Previous meta-analyses looking at the use of antidepressants during pregnancy and risk of neurodevelopmental disorders in children were conducted nearly a decade ago and limited by small study numbers and a lack of controlling for additional factors. This new meta-analysis provides the best evidence to date that the small increase in risk of autism or ADHD in the children of women who used antidepressants when pregnant identified in many studies is not caused by the medication.

“We know many parents-to-be worry about the potential impact of taking medication during pregnancy; our study provides reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism and ADHD in children. While all medications carry risks, so too does stopping antidepressants during pregnancy due to an increased risk of relapse. Therefore, for women with moderate-severe depression, doctors and patients must carefully weigh the potential risks and benefits of continuing antidepressant treatment during pregnancy against the potential harms of untreated depression,” says author Dr Wing-Chung Chang, University of Hong Kong.

He continues, “Although our study found a small increase in the risk of autism and ADHD in the children of women who had used antidepressants during pregnancy, it also found that this risk disappeared when we accounted for other factors. The increased risk was also seen in the children of fathers who took antidepressants and of mothers with antidepressant use before, but not during, pregnancy. Together, this suggests that it is not the antidepressants themselves causing an increased risk in autism and ADHD but it is more likely to be due to other factors, including genetic predisposition to conditions such as ADHD, autism, and mental health conditions.”

Authors pooled data from 37 studies which included more than 600,000 pregnant women taking antidepressants and almost 25 million pregnancies with no antidepressant use.

Before controlling for key factors such as mental health conditions, the analysis found that antidepressant use by the mother during pregnancy was associated with a 35% increased risk of ADHD and a 69% increased risk of autism. However, this became greatly reduced or non-significant in analyses that better controlled for confounding factors. Use of antidepressants during pregnancy by the father was associated with a 46% increase in the risk of ADHD and a 28% increase in the risk of autism.

Among studies with analyses restricted to mothers with mental health disorders, all selective serotonin reuptake inhibitors (SSRIs) were found to not be associated, only amitriptyline/nortriptyline remained associated with increased ADHD and autism risk. Amitriptyline/nortriptyline are currently considered second or third options as treatments for depression and are often prescribed for treatment-resistant depression. Therefore, women treated with these may have more severe, chronic, or complex underlying mental health conditions than those receiving more common antidepressants, which could be influencing the association between amitriptyline/nortriptyline and increased ADHD and autism risk.

The study found no difference in risk between high and low doses of antidepressants.

“The evidence suggests a link between either parent having a mental health condition and a slightly higher risk of ADHD or autism. In addition to genetic factors, this link could be explained by the home and social environment as ongoing family stress, changes in how the family functions, and differences in how parents behave and care for their children may influence neurodevelopment. There is a need to ensure both parents have access to support and treatment for mental health conditions; for their own sake and to support neurodevelopment of their child,” says Dr. Joe Kwun-Nam Chan, University of Hong Kong.

The researchers note some limitations of their study, including that data on important factors such as socioeconomic status, lifestyle risk factors and low birth weight was lacking in the studies. Additionally, there was only a small number of studies looking at antidepressant use in specific trimesters or exact doses and dose changes, which makes it harder to draw conclusions about these. Finally, women who are prescribed antidepressants tend to have more severe depression than those who are not, so some bias may remain even after controlling for mental health status.

Writing in a linked Comment, Lisa Vitte, Emmanuel Devouche and Gisele Apter from University Rouen Normandy (France), who were not involved in the study, say, “Chang and colleagues’ study adds knowledge and confirms some of the pre-existing knowledge on the use of antidepressants during pregnancy: that they should continue to be taken as they protect maternal mental health and do not harm fetal development. This result is of considerable impact after many contradictory and controversial studies.”

There was no funding source for this study. The study was conducted by researchers from the University of Hong Kong.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf. If you have any questions or feedback, please contact The Lancet press office at pressoffice@lancet.com

Quotes from Authors cannot be found in the text of the Article but have been supplied for the press release. The Comment quote is taken directly from the linked Comment.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(26)00089-1/fulltext

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now widely used to treat overweight, obesity and type 2 diabetes (T2DM), with growing evidence of benefits that extend beyond blood sugar control.

