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PubMed2000

A qualitative study of participants' experiences with dietary assessment.

OBJECTIVE: This article reports on the use of focus groups and an experimental participatory activity to investigate factors influencing participants' decisions about what to eat and what to report on food records and food frequency questionnaires. DESIGN: Four focus groups examined participants' experience with diet records and 3 focus groups explored the topic of food portions using a group consensus activity. Twenty-two women participated in the diet record focus groups, and 15 participated in portion estimation groups. SUBJECTS: Focus group participants were equally distributed by age and body mass index values. Each woman completed a 10-day doubly labeled water protocol to measure total energy expenditure, 7 days of diet records (before and during total energy expenditure), and a food frequency questionnaire after the total energy expenditure. ANALYSIS: Transcripts of the focus groups were coded to index categories of responses and to identify themes within and across those responses. Themes discussed in this article are those that were discussed most often and at greatest length by all groups. RESULTS: The diet record focus groups revealed that 2 major factors influenced reporting on diet records: honesty vs social acceptability, and simplifying food intake. The portion estimation focus groups revealed 5 factors that influenced perceptions of portion size: the role of food in the meal, the type of food, personal preferences, product serving sizes, and comparison of personal servings with those of others. APPLICATIONS: The validity and reliability of self-reported food consumption is greatly influenced by the ways people interpret and respond to dietary assessment instruments. These findings indicate that dietetics professionals need to take extra steps to address issues of accurately recording "bad" foods when training patients to complete diet records. Extra probing is needed when dietary records do not include snacks and include simple meals and a large amount of prepared and packaged food because this may indicate that changes in normal dietary patterns were made in order to more easily complete a dietary record.

Adult↗
PubMed1978

As others see us. The patient's view of the anaesthetist.

One hundred hospital patients were given a questionnaire, designed to assess their beliefs about the anaesthetist in relationship to other workers in the United Kingdon national health service. The results of this survey, and the comments passed at a simultaneous interview, are discussed.

Adolescent↗
PubMed1998

Variations in population health status: results from a United Kingdom national questionnaire survey.

OBJECTIVE: To measure the health of a representative sample of the population of the United Kingdom by using the EuroQoL EQ-5D questionnaire. DESIGN: Stratified random sample representative of the general population aged 18 and over and living in the community. SETTING: United Kingdom. SUBJECTS: 3395 people resident in the United Kingdom. MAIN OUTCOME MEASURES: Average values for mobility, self care, usual activities, pain or discomfort, and anxiety or depression. RESULTS: One in three respondents reported problems with pain or discomfort. There were differences in the perception of health according to the respondent's age, social class, education, housing tenure, economic position, and smoking behaviour. CONCLUSIONS: The EQ-5D questionnaire is a practical way of measuring the health of a population and of detecting differences in subgroups of the population.

Adolescent↗
PubMed2000

[Rating scales and questionnaires in Parkinson's disease].

Rating scales and questionnaires used as measurement tools in Parkinson's disease are carefully constructed with well-defined items. The validity of a scale is its capacity to provide the intended measurement. One can distinguish perceived, content, and criteria-based validity as well as construction and sensitivity to change validity. The reliability of a scale is the capacity of a scale to produce statistically equivalent data in comparable situations. Reliability is composed of the following qualities: interobserver reliability, test-retest reliability, and internal coherence. UPDRES, mood scales (Hamilton, MADRS, CES-D, BDI), scales assessing cognitive disorders (MATTIS, MMSE), and quality of life questionnaires designed specifically for Parkinson's disease (PDQL, PDA-39, PDq-8) or for the general population (SF-36, SIP, NHP) are used in routine practice, and are particularly useful for clinical research. The metrological properties of these scales are analyzed here.

Humans↗
PubMed1988

Long term outcome of treatment of end stage renal failure.

