Robot-Assisted Pelvic Dissection for Enlarged Lymph Nodes in Melanoma Improves Recovery with Equivalent Oncological Outcomes to Open Pelvic Dissection.

BACKGROUND: Robot-assisted pelvic lymph node dissection (rPLND) has been reported in heterogenous groups of patients with melanoma, including macroscopic or at-high-risk-for microscopic metastasis. With changing indications for surgery in melanoma, and availability of effective systemic therapies, pelvic dissection is now performed for clinically detected bulky lymph node metastasis followed by adjuvant drug therapy. rPLND has not been compared with open pelvic lymph node dissection (oPLND) for modern practice. METHODS: All patients undergoing pelvic node dissection for macroscopic melanoma at a single institution were reviewed as a cohort, observational study. RESULTS: Twenty-two pelvic lymph node dissections were identified (8 oPLND; 14 rPLND). The number of pelvic lymph nodes removed was similar (median oPLND 6.5 (interquartile range [IQR] 6.0-12.5] versus rPLND 6.0 [3.75-9.0]), with frequent matted nodes (11/22, 50.0%). Operative time (median oPLND 130 min [IQR 95.5-182] versus rPLND 126 min [IQR 97.8-160]) and complications (Clavien-Dindo scale) were similar. Length of hospital stay (median 5.34 days (IQR 3.77-6.94) versus 1.98 days (IQR 1.39-3.50) and time to postoperative adjuvant therapy (median 11.6 weeks [IQR 10.6-18.5] versus 7.71 weeks [IQR 6.29-10.4]) were shorter in the rPLND group. No differences in pelvic lymph node recurrence (p = 0.984), distant metastatic recurrence (p = 0.678), or melanoma-specific survival (p = 0.655) were seen (median follow-up 21.1 months [rPLND] and 25.7 months [oPLND]). CONCLUSIONS: rPLND is an effective way to remove bulky pelvic lymph nodes in melanoma, with a shorter recovery and reduced interval to initiating adjuvant therapy compared with oPLND. This group of patients may especially benefit from neoadjuvant systemic approaches to management.

What is the impact of a Hepatitis C 'test, trace and treat' pilot using peer workers?

Chronic Hepatitis C virus (HCV) infection is a major cause of morbidity and deaths worldwide. HCV treating teams are working toward the goal of eliminating HCV by 2030. People who inject drugs (PWIDs) are at high risk of HCV but contact tracing is not routine practice. Here, we present the outcomes of a HCV 'test, trace and treat' pilot using peer workers to test contacts of individuals with HCV. PWIDs with HCV were invited to participate when they presented for treatment. For those agreeing to participate, a peer approached them to invite potential contacts for HCV testing. Data were collected on uptake, HCV test results, treatment rates and reasons for declining. Overall, 295 individuals (162 recent HCV [<1 year], 69 reinfections, 64 known chronic HCV) were invited to participate, of whom 147 (50%) agreed and 30 (20% of those agreeing) brought forward 120 contacts for testing. Of these, 44 (37%) were HCV RNA positive, including 23 who were not known to services. 34 (77%) started antiviral treatment. HCV RNA positivity was highest in contacts of reinfections (45%) compared with recent HCV (33%) and known chronic HCV (25%). The most common reason for index individuals declining participation was that they reported no longer being in contact with individuals from their injecting network (65%). In conclusion, half of PWIDs with HCV agreed to participate in the pilot, but only 20% of these brought contacts forward. The frequency of active HCV was high in the contacts and the majority started antiviral treatment.

Paediatric neurosurgical implications of a ribosomopathy: illustrative case and literature review.

Ribosomopathies are rare, recently defined entities. One of these, Labrune syndrome, is recognisable radiologically by its distinctive triad of leukoencephalopathy, intracranial calcifications and cysts (LCC). These cysts may have neurosurgical implications at different ages because of their progressive expansion and local mass effect. The aetiology of LCC is related to a widespread cerebral microangiopathy and is due to a genetic mutation in SNORD118, responsible for stabilisation of the large ribosomal subunit during assembly.

Phosphaturic Mesenchymal Tumor of the Ankle: A Case Report and Review of the Literature.

