Southampton researchers are improving how people who experience recurrent urinary tract infections (UTIs) are supported. UTIs usually clear up after a short course of antibiotics. However, recurrent UTIs are also common. The growing threat of antibiotic resistance makes this a concern. Researchers in our NIHR Southampton Biomedical Research Centre (BRC) are improving understanding of barriers to care. This involves working closely with underserved communities. The project is being driven by Dr Sascha Miller. She is a Senior Research Fellow at the University of Southampton. Here, Dr Miller explains what she hopes to achieve through a one-year BRC Postdoctoral Bridging Fellowship. How did you become interested in research? I fell into research by luck. I’ve always been interested in health, and after doing a master’s in social psychology, I was looking for a practical way to apply that. My first research job was at the Centre for Clinical and Community Applications of Health Psychology here at the University of Southampton. There, I found my niche! I worked on developing a digital intervention for infection prevention using the Person-Based Approach. This is still my field of work now. I like that research is methodical and structured - but never boring as there’s always something new to learn. It suits me because it feels a bit like project management with more purpose and creativity. I love being part of work that has the potential to make a difference in people’s lives. What is the healthcare challenge that you are seeking to address? I’m currently looking at how to better support people who get recurrent urinary tract infections (rUTIs) and are from under-served communities. rUTIs are very common and really disrupt people’s lives. Treatment for rUTIs in primary care relies heavily on antibiotic use, contributing to antimicrobial resistance. Whilst behavioural advice for managing them is available, seeking help and following advice can be challenging for people from underserved communities. This includes people experiencing economic deprivation, people from ethnic minority communities, neurodivergent people and people who identify as LGBTQ+. My research is about working with these communities and understanding the barriers they face when it comes to care and self-management. The aim is to use what we learn to design support that’s genuinely helpful, inclusive and avoids over-reliance on antibiotics. What do you hope to achieve in your research at the BRC? My BRC Bridging Fellowship aims to lay the groundwork for an NIHR Early Career Researcher Award application. The goal is to develop an intervention to help people from underserved groups self-manage rUTIs.  I’ll be co-designing the research with people with lived experience, so that it’s shaped by their needs from the outset. The idea is to build something that leads to a useful, inclusive intervention in the future. We want it to be something that helps people manage their health in ways that work for them and reduces unnecessary antibiotic use. Long term, I’d love to lead a programme of research that brings together behavioural science, digital tools and lived experience to tackle health inequalities in practical ways. How would you sum up your fellowship in three words? Inclusive, engaging, rewarding What’s it like being an early career researcher in Southampton? I moved over to the Primary Care Research Centre about three years ago, and it feels like home. There’s a great ECR community here; people are genuinely supportive, and there are lots of opportunities to get involved. I’m part of the Behavioural Science Group. I’ve also joined two special interest groups (SIGs). These focus on neurodivergence and learning disabilities, and LGBTQ+ health. Both SIGs have been set up by ECRs, which says a lot about the culture here. I live some distance from Southampton, so being able to work remotely has been a big help.  The flexibility that the department offers is also fantastic. What advice would you give other early career researchers? Don’t try to do it all alone! Having supportive peers and mentors has made a huge difference for me. They’re always there to offer helpful advice, bounce ideas around or remind me that other people are facing the same challenges. Building a network has been especially helpful when imposter syndrome creeps in - it’s easy to feel out of your depth when you’re surrounded by incredibly smart and experienced people. As I’m working to become an independent researcher, I have started applying for small grants. I’ve had great support from peers and senior staff and have loved working on these projects. I would recommend finding an area you’re genuinely interested in and passionate about. I’m especially motivated by working with members of the public. It doesn’t even feel like work most of the time because I enjoy it so much.

