This Fatal Disease Are Prevented by Measles Immunization than Was Previously Recognized

Subacute Sclerosing Panencephalitis: More Cases of This Fatal Disease Are Prevented by Measles Immunization than Was Previously Recognized | Medical GIS Guide | Scoop.it

Cases of Subacute Sclerosing Panencephalitis (SSPE) in one of the hottest regions in the world for recent measles cases, progressed into SSPE.  SSPE is the the consequence of inadequate measles vaccine supplies in parts of Africa and China, the Philippines, Turkey and the Middle East.   [see world map on this at http://www.sodahead.com/united-states/cdc-warns-of-large-outbreak-of-measles-in-america-is-usa-turning-into-a-third-world/question-4690530/?postId=136107790&page=5]

Brian Altonens insight:

A most convincing video from the UK on this problem is at: https://www.youtube.com/watch?v=aB8kGwKZiq0 

 

We don't like exceptionally sad stories, and so often we try to ignore them.  We treat them as though they were exaggerations of the truth, or even worse, propaganda.


The above link is to a 4 minute video about SSPE, produced by the Oxford Vaccine Group.  It is about a case that involves someone who could be anyone's daughter, a teenage girl whose goal in life was to complete a college degree and then go to a specialty school to earn her license in some form of healthcare or medicine.   Due to the measles she had as a child, the virus resurfaced in her about 18 years later, resulting in her SSPE diagnosis following just several months of progressive worse symptoms.  In just a couple of years she was totally disabled, suffering from significant myoclonic seizures.  Shortly thereafter, she was deceased.

 

I have a hard time finding any spatial epidemiology evaluations of this disease or diagnosis, either genetically, biologically, culturally, clinically or environmentally.  Perhaps this is because it is most prevalent in underserved countries.

 

The kinds of research questions we need to be asking about this disease is:  Is this form of the measles virus likely to behave this way only in specific countries, at specific latitudes, in specific climate and/or weather conditions?  

 

We don't know the answer to this question (in the public or medical sector at least) because we haven't spent the time researching it well enough using medical GIS.

 



 

 

Brian Altonen's curator insight, February 7, 2015 7:24 PM

Epidemiological Transition, Stage 3:  from progress to a new route to failure.   The first step in Epidemiological Transition describes how disease change as a developing country becomes a developed country, due to all of the health consequences resulting from this progress.   Stage 3 is when health care systems begin to show signs of failure, and the country's disease ecology and population health statistics seem to reverse.   For the U.S., this represents a return to the public health system we had about 50 years ago.  Like the following article implies:         CDC Warns of 'Large Outbreak' of Measles in America: Is USA Turning Into a Third World?    

http://www.sodahead.com/united-states/cdc-warns-of-large-outbreak-of-measles-in-america-is-usa-turning-into-a-third-world/question-4690530/?postId=136107790&page=5

 

 The cases illustrated above are examples of a major consequence of inadequate measles vaccination.  

 

SSPE is usually fatal at a young age; and when it occurs, its signs begin several years after the measles experience.  

 

Currently considered rare, SSPE could soon increase in numbers for the U.S., due to the increasing numbers of measles cases.  

 

Such an increase would significant impact the cost for care in our future healthcare system, and increase the demand for PT/OT workers and home- or institutional-based 24 hour personal care providers.  

 

These increases in costs will first be felt about 5 to 10 years from now.

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Vaccinate? The Sooner the Better!

Vaccinate?  The Sooner the Better! | Medical GIS Guide | Scoop.it

[The last slide in my presentation that this links to.]  I have over the past 10 years produced 3 videos that are designed to depict where claims of immunizable diseases were documented within the U.S. healthcare EMR during the first decade of this millenium, a series of partner videos depicting where these claims of refusals to vaccinate rest in the U.S., and this short version of my video materials on what people afflicted by these diseases can suffer.  

