The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers, children and young people and young adults

Objectives: To measure the prevalence of maltreatment and other types of victimization among children , young people and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardised scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people and young adults taking into account other types of childhood victimization, different perpetrators, non–victimization adversities and variables known to influence mental health. Methods: A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health. Results: 2.5% of children aged under 11 years, 6% of children and young people aged 11 to 17 years had one or more experiences of physical, sexual or emotional abuse, or neglect by a parent or caregiver in the past year and 8.9% of children under 11 years, 21.9% of young people aged 11 to 17 years and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were found, 7.2% of females aged 11 to 17 and 18.6% of females aged 18 to 24 reporting childhood experiences of sexual victimization by any adult or peer that involved physical contact (from rape to sexual touching). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization and to have higher levels of trauma symptoms. Conclusions: The past year maltreatment rates for children under age 18 were seven to seventeen times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children’s mental health

Dealing with disaster: a qualitative exploration of the experiences of healthcare and emergency services staff following a mass casualty incident

Background – Globally there has been an increase in mass casualty incidents, which have a detrimental impact on the environment, community, and human life. Research following the 9/11 attacks identified the psychological toll on front line emergency workers and there has been an increased awareness of the prevalence of PTSD within this group. However, research to date has not focused on the UK perspective, nor used qualitative methods to explore the impact on front line emergency workers of being involved in mass casualty incidents (MCIs). Methods – This qualitative study was undertaken using semi-structured interviews with ten UK front line health care professionals (HCPs), who worked at the scene or in the accident and emergency department during an MCI. These participants were selected via purposive and snowball sampling between January 2020 to August 2021. Braun and Clarke’s six stage thematic analysis were used to analyse the data. Findings – Eight key themes were identified with three involving external factors, namely training, operational environment and media and these four were associated with both positive and negative perceived outcomes). Three further themes around job satisfaction, scrutiny and support involved both internal and external factors. Job satisfaction was protective for wellbeing, however scrutiny caused decreased motivation to work in the medical profession. In terms of support, most interviewees favoured informal approaches, due to formal support being associated with stigma or judgement. The final theme psychological effects were perceived negatively and involved burnout, insecurity, delayed emotions, avoidance, and difficulties with re-experiencing reminders within the community and during anniversaries of MCIs. These eight themes could be further organised across different aspects of time, place and organisation or agent. Discussion and Conclusion – This exploratory research has revealed unique new insights into experiences of HCPs involved in MCIs in the UK. Policy and practice implications relate to three key areas: tailoring ongoing HCP MCI training/preparedness, enhancing organisational support for staff involved in an MCI and finally reviewing the role of the media. Participant experiences of an MCI varied but revealed significant negative, but some rewarding, aspects which could be linked to different times, locations, and agencies

Child Abuse and Neglect in the UK Today

This report presents new research findings from the NSPCC on child maltreatment in the United Kingdom, looking specifically at the prevalence and impact of severe maltreatment. We found that the rates of child maltreatment reported by young adults aged 18–24 were lower in 2009 than in 1998, suggesting maltreatment may be less prevalent today. However, significant minorities of children and young people in the UK today are experiencing severe maltreatment and this is associated with poorer emotional wellbeing, self-harm, suicidal ideation and delinquent behaviour

Physical activity and fatigue in adults with Inflammatory Bowel Disease (IBD): a systematic review

Background: Fatigue is frequently reported in inflammatory bowel disease (IBD). IBD has been shown to have an impact on, and be impacted by, physical activity levels in IBD patients, Yet, to date, there have been no systematic reviews considering the impact of physical activity on levels of IBD fatigue.Aim: This aim of this review is to explore the current body of knowledge of what kind of physical activity interventions are available to treat IBD fatigue.Methods: Systematic database searchs (CINAHL, EMBASE, PsychInfo, PsycARTICLES, AMED, Medline) and hand searching were conducted on 03/03/2019. Searches were restricted to ‘human’, ‘adult’, ‘primary research’ and ‘English language’publications. No time limit was set. Quality appraisal and data extraction was undertaken by at least 2 reviewers.Results: searches yielded 32 publications; 2 studies were included in the review. Physical activity is inhibited by higher fatigue levels, lowering HRQoL, but also as a means of reducing fatigue, subsequently improving HRQoL.Conclusion: There was very little data eligible for inclusion in this review, and it was not of a high quality. The findings of the review suggest that physical activity may be beneficial for IBD fatigue, but this cannot be definitively stated. Evidence suggests physical activity is safe to undertake in active disease, therefore better-quality studiesare needed in this area

Research Review: Early Childhood and the ‘Intergenerational Cycle of Domestic Violence’

This rapid evidence review was commissioned by the NSPCC to increase our understanding of the complex surrounding the evidence about domestic violence and the potential for this to impact on children's own violent behaviour, and any evidence of effectiveness of targeted interventions aimed at young families

