Search Results (1,152)

Background/Objectives: Young adulthood is a transitional period associated with changes in lifestyle and preventive dental attendance, which may influence caries risk. In routine practice, the use of comprehensive caries risk assessment systems is often limited by time and diagnostic requirements, highlighting the need for simplified diagnostic screening tools. This study aimed to develop and clinically validate a simplified, questionnaire-based caries risk assessment tool derived from the CAMBRA framework for use in young adults. Methods: An observational cross-sectional study was conducted among 246 Romanian young adults aged 18–25 years. The instrument was designed to enable rapid caries risk stratification based exclusively on questionnaire data, without radiographic or laboratory investigations. Internal consistency, test–retest reliability, and construct validity were evaluated by comparison with clinically recorded indicators, including DMFT values, early enamel changes, visible dental plaque, and active carious lesions. Results: The questionnaire showed acceptable internal consistency (Cronbach’s alpha = 0.71) and good temporal stability (ICC = 0.82). Higher caries risk categories were consistently associated with unfavorable clinical findings, including increased DMFT values, a higher prevalence of early enamel changes, greater plaque accumulation, and more frequent active caries (p < 0.01). Conclusions: The simplified CAMBRA-based questionnaire demonstrated satisfactory reliability and clinical relevance in young adults. It may serve as a practical diagnostic screening and decision-support tool for risk-based caries prevention in routine and community dental settings. Full article

Background: Sustainable dietary transitions are increasingly emphasized in public health policy; however, validated psychometric instruments assessing knowledge, attitudes, and practices (KAP) in Asian contexts remain limited. Objectives: This study aimed to develop and evaluate a KAP questionnaire on sustainable diets and examine sociodemographic variations and behavioral correlates among Taiwanese adults. Methods: A two-phase mixed-methods design was used, including expert validation and a cross-sectional online survey (n = 587). Construct validity was examined using exploratory factor analysis, and reliability was evaluated through internal consistency and test–retest assessments. Multivariable logistic regression models were fitted to identify factors associated with low adherence to a low-carbon diet. Model diagnostics included variance inflation factors (VIF), Hosmer–Lemeshow tests, Nagelkerke pseudo-R², and ROC analysis. Results: Content validity was high (S-CVI/Ave = 0.95–0.98). The attitude and practice domains demonstrated satisfactory internal consistency, whereas the knowledge domain showed comparatively lower reliability. In multivariable logistic regression analyses, higher attitude scores were independently associated with lower odds of low adherence to a low-carbon diet. Eating-out frequency and clear awareness of sustainability in Taiwan’s Dietary Guidelines were also significantly associated with adherence. The fully adjusted model demonstrated adequate calibration and excellent discrimination (AUC = 0.778). Conclusions: The instrument provides preliminary psychometric evidence supporting the assessment of sustainable diet-related KAP among Taiwanese adults. Attitudes appear more strongly associated with dietary practices than knowledge alone. The questionnaire may support future monitoring and research. Full article

Objective: This study aimed to develop the Infectious Diseases Knowledge Questionnaire (IDKQ) and evaluate its psychometric properties for use in community settings. Methods: This methodological study was conducted with 533 adults aged ≥ 18 years. Data were collected using a sociodemographic information form and the IDKQ. Content validity was assessed by expert evaluation. Construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was evaluated through item–total correlations, internal consistency (KR-20), test–retest reliability, and intraclass correlation coefficients (ICC). Data analyses were performed using SPSS 25.0 and AMOS 21.0. Results: Content validity index values ranged from 0.94 to 1.00. EFA revealed a four-factor structure consisting of 17 items, explaining 45.66% of the total variance (KMO = 0.784; Bartlett’s test, p < 0.001). CFA demonstrated good model fit (χ²/df = 2.329, RMSEA = 0.074, CFI = 0.946, AGFI = 0.847, GFI = 0.887, SRMR = 0.045). The KR-20 coefficient was 0.735, the test–retest correlation was 0.604, and the ICC was 0.781. Conclusions: The IDKQ demonstrates acceptable internal consistency and moderate temporal stability, providing preliminary evidence of reliability and construct validity. It may serve as a tool for assessing infectious disease knowledge, although further validation in independent samples is recommended. Full article

