The study, led by Ryan Nall of the University of Florida College of Medicine with colleagues from institutions across the country and the Alliance for Academic Internal Medicine, surveyed clerkship directors at U.S. medical schools who hold membership in Clerkship Directors in Internal Medicine, the national organization that represents the faculty responsible for running the core rotation. Of 141 clerkship directors invited to participate, 114 completed the survey, an exceptionally strong response rate of 80.9 percent that lends considerable weight to the results. The cross-sectional instrument collected descriptive data on the fundamental architecture of the clerkship: how long it lasts, which educational models it employs, what students experience on inpatient wards and in outpatient clinics, and how all of this has shifted relative to the period before the pandemic. Because the survey captured a nationally representative sample, the findings can reasonably be generalized to the vast majority of MD-granting schools in the United States.

The headline structural finding is one of continuity. Nearly nine in ten clerkships, 87.7 percent, still use the traditional block model, in which students are immersed in internal medicine for a concentrated period rather than weaving the specialty through an entire academic year as in longitudinal integrated clerkships. The median clerkship length stands at eight weeks, a figure that has remained remarkably consistent across successive national surveys. This persistence is notable given that longitudinal models have attracted substantial enthusiasm in the education literature for more than a decade. Studies of longitudinal integrated clerkships have documented benefits for continuity of relationships between students, preceptors, and patients, and prior surveys of clerkship directors explored the diffusion of these innovations. Yet the block model endures as the dominant format, likely reflecting institutional inertia, scheduling complexity, faculty capacity, and the logistical costs of restructuring an entire clinical curriculum around a minority model.

Beneath that stability, however, the survey documented measurable post-pandemic compression. Compared with the pre-pandemic period, 34.2 percent of clerkships reported an increase in the number of students assigned per rotation, while 19.3 percent reported a decrease in overall clerkship length. These two trends point in the same direction: more learners passing through less protected time. The authors characterize this as clerkship directors navigating increasing complexity in the learning environment, alongside structural, institutional, and system-level challenges. Rising student density on teaching services has been a recurring concern in the hospital medicine literature, where studies of direct-care teaching services have examined how many learners can be accommodated without diluting the educational experience or compromising patient care. A clerkship that simultaneously absorbs more students per rotation and shortens its duration faces a compounding challenge to the apprenticeship model at its core.

Ambulatory training emerged as one of the most striking weak points in the current landscape. Only 49.6 percent of clerkships require an internal medicine-specific ambulatory experience, meaning that roughly half of American medical students complete the core internal medicine rotation without a mandatory outpatient component in the discipline. This is a paradoxical finding for a specialty that defines itself around comprehensive, longitudinal care of adults, and it echoes longstanding critiques that undergraduate medical education underweights chronic disease and outpatient management relative to acute hospital care. The ambulatory half of internal medicine, where hypertension, diabetes, and preventive care are actually managed, remains an optional experience for a substantial share of students. As physician workforce projections raise alarms about the adequacy of the future physician supply and the distribution of generalist physicians, the marginal status of outpatient training within the flagship generalist clerkship is a detail with potentially outsized consequences.

The pandemic’s imprint on teaching methods is also visible in the data, though in a way that suggests partial reversal rather than permanent transformation. A full 92.0 percent of clerkships have returned to in-person didactics since the pandemic, indicating that the wholesale shift to remote learning that defined 2020 and 2021 has largely been unwound for the core rotation’s classroom teaching. This finding aligns with systematic reviews comparing blended and traditional learning in medical education, which have shown that digital formats can match traditional instruction on some outcomes but rarely replicate the tacit learning of the clinical workplace. The rapid return to in-person teaching suggests that clerkship directors, having experimented with virtual didactics under duress, judged face-to-face instruction essential to the clerkship’s mission even as many institutions retain hybrid elements elsewhere in their curricula.

Perhaps the most sobering results concern the challenges clerkship directors themselves identify as most pressing. The most common difficulties reported were ensuring that students receive formative feedback, recruiting enough faculty preceptors, and delivering faculty development. Each of these points to a structural vulnerability in clinical education. Formative feedback, the low-stakes coaching that allows students to correct errors before high-stakes assessment, depends on preceptors having time and skill to observe and critique performance. Preceptor recruitment is strained by the same workforce pressures documented in recent analyses of the physician pipeline, as clinical productivity demands compete with teaching obligations. Faculty development, meanwhile, requires institutional investment in clinicians as educators, an investment that is easy to defer when clinical volumes surge. That these three challenges top the list suggests the clerkship’s most serious problems are not curricular but human: too few trained teachers, with too little time, for a growing cohort of learners.

The survey arrives at a moment of unusual flux in how clinical performance is measured. The transition of USMLE Step 1 to pass/fail scoring has shifted weight toward clerkship evaluations and away from a single numerical score, intensifying scrutiny of assessment practices within rotations. Commentators have described a shadow economy of effort emerging around pass/fail grading, with unintended consequences for how students engage with clinical work, and others have called for rebuilding clerkship assessment around objectivity and equity. Against this backdrop, the survey’s finding that clerkship directors struggle to guarantee formative feedback takes on added significance: if national licensing examinations no longer differentiate students numerically, the quality of day-to-day feedback and evaluation within the clerkship becomes the load-bearing element of the assessment system, and it is precisely that element directors report as most fragile.

There is also a genuinely reassuring thread running through the data. Despite the pressures of increased student numbers, shortened rotations, and strained preceptor pools, the authors report that clerkship directors have maintained stable learner density on rotations and preserved ambulatory training within the clerkship overall. The median eight-week duration and the dominant block structure have held. In other words, the system has bent without breaking. The pandemic prompted clerkship directors to reevaluate their curricula and educational strategies, and the resilience they demonstrated, restoring in-person teaching and holding core structures in place, represents a quiet institutional achievement that rarely makes headlines but directly shapes the competence of every graduating physician who passes through an internal medicine ward.

What the survey ultimately provides is a baseline for the decisions ahead. Medical schools continue to multiply, with recent counts documenting steady growth in MD-granting institutions and enrollment, which will only intensify the competition for teaching patients, teaching beds, and teaching faculty. Workforce analyses published in leading journals warn of mounting challenges to sustaining a robust physician pipeline, making the internal medicine clerkship, the specialty’s principal recruitment and training vehicle, a strategic asset rather than a curricular formality. Whether the field responds by protecting clerkship length, capping learner density, mandating ambulatory experiences, and investing in preceptor development will determine whether the next national survey documents recovery or continued erosion. For now, the picture is clear: the traditional clerkship endures, but the margins are thinning, and the educators who run it know exactly where the strain is greatest.

Subject of Research: National survey of the structure of the internal medicine clerkship in U.S. medical schools

Article Title: Current Landscape of the Internal Medicine Clerkship: A National Survey

Article References: Nall, R., Pincavage, A., Ratcliffe, T. A., Williams, W., Mullick, D. T., Duca, N. S., Kisielewski, M., Eadie, E., Weinstein, A. R., & Lai, C. J. (2026). Current Landscape of the Internal Medicine Clerkship: A National Survey. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10718-7

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10718-7

Keywords: internal medicine, clerkship, medical education, clerkship directors, COVID-19, ambulatory training, block rotation, formative feedback, preceptors, undergraduate medical education, national survey, Journal of General Internal Medicine

The numbers tell a stark story. Perceived availability of sports facilities or adequate spaces near the home was 92.1 percent among adults with disabilities and 91.4 percent among those without, a difference so small it vanished statistically (crude prevalence ratio 1.01; 95 percent CI 0.99 to 1.03; p = 0.478). But when the researchers asked who actually used those available spaces, the picture inverted. Only 29.9 percent of adults with disabilities who had spaces nearby reported using them, compared with 42.7 percent of adults without disabilities. That translates into a 22 percent higher prevalence of non-use among people with disabilities, a gap that persisted even after the researchers adjusted for sex, age group and socioeconomic status.

The study, published in Frontiers in Sports and Active Living, is the first to separate perceived availability from actual use along the full access chain in a national surveillance instrument, and it does so with unusual methodological care. The team classified disability into six mutually exclusive categories: sensory only, physical only, cognitive only, multiple types, other only, and none. They then used weighted Poisson regression with robust variance to estimate prevalence ratios, adjusting for confounders selected a priori through a directed acyclic graph rather than by statistical fishing. Because the public database provided survey weights but not stratum or cluster identifiers, the researchers approximated variance using a Kish design effect of 2.51, and they confirmed that their conclusions held when they recomputed key contrasts under design effects ranging from 2.0 to 3.0.

