Low hepatitis B testing among migrants:a cross-sectional study in a UK city

BACKGROUND: In 2012, hepatitis B virus (HBV) testing of people born in a country with a prevalence of ≥2% was recommended in the UK. Implementation of this recommendation requires an understanding of prior HBV testing practice and coverage, for which there are limited data. AIM: To estimate the proportion of migrants tested for HBV and explore GP testing practices and barriers to testing. DESIGN AND SETTING: A cross-sectional study of (a) migrants for whom testing was recommended under English national guidance, living in Bristol, and registered with a GP in 2006–2013, and (b) GPs practising in Bristol. METHOD: NHS patient demographic data and HBV laboratory surveillance data were linked. A person was defined as ‘HBV-tested’ if a laboratory result was available. An online GP survey was undertaken, using a structured questionnaire. RESULTS: Among 82 561 migrants for whom HBV testing was recommended, 9627 (12%) were ‘HBV-tested’. The HBV testing coverage was: Eastern Africa 20%; Western Africa 15%; South Eastern Asia 9%; Eastern Asia 5%. Of 19 GPs, the majority did not use guidelines to inform HBV testing in migrants and did not believe routine testing of migrants was indicated; 12/17 GPs stated that workload and lack of human, and financial resources were the most significant barriers to increased testing. CONCLUSION: The majority of migrants to a multicultural UK city from medium-/high-prevalence regions have no evidence of HBV testing. Much greater support for primary care in the UK and increased GP awareness of national guidance are required to achieve adherence to current testing guidance

Solidarity outpatient clinics in Greece: a survey of a massive social movement

OBJECTIVE: Until 2016, around 3 million persons had limited access to health care in Greece due to the economic crisis. We describe a massive solidarity movement of community clinics and pharmacies in Greece. METHOD: We conducted a survey in 2014-15 and describe the characteristics of community clinics and pharmacies spontaneously established all over Greece after 2008. RESULTS: A characteristic of the 92 active solidarity clinics is autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status were the main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs. CONCLUSIONS: The community outpatient clinics were an outstanding example of solidarity and temporarily alleviated the health needs of a large part of the population

Solidarity outpatient clinics in Greece: a survey of a massive social movement

Objective: Until 2016, around 3 million persons had limited access to health care in Greece due to the economic crisis. We describe a massive solidarity movement of community clinics and pharmacies in Greece. Method: We conducted a survey in 2014-15 and describe the characteristics of community clinics and pharmacies spontaneously established all over Greece after 2008. Results: A characteristic of the 92 active solidarity clinics is autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status were the main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs. Conclusions: The community outpatient clinics were an outstanding example of solidarity and temporarily alleviated the health needs of a large part of the population. (C) 2018 SESPAS. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Clínicas ambulatorias solidarias en Grecia: una encuesta de un movimiento social masivo

Objective: Until 2016, around 3 million persons had limited access to health care in Greece due to the economic crisis. We describe a massive solidarity movement of community clinics and pharmacies in Greece. Method: We conducted a survey in 2014-15 and describe the characteristics of community clinics and pharmacies spontaneously established all over Greece after 2008. Results: A characteristic of the 92 active solidarity clinics is autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status were the main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs. Conclusions: The community outpatient clinics were an outstanding example of solidarity and temporarily alleviated the health needs of a large part of the population.Objetivo: Hasta 2016, alrededor de 3 millones de personas tenían acceso limitado a la atención médica en Grecia debido a la crisis económica. Describimos un movimiento masivo de solidaridad de clínicas comunitarias y farmacias en Grecia. Métodos: Realizamos una encuesta en 2014-15 y describimos las características de las clínicas comunitarias y de las farmacias espontáneamente establecidas en toda Grecia después de 2008. Resultados: Una característica de las 92 clínicas solidarias activas es el funcionamiento colectivo autónomo, con servicios gratuitos y financiación de fuentes no gubernamentales. Las clínicas más grandes examinaron más de 500 pacientes no asegurados o parcialmente asegurados por mes. Las clínicas cubrieron una amplia gama de servicios clínicos y preventivos. La financiación, la disponibilidad de medicamentos, vacunas y material médico, y su estado legal, son los principales problemas identificados. El movimiento de solidaridad involucró a miles de profesionales de la salud que cubrieron las necesidades esenciales de la población. Conclusiones: Las clínicas ambulatorias comunitarias fueron un ejemplo de solidaridad y aliviaron temporalmente las necesidades de salud de una gran parte de la población

