Variation in initial health assessment of unaccompanied asylum-seeking children: a cross-sectional survey across England.

OBJECTIVE: To assess variation in current practice of initial health assessments (IHAs) for unaccompanied asylum-seeking children (UASC) across England. DESIGN: Cross-sectional survey. MAIN OUTCOMES MEASURES: Type of routine assessment carried out, threshold to specialist referrals and facilities available to complete IHA. RESULTS: Eighty-six health professionals responded across England; 47% had received training in UASC IHA and 33% in UASC mental health issues. The majority (80%) of IHAs were conducted with translator support and 7% of participants reported Child and Adolescent Mental Health Services (CAMHS) input. Around half of clinicians (53%) performed tuberculosis and bloodborne virus screening for all UASC, while other infectious diseases (IDs) screening was symptom and risk factor dependent. Overall, 14% of clinicians routinely comment on age assessment and 76% share the IHA report and health plan with UASC. The time allocated for assessment range between 30 and 90 min. CONCLUSION: There is significant variation in practice around UASC IHAs across England, notably around CAMHS input, time allocated, translation facilities and ID screening. The results suggest that, an increase in resources available for UASC teams, improved access to specialist services and further training on UASC health are all needed. Guidance that aims to set a best practice framework for UASC IHA delivery such as a 'one-stop shop' model would help to standardise UASC IHA across the country.

Obstetric outcome of female genital mutilation in the Gambia - an observational study.

Background: A 2010 survey in The Gambia among women of reproductive age put the prevalence rate of FGM/C at 76.3%. FGM/C was banned in 2015, but there is no real effort at enforcement of the ban. This study aimed to provide national data on obstetric outcomes to support advocacy and health education. A multicentre observational study to assess the obstetric and neonatal outcomes of parturient women with and without FGM/C was carried out across 4 healthcare facilities in The Gambia. The primary outcome was postpartum haemorrhage (>500ml) and secondary outcomes were caesarean section, perineal tears (including episiotomy), neonatal resuscitation and perinatal death. Of the 1,569 participants recruited into the study, 23% had no FGM/C while 77% had FGM/C of varying severity. The risk of postpartum haemorrhage was doubled for women with type I FGM/C, tripled in type II FGM/C and increased by 5-fold for those with type III and IV FGM/C. Caesarean section and perineal tears were also increased. FGM/C was associated with increased risk for neonatal resuscitation and perinatal death. FGM/C is associated with poor obstetric and neonatal outcomes in the Gambia with degree of risk correlating with the severity of FGM/C.

Description and evaluation of a pathway for unaccompanied asylum-seeking children.

OBJECTIVE: (1) To describe a novel integrated pathway for unaccompanied asylum-seeking children (UASC).(2) To evaluate a population engaged with this service. DESIGN: Description of the integrated pathway (objective 1) and retrospective evaluation, using data from community paediatrics, infectious diseases (IDs) screening and a sexual health (SH) service (objective 2). SETTING: Unlinked data were collected from three services across three National Health Service (NHS) trusts in London. PATIENTS: All Camden UASC engaged with the service from 01 January 2016 to 30 March 2019. INTERVENTIONS: A multidisciplinary approach prioritising the health needs of UASC including a childre and adolescent mental health service (CAMHS) clinican and a health improvement practitioner. There are low thresholds for onward referral and universal asymptomatic screening of UASC for ID. MAIN OUTCOME MEASURES: Data on demographics, unmet health needs and known outcomes. RESULTS: Data were available for 101 UASC, 16% female, median age 16 years (range 14-17). Physical assault/abuse was reported in 67% and 13% disclosed sexual assault/abuse, including 38% of female UASC. Mental health symptoms were documented in 77%. IDs warranting treatment were identified in 41% including latent tuberculosis (25%) and schistosomiasis (13%). Interpreters were required for 97% and initial non-attendance rates at follow-up were 40% (ID) and 49% (SH). CONCLUSIONS: These data demonstrate high rates of historical physical and sexual assault/abuse, unmet physical, mental and emotional health needs among UASC and significant barriers to engaging with services. An integrated pathway has been successfully implemented and shown to deliver appropriate, joined-up care for UASC, consistent with current recommendations, with the potential to improve outcomes.

Health outcomes in international migrant children: protocol for a systematic review.