Researchers have come to widespread agreement on how surgery schools should be delivered across the world. Surgery school is a group education class. Patients can attend it in the weeks before planned surgery. This helps them to prepare physically and emotionally.  Research suggests that this preparation can lead to shorter hospital stays and quicker recovery times. It can also result in the patient having a better experience due to them being more informed. Although surgery schools are delivered across the UK and in many other parts of the world, there is a lack of standardisation in how they are designed and delivered.  There is significant variation in what patients are taught. New research has sought to reach the first consensus among experts in the field. This work was led by researchers from the NIHR Southampton Biomedical Research Centre (BRC). They worked in collaboration with the international Perioperative Quality Initiative. Their recommendations have been published in the journal Anaesthesia . Preparing for surgery Patients who increase their physical activity, avoid becoming malnourished and proactively manage their emotional well-being have been shown to have better outcomes from surgery. Surgery schools have become part of standard care in many settings. Some are face-to-face group sessions, and others are virtual. University Hospital Southampton (UHS) began offering surgery school in 2015. It was one of the first places in the UK to do so. Since the COVID-19 pandemic, UHS has delivered surgery school as an interactive video conference call.  The one-off session lasts for an hour and a half. Around ten patients attend each session. Family and friends are also encouraged to attend. The session helps patients prepare for their operation by making changes to their lifestyle. It covers nutrition, emotional wellbeing, exercise and what to expect. At the end of the session, patients set goals based on what they’ve learnt. Reaching an agreement Imogen Fecher-Jones has led surgery school at UHS since it began. She is an advanced nurse practitioner and doctoral researcher. She identified the lack of agreement internationally regarding what surgery schools are. Her research showed significant variation in how they are delivered and what information patients receive. A series of consensus workshops were arranged in collaboration with the Perioperative Quality Initiative (POQI) . POQI is an international multidisciplinary non-profit organisation. It organises expert consensus conferences about perioperative care. Thirty-two international multidisciplinary experts attended the virtual workshops. These experts were each selected for their clinical expertise in surgery school and pre-operative preparation. Their academic track record was also taken into account. The meetings used a technique called the Delphi method. It involves gathering everyone’s opinions to form a consensus. The following definition was developed: ‘ Surgery school is an education and behaviour change intervention, delivered by healthcare professionals to groups of patients and their family, friends and carers, which aims to prepare them for major surgery .’ The group was unanimous about the aims of surgery school. They all agreed that it should be an   interactive and engaging experience for patients and their support networks. They also felt that there should be a focus on supporting patients to be successful in lifestyle behavioural change. Informing best practice The group developed three consensus statements and eighteen recommendations. Each achieved at least 85% agreement through the voting process. They made recommendations on how surgery schools should be designed and delivered. They covered what content should be included.   The group also identified priorities for future research in this field. These recommendations will guide teams setting up surgery schools in the future. NHS England has adopted them within their ‘Surgery School Clinician Toolkit’. They are due to release the toolkit later this year. Imogen Fecher-Jones is currently undertaking doctoral studies. These are sponsored by UHS, Southampton Academy of Research and the National Institute of Academic Anaesthetists. She said: “I am enormously proud of what we have achieved. Patients have told us how useful they find attending surgery school. Many make successful lifestyle changes as a result of attending. “Having these recommendations means that any secondary care provider can set up an effective surgery school. They will be following the best available evidence and expert advice. “We hope this will result in more patients having access to surgery schools across the world.” Professor Denny Levett and Professor Mike Grocott made significant contributions . They jointly lead the NIHR Southampton BRC’s Perioperative and Critical Care theme. Professor Grocott, who is president of the POQI, said: “The POQI team are delighted to have enabled this excellent work led from Southampton. It will be a landmark in improving perioperative care through the development of surgery schools.”

Government minister Stephen Morgan has learned how Southampton researchers are improving children's long-term health prospects. The Minister for Early Education visited University Hospital Southampton (UHS) yesterday. He was joined by the Member of Parliament for Southampton Test, Satvir Kaur. They spoke to pupils from a secondary school in Gosport, who were taking part in a hands-on session at LifeLab. LifeLab is a unique research-based educational programme. It is a collaboration between the University of Southampton, the NIHR Southampton Biomedical Research Centre and UHS. Its teaching laboratory is based at Southampton General Hospital. The programme empowers children and young people to understand the science behind their health. This informs the choices they make for their own lives. Official engagement Stephen Morgan oversees early education in his ministerial role. He has a particular interest in the use of data, digital technology and science. During his visit to LifeLab, the Minister mixed with secondary school students from King’s Academy Bay House School. They explored how factors such as diet, physical activity and sleep can affect their health and wellbeing. He also heard how scientists are using big data on pregnancy and early life to predict obesity at a young age. Minister Morgan said: “It’s been brilliant to see the impact of the innovative work to improve child health being driven by the university. “Through our Plan for Change this government is determined to give every child the best start in life, which includes creating the healthiest generation of children