Systemic failures in maternity and neonatal care have resulted in adverse outcomes for families. The 2020 Ockenden review (interim findings) recommended creating an Independent Senior Advocate Role as an Immediate and Essential Action. During 2024-March 2026, the Maternity and Neonatal Independent Senior Advocate (MNISA) service was piloted in 16 Integrated Care Boards (ICBs)1 and aimed to (1) enable families to feel listened to and heard, with their concerns acted upon, and (2) influence system change. MNISAs supported families following the death or serious injury of a mother or baby during NHS care. To explore the experiences of families who did, and did not, receive MNISA support and the perceived impact of MNISAs. A rapid qualitative study with families who did, and did not, receive MNISA support in 11 ICBs. Interviews were conducted, or written responses to interview questions were collected via an electronic survey tool. All responses were analysed using rapid assessment procedure sheets and inductive thematic analysis. We interviewed 34 families (n = 31 received support and n = 3 did not, but were eligible). Findings indicate that MNISAs met service aims by listening to and validating families, enabling their voices to be heard, supporting them to navigate investigative processes and understand their care, facilitating family-led change. MNISA support was continuous, which helped to alleviate the emotional overwhelm that families experienced. Important barriers to access and engagement were identified. Families who did not receive the service indicated that they would have valued independent advocacy support. All families felt that the service should continue. Independent advocacy in maternity care creates opportunities for families to be heard and listened to, supporting family-led change. Further research is essential to understand the ongoing and sustained impact of independent advocacy on family experiences, how the positioning of these services can facilitate equitable access and their role in preventing avoidable harm.
The genus Austinixa is one of the most studied pinnotherid genera from both taxonomic and phylogenetic perspectives. However, the three species from the southwestern Atlantic, A. aidae, A. leptodactyla and A. patagoniensis have been underrepresented or absent from phylogenetic analyses. Recently, A. leptodactyla was redescribed and A. roblesi was determined to be its junior synonym. We have analyzed specimens belonging to all three species and constructed a rediagnosis and redescription of A. leptodactyla and A. patagoniensis. The distribution of A. aidae is restricted to southern São Paulo (Brazil), given that no specimens from any localities further south of this area were found. Austinixa leptodactyla is distinct from A. roblesi, and although they share several morphological characteristics, we propose herein that the latter it is not a junior synonym of A. leptodactyla. These two species, along with A. marianae, are very similar with all possessing a depression on the pereopod 4 merus. Austinixa leptodactyla can be distinguished from A. marianae by the shape of the male pleon and first male gonopod, and from A. roblesi by the shape and proportions of the male telson. Lastly, the morphology of A. patagoniensis is very distinct from that of all other species of the genus, including the branchial ridge that extends to the orbits or nearly so, and the overall morphology of the first male gonopod.
Childhood obesity prevalence is increasing globally, with Aboriginal and Torres Strait Islander children over-represented in Australian data. Evidence-based, community healthy lifestyle programs require culturally safe adaptation when implemented in new First Nations contexts, where prioritising access and engagement of First Nations groups is critical. This study aimed to identify Aboriginal community representatives' perspectives on potential barriers and enablers to recipient engagement and program implementation, and to identify cultural and place-based considerations to inform culturally safe adaptation of Whānau Pakari from Aotearoa/New Zealand for delivery as the Healthy Lifestyle Program in Boorloo/Perth, Western Australia. A 3-h workshop was conducted with 29 Aboriginal advisors, with whole-group discussions and 5 facilitated breakout groups, to obtain Aboriginal community guidance on cultural and place-based considerations needed to adapt the program locally. Data were analysed by Framework Analysis using the updated Consolidated Framework for Implementation Research (CFIR) to identify barriers and enablers (determinants) of program engagement and implementation. Determinants were then reclassified inductively into themes to enhance participant relatability, supporting communication and feedback. A total of 44 potential determinants (16 barriers and 28 enablers) were mapped to 18 CFIR constructs across all five domains of innovation, outer setting, inner setting, individuals and implementation process. Three themes were identified from these determinants: acknowledging cultural context encompassed healing and self-determination, reclaiming knowledge and culture, and addressing limited access to health-promoting environments; guiding values included mutual respect, building and earning trust, and intergenerational learning; and program considerations included culturally secure practice, specific ways of working, and keeping families engaged. Aboriginal community guidance highlighted cultural and place-based priorities for program adaptation, and potential determinants of successful implementation within a prevailing healthcare service, iteratively informing program adaptation. This study used a unique methodological approach, prioritising participant voice alongside CFIR terminology, to provide rare evidence of pre-implementation First Nations engagement outcomes when adapting a program to integrate into the prevailing healthcare service. Partnership with First Nations communities is essential to implementing accessible, culturally safe models of care, thereby addressing health inequities. An established Cultural Advisory Group of 12 Aboriginal Elders worked in partnership with the Healthy Lifestyle Program, 10 of whom reviewed the identified themes and sub-themes throughout the analysis process. Two members were nominated by the group and reviewed the final draft manuscript. Identified determinants iteratively informed program adaptation, guided by the Cultural Advisory Group. This work was also supported and guided by a representative consumer body, Health Consumers' Council WA.
