The survey was conducted between February and May 2026 among undergraduates in medicine, dentistry, nursing and applied medical sciences at five universities in Riyadh. Participants had a mean age of 21.78 ± 3.73 years; 352, or 77.1%, were female and 104, or 22.9%, were male. Medicine was the largest professional group, contributing 280 participants, followed by applied medical sciences with 100, nursing with 53 and dentistry with 23. Recruitment into the university groups was also uneven: University A supplied 201 respondents, University B 90, University C 74, University D 63 and University E 28. The final dataset contained no missing observations, and all 456 students were included in the analyses.

Researchers used a 32-item questionnaire adapted from a previously validated instrument for health workers. A panel of five specialists in oral medicine, oral pathology and dental public health reviewed the questions for relevance, clarity and cultural appropriateness in Saudi Arabia. The panel removed 22 of the original 54 items, including questions about alcohol use, betel-quid or areca-nut chewing and practices not routinely performed by Saudi healthcare students. The adapted questionnaire achieved a scale-level content validity index of 0.94. A pilot study with 40 students, excluded from the main analysis, produced an intraclass correlation coefficient of 0.82, while internal consistency was 0.74 for awareness, 0.72 for attitudes and 0.77 for practice.

Because eight of the 12 knowledge questions allowed multiple answers, the researchers did not construct a conventional total knowledge score. Instead, they used two-step cluster analysis on 27 categorical variables covering risk factors, oral changes, lesion recognition and treatment-related responses. This method separated 195 students into a higher-knowledge cluster and 261 into a lower-knowledge cluster. The higher cluster was much more likely to identify leukoplakia, tobacco use and non-healing ulcers: 82.1% recognized leukoplakia, 94.4% identified tobacco use and 67.2% recognized non-healing ulcers. In the lower cluster, the corresponding proportions were 13.0%, 58.2% and 30.3%.

Dental students had substantially stronger results: 18 of 23, or 78.3%, fell into the higher-knowledge cluster, compared with 143 of 280 medical students, or 51.1%; 21 of 100 applied medical sciences students, or 21.0%; and 13 of 53 nursing students, or 24.5%. In multivariable binary logistic regression, dental students had 12.67 times the odds of belonging to the higher-knowledge cluster than applied medical sciences students, with a 95% confidence interval of 4.17 to 38.40 and p < 0.001. The wide interval signals considerable imprecision, however, and medical students also had higher odds than applied sciences students, at 3.77 with a 95% confidence interval of 2.19 to 6.49 and p < 0.001. Nursing did not differ significantly from applied sciences, and age was not a significant independent predictor.

Awareness also varied by professional stream, with a p-value of 0.006. Fifteen dental students, or 65.2%, were classified as having high awareness, compared with 29.3% of medical students, 32.0% of applied sciences students and 32.1% of nursing students. In regression analysis, however, the dental difference from applied sciences narrowly missed the conventional threshold for statistical significance, producing an odds ratio of 2.68, a 95% confidence interval of 0.99 to 7.23 and p = 0.052. Knowledge was more clearly associated with awareness: students in the higher-knowledge cluster had 2.07 times the odds of high awareness than those in the lower cluster, with a 95% confidence interval of 1.35 to 3.19 and p = 0.001.

Attitudes and reported practices showed parallel variation. Positive attitudes toward oral cancer examination, screening and education were recorded for 52.2% of dental students, 24.5% of nursing students, 17.0% of applied sciences students and 13.6% of medical students; the association with professional stream was significant at p < 0.001. Dental students also had 3.54 times the odds of a positive attitude than applied sciences students, with a 95% confidence interval of 1.23 to 10.17 and p = 0.019. University D had higher odds of a positive attitude than University E, although the study did not model possible within-university correlation fully. The knowledge cluster itself was not independently associated with positive attitude after adjustment, with an odds ratio of 1.66, a 95% confidence interval of 0.96 to 2.87 and p = 0.070.

Good clinical practice was reported by 65.2% of dental students, 26.4% of nursing students, 19.0% of applied sciences students and 16.4% of medical students. High awareness was associated with 3.53 times the odds of good practice, while a positive attitude was associated with 5.10 times the odds; both confidence intervals excluded 1 and both p-values were below 0.001. Dental students also had 4.40 times the odds of good practice compared with applied sciences students, with a 95% confidence interval of 1.44 to 13.43 and p = 0.009. Medical and nursing students did not differ significantly from applied sciences in the adjusted model. Notably, the higher-knowledge cluster itself was not independently associated with good practice, with p = 0.374, indicating that greater factual knowledge alone was not fully aligned with reported clinical behavior.

Knowledge did not differ significantly among the five universities, with p = 0.057. That borderline result should not be read as evidence that the institutions were equivalent, particularly because institutional sample sizes ranged from 28 to 201 and potential clustering within universities was not formally modeled. Differences in curriculum, academic stage, prior training and clinical exposure were also not measured, so the study cannot establish that professional discipline itself caused the observed variations. Its cross-sectional design, voluntary online convenience sampling and self-reported answers further limit causal interpretation and generalizability. Without a complete sampling frame or denominator of eligible students, the researchers could not calculate a reliable response rate or assess nonresponse bias. Selection of students with greater interest in oral health may also have produced more favorable results than those found in the wider Riyadh student population.

The results point toward interdisciplinary education that combines recognition of oral potentially malignant disorders with practical examination, counseling and referral training. Students across medicine, nursing and applied medical sciences may encounter oral lesions during routine care, yet the survey indicates that knowledge alone does not reliably predict favorable attitudes or practices. The authors therefore recommend clinically oriented oral cancer instruction, interprofessional collaboration and opportunities to apply knowledge in realistic settings. They also call for larger, representative multicenter studies using probability-based recruitment, balanced participation across professions and institutions, objective assessments of clinical performance and statistical methods that account for institutional clustering. Until such evidence is available, the dental advantage and the size of the broader educational gaps should be treated as preliminary rather than definitive.

Subject of Research: Knowledge and clinical readiness concerning oral potentially malignant disorders and oral cancer among health professional students in Riyadh

Article Title: Knowledge, awareness, attitudes and practice regarding oral potentially malignant disorders and oral cancer among health professional students in Riyadh, Saudi Arabia: a multicenter cross-sectional study

Article References: Khanagar, S. B., Alofi, A., Alzaaqi, L. A., Alsubaie, J. M., Alayed, D., Abothnin, S. M., Almuammar, A. A., Alfaifi, A., & Iyer, K. (2026). Knowledge, awareness, attitudes and practice regarding oral potentially malignant disorders and oral cancer among health professional students in Riyadh, Saudi Arabia: a multicenter cross-sectional study. Frontiers in Oral Health, 7, Article 1942387. https://doi.org/10.3389/froh.2026.1942387

Image Credits: AI Generated

DOI: 10.3389/froh.2026.1942387

Keywords: oral cancer, oral potentially malignant disorders, health professional education, Riyadh, Saudi Arabia, dental students, medical students, early detection, cross-sectional study, Knowledge, awareness, attitudes

Data were collected from March 25 to June 6, 2025, at Rwanda Military Referral and Teaching Hospital, Ndera Neuropsychiatric Teaching Hospital, King Faisal Hospital, Byumba Level II Teaching Hospital and Kabgayi Level II Teaching Hospital. The facilities were deliberately selected because occupational therapists were already practicing there, making them suitable for examining awareness among clinicians with some potential exposure to the profession. They do not constitute a nationally representative sample: 262 of 298 distributed questionnaires were returned, but 61 were excluded because respondents were ineligible or had not completed the survey, leaving 201 participants for analysis.

Eligible participants were adults actively providing direct clinical care, holding at least an A1-level professional qualification, having at least three months of experience and being able to answer the questionnaire in English. Occupational therapists were excluded to avoid bias, as were trainees, administrators without clinical roles and staff outside the five hospitals. The investigators used the Knowledge and Attitude Toward Occupational Therapy Practice Tool, covering professional characteristics, awareness, factual knowledge and perceptions. After expert review, a five-person pilot and an internal-consistency assessment of 50 participants, the tool produced a Cronbach’s alpha of 0.78.

The sample was almost evenly divided by sex: 102 participants, or 50.7%, were women and 99 were men. The largest age groups were 31–40 years, with 74 respondents, and 21–30 years, with 69. Mental health nurses formed the largest profession at 40 respondents, followed by general nurses with 39, medical doctors with 31, physiotherapists with 26 and ophthalmic clinical officers with nine. Overall, 113 participants, or 56%, provided habilitation or rehabilitation services. Twenty-seven respondents, 13%, had previously practiced outside Rwanda, while 140, 69.7%, reported working with an occupational therapist.

Awareness was markedly associated with professional group. It was reported by 88.5% of physiotherapists, 87.5% of mental health nurses and 87.2% of general nurses, compared with 54.8% of medical doctors. In multivariable models using medical doctors as the reference, physiotherapists had 6.3 times the odds of awareness, with a 95% confidence interval of 1.6–25.5; general nurses had 5.6 times the odds, with a 95% confidence interval of 1.7–18.1; and mental health nurses had 5.8 times the odds, with a 95% confidence interval of 1.8–18.7. Professionals providing habilitation or rehabilitation services also had higher odds of awareness than those who did not: adjusted odds ratio 3.8, 95% confidence interval 1.9–7.5.

Positive perceptions were another strong correlate of awareness. Respondents who viewed occupational therapy favorably had 4.1 times the odds of awareness compared with those who viewed it negatively, with a 95% confidence interval of 2.1–8.0. University curricula were the most frequently reported source of awareness, cited by 82 participants, or 40.8%, followed by work practice, cited by 68, or 33.8%. In the adjusted awareness model, learning from a patient, the internet or colleagues was associated with lower odds of awareness than learning through a university curriculum, although the study did not test any educational intervention.

Knowledge was measured through four questions addressing the distinction between occupational therapy and other professions, areas of practice, the people who require the service and the settings in which it is provided. Responses were totaled to a maximum score of 33. Because the instrument has no established psychometrically validated cutoffs, investigators used thresholds adapted from similar questionnaire studies: scores of 1–16 were classified as poor knowledge and 17–33 as good knowledge. On those analytical categories, 104 respondents, or 51.7%, had poor knowledge and 97, or 48.3%, had good knowledge. The cutoffs were not clinically validated and should not be interpreted as diagnostic or professional standards.

The adjusted model for good knowledge identified several statistically significant associations. Compared with medical doctors, physiotherapists had 8.2 times the odds of good knowledge, with a 95% confidence interval of 2.5–27.0; ophthalmic clinical officers had 8.6 times the odds, with a 95% confidence interval of 1.5–49.4; general nurses had 3.2 times the odds, with a 95% confidence interval of 1.2–8.6; and mental health nurses had 2.7 times the odds, with a 95% confidence interval of 1.1–7.3. Respondents who had practiced in another country had 4.5 times the odds of good knowledge than those who had practiced only in Rwanda, with a 95% confidence interval of 1.7–11.7. Some estimates had wide confidence intervals, indicating appreciable uncertainty.

Workplace exposure showed particularly strong associations with good knowledge. Professionals providing habilitation or rehabilitation services had 8.1 times the odds of good knowledge compared with those who did not, with a 95% confidence interval of 4.2–15.4. Being aware of occupational therapy was associated with 7.5 times the odds of good knowledge, with a 95% confidence interval of 3.3–17.2, while working with an occupational therapist was associated with 2.8 times the odds, with a 95% confidence interval of 1.5–5.3. The largest adjusted association involved perceptions: respondents who considered occupational therapy an important member of the healthcare team had 12.7 times the odds of good knowledge, with a 95% confidence interval of 6.3–25.9. These results describe correlations rather than causal effects.

Most respondents expressed support for the profession, even though more than half met the study’s analytical threshold for poor knowledge. A total of 144 participants, or 71.6%, agreed or strongly agreed that occupational therapy plays a significant role in their workplace, and 167, or 83.1%, agreed or strongly agreed that it deserved greater emphasis. Common reasons included improved functional outcomes, selected by 67.4% of respondents, better prognosis and greater independence in daily living, each selected by 64.8%. The findings support the authors’ call for stronger interprofessional education, continuing professional development and clearer visibility of occupational therapy’s role, but the effectiveness of those measures was not tested. Convenience sampling, self-reported responses, a final sample below the planned target, selection of hospitals with occupational therapy services and possible hospital-level clustering limit generalizability.

Subject of Research: Occupational therapy awareness and knowledge among healthcare professionals at five Rwandan teaching hospitals

Article Title: Knowledge and awareness of occupational therapy and associated factors among healthcare professionals in Rwanda: a cross-sectional study

Article References: Ishimwe, D., Nsengimana, E. A., Biracyaza, E., Turikumana, P. D., Niyonkuru, F., Uwihoreye, P., & Cloete, L. G. (2026). Knowledge and awareness of occupational therapy and associated factors among healthcare professionals in Rwanda: a cross-sectional study. Frontiers in Medicine, 13, Article 1722607. https://doi.org/10.3389/fmed.2026.1722607

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1722607

Keywords: occupational therapy, Rwanda, healthcare professionals, cross-sectional study, professional awareness, clinical knowledge, rehabilitation, interprofessional education, Knowledge, awareness, occupational, therapy

Researchers administered a spatial reasoning test to students aged 12 to 14. The test assessed spatial visualisation, spatial orientation and mental rotation, with each answer scored from 0 to 3. Students achieved a mean score of 7.34, with a standard deviation of 1.76. Based on the study’s classification criteria, 74.74% of students were in the medium spatial reasoning category, 9.47% were in the high category and 15.79% were in the low category.

Beliefs and metacognitive awareness were measured separately through questionnaires. The belief instrument was based on three domains: beliefs about mathematics, beliefs about oneself as a mathematics learner, and beliefs about the social context of mathematics learning. The metacognitive questionnaire addressed knowledge and regulation, including planning, information management, monitoring, debugging and evaluation. Responses were converted to scores from 1 to 4 and averaged for each student.

Two mathematics-education experts assessed the instruments’ content validity. Item-level Pearson correlations ranged from 0.785 to 0.892 for the spatial reasoning test and from 0.375 to 0.937 for the belief and metacognitive questionnaires. Cronbach’s alpha values were 0.882 for the spatial test, 0.949 for the belief questionnaire and 0.843 for the metacognition questionnaire. A pilot study involving 30 students from comparable schools preceded data collection.

Questionnaire results showed high reported confidence in mathematics learning: 52.63% of students were classified as very confident and 46.32% as confident, while 1.05% were not very confident and none were classified as not confident. For metacognition, 74.74% of students were classified as reflective, 24.21% as strategic, 1.05% as conscious and none as tacit. These self-reported categories indicate that students generally perceived themselves as confident and able to monitor their thinking, although questionnaire responses may be affected by social desirability bias.

Multiple linear regression showed that the combined model was statistically significant, with F = 21.13 and p < 0.001. Beliefs were positively associated with spatial reasoning after accounting for metacognition (β = 0.103, p = 0.023), as was metacognitive awareness (β = 0.167, p = 0.006). The larger metacognition coefficient indicates stronger statistical predictive power in this sample, but neither result demonstrates that changing beliefs or metacognition would directly cause an improvement in spatial reasoning.

The reported explained variance differs slightly across sections of the article. The abstract gives R² = 0.315, or 31.5%, while the results and conclusion give R² = 0.314, or 31.4%. The results also report R = 0.561; this is the multiple correlation for the model, not a correlation coefficient between any single pair of variables. On the results-and-conclusion value, the model accounted for 31.4% of the observed variation in spatial reasoning, leaving 68.6% associated with factors not included in the analysis.

The study was framed within Education 5.0, an approach that places human cognitive, social and emotional development at the centre while using technology to support learning. The authors discuss visual and digital resources such as Augmented Reality, three-dimensional simulations and interactive geometry software. They also describe belief-strengthening activities, metacognitive reflection, self-assessment, peer evaluation and opportunities to revise work after feedback as possible elements of learning design. These are proposed applications of the findings, not interventions tested in this study.

Important limitations include the purposive sample of 95 students from a single public school, the correlational design and the modest amount of variance accounted for by the model. Potential influences omitted from the regression include working-memory capacity, spatial experiences outside school, teacher instruction and previous geometry achievement. The direction of the relationships may also be reciprocal: stronger spatial reasoning could support more positive beliefs and metacognitive reports rather than the reverse. The authors recommend replication with larger and more geographically diverse samples, experimental or quasi-experimental intervention studies, longitudinal research and mixed-methods investigations of the processes behind the statistical associations.

Subject of Research: Correlational analysis of mathematics beliefs, metacognitive awareness and spatial reasoning among Indonesian junior high school students

Article Title: How beliefs and metacognitive awareness influence junior high students’ spatial reasoning ability for education 5.0

Article References: Hafizatunnisa, Fauzan, A., Candra, O., & Harisman, Y. (2026). How beliefs and metacognitive awareness influence junior high students’ spatial reasoning ability for education 5.0. Discover Education, 5(1), Article 926. https://doi.org/10.1007/s44217-026-02008-5

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02008-5

Keywords: spatial reasoning, metacognition, mathematics beliefs, junior high students, Indonesia, multiple regression, mathematics education, Education 5.0, beliefs, metacognitive, awareness, influence

The Federal District is a highly urbanized administrative area centered on Brasília, with an estimated population approaching 3 million in 2024. Researchers used a structured questionnaire based on a framework developed for an earlier study in Colombia. The instrument was linguistically and culturally adapted for the Federal District by the Environmental Agency, Instituto Brasília Ambiental, or IBRAM. Questions covered sociodemographic characteristics, general awareness of invasive species, direct experiences with L. fulica, perceived environmental and health effects, familiarity with control measures and assessments of government information and control efforts. Binary responses and Likert-style scales were used, including 1–10 ratings for perceived knowledge, harm and government performance.

Recruitment combined an online questionnaire hosted through the IBRAM website with in-person distribution of printed forms. Online participation provided 423 responses, while 190 people completed the survey in person. The researchers said support from IBRAM and the University of Brasília may have attracted online respondents with higher education or stronger environmental interests. To improve geographic representation, they circulated the online survey through social networks, approached people at locations such as the main bus station and monitored the distribution of responses by region. Sampling temporarily paused where one administrative region was disproportionately represented.

General recognition of invasive species was widespread but did not translate into procedural knowledge. Seventy-nine percent of respondents had heard of invasive species, 88% believed they could have negative effects and 53% said they had noticed a possible invasive species in their home. By contrast, most lacked the next stage of practical information: 75% did not know what action to take if they found an invasive species at home, and 80% did not know which authority to contact. The survey therefore distinguished recognition of a general ecological problem from knowledge of reporting routes and response procedures, rather than treating the two as interchangeable.

Responses about the giant African snail showed a similar divide between exposure, perceived danger and operational knowledge. Fifty-one percent rated their knowledge of L. fulica as low, assigning scores from 1 to 3 on the 10-point scale, while 41% rated its environmental effects as high and 48% rated its effects on public and animal health as high. Fifty-eight percent reported personally seeing the snail and 32% said they had collected one, but only 16% said they knew any control methods. The study also documented low evaluations of official action: 59% rated government information on L. fulica as inadequate, with scores from 1 to 3, and 75% considered control efforts insufficient.

Education was the sociodemographic variable most strongly associated with awareness and knowledge of control. Permutation Fisher’s exact tests returned P < 0.001 for education. Respondents with higher educational attainment were more likely to know about invasive species generally, report greater familiarity with L. fulica and understand control measures. Age was also significantly associated with responses at P < 0.002. Older participants, especially those with more education, were more likely to consider invasive species a serious threat and to recognize the need to control the snail. Men showed slightly greater awareness of the authority to which invasive-species occurrences should be reported than women, at P = 0.008, while other gender differences were less pronounced. Evaluations of government performance in snail management were not significantly associated with any sociodemographic factor at P > 0.05.

Multiple correspondence analysis identified two dimensions that structured responses across the questionnaire. The first explained 32% of the variance and linked general knowledge of invasive species with self-reported familiarity with L. fulica, awareness of parasites, personal encounters and judgments about environmental and health effects. The second explained 14% and was dominated by procedural items: knowing what to do after finding an invasive species, whom to contact and which measures can control L. fulica. This configuration separated factual awareness and risk judgments from management-related knowledge within the survey responses. It did not establish a causal sequence, nor did it test whether one kind of knowledge produced another.

A negative binomial generalized linear model examined how self-reported knowledge and perceived impacts related to ratings of government action. Greater self-reported knowledge of L. fulica was associated with more favorable government-performance ratings, with χ² = 29.90, one degree of freedom and P < 0.001. That association varied with awareness of environmental harm. Among respondents scoring environmental impact awareness from 6 to 10, greater knowledge of the snail corresponded with more positive government ratings. Environmental and health awareness also interacted significantly, with χ² = 8.39, one degree of freedom and P = 0.004. Respondents aware of neither impact gave the lowest ratings, those aware of either impact gave the highest ratings, and those aware of both gave intermediate ratings. The model therefore identified statistical relationships within the sample rather than showing that knowledge caused favorable assessments.

Several limitations constrain how the findings should be interpreted. The survey measured respondents’ confidence in their knowledge rather than testing their answers, so self-reported familiarity may exceed factual understanding. The authors noted that research from Paraná found that half of its respondents could not correctly identify L. fulica. Collection during the dry season may also have affected responses because the snails typically aestivate underground and are less visible then. Although in-person recruitment and geographic monitoring helped broaden the sample, people with higher education may still have been overrepresented. The cross-sectional design identified associations among education, age, knowledge and attitudes; it did not establish causal effects, observe actual control behavior or evaluate whether any management intervention reduced snail populations.

The results point to a communication problem in which broad concern and recognition of ecological risk coexist with limited knowledge of procedures. Younger and less-educated respondents were identified as important groups for expanded outreach, while the high proportion lacking knowledge of control methods indicates a wider practical gap. The authors advocate education that combines ecological understanding with actionable information, greater clarity about institutional responsibilities, more transparent communication of government efforts and incorporation of community feedback into management. They also call for stakeholders to co-produce useful knowledge and for incentives and tangible benefits to support participation. The survey did not test the effectiveness of those measures or demonstrate improved control of L. fulica, but it quantified where residents’ general awareness, practical knowledge and confidence in official action diverged.

Subject of Research: Public awareness, perceptions and control knowledge regarding the giant African snail in Brazil’s Federal District

Article Title: Perceptions and awareness of invasive species in the Brazilian Federal District: implications for controlling the giant African snail ( Lissachatina fulica )

Article References: Patiño-Montoya, A., Marins, G., Nomiyama, T. S., & Tidon, R. (2025). Perceptions and awareness of invasive species in the Brazilian Federal District: implications for controlling the giant African snail (Lissachatina fulica). NeoBiota, 103, 325-337. https://doi.org/10.3897/neobiota.103.156013

Image Credits: AI Generated

DOI: 10.3897/neobiota.103.156013

Keywords: giant African snail, Lissachatina fulica, invasive species, Brazil, Federal District, public awareness, knowledge-action gap, government communication, snail control, cross-sectional survey, Perceptions, awareness

The researchers used reflexive thematic analysis, an interpretive approach designed to examine how participants constructed meaning rather than to measure the frequency or distribution of experiences. They conducted face-to-face, semi-structured interviews averaging 37 minutes, with individual sessions lasting between 30 and 45 minutes. An open question about when the women first became aware of heart failure was followed by prompts concerning emotion, identity, relationships, daily life, treatment and coping.

The guide was flexible, allowing interviewers to move between past and present experiences while participants explored what illness meant to them. Field notes captured contextual details, salient nonverbal cues and researchers’ reflexive observations, while all interviews were audio-recorded with consent and transcribed verbatim. Two researchers independently performed inductive, line-by-line coding before comparing codes and jointly developing themes through iterative discussion.

The analysis then moved recursively between extracts, coding, thematic construction and theoretical interpretation. Recruitment continued until the team judged the interviews sufficiently rich, nuanced and conceptually coherent to address the research question; adequacy was assessed through informational depth and interpretive potential rather than statistical saturation or coding redundancy. The team used an audit trail, reflexive journals, researcher triangulation and discussions to strengthen credibility and confirmability.

