Category Archives: bbc-post

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Mental Health: Tougher checks before Superdrug Botox

The NHS has told Superdrug it could do more to protect the mental health of customers who want injections to smooth skin or plump lips.

The High Street chain started offering Botox and dermal fillers last year.

But the NHS said the injections risked fuelling mental health disorders about appearance – and it was being left to pick up the pieces.

Superdrug said it was “fully committed” to the issue and was now enhancing mental health checks for customers.

  • Botox is an injection of Botulinum toxin that relaxes muscles to temporarily hide lines and wrinkles.
  • Dermal fillers are injections under the skin that can fill skin creases or lead to bigger lips.

NHS Choices: Botox and Dermal fillers

Superdrug’s Skin Renew Service offers the cosmetic procedures to people over the age of 25.

But surgeons have criticised the company for treating Botox and fillers as “casual beauty treatments” on a par with having a wax.

The NHS is concerned about the impact on people who are mentally ill, including with Body Dysmorphic Disorder (BDD), in which people are fixated on what they think are flaws in their appearance.

The BDD Foundation says it can be a crippling illness and severely impair someone’s life.

Prof Stephen Powis, the medical director of NHS England, wrote to Superdrug’s chief executive, saying the company could do more to protect people who were seeking treatment because they were mentally unwell, or might have a mental health disorder triggered by treatment.

Prof Powis said: “Pressures on young people’s mental health are greater than they ever have been, with families and the health service too often left to pick up the pieces.

“The lack of tough checks on cosmetic surgery means that the public is dependent on businesses taking voluntary steps to get their house in order, leaving people avoidably exposed to dangerous practices.”

Superdrug said it already performs an hour-long consultation before cosmetic procedures take place and these include a mental health assessment.

The company said it would now ask specific questions about Body Dysmorphic Disorder: “We remain fully committed to including recommended protections for mental health. We met with the NHS to ensure we have the highest safety standards and quality of patient care.”

The do I have Body Dysmorphic Disorder questionnaire, made by the BDD Foundation, asks questions about how much people fixate about their appearance and how much it affects their day-to-day life.

Kitty Wallace, a trustee with the Foundation, said more than nine-in-ten people with BDD were satisfied with the results of their cosmetic procedures.

She said: “It is important that these measures are in place to protect such individuals from potentially damaging and unnecessary procedures.

“Although their anxiety might reduce temporarily, they will often find themselves fixating on another part of their body that they want to change.

“We commend that Superdrug will be screening for the disorder, and referring people who are positive to their GP and Mind.”

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IVF dad 'floored' over baby he did not consent to

A father, whose ex-partner forged his signature to conceive a child via an IVF clinic, said he was “absolutely floored” when he found out.

The man, who can only be identified as ARB, sued IVF Hammersmith for damages for the cost of bringing up the girl.

Although judges found the clinic was in breach of contract, they rejected his claim for damages.

The clinic said it had “reinforced” its procedures since then “to ensure such a situation could not occur again”.

The couple had a son together through IVF at the clinic in 2008, because, he said they had “this romanticised idea” that a child would improve their the relationship which “wasn’t strong”, ARB said.

Following the procedure, a number of embryos were frozen and the couple signed agreements annually for these to remain in storage.

In 2010, the couple broke up.

After the split, the woman, known as R, provided the clinic with a “consent to thaw” form, forged with ARB’s signature, resulting in successful conception, and the birth of a daughter.

“Out of the blue, she sent me a text message saying she was pregnant. I was absolutely floored,” said ARB, who has since married his new partner.

The High Court in 2017 ruled against ARB’s claim for damages because of a legal precedent in which the The House of Lords – now the Supreme Court – said that healthy children are always “a blessing”.

Court of Appeal judge Lady Justice Nicola Davies DBE backed this view in December 2018, writing in her judgment that it was “morally unacceptable to regard a child as a financial liability”.

However, Lady Justice also agreed with the High Court that the clinic had failed in its oblication to obtain ARB’s “informed consent to the procedure”.

Deception ‘very unusual’

IVF Hammersmith said: “This has been a distressing case and we are deeply saddened by the effect it has had on all concerned.

“In this case as in all others, we adhered to the highest industry standards and we met all obligations as set out by the governing body at the time.

“Since then, we have reinforced our procedures to go above and beyond the industry standard to ensure such a situation could not occur again.”

Industry regulator the Human Fertilisation and Embryology Authority (HFEA) said: “The deception in this case is very unusual.”

It added that it “strengthened” its guidance in 2016 to “make it clear to clinics the steps they should take to ensure they do not fall victim to individuals who are determined to mislead them”.

