Issued monthly by Kessler Foundation and the University of New Hampshire’s Institute on Disability, nTIDE tracks employment and labor force trends for people with and without disabilities.

Based on data from today’s BLS Jobs Report and nTIDE analysis, the employment-to-population ratio for people with disabilities (ages 16-64) increased slightly from 38.0 percent in June 2026 to 38.3 percent in July 2026 (up 0.8 percent or 0.3 percentage points). For people without disabilities (ages 16-64), the employment-to-population ratio also increased slightly from 74.8 percent in June 2026 to 75.0 percent in July 2026 (up 0.3 percent or 0.2 percentage points). The employment-to-population ratio, a key indicator, is the percentage of people who are working relative to the total population (the number of people working divided by the total population, then multiplied by 100).

“The employment-to-population ratio increased slightly, possibly reflecting the need employers have for additional hospitality workers during the summer vacation season,” said John O’Neill, PhD, director of the Center for Employment and Disability Research at Kessler Foundation.

Month-to-Month nTIDE Numbers (comparing June 2026 to July 2026)

More pronouncedly, the labor force participation rate for people with disabilities (ages 16-64) increased from 41.8 percent in June 2026 to 42.4 percent in July 2026 (up 1.4 percent, or 0.6 percentage points). For people without disabilities (ages 16-64), the labor force participation rate remained the same at 78.2 percent in June and July 2026. The labor force participation rate reflects the percentage of people who are in the labor force (working, actively looking for work in the last four weeks, or on temporary layoff/furlough) relative to the total population (the number of people in the labor force divided by the number of people in the total population multiplied by 100).

“With prices showing no signs of declining anytime soon, it is not surprising that people with disabilities are more likely to seek work these days, especially given they are more likely to experience poverty,” said Andrew Houtenville, PhD, professor of economics and director of the UNH-IOD. “When the labor force participation rate increases by more than the employment-to-population rate, we know that more people are actively looking for work,” he added.

Year-to-Year nTIDE Numbers (comparing July 2025 to July 2026)

Compared with the same time last year, the employment-to-population ratio for people with disabilities (ages 16-64) increased from 37.0 percent in July 2025 to 38.3 percent in July 2026 (up 3.5 percent or 1.3 percentage points). For people without disabilities (ages 16-64), the employment-to-population ratio slightly decreased from 75.1 percent in July 2025 to 75.0 percent in July 2026 (down 0.1 percent or 0.1 percentage points).

The labor force participation rate for people with disabilities (ages 16-64) increased from 41.6 percent in July 2025 to 42.4 percent in July 2026 (up 1.9 percent or 0.8 percentage points). For people without disabilities (ages 16-64), the labor force participation rate decreased from 78.5 percent in July 2025 to 78.2 percent in July 2026 (down 0.4 percent or 0.3 percentage points).

In July, among workers ages 16-64, the 6,690,000 workers with disabilities represented 4.4 percent of the total 151,261,000 workers in the U.S.

Ask Questions about Disability and Employment
On the same day nTIDE is issued, the team hosts an nTIDE Lunch and Learn webinar. This live Zoom broadcast gives attendees a chance to ask questions about the latest findings, hear news and updates from the field, and learn from invited panelists who discuss current disability-related research and events.

On August 7, 2026, guest presenters Jeff Friedman and Javier Robles of Rutgers University join Drs. O’Neill and Houtenville, and Lillie Heigl, director of policy at the Association of University Centers on Disabilities. Visit the nTIDE archives at ResearchonDisability.org/nTIDE to see a recording of this nTIDE Lunch and Learn episode.

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More than one-third of high-risk therapeutic medical devices authorised for use in the United States have been subject to a serious recall, according to a cross-sectional study published today in JAMA Health Forum.

The study examined the relationship between the strength of premarket clinical evidence supporting high-risk therapeutic devices and their subsequent recall history. Serious recalls — those involving a reasonable probability of serious adverse health consequences or death — were identified in over 35% of the devices assessed.

Critically, the researchers found that device characteristics, the strength of the premarket clinical evidence submitted to regulators, and regulatory characteristics were not consistently associated with whether a device went on to be seriously recalled. In other words, stronger evidence at the point of approval did not reliably predict a safer performance record once the device reached patients.

The authors conclude that robust postmarket surveillance is needed to ensure patient safety, and that premarket review alone cannot be relied upon to identify devices that will later present serious risks to patients.

