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Zimmerman C, Hargreaves S, Lau K, Kiss L, Lin RCY, Pocock N. Addressing labour exploitation in the global workforce. Lancet 2024; 403:1748. [PMID: 38704165 DOI: 10.1016/s0140-6736(24)00459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/01/2024] [Indexed: 05/06/2024]
Affiliation(s)
- C Zimmerman
- London School of Hygiene and Tropical Medicine, London, UK
| | - S Hargreaves
- The Migrant Health Research Group, St George's University of London, London SW17 0RE, UK.
| | - K Lau
- The Migrant Health Research Group, St George's University of London, London SW17 0RE, UK
| | - L Kiss
- London School of Hygiene and Tropical Medicine, London, UK
| | - R Chia-Yin Lin
- The Migrant Health Research Group, St George's University of London, London SW17 0RE, UK
| | - N Pocock
- London School of Hygiene and Tropical Medicine, London, UK
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2
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Puchner KP, Giannakou V, Veizis A, Bougioukas K, Hargreaves S, Benos A, Kondilis E. COVID-19 vaccination roll-out and uptake among refugees and migrants in Greece: a retrospective analysis of national vaccination routine data. Public Health 2024; 229:84-87. [PMID: 38412698 DOI: 10.1016/j.puhe.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/01/2024] [Accepted: 01/13/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Refugees and migrants (R&Ms) exhibited higher risk of COVID-19 infection, and higher mortality rates during the pandemic. Acknowledging these risks, R&Ms early in the pandemic were identified by WHO as a priority vaccination group in need of protection. The aim of this study was to assess the vaccination roll-out and uptake among R&Ms residing in Reception Identification Centers (RICs) and Reception Sites (RSs) in Greece, relative to the general population. STUDY DESIGN Nationwide observational study. METHODS Retrospective analysis of national vaccination routine data and population census data, collected and triangulated from multiple official/governmental sources. Weekly vaccine roll-out and uptake were calculated for the general Greek population and the R&M population, through the first year of the vaccination programme in Greece (December 2020-December 2021). RESULTS Vaccine roll-out among migrants in RICs/RSs started with a 22-week delay, compared to the general population. By the end of the first year of the vaccination programme in Greece in December 2021, the national vaccination uptake among registered R&Ms residing in official reception facilities was 27.3 % for 1st dose and 4.7 % for booster dose; considerably lower compared to the general population (69.5 % uptake for 1st dose, 64.7 % for 2nd dose, and 32.0 % for 3rd dose). CONCLUSION Delayed vaccine roll-out and low vaccine uptake among R&Ms in Greece are signs of low prioritisation and implementation failures in the R&M vaccination strategy. In face of future public health threats, lessons should be learned, and vaccine equity should be insured for all socially vulnerable and high-risk population groups.
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Affiliation(s)
- K P Puchner
- Laboratory of Primary Health Care, General Medicine and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - V Giannakou
- MSc Program in Public Health and Health Policy, School of Medicine, Aristotle University of Thessaloniki, Greece
| | | | - K Bougioukas
- Laboratory of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - S Hargreaves
- Infection and Immunity Research Institute, St George's, University of London, UK
| | - A Benos
- Laboratory of Primary Health Care, General Medicine and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - E Kondilis
- Laboratory of Primary Health Care, General Medicine and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Greece.
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3
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Mercer CE, Hargreaves S, Hill C, Turnbull R, Szczepura K. An exploration of factors involved in the roll out of a digital application in breast services: A case study approach. Radiography (Lond) 2024; 30:666-672. [PMID: 38359756 DOI: 10.1016/j.radi.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Acceptance of new technologies in health care, by those who use them as part of their role, is challenging with confounding contextual factors surrounding the acceptance of technology. As healthcare is rapidly digitising, stakeholder groups should be included in each stage of evaluation and implementation to allow opportunities to influence and contribute to digital health policies. This research employed a case study methodology to initiate an exploration into the factors associated with implementing a digital application into a mammography service. It examined the initial implementation and subsequent impact of the rollout of a digital application (VA) within a breast service in South Australia. METHODS Stakeholders' opinions on team performance and feedback mechanisms of the digital application were evaluated through a staff questionnaire distributed through an online survey JISC. RESULTS The incorporation of digitised technology into a service is evidently met with challenges. Although there is potential value in utelising automated feedback for workflow improvement and patient services, it appears imperative to provide targeted and developmental resources for educational development and staff well-being during the implementation phase. CONCLUSION This case study approach delves into key discussion areas and serves as the initial insight into the implementation of a digital application. It could be regarded as a foundational reference for future evaluations of digital applications. IMPLICATIONS FOR PRACTICE Research around digital fluency within the radiography profession requires further consideration. Under-utilisation or resistance may result in missed opportunities to enhance patient experiences and care outcomes and support staff wellbeing. Therefore, continued engagement and the encouragement of user feedback during the implementation phase are crucial to demonstrate future acceptance of digital applications in clinical settings.
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Affiliation(s)
- C E Mercer
- School of Health and Society, University of Salford, Manchester M5 4WT, UK.
| | - S Hargreaves
- School of Health and Society, University of Salford, Manchester M5 4WT, UK.
| | - C Hill
- Bayer Australia Limited, Eastwood, SA 5063, Australia.
| | - R Turnbull
- Jones Radiology, Eastwood, SA 5063, Australia.
| | - K Szczepura
- School of Health and Society, University of Salford, Manchester M5 4WT, UK.
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4
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Pironon S, Ondo I, Diazgranados M, Allkin R, Baquero AC, Cámara-Leret R, Canteiro C, Dennehy-Carr Z, Govaerts R, Hargreaves S, Hudson AJ, Lemmens R, Milliken W, Nesbitt M, Patmore K, Schmelzer G, Turner RM, van Andel TR, Ulian T, Antonelli A, Willis KJ. The global distribution of plants used by humans. Science 2024; 383:293-297. [PMID: 38236975 DOI: 10.1126/science.adg8028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
Plants sustain human life. Understanding geographic patterns of the diversity of species used by people is thus essential for the sustainable management of plant resources. Here, we investigate the global distribution of 35,687 utilized plant species spanning 10 use categories (e.g., food, medicine, material). Our findings indicate general concordance between utilized and total plant diversity, supporting the potential for simultaneously conserving species diversity and its contributions to people. Although Indigenous lands across Mesoamerica, the Horn of Africa, and Southern Asia harbor a disproportionate diversity of utilized plants, the incidence of protected areas is negatively correlated with utilized species richness. Finding mechanisms to preserve areas containing concentrations of utilized plants and traditional knowledge must become a priority for the implementation of the Kunming-Montreal Global Biodiversity Framework.
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Affiliation(s)
- S Pironon
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), Cambridge, UK
| | - I Ondo
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), Cambridge, UK
| | - M Diazgranados
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
- International Plant Science Center, New York Botanical Garden, New York, NY, USA
| | - R Allkin
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
| | - A C Baquero
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), Cambridge, UK
| | - R Cámara-Leret
- Department of Systematic and Evolutionary Botany, University of Zurich, Switzerland
| | - C Canteiro
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
| | - Z Dennehy-Carr
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
- Herbarium, School of Biological Sciences, University of Reading, Whiteknights, UK
| | - R Govaerts
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
| | - S Hargreaves
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
| | - A J Hudson
- Royal Botanic Gardens, Kew, Wakehurst, Ardingly, UK
- Botanic Gardens Conservation International, Richmond, UK
| | - R Lemmens
- Wageningen University and Research, Wageningen, Netherlands
| | - W Milliken
- Royal Botanic Gardens, Kew, Wakehurst, Ardingly, UK
| | - M Nesbitt
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
- Department of Geography, Royal Holloway, University of London, Egham, UK
- Institute of Archaeology, University College London, London, UK
| | - K Patmore
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
| | - G Schmelzer
- Wageningen University and Research, Wageningen, Netherlands
| | - R M Turner
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
| | - T R van Andel
- Wageningen University and Research, Wageningen, Netherlands
- Naturalis Biodiversity Center, Leiden, Netherlands
| | - T Ulian
- Royal Botanic Gardens, Kew, Wakehurst, Ardingly, UK
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - A Antonelli
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
- Gothenburg Global Biodiversity Centre, Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Biology, University of Oxford, Oxford, UK
| | - K J Willis
- Royal Botanic Gardens, Kew, Richmond, Surrey, UK
- Department of Biology, University of Oxford, Oxford, UK
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5
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Hargreaves S, Carter J, Mehrotra A, Knights F, Deal A, Crawshaw AF, Wurie F, Ciftci Y, Majeed A. Exploring barriers to vaccine delivery in adult migrants: a qualitative study in primary care. Eur J Public Health 2022. [PMCID: PMC9593771 DOI: 10.1093/eurpub/ckac130.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to older migrant groups. Guidelines exist, however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. We explored the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born; 18+ years) with incomplete or uncertain vaccination status. Methods We did a qualitative interview study with purposive sampling and thematic analysis in UK primary care (50 practices included nationally; 1 hour qualitative interviews) with 64 primary care professionals (PCPs): 48 clinical staff including GPs, Practice Nurses and healthcare assistants (HCAs); 16 administrative staff including practice managers and receptionists (mean age 45 years; 84.4% female; a range of ethnicities). Results Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK's vaccine schedule, from both a personal and service-delivery level, with themes including: lack of training and knowledge of guidance around catch-up vaccination among staff; unclear or incomplete vaccine records; and lack of incentivization (including financial reimbursement) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal. Conclusions Vaccine uptake in adult migrants could be improved through implementing new financial incentives, strengthening care pathways and training, and working directly with local community groups to improve understanding around the benefits of vaccination at all ages. Key messages
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Mehrotra
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - AF Crawshaw
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - F Wurie
- Office for Improvements and Disparities, UK Health Security Agency London , London, UK
| | - Y Ciftci
- Doctors of the World UK , London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London , London, UK
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6
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Hargreaves S. Strengthening implementation of catch-up vaccination and multi-disease screening for new migrants. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Dr Hargreaves will discuss the current guidance for EU/EEA countries on public health considerations for newly arrived migrants, with a specific focus on catch-up vaccination delivery across the life course in mobile populations. She will explore current initiatives and best practices to ensure child, adolescent and adult refugees and migrants are included in catch-up planning and delivery for missed vaccines and missed doses and to align them with the host country vaccine schedule.
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Affiliation(s)
- S Hargreaves
- The Migrant Health Research Group , St Georges, , London, UK
- University of London , St Georges, , London, UK
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7
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Hargreaves S, Goldsmith LP, Rowland-Pomp M, Hanson K, Deal A, Crawshaw AF, Ahmad A, Razai M, Vandrevala T. The use of social media platforms by migrant populations during the COVID-19 pandemic. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The rapid expansion of internet and social media use has meant that both useful and potentially harmful health information can spread rapidly. Groups experiencing barriers to health systems may be more reliant on social media as a source of health information. We did a systematic review to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake.
Methods
We reviewed published and grey literature following PRISMA guidelines (PROSPERO registered CRD42021259190). Global research was included that reported on the use of social media by migrants and/or ethnic minority groups in relation to COVID-19.
Results
1849 unique records were screened, and 21 data sources included in our analysis involving studies from the UK, US, China, Jordan, Qatar, and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. There were positive and negative associations with social media use reported, with some evidence suggesting circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings of which are likely relevant to multiple population groups.
