Teaching cultural competency is a critical but challenging task for clinician educators. Immersive experiential learning in the local community through the arts and humanities remains underexplored in medical education. To address this gap, a novel arts and humanities-based cultural competency workshop was developed. This half-day cultural competency workshop was a collaborative effort between a center for humanities in medicine and an Internal Medicine residency program at an academic institution in the southeastern United States. The workshop incorporated a walking tour to sites in the historic downtown area near the institution's Community Health Collaborative to highlight local artists and the intersection of art, history, community, and health. Facilitators provided prompts to help guide discussion. Residents were asked to complete an anonymous, pre- and postintervention survey comprising five questions about arts and humanities-based learning and several aspects of cultural competency. Likert scale responses ranged from 1 (strongly disagree/extremely uncomfortable) to 5 (strongly agree/extremely comfortable). A total of 43 residents participated in the workshop, 35 of whom (82%) completed the presurvey and 26 (60%) completed the postsurvey. Pre- and postintervention surveys demonstrated statistically significant improvements across all five learning outcomes assessed. The findings indicate improved awareness and self-perceived readiness to engage with cultural issues in clinical practice, demonstrating the value of humanities in facilitating experiential understanding of such concepts. This pilot study highlights the significant potential of immersive arts and humanities-based learning to enhance cultural competency in medical education. This approach can effectively complement traditional clinical training to enhance culturally responsive care. Future studies should implement this model across a broader range of training environments and specialties. By investing in such innovative educational approaches, we can better prepare the next generation of physicians to navigate the complexities of patients and deliver better care.
Improving infant and young child nutrition among marginalized ethnic groups urgently requires a paradigm shift from traditional health education to culturally integrated systemic interventions. Nutrition in the first 1,000 days is critical for long-term health and human capital development. Amid global efforts to eliminate health disparities, Tibetan infants face severe nutritional challenges, with stunting and anemia rates far exceeding national averages. Feeding practices, rooted in their unique high-altitude environment and deep cultural traditions, are a key social determinant of their health. This study aimed to comprehensively describe the traditional feeding practices among Tibetan infants aged 0-24 months via an integrative review, assess their health impacts, analyze influencing factors using the socio-ecological model, and ultimately construct a multi-level, culturally adapted public health intervention framework. An integrative review methodology was employed. Multiple English and Chinese databases (PubMed, Web of Science, Scopus, CNKI, etc.) were systematically searched for quantitative, qualitative, and mixed-methods studies on Tibetan infant feeding practices. Evidence was thematically analyzed and synthesized based on the socio-ecological model. The review revealed significant deviations between traditional Tibetan feeding practices and scientific guidelines: low rates of exclusive breastfeeding, prevalent early introduction of complementary foods (median age ~1 month), primarily Tsampa, and high dietary monotony. These feeding patterns were reported to be associated with a high burden of stunting and anemia, with anemia rates exceeding 60% in some areas, and early introduction of traditional infant feeding items such as Tsampa was also described in some reports as a possible factor related to neonatal necrotizing enterocolitis (NEC). Socio-ecological analysis identified potential multi-level factors including individual knowledge gaps, community cultural norms and inadequate health services, and macro-level high-altitude environment and poverty. This study proposes a novel, culturally integrated intervention conceptual framework that systematically elucidates the multi-level determinants of malnutrition and provides a conceptual basis for multi-sectoral collaboration. The framework aims to reconcile traditional practices with nutritional science, highlighting the necessity of systemic, multi-level interventions, and may offer a context-sensitive conceptual reference for thinking about culturally embedded health inequities in other marginalized communities, although its applicability beyond Tibetan populations requires empirical validation in other cultural and geographic settings.
