Family caregivers' experiences and perspectives regarding the implementation of advance care planning among older adults: A systematic review and meta-synthesis.

Cultural diversity is a broad term used to encompass ethnic and racial diversity, multiculturalism, diverse languages, religions, practices, beliefs and identities of people. In ICU, people who are culturally diverse are at increased risk of marginalisation, sub-optimal care, higher morbidity and mortality. Ethnocultural biases and stereotypical assumptions can negatively influence ICU care. To explore the experiences of nurses, physicians and allied health professionals (clinicians) in caring for patients and their family members from culturally diverse backgrounds. Ethical approval was granted for an exploratory descriptive study. Convenience sampling was used to recruit clinicians involved in patient care, from two ICUs in Australia. Semi-structured individual interviews were undertaken to gather data, with interviews audio recorded and auto-transcribed. Data were analysed using inductive content analysis. Twenty clinicians participated, with interviews lasting 26min (mean). Analysis revealed four main themes: (i) Cultural sensitivity and responsiveness, which describes the importance of cultural sensitivity and responsiveness in care; (ii) Complexities of communication, which includes descriptions of strategies to overcome communication barriers; (iii) At the end of life, which describes end-of-life care challenges, particularly in the context of brain death and organ donation; and (iv) The way forward, offering suggestions for optimising care for patients and family members who were culturally diverse. Cultural diversity complicates patient and family care and communication in the ICU. These findings emphasise the importance of clinicians' sensitivity and openness to difference, and that it is clinicians' responsibility to overcome cultural and linguistic differences, not the critically ill patient or their family. Achieving greater openness and awareness requires ICU and healthcare leaders to promote the use of professional interpreters to their full scope of expertise, development of culturally-specific resources and creation of a wider community network of cultural representatives to bridge cultural gaps.

This study explores the integration of Islamic values in English Language Teaching especially reading within Islamic higher educational institutions, utilizing contrastive analysis as a pedagogical approach. The integration of these values aims to create a learning environment that not only emphasizes language skills but also reinforces Islamic ethical and moral principles. Contrastive analysis, which compares the students' native language (L1) with English (L2), helps educators identify potential challenges and similarities, facilitating a more effective and contextually relevant language acquisition process. This method allows instructors to design reading challenges and activities to improve reading skills while infusing Islamic perspectives. In teaching generic text structures, contrastive analysis enables a comparison of Arabic language awareness with English terminology, assisting students in mastering these structures with an understanding of both linguistic contexts. Furthermore, contrastive analysis supports vocabulary acquisition by connecting English words with Islamic concepts, enhancing students' cultural sensitivity and ethical engagement with language learning. By linking English terminology with Islamic principles such as "charity" with zakat and "patience" with sabr students gain deeper insights into the linguistic and cultural meanings behind these words. The study also emphasizes building a culturally aware mindset, wherein students understand cultural distinctions and apply language respectfully and ethically, in alignment with Islamic values. Ultimately, integrating Islamic values through contrastive analysis fosters a learning environment where students strengthen their Islamic identity, ethical conduct, and language competency, preparing them to communicate effectively in a global context while upholding their faith and cultural identity.

Psychometric evaluation of the flourishing-at-work scale in the Indonesian context.

This article analyzes the growing cultural diversity in Spain as a result of immigration, with a specific focus on the impact on the healthcare system. It explores the theoretical frameworks of interculturality, cultural competence, and cultural sensitivity, and evaluates their implementation through regional healthcare protocols. Through a comparative analysis of models such as those by Campinha-Bacote, Purnell, Leininger, and Kleinman, as well as empirical research from Bas-Sarmiento et al. (2015) and Valero-Garcés (2019), this study offers a comprehensive review of challenges, strategies, and good practices in intercultural healthcare. It also proposes inclusive policies and culturally competent training to improve healthcare delivery to migrant populations in Spain.

Volcanoes assert themselves as true anthropological and cultural topoi, symbols of nature’s power and, at the same time, mirrors of human fragility and aspiration. The awe with which humans have long approached their force has generated mythological, literary, philosophical, and scientific experiences and practices of great fascination and marked cultural interest, revealing how fear and wonder can become drivers of knowledge and responsibility. In this contribution, an attempt will be made to offer an exemplary synthesis of some of these anthropological practices, ranging from myth and its role in the development of scientific thought, to literature and philosophy, with particular attention to the concept of the sublime and to the function of wonder/tháuma as both a cognitive and emotional experience. From this perspective, volcanoes are not only objects of study or threats to be managed, but also instruments of geoethical reflection, as they invite recognition of our belonging to nature, our finitude, and the need to establish relationships with the environment based on respect, care, and shared responsibility. Wonder, far from being a mere irrational feeling, thus becomes a driver of prudent behaviour, social awareness, and sustainable practices, integrating scientific knowledge and cultural sensitivity in coexistence with natural forces.

