Reliability and Validity of Swedish Versions of the Diabetes Self-Management Questionnaire and the Diabetes Distress Scale.

There is a wealth of nursing literature about nursing students' loneliness, self-efficacy, and influence on academic performance; however, the mediating role of social media addiction among these associations remains scant after the pandemic and in a Middle Eastern context. To investigate the mediating effect of social media addiction in the interrelationships between loneliness, academic self-efficacy, and academic performance among nursing students. Cross-sectional and correlational study design was used. Five nursing colleges in Saudi Arabia were selected as the study settings using convenience sampling. Nursing students (n = 775) were consecutively invited to participate and completed three standardized self-report scales (6-item Loneliness Scale, 6-item Bergen Social Media Addiction Scale, and the 5-item General Academic Self-Efficacy Scale). For data analysis, the covariance-based structural equation modeling was utilized. Data were analyzed using covariance-based structural equation modeling with maximum likelihood estimation. Path analysis was conducted to test direct and mediating relationships, and model fit was evaluated using χ2/df, root mean square error of approximation, comparative fit index, Tucker-Lewis index, and standardized root mean square residual. Loneliness was negatively associated with social media addiction (β = - 0.18, p = 0.001) and positively associated with academic self-efficacy (β = 0.14, p = 0.001) and academic performance (β = 0.14, p < 0.05), contrary to the hypothesized directions. Social media addiction was positively associated with academic self-efficacy (β = 0.19, p = 0.001) but negatively associated with academic performance (β = - 0.11, p < 0.05). Social media addiction significantly mediated the indirect effect of loneliness on academic self-efficacy (β = - 0.03, p = 0.005), but not on academic performance. Loneliness explained 3.33% of the variance in social media addiction, while loneliness and social media addiction explained 4.57% and 3.89% of the variance in academic self-efficacy and academic performance, respectively. Some findings diverged from theoretical expectations, suggesting that the relationships among loneliness, social media addiction, academic self-efficacy, and academic performance may be context-dependent. Social media addiction mediated only the relationship between loneliness and academic self-efficacy. Nursing educators and policymakers should interpret these findings cautiously and consider multifactorial strategies that address loneliness, problematic social media use, and broader academic and psychosocial support needs among nursing students. Not applicable.

Somatic symptoms frequently occur in haemodialysis patients, whereas depression and anxiety are also common but are often under-recognised issues. This study aims to examine the associations among depression, anxiety and somatic symptoms in haemodialysis patients. These symptoms may be linked together under a general distress construct in haemodialysis patients. We surveyed 1085 dialysis patients between 1 March 2018 and 28 February 2023 at 17 dialysis facilities in Northeast Ohio with the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder and Kidney Disease Quality of Life instrument somatic questions. To evaluate associations across these multi-item questionnaires, we used latent variables and a structural equation modelling approach. We first compared single-factor, two-factor and three-factor models. We next considered bifactor and higher order factor models. We controlled for race, gender and age in all models. Our study sample included a high percentage of black patients (75%) and 150 (14.3%) survey participants screened positive for depression (PHQ-9 ≥10). All models fit relatively well, with the three-factor model fitting slightly better than the single and two-factor models. In the three-factor model, the associations for depression and anxiety (r=0.818), depression and somatic (r=0.800) and anxiety and somatic (r=0.784) were all high, potentially indicative of poor discriminant validity. We found that the bifactor model fit the best of the five models tested (comparative fit index=0.957, Tucker-Lewis fit index=0.959, root mean square error of approximation=0.043) and was the most substantively meaningful, with an overall internalising construct and specific domains explaining additional covariance across the questions. Being black (vs all other races), male (vs female) and older age all had significantly (p<0.05) lower levels of reported symptoms on most constructs. We found very strong associations among depression, anxiety and somatic symptoms in our sample of haemodialysis patients. All questionnaire items may be linked together under a common general distress disorder, while each still retains unique features of depression, anxiety and somatic symptoms not fully explained by internalising processes. Patient care approaches should generally consider screening for all three together, rather than only one.

