Risk Of Harm Research Articles

Postoperative Exercise Training in Patients with Colorectal Liver Metastases A Randomized Controlled Trial

Background: Postoperative morbidity can reduce quality of life, physical performance, and tolerability of postoperative chemotherapy in patients with colorectal liver metastases (CRLM). Exercise can improve these outcomes in some cancer populations. However, it remains unknown whether exercise can be delivered in the early postoperative period following surgery for CRLM without increasing the risk of harms. Objective: The primary objective was to compare the number of serious adverse events (SAEs) with exercise intervention versus control. The secondary objectives were to compare non-SAEs, chemotherapy dose modifications, patient-reported outcomes, cardiorespiratory fitness, and physical performance. Methods: Patients with CRLM scheduled to open surgery with or without postoperative chemotherapy were randomized 2:1 to intervention or control. The intervention group performed 30-50 min low-to-high intensity exercise 5 times/week for 8 weeks, initiated one day after postoperative hospital discharge. The primary outcome was SAEs. The secondary outcomes were SAEs; chemotherapy dose modifications; patient-reported outcomes; cardiorespiratory fitness; and physical performance. Results: Fifty-five participants were randomized. The number of SAEs was similar between the groups (between-group difference [95% CI]: -0.07 [-0.59; 0.43] events), whereas the number of non-SAEs was lower in intervention (between-group difference [95% CI]: -4.65 [-9.14; -0.17] events). We found between-group differences in time to postoperative chemotherapy (intervention: 25 days, control; 42 days) and chemotherapy dose modifications (RR [95%CI]: 0.55 [0.35; 0.88]). Additionally, we found between-group differences in quality of life, cardiorespiratory fitness, and physical performance, in favor of intervention. Conclusions: Early-onset postoperative exercise exhibit a favorable harms-benefit profile in patients with CRLM. This warrants further investigation in larger randomized controlled trials. Trial registration: Prospectively registered at clinicaltrials.gov (NCT04751773).

Experiences of treating problematic over the counter and prescription only medication use in substance misuse services

Abstract Introduction There are growing concerns about the misuse of over the counter (OTC) and prescription only medication (POM), due to the associated negative socioeconomic and health implications1. To improve care delivery, stigma needs to be addressed and more needs to be known about the perspectives of staff who are working in substance misuse services (SMS)2. Aims To use confidential semi-structured interviews, to explore the experiences of community English SMS staff who have supported adults that have misused OTC/POM. Methods This research was conducted across five community adult English SMS operated by a national treatment provider. Individuals were eligible for participating in semi-structured interviews if they had current experience of working in a community SMS role which involved supporting adults who had misused OTC/POM, were at least 18 years of age and provided informed consent. Potential participants self-identified as being eligible and interested in being included, after receiving the participant information sheet. The interviews explored their experience of working in SMS and supporting people who have misused OTC/POM, and potential changes to current SMS provision. Thematic analysis of the audio-recording transcripts was undertaken using NVivo®. This research was funded by a Research Award from Pharmacy Research UK and the College of Mental Health Pharmacy [PRUK_CMHP-2019-2-RG]. This research was approved by Humankind/EDP and Aston University’s Life and Health Sciences Ethics Committees (ID#1655). Results Organising interviews was challenging due to pandemic-related work pressures, between October 2020 and January 2021. Thematic analyses of twenty SMS staff transcripts was undertaken and data saturation was thought to have been achieved. Three overarching themes were identified: characteristics of OTC/POM misuse; different groups of people; and negative experiences (with six sub-themes: lack of awareness of risk of harm; unmanaged health conditions; withdrawal symptoms; side-effects; problematic behaviours; and treatment pathways). Oral dependent use of opioids (especially codeine products), benzodiazepines and gabapentinoids predominated. Polypharmacy and the use of other substances sometimes occurred. OTC/POM misuse was associated with a wide range of adverse socioeconomic, physical, and psychological effects. Unmanaged withdrawal symptoms caused concern, contributed to perpetuating misuse, and sudden cessation in supplies created risks. Discussion and Conclusion This study had a unique focus on the experiences of third sector English SMS staff. OTC/POM misuse (and withdrawal symptoms) should be routinely enquired about during healthcare reviews, and tailored harm reduction, pharmacological and psychosocial interventions offered. Increased awareness, vigilance for associated safeguarding issues, and more training is required. SMS should sensitively consider how to incorporate the views of staff with lived experience to further optimise service delivery co-production. As staff were all employed by the same SMS provider, future research, conducted in SMS operated by other providers, and covering a wider geography, may enable more information to be shared, more participants to be recruited, and the results more generalisable. Repeat interviews and member-checking may improve assurance in the findings. The possible need for different SMS for those who only misuse OTC/POM without exacerbating stigma requires further exploration. Future research should identify if demographic characteristics and treatment needs differ by OTC/POM type.

