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Supporting policy through research funding: how UK funders can use Areas of Research Interest to bridge evidence gaps.
Get PDFBACKGROUND: Supporting the use of research evidence in policy making is a perennial challenge. A key theme in the literature is the importance of the production and mobilisation of research that is relevant to policy needs. Areas of Research Interest (ARIs) are an example of a UK government lever designed to support the production of policy-relevant research. The often-overlooked role of research funders in this process forms the focus of this article.
AIMS AND OBJECTIVES: This article looks at the ways in which ARIs act as a mechanism for negotiation and interaction between government and research funders in order to mobilise existing research and to connect government research interests with the priorities of research funders.
METHODS: Thirty semi-structured interviews were conducted with academic researchers, research funders, government officials and knowledge mobilisers.
FINDINGS AND DISCUSSION: ARIs provide a systematic and transparent set of policy research needs which can be used to support cross-government discussions to inform funding processes, both in terms of new research investments and mobilising existing funded research. While funders were committed to knowledge mobilisation, they can lack the skills and capacity required to implement it effectively. That is not to underestimate the volume of time and work required to support this process. While technical developments are likely to help, we argue that this will need to be complemented by a significant amount of relational work to understand and engage with the research needs of government officials and to support the interpretation and use of existing research
Minimally invasive surgical resection reduces one-year mortality, especially in high-risk colon cancer patients: an emulated trial.
Get PDFBACKGROUND: Comorbidity, older age, frailty and socioeconomic deprivation are associated with higher risk of complications and death following resection for colon cancer. Minimally invasive surgical (MIS) resection is associated with earlier recovery, fewer postoperative complications and potentially lower early mortality than open surgical (OS) resection. We investigated the likelihood of receiving MIS vs OS resection by patient characteristics, and whether MIS resection reduces mortality after elective resection for colon cancer.
METHODS: We analysed cancer registration data linked to secondary care records of 21,931 patients diagnosed with stage I-III colon cancer in NHS Trusts in England, in 2021 and 2022. We focused on elective operations completed as either MIS resections or OS resections. We used an emulated trial to estimate the impact of MIS resection on one-year mortality (expressed as Average Treatment Effect) compared with OS resection. Inverse-probability-weights with regression adjustment ensured comparability between the surgical groups.
FINDINGS: MIS resection was attempted in 18,264 (83.3% of 21,931) patients and completed in 16,271 (74.2% of 21,931), among whom higher levels of deprivation, frailty, comorbidity and stage at diagnosis were independently associated with lower odds of receiving MIS resection. Observed one-year mortality was 7.7% after OS resection (436 deaths among 5660) vs 2.9% after MIS resection (472 deaths among 16,271). In the emulated trial, the average treatment effect of MIS resection was a reduction in one-year mortality from 6.8% to 3.0%; with the largest absolute reductions among patients aged 85 years or more, frail patients, and those with major comorbidities.
INTERPRETATION: The emulated trial confirms that MIS resection for colon cancer reduces mortality at one year, compared with OS resection. However, patients in higher-risk groups, who were most likely to benefit from MIS resection, were less likely to receive it. The NHS needs to eliminate ongoing inequalities in optimal surgery for colon cancer.
FUNDING: Cancer Research UK C7923/A29018; Medical Research Council MR/T032448/1 and MR/W021021
Beyond trauma: Understanding death encounters in Chinese community health.
Get PDFEncounters with patient death, often seen as traumatic for health professionals, may also drive post-traumatic growth and systemic improvement. This study explores how such experiences transform community health professionals (CHPs) in China. Employing a constructivist grounded theory approach, we conducted a year of non-participant observation and 23 semi-structured interviews with CHPs in Shenzhen. Our analysis produced a psychological-professional-systems model of transformation, which is substantiated by three themes: first, these encounters fostered emotional resilience and deeper human connection, enhancing psychological endurance and relational care; second, CHPs redefined their professional identity, expanding their roles to provide holistic support aligned with person-centred public health; third, witnessing death prompted ethical reflection, shaped by systemic tensions between individual adaptation and structural support. While contextually Chinese, these findings offer transferable insights for workforce resilience and trauma-informed care, highlighting strategies such as resilience training, flexible care models, and ethics-based debriefing
Associations of Albuminuria and Metabolic Syndrome Traits With Fracture Risk in Patients With Type 2 Diabetes: A Population-Based Cohort Study.
