Victimised adolescents more likely to self-harm and have suicidal thoughts

Baldwin, J. R. et al. | 2018| Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study| Journal of the American Academy of Child & Adolescent Psychiatry | Vol.0 |Issue 0| DOI: https://doi.org/10.1016/j.jaac.2018.07.903

Children and young people that are victimised have double the likelihood of self-harm and their risk of suicide  is trebled compared to non-victimised peers according to researchers at King’s College London. The study looked at over 2000 twins born in England and Wales between 1994-95. They studied different forms of adolescent victimisation- including maltreatment, neglect, bullying, crime, sexual victimisation, and family violence- which were identified in interviews with the participants when they turned 18. Among their findings was that over a third of the sample had experienced one severe form of victimisation during their adolescence and 7 per cent had experienced at least three or more severe types of victimisation. Almost 20 per cent (18.9%) had had some form of self-injurious thoughts and behaviours. Victimized adolescents had an increased risk of suicidal ideation and over a quarter had atempted suicide.  

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Abstract

Objective

Victimized adolescents have elevated risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death among adolescents. We tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents’ elevated risk of self-injurious thoughts and behaviors.


Method

Participants were 2,232 British children followed from birth to age 18 as part of the Environmental Risk (E-Risk) Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber-victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the age 18 assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at age 18.

Results

Victimized adolescents had an increased risk of suicidal ideation, self-harm, and suicide attempt. Co-twin control and propensity-score matching analyses showed that these associations were largely accounted for pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest elevation in risk for suicidal ideation.

Conclusion

Risk for self-injurious thoughts and behaviors in victimized adolescents is only partly explained by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.

The article is in press but may be requested through interlibrary loan by Rotherham NHS staff 

In the news:

BBC News Teenage victims ‘more likely to self-harm’

A space to talk: An evaluation of the WISH Centre’s services with young people who self- harm

Centre for Mental Health | November 2018 | An evaluation of the WISH Centre’s services with young people who self-harm

Young people who attend WISH have far fewer A&E attendances during that time than before, and at least two-thirds of young people had improved wellbeing after receiving therapy and over four-fifths reduce or stop self-harming;  finds WISH report: A space to talk: An evaluation of the WISH Centre’s services with young people who self-harm.  

The report is based on WISH’s evaluation of the  WISH Centre’s work with young people across several London boroughs, finding that WISH demonstrates success in helping young people who are self-harming to improve their mental health and quality of life. WISH Centre’s work makes a difference to young people, by combining counselling and psychotherapy with facilitated peer support and outreach to young people in schools and communities.

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Image source: centreformentalhealth.org.uk

 

Their findings are based on analysis of outcome data and conversation with users of WISH services and stakeholders

WISH are calling for:

  • CCGs and local authorities across the country to commission services similar to WISH to support young people struggling with self-harm;
  • Commissioning more for young men, and a specific offer for young people who identify as LGBT;
  • More support for parents, carers, teachers and other professionals;
  • Awareness-raising and myth-busting about self-harm to encourage young people to seek help. (Source: WISH).

A space to talk – executive summary

A space to talk – full report

 

Unfinished Business: An assessment of the national approach to improving cancer services in England 1995–2015

The Health Foundation | November 2018 | Unfinished Business: An assessment of the national approach to improving cancer services in England 1995–2015

A major report of the progress in cancer care during the last two decades has been released by The Health Foundation. It reports that progress has been made on reducing mortality, and improving the chances of survival and the experience of care, for people in England diagnosed with cancer. 

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Image source: .health.org.uk

Unfinished Business sets out recommendations to help close the gap in survival between England and other comparable countries.

These include: radical improvements in early diagnosis and detection of cancer, such as increasing investment in diagnostic equipment, building public understanding of cancer symptoms, improving resourcing of primary care, greater support for GPs to refer more patients and supporting collaboration across primary and secondary care (Source: The Health Foundation).

Read the report in full from The Health Foundation 

Read The Health Foundation’s press release 

Cycling and walking for individual and population health benefits

Public Health England | November 2018 | Cycling and walking for individual and population health benefits: A rapid evidence review for health and care system decision-makers

Public Health England (PHE)  has published Cycling and walking for individual and population health benefits, the publication is based on an evidence review to answer the question: What is the impact of walking and/or cycling on different health outcomes?

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  • This review found that walking and cycling benefit health in a number of ways:
    people who walk or cycle have improved metabolic health and a reduced risk of
    premature mortality
  • walking and cycling reduce the risk factors for a number of diseases, including
    cardiovascular disease, respiratory disease, some cancers, and Type II diabetes
  • walking and cycling also have positive effects on mental health and general wellbeing. The mental health and neurological benefits include reduced risk of
    dementia, improved sleep quality, and a greater sense of wellbeing
  • in environmental terms, health benefits accrue for the general population from a
    reduction in pollution due to car use and a decrease in road congestion
  •  the evidence is that the health benefits of walking and cycling outweigh any
    potential health risks and harms – for example from injury or pollution (Source: PHE)

Read the evidence review in full from PHE 

Smoking in the home:  New solutions for a Smokefree Generation

ASH| November 2018 | Smoking in the home:  New solutions for a Smokefree Generation

ASH (Action on Smoking) has published Smoking in the home:  New solutions for a Smokefree Generation; the report calls for collaboration between partners including housing, public health, environmental health, trading standards and the fire service to address the harms from smoking and intervene in communities with the highest rates of smoking.

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Image source: ash.org.uk

The recommendations have been informed by close working with professionals from across a range of sectors, engagement with tenants in the private and social sectors, and through analysis of national datasets and published evidence (Source: ASH).