The corresponding author is Maryam Mooghali, MD, MSc, of the Department of Internal Medicine, Yale School of Medicine.

Study: Premarket Clinical Evidence Strength and Recalls of High-Risk Therapeutic Medical Devices
Journal: JAMA Health Forum
DOI: 10.1001/jamahealthforum.2026.2626
Full article (free access for readers for one year): https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2026.2626?guestAccessKey=0809ea7a-d9c4-44c3-b758-f5703f67bccd&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_term=080726

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Studies in humans show that disrupting the body’s internal clock can weaken immune responses and increase susceptibility to infections. During the COVID-19 pandemic, a study in UK found that sleep disturbances were linked to a higher risk of SARS-CoV-2 infection. “However, no previous study had evaluated whether disrupting the body’s biological clock also increases the risk of developing long COVID”, says first author Kyriaki Papantoniou, Associate Professor at the Medical University of Vienna and Associated Researcher at ISGlobal.

Night shift workers at increased risk of long COVID

In this study, the research team followed 2,941 adults in the population-based COVICAT cohort in Catalonia between 2021 and 2023. Among the 1,899 participants who became infected with SARS-CoV-2, 284 developed long COVID – defined as having persistent symptoms lasting for more than three months after the infection – during the 2-year follow-up.

Compared with day workers, those working night shifts had an 88% higher risk (i.e. almost double) of developing long COVID after accounting for other risk factors such as vaccination history or chronic diseases. This association was stronger in night workers with obesity. Moreover, the increased risk was observed both in current and former night workers, suggesting that it reflects longer-term effects of circadian disruption rather than short-term changes.

In contrast, night shift work was not associated with a higher risk of becoming infected, suggesting that disruption of the biological clock may influence how the body recovers from infection rather than the likelihood of catching the virus.

“Our findings suggest that circadian disruption plays a role in the transition from acute infection to persistent symptoms,” says ISGlobal researcher Manolis Kogevinas, who coordinated the study.

Poor sleep further amplifies the risk

The researchers found that chronic insomnia also increased the risk of long COVID by 42%, independently of night shift work. Together, the two factors had a synergistic effect: night shift workers with chronic insomnia were 2.7 times more likely to develop long COVID than day workers without insomnia.

The biological mechanisms involved are not yet fully understood, but the time of day when the body encounters a pathogen may influence the immune response. In addition, disruption of the body’s biological clock can impair the immune system’s ability to clear the infection.

Improving sleep as a preventive strategy

Given the increase of insomnia prevalence in the general population, the authors underline the need to understand the short and long-term effects of disturbed sleep on infection-related outcomes. In any case, the findings point to sleep as a potentially modifiable factor in preventing long COVID and other post-infectious conditions.

“Promoting healthy sleep habits and minimising circadian disruption could represent simple, low-cost strategies to reduce the long-term consequences of viral infections, particularly among people who work night shifts,” concludes Kogevinas.

The researchers note that the study’s strengths include the use of a well-characterised population-based cohort with detailed information on work schedules, sleep habits and health, as well as an internationally recognised definition of long COVID. However, the participants were aged 40 to 65 years, so the findings may not necessarily apply to younger or older populations, and other occupational factors, such as work-related stress, cannot be completely ruled out.

Reference

K. Papantoniou, A. Espinosa, M Karachaliou, C Lassale, G Castaño-Vinyals, B Harding, De Matteis S, Straif K, E Alonso, C Dobaño, G Moncunill, N Blay, S Iraola-Guzmán, R de Cid, J Garcia-Aymerich, M Kogevinas. Night work, sleep disruption and long-COVID risk: a population-based cohort study. SJWEH. 2026. Doi: 10.5271/sjweh.4318

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The results, published in The Lancet on Aug. 6, may change the standard of care for many patients with prostate-specific membrane antigen (PSMA)-positive metastatic prostate cancer. The most standard backbone of therapy had been an androgen receptor pathway inhibitor (ARPI) paired with androgen deprivation therapy (ADT). But the trial showed that adding a targeted radionuclide therapy drug called ¹⁷⁷Lu-PSMA-617 or lutetium PSMA 617 vipivotide tetraxetan to backbone therapy in patients with PSMA-positive cancer reduces the risk of disease progression as determined by scans or death by 28% when given soon after the diagnosis of metastatic cancer. Results of the study and ongoing analyses led the U.S. Food and Drug Administration to approve early use of the drug for PSMA-positive metastatic prostate cancer in late July.

