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.

Photo credits

Thursday, 31 March 2016

An egg-cellent reason to go to A & E?

Posted by Emma Dorée, Fuse Communications Assistant, Teesside University

Easter is a time that many people look forward to, not only because we get a couple of extra days off work but because it is an excuse to over indulge in copious amounts of chocolate.

This year however, it seems that Easter has become a problem for many people, especially the NHS. South Tees Foundation Trust NHS have this weekend released an urgent statement on their social media sites, urging people who have given themselves stomach ache from eating too many Easter eggs not to attend Accident and Emergency.

Data for NHS England in January showed that 88.7% of patients attending Accident and Emergency were dealt with in four hours – the worst monthly performance since the target of 95% began in 2004. These figures show that Doctors are under a lot of time pressure but what they don’t show is why.

I did a piece of investigative journalism to unearth the most comical reasons why people attend A&E departments in the UK and need your help in deciding which reason is the most outrageous one.

Below are 10 reasons, most of which featured in the The Choose Well campaign developed by NHS North West in 2011 to urge people to go to the right place for NHS treatment after new figures revealed that one in four A&E patients could care for themselves or get treatment elsewhere. The campaign includes a number of short films depicting "inappropriate" A&E scenarios being played out by actors, which are very entertaining and might help you to make an informed choice.

We added stomach ache from eating too many Easter eggs as the ninth reason to keep the list up to date. Which one will get your vote?

Make sure to keep an eye on our Twitter page to find out the results!

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Thursday, 24 March 2016

Supporting vulnerable communities in Australia and the UK: linking data through knowledge exchange

Posted by Theodora Machaira, PhD student at Teesside University

On the 8th of March we were pleased to welcome Jen Lorains, researcher from Australia, in Fuse. Jen was successful in winning a Winston Churchill fellowship and decided to visit Fuse as her main research interest is knowledge exchange and translational research.

As part of her visit, Jen delivered a Knowledge Exchange Seminar on ‘Early Childhood Data with Communities in Australia’. Her presentation focused on the Australian Early Development Census (AEDC) which is a national census which measures physical health, social skills, communication and general knowledge, language skills and emotions of 5 years old children. The AECD data is publically available and although it is not primarily used for knowledge exchange, it certainly facilitates it by enabling key stakeholders in early years to work with the data in order to improve child development outcomes.

Theodora (left) with Jen Lorains
Jen’s presentation was interesting on a number of levels but from a PhD researcher’s point of view, two things were most striking. First of all, thinking about child development assessments in diverse populations, I felt that Australia and the UK are not as different as I thought. In Australia, diversity exists mainly between indigenous and non-indigenous populations. Indigenous Australians have their own language, rituals and beliefs, which in early years and education settings can be challenging to deal with. Although, diversity in the UK is different and not as clear cut with many different cultures calling the country their home, diversity is also an issue over here and is now perhaps more prominent than ever. With that in mind, I was wondering, how fair (or accurate for that matter), is it to collect data on child development from all 5 years old children in English? Isn’t it possible that an indigenous child has good communication skills but in a different language? Of course, this cannot necessarily be taken into consideration in a national census. But surely that begs the question, are we classing children as having delayed development when perhaps we shouldn’t?

The second thing that got my attention was the issues with knowledge exchange in Australia that Jen discussed. She talked about how different professionals use the data and how challenging it is to have everyone on board when trying to develop common approaches to help children in areas where vulnerable children are identified as different professionals identify different solutions for highlighted problems. As my PhD focuses on systems change and developing a common approach between early years’ professionals, I again, thought about the similarities between Australia and the UK. Perhaps foolishly (I am only a year into my PhD!) I thought that these issues are a UK phenomenon, however, I quickly realised during Jen’s presentation that they are not.

Intrigued by these observations, I started talking to Jen after the seminar (and because Jen had an hour and a half to kill before her train) we decided to go for a drink after her seminar. Although some people might disagree, I thought that the pub was a great setting for knowledge exchange! We discussed my and her thoughts having travelled to the UK, USA, Canada and Peru, and realised that using research data with different communities in these counties requires researchers to be skilled in knowledge exchange. This will enable researchers to include these communities in interpreting the data and developing useful interventions with these communities. This might sometimes feel like fighting a lost battle but is essential to support vulnerable children identified through collected census data.

Thursday, 17 March 2016

Obesity: many perspectives, no magic solution

Lorraine McSweeney, Research Associate, Newcastle University

To coincide with Nutrition and Hydration week Lorraine reports back from the Westminster Food and Nutrition Forum.

On the 9 March I attended a Westminster Food and Nutrition Forum titled: ‘Next Steps on Policy for Obesity - Prevention, Sugar Consumption and Priorities for Children’s Health’. The original purpose of the forum was to discuss the Government’s childhood obesity strategy. However, as publicised in the Guardian on the 26 February, this has been delayed; with the Department of Health calling it a ‘complicated issue’ that they want to ensure is a ‘game changing moment’. Despite the strategy delay the forum went ahead to allow ‘experts’ in the field to share ideas and possible approaches for the strategy.

Speakers and panel members were a diverse group ranging from Public Health England (PHE); School Food Plan; Southampton Health and Wellbeing Board; Children’s Food Trust; ukactive kids; Family Lives; primary care; Advertising Standard’s Authority; British Retail Consortium; Kantar World Panel; Food and Drink Federation; and London Food Board… the list goes on...

The McLympics - advertising and sponsorship
PHE stated that the average diet in the UK is poor with too much saturated fat and sugar and too little fibre, fruit and vegetables. This is having a knock-on effect on our children, with one in five primary school kids overweight or obese, by the time children leave primary school, this figure rises to one in three. Contrary to popular belief, this is not just an issue of poverty; obesity is happening in both the most and least affluent areas. We are bombarded with opportunities to eat 24 hours a day and there are many drivers to buy and eat. Advertising and sponsorship, which some people don’t associate with advertising, can have a negative impact on child health.

The Chief Executive Officer from the Children’s Food Trust argued that good food should be a part of a child’s life from day one, right through their life. Food should not be tailored to be ‘child-friendly’. Children should be encouraged to eat smaller portions of adult food and should not be targeted by the food industries. Parents need to be listened to and families should be helped to cook more.

The need to get children moving more was discussed and included comments about modern life not encouraging children to be active; and schools too scared to work with parents and tell them how to keep their children active. It was stated that only a third of children enjoy sports and other solutions need to be encouraged. The primary care representative felt that too many patients are being treated with the consequences of obesity. She believes that primary care professionals are missing opportunities to discuss weight with parents; however, GPs reported not wanting to cause offence and felt they did not have the time to deal with the issues.

An overarching theme from the ‘health’ representatives was that prevention is key and that the food industry was part of the problem and should be involved in solving the problem. We were informed that in an average supermarket consumers have 30,000 products to choose from and consumer change is very hard to drive.

The impact of volume of sales of products such as sugar and bread, which have no immediate substitute, are shown not to be affected by price rise. The introduction of a sugar tax was highly debated; some felt it would not change consumer behaviour, whilst others argued it would offer one solution. However, following the success of the reformulation of products to reduce salt and saturated fat, it was agreed that the reformulation of products containing sugar could be a way forward. However, representatives from the food and drink industries stated that sugars would be more difficult as it has a structural function in food.

In addition, if a product was made ‘healthier’ consumers may be inclined to eat more of the product but it was agreed that alongside reformulation, portion size control could be beneficial. There was much discussion of whether legislation should be enforced on food and drink companies – the representatives believed that due to diversity of companies, a voluntary approach was better. However, it was argued that ‘if consumers continued to make incorrect choices – legislation was all that was left’.

As you can see from this very brief summary, obesity continues to be a very complex issue; it was thought-provoking to hear the different perspectives from health, policy, practice and industry. However, the discussions emphasised the point that there is no magic solution; the publication of the Government’s childhood obesity strategy is eagerly awaited.

Photo attribution:, Santo Chino, "McLympics":