We report the case of a phosphaturic mesenchymal tumor of the ankle; an extremely rare lesion that causes osteomalacia via paraneoplastic renal phosphate wasting. A 41-year-old man was referred to plastic surgery with a swelling over the anterior ankle, which had been increasing in size for 1 year. Focused ultrasound assessment was inconclusive, but excision biopsy demonstrated features in keeping with a phosphaturic mesenchymal tumor. Evidence of tumor-induced osteomalacia was subsequently identified on review of historical biochemistry. The patient was followed-up for 1 year with normalization of serum phosphate. In this case report, we present a discussion of the differential diagnosis for foot and ankle soft tissue lesions, and a review of the literature regarding the diagnosis and management of these tumors. Accurate identification of any soft tissue lesion on clinical examination alone is extremely challenging and excision biopsy should be considered in cases of diagnostic uncertainty.

A Dietary Supplement Frequency Questionnaire Correctly Ranks Nutrient Intakes in US Older Adults When Compared to a Comprehensive Dietary Supplement Inventory.

BACKGROUND: Dietary supplements are commonly taken by adults in the United States and can contribute substantially to daily nutrient intakes. Short supplement-use questionnaires are often used in dietary surveys, but their accuracy has not been well studied. OBJECTIVES: The primary objective was to evaluate the accuracy of a short, self-administered supplement frequency questionnaire (SFQ) relative to a comprehensive 1-y inventory of supplement use. A secondary objective was to compare SFQ responses for participants in the intensive measurement study to those from a control group to investigate a possible research participation effect. METHODS: The Supplement Reporting study enrolled 1029 older adults in 2005-2006, with a mean age of 67.8 y, who participated in the Multiethnic Cohort and reported regular use of dietary supplements. Of these, 375 were interviewed quarterly to collect detailed information on types and amounts of dietary supplements used, while 654 served as the control group. All participants completed 2 SFQs, 1 y apart. RESULTS: Agreement between the 2 instruments in use at least weekly ranged from 88% to 97% for 15 of 16 supplement types, with a lower agreement of 74% for vitamin D. The correlations of nutrient intakes from supplements between the 2 instruments were high, ranging from 0.48 to 0.75, except for iron (r = 0.29). However, mean nutrient intakes as reported on the SFQ were higher than intakes from the inventory for most nutrients, sometimes twice as high. Nutrient intakes based on the SFQ were similar for the inventory and control groups, at both baseline and the end of the study. CONCLUSIONS: A self-administered short SFQ can be used in large surveys to identify participants who use 16 categories of dietary supplements at least once a week and can correctly rank participant intakes of nutrients. However, the SFQ does not accurately estimate absolute levels of nutrient intakes from supplements.

Regulation and validation of smartphone applications in plastic surgery: It's the Wild West out there.

BACKGROUND AND PURPOSE: The use of smartphone applications is ubiquitous within healthcare. Over recent years there have been multiple applications developed within the field of plastic surgery. In the UK, applications with a medical purpose should be registered with the Medicines and Healthcare products Regulatory Authority (MHRA) as a medical device. The aim of this study was to evaluate plastic surgery specific smartphone applications designed for healthcare professional usage, and determine what proportion meet the criteria of a medical device and are suitably certified. METHODS: A systematic review of the Apple and Google Play App stores was carried out using search terms relevant to plastic surgery. Data was extracted from the app store listing, developer website and the contents of each application. Each application was evaluated against the criteria given by the MHRA to determine whether it constituted a medical device. RESULTS: 215 applications for plastic surgery healthcare professionals were identified, of which 22 met the definition of a medical device. Only 14% (n = 3) of these applications were appropriately certified, 14% (n = 3) were validated in peer-reviewed literature and 45% (n = 10) had documented medical professional involvement. CONCLUSION: Most applications with a medical purpose were not certified as a medical device, had not been validated in any peer-reviewed research, and did not have any documented involvement of medical professionals. The potential consequences of such applications operating incorrectly are stark and represent a risk to patient safety. Usage of multiple applications in a single patient encounter may compound error and safety of clinical care.

Neurosurgical education in Ireland; a conference and medical student experiences.