“About 9 out of 10 patients with metastatic prostate cancer have tumors that are positive for PSMA,” said lead author Dr. Scott Tagawa, the Gebroe Family Professor of Hematology-Oncology in honor of Morton Coleman, M.D. at Weill Cornell Medicine and director of the Genitourinary Oncology Program at NewYork-Presbyterian/Weill Cornell Medical Center. “Now, we have a new therapy that, when added to the backbone therapy, extended radiographic progression-free survival for almost all patients with metastatic prostate cancer.”

The PSMAddition trial, funded by Novartis, enrolled more than 1100 patients with minimally treated or untreated PSMA-positive prostate cancer across 169 sites in 20 countries, including NewYork-Presbyterian/Weill Cornell Medical Center and MSK. Half the participants received intravenous ¹⁷⁷Lu-PSMA-617 every six weeks, with ADT and ARPI; the other half received the previous standard of care, ADT and ARPI only. Patients who were in the control arm were allowed to crossover to the triple therapy group if disease progression occurred.

More adverse events occurred in the patients who received ¹⁷⁷Lu-PSMA-617, an expected result with triple therapy, said Dr. Tagawa, who is also a member of the Sandra and Edward Meyer Cancer Center and the Englander Institute of Precision Medicine at Weill Cornell Medicine. The most common was dry mouth, which occurred in 46% of patients. Fatigue, a typical side effect of radiation and hormonal therapy, was also common.

In addition to delayed progression, ¹⁷⁷Lu-PSMA-617 increased the amount of time until a patient developed resistance and needed to switch to a new therapy and delayed symptoms of cancer spread to the skeleton. Previous trials by Dr. Tagawa and his colleagues had shown the drug was effective in patients with treatment-resistant metastatic prostate cancer, and it was approved for that purpose in 2022.

“Now our patients can get ¹⁷⁷Lu-PSMA-617 at diagnosis and don’t have to wait until they develop resistance to the backbone therapies,” Dr. Tagawa said.

The drug’s success is the result of more than two decades of collaboration between a multidisciplinary team of Weill Cornell Medicine investigators and the team’s colleagues at MSK. It consists of an agent that targets the PSMA protein on the surface of prostate cancer cells linked with a molecule that contains a dose of radiation. The combination helps find and destroy prostate cancer with relative sparing of normal tissue.

“The PSMA gene was first discovered at MSK, and the first therapeutics targeting it were developed and tested at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center,” Dr. Tagawa said.

Dr. Tagawa and his team are continuing to analyze the data from the PSMAddition trial to assess longer-term outcomes, such as overall survival and potential safety concerns with longer-term use. He noted that the therapy may not be the best choice for every patient. Only nuclear medicine physicians or radiation oncologists can administer the drug, and specialized imaging scans are needed to identify eligible patients. Such care is usually available at academic medical centers, but patients from areas with few specialists may have to travel long distances. Additionally, he noted there are some additional safety precautions to consider with radiotherapies to prevent exposure to others in the household.

But Dr. Tagawa noted there are now multiple options for targeted therapies available to add to the backbone therapy for metastatic prostate cancer depending on the patient’s tumor biomarkers and preferences. Several new imaging agents can help physicians detect cancers earlier and help select the right drug for the patient.

“We can find tumors we couldn’t see before,” he said. “We now have multiple drugs that delay metastatic prostate cancer progression,” he said. “It is unclear yet if they delay death from all causes, but the data on all of them is trending in that direction.”

Dr. Scott Tagawa serves as a paid consultant for Novartis, the study funder.

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Q: What challenges or unmet needs make this study important?

Survival among people with HIV in the United States continues to improve due to highly effective antiretroviral therapy (ART), a lifelong treatment. As a result, costs to Medicare are expected to rise substantially as more adults with HIV live long enough to age into the program. However, it’s been largely unknown just how extensive the increase in Medicare beneficiaries may be over the next decade and how much the program’s spending could rise.

Q: What central question(s) were you investigating?

Our team used simulation modeling to answer these three main questions:

• Over the next decade, how many people with HIV (who are receiving HIV care) over the age of 65 are likely to be enrolled in Medicare?
• How much is Medicare estimated to spend on this population over this time period?
• How might policies or strategies to reduce the cost of ART impact these projections?

