If someone’s heart suddenly stops beating, they may only have minutes to live. Doing CPR (cardiopulmonary resusciation) can increase their chances of survival. CPR makes sure blood keeps pumping, providing oxygen to the brain and vital organs until specialist treatment arrives.

But research shows bystanders are less likely to intervene to perform CPR when that person is a woman. A recent Australian study analysed 4,491 cardiac arrests between 2017–19 and found bystanders were more likely to give CPR to men (74%) than women (65%).

Could this partly be because CPR training dummies (known as manikins) don’t have breasts? Our new research looked at manikins available worldwide to train people in performing CPR and found 95% are flat-chested.

Anatomically, breasts don’t change CPR technique. But they may influence whether people attempt it – and hesitation in these crucial moments could mean the difference between life and death.

Heart health disparities

Cardiovascular diseases – including heart disease, stroke and cardiac arrest – are the leading cause of death for women across the world.

But if a woman has a cardiac arrest outside hospital (meaning her heart stops pumping properly), she is 10% less likely to receive CPR than a man. Women are also less likely to survive CPR and more likely to have brain damage following cardiac arrests.

These are just some of many unequal health outcomes women experience, along with transgender and non-binary people. Compared to men, their symptoms are more likely to be dismissed or misdiagnosed, or it may take longer for them to receive a diagnosis.

Bystander reluctance

There is also increasing evidence women are less likely to receive CPR compared to men.

This may be partly due to bystander concerns they’ll be accused of sexual harassment, worry they might cause damage (in some cases based on a perception women are more “frail”) and discomfort about touching a woman’s breast.

Bystanders may also have trouble recognising a woman is experiencing a cardiac arrest.

Even in simulations of scenarios, researchers have found those who intervened were less likely to remove a woman’s clothing to prepare for resuscitation, compared to men. And women were less likely to receive CPR or defibrillation (an electric charge to restart the heart) – even when the training was an online game that didn’t involve touching anyone.

There is evidence that how people act in resuscitation training scenarios mirrors what they do in real emergencies. This means it’s vital to train people to recognise a cardiac arrest and be prepared to intervene, across genders and body types.

Skewed to male bodies

Most CPR training resources feature male bodies, or don’t specify a sex. If the bodies don’t have breasts, it implies a male default.

For example, a 2022 study looking at CPR training across North, Central and South America, found most manikins available were white (88%), male (94%) and lean (99%).

These studies reflect what we see in our own work, training other health practitioners to do CPR. We have noticed all the manikins available to for training are flat-chested. One of us (Rebecca) found it difficult to find any training manikins with breasts.

A single manikin with breasts

Our new research investigated what CPR manikins are available and how diverse they are. We identified 20 CPR manikins on the global market in 2023. Manikins are usually a torso with a head and no arms.

Of the 20 available, five (25%) were sold as “female” – but only one of these had breasts. That means 95% of available CPR training manikins were flat-chested.

We also looked at other features of diversity, including skin tone and larger bodies. We found 65% had more than one skin tone available, but just one was a larger size body. More research is needed on how these aspects affect bystanders in giving CPR.

Breasts don’t change CPR technique

CPR technique doesn’t change when someone has breasts. The barriers are cultural. And while you might feel uncomfortable, starting CPR as soon as possible could save a life.

Signs someone might need CPR include not breathing properly or at all, or not responding to you.

To perform effective CPR, you should:

• put the heel of your hand on the middle of their chest
• put your other hand on the top of the first hand, and interlock fingers (keep your arms straight)
• press down hard, to a depth of about 5cm before releasing
• push the chest at a rate of 100-120 beats per minute (you can sing a song) in your head to help keep time!)

https://www.youtube.com/embed/Plse2FOkV4Q?wmode=transparent&start=94 An example of how to do CPR – with a flat-chested manikin.

What about a defibrillator?

You don’t need to remove someone’s bra to perform CPR. But you may need to if a defibrillator is required.

A defibrillator is a device that applies an electric charge to restore the heartbeat. A bra with an underwire could cause a slight burn to the skin when the debrillator’s pads apply the electric charge. But if you can’t remove the bra, don’t let it delay care.

What should change?

