Impact on and use of an inner-city London Infectious Diseases Department by international migrants: a questionnaire survey

<p>Abstract</p> <p>Background</p> <p>The UK has witnessed a considerable increase in immigration in the past decade. Migrant may face barriers to accessing appropriate health care on arrival and the current focus on screening certain migrants for tuberculosis on arrival is considered inadequate. We assessed the implications for an inner-city London Infectious Diseases Department in a high migrant area.</p> <p>Methods</p> <p>We administered an anonymous 20-point questionnaire survey to all admitted patients during a 6 week period. Questions related to sociodemographic characteristics and clinical presentation. Analysis was by migration status (UK born <it>vs </it>overseas born).</p> <p>Results</p> <p>111 of 133 patients completed the survey (response rate 83.4%). 58 (52.2%) were born in the UK; 53 (47.7%) of the cohort were overseas born. Overseas-born were over-represented in comparison to Census data for this survey site (47.7% <it>vs </it>33.6%; proportional difference 0.142 [95% CI 0.049–0.235]; p = 0.002): overseas born reported 33 different countries of birth, most (73.6%) of whom arrived in the UK pre-1975 and self-reported their nationality as British. A smaller number (26.4%) were new migrants to the UK (≤10 years), mostly refugees/asylum seekers. Overseas-born patients presented with a broad range and more severe spectrum of infections, differing from the UK-born population, resulting in two deaths in this group only. Presentation with a primary infection was associated with refugee/asylum status (n = 8; OR 6.35 [95% CI 1.28–31.50]; p = 0.023), being a new migrant (12; 10.62 [2.24–50.23]; p = 0.003), and being overseas born (31; 3.69 [1.67–8.18]; p = 0.001). Not having registered with a primary-care physician was associated with being overseas born, being a refugee/asylum seeker, being a new migrant, not having English as a first language, and being in the UK for ≤5 years. No significant differences were found between groups in terms of duration of illness prior to presentation or duration of hospitalisation (mean 11.74 days [SD 12.69]).</p> <p>Conclusion</p> <p>Migrants presented with a range of more severe infections, which suggests they face barriers to accessing appropriate health care and screening both on arrival and once settled through primary care services. A more organised and holistic approach to migrant health care is required.</p

Robust effects of stress on early lexical representation

This study aims to elucidate the factors that affect the robustness of word-form representations by exploring the relative influence of lexical stress and segmental identity (consonant versus vowel) on infant word recognition. Our main question was which changes to the words may go unnoticed and which may lead the words to be unrecognizable. One-hundred 11-month-old Hebrew-learning infants were tested in two experiments using the Central Fixation Procedure. In Experiment 1, 20 infants were presented with iambic Familiar and Unfamiliar words. The infants listened longer to Familiar than to Unfamiliar words, indicating their recognition of frequently heard word forms. In Experiment 2 four groups of 20 infants each were tested in each of four conditions involving altered iambic Familiar words contrasted with iambic Unfamiliar nonwords. In each condition one segment in the Familiar word was changed – either a consonant or a vowel, in either the first (unstressed) or the second (stressed) syllable. In each condition recognition of the Familiar words despite the change indicates a less accurate or less well-specified representation. Infants recognized Familiar words despite changes to the weak (first) syllable, regardless of whether the change involved a consonant or a vowel (conditions 2a, 2c). However, a change of either consonant or vowel in the stressed (second) syllable blocked word recognition (conditions 2b, 2d). These findings support the proposal that stress pattern plays a key role in early word representation, regardless of segmental identity