Validation of Electronic Data Capture of the Irritable Bowel Syndrome—Quality of Life Measure, the Work Productivity and Activity Impairment Questionnaire for Irritable Bowel Syndrome and the EuroQol

OBJECTIVES: To assess the comparability, reliability, and subject acceptability of electronic data capture (EDC) versions of Irritable Bowel Syndrome-Quality of Life (IBS-QOL), EuroQoL (EQ-5D) and Work Productivity and Activity Impairment (WPAI:IBS) instruments. METHODS: Comparability of EDC and paper questionnaires was evaluated in 72 subjects with IBS who completed a baseline EDC or paper questionnaire, a crossover questionnaire 24 hours later, and a retest of the crossover version at 1 week. The EDC version was presented on a hand-held device. Comparability was assessed using paired t-test statistics, intraclass correlation coefficients (ICC) and tests for internal consistency (Cronbach's alpha). RESULTS: No significant differences were found between scores obtained by paper questionnaire and EDC at the baseline and crossover assessments. ICCs between baseline and crossover assessments ranged from 0.83 to 0.96 for the IBS-QOL scores, 0.82 to 0.96 for the WPAI:IBS scores, and 0.77 to 0.82 for the EQ-5D. Internal consistency was comparable for the two data collection methods for the IBS-QOL overall score (0.96) and subscales and the EQ-5D Index (0.70 vs. 0.74). Retest statistics (ICC) were generally comparable between the EDC and paper versions for all scores. Ease of use was comparable for the two modes of administration, but more patients preferred EDC (47.2%) than the paper questionnaire (23.6%). CONCLUSIONS: EDC versions of the IBS-QOL, EQ-5D, and WPAI:IBS are comparable to paper questionnaires in internal consistency and test-retest reliability, and have greater patient acceptability.     

Construct Validity of the Work Productivity and Activity Impairment Questionnaire across Informal Caregivers of Chronically Ill Older Patients

Objectives:  To assess the validity of the Work Productivity and Activity Impairment questionnaire as adapted for caregiving (WPAI:CG) to measure productivity loss (hours missed from work, impairment while at work, and impairment in regular activities) due to unpaid caregiving for medically complex older adults.
Methods:  The WPAI:CG was administered along with the Caregiver Strain Index (CSI) and Center for Epidemiologic Studies Depression Scale (CESD) to a caregiving population (N = 308) enrolled with their older, medically complex care-recipient in a cluster-randomized controlled study. Correlation coefficients were calculated between each productivity variable derived from the WPAI:CG and CSI/CESD scores. Nonparametric tests for trend across ordered groups were carried out to examine the relationship between each productivity variable and the intensity of the caregiving.
Results:  Significant positive correlations were found between work productivity loss and caregiving-related strain ( r  = 0.45) and depression ( r  = 0.30). Measures of productivity loss were also highly associated with caregiving intensity ( P  < 0.05) and care-recipient medical care use ( P  < 0.05). The average employed caregiver reported 1.5 hours absence from work in the previous week and 18.5% reduced productivity while at work due to caregiving. Employed and nonemployed caregivers reported 27.2% reduced productivity in regular activities in the previous week.
Conclusion:  The results indicate high convergent validity of the WPAI:CG questionnaire. This measure could facilitate research on the cost-effectiveness of caregiver-workplace interventions and provide employers and policy experts with a more accurate and comprehensive estimate of caregiving-related costs incurred by employers and society.     

Adaptation,Update and Validation of the General Nutrition Questionnaire in a Portuguese Adolescent Sample

This article describes the adaptation of the adult Portuguese version of the General Nutrition Knowledge Questionnaire (GNKQ) for adolescents, and its validation. Respondents were 1,315 adolescents, who completed the questionnaire in two phases. A subsample of 73 adolescents was used to measure test–retest reliability. Concurrent validity was tested using a sample of 32 dietetic students. The adapted version showed high internal consistency (Cronbach’s alpha = 0.92), test–retest reliability (R = 0.71) and concurrent validity (U = 22766.0; p < .01). Adolescents’ nutrition knowledge can now be assessed with a valid and reliable instrument. Future validation works of this or others questionnaires for children and elderly are warranted.     

Validation of the General and Sport Nutrition Knowledge Questionnaire (GeSNK) in Spanish Adolescents

The General and Sport Nutrition Knowledge Questionnaire (GeSNK) is an instrument that has been developed and validated to assess the level of nutrition knowledge in adolescents and young adults. The aim of the present study was to validate the GeSNK questionnaire in a group of Spanish adolescents in the framework of a Nutrition Education Programme in Secondary Schools in Andalusia, Spain. This cross-sectional questionnaire validation study was developed in two phases: translation-cultural adaptation and validation. A total of 305 adolescents aged 11 to 17 years, studying from the first to the third year of compulsory secondary education, participated on a voluntary basis. The GeSNK questionnaire consists of 62 items: 29 items for the General Nutrition section and 33 items for the Sports Nutrition section. Cronbach’s alpha coefficient for the complete questionnaire (GeSNK Total) was: 0.934; for the GeSNK General Nutrition section it was 0.918; and for the GeSNK Sports Nutrition section it was 0.856. The stability measured by the correlation coefficient for the General Nutrition section was 0.406 (p = 0.000); for the Sports Nutrition section it was 0.198 (p = 0.017); and for GeSNK Total the stability was 0.545 (p = 0.000). The questionnaire also demonstrated adequate construct validity. We therefore conclude that the Spanish version of the GeSNK questionnaire is a valid instrument to measure the level of knowledge in general nutrition and sports nutrition in adolescents.     

Understanding the Economic Burden of Nonsevere Nocturnal Hypoglycemic Events: Impact on Work Productivity,Disease Management,and Resource Utilization

ObjectiveNonsevere hypoglycemic events are common and may occur in one-third of persons with diabetes as often as several times a week. This study’s objective was to examine the economic burden of nonsevere nocturnal hypoglycemic events (NSNHEs).MethodsA 20-minute Web-based survey, with items derived from the literature, expert input, and patient interviews, assessing the impact of NSNHEs was administered in nine countries to 18 years and older patients with self-reported diabetes having an NSNHE in the past month.ResultsA total of 20,212 persons were screened, with 2,108 respondents meeting criteria and included in the analysis sample. The cost of lost work productivity per NSNHE was estimated to be between $10.21 (Germany) and $28.13 (the United Kingdom), representing 3.3 to 7.5 hours of lost work time per event. A reduction in work productivity (presenteeism) was also reported. Compared with respondents’ usual blood sugar monitoring practice, on average, 3.6 ± 6.6 extra tests were conducted in the week following the event at a cost of approximately $87.1 per year. Additional costs were also incurred for doctor visits as well as medical care required because of falls or injuries incurred during the NSNHE for an annual cost of $2,111.3 per person per year. When taking into consideration the multiple impacts of NSNHEs for the total sample and the frequency that these events occur, the resulting total annual economic burden was $288,000 or $127 per person per event.ConclusionsNSNHEs have serious consequences for patients. Greater attention to treatments that reduce NSNHEs can have a major impact on reducing the economic burden of diabetes.     

Multinational Trials—Recommendations on the Translations Required, Approaches to Using the Same Language in Different Countries, and the Approaches to Support Pooling the Data: The ISPOR Patient-Reported Outcomes Translation and Linguistic Validation Good Research Practices Task Force Report

Objectives:  With the internationalization of clinical trial programs, there is an increased need to translate and culturally adapt patient-reported outcome (PRO) measures. Although guidelines for good practices in translation and linguistic validation are available, the ISPOR Patient-Reported Outcomes Translation and Linguistic Validation Task Force identified a number of areas where they felt that further discussion around methods and best practices would be beneficial.
The areas identified by the team were as follows: 1) the selection of the languages required for multinational trials; 2) the approaches suggested when the same language is required across two or more countries; and 3) the assessment of measurement equivalence to support the aggregation of data from different countries.
Methods:  The task force addressed these three areas, reviewed the available literature, and had multiple discussions to develop this report.
Results:  Decision aid tools have also been developed and presented for the selection of languages and the approaches suggested for the use of the same language in different countries.
Conclusion:  It is hoped that this report and the decision tools proposed will assist those involved with multinational trials to 1) decide on the translations required for each country; 2) choose the approach to use when the same language is spoken in more than one country; and 3) choose methods to gather evidence to support the pooling of data collected using different language versions of the same tool.     

