Development of a brief measure to assess quality of life in obesity. Are Anti-Stigma Films a Useful Strategy for Reducing Weight Bias Among Trainee Healthcare Professionals? Results of a Pilot Randomized Control Trial The mixed impact of medical school on medical students' implicit and explicit weight bias. Weight Bias and Weight Loss Treatment Outcomes in Treatment-Seeking Adults Unawareness of weight and height - the effect on self-reported prevalence of overweight in a population-based study Revision of a method quality rating scale for single-case experimental designs and n-of-1 trials: The 15-item Risk of Bias in N-of-1 Trials (RoBiNT) Scale Psychometric properties of reaction time based experimental paradigms measuring anxiety-related information-processing biases in children. The Anti-Clot Treatment Scale (ACTS) in clinical trials: cross-cultural validation in venous thromboembolism patients The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Weight bias among dietetics students: implications for treatment practices. The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. A Comparison of Psychometric Properties Between Internet and Paper Versions of Two Depression Instruments (BDI-II and MADRS-S) Administered to Clinic Patients A new approach to multicultural item generation in the development of two obesity-specific measures: the Obesity and Weight Loss Quality of Life (OWLQOL) questionnaire and the Weight-Related Symptom Measure (WRSM). BMI-related errors in the measurement of obesity Using routinely collected growth data to assess a school-based obesity prevention strategy Psychometric Properties of an Instrument for Assessing Treatment Satisfaction Associated With Pramlintide Use [Diet, metformin and inositol in overweight and obese women with polycystic ovary syndrome: effects on body composition]. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study Systematic review of interventions in the management of overweight and obese children which include a dietary component Systematic review of interventions in the management of overweight and obese children which include a dietary component. Falls efficacy scale-international: a cross-sectional validation in people with multiple sclerosis. Functional Rating Index: A New Valid and Reliable Instrument to Measure the Magnitude of Clinical Change in Spinal Conditions
OBJECTIVE Obesity research ers have a growing interest in measuring the impact of weight and weight reduction on quality of life . The Impact of Weight on  Quality of Life question naire ( IWQOL ) was the first self-report instrument specifically developed to assess the effect of obesity on quality of life . Although the IWQOL has demonstrated excellent psychometric properties , its length ( 74 items ) makes it somewhat cumbersome as an outcome measure in clinical research . This report describes the development of a 31-item version of the IWQOL ( IWQOL-Lite ) . RESEARCH METHODS AND PROCEDURES IWQOLs from 996 obese patients and controls were used to develop the IWQOL-Lite . Psychometric properties of the IWQOL-Lite were examined in a separate cross-validation sample of 991 patients and controls . RESULTS Confirmatory factor analysis provided strong support for the adequacy of the scale structure . The five identified scales of the IWQOL-Lite  ( Physical Function , Self-Esteem , Sexual Life , Public Distress , and Work ) and the total IWQOL-Lite score demonstrated excellent psychometric properties . The reliability of the IWQOL-Lite scales ranged from 0.90 to 0.94 and was 0.96 for the total score . Correlations between the IWQOL-Lite and collateral measures supported the construct validity of the IWQOL-Lite . Changes in  IWQOL-Lite scales over time correlated significantly with changes in weight , supporting its sensitivity to change . Significant differences in IWQOL-Lite scale and total scores were found among groups differing in body mass index , supporting the utility of the IWQOL-Lite across the body mass index spectrum . DISCUSSION The IWQOL-Lite appears to be a psychometrically sound and clinical ly sensitive brief measure of quality of life in obese persons Background : Weight bias is an important clinical issue that the educators of tomorrow 's healthcare professionals can not afford to ignore . This study , therefore , aim ed to pilot a r and omized controlled trial of the effects of educational films design ed to reduce weight stigmatization toward obese patients on trainee dietitians ' and doctors ' attitudes . Methods : A pre-post experimental design with a 6-week follow-up , which consisted of an  intervention group ( n = 22 ) and a  control group ( n = 21 ) , was conducted to assess the efficacy of brief anti-stigma films in reducing weight bias , and to test whether future , larger-scale studies among trainee healthcare professionals are feasible . Results : Participants at baseline  demonstrated weight bias , on both implicit and explicit attitude measures , as well as strong beliefs that obesity is under a person 's control . The intervention films significantly improved explicit attitudes and