Thursday 28 April 2016

An overseas institutional visit to Australia: expectations and initial experiences (part 1 of 3)

Guest post by Stephanie Morris, PhD Candidate at Durham University

Yesterday I sat in Perth’s Botanical Gardens in the Kings Park looking out over the city scape. As I sat and enjoyed the shade of a Eucalyptus tree I noticed a trio of children playing with a Frisbee barefoot on the grass in the sunshine. They stepped to throw and leapt to catch the Frisbee all within view of their parents who sat further up the incline. At one point one of the girls threw the Frisbee high in the air; it landed in the branches of another Eucalyptus tree (thankfully). The tallest boy then reached up to rescue it from where it was lodged so they could continue playing their game. At that point I began thinking about how different these children’s lives seemed to be in comparison to some of the boys I worked with in the North East of England during my ethnographic PhD fieldwork on daily physical activity. I remember images of some of the boys kicking a football down a back alley between terraced houses avoiding wheelie bins, broken glass and rubbish at the sides. Sometimes a ball would get kicked into a yard so one of them would climb over the wall or gate to fetch it. There were no bare feet on grass. There were no eucalyptus trees. But there were young people engaging in unstructured physical activity. I start to wonder about differences and similarities in contexts within and between Australia and the UK, and what exciting insights I will gain from others whilst I am here on the other side of the world.

This is my second full-day in Perth at the start of my seven-week Overseas Institutional Visit (OIV) to Australia. As part of this scheme I am writing a three-part Fuse blog to share my experiences, insights learnt and reflections on my visit ‘down under’. The OIV scheme is funded by the North East Doctoral Training Centre (NEDTC) and Economic and Social Research Council (ESRC), giving me the opportunity to visit the University of Western Australia, the University of Wollongong and the University of Queensland. These institutions are home to researchers who are at the forefront of applied and critical research on young people’s physical activity; I am going to be meeting some of the key academics I am citing (often time and time again) in my PhD thesis. Pretty big deal.

So what am I going to be doing during this visit? Firstly, I will be giving presentations about my PhD research to different groups of researchers at the three Universities all with an interest in health and physical activity. From these presentations I hope to gain feedback and discuss key ideas that are forming the discussion chapters of my thesis. Secondly, I am having meetings with various researchers and experts in my field; I hope to learn more about new and innovative current research projects, get new ideas for my own future research and uncover many pearls of wisdom about publishing and how to succeed in academia post-PhD. Thirdly, I’m going to shadow my hosts at certain points, attend events and get involved in any ongoing research projects they are involved with. I want to find out what it is like to work in these institutions, their research groups, and their small and large scale research projects.

I clearly have high hopes about the several weeks to come as well as, I must admit, a few fears. This is my first time in Australia, my first time giving presentations to people who are the experts in my field, and my first experience in any University other than Durham(!). So far my host Hayley at the School of Population Health here in Perth has given me an incredibly warm welcome; my first week has an exciting line up, including attending a launch event where the Department for Sport and Recreation are announcing the future strategic directions in Western Australian Sport and Recreation Industry. Until next time, all the best from ‘Down Under’.

Thursday 21 April 2016

Successfully reuniting planning and health

Posted by Tim Townshend, Fuse Associate and Acting Head of School, Director of Planning and Urban Design at Newcastle University

On Thursday 7 April I chaired an event that was jointly a Fuse Quarterly Research Meeting (QRM) and the fourth in the ESRC funded seminar series entitled ‘Reuniting Planning and Health’. It was the culmination of quite a few months of preparation and though it’s not the first such event I’ve organised it’s always a bit nerve-racking on the day – will all the speakers arrive? Will the participants enjoy themselves? Will lunch be any good?! As it was I needn’t have worried about a thing.

The day kicked off with a great overarching review of the need for planners and health professionals to work more closely together from Laurence Carmichael, Head of WHO Collaborating Centre for Health Environments – showing that while there is a lot of momentum behind the initiative there is much work still to be done. We then went north of the border with a presentation from Etive Currie, Glasgow City Council, who has been working on healthy planning initiatives for many a year – Etive’s presentation was full of amusing anecdotes about how local communities are not always initially receptive to such ideas! However there were also lots of really good news stories about individual lives that had been turned around. This was followed by Lee Parry-Williams, Public Health Wales, who gave a very informative overview of progress with Health Impact Assessment (HIA) in Wales – and also some insights into how political rivalries can stand in the way of real progress!