The weighted prevalence of disability in the sample was 9.3 percent, with sensory disability alone accounting for 57.4 percent of the group with disabilities, followed by physical only at 28.6 percent. Adults with disabilities were older (45.0 percent aged 60 or older, versus 19.7 percent of those without), more frequently women (55.8 percent versus 50.5 percent), and more frequently of low socioeconomic status (38.7 percent versus 31.0 percent). These demographic differences matter because they partially explain the crude inactivity gap: 40.5 percent of adults with disabilities were physically inactive compared with 27.0 percent of those without, a raw difference of roughly 13.5 percentage points that narrowed to a prevalence ratio of 1.22 after adjustment. The persistence of that association after controlling for demographics indicates a disability-specific disadvantage beyond age structure alone.

What makes the finding actionable is the barrier profile among non-users. Among the 634 adults with disabilities and 3,635 without who reported having available spaces but not using them, three barriers stood out as significantly more frequent in the disability group. Distance or difficulty of access was reported by 14.0 percent versus 7.7 percent (prevalence ratio 1.82; 95 percent CI 1.44 to 2.31). Lack of companionship was reported by 25.9 percent versus 16.8 percent (PR 1.54; 1.31 to 1.80). Presence of crime was reported by 26.4 percent versus 21.4 percent (PR 1.23; 1.06 to 1.44). Inadequate lighting was borderline (15.3 percent versus 12.2 percent; PR 1.25; p = 0.046). Notably, complaints about poor maintenance were actually less frequent among adults with disabilities (19.2 percent versus 23.5 percent; PR 0.82), which the authors interpret as evidence that the excess is not driven by a uniformly more negative perception of the environment but concentrates in barriers plausibly related to functional limitations: getting to the space and having support once there.

The heterogeneity across disability types adds another layer. Adults reporting multiple disability types showed the strongest association with non-use of available spaces (adjusted PR 1.47; 1.35 to 1.60), followed by cognitive only (1.29; 1.00 to 1.67), other only (1.20; 1.01 to 1.43), physical only (1.14; 1.05 to 1.24) and sensory only (1.09; 1.02 to 1.17). This ordering mirrors international evidence: among Spanish users of adapted sport programs, environmental barriers predominated in visual disability while intrinsic barriers predominated in physical and intellectual disability. The pattern is consistent with the global estimate that people with disabilities are 16 to 62 percent less likely to meet physical activity guidelines, a range that reflects precisely this heterogeneity across disability types and contexts.

The stratified analyses reveal a striking sex pattern. Disability appears to erase the male advantage in physical activity observed in the general population: men without disabilities were substantially more active than women without disabilities, but inactivity among adults with disabilities converged near 40 percent in both sexes. The interaction between disability and sex for inactivity was statistically significant (p = 0.009), with the crude prevalence ratio reaching 1.78 among men compared with 1.30 among women. Barrier profiles also diverged by group: lack of companionship weighed most heavily among adults aged 60 and over (30.5 percent versus 19.4 percent) and among men (27.7 percent versus 14.2 percent), while presence of crime was differential only among women (30.9 percent versus 24.3 percent). Distance or difficult access was elevated in nearly every stratum examined.

The policy implications are direct. Chile’s newly enacted National Policy on Physical Activity and Sport 2026-2037 acknowledges that 79.3 percent of persons with disabilities engage in no physical activity, citing the national disability survey, but delegates its quantified targets to forthcoming national and regional plans. The present findings suggest that building more infrastructure would not by itself close the gap, since perceived availability is already near universal in both groups. Instead, the actionable margins are accessibility audits and universal design retrofitting of existing spaces, safe route programs connecting homes to spaces, and accompanied or peer-supported physical activity schemes that directly target the three differential barriers identified. The authors also point to a comparatively low-cost complement: training physical education teachers, sport coaches and municipal staff in inclusive and adapted physical activity, so that existing spaces are staffed by professionals prepared to receive people with disabilities.

The study has limitations that the authors acknowledge candidly. Disability was self-reported through a brief dichotomous item battery without severity grading or use of the standardized Washington Group questions, which likely captures more severe cases; the 9.3 percent prevalence sits closer to the severe fraction of the III National Disability Study (ENDISC 2022), which estimates 17.6 percent of Chilean adults live with some degree of disability. The cognitive only group was small (n = 45), yielding wide confidence intervals. The residual

Subject of Research: Disability and use of physical activity spaces in Chilean adults

Article Title: Similar perceived availability but lower use of physical activity spaces among Chilean adults with disabilities

Article References: De Souza-Lima, J., Winckler, C., Olasagasti-Ibargoien, J., Yáñez-Sepúlveda, R., Godoy-Tapia, C., Parra-Saldías, M., Duclos-Bastías, D., Godoy-Cumillaf, A., Merellano-Navarro, E., Bruneau-Chávez, J., Reyes-Amigo, T., & Farías-Valenzuela, C. (2026). Similar perceived availability but lower use of physical activity spaces among Chilean adults with disabilities. Frontiers in Sports and Active Living, 8, Article 1969080. https://doi.org/10.3389/fspor.2026.1969080

Image Credits: AI Generated

DOI: 10.3389/fspor.2026.1969080

Keywords: physical activity, disability, Chile, built environment, accessibility, national survey, ENAFyD, public health, health equity, barriers, inclusive policy, Similar

The survey’s methodology reflects the kind of rigor that national workforce studies in medical education typically demand. Program directors, the physicians who bear ultimate responsibility for the curriculum and competency of every resident in their programs, were invited to complete a questionnaire developed by the authors and refined through both pretesting and live pilot testing with members of the Alliance for Academic Internal Medicine. The survey team, which included Verity Schaye of NYU Grossman School of Medicine, Andrew Olson of the University of Minnesota, Marygrace Zetkulic of Hackensack University Medical Center, Michael Kisielewski of the Alliance for Academic Internal Medicine, and Casey McQuade of the University of Pittsburgh, built statistical weighting into the analysis plan and explicitly estimated nonresponse bias, techniques that help ensure the reported results represent the full national landscape of internal medicine training programs rather than just the subset of directors motivated enough to reply. The study was reviewed by an independent institutional review board and deemed exempt, and participants provided informed consent through the survey itself.

Why does formal AI education in residency matter so much? The answer lies in how quickly large language models and related tools have penetrated clinical environments. Unlike previous waves of clinical technology, such as electronic health records or computerized order entry, generative AI systems are not deployed through a single institutional gateway. Residents can open a chatbot on a personal phone between patient encounters, paste in a de-identified or, worse, an identifiable clinical vignette, and receive fluent, confident, and occasionally fabricated medical advice within seconds. Surveys of internal medicine residents published in recent years have documented substantial self-directed use of these tools alongside ambivalent attitudes, with residents reporting both enthusiasm for the technology’s potential and unease about its reliability. That combination of widespread informal use and limited formal instruction is precisely the gap the new study set out to measure.

The technical risks of unsupervised AI use are not hypothetical. Research on large language model hallucinations, the phenomenon in which a model generates plausible-sounding but factually false content, has documented user-reported fabrication across consumer AI applications, and the medical domain is particularly unforgiving of such errors because the consequences fall on patients. A hallucinated drug interaction, a nonexistent guideline citation, or a subtly wrong diagnostic suggestion can propagate into clinical documentation and decision-making before any human catches it. At the same time, evidence is accumulating that these tools can meaningfully influence clinical reasoning in both directions. A randomized clinical trial published in JAMA Network Open in 2024 found that access to a large language model affected physicians’ diagnostic reasoning in measurable ways, and subsequent work on clinician-AI collaborative workflows has explored how the technology might function less as a passive tool and more as an active teammate in the diagnostic process. Both the promise and the peril argue for structured education, because untrained clinicians are poorly positioned to calibrate when to trust, when to verify, and when to ignore an AI output.

