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Portion size images are advantageous in dietary assessment. The aim of the present study was to develop and validate new culturally specific image-series for portion size estimation to be used in a new Norwegian version of a British web-based dietary assessment tool (myfood24). Twenty-three image-series of different foods, each containing seven portion size images, were created and validated in a group of adults (n 41, 58 % female) aged 19–44 (median 23), out of which 63 % had higher (tertiary) education. The participants compared 46 portions of pre-weighed foods to the portion size images (1886 comparisons in total). Portion size estimations were either classified as correct, adjacent or misclassified. The weight discrepancy in percentage between the chosen and the correct portion size image was also calculated. Mann–Whitney U tests were used to explore if portion size estimation accuracy differed across sample characteristics, or if it depended on how the foods were presented. For thirty-eight of the forty-six presented food items, the participants selected the correct or adjacent portion size image 98 % on average. The remaining eight food items were on average misclassified by 27 % of the participants. Overall, a mean weight discrepancy of 2⋅5 % was observed between the chosen and the correct portion size images. Females estimated portion size more accurately than males (P = 0⋅019). No other significant differences in estimation accuracy were observed. In conclusion, the new image-series performed satisfactorily, except for the image-series depicting bread, caviar spread and marzipan cake, which will be altered. The present study demonstrates the importance of validating portion size estimation tools.
The COVID-19 pandemic has caused unprecedented stress and fear throughout the world.
To evaluate the psychological effects of the COVID-19 pandemic on the Saudi public, and to examine the performance of the Arabic version of the Four-Dimensional Symptom Questionnaire (4DSQ) scale.
We conducted an online questionnaire-based cross-sectional survey of a sample of the Saudi public.
The study included 347 participants, who reported significantly higher levels of distress, depressive symptoms, anxiety symptoms and somatisation compared with a normative sample. Females scored higher in terms of somatisation, depression and anxiety symptoms, and distress. Obtaining COVID-19 information from friends and relatives was associated with higher levels of somatisation, depression and anxiety symptoms, and distress. Cronbach's alpha was 0.93 for the distress scale, 0.88 for the depression scale, 0.88 for the anxiety scale and 0.86 for the somatisation scale.
Levels of psychological distress were high among the Saudi public during the COVID-19 pandemic. We found high reliability for the Arabic version of the 4DSQ scale. However, three items did not conform to the four-factor structure, namely, item 1: ‘During the past week, did you suffer from dizziness or feeling light-headed?’, item 20: ‘During the past week, did you suffer from disturbed sleep?’ and item 46: ‘During the past week did you ever think I wish I was dead?’.
Few studies have validated FFQ estimates of dietary glycaemic index (GI) and load (GL). We investigated how well our estimates of overall GI and GL from FFQs correlate with estimates from repeated 24 h recall data to validate overall GI and GL in the Adventist Health Study-2 (AHS-2).
The AHS-2 is a prospective population-based cohort of 95 873 Seventh-day Adventist adult church members enrolled from 2002 to 2007 to investigate diet, cancer and mortality.
A 204-item FFQ was used to assess race- and gender-specific validity of GI and GL and 24 h recall data, from the calibration sub-study, were used as the reference.
The 734 calibration study participants were randomly selected by church and included approximately equal numbers of blacks and whites but were otherwise similar to the whole cohort with respect to gender, age, education and vegetarian status.
The deattenuated correlation coefficients for overall GI ranged from 0·19 (95 % CI −0·06, 0·53) in black men to 0·46 (95 % CI 0·40, 0·60) in black women, with both non-black men and women falling between those values (0·45 (95 % CI 0·35, 0·65) and 0·38 (95 % CI 0·27, 0·57), respectively). GL correlations were somewhat higher for all study participants. When looking at the entire cohort, the deattenuated validity correlation value for overall GI was (r 0·38, 95 % CI 0·36, 0·47) and GL was (r 0·39, 95 % CI 0·34, 0·49).
Our findings support the cautious use of our FFQ in epidemiological studies when assessing associations of overall GI and GL with disease risk. However, observed differences by race should be considered when interpreting results.
