Alcohol-free and low alcohol (“nolo”) drinks have the potential to improve public health, but experts in The BMJ today call for a precautionary approach that maximises potential benefits (eg. increased substitution of alcoholic drinks with nolo alternatives) while minimising risks (eg. preventing encroachment of nolo drinks into alcohol-free spaces).

Sales of alcohol-free and low alcohol drinks have increased substantially over recent years, driven by improved manufacturing techniques and consumer demand for better and healthier alternatives to alcoholic drinks, explain John Holmes, professor of alcohol policy at the University of Sheffield, and colleagues.

In Britain, one in five adults reports consuming nolo drinks at least once a month, and nolo drinks now account for 1.4% of total alcohol sales, mainly from products that share branding with an established alcoholic drink.

Nolo drinks have obvious potential to improve public health, especially for heavier drinkers, those in lower socioeconomic groups, and people drinking in high risk circumstances, such as when pregnant, driving, or in adolescence.

However, the World Health Organization (WHO) and alcohol charities have argued that no and low alcohol drinks also pose risks to public health, such as companies using nolo drinks marketing to deter or circumvent restrictions on alcohol marketing.

In Ireland, for instance, major beer companies have responded to advertising restrictions – such as on public transport and during sports matches – by promoting alcohol-free variants which have similar branding.

Similarly, nolo drinks or related marketing may encroach on otherwise alcohol-free spaces, such as gyms and sports events or in supermarket lunchtime meal deals.

For example, the 2024 Olympics named Corona Cero (an alcohol-free variant of Corona) as its official global beer sponsor, allowing the Corona brand to appear in a wide range of sporting and media contexts that were previously unavailable to it.

To protect public health, the authors call for a precautionary approach that aims to facilitate and enhance potential benefits while also preventing or minimising any harms.

Policies that could help achieve this include encouraging companies to substitute higher alcohol products with nolo alternatives, while preventing marketing to children, protecting alcohol-free spaces, and using taxes based on alcoholic strength to incentivise consumption of alcoholic drinks that contain less alcohol.

Yet the authors warn that some policy decisions seem to be driven by the concerns of businesses, trade organisations, and self-regulatory bodies, and say public health actors must engage with nolo policy questions to ensure that their perspectives, and not just commercial priorities, shape regulation of the production, marketing, sale and use of nolo drinks, and how they are framed in public debate.

“Although we argue for a public health response to nolo drinks, we are not suggesting a reduced focus on [preventing harm from consumption of] standard alcoholic drinks. Nor are we seeking to exaggerate the degree of risk that nolo drinks present,” they write. “However, as with e-cigarettes and reformulated foods, we should not take [claims about the public health benefits of] market led solutions at face value.”

“Benefits may emerge from nolo drinks, but a hands-off approach could mean these are smaller and less equitable than desired. Public health actors should therefore develop a strategic and comprehensive response that balances different concerns and aspirations,” they conclude.

14/01/2026

Notes for editors
Analysis: How should public health respond to the rise of alcohol-free and low alcohol drinks? doi: 10.1136/bmj-2025-086563
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Analysis
Subject: Alcohol-free and low alcohol drinks

The post Precautionary approach to alcohol-free and low alcohol drinks needed to protect public health, say experts first appeared on BMJ Group.

Largest study on this topic suggests that measurement errors lead to potential delays in care and contribute to health disparities

Fingertip monitors known as pulse oximeters that can be used at home to detect low blood oxygen levels (hypoxaemia) give higher readings for patients with darker than lighter skin tones, finds the largest study on this topic published by The BMJ today.

This means that low blood oxygen levels may be missed in patients with darker skin tones, potentially delaying care, while patients with lighter skin tones may get unnecessary treatment.

Pulse oximeters use light to measure the amount of oxygen in the blood (SpO2). For most people, a normal pulse oximeter reading is between 95% and 100%, with readings below 90-92% generally considered low and requiring medical attention.

They are known to be affected by several factors, including skin tone, as pigment in darker skin can absorb more light, making the device “think” there’s more oxygen than there is. But so far, studies have been unable to draw any firm conclusions about the impact of skin tone on diagnostic accuracy.

To address this, researchers set out to test the measurement and diagnostic accuracy of five fingertip pulse oximeters provided by the NHS for use at home in the NHS England COVID oximetry @home scheme.