The objective of this cross-sectional observational study was to validate a scale that highlights the personal and environmental barriers that hinder adherence to regular physical exercise in older adults. Individuals aged 60 years or over, sedentary and/or ex-practitioners, regular practitioners of physical exercise, with Brazilian Portuguese as their mother tongue. In addition to the Regular Physical Exercise Adherence Scale (REPEAS), the following instruments were applied: sociodemographic data sheet and Baecke Habitual Physical Activity Questionnaire. The measurement properties tested were: structural validity, construct validity, reliability, consistency internal and ceiling and floor effects. This research involved 200 older adults' participants, predominantly women. The confirmatory factor analysis supported the two-domain, 12-item structure of the REPEAS, demonstrating good model fit with the following indices: chi-square/degrees of freedom = 1.60, comparative fit index = 0.965, Tucker-Lewis index = 0.957, root mean square error of approximation = 0.078, and standardized root mean square residual = 0.078. Construct validity was evidenced by a statistically significant difference (p < 0.05) in the personal factors domain between groups. Additionally, the domains of the REPEAS showed appropriate correlations with the items in the factor analysis. Reliability was acceptable, with composite reliability ≥ 0.84 and intraclass correlation coefficient ≥ 0.89. This scale presented adequate measurement properties when tested on Brazilian older adults to assess environmental and personal barriers to regular physical exercise. However, as this was a study conducted with a convenience sample, generalization of the findings should be made with caution. Despite this, the REPEAS can serve as a practical tool for health professionals and researchers to identify modifiable barriers and guide strategies to promote physical activity among older adults. Not applicable.

Exploratory factor analysis (EFA) is widely used to identify latent structures measured by observed indicators. Nevertheless, determining the number of factors remains a methodological challenge, especially when the size of the EFA model is large (e.g., models with more than 10 indicators per factor and more than five factors). This study evaluated the performance of 15 factor-retention methods under large factor analysis models, including parallel analysis (PA) using the mean and 95th percentiles of threshold, exploratory graph analysis (EGA) with GLASSO and TMFG estimations, sequential χ2, fit indices (Comparative Fit Index [CFI], Tucker-Lewis Index [TLI], Root Mean Square Error of Approximation [RMSEA]), Kaiser Criterion (K1 rule), the very simple structure (VSS) method, the comparison data (CD) approach, the minimum average partial (MAP) test, the Hull method using the comparative fit index, Cattell's acceleration factor criteria, and Bayesian information criterion (BIC). Specifically, we manipulated the number of factors (5, 6, and 7), indicators per factor (10 and 15), sample sizes (100, 200, 500, 800, 1,000, 1,500, 2,000, and 4,000), inter-factor correlations (.30, .50, and .70), and factor loadings (.40 and .70). Results reveal that PA-M and EGA-TMFG are the most robust methods across varying conditions. PA-M excels under low-to-moderate inter-factor correlations, while EGA-TMFG is more accurate in high-correlation scenarios when sample sizes are sufficient. Notably, EGA-Glasso may fail to converge when sample size is insufficient in large factor models.

Community violence and crime in Arab society in Israel have risen substantially, to the point of becoming one of the most distressing issues for Arab citizens. While many studies have examined the extent of social violence, few have examined its relationship with emotional health, and the mediating role of stress has not been the topic of any scientific investigation. Based on a cross-sectional survey conducted among 941 adult Israeli Arab citizens, the current study assesses the ramifications of community violence on the emotional health of the Arab population in Israel. A mediation model was found to fit the data comparative fit index (CFI) = 0.901, root mean square error of approximation (RMSEA) = 0.039, standardized root mean squared residual (SRMR) = 0.050), where stress was found to mediate the association between exposure to violence and depression (95% CI = 0.17, 0.30) and anxiety (95% CI = 0.18, 0.31), as well as between threat of violence and depression (95% CI = 0.02, 0.24) and anxiety (95% CI = 0.02, 0.25). Stress also mediated the association between worry about social crime and violence and depression (95% CI = 0.04, 0.25) and anxiety (95% CI = 0.04, 0.26), as well as between the attitudes that more should be done about social crime and violence and depression (95% CI = 0.03, 0.19) and anxiety (95% CI = 0.03, 0.19). The findings suggest that stress plays a central role in the association between community violence and symptoms of depression and anxiety among Arab citizens in Israel.