Four participants were also invited to reflect on the preliminary thematic synthesis, rather than being asked to verify factual details in their transcripts, consistent with the reflexive approach. The participants had a mean age of 79 years, with a standard deviation of 7.4 years, and had lived with heart failure for an average of eight years, with a standard deviation of 4.7 years. All were retired.

Six were classified in New York Heart Association functional class II and five in class III, indicating mild-to-moderate limits on physical activity. Ischemic cardiomyopathy was the cause of heart failure in five participants, hypertensive heart disease in three and valvular heart disease in three. The analysis produced four interconnected themes: confronting vulnerability, reconnecting through others and faith, adapting daily life and learning through awareness and self-care.

The authors interpreted the sequence as a developmental pathway, but the cross-sectional design meant that its progression was reconstructed from retrospective accounts rather than directly observed over time. Diagnosis initially disrupted the women’s sense of safety and continuity. Shortness of breath, profound fatigue and swelling often occurred during acute symptom exacerbations that led to hospitalization, intensifying the impression that the condition was life-threatening and irreversible.

One participant recalled feeling as though she was dying, while another said the diagnosis was “a major blow.” The phrase “heart failure” itself carried a strong association with futility. For some, the severity of the situation was initially overwhelming: one woman said, “It felt like I couldn’t handle it,” and another asked a chaplain for the last rites. These reactions showed that the first stage of adaptation could be dominated by existential fear rather than active management, with the body’s limits unsettling previous expectations about identity, continuity and future life.

Over time, however, bodily symptoms and repeated clinical encounters became reference points for reflection. Some women continued to fear recurrence, but others began to recognize signs of improvement and describe a modest return of control. One participant said that, after following prescribed treatments, she could walk without becoming tired and climb stairs she had previously found difficult.

Another associated her relatively good condition with following the recommendations of her clinicians. The researchers interpreted this progression as movement from distress toward meaning-making, one of the dimensions of the Inner Strength framework, which describes an internal developmental capacity involving distress, connection, commitment, movement and construction of a new normal. This was an interpretive framework applied by the researchers, not a clinical score or an outcome measured in the interviews.

Relationships and faith supplied resources during this process. Family members, friends and neighbors offered both practical assistance and companionship. One woman said her children left work to help her, while another described being cared for by her sisters and daughters.

A participant living in a supportive building said she could always find someone to accompany her to the hospital. Some women also drew serenity and patience from inner dialogue or explicitly religious beliefs. “I take things with patience, and the Lord watches over me from above,” one participant said. Support was not unambiguously comforting, however: receiving help could also evoke guilt, dependence or a sense of being a burden.

The findings therefore portray connection as a negotiated resource capable of both stabilizing and complicating everyday life. Some mourned a life in which they could move independently and pursue activities without planning around fatigue. “I used to take long trips, visit exhibitions… but now I can’t anymore,” one woman said. Another said, “Now I can’t do anything, I feel almost useless.” Gradually, some participants began to define a new normal around medication schedules, short walks, quiet periods at home and assistance with daily tasks.

The authors described this as a movement from resistance toward adaptation, but the accounts also preserve the grief accompanying lost roles and independence rather than presenting resilience as a simple or complete reversal of disability. For several women, accepting help also required renegotiating family roles and expectations that had previously been organized around independence. Illness awareness emerged as a fragile and uneven learning process.

Although every participant had lived with chronic heart failure for years, several still did not fully understand its severity or progression. One said she did not “fully realize the severity of the situation,” while another described hearing about the disease “as if it didn’t concern me.” Some followed medication without understanding its purpose. These accounts illustrate a gap between knowledge and action, but the study did not test a causal relationship between awareness, adherence and clinical outcomes.

The final theme described a movement from passive compliance toward conscious engagement with self-care. Repeated hospitalizations, conversations with clinicians and reflection on bodily changes helped some women interpret the relationship between everyday behavior and well-being. “Now I follow everything they prescribe and recommend,” one participant said, while another described continuing to “keep going” in terms that shifted from endurance toward persistence and hope. The study therefore portrays awareness as both an educational and a therapeutic process within the participants’ accounts, although it did not test whether such a process improves resilience, reduces hospitalization or prolongs survival.

The authors proposed that structured educational and psychosocial support may help women connect clinical information with reflection, relationships and daily self-management, but that prospect requires evaluation in intervention studies. The findings come from a small, purposively selected sample at one hospital, so they are not intended to represent all women with heart failure or establish population-wide prevalence. Participants were selected for their ability to provide articulate, reflective accounts, and all were fluent in Italian.

Educational level, socioeconomic status and living arrangements were not systematically collected. ACC/AHA heart-failure staging was not routinely recorded, limiting the researchers’ ability to contextualize progression further. Because the interviews captured one point in time, the study could not directly observe how awareness and inner strength evolved; the developmental sequence was reconstructed from retrospective accounts.

The researchers’ backgrounds in nursing, cardiovascular care and education may also have shaped the interpretive lens. Within those limits, the study identifies a clinically relevant tension: information alone did not necessarily produce informed action, whereas awareness embedded in emotional, social and spiritual experience appeared more closely associated with resilient adaptation. The results point toward person-centred education for further testing, not proof of a new treatment.

Subject of Research: How illness awareness and inner strength developed among 11 women living with chronic heart failure in northern Italy

Article Title: Awareness as a path to inner strength: a qualitative study on women living with heart failure

Article References: Dellafiore, F., Cazzato, S., Primosa, F., Gotri, L., Diamanti, O., Modena, G., & Artioli, G. (2026). Awareness as a path to inner strength: a qualitative study on women living with heart failure. Frontiers in Cardiovascular Medicine, 13, Article 1744193. https://doi.org/10.3389/fcvm.2026.1744193

Image Credits: AI Generated

DOI: 10.3389/fcvm.2026.1744193

Keywords: heart failure, women's health, illness awareness, inner strength, qualitative research, self-care, resilience, patient education, reflexive thematic analysis, cardiovascular nursing, Awareness, path

The research team, led by Sihua Liu of Nanchang Institute of Technology and Yuanyuan Ma of Henan Finance University, set out to test an embodiment-based account of body image. Most exercise interventions aimed at undergraduates, they note, chase fitness gains or appearance change—outcomes that can paradoxically reinforce an appearance-focused relationship with the body. An alternative framework argues that body image improves more sustainably when activities strengthen how a person attends to and experiences the body internally. Aerobics, with its sustained rhythmic whole-body movement, attention to breathing, posture, coordination, and the internal sensations of exertion and recovery, offered a plausible testing ground for that hypothesis.

The study enrolled 240 undergraduates aged 18 to 24, nested within eight intact physical-education classes: four aerobics classes and four comparison classes. Thirty students were randomly sampled from each class, and all were assessed at baseline and again at weeks 4, 8, and 12. Because students chose their courses before recruitment, the design was quasi-experimental rather than a randomized controlled trial—a distinction that shapes how the results should be read. The aerobics course met once weekly for 60 minutes across 12 consecutive weeks, while the comparison condition comprised usual-practice physical-education classes scheduled at the same frequency and duration.

Three validated instruments captured the psychological outcomes. Body awareness was measured with the Body Awareness Questionnaire, an 18-item self-report scale assessing habitual attentiveness to internal bodily processes such as heartbeat, breathing, and bodily tension. Body appreciation was assessed with the Body Appreciation Scale-2, a 10-item measure of accepting one’s body and respecting its functions. Self-esteem was gauged with the Rosenberg Self-Esteem Scale, a 10-item summed total ranging from 10 to 40. Baseline physical activity was recorded using the International Physical Activity Questionnaire–Short Form, allowing the researchers to control for pre-existing exercise exposure.

