Thursday, 4 February 2016

Doing the dots

Guest post by Jane Johnson, PhD Researcher at Teesside University

“You coming over to see the New Year in?” asked my sister, munching what I imagined was a handful of salted pretzels in the shape of small Christmas trees.

“Yes if I can do your posture.”

“What’s that?”

“You know, where you stand in your underwear and I stick dots on you.”

“Sure.” She didn’t need convincing, and as a blood relative was beholden to support my requests as long as I turned up with two bottles of something excruciatingly dry with an alcohol content that prevented you from driving anything other than an electronic wheelchair within the next 24 hours.

“Is she doing me?” said a voice in the background, my mum, no doubt trying to find when Downton Abbey was on. Not having had a TV for the last 10 years, period dramas pass me by unless any of the characters have interesting postural faults, not the kind of thing usually reported on in the review section of The Telegraph.

“Mum says are you doing her too?”

“Happy to. Don’t drink anything ‘til I’m done though, ok?”

“Don’t drink anything, it’s New Year’s Eve!?”

“I know. Postural sway. I need to minimize it.”

Many therapists believe there is a link between posture and pain. Postural assessment is carried out in order to help with diagnosis, inform treatment plans and monitor postural change. Most therapists do this with visual assessment alone, the inter-rater reliability (degree of agreement among raters) of which is poor, and despite reasonable intra-rater reliability (degree of agreement among repeated administrations of a test by a single rater), it's unlikely a therapist can visually detect what could be a clinically significant minor change in posture. For many years researchers have been looking into ways to measure posture more accurately and more reliably than with visual assessment alone. This is where my research comes in. Whilst there are ways to do this in research settings, there are none that are yet viable for practicing clinicians to use in situ. My PhD involves the development of a postural assessment app from existing software which has already been validated for use on a PC, which was initially designed for use with patients with scoliosis.

Mum stood first, fresh from a bath and eager for me to finish so she could cover herself in moisturizer. “No you can’t put it on,” I said sternly as she sat in a bathrobe snacking on savories from small china bowls, “otherwise my dots won’t stick.” I agreed she could keep her socks on. She was 80 after all. My sister was next. I only had to admonish for laughing during the procedure.

Once the self-adhesive dots have been applied to specific anatomical landmarks, software can be used to calculate the angles between the dots from photographs. The angles that are calculated describe different types of posture in different parts of the body, more so in the spine. There are other apps on the market but it is not known how reliable these are. Unlike these commercial apps, the purpose of my PhD is to create an app for data collection. It will be used in year three of the project by chiropractors, to record the posture of their patients with back and neck symptoms. Use by chiropractors is important because the project is joint-funded by the Royal College of Chiropractors and Teesside University. The patients of participating chiropractors already complete a validated Patient Reported Outcomes Measures questionnaire. Combining this data with the additional photographic posture data, we will hopefully identify whether postural change occurs as a result of chiropractic intervention and whether there is a relationship between posture and pain (symptoms). In the future we hope we can identify whether any postures increase the likelihood of a subject developing back or neck pain, and whether changing back or neck posture reduces symptoms. If we can do this, we can then advise people proactively and reduce their likelihood of developing symptoms in the first place.

With my sister and mum in their New Year’s Eve underwear I worked consistently, palpating the required anatomical points, peeling off and applying green dots to them. The initial satisfaction of fixing self-adhesive dots to skin wore thin after an hour. I took the 12 photographs knowing that photographs taken by candlelight would not be of publishable quality but were adequate for my purpose, which was simply to have some images with which to practice using the software. “Can we drink now?” asked mum and my sister together? “You can drink now,” I said.

Tuesday, 26 January 2016

Should Nanny be in charge of the tuck-shop (and off-licence)?

Guest post by John Mooney, senior lecturer in Public Health at Sunderland University

Aside from inclement weather and beautiful coastlines, there are a number of more worrying close parallels which the North East of England shares with my native Scotland. Most notable among these are an embedded culture of heavy drinking and an ongoing aversion for substantive proportions of both populations to fresh fruit and vegetables, alongside a fondness for fried and fast food.

