'If I cannot access services then there is no reason for me to test': the impact of health service charges on HIV testing and treatment amongst migrants in England

Policy governing entitlement to access government health care for foreign nationals in England is a subject of debate, controversy and confusion. Of particular concern to health providers has been the impact of National Health Service charges on delaying HIV testing and anti-retroviral treatment uptake and adherence amongst certain migrant groups. Data obtained through focus groups with 70 migrants from southern Africa, suggest that confusion over health care entitlements exists amongst those seeking health care and is reported amongst health service providers. This confusion, as well as financial difficulties and fears over deportation facing some migrants, can in turn be a factor influencing their decisions to avoid formal health services, resort to alternative and often ineffective or potentially adverse forms of therapy, and delay HIV testing and treatment uptake

The Benefits of an Open-Science Approach in Student Research Projects

Student projects can sometimes be overlooked when considering open science methods. This is perhaps because of the limited time available to complete the project, a lack of confidence in their open research skills by supervision staff or students, and lower expectations of publications resulting from student project work (particularly at undergraduate level). However, open science methods add value to student projects and provide benefits on several levels. This talk describes from both the student and supervisor perspectives how open science can benefit student projects - from methods to management - using recent undergraduate projects as an example. We give a brief description of the concept of open science as we understand it and discuss the general benefits of an open science approach to research. The Edward Wallace lab (School of Biological Sciences, University of Edinburgh) has run several student projects working with and extending the open source software tool 'riboviz' to process and analyse ribosome profiling sequencing datasets. This collaborative project worked with experts in the UK and USA and aimed to add new features and capabilities to riboviz, thoroughly documenting the software, and successfully using it to analyse a diverse range of datasets from organisms across the tree of life. Student projects recreated existing published results using riboviz, developed new visualisation scripts, and added new optional features to the codebase to address specific research questions. This talk discusses how both the student project and the riboviz project fit into open science research, covering how open science tools were used to plan, manage and carry out an open science project and the challenges these presented. For example, as this was a computer-based project, we discuss the tools and skills needed by the students to successfully complete the project, including programming skills (Unix command-line, R, Python) and version control (using Git and GitHub) and the open resources used to learn and develop these skills. Open software tools such as version control are also explained in the context of student supervision and project management (for example how to use GitHub issue tickets for identifying and quickly solving project problems remotely), and for writing collaborative manuscripts (such as the recently published riboviz 2 paper and open science article). Our experiences provide a strong case study for successful open science approaches in student projects and clear evidence of their long-term benefits to students, supervisors and wider lab groups. We highlight our "top takeaways" aimed at students, day-to-day supervisors, and PIs and demonstrate how others can take the same approach

'Experts', 'partners' and 'fools': exploring agency in HIV treatment seeking among African migrants in London

In an attempt to promote patient agency and foster more egalitarian relationships between patients and doctors, discourse concerning health and wellbeing in the UK has increasingly centred around the notion of informed and 'expert' patients who are able to effectively input into the direction and management of their own health care and treatment. While the relationship between a patient and their doctor can play a vital role in influencing the treatment decisions and health-related outcomes of people living with long term illness, little is known about the ways in which people living with HIV actually perceive their relationship with their doctors, nor the implications this may have for the types of treatment they may seek to use and the related information that they share. Drawing on 11 focus group discussions and 20 repeat interviews undertaken in 2008-2009 with HIV-positive adult migrants from Zambia, Zimbabwe and South Africa living in the UK, this paper argues that patient-doctor relationships can be heavily influenced by the perceived legitimacy of different forms of medical knowledge and treatments and by culturally influenced ideas regarding health, wellbeing and agency. Despite a desire amongst some migrants to use 'traditional' medicines from southern Africa as well as other non-biomedical treatments and therapies, the research found that the perceived lack of legitimacy associated with these treatments in the UK rendered their use a largely clandestine activity. At the same time, many patients made clear distinctions concerning issues affecting their immediate health and factors influencing their more general wellbeing, which in turn, impacted upon the information that they chose to share with, or conceal from, their doctors. Such findings challenge assumptions underpinning policy promoting patient agency and have significant and, in cases, potentially adverse implications for the safety and effective administration and management of HIV treatments in African migrant populations and possibly more generally. (C) 2009 Elsevier Ltd. All rights reserved

Emotional interactions and an ethic of care: caring relations in families affected by HIV and AIDS

In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process

Occupational Health and Safety in the New Zealand Fishing Industry: Preliminary Finding of the Key Issues

In 2008 there were approximately 3,500 registered commercial fishing vessels in New Zealand and 2,500 full­time employees working in the industry, a fraction of New Zealand’s two million plus labour force. However, in the Maritime New Zealand’s Annual Report 2000­2001 it was reported that New Zealand’s commercial fishing sector represented a disproportionately high number of maritime fatalities. With the exception of the 2007 fatality figures, the rate of Maritime New Zealand reported fatalities and accidents within the commercial fishing sector have remained fairly static. As a result, there have been a variety of initiatives implemented in this hazardous industry, for example, FishSAFE, and a number of reviews undertaken. However, unlike other sectors, implementing OHS interventions in the fishing industry has to account for a number of unique features such as the employment strata, geographical isolation of job, precariousness of employment, increasingly a diverse workforce and social issues such as substance abuse, and. This paper reports on preliminary findings based on interview data of employers and employees in the New Zealand fishing industry. In particular, it exposes a number of barriers to implementing and maintaining OHS measures, for example, increasingly tight profit margins, time pressures, and confusion around regulatory requirements. The initial findings also indicate that the command and control structure of managing staff in the fishing industry can influence individual and group perception and acceptance of risk. Finally, the paper highlights areas requiring further investigation