At week 12, after adjusting for baseline scores, sex, age, BMI, baseline physical activity, and prior aerobics experience, the aerobics group scored significantly higher than the comparison group on all three outcomes. The adjusted difference was largest for body awareness, with a coefficient of 0.43 and a 95 percent confidence interval of 0.29 to 0.56, followed by body appreciation at 0.18 (0.09 to 0.28) and self-esteem at 0.77 (0.62 to 0.91). In standardized effect-size terms, the between-course difference reached Hedges’ g of 0.78 for body awareness, 0.55 for body appreciation, and 0.44 for self-esteem—a pattern suggesting the clearest practical signal of the course was in students’ self-reported attentiveness to bodily states, with changes in broader body appreciation and especially global self-esteem more modest.

Because only eight classes contributed independent replication—four per condition—the researchers took statistical precautions that go well beyond conventional practice. With so few clusters, cluster-robust standard errors alone can be unreliable, so the team corroborated every primary contrast with a wild cluster bootstrap-t procedure. With eight classes, there are exactly 256 possible Rademacher sign-weight combinations; all 256 were enumerated exhaustively rather than approximated by random resampling. All three outcomes attained the smallest two-sided p-value attainable under this exhaustive sign-flip procedure, approximately 0.0078, and remained significant after Holm’s sequential correction across the three primary tests. A class-level sensitivity analysis treating each class as a single unit showed all four aerobics classes with larger mean change than all four comparison classes on every outcome, with no overlap between the two sets of class means.

The timing of the differences offered a suggestive descriptive pattern. Body awareness diverged between conditions as early as week 4, body appreciation followed a similar early trajectory that leveled off after week 8, and self-esteem did not show a clearly separated difference until week 8. This ordering is compatible with the researchers’ hypothesized sequence—course condition, then change in body awareness, then change in body appreciation, then change in self-esteem—but the authors are emphatic that it does not establish temporal precedence, because the underlying change intervals overlap in time and the analytic model specified the mediator ordering a priori rather than deriving it independently from the measurement schedule.

An exploratory mediation analysis, bootstrapped at the class level with 5,000 resamples of intact classes, produced an indirect estimate following the hypothesized serial chain that was different from zero: 0.146, with a 95 percent confidence interval of 0.079 to 0.240. Yet the authors urge restraint in interpreting this number. The serial estimate was similar in magnitude to the indirect pathway through body awareness alone (0.162) and through body appreciation alone (0.157), meaning the data do not indicate that the specific sequential ordering is a stronger mechanism than either construct operating independently. The mediation findings, the researchers write, should be read as descriptive and hypothesis-generating rather than as confirmation of a privileged psychological pathway.

The theoretical resonance is hard to ignore. The results align with embodiment-based accounts of body-attentive movement, including evidence from yoga practitioners showing that internal-experience-focused practice shifts self-evaluation away from appearance and toward functionality. They also fit functionality-based models of positive body image, which treat body appreciation as consistently associated with broader self-esteem. But the authors caution that several alternative explanations cannot be ruled out by this design: differences in instructor style or enthusiasm, the inherent enjoyment or novelty of aerobics choreography, heightened social interaction or group cohesion fostered by synchronized group movement and shared music, differences in objective exercise intensity, self-selection of more body-motivated students into the aerobics elective, and participants’ awareness of the study’s likely hypotheses given repeated body-focused questionnaires alongside a body-focused course.

The study also faces substantive measurement constraints. All outcomes were self-report, and only scale-level composite scores were retained in the de-identified analytic dataset, meaning item-level scoring cannot now be independently reconstructed, sample-specific reliability coefficients cannot be calculated, and measurement invariance across time or condition cannot be tested. The comparison condition was an incompletely characterized usual-practice comparator rather than a standardized active control, with information on its specific activities, instructors, use of music, attendance procedures, and exercise intensity unavailable. Intervention attendance could not be reliably verified because original attendance registers were not retained. Generalizability is limited to undergraduates from a single Chinese university, and replication across additional institutions and populations is needed.

Still, the study’s applied implications are worth considering. If a routine, non-mindfulness-based aerobics course—one that did not formally include interoceptive or mindfulness instruction—was associated with measurable gains in body awareness, body appreciation, and self-esteem over a single semester, the psychological benefits of structured movement may be broader than commonly assumed. The authors stress that the present mediation findings do not indicate whether body awareness, body appreciation, or their sequential ordering should be preferentially targeted in university physical-education programs, since the mediators were not experimentally manipulated and the three indirect pathways were of broadly similar magnitude. Experimental studies that manipulate these components separately would be required to distinguish among competing possibilities.

For now, the study stands as a preliminary between-course association rather than evidence of an aerobics-specific causal effect. The authors call for replication with a substantially larger number of independently observed classes and instructors, ideally within randomized, multi-site designs with fully documented intervention and comparison protocols. Until then, the idea that a semester of rhythm, breath, and coordinated movement might quietly reshape how students relate to their bodies—and, through that relationship, how they value themselves—remains an intriguing hypothesis worth watching as the science of embodiment continues to evolve.

Subject of Research: Psychology

Article Title: Changes in body awareness, body appreciation, and self-esteem during a university aerobics course: a quasi-experimental study

Article References: Liu, S., & Ma, Y. (2026). Changes in body awareness, body appreciation, and self-esteem during a university aerobics course: a quasi-experimental study. Frontiers in Psychology, 17, Article 1952535. https://doi.org/10.3389/fpsyg.2026.1952535

Image Credits: AI Generated

DOI: 10.3389/fpsyg.2026.1952535

Keywords: Changes, body, awareness, appreciation, self-esteem, during, university, aerobics, course, quasi-experimental, scientific research

The study, led by researchers affiliated with the Medical University of Varna, was designed to answer three deceptively simple questions: to what extent are consumers aware of the edibility and health benefits of microgreens, how frequently are these seedlings consumed among adults in Northeastern Bulgaria, and what perceptions and attitudes influence their use as an alternative nutrient source. Bulgaria presents a compelling case study because national dietary surveys consistently report insufficient vegetable intake, unbalanced dietary patterns, and suboptimal adherence to nutritional recommendations among Bulgarian adults, particularly in urban populations. These dietary characteristics have been identified as contributing factors to the national burden of chronic non-communicable diseases, making the search for accessible and nutrient-dense alternative sources of essential nutrients increasingly urgent.

To capture consumer behaviour, the researchers conducted a cross-sectional survey using two recruitment approaches: an online questionnaire distributed via social media platforms and a paper-based questionnaire administered in public locations. The structured, self-administered instrument covered sociodemographic characteristics such as gender, age group, education, place of residence, monthly household budget, and employment status, alongside items on awareness and recognition of microgreens and other non-traditional edible plants, consumption patterns, forms of intake, nutritional knowledge, perceived market availability, and home cultivation. The questionnaire was pilot-tested with 20 adults to ensure clarity and content validity, after which minor wording adjustments were made. Participation was voluntary and anonymous, informed consent was obtained from all respondents, and ethical approval was granted by the Ethics Committee of the Medical University of Varna in accordance with the principles of the Declaration of Helsinki.

The demographic profile of the sample was predominantly urban, female, and relatively young. Of the 198 respondents, 68.7 percent were female and 31.3 percent male, while the largest age group was 18 to 30 years, accounting for 44.9 percent of participants. More than half of the respondents had higher education, including bachelor’s, professional bachelor’s, master’s, or doctoral degrees, and 96.0 percent lived in cities or towns rather than villages. The most frequently reported monthly family budget was 2000 to 3000 BGN, reported by 41.4 percent of respondents, while permanent employment was reported by 56.6 percent and student status by 32.8 percent. The researchers emphasise that because participants were recruited through convenience sampling via open channels and public recruitment, the resulting sample should not be considered representative of the general population.

Recognition of the listed plant species was generally high, with the most familiar microgreens being leeks at 63.4 percent, buckwheat at 58.5 percent, peas at 52.4 percent, and spelt grass at 51.0 percent. Most respondents, 82.9 percent, correctly indicated that all listed plants were edible, while only 4.8 percent reported uncertainty regarding their edibility. Among respondents who answered the nutritional knowledge section, vitamins were the most frequently cited benefit at 53.8 percent, followed by minerals at 48.3 percent, fibre at 47.6 percent, and antioxidants at 42.7 percent. However, a considerable proportion, 35.7 percent, reported no knowledge of any specific benefits, revealing that general awareness of healthfulness coexists with significant gaps in detailed nutritional understanding.

