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The Three Ghosts of Child Protection

9 Oct, 14 | by shaworth

It’s been a depressing time for child protection in the UK recently. Admittedly, child protection work rarely hits the headlines for the right reasons, as confidentiality restricts the pronouncement of victory, and the media rarely gets excited about restoring safety and normality. The prevention of bad outcomes doesn’t make for headlines that sell newspapers in the same way that terrible events do.

This year, historical accusations of abuse have been a recurring feature in the news, sometimes too late for justice to be served, but sometimes with successful convictions against perpetrators who probably thought they had gotten away with it. Many of us felt that the public figures involved in these crimes were people that we could trust, and feel a sense of revulsion that we innocently did so. At the same time, it is some comfort to see that fame is no protection from justice.

Unfortunately, the same cannot be said for the widespread sexual abuse of vulnerable children in Rotherham, which has garnered widespread media attention, sometimes for the wrong reasons, with several media outlets quick to place the blame on the race of the perpetrators, and ignoring the police inefficiency at following up complaints. Perhaps what’s most worrying are the disturbing reports of attempts to silence those who spoke up to report the abuse, and the repeated instances of incompetence such as losing or destroying evidence.

Earlier this month, the Liberal Democrat leader Nick Clegg announced new legislation that will make a failure to report child abuse a crime. The motion was originally tabled by the Prime Minster in July, and takes the form of an amendment to the Series Crimes Act, which is currently sponsored by the Bishop of Durham and Baroness Walmesly. Concerns have been raised that this may result in malicious or nuisance reports, but where similar legislation has been enacted abroad, the proportion of reports deemed to be nuisance, has not been shown to have increased.

For those of us who work with vulnerable children and adolescents, the knowledge that our attempts to keep children safe, and bring justice to those who seek to harm them are being undermined elsewhere is disheartening in the extreme. We as medical professionals can only so much to collect evidence and share with external agencies, in the hope that due processes will be followed.

We can but hope that an increased media focus on child protection issues will encourage the government to fund social work and charitable organisations which work to safeguard children, but for all the talk of Big Society, the lack of cohesion between voluntary sector organisations and local authorities has been thrown into sharp relief by the publication of the Centre for Social Justice’s Report “Enough Is Enough” earlier this year, which worked with the charity Kids Company to detail instances of failure to act by local authorities where the charity had voiced concerns.

In Ofsted’s 2013 social care report, the cost of looked after children had increased by £173 million pounds, and at the same time, funding for social work had decreased by a quarter over the last four years, with an overall 4% decrease in social worker psoters. Whilst local authorities with difficulties achieving good quality safeguarding services for children have complex problems underneath, a lack of funding is a chronic drain on any social work budget.

In the last month, in an attempt to rectify child protection serves which had been found to be inadequate, Doncaster has removed child services from the local authority, instead setting up a third party, not-for-profit organisation to manage services instead. Obviously, this had raised accusations of stealth attempts at privatisation; although the company will continued to be funded by the local authority. This is not the first attempt to manage childrens’ services in this way, and results from previous similar initiatives have been mixed, largely blamed on chronic budget cuts.

Ultimately, children are safer now than previously, and it’s a testament to the hard work of those in child protection that this is the case; however, we cannot continue to make gains in this area unless we are willing to priorities support for the most vulnerable who need our help.

Marie Stopes International launches “Time to Act: Achieving a world where no woman dies from unsafe abortion”

25 Sep, 14 | by shellraine, e-Media Editor

Ahead of World Contraception Day (September 26th) Marie Stopes International (MSI) is launching Time to Act: Achieving a world where no woman dies from unsafe abortion to coincide with the UNGA’s deliberations on the 1994 Cairo agenda and the post-2015 goals.  A copy of the report is available here: http://www.makewomenmatter.org/timetoact.

Part of MSI’s Make Women Matter campaign, the report brings to light the damage being caused by the unmet need for contraception and unsafe abortions and warns how much worse the situation is yet to become as the developing world faces its biggest population growth in history.

FGM Awareness

24 Sep, 14 | by shaworth

Female Genital Mutilation has come to the forefront of media attention this summer, with the government allocating a quarter of a million pounds of funding towards the eradication of the practice earlier this year. and readers of the Journal have probably noticed an increasing focus on this issue. Last week Yvette Cooper, the shadow home secretary, as part of an interview with the House magazine, outlined proposals to detain girls at risk of being removed from the UK for the purpose of FGM being performed. These measures are similar to those outlined previously in the 2007 Forced Marriage Act.