Conclusions
Urgent actions and further research are now needed to better understand the use of social media platforms for accessing health information by groups who may be marginalised from health systems, effective approaches to tackling circulating misinformation, and to seize on opportunities to make better use of social media platforms to support public health communication.
Key messages
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - M Rowland-Pomp
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - K Hanson
- Faculty of Health, Social Care and Education, Kingston University & St George’s , London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - AF Crawshaw
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Ahmad
- Population Health Research Institute, St George's University of London , London, UK
| | - M Razai
- Population Health Research Institute, St George's University of London , London, UK
| | - T Vandrevala
- Faculty of Health, Social Care and Education, Kingston University & St George’s , London, UK
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8
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Deal A, Crawshaw AC, Salloum M, Hayward SE, Knights F, Goldsmith LP, Carter J, Rustage K, Mounier-Jack S, Hargreaves S. Strategies to increase catch-up vaccination among migrants: a qualitative study and rapid review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
WHO’s Immunization Agenda 2030 has placed renewed focus on catch-up vaccination across the life course to meet global targets for reduction in vaccine-preventable diseases through increased vaccine coverage, including among migrant groups who may require catch-up vaccination to align them with host country vaccination schedules.
Methods
We did a global rapid review (01/2010 to 04/2022) to explore drivers of vaccine hesitancy among migrants followed by an in-depth qualitative study (semi-structured, telephone interviews) among recently arrived adult migrants (foreign-born, >18 years old, residing in the UK < 10 years). Interviews explored views on routine vaccination including accessibility, confidence and awareness. Data were analysed iteratively using thematic analysis.
Results
63 papers were included in the rapid review, including data from 22 countries/regions. Multiple factors driving under-immunisation and hesitancy in migrants were reported, including language barriers, low health literacy, social exclusion, low cultural competency and accessibility in healthcare systems. Our qualitative study recruited 40 migrants (mean age: 36.7 years; 62.5% female) resident in the UK (6 refugees, 19 asylum-seekers, 8 undocumented, 7 labour migrants). Major barriers to catch-up vaccination included a lack of provider recommendation and low awareness, with vaccination viewed as only relevant to children. Hesitancy around specific vaccines, such as MMR, was often influenced by misinformation. Participants suggested that novel strategies such as walk-in or mobile access points, consistent provider recommendations, and translation of information into relevant languages, may enhance accessibility and uptake of routine vaccinations.
Conclusions
Targeted and tailored information campaigns, versatile and proactive access pathways and education for healthcare staff on cultural competency will be needed to ensure uptake of catch-up vaccination among marginalised migrant groups.
Key messages
• Newly arrived adult migrants face barriers to catch-up vaccination in host countries, which may hinder immunisation coverage and increase the risk of vaccine-preventable disease outbreaks.
• Health systems must develop novel mechanisms to proactively offer culturally competent and accessible catch-up vaccination services to adult migrants on and after arrival.
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Affiliation(s)
- A Deal
- Institute for Infection and Immunity, St George’s, University of London , London, UK
- Faculty of Public Health and Policy, LSHTM , London, UK
| | - AC Crawshaw
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - M Salloum
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - SE Hayward
- Institute for Infection and Immunity, St George’s, University of London , London, UK
- Faculty of Public Health and Policy, LSHTM , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - J Carter
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | | | - S Hargreaves
- Institute for Infection and Immunity, St George’s, University of London , London, UK
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Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi SL, Knights F, Ciftci Y, Vandrevala T, Forster AS, Hargreaves S. Co-developing a tailored vaccination intervention with Congolese migrants: a participatory study. Eur J Public Health 2022. [PMCID: PMC9594176 DOI: 10.1093/eurpub/ckac131.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Disparities in vaccination uptake among migrant populations are well documented. WHO and ECDC have sought renewed focus on participatory research that engages migrants in co-producing tailored initiatives to address vaccination inequities and increase coverage. Methods This community-based participatory research study aims to engage Congolese migrants in co-developing a tailored approach to increase vaccine uptake. Phase 1 used poster walls and in-depth interviews with Congolese migrants (n = 32) to explore COVID-19 vaccination beliefs, experiences, and preferred information sources and communication methods, analysed iteratively and thematically in NVivo. Preliminary results Institutional distrust has shaped this population’s interpretation of the pandemic response and enabled vaccine misinformation and conspiracy theories to take hold. We found complex information networks and preference for Francophone, African and social media. Limited English proficiency and preference for the oral tradition restricted engagement with official public health messaging. Suspicion of government motives, low knowledge, and culturally specific perceptions about vaccination contributed to belief that breakthrough infections and need for COVID-19 boosters imply the vaccine is not effective. The population felt coerced by vaccination reminders and mandates, and were resultantly more hesitant to accept COVID-19 vaccination. Conclusions The population’s specific characteristics suggest that existing and trusted interpersonal networks and oral communication in first languages should be harnessed to spread credible information and encourage vaccine uptake, and mandate policies are unlikely to be effective. Training local role models to facilitate vaccination dialogues and myth-bust may be effective at changing behaviour. The next phases will gather more information from key stakeholders and engage migrants in workshops to co-design insight-driven, tailored interventions. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • Populations with strong interpersonal networks and low trust in public institutions may be receptive to tailored, community-centred dialogue approaches using local messengers and role models.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - C Hickey
- Hackney Refugee and Migrant Forum, Hackney CVS , London, UK
| | - LM Lutumba
- Hackney Congolese Women Support Group , London, UK
| | - LM Kitoko
- Hackney Congolese Women Support Group , London, UK
| | - SL Nkembi
- Hackney Congolese Women Support Group , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - Y Ciftci
- Doctors of the World UK , London, UK
| | - T Vandrevala
- Faculty of Health, Social Care and Education, Kingston and St George’s, University of London , London, UK
| | | | - S Hargreaves
- Institute for Infection and Immunity, St George’s, University of London , London, UK
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10
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Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi SL, Knights F, Ciftci Y, Vandrevala T, Forster AS, Hargreaves S. A community-based participatory approach to engaging Congolese migrants in intervention co-design. Eur J Public Health 2022. [PMCID: PMC9594374 DOI: 10.1093/eurpub/ckac129.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Issue The World Health Organization has called for tailored, community-based interventions to address disparities in vaccination uptake affecting migrant and minoritised populations, however few exist. This study directly responds to global calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination. Problem description Black and African migrants are known to be at risk of under-immunisation and have lower COVID-19 vaccine uptake rates in high-income countries. This UK study will use community-based participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead the study. Community members will be trained as peer researchers and financially compensated. The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community. Preliminary results The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants. Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised). Lessons Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study. Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort. This study offers an innovative engagement model and study design that can be adapted to other underserved populations. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George's, University of London , London, UK
| | - C Hickey
- Hackney Refugee and Migrant Forum, Hackney CVS , London, UK
| | - LM Lutumba
- Hackney Congolese Women Support Group , London, UK
| | - LM Kitoko
- Hackney Congolese Women Support Group , London, UK
| | - SL Nkembi
- Hackney Congolese Women Support Group , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George's, University of London , London, UK
| | - Y Ciftci
- Doctors of the World UK , London, UK
| | - T Vandrevala
- Faculty of Health, Social Care and Education, Kingston and St George's, University of London , London, UK
| | | | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London , London, UK
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Tack W, Engledow H, Veríssimo Pereira N, Amani C, Bachman SP, Barberá P, Beentje HJ, Bouka GUD, Cheek M, Cosiaux A, Dauby G, De Block P, Ewango CEN, Fischer E, Gereau RE, Hargreaves S, Harvey-Brown Y, Ikabanga DU, Ilunga wa Ilunga E, Kalema J, Kamau P, Lachenaud O, Luke Q, Mwanga Mwanga I, Ndolo Ebika ST, Nkengurutse J, Nsanzurwimo A, Ntore S, Richards SL, Shutsha Ehata R, Simo-Droissart M, Stévart T, Sosef MSM. The ECAT dataset: expert-validated distribution data of endemic and sub-endemic trees of Central Africa (Dem. Rep. Congo, Rwanda, Burundi). PhytoKeys 2022; 206:137-151. [PMID: 36761267 PMCID: PMC9849015 DOI: 10.3897/phytokeys.206.77379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 08/15/2022] [Indexed: 06/18/2023]
Abstract
In this data paper, we present a specimen-based occurrence dataset compiled in the framework of the Conservation of Endemic Central African Trees (ECAT) project with the aim of producing global conservation assessments for the IUCN Red List. The project targets all tree species endemic or sub-endemic to the Central African region comprising the Democratic Republic of the Congo (DR Congo), Rwanda, and Burundi. The dataset contains 6361 plant collection records with occurrences of 8910 specimens from 337 taxa belonging to 153 genera in 52 families. Many of these tree taxa have restricted geographic ranges and are only known from a small number of herbarium specimens. As assessments for such taxa can be compromised by inadequate data, we transcribed and geo-referenced specimen label information to obtain a more accurate and complete locality dataset. All specimen data were manually cleaned and verified by botanical experts, resulting in improved data quality and consistency.
