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[Is the Berlin questionnaire an appropriate diagnostic tool for sleep medicine in pneumological rehabilitation?].

BACKGROUND: The Berlin Questionnaire is an explorative tool of 13 questions designed to identify patients with obstructive sleep apnea. The questions are targeted toward key symptoms of snoring, apneas, daytime sleepiness, hypertension and overweight. METHODS: 153 patients undergoing pulmonary rehabilitation were screened for obstructive sleep apnea via i) ApneaLink (ResMed, Munich) and ii) the Berlin Questionnaire. The Epworth Sleepiness Scale (ESS) was administered to grade daytime sleepiness. Results of ApneaLink screening and questionnaires were prospectively compared. The Respiratory Disturbance Index (RDI) was used to compute predictive performance of the Berlin Questionnaire for obstructive sleep apnea. Results were also compared to previously published data from a primary care patient cohort. RESULTS: At a cut-off RDI=10/h, the Berlin Questionnaire had a sensitivity of 62.5 %, a specificity of 53.8 %, a positive predictive value of 38.4 %, a negative predictive value of 74.2 %, a positive likelihood ratio of 1.35 and a negative likelihood ratio of 0.69. At a cut-off RDI=15/h, the Berlin Questionnaire had a sensitivity of 67.2 %, a specificity of 52.8 %, a positive predictive value of 25.1 %, a negative predictive value of 84.7 %, a positive likelihood ratio of 1.42 and a negative likelihood ratio of 0.62. There was evidence that the participants of this study suffered from an increased daytime sleepiness (ESS=8.8 +/- 4.8). The study group was more likely to snore, have apneas (men 6.7 % more often, women 12.6 % more often) and suffer from daytime sleepiness (men 19.0 % more often, women 14.6 % more often) than the control group. Also, hypertension and overweight were more prevalent (men 6.1 % more often, women 11.1 % more often). CONCLUSIONS: The Berlin Questionnaire is a poor predictor of obstructive sleep apnea in a random group of patients undergoing pulmonary rehabilitation.

Adult↗

Self-assessment of the quality of vision: association of questionnaire score with objective clinical tests.

PURPOSE: To investigate the association of a quality of life-visual function questionnaire with an objective clinical test of visual function. METHODS: We have developed a questionnaire to assess self-reported visual satisfaction in ophthalmic patients suffering from chronic eye conditions causing visual impairment. The questionnaire was administered to 120 patients suffering from age-related cataract, chronic open angle glaucoma, age-related macular degeneration, branch retinal vein occlusion, and presbyopia or minor refractive defects. All the participants also underwent determination of visual acuity, contrast sensitivity, glare, and visual field. RESULTS: The questionnaire has a good reproducibility, a high internal consistency, and is able to discriminate between the different groups of patients. The total questionnaire score is significantly associated with the results of all visual function tests with the exception of glare. When entered into a multiple linear regression model, near visual acuity and contrast sensitivity are still considerably associated with the total questionnaire score. The psychological attitude of the patient towards his/her health problem is also associated with the total average score. CONCLUSIONS: Overall, the model explains 49% of the variance in the average questionnaire score.

Adult↗

A comparison of five questionnaires to assess alcohol consumption in a Mediterranean population.

OBJECTIVE: To evaluate the reliability of alcohol consumption measured by five different dietary methods in the Catalan Nutrition Survey (1992-1993). DESIGN: The different questionnaires used were: (1) two 7-day food records, (2) five items addressing alcoholic beverages in a 76-item food-frequency questionnaire, (3) a 1-week recall of 13 alcoholic beverages, (4) a 13-item alcoholic beverages frequency questionnaire and (5) two 24-hour recalls. SUBJECTS: Ninety-three of the 120 adults (aged 20 to 70 years) initially recruited completed the questionnaires and provided a peripheral blood sample. RESULTS: Mean daily alcohol intakes as assessed by the questionnaires were very similar. Beer was the alcoholic beverage most frequently consumed, followed by wine and liquor. Eighty-two per cent of the study population consumed less than 20 g of alcohol per day. No biochemical parameters were significantly correlated with alcohol intake estimated from the questionnaires. CONCLUSIONS: We found a satisfactory level of reproducibility and validity in the pattern of alcohol consumption across different levels and types of alcoholic beverage intake. We also found that the self-administered 13-item questionnaire and the 1-week recall were the best techniques to measure moderate or low alcohol consumption, suggesting that the two methods are the most suitable to assess overall alcohol intake in the general population.

