Music provides respite from an uncertain and stressful situation, says expert

Playing soothing live music in intensive care units not only helps parents bond with their baby but also provides a moment’s respite from an uncertain and stressful situation, says a senior doctor in the Christmas issue of The BMJ.

In 2025, Music in Hospitals & Care has delivered more than 90 hours of live music to neonatal intensive care units (NICUs) in the UK, reaching more than 1000 seriously ill babies.

The charity has been providing soothing tunes for babies and parents through its Lullaby Hour sessions since 2017, bringing a sense of calm to intensive medical settings, including adult intensive care units.

Several studies have found a positive effect of music therapy on preterm babies in the NICU – including lowering heart rate and respiratory rate, as well as increasing feeding volume – although a 2021 meta-analysis highlighted the low certainty of the evidence.

Mica Bernard, singer and guitarist, says: “When I’m singing to the baby, I can literally see their heart rate calming down or their oxygen increasing. I think it goes to show just how built in music is for human beings.”

Contrary to some parents’ concerns, research by Music in Hospitals & Care shows that babies are frequently observed falling asleep or staying asleep during the live music. Sometimes it’s played during distressing times such as clinical procedures and nappy changes.

Jay Banerjee, neonatal consultant at the Imperial College Healthcare NHS Trust, says: “These music sessions not only help parents bond with their baby but also provide a moment’s respite from an uncertain and stressful situation. The feedback from families and the clinical team here has been universally positive.”

The bonding element of Lullaby Hour is particularly important for parents who can’t hold their baby who is in an incubator.

Bernard explains: “Often, if it’s the first time I’ve sung to a parent, it’s the perfect outlet for them to be able to cry … The music helps them get in touch with what they’re feeling.”

The music also provides some sense of normality in intensive care wards.

Gail Scott-Spicer, chief executive of Imperial Health Charity, which delivers arts programmes to hospitals, says: “The environment of a neonatal intensive care unit is, of course, quite overwhelming … To be able to bring a bit of ‘normal’ into that situation starts to explain the really positive health outcomes for the babies, and it reduces stress and anxiety for the families.”

17/12/2025

Notes for editors
Feature: Where medicine meets melody—Lullaby Hour brings harmony to the neonatal ICU doi:10.1136/bmj.r2587
Journal: The BMJ

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

Externally peer reviewed? No
Evidence type: Feature; Opinion
Subjects: Babies and parents 

The post Where medicine meets melody – how lullabies help babies and parents in intensive care first appeared on BMJ Group.

Improving their living conditions may benefit both health and exam results, say researchers

Children living in substandard housing in England miss 15 more school days and achieve worse test scores in English and maths than their peers living in better quality housing, suggests research published online in the Journal of Epidemiology & Community Health.

Improving their living conditions—specifically reducing overcrowding and damp, and upgrading heating systems—may not only benefit their health, but also their grades,conclude the researchers.

One in 7 families in England live in homes that fail to meet the official decent homes standard, point out the researchers. Housing is a key determinant of child health, yet relatively little is known about how its quality may affect educational outcomes, particularly the number of missed school days and exam grades, they add.

To explore this further, the researchers drew on data for 8992 children, born between 2000 and 2002 participating in the nationally representative Millennium Cohort Study.

Housing quality at the age of 7 was calculated from 6 key indicators: accommodation type; floor level; lack of access to a garden; presence of damp; inadequate/no heating; and overcrowding.

Housing quality was linked to the percentage of missed school days and standardised test results in maths and English at the ages of 7, 11, and 16 in the National Pupil Database.

On average, children missed 5% (86 days) of compulsory schooling (years 1–11). And approximately 16% of them lived in poor quality housing, defined as meeting at least 2 of the 6 indicators.

After accounting for potentially influential factors, including parental educational attainment and ethnicity, analysis of the data showed that children living in poor quality housing missed more school days and achieved worse grades than children living in better quality housing.

These children missed nearly 1.5 more school days, on average, for each of the 11 years of compulsory schooling than their peers living in higher quality housing (based on 7272 children). Damp, overcrowding, and living in a flat were most strongly associated with missed schooling.

Test scores in maths and English during primary and secondary school were between 0.07 and 0.13 points (2-5%) lower for children living in poorer quality housing (based on 6741 children), mainly driven by overcrowding, and to a lesser extent, lack of central heating.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, added to which data on school absences or test results on at least one data collection point were missing for 10% of the participants.

Children exclusively in home schooling and attending private schools (7%) aren’t captured in the National Pupils Database. And housing conditions were subjectively assessed by parents rather than being objectively measured.

