52 weeks in public health research, part 47

Posted by Bronia Arnott, Dominika Kwasnicka, and Lynne Forrest

From Bronia Arnott: The only way (is Essex)? Recently I was in Essex and the queue of traffic with all of the “slow” warnings on the road resonated with me as I had just had a systematic review of interventions to reduce car use and increase more active and sustainable modes of travel accepted for publication.

From Dominika Kwasnicka: National Institute for Health and Care Excellence (NICE) strongly recommends that adults engage in any suitable form of physical activity. So you just need to pick and choose the one that’s best for you. Here is an adult version of a bouncy castle at a great event co-organised by one of Fuse's practice and policy partners Scott Lloyd. It’s always good to try new things. And if a bouncy castle isn’t your thing, how about some ice skating this winter?

From Lynne Forrest: A number of Fuse representatives, including myself, Shelina Visram and David Hunter, were among the 1500 delegates who attended the European Public Health (EUPHA) conference on Health Inequalities in Glasgow. This is my poster on a systematic review and meta-analysis that found no evidence of socioeconomic inequalities in stage at diagnosis for lung cancer.

From Bronia Arnott: An early morning trip to Newcastle Central Station which has recently been refurbished and is now looking much better. They even have some bike racks in decent places rather than stuck out of the way at the wrong end of the station. Coincidently, I was off to talk to people about active travel!


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A reminder from the Fuse blog group:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in most of our lives, we foresee problems compiling 208 images worth posting on our own. So this is going to have to be a group project. Send an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and we’ll post them as soon as we can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Email your posts to m.welford@tees.ac.uk or contact any member of the Fuse blog group.

Bitten by the blogging bug

Posted by Sarah Smith

On the 1st of October 2014 I started my PhD. I felt excited and happy at the prospect and keen to get started, although I was a little sad to be leaving the research group that had taken me under its wing again. I feel very fortunate to be in this position and know it’s in part due to them really. My first task is to move my ‘things’ to the PhD office, all the way next door! Two years’ worth of research work needs sorting and it takes me a while (most goes into recycling) but finally I am set up in my new office space. I meet new officemates and all seems well. I meet with my supervisor, we chat about my work and I head off back to my new desk to begin my journey as a PhD student. Student? [thoughtful pause].

Using the word ‘student’ to describe myself seems strange. I’ve worked in research for 10 years already and feel that at my age I’m too old to be even a mature student. It’s made even stranger by the fact that I’ve worked in the same University, department and corridor even up until only yesterday. My whole status has changed overnight. I start to waiver a little. But after a coffee break and chat with new officemates I feel this newly acquired student status could work out just fine.

My fear of blogging is actually that of the unknown

During the first week, after the usual student-related teething problems I start to join up to activities offered by my department, and workshops and reading groups. I have the time to attend these now. The daily pace is slower than my previous role, there seem to be fewer demands on my time, I get headspace, I can think, I get to read, a real luxury! Things are looking more and more on the up.

My first student outing is to attend the Qualitative Health Research Writing Group Network meeting where Jenni Remnant introduces me to the world of blogging, something I’ve heard other people doing but never dared myself. She really sells it to me, that it’s a great way to network, and collaborate even with other academics, some out of reach normally. Then she sets us a practical exercise, to write a blog. Panic ensues. I draw a blank. I’m only a PhD baby of a week old; I have nothing to blog about. I glance around the room and everyone else seems to ‘get it’, writing notes, chatting about their existing blogs with others. I admit ‘I’ve never written a blog, I’ve never even read one’ to which people repeat my words back to me ‘you’ve never read a blog?!’. Am I so out of touch? Am I cut out for this? More panic ensues.

