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PubMed1995

International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods.

The aetiology of asthma and allergic disease remains poorly understood, despite considerable research. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease, by establishing a standardized methodology and facilitating international collaboration. Its specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases. The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence.

Adolescent↗
PubMed2002

Pain measurement tools and methods in clinical research in palliative care: recommendations of an Expert Working Group of the European Association of Palliative Care.

An Expert Working Group was convened under the auspices of the Steering Committee of the Research Network of the European Association of Palliative Care to review the status of the use of pain measurement tools (PMTs) in palliative care research conducted in a multilingual-multicenter setting. Based on a literature review and on the experts' opinion, the present work recommends that standardized methods should be applied for the use of PMTs in research in palliative care. Visual analogue scales, numerical rating scales, and verbal rating scales are considered valid to assess pain intensity in clinical trials and in other types of studies. Among the multidimensional questionnaires designed to assess pain, the McGill Pain Questionnaire and Brief Pain Inventory are valid in many multilingual versions. Specific recommendations for PMT use and administration, depending on the study type and aim, are reviewed. Special population requirements specific of clinical situations encountered in palliative care (elderly, terminal, cognitively impaired patients, pediatric patients) are also considered.

Europe↗
PubMed1995

Pediatric residents' continuity clinics: how are we really doing?

The Accreditation Council for Graduate Medical Education (ACGME) established guidelines in 1989 requiring pediatric residents to attend a continuity clinic (CC) one half-day per week. OBJECTIVE. To assess pediatric residents' CCs, with an emphasis on those factors potentially affecting house staff education and patient care. DESIGN AND PARTICIPANTS. A multi-item questionnaire designed to assess the educational, administrative, and clinical components of CCs was distributed to all US CC directors. RESULTS. Responses were received from 164 programs (74.9%), which represented more than 90% of all house staff in accredited US pediatric programs. Fifty-five percent of programs acknowledged non-ACGME-approved exemptions from attendance, and 64% changed CC schedules dependent on in-patient rotation assignment. Less than half of the programs had core curricula or didactic conferences. Most programs (76%) were located in hospital clinics. Clinic resources and equipment were often limited; faculty preceptors and nursing and clerical support staff were frequently insufficient in number. On average, PL1s saw four patients per session, whereas PL2s and PL3s saw five. Continuity of care for the patient for phone calls, acute and after-hours visits, and hospitalization was limited. Directors' perceived support for CCs' educational programs ranged from a high of 87% by generalists to a low of 33% by intensivists. CONCLUSIONS. Despite the ACGME directives, many residency programs have not provided the required priority, protected time, or adequate resources for CCs. The recent emphasis on health care reform and primary care medical education highlights the prominent role the CC should play as an important site in our teaching of longitudinal and ambulatory medicine. Departmental support and committed resources necessary to enhance the experience and to meet the educational challenge successfully will be required.

Ambulatory Care↗
PubMed1995

Using a pen-based computer to collect health-related quality of life and utilities information.

We have developed a system that uses the Newton MessagePad technology as part of a client-client-server paradigm to collect health-related quality of life information from breast cancer patients attending an outpatient clinic at the Dana-Farber Cancer Institute. Patients are asked to fill out an electronic questionnaire on the Newton, which then uploads the information into the institution's Oracle database. The program consists of a separate questionnaire engine and question base, facilitating questionnaire design and allowing us to give different questionnaires to different patients dynamically. The results of a preliminary trial show excellent user-acceptance of the device. Finally, we present a general framework for such systems and discuss issues that developers must consider when implementing a pen-based computer project.

Adult↗
PubMed1992

Effects of speech output type, message length, and reauditorization on perceptions of the communicative competence of an adult AAC user.

