The idea of violent uncertainty was first introduced in the New England Journal of Medicine (Grace et al., 2018) making claims about the deleterious impacts of insecure immigration status on the health of migrants. Policies of uncertainty are said to directly and indirectly create harm by impacting on individual's health via detention and public degradation and undermining healthcare services. We offer original empirical evidence indicating an association with uncertainty, in the form of asylum waiting times, on refugees' self-reported health. ML385 order We devise four hypotheses that long waiting time for asylum decisions increases likelihood of self-reported health problems and the effect persists overtime, that female refugees report higher levels of health problems resulting from uncertainty and religion moderates the association between health and uncertainty. We use data from the UK longitudinal Survey of New Refugees wherein all new refugees were sent a baseline survey immediately after receiving refugee status and then follow-up surveys 21 months later. The findings show longer asylum waiting time is associated with poor health. Female refugees were more likely to report poor emotional and physical health. The negative effect of asylum waiting time on emotional health persists 21 months post settlement and is worse for women. The hypothesisabout the ameliorating effect of religion is only partially supported. Our findings supports existing theory and qualitative studies about the deleterious effects of using policies of waiting-related uncertainty for managing migration. Given the wide use of such policies in the Global North, our work is suggestive of likely generalisability. Thus, countries with large refugee populations might want to consider our findings when developing asylum policy which minimises impact on refugee health.Although Value-Based Health Care (VBHC) is widely debated and cited, there are few empirical studies focused on how its concepts are understood and applied in real-world contexts. This comparative case study of two prominent adopters in Brazil and Sweden, situated at either end of the spectrum in terms of contextual prerequisites, provides insights into the complex interactions involved in the adoption of value-based strategies. We found that the adoption of VBHC emphasized either health outcomes or costs - not both as suggested by the value equation. This may be linked to broader health system and societal contexts. Implementation can generate tensions with traditional business models, suggesting that providers should first analyze how these strategies align with their internal context. Adoption by a single provider organization is challenging, if not impossible. An effective VBHC transformation seems to require a systematic and systemic approach where all stakeholders need to clearly define the purpose and the scope of the transformation, and together steer their actions and decisions accordingly.Existing research has identified numerous barriers to the adoption of public health policies for alcohol, including the cross-cutting nature of the policy problem and industry influence. Recent developments in Ireland suggest that while formidable, such barriers can be overcome. Ireland's 2018 alcohol legislation adopts key evidence-based measures, introducing pricing, availability and marketing regulations that are world-leading in public health terms. Drawing primarily on the Multiple Streams Approach (MSA), this study investigates the adoption of the Public Health (Alcohol) Act 2018. We draw data from 20 semi-structured interviews with politicians, government advisors, public health experts, and advocates, as well as from relevant primary documents, newspaper articles, and other material in the public domain. We find that increased public attention to alcohol-related harms in Ireland (problem stream), developments within the institutional location of policymaking (the policy stream), and the political pressure exerted by politicians and advocates (the political stream) all combined to open a policy window. Unlike previous alcohol policy reform efforts in Ireland, several personally committed and well-positioned leaders championed policy change. This study suggests that political leadership might be important in understanding why public health approaches to alcohol have been embraced in some contexts but not in others.
The prognosis for unilateral lateral medullary infarction (ULMI) is generally good but may be aggravated by respiratory failure with fatal outcome. Respiratory failure has been reported in patients with severe bulbar dysfunction and large rostral medullary lesions, but its associated factors have not been systematically studied. We aimed to assess clinical and radiological characteristics associated with respiratory failure in patients with pure acute ULMI.
Seventy-one patients (median age 55 years, 59 males) with MRI-confirmed acute pure ULMI were studied retrospectively. Clinical characteristics were assessed and bulbar symptoms were scored using a scale developed for this study. MRI lesions were classified into 4 groups based on their vertical extent (localized/extensive) and the involvement of the open and/or closed medulla. Clinical characteristics, bulbar scores and MRI lesion characteristics were compared between patients with and without respiratory failure.
Respiratory failure occurred in 8(11%opment of respiratory failure in pure ULMI. Further prospective studies are needed to identify other potential risk factors, pathophysiology, and effective preventive measures for respiratory failure in these patients.
Hypertensive cerebral hemorrhage seriously endangers the health of the elderly. However, the relationship between obesity and arterial elasticity in hypertensive cerebral hemorrhage remains to be clarified. The purpose of our study is to explore the associations between body mass index (BMI) and central arterial reflected wave augmentation index (cAIx), toe-brachial index (TBI), brachial-ankle pulse wave velocity (baPWV), and ankle-brachial index (ABI) in the elderly hypertensive patients with hemorrhagic stroke.
A total of 502 elderly hypertensive patients with hemorrhagic stroke and 100 healthy controls were collected. According to the BMI, patients were divided into normal BMI, overweight, obesity, and obese groups. The multivariate logistic regression model was used to establish a risk model for elderly hypertensive hemorrhagic stroke.
Compared with the normal BMI group, systolic blood pressure (SBP), diastolic blood pressure (DBP), cAIx, and baPWV in the abnormal BMI group were significantly increased (P<0.ML385 order
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