beliefs toward obese people , and participant evaluation was very positive . The intervention did not significantly improve implicit anti-fat bias . Conclusion : The current study suggests both that it is possible to conduct a substantive trial of the effects of educational films design ed to reduce weight stigma on a larger cohort of trainee healthcare professionals , and that brief educational interventions may be effective in reducing stigmatizing attitudes in this population CONTEXT Health care trainees demonstrate implicit ( automatic , unconscious ) and explicit ( conscious ) bias against people from stigmatised and marginalised social groups , which can negatively influence communication and decision making . Medical schools are well positioned to intervene and reduce bias in new physicians . OBJECTIVES This study was design ed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group : people with obesity . METHODS This was a prospect i ve cohort study of medical students enrolled at 49 US medical schools r and omly selected from all US medical schools within the strata of public and private schools and region . Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year .  Web-based surveys included measures of weight bias , and medical school experiences and climate . Bias change was compared with changes in bias in the general public over the same period . Linear mixed models were used to assess the impact of curriculum , contact with people with obesity , and faculty role modelling on weight bias change . RESULTS Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity . Increased implicit bias was associated with training in how to deal with difficult patients . On average , implicit weight bias decreased and explicit bias increased during medical school , over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable . CONCLUSIONS Medical schools may reduce students '  weight biases by increasing positive contact between students and patients with obesity , eliminating unprofessional role modelling by faculty members and residents , and altering curricula focused on treating difficult patients Background Few studies have explored the relationship between weight bias and weight loss treatment outcomes . Purpose This investigation examined the relationship between implicit and explicit weight bias and ( a ) program attrition , ( b ) weight loss , ( c ) self-monitoring adherence , ( d ) daily exercise levels and overall caloric expenditure , ( e ) daily caloric intake , and ( f ) daily caloric deficit among overweight/obese treatment-seeking adults . Methods Forty-six overweight/obese adults ( body mass index ≥ 27 kg/m2 ) participating in an 18-week , stepped-care , behavioral weight loss program completed implicit and explicit measures of weight bias .  Participants were instructed to self-monitor and electronically report  daily energy intake , exercise , and energy expenditure . Results Greater weight bias was associated with inconsistent self-monitoring , greater caloric intake , lower energy expenditure and exercise , creation of a smaller caloric deficit , higher program attrition , as well as less weight loss during the self-help phase of the stepped-care treatment . Conclusions Weight bias may interfere with overweight/obese treatment-seeking adults ' ability to achieve optimal health ObjectiveS elf-reported height and weight are commonly used to estimate body mass index . The present study aims to identify the characteristics of participants who reported not to know their height or weight and to evaluate the consequence of these missing data on the estimates of the prevalence of body mass index categories . Design and Participants We evaluated 1492 adults , aged 18–92 years , who were selected using r and om digit dialling .  During a general interview , participants were asked to report their current height and weight and actual anthropometrical measurements were obtained as part of a subsequent physical examination . We classified as unaware subjects who reported not to know their height or weight . Results In this sample , 185 ( 12.4 % ) subjects reported not to know their height or weight ( 19.6 % of females and 6.3 % of males , p<0.001 ) . Women unaware of their weight or height were older , less educated , overweight or obese , never smoker and more frequently reported no regular physical exercise practice . In men , only ex-smokers were significantly less aware of their weight or height . In women , the prevalence of obesity using measured data was 25.3 % , decreasing to 22.2 % when considering only participants aware of their weight and height . Using self-reported data the obesity prevalence , in females , was 15.0 % . Conclusion A large proportion of adults , mainly women and older persons , reported not to know their weight and height and the exclusion of those participants results in differential errors depending on the actual values . The exclusion of participants unaware of their weight or height is an additional source of bias that decreases the sensitivity in detecting obesity and underestimates the real problem , namely in the older population Recent literature suggests a revival of interest in  single-case methodology  ( e.g. , the r and omised n-of-1 trial is now considered Level 1 evidence for treatment decision purpose s by the Oxford Centre for Evidence -Based Medicine ) . Consequently , the availability of tools to critically appraise single-case reports is of great importance . We report on a major revision of our method quality instrument , the Single-Case Experimental Design Scale . Three changes result ed in a radically revised instrument , now entitled the Risk of Bias in N-of-1 Trials ( RoBiNT ) Scale : ( i ) item content was revised and increased to 15 items , ( ii ) two subscales were developed for internal validity ( IV ; 7 items ) and external validity and interpretation ( EVI ; 8 items ) , and ( iii ) the scoring system was changed from a 2-point to 3-point scale to accommo date currently accepted st and ards . Psychometric evaluation indicated that the RoBiNT Scale showed evidence of construct ( discriminative ) validity . Inter-rater reliability was excellent , for pairs of both experienced and trained novice raters . Intraclass correlation coefficients of summary scores for individual ( experienced ) raters : ICCTotalScore = .90 , ICCIVSubscale = .88 , ICCEVISubscale = .87 ; individual ( novice ) raters : ICCTotalScore = .88 , ICCIVSubscale = .87 , ICCEVISubscale = .93 ; consensus ratings between experienced and novice raters ( ICCTotalScore = .95 , ICCIVSubscale = .93 , ICCEVISubscale = .93 . The RoBiNT Scale thus shows sound psychometric properties and provides a comprehensive yet efficient examination of important features of single-case methodology Theoretical frameworks highlight the importance of threat-related information-processing biases for underst and ing the emergence of anxiety in childhood . The psychometric properties of several tasks measuring these biases and their associations with anxiety were examined in an unselected sample of 9-year-old children ( N=155 ) . In each task , threat bias was assessed using bias scores reflecting task performance on threat versus non-threat conditions . Reliability was assessed using split-half and test-retest correlations of mean reaction times ( RTs ) , accuracy and bias indices . Convergence between measures was also examined . Mean RTs showed substantial split-half and test-retest correlations . Bias score reliability coefficients were near zero and non-significant , suggesting poor reliability in children of this age . Additionally , associations between bias scores and anxiety were weak and inconsistent and performance between tasks showed little convergence . Bias scores from RT based paradigms in the current study lacked adequate psychometric properties for measuring individual differences in anxiety-related information-processing in children Background The Anti-Clot Treatment Scale ( ACTS ) is a 15-item patient-reported instrument of satisfaction with anticoagulant treatment . It includes a 12-item ACTS Burdens scale and a 3-item ACTS Benefits scale . Its role in clinical trials and other setting s should be supported by evidence that it is both clinical ly meaningful and scientifically sound . The aim of the study was to evaluate the measurement performance of the ACTS ( Dutch , Italian , French , German and English language versions ) in patients with venous thromboembolism based on traditional psychometric methods . Methods ACTS Burdens and Benefits scale data from a large clinical trial ( EINSTEIN DVT ) involving 1336 people with venous thromboembolism were analysed at both the scale and item level . Five key psychometric properties were examined using traditional psychometric methods : acceptability , scaling assumptions , reliability ( including internal consistency reliability , test-retest reproducibility ) ; validity ( including known groups and discriminant validity ) ; and responsiveness . These methods of examination underpin the US Food and Drug Administration recommendations for patient-reported outcome instrument evaluation . Results Overall , the 12-item ACTS Burdens scale and 3-item ACTS Benefits scale met the psychometric criteria evaluated at both item and scale levels , with the exception of some relatively minor issues in the Dutch language version , which were just below reliability criteria ( i.e. alpha = 0.72 , test-retest intraclass correlation = 0.79 ) . A consistent finding from item-level evaluations of aggregate endorsement frequencies and skewness suggested that response scales may be improved by reducing the number of response options from five to four . Conclusions Both the ACTS Burdens and ACTS Benefits scales consistently satisfied traditional reliability and validity criteria across multiple language data sets , supporting it as a clinical ly useful patient-reported instrument of satisfaction with anticoagulant treatment in clinical trials . Trial registration Changes in health policy have underlined the importance of evidence -based clinical practice and rigorous evaluation of patient-based outcomes . As patient-based