in our history. “As we roll out free breakfast clubs across the country and make free school meals available to all households on universal credit, we will continue working alongside experts and the sector to build a healthier future for generations to come.” Long-lasting benefits The LifeLab programme is linked to the school curriculum. Over the last twelve years, it has worked with more than 17,000 secondary school students from over 120 schools. The programme is also reaching primary school children across the city through Early LifeLab. It is up and running in over 40 percent of Southampton primary schools. To date, it has reached more than 6,500 children. Professor Kathryn Woods-Townsend is the LifeLab Director. She said: “We were delighted to welcome Mr Morgan to LifeLab to see first-hand the interactive way we engage young people with the science behind the health messages. This gives them the skills and knowledge to be able to make healthier choices. “We believe that supporting young people to lead healthier lives will not only positively impact them now, but also their future selves and their future children. “It was good to see the students show Mr Morgan the ways the programme has helped them reflect on how they can make informed decisions about their own lives.” Obesity research The MPs also met the University of Southampton’s Professor Nisreen Alwan, Professor Simon Fraser and Dr Nida Ziauddeen. They are leading a study that aims to identify whether a child is at risk of obesity in later life. It is using data collected during pregnancy and early childhood at UHS. The researchers have devised a prediction model to estimate the risk of obesity at primary school. It will help provide targeted interventions. This could support families, nurseries and schools to mitigate the risk of children becoming overweight. They have also found lower education and academic ability in primary school is related to greater use of health services, with more hospital admissions and outpatient appointments, when they reach middle age. The age at which people leave school seems to be an important mediator in this relationship, underscoring the positive impact of time spent in education. This research was supported by NIHR Applied Research Collaboration Wessex and the NIHR Southampton Biomedical Research Centre. Professor Alwan explained: “Obesity increases our risk of developing other long-term health conditions later in life. “It’s important to develop tools to help us identify families at risk early on in children’s lives and provide support and resources to them. Preventing obesity across generations is key to improving the population’s health.”

A new report has highlighted the role of Southampton researchers and their partners in shaping the global conversation on preconception care. The time before pregnancy is known as 'preconception'. It is an important window that can help determine the future health and wellbeing of parents and children. The report has been published by the World Health Organization (WHO). It is titled Reframing Care and Services to Improve Preconception Health . It draws on insights from the NIHR Southampton Biomedical Research Centre, University Hospital Southampton and the University of Southampton. Southampton voices The report has emerged from a high-level consultation meeting in May 2024. Dr Danielle Schoenaker and Professors Shane Norris and Mark Hanson were invited to speak at the meeting. They were joined by Professors Keith Godfrey and Kalyanaraman Kumaran. Together, their work is helping to reshape how health systems around the world approach preconception care. Global perspectives The report draws on University of Southampton and University of the Witwatersrand-led studies. Through two international surveys, Dr Schoenaker and Professor Norris gathered community perspectives on preconception health. The research spanned a wide range of settings. These included richer countries like the UK, Belgium and Australia. They also covered poorer contexts such as Bangladesh, Ghana and Brazil. Key findings include: Men understood less about health before pregnancy than women—even in richer countries. Mental health was the biggest worry for most people, followed by physical health, strong relationships and having enough money. People said things like eating well, being able to see a doctor, having a safe home and enough food were really important for staying healthy before pregnancy. Southampton’s LifeLab programme also features in the report. It was highlighted for teaching how the choices you make when you're young can affect your future health, including when you have children. Bridging the evidence gap The report talks about some big challenges in improving health before pregnancy around the world. These include things like not having clear guidelines, different countries doing things in different ways, and the need to think carefully about gender and people’s rights when making health policies. It also says we need to keep talking about how we use language, how to bring preconception care into health systems, and how to make sure it works for people from all cultures and backgrounds. Shaping the future The Southampton-led preconception health report card was also presented at the meeting. This highlights the importance of measuring and monitoring preconception health to define population needs. Findings can then guide policy, service design and evaluation. The meeting report described the International Core Indicators for Preconception Health and Equity (iCIPHE) Alliance. This is co-led by Dr Schoenaker. iCIPHE is developing core indicators to monitor global preconception health. This recognition from the WHO shows that Southampton is leading the way in helping people stay healthy before pregnancy. This is making a difference in the UK and around the world. Read the full report here

