“Our results showed that discharging older adults after an acute care hospital stay with a new prescription for these medications was associated with an increased hazard of falls requiring medical attention, further need for acute hospital care, and death in the 30 days after hospital discharge, whereas individuals with prior exposure did not experience the same increased hazards,” writes Dr. Lisa Burry, clinician scientist at Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, with coauthors.

Falls are a major public health burden and affect older adults in particular. Sedatives and antipsychotics are associated with adverse events, and clinical guidance discourages prescribing these potentially inappropriate medications for older adults.

The study of more than 1.86 million adults aged 66 years and older aimed to understand prescribing patterns to inform discharge prescribing in future. Based on ICES data, it looked at all patients discharged from hospital between April 2003 and August 2023. In total, 13% (246 440) filled at least 1 prescription for any sedative within 7 days of discharge, and about one-third (76 335) of them had not filled a prescription for a sedative within the 6-month period before hospitalization. The risk of falls was 20% higher in people with a new sedative prescription, and the risk of an emergency department visit, readmission, and death within 30 days was also increased.

“Although the overall absolute magnitude of the risk of adverse events identified was modest from a population perspective, the effects on patients and their families are clinically and socially important,” write the authors. “Moreover, given the volume of hospital admissions among older adults and the aging population, a modest increase in risk translates into a large impact on the health care system.”

The authors suggest caution when prescribing these medications on hospital discharge, ensuring medical follow-up 1 to 2 weeks after discharge to monitor patients, continue risk assessment, and review the need for the prescription.

“Given the identified associations, clinicians must consider whether new sedative prescriptions are essential or can be deprescribed or de-escalated before or shortly after hospital discharge. When ongoing sedative use is required, community support, such as falls or mobility assessments, and ongoing medication reviews may help mitigate risks,” the authors conclude.

Heart failure affects approximately 860,000 Canadians, is associated with reduced survival and quality of life, and is the third leading cause of hospitalization in the country. Heart failure with reduced ejection fraction (HFrEF) accounts for approximately half of these cases.

Despite high-quality evidence supporting the benefits of guideline-directed medical therapy (GDMT) for patients with HFrEF, which entails the rapid initiation of four distinct classes of medication collectively known as quadruple therapy, use of these medications remains suboptimal. This is in part due to inadequate access to heart failure specialists and clinics for many Canadian patients living with HFrEF. This high unmet need underscores the importance of alternative models that expand beyond physician-led GDMT management.

“Heart failure is a serious medical condition that has several effective medications that are underused across Canada,” says lead investigator Ricky Turgeon, BSc(Pharm), ACPR, PharmD, Faculty of Pharmaceutical Sciences, University of British Columbia. “Pharmacists and nurse practitioners are important members of the healthcare team who can help to improve medication use for heart failure.”

The researchers evaluated whether getting pharmacists and nurse practitioners to initiate and manage heart failure medications would be good value for money for the healthcare system by comparing two different scenarios using an economic model.

In the first scenario, patients with heart failure received the usual care currently experienced by most British Columbians with heart failure. In the second scenario, patients with heart failure received the usual care plus additional medication management from pharmacists and nurse practitioners. The investigators then modelled what would happen to these patients over time and tracked how long they would live, how often they would be hospitalized, and how much healthcare resources they would need.

It was estimated that within the first year of implementation, this added service would save approximately 10 lives and prevent 25 hospitalizations per every 1,000 patients who received the pharmacist- or nurse practitioner-led intervention.

“While this service would require additional funding, we demonstrated that this investment would be well justified given what the Canadian healthcare system is generally willing to pay,” notes Dr. Turgeon. “The size of this benefit was far beyond what was anticipated. As a pharmacist caring for people with heart failure, I find these results genuinely empowering. They show that we play an important role in improving patients’ lives while also easing pressure on the healthcare system. We have the evidence; now we need to implement this approach.”

By quantifying the clinical and economic impacts of these additional medication management services, this study provides healthcare system planners with the insights needed to effectively address persistent gaps in care for heart failure patients.

Co-lead investigator Kelly Mackay, MA, Cardiac Services BC, Provincial Health Services Authority, comments, “Our research offers a roadmap to improving patient outcomes while strengthening the sustainability of our health system. The research also provides Cardiac Services BC with the evidence and innovation needed to drive meaningful system change.”

