“Attacks” or “Whistling”: Impact of Questionnaire Wording on Wheeze Prevalence Estimates

Background

Estimates of prevalence of wheeze depend on questionnaires. However, wording of questions may vary between studies. We investigated effects of alternative wording on estimates of prevalence and severity of wheeze, and associations with risk factors.

Methods

White and South Asian children from a population-based cohort (UK) were randomly assigned to two groups and followed up at one, four and six years (1998, 2001, 2003). Parents were asked either if their child ever had “attacks of wheeze” (attack group, N=535), or “wheezing or whistling in the chest” (whistling group, N=2859). All other study aspects were identical, including questions about other respiratory symptoms.

Results

Prevalence of wheeze ever was lower in the attack group than in the whistling group for all surveys (32 vs. 40% in white children aged one year, p<0.001). Prevalence of other respiratory symptoms did not differ between groups. Wheeze tended to be more severe in the attack group. The strength of association with risk factors was comparable in the two groups.

Conclusions

The wording of questions on wheeze can affect estimates of prevalence, but has less impact on measured associations with risk factors. Question wording is a potential source of between-study-heterogeneity in meta-analyses.     

Influence of wording and framing effects on moral intuitions

This research considers biasing effects on the expression of moral intuitions. Participants in Study 1 were asked to resolve some hypothetical moral dilemmas that involved the death of one or another set of individuals. For half of the participants, the problems were phrased using a Kill wording and for the other half a Save wording, although the outcomes were identical in each case. In Study 2, framing effects were produced by posing dilemma problems in different orders and in different contexts. In Study 1, the Kill-Save wording difference strongly influenced the resolution of the problems. In Study 2, if the problems involved a single kind of dilemma, the order in which the dilemmas were presented affected the pattern of response, whereas order had no major effect for another two series using different dilemmas. Thus, there were framing effects produced by differences in wording and order that could influence the decisions people make when presented with dilemmas, but the effects were not always large nor did they always appear. The presence and strength of the effects seem to depend on a variety of psychological factors that the problem sets activate. These findings are considered within the perspective of the evolution of cognitive strategies.     

Wording effects and the factor structure of the Hospital Anxiety & Depression Scale in HIV/AIDS patients on antiretroviral treatment in South Africa

Background

Given the immense burden of HIV/AIDS on health systems in sub-Saharan Africa and the intricate link between HIV/AIDS and mental health problems, health care providers need a valid and reliable instrument to assess mental health rapidly. The Hospital Anxiety and Depression Scale (HADS) may constitute such an instrument. The aims of this study were to: (1) examine the factor structure of the HADS in a population of South African HIV/AIDS patients on antiretroviral treatment (ART); and (2) identify and control the disturbing influence of systematic wording effects in vulnerable respondent groups.

Methodology/Principal Findings

The translated scale was administered to 716 HIV/AIDS patients enrolled in the public sector ART program in South Africa. A combined confirmatory factor analysis and correlated-traits-correlated-methods framework was used to determine the preferred factor structure of the HADS, while controlling for the disturbing influence of systematic wording effects. When assessing the structure without a negative wording factor, all three factor structures displayed an acceptable fit to the data. The three-factor solution best fitted the data. Addition of a method factor significantly improved the fit of all three factor solutions. Using χ² difference testing, Razavi''s one-factor solution displayed a superior fit compared to the other two factor solutions.

Conclusions

The study outcomes support the use of the HADS as a valid and reliable means to screen for mental health problems in HIV/AIDS patients enrolled in a public-sector ART program in a resource-limited context. The results demonstrate the importance of evaluating and correcting for wording effects when examining the factor structure of the screening instrument in vulnerable patient groups. In light of the inter-relationships between HIV/AIDS and mental health problems and the scarcity of adequate screening tools, additional studies on this topic are required.     

Wording, Meaning, and Linguistic Ideology

Two seemingly disparate areas of English language structure—the grammar of reported speech and of textual cohesion—are functionally related in that both entail a distinction between "wording" and "meaning." This is consistent with the Western ideological disjunction between language and reality, talk and action. Neither these language structures nor this linguistic ideology are found among the Ngarinyin people of northwestern Australia, suggesting a Whorfian hypothesis about their possible interrelationship.     