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Affiliation(s)
- Wesley Tack
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
| | - Henry Engledow
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
| | - Nuno Veríssimo Pereira
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
| | - Christian Amani
- Université Officielle de Bukavu, Bukavu, Democratic Republic of the CongoIUCN SSC Eastern African Plant Red List Authority (EAPRLA)GlandSwitzerland
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
| | - Steven P. Bachman
- Royal Botanic Gardens, Kew, Richmond, Surrey, UKRoyal Botanic GardensRichmondUnited Kingdom
| | - Patricia Barberá
- Missouri Botanical Garden, Africa & Madagascar Department, St. Louis, MO 63110, USAMissouri Botanical Garden, Africa & Madagascar DepartmentSt. LouisUnited States of America
| | - Henk J. Beentje
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
- Royal Botanic Gardens, Kew, Richmond, Surrey, UKRoyal Botanic GardensRichmondUnited Kingdom
| | - Gaël U. D. Bouka
- Laboratoire de Biodiversité, de Gestion des Ecosystèmes et de l’Environnement, Faculté des Sciences et Techniques, Université Marien Ngouabi, BP 69, Brazzaville, Democratic Republic of the CongoUniversité Marien NgouabiBrazzavilleDemocratic Republic of the Congo
| | - Martin Cheek
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
- Royal Botanic Gardens, Kew, Richmond, Surrey, UKRoyal Botanic GardensRichmondUnited Kingdom
| | - Ariane Cosiaux
- Plant Systematics and Ecology Laboratory, University of Yaoundé I, P.O. Box 047, Yaoundé, CameroonUniversity of Yaoundé IYaoundéCameroon
- Institut de Recherche pour le Développement, Université de Montpellier, Montpellier, FranceUniversité de MontpellierMontpellierFrance
| | - Gilles Dauby
- Institut de Recherche pour le Développement, Université de Montpellier, Montpellier, FranceUniversité de MontpellierMontpellierFrance
| | - Petra De Block
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
| | - Corneille E. N. Ewango
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
- AMAP, Université de Montpellier, CIRAD, CNRS, INRAE, IRD, Montpellier, FranceUniversité de KisanganiKisanganiDemocratic Republic of the Congo
| | - Eberhard Fischer
- Centre de Surveillance de la Biodiversité, Université de Kisangani, Kisangani, Democratic Republic of the CongoUniversity of Koblenz and LandauKoblenzGermany
- University of Koblenz-Landau, Universitätsstraße 1, Koblenz, 56070, GermanyIUCN SSC Central Africa Plant Red List Authority (CARLA)GlandSwitzerland
| | - Roy E. Gereau
- Missouri Botanical Garden, Africa & Madagascar Department, St. Louis, MO 63110, USAMissouri Botanical Garden, Africa & Madagascar DepartmentSt. LouisUnited States of America
- University of Koblenz-Landau, Universitätsstraße 1, Koblenz, 56070, GermanyIUCN SSC Central Africa Plant Red List Authority (CARLA)GlandSwitzerland
| | - Serene Hargreaves
- Royal Botanic Gardens, Kew, Richmond, Surrey, UKRoyal Botanic GardensRichmondUnited Kingdom
| | - Yvette Harvey-Brown
- IUCN SSC Central Africa Plant Red List Authority (CARLA), Gland, SwitzerlandBotanic Gardens Conservation InternationalRichmondUnited Kingdom
| | - Davy U. Ikabanga
- Botanic Gardens Conservation International, Richmond, Surrey, UKUniversity of Sciences and Techniques of MasukuFrancevilleGabon
| | - Edouard Ilunga wa Ilunga
- Department of Biology, Faculty of Sciences, University of Sciences and Techniques of Masuku, BP: 941, Franceville, GabonUniversité de LubumbashiLubumbashiDemocratic Republic of the Congo
| | - James Kalema
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
- Herbarium de Lubumbashi, Université de Lubumbashi, 1825, Route Kasapa, Lubumbashi, Democratic Republic of the CongoMakerere University Herbarium, Department of Plant Sciences Microbiology and BiotechnologyKampalaUganda
| | - Peris Kamau
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
- Makerere University Herbarium, Department of Plant Sciences Microbiology and Biotechnology, P.O. Box 7062, Kampala, UgandaEast African Herbarium, National Museums of KenyaNairobiKenya
| | - Olivier Lachenaud
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
- East African Herbarium, National Museums of Kenya, P.O. Box 45166-00100, Nairobi, KenyaUniversité Libre de BruxellesBrusselsBelgium
| | - Quentin Luke
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
- Makerere University Herbarium, Department of Plant Sciences Microbiology and Biotechnology, P.O. Box 7062, Kampala, UgandaEast African Herbarium, National Museums of KenyaNairobiKenya
| | - Ithe Mwanga Mwanga
- Herbarium et Bibliothèque de Botanique africaine, C.P. 265, Université Libre de Bruxelles, Campus de la Plaine, Boulevard du Triomphe 1050, Brussels, BelgiumCentre de Recherche en Sciences Naturelles CRSN/Lwiro, Laboratoire de Systématiquement et Taxonomie végétaleBukavuDemocratic Republic of the Congo
| | - Sydney T. Ndolo Ebika
- Laboratoire de Biodiversité, de Gestion des Ecosystèmes et de l’Environnement, Faculté des Sciences et Techniques, Université Marien Ngouabi, BP 69, Brazzaville, Democratic Republic of the CongoUniversité Marien NgouabiBrazzavilleDemocratic Republic of the Congo
| | - Jacques Nkengurutse
- Centre de Recherche en Sciences Naturelles CRSN/Lwiro, Laboratoire de Systématiquement et Taxonomie végétale, D.S. Bukavu, Democratic Republic of the CongoUniversity of BurundiBujumburaBurundi
| | - Aimable Nsanzurwimo
- Department of Biology, Faculty of Science, University of Burundi, P.O. Box 2700, Bujumbura, BurundiDepartment of Biotechnologies, Faculty of Applied Sciences, INES-RuhengeriRuhengeriRwanda
| | - Salvator Ntore
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
- IUCN SSC Eastern African Plant Red List Authority (EAPRLA), Gland, SwitzerlandUniversité Officielle de BukavuBukavuDemocratic Republic of the Congo
- University of Koblenz-Landau, Universitätsstraße 1, Koblenz, 56070, GermanyIUCN SSC Central Africa Plant Red List Authority (CARLA)GlandSwitzerland
| | - Sophie L. Richards
- Royal Botanic Gardens, Kew, Richmond, Surrey, UKRoyal Botanic GardensRichmondUnited Kingdom
| | - Reddy Shutsha Ehata
- AMAP, Université de Montpellier, CIRAD, CNRS, INRAE, IRD, Montpellier, FranceUniversité de KisanganiKisanganiDemocratic Republic of the Congo
| | - Murielle Simo-Droissart
- Plant Systematics and Ecology Laboratory, University of Yaoundé I, P.O. Box 047, Yaoundé, CameroonUniversity of Yaoundé IYaoundéCameroon
- Department of Biotechnologies, Faculty of Applied Sciences, INES-Ruhengeri, B.P.155 Ruhengeri, RwandaUCN SSC Central Africa Plant Red List Authority (CARLA)GlandSwaziland
| | - Tariq Stévart
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
- Missouri Botanical Garden, Africa & Madagascar Department, St. Louis, MO 63110, USAMissouri Botanical Garden, Africa & Madagascar DepartmentSt. LouisUnited States of America
- University of Koblenz-Landau, Universitätsstraße 1, Koblenz, 56070, GermanyIUCN SSC Central Africa Plant Red List Authority (CARLA)GlandSwitzerland
- East African Herbarium, National Museums of Kenya, P.O. Box 45166-00100, Nairobi, KenyaUniversité Libre de BruxellesBrusselsBelgium
| | - Marc S. M. Sosef
- Meise Botanic Garden, Nieuwelaan 38, 1860 Meise, BelgiumMeise Botanic GardenMeiseBelgium
- University of Koblenz-Landau, Universitätsstraße 1, Koblenz, 56070, GermanyIUCN SSC Central Africa Plant Red List Authority (CARLA)GlandSwitzerland
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Luan L, Fraisse P, Cordel H, Charlois C, Méchaï F, Ibanez G, Hargreaves S, Mechain M, Vignier N. Screening for active and latent TB among migrants in France. Int J Tuberc Lung Dis 2021; 25:903-910. [PMID: 34686232 DOI: 10.5588/ijtld.21.0231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Migrants to Europe face a disproportionate burden of infections, including TB, yet little is known about the approach taken by primary and secondary care providers to screening and treatment. We therefore explored policy and practice relating to screening of active TB and latent TB infection (LTBI) in France.METHODS: We conducted an online national survey of French primary and secondary care physicians regarding their practices in relation to TB/LTBI screening among migrants.RESULTS: 367 physicians responded to the questionnaire among which 195 (53.1%) were primary care physicians, 126 (34.3%) were TB specialists in secondary care, and 46 (12.5%) other physicians; 303 (85.5%) were involved daily in the care of migrants. Most respondents recommended systematic TB screening with chest X-ray for migrants from medium and high-incidence countries (71.9%). Primary care physicians were less likely to offer screening than physicians in other settings (aOR 0.21, 95% CI 0.09-0.48). 220 (61.8%) offered LTBI screening for children (<15 years) and 34.0% for all migrants from high incidence countries.CONCLUSION: Improving awareness on TB screening is a critical next step to improve health outcomes in migrant groups and meet regional targets for tackling TB.
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Affiliation(s)
- L Luan
- Groupe hospitalier Sud Ile-de-France, Department of Public Health, Melun, Department of Social Epidemiology, Unité mixte de Recherche (UMR) 1136, Institut Pierre Louis d´Épidémiologie et de Santé Publique, Institut national de la Santé et de la Recherche médicale (INSERM), Sorbonne Université, Paris
| | - P Fraisse
- National network of TB control centres, Strasbourg Hospital, Strasbourg, France
| | - H Cordel
- Department of Tropical and Infectious Disease, Hôpital Avicenne, Assistance publique - Hôpitaux de Paris, Hôpitaux universitaires Paris Seine Saint-Denis, Université Sorbonne Paris Nord, Bobigny, France
| | - C Charlois
- Paris Tuberculosis Control Centre, Strasbourg, France
| | - F Méchaï
- Department of Tropical and Infectious Disease, Hôpital Avicenne, Assistance publique - Hôpitaux de Paris, Hôpitaux universitaires Paris Seine Saint-Denis, Université Sorbonne Paris Nord, Bobigny, France, Infection Antimicrobials Modelling Evolution, INSERM UMR 1137, Université Sorbonne Paris Nord, Paris, France
| | - G Ibanez
- Department of Social Epidemiology, Unité mixte de Recherche (UMR) 1136, Institut Pierre Louis d´Épidémiologie et de Santé Publique, Institut national de la Santé et de la Recherche médicale (INSERM), Sorbonne Université, Paris, Department of General Practice, Sorbonne Université, Paris, France
| | - S Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George´s University of London, London, UK
| | - M Mechain
- Bordeaux University Hospital, Bordeaux, France
| | - N Vignier
- Groupe hospitalier Sud Ile-de-France, Department of Public Health, Melun, Department of Social Epidemiology, Unité mixte de Recherche (UMR) 1136, Institut Pierre Louis d´Épidémiologie et de Santé Publique, Institut national de la Santé et de la Recherche médicale (INSERM), Sorbonne Université, Paris, Department of Tropical and Infectious Disease, Hôpital Avicenne, Assistance publique - Hôpitaux de Paris, Hôpitaux universitaires Paris Seine Saint-Denis, Université Sorbonne Paris Nord, Bobigny, France, Centre d´Investigation clinique (CIC) Antilles Guyane, CIC INSERM 1424, Département de Recherche Innovation et Santé Publique, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Crawshaw AF, Farah Y, Deal A, Goldsmith LP, Carter J, Rustage K, Campos-Matos I, Vandrevala T, Forster AS, Hargreaves S. Analysing drivers of routine and COVID-19 vaccination in migrants to develop tailored interventions. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrant-sensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic.
Methods
We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out.
Results
We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns about side-effects, and cultural beliefs/stigma around specific vaccinations. Migrants who had recently arrived, were older, female or of African and Eastern Mediterranean origin were at risk for under-immunisation for key vaccine-preventable diseases. Migrant community leaders reported considerable hesitancy towards COVID-19 vaccination in their communities and misinformation circulating via social media. Leaders requested support in producing simple COVID-19 guidance that could be translated and adapted locally, alongside more meaningful engagement and partnership-working.
Conclusions
Access barriers and vaccine hesitancy may affect vaccine uptake in some migrant populations in Europe, which needs to be urgently addressed for COVID-19 vaccine roll-out but also beyond the pandemic to strengthen uptake of routine vaccinations. Actively involving migrant communities in the planning, co-production and implementation of tailored and targeted approaches will be essential.
On behalf of ESGITM.