“Expedited and increased access to quadruple therapy has the potential to save lives and reduce some of the pressures in British Columbia’s hospitals. We believe this model could also be successful in other Canadian provinces. We’re thrilled that this research presents such an effective—and feasible—way for more heart failure patients to receive this gold-standard treatment,” concludes co-investigator Nathaniel Hawkins, MBChB, MD, MPH, Cardiac Services BC, Provincial Health Services Authority, and Division of Cardiology, University of British Columbia.

Dr Deniz Turkmen, a postdoctoral researcher at the University of Exeter AGE Group, Exeter, UK, and colleagues studied data from nearly 38,000 UK Biobank participants who had been prescribed steroids. They calculated how much steroid each one had taken over time; whether higher doses were linked to more side effects; examined whether genetic differences could help explain those who were at risk; and, finally, tested whether adding genetic information improved risk assessment. They found that, in patients treated with steroids, certain genetic variants increased the risk of side effects; CYP3A4 for osteoporosis and CTLA4 for stroke and cataract, among others. “We were also able to show a clear relationship between the dose of steroid and side effects,” says Dr Turkmen. “This precise analysis shows the increased risk associated with long-term treatment”.

Incorporating polygenic risk scores* (PRSs) for osteoporosis enabled the researchers to further improve the steroid risk assessment. This improvement went beyond routinely available factors such as age and sex, and was particularly marked in in younger individuals at the time of their first prescription. “Currently, without efficient prediction methods, clinicians try to reduce risks by using only short courses of steroids, prescribing the lowest possible dose, or switching to alternative steroid-sparing treatments such as biologics. However, biologic treatments are often more expensive and may not be easily accessible to all patients. These strategies may also be insufficient for individuals with chronic conditions who require repeated or long-term steroid treatment. The routine use of genetic information could mean that, in the future, patients at high risk could be identified and given earlier steroid-sparing treatments, or have closer monitoring for side effects,” she says.

Given the widespread use of steroids, large-scale implementation of PRSs in their prescribing will present a major challenge. The most practical application is likely to be targeted to higher risk individuals, and particularly those where steroid use may be longer-term.  The findings also need to be studied in other cohorts to ensure that they are applicable more widely, say the researchers. Larger and ethnically more diverse populations may also enhance predictive performance, since the pharmacogenetic effects observed in the study are consistent with other biological mechanisms that influence steroid metabolism and immune response.

“We anticipated that we would find a clear relationship between dose and adverse outcomes,” says Dr Turkmen, “It was reassuring that the genetic findings involving CYP3A4 and CTLA4 aligned with their roles in steroid metabolism and immune regulation, but the improvement in prediction of osteoporosis when we incorporated polygenic risk scores data was remarkable, especially in younger patients. While single variants had a relatively limited influence on the risk of serious side effects from steroids, adding PRSs for traits such as bone mineral density improved risk prediction. We hope that, in time, greater availability of genetic data at population level will mean that it will be possible to integrate genomics into everyday healthcare and hence into prescribing decisions. That will be a major step on the road to the provision of personalised medicine for all.”

Chair of the conference, Professor Alexandre Reymond, who was not involved in the research, said: “Today we are seeing more and more examples of the predictive value of compounding the risk foreseen for variants that are rare and have a large effect with those of common variants with small effects.”

* A polygenic risk score is the assessment of the risk of specific conditions based on the collective influence of many genetic variants in an individual’s genome.

The findings highlight that fear, often criticized in health communication, can be highly effective when combined with credible information and practical guidance. This is particularly important given that tobacco use causes more than 8 million deaths globally each year, according to the World Health Organization, underscoring the need for more effective public health messaging strategies.

The research is detailed in a study titled Fear and persuasion in public health discourse: The case of CDC anti-smoking campaigns, published in Language and Health.

“Fear is often criticized in health campaigns, but our study shows that when fear is used responsibly, it can save lives,” said lead author Ghaleb Rabab’ah, professor of linguistics at the University of Sharjah.

Analysing fear in public health messaging

The study employed a qualitative, descriptive content analysis of 27 press releases issued between 2012 and 2024 as part of the CDC’s Tips From Former Smokers campaign. Drawing on Aristotle’s theory of persuasion and the Extended Parallel Process Model, the researchers examined how fear-based messages are constructed and how they influence audience behavior.

The analysis reveals that these strategies “enhance the CDC’s message by amplifying fear appeals, thereby altering smokers’ current behaviors and attitudes.”

“Fear functions by highlighting the potential threat itself. Once people understand that certain careless behaviors can endanger their well-being or that of their loved ones, they become more inclined to stop and re-evaluate their behaviors,” Prof. Rabab’ah explained.

