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This paper examined the occurrence and seasonality of meteotsunami in the United Kingdom (UK) to present a revised and updated catalogue of events occurring since 1750. Previous case studies have alluded to a summer prevalence and rarity of this hazard in the UK. We have verified and classified 95 events using a developed set of identification criteria. The results have revealed a prominent seasonal pattern of winter events which are related to mid latitude depressions with precipitating convective weather systems. A geographical pattern has also emerged, highlighting three 'hotspot' areas at the highest risk from meteotsunami. The evidence reviewed, and new data presented here shows that the hazard posed by meteotsunami has been underestimated in the UK. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The 1920–1935 epidemic of variola minor in England and Wales is a prime example of a major smallpox outbreak that spread in a national population with waning levels of vaccine-induced immunity. This paper examines the geographical course of the epidemic and the reasons why the disease was able to evade the (then) established protocols for smallpox control in many local government areas. The control issue is examined using archival records from the English county of Gloucestershire, where smallpox spread out of effective control in 1923. At the national level, our analysis demonstrates that the build-up (1920–1927) of the epidemic was characterised by a persistent core of reported cases of high intensity in the counties of central and northern England. Epidemic fade-out (1928–1935) was associated with an accelerated shift of disease activity to London and the southeast. Set against this national context, Gloucestershire represented a microcosm of the impediments to smallpox control in inter-war Britain. Here, a series of sociodemographic and administrative factors operated to impede disease control. Our study demonstrates the potential fragility of established disease control systems and the importance of professional and public cooperation, sometimes in the face of vehemently contested evidence over the nature of a disease and the means of its control, in attempts to limit the spread of epidemics. [ABSTRACT FROM AUTHOR]

This paper uses techniques of binary logistic regression to identify the spatial determinants of the last national epidemic of smallpox to spread in England and Wales, the variola minor epidemic of 1921–34. Adjusting for age and county-level variations in vaccination coverage in infancy, the analysis identifies a dose-response gradient with increasing odds of elevated smallpox rates in local government areas with (i) medium (odds ratio [ OR ] = 5.32, 95% Confidence Interval [95% CI] 1.96–14.41) and high ( OR = 11.32, 95% CI 4.20–31.59) coal mining occupation rates and (ii) medium ( OR = 16.74, 95% CI 2.24–125.21) and high ( OR = 63.43, 95% CI 7.82–497.21) levels of residential density. The results imply that the spatial transmission of variola virus was facilitated by the close spatial packing of individuals, with a heightened transmission risk in coal mining areas of the country. A syndemic interaction between common respiratory conditions arising from exposure to coal dust and smallpox virus transmission is postulated to have contributed to the findings. We suggest that further studies of the geographical intersection of coal mining and acute infections that are transmitted via respiratory secretions are warranted. [ABSTRACT FROM AUTHOR]

Introduction Given the expected increase in the number of patients with osteoporosis and fragility fractures it is important to have concise information on trends in prescription rates of anti-osteoporosis drugs (AOD). Methods We undertook a retrospective observational study using the UK Clinical Practice Research Datalink (CPRD) in the UK between 1990 and 2012 in subjects 50 years or older, stratified by age, sex, geographic region and ethnicity. Yearly prescription incidence rates of any AOD and of each specific AOD were calculated as the number of patients first prescribed these AODs per 10,000 person-years (py). Results In women, yearly rates of first prescription of any AOD increased from 1990 to 2006 (from 2.3 to 169.7 per 10,000 py), followed by a plateau and a 12% decrease in the last three years. In men, a less steep increase from 1990 to 2007 (from 1.4 to 45.3 per 10,000 py) was followed by a plateau from 2008 onwards. Yearly rates of first prescription of any AOD increased up to the age of 85–89 years (248.9 per 10,000 py in women and 119.3 in men). There were marked differences between ethnic groups and regions. Bisphosphonates were the most frequently prescribed AODs: etidronate till 2000, and then subsequently alendronate. Conclusion We have demonstrated marked secular changes in rates of anti-osteoporosis drug prescription over the last two decades. The plateau (and decrease amongst women) in rates in recent years, set against an ever ageing population, is worrying, suggesting that the well-documented care gap in osteoporosis treatment persists. The differences in prescription rates by geographic location and ethnicity raise intriguing questions in relation to underlying fracture rates, provision of care and health behaviour. Summary We studied the prescription incidence of anti-osteoporosis drugs (AOD) from 1990 to 2012 in the UK CPRD. Overall AOD prescription incidence showed a strong increase from 1990 to 2006, followed by a plateau in both sexes and a decrease amongst women in the last three years. [ABSTRACT FROM AUTHOR]

