University of Cambridge - National Institute for Health Research (NIHR)

Deaf opera singer welcomes new Cambridge-led cochlear implant trial

cjb250 — Wed, 06 May 2026 07:34:21 +0000

The UK trial will provide bilateral cochlear implants (cochlear implants on both sides) to some profoundly deaf adults. The results will be used to review NHS guidance for the provision of implants to adults.

Each year over 1,000 adults in the UK receive cochlear implants to restore their hearing. Under NHS guidance, adults currently only receive a single (unilateral) implant, yet evidence suggests having two could offer significant improvements in prospects and quality of life and may now be cost effective.

Janine said: “With bilateral implants, I no longer consider myself to be deaf. They have been utterly life changing and, for me, have broken a generational curse. I am excited that this trial will offer the same opportunity to others.”

Funded by the National Institute for Health and Care Research (NIHR), the trial is being co-led from Addenbrooke’s Hospital and the University of Cambridge. It will run in 14 hospitals and include over 250 adult participants, who will either receive one (unilateral) or two (bilateral) implants. Participants will be monitored for 12 months after surgery to assess the effects of the implants on wellbeing, ability to hear speech in noise, and quality of life. The study will also evaluate the economic benefits and cost of bilateral implants for the NHS.

Called LUCIA, the trial will be co-led by Dr Matthew Smith, an ear, nose and throat (ENT) surgeon at Addenbrooke’s Hospital, and Professor Debi Vickers, a speech and hearing scientist in the Department of Clinical Neurosciences, University of Cambridge, who leads the SOUND Lab.

Professor Debi Vickers, who also co-leads the Devices and Advanced Therapies theme at the NIHR Cambridge Biomedical Research Centre, said: “Children routinely receive bilateral cochlear implants. These can provide 3-dimensional hearing, enabling them to hear more naturally than unilateral, with improved access to sound and better engagement with society.

“Adults tell us, and I agree, that they should be given the same hearing opportunities as children. In turn these will result in reduced social isolation, enriched communication, improved mental health, and better overall quality of life.”

The trial, which is expected to begin recruiting patients in the autumn, has been designed in collaboration with Janine and other patients. By involving individuals with lived experience of cochlear implantation, the researchers aim to measure changes that patients consider to be most important.

The primary trial outcome will reflect participants’ own perceptions of their quality of hearing. The study will also measure common challenges faced by patients, such as listening effort and fatigue, a choice directly based on discussions with patient groups.

Dr Smith, who is also an academic surgeon at the University of Cambridge, said: “We know from giving bilateral implants to children that it can have a transformative effect on their quality of life and interactions with other people. Through this study, we can offer the same opportunity to adults who have become deaf, and understand the potential added value of bilateral cochlear implants, not just in terms of hearing, but also how they enrich quality of life.”

Janine was diagnosed as a teenager with a genetic condition that caused hearing loss and eventually led to her needing hearing aids. For over 30 years she hid her deteriorating hearing and became a well-known mezzo-soprano, performing in operas, operettas and musicals, including at the Royal Opera House in London.

It was only in 2019, after she had retired due to profound hearing loss, that she had cochlear implant surgery, and received bilateral implants partly through personal funding. She said: “Having two implants is lightyears away from just one. Sound quality is so much better, sounds are fuller, clearer, louder and more natural. It’s much easier to tell where sounds are coming from, especially in busy spaces.

“If you’re out in public, it can be hard to follow who is speaking, making joining in with conversations almost impossible. As a result, you have debilitating concentration fatigue at the end of every day.”

Just like at the cinema, multi-directional surround sound is a key part of creating an engaging immersive experience. By comparison, living with one implant can be like listening to life through a single, poor-quality speaker.

She explains: “Struggling to hear can be extremely isolating and many people experience anxiety or depression as a result. The implants are life changing. They reconnect you to the world and most importantly people. Communication is surely the longing of every human heart.

“I also feel safer and more secure having the two implants. I am more aware of and connected to what’s happening in the world around me. And, if anything goes wrong with one of the implants, I’m not suddenly plunged into a world of total silence.”