Against this backdrop, the survey’s central finding carries a sobering implication: formal education on artificial intelligence within US internal medicine residencies remains inconsistent and underdeveloped, leaving programs to improvise curricula in an area where few feel equipped to teach. Program directors reported on whether their programs offered dedicated instruction on AI, what topics that instruction covered, and what barriers stood in the way of doing more. The picture that emerges is one of a training enterprise aware that it must act but constrained by a shortage of faculty expertise, an absence of validated curricular materials, competing demands on limited educational time, and the sheer speed at which the underlying technology changes. A curriculum module written eighteen months ago may already reference tools or capabilities that have been superseded, a challenge that conventional medical education, accustomed to updating content on the scale of years rather than months, is structurally unprepared to meet.

The study did not emerge in an institutional vacuum. A companion national survey examining artificial intelligence in the internal medicine clerkship, published by an overlapping author group in the same journal, documented similar dynamics at the undergraduate medical education level, suggesting that the gap begins before residency and persists through it. Meanwhile, accrediting and standard-setting bodies have begun to respond. The Accreditation Council for Continuing Medical Education issued guidance in 2026 on the use of artificial intelligence in accredited continuing education, acknowledging that the technology now touches how physicians learn as well as how they practice. Scholars of medical education, including Marc Triola and Rodman’s collaborators writing in Academic Medicine, have argued that integrating generative AI into medical training requires coordinated attention to curriculum, policy, and governance, rather than leaving individual instructors to improvise. The new residency survey provides the empirical baseline against which such proposals can be judged.

What would adequate AI education for internal medicine residents actually look like? The literature points toward several core components. Residents need a working technical literacy: an understanding of what large language models are, how they are trained on vast text corpora, why they generate probabilistic rather than verified outputs, and why their fluency can mask unreliability. They need prompt-level skills, the ability to structure a query so that a model’s strengths are exploited and its weaknesses exposed. They need verification habits, including the discipline of checking AI-generated citations and clinical claims against primary sources before acting on them. They need to understand privacy and data governance, because entering patient information into unapproved consumer tools can violate institutional policy and health privacy law. And they need to understand bias, since models trained on historical medical data can reproduce and amplify documented inequities in care. None of these topics requires a residency program to teach computer science, but all of them require faculty who are themselves conversant enough to lead the discussion.

The barrier most frequently implicated in the survey context, faculty expertise, illustrates a structural irony of the moment. The physicians most fluent in AI are often early in their careers or embedded in technical fields, while the educators responsible for residency curriculum were trained in an era when the dominant computational tools of medicine were databases and search engines. Closing that gap will require deliberate faculty development, partnerships between clinical departments and informatics or data science units, and shared curricular resources that individual programs can adopt rather than each rebuilding from scratch. The authors’ decision to publish their survey summary results and methodology openly, including the statistical weighting plan and nonresponse bias estimates, reflects a broader push within the Alliance for Academic Internal Medicine to make national educational research transparent and reusable.

The stakes extend well beyond the residency classroom. Today’s residents will practice for decades in environments where AI is woven into documentation, diagnostic support, triage, and patient communication. If their only training comes from trial and error with consumer chatbots, the profession will have abdicated one of its core responsibilities: ensuring that every physician who holds itself out as competent can use the tools of contemporary practice safely and critically. The survey also carries a message for patients, who increasingly encounter AI-generated content in their care, from portal messages to after-visit summaries, often without knowing it. A physician workforce trained to interrogate those outputs is a direct patient safety safeguard.

What happens next will depend on whether the survey’s findings catalyze action at the level of accreditation, specialty societies, and individual programs. The infrastructure already exists: national program director networks, annual surveys that can track progress over time, and a growing evidence base on how AI affects clinical reasoning. The Journal of General Internal Medicine study, received in June 2026 and published in September, arrives at a moment when the question is no longer whether internal medicine should teach about artificial intelligence but how quickly programs can build the expertise to do it well. The survey’s most important contribution may be its candor: it documents, with national scope and methodological care, exactly how far the training system still has to go, and it gives educators, accreditors, and policymakers a shared factual baseline from which to start closing the gap.

Subject of Research: AI education in US internal medicine residency programs

Article Title: Education on Artificial Intelligence in US Internal Medicine Residencies: Results of a National Survey

Article References: Bonifacino, E., Schaye, V., Olson, A., Zetkulic, M., Kisielewski, M., & McQuade, C. N. (2026). Education on Artificial Intelligence in US Internal Medicine Residencies: Results of a National Survey. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10811-x

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10811-x

Keywords: artificial intelligence, medical education, internal medicine residency, large language models, program directors, national survey, graduate medical education, hallucinations, clinical reasoning, curriculum, generative AI, patient safety

The study, led by Roberta Asher, Rachael M. Taylor and colleagues at the University of Newcastle and Hunter Medical Research Institute, took the form of a cross-sectional online survey. A total of 208 health professionals completed it, spanning the disciplines most directly involved in day-to-day diabetes management: dietitians made up 48 percent of respondents, credentialled diabetes educators 34 percent, general practitioners 11 percent, and practice nurses 7 percent. Participants were asked to report both the facilitators that help them deliver medical nutrition therapy, often abbreviated to MNT, and podiatry care for adults with diabetes, and the barriers that get in the way. The quantitative responses were summarised with descriptive statistics, while the free-text answers were sorted into themes using inductive content analysis, a technique that lets categories emerge from the data rather than being imposed in advance.

Medical nutrition therapy is the formal term for individualised dietary counselling delivered by a qualified dietitian, and clinical guidelines around the world position it as a cornerstone of diabetes management. The survey found grounds for cautious optimism here: the most frequently reported facilitator, cited by more than 70 percent of respondents in every discipline, related to health professionals’ own nutrition knowledge for diabetes management. In other words, the clinicians who refer and deliver this care feel confident in the underlying science of diet and blood glucose. That confidence, however, sits alongside a striking problem identified by the dietitians themselves: adults with diabetes were receiving conflicting nutrition advice from other health professionals, which directly undermined patients’ willingness to take up formal nutrition therapy. When a patient hears one message from their dietitian and a different one from another member of their care team, the result is confusion, distrust, and disengagement.

The barriers reported by the non-dietitian disciplines tell the other half of the story. Health professionals outside dietetics identified patient reluctance to consult a dietitian as a major obstacle, alongside a lack of understanding of the importance of nutrition within their own ranks, and limited availability of dietetic services in the first place. This is a layered problem. Patients are hesitant to book appointments they may not fully understand; some referring clinicians do not emphasise nutrition strongly enough; and even when both parties are willing, the service may simply not exist nearby. Each layer compounds the others, which helps explain why Australian allied health services, including dietetics and podiatry, remain underused by adults with diabetes despite being explicitly recommended in clinical guidelines.

On the podiatry side of the ledger, the survey found a genuine structural success. Foot assessment was performed by many health professionals—more than 65 percent in each discipline—as part of an annual cycle of care, the structured review schedule that Australian diabetes care is built around. This matters because diabetic foot disease is one of the most feared complications of the condition: peripheral neuropathy dulls sensation, peripheral arterial disease impairs healing, and the combination can turn a minor ulcer into an infection that ends in amputation. Regular professional foot checks are the single most effective way to catch problems early, and the fact that this assessment is embedded in routine annual care appears to be working as intended. The system, in this one respect, is doing what the guidelines ask of it.

But the podiatry findings also exposed two stubborn barriers. The first was appointment cost, reported by between 48 and 53 percent of respondents in each discipline. Private podiatry in Australia is often only partially subsidised, and for patients managing the considerable ongoing expenses of diabetes—glucose monitoring, medications, transport—out-of-pocket fees for foot care can feel like a discretionary luxury rather than essential preventive medicine. The second barrier was patients’ lack of understanding of why a podiatry foot assessment matters for diabetes management, reported across a remarkably wide range of 48 to 93 percent depending on discipline. That spread is itself informative: general practitioners and practice nurses, who see the consequences of neglected feet in their practices, appear far more aware of the stakes than some other professional groups, or perhaps more attuned to their patients’ misconceptions.

The technical architecture of the study deserves attention because it shapes how the results should be read. As a cross-sectional survey, it captures a snapshot of professional opinion at a single point in time rather than tracking outcomes in patients, so it measures perceived barriers and facilitators, not hard clinical endpoints such as amputation rates or glycaemic control. The sample of 208 is respectable for a national professional survey but is dominated by dietitians and diabetes educators, with only 11 percent general practitioners, which means the perspectives of the medical workforce that does most of the referring are represented more thinly. The inductive content analysis of qualitative responses is a strength, allowing unexpected themes such as conflicting nutrition advice to surface, but the themes are a posteriori categories and would benefit from confirmation in future studies. The study received ethics approval from the Hunter New England Human Research Ethics Committee and was conducted in accordance with the Declaration of Helsinki, and the authors declared no competing interests.