Global assessment of chemical quality of drinking water: the case of trihalomethanes

Trihalomethanes (THM), a major class of disinfection by-products, are widespread and are associated with adverse health effects. We conducted a global evaluation of current THM regulations and concentrations in drinking water. We included 120 countries (∼7000 million inhabitants in 2016), representing 94% of the world population. We searched for country regulations and THM routine monitoring data using a questionnaire addressed to referent contacts. Scientific and gray literature was reviewed where contacts were not identified or declined participation. We obtained or estimated annual average THM concentrations, weighted to the population served when possible. Drinking water regulations were ascertained for 116/120 (97%) countries, with 89/116 (77%) including THM regulations. Routine monitoring was implemented in 47/89 (53%) of countries with THM regulations. THM data with a varying population coverage was obtained for 69/120 (58%) countries consisting of ∼5600 million inhabitants (76% of world's population in 2016). Population coverage was ≥90% in 14 countries, mostly in the Global North, 50–89% in 19 countries, 11–49% among 21 countries, and ≤10% in 14 countries including India, China, Russian Federation and Nigeria (40% of world's population). An enormous gap exists in THM regulatory status, routine monitoring practice, reporting and data availability among countries, especially between high- vs. low- and middle-income countries (LMICs). More efforts are warranted to regulate and systematically assess chemical quality of drinking water, centralize, harmonize, and openly report data, particularly in LMICs.We acknowledge support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019–2023″ Program (CEX2018–000806-S) and support from the Generalitat de Catalunya through the CERCA Program, and from the University of South Carolina's Magellan scholarship and Honors College. This work was funded by the 7th Framework Programme EXPOSOMICS Project (Grant agreement 308610)

Prenatal Second-Hand Smoke Exposure Measured with Urine Cotinine May Reduce Gross Motor Development at 18 Months of Age EDITORIAL COMMENT

Objective To evaluate the association of second-hand smoke exposure of pregnant mothers using urine cotinine with the neurodevelopment of their children at 18 months of age in the mother-child cohort in Crete (Rhea Study). Study design Selected participants were Greek mothers with singleton pregnancies, had never smoked, and had available urine cotinine measurements in pregnancy, and their children for whom a neurodevelopmental assessment was completed. We performed face-to-face interviews twice during pregnancy and postnatally, and assessed children’s neurodevelopment at 18 months of age using the Bayley Scales of Infant and Toddler Development, Third Edition. We used linear regression and generalized additive models. Results Of 599 mothers, 175 (29%) met the inclusion criteria. Maternal urine cotinine levels were low (mean: 10.3 ng/mL, SD: 11.7 ng/mL). Reported passive smoking from different sources was strongly associated with urine cotinine levels. A negative association was observed between cotinine levels in pregnancy and child’s gross motor function (beta = -3.22 per 10 ng/mL, 95% CI -5.09 to -1.34) after adjusting for factors potentially associated with neurodevelopment; results were similar in both sexes. A negative association was also observed for cognitive and receptive communication scales but the effect was small and not statistically significant. Conclusions Maternal exposure during pregnancy to second-hand smoke measured through urine cotinine was associated with a decrease in gross motor function among 18-month-old children, even at low levels of exposure

Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis

Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. Materials and Methods: We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016. Results: The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help. Discussion: Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly