A look at the top 10 most read BMJ Open articles for March shows that the top spot is unchanged from February, four papers in the top ten last month have climbed, two have dropped down the list, and we have three new entries.

Screen time

Many parents of young children face the dilemma of how much time to allow their children to spend using electronic media. Alongside traditional children’s TV, a large growth in educational content delivered via phones and tablets gives interactive opportunities for both teaching and entertaining children. Parents are aware that children will need to grow up to be ‘tech-savvy’. Plenty of time-pressed parents will admit to getting some time to spend on themselves or for getting jobs done by giving the kids a tablet with a game or film loaded up. However, a long-held concern has been about whether too much time spent in front of screens is harmful, and if so, how long is excessive? Too much time and the harms could outweigh the benefits. Many parents have differing views on what age is suitable to introduce technology. A study by Niiranen and colleagues demonstrates that excess exposure below the age of five can lead to hyperactivity, short attention span, poor concentration, peer relationship issues and other behavioural problems. Using data from nearly 700 children from the START-SLEEP cohort the authors found that from 18 months to 5 years, screen time increased from an average of 32 minutes per day to 114 minutes. Two-thirds of five-year-olds watched programmes for more than an hour per day and 10% spent at least 60 minutes playing games. The authors sound a note of caution, commenting “although children’s e-media use patterns might not seem problematic when considering use on a daily level, they do have risks in the long term.”

Mental health

The compound effects of isolation, restrictions on daily life, concern for family, home working and schooling, risks during previously mundane activities, all against a backdrop of all-to-often grim news stories has, unsurprisingly, taken its toll on mental health for many people. These effects were seen from early in the COVID-19 pandemic, as Jia and colleagues show from a study carried out in the UK in April 2020. The cohort of over 3,000 participants was recruited from social media and the majority of respondents were female (84%), with an average age of 44 years. Younger women appeared to be more at risk from mental health difficulties such as anxiety and depression, especially if they were in a recognised high-risk group for COVID-19. The authors recommend implementing “public health and mental health interventions able to ameliorate perceptions of risk of COVID-19, worry about COVID-19, loneliness and boost positive mood”.

Long COVID

Although the majority of COVID-19 survivors return to full health, there is a growing number of people who have been living with the effects for a considerable amount of time after initial infection and research is underway to understand ‘long COVID’. Humphreys and colleagues have investigated how people are trying to cope with the physical and mental impairments resulting from long-COVID and report four major themes from their qualitative study. Patients are struggling to cope with these long-term effects, and also report that there is a lack of appropriately tailored advice on managing physical activity with long COVID. Patients found a range of individual strategies for coping with fatigue and ‘brain fog’ as they attempt to continue daily activities and engage in exercise. Finally, they report how some are finding it hard to accept these symptoms and fear that the impairments could be permanent. The authors note that “greater clarity and tailoring of physical activity-related advice for people with long COVID and improved support to resume activities” are crucial to restoring individual wellbeing. 

Here is the full list of most read papers in BMJ Open during March 2021:

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

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