While hearing aids help people with mild to moderate hearing loss by making sounds louder, they often provide very little benefit for people with severe or profound hearing loss. Cochlear implants bypass the outer, middle and inner ear and send electrical impulses directly to the hearing nerve which carries signals to the brain.

Participants in the trial will need to have become deaf later in life and cannot already have an implant.

People with cochlear implants will also be involved in delivering the trial. They will be specially trained to participate in interviewing trial participants that will be used to measure the impacts of the trial.

Professor Anthony Gordon, Programme Director for the NIHR Health Technology Assessment Programme, which funded the trial, said: "We fund innovative trials like the LUCIA study which explore how advances in technology can help make a positive difference to the day-to-day lives of those affected. This study offers real hope to people with severe hearing loss and the chance of a significant improvement in their quality of life."

Adapted from a press release from Cambridge University Hospitals NHS Foundation Trust

Janine Roebuck, a formerly deaf opera singer who regained her hearing thanks to cochlear implants, has described as ‘life changing’ an upcoming Cambridge-led trial in hearing loss.

We know from giving bilateral implants to children that it can have a transformative effect on their quality of life and interactions with other people. Through this study, we can offer the same opportunity to adults

Matthew Smith

Janine Roebuck

Janine Roebuck as Flora in La Traviata by Verdi at New Sadler's Wells Opera

The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

AI stethoscope can help spot ‘silent epidemic’ of heart valve disease earlier than GPs, study suggests

sc604 — Tue, 10 Feb 2026 10:00:00 +0000

Researchers led by the University of Cambridge analysed heart sounds from nearly 1,800 patients using an AI algorithm trained to recognise valve disease, a condition that often goes undiagnosed until it becomes life-threatening.

The AI correctly identified 98% of patients with severe aortic stenosis, the most common form of valve disease requiring surgery, and 94% of those with severe mitral regurgitation, where the heart valve doesn’t fully close and blood leaks backwards across the valve.

The technology, which works with digital stethoscopes, outperformed GPs at detecting valve disease and could be used as a rapid screening tool in primary care. The results are reported in the journal npj Cardiovascular Health.

“Valve disease is a silent epidemic,” said Professor Anurag Agarwal from Cambridge’s Department of Engineering, who led the research. “An estimated 300,000 people in the UK have severe aortic stenosis alone, and around a third don’t know it. By the time symptoms appear, outcomes can be worse than for many cancers.”

Valvular heart disease affects more than half of people over the age of 65, with around one in ten having significant disease. In its early stages, it is often symptom-free. “By the time advanced symptoms develop, the risk of death can be as high as 80% within two years if untreated,” said co-author Professor Rick Steeds, from University Hospitals Birmingham. “The only current treatment is surgery to repair or replace the valve.”

Currently, diagnosis of valve disease relies on echocardiography, which is the gold standard, but is expensive and time-consuming. Wait times on the NHS can stretch to many months, meaning it cannot be used as a screening tool for the general population.

Doctors may listen to the heart using a stethoscope, but this is not routinely done in short GP appointments, and is known to miss many cases.

“Cardiac auscultation is a difficult skill, and it’s used less and less in busy GP surgeries,” said Agarwal. “That’s a big part of why so many cases of valve disease are being missed.”

The new study – a collaboration between engineers and cardiologists, research nurses and other clinicians from five NHS Trusts – used digital stethoscopes to record heart sounds from 1,767 patients. Each study participant also had an echocardiogram, which was used as a reference.

Rather than training the algorithm to recognise heart murmurs — the traditional diagnostic marker — the researchers trained it directly on echocardiogram results. This allowed the system to learn subtle acoustic patterns that humans might miss, including cases with no obvious murmur.

When tested against 14 GPs who listened to the same recordings, the algorithm outperformed every single one, and did so consistently. Individual GPs varied widely in their judgments, with some prioritising sensitivity and others specificity. The AI delivered reliable results every time and was particularly accurate for severe disease.

The system was designed to minimise false alarms, reducing the risk of overwhelming already-stretched echocardiography services. The researchers say that the technology is not intended to replace doctors, but could be a useful screening tool, helping doctors decide which patients should be referred for further investigation and treatment.

