Bodily maps of musical sensations across cultures.

Emotions, bodily sensations and movement are integral parts of musical experiences. Yet, it remains unknown i) whether emotional connotations and structural features of music elicit discrete bodily sensations and ii) whether these sensations are culturally consistent. We addressed these questions in a cross-cultural study with Western (European and North American, n = 903) and East Asian (Chinese, n = 1035). We precented participants with silhouettes of human bodies and asked them to indicate the bodily regions whose activity they felt changing while listening to Western and Asian musical pieces with varying emotional and acoustic qualities. The resulting bodily sensation maps (BSMs) varied as a function of the emotional qualities of the songs, particularly in the limb, chest, and head regions. Music-induced emotions and corresponding BSMs were replicable across Western and East Asian subjects. The BSMs clustered similarly across cultures, and cluster structures were similar for BSMs and self-reports of emotional experience. The acoustic and structural features of music were consistently associated with the emotion ratings and music-induced bodily sensations across cultures. These results highlight the importance of subjective bodily experience in music-induced emotions and demonstrate consistent associations between musical features, music-induced emotions, and bodily sensations across distant cultures.

Infants who are rarely spoken to nevertheless understand many words.

Theories of language development-informed largely by studies of Western, middleclass infants-have highlighted the language that caregivers direct to children as a key driver of language learning. However, some have argued that language development unfolds similarly across environmental contexts, including those in which childdirected language is scarce. This raises the possibility that children are able to learn from other sources of language in their environments, particularly the language directed to others in their environment. We explore this hypothesis with infants in an indigenous Tseltal-speaking community in Southern Mexico who are rarely spoken to, yet have the opportunity to overhear a great deal of other-directed language by virtue of being carried on their mothers' backs. Adapting a previously established gaze-tracking method for detecting early word knowledge to our field setting, we find that Tseltal infants exhibit implicit knowledge of common nouns (Exp. 1), analogous to their US peers who are frequently spoken to. Moreover, they exhibit comprehension of Tseltal honorific terms that are exclusively used to greet adults in the community (Exp. 2), representing language that could only have been learned through overhearing. In so doing, Tseltal infants demonstrate an ability to discriminate words with similar meanings and perceptually similar referents at an earlier age than has been shown among Western children. Together, these results suggest that for some infants, learning from overhearing may be an important path toward developing language.

Women's subsistence strategies predict fertility across cultures, but context matters.

While it is commonly assumed that farmers have higher, and foragers lower, fertility compared to populations practicing other forms of subsistence, robust supportive evidence is lacking. We tested whether subsistence activities-incorporating market integration-are associated with fertility in 10,250 women from 27 small-scale societies and found considerable variation in fertility. This variation did not align with group-level subsistence typologies. Societies labeled as "farmers" did not have higher fertility than others, while "foragers" did not have lower fertility. However, at the individual level, we found strong evidence that fertility was positively associated with farming and moderate evidence of a negative relationship between foraging and fertility. Markers of market integration were strongly negatively correlated with fertility. Despite strong cross-cultural evidence, these relationships were not consistent in all populations, highlighting the importance of the socioecological context, which likely influences the diverse mechanisms driving the relationship between fertility and subsistence.

Do some languages sound more beautiful than others?

Italian is sexy, German is rough-but how about Páez or Tamil? Are there universal phonesthetic judgments based purely on the sound of a language, or are preferences attributable to language-external factors such as familiarity and cultural stereotypes? We collected 2,125 recordings of 228 languages from 43 language families, including 5 to 11 speakers of each language to control for personal vocal attractiveness, and asked 820 native speakers of English, Chinese, or Semitic languages to indicate how much they liked these languages. We found a strong preference for languages perceived as familiar, even when they were misidentified, a variety of cultural-geographical biases, and a preference for breathy female voices. The scores by English, Chinese, and Semitic speakers were weakly correlated, indicating some cross-cultural concordance in phonesthetic judgments, but overall there was little consensus between raters about which languages sounded more beautiful, and average scores per language remained within ±2% after accounting for confounds related to familiarity and voice quality of individual speakers. None of the tested phonetic features-the presence of specific phonemic classes, the overall size of phonetic repertoire, its typicality and similarity to the listener's first language-were robust predictors of pleasantness ratings, apart from a possible slight preference for nontonal languages. While population-level phonesthetic preferences may exist, their contribution to perceptual judgments of short speech recordings appears to be minor compared to purely personal preferences, the speaker's voice quality, and perceived resemblance to other languages culturally branded as beautiful or ugly.

