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Patients' expectations of orthodontic treatment: part 1 - development of a questionnaire.

OBJECTIVE: The development of a questionnaire to measure patients' and their parents' expectations before orthodontic treatment, and to test the reliability and validity of this measure. DESIGN: A two-stage methodology, with open-ended interviews to identify themes and concepts followed by development and testing of the questionnaire. SETTING: GKT Orthodontic Department, King's College Dental Hospital. SUBJECTS: The sample consisted of 140 participants, 70 patients aged 12-14 years, who had been referred to the orthodontic department for treatment. One parent of each patient was also recruited. MATERIALS AND METHODS: The study was in two phases. In the first phase 30 participants (15 new patients and their 15 parents) participated in open-ended interviews, which were analysed qualitatively. Information from these interviews was used to construct a questionnaire. During the second phase, the questionnaire was piloted on 10 participants, five new consecutive patients and their parents. The questionnaire was then distributed to 174 subjects (87 new patients and their 87 parents). Seventy-eight subjects (39 new patients and their 39 parents) completed the questionnaire before their orthodontic consultation. Another 96 subjects (48 new patients and their 48 parents) were invited to complete the questionnaire prior to and at their orthodontic consultation. Test-retest analysis was conducted on 22 participants (11 patients and their 11 parents), who completed the questionnaire previous to and at their orthodontic consultation, and contributed to the psychometric validation of this questionnaire. MAIN OUTCOME MEASURES: A questionnaire was devized using the key themes and concepts identified in the open-ended interviews. As a result, 10 questions, some with sub-questions were constructed using a visual analogue scale as the response format. RESULTS: The questionnaire developed had good face validity. Internal consistency of the questionnaire using Cronbach's alpha, produced an overall inter-item reliability > 0.7 along with item-total correlations > 0.3 in over 50% of questions. Test-retest reliability was statistically significant using Spearman's correlation. CONCLUSION: This study provides a valid and reliable measure of orthodontic expectations in participants aged 12-14 years and their parents.

Adolescent↗

Satisfaction of patients hospitalised in psychiatric hospitals: a randomised comparison of two psychiatric-specific and one generic satisfaction questionnaires.

BACKGROUND: While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital. METHODS: We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed. RESULTS: 728 out of 1550 eligible patients (47%) participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08), average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005), the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P < 0.001) and the Perceptions of Care questionnaire showed the highest ceiling effect (Saphora-Psy: 17.1%, Perceptions of Care: 41.9%, Picker: 36.3%; P < 0.001). There were no differences in the patients' evaluation of the questionnaires. CONCLUSION: Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients. However, if comparison across medical services or hospitals is desired, using a generic questionnaire might be advantageous.

Adult↗

Predictors of non-response to a questionnaire survey of a volunteer twin panel: findings from the Australian 1989 twin cohort.

Questionnaire surveys, while more economical, typically achieve poorer response rates than interview surveys. We used data from a national volunteer cohort of young adult twins, who were scheduled for assessment by questionnaire in 1989 and by interview in 1996-2000, to identify predictors of questionnaire non-response. Out of a total of 8536 twins, 5058 completed the questionnaire survey (59% response rate), and 6255 completed a telephone interview survey conducted a decade later (73% response rate). Multinomial logit models were fitted to the interview data to identify socioeconomic, psychiatric and health behavior correlates of non-response in the earlier questionnaire survey. Male gender, education below University level, and being a dizygotic rather than monozygotic twin, all predicted reduced likelihood of participating in the questionnaire survey. Associations between questionnaire response status and psychiatric history and health behavior variables were modest, with history of alcohol dependence and childhood conduct disorder predicting decreased probability of returning a questionnaire, and history of smoking and heavy drinking more weakly associated with non-response. Body-mass index showed no association with questionnaire non-response. Despite a poor response rate to the self-report questionnaire survey, we found only limited sampling biases for most variables. While not appropriate for studies where socioeconomic variables are critical, it appears that survey by questionnaire, with questionnaire administration by telephone to non-responders, will represent a viable strategy for gene-mapping studies requiring that large numbers of relatives be screened.

Adult↗

[Adaptation of health-related quality of life ("SF-36") questionnaire, its validation and assessment of performance for control group and patients with rheumatoid arthritis].