Background: Vaginal discharge is a common gynecological problem of varying etiol ogies affecting women's health. This study aimed to assess the characteristics of vaginal discharge in women and aimed to bridge the gap by assessing knowledge, attitude and practice related to menstrual and puerperal hygiene. Materials and methods: This cross-sectional study was conducted at the outpatient department of Obstetrics and gynecology at Chattagram Maa-O-Shishu Hospital Medical College, from July to December 2018 and included 91 women presenting with vaginal discharge and related problems. Data were collected through pretested semi structured questionnaires, clinical examinations, High Vaginal Swab (HVS) Pap Smear and Urine Routine and Microscopic Examination (RME) and Culture Sensitivity (C/S). Results: The majority of participants were in the 20-24 (34.07%) and 25-29 (26.37%) age groups, predominantly married (90.11%), largely housewives (75.82%) with education below higher secondary level (59.34%). Over half (51.65%) were overweight. Oral contraceptives were the most common contraceptive method (35.16%). Good menstrual hygiene and puerperal hygiene practiced by 43.96% participants and poor menstrual and puerperal hygiene by 56.04%. HVS results showed Candida and mixed infections (10.99% each) Trichomonas (8.79%) and Bacterial Vaginosis (BV) (3.30%). Pap Smear indicated a range of infection severity and Urine RME& C/S revealed infection rate 30.77%. Conclusion: The study highlights the need for accurate diagnosis and comprehensive reproductive healthcare and practice of healthy menstrual and puerperal hygiene to manage vaginal discharge effectively. It emphasizes the significance of various factors such as lifestyle, educational background and clinical characteristics for accurate diagnosis and treatment. Chatt Maa Shi Hosp Med Coll J; Vol.24 (2); July 2025; Page 91-96

Introduction Pregnant immigrant women and birthing people face unique challenges in accessing and navigating healthcare systems in their host countries. In the United Kingdom, these barriers can lead to delayed care, missed appointments, and poorer maternal and neonatal outcomes. This protocol outlines a comprehensive methodology for investigating these barriers and developing solution-focused approaches to address them. Methods This cross-sectional, mixed-methods study will recruit 100–150 pregnant immigrant women from antenatal clinics, postnatal wards, and community settings associated with the Princess Royal University Hospital and other King’s College Hospital NHS Foundation Trust facilities. Study Registration: King’s College audit committee (Registration number #625, date 03 June 2025). Data will be collected using a structured questionnaire covering demographics, language and communication barriers, healthcare access and experiences, and satisfaction with services. Quantitative data will be analyzed using descriptive statistics, chi-square tests, and logistic regression, while qualitative responses will undergo thematic analysis. Analysis This study aims to identify the prevalence and nature of barriers to maternity care among immigrant women, examine associations between demographic factors and specific barriers, and develop practical recommendations for healthcare providers and policymakers. The findings will inform targeted interventions to enhance accessibility, cultural sensitivity, and overall quality of maternity services for this vulnerable population. By adopting a solution-focused approach, this study will move beyond problem identification to actionable recommendations, contributing to the development of more inclusive and responsive maternity services for immigrant women in the UK and potentially other countries with similar healthcare systems.

Artificial intelligence (AI) technology is deeply reshaping how culture is communicated, creating both chances to improve efficiency and reach a global audience, but also raising concerns about the loss of authentic culture and biased algorithms. This work builds a three-part structure—technology support-culture fit-system regulation—combining Hofstede's cultural dimensions and new institutionalism to study how generative AI performs in understanding cultural symbols and in cross-cultural storytelling. An examination of how the ChatGPT model series interprets Chinese traditional symbols shows that current AI systems have limits, like oversimplifying culture (for example, linking the dragon symbol too closely with royal power) and creating logical conflicts (the differing Western and Chinese views of the phoenix). It also shows that the cultural alignment of GPT-4 in Chinese (68%) is much better than GPT-3.5 (42%). This research suggests a cultural digital governance approach: creating diverse cultural knowledge banks, creating cultural sensitivity assessment measurements, and applying graded cooperation between people and machines. This provides a source for balancing tech progress and cultural heritage.

Sexual and gender minority (SGM) individuals can experience notable health disparities, including higher HIV prevalence, social isolation, substance abuse, lack of culturally competent providers, and poorer health outcomes compared to heterosexuals due to stigma and discrimination. This study aims to identify predictors of dental care utilization across sexual minorities using the 2023 TEXAS PRIDE Survey. We analyzed data from 517 SGM individuals, assessing sociodemographic characteristics, health behaviors, and recent medical and dental visits. Multivariable logistic regression identified predictors of dental care utilization (i.e., a dental visit in the past year). Among sexual orientation groups, reported dental care utilization was highest among gay (23.7%) and lesbian (21%) individuals, followed by bisexual (18.3%), pansexual (11.1%), queer (9.9%), and other sexual orientations (16.2%). Those with a college degree were significantly more likely to report dental utilization compared to those with less education. Individuals who did not have a medical visit in the past year were 0.27 times as likely to utilize dental care than those who did. No significant disparities in dental care utilization were found based on sexual orientation in the regression analysis. Higher education and recent medical visits are significant predictors of dental care utilization among SGM individuals. Efforts to reduce oral health disparities should focus on affordable dental care coverage, improving health literacy, fostering inclusive dental environments, and training providers in SGM cultural sensitivity. Future research should explore integrated healthcare approaches and provider cultural competence training to address these gaps.

ABSTRACT Despite considerable research on women in leadership, the interplay of race, ethnicity, and gender in academic leadership roles remains underexplored. Additionally, variations in mentoring, resiliency, and spirituality among different ethnic groups in academia have not been adequately addressed. This study aims to bridge these gaps by examining unique barriers faced by women of color in academia. Using a sample of 103 academic leaders occupying various leadership or faculty positions, our findings reveal the distinctive challenges for African American and Asian women in leadership roles, particularly concerning cultural sensitivity and discrimination. Also, African American women exhibit higher self-efficacy in leadership aspects such as delegation, goal management, and relationship management than their Asian counterparts. The study underscores the necessity for higher education institutions to not only address leadership diversity but also to implement tailored initiatives that acknowledge and support the distinct experiences of women of color, fostering an equitable academic leadership landscape.

ABSTRACT This scoping review examines the design and effectiveness of AI coaching chatbots in light of recent advances in generative artificial intelligence. Following the emergence of large language models in 2022–2023, AI coaching has gained traction as a scalable and cost-effective intervention, yet evidence guiding effective design remains limited. Using a five-stage PRISMA-ScR methodology, 17 empirical studies were analysed through thematic synthesis. Three overarching themes emerged: chatbot design considerations, determinants of adoption, and the operationalisation of AI coaching. Findings indicate that generative AI enhances interaction quality, usability, and engagement, particularly for structured tasks such as goal setting, reflection, feedback, and intersessional support. However, limitations in relational depth, cultural sensitivity, and psychological nuance persist, positioning AI coaches as complementary rather than substitutive to human coaching.

Spirituality is a vital, yet sometimes misunderstood component of whole-person care. A growing body of evidence links meaning, purpose, and spirituality (MPS) with improved health outcomes, greater patient satisfaction, and enhanced clinician well-being. In 2024, the American Medical Association (AMA) adopted Resolution 304 (A-24), advocating for the integration of MPS education throughout medical training and continuing education. Despite previous consensus statements and competencies from other professional organizations and accrediting bodies, such as the Association of American Medical Colleges (AAMC), the Liaison Committee on Medical Education (LCME), and the Accreditation Council for Graduate Medical Education (ACGME), MPS-related competencies remain inconsistently embedded within health professions education, including within lifestyle medicine (LM). To examine competencies, consensus statements and current evidence for spiritual care across various disciplines in order to discern common elements to support the establishment of MPS competencies within lifestyle medicine education and training. The competencies reviewed frame person-centered care through an expanded lens of the human person as biopsychosocial-spiritual. Across disciplines, 5 common categories of competencies emerged, which include: (1) An understanding of whole-person care and broad definitions of spirituality and religion; (2) clinician spiritual self-awareness and self-care, including exploration of potential biases and barriers to patient-centered care; (3) ethical practice, cultural sensitivity, and respect for diversity, including not imposing one's own personal beliefs (or lack thereof) on the patient; (4) spiritual assessment, communication and care planning skills in patient interactions, including team-based collaboration and referral to spiritual care professionals; (5) clinician therapeutic skills, including compassionate presence, active listening, sensitive communication, motivational interviewing and shared decision-making. Incorporating MPS competencies within LM education aligns with the updated pillar of connectedness, recognizing spirituality as a core driver of lifestyle behavior change. Embedding MPS competencies across the continuum of health professions education represents a timely, evidence-based, and ethically grounded step toward delivering more compassionate, sustainable, and impactful person-centered care.