Universal interpretations of vocal music.

Despite the variability of music across cultures, some types of human songs share acoustic characteristics. For example, dance songs tend to be loud and rhythmic, and lullabies tend to be quiet and melodious. Human perceptual sensitivity to the behavioral contexts of songs, based on these musical features, suggests that basic properties of music are mutually intelligible, independent of linguistic or cultural content. Whether these effects reflect universal interpretations of vocal music, however, is unclear because prior studies focus almost exclusively on English-speaking participants, a group that is not representative of humans. Here, we report shared intuitions concerning the behavioral contexts of unfamiliar songs produced in unfamiliar languages, in participants living in Internet-connected industrialized societies (n = 5,516 native speakers of 28 languages) or smaller-scale societies with limited access to global media (n = 116 native speakers of three non-English languages). Participants listened to songs randomly selected from a representative sample of human vocal music, originally used in four behavioral contexts, and rated the degree to which they believed the song was used for each context. Listeners in both industrialized and smaller-scale societies inferred the contexts of dance songs, lullabies, and healing songs, but not love songs. Within and across cohorts, inferences were mutually consistent. Further, increased linguistic or geographical proximity between listeners and singers only minimally increased the accuracy of the inferences. These results demonstrate that the behavioral contexts of three common forms of music are mutually intelligible cross-culturally and imply that musical diversity, shaped by cultural evolution, is nonetheless grounded in some universal perceptual phenomena.

Male androphilia, fraternal birth order, and female fecundity in Samoa: A 10-y retrospective.

Two separate but related literatures have examined familial correlates of male androphilia (i.e., sexual attraction and arousal to masculine adult males). The fraternal birth order effect (FBOE) is a widely established finding that each biological older brother a male has increased the probability of androphilia 20-35% above baseline rates. Other family demographic variables, such as reproduction by mothers, maternal aunts, and grandmothers, have been used to test evolutionary hypotheses that sexually antagonistic genes lead to androphilia among males, lowering or eliminating reproduction, which is offset by greater reproductive output among their female relatives. These proposed female fecundity effects (FFEs), and the FBOE, have historically been treated as separate yet complementary ways to understand the development and evolution of male androphilia. However, this approach ignores a vital confound within the data. The high overall reproductive output indicative of an FFE results in similar statistical patterns as the FBOE, wherein women with high reproductive output subsequently produce later-born androphilic sons. Thus, examination of the FBOE requires analytic approaches capable of controlling for the FFE, and vice-versa. Here, we present data simultaneously examining the FBOE and FFE for male androphilia in a large dataset collected in Samoa across 10 y of fieldwork, which only shows evidence of the FBOE.

Sex and age differences in "theory of mind" across 57 countries using the English version of the "Reading the Mind in the Eyes" Test.

The "Reading the Mind in the Eyes" Test (Eyes Test) is a widely used assessment of "theory of mind." The NIMH Research Domain Criteria recommends it as one of two tests for "understanding mental states." Previous studies have demonstrated an on-average female advantage on the Eyes Test. However, it is unknown whether this female advantage exists across the lifespan and across a large number of countries. Thus, we tested sex and age differences using the English version of the Eyes Test in adolescents and adults across 57 countries. We also tested for associations with sociodemographic and cognitive/personality factors. We leveraged one discovery dataset (N = 305,726) and three validation datasets (Ns = 642; 5,284; and 1,087). The results show that: i) there is a replicable on-average female advantage in performance on the Eyes Test; ii) performance increases through adolescence and shallowly declines across adulthood; iii) the on-average female advantage is evident across the lifespan; iv) there is a significant on-average female advantage in 36 out of 57 countries; v) there is a significant on-average female advantage on translated (non-English) versions of the Eyes Test in 12 out of 16 countries, as confirmed by a systematic review; vi) D-scores, or empathizing-systemizing, predict Eyes Test performance above and beyond sex differences; and vii) the female advantage is negatively linked to "prosperity" and "autonomy," and positively linked to "collectivism," as confirmed by exploratory country-level analyses. We conclude that the on-average female advantage on the Eyes Test is observed across ages and most countries.

Children across societies enforce conventional norms but in culturally variable ways.

Individuals in all societies conform to their cultural group's conventional norms, from how to dress on certain occasions to how to play certain games. It is an open question, however, whether individuals in all societies actively enforce the group's conventional norms when others break them. We investigated third-party enforcement of conventional norms in 5- to 8-y-old children (n = 376) from eight diverse small-scale and large-scale societies. Children learned the rules for playing a new sorting game and then, observed a peer who was apparently breaking them. Across societies, observer children intervened frequently to correct their misguided peer (i.e., more frequently than when the peer was following the rules). However, both the magnitude and the style of interventions varied across societies. Detailed analyses of children's interactions revealed societal differences in children's verbal protest styles as well as in their use of actions, gestures, and nonverbal expressions to intervene. Observers' interventions predicted whether their peer adopted the observer's sorting rule. Enforcement of conventional norms appears to be an early emerging human universal that comes to be expressed in culturally variable ways.

Coordination and expertise foster legal textualism.

A cross-cultural survey experiment revealed a dominant tendency to rely on a rule's letter over its spirit when deciding which behaviors violate the rule. This tendency varied markedly across (k = 15) countries, owing to variation in the impact of moral appraisals on judgments of rule violation. Compared with laypeople, legal experts were more inclined to disregard their moral evaluations of the acts altogether and consequently exhibited stronger textualist tendencies. Finally, we evaluated a plausible mechanism for the emergence of textualism: in a two-player coordination game, incentives to coordinate in the absence of communication reinforced participants' adherence to rules' literal meaning. Together, these studies (total n = 5,794) help clarify the origins and allure of textualism, especially in the law. Within heterogeneous communities in which members diverge in their moral appraisals involving a rule's purpose, the rule's literal meaning provides a clear focal point-an identifiable point of agreement enabling coordinated interpretation among citizens, lawmakers, and judges.

Experience and Reporting of Postnatal Depression Across Cultures: A Comparison Using Anchoring Vignettes of Mothers in the United Kingdom and India.

Postnatal mental health is often assessed using self-assessment questionnaires in epidemiologic research. Differences in response style, influenced by language, culture, and experience, may mean that the same response may not have the same meaning in different settings. These differences need to be identified and accounted for in cross-cultural comparisons. Here we describe the development and application of anchoring vignettes to investigate the cross-cultural functioning of the Edinburgh Postnatal Depression Scale (EPDS) in urban community samples in India (n = 549) and the United Kingdom (n = 828), alongside a UK calibration sample (n = 226). Participants completed the EPDS and anchoring vignettes when their children were 12-24 months old. In an unadjusted item-response theory model, UK mothers reported higher depressive symptoms than Indian mothers (d = 0.48, 95% confidence interval: 0.358, 0.599). Following adjustment for differences in response style, these positions were reversed (d = -0.25, 95% confidence interval: -0.391, -0.103). Response styles vary between India and the United Kingdom, indicating a need to take these differences into account when making cross-cultural comparisons. Anchoring vignettes offer a valid and feasible method for global data harmonization.

A practical guide to cross-cultural and multi-sited data collection in the biological and behavioural sciences.

Researchers in the biological and behavioural sciences are increasingly conducting collaborative, multi-sited projects to address how phenomena vary across ecologies. These types of projects, however, pose additional workflow challenges beyond those typically encountered in single-sited projects. Through specific attention to cross-cultural research projects, we highlight four key aspects of multi-sited projects that must be considered during the design phase to ensure success: (1) project and team management; (2) protocol and instrument development; (3) data management and documentation; and (4) equitable and collaborative practices. Our recommendations are supported by examples from our experiences collaborating on the Evolutionary Demography of Religion project, a mixed-methods project collecting data across five countries in collaboration with research partners in each host country. To existing discourse, we contribute new recommendations around team and project management, introduce practical recommendations for exploring the validity of instruments through qualitative techniques during piloting, highlight the importance of good documentation at all steps of the project, and demonstrate how data management workflows can be strengthened through open science practices. While this project was rooted in cross-cultural human behavioural ecology and evolutionary anthropology, lessons learned from this project are applicable to multi-sited research across the biological and behavioural sciences.

Children Sustain Cooperation in a Threshold Public-Goods Game Even When Seeing Others' Outcomes.

Many societal challenges are threshold dilemmas requiring people to cooperate to reach a threshold before group benefits can be reaped. Yet receiving feedback about others' outcomes relative to one's own (relative feedback) can undermine cooperation by focusing group members' attention on outperforming each other. We investigated the impact of relative feedback compared to individual feedback (only seeing one's own outcome) on cooperation in children from Germany and India (6- to 10-year-olds, N = 240). Using a threshold public-goods game with real water as a resource, we show that, although feedback had an effect, most groups sustained cooperation at high levels in both feedback conditions until the end of the game. Analyses of children's communication (14,374 codable utterances) revealed more references to social comparisons and more verbal efforts to coordinate in the relative-feedback condition. Thresholds can mitigate the most adverse effects of social comparisons by focusing attention on a common goal.

Effects of Voice Pitch on Social Perceptions Vary With Relational Mobility and Homicide Rate.

Fundamental frequency ( fo) is the most perceptually salient vocal acoustic parameter, yet little is known about how its perceptual influence varies across societies. We examined how fo affects key social perceptions and how socioecological variables modulate these effects in 2,647 adult listeners sampled from 44 locations across 22 nations. Low male fo increased men's perceptions of formidability and prestige, especially in societies with higher homicide rates and greater relational mobility in which male intrasexual competition may be more intense and rapid identification of high-status competitors may be exigent. High female fo increased women's perceptions of flirtatiousness where relational mobility was lower and threats to mating relationships may be greater. These results indicate that the influence of fo on social perceptions depends on socioecological variables, including those related to competition for status and mates.

Generating New Musical Preferences From Multilevel Mapping of Predictions to Reward.

Much of what we know and love about music hinges on our ability to make successful predictions, which appears to be an intrinsically rewarding process. Yet the exact process by which learned predictions become pleasurable is unclear. Here we created novel melodies in an alternative scale different from any established musical culture to show how musical preference is generated de novo. Across nine studies (n = 1,185), adult participants learned to like more frequently presented items that adhered to this rapidly learned structure, suggesting that exposure and prediction errors both affected self-report liking ratings. Learning trajectories varied by music-reward sensitivity but were similar for U.S. and Chinese participants. Furthermore, functional MRI activity in auditory areas reflected prediction errors, whereas functional connectivity between auditory and medial prefrontal regions reflected both exposure and prediction errors. Collectively, results support predictive coding as a cognitive mechanism by which new musical sounds become rewarding.

Sex significantly predicts medial temporal volume when controlling for the influence of ApoE4 biomarker and demographic variables: A cross-ethnic comparison.

OBJECTIVE: To explore the relationship between age, education, sex, and ApoE4 (+) status to brain volume among a cohort with amnestic mild cognitive impairment (aMCI). METHOD: One hundred and twenty-three participants were stratified into Hispanic (n = 75) and White non-Hispanic (WNH, N = 48). Multiple linear regression analyses were conducted with age, education, sex, and ApoE4 status as predictor variables and left and right combined MRI volumes of the hippocampus, parahippocampus, and entorhinal cortex as dependent variables. Variations in head sizes were corrected by normalization with a total intracranial volume measurement. RESULTS: Bonferroni-corrected results indicated that when controlling for ApoE4 status, education, and age, sex was a significant predictor of hippocampal volume among the Hispanic group (ß = .000464, R2 = .196, p < .01) and the WNH group (ß = .000455, R2 = .195, p < .05). Education (ß = .000028, R2 = .168, p < .01) and sex (ß = .000261, R2 = .168, p < .01) were significant predictors of parahippocampal volume among the Hispanic MCI group when controlling for the effects of ApoE4 status and age. One-way ANCOVAs comparing hippocampal and parahippocampal volume between males and females within groups revealed that females had significantly larger hippocampal volumes (p < .05). Hispanic females had significantly larger hippocampal (p < .001) and parahippocampal (p < .05) volume compared to males. No sex differences in parahippocampal volume were noted among WNHs. CONCLUSIONS: Biological sex, rather than ApoE4 status, was a greater predictor of hippocampal volume among Hispanic and WNH females. These findings add to the mixed literature on sex differences in dementia research and highlight continued emphasis on ethnic populations to elucidate on neurodegenerative disparities.

Brazilian Version of the Health Care Provider HIV/AIDS Stigma Scale: Cross-Cultural Adaptation and Psychometric Evaluation Among Healthcare Students.

We aimed to validate the Health Care Provider HIV/AIDS Stigma Scale (HPASS) among healthcare students in Brazil. The validation process occurred in three phases from August 2022 to July 2023: translation and cross-cultural adaptation; content validity assessment involving four experts; and evaluation of psychometric properties among 553 healthcare students from the Federal University of Espírito Santo. We used exploratory factor analysis and convergent validity for structural validation. The average scale content validity index was 0.90, while the evaluation of validity evidence based on the internal structure indicated a robust explanatory model. Parallel analysis indicated that the scale is composed by two dimensions: "Discrimination/Prejudice" and "Stereotype"; the composite reliability values for these dimensions were 0.96 and 0.85, respectively. The Brazilian version of HPASS has shown to be a simple, reliable, and psychometrically valid measure to quantify HIV stigma among healthcare students who speak Brazilian Portuguese.Resumen El objetivo de este estudio fue validar la "Health Care Provider HIV/AIDS Stigma Scale" (HPASS) entre estudiantes de salud en Brasil. El proceso de validación se llevó a cabo en tres etapas: traducción y adaptación transcultural; evaluación de la validez de contenido; y evaluación de las propiedades psicométricas con estudiantes de salud de la Universidad Federal de Espírito Santo. El índice de validez de contenido promedio de la escala fue de 0.90, mientras que la evaluación de la evidencia de validez basada en la estructura interna indicó un modelo explicativo sólido. El análisis paralelo indicó que la escala está compuesta por dos dimensiones: "Discriminación/Prejuicio" y "Estereotipo". La versión brasileña de HPASS ha demostrado ser una medida simple, confiable y psicométricamente válida para cuantificar el estigma del VIH entre estudiantes de salud que hablan portugués brasileño.

Urdu translation and cross-cultural validation of the stroke self-efficacy questionnaire.

BACKGROUND: The Stroke Self-Efficacy Questionnaire (SSEQ) measures the self-confidence of the individual in functional activities after a stroke. The SSEQ is a self-report scale with 13 items that assess self-efficacy after a stroke in several functional domains. OBJECTIVE: The purpose was to translate the Stroke Self-Efficacy Questionnaire into Urdu Language and to find out the validity and reliability of Urdu SSEQ among stroke patients. METHODS: The cross-cultural validation study design was used. Following COSMIN guidelines, forward and backward translation protocols were adopted. After pilot testing on 10 stroke patients, the final Urdu version was drafted. A sample of 110 stroke patients was used to evaluate the validity and reliability of the SSEQ-U. Content and Concurrent validity were determined. The intraclass correlation coefficient and Cronbach's alpha were used to measure internal consistency and test-retest reliability. Data analysis was performed using SPSS 25. RESULTS: The final version was drafted after application on 10 stroke patients. Content validity was analyzed by a content validity index ranging from 0.87 to 1. The internal consistency was calculated by Cronbach's alpha (α > 0.80). Test-retest reliability was determined by the Intra-class correlation coefficient (ICC2,1=0.956). Concurrent validity was determined by correlations with other scales by using the Spearman correlation coefficient; moderate to strong correlations (positive and negative) were found with the Functional Independence Measure (r = 0.76), Beck Depression Inventory (r=-0.54), Short Form of 12-item Scale (r = 0.68) and Fall Efficacy Scale (r = 0.82) with p < 0.05. CONCLUSION: The Urdu version was linguistically acceptable and accurate for stroke survivors for determining self-efficacy. It showed good content and concurrent validity, internal consistency and test-retest reliability.