The study shows that fear-based messaging is used as a “persuasive strategy” to highlight the negative consequences of smoking and influence behavior.

“The fear elements present in CDC messages are not gratuitous, as the representation of fear is intentional and is systematically designed to nudge people to quit smoking or to choose not to start smoking,” he added.

Five strategies behind fear-based messaging

The researchers identified five core strategies that characterize how fear is used in CDC anti-smoking campaigns: fear-induced narratives, health-hazard emphasis, statistics, expert endorsement, and urgency.”

One of the most effective approaches is the use of real-life stories from former smokers who have experienced severe health consequences, making the risks of smoking more immediate and relatable.

“These are real people who, because of smoking, suffered from one or more smoking-related, life-threatening diseases. Some people lost portions of their lungs, whereas others suffered from heart failure or cancer, and many became dependent on their family members for routine daily care. This strategy is intentionally used to convince the audience and/or readers to either quit smoking or not start smoking, as it touches upon their emotions,” said Prof. Rabab’ah.

He added, “The CDC doesn’t just warn people that smoking is dangerous—it shows the human cost of smoking through real stories, real suffering, and real consequences.”

The campaigns also emphasize health hazards by clearly outlining serious smoking conditions such as cancer, heart disease, and premature death.

“The content … prominently highlights the negative consequences that will befall viewers if they do not quit smoking, and it suggests crucial conditions for the target recipient to quit smoking and change lifestyle habits,” the researchers noted.

The campaigns present statistical evidence to demonstrate the scale of harm caused by smoking, noting that such strategies strengthen the credibility of the message and reinforce its public health significance.

“The press releases state that hundreds of thousands of people die every year due to smoking, and billions of dollars are spent on smoking-related medical expenses and lost productivity. These statistics highlight the magnitude of the problem and show that it goes beyond individual issues and speaks to public health,” said Prof. Rabab’ah.

Another key strategy, according to the authors, is “expert endorsement,” which strengthens the persuasive power of these messages in authoritative medical voices.

Finally, the campaigns create a sense of urgency by encouraging immediate action, with messaging designed to prompt individuals to quit smoking or avoid starting.

“Statements like ‘Quit now’ and ‘The sooner you quit, the better’ are commonplace. The press releases offer assistance, including quitlines and text message support services. This creates an immediacy that encourages the reader to take action rather than defer their plans to make a change. It suggests that assistance is on hand and that waiting could have negative consequences,” Prof. Rabab’ah said.

Implications for public health communication

The study demonstrates that fear-based messaging is most effective when it is combined with clear guidance and accessible support rather than used in isolation.

“Public health messages are strongest when emotion, evidence, and action work together,” explained Rabab’ah.

The findings offer practical implications for healthcare institutions by providing evidence of effective strategies.

“The use of fear in anti-smoking campaigns provides insight into why certain public health communications resonate more than others. Health organizations can use this study to create more focused, convincing messages that promote healthy behavioral changes,” he added.

Next steps

The researchers plan to extend their work by conducting a multimodal analysis of CDC interviews with former smokers to further explore how fear operates across different forms of public health communication.

Researchers used two behavioral science-backed methods to prompt clinicians to prescribe the medication, called naltrexone, to qualified patients, resulting in a 15-fold increase in the likelihood that a patient would leave the emergency department with a prescription. The research from the Perelman School of Medicine at the University of Pennsylvania was recently published in the Annals of Emergency Medicine.

“Nationally, because of stigma and a lack of awareness, we are missing out on a huge opportunity to offer effective treatment to patients who struggle with alcohol,” said first author Jeffrey Ebert, PhD, the director of Applied Behavioral Science at Penn Medicine’s Nudge Unit. “Our work shows that it only takes a small adjustment to make a huge impact on who gets the medicine they need.”

Demonstrating an effective medication with few prescriptions

A 2023 national study found that only 1.9 percent of people with AUD received medication to treat their condition. The initiation of naltrexone in the emergency department is significantly lower: Just 0.5 percent of patients presenting with alcohol use disorder received a prescription from the emergency department.

But, the positive effects of naltrexone have been demonstrated: Compared to those taking placebos, 1 in 11 patients with alcohol use disorder quit drinking altogether when taking naltrexone, with the typical patient reducing their heavy drinking days­­­—characterized as four-plus drinks a day for women, and five-plus for men—by one to two days per month.

