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Purpose: To explore the use of the Pulsar Z1 solid-state 213 nm photorefractive laser platform in topography-guided transepithelial photorefractive keratectomy (PRK) for irregular astigmatism. Setting: Moorfields Eye Hospital, London, United Kingdom. Design: Prospective clinical case series. Methods: Patients with irregular astigmatism after previous refractive surgery or corneal transplantation were treated with topography-guided transepithelial PRK. Preoperatively and 1-year postoperatively, corrected distance visual acuity (CDVA) and secondary outcome measures (including manifest refraction, contrast sensitivity, haze score, index of surface variation, root-mean-square higher-order aberrations, and subjective visual change) were compared between groups. Adjunctive mitomycin-C was not used. Results: Seven patients had previous refractive surgery, and 7 had previous corneal transplantation. All but 2 patients with a marked haze response had subjective gains in vision and improved CDVA. Gains in CDVA for patients with irregular astigmatism after previous refractive surgery (median 2 lines gain; range 0 to 2 lines gained) were higher than for patients with irregular astigmatism after keratoplasty (median 0 lines; range 5 lines lost to 4 lines gained). Trends in secondary outcome measures were similar, with greater variation in post-keratoplasty patients. Haze scores were higher in post-keratoplasty patients. Conclusions: 213 nm topography-guided transepithelial PRK was easy to perform and well tolerated by patients with irregular astigmatism. Most patients gained CDVA; however, increased haze responses were observed in post-keratoplasty cases. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Abstract: Few cases in the history of epidemiology and public health are more famous than John Snow''s investigation of a neighborhood cholera outbreak in the St. James, Westminster, area of London in 1854. In this study Snow is assumed to have proven that cholera was water rather than airborne through a methodology that became, and to a great extent remains, central to the science and social science of disease studies. And yet, Snow''s work did not satisfy most of his contemporaries who considered his proof of a solely waterborne cholera interesting but unconvincing. Uniquely, this paper asks whether the caution of Snow''s contemporaries was reasonable, and secondly, whether Snow might have been more convincing within the science of the day. The answers significantly alter our understanding of this paradigmatic case. It does so in a manner offering insights both into the origins of nineteenth century disease analysis and more generally, the relation of mapping in the investigation of an outbreak of uncertain origin. The result has general relevance—pedagogically and practically—in epidemiology, medical geography, and public health. [Copyright &y& Elsevier]

Abstract: A previous study found a thyroid cancer excess in Cumbria following the Chernobyl explosion, but did not analyse sex-specific effects. This study examines sex differences in the incidence of thyroid cancer. Ninety-five primary thyroid carcinomas (69 females, 26 males) diagnosed in those aged 0–24 during 1968–2005 were identified from the Northern Region Young Persons’ Malignant Disease Registry. Age-standardised incidence rates (ASRs), rate ratios (RRs) and 95% confidence intervals (CIs) were calculated. For males, the ASR was 0.6 per million person-years during the pre-Chernobyl period (1968–1986), and was 1.8 per million person-years during the post-Chernobyl period (1987–2005). For females, the ASR was 2.4 pre-Chernobyl and was 3.9 post-Chernobyl. The previously noted excess in Cumbria was entirely confined to females (Cumbrian females: RR for post-Chernobyl compared with pre-Chernobyl=10.8; 95% CI: 1.4–85.3). These findings may be consistent with sex-specific differences in susceptibility to an environmental exposure, such as fallout from the Chernobyl nuclear accident. [Copyright &y& Elsevier]

Abstract: This paper examines the implications for design of inpatient settings of community-based models of care and treatment of mental illness. The study draws on ideas from relational geographies and expands interpretations based on Foucault''s writing. We analyse material from a case study which explored the views of patients, consultants, and other staff from a new Psychiatric Inpatient Unit in a deprived area of East London, UK. We discuss in particular: the tension between providing a caring and supportive institutional environment and ensuring that patients are returned to the community when they are ready; the links between an acute inpatient facility and its local community; the potential significance of the psychiatric hospital as a relatively stable feature in the otherwise insecure and unpredictable geographical experience of people with long-term mental illnesses. We discuss the relevance of these issues for design of new psychiatric inpatient facilities. [Copyright &y& Elsevier]

