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Welcome to the BMJ Open blog. BMJ Open is an open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas.

Publication has begun – see the latest articles here and find out more about the journal here.

We will be updating the blog with news about the journal, highly accessed papers, press coverage, events and matters of interest in the open access and publishing world, and anything else that catches our eye.

More bed sharing, baldness and vitamin C: Most read articles in June

8 Jul, 13 | by bdevaney


The most-read article in June was once again Carpenter et al‘s article on bed sharing with non-smoking parents and the risks of SIDS, which received widespread press coverage. Another popular title was Yamada et al‘s paper on the associations between male pattern baldness and coronary heart disease. Other newly-published papers in the top ten include Hemilä et al‘s study on the way in which vitamin C may help alleviate exercise induced bronchoconstriction and Ford et al‘s study of current treatments in diabetic macular ordema.

Rank Author(s) Title
1 Carpenter et al Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies
2 Humphriss et al Prenatal alcohol exposure and childhood balance ability: findings from a UK birth cohort study
3 Ford et al Current treatments in diabetic macular oedema: systematic review and meta-analysis
4 Katzmarzyk et al Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis
5 Yamada et al Male pattern baldness and its association with coronary heart disease: a meta-analysis
6 Gotts et al Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis
7 Morgenstern et al From never to daily smoking in 30 months: the predictive value of tobacco and non-tobacco advertising exposure
8 Schmidt et al Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study
9 Doyle et al A systematic review of evidence on the links between patient experience and clinical safety and effectiveness
10 Hemilä et al Vitamin C may alleviate exercise-induced bronchoconstriction: a meta-analysis


Most read figures are based on pdf downloads and full text views. Abstract views are excluded.

New generation electronic games boosts kids’ physical activity at home

2 Jul, 13 | by flee

Giving kids new generation “active” electronic games boosts their physical activity at home and has the same effect as stopping them from using the older versions altogether, indicates a small study published in BMJ Open.

Most electronic games are no better than watching TV in terms of the body movement and energy expenditure involved, say the authors. Kids in developed countries spend an estimated 38 to 90 minutes a day playing these games.

But what has not been clear is whether the newer generation “active” games, such as Sony PlayStation EyeToy and Move, dance mats, and Microsoft Xbox Kinect, are any better.

The Australian researchers compared the impact of removing traditional electronic games, involving a game pad, from the home or replacing them with more active newer generation versions among 56 ten to 12 year olds over a total of three years (2007-2010).

They wanted to see if either approach boosted kids’ daily physical activity levels and/or curbed the amount of sedentary time they spent in front of a screen.

For a period of 8 weeks, the daily use of electronic games at home was banned, while levels of moderate to vigorous physical activity were measured using a portable device (accelerometer) worn on the hip.

This was followed by two identical periods of time during which the children were given daily access to traditional sedentary electronic games or active versions.

The children also kept 7-day diaries of the main activities they did for each 30 minute period during waking hours.

The diaries showed that they spent a daily average of 1.5 hours on active leisure and transport and 4.5 hours on all sedentary leisure, of which screen time made up more than half.

Watching TV made up the largest chunk of screen time, at an average of 107 minutes every day, followed by sedentary electronic games at an average of 44 minutes, and non-gaming computer use (24 minutes).

Levels of physical activity across the week didn’t vary much for any of the three periods. But compared with after school access to traditional electronic games, removal of all devices increased daily moderate to vigorous physical activity by almost 4 (3.8 ) minutes and decreased sedentary time by almost 5 (4.7) minutes.

Giving the children access to active electronic games after school also significantly boosted daily physical activity levels by just over 3 minutes and reduced sedentary time by just over 6 minutes.

These differences may seem small, say the authors, and are unlikely to have any clinical impact by themselves. But they are significant, because of the rapidly increasing levels of exposure children have to electronic gaming on computers, tablets and smart phones, in addition to internet surfing and social media, they say.

“Therefore small changes across a variety of these platforms could result in a more substantial clinical impact,” they write, adding: “While our study focused on the home setting, school offers another opportunity for more active technologies…such as sit-stand desks or active-input electronic media as part of lessons.”