Progressive improvements in the health and survival of patients with thalassaemia and sickle cell disease have increased the reproductive prospects of affected individuals. However, pregnancy in these disorders is associated with significant maternal and fetal risks and expert management is required to ensure good outcomes. In the United Kingdom, it is recognised that the patchy geographical distribution of these conditions poses challenges for access to specialist care, including specialist obstetric services. Guidelines on the pregnancy management of thalassaemia and sickle cell disease in the UK have been published by the Royal College of Obstetricians and Gynaecologists. These guidelines describe the preconceptual, antenatal, intrapartum and postpartum aspects of care. They highlight the high-risk status of pregnancy in these conditions and emphasise the vital importance of specialist multidisciplinary care to the achievement of favourable maternal and fetal outcomes. The guidelines are a valuable resource to healthcare professionals, especially those working in low prevalence areas. [ABSTRACT FROM AUTHOR]

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]

Background & Aims: Cholangiocarcinomas (CC) can be sub-divided into intrahepatic (IHCC) or extrahepatic (EHCC). Hilar or ‘Klatskin’ tumours are anatomically extrahepatic. Most international studies, also from the UK, report increasing IHCC and decreasing EHCC incidence. The second edition of the International Classification of Diseases for Oncology (ICD-O-2) assigned ‘Klatskin’ tumours a unique histology code (8162/3), but this was cross-referenced to the topography code for intrahepatic (IHBD) rather than extrahepatic bile duct tumours (EHBD). Under the third ICD-O edition, ‘Klatskin’ tumours are cross-referenced to either IHBD or EHBD. New editions of the ICD-O classification are adopted at different time points by different countries. We investigated the impact of changing ICD-O classifications and the potential misclassification of hilar/’Klatskin’ tumours on bile duct tumour and CC incidence rates in England and Wales and the US. We also examined whether coding practices by cancer registries in England and Wales could be influencing these rates. Methods: We analysed age-standardised incidence rates (ASIR) in England and Wales for IHBD and EHBD tumours between 1990 and 2008, then transferred all ‘Klatskin’ tumours from IHBD to EHBD and reanalysed rates from 1995, when ICD-O-2 was introduced in the UK. We also compared trends in IHBD, EHBD, and ‘Klatskin’ tumours in England and Wales with those in the USSEER (Surveillance, Epidemiology and End Results) database. Coding practice at Cancer registry level in England and Wales was investigated via a questionnaire completed by all national cancer registries. Results: In England and Wales, 1990–2008, ASIR of IHBD cancers rose (0.43–1.84/100,000 population in males; 0.27–1.51 in females) but fell for EHBD (0.78–0.51/100,000 population in males; 0.62–0.39 in females). After transferring all ‘Klatskin’ tumours from IHBD to EHBD, there remained a marked increase in ASIR of IHBD cancers and a decrease in ASIR for EHBD, as only 1% of CC were reportedly ‘Klatskin’. The US SEER data showed that ASIR for IHBD gradually rose from 0.59/100,000 population in 1990 to 0.91 in 2001, then sharply fell before plateauing at 0.60 by 2007. ASIR for EHBD remained relatively stable at around 0.80/100,000 population until 2001, then began increasing, to 0.97 by 2007. Annually, between 1995 and 2008, the vast majority of ‘Klatskin’ tumours in England and Wales were coded as IHBD. This was also the case in the SEER data until 2001, when the situation was reversed and subsequently most ‘Klatskin’ tumours were coded as EHBD. US trends coincide with a switch from ICD-O2 to ICD-O-3 in 2001. In the UK, the switch to ICD-O-3 only occurred in 2008. On questioning, cancer registries in England and Wales stated they would not code a CC described as ‘hilar’ with the designated ‘Klatskin’ histology code. If the tumour site is unspecified, most registries classify CC as intrahepatic. Conclusions: Changes in ICD-classification may be influencing observed changes in IHBD and EHBD incidence rates. Coding misclassification is likely to have been skewing CC registration to an intrahepatic site, thereby contributing to the previously reported rise in intrahepatic tumours. [Copyright &y& Elsevier]