Brian Altonens insight:

My video (slides, no audio) entitled "A History of [Un]Vaccinated Diseases" is at 

https://www.youtube.com/watch?v=LOp-KGd4hV0 

 

My 3 minute video of the various immunized diseases and where they popped up in EMRs around his country is at:  https://www.youtube.com/playlist?list=PLWrApErk5byY6emyCz0_ROOXw9FdsfCfY 

 

My immunization refusal study had several video types or presentations being tested.

 

The national data for all immunizations combined, https://www.youtube.com/watch?v=9TYCqtIg2Xs 

 

My focus on the Pacific Northwest due to its exceptionally high rates.  https://www.youtube.com/watch?v=YHH32Oq_obs 

 

My complete coverage of this is in several places, but first check http://nationalpopulationhealthgrid.com/applications/01-childhoodimmunization/  ;

 

Or, you can type my name "Altonen" and "immunizations" or "immunizations refusals", and even "nationalpopulationhealthgrid.com".    

 

Thanks to good old Google, and the number of people visiting my personal blogsites, my stuff tends to show up early in these searches now.

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How Does Cholera Diffusion relate to Measles Diffusion?

How Does Cholera Diffusion relate to Measles Diffusion? | Medical GIS Guide | Scoop.it

Original version of Judson’s map, found along with Peters’ work in Wendt’s A Treatise on the Asiatic Cholera.  This demonstrates some of the similarity in the diffusion patterns demonstrated by a mostly population-dependent disease pattern like Measles, and a combined demographic-ecological pattern like that of Cholera.  However, chief differences may also be noted.

Brian Altonens insight:

Dr. Adoniram Brown Judson (1837-1916) of New York produced one of the most introspective maps on the diffusion of Cholera in the United States for the 19th century that commenced at the ecological nidus down off Louisiana.  (Vibrio cholera is still native to this deltaic setting.)

 

Judson's map details the chronology of events for an outbreak in 1873.  It was published nearly 20 (or 25) years after the most famous map on cholera was produced and published by John Snow, but has the unique ability of demonstrating to us how large areas are impacted by travelling disease patterns and how these patterns relate to the spatial behavior of disease outbreaks.

 

Judson's map provides us with info on the places and dates of these cases, the days each area was hit.  We can use it to develop a better understanding of how certain high risk areas form, over time and space, and how they diffuse to less obvious areas located in suburban, rural, backwoods or countryside settings, the places where the greatest impacts might even happen.  

 

In nearly every one of the stories told about the outbreaks of Cholera in the part of this book written by John C. Peters, the urban setting is the focus.  Peters concluded that an urban setting and its culture helped define the reasons  outbreaks initiated the way they did in the city.  

 

A chief concern we might have about Peter's review is his own bias in this matter.  As a homeopath and regular allopath during the 1840s to mid 1850s, he turned to allopathy and disease climatology in 1856, after he was convinced that he knew the cause for cholera.  So much of the writings in this book in fact reflect these observations of his, claiming that poor sanitation settings, with certain cultures residing in them, and the least acclimated immigrants residing in the lowest income neighborhoods, were to blame for how and why each city became infected.  

 

As the 2008 to 2014  measles outbreaks are showing us, maybe Peters was right.  

 

Perhaps culture is the reason epidemics are emerging the way they do right now.  In the 1800s, attached to the culture linked to cholera outbreaks was  poverty, and attached to poverty of course was unhealthy living environments and water sources, disease conducive community settings, malnourished elders and children, vermins, rodents and other potential animal hosts.  But it is these people, behaving in their own unique way because of culture and heritage, who are the first to suffer, the first to pass it on, and in today's communities, they may be poor or not.  

 

The most susceptible communities for measles today are those where certain ethnic, cultural, religious or popular culture groups establish neighborhoods, rich in kids and adults that are underimmunized if not completely non-immunized.  Where the choice made deliberately back in the 19th century for this social inequality, has become a way of living decided upon by choice too often,  except of course those poorer regions where the residents are still in need of some decent health care.  

