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The Strengths and Difficulties Questionnaire: a research note.

A novel behavioural screening questionnaire, the Strengths and Difficulties Questionnaire (SDQ), was administered along with Rutter questionnaires to parents and teachers of 403 children drawn from dental and psychiatric clinics. Scores derived from the SDQ and Rutter questionnaires were highly correlated; parent-teacher correlations for the two sets of measures were comparable or favoured the SDQ. The two sets of measures did not differ in their ability to discriminate between psychiatric and dental clinic attenders. These preliminary findings suggest that the SDQ functions as well as the Rutter questionnaires while offering the following additional advantages: a focus on strengths as well as difficulties; better coverage of inattention, peer relationships, and prosocial behaviour; a shorter format; and a single form suitable for both parents and teachers, perhaps thereby increasing parent-teacher correlations.

Adolescent↗

Preliminary evaluation of the Health Background Questionnaire for Pain and clinical encounter form for pain.

OBJECTIVES: The principal aims of this study were to evaluate the extent to which patients completed, understood, and were satisfied with the Health Background Questionnaire for Pain (HBQ-P), a health and pain history questionnaire that includes a modification of the Medical Outcome Study Short Form-36, the Treatment Outcomes in Pain Survey, and to examine the degree to which the questionnaire produced reliable and valid responses. A secondary aim was to determine the length of time for a physician to complete the Clinician Evaluation Form for Pain (CEF-P), a brief questionnaire designed to obtain key elements resulting from clinical assessment and management decisions. METHODS: This cross-sectional study utilized data from consecutive new patients seen from January to December 2001 in Drexel University College of Medicine's Pain Medicine and Comprehensive Rehabilitation Center at Graduate Hospital in Philadelphia, PA. The HBQ-P and an accompanying brief satisfaction inventory were completed at home by the patient prior to the individual's initial office visit. The CEF-P was completed by the physician after seeing the patient. RESULTS: Ten of 11 comparisons of patient responses to similar questions on the HBQ-P showed significant consistency. Of eight comparisons between the CEF-P and HBQ-P, two pain duration comparisons showed moderate agreement and one depression comparison showed significant association. Patients consistently had difficulty in answering six single questions and two question sets. Overall patient satisfaction was high. The mean time for the physician to complete the CEF-P was 90 seconds. CONCLUSIONS: Analyses indicate patient responses to similar HBQ-P questions have sufficient reliability to support the use of the Health Background Questionnaire for clinically related data collection and for outcome evaluation of treatments for chronic and recurring pain. The consistently missed questions on the HBQ-P should be revised.

Adult↗

The HK/MBD questionnaire: replication and validation of distinct factors in a nonclinical sample.

Although Tarter et al.'s (1977) HK/MBD questionnaire has been found useful in subtyping populations of clinical alcoholics, its potential utility in nonclinical populations has yet to be determined. The current study examined the family history, personality, and substance use/abuse correlates of Tarter et al.'s HK/MBD questionnaire and factor analytically derived subscales (Alterman and McLellan, 1986) in a nonclinical sample of 580 young, adult males. In addition, a factor analysis of the HK/MBD questionnaire was undertaken to assess the extent to which the factor structure determined on a clinical alcoholic sample replicates in a nonclinical sample. Results indicated that each of the HK/MBD subscales showed relatively unique patterns of correlations with the various personality measures employed suggesting that they are measuring separate constructs. Perhaps of greatest importance, the HK/MBD items that appear to be of greatest relevance for understanding substance use/abuse are those related to antisocial behavior. Finally, the factor structure of the HK/MBD questionnaire in the nonclinical sample was found to be quite similar to the structure obtained in a clinical sample. These results demonstrate the multidimensional structure of the HK/MBD questionnaire and the utility of using the more homogeneous subscales in research with both clinical and nonclinical samples.

Adult↗

Distinguishing Alzheimer's disease from other dementias. Questionnaire responses of close relatives and autopsy results.

