Three terminated appraisals in a single month is an unusually high number, and includes the CAR-T cell therapy Breyanzi in follicular lymphoma, a setting in which the treatment had previously received a positive recommendation in diffuse large B-cell lymphoma.

Positive Recommendations

Kerendia recommended for heart failure

Finerenone (Kerendia), a non-steroidal mineralocorticoid receptor antagonist developed by Bayer HealthCare, received a positive NICE recommendation on 5 August 2026 for heart failure. Finerenone is already approved in the EU and UK for chronic kidney disease associated with type 2 diabetes, and this recommendation extends its application to heart failure, a condition in which fluid overload and neurohormonal activation play a central role in disease progression. Unlike older steroidal mineralocorticoid receptor antagonists such as spironolactone and eplerenone, finerenone has been designed to offer greater receptor selectivity, potentially reducing the risk of hyperkalaemia and other off-target effects while maintaining cardiovascular and renal protection.

Dawnzera recommended for hereditary angio-oedema

Donidalorsen (Dawnzera), an oral plasma kallikrein inhibitor developed by Ionis Pharmaceuticals and Otsuka, received a positive NICE recommendation on 19 August 2026 for the prevention of attacks in hereditary angio-oedema (HAE). HAE is a rare and potentially life-threatening genetic condition characterised by episodes of severe swelling affecting the skin, gastrointestinal tract, and upper airways; laryngeal attacks in particular can be fatal without prompt treatment. Donidalorsen is administered orally on a prophylactic basis, offering a significant practical advantage over existing parenteral prophylactic therapies. The recommendation represents a meaningful step forward for patients seeking a convenient, long-term preventive option.

Calquence combinations recommended for mantle cell lymphoma and CLL

Two separate NICE recommendations were issued on 19 August 2026 for acalabrutinib (Calquence)-based combination regimens in haematological malignancies, both submitted by AstraZeneca.

For mantle cell lymphoma, acalabrutinib in combination with bendamustine and rituximab (Calquence, Treanda, and Rituxan) was recommended for previously untreated patients. Mantle cell lymphoma is an aggressive B-cell non-Hodgkin lymphoma with a tendency to relapse; adding BTK inhibition to the established bendamustine-rituximab backbone offers a chemotherapy-intensified and targeted approach that has demonstrated improved outcomes in clinical trials.

For chronic lymphocytic leukaemia and small lymphocytic lymphoma (CLL/SLL), acalabrutinib in combination with venetoclax, with or without obinutuzumab (Calquence, Venclexta, and optionally Gazyva), was recommended. This all-oral, chemotherapy-free triplet targets three distinct mechanisms: BTK inhibition, BCL-2 inhibition, and CD20 targeting. CLL is the most common adult leukaemia in the Western world, and the combination approach represents a shift towards deeper, potentially time-limited treatment that may reduce the likelihood of resistance compared with continuous monotherapy.

Odactra recommended for dust mite allergic rhinitis

The sublingual allergy immunotherapy tablet for house dust mite allergy (Odactra), developed by ALK-Abello, received a positive NICE recommendation on 26 August 2026 for allergic rhinitis caused by house dust mite sensitisation. Allergen immunotherapy is the only treatment modality that addresses the underlying allergic mechanism rather than simply controlling symptoms, and sublingual tablet formulations offer a more convenient alternative to subcutaneous immunotherapy injections administered in a clinical setting. The recommendation is significant for the large number of patients with persistent, poorly controlled dust mite allergic rhinitis who do not achieve adequate symptom relief with antihistamines and intranasal corticosteroids.

Updated Recommendation

Itulazax receives updated recommendation for birch pollen allergy

Betula verrucosa sublingual tablet (Itulazax), a birch pollen allergen immunotherapy developed by ALK-Abello and partnered with Torii Pharma and Shionogi, received a positive second appraisal recommendation on 25 August 2026 for allergic rhinoconjunctivitis caused by birch pollen. Itulazax is administered daily as a sublingual tablet and works by gradually desensitising the immune system to birch pollen allergens over a course of treatment typically lasting several years. The updated recommendation follows the initial positive appraisal and likely reflects revised evidence or access arrangements, and sits alongside the same cycle’s first recommendation for Odactra, underscoring growing NICE support for sublingual immunotherapy as a treatment modality across different allergen types.