Non-pharmacological interventions to reduce psychological distress in patients undergoing diagnostic cardiac catheterization: a rapid review

Abstract Background: Cardiac catheterization is the standard procedure for the diagnosis of coronary heart disease. The threat physically and emotionally from this procedure can effect the patient’s perception of their health. The heightened psychological distress associated with this diagnostic procedure can cause adverse patient outcomes. Non-pharmacologic interventions have been implemented to reduce psychological distress associated with cardiac catheterization. Aims: The objective of this rapid review is to assess the efficacy of non-pharmacologic interventions (procedural education, relaxation techniques, psychological preparation) on psychological distress experienced by patients as they undergo a cardiac catheterization. Methods: Published, peer-reviewed, English-language intervention studies from 1981 to 2014 were identified in a search of CINAHL, Medline, and Cochrane Library. Eligible studies included adults undergoing cardiac catheterization. Studies included in this review used experimental and quasi-experimental designs and assessed at least one primary outcome: anxiety, depression, and pain to test non-pharmacologic interventions pre and post-cardiac catheterization. Researchers independently extracted data from included studies and completed a quality assessment using a published tool. Data was synthesised as a narrative. Results: There were 29 eligible experimental and quasi-experimental studies that tested the 3 interventions (n=2504). Findings suggest that non-pharmacologic interventions were able to effectively reduce psychological distress in some patients undergoing cardiac catheterization. Conclusion: Evidence is stronger in recent studies that non-pharmacologic interventions of procedural education and psychological preparation can reduce psychological distress in patients undergoing cardiac catheterization. Further research is needed to define the various relaxation techniques that can be effectively implemented for patients undergoing cardiac catheterization

Child Labour: What is Happening in New Zealand?

While the rights of New Zealand adult workers have been the primary concern of successive governments and their agencies, the rights of child workers have often been overshadowed. With the recent Government report to the United Nations on New Zealand released, the issues surrounding New Zealand young workers have come to the fore and now require further investigation. The purpose o f this paper is to report on Phase One o f ongoing research into the working lives and experiences of New Zealand children (thoseunder18years). Drawing on existing academic literature as well as government and non-governmental organisations' (NGO) reports and statistics, the paper will present an overview of the status of New Zealand children in terms of the minimum working age; the minimum wage rates; and occupational health and safety standards. Finally, the paper will outline areas of future research

Major adverse cardiovascular events and all-cause mortality after emergency general surgery among kidney failure patients

BACKGROUND: Emergency general surgery (EGS) is associated with increased mortality, with kidney failure a contributing risk, but comparative outcomes between patients with kidney failure and the general population are lacking.METHODS: In this retrospective population-cohort study, data were analysed for all EGS procedures performed in England between 1 April 2004 and 31 March 2019. EGS was defined as partial colectomy, small bowel resection, cholecystectomy, appendicectomy, lysis of peritoneal adhesions, surgery for peptic ulcer, or laparotomy. The main outcome measure was major adverse cardiovascular events (MACEs) and all-cause mortality after surgery.RESULTS: From 691 064 procedures, 0.16 per cent (n = 1097) and 0.23 per cent (n = 1567) were performed on kidney transplant and dialysis recipients respectively. Laparotomy was the most frequent EGS procedure for kidney transplant (46 per cent of procedures, n = 507) and dialysis (45 per cent of procedures, n = 704) recipients, with the highest 30-day and 1-year mortality. In logistic regression analysis, both kidney failure cohorts had higher risk for experiencing MACEs in the postoperative interval after emergency laparotomy; within 3 months (dialysis; OR 2.44 (95 per cent c.i. 2.08 to 2.87), P &amp;lt; 0.001 and transplant; OR 2.05 (95 per cent c.i. 1.57 to 2.68), P &amp;lt; 0.001) and within 1 year (dialysis; OR 2.39 (95 per cent c.i. 2.06 to 2.77), P &amp;lt; 0.001 and transplant; OR 2.21 (95 per cent c.i. 1.76 to 2.77), P &amp;lt; 0.001); however, in a propensity-score-matched cohort, increased risk for MACEs was observed among dialysis patients after emergency laparotomy (HR 2.10 (95 per cent c.i. 1.82 to 2.43), P &amp;lt; 0.001) but not kidney transplant recipients (HR 1.17 (95 per cent c.i. 0.97 to 1.41), P = 0.096).CONCLUSION: Mortality after emergency surgery is higher for patients with kidney failure and dialysis is worse than kidney transplantation, with cardiovascular deaths more common than the general population.</p