BACKGROUND: Adult neurosurgery in Ireland is carried out in two specialist centres, attached to only two medical schools. This leaves four Irish medical schools with no formal clinical attachment in neurosurgery. We organised a student neurosurgical conference to increase exposure to neurosurgical topics and to evaluate student's experience of undergraduate neurosurgical education. METHODS: The conference was organised by students from two Irish Universities with assistance from the National Neurosurgical Centre. It was open to students from all medical students in Ireland. Attendees were invited to complete a questionnaire before and after the conference. Questions were either yes or no answer or responses on a Likert scale. RESULTS: 95 students attended and all medical schools in Ireland were represented. 22% of attendees have received neurosurgical teaching during their medical education, while only 12% had a clinical rotation in neurosurgery. 40% of students are in a medical school attached to a hospital that performs neurosurgery. 54% of attendees disagreed or strongly disagreed that their medical education has comprehensively covered neurosurgical topics. 92% agreed or strongly agreed that they would like more teaching or clinical exposure in neurosurgery. 96% would attend future neurological study days. CONCLUSIONS: Undergraduate neurosurgical education in Ireland varies between Irish medical schools. Many students reported their medical education has not adequately covered neurosurgical topics and that they would like more exposure to neurosurgical teaching and clinical attachments. Nearly all students reported they would attend future neurosurgical student conferences and this may be one method of increasing exposure to neurosurgery as a medical student.

Method for Securing Methlymethacrylate Bone Cement Using Histoacryl Glue During Cranioplasty for Contour Deformities.

Methylmethacrylate bone cement (MM-BC) is one of the reconstructive methods: during cranioplasty to correct cranial defects following trauma or cranial surgery. Perfect intraoperative immobilization of the MM-BC is crucial to ensure correct subsequent shaping to best improve contour defects. Current immobilization techniques reported are time-consuming and involve complex metalwork. The authors hereby present a technique that may simplify the immobilization process by using histoacryl glue to secure the MM-BC. This provides a quick, inexpensive, and readily available option providing fixation strong enough to withstand final shaping of the MM-BC.

Crisis intervention for people with severe mental illnesses.

BACKGROUND: A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis-intervention models of care were developed as a possible solution. OBJECTIVES: To review the effects of crisis-intervention models for anyone with serious mental illness experiencing an acute episode compared to the standard care they would normally receive. If possible, to compare the effects of mobile crisis teams visiting patients' homes with crisis units based in home-like residential houses. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials. There is no language, time, document type, or publication status limitations for inclusion of records in the register. This search was undertaken in 1998 and then updated 2003, 2006, 2010 and September 29, 2014. SELECTION CRITERIA: We included all randomised controlled trials of crisis-intervention models versus standard care for people with severe mental illnesses that met our inclusion criteria. DATA COLLECTION AND ANALYSIS: We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. MAIN RESULTS: The update search September 2014 found no further new studies for inclusion, the number of studies included in this review remains eight with a total of 1144 participants. Our main outcomes of interest are hospital use, global state, mental state, quality of life, participant satisfaction and family burden. With the exception of mental state, it was not possible to pool data for these outcomes.Crisis intervention may reduce repeat admissions to hospital (excluding index admissions) at six months (1 RCT, n = 369, RR 0.75 CI 0.50 to 1.13, high quality evidence), but does appear to reduce family burden (at six months: 1 RCT, n = 120, RR 0.34 CI 0.20 to 0.59, low quality evidence), improve mental state (Brief Psychiatric Rating Scale (BPRS) three months: 2 RCTs, n = 248, MD -4.03 CI -8.18 to 0.12, low quality evidence), and improve global state (Global Assessment Scale (GAS) 20 months; 1 RCT, n = 142, MD 5.70, -0.26 to 11.66, moderate quality evidence). Participants in the crisis-intervention group were more satisfied with their care 20 months after crisis (Client Satisfaction Questionnaire (CSQ-8): 1 RCT, n = 137, MD 5.40 CI 3.91 to 6.89, moderate quality evidence). However, quality of life scores at six months were similar between treatment groups (Manchester Short Assessment of quality of life (MANSA); 1 RCT, n = 226, MD -1.50 CI -5.15 to 2.15, low quality evidence). Favourable results for crisis intervention were also found for leaving the study early and family satisfaction. No differences in death rates were found. Some studies suggested crisis intervention to be more cost-effective than hospital care but all numerical data were either skewed or unusable. We identified no data on staff satisfaction, carer input, complications with medication or number of relapses. AUTHORS' CONCLUSIONS: Care based on crisis-intervention principles, with or without an ongoing homecare package, appears to be a viable and acceptable way of treating people with serious mental illnesses. However only eight small studies with unclear blinding, reporting and attrition bias could be included and evidence for the main outcomes of interest is low to moderate quality. If this approach is to be widely implemented it would seem that more evaluative studies are still needed.

Developmental associations between victimization and body mass index from 3 to 10 years in a population sample.