They drew on data from 903 critically ill adults (average age 56 years; 67% male) on 24 NHS intensive care units in England between June 2022 and August 2024.

Although the fingertip pulse oximeters tested were those used at home, intensive care units were used as the test laboratory as patients have lower blood oxygen values and routinely have their blood oxygen accurately measured using hospital machines.

For each patient, skin tone was measured objectively using a spectrophotometer (a type of camera that measures colour). The researchers then compared pulse oximetry blood oxygen values (SpO2) with “gold-standard” arterial blood gas measurements (SaO2).

SpO2 values were assessed at two thresholds in line with current guidance either to seek medical help (94% or lower) or to attend the emergency department (92% or lower).

A total of 11,018 paired SpO2-SaO2 measurements were analysed. All five pulse oximeters returned higher SpO2 values for patients with darker skin tones than patients with lighter skin tones, at any given level of SaO2 measurement.

SpO2 readings were, on average, 0.6-1.5 percentage points higher for patients with darker than lighter skin tone.

At both SpO2 thresholds assessed, false negative rates (low oxygen missed by the pulse oximeter when present) increased with darker skin tones, while false positive rates (low oxygen indicated by the pulse oximeter when absent) decreased with darker skin tone.

And while absolute differences in readings were small, “they can result in substantially higher rates of false negatives and lower rates of false positives in the diagnosis of hypoxaemia,” note the researchers.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. And the authors acknowledge that the study was conducted in critically ill patients, which may limit the generalisability of the findings.

However, they say this was a large study using sophisticated statistical modelling to assess the performance of the pulse oximeters across multiple domains of both measurement and diagnostic accuracy.

As such, they conclude: “SpO2 readings should be interpreted in the context of other clinical information and trends in SpO2 values given greater importance than single readings, particularly in patients with darker skin tones.”

They add: “Healthcare systems should develop guidance to inform and aid practitioners, patients and the public, particularly in settings where additional clinical readings from other medical measurement devices would not be available.”

In a linked editorial, researchers agree that clinicians must recognise the limitations of current devices and interpret readings for patients with darker skin with care and caution, and they say regulation must now catch up with science to mitigate harm.

“The goal is not to abandon pulse oximetry but to understand its limits and make it equitable, ensuring that the technology designed to measure oxygen does not itself perpetuate inequalities in those who receive it,” they conclude.

14/01/2026

Notes for editors
Research: The impact of skin tone on the performance of pulse oximeters used by the National Health Service COVID oximetry @home scheme: measurement and diagnostic accuracy study doi: 10.1136/bmj-2025-085535
Editorial: Pulse oximetry in people with darker skin tones doi: 10.1136/bmj.s37
Journal: The BMJ

Funding: National Institute for Health and Care Research (NIHR)

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Observational; Opinion
Subject: People

The post Home fingertip oxygen monitors less accurate for people with darker skin tones first appeared on BMJ Group.

Cast also carries fewer treatment related harms than surgery, say researchers

Wearing a cast for six weeks appears to be no less effective than surgery for healing unstable ankle fractures and carries fewer treatment related harms, finds a clinical trial from Finland published by The BMJ today.

Around two thirds of all ankle fractures involve a break in the fibula (the outer ankle bone). Known as Weber B fractures, they leave the ankle either stable or unstable (at risk of falling out of alignment).

Surgery remains the main treatment for Weber B ankle fractures deemed unstable, despite recent trials and guidelines increasingly supporting non-surgical options in selected patients.

To explore this further, researchers set out to assess whether cast immobilisation is comparable (“non-inferior”) to surgery in adults with Weber B ankle fractures deemed unstable.

They identified 126 participants aged 16 years or older with an unstable Weber B ankle fracture confirmed by an external rotation stress test at a specialist university hospital trauma centre in Finland between January 2013 and July 2021.

Sixty-two participants were randomly assigned to conventional cast immobilisation for six weeks and 64 were assigned to undergo surgery followed by cast immobilisation for six weeks.

Both groups had check-ups at two, six, and 12 weeks and met with a physiotherapist at six and 12 weeks to guide rehabilitation.

At two years, participants were assessed using the Olerud-Molander Ankle Score (OMAS), a 0 to 100 point scale where higher scores indicate better healing. An 8 point difference between groups was pre-set as the non-inferiority margin.