Objectives: This study evaluated the test–retest repeatability of semi-quantitative and volumetric features derived from artificial intelligence (AI)-assisted lesion segmentation on ¹⁸F-DCFPyL Prostate Specific Membrane Antigen (PSMA)-PET/CT imaging of patients with prostate cancer (PCa). Specifically, we assessed the reliability of maximum, minimum and total standardized uptake values (SUV_max, SUV_mean, SUV_total) and lesion volume measurements across varying lesion sizes and explored the implications of variability for clinical decision-making. Methods: We analyzed ¹⁸F-DCFPyL PSMA-PET/CT images from 22 patients with metastatic PCa. Lesion segmentation was performed using the AI-guided TRAQinform IQ technology, followed by a manual review to eliminate potential false-positive sites of uptake. Lesion-level test–retest repeatability was evaluated using 95% limits of agreement (LOA), intra-class correlation coefficient (ICC), within-subject coefficient of variation (wCOV) and Bland–Altman analysis for SUV and volumetric parameters. Lesions were stratified by size (>1 cm³ and >1.5 cm³) to assess the impact of lesion volume cut-offs on measurement variability. Results: A total of 297 lesions were analyzed, including 191 lesions > 1 cm³ and 161 lesions > 1.5 cm³. Test–retest variability was higher in smaller lesions, with narrower LOA and lower wCOV for larger lesions. SUV_max and SUV_mean exhibited lower variability than SUV_total and lesion volume. The 95% LOA for SUV_max ranged from −33.81% to +38.02% for all lesions, improving to −31.82% to +31.01% for lesions > 1.5 cm³. Similar trends were observed for SUV_mean, SUV_total, and volume. Bland–Altman plots confirmed reduced variability in larger lesions, with no significant systematic bias. Conclusions: The test–retest repeatability of AI-assisted PSMA-PET/CT features varies by feature type, with semi-quantitative features demonstrating improved repeatability relative to volumetric features. Additionally, repeatability is influenced by lesion size, with larger lesions exhibiting greater reliability. These findings highlight the importance of lesion size-dependent thresholds in response assessment and variability-aware feature selection in prognostic models. Current algorithms may be better optimized for larger lesions and higher volumes of disease, with limitations remaining in the robust detection and segmentation of smaller/more subtle lesions. Full article

Oral health during pregnancy is a critical factor in preventing caries in both mothers and children. Croatia currently lacks validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in the general population. This study aimed to develop and provide initial psychometric evidence for a comprehensive instrument for this purpose in Croatia, with potential relevance for future cross-cultural adaptation. Following Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines, an initial item pool was generated through literature review and expert consultation. The study was conducted from May 2024 to February 2025 in primary healthcare settings across Primorje-Gorski Kotar County (PGC). The validation study included 319 pregnant women. Exploratory factor analysis (EFA) revealed a six-factor structure with acceptable to strong factor loadings (ranging from 0.423 to 0.984). The instrument showed acceptable to good internal consistency (Cronbach’s α = 0.61–0.87) and excellent test–retest reliability (Pearson r = 0.993). Results indicated that knowledge about oral health was independent of attitudes and practices during pregnancy. Regression analyses were exploratory and did not provide evidence of predictive validity at this stage, suggesting that additional contextual and psychosocial factors should be considered in future modelling. The present study provides initial psychometric evidence supporting the proposed structure and reliability of the instrument; however, further confirmatory and longitudinal validation studies are required before broader implementation and generalization can be fully justified. Full article

Background and Objectives: Visual impairment and reduced stereovision significantly impact the quality of life and increase fall risk in older adults. While standard clinical assessment of visual functions is essential in this population, its use is often limited by the need for specialized equipment and trained personnel. Tablet-based screening tools offer a practical alternative but require clinical validation. This study aimed to assess the agreement, reliability, and diagnostic performance of a tablet-based screening application (index methods) compared to established clinical reference methods for assessing visual acuity (VA) and stereovision (SV) in adults over 60 years. Materials and Methods: This prospective, non-blinded, cross-sectional, feasibility study included two cohorts: a test–retest group of 24 older adults assessed twice within 7 days, and a clinical cross-sectional group of 135 participants recruited from primary care practices. VA was measured using tablet-based Landolt C test and compared with an ETDRS-style chart, while stereovision was assessed using tablet-based static and dynamic random dot stereograms and compared with the TNO stereotest. Agreement and reliability were evaluated using Bland–Altman analysis, intraclass correlation coefficients (ICC), and receiver operating characteristic (ROC) curves. Results: The index VA method demonstrated good test–retest reliability (ICC = 0.79) with no significant difference between repeated measurements. In the clinical cross-sectional group, visual acuity measurements showed a small mean bias (0.022 logMAR) between the index and reference methods, which remained within clinically acceptable limits, particularly in the intermediate acuity range. For stereovision, the index SV tests showed high test–retest agreement. Using a TNO cutoff of 480 arcsec, the index SV method demonstrated good diagnostic accuracy (AUC 0.87 for static and 0.85 for dynamic stimuli) with high sensitivity for detecting impaired stereovision. Conclusions: The tablet-based index method provided reliable and clinically comparable results for VA and SV assessments in older adults, supporting its potential use as a screening tool in primary care and community-based settings. Full article

Background: Voluntary activation testing quantifies the ability of the motor nervous system to produce maximal force. Laboratory assessment of ankle plantar flexor voluntary activation is common, but field testing in practical settings is limited by equipment portability. We aimed to compare plantar flexor voluntary activation and maximal voluntary contraction (MVC) using a portable device with a standardised laboratory method and evaluate the test–retest reliability of the portable protocol. Methods: We performed a pseudo-randomised, crossover design. Participants completed two protocols: (1) portable force plate testing and (2) a laboratory-based isokinetic dynamometer. Voluntary activation was assessed using twitch interpolation via tibial nerve stimulation. Differences between protocols were analysed using generalised estimating equations. Reliability was assessed with the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and coefficient of variation (CV). Results: Twenty healthy participants (8 females, 12 males; median age 28.5 years) were included. No difference between protocols was detected for voluntary activation (β = 0.6, p = 0.68). The portable protocol demonstrated good reliability (ICC = 0.85) and low measurement error (SEM = 2.56%, CV = 2.79%). Conclusions: We demonstrated that the portable protocol is a valid and reliable method for assessing plantar flexor voluntary activation. It is suitable for assessing within-subject changes over time and can reduce participant attendance burden for neurophysiological muscle testing. Full article

Accurate estimation of brain age from structural magnetic resonance imaging (MRI) serves as a vital biomarker for quantifying individual neurobiological aging and identifying risks for neurological disorders. However, developing robust models that generalize across the entire lifespan (from infancy to aging) remains challenging due to heterogeneous maturation/degeneration patterns, limited cross-center generalizability, and insufficient temporal reliability evaluation. To address these limitations, we curated a large-scale, multi-center T1-weighted MRI dataset across 27 public cohorts. Of these, 22,271 scans from 17 cohorts (aged 0–96 years) formed the primary foundation for model development, complemented by 10 additional cohorts utilized for independent multi-center evaluation and robustness testing. We propose ResNet-CrossViT, a novel hybrid architecture that synergistically combines a 3D Contextual Transformer-ResNet (CoTResNet3D) backbone for enriched local feature extraction and a CrossVision Transformer (CrossViT) module for cross-scale global dependency modeling. The model was rigorously evaluated on an internal test set, an unseen external dataset for cross-center validation, a longitudinal dataset for assessing temporal consistency, and a test–retest dataset for measuring reproducibility. On the internal test set, ResNet-CrossViT achieved a mean absolute error (MAE) of 2.72 years and a maximal MAE (mMAE) of 5.10 years, demonstrating marked performance improvements, particularly within the challenging adolescent cohort. The model maintained strong generalization on the unseen dataset (MAE = 4.19 years) and exhibited superior longitudinal consistency (Mean Absolute Difference Error, MAdE = 3.68) and excellent test–retest reliability (Intraclass Correlation Coefficient, ICC = 0.994). By integrating a large-scale, heterogeneous lifespan dataset with a hybrid architecture that effectively captures both local structural details and global long-range interactions, our study provides a precise, generalizable, and reliable framework for brain age estimation. Full article

