Search Results (145)

Within the silk manuscript Yizhuan, Confucius underscores the priority of moral righteousness over divination, advocating the cultivation of virtue, benevolence, and righteousness as the proper way to seek auspiciousness and blessing. However, this stance serves merely as a value orientation for the study, application, and interpretation of the Zhouyi. In other words, moral virtue is neither a necessary nor a sufficient condition for divination. In fact, the emergence of the Zhouyi lies in the misalignment and separation between virtue and fortune. The “alignment of virtue and fortune [德福一致]” formed the foundation of the early Western Zhou view of the Mandate of Heaven and served to legitimize the Zhou replacement of the Shang Dynasty. Under this understanding of the Mandate of Heaven, judgments of auspiciousness and inauspiciousness could be made based on the presence or absence of virtue, thereby reducing the relative importance of divination. Confucius’ early attitude toward the Zhouyi reflected this perspective. Nevertheless, the alignment of virtue and fortune could not adequately explain the evident inconsistency between moral conduct and human fate in reality. Consequently, by the late Spring and Autumn period, this framework gradually developed into the notion of “timely mandate” (shiming 時命), which denied a necessary correspondence between virtue and fortune. In response to this shift, the late-life Confucius and his disciples emphasized finding moral and spiritual grounding through virtue, while adopting a calm and accepting attitude toward external circumstances such as success and failure, wealth and poverty, and longevity and premature death. The shift corresponded to the transformation in the conception of the Mandate of Heaven. It was also in this context that Confucius came to value the Zhouyi in his later years. Full article

Background/Objectives: Attitudes toward end-of-life care (EOLC) are a key component of nursing practice. This study aimed to assess nursing students’ attitudes toward EOLC and their perceived preparedness to manage end-of-life situations. Methods: A cross-sectional descriptive study was conducted with 593 undergraduate nursing students from a public Spanish university. Data were collected using an online questionnaire, including the validated Spanish version of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-S). Descriptive and inferential analyses were performed. Results: The median reverse-coded FATCOD-S total score was 125.0 (IQR 119.0–131.0), and 99.7% of students were classified as having positive or very positive attitudes when the descriptive cut-offs were applied. In the exploratory adjusted model, fourth-year status and previous EOLC training were associated with higher FATCOD-S total scores. However, 59.5% of respondents reported feeling unprepared to provide EOLC, and 59.0% perceived EOLC as a significant source of stress for nurses. Additionally, 62.0% of students with positive attitudes reported not feeling prepared to provide such care. Responses related to emotional involvement, communication about death, and ethical aspects showed greater variability. Conclusions: Although most nursing students display favorable attitudes toward EOLC, these coexist with a low perceived level of preparedness, with more than half of students reporting that they do not feel prepared to provide EOLC. Positive attitudes alone may not ensure confidence in clinical practice. Strengthening undergraduate education—particularly in emotional preparation, communication skills, and coping strategies—is essential to better prepare future nurses for the complexities of EOLC. These findings should be interpreted in light of the study’s cross-sectional design and single-university setting. Full article

For vaccine-preventable diseases, vaccination uptake is among the best public health behaviors to prevent infection, disease and death. However, public confidence in this behavior has waned in recent years alongside the twin respiratory threats of influenza and COVID-19. Moreover, certain populations, such as emerging adults, may be amenable to vaccination attitude and behavior change as they navigate their path between adolescence and adulthood. The current investigation presents two studies that address influenza and COVID-19 vaccination uptake among emerging adults. First, among more than 2000 emerging adults during the years of 2022–2024, we examined rates of vaccination uptake and attitudes, as well as relationships of vaccine rates with other concomitant health behaviors. Second, we explored the efficacy of a classroom-based vaccination promotion experience in altering both attitudes and behaviors regarding vaccination uptake among 275 emerging adults at college. Results highlighted some health behaviors that are related to influenza uptake but not COVID-19 uptake. Moreover, results from Study 2 demonstrated that attitudes, but not behavior, seem to be most amenable to the classroom-based approach to encourage health behavior change, as a significant increase in positive attitudes toward both influenza and COVID-19 vaccines was observed. These findings are discussed further, considering theoretical and practical applications. Full article

Ageism refers to prejudice on the basis of a person’s age, often directed toward older adults. Arab culture represents a pertinent case, as this culture is historically known for its appreciation of older people, but recent studies have indicated high levels of ageism. This systematic integrative review aims to synthesize the attitudes toward older adults in Arab culture and their determining factors. Research was screened using the PRISMA guidelines, and 23 articles were included for synthesis. Thematic and content analyses were performed, from which five themes emerged: “demographic factors”, “psychological factors”, “knowledge of ageing”, “sociocultural factors and aspects” and “self-ageism and ageing experiences”. Knowledge of aging and close interpersonal relationships with older adults were associated with lower levels of ageism and more positive attitudes. Sociocultural aspects, including the low socioeconomic status in most Arab countries, seem to be associated with ageism. Moreover, individual factors like low self-esteem, low empathy, and high death anxiety were related to negative attitudes toward older adults. The review also underlines the experiences and self-ageism among older people. The article provides insights into ageism directed towards older adults in Arab culture and ties knowledge with practice by highlighting the social and policy implications of the findings. Full article

