Introdução: O comprometimento cognitivo (CC) na Esclerose Múltipla (EM) possui taxas de prevalência de 43% a 70% e pode surgir desde a Síndrome Clinicamente Isolada (CIS) aos estágios iniciais da EM. O CC na EM pode evoluir independentemente dos sinais e sintomas motores, dos resultados do EDSS e ausência de lesões ativas (captantes) na Ressonância Magnética. Neste contexto, o Multiple Sclerosis National Questionaire (MSNQ) e o protocolo Brief International Cognitive Assesment for Multiple Sclerosis (BICAMS) são instrumentos internacionais empregados para a triagem e o monitoramento nos centros de atendimento para os pacientes com EM. Estudos posteriores e reuniões do mesmo comitê concluíram que o MSNQ possui várias limitações por ser uma medida não objetiva e a triagem única pelo Symbol Digit Modalities Test (SDMT) por si só não é capaz de acessar outras áreas que podem estar comprometidas na EM. Com a segunda revisão do MMSE, e na falta de instrumentos de triagem objetivos capazes de triar os pacientes que precisassem ser melhor acompanhados pelo BICAMS, buscou-se no presente estudo criar a partir do BICAMS e do MMSE-2 uma medida rápida para triagem, que tivesse medidas de memória episódica, velocidade de processamento, atenção e memória operacional. Objetivo: Para obter uma ferramenta de triagem para este propósito (MMSE-MS) foram conduzidos estudos de adaptação segundo o estímulo: estudo de protótipos, estudo de adaptação, propriedades psicométricas e normas do MMSE-2 (como a nossa ferramenta experimental) e estudo preliminar de desenvolvimento de uma ferramenta objetiva de triagem para EM, com base no MMSE-3. Métodos: Todos os estudos de tradução e adaptação foram conduzidos seguindo um mesmo método, já amplamente utilizado pela literatura. O primeiro estudo consistiu no estudo convencional e de protótipos para verificar qual possuía melhor estimativa de equivalência entre as culturas. O segundo estudo consistiu em adaptar, verificar as propriedades psicométricas e estabelecer normas para o MMSE-2. Similarmente ao estudo anterior, um juiz internacional discutiu os resultados do estudo de adaptação para estabelecimento dos parâmetros de transculturalidade. O último estudo foi realizado com o objetivo de obter uma ferramenta com estimativas de sensibilidade e especificidade similares ao BICAMS, mas que fosse designada à triagem dos pacientes que são elegíveis para ser acompanhados pelo BICAMS. Para tal participaram do primeiro estudo, 374 voluntários da comunidade e 25 pacientes com EM. No segundo e terceiro estudo, participaram 128 pacientes com EM e 602 voluntários saudáveis. Todos os estudos clínicos e com as amostras da comunidade foram realizados no período de 2013 à 2015 e contaram com a parceria em pesquisa do Instituto Brasileiro de Neuropsicologia (IBNeuro) e do Laboratório de Instrumentação e Avaliação Psicológica (LABIAP). A coleta de pacientes foi realizada no Ambulatório de Neuroimunologia do Hospital das clínicas da Faculdade de Medicina de Ribeirão Perto (FMRP-USP). Resultados: No primeiro estudo, foram mantidas 5 palavras das 15 da versão original. A razão para as modificações na lista Brasileira foram as diferenças entre a divisão silábica, extensão das palavras e presença de protótipos. Verificou-se ainda que até a quarta palavra evocada na nossa cultura em cada categoria semântica foram as mesmas que foram evocadas na língua nativa do instrumento, mas a ordem da frequência variou dentro de cada categoria, mostrando que embora existam palavras que são prototípicas às duas culturas na classificação semântica global, o contexto cultural interfere muito quando partimos para as especificidades dentro de cada classificação e categoria semântica. O MMSE-2 também apresentou estimativas de validade e precisão comum às duas culturas. No quarto estudo, as medidas do MMSE-2 que tiveram melhor relação com o BICAMS e índices de sensibilidade e especificidade parecidos foram as medidas da tarefa de evocação, atenção e cálculo, memória de histórias e codificação dígitos-símbolos. As correlações selecionadas foram aquelas classificadas em moderadas e fortes. Como segundo critério, as medidas do MMSE-2 foram comparadas às medidas do BICAMS pela curva ROC. As medidas do MMSE- 2 que tiveram especificidade e sensibilidade significativas (p<0,001) foram as elegíveis para compor o teste de triagem. Como a tarefa de codificação dígitos-símbolos é susceptível à demanda motora, optou-se pelo uso da forma oral do SDMT em conjunto. Deste modo, no nosso instrumento de triagem, normas para este instrumento foram criadas a partir da soma dos itens do MMSE-MS com o SDMT oral. Conclusão: A integração de dados desses diversos estudos evidencia cautela quanto aos procedimentos de adaptação empregados para adaptação transcultural das tarefas que são de origem verbal e semântica. Há também evidências da necessidade de instrumentos capazes de triar esses pacientes. Para tal, o MMSE-EM mostrou-se válido, preciso, com índices de sensibilidade e especificidade similares ao BICAMS, com normas ajustadas ao contexto Brasileiro. / Background: The cognitive impairment (CI) in Multiple Sclerosis (MS) has the prevalence rate from 43% to 70% and may occur from the Clinically Isolated Syndrome (CIS) to the early stages of MS. The CI in MS can advance independently of motor signs and