The unfortunate consequences of these ‘’lifestyle choices” speak for themselves in the league tables for obesity across the life-course and in the statistics for alcohol related liver disease mortality, where only Scotland has higher rates than the North East. Despite good evidence that parts of Scotland, notably Greater Glasgow and West Central Scotland, have a more significant health burden than comparable areas in England (the widely publicised ‘Glasgow Effect’), there is no room for complacency in the North East, as front-line public health teams know only too well (especially since much of Scotland's culinary delights, including Tunnock's teacakes, are readily available in most major grocery retailers).

Is Scotland ready for a Tunnock’s tea-cake tax?

As an embedded researcher in Sunderland City Council where I work one day a week with the public health team, I have the dubious privilege of being immersed in the reality of what this means for those engaged in efforts to improve population health in the region. Specifically, there is the ever present tension arising from the contrast between the current consensus about what types of intervention might work best, alongside the reality and constraints that can frustrate their implementation. Flipping back to North of the border, Scotland’s best example of that practical tension has to be the ongoing legal machinations of the European Courts, dealing with industry raised legal challenges to alcohol minimum unit pricing.

My own previous experience during a career development fellowship at the Scottish Collaboration for Public Health Research and Policy (SCPHRP), gave me a small taste of comparable “practicality constraints” when our review of the international evidence around obesity prevention highlighted that a sugared-drinks tax would be the most promising and cost effective intervention at a national level. The commonly used slang for all fizzy drinks in Scotland (due to the popularity of a certain rustic coloured tipple) of ‘bottles of ginger’ led the Scottish Daily Mail to pronounce on its front page: “Nanny State Researchers propose a Ginger Tax!”. It’s only fair to say that SCPHRP Director, Prof John Frank’s subsequent telephone conversation with the then Treasury Secretary, Danny Alexander was particularly tense!

The all pervasiveness of the term “nanny state” in relation to public health interventions was recently brought home with a colleague’s recollection of her eight year old daughter’s reaction to school tuck shop restrictions: “I don’t want to be living in a <>~^+*!! nanny state”. It was very much in evidence also with the Chief Medical Officer’s festive cheer about there being no safe minimum level of alcohol consumption in relation to cancer risk. No surprises for guessing how that particular advice was received by New Year revellers in Scotland.

While public health “nudge” messages are often ridiculed as nanny state interventions, what is often forgotten in relation to dietary or behavioural advice is that these “nudge messages”, whether around availability, affordability, or portion (glass size/ strength of beverages), have all been incrementally (and imperceptibly) ratcheted up in the other direction over preceding decades. This could equally apply to the added sugar content of processed food and drink or the cultural normalisation of everyday drinking.

This should not however be a council of despair for public health practitioners and policy makers across the board. Smoking was once thoroughly normalised behaviour in all public and workplace environments. The legal challenges to alcohol minimum unit pricing, the most effective intervention at reducing excessive consumption based on solid international evidence, are steadily being chipped away in my native Scotland and perhaps “a ginger tax” for the whole of the UK might not be far away. Especially now Jamie Oliver has taken up the mantle of the sugared drinks tax debate and NHS Chief (Simon Stevens) seems, as of last week, to be fully on board – for NHS premises at least. Although I dread the reaction of my colleague’s politically savvy eight year old when she finds out!


John Mooney FFPH is senior lecturer in Public Health at The University of Sunderland and spends one day per week with the public health team at Sunderland City Council.

He will be presenting at Teesside University’s Health and Social Care Institute lunchtime meeting in a talk entitled: Is Scotland Ready for a Tunnock’s Tea-cake Tax and other public health conundrums? On Wednesday 27 January 12.30 – 2pm in C2.22, Constantine Building, Middlesbrough.