Key messages
Access barriers and vaccine hesitancy (from information gaps, cultural factors) contribute to low vaccine uptake in some migrant populations in the EU/EEA, with implications for COVID-19 vaccination. Meaningful engagement and co-production of tailored approaches with under-immunised migrants are urgently needed to ensure their inclusion in COVID-19 and routine vaccination programmes.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Y Farah
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - I Campos-Matos
- Health Improvement Division, Public Health England, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - T Vandrevala
- Department of Psychology, Kingston University London, London, UK
| | - AS Forster
- Department of Behavioural Science and Health, University College London, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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Hargreaves S, Kondilis E, Papamichail D, McCann S, Orcutt M, Carruthers E, Veizis A. The impact of COVID-19 on migrants in Greece: a retrospective analysis of national data. Eur J Public Health 2021. [PMCID: PMC8574628 DOI: 10.1093/eurpub/ckab164.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background For 56,000 refugees and asylum seekers in Reception and Identification Centres (RICs) and Reception Sites (RS) in Greece, living in severely substandard living conditions, prevention measures have been severely limited. We assessed the impact of COVID-19 on migrants in these settings. Methods We did a retrospective analysis of policy documents and national surveillance data to identify COVID-19 outbreaks and estimate incidence among migrants residing in these camps (26th Feb - 15th Nov 2020). Incidence proportion (IP) of COVID-19 confirmed cases was calculated for three population groups (migrant populations in RICs, migrant populations in RSs, and the general population in Greece) during three time periods (first wave, second wave, and overall across the 9-month period). Results 25 outbreaks were identified in migrant reception facilities, with 6 (85.7%) of 7 RICs and 18 (56.3%) of 32 RSs reporting at least one outbreak during the study period. The overall 9-month COVID-19 IP among refugee and asylum seeker populations residing in RSs on the Greek mainland was 1,758 cases per 100,000 population; in RICs the incidence was 2,052 cases per 100,000 population. Compared to the general population the risk of COVID-19 infection among migrants in reception facilities was 2.5 to 3 times higher; the risk of acquiring COVID-19 infection was higher among migrant populations in RSs on the Greek mainland (IP ratio: 2.45; 95% CI: 2.25-2.68) but higher still among migrant populations in RICs in the Greek islands and the land border with Turkey (IP ratio: 2.86; 95% CI: 2.64-3.10), where living conditions are particularly poor. Conclusions We identified high levels of COVID-19 transmission among migrants in reception facilities in Greece, with immediate implications for policy and practice to ensure refugee and asylum seeker populations are included in national response plans to reduce transmission, alongside ensuring their inclusion in plans for COVID-19 vaccine roll out. Key messages Thousands of migrants in Greece live in severely substandard conditions and largely excluded from the COVID-19 response. We identified high levels of COVID-19 transmission among migrants in reception facilities in Greece, with immediate implications for policy and practice.
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Affiliation(s)
- S Hargreaves
- Migrant Health Research Group, St George's University of London, London, UK
| | - E Kondilis
- Laboratory of Primary Health Care, General Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Papamichail
- Department of Public Health Policy, University of West Attica, Attica, Greece
| | - S McCann
- Institute for Global Health, University College London, London, UK
| | - M Orcutt
- Institute for Global Health, University College London, London, UK
| | - E Carruthers
- Institute for Global Health, University College London, London, UK
| | - A Veizis
- INTERSOS Hellas, Thessaloniki, Greece
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Hayward SE, Deal A, Cheng C, Orcutt M, Norredam M, Veizis A, Campos-Matos I, McKee M, Kumar B, Hargreaves S. Impact of COVID-19 on migrant populations in high-income countries: a systematic review. Eur J Public Health 2021. [PMCID: PMC8574658 DOI: 10.1093/eurpub/ckab164.882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Migrants in high-income countries (HICs) may have been disproportionately affected by the COVID-19 pandemic, yet the extent to which they are impacted, and their predisposing risk factors, are not clearly understood. We did a systematic review to assess clinical outcomes, indirect health and social impacts, and key risk factors in migrants. Methods Our systematic review following PRISMA guidelines (PROSPERO CRD42020222135) identified peer-reviewed and grey literature relating to migrants (foreign-born) and COVID-19 in 82 HICs. Primary outcomes were cases, hospitalisations and deaths from COVID-19 involving migrants; secondary outcomes were indirect health and social impacts and risk factors. Results 3016 data sources were screened with 158 from 15 countries included in the analysis. We found migrants are at increased risk of SARS-CoV-2 infection and are over-represented among cases (e.g. constituting 42% of cases in Norway [to 27/4/2020], 26% in Denmark [to 7/9/2020], and 32% in Sweden [to 7/5/2020]); some datasets from Europe show migrants may be over-represented in deaths with increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected, with certain nationality groups disproportionately impacted. Migrants experience a range of risk factors for COVID-19, including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. Conclusions Migrants in HICs are at high risk of COVID-19, with a range of specific risk factors that have not been well-considered in the public health response to date. These data are of immediate relevance to the policy response to the pandemic, with strategies urgently needed to reduce transmission. Migrant populations must also be better considered in national plans for COVID-19 vaccination roll-out. On behalf of ESGITM Key messages Migrants in high-income countries may be disproportionately represented in COVID-19 infections and deaths, with higher levels of many vulnerabilities and risk factors. Migrants must be better included in all aspects of the pandemic response, including vaccination roll-out.
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Affiliation(s)
- SE Hayward
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - C Cheng
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - M Orcutt
- Institute for Global Health, University College London, London, UK
| | - M Norredam
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - A Veizis
- Médecins Sans Frontières Greece, Athens, Greece
| | - I Campos-Matos
- Public Health England, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - M McKee
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - B Kumar
- Norwegian Institute of Public Health, Oslo, Norway
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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Hargreaves S, Carter J, Knights F, Deal A, Goldsmith L, Crawshaw AF, Hayward S, Zenner D, Wurie F, Hall R. Digital screening tool (Health Catch-UP!) to promote multi-disease screening in migrants. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The ECDC has called for innovative strategies to deliver multi-disease screening (TB, LTBI, HIV, hepatitis B/C, Chagas, Strongyloidiasis and schistosomiasis) and catch-up vaccination (MMR, DTP) to adult migrants within the primary care context. We did a UK i qualitative study to explore current practice and seek views on a novel integrated digital tool to support delivery of screening recommendations for migrants https://emishealth.vids.io/videos/a49ad1bb1a18e4c72c/health-catch-up-with-requested-edits-mp4).
Methods
Phase 1 was conducted via telephone with clinical primary care practitioners (PCPs) (phase 1) and informed data collection and analysis for phase 2 with administrative staff. Data were analysed iteratively, informed by thematic analysis (Ethics no.20/HRA/1674).
Results
64 participants were recruited in Phase 1 (25 general practitioners [GPs], 15 nurses, 7 healthcare assistants, 1 pharmacist); Phase 2 comprised administrative staff (11 Practice-Managers, 5 receptionists). There was lack of consistency in delivery of screening and vaccination. Most GP practices adopted a practice-specific approach, or had no system in place; screening only for HIV and hepatitis B/C. Barriers to screening were perceived lack of knowledge/training and limited financial resources. Facilitators included having an infectious disease/migrant-health champion, incentivisation, and clear protocols. Participants responded positively to the integrated Health Catch-UP! tool, confirming that it would increase screening and vaccination, reduce missed opportunities for preventative healthcare, and raise awareness of migrant health.
Conclusions
Infectious disease screening and catch-up vaccination is not currently delivered well in primary care in high-migrant receiving European countries. Innovative digital tools like Health Catch-UP! could aid clinical decision-making and facilitating improved health outcomes for migrants. Further work is needed to evaluate this intervention.
Key messages
Infectious disease screening and catch-up vaccination is not currently delivered well in primary care in high-migrant receiving European countries. Innovative digital tools could aid clinical decision-making and facilitating improved health outcomes for migrants.
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Affiliation(s)
- S Hargreaves
- Migrant Health Research Group, St George's University of London, London, UK
| | - J Carter
- Migrant Health Research Group, St George's University of London, London, UK
| | - F Knights
- Migrant Health Research Group, St George's University of London, London, UK
| | - A Deal
- Migrant Health Research Group, St George's University of London, London, UK
| | - L Goldsmith
- Migrant Health Research Group, St George's University of London, London, UK
| | - AF Crawshaw
- Migrant Health Research Group, St George's University of London, London, UK
| | - S Hayward
- Migrant Health Research Group, St George's University of London, London, UK
| | - D Zenner
- Queen Mary's, University of London, London, UK
| | - F Wurie
- Health Improvement Directorate, Public Health England, London, UK
| | - R Hall
- Migrant Health Research Group, St George's University of London, London, UK
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Hayward SE, Deal A, Rustage K, Nellums LB, Sweetland AC, Boccia D, Hargreaves S, Friedland JS. A systematic review of the association between mental health and tuberculosis disease risk. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Tuberculosis (TB) and mental illnesses are highly prevalent globally and often co-exist. Whilst poor mental health is known to modulate immune function, whether mental disorders causally increase TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and public health measures.
Methods
We carried out a systematic review following PRISMA guidelines (PROSPERO CRD42019158071). We searched MEDLINE, PsycINFO and PsycEXTRA databases alongside reference list and citation searching. Inclusion criteria were original research studies published 01/01/1970-11/05/2020 reporting data on the relationship between mental health and risk of TB disease. CASP and AXIS checklists were used to critically appraise included studies.
Results
We screened 1546 records published over 50 years, resulting in data synthesised from 607,184 individuals. Settings include Asia, South America, and Africa, and both mood (e.g. depression) and psychotic (e.g. schizophrenia) disorders are investigated. Robust evidence from cohort studies in Asia shows that depression and schizophrenia can increase risk of TB disease, with effect estimates ranging from HR = 1.15 [95% CI 1.03-1.28] to HR = 2.63 [95% CI 1.74-3.96] for depression and HR = 1.52 [95% CI 1.29-1.79] to RR = 3.04 for schizophrenia, and a dose-response relationship reported in one study. These data are consistent with data from cross-sectional studies, such as a large survey across low- and middle-income countries (n = 242,952) reporting OR = 3.36 [95% CI 3.01-4.50] for a depressive episode in those with TB versus those without.
Conclusions
Individuals with mental illnesses including depression and schizophrenia experience increased TB incidence and represent a high-risk population to target for screening and treatment. Integrated care for mental health and TB is needed, and interventions tackling mental illnesses and underlying drivers may help reduce TB incidence globally.
Key messages
This systematic review examines data from 607,184 individuals and finds evidence that mental health is a risk factor for TB disease. Those suffering from depression and schizophrenia are an at-risk population that could be identified and targeted for TB screening and treatment.
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Affiliation(s)
- SE Hayward
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - LB Nellums
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - AC Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA
| | - D Boccia
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - JS Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
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18
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Paterson C, Hargreaves S, Rumley CN. Functional Imaging to Predict Treatment Response in Head and Neck Cancer: How Close are We to Biologically Adaptive Radiotherapy? Clin Oncol (R Coll Radiol) 2020; 32:861-873. [PMID: 33127234 DOI: 10.1016/j.clon.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
It is increasingly recognised that head and neck cancer represents a spectrum of disease with a differential response to standard treatments. Although prognostic factors are well established, they do not reliably predict response. The ability to predict response early during radiotherapy would allow adaptation of treatment: intensifying treatment for those not responding adequately or de-intensifying remaining therapy for those likely to achieve a complete response. Functional imaging offers such an opportunity. Changes in parameters obtained with functional magnetic resonance imaging or positron emission tomography-computed tomography during treatment have been found to be predictive of disease control in head and neck cancer. Although many questions remain unanswered regarding the optimal implementation of these techniques, current, maturing and future studies may provide the much-needed homogeneous cohorts with larger sample sizes and external validation of parameters. With a stepwise and collaborative approach, we may be able to develop imaging biomarkers that allow us to deliver personalised, biologically adaptive radiotherapy for head and neck cancer.