ARB said: “A great injustice has been inflicted upon us, for myself and my family and the wellbeing of my family.

“We needed to have that event exposed and a light shone upon it in order to find some measure of emotional closure around these tumultuous events.”

He added he was in discussion with his legal team “about the next move”.

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IVF couple have triplets after sex mistake

A mother who turned to IVF after years of trying in vain for a baby said she was shocked to find out she was expecting triplets – two of whom had been conceived naturally.

Betty Bienias and her husband Pawel, from Corsham, had been trying to have children for seven years.

When the couple eventually turned to IVF, they ended up conceiving one child through the NHS treatment – and two more naturally as part of the same pregnancy.

Mrs Bienias, admitted that she and her husband “didn’t listen” to advice to remain celibate during the egg collection.

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Pharmacists warn of a 'surge' in shortage of common medicines

Pharmacists say they are struggling to obtain many common medicines and paying “vastly increased” prices for them.

This is leaving patients complaining of delays in getting hold of drugs such as painkillers, anti-depressants and blood pressure medication.

The BBC has found there has been a big rise in the number of drugs on the “shortage of supply” list for England.

There are 80 medicines in such short supply, that the Department of Health has agreed to pay a premium for them.

This is up from 45 in October.

There are a number of reasons why this has happened, but there are now concerns that uncertainty over Brexit will only make the situation worse.

The Royal Pharmaceutical Society said there was “a massive shortage and price spikes”.

What does this mean for patients?

Most people should be able to get their prescriptions filled as normal.

But if they need one of the drugs that is running short, they might not be so lucky.

Some pharmacists are sending patients back to their GPs to ask for a different medicine or dosage.

Others are giving as much of a drug as they can spare and sending people away with IOU notes for the remainder.

The best advice is to make sure you get prescriptions to your pharmacist in good time.

It is almost always possible to come up with an alternative.

However, that can be more difficult with conditions like epilepsy, where patients need to be on specific drugs.

What is the scale of the problem?

It is hard to obtain a definitive tally of which medicines are running short.

But the industry in England uses a list from the Pharmaceutical Services Negotiating Committee (PSNC).

It shows which drugs are in such short supply and for which ones the NHS has agreed to temporarily pay a higher price.

The PSNC publishes monthly lists of these so-called concession prices.

The BBC has analysed this data and found that the number of medications on the list has grown six-fold in three years.

During this time period the peak was in November 2017, but there has been a recent surge and figures for December show it is approaching that level again.

What drugs are affected?

This is about prescriptions for generic medicines, rather than specific brand names.

For example, Nurofen is a common painkiller, but you can buy the same generic drug, ibuprofen.

Ash Soni, president of the Royal Pharmaceutical Society, says he has never seen so many common drugs affected by shortages.

He explains: “The items are out of stock and unavailable. Patients are having to wait.

“We’re having to send some patients back to the GP to get a different prescription, because we just can’t fill them.”

On December 2018’s concession list, 28 drugs, or about a third, were among the 500 most commonly prescribed.

For example, furosemide is used to treat high blood pressure and other cardiovascular problems.

It comes in various dosages, but one type, 40mg tablets, is the 23rd most commonly prescribed drug in England.

Other drugs on the list include fluoxetine, which treats depression, and naproxen, which is an anti-inflammatory.

Mr Soni says naproxen went “completely out of stock” recently.

“I didn’t have any on my shelf last week. I’ve got patients who are waiting for it.”

He did manage to track some down eventually, but it cost £6.49 a box. That is £2 more than the NHS last agreed to pay for it.

He says: “I’ve ordered 20 boxes today and that will last me about two or three days.

“We’re dispensing at a loss. We’re paying for patients to get their meds on the behalf of the NHS.”

What do drug companies say?

Warwick Smith, director general of the British Generic Manufacturers Association, says stock levels can fluctuate.

He prefers to call it a “tightening of supply” rather than a shortage.

“It’s normal for levels of availability to increase and decrease, which impacts prices,” he adds.

The government stresses that two million prescription items are dispensed in England every day, and the vast majority of medicines are not in short supply.

A Department of Health and Social Care spokesperson said: “We continue to work closely with industry and partners to ensure patients receive the medicines they need and pharmacies are reimbursed fairly.”

Why is this happening?

Industry figures all stress that there is no single, neat answer to explain such a complicated situation.

Suggestions for reasons behind the shortage include:

  • increased global demand
  • cost of raw materials
  • new regulatory requirements driving up costs
  • fluctuations in exchange rates
  • generic companies being unwilling to carry on selling unprofitable products.