Adequate dietary intake is critical to prevent adverse pregnancy outcomes. India has a high burden of maternal and child morbidity and mortality, but there is a lack of adequate tools to assess dietary intake. We validate a food frequency questionnaire (FFQ), New-Interactive Nutrition Assistant-Diets in India Study of Health (NINA-DISH), among pregnant women living with and without HIV in Pune, India. Women were selected from a cohort study investigating immune responses to HIV and latent TB during pregnancy. The FFQ was administered during the third trimester and validated against multiple 24-hour diet recalls (24-HDRs) collected in second and third trimesters. Data for analysis was available from 58 women out of 70 enrolled into this sub-study, after excluding those with incomplete data or implausible energy intake. The median (Q1, Q3) age of study participants was 23 (20, 25) years. Median (Q1, Q3) daily energy intakes were 2522 (1912, 2858) kcal and 2551 (2034, 3337) kcal by 24-HDR and FFQ, respectively with FFQ overestimating nutrient intake. Pearson correlations between log-transformed estimates from FFQ and 24-HDR for energy, protein, carbohydrate, fat, iron and zinc were 0.47, 0.48, 0.45, 0.33, 0.4, and 0.54, respectively. Energy-adjusted and deattenuated correlations ranged from 0.41 (saturated fat) to 0.73 (sodium). The highest misclassification into extreme tertiles was observed for fat (22%), saturated fat (21%), and sodium (21%). Bias existed at higher intake levels as observed by Bland-Altman plots. In conclusion, NINA-DISH is a valid and feasible tool for estimating dietary intakes among urban pregnant women in western India.
This study was conducted to develop and validate a questionnaire to assess the impact of COVID-19 pandemic on lifestyle-related behaviour related to eating, activity and sleep pattern.
Indexed study used a mixed method design. Phase I employed qualitative methods for development of questionnaire including literature review, focus group discussion, expert evaluation and pre-testing. Phase II used quantitative methods for establishing construct validity of the questionnaire via parallel factor analysis.
Phase 1 involved participation of experts from different fields (Departments of Medicine, Nutrition and Clinical Psychology) and general adult population. For phase II, data were collected from 124 adult respondents (female = 57·26 %); mean age (36 ± 14·8 years) residing in an urban setting.
The questionnaire consisted of three sections: (A) socio-demographic and anthropometric parameters, (B) twenty-four items each for investigating the changes in eating, activity and sleep behaviour before v. during COVID-19, (C) six items assessing COVID-19 specific reasons for lifestyle change. The Cronbach’s α value of the questionnaire is 0·83 suggesting its good internal consistency.
This appears to be a valid tool to assess the impact of COVID-19 on lifestyle-related behaviours with potential utility for public health researchers to identify these changes at community level and develop strategies to reinforce corrective behaviours.
The aim of the present study was to develop and validate a vitamin D food frequency questionnaire (FFQ) for assessment of dietary vitamin D intake in healthy adults in England, UK.
The current study assessed the agreement between a four-day food diary (4d-FD) and a new vitamin D FFQ to measure dietary intake of vitamin D. Dietary intake was estimated using Nutritics dietary analysis software and Spearman’s and Bland-Altman tests were utilised to assess correlation and agreement, respectively. Participants also provided a blood sample for plasma analysis of vitamin D concentrations.
Fifty participants were recruited to the study from the University of Chester and vicinity.
Results showed a strong correlation between vitamin D intake recorded by the FFQ and the 4d-FD (r = 0.609; P < 0.0001) within 95% limits of agreement. Furthermore, a significant correlation between plasma 25(OH)D concentrations and vitamin D intake measured by the FFQ (r = 0.290, P = 0.041) and the 4d-FD (r = 0.360, P = 0.01) was observed.
Our analysis suggests this FFQ is a useful and rapid tool for researchers and health professionals to assess vitamin D dietary intakes in healthy adults in the UK.
Reassurance seeking (RS) is motivated by perceived general and social/relational threats across disorders, yet is often under-recognized because it occurs in covert (i.e. subtle) and overt forms. Covert safety-seeking behaviour may maintain disorders by preventing corrective learning and is therefore important to identify effectively.
This study presents the validation and psychometric analyses of a novel measure of covert and overt, general and social/relational threat-related interpersonal RS.
An initial 30-item measure was administered to an undergraduate sample (N = 1626), as well as to samples of individuals diagnosed with obsessive compulsive disorder (OCD; n = 50), anxiety disorders (n = 60) and depression (n = 30). The data were subjected to exploratory and confirmatory factor analyses, and validation analyses.