Nevertheless there are plausible explanations for the observed associations, suggest the researchers, with living in damp housing increasing the risk of respiratory illness.

“While study participants were not asked directly about the presence of mould, damp conditions are a major determinant of fungal growth which can in turn release hazardous spores, fragments, and microbial volatile organic compounds into indoor air,” they explain.

Overcrowding also creates an unfavourable environment for study, they add. “Crowded housing is linked to behavioural problems and to worse health in children…Living in crowded homes is linked to lower academic achievement due to noise, lack of study space, insufficient sleep, reduced concentration and added responsibilities (eg, childcare).”

They conclude: “Improving housing conditions, especially reducing damp and overcrowding, and updating heating systems and energy efficiency can have significant benefits.

“Given the magnitude of the problem in England, national and local public health and housing policies targeting these features of housing quality could improve children’s health and school outcomes across the country and narrow the health inequality gaps.”

The NHS could also save the £1.4 (€1.6, US$1.8) billion every year it spends on treatment associated with the effects of poor housing, they add.

16/12/2025

Notes for editors
Research: Housing quality and school outcomes in England: a nationally representative linked cohort study Doi: 10.1136/jech-2025-224495

Journal: Journal of Epidemiology & Community Health

External funding: Economic and Social Research Council

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational cohort study
Subjects: People

The post Living in substandard housing linked to kids’ missed schooling and poor grades first appeared on BMJ Group.

Experts warn of a generation learning to form emotional bonds with entities that lack the capacity for empathy and care 

AI chatbot systems, such as ChatGPT, Claude, and Copilot, are used increasingly as confidants of choice, but turning to AI chatbots for companionship and emotional support is a cause for concern, especially in younger people, say experts in the Christmas issue of The BMJ.

They warn that “we might be witnessing a generation learning to form emotional bonds with entities that lack capacities for human-like empathy, care, and relational attunement” and say evidence based strategies for reducing social isolation and loneliness are paramount.

In 2023, the US Surgeon General declared that the nation was experiencing a loneliness epidemic, constituting a public health concern on par with smoking and obesity, write Susan Shelmerdine and Matthew Nour.

In the UK, nearly half of adults (25.9 million) report feeling lonely either occasionally,

sometimes, always, or often; with almost 1 in 10 experiencing chronic loneliness (defined as feeling lonely “often or always”). Younger people (aged 16-24 years) are also affected.

Given these trends, it’s no wonder that many are looking to alternative sources for companionship and emotional support, say the authors. ChatGPT, for example, has around 810 million weekly active users worldwide, and some reports place therapy and companionship as a top reason for use.

Among younger people, one study found a third of teenagers use AI companions for social interaction, with 1 in 10 reporting that the AI conversations are more satisfying than human conversations, and 1 in 3 reporting that they would choose AI companions over humans for serious conversations.

In light of this evidence, they say it seems prudent to consider problematic chatbot use as a new environmental risk factor when assessing a patient with mental state disturbance.

In these cases, they propose that clinicians should begin with a gentle enquiry on problematic chatbot use, particularly during holiday periods when vulnerable

populations are most at risk, followed if necessary by more directed questions to assess compulsive use patterns, dependency, and emotional attachment.

They acknowledge that AI might bring benefits for improving accessibility and support for individuals experiencing loneliness, and say empirical studies are needed “to characterise the prevalence and nature of risks of human-chatbot interactions, to develop clinical competencies in assessing patients’ AI use, to implement evidence based interventions for problematic dependency, and to advocate for regulatory frameworks that prioritise long term wellbeing over superficial and myopic engagement metrics.”

Meanwhile, focusing and building on evidence based strategies for reducing social isolation and loneliness are paramount, they conclude.

11/12/2025

Notes for editors
Feature: AI chatbots and the loneliness crisis doi: 10.1136/bmj.r2509
Journal: The BMJ

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

Externally peer reviewed? No
Evidence type: Feature; Opinion
Subjects: AI chatbots 

The post Concern over growing use of AI chatbots to stave off loneliness first appeared on BMJ Group.

No significant variation in risk by type of disorder or timing of child’s exposure
Include dedicated support for these disorders in maternal healthcare, say researchers

Eating disorders in mums-to-be are linked to a heightened risk of asthma and wheezing in their children, irrespective of the type of disorder, presence of co-existing depression/anxiety, or the timing of their child’s exposure, finds research published online in the journal Thorax.

The findings prompt the researchers to call for the inclusion of dedicated support in the healthcare of pregnant women with eating disorders to improve the respiratory health of their children.

To date, research on the effects of maternal mental health on children’s respiratory health has focused predominantly on depression, anxiety, and broadly defined stress, with limited evidence on less common conditions like eating disorders, note the researchers.