In asthma, where overweight, obesity and metabolic dysfunction can lead to increased severity of symptoms and adverse events such as acute exacerbations, the authors suggest that GLP-1 RAs may improve asthma outcomes through weight loss, modulation of airway inflammation, and improvements in metabolic functions. Reductions in occurrence of asthma exacerbations are likely to reduce systemic corticosteroid exposure (a common treatment for acute asthma exacerbations orally or intravenously) and thus may reduce the risk of corticosteroid exposure-associated adverse events such as osteoporosis or new-onset T2DM. As such, as the clinical use of GLP-1 RAs expands, reliable estimates of their impact on asthma control are needed for individuals living with both asthma and overweight, obesity or T2DM.

The researchers conducted a nationwide self-controlled cohort study using linked Danish health registers. Adult individuals with a prior asthma diagnosis or ≥2 asthma inhaler prescriptions redeemed within 12 months) were included on the date of their first GLP-1 RA dispensing (index date). Eligible individuals had continuous registration data for at least 12 months before and after the index date.

Individuals with COPD or patients with severe asthma treated with new and relatively expensive biologic drugs within 12 months before or after the index date were excluded. Overweight or obesity was defined using ICD-10 codes for those conditions. Those who had no evidence of T2DM – with no diagnosis recorded or no evidence of other first line diabetes drugs prescribed – were also placed in the with obesity/overweight group. Those with a T2DM diagnosis or prescriptions recorded for first line diabetes drugs such as metformin were placed in the T2DM group.

The primary outcome was exacerbations, defined as an inpatient asthma hospital contact(s) and/or systemic oral or intravenous corticosteroid course(s). Secondary outcomes were the use of rescue medication (inhaled short-acting β2-agonists), inhaled corticosteroid exposure, and chest infection events defined as redemption of antibiotics commonly used for lower airway infections

The cohort comprised 27,523 individuals (mean age 54 years, 66% female) with asthma and comorbid overweight or obesity (49%) or T2DM (61%) and 26% recorded as having both conditions. Around 50% of the GLP-1 prescriptions were liraglutide, 48% semaglutide, and 2% others (exenatide, dulaglutide, lixisenatide).

Compared with the year before GLP-1 RA treatment, GLP-1 RA treatment was associated with a 26% lower exacerbation rate overall; and 28% lower in men compared with 23% lower in women. When stratified according to GLP1 RA treatment indication, the analysis showed individuals with asthma and comorbid overweight or obesity and individuals with asthma and comorbid T2DM had similar effect estimates – a 22% reduction in those with overweight or obesity and a 26% reduction in those with T2D.

Reliever medication use fell by 14% overall, suggesting fewer symptoms despite daily inhaled corticosteroid exposure also decreasing by 23% (inhaled corticosteroids are used to prevent exacerbations and treat symptoms in asthma). Furthermore, pneumonia events were reduced by 10%. People also living with allergic rhinitis saw similar decreases (23%) in exacerbations to those living without allergic rhinitis (28%). The authors are also working on updated analyses to show differences between men and women for these specific outcomes.

The authors conclude: “In this nationwide cohort of over 27,000 individuals with asthma and also overweight, obesity or type 2 diabetes, use of GLP-1 drugs  was associated with significant reductions in exacerbation burden as well as reliever use, exposure to inhaled corticosteroids and pneumonia events, irrespective of whether the drugs were being used to treat obesity or type 2 diabetes.”

The authors explain that their study did not have access to clinical records (just if people had used GLP-1 and hospital admissions), so data on BMI and weight loss for participants were not available.

But Dr Håkansson says: “There’s a high chance that the weight loss is a major contributor to these results. A common symptom in both asthma and obesity is shortness of breath, and the presence of excess fatty tissue creates a pro-inflammatory state in the body in general. There’s also evidence from other studies suggesting that the inflammation caused by excess adipose tissue is distinct from the ‘classic’ asthma inflammation which often is driven by allergies or cells called eosinophils.”

And he adds: “As the use of GLP-1 therapies increase, researchers are finding an increasing number of effects outside of weight loss.”

Pain and fever are common in early pregnancy and the options to manage them have been limited. Studies have raised safety concerns regarding acetaminophen while data on the safety of NSAIDs—which include widely used medications such as ibuprofen, diclofenac, and naproxen—has remained inconclusive.

The new study used data from the Southern Israeli Pregnancy Registry (SiPREG) to analyze 264,858 singleton pregnancies between 1998 and 2018, of which 20,202 (7.6%) were exposed to NSAIDs during the first trimester—most commonly ibuprofen (5.1%), diclofenac (1.6%), and naproxen (1.2%). Major congenital malformations were identified from linked clinical, hospitalization, and termination records. The researchers adjusted risks for maternal and pregnancy characteristics including maternal age, ethnicity, diabetes, obesity, folic acid use, and the reason for NSAID use.

