Friday 29 November 2019

Bridging the research industry 'Valley of Death'

Posted by Peter van der Graaf, AskFuse Research Manager / Fuse Knowledge Exchange Broker, Teesside University

I was recently invited to attend a meeting in the British Library of the Bloomsbury SET. Not a group of subversive English writers, intellectuals, philosophers and artists but an Advisory Council for an innovative collaboration between four partner Colleges of the University of London. Namely, the Royal Veterinary College; London School of Hygiene and Tropical Medicine; School of Oriental and African Studies; and the London School of Economics and Political Sciences.

Death Valley, Eastern California
The partnership is funded by Research England and aims to bridge the ‘Valley of Death’: supporting research projects that get stuck between university and the market place. It does this by creating a knowledge exchange platform between the four Colleges that accelerates the delivery of innovative scientific and technical solutions in the field of infectious disease and antimicrobial resistance.

Pronouncing pathogen emergence, zoonotic disease and antimicrobial whatsit was hard enough, let alone my hope of making a meaningful contribution. I thought I would feel completely out of place as a public health researcher and the only social scientist in the room, but to my surprise I quickly discovered that the collaboration faces very similar challenges to Fuse.

For example, the project is trying to pool their commercialisation expertise across the Colleges and create a ‘single open door’ for government agencies, big pharmaceutical companies, small and medium sized enterprises, and overseas partners particularly in Africa. So, similar to our AskFuse service but with industry. In spite of their best efforts to engage researchers from the different Colleges, the project leads found that not all academics are keen to engage in partnership working outside their immediate area of expertise and that interdisciplinary partnerships, particularly with social sciences and humanities colleagues, proved challenging, as they speak a different language and have different cultures for sourcing funding.

It also proved challenging to develop trusting relationships with industry partners: academics don’t know how to find these partners and engage them in their projects, while industry partners allege that academics are ignorant of innovate technologies that have been developed in-house. This is akin to public health researchers not being aware of different types of knowledge that are being used in local government. It takes time to develop these relationships and exchange knowledge within them, for which the three-year grant funding is not long enough to show full results.

While the partnership is keen to engage with social scientists about the social aspects of the commercialisation process (e.g. work with local non-governmental organisations on engaging communities and identifying cultural and societal perceptions around vaccine use and human health), Research England is more interested in the commercialisation of ‘hard’ intellectual property through licensing or spin-out. Hence, the key performance indicators are all skewed towards these outputs. In other words, the incentive structure set by the funder is not encouraging the very thing that the partnership is trying to achieve. This sounds very similar to the lack of incentives and career opportunities within universities for engaging in knowledge exchange in public health.

Group photo (me, furthest right)
During the meeting, the need for creating an infrastructure within the Bloomsbury SET that can facilitate conversations between academics across the Colleges and broker relationships with industry partners was acknowledged by the Advisory Council members. Dedicated funding to develop collaborative proposals between industry partners and academic researchers that address this need was suggested as a useful knowledge transfer mechanism. Similar to the Public Health Practice Evaluation Scheme (PHPES) operated within the NIHR School for Public Health Research.

In summary, even if you don’t have any expertise in a particular scientific field (and can’t even pronounce their topics), chances are that you have more in common and face similar struggles when moving research findings outside academic institutions, whether that involves industry or policy and practice partners. The Colleges study transmittable diseases from animals to humans but to have impact with their research equal attention is needed to the transmission of knowledge from one human sector/ academic discipline to another.

Thursday 14 November 2019

A tale of two families: diabetes and rugby

Posted by Ruth Boocock, Senior Lecturer in Dietetics, Teesside University

The rain is coming in sideways, the mud is three inches and counting, a Sunday afternoon somewhere in the North of England. My rugby family. Amongst the rain, probably beneath four or five bodies, my seventeen year old daughter is having fun.