Get PDFBACKGROUND: Type 2 diabetes is associated with an increased risk of fragility fractures. While obesity may protect against fractures, individuals with type 2 diabetes often exhibit other metabolic syndrome (MetS) traits and albuminuria. We evaluated their roles and synergistic implications on incident fractures, stratified by obesity status.
METHODS: Patients with type 2 diabetes were identified from territory-wide electronic health records in Hong Kong (2000-2018). MetS-related traits included albuminuria and individual MetS traits (obesity, hypertension, low HDL-cholesterol and hypertriglyceridemia). Outcomes were hip and major osteoporotic fractures (MOF). Patients were followed until fracture, death or 31 December 2020. Adjusted hazard ratios (aHRs) were estimated using multivariable Cox models.
RESULTS: Among 165 289 patients with type 2 diabetes (median age: 60.0 years; 54.2% men), 1583 (0.96%) experienced hip fractures, and 3393 (2.05%) had MOF over a median follow-up of 5.3 years. Albuminuria was the strongest risk factor for hip fractures (obese: aHR 1.33, 95% CI 1.11-1.60; non-obese: 1.54, 1.33-1.78) and MOF (obese: 1.13, 1.01-1.26; non-obese: 1.28, 1.15-1.43). Hypertension was a significant risk factor only in non-obese patients. In the non-obese group, each additional MetS-related trait was associated with an increased risk of hip fracture and MOF. When stratified by diabetes duration, albuminuria remained a significant risk factor across different diabetes durations, while suboptimal glycaemic control became a significant risk factor particularly when diabetes duration ≥ 5 years.
CONCLUSIONS: In this large population-based cohort of patients with type 2 diabetes predominantly of Asian descent from Hong Kong, albuminuria emerged as an important predictor of fracture risk. MetS traits compound this risk, especially in non-obese individuals. These findings could be instrumental in shaping screening initiatives for fracture risk optimization in type 2 diabetes
Translation, cross-cultural adaptation and validation of an Afan Oromo version of the Dermatology Life Quality Index in individuals with cutaneous leishmaniasis in Ethiopia.
Get PDFBACKGROUND: The Dermatology Life Quality Index (DLQI) is a widely used instrument to assess the health-related quality of life associated with skin conditions. Afan Oromo is spoken by 40% of Ethiopians. Objectives This study aimed to translate, culturally adapt and validate the DLQI in Afan Oromo. METHODS: This study was nested in a large hospital-based cohort study of cutaneous leishmaniasis (CL). Forward-backward translation followed by content validity, responsiveness to change, known group comparison, and convergent and discriminant validity were done. Internal consistency and inter-rater reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. RESULTS: The DLQI showed acceptable content validity with modified kappa between 0.8 and 1.0. One hundred individuals with confirmed active CL with a mean (SD) age of 36.81 (17.46) years, were interviewed using the translated draft of the Afan Oromo DLQI. The DLQI mean (SD) score was 11.93 (7.32). The instrument showed excellent internal consistency with a Cronbach alpha of 0.87 and inter-rater reliability ICC of 0.96. The median DLQI scores were significantly different between those with different physicians determined severity (P = 0.01) and lesion size (P = 0.004). There was high convergent validity (0.74-0.93). DLQI scores on day 90 were significantly lower than scores at enrolment prior to treatment (P = 0.0001). CONCLUSIONS: This translation of the DLQI to Afan Oromo is a valid and reliable patient-reported outcome measure instrument for research or clinical practice
"We carried her in a wheelbarrow to the clinic": process evaluation of the AMETHIST intervention combining microplanning with self-help groups to improve HIV prevention and treatment among female sex workers in Zimbabwe.