Q: What methods or approach did you use?

We developed and populated a new model called CHARMED with projections from the previously validated CEPAC model, Medicare claims data, and publicly available data. Our aim was to simulate a population of Medicare beneficiaries with HIV, aged 65+ and being treated with ART, and their associated costs.

To address uncertainty in model estimates and trends, we examined scenarios where the size and associated costs of this group varied—for example, by assessing the potential impact of policies to reduce the cost of ART. Such policies included the Inflation Reduction Act (IRA), which allows Medicare to negotiate the cost of Biktarvy, the most prescribed ART regimen in the United States, with lower prices to take effect in 2028. Additionally, generic dolutegravir is expected to become available in 2031, thereby enabling a highly effective, well-tolerated, fully generic ART regimen.

Q: What did you find?

Our projections show that nearly 122,000 older adults receiving HIV care may be enrolled in Medicare by the end of 2026—a number that may increase to about 193,600 by the end of 2035. We also estimated that annual Medicare spending for this population may increase from $10.9 billion at the end of 2026 to $27.3 billion at the end of 2035.

Cumulative 10-year costs may reach $187.2 billion, with 63% attributable to ART costs alone. If ART costs were reduced by 60%, Medicare could potentially save $70.3 billion over the next decade. Moreover, if current prescribing patterns remain unchanged, policies such as the IRA and the availability of generic HIV medications could save Medicare approximately $19 billion between 2026 and 2035.

Q: What are the real-world implications, particularly for patients?

Our findings demonstrate that the number of older adults living with HIV is likely to increase substantially over the next decade, driving up Medicare enrollment. Clinicians and healthcare systems must be prepared to address the medical needs of this growing population through comprehensive, person-centered care—especially given these individuals’ increased risk of comorbidities and polypharmacy (taking several medications regularly).

We also conclude that policymakers for Medicare and other public programs will likely seek out ways to reduce the cost of HIV care. While recent proposals have included higher Medicare premiums, drug coverage reductions, and stricter eligibility for drug assistance programs, our paper points to other promising strategies to reduce ART costs without increasing patient costs or limiting access.

Authorship: In addition to Hyle and Freedberg, Mass General Brigham authors include Luke Ang, Grace Luu, Florence Ebem, Satoshi Koiso, Paul E. Sax, John Giardina, E. John Orav, Anne M. Neilan, and Jose F. Figueroa. Additional authors include Parastu Kasaie, Dannie Dai, Jessica Phelan, Ciara Duggan, Elizabeth Humes, Dori Molozanov, Lucas Gerace, Tim Horn, Ankur Pandya, and Keri N. Althoff.

Paper cited: Hyle, EP., et al. “Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older with HIV.” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.21966

Funding: This research was funded by the National Institutes of Health (R01 AG069575, R01 AI042006, R01 AG081151, U01 AI069918, R01 AG053100, R01 AI179776) and the Massachusetts General Hospital Jerome and Celia Reich HIV Scholar Award.

Disclosures: Hyle, Humes, Giardina, Neilan, Figueroa, Althoff and Freedberg reported receiving grants from the National Institute of Health (NIH).

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Midlife women are at increased risk of a number of chronic illnesses such as type 2 diabetes mellitus as a result of hormone changes caused by menopause. Women in midlife commonly experience weight gain and a redistribution of fat to the midsection resulting in increased belly fat and an elevated risk of developing type 2 diabetes. The global prevalence of diabetes was estimated in 2024 at 10%, and that risk continues to increase with age.

Previous studies have shown a strong reciprocal relationship between menopause and the development of diabetes, identifying early menopause and the postmenopause stages as triggering factors. However, most previous studies have focused on menopause stage, age at menopause, or menopause timing rather than directly assessing menopause symptom burden. A new study involving nearly 300 women aged 40 to 64 years aimed to assess menopause symptoms using the Midlife Women’s Symptom Index and to examine whether type 2 diabetes is associated with the number and severity of menopause symptoms.

Across all menopause stages, women in the diabetic group (diabetes and prediabetes) reported a higher prevalence of menopause symptoms. However, the difference was only statistically significant in the postmenopause stage. Similarly, although symptom severity was consistently higher in the diabetic groups across menopause stages, a statistically significant difference was observed only in the postmenopause stage.