After a short coffee break, we had three further keynotes, Prof Ashley Cooper, University of Bristol – gave an excellent presentation setting out the complexity of linking children’s activity patterns to the built environment – it clearly demonstrated that for planning to deliver environments that are more supportive to healthy lifestyles, the research behind interventions needs to be extremely robust. Lesley Palmer – Chief Architect, Stirling University’s Dementia Services Development Centre, gave a really thought provoking presentation on how to design with dementia in mind – highlighting sufferers’ altered sense of reality – while showing elegant design solutions that could be incorporated into any environment that seeks to be age-friendly. The final presentation came from Gary Young, Director at Farrells, exploring the NHS Healthy Towns Initiative – including some of the initial housing at Bicester – a great talk to end with as it brought together so many key strands.

In the afternoon there were four interactive workshops – ‘The Casino’ a theatre based workshop run by local group Cap-a-Pie, explored how a proposed regeneration project for a run down seaside resort might impact a local community by actually asking participants to step into the shoes of the community themselves – an experimental methodology – it seemed extremely well received by those who took part. Jane Riley, Joanna Saunders and Carol Weir a team based at Leeds Beckett University gave a great workshop on the ‘total systems approach’ to obesity prevention – with participants asked to think about how they could make a real difference in their own work – quite a challenge! Douglas White of the Carnegie Trust did an excellent presentation on the Trust’s ‘Place Standard’ tool – which I’m sure participants will be using in future projects. Finally Pete Wright’s team undertook a kind of speed dating event so that participants could become familiar with various aspects of the MyPlace project based at Newcastle University’s OpenLab.

I observed all for at least a short time and was really impressed as to how participants became quickly absorbed – all the workshops were clearly thoughtfully prepared – the feedback overwhelmingly positive – so my huge thanks to all the organisers.

All round it was a fantastic day and all ran very smoothly – thanks very much to Terry, Ann and Peter the Fuse support team for all their help! And to The Core – it’s an excellent venue.

Thursday 14 April 2016

'Inappropriate' A&E attendance: One out of four ain't bad

Guest post by Dr Simon Howard, Associate Lecturer in Public Health, Northumbria University

Last week on the blog, Emma Dorée wrote about a statement from South Tees NHS Foundation Trust urging people not to attend Accident and Emergency departments for stomach aches caused by excessive consumption of Easter Eggs. Emma explained that one in four A&E attendances is considered inappropriate, and highlighted the NHS Choose Well campaign which helps people to select the right place to take their symptoms.

Photo attribution:
This made me wonder… is one in four A&E attendances being ‘inappropriate’ really so bad?

Clearly, the NHS is stretched at the moment, and nowhere more so than A&E, where only 83% of patients are seen and sent on their way within four hours, as compared with a target of 95%. It is natural for us to want to see performance improve, and waiting times are doubtless inflated by ‘inappropriate’ attendees.

Of course, we should wonder what is meant by ‘inappropriate’ in this context. There are many possible classifications. Of course, attending A&E seeking treatment for a sick dog is undoubtedly inappropriate. But is it inappropriate to attend for ‘hangover help’? What if the symptoms of your hangover are difficult to distinguish from the symptoms of meningitis? The final diagnosis and healthcare provider’s perspective is not necessarily the best viewpoint from which to determine ‘appropriateness’.

Even if we assume that one in four attendances truly is inappropriate, it’s reasonable to question whether that is so bad. Considering the problem in terms of sensitivity and specificity, it is vastly preferable that the self-triaging process is sensitive (i.e. all people who really need A&E attend A&E), even if that’s at the expense of a degree of specificity (i.e. some of the people who don’t need A&E still attend A&E). As a doctor, I want everyone who has a life-threatening emergency to attend A&E, not for one or two to go to their local pharmacy, and I’m willing to accept that making that happen might mean that some less urgent cases also slip through the net.