In the current prospective study, we investigated (1) whether high and low BMI in early childhood puts a child at risk of victimization by their peers, and (2) whether being victimized increases BMI over the short- and long-term, independent of the effect of BMI on victimization. We also examined whether gender moderated these prospective associations. Participants were 1,344 children who were assessed yearly from ages 3 to 10 years as part of the Québec Longitudinal Study of Child Development (QLSCD). BMI predicted annual increases in victimization for girls aged 6 years and over; for boys aged 7 and 8 years of age, higher BMI reduced victimization over the school year. Further, victimization predicted annual increases in BMI for girls after age 6 years. When these short-term effects were held constant, victimization was also shown to have a three and 5-year influence on annual BMI changes for girls from age 3 years. These short- and long-term cross-lagged effects were evident when the effects of family adversity were controlled. The findings support those from previous prospective research showing a link between higher BMI and victimization, but only for girls. Further, being victimized increased the likelihood that girls would put on weight over time, which then increased future victimization. The implications of these prospective findings for interventions are considered. Aggr. Behav. 42:109-122, 2015. © 2015 Wiley Periodicals, Inc.

Determining minimum food intake amounts for diet diversity scores to maximize associations with nutrient adequacy: an analysis of schoolchildren's diets in rural Kenya.

OBJECTIVE: To explore multiple methods of calculating diet diversity scores (DDS) to maximize associations with predicted dietary micronutrient adequacy among schoolchildren in rural Kenya. DESIGN: Up to three 24 h recall interviews were administered for each child for a total of 1544 d of intake from all schoolchildren. Daily amounts of food consumed were assigned to one of eight food groups. Five DDS were developed based on various minimum intake amounts from each food group: (i) 1 g; (ii) 15 g; (iii) a variable minimum based on the content of a target nutrient for each group; (iv) the median intake level for each group; and (v) the 90th percentile intake level for each group. A diet was assigned 1 point towards the daily DDS if the food group intake was above the defined minimum level. Five scores were calculated for each child, and bivariate longitudinal random-effects models were used to assess the correlation between each DDS and the mean probability of adequacy for fourteen nutrients. SETTING: Embu District, Kenya. SUBJECTS: Schoolchildren (n 529), mean age 7·00 (sd 1·41) years. RESULTS: Only DDS based on a 15 g minimum and DDS based on nutrient content were significantly associated with mean probability of adequacy after adjusting for energy intake (0·21 and 0·41, respectively). CONCLUSIONS: A DDS using minimum intakes based on nutrients contributed by a food group best predicted nutrient adequacy in this population. These analyses contribute to the continued search for simpler and more valid dietary quality indicators among low-income nations.

Enhancing Pragmatic Language skills for Young children with Social communication difficulties (E-PLAYS-2) trial: study protocol for a cluster-randomised controlled trial evaluating a computerised intervention to promote communicative development and collaborative skills in young children.

BACKGROUND: A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The E-PLAYS-2 study will test an intervention ('E-PLAYS') aimed at supporting such children. E-PLAYS uses a dyadic computer game to develop collaborative and communication skills. Preliminary studies by the authors show that E-PLAYS can produce improvements in children with social communication difficulties on communication test scores and observed collaborative behaviours. The study described here is a definitive trial to test the effectiveness and cost-effectiveness of E-PLAYS delivered by teaching assistants in schools. METHODS: The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, delivered in primary schools, compared to care as usual. Cluster-randomisation will take place at school level to avoid contamination. The E-PLAYS intervention will be delivered by schools' teaching assistants. Teachers will select suitable children (ages 5-7 years old) from their schools using guidelines provided by the research team. Assessments will include blinded language measures and observations (conducted by the research team), non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. A process evaluation will also include interviews with parents, children and teaching assistants, observations of intervention delivery and a survey of care as usual. The primary analysis will compare pragmatic language scores for children who received the E-PLAYS intervention versus those who did not at 40 weeks post-randomisation. Secondary analyses will assess cost-effectiveness and a mixed methods process evaluation will provide richer data on the delivery of E-PLAYS. DISCUSSION: The aim of this study is to undertake a final, definitive test of the effectiveness of E-PLAYS when delivered by teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. Should E-PLAYS prove to be effective at the end of this trial, we believe it is likely to be welcomed by schools, parents and children. TRIAL REGISTRATION: ISRCTN 17561417, registration date 19th December 2022. PROTOCOL VERSION: v1.1 19th June 2023.

Dietary choline and betaine intakes vary in an adult multiethnic population.