NSAID exposure was not associated with major congenital malformations overall (8.2% vs. 7.0% in unexposed pregnancies; matched adjusted relative risk = 0.99), nor with malformations in specific organ systems including the cardiovascular, musculoskeletal, central nervous system, gastrointestinal, and genitourinary systems. No association was observed for any individual drug, and dose-response analyses found no significant link between cumulative NSAID exposure and birth defect risk.

“Our results provide reassuring evidence that NSAID use in early pregnancy is not associated with major birth defects,” the authors say. “These findings can help both pregnant women and physicians make informed decisions about managing pain and fever in early pregnancy.”

Dr. Daniel adds, “We used data from SiPREG, a large pregnancy registry in southern Israel that tracks medication use and pregnancy outcomes, including birth defects identified not only at birth, but also in pregnancy terminations and during the first year of life.”

“We examined whether common pain relievers from the NSAID group, such as ibuprofen, are linked to birth defects. We found no increased risk overall or for specific types of birth defects.”

Dr. Ariel Hasidim notes, “One of the most interesting parts of this research was finding a careful way to deal with gaps in real-world data. One key issue was that some people may have used common medicines like ibuprofen without it being recorded, which could affect the results. We tackled this head-on by using a special analysis to see whether and how this missing information might have influenced our findings.”

Paper available in PLOS Medicine: https://plos.io/4mGgtZ9

Citation: Hasidim AA, Ben Shitrit I, Idan D, Michael T, Levy A, Pariente G, et al. (2026) First-trimester nonsteroidal anti-inflammatory drugs exposure and risk of major congenital malformations: A retrospective register-based cohort study. PLoS Med 23(5): e1005063. https://doi.org/10.1371/journal.pmed.1005063

Author countries: Israel

Funding: The author(s) received no specific funding for this work.

Obesity has a wide range of potential underlying causes, including mental and psychosocial factors. These factors include financial difficulties, mental stress and loneliness. This study aimed to examine whether these factors occur differently between people with normal weight, overweight or obesity.

The authors used data from the Dutch version of the online screening tool CheckCausesObesity.com This screening tool identifies possible underlying causes of obesity based on international guideline- and evidence-based algorithms. This is an online screening tool that helps identify the underlying causes of obesity in an individual. It systematically maps lifestyle factors, biological, psychological, social, and medication-related factors, as well as more rare medical (eg genetic) causes and also comorbidities, using guideline-based algorithms. All factors are explored in depth through detailed patient input. As part of a comprehensive assessment of multiple lifestyle factors, hormonal, genetic and medical factors which can contribute to overweight, this tool also includes questions about financial problems, loneliness and stress, as well as sex, weight, height and birthyear, enabling the researchers to calculate BMI and age. Patients complete the questions in this screening tool at home, and the results support a more personalized and medically informed treatment approach.

Statistical modelling was performed to explore the associations between financial problems, loneliness, stress and BMI classes (normal weight (BMI 20-24.9 kg/m²), overweight (BMI 25-29.9 kg/m²), obesity class 1 (BMI 30-34.9 kg/m²), obesity class 2 (BMI 35-39.9 kg/m²), and obesity class 3 (BMI ≥40 kg/m2)). Thereafter, statistical analyses were performed, adjusting for age and sex. Finally, potential sex differences in the results were assessed.

The screening tool was completed by 44.407 adults, between June 2024 and November 2025. Mean age was 52 years and the majority were female (76.7%). All the results reported below were statistically significant. The authors looked first at financial difficulties, which were present in 5.4% of the respondents with no difference between men and women. A higher proportion of respondents indicated having financial problems with increasing BMI (normal weight: 4.3%, overweight: 4.7%, obesity class 1: 5.0%, obesity class 2: 6.0% and obesity class 3: 7.2%). Respondents without financial problems had a lower BMI than those indicating they had financial problems (mean BMI: 33.2 kg/m² and 34.5 kg/m²). The association between financial issues and BMI was comparable between men and women.

