In production: to contribute please email Maggie Laurie
Autism is a condition that is estimated to affect up to 1% of the UK population. A POSTnote on autism, published in February 2008, outlined the prevalence of the condition, variations in the manifestations of autism across the autistic spectrum, possible causes, and the different approaches to treatment. However, much has changed, both in terms of awareness of the condition and in policies to address it. With respect to awareness of autism, the importance of early detection and treatment is now more widely recognised, as is the need for continuity in services for managing those with autism, particularly during the transition from child/adolescent to adult services. Furthermore, autism is now thought to be under-diagnosed in women and girls, and associated with increased risk of mental health problems in both females and males. Finally, treatment services have progressed, with a perceived need to address not only biological factors, but also psychological (mood, personality and behaviour) and social (familial, socioeconomic and cultural) factors, with increased emphasis on face-to-face interventions such as cognitive behavioural therapy.
In terms of autism policy, the last 10 years have seen the Autism Act 2009, which placed a legal duty on the government to publish a document outlining how it intended to meet the needs of people with a diagnosis of autism. That document, Fulfilling and Rewarding Lives, was published in 2010 alongside statutory guidance outlining the responsibilities of the NHS and local authorities. This was updated in 2014 by the Think Autism paper which focused on increasing awareness, service provision and integrated care across a wide range of sectors. The Care Act 2014 made provision for ensuring that all staff who undertake autism assessments are appropriately trained, while the Children and Families Act 2014 set in place a support system for those with special education needs or disabilities. In 2018, the government announced a review of the Think Autism paper, with the intention of setting out a new joint adults and children autism strategy in autumn 2019.
An updated POSTnote on autism will outline these changes and examine the extent to which they have improved service provision for people with autism across the full range of sectors.
3D printing in medicine
Provisional start date November 2019: to contribute please email Dr Peter Border
3-D printing has become more widely used in medicine in recent years as the cost of the printers has decreased. Medical applications for 3-D printing include the manufacture of:
tissue/organ slices for use in drug discovery and other research
models of patient-specific conditions, such as tumours, to aid diagnosis and allow surgeons to rehearse complex surgical procedures
bespoke (non-biologically active) permanent implants such as hip replacements and dental implants
biologically active scaffolds and gels to repair damaged tissues and organs.
Ultimately, the goal of current research in this area is to use 3-D printing to fabricate more complex tissues and organs for use in patients currently awaiting transplants. While this could potentially circumvent the current shortage of donor organs, the main obstacle to research in this area is replicating the complex vascular system that allows free circulation of blood and nutrients throughout organs and tissues. However, recent research has succeeded in producing 3-D printed tissues, such as skin and cartilage, as well as other components including an ear, trachea and cardiac valve.
A POSTnote on this subject will outline recent research on the use of 3-D printing in medicine and examine the regulatory issues that such approaches raise. A particular regulatory concern is that the proliferation of 3-D printing essentially decentralises the manufacture of implants and other medical devices, making it more difficult to enforce good manufacturing practice and other quality management processes.
Blockchain technology in the food chain
Provisional start date September 2019: to contribute please email Dr Peter Border
Claims made for food products are not easy to verify and have to be taken on trust by the consumer. Recent years have seen significant improvements in the traceability of the food supply chain a trend which is likely to be accelerated in the coming years with the advent of blockchain technology.
Blockchain was originally developed as a decentralised ledger that records financial transactions and stores this information on a network in a manner which prevents it being changed at a future point. Applying this technology to the food supply chain involves assigning a digital certificate to each new interaction (a manufacturing step, a change in location or a change in storage conditions) with a food product, and storing the entire record in a secure manner.
A POSTnote on this subject could look at the potential pros and cons of applying blockchain technology to the food supply chain for consumers, manufacturers and retailers.
Causes of obesity
In production: to contribute please email Dr Peter Border
Obesity is a global health concern with the worldwide prevalence more than doubling since 1980. In the UK, childhood obesity is a particular policy concern, with data from the National Child Measurement Programme showing that between 2006/07 and 2013/14 by year 6, there was a significant upward trend for both boys and girls in obesity and excess-weight with the trend being highest for girls.
This POSTnote will examine the evidence base for the links between such factors and obesity and assess its relevance to informing policy.
Industry influence on public health policy
In production: to contribute please email Dr Olivia Maynard
This POSTnote will examine the evidence of the extent and methods through which corporate interests influence public health policy-making, including in the tobacco, food and alcohol sectors.
It will compare the approaches used in different legislation for these sectors and explore the potential regulatory changes that could result after exiting the EU, particularly for tobacco control.