Background/Objectives: The COVID-19 pandemic caused over seven million deaths globally as of July 2024. In an attempt to bring the pandemic under control, immunization was implemented as the main preventive strategy. This study aimed to investigate the knowledge, attitudes, and practices (KAP) of hospitalized patients and healthcare workers (HCWs) regarding COVID-19 vaccination, as well as the factors contributing to COVID-19 vaccination rates. Methods: This cross-sectional, survey-based KAP study was conducted between November 2024 and February 2025 in five hospitals across five cities of the Republic of Srpska, Bosnia and Herzegovina. Results: There were 571 respondents, 68% of whom were female, with an average age of 39.17 ± 14.74 years; one-third held a university degree. The study sample consisted of patients and healthcare workers (HCWs) (59% vs. 41%). During the pandemic period, 46.6% of respondents were diagnosed with COVID-19, with a higher prevalence among healthcare workers compared to patients (54.2% vs. 41.2%). Among the 55.2% of respondents who were vaccinated, HCWs were more often vaccinated than patients (70.9% vs. 44.2%) and more likely to know that vaccines protect against severe forms of disease and death (80.8% vs. 68.5%). Patients more often believed that vaccination against COVID-19 may lead to sterility in young patients (11.3% vs. 6%) and were more often afraid of vaccination compared to the occurrence of COVID-19 (35.6% vs. 24.8%). Regression analyses showed that independent predictors of COVID-19 vaccination were older age (p < 0.001), higher education level (p = 0.039), knowledge of vaccine production technology, and the belief that vaccinated individuals have milder symptoms of the disease (p = 0.002). Conversely, the belief that the COVID-19 situation was overblown was negatively associated with vaccination (p = 0.004). Conclusions: HCWs had better knowledge, more positive attitudes, and better vaccination practices against COVID-19 in comparison to patients. However, there are still certain dilemmas and hesitations among HCWs toward COVID-19 vaccination. Full article

Background/Objective: Death is an inevitable part of life, and ensuring high-quality end-of-life care is a critical concern. Planning for a “good death” aligns care with patients’ preferences, and advance directive (AD) discussions should begin early between patients, physicians, and families. This project aimed to increase AD completion among older adults in the Indiana University Health Primary Care (IUHPC) Geriatrics Clinic, with the goal of meeting or exceeding the national average of 46%. Methods: An intervention was implemented from September to November 2024 and from January to June 2025, focusing on patient education and strengthening patient–provider communication. Results: The initiative significantly increased AD completion, demonstrating that older adults are receptive to advance care planning once informed of its benefits. Potential influencing factors included knowledge of life-sustaining care, demographic variables, health status, awareness of dying well, and attitudes toward ADs. Conclusions: Education and communication are key to increasing AD completion rates. These findings underscore the importance of ongoing efforts to raise awareness and ensure that end-of-life care respects patients’ wishes and values. Full article

Previous research demonstrates that expert witness education and experience have an influence on mock juror perceptions of credibility. However, whether this relationship extends to cases involving the insanity defense remains unclear, leaving an important gap in the literature given the high stakes of such trials. The current study used an experimental design to examine the impact of expert witness knowledge (high vs. low) on perceived credibility and subsequent NGRI endorsement. Participants (N = 425) read a case summary and the credentials and testimony of the expert witness, completed questionnaires, and reported the likelihood that they would endorse NGRI for the defendant. Results indicated that, regardless of expert witness testimony, prior attitudes about the insanity defense (IDA-R) predicted NGRI endorsement. Specifically, positive attitudes towards the insanity defense resulted in an increased likelihood of NGRI endorsement. These findings underscore that juror attitudes toward the insanity defense, rather than expert witness characteristics, may be the decisive factor shaping NGRI endorsement. This highlights the need for courts to consider such attitudes during jury selection in NGRI cases, paralleling the practice of death qualification in capital trials. Full article

