Final day of British Council sponsored ‘Researcher Links’ workshop in Montevideo, Uruguay

The final day’s first session had various speakers covering career development, applying for grants, publications and work with the media.

Career development advice included the advantages of:

– Mentorship
– Being part of a strong research team or network
– Having a key area of expertise
– Having the opportunity to teach as well as conduct research.
– Recognise the importance of publications
– Having a clear vision of one’s progress in 5-10 years time International collaborations are seen as increasingly important and are one measure of the World University rankings.

UK funding opportunities for collaborative work include the following from Cancer Research UK:

– Cancer Research UK/BUPA initiative
– CRUK Tobacco Advisory Group
– CRUK Population Research Committee
– CRUK innovation workshops for pilot work – held on regular basis (next opportunity in April 2016).

These are all regarded important in academic career development. Other funders were highlighted by the British Council (below) and in discussions.

Fernando Althabe then spoke about the Trial Funding Tool, developed by an EC support collaboration, the tool is a web-based ‘help’ application to guide researcher from initial idea to funding. The tool contains advice from many experts in the field.

Michael Ussher gave advice on preparing grant applications:

– Be aware of funder remits and priority areas
– Emphasise the impact for public health (e.g. how will be findings be applied; highlight cost saving; how straightforward is the intervention to implement etc)
– Focus on one application at a time
– Collaborate effectively
– Don’t assume whoever reads the proposal that they will know about the topic
– Have publications and even titles of papers in mind when you write the proposal
– Participate in funding panels and/or as a reviewer of proposals
– Interpret referee comments carefully
– Have a back-up plan if the application is rejected Public involvement can improve proposals considerably and funders like this approach.

User panels are common and UKCTAS has a smokers panel and alcohol discussion group.

Alicia and I
Linda Bauld and Alicia Aleman at the farwell lunch.

More details at ukctas.net/public-engagement.html

Laura Lambi then offered comprehensive advice on writing for publication, mentioning several websites that can assist the process. Researchers in the fields of tobacco and alcohol research are likely at one point to come into contact with the media. For ‘breaking’ research stories, telephone and face-to-face interviews on live or recorded broadcast are common.

Sally Marlow offered advice on dealing with this, and emphasised the importance of preparation. For example, preparing for the likely/actual questions, and speaking conviction were two of the recommendations. Others includes being honest, using lay words (not jargon), considering the audience, and thinking about getting 3 key messages to get across.

Topics for future collaborations

Group A – consisting of presentation groups 1 and 3, and Group B – consisting of presentation groups 2 and 4, met to discuss future collaborative work.

The following lines of enquiry were suggested, among others:

1. Secondary analyses of existing datasets. The UK has ALSPAC (Avon Longitudinal Study of Parents and Children) and there are two datasets available in Uruguay. The ESRC’s secondary data analysis scheme was signalled as appropriate.

2. Carbon monoxide screening in Uruguay in antenatal care – Laura and colleagues are interested in this. Similarly, there is a professional training course in the UK from the NSCST that could be translated.

3. Attitudes to smoking and smoking cessation. Both country colleagues are interested in this and the intention is to share tools developed for previous UK studies.

4.Alcohol use in students and young people. Several UK researchers have an interest in this area, particularly in relation to later school and university students. Alcohol Research UK may be an appropriate call. An suggestion is to roll out the FREE PASS intervention (mentioned by Gabriel Rossi on Day 2) in other parts of Uruguay, and consider pilot workin the UK.

5. Preventing relapse back to smoking following pregnancy. Consider using the ASSIST model in the UK, involving use of ‘mentors’ to assist women to stop smoking or drinking. The use of ‘mother-baby’ groups was mentioned as a recruitment channel.

6. Alcohol brief interventions in young people. Several colleagues were interested in the topic of drinking in young people/students, and this could be collaboratively developed in both countries – existing UK research and links were highlighted

7. Validation of existing measures of smoking cessation and behaviour.

8. Smoking and alcohol use among health professional and social care workers. To assess level of prevalence of smoking/drinking in groups delivering interventions.

9. Biomarkers of alcohol use in pregnancy

10. Visits to emergency departments due to intoxication. Has this been examined in Uruguay? UK HES data is available.

11. Predictors of return to smoking and tobacco dependence in pregnancy. CRUK or other funders may be interested in funding this line of enquiry.

12. Risks associated with low consumption of alcohol in pregnancy

13. Text messaging for smoking cessation. It was however mentioned that resources limitations may be an issue particularly in Uruguay.

Valentina Gomez-Fletcher from the British Council rounded off the workshop by a resume of the funding opportunities available for international collaborations which may well be suitable for this group. There is a potential Uruguay-Brazil-UK British Council programme which will be launched in the summer, which the group would be eligible to apply for.

More relevant tweets:

Day three of the ‘Researcher Links’ workshop in Montevideo, Uruguay

Day 3 got underway with a selection of video clips from international experts in the field of implementation theories;

Professor Nick Sevdalis, Professor of Implementation Science at Kings College London to explain aspects of implementation science and why it is important:

Professor Brendan MacCormack, Queen Margaret University, Edinburgh, described the PARiHS framework:

PARiHS translates to “Promoting Action on Research Implication in Health Services“. It is a framework that considers the evidence an intervention is based on, the context on where it is to be applied and how it can be facilitated in practice (i.e. how to make it easier for the practitioners who will apply intervention). These can be formed into a ‘cube’ to determine how we can get forms of evidence into practice.

