Digital transformation is key to the realisation of the NHS 10 Year Plan for England, “shifting from bricks to clicks,” but compliance with statutory digital clinical safety standards is not routinely monitored or enforced, explain the researchers.

This is despite statutory requirements under the Health and Social Care Act 2012 for digital health technologies to undergo formal clinical risk assessment (DCB0129/160), they point out.

The researchers previously reported compliance rates in a survey of 239 NHS trusts and integrated care boards (ICBs) in England, using freedom of information requests. They found that among the 14,848 digital health technologies in use in these organisations, 70% lacked documented safety assurance; only 17% were fully assured.

To better understand the drivers behind the poor compliance rates, the researchers carried out a secondary analysis of qualitative data from the original survey responses and additionally drew on previously unpublished quantitative data on Clinical Safety Officer (CSO) capacity.

CSOs are clinicians who are responsible for overseeing the clinical risk management of digital technologies used in the delivery of patient care.

On average, one full time CSO was deployed at each of the 211 organisations that responded to the original survey (February to March 2025). In all, 163 organisations (77%) provided data on hours worked

NHS trusts reported slightly higher capacity (average of 1.3 full time equivalent staff) than ICBs who reported an average of less than half (0.4).

Free text responses suggested the figures overstated actual capacity, with CSO duties typically performed alongside other substantive duties.

Twenty two organisations couldn’t quantify time spent on DCB implementation. And 11 identified the CSO function as part of a senior leader’s role, which included associate medical director, chief clinical information officer, and chief nurse.

“While embedding safety within senior clinical leadership may provide strategic visibility, it also means the individuals responsible for safety oversight are those with the least available time to undertake it; reducing effective capacity and impairing the development of experiential expertise,” point out the researchers.

Thirty-seven organisations invoked statutory exemptions to the original FOI request, with the most common being cost and time required to meet it, with inaccessible data and/or the absence of a central register, the most common justifications.

“While we have no reason to suspect the validity of these claims, we would nevertheless highlight that both reasons indicate immature clinical safety governance processes,” write the researchers.

Of particular note were the exemptions claimed under prevention or detection of crime and health and safety, which indicate a fundamental misunderstanding of what is meant by clinical safety, they highlight.

“These responses collectively suggest a workforce model that is structurally incapable of delivering the proactive, continuous risk management that the standards require,” they point out.

Thematic analysis of the free text comments pinpointed four major and mutually reinforcing drivers of non-compliance: poor understanding of the standards; immature governance infrastructure and oversight; ineffective assurance processes; and the perception of a CSO not as a dedicated, professionalised post, but as an ancillary responsibility absorbed into existing roles.

“These themes do not operate in isolation,” emphasise the researchers. “The result is a system in which no single component (ie, knowledge, governance, process or workforce) functions adequately, and the failure of each compounds the others.”

This matters, say the researchers, because:

• The Plan’s ambition to rapidly adopt frontier technologies, including AI, genomics and robotics, demands a highly skilled CSO workforce with dedicated time to undertake risk assessments of increasing complexity
• Despite the recognition (Topol Review) that preparing healthcare workers for a digital NHS requires embedding digital safety knowledge at undergraduate and postgraduate level, this study’s findings suggest that this hasn’t happened
• The shift from hospital to community will also likely require concomitant expansion of the community digital footprint, especially in primary care, which is likely to be smaller and less well resourced than trusts and ICBs, with less access to specialist CSO capacity
• The commissioning of services from diverse providers means extending digital safety obligations across a wider, heterogeneous provider landscape, which risks creating accountability gaps where ultimate responsibility for patient safety is unclear
• The Medium Term Planning Framework mandates a 2% year-on-year improvement in productivity, creating tension between the speed of deployment and the rigour of assurance

To tackle these issues, the researchers suggest:

• the need for regulation, with the Care Quality Commission uniquely placed to do this
• adding DCB0160/0129 compliance to the patient safety domain of the NHS Oversight Framework to signal that digital safety governance is core to care quality
• formalising the CSO pathway, introducing a tiered competency based structure for operational delivery to bring the NHS into line with other safety critical industries
• the development of mechanisms for sharing best practice, identifying standard deployment hazards and causes, and raising awareness of clinical incidents

The researchers acknowledge that their data lacked the depth, contextual detail, and opportunities for clarification that would typically be afforded by traditional qualitative methods, such as semi-structured interviews. And their survey excluded primary care and adult social care, so compliance remains unknown in these sectors.

Nevertheless, they conclude: “NHS organisations in England are systematically failing to comply with legislated digital safety standards…Before the UK Government pursues its ambitious digital future for the NHS, a new digital safety architecture must be established.”

They continue: “A model combining centralised assessment with local risk management, a professionalised CSO workforce, empowered regulatory enforcement, and integration of digital safety into national quality frameworks is needed to ensure that innovation and patient safety are pursued as concurrent priorities.

“Without these changes, the digital transformation envisaged in the 10 Year Health Plan risks propagating patient harm at unprecedented scale and speed.”