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Affiliation(s)
- C Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | | | - C N Rumley
- Department of Radiation Oncology, Townsville University Hospital, Douglas, Australia; South Western Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
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Hargreaves S, Himmels J, Nellums LB, Biswas G, Gabrielli AF, Gebreselassie N, Zignol M, Schellenberg D, Norris SL, Ford N, Maher D. Identifying research questions for HIV, tuberculosis, tuberculosis-HIV, malaria, and neglected tropical diseases through the World Health Organization guideline development process: a retrospective analysis, 2008-2018. Public Health 2020; 187:19-23. [PMID: 32889228 PMCID: PMC7660115 DOI: 10.1016/j.puhe.2020.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES World Health Organization (WHO) guidelines for health programmes and healthcare delivery are the foundation of its technical leadership in public health and essential to decision-making globally. A key function of guideline development is to identify areas in which further evidence is needed because filling these gaps will lead to future improvements in population health. The objective of this study was to examine the knowledge gaps and research questions for addressing those gaps generated through the WHO guideline development process, with the goal of informing future strategies for improving and strengthening the guideline development process. STUDY DESIGN We did a systematic, retrospective analysis of research questions identified in the published guidelines. METHODS We analyzed guidelines published between January 1, 2008, and December 31, 2018, by the Communicable Diseases Cluster in five disease areas: tuberculosis (TB), HIV, malaria, TB-HIV, and neglected tropical diseases (NTDs). Research questions were extracted independently by two researchers. We analyzed the distribution of research questions by disease and by topic category and did a qualitative assessment of optimum practice for research question generation during the guideline development process. RESULTS A total of 48 guidelines were included: 26 on HIV, 1 on malaria, 11 on TB, 5 on TB/HIV, and 5 on NTDs. Overall, 36 (75%) guidelines encompassed a total of 360 explicit research questions; the remainder did not contain specific research questions. The number of research questions that focused on TB was 49, TB/HIV was 38, HIV was 250, and NTDs was 23. The number of research questions that focused on diagnosis was 43 (11.9%) of 360, prevention was 62 (17.2%), treatment was 103 (28.6%), good practice was 12 (3.3%), service delivery was 86 (23.8%), and other areas was 54 (15%). Research questions were often not formulated in a specific or actionable way and were hard to identify in the guideline. Examples of good practice identified by the review team involved the generation of specific and narrowly defined research questions, with accompanying recommendations for appropriate study design. CONCLUSIONS The WHO must strengthen its approach to identifying and presenting research questions during the guideline development process. Ensuring access to research questions is a key next step in adding value to the guideline development process.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, UK
| | - J Himmels
- Institute for Infection and Immunity, St George's, University of London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George's, University of London, UK
| | - G Biswas
- World Health Organization, Geneva, Switzerland
| | | | | | - M Zignol
- World Health Organization, Geneva, Switzerland
| | | | - S L Norris
- World Health Organization, Geneva, Switzerland
| | - N Ford
- World Health Organization, Geneva, Switzerland
| | - D Maher
- World Health Organization, Geneva, Switzerland.
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20
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Hargreaves S, Nellums LB, Powis J, Jones L, Miller A, Rustage K, Russell N, Friedland J. Exploring the views of undocumented migrant women on access to maternity services in the UK. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Migrant women face inequalities in access to health-care services and are known to experience poorer maternal and child outcomes than women born in the UK. The development of more restrictive health policies in the UK and Europe, including being denied or charged for healthcare at maternity services, may be exacerbating these outcomes, particularly among undocumented migrant women without permission to reside. We investigated undocumented migrant women's experiences of accessing maternity services in the UK and their impact on health outcomes.
Methods
We did semi-structured in-depth qualitative interviews with a purposive sample of migrant women (born outside the UK) who were aged 18 and over, and had experiences of pregnancy in the UK whilst undocumented. Participants were recruited through the Doctors of the World UK clinic. Interviews were transcribed and analysed using thematic analysis.
Results
We did interviews with 20 undocumented women (age range 31-40 years; mainly from Africa and Asia). Among participants, of whom 13 were pregnant at the time of interview, 10 (50%) first accessed antenatal care late (after the national target of 13 weeks). Women described an ongoing cycle of precariousness, defined by their legal status, social isolation, and poor economic status. Women reported receiving bills of up to £11,500 for maternity services (range £3,072 to £11.500). The impact of their experiences meant that they were deterred from seeking timely health care and were reluctant to present to health services, with women reporting fear and loss of trust in the health system.
Conclusions
These women's narratives illustrated the potential deterrent and detrimental impact of increasingly restrictive health policies on women's access to care and their health. UK and European health policies must be equitable, non-discriminatory, and better align with our commitments to promote universal health coverage among all individual residing in the region.
Key messages
Increasingly restrictive health policies may have a deterrent and detrimental impact on migrant women’s access to health care. Undocumented migrant women in the UK reported fear and loss of trust in the health system.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George's University of London, London, UK
- University of Nottingham, London, UK
| | - J Powis
- Imperial College London, London, UK
| | - L Jones
- Doctors of the World UK, London, UK
| | - A Miller
- Doctors of the World UK, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - N Russell
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Friedland
- Institute for Infection and Immunity, St George's University of London, London, UK
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Hargreaves S. Are migrants to Europe an under-immunised group and involved in outbreaks? Implications for health systems, policy, and practice. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Migrant populations (defined as foreign-born) in the EU/EEA may be one of several under-immunised populations yet their role in outbreaks of vaccine-preventable diseases (VPDs) has been poorly defined to date. In this talk, SH will summarise our current understanding of the problem and explore implications for heath systems in Europe, policy, and practice in light of new ECDC guidelines detailing approaches to vaccination in recently arrived migrants to Europe.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
- ESCMID/ESGITM, ESCMID Study Group for Infections in Travellers and Migrants, London, UK
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22
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Hargreaves S, Deal A, Mounier-Jack S, Campos-Matos I, Edelstein M, Hayward S, Friedland J, Carter J, Rustage K, Majeed A. Migration and outbreaks of vaccine-preventable disease in Europe: a systematic analysis (1990-2019). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Migrant populations (defined as foreign-born) in the EU/EEA may be one of several under-immunised populations yet their role in outbreaks of vaccine-preventable diseases (VPDs) has been poorly defined to date.
Methods
We did both a temporal analysis to map published reports of migrant-related outbreaks against data from the ECDC's Surveillance Atlas of Infectious Disease, and a systematic review (PROSPERO CRD42019157473; 1990-2019) adhering to PRISMA guidelines, to explore whether migrants are involved in outbreaks in Europe and which particular subpopulations may be at increased risk. Studies on VPD outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, N meningitidis, and H influenzae) in migrants residing in the EU/EEA were included.
Results
46 studies were included, reporting on 50 VPD outbreaks across 13 EU/EEA countries, of which 98% (n = 49) occured since January 2000. Measles had the highest number of reports of outbreaks involving migrants (n = 21; 5043 cases), followed by varicella (n = 10; 595 cases) and hepatitis A (n = 10; 1226 cases). 21 (40%) of outbreaks were reported from shelters for asylum seekers and refugees (mainly varicella or measles). Of 27 outbreaks where the index case was defined, 20 (74.1%) were migrants, including 9 (33.3%) from Eastern Europe and 6 (22.2%) from Africa. When mapped against the ECDC timeline of measles outbreaks, migrant-related outbreaks coincide with Europe-wide peaks in measles incidence (in 2006, 2010, and 2018).
Conclusions
Migrants represent one key group involved in VPD outbreaks, with refugees/asylum seekers residing in shelters or camps particularly at risk. Measles accounted for 38% of all reported outbreaks. Improved data collection on migrant status across Europe is crucial to understanding the complex relationship between migration and occurrence of VPD outbreaks to inform policy decisions on the most effective strategies to prevent future outbreaks.
Key messages
Migrants represent one key group involved in vaccine-preventable diseases outbreaks in Europe. Refugees and asylum seekers may be particularly at risk.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | | | | | - S Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Friedland
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - A Majeed
- Department Primary Care and Public Health, Imperial College London, London, UK
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23
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Hayward SE, van der Werf MJ, Noori T, Nellums LB, Boccia D, Friedland JS, Hargreaves S. Extrapulmonary tuberculosis among migrants in the EU/EFTA: Implications for policy and practice. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The proportion of tuberculosis (TB) cases in the European Union/European Free Trade Association (EU/EFTA) that occur in migrants is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality. To date, there has been no in-depth exploration of extrapulmonary TB in migrants across Europe.
Methods
We analysed 22 years of data from the European Centre for Disease Prevention and Control's European Surveillance System (TESSy) for 32 EU/EFTA countries between 1995 and 2017. We investigated whether the proportion of TB cases that were extrapulmonary varied between migrants and non-migrants, and whether this varied by a) country/region of origin, b) reporting country/region, and c) site of disease.
Results
1,270,896 TB cases were included in the analysis, comprising 326,987 (25.7%) migrants, and 943,909 (74.3%) non-migrants. The proportion of TB that is extrapulmonary is significantly higher in migrants than in non-migrants: 45.2% (n = 147,814) of cases in migrants were extrapulmonary, compared to 21.7% (n = 204,613) in non-migrants (χ2=6.7x104, p < 0.001). A relatively low proportion of extrapulmonary TB was seen in Eastern (17.4%) and Southern (29.6%) Europe compared with Western (35.7%) and Northern (41.8%) Europe, with migrants having a greater proportion of extrapulmonary TB only in Northern/Western Europe. Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary TB, with over half of all cases being extrapulmonary (62.0% and 54.5% respectively).
Conclusions
Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than non-migrants, which has clinical and policy implications for patient detection and management. There is a need to improve clinical awareness of extrapulmonary TB, integrate detection of extrapulmonary TB into latent TB infection screening programmes, and harmonise data collection on migrant status in health systems.
Key messages
Migrants in the EU/EFTA are disproportionately affected by extrapulmonary TB compared to non-migrants. This has clinical and policy implications for diagnosis, screening, and data collection.
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Affiliation(s)
- S E Hayward
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - T Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - L B Nellums
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
| | - D Boccia
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - J S Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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24
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Hargreaves S, Himmels J, Nellums LB, McGuire E, Friedland JS. Vaccination status of migrant populations in EU/EEA countries and implications for VPD control. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Migrant populations in the EU/EEA are increasingly being associated with outbreaks of vaccine-preventable diseases (VPDs), including the large-scale measles outbreak currently ongoing across Europe; however, it is unclear to what extent migrants represent an under-immunised group in the European context and implications for VPD control. Ensuring high levels of vaccination coverage is a key priority for all countries through the European Vaccine Action Plan, with EU/EEA Member States committed to eliminating measles and rubella, sustaining polio-free status, and controlling hepatitis B infection. We synthesised existing EU/EEA data to assess under-immunisation in migrants (defined as foreign born) residing in EU/EEA countries.
Methods
We did a systematic review and meta-analysis (PROSPERO CRD42018103666) in accordance with PRISMA guidelines. Inclusion criteria were primary research studies pertaining to vaccination status (measles, mumps, rubella, diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b [Hib]) in migrants residing in all EU/EEA countries. Pooled prevalence (95% CIs) were calculated for the meta-analysis using a random effects model.
Results
56 studies met our criteria (14 EU/EEA countries); 36 studies, which included data from 80,432 migrants, were included in the meta-analysis. Vaccination status of migrants for key VPDs varied substantially, with pooled immunisation coverage well below the herd immunity threshold (HIT) targets for measles 80% (95% CI: 73-87%; HIT 92-95%), mumps 65% (95% CI: 48-82%; HIT 75-86%), and diphtheria 51% (95% CI: 29-73%; HIT 83-86%). Polio type 1 and 2 coverage was high (97% [95% CI: 95-98%]; 95 [95% CI: 92-97%], respectively).
Conclusions
Migrants represent an under-immunised group in Europe, thus a high priority group for catch-up vaccination. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and/or control of key VPDs.
