Asbjørn Aase

Gender, geography and socio-economic status in the diffusion of malignant melanoma risk.

Malignant melanoma is the cancer that has shown the fastest increase in incidence in most white populations in recent decades. This paper studies the diffusion of the disease for males and females, geographical areas and socio-economic groups. Incidence data from the Norwegian Cancer Registry covering the period 1955-1989 make it possible to establish birth cohorts covering a time span from the late 1880s to the late 1950s. For Norway as a whole the increase in incidence was apparent between cohorts born in the 1880s and the 1890s for both sexes. The epidemic was first observable in the most central, south-eastern part of the country, with the onset reaching the most peripheral Northern Norway from the cohort born in the late 1910s. The onset also came later in rural than urban Norway. There are indications that the epidemic started in the more affluent part of the population, followed by an equalization. The increase in melanoma could be a result of more active outdoor recreation from the end of the last century. In cohorts born from the 1930s onwards a slowing down in the increase can be observed. International comparisons show that in most countries the incidence pattern in the first decades of the epidemic was dominated by males; later on the incidence became higher for females. Many cancer registries in the U.S.A. and Oceania now show a downward trend in melanoma incidence for males and females aged 15-29 years. A similar development has not been observed in Europe and Canada up to 1983-1987.

The diffusion of cardiovascular disease in the Norwegian farming community: A comnination of morbidity and mortality data

This article analyses an observed increase in cardiovascular morbidity among male farmers in Norway during the last decade in the light of the traditionally low mortality in farmers. Three hypotheses to explain the increases in CVD morbidity are tested, of which one, stating that there is a time lag in the spread of risk factors, proves to be most fruitful. Mortality data for agricultural communities show no increase in overall CVD rates, but when age-specific rates are analysed, an increase in the younger age groups emerges, especially for ischaemic heart disease. If this process continues, farmers and farming areas may change from low to high mortality, relatively speaking. It is argued that this change is due to a time lag in two waves, first an increase in risk factors such as smoking, more fatty diets and less physically demanding work, then improved lifestyles due to a better perception of risk factors. Both waves may be affecting rural areas later than the urban centres. Knowledge of such geographical and socio-economic diffusion processes is important in the planning and implementation of prevention programmes.

Regionalizing mortality data: ischaemic heart disease in Norway.

The way regions are delimited has a bearing on the geographical patterns and time trends which emerge from cause specific mortality analysis. Whenever possible, alternative regionalizations should be used to explore the full information potential of the data. For statistical reasons, the size of the regional units (populations-at-risk) should be selected according to the frequency of the cause of death, number of years in the time period, etc. A geographical mortality information system for Norway, based on individual death records and with quick and flexible retrieval options is described. As a demonstration, geographical time trends in ischaemic heart disease from 1970 to 1985 are studied, using different schemes of regionalization. A clear tendency towards regional convergence appears in the rural-urban dimension, but there is no convergence between the five subnational regions of the country. There is no evidence that counties which have received heart disease intervention projects fare any better than those which have not, but here a more thorough analysis is recommended. Within the intervention counties, there are large variations both in mortality levels and trends.

Delays in TB hospital diagnosis – a major threat for the HIV/AIDS situation in a society: A study of TB as an opportunistic infection in southern Malawi

Abstract HIV/AIDS and TB cases in Malawi have been increasing simultaneously since the first case of HIV/AIDS was reported in 1985. Cure rates for TB treatment are rated good in Malawian hospitals but TB suspects delay going to hospital for diagnosis. This study aims at exploring the reasons why the TB suspects delay or are unwilling to go for hospital diagnosis and thus for effective treatment. A comparative study was undertaken in Zomba and Mangochi Districts in Southern Malawi using methodological pluralism during data collection and analysis. Results show that the main reasons for hospital delay were: TB stigma due to HIV/AIDS prevalence, lack of TB knowledge, geographical factors (climate, accessibility, occupations, and culture), and use of traditional healers to treat TB. Zomba people delayed more despite having higher educational levels than those in Mangochi. Gender and marital status had a significant impact in delaying TB suspects in Mangochi but not in Zomba. The study concludes that differences between places and socio-cultural groups need to be considered in studies of diseases such as the TB/HIV epidemic and taken into account for intervention to be effective. Furthermore, close collaboration between TB/HIV experts and traditional healers is recommended.

HIV/AIDS in sub-Saharan Africa: Geographical perspectives

Abstract

The Geography of Malignant Melanoma in the Nordic Countries: The Implications of Stratospheric Ozone Depletion

Malignant melanoma is a disease for which exposure to ultraviolet radiation in sunlight is probably an important risk factor. The high latitudes and low intensity of UV radiation in the Nordic countries might therefore be expected to produce a low risk. However, this is not the case with the Nordic countries having amongst the highest rates in Europe and a sustained increase over time. Concern has been heightened by the prospects of increased exposure to UV as a result of stratospheric ozone depletion which is expected to be greatest at high latitudes. This study analyses the geographical pattern of melanoma incidence within Scandinavia using data for counties from the Nordic Cancer Atlas. Regression analysis shows that differences in levels of affluence (and associated patterns of behaviour) account for some of the geographical variations in melanoma risk. Significant national differences in risk are also revealed, possibly as a result of genetically determined differences in susceptibility to exposure to UV. However, it is shown that variations in estimated local levels of UV flux are the dominant influence on the geographical pattern of melanoma incidence within Scandinavia. It can therefore be expected that an increase in UV levels as a result of stratospheric ozone depletion will lead to an increase in melanoma. From the regression model it is estimated that a 10% increase in UV would be associated with a 13.7% increase in melanoma. This means that any major depletion of ozone could dramatically worsen the melanoma epidemic in the Nordic countries.

Towards a methodology for regional welfare planning

If welfare research is to serve as a useful tool for regional welfare planning, a series of methodological developments is necessary. Means and ends in planning must be more closely related by bridging the gap between wellbeing research and welfare state research. Welfare research and planning must have a dual orientation towards growth and distribution and, consequently, address issues of production as well as allocation. Current political reforms are paving the way for local goal-oriented, intersectorial, welfare planning. The renewed interest in place and regional synthesis in geography can be helpful for developing planning strategies. As a demonstration, a model for health planning at the local level is shown.

Noen tendenser og problemer i dagens samfunnsgeografi

Aase, A. 1970. Geography and Society. Norsk geogr. Tidsskr. 24, 1-21. Samfunnsgeografi (samfunn = society) is a recent concept in the Scandinavian languages. It is not distinct from kulturgeografi but signifies the orientation toward general social science methods and planning problems. The article is concerned with trends and problems which the author finds important when describing the present state of this discipline.

Studies in medical geography. An introduction to this issue of the Norwegian Journal of Geography

This introduction provides a background to the works appearing in the present issue and an overview of the articles.

Exploring cancer patterns in Norway through cluster analysis

Cluster analysis may be applied to group different diseases based on similarities in their geographical distributions as well as to group different areal units based on their disease ‘profiles’. In this study both approaches are being demonstrated using mortality data for different types of cancer for the period 1966–1987. Results from the use of different options in the SPSS/PC program are compared. Two alternative regionalizations are used, counties and rural-urban dichotomies of counties. In southern Norway rural and urban areas respectively tend to cluster with similar areas in neighbouring counties, whereas in northern Norway disease regions are formed through clustering of urban and rural areas within the same county.