Search Results (677)

Introduction: Throughout life, the characteristics of a woman’s pelvic floor change due to physiological changes, including pregnancy, childbirth and menopause. These changes can predispose them to pelvic floor dysfunction. Objectives: To develop a linguistically and psychometrically adapted Portuguese (European) version of the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7), for assessing symptoms and quality of life in women with pelvic floor dysfunction. Methods: This cross-cultural study used a translation method, followed by an assessment of the validity and reliability of the instruments. The Portuguese versions of the PFDI-20 and PFIQ-7 were completed by 287 women (33.47 ± 8.2 years). To assess reliability, internal consistency was evaluated using Cronbach’s alpha (CA). Descriptive statistical analysis was applied for sociodemographic and clinical characterization, as well as questionnaire scoring. Spearman’s correlation (r) and Student’s t-test were used to analyze criterion and construct validity. Results: The Portuguese versions of PFDI-20 and PFIQ-7 were effectively translated and adjusted, revealing excellent internal consistency, as reflected in Cronbach’s alpha values of 0.853 for PFDI-20 and 0.937 for PFIQ-7. No Ceiling Effect was observed, while a Floor Effect was identified in both Portuguese versions of the PFDI-20 (5.2%) and PFIQ-7 (41.5%). Significant correlations were established between the instruments and five questions. Conclusions: The Portuguese versions of the PFDI-20 and PFIQ-7 showed adequate psychometric characteristics and are valid for use in the Portuguese population. Full article

Background/Objective: Culturally adapted frailty screening tools are essential for improving health outcomes, facilitating clinical decision-making, promoting effective care planning, and ensuring accurate frailty assessment across diverse cultural contexts; their use among clinicians and academics is therefore supported. The purpose of this study was to assess internal consistency, test–retest reliability, and validity of the Arabic FRAIL scale (FRAIL-AR scale) for Arabic-speaking populations with colorectal cancer (CRC). Methods: This cross-sectional study included 137 participants diagnosed with CRC who completed the FRAIL-AR scale, the EORTC QLQ-C30 physical function subscale, and functional performance-based Timed Up and Go (TUG) and Five Times Sit-to-Stand (5xSTS) tasks. Internal consistency was assessed using Kuder–Richardson formula 20 (KR-20), and test–retest reliability was determined using the two-way random intraclass correlation coefficient ICC _(2.1). Convergent validity was evaluated by assessing the correlation between the FRAIL-AR scale against the EORTC QLQ-C30 physical function scale, TUG, and 5xSTS. Results: The FRAIL-AR scale exhibited good internal consistency (KR-20 = 0.80) and test–retest reliability (ICC _(2.1) = 0.89, 95% CI 0.77–0.94). Correlation analysis showed a weak negative correlation between the overall FRAIL-AR scale scores and EORTC QLQ-C30 physical function scale scores (r = −0.38, p < 0.05), while it exhibited a moderate positive correlation with TUG (r = 0.75, p < 0.01) and 5xSTS (r = 0.63, p < 0.01) scores. FRAIL-AR scores showed significant known-groups validity with higher frailty scores in older-age individuals (p < 0.01), females (p < 0.05), and those with comorbid conditions (≥5) (p < 0.05). Conclusion: The FRAIL-AR scale’s validity and reliability make it an appropriate tool for geriatricians, oncologists, and healthcare providers to evaluate and monitor frailty among Arabic-speaking colorectal cancer patients. Full article

Culinary culture shock (CCS)—the discomfort and ambivalence travelers feel when encountering unfamiliar foods—remains underexplored from a short-horizon, trip-bounded perspective. While prior work notes both attractions and impediments of food in tourism, a process-oriented account of how ordinary travelers experience and navigate CCS during brief trips is still limited. This study examines CCS in Guangzhou, China and delineates how it shapes travelers’ evaluations of place. We adopt a qualitative design, combining 30 semi-structured interviews with in situ ethnographic observations across markets, street-food settings, restaurants, and guided food tours, supplemented by document analysis (e.g., visitor materials and menus). Using reflexive thematic analysis, we identify three recurrent coping trajectories—avoidance, gradual adaptation, and immersion—that unfold nonlinearly as travelers recalibrate expectations, manage sensory dissonance, and renegotiate comfort boundaries. We integrate expectancy–disconfirmation theory (EDT) with an embodied view of tasting to develop the Palate Adaptation Spiral Model (PASM), which explains CCS as recursive cycles of appraisal, strategy enactment, and re-appraisal within the span of a trip. Social influence (peers, guides, and service staff) operates as a cross-cutting mechanism that can accelerate adaptation or entrench avoidance depending on cue valence and credibility. The study clarifies the scope of CCS as general travel encounters (not restricted to culinary-motivated tourists) and specifies contextual conditions under which negative reactions are reversible. Theoretically, we connect EDT to short-term culinary adaptation through PASM; practically, we outline design levers—pre-trip expectation management, pictorial/transparent menus, and guide-mediated tasting sequences—to reduce anxiety and support constructive exploration. Full article

Background: Scoliosis is a common musculoskeletal disorder that remains underrecognized in Saudi Arabia, where limited public awareness may delay early detection and treatment. This study assessed public knowledge, support for school-based screening, and attitudes toward treatment. Methods: A nationwide cross-sectional survey was conducted during the 2025 Saudi National Scoliosis Awareness Campaign through public venues and online platforms. A culturally adapted questionnaire assessed demographics, knowledge, symptom recognition, treatment preferences, barriers, and information sources. A total of 2055 responses were analyzed using descriptive statistics and chi-square tests. Results: While 70.9% of participants had heard of scoliosis, only 18.1% reported good understanding. Symptom recognition was limited, with spinal curvature, back pain, and uneven shoulders most often identified. Most respondents supported school-based screening (88.2%) and early detection (92.1%), with a mean preferred screening age of 8 years. Bracing (64.3%) and surgery (53.5%) were more accepted than observation (30.5%), though concerns about pain, effectiveness, and appearance were frequent. Social media was the most common initial information source (34.6%), while healthcare professionals were the preferred future source (79.2%). Reported barriers included lack of awareness (68.2%), difficulty accessing specialists (19.9%), and cost (8.9%). Conclusions: Public support for school-based screening is strong, but baseline knowledge remains limited, and treatment perceptions are shaped by psychosocial and cultural concerns. National campaigns, school curricula, and healthcare-led education, combined with accessible, low-cost screening, may enhance early detection and improve scoliosis management in Saudi Arabia. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, often impairing daily function and quality of life. This study aimed to translate, cross-culturally adapt, and assess the validity of the Boston Carpal Tunnel Questionnaire (BCTQ) in a Romanian cohort. Methods: We conducted a cross-sectional study to translate, culturally adapt, and validate the Romanian version of the BCTQ. A total of 190 participants were recruited, representing 380 wrists, including 130 patients with suspected or confirmed CTS and 60 healthy controls. The adaptation process followed international standards, with forward and backward translation, expert committee review, and pilot testing. Participants completed the Romanian BCTQ and performed standardized nerve conduction studies. The internal consistency and validity, including convergent and discriminant validity, exploratory factor analysis, and test–retest assessments, were performed. Results: The Romanian BCTQ exhibited exceptional internal consistency (Cronbach’s α = 0.96), significant inter-item correlations, and robust factor loadings confirming a one-factor structure. Convergent validity was evidenced by strong correlations with electrodiagnostic measurements. The test–retest reliability was high, with intraclass correlation coefficients above 0,99. Conclusions: The Romanian adaptation of the BCTQ is a valid, reliable, and culturally appropriate patient-reported instrument to assess symptom severity and functional status in CTS, improving clinical decision-making and cross-cultural research. Full article

The objective of this study is to determine if the thematic priorities of news organizations are consistent or platform-specific by investigating the cross-platform strategies of three leading Bulgarian news agencies. Methodologically, the study combines a quantitative TF-IDF text analysis of 315,103 headlines from their websites and 6961 titles from their official YouTube channels with a qualitative analysis of YouTube thumbnails to assess their strategic visual contribution. The findings reveal a significant strategic divergence: YouTube channels are primarily dedicated to high-impact domestic political news centered on key public figures, while their official websites feature a much broader thematic scope, covering international conflicts or extensive cultural events. The thumbnail analysis further shows they function as a critical visual layer, adding emotional context and explicit cues that are not present in text headlines. This research concludes that news agencies do not simply mirror content but strategically adapt it to leverage the unique characteristics and audience expectations of each platform, employing distinct models for their YouTube and web presences. Full article

Background/Objectives: The Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC) is used to identify dysfunctions and estimate injury risk in overhead sports athletes. Although it has been validated in several countries, a European Portuguese version is currently unavailable. This study aimed to translate, culturally adapt and assess psychometric properties (validity and reliability) of the European Portuguese KJOC (KJOC-PT). Methods: The KJOC-PT was translated and culturally adapted according to international guidelines. One hundred athletes were selected (median age 24 [IQR 17] years, 72% male) and divided into two groups: asymptomatic and symptomatic athletes. The convergent validity was assessed by correlating the KJOC-PT with the Disabilities of the Arm, Shoulder and Hand (DASH) and DASH-Sports. 31 athletes from the initial sample were considered to assess between-day reliability and agreement (Bland-Altman analysis). Floor and ceiling effects were also calculated. Sampling adequacy was assessed using the Kaiser Meyer-Olkin (KMO) test. Results: Minor cultural and linguistic changes were made in the KJOC-PT. This version demonstrated excellent internal consistency (Cronbach’s α = 0.91 to 0.97) and moderate negative correlations for validity (KJOC-PT with DASH, rho = −0.595; with DASH-Sports, rho = −0.533, both p < 0.001). Good reliability (ICC_2,1 = 0.77 to 0.89 [95%CI 0.36 to 0.96]), measurement error (SEM = 4.11 to 6.90; MDC = 11.39 to 19.13) and mean difference ranging from −0.08 ± 6.14 to 3 ± 9.17 were found. No floor effect (0%) and ceiling effects of 24.2% for the total sample (50% for asymptomatic and 5.1% for symptomatic athletes) were found. Conclusions: KJOC-PT is now available and is a valid and reliable instrument for use by athletes in overhead sports. Full article

Background: There is a growing demand for sensitive and accurate screening tools for the early detection of cognitive impairment. The Rowland Universal Dementia Assessment Scale (RUDAS) has shown promise in multicultural populations. It may offer advantages over the widely used Mini-Mental State Examination (MMSE), which has limited sensitivity, particularly in assessing executive functions. The aim of this study was to adapt and validate the Polish version of the RUDAS and to compare its diagnostic performance with the MMSE in detecting cognitive impairment among patients with Alzheimer’s disease (AD) and vascular dementia (VaD). Methods: A total of 126 subjects were evaluated, including 37 with AD, 30 with VaD, and 59 healthy controls. All participants were assessed with both the MMSE and RUDAS, and their test results were subsequently compared. Results: A strong correlation was found between total scores on the RUDAS and MMSE (RS = 0.81, p < 0.001). The area under the ROC curve was slightly higher for RUDAS (AUC = 0.94) than for MMSE (AUC = 0.89), suggesting better diagnostic accuracy. At a cut-off score of 25, RUDAS showed a sensitivity of 0.84 and a specificity of 0.87; MMSE showed a sensitivity of 0.74 and a specificity of 0.91. Conclusions: The Polish version of RUDAS demonstrates strong diagnostic utility and may offer a slightly more sensitive alternative to MMSE for dementia screening, especially in its early stages. Further normalization studies on larger and more diverse clinical populations are recommended. Full article

We investigate why the remarkable diversity of human identity, including gender fluidity, non-binary roles, and varied sexual orientations, is fundamentally rooted in the evolutionary and neurocognitive complexity of the human brain. Drawing upon interdisciplinary evidence from comparative biology, neuroimaging, anthropology, and social neuroscience, this paper explores how increased neural complexity across evolutionary trajectories supports behavioral plasticity and identity diversification. The concept of neural degeneracy, wherein different neural structures produce functionally similar outcomes, is central to understanding how individual and cultural diversity naturally emerges from the brain’s highly adaptable networks. By reviewing historical, prehistoric, and cross-species data, the paper demonstrates that identity diversity is neither recent nor culturally limited but has longstanding evolutionary and social foundations. Despite substantial scientific consensus on this inherent complexity, societal resistance persists, often driven by oversimplified and biologically reductionist interpretations of neuroscience. To counter these misunderstandings, the article introduces Complexity Neuroethics, a framework advocating the acknowledgment of diversity of identity expressions as an evolutionarily expected outcome of neurocognitive evolution. Ultimately, the review calls for a transformative dialogue between neuroscience and society, promoting policies, healthcare practices, and educational initiatives aligned with neuroscientific realities to foster more inclusive societies that embrace self-identity as an evolutionary and cognitive achievement. Full article