And while the evidence on the consequences of maternal eating disorders has consistently reported on their children’s cognitive, social, emotional, behavioural and eating behaviours, the evidence is less consistent for physical health outcomes.

To strengthen the evidence base, the researchers analysed data from 131,495 mother and child pairs from 7 distinct European birth cohorts in the EU Child Cohort Network (EUCCN), looking at potential associations between maternal eating disorders before pregnancy and their children’s preschool wheezing and school age asthma.

They subsequently explored potential associations between women who didn’t have depression or anxiety by type of eating disorder (anorexia or bulimia) and period of exposure (pregnancy or after birth).

The prevalence of maternal eating disorders before pregnancy ranged from nearly 1% to 17% across the 7 cohorts. And the prevalence of co-existing depression/anxiety among women with eating disorders ranged from 11% to 75%.

The prevalence of preschool wheezing ranged from 21% to nearly 50%, while that of school age asthma ranged from just over 2% to nearly 17.5%.

An eating disorder before pregnancy was associated with an overall 25% heightened risk of preschool wheeze, although this varied considerably in each cohort, and with a 26% heightened risk of school age asthma, which was much more consistent across the cohorts.

These heightened risks weakened slightly after excluding mothers who had depression/anxiety.

Similar associations with childhood asthma were found for anorexia and bulimia, while preschool wheezing was associated with bulimia only.

Although the observed associations differed slightly across exposure periods (before, during, or after pregnancy), no distinct window of susceptibility emerged.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, and the prevalence of eating and respiratory disorders varied widely across the cohorts.

“Although this may make some of the findings less comparable, the direction and the magnitude of the associations were relatively stable in all the analyses,” explain the researchers.

But they add: “The mechanisms underlying the associations between maternal mental health and childhood respiratory outcomes remain unclear.”

They suggest that mental ill health and associated stress may activate the hypothalamic-pituitary-adrenal axis, disrupting the baby’s lung development during pregnancy and maturation of the child’s immune system, thereby increasing susceptibility to immune mediated conditions, including asthma.

“Children born to mothers with [eating disorders] are at an increased risk of foetal growth restriction, prematurity, Caesarean delivery and low birth weight. These are also well-known risk factors for respiratory morbidity, suggesting multiple possible mediating pathways in the link between maternal [eating disorders] and childhood respiratory outcomes,” they point out.

“In addition, research has shown that both mental health disorders and asthma involve dysregulation in immune response and inflammatory pathways, suggesting a common genetic basis that may contribute to both conditions,” they add.

They conclude: “There is a need to include maternal [eating disorders] in research on early- life respiratory risk factors and to integrate [eating disorder] screening and support into maternal healthcare to improve respiratory outcomes in offspring.”

02/12/2025

Notes for editors
Research: Maternal eating disorders and respiratory outcomes in childhood: findings from the EU Child Cohort Network Doi: 10.1136/thorax-2025-223718
Journal: Thorax

About the journal
Thorax is one of 70 journals published by BMJ Group. The title is co-owned with the British Thoracic Society.
https://thorax.bmj.com

External funding: EU Horizon 2020 research and innovation programme

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

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

The post Eating disorders in mums-to-be linked to heightened risk of asthma and wheezing in their kids first appeared on BMJ Group.

80% of respondents’ children exposed to skin bleaching products were under 2 years old
Aesthetic preferences trumped knowledge of health risks, responses indicated

A significant proportion of under 5s in Nigeria may be being exposed to skin lightning products, if the results of a semi-urban community survey are indicative, suggests research published in the open access journal BMJ Open.

Most (80%) of the respondents’ children exposed to skin bleaching products were under 2 years old, and despite good knowledge of the health risks of the practice, these were trumped by aesthetic preferences for lighter skin tones, the survey responses show.

The cosmetic use of skin lightening products has become increasingly common globally, with very high rates among women of reproductive age in Africa, note the researchers. And while the practice used to be associated only with poverty, youth, and female sex, this is now no longer the case, they add.

Of particular concern is the increasing trend of mothers using skin lightening creams on their young children who are especially vulnerable to the side effects of these products, explain the researchers.

This is because of their higher ratio of body surface area to weight, which increases systemic exposure, and their thinner and more permeable skin, which heightens the risk of absorption, they add.

And skin lightening products often contain endocrine system disruptors, such as liquorice, resveratrol, steroids, as well as heavy metals, such as mercury, they point out.

To better understand the prevalence and motives for the practice and inform policy to safeguard children’s health, the researchers surveyed 369 mothers with at least one child under 5 in Ile-Ife, Osun State, Southwestern Nigeria.