INTRODUCTION: Migration status is a key determinant of health, but health outcomes among migrant children and young people (CYP), that is, those aged under 18 years, are poorly understood. A 'healthy migrant' effect has been demonstrated among adults, but evidence for the same effect in CYP is lacking. No large studies or reviews exist reporting comprehensive or holistic health outcomes among migrant CYP. We aim to identify and synthesise original quantitative research on health of migrant CYP to explore the relations between migration status and health outcomes. METHODS AND ANALYSIS: A search of PubMed/Medline, Embase, Cochrane and grey literature sites will be undertaken for any original quantitative research on health outcomes of migrant CYP from 01 January 2000 onwards. Outcomes addressed: mortality, communicable diseases, non-communicable diseases, nutritional status, mental health, disability, vaccine coverage, and accidental and non-accidental injuries (including assault and abuse). Search results will be screened and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.The Newcastle-Ottawa Scale assessment tool will be used to assess study quality. If feasible, depending on study availability data heterogeneity (explored using I2 statistic), results will be pooled for meta-analysis. If sufficient data are available, a priori defined subgroup analyses will be undertaken. A narrative quantitative synthesis will be presented, taking account of study quality and assessed risk of bias.The anticipated search completion date is 01 June 2021 with write-up completed by 01 April 2022. ETHICS AND DISSEMINATION: Formal ethical approval will not be sought as we will be accessing data already in the public domain. This review will be submitted for publication in a high-impact journal and presented at international conferences. The results of this work will be shared with groups of migrant children as part of an ongoing engagement project. PROSPERO REGISTRATION NUMBER: CRD42020166305.

Health outcomes, healthcare use and development in children born into or growing up in single-parent households: a systematic review study protocol.

INTRODUCTION: Up to a quarter of all children globally live in single-parent households. Studies have concluded that children who grow up with continuously married parents have better health outcomes than children who grow up with single or separated parents. This is consistent for key health and development outcomes including physical health, psychological well-being and educational attainment. Possible explanations include higher poverty and time limitations of parental engagement within single-parent families, but these only represent a narrow range of mechanisms. We aim to identify and synthesise the evidence on how being born into and/or living in a single-parent household compared with living in a two-parent household as a child impacts health and development outcomes, healthcare use and factors that may be driving differences. METHODS AND ANALYSIS: We will search PubMed, Scopus and ERIC and adapt our search terms for search engines and grey literature sites to include relevant conference abstracts and grey literature. We will restrict results to English language publications from 2000 to 2020 and screen against inclusion criteria. We will categorise main outcomes into five groups of outcomes: birth outcomes, mortality, physical health, mental health and development, and healthcare use. We will use the Newcastle-Ottawa Scale to assess the methodological quality of studies. Narrative synthesis will form the primary analysis in the review. Synthesis of effect estimates without meta-analysis will follow the Synthesis Without Meta-analysis guidelines. ETHICS AND DISSEMINATION: All documents used are publicly accessible. We will submit results to a peer-reviewed journal and international social science conferences. We will communicate results with single-parent groups and relevant charitable organisations. This review will also be included in IL's PhD thesis. PROSPERO REGISTRATION NUMBER: CRD42020197890.

Medical student-led simulation in COVID-19 crisis.

BACKGROUND: Simulation training is an effective tool for improving confidence in healthcare workers. During the recent COVID-19 pandemic, large numbers of staff required re-training to manage unfamiliar situations. We present a set of medical student-led clinical simulation sessions and evaluate their effects on (i) confidence among redeployed healthcare workers managing COVID-19 patients and (ii) medical students' confidence as educators. METHODS: Half-day simulation training sessions consisting of three COVID-related clinical scenarios were devised by senior medical students and delivered to a group of approximately 150 healthcare workers over six repeated sessions prior to redeployment to COVID-19 wards. We distributed an anonymous pre- and post-simulation questionnaire to 36 participants in the final group exploring their experiences. The confidence scores were analysed using the Wilcoxon signed-rank test. Following the delivery of teaching, medical students completed a questionnaire assessing their personal experiences of designing and delivering the exercises. RESULTS: Data are available for 35/36 participants approached. Respondents reported being significantly more confident after the training in all aspects of managing COVID-19 patients, including triage, complex discharge, recognising deterioration, initiating basic life support, managing symptoms and advising on visiting policies (p < 0.001); 97% of respondents rated the training as useful. Thematic analysis of medical students' responses demonstrated mutual benefit. DISCUSSION: This study demonstrates the strengths of simulation training in helping to build staff confidence in a rapidly evolving situation and highlights the value of medical students in supporting a hospital's response to an outbreak. We recommend further studies of student-led simulation exercises, including longer-term follow-up.

Epidemiological surveillance study of female genital mutilation in the UK.

