Geography, Department of

Receive updates for this collection

Pedestrian Injury and the Built Environment: An Environmental Scan of Hotspots

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009
Abstract: 

Background: Pedestrian injury frequently results in devastating and costly injuries and accountsfor 11% of all road user fatalities. In the United States in 2006 there were 4,784 fatalities and 61,000injuries from pedestrian injury, and in 2007 there were 4,654 fatalities and 70,000 injuries. InCanada, injury is the leading cause of death for those under 45 years of age and the fourth mostcommon cause of death for all ages Traumatic pedestrian injury results in nearly 4000hospitalizations in Canada annually. These injuries result from the interplay of modifiableenvironmental factors. The objective of this study was to determine links between the builtenvironment and pedestrian injury hotspots in Vancouver.Methods: Data were obtained from the Insurance Corporation of British Columbia (ICBC) forthe 6 year period from 2000 to 2005 and combined with pedestrian injury data extracted from theBritish Columbia Trauma Registry (BCTR) for the same period. High incident locations (hotspots)for pedestrian injury in the City of Vancouver were identified and mapped using geographicinformation systems (GIS), and the characteristics of the built environment at each of the hotspotlocations were examined by a team of researchers.Results: The analysis highlighted 32 pedestrian injury hotspot locations in Vancouver. 31 of 32hotspots were situated on major roads. Likewise, the majority of hotspots were located ondowntown streets. The 'downtown eastside' was identified as an area with multiple high-incidentlocations, including the 2 highest ranked pedestrian injury hotspots. Bars were present at 21 of thehotspot locations, with 11 of these locations being judged to have high alcohol establishmentdensity.Conclusion: This study highlighted the disproportionate burden of pedestrian injury centred onthe downtown eastside area of Vancouver. The environmental scan revealed that important passivepedestrian safety countermeasures were only present at a minority of high-incident locations. Moreimportantly, bars were highly associated with risk of pedestrian injury. This study is the basis forpotential public health intervention by clearly indicating optimal locations for signalized pedestriancrosswalks.

Document type: 
Article

Modelling Optimal Location for Pre-Hospital Helicopter Emergency Medical Services

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009
Abstract: 

Background: Increasing the range and scope of early activation/auto launch helicopter emergencymedical services (HEMS) may alleviate unnecessary injury mortality that disproportionately affectsrural populations. To date, attempts to develop a quantitative framework for the optimal locationof HEMS facilities have been absent.Methods: Our analysis used five years of critical care data from tertiary health care facilities, spatialdata on origin of transport and accurate road travel time catchments for tertiary centres. Alocation optimization model was developed to identify where the expansion of HEMS would coverthe greatest population among those currently underserved. The protocol was developed usinggeographic information systems (GIS) to measure populations, distances and accessibility toservices.Results: Our model determined Royal Inland Hospital (RIH) was the optimal site for an expandedHEMS – based on denominator population, distance to services and historical usage patterns.Conclusion: GIS based protocols for location of emergency medical resources can providesupportive evidence for allocation decisions – especially when resources are limited. In this study,we were able to demonstrate conclusively that a logical choice exists for location of additionalHEMS. This protocol could be extended to location analysis for other emergency and healthservices.

Document type: 
Article

An Agent-Based Approach for Modeling Dynamics of Contagious Disease Spread

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009
Abstract: 