Other check-up assessments included ankle function, pain, health related quality of life, ankle range of motion and x-rays. Treatment related adverse events were also recorded.

In all, 121 of the 126 randomised participants completed the two year follow-up. The mean OMAS was 89 in the cast immobilisation group and 87 in the surgery group (a between group mean difference of 1.3 points).

No statistically significant between group differences were seen in any of the other outcomes and overall, fewer treatment related harms occurred with cast immobilisation compared with surgery.

The authors acknowledge that their trial was from a single university hospital, which may limit generalisability and note the lack of consensus of the external rotation stress test to determine fracture instability, but say this was a robust analysis that achieved a high follow-up rate at two years – a time point generally considered sufficient to capture longer term outcomes.

“Together, our findings and those of previous studies show that a standard below-the-knee cast provides adequate stabilisation of an isolated unimalleolar fibular fracture with a congruent ankle mortise [the bracket-shaped socket of the ankle],” they write.

“This lends further support to the evolving concept that the treatment of ankle fractures should focus on obtaining and maintaining a congruent ankle mortise until fracture union, using the most conservative means possible.”

This team is to be commended for conducting a robust study which addresses an important clinical question, and will support treatment decisions and updates to clinical guidelines, say UK researchers in a linked editorial.

They discuss some limitations, but say collectively this and other trials “are supporting much needed advances in the evidence base for ankle fracture management and are a testament to the collaborative network of trauma and orthopaedic health professionals, researchers, and, most importantly, patient participants.”

14/01/2026

Notes for editors
Research: Cast immobilisation versus surgery for unstable lateral malleolus fractures (SUPER-FIN): randomised non-inferiority clinical trial doi: 10.1136/bmj-2025-085295
Editorial: A step forward for ankle fracture management doi: 10.1136/bmj.s56
Journal: The BMJ

Funding: Oulu University Hospital

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Non-inferiority clinical trial; Opinion
Subject: People

The post Six weeks in a cast no less effective than surgery for unstable ankle fractures first appeared on BMJ Group.

Women’s odds of obesity nearly 5 times higher than men’s in the region
And obesity 3 times more likely in those with tertiary level education

Female sex and higher education are significantly linked to the escalating prevalence of obesity and overweight in Africa, finds one of the largest and most detailed analyses of body weight trends in the region, published in the open access journal BMJ Global Health.

Women’s odds of obesity in Africa are 5 times greater than those of men’s, while obesity is 3 times more likely in those with tertiary level education than in those with lower levels, the findings indicate.

The global prevalence of overweight and obesity has more than doubled over the past 4 decades. In 2022, 2.5 billion adults were overweight, representing 43% of all the world’s adults, and 890 million were living with obesity, note the researchers.

While recent research suggests that the rate of increase in overweight and obesity may be slowing in high income countries, it seems to be speeding up in low- and middle-income countries, where around two thirds of those living with obesity now reside, they explain.

Africa is particularly vulnerable because of its fragile healthcare systems, limited resources, socioeconomic complexities, urbanisation and sparse public health policies, they add.

The researchers wanted to explore the extent of overweight and obesity in Africa, and capture 20 year trends (2003-22).

They analysed data from 54 nationally and regionally representative STEPS (STEPwise approach to non-communicable disease risk factor surveillance) surveys carried out between 2003 and 2022 for 36 of the 47 countries in the World Health Organization (WHO) Africa region—representing three-quarters of the total population and 156 million adults.

Underweight was defined as a BMI of less than 18.5, overweight as a BMI of between 25 and 29.9, and obesity as a BMI of 30 or more.

The surveys captured weekly physical activity levels from low (below the recommended weekly tally) to high (above this) and daily portions of fruits and vegetables consumed (from 0-1 to 4-5).

In all, data were obtained for 198,901 adults with an average age of 36; half were women. Of the countries included in the analysis, 13 were in West Africa, 9 in East Africa, 5 in Southern Africa, 8 in Central Africa and 1 in North Africa (Algeria).

The analysis revealed that the age standardised and weighted prevalence of underweight, overweight, and obesity was 11.5%, just under 18%, and 9%, respectively.