With this in mind, the Nudge Unit researchers decided to use Penn Medicine’s own emergency departments to establish a potential solution to spur higher naltrexone prescription numbers.

They employed nudges in two phases:

• The first phase, initiated in March 2024 involved establishing a standardized set of steps for caring for a patient potentially presenting with alcohol use disorder or other forms of problematic drinking, and a formatted discharge order that included a prepopulated order for a naltrexone prescription.
• The second phase began three months later, in August 2024. This phase added questions about alcohol to the typical triage questions nurses asked, and a banner alert in patients’ electronic health records if they had screened potentially positive for harmful drinking. Clicking on it immediately sent the physician to the standardized steps for treating these types of patients and the naltrexone order.

“We were very cognizant of the ‘alert fatigue’ that clinicians experience, so we were sure to make the emergency department electronic health record screening prompts and pre-populated orders seamless, user-friendly, and removed some dated components to make sure there was no extra clutter or time burden,” said senior author M. Kit Delgado, MD, MS, faculty director of the Nudge Unit and an associate professor of Emergency Medicine.

Seeing big increases

The nudges were implemented in four hospitals across the University of Pennsylvania Health System, with two others serving as controls.

At baseline, which included data from two-and-a-half years before the nudges started, only 13 (0.2 percent) of patients with an alcohol-related diagnosis received a naltrexone prescription from the emergency department.

When the nudges began, however, 2.7 percent of these patients were prescribed naltrexone during Phase 1. In Phase 2, that rate increased to 3.2 percent, resulting in 99 patients being prescribed naltrexone in just over a year.

In comparison, at the hospitals with no nudging, naltrexone prescribing remained close to 0 (just 0.3 percent of patients with an alcohol-related diagnosis received a prescription).

The jumps in ordering at the nudge hospitals translated to a 12-fold increase in the likelihood of receiving a naltrexone prescription in the Phase 1 period, and a 15-fold increase during Phase 2.

“Before our intervention, only a handful of experts prescribed naltrexone, and only one patient every couple months left with a prescription,” Ebert explained. “It just wasn’t something routinely done in the emergency department. After our intervention, 46 different clinicians prescribed it, with two patients each week, on average, getting a prescription.”

Implemented elsewhere in Philly…and Bhutan

Amid their findings, study-co-author Jeanmarie Perrone, MD, a professor of Emergency Medicine and the founding director of the Penn Medicine Center for Addiction Medicine and Policy, emphasized the opportunity for spreading the word to other physicians about naltrexone.

“There are highly effective, underutilized, low-cost medications for alcohol use disorder, a disease that affects roughly one in 10 Americans,” said Perrone. “It’s something that, likely, many in our own community have been affected by in their loved ones or personally, so it would be helpful to spread information about these good, accessible treatments.”

Already, the team is working to apply their methods to other emergency departments in the health system that didn’t originally get the nudges.

The team was also called upon to implement their work in low-resource settings like Philadelphia’s Puentes de Salud. The learnings are also being applied further afield: Emergency departments in Bhutan are adopting the nudges, too.

The researchers are also exploring how they could expand screening for alcohol misuse in primary care and effectively connect people to treatment.

This study was supported by philanthropic donations directed to the Penn Medicine Nudge Unit.

The poll included 2,200 U.S. adults surveyed May 26-27, 2026. When asked, “What is the effect of the following foods on an individual’s blood cholesterol level?” roughly half correctly answered that beans, whole grains, and soy products reduce risk, but 36% said chicken, 26% said lean cuts of red meat, and 18% said eggs also decrease a person’s risk of developing high cholesterol.

“Americans consume over 100 pounds of chicken each year — more than double the amount eaten in 1980.  Unfortunately, more than one in three people inaccurately believe that consuming chicken actually protects against elevated cholesterol,” said Heather Shenkman, MD, an interventional and preventive cardiologist in Encino, Calif. “In reality, meat and dairy products, which also includes chicken, contribute to artery-clogging hyperlipidemia — a symptomless public health crisis affecting one in four U.S. adults — which is a leading cause of cardiovascular disease, heart attack, and stroke.”

Chicken is not a healthy choice. It raises cholesterol levels as much as red meat. In 2019, researchers tested the effects of low-saturated-fat diets that drew their protein from red meat (beef and pork), white meat (chicken and turkey), or nonmeat sources (legumes, nuts, grains, and soy products). It turned out that both white and red meat raised LDL cholesterol, compared with plant-based proteins, and did so to about the same extent.