Background: The willingness to donate organs after death remains low in many populations, often due to informational and psychological barriers. This study assessed the impact of an educational lecture on knowledge and attitudes toward postmortem organ donation among university students in Kazakhstan. Methods: A total of 129 students completed a pre-lecture questionnaire on donation attitudes, knowledge, and barriers; 97 also completed the post-lecture assessment. Changes were analyzed using paired t-tests, repeated-measures ANOVA, and logistic regression. Participants were grouped by attitudinal changes to identify predictors of consent. Results: Knowledge about organ donation increased significantly after the lecture (p < 0.001), with larger gains among females and non-medical students. The number of participants who were willing to donate rose from 27 to 56 (p < 0.001). About 37% showed a positive shift, while 3% shifted toward refusal. In the initially ambivalent group (n = 49), female gender (AOR = 35.6), greater knowledge gain (AOR = 3.03), and lower perceived barriers (AOR = 0.05) predicted a change towards consent. Uncertainty about how to express consent was the only significantly differing barrier (p = 0.036). Conclusion: A brief educational lecture effectively increased knowledge and willingness to donate. Targeted information on procedural aspects may reduce indecision and promote informed donor registration. Full article

This study explores economic and risk perceptions that spark off-shore irregular migration among West Africans through the Mediterranean Sea to countries of destination (CODs). This study is timely because deaths on the Mediterranean Sea, which are unprecedented in migration history, result in a need to create awareness and save lives. Grounded in the Theory of Reasoned Action and the Cultural Theory of Risk Perception, this study explores the economic and risk perceptions of off-shore irregular migration. This study comprised a literature review, otherwise known as a “meta study”. The study’s findings reveal that there is a nexus between a person’s attitude and behaviours in terms of human action. Human nurturing determines a person’s attitudes and behaviours. The human mind does what it wants when one is desperate for economic survival. This forces humankind to engage in dangerous activities to survive. Therefore, irregular migrants’ choice of unsafe routes through the Mediterranean Sea to CODs depends on their expected outcomes. Irregular migrants consider migration as an “insurance”, and flee from hardship towards opportunities. The perceptions that lead to this range from salary disparities to economic freedom. I argue that spiritual beliefs, peer pressure, media platforms, and personal factors influence irregular route choices. This study recommends collaboration among the ECOWAS, African nations’ governments, and the IOM to engage returning migrants to narrate their in-depth experiences about the routes’ dangers to create awareness. Returning migrants’ narratives should be disseminated in mass media and on social media platforms to target youth. This would discourage West African youth from choosing unsafe routes to CODs. Collaboration should be extended to youth training in entrepreneurship to equip youth as job creators rather than job seekers to curb unemployment, which usually sparks off-shore irregular migration. Full article

By the end of the nineteenth century, picture postcards had become ubiquitous not only as an inexpensive means of communication but also as objects for collection. Literary postcards were especially popular in Russia, and the rapid proliferation of cards featuring portraits of contemporary writers helped feed celebrity culture, turning those images into sought-after commodities for consumption. At the same time, celebrating Russian cultural accomplishments through picture postcards also helped shape contemporary perspectives of nation and national identity. As a rising star on the literary scene at that time, Maksim Gorky quickly became an icon of contemporary Russian youth culture and, consequently, a popular subject for picture postcards. With his floppy hair and distinctive clothing, Gorky’s image itself demonstrated his difference from established traditional norms for the profession of “writer,” and his revolutionary leanings and unconventional life challenged the dominant mores of the time. In the Soviet period, as picture postcards continued to serve this function of shaping national identity and values, Gorky’s image was frequently used on state-issued postcards, both before and after his death, but this time in service to the state as the “father of Soviet literature” (and regardless of his uneven and at times ambivalent attitude toward that state). This paper examines the evolution in the use and function of Gorky’s images on pre-revolutionary and Soviet-era postcards. As an early icon of non-conformism and liberation, Gorky’s image ironically was co-opted by the Soviet regime to serve as a symbol of political orthodoxy and conformity. Full article

Background: This study stems from the perceived need to update skills and training in the process of educating healthcare professionals in light of the needs of individuals and their families. Objectives: This study aimed to assess the prevailing attitudes toward death and hospice care among medical students in China, providing a foundation for implementing hospice care and death education within these institutions. Methods: We conducted an online survey questionnaire with 568 medical students. Results: The results indicate that the overall attitude toward death was more inclined to accepting death neutrally. Gender, place of origin, educational background, willingness to care for terminally ill patients, experience in caring for terminally ill patients, and more will affect the attitude toward death of medical students. Compared to their rural counterparts, medical students in urban areas are more likely to view death as neutral. Instead of reducing fear, death and hospice education made people more likely to avoid situations. All five dimensions of death attitude exhibit a substantial positive connection with attitudes toward hospice care. In comparison to earlier research, medical students exhibit increasingly favorable attitudes regarding hospice care, and their overall perspective on death remains one of natural approval, suggesting that the integration of death and hospice care teaching is progressing effectively in mainland China. Conclusions: Simultaneously, it was discovered that numerous deficiencies required enhancement, including the need for timely feedback and optimization in hospice care instruction and death education, as well as insufficient attention and educational guidance regarding the individual differences and psychological conditions of medical personnel in the future. Full article