OBJECTIVE: To adapt the Lithuanian "SF-36" questionnaire, to assess psychometric and life quality criteria for patients with rheumatoid arthritis and for control group. MATERIAL AND METHODS: Linguistic and cross-cultural adaptation of the Lithuanian "SF-36" questionnaire was made on the basis of the stages referred to in the international project of health quality assessment. For the evaluation of psychometric criteria, data from Vilnius rheumatoid arthritis register (502 patients) and those of the control group (83 people) were used. The reliability of "SF-36" questionnaire was assessed by determining homogeneity, internal consistency of scales and scale stability in time and by calculating the intraclass correlation coefficient. Face, contents and construct validity of the "SF-36" questionnaire has been evaluated, as well as the quality of life of patients with rheumatoid arthritis and those of the control group. RESULTS: After making linguistic and cultural adaptation of the questionnaire, its final version has been prepared. In assessing the homogeneity of "SF-36", a high and middle-sized correlation between different items of the questionnaire has been noticed in the control group (r=0.51-0.71) and in patients with rheumatoid arthritis (r=0.57-0.83). Internal consistency for the items was also good enough (Kronbach alpha=0.79-0.85) for both tested groups. Stability in time was high for all items of the questionnaire, for the exception of vitality (r=0.074). Face and contents validity of the questionnaire is rather good. Estimates of the correlation between items of the quality of life questionnaire and other questionnaires have shown good convergent and discriminant construct validity. Evaluations of the quality of life in almost all spheres, except emotional, by patients with rheumatoid arthritis were worse than by the rest. CONCLUSIONS: Questions of health-related quality of life questionnaire are easy to understand and acceptable for the respondents. Reliability and validity of the questionnaire is rather high. For the exception of emotional status, quality of life in almost all spheres was considered as bad by patients with rheumatoid arthritis. The control group had more complaints about the emotional status.

Arthritis, Rheumatoid↗

[Study of psychometric properties of two new questionnaires assessing beliefs in hypochondriasis in a non-clinical population].

Most instruments focussing on hypochondriasis symptoms do not have for goal to assess beliefs specifically. Instead, these instruments are used to measure specific behaviors. To assess underlying beliefs with these kinds of instruments, you have to extract false beliefs by deduction. In cognitive therapy, it is important to target erroneous beliefs in order to change them. On the other hand, existing instruments are not really suitable to target erroneous health beliefs. Even if some questionnaires are built to assess beliefs directly, it seems that they only measure the conviction of having an illness and do not assess the general health beliefs present in excessive health worriers. However, many researchers argue that this other kind of beliefs are the ones responsible in maintaining hypochondriasis symptoms. Presently, researchers assume that erroneous beliefs can maintain worries about illness among people with hypochondriasis symptoms like false beliefs about worry maintain worries in people with General Anxiety Disorder (GAD). Even if the importance of false beliefs in the maintenance of pathological worries is now recognized, most instruments on hypochondriasis symptoms do not have for goal to assess erroneous beliefs concerning worry about health. For instance, although the questionnaire Why do people worry? (WW) shows good psychometric properties and measures beliefs related to general worries, this questionnaire is not specific enough to correctly evaluate beliefs associated to health worry. A new questionnaire has to emerge in order to assess false beliefs associated to worry about health. This manuscript presents the development and the validation of a new questionnaire: the General Health Beliefs Questionnaire (GHBQ) that assesses general health beliefs, and also presents the development and the validation of a new questionnaire assessing beliefs associated to worry about health: the Why do people Worry about Health? (WW-H) . In this study, the GHBQ's and the WW-H's psychometric qualities and the factorial structure were assessed. More precisely, this study examined the factorial structure, the temporal stability, the convergent, divergent and criteria validities of the GHBQ and the WW-H. Four hundred and twenty nine French-speaking university students (non-clinical participants) completed a battery of questionnaires at the beginning of a class. The questionnaires were: The General Health Beliefs Questionnaire (GHBQ), the Why do people Worry about Health (WW-H), the Illness Worry Scale (IWS), the Beck Depression Inventory-short form (BDI-short form) and the Beck Anxiety Inventory (BAI). A second administration took place three weeks later with the same sample to test the temporal stability of the GHBQ and the WW-H. The principal component analysis with orthogonal rotation (varimax) supports a five components solution for the GHBQ: 1) magical thinking, 2) health, 3) consequences, 4) responsibility, and 5) vulnerability. The principal component analysis with oblique rotation (direct oblimin) (d=0) found a two components solution for the WW-H: 1) utility and 2) magical thinking associated to worries about health. The internal consistency of the GHBQ and the WW-H is excellent (a=.80 and a=.90, respectively). A correlation of 0.49 was found between the GHBQ and the WW-H. The correlation between the GHBQ and the IWS who evaluates the tendency to worry (r=.50) and between the WW-H and the IWS (r=.49) showed that the convergent validity of these questionnaires is adequate. On a three weeks interval, the GHBQ (r=.70) and the WW-H (r=.71) showed a satisfying temporal stability. The means of the high worriers (80 superior percentile at the IWS) (M=38.8, ET=8.93) and the means of the moderate worriers (between the 40 and the 60 percentile at the IWS) (M=32.8, ET=8.00) on the GHBQ have been compared. A significant difference has been found between the two groups [F(1,181)=23,129, p<0,001]. Also, the means of the high worriers (M=27.3, ET=8.59) and the means of the moderate worriers (M=23.8, ET=8.56) on the WW-H haveave been compared. An ANOVA has found a significant difference between these two groups [F(1,180)=7,396, p=0,007]. These results show that general health beliefs and false beliefs associated to worry about health are more often present in high worriers than in moderate worriers. The GHBQ and the WW-H allow psychologists, physicians and psychiatrists to do a quicker and more exhaustive evaluation of general health beliefs and false beliefs associated to worry about health, in less costs. These questionnaires will improve the chances of success of the hypochondriasis' treatment by helping clinicians to detect and correct false beliefs more easily.