Twenty year trends showed a significant increase in the overall prevalence of obesity from nearly 15.5% in 2003 to nearly 17% in 2022; of underweight from 12% to just under 13%; and a levelling out in the prevalence of overweight (around 18% between 2003 and 2022).

The prevalence of overweight and obesity was, respectively, just under 18% and 9% higher in women (21% and nearly 13.5%) than in men (15% and just over 4.5%).

After adjusting for potentially influential factors, female sex, older age, higher education level, physical inactivity and poor diet were all associated with overweight or obesity.

The odds of overweight and obesity were, respectively, twice as high and almost 5 times as high, in women as they were in men. And those educated to tertiary level were twice as likely to be overweight and nearly 4 times as likely to be obese than those educated to lower levels.

“Taken together, these findings underscore the need for targeted public health interventions that consider the unique socio-cultural and economic contexts affecting women in the WHO African region,” say the researchers.

“Also, the results raise the point that education and awareness campaigns should not solely target individuals with lower education levels, as those with higher education may also require information and support,” they add.

“The present study further underscores the dual burden of malnutrition in the Africa region, showing significant increased trends in both obesity and underweight,” they continue.

The researchers acknowledge various limitations to their findings including that the WHO Africa region does not cover all of the continent, and that no data were available from South Africa, a country with one of the highest rates of overweight and obesity.

Nor did they study potentially influential factors, including cultural norms, accessibility to preventive healthcare, commercial factors, and household income. And the survey focused only on 18–69 year olds, excluding children and older adults.

But they nevertheless conclude: “These findings support the urgent need to intensify preventive health policies and programmes in the WHO African region.”

13/01/2026

Notes for editors
Research: Prevalence, time trends and associated factors of adult overweight and obesity in 36 countries in the WHO African region from 2003 to 2022: a study of 54 WHO STEPS surveys representing 156 million adults Doi: 10.1136/bmjgh-2025-019988
Journal: BMJ Global Health

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post Female sex and higher education linked to escalating prevalence of obesity and overweight in Africa first appeared on BMJ Group.

If high quality clinical trials confirm lasting benefits and key features, apps could become cornerstone of global tobacco control efforts, suggest researchers

Smartphone apps—particularly those based on psychological theories—are 3 times as effective as no/minimal support at helping people who smoke stub out their tobacco use long term, suggests a pooled data analysis of the available evidence, published in the online journal BMJ Evidence Based Medicine.

If high quality clinical trials can confirm lasting benefits and key features, these apps could become a cornerstone of global tobacco control efforts, suggest the researchers.

Smartphone apps offer an accessible and versatile approach to smoking cessation efforts. But the current body of evidence has been hindered by small study numbers and app obsolescence, say the researchers.

Most currently available smoking cessation apps adopt either traditional behavioural frameworks, focused on directly modifying smoking behaviour, or psychological-behavioural theories, targeting cognition, emotion regulation, and motivation through techniques such as cognitive behavioural therapy (CBT), acceptance and commitment therapy, and mindfulness, explain the researchers.

But it’s not clear which approach might be more effective for improving sustained abstinence.

To strengthen and update the evidence base, the researchers assessed the effectiveness of smartphone apps, when used alone or when combined with traditional approaches, such as nicotine replacement therapy and counselling, for helping people quit smoking and stay away from tobacco long term (6 months continuously).

They trawled research databases for relevant randomised controlled trials published up to August 2025 of people aged at least 15 who planned to quit smoking. Comparisons included: no intervention; minimal smoking cessation support; traditional interventions; and apps based on traditional behavioural interventions.

Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

The data from a total of 31 eligible studies, involving 12,802 participants, were pooled. Low certainty evidence from 4 studies (1402 participants) suggests that smartphone apps used alone may nearly triple the rate of 6-month continuous abstinence, increasing the number of ‘abstainers’ by 40 in every 1000, compared with no or minimal smoking cessation support.

When combined with traditional interventions, these apps may nearly double 6-month continuous abstinence compared with traditional interventions alone (4 studies involving 2163 participants; low certainty evidence).

And based on data from 3 studies (1502 participants; low certainty evidence), these apps plus pharmacotherapy may improve 6-month continuous abstinence by 77% compared with pharmacotherapy alone.