Choline and betaine are important nutrients for human health, but reference food composition databases for these nutrients became available only recently. We tested the feasibility of using these databases to estimate dietary choline and betaine intakes among ethnically diverse adults who participated in the Multiethnic Cohort (MEC) Study. Of the food items (n = 965) used to quantify intakes for the MEC FFQ, 189 items were exactly matched with items in the USDA Database for the Choline Content of Common Foods for total choline, choline-containing compounds, and betaine, and 547 items were matched to the USDA National Nutrient Database for Standard Reference for total choline (n = 547) and 148 for betaine. When a match was not found, choline and betaine values were imputed based on the same food with a different form (124 food items for choline, 300 for choline compounds, 236 for betaine), a similar food (n = 98, 284, and 227, respectively) or the closest item in the same food category (n = 6, 191, and 157, respectively), or the values were assumed to be zero (n = 1, 1, and 8, respectively). The resulting mean intake estimates for choline and betaine among 188,147 MEC participants (aged 45-75) varied by sex (372 and 154 mg/d in men, 304 and 128 mg/d in women, respectively; P-heterogeneity < 0.0001) and by race/ethnicity among Caucasians, African Americans, Japanese Americans, Latinos, and Native Hawaiians (P-heterogeneity < 0.0001), largely due to the variation in energy intake. Our findings demonstrate the feasibility of assessing choline and betaine intake and characterize the variation in intake that exists in a multiethnic population.

Meat supplementation increases arm muscle area in Kenyan schoolchildren.

The present study examines the effect of animal-source-food (ASF) intake on arm muscle area growth as part of a larger study examining causal links between ASF intake, growth rate, physical activity, cognitive function and micronutrient status in Kenyan schoolchildren. This randomised, controlled feeding intervention study was designed with three isoenergetic feeding interventions of meat, milk, and plain traditional vegetable stew (githeri), and a control group receiving no snack. A total of twelve elementary schools were randomly assigned to interventions, with three schools per group, and two cohorts of 518 and 392 schoolchildren were enrolled 1 year apart. Children in each cohort were given feedings at school and studied for three school terms per year over 2 years, a total of 9 months per year: cohort I from 1998 to 2000 and cohort II from 1999 to 2001. Food intake was assessed by 24 h recall every 1-2 months and biochemical analysis for micronutrient status conducted annually (in cohort I only). Anthropometric measurements included height, weight, triceps skinfold (TSF) and mid-upper-arm circumference (MUAC). Mid-upper-arm muscle area (MAMA) and mid-upper-arm fat area (MAFA) were calculated. The two cohorts were combined for analyses. The meat group showed the steepest rates of gain in MUAC and MAMA over time, and the milk group showed the next largest significant MUAC and MAMA gain compared with the plain githeri and control groups (P< 0.05). The meat group showed the least increase in TSF and MAFA of all groups. These findings have implications for increasing micronutrient intake and lean body mass in primary schoolchildren consuming vegetarian diets.

A school-based supplementary food programme in rural Kenya did not reduce children's intake at home.

OBJECTIVE: To examine changes in energy intake along with markers of dietary quality (animal-source energy and protein intakes) among household members in the presence of supplementary school feeding in rural Kenya. DESIGN: A 2-year, longitudinal, randomized controlled feeding intervention study. SETTING: Kyeni South Division, Embu District, Kenya. SUBJECTS: A total of 182 schoolchildren and selected household members. RESULTS: There was no evidence that schoolchildren who received supplementary snacks at school experienced reduced intakes at home or that intakes by other family members were increased at the expense of the schoolchild's intake. CONCLUSIONS: This analysis highlights a number of factors useful in planning for supplementary feeding interventions in rural Kenya and similar communities.

Women's experiences of Hyperemesis Gravidarum (HG) and of attending a dedicated multi-disciplinary hydration clinic.

PROBLEM: Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that affects 1-3 % of women and has profound nutritional, physical and psychological consequences. Previous research identified that women with HG report inadequate infrastructure for day case management. INTRODUCTION: A multi-disciplinary HG day case service (IRIS Hydration Clinic) was launched and provides routine care for women with HG in a dedicated unit. The multi-disciplinary team involves midwives, dietitians, obstetricians and perinatal mental health. AIMS: To explore women's experiences of HG and of attending the dedicated clinic. METHODS: Ten interviews were conducted with women who attended the clinic. Data were transcribed and analysed using Reflexive Thematic Analysis. FINDINGS: The physical and psychological impact of HG was captured. The appreciation for the dedicated clinic was a common theme, regarding having somewhere specific for treatment rather than ad-hoc treatment. 'Relationships' was a significant theme - women described the benefits of continuity of care and the positive impact of peer support. Areas for improvement were explored, such as expansion and extra sensitivity around some women's issues around weight gain/loss. DISCUSSION: HG causes significant ill-health and its impact remains undervalued. Women had highly positive experiences of attending the dedicated HG clinic. The impact of continuity and individualized care in a day-case setting improved women's experiences of this condition. CONCLUSION: The dedicated HG clinic was highly valued by women experiencing the condition. The IRIS clinic provides much-needed validation for a medical condition with little understanding from the general public or many healthcare professionals.