Secondly, they examined stress, which was reported more frequently by women (34.5%) than by men (22.5%). Respondents experienced more stress with increasing BMI (normal weight: 27.5%, overweight: 28.6%, obesity class 1: 31.2%, obesity class 2: 34.3% and obesity class 3: 37.3%). Accordingly, respondents indicating experiencing stress had a higher mean BMI compared to those without stress (mean BMI: 34.0 kg/m² and BMI: 33.1 kg/m² respectively). This association did not differ between men and women. To explore the reasons underlying respondents’ stress, participants could elaborate on their stress experiences. These qualitative responses were analysed and organised into clusters representing the most frequently reported stress domains. According to these clusters, the three most experienced stress domains were work-related, focused on general well-being or concerns about family-members.

Thirdly, loneliness was more often reported in women (8.7%) than in men (6.3%), and more prevalent among respondents with increasing class of obesity (normal weight: 7.7%, overweight: 7.0%, obesity class 1: 7.6%, obesity class 2: 8.5%, obesity class 3: 11.7%). In addition, individuals who reported loneliness had a higher BMI (mean BMI 34.5 kg/m²) than those without loneliness (mean BMI 33.3 kg/m²). Interestingly, the results suggest that loneliness is more strongly associated with a higher BMI in men than in women.

The authors conclude: “This study shows that higher BMI is associated with more financial problems, loneliness, and stress. These relationships may be bidirectional. On the one hand, higher BMI may contribute to stigma and social isolation, reduced work capacity, and increased healthcare costs. On the other hand, financial strain, chronic stress and social isolation may influence lifestyle coping behaviours, and even biological processes that promote weight gain. Broader environmental factors may further reinforce these patterns. Further research is needed to better understand these mechanisms and to inform prevention and support strategies for individuals facing financial difficulties, mental stress, and loneliness in the context of obesity.

“While the risk is still low to the general public, we are seeing a virus with a high fatality rate transmitting person-to-person,” said Milton, whose research has shown how viruses such as COVID and the flu are transmitted in exhaled breath and has demonstrated the efficacy of masks for prevention.

“WHO should change its default response – the starting point should not be to downplay the risk of airborne transmission until it is definitively proven. ”

Milton worked with a group of international experts: Trisha Greenhalg at University of Oxford, David N. Fisman at University of Toronto, Amanda Kvalsvig at University of Otago, Lidia Morawska at Queensland University of Technology and Jonathan M. Samet at Colorado School of Public Health.

The group writes: “The starting point should be the immediate adoption of precautionary measures to reduce airborne transmission, such as respirator use by healthcare workers, [infected people] and their close contacts.” They also recommend WHO include guidelines on improving ventilation, avoiding unfiltered air recirculation and use of portable HEPA (high efficiency particulate air) filtration in all enclosed quarantine and transport settings.”

The group also provided more detail to the BMJ article in this substack.

The study examined the facilitators and challenges of so-called tobacco endgame policies in Europe. These policies refer to goals and measures aimed at reducing the use of tobacco products in the population to such a low level that it no longer places a significant burden on public health. Tobacco causes more than seven million premature deaths worldwide each year.

The EU’s Tobacco-Free Generation target was launched in the 2021 Cancer Plan and was recently reinforced in the Safe Hearts Plan. The aim is to reduce the use of tobacco products among the European population to below five per cent by 2040.

EU support is decisive for achieving the targets

According to the study, achieving the targets is particularly supported by broad political commitment, effective and long-term cooperation between different actors, and an active civil society that keeps the issue visible and brings public opinion to light.

In contrast, tobacco industry influence on decision-making, the visible marketing of new nicotine products, and the slowness of regulation make progress towards the targets more difficult.

The interviewees saw the EU’s role as central in reducing the use of tobacco and nicotine products. Common EU regulation and examples from other countries can accelerate national measures and encourage countries to set more ambitious targets for reducing the use of tobacco and nicotine products.

“The ongoing revision of EU tobacco legislation provides an important opportunity to strengthen Member States’ actions and accelerate progress towards the Tobacco-Free Generation target,” says Senior Specialist Hanna Ollila from the Finnish Institute for Health and Welfare.

Finland has been a forerunner

In some countries, the target has been extended to cover nicotine products as well. Finland has been a forerunner in this respect. In Finland, the objective of the Tobacco Act is to end the use of tobacco and nicotine products. In practice, the aim is to achieve a prevalence below five per cent by 2030.

“It is important for Finland to continue its active role and ensure that national regulation remains up to date, particularly with regard to new nicotine products. The rapid increase in the use of nicotine pouches among young people requires swift additional measures, such as raising the age limit,” Ollila states.