The NHS 10 year Health Plan “risks propagating patient harm at an unprecedented scale” due to the lack of appropriate safety architecture to support the envisaged digital transformation, warn experts in an analysis published in the online journal BMJ Innovations.

Digital transformation is key to the realisation of the NHS 10 Year Plan for England, “shifting from bricks to clicks,” but compliance with statutory digital clinical safety standards is not routinely monitored or enforced, explain the researchers.

This is despite statutory requirements under the Health and Social Care Act 2012 for digital health technologies to undergo formal clinical risk assessment (DCB0129/160), they point out.

The researchers previously reported compliance rates in a survey of 239 NHS trusts and integrated care boards (ICBs) in England, using freedom of information requests. They found that among the 14,848 digital health technologies in use in these organisations, 70% lacked documented safety assurance; only 17% were fully assured.

To better understand the drivers behind the poor compliance rates, the researchers carried out a secondary analysis of qualitative data from the original survey responses and additionally drew on previously unpublished quantitative data on Clinical Safety Officer (CSO) capacity.

CSOs are clinicians who are responsible for overseeing the clinical risk management of digital technologies used in the delivery of patient care.

On average, one full time CSO was deployed at each of the 211 organisations that responded to the original survey (February to March 2025). In all, 163 organisations (77%) provided data on hours worked

NHS trusts reported slightly higher capacity (average of 1.3 full time equivalent staff) than ICBs who reported an average of less than half (0.4).

Free text responses suggested the figures overstated actual capacity, with CSO duties typically performed alongside other substantive duties.

Twenty two organisations couldn’t quantify time spent on DCB implementation. And 11 identified the CSO function as part of a senior leader’s role, which included associate medical director, chief clinical information officer, and chief nurse.

“While embedding safety within senior clinical leadership may provide strategic visibility, it also means the individuals responsible for safety oversight are those with the least available time to undertake it; reducing effective capacity and impairing the development of experiential expertise,” point out the researchers.

Thirty-seven organisations invoked statutory exemptions to the original FOI request, with the most common being cost and time required to meet it, with inaccessible data and/or the absence of a central register, the most common justifications.

“While we have no reason to suspect the validity of these claims, we would nevertheless highlight that both reasons indicate immature clinical safety governance processes,” write the researchers.

Of particular note were the exemptions claimed under prevention or detection of crime and health and safety, which indicate a fundamental misunderstanding of what is meant by clinical safety, they highlight.

“These responses collectively suggest a workforce model that is structurally incapable of delivering the proactive, continuous risk management that the standards require,” they point out.

Thematic analysis of the free text comments pinpointed four major and mutually reinforcing drivers of non-compliance: poor understanding of the standards; immature governance infrastructure and oversight; ineffective assurance processes; and the perception of a CSO not as a dedicated, professionalised post, but as an ancillary responsibility absorbed into existing roles.

“These themes do not operate in isolation,” emphasise the researchers. “The result is a system in which no single component (ie, knowledge, governance, process or workforce) functions adequately, and the failure of each compounds the others.”

This matters, say the researchers, because:

• The Plan’s ambition to rapidly adopt frontier technologies, including AI, genomics and robotics, demands a highly skilled CSO workforce with dedicated time to undertake risk assessments of increasing complexity
• Despite the recognition (Topol Review) that preparing healthcare workers for a digital NHS requires embedding digital safety knowledge at undergraduate and postgraduate level, this study’s findings suggest that this hasn’t happened
• The shift from hospital to community will also likely require concomitant expansion of the community digital footprint, especially in primary care, which is likely to be smaller and less well resourced than trusts and ICBs, with less access to specialist CSO capacity
• The commissioning of services from diverse providers means extending digital safety obligations across a wider, heterogeneous provider landscape, which risks creating accountability gaps where ultimate responsibility for patient safety is unclear
• The Medium Term Planning Framework mandates a 2% year-on-year improvement in productivity, creating tension between the speed of deployment and the rigour of assurance

To tackle these issues, the researchers suggest:

• the need for regulation, with the Care Quality Commission uniquely placed to do this
• adding DCB0160/0129 compliance to the patient safety domain of the NHS Oversight Framework to signal that digital safety governance is core to care quality
• formalising the CSO pathway, introducing a tiered competency based structure for operational delivery to bring the NHS into line with other safety critical industries
• the development of mechanisms for sharing best practice, identifying standard deployment hazards and causes, and raising awareness of clinical incidents

The researchers acknowledge that their data lacked the depth, contextual detail, and opportunities for clarification that would typically be afforded by traditional qualitative methods, such as semi-structured interviews. And their survey excluded primary care and adult social care, so compliance remains unknown in these sectors.

Nevertheless, they conclude: “NHS organisations in England are systematically failing to comply with legislated digital safety standards…Before the UK Government pursues its ambitious digital future for the NHS, a new digital safety architecture must be established.”

