Einar Holm

MICROSIMULATION METHODS IN SPATIAL ANALYSIS AND PLANNING

Despite the significant potential afforded to model based geography by microsimulation methods they are still largely ignored by spatial analysts. In the worse case there is the possibility of the method being reinvented by different re- searchers independently. In this paper we attempt to describe the main features of the method and to briefly review some of the more important applications. We also speculate on some future developments of the methodology in the area of social and economic geography.

Economic-Demographic Effects of Immigration: Results from a Dynamic Spatial Microsimulation Model

Sweden has a liberal immigration policy compared to other developed countries. However, this policy has been reexamined in recent years. This article examines the economic-demographic effects of immigration using a dynamic spatial microsimulation model called SVERIGE (System for Visualizing Economic and Regional Influences Governing the Environment). It presents simulations that vary three key characteristics of immigration:(1) magnitude, (2) ethnicorigins, and (3) settlement characteristics. Outcome variables examined include immigration, emigration, births, population, migration, labor force participation, and average earnings. Preliminary and illustrative results suggest that large immigration flows can be accommodated by a country with modest economic-demographic effects. Also, the characteristics of immigrants, including initial settlement choice, affect outcomes in different ways.

Population-based simulations of influenza pandemics: validity and significance for public health policy

OBJECTIVE To examine the validity and usefulness of pandemic simulations aimed at informing practical decision-making in public health. METHODS We recruited a multidisciplinary group of nine experts to assess a case-study simulation of influenza transmission in a Swedish county. We used a non-statistical nominal group technique to generate evaluations of the plausibility, formal validity (verification) and predictive validity of the simulation. A health-effect assessment structure was used as a framework for data collection. FINDINGS The unpredictability of social order during disasters was not adequately addressed by simulation methods; even minor disruptions of the social order may invalidate key infrastructural assumptions underpinning current pandemic simulation models. Further, a direct relationship between model flexibility and computation time was noted. Consequently, simulation methods cannot, in practice, support integrated modifications of microbiological, epidemiological and spatial submodels or handle multiple parallel scenarios. CONCLUSION The combination of incomplete surveillance data and simulation methods that neglect social dynamics limits the ability of national public health agencies to provide policy-makers and the general public with the critical and timely information needed during a pandemic.

Multi-agent systems, time geography, and microsimulations

In this chapter we consider the role virtual conferencing has to play in realising a successful Inhabited Information Space (IIS). For any IIS to be successful it needs to weave together many different constituent elements and present these in a coherent and seamless manner. For example, Maher et al (2000) describe how many different components are used together to create a virtual design studio for architectural collaboration. For the IIS to function all the elements must work both individually and collectively. Communication is one of the basic building blocks for an IIS, and can be in many modes across many media. Approaches to virtual conferencing offer support for communication across a number of media and can be utilised in an IIS. These approaches are also starting to additionally offer support for collaboration. By providing an introduction to and overview of various possibilities for virtual conferencing we aim to show how these solutions can provide the required and appropriate support for communication and collaboration between inhabitants in a shared information space. Of course virtual conferencing solutions exist at many levels of sophistication and fidelity. Communication media can range from text through 3d graphics to video representations. The aim of this chapter is to present these many and varied possibilities, drawing on the experience of the author as well as insights into the past, present and future. In this way it is possible to see how diverse a range of IISes can make use of virtual conferencing functionality.

Performance of eHealth Data Sources in Local Influenza Surveillance:A 5-Year Open Cohort Study

Background There is abundant global interest in using syndromic data from population-wide health information systems—referred to as eHealth resources—to improve infectious disease surveillance. Recently, the necessity for these systems to achieve two potentially conflicting requirements has been emphasized. First, they must be evidence-based; second, they must be adjusted for the diversity of populations, lifestyles, and environments. Objective The primary objective was to examine correlations between data from Google Flu Trends (GFT), computer-supported telenursing centers, health service websites, and influenza case rates during seasonal and pandemic influenza outbreaks. The secondary objective was to investigate associations between eHealth data, media coverage, and the interaction between circulating influenza strain(s) and the age-related population immunity. Methods An open cohort design was used for a five-year study in a Swedish county (population 427,000). Syndromic eHealth data were collected from GFT, telenursing call centers, and local health service website visits at page level. Data on mass media coverage of influenza was collected from the major regional newspaper. The performance of eHealth data in surveillance was measured by correlation effect size and time lag to clinically diagnosed influenza cases. Results Local media coverage data and influenza case rates showed correlations with large effect sizes only for the influenza A (A) pH1N1 outbreak in 2009 (r=.74, 95% CI .42-.90; P<.001) and the severe seasonal A H3N2 outbreak in 2011-2012 (r=.79, 95% CI .42-.93; P=.001), with media coverage preceding case rates with one week. Correlations between GFT and influenza case data showed large effect sizes for all outbreaks, the largest being the seasonal A H3N2 outbreak in 2008-2009 (r=.96, 95% CI .88-.99; P<.001). The preceding time lag decreased from two weeks during the first outbreaks to one week from the 2009 A pH1N1 pandemic. Telenursing data and influenza case data showed correlations with large effect sizes for all outbreaks after the seasonal B and A H1 outbreak in 2007-2008, with a time lag decreasing from two weeks for the seasonal A H3N2 outbreak in 2008-2009 (r=.95, 95% CI .82-.98; P<.001) to none for the A p H1N1 outbreak in 2009 (r=.84, 95% CI .62-.94; P<.001). Large effect sizes were also observed between website visits and influenza case data. Conclusions Correlations between the eHealth data and influenza case rates in a Swedish county showed large effect sizes throughout a five-year period, while the time lag between signals in eHealth data and influenza rates changed. Further research is needed on analytic methods for adjusting eHealth surveillance systems to shifts in media coverage and to variations in age-group related immunity between virus strains. The results can be used to inform the development of alert-generating eHealth surveillance systems that can be subject for prospective evaluations in routine public health practice.