Therapist actions, qualities and strategies are a potentially modifiable factor influencing outcome in psychological therapies for eating disorders. This study aims to hear the perspectives of those with lived experience, to identify therapist actions and behaviours which were helpful or unhelpful in change and recovery, and to construct a theory of the processes by which these therapist actions might impact on recovery. Eighteen participants who had undergone various psychological therapies for EDs took part in semi-structured interviews. They described helpful and unhelpful therapist behaviours, their emotional and cognitive impacts, and how these influenced recovery. Using a constructivist grounded theory approach, data were analysed through initial and focused coding, comparative methods, theoretical sampling, and memo-writing to develop a theoretical model. Participants described two interacting major categories of therapist actions, strategies and qualities: therapist 'style and stance' along with 'tasks of therapy'. These were described as having some direct pathways of influence on 'change processes and recovery', but also acted through three core categories of interacting intervening processes: 'the person seen heard and cared for', 'trust and openness to therapy' and 'turning towards change'. These processes are the core of the model, acting to catalyse (or block) change. Elements of therapist style and the tasks of therapy influence recovery both directly and through key intervening processes: feeling seen, heard and cared for; developing trust and openness to therapy; and turning towards change. The constructed model and categories are considered in light of psychotherapy theory. The identified aspects of therapist style and tasks are relevant to clinicians and can inform the co-production of guidance for future use in training and delivery of ED therapies. Therapists play an important role in helping people recover from eating disorders, but we still know relatively little about which therapist behaviours are most helpful, and how they support change. This study explored these questions by listening to the experiences of people who had received psychological therapy for an eating disorder. Eighteen adults took part in in-depth interviews about what their therapists did that helped or hindered their recovery, how this made them feel and think, and how it influenced their willingness and ability to change. We analysed these interviews to develop a model explaining how therapist actions may affect recovery. Participants described two main aspects of therapy that mattered: the therapist’s style and personal approach (such as warmth, respect, and collaboration) and the tasks of therapy (what the therapist focused on). These influenced recovery both directly and by shaping three key experiences: feeling seen, heard and cared for; developing trust and openness to therapy; and turning towards change. These findings highlight therapist behaviours that may help create the conditions needed for recovery and can inform future training and delivery of eating disorder therapies.