Placed in global context, the findings carry weight well beyond Australia. With at least 10 percent of adults worldwide living with diabetes and half of those cases untreated with glucose-lowering medication, the burden falls disproportionately on health systems that can least afford complications. Nutrition therapy and foot screening are among the most cost-effective interventions available: better dietary management can delay or prevent the need for medication escalation, and early detection of foot pathology can avert amputations that cost orders of magnitude more than the screening visit itself. If even a wealthy system with universal health insurance infrastructure struggles to deliver these services reliably, the barriers identified here—cost, awareness, workforce availability, and contradictory advice—are likely to be magnified elsewhere.

The authors’ conclusion is correspondingly practical: increasing health professionals’ knowledge of general nutrition advice, as well as the role and value of dietetic and podiatry services, will be important for improving diabetes care. That recommendation cuts in two directions. Referring clinicians need enough nutrition literacy to give consistent, evidence-based messages that reinforce rather than contradict the dietitian’s plan, and patients need clearer communication about why an annual foot check or a session with a dietitian is not an optional extra but a core component of staying well with diabetes. The funding for the work came from a Hunter Medical Research Institute Colonial Diabetes Alliance Program Grant, with the funder having no role in the study’s design, analysis, or reporting.

What makes this survey genuinely useful is that it converts a vague sense that allied health is underused into a specific, actionable checklist. Embedding foot assessment in the annual cycle of care has demonstrably worked; the same logic suggests that embedding consistent nutrition messaging across the whole care team, subsidising podiatry access for high-risk patients, and educating both clinicians and patients about the value of these services could close the remaining gaps. Diabetes is a disease managed largely between clinic visits, in kitchens and bathrooms and on daily walks, and the professionals surveyed here have identified exactly which levers need pulling to support that daily self-management. The evidence now exists; the task is turning survey findings into referral pathways, funding decisions, and conversations that patients actually hear.

Subject of Research: Barriers and facilitators to delivering medical nutrition therapy and podiatry care for adults with diabetes

Article Title: Barriers and facilitators to delivering medical nutrition therapy and podiatry care for adults with diabetes: a national survey of health professionals

Article References: Asher, R., Burrows, T., Acharya, S., Parsons, M., Southwell, A., Joseph, M., Redford, M., Chan, K., Ross-Evans, S., Tehan, P. E., Martin, E., Stanford, J., Clarke, E., Hure, A., Donnelly, H., Collins, C. E., & Taylor, R. M. (2026). Barriers and facilitators to delivering medical nutrition therapy and podiatry care for adults with diabetes: a national survey of health professionals. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02604-4

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02604-4

Keywords: diabetes, medical nutrition therapy, podiatry, dietitians, health professionals, national survey, barriers, facilitators, foot assessment, diabetes educators, allied health, diabetes management

The study, led by Clement P. Buclin of Geneva University Hospitals and the University of Geneva together with colleagues across Swiss and Canadian institutions, was conducted between March and June 2025. The researchers embedded questions on GLP-1 receptor agonist use into an omnibus survey run with the Swiss Federal Office for Statistics, using a probabilistic sampling design so that the 5,818 respondents surveyed could be weighted to represent 7.43 million individuals nationwide. This approach matters because most existing evidence on GLP-1 uptake comes from prescription databases or insurance claims, which capture only the formal, physician-mediated pathway. By asking people directly, the team could detect use that never appears in any pharmacy record, including medications bought abroad, obtained through informal networks, or shared within households.

The headline prevalence figure of 2.5 percent, with a 95 percent confidence interval of 2.1 to 3.0 percent, may sound modest, but it translates into a substantial population burden for a drug class that requires ongoing injections, careful dose titration, and monitoring for gastrointestinal and other adverse effects. Semaglutide emerged as the most frequently reported agent, consistent with its dominance in both diabetes and obesity treatment guidelines and its outsized presence in public discourse. The finding that weight loss, rather than glycemic control, was the primary indication among most users underscores how thoroughly these agents have been repositioned in the public mind from diabetes drugs to lifestyle medications, a shift that regulators and clinicians are still catching up with.

Statistically, the survey revealed that use was strongly patterned by body size and, intriguingly, by perceived weight status. In multivariable models adjusting for other factors, participants reporting important overweight had nearly seven times the odds of using a GLP-1 receptor agonist compared with those reporting normal weight, with an odds ratio of 6.94 and a confidence interval of 3.01 to 16.02. Among those with a body mass index of 35 kilograms per square meter or higher, the odds ratio climbed to 8.54, with a confidence interval of 4.34 to 16.81. These gradients are exactly what clinical guidelines would predict, since obesity indications are typically reserved for people with a BMI of 30 or above, or 27 and above with weight-related comorbidities. The fact that the observed association tracks BMI so cleanly suggests that, at the population level, the drugs are at least reaching the populations for which they were designed.

One of the more unexpected results concerned gender. Despite the intense marketing of these drugs toward women in popular media, and despite women’s generally higher engagement with weight-loss interventions, the survey found no independent association between gender and GLP-1 receptor agonist use once age, BMI category, and self-reported weight status were accounted for. Age, by contrast, was independently associated with use, with the relationship varying across the lifespan in ways the authors suggest reflect both the epidemiology of obesity and prescribing caution in older adults. This dissociation between perceived demand and actual use patterns is a useful corrective to anecdotal impressions and highlights why representative surveys remain indispensable even in an era of big prescription data.

The most policy-relevant finding, however, lies in the informal access pathway. Among users, 7.3 percent reported obtaining the medication at least once outside physician-led prescribing pathways, or passing it forwards to family and friends. Weighted to the national level, that corresponds to more than 13,500 individuals in Switzerland. In practical terms, this means vials and pens intended for a single named patient are being split, lent, or sold within social networks, a practice with real pharmacological consequences. GLP-1 receptor agonists require individualized dose escalation, screening for contraindications such as personal or family history of medullary thyroid carcinoma or pancreatitis, and monitoring for red-flag symptoms. A medication borrowed from a friend arrives with none of that scaffolding, and the person receiving it may not even know the correct injection technique or storage requirements.

Perhaps most telling is who these informal users are. The study found that people reporting informal access were younger, more likely to be single, and more likely to report normal weight than formal-pathway users. That profile, young, socially connected, and not meeting conventional obesity thresholds, paints a picture of cosmetic or preventive use flowing through peer networks rather than medical channels. It also raises the possibility that informal access functions as a workaround for people who cannot obtain a prescription because they do not meet clinical criteria, or who face cost barriers, waiting lists, or reluctance to discuss weight with a physician. Whatever the mechanism, the direction is clear: the tighter the formal gatekeeping, the greater the incentive to find the drug elsewhere, and the younger the population doing so.

The clinical implications extend beyond Switzerland. Semaglutide and related agents such as tirzepatide act on the GLP-1 receptor to slow gastric emptying, enhance satiety, and improve insulin secretion in a glucose-dependent manner, effects that translate into substantial average weight reductions in trials but also into nausea, vomiting, and, rarely, more serious events such as pancreatitis and gallbladder disease. Discontinuation typically leads to weight regain, meaning these are long-term therapies, not short courses. When use migrates into informal channels, the risks multiply: no baseline assessment, no titration schedule, no adverse-event reporting, and no mechanism for detecting counterfeit or improperly stored products. Regulators across Europe and North America have already warned about compounded and counterfeit semaglutide circulating outside legitimate supply chains, and the Swiss data provide a quantitative estimate of how much informal circulation may underlie those warnings.

The authors argue that informal access among younger adults with lower BMI warrants both clinical and policy attention, and the survey gives policymakers a baseline against which future interventions can be measured. Possible responses include clearer public communication about who benefits from these drugs and who does not, tighter stewardship of the supply chain, and better access to structured obesity care so that patients are not pushed toward informal sources by default. The study also demonstrates the value of the omnibus survey model: by piggybacking a small set of well-designed items onto an existing national survey, the team produced actionable prevalence estimates at modest cost, funded by the Department of Medicine at Geneva University Hospitals, with no role for the funder in design, analysis, or reporting.