Epidemiologic study of Alzheimer's disease by family history requires that Alzheimer's be distinguished from other dementias. Identification of demented family members is usually based on recall by relatives. This study examines the validity of the classification of Alzheimer's disease and other dementias based on relatives' reports. Close relatives of autopsy-confirmed dementia cases were asked to complete a questionnaire describing the patient's symptoms. These informants were familiar with the patient's disease and involved in his/her care prior to death. The questionnaire included the DSM-III criteria for Primary Degenerative Dementia and the Hachinski Ischemic Scale. A diagnosis derived from the close relatives' responses was compared to the neuropathologic diagnosis for thirty-six cases: 20 Alzheimer's disease, 9 mixed Alzheimer's disease, and 7 non-Alzheimer's disease dementias. The diagnosis of Primary Degenerative Dementia derived from questionnaire responses had a sensitivity of 0.93 and specificity of 0.43 for pathologic Alzheimer's disease. Few vascular dementias were included in the series, thereby precluding the study of so-called multi-infarct dementia. Hachinski scores based on relatives' responses classified 40% of pathologically pure Alzheimer's disease cases as multi-infarct dementia (HIS greater than 7). Thus, using these elevated Hachinski scores to rule out Alzheimer's disease would cause substantial misclassification. Diagnosis based on questionnaire Primary Degenerative Dementia criteria was quite sensitive but relatively nonspecific. When attempting to obtain a complete family history or pedigree that describes the occurrence of Alzheimer's disease and other dementias in all family members, the questionnaire approach should be supplemented with additional information from medical records, physicians, and other relatives.

Aged↗

A questionnaire to screen for cognitive impairment among elderly people in developing countries.

Most questionnaires designed to assess cognitive impairment among elderly people are constructed in the West, where literacy is high. However, such questionnaires may not be applicable in developing countries because of cultural differences or low literacy. The Elderly Cognitive Assessment Questionnaire (ECAQ) is derived from items in the Mini-Mental State Examination and Geriatric Mental State Schedule. It is a satisfactory scale for quantitative assessment of cognitive impairment among elderly people living in developing countries. This 10-item questionnaire shows a sensitivity of 85.3%, specificity 91.5%, positive predictive value 82.8% and overall miscalculation rate 10.5%. In a sample of 105 elderly subjects from 2 day centres and a psychiatric outpatient clinic in Singapore, the ECAQ was compared with Kahn's Mental Status Questionnaire. The sensitivity of the scales was found to be similar but the ECAQ had a higher specificity and positive predictive value, and lower overall miscalculation rate.

Age Factors↗

Development of an antidepressant compliance questionnaire.

OBJECTIVE: The development of the Antidepressant Compliance Questionnaire (ADCQ), assessing patients' attitudes and beliefs on depression and antidepressants. METHOD: A 51-item questionnaire was applied to 85 psychiatric out-patients with a DSM-IV diagnosis of major depressive disorder (MDD). This data set was used to assess psychometric properties of the ADCQ. The questionnaire was also applied to 272 primary care out-patients with MDD. RESULTS: A principal component analysis revealed four dimensions with good internal consistency and acceptable test-retest reliability: 'perceived doctor-patient relationship', 'preserved autonomy', 'positive beliefs on antidepressants' and 'partner agreement', resulting in a final questionnaire comprising 33-items. Responses were independent from depression severity and patient age. The response patterns of both psychiatric and primary care patients are provided and illustrate the many erroneous beliefs on antidepressants. CONCLUSION: The ADCQ has good psychometric properties; further investigation should investigate whether this questionnaire is predictive of patient compliance.

Major Depressive Disorder↗

Reproducibility of response to a questionnaire on symptoms of masticatory dysfunction.

The aim of the present investigation was to check the reproducibility of answers to multiple-choice questions used in a questionnaire. The questionnaire was concerned with symptoms in patients with dysfunction of the masticatory system. Five main types of questions were tested by repetition within 1 week by 98 patients. Comparisons were also made between questionnaire data and clinical findings. The interval between the questionnaire and the clinical examination was 1 week. The best reproducibility was found for answers to a question about previous joint radiography, which was the simplest question with the fewest alternatives. The second best was found for a question about the duration of the symptoms referable to the masticatory system. The poorest reproducibility was noted for a question about masticatory muscle pain. The comparison between the questionnaire data and clinical findings showed the best agreement for joint sounds. The reported pain symptoms and palpatory tenderness seem to be different entities.

Humans↗

Reproducibility of indoor environment characteristics obtained in a walk through questionnaire. A pilot study.

Walk through questionnaires may be feasible tools to obtain data on the indoor environment in community studies. However, limited information is available regarding the reproducibility of the data obtained through these questionnaires. In this pilot study, two construction engineering students inspected ten dwellings twice by means of a standardized walk through questionnaire. The two engineering students inspected the dwellings independent of each other within two months. Time between the two visits varied between 14 and 40 days. The variables presented were based on information from the residents and inspection. The continuous variables recorded included number of rooms in the dwellings, room volume, length of filled shelves and textile area. The inter- and intra-observed variabilities were poorer for number of rooms and shelf factor than for the other variables. For the 3 of the 9 categorical variables based on inspection, the inter-observer comparison showed complete agreement with a kappa statistics of 1.0, these variables being condition of the window frames and construction of outside walls and roof. One of the categorical variables showed a kappa statistics of < 0.5, these variables being presence of basement and presence of condensation at windows. This study indicates a wide variation in observer variability between various items of a walk through questionnaire. Clear definitions of all the parts of the questionnaire are needed, as well as thorough training of observers.