Adult↗

Validation of the Spanish version of the physical activity questionnaire used in the Nurses' Health Study and the Health Professionals' Follow-up Study.

OBJECTIVE: The objective of this analysis was to test the validity of the estimates of energy expenditure and sedentary lifestyle obtained through a self-administered questionnaire of physical activity for Spanish-speaking people adapted from US questionnaires (Nurses' Health Study and Health Professionals' Follow-up Study) using a triaxial accelerometer (RT3 Triaxial Research Tracker) as the reference. DESIGN AND SETTING: Validation study, calculating the non-parametric correlation coefficients between the level of physical activity and sedentary lifestyle collected by the self-administered questionnaire and the triaxial accelerometer measurements. Percentage of misclassification and kappa coefficients were also calculated. SUBJECTS: The study population consisted of a sample of 40 obese women who were participants of the SUN (Seguimiento Universidad de Navarra) project (a prospective cohort study among Spanish university alumni). They were selected because of their peculiar metabolic characteristics, in the search for a sub-optimal scenario for validity. RESULTS: Physical activity during leisure time (estimated as MET-h week(-1)) derived from the self-administered questionnaire moderately correlated with kcal day(-1) assessed through the accelerometer (Spearman's rho = 0.507, 95% confidence interval (CI) 0.232, 0.707). The Spearman correlation between the ratio of sedentary lifestyle to physical activity obtained through the questionnaire and the direct estimation (RT3) was -0.578 (95% CI -0.754, -0.325). The kappa index was 0.25 (P = 0.002) when assessing the cross-classification into quintiles and 0.41 for the dichotomous estimation of a sedentary lifestyle. Only 2.5% of participants were misclassified by the questionnaire more than two quintiles apart from the estimates of the RT3. CONCLUSIONS: The moderate values obtained for correlation in a sub-optimal scenario for validity and the low percentage of extreme misclassification suggest the validity of the questionnaire to assess physical activity in Spanish-speaking women aged 20-50 years.

Adult↗

Is the questionnaire for the assessment of gastroesophageal reflux useful for diabetic patients?

OBJECTIVE: It has been suggested that the questionnaire reported by Carlsson et al. has high sensitivity in diagnosing gastroesophageal reflux disease (GERD) and is considered to be one of the most useful diagnostic tools for GERD. The aim of the present study was to evaluate the ability of the questionnaire to identify gastroesophageal reflux (GER) diagnosed by 24-h pH monitoring in diabetic patients. MATERIAL AND METHODS: Fifty-three patients with type 2 diabetes were enrolled in the present study. GER was monitored by means of an antimony electrode. Patients completed the questionnaires immediately before undergoing pH monitoring. RESULTS: Diabetic patients were found to have few symptoms, and the average score on the questionnaire was extremely low. No significant difference in scores on the questionnaire was observed between patients with and those without GER. CONCLUSIONS: The questionnaire was shown not to be useful for diagnosing GER as a complication in diabetic patients. We, therefore, should not diagnose GER as a complication in diabetes mellitus on the basis of the questionnaire.

Adult↗

A longitudinal study of the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire in patients treated for laryngeal cancer.