Investigating bacterial samples taken from cystic fibrosis patients Southampton researchers   are enlisting the public to become citizen scientists in the fight against antibiotic resistance. They will have a presence at the prestigious Royal Society Summer Science Exhibition in London. It opens to the public on Wednesday. Visitors to the ‘ Fighting superbugs ’ exhibit will be invited to help find phages. These are tiny viruses that could be key to combating antimicrobial resistance (AMR). Members of the public will be asked to collect and send water samples from their homes, local parks and rivers, or even their toilets. They will be analysed at the University of Southampton. The lead researcher on the project is Dr Franklin Nobrega. He is part of the NIHR Southampton Biomedical Research Centre’s Microbiology, Immunology and Infection theme. Pressing public health issue The World Health Organization identifies AMR as one of the top global public health threats. They estimate that it was directly responsible for more than one million global deaths in 2021. They also suggest that it contributed to over four million more. When bacteria become resistant to antibiotics, infections become harder to treat. This leads to longer illnesses and higher healthcare costs. There is also a greater risk of death from infections that would normally be manageable. AMR threatens the safety of a wide range of medical procedures. These range from chemotherapy and organ transplants to something as routine as a tooth extraction. Even minor infections resulting from these interventions could become life-threatening without effective antibiotics. ‘Promising alternative’ Phages present a promising alternative. Unlike antibiotics, they are highly specific. They target harmful bacteria without affecting healthy microbes. Phages also multiply at the site of infection. They provide continuous, focused treatment until the bacteria are eradicated. This “self-amplifying” ability could make phage therapy a sustainable and efficient solution for tackling resistant infections. In the UK, phages can now be used under existing regulatory routes for unlicensed treatments in individual patients. New guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) aims to accelerate the safe development of licensed phage-based medicines for wider clinical use. Phage therapy has already been used in the UK and globally to treat patients with life-threatening antibiotic-resistant infections when antibiotics alone have failed. These include bone infections, sepsis, and cystic fibrosis-related infections.   Dr Franklin Nobrega said: “The threat of antimicrobial resistance grows year on year. We urgently need to find alternative treatments to reduce our reliance on antibiotics. Phages have enormous potential. They are everywhere and can provide incredibly precise, targeted treatments for resistant infections. “We know that phage therapy can be effective in treating resistant infections. However, there are billions of different phages, each targeting a specific microbe. “By finding more of these phages, we can improve our chances of beating AMR. In this arms race against resistant bacteria, every new phage we discover adds a valuable weapon to our arsenal.” Collecting hundreds of samples Over 500 visitors to the Summer Science Exhibition will be provided with free sampling kits. Participants will name their phage before sending it to Southampton in the post. This is in the hope that scientists can isolate a phage from their sample. They will also be asked to upload coordinates of where their sample was taken to phage-collection.org . Then, the researchers next step will be to analyse the 500+ citizen scientist samples. They will check if any of them contain therapeutically relevant phages. Participants will be able to track the progress of their own sample on the website. This will be updated with the overall findings of the project. Attendees at the Summer Science Exhibition will be able to take part in a VR experience that explains how to apply phage therapy therapeutically. Another activity will see them get the chance to build their own Lego model of a phage. Southampton researchers will use the event to gauge public opinion on phage therapy as an alternative to antibiotics. This will help them design new therapies.

Southampton researchers are making advances in genetic testing to help diagnose Primary Ciliary Dyskinesia (PCD). PCD is a rare genetic lung disease that currently has no cure. It affects one in 7,500 people in the UK. Early diagnosis of PCD improves patient outcomes. However, this can be challenging due to the lack of a single, definitive test to diagnose it. PhD student Lee Baker is driving new research to improve genetic diagnosis rates at the NIHR Southampton Biomedical Research Centre (BRC). His work is supervised by Professor Jane Lucas. The research forms part of the NIHR Southampton BRC’s Data, Health and Society theme. What is PCD? PCD affects small, hair-like structures called motile cilia. Responsible for fluid movement, these are found in the airways, reproductive system and parts of the brain. In people with PCD, the motile cilia can’t clear enough mucus away from the lungs, nose, and ears.  It builds up, causing inflammation and chronic lung, ear and sinus infections. PCD can cause other symptoms throughout the body, including hearing problems and infertility. Half of those diagnosed with this disease also have a complication called ‘situs inversus’. This means the organs in their chest and abdomen are on the wrong side of the body. Difficult to diagnose Early diagnosis of PCD is important to start treatments that can delay permanent lung damage. Guidelines suggest that clinicians should use a combination of functional tests, imaging and genetic tests for diagnosis. Researchers have so far identified over 60 genes that cause PCD. However, between 20-30% of patients are still unable to get a firm genetic diagnosis. Standard genetic testing often identifies ‘variants of unknown significance’. The effect they have on causing disease is not yet known. This prevents a confident genetic diagnosis from being made. Advanced genetic testing Researchers are now investigating if techniques like RNA sequencing can support genetic diagnosis when standard tests are inconclusive. RNA sequencing provides deeper insights into how genes are activated (gene expression). It can also show if parts of a gene have been joined together in an unusual way (alternative splicing). Clinicians take cell samples from the nose using a tiny brush and send them off for sequencing. The research team then receive data for processing and analysis. They compare it to samples from healthy volunteers to determine any genomic changes that may be contributing to the disease. “RNA sequencing provides additional evidence,” Lee explained. “It has helped resolve challenging PCD patient cases where the DNA-level information was inconclusive. “By refining our analytical approach, we have enabled faster generation of RNA results. Delivering this information to clinicians more rapidly helps shorten the patient’s diagnostic journey. This allows earlier access to appropriate support.” Lee added: “We hope to explore the application of machine learning models in predicting patient disease outcome and identifying novel insights relating to PCD. This will help better characterise this rare disease and contribute to a higher sensitivity in PCD diagnosis.”