Reported perceptual differences in autism may arise from reduced use of prior context to shape incoming sensory input. Speech perception provides a critical test of this account because stable perception requires listeners to integrate variable acoustic signals with contextual expectations. This study examined context-dependent modulation of speech encoding in autistic and non-autistic adults using the frequency-following response (FFR), a neurophysiological measure of phase-locked auditory encoding. Participants heard English intonational pitch contours presented in repetitive and variable contexts while EEG was recorded. Principal component analysis of FFR metrics yielded components indexing neural encoding fidelity and timing. Non-autistic participants showed enhanced encoding fidelity in more predictable contexts, whereas autistic participants showed reduced context-dependent modulation. Neural encoding timing also showed divergent context effects across groups, suggesting altered balance between feedback-based predictive mechanisms and locally driven adaptation processes. Within the autistic group, greater context-related modulation of encoding fidelity was associated with lower ADOS-2 Social Affect severity but poorer speech-in-noise perception, suggesting that the functional impact of contextual modulation depends on input reliability and task demands. These findings indicate that context-dependent modulation of speech encoding is altered in autism and may contribute to individual differences in auditory and social-communicative function. When we listen to speech, the brain often uses sounds it has recently heard to help make sense of new ones, which is especially useful in noisy, everyday settings. In this study, autistic adults' brains tended to process speech differently, drawing less on recent sound patterns than non-autistic adults, and this difference was related to their autism domain variability and to understanding speech in background noise. These effects were not simply better or worse but depended on the listening conditions, suggesting that natural differences in how the brain uses recent context may shape some of the ways autistic people listen to speech.
Studies have shown that young children are more likely to persist on tasks when they are exposed to adults in their immediate environment who are persistent themselves. Here, we examined whether listening to three readily available commercial storybooks featuring perseverant characters would increase children's effort on difficult tasks. We worked with 154 children in Grades 2 and 3. Eighty-seven participants were randomly selected to hear storybooks that focused on overcoming adversity, while the remaining 67 students heard storybooks that focused on wordplay. Children in both groups were pretested, heard a different story each day for three days, and were posttested 24 h after storybook reading was complete. Each storybook read aloud included one vocabulary term appropriate to the stories' theme. Children completed target vocabulary assessments and challenging tasks (e.g., mazes, tangrams) at pre and posttest. Our results showed an adversity advantage. Namely, the Struggle group demonstrated significant increases in time-on-task, number of attempts, and accuracy across difficult tasks at posttest. We found that exposure to struggle-themed storybooks produced measurable gains in perseverance relative to an active control. Commercially available storybooks, when paired with explicit vocabulary instruction, offer educators and parents a simple, scalable tool to promote perseverance.
Within modern medical practice, growing demands for productivity and efficiency increasingly endanger opportunities for meaningful patient connection, leaving patients and caregivers feeling unheard. Narrative medicine seeks to rehumanize care by cultivating narrative competence - the ability to recognize, absorb, interpret, and act on the stories of illness. Yet few, if any, standardized frameworks exist to teach and assess narrative competence as a specific clinical skill. We introduce the concept of narrative quotient (NQ) to address this gap by providing medical educators with a structured approach to teach and evaluate narrative competence across various stages of clinical training. NQ encompasses three pillars - perceptive listening, reflective recall, and narrative-affirming language - each grounded in existing scholarship and supported by specific, evidence-based pedagogical and assessment strategies. Integration of NQ into longitudinal medical training has the potential to enhance clinician empathy, protect against burnout, and enable patients to feel genuinely heard and understood.
Consultation is fundamental to a responsive aged care system. Cornerstone aged care reforms based on recommendations by the Australian Aged Care Royal Commission mandate resident consultation through the Quality Indicator Program and Resident Experience Survey, a new Aged Care Act and Strengthened Quality Standards. However, people with dementia are known to be underrepresented in research, particularly in residential aged care settings, and emergent scholarship indicates a similar exclusion from aged care policy and reform. Currently, the extent to which residents with dementia participate in consultation remains underexamined. Given the majority of aged care residents live with dementia, it is critical to ensure their voices are heard in consultation that informs aged care systems change. This paper critically examines intersecting domains of cultural, legal and structural barriers that are predicted to contribute to the exclusion of residents with dementia from direct participation in aged care consultation processes. This unaddressed exclusion is argued to be a form of epistemic injustice for residents with dementia that may contribute to unresponsive aged care delivery and high rates of proxy participation. Future directions propose data transparency of resident participation in aged care consultation, and a radical shift towards innovative approaches to ensure all resident voices are heard.