Cross-Country Validation of the Association Between Oral Health and General Health in Community-Dwelling Older Adults

ObjectiveOral health is known to be associated with general health, but longitudinal relationships between oral health and general health indicators have not yet been fully explored in international research.Setting and participantsThe sample consisted of 3 longitudinal databases: a sample from Belgium from the Protocol 3 project (n = 8359), a combined sample from 6 European countries (n = 2501) from the IBenC study (Belgium, Finland, Iceland, Germany, Italy, and the Netherlands), and a sample from New Zealand (n = 15,012). All clients were 65 years or older and received long-term home care services.MethodsBayesian models were used to analyze the associations between 3 oral health indicators (chewing difficulty, nonintact teeth, and dry mouth) and 4 aspects of general health (activities of daily living functioning, cognition, depression, and health instability). In addition, the models explored the associations between current oral health and general health status and future oral health and general health status.ResultsClients who had poorer oral health had a higher risk of suffering from poor general health. Especially chewing difficulty was associated with all general health indicators in all data sets (odds ratios > 1). Dry mouth and nonintact teeth showed significant associations with almost all general health indicators. Additionally, having poor oral health (respectively general health) was predictive of poor general health (respectively oral health) at future assessments (significant cross-lagged parameters).Conclusions/ImplicationsThe results point out the need of the inclusion of oral health assessment and advice from dentists or oral health practitioners into the multidisciplinary conversation. In addition, identifying older people with oral health problems is essential in order to provide treatment and monitoring. Raising awareness for oral health is important, and policy makers should foster oral health promotion and care for older adults in order to keep them in good health.     

The Spanish Version of the Eating Habits Questionnaire (EHQ-ES) and Its Links to Symptoms and Concerns Characteristic of Eating Disorders among Young Adults

The aim of the study was to investigate the psychometric properties (internal consistency, factor structure, and convergent validity) of the Spanish version of the Eating Habits Questionnaire (EHQ-ES) and its links to disordered eating in young adults. Two university student samples with a total of 487 participants (N1_age = 21.75 ± 5.10; N2_age = 21.17 ± 6.81) participated in the study. They filled out the Eating Habits Questionnaire and the Eating Attitudes Test. Our findings showed that the EHQ-ES demonstrated strong internal consistency, with a Cronbach’s α = 0.903 and ω = 0.939. The EHQ-ES consists of 20 items to measure problems associated with healthy eating (α = 0.855, ω = 0.879), knowledge of healthy eating (α = 0.783, ω = 0.826) and feeling positively about healthy eating (α = 0.775, ω = 0.773). In addition, subscales of the EHQ correlated with subscales of the EAT-26, showing that Orthorexia Nervosa is associated with disordered eating in a sample of university students. The current study is the first to describe a Spanish version of the EHQ. This demonstrates that EHQ-ES is a reliable screening tool for Spanish-speaking young adults. Moreover, the EHQ-ES can be a useful instrument for assessing ON in research and clinical practice.     

Content Validation of a Chrononutrition Questionnaire for the General and Shift Work Populations: A Delphi Study

Unusual meal timing has been associated with a higher prevalence of chronic disease. Those at greater risk include shift workers and evening chronotypes. This study aimed to validate the content of a Chrononutrition Questionnaire for shift and non-shift workers to identify temporal patterns of eating in relation to chronotype. Content validity was determined using a Delphi study of three rounds. Experts rated the relevance of, and provided feedback on, 46 items across seven outcomes: meal regularity, times of first eating occasion, last eating occasion, largest meal, main meals/snacks, wake, and sleep, which were edited in response. Items with greater than 70% consensus of relevance were accepted. Rounds one, two, and three had 28, 26, and 24 experts, respectively. Across three rounds, no outcomes were irrelevant, but seven were merged into three for ease of usage, and two sections were added for experts to rate and comment on. In the final round, all but one of 29 items achieved greater than 70% consensus of relevance with no further changes. The Chrononutrition Questionnaire was deemed relevant to experts in circadian biology and chrononutrition, and could represent a convenient tool to assess temporal patterns of eating in relation to chronotype in future studies.     