A whistle goes and a rain sodden, mud covered monstrosity jogs towards her family on the touch line. An upper arm extended, a mobile phone waved at a discreetly protected sensor and a blood glucose level read. Sometimes it’s an insulin pen to compensate for the adrenaline, other times a sports drink to refuel, such is the trial and error process of educating herself on what management routines work for training and matches. Blood glucose responses to physical activity for this recently diagnosed teenager with type 1 diabetes are highly variable based on activity type and timing and require different adjustments (Colberg et al, 2016)1. There are looks of course. Some parents are confused but a hurried whisper and the confusion is quickly replaced by respect. No mess, no fuss, just ordinary life. There are more important and more exciting things to do. Opponents to fell, tries to be scored. Rugby here, really has no barriers. A progressive, modern, attractive, dynamic and inclusive sport played by all (World Rugby, 2017-2025 vision)2.

Today is World Diabetes Day and the theme for 2019 is ‘The Family and Diabetes’. The aim, to raise awareness of the impact that diabetes has on the family and support network of those affected, as well as promoting the role of family in the management, care, prevention and education of diabetes.

On the rugby pitch my personal and professional life comes into sharp focus. I have spent the last twenty years as a dietitian sharing the journeys of people with diabetes. From the familiar insulin dose adjustment which offers greater freedom to eat and exercise while minimising glycaemic excursions (changes in blood glucose levels), to the battle of weight management and diabetes polypharmacy (the use of multiple medications). Weight loss for those with type 2 diabetes unlocking a future without diabetes or at least the ability to rationalise the use of diabetes medications.

Willowy wings take to the pitch alongside broader hardier oaks. At its best they complement each other wonderfully. From helping to prevent and manage medical conditions to reducing the risk of type 2 diabetes, the benefits of sport and activity on a person’s physical wellbeing are huge. But only 63% of adults are physically active for the recommended 150 minutes weekly, with figures lower still for children (Department of Health and Social Care, 2019; Sport England, 2019)3,4.

Rugby helps to maintain or improve aerobic capacity (the ability of the heart and lungs to get oxygen to the muscles), strength and balance and bone health and contributes to meeting the physical activity guidelines. Other benefits to exercise include reduced stress and improved self-esteem. Rugby reminds these girls that nobody’s self-worth comes from how they look or the perfect make-up or beautiful hair or high fashion clothes of online celebrities. There is a wonderful freedom here but also a challenge. Obesity. There is a fine line between giving girls and women confidence in their bodies and shape while also encouraging those patterns of healthy eating that will allow them to play at their best and get the most out of their training and their life. We do not always get the balance right. Push come to shove however they are out there two-to-three-times a week, come rain or shine working incredibly hard, growing as team mates and women, and reducing their risk of developing type 2 diabetes by 30-40%. That has to be an excellent beginning.

On the pitch there is just the team, on the side lines the wider rugby family. Sometimes also the diabetes family. Nicknames abound. Banter flows. Yet there are no labels. There are no diabetics, no 'fat girls', just a team and its friendships, its victories and losses, its celebrations and of course, lots and lots of mud.

Ruth’s current doctoral studies seek to identify barriers and enablers to the implementation of diabetes remission strategies for adults with type 2 diabetes recently diagnosed within general practice in one of the most deprived local authority districts in England.

  1. Colberg et al. (2016). Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care; 39(11): 2065-2079.
  2. Accelerating the global development of women in rugby 2017-25. 
  3. Department of Health and Social Care (2019). UK Chief Medical Officers' Physical Activity Guidelines.
  4. Sport England (2019). Active Lives Adult Survey: May 18/19 report.

  1. 'Logo for the World Diabetes Day' by International Diabetes Foundation via Wikimedia Commons:
  2. Published by: West Park Leeds Girls Rugby ‘Meet your #innerwarrior’ event, with thanks to Kurt Nutchey

Monday 11 November 2019

Can Scottish inventiveness curb the nation’s alcohol habit?