Thursday, 21 January 2016

Dry January works for many. I'm going binge-free all year round

Guest post by Dr Victoria McGowan, Research Associate, Alcohol and Public Health Team, Teesside University, @teamalphatees

New Year’s Eve is celebrated around the world and New Year’s Day follows with many debilitating hangovers. In my case this is made so much worse as a close friend’s birthday is on 30 December, so on New Year’s Eve I’m usually nursing a hangover and wondering how I’ll conform to social convention and partake in more alcohol consumption while waiting for the clocks to strike midnight. I always manage. Taking a look at Professor Newbury-Birch’s post from November 2015 I will hold my hands up and tell you over those two nights I binge drink, every year.

About five years ago my friend and I sat in my back garden in an inebriated state and discussed how terrible we’d feel in the morning and that we should, and could, spend a whole month off the booze. I wasn’t aware of any dry January campaigns at the time and according to Wikipedia “Dry January” was registered as a trademark by Alcohol Concern in 2014, so my friend and I were ahead of the game. At the time I thought it would be quite difficult to spend a whole month booze free but I found it surprisingly easy. Although, I often go weeks without consuming alcohol so perhaps abstinence for a month wasn’t a great stretch from my normal consumption patterns. My friend made it until 30 January before she succumbed to social convention when we went out to see a band. But still, 30 days out of 31 is close enough.

Abstaining from alcohol couldn’t happen at a better time in the year, our purses tend to be a little lighter and our waistbands a little tighter so it’s a win-win situation saving £s and shaving lbs, by swapping the wine for water. But also, according to the New Scientist, dry January can have beneficial effects on your liver, and NHS Choices say it can lead to healthier long-term drinking patterns. So if it’s so good for us and it’s only one month out of 12 why am I never doing it again? Because dry January would be easy for me, I do it often without thinking and I have done it successfully in the past. What I would find challenging is consuming the recommended daily units for a woman on the occasions I do drink alcohol. This equates to 3 units (three small glasses of wine) as opposed to the 18 (two bottles of wine) I consumed at the end of 2015. I might abstain from alcohol a month at a time but drinking a whole bottle of wine in one sitting puts me above recommended daily limits. Dry January is a great idea but one booze free month cannot outweigh 11 months of 9 units even if they only happen once a month. A similar argument has been made by other writers, including a recent paper in the MBJ by Ian Hamilton titled: Could campaigns like Dry January do more harm than good?

So instead of taking part in dry January this year I’m attempting binge-free moderate-months by being aware of, and trying to stick to, the recommended daily limits on the occasions when I consume alcohol.

What do you think about Dry January? Post your comments below.

Photograph ‘Conundrum’ by Robert S. Donovan via © 2010:

Thursday, 14 January 2016

Christmas dinner: a pleasure not to be underestimated

Posted by Duika Burges Watson, Fuse staff member and Lecturer in Evaluation and Policy Interventions, Centre for Public Policy & Health, Durham University

The final event for our research project exploring the potential of progressive cuisine to improve quality of life for head and neck cancer survivors was a Babette’s feast of sorts. Babette’s feast, the novella by Isak Dinesen (Karen Blixen), centres on the story of a most remarkable and transformative meal. In a remote and austere community in Northern Denmark, Babette cooks up a storm for the abstemious community. A religious cult denying all pleasure, the community is reluctant to eat anything that might be ‘wickedly’ enjoyable. Finally convinced of Babette’s desire to thank them for their support at the time of her father’s death, the French trained chef is permitted to use some new found wealth to prepare a sumptuous feast. During the multiple courses, the community is existentially transformed. Their enjoyment and love of life and feelings of well-being become undeniable as each delicious course is presented, despite their efforts to pretend otherwise...

