One Arctic - One Health

One Health takes a multidisciplinary approach to health risks and risk mitigation for humans, animals, plants and the environment, with the understanding that human health welfare is dependent on ecosystem health. The U.S. and Canada started the One Health project under the Sustainable Development Working Group (SDWG) of the Arctic Council in 2015, Finland joined the project as a colead in 2017. This report is a summary of the Finnish activities and achievements in the One Arctic - One Health project during the Finnish Chairmanship of the Arctic Council. The main actions included the One Arctic - One Health conference in Oulu, establishment of the TremArctic network, and two published Systematic Review papers and two manuscripts. There were also joint sessions and presentations in scientific conferences, seminars and workshops, and joint meetings and collaboration with the other Arctic Council Working Groups, the University of the Arctic, other organisations, and scientific projects. The report concludes with some updated proposals for further work, based on previous works and reflecting progress over the past two years. The Finnish One Arctic - One Health team consisted of scientists from the University of Oulu, National Institute for Health and Welfare (THL), University of Helsinki and the Finnish Food Authority. This work was supported by the grant of the Ministry for Foreign Affairs of Finland.Yhteisen terveyden (One Health) perusajatus on, että ihmisten, eläinten, kasvien ja ympäristön terveys on toisistaan riippuvaista, ainakin niin, että sairaassa ympäristössä ei ihminenkään voi olla hyvinvoiva. Yhdysvaltain johtaessa puhetta Arktisessa neuvostossa, USA ja Kanada aloittivat kestävän kehityksen työryhmän (SDWG) alaisuudessa One Health -hankkeen, jonka johtoon Suomi liittyi toimiessaan Arktisen neuvoston puheenjohtajana 2017-2019. Tämä raportti on yhteenveto Suomen toimista ja saavutuksista puheenjohtajakaudellaan. Tärkeimmät toimet olivat One Arctic - One Health -konferenssi Oulussa, TremArctic-verkoston toiminnan aloittaminen, kaksi julkaistua laajaa systemaattista katsausta ja kaksi käsikirjoitusta. Lisäksi Suomen työryhmä osallistui tieteellisiin konferensseihin, seminaareihin ja työpajoihin, sekä yhteisiin kokouksiin ja muuhun yhteistyöhön Arktisen neuvoston muiden työryhmien kanssa. Raportti sisältää myös päivitettyjä jatkotoimenpide-ehdotuksia, jotka perustuvat aikaisempaan työhön ja viimeisten kahden vuoden aikana tapahtuneeseen kehitykseen. Suomen Yksi Arktis – yhteinen terveys -työryhmä koostui asiantuntijoista Oulun yliopistosta, Terveyden ja hyvinvoinnin laitoksesta, Helsingin yliopistosta ja Ruokavirastosta. Hanketta rahoitti Suomen ulkoministeriö.Grundprincipen till One Health -tänkandet är att människohälsa, djurhälsa, planthälsa och ekosystemhälsa är nära besläktade. I alla fall så att människans välfärd kräver frisk natur. Under det amerikanska ordförandeskapet i Arktiska rådet inledde USA och Kanada One Health -projektet i regi av arbetsgruppen för hållbar utveckling (Sustainable Development Working Group, SDWG). Finland gick med i ledningen av projektet under Finland ordförandeskap 2017-2019. Denna rapport är en sammanfattning av finska åtgärder och resultat under Finlands ordförandeskap. De mest viktiga handlingarna var arrangerandet av One Arctic - One Health – konferensen i Uleåborg, startandet av TremArctic-nätverket, publiceringen av två systematiska litteraturöversikter och produceringen av två vetenskapliga manuskript. I tillägg deltog den finska arbetsgruppen i vetenskapliga konferenser, seminar och verkstäder med gemensamma sessioner och presentationer. Vidare hade man gemensamma möter samt annat samarbete med andra arbetsgrupper under Arktiska rådet. Rapporten innehåller också uppdaterade förslag till för ytterligare åtgärder baserade på tidigare arbeten och utvecklingen under Finland ordförandeskap. Finlands One Arctic – One Health - arbetsgrupp bestod av forskare från Uleåborgs universitet, Institutet för hälsa och välfärd, Helsingfors universitet, samt Livsmedelsverket. Projektet fick finansiering från det finska utrikesministeriet