As for eggs, about 60% of their calories are from fat — much of which is saturated fat, which also contributes to heart disease. Eggs are also loaded with cholesterol — about 200 milligrams each. That’s more than double the amount in a Big Mac.

An analysis published in JAMA found that that each 300-milligram dose of dietary cholesterol was associated with an increased risk for cardiovascular disease and mortality by 17% and 18%, respectively. When it came to eggs, each half egg caused a 6% and 8% increased risk, respectively.

“The good news,” said Physicians Committee Registered Dietitian Anna Herby, “is that plant staples like beans, lentils, and soy milk can easily replace meat and dairy. They also taste delicious, and can cut grocery costs.”

When asked, “If you had high cholesterol or wanted to reduce your risk of high cholesterol, would you be willing to try a plant-based diet?” over half of survey respondents said they would.

Studies have shown a multitude of heart-health-related benefits of eating an array of whole grains, fruits, vegetables, and beans and legumes.

A recent study with 22 pairs of identical twins found that a plant-based diet improved heart health in as little as eight weeks. The twins following a plant-based diet experienced lower LDL cholesterol, and they lost more weight than the omnivore twins.

The twin study adds to numerous other published scientific studies showing that a plant-based diet can help people maintain a healthy weight, lower blood pressure, improve heart health, and reduce their risk of diabetes among other benefits. What’s more, replacing meat with plant-based meat alternatives may also be beneficial for heart health.

High cholesterol is a key modifiable risk factor for cardiovascular disease, but many eligible patients are not receiving lipid-lowering therapy. A service evaluation by Ankush Sareen (Clinical Pharmacist, Long Lane Surgery, North West Leicestershire GP Federation) demonstrates how a pharmacist-led group consultation model can address this gap — improving patient engagement, increasing treatment uptake, and delivering meaningful clinical outcomes.

Conventional one-to-one appointments often leave insufficient time for education and shared decision-making, contributing to patient misconceptions about statins and low treatment uptake. The group consultation model was designed to tackle these barriers directly.

Method

Patients with a QRISK2 score ≥10% and LDL-C cholesterol >1.8 mmol/L who were not yet on lipid-lowering therapy were identified via a SystmOne and invited by Accurx with a self-booking link. The pharmacist-led group session covered cardiovascular risk, lifestyle modification, and the benefits and safety of statins. Common misconceptions were also addressed. A post-session Accurx questionnaire captured treatment preferences and automatically coded responses in the clinical record. Each patient then received an individual clinical review prior to prescribing, with a repeat lipid profile and liver function tests at eight weeks.

FIndings

Attendance was high, with 88% of invited patients (n=35) taking up the invitation to the group consultation. Following the session, 23 patients opted to start statin therapy and 7 declined.  At eight weeks, results among biochemical responders were clinically significant: 63% achieved a ≥40% reduction in LDL cholesterol, and 32% reached the target of LDL <1.8 mmol/L. The average LDL reduction was 1.52 mmol/L. The authors noted that each 1 mmol/L LDL reduction is associated with a 20–25% relative reduction in major cardiovascular events. Mr Sareen commented that the feedback from patients had been particularly favourable, saying that their questions had been answered.

Managing the same cohort through individual 15-minute appointments would have required approximately eight hours and 45 minutes of pharmacist time. The group model took around two and a half hours — releasing over six hours of clinical capacity for other long-term condition work.

Next steps

For primary care teams looking to improve cardiovascular outcomes efficiently, this approach offers a replicable template. Plans are now underway to scale this model across a 12-practice GP federation, with potential expansion into hypertension and diabetes management.

Photo: Ankush Sareen, Clinical Pharmacist, Long Lane Surgery, North West Leicestershire GP Federation

Published in the high‑ranking Annals of the American Thoracic Society, the study found that low‑dose quetiapine (Seroquel) – frequently prescribed off‑label for insomnia – modestly improved sleep quality and reduced obstructive sleep apnoea (OSA) severity, but significantly impaired alertness and driving performance the following day.

Off-label use refers to prescribing a medication for an unapproved purpose. Quetiapine, approved for schizophrenia and bipolar disorder, is increasingly prescribed at low doses for insomnia and anxiety because of its sedative effects.

“There’s a growing belief that low‑dose quetiapine is a relatively harmless way to help people sleep,” says lead author, Cricket Fauska, a PhD candidate for FHMRI Sleep Health at Flinders University.

“Our results show it’s not that simple. Although participants slept longer and woke less overnight, their reaction times were slower, and their simulated driving performance was noticeably worse the next morning.”