Hamman sign is a rare clinical finding characterized by a crunching or clicking sound synchronous with the cardiac cycle, typically heard over the precordium. It is most commonly associated with pneumomediastinum or, less frequently, pneumothorax. Although often subtle and transient, its presence can provide an important early clue to underlying thoracic air leakage, especially in young patients without a history of trauma. This case illustrates how timely identification of Hamman sign, followed by appropriate diagnostic imaging-most notably chest radiography or computed tomography-is vital for recognizing this clinical finding and guiding effective management. In addition, increased clinician awareness can facilitate earlier intervention and reduce the risk of complications.
The Blue Coats program at Penn Medicine is a systemwide initiative designed to amplify the voices of clinical teams to understand and support workforce well-being. Recognizing that traditional system-level strategies often cannot address real-time frontline team needs, the Blue Coats program, launched in August 2022, is a locally embedded group of well-being ambassadors and operational consultants. These trained team members engage directly with clinicians and staff within their local clinical environments - observing, shadowing, and listening to all team members - to identify pain points and bring forth opportunities for improvement for local and senior leadership. The Blue Coats bridge the gap between frontline experience and leadership decision-making by operating within departments and aligning workforce concerns with leadership decision-making. The program utilizes a discovery-to-delivery model: Blue Coats gather actionable insights from clinicians and staff, then collaborate with department leadership to implement customized interventions that enhance workforce well-being and trust, ultimately working to improve retention. Individual solutions informed by Blue Coats' insights are variable by clinical site and have included hiring supply and support staff, redesigning workflows to balance clinical duties, enhancing physical safety infrastructure, and launching local recognition and small division-based reward programs. Early outcome data demonstrated meaningful gains across the domains of hope, trust, and belonging on the part of outpatient clinical staff; the largest improvements, as seen in survey results scored on a five-point Likert scale, include an 11.8% increase in trust (from 3.4 to 3.8) and 7.4% improvement in hope (from 3.4 to 3.65) among nursing staff, and a 24.6% increase in trust among support staff (from 2.85 to 3.55). The Blue Coats initiative has been deployed across diverse clinical units ranging from emergency departments to outpatient clinics. Staff expressed appreciation for being "seen, heard, and supported" - qualities often lost, or difficult to capture, in large health system surveys. Senior clinical leadership recognizes the Blue Coats as a feedback loop and a strategic tool to inform resource allocation, staffing decisions, and cultural investment. Notably, departments engaged with Blue Coats could move quickly from problem discovery to implementation, shortening the traditional lag between insight and action. Perhaps most importantly, the program restored a sense of agency among clinical teams. Many expressed that the presence of Blue Coats signaled a culture shift toward listening, transparency, and shared ownership of workplace challenges. This shift has led to higher trust scores, improvements in self-reported workforce retention, and renewed collaboration and engagement with staff and leadership. The Blue Coats approach offers a scalable, in-house framework for health systems nationally: embed, listen, act, and evolve. As health care continues to confront burnout and operational strain, this model demonstrates how relational, human-centered design can fuel the future of the workforce.
Speech perception and production are linked in adults. Since infants show sophisticated speech perception abilities before they produce language, the link has been assumed to emerge with development. However, crying is a communication signal that infants produce from birth and their cry melodies are modulated by prenatally heard speech. Cries and speech may thus be developmentally continuous, and the production-perception link may be most evident early in life for cries. We therefore examined whether newborns perceive cries similarly to speech. French neonates exposed to French cries and French speech showed greater neural responses to cries than to speech in the right temporal region. By contrast, Italian adults unfamiliar with French responded more strongly to speech than to cries. Newborns' heightened response to a communicative signal that is less familiar and acoustically less complex, but one they can produce suggests that vocal production and auditory perception may be linked from birth.
