Despite laws to protect NHS workers who wish to raise concerns about patient care, a BMJ investigation reveals that some NHS trusts still make it hard for staff to speak out.

The BMJ obtained whistleblowing policy documents valid up to November 2009 from 118 of the 122 NHS foundation trusts. The documents were then compared against six standards set out in guidance produced by Public Concern at Work, an independent authority on public interest whistleblowing that also runs a helpline for NHS staff. These include taking malpractice seriously, giving staff the option to raise concerns outside of the trust, and respecting the confidentiality of staff raising concerns.

The results, published on bmj.com today, show that some trusts do not have measures in place to protect whistleblowers.

Twenty two of the 118 trust policies do not give examples of types of concerns to be raised, while four do not mention the option for a person to raise concerns outside of the trust.

More than a third of trust policies say staff can go outside the trust with a concern, but insist that a person goes through management first. Some mention that staff must go to an outside organisation “in good faith” but warn that there may be disciplinary action if they go to them unjustifiably.

A fifth of trust policies do not specifically say they will respect the confidentiality of the whistleblower, or it is not clear that they will do, and 106 trusts mention sanctions against any malicious or false claims made.

Twenty two trusts mention “disciplinary” in their policies, a term unlikely to make potential whistleblowers comfortable in coming forward with a concern, while 30 trusts mention staff have a duty, implied duty, or loyalty to the trust as well as to patient confidentiality.

Commenting on the results, Peter Gooderham, a law lecturer at the University of Manchester, says trusts should give assurances of protecting the whistleblower’s confidentiality. “It should be made clear that the finger won’t be pointed at them if they take steps to raise a genuine concern,” he says.

He argues that policies need to be user friendly and encourage people to raise concerns. “We need some positive recognition for people who have raised concerns … they shouldn’t be treated as troublemakers, ostracising them, suspending them from work, and so on,” he writes.

To address these issues, Public Concern at Work will launch a policy pack, developed in conjunction with a Social Partnership Forum working group, on whistleblowing for distribution throughout the NHS in June. It also recommends that trusts audit, review, and check how their whistleblowing policies are performing in practice and promote their use to staff regularly.

The BMA is also aware of the problems that some whistleblowers can face. Dr Mark Porter, Chairman of the BMA Consultants’ Committee, says: “We get very concerned about doctors who fall foul of these whistleblowing policies while following their professional duty. Members continue to raise examples with us, and there are high profile cases, some of which take place in organisations that have good policies. The BMA will support members before, during and after they raise concerns.”

According to a BMA survey, around 1 in 7 hospital doctors in England and Wales who reported concerns said that their trusts had indicated that by speaking up, their employment could be negatively affected.

A new study has found that fathers give toddlers more leeway and that allows them to actively explore their environments, according to a new study on parent-child attachment published in Early Child Development and Care.

Daniel Paquette, a professor at the Université de Montréal School of Psychoeducation, says the ‘activation theory’ is just as important as the ‘attachment theory.’ The latter was the prevailing 20th-Century notion that children usually connect with their primary caregiver since they fulfill their emotional needs and guarantee their survival.

“In attachment theory, a child seeks comfort from a parent when he or she is insecure. This theory underestimates the importance of exploratory behavior in children,” says Dr. Paquette, who completed his study with Marc Bigras of the Université du Québec à Montréal.

As part of the investigations, kids aged 12 to 18 months (accompanied by a parent) were placed in three different risky situations: social risk (a strange adult entered his or her environment), physical risk (toys were placed at the top of a stairway), and a forbidden activity (parents were forbidden to climb the stairs after the child succeeded the first time).

“We found fathers are more inclined than mothers to activate exploratory behavior by being less protective,” says Paquette. “The less the parent is protective, the more activated is the exploratory behavior in the child. Children who were optimally stimulated, meaning they were exploratory yet respective of the rules, were 71 percent boys. Meanwhile, 70 percent of children who were risk averse were girls.”

The parent’s behavior was measured by the distance they kept from their child as he or she climbed the stairs. “For a child to become self-confident, the parent mustn’t be too far or too close,” says Paquette. “The ideal distance seems to be an arm’s length. This distance was statistically significant with fathers yet not with mothers.”

According to Paquette, classical attachment theory doesn’t highlight these differences between boys and girls. This is why he feels his theory is better adapted to evaluate the role of the father while factoring in the temperament of the child and the level of protective parenting, both of which trigger the activation relationship.

Paquette is convinced that mothers and fathers intervene differently in the education of a child and these complementarities benefit a child. “Even if both parents change diapers and give the bottle, they don’t do it the same way,” says Paquette. “By stimulating exploration, controlled risk-taking and competition, fathers provide something different to the child who will benefit greatly from this singular contribution.”