The trial focused on people with obstructive sleep apnoea who also struggle to stay asleep – a common but often overlooked combination known as comorbid insomnia and sleep apnoea. While many patients and clinicians assume a better night’s sleep leads to better daytime functioning, the findings suggest this may not hold true when quetiapine is used.

In the randomised, double‑blind, placebo‑controlled study, 15 adults spent two nights in a sleep laboratory – one night after taking 50 milligrams of quetiapine and one after taking a placebo. Full overnight sleep studies were conducted, and the following morning participants completed a driving simulator task and a vigilance test to objectively measure alertness.

Compared with placebo, quetiapine reduced the number of breathing interruptions during sleep and improved sleep efficiency, without worsening oxygen levels. However, it also caused slower reaction times, more lapses in attention and poorer steering control during the driving simulation – markers that are strongly linked to real‑world crash risk.

“What was particularly concerning is that some people didn’t feel especially sleepy the next day, despite performing worse on objective tests,” says Fauska.

“That mismatch between how people feel and how they actually function poses a serious safety risk, especially when it comes to driving.”

Quetiapine is approved to treat conditions such as schizophrenia and bipolar disorder, but it is increasingly prescribed at much lower doses for insomnia, anxiety and general sleep complaints.

Matthew Flinders Professor Danny Eckert, Director of FHMRI Sleep Health and senior author on the paper says the findings raise important questions about current prescribing practices particularly in primary care.

“Around 80 percent of people with OSA are undiagnosed and unaware they have the condition, and to add to this, a key symptom is finding it difficult to stay asleep,” says Professor Eckert.

“Sleep complaints like this are common in general practice, and in Australia around 90 per cent of people who present with insomnia symptoms will leave with a sleeping pill rather than a sleep assessment”.

“Our study shows that while quetiapine can make sleep look better on the surface, it may actually make people less safe the next day.”

The findings also highlight a broader shift in how sleep disorders like OSA are best managed with another new study finding that rather than relying on one‑size‑fits‑all solutions, there is growing evidence that targeting the underlying causes of sleep disruption can improve both treatment effectiveness and patient outcomes.

“Sleep apnoea is a complex condition with different underlying drivers in different people,” says Professor Eckert.

“What we’re learning is that treatment needs to be tailored — using the right approach, or combination of approaches, for the individual rather than defaulting to sedating medications.”

The researchers say better screening for sleep apnoea, increased access to evidence‑based treatments such as cognitive behavioural therapy for insomnia (CBTi), and clear warnings about next‑day impairment are essential.

More than three‑quarters of participants experienced side effects after just a single dose of quetiapine, including grogginess, dizziness and drops in blood pressure. One participant required medical review after a fall.

Although no serious long‑term harm occurred, the researchers say the results underscore the need for caution.

“Our findings suggest quetiapine should not be used as a routine sleep medication in people with known or possible sleep apnoea, particularly when next‑day alertness is critical,” says Professor Eckert.

The research team recommend safer alternatives such as CBTi, alongside care pathways that prioritise sleep apnoea screening before prescribing sedating medications.

The paper, ‘Quetiapine modestly improves sleep and breathing but impairs next day performance in people with OSA and difficulty maintaining sleep: A randomized controlled trial’, by Cricket Fauska, Tarun Bastiampillai, Georgina Rawson, Barbara Toson, Andrew Vakulin, Robert Adams, Gary Wittert, Kelly A. Loffler and Danny J. Eckert, was published in the Annals of the American Thoracic Society journal. DOI: 10.1093/annalsats/aaoag092

See also, “Developments in Pharmacotherapy for Obstructive Sleep Apnoea: Unlocking the Potential for Targeted Treatment” by Danny J Eckert was published in Drugs 2026. DOI: 10.1007/s40265-025-02268-9.

Acknowledgements: This study was funded by a National Health and Medical Research Council of Australia Grant (1196261).

The study reveals that overheating is no longer just a design issue – it is an escalating public health challenge, with the greatest impact falling on people least able to adapt. Hospitals and care homes are among the highest-risk environments, where rising indoor temperatures are already affecting safety, care delivery and wellbeing.

Led by researchers at the University of East London (UEL), the paper highlights how gaps in building regulations, weak enforcement and low public awareness are combining to leave millions exposed as temperatures continue to rise.

Despite the introduction of overheating rules under Part O of the Building Regulations, the research finds these measures are limited, inconsistently applied and often fail to account for real-world conditions – particularly in existing homes and institutional settings.