 

Relating this to Judson's maps.  We can see how low income settings are the cause for how cholera and measles are spread, in separate ways.  The disease maintains it's hierarchical and radial diffusion patterns, following the transportation routes for its hierarchical diffusion pattern, spreading radially throughout suburban to wilderness areas, passing from household to household, behaving like we'd expect it to according to some theories out there.

 

But deviating from this standard diffusion theory paradigm, there is that social inequality impact (reviewed in my thesis) that reversed hierarchical diffusion pattern I defined that has to be included in this paradigm as well.  The poor get sick more easily than the rich.  So one has to wonder if that makes the pathogen emerges more adapted for its next victim, more ready to produce a new case.

 

This Measles outbreak happening now in the Hudson Valley introduces a fourth possible spatial feature to consider for predicting disease spread.   Some cultural lifestyles are highly susceptible to  catching the disease, harboring it, and then distributing it to more people.   Those with a foreign born heritage, with frequent visitors from afar, are even more susceptible to introducing active viruses into some community setting or region.  

 

A possible reason these diseases are hard to predict today is that we pay little attention to this cultural aspect of its diffusion pattern.  The Cultural diversity of the U.S. population and its subregions is not researched well enough to determine where the most susceptible subpopulations reside.  This is because human privacy rights are working against us for this part of our prediction modelling routine.  

 

To be able to predict where a disease might first hit, the Big City region is an easy task.  To be able to predict where in might hit next, requires a totally different analytic approach.

 

The hierarchical nature of the local diffusion of measles in the New York Hudson valley appears to be linked to its cultural diversity and richess and density, in both urban to rural settings.  In the city of Beacon, NY, in the years 1917 +/- several years, the waves of  "visitors" from the city gave this settings its major outbreaks, producing 2/3rds of the cases for the total county.  This is not the case today however, for a similar reason.  There are certain culturally-related parallels that exist in 1917 and 2015, which have resulted in the several measles outbreaks noted in recent years.  Culture, not density, defined the most likely places for the next outbreaks to strike, in 1917 or 2012-15.    

 

From this county of Dutchess, this train continued north through Albany, and then out west to Buffalo and finally Niagara, next to the Canadian border.  

 

The next obvious questions to ask are:

 

Will the local valley behavior remain radial and diffuse evenly in the valley?

 

Will the passage of the train through Albany, Rochester and Buffalo areas have an impact on their measles patterns?

 

Will the ending of this travel at the Canadian border make it possible for the disease to cross international lines?  

 

And for each of these above three options, which are hierarchical and which are not?  

 

Which are dependent upon poverty, versus those more dependent upon culture?

 

Such is the use of these four key diffusion patterns I noted and speculated about above; they are all based upon the insights that Judson's maps can provide us with.

 

REFERENCES

 

My detailed coverage of Judson's map is at my personal blog site: http://brianaltonenmph.com/gis/historical-disease-maps/john-c-peters-and-the-asiatic-cholera/1873-a-b-judson-and-the-mississippi-river-valley/  ;

 

Edmund Charles Wendt's Treatise on Asiatic Cholera is available at Archives.org , at https://archive.org/details/treatiseonasiati00wend ;

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Dutchess County Department of Public Health Responds to Isolated Measles Case

Dutchess County Department of Public Health Responds to Isolated Measles Case | Medical GIS Guide | Scoop.it

Dutchess County Department of Public Health Responds to Isolated Measles Case.  This was also the case, nearly 100 years before . . . 

Brian Altonens insight:

A review of the measles flow in the Hudson valley in 1917 depicts events that relate to those of today.  In 1917, a measles epidemic struck this county, producing most of its victims in the southernmost urban center of beacon, followed by the culturally unique population in Rhinebeck, N.Y.  What is interesting here is how much the probability for a measles outbreak back then coincide with what is happening today, both for very similar human behavior and cultural reasons, not because of population density reasons.     