An exploratory factor analysis using principal axis factoring with oblique rotation yielded five interpretable factors, after removing four complex items. The resulting 26-item measure, the Covert and Overt Reassurance Seeking Inventory (CORSI), evidenced good convergent and divergent validity and accounted for 54.99% of the total variance after extraction. Factor correlations ranged from r = .268 to .736, suggesting that they may be tapping into unique facets of RS behaviour. In comparison with undergraduate participants, all clinical groups had significantly higher total scores [t (51.80–840) = 3.92–5.84, p < .001]. The CFA confirmed the five-factor model with good fit following the addition of four covariance terms (goodness of fit index = .897, comparative fit index = .918, Tucker–Lewis index = .907, root mean square error approximation = .061).
The CORSI is a brief, yet comprehensive and psychometrically strong measure of problematic RS. With further validation, the CORSI has potential for use within clinical and research contexts.
Validating phase quantification procedures of powder X-ray diffraction (XRD) data for an implementation in an ISO/IEC 17025 accredited environment has been challenging due to a general lack of suitable certified reference materials. The preparation of highly pure and crystalline reference materials and mixtures thereof may exceed the costs for a profitable and justifiable implementation. This study presents a method for the validation of XRD phase quantifications based on semi-synthetic datasets that reduces the effort for a full method validation drastically. Datasets of nearly pure reference substances are stripped of impurity signals and rescaled to 100% crystallinity, thus eliminating the need for the preparation of ultra-pure and -crystalline materials. The processed datasets are then combined numerically while preserving all sample- and instrument-characteristic features of the peak profile, thereby creating multi-phase diffraction patterns of precisely known composition. The number of compositions and repetitions is only limited by computational power and storage capacity. These datasets can be used as input files for the phase quantification procedure, in which statistical validation parameters such as precision, accuracy, linearity, and limits of detection and quantification can be determined from a statistically sound number of datasets and compositions.
Synkinesis is a distressing sequela of peripheral facial palsy (PFP). This study aimed to translate and validate the Synkinesis Assessment Questionnaire (SAQ), a reliable patient-reported outcome evaluation tool for synkinesis, in French. The SAQ was translated following a standard forward–backward translation procedure. After a cognitive debriefing with 10 PFP patients, the SAQ-F was assessed amongst 50 patients for internal consistency, known-group validity, construct validity, criterion validity, and test–retest reliability. Results demonstrated that the SAQ-F was valid, reliable, and had a unidimensional structure. The SAQ-F should be accompanied by clinician-based scales, to provide valuable additional information on the severity of synkinesis.
The Eating Assessment in Toddlers FFQ (EAT FFQ) has been shown to have good reliability and comparative validity for ranking nutrient intakes in young children. With the addition of food items (n 4), we aimed to re-assess the validity of the EAT FFQ and estimate calibration factors in a sub-sample of children (n 97) participating in the Growing Up Milk – Lite (GUMLi) randomised control trial (2015–2017). Participants completed the ninety-nine-item GUMLi EAT FFQ and record-assisted 24-h recalls (24HR) on two occasions. Energy and nutrient intakes were assessed at months 9 and 12 post-randomisation and calibration factors calculated to determine predicted estimates from the GUMLi EAT FFQ. Validity was assessed using Pearson correlation coefficients, weighted kappa (κ) and exact quartile categorisation. Calibration was calculated using linear regression models on 24HR, adjusted for sex and treatment group. Nutrient intakes were significantly correlated between the GUMLi EAT FFQ and 24HR at both time points. Energy-adjusted, de-attenuated Pearson correlations ranged from 0·3 (fibre) to 0·8 (Fe) at 9 months and from 0·3 (Ca) to 0·7 (Fe) at 12 months. Weighted κ for the quartiles ranged from 0·2 (Zn) to 0·6 (Fe) at 9 months and from 0·1 (total fat) to 0·5 (Fe) at 12 months. Exact agreement ranged from 30 to 74 %. Calibration factors predicted up to 56 % of the variation in the 24HR at 9 months and 44 % at 12 months. The GUMLi EAT FFQ remained a useful tool for ranking nutrient intakes with similar estimated validity compared with other FFQ used in children under 2 years.
To conduct a systematic review of studies for the validation of semiquantitative FFQ (SFFQ) that assess food intake in adults.