The most common causes of end stage renal failure in 46 children (mean age 11 years, range 4-14) treated between January 1972 and June 1977 were: reflux nephropathy (n = 12), cystinosis (n = 7), focal and segmental glomerulosclerosis (n = 6), and Schönlein-Henoch disease (n = 5). The quality of life, degree of renal function, and height attainment of the 31 survivors were assessed in June 1985, when their mean age was 22 years (range 14-27), using hospital records and a questionnaire designed to highlight social and psychological problems. Twenty six patients had a functioning transplanted kidney. Average growth during treatment for all survivors was normal, but most were disappointed with their 'final height'. Though five patients had some form of disabling bone disease, all 31 could walk and 27 could run. Sixteen (67%) were in full or part time employment and nine were living independently. A group of 32 patients with juvenile onset diabetes treated at this hospital for at least five years were also asked to complete the questionnaire and of these, 17 responded. On average, their data could usefully be compared with those of cases of end stage renal failure. More of the diabetics had jobs, but most sexually mature patients with renal disease were concerned about their physical appearance and had not achieved any stable long term sexual relationships. We suggest that a poor body image resulting in low self esteem may be responsible for the deficiency and believe that further study in this group is warranted.

Adolescent↗
PubMed1991

The pediatric program director. An analysis of the role and its problems.

A questionnaire designed to elicit information about the work environment, knowledge, and stresses of pediatric residency program directors was mailed to the 235 member programs of the Association of Pediatric Program Directors (APPD). At the time that the 187 respondents (80% return rate) assumed responsibility for their training programs, many rated their knowledge of various aspects of residency program administration as "poor." The respondents indicated that a lack of time, the pressures of too many other academic responsibilities, and a fear of not "filling" all positions in the National Intern Matching Program created much personal stress. Most program directors felt that educational conferences designed to teach educational methods, and administrative skills, and provide technical information knowledge necessary for residency program supervision would be beneficial.

Adult↗
PubMed2006

Validation of an asthma questionnaire for use in healthcare workers.

BACKGROUND: Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. AIMS: To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. METHODS: An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk-through surveys and review of material safety data sheets. A cross-sectional validation study was conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. RESULTS: The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test-retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach's alpha > or = 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. CONCLUSIONS: Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross-validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self-report is underscored.

Adult↗
PubMed1981

Patient characteristics and clinician attitudes influencing the prescribing of benzodiazepines.

A questionnaire designed to evaluate the effect of patient characteristics and clinician attitudes on the prescribing of benzodiazepines was distributed to 86 members of the Departments of Psychiatry and Family Practice; the return rate was 87%. Of the respondents, 30% were consistently for, 20% were consistently against, and 50% were neither consistently for nor against the use of benzodiazepines. Prescribing decisions apparently depended on a complex interaction of patient's sex, employment, symptom severity and chronicity, and the respondent's attitude about the drugs. Plans are under way to revise the questionnaire, undertake in depth interviews, and compare questionnaire data with actual prescribing practices.

Anxiety↗
PubMed1994

Reproducibility of a meal-based food frequency questionnaire. The influence of format and time interval between questionnaires.

OBJECTIVE: To compare the reproducibility and reported level of energy intake obtained using three versions of a meal-based food frequency questionnaire (FFQ) considering, firstly, the influence of FFQ format and, secondly, the influence of time interval between questionnaires. DESIGN: The study was conducted in two parts. In the first, subjects were randomly allocated to three groups (one for each FFQ) and sent, by mail, the same FFQ to complete on two separate occasions with a time interval of 4-6 weeks. In the second study, the reproducibility of one of the FFQs used in the initial study was compared, after an interval of 3 months, in a further group of people, matched as far as possible for gender, age and socio-economic status of area of residence. SUBJECTS: The study population was 651 supermarket shoppers from Geelong, a regional centre with a population of 150,000 situated in Victoria, Australia, who had previously responded to an in-store survey about meat purchasing patterns. Of the 651 shoppers, 144 women and nine men (38% of those eligible) in part I and 98 women and two men (45% of those eligible) in part II of the study satisfactorily completed a FFQ on both occasions. RESULTS: While there were few statistically significant differences in terms of mean nutrient intake and nutrient density between the three FFQ formats, all under-estimated energy intake relative to the minimum estimated energy requirements for a sedentary population. A significant decrease in reported intake of approximately 10% was also observed, regardless of FFQ format used, when the same questionnaire was completed a second time after an interval of 4-6 weeks. In contrast, when the time interval between questionnaires was increased to 3 months, there were few significant differences in intake between the first and second administrations. Moreover those changes in food intake which were significantly different after the longer interval were, in general, consistent with expected seasonal changes in food intake patterns. CONCLUSION: Under the conditions of our study differences in FFQ format appeared to have less effect on estimates of mean intake than the length of the time interval between questionnaires. Our results suggest that motivation to complete a FFQ is significantly diminished on the second occasion, when the interval between FFQs is only 4-6 weeks and to a lesser extent when it is 3 months. Researchers planning studies which aim to assess short-term changes in food intake by means of a FFQ, for example after an intervention programme, need to be aware of this effect and to determine its magnitude, by assessing the reproducibility of their FFQ over the relevant time-interval prior to the proposed intervention and by including an appropriate non-intervention comparison group in the design of their study if seasonal effects are likely to occur in the course of the study.