Early Childhood Education (ECE) educators experience high levels of stress, burnout, and job turnover, contributing to workforce instability. Efforts to better understand how interpersonal and environmental work-related factors contribute to burnout and job turnover intentions are essential to improving ECE educator wellbeing. Grounded in the social ecological model, this study quantitatively examined how stress, the social climate (social support and social strain), and health behaviors contribute to burnout and job turnover intentions in ECE educators. The StayWell ECE (Staff and Youth Wellness for Early Childhood Educators) project administered two online surveys to licensed ECE educators in New York: the Health Behaviors Survey (n = 1,423), assessing burnout, stress, turnover intentions, and health behaviors (diet, physical activity, and sleep), and the Social Environment Survey (n = 263), assessing workplace social climate (social support and social strain). Multiple linear regression analyses examined associations between burnout, the social climate, and health behaviors. Path analysis was conducted to test relationships among perceived stress, the social climate, burnout, and turnover intentions, controlling for age, income, and education; model fit was evaluated using chi-square, comparative fit index, root mean square error of approximation, and standardized root mean square residual. Higher burnout was significantly associated with poorer diet quality and lower physical activity and sleep. Lower workplace social support was also associated with poorer diet quality and sleep. Path analysis demonstrated adequate model fit and showed that stress was associated with lower social support, higher social strain, and higher levels of burnout. Social strain was strongly associated with two burnout subdomains (lower emotional exhaustion and depersonalization; p < 0.01 and p < 0.01), while social support was associated with one (greater personal accomplishment; p < 0.01). All burnout subdomains were associated with higher turnover intentions. Findings highlight burnout as a key mechanism linking stress and workplace social climate to health behaviors and turnover intentions among ECE educators. Interventions that reduce perceived stress and address both social support and social strain may improve wellbeing, support healthier behaviors, and reduce job turnover in this workforce.

Asthma education among caregivers is an integral part of asthma management. The study validates the Hindi version of the Newcastle Asthma Knowledge Questionnaire (NAKQ). This was a pilot study conducted among 100 parents of children between 7 and 15 years with bronchial asthma. The original English NAKQ tool was forward and back translated into Hindi. A face-to-face interview was conducted to administer the tool. Exploratory factor analysis (EFA) and confirmatory factor analysis were carried out to understand the factor structure, construct, validity, and reliability of the questionnaire. The Cronbach's alpha value was 0.641. The Hindi NAKQ was factorable as demonstrated by a significant Bartlett's test of sphericity. The EFA revealed a four-factor solution explaining 22.5% of the variance. The construct validity showed that items 4, 7, 14, and 17 had poor correlation (of the total 31 items) with the overall scale score (<0.2), and therefore, the items were deleted. Using the four factors with all 27 items, a statistical model was generated with a good fit, as indicated by a root mean square error of approximation (RMSEA) value of 0.0546, which was close to the acceptable cutoff of 0.06. The Hindi-translated version of NAKQ tool is reliable and valid to be administered among the Indian participants.

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.