Artificial Intelligence-Generated Writing in the ERAS Personal Statement: An Emerging Quandary for Post-graduate Medical Education.

This study was designed to investigate if artificial intelligence (AI) detection software can determine the use of AI in personal statements for residency applications. Previously written personal statements were collected from physicians who had already matched to residency through the Electronic Residency Application System. Physicians were recruited for the study through collegial relationships and were given study information via email. The study team constructed five parallel statements from the shared personal statements to prompt AI to create a personal statement of similar content. An online AI detection tool, GPTZero, was used to assess all the personal statements. Statistical analyses were conducted using R. Descriptive statistics, t-tests, and Pearson correlations were used to assess the data. Eight physicians' statements were compared to eight AI-generated statements. GPTZero was able to correctly identify AI-generated writing, assigning them significantly higher AI probability scores compared to human-authored essays. Human-generated statements were considered more readable, used shorter words with fewer syllables, and had more sentences compared to AI-generated essays. Longer average sentence length, low readability scores, and high SAT word percentages were strongly associated with AI-generated essays. This study shows the capacity of GPTZero to distinguish human-created versus AI-generated writing. Use of AI can pose significant ethical challenges and carries a risk of inadvertent harm to certain applicants and erosion of trust in the application process. Authors suggest standardization of protocol regarding the use of AI prior to its integration in post-graduate medical education.

Healthcare worker perspectives on HIV status sharing intervention components for partnered, Black sexual minority men in South Africa

ABSTRACT: Background Globally, there is suboptimal coverage of antiretroviral treatment to treat and prevent HIV. It is crucial for individuals to know their partner’s HIV status so they may use all appropriate and available prevention tools. For sexual minority men in South Africa, a population known to face intersecting forms of marginalization including a disparate burden of HIV incidence, there are challenges to status sharing. Objective We explore perspectives of healthcare workers (HCW) with expertise providing services to sexual minority men to identify strategies to support HIV status sharing. Methods As part of a larger study designed to improve HIV-related health outcomes for sexual minority men, we conducted one focus group discussion (participant n = 4) and two in-depth-interviews with HCW. We used thematic analysis to synthesize qualitative themes and identify corresponding implications for interventions. Results HCW each had 5–23 years of experience. We identified three implementation considerations to support sharing of HIV status: (1) ensuring partner support for sharing status while circumventing risk of personal harms, (2) facilitating concordant couple-based peer support and belonging, and (3) leveraging the strengths of mass media as educational tools. Conclusion HCW highlighted that sharing that one is living with HIV is a sensitive and potentially dangerous process that can be managed by involving both partners in the process. This process may be supported by incorporating HIV status sharing narratives in popular media.

Patient safety incidents in anaesthesia: a qualitative studyof trainee experience from a single UK healthcare region.

Anaesthetic training has always had patient safety as part of the curriculum. However, there is limited emphasis on what happens when things do not go to plan. Our aims were to understand the impact of involvement in patient safety incidents on anaesthetic trainees in our region, to describe the range of support currently offered and put forward suggestions for improvement. An initial electronic survey was sent to all anaesthetic trainees in a single UK healthcare region to capture qualitative and quantitative information on patient safety incidents. After completing the questionnaire, participants were asked to consent to involvement in a semi-structured interview to provide a more detailed understanding of the impact of safety incidents. Data were analysed from the questionnaires and interview transcripts using descriptive statistics and thematic analysis. Thirty-four completed questionnaires were analysed revealing 27 trainees had been involved in a patient safety incident. Ten semi-structured interviews were conducted and six themes were identified: team dynamics (including adequacy of staffing and supportive departmental culture); context of the event; reflex immediate support post-event; working environment pending completion of the investigation; personal impact (including physical and mental health); and suggestions for future support. This study has shown the significant impact of safety incidents on anaesthetic trainees in one training region in the UK and highlights the importance of implementing early, tailored debriefs led by trained facilitators, the value of a supportive work environment and the need to raise awareness of system-based approaches to learning from incident investigations. Further research should guide the format and delivery of support for trainees to provide more helpful and timely interventions after patient safety incidents and reduce the risk of future harm to both patients and trainees.

