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Adherence to Gluten-Free Diet in Coeliac Paediatric Patients Assessed through a Questionnaire Positively Influences Growth and Quality of Life.
Pedoto, D, Troncone, R, Massitti, M, Greco, L, Auricchio, R
Nutrients. 2020;(12)
Abstract
Assessment of adherence to gluten-free diet (GFD) represents the cornerstone in the management of coeliac disease. The primary aim of this study was to assess diet adherence through a questionnaire adapted to children. The secondary aim was to identify influencing factors and outcomes related to diet adherence. In this study, data about diagnosis, education, quality of life (QoL) and anti-transglutaminase (anti-TG2) titers of 160 coeliac children were collected. For the assessment of diet adherence, all participants completed the questionnaire modified from Leffler et al. (2009), while a random sample of 37 also underwent an extensive dietary interview. According to the questionnaire, diet adherence was excellent in 95 (59.4%), fair in 46 (28.8%) and low in 19 (11.9%) patients. Children diagnosed with biopsy showed better adherence than those with a biopsy-sparing approach (p = 0.036). Adherence to GFD tended to worsen during the follow up, with the average length of follow up being associated with lower scores of diet adherence (p = 0.009). Moreover, adherence to GFD decreased throughout school career, dropping from elementary until high school (p = 0.037). A positive correlation was observed between adherence to GFD and growth percentiles, which increased when higher scores of adherence were achieved. Diet adherence positively correlated with QoL (p = 0.001). In conclusion, the questionnaire displayed good sensitivity in detecting problems in diet adherence, being useful as a screening tool. Better comprehension of influencing factors and outcomes may allow the development of new strategies to improve diet adherence.
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Reliability and validity of body weight and body image perception in children and adolescents from the South American Youth/Child Cardiovascular and Environmental (SAYCARE) Study.
González-Zapata, LI, Restrepo-Mesa, SL, Aristizabal, JC, Skapino, E, Collese, TS, Azzaretti, LB, Nascimento-Junior, WV, Moreno, LA, De Moraes, ACF, Carvalho, HB, et al
Public health nutrition. 2019;(6):988-996
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OBJECTIVE To assess the reliability and validity of body weight (BW) and body image (BI) perception reported by parents (in children) and by adolescents in a South American population. DESIGN Cross-sectional study. BW perception was evaluated by the question, 'Do you think you/your child are/is: severely wasted, wasted, normal weight, overweight, obese?' BI perception was evaluated using the Gardner scale. To evaluate reliability, BW and BI perceptions were reported twice, two weeks apart. To evaluate validity, the BW and BI perceptions were compared with WHO BMI Z-scores. Kappa and Kendall's tau-c coefficients were obtained. SETTING Public and private schools and high schools from six countries of South America (Argentina, Peru, Colombia, Uruguay, Chile, Brazil).ParticipantsChildren aged 3-10 years (n 635) and adolescents aged 11-17 years (n 400). RESULTS Reliability of BW perception was fair in children's parents (κ=0·337) and substantial in adolescents (κ=0·709). Validity of BW perception was slight in children's parents (κ=0·176) and fair in adolescents (κ=0·268). When evaluating BI, most children were perceived by parents as having lower weight. Reliability of BI perception was slight in children's parents (κ=0·124) and moderate in adolescents (κ=0·599). Validity of BI perception was poor in children's parents (κ=-0·018) and slight in adolescents (κ=0·023). CONCLUSIONS Reliability of BW and BI perceptions was higher in adolescents than in children's parents. Validity of BW perception was good among the parents of the children and adolescents with underweight and normal weight.
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Adults with alcohol use disorder may overreport dietary intake using the 1-year Diet History Questionnaire II.