Throughout their social development, people may experience various forms of discrimination. Discrimination research typically analyzes such experiences based on one characteristic, for instance, by isolating age from other characteristics such as gender, race/ethnicity, or financial status. We propose expanding the perspective in discrimination research by examining how discrimination across multiple dimensions is interlinked, resulting in what we call generalized discrimination experiences. Focusing on age specifically, recent research has shown that in highly modernized societies, teenagers and young adults report more age discrimination than do older adults. We hypothesized that younger people are particularly affected by generalized discrimination. By contrast, discrimination toward older adults may be more age-specific. This perspective helps reconcile conflicting views on ageism in the literature. To test the hypothesis of generalized discrimination experiences, we analyzed survey data collected in the United Kingdom (N > 14,000, ages 18-93, with diverse ethnicities and socioeconomic backgrounds). Confirmatory factor analysis supported a one-factor model of generalized discrimination across domains: discrimination based on age, gender, ethnicity, religion, sexual orientation, health/disability, and financial situation (comparative fit index = .994; root mean square error of approximation = .030). Structural equation modeling then distinguished generalized from age-specific discrimination, showing that younger respondents reported substantially more generalized discrimination experiences, whereas older respondents reported more age-specific discrimination (comparative fit index = .996; root mean square error of approximation = .014). We also found that older adults reported generalized discrimination experiences primarily if they had lower social status. We conclude that discrimination research will benefit from an awareness of how multiple forms of discrimination can converge into generalized discrimination experiences. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This study investigates the relationships among perceived value, satisfaction, and behavioral intention in home care for older adult patients in the context of doctor-patient disputes and examines the moderating role of trust. This cross-sectional observational study used convenience sampling to recruit 306 older adult patients who had received home care services within the past year. Data were collected via a structured questionnaire comprising 26 items across 7 constructs (functional, emotional, efficiency, and social value; satisfaction; behavioral intention; and trust), each rated on a 5-point Likert scale. The questionnaire demonstrated good reliability and validity. Structural equation modeling was performed using AMOS 24.0 to test path relationships, with model fit evaluated by multiple indices (chi-square to degrees of freedom ratio = 1.289, root mean square error of approximation = 0.031, comparative fit index = 0.983, Tucker-Lewis index = 0.980). Mediation effects were examined using the bootstrap method (5000 resamples), and moderation effects of trust were tested using PROCESS macro (Model 1) in SPSS 26.0. The results showed that social value most strongly predicts satisfaction (β = 0.330, P < .001), followed by emotional (β = 0.236, P < .001) and functional value (β = 0.192, P < .01); efficiency value is nonsignificant (β = 0.080, P > .05). For behavioral intention, emotional value has the strongest direct effect (β = 0.208, P < .01), followed by functional (β = 0.172, P < .01) and efficiency value (β = 0.159, P < .05), social value is nonsignificant (β = 0.114, P > .05). Satisfaction significantly predicted behavioral intention (β = 0.285, P < .001), and partially mediated the relationship between perceived value and behavioral intention. The indirect effect between efficiency value and behavioral intention was not significant (0.027, P > .05), and the 95% CI was 0 (–0.011, 0.115), thus not playing a mediating role. Trust moderates perceived value’s effect on satisfaction, but not for efficiency value (β = –0.043, P > .05). Findings suggest a need for human-centered home care models emphasizing emotional support and social recognition, moving beyond technology-driven approaches. This research supports policymakers in evaluating older adult care services and building trust-based, satisfaction-centered, and value-driven doctor-patient interactions for healthy aging and high-quality elder care.

ABSTRACT Social capital is a fundamental social determinant of health for older adults in rapidly aging societies; however, existing comprehensive instruments often impose high cognitive friction through complex recall tasks, potentially leading to systematically excluding vulnerable populations. This study validated the factor structure of the Fujisawa Social Capital Scale (FSCS) – an independent, brief tool designed for inclusive community-based practice – among community-dwelling Japanese older adults participating in “Kayoi-no-ba” (neighborhood social participation hubs). Data were analyzed from 587 participants in the Gunma Aging Cohort (mean age 79.2 ± 6.0 years; 87.1% female; 29.6% living alone). Exploratory factor analysis using the Weighted Least Squares Mean- and Variance-adjusted estimator was prioritized to ensure statistical stability for this specific cohort. A robust two-factor structure emerged: Factor 1, “Sense of Security and Attachment to the Community,” and Factor 2, “Mutual Aid Among Neighbors.” These findings underscore the conceptual distinction between psychological belonging and functional support within community settings. The model demonstrated favorable fit indices, with a Root Mean Square Error of Approximation of 0.071 and a Tucker-Lewis Index of 0.96. High internal consistency was confirmed using McDonald’s omega (ω) for the total scale (ωt = 0.85), Factor 1 (ω = 0.77), and Factor 2 (ω = 0.74). Overall, these results indicate that the FSCS is a “practice-first” instrument that minimizes respondent burden while maintaining data reliability. By distinguishing psychological attachment from functional support, it provides a “common language” for interdisciplinary teams to guide social prescribing and prioritize targeted community-based support for socially vulnerable older adults.

