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Women's perceptions, expectations and satisfaction with induced labour--a questionnaire-based study.

OBJECTIVES: To evaluate the understanding and expectations of women undergoing labour induction, to assess their actual experience of the process and to compare their satisfaction with labour to those labouring spontaneously. STUDY DESIGN: Four hundred and fifty women at term undergoing induction of labour and cervical ripening with prostaglandinE2 vaginal tablets and 450 women labouring spontaneously were recruited into the study. The induction group were requested to complete a questionnaire prior to the start of their induction process and another questionnaire post-delivery. The post-delivery questionnaire contained two sections, one pertaining to issues to do with the induction and the second with the actual labour process. The spontaneously labouring group was requested to complete a questionnaire post-delivery, which only contained the section pertaining to the actual labour process. The main outcome measures were satisfaction with labour, perception of pain and length of labour between the induced and spontaneous labour groups, and issues that the women might wish changed about their induction. RESULTS: In the induction group, 34.7% were not satisfied with the information they received about the induction prior to the procedure and 27.2% expected to deliver within 12h of the administration of the inducing agent. Post-induction, 40% of the women felt the most important aspect they would like to change about their induction were they to have another one, would be the speed of the induction, 13.6% felt they might wish to take the inducing agent orally, 7% to have fewer vaginal examinations and 9% to have fewer complications. Among the women who returned questionnaires, 26.3% had a caesarean delivery in the induction group and 21.4% in the spontaneous labour group. Significantly more women were satisfied with their labour in the spontaneous labour group 79.5% versus 70.4%, RR 0.89, 95% CI 0.8-0.96, P=0.006). CONCLUSIONS: Labour that is artificially induced does result in lower satisfaction rates as compared to that following spontaneous onset. The longer time delay between the start of the induction and the delivery plays a significant part in this, with the mode of administration of the inducing agent, more vaginal examinations and the increase in caesarean deliveries being perceived as secondary issues. There is a need to improve the information provided to women undergoing labour induction, to counter unrealistic expectations and thereby improve satisfaction.

Adult↗

Validity of the CAGE questionnaire in hospital.

OBJECTIVE: The CAGE questionnaire is considered a useful screening and case-finding tool for alcohol use disorders in clinical populations. Our objectives were to validate the French version of the CAGE against DSM-IV criteria and to assess performance of each item of the scale. METHOD: Data were extracted from a hospital morbidity study conducted in central France. It concerned 5452 patients-48.5% men-in short and medium-stay units. Patients answered the CAGE questionnaire as a past-year assessment. The alcohol use disorders were diagnosed by the physicians using DSM-IV alcohol abuse or dependency criteria. RESULTS: The CAGE questionnaire for a cut-off of 2 had a sensitivity of 77% and a specificity of 94%. The CAGE test was more sensitive for patients diagnosed as alcohol-dependent than for alcohol abusers (61% vs. 84%) with the same specificity (94%). These values are close to those for the English-language CAGE. The first three items (CAG) were very similar, with sensitivity 70% and specificity 94%. The eye-opening question (E) differentiated sharply between abuse and dependency, with sensitivities of 18% and 46%, respectively. A questionnaire comprising only the CAG questions of the CAGE had properties similar to the full questionnaire. CONCLUSION: CAGE is a good screening tool for alcohol abuse or alcohol dependency. Given the frequent-and insufficiently diagnosed-alcohol problems among inpatients, CAGE is indicated as a first-line tool for screening for the most severe alcohol use disorders in hospital. It should ideally be used systematically. A positive reply to any of the first three items should alert the clinician and prompt further investigation.

Adult↗

Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: a questionnaire survey.