outcome measurement is particularly important in treatment trials of multiple sclerosis , a number of disease-specific instruments have been developed recently . One limitation of these instruments is that none was developed using the st and ard psychometric approach of reducing a large item pool generated from people with multiple sclerosis . Consequently , an outcome measure for clinical trials of multiple sclerosis that is disease specific and combines patient perspective with rigorous psychometric methods will complement existing instruments . The aim of this study was to develop such a measure . St and ard psychometric methods were used . A pool of 129 question naire items was generated from interviews with 30 people with multiple sclerosis , expert opinion and literature review . The question naire was administered by postal survey to 1530 people selected r and omly from the Multiple Sclerosis Society membership data base . Redundant items and those with limited measurement properties were removed . The remaining items ( n = 41 ) were grouped into scales using factor analysis , and then refined to form the Multiple Sclerosis Impact Scale ( MSIS-29 ) , an instrument measuring the physical ( 20 items ) and psychological ( nine items ) impact of multiple sclerosis . Five psychometric properties of the MSIS-29  ( data quality , scaling assumptions , acceptability , reliability and validity ) were examined in a separate postal survey of 1250 Multiple Sclerosis Society members . A preliminary responsiveness study of the MSIS-29 was undertaken in 55 people admitted for rehabilitation and intravenous steroid treatment of relapses . The MSIS-29 satisfied all psychometric criteria . Data quality was excellent , missing data were low ( maximum 3.9 % ) , item test-re-test reliability was high ( r = 0.65 - 0.90 ) and scale scores could be generated for > 98 % of respondents . Item descriptive statistics , item convergent and discriminant validity , and factor analysis indicated that it was legitimate to generate scores for MSIS-29 scales by summing items . MSIS-29 scales showed good variability , small floor and ceiling effects , high internal consistency ( Cronbach 's alpha < or=0.91 ) and high test-re-test reliability ( intraclass correlation < or=0.87 ) . Correlations with other measures and the analysis of group differences provided evidence that the MSIS-29 measures the physical and psychological impact of multiple sclerosis . Effect sizes ( physical scale = 0.82 , psychological scale = 0.66 ) demonstrated preliminary evidence of good responsiveness . These results indicate the MSIS-29 is a clinical ly useful and scientifically sound patient-based outcome measure of the impact of multiple sclerosis suitable for clinical trials and epidemiological studies BACKGROUND Several studies have examined attitudes about obesity among food and nutrition professionals , yielding mixed results , and no experimental research has tested the impact of dietitians ' attitudes on their treatment practice s or health evaluations with obese patients . OBJECTIVE This study investigated attitudes of dietetics students toward obese persons and tested whether a patient 's body weight influences students ' treatment decisions and health evaluations within a r and omized experiment . DESIGN Between the months of September and December 2007 , a convenience sample of 182 dietetics undergraduate students ( 92 % women ; mean age 23.1+/-5.4 years ) from colleges throughout the United States completed online self-report surveys to assess weight bias ( using the Fat Phobia Scale ) . Participants were also r and omly assigned to read one of four mock health profiles of patients who varied only by weight-related characteristics ( eg , obese or average weight ) and sex ( male or female ) , and asked to make judgments about the patient 's health status and participation in treatment . STATISTICAL ANALYSES PERFORMED To compare group data , multiple analysis of variance was used to test for an effect of the patient 's body mass index on participants ' health evaluations and their perceptions of patients in each of the four experimental conditions . Correlations were calculated between mean fat phobia scores and perceptions of patients . RESULTS Participants in all conditions expressed a moderate amount of fat phobia ( mean=3.7 ) , and students rated obese patients as being less likely to comply with treatment recommendations compared with nonobese patients ( P<0.05 ) . Results from multivariate analysis of variance tests showed students also evaluated obese patients ' diet quality and health status to be poorer than nonobese patients , despite equivalent nutritional and health information across weight categories for each sex in patient profiles . In contrast , obese and nonobese patients were rated to be similarly motivated , receptive , and successful in treatment . CONCLUSION Implication s of these findings for education and intervention in dietetics training are discussed , with emphasis on increasing awareness of weight bias in existing dietetics curricula Prepregnancy BMI is