Spatially aggregated data are frequently used for official statistics and by researchers investigating the contextual determinants of health. Results of reporting and analysis vary according to the choice of areal unit. This is the well-known Modifiable Areal Unit Problem or MAUP. Its implication for the monitoring and understanding of area inequalities in health has received little empirical attention in the public health literature. Health differences will likely be smallest across arbitrarily chosen areas whereas boundaries acknowledging the physical and social geography should indicate greater differences between areas. Here we use three methods to define area boundaries and compare the extent of health inequalities across each drawing on data from the London boroughs of Camden and Islington. Irrespective of the boundary definition used, between-area inequalities in obesity, alcohol intake, smoking, walking and self-rated health were small compared with inequalities between individuals. There was a tendency for slightly larger estimated inequalities across areas defined by socioeconomic homogeneity compared with other definitions, but differences between methods were very small in magnitude. Existing studies predominantly use area boundaries that are based on administrative boundaries. Although these have little theoretical basis for the study of neighbourhood inequalities in health, our findings indicate that alternative definitions of the neighbourhood boundaries have no substantive effect on the estimates of those inequalities. Based on these findings, we can have greater confidence in the results of numerous studies which have used administrative boundaries to define the neighbourhood. [Copyright &y& Elsevier]

Background: Primary Percutaneous Coronary Intervention (PCI) is more efficacious than thrombolysis in the management of acute myocardial infarction, but, because of the requirement for prompt treatment, there are practical challenges in developing such services. We examined the proportion of patients with ST segment Elevation Myocardial Infarction (STEMI) who could receive timely treatment from a primary Percutaneous Coronary Intervention (PCI) service assuming different geographical locations of potential treatment centres in three English counties. Methods and results: Information on the residential location of patients with new STEMI hospitalisations recorded in Hospital Episodes Statistics was analysed and the proportion of episodes of STEMI within 60' and 45' travel time isochrones from potential primary PCI centres in three English counties was calculated. There were on average 1,815 new STEMI hospitalisations per year occurring in the studied population. Introduction of a primary PCI service in one, two or three potential treatment centres would have covered respectively 28%, 73% and 90% of such episodes within 60 minutes travel time, and 17%, 51% and 69% within 45 minutes travel time. Conclusion: In the study context, a primary PCI service in an existing tertiary centre would only cover a minority of STEMI events and would generate geographical inequities. A two-centre model would improve coverage and equity considerably, but may be associated with practical, clinical quality and financial challenges. [ABSTRACT FROM AUTHOR]

During recent years, health geography has focused increasingly on how people's experiences of health and places are interrelated. This has included historical research on a variety of well-known places and remarkable events. In contrast, relatively little attention has been paid to how health and health care can be influential historically to the development, image and identity of `everyday' and ordinary places. We focus on the case of a small town in Southern England to demonstrate the long and diverse historical connections that exist between health and such places. Using both historical documents and local literature, the paper reviews early invasions and incursions, epidemics of infectious disease, the development of a therapeutic seaside resort, the impacts of the Second World War, and more recent social and economic developments associated with an ageing population. Complex and diverse health-related histories are shown to be interwoven with local and extra-local histories including those of national or international significance. We argue that health histories can be integral to shaping the past and present of places and our broader understandings and interpretations of them. From a disciplinary perspective, we contend that by adopting theoretical perspectives from cultural geography, an enhanced historical geography of health could disentangle these historical strands, tell these important stories and put everyday health histories in their place. [ABSTRACT FROM AUTHOR]

The article presents a brief introduction of "10th International Symposium in Medical Geography," which was held in Manchester, England in the year of 2003. It represents a selection of papers presented at the Symposium. The conference attracted participants from 23 countries and saw over 100 presentations given over 4 days. The program covered the breadth of contemporary research in medical/health geographies with sessions focusing on issues of health, disease as well as qualitative and quantitative methods. The breadth of papers presented reflected the considerable changes seen in medical geography over the last decade which has, in many ways, reinvigorated our sub-discipline.

Background: The rates of Sexually transmitted diseases (STDs) in England have been rising steadily since the mid 1990s, making them a major public health concern. In 2003, 672,718 people were diagnosed with an STD in England, and around one third of those cases were diagnosed in London. Results: Using GeoReveal v1.1 for Windows, we produced Web-based interactive choropleth maps of diagnoses of STDs by Primary Care Trust (PCT) in London for the years from 1997 to 2003 http://healthcybermap.org/PCT/STDs/. These maps are in Scalable Vector Graphics (SVG) format and require a freely available Adobe SVG browser plug-in to be displayed. They are based on data obtained from the House of Commons Hansard Written Answers for 15 October 2004. They show steadily rising rates of STDs in London over the covered seven-year period. Also, one can clearly see on the maps that PCTs located in central London had the highest numbers of STD diagnoses throughout the mapped seven years. A companion bar chart allows users to instantly compare the STD figure of a given PCT for a given year against the average figure for all 25 mapped PCTs for the same year, and also compare those figures across all seven years. The maps offer users a rich set of useful features and functions, including the ability to change the classification method in use, the number of ranges in the map, and the colour theme, among others. Conclusions: Wizard-driven tools like GeoReveal have made it very easy to transform complex raw data into valuable decision support information products (interactive Web maps) in very little time and without requiring much expertise. The resultant interactive maps have the potential of further supporting health planners and decision makers in their planning and management tasks by allowing them to graphically interrogate data, instantly spot trends, and make quick and effective visual comparisons of geographically differentiated phenomena between different geographical areas and over time. SVG makes an ideal format for such maps. SVG is a World Wide Web Consortium nonproprietary, XML-based vector graphics format, and is an extremely powerful alternative to Macromedia® Flash and bitmap graphics. [ABSTRACT FROM AUTHOR]

