The NHS visitor and migrant cost recovery programme - a threat to health?

BACKGROUND: In April 2014 the UK government launched the 'NHS Visitor and Migrant Cost Recovery Programme Implementation Plan' which set out a series of policy changes to recoup costs from 'chargeable' (largely non-UK born) patients. In England, approximately 75% of tuberculosis (TB) cases occur in people born abroad. Delays in TB treatment increase risk of morbidity, mortality and transmission in the community. We investigated whether diagnostic delay has increased since the Cost Recovery Programme (CRP) was introduced. METHODS: There were 3342 adult TB cases notified on the London TB Register across Barts Health NHS Trust between 1st January 2011 and 31st December 2016. Cases with missing relevant information were excluded. The median time between symptom onset and treatment initiation before and after the CRP was calculated according to birthplace and compared using the Mann Whitney test. Delayed diagnosis was considered greater or equal to median time to treatment for all patients (79 days). Univariable logistic regression was used to manually select exposure variables for inclusion in a multivariable model to test the association between diagnostic delay and the implementation of the CRP. RESULTS: We included 2237 TB cases. Among non-UK born patients, median time-to-treatment increased from 69 days to 89 days following introduction of CRP (p < 0.001). Median time-to-treatment also increased for the UK-born population from 75.5 days to 89.5 days (p = 0.307). The multivariable logistic regression model showed non-UK born patients were more likely to have a delay in diagnosis after the CRP (adjOR 1.37, 95% CI 1.13-1.66, p value 0.001). CONCLUSION: Since the introduction of the CRP there has been a significant delay for TB treatment among non-UK born patients. Further research exploring the effect of policies restricting access to healthcare for migrants is urgently needed if we wish to eliminate TB nationally.

Impact of bottom trawling on sediment characteristics--a study along inshore waters off Veraval coast, India.

The present communication is a study on the impact of bottom trawling on the sediment characteristics along Veraval coast, which is the largest trawler port of India. Experimental bottom trawling was conducted from MFV Sagarkripa at five transects of water depths 15-20 m, 21-25 m, 26-30 m, 31-35 m and 36-40 m in commercial trawling grounds. Trawling was conducted for 12 months in a span of 15 months (September 2005-November 2006) excluding the trawl ban period (June to August). The sediment texture was analysed by pipette analysis and organic matter by wet oxidation method. The variations in organic matter and sediment texture were prominent between the stations selected at different depths. The sedimentary organic matter exhibited variations with different water depths and seasons. The organic matter content decreased with depth. Experimental trawling considerably reduced the organic matter content at all depths. Continued and incessant trawling operation can cause even more drastic reductions, where organic matter (OM) content is already very small. The sand proportion showed depth-wise variation; but seasonal and trawling effect was not significant showing highest values at 36-40 m depth. The silt proportion did not exhibit significant depth-wise variation. The seasonal variation of silt was significant whereas trawling effect imparted to silt was not evident. Trawling has no significant effect on clay concentration. But seasonal variation had great influence on the clay distribution and indicated significantly high depth-season interaction. The sediment of the study area was predominant in silt proportion. It was observed that the seasonal/natural variations were more prominent masking the trawling effect on silt.

Shelf life evaluation of Laghu Sutashekhara Rasa - A preliminary assessment.

BACKGROUND: Laghu Sutashekhara Rasa (LSR) is a herbo mineral formulation containing Shuddha Gairika (Fe2O3) and Shunthi (Zingiber officinale Roxb.) with the levigation of Nagawalli Swarasa (fresh juice of Piper betel Linn.) prepared as per the reference of Rasatarangini Parishistha. This is an important formulation in Ayurveda therapeutics, but its shelf life is not evaluated till date. The Govt. of India Gazette specifies the shelf life of various Ayurvedic medicines. However, there is a need to revalidate the shelf life of individual formulations by following parameters prevalent in respective scenario. OBJECTIVES: To evaluate shelf life of Laghu Sutashekhara Rasa. MATERIALS AND METHODS: Laghu Sutashekhara Rasa was prepared in the Pharmacy, Gujarat Ayurved University, Jamnagar following classical guidelines. The samples were subjected to accelerated stability study maintaining temperature and humidity 40 ± 2 °C and 75 ± 5% respectively. Relevant analytical parameters were analyzed at an interval of 0, 1, 3 and 6 months to check the degradation levels in the formulation. RESULT: Product was free from microbial contamination and heavy metals were within the prescribed limits. There were insignificant changes in physico-chemical profiles at different intervals of analysis. On extrapolation of the observations, the shelf life of Rasayoga was found to be 2 years and 8 months. CONCLUSION: The shelf life of Laghu Sutashekhara Rasa was found to be less than the given standards in official gazettes of Govt. of India. This decreased shelf life may be because of the predominantly (approximately 70%) herbal component present in the formulation.