Air Pollution, Indoor↗

Estimating children's eating habits. Validity of a questionnaire measuring food frequency compared to a 7-day record.

A questionnaire measuring food frequency was validated against 7-day records of food intake in a group of 30 children, 2-16 years of age. Special emphasis was given to the ability of the questionnaire to estimate frequency of intake of foods of particular interest in diabetes mellitus. Fifteen children had insulin-dependent diabetes; 15 were healthy. Comparison of the two methods regarding frequency of foods with high content of sucrose, protein, fat, fibres, nitrite or vitamin C showed a correlation of 0.52-0.76. The frequency of intake of some staple foods was often overestimated by the questionnaire, while the frequency of meat, sausage and some sweet snacks was underestimated. The use of the questionnaire to identify high or low consumers of the mentioned nutrients showed a rather low sensitivity (0.38-0.50), but a high specificity (0.86-1.0) when compared with results of the 7-day record. In our limited sample of subjects no systematic differences were found comparing sexes or diabetic and healthy children. A food frequency questionnaire may, in spite of some important reservations, be a useful tool for screening purposes when more time-consuming and resource-demanding methods cannot be used.

Adolescent↗

Questionnaire study of canine neutering techniques taught in UK veterinary schools and those used in practice.

OBJECTIVES: To gather information about the different techniques employed in general practice and to compare this with current undergraduate teaching. This would provide an insight into any areas of discrepancy and influences on technique in practice. METHODS: A questionnaire was composed and distributed to 407 practices throughout the UK, using a commercial mailing list. Fifty further questionnaires were distributed by final-year students to their foster practices and five were sent to practices on request. A second questionnaire was composed and sent to the members of staff responsible for teaching surgical neutering techniques at each of the UK veterinary schools. RESULTS: Completed questionnaires were received from 183 respondents. These were compared with seven questionnaires from university teachers. Only areas in which the teachers reached a consensus of opinion were directly compared. CLINICAL SIGNIFICANCE: Several areas of discrepancy between current teaching and techniques in practice were identified. A study of complications compared with technique would provide further information. There is a lack of published material or an evidence base in many aspects of surgical neutering to support one technique over another.

Animals↗

Short fat questionnaire: a self-administered measure of fat-intake behaviour.

A brief questionnaire has been developed to measure behaviour related to dietary fat intake. It is self-administered and self-coded. Mean completion time is about three minutes. Criterion validity was assessed by comparison with a well-established food frequency questionnaire using 124 adults from Newcastle and Sydney. The correlations with the questionnaire scores were: r = 0.55 for total fat as a percentage of total energy, r = 0.67 for saturated fat as a percentage of total energy, and r = 0.44 for polyunsaturated to saturated fat ratio. Reproducibility was assessed by re-use by 25 subjects after seven to nine months (r = 0.85). When used in a community survey of other 300 randomly chosen people in the Hunter Region, the mean scores for men and for women and among different age groups were significantly different. The questionnaire was strongly associated with other scales measuring attitudes, behaviour and knowledge related to low-fat diets. The questionnaire appears suitable for rapid self-assessment by subjects, and as it directs their attention to aspects of their diet which might need improvement, it could be used for health education. It might also be used for epidemiological studies to rank subjects broadly according to their fat-intake behaviour.

Adolescent↗

Evaluation of health questionnaires used in dentistry.

An evaluation of a patient's general health before dental treatment is necessary to identify any systemic conditions, which may influence treatment and allow the dentist to evaluate risks, and reduce possible complications. Of the 860 dentists contacted by mail, 112 provided health questionnaires used in their offices. The authors evaluated the information in these questionnaires by describing content and rating them according to the importance of each topic. Questions were divided into categories and compared against a standard list of health-related topics. The authors also assessed the questionnaires based on dentists' area of specialization and length of clinical experience. It was not possible to establish a statistically significant correlation between the quality of a health questionnaire and dentists' specialty or length of experience; however, the questionnaires used by periodontists were rated as more comprehensive than those adopted by pedodontists (p < 0.05). Overall, the topics asked about most frequently were allergies, diabetes, and patient drug use.