Key messages
Migrants represent an under-immunised group in Europe and a high priority group for catch-up vaccination campaigns. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and control of vaccine-preventable diseases.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - J Himmels
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - E McGuire
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - J S Friedland
- Institute for Infection and Immunity, St George’s University of London, London, UK
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Hargreaves S, Zandonadi R, Nakano E, Botelho R, Ginani V, Araújo W. Development of a Specific Vegetarian Diet Quality of Life Questionnaire for Brazilian Adult Population. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.08.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Hargreaves S, Johnstone E, Parkinson C, Rackley T, Spezi E, Staffurth J, Evans M. Interim 18F-FDG Positron Emission Tomography/Computed Tomography During Chemoradiotherapy in the Management of Cancer Patients: a Response. Clin Oncol (R Coll Radiol) 2019; 31:669-670. [PMID: 31151841 DOI: 10.1016/j.clon.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/24/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - E Johnstone
- Department of Engineering, Cardiff University, Cardiff, UK
| | - C Parkinson
- Department of Engineering, Cardiff University, Cardiff, UK
| | | | - E Spezi
- Department of Engineering, Cardiff University, Cardiff, UK
| | - J Staffurth
- Velindre Cancer Centre, Cardiff, UK; Department of Engineering, Cardiff University, Cardiff, UK
| | - M Evans
- Velindre Cancer Centre, Cardiff, UK
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27
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Davis AP, Chadburn H, Moat J, O’Sullivan R, Hargreaves S, Nic Lughadha E. High extinction risk for wild coffee species and implications for coffee sector sustainability. Sci Adv 2019; 5:eaav3473. [PMID: 30746478 PMCID: PMC6357749 DOI: 10.1126/sciadv.aav3473] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/19/2018] [Indexed: 05/14/2023]
Abstract
Wild coffee species are critical for coffee crop development and, thus, for sustainability of global coffee production. Despite this fact, the extinction risk and conservation priority status of the world's coffee species are poorly known. Applying IUCN Red List of Threatened Species criteria to all (124) wild coffee species, we undertook a gap analysis for germplasm collections and protected areas and devised a crop wild relative (CWR) priority system. We found that at least 60% of all coffee species are threatened with extinction, 45% are not held in any germplasm collection, and 28% are not known to occur in any protected area. Existing conservation measures, including those for key coffee CWRs, are inadequate. We propose that wild coffee species are extinction sensitive, especially in an era of accelerated climatic change.
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Affiliation(s)
- Aaron P. Davis
- Royal Botanic Gardens, Kew, Richmond, Surrey TW9 3AE, UK
- Corresponding author.
| | - Helen Chadburn
- Royal Botanic Gardens, Kew, Richmond, Surrey TW9 3AE, UK
| | - Justin Moat
- Royal Botanic Gardens, Kew, Richmond, Surrey TW9 3AE, UK
- School of Geography, University of Nottingham, Nottingham NG7 2RD, UK
| | - Robert O’Sullivan
- Royal Botanic Gardens, Kew, Richmond, Surrey TW9 3AE, UK
- School of Biological and Chemical Sciences, Queen Mary University of London, London E1 4NS, UK
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28
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Nic Lughadha E, Walker BE, Canteiro C, Chadburn H, Davis AP, Hargreaves S, Lucas EJ, Schuiteman A, Williams E, Bachman SP, Baines D, Barker A, Budden AP, Carretero J, Clarkson JJ, Roberts A, Rivers MC. The use and misuse of herbarium specimens in evaluating plant extinction risks. Philos Trans R Soc Lond B Biol Sci 2018; 374:20170402. [PMID: 30455216 PMCID: PMC6282085 DOI: 10.1098/rstb.2017.0402] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 11/12/2022] Open
Abstract
Herbarium specimens provide verifiable and citable evidence of the occurrence of particular plants at particular points in space and time, and are vital resources for assessing extinction risk in the tropics, where plant diversity and threats to plants are greatest. We reviewed approaches to assessing extinction risk in response to the Convention on Biological Diversity's Global Strategy for Plant Conservation Target 2: an assessment of the conservation status of all known plant species by 2020. We tested five alternative approaches, using herbarium-derived data for trees, shrubs and herbs in five different plant groups from temperate and tropical regions. All species were previously fully assessed for the IUCN Red List. We found significant variation in the accuracy with which different approaches classified species as threatened or not threatened. Accuracy was highest for the machine learning model (90%) but the least data-intensive approach also performed well (82%). Despite concerns about spatial, temporal and taxonomic biases and uncertainties in herbarium data, when specimens represent the best available evidence for particular species, their use as a basis for extinction risk assessment is appropriate, necessary and urgent. Resourcing herbaria to maintain, increase and disseminate their specimen data is essential to guide and focus conservation action.This article is part of the theme issue 'Biological collections for understanding biodiversity in the Anthropocene'.
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Affiliation(s)
| | | | | | | | | | | | - Eve J Lucas
- Royal Botanic Gardens, Kew, Richmond TW9 3AE, UK
| | | | | | | | - David Baines
- Royal Botanic Gardens, Kew, Richmond TW9 3AE, UK
- College of Life and Environmental Sciences, University of Exeter, Penryn, Cornwall, TR10 9FE
| | - Amy Barker
- Royal Botanic Gardens, Kew, Richmond TW9 3AE, UK
| | | | | | | | | | - Malin C Rivers
- Botanic Gardens Conservation International, Richmond TW9 3BW, UK
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Habiyambere V, Dongmo Nguimfack B, Vojnov L, Ford N, Stover J, Hasek L, Maggiore P, Low-Beer D, Pérez Gonzàlez M, Edgil D, Williams J, Kuritsky J, Hargreaves S, NeSmith T. Forecasting the global demand for HIV monitoring and diagnostic tests: A 2016-2021 analysis. PLoS One 2018; 13:e0201341. [PMID: 30231022 PMCID: PMC6145505 DOI: 10.1371/journal.pone.0201341] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 07/13/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Despite considerable progress, just over half of the 37 million people eligible to start antiretroviral therapy (ART) have accessed treatment and millions of HIV-positive people still do not know their status. With demand for ART continuing to grow, meeting the ambitious 90-90-90 HIV treatment targets will depend on improved access to high-quality diagnostics to both diagnose infection and monitor treatment adherence in low and middle-income countries (LMICs). Robust projections of future demand for CD4, viral load (VL), HIV early-infant-diagnosis (EID) tests and HIV rapid diagnostic tests (RDTs) are needed as scale-up continues. Methods We estimate the current coverage for HIV diagnostics and project future demand to 2021 using a consolidated forecast using data on past coverage and current demand from a number of sources, from 130 predominantly LMIC countries. Results We forecast that the overall number of CD4 tests is expected to decline between now and 2021 as more countries adopt test-and-treat and shift to VL testing for patient monitoring. Our consolidated forecast projects a gradual decline in demand for CD4 tests to 16.6 million by 2021. We anticipate that demand for VL tests will increase to 28.5 million by 2021, reflecting the increasing number of people who will receive ART and the adoption of VL testing for patient monitoring. We expect that the demand for EID tests will grow more rapidly than in past years, driven by the implementation of testing at birth in programmes globally, in line with WHO guideline recommendations, doubling to 2.1 million tests by 2021. Demand for rapid diagnostic tests is also likely to increase, reaching 509 million tests by 2021. Discussion In order to achieve the ambitious 90-90-90 targets, it will be essential to maintain and improve access to CD4, VL, EID tests and RDTs. These projections provide insight into the global demand we can expect to see for these HIV monitoring and diagnostic tests, both in relation to historical trends, and the 90-90-90 targets. Our projections will better enable producers to ensure adequate supply, and to support procurement organisations in planning future funding and purchase plans to meet the anticipated demand. The findings highlight the ongoing need for governments and international funding bodies to prioritise improving capacity and access to HIV diagnostic and monitoring technologies in line with demand.
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Affiliation(s)
| | | | - L. Vojnov
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - N. Ford
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - J. Stover
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - L. Hasek
- CHAI, Boston, Massachusetts, United States of America
| | - P. Maggiore
- CHAI, Boston, Massachusetts, United States of America
| | - D. Low-Beer
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | | | - D. Edgil
- USAID, Washington DC, United States of America
| | - J. Williams
- US CDC, Atlanta, Georgia, United States of America
| | - J. Kuritsky
- USAID, Washington DC, United States of America
| | - S. Hargreaves
- International Health Unit, Imperial College London, London, United Kingdom
| | - T. NeSmith
- US CDC, Atlanta, Georgia, United States of America
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Friedland J, Hargreaves S, Jones L, Mladovsky P, Norredam M, Petrova-Benedict R. 7.9-W1Migrants and health data: concerns and solutions. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky049.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - J Friedland
- Hammersmith Campus Director, Imperial College London, United Kingdom
| | | | - L Jones
- Doctors of the World, London, United Kingdom
| | - P Mladovsky
- London School of Hygiene and Tropical Medicine, United Kingdom
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Friedland J, Hargreaves S, Jablonka A, Noori T. 4.10-P5Vaccine preventable diseases in migrants. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nellums L, Hargreaves S, Johnson C, Elden S, Goldberg J, Friedland J. 3.4-O2Feasibility of infectious diseases screening for migrants in emergency departments. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Nellums
- Imperial College London, United Kingdom
| | | | - C Johnson
- Imperial College London, United Kingdom
| | - S Elden
- Imperial College London, United Kingdom
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Nakken CS, Skovdal M, Nellums LB, Friedland JS, Hargreaves S, Norredam M. Vaccination status and needs of asylum-seeking children in Denmark: a retrospective data analysis. Public Health 2018; 158:110-116. [PMID: 29653865 PMCID: PMC5947822 DOI: 10.1016/j.puhe.2018.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 11/23/2022]
Abstract
Objectives Asylum seekers to Europe may come from war-torn countries where health systems have broken down, and there is evidence that asylum-seeking children have low coverage of childhood vaccinations, as well as uptake of immunisations in host countries. Such gaps in immunisation have important implications for effective national vaccination programmes. How we approach vaccination in children and adults entering Western Europe, where as a group they face barriers to health services and screening, is a growing debate; however, there are limited data on the vaccination status of these hard-to-reach communities, and robust evidence is needed to inform immunisation strategies. The aim of this study was to explore the vaccination status and needs of asylum-seeking children and adolescents in Denmark. Study design We conducted a retrospective data analysis of anonymised patient records for asylum-seeking children and adolescents extracted from the Danish Red Cross database. Methods We retrospectively searched the Danish Red Cross database for children and adolescents (aged 3 months–17 years) with active asylum applications in Denmark as of October 28, 2015. Data were extracted for demographic characteristics, vaccination status and vaccinations needed by asylum-seeking children presenting to Red Cross asylum centres for routine statutory health screening. Results We explored the vaccination status and needs of 2126 asylum-seeking children and adolescents. About 64% of the study population were male and 36% were female. Eight nationalities were represented, where 33% of the total of children and adolescents were not immunised in accordance with Danish national guidelines, while 7% were considered partly vaccinated, and 60% were considered adequately vaccinated. Afghan (57% not vaccinated/unknown) and Eritrean (54% not vaccinated/unknown) children were the least likely to be vaccinated of all nationalities represented, as were boys (37% not vaccinated/unknown) compared with girls (27% not vaccinated/unknown) and children and adolescents aged between 12 and 17 years (48% not vaccinated/unknown) compared with 6- to 11-year olds (26%) and 0- to 5-year olds (22%). The health screenings resulted in 1328 vaccinations. The most commonly needed vaccines were diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b, (DTaP/IPV/Hib) which comprised 49% of the vaccines distributed, followed by the pneumococcal vaccine (Prevnar) (28%) and measles, mumps and rubella (MMR) vaccine (23%). Conclusions The finding that nearly one-third of asylum-seeking children and adolescents in Denmark were in need of further vaccinations highlights the gaps in immunisation coverage in these populations. These results point to the need to improve access to health services and promote national vaccine programmes targeted at these communities to facilitate vaccination uptake and increase immunisation coverage to reduce the risk of preventable infectious diseases among asylum-seeking children. Little is known on the state of immunisation of refugees arriving in Western receiving countries. Variations in status on arrival to Denmark were associated with gender, country of origin and age groups. Vaccination needs were found to be associated with country of origin, while gender did not act as a significant determinant. Immunisations for vaccine-preventable diseases is critical for protecting refugee health and host communities.