BACKGROUND: There is a growing interest in the psychosocial work environment of health care staff since they are at high risk for burnout, role conflict and job dissatisfaction. Burnout, as a type of prolonged response to chronic job-related stressors, has a special significance in health care where staff experience both psychological-emotional and physical stress. Burnout and the other negative aspects of the job of health care staff have major behavioural and health implications. OBJECTIVES: The present study investigated the interrelationships among burnout, role conflict and job satisfaction in a sample of Hungarian health care staff. The study also investigated how these indicators of psychosocial work climate influence respondents' frequency of psychosomatic symptoms. DESIGN: A questionnaire survey (anonymous questionnaires) has been carried out to detect these interrelationships. SETTINGS: Two major hospitals in Szeged, Hungary. PARTICIPANTS: Questionnaires were distributed to 450 health care staff among whom 55.7% were registered nurses. All together, 201 questionnaires were returned and analyzed, giving a response rate of 44.6%. METHODS: Questionnaire contained items on work and health-related information (i.e., burnout, job satisfaction, role conflict, and psychosomatic symptoms) and on some basic sociodemographics. Beyond descriptive statistics, correlation and multiple regression analyses were computed. RESULTS: Findings show that emotional exhaustion and depersonalization scores were higher, while scores on personal accomplishment was lower as compared to Canadian, Norwegian or US samples. Burnout, particularly emotional exhaustion (p<.001), was found to be strongly related to job dissatisfaction. Schooling was inversely related to satisfaction with the job (p<.05). While job satisfaction was a negative predictor of each type of burnout subscale (p<.001), role conflict was a factor contributing positively to emotional exhaustion (p<.001) and depersonalization scores (p<.001). CONCLUSIONS: The study results underline the importance of the role of psychosocial work environment and the interrelationships among burnout, role conflict, job satisfaction and psychosomatic health among Hungarian health care staff.

Adult↗

Botulinum toxin improves quality of life in hemifacial spasm: validation of a questionnaire (HFS-30).

BACKGROUND: Hemifacial spasm (HFS) can be disabling and affect quality of life. There is a lack of a validated scale for evaluating botulinum toxin (BTX) response in HFS. OBJECTIVE: We examined the validity and reliability of a self-rating health-related quality of life (HRQOL) questionnaire (HFS-30) in HFS and investigated the correlation of this questionnaire with the neurologists' assessment of severity of HFS and response to botulinum toxin (BTX) treatment. METHODS: HFS patients were asked to answer a total of 30 self-rating questions divided into seven subscales: Mobility; Activities of Daily Living (ADL); Emotional Well-being; Stigma; Social support; Cognition; and Communication. All of the items were scored on a 5-point scales ranging from 0 ("never") to 4 ("always"). They were also asked to assess their response to the BTX treatment based on a similar questionnaire at 6-8 weeks after BTX. The validity, reliability and sensitivity of the questionnaire were analyzed statistically. RESULTS: There were 80 HFS patients with mean age of 56.3+/-11.1 (S.D.) years (range 35 to 81), consisting of 54 (67.5%) females, 26 (32.5%) males. The intraclass correlation coefficient (ICC) and Cronbach's alpha were more than 0.7 for the majority of the items and subscales, respectively. There was a good positive correlation of severity of HFS with the subscale scores. Regression analysis of physicians' assessment of response to BTX on change in scores from baseline as rated by patients demonstrated a significant correlation. CONCLUSIONS: We demonstrated validity, reliability and sensitivity of the HFS-30 questionnaire. BTX improves quality of life in HFS.

Adult↗

Injury location and screening questionnaires as markers for intimate partner violence.