The mothers were all attending community immunisation and infant welfare clinics in three government-owned primary healthcare centres.

The questions aimed to find out how many of them used skin lightening creams, soaps, or lotions on their young children and to explore their knowledge, attitudes, and perceptions of the pros and cons of these products.

Potentially influential factors, such as age, marital status, religion, income, occupation, cultural beliefs, educational attainment, personal skin colour and use of skin lightening creams, perceived social factors, and access to media were all taken into account.

The average age of the mothers was 30, and nearly all had attained at least secondary level education. Most (87%; 320) reported low household income. Between them, they had 792 children, ranging in age from 1 to 59 months.

Around 1 in 5 (19.5%;72) of the mothers said they used skin lightening creams on their children. Of these, 90% (65) applied the products routinely; the rest used them intermittently.

Infants and young children were the primary recipients. Over three quarters (81%; 58) of those exposed to these products were under 2 years old, with just over half (51.5%; 37) 6 months or younger.

Children under 2 were twice as likely to be the recipients of skin lightening attempts as older children.

The most frequently used agents were hydroquinone-based creams (60%; 43), followed by powerful topical steroid creams (29%; 21).

Three quarters (76.5%; 55) of the mothers who used skin lightening products on their children self-identified as light skinned, and a similar proportion (75%; 54) expressed a preference for lighter complexions.

Most of these mothers (89%; 64) said they had used skin lightening creams on their own skin. But only just over half of them (56%; 40) perceived lighter skin as conferring social or economic advantages over darker skin tones.

The most frequently cited reasons for the use of skin lightening products were to improve the child’s complexion (61%; 50) and to preserve or maintain what was described as the child’s natural skin colour (79%; 65).

Less than half (43%; 31) of the mothers cited specific perceived benefits of skin lightening, including the treatment of blemishes (8%; 6), enhancement of beauty (19.5%;14), or prevention of darkening from sun exposure (6%; 4).

Almost all the respondents (97%) were aware of the health risks associated with these products, and most (81%;58) of those using them on their children were aware of at least one serious systemic side effect associated with use.

One in three, (34%; 24) acknowledged the potential presence of toxic substances in some of these formulations. But they were around 4 times less likely to acknowledge specific dangers or identify complications than those who didn’t use these products.

“The observed disconnect between awareness of risks, recognition of specific danger and skin lightening practices indicates that social expectations and perceived advantages can outweigh safety concerns,” note the researchers.

Mothers who had used skin lightening creams on themselves were 15 times more likely to use them on their own children than those who didn’t report personal use, while perceiving light skin as more attractive or socially advantageous nearly doubled the odds of early childhood exposure.

And having a family member who practised skin lightening was also associated with a doubling in the likelihood of using one of these products on a child.

This is an observational study and, as such, can’t establish cause. And the researchers acknowledge that relying on survey data risks recall bias and possible under reporting through fear of judgment. And they only included mothers’ perspectives, precluding the potentially influential views of other caregivers or household members.

But they point out: “Beyond physical health implications, these practices also transmit colourist ideals, positioning lighter skin as a marker of beauty, self-worth, and social acceptance.”

They add: “Such early internalisation may adversely affect self-concept and identity, reinforcing intergenerational cycles of dissatisfaction with natural skin tone, stigma, and harmful cosmetic norms that persist across the life course.”

And they conclude: “The dual risk of toxic exposure and early internalisation of colourist ideals from childhood skin-lightening carry profound public health implications. While risk awareness may contribute to reducing the practice, cognitive dissonance may undermine its impact.

“Addressing this requires policy measures that go beyond individual risk education to challenge cultural narratives and normative pressures, alongside stronger regulatory oversight to ensure accurate labelling and restrict hazardous formulations.

“Culturally sensitive strategies, such as integrating skin health education into maternal child health services, leveraging immunisation visits, and engaging trusted community leaders, may offer effective avenues for change.”

20/11/2025

Notes for editors
Research: Early childhood exposure to skin-lightening products in Nigeria: prevalence, maternal perspectives, and predictors from a cross- sectional study Doi: 10.1136/bmjopen-2025-105631
Journal: BMJ Open

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

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

The post High prevalence of artificial skin lightening in under 5s, Nigerian survey suggests first appeared on BMJ Group.

Experts argue for an approach to regulation that puts children’s best interests first

Exposing children to e-cigarettes compromises their human rights. These products should be regulated in a way that puts children’s best interests first and protects them from the harms associated with nicotine consumption in all its forms, argue experts in The BMJ today.

