The contested nature of third sector organisations

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Increasing uptake of FIT colorectal screening: protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool

INTRODUCTION: Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening. METHODS AND ANALYSIS: A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50-74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants. ETHICS AND DISSEMINATION: The study has been approved by the National Health Service South Central-Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results. TRIAL REGISTRATION NUMBER: clinicaltrials.govNCT05408169

Increasing uptake of FIT colorectal screening : protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool

Funding: This study is supported by an Early Diagnosis Advisory Group (EDAG) Project Grant from Cancer Research UK (C9227/A27877 - Increasing uptake of faecal immunochemical test (FIT) bowel screening: trial of providing a suggested deadline for FIT kit return, PI KAR, Co-investigators: CMC, AM, GJH, RJCS) and by a Response Mode Grant from the Scottish Chief Scientist Office (HIPS/17/23 - Increasing uptake of bowel cancer screening: development of a FIT planning support tool, PI: KAR, Co-investigators: SM, REOC, RCOC, AI, RJCS, MK).Introduction Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening. Methods and analysis A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50–74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants. Ethics and dissemination The study has been approved by the National Health Service South Central—Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results. Trial registration number clinicaltrials.govNCT05408169.Publisher PDFPeer reviewe

Prebiotic effects: metabolic and health benefits

The different compartments of the gastrointestinal tract are inhabited by populations of micro-organisms. By far the most important predominant populations are in the colon where a true symbiosis with the host exists that is a key for well-being and health. For such a microbiota, 'normobiosis' characterises a composition of the gut 'ecosystem' in which micro-organisms with potential health benefits predominate in number over potentially harmful ones, in contrast to 'dysbiosis', in which one or a few potentially harmful micro-organisms are dominant, thus creating a disease-prone situation. The present document has been written by a group of both academic and industry experts (in the ILSI Europe Prebiotic Expert Group and Prebiotic Task Force, respectively). It does not aim to propose a new definition of a prebiotic nor to identify which food products are classified as prebiotic but rather to validate and expand the original idea of the prebiotic concept (that can be translated in 'prebiotic effects'), defined as: 'The selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host.' Thanks to the methodological and fundamental research of microbiologists, immense progress has very recently been made in our understanding of the gut microbiota. A large number of human intervention studies have been performed that have demonstrated that dietary consumption of certain food products can result in statistically significant changes in the composition of the gut microbiota in line with the prebiotic concept. Thus the prebiotic effect is now a well-established scientific fact. The more data are accumulating, the more it will be recognised that such changes in the microbiota's composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health. The review is divided in chapters that cover the major areas of nutrition research where a prebiotic effect has tentatively been investigated for potential health benefits. The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system. Confirming the studies in adults, it has been demonstrated that, in infant nutrition, the prebiotic effect includes a significant change of gut microbiota composition, especially an increase of faecal concentrations of bifidobacteria. This concomitantly improves stool quality (pH, SCFA, frequency and consistency), reduces the risk of gastroenteritis and infections, improves general well-being and reduces the incidence of allergic symptoms such as atopic eczema. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Promising beneficial effects have been demonstrated in some preliminary studies, including changes in gut microbiota composition (especially increase in bifidobacteria concentration). Often associated with toxic load and/or miscellaneous risk factors, colon cancer is another pathology for which a possible role of gut microbiota composition has been hypothesised. Numerous experimental studies have reported reduction in incidence of tumours and cancers after feeding specific food products with a prebiotic effect. Some of these studies (including one human trial) have also reported that, in such conditions, gut microbiota composition was modified (especially due to increased concentration of bifidobacteria). Dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase Ca absorption as well as bone Ca accretion and bone mineral density. Recent data, both from experimental models and from human studies, support the beneficial effects of particular food products with prebiotic properties on energy homaeostasis, satiety regulation and body weight gain. Together, with data in obese animals and patients, these studies support the hypothesis that gut microbiota composition (especially the number of bifidobacteria) may contribute to modulate metabolic processes associated with syndrome X, especially obesity and diabetes type 2. It is plausible, even though not exclusive, that these effects are linked to the microbiota-induced changes and it is feasible to conclude that their mechanisms fit into the prebiotic effect. However, the role of such changes in these health benefits remains to be definitively proven. As a result of the research activity that followed the publication of the prebiotic concept 15 years ago, it has become clear that products that cause a selective modification in the gut microbiota's composition and/or activity(ies) and thus strengthens normobiosis could either induce beneficial physiological effects in the colon and also in extra-intestinal compartments or contribute towards reducing the risk of dysbiosis and associated intestinal and systemic pathologies

Beyond The Gap:Placing Biodiversity Finance in the Global Economy

Governments and conservation organisations often point to a large gap between existing financial resources and the resources needed to achieve biodiversity objectives. But the gap is almost always presented without context, as though biodiversity loss will be resolved through increased funding alone. To illuminate crucial pathways for transformative change, this report examines the political and economic dimensions of biodiversity loss. “Beyond the gap: placing biodiversity finance in the global economy” addresses two questions: how does the organization of the global economy drive biodiversity loss, and how has existing biodiversity finance performed? Trade, investment and financial regulation (or lack thereof), global economic pressures that push biodiverse countries into debt, and inequality across racialized, gender, class and colonial lines, all drive biodiversity loss and require urgent attention. Instead of transformation, a series of voluntary measures and market-based mechanisms such as payments for ecosystem services or blended finance schemes have been presented as tools to span the resource gap. This report shows that these efforts are marginal at best, and, at worst, entrench the power of rich world governments and non-state institutions like banks, large international NGOs, and supranationals. It is apparent that we must move “beyond the gap”. Only by placing biodiversity loss in the global economy will it be possible to realize transformative, inclusive and equitable change. The authors offer concrete recommendations for negotiators, civil society organizations, and activist groups to push questions of biodiversity finance beyond the gap

Creating Conditions for Harnessing the Potential of Transitions to Agroecology in Europe and Requirements for Policy

Food systems require reorientation to take greater account of interactions with the environment, economy, health and society. Transitions to agroecological farming practices and systems can connect policy areas and realise environmental, economic and social aims. These transitions provide a lens for reviewing policy, practice and behaviours of actors in farming systems and value chains, identification of barriers to uptake, and policy areas to which they contribute or where there are gaps. Developing social and human capital, and governance structures that enable transitions to agroecology are key to their prospects of success. Education and life-long learning are key to developing the knowledge and skills of younger generations of land managers and other actors in value chains, throughout their careers. The outcome sought is for a shared understanding of the benefits of agroecological practices and systems, creating opportunities to rebalance policies towards delivering climate neutrality, reversing biodiversity loss, and enhancing rights of citizens. To realise those opportunities policies and strategies should be coherent across territorial and systems levels, and tailored to place, system, people, and stages of transitions. Overall, they should be designed to ensure all citizens are beneficiaries of transitions to agroecological farming systems, over the long term, and that no-one or place is disadvantaged by the processes of change or the outcome intended.</p