A prospective longitudinal study was performed to investigate the sensitivity to change over time of the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire (S-SECEL), addressing communication dysfunction in patients with laryngeal cancer. Twenty-six consecutive patients attending a weekly tumour conference over a period of one year at Sahlgrenska University Hospital were included in the study prior to start of treatment. The patients answered four questionnaire repeatedly in the course of one year: the S-SECEL, the European Organization for Research and Treatment of Cancer (EORTC), the Core Quality of Life Core Questionnaire (QLQ-C30) supplemented by the Head and Neck cancer questionnaire module (QLQ-H&N35), and the Hospital Anxiety and Depression (HAD) scale. In addition, performance status was assessed. The S-SECEL questionnaire was well accepted by the patients, and compliance was satisfactory with a cumulative response rate of 88% at one year, supporting its feasibility in clinical settings. Repeated measures with the S-SECEL over one year demonstrated a significant decrease in voice and speech dysfunction. The correlation pattern over time between the S-SECEL and the EORTC and HAD questionnaires lent support to the construct validity of the S-SECEL and indicated that the questionnaire was sensitive to clinical change. The changes in S-SECEL correlated most strongly with changes in the EORTC QLQ-H&N35 speech scale, moderately with changes in the QLQ-C30 role and emotional functioning and global QoL scales, while the weakest correlations were with changes in physical functioning. The S-SECEL was sensitive to changes in communication dysfunction, with convergent and discriminant validity of longitudinal assessments, and with relevance for the quality of life of patients with laryngeal cancer receiving different treatment modalities.

Adult↗

Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate.

The purpose of this study was to evaluate the reliability of a multidimensional questionnaire for Swedish adults with treated complete unilateral or bilateral cleft lip and palate (CLP). The questionnaire was designed to be used in the evaluation of adults with treated CLP after treatment. Before any conclusions were drawn from the results of the study we assessed the test-retest reliability of the questionnaire. The questionnaire included 168 questions and assessed the following domains: aesthetics, functions associated with CLP, satisfaction with treatment and perceived need for treatment, quality of life, depression and non-specific physical symptoms, body image, and jaw function. The subjects answered the questionnaire twice at a 2-3-week interval. Sixty-one adults (38 men, 23 women) mean age 24 years (range 20-29) participated in the study. The response rate for the questionnaire was acceptable at 75%. The test-retest reliability varied among the different domains. The reliability of questions regarding aesthetics, functions associated with CLP, and treatment satisfaction was good to excellent (intraclass correlation coefficient (ICC) = 0.51 to 0.89). Good to excellent (ICC = 0.61 to 1.0) reliability was also found for the quality of life in various life domains and the wellbeing scales. The reliability of the body image scale was moderate (kappa = 0.43-0.60) for most items and lower than that of other scales used in this study. The reliability of the mean depression symptom score (ICC = 0.93) and the mean non-specific physical symptoms score (ICC = 0.85) were excellent. The reliability of the mandibular function impairment was good (ICC = 0.67). The conclusion of the study is that an overall reliability was good for the multidimensional questionnaire.

Adult↗

Story-based scales: development and validation of questionnaires to measure subjective health status and cultural adherence in British Bangladeshis with diabetes.

Questionnaires that measure subjective health status are increasingly used in clinical trials. But scales based on the quantification of subjective traits ("rate your feelings on a scale of 1 to 5") and initially developed in western population samples may not be valid for use in minority ethnic groups, even if accurately translated. The measurement of cultural adaptation and assimilation in immigrant groups is important for health research but has well documented methodological challenges. The aim of this study was to develop valid and reliable questionnaires to measure subjective health status and cultural adherence in a minority ethnic group, using the story as the unit of inquiry. The design was a multi-phase study involving (a) narrative interview, (b) vignette construction, (c) questionnaire development, and (d) questionnaire validation in relation to two scales (well-being and cultural adherence) in British Bangladeshis with diabetes. Using data from in-depth narrative interviews (i.e., a non-directive research technique in which the participant is invited to "tell me the story about your diabetes, starting with when you first noticed anything wrong", and the only prompts used are "tell me more about that" or "what happened next?"; Greenhalgh, Helman, & Chowdhury, 1998; Muller, 1999), we constructed culturally congruent vignettes to depict different subjective health states and behaviours. We refined these items in focus group interviews and validated the instruments on 98 Bangladeshi participants, randomly sampled from GP diabetes registers in inner London and interviewed by a Bangladeshi anthropologist. We used factor analysis to explore the underlying structure in the responses to questionnaire items, plus Cronbach alpha tests to measure internal consistency of scales. The questionnaires were acceptable and credible to Bangladeshi participants with diabetes. Ninety of 98 participants were able and willing to complete them with interviewer assistance. Following factor analysis, we produced two definitive instruments. The well-being scale was a single-factor model with four story-based items (measuring depression, anxiety, physical energy, and social activities), with a Cronbach's alpha of .92. The cultural adherence scale was a single-factor model with five items (measuring religious restrictions, ethnic practices, and social ties), with a Cronbach's alpha of .83. In conclusion, this study has produced two important outputs: (a) easy-to-administer, story-based questionnaires that measure well-being and cultural adherence, which are specific to British Bangladeshis with diabetes; (b) a general method for developing story-based instruments to quantify the subjective experience of illness and adherence to cultural norms, which potentially has applications beyond the study population.