Ineffectiveness of Reverse Wording of Questionnaire Items: Let’s Learn from Cows in the Rain

Objective

We examined the effectiveness of reverse worded items as a means of reducing or preventing response bias. We first distinguished between several types of response bias that are often confused in literature. We next developed arguments why reversing items is probably never a good way to address response bias. We proposed testing whether reverse wording affects response bias with item-level data from the Multidimensional Fatigue Inventory (MFI-20), an instrument that contains reversed worded items.

Methods

With data from 700 respondents, we compared scores on items that were similar with respect either to content or to direction of wording. Psychometric properties of sets of these items worded in the same direction were compared with sets consisting of both straightforward and reversed worded items.

Results

We did not find evidence that ten reverse-worded items prevented response bias. Instead, the data suggest scores were contaminated by respondent inattention and confusion.

Conclusions

Using twenty items, balanced for scoring direction, to assess fatigue did not prevent respondents from inattentive or acquiescent answering. Rather, fewer mistakes are made with a 10-item instrument with items posed in the same direction. Such a format is preferable for both epidemiological and clinical studies.     

Correction to: Incongruence between life-history traits and conservation status in reef corals

Coral Reefs - This erratum is published as vendor overlooked corrections with misspelt scientific wording of family Siderastreidae.     

Measuring inhalant nitrite exposure in gay men: Implications for elucidating the etiology of AIDS-related Kaposi's sarcoma

We reviewed 12 epidemiologic studies conducted among gay men with AIDS to examine the role of potential cofactors in the development of KS. Aspects of the studies reviewed include basic study design, wording of the questionnaires, and published results comparing KS patients with those who developed opportunistic infections indicative of AIDS. The studies included questions about sociodemographics, medical history, use of drugs, travel, and sexual behaviors. Patients were invited to provide blood and/or other specimens for laboratory analysis.The results of the review of epidemiologic studies are inconclusive. Nitrite inhalant use was a variable often associated with KS (five studies). The differences in outcomes of these studies may reflect differences in study designs, sample sizes, timing, quality, and content of interviews regarding nitrites, sexual behaviours and other potential cofactors. Epidemiologic study with careful consideration to content of questionnaires and laboratory testing may yet reveal the causes or cofactors for this tumor.     

Ernst Mayr through time on the biological species concept — a conceptual analysis

Summary An analysis is made of Ernst Mayr’s treatment of the biological species definition over time. To avoid misunderstandings, it is important to distinguish between the varying conceptual assumptions which Mayr associates with this definition and the unchanged wording of the definition. A polytypic species, that is a geographical aggregate of allopatric populations, does not fit the biological species definition very well. There is an undeniable tension between these two aspects [the polytypic and nondimensional] of the word species and from 1942 until the present time, I have never ceased to struggle with this problem (Mayr 1992b, p. 9). ... indeed, I pride myself on having changed my mind on frequent occasions (Mayr 1982a, p. 9).     

Response to: “Response to Different measures of 'genome-wide' DNA methylation exhibit unique properties in placental and somatic tissues

We are responding to a Letter to the Editor addressing the Method section of our paper “Different measures of ‘genome-wide’ DNA methylation exhibit unique properties in placental and somatic tissues.” The letter raised concerns that the protocol for Epigentek’s MethylFlash kit was followed incorrectly based on the wording of an online publication of our article. We admittedly made an error in the language used to describe the MethylFlash protocol in our initial submission and thus this was corrected as soon as it was brought to our attention. However, the error was only in language and not procedure. We are confident that the protocol was followed as stated in the insert provided with the MethylFlash^TM Methylated DNA Quantification kit (Colorimetric).We are responding to a Letter to the Editor addressing the Method section of our paper “Different measures of ‘genome-wide’ DNA methylation exhibit unique properties in placental and somatic tissues” (Price ME, Cotton AM, PeÒaherrera MS, McFadden DE, Kobor MS, Robinson WP. Different measures of “genome-wide” DNA methylation exhibit unique properties in placental and somatic tissues. Epigenetics 2012; 7: 652–63; PMID: 22531475; 10.4161/epi.20221). The letter raised concerns that the protocol for Epigentek’s MethylFlash kit was followed incorrectly based on the wording of an online publication of our article. We admittedly made an error in the language used to describe the MethylFlash protocol in our initial submission and thus this was corrected as soon as it was brought to our attention. However, the error was only in language and not procedure. We are confident that the protocol was followed as stated in the insert provided with the MethylFlash^TM Methylated DNA Quantification kit (Colorimetric).     

Cancer patients’ attitudes towards euthanasia and physician-assisted suicide: The influence of question wording and patients’ own definitions on responses

Objectives: The aims of this study were to: (1) investigate patients' views on euthanasia and physician-assisted suicide (PAS), and (2) examine the impact of question wording and patients' own definitions on their responses. Design: Cross-sectional survey of consecutive patients with cancer. Setting: Newcastle (Australia) Mater Hospital Outpatients Clinic. Participants: Patients over 18 years of age, attending the clinic for follow-up consultation or treatment by a medical oncologist, radiation oncologist or haematologist. Main Outcome Measures: Face-to-face patient interviews were conducted examining attitudes to euthanasia and PAS. Results: 236 patients with cancer (24% participation rate; 87% consent rate) were interviewed. Though the majority of participants supported the idea of euthanasia, patient views varied significantly according to question wording and their own understanding of the definition of euthanasia. Conclusions: Researchers need to be circumspect about framing and interpreting questions about support of 'euthanasia', as the term can mean different things to different people, and response may depend upon the specifics of the question asked.     

Can different patient satisfaction survey methods yield consistent results? Comparison of three surveys.

OBJECTIVE: To examine the consistency of survey estimates of patient satisfaction with interpersonal aspects of hospital experience. DESIGN: Interview and postal surveys, evidence from three independent population surveys being compared. SETTING: Scotland and Lothian. SUBJECTS: Randomly selected members of the general adult population who had received hospital care in the past 12 months. MAIN OUTCOME MEASURES: Percentages of respondents dissatisfied with aspects of patient care. RESULTS: For items covering respect for privacy, treatment with dignity, sensitivity to feelings, treatment as an individual, and clear explanation of care there was good agreement among the surveys despite differences in wording. But for items to do with being encouraged and given time to ask questions and being listened to by doctors there was substantial disagreement. CONCLUSIONS: Evidence regarding levels of patient dissatisfaction from national or local surveys should be calibrated against evidence from other surveys to improve reliability. Some important aspects of patient satisfaction seem to have been reliably estimated by surveys of all Scottish NHS users commissioned by the management executive, but certain questions may have underestimated the extent of dissatisfaction, possibly as a result of choice of wording.     

A Delicate Adjustment: Wallace and Bates on the Amazon and “The Problem of the Origin of Species”

For over a century it has been believed that Alfred Russel Wallace and Henry Walter Bates set out for the Amazon in 1848 with the aim of “solving the problem of the origin of species”. Yet this enticing story is based on only one sentence. Bates claimed in the preface to his 1863 book that Wallace stated this was the aim of their expedition in an 1847 letter. Bates gave a quotation from the letter. But Wallace himself never endorsed or repeated this story. Many writers have acknowledged that this letter still survives. Yet the wording is different from that quoted by Bates and the letter says nothing of an expedition. It is argued that the sentence given by Bates is not a genuine quotation from this or any other Wallace letter but was modified by Bates to promote his own reputation. More significantly, this leads to the conclusion that there was a very sudden and dramatic shift in the way species were thought of and discussed after Darwin’s Origin of species appeared. Something called “the problem of the origin of species” (and similar variants) never occurred before Darwin’s book but exploded in frequency immediately after it. A profound change in how species origins were discussed happened which no one seemed to notice.     