Reliable measurement tools are essential for assessing facility performance and guiding digital tool implementation maturity. Despite Ethiopia's progress in digital tool implementation and maturity, the lack of a standardized instrument to assess digital supply chain maturity remains a significant challenge. The lower-level pharmaceutical supply system (Dagu) is a locally developed open-source platform in the supply chain system designed to provide systematic record-keeping and manage health commodities in Ethiopia. This study aimed to develop and validate Dagu maturity assessment tool at primary healthcare units in Ethiopia. A cross-sectional study was conducted in all Dagu system implementing facilities in Ethiopia. Item identification, domain generation, and establishment of face and content validity were conducted. Data were collected electronically using the Open Data Kit and analyzed using R version 3.4.6. Factor analysis assumptions such as KMO and Bartlett's test of Sphericity, were checked, and confirmatory factor analysis was carried out to determine item loading across measurement domains. Model fitness was assessed using Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Standardized Root Mean Square Residual (SRMR). Item-level explanatory power was evaluated using square multiple correlation (R2). A total of 365 facilities were included for psychometric development and validation. Dagu implementation maturity tool was developed, comprising five domains, twenty-four sub-domains and ninety-four stages of progression with a strong content validity index. The largest factor loading was found in issue data quality, while the lowest was found in stock according to plan. Similarly, the data quality domain demonstrates the highest reliability among the domains identified. The model fit indices were found to be acceptable: RMSEA = 0.079, SRMR = 0.062, TLI = 0.904, and CFI = 0.921. The highest R2 was reported for issue completeness, followed by receive completeness while the lowest R2 was found in stocked according to plan. This study provides the first validated tool to measure supply chain digital tool implementation maturity in Ethiopia's primary healthcare. The tool reveals strong psychometric performance and highlights the importance of domains, sub-domains and stages of progression identified for supply chain digital tool maturity assessment. This tool can be applied in similar settings to track facilities digital tool maturity progress.

Psychological First Aid Self-Efficacy and Perceived Ability to Cope With Trauma Among Emergency Nurses: The Mediating Role of Mindful Self-Care Skills.

Psychometric Evaluation of the Fatigue Severity Scale in Chronic Neck Pain.

The aim of this study was to translate the Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire into Norwegian and assess its psychometric properties among individuals with a history of myocardial infarction. The study adopted a cross-sectional design. The original questionnaire was translated into Norwegian and adapted for use in the target population. The Norwegian version was pilot tested in a sample of patients and then validated in the target population. Norway, using a web-based solution to collect data. A random sample of Norwegian individuals <85 years old with a history of myocardial infarction and no cardiovascular disease before their first myocardial infarction. Internal consistency was tested using Cronbach's α and test-retest reliability using intraclass correlation coefficient (ICC). Difficulty and discrimination indices were determined for the Knowledge scale. Confirmatory factor analysis (CFA) was used to assess structural validity of the Risk scale. Data for 746 participants (mean age, SD: 66.4, 10.3 years), of which 26.9% females were analysed. The Norwegian version showed satisfactory internal consistency (Cronbach's α 0.73-0.79) but modest test-retest reliability (ICC 0.35-0.64). The Knowledge scale showed moderate difficulty (0.39-0.84) and good discrimination power (0.44-0.60). The one-factor model CFA for each scale achieved acceptable fit, and the four-factor model showed moderate fit (root mean square error of approximation=0.05, standardised root mean squared residual=0.07, Comparative Fit Index=0.91, Tucker-Lewis Index=0.88). The Norwegian translated ABCD Risk Questionnaire demonstrated satisfactory psychometric properties and can be considered a useful instrument for assessing knowledge and risk perception among individuals with a history of myocardial infarction.

