Water immersion for labour and birth supports physiological birth and positive birth experiences. Larger-bodied women experience more complications from obstetric interventions yet are often denied access to water immersion. To explore larger-bodied women's experiences of trying to access water immersion for labour and birth in Australia. This qualitative sub-study draws on data from the RADIANT study, a consumer-led project exploring weight-inclusive maternity care. Using an online Photovoice method, 65 participants shared images and narratives in moderated discussion groups and virtual workshops. Data related to water immersion for labour and birth were analysed using reflexive thematic analysis. Four themes were identified: 1) "Because your body mass index (BMI) is too high"; 2) "Rugs frequently pulled out"; 3) "No input or final say"; and 4) "Little energy left to fight". Findings reveal that BMI-based restrictions and inconsistent clinical practices undermine autonomy and equitable access to the effective pain relief offered through water immersion for labour and birth. Women reported emotional distress, reduced trust in care, and challenges self-advocating in a system that often pathologises their larger bodies. Larger-bodied women value access to water immersion for pain relief during labour and birth but face systemic barriers. A shift toward weight-inclusive individualised care is needed to support informed choice and respectful maternity care.
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Too much work on graphene and related materials cannot be repeated, a problem that wastes time and holds back commercialization. New rules could help solve it.
Avoidant restrictive food intake disorder (ARFID) was introduced to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 and current guidelines recommend multidisciplinary care, however there are few evaluations of such pathways. This study aims to enhance the study stage of the plan-do-study-act (PDSA) cycle using qualitative methods to improve the development, refinement, and implementation of a novel pilot ARFID pathway in a community eating disorder service. Semi-structured interviews were conducted with 17 participants with experience of the pathway (7 service users:10 staff members) according to an interview schedule. Reflexive, codebook thematic analysis was used to analyse the interview data. Gaps in understanding and treating ARFID were revealed, leading to feelings of uncertainty and frustration. The establishment of a specialist multidisciplinary team (MDT) improved knowledge and efficiency but created challenges related to team integration and resource allocation. Barriers for service user engagement and communication demonstrated the need for service user consultation and pathway co-creation. Service user consultation, treatment adaptations for neurodiversity and cross-service working were identified to improve the pathway as part of the act stage of the PDSA cycle. Future ARFID pathways should prioritise service user agency and access to multidisciplinary care and incorporate consultation from external eating disorder service, as well as lived experience experts. People who have avoidant restrictive food intake disorder (ARFID) have very limited diets and struggle to eat enough or certain kinds of food. This can cause problems with their health and daily life. A new pilot pathway in a community eating disorder service was set up to help adults with these eating difficulties.To help improve this pathway we asked patients and staff what they thought about it. Seven patients and ten staff members were interviewed, and we organized what they said into key messages.Both staff and patients said they were often unsure about what might be most helpful for people with ARFID. Having a team of different professionals made things easier, but it also brought some challenges. Patients said it was important to be involved in planning their care.The study shows that care works best when patients are listened to, teams work together, and support is flexible to fit each person’s needs.
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Sexual minority (SM) people may be at increased risk of "unintended" pregnancies, but limited research has examined potential disparities. We examined the intention status of lifetime pregnancies by sexual orientation. We pooled data from the Nurses' Health Study 3 and Growing Up Today Study (n = 36 967 pregnancies 1978-2024). Using multinomial models, we estimated relative risk ratios (RRRs) for pregnancy intention (actively trying/wanted then or sooner, not trying but glad, wanted later but not then, and unwanted then and in the future) among SM groups (completely heterosexual with same-sex experience, mostly heterosexual, bisexual, and lesbian/gay) versus completely heterosexual participants with no same-sex experience. Model predicted probabilities show that 15%-33% of pregnancies within each sexual orientation group were wanted later/unwanted. Compared to pregnancies to completely heterosexual participants with no same-sex experience, all SM groups had more pregnancies that were wanted later (RRRs from 1.22 [completely heterosexual with same-sex experience] to 2.28 [bisexual]) and unwanted then and in the future (RRRs ranging from 1.74 [completely heterosexual with same-sex experience] to 5.23 [bisexual participants]), compared to pregnancies occurring when participants were actively trying/wanted the pregnancy then or sooner. Our findings suggest that pregnancies among SM groups disproportionately are unwanted or occur too early.
This study examined whether social robots influence 4-5-year-olds' persistence. Almost all participants (97%) were Japanese. Most participants lived in urban or suburban areas in Osaka and came from middle socioeconomic backgrounds. The data were collected in 2023-2025. In Experiment 1 (N = 108, 45 girls), a robot's verbal time updates enhanced persistence, but robot interactions did not. In Experiment 2 (N = 27, 12 girls), providing time updates from a personal computer (PC) did not increase persistence. In Experiment 3 (N = 54, 24 girls), children worked with a robot (from Experiment 1), a human, or alone. Verbal time updates from both agents increased persistence compared to working alone although children behaved differently, for example, making qualitatively different comments to each agent. Findings indicate that robots and humans can foster children's persistence, though their roles may differ, reflecting robots' growing presence in children's lives. Young children often give up when tasks become difficult. This study explored whether robots could help children keep trying. We worked with 189 Japanese children aged 4–5 years and asked them to work on a challenging task. When a robot told the children how long they had been working, the children persisted longer, whereas time updates from a computer did not have this effect. When a human provided the same time information, the children persisted longer. The children interacted differently with robots and humans, suggesting that robots and humans may support persistence in different ways. These findings suggest that reminding children of their ongoing effort can help them keep trying. Robots could play a supportive role in children’s persistence.
Camouflaging of autistic traits has gained increasing attention as a psychological construct capturing strategies used to conceal or compensate for autistic characteristics in social contexts. Given the cultural specificity of social behavior, the adaptation and validation of measurement instruments across diverse populations are essential. The present study aimed to culturally adapt and validate the Persian version of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and to examine its measurement invariance and group differences between adults with high and low autistic traits in Iran. Following a standardized forward-backward translation procedure and expert panel review, the Persian CAT-Q was administered to 1,100 individuals, of whom 948 (aged 15-50 years) met the inclusion criteria after data screening. Construct validity was examined using confirmatory factor analysis (CFA). Convergent validity was assessed through correlations with the social camouflage subscale of the Comprehensive Autistic Trait Inventory (CATI), and reliability was evaluated using Cronbach's alpha and mean inter-item correlations. CFA supported the original three-factor structure of the CAT-Q (compensation, masking, and assimilation) with acceptable fit indices (Comparative Fit Index [CFI] = 0.91, Root Mean Square Error of Approximation [RMSEA] = 0.06). Measurement invariance testing supported configural, metric, and scalar invariance across high and low autistic traits groups, indicating comparable measurement properties. Convergent validity was confirmed through significant correlations with the social camouflage subscale of the CATI. Internal consistency was strong, with Cronbach's alpha coefficients ranging from .66 to .89 across subscales and .89 for the total scale, although the assimilation subscale showed comparatively lower reliability. The Persian version of the CAT-Q demonstrates satisfactory psychometric properties and measurement equivalence across groups, supporting its use in research contexts within Iran. Findings should be interpreted with attention to cultural context and the relatively lower reliability of the assimilation subscale.Lay AbstractMany autistic people use "camouflaging" to cope in social situations. Camouflaging means trying to hide autistic traits or to compensate for social difficulties so that others will not notice differences. These efforts may help someone blend in, but they can also be tiring and may affect wellbeing. Because social rules and expectations differ across cultures, researchers and clinicians need tools that are carefully adapted for each language and society. This study adapted the Camouflaging Autistic Traits Questionnaire (CAT-Q) into Persian and examined whether it works well for adults in Iran. The questionnaire was translated using a standard forward-backward process, reviewed by specialists for clarity and cultural suitability, and then tested in a large Iranian sample recruited online. We examined whether the Persian CAT-Q keeps the same three parts found in earlier research: (1) compensation (actively managing social situations), (2) masking (hiding autistic traits), and (3) assimilation (trying to fit in by suppressing one's natural style). We also tested whether the questionnaire measures camouflaging in the same way for people with higher versus lower levels of autistic traits, so that comparisons between these groups are fair. Overall, results showed that the Persian CAT-Q is a useful and consistent measure of camouflaging in Iranian adults. The "Assimilation" part was somewhat less consistent than the other parts, so it should be interpreted with extra care. This Persian version can support future research and may help improve understanding of hidden social effort and support needs in Iran.
The cardiovascular-kidney-metabolic syndrome (CKM) framework captures interconnected risks of adiposity, metabolic dysregulation, kidney disease, and cardiovascular disease, yet sex-specific differences in CKM stage distribution and lifestyle associations remain underexplored in adolescents. This study examined sex-specific CKM stage prevalence, the distribution of stage-1 features within stage-2 subgroups, and associations with modifiable lifestyle factors in US adolescents. We analyzed National Health and Nutrition Examination Survey 2017-2020 data for 1,387 adolescents aged 12-19 years. Participants were classified into CKM stages 0-2. Survey-weighted multinomial logistic regression was used to examine sex-stratified associations with dietary intake, meal sources, and lifestyle factors after covariate adjustment. CKM stage prevalence was similar between sexes: among boys, 42.3% were stage-0, 28.4% stage-1, and 29.4% stage-2, compared with 42.2%, 32.9%, and 24.9% in girls. Within stage-2, boys most commonly had hypertriglyceridemia only (39.8%), whereas girls predominantly had moderate-to-high-risk chronic kidney disease only (35.6%). In boys, daily school lunch intake was associated with lower odds of stage-1 (adjusted odds ratio = 0.11, 95% confidence interval = 0.03-0.40). In girls, each additional day of moderate-to-vigorous physical activity was associated with markedly lower odds of stage-1 (adjusted odds ratio = 0.78, 95% confidence interval = 0.67-0.91). Trying to lose weight showed the strongest associations with CKM stages in both sexes. After adjustment for multiple comparisons, daily school lunch in boys and trying to lose weight in both sexes remained associated with CKM stages. CKM stage distribution and related lifestyle associations differed by sex in US adolescents, highlighting the importance of sex-specific prevention strategies and longitudinal research.
Clinical care for patients who report substantial hearing difficulties despite having little or no hearing loss is a topic of great debate within and beyond audiology. Building on our previous retrospective review of veterans evaluated for auditory processing disorders across the Veterans Health Administration (VHA), the current work presents five such case studies. The goal is to work toward improved patient care by providing a more in-depth view highlighting both strengths and weaknesses of approaches to care for veterans whose hearing difficulties are not explained by hearing loss. Five case studies were selected for review with the goal of identifying individuals with a wide range of etiologies and experiences receiving care for auditory complaints across the VHA. All information provided is taken directly from chart notes available from VHA and Defense Health Agency sources. Etiologies included traumatic brain injury, jet fuel exposure, and nonspecific origins. Some patients experienced well-coordinated care across medical departments, while others experienced repeated barriers and high burdens of self-advocacy while trying to navigate the health care system. Furthermore, differences in the approach of audiologists and speech-language pathologists are highlighted, including differing emphasis on diagnostic tests versus self-report measures and use of top-down versus bottom-up rehabilitation tools. This work highlights several options likely to improve care for veterans with auditory processing deficits, including greater emphasis on addressing patient-specific needs and goals, improved communication and collaboration between audiology and other medical disciplines, and the potential role for auditory device-based rehabilitation options, even among patients with minimal hearing loss.
Kratom use is growing for both therapeutic and non-therapeutic effects. This survey assessed the temporal relationship between kratom initiation and prior, subsequent, or concurrent substance use or medical treatment. This cross-sectional, anonymous electronic survey was disseminated to American Kratom Association and Global Kratom Coalition members from 3/2025-9/2025. Adults aged ≥18 years who reported past or current kratom use were eligible. A novel questionnaire was generated assessing: kratom and other substance use characteristics; pursuit of medical treatment for selected diagnoses; and temporal relationships between kratom use and substance use or medical treatment. Of 161 respondents included, most (95.7%) currently versus previously used kratom. Whole-leaf product use was reported most often (90.3%), with 38.3% reporting concentrated kratom extracts and 16.9% single alkaloid isolates. Reasons for kratom use were therapeutic (50.3%), non-therapeutic (16.1%), or both (33.5%). Therapeutic (self-treatment) use was most commonly cited for pain (86.2%), mental focus (52.3%), mental health (46.9%), sleep (43.1%), and substance use disorder (27.7%). Most respondents had used ≥1 other psychoactive substance in their lifetime, including cannabis (74.3%), alcohol (68.2%), stimulants (43.2%), sedatives (33.1%), non-prescribed opioids (26.4%), or tobacco (6.1%); 10.1% reported no prior substance use besides kratom. Whether used for non-therapeutic or therapeutic purposes, kratom was rarely initiated first. Among those with a substance use history, only 3-10% reported trying kratom prior to other substances reported. Among those with pertinent medical conditions, 0-20% initiated kratom before receiving medical care for their reported conditions. This study builds on previous research assessing kratom use motivations, providing insight into the temporal relationship between kratom initiation and substance use or medical treatment. Kratom was rarely the first substance or therapeutic treatment tried, but rather most individuals initiated it concurrently with or after discontinuing other substances or medical care. Larger follow-up studies are warranted to confirm these results.
Mannardite, Ba[(Ti4+)6(V3+)2]O16, a mineral of the hollandite supergroup, is characterized by a tunnel structure built up from double chains of edge-sharing octahedra. It shows complex order/disorder phenomena that are often related to the occurrence of diffuse scattering, satellite reflections or both. So far, diffuse scattering features have been linked to ordering of large cations in the tunnel, but recent studies on hollandite sensu stricto suggested that other contributions could play an important role in determining diffuse scattering features. New single-crystal X-ray diffuse scattering data, modelling with Monte Carlo simulations and the three-dimensional difference pair-distribution function (3D-ΔPDF) approach unveil a complex scenario, involving interactions not only between the Ba2+ cations in the tunnel, trying to avoid each other, but also among neighbouring tunnels. Short-range order observed within and between the tunnels is coupled with framework relaxation. The possible occurrence of additional cation sites in the channel, as reported in some synthetic hollandites and electrode materials, is discussed on the basis of the diffuse scattering features and modelling. This study highlights the importance of a thorough characterization of short-range order to understand, and thus tune, the physical properties of hollandite-like materials.
Sibling sexual behaviour and abuse (SSB/A) is common and has adverse effects not only to the child who is harmed and the child responsible, but the whole family unit is deeply impacted. The study aimed to understand how SSB/A is experienced by parents and what impact SSB/A has on parents. A secondary qualitative design was used to examine 22 narrative stories written by parents (primarily mothers) about their experience of SSB/A that were submitted to #SiblingsToo, a Canadian organisation dedicated to raising awareness of SSB/A. Thematic analysis was used to analyse all narratives. SSB/A produces multifaceted disruption across the family system, with parents describing emotional, relational and practical consequences in the aftermath of disclosure or discovery. Parents framed SSB/A as an event that changed their understanding of their family, forcing them to renegotiate family roles, restructure daily routines and confront intense feelings of guilt, shame, fear and self-blame, exacerbated in some circumstances by gendered expectations. Parents also reported the burden of navigating divided loyalties, while trying to maintain safety, stability and emotional availability. The strain of these competing demands frequently intersected with challenges in accessing professional support, particularly where services were experienced as inadequate, retraumatising, or focused primarily on the harmed child. This study contributes important new insights into the experiences of parents whose families have been affected by SSB/A. Through a collection of written narratives, the findings demonstrate that SSB/A constitutes a family-level negative impact that reshapes parents' emotional landscapes, daily routines, relationships and caregiving roles.
In Vietnam, smoking remains highly prevalent among people living with HIV (PLWH), posing significant health risks. As PLWH receiving HIV care represent a selected population that may differ from the general smoking population, evidence on the psychosocial factors shaping readiness to quit in this group remains limited. This study examines the associations between tobacco-related risk perception, self-efficacy, and social norms with advanced readiness to quit among PLWH who smoke and were enrolled in a smoking cessation trial in Vietnam. We conducted a secondary cross-sectional analysis of baseline data from the VQUIT randomized controlled trial, including 672 PLWH who currently smoked cigarettes some days or every day, recruited from 13 HIV outpatient clinics in Hanoi, Vietnam. Advanced readiness to quit was defined as currently trying to quit or planning to quit within 30 days; all other responses were classified as lower or no readiness. Multivariable logistic regression models with robust standard errors, clustered at the clinic level, were fitted to examine associations between risk perception, self-efficacy, four social norm constructs, and advanced readiness to quit. Overall, 76.6% of participants reported advanced readiness to quit. Higher risk perception was consistently associated with increased odds of advanced readiness to quit (aORs ranged 1.10 to 1.13 across models). Injunctive norms (aOR=1.11, 95% CI: 1.03-1.20) and internalized norms (aOR=1.40, 95% CI: 1.02-1.94) were positively associated with advanced readiness to quit, while descriptive and subjective norms were not. Self-efficacy showed no significant association. Among PLWH enrolled in a smoking cessation trial in Vietnam, higher risk perception and stronger injunctive and internalized norms were associated with advanced readiness to quit. Cessation interventions integrated into HIV care may benefit from addressing both perceived smoking-related risks and norm-based motivations to quit.