Courtesy of
With our Christmas dinner, we didn’t set out to do anything other than thank the participants for their involvement in the research. We knew from our qualitative food play workshops (25 in all) that participant survivors missed the opportunity to socialise around food; their difficulties with food and eating (including swallowing, speed of eating, limited food choices, and fear of choking) made a ‘normal’ eating out experience unlikely[i]. So we invited the project’s Research Chef to prepare a Christmas meal that we hoped they would enjoy.

The tasting menu, or menu degustation (below) was designed as an adventure in dining, in which multiple very small courses make it easier to undertake - when you know that if you don’t like one, there are plenty more before and after to select from. The delightful setting at Irvin’s brassiere on the North Shields Fish Quay provided an opportunity for survivors to dine out, at their pace; to select from a range of dishes, and to enjoy some of the foods we now knew would be acceptable (with a diversity of eating difficulties, increasing options would ensure there was something on the menu for everyone). What we hadn’t anticipated was how much they’d enjoy the leisurely three hour lunch. Unlike the diners at Babette’s feast, survivors of head and neck cancer do not deny the pleasure of food, it simply may not be an option.

The menu that was offered to participants
Our Resources for Living research has centred on the potential of using some of the progressive cuisine techniques derived from the new ‘science of deliciousness’, an interdisciplinary approach to understanding our sensory perception of food with input from physics, chemistry, neurology and psychology[ii]. Chefs around the world are gaining insights into food in ways never before explored, and we developed the interdisciplinary research project on the assumption that some of these new understandings might improve quality of life for those living with the long term altered eating side effects of cancer and its treatment.

Our research, and the research of others, has showed that the loss of pleasure associated with food can be ‘almost unbearable’. Recent research in neurology suggests that there is one ‘pleasure centre’ in the human brain. In other words, “the pleasure evoked by food is remarkably similar to that of other rewards, suggesting a unitary pleasure system, whether engaging with food, sex, social or higher-order rewards”[iii]. In our research, finding ways to improve quality of life is intimately connected with the loss of pleasure. While we uncovered some ‘compensatory pathways’ such as participants finding pleasure in cooking for loved ones or engaging in exercise, the ability to eat a nine course meal appeared to do much more than just provide satisfaction. Participants reported feelings of well-being and happiness that they’d truly missed, some for years.

For our Christmas meal insights, thanks must go to Sam Storey, our brilliant chef on the project, and to the team of researchers and survivors involved who together have worked to understand, and find ways to manage, the challenge of living with altered eating difficulties.

Resources for Living (R4L) Pilot: Exploring the Potential of Progressive Cuisine for Quality of Life Improvement for Head and Neck Cancer Survivors is funded by the National Institute for Health Research (NIHR) Research for Public Benefit (RfPB) programme.

[i] Wells, M., 1998. The hidden experience of radiotherapy to the head and neck: a qualitative study of patients after completion of treatment. Journal of Advanced Nursing, 28(4), pp.840-848; Cousins, N., MacAulay, F., Lang, H., MacGillivray, S. and Wells, M., 2013. A systematic review of interventions for eating and drinking problems following treatment for head and neck cancer suggests a need to look beyond swallowing and trismus. Oral Oncology, 49(5), pp.387-400. 

[ii] Mouritsen, Ole G. "The science of taste." Flavour 4.1 (2015): 18.

[iii] Kringelbach, M.L., 2015. The pleasure of food: underlying brain mechanisms of eating and other pleasures. Flavour, 4(1), p.20.

Thursday, 7 January 2016

The blog monster returns with a shameless plug

Posted by Emma Dorée, Fuse Communications Assistant

Just over a year ago, we wrote about how far the blog had come since it hatched and it’s safe to say that the waistline of the - now fully grown - ravenous blog monster continues to expand.

Feed me, Seymour!
Since its creation in May 2010, the Fuse blog has had just over 167,000 views and we’ve posted 334 blogs – a great achievement, right?!

As a result, we wanted to do something to celebrate this success and to see if we could reward all the contributors that make the Fuse blog what it is, so we have entered the UK Blog Awards 2016!