They continue: “A model combining centralised assessment with local risk management, a professionalised CSO workforce, empowered regulatory enforcement, and integration of digital safety into national quality frameworks is needed to ensure that innovation and patient safety are pursued as concurrent priorities.

“Without these changes, the digital transformation envisaged in the 10 Year Health Plan risks propagating patient harm at unprecedented scale and speed.”

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The landmark review, published in JAMA Internal Medicine, provides general practitioners and physiotherapists with an updated roadmap for managing shoulder pain.

It suggests that simple supportive care delivers better patient outcomes in most cases, rather than unnecessary scans and invasive procedures.

Shoulder pain affects nearly one in six adults each year, making it the third most common musculoskeletal complaint in primary care, trailing only behind back and knee conditions.

For most of these patients, the review emphasises that routine scans (X-rays, ultrasounds or MRIs) are not recommended because what appears on a scan often does not explain a person’s pain.

Instead, clinicians should focus on understanding the patient’s symptoms and history, conducting a physical examination, providing reassurance about their expected recovery, and recommending activity modifications, symptom relief or a wait-and-see approach where appropriate.

Lead author Dr Romi Haas, Research Fellow at the Monash School of Public Health and Preventive Medicine, said initial assessments should focus on ruling out serious underlying causes, such as infections, tumours or broken bones, and distinguishing localised shoulder pain from referred pain, such as pain originating from the neck or heart.

“The traditional approach has been to look for a structural flaw by scanning the shoulder, assuming that if you can identify the source of the pain, you can fix it,” Dr Haas said.

“However, global evidence shows these findings are often just normal signs of ageing, akin to grey hair or wrinkles.

“Unwarranted imaging can wrongly attribute a person’s pain to these normal age-related changes, causing undue worry, overdiagnosis and treatments they don’t need. Importantly, early scans don’t improve long-term recovery.”

Subacromial pain is the most common presentation of shoulder pain. It’s usually felt around the top and outside of the shoulder, and can worsen when lifting or reaching with the arm, or when sleeping on that side.

“Structural labels like ‘bursitis’ or ‘tendon tears’ make people think their shoulder is damaged and needs fixing,” Dr Haas said.

“Shifting to location-based labels, such as ‘subacromial pain’, helps reassure patients that it’s safe to keep moving while they manage their symptoms and recover.”

Co-author Dr Thomas Ibounig, a shoulder and elbow surgeon at Helsinki University Hospital in Finland, said the evidence is just as relevant for surgeons as it is for other clinicians.

“High-quality evidence has found that a common shoulder operation, which removes bone and tissue to create more space for the tendons, provides no meaningful benefit over a dummy procedure, where incisions are still cut into a patient, but nothing has been repaired,” Dr Ibounig said.

“It’s a reminder that pain isn’t always caused by an anatomical or structural problem we can simply fix with surgery.

“This guidance helps clinicians explain that clearly, so patients aren’t unnecessarily worried or pushed toward treatments they don’t need.”

Dr Haas said the same principle applies to corticosteroid injections.

“They can provide short-term pain relief, but they don’t routinely need to be guided by imaging,” Dr Haas said.

“Evidence shows an injection given by a doctor using the patient’s physical anatomy as a guide works just as well, without the additional cost or inconvenience of imaging.”

Senior author, Professor Rachelle Buchbinder, a rheumatologist and clinical epidemiologist from the Monash School of Public Health and Preventive Medicine, said most people recover from shoulder pain within one year, although often much sooner.

“Based on a long-term study of 526 adults with new shoulder concerns, followed for more than 10 years, almost 80 per cent experienced satisfactory improvement, through watchful waiting or anti-inflammatory medication,” Professor Buchbinder said.

“Our new guidance is a practical tool and a reassuring reminder for clinicians.

“It gives GPs, physios and surgeons the evidence base they need to reassure patients that self-management, time, and targeted advice are usually the safest and most effective path to recovery.”

Read the research paper: https://doi.org/10.1001/jamainternmed.2026.3135

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Seizures are among the more common in-flight medical events, and benzodiazepines are the standard first-line treatment for a seizure that does not stop on its own. The authors argue that the current contents of airline emergency medical kits leave clinicians who volunteer to assist during a flight without access to the medication they would ordinarily reach for.

The Viewpoint sets out the case for adding the drug class to standard kits and discusses the practical considerations involved, including which formulations would be appropriate at altitude and in a confined cabin setting, and how a controlled substance would be stored and accounted for on board.

Emergency medical kit contents are set by regulators, so any change to what airlines carry would require action at that level rather than by individual carriers.

The corresponding author is Joseph I. Sirven, MD, of the Department of Neurology at Mayo Clinic, Scottsdale, Arizona.

Read the full article: A Call for Benzodiazepines in Airline Emergency Medical Kits

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In a Rutgers-led study published in the Journal of Exposure Science & Environmental Epidemiology, researchers conducted a survey of product usage among 143 students at Princeton High School in New Jersey. They found that more time on social media and greater engagement with beauty-related content predicted more usage. After researchers accounted for gender, grade, race, ethnicity and parents’ education, they found students who followed influencers with product lines reported using 30% more products in the previous 24 hours. Those who watched hair or beauty tutorials used 40% more.