The total fertility rate (TFR) in most developed countries has been declining for decades. In the United States (U.S.), the total fertility rate has remained below replacement level since 2007. Subfertility affects at least 15% of women or couples over their reproductive lifespan and contributes to reduced TFR. Restorative reproductive medicine (RRM) is a medically based approach to subfertility care that can be delivered in primary care settings to increase live birth rates. To estimate the theoretical impact of use of RRM among subfertile couples in the United States. We conducted a simulation study. Model inputs included the number of women of reproductive age in the United States by 5-year age groups; current age-specific and total fertility rates; the proportion of women in each age group with subfertility; estimated spontaneous live birth rates among women with subfertility; and age-specific crude live birth rates with RRM treatment. We evaluated fifteen scenarios including sensitivity analyses: two different varying assumptions for live births from spontaneous conception (25% vs. 50%), two levels of RRM utilization among subfertile women (20% vs. 50%), three different estimates of the number of subfertile women who would be potentially eligible for RRM treatment, and 4 different levels of effectiveness (live birth) from RRM treatment. The baseline TFR in the United States was 1.77 during 2015-2019, and 13.5% of women ages 20-44 were estimated to have subfertility. In a conservative scenario (50% spontaneous births; 20% RRM utilization; married women trying to conceive for at least 12 months, 20.7% RRM live births), the TFR increased to 1.79, representing a 1.0% relative increase (absolute +0.02). In an optimistic scenario (25% spontaneous births; 50% RRM utilization; all subfertile women), the TFR increased to 2.02, a 14.5% relative increase (absolute +0.26), approaching replacement-level fertility. Simulation results suggest that expanding access to RRM within primary care settings could meaningfully increase the U.S. TFR, by reducing unresolved subfertility. Realizing this potential would require policy and health system changes to address workforce capacity, insurance coverage, and equitable access. These findings underscore the potential contribution of non-IVF fertility care pathways in addressing population-level fertility decline.
Background/Objectives: Heart failure (HF) is a highly unpredictable disease that significantly impacts patients' well-being. One of the fundamental problems faced by cardiac patients is trying to answer the question of how to lead a meaningful life. Meaning in life is a crucial predictor of well-being, ill-being and quality of life for everyone, not just cardiac patients. Therefore, identifying its predictors is crucial. Based on Leventhal et al.'s common-sense model of self-regulation of health and illness, and Lipowski's disease perception concept, this study verified the role of illness perception and perceived stress in existential meaning in Polish HF patients. Methods: This manuscript presents the results of a cross-sectional study. Overall, 336 HF patients from Poland were examined. Four questionnaires were used: the Meaning in Life Questionnaire (MLQ), the Multidimensional Existential Meaning Scale (MEMS), the Perceived Stress Scale (PSS-10) and the Disease-Related Appraisals Scale (DRAS). Results: Negative illness perception and positive cognitive assessment of the illness were shown to be significant predictors of meaning in life in patients with HF. Furthermore, this relationship was mediated by perceived stress. Additionally, the positive correlation between negative illness assessment and positive illness perception was found. Conclusions: This study demonstrates that cognitive assessment of the disease can be associated with the existential resources of heart failure patients. It also highlights the importance of working on the existential sphere of cardiac patients and accurately verified theoretical assumptions regarding the relationship between illness perception and meaning in life, providing a basis for future longitudinal studies and meaning-oriented psychological help focused on individuals with HF.
