Our projects

Welcome to the Baby Bathe Study!

The study is a randomised controlled feasibility trial to determine whether families are willing to change baby bathing practice during the first months of life. The study team includes a dermatologist, paediatricians, psychologists and an expert patient. We designed the study with advice from midwives, health visitors and GPs. We interviewed 20 families about our plans for the study and We have incorporated advice from the Centre for Evidence Based Dermatology patient panel in this study proposal.

This study is funded by the NIRH; Award ID: NIHR203170NIHR.

Diabetic eye disease, is an important indicator of cardiovascular disease complications of diabetes, and a major cause of blindness in the working-age population.  Early detection through screening programmes can avoid further life-threatening complications and sight loss.¹

The National Health Service (NHS) Diabetic Eye Screening Programme (DESP) launched in 2003, involves yearly screening using digital photographs of the retina, which are assessed by human graders for the presence of diabetic eye disease, but with 2.2 million eye screening appointments each year in England alone, generating approximately 10 million retinal images, there is an urgent need to seek computerised solutions.

Artificial Intelligence (AI) systems designed to detect diabetic eye disease have been developed over the last 15 years and we have previously shown that they can meet pre-defined safety standards of performance and could be used to partially replace human grading.^2-4 With the acceleration of AI implementation into healthcare settings, there is a need to ensure that AI-systems designed to detect presence of diabetic eye disease perform equally well for all people with diabetes.

We will evaluate the accuracy of AI-systems to successfully triage patients into low- and medium-/high-risk diabetic eye disease cases across subgroups of the population.  We will also evaluate the perceptions, acceptability and expectations of health care professionals and people living with diabetes in relation to AI technology implementation into the eye screening programme, in particular to understand the potential impact of any ethnic differences that might lead to inequalities.

We are working with NHS AI Lab to develop a pipeline for long-term, ongoing, prospective evaluations of the best commercially available systems leading to implementation within the English NHS DESP. Our multidisciplinary teams have expertise in this area, are independent of any commercial partners and have no conflicts of interest to declare in this regard. Crucially, the project will develop safeguarding systems to ensure it works for all and that AI performance does not vary across population sub-groups, such as ethnicity or gender.

The project will also provide evidence to support the commissioning and deployment of the first potential widespread use of AI within the NHS.

1. Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA 2007;298(8):902-16. doi: 10.1001/jama.298.8.902

2. Tufail A, Kapetanakis VV, Salas-Vega S, et al. An observational study to assess if automated diabetic retinopathy image assessment software can replace one or more steps of manual imaging grading and to determine their cost-effectiveness. Health Technol Assess 2016;20(92):1-72. doi: 10.3310/hta20920 [doi]

3. Tufail A, Rudisill C, Egan C, et al. Automated Diabetic Retinopathy Image Assessment Software: Diagnostic Accuracy and Cost-Effectiveness Compared with Human Graders. Ophthalmology 2017;124(3):343-51. doi: 10.1016/j.ophtha.2016.11.014

4. Heydon P, Egan C, Bolter L, et al. Prospective evaluation of an artificial intelligence-enabled algorithm for automated diabetic retinopathy screening of 30 000 patients. Br J Ophthalmol 2020 doi: 10.1136/bjophthalmol-2020-316594

The Aviation Night Noise Effects (ANNE) study will examine the relationship of aviation noise on sleep disturbance and annoyance, and how this varies by different times of night. The study is funded by the Department for Transport (DfT) and is a collaboration between City St George’s, University of London, NatCen Social Research, Noise Consultants Limited, and the University of Pennsylvania. This is the first study of aviation noise effects on sleep disturbance in the UK for 30 years.

Exposure to aviation noise at night can impact on physical and mental well-being¹. Humans continue to respond to sounds in the environment even when asleep, which can cause awakenings and poor sleep quality^2,3. This sleep disturbance can have a negative impact on health, increasing the risk of daytime sleepiness, hypertension, and cardiovascular disease⁴.