Another possible explanation is that the NHS has done too good a job of driving down the prices it will pay for drugs.

The PSNC says this makes the UK a less attractive market for manufacturers.

Has Brexit had an impact?

The government has told manufacturers of both branded and generic drugs to stockpile six weeks’ worth of supplies, so that people would still get their medications if we have a no-deal Brexit.

Hospitals, distributors and patients have been told not to stockpile their own supplies.

Generic shortages started peaking in 2017, so it is not possible to say that this issue has arisen because we are so close to Brexit.

But Gareth Jones, from the National Pharmacy Association, says: “Uncertainty over Brexit appears to be a significant factor.”

He says patients do not seem to be panicking about getting their medicines after a possible no-deal Brexit, but thinks there could be an element of “unconscious stockpiling”.

In other words, if people at every step of the supply chain hold on to extra medicines, it could have a significant impact on supplies.

Martin Sawer is executive director of the Healthcare Distribution Association, which circulates 92% of the medicines in the UK.

He says: “You can bet your bottom dollar people might be stockpiling.

“Some businesses could be speculating on Brexit. That’s the nature of the market.”

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Haemochromatosis 'bigger threat than we thought'

A “stealth disease” which can cause liver failure, diabetes and severe arthritis may be much more common than previously thought, research has shown.

Genetic disorder Haemochromatosis causes the body to absorb too much iron from food and can lead to serious complications if left untreated.

Exeter University said the condition could affect up to 20 times more people than earlier figures suggested.

Public Health England has welcomed the research.

Thought to be the UK’s most common genetic disorder, haemochromatosis is linked to a faulty gene passed from both parents to their child.

It was believed to seriously affect about one in 100 carriers.

But the new research has suggested the true level could be closer to one in 10 among female carriers, and one in five for men.

Lead researcher Prof David Melzer said he was astonished at the findings.

“We’ve shown that hereditary haemochromatosis is actually a much more common and stealth disease, including in older people,” he said.

‘You don’t believe you’re going to lose a child’

Jason Cloke, 42, died in 2010 after his organs were damaged by a build up of iron.

His mother, Jenny Lees, herself a haemochromatosis sufferer, believes three members of her family died from the condition.

While her mother and sister were never diagnosed before their deaths, she said they died from severe liver damage; a common symptom.

The cause of her son’s death, however, was confirmed as haemochromatosis.

“His liver was cirrhosed, he had chronic diabetes, he then picked up hepatitis A and they couldn’t give him the antibiotics that he needed,” said Mrs Lees.

She has called for regular blood tests to help detect the condition.

“You don’t believe that you’re going to lose a child before your death, it’s the wrong way round,” she said.

Prof Melzer said haemochromatosis was easy to treat if caught early enough, but was “difficult to spot”.

“It tends to only be diagnosed quite late on when a lot of the damage is done and treatment is only partially successful,” he added.

The professor and his fellow researchers have called on the NHS to find routine ways of testing for it.

Public Health England said the findings could affect clinical practice.

What is haemochromatosis?

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  • Haemochromatosis is a condition that leads to the accumulation of iron in the organs of the body
  • It is caused by a faulty gene – Northern Europeans with Celtic origins, particularly of Irish backgrounds, are more likely to carry the gene
  • Symptoms include fatigue, joint disease, skin problems, and sexual health issues – left untreated it can cause serious illness such as liver cancer and cirrhosis
  • Treatment is relatively simple and consists of venesection (bloodletting) – as the body makes more blood to replace that taken, it uses up the excess stored iron

Source: Haemochromatosis UK

Diagnosis ‘took months’

Long-distance runner Ruth Jones, 38, said it took nine months of tests before she was diagnosed with haemochromatosis.

The mother-of-two from Stamford, Lincolnshire runs up to 70 miles a week and first visited a doctor with symptoms of low energy levels in September 2017.

She said she was “feeling exhausted” all the time and found running much harder for “no obvious reason”.

After being diagnosed, she said she was met with a lack of understanding about the condition among medical staff.

However, after a transfer to a consultant and undergoing a few treatments, she noticed aches in her joints alleviating. “I just felt more ‘with it’ and alive,” she said.

Mrs Jones’s husband Brian is now undergoing testing to see if he too has haemochromatosis, which would help to indicate whether their daughters, aged 10 and 13, carry the gene or have the condition.

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Teenage cancer survival 'on the up' in England, report finds

Survival rates for teenagers and young adults with cancer in England are improving, particularly for those with leukaemia and bone cancer, says a report by Teenage Cancer Trust and Public Health England.