The issue of insufficient physical activity in adolescents (defined by the World Health Organization as those aged 10-19 years) is a significant worldwide health concern, as 81% do not achieve the suggested levels of physical exercise. Although digital health interventions (DHIs) present promising scalable solutions, their actual performance in practical environments often falls short of anticipated outcomes. This systematic review provides a critical analysis of the existing research on digital strategies aimed at enhancing physical activity among adolescents, emphasizing the factors that contribute to their success, user engagement, and equitable access. This systematic synthesis compiles findings from scholarly articles released from 2020 to 2026. The primary outcome was physical activity, measured by daily step counts or minutes of moderate-to-vigorous physical activity (MVPA). Secondary outcomes included engagement, adherence, motivation, psychological factors, equity, and other health-related measures. We included randomized controlled trials, cohort studies, cross-sectional studies, mixed-methods studies, systematic reviews, and meta-analyses. By examining research on a range of digital health technologies-including wearable devices (e.g., fitness trackers, smartwatches), mobile applications, gamified platforms, chatbots, and AI-driven tools-the analysis integrates quantitative data with qualitative insights from co-design studies to provide comprehensive insight into the effectiveness, timing, and target audiences of digital interventions. Methodological quality and risk of bias were assessed using study-design-specific tools: RoB 2 for randomized controlled trials, ROBINS-I for non-randomized interventional studies, AMSTAR 2 for systematic reviews and meta-analyses, NOS for cohort and longitudinal studies, AXIS for cross-sectional studies, CASP for qualitative studies, and MMAT for mixed-methods studies. The results reveal a persistent disparity between effectiveness and user involvement: while 63% of the examined DHIs demonstrated positive results in their initial assessments, adherence levels dropped from 73% at the start to just 14% by the fifth month. (The 63% = 29/48 studies reporting a significant positive effect on PA. The adherence rates are from a single cohort study tracking device usage over time, not pooled across studies). The success of these interventions is not solely dependent on advanced technology but rather on the integration of three interconnected factors: (1) developmental suitability, where younger adolescents (approximately 10-13 years) are more responsive to playful, sensorimotor activities, whereas older adolescents (approximately 14-19 years) prefer goal-setting and tracking their own progress. (2) relational design, features like team challenges, empathetic AI characters, and customizable avatars can boost confidence by 50% and motivation by 120%; and (3) contextual relevance, data indicates that moderate to vigorous physical activity (MVPA) peaks between 5 and 8 p.m., highlighting the critical difference between screen time (which can hinder activity) and the frequency of physical engagement (which encourages it). Ongoing disparities in equity-such as digital literacy gaps exceeding 35% and reduced engagement among racial and ethnic minorities-emphasize the need for intentional structural and cultural alignment to prevent digital interventions from widening existing inequalities. Effective digital solutions prioritize the needs of adolescents rather than focusing solely on technology. They emphasize tailored experiences instead of fixed features, foster meaningful connections rather than relying on precise algorithms, and adapt to specific contexts instead of aiming for one-size-fits-all scalability. Future developments should shift away from merely measuring screen time and instead embrace approaches that are rich in experience, affirm individual identities, and promote social justice while incorporating physical activity into the everyday lives of young people. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261415756.
India is one of the countries where many regional languages are spoken in different parts of the country. Each part of the country has its unique cultural traditions; therefore, an abundance of cultural texts is available in Indian Regional languages. The cultural texts are mostly ancient scriptures that represent the community's heritage, values, and ancient knowledge. Braj is one of the Indian regional languages that represents the cultural heritage of the Braj region. The BrajText-Saar dataset contains texts from the Braj language, which features a variety of prehistoric scripts. The data was collected from the Maan Mandir trust's portal, which operates to maintain Braj culture and heritage. The Braj text primarily explains the divine actions and the life of Lord Krishna in the form of poetry and devotional songs. Offline Braj literature from renowned writers is available in manuscript form. This represents an opportunity for cultural text mining in the Braj Language. The developed dataset opens new paths in various research areas, including language studies, sentiment analysis, and emotion analysis, and is also suitable for digital humanities research.
This paper examines the relationship between perceived corporate social responsibility (CSR) and intention to leave the organization through a cross-cultural comparison between France and Morocco. It also explores the roles of CSR sensitivity and CSR information sharing as antecedents, and of person-organization fit (PO-fit) as a mediator of the relationship under study. Two cross-sectional samples were collected: French (n = 243) and Moroccan (n = 234). Invariance and structural equation modeling path analyses were conducted to test the hypothesized model. Results reveal partial scalar (mean) invariance across the measurement scales, indicating similar structures between France and Morocco. Path analyses support the proposed model and highlight differences between the samples. A negative relationship between perceived CSR and intention to leave the organization is mediated by PO-fit. This cross-cultural study advances micro-CSR by integrating CSR sensitivity and CSR information sharing into a unified model of their joint and distinct effects on perceived CSR, PO-fit, and turnover, extending signaling theory by positioning sensitivity as a boundary condition. Findings showed that organizations must adopt practices that align with the country's cultural reality. Nevertheless, cross-cultural training is essential for multinational organizations operating in France and Morocco. However, the survey was not multilevel or longitudinal, which limits the ability to generalize the results to other countries. This study highlights the mediating role of PO-fit in the relationship between CSR perception and turnover intention, determined by CSR sensitivity and information sharing. It offers a new direction to research on micro-CSR and its cross-cultural dimensions.
Assessing balance in daily life is a crucial component of fall prevention. The Balance in Daily Life (BDL) scale is used to assess the balance ability of older adults in real-life situations, but there is a lack of a Chinese version. This study aimed to cross-culturally adapt and evaluate the psychometric properties of the Chinese version of the Balance in Daily Life (C-BDL) scale. Translation and cross-cultural adaptation were conducted according to international guidelines. The translated scales were administered to 280 older adults from February to March 2025. Psychometric evaluation included content validity, construct validity, reliability and convergent validity. A total of 280 older adults participated in this survey. The scale-level content validity index average was 0.976. Exploratory factor analysis exhibited single-factor structure and explained 69.966% of the total variance. Confirmatory factor analysis confirmed that the single-factor model fits well. The overall Cronbach's α of the C-BDL was 0.913, and the test-retest reliability was 0.987. Convergent validity indicated that C-BDL was highly associated with the total ADL score (r = 0.694, p < 0.001). The C-BDL exhibits good psychometric properties and is an effective tool for future cross-cultural comparative studies on the balance in daily life of older adults in the community.
Despite public health efforts, the prevalence of diabetes has quadrupled since 1990, disproportionately impacting marginalized communities including immigrants and refugees. Immigrants and refugees face access, education and management inequities as the prevalence and cost of chronic disease management escalates in host countries. Digital health applications may offer effective and equitable solutions to support self-management and empower immigrants. This study systematically scoped published evidence on digital health applications tailored for type 2 diabetes management among racialized immigrants, addressing an important intersection of digital innovation and health equity. Searching multiple databases (2010-March 2025), 14 primary studies and 15 reviews were identified, featuring culturally adapted, multimodal interventions with human (peer or provider) support across patient-matched languages and cultures such as Arabic, Chinese, Spanish, and Vietnamese. The 15 reviews on mainstream digital education allowed us to contextualize digital features, outcomes, and practice mediators and challenges. Primary studies found that tailored digital health interventions significantly enhanced engagement, self-efficacy, health literacy and motivation for self-management, and most clinically significantly lowered HbA1c levels (moderate-high risk of bias). Tailoring included cultural food advice, education framed around family and faith, and apps in patients' native language. In comparing digital application features and type 2 diabetes outcomes with our review of reviews results, we were able to show successful replication in racialized immigrant populations, demonstrating health equity opportunities. These results demonstrate the importance of adapting, personalizing, creating a trusted environment, and integrating human supports to ensure long-term engagement and equitable health outcomes.
This review presents recent advances in integrated vibrational and X-ray spectroscopic approaches for the characterization of cultural heritage materials. Vibrational techniques, including Raman, Fourier transform infrared (FT-IR), and optical photothermal infrared (O-PTIR) spectroscopy, together with X-ray fluorescence, diffraction, and absorption methods, provide complementary molecular, elemental, and structural information for the analysis of pigments, binders, and degradation products. Emphasis is placed on analytical capabilities, limitations, and the synergistic use of these techniques within multimodal workflows.Vibrational spectroscopy plays a central role in molecular identification and monitoring chemical transformations, whereas X-ray methods provide insight into elemental composition, crystallography, and pigment alteration mechanisms. Their integration establishes a robust framework for materials identification, stratigraphic interpretation, and investigation of degradation pathways in historical objects.Representative case studies discussed in this review illustrate how integrated vibrational and X-ray spectroscopic strategies address key analytical challenges in cultural heritage research, including the characterization of lead-based materials in works attributed to Leonardo da Vinci, compositional layering in paintings by Pablo Picasso, and cadmium yellow degradation in masterpieces by Edvard Munch and Vincent van Gogh. O-PTIR is highlighted as an emerging tool for submicron analysis, while combined Raman and X-Ray spectoscopic methods resolve environmentally driven pigment transformations.This review outlines current advances, practical challenges, and future directions in spectroscopy-driven research on complex materials.