How students cope with academic stress is crucial for learning and well-being. The Multidimensional Measure of Coping (MMC) provides a comprehensive hierarchical assessment of academic coping; however, its length and adaptive–maladaptive distinction may limit practical use and constrain a more differentiated understanding of academic coping. This study aimed to refine the MMC and propose a differentiated higher-order structure for the MMC-Short Form (MMC-SF). Data were drawn from three adolescent samples from Northwest China (2024–2025): an exploratory sample (N = 1342), a confirmatory sample (N = 2037; test–retest N = 367; 4 weeks), and a longitudinal sample (T1 N = 948; T2 N = 760 at 1 month; T3 N = 893 at 6 months). Psychometric analyses (item analysis, exploratory structural equation modeling and confirmatory factor analysis [CFA]) demonstrated that the 34-item MMC-SF reliably preserved the original 11-factor structure. Furthermore, a multi-method investigation integrating higher-order exploratory factor analysis and second-order CFA supported a hybrid higher-order structure, with proactive engagement and defensive disengagement as higher-order dimensions and escape coping as a distinct first-order factor. The predictive validity was examined in relation to academic self-efficacy and burnout. These findings support the reconceptualization of academic coping and provide a brief, psychometrically robust assessment tool. Full article

This study evaluated the test–retest reliability of a depth sensor-based Fukuda Stepping Test and examined associations between sensor-derived kinematic parameters and established clinical outcomes in older adults. Eighty-six community-dwelling older adults (mean age 70.3 ± 4.7 years) performed an eyes-closed stepping task monitored by a Microsoft Kinect v2 sensor. Clinical assessments included the Berg Balance Scale, Timed Up and Go test, Five Times Sit-to-Stand, Montreal Cognitive Assessment, International Physical Activity Questionnaire, and WHOQOL-OLD. Test–retest reliability was assessed using intraclass correlation coefficients in a randomly selected subgroup. Reliability estimates varied across parameters, with temporal and displacement-based measures demonstrating more consistent agreement across sessions, whereas selected angular variables showed greater variability. Correlation analyses identified statistically significant associations between trunk kinematic changes and clinical measures, with effect sizes generally ranging from weak to moderate magnitude. Upper trunk rotation was associated with functional mobility measures, while traditional displacement-based metrics demonstrated limited clinical relationships. These findings support the feasibility of markerless depth-sensing technology for objective quantification of movement during the Fukuda Stepping Test and highlight the potential contribution of segmental kinematic parameters to multidimensional functional assessment in older adults. Full article

Background: The Temporomandibular Joint Ankylosis Quality of Life Questionnaire (TMJAQoL) is a disease-specific instrument designed to assess quality of life in patients with temporomandibular joint (TMJ) ankylosis. No validated Turkish version of this scale existed prior to this study. The aim of this study was to translate, culturally adapt, and evaluate the Turkish version of the TMJAQoL (TMJAQoL-TR) in patients with severe temporomandibular disorders, including a predefined ankylosis subgroup. Materials and Methods: A total of 120 patients with temporomandibular complaints were included. Test–retest reliability was evaluated in a clinically stable subsample of 72 participants with a one-week interval. Following forward–backward translation and cultural adaptation procedures, the TMJAQoL-TR was administered together with the Oral Health Impact Profile Short Form-14 (OHIP-14), the Short Form-36 (SF-36), and Visual Analog Scale (VAS) pain scores. Reliability was assessed using Cronbach’s α, item-level Weighted Cohen’s Kappa, and test–retest Intraclass Correlation Coefficients (ICC), supported by measurement error indices (Standard Error of Measurement [SEM] and Minimal Detectable Change at 95% confidence [MDC₉₅]). Construct validity was examined using Spearman correlation coefficients. Structural validity was investigated through exploratory factor analysis, followed by a confirmatory structural model in AMOS to evaluate preliminary model consistency. Floor and ceiling effects were analyzed using the 15% criterion. Results: The TMJAQoL-TR demonstrated excellent internal consistency (Cronbach’s α = 0.879) and very high test–retest reliability (ICC = 0.995; 95% CI: 0.992–0.997). Strong correlations were observed with OHIP-14 (r = 0.772, p < 0.01), and moderate correlations with VAS pain scores (r = 0.312, p < 0.01). No significant floor or ceiling effects were detected. A weak but significant negative correlation with the SF-36 physical role subscale suggests that TMJ-related quality of life impairment is associated with role limitations in daily activities, although the magnitude of this association was modest. Exploratory factor analysis supported a clinically coherent two-factor structure, and the AMOS structural model demonstrated acceptable consistency with this framework. Conclusions: The TMJAQoL-TR appears to be a valid and reliable instrument for assessing quality of life in patients with severe TMJ-related functional limitations. Findings from the ankylosis subgroup support potential applicability within the instrument’s original target population; however, further validation in larger ankylosis-specific samples is warranted. Full article