Background: Mental well-being now features prominently in UK and international health policy. However, progress has been hampered by lack of valid measures that are responsive to change. The objective of this study was to evaluate the responsiveness of the Warwick Edinburgh Mental Well-being Scale (WEMWBS) at both the individual and group level. Methods: Secondary analysis of twelve different interventional studies undertaken in different populations using WEMWBS as an outcome measure. Standardised response mean (SRM), probability of change statistic (̂P ) and standard error of measurement (SEM) were used to evaluate whether WEMWBS detected statistically important changes at the group and individual level, respectively. Results: Mean change in WEMWBS score ranged from -0.6 to 10.6. SRM ranged from -0.10 (95% CI: -0.35, 0.15) to 1.35 (95% CI: 1.06, 1.64). In 9/12 studies the lower limit of the 95% CI for ̂P was greater than 0.5, denoting responsiveness. SEM ranged from 2.4 to 3.1 units, and at the threshold 2.77 SEM, WEMWBS detected important improvement in at least 12.8% to 45.7% of participants (lower limit of 95% CI>5.0%). Conclusions: WEMWBS is responsive to changes occurring in a wide range of mental health interventions undertaken in different populations. It offers a secure base for research and development in this rapidly evolving field. Further research using external criteria of change is warranted. [ABSTRACT FROM AUTHOR]

This study investigated 339 cases of feline mycobacterial disease from cats with cutaneous lesions or masses found at exploratory laparotomy. Tissue samples were submitted to the Veterinary Laboratories Agency for mycobacterial culture over a 4-year period to December 2008. The study assessed which species of culturable mycobacteria were involved, where the cats lived, and their clinical presentation (physical findings, serum biochemistry, radiography, feline leukaemia virus and feline immunodeficiency virus status). Mycobacterium microti was cultured from 19%, Mycobacterium bovis 15%, Mycobacterium avium 7%, non-M avium non-tuberculous mycobacteria 6%, with no growth in 53% of samples. M microti, M bovis and M avium were found in almost mutually exclusive clusters within Great Britain (GB) (ie, M bovis in South-West England/Wales/Welsh Border, M avium in eastern England and M microti south of London and in South-West Scotland). While differences were seen in the clinical presentation and distribution of lesions caused by the different infections, these were not sufficiently different to be diagnostic. Cats commonly presented with single or multiple cutaneous lesions (74%), which were sometimes ulcerated or discharging, located most frequently on the head (54%). Lymph nodes were usually involved (47%); typically the submandibular nodes. Systemic or pulmonary signs were rarely seen (10–16%). When a cat is suspected of having mycobacteriosis, accurate identification of the species involved helps to determine appropriate action. Our findings show that knowing the cat’s geographic location can be helpful, while the nature of the clinical presentation is less useful. Most cases of feline mycobacterial disease in GB are cutaneous. [ABSTRACT FROM AUTHOR]

Aims To ascertain the frequency and geographical distribution of patients diagnosed with known genetic causes of Alzheimer's disease (AD) and inherited prion disease (IPD) in the UK 2001-2005. By comparison with frequencies predicted from published population studies, to estimate the proportion of patients with these conditions who are being accurately diagnosed. Methods All the positive diagnostic test results (from both genetic testing centres) were identified for mutations in presenilin-1 (PSEN1), presenilin-2 (PSEN2), amyloid precursor protein (APP) and prion protein genes (PRNP) for patients resident in the UK in a 5 year period. The variation in the incidence of mutation detection between UK regions was assessed with census population data. Published studies of the genetic epidemiology of familial early onset AD (EOAD) were reviewed to produce estimates of the number of patients in the UK that should be detected. Results The rate of detection of EOAD and IPD varied very significantly and consistently between regions of the UK with low rates of detection in Northern and Western Britain (72% less detection in these regions compared with Central and Southeast Britain). The estimates from population studies further suggest a greater number of patients with EOAD than are diagnosed by genetic testing throughout the UK. Conclusions It is likely that patients with EOAD and IPD are not being recognised and referred for testing. With the prospect of meaningful disease modifying therapeutics for these diseases, this study highlights an issue of relevance to neurologists and those planning for provision of National Health Services. [ABSTRACT FROM AUTHOR]

Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating the catchment area of a planned new hospital, the extra level of detail provided by the gravity model may prove necessary. However, in virtually all other applications, the Proportional Flow method produced the optimal model for catchment populations in Manchester, based on several criteria: it produced the smallest RMS error; it addressed cross-boundary flows; the data used to create the catchment was readily available to SCPs; and it was simpler to reproduce than the gravity model method. Further work is needed to address how the Proportional Flow method can be used to reflect service redesign and handle OAs with zero or low activity. A next step should be the rolling out of the method across England and looking at further drill downs of data such as catchment by Healthcare Resource Group (HRG) rather than specialty level. [ABSTRACT FROM AUTHOR]

Objectives Evolutionary psychology suggests that a woman’s age and physical appearance are important mate choice criteria. Given that changes in female facial skin surface topography are important, prominent visible signs of aging, male perceptual sensitivity for variation in this trait may also affect preference and attractiveness judgment. Methods Two experiments were conducted to investigate perception (Experiment 1) and noticeability (Experiment 2) of skin surface topography manipulations in facial images of six British women, aged 45–65 years. In Experiment 1 skin surface topography cues were completely removed on the cheeks, the “crow’s feet” area adjacent to the eye, under the eyes, above the upper lip, and on the forehead while, in Experiment 2, it was removed gradually (20% increments) on the forehead and around the eyes. In both experiments, stimuli were presented to American and German participants (total N = 300, aged 15–55 years) in omnibus pair-wise combinations (within-face). With each pair, respondents were asked to select that face which they considered as younger looking (Experiments 1 and 2) and more attractive (Experiment 1). Results Faces with skin surface topography cues removed were judged significantly younger and more attractive than their original (unmodified) counterparts, with modifications on the forehead and around the eyes showing the highest differences. In these areas, participants were able to detect at least a 20% visual change in skin surface topography. Conclusions The results support the assertion that even small changes in skin surface topography affect the perceptions of a woman’s facial age and attractiveness and may, thus, also influence men’s mate preferences. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents research aimed at identifying the extent to which pharmacy spaces are aligned to good professional practice, enhance a professional''s sense of self and meet the demands of the public. Findings from a novel, qualitative, mixed-methods approach employing biographic and photographic techniques indicate that UK pharmacy spaces are less accessible than intended by the Department of Health''s pharmacy contract. Pharmacists escape to the dispensary to preserve their professional self-identity and to avoid the expectations of a demanding public. Recent innovations such as consultation rooms lack clarity of intent amid the multiple functions that a busy community pharmacy demands. [Copyright &y& Elsevier]

The geographic distribution of multiple sclerosis is nonrandom, as the disease is more prevalent in temperate than in tropical regions. Surveys conducted between 1970 and 1996 suggest that multiple sclerosis is more prevalent in the northern part of the United Kingdom than in the southern part. This north-south gradient (“the latitudinal gradient”) might be a methodological artifact, because high prevalence figures from serial surveys of the northern part of the United Kingdom might have been the result of better ascertainment. By using capture-recapture methods, the authors found that case ascertainment was similar in the northern and southern parts of the United Kingdom. When prevalence figures for multiple sclerosis in the southern United Kingdom were increased to account for the number of unobserved cases, the difference persisted: The prevalence of multiple sclerosis in the northern part of the United Kingdom appeared to be at least 180 cases per 100, 000 persons, whereas the maximum prevalence in the southern part of the United Kingdom was less than 160 cases per 100, 000 persons. The distribution of multiple sclerosis in the United Kingdom is not uniform and is consistent with the hypothesis that populations with a high prevalence of multiple sclerosis may be genetically predisposed to the disease. Am J Epidemiol 1999; 149:1016–24. [ABSTRACT FROM PUBLISHER]