To move beyond simple percentages, the researchers employed exploratory factor analysis using principal axis factoring with varimax rotation to identify latent dimensions of respondents’ knowledge and familiarity. Sampling adequacy was confirmed using the Kaiser–Meyer–Olkin measure, which reached 0.80, and Bartlett’s test of sphericity was statistically significant, indicating suitability for factor extraction. Two factors with eigenvalues greater than 1.0 emerged, explaining 56.7 percent of the total variance. Factor 1, labelled nutritional awareness, was characterised by strong loadings on knowledge of at least one health benefit, identification of vitamins and fibre as nutritional attributes, and awareness that the listed species are produced on Bulgarian farms. Factor 2, labelled exposure and plant familiarity, loaded strongly on recognition of plant species, exposure to microgreens in retail settings, home cultivation, and identification of minerals and antioxidants as nutritional attributes. The resulting structure reveals a clear distinction between a knowledge-based dimension of nutritional awareness and an exposure-related dimension reflecting familiarity and market interaction.

Factor scores were then used to perform K-means cluster analysis, which identified three distinct consumer profiles. Cluster 1, representing 32.1 percent of respondents, scored highest on both factors and was characterised by strong nutritional awareness, frequent exposure to microgreens in retail settings, a comparatively higher likelihood of home cultivation, and regular consumption of multiple microgreen species. Cluster 2, the largest group at 41.5 percent, demonstrated intermediate levels of nutritional knowledge, moderate species recognition and market familiarity, and expressed interest in microgreens without consistent long-term behavioural engagement. Cluster 3, accounting for 26.4 percent, showed low levels of nutritional awareness, minimal market familiarity, infrequent consumption, and little or no engagement in home cultivation. Based on the number of different microgreen species consumed, respondents were categorised as regular consumers consuming more than three species, occasional consumers consuming one or two species, or non-consumers consuming none. Occasional consumers formed the predominant group at 52.0 percent, regular consumers accounted for 28.0 percent, and non-consumers constituted 20.0 percent of the sample.

Across species, consumption patterns were selective, with the highest intake reported for leeks at 37.1 percent, buckwheat at 36.4 percent, peas at 32.1 percent, and spelt grass at 28.6 percent, suggesting that consumer choices are driven by familiarity and perceived ease of use. Among respondents who reported consumption methods, 50.7 percent consumed microgreens in fresh form while 49.3 percent used them after thermal processing, with regular consumers showing a stronger preference for fresh intake. Market accessibility varied considerably: 26.0 percent of respondents reported no retail exposure to microgreens, 43.6 percent reported having seen only leafy-vegetable microgreens, and encounters with specific species such as buckwheat or leeks ranged from 17.1 to 30.0 percent depending on the species. More than 80 percent of respondents reported that they did not cultivate microgreens at home, and awareness of Bulgarian producers was strikingly low, with 61.4 percent reporting that they did not recognise any domestic producer.

The comparative analysis across consumer groups reinforces the central message of the study. Regular consumers demonstrated consistently higher awareness and stronger engagement with microgreens across all indicators, recognising microgreens at 78 percent versus 60 percent for occasional consumers and 35 percent for non-consumers. Knowledge of vitamins reached 68.0 percent among regular consumers compared with 52.0 percent among occasional consumers and just 27.0 percent among non-consumers, while 67.0 percent of non-consumers reported not knowing any benefits at all. Home cultivation was reported by 21.0 percent of regular consumers, 12.0 percent of occasional consumers, and only 3.0 percent of non-consumers, while market availability encountered ranged from 57.0 percent among regular consumers down to 14.0 percent among non-consumers. These patterns indicate that familiarity, accessibility, and repeated exposure play a decisive role in shaping consumer behaviour, consistent with earlier consumer research on functional plant-based foods demonstrating that perceived health benefits alone are insufficient to ensure regular consumption.

The authors argue that several interacting factors explain the low level of regular consumption despite relatively high awareness. Economic considerations appear to play an important role, as microgreens are often perceived as premium products with higher prices compared to conventional vegetables, which may limit their suitability for everyday use. Limited and inconsistent availability in retail settings reduces opportunities for repeated exposure and habitual purchase, while established culinary traditions and a lack of familiarity with preparation methods may discourage consumers from incorporating microgreens into routine meals. Similar combinations of price sensitivity, availability constraints, and culinary uncertainty have been identified as major barriers to the adoption of novel plant-based foods across Europe. The researchers suggest that improving availability through urban farming initiatives, expanded retail distribution, and the development of processed microgreen formats such as freeze-dried powders or extracts may facilitate their integration into daily diets, noting that both fresh and dried microgreens retain substantial levels of bioactive compounds. Taken together, the results indicate that increasing nutritional awareness alone is unlikely to lead to substantial changes in consumption patterns, and that integrated strategies combining improved market visibility, consistent availability, competitive pricing, and clear culinary guidance are required to support the transition from occasional use to the habitual inclusion of microgreens in everyday diets. The authors also caution that the sample was restricted to Northeastern Bulgaria, was not nationally representative, displayed a high proportion of urban and younger respondents, and relied on self-reported data that may be affected by recall and social desirability bias. Nevertheless, as nutrient-dense, fast-growing, and accessible plant foods, microgreens retain genuine potential to contribute to improved dietary quality and nutritional intake, particularly in urban environments where access to fresh produce may be restricted.

Subject of Research: Nutrition and public health

Article Title: Awareness, consumption, and home cultivation of microgreens in northeastern Bulgaria: a questionnaire-based survey

Article References: Stoycheva, T., Merdzhanova, A., Peycheva, K., Panayotova, V., Stancheva, R., Markova, N., Hristova, T., & Dobreva, D. A. (2026). Awareness, consumption, and home cultivation of microgreens in northeastern Bulgaria: a questionnaire-based survey. Pharmacia, 73, Article e188629. https://doi.org/10.3897/pharmacia.73.e188629

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e188629

Keywords: Awareness, consumption, home, cultivation, microgreens, northeastern, Bulgaria, questionnaire-based, survey, scientific research

The research team surveyed 316 undergraduate and postgraduate radiography students drawn from government and private institutions across South India. Participants completed an 11-item questionnaire adapted from a validated instrument originally developed by Arruzza and colleagues, with minor modifications to improve clarity and contextual relevance for Indian students. Responses were recorded on a five-point Likert scale, and the researchers applied non-parametric statistical methods suited to ordinal data. The Kruskal–Wallis H test compared AI awareness and perception scores across academic years, the Mann–Whitney U test examined gender differences, Spearman’s rank correlation evaluated associations between variables, and ordinal logistic regression identified independent predictors of AI acceptance.

The results paint a nuanced picture of AI literacy among future radiographers. A majority of participants—63.0 percent—reported general awareness of AI as an emerging trend in medical imaging, with a mean score of 2.62 (standard deviation 0.98) on a 0–4 Likert scale. Yet this surface-level familiarity masked a fundamental misconception: approximately 44 percent of students incorrectly categorized conventional systems such as Automatic Exposure Control (AEC) and auto-positioning as AI technologies. These are deterministic, rule-based automation tools that have existed in radiography for decades, not machine learning systems that learn from data. The confusion suggests that students conflate any form of automated assistance with artificial intelligence, blurring the technical boundary between classical automation and genuine data-driven learning algorithms.

This misconception carries real consequences for education and practice. When students believe that familiar conventional tools already constitute AI, they may overestimate their understanding of how modern AI systems actually function—systems built on neural networks, deep learning architectures, and statistical pattern recognition trained on large imaging datasets. The researchers argue that such gaps in technical fundamentals could leave graduates unprepared to critically evaluate, safely operate, or responsibly integrate genuine AI tools into clinical workflows. Without a clear conceptual distinction between automation and intelligence, students cannot fully grasp what AI can and cannot do in medical imaging.

The paradox at the heart of the study emerges most clearly in students’ professional attitudes. Although 66.2 percent of respondents acknowledged AI’s role in reducing workload—a view consistent with AI’s design purpose as an assistive technology—43.4 percent simultaneously expressed concerns about its potential impact on job opportunities. In other words, students see AI as both a helper and a threat, embracing its utility while fearing its reach. This duality reflects a broader tension documented across healthcare professions: AI is marketed as augmentation, yet workers experience it as potential replacement. The researchers suggest that this ambivalence is not irrational but rooted in uncertainty about how AI will reshape professional roles in radiography.