As GLP-1 receptor agonists continue their march from specialty clinics into everyday life, the Swiss survey offers a template for surveillance that other countries would do well to copy. It quantifies not just how many people use these drugs, but who uses them, why, and through which channels, revealing a hidden layer of informal circulation concentrated among the young and the slim. If the global trajectory of these medications mirrors what Switzerland is already experiencing, the coming years will see informal access grow alongside legitimate prescribing, and health systems will need data of exactly this kind to keep the balance between access and safety. For now, the message is sobering: the Ozempic era is not only bigger than prescription records suggest, it is also less visible, less supervised, and younger than most clinicians might assume.

Subject of Research: Population-level use and informal access pathways of GLP-1 receptor agonists in Switzerland

Article Title: Use and informal access to GLP-1 receptor agonists in Switzerland: a national survey

Article References: Buclin, C. P., Bonnet, R., Mongin, D., de Marcos, L., Reny, J.-L., Agoritsas, T., & Courvoisier, D. S. (2026). Use and informal access to GLP-1 receptor agonists in Switzerland: a national survey. BMC Medicine. https://doi.org/10.1186/s12916-026-05206-y

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05206-y

Keywords: GLP-1 receptor agonists, semaglutide, obesity, weight loss, Switzerland, national survey, informal access, prescription drugs, self-medication, BMI, public health, drug safety

The scale of the findings challenges long-held assumptions about who is affected by violence in America. According to the report, intimate partner violence alone has touched six in ten women and nearly half of men over their lifetimes. Among women, the severity of some of these experiences is particularly alarming: nearly one in five women, 19 percent, reported potentially lethal intimate partner violence, a category that includes beating, burning, strangulation, or violence involving a knife or gun. By comparison, 3 percent of men reported experiences in this most severe category. The researchers emphasize that these figures are not abstractions but reflect the experiences of millions of people whose encounters with violence often never appear in any police blotter or court record.

Methodologically, USVEX represents a significant departure from the administrative data sources that have historically shaped American understanding of violence. Crime reports and official statistics depend on incidents being formally reported, which means that a substantial share of violent experiences, particularly sexual violence and violence within intimate relationships, remains invisible to researchers and policymakers. By surveying a nationally representative sample of 2,720 adults across all 50 states, administered by NORC at the University of Chicago between October and December 2025 and conducted in both English and Spanish, the study captures experiences that may never reach law enforcement or service systems. This direct-measurement approach allows violence to be examined alongside social, economic, and behavioral health factors, rather than in isolation from the conditions in which it occurs.

The survey builds on a foundation of earlier regional work. It extends the Violence Experiences Across the Lifespan series of studies previously conducted by the Newcomb Institute in California, Louisiana, Mississippi, and Texas, expanding that research program into its first nationally representative survey. This progression from state-level studies to a national baseline matters for the science of violence prevention: without representative national data, researchers cannot reliably track trends over time, identify emerging patterns, or measure whether prevention efforts are actually working. Establishing that baseline, the study’s authors argue, is itself a critical scientific contribution, one that future surveys can measure against.

One of the study’s most consequential findings concerns the relationship between economic hardship and violence. The associations documented are dramatic. Adults who experienced eviction in the previous year were seven times as likely to report recent physical violence, three times as likely to report sexual violence, and nearly five times as likely to report intimate partner violence compared with those who had not. Among people experiencing homelessness, physical violence was five times as prevalent, sexual violence more than three times as prevalent, and intimate partner violence four times as prevalent. Economic vulnerability, in other words, was consistently associated with greater exposure to physical, sexual, and intimate partner violence, suggesting that housing instability and economic precarity are not merely background conditions but central features of the violence landscape.

The connections between violence and behavioral health are equally pronounced. People reporting recent violence were significantly more likely to report depression or anxiety, suicidality, and substance use. The study examined how experiences of physical violence, sexual violence, and intimate partner violence across the lifespan intersect with behavioral health, economic hardship, neighborhood safety, substance use, and other factors associated with both violence exposure and recovery. While the survey design documents strong associations rather than proving causal direction, the pattern is clear: violence, mental health struggles, and substance use cluster together in the same lives and the same communities, reinforcing one another in ways that single-issue interventions are poorly equipped to address.

Timing emerges as another crucial dimension of the findings. The report found that violence rises substantially during adolescence and continues into young adulthood, a period when nearly one-third of adults reported experiencing sexual violence. The researchers identify these life stages as important opportunities for prevention, arguing that interventions targeted at adolescents and young adults could reach people at the moments when their risk is highest. This developmental framing shifts the focus of prevention policy away from reactive responses and toward earlier, more strategic timing, an approach the authors suggest could yield disproportionate benefits given how much lifetime violence exposure appears to be concentrated in these years.

The study also documents stark disparities in who experiences violence. Women reported higher levels of sexual violence and intimate partner violence than men, and LGBTQ+ populations reported disproportionately high levels of violence overall. These patterns, the researchers note, mean that violence is not evenly distributed across the population but follows lines of gender, sexual orientation, and economic circumstance. Understanding this uneven distribution is essential for targeting resources effectively, because a prevention strategy designed around an average experience of violence will inevitably miss the communities where exposure is most concentrated and most severe.

The study’s co-leaders argue that the findings demand a fundamental rethinking of how the United States approaches violence prevention. Anita Raj, executive director of the Newcomb Institute, noted that for too long the understanding of violence has depended largely on crime reports, leaving many experiences invisible, and that the study shows not only how common violence is but how closely these experiences are connected with economic hardship, behavioral health, and other forms of social inequality. Jakana Thomas, professor of political science at UC San Diego, emphasized that the data reveal the disparate ways violence is experienced across communities and that violence prevention cannot occur in isolation. Both argue that effective prevention must be part of a broader strategy addressing economic hardship, mental health, and social inequality alongside violence itself.

The implications reach well beyond academia. By better understanding when violence occurs, who is most at risk, and the conditions associated with it, the researchers contend that prevention efforts and resources can be targeted where they are needed most, from housing and economic support programs to behavioral health services and community-based interventions. The full report is publicly available, giving policymakers, public health officials, and advocates a common evidence base for the first time. As the first comprehensive national survey of its kind, USVEX offers something the United States has lacked: a complete, representative picture of violence as it is actually experienced across American lives, and a baseline against which future progress, or failure, can be measured.

Subject of Research: National survey of violence experiences and their links to health and economic hardship in the United States

Article Title: National study finds violence affects millions across US with links to health, economic hardship

Article References: National study finds violence affects millions across US with links to health, economic hardship. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: violence, intimate partner violence, sexual violence, physical violence, public health, economic hardship, mental health, substance use, national survey, USVEX, prevention, social inequality

The study, led by Larissa Couto-Rosa and colleagues at the Federal University of Espírito Santo, set out to fill a conspicuous gap. International research had repeatedly suggested that pharmacists in many countries hold unsatisfactory knowledge about ASD, which can interfere with the quality of care they deliver. Yet until now, no nationwide study had ever assessed the knowledge of Brazilian pharmacists about the disorder. Given that Brazil has one of the largest pharmacy workforces in the world and a universal health system that relies heavily on pharmaceutical services, the absence of such data was a genuine blind spot in health services research.

To close that gap, the team conducted a cross-sectional survey running from June 2021 to August 2022. Pharmacists from all five regions of Brazil were selected by convenience sampling and answered an online questionnaire, open from June 2021 to February 2022, that collected sociodemographic information and measured both knowledge and stigma related to ASD. The instrument at the heart of the study was the Brazilian version of the Autism Stigma and Knowledge Questionnaire, known as the ASK-Q, a validated tool that breaks understanding of autism into distinct domains: diagnosis, etiology, and treatment, alongside items probing stigmatizing attitudes.

The technical thresholds of the ASK-Q are worth understanding, because they set a demanding bar. To be classified as having adequate knowledge, respondents needed to score at least 92.3 percent on the diagnosis domain, 88.7 percent on etiology, and 92.9 percent on treatment. On the stigma scale, the expectation is even stricter: respondents should not endorse stigma at all, with the cut-off set at 99.01 percent. These are not lenient benchmarks. They require near-complete mastery of facts about how autism is identified, what causes it, and how it is treated, as well as the complete absence of misconceptions that have historically surrounded the condition.