It has commonly been suggested that in modern cities individual or household deprivation (for example, low income or education) is amplified by area level deprivation (for example, lack of jobs or good schools), in ways which damage the health of the poorest and increase health inequalities. The aim of this study was to determine the location of a range of resources and exposures by deprivation in a UK city. We examined the location of 42 resources in Glasgow City, Scotland, in 2005–2006, by quintile of small area deprivation. Measures included number per 1000 population, network distance to nearest resource, and percentage of data zones containing at least one of each type of resource. Twelve resources had higher density in, and/or were closer to or more common in, more deprived neighbourhoods: public nurseries, public primary schools, police stations, pharmacies, credit unions, post offices, bus stops, bingo halls, public swimming pools, public sports centres, outdoor play areas, and vacant and derelict land/buildings. Sixteen had higher density in, and/or were closer to, or more common in, more affluent neighbourhoods: public secondary schools, private schools, banks, building societies, museums/art galleries, railway stations, subway stations, tennis courts, bowling greens, private health clubs, private swimming pools, colleges, A & E hospitals, parks, waste disposal sites, and tourist attractions. Private nurseries, Universities, fire stations, general, dental and ophthalmic practices, pawn brokers, ATMs, supermarkets, fast food chains, cafes, public libraries, golf courses, and cinemas showed no clear pattern by deprivation. Thus it appears that in the early 21st century access to resources does not always disadvantage poorer neighbourhoods in the UK. We conclude that we need to ensure that theories and policies are based on up-to-date and context-specific empirical evidence on the distribution of neighbourhood resources, and to engage in further research on interactions between individual and environmental factors in shaping health and health inequalities. [Copyright &y& Elsevier]

Aims Information on the population at risk of developing Type 2 diabetes in the UK is scarce. We used data from the 1958 British birth cohort to estimate geographical and socio-economic variations in HbA1c in mid life. Methods Participants ( n = 7799) born in England, Scotland and Wales and currently living in the UK. Individuals were classified according to the presence of Type 2 diabetes and by thresholds of HbA1c. HbA1c≥ 5.5 was used as an indicator for possible subclinical alterations in glucose metabolism. Results The majority of the population had HbA1c < 5.5% (79.3%); 16.7% had HbA1c 5.5–5.9%, 2.0% 6.0–6.9% and 0.6% had HbA1c≥ 7.0%. Individuals from manual socio-economic groups and those living in the East of England and Scotland had a higher prevalence of HbA1c at or above the upper normal range (5.5%). Conclusions Estimates from this nationwide sample suggest that a proportion of Britons are likely to have subclinical alterations in glucose metabolism by their mid 40s, and this proportion is greater in some socio-economic groups and geographical regions than in others. [ABSTRACT FROM AUTHOR]

In many countries, obesity is high on public health policy agendas, and geographical research has begun to engage with obesity. However, obesity is a highly contested term, and recent debates about geographers’ engagement with policy, and critical discussions of the presence of bodies in medical geography, bear great relevance for developing a critical perspective on dominant ‘obesity discourse’. Through a critical reading of a recent UK policy document, this paper considers the presence of bodies in (anti)obesity campaigns, calling for a more critical approach to the medicalization of body size to be central to future geographical work on obesity. [ABSTRACT FROM AUTHOR]

Increasingly, international health links are evolving between UK health-care institutions and those in developing countries, the core aims of which are to seek the transfer of ideas, knowledge, skills and training. This study aimed to evaluate established health links, what constitutes them and how they are supported. Benefits and challenges associated with the links, as perceived both by link coordinators in the UK and their overseas partners, were explored. Fourteen links between health-care organizations in the UK and those in developing countries were identified and interviews were successfully conducted with 22 link coordinators: 13 in the UK and nine in developing countries. The interviews indicated that health links offer mutual benefits to both partners in terms of shared skills and the promotion of global awareness. Links can act as important catalysts; stimulating increases in institutional capacity for research and training. They provide opportunities for personal and professional development of staff and promote the development of friendships and supportive networks between diverse communities. Many of the health links showed signs of evolving from uniprofessional links between individual institutions into broader, multidisciplinary community partnerships. The main challenges facing health links arise from cultural differences, funding problems, communication difficulties and bureaucracy. There was broad agreement that greater recognition of the value and importance of health links by the NHS and closer collaboration between government departments to provide support and resources could promote wider and more effective link partnerships. [ABSTRACT FROM AUTHOR]

Focuses on the trends in medical geography in Great Britain. Fundamental processes important to human geography; Contributions of health geography to cultural geography; Variations of the health status of people in rural areas.

Investigates geographical variations in women's reports of limiting long-term illness in terms of individual inequalities in Great Britain. Indicators of social and material advantage; Consideration of migration into the South-East region as beneficial; Importance of the social composition of the locality for health inequalities among men.