Atopic dermatitis (AD) causes significant physical and psychosocial distress. This study aimed to determine the self-reported prevalence of AD and evaluate disease-related knowledge among adult Jordanians. A cross-sectional study was conducted from October to December 2025 using a self-administered online questionnaire distributed via social media. Data on sociodemographic characteristics, AD-related knowledge, awareness, clinical features, and treatments were collected from 818 Jordanian adults (aged ≥18 years) and analysed using SPSS 28. While 94.6% of participants had heard of AD, the median knowledge score was suboptimal at 8 (7-10) out of 14. Awareness was high regarding the necessity of regular moisturization (93.9%) and aggravating role of triggers (≥ 86.5%). However, knowledge gaps were observed regarding the disease's hereditary nature (45.6% recognizing parental inheritance) and the "atopic march"; few recognized associations with asthma (30.4%) or allergic rhinitis (37.7%). The self-reported AD prevalence was 16.4% (n=134). Affected participants primarily reported itching (65.7%), redness (61.9%), and dryness with skin cracking (60.4%), with the hands being the most affected site (59.7%). Moisturizers were the most common treatment (49.3%), while AD affected daily performance in 42.5% and sleep at night in 41.8% of affected participants. Lower socioeconomic status (among those without AD), male gender, and lack of a family history of AD (among those with AD) were significantly associated with lower knowledge scores. Detailed knowledge of AD among Jordanian adults is insufficient, with significant gaps in hereditary nature and allergic associations (atopic march). Targeted public health educational initiatives are essential to improve understanding, promote disease self-management, and enhance patient quality of life.
Respiratory syncytial virus (RSV) vaccines are approved in the United States (US) for adults at increased risk for severe RSV disease. However, RSV disease and vaccination knowledge gaps have been reported among US adults. This study provides an up-to-date assessment of knowledge, attitudes, and practices (KAP) regarding RSV disease and vaccination among US adults at increased risk for severe RSV disease. Between December 2024 and January 2025, a web-based survey was conducted to assess RSV-related KAP. Adults aged 18-59 years were required to have ≥1 risk factor for severe RSV disease. Descriptive results were reported overall and by age (18-49, 50-59, 60-74, and ≥75 years); multivariable logistic regression modeling identified characteristics associated with RSV-related KAP. Overall (N = 1227), 75.3% of respondents had heard of RSV; of these, 34.8% reported feeling knowledgeable about RSV. Most (79.6%) considered RSV vaccination as beneficial for individuals of their age and health status, and 67.4% indicated being at least somewhat likely to receive RSV vaccination following healthcare professional (HCP) recommendation. Among adults aged ≥60 years, 49.0% reported having received an HCP recommendation for RSV vaccination, and 35.3% reported ever being vaccinated. The likelihood of having discussed RSV vaccination with and/or received a recommendation from an HCP varied significantly by age and knowledge of respiratory illnesses, among other characteristics. RSV knowledge and practice gaps remain among US adults at increased risk for severe RSV disease. Findings can help inform patient and HCP education efforts to increase access to RSV vaccination.
Autistic individuals often mask/camouflage to conceal their autistic traits, but this practice is stressful and damaging to mental health. Unmasking, a newly identified phenomenon, is the deliberate effort to stop masking and reclaim a more authentic self-presentation. This study is the first to examine autistic people's experiences with unmasking and its mental health implications. Interviews (n = 14) and surveys (n = 214) examined autistic college students' understanding of unmasking, experiences and motivations, and impacts on mental health. The majority of participants in both samples had heard of unmasking, and half had tried it. Interviewees showed substantial variation in ability and willingness to unmask. Unmasking was difficult-to-impossible when masking was highly ingrained, as deconstructing masking repertoires and rediscovering their "true selves" was challenging. Unmasking relieved stress from masking and increased authenticity, but also created worries that revealing a more autistic self-presentation would garner social backlash, unless supported by friends or other unmaskers. Survey respondents' unmasking frequency was overall low, but varied across social contexts. Unmasking difficulty was associated with heightened anxiety, whereas unmasking with family predicted decreased anxiety and depression. Other unmasking variables were less robust predictors, but suggest that unmasking is beneficial amongst those who try it. We need further research into unmasking, especially its trajectories and mental health impacts. In comparison to masking, unmasking may be a more collectively beneficial practice. Its drawbacks are all rooted in external stigma, suggesting that increasing autism acceptance is key to supporting autistic individuals' unmasking and long-term mental well-being.