Professor Margaret Maxwell, University of Stirling, described the RE-AIM framework alongside Realist Evaluation:

RE-AIM represents Reach, Effectiveness, Adoption, Implementation, Maintenance.  The R and E consider individual effects of implication, A and I are concerned with the effects on the organisation and the M applies to either individual or organisation.

These videos were interspersed with talks from Mercedes Colombar and Kirsty Loudon. Mercedes described the range of implementation theories available. For more information see this Nilsen article.

Kirsty described the PRECIS-2 (www.PRECIS-2.org), developed as part of Kirsty’s PhD thesis and is being used by several parties including the National Institutes of Health in the USA. In the UK the NIHR are considering use of the tool to apply to their pragmatic trials.

PRECIS-2 is an acronym for Pragmatic, Exploratory, Continuum, Indicator, Summaries and can be used as a tool to assist the applicability of trials.

A later discussion highlighted that this framework can be used to highlight research that is likely to be implemented. More information can be found in this BMJ article.

There followed a discussion relating to how participants had used frameworks previously in their research and practice. PRIME theory was mentioned, this theory, developed by Professor Robert West at UCL, is one of the most popular theories that can be applied to addiction (primetheory.com).

One element is concerned with identity – for example, if a smoker identifies him/herself as a smoker, this will make it difficult to quit smoking; however if the smoker starts to identify him/herself as a non-smokers (e.g. through association with non-smokers, identifying as another role in life) then this will greatly aid any quit attempt.

The session ended by those present splitting into two groups, each with tobacco and alcohol researchers.

These groups discussed areas for future collaborations and these discussions were continued on Day 4…

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Summary of day two of the #ukctasMVD researcher links workshop in Uruguay

On day two of the workshop we discussed interventions to reduce tobacco and alcohol use in pregnancy. Michael Ussher and Laura Lambi gave overviews of the situation in tobacco, and Sally Marlow and Gabriel Rossi described the situation as it stands for alcohol.

Interventions to reduce smoking include:

  • Pharmacotherapy
  • E-cigarettes
  • Financial incentives
  • Exercise

Each has varying levels of success, however exercise appears not to be effective for pregnant smokers as having to take additional exercise is often seen as an addition burden on women already struggling to adapt to being pregnant. No clear evidence on e-cigarettes in pregnancy exists to date but this is an important area for research in countries were they are available.

Psycho-social interventions include:

  • Counselling
  • Feedback
  • Social support
  • Health education
  • Internet
  • Telephone Quitlines

Again, each has varying levels of success, often depending on the context/country of delivery. The key message is that when interventions are combined (multiple) or tailored to specific groups, these are more likely to be effective.

Laura added that in Uruguay when interventions involve a group context these tend not to be popular, as it involves exposure to others, so we need to be determine whether interventions will be ‘culturally acceptable’.

Sally Marlow then gave some background into the topic of alcohol use and misuse. Alcohol use has been classified into 3 terms:
‘Hazardous drinking – the lowest end of the spectrum, and can be within ‘safe’ levels
‘Harmful drinking’ – this falls above safe levels, and can cause harm
‘Dependence’ – signifying addiction to alcohol, this is the most complex of the definitions.

It is important to realise that ‘alcohol use disorders’ does not just relate to consumption, but also patterns of drinking and the effect on a person’s life.

It is difficult to assess the levels of harmful drinking in pregnancy merely from the use of maternal self-report and study of animal models.

Gabriel Rossi then covered recent policy developments in Uruguay and explained a draft bill in 2008 with various alcohol control measures was not debated in parliament, partly or mostly due to industry lobbying. However, in 2016 the Presidential Commission will debate tax and advertising and the regulation of times when alcohol can be sold. Additionally, the Ministry of Health plans to introduce education campaigns on the dangers of excessive drinking.

In South America, consumption is highest in Argentina, Chile and Uruguay. In Uruguay, alcohol is a problem in youth, with a study showing that nearly 1 on 4 high school students had experienced intoxication in the previous 14 days, while the average age this group started drinking was 12.8 years of age. Alcohol remains the most popular drug in this group, followed by marijuana, energisers (energy drinks) and tobacco.

With regard to UK population-based interventions, Sally proceeded to summarise the recommendations from the University of Stirling and the Alcohol Health Alliances’ Health First (2013) report which examined evidence for population-based policies.

Poor progress has been made in current UK policy.

There has been resistance to minimum unit pricing, with pressure from the alcohol industry and the UK Government have backtracked on a pledge to introduce it. Scotland has made progress with reduced drinking limits for drivers but no change is expected in the other UK regions of England, Wales and N Ireland (although a private members bill is being considered in the House of Lords).

Funding for alcohol treatment services has been cut, and in some cases alcohol has been amalgamated into drug treatment services that may deter some potential users needing support.