Rapid Evidence Assessment: What can be learnt from other jurisdictions about preventing and responding to child sexual abuse

This Rapid Evidence Assessment was commissioned by the Independent Inquiry into Child Sexual Abuse in England and Wales which is investigating whether public bodies and other non-state institutions have taken seriously their duties to care for and protect children and young people from child sexual abuse and exploitation. The question for the review was: What can be learnt from jurisdictions, outside of England and Wales, about the role of institutions, including accountable state and non-state organisations with responsibility for children in preventing and responding to child sexual abuse and exploitation? Key messages ● No jurisdiction has everything ‘right’. While overall robust research on what is effective is limited, there is plenty of promising evidence that can be developed further to inform work in England and Wales. ● Adequately resourced, comprehensive, multi sector approaches that aim to prevent and respond to child sexual abuse and exploitation are likely to be the most effective approaches. ● Effective responses are those able to meet the complexity and diversity of the needs of children and young people who are vulnerable or affected. ● Work with sexual offenders could broaden out to include earlier intervention to prevent offending by adults and adolescents who have not been convicted. Findings Primary prevention None of the jurisdictions1 included in the review had a comprehensive approach combining primary prevention and response but we found more evidence of prevention efforts in Australia, Finland, Norway, Sweden and the USA. Changing attitudes and behaviour by education or awareness raising - There is moderately good evidence from Canada and the USA that pre-school and school based education programmes on child sexual abuse are effective at teaching children to recognise inappropriate behaviour and improving their knowledge of self protection. Research in Australia and the USA supports whole school approaches and involving parents, faith and community groups. Public education and social marketing campaigns to prevent abuse are commonly used but poorly evaluated. 1 Wales, Scotland, Northern Ireland, Ireland, EU 28 countries, Norway, Iceland, USA, Canada, Australia, New Zealand Situational prevention – The UK has led primary prevention and early identification efforts online and there is evidence of successful take-down, site blocking, extensive take up of online safety resources and considerable international collaboration through the work of CEOP, the National Crime Agency, and participation in the Global Alliance and WePROTECT. In other organisational contexts, efforts have been more limited covering pre-employment checks, vetting and barring. While important, these only exclude the minority of offenders already known or convicted. Inquiries in the USA, Germany, the Netherlands, Belgium and Ireland on institutional child abuse in churches show we need a wider focus on organisational safety and the opportunities for unmonitored contact. Reducing vulnerabilities - Very little evidence could be found on the best approaches to reduce the vulnerabilities of children to sexual abuse and exploitation in the jurisdictions covered. Some promising evidence from the UK, Canada and the Netherlands was found from Stop It Now which aims to reduce offending among those not previously identified as offenders. Disclosure, identification, reporting and response Professionals need to be aware of the barriers children face in disclosing abuse and trained to recognise signs of abuse other than the child’s disclosure. Identification in children’s social services, education and health particularly needs to be recognised as a process of proactively asking, building a relationship with a vulnerable child or young person and collecting information from a range of sources over time. Research in Australia confirms that mandatory reporting can increase reports of child sexual abuse but that resources are needed to manage these. The number of cases investigated but not then substantiated also increased. From Australia and the USA, there is evidence that training, proactive identification and promoting expertise and good practice through specialist mobile teams or task forces in health, justice and child protection can have a positive impact. For health, use of new technologies such as telemedicine can give access to specialist skills. Also in Australia, proactive approaches to involve the wider community in identification and reporting had a positive impact on reporting rates, arrests, prosecution and convictions for child sexual abuse cases. Support for children through prosecution and the court process is generally poor but there is promising evidence on the effectiveness of co-located multi-disciplinary services such as the National Children’s Advocacy Centers in the USA and the Children’s Houses (or Barnahus) in Iceland and other parts of Europe. Managing offenders Management of offenders has focused largely on those high risk sexual offenders against children already convicted. In the UK, Germany and Sweden, attention is shifting to look at offenders at lower levels of assessed risk, including those not convicted. More work is needed on effective responses for health, education and social work; on managing peer abusers; on improving prosecution and the use of appropriate sanctions for offenders in organisations such as churches and faith groups. Commonly used policies such as sexual offender registration, notification schemes and residency restrictions evaluated in the USA found these have not been effective in reducing recidivism and may work against efforts to rehabilitate offenders. Sex offender treatment responses are more likely to be effective if they can address the type of offence and level of risk, the offender’s criminogenic needs, learning style and abilities. Restorative justice approaches to sex offender treatment such as Circles of Support and Accountability show promising results from Australia and the US, but have high levels of programme drop out. Treatment responses developed for adults are less relevant for young people who present with harmful sexual behaviour. There is more evidence to support the use of MST than CBT based treatment approaches for young people who present with harmful sexual behaviour. Supporting victims and survivors There are significant gaps in the availability of relevant support and therapeutic services for child victims of sexual abuse in the UK and funding for services addressing significant risks such as domestic abuse has declined. Research from Scotland on guardianship schemes shows positive results improving support for trafficked young people. Advocacy schemes do not prevent sexually exploited young people from going missing, but can ensure there is a coordinated response should this happen. The evidence on victim support and recovery focuses mostly on child sexual abuse, while needs of those who have been sexually exploited may differ. Best evidence on therapeutic treatment for children exists for trauma focused CBT although a variety of therapeutic methods, for example those using drama or EMDR, also show promise. Therapy approaches may be more effective when tailored to the individual needs of the child or young person, taking into account their specific symptom constellation, development, context, and background. Evidence from other jurisdictions on the effectiveness of victim redress, compensation schemes, no fault insurance, publicly available insurance registers and the structure and source of different funding streams could not be found. Implications ● A wider focus on prevention and response is needed, with prevention moving beyond teaching children to protect themselves and beyond the regulation of convicted sexual offenders to focus on wider prevention efforts targeting risks and vulnerabilities. ● Prevention and response needs to be comprehensive, cover the complexity and diversity of children’s experiences and be guided by leadership promoting an outcome focused theory of change. ● Responsibility for preventing and responding to child sexual abuse and exploitation needs to extend beyond specialist and child protection services to include the wider range of organisations, particularly faith groups, industry, the private sector, sport and leisure. The National Response Unit and proposed Centre for Excellence (in the UK) could play an important role in partnerships. ● Research from the USA and Canada provides evidence for prevention delivered in schools to increase children’s knowledge and awareness and starting to change the attitudes and environments that contribute to abuse. A strong argument could be made for compulsory PSHE for all schools and academies on safety and respectful relationships. ● Additional resources will be needed to deal with increased reports and additional screening procedures that will result if mandatory reporting is introduced. ● The gaps in knowledge identified in this review could be used to inform priorities for future funding. Approach The project was desk based using recognised methods for rapid evidence assessment. Rapid evidence assessments, like systematic reviews, aim to thoroughly and transparently identify and assess the evidence on a particular topic but within a more limited time frame and with restrictions on the breadth of literature included. Using agreed search terms, we searched online databases (Embase, ASSIA, PsychInfo, Social Work Abstracts and Criminal Justice Abstracts) and websites for relevant peer reviewed articles and research reports on effective responses delivered by different institutions from jurisdictions outside of, but similar to, those in England and Wales. Grey literature and references in publications included were additionally searched. We rated 1,460 relevant studies for quality and included 88 high quality studies in the review. To address gaps in the research, we were asked to identify examples of responses where the evidence was promising but did not yet meet quality standards. We were also asked to discuss the findings with reference to the current context of research, policy and practice in England and Wales. This meant reading a large body of additional materials which we included in the report bibliography. A full description of the methods are in the research report. Limitations The scope of the Rapid Evidence Assessment was narrow and might not have identified all the relevant evidence. The search was limited to articles published in English, between 2004- 2016, in peer reviewed journals and online in ‘grey literature’ research reports. We were unable to consult with international academic or practice experts to check whether all significant research evidence had been covered, but the draft report was reviewed by the IICSA advisory groups, including academic experts, who made suggestions on research to include (mostly from the UK)