 

When I returned to my local materials on the local epidemics, my initial expectation was that since Poughkeepsie was the primary commercial / industrial city for this region for much of the 19th century, that this epidemic would take a logical migration route into this county focused very much upon urban population density features.  However, I immediately learned that such behavior was not the case back in 1917, when measles struck this county and managed to infect a total of 245 people (26.9 / 10,000, not age adjusted), two thirds of which were all in the city of Beacon (where I reside).  

 

[FYI background.  1917 Population  (Rate per 10,000):  Beacon - 10,165 (163.3);  Rhinebeck village 1580 (88.6);  Rhinebeck township - 1905 (57.7);   Fishkill - 2683 (33.5); Wappingers Falls twsp - 1524 (26.2);  Stanford - 1582 (25.3), Millerton Village - 890 (22.5);  Wappingers Village - 3742 (10.7); LaGrange - 1326 (7.5); Pine Plains - 1387 (7.2);  Poughkeepsie City - 32,714 (6.7); Poughkeepsie Twsp - 4937 (6.1) . . . Hyde Park - 3144 (3.2) . . .  ]  

   

 

So why these differences?   

 

The city of Beacon is the most frequently traveled destination for early 20th C New York City folk searching for a healthy climate and taking advantage of the retreat facilities established for their use within the local Hudson Highlands.  (It was after all the mountain cure, sanitation period, anti-tuberculosis era.)     

 

But more important, the largest urban setting, Poughkeepsie, did not rank second to Beacon in terms of Measles.  In fact, it had 1/30th the number of cases. (Was this due to great prevention work going on?)   

 

The second region for the largest number of cases of measles in the county 98 years ago was Rhinebeck, a village at the northern end of the county and just south of the current quarantine case.     

 

What makes Rhinebeck area stand out as a potential site, today as in back then, is its cultural heritage.   

 

Just three years ago, a foreign case came into this region by way of international travels, infecting a childcare facility just across the river in New Paltz.  New Paltz and Rhinebeck are both very "post-modern" in their ways of conceptualizing and practicing personal health care.  The variety of mindbody movements have their major followers in this region (the Omega Institute is a couple of miles away).  The New Paltz State University setting is, need I say, very much "progressive" and "post-modern" in how the community its complementary-alternative medical beliefs and faiths.     

 

Thus population density alone is not the prime indicator for how a disease can impact a region.  Cultural attributes play a very important role in the local disease diffusion process.  In Disneyland California, as in the Hudson Valley, international travel is a primary concern of local public health officials. Disney's case 0 is suspected to be from Mexico. The 2012 event was due to international travels.  The late 1980s cases of measles in Rhinebeck may also have this unique international feature to its history.  But one thing's for sure--the combined rural settings around Rhinebeck and the popular CAM and cultural "explorers" residing in this region make it an interesting region to research, especially when it comes to studying the interactions of Darwinian and Neo-Darwinian features with infectious disease behavior and diffusion.

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Doctor explains why he lets kids avoid the measles vaccine

Doctor explains why he lets kids avoid the measles vaccine | Medical GIS Guide | Scoop.it
Dr. Jay Gordon signs hundreds of "personal belief exemptions," allowing parents to bypass laws requiring vaccinations
Brian Altonens insight:

An important note to keep in mind is that we are responding faster to the Measles outbreak than we did to this Ebola outbreak.  Ebola took from April to June to get a reaction from any outside countries or agencies.  And from June through July to grab the attention of CDC and WHO.  It took the month of August for WHO to prepare and determine what to do, which they began in September.  

 

By the time October hit (I predicted October 15th), we saw mathematical hints suggesting that is wasn't rising as quickly as feared and may even be going down quite soon.  In late October I had confirmed it was descending and posted such for my own records.  In November, two weeks later, others realized it may not be rising as quickly as feared; my explanations for this were confirmed--normal ecological, climate and host-vector natural relationships kept the disease from progressing and impacting more people.  

