Bart’s Research Centre for Women’s Health is up and running with the EMmY study

We’re delighted to announce our latest research partnership – with the the Bart’s Research Centre for Women’s Health (BARC) .

BARC was launched in June 2017 and is led by Professors Shakila Thangaratinam and Khalid Khan.

The Centre is funded by Barts Charity and based within Queen Mary University of London at the Whitechapel campus.

The centre team (pictured above) will focus on improving the health of mothers and babies in East London, addressing healthcare challenges such as diabetes, obesity and heavy blood loss during childbirth.

The first BARC study is set to start in January 2018 –  “EMmY: Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes: a pilot placebo controlled double blind randomised trial”.

EmMY will aim to randomise 200 women who are at risk of developing gestational diabetes, across three sites (Barts Health, Guy’s and St Thomas’, and Central Manchester University NHS Trusts).

Participants will be randomised to receive either 4g of Myo-inositol – a naturally occurring substance produced in the human body that belongs to the vitamin B complex group – or placebo study supplement daily, from the end of the first trimester until delivery.

The pilot will examine rates of recruitment and randomisation to the trial, and rates of adherence to the intervention. Researchers will analyse reasons for participation, non-participation, and non-adherence to the trial protocol. Any preliminary estimates and insight into trial procedures from the EMmY study will then inform a future large-scale trial.

The CLAHRC is supporting the study by providing health economic analysis for the pilot and full trial and assisting with patient and public involvement..

Contact Doris Lanz, BARC Senior Trial Manager for more info at d.lanz@qmul.ac.uk

Dr Elena Pizzo

Elena is a Senior Health Economics. She holds a PhD in Economics and Management from Padua University, a Master degree in Economics and Management of Health Care Services from Ferrara University and a first degree in Economics from Padua University.

Prior to coming to UCL she was a Research Associate at the Imperial College Business School, working on the economic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London.

She previously held a research post at the Department of Economics, Ferrara University, where she collaborated to a multi-year research project and undertook an economic evaluation of a Regional Colorectal Cancer Screening Program.

Requests for emergency contraception could be an important sign of abuse

Women who experience domestic violence and abuse (DVA) are more than twice as likely to seek emergency contraception as other women, according to a study by National Institute for Health Research (NIHR)-funded researchers at the University of Bristol and Queen Mary University of London, suggesting that requests for emergency contraception could be an important sign of abuse.

In the study, published in the British Journal of General Practice today, the researchers analysed medical records of over 200,000 women of reproductive age registered with a GP and found that those who had a record of DVA were 2.06 times more likely to have a consultation for emergency contraception compared to other women, rising to 2.8 times for women aged 25-39.

The researchers also found some evidence that abused women are more likely to seek emergency contraception repeatedly.

DVA is a major public health problem, with devastating consequences for the women who experience it and great financial cost to the NHS. It is known to have a significant impact on women’s reproductive health, including an increased risk of unintended pregnancy and abortion, as abusive and controlling partners coerce women to have unprotected sex or rape them.

Although emergency hormonal contraceptive, also known as the morning-after pill, is available from pharmacies, women can also get it from their GP. Up to a third of all emergency contraceptives are prescribed by GPs.

The researchers are calling for this new evidence to be included in existing DVA training programmes for GPs and sexual health practitioners, and for the training to be extended to community pharmacists, to help them identify and refer women who have experienced DVA on to specialist support services. Such programmes are recommended by the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) as part of a multi-sector response to DVA.

Joni Jackson, Research Associate from the NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West and co-lead author of the study, said:

We found a strong positive association between exposure to domestic violence and abuse and requests for emergency contraception. Our findings are in line with evidence from studies in other countries suggesting that women experiencing DVA use more emergency contraception than other women. GPs, pharmacists and sexual health practitioners are at the frontline responding to these requests, with community pharmacists dispensing 50% of all emergency contraceptive pills. This presents an important opportunity to identify women experiencing DVA, signpost them to appropriate support services, and potentially save lives.”

Dr Natalia Lewis, from the Centre for Academic Primary Care at the University of Bristol and co-lead author, said:

The negative impact of domestic violence and abuse on health results in higher use of healthcare services by abused women compared to the general population. This means that healthcare services are an important point of contact for DVA victims and survivors. We have already seen improvements in GPs’ ability to identify and refer women experiencing DVA through the success of the IRIS (Identification and Referral to Improve Safety) programme. IRIS has recently been adapted for sexual and reproductive health services. Our findings support the case for adapting the IRIS intervention to the community pharmacy setting, although more research is needed to explore if and how this could be done.”

The research was supported by NIHR CLAHRC West and CLAHRC North Thames.

Papers:

Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset. Joni Jackson, Natalia V Lewis, Gene S Feder, Penny Whiting, Timothy Jones, John Macleod, Maria Theresa Redaniel. British Journal of General Practice. 4 December 2018.

Use of emergency contraception among women with experience of domestic violence and abuse: a systematic review. Natalia V Lewis, Theresa HM Moore, Gene S Feder, John Macleod, Penny Whiting. BMC Family Practice. 26 September 2018.

How can we improve dementia care in UK black elders?

Black elders dismiss the warning signs of dementia until the condition becomes too severe to ignore or a crisis strikes. They are also less likely to receive a diagnosis of their condition, resulting in delayed treatment and
less time to plan for the future.