Exploring crime in Toronto, Ontario with applications for law enforcement planning: Geographic analysis of hot spots and risk factors for expressive and acquisitive crimes

This thesis explores crime hot spots and identifies risk factors of expressive and acquisitive crimes in Toronto, Ontario at the census tract scale using official crime offence data from 2006. Four research objectives motivate this thesis: 1) to understand a number of local spatial cluster detection tests and how they can be applied to inform law enforcement planning and confirmatory research, 2) explore spatial regression techniques and applications in past spatial studies of crime, 3) to examine the influence of social disorganization and non-residential land use on expressive crime at the census tract scale, and 4) integrate social disorganization and routine activity theories to understand the small-area risk factors of acquisitive crimes. Research chapters are thematically linked by an intent to recognize crime as a spatial phenomenon, provide insight into the processes and risk factors associated with crime, and inform efficient and effective law enforcement planning

Characterizing the Information Needs of Rural Healthcare Practitioners with Language Agnostic Automated Text Analysis

Objectives – Previous research has characterized urban healthcare providers\u27 information needs, using various qualitative methods. However, little is known about the needs of rural primary care practitioners in Brazil. Communication exchanged during tele-consultations presents a unique data source for the study of these information needs. In this study, I characterize rural healthcare providers\u27 information needs expressed electronically, using automated methods. Methods – I applied automated methods to categorize messages obtained from the telehealth system from two regions in Brazil. A subset of these messages, annotated with top-level categories in the DeCS terminology (the regional equivalent of MeSH), was used to train text categorization models, which were then applied to a larger, unannotated data set. On account of their more granular nature, I focused on answers provided to the queries sent by rural healthcare providers. I studied these answers, as surrogates for the information needs they met. Message representations were generated using methods of distributional semantics, permitting the application of k-Nearest Neighbor classification for category assignment. The resulting category assignments were analyzed to determine differences across regions, and healthcare providers. Results – Analysis of the assigned categories revealed differences in information needs across regions, corresponding to known differences in the distributions of diseases and tele-consultant expertise across these regions. Furthermore, information needs of rural nurses were observed to be different from those documented in qualitative studies of their urban counterparts, and the distribution of expressed information needs categories differed across types of providers (e.g. nurses vs. physicians). Discussion – The automated analysis of large amounts of digitally-captured tele-consultation data suggests that rural healthcare providers\u27 information needs in Brazil are different than those of their urban counterparts in developed countries. The observed disparities in information needs correspond to known differences in the distribution of illness and expertise in these regions, supporting the applicability of my methods in this context. In addition, these methods have the potential to mediate near real-time monitoring of information needs, without imposing a direct burden upon healthcare providers. Potential applications include automated delivery of needed information at the point of care, needs-based deployment of tele-consultation resources and syndromic surveillance. Conclusion – I used automated text categorization methods to assess the information needs expressed at the point of care in rural Brazil. My findings reveal differences in information needs across regions, and across practitioner types, demonstrating the utility of these methods and data as a means to characterize information needs

Water security in the rural North: responding to change, engineering perspectives, and community focused solutions