In some cases, homes that meet modern energy efficiency standards may actually be more prone to overheating, as airtight construction and insulation trap heat indoors during summer months – exposing a critical flaw in current policy.

The research also shows that overheating is often addressed too late in the design process, meaning simple solutions such as shading or building orientation are missed. Developers are frequently left relying on last-minute fixes that do little to improve long-term resilience.

Beyond buildings, behavioural and institutional barriers are compounding the problem. Low public awareness of heat risk, unclear guidance during heatwaves and gaps in healthcare preparedness are all limiting the UK’s ability to respond effectively.

The study draws on insights from a national roundtable of experts across housing, healthcare and the built environment, revealing widespread concern that current systems are not keeping pace with rising temperatures.

Among the key recommendations are extending overheating regulations to existing homes as well as new builds, strengthening enforcement, and embedding heat resilience into planning decisions from the outset.

The researchers also call for clearer, more actionable public guidance, alongside targeted support for vulnerable groups and stronger integration of heat risk into NHS planning and services.

Dr Mehri Khosravi, Senior Research Fellow at UEL’s Sustainable Research Institute, and lead author of the study, said:

“Extreme heat is already putting the most vulnerable people at risk, particularly those in care settings and poor-quality housing. Yet our current systems are not designed to protect them.”

She added:

“We need to stop thinking of overheating as just a building problem. It is a public health issue that requires coordinated action across housing, healthcare and climate policy.”

The paper concludes that without urgent reform, the UK risks locking in homes and systems that will become increasingly unsafe in future heatwaves, with the greatest burden falling on those least able to respond.

The research, From building codes to behaviour: Strengthening extreme heat adaptation policy in the United Kingdom, is published in Energy Research & Social Science.

The research was led by Dr Mathilde Touvier, a research director at INSERM (the French National Institute for Health and Medical Research), and Anaïs Hasenböhler, PhD student, both from the Nutritional Epidemiology Research Team at the Université Sorbonne Paris Nord and Université Paris Cité, France.

Ms Hasenböhler said: “Food preservatives are used in hundreds of thousands of industrially processed foods. Experimental studies suggest that some preservative food additives may be harmful to cardiovascular health, but we have not had enough evidence on the impact of these ingredients in humans. As far as we know, this is the first study of its kind to investigate the links between a wide range of preservatives and cardiovascular health.”

The research is part of a larger study, called NutriNet-Santé, and included 112,395 volunteers from across France. Every six months the volunteers told researchers everything they ate and drank over a period of three days.

Researchers carried out detailed analyses of the ingredients of all the food and drink, including any preservatives. They also tracked the volunteers’ health for an average of seven to eight years to see if they develop high blood pressure or any cardiovascular disease.

Researcher found that 99.5% of the volunteers had consumed at least one food preservative within the first two years of taking part.

Overall, they found that people who ate the largest amounts of ‘non-antioxidant’ preservatives had a 29% higher risk of hypertension, compared to those who ate the least, and a 16% higher risk of cardiovascular disease, including heart attack, stroke and angina. People who ate the most antioxidant preservatives had a 22% higher risk of hypertension. Non-antioxidant preservatives are designed to stop harmful microbes, such as mould and bacteria, from growing, whereas antioxidant preservatives are designed to stop oxidation which means the food will not turn brown or become rancid.

Researchers also looked at 17 of the most commonly eaten preservatives and found that eight of these were specifically linked to high blood pressure. These were: potassium sorbate (E202), potassium metabisulphite (E224), sodium nitrite (E250), ascorbic acid (E300), sodium ascorbate (E301), sodium erythorbate (E316), citric acid (E330) and extracts of rosemary (E392). Ascorbic acid (E300) was also specifically linked to cardiovascular disease.

Dr Touvier added: “This study has some limitations inherent to its observational design. However, the findings are based on highly detailed data, and we have taken account of other factors that can increase or lower the risk of cardiovascular disease. Experimental research in the literature consistently suggested that preservatives may cause oxidative stress in the body or affect the way the pancreas works.

These results suggest we need a re-evaluation of the risks and benefits of these food additives by the authorities in charge, such as the EFSA in Europe and the FDA in the USA, for better consumer protection. In the meantime, these findings support existing recommendations to favour non-processed and minimally processed foods, and avoid unnecessary additives. Doctors and other healthcare professionals play a key role in explaining these recommendations to the public.”