Energy Intake↗
PubMed2004

Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital.

BACKGROUND: The sudden emergence of severe acute respiratory syndrome (SARS) caused international anxiety owing to its highly contagious and pandemic transmission. Health workers are vulnerable and are at high risk of infection. AIMS: To assess SARS-related stress and its immediate psychological impact and responses among health workers. METHOD: Health workers in a tertiary hospital affected by SARS were invited to complete a questionnaire designed to evaluate exposure experience, psychological impact and psychiatric morbidity. The risk and rates of psychiatric morbidity were estimated for exposure experience. RESULTS: Altogether, 1257 health workers successfully completed the survey. In the initial phase of the outbreak, when the infection was spreading rapidly, feelings of extreme vulnerability, uncertainty and threat to life were perceived, dominated by somatic and cognitive symptoms of anxiety. During the 'repair' phase, when the infection was being brought under control, depression and avoidance were evident. The estimated prevalence of psychiatric morbidity measured by the Chinese Health Questionnaire was about 75%. CONCLUSIONS: The outbreak of SARS could be regarded as an acute episode of a bio-disaster, leading to a significantly high rate of psychiatric morbidity.

Adult↗
PubMed2001

Quality of life and patterns of nontraditional therapy use by patients with cancer.

PURPOSE/OBJECTIVES: To describe the characteristics of patients with cancer that may be associated with use of or interest in nontraditional healthcare practices or therapies. DESIGN: Descriptive study using survey methodology with a large convenience sample. SETTING: Private, outpatient, adult hematology/oncology practice in the midwestern United States. SAMPLE: 89 outpatients who had received, were currently receiving, or were scheduled to receive chemotherapy for cancer. Participants ranged in age from 21-88 years (X = 63.26), were predominately Caucasian and female, and had a high school education. METHODS: Patients presenting for treatment were handed surveys and asked to mail them back to the investigators. Instruments included Ferrans and Powers' Quality of Life (QOL) Index--Cancer Version and a questionnaire designed for the purpose of this study to obtain demographic information and information regarding interest in or use of nontraditional therapy (NT). Data were analyzed for frequency of use, interest in using NT, and relationship between use/interest and quality of life. MAIN RESEARCH VARIABLES: QOL, using NT. FINDINGS: 34 (39.5%) of the respondents initiated use of NT after receiving a diagnosis of cancer; they were more commonly female, less than 65 years of age, and more highly educated. New users of NT tended to have known about their diagnosis longer, had experienced a recurrence or metastasis, and had been told that the possibility of cure was unlikely. QOL scores were higher among new users versus continuous users of various individual categories of NT. CONCLUSIONS: Adult patients with cancer in this study sample very commonly used nontraditional healthcare practices; more than one-third initiated their use after diagnosis. IMPLICATIONS FOR NURSING PRACTICE: Practitioners are challenged and encouraged to become more knowledgeable regarding NT therapy use and more sensitive to issues surrounding patients' decisions to use them.

Adult↗
PubMed2005

[Primary hyperhidrosis and anxiety: a prospective preoperative survey of 158 patients].

OBJECTIVE: To determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxiety assessed on 2 scales and standardized psychometric instruments. PATIENTS AND METHODS: A prospective study of patients with hyperhidrosis was carried out between September 1, 2001 and June 30, 2003 with a self-administered preoperative questionnaire. The variables studied included the location of hyperhidrosis, the accompanying signs and symptoms, and the self-reported degree of anxiety and perception of its effect on daily life assessed by the State-Trait Anxiety Inventory (STAI) and a questionnaire designed in our department. RESULTS: Palmar hyperhidrosis was reported by 93.6% of patients, plantar by 70.2%, axillary by 66.4%, facial by 12.1%, groin by 8.2%, chest by 5%, and abdominal by 2%. While more than 50% of the patients reported facial blushing and palpitations as accompanying signs and symptoms, approximately 30% experienced epigastric pain, trembling, and headaches. Over half of the patients reported that their anxiety was incapacitating, and a mere 1.2% experienced none at all. STAI scores were similar to those of the general population whereas scores on our department's questionnaire reflected those of the self-reported anxiety ratings. CONCLUSIONS: Primary hyperhidrosis is a disorder in which excessive sweating occurs mainly, but not exclusively, on the palms. The condition is accompanied by signs and symptoms typical of autonomic nervous system hyperactivity and by a degree of anxiety that has an incapacitating effect on normal life, although that anxiety is not detected by the STAI questionnaire alone.