Longitudinal birth cohort studies are an under-examined context for considering the dynamics of healthism. This article presents a comparative perspective from the 'Biosocial Lives of Birth Cohorts' study, which takes birth cohorts as an ethnographic object of knowledge-making, social practice and participation in the Netherlands, Brazil, Portugal and the United Kingdom. Drawing from ethnographic research with participants and professionals involved in cohort data collection, we examine how, in the routine monitoring and measuring of bodies and lives in cohort studies, 'healthism', as an individualised form of moral self-responsibility for health, is entangled with medicalisation. Healthism is also at stake in the way that individual cohort test results are communicated and received. Yet the relational dynamics of cohort studies, which encompass but also exceed the scope of healthism, are also shaped by the precarity of public health infrastructures and closely entangled with the motivational desire of cohort participants, as birth cohorts can act as a stopgap for public health failures. In this way, we demonstrate how birth cohorts are an important context for considering the politics of health and how medicalisation is entangled with healthism in cohort data collection, even as this unfolds in tension with efforts to collectively intervene in public health.
Advances in data science and medical artificial intelligence (AI) raise complex philosophical and ethical quandaries about what it means to know a person or a community through data and what kinds of people and societies we are becoming in this era of predictive data science. Drawing on four lightly fictional but reality-informed case studies in mental health, radiology, genomics and environmental public health, we reflect on how AI technologies, largely built on Western biomedical traditions, may conflict with relational, spiritual and Indigenous understandings of health and wellbeing. This may manifest as epistemic friction, algorithmic fatalism and diminished trust in patient-clinician relationships. Besides familiar concerns regarding bias and transparency, this paper advances the discourse on the ethics of medical AI and data science in healthcare by shifting the analysis from epistemology (how AI systems know, classify and predict) to ontology (the study of the nature of being, as reconfigured by data and AI). We argue that AI systems may inflict significant ontological harm by reconfiguring identity, moral agency and imagined futures and advocate for a renewed medical humanism driven by inter- philosophies dialogue, cross-cultural ethics and ecocentric approaches to care. From Bamenda, Cameroon, to Mthatha, South Africa and Toronto, Canada, the future of medical AI must be defined by the moral and philosophical traditions that people already live by. African, Indigenous, Islamic, Buddhist, Confucian and marginalised Western worldviews should not be treated as peripheral critiques, but as constitutive resources for building inclusive, human-centred health technologies. We conclude that bioethics should be recognised as a core infrastructure in global health, on equal footing with data science, medicine, biomedical research and health innovation.
We discuss a historical report of chimpanzees Pan troglodytes using stone tools to forage for large oysters Crassostrea tulipa at the Sierra Leone River estuary in 1678, a behaviour that was also noted there in 1682, apparently independently and with a stick used as the tool, but which has not been reported in any modern study. The animals in question can be identified as chimpanzees by a combination of descriptive, faunistic and linguistic evidence, including their local name. These two accounts together indicate that this behaviour was being used by several chimpanzees in that area over a period exceeding four years, and was therefore probably an established cultural trait of the local chimpanzee population at that time. Chimpanzees are no longer found at the coast in the Sierra Leone estuary, so this trait is probably now extinct there, and opportunities for chimpanzees to encounter oysters are now limited throughout their African range. This behaviour would therefore be unknown if not for these two 17th-century reports, which emphasises the continuing value of such accounts as sources of natural history information.