Terminated Appraisals

Brinsupri appraisal terminated for non-CF bronchiectasis

The appraisal of brensocatib (Brinsupri), a dipeptidyl peptidase 1 (DPP1) inhibitor developed by Insmed, was terminated on 25 August 2026 for non-cystic fibrosis bronchiectasis. Bronchiectasis is a chronic lung condition characterised by irreversible airway dilation and recurrent infections driven by neutrophilic inflammation; DPP1 inhibition reduces the activation of neutrophil serine proteases that contribute to lung damage and exacerbations. Brensocatib had been considered a significant advance in a condition with very few approved pharmacological therapies, making its termination a notable setback for patients and clinicians in this field. The reasons for termination were not specified in the available data.

Wayrilz appraisal terminated for immune thrombocytopenic purpura

The appraisal of rilzabrutinib (Wayrilz), an oral BTK inhibitor developed by Principia Biopharma and Sanofi, was terminated on 20 August 2026 for immune thrombocytopenic purpura (ITP). ITP is an autoimmune bleeding disorder characterised by low platelet counts resulting from immune-mediated destruction of platelets and suppression of platelet production. Rilzabrutinib targets the B-cell receptor signalling pathway and had been under investigation as an oral option for patients with persistent or chronic ITP who have failed or are intolerant of existing therapies. The termination means this treatment will not be available via the NICE appraisal route at this time.

Breyanzi appraisal terminated for follicular lymphoma

The appraisal of lisocabtagene maraleucel (Breyanzi), a CD19-directed CAR-T cell therapy developed by Bristol Myers Squibb, was terminated on 20 August 2026 for relapsed or refractory follicular lymphoma. This termination is particularly notable given that Breyanzi received a positive NICE recommendation for diffuse large B-cell lymphoma earlier in 2026, and is approved in other markets for follicular lymphoma. Follicular lymphoma is an indolent B-cell malignancy that, despite its relatively slow progression, frequently relapses and ultimately requires multiple lines of therapy. CAR-T cell treatment has shown strong efficacy in this setting, and the termination — likely reflecting cost-effectiveness or access agreement issues — will be disappointing for patients and their clinicians.

Decisions referenced carry NICE Positive 1, NICE Positive 2, or Terminated status, issued between 5–26 August 2026. This article is based on data from the NICE Technology Appraisal Programme for England and Wales.

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The study found that the global health workforce nearly tripled between 1990 and 2023, growing from 40.9 million to 122.1 million workers. Women accounted for 71.4% of this growth and represented 68.9% of all health workers in 2023. Despite this progress, substantial shortages persist across many regions, particularly South Asia and sub-Saharan Africa, where health systems continue to face some of the world’s lowest workforce densities.

Based on Global Burden of Disease (GBD) 2023 estimates, this study provides the first global, sex-disaggregated estimates of 20 health worker cadres, or groups of specially trained health personnel such as doctors, nurses, midwives, pharmacists, dentists, and community health workers, across 204 countries and territories from 1990 to 2023, including the first global estimates of community health workers. It also offers the most comprehensive assessment of the global health workforce to date.

Women have driven global health workforce growth but remain underrepresented in many higher-paid professions.  

Between 1990 and 2023, the global health workforce expanded by more than 81 million workers, including 18.9 million nurses and 8.7 million doctors. Most regions saw substantial growth over this period, although the pace of expansion varied across countries and health professions.

In 2023, the global health workforce included 122.1 million health workers, including 33.2 million nurses, 15.1 million doctors, 7.6 million community health workers, 6.8 million pharmacists and pharmaceutical assistants, and 6.1 million dentists and dental assistants. Women represented nearly seven in ten health workers worldwide, comprising 80.7% of nurses, 96.0% of midwives, and 89.5% of community health workers, while less than half of doctors were women. Similar patterns were observed across dentistry and pharmacy, where women were more likely to work as assistants than as dentists or pharmacists.

“Women have transformed the global health workforce over the past three decades, but they continue to be concentrated in professions that generally offer lower pay and fewer opportunities for leadership,” said Megan Knight, lead author of the study and researcher at the Institute for Health Metrics and Evaluation (IHME). “Building stronger health systems will require not only expanding the workforce, but also creating equitable opportunities for career advancement, leadership, and safe, supportive working environments.”

Millions of health workers will be needed to achieve universal health coverage.  

Despite substantial workforce growth, researchers estimate the world would need an additional 34.4 million health workers to achieve a score of 80 out of 100 on the GBD universal health coverage effective coverage index, a benchmark representing moderate levels of universal health coverage. This includes shortages of 23.9 million nurses and midwives, 7.1 million doctors, 1.8 million dentists, and 1.6 million pharmacists.