The authors conducted a systematic search in PubMed for articles published as late as January 2020 in Spanish, English, French and Portuguese. Individual searches (twelve in total) paired three hyphenated and non-hyphenated variations of ‘semiquantitative food frequency questionnaire’ with both ‘validity’ and ‘validation’ using the ‘all fields’ and the ‘title/abstract’ retrieval categories. Independent extraction of articles was performed by four authors using predefined data fields.
We searched for original SFFQ validation studies that analysed general diet composition (nutrients with or without food groups or energy analysis) in healthy adults, in any setting, and that also reported correlation coefficients.
Sixty articles were included. The preferred comparison standard for validation was food records (n 37). The main correlation coefficients used were Pearson’s (n 41), and validity coefficients varied from −0·45 to 1. Most correlation coefficients were adjusted by energy (twelve studies presented only crude values). The elements mentioned most frequently were energy, macronutrients, cholesterol, SFA, PUFA, fibre, vitamin C, Ca and Fe.
Although all these SFFQ are reported as validated, coefficients may vary across groups of foods and nutrients. Based on our findings, we suggest researchers to consult our revision before choosing a SFFQ and to review important issues about them, such as their validation, number of items, number of participants, etc. Systematic Review Registration: PROSPERO number CRD42017064716. Available at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017064716.
The accuracy of sea-ice motion products provided by the National Snow and Ice Data Center (NSIDC) and the Ocean and Sea Ice Satellite Application Facility (OSI-SAF) was validated with data collected by ice drifters that were deployed in the western Arctic Ocean in 2014 and 2016. Data from both NSIDC and OSI-SAF products exhibited statistically significant (p < 0.001) correlation with drifter data. The OSI-SAF product tended to overestimate ice speed, while underestimation was demonstrated for the NSIDC product, especially for the melt season and the marginal ice zone. Monthly Lagrangian trajectories of ice floes were reconstructed using the products. Larger spatial variability in the deviation between NSIDC and drifter trajectories was observed than that of OSI-SAF, and seasonal variability in the deviation for NSIDC was observed. Furthermore, trajectories reconstructed using the NSIDC product were sensitive to variations in sea-ice concentration. The feasibility of using remote-sensing products to characterize sea-ice deformation was assessed by evaluating the distance between two arbitrary positions as estimated by the products. Compared with the OSI-SAF product, relative errors are lower (<11.6%), and spatial-temporal resolutions are higher in the NSIDC product, which makes it more suitable for estimating sea-ice deformation.
Economic models play a central role in the decision-making process of the National Institute for Health and Care Excellence (NICE). Inadequate validation methods allow for errors to be included in economic models. These errors may alter the final recommendations and have a significant impact on outcomes for stakeholders.
To describe the patterns of technical errors found in NICE submissions and to provide an insight into the validation exercises carried out by the companies prior to submission.
All forty-one single technology appraisals (STAs) completed in 2017 by NICE were reviewed and all were on medicines. The frequency of errors and information on their type, magnitude, and impact was extracted from publicly available NICE documentation along with the details of model validation methods used.
Two STAs (5 percent) had no reported errors, nineteen (46 percent) had between one and four errors, sixteen (39 percent) had between five and nine errors, and four (10 percent) had more than ten errors. The most common errors were transcription errors (29 percent), logic errors (29 percent), and computational errors (25 percent). All STAs went through at least one type of validation. Moreover, errors that were notable enough were reported in the final appraisal document (FAD) in eight (20 percent) of the STAs assessed but each of these eight STAs received positive recommendations.
Technical errors are common in the economic models submitted to NICE. Some errors were considered important enough to be reported in the FAD. Improvements are needed in the model development process to ensure technical errors are kept to a minimum.
The aim of the current study was to evaluate the accuracy of the new software eAT24 used to assess dietary intake in the National Food, Nutrition and Physical Activity Survey (IAN-AF) against urinary biomarkers: N (nitrogen), K (potassium) and Na (sodium).
We conducted a cross-sectional study. Two non-consecutive 24-h dietary recalls (24-HDR) were applied, and a 24-h urine sample was collected. We examined differences between estimates from dietary and urine measures, Pearson correlation coefficients were calculated and the Bland–Altman plots were drawn. Multiple linear regression was used to evaluate the factors associated with the difference between estimates.