OBJECTIVES: Describe cases of female genital mutilation (FGM) presenting to consultant paediatricians and sexual assault referral centres (SARCs), including demographics, medical symptoms, examination findings and outcome. DESIGN: The well-established epidemiological surveillance study performed through the British Paediatric Surveillance Unit included FGM on the monthly returns. SETTING: All consultant paediatricians and relevant SARC leads across the UK and Ireland. PATIENTS: Under 16 years old with FGM. INTERVENTIONS: Data on cases from November 2015 to November 2017 and 12 months later meeting the case definition of FGM. MAIN OUTCOME MEASURES: Returns included 146 cases, 103 (71%) had confirmed FGM and 43 (29%) did not meet the case definition. There were none from Northern Ireland. RESULTS: The mean reported age was 3 years. Using the WHO classification of FGM, 58% (n=60) had either type 1 or type 2, 8% (n=8) had type 3 and 21% (n=22) had type 4. 13% (n=13) of the cases were not classified and none had piercings or labiaplasty. The majority, 70% had FGM performed in Africa with others from Europe, Middle East and South-East Asia. There were few physical and mental health symptoms. Only one case resulted in a successful prosecution. CONCLUSIONS: There were low numbers of children presenting with FGM and in the 2 years there was only one prosecution. The findings may be consistent with attitude changes in FGM practising communities and those at risk should be protected and supported by culturally competent national policies.

Female genital mutilation (FGM) in UK children: a review of a dedicated paediatric service for FGM.

OBJECTIVE: To describe the presentation and management of children with suspected or confirmed female genital mutilation (FGM) referred to a specialist paediatric clinic. METHODS: Data collected included referral source, age, ethnicity, circumstances of FGM and clinical findings in accordance with the WHO FGM classification. RESULTS: Between September 2014 and January 2019, 148 children attended the clinic of whom 55 (37.2%) had confirmed FGM. Police or social care referred 112 (76%) children. The proportion of looked-after children (LAC) was significantly higher in the group with confirmed FGM (17/55, 31%) compared with children where FGM was not confirmed (5/93, 5%). In almost all children where FGM was confirmed, FGM was initially disclosed by the child or family (53/55, 96%) and of these 48/55 (87%) underwent FGM prior to UK entry. The remaining seven cases were British children, potentially meeting legal criteria under the FGM Act, and one resulted in a successful prosecution. CONCLUSIONS: The number of children with FGM was significantly lower than expected based on UK prevalence estimates. Most children had undergone FGM prior to UK entry, and the majority of cases were initially disclosed by the child or family themselves. These results reflect the lack of large-scale proof of the practice of FGM in the UK and are consistent with growing evidence of the abandonment of FGM among communities after migration.

The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews.

PURPOSE: International guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes? METHODS: We included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded. RESULTS: Initial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer. CONCLUSION: We found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.

Recording inpatient weight: implications for medicines administration.

AIM: To identify the proportions of hospital inpatients with recorded weights: among all patients, and among those receiving weight-dosed drug therapy. METHOD: Survey of clinical notes of hospital inpatients across a convenience sample of 11 secondary and tertiary referral hospitals in England and Wales in November 2011. RESULTS: 1068 patients were included, and 1061 patient clinical notes were available (99.3%). Nearly all paediatric patients had recorded weights (77/78; 98.7%). Half of adult inpatients had recorded weights (503/983, 51.2%). The proportion of adult inpatients with recorded weights varied by hospital, ranging from 13.5% to 92.5% (p<0.0001). In those receiving gentamicin or therapeutic-dose low molecular weight heparin (t-LMWH), only 64.5% (71/110) had a recorded weight. CONCLUSIONS: Half of adult inpatients, and two-thirds of those receiving gentamicin or t-LMWH, had recorded weights. There was significant variation in rates of weighing adult inpatients across hospitals. This may put patients at increased risk of side effects and problems resulting from malnutrition.

Female genital mutilation in children presenting to a London safeguarding clinic: a case series.

OBJECTIVE: To describe the presentation and management of children referred with suspected female genital mutilation (FGM) to a UK safeguarding clinic. DESIGN AND SETTING: Case series of all children under 18 years of age referred with suspected FGM between June 2006 and May 2014. MAIN OUTCOME MEASURES: These include indication for referral, demographic data, circumstances of FGM, medical symptoms, type of FGM, investigations and short-term outcome. RESULTS: Of the 47 girls referred, 27 (57%) had confirmed FGM. According to the WHO classification of genital findings, FGM type 1 was found in 2 girls, type 2 in 8 girls and type 4 in 11 girls. No type 3 FGM was seen. The circumstances of FGM were known in 17 cases, of which 12 (71%) were performed by a health professional or in a medical setting (medicalisation). Ten cases were potentially illegal, yet despite police involvement there have been no prosecutions. CONCLUSIONS: This study is an important snapshot of FGM within the UK paediatric population. The most frequent genital finding was type 4 FGM with no tissue damage or minimal scarring. FGM was performed at a young age, with 15% reported under the age of 1 year. The study also demonstrated significant medicalisation of FGM, which matches recent trends in international data. Type 4 FGM performed in infancy is easily missed on examination and so vigilance in assessing children with suspected FGM is essential.