Risk stratification of sudden cardiac death in asymptomatic female Brugada syndrome patients: A literature review

Background and Objectives Risk stratification in Brugada syndrome remains a difficult problem. Given the male predominance of this disease and their elevated risks of arrhythmic events, affected females have received less attention. It is widely known that symptomatic patients are at increased risk of sudden cardiac death (SCD) than asymptomatic patients, while this might be true in the male population; recent studies have shown that this association might not be significant in females. Over the past few decades, numerous markers involving clinical symptoms, electrocardiographic (ECG) indices, and genetic tests have been explored, with several risk-scoring models developed so far. The objective of this study is to review the current evidence of clinical and ECG markers as well as risk scores on asymptomatic females with Brugada syndrome. Findings Gender differences in ECG markers, the yield of genetic findings, and the applicability of risk scores are highlighted. Conclusions Various clinical, electrocardiographic, and genetic risk factors are available for assessing SCD risk amongst asymptomatic female BrS patients. However, due to the significant gender discrepancy in BrS, the SCD risk amongst females is often underestimated, and there is a lack of research on female-specific risk factors and multiparametric risk scores. Therefore, multinational studies pooling female BrS patients are needed for the development of a gender-specific risk stratification approach amongst asymptomatic BrS patients

A qualitative study exploring how vocational rehabilitation for people with multiple sclerosis can be integrated within existing healthcare services in the United Kingdom