BackgroundCyberbullying victimization is a significant risk factor for poor psychological well-being among college students. Existing tools fail to capture the distinct dimensions of victimization in social media contexts.ObjectiveThis study aimed to adapt and validate a Social Media Cyberbullying Victimization Scale (SMCVS) and examine its associations with psychological outcomes among Chinese college students.MethodsIn Shanghai, China, 1766 students from multiple universities completed questionnaires including demographic information, the SMCVS, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 scale. The psychometric evaluation of the SMCVS included content validity, construct validity, criterion validity, internal consistency reliability, split-half reliability, and test-retest reliability. Receiver operating characteristic analyses were used to evaluate predictive ability for depression and anxiety.ResultsContent validity was satisfactory, and 13 items were retained, with item-level content validity index values ranging from 0.833 to 1 and a scale-level content validity index of 0.949. Exploratory factor analysis identified 2 dimensions—“information harassment” and “reputation and privacy violation”—explaining 82.2% of the total variance. Confirmatory factor analysis supported this structure (goodness-of-fit index=0.943, comparative fit index [CFI]=0.982, normed fit index=0.978, and root mean square error of approximation [RMSEA]=0.075). Multigroup confirmatory factor analysis supported configural and metric invariance across both gender and academic major (ΔCFI≤0.01, ΔRMSEA≤0.015); scalar invariance was achieved for gender but not for academic major. Both dimensions showed significant correlations with depression (r=0.433‐0.457) and anxiety (r=0.356‐0.372). Cronbach α, Spearman-Brown coefficient, and test-retest reliability coefficient were 0.959, 0.973, and 0.860, respectively. The SMCVS demonstrated moderate discriminative accuracy for depression (area under the curve [AUC]=0.738; optimal cutoff=19.5) and anxiety (AUC=0.739; optimal cutoff=22.5).ConclusionsThe SMCVS demonstrates sound psychometric properties and may be useful for assessing social media cyberbullying victimization among Chinese college students. Its validated 2D structure clarifies distinct patterns of victimization and their psychological correlates, offering implications for targeted prevention and intervention.

Lipedema is a chronic condition that is often underdiagnosed. Clinical overlap with other disorders and the absence of specific diagnostic tools may delay diagnosis. This study aimed to translate and culturally adapt the lipedema screening questionnaire (LSQ) into Turkish and evaluate its validity and reliability. The study was conducted with 52 female patients diagnosed with lipedema and 49 healthy female volunteers who attended a physical medicine and rehabilitation outpatient clinic between August 2024 and January 2025. Following Beaton's guidelines, the questionnaire was translated into Turkish and culturally adapted. Exploratory and confirmatory factor analyses (CFA) were used to evaluate construct validity, while Cronbach's alpha was calculated to assess internal consistency. Receiver operating characteristic (ROC) analysis was performed to determine the discriminative ability and optimal cut-off score of the questionnaire. The Kaiser-Meyer-Olkin coefficient was 0.866, and Bartlett's test result was significant (p<0.001), supporting the suitability of the data for factor analysis. Exploratory factor analysis identified a two-factor structure explaining 63.5% of the total variance. CFA showed acceptable model fit (comparative fit index: 0.9668; root mean square error of approximation: 0.0782). Internal consistency was high, with a Cronbach's alpha of 0.866. In ROC analysis, the questionnaire demonstrated excellent discriminative ability, with an area under the curve of 0.970 (95% confidence interval: 0.942-0.999; p<0.001). The optimal cut-off score was 8.5, corresponding to 90.4% sensitivity and 91.8% specificity. The Turkish version of the LSQ appears to be a valid and reliable tool for the preliminary screening of individuals at risk for lipedema in clinical settings.