Then I start to think rationally and realise that my fear of blogging is actually that of the unknown and that I might do something I shouldn’t and once I do it’s out there in the ether. I’m reassured that as a first time blogger I can submit my blog, editors read it and will bounce it back to me if they think it or parts are not suitable for the public domain [sigh] I feel more comfortable about the idea now. But still, what do I blog about. Apparently anything, but it still seems daunting. I decide to embrace it and write a blog, but I’ll start tomorrow, then I’ll start the next day and it doesn’t happen, until I’m gently persuaded once more.

So today is the day, blog writing day. I open a blank word document and write ‘Blog’ at the top, the cursor blinking at me expectantly, and I have no idea what to write. Then I think back to where the blogging story began, the Qualitative Health Research Writing Group Network, and I remember my blog-writing fear, and I realise I’ve partly conquered that fear by even opening a Word document and being willing. I recall Sally Brown’s presentation at the meeting and a quote plays back through my head ‘don’t get it right, get it written’. And so I start typing, and typing. And the rest is history….

52 weeks in public health research, part 46

Posted by Amelia Lake, Mark Welford, Sarah Smith, and Shelina Visram

From Amelia Lake: My office mate Duika Burges Watson (@debedub) doing her daily handstand #yogaintheoffice

From Mark Welford: Discussing blogging with Lisa Briggs and Kirsty Metcalfe from the Graduate Research School at Teesside University (@TeesUniResearch). They wanted to know all about the inner workings of a research related blog with a view to entering the blogosphere.

From Sarah Smith: Meta-analysis masterclass courtesy of the Centre for Reviews and Dissemination (CRD) York where I've been on the Systematic Reviewing course this week.

From Shelina Visram: Fieldwork for the HYPER! (Hearing Young People’s views on Energy drinks: Research) study is now underway. The focus groups with schoolchildren include a fun sorting exercise to explore perceived differences between energy drinks, soft drinks and sports drinks.

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A reminder from the Fuse blog group:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in most of our lives, we foresee problems compiling 208 images worth posting on our own. So this is going to have to be a group project. Send an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and we’ll post them as soon as we can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Email your posts to m.welford@tees.ac.uk or contact any member of the Fuse blog group.

The 'C' Word VI: Crisis

Posted by Jenni Remnant and Libby Morrison

The Age UK Care in Crisis Report 2014 highlights the problem in Health and Social Care across the country with cuts in real terms; most councils are now only covering critical care criteria, so that those people with moderate needs will not be entitled to help.

Newspaper headlines shout out about the looming national crisis in care and public health for the elderly, and particularly the ‘ticking time-bomb’ of dementia. The number of people living with dementia looks set to rise year on year. How will our health and social care system cope with this – is crisis inevitable?

What perhaps isn’t highlighted is how, as with any crisis, it is a collection of individual experiences of people living with dementia and their carers.


An aged but blank piece of paper - having all the experience and history, but none of the words - because that's
 what dementia and Alzheimer's patients can seem like. It's there in the book, but you can't read it off the page.
 

The following diary extract is by someone recently caring for her elderly parents. Her mum was the main carer for her dad who was in late stages of dementia. Her mum had refused most offers of help as he was ‘HER husband’ and it was ‘HER job’ to care for him. She had become increasingly tired, and confused herself. The extract covers one weekend in crisis.

Friday

4.30pm
I went round to Mum and Dads to bring them some cakes I had made. I was met with a scene of chaos. Mum had packed up suitcases and bags which were stacked up in the living room. "What are you doing Mum?" She replied: "We don’t like this house, we are going back to our old one." I tried to explain that she couldn’t go back to her old house; they had sold it 7 years ago. There were pills in different bags, piles of notes and coins, clothes, rubbish etc. Dad was agitated of course, pacing up and down and making his ‘um um’ sound. Oh god what to do – Jessie is due back from school, the dog needs walked, I have a conference to go to tomorrow – I unpack all the bags and put everything away, make them tea and toast and promise to come back. Beg Mum not to leave the house with Dad. Run home make tea for Jessie, and walk the dog.

Dad once led a campaign to save the local library – and succeeded.