Tribute has been paid to former BBC boxing commentator Harry Carpenter who has died at the age of 84.

Barbara Slater, Director BBC Sport, said: “Harry Carpenter was for decades one of the standout voices of sports broadcasting. While many will no doubt best remember him for his boxing commentaries on the BBC, he should also be hailed for his work on a number of other flagship BBC programmes such as Sportsnight, Grandstand, Wimbledon, the BBC’s golf coverage, the Boat Race and of course the Olympics.

“Harry’s passing is a huge loss to the world of sports broadcasting. His journalistic credentials, professionalism and presence marked him out as an inspirational figure for a generation of aspiring presenters, commentators and producers.

“He will be sorely missed by all those who had the good fortune to work with and learn from a master. We send our deepest sympathies to his family.”

Patients seen at private facilities reimbursed by Medicare were more than 550 percent more likely to have routine cataract surgery than those who received their care from the Department of Veterans Affairs, a strong indication that the frequency of cataract surgery may be responsive to financial incentives to either or both the medical facility and the physicians who perform the procedure.

These findings from a large eight-year study are reported in the March 2010 issue of the American Journal of Medical Quality.

The authors are uncertain of the cause of the disparity in cataract surgery given that the vast majority of older veterans are enrolled in both Medicare and the VA health system, both government-funded systems.

“We don’t know yet what exactly accounts for the five and a half fold difference in surgery rates between the two systems. It may be related to how the two systems are funded by the government, it could be a difference between physician-driven decisions or it may be related to a lack of ophthalmologists within the VA system or it could be more than one of these factors,’ said first author Dustin French, Ph.D., Regenstrief Institute investigator and assistant professor of medicine at the Indiana University School of Medicine. Dr. French is a health economist who studies health outcomes.

VA physicians and hospitals do not have the same financial incentives to perform cataract surgery as physicians and medical facilities outside the VA system.

“The results of our study raise important questions about the possible existence of a two-tier, federally funded health-care system that may not be equivalent in terms of quality of care,” said Dr. French, who is also a research scientist with the Center of Excellence on Implementing Evidence Based Practice at the Richard A. Roudebush VA Medical Center.

The authors note that their findings provide ample reason to further investigate the determinants of cataract surgery rates. Nationwide, cataract surgery is the most common surgical procedure performed by ophthalmologists.

More than 10 percent of newborns who receive oxygenation and ventilation using nasal continuous airway pressure in the neonatal intensive care unit (NICU) may experience complications inside or outside the nose, according to a report in the March issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

Nearly all patients in the NICU require some method of oxygen supplementation, according to background information in the article. Oxygen is most often delivered to infants through an endotracheal tube, nasal cannula (slender tubes inserted into the nose) or nasal continuous positive airway pressure (CPAP, which delivers pressurized air through the nose to help keep breathing passages open). Nasal CPAP is a good alternative for many newborns because it avoids complications associated with long-term use of tracheal tubes, including narrowing of the airways under the vocal cords (subglottic stenosis).

However, some reports have linked CPAP devices to nasal complications. To investigate the potential effects, Kris R. Jatana, M.D., of The Ohio State University Medical Center and Nationwide Children’s Hospital, Columbus, and colleagues studied 100 patients younger than one year who received at least seven days of nasal CPAP or oxygen supplementation with cannula in the NICU in 2007 or 2008. All patients underwent an external examination of the nose and then nasal endoscopy to identify any internal complications.

Nasal complications were observed in 12 of the 91 patients (13.2 percent) with at least seven days of nasal CPAP use, whereas no complications were seen in the nine patients with only nasal cannula use. Complications inside the nose included ulceration in six of 182 nasal cavities (3.3 percent), granulation or the formation of healing tissue in three nasal cavities (1.6 percent) and vestibular stenosis (narrowing of the front portion of the nasal passage) in four nasal cavities (2.2 percent).

The primary external complication was columellar necrosis, or tissue death at the end of the nasal septum, which was observed in five of 91 patients (5.5 percent). “Once this occurs, it is difficult to repair surgically, and adverse cosmetic results may ensue,” the authors write. “In our series, columellar necrosis was found as early as 10 days after placement of nasal CPAP, but columellar necrosis has been reported as early as after only three days of nasal CPAP use in very-low-birthweight infants.”

All nasal complications from CPAP were associated with lower Apgar scores—an overall measure of newborn health—at one and five minutes after birth.