Only a few seconds of heart sound recording is needed, and the test could be carried out by staff with minimal training. “If you can rule out people who definitely don’t have significant disease, you can focus resources on those who need them most,” said Agarwal.

The researchers say that further trials, carried out in real-world GP settings with a diverse group of patients, will be needed before the device can be rolled out to the general population. In addition, they say that more moderate forms of valve disease are more difficult to detect.

However, they say that AI could help address growing pressures on the health service caused by an ageing population.

“Valve disease is treatable. We can repair or replace damaged valves and give people many more years of healthy life,” said Steeds. “But timing is everything. Simple, scalable screening tools like this could make a real difference by finding patients before irreversible damage occurs.”

The research was supported in part by the National Institute for Health Research, the British Heart Foundation, and the Medical Research Council (MRC), part of UK Research and Innovation (UKRI). Anurag Agarwal is a Fellow of Emmanuel College, Cambridge.

Reference:
Andrew McDonald et al. ‘Development and Validation of AI-Enhanced Auscultation for Valvular Heart Disease Screening through a Multi-Centre Study.’ npj Cardiovascular Health (2026). DOI: 10.1038/s44325-026-00103-y

Artificial intelligence could help doctors detect serious heart valve disease years earlier, potentially saving thousands of lives, a new study suggests.

MoMo Productions via Getty Images

Doctor listening to a man's heart with a stethoscope

Yes

One in four patients in vegetative or minimally conscious state able to perform cognitive tasks, study finds

cjb250 — Wed, 14 Aug 2024 21:00:11 +0000

Severe brain injury can leave individuals unable to respond to commands physically, but in some cases they are still able to activate areas of the brain that would ordinarily play a role in movement. This phenomenon is known as ‘cognitive motor dissociation’.

To determine what proportion of patients in so-called ‘disorders of consciousness’ experience this phenomenon – and help inform clinical practice – researchers across Europe and North America recruited a total of 353 adults with disorders of consciousness, including the largest cohort of 100 patients studied at Cambridge University Hospitals NHS Foundation Trust.

Participants had mostly sustained brain injury from severe trauma, strokes or interrupted oxygen supply to the brain after heart attacks. Most were living in specialised long-term care facilities and a few were living at home with extensive care packages. The median time from injury for the whole group was about eight months.

Researchers assessed patterns of brain activation among these patients using functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). Subjects were asked to repeatedly imagine performing a motor activity (for example, “keep wiggling your toes”, “swinging your arm as if playing tennis”, “walking around your house from room to room”) for periods of 15 to 30 seconds separated by equal periods of rest. To be able to follow such instructions requires not only the understanding of and response to a simple spoken command, but also more complex thought processes including paying attention and remembering the command.

The results of the study are published today in the New England Journal of Medicine.

Dr Emmanuel Stamatakis from the Department of Clinical Neurosciences at the University of Cambridge said: “When a patient has sustained a severe brain injury, there are very important, and often difficult, decisions to be made by doctors and family members about their care. It’s vitally important that we are able to understand the extent to which their cognitive processes are still functioning by utilising all available technology.”

Among the 241 patients with a prolonged disorder of consciousness, who could not make any visible responses to bedside commands, one in four (25%) was able to perform cognitive tasks, producing the same patterns of brain activity recorded with EEG and/or fMRI that are seen in healthy subjects in response to the same instructions.

In the 112 patients who did demonstrate some motor responses to spoken commands at the bedside, 38% performed these complex cognitive tasks during fMRI or EEG. However, the majority of these patients (62%) did not demonstrate such brain activation. This counter-intuitive finding emphasises that the fMRI and EEG tasks require patients to have complex cognitive abilities such as short-term memory and sustained concentration, which are not required to the same extent for following bedside commands.

These findings are clinically very important for the assessment and management of the estimated 1,000 to 8,000 individuals in the UK in the vegetative state and 20,000 to 50,000 in a minimally conscious state. The detection of cognitive motor dissociation has been associated with more rapid recovery and better outcomes one year post injury, although the majority of such patients will remain significantly disabled, albeit with some making remarkable recoveries.