Posted by John Mooney, Senior Lecturer in Public Health, University of Sunderland
 Churchill is defeated by a Temperance movement MP - Dundee election result in 1922

“Of all the nations of this earth, perhaps only the ancient Greeks surpass the Scots in their contribution to mankind…” 
Sir Winston Churchill

This often cited sentence from the great orator’s canon of memorable expressions, frequently (in social media posts at least), is accompanied by a story of the number of times in a normal day ‘the typical Englishman’ is obliged to thank his Northern cousins for gifts bestowed:

From the spreading of ‘Dundee marmalade’ in the morning to his whisky night-cap it is easy to lose count of those almost innumerable causes for daily gratitude. In these days of Prophet Greta, perhaps the less said about ‘TarMacAdam’ and the internal combustion engine the better… but in our defence there is always Kirkpatrick MacMillan’s bicycle to offset that carbon footprint!

It’s no accident of course that pride of place be afforded in the above account to Scotland’s national drink of distilled and malted barley – renowned the World over for its unparalleled quality and distinctive dalliance on the palate. Scotland’s broader relationship with alcohol however, has not traditionally been a reputation to which one might raise a glass and is perhaps better summed up by the lovable and tragic Rab C Nesbit (right). The real tragedy of course being the excessive and abiding toll of alcohol related illness and premature death for which Scotland is infamous and also near the top of the World league table, for all the wrong reasons...

And yet, the nation’s pioneering spirit (of the non-liquid variety!) and very inventiveness in the face of a challenge may yet serve up another exemplar for others to follow. In May 2018 Scotland became the first country in the World to introduce legislation that set a minimum floor price for a unit of alcohol (MUP). While other fiscal mechanisms have been tried and tested for tackling cheap alcohol, MUP has consistently shown the greatest promise in modelling studies, since it cannot be “absorbed” by the retailer [1].

Sure enough, the first evaluation of the population level impact of MUP has found the policy to be associated with reduced alcohol purchasing. In line with model predictions, the reductions were largest for those households purchasing the most alcohol and for those drinks with the cheapest alcohol content [2, 3]. The very modest impacts on household budgets and the effect of reducing alcohol purchasing / consumption the most for those at greatest risk of harm also in line with predictions [4], helps counter any serious criticisms that the policy represents a regressive measure by unfairly targeting the economically disadvantaged. In the words of the Glaswegian novelist Val McDermid, on BBC Television’s Question Time in 2017: “There is nothing regressive about preventing people in Scotland’s poorest communities drinking themselves to death with cheap alcohol”.

Returning to the bigger picture, Scotland’s appetite for policy innovation to tackle alcohol harms is by no means restricted to minimum pricing. Rather, MUP is seen as only one component of a ‘whole system’ approach to tackling this most intractable and culturally embedded of public health problems. Bringing drink driving levels into line with the lower threshold in place across the rest of the EU [5] and incorporating health outcomes as a long overdue legitimate alcohol licensing objective [6], being two potential ingredients in the mix…

The Scottish ‘double edged’ relationship with alcohol can be best summed up by another snippet of Churchillian wisdom, a man who by all accounts was not unaccustomed to enjoying a ‘brandy before breakfast’:

"Whisky has killed more men then bullets, but most men would rather be full of whisky then bullets." 
Sir Winston Churchill

Perhaps the pragmatic recognition of a population’s natural affinity for a risky behaviour responsible for such a significant health burden is the first step towards realising that only meaningful restrictions in access mediated through price and availability, as well as legislative sanctions, might yet constitute the best defence against our worst excesses. Most Scots, myself included, know only too well of the devastating impact alcohol can exert on friends, families and communities. Maybe that is why we are most responsive to the remedies!

