Service providers' perceptions of the strengths and prospective improvements in UK eating disorder services: findings from a Royal College survey.

AIMS AND METHODS: This study aims to explore perceptions of eating disorder service strengths and to develop a clearer picture of improvements clinicians would like to see occur in the services they lead. A survey designed by the Royal College of Psychiatrists' Section of Eating Disorders was completed by 83 lead clinicians in both public and private sector services in the UK and Eire. Content analysis was performed, and common themes were identified. RESULTS: Five main strengths of a service were identified as follows: quality of treatment (n = 36), staff skills (n = 21), continuity of care (n = 15), family involvement (n = 12) and accessibility and availability (n = 11). These themes also arose when clinicians evaluated areas they wished to develop and improve. CONCLUSIONS: Service providers' views were congruent with each other, NICE guidelines and quality standards as proposed by the Royal College. Although clinicians feel that their service fulfils many practice guidelines, there remains areas in which adherence is felt to be lacking.

Family size in white gay and heterosexual men.

There is some evidence for a genetic influence on sexual orientation. However, gay men have fewer children than heterosexual men. Increased fecundity in the biological relatives of gay men could offset this selection pressure. We measured family size in gay (n = 301) and heterosexual (n = 404) men, attending clinics for sexually transmitted infections. The main outcome measure was the number of each man's uncles and aunts, first cousins, siblings, nephews and nieces, and his own children. With the exception of the participants' own offspring, mean family size of each category of relatives was significantly larger for gay men (paternal and maternal total OR = 1.02, CI = 1.01-1.03). This remained the case after adjustment for other predictors of family size (paternal and maternal total OR = 1.02, CI = 1.00-1.03). We found increased fecundity in the relatives of gay men and this is one explanation of how a genetic influence might persist in spite of reduced reproductive fitness in the gay phenotype. There are, however, a number of alternative explanations for our finding, including unknown psychological and social factors, which might mediate the association between family size and sexual orientation.