It was a novel finding that researchers on the study team credited a pair of then-high school students, Gabrielle Kaputa and Vita Moss-Wang, who helped design and conduct the survey and suggested it include questions about social media usage.

“Social media turned out to be the most interesting part of our results,” said Emily Barrett, the George G. Rhoads Endowed Legacy Professor and vice chair of the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health and the lead author of the study.

“We often hear that social media may hurt kids’ mental health and socioemotional development,” she added. “This study suggests another cause for concern: social media’s potential to increase the use of personal care products that often include hormone-disrupting and potentially carcinogenic chemicals.”

Barrett and her colleagues, who have conducted several studies of adult product use, see much need for more information about student usage patterns.

“Teenagers are a particularly interesting population to study because they are undergoing rapid changes, including in their hormone systems,” Barrett said. “It may be a sensitive period in which better product choices could reduce chemical exposure.”

Such products include soap, toothpaste, shampoo, deodorant, sunscreen, skin care products, fragrance and makeup. Some contain phthalates, parabens, phenols or other chemicals that may affect hormone signaling and cancer risk. Previous research has found that people who use more products tend to have higher levels of some of these chemicals in their bodies.

In this study, girls reported using a median of 14 products in the previous day, twice as many as boys. In addition to near universal reports of using soaps and toothpaste in the past day, 57% reported the use of fragrances, which often use endocrine-disrupting phthalates without reporting them on labels. Overall product use among the students was comparable to levels reported in adult studies.

The students voiced some concern about potential chemical exposure, but few took the necessary steps to minimize it. Nineteen percent regularly read ingredient lists, and 5% regularly used an app or website intended to identify healthier products.

“Teenagers don’t read labels, it turns out,” said Moss-Wang, who was a sophomore at Princeton High School when the project began and is now a sophomore at Wellesley College.

The unusual collaboration began when investigators from the Rutgers Center for Environmental Exposures and Disease approached the Princeton High School research program in 2023. Moss-Wang and Kaputa joined the team, helped design the survey and urged the researchers to explore social media. They also prepared research ethics materials, created a recruitment video and flyers, visited classes and tracked responses. A second recruitment wave reached high school students in Rutgers summer programs.

“Dr. Barrett allowed us to manage the high school population outreach and data collection,” said Kaputa, now a junior at the University of Connecticut. “We identified interesting aspects of social media exposure within our student questionnaires.” Both students used the data for a three-year research project and became coauthors of the scientific paper.

The professional researchers, meanwhile, are now doing follow-up research with focus groups to learn which accounts, messages and influencers shape teenagers’ choices.

Larger studies across more diverse communities could test whether the pattern holds and could pair product inventories with urine samples that measure chemical exposure. Researchers also want to learn whether trusted online voices can steer adolescents toward safer choices.

The study was supported by the National Institute of Environmental Health Sciences through the Rutgers Center for Environmental Exposures and Disease.

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The editorial, “Unanticipated Effects of GLP-1 Receptor Agonists: A Net Positive,” was published in the journal Obesity and highlights additional benefits that were not fully anticipated when the drugs were initially developed.

“Most of the unanticipated side effects of GLP-1 receptor agonists have been positive,” the authors wrote.

The researchers highlight evidence suggesting GLP-1 medications may reduce inflammation and lower the risk of certain cardiovascular and musculoskeletal conditions. Emerging studies also suggest the medications may reduce alcohol consumption and the risk of certain substance use disorders, although additional clinical trials are needed to confirm these effects.

At the same time, questions remain about the medications’ effects on lean body mass and nutritional health. Weight loss associated with GLP-1 medications can include reductions in lean mass, including muscle, making it important to understand how to preserve muscle through exercise and appropriate nutrition. Reduced appetite may also increase the risk of micronutrient deficiencies in some patients.

“GLP-1 receptor agonists have already transformed the practice of medicine in the United States, and this change will continue as more medications come onto the market,” the authors wrote.

The researchers identify three key priorities for future GLP-1 research:

• Understanding the mechanisms behind potential reductions in inflammation,
• Conducting randomized trials to better understand changes in lean body mass and ways to preserve muscle,
• Conducting larger randomized trials to determine whether these medications can reduce alcohol use disorders.

Despite the remaining questions, the authors conclude that the evidence available to date supports a favorable overall risk-benefit profile for GLP-1 receptor agonists and dual agonists.

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RTPB tools sit within the electronic prescribing workflow and show clinicians a patient’s expected out-of-pocket cost for a selected medication, alongside lower-cost alternatives where these are available. The intention is to allow cost to be factored into prescribing decisions at the point of ordering rather than at the pharmacy counter, where an unexpected price can lead to a prescription going unfilled.