High certainty evidence indicated that apps based on psychological behavioural theories significantly increased abstinence in the short term at 3 months (69%; 2 studies, 2565 participants) and in the long term at 6 months (36%; 4 studies, 3258 participants) compared with apps based on traditional behavioural interventions.

“Smartphone apps can deliver intensive, interactive and real-time behavioural support, exceeding the effect of brief advice. A clear dose–response relationship exists between counselling intensity and quit success, and apps help meet this need while bypassing barriers such as limited clinic capacity, staff time, and declining use of telephone quitlines,” point out the researchers.

“Consequently, smartphone apps represent a scalable alternative or adjunct to traditional cessation services, particularly in resource-limited settings,” they suggest.

But the certainty of the evidence remains low due to limited sample sizes and methodological limitations, including design variations in the apps and their use, caution the researchers, adding that the findings “should be viewed as generating a hypothesis for future research rather than as a definitive conclusion.”

They conclude: “Should future evidence confirm lasting benefits and pinpoint key features, rigorously validated apps could become a cornerstone of global tobacco control efforts.”

13/01/2025

Notes for editors
Research: Efficacy of smartphone apps used alone or with traditional interventions for smoking cessation: a systematic review and meta- analysis Doi: 10.1136/bmjebm- 2025-113971
Journal: BMJ Evidence Based Medicine

External funding: China Association on Tobacco Control for Health

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Systematic review + meta analysis
Subjects: People

The post Phone apps nearly 3 times as good as no/basic support for quitting smoking long term first appeared on BMJ Group.

But data on use, frequency, and consequences for NHS incomplete and haphazard
Currently impossible to fully understand risks of opting for surgery abroad, warn researchers

The postoperative complications of medical tourism may be costing the NHS up to £20,000 per patient, suggest the findings of a rapid review of the available data, published in the open access journal BMJ Open.

But data on the use, frequency, and consequences for the NHS are incomplete and haphazard, making it currently impossible to fully understand the risks of opting for surgery overseas, warn the researchers.

The number of medical tourists has risen steadily over the past several decades, a trend that shows no sign of abating, note the researchers. And treatment of any postoperative complications usually falls to the home country’s health service and can be further complicated by inadequate information about the initial surgery, they add.

Amid an absence of systematically collected data, the researchers wanted to gauge the costs and savings to the NHS of medical tourism as well as the type, frequency, and complications involved, plus any subsequent treatment, care, and use of NHS resources.

They reviewed research databases for relevant studies as well as ‘grey literature,’ such as conference proceedings, discussion papers, editorials, and government, industry, and institutional reports, published between 2012 and December 2024.

Studies that described cases of emergency and urgent surgery abroad; treatment for cancer, infertility, and dentistry; and transplant surgery were excluded from the analysis.

In all, 90 full text articles were selected for review, of which 38 reports describing 37 studies, were eligible for inclusion: 19 described complications due to metabolic/bariatric surgery; 17 complications due to cosmetic surgery; and one complications arising from eye surgery.

The case series and case reports included 655 patients treated by the NHS between 2011 and 2024 for complications arising from metabolic/bariatric (385), cosmetic (265), or eye (5) surgery tourism.

Twenty three studies reported the destination country. Overall, 29 countries from every continent were reported, but Turkey was the most common destination (61%). Most patients were women (90%), and the average age was 38, but ranged from 14 to 69.

The most commonly reported procedures were sleeve gastrectomy–removal of part of the stomach to create a smaller ‘sleeve’–breast surgery enlargement, and ‘tummy tuck’ (abdominoplasty).

Twenty two studies (371 patients) reported some details on complications. No deaths were reported in the included studies, but at least 196 patients (53%) experienced moderate to severe complications.

Treatment for these was not clearly reported in most of the studies, however, and only 14 studies reported on the associated costs, which ranged from £1058 to £19,549 per patient in 2024 prices.

Eight studies (159 patients) reported length of hospital stay for the treatment of complications from metabolic/ bariatric surgery tourism. The combined average length of stay was just over 17 days; the longest was 45 days.

The combined average length of stay for the treatment of cosmetic surgery complications was just under 6 days; the longest was 49 days. For eye surgery tourism, over 50 outpatient appointments and 4 surgical procedures were reported.

Very few studies reported on the use of other resources, such as day case procedures, surgery time, clinic appointments or number and type of diagnostic tests.