Sub-sample from the Portuguese IAN-AF sampling frame.
Ninety-five adults (men and women) aged 18–84 years.
The estimated intake calculated using the dietary recall data was lower than that estimated from urinary excretion for the three biomarkers studied (protein 94·3 v. 100·4 g/d, K 3212 v. 3416 mg/d and Na 3489 v. 4003 mg/d). Considering 2 d of recall, the deattenuated correlation coefficients were 0·33, 0·64 and 0·26 for protein, K and Na, respectively. For protein, differences between dietary and urinary estimates varied according to BMI (β = −1·96, P = 0·017). The energy intake and 24-h urine volume were significantly associated with the difference between estimates for protein (β = 0·03, P < 0·001 and β = −0·02, P = 0·002, respectively), K (β = 0·71, P < 0·001 and β = −0·42, P = 0·040, respectively) and Na (β = 1·55, P < 0·001 and β = −0·81, P = 0·011, respectively).
The new software eAT24 performed well in estimating protein and K intakes, but lesser so in estimating Na intake, using two non-consecutive 24-HDR.
How well do vignette designs capture actual behaviour in the real world? This study employs original survey data featuring both hypothetical vignettes and behavioural questions in order to assess the external validity of descriptive and causal inferences in survey experiments. The survey was conducted in a three-province, probability-proportional-to-size sample of 1,897 rural residents in China and focuses on the legal mobilization of citizens in response to grievances involving land rights. In terms of descriptive inference, we find that relative to the behavioural benchmark, hypothetical vignettes significantly over-estimate legal mobilization in response to a grievance, particularly for higher-cost actions like petitioning the government and litigating in court. We find that data from hypothetical vignettes affect causal inference as well, producing significantly different results regarding the effect of political connections and legal knowledge on legal mobilization. The study makes a contribution by identifying conditions under which hypothetical vignettes are less likely to produce valid inference. It engages a rich literature on disputing and legal mobilization in the field of Chinese politics and helps to resolve debates over the role of political connections and legal knowledge.
This study aimed to validate a nutrition knowledge questionnaire appropriate for use in Australia.
Nutrition knowledge is essential in establishing and maintaining strategies that reduce the burden of disease and promote wellbeing. The General Nutrition Knowledge Questionnaire (GNKQ) was developed in the United Kingdom in 1999 and validated for Australia in 2008. Changes in national nutrition recommendations and food availability prompted the redevelopment and revalidation of the UK questionnaire in 2016. However, the Australian questionnaire had not been subsequently updated.
Content validity was determined using a sample of academic dietitians in Australia (n 8). Face validity was undertaken with retail employees (n 11) whose highest level of education was secondary school. Ninety-three undergraduate nutrition and engineering students at Queensland University of Technology completed the questionnaire for construct validity, and nineteen students were contacted a week later for test–retest reliability.
In the 117-scored questionnaire, nutrition students scored consistently higher in each of the four sections and overall (87 %, M 102, IQR 95, 107) compared with engineering students (77 %, M 82, IQR 76, 87·25, P < 0·01). Internal reliability of the questionnaire was high (α = 0·92) as was test–retest reliability (rs = 0·96, ICC2,1 = 0·99). AUS-R NKQ determined significant differences between individuals with known higher levels of nutrition knowledge and obtained high validity, reliability and consistency within an Australian sample.
AUS-R NKQ refined through this research is valid and would be an appropriate questionnaire for assessing the effectiveness of nutrition knowledge-based interventions for public health programmes, clinicians and researchers.
Continuous point-of-care patient monitoring is now the standard in emergency room and critical care settings, and the technology to produce small, affordable, safe bedside vital sign monitors is ubiquitous. The statistical methods to validate these emerging monitoring technologies, however, are in their infancy. Validation statistics have centered on the Bland–Altman method and cardiac output measurement, but this method fails to evaluate the ability of a device to reliably detect serial changes (trend analysis). Newer statistical methods such as concordance and polar plots have been developed to assess trending. Small-sized studies assessing within-subject trending require other statistical approaches. Since clinical validation studies must be of a sufficient standard to be used in evidence-based reviews, researchers assessing the value of emerging clinical monitoring technologies must have an understanding of these new statistical methodologies. They must also take into consideration the precision of the reference method and issues pertaining to setting the criteria for accepting a new monitoring method, particularly when using percentage error and the traditional <30% benchmark.