As part of the push against the practice of FGM in the UK, the UK Border Agency is being supported by officers with specialist child protection training, who are attempting to identify those at risk on both exiting and entering the UK. This year, whilst the team has been deployed at Gatwick, 30 cases have been identified compared with none previously.

In support of the move, the UK Muslim Council issued a statement earlier this year condemning the practice as being against the principles of Islam, an important move considering that religious reasons are often cited as being part of the rationale of continuing the practice. Meanwhile in Kenya, there seems to have been some progress at reducing the incidence of the practice with several cases coming to court prosecuting those who perform FGM, with increased sentencing against fatalities.

At the moment, there are UK Government interim guidelines for professionals with regard to FGM which were issued in July of this year and due to be updated in November. Readers may also be interested in the work of the Orchid Project, a charity in the UK dedicated to assisting the eradication of the practice.

21 Sep, 14 | by shaworth

Readers might be interested to know that Pfizer are sponsoring a series of educational events on womens’ healthcare, encompassing  aspects of sexual health and family planning. These are taking place in England through October and November.

Manchester – Saturday 4th October 2014
Nottingham – Saturday 11th October 2014
Durham – Tuesday 4th November 2014
Blackburn – Wednesday 18th November 2014
Maidstone – Tuesday 18th November 2014

Agendas for the meetings can be found here.

Those attending should be aware that the session feature talks about the prescribing of Depo-Provera, and that this is manufactured by the sponsors.

Crowdsource, Contraception and No Small Potatoes

14 Sep, 14 | by shaworth

Contraception for men has been an area of dashed dreams for many years, so the ongoing trials of potentially reversible vas deferens occlusion by polymer injection represents an interesting development. Reported in the UK press as an “injectable contraceptive for men”, a description that seems grossly inaccurate in some respects as it’s not equivalent to the injectable contraceptives for women which work using high dose progestrogen; although it is injected into the vas itself, Valsagel is currently undergoing testing in animal models with hopes to begin trials in humans if this is deemed to be a success.

Valsagel is not the first polymer injected vas-affecting agent to be developed, and the work was inspired by the ongoing trials of RISUG in India, covered by Wired in 2010 in an extensive article that also details how Valsagel came to be and containing an account of a consenting process that seems less than entirely rigorous. RISUG was passed over by the WHO after phase II trials in 1997, due to production problems, but interest in the project was renewed in India in recent years and Phase III trials continue locally.

Valsagel works slightly differently to RISUG, by occluding the vas deferens using the polymer. Theoretically, the polymer can be subsequently dislodged using another injectable agent; although whether this is true in humans, only time will tell. Interested clinicians can follow the Valsagel trials through the Parsemus Foundation, who are partly funding the trials through crowdsourcing initiatives.

This is not the first crowd-sourced initiative in medial research discussed in the blog, and it also remains to be seen whether this will represent a useful source of funding for medical research in future, by bringing patients and small donors into contact with large-scale projects.

Those following developments in this field may also be interested in the attempt of an American woman, known only as Bailey, who attempted to crowd-fund her termination of pregnancy through the website GoFundMe (which the website subsequently revoked; although she did receive the funds allocated). Bailey was interviewed about her decision in the fashion and design magazine Vice*, where she discusses that her decision to crowd-fund donations was due to being unable to finance the procedure herself, and the use of crowd-funding to help people achieve their goals. She makes reference to the $50,000 raised to produce a single serving of potato salad, something that suggests the world has not yet run out of ways to waste money.

*This magazine contains content, including nudity and profanity, which is probably in violation of your work internet use policy, but you can read the interview here.

Young People And Their Experiences of Anal Sex

21 Aug, 14 | by shaworth

Readers of the Journal may have come across the recent study into teenage attitudes towards anal sex in heterosexual couples by the London School of Hygiene and Tropical Medicine, published last month via their Online First initiative already, but if you’ve not, it makes interesting reading for anyone working in young people’s sexual health.