Some studies have suggested that the prevalence of atopic eczema may vary between geographical regions. This descriptive study investigates the regional and subregional geography of reported and examined eczema prevalence at the age of 7, 11 and 16 years in Britain using data from the 1958 birth cohort study (n = 828). Estimates of the relative risk of reported eczema associated with residence in each region of the country were calculated and the regional distribution of reported and examined eczema prevalence was compared. The reported prevalence of eczema was mapped at the smaller county level. Comparisons were made with the county-level distribution of asthma and hay fever prevalence. The study showed a marked and statistically significant variation in eczema prevalence across the regions in Britain which was present for examined as well as reported eczema. The highest risk was associated with four regions: North Midlands; Eastern; London and the South-East; and Southern. This regional pattern was not altered significantly after adjustment for social class and family size. The geographical distribution of eczema prevalence was largely maintained when analysed at the county level. Few similarities were found between the county-level distribution of eczema prevalence and that for asthma and hay fever. Explanations for this strong regional variation now need to be sought in terms of environmental and life-style associations. [ABSTRACT FROM AUTHOR]

It is accepted that within Britain there are persistent and growing inequalities in mortality between groups of people as defined by their social class. This paper shows that similar persistent and growing inequalities prevail between groups of people defined by district of residence. Although there is some confusion between these two ways of grouping people -- there is a slight tendency for people of the same class to live in the same district. This paper reviews the geographical literature which may shed light on why inequalities in mortality are widening between districts in Britain. We present new data for a set of 293 unchanging districts by amalgamating published reports from the 1950s, 60s and 70s with individual post-coded mortality records from the 1980s and 90s, aggregated to the 293 districts using a Geographic Information System and Census data from 1971, 1981 and 1991 (including estimates of the residence of the 'missing million'). We find that a growing proportion of premature deaths in Britain can be attributed to some aspect of rising spatial inequalities. Changing geographical inequalities in health are not simply a passive reflection of social inequalities. To begin to investigate them, however, we first need to measure them properly. [ABSTRACT FROM AUTHOR]

We report an apparent cluster of seven cases of autism spectrum disorder in a network of a few streets in the UK. Clusters do not easily fit the dominant genetic theory of autism. Whilst this could in principle represent the effect of an environmental pathogen, we consider an alternative interpretation: that autism spectrum conditions may be so much more common than was previously thought that finding seven cases in an area of a few streets is not necessarily higher than one would expect from chance. We conclude by highlighting the need for an agewise epidemiological study of autism spectrum conditions, since this cluster is only higher than expected when compared with expected rates for under-5s rather than under-18s. [ABSTRACT FROM AUTHOR]

This article critically examines the state of knowledge with respect to the geographical provision of health care before the national health service (NHS). Most accounts claim that health care was geographically unequal and/or inequitable. On closer examination, however, the claims of these studies appear problematic. This is due to problems of the sources of data, interpretation of the data, and one writer's assertion becoming a subsequent writer's ‘fact’. The charges of inequality and inequity are critically examined. Then, for the hospital services, the situation is explored using data from a well respected but underutilized national wartime survey. Finally, an attempt is made to compare the degree of geographical inequality before the NHS with that of today. It is concluded that the degree of inequality before the NHS is not as great as some conventional wisdom would suggest. Therefore, if the charges against the pre-NHS system are to stand, more evidence will be needed. [ABSTRACT FROM AUTHOR]

Discusses the spatial pattern of mortality variations in Great Britain particularly in England and Wales through the medium of maps. Implications of the inaccuracy of biostatistics for comparative studies in medical geography; Identification of the individual cause of death categories used in a map; Importance of the inclusion of a map of mortality from all causes.

The article discusses the author's experience in the malaria eradication campaign in Great Britain. The author was a representative of the World Health Organization (WHO) in Cambodia, Laos, and Vietnam. He looked after the WHO-assisted programs, advised the governments on public health matters, and arbitrated with various participants.

Focuses on the geographical distribution of diseases in Great Britain. Impact of climate on the variation of the disease; Mortality rate of breast cancer; Correlation between disease distribution and socioeconomic influences.

The article focuses on the results of a study reported in the "British Journal of Cancer" which examined the incidence of cancer in the nine Government Office Regions in England. The study found that the highest incidence of cancer among teenagers and young adults was found in the South East of the country, that the lowest incidence for the groups was found in the North East, that the overall incidences of cancer in the country was 188 per million people, and that the incidence varied from 173 in the North West to 208 in the South East and South West.