These findings suggest the importance of integrating menopause symptom assessment and management into diabetes care for midlife women to improve quality of life. Additional longitudinal studies are recommended to further clarify the biological and psychosocial mechanisms linking glucose metabolism and menopause symptom burden in this population.

Survey results are published in the article “Association between type 2 diabetes mellitus and menopause symptoms among Korean midlife women.”

“This study demonstrates that women with diabetes may experience a greater burden of menopause symptoms. Prior research has also shown that cardiovascular risk factors, including diabetes, hypertension, and dyslipidemia, are associated with more frequent vasomotor symptoms, and women with a higher vasomotor symptom burden tend to have a less favorable cardiometabolic risk profile. Together, these findings not only highlight the need to recognize and address menopause symptoms in women with diabetes but also underscore the menopause transition as an important opportunity to identify and manage cardiovascular risk factors in all women,” says Dr. Stephanie Faubion, medical director for The Menopause Society.

For more information about menopause and healthy aging, visit www.menopause.org.

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Drastic or even life-threatening events can have lingering effects, like an echo. This is referred to as post-traumatic stress disorder (PTSD). The brain is unable to process these overwhelming experiences and stores the memories in such a way that they cannot be consciously controlled. They resurface again and again. Also at night, when people with PTSD relive the trauma over and over again until they wake up – usually in a state of panic. Antidepressants or blood pressure-lowering medications are commonly used to provide relief, among other treatments, but these are only partially effective and usually do not help relieving the nightmares. A medication specifically for treating trauma-related nightmares has not yet been approved in Germany.

Prof. Stefan Röpke conducts research on trauma-related disorders at the Department of Psychiatry and Neurosciences on the Benjamin Franklin Campus of Charité. In their search for new treatment approaches and avenues, he and his team, along with other partners, focused on the principal psychoactive compound of the cannabis plant: tetrahydrocannabinol, or THC for short. This active ingredient, also known for its psychoactive effects, interacts with the body’s endocannabinoid system, which is involved in regulating sleep, stress, and the processing of emotional memories. Stefan Röpke explains: “There is evidence suggesting that during REM sleep – the intense dream phases in which the brain processes experiences and regulates emotions – THC reduces dream activity and thereby alleviates nocturnal stress responses.”

A cannabinoid specifically targeting nightmares

Cannabis-based medications are already finding use in pain management, typically when standard treatments prove insufficient or patients cannot tolerate them. In Germany, this has been possible since the so-called “Cannabis for medical purposes” law took effect in 2017. Since then, it has become easier to use plant-derived or synthetically produced cannabinoids for medical and medical-scientific purposes. For their current study the researchers selected a form of THC derived directly from the cannabis plant in the form of drops – the prescription medication Dronabinol. The aim was to determine whether this approach could alleviate nightmares associated with PTSD and whether its use is safe in this context.

More than 170 patients with post-traumatic stress disorder and frequent, intense nightmares participated in the study. For a ten week period, they received either the medication or an identical-looking, cannabis-flavored placebo every evening before bedtime. Neither the healthcare providers nor the participants knew who was receiving which treatment – the gold standard of medical research, a so-called double-blind, placebo-controlled study.

By the end of the study period, nightmares had decreased to a significantly greater extent in the Dronabinol group than in the placebo group. On a scale of zero to eight points, the nightmare burden decreased by an average of 3.7 points, compared to only 2.2 points in the placebo group – a difference that is clearly noticeable to those affected. “More than a third of the patients treated with Dronabinol reported that they no longer experienced any nightmares after ten weeks. Another 21 percent reported that their nightmare burden had been at least halved,” as Stefan Röpke stated. “And about five out of six patients in the dronabinol group felt their health had markedly improved.”

No dependence or severe side effects

According to the studies, the cannabinoid had a specific effect on nightmares and sleep, but not on all PTSD symptoms. Moreover, the severity of the post-traumatic stress disorder and any accompanying depression did not change conclusively. Nevertheless, the majority of participants experienced significant relief, as the tormenting nightly re-experiencing of the traumatic event was interrupted, allowing for restful sleep. Taking the medication did not cause any severe side effects; however, the researchers observed moderate and mild side effects such as dizziness, headache, or increased appetite more frequently. The study team did not observe any withdrawal symptoms after the end of the study period and the discontinuation of the evening doses. In the next steps going forward, the researchers now aim to determine whether taking the cannabinoid is also effective and safe over the long term, or whether a tolerance effect develops over time.