Intrinsic value, sovereignty rights, and sentient animals in Antarctica

ABSTRACT Two things central to the Antarctic Treaty System fill the minds of ethicists and political theorists the more often they reflect upon them: territorial sovereignty (AT, IV.2) and the intrinsic value of Antarctica (Protocol, art.3). Regarding its intrinsic value, in the first half of the paper I argue that to give adequate consideration to the different morally significant constituent parts of Antarctica, it is necessary to recognise sentient animals as a fundamental source of intrinsic value. In the second part of the paper, I look at the implications this interpretation would have particularly, but not only, for those States with sovereignty claims over the continent. The conclusion I draw is twofold. On the one hand, State sovereignty in Antarctica would have to become conditional to acting on the continent in ways that are consistent with the respect owed to wild sentient animals. On the other hand, claimant States and State parties would be required to revisit and amend domestic policies that generate direct harm or unreasonable risk to wild animals in the white continent, even when performed far away from Antarctica.

Clinical accuracy and risk of harm in asthma related content on TikTok

Clinical accuracy and risk of harm in asthma related content on TikTok

Reconsidering the City of New York Directive on Mental Health Involuntary Removals

Abstract Background Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed. Methods We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as “homelessness and mental health,” “policy interventions for homeless populations,” and “health care services costs.” We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care. Results Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve.

INtelligent toolkit for reconnaissance, assessments and prehospital support in Perilous InciDents: a realistic experiment in prehospital environment

BackgroundFirst responders, when arriving at a disaster, need a rapid analysis of the environment in which they are going to operate, as they have to assess the conditions surrounding potential victims and neutralize any risks that may exist.The EU-funded INTREPID develops a new technology platform to assist first responders when arriving on the scene of a disaster. The project INTREPID aims to support safer operations in the form of more efficient, fast, and safe disaster site assessments. The objective of the study is to implement new technologies into rescue operations to facilitate and improve situational awareness and operation management capabilities to save lives.The focus of the study is relevant to the field of mass casualty incident management and disaster, as proper communication is extremely relevant in the management of catastrophes.MethodThe first phase of the project started with a qualitative methodology SCRUM, for catching the end user’s feedback and requirements to design the interface platform. It was developed a platform to support first responders in disasters areas improving the 3D scanning and analysis of disaster areas. This platform is based on the concepts of intelligence amplification and eXtended Reality, with hololens, drones and robots. The project continued with a β phase in which the platform with all tools integrated were tested in simulated mass casualty disasters.ResultsThese technologies are tested in different disaster scenarios: A flooded subway stop in Stockholm, an accident in the chemical industry in Marseille, and a man-made explosion in a hospital in Madrid. Through this platform, first responders can immediately initiate operations without exposing personnel to potential harmful risks without specialized equipment, with all important information shared and coordinated, among all responders, whether they are security, firefighters, or emergency health professionals.ConclusionsThe performance pilots and the questionnaire results validated the effectiveness and usability of the final version of the INTREPID platform and tools.

Polypharmacy in Older Patients.

Polypharmacy is common among older people and is associated with multiple adverse outcomes. Assessing whether it is appropriate or inappropriate for an individual is more informative than relying on a simple pill count. Modern medicine is based on single disease guidelines that promote prescribing but tend not to have deprescribing criteria. Barriers to deprescribing promote the accumulation of medicines over time. Clinical trial data have limitations due to the selected populations recruited. Some evidence suggests older people with multi-morbidity may benefit less and people with frailty are at increased risk of harm. Prescribing can be inappropriate if it is not evidence-based, harm is likely to exceed the benefit, includes hazardous medications or combinations of medicines, the patient experiences therapeutic burden, there is reduced adherence or prescribing cascades. Medicines optimisation aims to improve prescribing quality for an individual patient and may include deprescribing. It is a complex process that includes shared decision-making, careful follow-up, and communication of any resulting prescription changes.