Furthermore, substituting older style electronic games with newer generation active versions may be easier for both kids and their parents to sustain than an outright ban, they conclude.

One in five UK NHS staff report bullying by colleagues

1 Jul, 13 | by bdevaney

One in five UK NHS staff report bullying by colleagues, with almost half saying they have witnessed bullying, in the past six months, indicates research published in BMJ Open.

Managers are the most common source of bullying, with workload pressures and organisational culture contributory factors, the study reveals.

The findings are based on the responses of almost 3000 NHS staff (46% response rate) to a validated questionnaire (NAQ-R), designed to tease out exposure to negative and bullying behaviours. The 12 item General Health Questionnaire (GHQ-12) was also included to assess the impact of bullying on psychological distress.

All the respondents worked at seven different secondary care, primary care, and mental health NHS trusts in the north east of England. Forty three staff were additionally interviewed in greater depth.

All types of staff were represented, but the largest proportion of respondents were drawn from support staff, trainee doctors and dentists, healthcare assistants and nurses caring for adults.

One in five (19.9%) of respondents had been bullied by colleagues within the past 6 months, ranging in frequency from rarely to daily. Medical and dental staff reported the highest levels of bullying (23%).

Many more (43%) had witnessed other staff being bullied at work at least now and then in the preceding six months, with one in 20 (5%) witnessing it weekly or daily.

The most commonly reported behaviours were unmanageable workloads; withholding key information; public humiliation; being deliberately ignored; and being shouted at or the target of an angry outburst.

Over two thirds of respondents (69%) had experienced at least one such behaviour over the past six months, while almost one in five (18%) had had to endure this on a daily or weekly basis.

Half the respondents (51%) who had been bullied said they had been bullied by a manager/supervisor, and around one in three (31%) accused their peers. Almost one in five staff (18%) blamed workplace culture.

Men, and those with disabilities, experienced higher levels of negative behaviours, overall.

Only between 2.7% and 14% of staff reported bullying to someone in authority. The most frequently cited deterrents to reporting a bullying incident included disbelief that anything would change/lack of action by managers; fear of being seen as a trouble-maker; the seniority of the bully; and concern that it would make matters worse.

Exposure to bullying was associated with psychological distress, as measured by the GHQ-12 survey. It was also associated with lower job satisfaction and increased stated intentions to look for work elsewhere.

The authors point out that the evidence shows that bullying can have serious repercussions on physical and mental health, and previous research has linked it with a higher risk of error and poorer performance, both of which can affect patient care. Bullying in UK organisations is estimated to cost £13.75 billion a year.

They conclude: “…In UK healthcare, workplace bullying remains a significant issue with far-reaching consequences for the healthcare workforce,” and add that the recent Francis report into failings at Mid-Staffordshire NHS Foundation Trust highlighted the contributory role of a bullying culture to poor practice.

700 women with urinary cancers missing out on prompt diagnosis every year

24 Jun, 13 | by flee

Around 700 women in England with symptoms of kidney or bladder cancer are missing out on prompt diagnosis and treatment of their condition every year, reveals research in BMJ Open.

This may be because family doctors tend to attribute women’s – rather than men’s – initial symptoms to harmless causes, such as bacterial infections, and some women therefore have to visit their GP several times before they get referred to a specialist, say the researchers.

Currently, survival rates for kidney and bladder cancer in England show that fewer women than men live for five years after diagnosis.

The researchers looked at the numbers of patients diagnosed with kidney and bladder cancers in England between 2009 and 2010. They used data from the National Audit of Cancer Diagnosis in Primary Care, covering 1170 representative general practices – equivalent to around 14% of the national total. They looked at two interrelated measures of the promptness of diagnosis: the number of consultations the patient made before s/he was referred; and the time interval between the first visit to the GP with symptoms and specialist referral.

In all, 920 patients were diagnosed with bladder cancer during the study period, of whom 252 (27%) were women; and 398 were diagnosed with kidney cancer, of whom 165 (42%) were women. These proportions are similar to national figures: 28% and 38%, respectively.

Women were around twice as likely as men to have visited their GP on three or more occasions before they were referred to a specialist, the analysis showed.

Around one in 10 men (11%) with bladder cancer had three or more visits before referral, compared with 27% of women. The equivalent figures for kidney cancer were 18% and 30%.