Dr Judith Allanson, Consultant in Neurorehabilitation, said: “A quarter of the patients who have been diagnosed as in a vegetative or minimally conscious state after detailed behavioural assessments by experienced clinicians, have been found to be able to imagine carrying out complex activities when specifically asked to. This sobering fact suggests that some seemingly unconscious patients may be aware and possibly capable of significant participation in rehabilitation and communication with the support of appropriate technology.

“Just knowing that a patient has this ability to respond cognitively is a game changer in terms of the degree of engagement of caregivers and family members, referrals for specialist rehabilitation and best interest discussions about the continuation of life sustaining treatments.”

The researchers caution that care must be taken to ensure the findings are not misrepresented, pointing out, for example, that a negative fMRI/EEG result does not per se exclude cognitive motor dissociation as even some healthy volunteers do not show these responses.

Professor John Pickard, emeritus professorial Fellow of St Catharine's College, Cambridge, said: “Only positive results – in other words, where patients are able to perform complex cognitive processes – should be used to inform management of patients, which will require meticulous follow up involving specialist rehabilitation services.”

The team is calling for a network of research platforms to be established in the UK to enable multicentre studies to examine mechanisms of recovery, develop easier methods of assessment than task-based fMRI/EEG, and to design novel interventions to enhance recovery including drugs, brain stimulation and brain-computer interfaces.

The research reported here was primarily funded by the James S. McDonnell Foundation. The work in Cambridge was supported by the National Institute for Health and Care Research UK, MRC, Smith’s Charity, Evelyn Trust, CLAHRC ARC fellowship and the Stephen Erskine Fellowship (Queens’ College).

Reference
Bodien, YG et al. Cognitive Motor Dissociation in Disorders of Consciousness. NEJM; 14 Aug 2024; DOI: 10.1056/NEJMoa2400645

Adapted from a press release from Weill Cornell Medicine

Around one in four patients with severe brain injury who cannot move or speak – because they are in a prolonged coma, vegetative or minimally conscious state – is still able to perform complex mental tasks, a major international study has concluded in confirmation of much smaller previous studies.

When a patient has sustained a severe brain injury, there are very important, and often difficult, decisions to be made by doctors and family members about their care

Emmanuel Stamatakis

Witthaya Prasongsin (Getty Images)

Male patient in a hospital bed - stock image

Acknowledgements

The multidisciplinary Cambridge Impaired Consciousness Research Group, led by Emeritus Professors John Pickard (Neurosurgery) & David Menon (Anaesthesia) and Drs Judith Allanson & Emmanuel A. Stamatakis (Lead, Cognition and Consciousness Imaging Group), started its research programme in 1997, partly in response to emerging concern over the misdiagnosis of the vegetative state. This pioneering work has only been possible by having access to the world class resources of the Wolfson Brain Imaging Centre, the NIHR/Wellcome Clinical Research Facility at Addenbrooke’s Hospital, the MRC Cognition and Brain Sciences Unit (Professors Barbara Wilson & Adrian Owen), the Royal Hospital for Neuro-disability (Putney) and the Central England Rehabilitation Unit (Royal Leamington Spa).

Yes

Ultra-processed food makes up almost two-thirds of calorie intake of UK adolescents

cjb250 — Wed, 17 Jul 2024 01:30:13 +0000

The study found that UPF consumption was highest among adolescents from deprived backgrounds, those of white ethnicity, and younger adolescents.

UPFs are food items that are manufactured from industrial substances and contain additives such as preservatives, sweeteners, colourings, flavourings, and emulsifiers. UPFs vary greatly, but tend to indicate poor dietary quality, with higher levels of added sugars, saturated fat, and sodium, as well as decreased fibre, protein, and micronutrient content. They have been suggested as one of the key drivers of the global rise in diseases such as obesity, type 2 diabetes, and cancer.

Globally, the availability and sales of UPFs have increased over time and previous evidence suggests that this has led to increased consumption among adolescents. To look at trends within the UK, researchers from Cambridge and Bristol analysed data from four-day food diaries of almost 3,000 adolescents in the UK National Diet and Nutrition Survey between 2008/09 and 2018/19.