 

Yellow Fever shows us that October is the most important spreading time for other countries.  Since it managed to stay mostly landbound (a few malingerers made their way to the US), we dodged the Ebola this time for a potential global pandemic impact. December and now January continue to show the decline is ecological cases, and a slower perpetuation of human ecology generated cases.  Hierarchical diffusion never left the country, so this disease as a pandemic issue is over (until the next ripe season for it's natural hosts returns).

 

Measles we know is a disease with a diffusion process that is highly human dependent, and impacted by seasons and climates only in terms of how  contacts between host or carrier and future victim become possible.

 

Apparently this was initiated by an individual crossing the Tex Mex or westward border and heading over the California for Disneyland.  This case is akin to the other issue we haven't heard much about in recent months--the in-migration of people across the Tex-Mex borders hoping to establish citizenship.  These people, teens, kids, are being lodged by US facilities, which resulted in some incriminating articles on the Obama plan for dealing with the migrating masses.  This migration pattern is a major public health concern, as I demonstrates with my maps on yellow fever, chiclero's ear, immunized disease outbreaks, immunizable disease pattern outbreaks from the past, my topographical central-south America disease pattern behaviors, the several new vectored disease patterns from the Americas that I mapped showing hot spots and migration routes through the great plains, and the peak in childhood prostitution my mapping identified at a twin city border of the Tex-Mex setting (teen age prostitution rings).   (How much more proof does the government really need?)

 

If we combine this doctor's attitudes with the other behaviors happening in California and Mexico, we see an interesting social pattern likely to allow this problem to continue for years to come.  The carrier migrates to the US with the infectious disease.  The PCP on the other side of the border doesn't keep his/her patients up to date in preventing an outbreak due to exposure to such individuals.  The current system fails to do much to control or put a halt to the unhealthy social practices now being engaged in between California and Mexico

 

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Articles to keep in mind:

 

Why Did Vaccinated People Get Measles at Disneyland? Blame the Unvaccinated.  BY KATIE M. PALMER 01.26.15.  http://www.wired.com/2015/01/vaccinated-people-get-measles-disneyland-blame-unvaccinated/

 

Six more measles cases reported in California after Disneyland outbreak.  BY DAN WHITCOMB.  LOS ANGELES Mon Jan 26, 2015.  http://www.reuters.com/article/2015/01/27/us-usa-measles-disneyland-idUSKBN0L002S20150127

 

Measles outbreak traced to Disneyland continues to grow.ByCARTER EVANSCBS NEWSJanuary 24, 2015, 9:55 PM.   [85 cases]   http://www.cbsnews.com/news/measles-outbreak-traced-to-disneyland-continues-to-grow/

 

6 More Measles Cases Confirmed In California After Disneyland Outbreak.  Reuters.  Posted: 01/26/2015 8:17 pm EST Updated: 01/27/2015 8:59 am  .  http://www.huffingtonpost.com/2015/01/27/more-measles-cases-disneyland_n_6551334.html

 

Measles Outbreak That Began at Disneyland Rises to 87 Cases in 7 States, Mexico.  POSTED 4:49 PM, JANUARY 26, 2015, BY LOS ANGELES TIMES, UPDATED AT 05:10PM, JANUARY 26, 2015.  http://ktla.com/2015/01/26/california-measles-outbreak-is-up-to-87-cases-in-7-states-mexico/

 

Anti-Vaxxers Fingered in Disney Measles Outbreak
Jack Dickey @jackdickey Jan. 24, 2015 . American Academy of Pediatrics makes statement.   http://time.com/3681398/disney-measles-outbreak/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+time%2Ftopstories+%28TIME%3A+Top+Stories%29

 

Disneyland Measles Outbreak Spreads Across Country
35,12313.  Stassa Edwards.  http://jezebel.com/disneyland-measles-outbreak-spreads-across-country-1681680847

 

Disneyland Measles Outbreak: Why One Mom Recommends Vaccination.  BY MAGGIE FOX AND TAHSIN HYDER.  http://www.nbcnews.com/health/health-news/disneyland-measles-outbreak-why-one-mom-recommends-vaccination-n292561