A national intensive care trial is informing how much oxygen patients should be given to boost their recovery. Reducing supplementary oxygen given to intensive care patients does not deliver any clear and obvious health benefits, according to new research. It also found that it does not harm their chances of survival. The National Institute for Health and Care Research (NIHR) funded the UK-ROX trial. It is the largest ever trial of intensive care oxygen therapies outside of the COVID-19 pandemic. The trial was led by researchers at the University of Plymouth and the Intensive Care National Audit & Research Centre (ICNARC). Southampton’s Professor Mike Grocott was a co-investigator. He was also involved in the trial’s design. Results have been published in the JAMA journal . Breathing support Each year, around 184,000 patients are admitted to NHS intensive care units (ICUs). Over 30% need breathing support. They are given extra oxygen through mechanical ventilators. However, there is insufficient evidence to guide the use of oxygen. Administering too much, or too little, oxygen may not deliver the intended benefits. It could even cause the patient additional harm. UK-ROX is the largest ever clinical trial of oxygen use in UK ICUs. Researchers recruited 16,500 patients across almost 100 intensive care units at UK hospitals. They then sought to find out whether a strategy of conservative oxygen therapy would reduce mortality rates among ICU patients. This involved delivering less oxygen to maintain a person’s oxygen saturation at around 90%. Providing new evidence The results showed there was no statistically significant difference in patient outcomes. 35.4% of patients receiving conservative oxygen therapy died within 90 days of their admission. This is compared with 34.9% of patients receiving usual oxygen therapy. As a result, the research team believe it is safe to allow oxygen levels to be lower in ICU patients. However, it may not necessarily be better for them in terms of survival. They say there is a need to develop and evaluate more personalised therapies based on a person’s specific medical conditions. Professor Daniel Martin OBE is Professor of Perioperative and Intensive Care Medicine at the University of Plymouth and a Consultant at University Hospitals Plymouth NHS Foundation Trust. He is co-chief investigator of the UK-ROX trial. Professor Martin said: “Administering supplemental oxygen through mechanical ventilation is a standard course of treatment for many of those admitted to intensive care. However, there is insufficient evidence to guide us on what oxygen levels deliver the greatest benefits or have the potential to cause harm. “The results of this study show that reducing supplementary oxygen results in no overall benefit or harm to the patients. That doesn’t mean it is not important for intensive care patients. On the contrary, it means that we will have to come up with ways of determining how much oxygen an individual patient needs. We have to deliver it to them in a precise way if we are to improve patient outcomes.” Improving patient care Paul Mouncey, Co-Director of ICNARC, was the other co-chief investigator of the UK-ROX trial. Mr Mouncey said: “UK-ROX is the largest individually randomised trial conducted in intensive care in the UK. The study has provided much needed evidence to inform clinicians in their day-to-day management of patients. “A study of this size was only possible by using routinely collected data held within NHS England and within the Case Mix Programme, the national clinical audit of adult critical care in England, Wales and Northern Ireland. We would like to thank the 97 NHS hospitals and 16,500 patients and their families for taking part in the clinical trial.” Co-investigator Professor Mike Grocott is Director of the NIHR Southampton Biomedical Research Centre. Professor Grocott added: “This landmark study clarifies the safety of administering lower levels of oxygen to critically ill patients. Understanding how to individualise oxygen therapy will be the next step in improving patient care.” Professor Martin and Mr Mouncey have presented the results of the UK-ROX trial to delegates at the Critical Care Reviews Meeting 2025  in Belfast. UK-ROX was delivered at a fraction of the usual cost (around £100 per patient) of a randomised control trial. This shows that clinical trials can be conducted differently and cost-effectively. This is important in an increasingly challenging financial climate.