Executive function (EF) is associated with higher cognitive functions in the prefrontal cortex, and its assessment may support daily life activities. The reliability and validity of the Japanese Behavior Rating Inventory of Executive Function-Adult Version (J-BRIEF-A) were evaluated in this study. Gender and age differences in EF among adults were explored as a secondary objective. This cross-sectional study involved an online survey among 1378 adults (age: 18-89 years; 689 men) across Japan. Confirmatory factor analysis supported the nine subscales and three-factor model of the J-BRIEF-A (comparative fit index = .98, root mean square error of approximation = .094). Internal consistency and high test-retest stability were also confirmed. Construct validity was confirmed using the Dysexecutive Questionnaire as an external criterion. Younger age groups tended to have higher scores for each item. This study confirmed the reliability of the J-BRIEF-A and provided partial evidence for its validity. The factor analysis supported the theoretical structure of the scale, suggesting factorial validity. The significant correlation between the J-BRIEF-A and Dysexecutive Questionnaire partially supports the J-BRIEF-A's construct validity. Despite relying on self-reported data and there being no direct comparisons with performance-based EF tests, the J-BRIEF-A remains valuable for assessing EF in daily life.

Mobile health (mHealth) technologies are increasingly promoted as tools for chronic disease management and healthy aging, yet adoption remains persistently uneven across demographic groups. Japan, where 29.1% of the population is 65 years or older-the highest proportion globally-exemplifies the challenges of mHealth promotion in super-aging societies. Despite high smartphone penetration (90.1%) and active national digital transformation initiatives, only 21.6% of Japanese adults report regular mHealth app use, with marked disparities by age and sex. This study examined determinants of mHealth acceptance by extending the unified theory of acceptance and use of technology to incorporate eHealth literacy, self-efficacy, perceived risk, distrust, and health-related factors (health status and health interest). Age- and sex-specific differences in acceptance mechanisms were also investigated using multigroup structural equation modeling (SEM). We conducted a cross-sectional online survey in November 2023 with 960 Japanese adults sampled across 7 age strata (aged 18-27 years to aged ≥78 years). SEM tested hypothesized relationships among 9 constructs. Health status and health interest were included as observed covariates. Multigroup SEM with configural, metric, and structural invariance testing examined age- and sex-specific differences, and binary logistic regression identified predictors of current mHealth app use. The structural model demonstrated good fit (χ2/df=2.06; comparative fit index 0.953; Tucker-Lewis index 0.945; root mean square error of approximation 0.047) and explained 71.6% of the variance in behavioral intention. Effort expectancy (β=0.404), facilitating conditions (β=0.349), and performance expectancy (β=0.188) were the primary proximal predictors of behavioral intention. Social influence exerted strong upstream effects on effort expectancy (β=0.811), eHealth literacy (β=0.507), and self-efficacy (β=0.422). Health interest positively influenced performance expectancy (β=0.133), whereas neither health interest nor health status showed a significant direct effect on distrust. Distrust did not directly predict behavioral intention in the overall sample. Multigroup analyses identified 5 significant age differences and 5 sex differences. eHealth literacy increased distrust among young adults but reduced perceived risk among middle-aged and older adults. Self-efficacy negatively predicted performance expectancy among young adults yet positively predicted it among middle-aged and older adults. Distrust significantly reduced behavioral intention only among middle-aged adults. mHealth acceptance in Japan's aging society is characterized by stable proximal determinants of behavioral intention alongside heterogeneous upstream belief formation processes that vary systematically by age and sex. Health interest, rather than health status, emerged as the key contextual driver of perceived usefulness. At the theoretical level, this study clarifies how eHealth literacy, self-efficacy, and distrust function as age- and sex-contingent antecedents within an extended unified theory of acceptance and use of technology framework. At the practical level, these findings highlight the need for trust-centered, demographically tailored, and literacy-sensitive strategies to promote equitable mHealth adoption in rapidly aging societies.