To provide a word bank based on familiarity and representativeness for the 18- to 36-month age group, considering the Brazilian cultural context. This was a cross-sectional study with a quantitative design. The questionnaire, sent to expert judges, was based on the list of words and sentences from the MacArthur-Bates Communicative Development Inventories (MB-CDIs). Three groups of experts participated: experienced speech therapists, speech therapists, and mothers with no training in the area. The questionnaire included 21 questions on familiarity and 13 on representation, which were answered using a Likert scale on familiarity (familiar or unfamiliar) and representativeness (representation by pictures or not). The responses were analyzed using descriptive and inferential statistics and visually represented through word clouds. According to the criteria, only those that met the mean values were selected, leaving a total of 146 words. Based on the list from the MB-CDIs inventory adapted to Portuguese, the words were organized by category to generate the word bank, called the Word Bank for Childhood Language Development (BPDLI): A Validated Instrument for Brazilian Portuguese. This work provides a validated tool that can be used in clinical language assessment and intervention at early ages, allowing for greater sensitivity to the child's cultural and family context. This word bank also has therapeutic potential for approaches to phonology, narrative language, and augmentative and alternative communication. Proporcionar un banco de palabras basado en la familiaridad y representatividad de las palabras para el intervalo de 18 a 36 meses, considerando el contexto cultural brasileño. Se trata de una investigación transversal con un diseño cuantitativo. El cuestionario, enviado a los jueces especialistas, se basa en la lista de palabras y oraciones del Inventario de Desarrollo de la Comunicación (The MacArthur-Bates Communicative Development Inventories - MB-CDIs). Participaron tres grupos de expertos: logopedas expertos, logopedas y madres sin formación en el área. El cuestionario incluía 21 preguntas de familiaridad y 13 de representación, que se respondían mediante una escala Likert sobre familiaridad (familiar o desconocido) y representatividad (representación por imágenes o no). Las respuestas fueron analizadas utilizando estadística descriptiva e inferencial y representadas visualmente a través de nubes de palabras. De acuerdo con los criterios, se seleccionaron solo aquellas que cumplieran con los valores de media, quedando un total de 146 palabras en total. A partir de la lista del inventario MB-CDIs adaptado al portugués, se organizaron por categorías para generar el banco de palabras, llamado Banco de Palabras para el Desarrollo Lingüístico Infantil (BPDLI): un Instrumento Validado para Portugués Brasileño. El trabajo aporta una herramienta validada que puede ser utilizada en la evaluación e intervención clínica del lenguaje en edades tempranas, permitiendo una mayor sensibilidad al contexto cultural y familiar del niño. Este banco de palabras también posee potencial terapéutico para enfoques en fonología, lenguaje narrativo y comunicación aumentativa y alternativa. Proporcionar un banco de palabras basado en la familiaridad y representatividad de las palabras para el intervalo de 18 a 36 meses, considerando el contexto cultural brasileño. Se trata de una investigación transversal con un diseño cuantitativo. El cuestionario, enviado a los jueces especialistas, se basa en la lista de palabras y oraciones del Inventario de Desarrollo de la Comunicación (The MacArthur-Bates Communicative Development Inventories - MB-CDIs). Participaron tres grupos de expertos: logopedas expertos, logopedas y madres sin formación en el área. El cuestionario incluía 21 preguntas de familiaridad y 13 de representación, que se respondían mediante una escala Likert sobre familiaridad (familiar o desconocido) y representatividad (representación por imágenes o no). Las respuestas fueron analizadas utilizando estadística descriptiva e inferencial y representadas visualmente a través de nubes de palabras. De acuerdo con los criterios, se seleccionaron solo aquellas que cumplieran con los valores de media, quedando un total de 146 palabras en total. A partir de la lista del inventario MB-CDIs adaptado al portugués, se organizaron por categorías para generar el banco de palabras, llamado Banco de Palabras para el Desarrollo Lingüístico Infantil (BPDLI): un Instrumento Validado para Portugués Brasileño. El trabajo aporta una herramienta validada que puede ser utilizada en la evaluación e intervención clínica del lenguaje en edades tempranas, permitiendo una mayor sensibilidad al contexto cultural y familiar del niño. Este banco de palabras también posee potencial terapéutico para enfoques en fonología, lenguaje narrativo y comunicación aumentativa y alternativa.
Caregivers of children with short stature undergoing growth hormone therapy face substantial physical, emotional, and social burdens. However, qualitative evidence on their experiences remains fragmented across studies and cultural contexts. This meta synthesis aimed to systematically integrate existing qualitative findings to generate a comprehensive understanding of caregivers' experiences and support needs. This qualitative meta-synthesis was conducted and reported following the PRISMA 2020 statement and the ENTREQ guidelines. A systematic search was conducted in 10 databases (PubMed, Web of Science, Embase, CINAHL, MEDLINE, ProQuest, China National Knowledge Internet, Wanfang, VIP Database, and Chinese BioMedical Literature Database) from inception to December 6, 2025. Qualitative and mixed-methods studies were included. Two reviewers independently performed study selection, data extraction, and quality appraisal using the JBI checklist. Thematic synthesis was employed to analyze and integrate findings. Fifteen studies involving 648 caregivers were included. Seventy-six findings were synthesized into four overarching themes: (1) disease cognition and adaptation process; (2) emotional burden; (3) multidimensional challenges; and (4) external support needs. Caregivers' emotional distress was synergistic, and practical challenges evolved across children's developmental stages. Caregivers of children on growth hormone therapy endure complex, cumulative burdens that require systematic and culturally sensitive responses. Healthcare professionals should adopt family centered approaches, provide tailored emotional and practical support, and facilitate integrated professional and peer support networks. These findings provide an evidence base for developing targeted interventions and informing pediatric nursing policy. The protocol for this systematic review was prospectively registered in PROSPERO (CRD420261435912).