PURPOSE: We sought to evaluate the performance of 2 different screening questionnaires for intimate partner violence (IPV), in conjunction with injury location, as markers for IPV-related injuries. METHODS: We implemented a cross-sectional study and enrolled a sample of women presenting to the emergency department for evaluation and management of nonverifiable injuries. Study subjects were randomly assigned to receive 1 of 2 IPV screening questionnaires: the Partner Violence Screen (PVS) or the short-Woman Abuse Screening Tool (short-WAST). We evaluated a combination of 2 markers of IPV-related injury: (1) injury location, classified as head/neck/facial (HNF) or other and (2) responses to the IPV questionnaires: positive or negative. Our predictor variable was the probability of self-report of IPV-related injury defined as (1) high probability (HNF injuries were present and there was a positive response to the IPV questionnaire) or (2) low probability (all other combinations of injury location and responses to the questionnaires). The outcome variable was self-reported injury etiology, IPV or other. Demographic variables were also recorded for our study sample. Univariate and bivariate statistical analyses were computed for the sample. Sensitivity, specificity, and positive and negative predictive values and odds ratios were calculated (P < .05). RESULTS: The sample was composed of 200 women. The sensitivities/specificities for the PVS-injury location and short-WAST-injury location combinations were 0.75/0.70 and 0.77/0.61, respectively. The odds ratios for IPV-related injury etiology were 10.2 (3 < OR < 41, P = .01) for the PVS-injury location combination and 3.7 (0.90 < OR < 15, P = .07) for the short-WAST-injury location combination. CONCLUSIONS: A set of markers composed of injury location and the PVS was statistically associated with the likelihood of reporting IPV-related injuries. The short-WAST did not perform as well as the PVS in the study's clinical setting.

Adult↗

Use of the Liverpool Elbow Score as a postal questionnaire for the assessment of outcome after total elbow arthroplasty.

The Liverpool Elbow Score (LES) is a newly developed, validated elbow-specific score. It consists of a patient-answered questionnaire (PAQ) and a clinical assessment. The purpose of this study was to determine whether the PAQ portion of the LES could be used independently as a postal questionnaire for the assessment of outcome after total elbow arthroplasty and to correlate the LES and the Mayo Elbow Performance Score (MEPS). A series of 51 total elbow replacements were reviewed by postal questionnaire. Patients then attended the clinic for assessment by use of both the LES and the MEPS. There was an excellent response rate to the postal questionnaire (98%), and 44 elbows were available for clinical review. Good correlation was shown between the LES and the MEPS (Spearman correlation coefficient, 0.84; P < .001) and between the PAQ portion of the LES and the MEPS (Spearman correlation coefficient, 0.76; P < .001). We conclude that there is good correlation between the LES PAQ component and the MEPS, suggesting that outcome assessment is possible by postal questionnaire.

Aged↗

Development of questionnaires to measure patient preferences for intranasal corticosteroids in patients with allergic rhinitis.

OBJECTIVE: To develop a questionnaire to evaluate preferences for attributes of intranasal corticosteroids (INSs) in clinical trials with allergic rhinitis (AR) patients. STUDY DESIGN AND SETTING: Established questionnaire development practices were used, including performance of a literature review and use of patient and physician focus groups, cognitive debriefing interviews, and pilot testing before validation. RESULTS: Findings from patient and physician focus groups suggest that sensory attributes are relevant to AR patients when choosing INSs. Physician focus groups identified the need for 2 distinct preference instruments, a clinical trial patient preference questionnaire (CTPPQ) and a clinical practice preference questionnaire (CPPPQ). A pilot study suggests that the CTPPQ is capable of discriminating between 2 INSs in the clinical trial setting. CONCLUSIONS: Initial findings suggest that items in the CTPPQ and CPPPQ are easy to understand and relevant to patients. Further validation studies with larger sample sizes are needed to assess the psychometric properties of both questionnaires. EBM RATING: B-20.

Administration, Intranasal↗

Determinants of poor adherence in hypertensive patients: development and validation of the "Maastricht Utrecht Adherence in Hypertension (MUAH)-questionnaire".

OBJECTIVES: (1) To help identify patients with poor adherence and (2) to identify potential reasons that impede or facilitate adherence. METHODS: Seventeen patients who used antihypertensive drugs participated in semi-standardized interviews. Interviews were recorded and reviewed by two investigators. Forty-four items were selected. An exploratory factor analysis was performed. Convergent validity was assessed by evaluating the association between sum scores on the identified subscales and three other adherence measures: (1) the Brief Medication Questionnaire (BMQ), (2) pharmacy refill records and (3) electronic monitoring. Regression analysis was used to evaluate the magnitude of associations. RESULTS: Two hundred and fifty-five (90%) patients completed the questionnaire. Factor analysis resulted in a four-factor solution, explaining 30% of cumulative variance among respondents. The factors (scales) were labeled: positive attitude towards health care and medication (I), lack of discipline (II), aversion towards medication (III) and active coping with health problems (IV). Chronbach's alpha coefficient was 0.75, 0.80, 0.63 and 0.76 for scales I, II, III and IV, respectively. Convergent validity was partly supported by statistically significant associations that were found between sum scores of subscales 1 and II and the BMQ and electronic monitoring, respectively. CONCLUSION: The MUAH-questionnaire has excellent psychometric properties and may be useful to identify factors that impede or facilitate adherence. However, it is not clear to what extent the questionnaire measures actual adherence. PRACTICE IMPLICATIONS: Validation of the MUAH-questionnaire in other studies is needed.

Adaptation, Psychological↗

Developing and testing a questionnaire to assess the quality of pain management in acute care in Sweden.

Pain management is an important indicator of the quality of patient care. The aim of this study was to develop and test a questionnaire to assess the quality of pain management in acute care in Sweden with emphasis on validity and reliability, as well as pain severity, interference with function, and patient participation. A descriptive cross-sectional study was conducted with consecutively selected patients in pain (n=100 in study group I and n=127 in study group II) who completed the questionnaire. Cronbach's reliability coefficient alpha for 20 items in the questionnaire was 0.80. The construct validity of the questionnaire was estimated using a principal components analysis. Four orthogonal factors were identified: (1) "Interference with function," (2) "Pain severity," (3) "Communication," and (4) "Participation." The results indicate that the item "pain right now" is reliable and valid, although the item was divided to assess pain at rest as well as with movement. Interference scores were significantly and positively correlated with pain scores at rest and with movement, as well as with average pain scores. High numeric rating scale scores influenced both the patients' enjoyment of life and their capacity to walk and general activity. The questionnaire is considered to be a useful, reliable, and valid self-report tool to assess the quality of pain management in acute care. A few items need to be refined, tested, and evaluated in future research.

Acute Disease↗

Subjective response to neuroleptics: the effect of a questionnaire about neuroleptic side effects.

BACKGROUND: A patient's subjective response to neuroleptics is an important factor in pharmacotherapy of schizophrenia. In this study, we conducted an intervention to assess the effect of a questionnaire about neuroleptic side effects. We hypothesized that paying more attention to a patient's subjective distress associated with neuroleptic side effects would improve the patient's subjective response to neuroleptics. So we made a questionnaire about neuroleptic side effects, and used this questionnaire repeatedly in the usual clinical setting as an intervention. METHOD: We administered this study to 210 outpatients who met the following criteria: (1) diagnosis of schizophrenia or schizoaffective disorder as defined by DSM-IV and (2) no worsening of symptoms in the past 6 months. The patients were divided into the intervention and the control groups. Patients of the intervention group filled out the questionnaire four times during 6 months and were given routine clinical care. Patients of the control group had routine clinical care only. The 10-item Drug Attitude Inventory (DAI-10) was used to evaluate the patients' subjective responses to neuroleptics. RESULTS: After 6 months, the patients' subjective responses to neuroleptics assessed by the DAI-10 significantly improved in the intervention group (p<0.05 for within-group comparison). The most improved response was that the patients felt they were taking medications of their own free choice. CONCLUSION: Paying more attention to the patient's subjective distress associated with neuroleptic side effects may have encouraged patients to participate in pharmacotherapy on their own initiative. This study suggests that our 19-item questionnaire is a useful tool to improve a patient's subjective response to neuroleptics.

Adult↗

Questionnaire based quality assurance for the RT01 trial of dose escalation in conformal radiotherapy for prostate cancer (ISRCTN 47772397).