The first stage of the ANNE study will involve a cross-sectional survey of 4,000 people who live near eight UK airports, to assess the association between aircraft noise exposure at night and subjective assessments of sleep quality and annoyance. The second stage of the study will involve an observational study of 170 people, recruited from the survey, to assess the association between aircraft noise exposure and objective sleep quality, using physiological assessments of sleep disturbance and sound level measurements in participants’ bedrooms.

There is some concern about aviation noise exposure at night to communities around airports and the UK government is currently reviewing night-time aviation policy. The ANNE study will derive exposure-response functions between night-time aviation noise metrics and sleep and annoyance outcomes. This evidence will be used to inform the DfT’s future policies for night-time aviation noise exposure, and assist with the management and mitigation of health impacts on local communities, as part of a wider assessment of the costs and benefits of night flying.

For a list of frequently asked questions about the study, please visit our FAQs webpage.

Read the privacy notice for this study.

1. European Environment Agency. Environmental Noise in Europe 2020. Luxembourg: Publications of the European Union; 2020.

2. Basner M, McGuire S. WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep. Int J Environ Res Public Health 2018;15:519.

3. Basner M, Witte M, McGuire S. Aircraft Noise Effects on Sleep-Results of a Pilot Study Near Philadelphia International Airport. Int J Environ Res Public Health 2019;16.

4. Hahad O, Kroller-Schon S, Daiber A, Munzel T. The Cardiovascular Effects of Noise. Dtsch Arztebl Int 2019;116:245-+.

The Young Carers Project is a collaborative and interdisciplinary research project exploring how being a young carer may influence diverse aspects of life. Through innovative data analysis this study aims to visualize the role young carers play and identify areas to support them.

Project overview

Unpaid carers play an indispensable role in providing assistance to individuals facing health challenges and daily struggles. Among these caregivers, young carers – children and adolescents who assume caregiving responsibilities – constitute a significant yet often overlooked group. Despite their invaluable contributions, the scarcity of research on young carers makes it challenging to provide them with effective support.

As the population of the UK ages, the demand for family care has surged. Young people are increasingly shouldering caregiving responsibilities due to factors such as delayed parenthood and single-parent households. While the 2021 Census documented around 120,000 young carers under 18 in England and Wales, the actual numbers are likely higher.

Enriching Insights Through Longitudinal Data

The Young Carers Project addresses these knowledge gaps by leveraging data from four large-scale longitudinal studies representing the UK population. Longitudinal studies offer a deep understanding of caregiving's influence on health, education, employment, and social engagement over time.

This longitudinal approach overcomes prior limitations and explores the relationships between being a young carer and its impact on various aspects of life. Through innovative data analysis, the project identifies vulnerable young carers and those with better-than-expected outcomes, shedding light on their specific needs and resilience factors.

Empowering Young Carers: Our Vision

Ultimately, our mission is to enhance the social well-being of young carers throughout their lifecourse. We aspire to secure recognition and assistance for their crucial contributions. By fostering a thorough comprehension of their experiences, our efforts aim to lead to policy changes and initiatives tailored to their specific needs.

Our team

Our research team comprises:

• Dr. Rebecca Lacey, City St George's University of London
• Professor Anne McMunn, University College London
• Dr Alejandra Letelier, City St George's University of London.

Supported by:

• Rohati Chapman, Carers Trust
• Vicky Morgan, Carers Trust
• Alice Reeves, Nuffield Foundation.

Collaborative partnerships:

• We collaborate with a range of partners, among them the Carer Trust. This project is generously funded by the Nuffield Foundation from 2023-2026.

Engagement and impact

In collaboration with one of our project partners, the Carers Trust, we are working with an advisory panel of young carers who will actively influence the research and dissemination strategies. This panel will co-produce a project output as part of the Young Carers Action Day in 2025.

The research findings will engage a diverse array of stakeholders, including young carers, policymakers, parliamentarians, care recipients, medical professionals, educators, and community leaders. This concerted effort seeks to raise awareness about the pivotal role young carers play and the imperative to identify and support them.