a widely used marker of maternal nutritional status that relies on maternal self-report of prepregnancy weight and height . Pregravid BMI has been associated with adverse health outcomes for the mother and infant , but the impact of BMI misclassification on measures of effect has not been quantified . The authors applied published probabilistic bias analysis methods to quantify the impact of exposure misclassification bias on well-established associations between self-reported prepregnancy BMI category and five pregnancy outcomes ( small for gestational age ( SGA ) and large for gestational age ( LGA ) birth , spontaneous preterm birth ( sPTB ) , gestational diabetes mellitus ( GDM ) , and preeclampsia ) derived from a hospital-based delivery data base in Pittsburgh , PA ( 2003 - 2005 ; n = 18,362 ) . The bias analysis method recreates the data that would have been observed had BMI been correctly classified , assuming given classification parameters . The point estimates derived from the bias analysis account for r and om error as well as systematic error caused by exposure misclassification bias and additional uncertainty contributed by classification errors . In conventional multivariable logistic regression models , underweight women were at increased risk of SGA and sPTB , and reduced risk of LGA , whereas overweight , obese , and severely obese women had elevated risks of LGA , GDM , and preeclampsia compared with normal-weight women . After applying the probabilistic bias analysis method , adjusted point estimates were attenuated , indicating the conventional estimates were biased away from the null . However , the majority of relations remained readily apparent . This analysis suggests that in this population , associations between self-reported prepregnancy BMI and pregnancy outcomes are slightly overestimated Background Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes . However , many clinicians do not use self-report measures systematic ally in their clinical practice . Internet-based question naires could facilitate administration , but the psychometric properties of the online version of an instrument should be explored before implementation . The recommendation from the International Test Commission is to test the psychometric properties of each question naire separately . Objective Our objective was to compare the psychometric properties of paper- and -pencil versions and Internet versions of two question naires measuring depressive symptoms . Methods The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden . Participants completed the  Beck Depression Inventory ( BDI-II )  and the  Montgomery-Åsberg Depression Rating Scale — Self-rated ( MADRS-S )  , both on paper and on the Internet . The order was r and omized to control for order effects . Symptom severity in the sample ranged from mild to severe depressive symptoms . Results Psychometric properties of the two administration formats were mostly equivalent . The internal consistency was similar for the Internet and paper versions , and significant correlations were found between the formats for both MADRS-S ( r = .84 ) and the BDI-II ( r = .89 ) . Differences between paper and Internet total scores were not statistically significant for either question naire nor for the MADRS-S question dealing with suicidality ( item 9 ) when analyzed separately . The score on the BDI-II question about suicidality ( item 9 ) was significantly lower when administered via the Internet compared with the paper score , but the difference was small ( effect size , Cohen ’s [ d ] = 0.14 ) . There were significant main effects for order of administration on both question naires and significant interaction effects between format and order . This should not , however , pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made . Conclusions The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinical ly meaningful way . The full BDI-II also seems to retain its properties when transferred ; however , the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study . The use of online question naires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save re sources BACKGROUND Being overweight or obese has substantial effects on individuals ' perceptions of their health and quality of life ( QoL ) . Generic measures often miss important QoL information , and existing obesity-specific instruments have shortcomings with respect to cross-cultural input , application to differing levels of severity , conceptual clarity , and patient burden . OBJECTIVE This study aim ed to develop culturally sensitive measures of QoL and symptoms in overweight or obese persons , both those trying to lose weight and those not trying to lose weight . METHODS Currently accepted criteria and guidelines for question naire development were streamlined and augmented to include cross-cultural input from 5 European countries and the United States . The preliminary pool of items was created based on qualitative interviews conducted in the United States , followed by an early check of item translatability and preharmonization