*Roepke S et al. Dronabinol for nightmares in post-traumatic stress disorder: a randomized controlled trial. Nat Med 2026 Aug 05. doi: 10.1038/s41591-026-04546-9

About the study
The research was initiated and led by Charité; researchers from the Psychiatric University Clinic of the Charité at St. Hedwig Hospital, the University Medical Center Hamburg-Eppendorf, and the Central Institute for Mental Health in Mannheim were also involved. The work was supported by the company Bionorica SE

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A new study led by the University of Technology Sydney (UTS) found that Australia’s Pharmaceutical Benefits Scheme (PBS) is failing to meet the therapeutic needs of pregnant patients, driving widespread off-label prescribing and perpetuating structural health inequities.

Nausea and vomiting in pregnancy (NVP) affects up to 80 percent of pregnant women, yet only 10 to 20 percent of women who suffer from it use conventional medications.

Lead author Dr Hannah Jackson, a recent PhD graduate from the UTS Faculty of Health, said treatment of NVP has a complex history due to the thalidomide tragedy, which has resulted in conservative pharmaceutical regulations and limited therapeutic innovation.

The study explored the significant challenges some women face when trying to treat one of pregnancy’s most common conditions.

“We found that in some cases prescribers were finding alternative ways to get women the medication they need in a community-based setting, which can reduce health system costs by keeping them out of hospital,” Dr Jackson said.

The historical cohort study analysed PBS dispensing records from nearly 300,000 pregnancies over a five-year period to assess how public resources for anti-nausea medications were distributed across different socioeconomic regions.

The findings show that while the PBS successfully performs its intended role of progressively providing affordable access to necessary medications, the narrow range of approved drugs for NVP can create significant disparities in treatment type and cost.

Despite lacking official approval or a specific listing for pregnancy under the PBS framework, the findings show that the drug ondansetron accounted for 54 percent of total PBS expenditure on anti-nausea medications in pregnancy.

“Because official subsidised options are so limited, doctors frequently rely on system workarounds to ensure patients on low incomes can afford necessary treatment,” said Dr Jackson.

Total PBS-funded expenditure across all anti-nausea medications for pregnancy was concentrated most among disadvantaged women, with the rate of ondansetron use rising faster in low-income areas.

Co-author on the paper, Associate Professor Luke Grzeskowiak from Flinders University, said “the observed system workarounds create a kind of ‘Robin Hood’ scenario, where providing medicines outside of PBS restrictions is seen as an acceptable workaround, because it’s helping vulnerable women get necessary treatment they would otherwise not be able to afford.”

“With fewer medications subsidised on the PBS, pregnant women with lower financial capacity must rely on a narrow selection of older therapies, while those with more means can pay out-of-pocket for non-PBS medications which may be more suitable,” said Associate Professor Grzeskowiak.

The authors argue that limited access to anti-nausea medications through the PBS can actually drive inequalities in medication access by seeing disadvantaged women access the limited subsidised medications, while affluent women can self-fund the full suite of guideline-recommended options.

With maternal health designated a national priority, the researchers urge policymakers to update Australia’s medication funding structures by expanding the range of pregnancy relevant medications approved and subsidised under the PBS.

“Without reform, the current policy framework will continue to perpetuate socioeconomic inequalities, incentivise prescribing outside of standard regulatory safeguards, and lead to potential inefficiencies in public spending,” said Dr Jackson.

“Ultimately, expanding PBS access to both new and repurposed existing medications will create a more dynamic, evidence-based health policy system that is truly responsive to pregnant women’s health needs.”

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Adults with type 2 diabetes and obesity have a high risk of fragility fractures, which are caused by low-energy trauma such as falling from standing height and are often the result of underlying bone weakness.

While GLP-1 receptor agonists can significantly reduce weight in users, there has been debate on whether rapid weight reduction could further weaken bones and make them more prone to fractures.

The new UCLA study, published in JAMA Network Open, used electronic health records of nearly 134,000 U.S. adults, ages 50-90, with type 2 diabetes to compare fracture risk of new users of GLP-1s to new users of another common diabetes medication, DPP-4 inhibitors.