In research published today in the European Journal of Nutrition, the researchers found that a mean of 66% of adolescents’ energy intake came from UPF consumption during this period, though there was a slight fall from 68% to 63% between 2008/09 and 2018/2019.

Parents’ occupation, ethnic group and UK region all influenced the proportion of calorie intake from UPFs:

Adolescents from disadvantaged backgrounds consumed a higher proportion of their calorie intake from UPFs compared to adolescents from less disadvantaged backgrounds (68.4% compared with 63.8%).
Adolescents from a non-white ethnicity consumed a lower proportion of their calorie intake from UPFs (59.0% compared with 67.3%).
Adolescents living in the North of England consumed a higher proportion of their calorie intake from UPFs compared with those living in the South of England and London (67.4% compared with 64.1%).
18-year-olds consumed a lower proportion of their calorie intake from UPFs compared with 11-year-olds (63.4% compared with 65.6%).

Dr Yanaina Chavez-Ugalde from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, the study’s first author, said: “Adolescents’ food patterns and practices are influenced by many factors, including their home environment, the marketing they are exposed to and the influence of their friends and peers. But adolescence is also an important time in our lives where behaviours begin to become ingrained.

“It’s clear from our findings that ultra-processed foods make up the majority of adolescents’ diets, and their consumption is at a much higher level than is ideal, given their potential negative health impacts.”

The researchers argue that the observed reduction in UPF intake pre-pandemic could be partly explained by an increased public awareness and health concerns associated with sugar consumption, government-led campaigns, sugar-taxes in other countries and the reformulation of sugary drinks to reduce their sugar content.

Dr Esther van Sluijs from the MRC Epidemiology Unit at Cambridge, joint senior author, said: “Ultra-processed foods offer convenient and often cheaper solutions to time- and income-poor families, but unfortunately many of these foods also offer poor nutritional value. This could be contributing to the inequalities in health we see emerging across childhood and adolescence.”

Dr Zoi Toumpakari from the Centre for Exercise, Nutrition and Health Sciences at the University of Bristol, joint senior author, added: “Our findings suggest that disparities in consumption of ultra-processed foods are not just down to individual choices. We hope this evidence can help guide policymakers in designing more effective policies to combat the negative effects of ultra-processed food consumption among youth and the ripple effects this has on public health.”

This study was largely funded by the National Institute for Health and Care Research School for Public Health Research.

Reference
Chavez-Ugalde, Y et al. Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19. Eur J Nutr; 17 Jul 2024; DOI: 10.1007/s00394-024-03458-z

Adolescents consume around two-thirds of their daily calories from ultra-processed foods (UPFs), new research from the Universities of Cambridge and Bristol has found.

Ultra-processed foods make up the majority of adolescents’ diets, and their consumption is at a much higher level than is ideal, given their potential negative health impacts

Yanaina Chavez-Ugalde

Juanmonino (Getty Images)

Boy eating a burger

Yes

‘Wraparound’ implants represent new approach to treating spinal cord injuries

sc604 — Wed, 08 May 2024 18:01:25 +0000

A team of engineers, neuroscientists and surgeons from the University of Cambridge developed the devices and used them to record the nerve signals going back and forth between the brain and the spinal cord. Unlike current approaches, the Cambridge devices can record 360-degree information, giving a complete picture of spinal cord activity.

Tests in live animal and human cadaver models showed the devices could also stimulate limb movement and bypass complete spinal cord injuries where communication between the brain and spinal cord had been completely interrupted.

Most current approaches to treating spinal injuries involve both piercing the spinal cord with electrodes and placing implants in the brain, which are both high-risk surgeries. The Cambridge-developed devices could lead to treatments for spinal injuries without the need for brain surgery, which would be far safer for patients.

While such treatments are still at least several years away, the researchers say the devices could be useful in the near-term for monitoring spinal cord activity during surgery. Better understanding of the spinal cord, which is difficult to study, could lead to improved treatments for a range of conditions, including chronic pain, inflammation and hypertension. The results are reported in the journal Science Advances.