Acculturation↗

Measurement of passive smoking in adults: self-reported questionnaire or serum cotinine?

BACKGROUND: Low to moderate agreement between self-reported exposure to environmental tobacco smoke (ETS) and serum cotinine levels in non-smokers questions the accuracy of the measurement of ETS exposure. We examined the relationship of serum cotinine to different self-reported ETS questionnaires in a large community-based study. METHODS: Subjects were derived from four Scottish MONICA surveys. Agreement between self-reported ETS (yes/no) and serum cotinine levels (> 0, 0) in non-smokers was tested by K, and the difference in cotinine levels among self-reported ETS exposure by ANOVA and the relationship by linear regression. RESULTS: None of the values for K was > 0.24 for any ETS questionnaire. In non-smokers with serum cotinine > 0, cotinine levels increased with increasing ETS exposures. In the first and second surveys with the questionnaire of ETS exposure in the last 3 days, standardised coefficients were 0.28-0.39, while in the third and fourth surveys with the questionnaire of a total exposure to ETS at work, at home and in other places the standardised coefficients were 0.19-0.36, with the questionnaire of ETS daily exposure hours, 0.23-0.36. The relationship between self-reported ETS and cotinine levels varied with the questionnaires, and with the time of day of the blood sample collection. In current smokers, cotinine levels were significantly related to both the number of cigarettes smoked daily (the coefficients were 0.13-0.41) and time elapsed since the last cigarette (-0.24 to -0.40). CONCLUSION: The findings raise the question of whether it is ideal to take only serum cotinine as an index of ETS exposure in adults, because of time delays between ETS exposure and blood collection, and suggest the combined use of appropriately worded self-reported questionnaires and cotinine levels to estimate ETS exposure.

Adult↗

Measurement properties and interpretability of the Chronic respiratory disease questionnaire (CRQ).

The chronic respiratory questionnaire, available as an interviewer and a self-administered instrument, includes 20 items across four domains: dyspnea (5 items), fatigue (4 items), emotional function (7 items), and mastery (4 items). When completing this instrument, patients rate their experience on a 7-point scale ranging from 1 (maximum impairment) to 7 (no impairment). The Chronic Respiratory Questionnaire has demonstrated excellent measurement properties for both discriminative and evaluative purposes and served as a model in numerous methodological studies in chronic airflow limitation and patients with chronic obstructive pulmonary disease. We performed a systematic review of the literature on the chronic respiratory questionnaire to summarize the key qualities of the chronic respiratory questionnaire and to appraise the work regarding the minimal important difference of the chronic respiratory questionnaire. This paper includes a revision of our initial definition of the minimal important difference and a methodological framework for using anchor based approaches to establish the minimal important difference pioneered by Jaeschke and colleagues. Other approaches to evaluate the minimal important difference include distribution-based methods and panel-based methods. Investigators have used all of these approaches to establish the minimal important difference for the chronic respiratory questionnaire and the results are in general agreement with the minimal important difference of 0.5 for the mean domain scores of the chronic respiratory questionnaire. As a result of this literature review and discussion at the workshop, we established several research objectives. These objectives include the exploration of presentation of quality of life information and prospective anchor-based approaches.

Chronic Disease↗

Comparison of short questionnaires on alcohol drinking behavior in a nonclinical population of 36-year-old men and women.

