Abortion Care: The Staff Perspective

Working in abortion care presented a unique set of social, emotional and practical challenges for staff. Because of working in abortion care some staff expressed a sense of isolation from other colleagues. They said that those who didn’t work in abortion care considered it an unpopular job and perceived patients requesting abortion as more ‘challenging ‘and ‘problematic’ than other patients, partly because of the additional time required but also because of the emotional investment which is associated with the role. Staff’s sense of isolation was manifested because they felt they couldn’t talk to others about their job. Irrespective of their perceived sense of isolation the desire to provide a service for women in need was a motivational factor for those staff who had chosen to work in this area. Although staff, said personal opinions did not have a place in the delivery of care some were unable to disassociate themselves professionally from their own deeply held personal convictions. In addition, some said that they felt unable to voice opposition to an expectation that they would work in this area if it was included as part of a wider women’s health remit. They indicated that sometimes their feelings were compromised by this aspect of the role indicating they felt unable to exercise their right to conscientious objection. The subject of repeat abortion provoked particularly negative staff emotions for personal and professional reasons, especially if patients repeatedly accessed abortion services because of non use of contraception. Often staff admitted they wanted to ‘lecture’ patients about the issue and some implied that eventually patients may be less likely to receive good care in these instances. However staff reported that women who requested abortion for foetal abnormality were likely to receive more sympathy, understanding and care. The practical challenges mainly concerned whether facilities were appropriate, available and accessible for patient care. Staff recommended that facilities ideally shouldn’t be sited near ante-natal or post-natal areas and there should be provision locally for late gestation abortion and swift access

Emotional and psychological impact of abortion: a critique

No abstract is available for this articl

Menopause, sexuality and culture: Is there a universal experience?

Menopause is a universal phenomenon, but do all women experience a universal event? The aim of this article is to identify common trends or patterns occurring exclusively within certain different cultures, and whether these have an effect on how menopause is experienced or perceived by those women. This paper will first consider the physiological changes that occur during menopause and will then look at psychosocial influences that may affect women’s perception and experience of menopause

From Kama Sutra to dot.com- The History, Myths and Management of Premature Ejaculation

As long as man has breathed, his quest for the perfect sexual experience seems to have eluded him. Often the experience has been brought to an abrupt end by the misery of premature ejaculation. This paper will look at the history of premature ejaculation, charting the importance of this event throughout the years and across cultures. It will look at all modern day therapies and will discuss the implications of introducing pharmocotherapy to a problem that has been traditionally treated by sex therapy

Abortion 'on the NHS': The National Health Service and abortion stigma

This is the final accepted manuscript of an article published in Journal of Family Planning and Reproductive Health Care, 2015.Before the creation of the National Health Service (NHS), the health of the British nation was in a perilous state and hospitals survived on the philanthropy of rich benefactors. Following its introduction on 5 July 1948, the NHS was the biggest and most expensive social reform of the era.1 It was founded on three core principles: that it should meet the needs of everyone, that it should be free at the point of delivery, and that its use should be based on clinical need, not ability to pay. These principles govern the NHS today. The NHS should not discriminate against anyone who requires health care. Yet abortion care remains almost the only acute health need not comprehensively provided for within the NHS.2 In England and Wales in 2013, 98% (185 331) of all abortions were funded by the NHS,3 but only 34% of abortions took place in NHS settings. The majority were in the independent sector, funded by the NHS.4 This is in sharp contrast to Scotland, where in 2013 only 40 women out of 12 447 (0.3%) had their abortions in a non-NHS setting.5 The question is why?Funded by Research Capacity Building Collaboration & Welsh Assembly Governmen

A Literature Review of Transgender People in Prison: An ‘invisible’ population in England and Wales

The last few decades have witnessed a growth in advocacy for Lesbian, Gay, Bisexual and Transgender (LGBT) people, and that this activism for equality is now increasingly visible within the Criminal Justice System.1 The Ministry of Justice report The Care and Management of Transsexual Prisoners PSI 07/2011 provides guidelines about the duties and responsibilities that prisons must comply with in ensuring that all transsexual people are treated fairly and in accordance with the law. However, two high profile cases highlighted issues of inequality for transgender people in the secure estate. In late 2015, Vikki Thompson and Joanne Latham, two transgender women placed in male prisons in England, committed suicide in their prison cells within weeks of each other. While it is understood that Joanne Latham had not requested a transfer to a women’s prison, it is reported that Vikki Thompson said she would kill herself if placed in a male prison.2 Following their deaths, it was announced that a review into the care and management of transgender people in prisons would be undertaken in light of a number of concerns that the current system does not adequately address their specific needs. In addition, the Minister for Women, Equalities and Family Justice, Caroline Dinenage indicated that the review extend to transgender people being managed in the community.3 The review was published in November 2016 that aimed to ensure that the care and management of transgender people in prison was ‘fit for purpose and provides an appropriate balance between the needs of the individual and the responsibility to manage risk and safeguard the wellbeing of all prisoners’.4 According to Caroline Dinenage, there are approximately 80 transgender people in prison in England and Wales and although the exact number is unknown, she estimates that the population is increasing. Referring to prisons in the USA, Simopoulos and Khin Khin5 argue that the true estimate of transgender people may be unknown because people in prison are reluctant to disclose their gender identity for fear of transphobia and abuse. However, the recently published review indicated that there will be a data collection exercise across the prison estate (that has already been commissioned) and there will be a new equality information form that among other equality questions, will be a question on gender identity.6 The experience of transgender people in prison is an under-researched area generally but particularly in the UK. The majority of research about transgender people who offend has been undertaken in the USA. This is despite existing research (discussed in this literature review) indicating that transgender people in prison are significantly more likely to experience more problems than other prison populations

Planet Occurrence within 0.25 AU of Solar-type Stars from Kepler

We report the distribution of planets as a function of planet radius (R_p), orbital period (P), and stellar effective temperature (Teff) for P < 50 day orbits around GK stars. These results are based on the 1,235 planets (formally "planet candidates") from the Kepler mission that include a nearly complete set of detected planets as small as 2 Earth radii (Re). For each of the 156,000 target stars we assess the detectability of planets as a function of R_p and P. We also correct for the geometric probability of transit, R*/a. We consider first stars within the "solar subset" having Teff = 4100-6100 K, logg = 4.0-4.9, and Kepler magnitude Kp < 15 mag. We include only those stars having noise low enough to permit detection of planets down to 2 Re. We count planets in small domains of R_p and P and divide by the included target stars to calculate planet occurrence in each domain. Occurrence of planets varies by more than three orders of magnitude and increases substantially down to the smallest radius (2 Re) and out to the longest orbital period (50 days, ~0.25 AU) in our study. For P < 50 days, the radius distribution is given by a power law, df/dlogR= k R^\alpha. This rapid increase in planet occurrence with decreasing planet size agrees with core-accretion, but disagrees with population synthesis models. We fit occurrence as a function of P to a power law model with an exponential cutoff below a critical period P_0. For smaller planets, P_0 has larger values, suggesting that the "parking distance" for migrating planets moves outward with decreasing planet size. We also measured planet occurrence over Teff = 3600-7100 K, spanning M0 to F2 dwarfs. The occurrence of 2-4 Re planets in the Kepler field increases with decreasing Teff, making these small planets seven times more abundant around cool stars than the hottest stars in our sample. [abridged]Comment: Submitted to ApJ, 22 pages, 10 figure

Screening ethnically diverse human embryonic stem cells identifies a chromosome 20 minimal amplicon conferring growth advantage

The International Stem Cell Initiative analyzed 125 human embryonic stem (ES) cell lines and 11 induced pluripotent stem (iPS) cell lines, from 38 laboratories worldwide, for genetic changes occurring during culture. Most lines were analyzed at an early and late passage. Single-nucleotide polymorphism (SNP) analysis revealed that they included representatives of most major ethnic groups. Most lines remained karyotypically normal, but there was a progressive tendency to acquire changes on prolonged culture, commonly affecting chromosomes 1, 12, 17 and 20. DNA methylation patterns changed haphazardly with no link to time in culture. Structural variants, determined from the SNP arrays, also appeared sporadically. No common variants related to culture were observed on chromosomes 1, 12 and 17, but a minimal amplicon in chromosome 20q11.21, including three genes expressed in human ES cells, ID1, BCL2L1 and HM13, occurred in >20% of the lines. Of these genes, BCL2L1 is a strong candidate for driving culture adaptation of ES cells

Children’s and adolescents’ rising animal-source food intakes in 1990–2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15–19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.publishedVersio

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.publishedVersio