People presenting to services inappropriately is anything but a new problem. Writing in The Lancet in 1849, Joseph Hodgson - the founder of what is now known as the Birmingham Midland Eye Centre - complained of the “growing evil” of “the indiscriminate admission of out-patients to charitable institutions”. His problem was, perhaps, a little different: people referring themselves to charitable hospitals even though “one half of the patients can afford to pay the surgeon his fee”. In order to avoid detection, many of his patients chose to “dress shabbily, and even borrow their servants’ bonnets and shawls”.

To my mind, the root of the modern problem is that we expect people, most of whom rarely use the health service, to self-triage between six (or more) levels of care. This is not sensible. Campaigns admonishing people for making obviously incorrect choices don't help this core problem, and may even counteract campaigns like Be Clear on Cancer, which encourage people to consult health services with symptoms which they may not recognise as ‘red flags’.

One solution to this problem is to introduce professional triage. Back in 1849, Hodgson suggested that “each applicant be compelled to bring a note of recommendations from the clergyman”; perhaps not quite such a useful recommendation for the 21st century. NHS Direct, and its successor NHS 111, were perhaps intended to provide the modern equivalent of the clergyman’s note, but do not enjoy a high degree of public or professional confidence. This is probably because triage over the phone is very difficult, even if it has been shown in research to reduce A&E demand. Perhaps options such as embedding GPs within A&E, as proposed by South Tees CCG, will provide an answer.

For now, here’s the bottom line: even as someone working in the system, I couldn't tell you where I'm supposed to take myself if I develop an unclear symptom. Telling me how inappropriate other people’s attendances are don’t help signpost me to the right place if I have, for example, sudden hearing loss or eye pain. Like very many other people, in situations of uncertainty, I am likely to err on the side of accessing a higher level of care, as I would not want to delay urgent treatment. Though I probably wouldn’t turn up wearing my servant’s bonnet.

Thursday 7 April 2016

It's April: happy stress awareness month everyone!

Guest post by Dr Emily Henderson, Lecturer in Knowledge Exchange in Public Health and Research Fellow in Complex Systems at Durham University

April is stress awareness month. Why, you may ask? Maybe because it’s tax season. Or because parents have to look after their children during the Easter holidays. Or perhaps it’s to help recover from all the April Fools’ Day jokes, like the poor guy in Canada this year who reportedly collapsed from heart palpitations after his work colleagues convinced him he had to cut his holiday short to meet a deadline that had been moved forward.

Whatever the reason, it is happening this month. The Health Resource Network has deemed it so. And we at Fuse think it is a good opportunity to raise awareness about stress.

But I am already aware that I’m stressed
, I can virtually hear you reply. Fair enough. Nearly half of UK adults report feeling stressed every day or every few days, according to the Mental Health Foundation. With budget cuts, job insecurity and global crises, just to begin with, we all are stressed.
So what am I to do about it? We all have our coping strategies, which are biologically understood responses that humans and animals alike have evolved. Chimpanzees are known to groom each other to cope with threats and re-establish bonds. Stress and suffering are human universals. We can measure stress via stress hormones like cortisol, and there are physiological and some behavioural responses we can predict, like the ‘fight or flight’ response. But some behaviours are not predictable, and do not always make (immediate) sense. For example, Hilary Graham’s ethnographies of low-income single mothers showed us that, paradoxically, smoking was used to cope with suffering and thus improve wellbeing.

You, dear reader, have asked so many good questions up to this point, I have one for you: Considering the ‘causes of the causes’ of ill health, is the actual problem that these women smoked or is it the disadvantage they experienced? We have no choice but to cope in our own ways with stress. After trial and error, I know better now what I need to get perspective and find stillness inside. I am addicted to the oxygen highs I get through practicing yoga, and require connection with nature and people. But as a native to San Francisco, I am under cultural obligations to indulge in wine. Nobody is perfect. And nor should we ever aspire to this elusive ideal. Indeed, evidence for the health benefits of practicing compassion - either compassion for ourselves or for others - is growing. Beyond changing our behaviours, we must change the structures and systems that generate stress.

Spring is actually not about chocolate bunnies, but about renewal. So this April, in addition to trying new ways to cope with stress (see the Huffington Posts compilation of articles for Stress Awareness month, or NHS Choices mindfulness article), maybe get involved in a cause that seeks to alleviate suffering.

Please check out the Stress, Health and Wellbeing special interest group that I run through the Wolfson Research Institute for Health and Wellbeing at Durham University.

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