The Salzburg Stress Eating Scale (SSES) was developed in 2018 to measure stress-related changes in food intake. The questionnaire consists of 10 items that depict stressful situations and responses are recorded on a five-point scale ranging from 1 = I eat much less than usual to 5 = I eat much more than usual (with the middle of the scale indicating no change in food intake when being stressed). In this narrative review, we provide an overview of studies that have used the SSES thus far, which includes a description of adaptations of the SSES (e.g., translations into other languages and versions for other health-related behaviors) and its psychometric properties. Findings generally support reliability and validity of the SSES in multiple languages. However, whether the SSES exhibits predictive validity (i.e., accurate prediction of naturalistic and experimental data) remains an open question for future research, as findings of naturalistic studies have been mixed and laboratory studies are absent. Future avenues include developing alternative scoring procedures, combining the scale with adapted versions for other health behaviors-such as alcohol consumption, smoking, and physical activity-and promoting its use in trans-cultural, longitudinal, and clinical studies.
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children worldwide. In the United States, and in the state of Alaska in particular, American Indian/Alaska Native (AI/AN) children experience a disproportionate burden of healthcare disparities. Understanding the epidemiology, mechanisms of injury, access to care, and long-term clinical outcomes in this vulnerable population is crucial for guiding management strategies and prevention initiatives. This scoping review aimed to characterize the epidemiology of pediatric TBI among AI/AN children in the United States; examine mechanisms of injury, hospitalization, and mortality patterns; assess disparities in diagnostic evaluation, insurance status, inpatient and post-discharge care; evaluate current prevention and intervention strategies; and and propose future directions to reduce healthcare inequities among AI/AN children. we systematically searched PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar for English-language, peer-reviewed studies examining TBI in AI/AN children (<18 years). Eligible studies reported epidemiology, clinical outcomes, healthcare disparities, or interventions. Data extraction and quality assessment were conducted independently by multiple reviewers, with methodological rigor assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. AI/AN children demonstrated the highest TBI-related hospitalization and mortality rates nationally, with the burden most pronounced in children < 4 years and in adolescents. Motor vehicle accidents were the leading cause of TBI-related hospitalization and mortality, often associated with alcohol involvement and low utilization of protective equipment. Violence, including blunt trauma and firearm injuries, accounted for disproportionately higher mortality rates, with firearm-related TBI deaths up to three-fold higher compared to that among white children. Disparities extended beyond the mechanism of injury, as AI/AN children were less likely to undergo advanced imaging and experienced longer hospital stays. Additionally, AI/AN children had the lowest rates of private insurance coverage and the highest reliance on Medicaid/Medicare, contributing to the limited access to rehabilitation services and post-discharge healthcare services. AI/AN children with TBI bear a substantial burden of healthcare disparities. The limited healthcare infrastructure, insurance disparities, and cultural barriers, in addition to the geographical isolation of those who live in the state of Alaska amplify the burden of healthcare disparities faced by these children. Addressing these disparities requires a multi-faceted approach, including improved surveillance, standardized case definitions, expansion of preventive initiatives, telemedicine, workforce development and diversification, and culturally sensitive care models.