“The spinal cord is like a highway, carrying information in the form of nerve impulses to and from the brain,” said Professor George Malliaras from the Department of Engineering, who co-led the research. “Damage to the spinal cord causes that traffic to be interrupted, resulting in profound disability, including irreversible loss of sensory and motor functions.”

The ability to monitor signals going to and from the spinal cord could dramatically aid in the development of treatments for spinal injuries, and could also be useful in the nearer term for better monitoring of the spinal cord during surgery.

“Most technologies for monitoring or stimulating the spinal cord only interact with motor neurons along the back, or dorsal, part of the spinal cord,” said Dr Damiano Barone from the Department of Clinical Neurosciences, who co-led the research. “These approaches can only reach between 20 and 30 percent of the spine, so you’re getting an incomplete picture.”

By taking their inspiration from microelectronics, the researchers developed a way to gain information from the whole spine, by wrapping very thin, high-resolution implants around the spinal cord’s circumference. This is the first time that safe 360-degree recording of the spinal cord has been possible – earlier approaches for 360-degree monitoring use electrodes that pierce the spine, which can cause spinal injury.

The Cambridge-developed biocompatible devices – just a few millionths of a metre thick – are made using advanced photolithography and thin film deposition techniques, and require minimal power to function.

The devices intercept the signals travelling on the axons, or nerve fibres, of the spinal cord, allowing the signals to be recorded. The thinness of the devices means they can record the signals without causing any damage to the nerves, since they do not penetrate the spinal cord itself.

“It was a difficult process, because we haven’t made spinal implants in this way before, and it wasn’t clear that we could safely and successfully place them around the spine,” said Malliaras. “But because of recent advances in both engineering and neurosurgery, the planets have aligned and we’ve made major progress in this important area.”

The devices were implanted using an adaptation to routine surgical procedure so they could be slid under the spinal cord without damaging it. In tests using rat models, the researchers successfully used the devices to stimulate limb movement. The devices showed very low latency – that is, their reaction time was close to human reflexive movement. Further tests in human cadaver models showed that the devices can be successfully placed in humans.

The researchers say their approach could change how spinal injuries are treated in future. Current attempts to treat spinal injuries involve both brain and spinal implants, but the Cambridge researchers say the brain implants may not be necessary.

“If someone has a spinal injury, their brain is fine, but it’s the connection that’s been interrupted,” said Barone. “As a surgeon, you want to go where the problem is, so adding brain surgery on top of spinal surgery just increases the risk to the patient. We can collect all the information we need from the spinal cord in a far less invasive way, so this would be a much safer approach for treating spinal injuries.”

While a treatment for spinal injuries is still years away, in the nearer term, the devices could be useful for researchers and surgeons to learn more about this vital, but understudied, part of human anatomy in a non-invasive way. The Cambridge researchers are currently planning to use the devices to monitor nerve activity in the spinal cord during surgery.

“It’s been almost impossible to study the whole of the spinal cord directly in a human, because it’s so delicate and complex,” said Barone. “Monitoring during surgery will help us to understand the spinal cord better without damaging it, which in turn will help us develop better therapies for conditions like chronic pain, hypertension or inflammation. This approach shows enormous potential for helping patients.”

The research was supported in part by the Royal College of Surgeons, the Academy of Medical Sciences, Health Education England, the National Institute for Health Research, MRC Confidence in Concept, and the Engineering and Physical Sciences Research Council (EPSRC), part of UK Research and Innovation (UKRI).

Reference:
Ben J Woodington, Jiang Lei et al. ‘Flexible Circumferential Bioelectronics to Enable 360-degree Recording and Stimulation of the Spinal Cord.’ Science Advances (2024). DOI: 10.1126/sciadv.adl1230

A tiny, flexible electronic device that wraps around the spinal cord could represent a new approach to the treatment of spinal injuries, which can cause profound disability and paralysis.

Because of recent advances in both engineering and neurosurgery, the planets have aligned and we’ve made major progress in this important area

George Malliaras

SEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARY

Illustration of spinal cord

Yes

Report highlights inequalities and hidden suffering among people living with breast cancer

cjb250 — Mon, 15 Apr 2024 22:31:36 +0000

Many people with breast cancer ‘systematically left behind’, say researchers in Lancet Commission led by Professor Charlotte Coles.