But it found young patients living in poorer areas had lower chances of survival.

Understanding why this happens should be a priority, the charity said.

The report looked at data on 13 to 24-year-olds between 2001 and 2015.

Cancer in young people is rare, with fewer than 1% of all cancer cases affecting 13 to 24-year-olds.

That equates to 2,397 young people in England being diagnosed with the disease each year, based on figures for 2013 to 2015. Most occurred in 19 to 24-year-olds.

‘Complete shock’

Aggie Kasicka was diagnosed with Hodgkin lymphoma when she was 20 and a second-year university student at University of Nottingham.

She felt relentlessly tired – but put it down to working hard for exams and juggling a part-time job.

“I’d be falling asleep at my desk and didn’t have the energy to walk upstairs,” she says.

When she was finally diagnosed, the news was a complete shock, but her approach was to keep going.

“It was two weeks before my exams, but I still went ahead and sat them – in isolation because of my immune system.

“The diagnosis made me study with a clearer head I think.”

She then had six months of treatment and, at the end of it, went to Spain on her year abroad.

The recovery process was hard, she admits, and she now suffers from anxiety, but with the help of supportive friends and family, she has stayed positive.

Five years on, she is now working as a management consultant in London.

When the report compared five-year survival rates for those diagnosed between 2001-05 and 2007-11, it found they had risen from 83% to 87% for females and 80% to 84% for males.

In that time, the chances of teenagers and young adults surviving leukaemia had increased from 61% to 71%.

The survival rates of other common cancers among 13 to 24-year-olds had also improved, such as lymphoma (92%), bone cancer (63%) and carcinomas (84%).

This reflects an improvement in cancer survival in adults, which has doubled in the last 40 years in the UK.

However, teenagers and young people living in the least deprived areas had better survival chances – 88% – compared to those in the poorest areas – 84%.

And there were large regional variations in the number of young people with cancer – but this could be because of the differing size of populations in each area.

Although cancer death rates among young people have come down too – to 32 deaths per million young people – the report found a rise in the overall number of cases of cancer among 13 to 24-year-olds.

This could be because of a “dramatic increase” in cervical cancer diagnoses in young women aged 24 and a reclassification of some other cancers, the report said.

The figures were taken from Public Health England’s National Cancer Registration and Analysis Service (NCRAS).

‘More action’

Kate Collins, chief executive of Teenage Cancer Trust, said the improvements were down to teenagers and young adults being treated as a unique patient group, allowing them to access clinical trials and new treatments.

“This report makes a strong case for the importance of such services and for sustained funding of teenage and young adult specialist care into the future,” she said.

“As more young people are diagnosed with cancer, more face an uncertain future where their life is put on hold at a time when it should just be getting started.

“We know that there are now more young people than ever before who need our specialist care and support.”

But she said there was no time for complacency – just “even more action”.

In NHS England’s long-term plan announced recently, it set out plans to record the DNA of every child with cancer and give half of young people with the disease the opportunity to be part of a clinical trial by 2025.

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Clean air: Do low emission schemes improve children’s lungs?

A new study with 3,000 primary school children in London and Luton will see if new initiatives to reduce air pollution, such as London’s new Ultra Low Emission Zone, can provide health benefits. Children are especially vulnerable to damage caused by air pollution, which can stunt lung growth and affect other organs.

Produced by Alison Francis and Hannah Gelbart for the BBC News at Six and BBC News at Ten.

BBC Science Editor: David Shukman

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Becca Henderson: Transplant hope for rucksack heart woman

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A woman who carries an artificial heart in a rucksack after her own organ was removed because of cancer has been added to the transplant list.

Becca Henderson, 24, has been given the green light to receive a donor heart after scans showed she has been clear of cancer for a year.

Now she is on the list, the Oxford University post-graduate student could get a new heart in weeks.

“At no point did it ever occur to me to give up,” she told the BBC.

“No matter how hard it is for me, even if it is hard for me, it will then be easier for the next person.

“I had my sister’s wedding and I had to get to that, I have other friends’ weddings, I’ve got my mum, my dad, and I’m not going to be outlived by the dog.”

In October she returned to study at Oxford – along with her parents, who are on standby in case the 7kg machine stops and the batteries need changing.

Ms Henderson said: “If anything goes wrong with the machine, they are the ones who can do the changeover in four minutes and save my life.”

Ms Henderson is one of two people in the UK with an artificial heart.

Heart surgeon Stephen Westaby said Ms Henderson “must be the most courageous young woman”.

He congratulated her on the news there had been no sign the cancer had spread.

