Assessment of infant feeding: the validity of measuring milk intake

Accurate assessment of infant feeding is needed for clinical practice and research. We identified 32 studies that evaluated the validity of direct observation, test weighing, or doubly labeled water methods. Correlations with validation standards were highest for doubly labeled water and test weighing, and lowest for observation. Cost and availability of isotope may limit the doubly labeled water method to research studies, whereas observation may be useful for clinical practice. Test weighing could be applied to either setting, but it may be practical to sample less frequently over 24 hours. Validity results and intended use of the measurement should be considered when selecting a method.     

An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, beta-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.     

The Nottingham Health Profile as a measure of quality of life in zoster patients: convergent and discriminant validity

The main symptoms of zoster, a disease caused by the reactivation of the varicella zoster virus (that causes chicken-pox) are: rash, associated with pain, burning, or itching, and pain that outlasts the rash sometimes by months or years. The uncomfortable and long-lasting symptoms of herpes zoster are likely to compromise the patient's quality of life. However, the impact of zoster on health-related quality of life has not previously been measured directly. Recent papers have demonstrated the ability of generic measures to discriminate among patients with different clinical symptoms. In this paper, we demonstrate the convergent validity for zoster of a generic measure, the Nottingham Health Profile (NHP), by measuring its correlation with rash progression, pain levels, and pain medications. The discriminant validity of the NHP was demonstrated by its ability to distinguish between different levels of pain severity. The NHP dimensions most highly correlated with the pain measures, were pain (0.42–0.50), energy (0.34–0.38) and sleep (0.32–0.38). The NHP scores in all six dimensions show large differences at different levels of pain severity that are statistically significant. These results demonstrate the NHP's validity as a measure of health-related quality of life in zoster patients.     

Development of a food composition database to study complementary feeding: An Italian experience

Food Composition Databases (FCDBs) are important tools for epidemiological research, public health nutrition and education, clinical practice and nutrition declaration on food labels. The aim of this paper is to describe the methodology used to compile a FCDB for the analysis on the dietary intake of an Italian cohort of infants, and to assess its strengths and weaknesses. Dietary data were collected using a 3-DD records compiled at 6, 9 and 12 months of age of the infants. We developed a FCDB that contains data from the Italian and the USDA food composition databases and other sources. Our FCDB includes 563 food derived from the analysis of 623 3-DD records. Non-commercial products are more consumed than commercial products (25.5% vs. 9.1% at 6 months, 58.4% vs. 18.1% at 9 months and 77.8% vs. 11.3% at 12 months) but the latter are the main source of missing data (>70% in each database, with the exception of the energy components), which is one of the major weaknesses of this tool. An integrated system of data collection (NUTRIRETE.lab) that brings together food composition data from public and private laboratories will allow us to build a more complete and representative food composition database.     

Methods to detect response shift in quality of life data: A convergent validity study

When measuring changes in quality of life (QL) with a pretest-posttest design, response shift can affect results. We investigated the convergent validity of three approaches to detect response shift. (1) In the thentest approach, response shift is measured using a retrospective judgment of pretest QL-levels (thentest). (2) In the anchor–recalibration approach response shift is measured, assessing shifts in patients individual definitions of the scale-anchors (worst and best imaginable QL) over time. (3) In the Structural Equation Modeling (SEM) approach response shift is indicated by mathematically defined changes in factor solutions and variance–covariance matrices over time. Prior to and three months after invasive surgery, 170 cancer patients completed the SF-36, the Multidimensional Fatigue Inventory (as pre-, post-, and thentest), and the anchor–recalibration task (as pre-, and posttest). Results showed agreement between the thentest and SEM approach on the absence (6 scales) and presence (2 scales) of response shift in 8 of the 9 scales. For the ninth scale both methods detected response shift, but in opposite directions. Possible explanations for this discrepancy are discussed. The anchor–recalibration task agreed with the other approaches on only the absence of response shift in 4 of the 7 scales. The convergent results of thentest and SEM support their validity, especially because they use statistically independent operationalizations of response shift. In this study, recall bias did not invalidate thentest results.     

Lack of validity of a French adaptation of a scale measuring attitudes towards clinical practice guidelines.

BACKGROUND: Valid instruments to measure practitioners' attitudes towards clinical practice guidelines need to be developed. However, few of the available instruments have been thoroughly validated. OBJECTIVE: To adapt into French and to test the reliability and validity of a scale for measurement of attitudes towards guidelines developed by Elovainio et al. METHODS: A 27-item scale (divided into six dimensions) measuring attitudes towards guidelines was translated into French by two English native translators, reviewed and finalized by expert committee and administered to 314 practitioners who agreed to participate. Main practitioners' characteristics were collected. Item and dimension reproducibility were assessed for 62 practitioners by calculation of intraclass correlation coefficients. Internal construct validity was assessed by principal components analyses. Convergent and discriminant validity were analysed. RESULTS: Item response rates ranged from 82 to 100%. In the test-retest procedure, intraclass correlation coefficients for separate items ranged from 0.1 to 0.7 and those for dimensions were 0.7 [95% confidence interval (CI): 0.5-0.8] for usefulness, 0.5 (0.3-0.6) for reliability, 0.4 (0.2-0.5) for individual competence, 0.5 (0.3-0.6) for organizational competence, 0.7 (0.5-0.8) for impracticality and 0.4 (0.3-0.6) for availability. The factorial structure after Varimax rotation showed that none of the different solutions obtained had a strictly comparable structure to that of the original scale. External construct validity was satisfactory. CONCLUSION: This scale does not have satisfactory psychometric properties and therefore cannot confidently be used in future research assessing whether attitudes towards guidelines are a determining factor in physicians' compliance with guidelines. More research is needed to develop valid scales in a more rigorous procedure, involving qualitative and quantitative steps.     

A new index to measure healthy food diversity better reflects a healthy diet than traditional measures

The recommendation to eat diverse types of foodstuffs is an internationally accepted recommendation for a healthy diet. The importance of dietary variety is based on several studies that have shown that diverse diets are accompanied by positive health outcomes. However, the definition and measurement of healthy food diversity are often criticized in the literature. Nutritional studies generally use count indices to quantify food diversity. As these measures have considerable disadvantages, several nutritionists have called for a precise definition and measurement of food diversity. This study aimed to develop a new healthy food diversity indicator. This index is based on a distribution measure mainly applied in economic and ecological studies. It considers 3 aspects important for healthy food diversity: number, distribution, and health value of consumed foods. We have validated the new index using energy-adjusted correlations with diet quality indicators. A comparison with selected traditional diversity indices revealed that the new indicator more appropriately reflected healthy food diversity.     

十六味杜鹃花丸中丁香酚含量的GC测定法

目的建立内在质量监控指标,提高药品质量标准。方法采用气相色谱法测定丁香酚的含量。结果丁香酚在50～500μg范围内呈良好线性关系,回归方程Y=1215.3 X-42.233,R=1.000,平均回收率为99.23%,RSD为0.53%。结论该方法简便、灵敏、准确,为进一步提高该药的质量标准打下了基础。     

Use of the health and activities limitation index as a measure of quality of life in obesity

OBJECTIVE: Obesity reduces the quality of life (QOL); however, quantification of obesity's impact on QOL is cumbersome. Utility indices reduce QOL measurements to a single numerical value that can be used in the calculation of Quality-Adjusted Life-Years and the cost effectiveness for obesity treatment. The purpose of this investigation is to assess the sensitivity of the Health and Activities Limitation Index (HALex) utility index to obesity. RESEARCH METHODS AND PROCEDURES: The answers to five questions regarding an individual's self-perception of his or her health status and information about limitation in daily and work activities were collected from 32,440 adults in the 1998 National Health Information Survey. Answers to the questions were scored and converted to a utility index score ranging from 0 (near-death state) to 1 (perfect health) with no limitations. Average values for indices corresponding to differing body mass indices were obtained and significance determined by ANOVA. RESULTS: The utility index for normal weight males and females was 0.86 +/- 0.19 and fell to 0.68 +/- 0.27 for superobese males and 0.60 +/- 0.28 in superobese females. Utility indices fell linearly with increasing body mass index and were lower for respondents having obesity-related comorbid conditions known to reduce the quality of life. DISCUSSION: There is a statistically significant decrease in the QOL with increasing obesity, slightly worse for women compared with men. The Health and Activities Limitation Index can quantitate the effect obesity and its complications have on quality of life.     

The validity of self-reported exercise-induced sweating as a measure of physical activity

The validity of self-reported hours in which one engages in activities strenuous enough to produce sweating was assessed as a measure of physical activity. Respondents were 732 randomly selected adults between the ages of 25 and 65 years from the Boston, Massachusetts, metropolitan area who participated in a field trial of health risk appraisal instruments in 1987. A total of 68% of the men and 57% of the women in the sample were involved in sweat-inducing activities at least once per week. The correlation between the natural logarithm of reported sweat hours per week and energy expenditure measured by the Harvard Alumni Activity Survey was 0.39. Following a logarithmic transformation and adjustment for age and sex, sweat hours was significantly correlated with high density lipoprotein cholesterol (r = 0.11, p less than 0.05). However, these associations were not as strong as those found for the age- and sex-adjusted log of the Harvard Alumni Activity Survey score (r = 0.19 and r = -0.15 for high density lipoprotein cholesterol and body mass index (weight (kg)/height(m)2), respectively) and are considerably weaker than those reported in other studies using sweat episodes (days per week on which sweating occurred) as an indicator of physical activity. These results suggest that the utility of self-reported sweat hours may be limited to distinguishing active from inactive subjects in epidemiologic surveys.     