Thesis (Ph.D.) University of Alaska Fairbanks, 2016This project explores the capacity of rural communities to manage their water resources in a changing climate, environment and society. Using water resources as a lens through which to evaluate the effects of social and environmental changes on Alaska’s rural communities, and working from conversations with key community members including city planners and infrastructure operators, this research develops theoretical frameworks for increasing community capacity. The prospect of developing community capacity, and more specifically water resources management capacity, in order to respond to societal and climatic change is a present concern for rural communities, and is becoming increasingly so in today’s fiscally challenged environment. Many rural water managers in Alaska are challenged by aging systems designed and built over 20 years ago, and are now operating well beyond their design life. While the configuration of existing systems varies across Alaska, a common suite of problems exists; regular breakdowns, failure to achieve regulatory standards, wide variability of raw water quality, low payment rates, and historically high electricity and fuel prices. These systems are also operating during a period of historically high deficit between community needs and available grant funding at both a State and Federal level. Existing theoretical frameworks for exploring the impacts of change on regional water security (i.e. resilience and vulnerability) are informative heuristics for triage of impacts at the individual community level. Presently, however, there is little consideration given to water security solutions that do not involve the construction of a new system. This research proposes that the focus upon “new system solutions” limits available solutions for improving security at both the local and regional levels. Further this research seeks to understand the extent to which “new utility solutions” create additional capacity at both the community and regional level to respond to change. At the core of this work are informal interviews and participant observation research in 11 coastal communities in Bristol Bay and Northwest Arctic regions of Alaska.Introduction -- Chapter 1: Seasons of stress: understanding the dynamic nature of people’s ability to respond to change and surprise -- Chapter 2: Diagnosing water security in the rural North with an environmental security framework -- Chapter 3: Stop Trying to Fix Rurality, and Start Designing for it: Challenging the Complexity of Rural Water Infrastructure in the North -- Conclusions -- Appendix

Worldwide variations in sex ratio of cancer incidence : temporal and geographic patterns