Oscillatory Brain Activity Reveals Linguistic Prints in the Quantity Code

Number representations change through education, although it is currently unclear whether and how language could impact the magnitude representation that we share with other species. The most prominent view is that language does not play any role in modulating the core numeric representation involved in the contrast of quantities. Nevertheless, possible cultural hints on the numerical magnitude representation are currently on discussion focus. In fact, the acquisition of number words provides linguistic input that the quantity system may not ignore. Bilingualism offers a window to the study of this question, especially in bilinguals where the two number wording systems imply also two different numerical systems, such as in Basque-Spanish bilinguals. The present study evidences linguistic prints in the core number representational system through the analysis of EEG oscillatory activity during a simple number comparison task. Gamma band synchronization appears when Basque-Spanish bilinguals compare pairs of Arabic numbers linked through the Basque base-20 wording system, but it does not if the pairs are related through the base-10 system. Crucially, this gamma activity, originated in a left fronto-parietal network, only appears in bilinguals who learned math in Basque and not in equivalent proficiency bilinguals who learned math in Spanish. Thus, this neural index reflected in gamma band synchrony appears to be triggered by early learning experience with the base-20 numerical associations in Basque number words.     

How to Test Mandatory Text Templates: The European Patient Information Leaflet

The structure of patient information leaflets (PILs) supplied with medicines in the European Union is largely determined by a regulatory template, requiring a fixed sequence of pre-formulated headings and sub-headings. The template has been criticized on various occasions, but it has never been tested with users. This paper proposes an alternative template, informed by templates used in the USA and Australia, and by previous user testing.The main research question is whether the revision better enables users to find relevant information. Besides, the paper proposes a methodology for testing templates. Testing document templates is complex, as they are “empty”. For both the current and the alternative template, we produced a document with bogus text and real headings (reflecting the empty template) and a real-life document with readable text (reflecting the “filled” template). The documents were tested both in Dutch and in English, with 64 British and 64 Dutch users. The test used a set of scenario questions that covers the full range of template (sub)topics; users needed to indicate the text locations where they expected each question to be answered. The revised template improved findability of information; this effect was strongest for the “filled” template with readable text. When participants were shown both filled templates, there was a clear preference for the revised template. A closer analysis of the findability data revealed question-specific effects of topic grouping, topic ordering, subtopic granularity and wording of headings. Most of these favoured the revised template, but our revision led to adverse effects as well, for instance in the new heading Check with your doctor. Language-specific effects showed that the wording of the headings is a delicate task. Generally, we conclude that document template designs can be analyzed in terms of the four parameters grouping, ordering, granularity and wording. Furthermore, they need to be tested on their effects on information findability, with template translations requiring separate testing. The methodology used in this study seems an appropriate one for such tests. More specifically, we find that the new patient information leaflet template proposed here provides better information findability.     

Chemiosmotic coupling in oxidative and photosynthetic phosphorylation. 1966

50 years ago Peter Mitchell proposed the chemiosmotic hypothesis for which he was awarded the Nobel Prize for Chemistry in 1978. His comprehensive review on chemiosmotic coupling known as the first "Grey Book", has been reprinted here with permission, to offer an electronic record and easy access to this important contribution to the biochemical literature. This remarkable account of Peter Mitchell's ideas originally published in 1966 is a landmark and must-read publication for any scientist in the field of bioenergetics. As far as was possible, the wording and format of the original publication have been retained. Some changes were required for consistency with BBA formats though these do not affect scientific meaning. A scanned version of the original publication is also provided as a downloadable file in Supplementary Information and can be found online at doi:10.1016/j.bbabio.2011.09.018. See also Editorial in this issue by Peter R. Rich. Original title: CHEMIOSMOTIC COUPLING IN OXIDATIVE AND PHOTOSYNTHETIC PHOSPHORYLATION, by Peter Mitchell, Glynn Research Laboratories, Bodmin, Cornwall, England.     

Control of allergic rhinitis and asthma test – a formal approach to the development of a measuring tool

Background

The concurrent management of allergic rhinitis and asthma (ARA) has been recommended by Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. However, a tool capable of assessing simultaneously the control of upper and lower airways diseases is lacking.

Aim

To describe the studies conducted to design the control of ARA test (CARAT) questionnaire.

Methods

We performed a literature review to generate a list of potentially important items for the assessment of control of ARA. A formal consensus development process, that used an innovative web-based application, was designed – 111 experts in ARA and 60 patients participated. At the final consensus meeting, 25 primary and secondary care physicians formulated the questions and response options. A qualitative feasibility study (n = 31 patients) was conducted to evaluate the comprehensibility of the questionnaire while testing two different designs.

