Circles of Support and Accountability for Sex Offenders: A Systematic Review of Outcomes

We conducted a systematic review of studies reporting on the effectiveness of Circles of Support and Accountability (Circles). Circles use volunteers to provide support for sex offenders living in the community. We searched 10 databases up to the end of 2013 and identified 3 relevant outcome studies. An additional 12 papers or reports were identified by searching reference lists, Google, and contacting key authors and Circles providers to obtain unpublished data. These 15 studies comprised one randomized controlled trial, three retrospective cohorts with matched controls, and 11 case series. The majority reported measures of recidivism, particularly reconviction. The 4 studies with controls generally reported that participation in Circles was associated with lower recidivism although there were few statistically significant differences. Few studies examined changes in risk or psychosocial outcomes. A number of methodological issues are discussed. Longer term, prospective follow-up studies with control groups are required to address these issues.

Vitamin D insufficiency in the first 6 months of infancy and challenge-proven IgE-mediated food allergy at 1 year of age: a case-cohort study

BACKGROUND

Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy.

OBJECTIVE

To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year.

METHODS

In a birth cohort (n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D₃ (25(OH)D₃ ) levels among infants with food allergy vs a random subcohort (n = 274). The primary exposures were VDI (25(OH)D₃ <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding.

RESULTS

Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year.

CONCLUSIONS

There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required.

Wula (Voices) of Aboriginal women on barriers to accepting smoking cessation support during pregnancy: Findings from a qualitative study

AIM

To gather Aboriginal women's stories of smoking and becoming pregnant to identify the barriers in accepting smoking cessation support during pregnancy.

METHODS

Qualitative data were collected through use of yarning methodology between August 2015 and January 2016 by an Aboriginal Researcher with experience in social and community services. A short on-line survey was used to collect quantitative data. Interviews only recorded the therapeutic yarning process, which ranged from 9 to 45min duration, averaging 30min. Audio-recorded interviews were transcribed and independently coded. A general inductive analysis was used to determine emergent themes.

RESULTS

Twenty Aboriginal women between 17-38 years of age, who were pregnant or recently given birth, living in the Hunter New England (HNE) area took part. Eleven women were still smoking; nine had quit. Most were highly aware of the implications of smoking for their babies. Major themes identified for accepting support were: ambivalence towards a need for support, health professional advice, reduction in smoking, and attitudes to Nicotine Replacement Therapy (NRT). Women reported being advised to cut down, rather than to quit; reducing consumption may be a barrier to accepting NRT. Women recommended enhanced clinical support and Aboriginal community engagement in cessation care.

DISCUSSION/CONCLUSIONS

Aboriginal women in the HNE area reported quitting or reducing their cigarette intake during pregnancy. Health Professionals working with Aboriginal women during pregnancy should give consistent messages to quit smoking completely, and offer increased, ongoing and extensive smoking cessation support to Aboriginal mothers. Clinical practices could partner with Aboriginal communities to support the delivery of smoking cessation services.

Fetal Grafting for Parkinson's Disease: Expression of Immune Markers in Two Patients with Functional Fetal Nigral Implants

In a number of centers throughout the world, fetal nigral transplantation is being performed for the treatment of Parkinson's disease (PD). Clinical results have been inconsistent. One parameter that differs among transplant studies is the degree and manner by which patients are immunosuppressed following transplantation. Indeed, the role of the immune system following fetal grafting in humans is not well understood. Recently, two patients from our open label trial that received fetal nigral implants have come to autopsy. These patients were immunosuppressed with cyclosporin for 6 mo posttransplantation and survived for a total of 18 mo postgrafting. Robust survival of grafted dopamine-containing cells was observed in both cases. Immunostaining for HLA-DR revealed a dense collection of cells within grafts from both cases. HLA-DR staining was rarely observed within the host including non-grafted regions of the striatum. A more detailed analysis of immune markers was performed in Case 2. Numerous pan macrophages, T-cells, and B-cells were observed within graft sites located in the postcommissural putamen. In contrast, staining for these immune cells was not observed within the ungrafted anterior putamen. These findings suggest that even in healthy appearing functional nigral implants, grafts are invaded by host immune cells that could compromise their long-term viability and function. Alternatively, immune cells are known to secrete trophic factors, which may ultimately favor graft survival and function. Further work is needed to understand the role of the immune system in fetal grafting.

Circles of support and accountability: The characteristics of core members in England and Wales

BACKGROUND

Circles of support and accountability, or Circles, use community volunteers to help reintegrate sex offenders at risk of reoffending in the community.