A framework for understanding the human experience of nature through cognitive mapping.

Human behavior is a key driver of the biodiversity crisis, and addressing it requires changing individual choices and actions. Yet, the same processes that imperil biodiversity (e.g., urbanization) also alienate people from the experience of nature, eroding care for the natural world. Although averting this extinction of experience is increasingly recognized as a major contemporary conservation challenge, understanding of what constitutes nature experience remains elusive and few empirical studies have explored it directly. Most researchers have used nature interactions as a stand-in for experience, even though experience extends beyond interactions. We aimed to determine what constitutes the experience of nature and to propose a holistic, empirically derived framework that incorporates the multiple dimensions and components of the experience of nature. Using a mixed-method approach across 3 countries (the United States, Switzerland, and Israel), we conducted a multistage, conceptual content, cognitive mapping (3CM) exercise with 106 participants. This methodology included developing a prompt to capture participants' perceptions of nature experiences and subsequently refining and organizing their input into distinct components and underlying dimensions through an iterative engagement process. Beyond multisensory interactions with nature, experience of nature consisted of 2 dimensions: the circumstances in which interactions occur and the internal responses that encompass various cognitive, affective, and restorative benefits associated with nature interactions. These 3 dimensions had 33 components that occurred consistently across participants in the 3 countries. Frequently mentioned components included seeing animals, landscapes, or scenery; lack of human influence; weather conditions; relaxing, recharging; feeling good; and awe for nature. Fear and nature experienced at home were the least mentioned components. Together, our results showed that nature experience is a combination of nature interactions, circumstances, and internal responses. The emphasized components underscore the significance of offering access to extensive, less human-influenced natural spaces. This in turn can foster a profound nature experience, cultivating feelings of connectedness and care for nature.

Un marco de trabajo para entender la experiencia humana de la naturaleza a través del mapeo cognitivo Resumen El comportamiento humano es un factor clave en la crisis de la biodiversidad, por lo que abordarlo requiere cambios en las acciones y elecciones individuales. Aun así, los mismos procesos que ponen en peligro la biodiversidad (p. ej.: la urbanización) también alejan a las personas de experimentar la naturaleza, lo que disminuye el cuidado por la naturaleza. Aunque cada vez se reconoce más que evitar la extinción de las experiencias es un reto importante para la conservación, todavía no está claro qué constituye una experiencia de la naturaleza y pocos estudios empíricos lo han estudiado directamente. La mayoría de los investigadores ha usado las interacciones con la naturaleza como un sustituto para las experiencias, aunque éstas van más allá de las interacciones. Buscamos determinar qué constituye a las experiencias de la naturaleza y proponer un marco holístico y empírico que incorpore las múltiples dimensiones y componentes de la experiencia de la naturaleza. Usamos una estrategia de método mixto en tres países (EUA, Suiza e Israel) para realizar un ejercicio de un mapeo cognitivo de contenido conceptual en varias fases (3CM) con 106 participantes. Esta metodología incluyó el desarrollo de una entrada para capturar la percepción de los participantes con respecto a las experiencias de la naturaleza y con ello refinar y organizar sus contribuciones en diferentes componentes y dimensiones subyacentes por medio de un proceso iterativo de participación. Más allá de las interacciones multisensoriales con la naturaleza, las vivencias de la naturaleza consistieron en dos dimensiones: las circunstancias en las que ocurren las interacciones y las respuestas internas que engloban varios beneficios cognitivos, afectivos y restauradores asociados con las interacciones con la naturaleza. Estas dos dimensiones contaron con 33 componentes que aparecieron constantemente entre los participantes de los tres países. Con frecuencia mencionaron componentes que incluían avistamiento de animales o paisajes; la ausencia de influencia humana; las condiciones del clima; relajarse, recargarse; sentirse bien; y asombro por la naturaleza. El miedo y la naturaleza vivida en casa fueron los componentes menos mencionados. En conjunto, nuestros resultados mostraron que las vivencias de la naturaleza son una combinación de interacciones con la naturaleza, circunstancias y respuestas internas. Los componentes enfatizados resaltan la importancia de ofrecer acceso a los espacios naturales extensos con menos influencia humana. Esto a la vez puede promover una experiencia profunda de la naturaleza, lo que genera sentimientos de conexión y cuidado de la naturaleza.