The Default Mode Network was a key finding for cognitive neuroscience, but being the result of a data-driven analysis of resting-state fMRI data, its psychological and clinical implications have been difficult to elucidate. This is because in the resting-state paradigm we cannot directly correlate an observable specific task with specific brain connectivity patterns, and therefore inferences about the relationship between particular cognitive domains and the resting-state networks are limited. A similar problem arises when trying to link the network with personality traits: the DMN, as other intrinsic networks, is not a simple metric to compare with the results of a psychological test, but a complex composite of spatio-temporal features. Although over the last two decades several research works have provided insights about these relationships, we still lack a consensus on the methodology that best captures these interactions. In this context, we propose an alternative method to model the psycho-physiological relationships of the resting state components with behavioral data, based on the dimensionality reduction of an extensive psychological evaluation and the spatial dimension of the intrinsic connectivity components. Our results show that the connectivity networks are low to moderately related with behavioral and personality traits, or at least this relation is not in a direct way. This integration of neuroimaging and psychological assessment data creates valuable pathways for cognitive neuroscience, potentially revealing with precision how intrinsic brain network organization relates to individual variations in cognitive functioning and personality dimensions.
After the shocks of 2025, Malawi is rethinking its relationship to foreign aid-and trying to protect dramatic gains in maternal health.
Cerebral venous and sinus thrombosis (CVST) is a life-threatening disorder which can present with papilledema. Idiopathic intracranial hypertension (IIH) also presents with papilledema, but is a relatively benign condition. Despite often presenting in a similar manner, CVST and IIH may lead to markedly different outcomes. We investigated if papilledema severity, related clinical features, and paraclinical visual assessment, can be used to differentiate between CVST and IIH-related papilledema, this way trying to improve a priori probability for both conditions at the bedside. Consecutive CVST and IIH ambulant alert patients presenting with papilledema were enrolled. Clinical and paraclinical (optical coherence tomography, automated perimetry) data were compared between groups. Twelve out of 39 CVST and 34 IIH patients were recruited (males: 2 [CVT], 8 [IIH]; mean age: 40,8 [CVST], 34,1 years [IIH] [p = 0,249]). CVST patients presented with lower papilledema Frisén grade (p = 0.036 OD, p = 0.013 OS), more headache (p = 0.017), shorter headache duration (p = 0.000), and less scotomas on the Amsler grid (p = 0.047). Diplopia was only present in IIH group (n = 7) and additional focal neurological signs were only present in CVST group (n = 5). The CVST group further showed lower peripapillary retinal nerve fiber layer (RNFL) thickness (p = 0.03 OD, p = 0.04 OS), and near significantly lower perimetric mean deviation ((p = 0,058 OD, 0,06 OS). Time to observation, RNFL thickness, and Frisén grade showed area under curve values > 0.76 for distinguishing CVST versus IIH. (0.904, 0.822, 0.761, respectively) CONCLUSIONS: Combined clinical and paraclinical visual assessment can help to distinguish between CVST- vs. IIH-related papilledema at the bedside.
Home safety is a major issue for individuals involved in caring for dementia patients due to a lack of practice and awareness, as it accounts for more than 90% of the needs of patients with dementia. Such caregivers face constant challenges in preventing accidents while trying to maintain the dementia patients' independence and quality of life. The objective of this unicentric study was to assess the correlates of dementia patients' caregivers' home safety practices. A cross-sectional study was conducted in an outpatient setting of a private hospital in Jeddah (Saudi Arabia) from November 2022 until January 2023 by assessing the possible correlation between the caregivers' demographics among 128 dementia patients' caregivers. It also evaluates their service experience including the type of care, assistance duration, duration of caregiving, average time spent with persons living with dementia, dementia care training experience and their home safety practice quality. A questionnaire utilizing selected items from the validated "Alzheimer's Association Home Safety Checklist" was employed to assess the caregivers' home safety practices. Besides, the caregivers' psychological well-being and depression were assessed through a validated "Patient Health Questionnaire-2. Although 66% of caregivers showed good home safety practices, 29% of caregivers reported depressive symptoms. Caregivers with extended caregiving duration (more than 5 years) demonstrated significantly better home safety practices as compared to those with shorter duration (AOR: 5.68, 95% CI: 1.76-18.33, p = 0.004). Further, depressed caregivers provided poor service as compared to non-depressed caregivers (AOR: 2.94, 95% CI: 1.19-7.24, p = 0.019). Short-term and long-term dementia training aligning with cultural values and traditions of Saudi Arabia are required to ensure the care of such persons living with dementia is achieved in an effective and respectful way. Moreover, trained caregivers can improve quality of life, delay institutionalization and reduce healthcare costs.