AIMS

The aims of this study are to describe the first 275 male sex offenders ('core members') in England and Wales supported by a Circle and to compare those attending the five largest Circles.

METHODS

As part of their monitoring activity, 10 Circles extracted data from case files, anonymised it and submitted it to Circles UK, the national oversight body.

RESULTS

Circles have expanded rapidly with 165 (60%) of Circles commencing in the three years 2011-2013 compared with 110 in the nine years 2002-2010. Most core members were referred from the Probation Service (82%). Circles were provided to men with a range of predicted risks of reoffending - from low (26%) to very high (12%). There were some positive changes between the beginning and end of Circles, such as fewer men being unemployed and more living in their own chosen accommodation.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Circles have been used to support the reintegration of a wide range of sex offenders. Given their rapid growth and flexibility, consistent recording standards are required across. These standards should be reviewed periodically to ensure all important fields of change are captured, including frequency of attendance, length per session and quality of engagement in the work. Copyright © 2016 John Wiley & Sons, Ltd.

The COMET Initiative database: progress and activities update (2015)

This letter describes the substantial activity on the Core Outcome Measure in Effectiveness Trials (COMET) website in 2015, updating our earlier progress reports for the period from the launch of the COMET website and database in August 2011 to December 2014. As in previous years, 2015 saw further increases in the annual number of visits to the website, the number of pages viewed and the number of searches undertaken. The sustained growth in use of the website and database suggests that COMET is continuing to gain interest and prominence, and that the resources are useful to people interested in the development of core outcome sets.

Organizational democracy, ethics and leadership: The mediating role of organizational politics

There has been a growing concern amongst commentators about the disconnection between the apparent pluralisation of society and the relatively limited adoption of democratic practices in the corporate workplace. This paper examines the experience of employees in an international broking company in order to explore the extent to which a political leadership perspective can provide insight into furthering organizational democratisation. Attention is given to the integral relationship between democracy, ethics and a political mindset, and the influence this has upon others. In the account reported here, the ethical and developmental agenda of one influential senior manager is central to both the enactment of politics and the form of democratisation which it enables.

Fractured root tips during dental extractions and retained root fragments. A clinical dilemma?

Root tip fracture can occur during the extraction of teeth. The clinician must then decide to either leave the root fragment in situ, or to attempt its removal. A similar decision is made when retained root fragments are found incidentally on oral radiographs. The prevalence of retained root fragments is reported as 11-37%. This article aims to highlight the risk benefit matrix of the removal or retention of retained root fragments, in light of the present evidence base.

A Descriptive Study of Feelings of Arrested Escape (Entrapment) and Arrested Anger in People Presenting to an Emergency Department Following an Episode of Self-Harm

BACKGROUND AND OBJECTIVES

To explore the role of elevated feelings of anger and desires to escape (fight/flight), which are experienced as inhibited, blocked, and arrested (i.e., arrested anger and arrested flight/escape leading to feelings of entrapment). This descriptive study developed measures of arrested anger and arrested flight and explored these in the context of a recent self-harm event in people presenting to a Hospital's Emergency Department (ED).

METHODS

Fifty-eight individuals presenting to an ED following an act of self-harm were recruited. Participants completed newly developed measures of arrested flight, arrested anger and anger with self in regard to self-harm, and suicide intent and depression.

RESULTS

Ninety-three percent of participants presented after self-poisoning. The majority (95%) reported having experienced high escape motivation that felt blocked (arrested flight) with 69% reporting feeling angry with someone but unable to express it (arrested anger). For many participants (53.7%), strong desires to escape from current situations and/or to express anger did not diminish immediately after the act.

LIMITATIONS

As with many studies, a select group of participants agreed to take part and we did not keep records of how many refused. There are no other validated measures of arrested escape and arrested anger and so for this study, our short item-focused measures rely on face validity.

CONCLUSION

Arrested defenses of fight and flight, and self-criticism are common in those who have self-harmed and may continue after acts of self-harm. Many participants revealed that talking about their experiences of escape motivation and blocked anger (using our measures) was helpful to them.

PRACTICE POINTS

Feelings of entrapment and arrested anger are common in people who self-harmClinicians could benefit from increased awareness and measures of arrested flight and arrested angerDiscussing these concepts and experiences appears to be useful to people who have self-harmedFurther research is needed on how best to help people with such experiences.