Children are now using e-cigarettes at higher rates than adults, write Tom Gatehouse and colleagues. Globally, the World Health Organization (WHO) estimates that 7.2% of children aged 13-15 currently use e-cigarettes. Data indicate use in this group is nine times that of adults, in countries which monitor both groups.

As their brains are still developing, adolescents are particularly sensitive to nicotine exposure, which may have long term effects on attention, cognition, memory, and mood, they explain. They are also more susceptible to nicotine addiction, which can lead to problems with addiction and substance abuse later in life, and evidence is also growing that e-cigarettes may act as a gateway to tobacco smoking.

Yet while protecting children’s health is legally required under the UN Convention on the Rights of the Child (CRC), they point out that 62 countries still have no e-cigarette regulation.

An explicit link between tobacco control and children’s rights was established in 2003 with adoption of the WHO Framework Convention on Tobacco Control, which the authors say is relevant to youth use of e-cigarettes as well as conventional tobacco products, since the framework obliges countries to prevent and reduce both tobacco consumption and nicotine addiction.

This link was reinforced in 2013 with recommendations that parties protect children from unhealthy food and drink, alcohol, solvents, illicit drugs, and “other toxic substances,” which should obviously include e-cigarettes, they add.

The tobacco and nicotine industries argue that regulating e-cigarettes in the same way as conventional tobacco products will prevent people who smoke from switching to safer alternatives. For the authors, by stressing potential benefit to this group, these industries have persuaded governments “to downplay potential harms to a much larger group, which includes children.”

They note that WHO recommends strong regulation of e-cigarettes to protect public health, with appropriate implementation. Options include bans on e-cigarette sales and, where they are not banned, measures similar to those that have helped reduce youth smoking rates worldwide, including strictly enforced age restrictions; restrictions on e-cigarette advertising, promotion and sponsorship; retail display bans; plain packaging; and bans or restrictions on flavours.

The overarching goal should be to reduce the appeal, availability, and affordability of e-cigarettes to children, as many countries have already done for tobacco, they say.

Governments will need to be mindful of practical barriers to enforcement, such as social media marketing and transborder e-commerce, they add, but say pre-empting such challenges “will ensure that a child centric approach to e-cigarette regulation has the greatest chance of success.”

“E-cigarettes are known to be harmful for those who do not smoke, particularly for children, regardless of any potential role in smoking cessation, or conversely, potential gateway effects,” they write. “Governments are therefore legally bound to prevent their use among this demographic under the CRC and the WHO framework convention.”

Given the uncertainty around the long term effects of e-cigarette use, they conclude: “The failure to protect children’s right to health today could result in harms which span generations.”

12/11/2025

Notes for editors
Analysis: How e-cigarettes compromise children’s human rights doi: 10.1136/bmj-2025-085850
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: E-cigarettes and children

The post E-cigarettes compromise children’s human rights first appeared on BMJ Group.

Confidence in previous study findings is low to critically low

Women should be advised to take paracetamol when needed to treat pain and fever in pregnancy, say researchers

Existing evidence does not clearly link paracetamol (acetaminophen) use during pregnancy with autism or ADHD in children, finds an in-depth evidence review published by The BMJ today, in direct response to recent announcements around the safety of using paracetamol in pregnancy.

The researchers say confidence in the findings of existing evidence reviews and studies on this topic is low to critically low, and suggest that any apparent effect seen in previous studies may be driven by shared genetic and environmental factors within families.

Regulatory bodies, clinicians, pregnant women, parents, and those affected by autism and ADHD should be informed about the poor quality of the existing reviews and women should be advised to take paracetamol when needed to treat pain and fever in pregnancy, they add.

Paracetamol (acetaminophen) is the recommended treatment for pain and fever in pregnancy and is considered safe by regulatory agencies worldwide.

Existing systematic reviews on this topic vary in quality, and studies that do not adjust for important factors shared by families or parents’ health and lifestyle cannot accurately estimate the effects of exposure to paracetamol before birth on neurodevelopment in babies.

To address this uncertainty, researchers carried out an umbrella review (a high-level evidence summary) of systematic reviews to assess the overall quality and validity of existing evidence and the strength of association between paracetamol use during pregnancy and the risks of autism or ADHD in offspring.

They identified nine systematic reviews that included a total of 40 observational studies reporting on paracetamol use during pregnancy and the risk of autism, ADHD, or other neurodevelopmental outcomes in exposed babies.

Four reviews included meta-analysis (a statistical method that combines data from several studies to give a single, more precise estimate of an effect).

The researchers used recognised tools to carefully assess each review for bias and rated their overall confidence in the findings as high, moderate, low, or critically low. They also recorded the degree of study overlap across reviews as very high.