Statistical analysis revealed additional layers of complexity. In unadjusted analysis, academic level was associated with AI awareness (Kruskal–Wallis H = 15.36, p = 0.004), suggesting that more advanced students might hold greater awareness. However, this association lost statistical significance after Bonferroni correction (adjusted p = 0.1203), indicating that the apparent relationship may have been driven by multiple comparisons rather than a genuine educational progression effect. The finding implies that simply advancing through academic years does not automatically deepen AI understanding—a sobering result for curricula that assume technology literacy grows organically with training.

Gender differences also emerged in the data. Male students demonstrated significantly more positive expectations regarding patient acceptance of AI (p = 0.004), a result that hints at how demographic factors shape technology attitudes even within the same educational environment. The researchers note that such differences may reflect broader patterns in technology confidence and communication styles, though the study did not explore the underlying causes. Understanding these variations could help educators tailor AI instruction to address the specific concerns and expectations of different student groups.

Despite the anxieties and misconceptions, one finding stands out as genuinely hopeful: a strong interest in formal AI education was evident, with 68.7 percent of participants supporting its inclusion in the radiography curriculum. This enthusiasm suggests that students are not resistant to AI but rather hungry for structured guidance on what it is, how it works, and what it means for their profession. The demand for competency-based AI education aligns with international calls to integrate digital health technologies into medical training, ensuring that graduates enter the workforce prepared rather than perplexed.

The study’s conclusions carry weight beyond South India. As AI integration into medical imaging accelerates globally, the readiness of future professionals in high-demand healthcare settings becomes a critical determinant of successful adoption. India’s healthcare system, with its enormous patient volumes and rapidly expanding imaging infrastructure, offers a revealing case study of how AI will encounter workforces that may lack formal preparation. The researchers argue that structured, competency-based AI education should be introduced early in training—not as an elective afterthought but as a core component—promoting balanced and responsible integration of AI into clinical practice.

What makes this research resonate is its honest portrayal of a generation caught between excitement and unease. The Assistive Tool Paradox is not unique to radiography students; it echoes across professions confronting automation, from law to logistics. But in medical imaging, where AI’s capabilities are advancing with remarkable speed and where patient safety depends on operator competence, the stakes are particularly high. The SRM team’s work provides educators, policymakers, and professional bodies with concrete evidence that awareness alone is insufficient—true readiness requires deep technical understanding, honest dialogue about professional fears, and curricula that prepare students to work alongside intelligent systems rather than compete against them. As AI continues its march into clinics worldwide, the question is no longer whether it will transform radiography, but whether the humans operating it will be equipped to harness its promise while navigating its perils.

Subject of Research: The Assistive Tool Paradox in radiology education: AI awareness, misconceptions, and job anxiety among Indian radiography students

Article Title: The Assistive Tool Paradox in radiology education: AI awareness, misconceptions, and job anxiety among Indian radiography students

Article References: Hemamadhuri D, Lazar, V. R., Samuel, A., Kulandaivel, M., & C R, H. (2026). The Assistive Tool Paradox in radiology education: AI awareness, misconceptions, and job anxiety among Indian radiography students. BMC Medical Education. https://doi.org/10.1186/s12909-026-10266-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10266-y

Keywords: Assistive, Tool, Paradox, radiology, education, awareness, misconceptions, anxiety, Indian, radiography, students, scientific research

The research team, led by Yan Gao, Yingjie Peng, and Yuanyuan Wang of Weifang Maternal and Child Health Hospital and collaborating institutions in Shandong, China, set out to answer a deceptively simple question: after accounting for how high someone’s blood pressure actually is, does knowing about a hypertension diagnosis matter for survival? The question matters because awareness is often treated as a key performance indicator in hypertension care. National surveys track the percentage of hypertensive adults who know their status, and screening programs celebrate rising awareness figures. But if awareness itself does not translate into lower mortality, the metric may be a weaker proxy for health benefit than commonly believed.

To investigate, the researchers turned to two of the most respected population-based cohort studies in the world. The first was the China Health and Retirement Longitudinal Study, known as CHARLS, which enrolled adults aged 45 and older with a baseline survey conducted in 2011 and 2012. The second was the US National Health and Nutrition Examination Survey, or NHANES, drawing on cycles conducted between 1999 and 2018. Both studies combine household interviews with physical examinations, meaning participants had their blood pressure actually measured by trained staff rather than merely self-reported. That combination of subjective awareness data and objective measurements is what made the analysis possible.

The analytic samples were substantial: 12,868 participants in CHARLS, of whom 12,640 contributed mortality follow-up, and 26,351 participants in NHANES. Hypertension awareness was defined strictly as a self-reported previous diagnosis of hypertension made by a physician or other health professional. Participants were then sorted into five mutually exclusive categories based on their awareness status and their baseline measured blood pressure: normotension, aware controlled hypertension, aware uncontrolled hypertension, unaware grade 1 hypertension, and unaware grade 2 to 3 hypertension. This classification scheme allowed the team to compare, for example, someone with severe but undiagnosed hypertension against someone with equally severe diagnosed hypertension, isolating the effect of awareness itself.

The two cohorts were analyzed independently using a broadly common analytical framework, a deliberate design choice that guards against pooling artifacts and allows each country’s data to speak with its own weighting and covariate adjustments. The researchers employed cohort-specific Cox proportional hazards models, the standard statistical tool for survival analysis, incorporating appropriate survey weights and adjusting for demographic, lifestyle, and clinical covariates such as age, sex, body mass index, smoking status, and relevant clinical markers. They also compared aware and unaware hypertension within the same blood pressure severity categories and modeled continuous systolic blood pressure in relation to mortality, providing both categorical and continuous views of the same underlying biology.

The headline results were striking in their consistency across two very different health systems. Compared with normotension, aware but uncontrolled hypertension was associated with higher all-cause mortality in both cohorts. In CHARLS, the hazard ratio was 1.53, with a 95 percent confidence interval of 1.26 to 1.85, meaning a roughly 53 percent higher risk of death during follow-up. In NHANES, the corresponding hazard ratio was 1.39, with a confidence interval of 1.28 to 1.52. Unaware severe hypertension, grade 2 to 3, showed similarly elevated risks: a hazard ratio of 1.58 in CHARLS and 1.50 in NHANES. In other words, a person walking around with dangerously high blood pressure faced substantially elevated mortality whether or not a doctor had ever told them they had the condition.

The more provocative finding emerged when the researchers compared aware and unaware participants within the same broad blood pressure severity categories. If awareness itself conferred a survival advantage, aware individuals should have fared better than unaware individuals with equivalent blood pressure. They did not, at least not consistently. Awareness status was not reliably associated with mortality across the two cohorts, and the pattern of results differed between China and the United States. When the team modeled systolic blood pressure as a continuous variable, mortality rose steadily with increasing systolic pressure in both countries, but evidence of an interaction between systolic pressure and awareness appeared in NHANES and not in CHARLS. Notably, the main phenotype associations did not differ significantly between the cohorts, underscoring that the core relationship between blood pressure severity and death was robust on both sides of the Pacific.

What might explain the inconsistency of awareness as a predictor? The authors are careful to frame their conclusions as observational, describing associations among baseline-defined phenotypes rather than causal effects of knowing one’s diagnosis. Awareness, after all, is only meaningful if it leads to treatment, and treatment only matters if it achieves control. A person diagnosed with hypertension who never fills a prescription, or whose medication fails to bring readings down, is physiologically little different from someone who was never diagnosed at all. The data appear to reflect that reality: the aware uncontrolled group fared about as badly as the unaware severe group, while the measured blood pressure categories told a coherent story in both nations. Awareness without control is, from the body’s perspective, a label rather than a protection.