UK ‘sugar tax’ linked to fall in child hospital admissions for tooth extraction

Anonymous — Wed, 15 Nov 2023 00:00:45 +0000

In a study published today in BMJ Nutrition, Prevention & Health, researchers at the Medical Research Council (MRC) Epidemiology Unit at Cambridge found that the levy may have reduced the number of under-18s having a tooth removed due to tooth decay by 12%. The largest reductions were in children aged up to nine years old.

Sugar-sweetened drinks account for around 30% of the added sugars in the diets of children aged one to three years and over a half by late adolescence. In England, nearly 90% of all tooth extractions in young children are due to decay, resulting in around 60,000 missed school days a year.

The World Health Organization has recommended a tax on sugar-sweetened drinks to reduce sugar consumption, which more than 50 countries have implemented. In March 2016, the UK Government announced a soft drinks industry levy or ‘sugar tax’, which aimed to reduce sugar intake by encouraging drinks manufacturers to reformulate their products. The levy was implemented in April 2018.

While the relationship between sugar-sweetened drinks and tooth decay is well established, no studies have used real-world data to examine the relationship between the levy and dental health.

To address this, the researchers analysed hospital admissions data for tooth extractions due to tooth decay in children up to 18 years old in England from January 2014 to February 2020. They studied trends overall as well as broken down by neighbourhood deprivation and age groups.

Overall, in children aged 18 and under, there was an absolute reduction in hospital admissions of 3.7 per 100,000 population per month compared to if the soft drinks levy had not happened. This equated to a relative reduction of 12% compared to if the levy had not been introduced.

Based on a population of nearly 13 million children in England in 2020, the researchers estimated that the reduction avoided 5,638 admissions for tooth decay. Reductions in hospital admissions were greatest in younger children aged up to four years and among children aged five to nine years, with absolute reductions of 6.5 and 3.3 per 100,000 respectively.

Dr Nina Rogers from the MRC Epidemiology Unit at the University of Cambridge, the study’s first author, said: “This is an important finding given that children aged five to nine are the most likely to be admitted to hospital for tooth extractions under general anaesthesia.”

No significant changes in admission rates for tooth decay were seen in older age groups of 10–14 years and 15–18 years. However, reductions in hospital admissions were seen in children living in most areas regardless of deprivation.

As this is an observational study and because there was no comparable control group, the researchers cannot say definitively that the soft drinks levy caused this reduction in tooth decay. They acknowledge that other national interventions such as the sugar reduction programme and compulsory nutrition labels alongside the levy may have raised public awareness of sugar consumption and influenced buying habits.

Nevertheless, they conclude that their study “provides evidence of possible benefits to children’s health from the UK soft drinks industry levy beyond obesity which it was initially developed to address.”

Professor David Conway, co-author, and professor of dental public health at University of Glasgow added: “Tooth extractions under general anaesthesia is among the most common reason for children to be admitted to hospital across the UK. This study shows that ambitious public health policies such as a tax on sugary drinks can impact on improving child oral health.”

The research was funded by the Medical Research Council and the National Institute for Health and Care Research.

Reference
Rogers, N T et al. Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis. BMJ Nutrition Prevention & Health; 14 Nov 2023; DOI:10.1136/bmjnph-2023-000714

Adapted from a press release from the BMJ.

The UK soft drinks industry levy introduced in 2018 may have saved more than 5,500 hospital admissions for tooth extractions, according to an analysis by researchers at the University of Cambridge.

This is an important finding given that children aged five to nine are the most likely to be admitted to hospital for tooth extractions under general anaesthesia

Nina Rogers

Michal Jarmoluk (Pixabay)

Child receiving dental treatment

The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Licence type:

Public Domain

Risk of premature birth from smoking while pregnant more than double previous estimates

cjb250 — Wed, 27 Sep 2023 23:01:31 +0000

The study, published today in the International Journal of Epidemiology, also found that smoking meant that the baby was four times more likely to be small for its gestational age, putting it at risk of potentially serious complications including breathing difficulties and infections.

