'Mum never loved me.' How structural factors influence adolescent sexual and reproductive health through parent–child connectedness: a qualitative study in rural Tanzania

Research in high income countries shows parent–child connectedness to be protective against undesirable sexual and reproductive health (SRH) outcomes among young people. Little has been done to understand the nature of parent–child connectedness, the structural factors that impact on connectedness and parents’ understanding of how connectedness affects their children's sexual behaviour in sub-Saharan Africa and Tanzania in particular. Ethnographic research involved 30 days of observation in 10 households, 9 focus group discussions and 60 in-depth interviews. Thematic analysis was conducted using NVIVO qualitative data analysis software.<p></p> The structural factors with greatest influence on connectedness were economic circumstances, gender, social status, state education, and globalisation. Economic circumstances impacted on parent–child connectedness through parents’ ability to provide for their children's material needs, and the time their occupation allowed for them to spend with their children and monitor their activities. Appropriate parent–child interactions were shaped by gender norms and by social status in the form of respectability, adolescents’ adherence to norms of respect/ obedience shaping their parents’ affection. State education affected parents’ preferences between children but also undermined parental authority, as did broader globalisation. Connectedness was related to SRH in a bi-directional way: lack of connectedness was linked to young people's low self-esteem and risky sexual behaviour while unplanned pregnancies seriously undermined young women's connectedness with their parents. Since material provision was perceived to be a central element of parent–child connectedness, structural factors limiting provision made transactional sex more likely both through direct material pathways and emotional ones. Motives for transactional sex were said to be material needs and to feel loved and cared for.<p></p> An important pathway by which structural factors shape adolescent SRH outcomes is through parent–child connectedness, especially parents’ ability to spend time with their children and provide for their economic needs. Modifying these structural factors should facilitate parent–child connectedness, which may help delay early sexual intercourse, protect young people against unplanned pregnancy through encouraging communication on contraception use and, overall, promote healthy adolescent development

What's the matter with realism?

International relations, as an academic discipline, is not known for its strength in the area of theory. It has no immediate equivalent to the rich contrasts of perspective generated in sociology by the legacy of Max Weber, Marx and Durkheim—a lack so felt that Martin Wight once wrote a paper called ‘Why is there no International Theory?’ His own answer was, in part, that there is nothing further to theorize after the discovery of the repetitive mechanisms of the balance of power. This was a sad conclusion for such an acute and creative mind to reach. But it does illustrate a central feature of IR theory. For the balance of power, it can be argued, is the limit of any Realist theory of international relations. And Wight's conclusion was perhaps more an index of the dominance of a Realist orthodoxy than a relection of the inherent properties of ‘the international’

Parenting stress and parent support among mothers with high and low education

Current theorising and evidence suggest that parenting stress might be greater among parents from both low and high socio-economic positions (SEP), compared to those from intermediate levels; due to material hardship among parents of low SEP, and to employment demands among parents of high SEP. However, little is known about how this socio-economic variation in stress relates to the support that parents receive. This study explored whether variation in maternal parenting stress in a population sample was associated with support deficits. In order to obtain a clearer understanding of support deficits among high-and low-educated mothers, subgroups were distinguished according to mothers’ migrant and single parent status. Participants were 5865 mothers from the Growing Up in Scotland study, interviewed when their child was 10 months old. Parenting stress was greater among mothers with either high or low education than among mothers with intermediate education, although it was highest for those with low education. Support deficits accounted for around 50% of higher stress among high-and low-educated groups. Less frequent grandparent contact mediated parenting stress among both high- and low-educated mothers, particularly migrants. Aside from this common feature, different aspects of support were relevant for high- compared with low-educated mothers. For high-educated mothers, reliance on formal childcare and less frequent support from friends mediated higher stress. Among low-educated mothers, smaller grandparent and friend networks and barriers to professional parent support mediated higher stress. Implications of differing support deficits are discussed

Treatments for spasticity and pain in multiple sclerosis: a systematic review

Objectives: To identify the drug treatments currently available for the management of spasticity and pain in multiple sclerosis (MS), and to evaluate their clinical and cost-effectiveness. Data sources: Electronic bibliographic databases, National Research Register, MRC Clinical Trials Register and the US National Institutes of Health Clinical Trials Register. Review methods: Systematic searches identified 15 interventions for the treatment of spasticity and 15 interventions for treatment of pain. The quality and outcomes of the studies were evaluated. Reviews of the treatment of spasticity and pain when due to other aetiologies were also sought. Results: There is limited evidence of the effectiveness of four oral drugs for spasticity: baclofen, dantrolene, diazepam and tizanidine. Tizanidine appears to be no more effective than comparator drugs such as baclofen and has a slightly different side-effects profile. Despite claims that it causes less muscle weakness, there was very little evidence that tizanidine performed any better in this respect than other drugs, although it is more expensive. The findings of this review are consistent with reviews of the same treatments for spasticity derived from other aetiologies. There is good evidence that both botulinum toxin (BT) and intrathecal baclofen are effective in reducing spasticity, and both are associated with functional benefit. However, they are invasive, and substantially more expensive. None of the studies included in the review of pain were designed specifically to evaluate the alleviation of pain in patients with MS and there was no consistency regarding the use of validated outcome measures. It was suggested that, although expensive, the use of intrathecal baclofen may be associated with significant savings in hospitalisation costs in relation to bed-bound patients who are at risk of developing pressure sores, thus enhancing its cost-effectiveness. No studies of cost-effectiveness were identified in the review of pain. There is evidence, albeit limited, of the clinical effectiveness of baclofen, dantrolene, diazepam, tizanidine, intrathecal baclofen and BT and of the potential cost-effectiveness of intrathecal baclofen in the treatment of spasticity in MS. Conclusions: Many of the interventions identified are not licensed for the alleviation of pain or spasticity in MS and the lack of evidence relating to their effectiveness may also limit their widespread use. Indeed, forthcoming information relating to the use of cannabinoids in MS may result in there being better evidence of the effectiveness of new treatments than of any of the currently used drugs. It may therefore be of value to carry out double-blind randomised controlled trials of interventions used in current practice, where outcomes could include functional benefit and impact on quality of life. Further research into the development and validation of outcomes measures for pain and spasticity may also be useful, as perhaps would cost–utility studies

High and low contraceptive use amongst male young offenders: a qualitative interview study

<b>Objectives</b> There are high rates of fatherhood and sexually transmitted infections (STIs) among young incarcerated men. Here we focus on a sample of men incarcerated in a Scottish Young Offender Institution, analysing their accounts of their contraceptive use. Those who report low or no use of contraception are compared with those who report high use.<p></p> <b>Methods</b> Semi-structured interviews with 40 young male offenders, aged 16–21 years. Participants were purposively sampled using answers from a questionnaire administered to 67 inmates. Data from those men (n=31) reporting either high (n=14) or low/no use (n=17) of contraception are analysed here.<p></p> <b>Results</b> Low users emphasise their desire for pleasure and appear fatalistic about both pregnancy and disease prevention. High users report a strong desire to protect themselves and their ‘manliness’ by using condoms to avoid the risk of STIs and, to a lesser extent, pregnancy. Both sets of men present themselves in a traditionally masculine way, with high users emphasising power, authority and self-control to justify their non-risk-taking contraceptive behaviour.<p></p> <b>Conclusions</b> The masculine narrative regarding self-protection, utilised by the high users, may be an effective method of intervention with potential and actual low users. Conventional masculinity valorises risk-taking but if particular forms of risk avoidance – condom use – can be legitimised as confirming one's masculinity it may be possible to persuade low users to adopt them. The opportunity to work with young men whilst incarcerated should be grasped.<p></p&gt

What's the matter with realism?

International relations, as an academic discipline, is not known for its strength in the area of theory. It has no immediate equivalent to the rich contrasts of perspective generated in sociology by the legacy of Max Weber, Marx and Durkheim—a lack so felt that Martin Wight once wrote a paper called ‘Why is there no International Theory?’ His own answer was, in part, that there is nothing further to theorize after the discovery of the repetitive mechanisms of the balance of power. This was a sad conclusion for such an acute and creative mind to reach. But it does illustrate a central feature of IR theory. For the balance of power, it can be argued, is the limit of any Realist theory of international relations. And Wight's conclusion was perhaps more an index of the dominance of a Realist orthodoxy than a relection of the inherent properties of ‘the international’

The structural influence of family and parenting on young people's sexual and reproductive health in rural northern Tanzania

This paper explores the structural role of the family and parenting in young people's sexual and reproductive health. The study involved eight weeks of participant observation, 26 in-depth interviews, and 11 group discussions with young people aged 14–24 years, and 20 in-depth interviews and 6 group discussions with parents/carers of children in this age group. At an individual level, parenting and family structure were found to affect young people's sexual behaviour by influencing children's self-confidence and interactional competence, limiting discussion of sexual health and shaping economic provision for children, which in turn affected parental authority and daughters' engagement in risky sexual behaviour. Sexual norms are reproduced both through parents' explicit prohibitions and their own behaviours. Girls are socialised to accept men's superiority, which shapes their negotiation of sexual relationships. Interventions to improve young people's sexual and reproductive health should recognise the structural effects of parenting, both in terms of direct influences on children and the dynamics by which structural barriers such as gendered power relations and cultural norms around sexuality are transmitted across generations

Do television and electronic games predict children's psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study

Background: Screen entertainment for young children has been associated with several aspects of psychosocial adjustment. Most research is from North America and focuses on television. Few longitudinal studies have compared the effects of TV and electronic games, or have investigated gender differences. Purpose: To explore how time watching TV and playing electronic games at age 5 years each predicts change in psychosocial adjustment in a representative sample of 7 year-olds from the UK. Methods: Typical daily hours viewing television and playing electronic games at age 5 years were reported by mothers of 11 014 children from the UK Millennium Cohort Study. Conduct problems, emotional symptoms, peer relationship problems, hyperactivity/inattention and prosocial behaviour were reported by mothers using the Strengths and Difficulties Questionnaire. Change in adjustment from age 5 years to 7 years was regressed on screen exposures; adjusting for family characteristics and functioning, and child characteristics. Results: Watching TV for 3 h or more at 5 years predicted a 0.13 point increase (95% CI 0.03 to 0.24) in conduct problems by 7 years, compared with watching for under an hour, but playing electronic games was not associated with conduct problems. No associations were found between either type of screen time and emotional symptoms, hyperactivity/inattention, peer relationship problems or prosocial behaviour. There was no evidence of gender differences in the effect of screen time. Conclusions: TV but not electronic games predicted a small increase in conduct problems. Screen time did not predict other aspects of psychosocial adjustment. Further work is required to establish causal mechanisms