Medical Bulletin 16/ January/ 2025 - Video

Rewards and financial incentives are successful methods to help people quit smoking, according to a new Cochrane review. For the first time, the researchers also found “high-certainty evidence” that this intervention works for pregnant people as well.

The latest review included 47 mixed-population studies including 14 new to this review, with just under 22,000 participants. The researchers again found “high-certainty evidence” that financial incentives improve smoking cessation rates at long-term follow-up, even after the incentives are withdrawn.

Separately, the researchers looked at 13 studies from the U.S., United Kingdom and France, with 3,942 pregnant people participating. For every 100 pregnant persons who received financial incentives, 13 were likely to successfully quit smoking at six months or longer, compared to six in 100 who did not receive financial incentives.

The financial amount, given in cash or vouchers, varied widely among the studies examined, from zero (self-deposits returned to the smokers who quit) to between $45 and $1,185. The value of the incentive was not found to be related to the quit rate. “We did not have enough evidence to find out if offering different value rewards had an impact on smoking cessation,” the paper states.

“Smoking is the leading preventable cause of ill health and early death worldwide, and quitting smoking is vitally important to help people live in good health for longer,” says lead author Caitlin Notley, professor of addiction sciences at UEA’s Norwich Medical School. “We are now very confident that incentives help people, and pregnant people too, to quit smoking better than not offering incentives.”

Reference: Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M, Hartmann-Boyce J. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2025, Issue 1. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub7. Accessed 13 January 2025.

Women may be missing a diagnosis of a potentially deadly heart condition due to guidelines that don't account for natural differences in sex and body size, according to a new study led by UCL researchers. The findings are published in the Journal of the American College of Cardiology

When they tested their updated approach in 1,600 patients with clinically diagnosed hypertrophic cardiomyopathy (HCM), the researchers found that it was particularly beneficial for women, increasing identification by 20 percentage points.

The new method takes people's age, sex and size into account to determine whether their heart muscle is dangerously large. As well as preventing people being missed, it could also reduce the number of people mis-diagnosed with hypertrophic cardiomyopathy.

The team used an AI tool they developed to analyse MRI heart scans with greater precision and in much less time than a human can. The tool was given 5,000 MRI scans of healthy hearts and measured the thickness of the left ventricle wall in each. From these data, the researchers were able to determine what normal ventricle wall thickness is for people of different ages, sexes, and sizes.

This allowed them to set thresholds for abnormal wall thickness. After testing the accuracy of the new thresholds in the group of hypertrophic cardiomyopathy patients, the researchers applied them, as well as the current 15 mm cut-off, to a group of over 43,000 participants in the UK Biobank.

For every eight people identified with possible hypertrophic cardiomyopathy using the current threshold, only one was a woman. People identified were also much taller, heavier and older than the population average.

When the new personalised thresholds were applied instead, the overall number of people identified was lower, suggesting fewer misdiagnoses. Importantly, there was a much more even split between men and women -- with women making up 44% of those identified.

Reference: https://news.liverpool.ac.uk/2025/01/08/pct-blood-test-does-not-lower-antibiotic-treatment-duration-for-hospitalised-children-study-shows/

A new study found that using the procalcitonin biomarker to guide treatment decisions did not reduce antibiotic duration when compared to usual care for children.

The study, published in the Lancet Child & Adolescent Health, is part of the 'Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection' (BATCH) trial. BATCH is a national research trial to tackle antibiotic overuse in hospitalised children and reduce the spread of antimicrobial resistance (AMR).

This study, conducted across 15 hospitals, enrolled nearly 2,000 children aged between 72 hours and 18 years with suspected bacterial infections.

The researchers found that adding the PCT test to routine care did not reduce the duration of IV antibiotic use. The test was safe but costlier than standard methods, and healthcare teams faced challenges integrating it into their decision-making processes.

The results highlight that introducing new tools like PCT tests alone isn't enough. Effective use requires:

Robust Antimicrobial Stewardship (AMS) programmes

Training and education for Clinicians

Future studies should identify barriers and facilitators to implementation to optimise fidelity of the intervention.

Better understanding of the complex interactions influencing whether/how/why clinicians act on information from diagnostic tests to make antibiotic prescribing decisions will improve trial intervention fidelity and facilitate implementation and adoption of tests shown to be effective.

The researchers note that although PCT-guided treatment didn't provide clear benefits in this trial, it could still play a role in specific situations with further refinement.

Chief investigator the University of Liverpool's Professor Enitan Carrol said: "We are pleased to have completed this large multi-centre trial in hospitalised children. Whilst the study did not demonstrate benefit from the additional procalcitonin test, there is important learning for future biomarker-guided trials in the NHS.

"The BATCH study was a pragmatic trial evaluating if the intervention works under real-world conditions where clinicians do not have to adhere to diagnostic algorithms about antibiotic discontinuation. Adherence to the algorithm was low in our study, and there were challenges in integrating the test into routine clinical workflows. The study highlights the importance of including behaviour change and implementation frameworks into pragmatic trial designs."

Reference: https://www.ucl.ac.uk/news/2025/jan/research-reveals-why-more-men-women-are-diagnosed-deadly-heart-disease

A new paper in Nicotine & Tobacco Research finds that smoking has a negative effect on earnings among younger workers. This is particularly true among the less well educated.

Researchers here used data from the Cardiovascular Risk in Young Finns Study, a longitudinal analysis of 3,596 participants from urban and rural areas of five Finnish university regions, born between 1962 and 1977. They linked this data to labor market outcomes from Statistics Finland and parental background information from the Longitudinal Population Census using personal identifiers. The observation period, starting in 2001, covered people aged 24 to 39.

The researchers assessed smoking using “pack-years”.

The researchers found that a one-unit increase in pack-years was associated with a 1.8% decrease in earnings. This suggests that reducing smoking by the equivalent of five pack-years could lead to a 9% earnings increase. Additionally, the investigators involved with this study found that a one-unit increase in pack-years led to a 0.5% decrease in years employed.

The research revealed significant earnings differences between smokers and nonsmokers among younger workers, particularly among the lowest educated people. There was no such distinction among older workers. This suggests that smoking among younger generations, where it is less prevalent, may negatively affect labor market prospects more seriously.

“Smoking in early adulthood is closely linked to long-term earnings and employment, with lower-educated individuals experiencing the most severe consequences,” said the paper’s lead author, Jutta Viinikainen. “These findings highlight the need for policies that address smoking's hidden economic costs and promote healthier behaviors.”

Reference: Jutta Viinikainen, Petri Böckerman, Christian Hakulinen, Jaana T Kari, Terho Lehtimäki, Katja Pahkala, Jaakko Pehkonen, Jorma Viikari, Olli T Raitakari, Tobacco Smoking in Early Adulthood and Labor Market Performance: The Cardiovascular Risk in Young Finns Study, Nicotine & Tobacco Research, 2025;, ntae296, https://doi.org/10.1093/ntr/ntae296