“Miniscule numbers of people” ever had cancer in the heart, he said, and it was the “most fearful condition”.

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Family bids to get premature baby home to Wales from Vietnam

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A couple is trying to get their baby back to Wales from Vietnam after she was born almost three months early.

Jessica Jones and Alfredo Duenas’s daughter Aurelia was born by emergency Caesarean section in Hanoi in October.

Aurelia, who weighed 2lb 1oz (970g), could not breathe unaided, has under-developed organs and a heart defect.

Ms Jones, 36, from Borth-y-Gest, Gwynedd, said she spent the first few months of her daughter’s life “thinking she was going to die”.

She works as a teacher in Vietnam, where she has been living with her Mexican husband for a year and a half.

Ms Jones’s waters broke at 05:00 on 10 October and she had Aurelia by 11:00 at just 27 weeks.

She said doctors told her there was a 5% chance her baby would survive if she had a Caesarean section and 2% or 3% if she had a natural birth.

Among her other health problems, Aurelia also has retinopathy of prematurity – which can lead to blindness – and needs reconstructive surgery on her nose after her septum was eroded by tubes providing air.

She spent spent two-and-a-half months in hospital before being discharged on Christmas Eve.

“To be told I was in labour and giving me a 5% chance of survival was one of the hardest things to hear,” she said.

The couple had to use translators – and their phones – to communicate with doctors and nurses, but even with interpreters, they were left struggling to understand what was happening to their daughter.

“There aren’t any words that can really do justice to the amount of trauma we’ve gone through – thinking your baby is going to die for the first three months and looking at them through a plastic box,” Ms Jones said.

The couple are now trying to raise £15,000 to get Aurelia back to the UK so she can have the best possible care.

Ms Jones said Aurelia needed to have surgery on her nose done now to prevent further damage and to give surgeons in the future the best chance of reconstructing her septum.

“Working on premature babies and such small craniofacial surgery of that magnitude is incredibly specialised and that just makes you appreciate so much what the NHS does and offers,” she said.

“The care and treatment that babies and children receive is second to none, and unfortunately living here it means she is suffering and is not able to have access to a higher standard of treatment.”

She added: “She needs extra help and care and unfortunately it isn’t here for her.”

Money will go towards flying her home – due to her poor immune system, they have been advised to fly business class rather than economy in order to avoid the large number of people in a small space.

Ms Jones said: “It’s been the only thing keeping me going is the thought of being able to go home, have some support from family and friends and the NHS.

“I cannot describe how much I’m counting the seconds until we can get her on that plane.”

It will also fund the cost of getting to and from hospital when they are back in Wales, as well as the fact they will not be able to work while caring for Aurelia.

They have so far raised more than £9,000 in donations from people across the world.

“Words fail us – the kindness of strangers has been overwhelming – everybody has been blown away, it’s been amazing,” Ms Jones added.

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Breast cancer risk test 'game changer'

Experts have developed a potentially “game-changing” test to predict a woman’s risk of breast cancer.

It combines information on family history and hundreds of genetic markers with other factors, such as weight, to give the most comprehensive assessment possible, says Cancer Research UK.

The test is not yet routinely available on the NHS – some GPs and specialists are trialling it first.

It is part of a push to spot cancers earlier through tailored screening.

Women at high risk could be given preventative treatments or offered more checks, say the researchers.

Nearly 55,000 women are diagnosed with breast cancer each year. A large proportion of the cases occur in women who have risk factors.

Prof Antonis Antoniou, lead researcher at the University of Cambridge, said: “This is the first time that anyone has combined so many elements into one breast cancer prediction tool.

“It could be a game changer for breast cancer because now we can identify large numbers of women with different levels of risk – not just women who are at high risk.

“This should help doctors to tailor the care they provide depending on their patients’ level of risk.

“For example, some women may need additional appointments with their doctor to discuss screening or prevention options and others may just need advice on their lifestyle and diet.

“We hope this means more people can be diagnosed early and survive their disease for longer but more research and trials are needed before we will fully understand how this could be used.”

The Breast Cancer Now charity called it a “promising step” but cautioned that more research was needed to develop and test the tool before it could begin to change NHS practice.

“In the meantime, we’d encourage anyone who is concerned about their breast cancer risk to speak to their GP,” spokeswoman Eluned Hughes said.

“While there are some factors that we can’t change, there are steps everyone can take to reduce their risk of breast cancer, such as exercising regularly, maintaining a healthy weight and drinking less alcohol.”

The test, which also assess ovarian cancer risk, is described in the journal Genetics in Medicine.