BACKGROUND AND PURPOSE: In order to ensure the validity of the outcome of the Medical Research Council's 'RTO1 trial' of dose escalation in conformal radiotherapy for prostate cancer it was considered important that the quality of treatment delivery should meet an adequate standard across all contributing centres. A questionnaire was therefore devised to ensure that all aspects of the planning and delivery process were adequately covered. PATIENTS AND METHODS: The questionnaire considered each step in the planning and delivery process and drew the attention of the participants to the specific requirements of the trial. Before entering patients into the trial each participating centre had to complete the questionnaire and an outlining exercise (reported elsewhere). RESULTS: It was not practicable to define a detailed universally acceptable protocol for the whole process of delivery of conformal radiotherapy, not least because of the different equipment available for planning and treatment in different centres. The questionnaire identified some areas of difference in practice between centres where there may be a need for the development of a consensus as to best practice, particularly in the area of patient set-up. Occasionally it was necessary to follow up responses to questions that had been misunderstood or inadequately answered, but in most cases these issues proved to be easily resolved. CONCLUSIONS: The questionnaire proved to be a useful self-assessment tool as well as enabling the quality assurance group to ensure that the standards of the trial were being met. Subsequent follow-up visits confirmed the usefulness and validity of this self assessment process.

Adult↗

Clinical application of a simple questionnaire for the differentiation of asthma and chronic obstructive pulmonary disease.

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases characterized by airflow limitation. Both diseases have a distinct pathogenesis and require unique treatment approaches. Due to some common characteristic traits, asthma and COPD are often lumped together in clinical practice. We sought to develop a simple questionnaire for the distinction of asthma and COPD. METHODS: Clinical discriminants of asthma and COPD were retrospectively identified by multiple logistic regression using files from 547 consecutive adult patients presenting to a pulmonary specialist practice with a diagnosis of asthma or COPD. With these features, we generated a simple quantitative questionnaire supporting a diagnosis of COPD with high scores and asthma with low scores (range 0-15 points). Questionnaire results were compared with physician's diagnosis based on GINA and GOLD guidelines including skin tests, spirometry and reversibility data. RESULTS: 210 patients had COPD and 337 had asthma. Age of onset, smoking history, atopy status, and cough quality were significantly associated with a diagnosis of asthma or COPD. Questionnaire scores for COPD patients were higher than those for asthmatics (mean score 10.5+/-0.18 vs. 4+/-0.12, P<0.0001). Receiver operational characteristics (ROC) analysis revealed a cutoff score of 7 with the highest discriminant power (87.6% sensitivity, 87.2% specificity for COPD, 87.4% correctly classified, area under the ROC curve: 0.954). The overlap between asthma and COPD (score 6-8) comprised about 20% of the total population, these patients included a higher proportion of COPD patients with atopy, and smoking asthmatics. CONCLUSIONS: In patients with obstructive airway diseases, a simple questionnaire can support the differentiation of asthma and COPD in everyday clinical practice. Further prospective trials are necessary to confirm these initial observations.

Adolescent↗

International consultation on incontinence questionnaire short form: comparison of physician versus patient completion and immediate and delayed self-administration.

OBJECTIVES: To compare the results of International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with physician completion versus patient self-administration. The ICIQ-SF is a new self-administered questionnaire that qualifies the symptoms and quality of life in both male and female adult patients with symptoms of urine loss. METHODS: Sixty-four women consulting for urinary incontinence completed the ICIQ-SF three times: twice during the same visit, by self-administration and physician interview, and once at home, approximately 1 week later. RESULTS: All 64 patients completed the questionnaire the first two times, but only 59 of them sent back the questionnaire after 1 week. The mean patient age was 59 +/- 3.8 years. The distribution of the differences was similar among the three kinds of administration. The mean total symptom score for the self-administered, physician completed, and self-administered 1 week later ICIQ-SF was 11.31 +/- 4.6, 11.98 +/- 4.4, and 11.4 +/- 4.7, respectively. The corresponding quality-of-life assessments were 5.2 +/- 2.9, 5.5 +/- 3, and 5.18 +/- 2.9. No statistically significant differences were observed. CONCLUSIONS: The results of this study demonstrated that the information obtained by self-administration of the ICIQ-SF at the office or at home or when completed by the physician during an interview is not different. These findings, showing the intraobserver and interobserver reliability of this new questionnaire, are extremely important for clinical use and research.

Adult↗

[Validation of the Spanish version of the Psoriasis Disability Index questionnaire in assessing the quality of life of patients with moderate-severe psoriasis].