across all language s. Ten additional qualitative in-country interviews were then conducted to produce further culture-specific items . This was followed by 2 forward and 1 backward translation , plus cognitive debriefing interviews in each country . Finally , an exp and ed international harmonization meeting was held to ensure inclusion of appropriate new items and their acceptability across all 6 cultures . RESULTS The procedures described result ed in development of the 41-item Obesity and Weight Loss Quality of Life question naire and the 20-item Weight-Related Symptom Measure . These question naires are subject to further psychometric validation . CONCLUSIONS Augmentation of the initial item-generation and international harmonization steps of question naire development through integration of cross-cultural input allowed greater validity of cross-cultural content while meeting time , budget , and re source constraints Body mass index ( BMI ) has various deficiencies as a measure of obesity , especially when the BMI measure is based on self-reported height and weight . BMI is an indirect measure of body fat compared with more direct approaches such as bioelectrical impedance . Moreover , BMI does not necessarily reflect the changes that occur with age . The proportion of body fat increases with age , whereas muscle mass decreases , but corresponding changes in height , weight and BMI may not reflect changes in body fat and muscle mass . Both the sensitivity and specificity of BMI have been shown to be poor . Additionally , the relation between BMI and percentage of body fat is not linear and differs for men and women . The consequences of the errors in the measurement of obesity with BMI depend on whether they are differential or nondifferential . Differential misclassification , a potentially greater problem in case – control and cross-sectional studies than in prospect i ve cohort studies , can produce a bias toward or away from the null . Nondifferential misclassification produces a bias toward the null for a dichotomous exposure ; for measures of exposure that are not dichotomous , the bias may be away from the null . In short , the use of BMI as a measure of obesity can introduce misclassification problems that may result in important bias in estimating the effects related to obesity Background : Studies of school-based anti-obesity interventions have yielded inconsistent results . Using growth screening data from a school administrative data base , we re-evaluated an obesity prevention strategy that was previously reported to have a beneficial effect on weight status of a sample of students in grade s 5–7 . Methods : Ten K-8 schools ( five control and five intervention ) participated in a 2-year cluster-r and omized trial of a multi-component nutrition education intervention . We obtained student height and weight data for 6 consecutive school years and imputed missing baseline and follow-up measurements ( 53 % and 55 % , respectively ) and defined the target population based on the intent-to-treat principle . We analyzed changes in body mass index ( BMI ) Z-scores via mixed-effects linear regression and in the prevalence of overweight/obesity via conditional logistic regression . We also assessed incidence and remission of overweight/obesity and long-term effects . Results : We analyzed data for 8186 ( 96 % ) K-8 students in the 10 schools ( 4511 in intervention ; 3675 in control ) . From baseline to the end of the intervention period , mean increases in BMI Z-score were 0.10 and 0.09 in the control and intervention groups , respectively ( P=0.671 ) . The prevalence of overweight/obesity increased by 3 % in both groups ( P=0.926 ) . There was no significant intervention effect on the incidence or remission of overweight/obesity .  Among 5469 students who attended study schools during both years of the intervention , there was no significant intervention effect . Furthermore , there was no long-term effect among students with up to 2 years of data beyond the end of the intervention . Conclusion : Using routinely collected data for the entire target population , we failed to confirm earlier findings of an intervention effect observed in a subset of students in grade s 5–7 . Volunteer bias in the prior evaluation and /or measurement error in the routinely collected data are potential reasons for the discrepant findings Background The clinical benefits of any new treatment depend substantially on patient acceptance and treatment satisfaction , because only well-accepted treatments will be widely used . Thus , it is important to underst and how patients experience a new treatment . Objective This study assessed the psychometric properties of a question naire ( PRAM-TSQ ) design ed to measure treatment satisfaction in patients using pramlintide ( an analog of amylin , a glucoregulatory hormone co-secreted with insulin ) , which is design ed to improve glucose control . Methods Patients with diabetes completed the 14-item PRAM-TSQ  at the end of 2 separate placebo-controlled , double-blind , r and omized clinical trials in which