Evaluates the partnership program between the University of Derby in England and the Derbyshire Family Health Services Authority which required medical geography students to participate in a group project devised in association with the health authority. Description of the program and the medical geography module; Results and evaluation.

The article focuses on the comparison of the rates of suicide in Scotland from England and Wales. Scotland, over many decades ago, has lower rates of suicide compared to England and Wales while a report released by the World Health Organization(WHO) placed Scotland 19th among the 20 sample different countries on the rate of suicides. However, during the last two decades, same WHO officials, declared that such picture has been changing, making Scotland down to number 15 of the same 20 different sample countries. According to the study, the Scottish rates have increased since 1951 while England and Wales rate has remained largely stable.

Background: Established surveillance systems can follow trends in community disease and illness over many years. However, within England there are known regional differences in healthcare utilisation, which can affect interpretation of trends. Here, we explore regional differences for a range of respiratory conditions using general practitioner (GP) consultation data., Methods: Daily data for respiratory conditions were extracted from a national GP surveillance system. Average daily GP consultation rates per 100 000 registered patient population were calculated by each region of England and for each study year (2013-17). Consultation rates and incidence rate ratios were also calculated for each condition by deprivation quintile and by rural, urban, and conurbation groups., Results: Upper and lower respiratory tract infections and asthma were higher in the North and the Midlands than in London and the South, were highest in the most deprived groups and tended to be higher in more urban areas. Influenza-like illness was highest in the least deprived and rural areas., Conclusions: There are consistent differences in GP consultation rates across the English regions. This work has improved our understanding and interpretation of GP surveillance data at regional level and will guide more accurate public health messages., (© Crown copyright 2020.)

• European herbalists and physicians of the 16th century were instrumental in promoting the use and world-wide spread of tobacco as a botanical medicine. • Initial opposition to the excessive use of tobacco was based on the concept that patients continued to use it long after the ailment was cured. Continuous use of tobacco simply for the pleasure of smoking was considered immoral, and provided the first wave of opposition to tobacco, especially by Puritans in England and America. • Over time, skepticism on the value of tobacco as a universal remedy was transformed into the contemporary medical opinion that chronic use is deleterious to health. • Scholars and biomedical researchers studying botanical medications should learn from the history of tobacco the importance of distinguishing true medical benefits from abuse. A forgotten and valuable chapter in the history of tobacco concerns its role as a botanical medicine. For three hundred years following its importation into Europe, tobacco came to be considered a universal remedy highly prescribed by physicians. In the early history of tobacco, the literature on its medicinal benefits was voluminous. Nonetheless, bitter opposition to its use for non-medicinal purposes began to arise. There was little doubt of its medicinal efficacy at first, but with time, as the concepts and practice of medicine changed, the tide of medical opinion turned against it. Medical support for the therapeutic use of tobacco reached its nadir during the mid-nineteenth century, when it was dropped from most medical pharmacoepiae. Medical opinion on the health hazards of recreational smoking required another 100 years to arrive at the contemporary opinion that cigarette smoking is the single most important preventable environmental factor contributing to illness, disability and death in the U. S. [ABSTRACT FROM AUTHOR]

Focuses on the geographical variations on the supply of domiciliary oxygen in England. Amount of oxygen prescribed by general practitioners; Association on the level of supply with urbanization of areas; Rationale on the prescription of domiciliary oxygen.

This article discusses historical interpretations of the epidemiological work of John Snow. Snow became famous for his ideas about the medical geography and epidemiology of cholera outbreaks in London, England in 1848 and 1854. The presentation of this research as part of the heroic medical heritage of London in 2008 is explored. The author frames the significance of Snow's work as part of a debate regarding epidemiology in the 19th century rather than a clear cut instance of heroism. The valorisation of Snow as a public health hero by Wade Hampton Frost during the 1930s is noted. Snow's role in the professionalisation of epidemiology during the 1930s is noted.