  1. Meier PS, Holmes J, Angus C, Ally AK, Meng Y, Brennan A: Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study. PLoS Med 2016, 13(2):e1001963-e1001963.
  2. Mooney JD, Carlin E: Minimum unit pricing for alcohol in Scotland. BMJ 2019, 366:l5603.
  3. O’Donnell A, Anderson P, Jané-Llopis E, Manthey J, Kaner E, Rehm J: Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18. BMJ 2019, 366:l5274.
  4. Holmes J, Meng Y, Meier PS, Brennan A, Angus C, Campbell-Burton A, Guo Y, Hill-McManus D, Purshouse RC: Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: A modelling study. The Lancet 2014, 383(9929):1655-1664.
  5. Haghpanahan H, Lewsey J, Mackay DF, McIntosh E, Pell J, Jones A, Fitzgerald N, Robinson M: An evaluation of the effects of lowering blood alcohol concentration limits for drivers on the rates of road traffic accidents and alcohol consumption: a natural experiment. Lancet 2019, 393(10169):321-329.
  6. Mooney JD, Sattar Z, de Vocht F, M Smolar M, Nicholls J, Ling J: Assessing the feasibility of using health information in alcohol licensing decisions: a case study of seven English local authorities. In: Lancet Public Health Science: 2016; Cardiff: The Lancet; 2016: 78.
  1. Election result in Dundee in the 1920s when Churchill was defeated by a Temperance movement MP. With thanks to Eric Carlin, Director of the Scottish Health Action on Alcohol Problems (SHAAP).

Friday 8 November 2019

The hardest thing was admitting that I was stressed at work...

To coincide with International Stress Awareness Week Annabel Gipp writes about workplace stress and shares her personal experience of working in the NHS.

Stress is something we all experience at some point in our working life, academic studies and at home. It’s almost become a standard for measuring how our day has been. I can recall many a time when I have exclaimed ‘That day was pretty unstressful!’, where this has really been code for ‘I’ve had a really great day’.

Being in employment has been found to have a beneficial impact on the health and wellbeing of a person, and helps to reduce workplace inequalities. Sadly however, being in low paid, insecure employment can actually contribute more to stress than being unemployed according to the National Institute for Health & Care Excellence. In non-manual workers, the most common cause of workplace absence was stress.

Workplace stress in defined as a harmful reaction people have to undue pressures and demands placed on them at work. Stress can manifest in a variety of mental and physical symptoms. Mentally, this includes:

  • Trouble concentrating
  • Negative feelings towards yourself, others and situation 
  • Difficulty processing information or thinking logically 
  • Constantly worrying something awful might happen 
  • Forgetfulness 
This can also manifest in physical symptoms:
  • Dizziness/ hyperventilating
  • Trouble sleeping 
  • High blood pressure 
  • Chest pains 
  • Tension and muscle pains 
  • Fatigue 
  • Digestive problems 

All of these can make it very difficult to focus on work or study, or even just keeping your home and socialising. This can result in a vicious circle which can worsen stress: 

A paper written by the Health and Safety Executive in October 2019 estimated that there were 602,000 workers across the UK suffering from work related stress, depression and anxiety. This resulted in 12.8 million working days lost and 54% of all working days lost to ill health were as a result of stress, anxiety and depression. The biggest cause of a build-up of stress was due to increasing workload, tight deadlines, too much responsibility and lack of managerial support.

It is also acknowledged that stress, depression and anxiety are more prevalent in public sector industries such as education, health and social care and public administration. Sadly, trends of reported workplace stress seem to be increasing slowly year-on-year, with 1,800 per 100,000 workers reporting work place stress in 2018/2019.

Stress has been linked with increased risk of many chronic health conditions, including heart disease, high blood pressure and depression. It has also shown to have links with immune system suppression, including in the progression of cancers, gastrointestinal disorders such as irritable bowel syndrome, skin conditions, neurological and emotional disorders.

So, stress is a very serious condition that needs to be reduced wherever possible, and organisations have a part to play to help manage it as much as possible.

Sadly it is not always possible to remove stress completely. I work in the NHS, and the nature of working in this organisation can potentially increase stress. Using this as one example, workers within the NHS are often faced with increasingly large workloads, stretched budgets, emotionally distressing situations or challenging patients - which can all increase stress.

I have had to take some time off work due to workplace stress. For me this was caused by a number of factors but what helped me return was a very supportive manager and team, and adjustments at work to help manage my caseload.

For me, the hardest thing was admitting that I was stressed at work. I felt guilty for letting the team down and that I should be able to manage. However, reducing the stigma around workplace stress is essential, as seeking support allowed me to return more quickly and stay in work.

So what can we do? The NHS Employers Website has a great tool to assess how you are feeling today, and it’s essential to check in on yourself. Having space to reflect and allowing yourself to voice worries or anxieties can help and give you time away from the stressful environment.