Researchers found that GLP-1 receptor agonist use was associated with a 21% lower risk of fragility fracture over the 3-year study period compared to DPP-4 users, with the largest reductions occurring in fractures of the hip, femur and spine. A separate analysis found that the reduced risk was only associated with type 2 diabetes participants compared to a matching cohort of non-diabetic participants.

“Fractures are relatively uncommon, so very large studies are needed to detect a meaningful difference,” said Dr. Christopher Hamad. “Most previous studies were too small or were not designed to answer this question, and having data from more than 133,000 patients allowed us to better understand how GLP-1 medications may affect fracture risk and bone health.”

The authors noted that the findings come from a retrospective observational study and do not prove GLP-1s reduce fracture risk.  Prospective and translational studies are needed to confirm their mechanistic impacts and long-term effects on bone health.

Article: Hamad CD, Wiener J, Golzar A, et al. Glucagon-Like Peptide-1 Receptor Agonists and Fragility Fracture Risk in Type 2 Diabetes. JAMA Netw Open. 2026;9(7):e2625141. doi:10.1001/jamanetworkopen.2026.25141

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Their readability is mostly college level, the analysis—the first of its kind–shows. This isn’t recommended for content designed to be read by patients, say the researchers, who add that while communication quality may influence clinical outcomes, the dual purpose clinical letters serve makes improvement challenging.

Unlike many other health systems, there is a well established practice in the UK of sending letters to patients following an outpatient clinic appointment. These letters used to be copies of those sent to the patient’s family doctor (GP), but the emphasis has shifted to making them clearer and more patient centred, note the researchers.

Academy of Medical Royal Colleges (AoMRC) guidance in 2018 encouraged clinicians to write directly to patients rather than about them, and NHS England has since reinforced the importance of clear and timely communication with patients as essential for efficient and effective outpatient services, they add.

But it’s not clear to what extent clinical letters meet recommended readability standards. To find out and set a quality benchmark, the researchers focused on the highest volume outpatient specialty in UK healthcare—-ophthalmology.

They measured the readability and linguistic complexity of over 4.6 million outpatient clinic letters sent to 804,986 patients between 2013 and 2025 attending 17 subspecialty services at a UK hospital trust, specialising in various aspects of eye health.

Their analysis shows that the average readability score (Flesch Reading Ease) of the letters was 51.1, indicating college-level understanding. This means the correspondence was more complex and less accessible than recommended for content designed to be read by patients. Overall, 95% of the letters were less readable than recommended.

Readability varied across the 17 subspecialties, however, suggesting that communication quality may reflect service-level culture and documentation requirements, say the researchers.

The highest readability was observed for letters from paediatrics, optometry, and orthoptics services.

In children’s eye services, correspondence was often directed to parents or caregivers, which may encourage use of simpler language, suggest the researchers. And in optometry and orthoptics structured templates were often used, likely facilitating more consistent readability, they add.

There was a slight upward trend over the study period in the likelihood of letters being addressed directly to patients over the study period, but the proportion doing so remained very low, overall, at just over 2%, while use of the personal pronoun ‘you’ was also very low.

The researchers highlight several limitations to their findings, including the inability to assess variations in the readability of individual clinicians’ letters. The analysis also focused on readability and linguistic complexity rather than measuring which aspects of communication matter most to patients or had the greatest impact on healthcare outcomes.

The methods used to classify the intended audience may not fully reflect how correspondence is ultimately used or interpreted, while shifts in clinical practice, record keeping, or institutional policies may also have introduced effects not accounted for in the analysis, the researchers add.

But the study is the first long term population-scale evaluation of outpatient clinic letter readability over more than a decade, and exposes a gap between policy recommendations and routine practice, they point out.

“It demonstrates that poor readability is pervasive, has worsened over time, and varies
substantially between services, revealing system-level patterns that were previously unquantified,” they write.

Clinician letters must simultaneously work as a medical record and provide key information for other healthcare professionals as well as for patients, making it hard to simplify the linguistic content—a challenge that is further compounded by time pressures—they explain.

But they conclude: “These findings highlight a persistent gap between national recommendations and real-world practice, which underscores the need for targeted interventions and innovative approaches to support clear and patient-centred communication.”

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This figure increases for teenagers, with half of those attending CAMHS as teens going on to access adult mental health services by their early 30s – far more than previous research has suggested.

The findings shed light on the often severe mental health burden experienced by children who come to CAMHS and highlight the need for a better understanding of the long-term impact of childhood treatments, experts say.