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Affiliation(s)
- C S Nakken
- Danish Research Center for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - M Skovdal
- Danish Research Center for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - L B Nellums
- Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, London, UK.
| | - J S Friedland
- Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, London, UK
| | - S Hargreaves
- Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, London, UK
| | - M Norredam
- Danish Research Center for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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Fitzpatrick NK, Thompson CJ, Hemingway H, Barnes TRE, Higgitt A, Molloy C, Hargreaves S. Acute mental health admissions in inner London: changes in patient characteristics and clinical admission thresholds between 1988 and 1998. Psychiatr bull 2018. [DOI: 10.1192/pb.27.1.7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodWe undertook a retrospective case-note review of three cohorts of mental health admissions to determine the extent to which patient and service characteristics changed between 1988 and 1998. Changes in clinical admission thresholds were investigated by a psychiatrists' review of handwritten medical admission assessments.ResultsPatients admitted in 1998 were demographically less stable and clinically more complex than those admitted 10 years earlier. Clinical admission thresholds remained consistent.Clinical ImplicationsOur findings suggest that the perceived increase in pressure on psychiatric services over this period was a response to a change in population need. This study highlights important questions about the clinical decision-making process leading to use of alternatives to admission and the appropriateness of acute admissions.
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Abstract
Drawing a human figure involves mastery over complex planning problems. The variant forms which young children produce may be an index of these. The most common variant is the “tadpole figure” with arms seemingly on the head. It is known that children who spontaneously draw this variant will attach arms correctly to the trunk of an incomplete pre-drawn figure if the head is small, but will attach them to the head if that exceeds the trunk in size. The present study shows that this body-proportion effect cannot be reliably modified by directing the pen to the head or trunk for the purpose of drawing body-parts other than arms; and that the arms are much more subject to the effect than the legs, nose, navel or ears. Experimental analysis of drawing based on completion-tasks can in principle help to bring out, and put under stimulus-control, performance characteristics which cannot reliably be inferred from post-hoc inspection of spontaneous finished products.
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Affiliation(s)
- N. H. Freeman
- Department of Psychology, University of Bristol, Bristol, 8–10 Berkeley Square, BS8 1HH, U.K
| | - S. Hargreaves
- Department of Psychology, University of Bristol, Bristol, 8–10 Berkeley Square, BS8 1HH, U.K
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Habiyambere V, Dongmo Nguimfack B, Vojnov L, Ford N, Stover J, Hasek L, Maggiore P, Low-Beer D, Pérez Gonzàlez M, Edgil D, Williams J, Kuritsky J, Hargreaves S, NeSmith T. Forecasting the global demand for HIV monitoring and diagnostic tests: A 2016-2021 analysis. PLoS One 2018. [PMID: 30231022 DOI: 10.1371/journal.pone.020134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Despite considerable progress, just over half of the 37 million people eligible to start antiretroviral therapy (ART) have accessed treatment and millions of HIV-positive people still do not know their status. With demand for ART continuing to grow, meeting the ambitious 90-90-90 HIV treatment targets will depend on improved access to high-quality diagnostics to both diagnose infection and monitor treatment adherence in low and middle-income countries (LMICs). Robust projections of future demand for CD4, viral load (VL), HIV early-infant-diagnosis (EID) tests and HIV rapid diagnostic tests (RDTs) are needed as scale-up continues. METHODS We estimate the current coverage for HIV diagnostics and project future demand to 2021 using a consolidated forecast using data on past coverage and current demand from a number of sources, from 130 predominantly LMIC countries. RESULTS We forecast that the overall number of CD4 tests is expected to decline between now and 2021 as more countries adopt test-and-treat and shift to VL testing for patient monitoring. Our consolidated forecast projects a gradual decline in demand for CD4 tests to 16.6 million by 2021. We anticipate that demand for VL tests will increase to 28.5 million by 2021, reflecting the increasing number of people who will receive ART and the adoption of VL testing for patient monitoring. We expect that the demand for EID tests will grow more rapidly than in past years, driven by the implementation of testing at birth in programmes globally, in line with WHO guideline recommendations, doubling to 2.1 million tests by 2021. Demand for rapid diagnostic tests is also likely to increase, reaching 509 million tests by 2021. DISCUSSION In order to achieve the ambitious 90-90-90 targets, it will be essential to maintain and improve access to CD4, VL, EID tests and RDTs. These projections provide insight into the global demand we can expect to see for these HIV monitoring and diagnostic tests, both in relation to historical trends, and the 90-90-90 targets. Our projections will better enable producers to ensure adequate supply, and to support procurement organisations in planning future funding and purchase plans to meet the anticipated demand. The findings highlight the ongoing need for governments and international funding bodies to prioritise improving capacity and access to HIV diagnostic and monitoring technologies in line with demand.
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Affiliation(s)
| | | | - L Vojnov
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - N Ford
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - J Stover
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - L Hasek
- CHAI, Boston, Massachusetts, United States of America
| | - P Maggiore
- CHAI, Boston, Massachusetts, United States of America
| | - D Low-Beer
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | | | - D Edgil
- USAID, Washington DC, United States of America
| | - J Williams
- US CDC, Atlanta, Georgia, United States of America
| | - J Kuritsky
- USAID, Washington DC, United States of America
| | - S Hargreaves
- International Health Unit, Imperial College London, London, United Kingdom
| | - T NeSmith
- US CDC, Atlanta, Georgia, United States of America
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Erdem H, Inan A, Guven E, Hargreaves S, Larsen L, Shehata G, Pernicova E, Khan E, Bastakova L, Namani S, Harxhi A, Roganovic T, Lakatos B, Uysal S, Sipahi OR, Crisan A, Miftode E, Stebel R, Jegorovic B, Fehér Z, Jekkel C, Pandak N, Moravveji A, Yilmaz H, Khalifa A, Musabak U, Yilmaz S, Jouhar A, Oztoprak N, Argemi X, Baldeyrou M, Bellaud G, Moroti RV, Hasbun R, Salazar L, Tekin R, Canestri A, Čalkić L, Praticò L, Yilmaz-Karadag F, Santos L, Pinto A, Kaptan F, Bossi P, Aron J, Duissenova A, Shopayeva G, Utaganov B, Grgic S, Ersoz G, Wu AKL, Lung KC, Bruzsa A, Radic LB, Kahraman H, Momen-Heravi M, Kulzhanova S, Rigo F, Konkayeva M, Smagulova Z, Tang T, Chan P, Ahmetagic S, Porobic-Jahic H, Moradi F, Kaya S, Cag Y, Bohr A, Artuk C, Celik I, Amsilli M, Gul HC, Cascio A, Lanzafame M, Nassar M. The burden and epidemiology of community-acquired central nervous system infections: a multinational study. Eur J Clin Microbiol Infect Dis 2017; 36:1595-1611. [PMID: 28397100 DOI: 10.1007/s10096-017-2973-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.
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Affiliation(s)
- H Erdem
- Principal Coordinator of ID-IRI, Ankara, Turkey.
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, 06010, Etlik, Ankara, Turkey.
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - E Guven
- Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Commonwealth Building, Hammersmith Campus, Imperial College London, London, UK
| | - L Larsen
- Department of Infectious Diseases Q, Odense University Hospital, Odense, Denmark
| | - G Shehata
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - E Pernicova
- Avenier, Centres for Vaccination and Travel Medicine, Prague, Czech Republic
- Faculty Hospital Brno, Department of Infectious Diseases, Brno, Czech Republic
| | - E Khan
- Shifa International Hospital, Islamabad, Pakistan
| | - L Bastakova
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - S Namani
- Infectious Diseases Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - A Harxhi
- Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania
| | - T Roganovic
- Infectious Diseases Clinic, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - B Lakatos
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - S Uysal
- Department of Infectious Diseases and Clinical Microbiology, Seyfi Demirsoy State Hospital, Buca, İzmir, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - A Crisan
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - E Miftode
- Hospital of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - R Stebel
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - B Jegorovic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Z Fehér
- Department of Infectious Diseases, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - C Jekkel
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - N Pandak
- General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia
| | - A Moravveji
- Social Determinants of Health Research Center, Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - H Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - A Khalifa
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - U Musabak
- Department of Immunology and Allergy, Losante Hospital, Ankara, Turkey
| | - S Yilmaz
- Gulhane Medical Academy, Blood Bank, Clinical Microbiology Division, Ankara, Turkey
| | - A Jouhar
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - N Oztoprak
- Antalya Education and Research Hospital, Antalya, Turkey
| | - X Argemi
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - M Baldeyrou
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - G Bellaud
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - R V Moroti
- Carol Davila University of Medicine and Pharmacy and Matei Bals National Institute for Infectious Diseases, Bucharest, Romania
| | - R Hasbun
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Salazar
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - A Canestri
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - L Čalkić
- Department of Infectious Diseases, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina
| | - L Praticò
- University Division of Infectious and Tropical Diseases, Piazza Spedali Civili, 25123, Brescia, Italy
| | - F Yilmaz-Karadag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - L Santos
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Pinto
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Kaptan
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - P Bossi
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - J Aron
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - A Duissenova
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - G Shopayeva
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - B Utaganov
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - S Grgic
- Clinic for Infectious Diseases, University Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - G Ersoz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - A K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K C Lung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - A Bruzsa
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - L B Radic
- Department of Infectious Diseases, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - H Kahraman
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - M Momen-Heravi
- Department of Infectious Diseases, Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - S Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - F Rigo
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Konkayeva
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - Z Smagulova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - T Tang
- Infectious Diseases Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - P Chan
- Neurology Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - S Ahmetagic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - H Porobic-Jahic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - F Moradi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - S Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Y Cag
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - A Bohr
- Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Artuk
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - I Celik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - M Amsilli
- Infectious Diseases Unit, CHU Bicètre, Paris, France
| | - H C Gul
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - A Cascio
- Department of Health Promotion Sciences and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - M Lanzafame
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Nassar
- Infection Control Department, Saudi German Hospital Group, Jeddah, Saudi Arabia
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Hargreaves S, Lönnroth K, Nellums LB, Olaru ID, Nathavitharana RR, Norredam M, Friedland JS. Response to Letter to the Editor by M. van der Werf, V. Hollo and C. Ködmön concerning 'Multidrug-resistant tuberculosis and migration to Europe'. Clin Microbiol Infect 2017; 23:580. [PMID: 28257900 DOI: 10.1016/j.cmi.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Affiliation(s)
- S Hargreaves
- Infectious Diseases & Immunity, Imperial College London, UK
| | - K Lönnroth
- Karolinska Institutet, Stockholm, Sweden; Global TB Programme, WHO, Geneva, Switzerland
| | - L B Nellums
- Infectious Diseases & Immunity, Imperial College London, UK
| | - I D Olaru
- Division of Clinical Infectious Diseases, Research Centre, Borstel, Germany; German Center for Infection Research, Clinical Tuberculosis Centre, Borstel, Germany
| | - R R Nathavitharana
- Infectious Diseases & Immunity, Imperial College London, UK; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Norredam
- Danish Research Centre for Migration Ethnicity and Health, University of Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital, Hvidovre, Denmark
| | - J S Friedland
- Infectious Diseases & Immunity, Imperial College London, UK.