The analysis found no difference in fill rates across all prescriptions written. When the researchers looked specifically at high-cost drugs, however, prescriptions were more likely to be filled when the tool was in use. The effect was most pronounced among patients from low-income communities, the group for whom out-of-pocket costs are most likely to act as a barrier to starting treatment.

The authors note an important limitation. The RTPB tool generated recommendations for only a small proportion of prescription orders, which means the findings apply to a narrow segment of the randomised population rather than to prescribing as a whole.

The corresponding author is Sunita M. Desai, PhD, of the Department of Population Health at NYU Grossman School of Medicine.

Read the full study: Real-Time Prescription Benefit Tool Availability and Prescription Medication Fill Rates

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Drawing on a national survey of adults and interviews with experts responsible for communicating heat risk in England, Strengthening England’s Heat Resilience: From Warnings to Long-Term Adaptation, published by the UN University’s Institute for Water, Environment and Health (UNU-INWEH), examines whether England’s warning system translates into protective behaviour.

England’s warnings were tested severely this summer. On 26 June, the country recorded a provisional maximum of 37.7°C at Lingwood, Strumpshaw Hill, breaking a June record that had stood since 1976, while England was placed under only the second Red Heat Health Alert in the system’s history. Nights brought little relief, with a new June minimum of 23.2°C recorded at Hastings, limiting the overnight recovery that helps reduce the health impacts of daytime heat, particularly for older adults. The pressure returned in August, as another spell of extreme heat prompted widespread amber health alerts across England, with temperatures again reaching levels that posed significant risks to health, particularly for older adults.

The survey results suggest that seven in ten people encountered a Heat Health Alert. Among them, 41% did nothing to protect themselves. The reason given most often was that they did not see themselves as personally at risk. Some did not recognise what they were looking at when it came to the alert, while others were unsure what they were supposed to do or found the alert hard to understand.

The UN University publication explains why. Only 18% of people in England report a high perception of heat risk, and around 30% say they know little or nothing about the actions that would protect them. A similar percentage had come across no alerts or heat protection information at all, a separate group from those who saw the information and did not know what to do with it. The system leans heavily on digital channels, which spread information fast but reach unevenly, and social media was the least trusted source of heat information, particularly among older adults. The channels carrying the warning are often the ones least likely to reach the people most vulnerable to heat.

“People aren’t ignoring these alerts because they don’t care,” said Dr Mehri Khosravi, Research Fellow, Behavioural Change and Risk Communication at UNU-INWEH and lead author of the Policy Brief. “They read them and think, this isn’t about me. Heat still gets treated as good weather, or as something that only happens to the very old and the very ill. Until that changes, we can send perfect warnings and watch very little happen.”

Interviews with the heat risk experts describe a system built for institutions rather than households. Informing the public was not the dominant communication objective, cited by 76% of interviewed practitioners, with far less emphasis on motivating action or enabling it. Communication does most of its work coordinating national agencies, local authorities, health services and emergency responders once a heatwave is under way.

The publication argues that the deeper problem lies outside the alerting system altogether. Housing conditions, deprivation, existing health problems and environmental exposure shape who suffers in a heatwave, and none of them are addressed by a warning. International guidance holds that a heat health action plan should pair short-term alerts with long-term measures that reduce vulnerability, yet England’s approach remains weighted towards the warning component.

To close that gap, the authors call for heat resilience to be built into housing standards, planning policy and retrofit programmes, with stronger enforcement and implementation of Part O of the Building Regulations. They also call for investment in the institutional capacity of local authorities and community organisations, and for wider use of trusted intermediaries such as libraries, faith groups, voluntary organisations and social care providers to reach people that digital channels miss. Few organisations currently measure whether their communication changes behaviour, and the brief argues that evaluation should track whether alerts prompt protective action rather than how many people saw them.

“A warning tells you a heatwave is coming. It doesn’t tell you how to get through the night in a flat that traps heat,” said Professor Kaveh Madani, Director of UNU-INWEH and a co-author of the Policy Brief. “England has built one half of a heat plan, and built it well. The other half is where people actually live. That is where the next decade of work has to go.”

Read the Policy Brief

Khosravi, M., Assan, A. and Madani, K. (2026). Strengthening England’s Heat Resilience: From Warnings to Long-Term Adaptation. United Nations University Institute for Water, Environment and Health (UNU-INWEH), Richmond Hill, Ontario, Canada. doi: 10.53328/INP26PMK001

Support Paper: Assan, A. A., Khosravi, F. and Osei, G. (2026). The heat is on: Understanding public responses to heat-health alerts in England. Energy Research & Social Science, 135, 104685.

DOI 10.53328/INP26PMK001 

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“Always finish your antibiotics” is no longer considered medical best practice for all conditions.

Surprised? You’re not alone.

A new study has found that almost 90% of Americans believe that it’s always best to take the full course of antibiotics, even when you feel better—consistent with long-running but now outdated health campaigns. The reality is more complicated. Sometimes shorter courses are safer, and sometimes longer courses are best.

The survey demonstrates a need for better communication between doctors and patients about what’s healthiest.