Existing data suggests that anal sex between heterosexual couples is on the rise, and often increased access to pornographic materials in the digital age is cited as the reason behind this; although the evidence to suggest this is limited. Recent data, according to this study, suggests that 1 in 5 young people has tried anal sex.

The study took place in three centres in England, surveying 130 young people in total with various levels of interviews. Questions involved their perceptions of their own experiences, their partner’s experience and their reasons for trying anal intercourse. The answers seem to confirm some of the previous hypotheses, but with pornographic material being a small factor in why young people explored the idea of anal intercourse; although the belief that anal intercourse would be more pleasurable for the male partner due to a linked believe that “tightness” was integral to male sexual pleasure during penetrative intercourse, and encouragement from peers to try anal intercourse as part of a sexual conquest, were also prevalent attitudes amongst male interviewees.

Perhaps what’s most worrying is the evidence that some men felt that they had a right to coerce partners into trying anal intercourse, despite holding the belief that female partners would find anal sex painful. To those of us interested in the wider climate of sexual equality and sexual behaviour, this isn’t a shocking finding. The idea that some men feel entitled to sexual favours from women, and how this defines their behaviour and attitudes towards them, has been a centrepoint of modern feminist debate in recent years.

The study is of value to those working in sexual health, particularly with young people. It highlights that young people are unaware of the risks to their sexual health with regard to anal intercourse, and suggests that targeted interventions to improve condom use and safe anal intercourse is needed in this group. It also suggests that the worrying disparity between male and female experiences of anal intercourse needs to be addressed, perhaps through initiatives that empower young women to control their own sexual experience, and perhaps through initiatives that educate young men on how to achieve sexual pleasure for their partner as well as themselves.

Sexual Function In Childhood Cancer Survivors

12 Aug, 14 | by shaworth

Journal readers may be interested to know about a recent study published in the Journal of Clinical Oncology, a cohort study of over two thousand women who had suffered from childhood cancer compared with their female siblings, which demonstrated an excess of psychosexual morbidity in those who had suffered cancer as children.

It is known that the treatment of cancer can affect sexual functioning in a variety of ways, from premature menopause to the direct effects on the genital tract; however in these women, it would appear that the effects of the cancer, and treatment, persisted into adulthood. Compared with their sisters, they reported having less sex, less desire for sexual and less satisfaction with sexual intercourse. Speaking to Reuters Health, the study lead Jennifer Ford, expressed her surprised at the persistence of these effects.

About ten percent of women in the study experienced premature menopause, and only half of these were taking some form of hormone replacement; although this did not seem to improve the outcomes measured.

The study did not measure similar outcomes in men, so it is not clear if their experience is similar; however, the study does suggest that sexual function should be addressed in adolescents who have suffered cancer, and opened up for discussion with those who are facing cancer treatment.

HIV and Sex Work: The Lancet Series

28 Jul, 14 | by shaworth

This week saw the publication of the new Lancet series, an ongoing series of analyses of research in HIV with a focus on identifying those at risk and collating the data on prevention strategies. Previous parts of the series have looked at men who have sex with men (2012), and general prevention strategies (2008); however the latest part of the series is a detailed look at the burden of HIV prevention in sex workers.

The series is a detailed look at the studies detailing the HIV burden in sex workers who are female, male and transgender, and as such, gives a fairly broad look at the subject area. It identifies the barriers that are faced in attempts to reduce HIV incidence in this population, and it’s clear from the review that decriminalisation of sex work in order to reduce human rights violations and protect sex workers is a key part of the HIV prevention strategy. For many years, sex workers have been marginalised in attempts to prevent HIV, but it is obvious from the high disease burden in this group that sex workers need to be brought into the centre of HIV prevention strategies.

A particularly interesting part of the report concerning female sex workers comes from a representative of the Dutch police force, who discusses the change in legislation that has decriminalised sex work for those adults who are working voluntarily in this sector, allowing the police to focus their efforts on investigating human rights violations against sex workers and children who are working illegally. The fact that they are still unable to effectively target sex workers who are working illegally in the country remains a point of concern, but it’s hard to doubt that the decriminalisation does allow them to focus their efforts to protect those who chose to be employed in this way.