Trying to connect with people around you and with meaningful activities can all be helpful as well. But the key message is to seek support when you need it, from whoever you feel able to seek this from. Be it a colleague, friend, GP or charitable service, talking is essential and no-one is an island.

Annabel is a Floating Dietetic Clinical Specialist at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). Practitioner of Public Health, Faculty of Public Health, Trade Union Representative for the BDA (Association of UK Dietitians) and Staff and Dietetic Wellness Champion.

Good sources of information:

  1. "According to HR you haven't had any stress-related illnesses yet." by Grizelda Grizlingham via University of Kent, British Cartoon Archive (Reference number: GGD1406, Published by: Prospect, Sep 2017, with thanks to Copyright holder: Grizelda Grizlingham):

Friday 1 November 2019

Research on the go with women in walking groups

Posted by Stephanie Morris, Research Fellow, University of York

In this blog Steph reflects on the use of mobile ethnography in a recent study of the place of walking groups in the lives of women in deprived areas of north-east England.

Ethnography’s signature method, participant observation, or ‘hanging out’, provides rich data inaccessible by other forms of qualitative research. Mobile ethnography, as the name suggests, uses this methodology in the context of mobility. It can involve ‘go-along’ interviewing (See Carpiano 2008, Kusenbach, 2003) and participant observation as researchers travel and converse with participants.

When conducting research with women in walking groups, I found that mobile ethnography facilitated inclusivity and openness. For example, some women were interested in participating in the study, but uninterested in having a formal ‘sit down’ interview. So this approach opened up the study to those who might not usually opt to take part in research. Walking with study participants also enabled me to build rapport in a more ‘natural’ way than in a one-off interview, when the research and participant go in ‘cold’. Walking and talking, what the women did on the walks, encouraged free and open conversation: participants talked a lot to me about the intricacies of their lives, as they did with each other.

Mobile ethnography produces data which I feel is not likely to be created in static interview interactions. In ‘go along’ informal interviews, objects and embodied experiences along the route are often talked about. Conversations ranged from discussing fly tipping and historical features in the landscape, to sharing experiences of bodily sensations whilst walking in all weathers! Walking with the groups also provided a first-hand experience of the sense of safety and solidarity that comes with group walking. The following excerpt from my fieldnotes* shows an example of how this happened:

"As we walk along, Ashley who is in front of us by a few metres, points out that there is a hole in the path. She puts her stick down it and shouts to us to be careful of the hole. We do the same for the people behind us. Less than a minute later, Lisa says ‘step’, as there is a slight step in the hard soil and she is warning me about it. I do the same for the people behind me, and I get the feeling that I am being watched out for, and that I am instantly doing the same for the others."

Acts like this also quickly make the researcher feel part of the group, an insider participant-observer.

Despite its broad affordances, mobile ethnography is not without its challenges. The logistics of note taking when walking are tricky to say the least! I used the note function on a smartphone to take notes and took photographs along the route to remind me of encounters noteworthy of description. I walked with a Nordic walking group, which was even more difficult as I often had to carry the Nordic poles in one hand or clip and unclip at the group’s brief stops to quickly take notes of conversations or observations. However, as it was usual for people to walk alone for moments during walks, these times provided me with opportunities for note-taking. Conducting ‘go along’ formal interviews with a voice recorder was for the most part unproblematic; however, external noise was an issue at points near busy roads.

As with all ethnography, doing it well requires a lot of time and emotional labour. For instance, as transcribing fieldnotes is time intensive and needs to be completed as soon as possible after participating in the activity/group being studied, this task can clash with life’s other responsibilities. Likewise, as participants can become friends, research relationships and boundaries need to be carefully negotiated. And lastly, when using a method that helps to build rapport and relationships valuable for research, at the end of a project it can be difficult to say goodbye (and it was particularly hard to say goodbye to the many pleasures of group walking!).

There are many other contexts where mobile ethnography could contribute to health research, including but not limited to other physical activity and sustainable travel interventions. Why not give it a try?!

*Anonymised using pseudonyms