A comparative study of Bilvadi Yoga Ashchyotana and eye drops in Vataja Abhishyanda (Simple Allergic Conjunctivitis).

Simple allergic conjunctivitis is the most common form of ocular allergy (prevalence 5 - 22 %). It is a hypersensitivity reaction to specific airborne antigens. The disease Vataja Abhishyanda, which is due to vitiation of Vata Pradhana Tridosha is comparable with this condition. The management of simple allergic conjunctivitis in modern ophthalmology is very expensive and it should be followed lifelong and Ayurveda can provide better relief in such manifestation. This is the first research study on Vataja Abhishyanda. Patients were selected from the Outpatient Department (OPD), Inpatient Department (IPD), of the Shalakya Tantra Department and were randomly divided into two groups. In Group-A Bilvadi Ashchyotana and in Group-B Bilvadi eye drops were instilled for three months. Total 32 patients were registered and 27 patients completed the course of treatment. Bilvadi Ashchyotana gave better results in Toda, Sangharsha, Parushya, Kandu and Ragata as compared with Bilvadi Eye Drops in Vataja Abhishyanda.

A clinical study on the effect of Arka Taila in the management of Karnasrava (Otomycosis).

Karnasrava is the condition characterized by discharge from Karna and occurs mainly due to Avarana of Vata Dosha. Otomycosis denotes diffuse otitis externa due to fungal infection in ear. Otomycosis being one of the causes of Karnasrava was selected for the study. The present study is done on 28 patients of Karnasrava, who were grouped in to two with 14 patients in each group. Group-A was treated with Arka TailaKarnapurana and Group-B with Clotrimazole ear drops (standard control). The signs and symptoms were studied before and after treatment. Result of the study indicates that Arka Taila and Clotrimazole are equally effective in all the signs and symptoms of Karnasrava (Otomycosis).

A clinical study on the role of Akshi Tarpana with Jeevantyadi Ghrita in Timira (Myopia).

Myopia is a major public health problem pertaining to eye that entails substantial societal, personal, educational, and economical impact. Various surveys in India have found the prevalence of myopia ranging from 6.9% to 19.7%. Myopia progression is irreversible and methods for the correction of myopia are not without complications. Myopia closely resembles Timira involving first and second Patala in terms of symptoms, anatomical structures involved, and the pathogenesis of the disease. The study is aimed at evaluating the efficacy of the Akshi-Tarpana procedure with Jeevantyadi Ghrita in fresh and old myopes. A total of 54 patients (108 eyes) having myopia ≥-6 D were registered for the study and divided into two groups (Group A, Akshi-Tarpana with Jeevantyadi Ghrita, and Group B, Akshi-Tarpana with plain Go Ghrita), by stratified sampling. The procedure was done in 5 sittings of 5 days each with an equal interval of 5 days between each sitting. A total of 22 patients in Group A and 18 in Group B completed the treatment. Obtained data were statistically analyzed using a t-test and the study reveals that objectively, 09.30% and 05.55% eyes were cured, 16.28% and 02.78% markedly improved, and 34.88% and 11.11% moderately improved in Group A and B, respectively.

Role of Pradhamana Nasya and Trayodashanga Kwatha in the management of Dushta Pratishyaya with special reference to chronic sinusitis.

Dushta Pratishyaya is the chronic stage of Pratishyaya, which occurs due to neglect or improper management of the disease Pratishyaya. In modern science, chronic sinusitis can be correlated with Dushta Pratishyaya on the basis of the signs, symptoms, complications, and prognosis. Changing lifestyles, rapid urbanization, and the increase in cases of antibiotic resistance are responsible for the rise in the prevalence of sinusitis. In the present clinical study, 37 patients were registered and were randomly divided into three groups: A, B, and C; of the 37 patients, 31 completed the full course of treatment. In group A, Trayodashanga Kwatha with Madhu was given orally; in group B, Pradhamana Nasya with Trikatu + Triphala Churna was administered; and in group C (combined group), Pradhamana Nasya was administered initially, followed by oral Trayodashanga Kwatha with Madhu. In group A, complete relief was observed in 10% of the patients; in group B, marked improvement was observed in 81.82% of patients; and in group C, marked relief was observed in 60% of patients. In comparison to other groups (Group A and Group B), Group C showed percentage wise better results in most of the symptoms.