The average interval between first GP consultation and specialist referral didn’t differ greatly between men and women – four versus six days for bladder cancer and 10 versus 16 days for kidney cancer. But among the 25% of women experiencing the longest delays, it took two weeks longer to get referred than the 25% of men with the longest delays. When this was narrowed down to the 10% of those experiencing the longest delays, the figure rose to more than two months for women with bladder cancer and over three weeks for those with kidney cancer, compared with the men.

Two thirds of all patients with bladder cancer and one in four of those with kidney cancer had blood in their urine (haematuria), a red flag symptom for further investigation.

But the presence or absence of this symptom could not account for the gender difference in referral times, the analysis indicated.

Even when they came to see their GP with haematuria, women with bladder cancer were more than three times as likely to have three or more GP visits before referral compared with men with the same symptom.

And women with kidney cancer were almost twice as likely as men to experience three or more consultations, when they had blood in their urine.

As almost 3000 women are diagnosed with each cancer every year in England, the authors calculate that around 700 women will experience delayed diagnosis.

Reinforcing the need to follow guidelines and view blood in the urine as suspicious might prompt GPs to refer women more quickly, but it won’t help in those cases where this symptom is absent, warn the authors, who call for new approaches to tackle this issue.

“The findings signal a large potential for improving the timeliness of diagnosis of urinary tract cancer in women,” write the authors. “Interventions to help [GPs] avoid initial misattribution of haematuria in women with urinary tract cancer to benign causes need to be promptly developed and evaluated,” they urge.

First impact factor announced: 1.583

20 Jun, 13 | by Richard Sands, Managing Editor


BMJ Open’s first impact factor has been announced: 1.583. We are delighted to have this further evidence that BMJ Open is considered a journal of credible, valued research.

Does a journal’s impact factor matter?

In short – yes. When we surveyed our authors earlier this year, we asked what improvements we could make to BMJ Open. By far the most frequent response was: get an impact factor. The impact factor is over-interpreted, misinterpreted and almost certainly too influential. For as long as it remains important to authors, though, it will remain something journals must promote.

The question of whether a journal’s impact factor should matter, and how much, has been discussed for years. The San Francisco Declaration on Research Assessment (or DORA) highlights some of the issues.

Unlike many journals, BMJ Open doesn’t attempt to select articles on the strength of their likely citation count. So we’ll never have the highest in our field, and you won’t find us worrying about that.

In the future our impact factor may go up or it may go down. Our influence over this will go no further than our continued efforts to ensure BMJ Open publishes thoroughly peer-reviewed open access research and serving all our authors as best we can, so we can build on our reputation as a reliable publishing choice for researchers.  

Article-level impact

The impact factor is an aggregate measure of BMJ Open’s articles and so says nothing about any individual paper. This is why we also publish article-level metrics. Alongside every paper we publish you can see its abstract, HTML and PDF views, and citations to the article from elsewhere on the HighWire publishing platform.

Such so-called ‘altmetrics’ are increasingly popular. There’s a wealth of information about these available, and the BMJ Web Development Blog is a great place to find out more and keep up to date on these.

It is important to remember that research impact extends well beyond an article’s citation rate. This is especially so in clinical research where impact on public health and clinical care cannot be captured by bibliographic measures. 

What is the impact factor?

The impact factor is a journal-level citation metric. It is usually calculated over three years, by adding the number of articles a journal publishes in years 1 and 2, and seeing how often, on average, these articles were cited in year 3. As BMJ Open only has two years’ worth of citation information, our impact factor was calculated using the number of articles we published in 2011 (which Thomson Reuters calculated as  151) and the number of times they were cited in 2012 (239). 239/151 = 1.583

Most-cited from 2011

The following are the papers we published in 2011 with the most citations in the Thomson Reuters Web of Science in 2012:

Armstrong PK, Dowse GK, Effler PV, et al. Epidemiological study of severe febrile reactions in young children in Western Australia caused by a 2010 trivalent inactivated influenza vaccine. BMJ Open 2011;1:e000016. doi:10.1136/bmjopen-2010-000016 

da Costa BR, Cevallos M, Altman DG, et al. Uses and misuses of the STROBE statement: bibliographic study. BMJ Open 2011;1:e000048. doi:10.1136/bmjopen-2010-000048