The projects aim to shine a spotlight on the experiences of young carers and work collectively towards a society that recognizes and supports their invaluable contributions.

Publications

• Young carers and education: An analysis of how caring can influence educational attainment (PDF) - Rebecca Lacey, Anne McMunn, Alejandra Letelier, Andy McGown and Krista Cartlidge
• Who are young carers in the UK? Understanding the prevalcence and characteristics of adolescent young carers in the UK before and after Covid-19 (PDF) - Alejandra Letelier, Anne McMunn, Andy McGowan, Beth Neale and Rebecca Lacey
• Changes in life satisfaction, self-esteem, and self-rated health before, during, and after becoming  a young carer in the UK: a longitudinal, propensity score analysis (PDF) - Rebecca Lacey, Alejandra Letelier, Baowen Xue and Anne McMunn
• Understanding young caring in the UK pre- and post-Covid-19: Prevalance, correlates, and insights from three UK longitudinal surveys - Alejandra Letelier, Anne McMunn, Andy McGowan, Beth Neale and Rebecca Lacey.

Get in touch

• Dr Rebecca Lacey: rlacey@citystgeorges.ac.uk
• Dr Alejandra Letelier: aletelie@citystgeorges.ac.uk.

Useful links

• Carers Trust
• The long-term effects of being a young carer - Nuffield Foundation

The Child Heart and Health Study in England (CHASE)

The Child Heart And Health Study in England (CHASE) is a detailed investigation of patterns of risk factors for cardiovascular disease and type 2 diabetes of UK children of South Asian, black African-Caribbean and white European origin. CHASE is based in 200 Primary Schools in London, Birmingham and Leicester, which were sampled to allow the invitation of balanced numbers of South Asians (including similar numbers of Indian, Pakistani and Bangladeshi origin), black African-Caribbeans (including similar numbers of African and Caribbean origin) and white Europeans. Recruitment of 5000 participants began in late 2004; fieldwork was completed in mid 2008, with an overall 69% participation rate (similar in all major ethnic groups). More details of the data collected in CHASE are provided in (Appendix 2). The study can best be understood in 3 parts:-

• a study of heart disease risk factors, carried out in approximately 5000 children (CHASE-5000)
• a study of heart disease risk factors and health behaviours, carried out in approximately 2000 children (CHASE-2000)
• a study of heart disease risk factors, health behaviours and measurements of vascular structure and function, carried out in approximately 1000 children (CHASE-1000)

CHASE main risk factor study in 5000 children in 200 schools (CHASE-5000 Study)

In this study, standardized measurements of height, weight, waist and hip circumference, abdominal diameter, bioelectrical impedance, skinfold thickness, pubertal status and blood pressure were made. Participants provided fasting blood for measurement of plasma glucose, glycated haemoglobin (HbA1c), serum insulin and lipids (total, LDL and HDL cholesterol and triglyceride) and plasma vitamin C. Detailed information on ethnicity (self-defined ethnicity; place of birth, language and religion of child, parents and grand-parents) has been sought from participants and parents. Data on individual social markers (parental occupation, housing tenure, car ownership, household amenities) has been collected.

CHASE health behaviour study in 2000 children in 80 schools (CHASE-2000 Study)

In a sub-study of 2,000 participants in the main risk factor study (examined 2006-2007), detailed additional assessments of physical activity, physical fitness and diet were made. Objective assessment of physical activity was carried out over a one week period using an Actigraph GT1M accelerometer, which has been validated against gold standard methods of assessment for energy expenditure. Physical fitness was assessed using a submaximal ramped exercise step test, with continuous heart rate monitoring to a maximal workload of approximately 30 ml/kg/min. Dietary habits, nutritional composition were assessed in detail using 24 hour recalls and 4-day diaries. Supplementary studies examined short-term variation in physical activity, physical fitness and nutritional composition over periods between one month and one year.