The effects of speech output type, aided message length, and partner reauditorization on naive observers' perceptions of the communicative competence of an adult augmentative and alternative communication (AAC) system user were examined. Subjects consisted of 48 naive adults with minimal exposure to nonspeaking persons. Eight scripted videotaped conversational conditions involving an AAC user and a normal-speaking partner were employed in the manipulation of the three independent variables. A balanced incomplete block design was used. Following each viewing, subjects completed a questionnaire designed to assess the communicative competence of the AAC user. Results indicated a significant main effect for aided message length only. Ratings of the AAC user were higher in conditions with phrases than in conditions with single-word messages. Of interest was the finding that the use of digitized versus synthesized speech output had no effect on observer ratings. Clinical implications are discussed.

Adult↗
PubMed1993

National Family Health Survey.

The authors outline the organization and administration of India's National Family Health Survey, for which data collection was scheduled for completion in June 1993. Data analysis and survey objectives are discussed, as well as some political factors affecting data collection. It is noted that "the National Family Health Survey is...a large-scale sample survey covering 97 per cent of the population and involving more than 90,500 households.... Another feature of the NFHS is its uniformity in questionnaire design, sample design, data collection and analysis. This uniformity provides an opportunity for inter-state comparison."

Asia↗
PubMed2002

Stability of questionnaire items measuring behaviours, attitudes and stages of change related to sun exposure.

The use of questionnaires in epidemiological studies needs more methodological research. The time and effort spent on questionnaire design is often limited. Studies on the construction of questionnaires could lead to a higher quality of data, enhanced comparability and improved credibility of epidemiological findings. The aim of the present study was to examine the test-retest reliability of some common items measuring sun-related variables. A sample of 52 female Swedish nurses attending a postgraduate course in research methodology was chosen. They completed a questionnaire on two occasions spaced 3 weeks apart in the winter of 2000. When the results were analysed, items on sun-related behaviours and sunbed use were sufficiently reliable. The items on skin type and sunburn showed moderate stability. Stage of change related to sunlight exposure, items measuring beliefs about sunbathing along with items assessing self-efficacy and risk perception with regards to sunbathing showed lower stability. The results showed that many essential items concerning exposure to ultraviolet radiation and sunburns were sufficiently stable, but other items were less stable and could be improved upon; suggestions for improving these items are presented. The study illustrates the value of reliability testing in the process of item construction. Using methodological studies to improve the reliability and validity of data is an important step toward higher standards for questionnaire surveys.

Adult↗
PubMedDate not supplied

Psychosocial predictors of healthful dietary behavior in adolescents.

OBJECTIVE: To identify predictors of healthful dietary practices in adolescents using the Theory of Planned Behavior and determine how gender and ethnicity influence the relationship among the theoretical constructs. DESIGN: Initial and 1-month follow-up questionnaires, designed to measure the constructs of the Theory of Planned Behavior and select demographic items, were administered to the participants in the spring of 1997 to gather data for this descriptive research. SETTINGS/PARTICIPANTS: A sample of 780 adolescents, aged 14 to 19 years, was recruited from randomly selected science classes at 4 public high schools in San Bernardino, California. Seven hundred and fifty participants (96%) completed the initial questionnaire and 672 (86%) completed the follow-up questionnaire. ANALYSIS: A 5-step hierarchical multiple regression procedure, general linear model analysis, and Tukey's honestly significant difference post hoc test were used to analyze the data. RESULTS: Intention to eat a healthful diet was a predictor of healthful dietary behavior. Intention was influenced most by attitude and then by perceived behavioral control and subjective norm. Those with positive attitudes toward healthful eating believed that they would like the taste of healthful foods, feel good about themselves, tolerate giving up foods that they like to eat, and lose weight or maintain a healthful weight. Mother, siblings, and friends were identified as important predictors of subjective norm. Knowledge about how to eat a healthful diet, availability of healthful foods, motivation, and access to enough money were salient facilitating factors related to perceived behavioral control. Interesting contrasts among gender and ethnic groups also were noted. CONCLUSIONS AND IMPLICATIONS: The findings indicate that multiple attitudinal, normative, and control factors influence healthful dietary behavior in adolescents. The synergistic use of these factors in the development and implementation of nutrition education interventions may assist in the promotion of healthful eating among teens from culturally diverse communities.

Adolescent↗
PubMed2001

Validity and reproducibility of a self-administered questionnaire to determine dietary supplement users among Japanese.