Findings from a national trial are guiding the use of sedatives in intensive care. Sedation is essential for keeping critically ill patients comfortable and supporting mechanical ventilation. In the A2B trial, researchers compared two alternative drugs with propofol - the most widely used sedative medication. The alternatives were clonidine and dexmedetomidine. Their results, published in JAMA , showed no clear benefits. For example, patients who received the alternatives were on average not able to come off the ventilator (be extubated) any sooner. With both clonidine and dexmedetomidine, there was an increase in adverse effects. These were most severe with dexmedetomidine. The trial involved over 1,400 patients across the UK. It was led by Professor Timothy Walsh from the University of Edinburgh. Southampton’s Dr Cathy McKenzie led the UK’s intensive care pharmacy involvement in the trial. Dr Rebecca Cusack led recruitment in the region. Sedation in intensive care Around one in three patients admitted to intensive care need mechanical ventilation. This helps them to breathe when they are unable to do so on their own. Most of these patients also need sedation to relieve pain and anxiety caused by mechanical ventilation and the severity of their illness. It also prompts sleepiness. Propofol is the most widely used sedative medication in intensive care units. However, it is not a pain killer. This means that additional medicines are used, mostly opioid analgesics. Previous trials have suggested that another sedative medication called dexmedetomidine may be more effective. It has been linked with potentially spending less time on a ventilator and reduced confusion (delirium). Dexmedetomidine belongs to a group of drugs called α2-adrenergic receptor agonists. Unlike propofol, they provide pain relief as well as sedation. Clonidine belongs to the same class of agents and is widely used in the UK. Informing future care Patients were recruited from 41 intensive care units (ICUs) in the UK between 2018 and 2023, including University Hospital Southampton (UHS). They were all expected to need mechanical ventilation for two days or longer. Patients were randomly assigned to receive one of three sedative medications: propofol, dexmedetomidine and clonidine.  They all received additional pain relief as needed. The results reveal that each group spent similar amounts of time on a ventilator. There was no evidence of less problems like delirium among those who received dexmedetomidine or clonidine. Mortality rates were also similar across the three groups. However, adverse effects were higher with clonidine and dexmedetomidine. Dr McKenzie is a Consultant Pharmacist in Critical Care at UHS and an Associate Professor in Critical Care Pharmacology at the University of Southampton. She is part of the NIHR Southampton Biomedical Research Centre (BRC). She is also an awardee in the UHS Research Leaders Programme (RLP) and holds an NIHR Senior Clinical Practitioner Award. Dr McKenzie said: “The A2B trial was very important for intensive care sedation practice. It gives us assurance that while propofol is not the ideal sedative for every patient that is ventilated, it is probably indicated for most short-term ventilation (48 hours or less). “We thank participants, their families and the study team in Southampton for their part in this important research. Our hope is that these findings will help patients receive the best possible treatment in intensive care in the future.” Cost of treatment Researchers also assessed the cost-effectiveness of the three medications. They found no significant economic benefit to using dexmedetomidine or clonidine instead of propofol. These results have also been published in JAMA . Dr Cusack is a Consultant and Associate Professor in Critical Care Medicine at UHS and the University of Southampton. She holds a UHS RLP award. She is also part of the NIHR Southampton BRC. Dr Cusack said: “This cost effective analysis should give assurance to ICUs all over the world. The analysis shows us that sedative choice should not be based on cost alone but should be tailored to the individual patient."