Comments on an analysis of the role of cattle movements in the epidemiology of bovine tuberculosis (BTB) in Great Britain. Statistical analysis of a set of complex databases, including records from the British Cattle Movement Service, using multiple logistic regression; Association of the geographical distribution of BTB with the number of recent cattle imports from infected areas; Other determinants of BTB incidence.

The article provides an overview of the mental health research and development in Great Britain. The World Health Organization (WHO) has published in 1996 a report written by the Ad Hoc Committee on Health Research Relating to Future Intervention Options entitled "Investing in Health Research and Development." The 1996 WHO reports have presented predictions of the global burden of disease for 2020. The reports also stated that ageing populations and exposure to certain risk factors are largely responsible for the growing impact of heart disease, mental illness, cancers, strokes, and chronic respiratory diseases.

Objectives: To describe and compare the demographic and clinical characteristics of adult patients with depression in the UK treated with duloxetine and venlafaxine XR. Methods: Depressed adults treated with duloxetine or venlafaxine XR between 1/1/2006 and 9/30/2007 were identified using the General Practice Research Database (GPRD), which represents all primary care practices in the UK. Demographic (age and sex) and clinical characteristics (psychiatric and physical comorbid conditions and concomitant medication use) were examined and the characteristics of the two treatment groups were compared using chi-square or t tests, as appropriate. Results: Of 2,195 patients identified (mean age 47.2 years; 65.8% female), 41% were prescribed duloxetine and 59% were prescribed venlafaxine XR. On average, patients treated with duloxetine were older than patients treated with venlafaxine XR (49.6 years versus 45.5 years; p< 0.001). Compared to patients treated with venlafaxine XR, patients treated with duloxetine had higher prevalence of a variety of comorbid physical health conditions, including diseases of the circulatory, digestive, respiratory systems, as well as a higher prevalence of diabetes (p< 0.01 for all). Additionally, patients treated with duloxetine had higher prevalence of unexplained pain (p< 0.001). Greater proportions of patients treated with duloxetine had prescription utilization of medications in a variety of classes, including anticonvulsants, analgesics, migraine medications, as well as medications used to treat cardiovascular and gastrointestinal disorders (p< 0.01 for all). Conclusions: Depressed patients treated with duloxetine in the UK are slightly older and appear to be in poorer health overall than patients treated with venlafaxine XR. [Copyright &y& Elsevier]

Reports on the existence of geographical variations in the incidence of cervical cancer in Great Britain according to a study published by the Office for National Statistics Cancer Atlas of UK and Ireland.

Study of geographical variations in disease is a key component of descriptive epidemiology and can give important clues as to aetiology. For example, large international differences in incidence and mortality from coronary heart disease reflect to a great extent differences in the distributions of the major coronary risk factors-serum cholesterol (reflecting dietary patterns), smoking and blood pressure. That these differences are largely environmental rather than genetic in origin is apparent from the results of migrant studies where people moving from low disease risk areas to high risk areas tend to accrue the disease patterns of the new environment. Large differences in disease risk occur not only at international (or national) scales, but also at the local (small-area) scale. We investigated mortality at small-area scale in London in relation to various measures of socio-economic conditions, ethnicity and environmental pollution, especially outdoor air pollution.Geographical Information Systems (GIS) were used to bring the various health, demographic, socio-economic and environmental pollution data together at common geographic scale. The inter-relationships between these various factors, and the extent to which combinations of factors can explain any observed disease patterns, are explored using multivariate statistical techniques.We found 2-3 fold variations in risk of cardiovascular, cancer and all-cause mortality during 1991-1999 at the level of electoral ward, comprising on average 5,000 people. There were also marked variations on the same geographic scale in a range of indicators of socioeconomic conditions, and in the proportions of people from different ethnic groups based on census projections.The variations in mortality at small-area scale reflect a complex mix of differences between areas in ethnic make-up, sociodemography and socio-economic conditions — which in themselves reflect smoking, diet and other lifestyle factors as well as “environmental injustice” concerning potential differential exposure to environmental pollution. The findings have implications for environmental and public health policy. [ABSTRACT FROM AUTHOR]

Investigates legionnaire's disease in Great Britain. Identification of the disease; Analysis of the cases by age and sex; Review of the geographical distribution of legionnaire's disease.