6.30pm
She's packed all the bags again and says her and Dad are leaving the house. She has drunk some whisky and possibly taken her sleeping pill. If I phone the GP or 999 they will probably take her to hospital – what then for Dad? He needs 24 hour care – where would he go? I have no space in my house and I need to care for Jessie and (just as an afterthought) go to work tomorrow! How can I do that – how can I not? If I don’t go into work I won’t get paid (care work – poor terms and conditions – ironic!). But the thought of Dad getting sent to any old place in an emergency, scared and alone, I can’t do it. Maybe if I can get them both to bed and to sleep, Mum might be better in the morning. Phone my sister and aunt to see if they can help tomorrow while I go to work. Ask my friend if Jessie can stay over with them tonight. Go to make a cup of tea – there is urine in the cutlery drawer – Dad has taken to peeing randomly in unexpected places. Clean out drawer. Make tea. Dad makes his ‘um um’ noise rhythmically and noisily – it drives me mad.

Dad was a school governor. He fund raised and campaigned to get new facilities and buildings for the local school.

10pm
They are both in bed (for how long is anyone’s guess). I make up a bed on the sofa and write this diary. I can’t sleep, although I am very tired.

3am
Dad is in the kitchen – peeing into a pie dish in which my aunt had brought them dinner yesterday. I clean up and lead him back to bed. He doesn’t object (thankfully).

Dad used to play tennis and rugby and was a big football fan.

Saturday

9am
My aunt arrives so I can go to work. Mum is a little better, seems less confused and has slept well. I hide the whisky before I leave. My sister and aunt go in to see them 3 times today. We have agreed to try and manage the situation until Monday, when we have a pre-arranged meeting with Social Services anyway as problems have been mounting over the last few months.

Dad set up and ran community education classes for local people.

6pm
Things are a little calmer tonight. Mum is clearly still confused but more reasonable. I cook them both tea. My aunt phones for an update. She says: "I didn’t think my toad-in-the-hole was that bad" when I recount the story of the pee in the pie dish!! We both laugh at that. But then I find myself in floods of tears – go upstairs quickly so they can’t see.

Dad has a glass plate which was presented to him for donating blood 75 times – there is a little certificate too.

9pm
I have given them dinner and we have watched a bit of telly. Mum doesn’t seem to know where anything is in the kitchen. Should we phone the doctor anyway? They will try and get us to bring her in to see them (I know of old). But that means bringing Dad and that means…….. oh let's leave it until tomorrow.

Dad loves singing and all sorts of music. He was once a choir boy in a big church in Edinburgh.


This is only the briefest of insights into the personal dimension of the impending dementia crisis, but in this limited glimpse at the nuanced and emotive narrative, it is already painfully obvious how much of a challenge public health professionals and researchers, and the health and social care structures in the UK have on their hands.

52 weeks in public health research, part 45

Posted by Sarah Smith, Amelia Lake, David Hunter, and Mark Welford

From Sarah Smith: I attended the Public Health England work, health and wellbeing workshop on Monday in Manchester. This is Sam Haskell, Health and Work Lead from PHE, who used the Fuse logo in his presentation!

From Amelia Lake: I am grateful for the front of pack labelling which illustrate just how high in saturated fats & fats this prepared pizza is. Clear information is so important in terms of public health nutrition.

From David Hunter: Earlier this week I was involved in a Health Summit held at the Lindisfarne Centre in Durham to discuss and debate the challenges facing governance for health. We had a reception and dinner at the Castle on the first night and the event was attended by around 30 invited participants from across Europe, mainly from the UK. Partly organised to launch our WHO Collaborating Centre on Complex Systems Research, Knowledge and Action. Pictured are the speakers from the event.

From Mark Welford: Boxed, labelled and ready to go. We (the staff, students and researchers) at Teesside University's Health and Social Care Institute (HSCI) are moving offices from Parkside West to the much more central Constantine Building.   