“Nasal CPAP is gaining popularity as a preferred means of ventilatory support in the NICU, and its potential complications will be encountered more frequently,” the authors write. “Close surveillance for potential complications should be considered during nasal CPAP use.”

Sport Relief is nearly here and celebrities and sports stars are coming to Manchester to take on various challenges to get active, raise cash and help change lives for the better.

On Thursday 18 March, comedians Nick Hancock and Justin Moorhouse, along with ex-Hollyoaks and Holby City actor Jeremy Edwards, are teaming up in a Dragon Boat race through Salford Quays with a bunch of other celebs ready to risk a splashing for Sport Relief.

Stars from the world of sport – England rugby player Austin Healey, England cricketer James Anderson, England footballer Rachel Brown, Olympic swimmer Steve Parry and former Great Britain Rugby League captain Paul Sculthorpe – will add some serious sporting muscle to the teams as they go head to head.

Battling with them on the one-mile course will be BBC North West Tonight presenters Tony Livesey, Annabel Tiffin and Dianne Oxberry, along with BBC Radio Lancashire‘s Graham Liver.

Experienced oarsmen from the Pool of Life Dragon Boat club in Liverpool make up the numbers in each boat – and keep the stars heading in a straight line over the mile course in Salford Quays.

The Dragon Boat Challenge takes place at 1.30pm on Thursday 18 March in the Huron Basin, outside the future home of BBC Sport in Salford Quays.

Follow the build up to the race on North West Tonight, on Tony Livesey’s show on BBC Radio 5 Live and in Graham Liver’s Breakfast Show on BBC Radio Lancashire.

You can sponsor the team by going to www.mysportrelief.com/dragonboatteam.

And the challenges, bravely taken on by local personalities, do not stop there.

BBC Radio Manchester‘s sports reporter Ian Cheeseman will be teaming up with World Champion tandem cyclist Barney Storey in a tour of all nine Premier League and Football League grounds covered by the station.

On Friday 19 March, Cheeseman’s Challenge will see Ian and Barney ride nearly 100 miles in tandem, pushing off from Macclesfield Town and finishing at Manchester City.

Come down to your club to cheer on the plucky pair as they stop off for a welcome rest along the way at Stockport County, Oldham Athletic, Rochdale FC, Bury FC, Bolton Wanderers, Wigan Athletic and Manchester United.

Support Cheeseman’s Challenge at www.mysportrelief.com/iancheeseman.

And you can join in the fun on Sunday 21 March, when thousands of people will take to the streets across the UK to run The Sainsbury’s Sport Relief Mile in Manchester. Full details of all the challenges and events taking place near you can be found at www.sportrelief.com

All the money you raise will be spent by Sport Relief to help disadvantaged people, both at home in the UK and across the world’s poorest countries, to turn their lives around.

Iowa State University Distinguished Professor of Psychology Craig Anderson has made much of his life’s work studying how violent video game play affects youth behavior. And he says a new study he led, analyzing 130 research reports on more than 130,000 subjects worldwide, proves conclusively that exposure to violent video games makes more aggressive, less caring kids — regardless of their age, sex or culture.

The study was published today in the March 2010 issue of the

Craig Anderson , an Iowa State Distinguished Professor of psychology who co-authored a previous book on violent video games' effects with ISU researchers, is now lead author on a study that provides comprehensive analysis of previous literature about the effects of playing violent video games. Photo by Bob Elbert, News Service

Psychological Bulletin, an American Psychological Association journal. It reports that exposure to violent video games is a causal risk factor for increased aggressive thoughts and behavior, and decreased empathy and prosocial behavior in youths.

“We can now say with utmost confidence that regardless of research method — that is experimental, correlational, or longitudinal — and regardless of the cultures tested in this study [East and West], you get the same effects,” said Anderson, who is also director of Iowa State’s Center for the Study of Violence. “And the effects are that exposure to violent video games increases the likelihood of aggressive behavior in both short-term and long-term contexts. Such exposure also increases aggressive thinking and aggressive affect, and decreases prosocial behavior.”

The study was conducted by a team of eight researchers, including ISU psychology graduate students Edward Swing and Muniba Saleem; and Brad Bushman, a former Iowa State psychology professor who now is on the faculty at the University of Michigan. Also on the team were the top video game researchers from Japan – Akiko Shibuya from Keio University and Nobuko Ihori from Ochanomizu University – and Hannah Rothstein, a noted scholar on meta-analytic review from the City University of New York.

Meta-analytic procedure used in research

The team used meta-analytic procedures — the statistical methods used to analyze and combine results from previous, related literature — to test the effects of violent video game play on the behaviors, thoughts and feelings of the individuals, ranging from elementary school-aged children to college undergraduates.