Cohen JI, Yates KF, Duong M, et al. Obesity, orbitofrontal structure and function are associated with food choice: a cross-sectional study. BMJ Open 2011;1:e000175. doi:10.1136/bmjopen-2011-000175

Hotchkiss JW, Davies C, Gray L, et al. Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995–2008: cross-sectional surveys. BMJ Open 2011;1:e000176. doi:10.1136/bmjopen-2011-000176 

Moderate drinking during pregnancy does not seem to harm baby’s neurodevelopment

17 Jun, 13 | by flee

Moderate drinking during pregnancy – 3 to 7 glasses of alcohol a week – does not seem to harm fetal neurodevelopment, as indicated by the child’s ability to balance, suggests a large study published in BMJ Open.

But social advantage may be a factor, as more affluent and better educated mums-to-be tend to drink more than women who are less well off, say the researchers.

The researchers assessed the ability to balance – an indicator of prenatal neurodevelopment – of almost 7000 ten year olds who were part of the Avon Longitudinal Study of Parents and Children (ALSPAC).

ALSPAC has been tracking the long term health of around 14,000 children born between 1991 and 1992 to women resident in the former Avon region of the UK.

Those children whose mothers’ alcohol consumption during (18 weeks) and after pregnancy (47 months) was known, underwent a 20 minute balance assessment when they reached the age of 10.

The assessment included dynamic balance (walking on a beam); and static balance (heel to toe balance on a beam, standing on one leg for 20 seconds) with eyes open and then again with eyes closed. Each child had two attempts at the test.

Their dads were also asked how much alcohol they drank when their partners were three months pregnant. Over half said they drank one or more glasses a week, and one in five said they drank one or more glasses a day.

Most of the children’s mums had drunk no alcohol (70%) while pregnant, while one in four drank between 1 and 2 (low consumption) and 3 and 7 glasses a week (moderate consumption).

Some 4.5% drank 7 or more glasses a week. Of these, around one in seven were classified as binge drinkers – 4 or more glasses at any one time.

Four years after the pregnancy, more than 28% of the women were not drinking any alcohol, and over half were drinking between 3 and 7+ glasses of alcohol a week.

In general, the mums who drank more, but who were not binge drinkers, were better off and older; the mums who binge drank were less well off and younger.

Higher total alcohol consumption before and after pregnancy by the mums, as well as higher consumption by the dad during the first three months of pregnancy, were associated with better performance by the children, particularly static balance.

In an additional analysis, the genetic predisposition to low levels of alcohol consumption was assessed in 4335 women by blood test. If the apparently “beneficial” effects of higher parental alcohol consumption on children’s balance were true, those whose mums had the “low alcohol” gene would be expected to have poorer balance.

But there was no evidence that the children of these women were less able to balance than those whose mums who did not have this genetic profile. In fact there was a weak suggestion that children of mums with the “low alcohol” gene actually had better balance, although the numbers were too small to show this reliably.

Taken together, the results show that after taking account of influential factors, such as age, smoking, and previous motherhood, low to moderate alcohol consumption did not seem to interfere with a child’s ability to balance for any of the three components assessed.

But in general, better static balance was associated with greater levels of affluence and educational attainment. And in this group of mums, moderate alcohol intake was a marker for social advantage, which may itself be the key factor in better balance, possibly overriding subtle harmful effects of moderate alcohol use, say the authors.

Average UK salt content of packaged bread has fallen 20 per cent in a decade

17 Jun, 13 | by flee

The average salt content of packaged bread sold in the UK has fallen by 20 per cent over the past decade. But salt levels still vary widely, indicating that further targets are required, finds research published in BMJ Open.

Bread is the biggest contributor of dietary salt in the UK, providing almost a fifth of the total derived from processed foods. The recommended daily intake for UK adults is a maximum of 6 g, with the current average 8.1 g a day.

Excess dietary salt can lead to high blood pressure, and an increased risk of heart attack, stroke, and kidney disease, as well as to other health problems. And the evidence shows that curbing dietary salt at the population level is one of the most cost effective means of improving public health.