Characteristics of attrition within the SuperMIX cohort of people who inject drugs: a multiple event discrete-time survival analysis

BackgroundCompared to the general population, people who inject drugs have poor health and wellbeing. Longitudinal studies can provide insight into factors driving these worse health outcomes but are subject to methodological challenges, such as cohort attrition. The aim of this study was to assess and characterise attrition in a prospective cohort of people who inject drugs in Victoria, Australia.MethodsUsing annually collected self-reported data from The Melbourne Injecting Drug User Cohort Study (SuperMIX) from September 2008 to January 2021, we estimated the incidence of participants being lost-to-follow-up (LTFU), with an episode of being LTFU defined as participants not undertaking a follow-up interview within two years of their last interview. We utilised a multiple event discrete-time survival analysis on participant period-observation data to estimate the associations between key factors and LTFU. Key areas of exposure measurement in analyses were sociodemographic, drug use and mental health.ResultsA total of n = 1328 SuperMIX participants completed a baseline interview, with n = 489 (36.8%) LTFU, i.e. not completing a follow-up interview in the following two years. Increased attrition was observed among SuperMIX participants who were: born outside Australia, younger than 30 years, reporting having completed fewer years of education, not residing in stable accommodation, not in stable employment and not on opioid agonist therapy (OAT).ConclusionsThe attrition rate of the SuperMIX cohort has largely been stable throughout the duration of the study. Higher attrition rates among individuals at greater sociodemographic disadvantage and not on OAT suggest that additional efforts are required to retain these participants. Findings also suggest that SuperMIX might not be capturing data on adverse health and wellbeing outcomes among subpopulations at high risk of harm.

African American Men and Mental Health

African American men face challenges that include internalized negative social identities, marginalization, oppression, systemic racism, invisibility syndrome, targets of violence, murder, and erasure. Social workers may place the population at further risk of harm by using methods influenced solely by Eurocentric values. There is a paucity of peer-reviewed journal articles in the social work literature regarding the mental health of African American men. The literature fails to support social workers in acquiring the clinical skills required to provide services to African American men. This article will provide guidance to improve assessment, diagnosis, and clinician engagement with adult African American male clients. Barriers to the care of this population include the stigma of receiving mental health services, avoidance of vulnerability, medical distrust, clinician bias, no knowledge culturally expressed symptomology of mental illness, and an absence of culturally responsive care. Theories that inform the work with African American men in this article are the social determinants of health theory, intersectional theory, and narrative theory.

Co-use of psychedelics with other substances: Findings from the global psychedelic survey.

While most psychedelic substances are considered to carry a relatively low risk of acute or long-term harm, co-use with other psychoactive substances may increase health and social harm. Using a large international survey of adults who use psychedelics, we sought to comprehensively characterize psychedelic co-use. We used data from the 2023 Global Psychedelic Survey, a web-based survey of adults ⩾21 with lifetime use of psychedelics. We explored patterns of co-use (prevalence, secondary substances used, timing, and motives of co-use) and examined sociodemographic and psychedelic use-related characteristics associated with co-use overall and by specific psychedelics. In total, 5370 respondents were included in this analysis, of whom 3228 (56.3%) reported typically co-using at least one of the 11 psychedelic substances of interest, with co-use lowest for ayahuasca (14.8%) and highest for nitrous oxide (54.5%). Cannabis and alcohol were the most common secondary substances. Depressants were the only secondary substance class that increased in use following psychedelic experiences. Greater experience with psychedelics was significantly associated with co-use, as was using for recreational purposes or to reduce/substitute the use of other substances. Personal exploration and therapeutic purposes for psychedelic use were negatively associated with co-use. In this detailed analysis of psychedelic co-use, we observed high rates of co-use with certain psychedelics, specifically when used recreationally. Our findings highlight psychedelic-specific consumers for whom harm reduction messaging around co-use practices may be best tailored. Further research is justified to assess whether specific patterns of co-use might reduce or increase potential harms.

Alcohol related emergencies among adolescents admitted in a referral acute-care center for adults in Genoa, northwest Italy

Abstract Background As a result of underage drinking, adolescents have an increased risk of physical, mental, emotional, and social harm. Methods In order to assess the emergencies for alcohol use, data of the emergency department (ED) of San Martino Hospital - the referral acute-care center for adults in Genoa, Northwest Italy - was analyzed retrospectively. 330 records of 320 adolescents visiting the ED between 2014 and 2023 were considered. Results The median age of access was 16 (IQR 2), 54.8% were males, 17.4% had foreign nationalities, and the average blood alcohol concentration (BAC) was 1.8 g/L (SD 0.7), with 14.7% testing positive for other substances (6.1% benzodiazepines and 11.2% other drugs). 16.8%, 46.6% and 36.6% were assigned an emergency, urgent, and not-urgent acuity code. 2.8% had a repeated episode, 3.4% had to be removed for inappropriate behavior, 7.8% left spontaneously, 13.1% were hospitalized for additional care (5.5% in the Psychiatry ward). The average length of stay was 1.24 days (SD 5.86). Multivariable logistic regression showed that higher age, an emergency code and the use of other substances were positively associated with hospitalization [ORs 1.74 (95%CI 1.1-2.7), p 0.01; 7.1 (95%CI 2.2-22.4) p < 0.001; and 15.6 (95%CI 6.8-35.6) p < 0.001, respectively]. Admission in Psychiatry, in particular, was strongly associated with the use of other substances [OR 11.8 (95%CI 3.8-36.6), p < 0.001]. Multivariable linear regression showed that, in comparison with other access reasons, accidents and decreased consciousness were associated with higher BAC [beta 0.6 (95%CI 0.1-1.1), p 0.01; beta 0.8 (95%CI 0.3-1.2) p < 0.001]. Length of stay, however, was associated with lower BAC [beta -0.2 (95%CI -0.3 -0.01), p 0.04]. Conclusions In Italy, binge drinking affects 120,000 adolescents aged 11-17. Our findings highlight the harm of this practice and support the need for prompt interventions to reduce the onset and prevalence of adolescent alcohol use.