Background: University students often display unhealthy eating habits shaped by economic, cultural, and psychosocial factors. These behaviors increase risks of chronic and mental disorders. The COVID-19 pandemic further changed their diet and physical activity (PA) habits, highlighting the need to identify determinants of diet quality (DQ). Objective: The objective of this study is to identify risk profiles of poor DQ among university students from Chile, Mexico, Spain, and Italy through multivariate segmentation analysis. Methods: A cross-sectional predictive study was conducted among 686 university students (60.8% women; mean age = 22.4 ± 5.1 years) using an online questionnaire on sociodemographic, academic, health, and lifestyle factors, including PA (IPAQ-SF^®) and DQ (HEI). Analyses included descriptive, inferential, and decision tree (CHAID and CART) models. Results: Significant differences in HEI scores (p < 0.001) were observed by country, field of study, academic year, and PA level. Chilean and Mexican students had the lowest DQ. Both models achieved high overall accuracy (≈91%), but balanced accuracy was around 50%, reflecting limited discrimination of healthy diet profiles and underscoring their exploratory value for identifying at-risk subgroups rather than precise prediction. CART identified country of residence and socioeconomic status as the primary determinants of poor diet quality (DQ), while CHAID highlighted field of study and socioeconomic status, with PA and BMI contributing at secondary levels. Conclusions: The results emphasize adapting public health strategies to local contexts—promoting Mediterranean-style diets in European universities and improving access to affordable healthy foods in Latin American campuses, complemented by campus initiatives integrating nutrition education, physical activity, and psychosocial support. Full article

Contemporary transformations in the world of work, together with the growing emotional and physical demands in nursing, have led to the emergence of new labor phenomena such as quiet quitting, which reflects changes in professional engagement and in the management of nurses’ well-being. Objective: To translate, culturally adapt, and validate the Quiet Quitting Scale for European Portuguese, evaluating its psychometric properties among the nursing population. Methods: A cross-sectional validation study was conducted following COSMIN guidelines. The process included forward and back translation, expert panel review, and pretesting with 30 nurses. The psychometric evaluation was carried out with 347 nurses from Northern Portugal. Data were analyzed using descriptive and inferential statistics, internal consistency measures (Cronbach’s α and McDonald’s ω), and confirmatory factor analysis (CFA) with maximum likelihood estimation to assess construct validity. Results: The Portuguese version (QQS-PT) maintained the original three-factor structure (Detachment/Disinterest, Lack of Initiative, and Lack of Motivation). The model showed satisfactory fit indices (CFI = 0.936; GFI = 0.901; AGFI = 0.814; TLI = 0.905; RMSEA = 0.133). The overall internal consistency was excellent (α = 0.918; ω = 0.922), with subscale α ranging from 0.788 to 0.924. Composite reliability (CR) ranged from 0.815 to 0.924, and average variance extracted (AVE) from 0.606 to 0.859, confirming convergent and discriminant validity. Conclusions: The QQS-PT demonstrated a stable factorial structure, strong reliability, and solid validity evidence. It is a brief and psychometrically sound instrument for assessing quiet quitting among nurses, providing valuable insights for research and management of professional engagement and well-being in healthcare contexts. Full article

Background: Physical activity (PA) provides significant health benefits, yet inactivity remains high in Spain, especially among adolescents and increasingly in children. Identifying barriers to PA is essential, but available tools are mainly designed for adolescents. This study aimed to adapt the “Brief Scale of Perceived Barriers to Physical Activity” for Spanish schoolchildren aged 6–12 and examine its validity and reliability. Methods: The “Brief Scale of Perceived Barriers to Physical Activity for Children” was linguistically and culturally adapted. Comprehension was assessed through cognitive interviews, and reliability was examined via a test–retest procedure with 137 Spanish schoolchildren. Several analyses were conducted, including confirmatory factor analysis (CFA) to assess the factor structure, along with reliability metrics: Cronbach’s alpha (α) for internal consistency and the intraclass correlation coefficient (ICC) for test–retest reliability. Results: CFA confirmed a four-factor structure (self-concept, motivation–interest, social support, and task incompatibility) in a sample of 137 with excellent fit indices (χ²/df = 1.394, RMSEA = 0.054, CFI = 0.976, TLI = 0.966). Internal consistency ranged from good to excellent (α = 0.831–0.979). Temporal stability was substantial to near perfect (ICC = 0.708–0.979). Measurement error was low for all items and the total score (SEM% = 6.1–37.2; MDC% = 17.0–103.0), demonstrating accuracy. Conclusions: The “Brief Scale of Perceived Barriers to Physical Activity for Children” was proven to be a reliable and valid tool for assessing perceived barriers to PA in Spanish children. It offers developmentally appropriate insights that can guide strategies to enhance supportive environments and promote long-term active behaviours. As part of the social domain, it contributes to the Spanish Physical Literacy Assessment for Children (SPLA-C) model, the first physical literacy (PL) assessment instrument developed in Spain. Full article