The study is based on interviews with 23 experts in eight European countries. The interviewees included officials, researchers and representatives of non-governmental organisations. It was carried out as part of the Joint Action on Tobacco Control 2 -project, within a work package led by THL.

The endorsement came on January 9, 2025, when actor Mel Gibson appeared on The Joe Rogan Experience and described three friends with stage IV cancer who he said recovered after taking ivermectin and fenbendazole. Clips of the segment were viewed tens of millions of times across social media in the weeks that followed.

Although ivermectin and benzimidazole drugs like fenbendazole have shown anti-cancer activity in laboratory cells and animal studies, no clinical trials have shown they are safe or effective for treating cancer in people. Ivermectin is FDA-approved for parasitic infections in humans; fenbendazole is approved only for veterinary use.

The increases were largest among men, White patients, residents in the US south, and people with cancer.

The findings, to be published May 12 in the peer-reviewed journal JAMA Network Open, raise concerns that celebrity endorsements like this could influence people to turn to unproven treatments, at the risk of delaying or forgoing conventional treatments that have been confirmed to work.

“As a primary care doctor, I want my patients and people across the country to have the chance to get treatments we know can help them live longer, healthier lives,” said senior author Dr. John N. Mafi, an associate professor-in-residence of medicine, division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “When prescribing for an unproven cancer treatment more than doubles after a single podcast, especially among men and people in the South, it raises a concern that patients may be skipping or delaying treatments we know work in favor of something that hasn’t been proven to help them.”

The researchers compared prescription patterns for the combination ivermectin-benzimidazole among people with and without cancer from January 1 through July 31, 2025 following the endorsement to prescription patterns for the medication combination from the corresponding year-ago period. They used de-identified electronic health records from more than 68 million patients from the multicenter US TriNetX research network capturing prescriptions given to 18- to 90-year-old patients in ambulatory care and emergency departments.

They found that overall prescribing rates within the entire cohort doubled during the months following the endorsement compared with the similar year-ago period. Among people with cancer, prescribing rates were more than 2.5 times higher during the more recent period. In the US South, those rates were more than three times higher during the six months in 2025 compared with the same period the previous year.

“We often focus on how to efficiently get evidence into practice,” said Dr. Michelle Rockwell, an assistant professor of family and community medicine at Virginia Tech and the study’s lead author. ”But these findings remind us that some forces can influence care very quickly. The challenge for health systems is how to meet patients in that moment with information that is both timely and trustworthy.”

The study has some limitations. The study’s observational design cannot establish cause and effect. Given that it was a convenience sample, it may not be representative of the entire US. Also, it focused on physician orders rather than actual use of the drug.

The findings raise several questions that warrant further study: whether patients are substituting ivermectin-benzimidazole for proven cancer treatments, whether its use leads to adverse outcomes, which physicians are prescribing it and in what settings, and what strategies can counter misinformation at the point of care.

“Not all widely shared health information is accurate, even when it comes from familiar or influential sources,” said co-author Dr. Katherine Kahn, Distinguished Professor of Medicine at the Geffen School. “Using unproven treatments can carry real risks, especially if it delays care that is known to work. Clinicians and health systems play a critical role in helping patients navigate information and make informed decisions.”

Study co-authors are Sitaram Vangala of UCLA and Dr. A Mark Fendrick of the University of Michigan.

The National Institute on Aging (R01AG070017-01) and an NIA Beeson Emerging Leaders in Aging Research Career Development Award (K76AG064392-01A1) supported this study.

“Glaucoma is a leading cause of blindness, and evidence has linked migraine with an increased risk of glaucoma, with both conditions affecting the capacity of the blood vessels in the brain to alter blood flow in response to stimuli,” said study author Chien-Hsiang Weng, MD, MPH, of Brown University in Providence, Rhode Island. “Since CGRP inhibitors help regulate blood vessel contraction and inflammation in the nervous system, there has been hope that these drugs could benefit eye health in people at risk of glaucoma.”

For this retrospective study investigators enrolled adults diagnosed with migraine who had, in 2018–2024, been treated with migraine preventive drugs known as calcitonin gene-related peptide (CGRP) inhibitors.

They matched 36,822 subjects who took (CGRP) inhibitors to an equal number of subjects who were treated with other types of migraine prevention drugs.

The drugs in the CGRP inhibitor group were erenumab, fremanezumab, galcanezumab, eptinezumab, atogepant and rimegepant. The drugs in the non-CRGP inhibitor group were valproate, topiramate, flunarizine, candesartan, lisinopril, metoprolol, propranolol, nadolol, amitriptyline and venlafaxine.