Our research highlights the need for a range of CPR training manikins with breasts, as well as different body sizes.

Training resources need to better prepare people to intervene and perform CPR on people with breasts. We also need greater education about women’s risk of getting and dying from heart-related diseases.

Jessica Stokes-Parish, Assistant Professor in Medicine, Bond University and Rebecca A. Szabo, Honorary Senior Lecturer in Critical Care and Obstetrics, Gynaecology and Newborn Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Many people are drinking less sugary soft drink than in the past. This is a great win for public health, given the recognised risks of diets high in sugar-sweetened drinks.

But over time, intake of diet soft drinks has grown. In fact, it’s so high that these products are now regularly detected in wastewater.

So what does the research say about how your health is affected in the long term if you drink them often?

What makes diet soft drinks sweet?

The World Health Organization (WHO) advises people “reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (six teaspoons) per day would provide additional health benefits.”

But most regular soft drinks contain a lot of sugar. A regular 335 millilitre can of original Coca-Cola contains at least seven teaspoons of added sugar.

Diet soft drinks are designed to taste similar to regular soft drinks but without the sugar. Instead of sugar, diet soft drinks contain artificial or natural sweeteners. The artificial sweeteners include aspartame, saccharin and sucralose. The natural sweeteners include stevia and monk fruit extract, which come from plant sources.

Many artificial sweeteners are much sweeter than sugar so less is needed to provide the same burst of sweetness.

Diet soft drinks are marketed as healthier alternatives to regular soft drinks, particularly for people who want to reduce their sugar intake or manage their weight.

But while surveys of Australian adults and adolescents show most people understand the benefits of reducing their sugar intake, they often aren’t as aware about how diet drinks may affect health more broadly.

What does the research say about aspartame?

The artificial sweeteners in soft drinks are considered safe for consumption by food authorities, including in the US and Australia. However, some researchers have raised concern about the long-term risks of consumption.

People who drink diet soft drinks regularly and often are more likely to develop certain metabolic conditions (such as diabetes and heart disease) than those who don’t drink diet soft drinks.

The link was found even after accounting for other dietary and lifestyle factors (such as physical activity).

In 2023, the WHO announced reports had found aspartame – the main sweetener used in diet soft drinks – was “possibly carcinogenic to humans” (carcinogenic means cancer-causing).

Importantly though, the report noted there is not enough current scientific evidence to be truly confident aspartame may increase the risk of cancer and emphasised it’s safe to consume occasionally.

Will diet soft drinks help manage weight?

Despite the word “diet” in the name, diet soft drinks are not strongly linked with weight management.

In 2022, the WHO conducted a systematic review (where researchers look at all available evidence on a topic) on whether the use of artificial sweeteners is beneficial for weight management.

Overall, the randomised controlled trials they looked at suggested slightly more weight loss in people who used artificial sweeteners.

But the observational studies (where no intervention occurs and participants are monitored over time) found people who consume high amounts of artificial sweeteners tended to have an increased risk of higher body mass index and a 76% increased likelihood of having obesity.

In other words, artificial sweeteners may not directly help manage weight over the long term. This resulted in the WHO advising artificial sweeteners should not be used to manage weight.

Studies in animals have suggested consuming high levels of artificial sweeteners can signal to the brain it is being starved of fuel, which can lead to more eating. However, the evidence for this happening in humans is still unproven.

What about inflammation and dental issues?

There is some early evidence artificial sweeteners may irritate the lining of the digestive system, causing inflammation and increasing the likelihood of diarrhoea, constipation, bloating and other symptoms often associated with irritable bowel syndrome. However, this study noted more research is needed.

High amounts of diet soft drinks have also been linked with liver disease, which is based on inflammation.

The consumption of diet soft drinks is also associated with dental erosion.

Many soft drinks contain phosphoric and citric acid, which can damage your tooth enamel and contribute to dental erosion.

Moderation is key

As with many aspects of nutrition, moderation is key with diet soft drinks.

Drinking diet soft drinks occasionally is unlikely to harm your health, but frequent or excessive intake may increase health risks in the longer term.

Plain water, infused water, sparkling water, herbal teas or milks remain the best options for hydration.

Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.