The incremental diagnostic yield of consecutive sputum nucleic acid amplification tests (NAATs) for pulmonary tuberculosis (PTB) is not well established. We aimed to assess the diagnostic performance of one to three consecutive sputum NAATs in a non-high-tuberculosis-burden setting. We retrospectively analyzed data from 4,051 patients with suspected PTB in Japan between 2010 and 2023. Patients with a positive culture or a positive NAAT consistent with clinical findings were classified into the PTB group (n = 290); all others were classified into the non-PTB group (n = 3,761). We evaluated the cumulative sensitivity and specificity of smear microscopy, NAAT, and culture for one, two, and three sputum specimens and compared the time to microbiological diagnosis for culture alone versus culture combined with one, two, or three sputum NAATs. In the PTB group, a second NAAT substantially increased cumulative sensitivity from 53.1% to 63.1% (+10.0%) and shortened the mean time to diagnosis from 10.9 to 8.3 days (-2.6 days). A third NAAT provided minimal additional benefit, increasing sensitivity to 67.2% (+4.1%) and reducing the time to diagnosis to 8.1 days (-0.2 days). In smear-positive PTB, the NAAT sensitivity increased from an already high 84.9% with a single test to 97.8% with a second test. Similarly, in smear-negative patients, sensitivity increased from 23.8% to 31.1%. In a non-high-tuberculosis-burden setting, performing a second sputum NAAT significantly improves diagnostic sensitivity and shortens the time to diagnosis.IMPORTANCEThe standard diagnostic protocol for pulmonary tuberculosis still relies on collecting three consecutive sputum specimens to maximize the diagnostic yield of smear and culture. While nucleic acid amplification tests (NAATs) have become increasingly important diagnostic tools, the incremental value of this approach for sputum NAAT-based diagnosis has remained uncertain. In a large cohort from a non-high-tuberculosis-burden setting, we show that adding a second sputum NAAT meaningfully improves cumulative sensitivity and shortens the mean time to diagnosis, whereas a third sputum NAAT provides only modest additional benefit. Notably, a two-sputum NAAT strategy optimizes yield irrespective of smear status, achieving saturation in smear-positive cases and securing a modest but steady stepwise gain in sensitivity for smear-negative patients. Therefore, our findings provide crucial evidence to support a two-sputum NAAT strategy to optimize the diagnostic workflow for PTB in non-high-tuberculosis-burden settings.

Cross-cultural teaching has garnered widespread attention in English-speaking countries such as the UK and the US, gradually becoming a key issue in educational reform and curriculum development. However, a gap persists between the concept and implementation of cross-cultural teaching in practical teaching practices. Through literature analysis and comparative research, this paper systematically examines the primary measures taken by English-speaking countries in cross-cultural teaching and the real-world challenges they face. The study finds that both the UK and the US have made varying degrees of effort in advancing cross-cultural education, including strengthening teachers' cross-cultural awareness, integrating cross-cultural concepts into curricula, and developing culturally responsive teaching resources. However, shortcomings such as insufficient cultural content exploration and uneven professional support for teachers remain. Based on these findings, the paper proposes that cross-cultural education should further prioritize the systematic cultivation of teachers' cultural sensitivity, deeply present cultural core values in curriculum design, and promote the sustainable development and continuous improvement of cross-cultural teaching by establishing a platform for sharing diverse cultural resources.

Background/Aims Birth trauma can have long-lasting effects on women's quality of life, influencing emotional wellbeing, intimate and family relationships and, in some cases, adverse cognitive outcomes for children. This study's aim was to explore community midwives’ awareness of birth trauma, wider support and barriers to supporting those in need. Methods A purposive sample of 17 community midwives were interviewed about their knowledge of signs and symptoms of birth trauma, including experiences and barriers to identifying and support. Data were analysed thematically within the COM-B framework to explore participants’ capability, opportunity and motivation in caring for women with birth trauma. Results Participants’ knowledge of the signs and symptoms of birth trauma and identifying and supporting individuals with birth trauma was broadly good. However, some limitations in information and resources were identified. Conclusions The participants were strongly motivated to support those with birth trauma. Nevertheless, they experienced barriers including time constraints and reduced continuity of care affecting the midwife–mother relationship. Cultural, social and language barriers further limited the participants’ ability to identify and support individuals with birth trauma or enable some women to disclose. Implications for practice Birth trauma training, resources and support for midwives are required, considering cultural sensitivities and working patterns. Changes to maximise continuity may enable community midwives to effectively support those with birth trauma.