High rates of anxiety in children and young people may be rooted in the earliest stages of life, researchers have warned. The number of young people living with anxiety is rising. Rates are highest in developed countries. Stress caused by the COVID-19 pandemic cannot fully explain this trend. While it did worsen mental health in young people, it had a lesser effect than many experts predicted. Writing in Science , Professors Mark Hanson and Sir Peter Gluckman hypothesise that early biological adaptations may contribute to anxiety. Some of these adaptations happen even before birth. While they were once protective, the researchers suggest they may now be mismatched to modern life. Professor Hanson is Emeritus Professor at the University of Southampton. He is also part of the NIHR Southampton Biomedical Research Centre (BRC)’s Nutrition, Lifestyle and Metabolism theme. Professor Sir Peter Gluckman is based at the University of Auckland. An evolutionary mismatch Anxiety evolved as a survival tool. It can be understood as an internal alarm system to detect danger. In pregnancy, early environmental signals can shape how a child’s brain responds to threats. These predictive adaptive responses prepare the body for the expected environment. However, the new hypothesis suggests that the environments children are born into may no longer align with the environments they grow up in. Signals in the womb or early childhood may suggest a harsh, threatening environment. Adaptations could misfire if a child then grows up in a fast-paced, digital world where threats are more social than physical. This can result in heightened anxiety, poor emotional regulation and depression. It can also reduce their ability to handle everyday stress. A critical window The researchers challenge the traditional diathesis-stress model, which focuses on predisposition plus later-life stress. Instead, they highlight the first 1,000 days - from pregnancy through early childhood - as the key period for shaping mental resilience. The brain’s executive functions take shape in early childhood. A child’s ability to manage stress, build relationships, make decisions and maintain focus is largely shaped before the age of four. Modern families face a range of pressures, including rising levels of maternal stress, limited caregiver interaction and the increasing presence of digital devices. These can all interfere with early brain development, priming children for dangers that may never appear. Rethinking government policy The researchers say that most government strategies for mental health begin too late as they miss the critical window of early development. Professors Hanson and Gluckman are calling on policymakers to adopt a lifecourse approach. It includes: Prioritising maternal mental health during pregnancy Investing in responsive, high-quality early childhood care Shifting education and social policy to support early brain development This is the approach taken by the NIHR Southampton BRC.

Dr Mark Burton has secured a prestigious fellowship to improve understanding of muscle loss in later life. The Vivensa Foundation Proleptic Fellowship is awarded to promising researchers in the ageing field. It will support Dr Burton’s transition to a permanent position within academia. This is his next step after a Bridging Fellowship from the NIHR Southampton Biomedical Research Centre (BRC). Dr Burton’s work focusses on sarcopenia. The condition, which affects almost three million people in the UK, causes a loss of muscle mass and function in older age. With this new award, he will continue looking into the molecular changes that cause sarcopenia to develop. Improving understanding of sarcopenia People with sarcopenia can become weak and frail as it progresses. The condition is a major cause of lost independence in older age. A previous project generated preliminary data in support of Dr Burton’s fellowship application. This was a collaboration with a spin-out company called TopMD. The project also involved other NIHR Southampton BRC researchers, including Professor Keith Godfrey and Dr Harnish Patel. The researchers used sequencing data to show molecular changes in blood taken from people with sarcopenia. It was compared to blood from healthy older adults. They measured levels of molecules called small non-coding RNAs (sncRNAs). These control gene expression. ‘New and exciting’ developments Alterations in levels of specific sncRNAs may reflect changes in ageing and muscle dysregulation. Gaining a better understanding of these changes is key to identifying biomarkers of ageing and sarcopenia. This could lead to advances in diagnosis and treatment in the future. Dr Burton said: “This collaboration has allowed us to work on something completely new and exciting. There is a huge amount of useful information when we look at the data in high resolution. This provides vital new insights that might support future treatments for sarcopenia. "The Vivensa Foundation fellowship will build on these and previous findings using muscle tissue and blood serum. It will integrate information from sncRNAs, RNAs and circulating metabolites to help us understand the complete disease signature.” BRC support Dr Burton is a Senior Research Fellow at the University of Southampton. His research forms part of the NIHR Southampton BRC’s Nutrition, Lifestyle and Metabolism theme. He was awarded a one-year BRC Postdoctoral Bridging Fellowship in May 2024. These fellowships support researchers while they apply for external funding. Dr Burton added: “I would like to give special thanks to my current mentor, Prof Godfrey, and my supervisor, the late Prof Karen Lillycrop, for their leadership, inspiration and support. I am energised and excited to take this research forward.”