Validation of a Shortened Version of the Children's Eating Behavior Questionnaire and Associations with BMI in a Clinical Sample of Latino Children

Objective

To examine the validity of the Children's Eating Behavior Questionnaire (CEBQ) through the associations of its 3 subscale scores (food responsiveness, slowness in eating, and satiety responsiveness) with body mass index (BMI).

The Work Role Functioning Questionnaire 2.0 (Dutch Version): Examination of its Reliability, Validity and Responsiveness in the General Working Population

Purpose: The promotion of a sustainable, healthy and productive working life attracts more and more attention. Recently the Work Role Functioning Questionnaire (WRFQ) has been cross-culturally translated and adapted to Dutch. This questionnaire aims to measure the health-related work functioning of workers with health problems. The aim of this study is to evaluate the reliability, validity (including five new items) and responsiveness of the WRFQ 2.0 in the working population. Methods: A longitudinal study was conducted among workers. The reliability (internal consistency, test–retest reliability, measurement error), validity (structural validity-factor analysis, construct validity by means of hypotheses testing) and responsiveness of the WRFQ 2.0 were evaluated. Results: A total of N = 553 workers completed the survey. The final WRFQ 2.0 has four subscales and showed very good internal consistency, moderate test–retest reliability, good construct validity and moderate responsiveness in the working population. The WRFQ was able to distinguish between groups with different levels of mental health, physical health, fatigue and need for recovery. A moderate correlation was found between WRFQ and related constructs respectively work ability and work productivity. A weak relationship was found with general self-rated health, work engagement and work involvement. Conclusion: The WRFQ 2.0 is a reliable and valid instrument to measure health-related work functioning in the working population. Further validation in larger samples is recommended, especially for test–retest reliability, responsiveness and the questionnaire’s ability to predict the future course of health-related work functioning.     

A Year in the Life of U.S. Frontline Health Care Workers: Impact of COVID-19 on Weight Change,Physical Activity,Lifestyle Habits,and Psychological Factors

Healthcare workers (HCWs) experienced significantly higher burdens and life demands due to the COVID-19 pandemic. This study sought to assess the longitudinal effects among HCWs throughout the pandemic. Qualtrics surveys collected self-reported data on weight changes, eating patterns, physical activity (PA), and psychological factors with data organized by timepoints prior to the pandemic (PP0—prior to March 2020), baseline (M0—January 2021), month 6 (M6—July 2021), and month 12 (M12—January 2022). Eating patterns were negatively impacted at the M0, with reported increases in snacking/grazing (69.7%), fast food/take-out consumption (57.8%), and alcohol (48.8%). However, by M6 and M12 there were no statistically significant differences in eating patterns, suggesting that eating patterns normalized over time. Mean weight increased from PP0 to M0 by 2.99 pounds (p < 0.001, n = 226) and from PP0 to M6 by 2.12 pounds (p < 0.027, n = 146), though the difference in mean weight from PP0 to M12 was not statistically significant (n = 122). PA counts decreased from 8.00 sessions per week PP0 to 6.80 by M0 (p = 0.005) before jumping to 12.00 at M6 (p < 0.001) and 10.67 at M12 (p < 0.001). Psychological factors comparing M0 to M12 found statistically significant differences for depression (p-value = 0.018) and anxiety (p-value = 0.001), meaning depression and anxiety were initially increased but improved by M12. Additionally, higher scores on depression and insomnia scales were associated with lower PA levels. These overall results imply that the COVID-19 pandemic had immediate effects on the eating patterns, weight changes, PA, and psychological factors of HCWs; however, routines and lifestyle habits appeared to have normalized one year later.