But the team found no evidence that caffeine intake was linked to adverse outcomes.

Women are currently recommended to stop smoking and limit their caffeine intake during pregnancy because of the risk of complications to the baby. For example, smoking during pregnancy is associated with an increased risk of fetal growth restriction, premature birth and low birthweight, though it has also been linked to a reduced risk of preeclampsia (high blood pressure during pregnancy).

High caffeine intake has also been shown to be associated with lower birthweights and possibly fetal growth restriction. Caffeine is more difficult to avoid than cigarette smoke as is found in coffee, tea, chocolate, energy drinks, soft drinks, and certain medications.

Studies looking at the links between smoking, caffeine and adverse pregnancy outcomes tend to rely on self-reported data to estimate exposure, which is not always reliable. A more objective measure is to look at levels of metabolites in the blood – chemical by-products created when substances such as tobacco and caffeine are processed in the body.

Researchers at the University of Cambridge and the Rosie Hospital, part of Cambridge University Hospitals NHS Foundation Trust, recruited more than 4,200 women who attended the hospital between 2008 and 2012 as part of the Pregnancy Outcome Prediction (POP) study. The team analysed blood samples taken from a subset of these women four times during their pregnancies.

To assess exposure to cigarette smoke, the team looked at levels of the metabolite cotinine, which can be detected in blood, urine, and saliva. Only two out of three women with detectable levels of cotinine in every blood sample were self-reported smokers, showing that this measure is a more objective way of assessing smoking behaviour.

A total of 914 women were included in the smoking analysis. Of these, 78.6% were classified as having no exposure to smoking while pregnant, 11.7% as having some exposure and 9.7% as having consistent exposure.

Compared to women who were not exposed to smoking while pregnant, those with consistent exposure were 2.6 times more likely to experience spontaneous preterm birth – more than double the previous estimate of 1.27 from a meta-analysis of studies – and 4.1 times as likely to experience fetal growth restriction.

Babies born to smokers were found to be on average 387g lighter than babies born to non-smokers – that is, more than 10% smaller than the weight of an average newborn. This increases the risk that the baby will have a low birth weight (2.5kg or less), which in turn is linked to an increased risk of developmental problems as well as poorer health in later life.

Unlike in previous studies, however, the team found no evidence that smoking reduced the risk of pre-eclampsia.

Professor Gordon Smith, Head of the Department of Obstetrics and Gynaecology at the University of Cambridge, said: “We’ve known for a long time that smoking during pregnancy is not good for the baby, but our study shows that it’s potentially much worse than previously thought. It puts the baby at risk of potentially serious complications from growing too slowly in the womb or from being born too soon.

“We hope this knowledge will help encourage pregnant mums and women planning pregnancy to access smoking-cessation services. Pregnancy is a key time when women quit and if they can remain tobacco free after the birth there are lifelong benefits for them and their child.”

Smoking cessation is offered routinely to all pregnant women and the NHS has local smoking cessation services for anyone, pregnant or not. Further information is available on the NHS website.

To assess caffeine intake, they researchers looked for the metabolite paraxanthine, which accounts for 80% of caffeine metabolism and is both less sensitive to recent intake and more stable throughout the day.

915 women were included in the caffeine analysis. Of these women, 12.8% had low levels of paraxanthine throughout pregnancy (suggesting low caffeine intake), 74.0% had moderate levels and 13.2% had high levels. There was little evidence of an association between caffeine intake and any of the adverse outcomes.

The work was supported by the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre and the Medical Research Council.

Reference
Selvaratnam, RJ et al. Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcome. International Journal of Epidemiology; 28 Sept 2023; DOI: 10.1093/ije/dyad123

Cambridge researchers have found that women who smoke during pregnancy are 2.6 times more likely to give birth prematurely compared to non-smokers – more than double the previous estimate.

We’ve known for a long time that smoking during pregnancy is not good for the baby, but our study shows that it’s potentially much worse than previously thought

Gordon Smith

Malte Mueller (Getty Images)

Pregnant woman smoking cigarette - stock illustration

The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes