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PubMed2005

[A case-control study on road-related traffic injury in Shanghai].

OBJECTIVE: To explore the risk factors that influencing the occurrence of road-related traffic injuries, so as to provide related bases for controlling injuries. METHODS: A case-control study was conducted on 256 drivers with histories of accidents and their controls. EPQ questionnaire and a self-designed questionnaire were used to collect data. Risk factors would include behaviors as driving time per day, types of vehicles, time and status of sleep, degree of education, diet habits, feeling of tiredness, alcohol intake, time of watching television before driving and marriage status. Physiological index as blood type, blood pressure, cordial, using tranquillizers, disease history, reaction time, eyesight, overweight, etc. were also tested. Conditional logistic regression model was used to analyze risk factors. RESULTS: From all these tests, risk factors which including dietetic rhythm (OR = 1.815), tiredness (OR = 3.263), history of digestive disease (OR = 3.504), weak eye sight (OR = 3.825), being divorced (OR = 3.226), wake up early (OR = 4.931), mixed insomnia (OR = 5.719), simple reaction time (OR = 3.498), complex reaction time (OR = 2.292), P score (OR = 1.352), E score (OR = 1.439) were noticed to be significantly important. CONCLUSION: The occurrence of road-related injuries were related to a series of physiological, psychological and behavioral risk factors among drivers.

Accidents, Traffic↗

PubMed2006

Associations of decisional balance, processes of change, and self-efficacy with stages of change for increased fruit and vegetable intake among low-income, African-American mothers.

OBJECTIVE: To determine the relationship between stage of change and decisional balance, processes of change, and self-efficacy variables of the Transtheoretical Model to increase fruit and vegetable consumption by low-income, African-American mothers, and to assess the usefulness of the model for intervention efforts. DESIGN: We used a cross-sectional questionnaire design with a food frequency questionnaire and a staging algorithm to classify women by stage of change before enrollment. We used scaled questionnaire items based on think-aloud data to measure self-efficacy, processes of change, and pros and cons to increasing fruit and vegetable intake and variety. SUBJECTS/SETTING: We recruited a convenience sample of low-income, African-American mothers (n=420) aged 18 to 45 years with children <12 years of age to complete questionnaires at community-based sites. STATISTICAL ANALYSES PERFORMED: Analysis of variance, principal component analysis, chi(2) tests, correlation, and regression analyses were conducted. RESULTS: Perceptions of benefits for health and planning meals were stronger for women in later stages compared with earlier stages. The same relationship was observed for the use of processes of change related to becoming aware of health benefits and engaging in enabling behaviors, and variety of fruits and vegetables consumed. Self-efficacy based on eating fruits and vegetables for various eating occasions and in difficult situations was greater for women in later stages compared to earlier stages. CONCLUSIONS: Interventions for women in earlier stages should include making women aware of health benefits, increasing self-efficacy, and improving ability to make plans and engage in behaviors to increase intake.

Adolescent↗

PubMed1995

Trivial or terrible? The psychosocial impact of psoriasis.

BACKGROUND: Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment. METHODS: The present study utilized a new questionnaire designed to assess the type and degree of psychosocial impairment present among psoriasis patients. The questionnaire was designed to assess major areas of psychosocial functioning and was completed by 64 patients undergoing outpatient treatment. RESULTS: Approximately half the patients were found to have moderate to extreme levels of anxiety, depression, and anger. Patients reported experiencing these negative emotional sequelae both during their disease flares and during periods of remission. Patients were also found to have moderate to extreme levels of pruritus associated with their flares. Psychologic morbidity was positively associated with length of disease flare. Significant levels of social embarrassment, life disruption, and social withdrawal were found as well. CONCLUSIONS: Psoriasis does appear to cause significant psychosocial morbidity. Greater awareness by physicians and more comprehensive treatment addressing these psychosocial components may avert, or at least minimize, some of these negative sequelae.

Anger↗

PubMed2003

Pretesting survey instruments: an overview of cognitive methods.

This article puts forward the case that survey questionnaires, which are a type of measuring instrument, can and should be tested to ensure they meet their purpose. Traditionally survey researchers have been pre-occupied with 'standardising' data collection instruments and procedures such as question wording and have assumed that experience in questionnaire design, coupled with pilot testing of questionnaires, will then ensure valid and reliable results. However, implicit in the notion of standardisation are the assumptions that respondents are able to understand the questions being asked, that questions are understood in the same way by all respondents, and that respondents are willing and able to answer such questions. The development of cognitive question testing methods has provided social researchers with a number of theories and tools to test these assumptions, and to develop better survey instruments and questionnaires. This paper describes some of these theories and tools, and argues that cognitive testing should be a standard part of the development process of any survey instrument.

Attitude to Health↗

PubMed1998

Mail-in questionnaire for monitoring nausea and vomiting in oncology outpatients.

A patient questionnaire designed to help pharmacists monitor nausea and vomiting in outpatients receiving cancer chemotherapy was studied. A 12-item questionnaire was designed by combining items from the Morrow Assessment of Nausea and Emesis (MANE) and the Functional Living Index-Emesis (FLIE). Items included number of vomiting episodes, duration of nausea, number of antiemetics, severity of nausea and vomiting, impact on quality of life, and adverse effects. The questionnaire was printed on an addressed, postage-paid card. Over an eight-week period, outpatients in a hospital's oncology clinic were asked to complete the questionnaire at home during the three days after chemotherapy. Of 48 patients asked, 42 (88%) agreed to complete the questionnaire, and 36 (86%) of these patients mailed it back to the clinic. Of the respondents, 11 reported at least one episode of vomiting, and 22 reported nausea. Thirteen respondents logged nausea ratings of 3 or higher on a 7-point scale. Twenty respondents used antiemetics. Responses given by the patients in follow-up telephone interviews did not differ significantly from the responses collected with the questionnaire. More than 90% of patients who returned the questionnaire rated it as simple to complete. Pharmacists used the self-reports of nausea or vomiting in 7 (17%) of 42 cases to recommend alternative antiemetic regimens. A mail-in questionnaire for monitoring nausea and vomiting in outpatients undergoing chemotherapy was completed and returned by a high percentage of patients and was useful to clinic pharmacists.

Adult↗

PubMed2000

Respiratory-related quality of life: relation to pulmonary function, functional exercise capacity, and sputum biophysical properties.

One of the difficulties in assessing mucoactive therapy is selecting clinical outcome variables that reflect the impact of clearing airway secretions on quality of life (QOL). Petty and colleagues developed a questionnaire designed to evaluate the clinical impact of mucoactive therapy in patients with chronic bronchitis (CB). We evaluated this questionnaire in a multicenter study of a mucolytic medication used in patients with CB and hypothesized that spirometry, exercise capacity, and sputum clearability changes would correlate with QOL changes. This was a multicenter trial in 159 patients with stable CB (111 completed the 16-week study). Spirometry, plethysmography, the 6-minute walk test (6MWT), and Petty score as a measure of QOL were assessed at each visit. Sputum was collected at each visit. Cough transportability was measured in a cough machine, and mucociliary transportability was measured on the frog palate. Cohesivity was measured in a filancemeter, interfacial tension by de Noüy ring, and wettability by contact angle analysis. Within the entire data set of 694 evaluations, there was no correlation between pulmonary function and QOL. There was an inverse correlation with distance covered in a 6MWT (R(2) = 0.041, p < 0.0001). Sputum CTR was directly correlated with QOL (R(2) = 0.027, p < 0.0001). Change from baseline (mean of first three visits) was computed and compared the change in the mean of values at the 8- and 12-week visits (n = 108 sets of data pairs). This was analyzed as a percentage of change for continuous measurements, and as QOL is normative, we calculated the absolute change in QOL. There was no relation between QOL and 6MWT changes. There was an inverse relation between change in forced expiratory volume in 1 second and QOL (R(2) = 0.092, p = 0.0021) as well as between forced vital capacity and QOL (R(2) = 0.05, p = 0.024). There was a direct relation between CTR and QOL (R(2) = 0.039, p = 0.048). The relation between QOL and 6-minute walk distance was expected but weak. The consistent relation between CTR and QOL (suggesting that improved CTR of sputum is associated with decreased QOL) is difficult to explain. A change in forced expiratory volume in 1 second and forced vital capacity did correlate with a change in QOL. There is a need for a good QOL tool to evaluate mucus clearance devices or medications. The Petty questionnaire was designed specifically for this task, but the effect on sputum properties by current mucoactive agents may be too small to elicit a significant change in the Petty score.

Analysis of Variance↗

PubMed1994

Clinical and symptom measures.

We present a review of specific health status measures, including symptoms, physical examination, and laboratory tests (exclusive of lung function tests), in terms of their suitability for assessing the presence and severity of asthma in epidemiologic and clinical research. We focus on the validity, reliability, and responsiveness to clinical intervention of these measures. Several adult questionnaires designed for epidemiologic research include questions on asthma and wheezing that have demonstrated repeatability and validity against concurrent measurements of nonspecific airway responsiveness. The International Union Against Tuberculosis Bronchial Symptoms Questionnaire was designed specifically to detect asthma and airway hyperresponsiveness in adult populations, and its reliability and validity have been well documented. A childhood questionnaire developed by Australian investigators has been demonstrated to provide information on asthma and wheezing that is reliable and valid against the criterion of concurrently measured nonspecific airway responsiveness. Although suitable for epidemiologic research, these questionnaires do not provide sufficient data on the severity of current asthma symptoms (aspects of which include intensity, duration, and frequency of symptoms) to be useful for clinical research involving subjects with established asthma. Many different methods of obtaining and analyzing symptom data have been used in clinical trials, but these have not received the methodologic scrutiny that allow the recommendation of a "best" approach for evaluating symptoms in clinical trials of interventions for asthma. The use of daily symptom diaries in short-term drug trials is common, but the optimal symptom-reporting interval for such studies has not been established. Similarly, a particular approach to integrating different symptoms (wheeze, dyspnea, cough, sputum) and the different aspects of these symptoms (intensity, duration, frequency) cannot be recommended on the basis of available data. Physical examination findings have little utility as asthma outcome measures because they may be normal between symptom episodes, they have relatively poor interobserver reliability, and they are relatively poor predictors of the outcome of emergency room visits for asthma. The finding of an elevated arterial PCO2 has utility as an indicator of a severe asthma attack, but arterial blood gas measurements have little other utility as asthma outcome measures. The chest radiograph is generally normal in patients with asthma and therefore not useful as an asthma outcome measure.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2005

A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-QoL).

BACKGROUND: Health-related quality of Life in patients with chronic urticaria is evaluated by mean of generic instruments or questionnaire designed for skin diseases. No disease-specific tool is now available for the assessment of chronic urticaria impact from patients' viewpoint. OBJECTIVE: The aim of our study is to develop and validate a new questionnaire specifically designed for the assessment of quality of life in chronic urticaria (Chronic Urticaria Quality of Life Questionnaire -- CU-Q(2)oL). METHODS: In the development phase of CU-Q(2)oL an initial list of items of 37 items was compiled and given to 80 patients with chronic urticaria; the 23 most significant items were selected and converted into questions evaluating the answers on a Likert scale of five steps. The validation procedure involved 125 patients (86 F and 39 M) (age 42.17 +/- 9.24 years). RESULTS: Following a statistical analysis, CU-Q(2)oL showed a six-dimensional structure and good levels of internal consistency for the extracted factors: Pruritus (0.79), Swelling (0.65), Impact on life activities (0.83), Sleep problems (0.77), Looks (0.83) and Limits (0.74). In stable conditions CU-Q(2)oL showed a good reliability, ranged between 0.64 and 0.92. Responsiveness to clinical changes was accomplished. DISCUSSION: These results provide evidence that CU-Q(2)oL has specificity enough for being a valid tool for detecting the relative burden of CU on subjective wellbeing, and for obtaining a global evaluation both of CU impact and of treatments, taking into account the patient's point of view. The CU-Q(2)oL was easily and quickly filled up and well accepted by the patients.

Adult↗

PubMed1994

Development of the Leeds Dependence Questionnaire (LDQ): a questionnaire to measure alcohol and opiate dependence in the context of a treatment evaluation package.

The Leeds Dependence Questionnaire (LDQ) has been developed as part of a treatment evaluation package. The LDQ is a 10-item, self completion questionnaire designed to measure dependence upon a variety of substances; it has been shown to be understood by users of alcohol and opiates. The questionnaire was designed to be sensitive to change over time and to be sensitive through the range from mild to severe dependence; the follow-up data are insufficient to demonstrate change over time, but are encouraging. It is expected that both clinicians and researchers will find it useful to have a single measure relating to substance use, but not limited by specific substances. All items are scored 0-1-2-3; there are no normative data. The procedure for establishing content validity is described and estimates of concurrent, discriminant and convergent validities are reported; these validities are thought to be satisfactory. A principal components analysis produced a single factor accounting for 64% of the variance. Cronbach's alpha was 0.94. Test-retest reliability was found to be 0.95.

Adult↗

PubMed2004

Sociodemographic and symptom correlates of fatigue in an adolescent primary care sample.

PURPOSE: To describe the prevalence of prolonged fatigue, chronic fatigue syndrome (CFS)-like illness, and associated symptom patterns in adolescents attending primary care. METHODS: The design was cross-sectional. A questionnaire designed by the authors assessing fatigue and associated symptoms was administered to 901 adolescents (aged 11-18 years) attending 12 primary care clinics in the Chicago area. Prevalence rates for prolonged fatigue and CFS-like illness were calculated. Univariate comparisons involving sociodemographic data and fatigue severity were made between adolescents with and without prolonged fatigue, and sociodemographic and symptom predictors of prolonged fatigue were identified using logistic regression analysis. RESULTS: Prolonged fatigue (> or = 1 month) occurred at a rate of 8.0% and CFS-like illness occurred at a rate of 4.4%. Adolescents with prolonged fatigue were significantly older and also reported greater fatigue severity than those without fatigue. Findings from logistic regression indicated that, in addition to increasing age, headaches, muscle pains, fever, and fatigue made worse by exercise were significantly associated with prolonged fatigue. CONCLUSIONS: Abnormal fatigue is a disabling and prevalent condition in adolescents in primary care. It is associated with a number of additional symptoms, many of which may have viral origins.

Adolescent↗

PubMed1993

Variations in the treatment of childhood asthma.

OBJECTIVE: To survey the assessment and management of childhood asthma by paediatricians, general practitioners, and respiratory physicians, and compare these findings with the Australian and New Zealand Consensus Statement guidelines on asthma management in children. SETTING AND DESIGN: A six-item postal questionnaire designed to cover assessment, management of acute and mild asthma, use of prophylaxis and methods of delivery of medication. PARTICIPANTS: A random sample of 100 paediatricians, 300 general practitioners and 100 respiratory physicians. RESULTS: Response rates were: paediatricians, 88%; general practitioners, 66%; and respiratory physicians 51%. There was agreement between all three groups in most aspects of asthma management. Deviations from the Consensus Statement guidelines included: between 38% and 49% not using oxygen as one of the first-line treatments for acute asthma; a higher use of orally administered beta 2-agonists by general practitioners (up to 40% for children between one and three years compared with 17% of paediatricians and 12% of respiratory physicians); a tendency to use intravenously administered aminophylline before corticosteroids (20% of paediatricians, 40% of general practitioners and 30% of respiratory physicians); a preference among general practitioners and respiratory physicians to prescribe inhaled corticosteroids rather than sodium cromoglycate for prophylaxis in older children; and a low incidence of use of spacer devices in older children. CONCLUSIONS: If currently published recommendations on managing asthma in children are followed, there should be: more education and emphasis on the value of oxygen and short courses of orally administered corticosteroids in acute asthma management; less reliance on intravenously administered aminophylline; decreased use of orally administered beta 2-agonists coupled with a more wide-spread use of spacer devices; and an increased emphasis on sodium cromoglycate as first-line daily prophylaxis.

Acute Disease↗

PubMed1999

Evaluating the outcomes of low vision rehabilitation.

The requirement for those providing healthcare to measure outcomes raises the fundamental question of how these should be measured. Both the scale of the low vision population and the different models of care proposed make it a pressing need to determine outcomes using valid and reliable measures. In this study we describe the development and piloting of a questionnaire designed to meet this requirement. The questionnaire was piloted on 56 subjects with age-related macular degeneration (ARMD). Test-retest reliability of the questionnaire was estimated using a further sample of 28 subjects with ARMD. Pilot testing confirmed the feasibility of administering the questionnaire to an elderly population with ARMD. A total of 87% of the sample reported using an LVA (65% on a daily basis), predominantly for a reading task. The number of tasks an LVA was used for, its frequency of use, length of continuous use and ease of use are significantly associated with the rating of an LVA as important/less important (P < 0.0001), but the acuity achieved with the device is not significantly associated with rated importance (P = 0.11), reinforcing doubt about the validity of visual function outcomes. The limitations of this pilot study and earlier case series in describing the outcomes of low vision care are discussed and a randomised controlled trial using a broad range of outcomes is proposed in order to fully describe the effectiveness of low vision rehabilitation and inform the debate about models of care.

Aged↗

PubMed2006

[Impact of attachment style, social support and the number of implantable cardioverter defibrillator (ICD) discharges on psychological strain of ICD patients].

OBJECTIVE It is well known fact, that the life of ICD patients is often affected by anxiety and depression. The number of ICD discharges is only a contributing factor explaining the variance of anxiety and depression. There have to be other factors that have more influence on the physical strain of ICD patients. In this study we examined the impact of attachment style and social support in addition to the number of ICD discharges. METHODS 119 out-patients at an out-patient ICD unit were examined consecutively with the following self report scales: (1) the State-Trait-Anxiety Inventory (STAI), (2) the Beck Depression Inventory (BDI), (3) a short form of a social support questionnaire (F-SOZU), (4) the Bielefeld Partnership Expectations Questionnaire (BFPE) and (5) a specifically designed questionnaire for the assessment of sociodemografic data. To determine the frequency and timing of the ICD discharges we analysed the ICD data. RESULTS 38 % of the ICD patients reported enhanced anxiety levels and 37 % reported enhanced depression levels. Only 38 % of the ICD patients received discharges at all. Elevated levels of anxiety and depression were found in patients who showed insecure attachment styles, low social support, long-term treatment in hospital and a higher number of ICD discharges. To explain the variance of anxiety we found social support, attachment style, and the number of ICD storms to be contributing factors. To explain the variance of depression we found social support and time spent in hospital in the previous year to be contributing factors. CONCLUSIONS Almost half of the ICD patients suffer considerably from anxiety and/or depression. These patients have to be identified and treated psychotherapeutically. Patients who show insecure attachment styles, receive low social support, undergo long-term treatment in hospital and receive a higher number of discharges, especially so called ICD storms, bear the highest risk to develop psychological strain. Attachment style and social support have even more impact on the development of anxiety and depression than the number of ICD discharges. It has to be shown in future studies whether psychotherapy can improve the quality of life of ICD patients.

Aged↗

PubMed2006

Inaccessible novel questionnaires in published medical research: hidden methods, hidden costs.

Although critical analysis of survey research is limited when reviewers and readers cannot view a study's questionnaire, access to novel questionnaires used in published research has not been systematically examined. The authors identified publications reporting the results of novel questionnaires in three medical journals (JAMA, The New England Journal of Medicine, and The Lancet) in January 2000-May 2003 and searched portable document format (PDF) versions of the studies for the complete questionnaire or a Uniform Resource Locator (URL) providing access to the questionnaire. When the questionnaire was not provided in the publication or a published URL, the authors requested it from the corresponding author in writing up to three times over a 6-week period. Of 93 publications with novel questionnaires, four printed the questionnaire in the article and three provided online access. Corresponding authors failed to provide questionnaires for 37 of 81 (46%) studies. Novel questionnaires used in published research are frequently not available to readers or researchers. Policies that improve access to novel questionnaires will allow better assessment of study results, reduce duplicated efforts, and improve authorship attribution for questionnaire design.

Access to Information↗

PubMed1999

The quest for better questionnaires.

The development of questionnaires is a neglected enterprise in epidemiology. It has recently been proposed that a prestigious health authority such as the World Health Organization establish a committee to tackle issues of questionnaire quality, moving eventually toward standardized instruments. However, standardization may not be the best way to invigorate this enterprise. As an alternative, the author suggests that the first step in improving questionnaires would be to make them more accessible. Ideally, questionnaires should be as easily scrutinized as a study's methods or results. To this end, the author suggests that when a research paper is published, the entire questionnaire be made available on the worldwide web. Electronic access to questionnaires could stimulate a new era of awareness about the importance of questionnaire design.

Data Collection↗

PubMed2005

Temporomandibular disorders in association with scuba diving.

OBJECTIVE: To determine the prevalence of temporomandibular disorders (TMD) in scuba divers and to identify the risk factors for the development of pain in the stomatognathic system before and after diving by the use of a questionnaire. DESIGN: : Retrospective cohort study based on questionnaires. PARTICIPANTS: A total of 296 active divers, aged 18 to 65 years, participating in scuba diving meetings in Heidelberg, Germany. INTERVENTIONS: Each diver answered a questionnaire containing 29 questions, predominantly on symptoms of TMD. MAIN OUTCOME MEASURES: The data collected from the divers were calculated by the use of logistic regression tests. Risk factors for the development of TMD were evaluated. RESULTS: Clenching seemed to be the greatest risk factor for pain while holding the mouthpiece and for pain in the masticatory muscle system after diving. Limited mouth opening and clenching were responsible for the development of pain in the temporomandibular joint after the dive. The prevalence of TMD-related symptoms was higher in women before, during, and after the dive. CONCLUSIONS: Individuals exhibiting TMD-related symptoms seem to be at the greatest risk of developing pain in the masticatory muscle system and/or the temporomandibular joint during or after the dive.

Adolescent↗

PubMed1992

Adolescent medicine practice in urban Pittsburgh--1990.

Adolescent medicine has emerged as a discipline in the present era with few key curricular or skill areas clarified and little consensus regarding the acceptance and interest generated in pediatricians by this area. This investigation was undertaken to ascertain present adolescent medicine practice patterns in Pittsburgh, Pennsylvania. The data generated are intended to serve as a basis for future comparisons. The methodology was a questionnaire design, with 178 (54%) of the questionnaires returned and subjected to analysis. The results indicated that 6% of pediatricians actually limit their practices to patients 16 years of age or younger, and 65% limit their practices to patients younger than 19 years of age. Most practices (64%) do not have a gynecological table. Only 20% of practices offer clinical services which would match the needs of adolescent patients, such as the prescription of oral contraceptives, counseling for homosexuality, or treatment of dysfunctional uterine bleeding. Most interestingly, pediatricians report seeing few adolescents with drug and alcohol problems or sexually transmitted diseases. These data provide the basis for future investigations.

Adolescent↗

PubMedDate not supplied

Outpatient satisfaction: validation of a French-language questionnaire: data quality and identification of associated factors.

OBJECTIVES: Following 1996 legislation requiring French hospitals to assess patient satisfaction, this study developed and validated a brief French-language multidimensional questionnaire designed to measure outpatient satisfaction with hospital visits and compared data quality for two patient-satisfaction survey methods. DESIGN: Authors developed a 19-item questionnaire following a strict procedure (identification of dimensions to explore, formulation, and selection of items). SETTING: Validation data were obtained from patients of six outpatient clinics in a teaching hospital. PARTICIPANTS: 586 consenting eligible patients were randomized to receive the questionnaire 2 weeks after their visit with one of two survey methods: a mailed self-administered questionnaire or a telephone interview. RESULTS: The response rate (79%) was not significantly different between the two survey methods. The risk of having one or more missing values was higher in the mail survey group (odds ratio, 1.65; 95% confidence interval, 1.03-2.63), but mail respondents were less likely to use the "extremely positive" response category. Principal component analysis identified four factors that accounted for 56% of the variance: interpersonal skills and information transfer, physical surroundings, convenience, and appointment delay. Patients' comments on open-ended questions validated the semantic content of the factorial construct. The internal consistency coefficient was greater than 0.70 for three of four subscales. Patient background characteristics accounted for less than 10% of the factorial score variance. Patient satisfaction was correlated with age, type of visit, and, to a lesser extent, gender and education level. CONCLUSION: This easily administered, multidimensional out-patient-satisfaction questionnaire provided encouraging preliminary psychometric characteristics.

Adolescent↗