Background: The propagation of communicable diseases through a population is an inherentspatial and temporal process of great importance for modern society. For this reason a spatiallyexplicit epidemiologic model of infectious disease is proposed for a greater understanding of thedisease's spatial diffusion through a network of human contacts.Objective: The objective of this study is to develop an agent-based modelling approach theintegrates geographic information systems (GIS) to simulate the spread of a communicable diseasein an urban environment, as a result of individuals' interactions in a geospatial context.Methods: The methodology for simulating spatiotemporal dynamics of communicable diseasepropagation is presented and the model is implemented using measles outbreak in an urbanenvironment as a case study. Individuals in a closed population are explicitly represented by agentsassociated to places where they interact with other agents. They are endowed with mobility,through a transportation network allowing them to move between places within the urbanenvironment, in order to represent the spatial heterogeneity and the complexity involved ininfectious diseases diffusion. The model is implemented on georeferenced land use dataset fromMetro Vancouver and makes use of census data sets from Statistics Canada for the municipality ofBurnaby, BC, Canada study site.Results: The results provide insights into the application of the model to calculate ratios ofsusceptible/infected in specific time frames and urban environments, due to its ability to depict thedisease progression based on individuals' interactions. It is demonstrated that the dynamic spatialinteractions within the population lead to high numbers of exposed individuals who performstationary activities in areas after they have finished commuting. As a result, the sick individuals areconcentrated in geographical locations like schools and universities.Conclusion: The GIS-agent based model designed for this study can be easily customized to studythe disease spread dynamics of any other communicable disease by simply adjusting the modeleddisease timeline and/or the infection model and modifying the transmission process. This type ofsimulations can help to improve comprehension of disease spread dynamics and to take bettersteps towards the prevention and control of an epidemic outbreak.

Document type: 
Article

Risk Communication and Informed Consent in the Medical Tourism Industry: A Thematic Content Analysis of Canadian Broker Websites

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2011
Abstract: 

Background:

Medical tourism, thought of as patients seeking non-emergency medical care outside of their homecountries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and manyare helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in makinginternational medical care arrangements for patients. As a key source of information for these patients, brokers arelikely to play an important role in communicating the risks and benefits of undergoing surgery or other proceduresabroad to their clientele. This raises important ethical concerns regarding processes such as informed consent andthe liability of brokers in the event that complications arise from procedures. The purpose of this article is toexamine the language, information, and online marketing of Canadian medical tourism brokers’ websites in light ofsuch ethical concerns.

Methods:

An exhaustive online search using multiple search engines and keywords was performed to compile acomprehensive directory of English-language Canadian medical tourism brokerage websites. These websites wereexamined using thematic content analysis, which included identifying informational themes, generating frequencycounts of these themes, and comparing trends in these counts to the established literature.

Results:

Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourismbroker websites varied widely in scope, content, professionalism and depth of information. Three themes emergedfrom the thematic content analysis: training and accreditation, risk communication, and business dimensions. Thirdparty accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, anddiscussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on theremaining ones. Terminology describing brokers’ roles was somewhat inconsistent across the websites. Finally,brokers’ roles in follow up care, their prices, and the speed of surgery were the most commonly included businessdimensions on the reviewed websites.

Conclusion:

Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implicationsfor the informed consent and consequent safety of Canadian medical tourists.

Document type: 
Article

Assessing the Influence of the Built Environment on Physical Activity for Utility and Recreation in Suburban Metro Vancouver

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2011
Abstract: 

Background:

Physical inactivity and associated co-morbidities such as obesity and cardiovascular disease areestimated to have large societal costs. There is increasing interest in examining the role of the built environment inshaping patterns of physical activity. However, few studies have: (1) simultaneously examined physical activity forleisure and utility; (2) selected study areas with a range of built environment characteristics; and (3) assessed thebuilt environment using high-resolution land use data.

Methods:

Data on individuals used for this study are from a survey of 1602 adults in selected sites acrosssuburban Metro Vancouver. Four types of physical activity were assessed: walking to work/school, walking forerrands, walking for leisure and moderate physical activity for exercise. The built environment was assessed byconstructing one-kilometre road network buffers around each respondent’s postal code. Measures of the builtenvironment include terciles of recreational and park land, residential land, institutional land, commercial land andland use mix.

Results:

Logistic regression analyses showed that walking to work/school and moderate physical activity were notassociated with any built environment measure. Living in areas with lower land use mix, lower commercial andlower recreational land increased the odds of low levels of walking for errands. Individuals living in the lower thirdof land use mix and institutional land were more likely to report low levels of walking for leisure.