OBJECTIVE: To evaluate reproducibility and validity of a self-administered food frequency questionnaire (FFQ) to determine the dietary supplement use. DESIGN: Questionnaire data were compared with dietary records (DR) in four 7 day periods for validity. FFQ1 and FFQ2 administered at an interval of approximately one year were compared for reproducibility. SETTING AND SUBJECTS: A total of 361 samples were selected for a validation study of a questionnaire from the subgroup of the Japan Public Health Center-based prospective Study on cancer and cardiovascular disease (JPHC Study) cohort II. Categories of dietary supplements in the FFQ were 'multivitamins', 'beta-carotene', 'vitamin C', 'vitamin E', and 'other supplements'. For each category, inquiries were made as to the brand name, frequency and duration of use. A dietary supplement user was defined as a subject who used a dietary supplement one or more times a week for a year or longer. RESULTS: Prevalence of overall supplement use was 10.9%. Percentage agreement between FFQ1 and FFQ2 was 91.7%. Sensitivity and specificity of supplement use by FFQ were 80.6% and 89.2%, respectively. Sensitivity was high for 'vitamin C'. When the self-reported categories were corrected, sensitivity for 'multivitamins' and 'vitamin E' improved. CONCLUSIONS: The FFQ on dietary supplements used for the JPHC 5 y follow-up survey was valid to determine overall use and well-defined dietary supplement use such as vitamin C. Categories must be corrected when determining multivitamin and 'vitamin E'.

Ascorbic Acid↗
PubMed1993

Reproducibility and validity of a postal questionnaire. The abdominal symptom study.

OBJECTIVE: To find out whether it is possible to examine abdominal/gastrointestinal symptoms by a postal questionnaire. DESIGN: In the Abdominal Symptom Study a postal questionnaire was sent to a representative sample of adults (n = 1290) on two occasions, one year apart. The questionnaire was sent a third time to a subsample (n = 110), and to another sample (n = 213) who had not seen the questionnaire before. A subsample (n = 150 of the 1290) was subjected to a medical interview and examination. SETTING: The municipality of Osthammar, Sweden. PARTICIPANTS: A sample (9.3%) of all Swedish citizens (20-79 yrs) in the municipality. MAIN OUTCOME MEASURE: Reproducibility and validity of a postal questionnaire. RESULTS: The response rate was 90%. Roughly 50% of the study population reported abdominal symptoms. The reproducibility of the results was satisfactory, as was the validity of the questionnaire evaluated by medical interview and examination. Non-responders did not report more symptoms than responders. CONCLUSION: It is possible to examine abdominal/gastrointestinal symptoms with a postal questionnaire. The questionnaire used in The Abdominal Symptom Study seems to be useful for this purpose.

Abdominal Pain↗
PubMedDate not supplied

[The comparison of tianeptine and carbamazepine in benzodiazepines withdrawal symptoms].

Dealing with benzodiazepine dependent creates as serious clinical problem that requires knowledge and experience. Abrupt discontinuation of benzodiazepines, particularly those with short half-life is not advised to avoid severe withdrawal syndrome. Reports from literature suggest use of carbamazepine and recently tianeptine as substances useful in treatment of benzodiazepine dependence. This paper presents a double-blind trial in which both, carbamazepine and tianeptine were used in treatment of benzodiazepiene withdrawal syndrome. Patient mental state was evaluated by using questionnaire SCL-90, Beck Depression Inventory and specifically designed questionnaire assessing severity of symptoms following benzodiazepine withdrawal. It appears from this study that both drugs (carbamazepine and tianeptine) are comparable, safe and efficient in treating benzodiazepine withdrawal symptoms.

Adult↗
PubMed2003

Use of psychometric techniques in the analysis of epidemiologic data.