“Historically, there was very strong guidance by major health organizations and clinicians that you must always finish the course,” says Alistair Thorpe, PhD, research assistant professor of population health sciences at University of Utah Health and first author on the study. “Now, we’re seeing a growing body of evidence saying that that is not always the case. And oftentimes, shorter durations of antibiotics are as effective and safe as longer alternatives.”

The results are published in Open Forum Infectious Diseases.

A complex reality

The research team surveyed 1,475 people across the country on their attitudes about antibiotic course length. They asked participants whether they’d feel more comfortable taking a three- to five-day course of antibiotics if they had pneumonia, as is recommended by current guidelines, or if they’d prefer an antibiotic course of a week or more, which is recommended by outdated guidelines. While shorter courses of antibiotics are as effective and safer for pneumonia than longer ones, about 60% of people said they’d rather take the longer course.

One of the main reasons people gave for preferring longer antibiotic courses was that they had been told to “always finish their antibiotic course”—88% of respondents had heard of, and agreed with, this common mantra. Most had been told this by their clinician, and many had also heard it via a public health campaign.

A strong body of scientific evidence shows that, for many common infections, shorter courses of antibiotics work as well as longer courses and are less likely to cause side effects. Still, there are some cases, like tuberculosis, where longer courses are most effective.

The study authors suggest that doctors and public health campaigns use several evidence-informed strategies to better communicate the complex reality of antibiotic course length—for instance, avoiding overly simplistic claims that either shorter or longer courses are universally better, and acknowledging that as scientific evidence accumulates over time, health recommendations can change.

To patients who have been prescribed antibiotics, Thorpe recommends having an open conversation with your doctor about the appropriate course length and adherence plan to get health advice that’s specific to your situation.

“Discuss with your clinician what the right duration is for you and when the right time is to stop your course,” Thorpe says. “Getting advice directly from a clinician on a one-to-one basis about what is most appropriate for you in that situation is the right way to go.”

Thorpe emphasizes that the changing recommendations are a positive outcome of increasing knowledge.

“Evidence is growing and guidance is evolving on antibiotic use, which is a normal process and a good sign that we are working to improve how we provide care,” he says. “Our knowledge about how best to use antibiotics has changed, but it has changed because we’re learning more, and it’s important that we make sure we are communicating this well to the public.”

This research is published in Open Forum Infectious Diseases as “US Adults’ Perspectives on Antibiotic Durations and Adherence to Therapy for Common Bacterial Respiratory Infections: A National Survey.”

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Researchers at Semmelweis University analyzed data from 566 women with endometriosis and 447 women without the condition. Using internationally validated questionnaires, they assessed work productivity, absenteeism, and work ability. Women with endometriosis lost an average of 12.7 work hours over a four-week period because of health-related problems, compared with 5.7 hours among women in the control group. Based on the hours missed, the researchers estimated an average annual income loss of €1,757 per affected woman.

“The impact of endometriosis is not only a health issue but also a major social and economic one. The condition affects women during one of the most active stages of their lives, meaning it can influence employment, career development, and long-term financial security,” said Dr. Dóra Balogh, Assistant Professor in the Department of Obstetrics and Gynecology at Semmelweis University and senior author of the study.

Endometriosis affects about 10% of women of reproductive age worldwide. In this chronic gynecological condition, tissue similar to the lining of the uterus grows outside the uterus, causing chronic pelvic pain, painful periods, fatigue, and, in some cases, infertility. Symptoms often persist for many years before the condition is diagnosed.

The study found that 42% of women with endometriosis had poor work ability, compared with 17.9% of women in the control group. Poor work ability means that a person’s health makes it harder to perform their job and increases the risk of prolonged work disability or leaving the workforce.

“The most surprising finding was that nearly half of the women with endometriosis fell into this category. Without appropriate support, the condition may not only make day-to-day work more difficult but also threaten women’s ability to remain in the workforce over the long term,” said Dr. Dominika Miklós, a resident physician in the Department of Obstetrics and Gynecology at Semmelweis University and first author of the study.

The researchers also found that many workplaces are not adequately prepared to support employees with endometriosis. Fifty-four percent of respondents said their employer had little or no knowledge of the condition, while only 17% believed their workplace was sufficiently informed about it. Participants said they would most value menstrual leave, flexible work hours, remote or hybrid work options, and greater understanding and support from employers. Some European countries, including Spain and Portugal, already allow menstrual leave under certain circumstances.

Part of a larger research program
The study was conducted as part of the international FEMaLe (Finding Endometriosis with Machine Learning) research program, launched in 2020. At Semmelweis University, the project is led by Dr. Attila Bokor, Associate Professor in the Department of Obstetrics and Gynecology. Its aim is to improve understanding of endometriosis, promote earlier diagnosis, and investigate the health, social, and economic impact of the disease.