Against those demanding standards, the 413 participating pharmacists performed remarkably well. Almost all respondents demonstrated adequate knowledge in every clinical domain: 99.0 percent reached the threshold for etiology, 99.0 percent for diagnosis, and 98.8 percent for treatment. Perhaps most striking of all, every single participant, 100.0 percent, declined to endorse stigma toward people with autism. In a field where international studies have often painted a more troubling picture of gaps and misconceptions among frontline health workers, the Brazilian results stand out as an unusually strong foundational understanding of the disorder.

The survey also revealed a clear pattern in where that knowledge came from. Pharmacists who had a family member with ASD achieved the highest rates of correct answers in the diagnosis domain, a difference that was statistically significant with a p-value below 0.001. Similarly, pharmacists who had direct contact with a person with autism scored highest on the etiology and diagnosis domains, with p-values of 0.004 and 0.002 respectively. In other words, personal exposure to autism, whether through family ties or professional and social contact, was the strongest predictor of deeper understanding. Knowledge, it seems, travels through lived experience more powerfully than through formal training alone.

The demographic profile of the sample adds important context. The majority of participants, 81.1 percent, were women, which mirrors the composition of the pharmacy profession in Brazil and much of the world. The researchers emphasize that the sample was comprehensive, spanning different age groups and socioeconomic backgrounds across the country’s five regions, which strengthens the generalizability of the findings. At the same time, they are candid about a key limitation: because convenience sampling was used, individuals with greater awareness of or interest in autism may have been more likely to agree to participate. That means the true national average could plausibly be lower than the near-perfect scores reported, a caveat that any interpretation of the results must carry.

The study was conducted with rigorous ethical oversight. It was approved by the Human Research Ethics Committee under registration CAAE 39222520.6.0000.8151, carried out in accordance with the Declaration of Helsinki, and all participants provided informed consent and agreed to confidentiality and privacy statements. The statistical analysis was appropriately matched to the data: descriptive statistics summarized the sample, the Mann-Whitney test compared unpaired samples, and the chi-square test assessed associations with categorical variables. The research received no external financial support and was conducted by a team affiliated with the Federal University of Espírito Santo and the Federal University of Catalão.

Why does pharmacist knowledge about autism matter so much in practice? Pharmacists occupy a unique position in the medication-use system. They counsel families starting new therapies, monitor for adverse effects and drug interactions, and increasingly participate in pharmaceutical care programs within Brazil’s unified health system, the SUS. For autistic patients, who may take psychotropic medications or manage co-occurring conditions, a pharmacist who understands the disorder can communicate more effectively, adapt counseling to sensory and communication needs, and flag inappropriate prescriptions. Conversely, a pharmacist who misunderstands autism may reinforce myths, dismiss family concerns, or fail to recognize when a referral is needed. The near-universal absence of stigmatizing attitudes found in this survey is particularly encouraging, because stigma is often the hardest barrier to dismantle.

The authors argue that their findings should feed directly into policy and education. The results, they write, may contribute to strategies to improve knowledge about ASD, such as continuing education programs, integrating autism training into pharmacy curricula, and public health campaigns. They may also influence public policies, clinical practices, and future research in pharmacy and autism care. Given the strong baseline documented here, the priority shifts from remediation to refinement: embedding structured ASD content into professional education so that understanding does not depend on personal contact with an autistic person. For a profession that sees millions of Brazilians every day, even incremental gains in knowledge could translate into earlier recognition of developmental concerns and better support for autistic individuals and their families, long before they reach a specialist’s office.

Subject of Research: Pharmacists' knowledge and stigma regarding autism spectrum disorder in Brazil

Article Title: Pharmacists’ knowledge about Autism Spectrum Disorder – a national survey

Article References: Couto-Rosa, L., Schultz, P. V., Brambila-Manso, B., Rocha, K. S., Ayres, L., Araújo, D. C., & Santos-Júnior, G. A. D. (2026). Pharmacists’ knowledge about Autism Spectrum Disorder – a national survey. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15564-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15564-1

Keywords: autism spectrum disorder, pharmacists, Brazil, national survey, health services research, ASK-Q questionnaire, stigma, pharmaceutical care, continuing education, cross-sectional study, public health, diagnosis knowledge

Researchers at Washington University in St. Louis, led by Kimberly J. Johnson, drew on the Behavioral Risk Factor Surveillance System, or BRFSS, a giant telephone survey run by the U.S. Centers for Disease Control and Prevention that collects health information from more than 400,000 residents each year across all fifty states, the District of Columbia, and U.S. territories. For their trend analysis, the team pooled data from 2016 through 2024, encompassing 3,968,799 respondents after imputation of missing values. For a finer-grained comparison of drinking prevalence by cancer type, they used the most recent 2022 to 2024 data from the 38 states and territories that included an optional cancer survivorship module, yielding 465,870 respondents. Because BRFSS uses complex, stratified sampling, the analysts applied survey weights and multiple imputation, then pooled estimates using established statistical rules to produce nationally representative figures.

The survey questions distinguished three patterns of consumption. Current drinking was defined as having had at least one alcoholic drink in the past 30 days. Binge drinking meant four or more drinks on a single occasion for women, or five or more for men, while heavy drinking was classified as more than seven drinks per week for women and more than fourteen for men. Cancer history came from a question asking whether a respondent had ever been told by a doctor that they had cancer, and a follow-up item identified the specific cancer type. The researchers classified head and neck, esophageal, liver, breast, and colorectal cancers as alcohol-related, following the National Cancer Institute’s categorization.

The headline finding is a story of divergence, albeit a subtle one. Among adults without a cancer history, the prevalence of current drinking declined significantly, from 53.9 percent in 2016 to 51.5 percent in 2024, an average drop of 0.28 percentage points per year. Binge drinking in this group also fell, by about 0.20 percentage points annually. Among people with a cancer history, however, current drinking was essentially flat, hovering at 45.8 percent in both 2016 and 2024, with a statistically non-significant upward drift of 0.06 percentage points per year. Binge and heavy drinking trends in survivors were similarly unremarkable. In other words, whatever forces are nudging the general population toward slightly less drinking, they do not appear to be operating among cancer survivors, who started from a lower baseline and stayed there.

That baseline gap persisted after statistical adjustment. Compared with adults never diagnosed with cancer, those with a cancer history had an adjusted prevalence of current drinking 1.01 percentage points lower and binge drinking 1.16 percentage points lower, while heavy drinking showed no significant difference. People who had survived an alcohol-related cancer, such as breast or colorectal cancer, reported current drinking at a prevalence 2.17 percentage points lower than the cancer-free population, though their binge and heavy drinking rates were not significantly different. The direction of these differences held even when the analysis was restricted to adults aged 55 and older, although the estimates were attenuated and generally lost statistical significance.

The cancer-type breakdown produced some of the study’s most intriguing results. Current drinking prevalence was significantly higher than expected among survivors of testicular cancer, melanoma, and other skin cancers, while most other cancer types showed lower prevalences, with prostate and throat or pharyngeal cancers non-significantly elevated. The most common cancer types in the dataset were breast, non-melanoma skin cancer, melanoma, and prostate cancer. Because small cell sizes limited stable estimation for binge and heavy drinking within individual cancer types, the type-specific models focused on current drinking, with sex-specific restrictions applied for reproductive cancers.

One of the most revealing analyses came from a simple sensitivity check. Because some patients reduce or stop drinking during cancer treatment, the researchers repeated their prevalence difference models excluding respondents who reported currently being in treatment. The result was striking: most of the negative prevalence differences, where survivors drank less than the cancer-free population, shifted toward zero, while some of the positive differences moved further from the null. The authors interpret this as suggesting that many individuals resume alcohol consumption once treatment ends, meaning that the apparent protective gap between survivors and others may partly reflect temporary abstinence during therapy rather than a durable lifestyle change. The cross-sectional nature of the survey data, however, prevents any conclusion that a cancer diagnosis itself causes changes in drinking behavior.

The findings arrive against a backdrop of intensifying public debate about alcohol and cancer. The scientific consensus has hardened over the past decade, with meta-analyses confirming dose-response relationships and population attributable fractions estimated at 4.4 percent for female breast cancer and as high as 31.6 percent for esophageal cancer. In 2025, the U.S. Surgeon General called for cancer warning labels on alcoholic beverages, echoing advocacy from consumer and public health groups dating back to 2019. The American Cancer Society now states flatly that it is best not to drink alcohol, and the U.S. Preventive Services Task Force recommends that adults be screened for unhealthy alcohol use. Google Trends data show a steady rise in searches connecting alcohol and cancer risk since 2004. Yet awareness remains startlingly low: in a 2024 survey, only 39.4 percent of U.S. adults knew that alcohol increases cancer risk, and earlier data suggested more than half were unaware that wine, beer, or liquor carries any such risk.