The certainty of the evidence obtained from most of the studies was low, primarily because most of the studies were retrospective, with data obtained from medical notes, which can be incomplete or wrongly coded; few studies included demographic details or previous medical history; and not all outcomes were reported by all the studies, explain the researchers.

But this suggests that both the complications arising from medical tourism for elective surgery and the associated costs are likely to be underestimated, they add.

“There are areas of the UK, such as Wales and the South West of England, which are almost unrepresented [in published evidence]. We did not identify any studies that related to other surgical specialties, such as orthopaedic surgery, and we did not identify any eligible studies conducted in primary care or that considered longer-term follow- up,” they point out.

“We still do not know how many people resident in the UK go abroad for elective surgery or how many people subsequently experience complications. Without these data, we cannot fully understand the levels of risk that people seeking surgery abroad are taking,” they emphasise.

“A systematic approach is needed to collecting information on the number of people who travel abroad for elective surgery and the frequency and impact on the UK NHS of treating complications,” they insist.

“Awareness-raising campaigns and interventions are warranted to inform members of the public in the UK considering going abroad for surgery about the potential for complications.” they add.

“Those seeking medical treatment abroad should be made aware of which complications the NHS is responsible for treating, and costs for which the patient may be potentially personally liable, including non-emergency treatment,” they suggest.

13/01/2026

Notes for editors
The authors have previously posted a non-peer reviewed, unedited version of this study for feedback from the research community, on a recognised preprint server.
Research: Complications and costs to the UK National Health Service due to outward medical tourism for elective surgery: a rapid review Doi: 10.1136/bmjopen-2025-109050
Journal: BMJ Open

External funding: Health and Care Research Wales Evidence Centre

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Rapid review
Subjects: People

The post Postoperative complications of medical tourism may cost NHS up to £20,000/patient first appeared on BMJ Group.

That single introduction at the Forum led to the formation of a national group of clinical leaders focused on scaling proactive patient and family escalation beyond a single service. Leaders from multiple Australian states began meeting regularly to share data, align approaches and test feasibility across different healthcare contexts.

This group evolved into a nationwide community of practice that has now met regularly for several years. It has supported collaborative research, shared implementation learning and coordinated rollout across jurisdictions, demonstrating the progression of the project from local improvement to system-level adoption.

The post Recognising deterioration earlier by partnering with families first appeared on BMJ Group.

“Having an unusual case and exposing it to the medical fraternity is important, and I love it that BMJ Case Reports does that. It became a big issue in Australia. I hope this report raises awareness on nutritional deficiencies and encourages clinicians to screen for them in patients with risk factors.”

Dr Andrew Dermawan
General Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia

The post ‘Renaissance era’ diagnosis of scurvy in today’s bariatric population first appeared on BMJ Group.

Associations apparent for any, exclusive, and cumulative (at least 1 year) breastfeeding

Breastfeeding may lower mothers’ later life risks of depression and anxiety for up to 10 years after pregnancy, suggest the findings of a small observational study, published in the open access journal BMJ Open.

The observed associations were apparent for any, exclusive, and cumulative (at least 12  months) breastfeeding, the study shows.

Breastfeeding is associated with lower risks of postnatal depression and anxiety, but it’s not clear if these lowered risks might persist in the longer term, say the researchers.

To find out, they tracked the breastfeeding behaviour and health of 168 second time mothers who were originally part of the ROLO Longitudinal Birth Cohort Study for 10 years.

All the women had given birth to a child weighing under 4 kg and they and their children had check-ups 3 and 6 months, and 2, 5, and 10 years after birth by which time the mothers’ average age was 42.

At each check-up, the mothers completed a detailed health history questionnaire. This asked whether they had been diagnosed with, and treated for, depression/anxiety. They also provided information on potentially influential factors, including diet and physical activity levels.

At the check-ups, the mothers provided information on: whether they had ever breastfed or expressed milk for 1 day or more; total number of weeks of exclusive breastfeeding; total number of weeks of any breastfeeding; and cumulative periods of breastfeeding of less or more than 12 months.

Nearly three quarters of the women (73%; 122) reported having breastfed at some point. The average period of exclusive breastfeeding lasted 5.5 weeks and that of any breastfeeding for 30.5 weeks. More than a third (37.5%; 63) reported cumulative periods of breastfeeding adding up to at least 12 months.

