BackgroundThe United Kingdom (UK) National Health Service (NHS) charging regulations have increasingly restricted migrants’ healthcare access, in the context of a wider national policy shift over the past few years intending to create a ‘hostile environment’ for migrants. With an estimated 144 000 undocumented children living in the UK and increasing public concern that these regulations are negatively impacting migrant health and well-being, as well as contravening international child rights agreements, it has become imperative to understand their implications.MethodsA mixed methods digital survey, covering attitudes towards and understanding of UK healthcare charging, and giving space for relevant case submission, was disseminated through communications channels of the Royal College of Paediatrics and Child Health (RCPCH) to their members. Quantitative data were analysed on Stata, and basic proportions were calculated for each response proportion. Qualitative data were analysed using a framework analysis approach.ResultsThere were 200 responses, from a range of healthcare professional backgrounds. The majority were not confident in interpreting and applying the charging regulations. One-third (34%) reported examples of the charging regulations impacting patient care, analysis of which elicited seven key themes. Our survey gathered 18 cases of migrants being deterred from accessing healthcare, 11 cases of healthcare being delayed or denied outright, and 12 cases of delay in accessing care leading to worse health outcomes, including two intrauterine deaths.DiscussionOur results describe a range of harms arising from the current NHS charging regulations contributing to delays in or denials of healthcare, due to patients’ fear of charging or immigration enforcement, including potential deportation, and confusion around entitlements. This harm affects individual patients, the migrant community and the NHS – often in multiple simultaneous ways. Many patients eligible for NHS care, such as trafficking victims, are not being identified as such. We found the current charging regulations to be unworkable, and that harm could not be eliminated simply through improved awareness or implementation.
Objective: Seizure recurrence following surgery for temporal lobe (TL) epilepsy may be related to extratemporal epileptogenic foci, so-called temporal-plus (TL+) epilepsy. Here, we sought to leverage whole brain connectomic profiling in magnetoencephalography (MEG) to identify neural networks indicative of TL+ epilepsy in children. Methods: Clinical and MEG data were analyzed for 121 children with TL and TL+ epilepsy spanning 20 years at the Hospital for Sick Children. Resting-state connectomes were derived using the weighted phase lag index from neuromagnetic oscillations. Multidimensional associations between patient connectomes, TL versus TL+ epilepsy, seizure freedom, and clinical covariates were performed using a partial least squares (PLS) analysis. Bootstrap resampling statistics were performed to assess statistical significance. Results: A single significant latent variable representing 66% of the variance in the data was identified with significant contributions from extent of epilepsy (TL vs TL+), duration of illness, and underlying etiology. This component was associated with significant bitemporal and frontotemporal connectivity in the theta, alpha, and beta bands. By extracting a brain score, representative of the observed connectivity profile, patients with TL epilepsy were dissociated from those with TL+, independent of their postoperative seizure outcome. Significance: By analyzing 121 connectomes derived from MEG data using a PLS approach, we find that connectomic profiling could dissociate TL from TL+ epilepsy. These findings may inform patient selection for resective procedures and guide decisions surrounding invasive monitoring.
By international standards, HIV/AIDS prevalence is low in Egypt (< 0.1%). However, questions about the accuracy of this figure are coupled with fears of an imminent increase in prevalence, with evidence suggesting that, despite Egypt's conservative culture, high-risk behaviour is more widespread than commonly reported and the country's changing socioeconomic context is perpetuating this trend. Through an analysis of the current HIV/AIDS surveillance system in Egypt, this paper explores some of the unique challenges this country faces in dealing with the HIV/AIDS epidemic. It concludes that constraints, such as Egypt's cultural norms and laws, the population's lack of knowledge about HIV/AIDS and the bureaucratic health system, hinder the development and implementation of effective surveillance systems. RÉSUMÉ Comparée aux normes internationales, la prévalence du VIH/sida est faible en Égypte (<0,1 %). Cependant, les interrogations sur la précision de ce chiffre sont associées à la crainte d'une augmentation imminente de la prévalence, avec des éléments qui laissent penser qu'en dépit d'une culture conservatrice en Égypte, les comportements à haut risque sont plus fréquents que communément rapporté et le contexte socio-économique qui tend à changer dans le pays accentue cette propension. Par le biais d'une analyse du système de surveillance actuel du VIH/sida en Égypte, le présent article examine certains des défis que ce pays doit relever face à l'épidémie de VIH/sida. Il conclut que les contraintes, telles les normes culturelles et la législation égyptiennes, le manque de connaissance de la population à propos du VIH/sida et le système de santé bureaucratique empêchent le développement et la mise en place des systèmes de surveillance efficaces.
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