PURPOSE: This article demonstrates techniques for developing reliable multi-item scales for analysis of complex public health data. METHODS: Information from a questionnaire designed to evaluate the acceptability and efficacy of the female condom as a method for STD/HIV prevention was summarized using psychometric analysis. 1159 high-risk women attending STD clinics participated in this study. Questionnaire items were designed to measure nine domains of predictors of condom use. RESULTS: Principal components analysis was employed to reduce the number of potential predictors. Reliability of the multiple-item scales was assessed using Cronbach's alpha. Pearson's correlation coefficients were calculated to evaluate collinearity among multi-item scales. Approximately half (51%) of the questionnaire items that were analyzed were retained in the final scales. Data reduction procedures identified several multi-item scales with acceptable reliability (Cronbach's alpha >0.70). The correlation coefficients between scales was never >.5, suggesting that there was little collinearity among the scales. CONCLUSIONS: When focused on multiple partially interdependent determinants of an outcome, data reduction decreases the number of independent variables to be evaluated, ensures they have adequate reliability, maximizes strength of their association with outcomes, and reduces collinearity among predictors.

Adolescent↗
PubMed1989

A rationale for assessing sports activity levels and limitations in knee disorders.

Existing published knee rating systems that assess sports participation, knee function, and subjective symptomatology following ligamentous surgical procedures were analyzed. Major errors in questionnaire design and data reduction have led to invalid conclusions. A questionnaire containing a minimum set of rating criteria was formulated to validly assess athletic participation before and after treatment or surgery. Select questions and a data reduction format were established to assess the intensity of sports participation, changes in sports participation, the variables that produced the changes, self-assessed functional limitations, and the ability to participate in different types of sports. A clinical trial of the questionnaire was performed on 59 patients. An interview conducted upon completion of the questionnaire enabled the authors to detect difficulties or inconsistencies in the responses to the questions. The design format described in this report forms the basis for a subjective evaluation of ligamentous surgery. A standard format for analysis of sports participation and knee function is proposed to aid investigators in comparing variations in clinical results.

Clinical Trials as Topic↗
PubMed2003

The Eating Behavior Patterns Questionnaire predicts dietary fat intake in African American women.

OBJECTIVE: To develop a behavioral assessment of eating that would be predictive of fat intake in African American women. DESIGN: Questionnaires were developed using a three-stage design, involving item generation, item refinement, and questionnaire validation. SUBJECTS: Focus groups sessions were conducted with 40 African American women, initial questionnaire development employed 80 African American women, and questionnaire validation involved 310 African American women from diverse socioeconomic backgrounds. Statistical analyses Transcripts of focus groups were used to generate 113 behavioral questionnaire items. The initial questionnaire was administered along with a food frequency questionnaire, and the item pool was reduced to 51 items. Factor analysis was used to create subscales. Correlation (r) and multiple regression analysis (R) were used to evaluate construct validity. RESULTS: Factor analysis revealed six subscales: low-fat eating, emotional eating, snacking on sweets, cultural/ethnic, haphazard planning, and meal skipping. The scales are significant predictors of micronutrient (R values from 0.22 to 0.47) and macronutrient intakes (R values from 0.33 to 0.58) assessed using a food frequency questionnaire and show construct validity in relationship to other measures of eating behavior (r values from 0.22 to 0.65). APPLICATIONS: The Eating Behavior Patterns Questionnaire (EBPQ) may be a useful tool for clinical assessment, clinical and community nutrition intervention studies, and epidemiologic research with African American women.

Adult↗
PubMed1998

Communicative competence as perceived by adults with severe speech impairments associated with cerebral palsy.

The effects of aided message length (single-word vs. phrase-generated messages) and partner feedback (presence vs. absence of expanded message repetitions) on perceptions of the communicative competence of an adult augmentative and alternative communication (AAC) system user were examined. Subjects consisted of 12 nonambulatory adults with severe speech impairments associated with cerebral palsy. Four scripted videotaped conversational conditions involving the AAC system user and a typically speaking partner were employed to manipulate the two independent variables. A balanced incomplete block design was used. Following each viewing, subjects completed a questionnaire designed to assess the communicative competence of the AAC system user. Results indicated that neither independent variable had an impact on the subjects' ratings of communicative competence. Findings are compared with those from an earlier investigation, and clinical implications are discussed.