Contexte: Les comparaisons internationales de taux d’incidence du cancer sont des sources importantes d’éléments pouvant aider à générer des hypothèses en lien à l’étiologie du cancer. Les estimations de la variation géographique de l’incidence de cancer peuvent être compromises par des artefacts tels que l’inexactitude et le manque de données complètes portant sur l’incidence du cancer, parmi plusieurs autres. Ces artefacts associés aux taux d’incidence pourront mener à des erreurs au niveau de l’interprétation et de la comparaison des tendances à travers les registres de cancers. Le ratio des sexes (défini comme le rapport du taux d’incidence de cancer masculin divisé par le taux d'incidence féminin) est une mesure qui pourra être moins susceptible d’avoir des ambiguïtés d’interprétation suite à de tels artefacts, dans la mesure où la mesure des cas de cancer est similaire chez les hommes et les femmes. Objectifs: L'objectif principal de cette étude sera donc de conclure quand aux causes qui pourront générer la variabilité dans le ratio des sexes pour des types de cancers spécifiques, à travers temps et lieu, en générant des hypothèses. L’objectif secondaire sera d’explorer la mesure dans laquelle les inégalités de genre entre les pays peuvent fournir des indices sur la qualité des registres de cancer pour les types de cancer sélectionnés, à l'aide du rapport des sexes. Méthodes: L’incidence du cancer dans cinq continents (CI-5), une base de données de registres populationnels de cancer obtenue du Centre international de recherche sur le cancer (CIRC) de l’Organisation mondiale de la santé (OMS), a été utilisée afin d'accéder aux données d’incidence de 30 différents cancers durant 3 périodes de temps (c'est-à-dire 1974-77, 1988-92 et 2003-07) provenant de 77, 142 et 281 registres sur le cancer. Des méthodes descriptives ont été utilisées, soit des modèles à effets mixtes, pour l’étude des tendances temporelles et des variations géographiques au niveau du ratio des sexes. Afin d’explorer le biais en lien au genre, les ratios des sexes pour les cancers du poumon, de la vessie, de l’œsophage et du larynx ont été mis en concordance avec deux indices statistiques, à savoir l’Indice d’inégalité des genres de l’ONU et les estimations mondiales de prévalence du tabagisme de l’OMS. Résultats: Les résultats obtenus à l'aide de modèles à effets mixtes utilisant un nombre égal (soit 76) registres de cancer de longue durée pour chaque année entre 1983 et 2007, après avoir ajusté le ratio des des sexes pour la variation géographique, ont démontré que le cancer du poumon avait le plus haut ratio des sexes en moyenne lors de la première année («baseline») (soit 9.9), suivi de l’œsophage (7.8), la vessie (5.1), le foie (3.8), le pancréas (2.1), le rein (1.9), la leucémie (1.8), le lymphome non hodgkinien (1.8), le cerveau (1.6), le rectum et l’anus (1.5), le côlon (1.2), les yeux (1.2), le mélanome de la peau (0.9), la vésicule biliaire (0.6) et la thyroïde (0.5). Dans les registres de pays ayant une faible inégalité entre les sexes et une prévalence de tabagisme similaire chez les femmes et les hommes (la Suède, la Norvège et le Danemark), le ratio des sexes pour le cancer du poumon était relativement bas (1.2, 1.3 et 1.6). D'un autre côté l’Espagne, tout en ayant une prévalence similaire de tabagisme chez les hommes et les femmes, montrait un ratio des sexes inhabituellement haut pour le poumon (7.1) ainsi que pour d’autres cancers associés au tabagisme (vessie: 14.9, œsophage: 10.7, larynx: 28.2). Les résultats de cette étude tendent à mettre en relief plusieurs types de cancer, notamment celui des reins pour lequel les facteurs de risques connus seront peu susceptibles de pouvoir expliquer pleinement le ratio masculin-féminin de presque 2:1, uniformément stable à travers le temps et les régions. Conclusions: Les facteurs de risque établis dans la littérature dont la prévalence varie dans les deux sexes au niveau mondial, ne semblent pas pouvoir expliquer la stabilité du ratios des sexes pour le cancer du rein au cours des trois décennies. Suite à cette observation, nous avons émis l'hypothèse de certains facteurs endogènes, tels que la génétique ou la variance génétique, pouvant être en mesure d’expliquer la stabilité du ratio des sexes pour ce cancer. Un autre type de cancer, le myélome multiple, s'est lui aussi avéré stable à travers le temps et l’espace (le rôle de la vitamine D a été postulé). Notre étude nous a permis d'identifier des lacunes au niveau de la compréhension des causes de cancer au sein des populations.Context: International comparisons of cancer incidence rates are important sources of evidence for generating hypotheses about cancer etiology. The estimates of geographic variation in cancer incidence can be compromised by artifacts such as imperfect accuracy and completeness of available cancer incidence data among several others. The artifacts associated with incidence rates, can be potentially misleading when interpreting and comparing trends across cancer registries. The Sex Ratio (defined as the male-to-female cancer incidence rate) is one measure that can be less susceptible to ambiguity of interpretations by these artifacts, provided that the ascertainment of cancer cases is similar in males and females. Objectives: Hence, the main aim of this study is to infer as to potential causes that drive sex ratio variability (i.e., the ratio of male to female incidence rates), of type specific cancers across time and geography, generating hypotheses. The secondary aim is to explore the extent to which country-level gender inequalities can provide clues on quality of cancer registries for selected cancer types through sex ratios. Methods: Cancer Incidence in Five Continents (CI-5), a database of population-based cancer registries obtained from International Agency for Research on Cancer (IARC), was used to access incidence data on 30 different cancers in 3 time-periods (i.e., 1974-77; 1988-92 and 2003-07) from 77, 142 and 281 cancer registries. Descriptive methods were used with recourse to mixed-effect regression methods for studying temporal trends and geographic variations in sex ratios. To explore gender bias, sex ratios for cancers of lung, bladder, esophagus, and larynx were tallied with two statistics namely UN’s Gender Inequality Index and WHO’s global tobacco prevalence estimates. Results: In the mixed-effect regression analysis using equal number of 76 long-standing cancer registries in each year from 1983 to 2007, and after adjusting for geographic variation in sex ratio, lung cancer had the highest sex ratio on average in the baseline year (i.e., 9.9), followed by esophagus (7.8), bladder (5.1), liver (3.8), pancreas (2.1), kidney (1.9) leukemia (1.8), non-Hodgkin’s lymphoma (1.8), brain (1.6), rectum and anus (1.5), colon (1.2), eye (1.2), melanoma of skin (0.9), gallbladder (0.6), and thyroid (0.5). In registries belonging to countries, with low gender inequality and similar smoking prevalence in men and women (Sweden, Norway and Denmark), the sex ratio for lung cancer was relatively very low (1.2, 1.3 and 1.6). Whereas Spain with similar prevalence of smoking in men and women, showed an unusually high sex ratio for lung (7.1) as well as for other smoking associated cancers (bladder: 14.9; esophagus: 10.7; and larynx: 28.2). The results of our study also highlight several cancer types, in particular, kidney for which acknowledged and well-known risk factors are unlikely to fully explain the consistently stable male-female ratio of almost 2:1 across time and regions. Conclusions: The well-established risk factors in literature whose prevalence varies worldwide in both sexes, does not seem to decipher the curiously stable sex ratios in cancer of kidney maintained over three decades. This observation has made us to tentatively hypothesize that some endogenous factor such as a gene or gene variant might be able to explain the stable sex ratio of this cancer. Another cancer type, multiple myeloma is also consistently stable across time and place, and where the role of vitamin D has previously been postulated. The study points towards gaps in our understanding of causes of cancer risk in populations