The researchers base their findings on an analysis of the salt content of various packaged breads available in UK supermarkets between 2001 and 2011. They analysed salt levels in 40 products in 2001; in 138 products in 2006; and in 203 products in 2011.

In 2001, the average salt level in packaged bread was 1.23 g per 100 g. By 2006 this had fallen to 1.05 g, and by 2011 this had fallen further still to 0.98 g/100 g, equivalent to a reduction in salt levels of around 20% over the decade. The salt content of 18 products analysed at all three time points fell by 17%.

And, overall, the number of products meeting the Department of Health’s 2012 target – of less than or equal to 1 g of salt per 100 g – rose from under a third (28%) in 2001 to almost three quarters (71%) in 2011.

But wide variations in salt content persisted in similar products, and between supermarket own-label and branded products, the results showed.

In 2001, 38% of supermarket own-label loaves met the 2012 target compared with just 17% of branded products. By 2011, the equivalent figures were 89% and 42%, respectively.

Little difference in salt content was found between white, wholemeal, and brown loaves “despite the common perception that wholemeal and brown bread are healthier alternatives to white bread,” note the authors.

The variations in salt content indicate that there is further scope to lower levels even further in bread, say the study authors. “This requires further progressive lower targets to be set, so that the UK can continue to lead the world in salt reduction and save the maximum number of lives,” they write.

But they caution: “While a voluntary target based approach works to encourage industry reductions, the targets need to be coupled with the forceful government or quasi-government agency to ensure that all sectors of the food industry are aware of the targets and reducing salt in their products to meet [them].”

A target based approach does work, they conclude, adding: “Other countries around the world need to follow the UK’s lead and set salt targets.”

Every 10 tobacco ad sightings boost teens’ risk of starting to smoke by almost 40 per cent

12 Jun, 13 | by flee

Tobacco ads really do persuade teens to take up smoking, with every 10 sightings boosting the risk by almost 40 per cent, reveals research published in BMJ Open.

The researchers base their findings on over 1300 ten to 15 year old non-smokers whose exposure to tobacco advertising and subsequent behaviour were monitored over a period of 2.5 years.

In 2008, the children, who were pupils at 21 public schools in three different regions of Germany, were asked how often they had seen particular ads. These included images for six of the most popular cigarette brands in Germany and eight other products, such as chocolate, clothes, mobile phones, and cars.

In 2011, 30 months later, they were asked the same question, as well as how many cigarettes they had smoked to date, and whether they smoked regularly.

One in three (406) admitted to having tried smoking during the 30 month period, with one in 10 (138) saying that they had smoked within the preceding month.

One in 20 (66) kids said they had smoked more than 100 cigarettes, and were therefore classified as “established” smokers, while a similar proportion (58) said they now smoked every day. A third of the daily smokers were aged 14 or younger; one in four was 16 or older.

Exposure to cigarettes ads was much lower than that for the other non-tobacco products, but an ad for one particular cigarette brand was seen by almost half the kids at least once, and more than 10 times by 13% of the sample.

When a range of well known influences for taking up smoking was factored in, smoking among peers proved the strongest influence, followed closely by exposure to tobacco ads.

The greater the exposure to tobacco ads, the greater was the likelihood that the teen would take up smoking, the analysis showed.

Teens who saw the most tobacco ads (11 to 55) were around twice as likely to become established smokers and daily smokers as those who saw the least (0 to 2.5).

And for each additional 10 sightings of a tobacco ad, a teen was 38% more likely to become an established smoker, and 30% more likely to smoke every day compared with sightings for non-tobacco product ads.

After taking account of other influential factors, the overall risk of becoming an established smoker was between 3% and 7.3% greater, while that of taking up daily smoking was between 3% and 6.4% greater, depending on how many ads the teen had seen.

The authors acknowledge that a large proportion of the original 2300 students involved dropped out, and confirm that as with any observational study, there is always the chance that some as yet unmeasured factor could explain the results.

But they conclude that the data from their study support the content-specific association between tobacco advertising and smoking behaviour and, therefore, the total ban on tobacco advertising advocated by the World Health Organization Framework Convention on Tobacco Control.