INTRODUCTION: To assess the measurement properties of the Spanish version of the Psoriasis Disability Index (PDI) quality of life questionnaire for patients with moderate or severe psoriasis in ordinary clinical practice. PATIENTS AND METHODS: A study was carried out with 294 patients with moderate or severe psoriasis who had received therapeutic treatment. Sociodemographic and clinical variables were collected and the PDI and EuroQoL-5D questionnaires were administered at the baseline visit, and at 3 and 6 months later. The feasibility (percentage of patients responding to the questionnaire), validity of the construct, internal reliability and sensitivity to change were analyzed. RESULTS: Feasibility: 98.6 % of the patients answered over 80 % of the questions on the questionnaire. Validity of the construct: the PDI scores were correlated with the scores obtained in the Psoriasis Area Disability Index (PASI) (r = 0.33) and the Visual Analogue Scale (VAS) of the EQ-5D (r = -0.41) (p < 0.01). Longitudinal validity: the PDI questionnaire score after 6 months of treatment was correlated with the changes in the PASI index and the VAS (r = 0.39 y -0.51). Reliability: the internal consistency of the dimensions was high (Cronbach's alpha = 0.89). Sensitivity to changes: the size of the effect corresponding to the changes experienced by the patients who noticed an improvement in the severity of their psoriasis during the period between visits was 0.95. CONCLUSION: The Spanish version of the PDI has proven to be reliable, valid and sensitive to changes for use with patients with psoriasis in the Spanish population, although the test-retest reliability should be analyzed for clinically stable patients.

Adult↗

Development and reproducibility of a brief food frequency questionnaire for assessing the fat, fiber, and fruit and vegetable intakes of rural adolescents.

OBJECTIVE: To describe the systematic development and reproducibility of a food frequency questionnaire (FFQ) designed to meet the specific research requirements of the Goals for Health cancer prevention intervention program for rural middle school children. DESIGN: A 4-step process was used to develop a brief FFQ for scoring intakes of total fat, fiber, and fruits and vegetables. The resulting questionnaire consisted of 25 food frequency items and 10 supplemental questions. Reproducibility of the questionnaire was determined by comparing responses at the beginning and end of a 4-month interval. SUBJECTS: Study subjects were sixth- and seventh-grade students attending middle schools in rural areas of Virginia and upstate New York. Seventh-grade students participated in the pilot study, and sixth-grade students participated in the reproducibility study. The final version of the FFQ was completed twice by 539 sixth graders. After exclusions for missing and unreliable data, the usable sample size was 415. Boys were somewhat more likely than girls to be excluded for missing data. African-American students comprised 32% of the population. STATISTICAL ANALYSES PERFORMED: Each food frequency item was associated with 3 scores--a fat score, a fiber score, and a combined score for the number of servings of fruits and vegetables. Means and standard deviations were determined for nutrient variables, differences between repeat administrations were tested for significance by paired t test, and Pearson correlation coefficients were calculated for nutrients and for individual food items. RESULTS: Correlation coefficients for nutrient scores were 0.58 for fat, 0.49 for fiber, and 0.51 for fruits and vegetables. For individual food items, correlations ranged from 0.24 to 0.59 (mean=0.41). APPLICATIONS/CONCLUSIONS: Using a systematic approach to developing a study-specific FFQ for rural adolescents is feasible. Further, the reproducibility of the Goals for Health questionnaire was demonstrated for the 3 nutrient scores it was designed to measure. This developmental approach may be readily adapted to other populations, study designs, and nutrients of interest. The validity of the questionnaire remains to be tested.

Adolescent↗

Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents.