Twenty two (13%) of the women reported depression/anxiety at  the 10-year check-up, with a further 35 (21%) reporting depression or anxiety at any time point.

Those reporting depression/anxiety at the 10 year check-up were younger,  less physically active, and had lower wellbeing scores at the start of the study than those who didn’t report this. Those women reporting depression and anxiety at any time point differed only by age at the start of the study.

Analysis of the data showed that women experiencing depression and anxiety 10 years after pregnancy were less likely to have breastfed and had shorter periods of any or exclusive breastfeeding over their lifetime.

Each week of lifetime exclusive breastfeeding was associated with a 2% lower likelihood of reporting depression and anxiety, after accounting for potentially influential factors, including alcohol intake.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that participants were relatively few in number, not ethnically or socially diverse, and that the study relied on personal recall rather than objective measures of depression/anxiety.

Nevertheless, they write: “We suggest there also may be a protective effect of successful breastfeeding on postpartum depression and anxiety, which in turn lowers the risk of maternal depression and anxiety in the longer term.”

They explain: “The likelihood is that the association is multifactorial, as many socioeconomic and cultural factors influence both breastfeeding and mental health in addition to the impact of health history.  Additionally, women with a prior history of depression and anxiety are at risk of lower breastfeeding success, compounding the association but in the reverse direction.”

They conclude: “We know that improving breastfeeding rates and duration can improve lifetime health outcomes, reducing population level disease burden and resulting in significant healthcare savings.

“The possibility that breastfeeding could further reduce the huge burden of depression on individuals, families, healthcare systems and economies only adds to the argument for policymakers to improve breastfeeding support.”

08/01/2025

Notes for editors
Research: Breastfeeding and later depression and anxiety in mothers in Ireland: a 10- year prospective observational study Doi: 10.1136/bmjopen-2024-097323
Journal: BMJ Open

External funding: Health Research Board, Ireland; Health Research Centre for Health and Diet Research; National Maternity Hospital Medical Fund; European Commission Seventh Framework Programme; Children’s Health Ireland

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf  

About the journal
BMJ Open is one of 70 journals published by BMJ Group.
https://bmjopen.bmj.com

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Mothers

The post Breastfeeding may lower mums’ later life depression/anxiety risks for up to 10 years after pregnancy first appeared on BMJ Group.

Time off work and/or loss of earnings reported in over half of cases
Explore mandatory lead use in certain public spaces to boost public safety, urge researchers

Mental trauma, including specific phobias and post traumatic stress disorder (PTSD), succeeds 1 in 7 dog related injuries, while over half of cases result in the need for time off work and/or loss of earnings, suggests a study of personal injury claims data for England and Wales, published online in the journal Injury Prevention.

As most of these claims involved unrestrained dogs in non-residential locations, mandating lead use on highways and in public spaces should now be explored to boost public safety, urge the researchers.

The latest estimates for 2024 indicate that there are 13.6 million dogs in the UK. Hospital admissions for dog related injuries have risen from 4.76/100,000 people in 1998 to 18.7 in 2023 in England. In Wales, they rose from 16.3/100,000 people in 2014 to 23.7 in 2022, note the researchers.

The information on these injuries isn’t as comprehensive as it needs to be, suggest the researchers. Currently, hospital records don’t differentiate between dog bites and dog strikes (any dog-related injury not caused by a bite); not everyone who needs hospital treatment will be admitted to hospital; and there’s little or no information on the longer term effects.

While civil claims data are more informative, these claims are only pursued when there are sufficient assets to cover damages and legal costs, point out the researchers.

Most solicitors’ firms, however, collect initial contextual and impact data before making a judgement as to whether the case can be taken on. If these initial data were routinely collated and analysed, this would remove the inherent socioeconomic bias of analysing court records, they explain.

To find out if this might be a viable option, and how informative these data would be, the researchers analysed anonymised civil claims enquiry data from 1 January 2017 to 31 March 2024, provided by a specialist law firm operating throughout England and Wales.

The enquiry data contained information about the injured person, including their age and sex; date, location/land use, and context of the incident; breed and level of restraint of the dog; and consequences including physical injuries, mental trauma, medical treatment, time off work and loss of earnings.