symptoms, EDSS scores and MRI stable. In this context, the National Multiple Sclerosis Questionnaire (MSNQ) and the International Brief Cognitive Assesment for Multiple Sclerosis (BICAMS) are international tools used to screening and monitoring MS patients in care centers. Further studies and meetings provided by same committee alluded that MSNQ has several limitations for being a non-objective measure and the screening using the Symbol Digit Modalities Test (SDMT) alone is not effective because other areas that may be impaired in MS is not screened. With the second revision of the MMSE, and the lack of objective screening tools to quikly screening MS patients that needed to be monitored by BICAMS, we aimed in the presente study to create a fast measurement to screening the episodic memory, processing speed, attention and working memory from BICAMS and MMSE-2. Objective: To obtain brief a screening tool for MS (MMSE-MS) were conducted four studies using different tools: first the prototype study to development of CVLT-2 lists, adaptation, psychometric properties and normative data of BICAMS to the Braziliam context (as our gold standard), Cross cultural adaptation, psychometric properties, and normative data of MMSE-2 (the experimental tool) and the preliminary study of development of MMSE-MS. Methods: All translation and adaptation studies were conducted following the same method, as widely used in the literature. The first study consisted of conventional adaptation and prototypical norms, aiming to see which had the best estimates of equivalence between the cultures. The second study with BICAMS protocol show that MS scored significantly lower on all BICAMS tests. At the end of the study, the results were discussed with a member of the international committee to confirm the evidences of transculturality between the original and Brazilian versions. The third study consisted of Adapt, to investigate the psychometric properties and stablish normative data to the MMSE-2. Similarly to the previous study, an international judge discussed the results of the study of adaptation to identify the estimatives of transculturality. The fourth and last study was conducted in order to obtain a tool with sensitivity and similar specificity estimates BICAMS, but it was designed to screen patients who are eligible to be accompanied by BICAMS. Participated of the first study, 374 healthy volunteers and 25 patients with MS. In the second and third study participated 128 MS patients and 602 healthy volunteers. All clinical studies and community samples were carried out from 2013 to 2015 and had the partnership of the Brazilian Institute of Neuropsychology (IBNeuro) and the Laboratory of Instrumentation and Psychological Assessment (LABIAP). The collection of patients was performed at the Neuroimmunology Outpatient Clinic from Ribeirão Preto Medical School (FMRP-USP). Results: In the first study, were kept 5 words of 15 from the original American version. The reason for these changes in the Brazilian list were the differences between the syllabic division, extension of the words and the presence of prototypicall words. Was also found that until the fourth word evoked in our culture, in each semantic category were the same as those mentioned in the native language, but the order of the frequency varied within each category, indicating that although there are words that are prototypically commom between the two cultures in the overall semantic classification, the cultural context changes when we analyse the specifics prototipically words inside of each classification and semantic categories. To the second study, the BICAMS showed similar estimates of reliability and validity for current use as monitoring tool for MS in the Brazilian contexto, supporting the diagnostic validity of the Brazilian-Portuguese adaptation The normative data were satisfactory (p <0.001) in relation to the vocational status. The third study, with MMSE-2 also provided good estimates of validity and precision to the both cultures. To the fourth study, the MMSE-2 was compared to the BICAMS. The MMSE-2 tasks which had similar sensitivity and specificity to the BICAMS protocol was the recalling, attention and calculation, history memory and processing speed (Symbol Digit-coding). The selected tasks were those classified as moderate and Strong correlations. The second procedure consisted on comparisions among the MMSE-2 measurements and BICAMS using ROC curve. So, the MMSE-2 measures that had significant (p <0.001) specificity and sensitivity and similar area under the curve (ROC) were eligible to composse the screening tool. As the digit-symbol coding task is susceptible to motor demand, we decided to include the oral SDMT to the task. Thus, to get our screening tool, normative data for this instrument were created from the sum of the MMSE-MS items with oral SDMT. Conclusion: The overall of the data from these studies calls attention to the necessity of the caution to the adaptation procedures used in cross-cultural adaptation of the tasks that has verbal and semantic stimuli. There is also the need of tools abel to screening MS patients. For this, these preliminar data for MMSE-MS showed evidences of validation, similar sensitivity and and specificity, with normative data culturally adjusted to the Brazilian context.