The research also included new longitudinal data which provided further confirmation that playing violent video games is a causal risk factor for long-term harmful outcomes.

“These are not huge effects — not on the order of joining a gang vs. not joining a gang,” said Anderson. “But these effects are also not trivial in size. It is one risk factor for future aggression and other sort of negative outcomes. And it’s a risk factor that’s easy for an individual parent to deal with — at least, easier than changing most other known risk factors for aggression and violence, such as poverty or one’s genetic structure.”

The analysis found that violent video game effects are significant in both Eastern and Western cultures, in males and females, and in all age groups. Although there are good theoretical reasons to expect the long-term harmful effects to be higher in younger, pre-teen youths, there was only weak evidence of such age effects.

Time to refocus the public policy debate

The researchers conclude that the study has important implications for public policy debates, including development and testing of potential intervention strategies designed to reduce the harmful effects of playing violent video games.

“From a public policy standpoint, it’s time to get off the question of, ‘Are there real and serious effects?’ That’s been answered and answered repeatedly,” Anderson said. “It’s now time to move on to a more constructive question like, ‘How do we make it easier for parents — within the limits of culture, society and law — to provide a healthier childhood for their kids?’”

But Anderson knows it will take time for the creation and implementation of effective new policies. And until then, there is plenty parents can do to protect their kids at home.

“Just like your child’s diet and the foods you have available for them to eat in the house, you should be able to control the content of the video games they have available to play in your home,” he said. “And you should be able to explain to them why certain kinds of games are not allowed in the house — conveying your own values. You should convey the message that one should always be looking for more constructive solutions to disagreements and conflict.”

Anderson says the new study may be his last meta-analysis on violent video games because of its definitive findings. Largely because of his extensive work on violent video game effects, Anderson was chosen as one of the three 2010 American Psychological Association Distinguished Scientist Lecturers. He will give a lecture at October’s New England Psychological Association (NEPA) meeting in Colchester, Vt.

Progress towards the creation of 10,000 new jobs for young people in the cultural and sports sectors is now well past the half way mark, Secretary of State for Culture, Media and Sport Ben Bradshaw announced today.

Nine months after the Government first announced plans to fund employment opportunities for young people who might otherwise be struggling to find work, DCMS has secured funding for more than 6,500 posts in the sports and cultural sectors.

A diverse range of projects have received funding in recent months, including:  sports coaches and leisure centre workers; apprentices in theatres; internships with arts organisations; and support roles in museums and galleries.

Visiting Future Jobs Fund recruits in Leicester today, Ben Bradshaw said:

“Jobs in the cultural and sports sectors can be hard to come by.  It’s often the case that the supply of potential employees outstrips demand, so it can be particularly hard for young people with little experience who are keen to take their first steps into the world of work.

“Today I have met some young people who are very excited about their new jobs, but these unique opportunities would not have been possible without the Future Jobs Fund.

“We started with a target of between five and ten thousand new jobs in our sectors, and I am confident we will end up with a figure far higher than that.”

Examples of successful bids include:

• Thirty new staff starting at Southbank Centre in March, involved in a wide range of activities from welcoming visitors to behind the scenes support.  Southbank Centre was one of the first organisations to bid for jobs through the Future Jobs Fund, in collaboration with youth organisation SE1 United and New Deal of the Mind, a coalition that aims to help boost the UK economy by developing jobs in the creative industries.
• Fifty six jobs working for a disability-led theatre group in Essex.  Theatre Resource, based in Ongar, is an arts organisation specialising in disability arts and social inclusion.  Also co-ordinated by New Deal of the Mind, jobs include community craft workers, marketing assistants and arts programme workers.
• Two hundred jobs across the West Midlands, co-ordinated by the Skills Partnership and making a major contribution towards the region’s Olympics legacy.  Working as School Physical Activity Co-ordinators in Birmingham, Walsall, Sandwell, Solihull and Dudley, these jobs involve working alongside teaching staff engaging young people in physical activities in breakfast, lunch and after school clubs.

The Future Jobs Fund (FJF) is a Department for Work and Pensions (DWP) initiative that aims to create 170,000 new jobs for young people, 10,000 of which will be from DCMS sectors. Five thousand of these will be in the cultural sector and 5,000 in the sports sector.

As the world watches the Vancouver Olympics, researchers at St. Michael’s Hospital in Toronto and Children’s Hospital Boston have teamed up to monitor and assess potential infectious disease threats to Vancouver during the Winter Games by integrating two independently developed intelligence systems that focus on global infectious diseases; bio.DIASPORA and HealthMap.