Patient-reported experience measures (PREMs) capture how care is experienced and are essential quality indicators in paediatric healthcare, supporting children's right to be heard. Compared with patient-reported outcome measures (PROMs), which assess health status and well-being, PREMs are less developed, particularly for children. This study aimed to describe the development and initial psychometric evaluation of PREM-Ped, a short, child-friendly questionnaire designed to capture children's own healthcare experiences. PREM-Ped was developed using a multi-step, participatory process. Content validity was established through a focus group with children who had experience of paediatric healthcare. The questionnaire was refined through four iterative rounds of cognitive interviews. A digitally administered pilot study was conducted in out- or inpatient units at Astrid Lindgren Children's Hospital in Sweden during spring 2025. Children aged 4-15 years completed the PREM-Ped after care (n = 586). Qualitative data were analysed thematically. Validity was examined by comparing experiences in acute and elective care. Psychometric properties were evaluated using a unidimensional Rasch measurement model. The development process resulted in a short, comprehensible questionnaire suitable for children and adolescents. Initial psychometric evaluation demonstrated satisfactory measurement properties. Validity was supported, with PREM-Ped distinguishing between acute and elective care settings. We developed PREM-Ped, a short, child-friendly questionnaire that enables meaningful measurement of children's healthcare experiences and may support benchmarking and systematic child-centred quality improvement.
Identifying interventions for developing language skills in autistic people is a top research priority. To develop effective language interventions, it is essential to understand whether community members feel they are important, acceptable, and meaningful. The aim of our research was to elicit views from members of the autism community on language and language interventions for autistic people. Our diverse team (comprising those with lived and professional experience of autism and/or language interventions) achieved our goals using an online survey. Via opportunity sampling, we recruited 356 participants including autistic adults, parents of autistic children, and professionals/researchers working with autistic people. Data were thematically analyzed. Participants recognised the importance of language for self-advocacy, societal participation, interacting with others, and expressing needs, feelings and desires. Language was seen as a potential tool for communication, but one of crucial importance in navigating a world designed for non-autistic people. Responses also strongly emphasised the importance of language interventions being focused on autistic people's individual needs, that benefit them, allow them to be their authentic selves, and prioritise choice and agency. Our research highlights the importance of including community voices in the development of language interventions. Future language interventions should be individualised to a person's needs and wishes, respect autistic people's identity, and support self-advocacy. Subsequent work should ensure that seldom-heard voices are centered in such discussions.
This study aimed to assess self-medication with antibiotics and evaluate knowledge and attitudes toward rational antibiotic use among women of reproductive age. This descriptive study was conducted among 1002 women who attended a state hospital in the southern region of Türkiye. Data were collected using a Personal Information Form, the Antibiotic Use Scale (AUS) and the Knowledge-Attitude Scale for Rational Antibiotic Use (RAUKAS). The mean AUS score was 40.4 ± 17.9, while the RAUKAS knowledge and attitude scores were 27.7 ± 8.9 and 30.6 ± 12.6, respectively. Overall, 24.5% of women reported self-medication with antibiotics within the last 6 months. The most common indications were cold or influenza (62.4%), toothache or dental swelling (58.0%), sore throat (51.8%), fever (31.4%), cough (25.3%), urinary burning (23.3%), headache (19.2%), abdominal pain (16.7%), fatigue (15.9%), and skin infection (11.8%). In addition, 30.0% kept antibiotics at home, 64.0% had never heard of antibiotic resistance, and attitude toward rational antibiotic use was the strongest predictor of self-medication (p < 0.001). Self-medication with antibiotics is practiced and represents a significant public health concern, with insufficient awareness of rational antibiotic use, highlighting the need for targeted educational interventions and public health strategies.