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What is the right age to lose your virginity?

Having sex too soon is the biggest regret of young people losing their virginity, a survey of British sexual behaviour suggests.

More than a third of women and a quarter of men in their teens and early 20s admitted it had not been “the right time” when they first had sex.

People must be 16 or over to legally consent to sex.

The latest National Survey of Sexual Attitudes and Lifestyles poll says many people may not be ready at that age.

The Natsal survey, carried out every decade or so, gives a detailed picture of sexual behaviour in the UK.

For this latest work, published in BMJ Sexual & Reproductive Health, researchers at the London School of Hygiene and Tropical Medicine looked at the responses of nearly 3,000 young people who had completed the survey between 2010 and 2012.

The findings

The responses showed that nearly 40% of young women and 26% of young men did not feel that their first sexual experience had happened “at the right time”.

When asked in more depth, most said they wished they had waited longer to lose their virginity. Few said they should have done it sooner.

Most had had sex by the time they were 18 – half had done it by the time they were turning 17.

Nearly a third had sex before turning 16.

Equally willing

The survey also looked at sexual competence or readiness – whether a person could reasonably make an informed decision about whether to have sex for the first time. For example, they had to be sober enough to have consented and should not have been acting on peer pressure.

Around half of the young women and four in 10 of the young men who responded failed this measure.

And almost one in five women and one in 10 men said they and their partner had not been equally willing to have sex at the time, suggesting some felt pressured to have intercourse.

Founder of the Natsal survey, Prof Kaye Wellings, said the age of consent was not an indicator that someone might be ready to become sexually active. “Every young person is different – some 15-year-olds may be ready while some 18-year-olds are not.”

Co-researcher Dr Melissa Palmer said: “Our findings seem to support the idea that young women are more likely than young men to be under pressure from their partners to have sex.

“Although the survey results yielded some positive outcomes, such as nearly nine in 10 young people using a reliable method of contraception at first sex, further efforts are required to ensure that the broader wellbeing of young people is protected as they become sexually active.”

She said sex education in schools should equip young people with the right negotiating skills to enable them to have safe and positive first sexual experiences.

When is the right time?

If you think you might have sex, ask yourself:

  • Does it feel right?
  • Do I love my partner?
  • Does he/she love me just as much?
  • Have we talked about using condoms to prevent STIs and HIV, and was the talk OK?
  • Have we got contraception organised to protect against pregnancy?
  • Do I feel able to say “no” at any point if I change my mind, and will we both be OK with that?

If you answer yes to all these questions, the time may be right. But if you answer yes to any of the following questions, it might not be:

  • Do I feel under pressure from anyone, such as my partner or friends?
  • Could I have any regrets afterwards?
  • Am I thinking about having sex just to impress my friends or keep up with them?
  • Am I thinking about having sex just to keep my partner?

Source: NHS Choices

Isabel Inman from the sexual health charity Brook said: “We firmly believe that age and stage appropriate relationships and sex education (RSE) should start early in order to empower young people to make positive decisions that are right for them. We hope the introduction of mandatory RSE will provide this opportunity.”

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Student makes bucket list after cancer diagnosis

Laura Nuttall had just started university when a routine eye test discovered several brain tumours.

Soon after the diagnosis, the 19-year-old from Lancashire began creating a bucket list with her friends and family.

Fundraising is now under way to obtain experimental treatment to extend her life.

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Intersex surgeries: is it right to assign sex to a baby?

The UN says as many as 1.7% of the world have intersex traits – that’s the same as the number of people with red hair. All over the world, children with intersex traits are being operated on to be sex assigned at birth – sometimes with devastating consequences.

BBC Gender and Identity Reporter Megha Mohan explores the hidden world of intersex children.

Videojournalist: Natalia Zuo

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Tips on how to limit excessive screen time

New guidance from the Royal College of Paediatrics and Child Health (RCPCH) has stopped short of recommending specific limits on screen time, saying there is little evidence that it is harmful. But some parents have told the BBC they are frustrated by the advice and England’s children’s commissioner has said parents need more support.

Andy, whose son is 14, contacted the BBC to say he was disappointed by the advice.

“There is absolutely no doubt in my mind that screen time is damaging school performance and sports performance and dangerously addictive.

“I have had to restrict my son’s screen time to a Friday after school and a Saturday, due to lack of focus at school. His default was to head straight to the Xbox (which I would certainly classify as screen time… it is just a game after all which most boys are engaging in across all devices).

“After some grumbling, he has settled in and we have seen an improvement in school performance.