Objective: This study aimed to (i) examine the test–retest reliability of a holistic motor competence test (HOLMOT) in adults aged 30–60 years, and (ii) evaluate its ability to discriminate performance according to sex and age group. Methods: A total of 435 adults (206 women and 229 men; Mean age: 43.49 ± 7.55 years; Weight: 69.10 ± 9.88 kg; BMI: 23.81 ± 2.42 kg/m²) participated in this cross-sectional study. Motor Competence was assessed using the HOLMOT, a time-based protocol integrating motor-cognitive, locomotor, and manipulative domains. Test–retest reliability was examined in a subsample of 217 participants over a one-week interval using relative (ICC, Pearson’s r) and absolute (SEM, MDC) reliability indices. Sex and age-group differences were analyzed using independent t-tests and analysis of variance. Results: The HOLMOT demonstrated good to excellent reliability for the motor-cognitive (ICC = 0.89), locomotor (ICC = 0.94), and total time (ICC = 0.84) outcomes, with low SEM and MDC values. Reliability was lower for the manipulative section (ICC = 0.44). Men exhibited shorter completion times than women across all sections (p < 0.001), and adults over 50 years showed significantly longer times in the motor-cognitive and locomotor domains (p < 0.05). Conclusions: The HOLMOT is a feasible and reliable tool for assessing motor competence in mid-adulthood, demonstrating sensitivity to sex- and age-related differences and supporting holistic, lifespan-oriented models of motor competence. Full article

Despite the pervasive role of digital platforms in contemporary higher education, existing measurement tools fail to capture students’ psychological dependence on online approval within academic contexts, focusing instead on technical competencies or clinical addiction symptoms. This study developed and psychometrically validated the Digital Validation Seeking Scale (DVSS), a multidimensional instrument measuring university students’ reliance on digital feedback for academic and identity confirmation. Two independent samples of Egyptian undergraduate students were recruited: an exploratory sample of 511 students and a confirmatory sample of 740 students from six universities. The DVSS underwent rigorous content validation by eleven experts, exploratory factor analysis (EFA) using Principal Axis Factoring with Promax rotation, and confirmatory factor analysis (CFA) comparing competing structural models. Results revealed a robust four-factor structure comprising Academic Self-Quantification (ASQ), Feedback Hyper-vigilance (FHV), Social Comparison (SC), and Performative Studiousness (PS), with the first-order four-factor model demonstrating superior fit indices. The final 19-item scale exhibited excellent internal consistency, with Cronbach’s alpha coefficients ranging from 0.807 to 0.938 for subscales and total score, respectively, and strong test–retest reliability. The DVSS provides researchers and practitioners with a theoretically grounded, psychometrically sound instrument for identifying maladaptive digital validation patterns before they compromise academic engagement or psychological well-being, enabling targeted interventions within hybrid educational environments. Full article