Analysis of Variance↗

'Lost and found': some logical and methodological limitations of self-report questionnaires as tools to study cognitive ageing.

Laboratory tests show a decline in memory efficiency with age, but may not reflect highly practiced everyday memory skills. Self-rating questionnaires probe memory efficiency in everyday life, but seven logical and methodological problems ambiguate interpretation of the data they yield. To explore these problems, 442 volunteers aged from 50 to 85 years were given the AH 4 IQ tests, Mill Hill Vocabulary Tests, Beck Depression Inventory (BDI), Broadbent Cognitive Failures Questionnaire (CFQ), Sunderland & Harris Memory Failure Questionnaire (MFQ), the 'Lost and Found' Questionnaire (LF, a new domain-specific probe of the variety, frequency and aetiologies of losses of possessions) and two laboratory memory tests. All self-rating questionnaire scores correlated modestly with each other. Counter-intuitively, individuals over 60 years old reported fewer lapses on the LF and on the CFQ. No SRQ scores correlated with performance on laboratory tasks. CFQ scores did not correlate with IQ test scores but high IQ test scorers reported greater recent decline in memory efficiency (MFQ) and greater current frequency of losses of objects (LF). CFQ and LF scores correlated positively with Beck Depression Inventory scores, suggesting some common loading for poor self-regard. The results suggest that subjective self-ratings cannot reflect absolute levels of everyday competence, but only the relative success of individuals' adaptations to idiosyncratic environments which, as they age, may change faster than their abilities. However, besides exposing the limitations of self-report techniques, these analyses also suggest practical ways of adapting and using SRQs which may allow us to gain better insights into changes and individual differences in functional efficiency in everyday life.

Aged↗

The Health Status Questionnaire: achieving concordance with published disability criteria.

AIM: To compare the Health Status Questionnaire with established methods of assessing disability in preterm and very low birthweight infants. METHOD: All survivors of gestational age <31 weeks or birth weight <1500 g, born in 1994 to women resident in Wales were identified. Assessments were by a single observer at a median corrected age of 28.3 months and included the Health Status Questionnaire and a Griffiths developmental test. Outcome was also described according to criteria for disability used in three published studies. RESULTS: There were 297 survivors of which 279 (94%) were assessed. Using the Health Status Questionnaire, severe disability was found in 12.9% of cases compared to 8.2%, 2.9%, and 3.6% using the Northern, Victorian, and Mersey outcome criteria respectively. Following the simple modifications of removing the growth criteria from the Health Status Questionnaire and reclassifying the severe disability group in the Victorian and Mersey criteria, comparable severe disability rates ranging from 7.9% to 9.3% were found. CONCLUSION: The Health Status Questionnaire requires no formal training, is rapid to perform, and with simple modifications provides comparable results to established methods of assessing disability. Its use in the follow up of preterm and very low birthweight infants should be encouraged.

Child, Preschool↗

The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy.

BACKGROUND: There is no disease specific, reliable, and valid clinical measure of Achilles tendinopathy. OBJECTIVE: To develop and test a questionnaire based instrument that would serve as an index of severity of Achilles tendinopathy. METHODS: Item generation, item reduction, item scaling, and pretesting were used to develop a questionnaire to assess the severity of Achilles tendinopathy. The final version consisted of eight questions that measured the domains of pain, function in daily living, and sporting activity. Results range from 0 to 100, where 100 represents the perfect score. Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy (n = 45), presurgical patients with Achilles tendinopathy (n = 14), and two normal control populations (total n = 87). RESULTS: The VISA-A questionnaire had good test-retest (r = 0.93), intrarater (three tests, r = 0.90), and interrater (r = 0.90) reliability as well as good stability when compared one week apart (r = 0.81). The mean (95% confidence interval) VISA-A score in the non-surgical patients was 64 (59-69), in presurgical patients 44 (28-60), and in control subjects it exceeded 96 (94-99). Thus the VISA-A score was higher in non-surgical than presurgical patients (p = 0.02) and higher in control subjects than in both patient populations (p<0.001). CONCLUSIONS: The VISA-A questionnaire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects. The continuous numerical result of the VISA-A questionnaire has the potential to provide utility in both the clinical setting and research. The test is not designed to be diagnostic. Further studies are needed to determine whether the VISA-A score predicts prognosis.

Achilles Tendon↗

Validating the SF-36 health survey questionnaire: new outcome measure for primary care.

OBJECTIVES: To test the acceptability, validity, and reliability of the short form 36 health survey questionnaire (SF-36) and to compare it with the Nottingham health profile. DESIGN: Postal survey using a questionnaire booklet together with a letter from the general practitioner. Non-respondents received two reminders at two week intervals. The SF-36 questionnaire was retested on a subsample of respondents two weeks after the first mailing. SETTING: Two general practices in Sheffield. PATIENTS: 1980 patients aged 16-74 years randomly selected from the two practice lists. MAIN OUTCOME MEASURES: Scores for each health dimension on the SF-36 questionnaire and the Nottingham health profile. Response to questions on recent use of health services and sociodemographic characteristics. RESULTS: The response rate for the SF-36 questionnaire was high (83%) and the rate of completion for each dimension was over 95%. Considerable evidence was found for the reliability of the SF-36 (Cronbach's alpha greater than 0.85, reliability coefficient greater than 0.75 for all dimensions except social functioning) and for construct validity in terms of distinguishing between groups with expected health differences. The SF-36 was able to detect low levels of ill health in patients who had scored 0 (good health) on the Nottingham health profile. CONCLUSIONS: The SF-36 is a promising new instrument for measuring health perception in a general population. It is easy to use, acceptable to patients, and fulfils stringent criteria of reliability and validity. Its use in other contexts and with different disease groups requires further research.

Adolescent↗

Randomised comparison of three methods of administering a screening questionnaire to elderly people: findings from the MRC trial of the assessment and management of older people in the community.

OBJECTIVE: To compare three different methods of administering a brief screening questionnaire to elderly people: post, interview by lay interviewer, and interview by nurse. DESIGN: Randomised comparison of methods within a cluster randomised trial. SETTING: 106 general practices in the United Kingdom. PARTICIPANTS: 32 990 people aged 75 years or over registered with participating practices. MAIN OUTCOME MEASURES: Response rates, proportion of missing values, prevalence of self reported morbidity, and sensitivity and specificity of self reported measures by method of administration of questionnaire for four domains. RESULTS: The response rate was higher for the postal questionnaire than for the two interview methods combined (83.5% v 74.9%; difference 8.5%, 95% confidence interval 4.4% to 12.7%, P<0.001). The proportion of missing or invalid responses was low overall (mean 2.1%) but was greater for the postal method than for the interview methods combined (4.1% v 0.9%; difference 3.2%, 2.7% to 3.6%, P<0.001). With a few exceptions, levels of self reported morbidity were lower in the interview groups, particularly for interviews by nurses. The sensitivity of the self reported measures was lower in the nurse interview group for three out of four domains, but 95% confidence intervals for the estimates overlapped. Specificity of the self reported measures varied little by method of administration. CONCLUSIONS: Postal questionnaires were associated with higher response rates but also higher proportions of missing values than were interview methods. Lower estimates of self reported morbidity were obtained with the nurse interview method and to a lesser extent with the lay interview method than with postal questionnaires.

Aged↗

Measuring parent attributes and supervision behaviors relevant to child injury risk: examining the usefulness of questionnaire measures.

OBJECTIVE: This study aimed to identify self report questionnaire measures of parent attributes and behaviors that have relevance for understanding injury risk among children 2-5 years of age, and test a new Parent Supervision Attributes Profile Questionnaire (PSAPQ) that was developed to measure aspects of protectiveness and parent supervision. METHODS: Naturalistic observations were conducted of parents' supervision of children on playgrounds, with questionnaires subsequently completed by the parent to measure parent education, family income, parent personality attributes, attributes relevant to parent supervision, and beliefs about parents' control over the child's health status. These measures were then related to children's risk taking and injury history. RESULTS: Visual supervision, auditory supervision, and physical proximity were highly intercorrelated, indicating that parents employed all types of behaviors in service of supervision, rather than relying predominantly on one type of supervisory behavior. Physical proximity was the only aspect of supervision behavior that served a protective function and related to children's risk taking behaviors: parents who remained close to their children had children who engaged in less risk taking. On questionnaires, parents who reported more conscientiousness, protectiveness, worry about safety, vigilance in supervision, confidence in their ability to keep their child safe, and belief in control over their child's health had children who showed less risk taking and/or experienced fewer injuries. The new PSAPQ measure was associated with specific aspects of supervision as well as children's risk taking and injury history. CONCLUSIONS: This study reveals several parent attributes and behaviors with relevance for child injury risk that can be measured via self report questionnaires, including the new PSAPQ.

Accident Prevention↗