“I coach the under-15 football team and it is very clear, even with a 14:00 kick-off on a Sunday, who has been up all night on some form of screen.”

Anne Longfield, the children’s commissioner, believes guidance is sorely needed by parents.

“The fact that there isn’t enough evidence doesn’t mean we shouldn’t have a view and try to work out what’s best to do. Children are getting screens earlier, the average age to get a smartphone is now nine. Parents tell me that it is the one thing that drives them mad, causes huge rows, and they don’t know what to do about it.

“Parents are worried their kids will be socially damaged if they don’t give them a phone, so they’re in a tough spot.”

Is your family’s screen time out of control?

The RCPCH said there was no good evidence yet that time in front of a screen is definitely “toxic” to health, although they did publish a list of questions families can ask to assess whether screen use is affecting their children negatively.

The questions are:

  • Is your family’s screen time under control?
  • Does screen use interfere with what your family want to do?
  • Does screen use interfere with sleep?
  • Are you able to control snacking during screen time?

So if parents feel like screen time is having an adverse impact on their children’s life, what should they do?

Set boundaries

Last year, Anne Longfield published the Digital 5 A Day campaign, which encouraged the whole family to have a healthy digital lifestyle, including parents.

“It can’t be that parents have their phones in their hand the whole time. It works best if the whole family can look into a healthy digital way of life.”

Anne Longfield’s tips for managing screen time include:

  • Set some boundaries. You wouldn’t let a nine-year-old walk alone down a busy road. Phone use is the same, if a child has a smartphone at a young age you need to be aware of the dangers on their behalf.
  • If screen time is affecting sleep, meal time interaction, diet, and exercise then negotiate and make a deal. This might be that the phone is not used at the dinner table or in the bedroom, or before breakfast, or until homework is completed.
  • Consider your own use, parents need to demonstrate good behaviour.

Ms Longfield is now calling on the government to put digital emotional resilience into schools in Years 6 and 7. She is also calling for tech companies to be more “robust and have a duty of care for their users”.

Prioritise sleep

Dr Richard Graham is a child and adolescent psychiatrist. In 2010, he launched the UK’s first Technology Addiction Service for young people, and is on the board of the UK Council for Child Internet Safety.

He recommends that clients adopt the American Academy of Pediatrics family media plan, which allows a family to set limits together.

“This plan helps a family to look at the sort of media you are going to access, rather than restriction without explanation.

“There is good stuff online, which can make us feel well and healthy. A funny filter on Snapchat for example, can lift a child’s mood. But there is also toxic content, and also the fact that screen time can disrupt important and necessary things like sleep, exercise and conversation.”

His tips include:

  • Prioritise sleep. A well-rested child is more in control and able to think and discuss than a tired and irritable one. The American Academy of Pediatrics website offers a guide to the length of sleep your child needs for their age. Calculate their bedtime based on when they have to get up.
  • Be wary about surveillance as it can drive behaviour underground. It’s important children feel they can talk about issues.
  • Less time online equals less exposure to the possibility of toxic content. Says Dr Graham: “It makes sense that if the window is not open so wide, less dirt will fly in.”

‘A focus on appearance can lead to unhappiness’

Dr Tara Porter, a clinical psychologist specialising in child and adolescent mental health, says she is concerned about screen use as a clinician and a parent.

“Girls are being sucked into drama at a younger age, things said face-to-face are often less hurtful than things said in the online echo chamber, which can be escalated,” she says.

“A focus on the best appearance can also lead to dissatisfaction and unhappiness.”

Her tips include:

  • Supervise the device until they are 16 years old. Make it a condition of them having the device that you help them use it sensibly.
  • Use parental control apps like Our Pact and Circle to limit access to devices.
  • Stay on the front foot – before you give them a device, set out a contract of use

Use tech to limit screen time

Concerned parents have a bewildering array of options to choose from when seeking to manage how much time their children spend on screens.

Some home routers and security packages allow parents to set time limits for devices and monitor and police what can be seen online. Some can be used to impose time limits but these can be very blunt tools.

Most game consoles and computers include tools that can restrict how long the particular gadget is used for.

Finally, there are apps and other tools from Apple, Google, Facebook and others that can monitor how much time is spent on various programmes. Some let parents set hard limits so net access, apps or machines are locked at specific times.

A non-profit organisation Child Net has a guide that gives advice and links for concerned parents.


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Why did child screen advice not go further?

New guidance on screen use for under-18s has stopped short of telling parents how long their children should spend on the devices. Some studies have linked higher screen use to obesity and mental health problems, so why do the recommendations not go further?