The blog has been entered into two categories: 'Health and Social Care', and 'Education'. You can vote for us in either category but of course we would really appreciate it if you voted for us in both.

You can vote for the Fuse blog once a day by following this link. We will be encouraging people to do this via our social media feeds but it would be even better if you could spread the word and encourage your friends and family to vote for us too.
Click here to vote for the Fuse blog now

Most importantly however, we still need people to continue sending us blog posts so if you work in public health then please get in touch.

We want to hear about your aims, priorities and challenges or which issues you think need to be brought in to the public eye and debated. Could you give an insight into your role within public health for those not directly involved? Or is there a public health campaign in your area that you wish to promote or a topical news issue or event happening which could coincide with your post?

We post blogs at least once a week and publicise them via our Facebook page and Twitter account. The blog has its own website but of course, you can also view the blogs by visiting the Fuse website.

Email your posts to me ( and please let us know if you think there is anything we can do to improve the blog.

Thank you to everyone who has contributed to the blog so far. You have sparked great discussion and helped our readers learn what it is really like to work in public health, no matter what your role is.

The UK Blog Awards 2016 competition closes at 9pm on the 25 January so don’t forget to keep voting for us as much as possible until then!

Photograph ‘into the mouth’ by Len "Doc" Radin via © 2005:

Thursday, 17 December 2015

The big countdown

Posted by Emma Dorée, Communications Assistant for Fuse

It’s that lovely time of the year again when we count down the days to Christmas. Whilst we are frantically running around trying to complete our Christmas shopping, we are also eagerly waiting in anticipation to see if this year’s X Factor winner will make the number one top spot and whose festive Foxtrot will lead them to become the Strictly Come Dancing winner.

The Fuse Blog however is having a countdown of its own. Seeing as so many great blogs have been written this year, we thought it would be a good idea to have a look at all of the blogs from 2015 and create our very own ‘Top 5 chart’ of the ‘bestsellers’.
So let’s begin….

At number five: No time to run: role overload contributing to physical inactivity in parents? Caroline Dodd-Reynolds’ post looks at how parents find it difficult to fit physical activity into their daily busy routines. With 604 views, this is clearly a subject that lots of people, especially parents, can relate to.

At number four: How active are pregnant women? Measuring the methods. Louise Hayes and Cath McParlin debunk the ‘pregnant pause’ and tell us that guidance recommends that pregnant women should actually be doing at least 30mins of exercise on most days of the week to help reduce the risk of gestational diabetes. This post squeezes into fourth spot by the narrowest of margins, reaching 606 views since publication in May 2015.

In at number three: The troubled families programme: what’s health got to do with it? A guest post by PhD student Stephen Crossley explaining how the Government is helping (or rather not helping) families that need the most help. Stephen goes into great detail about the Troubled Families Programme explaining that health plays a huge role in this issue. This post has had 657 views since it was published in June 2015.

At number two: Bull Sperm and ‘poor parents’: the role of myths in public health practice. Another entry for Stephen Crossley. In this post he takes on the urban myths that surround energy drinks and political myths about benefits and austerity. This post has had close to 750 views.

And finally, time for the top Fuse blog post of 2015. Drum roll please….

Thunder, thunder, thunderclap: when a blog post hits the campaign trail. This blog was written by Fuse Communications Officer Mark Welford and has had an amazing 1575 views. It describes how a Fuse blog post caught the imagination of readers and became a national viral campaign, prompting a campaign page to be set up for people to support the idea that supermarkets should remove unhealthy food from their checkouts. This post followed two other ‘big-hitters’ on the same subject by Mel Wakeman and Amelia Lake: Who’s opting out of responsibility? Battle of the checkouts and Time to chuck the checkout junk? Both have received more than 900 views.

So there you have it, the top five Fuse blog posts from 2015. Let’s see if we can create even bigger and better blogs for 2016!

Did you enjoy reading this post? If so, please vote for Fuse in the UK Blog Awards 2016 by clicking here