Ratteree, K, Yang, S, Courville, AB, Sewall, A, Tuason, RTS, Kazmi, N, Brooks, A, Ames, N
Nutrition research (New York, N.Y.). 2019;:53-59
Abstract
Minimal recent research explores how alcohol use disorder (AUD) affects dietary intake during periods of alcohol consumption. Therefore, we aimed to assess the feasibility and utility of a computerized food frequency questionnaire, the Diet History Questionnaire II (DHQ II), to quantify dietary intake in adults with AUD. Participants were adult men and women seeking treatment for AUD at the National Institutes of Health Clinical Center. Participants (N = 21) were enrolled in an observational study examining the microbiome in AUD. The Web-based DHQ II, reflecting dietary intake over the past year, was administered to participants within 2 weeks of admission to an inpatient alcohol rehabilitation program. Descriptive data are reported as mean ± SEM. Analyses were run in the Statistical Package for the Social Sciences, and P < .05 was considered significant. Participants (67% male) were 46.3 ± 2.8 years old with a body mass index of 23.8 ± 0.6 kg/m2. Average energy intake was 27961.7 ± 3205.8 kj, alcohol intake was 4723.0 ± 75.8 g (45% kcal), carbohydrate intake was 514.3 ± 66.8 g (31% kcal), fat intake was 101.2 ± 13.6 g (16% kcal), and protein intake was 122.8 ± 17.0 g (8% kcal). In this population of adults with AUD, DHQ II results showed energy and micronutrient intakes that were higher than, but macronutrient distribution that was similar to, previous findings in similar populations.
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Prospective Validation of a Screening Tool to Identify Older Adults in Need of a Driving Evaluation.
Betz, ME, Haukoos, JS, Schwartz, R, DiGuiseppi, C, Kandasamy, D, Beaty, B, Juarez-Colunga, E, Carr, DB
Journal of the American Geriatrics Society. 2018;(2):357-363
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OBJECTIVES To prospectively validate and refine the 5-item "CRASH" screening tool for identifying older drivers needing a behind-the-wheel (BTW) test. DESIGN Prospective observational study. SETTING Geriatric and internal medicine primary care clinics affiliated with a tertiary care hospital and a local BTW program. PARTICIPANTS Cognitively intact drivers aged 65 and older (N = 315). MEASUREMENTS Participants completed baseline questionnaire (including CRASH tool) and assessments and BTW test (evaluator blinded to questionnaire results) and participated in 1-month telephone follow-up. Analysis included descriptive statistics and examination of predictive ability of the CRASH tool to discriminate normal (pass) from abnormal (conditional pass or fail) on the BTW test, with logistic regression and CART techniques for tool refinement. RESULTS Two hundred sixty-six participants (84%) had a BTW test; of these, 17% had a normal rating and 83% an abnormal rating. Forty-five percent of those with an abnormal score were advised to limit driving under particular conditions. Neither the CRASH tool nor its individual component variables were significantly associated with the summary BTW score; in refined models with other variables, the best-performing tool had approximately 67% sensitivity and specificity for an abnormal BTW score. Most participants found the BTW test useful and were willing to pay a median of $50. At 1-month follow-up, no participants had stopped driving. CONCLUSION The CRASH screening tool cannot be recommended for use in clinical practice. Findings on older adults' perceived utility of the BTW test and the stability of driving patterns at 1-month follow-up could be useful for future research studies and for design of older driver programs.
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Evaluation of the Greek TranQol: a novel questionnaire for measuring quality of life in transfusion-dependent thalassemia patients.
Klonizakis, P, Klaassen, R, Sousos, N, Liakos, A, Tsapas, A, Vlachaki, E
Annals of hematology. 2017;(11):1937-1944
Abstract
The aim of our study was to evaluate the Greek version of the transfusion-dependent quality of life (TranQol) questionnaire and report our experience of using this novel disease-specific quality of life (QoL) measure in patients with transfusion-dependent thalassemia (TDT). The TranQol and SF-36v2 questionnaires were administered to 94 adult TDT patients with a mean age of 32.1 years (SD = 7, range = 19-58), recruited from the Adult Thalassemia Unit of Hippokration General Hospital of Thessaloniki, Greece. The TranQol was evaluated in terms of construct validity, reliability, and responsiveness. There was a moderately strong correlation between the TranQol summary and both the SF-36v2 physical and mental component summaries (r = 0.4, p < 0.001 and r = 0.5, p < 0.001, respectively). There was also a moderately strong correlation between the physical health scale of TranQol and the relevant SF-36v2 scales, including physical functioning (r = 0.4, p < 0.001), role-physical (r = 0.6, p < 0.001), and bodily pain (r = 0.5, p < 0.001). TranQol also exhibited good internal consistency (Cronbach's alpha coefficient = 0.9) and excellent test-retest reliability (intra-class correlation coefficient = 0.9). The subgroup of patients that reported a better QoL 1 week after transfusion also demonstrated a significant improvement in their TranQol score. These are the first data regarding the administration of the Greek TranQol in a single thalassemia unit. The psychometric properties of the Greek TranQol confirmed it is a valid, reliable, and responsive to change questionnaire, which can be incorporated into future clinical trials.
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Psychometric Validation of the Heart Failure Caregiver Questionnaire (HF-CQ®).
Strömberg, A, Bonner, N, Grant, L, Bennett, B, Chung, ML, Jaarsma, T, Luttik, ML, Lewis, EF, Calado, F, Deschaseaux, C
The patient. 2017;(5):579-592
Abstract
BACKGROUND The Heart Failure Caregiver Questionnaire (HF-CQ®) was developed to assess subjective outcomes of heart failure caregivers. The HF-CQ® comprises 21 questions on three domains, namely physical, emotional/psychological and lifestyle. The objective of this study was to evaluate the psychometric properties of the HF-CQ®. METHODS Patients (n = 150) with heart failure and their primary caregivers (n = 150) were recruited from 11 sites in USA. Caregivers completed the HF-CQ® and additional questionnaires, namely Caregiver Reaction Assessment, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain, and the Hospital Anxiety and Depression Scale. Patient-completed Global Impression of Severity, construct validity, concurrent validity, reliability and responsiveness of the HF-CQ® were also assessed. RESULTS In the physical and lifestyle domains, all items showed acceptable validity. No high correlations between HF-CQ® scores and other caregiver-completed instruments, including the Hospital Anxiety and Depression Scale, Work Productivity and Activity Impairment questionnaire, EuroQol-5 domain or Caregiver Reaction Assessment, were reported. The intra-class correlation coefficient exceeded the threshold for reliability (>0.7) across the physical well-being (0.785), emotional/psychological (0.797), lifestyle (0.787) and total scores (0.850), indicating acceptable reliability. Internal consistency results using Cronbach's alpha showed the total aggregate score of 0.942 to be reliable. In the responsiveness analyses, each of the three scales and the total score showed responsiveness to changes defined by the Caregiver Global Impression of Severity. The overall caregiver burden score increased with increased severity of illness in the cared-for patients. CONCLUSIONS The study provides initial evidence for the acceptable validity of the HF-CQ® as an instrument to measure heart failure caregiver burden.
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Item response theory-based validation of a short form of the Eating Behavior Scale for Japanese adults.
Tayama, J, Ogawa, S, Takeoka, A, Kobayashi, M, Shirabe, S
Medicine. 2017;(42):e8334
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Obesity has become a serious social problem in industrialized countries in recent years. Clinically, although the evaluation of dietary behavior abnormalities is as important as any method of risk assessment for obesity, almost all the existing scales with many items may have numerous practical clinical difficulties. In this study, we aimed to prepare a short questionnaire to assess the dietary behavior abnormalities related to obesity. A total of 1032 individuals aged 20 to 59 years participated in the present study. Using item response theory (IRT), we selected the items for a short version from among 30 items of Sakata Eating Behavior Scale (EBS), which is widely used in Japan. As a result of the IRT-based analysis on the original 30-item version, 7 items were adopted as the short version. The correlation between the total score of the original EBS and the EBS short form was extremely high (r = 0.93, P = .001). In examining the criterion validity, for all participants (n = 1032), male (n = 516), and female (n = 516), the correlation coefficients between the total score of the EBS short form and body mass index (BMI) were r = 0.26, r = 0.28, and r = 0.28, respectively. The results of the receiver operating characteristic analysis was performed with obesity BMI > 25 kg/m as a dependent variable, the value of the area under the curve in the ROC was significantly higher in the 7-item version than in the total score of the original items (P = .0005). In conclusion, the 7-item EBS short form was created. Furthermore, it was found that the EBS short form is a reliable and valid measure that can be used as an indicator of obesity in both clinical and research settings.
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Development and psychometric validation of the second version of the Coronary Artery Disease Education Questionnaire (CADE-Q II).
Ghisi, GL, Grace, SL, Thomas, S, Evans, MF, Oh, P
Patient education and counseling. 2015;(3):378-83
Abstract
OBJECTIVES To develop and psychometrically-validate a revised version of the Coronary Artery Disease Education Questionnaire (CADE-Q)--a tool to assess patients' knowledge about CAD in cardiac rehabilitation (CR). METHODS After a needs assessment, a literature review and focus group with CR experts, the revised questionnaire was developed. It underwent pilot-testing in 30 patients, which lead to further refinement. The questionnaire was then psychometrically-tested in 307 CR patients. Internal consistency was assessed using Cronbach's alpha, the dimensional structure through exploratory factor analysis, and criterion validity with regard to educational level. RESULTS Cronbach's alpha was 0.91. Criterion validity was supported by significant differences in mean scores by educational level (p<0.001). Factor analysis revealed four factors, which were internally-consistent (0.65-0.77), and well-defined by items. The mean total score was 64.2±18.1/93. Patients with a history of heart failure, cardiomyopathy and percutaneous coronary intervention (p<0.05) had significantly higher knowledge scores compared with patients without such a history. Knowledge about exercise and their medical condition was significantly higher than risk factors, nutrition and psychosocial risk. CONCLUSIONS The CADE-QII has good reliability and validity. PRACTICAL IMPLICATIONS This tool may be useful to assess CR participants' knowledge gaps, and to evaluate the efficacy of educational delivery in CR.
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Development and validation of a symptom-based activity index for adults with eosinophilic esophagitis.
Schoepfer, AM, Straumann, A, Panczak, R, Coslovsky, M, Kuehni, CE, Maurer, E, Haas, NA, Romero, Y, Hirano, I, Alexander, JA, et al
Gastroenterology. 2014;(6):1255-66.e21
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BACKGROUND & AIMS Standardized instruments are needed to assess the activity of eosinophilic esophagitis (EoE) and to provide end points for clinical trials and observational studies. We aimed to develop and validate a patient-reported outcome (PRO) instrument and score, based on items that could account for variations in patient assessments of disease severity. We also evaluated relationships between patient assessment of disease severity and EoE-associated endoscopic, histologic, and laboratory findings. METHODS We collected information from 186 patients with EoE in Switzerland and the United States (69.4% male; median age, 43 y) via surveys (n = 135), focus groups (n = 27), and semistructured interviews (n = 24). Items were generated for the instruments to assess biologic activity based on physician input. Linear regression was used to quantify the extent to which variations in patient-reported disease characteristics could account for variations in patient assessment of EoE severity. The PRO instrument was used prospectively in 153 adult patients with EoE (72.5% male; median age, 38 y), and validated in an independent group of 120 patients with EoE (60.8% male; median age, 40.5 y). RESULTS Seven PRO factors that are used to assess characteristics of dysphagia, behavioral adaptations to living with dysphagia, and pain while swallowing accounted for 67% of the variation in patient assessment of disease severity. Based on statistical consideration and patient input, a 7-day recall period was selected. Highly active EoE, based on endoscopic and histologic findings, was associated with an increase in patient-assessed disease severity. In the validation study, the mean difference between patient assessment of EoE severity (range, 0-10) and PRO score (range, 0-8.52) was 0.15. CONCLUSIONS We developed and validated an EoE scoring system based on 7 PRO items that assess symptoms over a 7-day recall period. Clinicaltrials.gov number: NCT00939263.
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The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad.
Melin, A, Tornberg, AB, Skouby, S, Faber, J, Ritz, C, Sjödin, A, Sundgot-Borgen, J
British journal of sports medicine. 2014;(7):540-5
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BACKGROUND Low energy availability (EA) in female athletes with or without an eating disorder (ED) increases the risk of oligomenorrhoea/functional hypothalamic amenorrhoea and impaired bone health, a syndrome called the female athlete triad (Triad). There are validated psychometric instruments developed to detect disordered eating behaviour (DE), but no validated screening tool to detect persistent low EA and Triad conditions, with or without DE/ED, is available. AIM: The aim of this observational study was to develop and test a screening tool designed to identify female athletes at risk for the Triad. METHODS Female athletes (n=84) with 18-39 years of age and training ≥5 times/week filled out the Low Energy Availability in Females Questionnaire (LEAF-Q), which comprised questions regarding injuries and gastrointestinal and reproductive function. Reliability and internal consistency were evaluated in a subsample of female dancers and endurance athletes (n=37). Discriminant as well as concurrent validity was evaluated by testing self-reported data against measured current EA, menstrual function and bone health in endurance athletes from sports such as long distance running and triathlon (n=45). RESULTS The 25-item LEAF-Q produced an acceptable sensitivity (78%) and specificity (90%) in order to correctly classify current EA and/or reproductive function and/or bone health. CONCLUSIONS The LEAF-Q is brief and easy to administer, and relevant as a complement to existing validated DE screening instruments, when screening female athletes at risk for the Triad, in order to enable early detection and intervention.