This research investigates the critical role of intercultural communication and cultural intelligence in global international organisations and their link to effective stakeholder engagement and Environmental, Social, and Governance (ESG) practices. There is still a scarcity of empirical research focusing on global governance institutions like the United Nations (UN), which was chosen as a case study. Such organisations are one-of-a-kind communicative spaces in which people from various cultural, linguistic, and professional backgrounds work together to achieve common international goals. However, despite the UN’s prominent role in enabling global collaboration, the mechanisms by which intercultural communication occurs and adapts in such circumstances are little understood. Focusing on the social and governance dimensions of ESG, this research brings new insights into the work of the United Nations (UN)’s multicultural teams, as well as into the cross-cultural projects at the heart of this organisation and how they align with the goal of preserving local cultures in achieving the Sustainable Development Goals (SDGs). The study’s findings confirm the critical role of intercultural communication in engaging internal and external stakeholders and reinforcing sustainable ESG practices in international institutions such as the UN. Moreover, the managerial implications of the research could be of relevance to other global organisations which operate across diverse cultural contexts, where understanding and managing these differences become essential for fostering trust, collaboration, and responsibility. The paper proposes a conceptual framework verified through corroborated semistructured interviews to illustrate how intercultural communication enhances inclusivity, tailors ESG strategies to cultural contexts, and improves organisational decision-making and accountability. Full article

Religious clothing serves as the external manifestation of religious culture, and its evolutionary process not only reflects the developmental trajectory of religion but also demonstrates cultural exchange and social transformation in specific historical periods. This study focuses on the localization and evolution of Chinese Buddhism monks’ robes as its research subject. Through analyzing historical documents, archaeological materials, and artistic works, it explores the transformation process from Indian Kasaya to Chinese Haiqing 海青 (Chinese Buddhist Ceremonial Robe) and its cultural implications. The research findings reveal that the localization process of Chinese Buddhism monks’ robes exhibits characteristics of gradual Cultural Adaptation: while maintaining the core of Buddhist doctrine, it achieved organic integration with traditional Chinese culture through systematic reconstruction of material forms. This is specifically manifested in three aspects: formal adaptation responding to environmental constraints, the integration of craftsmanship and materials embodying cultural dialogue, and the color hierarchy system reflecting the dynamic interplay between secular power and religious authority. This process facilitated the reconstruction of monks’ multidimensional Identity Reconstruction—forming a new balance model among religious transcendence, cultural belonging, and social participation. This study provides a theoretical framework for understanding the internal logic of religious localization and the adaptive mechanisms of Cross-cultural Communication. Full article

Background/Objectives: Introduction: Food selectivity is highly prevalent in children with autism spectrum disorder (ASD) and is associated with sensory hypersensitivity, particularly in oral, olfactory, and tactile domains. Although international evidence exists, little is known about this phenomenon in Latin American populations. This study aimed to explore the relationship between sensory hypersensitivity and food selectivity in Chilean children with and without ASD. Methods: A cross-sectional study was conducted with 57 children aged 6–12 years, including 32 with ASD and 25 neurotypical controls. Sensory processing was assessed using the Dunn Sensory Profile 2, while food selectivity was evaluated with the Brief Autism Mealtime Behaviour Inventory (BAMBI) and a Food Frequency Questionnaire (FFQ). Statistical analyses included intergroup comparisons and correlation tests. Results: Children with ASD obtained significantly higher scores across all domains of sensory hypersensitivity (p < 0.001). Selective eating behaviours were more frequent, with texture (78%) and colour (53%) being the most common, and were strongly associated with ritualistic eating (OR 29.39; 95% CI 5.47–136.2; p < 0.0001). BAMBI scores were correlated with oral (p = 0.002), socio-emotional (p = 0.003), and somatic hypersensitivity (p = 0.025). Additionally, children with ASD reported lower intake of vegetables, dairy products, animal proteins, and legumes compared with controls. Conclusions: Food selectivity in Chilean children with ASD is closely related to sensory hypersensitivity, particularly in oral, socio-emotional, and somatic domains. These findings underscore the need for culturally adapted, sensory-based interventions to broaden dietary variety and reduce mealtime difficulties in this population. Full article