CAMHS are a cornerstone of public mental health strategies, providing vital opportunities for early intervention. Studies on CAMHS treatments, however, have focused on short-term outcomes. Little is known about the long-term effects of treatments delivered, which can include medication and psychological therapies.

The study marks the longest follow-up to date of young people attending mental health services in the UK.

Researchers at the University of Edinburgh studied every child born in Scotland between 1991 and 1998 until 2023 – almost half a million people. They found that eight per cent attended CAMHS before the age of 18.

This small group went on to account for 46 per cent of all adult psychiatric inpatient bed days and 41 per cent of all NHS adult mental health outpatient appointments by the age of 32.

Former CAMHS patients account for large proportions of all severe mental illness diagnoses in adult psychiatric hospitals, including personality disorders (49 per cent), eating disorders (50 per cent), schizophrenia (39 per cent) and opioid use disorders (39 per cent).

Long-term treatment outcomes are routinely tracked across other conditions, such as cancer care, where the effects of interventions can be monitored for years after treatment, experts say.

The research team is calling for the Scottish Government to bring mental health in line with other areas of the NHS by establishing a Mental Health Observatory, routinely linking childhood and adulthood mental health records to evaluate the impact of services and policy changes.

Professor Ian Kelleher, Chair of Child and Adolescent Psychiatry at the University of Edinburgh, who led the study, said: “We know about long-term outcomes for 27 types of cancer in Scotland, but we’ve known very little about long-term outcomes for children who attend our CAMHS services because there is no equivalent monitoring system for mental health. This is more important now than ever, given the rising number of children and young people presenting with mental health problems.

“CAMHS is not just a childhood treatment service – it identifies a population that will go on to be high-intensity users of specialist adult mental health services. From a health, societal and economic perspective, we need to robustly evaluate whether existing CAMHS interventions are leading to long-term benefits.”

Dr Jane Morris, Chair of the Royal College of Psychiatrists in Scotland, said: “This important work underlines the importance of identifying mental health conditions as early as possible to prevent irreversible damage to people’s healthy development. It goes further by highlighting the need for further intensive supports in our adult services to maintain those benefits through life. We and our colleagues in the field of public mental health would support the establishment of a Mental Health Observatory to ensure delivery of the best possible care to people in Scotland.”

The study is published in the journal European Child and Adolescent Psychiatry: https://www.nature.com/articles/s42004-026-01942-7 [URL will become active after embargo lifts]. It was funded by the Academy of Medical Sciences, the UK Department for Science, Innovation and Technology, and Research Data Scotland.

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The retrospective cohort study linked deidentified electronic health records with administrative claims from the Optum Labs Data Warehouse, identifying 1,428 adults with commercial or Medicare Advantage cover who received a first buprenorphine prescription for opioid use disorder (OUD) between 1 January 2020 and 25 September 2024. Abandonment was defined as no dispensing record within 30 days of the prescribing date.

Overall, 369 patients (25.8%) abandoned their first prescription, with the annual proportion rising from 19% in 2020 to 37% in 2024 (*P* for trend = .02).

Patients whose prescriptions went unfilled were younger (mean 54.3 vs 57.4 years), more frequently Hispanic (10.6% vs 4.8%), more likely to hold commercial rather than Medicare Advantage cover (51.8% vs 29.4%), and faced higher pharmacy deductibles (mean $483.80 vs $296.40). Those who collected their medication were more likely to have a recorded diagnosis of OUD or overdose in the previous 180 days (54.4% vs 40.1%) or a mental health diagnosis (52.5% vs 38.5%).

The authors, led by Xinyi Jiang, PhD, MS, of the CDC’s Division of Overdose Prevention, suggest pharmacy plan deductibles may be an important factor in abandonment, and point to dispensing buprenorphine directly during clinical encounters, strengthening linkage to care, and improving pharmacy availability as ways to reduce barriers to treatment.

**Source:** Jiang X, Zhang K, Chen Y, et al. Abandonment of Prescribed Buprenorphine for Opioid Use Disorder, 2020-2024. *JAMA Netw Open.* 2026;9(8):e2627142. doi:10.1001/jamanetworkopen.2026.27142

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.27142?guestAccessKey=1db66b39-91d4-4a88-b5b1-334a938dd52d&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_term=080426

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