Reforming regulatory relationships: The impact of medical revalidation on doctors,employers, and the General Medical Council in the United Kingdom

In 2012, medical regulation in the United Kingdom was fundamentally changed by the introduction of revalidation – a process by which all licensed doctors are required to regularly demonstrate that they are up to date and fit to practice in their chosen field and are able to provide a good level of care. This paper examines the implications of revalidation on the structure, governance, and performance management of the medical profession, as well as how it has changed the relationships between the regulator, employer organizations, and the profession. We conducted semi‐structured interviews with clinical and non‐clinical staff from a range of healthcare organizations. Our research suggests that organizations have become intermediaries in the relationship between the General Medical Council and doctors, enacting regulatory processes on its behalf and extending regulatory surveillance and oversight at local level. Doctors’ autonomy has been reduced as they have become more accountable to and reliant on the organizations that employ them.     

Qarase v. Bainimarama: the End of Democratic Rule in Fiji?

The judgment in Qarase v. Bainimarama provided a legal basis for the 2006 military coup in Fiji and stated that the President was entitled to grant authority to the military to act outside of the powers prescribed by the written Constitution. According to the ruling, the Royal Prerogative powers that remained in government following British rule could be utilised by the President at any time that he considered it necessary. This paper explores the rationale for that judgment and the role that Royal Prerogative powers may play in the governance of countries that were previously subject to British rule. It further considers the impact of this judgment upon democracy in Fiji and the future protection of human rights for its citizens.     

Unwanted sex among young adults in the United States: the role of physical disability and cognitive performance

This study examined associations between unwanted sexual experiences and both physical disability and cognitive performance in a nationally representative sample of young adults. We used data from 11,878 participants (ages 26-32) in Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regressions determined associations between physical disability and level of cognitive performance (using a modified Peabody Picture Vocabulary Test) and the odds of experiencing physically forced and nonphysically coerced sex. Approximately 24% of females and 4% of males reported unwanted sexual experiences. Compared to respondents without disabilities, females with a physical disability had greater odds of experiencing forced sex (OR = 1.49; 95% CI [1.06, 2.08]), whereas males with a physical disability had greater odds of coerced sex (OR = 1.90; 95% CI [1.02, 3.52]). Compared to those with average cognitive performance scores, females with scores above 110 had slightly higher odds of coerced sex (OR = 1.20; 95% CI [1.03-1.41]). Further research on pathways underlying these associations is needed to inform prevention efforts.     

Invited Commentary: Understanding Brain Mechanisms of Pain Processing in Adolescents’ Non-Suicidal Self-Injury

Whereas non-suicidal self injury (NSSI) is reported in 13–23% of adolescents and is an increasingly studied topic, there has been little investigation into the pathophysiology behind self-injury. This commentary examines recent research into pain and emotional distress to discuss implications for the manner we should understand, research, and treat NSSI in the future. Research indicates that adolescents may be particularly vulnerable to NSSI behaviors due to neurodevelopmental changes in the processing of distress and pain. Additionally, emotional distress and physical pain neural pathways may have been altered in these individuals, leading to the development of NSSI behaviors during adolescence when changes in ongoing brain development may lead to further emotional dysregulation and poor impulse control. Further studies that directly characterize the relationship between emotional distress and physical pain in adolescence, as well as the neural differences between self-injurers and non-self-injurers, are needed.