Revisiting the use of the EORTC QLQ-STO22 to assess health-related quality of life of patients with gastric cancer: incorporating updated treatment options and cross-cultural perspectives.

BACKGROUND: The EORTC QLQ-STO22 (QLQ-STO22) is a firmly established and validated measure of health-related quality of life (HRQoL) for people with gastric cancer (GC), developed over two decades ago. Since then there have been dramatic changes in treatment options for GC. Also, East Asian patients were not involved in the development of QLQ-STO22, where GC is most prevalent and the QLQ-STO22 is widely used. A review with appropriate updating of the measure was planned. This study aims to capture HRQoL issues associated with new treatments and the perspectives of patients and health care professionals (HCPs) from different cultural backgrounds, including East Asia. METHODS: A systematic literature review and open-ended interviews were preformed to identify potential new HRQoL issues relating to GC. This was followed by structured interviews where HCPs and patients reviewed the QLQ-STO22 alongside new issues regarding relevance, importance, and acceptability. RESULTS: The review of 267 publications and interviews with 104 patients and 18 HCPs (48 and 9 from East Asia, respectively) generated a list of 58 new issues. Three of these relating to eating small amounts, flatulence, and neuropathy were recommended for inclusion in an updated version of the QLQ-STO22 and covered by five additional questions. CONCLUSIONS: This study supports the content validity of the QLQ-STO22, suggesting its continued relevance to patients with GC, including those from East Asia. The updated version with additional questions and linguistic changes will enhance its specificity, but further testing is required.

The impact of sufferers' wealth status on pain perceptions: Its development and relation to allocation of healthcare resources.

Wealth-based disparities in health care wherein the poor receive undertreatment in painful conditions are a prominent issue that requires immediate attention. Research with adults suggests that these disparities are partly rooted in stereotypes associating poor individuals with pain insensitivity. However, whether and how children consider a sufferer's wealth status in their pain perceptions remains unknown. The present work addressed this question by testing 4- to 9-year-olds from the US and China. In Study 1 (N = 108, 56 girls, 79% White), US participants saw rich and poor White children experiencing identical injuries and indicated who they thought felt more pain. Although 4- to 6-year-olds responded at chance, children aged seven and above attributed more pain to the poor than to the rich. Study 2 with a new sample of US children (N = 111, 56 girls, 69% White) extended this effect to judgments of White adults' pain. Pain judgments also informed children's prosocial behaviors, leading them to provide medical resources to the poor. Studies 3 (N = 118, 59 girls, 100% Asian) and 4 (N = 80, 40 girls, 100% Asian) found that, when evaluating White and Asian people's suffering, Chinese children began to attribute more pain to the poor than to the rich earlier than US children. Thus, unlike US adults, US children and Chinese children recognize the poor's pain from early on. These findings add to our knowledge of group-based beliefs about pain sensitivity and have broad implications on ways to promote equitable health care. RESEARCH HIGHLIGHTS: Four studies examined whether 4- to 9-year-old children's pain perceptions were influenced by sufferers' wealth status. US children attributed more pain to White individuals of low wealth status than those of high wealth status by age seven. Chinese children demonstrated an earlier tendency to attribute more pain to the poor (versus the rich) compared to US children. Children's wealth-based pain judgments underlied their tendency to provide healthcare resources to people of low wealth status.