Workforce shortages were greatest in South Asia, which would require an additional 2.6 million doctors and 10 million nurses and midwives to reach moderate universal health coverage. Sub-Saharan Africa also faced severe shortages across major health professions, with nursing density of 14.5 per 10,000 population compared with 121.8 per 10,000 in high-income countries. At the country level, nurse density was as low as 3.2 per 10,000 in Chad and 3.3 in Madagascar, compared with 171.7 per 10,000 in Belgium and 161.4 in the United States.

“Health workers are the foundation of every health system,” said Dr. Annie Haakenstad, senior author of the study and Assistant Professor of Health Metrics Sciences at IHME. “Although the global workforce has expanded dramatically, millions more doctors, nurses, midwives, dentists, and pharmacists will be needed to ensure people everywhere can access essential health services. These findings provide countries with minimum thresholds for planning the workforce needed to strengthen health systems and move toward universal health coverage.”

Meeting global health goals will require sustained investments in the health workforce.  

The study estimates that achieving moderate universal health coverage is associated with minimum workforce densities of 23.8 doctors and 64.5 nurses and midwives per 10,000 people, along with 5.2 dentists and 5.6 pharmacists per 10,000. These minimum benchmarks can help countries identify workforce gaps and plan the investments needed to meet future health needs.

The estimates also provide a measure of progress toward Sustainable Development Goal (SDG) target 3.c.1, which calls for substantially increasing the recruitment, development, training, and retention of the health workforce, as well as SDG target 3.8 on achieving universal health coverage.

Closing global workforce gaps will require sustained investments in health worker education, recruitment, retention, and working conditions. Gender-responsive policies, including leadership development, workplace protections, paid parental leave, and flexible work arrangements, can also help support the predominantly female health workforce. Building a well-supported health workforce will be essential to expanding access to care and ensuring health systems are equipped to meet future health challenges.

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That may depend on several factors, including your digital literacy, income, age, and experience communicating with doctors and nurses, according to a new study led by researchers at NYU School of Global Public Health. The findings, published in JAMA Network Open, suggest that there is room for improvement in how health information is presented to patients.

The 21st Century Cures Act requires that electronic health information—including test results like labwork and imaging—be released to patients as soon as the results are available. As a result, many see their results before their provider.

“The Cures Act has restructured the traditional pathway between the release of a test result to a patient-clinician discussion,” said Jemar Bather, assistant professor of biostatistics at NYU School of Global Public Health and the study’s lead author. “We wanted to understand whether a patient’s probability of accessing test results—and understanding of them—varies based on sociodemographic characteristics, health status, patient-centered communication, and digital health literacy.”

The researchers analyzed data from the 2024 Health Information National Trends survey, a representative sample of US adults collected by the National Institutes of Health. A total of 4,982 respondents who had access to their electronic medical records and received a test result in the past year were included, which can be generalized to represent nearly 175,000,000 US adults.

More than two-thirds of adults (68.6 percent) reported viewing their test results before hearing from a provider. Those who immediately viewed results were more likely to be older and female, and have a higher income, multiple chronic health conditions, higher digital literacy, and greater use of health-related social media.

In addition, comprehension of test results varied. Among those who immediately viewed results, 6.6 percent said they had a poor understanding, 26.8 percent understood the results fairly well, 31.7 percent understood them well, and 34.9 percent understood the results very well. Those who reported having the lowest understanding of their test results were more likely to be from the Midwest or South and had experienced discrimination in medical care.

In contrast, people with higher digital literacy had a better understanding of their medical test results, as did those who experienced better patient-centered communication—for instance, feeling that health care professionals explain things in a way they can understand and involve them in decision making.

“Health systems give you your data, but that does not mean that they put a lot of effort into making the information easy to understand on your own,” said study author José Pagán, professor and chair of the Department of Public Health Policy and Management at NYU School of Global Public Health. “Health systems and online patient portal developers should look for innovative ways to improve how they communicate—for instance, using AI to summarize test results in plain language and provide easy means for follow-up questions.”

“While the Cures Act’s goal of expanded patient access is being realized, a subset of patients who view their results before being contacted by their health care provider is having difficulty understanding what they see. Improving patient-centered communication may help in closing this comprehension gap,” noted Bather.