Conclusions:

These results suggest that walking for errands and leisure have a greater association with the builtenvironment than other dimensions of physical activity.

Document type: 
Article

Comparing Circular and Network Buffers to Examine the Influence of Land Use on Walking for Leisure and Errands

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2007
Abstract: 

Background: There is increasing interest in examining the influence of the built environment onphysical activity. High-resolution data in a geographic information system is increasingly being usedto measure salient aspects of the built environment and studies often use circular or road networkbuffers to measure land use around an individual's home address. However, little research hasexamined the extent to which the selection of circular or road network buffers influences theresults of analysis.The objective of this study is to examine the influence of land use type (residential, commercial,recreational and park land and institutional land) on 'walking for leisure' and 'walking for errands'using 1 km circular and line-based road network buffers. Data on individual walking patterns isobtained from a survey of 1311 respondents in greater Vancouver and respondent's postal codecentroids were used to construct the individual buffers. Logistic regression was used for statisticalanalysis.Results: Using line-based road network buffers, increasing proportion of institutional landsignificantly reduced the odds of 'walking for leisure 15 minutes or less per day' no significant resultswere found for circular buffers. A greater proportion of residential land significantly increased theodds of 'walking for errands less than 1 hour per week' for line-based road network buffer whileno significant results for circular buffers. An increased proportion of commercial land significantlydecreased the odds of 'walking for errands less than 1 hour per week' for both circular and linebasedroad network buffers.Conclusion: The selection of network or circular buffers has a considerable influence on theresults of analysis. Land use characteristics generally show greater associations with walking usingline-based road network buffers than circular buffers. These results show that researchers need tocarefully consider the most appropriate buffer with which to calculate land use characteristics.

Document type: 
Article

Effects of Neighbourhood Income on Reported Body Mass Index: An Eight Year Longitudinal Study of Canadian Children

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background:

This study investigates the effects of neighbourhood income on children's BodyMass Index (BMI) from childhood (ages 2–3) to early adolescence (ages 10–11) using longitudinaldata.

Methods:

Five cycles of data from the Canadian National Longitudinal Survey of Children andYouth are analyzed for a sub-sample of children (n = 2152) aged 2–3 at baseline (1994) and assessedat two year intervals to 2002. Body mass index percentiles are based on height/weight estimatesreported by proxy respondents (child's person most knowledgeable). Family and neighbourhoodfactors were assessed at baseline. The prevalence of neighbourhood low income was obtained fromthe 1996 Census and divided into three categories from 'most poor' to 'least poor'. Longitudinalmodelling techniques were applied to the data.

Results:

After controlling for individual/family factors (age, sex, income, education, familystructure) living in the 'most poor' neighbourhood was associated with increasing BMI percentile(1.46, 95% CI 0.16 to 2.75) over time compared to a 'middle' income neighbourhood. Living in anurban (vs. rural) neighbourhood was associated with a decreased BMI percentile (-3.57, 95% CI -6.38 to -0.76) across all time periods.

Conclusion:

These findings provide evidence that effects of neighbourhood disadvantage onchildren's BMI occur between childhood and early adolescence and suggest that policies shouldtarget the conditions of childhood, including the neighbourhood environment.

Document type: 
Article

What is Known about the Effects of Medical Tourism in Destination and Departure Countries? A Scoping Review.

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010
Abstract: 

Background:

Medical tourism involves patients intentionally leaving their home country to access non-emergencyhealth care services abroad. Growth in the popularity of this practice has resulted in a significant amount ofattention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort tosystematically synthesize what is known about the effects of this phenomenon. This article presents the findings ofa scoping review examining what is known about the effects of medical tourism in destination and departurecountries.

Methods:

Drawing on academic articles, grey literature, and media sources extracted from18 databases, we followa widely used scoping review protocol to synthesize what is known about the effects of medical tourism indestination and departure countries. The review design has three main stages: (1) identifying the question andrelevant literature; (2) selecting the literature; and (3) charting, collating, and summarizing the data.