High-Volume Repeaters of Self-Harm

Abstract. Background: Repetition of self-harm is common and is strongly associated with suicide. Despite this, there is limited research on high-volume repetition. Aim: To investigate individuals with high-volume repeat self-harm attendances to the emergency department (ED), including their patterns of attendance and mortality. Method: Data from the Multicentre Study of Self-Harm in England were used. High-volume repetition was defined as ⩾15 attendances within 4 years. An attendance timeline was constructed for each high-volume repeater (HVR) and the different patterns of attendance were explored using an executive sorting task and hierarchical cluster analysis. Results: A small proportion of self-harm patients are HVRs (0.6%) but they account for a large percentage of self-harm attendances (10%). In this study, the new methodological approach resulted in three types of attendance patterns. All of the HVRs had clusters of attendance and a greater proportion died from external causes compared with non-HVRs. Conclusion: The approach used in this study offers a new method for investigating this problem that could have both clinical and research benefits. The need for early intervention is highlighted by the large number of self-harm episodes per patient, the clustered nature of attendances, and the higher prevalence of death from external causes.

Using the Grade Approach to Support the Development of Recommendations for Public Health Interventions in Radiation Emergencies

The World Health Organization (WHO) guideline development policy requires that WHO guidelines be developed in a manner that is transparent and based on all available evidences, which must be synthesised and formally assessed for quality. To fulfil this requirement, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach of rating quality of evidence and grading strength of recommendations was applied when developing the WHO recommendations on public health interventions in radiation emergencies. The guideline development group (GDG) formulated 10 PICO (P: population; I: intervention; C: comparator; O: outcomes) questions to guide the development of recommendations on response interventions during the early/intermediate and late emergency phases and on risk communications for mitigating psycho-social impact of radiation emergencies. For each PICO question, an extensive evidence search and systematic review was conducted. The GDG then formulated the recommendations using the evidence to recommendation (E-2-R) decision-making matrix and evaluated the strength of each recommendation.

Reconciling Hierarchy and Democracy

Pluralistic organizations are often argued to have become an indisputable reality for senior managers. In consequence, the role of hierarchy has come under close scrutiny. How can organizations balance the need for congruence, provided through hierarchy, with the need for greater organizational democracy? As yet, the potential for management education and learning to impact on this debate, at either an organizational or a societal level, has been largely unfulfilled. This article argues that the aspirational values of liberal adult educationalists have a significant contribution to make to the management of contemporary organizations. It positions these values alongside the business requisites that shape organizations and examine the motivations of senior managers to apply these ideas in practice. The concept of voluntarism, derived from the field of political philosophy, is proposed as an alternative organizational binding mechanism that alters the rationale for the role of hierarchy. The implications for senior executives and management educational-ists are considered.

A Study of the Role of ‘Representative’ Leadership in Stimulating Organization Democracy

There has been a growing concern among commentators about the disconnection between the apparent increase in the plurality of society, and the relatively limited facets of democracy practised in the corporate work place. Specifically, models of distributed leadership appear at odds with the dominant bureaucratic and unitary model of organizing. In addressing the problem, this article offers a model of Representative Leadership (RL) derived from a political institutional discourse and suggests that in settings of contested plurality, the representation of different organizational constituencies, by a wide range of individuals is central to effective organizing. This model of leadership is explored in the context of data derived from 31 senior managers in five different commercial organizations. Observations are provided about the causal relationships between organization context, managerial cognitions of plurality, personal interest, authority and politics. The potential for RL behaviour to inform future discourse on democratic governance is considered.

Saccade Programming in Strabismic Suppression

Individuals with strabismus frequently show a suppression phenomenon in which part of the visual input in one eye is apparently ignored when both eyes are seeing, although the eye may have normal vision when used monocularly. This is often described as an adaptive response to avoid diplopia. We have examined two patients with microstrabismus (angle of squint less than 5 deg) who show strong suppression but with only mild amblyopia. We studied saccade generation in the two eyes using a red — green anaglyph display which allowed us to present stimuli independently to each eye.

When single targets were presented in the suppressing eye, saccadic responses usually occurred. However the latencies of these saccades were increased with respect to those elicited from the normal eye (by about 70 ms for one subject and 270 ms for the other). The amplitudes of the saccades were less consistent than those of the normal eye, and saccades were sometimes made in the opposite direction to the target. We also investigated the remote distractor effect. This effect is found consistently in normal subjects and consists of an increase in the latency of a target-elicited saccade when a distractor is simultaneously presented elsewhere in the visual field. When distractors were presented in the suppressing eye, they had no effect on the latency of saccades to a simultaneous target in the other eye. We conclude that visual stimulation in a suppressing eye has no rapid access to the saccadic system.

Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis

BACKGROUND

The incidence of psychotic disorders varies between geographical areas and it has been hypothesized that neighbourhood-level factors may influence this variation. It is also plausible that the duration of untreated psychosis (DUP) is associated with neighbourhood characteristics. The aims of this study were to determine whether the incidence of first-episode psychosis (FEP) and the DUP are associated with the level of social deprivation, fragmentation, social capital and population density.

METHOD

All individuals with a FEP from a geographical defined catchment area over a 5-year period were included. Age-standardized incidence rates were calculated for each neighbourhood factor.

RESULTS

A total of 292 cases of FEP were included in the study and 45% had a diagnosis of a schizophrenia-spectrum disorder. The age standardized incidence rate of FEP in the most deprived area was 72.4 [95% confidence interval (CI) 26.4-162.7] per 100 000 person-years compared with 21.5 (95% CI 17.6-26.0) per 100 000 person-years in the most affluent areas. This represents a 3.4-fold increase in FEP incidence in the most deprived areas. The incidence of FEP was also increased in neighbourhoods that were more socially fragmented [incidence rate ratio (IRR) = 2.40, 95% CI 1.05-5.51, p = 0.04] and there was a trend for the incidence to be increased in neighbourhoods with lower social capital (IRR = 1.43, 95% CI 0.99-2.06, p = 0.05). The median DUP was 4 months and was higher in more socially fragmented neighbourhoods.

CONCLUSIONS

The incidence of psychotic disorders is related to neighbourhood factors and it may be useful to consider neighbourhood factors when allocating resources for early intervention services.

Knowledge and Uptake of Voting Rights By Adults With Mental Illness Living in Supported Accommodation in Westminster (London) During the 2015 Uk General Election

Introduction

Voting is an essential human right. Being able to vote and participate in elections is an important component of social inclusion; empowering people with mental illness to have a political voice and in turn reducing stigma. Previous research indicates that patients with mental illness are less likely to vote compared to the general population.

Objective

This study explores knowledge and uptake of the voting rights of adults living in mental health supported accommodation in Westminster (London) in the 2015 UK general election.

Aims

Understand patients’ awareness of their eligibility to register and cast their vote. Identify patients’ interest in engaging in the voting process and strategies to overcome potential obstacles.

Methods

A staff-assisted survey was undertaken in all mental health supported accommodation across Westminster prior to the general election in May 2015.

Results

A total of 142 surveys were returned. Nine out of 10 surveyed believed they were eligible to vote; over half wanted to exercise their right to vote & if registered, a third felt they required assistance to vote.

Conclusions

The majority of community patients were positively aware of the impending general election and their own eligibility to vote. Only half wanted to exercise their right to vote, which is lower than the general population. As a third of the patients requested assistance for voting, this shows us that there are potential barriers impacting on their ability to exercise their right to vote. Staffs have an important role in promoting patient's right to vote by providing assistance with both the registering and voting process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Maternal uptake of pertussis cocooning strategy and other pregnancy related recommended immunizations

Maternal immunization is an important strategy to prevent severe morbidity and mortality in mothers and their offspring. This study aimed to identify whether new parents were following immunization recommendations prior to pregnancy, during pregnancy, and postnatally. A cross-sectional survey was conducted by a questionnaire administered antenatally to pregnant women attending a maternity hospital with a follow-up telephone interview at 8-10 weeks post-delivery. Factors associated with uptake of pertussis vaccination within the previous 5 y or postnatally and influenza vaccination during pregnancy were explored using log binomial regression models. A total of 297 pregnant women completed the questionnaire. For influenza vaccine, 20.3% were immunized during pregnancy and 3.0% postnatally. For pertussis vaccine, 13.1% were vaccinated within 5 y prior to pregnancy and 31 women received the vaccine postnatally, 16 (51.6%) received the vaccine >4 weeks after delivery. Receiving a recommendation from a healthcare provider (HCP) was an independent predictor for receipt of both pertussis (RR 2.07, p < 0.001) and influenza vaccine (RR 2.26, p = 0.001). Non-English speaking mothers were significantly less likely to have received pertussis vaccination prior to pregnancy or postnatally (RR 0.24, p = 0.011). Multiparous pregnant women were less likely to have received an influenza vaccine during their current pregnancy (p = 0.015). Uptake of pregnancy related immunization is low and likely due to poor knowledge of availability, language barriers and lack of recommendations from HCPs. Strategies to improve maternal vaccine uptake should include education about recommended vaccines for both HCPs and parents and written information in a variety of languages.