In addition to Bather and Pagán, study authors include Melody Goodman of NYU School of Global Public Health, Zoe Lindenfeld of Rutgers University, Karen Fortuna of the Geisel School of Medicine at Dartmouth, and Guilherme Del Fiol and Kimberly Kaphingst of the University of Utah.

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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 team tested ‘BabyBreathe’ – a programme designed to help women who quit smoking before or during pregnancy stay smoke-free after giving birth, funded by the National Institute for Health and Care Research (NIHR).

The BabyBreathe scheme provides one-to-one support from trained health visitors with digital tools, text message support, a dedicated website and app, and a relapse-prevention kit sent to families after birth.

A major study published today in the BMJ shows that women who received this intervention as intended, with support from trained health visitors, were significantly more likely to remain smoke-free 12 months after giving birth compared to those without health visitor support.

Lead researcher Prof Caitlin Notley, Professor of Addiction Sciences at UEA’s Norwich Medical School, said: “Quitting smoking during pregnancy is an incredible achievement, but staying smoke-free after a baby is born can be just as challenging.

“Too often, support ends once a woman has quit, even though the stressful months after birth are when many women are most at risk of returning to smoking.

“Our research shows that when health visiting services are trained and supported to deliver specialist relapse prevention advice, they can make a real difference by significantly improving women’s chances of staying smoke-free. That means better health for mothers, babies and entire families.”

How the research happened

A total of 886 women from England and Scotland who had successfully stopped smoking before or during pregnancy took part in the study, as part of a large-scale randomised, controlled trial.

Participants were randomly assigned to receive either the BabyBreathe intervention or usual care – the latter of which offered no advice or support to prevent smoking relapse.

Although BabyBreathe was not delivered as intended for around one in five participants during the trial, either due to health visitor workforce pressures, missed appointments or administrative issues, health visitors provided one-to-one tailored advice and support to women in the intervention group. This was delivered at the end of pregnancy and immediately after the baby was born.

This support included advice on alternatives to try if they experienced urges to go back to smoking, as well as advice for partners and family members, and access to specially designed digital resources including the BabyBreathe app and website.

A relapse prevention ‘kit’ was also posted to women immediately after the birth of their baby and support continued for up to 12 months postpartum, at all routine health visitor appointments.

The intervention was the result of more than a decade of research and development involving women, families, health professionals and researchers – who worked together to co-design, develop and test this practical support package.

‘Health visitors play an important role’

When researchers looked at participants who received the intervention as intended, 57.6 per cent remained smoke-free at 12 months in the BabyBreathe group – compared to 49.9 per cent for those with usual care.

These findings suggest that health visiting services could play a significant role in ensuring the consistent delivery of relapse-prevention support, therefore also supporting the health of the entire family by helping more mothers to remain smoke-free after giving birth.

Prof Notley said: “Women of childbearing age who quit and stay non-smoking can reduce their risks of developing a smoking-related disease to almost the same level of risk as non-smokers.

“There are also great benefits for babies and children brought up by parents who do not smoke- in avoiding exposure to second-hand smoke, and in helping to prevent the next generation from taking up smoking.

“Until now, health visitors had no training on smoking relapse prevention. This meant that when women had made the extremely important – and difficult – health behaviour change of quitting smoking during pregnancy, no one picked up on this and gave them positive praise and support.

“This new approach extends the intensive support for initially quitting smoking that pregnant women are offered, going one step further to help women to stay smokefree in the long term,” she added.

The researchers note several limitations of the study that impacted the primary analysis, including incomplete delivery of the BabyBreathe programme and low engagement with some of its components. The participant group was also more highly educated and less socioeconomically deprived than the wider population, which may have affected the programme’s overall effectiveness and limit how broadly the findings can be applied.

The Institute of Health Visiting (iHV) worked collaboratively with UEA on the BabyBreathe study.

Vicky Gilroy, Director of Innovation and Research at the iHV, said: “Health visitors and their teams are uniquely placed to support women in preventing smoking relapse as part of their universal offer.

“It has been a privilege to contribute to the BabyBreathe study and help develop the evidence of the importance of their role. The findings reinforce the need for all health visitors to receive training in this important area.”

This research was led by UEA in collaboration with the University of Edinburgh, City St George’s, University of London, the University of Exeter, the University of Stirling, Glasgow Caledonian University, the Institute of Health Visiting (iHV) and the Norfolk 0-19 Healthy Child Service.

Prof Richard Holland, Professor of Public Health Medicine and Dean at the University of Exeter Medical School, said: “Our BabyBreathe study enrolled pregnant women who had quit smoking and showed great promise that a postpartum health visitor support package, if delivered as intended, could make a real difference to supporting them to stay off cigarettes. This is so important to improve their own health whilst protecting their baby too.”