Adolescent↗

Questionnaires to measure sexual quality of life.

CONTEXT: Sex is important to quality of life. There are a number of questionnaires to measure sexual-function, but many lack applicability and usefulness to certain groups. OBJECTIVE: To identify questionnaires measuring sexual function, determine the domains most commonly assessed, and examine evidence for their usefulness in different populations. DATA SOURCES: Computerized literature search using Medline, PubMed and PsychLit, reference lists, and unpublished reports, published in English between 1957 and 2001. MESH terms included sexual function, sexual dysfunction, sexual satisfaction, quality of life, and questionnaire. Articles were excluded if the questionnaire did not measure sexual function from the patient perspective. DATA EXTRACTION: Questionnaires were grouped as general questionnaires that include a sexual function domain, and sexual-function-specific questionnaires. Questionnaires were evaluated for domains, applicability to different populations, and evidence for reliability, validity and responsiveness. DATA SYNTHESIS: Literature search yielded 62 questionnaires, 57 which assessed sexual function from the patient perspective; 12 were general and 45 specific. Six domains were commonly represented, including interest and desire, satisfaction/quality of experience, excitement/arousal, performance, attitude/behavior, and relationship. Only 28% could be used in homosexual patients, and 52% were applicable to both genders; 57% were designed for use in chronic disease populations. Only nine questionnaires had evidence for both adequate reliability and validity. CONCLUSIONS: Current measures of sexual functioning often exclude important domains, lack applicability to gender and sexual preference groups, or lack adequate testing of validity and testing in important populations. Future questionnaires should take into account these concerns.

Humans↗

Development of a reliable and valid nutritional knowledge questionnaire for urban South African adolescents.

OBJECTIVES: We wanted to develop a valid and reliable nutritional knowledge test for urban South African adolescents who were participating in the Birth-to-Twenty cohort study. The questionnaire was intended for use every second year, from ages 13 to 14 y until age 20 y. METHODS: The initial steps involved the development of a conceptual framework and identification of nutritional concepts in collaboration with nutritional experts, and this defined the construct of the questionnaire. The South African national teaching curriculum objectives for nutritional education and other relevant issues were selected as the desired concepts, and most items were phrased in accordance with the recently developed South African Food-Based Dietary Guidelines. Thereafter, 140 items (questions) were developed and in turn assessed by an expert panel, and the result was that only 88 items remained. This was done to ensure content and face validity of the items. The 88 items were constructed into a questionnaire and piloted for appropriateness and understanding by adolescents, ages 13 to 14 y, as a means of assessing face validity by non-experts. The edited preliminary questionnaire (still with 88 items) was administered to a nutrition expert group (n = 71) versus a non-expert group (n = 82), referred to as sample 1, for the purposes of performing item analysis and assessing construct validity of the questionnaire. The result of the analysis, a 63-item questionnaire, was administered to adolescents at three school grade levels, 8 (n = 128), 10 (n = 143), and 12 (n = 98), referred to as sample 2, which was representative of the grades in which the Birth-to-Twenty group will be in when the questionnaire is administered. The questionnaire was administered to the sample to assess its content validity and internal consistency reliability. The final questionnaire had 60 items, and its construct, content, and internal consistency reliability were reassessed. RESULTS: The final 60-item questionnaire displayed a significant difference (P < 0.0001) in the mean scores of the expert and non-expert groups tested. It had internal consistencies (Cronbach's alpha) of 0.71, 0.79, and 0.82 for grades 8, 10, and 12 respectively, and an overall value of 0.77 for all groups combined. However, it was less than 0.7 for most grade 8 pupils and for all grades at a historically disadvantaged school. CONCLUSION: A nutritional knowledge questionnaire with construct, face, and content validities and internal consistency was developed for use in South African adolescents to evaluate their nutritional knowledge. Internal consistency was low in children at a disadvantaged school and those in grade 8 compared with multiracial groups at a multiracial school. It is recommended that pupils at disadvantaged schools be assisted by trained interviewers when taking the test.

Adolescent↗

Quality of life in Chinese patients with inflammatory bowel disease: validation of the Chinese translation of the Inflammatory Bowel Disease Questionnaire.

BACKGROUND: Health-related quality of life is an important outcome measure in inflammatory bowel disease. The Inflammatory Bowel Disease Questionnaire is a quality of life questionnaire that has not been validated previously in Chinese patients with inflammatory bowel disease. AIM: To develop and validate a Chinese translation of the Inflammatory Bowel Disease Questionnaire, specifically determining its construct validity, discriminant ability, reliability and sensitivity to change. METHODS: We developed a Chinese version of the Inflammatory Bowel Disease Questionnaire. Chinese patients with Crohn's disease and ulcerative colitis completed the Chinese Inflammatory Bowel Disease Questionnaire and visual analogue scales measuring systemic, social, bowel and emotional well-being. Patients also completed a validated Chinese SF-36 generic quality of life questionnaire, the Crohn's disease activity index or the clinical activity index for ulcerative colitis. RESULTS: One hundred and thirty-five patients (59 with Crohn's disease and 76 with ulcerative colitis) were enrolled, 99 of whom also completed the Chinese Inflammatory Bowel Disease Questionnaire for a second time. The Chinese Inflammatory Bowel Disease Questionnaire correlated well with the SF-36 for all four domains (Spearman: r = 0.55-0.80), the Crohn's disease activity index (r = -0.62-0.72) and the clinical activity index for ulcerative colitis (r = -0.44-0.68), as well as with the visual analogue scales. The Chinese Inflammatory Bowel Disease Questionnaire accurately distinguished between active and inactive disease. Test-re-test reliability showed excellent intra-class correlation (0.76-0.92; all P < 0.001). The Chinese Inflammatory Bowel Disease Questionnaire was also sensitive to changes in disease activity (P < 0.05). CONCLUSION: The Chinese Inflammatory Bowel Disease Questionnaire is a valid and reliable test that correlates well with the patients' subjective well-being and clinical disease activity.

Adolescent↗

Simultaneous validation of ten physical activity questionnaires in older men: a doubly labeled water study.

OBJECTIVE: The purpose of this study was to simultaneously validate 10 physical activity (PA) questionnaires in a homogenous population of healthy elderly men against the reference method: doubly labeled water (DLW). DESIGN: Cross-sectional study. SETTING: Community-based sample from Lyon, France. PARTICIPANTS: Nineteen healthy old men (age 73.4 +/- 4.1 years), recruited from various associations for elderly people in Lyon, agreed to participate in the study. MEASUREMENTS: The questionnaire-derived measures (scores) were compared with two validation measures: DLW and maximal oxygen uptake (VO2max). With the DLW method three parameters were calculated: (1) total energy expenditure (TEE), (2) physical activity level (PAL), i.e., the ratio of TEE to resting metabolic rate, (3) energy expenditure of PA. RESULTS: Relative validity. Correlation between the questionnaires and TEE ranged from 0.11 for the Yale Physical Activity Survey (YPAS) total index to 0.63 for the Stanford usual activity questionnaire. This questionnaire also gave the best correlation coefficients with PAL (0.75), and with VO2max (0.62). Significant results with TEE measured by the DLW method were also obtained for college alumni sports score, Seven Day Recall moderate activity, and Questionnaire d'Activité Physique Saint-Etienne sports activity (r = 0.54, r = 0.52, and r = 0.54, respectively). Absolute validity. No difference was found between PA measured by the Seven Day Recall or by the YPAS and DLW, on a group basis. The limits of agreement were wide for all the questionnaires. CONCLUSIONS: Only a few questionnaires demonstrated a reasonable degree of reliability and could be used to rank healthy older men according to PA. Correlation coefficients were best when the Stanford Usual Activity Questionnaire was compared with all the validation measures. The two questionnaires reporting recent PA, the Seven Day Recall, and YPAS accurately assessed energy expenditure for the group. The individual variability was high for all the questionnaires, suggesting that their use as a proxy measure of individual energy expenditure may be limited.