Age as a determinant for dissemination of seasonal and pandemic influenza : An open cohort study of influenza outbreaks in Östergötland County, Sweden

An understanding of the occurrence and comparative timing of influenza infections in different age groups is important for developing community response and disease control measures. This study uses data from a Scandinavian county (population 427.000) to investigate whether age was a determinant for being diagnosed with influenza 2005–2010 and to examine if age was associated with case timing during outbreaks. Aggregated demographic data were collected from Statistics Sweden, while influenza case data were collected from a county-wide electronic health record system. A logistic regression analysis was used to explore whether case risk was associated with age and outbreak. An analysis of variance was used to explore whether day for diagnosis was also associated to age and outbreak. The clinical case data were validated against case data from microbiological laboratories during one control year. The proportion of cases from the age groups 10–19 (p<0.001) and 20–29 years old (p<0.01) were found to be larger during the A pH1N1 outbreak in 2009 than during the seasonal outbreaks. An interaction between age and outbreak was observed (p<0.001) indicating a difference in age effects between circulating virus types; this interaction persisted for seasonal outbreaks only (p<0.001). The outbreaks also differed regarding when the age groups received their diagnosis (p<0.001). A post-hoc analysis showed a tendency for the young age groups, in particular the group 10–19 year olds, led outbreaks with influenza type A H1 circulating, while A H3N2 outbreaks displayed little variations in timing. The validation analysis showed a strong correlation (r = 0.625;p<0.001) between the recorded numbers of clinically and microbiologically defined influenza cases. Our findings demonstrate the complexity of age effects underlying the emergence of local influenza outbreaks. Disentangling these effects on the causal pathways will require an integrated information infrastructure for data collection and repeated studies of well-defined communities.

Requirements and design of the PROSPER protocol for implementation of information infrastructures supporting pandemic response: a Nominal Group study.

Background Advanced technical systems and analytic methods promise to provide policy makers with information to help them recognize the consequences of alternative courses of action during pandemics. Evaluations still show that response programs are insufficiently supported by information systems. This paper sets out to derive a protocol for implementation of integrated information infrastructures supporting regional and local pandemic response programs at the stage(s) when the outbreak no longer can be contained at its source. Methods Nominal group methods for reaching consensus on complex problems were used to transform requirements data obtained from international experts into an implementation protocol. The analysis was performed in a cyclical process in which the experts first individually provided input to working documents and then discussed them in conferences calls. Argument-based representation in design patterns was used to define the protocol at technical, system, and pandemic evidence levels. Results The Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER) outlines the implementation of information infrastructure aligned with pandemic response programs. The protocol covers analyses of the community at risk, the response processes, and response impacts. For each of these, the protocol outlines the implementation of a supporting information infrastructure in hierarchical patterns ranging from technical components and system functions to pandemic evidence production. Conclusions The PROSPER protocol provides guidelines for implementation of an information infrastructure for pandemic response programs both in settings where sophisticated health information systems already are used and in developing communities where there is limited access to financial and technical resources. The protocol is based on a generic health service model and its functions are adjusted for community-level analyses of outbreak detection and progress, and response program effectiveness. Scientifically grounded reporting principles need to be established for interpretation of information derived from outbreak detection algorithms and predictive modeling.

Intentions to Perform Non-Pharmaceutical Protective Behaviors during Influenza Outbreaks in Sweden: A Cross-Sectional Study following a Mass Vaccination Campaign

Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45–85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.

Contagious social practice

Abstract This paper explores the usefulness of spatial innovation diffusion theory for understanding the observed evolution of the social practice of attaining public support as a substitute for working. The empirical example chosen is sick leave. Several European countries have experienced a striking increase in costs for sick leave during the recent years, nowhere however as dramatic as in Sweden. Public costs for sick leave have doubled since 1997 while general health and life expectancy continually improve. No more than a small percentage of this change can be assigned to compositional changes in the population and labour market with respect to age, sex, education, location and sector of employment. Neither has economic benefit conditions changed substantially during this period. What essentially remain, as possible explanations, are changes in attitudes and practices among beneficiaries and physicians. One can observe substantial regional differences in the level of sick leave and apparent traces of spatial autocorrelation in the pattern. The spatial diffusion hypothesis was examined by help of a multivariate analysis based on socio‐economic panel data including sick leave benefits and location for each individual in the labour force 1996–2000. The analysis indicates that the neighbourhood effect is substantial on the local (290 municipalities) and the regional (21 counties) level. Largely, the regional diffusion effect remains when also controlling for more persistent average differences between counties. A semi‐public spatial attitude diffusion process, mainly operating at municipality and county levels, seems to be responsible for a substantial part of the observed increase in cost for sick leave in the period 1996–2000.

Interactions Between Forest Owners and Their Forests

More than half of the forest land in Europe is privately owned, and ownership structure is known to have implications for management, production of timber and other forest products and services that support the transformation towards a green economy. This chapter provides examples of how we can gain knowledge about the forest and forest owner/user relationship from a structural point of view. Sweden is taken as an example because of the accessibility of continuous data on forest conditions, ownership and demographic data. It is concluded that the pace of change in ownership structure and forest management behaviour is slow. Further, neither the ongoing migration, urbanisation, ageing population nor the increased proportion of women seems to reduce the willingness to manage and harvest.