Against this context, the stability of drinking among survivors is particularly consequential. Alcohol consumption may raise the risk of second primary cancers in survivors, making continued drinking a clinically meaningful concern rather than a matter of taste alone. Prior research offers mixed signals about whether diagnosis changes behavior. A Canadian study of more than 500 survivors found that among 299 patients who drank at diagnosis, 52 percent reported reduced or no consumption one year later. A study of 973 head and neck cancer patients recorded a decline in drinking from 54.3 percent to 41.2 percent within a year of diagnosis. But a German study of 300 survivors found that 70 percent continued to drink six months after diagnosis. The new BRFSS analysis suggests that, at the population level, any such reductions are modest and may fade once treatment concludes.

The study also highlights a persistent gap in clinical practice. Although alcohol screening is recommended in oncology and primary care settings, previous research indicates that heavy drinkers with a cancer history are not consistently counseled to cut back; one study found that only 15 percent of cancer survivors consuming three or more drinks per day were advised by a provider to reduce their intake. The authors note that their results provide a contemporary baseline against which future changes can be measured, as dietary guidance and the alcohol environment evolve. They also acknowledge limitations: cancer history and alcohol use were self-reported and subject to recall and social desirability bias, some states lacked data in certain years, and small samples for some cancer types reduced precision. Survivors aware of alcohol’s risks may also under-report their drinking, potentially widening the apparent gap. Still, with nearly four million respondents, weighted analyses, and careful handling of missing data, the study stands as a sobering snapshot: as national conversation about alcohol and cancer grows louder, the drinking habits of American cancer survivors have barely moved at all.

Subject of Research: Alcohol consumption patterns and trends among U.S. adults with and without a cancer history

Article Title: Prevalence and trends in recent alcohol consumption by cancer history and cancer type in a nationally representative sample of U.S. adults

Article References: Johnson, K. J., Eyler, A. A., & Harris, J. K. (2026). Prevalence and trends in recent alcohol consumption by cancer history and cancer type in a nationally representative sample of U.S. adults. Cancer Causes & Control, 37(10), Article 167. https://doi.org/10.1007/s10552-026-02248-8

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02248-8

Keywords: alcohol consumption, cancer survivors, cancer risk, BRFSS, binge drinking, heavy drinking, cancer epidemiology, public health, surgeon general, health behavior, national survey, alcohol-related cancers

The study, led by Demet Koç and Duygu Demirbaş Keskin of the Department of Medical Education at Acıbadem Mehmet Ali Aydınlar University, together with colleagues Melike Şahiner and Levent Altıntaş, set out to map, for the first time at national scale, how Turkish medical schools are confronting the climate-health nexus. The research team distributed an online questionnaire to academic leaders responsible for undergraduate medical education across Türkiye, probing the depth of curricular integration, the perceived effectiveness of existing teaching, faculty preparedness, available educational resources, institutional strategies, and the barriers standing in the way of reform. Fifty-three faculties responded, corresponding to a response rate of 58.9 percent—an unusually broad snapshot of a national medical education system.

The headline numbers are sobering. Just 26 percent of responding faculties reported fully including climate change content in their teaching. Another 32 percent indicated only partial integration, while 42 percent reported no inclusion whatsoever. In other words, in more than four out of ten of Türkiye’s medical faculties, the health consequences of a warming planet—heat-related illness, the spread of vector-borne diseases, respiratory impacts of air pollution, water scarcity, and climate-driven displacement—simply do not appear in the training of future physicians. Where climate content does exist, it is typically embedded within pre-existing mandatory courses rather than delivered through dedicated modules, and it tends to focus on basic concepts and general health impacts rather than applied clinical skills.

The gaps run deeper than mere presence or absence of content. The survey revealed that sophisticated and increasingly essential topics are being left out almost entirely. Climate literacy—the ability to critically interpret climate science and communicate it to patients and communities—was rarely addressed. The mental health dimensions of climate change, including eco-anxiety, trauma following extreme weather events, and the psychological toll of environmental degradation, were similarly neglected. Perhaps most strikingly, climate communication—teaching future doctors how to talk with patients and policymakers about climate-related health risks—was infrequently covered, even though physicians consistently rank among the most trusted voices in public discourse.

Faculty preparedness emerged as a critical weak point. Only 5.7 percent of respondents had received any training on how to teach climate-health content. This means that even in faculties where climate change has formally entered the curriculum, the educators delivering it are, in most cases, self-taught. Medical education researchers have long recognized that curriculum reform without parallel faculty development tends to produce shallow, inconsistent teaching, and the Turkish data conform precisely to that pattern. Without structured training programs, conference workshops, or institutional incentives to build climate-health teaching capacity, early adoption risks being symbolic rather than substantive.

Institutional support was similarly thin. Few faculties reported having dedicated structures—such as curriculum committees tasked with planetary health, designated coordinators, or formal policies—that could drive sustained integration. Student-led initiatives, which have proven to be powerful engines of curriculum change in other countries and in international assessment frameworks such as the Planetary Health Report Card, were likewise rare in Türkiye. The absence of these structural scaffolds suggests that even motivated individual faculty members face an uphill battle: without administrative backing, protected time, and dedicated resources, isolated efforts rarely translate into durable curricular reform.

Perhaps the most telling finding concerns perception. When asked to evaluate the effectiveness of the climate education currently offered at their institutions, 48.4 percent of respondents rated it as ineffective. Yet this pessimism coexists with a striking consensus on the importance of the topic: over 80 percent of respondents rated climate change education as important for medical students, and 83 percent supported the development of a national guidance tool to help faculties integrate climate-health content in a standardized way. That gap—between widespread recognition of importance and pervasive dissatisfaction with delivery—captures the central dilemma of climate education in medical training today. Awareness is not the problem. Structure, resources, and coordination are.

The barriers identified by respondents reflect challenges familiar to curriculum reformers worldwide. Overcrowded curricula leave little room for new content in programs already packed with biomedical science, clinical rotations, and licensing requirements. The absence of national learning objectives or standardized guidance means each faculty must invent its own approach, producing fragmentation and duplication of effort. Limited teaching materials in the local language, scarce expertise, and low institutional prioritization compound the problem. The authors of the study conclude that climate change education in Türkiye’s undergraduate medical programs remains fragmented, underdeveloped, and inconsistently implemented, and that structural and pedagogical barriers are actively hindering progress despite growing awareness.

Why does this matter beyond Türkiye? The World Health Organization has described climate change as the single biggest health threat facing humanity, and the Intergovernmental Panel on Climate Change has documented escalating impacts on food and water security, infectious disease patterns, and extreme heat mortality. Health systems themselves are both vulnerable to these impacts and significant contributors to greenhouse gas emissions, placing physicians at the center of both adaptation and mitigation. International bodies, including the Association for Medical Education in Europe, have urged medical schools to embed planetary health across the training pipeline. A physician who cannot recognize heat stroke in a changing climate, counsel patients during air quality emergencies, or anticipate shifting disease vectors is, by any modern standard, incompletely trained. The Turkish findings therefore serve as a warning for many countries where climate-health education has been championed in declarations and position papers but has yet to reach the lecture hall.

The study’s authors point toward a clear path forward. A coordinated national strategy—anchored by the guidance tool that 83 percent of surveyed educators support—could establish minimum competencies in climate and health, provide ready-made curricular materials, and give faculties a shared framework for implementation. Parallel faculty development initiatives would address the training deficit revealed by the 5.7 percent figure, while institutional investment in dedicated structures and student engagement could sustain momentum over time. The researchers emphasize that undergraduate medical education plays a foundational role in shaping future physicians, and that integrating climate-health content has become an urgent priority. If the medical profession is expected not only to understand the health effects of climate change but also to lead mitigation, adaptation, and advocacy efforts, that preparation must begin in medical school. Türkiye’s national survey has measured the distance between aspiration and reality—and, in doing so, has handed educators, policymakers, and professional bodies a detailed map of exactly what must change.