Results

Thirty-four potentially important items were identified. All the steps of the consensus process were completed in 2.5 months. The opinions of experts and patients lead to the formulation of 17 questions. At the feasibility study the instructions and wording problems were corrected and a semi-tabular format was chosen.

Conclusion

A tool to measure the control of allergic rhinitis and asthma was developed using a comprehensive set of methodological steps ensuring the design quality and the face and content validity. Additional validation studies to assess the psychometric properties of the questionnaire have started.     

Emmert's Law and the moon illusion

A cognitive account is offered of puzzling, though well known phenomena, including increased size of afterimages with greater distance (Emmert's Law) and increased size of the moon near the horizon (the Moon Illusion). Various classical distortion illusions are explained by Size Scaling when inappropriate to distance, 'flipping' depth ambiguity being used to separate botton-up and top-down visual scaling. Helmholtz's general Principle is discussed with simpler wording - that retinal images are attributed to objects - for object recognition and spatial vision.     

On article 3f of the code of phytosociological nomenclature

We draw attention to a number of syntaxon names which are invalidly published according to Article 3f of the Code of Phytosociological Nomenclature, and give the valid names for the corresponding syntaxa, ranging in rank from subassociation to alliance. A modification of the wording of Art. 3f is proposed, with the aim of clarifying its interpretation and application, as well as the deletion of the reference to Art. 3f in the second sentence of Art. 6.     

A Qualitative Assessment of the Content Validity of the ICECAP-A and EQ-5D-5L and Their Appropriateness for Use in Health Research

Purpose

The ICECAP-A and EQ-5D-5L are two index measures appropriate for use in health research. Assessment of content validity allows understanding of whether a measure captures the most relevant and important aspects of a concept. This paper reports a qualitative assessment of the content validity and appropriateness for use of the eq-5D-5L and ICECAP-A measures, using novel methodology.

Methods

In-depth semi-structured interviews were conducted with research professionals in the UK and Australia. Informants were purposively sampled based on their professional role. Data were analysed in an iterative, thematic and constant comparative manner. A two stage investigation - the comparative direct approach - was developed to address the methodological challenges of the content validity research and allow rigorous assessment.

Results

Informants viewed the ICECAP-A as an assessment of the broader determinants of quality of life, but lacking in assessment of health-related determinants. The eq-5D-5L was viewed as offering good coverage of health determinants, but as lacking in assessment of these broader determinants. Informants held some concerns about the content or wording of the Self-care, Pain/Discomfort and Anxiety/Depression items (EQ-5D-5L) and the Enjoyment, Achievement and attachment items (ICECAP-A).

Conclusion

Using rigorous qualitative methodology the results suggest that the ICECAP-A and EQ-5D-5L hold acceptable levels of content validity and are appropriate for use in health research. This work adds expert opinion to the emerging body of research using patients and public to validate these measures.     

Willingness to engage in casual sex

Sexually dimorphic mate selection strategies were examined in 200 university students reporting their willingness to engage in casual sexual encounters with hypothetical individuals of the opposite sex. Using a questionnaire format, the possibility of forming a long-term relationship was manipulated, while risk of disease, pregnancy, and detection was eliminated across all conditions. In addition, potential partners varied in level of attractiveness, and in personality and behavioral characteristics. As expected, men reported a greater anticipated willingness to engage in sexual intercourse across all conditions compared with women. The possibility of forming a long-term relationship elevated women’s, but not men’s, willingness for sexual intercourse. While a potential partner’s attractiveness had a significant positive overall effect on responses, reducing their relative attractiveness had a greater negative impact on men’s responses. Reference to the parental qualities of a potential partner significantly increased women’s, but not men’s, anticipated willingness for sexual intercourse. Describing a hypothetical partner as non-aggressive (safe) marginally increased women’s willingness (p<.09) and did not affect men’s responses. The wording of items relevant to this condition may have resulted in the potential partner sounding "wimpy" rather than nonaggressive, and this may have reduced the expected effect of this manipulation. The possibility that women may trade off personality and behavioral characteristics with attractiveness to a greater degree than men when assessing potential mates is considered.