The subjects were followed for up to three years to see who developed glaucoma.

A total of 73,644 subjects were included in the final analysis.

During the study period, 153 subjects, (0.42%), in the CGRP inhibitor cohort developed glaucoma, compared to 223 subjects (0.61%) in the non-CGRP inhibitor cohort.

After adjusting the data for age, migraine frequency and history of high blood pressure, the investigators reported that subjects treated with CGRP inhibitors had achieved a 25% lower risk of developing glaucoma than those taking other migraine drugs.

Notably, the researchers also reported that the reduced risk of glaucoma only appeared in CGRP inhibitors using monoclonal antibodies– erenumab, fremanezumab, galcanezumab and eptinezumab. The reduced risk was not found with the CGRP receptor antagonists (or gepants), atogepant and rimegepant.

The authors concluded, “Among adults with migraine receiving preventive treatment, systemic use of CGRPi, particularly monoclonal antibody CGRPi, is associated with a reduced risk of glaucoma compared with the use of other migraine preventive medications.”

Rates of depression and anxiety have increased worldwide since the COVID-19 pandemic, and more people are pursuing mental health treatment as a result. However, there is limited up-to-date data describing how these individuals seek out and receive care. Detailed, population-level information can help healthcare systems meet this growing population’s needs.

To make a start on gathering this data, Kruk and her colleagues surveyed 32,419 adults in 18 high-, low-, and medium-income countries. More than 1,000 people from each country responded. Participants self-reported data via the People’s Voice Survey in 2022 and 2023.

First, survey respondents self-assessed their physical and mental health (the latter including “poor,” “fair,” “good,” “very good,” and “excellent”). Then, they quantified their overall confidence in the healthcare system, their own use of healthcare services, the typical quality of care received, and their ability to manage their own mental health (a metric called patient activation).

Across all countries, respondents reporting poor mental health were more likely to report chronic illness, poorer overall health, lower patient activation, worse care quality and lower confidence in the healthcare system. Between 0.9% (Lao PDR) and 52.4% (UK) of these respondents reported receiving mental health care in the last year. Respondents in Nigeria reported the best overall mental health (4.7% people reported the lowest proportion of “poor” or “fair” mental health (4.7%), while respondents in China had the highest proportion (39.6%).

The researchers hope these results can help the countries in question — and individual healthcare systems — better serve the needs of those with poor mental health. While this is a descriptive study, the researchers posit patient activation as a potential target for elevating overall health and wellness.

The authors acknowledge that big-picture data doesn’t describe individuals’ specific experiences within the healthcare system. They suggest comparison across similar health systems and tracking system performance over time to continuously improve health services.

The authors add, “What stands out from this study is that poor mental health doesn’t exist in isolation. People reporting poor mental health were nearly twice as likely to have a chronic illness and far less likely to feel empowered to manage their own health. Health systems need to stop treating mental health in a silo and recognize that these patients are showing up across all areas of care — and often with more complex needs.”

Kruk adds, “As a research consortium working across very different health systems, we expected to find variation, and we did, in treatment access. But the experience gap was remarkably consistent: people with poor mental health had worse care, more unmet needs, and less trust in the system, regardless of where they lived. Health systems globally need to rethink how they serve this growing group, not just whether they can reach them.”

Freely available paper in PLOS Medicine: https://plos.io/3O045Xd

Citation: Kruk ME, Kapoor NR, Arsenault C, Carai S, Daray FM, Doubova SV, et al. (2026) Health system use and experience among people with poor mental health: A cross-sectional analysis of the People’s Voice Survey in 18 countries. PLoS Med 23(5): e1004745. https://doi.org/10.1371/journal.pmed.1004745

Author countries: United States of America, Greece, Argentina, Mexico, Peru, Ethiopia, India, South Africa, Republic of Korea, United Kingdom, Nigeria, Italy, China

Funding: This work was supported by the Bill & Melinda Gates Foundation (https://www.gatesfoundation.org/ INV-005254) to MEK; the Swiss Agency for Development and Cooperation (https://www.eda.admin.ch/deza/en/home.html; 81067262) to MEK; Merck Sharp & Dohme LLC (https://www.merck.com) to MEK; the Inter-American Development Bank (https://www.iadb.org/en; Project No. RG-T3768) to EGE; and the Taejae Research Foundation (https://taejaefoundation.or.kr/en) to JO. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The warning label currently required on alcohol containers in the United States has not changed since its adoption in 1988, despite new evidence linking alcohol to several diseases. The label states the risks of drinking during pregnancy and while driving or operating machinery and warns generally that drinking alcohol “may cause health problems.” The label often goes unnoticed and unremembered by consumers.