Activities of Daily Living↗

Repeatability of the ISAAC video questionnaire and its accuracy against a clinical diagnosis of asthma.

The objective of the study was to evaluate the performance of the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire in terms of repeatability and accuracy against a clinical diagnosis of asthma achieved according to the National Heart, Lung and Blood Institute (NHLBI) algorithm. Two hundred and forty-one subjects, aged 13-14 years from two secondary schools in Rome, Italy, were enrolled. Video and written ISAAC questionnaires were completed twice, 3 months apart, by 194 and 190 adolescents, respectively. Two months later, 106 subjects were visited by two physicians blinded to the results of questionnaires. Sixteen subjects were classified as having clinical asthma (CA) at the clinical visit, and eight of them as having clinical active asthma (CAA) on the basis of at least one positive outcome of the NHLBI algorithm. The repeatability of video questionnaire was similar to that of the written questionnaire for items on exercise wheeze and nocturnal cough and, to a lesser degree, for items concerning any wheeze in the past. The video questionnaire showed a worse performance than the written questionnaire for items on asthma attack: K-value (95% CL) = 0.59 (0.37-0.80) for video scene no. 5 and K-value (95% CL) = 0.86 (0.74-0.98) for written question no. 6. The overall accuracy of the video questionnaire, estimated as a positive answer to any video scene, was lower in terms of sensitivity than that of any written question when CA was used as a gold standard (0.50 vs. 0.81, P=0.025) and increased with respect to CAA (0.75 vs. 0.87, P = 0.317). The specificity of any video scene was better than that of any written question, independently from the gold standard used. In conclusion, the video questionnaire showed a fairly good accuracy, although slightly lower than that of the written questionnaire and provided sufficiently reliable results. However, samples of subjects from different geographic areas and cultures should be studied in order to conclusively define the performance of the ISAAC video questionnaire.

Adolescent↗

Handicap questionnaires: what do they assess?

BACKGROUND AND PURPOSE: There is an increasing need to get insight into the social and societal impact of chronic conditions on a person's life, i.e. person-perceived handicap. The purpose of this study is to report how current handicap questionnaires assess handicap. METHOD: A literature search using both Medline and the database of the Dutch Institute of Allied Health Professions (NPi) was conducted for handicap questionnaires. Questionnaires were included if addressing handicaps or life roles, environmental influences and social consequences of a disease. Excluded were questionnaires focusing on only impairments, disabilities or quality of life. RESULTS AND CONCLUSION: 20 questionnaires were identified. Handicap is not uniformly defined in these questionnaires. Based on different concepts, the various questionnaires encompass different domains and different aspects are emphasized in similar domains. Fourteen questionnaires assess society-perceived handicaps, and do not address the life roles, care needs or individual problem-experience. Six questionnaires are to some extent person-perceived, but a generic person-perceived handicap questionnaire could not be identified. It is concluded that development of a generic person-perceived handicap questionnaire is essential for adequate assessment of needs, outcome, and relevance of rehabilitation interventions from the individual's point of view.

Activities of Daily Living↗

Predictive validity of a postal questionnaire for screening community-dwelling elderly individuals at risk of functional decline.