While exposure to volatile organic compounds such as ethylene dichloride and vinyl chloride monomer is a well-established cause of liver disease, particularly hepatic hemangiosarcoma, characterizing real-world exposure profiles in communities surrounding industrial centers remains challenging. Calvert City, Kentucky (population ∼2,500), provides a unique setting characterized by both active industrial emissions and legacy sources of air toxics. To address these complexities, this method paper describes the framework for the Biomonitoring and Environmental Assessment for Community Outreach and Neighborhood Safety (BEACON) study. By utilizing a novel, multi-dimensional exposure assessment strategy, BEACON aims to characterize air toxic exposures and provide actionable data for community health and safety. For the BEACON study, we will leverage Kentucky Department of Air Quality measures of air toxics, analyze urine samples in a small cohort of community volunteers, analyze community urine via wastewater in an adjacent community, geocode citizen odor reporting, assess blood markers in wildlife, survey small and large animal veterinarians in the area for anomalies in morbidity and mortality, and work with the regional health system to enhance vigilance for health issues associated with toxicants present in the area. In addition, blood samples will be collected at three time points and biobanked for future analyses. Efforts will be made to link this study to additional large-scale long-term cohorts where possible. Throughout the project, community engagement will play a critical role by raising awareness, fostering collaboration, and ensuring that the voices of affected residents are heard.
To examine the association between climate change awareness, climate anxiety, and carbon footprint awareness among nursing students. A cross-sectional, descriptive, and correlational study. The study was conducted with 715 nursing students using self-administered questionnaires to assess their climate change awareness, climate change anxiety, and carbon footprint awareness. Sociodemographic information was also collected. Associations among variables were examined using correlation analysis, and associated factors related to carbon footprint awareness were evaluated through hierarchical regression analysis. Carbon footprint awareness was positively associated with both climate change awareness and climate change anxiety, with anxiety showing a stronger association. Psychosocial variables explained variance in carbon footprint awareness more strongly than sociodemographic characteristics (R2 = 0.13). Subgroup analyses showed no significant differences in carbon footprint scores according to academic year, previous awareness of the term 'carbon footprint', or place of residence. Climate change awareness was higher among students who had previously heard the term 'carbon footprint' (p = 0.013), whereas climate change anxiety differed significantly by academic year (p < 0.001). The findings suggest that carbon footprint awareness among nursing students is more closely related to psychosocial processes than sociodemographic characteristics. Climate change anxiety, in particular, appears to be an important factor associated with environmentally related awareness. Additional subgroup analyses showed no significant differences in carbon footprint scores across subgroups, whereas climate change awareness and anxiety varied according to certain subgroup characteristics. However, the findings should be interpreted cautiously given the cross-sectional design and the relatively low explained variance of the model. Integrating carbon footprint literacy and climate change into nursing curricula, considering peer education models, and promoting sustainable practices such as reducing the use of single-use materials during clinical education may contribute to increasing environmental awareness and supporting environmentally responsible nursing practice among nursing students. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. No patient or public contribution.
Cervical cancer remains a significant public health issue and is the second leading cause of cancer-related mortality among women globally. Its burden extends beyond individual health, affecting families, communities, and social systems. This study aimed to identify the factors influencing Pap smear testing among women of reproductive age in Owerri West, Imo State. This study adopted a descriptive cross-sectional design using 399 respondents selected through a multistage sampling method. Data were collected using a structured questionnaire and analysed with the Statistical Package for the Social Sciences (SPSS), with results presented in frequencies and percentages. Most respondents were married (51.6%), aged 20-29 years (42.9%), predominantly traders (34.6%) and civil servants (34.9%), of Igbo ethnicity (78.0%), and had tertiary education (48.4%). While 44.8% had heard of cervical cancer, they were not familiar with its details. About 59.0% had heard of Pap smear testing, with nearly half (49.3%) receiving the information from healthcare professionals. Despite a relatively high level of awareness, 61.8% had never undergone a Pap smear. Respondents identified several barriers to Pap smear testing, including the belief that the procedure is expensive or embarrassing. Some also associated undergoing the test before sexual activity with a loss of virginity, while others cited the distant location of screening centres as a significant challenge. There is a critical need for increased medical education and public sensitization on cervical cancer and the importance of routine screening to improve uptake and early detection.