Get PDFBACKGROUND: The Adapted Microplanning to Eliminate Transmission of HIV in Sex Transactions (AMETHIST) randomised controlled trial tested a combination of microplanning (peer-led risk-differentiated support) and self-help groups (SHGs) to reduce the proportion of female sex workers (FSW) at risk of acquiring or transmitting HIV infection in Zimbabwe. The trial found overall high levels of FSW engagement with treatment which further improved in intervention sites. HIV prevention uptake, however, was low and not affected by AMETHIST. METHODS: We conducted a mixed methods process evaluation to assess implementation, explore FSW perceptions, and understand the trial’s outcomes. We integrated routine programme statistics, qualitative data, and an endline respondent driven sampling survey among 4444 FSW to consider fidelity of implementation, feasibility of delivery, and acceptability. We also examined whether the intervention triggered changes hypothesised in its programme theory. RESULTS: Microplanning was successfully introduced, with peers effectively providing risk-differentiated support. Early difficulties related to mapping sex work “hotspots,”, maintaining contact with mobile FSW, and some resistance to regular risk assessments, but double the number of new FSW registered at intervention clinics compared to comparison sites (8443 v 3824), and significantly more HIV tests were performed (11882 vs. 6808). SARS-COV2 disrupted the intervention, particularly SHG. Fewer groups were established than planned, and lockdowns prevented group members meeting in person and participating in collective activities. Nonetheless, 30 of 65 established SHG remained active after two years, and more SHG members registered with clinics than those reached by microplanning alone (82 cv 76% p,0.001). Increased service use did not increase effective prevention. Over 80% FSW reported condomless sex and PrEP adherence was insufficient to achieve protection. Qualitative data show FSW prefer to “wait” until HIV seroconversion before taking daily medication. They feared conflation of ART with PrEP and resulting stigma. Concerns about side effects and immediate financial priorities undermined perceived future benefits of PrEP and condoms. CONCLUSIONS: Strengthening HIV prevention should consider how to improve FSW’s hope and agency alongside reducing stigma and supporting collective rights and action. TRIAL REGISTRATION: The Pan African Clinical Trials Registry registered the trial 2nd July 2020 (PACTR202007818077777) which was after randomisation but before any research data were collected. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14137-6
Airway microbiota in young people across four continents differ by country, asthma status and inflammatory phenotype.
Get PDFBACKGROUND: Asthma is an umbrella diagnosis encompassing distinct pathophysiological mechanisms. While a global problem, our understanding of the interplay between respiratory microbiology and airway inflammation is largely from populations in high-income settings. As a result, treatment approaches align poorly with asthma characteristics in less studied populations. OBJECTIVE: To identify conserved and geographically distinct relationships between airway inflammation and microbiota characteristics in young people with and without asthma. METHODS: We conducted a cross-sectional study performing inflammatory phenotyping, microbiota analysis and enumeration of total bacteria, Haemophilus influenzae and Moraxella catarrhalis on 488 induced sputum samples from participants from Brazil (asthma: 68; non-asthma: 8), Ecuador (asthma: 89; non-asthma: 30), Uganda (asthma: 61; non-asthma: 8), New Zealand (asthma: 129; non-asthma: 58) and the UK (asthma: 25; non-asthma: 20). Microbiota characteristics were compared by country, asthma status and inflammatory characteristics, adjusting for age and sex. RESULTS: Asthma inflammatory phenotypes and microbiology differed between countries, with Uganda characterised by higher neutrophils, microbial diversity and bacterial abundance. Comparison of airway inflammation with microbiota characteristics showed conserved relationships across centres, with airway neutrophil proportion explaining variance in microbiota Bray-Curtis dissimilarity (p<0.001) and being positively associated with bacterial abundance, including H. influenzae and M. catarrhalis load (all p<0.05). In contrast, eosinophil proportion was less strongly associated with microbiota dissimilarity (p=0.033) and only associated with Streptococcus abundance. Country-specific associations between airway inflammation and microbiology were evident. CONCLUSION: Both airway inflammation and microbiology varied geographically in young people with asthma. Associations between microbiota characteristics and neutrophilic phenotype were conserved
Attitudes and practices of researchers on the sharing of genomic data: a qualitative study in Uganda.