What’s also fascinating about the series is the study of male sex workers, and the findings that not all of these men identify as gay, potentially undermining public health strategies targeting this group that effectively make this assumption. The understanding of the driving factors behind the choice of these men who have become sex workers is paramount at identifying successful HIV prevention strategies. There’s also a short appendix of local terminology for male sex workers, which may be useful for those looking to work in sexual health abroad.

The inclusion of transgender individuals in the study makes for harrowing reading. Transwomen (the study does not include transmen) have a disproprotionate risk of HIV infection, 13.5 times the risk for natal women. The lack of research in this area, along with a lack of research into effective strategies to prevent HIV in this population undermines our efforts in this area, which is obviously not an acceptable situation to continue.

 

Coming Over Here: UK and Overseas Sperm Donors

29 Jun, 14 | by shaworth

 

Sperm donor anonymity was revoked in the UK in 2005, meaning that children born from donor sperm can now trace the identity of their genetic father at the age of eighteen. The same is true of egg donors. The reverse was not true at the time of the change, with gamete donors being unable to request information about any children they may have assisted in the production of; however cases have since been presented to court from sperm donors who are known to the recipient couple seeking access to the children they have produced.

This week there have been articles in the press about the perceived fall in UK sperm donors since the 2005 legislation was introduced; although few are able to prove this allegation, despite the data being available. All fertility clinics in the UK are regulated by the HFEA, who require registration data on all donors whose samples can be used to artificial reproduction techniques (thus excluding those whose samples are donated to research). In 2011, around 2,000 women received donor insemination and over the last few years, the number of embryos produced from donor procedures has remained steady; although this does not, for some reason, include ICSI procedures where sperm is directly injected into an egg, cultured and reimplanted, which somewhat muddies the waters.

In fact, contrary to the media reports, the number of new UK donor registrations with the HFEA has been rising steadily since 2005. New sperm donor registrations were actually lower in the year preceding the anonymity revoking than any other year since 1992. When the figures are broken down by UK and overseas donors, there has actually been a steady increase year-on-year since 2005. Yes, in 2005 1:10 new donors were from overseas, and in 2010 it’s 1:4, but over the same time period the UK new donor registrations have increased by a third, and overseas donors have increased four-fold, rather than a drop in UK donors and overseas donors making up a shortfall.

Of course, the data available to the public goes up to 2011, and it’s now 2014, so it’s possible that data has been selectively leaked to people who are not your humble blogger, and perhaps ICSI requests have risen stratospherically so that we can’t keep up with demand; although that wouldn’t explain why everyone is so quick to blame legislation that’s nine years old on a three year old phenomenon. Perhaps, the story here is not about a looming sperm-famine, but that you can make some good headlines out of unresearched articles produced with a mere flick of the wrist.

Review: The Menopause Exchange

9 Jun, 14 | by shaworth

The Menopause Exchange is an independent organisation founded by Norma Goldman, a pharmacist with a special interest in health promotion, to provide impartial information for patients and health professionals about the menopause. Information is circulated largely through the quarterly newsletters, which are free and through the Menopause Exchange blog. They are also present on Twitter and Facebook. Unlike some other magazines aimed at patients, they are not supported by advertising, and take no funding from sponsors; although there are no conflict of interest decelerations from the writers.

I read the Spring 2014 issue of Menopause Exchange which covers a diverse range of issues from irregular peri and post menopausal bleeding to the NHS screening programs available for women who are going through the menopause. There is also an “ask the experts” section where questions can be posed to those writing for the newsletter which explore fairly diverse subjects such as the length of time HRT can be used, to complementary and alternative therapies.Although Menopause Exchange states that it is for both patients and health professionals, the articles seem to be mainly aimed at the former rather than the latter. This is no bad thing, as patient support and resources are valuable to those experiencing menopause. The articles communicate the concepts they explore well, without jargon.

Whilst the information produced is good quality, the format of the newsletter could be improved. Digital media has leveled the playing field for communicating information, and high quality printers to produce slick and effective print media are available for home use, but Menopause Exchange isn’t taking maximum advantage of this and I felt that the look of the newsletter was dated. Back issues of the newsletter are available by post, paid by cheque (there is an option to pay digitally, but this doesn’t seem like the first choice), which seems absurd in 2014; although perhaps demand has produced this need.

Overall, I’d say that Menopause Exchange has a lot to offer your patients, and mine. If it took full advantage of technological advances, it would find itself a unique and valuable resource.

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