“We wanted to test whether new warnings could better inform consumers about alcohol’s harms and better encourage people to consider cutting back on their drinking,” says lead author Anna H. Grummon, Ph.D., M.S.P.H., assistant professor at the Stanford University School of Medicine. The study was conducted as part of a larger project co-led with Marissa G. Hall, Ph.D., associate professor at the University of North Carolina.

Designed to compare the effects of differently worded and designed warning labels, the study recruited a nationally representative sample of 1,036 adults of legal drinking age (21 and older) who reported drinking at least once a week.

Participants viewed 10 messages — one control, eight new warning labels, and the current U.S. warning label — in random order. They then rated each message on how well it encouraged them to drink less alcohol, reminded them of alcohol’s harms, and informed them of something new.

“Each participant rated multiple warnings covering a range of health harms — such as cancer, liver disease, hypertension, and dementia, among others — so we could make direct, apples-to-apples comparisons between them,” says Grummon.

All the new alcohol warnings in the study outperformed the current U.S. warning label, but those highlighting cancer risk were particularly effective. This finding is notable as policymakers in the United States and abroad debate whether to adopt a cancer warning on alcohol products.

“Ireland, for example, is set to require cancer warnings on alcohol containers in the coming years, and Alaska already requires a cancer warning to be posted in bars, restaurants, and liquor stores where alcohol is sold,” says Grummon. “Our findings suggest these policies could help people understand the risks of drinking and potentially reduce consumption.”

Study participants also rated the effectiveness of warning icons and label design. Triangles and octagons were perceived as more effective and attention-grabbing than other icons, such as a magnifying glass.

More research is underway. Grummon and Hall are currently running a randomized trial to test whether new alcohol warnings effectively lead people to drink less. The study will also measure whether the warnings improve knowledge of alcohol-related harms over time.

“We know from tobacco control that well-designed warnings can inform consumers and encourage healthier choices,” says Grummon. “Given that alcohol-related deaths are increasing, we hope policymakers will consider whether updating alcohol warnings should be part of a broader strategy to address alcohol-related harms.”
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Grummon, A. H., Lee, C. J. Y., Campos, A. D., Lazard, A. J., Brewer, N. T., Whitesell, C., Ruggles, P. R., Greenfield, T. K., & Hall, M. G. (2026). New alcohol warnings outperform the current U.S. warning in a national survey experiment. Journal of Studies on Alcohol and Drugs, 87(3), 433-443. https://doi.org/10.15288/jsad.25-00226

By W.B. Kagan

image: “Government warning” alcohol label

View more Credit: Journal of Studies on Alcohol and Drugs

The purchasing and consumption of foods high in energy, saturated fat, free sugars, and salt, is associated with an increased risk of obesity and diet-related non-communicable diseases. In recent years, the UK Government has set a series of voluntary targets for manufacturers, retailers, and restaurants to reduce the sugar, salt, and calorie content of food. The sugar targets were intended to be met by 2020, the salt targets by 2024, and the calorie targets by 2025. Few studies have assessed the nutritional quality of foods in the restaurant sector, despite an increasing percentage of weekly food intake coming from takeaway or restaurant meals.

In the new study, researchers gathered nutritional information from the 21 highest-grossing restaurant chains in the UK in 2024, using PDF menus or nutritional information on restaurant websites. They calculated the proportion of menu items from each restaurant and food subcategory that met the nutritional targets. Nine of the 21 restaurants had more than half of their menu items meeting all applicable targets. Menu items from Papa John’s were the lowest adhering to the calorie (35%) and salt (8%) targets, while menu items from Burger King, KFC, Nando’s, and Vintage Inns had zero adherence to the sugar targets.

Food within the same subcategory varied in adherence to the targets, with salads and breakfast items having the highest overall adherence, and desserts and pizzas the lowest. However, there were examples of companies across all subcategories performing well, indicating that performance is not constrained by the type of cuisine being offered.

“Our findings demonstrate that there was low adherence to the UK Government’s sugar, salt, and calorie reduction targets in 2024,” the authors say. “This is consistent with other research that finds limited effectiveness of voluntary regulation on reformulation, suggesting that mandatory regulation may be a more effective approach to improving the nutritional quality of out-of-home food.”