Our study investigated stance markers used in Materials Science research article abstracts by native Chinese-speaking (Chinese L1) and native English-speaking (English L1) researchers, adopting the widely recognized interactional metadiscourse framework. We constructed two comparable corpora, each comprising 501 abstracts from research articles published between 2023 and 2025 in Materials Science journals indexed in the Web of Science Core Collection. Quantitative analysis revealed that there were significant cross-cultural differences between the two corpora: Chinese L1 researchers used hedges more frequently than English L1 researchers (9.67 vs. 7.04 per 1,000 words). Chinese L1 researchers preferred to use the self-mention phrase "this paper", while English L1 researchers employed slightly more boosters and self-mentions generally. Attitude markers were found comparable between the two corpora (4.63 vs. 4.28 per 1,000 words), which can reflect the demands of this academic genre for objectivity. These usage patterns are consistent across all journal quartiles and are generally not influenced by impact levels of the journals. Further analysis of the subcategories shows that Chinese L1 researchers depended more on modal and phrase-based hedges, while English L1 ones used a more diversified range of hedging strategies. In terms of English L1 countries, researchers from the USA, the UK, and Canada shared similar rhetorical conventions. The findings indicate that cultural traditions and disciplinary norms jointly shape the use of stance markers. This study enriches cross-cultural academic discourse studies in hard sciences, and provides practical guidance on the academic English writing instruction for Chinese L1 researchers, especially graduate students.
Background: Estimating the association between childhood emotional maltreatment (CEM) and trauma-related outcomes is important for prevention and intervention.Objective: We synthesised the evidence by differentiating between emotional abuse and emotional neglect, examining post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) and exploring moderators and mediators.Method: Following PRISMA guidelines, seven databases were searched up to 19/03/2026 (PROSPERO-CRD42024598358) for studies on the association between CEM and PTSD/CPTSD. Study quality was assessed using an adapted Newcastle-Ottawa Scale (NOS), and certainty of evidence was evaluated using the GRADE framework.Results: Of 11,479 records, 62 were included in the review, of which 57 studies provided 132 effect sizes for a random-effects multilevel meta-analysis (N = 323,776). Study quality was overall fair (Mean NOS = 5.8). A positive association between CEM and PTSD/CPTSD (k = 132, r = .27, 95% CI [.23, .30]) 95% PI [-.04, .53] with substantial heterogeneity (I² = 86.5%). Higher estimates were identified for emotional abuse (k = 71, r = .29, 95% CI [.25, .33]) compared to emotional neglect (k = 55, r = .24, 95% CI [.19, .28]). Effect sizes were similar for CPTSD (k = 29, r = .29, 95% CI [.24, .35]) and PTSD (k = 103, r = .26, 95% CI [.22, .30]). No differences were observed by sex, age, or population type (clinical vs. non-clinical). However, higher estimates were identified in high-income settings and more developed contexts. Narrative synthesis identified cognitive, affective, physiological and interpersonal mechanisms as potential mediators. The certainty of the evidence was generally low. Limitations include the predominance of cross-sectional designs, reliance on self-report measures of CEM and variability across outcome measures.Conclusions: These findings underscore the importance of CEM in trauma-related symptomatology and support the need for its systematic assessment in clinical and research settings, particularly by highlighting differences between emotional abuse and emotional neglect. Childhood emotional maltreatment, particularly emotional abuse, is associated with trauma-related outcomes, including PTSD and complex PTSD.Evidence on complex PTSD remains limited, highlighting the need for further research on childhood emotional maltreatment and a broader range of trauma-related outcomes.Evidence on underlying mechanisms is scarce: region and socioeconomic status act as moderators, while psychological and affective processes may mediate these associations.Large longitudinal and cross-cultural studies using harmonised assessment approaches, including both subjective and objective measures, are needed to clarify causal pathways linking childhood emotional maltreatment to PTSD and complex PTSD.