Teesside University was originally founded as Constantine College and was officially opened by the Prince of Wales, the future King Edward VIII, on 2 July 1930. Below is a photo of two plaques that can be found on the wall of the Constantine Building.  Although you can't really see it clearly in the photo, the one above commemorates the fact that the college was a gift from local shipping magnate Joseph Constantine and his family and the one below marks the date when the college was officially opened.
    

The college became a polytechnic in 1969; and in 1992, the Privy Council gave approval to 14 higher education institutions, including Teesside, to become new universities.

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A reminder from the Fuse blog group:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in most of our lives, we foresee problems compiling 208 images worth posting on our own. So this is going to have to be a group project. Send an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and we’ll post them as soon as we can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Email your posts to m.welford@tees.ac.uk or contact any member of the Fuse blog group.

Nacademia

Posted by Samantha Level

Thoughts of a ‘nacademic’ (a cross between a ‘naka’ (no knowledge of any worth) and an academic (a longing to have knowledge of worth)).

According to the urban dictionary: 

'Nacademic; Nakk-a-dem-ik (noun). A person who claims knowledge in a particular subject, however they do not possess any kind of merit to back up such claims.' 

Manuel from Fawlty Towers played by Andrew Sachs

In the words of the loveable Manuel from Fawlty Towers ‘I know nothing’ (ironically from the episode communication problems and repeated by me in the worst Catalan accent imaginable). I feel that phrase pretty much summed up my first year as a part-time PhD student - especially when talking to academics and / or other postgraduate students, probably not so much when talking to non-academic friends. Now at the end of my second year I don’t feel that dread of someone asking me about my research for fear they will delve too deep into the abyss of my empty head expecting me to retrieve data that has not yet been collated, rather now I feel a hint of, dare I say, ‘confidence’.

In the beginning talking to other new students actually made me feel inferior. Some of them already seemed so knowledgeable, with clear aims and objectives, plans of their chosen methodology and some even knew about theory! How I was jealous of these people (or aliens as they might have been).  Whereas, I just had passion to learn (or as Jarvis Cocker said in the song Common People a ‘thirst for knowledge’) and the stubbornness not to quit. It didn’t help that a lot of the articles I attempted to read made me feel like self-diagnosing myself with narcolepsy, but with a dictionary at hand ready to translate I persevered - and here I am progressing to my third year.

My advice would be if, like me, you suffer from the paranoia of empty head syndrome (trust me, you’re head is NOT empty but in those dark moments of self-paranoia you may feel it is) - start off talking to other post-grads that may not be from your subject area - this way you learn to talk about your research without worrying that they may know more than you do about ‘your’ topic. I attended a three day researcher training event held at Durham University and I have to say the invitation to this arrived at a crucial time for me as my confidence levels were so low I wondered if I was even ‘smart’ enough to progress to year 2, let alone complete a PhD. Once there I chatted to others - many of whom felt just like me. They were from all areas - engineering, medical, psychology and so on - and this was the first time I felt I fitted in as a post-grad.

I guess the message I want to relay is that if you’re reading this and think OMG (editor: that's 'Oh my Goodness' for those who remember a time before text messages!) that’s me - I’m a nacademic, then don’t feel alone and hang on in there - the ‘naka’ section disintegrates (albeit often slowly) and you will emerge like a beautiful academic butterfly (or in my case more of a moth but still at least materialising into some form of an academic ….)

52 weeks in public health research, part 44

A day in the working life of Amelia Lake

Today has been about cars and traffic. Moving from one bit of the North East to another - all in the name of Fuse! Truly wish I'd been on a train - then I'd get work done...

Refuelled at Durham University and time to head to the Wolfson Research Institute for meetings with the rather fabulous Fuse energy drink team...

It's meeting 3 in a three location day hampered by horrendous traffic. I'm feeling weary but I'm energised talking about our Fuse energy drink research...