Background and aim: Traditional marker-based optical motion capture systems are costly, time-consuming to operate, and constrained by laboratory environments, limiting their broader adoption in clinical practice and naturalistic settings. Markerless motion capture based on a sums-of-Gaussians (SoG) body model is a potential alternative; however, its metrological properties for kinematic assessment during walking and slow running remain insufficiently validated. Using a conventional marker-based Vicon system as the reference, this study evaluated the reliability and concurrent validity of an SoG-based markerless system (MocapGS) for bilateral lower-limb joint range of motion (ROM) during gait. Methods: Thirty-six healthy adults completed self-selected-pace speed walking and slow running tasks while both systems synchronously acquired bilateral lower-limb kinematics. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), SEM percentage (SEM%), minimal detectable change (MDC), MDC percentage (MDC%), and root mean square error (RMSE) were used to assess reliability. Concurrent validity was evaluated using the Pearson correlation coefficient, paired-sample t-tests, and the concordance correlation coefficient (CCC) to compare the ROM. Results: Vicon showed moderate-to-high reliability for ROM in most joints across both tasks. By contrast, the MocapGS achieved acceptable ICC values mainly for the sagittal-plane ROM at the hip and knee. The CCC analysis showed no significant agreement between the two systems. Bland–Altman plots showed systematic biases with spatially heterogeneous random errors. During walking, MocapGS systematically overestimated ROM relative to Vicon at several joint axes; the widest limits of agreement (LOA) occurred at the left knee X-axis and right hip Z-axis. During running, overestimation was consistent across all bilateral joints at the X-axis and the right hip at the Y-axis, while the widest LOA were found at the bilateral hip X-axes. These specific discrepancies highlighted the joint–axis combinations with the greatest measurement variance. In walking, the test–retest reliability of the knee flexion–extension ROM measured by the MocapGS approached that of Vicon; however, the SEM% and MDC% were generally larger for MocapGS than for Vicon. The RMSE exceeded 5 degrees for ROM in most joint planes, especially in the frontal and transverse planes and at distal joints; errors increased further during slow running. Conclusions: MocapGS may be used for coarse monitoring of large-magnitude changes in sagittal-plane kinematics during gait; however, it is currently unlikely to replace Vicon for clinical decision-making or detecting subtle gait changes, and its outputs should be interpreted with caution, particularly for ankle kinematics and non-sagittal-plane motion. Full article

Background/Objectives: Nutritional management is central to the care of patients with end-stage renal disease (ESRD), yet malnutrition often remains under-recognized due to gaps in nursing knowledge and competencies. This study aimed to develop and validate the Nursing Education and Competencies in Nutrition for Patients with CKD in ESRD (NECN-ESRD) questionnaire, designed to assess nephrology nurses’ competencies, attitudes, and practices in nutritional care. Methods: A methodological and cross-sectional design was adopted, following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations for instrument development. The process comprised five phases: construct definition and item generation, expert consultation and revision, quantitative content validity analysis, pilot testing, and psychometric testing. Data were collected between August and September 2025 from 405 nephrology nurses across Italy. Exploratory Factor Analyses (EFAs) and Confirmatory Factor Analyses (CFAs) were conducted on split samples (60/40), and key psychometric properties were evaluated. Results: EFA identified a four-factor structure—Recommendations, Attitudes, Practice, and Advanced Competencies—which was confirmed through CFA with good fit indices [Comparative Fit Index (CFI) = 0.995, Tucker–Lewis Index (TLI) = 0.994, Root Mean Square Error of Approximation (RMSEA) = 0.07]. A higher-order model further improved fit (CFI = 0.994, RMSEA = 0.029), explaining 68.2% of variance. Internal consistency was excellent (ω = 0.89–0.96), test–retest reliability showed perfect agreement [Intraclass Correlation Coefficient (ICC) = 1.00], and invariance testing supported equivalence across educational and experience levels. Conclusions: The NECN-ESRD demonstrated strong validity, reliability, and stability, providing a robust and context-specific tool to assess and enhance nurses’ competencies in nutritional care for ESRD patients. Its application can support targeted educational interventions, improve clinical practice, and contribute to enhancing the quality of nutritional care for patients with ESRD within healthcare systems. Full article