This is the first comprehensive study in Central and Eastern Europe to examine the effects of endometriosis on work productivity, work ability, and workplace support simultaneously. Its findings are consistent with studies from Western Europe and Australia, suggesting that the impact of endometriosis on working life is similar across regions. The researchers conclude that flexible work arrangements and better-informed employers could help women with endometriosis remain in the workforce.

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“We found undisclosed harmful chemicals in products claiming to be free of them,” said Jenna Hua, PhD, MPH, senior author of the study and founder of the Million Marker Research Institute. “That means someone can carefully read ingredient lists, choose ‘clean’ products, and still end up exposed to the very chemicals they were trying to avoid. The label can’t protect you when it doesn’t show what’s really in the bottle.”

The researchers tested 113 personal care and cleaning products across 12 categories. On average, each product contained 51 detected chemicals, more than three times the average of 16 ingredients listed on the label. Overall, 98% of products contained at least one unlabeled chemical, and 85% contained at least one unlabeled chemical with known or suspected health hazards. The specific brands and items will be revealed in an upcoming report.

These undisclosed chemicals included endocrine-disrupting compounds such as phthalates and parabens, fragrance chemicals, silicone contaminants, and butylated hydroxytoluene (BHT). Previous research has linked some of these chemicals to infertility, miscarriage, breast cancer, obesity, diabetes, allergies, and other health problems. Others are classified as potential carcinogens, endocrine disruptors, reproductive or developmental toxicants, or skin sensitizers.

Undisclosed harmful chemicals were found across product categories, price points, company sizes, and marketing claims. Products advertised as “natural,” “non-toxic,” or “organic” frequently contained undisclosed chemicals linked to health harm.

More than one-quarter of the products contained chemicals that contradicted claims made on labels or company websites. Researchers found synthetic chemicals in some products marketed as “100% natural,” as well as fragrance, phthalates, parabens, silicones, or oxybenzone in products claiming to be specifically free of those substances. Some products labeled “hypoallergenic” contained known allergens or sensitizers.

The researchers note that this does not necessarily mean manufacturers intentionally added these chemicals. Contaminants can enter products through raw materials, processing equipment, chemical reactions, storage or packaging. Changes in suppliers may also alter a product’s chemical composition without a corresponding change to its label.

The study used nontargeted analysis, an advanced laboratory method that can screen for thousands of chemicals without relying on a predefined list of substances. Researchers detected 3,141 chemical signals and identified 303 compounds with confirmed, probable, or tentative confidence.

Most product safety ratings and certifications programs rely heavily on disclosed ingredient lists. According to the authors, that approach can miss contaminants, impurities, breakdown products, and chemicals introduced during manufacturing or packaging. The researchers recommend making nontargeted analysis of finished, packaged products a standard part of product safety and quality control, alongside existing checks such as stability, microbial, and preservative testing.

The authors also argue that current U.S. oversight remains too dependent on ingredient disclosure and manufacturer reporting. Although the 2022 Modernization of Cosmetics Regulation Act expanded the U.S. Food and Drug Administration’s authority over cosmetics, routine testing of finished products for undisclosed chemical contaminants is still generally not required.

“People shouldn’t need a chemistry lab to know what they’re bringing into their homes or putting on their skin,” Hua said. “The next generation of product safety must look beyond the label and test what is actually there.”

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Clearer public health messaging and a review of government legislation are urgently needed, in light of the findings, say the researchers.

E-scooters have become an increasingly popular form of transport worldwide, because they are cheap, fast, and convenient. And in July 2020, during the COVID-19 pandemic, the UK government launched e-scooter rental trials in England, which are due to complete in 2028, explain the researchers.

Since 2019, e-scooters have been involved in 59 reported deaths in the UK, where riding privately owned e-scooters is illegal unless on private land, and with the owner’s permission, they add.

But unlike rental use, which isn’t legally permitted until at least the age of 16, private use is unregulated, they point out.

While these vehicles are designed for adults, they are often used by children and teens, who are likely to be novice road users and to take more risks, say the researchers, prompting them to try and gauge the numbers and severity of injuries involving e-scooters in this age group.

They focused on emergency care data spanning January 2019 to December 2024 from 3 children’s major trauma centres in the cities of Liverpool, Manchester, and Sheffield. Liverpool and Manchester are part of the government’s e-scooter rental pilot; Sheffield isn’t.

Between 2019 and 2024, the 3 trauma centres dealt with 477 patients with e-scooter injuries, with the overall numbers of cases rising from fewer than 10 in 2019 to nearly 150 in 2024.

The average age of the injured children was 12; half were aged between 10 and 13. And nearly two thirds (64.5%) were boys.

Most (95%) injuries were sustained by the rider, and 80% of all the incidents involved a private e-scooter.

The most common cause was a fall from the e-scooter (75%), but nearly 11.5% were caused by a collision with a vehicle; 5% were pedestrians hit by an e-scooter.

Over half (52%) of the incidents happened on public land: nearly 1 in 4 (22%) occurred on public roads, and nearly 1 in 3 (30%) on public footpaths/parks.