All reviews reported a possible to strong association between a mother’s paracetamol intake and autism or ADHD, or both in offspring. However, seven of the nine reviews advised caution when interpreting the findings owing to the potential risk of bias and impact of unmeasured (confounding) factors in the included studies.

Overall confidence in the findings of the reviews was low (two reviews) to critically low (seven reviews).

Only one review included two studies that appropriately adjusted for possible effects of genetic and environmental factors shared by siblings, and accounted for other important factors such as parents’ mental health, background, and lifestyle.

In both these studies, the observed association between exposure to paracetamol and risk of autism and ADHD in childhood disappeared or reduced after adjustment, suggesting that these factors explain much of the observed risk, say the researchers.

They acknowledge some limitations. For example, the included reviews differed in scope and methods, they were unable to explore the effects of timing and dose, and their analyses were limited to autism and ADHD outcomes only.

However, they say this overview brings together all relevant evidence and applies established methods to assess quality, and shows “the lack of robust evidence linking paracetamol use in pregnancy and autism and ADHD in offspring.”

They conclude: “The current evidence base is insufficient to definitively link in utero exposure to paracetamol with autism and ADHD in childhood. High quality studies that control for familial and unmeasured confounders can help improve evidence on the timing and duration of paracetamol exposure, and for other child neurodevelopmental outcomes.”

10/11/2025

Notes for editors
Research: Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews doi: 10.1136/bmj-2025-088141
Journal: The BMJ

External funding: None

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

Externally peer reviewed? Yes
Evidence type: Umbrella review of existing systematic reviews
Subjects: Pregnant women

The post Existing evidence does not clearly link paracetamol use during pregnancy with autism or ADHD in children first appeared on BMJ Group.

Cannabis is estimated to be responsible for around 13% of new regular tobacco use

Teens and young adults who use cannabis are more likely to become regular tobacco users – even if they haven’t previously tried tobacco – compared to similar people who do not use cannabis, suggests a US study published online in the journal Tobacco Control.

Around 13% of new onset tobacco use was estimated to be attributable to cannabis, the study found.

Tobacco smoking has been considered a gateway to cannabis use since the 1970s when smoking was much more prevalent and when almost all people who used cannabis had smoked tobacco first.

Although tobacco use among teens and young adults has declined considerably in the United States since the 1970s, cannabis use has not. This raises the question of whether a reverse gateway from cannabis to regular tobacco use might exist.

To investigate the authors mined data from a regular survey of US households called PATH (Population Assessment of Tobacco and Health) to look at the association of cannabis use by teens and young adults in 2017 and their likelihood of regular tobacco use four years later in 2021.

A total of 13,851 respondents aged 12–24 years who in 2017 had said they had never or never regularly used any form of tobacco (combustible or non-combustible) and who completed the subsequent surveys were identified, of which 15.4% had admitted using cannabis in the last 12 months. The likelihood of cannabis use increased with age of the respondent.

Each person who used cannabis was matched to a similar non-user according to a number of characteristics including demographics, history of experimentation with tobacco products, perceived harmfulness of cigarettes and mental health symptoms.

The study found that 32.7% of US teens aged 12–17 years who had used cannabis had progressed to regular tobacco use four years later – an increase of 15.6 percentage points compared with their matched controls. Among the young adults aged 18–24 years, 14% of those who used cannabis reported regular tobacco use – an increase of 5.4 percentage points over their matched controls.

The analysis attributed 13% of total new regular tobacco use to cannabis and when extrapolated across the entire US population, the authors estimated that 509,800 fewer US teens and young adults would have progressed to regular tobacco use in 2021 if they had not had previous experience of cannabis in 2017.

This is an observational study, and as such, can’t establish cause and effect, and the authors also acknowledge several limitations including the use of self-reported measures for tobacco and cannabis use. Although a comprehensive list of baseline covariates was considered, some factors such as peer influences, socioeconomic factors and an underlying liability to substance use may not have been captured fully. Assessing cannabis use in the past 12 months rather than current use is also likely to have attenuated the estimated effect size.

Nevertheless, the authors conclude that cannabis use by US youth is a major risk factor for progression to regular tobacco use, independent of whether or not they have yet tried tobacco.

“The finding that prior cannabis use is a major risk factor for initiation of current regular tobacco use among youth, independent of whether or not they have tried tobacco, suggests that cannabis prevention should be included as a key goal in tobacco control programmes” the authors said.

“While early cannabis use is seen as a major public health problem, none of the major health agencies have addressed the potential of early cannabis use to increase future regular tobacco use.”

They add, “This study provides evidence that failure to address cannabis use among young people has the potential to undermine the progress tobacco control efforts have made in reducing tobacco initiation and progression to regular use.”