Screening elderly individuals who are at risk of functional decline in the community is essential in order to implement effective programmes of assessment and surveillance in a context of secondary prevention. The postal questionnaire technique consists of sending a simple questionnaire to all elderly individuals living in a defined area in order to identify those who are at risk. The objective of this study was to develop a postal questionnaire and to test its capacity to predict functional decline in community-dwelling elderly people. A 21-item postal questionnaire was sent with a birthday card to a representative sample of community-dwelling individuals over the age of 75 years (n = 842). One month after sending the questionnaire, all subjects were contacted by a nurse for an in-home interview (n = 655) that included assessment of functional autonomy. One year later, the subjects (n = 607) were reassessed by the same nurse. Of the eligible subjects, 87.4% returned the postal questionnaire. During the year following the completion of the postal questionnaire, 43 subjects died, 13 were institutionalized and 109 had experienced a significant decrease on the autonomy scale, for a total annual occurrence of functional decline of 27.2%. Age and 14 of the 21 items of the questionnaire were associated with a significant relative risk of functional decline. The relative risk associated with not responding to the questionnaire was 2.1. A stepwise logistic regression analysis showed that six items were independent predictors of functional decline. This 6-item Sherbrooke Postal Questionnaire identifies as positive 56% of the population with 75% sensitivity and 52% specificity. We conclude that a postal questionnaire is a feasible and valid technique for screening elderly individuals at risk for functional decline.

Activities of Daily Living↗

Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption.

The reproducibility and validity of responses for 55 specific foods and beverages on a self-administered food frequency questionnaire were evaluated. One hundred and seventy three women from the Nurses' Health Study completed the questionnaire twice approximately 12 months apart and also recorded their food consumption for seven consecutive days, four times during the one-year interval. For the 55 foods, the mean of correlation coefficients between frequencies of intake for first versus second questionnaire was 0.57 (range = 0.24 for fruit punch to 0.93 for beer). The mean of correlation coefficients between the dietary records and first questionnaire was 0.44 (range = 0.09 for yellow squash to 0.83 for beer and tea) and between the dietary records and the second questionnaire was 0.52 (range = 0.08 for spinach to 0.90 for tea). Ratios of within- to between-person variance for the 55 foods were computed using the mean four one-week dietary records for each person as replicate measurements. For most foods this ratio was greater than 1.0 (geometric mean of ratios = 1.88), ranging from 0.25 (skimmed milk) to 14.76 (spinach). Correlation coefficients comparing questionnaire and dietary record for the 55 foods were corrected for the within-person variation (mean corrected value = 0.55 for dietary record versus first questionnaire and 0.66 versus the second). Mean daily amounts of each food calculated by the questionnaire and by the dietary record were also compared; the observed differences suggested that responses to the questionnaire tended to over-represent socially desirable foods. This analysis documents the validity and reproducibility of the questionnaire for measuring specific foods and beverages, as well as the large within-person variation for food intake measured by dietary records. Differences in the degree of validity for specific foods revealed in this type of analysis can be useful in improving questionnaire design and in interpreting findings from epidemiological studies that use the instrument.

Adult↗

Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma.

BACKGROUND: The Tasmanian Asthma survey (TAS) and the International Study of Asthma and Allergies in Childhood (ISAAC) have used questionnaires to measure the prevalence of asthma in adults and children. We have investigated the validity of these questionnaires by comparing response to questionnaire with a physician assessment of asthma status in the past 12 months. METHODS: Ninety-three adults were given the TAS questionnaire to complete and 361 children were given the ISAAC questionnaire. Ninety-one adults and 168 children completed bronchial challenge with hypertonic saline. A consultation with a respiratory physician blinded to the results of the questionnaire and bronchial challenge was given to all subjects. RESULTS: In both adults and children, questionnaires showed high agreement with respiratory physician diagnosis with respect to asthma symptoms in the past 12 months. For the TAS questionnaire the positive and negative predictive values (95% confidence limits) for physician diagnosis for adults were 0.89 (0.68-0.98) and 0.94 (0. 86-0.98) respectively. The instrument was also sensitive 0.80 (0. 58-0.93) and highly specific 0.97 (0.90-0.99). For the ISAAC questionnaire the positive and negative predictive vales for physician diagnosis of asthma in children were 0.61 (0.50-0.71) and 0.94 (0.88-0.98) respectively. Sensitivity and specificity were 0.85 (0.73-0.93) and 0.81 (0.76-0.86) respectively. Compared to the physician diagnosis, the sensitivity of bronchial hyperresponsiveness (BHR) for asthma was low for adults 0.39 (0.21-0. 61) and children 0.54 (0.48-0.67) as were the positive predictive values: 0.55 (0.31-0.79) for adults and 0.64 (0.449-0.77) for children. A definition of asthma requiring both a positive questionnaire response and BHR was highly specific but not sensitive for adults 0.37 (0.20-0.59) or children 0.47 (0.35-0.60). CONCLUSIONS: Both the TAS and ISAAC questionnaires are valid instruments for the determination of asthma symptoms in the past 12 months.