Outward medical tourism
In production: to contribute please email Dr Peter Border
A POSTbrief on this subject will investigate and present recent data suggesting that there is an increasing number of UK citizens travelling abroad for medical treatments. Poland, Hungary, Romania, Turkey, and Spain were among the most visited countries for medical treatments in 2016.
Work on this area is timely given the recent upswing in the numbers of UK citizens travelling abroad for medical tourism and can examine the reasons for and the potential risks of seeking treatment abroad as well as look at the possible impacts on the NHS.
Regulating germline therapies
In production: to contribute please email Amarpreet Kaur.
New genome editing techniques for modifying DNA could potentially be used to modify the DNA present in human eggs, sperm or embryos. Any such changes would be passed on to future generations (so-called germ-line therapy). While such approaches have the potential to correct the mutations that cause serious genetic disorders, any unintended modifications would also be inherited.
To date there has been a consensus that it would be "inappropriate to perform germline gene editing that culminates in human pregnancy" because of safety and ethical concerns. However, in November 2018, a researcher at a University in Shenzhen, China, reported using genome editing to modify the DNA of twin girls to make them resistant to infection by HIV.
The study has yet to be published in a peer-reviewed journal, but the announcement provoked outrage among the wider scientific community. It also triggered on-going debate about what exactly constitutes a germline therapy.
For example, some scientists suggest that treatments could be regarded as germline therapy because they interfere with the flow of genetic information from one generation to another. There is also a lack of clarity over whether treatments that change the chemicals attached to a DNA sequence (so-called epigenetic changes) would constitute a germline therapy.
A POSTnote on this subject could outline the various possible definitions of a germline therapy, the potential applications of the techniques involved, and the possible alternatives. It could also examine the safety, ethical, legal and regulatory issues the use of such techniques raises.
Resilient food supply chains
No start date available: to contribute please email Dr Peter Border
The complexity of the food system and the wide array of competing ‘sustainability’ claims and certification labels make it difficult for even the most environmentally conscious consumers to make informed decisions about minimising the environmental impact of their food choices. This lack of clear information is especially true for so-called ‘embedded’ commodities, like palm oil and soy, which are typically consumed indirectly (e.g. in cakes, spreads, confectionary and soap in the case of palm oil, and animal feed in the case of soy).
New research approaches combine data from physical trade with financial records to track UK food imports back through the supply chain to provide a more accurate account of the environmental impacts of UK food imports in their places of origin. A POSTnote on the resilience of food supply chains could examine the potential for these new approaches to provide better information to consumers, businesses and policy makers about the environmental impacts of food supply chains. Such information could inform the design and delivery of more robust certification schemes that promote sustainable food systems.
In production: to contribute please email Dr Sarah Bunn
In 2010, an estimated 73% of the British population gambled at least once a year. In 2016, Gambling Commission data showed that 45% gambled in the last four weeks.
Gambling research is an active field in the UK, involving industry and academia, with funding and research grant awarding largely determined by the Advisory Board for Safer Gambling.
There is a debate as to what extent this arrangement encourages high-quality, independent research on gambling to take place. This POSTnote will describe the scale and nature of gambling in the UK. It will summarise the landscape within which gambling research is conducted, the evidence emerging from research and how this might inform policy.
Screen time and health in young people
Provisional start date November 2019: to contribute please email Dr Abbi Hobbs
The proliferation of devices with screens, such as televisions, laptops, smartphones and tablets, has led to concern that overuse of such devices by children and young people (high screen time) may have adverse effects on their physical and mental health. Such concerns have led bodies such as the World Health Organization and the American Psychiatric Association to publish guidance recommending that parents limit screen time for young children. For example, WHO guidance recommends that children up to the age of 2 years should be limited to 0 minutes a day screen time, and children between the ages of 2 to 4 years no more than 60 minutes a day.
However, the evidence base for such recommendations has been questioned. Much of the research in this area has focused on TV screen time, with relatively little focus on the use of social media on newer devices such as tablets, smartphones and laptops. Moreover, the nature of the research conducted is that it can only identify associations between screen time and indicators of health; it does not provide evidence of cause and effect.
To date, the available research suggests that high screen time (definitions vary but are typically greater than 2 hours per day) is most commonly associated with high adiposity (for example a higher BMI), an unhealthy diet and depressive symptoms. Taking this evidence into account, the Royal College of Paediatrics and Child Health published guidance on screen time for children and young people in 2019. Rather than setting arbitrary limits on screen time based on the child’s age, the guidance recommends that parents negotiate screen time limits with the child according to its individual needs, the ways that screens are used in the household and the extent to which screen use displaces other physical and social activities.
A POSTnote on this subject will outline the evidence on children and young people’s use of devices with screens, examine the strength of the links between screen time and adverse indicators of physical and mental health and explore the implications of the research evidence for public health policy.