they added active or placebo pramlintide to their established insulin regimen . Factor analysis was used to assess item clustering for the PRAM-TSQ , and the Cronbach 's α measure of inter-item agreement was used to assess scale reliability . PRAM-TSQ validity was assessed by comparing scores between treatment arms , and effect sizes were measured by the η statistic . Validity was also assessed by associations ( Pearson correlations ) between the PRAM-TSQ and clinical study outcomes ( end of study values and during study changes in clinical measures : postpr and ial glucose [ PPG ] , A1C , weight , and insulin requirements ) . Results Scaling revealed 4 PRAM-TSQ components : Global Benefits , Specific Benefits , Absence of Side Effects , Treatment Preference . The total composite PRAM-TSQ had good reliability in both studies ( type 1 α = .93 ; type 2 α = .94 ) ; subscale reliabilities ranged from .65 to 94 . Composite scores differed for pramlintide-treated and placebo-treated  patients ( type 1 P < .01 ; type 2 P < .05 ) , and were associated with lower PPG , weight , and insulin requirements ( all P < .05 ) . Results were similar for PRAM-TSQ subscales assessing Global Benefits and Treatment Preference ; Specific Benefits subscale scores were associated with lower PPG and weight ( all P < .05 ) . Conclusions The PRAM-TSQ shows evidence of being a valid , reliable instrument for assessing treatment satisfaction in patients using pramlintide . The subscales are comprehensive and sensitive to the known potential effects of pramlintide treatment . Diabetes educators can use patient responses to the PRAM-TSQ to facilitate treatment adherence by reminding patients of treatment benefits they experience and by helping patients overcome negative effects they report AIM The aim of this study was to evaluate the effects of diet alone , and in association with metformin in monotherapy or in cotreatment with myoinositol ( MYO ) on menstrual irregularities , hirsutism , body weight and composition in overweight/obese women with polycystic ovary syndrome ( PCOS ) . METHODS Twenty-seven PCOS overweight/obese patients were r and omly treated : nine with only diet ( D ) ; nine with diet and metformin 1000 mg/day continuously ( D+M ) ; nine with diet , metformin 500 mg/day and MYO 4 g/day plus 400 µg folic acid daily , continuously ( D+M+I ) . Menstrual cycle , Ferriman-Gallwey score , body mass index ( BMI ) , waist hip rate ( WHR ) , body composition by BIA 101 of AKERN SRL , were measured on basal condition and at 3 months . RESULTS Regularity of menstrual cycle was restored in a significantly number of patients of group D+M+I ( P<0.05 ) ; Ferriman score was significantly improved by weight loss ( P<0.05 ) . Body weight , BMI , waist and hip circumferences decreased significantly in all groups without WHR modification ; body weight loss significantly depended on adding metformin to diet . Fat mass ( FM ) kg and % was significantly reduced in groups D and D+M+I ; fat free mass ( FFM ) kg was slightly reduced by diet ( P<0.05 ) and correlated with Ferriman score . CONCLUSION Body weight loss  in obese PCOS patients improves symptoms and body composition ; weight loss was dependent on adding metformin to diet ; MYO was more effective in restoring regularity of menstrual cycle . Further investigation occurs to confirm metformin and MYO rule on body composition improvement , specially regarding FFM that is likewise FM correlated to cardiovascular risk BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application Background The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospect ively related to obesity . Engaging in episodic future thinking , which involves mental self-projection to pre-experience future events , reduces this bias and energy intake in overweight/obese adults and children . To examine how episodic future thinking can be incorporated into clinical interventions , a Web-based system was created to provide training for adults and children in their everyday lives . Objective Our study examined the technical feasibility , usability , and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions . Methods We recruited 20 parent-child dyads ( N=40 ) from the surrounding community and r and omized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention . Parents were 44.1 ( SD 7.8 ) years of age with BMI of 34.2 ( SD 6.8 ) kg/m2 . Children were 11.0 ( SD 1.3 ) years of age with BMI percentile of 96.0 ( SD 1.8 ) . Families met weekly with a case manager for 4 weeks and used the system daily . Adherence was collected through the Web-based system , and perceived acceptance of the Web-based system was assessed postintervention . Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention . Results All 20 families completed the intervention and attended all sessions . Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use , useful , and helpful . No differences between conditions were found in adherence for parents ( P=.65 ) or children ( P=.27 ) . In addition , results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight . Conclusions We showed that our Web-based system is an accepted technology and a feasible utility . Furthermore , results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control . These results show promising utility in using our Web-based system in interventions Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity‐related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE‐ MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non‐r and omised trials . Meta‐analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow‐up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric  overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet‐specific outcomes need to be reported in order to inform best practice Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity-related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE- MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non-r and omised trials . Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice OBJECTIVE To evaluate psychometric properties of 16-item and 7-item Falls Efficacy Scale-International ( FES-I ) in people with multiple sclerosis ( MS ) . DESIGN Validation and prospect i ve cohort study . SETTING People with MS living in metropolitan areas . PARTICIPANTS Community-dwelling people with MS ( N=169 ; aged 21 - 73y ) who were referred to Multiple Sclerosis Australia for physiotherapy assessment . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES FES-I scores and a range of sociodemographic , physical , and neuropsychological measures . RESULTS The mean score for the 16-item FES-I  was 34.9±11.2 , and the mean score for the 7-item FES-I was 14.7±4.7 . FES-I total scores were normally distributed : skewness of .35 ( SEM=.19 ) for the 16-item and .47 ( SEM .19 ) for the 7-item FES-I , indicating the absence of floor and ceiling effects . Internal reliability was excellent , with Cronbach 's alpha values of .94 ( 16-item ) and .86 ( 7-item ) . Rasch analyses indicated that the structure and measurement properties were better for the 7-item FES-I than for the 16-item FES-I. Construct validity of both scales was supported by sensitivity to group differences relating to demographic characteristics and fall-risk factors . CONCLUSIONS The findings indicate that both 16-item and 7-item versions of the FES-I provide valuable information about the fear of falling in people with MS . However , the 7-item version of FES-I has better psychometric properties in people with MS Study Design . A prospect i ve cohort design was used to evaluate the Functional Rating Index in a multicentered setting with 139 participants . The Functional Rating Index is a self-reporting instrument consisting of 10 items , each with 5 possible responses that express graduating degrees of disability . Objectives . The goal of this study was to evaluate the psychometric qualities of the Functional Rating Index . Summary of Background Data . The Functional Rating Index combines the concepts of the Oswestry Low Back Disability Question naire and the Neck Disability Index and seeks to improve on clinical utility ( time required for administration ) . Methods . One hundred thirty-nine subjects with spinal complaints participated in four different cohorts to study reliability , validity , responsiveness , and clinical utility . Results . Reliability : Test-retest : Intraclass correlation coefficient was excellent ( ICC3,k = 0.99 ) ; interitem correlation : Item efficiency was good , ranging between 0.54 and 0.82 , with a moderate correlation among all items ; Cronbach ’s alpha was excellent ( 0.92 ) . Validity : construct : The Functional Rating Index correlated with the Disability Rating Index ( 0.76 ) , the Short Form-12 Physical Component Score ( 0.76 ) , and the Short Form-12 Mental Component Score ( 0.36 ) . Responsiveness : Overall , the size effect was 1.24 , which is commendable . Clinical utility : Time required by the patient and staff averaged 78 seconds per administration , which is noteworthy . Effect of Sociodemographics : Total scores were not affected by education , gender , nor age , suggesting minimal external validity bias . Conclusions . The Functional Rating Index appears to be psychometrically sound with regard to reliability , validity , and responsiveness and is clearly superior to other instruments with regard to clinical utility . The Functional Rating Index is a promising useful instrument in the assessment of spinal conditions
Most question naires were brief , demonstrated adequate internal consistency , and tapped key cognitive and affective dimensions of weight bias such as stereotypes and blaming .
Background : People living with overweight and obesity often experience weight-based stigmatization .
Investigations of the prevalence and correlates of weight bias and evaluation of weight bias reduction interventions depend upon psychometrically-sound measurement .
Our paper is the first to comprehensively evaluate the psychometric properties , use of people-first language within items , and suitability for use with various population s of available self-report measures of weight bias .