An easy way to measure quality of physician-patient interactions

This article describes a simple method for rating the patient-clinician interaction from the perspective of the older adult patient, with the goal of improving patient outcomes. A measure for rating the quality of an interaction with a patient who is bothered by a problem is called the Functional Education Index or FNXEI. Usually, sicker patients are known to be less satisfied with their medical care. What is unique about the FNXEI is that it is not affected by a patient's overall health, giving clinicians an accurate account of their interactions with patients. Considering this, the FNXEI becomes a useful tool for improving care because it has face validity and specificity about the type of care clinicians are providing for their older adult patients.     

The K index: a proxy measure of health care quality.

An index of health care quality is described that requires data on "sentinel health events"--unnecessary death and disability caused by specific ICDA-coded conditions on which medical agreement can be reached about avoidability of negative outcomes. The proposed index combines measures of incidence, severity, and concentration of sentinel health events in communities and compares the measures with mean values for a group of normative communities, to arrive at index values that are distributed as X2 for a group of communities with regard to the mean health conditions experienced by the normative communities. Calculation of the index is illustrated with hypothetical data, and problems of selecting normative communities are discussed.     

Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial

Background

Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated.

Aim

To identify predictors of higher success of an intervention aimed to increase adherence to a Mediterranean diet (MeDiet) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease: the PREDIMED (PREvención con DIeta MEDiterránea) trial. Candidate predictors included demographic and socioeconomic characteristics, cardiovascular risk factors, and baseline dietary habits.

Methods

A total of 1,048 asymptomatic subjects aged 55–80 years allocated to the active intervention groups (subjects in the control group were excluded). Participants’ characteristics were assessed at baseline among subjects. Dietary changes were evaluated after 12 months. Main outcome measures were: attained changes in five dietary goals: increases in (1) fruit consumption, (2) vegetable consumption, (3) monounsaturated fatty acid (MUFA)/saturated fatty acid (SFA) ratio, and decreases in (4) sweets and pastries consumption, (5) and meat consumption. Univariate and multivariate logistic regression analyses were used to examine associations between the candidate predictors and likelihood of attaining optimum dietary change (improved adherence to a MeDiet).

Results

Among men, positive changes toward better compliance with the MeDiet were more frequent among non-diabetics, and among those with worse dietary habits at baseline (higher consumption of meat, higher SFA intake, lower consumption of fruit and vegetables). Among women, marital status (married) and worse baseline dietary habits (high in meats, low in fruits and vegetables) were the strongest predictors of success in improving adherence to the MeDiet.

Conclusions

Some participant characteristics (marital status and baseline dietary habits) could contribute to predicting the likelihood of achieving dietary goals in interventions aimed to improve adherence to a MeDiet, and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling.     

Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors

Purpose

Examination of reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (≥5 years post-diagnosis).

Methods

We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy and 750 anastomosis) a questionnaire containing the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O), SF-12v2, Duke–UNC Functional Social Support Questionnaire (FSSQ), and Memorial Sloan-Kettering Cancer Center Bowel Function Index (BFI). We adapted certain BFI items for use by subjects with intestinal ostomies. We evaluated reliability for all instruments with inter-item correlations and Cronbach’s alpha. We assessed construct validity only for the BFI in the ostomy group, because such use has not been reported.

Results

The overall response rate was 60.5 % (577 respondents/953 eligible). Compared with non-responders, participants were on average 2 years younger and more likely non-Hispanic white, resided in educationally non-deprived areas, and had KP membership through a group. The mCOH-QOL-O, SF-12, and FSSQ were found to be highly reliable for RC survivors. In the ostomy group, BFI Urgency/Soilage and Dietary subscales were found to be reliable, but Frequency was not. Factor analysis supported the construct of Urgency/Soilage and Dietary subscales in the ostomy group, although one item had a moderate correlation with all three factors. The BFI also demonstrated good concurrent validity with other instruments in the ostomy group.

Conclusions

With possible exception of the BFI Frequency subscale in populations with ostomies, components of our survey can be used for the entire population of RC survivors, no matter whether they received anastomosis or ostomy.