The researchers are now looking at how food additives and ultra-processed foods may affect signs of inflammation, oxidative stress, metabolic profile in the blood and the composition of the gut microbiota. This may help them to understand why additives may increase the risks of disease.

Now, new research presented at the 2026 ATS International Conference narrows down which patients are likely to have the best treatment outcomes.

Patients in this “strong response” subtype experienced nearly twice the improvement in sleep apnea as others. The findings could help doctors offer more personalized treatment and give patients clearer expectations for their sleep health. It’s the first time a subgroup of strong responders has been identified for this treatment.

“We are excited about these findings because they offer the chance to now be able to share with patients: ‘You have the characteristics that place you in a group of patients who respond remarkably to tirzepatide weight loss therapy.’ Or, by contrast, ‘You have characteristics that suggest additional treatments might still be needed,’” said first author Scott Sands, PhD, associate professor of medicine at Brigham and Women’s Hospital, Harvard Medical School in Boston.

For the study, researchers conducted a secondary analysis of data from an earlier clinical trial of tirzepatide in patients with OSA and obesity.

They identified a “strong response endotype,” a subgroup of patients who saw significantly better outcomes than others. These patients were younger and had milder obesity, and they also had specific characteristics related to the underlying cause of their sleep apnea, including more severe upper-airway collapsibility, greater breathing control instability (called “high loop gain”), and a tendency to wake themselves up more easily with airflow obstruction.

Dr. Sands said the finding that greater loop gain is a predictor of treatment effectiveness was initially surprising. But further study found that tirzepatide treatment helps improve both breathing instability and upper-airway collapsibility, suggesting this could be an additional target of the therapy.

Dr. Sands noted that the findings help fill a gap in physicians’ ability to counsel patients and identify those who could benefit the most from treatment.

“Currently, clinicians can only point to the average treatment responses – showing that, on average, patients can expect around a halving of their sleep apnea severity beyond what is seen with a placebo,” he noted. “Ultimately we hope to take the guesswork out of this experience for patients and their sleep doctors.”

Next, the team members hope to continue their research with future studies that examine OSA outcomes across different pharmacological and non-pharmacological weight-loss therapies, he added.

A new study published today [14 May] in The Lancet Psychiatry provides the most comprehensive view of dosage effects for five commonly used medications for ADHD.

To help patients and clinicians choose the right dosage, the international research team led by Professor Samuele Cortese from the University of Southampton has also developed a free online tool based on the findings.

The research was funded by the National Institute for Health and Care Research (NIHR).

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions, affecting about five per cent of school-age children and two to three per cent of adults.

Medication is a key part of treatment, and prescriptions have increased substantially in recent years. However, most clinical guidelines provide limited guidance on the most effective dosages.

Finding the right dose is important to avoid dosages that are too low to be effective or too high, causing unwanted side effects. To identify this dosage ‘sweet spot’, the research team analysed data from 113 clinical trials, including more than 25,000 participants.

They used an advanced method called dose–effects network meta-analysis, which allowed them to estimate how different doses of each medication affect both effectiveness and side effects.

The results show that patterns differ between medications and age groups.

Dr Mikail Nourredine from the University of Lyon, first author of the study, said: “Overall, our findings suggest that clinicians should avoid using doses that are too low to be effective. If symptoms are not well controlled, the dosage may need to be increased.

“We also found no evidence that going beyond the licensed maximum doses improves average effectiveness, and higher doses are usually linked to more side effects. However, our results derive from group averages. Specific individuals with ADHD may benefit from and tolerate well unlicensed doses.”

Evidence from other studies shows that a substantial proportion of children and adolescents are prescribed low dosages without appropriate increases. That’s despite timely and adequate dose adjustments being associated with better adherence to treatment.

Professor Cortese, an NIHR Research Professor at the University of Southampton, commented: “Our study and the tool have the potential to support shared decision-making between clinicians, patients, and families when choosing the best dose. It is not only a clinician’s decision – patients and caregivers should be involved.

“The tool helps show what can be expected from each dose so that the patient knows why that particular dose has been chosen. We are continuing research to further personalise these recommendations based on individual patient characteristics.”

The study Pharmacological interventions for ADHD: a systematic review and dose-effect network meta-analysis is published in The Lancet Psychiatry and is available online.

Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.

1. The study Pharmacological interventions for ADHD: a systematic review and dose-effect network meta-analysis will be published in The Lancet Psychiatry. An advanced copy is available upon request.
2. The online tool is available here: https://mikailnourredine.github.io/ADORMA/
3. For interviews, please contact Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.