The Epidemiology of Community-Acquired Clostridium Difficile in the Niagara Region, Ontario, Canada, Between September 2011 and December 2013

Clostridium difficile infections (CDIs) have historically been associated with exposure to healthcare settings. In recent years, however, the incidence of community-acquired Clostridium difficile infections (CA-CDI), along with the number of patients requiring hospitalization for it, has been increasing. This research uses a framework grounded in Complex Adaptive Systems (CAS) to reveal new and different epidemiological findings on CA-CDI to indicate novel health equity leverage points. It explores the epidemiology and established risk factors associated with CA-CDI in the Niagara Region, Ontario, and compares them with those of healthcare-associated CDI (HA-CDI) in the same area. The first manuscript evaluates the literature on existing evidence of risk factors for CA-CDI by applying The Joanna Briggs Institute (JBI) Reviewers Manual 2015, Methodology for JBI Scoping Reviews. The review identifies that CA-CDI is seen more often than HA-CDI in younger and female populations. Exposure to antimicrobials is common but not as common as in HA-CDI cases. The scoping review establishes the need for further epidemiological studies on CA-CDI. The second manuscript provides a nonparametric descriptive analysis, comparing CA-CDI and HA-CDI cases in Niagara Health System (NHS) hospitals, based on a retrospective case series design. Hospitalized CA-CDI patients have a lower median age and less exposure to antimicrobials and other medications. Gender proportions are similarly distributed between the two groups. The emerging recommendation is that CA-CDI must be considered as a potential diagnosis in patients admitted to hospital with diarrhea, even in the absence of conventional CDI risk factors. The third and final manuscript evaluates the spatial and genotype features of CA-CDI and HA-CDI. It finds that geographical clustering, temporal patterns, and genotypic features are unique in each category. These studies point to the need for a better understanding of transmission routes between communities and healthcare settings; further research is required to establish community CA-CDI risk factors. Together, these evaluations establish that we must develop a systems approach to explore health problems and respond effectively at a population level. The research and policy environment must be strengthened by modifying current practices, setting priorities, and providing funding for empirical studies and equitable health policies

The Design of Interactive Visualizations and Analytics for Public Health Data

Public health data plays a critical role in ensuring the health of the populace. Professionals use data as they engage in efforts to improve and protect the health of communities. For the public, data influences their ability to make health-related decisions. Health literacy, which is the ability of an individual to access, understand, and apply health data, is a key determinant of health. At present, people seeking to use public health data are confronted with a myriad of challenges some of which relate to the nature and structure of the data. Interactive visualizations are a category of computational tools that can support individuals as they seek to use public health data. With interactive visualizations, individuals can access underlying data, change how data is represented, manipulate various visual elements, and in certain tools control and perform analytic tasks. That being said, currently, in public health, simple visualizations, which fail to effectively support the exploration of large sets of data, are predominantly used. The goal of this dissertation is to demonstrate the benefit of sophisticated interactive visualizations and analytics. As improperly designed visualizations can negatively impact users’ discourse with data, there is a need for frameworks to help designers think systematically about design issues. Furthermore, there is a need to demonstrate how such frameworks can be utilized. This dissertation includes a process by which designers can create health visualizations. Using this process, five novel visualizations were designed to facilitate making sense of public health data. Three studies were conducted with the visualizations. The first study explores how computational models can be used to make sense of the discourse of health on a social media platform. The second study investigates the use of instructional materials to improve visualization literacy. Visualization literacy is important because even when visualizations are designed properly, there still exists a gap between how a tool works and users’ perceptions of how the tool should work. The last study examines the efficacy of visualizations to improve health literacy. Overall then, this dissertation provides designers with a deeper understanding of how to systematically design health visualizations