The authors explicitly warn against a misreading of their work. These findings should not be interpreted as evidence that hypertension awareness itself is unimportant, they conclude. Detection remains the essential gateway to treatment, and untreated severe hypertension carried some of the highest mortality risks in the study. The correct lesson is more nuanced: screening programs that stop at diagnosis, without ensuring continued clinical follow-up and sustained blood pressure control, may be capturing the credit for awareness statistics while leaving the underlying lethal physiology untouched. The researchers emphasize that hypertension detection remains important and should be followed by continued clinical follow-up and sustained blood pressure control.

For policymakers, the study arrives at a moment when hypertension burdens are climbing in both aging China and the United States, and when digital screening initiatives promise to push awareness figures ever higher. The message embedded in these two cohorts is that the numbers on the cuff, not the words on a chart, are what the body registers. Public health systems that measure success by diagnosis rates alone may be optimizing the wrong variable. The true target, this research suggests, is sustained control, verified by measurement, for everyone whose blood pressure sits in the danger zone, whether or not they have ever heard a doctor speak the word hypertension.

Subject of Research: Association of hypertension awareness and blood pressure severity with all-cause mortality in Chinese and US population cohorts

Article Title: Hypertension awareness, blood pressure severity, and all-cause mortality: independent analyses of population-based cohorts in China and the United States

Article References: Gao, Y., Peng, Y., & Wang, Y. (2026). Hypertension awareness, blood pressure severity, and all-cause mortality: independent analyses of population-based cohorts in China and the United States. BMC Public Health. https://doi.org/10.1186/s12889-026-29908-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29908-3

Keywords: hypertension, blood pressure, all-cause mortality, awareness, CHARLS, NHANES, systolic blood pressure, blood pressure control, Cox proportional hazards, epidemiology, public health, cohort study

The technical definition matters here, and most participants missed it. Microplastics are plastic particles smaller than 5 millimeters in diameter, a threshold adopted in much of the environmental health literature to distinguish them from larger macroplastic debris. Yet when the researchers asked participants to identify microplastics correctly, only 96 women — 16.0 percent of the total sample — could do so, correctly describing them as plastic particles smaller than 5 mm. The remaining women either offered incorrect definitions or could not answer at all. This gap between having heard of a term and understanding what it means is a recurring theme in environmental health communication, and the South Indian data suggest it applies forcefully to microplastics, a pollutant that has moved from obscure oceanographic literature to mainstream headlines in less than a decade.

What the survey also revealed was how little participants knew about where microplastics actually turn up in daily life. Awareness that microplastics may be present in drinking water was reported by 172 participants, or 28.66 percent, while awareness of their presence in seafood was reported by 164 participants, or 27.33 percent. In other words, roughly seven in ten pregnant women surveyed did not know that the water they drink and the fish they eat may carry microscopic plastic fragments. These are the two exposure routes most consistently documented in environmental monitoring studies worldwide, from bottled water analyses to shellfish surveys, and they are precisely the routes that a pregnant woman might reasonably want to know about when weighing dietary choices during pregnancy.

The most sobering numbers concerned the biological endpoints closest to pregnancy itself. Microplastics have been detected in the human placenta in laboratory studies, and researchers have also reported finding them in breast milk. Yet when the survey asked participants whether they knew about these findings, only 13 women — 2.16 percent — indicated awareness that microplastics had been detected in the placenta, and only 8 women — 1.33 percent — knew about their detection in breast milk. These are not obscure facts from a specialist journal; they are findings that have been widely reported in the popular press and that speak directly to the maternal-fetal interface. The near-total unawareness among the women surveyed suggests that even when microplastic research reaches the public sphere, it is not reaching the pregnant women who may be most affected by it.

Education emerged as the strongest predictor of awareness in the survey. When the researchers used chi-square tests to examine associations between educational status and awareness of microplastics, they found that higher educational attainment was significantly associated with greater awareness, with a p-value of 0.001. In practical terms, this means the knowledge deficit was not evenly distributed across the sample; women with less formal education were substantially less likely to have heard of microplastics at all. This pattern has implications for how environmental health information is designed and delivered. If awareness of a pollutant tracks educational level, then public health messaging that relies on written materials, social media campaigns, or general news coverage may systematically bypass the populations with the least formal schooling — the same populations that may face the highest cumulative exposures from environmental pollution.

Interestingly, awareness and concern did not translate into action. Although 228 participants — 38.0 percent — expressed concern about microplastic exposure, self-reported preventive behaviours were limited across the sample. The researchers noted that even among women who said they were worried, few reported taking concrete steps to reduce their exposure, such as changing water sources, altering seafood consumption, or reducing plastic use in the kitchen. This gap between concern and behaviour is a well-documented phenomenon in health psychology, sometimes described as the knowledge-behaviour gap, and it suggests that simply informing people about a risk is rarely enough to change what they do. Behaviour change typically requires a combination of awareness, perceived susceptibility, perceived severity, self-efficacy, and practical alternatives — and the survey suggests most of these ingredients were missing among the women studied.

The survey was conducted between January and May 2025 among 600 pregnant women attending a tertiary care centre in South India. Participants completed a structured, validated questionnaire assessing sociodemographic characteristics, awareness and knowledge of microplastics, perceived health risks, and self-reported preventive behaviours. The researchers analysed the data using descriptive statistics and chi-square tests to examine associations between educational status and awareness. The study protocol was reviewed and approved by the SRM-Institutional Ethics Committee, with participation entirely voluntary and informed consent obtained from all participants prior to enrolment. The study complied with the provisions of the Declaration of Helsinki, and confidentiality was strictly maintained throughout.

Why does this matter for maternal and fetal health? Microplastic pollution has emerged as a significant environmental and public health concern, with increasing detection in human tissues and growing concern about potential risks during pregnancy and early development. Researchers have reported finding microplastics in human blood, in lung tissue, in the placenta, and in breast milk, and animal studies have suggested possible effects on inflammation, oxidative stress, and reproductive outcomes. While the human health effects of microplastic exposure remain an active area of investigation and are not yet fully characterised, the very presence of these particles at the maternal-fetal interface has raised questions about whether exposure during pregnancy could affect fetal development. The South Indian survey does not measure exposure itself; it measures what women know about it. But the near-total unawareness it documents suggests that if microplastic exposure does pose risks during pregnancy, the women most likely to be exposed may have no idea the risk exists.

The researchers argue that the findings point toward a practical intervention: integrating targeted, culturally appropriate educational interventions into antenatal care. Antenatal visits are among the most frequent and trusted points of contact between pregnant women and the health system, and they offer a natural setting for discussing environmental exposures alongside nutrition, infection prevention, and other pregnancy-related topics. The authors suggest that such interventions may enhance awareness and encourage lower-plastic-use behaviours among pregnant women. At the same time, they are careful to note that the effects of these educational interventions on actual exposure and on maternal or fetal health outcomes require further study. In other words, the survey establishes a baseline of what women know, not what changing that knowledge would accomplish.

The study also highlights a broader challenge for environmental health communication in low- and middle-income countries. Microplastic research has largely been conducted in high-income settings, and much of the public awareness that exists has been shaped by coverage in English-language media and by campaigns aimed at consumers in wealthy countries. The South Indian data suggest that this awareness has not travelled to the populations that may face some of the highest cumulative exposures from plastic pollution, whether through drinking water, seafood, or airborne particles in rapidly urbanising environments. As microplastic detection methods improve and more human biomonitoring studies are conducted in diverse populations, the gap between what researchers know and what the public understands is likely to become an increasingly important target for public health action. The authors conclude that substantial knowledge deficits and limited self-reported preventive behaviours related to microplastic exposure exist among pregnant women in South India, and that addressing these deficits through antenatal care may be a practical first step toward reducing exposure during one of the most sensitive windows of human development.

Subject of Research: Gaps in knowledge and awareness of microplastic exposure among pregnant women in South India: implications for maternal and fetal health

Article Title: Gaps in knowledge and awareness of microplastic exposure among pregnant women in South India: implications for maternal and fetal health

Article References: Panneerselvam, D., & Murugesan, A. (2026). Gaps in knowledge and awareness of microplastic exposure among pregnant women in South India: implications for maternal and fetal health. BMC Public Health. https://doi.org/10.1186/s12889-026-29592-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29592-3

Keywords: Gaps, knowledge, awareness, microplastic, exposure, pregnant, women, South, India, implications, maternal, fetal