Introduction: Extreme heat events due to climate change are becoming increasingly frequent and severe, and may have an impact on human health. Administrative database studies using International Classification of Diseases 10th revision codes (ICD-10) are powerful tools to measure the burden of acute heat illness (AHI) in Canada. We aimed to assess the validity of the coding algorithm for emergency department (ED) encounters for AHI in our region. Methods: Two independent reviewers retrospectively abstracted data from 507 medical records of patients presenting at two EDs in Ontario between May-September 2015-2018. The Gold Standard definition of an AHI is chart-documented heat exposure with a heat related complaint, such as syncope while working outdoors on a hot day. To determine ICD coding algorithm positive predictive value (PPV), records that were previously coded as ICD-10 heat illnesses were compared to the Gold Standard for AHI. To determine sensitivity (Sn), specificity (Sp) and negative predictive values (NPV), the Gold Standard was compared to randomly selected records. A total of 326,702 ED visits were included in study period with 208 having an ICD-10 code related to heat illness. Sample size calculation demonstrated a need to manually review 62 previously coded heat illnesses and 931 random cases, of which 50 and 474 have been reviewed, respectively. In both abstractions, 20% of cases underwent a blinded duplicate review. Results: In our review of 474 random records, 2 cases were identified as AHI but without an appropriate ICD-10 code, 445 were not AHIs, and no cases had been identified as having an AHI ICD-10 inappropriately applied. In our review of 50 previously coded heat illnesses, 34 were found to be appropriately coded and 16 inappropriately coded, as AHI ICD-10. Average patient age and gender of heat illness vs non-heat illness ED presentations were 32 and 48 years of age and 49% and 64% male, respectively. The leading complaint in AHI was heat stroke/exhaustion (39%), followed by headaches (15%), dizziness (9%), shortness of breath (9%) and syncope/presyncope (6%). 76% of all heat illness presentations presented following a period of physical exertion. Conclusion: Final calculation of Sn, Sp, PPV, NPV for the algorithm will occur upon completion of the review. Preliminary results suggest that ICD-10 coding for AHI may be applied correctly in the ED. This study will help to determine if administrative data can accurately be used to measure the burden of heat illness in Canada.
Le Metacognitions Questionnaire-30 (MCQ-30), développé par Wells et Cartwright-Hatton (2004) , est une échelle de mesure multidimensionnelle de facteurs métacognitifs impliqués dans le développement et la persistance de troubles psychiques. La théorie définitoire inhérente à cette échelle est résumée par Wells et Matthews  dans le modèle Self-Regulatory Executive Function (S-REF). Dans la dépression, une rumination pathogène serait induite par des pensées (croyances métacognitives évaluées par le MCQ-30) et des stratégies de contrôle qui perpétuent une cognition et des stratégies de coping inadaptées. Le but de notre étude est d’adapter et de valider une version française du MCQ-30 en évaluant ses propriétés psychométriques dans un échantillon de patients qui ont un diagnostic de dépression.
L’adaptation française de l’instrument a été réalisée après une traduction back-forward permettant une bonne validité de face. Elle est en cours de passation dans un échantillon de patients hospitalisés ayant un diagnostic de dépression établi selon les critères du DSM 4 TR. Le nombre de sujets nécessaires est estimé à 150 . Une analyse factorielle confirmatoire permettra de vérifier la structure dimensionnelle à 5 facteurs retrouvée dans l’étude de validation de la version originale. Pour l’évaluation de la validité convergente, nous étudierons la corrélation des différents facteurs du MCQ-30 avec une mesure de l’anxiété d’état (Penn State Worry Questionnaire), de la rumination (Rumination on Sadness Scale), et de la dépression (Beck Depression Inventory). Hypothèses sur le comportement de l’échelle : en accord avec les validations étrangères, nous supposerons une corrélation positive et significative de la MCQ-30 avec les échelles sus-citées.
Des résultats partiels seront présentés et discutés à la lumière de la taille de l’échantillon.
The paper describes the adaptation and psychometric evaluation of the Hungarian version of the quality of life in depression scale. The adaptation procedure involved: bilingual translation; field-testing for face and content validity; and assessment of instrument's reliability and construct validity. The new language version was shown to be well-accepted by respondents and to have excellent psychometric properties.