Subject of Research: Climate change education in undergraduate medical curricula in Türkiye

Article Title: Climate change education in undergraduate medical faculties in Türkiye: a national descriptive cross-sectional study

Article References: Koç, D., Keskin, D. D., Şahiner, M., & Altıntaş, L. (2026). Climate change education in undergraduate medical faculties in Türkiye: a national descriptive cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10395-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10395-4

Keywords: climate change, medical education, Türkiye, undergraduate curriculum, planetary health, curriculum integration, faculty preparedness, cross-sectional study, BMC Medical Education, health impacts, faculty development, national survey

The research team, led by Tetsuji Minami of the National Cancer Center Japan alongside collaborators from several Japanese institutions, broke the 8.6 percent figure into distinct categories: 4.9 percent identified as gay or lesbian, 1.1 percent as bisexual, 1.0 percent as asexual or unsure of their attraction, and 1.6 percent as gender-diverse, meaning their current gender identity did not match the sex assigned to them at birth or fell outside the binary altogether. These estimates align with the 7.0 to 16.8 percent range reported in earlier Japanese studies conducted by private companies, government agencies, and sociologists, but earlier efforts suffered from convenience sampling, inadequate statistical adjustment, and narrow cohorts that limited their generalizability. By contrast, the new study calibrated its web-based sample against the Japanese government’s 2019 Comprehensive Survey of Living Conditions using a statistically demanding technique called inverse probability weighting.

The technical machinery behind the estimates deserves attention because it addresses a well-known weakness of internet surveys. Participants were drawn from a panel of 2.3 million people managed by Rakuten Insight, with stratified multistage sampling by age and sex, and a response rate of 65.7 percent among those invited. The researchers then applied two pre-set algorithms to screen out inattentive respondents, or “satisficers,” who straight-line their answers or fail directed attention checks, removing 9 percent of the raw sample. Sampling weights were predicted from a logistic regression model comparing the web survey respondents with the census-calibrated national survey, adjusting for area of residence, marital status, education, housing tenure, self-rated health, and smoking status. The resulting inverse probability weights allowed the team to produce population-level estimates with 95 percent confidence intervals, computed with a robust variance estimator, treating the findings explicitly as weighted distributions rather than causal effects, in line with modern descriptive epidemiology frameworks.

Measurement of sexual orientation and gender identity followed the internationally recommended “two-step approach,” which asks separately about sex assigned at birth and current gender identity, supplemented by a romantic and sexual attraction item to classify sexual orientation among cisgender respondents. Gender-diverse respondents were deliberately not reclassified by sexual orientation, and the authors caution that the gender-diverse category aggregates heterogeneous subgroups, including transgender, non-binary, and questioning individuals, because the survey instrument could not capture finer self-descriptions. Similarly, respondents who selected neither or unsure on the attraction item were grouped under an inclusive “asexual cisgender or unsure” label, an operationalization the authors urge readers to interpret cautiously since it may blend true asexuality with ongoing questioning. Inattentive respondents who reported anything other than male or female for assigned sex at birth were excluded as quality controls, consistent with Japan’s family register system, and were not intended to exclude minority identities.

Beyond headline prevalence, the study mapped striking demographic and socioeconomic patterns. All sexual and gender minority groups were younger on average than heterosexual respondents, with mean ages of 44.7 years for gay and lesbian participants, 38.3 for bisexual, 40.0 for asexual, and 38.4 for gender-diverse respondents, compared with 48.8 for heterosexual participants, and prevalence was concentrated under age 30. Gay respondents were more often male, while bisexual and asexual respondents were more often female, and gender-diverse respondents were evenly split by assigned sex. Marriage and partnership rates told a more complex story: only 47.7 percent of gay and lesbian respondents and 38.1 percent of gender-diverse respondents were married or partnered, versus 65.1 percent of heterosexual respondents, and a substantial share of gay and lesbian participants reported opposite-sex marriages or partnerships, a pattern the authors link to Confucian family norms emphasizing marriage and procreation, the absence of legal same-sex marriage recognition, and structural stigma.

Socioeconomic disparities emerged with unusual clarity because the national calibration allowed income, education, employment, insurance, and housing comparisons. Lower household equivalent income was more common among minority groups, particularly male sexual minorities and female gender-diverse respondents, and women had lower incomes than men within every category. Educational attainment diverged sharply from Western patterns: whereas studies in the United States and Europe generally find gay and bisexual men more educated than heterosexual men, Japanese gay, lesbian, and bisexual male respondents showed the opposite trend, with heterosexual men most likely to hold degrees. Employment differences also inverted expectations in places, with female sexual minorities more likely to be employed than heterosexual women, plausibly because married Japanese women are often outside the labor force while minority women marry less often. Health insurance coverage was lower among minority respondents of both sexes, and housing tenure varied significantly only among men, with asexual men and lesbian women least likely to own homes.

Health indicators painted a mixed picture that partially contradicts Western literature. Psychological distress, measured with the Kessler-6 scale, was consistently more common among minority respondents of both assigned sexes, echoing minority stress theory, which holds that stigma and marginalization drive mental health disparities. Body mass index patterns were also distinctive: underweight was more common among female minority respondents, while overweight and obesity clustered among male bisexual and asexual respondents and female asexual respondents. Perhaps most surprising, current smoking and habitual drinking showed limited or reversed differences, with minority groups tending to drink less than heterosexual respondents, contrary to consistent findings from England, Canada, and the United States. Substance use other than tobacco and alcohol was higher among minority respondents but remained rare overall. Medical comorbidity did not differ significantly once results were stratified by assigned sex at birth, and self-rated health differences disappeared under stratification, prompting the authors to call for future studies with covariate adjustment and clinical data linkage.

The significance of these findings extends well beyond Japanese borders. Until now, virtually all nationally representative data on sexual and gender minority populations came from Western countries, including the United States, the Netherlands, Sweden, Portugal, Canada, and the United Kingdom, creating a geographic evidence gap the authors argue reflects both research neglect and, in parts of Asia, legal environments where same-sex acts remain criminalized. Japan presents a distinctive hybrid context: same-sex relationships were historically tolerated within certain cultural traditions, cross-national analyses suggest relatively low structural stigma and low non-disclosure, yet Japan remains the only G7 nation without comprehensive anti-discrimination legislation or marriage equality. The study’s documentation of opposite-sex marriages among gay and lesbian respondents, observed at levels between the low Western figures of 3 to 9 percent and the much higher Chinese figures of 33 to 51 percent, offers rare quantitative grounding for understanding how family norms and legal structures shape minority lives in East Asian settings.

The authors draw direct policy implications from their data. They recommend that national administrative surveys routinely incorporate sexual orientation and gender identity items and household modules that recognize diverse partnership structures, enabling ongoing surveillance of socioeconomic disparities and targeted resource allocation. They call for accessible mental health support and anti-discrimination efforts in schools and workplaces to reduce the psychological burden the Kessler-6 results document, and for longitudinal and panel designs that oversample small subgroups and analyze intersections of age and assigned sex. Acknowledging limitations, including self-reported data, potential social desirability bias, residual web-survey selection bias that weighting could reduce but not eliminate, and the coarse aggregation of gender-diverse subgroups, the team nevertheless positions the work as a foundational step. With an estimated 8.6 percent of Japan’s population identifying as a sexual or gender minority, the study transforms a population previously invisible in national statistics into a measurable, monitorable constituency whose health and socioeconomic well-being can now be tracked, compared, and protected.

Subject of Research: National estimation of the proportion and characteristics of sexual and gender minorities in Japan using a nationwide cross-sectional internet survey

Article Title: Estimation of Sexual and Gender Diversity Among People Aged 15 Years and Older in Japan: A Descriptive Epidemiological Study Using a Nationwide Cross-Sectional Internet Survey

Article References: Minami, T., Inoue, M., Matsushima, M., Yoshioka, T., & Tabuchi, T. (2026). Estimation of Sexual and Gender Diversity Among People Aged 15 Years and Older in Japan: A Descriptive Epidemiological Study Using a Nationwide Cross-Sectional Internet Survey. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03515-0

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03515-0

Keywords: sexual orientation, gender identity, sexual and gender minorities, Japan, descriptive epidemiology, national survey, LGBTQ, health disparities, minority stress, inverse probability weighting, bisexual, transgender