The most relevant policies include:

1) Early identification of alcohol dependency and brief advice

2) Access to specialist alcohol services for those who need it.

However, ‘one size does not fit all’ applies here, as pregnant women vary in socio-economic status and other demographics, level of alcohol addiction and age, and it may require several interventions to effectively reduce alcohol use. Indeed, interventions may need to be different for each level of alcohol misuse – any, hazardous, harmful and dependency.

There is also the stigma of being known by medical services in fear of social services or similar agency removing the woman’s children.

New recommended safe drinking guidelines in the UK were introduced in January 2016, where pregnant women are advised to avoid alcohol completely.

The World Health Organisation have published guidelines on substance use in pregnancy, that includes alcohol, and for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy. Linda Bauld and Fernando Althabe briefly described these guidelines, which have 18 and 9 recommendations respectively, with varying levels of evidence attached to each. These recommendations are highly applicable to implementation science.

The workshop participants were then split into four groups – two for alcohol, two for tobacco, where each presented an aspect of their work, followed by discussion, which was then relayed back to the whole group at the end of the day’s programme.

Post written by Graeme Docherty and Linda Bauld.

‘Researcher links workshop gets underway in Uruguay! – Smoking/Alcohol use in Pregnancy’

Following a successful grant application, a group of UKCTAS researchers, have in collaboration with colleagues in Uruguay’s University of the Republic organised a workshop to explore how research into smoking and alcohol use in pregnancy can be used to develop and implement effective policies to curb the use of these substances, which remain a problem in many parts of the world, including the UK and Uruguay.

The workshop took place in the Hygiene Institute (part of the University’s medical faculty) in Montevideo on 22-25 February 2016.

Day 1 of the workshop was opened by Professor Alicia Aleman, the Uruguayan coordinator, with short talks from the Dean of the Medical School and representatives from the British Council and British Embassy, both having contributed funding to the event. Each emphasised the public health importance of tobacco and alcohol use in pregnancy, and in order to strengthen health policies, it was important to have international collaborations, and it was the aim of this workshop to create and strengthen such links between the UK and Uruguay.

 

Each of those present were asked to introduce themselves, demonstrating a variety of backgrounds and experience to enrich the workshop,  with expertise split fairly evenly between tobacco and alcohol.

Professor Linda Bauld, the UK coordinator, then explained the aims and objectives of the workshop. Although there has been success at the population level, progress has been slow in the area of pregnancy and this is especially a problem in poorer communities in both countries. This was also an opportunity to utilise the wider UK Centre for Tobacco & Alcohol Studies (www.ukctas.net), a strategic network of tobacco and alcohol researchers, which opens further collaboration opportunities in the UK.

The main objective of the workshop is to apply implementation science frameworks and theories to participants’ area of interest to encourage:

– Collaborations
– Joint publications
– Commentaries
– Policy work

It is intended this will lead to:

1) increased knowledge and awareness among the participants.

2) facilitate the development of future proposals.

3) the formation of a UK/Uruguay research network.

A light hearted quiz on tobacco and alcohol in pregnancy followed, which in itself was informative, especially for those with little experience of one of these topics.

One of the objectives of the workshop is to identify frameworks and theories than could assist with successful implementation of interventions. This is sometimes known as ‘implementation science’.  In his talk, Professor Fernando Althabe  from the Institute of Clinical Effectiveness and Public Health in Buenos Aires gave an introduction to implementation science in the context of maternal health.

He began by briefly describing the situation in Latin America in relation to pregnancy and birth facilities; with 75% living in urban areas, 84% of pregnant women have more than 4 antenatal visits from midwives. Unlike the UK where midwives mostly attend the deliveries, in Uruguay a physician is normally present. 90% of deliveries are within public health facilities and the caesarean section rate is around 35%, which is higher than in the UK.

Fernando then raised the following questions:
– How do we get policymakers to put recommendations into practice?
– What are the best ways of utilising an effective intervention?,

He added that it was important to study methods to promote the uptake of research findings.

He also provided a useful summary of the various terms used to describe implementation research. The terminology can vary in different parts of the world – including quality improvement research, knowledge translation and dissemination research but all these terms relate to a similar approach. Particular ‘areas’ of research often have a strong focus on implementation including health services and health systems research. He concluded by reflecting on why focusing on implementation is so important to reducing smoking and harmful use of alcohol as we often have the evidence but simply don’t use it or learn how to apply (or not apply) it in health and care practice.

The remainder of day 1 focused on an overview of tobacco and alcohol use internationally and then in more detail on figures from the UK and Uruguay presented by Linda Bauld, Alicia Aleman and Sally Marlow.

Participants attending from the UK and Uruguay then had an opportunity to present their own research, with day 1’s break out sessions focusing on the causes and consequences of tobacco and alcohol use in pregnancy. The work presented varied from lab-based studies on biomarkers to surveys and cohort studies and qualitative research. A lively discussion followed each session on similarities and differences between the UK and Uruguay as well as reflections on evidence from other countries.

More to follow as the week goes on!

Follow the workshops progress on twitter using #ukctasMVD