“Data from this study support this measure, because only exposure to tobacco advertisements predicted smoking initiation, which cannot be attributed to a general receptiveness to marketing,” they write.

Bed sharing, obesity and social media: Most read articles in May

7 Jun, 13 | by flee


The most-read article in May was Carpenter and colleagues’ article on bed sharing with non-smoking parents and the risks of SIDS, which received widespread press coverage. Still proving popular,was Küster et al‘s study highlighting the dangers of consuming over the counter analgesics before running a marathon which was also covered in the press in the run-up to the London marathon last month. Other newly-published papers in the top ten include Hamm et al‘s study of social media use among patients and caregivers and Sørensen et al‘s study on Dabigatran use in Danish atrial fibrillation patients in 2011.

Rank Author(s) Title
1 Carpenter et al Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies
2 Sørensen et al Dabigatran use in Danish atrial fibrillation patients in 2011: a nationwide study
3 Schmidt et al Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study
4 Hamm et al Social media use among patients and caregivers: a scoping review
5 Küster et al Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study
6 Ekström et al Aspirin treatment and risk of first incident cardiovascular diseases in patients with type 2 diabetes: an observational study from the Swedish National Diabetes Register
7 Katzmarzyk et al Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis
8 Yamada et al Male pattern baldness and its association with coronary heart disease: a meta-analysis
9 Doyle et al A systematic review of evidence on the links between patient experience and clinical safety and effectiveness
10 Mahtani et al Can the London 2012 Olympics ‘inspire a generation’ to do more physical or sporting activities? An overview of systematic reviews


Most read figures are based on pdf downloads and full text views. Abstract views are excluded.

The incidence of eating disorders is increasing in the UK

20 May, 13 | by flee

More people are being diagnosed with eating disorders every year and the most common type is not either of the two most well known—bulimia or anorexia—but eating disorders not otherwise specified (eating disorders that don’t quite reach the threshold to be defined as anorexia or bulimia), shows a study published online in BMJ Open.

Few studies have investigated the incidence of eating disorders, so the authors set out to determine the incidence of diagnosed anorexia nervosa, bulimia nervosa and other non-specified eating disorders in primary care over a 10-year period in the UK (2000–2009), to see how the incidence had changed and the most common age of diagnosis.

Eating disorders have the highest death rates of all mental disorders, and understanding changes in their incidence over time and by age and gender is essential to ensure timely diagnosis and appropriate service provision.

The researchers used data from the General Practice Database, which contains anonymised records of 5% of the UK population to identify all cases of eating disorder diagnosed between 2000 and 2009. They found a total of 9072 cases.

Analysis of the data revealed that in 2000 there were 32.3 new cases of eating disorder per 100,000 population aged between 10 and 49 years, and that this rose steadily to 37.2 new cases per 100,000 by 2009.

Despite other research suggesting a decrease in the incidence of bulimia, the incidence of bulimia and anorexia remained stable over the 10 years and it was new cases of eating disorder not otherwise specified which were responsible for the overall rise. The incidence of these unspecified eating disorders, which have been far less studied than bulimia and anorexia and are the most common type seen in hospital care (60% of cases seen in specialist services), has not been estimated previously in general practice care. However, publication of the new Diagnostic and Statistical Manual of Mental Disorders (DSM 5) last week is expected to mean that the majority of these cases will be diagnosed with anorexia, bulimia or a new condition of binge eating disorder in future.

The data showed that girls aged 15 to 19 years and boys aged 10 to 14 had the highest incidences of new diagnoses of eating disorder.

Two girls in every 1000 aged 15 to 19 years are likely to be diagnosed with an eating disorder every year, which means that there are around 4610 new cases in girls of this age group each year. As a result, eating disorder is probably the most common new onset mental health disorder in adolescent girls after depression, the authors say. In 2009, the incidence of new diagnoses of depression was 11.9 per 1000 in girls of this age group.

In girls aged 10-19 years, there are nine times as many new cases of eating disorder (1.2 per 1000 population) diagnosed every year as there are cases of type 1 diabetes (0.26 new cases per 1000), and about half as many new diagnoses as there are of type 2 diabetes (3.6 new cases per 1000).