Advancing urban health in Portugal: exploring liveability and its association with mental morbidity

Abstract Background As cities face challenges posed by urbanisation, it becomes essential to understand how city planning can contribute to protecting public health. In this study, we aimed to assess the liveability of different areas in Lisbon, Portugal, by developing a liveability index at the parish level. Secondly, we aimed to explore its association with hospitalisation due to mental disorders. Methods The liveability index was built based on the World Health Organisation’s Urban Health Index methodology. We obtained data on liveability related to housing, socio-economic conditions and access to services (e.g. healthcare) from the 2011 census and other open data sources for Lisbon’s parishes (n = 22). Data on hospital admissions due to mental disorders was sourced at the parish level from the national database for hospital morbidity for the period 2013-2016 and sex-age-standardised. Binomial negative regression was employed to estimate the association between the liveability index tertiles and observed hospital admissions. We used the expected number of hospitalisations as the offset variable and tested for spatial autocorrelation among the regression residuals. Results Our analysis showed that living in the most liveable parishes is associated with a significant decrease in the standardised admission ratio due to mental disorders, compared to living in the least liveable areas (Incidence Relative Ratio=0.643; 95% CI: 0.427, 0.967). We did not observe any geographical pattern in the regression residuals (Moran’s I= -0.035, p = 0.427). Conclusions Our findings show disparities in liveability among Lisbon’s parishes and identify a protective association between living in higher liveability areas and hospital admissions due to mental disorders. This work should prompt further studies concerning this subject to inform urban planning policies to improve liveability and equally reduce the risk of mental health-related harm within cities. Key messages • A spatial index to assess liveability in urban areas was developed. The association between the liveability of Lisbon’s parishes and hospital admissions due to mental disorders was explored. • We found a significant protective association between higher liveability and hospital admissions due to mental disorders. This work is relevant to inform the implementation of urban planning policies.

Assessments, assumptions and ableism: examining court-ordered parenting capacity assessments of parents with intellectual disability and cognitive difficulties

ABSTRACT Background Parental intellectual disability is considered a risk factor for child removal internationally. In New South Wales, Australia, authorised clinicians are court appointed experts who assess parenting and cognitive capacity in child protection matters. Method This study examined a sample of 20 assessment orders requesting parenting capacity and cognitive capacity assessments and corresponding authorised clinician reports. Results Authorised clinicians were requested to assess whether parental intellectual disability and cognitive impairment posed the risk of harm to children. Clinicians assessed parents as either “able with support” or “unable” to provide adequate care to their child. Conclusion Our findings highlight the law’s conceptualisation of risk, parenting capacity, and cognitive impairment in binary terms (i.e., risk or no risk, able or unable), which in turn limits casework planning and clinicians’ framing of parents’ abilities. We provide recommendations to improve fair and equitable assessment processes for parents with cognitive difficulties, as well as access to timely and appropriate services.

When is ‘the end of the road’ reached? Observing the presumption of parental involvement through systems theory

ABSTRACT In 2014 the Children Act 1989 was amended to include a presuption that involvement of a parent in a child’s life will further the child’s welfare unless there is evidence of the risk of harm. Kaganas published two seminal articles which concluded that the government’s ideological rationale for introducting the presumption of parental involvement not only failed to materialise but had some unintended, possibly detrimental, consequences for mothers. This article examines the operation and effects of the presumption of parental involvement in recent years based on an analysis of private law family court judgments between July 2020 and December 2023. Drawing on Luhmann’s theory of autopoietic social systems, it examines the possibilities for and limitations on using law to drive social change beyond the operations of the legal system itself. It concludes that the statutory presumption has failed to serve its stated purpose and has even had the unintended consequence of generating legal communications about the risks of parental involvement. From a feminist perspective, it concludes that positive changes observed in the family court response to domestic and child abuse are an achievement, in light of the limits on steering society, at least until something changes in the unknowable future.