Little is known on the diagnostic characteristics of brief questionnaires on alcohol drinking behaviors. This report investigates the determinants of three short alcohol questionnaires and investigates their diagnostic utility as screening tools for alcohol-related problems in a general population from The Netherlands. This report uses cross-sectional data obtained in the year 2000 from 36-year-old healthy male (N=166) and female (N=165) volunteers who reported to drink alcohol at least occasionally. Since they were 13-years-old these volunteers have been members of the Amsterdam Growth And Health Longitudinal Study, which started as a school-based study in 1977. Among many other variables, quantity-frequency questions (QF), the CAGE questionnaire, and a question on the highest number of alcoholic units consumed on one occasion during the previous month (MAX) were asked. The sensitivity, specificity, Cohen's kappa, and diagnostic odds ratio of QF, CAGE, MAX, and combinations of these three brief questionnaires were calculated using a 7-item questionnaire on alcohol-related problems as reference. Both in women and men, the prevalence of most alcohol-related problems and of a high QF, CAGE, and MAX was low. QF, CAGE, and MAX, as well as all possible combinations of the three questionnaires, were poor in detecting last-year alcohol-related problems. The CAGE appeared to perform worse than the even shorter and easier-to-interpret QF and MAX. In this healthy population of 36-year-old men and women, using the QF, MAX, and especially the CAGE questionnaire as screening instruments for alcohol-related problems resulted in many false positive and false negative classifications.

Adult↗

Electronic versus paper questionnaires: a further comparison in persons with asthma.

The use of electronic data capture (EDC) to assess health-related quality of life (HRQOL) using validated questionnaires is increasing; however, it must be determined how data collected electronically correlate with the original mode of administration used in validation. Our objective was to compare paper and electronic administration of the standardized Asthma Quality of Life Questionnaire (AQLQ(S)), Pediatric Asthma Quality of Life Questionnaire (PAQLQ(S)), and Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ). Using a crossover design, adults and children with asthma and caregivers of children with asthma were recruited from clinics. Subjects were asked to complete both forms of the appropriate HRQOL measures at enrollment and 24-48 hours later. In addition, 30 subjects from each group were asked to participate in a 1-week reproducibility assessment of the electronic versions of the three questionnaires. Psychometric properties were assessed for each of the EDC versions. Intraclass correlation coefficients (ICC) and Pearson correlations were calculated to compare EDC and paper versions. A total of 51 adults (mean age 37, 73% females), 52 children (mean age 13, 38% females), and 51 caregivers (mean age 43, 92% females) were evaluated. Internal consistency (Cronbach's alpha) for the overall score of each questionnaire was: 0.96 for the AQLQ(S) and the PAQLQ(S), and 0.92 for the PACQLQ. Overall ICCs comparing paper with EDC were: 0.96 for the AQLQ(S), 0.91 for the PAQLQ(S), and 0.82 for the PACQLQ. Pearson's correlations were identical. One-week reproducibility (ICC) of the EDC versions was: 0.88 for the AQLQ(S), 0.78 for the PAQLQ(S), and 0.85 for the PACQLQ. When asked which method subjects preferred, the electronic version was chosen by 69% of adults, 77% of children, and 73% of caregivers. Additionally, 14% of adults, 14% of children, and 18% of caregivers reported no difference in preference. As in previous studies comparing electronic with paper questionnaires, this study revealed statistical evidence to support the use of EDC of the AQLQ(S), PAQLQ(S), and PACQLQ for populations with asthma.

Adolescent↗

The combination of cognitive testing and an informant questionnaire in screening for dementia.

AIM: A cognitive test and an informant report questionnaire were used together to investigate whether their combined use could improve the accuracy of detecting dementia in a memory clinic, compared with either test used alone. METHOD: The subjects were 323 patients assessed at a memory clinic. The Mini-Mental State Examination and the short form of the Informant Questionnaire on Cognitive Decline in the Elderly were used. A method of combining the test scores developed by Mackinnon and Mulligan [Am J Psychiatry 1998; 155: 1529-35] was used. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised criteria. RESULTS: Logistic regression analysis showed that the combination of the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly produced a slightly more accurate prediction of dementia caseness than either test used alone. Using receiver operating characteristic analysis the performance of the combination of the tests according to a weighted sum rule was compared with the performance of either test used alone. This way of combining the tests resulted in a more accurate screening for dementia than when the Informant Questionnaire on Cognitive Decline in the Elderly was used alone. The area under the receiver operating characteristic curve for the Mini-Mental State Examination combined with the Informant Questionnaire on Cognitive Decline in the Elderly was 0.89 compared with 0.82 for the Informant Questionnaire on Cognitive Decline in the Elderly alone (chi-square = 10.63; P = 0.0011). However, there was no improvement in screening performance when the combination of Mini-Mental State Examination and Informant Questionnaire on Cognitive Decline in the Elderly was compared with the Mini-Mental State Examination used alone (area under the receiver operating characteristic curve = 0.89 versus 0.86; chi-square = 3.54; P = 0.060). CONCLUSION: The combination of cognitive testing and an informant report according to a weighted sum rule in this population did not result in any advantage over the use of the Mini-Mental State Examination alone. The mixed results of this study contrast with those of Mackinnon and Mulligan.