Adult↗
PubMed1994

The role of an initial single-blind placebo period in phase I clinical trials.

The effect of an initial single-blind placebo period in a phase I clinical trial was assessed in 12 volunteers who underwent five weekly treatment periods, consisting of treatment on the first day and a six-day wash-out period. An initial single-blind placebo period was followed by three different single doses of a platelet-aggregation factor inhibitor and another placebo period, under a double-blind Latin square design. Reports of abnormal symptoms were collected using a questionnaire designed by our group. A total of 13 abnormal symptoms were reported during the first period and only nine for the following four periods, indicating a clear placebo period effect. These preliminary results suggest that an initial single-blind period may be usefully included in phase I clinical trials.

Clinical Trials, Phase I as Topic↗
PubMed1996

The International Study of Asthma and Allergies in Childhood (ISAAC): objectives and methods; results from German ISAAC centres concerning traffic density and wheezing and allergic rhinitis.

The International Study of Asthma and Allergies in Childhood (ISAAC) was founded to maximize the value of epidemiological research into asthma and allergic disease by establishing a standardized methodology and facilitating international collaboration and comparison of data. The ISAAC design comprises three phases: Phase I uses validated core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations; Phase II will investigate possible aetiological factors suggested by findings of Phase I and apply lung, blood and skin tests; Phase III will be a repetition of Phase I after 5 years to assess time trends in the prevalence and severity of wheezing, rhinitis and eczema in each ISAAC centre. In 1991 a survey on wheezing and allergic rhinitis in 2050 12-15 year old adolescents in Bochum showed a positive correlation between the prevalence of wheezing as well as allergic rhinitis and indicators of traffic density, controlling for putative confounders such as age, sex, passive smoking, active smoking, etc. In 1994-1995 an ISAAC Phase I survey conducted on adolescents in Münster, applying methodology similar to that in Bochum, found positive associations between surrogate measures of traffic density and 12 months prevalence of wheezing and lifetime prevalence of allergic rhinitis of a magnitude very close to that found in Bochum. The results from the two German cities provide support to the hypothesis that exposure to automobile emissions is related to wheezing and allergic rhinitis in children.

Adolescent↗
PubMed2002

Increased fruit, vegetable and fiber intake and lower fat intake reported among women previously treated for invasive breast cancer.

OBJECTIVE: To describe the dietary intake patterns of women before and after breast cancer diagnosis. SUBJECTS AND SETTING: 3,084 women (age range 27 to 70 years) who had been treated for early-stage breast cancer, who were free of recurrent disease, and who were willing to complete study questionnaires. DESIGN: A descriptive analysis of baseline demographic and lifestyle questionnaire data, including reported dietary intake data from women who have had breast cancer participating in a randomized, controlled dietary intervention trial. Outcomes include dietary intakes of high- and low-fat foods, fruits and vegetables, and whole grains. STATISTICAL ANALYSIS PERFORMED: Analyses included frequency of intake of selected food items, chi2 analysis to determine associations between reported intakes and demographic and personal characteristics, and logistic regression to assess odds of making more healthful changes. RESULTS: Women who have had breast cancer reported higher fruit, vegetable, and fiber-rich food intakes (58%, 60%, 38% more, respectively) and lower intakes of high-fat foods, including fast foods, after diagnosis. Those older than age 60 years were more likely to report no change in intake, including red meat (41%), vegetables (51%), and whole grains (62%). Odds ratios (OR) for more healthful diet choices varied by age and time since diagnosis. The longer the time since diagnosis the more likely women selected low-fat (vs high-fat) foods (OR 1.56, 95% confidence interval [CI] 1.16-2.09 for 3 to 4 years vs <1 year after diagnosis) and reduced added fats (OR 1.47, 95% CI 1.17-1.84 for 3 to 4 years vs <1 year after diagnosis). APPLICATIONS: Women who have had breast cancer report more healthful diet habits after diagnosis. Through nutrition education and counseling, dietetics professionals may be able to promote healthful and evidence-based eating habits among women previously treated for breast cancer.

Adult↗