Big word of the week - courtesy of my colleague Stephen Crossley (@akindoftrouble).

------------------
A reminder from the Fuse blog group:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in most of our lives, we foresee problems compiling 208 images worth posting on our own. So this is going to have to be a group project. Send an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and we’ll post them as soon as we can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Email your posts to m.welford@tees.ac.uk or contact any member of the Fuse blog group.

Knowledge exchange: just do it (but be mindful of what you say). Part 3 of the KE blog series

Posted by Peter van der Graaf

In the last two blogs about knowledge exchange Avril and Mandy did a great job outlining the opportunities and pitfalls of academics working with public health practitioners and commissioners to get research into practice (or practice into research as a more subversive strategy). “Putting yourself in the shoes of service partners”, “connecting with people in different ways”, “demystifying the language” all makes sense but how do you do it? The toolkit provides plenty of ideas but until you put those ideas in practice your translational research skills are still untested.

AskFuse was set up in June last year to ‘just do it’ (incidentally a research manager was hired with strong connections to the American company that came up with the slogan): ask our policy and practice partners what evidence they need and then find academics in Fuse who can help them access or develop that evidence in a timely, useful manner and in a usable format. Almost 16 months and 100 enquiries later, there certainly seems to be an appetite for working together.

That doesn’t mean pitfalls no longer exist: procurement procedures can trip up the best laid proposals, reorganisations are still not conducive for collaborative research, academic language can be intimidating and impenetrable, and academics can be just as invisible to each other as they can be for policy and practice partners.

However, having conversations seems to be at the heart of any successful (and unsuccessful) collaboration. Moreover, what happens in these conversations is key. Below is a hypothetical conversation between a Fuse academic and health practitioner based on similar experiences within AskFuse. What this exchange highlights is not only the stereotypical views that exist on different sides of the fence but more importantly the ability to change our views about doing research with policy and practice partners. That doesn’t mean academic rigour and peer reviewed publications are out of the window. 'Rigorous' is after all an adjective not a verb, and changing a health policy or intervention is what ultimately improves public health, not journal ratings or citation indexes.

In a sunny office somewhere in the North East:

Public Health practitioner in Local Authority: I would like to know if my child obesity programme in schools is going to work before I ask commissioners to sink millions of pounds into it.
Fuse researcher: No problem. What you need is a full RCT with three arms after a feasibility and pilot study, followed up by a mixed methods impact evaluation after 24 months.

Practitioner: Great! When will I have the results and what will it cost me?

Researcher: Only £1.2 million pounds and 7 years of research.

Practitioner: But I need to convince the elected member in the Council, who decides on my budget, in 6 months’ time and I have only £15,000 available for research within my million pound intervention programme.

Researcher: Right, so what you really want to know is: do the children in my programme lose weight. What? You are already measuring this within the programme? And you have comparable data available through the National Child Measurement Programme? This is highly unusual! You are also more interested in why children do or do not engage with the various activities on offer? Why didn’t you say so! All you need is a process evaluation: some interviews with delivery staff, group interview with some of the children and parents and Bob is your uncle! We can even use some comparable data from a previous research project to inform the questions and speed up the research design process.

Practitioner: Fantastic! I am sure if you write a short outline to explain this to my boss, nothing too fancy you know: just bullet points and a nice picture or story will do, we can find a way around those nasty procurement procedures. I might even invite a colleague from the neighbouring local authority to join in as he is doing something similar and also has some funding hidden away from his colleagues in other departments, who are all too keen to get their hands on our ring-fenced budgets. He is quite busy at the moment but is available in eight months’ time.

 

Researcher: But wait a minute: you said there was no money and time? How do we know if your colleague will still be interested eight months down the line and how will we know if the research findings will apply to his patch? Surely his boss will have different ideas about spending that money. 

Practitioner: I think that’s where we will need a full RCT. Wasn’t there something about complex interventions mentioned in an earlier Fuse blog?