Bayesian spatial modelling of tuberculosis and its effects on socio-economic and demographic factors in South Africa : a case study of the Eastern Cape Province

This dissertation is concerned with evolving and extending statistical models in the area of Bayesian spatial modelling, an increasingly important field of spatial epidemiology with particular interest towards application to Tuberculosis data in the Eastern Cape province of South Africa. In spatial epidemiology, the diseases to be examined usually occur within a map that needs spatial statistical methods that are appropriate, to model the observed data in the presence of some covariates and also cater for the variation of the disease. In this thesis, the Bayesian models were developed in such a way that they allowed several factors classified as fixed and random effects, to be included in the models and using the Bayesian approach. The basic model used in disease mapping is the Besag, York and Mollie model, which incorporates two random effects; one which is spatially structured and the other random effect which is spatially unstructured. The effects (fixed and random) were the covariate effects, socio-economic and demographic variability and the spatial variability respectively, which were all investigated in seven different hierarchical/multilevel Bayesian models. These factors showed varying and substantial effects in the posterior relative risk estimation of the disease. We assumed a negative binomial and generalized Poisson distributions to the response variable or relative risk estimate, ,to capture the over-dispersion phenomenon that is common and inherent with Poisson density for counts data. Spatial and non-spatial models were developed to model over-dispersion with all the distributions; Poisson, negative binomial and generalized Poisson. Negative binomial and generalized Poisson showed varying properties from comparisons with DIC values and parameter estimates to standard errors, which made either of them fit depending on the choice of model selection. It was found that a lower DIC value could be insufficient to determine a best fit model, if other models present estimates with lower variances even at higher DIC values. The generalized Poisson, a two parameter distribution like the negative binomial, which also has the ability to capture both under-dispersion and over-dispersion, was found to perform better in the results than the negative binomial on the basis of a lower variance and with more exact parameter estimates. A new weighted prior distribution, the “Besag2” ICAR model for the structured spatial random effects, which is an extension of the traditional ICAR prior model with two hyperparameters, was also developed and compared with some existing prior models; BYM and ICAR, to measure for spatial dependency in the regions. This new prior distribution was found to show a better fit, when compared to the basic ICAR prior usually assumed for the spatial random effect in the BYM model. This newly parameterized prior distribution in the Besag, York and Mollie model also led to improved parameter control, as the hyperparameters can be seen independently from each other. The result also showed that the new model performed well, both presenting good learning abilities and good shrinkage behaviour. In terms of model choice criteria, the proposed model performed at least equally well and better than the existing models, and the new formulation also gave parameters that are interpretable and have a clearer meaning. To interpolate scattered or regularly distributed data, there are imprecise or exact methods, but there are some of these methods that could be used for interpolating data in a regular grid and others in an irregular grid. Linear and biharmonic spline methods were implemented in MATLAB, to compare for smoothing in the distribution patterns of tuberculosis in the province. This smoothing spline is a method of fitting a smooth curve to a set of noisy observations using a spline function. This new method is rarely used in disease mapping applications, but it has a superior advantage to be assessed at subjective locations rather than only on a rectangular grid as seen in most traditional GIS methods of geospatial analyses. The proposed new models and methods in this thesis were found to be flexible and robust, since they can be reduced or extended according to the nature of the data. Nevertheless, great care must be considered in the choice of prior densities. The approaches developed in this dissertation helped to broaden the scope for spatial analysis and disease mapping applications in epidemiology and public health studies