Aged↗

Lack of efficacy of a food-frequency questionnaire in assessing dietary macronutrient intakes in subjects consuming diets of known composition.

BACKGROUND: We compared the validity of a semiquantitative food-frequency questionnaire in assessing intakes of macronutrients (absolute amounts and percentages of energy) by 19 subjects fed natural-food diets of known composition. In small subsets (n = 5 or 6), we also tested 3-d diet records. OBJECTIVE: The objective of this study was to investigate the efficacy of food-frequency questionnaires and diet records in subjects fed natural-food diets of known composition. DESIGN: Each subject consumed 3 different diets for >/=6 wk and self-reported his or her food intake by using a food-frequency questionnaire and a diet record. The diets varied in their chemically analyzed contents of fat (15-35% energy), saturated fat (5-14%), monounsaturated fat (5-14.5%), polyunsaturated fat (2.5-10.5%), carbohydrate (49-68%), and cholesterol (108-348 mg/d). RESULTS: The food-frequency questionnaire significantly underestimated fat, saturated fat, monounsaturated fat, and protein intakes and significantly overestimated carbohydrate intake with the high-fat diet. The percentage of energy from fat was significantly underestimated for the high-fat diet and significantly overestimated for the very-low-fat diet. Estimates from the food-frequency questionnaire differed significantly from actual intakes for fat (absolute and percentage), saturated fat (absolute and percentage), monounsaturated fat (absolute and percentage), and protein (percentage) in the high-fat diet and for polyunsaturated fat (absolute and percentage), saturated fat (percentage), fiber (absolute), and cholesterol (daily absolute; in mg/d) in the lower-fat diet. Estimates from the diet records better agreed with actual intakes than did estimates from the food-frequency questionnaire except for monounsaturated fat (absolute and percentage) in the high-fat diet and polyunsaturated fat (percentage) in the lower-fat diet and the very-low-fat diet. CONCLUSION: Our data indicated that the food-frequency questionnaire did not provide reliable estimates of absolute amounts of dietary fats or cholesterol.

Adult↗

Comparison of energy expenditure estimates from 4 physical activity questionnaires with doubly labeled water estimates in postmenopausal women.

BACKGROUND: Physical activity energy expenditure (EE) is an important determinant of health, and epidemiologists have used various methods, such as physical activity and energy intake recalls and records, to estimate energy cost. However, most epidemiologic studies have not validated these methods against the doubly labeled water (DLW) technique for measuring EE. OBJECTIVE: The aim was to compare EE estimated by 4 physical activity questionnaires with that obtained with the DLW technique in free-living postmenopausal women. DESIGN: We measured EE in kcal/d using the DLW method, the Harvard Alumni questionnaire, the Five City Project questionnaire, the Cross-Cultural Activity Participation Study (CAPS) Four Week Activity Recall, and the CAPS Typical Week Activity Survey in 65 healthy postmenopausal women. RESULTS: Compared with DLW, the Harvard Alumni questionnaire, the Five City Project questionnaire, and the CAPS Four Week Activity Recall overestimated (P < 0.05) daily EE by 62%, 16%, and 11%, respectively, whereas the CAPS Typical Week Activity Recall underestimated (P < 0.05) EE by 31%. Both the Harvard Alumni and Five City Project questionnaires overestimated EE in obese and overweight women. CONCLUSIONS: When using 3 of the 4 questionnaire methods, postmenopausal women overestimated EEs. Of all women, obese women overestimated daily EE the most.

Aged↗

Validation of a parent outcome questionnaire from pediatric cochlear implantation.