Children’s Rights and Online Age Assurance Systems

Abstract Age assurance is a way to prevent children accessing content, products or services that are potentially harmful to them, ranging from gambling services or alcohol or tobacco or, increasingly, certain products and services online. Now that children’s lives are mediated by digital technologies, policymakers are deliberating over the legal, technical and practical challenges. These have been little examined from the perspective of children’s rights. By combining legal and social research methods, this article examines the legal requirements for age assurance in Europe, assesses compliance by companies and reveals the consequences for family life. In law and practice, we show that age assurance is often ineffective in protecting children from online risk of harm. Further, as currently implemented it risks children’s other rights – to non-discrimination, privacy, to be heard, and their civil rights and freedoms, and remedy. We identify promising directions for the use of age assurance in child online protection, focusing on European policy, regulators and civil society actors.

Congenital Cytomegalovirus Infection: Update on Screening, Diagnosis and Treatment: Scientific Impact Paper No. 56.

Cytomegalovirus (CMV) is the most common cause of viral infection in newborn babies, and affects 1 in 200 of all live born infants in high-income countries; and 1 in 71 in low- and middle-income countries. It is a major cause of hearing loss and brain damage. Women may get CMV infection for the first time during pregnancy (primary infection) or may experience 'non-primary' infection, either by reactivation of previous CMV infection or by a new infection with a different strain of the virus. The most common source of infection to pregnant women is the saliva and urine of young children. Therefore, all pregnant women, especially those in regular contact with young children, should be informed about hygiene-based measures to reduce the risks, e.g. handwashing. The UK National Screening Committee recommends against universal antenatal or newborn screening for CMV. Testing for CMV is usually offered only to women who develop symptoms of influenza, glandular fever or hepatitis (liver inflammation) during pregnancy, or for those whom a routine ultrasound scan detects fetal anomalies that suggests possible CMV infection. The risk of harm to the fetus is greatest following primary CMV infection of the woman in early pregnancy, and appears to be very low following infection after 12 weeks of pregnancy. Babies with CMV infection at birth may have jaundice, a rash, enlarged liver or spleen, a small brain, or be small for their gestational age. Around 1 in 8 babies born with CMV infection will have clinically detectable signs at birth. The rest will not have any features detectable by clinical examination alone. Therefore, all infants with CMV infection at birth should be followed up at a minimum of up to 2 years of age or later, depending upon the disease status, to check hearing and brain development. Following primary CMV infection in the first 12 weeks of pregnancy, if the woman starts taking the antiviral medicine valaciclovir (valacyclovir) it reduces the risk of the baby becoming infected. Where CMV infection of the fetus in the womb has been confirmed (by amniocentesis, for example), regular ultrasound scans should be offered every 2-3 weeks until birth. Detailed assessment of the fetal brain is an essential part of these scans. Where maternal CMV infection occurs, but fetal infection is not confirmed, repeated ultrasound scans of the fetus should be offered every 2-3 weeks until birth. In infected fetuses, as well as ultrasound scans, an MRI scan of the brain should be offered at 28-32 weeks of gestation (and sometimes repeated 3-4 weeks later) to assess for any signs of harm to the fetal brain. All babies born to women with confirmed or suspected CMV infection should be tested for CMV with a urine or saliva sample within the first 21 days of life. In newborns with symptomatic CMV infection at birth, treatment with antiviral medicine (valganciclovir or ganciclovir) can reduce hearing loss in 5 out of 6 babies, and improve long-term brain development outcomes in some. There is no licensed vaccine for CMV.

Felicity Kaganas: asking the woman question in family law

ABSTRACT This contribution to the special issue considers Felicity Kaganas as a feminist socio-legal scholar who persistently ‘asked the woman question’ in family law. It focuses on one of her important articles, ‘When it comes to contact disputes, what are family courts for?’ . After summarising her argument concerning the evolution of the family courts’ approach to contact disputes, it examines her critique of a problem-solving approach, in light of the recent introduction of the Pathfinder pilot courts, following the recommendations of the Ministry ofJustice report, Assessing risk of harm to children and parents inprivate law children cases (2020).