Injuries to the arms and legs were the most common (36%-40%), but around 1 in 4 (24%) were head injuries and nearly 1 in 5 (18.5%) were facial injuries.

Less than 2% of riders were reported to be wearing a helmet at the time of the incident. And 1 in 10  head injuries were sufficiently severe as to warrant imaging, hospital admission, and in some cases, surgery.

Among the most seriously injured, around half (48%) were the result of a collision with a car or stationary object.

Overall, the level of hospital care required was substantial: nearly two thirds of the injured children (64.5%) required some form of imaging (x-rays, computed tomography, or ultrasound scans); 13.5% were admitted; and 7% required surgery.

Three out of four injured children (74%) lived in areas of greatest social and economic disadvantage.

The researchers acknowledge that their study was based on data from only 3 children’s trauma centres, so the findings might not be more widely applicable. But they suggest that because a change in software limited data collection to 2023-4 at the trauma centre in Manchester, the actual numbers of e-scooter injuries may be higher than reported.

“Clearly, reporting these accidents is important to influence and change policy, but there must also be an onus on retailers to clearly advise customers of the law, and policymakers to regulate private e-scooters, such as with speed limiters, or mandate helmet use,” write the researchers.

“As well as legislative changes, schools, local councils, youth groups and road safety campaigns could all have a role in helping to reduce the burden of this emerging public health challenge. Utilising approaches like educational campaigns, such as bicycle safety schemes targeted to e-scooter riders, could be beneficial and have been shown to improve riders’ safety behaviour,” they suggest.

“We urgently need to increase public and clinician awareness, have clearer public health messaging, and a review of government legislation to prevent further injuries and deaths,” they conclude.

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In a newly published study, researchers found that high doses of clomiphene citrate – accumulated over multiple fertility treatment cycles – could increase the risk of pregnancy loss.

Supported by the NHMRC and conducted in partnership with Boston University and the Centers for Disease Control and Prevention, the study analysed 21,004 IVF embryo transfer cycles in the United States, finding that women receiving cumulative doses of 500-749 mg clomiphene citrate had a 12% higher risk of miscarriage; while women who received 750-999 mg had a 38% higher risk of miscarriage.

Women receiving cumulative doses of 750 mg or more were also more than twice as likely to have twins or other multiple births.

Spontaneous abortion rates increased as dose increased, but the researchers caution that the greater than tripling of stillbirth at the highest dose was not statistically significant as the dose was rare, and larger studies are needed to confirm the association. The observation is, however, consistent with a previous publication from Adelaide University showing a doubling of neonatal death in pregnancies involving clomiphene citrate.

Importantly for the new study, higher cumulative doses of the drug did not improve the chance of a live birth, but did increase twinning, which increases the risk of adverse outcomes for both mother and child.

Clomiphene citrate is one of the world’s most widely prescribed fertility drugs. It has been prescribed to millions of women worldwide since 1967 and remains a recommended first-line treatment for ovulation induction.

Recognised as an essential medicine by the World Health Organization, clomiphene citrate works by stimulating the ovaries to release eggs, thereby increasing the chance of pregnancy.

Women who do not respond to lower doses, or who require multiple treatment cycles, may receive progressively higher cumulative doses over time.

Lead author Associate Professor Sheree Boulet said the findings demonstrated a clear dose-response relationship.

“Women who received higher cumulative doses of clomiphene citrate experienced progressively greater risks of adverse pregnancy outcomes,” Assoc Prof Boulet said.

“We examined more than 21,000 embryo transfer cycles across four cumulative dose categories and found that increasing the dose did not significantly improve the chance of a live birth.

“Our findings suggest there may be a point where increasing the dose offers little additional benefit while exposing women to greater risk, highlighting the importance of carefully balancing effectiveness with safety when making treatment decisions.”

The findings build on a series of studies from Adelaide University’s Robinson Research Institute that linked clomiphene citrate with increased risks of pregnancy loss, stillbirth, perinatal death and some birth defects.

Experimental studies in mice supported these findings, showing that higher doses reduced successful pregnancies and were associated with pregnancy loss, impaired fetal growth and developmental abnormalities.

Senior researcher and co-author of all studies, Professor Michael Davies, said the study builds on more than two decades of Adelaide-led research examining the safety of fertility treatments.

“Clomiphene citrate has been used by many women since 1967, but it has never been comprehensively evaluated in large prospective clinical trials,” Prof Davies said.

“Our studies indicate that women respond differently to clomiphene citrate and that increasing cumulative doses may increase the risk of adverse pregnancy outcomes without improving the likelihood of a live birth.

“The findings confirm and extend our previous studies in both human and mouse models which highlight the need to better understand the dose-response relationship and whether more personalised dosing strategies could improve safety.

“Until we can better understand these differences, it remains important that clinicians rigorously follow manufacturer’s safety recommendations and avoid unnecessarily increasing cumulative doses.

“The same questions are now being asked of newer ovulation-inducing medications, so any move away from clomiphene citrate should also be guided by robust evidence rather than assumptions about safety.”

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