The communicating systems, developed by two Canadians – Dr. Kamran Khan at St. Michael’s and Dr. John Brownstein of the Informatics Program at Children’s Hospital Boston – are now producing the first, real-time analyses on potential threats to mass gatherings. The collaboration, and corresponding analysis of threats to the Olympic Games, is described in an article published online by the Canadian Medical Association Journal today.

“Mass gatherings can potentially amplify and disperse infectious disease threats globally because they can draw millions of people from around the world into a single space,” says Dr. Kamran Khan, an infectious disease physician and scientist at St. Michael’s Hospital. “By enabling our two systems to communicate in real-time, we are exploring new ways to generate actionable intelligence to organizers of mass gatherings.”

Dr. Khan is the developer of bio.DIASPORA, which enables the study of global air traffic patterns and applies this knowledge to help the world’s cities and countries better prepare for and respond to emerging infectious diseases threats. Dr. Brownstein is a co-founder of HealthMap, an online global disease-tracking and mapping tool which leverages information sources on the Internet to detect infectious disease outbreaks around the world.

For the 2010 Winter Olympic Games, Dr. Khan analyzed recent worldwide air traffic patterns during the month of February, to predict where passengers travelling into Vancouver would be originating from. His team found that nearly two-thirds of all international passengers traveling to Vancouver came from just 25 cities. Dr. Brownstein’s team then concentrated its infectious disease surveillance efforts on those cities, which it continues to do on an hourly basis during the course of the Winter Games (a real-time view of this analysis is available online at http://www.healthmap.org/olympics).

“Internet-based, geographically-directed infectious disease surveillance may greatly compliment traditional preparations for infectious disease threats at mass gatherings by identifying infectious disease at their source and potentially preventing importation/exportation of infection among attendees,” explains Dr. Brownstein at Children’s Hospital. “We look forward to continued research and dialogue in this area and seeing how the information we glean from monitoring these Games may be useful in terms of preparing for future mass gatherings like the upcoming G20 Summit in Ontario, Canada and this year’s FIFA World Cup in South Africa.”

Ancient human teeth are telling secrets that may relate to modern-day health: Some stressful events that occurred early in development are linked to shorter life spans.

“Prehistoric remains are providing strong, physical evidence that people who acquired tooth enamel defects while in the womb or early childhood tended to die earlier, even if they survived to adulthood,” says Emory University anthropologist George Armelagos.

Armelagos led a systematic review of defects in teeth enamel and early mortality recently published in Evolutionary Anthropology. The paper is the first summary of prehistoric evidence for the Barker hypothesis – the idea that many adult diseases originate during fetal development and early childhood.

“Teeth are like a snapshot into the past,” Armelagos says. “Since the chronology of enamel development is well known, it’s possible to determine the age at which a physiological disruption occurred. The evidence is there, and it’s indisputable.”

The Barker hypothesis is named after epidemiologist David Barker, who during the 1980s began studying links between early infant health and later adult health. The theory, also known as the Developmental Origins of Health and Disease Hypothesis (DOHaD), has expanded into wide acceptance.

As one of the founders of the field of bioarcheology, Armelagos studies skeletal remains to understand how diet and disease affected populations. Tooth enamel can give a particularly telling portrait of physiological events, since the enamel is secreted in a regular, ring-like fashion, starting from the second trimester of fetal development. Disruptions in the formation of the enamel, which can be caused by disease, poor diet or psychological stress, show up as grooves on the tooth surface.

Armelagos and other bioarcheologists have noted the connection between dental enamel and early mortality for years. For the Evolutionary Biology paper, Armelagos led a review of the evidence from eight published studies, applying the lens of the Barker hypothesis to remains dating back as far as 1 million years.

One study of a group of Australopithecines from the South African Pleistocence showed a nearly 12-year decrease in mean life expectancy associated with early enamel defects. In another striking example, remains from Dickson Mounds, Illinois, showed that individuals with teeth marked by early life stress lived 15.4 years less than those without the defects.

“During prehistory, the stresses of infectious disease, poor nutrition and psychological trauma were likely extreme. The teeth show the impact,” Armelagos says.

Until now, teeth have not been analyzed using the Barker hypothesis, which has mainly been supported by a correlation between birth weight in modern-day, high-income populations and ailments like diabetes and heart disease.

“The prehistoric data suggests that this type of dental evidence could be applied in modern populations, to give new insights into the scope of the Barker hypothesis,” Armelagos says. “Bioarcheology is yielding lessons that are still relevant today in the many parts of the world in which infectious diseases and under-nutrition are major killers.”