Xerostomia is a common oral manifestation of type 2 diabetes mellitus (T2DM) and may reflect alterations in salivary gland function associated with chronic metabolic dysregulation. Oral dryness can negatively affect mastication, speech, oral comfort, and quality of life, highlighting the need for reliable patient-reported assessment tools. This study aimed to assess xerostomia in adults with T2DM and to translate, culturally adapt, and validate the Romanian version of the Summated Xerostomia Inventory (SXI). A cross-sectional study was conducted in 132 adults with T2DM recruited from a tertiary diabetes outpatient center in Romania. Translation and cross-cultural adaptation followed COSMIN recommendations. Participants completed the Romanian SXI, a global xerostomia question, and a Visual Analog Scale (VAS) for oral dryness. Unstimulated whole salivary flow rate (UWSFR) was additionally measured. Internal consistency, test-retest reliability, concurrent validity, convergent validity, and feasibility were evaluated. The mean SXI score was 9.58 ± 3.82. Xerogenic medication use was reported by 87.1% of participants, while hyposalivation was identified in 9.1%. Xerostomia-related manifestations included oral burning sensation (21.2%), speech difficulties associated with oral dryness (20.5%), and suspected sleep apnea or habitual snoring (26.5%). The Romanian SXI demonstrated excellent psychometric performance, with high internal consistency (Cronbach's α = 0.90), corrected item-total correlations ranging from 0.56 to 0.86, and excellent test-retest reliability (ICC = 0.975). Mean SXI scores increased significantly across xerostomia severity categories (p < 0.001), and a very strong positive correlation was observed between SXI and VAS scores (Spearman's r = 0.93, p < 0.001). No significant floor or ceiling effects were detected. Xerostomia-related symptoms were common among adults with T2DM, supporting the importance of routine assessment of oral dryness in diabetes care. The Romanian version of the SXI demonstrated excellent validity, reliability, and feasibility and provides a practical instrument for the evaluation and monitoring of xerostomia in Romanian-speaking adults with T2DM. Beyond its application in diabetes care, the Romanian SXI may facilitate the assessment of xerostomia in other populations affected by salivary gland dysfunction, supporting future clinical practice, epidemiological research, and cross-cultural studies in Romanian-speaking populations.
Adults with major lower limb amputation (LLA) due to dysvascular etiology often experience diverse health outcomes. However, the absence of standardized outcome reporting limits the ability to synthesize evidence, evaluate care models, and develop consistent clinical pathways. This review updates a systematic review on outcome measures and indicators reported in this population. A systematic review update was conducted across six databases (MEDLINE, EMBASE, EBM Reviews, PsycINFO, Web of Science, and CINAHL) from 20 April 2017 to 1 December 2022. All study designs were eligible; however, the articles needed to report outcome measures and indicators on at least 50% of the adult population with major dysvascular LLAs. The extracted outcome measures and indicators were organized according to Dodd's framework and then reclassified alongside those reported in the study by Ambler and colleagues. The pilot phase of data extraction was carried out independently by multiple reviewers, after which a single reviewer completed the data extraction. Of the 12,557 articles, 160 studies reporting data on 228,116 individuals with major dysvascular LLA met the inclusion criteria. Combining these with the 440 studies from the previous review, 2,466 outcome measures and indicators were categorized in five core areas: life impact (25.7%), physiological/clinical (23.4%), death (18.7%), resource use (17.6%), and adverse events (14.6%). In terms of the outcome domains, mortality/survival was the most commonly reported domain, followed by physical functioning (e.g. prosthesis fit, use), skin (e.g., stump wound healing), nervous system outcomes (e.g., residual limb pain), need for further interventions (e.g., prescription of medications), hospital outcomes (e.g., duration of stay, discharge), and adverse events. This study builds on a previous review by identifying and categorizing outcome measures and indicators in adults with major dysvascular LLA, highlighting inconsistencies in outcome reporting across studies. The absence of a standardized set of outcome measures and indicators limits the ability to conduct meta-analyses or systematic reviews, evaluate the effectiveness of care models, and establish clinical pathways. Developing a core outcome set tailored to the needs of individuals with dysvascular LLA could help address these challenges by promoting consistency in outcome reporting and enabling meaningful comparisons across studies. Ultimately, this could contribute to improving the quality, efficiency, and person-centeredness of care. PROSPERO (CRD42023388570).
The Kihon Checklist (KCL) is a brief, multidimensional, and function-oriented instrument for frailty screening. However, a comprehensive synthesis of its psychometric properties remains lacking. This scoping review aimed to map and summarize psychometric evidence on the reliability and validity of the KCL in frailty screening. A systematic search of nine databases identified 22 eligible English-language studies published up to May 31, 2025. Most studies were conducted in community settings and findings on internal consistency reliability and concurrent validity were generally favourable. Evidence for predictive validity was mixed, while content validity was primarily evaluated in cross-cultural adaptation studies. Limited evidence was found for test-retest reliability, split-half reliability, and structural, convergent, or known-groups validity. Overall, the findings suggest that the KCL shows promise as a psychometrically evaluated instrument for frailty screening, especially in community settings. Further research is needed to address current evidence gaps and expand its applicability across diverse populations and clinical contexts.