Our latest BITE – a summary of published CLAHRC research provides an overview of our work with black elders, their families and carers to;

  1. identify barriers and facilitators to seeking help for dementia.
  2. based on what we found, work with dementia patients and their          carers, volunteers from the public, clinicians and experts in the treatment and research of dementia to develop an intervention – a leaflet entitled Getting help for forgetfulness (below)
  3. trial the intervention with GP registered patients, who were asked to rate it and evaluate its effect on their intention to seek help from their doctor.

Improving how professionals can identify and support children experiencing domestic violence

New CLAHRC research has highlighted a lack of guidance for health and social professionals who encounter children exposed to domestic violence.

Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. Children can be directly impacted – leading to emotional and behavioural problems and risks of physical injury and death when children are caught up in the violence between adults.  Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences. Health and social care workers are often the first professionals to have contact with a child experiencing these situations.


In a collaboration with CLAHRC East of England and international colleagues from the McMaster and Western Universities in Canada we examined the evidence on child, parent and professional views on acceptable approaches to identifying and responding to children exposed to domestic violence.

The resulting research paper, published in BMJ Open, highlighted conflicting views of children and mothers on the one hand and professionals on the other when it came an ideal response. Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals preferred to engage with children via the parent and they often did not perceive children exposed to domestic violence as patients or clients in their own right.

Guidelines for health professionals who encounter women who have experienced domestic violence provide various questions and prompts they can use in discussions, and a set of principles to follow. There are no equivalent recommendations on how to identify and respond to children exposed to domestic violence and limited evidence on which to base future guidance. Our analysis also revealed that professionals were not happy with the existing safety guidelines for children and mothers exposed to domestic violence and wanted changes.

The research was funded by the Public Health Agency of Canada through funding to the VEGA (Violence, Evidence, Guidance and Action) project. The VEGA Project is part of the Canadian Government’s Public Health Response to Family Violence. This research will inform the development of public health guidance, protocols, curricula and tools for health and social service providers. The research was supported by the NIHR CLAHRC North Thames and NIHR CLAHRC East of England.

Resources supporting this new research include a blog in The Conversation by lead researcher Dr Natalia Lewis, and we have worked with CLAHRC East of England on a joint BITE – a summary of the research with key learning for busy professionals interested in this work.

Read the paper

Natalia V. Lewis, Gene S. Feder, Emma Howarth, Eszter Szilassy, Jill R. McTavish, Harriet L. MacMillan, Nadine Wathen.

Identification and initial response to children’s exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals.

BMJ Open 2018. Published in BMJ Open. April 2018. Doi:. http://bmjopen.bmj.com/content/8/4/e019761

Read a BITE sized summary

How should health and social care professionals identify and respond to children experiencing domestic violence?

Finding a better way to identify children experiencing domestic violence

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Shutterstock

Natalia Lewis, University of Bristol

Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. When adults are involved in an abusive relationship, their children bear the consequences.

The effects of domestic violence on a child can range from emotional and behavioural problems to physical injury and death when children are caught up in the violence between adults.

Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences.

Health and social care workers are often the first professionals to have contact with a child experiencing these situations. This could be when the abused parent seeks help, or when children undergo health checks. It can happen during assessments for emotional or behavioural problems, or when social services, a child’s school or the police become involved.

The World Health Organisation (WHO) recommends that health professionals who see women with clinical signs of domestic violence should ask them about safety in their relationship and at home. They advise that responses to disclosure should follow what is known as the “LIVES” principles: Listen, Inquire about needs and concerns, Validate, Enhance safety, and provide Support.

But there are no equivalent recommendations for children, and there is no agreed approach regarding how best to identify and respond to children who are exposed to domestic violence. So far, there has also been only limited evidence on which to base future guidance.

Now researchers at universities in the UK (Bristol, Queen Mary and Cambridge) and Canada (McMaster and Western) have combined existing evidence on the best ways to identify and respond to children experiencing domestic violence. This synthesis, the first of its kind, integrates findings from 11 studies with 42 children, 220 parents, and 251 health care and social services professionals.

We found that study participants’ opinions were strikingly consistent, and matched the LIVES principles. Children, parents (mostly mothers) and professionals agreed that identification of the problem should happen in the context of a good patient-professional relationship, and in a safe and supportive environment.

Health care professionals should enquire about the child’s safety when they see clinical signs of domestic violence and abuse in children. The ideal initial response should include emotional support, discussion about domestic violence and advice on local specialist services.

We also discovered that a professional’s ability to identify and respond to children’s exposure to domestic violence was heavily influenced by constraints within the health and social service system. Lack of time, funding cuts and poor inter-agency collaboration all have an impact. Professionals needed more training and resources to be able to respond to these children and their families in an appropriate and safe way.

However, there was a difference of opinion when it came to engaging directly with children and managing their safety.

A direct approach?

Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals, on the other hand, preferred to engage with children via the parent – and did not perceive children exposed to domestic violence as patients or clients in their own right. Also, professionals were not happy with existing safety guidelines and practices for children and mothers exposed to domestic violence. These elements are certainly subjects for future research and training.

Given the scale of the problem, and the long-term emotional, behavioural and physical impacts on children, we hope that the results of this study can form the basis of new, internationally agreed guidelines.

Our research findings have already been used to inform point-of-care responses to adults and children in Canada’s VEGA (Violence, Evidence, Guidance, Action) Project. That program is already developing the “Recognising and Responding Safely to Family Violence” Handbook for health and social care professionals.

And we hope our evidence will inspire development of professional training and resources elsewhere – so that front line practitioners feel better equipped to appropriately and safely respond directly to the needs of children. Too many children’s lives and futures could depend upon it.

Natalia Lewis, Research Fellow in Primary Care, University of Bristol

This article was originally published on The Conversation. Read the original article.