Data were categorised into incidents involving dog bites and those involving strikes or other types of behaviour.

Analysis of the data showed that 816 dog-related incidents, comprising 842 individual claims, were recorded between January 2017 and March 2024.

Most (94%) incidents occurred in England and primarily involved dog bites (just over 91%); 7% were dog strikes.

Half of dog bite victims were male (53%), while dog strike victims were mainly female (70%). Women were more than twice as likely to be involved in a non-bite incident as men. Most of the injured didn’t know the dog involved (80%).

The three most common locations for dog bites were in front of a private residential property (just over 34%), on a highway or pavement (18%), and inside a private residential property (11%).

Almost half of non-bite incidents occurred in public spaces (49%), the most frequent of which were outdoor recreational areas, such as parks and nature reserves (34%), highways or pavements (23%), and ‘forestry, open land and water’ (11.5%).

Delivery workers made up over 1 in 4  (28%) of those bitten, most often during a delivery to a private residential property, when an unrestrained dog came out of the front door (12%). Other situations involved walking, exercising, playing in public without a dog (11.5%); and walking with one’s own dog (11%).

The most common circumstances for non-bite incidents were either with a dog when out walking, exercising, or playing in public (34%) or without (27%); and when a dog escaped from a private property (10%).

In both types of incident, most of the dogs weren’t restrained at the time: 79% of biting dogs; and 86% of non-bite incidents. Most dogs involved in a bite (69%) or non-bite (77.5%) incident were reported to be with their owner.

Almost all (98%) of bite, and 78% of non-bite, incidents ended up with a physical injury. Fractures comprised nearly 4% of injuries, while tissue loss or amputations made up 3%. Non-bite incidents were primarily described as fractures (73%), muscle/tendon/ligament damage (9%), and soft tissue damage (9%). The head was injured in 1 in 7 bite cases.

Most of those injured reported psychological consequences: (90%) of those who were bitten; and 76% of those who were the victims of other types of injuries.

In all, 15% (1 in 7) of all those injured were formally diagnosed with a mental illness as a result of the incident, while 6.5% were diagnosed with a specific phobia and 4% with PTSD. Other mental health consequences included anxiety, disturbed sleep, and avoidance.

Most of the physical injuries sustained resulted in a hospital visit. A quarter of those bitten, and nearly a third of those who weren’t bitten, required surgery.

Of the claimants still working when injured, 59.5% of those bitten and 56% of those who weren’t bitten took time off work, up to a maximum of 5 years. Over half of those bitten (54%) and 41.5% of those who weren’t reported loss of earnings as a result of their injuries.

There is no centralised registry of these cases across all law firms. And the researchers acknowledge that their study was based on data from one law firm and therefore may not be fully representative.

But they suggest: “These data implicate unrestrained dogs in non-residential locations as a major inciting factor for dog-related injuries, and injury prevention strategies need to explore how lead use can be effectively legislated.”

They add: “Most claimants reported that dogs were with their owners and off lead. Almost half of bite and more than 80% of non-bite incidents occurred in non-residential locations and the majority involved unrestrained dogs… These findings raise concerns over owner control.”

Current national legislation on lead control doesn’t affect public highways or urban green spaces, where most injuries occur, they argue.

The Highway Code advises that dogs should be ‘kept on a short lead when walking on the pavement, road or path shared with cyclists or horse riders’, but this is only guidance, not law. And while local authorities can introduce Public Space Protection Orders (PSPOs), it’s unclear how often these are applied or how much of a deterrent they are, they highlight.

“We recommend that national legislation is updated so that all dogs should be on a fixed- length short lead (less than 2 metres) on public highways and in urban green spaces (unless a local authority provides provisions for off-lead areas, or make areas exempt).

“This exemption provision is to ensure that the important balance between public safety and dog welfare can be achieved. This should be partnered with a nationally coordinated public communication campaign,” they conclude.

09/01/2025

Notes for editors
Research: Using civil claim enquiry data to understand the context and impact of dog- related injuries in England and Wales between 2017 and 2024 Doi: 10.1136/ip-2025-045863
Journal: Injury Prevention

External funding: Biotechnology and Biological Sciences Research Council; Economic and Social Research Council

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Data analysis
Subjects: People

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