Full report

Executive summary 

Type 2 diabetes affects 7000 young people in England and Wales, analysis shows

Iacobucci,  G. | 2018 | Type 2 diabetes affects 7000 young people in England and Wales, analysis shows

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Currently, over a third of children in England (34%) are overweight or obese by the time they leave primary school. Diabetes UK warned that thousands more children could have type 2 diabetes diagnosed without decisive support for young people (Source: BMJ)

Read the full BMJ article via Open Athens 

In the news:

BBC News Type 2 diabetes affects 7,000 under-25s in England and Wales 

The Guardian Type 2 diabetes now affects nearly 7,000 young Britons 

Letting Local Systems Lead: How the NHS Long Term Plan can deliver a Sustainable NHS

NHS Confederation | November 2018 | Letting Local Systems Lead

In Letting Local Systems Lead,  NHS Confederation are calling for action to remove the barriers to effective local system working.

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Image source: nhsconfed.org

The publication of Letting Local Systems Lead follows a survey of NHS Confederation members which found that:

  • Six in ten leaders (61%) agree that sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) represent the right approach for partnership working between the NHS and local government.
  • But the vast majority of respondents considered that only moderate progress (44%) or a little progress (42%) had been made in implementing the system working approach set out in the NHS Five Year Forward View
  • When asked what would make a difference, local leaders identified better local partnership working, improved engagement with staff, patients and communities, more effective local governance and a more supportive oversight regime (Source: NHS Confederation)

Full details at NHS Confederation 

Download  Letting Local Systems Lead 

Oral steroids do not help hearing for children with glue ear

NIHR | November 2018 | Oral steroids do not help hearing for children with glue ear

An NIHR-funded trial demonstrates that oral steroids do not improve hearing, symptoms, or quality of life in children with glue ear. This NIHR-funded trial compared oral steroids with placebo for 389 children with otitis media with effusion,  and found no significant effect on those outcomes.

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The study shows that many children will improve spontaneously, even after three months of glue ear and confirms that steroids are not useful, even though they are well tolerated. Surgery to place ventilation tubes known as grommets is an option for children with persistent glue ear in and hearing loss in both ears. This evidence supports more informed discussions with parents about watchful waiting and the surgical options available.

 

 

Abstract 

Background: Children with persistent hearing loss due to otitis media with effusion are commonly managed by surgical intervention. A safe, cheap, and effective medical treatment would enhance treatment options. Underpowered, poor-quality trials have found short-term benefit from oral steroids. We aimed to investigate whether a short course of oral steroids would achieve acceptable hearing in children with persistent otitis media with effusion and hearing loss.

Methods: In this individually randomised, parallel, double-blinded, placebo-controlled trial we recruited children aged 2-8 years with symptoms attributable to otitis media with effusion for at least 3 months and with confirmed bilateral hearing loss. Participants were recruited from 20 ear, nose, and throat (ENT), paediatric audiology, and audiovestibular medicine outpatient departments in England and Wales. Participants were randomly allocated (1:1) to sequentially numbered identical prednisolone (oral steroid) or placebo packs by use of computer-generated random permuted block sizes stratified by site and child’s age. The primary outcome was audiometry-confirmed acceptable hearing at 5 weeks. All analyses were by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN49798431.

Findings: Between March 20, 2014, and April 5, 2016, 1018 children were screened, of whom 389 were randomised. 200 were assigned to receive oral steroids and 189 to receive placebo. Hearing at 5 weeks was assessed in 183 children in the oral steroid group and in 180 in the placebo group. Acceptable hearing was observed in 73 (40%) children in the oral steroid group and in 59 (33%) in the placebo group (absolute difference 7% [95% CI -3 to 17], number needed to treat 14; adjusted odds ratio 1.36. There was no evidence of any significant differences in adverse events or quality-of-life measures between the groups.

Interpretation: Otitis media with effusion in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. A short course of oral prednisolone is not an effective treatment for most children aged 2-8 years with persistent otitis media with effusion, but is well tolerated. One in 14 children might achieve improved hearing but not quality of life. Discussions about watchful waiting and other interventions will be supported by this evidence.

Full reference: Francis, N. A., et al | 2018|  Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial | Lancet | 392 | 10147| 10.3310/signal-000674

Full signal from NIHR 

Overwhelming public support for sugar and calorie reduction

Public Health England | November 2018 | Overwhelming public support for sugar and calorie reduction

A new survey conducted by Public Health England (PHE) has found that 90% of the public support  the government working with the food industry to make food healthier.

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Helping the NHS was named as one of the main reasons for people supporting this work.

This applied to all sectors, and no concessions were made for food consumed in restaurants, coffee shops or cafes, despite this often being labelled as a ‘treat’

Other notable findings from the survey include:

  • over 9 in 10 respondents think obesity is a problem in the UK, and 79% believe it has a negative impact on the NHS
  • only cancer (47% of respondents) and mental health (43%) are seen as bigger health concerns for the UK population than obesity (39%)
  • people believe the greatest responsibility for tackling obesity lies with individuals and families (90%), the food industry (80%) and the government (72%), underlining a belief in a collective responsibility
  • there was support from 87% of people to replace unhealthy products near supermarket tills and checkouts, with healthier ones (Source: Public Health England)

Read the full story at PHE 

Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

NHS England | November 2018 | Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

The Walton Centre in Liverpool – the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services-   runs an advice line which means GPs in the Cheshire and Merseyside area can call neuro consultants for fast advice any weekday reducing extra patient appointments. 

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So far the service has received 181 calls 37% were resolved by the GP saving £51,698 which over a year saves around £100k.

Programme Director Julie Riley said: “We want to deliver services closer to home and when patients do come into hospital, support them so they can recover and go home quicker. From a patient point of view, we want to work in partnership with them. We, our consultant colleagues and GPs want to support them in self-management, where appropriate – rather than taking a paternalistic approach.”

Read the full case study at NHS England