Enteric fever, a systemic infection caused by Salmonella enterica serovars Typhi and Paratyphi, continue to pose a substantial public health concern, with an estimated 20million cases annually. It is transmitted via the consumption of contaminated food or water and is a substantial public health issue in low- and middle-income nations, resulting in extended fever, stomach pain, and severe sequelae if not addressed. The clinical diagnosis of enteric fever is complicated by nonspecific symptoms, the low sensitivity and specificity of blood cultures and serological methods, and the restricted application of qPCR in routine diagnostics, partly due to the insufficient testing or validation of numerous gene targets across various Salmonella strains. The study was conducted to evaluate mdh, dld, tcfA, and folE gene markers for detection of enteric fever causing typhoidal Salmonella species using real-time PCR. Primers specific to the mdh, dld, tcfA, and folE genes were developed and assessed utilizing Primer3Plus, an oligo calculator, and NCBI BLAST. Conventional PCR with optimized thermal profiles was employed for amplification, succeeded by SYBR Green-based real-time PCR and gel electrophoresis to verify the size and specificity of the amplicons. Sanger sequencing of specific folE amplicons confirmed their identity and revealed conserved sequences among S. Typhi and S. Paratyphi. The mdh gene demonstrated significant genus-level specificity, whereas dld and tcfA exhibited diagnostic potential for typhoidal strains. Initial in-silico predictions suggested that folE was specific to S. Typhi, but it was also experimentally identified in S. Paratyphi isolates. Sanger sequencing validated significant sequence similarity and a synonymous SNP, demonstrating functional conservation of folE, which encodes GTP cyclohydrolase I, among typhoidal Salmonella. The folE gene sequences for S. Typhi and S. Paratyphi have been submitted to GenBank with accession numbers PV700621 and PV700622. The assay demonstrated a strong correlation with biochemical findings; however, its restricted capacity to differentiate between typhoidal serovars underscores the necessity for more specific molecular markers to enhance diagnostic accuracy, inform targeted therapy, and facilitate comprehensive epidemiological surveillance.

In this study, we aimed to describe the cultural care given to immigrant women based on Leininger's Sunrise Model. A qualitative descriptive study. In this study, the ethno-nursing research method, a distinctive approach within the nursing discipline introduced by Leininger through the Sunrise Model, was employed. The study was conducted between June and October 2023. 28 participants were included in the study and coded as P1-P28. As a result of the analysis, the data were collected under 12 themes. These themes are ethnicity, worldview, kinship and social factors, cultural values/beliefs and lifestyle, religious/spiritual/philosophical factors, technological factors, economic factors, political and legal factors, educational factors, language and communication factors, emic and ethical care beliefs and practices, general and special nursing/midwifery care factors. In addition, each theme was further subdivided into subcodes. In addition, each theme was divided into subcodes. According to the study findings, immigrant women prioritise values such as privacy, respect and sincerity; they need family and social support; religious beliefs and spiritual practices positively affect their psychological well-being. In this context, it is recommended that transcultural training programs specific to immigrant health be disseminated to healthcare professionals, especially nurses and primary care workers, in order to increase cultural adaptation, reduce language barriers and integrate spiritual care. These trainings should include topics such as cultural sensitivity, effective communication, recognition of spiritual needs, confidentiality and respectful care. It is thought that the results of this study will be an important guide for our nurse and midwife colleagues and other health professionals, especially in understanding the cultural care needs of immigrant women in health services and developing solutions for these needs. No patient or public contribution.

Preparing Chinese higher vocational students to succeed in a globalized and multicultural world: Enhancing their oral English competence and intercultural competence.

Caring for patients in the emergency department requires health care providers to seamlessly integrate clinical expertise with cultural awareness. As communities grow increasingly diverse, delivering culturally sensitive care alongside acute management has become essential to effective emergency response. Traditional emergency frameworks, primarily developed within Western medical contexts, often require adaptation to accommodate populations whose cultural beliefs shape their engagement with triage systems, medical interventions, and health care communication during critical situations. This paper examines how emergency nurses can uphold cultural sensitivity while delivering time-critical care, illustrated through 3 real-world case scenarios. We explore practical strategies for rapid cultural assessment, effective communication systems, and adaptive care practices that can be implemented in high-stress situations. Through an analysis of current evidence and best practices, we provide frameworks for health care providers to deliver effective, culturally appropriate care while balancing the competing demands of time-sensitive interventions.