Adolescent↗

Measuring the functional status of patients with low back pain. Assessment of the quality of four disease-specific questionnaires.

STUDY DESIGN: This study was a literature review of the quality of four disease-specific functional status questionnaires for patients with low back pain: Oswestry; Million; Roland; and Waddell disability questionnaire. OBJECTIVES: The questionnaires were evaluated in terms of general description, scale structure, reliability, validity, responsiveness, and clinical research applications. SUMMARY OF BACKGROUND DATA: Functional status is an outcome of great interest for clinical trials of low back pain. METHODS: A computer-aided search was conducted of articles published between 1981 and 1993 and references given in selected relevant publications. Articles were selected if at least one of the four functional status questionnaires was used or if the authors gave relevant information about the methodology of these questionnaires. RESULTS: There was not enough information available about the criteria of item selection used for the development of the questionnaires. The test-retest reproducibility of the questionnaires seemed satisfactory. The Oswestry and Roland disability questionnaires have been used and evaluated more frequently than the Million and Waddell. Therefore, we can be more certain about the validity and responsiveness of the former pair of questionnaires. CONCLUSION: In the absence of a gold standard, direct comparisons of evaluative functional status questionnaires in a single patient group are needed. Through direct comparisons, comparative validity and responsiveness can be assessed. Functional status measures are not currently used in many settings in which they would be valuable. It is important to encourage their wider use in clinical trials. Additional research is needed to compare and improve the existing questionnaires.

Activities of Daily Living↗

Reliability of a short gun questionnaire.

BACKGROUND: The purpose of the study was to develop and test a short gun questionnaire and compare its reliability to a long gun questionnaire to identify youths who may have access to or ownership of a gun. METHODS: A seven-question short gun questionnaire asking about gun accessibility, ownership, and usage was modified from the much longer gun questionnaire. To determine reliability of the short tool, the results of the short gun questionnaire were compared with the long gun questionnaire. Both the long and the short gun questionnaires were administered to a convenience sample of 100 consenting young people aged 10 to 24 years old treated for any complaint. The study was approved by the institutional review board. RESULTS: Of the 100 youths, 66% of participants were black and 31% were Hispanic. The average age was 21 years and 39% were male. Two youths said that they had a gun, 38.0% said it would be easy to get a gun, and 25% said it would be impossible to obtain one. None of the youths had shared ownership of a gun and 4% said that there was a gun in their home, garage, or car. Eight percent of the youths had fired a gun in the past 6 months and 24% had fired a gun more than 6 months ago. The respondents' answers to all the questions in the short questionnaire were not statistically different from the responses in the long questionnaire at the P < 0.05 level. CONCLUSION: The developed short questionnaire provides results similar to the long questionnaire: a low number of gun owners but a high level of gun accessibility and availability.

Adolescent↗

Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure.

Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.

Dermatitis, Occupational↗

The Liverpool Oral Rehabilitation Questionnaire: a pilot study.

There are several validated health-related quality of life (HRQOL) questionnaires designed to record patient-derived outcomes in head and neck cancer. None deals specifically with oral rehabilitation. The aim of this study was to pilot a new questionnaire, the Liverpool Oral Rehabilitation Questionnaire (LORQ). The questionnaire consists of 25 items about oral function and denture satisfaction. A four-point Likert scale is used. Sixty-one consecutive patients attending oral rehabilitation clinics completed the LORQ in combination with the University of Washington Head and Neck questionnaire version 3 (UW-QOL) and European Organisation for Research and Treatment of Cancer H and N quality of life questionnaire (EORTC H and N 35). Forty-two patients received questionnaires at baseline, whereas the rest were provided with the questionnaires at various stages of oral rehabilitation. For each item on the questionnaire, a full range of possible responses were given by patients. Kappa coefficients of agreement for test-retest data indicated moderate to very good agreement between repeat questionnaires. There were significant correlations (P < 0.001) between items in the LORQ and those in the UW-QOL and EORTC HN questionnaires. The LORQ also identified differences in responses between non-cancer and cancer groups of patients undergoing oral rehabilitation. This study of the LORQ is encouraging, although data on its responsiveness over time and to intervention is awaited.

Atrophy↗