Results:

The large majority of the 203 sources accepted into the review offer a perspective of medical tourismfrom the Global North, focusing on the flow of patients from high income nations to lower and middle incomecountries. This greatly shapes any discussion of the effects of medical tourism on destination and departurecountries. Five interrelated themes that characterize existing discussion of the effects of this practice were extractedfrom the reviewed sources. These themes frame medical tourism as a: (1) user of public resources; (2) solution tohealth system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity. It isobserved that what is currently known about the effects of medical tourism is minimal, unreliable, geographicallyrestricted and mostly based on speculation.

Conclusions:

Given its positive and negative effects on the health care systems of departure and destinationcountries, medical tourism is a highly significant and contested phenomenon. This is especially true given itspotential to serve as a powerful force for the inequitable delivery of health care services globally. It isrecommended that empirical evidence and other data associated with medical tourism be subjected to clear andcoherent definitions, including reports focused on the flows of medical tourists and surgery success rates.Additional primary research on the effects of medical tourism is needed if the industry is to develop in a mannerthat is beneficial to citizens of both departure and destination countries.

Document type: 
Article

An Industry Perspective on Canadian Patients' Involvement in Medical Tourism: Implications for Public Health

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2011
Abstract: 

Background:

The medical tourism industry, which assists patients with accessing non-emergency medical careabroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to createpolicy, health system, and public health responses to address the associated risks and shortcomings, such as spreadof infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzinginterviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients’involvement in medical tourism and the implications of this involvement for public health.

Methods:

Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on businessdimensions, information exchange, medical tourists’ decision-making, and facilitators’ roles in medical tourism.Thematic analysis was undertaken following data collection.Results: Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number ofclients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical touristsaged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriersincluding affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to usefacilitators’ services were thought to be interested in saving money or have cultural/familial connections to thedestination country. Canadian doctors were commonly identified as barriers to securing clients.

Conclusions:

No effective Canadian public health response to medical tourism can treat medical tourists as aunified group with similar motivations for engaging in medical tourism and choosing similar mechanisms fordoing so. This situation may be echoed in other countries with patients seeking care abroad. Therefore, a call for acomprehensive public health response to medical tourism and its effects should be coupled with a clearunderstanding that medical tourism is a highly diverse practice. This response must also acknowledge facilitators asimportant stakeholders in medical tourism.

Document type: 
Article

Interpreting the Results of a Modified Gravity Model: Examining Access to Primary Health Care Physicians in Five Canadian Provinces and Territories

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2012
Abstract: 

Primary health care (PHC) encompasses an array of health and social services that focus onpreventative, diagnostic, and basic care measures to maintain wellbeing and address illnesses.In Canada, PHC involves the provision of first-contact health care services by providers suchas family physicians and general practitioners – collectively referred as PHC physicians here.Ensuring access is a key requirement of effective PHC delivery. This is because havingaccess to PHC has been shown to positively impact a number of health outcomes.MethodsWe build on recent innovations in measuring potential spatial access to PHC physicians usinggeographic information systems (GIS) by running and then interpreting the findings of amodified gravity model. Elsewhere we have introduced the protocol for this model. In thisarticle we run it for five selected Canadian provinces and territories. Our objectives are topresent the results of the modified gravity model in order to: (1) understand how potentialspatial access to PHC physicians can be interpreted in these Canadian jurisdictions, and (2)provide guidance regarding how findings of the modified gravity model should be interpretedin other analyses.ResultsRegarding the first objective, two distinct spatial patterns emerge regarding potential spatialaccess to PHC physicians in the five selected Canadian provinces: (1) a clear north–southpattern, where southern areas have greater potential spatial access than northern areas; and (2)while gradients of potential spatial access exist in and around urban areas, access outside ofdensely-to-moderately populated areas is fairly binary. Regarding the second objective, weidentify three principles that others can use to interpret the findings of the modified gravitymodel when used in other research contexts.

Document type: 
Article