‘Effectiveness of the BabyBreathe intervention for maintaining postpartum smoking cessation: multi-centre pragmatic randomised controlled trial’ is published in the BMJ.

1/ For more information, or to arrange interviews, please contact the UEA Communications office at: communications@uea.ac.uk.

2/ An embargoed copy of the paper is available via Dropbox link: https://www.dropbox.com/scl/fo/kkvto7owvcnb568wzhwrx/ADvTh36Lm77rkiUlRD1iS1k?rlkey=mlun95plxtvaulbm5ze0suvr8&st=8lnvumr2&dl=0

3/ The University of East Anglia (UEA) is a UK Top 25 university for research quality (Times Higher Education Rankings 2026) and UK 26th in the Complete University Guide. It also ranks in the World Top 60 (QS World Rankings for Sustainability 2025), World Top 9 for reduced inequalities (Times Higher Education Sustainability Impact Ratings 2026), and World Top 180 (TIME Magazine 2026). Known for its world-leading research and good student experience, its 360-acre campus has won 10 Green Flag awards in a row for its high environmental standards. The University is a leading member of Norwich Research Park, one of Europe’s biggest concentrations of researchers in the fields of environment, health and plant science. www.uea.ac.uk.

4/ The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research.

NIHR do this by:

• funding high quality, timely research that benefits the NHS, public health and social care

• investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services

• partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research

• attracting, training and supporting the best researchers to tackle complex health and social care challenges

• collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system

• funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Their work in low and middle income countries is principally funded through UK international development funding from the UK government.

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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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However, by reviewing clinical data from thousands of bariatric surgery candidates and applying new obesity definitions, the researchers were able to better understand their underlying health – which could have important implications for patient treatment and surgery prioritisation in the future.

Led by Professor Francesco Rubino, Chair of Metabolic and Bariatric Surgery at King’s College London, the researchers reviewed retrospective clinical data from 2,316 surgical candidates across four specialist centres – King’s College Hospital in the UK, and centres in France, Spain and Brazil.

They applied the new obesity definitions: clinical obesity, where there is clear evidence that excess fat, or adiposity, is causing organ damage, and preclinical obesity, where organ function is preserved despite excess adiposity.

From the surgical candidates, 73.8% had clinical obesity and 26.2% had preclinical obesity. Despite both groups of patients having similar BMI, patients with clinical obesity had far greater surgery-related and cardiovascular risks. They also had an overall high chance of death.

These findings suggest that distinguishing between clinical and preclinical obesity reveals key information about the health status and risks to surgery candidates that BMI alone cannot capture.

“This study shows that the distinction between clinical and pre-clinical obesity is clinically meaningful even among surgical candidates with very high BMI levels, because BMI alone cannot tell us who has active disease,” said Professor Francesco Rubino, senior author and Chair of Metabolic and Bariatric Surgery at King’s College London.

He continued: “It is now essential that future surgical studies and registries systematically report patients’ clinical or pre-clinical obesity status, so that surgical safety, effectiveness and cost-effectiveness can be interpreted in the appropriate clinical context.”

Traditionally, obesity has been classified primarily using BMI, a measure of weight relative to height that provides limited information about whether excess fat is actually affecting a person’s health. BMI levels have historically played a central role in determining eligibility and priority for metabolic bariatric surgery – operations of the stomach that help people lose weight and fix health issues, such as type 2 diabetes.

In 2025, the Lancet Diabetes & Endocrinology Commission on Clinical Obesity proposed a new diagnostic framework. This distinguished between clinical obesity, where there is clear evidence that excess fat, or adiposity, is leading to organ dysfunction, from preclinical obesity, where organ function is preserved but future health risk is increased.

In the latest study, the researchers found that these differences in disease status were not reflected in BMI. In the UK centre, for example, BMI was roughly 47.5 among patients with clinical obesity and 48.5 among those with preclinical obesity. Yet those with clinical obesity were approximately 10 years older and had substantially higher risk of death, cardiovascular risk and operation-related risk.

The researchers argue that for patients with clinical obesity, surgery primarily represents treatment of established disease. On the other hand, for those with preclinical obesity, its key goal may instead be to reduce future health risk. Recognising this distinction could help clinicians plan surgery, as well as select and prioritise surgical candidates.

Read the full study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2852615

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