23/10/2025

Notes for editors
Research: Cannabis use and progression to regular tobacco use among United States youth and young adults: evidence from the Population Assessment of Tobacco and Health (PATH) study, 2017–2021 doi: 10.1136/tc- 2025-059634
Journal: Tobacco Control

External funding: Tobacco- Related Disease Research Program (TRDRP) of the University of California, Office of the President and the National Cancer Institute of the National Institutes of Health.

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

About the journal
Tobacco Control is one of 70  journals published by BMJ Group. ‌The title is owned by BMJ.
https://tobaccocontrol.bmj.com/

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Teenagers and young adults

The post Teenagers and young adults who use cannabis have a higher risk of progressing to regular tobacco use first appeared on BMJ Group.

Findings support advice to minimise added sugars in pregnancy and infant diets 

Restricted sugar intake during early life is linked to lower risks of several heart conditions in adulthood, including heart attack, heart failure, and stroke, finds a study published by The BMJ today using data from the end of UK sugar rationing in 1953.

The greatest protection against the risk of developing heart problems – and the longest delay in disease onset – was seen in people whose sugar intake was restricted from conception (“in utero”) to around 2 years of age.

Evidence suggests that the first 1000 days of life (from conception to around 2 years of age) is a period when diet can have lasting health effects and leading health organisations recommend avoiding sugary drinks and ultra-processed foods (which often contain high amounts of sugar) as babies and toddlers are introduced to solids.

Researchers therefore wanted to examine whether restricting sugar during this time is associated with a reduced risk of cardiovascular outcomes in adulthood.

Using the end of UK sugar rationing in September 1953 as a natural experiment, they drew on data from 63,433 UK Biobank participants (average age 55 years) born between October 1951 and March 1956 with no history of heart disease.

In total, the study included 40,063 participants exposed to sugar rationing and 23,370 who were not.

Linked health records were then used to track rates of cardiovascular disease (CVD), heart attack, heart failure, irregular heart rhythm (atrial fibrillation), stroke, and cardiovascular death, adjusting for a range of genetic, environmental, and lifestyle factors.

An external control group of non-UK born adults who did not experience sugar rationing or similar policy changes around 1953 were also assessed for more reliable comparisons.

The results show that longer exposure to sugar rationing was associated with progressively lower cardiovascular risks in adulthood, partly due to reduced risks of diabetes and high blood pressure.

Compared with people never exposed to rationing, those exposed in utero plus 1–2 years had a 20% reduced risk of CVD, as well as reduced risks of heart attack (25%), heart failure (26%), atrial fibrillation (24%), stroke (31%), and cardiovascular death (27%).

People exposed to rationing in utero and during early life also showed progressively longer delays (up to two and a half years) in the age of onset of cardiovascular outcomes compared with those not exposed to rationing.

Sugar rationing was also associated with small yet meaningful increases in healthy heart function compared with those never rationed.

The authors point out that during the rationing period, sugar allowances for everyone, including pregnant women and children, were limited to under 40 g per day – and no added sugars were permitted for infants under 2 years old – restrictions consistent with modern dietary recommendations.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the authors acknowledge several limitations including a lack of detailed individual dietary data and potential recall bias that could have affected their results.

However, they say this large, well-designed study allowed them to separately assess the effects of different exposure periods and explore the potential pathways linking sugar rationing and cardiovascular outcomes.

As such, they conclude: “Our results underscore the cardiac benefit of early life policies focused on sugar rationing. Further studies should investigate individual level dietary exposures and consider the interplay between genetic, environmental, and lifestyle factors to develop more personalised prevention strategies.”

22/10/2025

Notes for editors
Research: Exposure to sugar rationing in first 1000 days after conception and long term cardiovascular outcomes: natural experiment study doi: 10.1136/bmj-2024-083890
Journal: The BMJ

External funding: Guangzhou Municipal Research Fund

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

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

The post Early life sugar restriction linked to lasting heart benefits in adulthood first appeared on BMJ Group.

Yet UK and European drug regulators specify access to 2 adrenaline devices at all times
Giving ‘spare’ devices to all schools would be safer and save local health bodies £millions

Less than half of schoolchildren in England who are at risk of a serious and potentially life-threatening allergic reaction (anaphylaxis) to food were prescribed the antidote—an adrenaline [epinephrine] autoinjector, or AAI for short—finds an analysis of national prescribing data, published online in the Archives of Disease in Childhood.

This is despite recommendations by the UK and European medicines regulators that those at risk should have access to 2 AAIs at all times, since some reactions need more than one dose or to allow for incorrect use.