旅居者在進入新文化社會時，往往面臨著跨文化適應的議題。而社群媒體的出現與滲透，也改變著旅居者流動於原文化與主文化之間的樣貌。本研究透過深度訪談探究背負著特殊脈絡的馬來西亞僑生，在進入台灣社會過程中所歷經的文化衝擊與跨文化適應歷程，並以新傳播科技臉書社群平台的角度切入，分析線上管道對馬來西亞僑生的疑慮消除及雙邊文化連結的影響，試圖描繪出臉書在旅台馬來西亞僑生跨文化適應經驗中所扮演的功能與角色。 研究發現，多數馬來西亞僑生在來台前透過人際與媒體管道的接觸而對台灣有著美好的印象，因此進入台灣社會即面臨著種種的文化衝擊，其中包含：生活、語言溝通、學業、人際關係、意識型態與價值觀等五個方面的適應問題。其跨文化適應歷程呈現壓力－調適－成長的螺旋上升模式。在旅居新文化社會台灣的初期，由於擁有較劇烈的衝擊，因此會在臉書採取主動、被動與互動的疑慮消除策略兼用的方式適應台灣，有助於初期龐大壓力的調解；而隨著時間的積累，雖然他們仍會面臨新議題事件的碰撞，但由於日常人際網絡日趨穩固以及跨文化經驗的提升，因此轉向被動策略的臉書使用。 整體來說，臉書為馬來西亞僑生在台灣的跨文化生活所提供的助益包括：資訊獲取與整合、情感支持、維繫關係與發展關係。在旅居初期如同橋樑一般，提供馬來西亞僑生在台灣社會中凝聚與跨越雙邊文化網絡的管道，讓流動於不同脈絡的他們，可以同時發揮不同連結人際網絡的潛力，將衝突化為成長的奠基，從而達到更好的跨文化適應階段，並在成長過後，更加自如地運用臉書作為生活的調味料，點綴其旅居生涯，成為更深層的跨文化能動者。 / Sojourners often come across the issue of cultural adaptation when they step into a new social environment. However, the presence of social media and its penetration change the way sojourners shift between host and ethnic culture. This study is about the cultural adaptation of Overseas Malaysian Chinese students in Taiwan’s social environment, through the social media platform, Facebook. This research analyzes in which way Facebook affects uncertainty reduction and bilateral culture context of the students, therefore demonstrating the functions and the role of Facebook in the cross-cultural adaptation of Overseas Malaysian Chinese students in Taiwan. The study is done through in-depth interviews with the students. This research shows that before most Overseas Malaysian Chinese students arrive, they have a remarkable impression of Taiwan. All these made up through social and media exposure of the country. It is also the reason they encounter culture shock upon their arrival, adaptation problems include living, communication, academic, social relationships, personal ideology and values. The stress – adaptation – growth model shows a rising spiral pattern during the period of adaptation. Due to severe culture shock during the early stage of the sojourners’ arrival, they tend to actively, passively and interactively utilize uncertainty reduction strategies to adapt Taiwan, it is effective to accommodate the high level of stress faced by them. In time, although they would still bump into new issues, they could passively make use of Facebook because they have stronger social networks and more cross-cultural experiences. To conclude, the benefits of Facebook toward Overseas Malaysian Chinese students in Taiwan include, gathering and compiling information, emotional support, sustaining and developing relationships. In the early stage, Facebook acts as a connecting bridge, providing a channel that bonds and breaches bilateral culture contexts, at the same time unleashing the potential their social relations among different ties. Eventually this will improve the cross-cultural adaptation process as conflicts are transformed into a foundation for growth. Subsequently after the growth, they are more casually utilizing Facebook being a condiment in their lives, to enhance the living in the country, as well as being an experienced cross-cultural agent.

Adopting the Ecological Contextual Model of Acculturation and Adjustment (Birman, 1994; Trickett, 1996) and the Stress and Coping paradigm (Lazarus & Folkman, 1984, 1986, 1991), the present thesis explored the psycho-social, work, and marital adjustment of 200 established older middle-aged refugees from the Former Yugoslavia living in the Ottawa area. More specifically, three studies were conducted to examine specific stressors and resources of relevance to the adjustment of Former Yugoslavian men and women, across the following three distinct life domains: psycho-social, work, and marital. Study I explored the potential buffering effects of interpersonal trust on the relational growth of Former Yugoslavian refugees. Results demonstrated that interpersonal trust moderated the negative effects of war-related trauma on the relational growth of Former Yugoslavian women. No such buffering effect was found for the men. Study II investigated Former Yugoslavians' work adjustment by exploring the influence of pre-migratory work-related expectations-outcome congruence, occupational mobility, work stress (general and discrimination), as well as personal (education, English language proficiency) and social resources (support at work) on their work satisfaction and distress. Results indicated that different factors emerged as significant predictors of work satisfaction and work distress for Former Yugoslavian men and women. Study III explored the potential moderating role of marital resilience on the relationship between marital stress (general and acculturative) and marital adjustment. Results showed that marital resilience moderated the negative effects of marital stress on the marital adjustment of Former Yugoslavian women. No protective effect of marital resilience was found for the men. Taken together, the results of the three studies provide support for the relevance and importance of studying the stress, resources, and adjustment of refugees across contexts and gender. Given that important gender differences were found in different adaptational domains, the need to study further the impact of gender in refugees is reinforced. The findings are discussed within the current gender and migration literatures as well as the multidimensional theories of cross-cultural adjustment. Theoretical, research, and clinical implications were presented, along with recommendations for future research.

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