Many of us will have seen the stories warning about the health problems linked to excessive screen use, or worried about how we or our children use our phones, computers and televisions.

So the fact that new guidance drawn up by the Royal College of Paediatrics and Child Health (RCPCH) steers clear of spelling out whether there should be limits on time spent in front of screens may come as a surprise to some parents and teachers.

Last January, head teachers union the Association of School and College Leaders surveyed 460 secondary school head teachers in England, Wales and Northern Ireland and found 96% had received reports of pupils missing out on sleep as a result of social media use, with most feeling the students’ mental health and wellbeing had suffered as a result.

What does the guidance say?

The guidance, the first of its kind in the UK for children, says it is important that screen use does not get in the way of healthy habits like sleep, exercising and time with family.

It recommends one clear rule on limiting screen use: devices should not be used in the hour before bed, because of the growing evidence that they can harm sleep.

But beyond that, it offers no hard answers, instead encouraging parents to consider a series of questions to determine if there might be a problem with screen use in the family.

These include checking if screen time is under control, whether it interferes with family time or getting enough sleep, and whether snacking gets out of control while using the devices.

It recommends that families “negotiate” screen time limits with their children based on their needs.

What evidence did they consider?

The guidance was largely based on a review of the existing body of scientific evidence that was co-authored by the college’s president Prof Russell Viner.

This looked at 940 journal summaries and incorporated 13 previous reviews on screen use and children and young people’s health, covering everything from mental health to food consumption and sleep.

Looking across the existing research, experts found “moderately strong” evidence for associations between screen time and greater obesity and higher depressive symptoms.

There was moderate evidence for an association between screen time and higher calorie intake, a less healthy diet and poorer quality of life.

The review concludes that the data “broadly supports” policy action to limit screen use by children and young people.

It also calls for more research into the issue to understand the impact of the contexts and content of screen use on children’s wellbeing.

One challenge is that this is still a developing area of science, and experts in the field say many of the studies so far carried out have been of low quality.

Most of the evidence in the review was based on television screen time.

So how much time do children spend looking at screens?

A 2017 study carried out by Ofcom, the broadcasting regulator, found that the traditional TV set is still used by more children than any other device – even though there has been a decline in TV viewing over the last decade.

But for older children (12-15 year-olds) the internet is king. This age group spends close to 21 hours a week online.

The growth of YouTube has also shifted the media environment, according to Ofcom.

Half of three to four-year-olds and more than 80% of five to 15-year-olds now use YouTube.

In terms of content, Ofcom says younger children are most likely to use YouTube to watch cartoons, animations, mini-movies or songs, while older children are most likely to watch music videos and funny or prank videos.

So why doesn’t the guidance go further?

There are a number of reasons the college has been cautious about setting limits on screen use.

Research, including in this review, has tended to lump all types of screen use together, ranging from browsing social media to playing computer games or viewing TV programmes.

And part of the problem is that studies have shown an association but this does not definitively prove that screen use is causing health problems.

How we use devices may also be more important than how much we use them, they say.

For example, there is likely to be a difference between using a tablet for educational purposes compared to browsing social media, although even here the evidence is not yet clear.

The college also says that attempts to recommend limits on screen use in other countries, including the US and Canada, have failed to change behaviour.

Beyond this, Prof Viner and his colleague, Dr Max Davie, also from the RCPCH, expressed doubts about some of the concerns over screen use, pointing out that devices offer benefits, too.

Prof Viner added: “The genie is out of the bottle – we cannot put it back.

“We need to stick to advising parents to do what they do well, which is to balance the risks and benefits. One size doesn’t fit all.”

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Why NHS costs just keep going up

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Small NHS funding rise would be ‘disastrous’

Health committee chair Sarah Wollaston says rise of 3% will ‘not be high enough’

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Tax rises needed ‘to prevent NHS misery’

Influential economists argue an extra £2,000 per UK household is needed over the next 15 years.

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Bank holiday warning over gardening and DIY accidents

Surgeons say this time of year can bring a spike in accidents with gardening and DIY equipment.

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Mum helps stop daughter being bullied for birthmark

Sophie Parker shares her story of being bullied for having a birthmark on her face.

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An egg a day to keep the doctor away?

A study in China suggests a daily egg may reduce the risk of a stroke

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Drug addicts in Scotland ‘waiting up to six months’ for treatment

Experts say more people with drug and alcohol problems should be fast-tracked for treatment.

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Period power brings free sanitary towels to school

A group of teenagers at a school where free sanitary products are available tackle the stigma around periods.

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Comfort box gives Norfolk cancer patients a ‘little lift’

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