And with 1 in 10 episodes of anaphylaxis occurring in schools, providing all of them with ‘spare’ devices would be safer and save most local health funding bodies £millions, estimate the researchers.

On average, every UK school class will have one or two children at risk of anaphylaxis to a foodstuff, and many schools require these pupils to leave an AAI on the premises, in case they forget to bring one in.

Children with food allergies are not always prescribed AAI. The researchers analysed routinely collected primary care data from the nationally representative Clinical Practice Research Datalink (CPRD) Aurum for children and young people (5-18) diagnosed with a food allergy between 2008 and 2018.

They found that less than half (44%) of schoolchildren with a food allergy in the CPRD had been prescribed at least one AAI, and only a third (34%) had repeat AAIs prescribed. Among pupils who had already experienced anaphylaxis, rates were 59% and 44%, respectively.

To boost access and safety for all school children, UK legislation was changed in 2017 to allow schools to obtain, without a prescription, ‘spare’ AAI devices for use in emergencies—when the pupil’s own AAI is not readily available or they haven’t been prescribed one.

But only around half of schools have done this, possibly because of the prohibitive cost, which often exceeds £100 a device, when the subsidised NHS tariff is around £10 for two devices, suggest the researchers.

As a result, some local health funding bodies (Integrated Care Boards or ICBs) have piloted the provision of spare AAIs to local schools for use on any child. The researchers therefore wanted to compare the potential costs of this approach with that of prescribing AAIs for retention on school premises to pupils on a named-patient basis.

They looked at NHS data on AAI prescriptions issued to primary and secondary school age children with a food allergy during the 2023-4 and 2024-5 academic years—specifically, the number of pupils prescribed more than two AAIs.

The researchers then used these data to estimate the potential annual savings if ICBs were to provide every school in England with four spare AAIs on an annual basis during the 2023-24 academic year, rather than funding AAIs to each at-risk pupil over the same time period.

Nearly two thirds (63%) of pupils prescribed AAIs with a food allergy were dispensed more than two AAIs at an estimated cost of over £9 million in 2023-4. Most of these additional AAIs were most likely provided for retention on school premises, given the spike in prescriptions at the start of the school year, suggest the researchers.

The estimated cost of providing spare AAIs to every school was £4.5 million. And the researchers calculated that if spare AAIs were to replace the supply of named-patient AAIs exclusively for retention on school premises, this would potentially save at least £4.6 million—equivalent to 25% of the total national spend on AAIs.

The researchers acknowledge that the study data only included primary care NHS prescriptions, dispensed by community pharmacies and so excluded AAIs dispensed through hospitals and private healthcare.

But they conclude: “Irrespective, there can be little doubt that if ICBs were to limit dispensing to two unexpired AAIs per pupil at any one time (and so no longer provide additional AAIs on a named- patient basis just for school use), then providing spare AAIs to schools (at no cost to the school) would be a cost-neutral strategy for the vast majority of ICBs—and one that is likely to improve emergency access to AAIs and therefore safety.”

“The National Child Mortality Database shows that 76% of fatal allergic reactions in children involve modifiable factors, including delays in treating with adrenaline,” points out Helen Blythe of the Benedict Blythe Foundation, in a linked editorial.

“Prevention of Future Death reports issued by HM Coroners echo the same failures. Countries like Canada have had laws mandating allergy safety in schools for two decades. In the UK, we’re still shaking buckets to raise money for potentially life-saving medication in our schools,” she adds.

She calls for Benedict’s Law to enter the statute books. First presented to the Department for Education in 2023, this would require schools to hold spare AAIs funded by the government; training for all staff in allergy awareness and emergency response; and the implementation of a school-wide allergy policy.

“Across the country, regional pilots and local initiatives have shown that it’s possible, practical, and financially sound to equip schools with AAIs,” she emphasises. Such a strategy “would improve emergency access to adrenaline to all pupils, irrespective of whether they had been prescribed AAIs.”

21/10/2025

Notes for editors
Research: Economic modelling of providing ‘spare’ adrenaline autoinjectors to all schools to improve the management of anaphylaxis Doi: 10.1136/archdischild-2025-329493
Viewpoint: Spare pens save lives—so why aren’t they in every school? Doi: 10.1136/archdischild-20225-329521

Journal: Archives of Disease in Childhood

External funding: UK Medical Research Council; UK Food Standards Agency (research)

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

Externally peer reviewed? Yes
Evidence type: Observational; Opinion
Subjects: Children + young people

The post Less than half of schoolkids at risk of food anaphylaxis in England prescribed adrenaline ‘antidote’ first appeared on BMJ Group.