Alice O’Hagan adds, “Our study shows that the UK Government’s voluntary sugar, salt, and calorie reduction targets were not being met consistently across the highest-grossing UK restaurant chains, in 2024. Only 43% of menu items met all of the targets they were eligible for, and adherence to the targets varied widely between restaurants and food categories, showing that healthier menus are achievable but are not yet the norm.”

“Interestingly, restaurants with similar menu styles performed quite differently in meeting the targets. This shows the nutritional quality of menus is not fixed by cuisine type, making the shift towards healthier menus a more attainable goal for food companies.”

Co-author Lauren Bandy adds, “Voluntary targets alone are not delivering consistent improvements in the salt, sugar or calorie content of food items on offer in UK restaurants. Our findings highlight the potential value of stricter regulation in the out-of-home sector, and show that improving transparency and accountability of individual food companies will be key in supporting healthier food provision for the UK population.”

Freely available paper in PLOS Medicine: https://plos.io/4bNeHl9

Citation: O’Hagan A, Pechey R, Forde H, Bandy L (2026) Adherence to voluntary UK sugar, salt, and calorie reduction targets in the highest-grossing restaurant chains: A cross-sectional study. PLoS Med 23(5): e1004681. https://doi.org/10.1371/journal.pmed.1004681

Author countries: United Kingdom

Funding: AOH and RP are supported by the NIHR Oxford Health Biomedical Research Centre (https://oxfordhealthbrc.nihr.ac.uk/). RP is also supported by the Royal Society and Wellcome Trust (Sir Henry Dale fellowship; 222566/Z/21/Z; https://www.royalsociety.org/grants/henry-dale/). HF is funded by the SHIFT: Sustainable and Healthy Interventions for Food Transitions project, which is funded by the Wellcome Trust (grant reference 227132/Z/23/Z; https://wellcome.org/research-funding/funding-portfolio/funded-grants/shift-sustainable-and-healthy-interventions-food), and by the COPPER project, which is funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (grant reference NIHR133887; https://fundingawards.nihr.ac.uk/award/NIHR133887). LB is supported by the NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley (https://www.arc-oxtv.nihr.ac.uk/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Image: Dan Gold, Unsplash (CC0, https://creativecommons.org/publicdomain/zero/1.0/)

Professor of Optometry Lisa Ostrin and postdoctoral researcher Barsha Lal are reporting that even one drop in the eye of low-dose atropine (0.01%–0.1%) produces clear changes in pupil size and focusing ability that persist for at least 24 hours. Importantly, they also found that the drop shows no short-term structural effects on the eye, with only temporary changes in blood flow inside the retina.

Ostrin’s latest research is published in the journal Eye and Vision. It adds to a growing body of vision research from David Berntsen, Golden-Golden Professor of Optometry at the University of Houston, who is co-leading a national $25 million NIH-funded clinical trial to delay the development of myopia in children by using the atropine drops.

Low concentration atropine is widely prescribed to slow myopia progression in children, yet its short-term retinal and choroidal effects remain incompletely understood. Ostrin’s new study evaluated short-term effects of a range of low atropine concentrations on the length of the eye, the blood vessels in the retina and the thickness of the retina and choroid, which sits just behind the retina. These are important measurements because longer eye length is associated with myopia and as it gets longer, the retina and choroid are stretched.

“These findings indicate that a single instillation of atropine does not alter axial length or retinal or choroidal thickness over 24 hours but may transiently affect superficial retinal perfusion in a time-dependent manner,” said Ostrin.

In the double-masked, randomized study, twenty healthy adults received a single instillation of either a placebo or atropine in the right eye during five separate sessions. Researchers then checked the eye structure, thickness, and length in the central retina both one-hour and 24-hours later.

“Characterizing these short-term effects is important for a better understanding of the physiological responses to atropine in clinical and research settings,” said Ostrin who previously published research results of a study investigating the short-term effects of a range of low-dose atropine concentrations on the pupils of young adults. In that study, she found similar results with a single drop of atropine inducing significant changes in the pupils.

Together, the studies indicate that atropine induces early functional and vascular effects in the eye, in the absence of structural change.

“By linking objective ocular responses with subjective visual experience, this work advances our understanding of how atropine works and supports more precise, evidence-based, and individualized approaches to myopia management,” said Ostrin.