CHASE vascular study in 1,000 children in 40 schools (CHASE-1000 Study)

In 1000 CHASE-2000 participants, objective markers of vascular structure and function which are predictors of later cardiovascular outcomes, including common carotid intimal-medial thickness, carotid arterial distensibility, carotid-femoral pulse wave velocity were measured; measurements of retinal arterial and venous tortuosity have also been made.

The Crunch study is a study examining the benefits of cereal fibre in breakfast cereals on children’s health.  Initially we are wanting to find out about which healthy breakfast cereals children enjoy eating by carrying out taste tests with school children.  Following this, children are invited to take part in our randomised controlled trial for one month which examines the effect of breakfast cereal, with varied amounts of fibre, on various health markers.

The ENABLE London study finished all data collection at the end of 2017. We are now analysing the data and will keep this website updated with the findings.

Thank you to all the participants who took part in the study, and the organisations that have supported us!

About Us

The ENABLE London study is a controlled longitudinal study investigating the impact of where we live on our health, in particular, our levels of physical activity. A major aim of the study is to find ways to improve the design of housing and of the surroundings in which we live for the future.

About us

PACE-UP was a Randomised Controlled Trial of a Pedometer Intervention to Increase Walking in Adults. It was organised and coordinated by St George's, University of London and was undertaken in selected general practices in South West London.

Purpose of the study?

Most adults are less physically active than they need to be to stay healthy. We wanted to find out if people aged 45-75 years can become more active if they were given a pedometer (a monitor that counts steps) with a physical activity diary and guidance on a 12-week programme to increase their walking. The programme was tailored to their individual baseline physical activity level. We were also interested in testing whether offering individual support from a practice nurse would increase any benefits.

When did the study start and finish?

Study recruitment started in October 2012 and our last participant joined the study in November 2013. Our 3 year follow-up finished in October 2016.

Which practices were involved?

We are grateful to the staff and patients at the following general practices for their participation in the study (number of patients recruited in brackets):

• Chatfield Medical Centre, Battersea (127)
• Cricket Green Medical Practice, Mitcham (164)
• Dr H M Freeman & Partners (Upper Tooting Surgery & Trevelyan Road Surgery) (117)
• Francis Grove Surgery, Wimbledon (218)
• Putneymead Group Medical Practice (153)
• Wrythe Green Surgery, Sutton (189)
• The Heathbridge Practice, Putney (65)

What did we do?

The Pedometer And Consultation Evaluation-UP (PACE-UP) trial recruited 1023 inactive 45- to 75-year-olds from seven South London practices, and randomised them to a usual physical activity (control) group or to one of two intervention groups. The postal group participants were sent a pedometer, diary and 12-week pedometer-based walking programme, advising them to gradually add in 3000 steps or a 30-minute walk on 5 or more days weekly. The nurse-support group received the same materials through practice nurse physical activity consultations. Physical activity and participant-reported 12-month outcomes were compared with the beginning of the trial, along with the costs of each trial group. A further 3-year follow-up was conducted and long-term value for money was estimated.

What resources did participants use?

As part of the trial participants had already worn a monitor for 7 days so their baseline targets were set.

• Patient information sheet
• Diary
• Handbook
• Walking planner

What did we find?

Both intervention groups significantly increased their walking (step counts and time in moderate-intensity physical activity) compared with controls, with no difference between nurse and postal groups. Interventions were safe and acceptable to participants and nurses. There was no effect on body size, pain or depression, but the nurse-support group participants increased their confidence in their ability to exercise. The 3-year follow-up found persistent positive effects of both interventions on physical activity levels. The postal intervention provided more value for money than the nurse-support group or the control group in the short and long term. A summary of the findings can be found here.

What does it mean?

A primary care pedometer intervention, delivered by post or with nurse support, could provide an effective way to increase physical activity levels in adults and older adults, with the postal route offering the most value for money. If you would like to try out the 12-week walking programme please click here.

Ethical Approval

This study was reviewed and given a favourable opinion by the London Hampstead Research Ethics Committee.