Context: A plethora of actors like individual and professional characteristics, religiosity, personality-related factors, personal experience of death, and empathy form the attitude of health professionals in patient care in clinical settings and euthanasia. Objectives: The aim of the study was to measure the attitudes of health professionals toward euthanasia. In addition, we examined how individual and professional characteristics, religiosity, death perspectives, and empathy may predict health professionals’ attitudes toward euthanasia. Methods: We collected socio-demographic characteristics and attitudes toward euthanasia and the end of life as well as empathy dimensions from 465 health professionals working in health services in Greece. Multiple linear regression was applied to test the association of the attitudes about euthanasia with (1) demographic and professional variables, (2) perceptions about death, and (3) empathy. Results: Findings of the study revealed that health professionals’ attitudes towards euthanasia are significantly associated with their age, the target group of their patients, religious beliefs, and their attitudes about the end of life. Meanwhile, empathy was an insignificant predictor of ATE (p > 0.05). Conclusions: Working in clinical settings with patients, especially at the end of their lives, will always include ethical issues for health professionals. Training and supporting new generations of health professionals in patient care and bioethics are crucial in order to face these ethical issues during their professional careers. Full article

Aim: This study aimed to explore the attitudes of family caregivers toward truth-telling practices in palliative care in Türkiye, a Muslim-majority context where disclosure is often mediated by relatives. Methods: Using a convergent parallel mixed-methods design, data were collected from 100 unpaid family caregivers of terminally ill patients at a palliative care unit. Quantitative data were gathered via a structured questionnaire, and qualitative data through in-depth interviews with a purposively selected subsample of 10 participants. Chi-square tests were used to analyze associations, and p < 0.05 was considered statistically significant. Results: The mean age of caregivers was 47.4 ± 16.5 years, 67% were female. Notably, 67% of participants did not prefer that the patient be informed of irreversible deterioration, while 71% stated they would want to be informed if they were in the patient’s position (p < 0.05). Most preferred a multidisciplinary disclosure process involving physicians, psychologists, and spiritual counselors. Qualitative analysis revealed four themes: emotional conflict, protective family-centered decision-making, spiritual readiness for death, and preference for multidisciplinary communication approach. The participants expressed cultural concerns about psychological harm to the patient and emphasized the family’s role as emotional guardians. Conclusions: The findings highlight a gap between caregivers’ attitudes when acting as family members versus imagining themselves as patients. These results underscore the critical need for culturally sensitive and family-inclusive communication strategies in palliative care settings. Full article

Background/Objectives: Breast cancer (BCA) is one of the most common cancers affecting women worldwide. Screening has been linked to up to a 33% reduction in breast cancer-related deaths by helping detect tumors at an early stage. The successful implementation of community-based breast cancer screening programs depends on understanding the attitudes of women within the target community. This study aims to systematically review the literature to assess the association between women’s attitudes toward breast cancer screening and their life satisfaction and general attitudes toward life. We also aimed to examine women’s attitudes toward breast cancer screening recommendations and the factors that influence these attitudes. Methods: A systematic review of English-language literature was carried out. PubMed and Scopus were searched up to November 2024 for studies that met the predefined inclusion criteria. Methodologic quality was assessed using the adapted Newcastle–Ottawa Scale for cross-sectional studies and the corresponding scale for cohort studies. Results: Eleven studies met the inclusion criteria. The percentage of women who had undergone at least one breast cancer screening ranged from 8.3% to 94.5%. Women’s attitudes toward and participation in breast cancer screening were linked to psychological, social, and demographic factors. Lower levels of life satisfaction, self-efficacy, and perceived control or mastery in life, along with higher levels of non-work-related stress, and higher levels of optimism, were associated with a lower likelihood of participating in breast cancer screening. Full article

Background/Objectives: Organ transplantation is a vital treatment for individuals with advanced chronic-degenerative diseases. However, the global shortage of donated organs remains a significant challenge. Improving knowledge and attitudes could positively impact this issue. This study assessed the knowledge and attitudes of nursing students regarding organ donation and transplantation. Methods: A cross-sectional study was conducted using a previously validated questionnaire administered to 235 second- and third-year undergraduate nursing students from two Italian universities. Results: The response rate was 67.3%. Only 40.4% of students felt adequately informed about transplants and brain death, while 12.8% would not authorise organ transplantation for a family member. Willingness to authorise organ procurement from family members in a brain-dead state was positively associated with being atheist or agnostic (χ² = 7.235; p = 0.022), being in the third year of study (χ² = 4.282; p = 0.039) and having positive self-assessed knowledge (χ² = 8.061; p = 0.005). Conclusions: Nursing students exhibited suboptimal knowledge and positive attitudes toward organ and tissue donation. However, there is a need for health policymakers to implement strategies to raise awareness of the importance of organ donation through school and community programmes and public education campaigns. Full article