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Hargreaves S, Comins C. Stereotactic Ablative Radiotherapy for Oligometastatic Disease: a Treatment in Search of Evidence – a Response. Clin Oncol (R Coll Radiol) 2016; 28:503-4. [DOI: 10.1016/j.clon.2016.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
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Erdem H, Ak O, Elaldi N, Demirdal T, Hargreaves S, Nemli SA, Cag Y, Ulug M, Naz H, Gunal O, Sirmatel F, Sipahi OR, Alpat SN, Ertem-Tuncer G, Sozen H, Evlice O, Meric-Koc M, Dogru A, Koksaldi-Motor V, Tekin R, Ozdemir D, Ozturk-Engin D, Savasci U, Karagoz E, Cekli Y, Inan A. Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study. Eur J Clin Microbiol Infect Dis 2016; 35:903-10. [PMID: 26964538 PMCID: PMC7087946 DOI: 10.1007/s10096-016-2614-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
Mass gatherings pooling people from different parts of the world—the largest of which is to Mecca, Saudi Arabia, for Hajj—may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were ≥ 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3–7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
| | - O Ak
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - N Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - T Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, Commonwealth Building, Hammersmith Campus, London, UK
| | - S A Nemli
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Y Cag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - M Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey
| | - H Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - O Gunal
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - F Sirmatel
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Bolu, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - S N Alpat
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - G Ertem-Tuncer
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - H Sozen
- Department of Infectious Diseases and Clinical Microbiology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - O Evlice
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - M Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Izmit, Turkey
| | - A Dogru
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - V Koksaldi-Motor
- Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University, Hatay, Turkey
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - D Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Duzce University School of Medicine, Konuralp, Duzce, Turkey
| | - D Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - U Savasci
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - E Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Military Hospital, Van, Turkey
| | - Y Cekli
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Palmer DH, Hussain SA, Smith AJ, Hargreaves S, Ma YT, Hull D, Johnson PJ, Ross PJ. Sorafenib for advanced hepatocellular carcinoma (HCC): impact of rationing in the United Kingdom. Br J Cancer 2013; 109:888-90. [PMID: 23880824 PMCID: PMC3749577 DOI: 10.1038/bjc.2013.410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/10/2013] [Accepted: 07/01/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prognosis for hepatocellular carcinoma (HCC) is dependent upon tumour stage, performance status (PS), severity of underlying liver disease, and the availability of appropriate therapies. The unavailability of sorafenib may have a significantly adverse effect on the prognosis of UK patients with advanced HCC. During the study period, access to sorafenib was at the discretion of local health funding bodies, a process that may delay or deny access to the drug and that remains in place for Wales, Scotland, and Northern Ireland. Here, we attempt to address the impact of this system on patients with advanced HCC in the United Kingdom. METHODS This is a retrospective study performed in the two largest specialist hepatobiliary oncology units in the United Kingdom. Funding applications were made to local funding bodies for patients with advanced HCC for whom sorafenib was considered appropriate (advanced HCC not suitable for loco-regional therapies, compensated chronic liver disease, PS 0-2). RESULTS A total of 133 applications were made, of which 57 (43%) were approved and 76 (57%) declined. Demographics and prognostic factors were balanced between the two groups. This cohort had a number of adverse prognostic features: patients were predominantly PS 1-2; the majority had multifocal disease with the largest lesion being >5 cm; and macroscopic vascular invasion, metastases, and AFP >,000 ng ml(-1), were each present in one-third of cases. The median time from application to funding decision was 17 days (range 3-260 days). For the primary 'intention-to-treat' analysis, median overall survival was 4.1 months when funding was declined, and 9.5 months when funding was approved (hazard ratio (HR) 0.48; 95% CI 0.3186-0.7267; P=0.0005). CONCLUSION These data support the use of sorafenib for patients with advanced HCC as an effective intervention. In the United Kingdom, this applies to a relatively small group of patients, estimated to total ∼800 per year who, unfortunately, do not survive long enough to themselves lobby for the availability of this drug. These data provide a comparison of sorafenib with supportive care and demonstrate the potential detrimental impact on patient outcomes of rationing health-care resources on the basis of cost.
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Affiliation(s)
- D H Palmer
- Cancer Research UK Centre, University of Liverpool, Daulby Street, Liverpool L69 3GA, UK.
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Sayer R, Paul J, Tuke PW, Hargreaves S, Noursadeghi M, Tedder RS, Grant P, Edwards SG, Miller RF. Can plasma HHV8 viral load be used to differentiate multicentric Castleman disease from Kaposi sarcoma? Int J STD AIDS 2011; 22:585-9. [DOI: 10.1258/ijsa.2011.010464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We measured plasma human herpesvirus 8 (HHV8) DNA load in consecutive patients presenting with HIV-associated multicentric Castleman disease (MCD) and in contemporaneous patients who had Kaposi sarcoma (KS), lymphoma or other diagnoses. All 11 patients with MCD had detectable plasma HHV8 DNA compared with 18 (72%) of 25 patients with KS, none with lymphoma and one of 38 patients with other diagnoses. Detectable plasma HHV8 DNA levels were higher among MCD patients, median (interquartile range [IQR]) = 43,500 (5200–150,000) copies/mL, when compared with those with KS, median (IQR) = 320 (167–822) copies/mL and those with lymphoma and other diagnoses (one-way analysis of variance; P = 0.0303). Using receiver operating characteristic analysis, a cut-off of >1000 copies HHV8 DNA/mL of plasma helped to discriminate between MCD and other diagnoses, with a specificity of 94.7% and a negative predictive value of 97.3%. The level of HHV8 viraemia, while not diagnostic, may aid discrimination between patients with MCD and those with KS and other systemic illnesses.
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Affiliation(s)
- R Sayer
- Mortimer Market Centre, Camden Provider Services
- T8, University College London Hospitals NHS Trust
| | - J Paul
- Department of Virology, University College London Hospitals
| | - P W Tuke
- Blood Borne Viruses Unit, Virus Reference Department, Centre for Infections, Health Protection Agency
| | - S Hargreaves
- Mortimer Market Centre, Camden Provider Services
| | - M Noursadeghi
- T8, University College London Hospitals NHS Trust
- Division of Infection and Immunity
| | - R S Tedder
- Blood Borne Viruses Unit, Virus Reference Department, Centre for Infections, Health Protection Agency
| | - P Grant
- Department of Virology, University College London Hospitals
| | - S G Edwards
- Mortimer Market Centre, Camden Provider Services
- T8, University College London Hospitals NHS Trust
| | - R F Miller
- Mortimer Market Centre, Camden Provider Services
- T8, University College London Hospitals NHS Trust
- Research Department of Infection and Population Health, Division of Population Health, University CollegeLondon
- Department of Clinical Research, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Hargreaves S, Lacasia C, Groom P. Regional audit â availability of equipment and training in emergency cricothyroidotomy. Anaesthesia 2010. [DOI: 10.1111/j.1365-2044.2009.06184_18.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cardozo AAJ, Hallikeri C, Lawrence H, Sankar V, Hargreaves S. Teenage and adult tonsillectomy: dose-response relationship between diathermy energy used and morbidity. Clin Otolaryngol 2008; 32:366-71. [PMID: 17883557 DOI: 10.1111/j.1749-4486.2007.01529.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether an increase in the use of bipolar diathermy energy to perform a tonsillectomy is associated with an increase in postoperative pain and haemorrhage. STUDY DESIGN Prospective study. SETTING District General Hospital. METHODS In all, 101 patients above the age of 13 years who underwent a tonsillectomy that involved the use of bipolar diathermy during the study period were included. The cumulative amount of diathermy energy used to perform each tonsillectomy was calculated with the help of a digital stop clock timing device connected to the diathermy foot-pedal. MAIN OUTCOME MEASURES Postoperative pain scores and the incidence of secondary haemorrhage were recorded for each patient at four points in time following surgery, up to the tenth postoperative day. The haemorrhage rates were categorised into three groups (no bleeding, minor bleeding and major bleeding) according to severity. Associations between the diathermy energy used to perform each tonsillectomy and the corresponding postoperative pain scores and secondary bleeding rates were investigated. RESULTS There was a statistically significant positive relationship between the total amount of bipolar diathermy energy used per tonsillectomy and the pain scores at all the four recorded points in time (r(s) = 0.44-0.72, P < 0.001). When the median energy consumption in the three groups (no bleeding, minor bleeding and major bleeding) were compared using the Kruskal-Wallis test, we found that there was limited evidence of a difference between the groups, but this was not statistically significant at the 5% level [H (2) = 5.374, P = 0.065, 99% CI 0.058-0.071]. CONCLUSIONS Increased use of bipolar diathermy during the performance of a tonsillectomy is associated with a statistically significant increased amount of postoperative pain. The dose-response relationship between diathermy energy and postoperative bleeding is less clear. This suggests that there could be other important factors such as surgical instrument characteristics and degree of tonsillar adherence that have an additional influence and are therefore possible areas for future research.
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Affiliation(s)
- A A J Cardozo
- Department of Otolaryngology, Royal Bolton Hospital, Bolton, Lancashire, UK.
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Cooke G, Hargreaves S, Natkunaraja J, Sandhu G, Dhasmana D, Holmes A, Friedland J. The Presentation of Infectious Diseases in International Migrants. J Infect 2007. [DOI: 10.1016/j.jinf.2006.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cook PA, Hargreaves S, Tocque K, Bellis MA. Relationship between the use of hospital services and deprivation score of place of residence among HIV-positive individuals in the north west of England. Commun Dis Public Health 2004; 7:319-21. [PMID: 15779798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We used routine surveillance data to investigate whether deprivation relates to hospital admission in a HIV-positive population. HIV-positive individuals living in the poorest areas were more likely to have spent one or more nights in hospital for HIV-related care (adjusted odds ratio = 1.6, p = 0.009, after controlling for infection route, disease stage and demographic variables). This implies that healthcare networks in poorer areas may incur disproportionately greater costs.
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Affiliation(s)
- P A Cook
- Centre for Public Health, Liverpool John Moores University, Castle House, North Street, Liverpool L3 2AY.
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Abstract
Coblation is a new soft tissue surgical technique that is being used for tonsillectomy. Published results show a significant decrease in the amount of post-operative pain experienced by patients undergoing coblation tonsillectomy. There has been no published work to date on the incidence of post-operative haemorrhage. From August 2001 to November 2002 one surgeon performed 36 coblation tonsillectomies on adults. On another list he performed 29 by his standard method of dissection and bipolar coagulation. Retrospective analysis found a significant increase in the secondary haemorrhage rate in adult patients undergoing coblation tonsillectomy (22.2 vs. 3.4 per cent). At our department coblation tonsillectomy has been abandoned until further work into its safety has been published.
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Affiliation(s)
- A P Noon
- Department of Ear, Nose and Throat Surgery, Royal Bolton Hospital, Bolton, UK.
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