This paper analyzes the reliability and validity of a questionnaire designed by Archbold, Lutman, Gregory, O'Neil, and Nikolpoulos (2002) for the assessment of pediatric cochlear implantation. Parents of 61 youngsters (age range 5 to 16 years), who had the implant for at least 3 years, responded to the questionnaire and to an interview. The alpha reliability of the 11 questionnaire scales varied between .41 and .74. Content validity was assessed by comparison with parents' responses to an interview. In general, there was agreement between parents' concerns and views expressed in the interview and as assessed by the questionnaire. However, extra issues were identified in the interview, which suggest the need for increasing the breadth of the questionnaire. Criterion validity was assessed by identifying contrasting cases, with very low or very high scores in each scale, and analyzing the descriptions obtained in the interviews. For nine scales this analysis provided support for the validity of the questionnaire; two scales did not produce positive results. Correlations with interview scores were calculated for only four scales: two were positive and significant whereas two were not significant. A factor analysis of the questionnaire scales identified four components, interpreted as the child's functioning in social situations, attitudes to the process of implantation, support required in the long term, and effective use of the implant. Suggestions for further research and descriptive comments provided by parents are included.

Adolescent↗

The NorVold Abuse Questionnaire (NorAQ): validation of new measures of emotional, physical, and sexual abuse, and abuse in the health care system among women.

BACKGROUND: In the literature about abuse, large variations in prevalence rates exist. Validated research instruments are scarce and are needed urgently. Our aim was to validate the 13 questions concerning the experiences of abuse among women in the NorVold Abuse Questionnaire against an interview and two validated questionnaires. METHOD: Data collection was in two parts. i) The NorVold Abuse Questionnaire was sent to a random sample of 2000 women in Ostergötland. ii) A subsample of 64 women was interviewed, and filled in the Conflict Tactic Scale, the Sexual Abuse Questionnaire, and the NorVold Abuse Questionnaire for a second time. The interview had open questions about abuse and was considered our gold standard. RESULTS: The response rate was 61%. The abuse variables in The NorVold Abuse Questionnaire showed good test-retest reliability (84-95%). Specificity was 98% for all kinds of abuse except physical (85%). Sensitivity ranged from 75% (emotional) to 96% (physical). The likelihood ratio ranged from 38 to 43 for all kinds of abuse except physical (likelihood ratio 6). NorAQ performed better against the interview than against the Sexual Abuse Questionnaire and equally against the Conflict Tactic Scale. High lifetime prevalence rates of abuse were found: emotional 21.4%; physical 36.4%; sexual 16.9%; abuse in the health care 15.6%. Prevalence rates of abuse dropped considerably when a criterion of current suffering was added. CONCLUSIONS: The abuse variables in NorAQ have good reliability and validity.

Adolescent↗

Development and validation of a questionnaire for the assessment of physical activity in epidemiological studies in Sub-Saharan Africa.

OBJECTIVE: To develop and validate a questionnaire for measuring physical activity within Sub-Saharan Africa. Methods We designed the Sub-Saharan Africa Activity Questionnaire (SSAAQ), based upon existing questionnaires and an activity survey carried out in Cameroon. The questionnaire targeted past-year occupation, walking/cycling and leisure-time activities, and was administered by trained interviewers on two occasions, 10-15 days apart to 89 urban and rural consenting Cameroonians aged 19-68 years. Reliability was assessed by inter-interview comparison and repeatability coefficients (standard deviation of the test-retest difference). Validation was performed against a 24-hour heart rate monitoring and accelerometer recording. RESULTS: The questionnaire was highly reproducible (rho = 0.95; P < 0.001). The inter-interview difference did not differ significantly from 0, with a repeatability coefficient of 0.46-1.46 hours. Total energy expenditure from the questionnaire was significantly correlated to heart rate monitoring (rho = 0.41-0.63; P < 0.05) and accelerometer measures (rho = 0.60-0.74; P < 0.01). Subject's self ranking of their activity did not match the questionnaire's quartiles of activity. CONCLUSIONS: The present study presents the design and confirms the reliability and validity of SSAAQ in a rural and urban population of Cameroon and shows that subject's self ranking of activity might not accurately serve epidemiological purpose.

Adult↗