People whose fathers were overweight as teenagers had DNA changes associated with asthma, obesity and low lung function. A new study has investigated the long-term consequences of fathers’ early teenage obesity. It was led by researchers at the University of Southampton (UoS) and the University of Bergen. They found boys who become overweight in their early teens risk damaging the genes of their future children. This puts them at greater risk of developing asthma, obesity and low lung function. Researchers say the study highlights how failure to address obesity in young teenagers today could harm future generations. Their findings have been published in Nature Communications Biology . Investigating the impact This is the first human study to reveal the likely biological mechanism behind the impact of fathers’ early teenage obesity on their children. The researchers analysed data from 339 people. They were aged between seven and fifty-one. They looked at the participants’ epigenetics - how a person’s environment affects the way their genes work, for example by switching them ‘on’ or ‘off’. They also assessed the father’s changes in body composition across adolescence. To do this, they used self-reported body image as a proxy for body fat composition. Changes to DNA The research team identified epigenetic changes in over 2,000 sites in 1,962 genes. The genes are linked with formation of fat cells (adipogenesis) and fat (lipid) metabolism. These changes in the way DNA is packaged in cells (methylation) regulate gene expression. They are associated with asthma, obesity and lung function. The effect was more pronounced in female children than male children, with different genes involved. Dr Negusse Tadesse Kitaba, Senior Research Fellow at UoS, authored the paper. Dr Kitaba said: “The overweight status of future fathers during puberty was associated with a strong signal in their children’s DNA which were also related to the likelihood of their children being overweight themselves. “Early puberty, when boys start their developing sperm, seems to be a key window of vulnerability for lifestyle influences to drive epigenetic changes in future offspring.” Lifelong health consequences Obesity is a major public health problem. People living with obesity are at greater risk of many health diseases. These include type 2 diabetes, heart disease and some types of cancer. It may also have a negative effect on their mental health. Prof John Holloway is a Professor of Allergy and Respiratory Genetics at UoS. He is also part of the NIHR Southampton Biomedical Research Centre. Prof Holloway said: “Childhood obesity is increasing globally. The results of this study demonstrate that this is a concern not only for the health of the population now, but also for generations to come.” Prof Cecilie Svanes is a Professor at the University of Bergen. Prof Svanes added: “The new findings have significant implications for public health. They may be a game-changer in public health intervention strategies. “They suggest that a failure to address obesity in young teenagers today could damage the health of future generations, further entrenching health inequalities for decades to come.” The research was funded by the Norwegian Research Council. Image credit: World Obesity Federation

Professor John Holloway has been named a Fellow of the European Respiratory Society (ERS). He is one of just 14 new awardees this year. The accolade recognises excellence in respiratory medicine. It acknowledges outstanding contributions in research, education and clinical leadership. Prof Holloway is Professor of Allergy and Respiratory Genetics at the University of Southampton (UoS). He leads research into how genetic and environmental factors influence respiratory diseases like asthma and COPD. He is also part of the NIHR Southampton Biomedical Research Centre (BRC). World-leading research Awardees are inducted into an elite advisory board. This international group is shaping the future of respiratory science. Prof Holloway joins five Southampton colleagues as a Fellow of ERS. They are Professors Jane Lucas, Tom Wilkinson, Ratko Djukanovic, Stephen Holgate and Donna Davies.  “I am honoured to be elected as a Fellow of the European Respiratory Society”, Prof Holloway said. “This recognition reflects the fantastic research by my students and colleagues over many years. It also shows the strength of respiratory research in Southampton.” Deserved recognition Originally from New Zealand, Prof Holloway completed his BSc in Biochemistry at Otago University. He earned a PhD in 1997. During this time, he was one of the first to identify a gene associated with severe asthma. Prof Holloway came to Southampton in 1997 as a postdoctoral fellow. Here, he joined up with Professor Stephen Holgate to look into the genetic factors that influence allergy and asthma. The research team he leads today are exploring how these conditions can develop before birth. They are looking into why symptoms vary between individuals. They also want to understand how genes and environmental triggers interact. It was Prof Stephen Holgate who nominated Prof Holloway for this award. Prof Holgate said: “John is a most deserving recipient of this prestigious award. His rich research portfolio is impressive, particularly his focus on genetic susceptibility to lung diseases such as asthma - including the landmark discovery of ADAM33 as the first novel asthma gene. “John’s relentless efforts to help the broader research community are considerable and greatly valued.” Supporting the next generation Beyond research, Prof Holloway is a dedicated educator and mentor. He became a lecturer in Pharmacology in 2005. This role has seen him help shape both undergraduate and postgraduate education. Prof Holloway is also Fellow of the Higher Education Academy. This reflects his commitment to teaching excellence. He has supervised more than 15 PhD and MD candidates. In his role as Associate Vice President of Interdisciplinary Research at UoS, Prof Holloway co-leads the interdisciplinary research programme and research culture strategy.