Get PDFBACKGROUND: Global genomic data sharing promotes transparency by enabling wider access to data. However, it raises ethical concerns, particularly in collaborations involving low- and middle-income countries. Despite growing emphasis on data sharing, limited research examines how researchers navigate these ethical complexities. This study explored researchers’ attitudes and practices regarding genomic data sharing in collaborative research. METHODS: A qualitative phenomenological design was employed, with key informant interviews (KIIs) conducted between August and December 2023. The study was guided by General Systems Theory (GST) and the Theory of Principlism. GST frames data sharing as part of an interconnected system where multiple components interact within a broader research and governance environment. Principlism offers a lens based on autonomy, beneficence, non-maleficence, and justice. The study was carried out at a university and selected research institutions in Uganda. Institutions and researchers were purposively sampled based on their engagement in genomic research. All interviews were conducted in English, analysed thematically, and managed using NVivo 14. Sixteen KIIs were conducted, with male participants comprising 75% of the sample. RESULTS: Three themes emerged: First, willingness to share genomic data: most participants (11/16) expressed willingness, commonly motivated by altruism and perceived scientific and societal benefits, aligning with beneficence. A few were hesitant to share data due to fears of data or preferred restricted access owing to concerns about misuse and re-identification risks, reflecting non-maleficence. Second, experiences with data sharing varied: participants described both positive and negative experiences shaped by collaborative arrangements, institutional capacity, and governance structures, consistent with a GST perspective. Third, attitudes and practices related to selective data sharing emerged, with some researchers emphasizing institutional mechanisms such as policies and data-sharing agreements to regulate access and use and to uphold fairness and justice. CONCLUSION: This study underscores the complex nature of genomic data sharing, characterised by both enthusiasm and hesitancy. Enthusiasm was linked to the principle of beneficence and hesitancy reflected the principle of non-maleficence both tied to Principlism. The theory served as a reminder that data sharing should be approached with caution. The GST lens highlights the need to strengthen institutional systems and governance frameworks. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12910-026-01386-7
Mathematical modelling of Wolbachia replacement in Aedes aegypti for dengue control: a scoping review.
Get PDFWolbachia replacement in dengue virus vectors is a promising tool for controlling transmission, and models can explore its potential in novel and complex scenarios. We analyse how research questions in Wolbachia replacement modelling have developed over time and in response to empirical findings. A scoping review was conducted of Wolbachia replacement models. For each study, we extracted research questions, key findings and modelling methodology and thematically categorized research questions. From 726 search results, 115 studies met inclusion criteria. Four themes were identified: identifying key Wolbachia characteristics (n = 61, 53.0%), investigating effects of environmental heterogeneity (n = 21, 18.3%), estimating epidemiological impact (n = 25, 21.7%) and exploring Wolbachia replacement in combination with other arboviral control measures (n = 8, 7.0%). Models identify cytoplasmic incompatibility (CI) and maternal transmission (MT) as key for fixation success. However, less than 20% (n = 6) of studies parameterize CI and MT using empirical sources. Although models agree outbreaks may occur with fixation, few explore epidemiological outcomes of heterogeneous Wolbachia fixation or combined vector control. These findings highlight the need for empirical parameterization and incorporating environmental complexity for models to remain insightful for decision-making. Policymakers would benefit from future models exploring heterogeneous coverage and combined control strategies, given evidence of context-specific outcomes and diverse control tools
Scenario-Based Guidance for International Growth Standards (GIGS): For Whom, When, and How to Apply the INTERGROWTH-21st and WHO Child Growth Standards.
Get PDFOBJECTIVE: To demonstrate when, for whom, and how to apply the INTERGROWTH-21st (IG-21st) and WHO Child Growth Standards (WHO GS) using a scenario-based approach with illustrations utilising a sub-set of data from a multi-country low birthweight infant prospective cohort. DESIGN: Scenario-based methodological study illustrating application of existing international growth standards. SETTING: Global; applicable across public health, clinical, research, and epidemiological contexts where child growth monitoring is key. POPULATION OR SAMPLE: Neonates and children under 5 years. METHODS: Scenario-based analyses were illustrated using a sub-set of data from the Low birthweight Infant Feeding Exploration (LIFE) study. Weight-for-age z-scores (WAZ) were computed and compared across two existing international growth standards for illustration. MAIN OUTCOME MEASURES: Differences in infant growth assessment outcomes when applying WHO GS and IG-21st, including effects of gestational age correction, are demonstrated through WAZ trajectories and classification differences across preterm and term infants. RESULTS: Scenario-based analyses showed that applying growth standards inappropriately can substantially misclassify infant growth. The GIGS-recommended approach, using IG-21st at birth and for preterm growth, and WHO GS for term and later postnatal growth, provides consistent and accurate assessment. CONCLUSION: The scenario-based analysis presented in this paper illustrates how growth assessment outcomes can vary depending on the standard used, highlighting the importance of selecting the appropriate growth chart based on gestational age or age at measurement and targeted population. This guidance promotes standardised application of existing international growth standards in research and programmatic settings to facilitate resource allocation and tracking towards global nutrition targets