BackgroundTo explore how a vocational rehabilitation (VR) intervention can be integrated within existing healthcare services for people with multiple sclerosis (MS) in the United Kingdom (UK) National Health Service (NHS).MethodsData from 37 semi-structured interviews with 22 people with MS, eight employers, and seven healthcare professionals were analysed using a framework method informed by the Consolidated Framework for Implementation Research and an intervention logic model.ResultsFour themes were identified relating to the structure of current NHS services, how to improve access to and awareness of VR services, the collaboration between internal and external networks, and the benefits of integrating VR within the NHS services. Participants identified several implementation barriers such as poor links with external organisations, staffing issues, and lack of funding. To overcome these barriers, participants suggested enablers such as technology (such as apps or online assessments) and collaboration with third-sector organisations to reduce the pressure on the NHS.ConclusionSignificant organisational changes are required to ensure a successful implementation of a VR intervention within current NHS services. Despite this, the NHS was seen as a trustworthy organisation to offer support that can optimise the health and professional lives of people with MS

Drosophila SPF45: A Bifunctional Protein with Roles in Both Splicing and DNA Repair

The sequence of the SPF45 protein is significantly conserved, yet functional studies have identified it as a splicing factor in animal cells and as a DNA-repair protein in plants. Using a combined genetic and biochemical approach to investigate this apparent functional discrepancy, we unify and validate both of these studies by demonstrating that the Drosophila melanogaster protein is bifunctional, with independent functions in DNA repair and splicing. We find that SPF45 associates with the U2 snRNP and that mutations that remove the C-terminal end of the protein disrupt this interaction. Although animals carrying this mutation are viable, they are nevertheless compromised in their ability to regulate Sex-lethal splicing, demonstrating that Sex-lethal is an important physiological target of SPF45. Furthermore, these mutant animals exhibit phenotypes diagnostic of difficulties in recovering from exogenously induced DNA damage. The conclusion that SPF45 functions in the DNA-repair pathway is strengthened by finding both genetic and physical interactions between SPF45 and RAD201, a previously uncharacterized member of the RecA/Rad51 protein family. Together with our finding that the fly SPF45 protein increases the survival rate of mutagen-treated bacteria lacking the RecG helicase, these studies provide the tantalizing suggestion that SPF45 has an ancient and evolutionarily conserved role in DNA repair

Roadmap Report and Executive Summary

Women’s Aid Federation England (WAFE) and SafeLives (SL) collaborated over five years (2016-21) to develop and implement the Roadmap Programme which aimed to transform the lives of women and girls through systemic change to policy, practice and commissioning by promoting early intervention and reducing the prevalence, impact and tolerance of domestic violence and abuse (DVA). Funded by the Big Lottery’s Women and Girls Initiative, WAFE and SL collaborated with DVA survivors and expert partners in specialist frontline services to develop and implement two contrasting interventions in five different sites in England. Both organisations were committed to making DVA services more accessible and responsive to survivors’ needs and both aimed to achieve wider system change in the sites where the programmes were delivered. However, the two organisations chose different but complementary routes by which to reach these broad goals:WAFE’s Change That Lasts (CtL) Programme1 aimed at developing a ‘whole community response’ that would increase responsiveness to DVA services at three levels: i) the community ii) frontline professionals in organisations that were not specialist DVA organisations and iii) services delivered by DVA specialist organisations. The programme comprised three interventions targeted on these three different audiences and delivered in three sites – Sunderland, Nottingham and Nottinghamshire (Nottingham/shire) and Surrey. Ask Me aimed to address cultural and attitudinal barriers to change through training and supporting Community Ambassadors who volunteered toincrease awareness and responsiveness to DVA in their local communities. Trusted Professionalcombined training with organisational development to improve expertise and responsiveness among frontline professionals. The VOICES intervention was designed to re-connect specialist DVA services to a strengths-based, needs-led, trauma-informed approach centred on the survivor for practitioners in specialist DVA organisations. The SafeLives Programme, designed by SafeLives, alongside Pioneers (survivors and experts by experience) and specialist frontline DVA partners, comprised an integrated suite of multiple interventions that would allow survivors and their families to access five different interventions within the same organisation. Two independent services, in Norwich and West Sussex (Worthing, Adur, and Crawley), were commissioned to deliver the interventions, hereafter referred to as the SafeLives Co-Designed Pilots (SLCDPs). These interventions were tailored to the needs of different groups so that survivors and their families could move between and through them on their journey to recovery. The intervention aimed to break down silos between services and deliver a ‘whole family’ service informed by DVA survivors’ views. The SLCDPs were targeted at those assessed as at medium risk of harm; people who wanted to remain in their relationships; those with complex needs; survivors recovering from abuse and children and young people. A wide range of individual and group interventions was utilised and training and skills development were provided to partner agencies