Adolescent↗
PubMed2003

Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases.

PURPOSE: To describe the immediate outcome of a large cohort of patients who underwent percutaneous polymethylmethacrylate (PMMA) vertebroplasty for treatment of one or more vertebral fractures. MATERIALS AND METHODS: This retrospective cohort study included seven university-based and private hospitals in the United States. Of 488 consecutive patients (mean age, 76 years) who underwent percutaneous PMMA vertebroplasty between 1996 and 1999, 245 were successfully interviewed retrospectively after vertebroplasty (median time, 7 months). Through telephone interview, patients completed our self-developed questionnaire designed to measure pain (10-point scale), ambulation (five-point scale), and ability to perform activities of daily living (ADL) (five-point scale) before and after vertebroplasty. Differences in reported pain, ambulation, and ability to perform ADL before and after vertebroplasty were evaluated with paired t tests. Differences in proportions were compared with the McNemar test. Subgroup analyses were performed to assess the consistency of differences in pre- and postprocedural pain and functional status by patient age, number of fractures, time from fracture to vertebroplasty, and time from vertebroplasty to questionnaire completion. RESULTS: On a 10-point scale, mean pain decreased from 8.9 before vertebroplasty to 3.4 afterward (P <.001). Seventy-two percent of patients had substantially impaired ambulation before vertebroplasty compared with 28% afterward (P <.001). Ability to perform ADL was also significantly improved following vertebroplasty (P <.001). Twelve patients (4.9%) experienced symptomatic complications (none major or life threatening). CONCLUSION: Treatment of vertebral fractures with percutaneous PMMA vertebroplasty appears to be safe and results in substantial immediate pain reduction and improved functional status. A randomized controlled trial appears warranted to assess the efficacy and safety of vertebroplasty.

Activities of Daily Living↗
PubMed2000

Pediatricians and the Advanced Trauma Life Support (ATLS): time for reconsideration?

BACKGROUND: General pediatricians in Israel are actively involved in the initial evaluation, resuscitation and management of traumatized children. However, pediatric trauma care is not a part of pediatric specialty training in Israel, and the few Advanced Trauma Life Support courses per year are insufficient for most pediatricians working in accident and emergency care. OBJECTIVE: To examine the value of the course in relation to the limited resources available for such training. METHODS: A telephone survey of 115 pediatricians who had taken the course between 1990 and 1994 was conducted. The responding physicians (67%) were asked to complete a specially designed questionnaire on life-saving procedures that were taught in the course. In addition, they were asked to subjectively assess the practical utility of the course. RESULTS: Forty-three (56%) pediatricians reported that they routinely treated both adult and pediatric trauma cases. Of these, 81% performed 27 life-saving ATLS procedures. Pediatric trauma was treated by only 22 (28%), of whom 72.3% performed 18 life-saving ATLS procedures. These pediatricians ranked the courses as being "very high" to "high" in impact. CONCLUSIONS: These figures indicate that an ATLS course designed specifically for pediatricians can markedly improve pediatric trauma care. To ensure standard education and patient care, such a course should be developed and made a mandatory component of residency training. Further studies to examine the objective impact of the courses on pediatric trauma care should be carried out.

Adolescent↗
PubMed1995

Body image and steroid use in male bodybuilders.

This study was designed to examine the association between body image and eating-related attitudes among male bodybuilders in relation to two athletic comparison groups, runners and martial artists. It was also of interest to examine whether steroid use may be associated with body image disturbances in athletes. The volunteer sample of 139 male athletes recruited from fitness centers comprised 43 bodybuilders, 48 runners, and 48 martial artists (tae kwon do practitioners). Standardized measures of body dissatisfaction, drive for thinness, drive for bulk, bulimia, self-esteem, depression, maturity fears, and perfectionism as well as questionnaires designed to measure attitudes toward steroids, and rates of steroid use were administered in a manner that encouraged disclosure. Bodybuilders reported significantly greater body dissatisfaction, with a high drive for bulk, high drive for thinness, and increased bulimic tendencies than either of the other athletic groups. In addition bodybuilders reported significant elevations on measures of perfectionism, ineffectiveness, and lower self-esteem. They also reported the greatest use of anabolic steroids and most liberal attitudes towards using steroids. Steroid users reported that the most significant reason for using steroids was to improve looks. Steroid users reported an elevated drive to put on muscle mass in the form of bulk, greater maturity fears, and enhanced bulimic tendencies than nonusers. The results suggest that male bodybuilders are at risk for body image disturbance and the associated psychological characteristics that have been commonly reported among eating disorder patients. These psychological characteristics also appear to predict steroid use in this group of males.

Adolescent↗
PubMed1983

A short dietary questionnaire for use in an epidemiological survey: comparison with weighed dietary records.

Nutrient data from a short dietary questionnaire designed for self-administration in epidemiological studies of ischaemic heart disease were compared with those from 7-day weighed dietary records obtained 2 to 6 weeks later in a sample of 119 men from the general population. For the major nutrients correlation coefficients of between 0.27 (total carbohydrate) and 0.75 (alcohol) were obtained all of which were statistically significant. In the case of alcohol over 90 per cent of the weekly intake was consumed outside the home in standard measures. In the case of other nutrients improvement in the precision of the questionnaire estimates may be obtained by direct estimates of portion sizes.

Alcohol Drinking↗
PubMed1997

Are reported stress and coping style associated with frequent recurrence of genital herpes?

OBJECTIVES: This paper reports on the cross sectional data from the longitudinal study examining the impact of genital herpes simplex virus (HSV) infection on quality of life. In particular the report sought to study the relation between recurrence of genital HSV and coping style, mood, personality, and quality of life, among other factors. SETTING AND SUBJECTS: 116 patients with a known history of genital herpes simplex infection attending the Department of Genitourinary Medicine at Chelsea and Westminster Hospital. METHODS: Psychosocial factors (stress, anxiety, depression, health locus of control, personality, social support, coping skills, and quality of life) and the reported frequency of genital herpes episodes were measured using self administered questionnaires designed to examine the relation between psychosocial status and the frequency of genital HSV episodes. RESULTS: The number of recurrences reported by patients was significantly related to the style of coping skills used. Higher recurrences were less likely to use problem focused coping skills of planning and active coping, and the emotion focused coping skills of positive reinterpretation and growth. There was a significant difference in the number of patients who believed that psychological stress was related to the number of recurrences they experienced. This belief was related to neuroticism on the Eysenck Personality Questionnaire scale, and not to any of the other measures investigated. CONCLUSION: The findings suggest that it is the way individuals cope, and their personality characteristics rather than actual levels of psychological stress, that influence their belief in a link between recurrent genital HSV and stress. HSV may become the focus of existing concerns and be viewed as the physical manifestation of stress.

Adaptation, Psychological↗
PubMed1995

Memory complaints in chronic pain.

OBJECTIVE: In clinical practice, patients with chronic pain frequently report problems with memory functioning. This issue, however, has received little attention in the scientific literature. The present study was designed to investigate this common problem and to stimulate research interest in this neglected and important area. DESIGN: Self-reported memory problems were investigated in two groups of chronic pain patients--patients with pain from acceleration-deceleration automobile accidents (n = 56) and patients with pain from various work accidents (n = 27)--and two control groups involving medical/dental (n = 24) and psychotherapy patients (n = 20). SETTING: Private practice, chronic pain, rehabilitation psychology services. RESULTS: Our findings suggest that memory complaints are higher in patients with chronic pain than in medical/dental or psychotherapy patients. No differences were found between chronic pain groups. On more general measures of memory complaint, differences between pain patients and controls were attributed to the severity of patients' depression. On a questionnaire designed to be more specific to memory complaint in chronic pain patients, differences in memory complaint between pain patients and controls were found, even after the effects due to depression were statistically removed. Although pain patients often attribute their memory problems to codeine use and/or psychoactive medications, there was no support for this in the present study. CONCLUSIONS: Within the limitations of this study, these findings suggest that memory complaints may be related not only to depression but also to the presence of chronic pain. Further research in this area is needed.

Adult↗