 

Disneyland measles outbreak leaves many anti-vaccination parents unmoved.  SUNDAY Jan. 25, 2015.  Andrew Gumbel.  http://www.theguardian.com/us-news/2015/jan/25/disneyland-measles-outbreak-anti-vaccination-parents

 

‘Completely avoidable’: Vaccination could have prevented Disneyland measles outbreak.  January 25, 2015 at 7:07 PM EST.  http://www.pbs.org/newshour/bb/completely-avoidable-vaccine-saved-victims-disneyland-measles-outbreak/

 

2 more Arizona measles cases tied to Disneyland
Connie Cone Sexton and Paulina Pineda, The Republic | azcentral.com 6:11 a.m. MST January 28, 2015.  http://www.azcentral.com/story/news/local/phoenix/2015/01/27/arizona-measles-outbreak-abrk/22422525/

 

 

 

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Coroner Investigates Death of Girl Who Refused Chemotherapy

Coroner Investigates Death of Girl Who Refused Chemotherapy | Medical GIS Guide | Scoop.it

I have posted a few pages on this topic over the last two years.    This is one of those cultural medicine topics practiced throughout the U.S.  The requirements for its nests or niduses are population density and of course the right religious background for the region.  The krigged map on the lower right depicts clusters where we'd expect them for the most part, except for the Utah-Colorado area.  Refusing medical care for religious reasons has a V-code which can be used to map this patient behavior.  

 

 

Brian Altonens insight:

Canadian First Nations policies are far more "allowing", "liberal", and/or sensitive and responsive to the rights of indigenous cultures, than the U.S. policies are. (Mi'kmaq and Inuit cases from 15-20 years ago serve as excellent examples.)  The nature of this article is therefore not as pointed as we might expect, had this event happened in the United States.    


From the article:      


"The death of an 11-year-old girl who sparked headlines after her family agreed to let her stop chemotherapy will be investigated by a local coroner. Makayla Sault, a member of the First Nations tribe in Canada, died after suffering a stroke on Sunday, according to a family statement. Makayla’s case grabbed headlines after, at the girl's request, she stopped chemotherapy treatment for her acute lymphoblastic leukemia in May. The move led to the family being investigated by a division of Canada's Children’s Aid Society, which ultimately allowed the family to continue to care for Makayla without requiring the chemotherapy treatments."

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Are you in the 14-year gap that was unreliable for measles vaccine?

Are you in the 14-year gap that was unreliable for measles vaccine? | Medical GIS Guide | Scoop.it
Disneyland is offering to test its employees for measles. The move comes after an outbreak of the disease was found to have originated from its theme park. But even if you've been vaccinated before, experts say there's a troubling 14-year period where people may not have been properly vaccinated. Ben Tracy reports.
Brian Altonens insight:

1957 to 1971 are the years when measles vaccinations are considered "unreliable".  Individuals born prior to 1957 will most likely have been exposed.  Those vaccinated after 1971 received more trustworthy vaccination products.     

 

It is now suspected that people born between 1957 and 1971, between 33 and 57 years of age, may be adding to the pool of people now considered susceptible to this measles outbreak.  In theory, we may soon be able to estimate the percentage of "failed or insufficient vaccinations" that took place from 1957 to 1971, assuming we have adequate records from that era.       

 

For now, this problem is just beginning.  October 2013 is when I first published my maps suggesting this would happen.  The national population health surveillance programs that exist currently are very inefficient, have limited access by other agencies and little predictive capacity or applicability, and are quite incapable of predicting this nation's public health security status.    

 

We are now more than ten years into our need for an efficient surveillance program(12+ years if you count 9-11 and the anti-terrorism movement into this).  This was possible when I asked about the by two agencies in Atlanta in 2005/6.  I see absolutely no legitimate reason for the lack of progress that has been made.

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