OBJECTIVE: To develop a self-administered food frequency questionnaire for older children and adolescents and to demonstrate reproducibility over a 1-year period. DESIGN: The youth/adolescent questionnaire (YAQ) was based on the validated Nurses' Health Study food frequency questionnaire and was developed to reflect the eating habits of this age group. SUBJECTS: The multiethnic sample consisted of 179 youths (ages 9 to 18 years) who completed the questionnaire twice, 1 year apart. STATISTICAL ANALYSIS: Pearson correlation coefficients were calculated on nutrient data adjusted in relation to energy intake and on unadjusted food data. RESULTS: Reproducibility for nutrients ranged from .26 for protein and iron to .58 for calcium, and for foods it ranged from .39 for meats to .57 for soda. Mean reproducibility was higher among girls than boys for energy and nutrients and for foods; no consistent pattern was observed for age. CONCLUSION: A self-administered food frequency questionnaire has a reasonable ability to assess the eating habits of older children and adolescents over time.

Adolescent↗

Incorporating fat-modified foods into a food frequency questionnaire improves classification of fat intake.

OBJECTIVE: To determine the extent to which incorporating fat-modified foods into a food frequency questionnaire influences the agreement of energy and nutrient estimates with estimates obtained from food records. DESIGN: Subjects completed four 2-day food records at 3-month intervals. At the end of the recording period, a food frequency questionnaire was administered to assess usual daily intake during the preceding year. SUBJECTS/SETTING: One hundred and three subjects selected from a population-based sample of adults participating in the Beaver Dam Eye Study. STATISTICAL ANALYSES PERFORMED: Subjects were categorized into three groups on the basis of their frequency of consumption of fat-modified foods. For each group, correlations were calculated between food record estimates and estimates obtained from the original food frequency questionnaire, the original with a low-fat option, and the fat-modified questionnaire. RESULTS: For persons categorized as high consumers of fat-modified foods, incorporating questions regarding the consumption of these products resulted in higher correlations with food record estimates (original vs fat-modified version) for percentage of energy from total fat (.32 vs .47), saturated fat (.20 vs .41), oleic acid (.32 vs .50), and linoleic acid (.40 vs .46). High consumers differed in several characteristics that could be associated with disease risk (eg, higher ratios of serum total cholesterol to high-density lipoprotein cholesterol). CONCLUSIONS: Failure to account for the consumption of fat-modified foods in epidemiologic studies may result in misclassification of fat exposures. Because patterns of misclassification could be different for those at risk for disease, results of epidemiologic studies could be biased if these foods are excluded. Thus, incorporating fat-modified foods into food frequency questionnaires will improve the ability of researchers to correctly classify fat exposures and to evaluate potentially important relationships between fat intake and disease risk.

Aged↗

Development of a soy food frequency questionnaire to estimate isoflavone consumption in US adults.

OBJECTIVE: To develop a dietary assessment instrument to measure soy food consumption and isoflavone intake and test it for reliability. DESIGN: A soy food frequency questionnaire, designed for use in this study, was administered twice to participants, separated by a 2-week interval. The questionnaire was tested for reproducibility of estimates of soy food consumption and isoflavone (genistein and daidzein) intake. SUBJECTS/SETTING: A convenience sample of 51 faculty, staff, and students was recruited from a naturopathic university. STATISTICAL ANALYSES PERFORMED: Intraclass correlation coefficients were used to assess reproducibility of estimates of soy food intake and genistein and daidzein intake. RESULTS: Correlation coefficients comparing mean soy food servings per month between the 2 administrations of the questionnaire ranged from 0.50 for soy yogurt to 0.89 for tempeh. Correlation coefficients for genistein and daidzein intake estimated by the 2 administrations of the questionnaire were the same: 0.89. Mean intake (+/- standard deviation) of genistein and daidzein was 7 +/- 10 and 4 +/- 6 mg/day, respectively. Fifteen soy foods contributed 95% of the total genistein and daidzein intake: tofu, soy yogurt, tempeh, soy milk, low-fat tofu, soy flour, miso, soy protein isolate, low-fat soy milk, veggie soy burger, textured vegetable protein, miso soup, cooked soybeans, soy hot dogs, and natto (fermented soy beans). APPLICATIONS: The soy food frequency questionnaire developed in this study provided highly reproducible estimates of soy food consumption and isoflavone intake. This instrument may be a useful tool in studies of the associations between isoflavone exposure and risk for chronic disease.

Adult↗