Endoscopy training through the COVID-19 pandemic: maintaining procedural volumes and key performance standards.

Objective: Endoscopy departments have experienced considerable challenges in the provision of endoscopy services since the start of the COVID-19 pandemic. Several studies have reported a reduction of procedures performed by trainee endoscopists during the pandemic. The aim of this study was to assess the impact on colonoscopy training and quality in an academic centre throughout successive waves of the pandemic. Methods: This was a single-centre, retrospective, observational study comparing colonoscopies performed at a tertiary endoscopy centre in Ireland at different stages of the pandemic with those performed during a similar time frame prepandemic. Data were collected using electronic patient records. Primary outcomes were procedure volumes, adenoma detection rate and mean adenoma per procedure. Results: In the prepandemic period, 798 colonoscopies were performed. During the same period in 2020, 172 colonoscopies were performed. In 2021, during the third wave of the pandemic, 538 colonoscopies were performed. Percentages of colonoscopies performed by trainees were 46.0% (n=367) in 2019, 25.6% (n=44) in 2020 and 45.2% (n=243) in 2021. Adenoma detection rate was 21.3% in 2019, 38.6% in 2020 and 23.9% in 2021. Mean adenoma per procedure was 0.45 in 2019, 0.86 in 2020 and 0.49 in 2021. Caecal intubation rate was 90.74% in 2019, 90.9% in 2020 and 95.88% in 2021. Conclusion: The COVID-19 pandemic initially had a negative impact on overall colonoscopy volumes and training. Despite a reduction in procedural volume, key performance standards were maintained by trainees. Maintenance of hands-on training is essential to allow trainees achieve and retain competency in endoscopy.

Validation and Comparison of Nutrient Intakes from Two Dietary Questionnaires Developed for the Multiethnic Cohort Study.

BACKGROUND: Quantitative food frequency questionnaires (QFFQs) are often used to measure dietary intakes in large cohort studies but the impact of updating these questionnaires over time is not often examined. OBJECTIVE: This study compared nutrient intakes estimated from two different QFFQs to each other and to intakes calculated from three 24-hour dietary recalls (24HDRs). DESIGN: This study used a cross-sectional design. PARTICIPANTS/SETTING PARTICIPANTS: Participants (N = 352) were members of the Multiethnic Cohort Study from five racial and ethnic groups (African American, Japanese American, Latino American, Native Hawaiian, and White) who lived in Hawaii and Los Angeles. They were recruited in 2010 and asked to complete two QFFQs, two months apart, and three 24HDRs in the time between completion of the QFFQs. One questionnaire had been developed for a baseline survey (baseline QFFQ) at the start of the Multiethnic Cohort Study during 1993-1996, and the other was updated for a follow-up study 10 years later (10-year QFFQ). MAIN OUTCOME MEASURES: Daily intakes of energy and nine nutrients were estimated from both QFFQs, and from the average of three 24HDRs. STATISTICAL ANALYSES PERFORMED: Pearson's correlation coefficients were calculated between log-transformed nutrient intakes from each QFFQ and the 24HDRs and between the two QFFQs overall, by sex, and by race and ethnicity. RESULTS: Correlations for the 10-year QFFQ with the 24HDRs (average = 0.45) were higher than for the baseline QFFQ (average = 0.41), although the differences were not statistically significant. The increase in correlations was particularly pronounced for Native Hawaiian and African American participants. When absolute values were adjusted for energy intake, the average correlations were higher at 0.57 for the baseline QFFQ and 0.58 for the 10-year QFFQ overall and this pattern was seen in most racial and ethnic subgroups. The average correlations between the two QFFQs were 0.73 for both absolute intakes and nutrient densities overall. CONCLUSIONS: Correlations of nutrient intakes between the two QFFQs and 24HDRs were similar, and intakes from the two QFFQs were highly correlated. QFFQs updated for changes to the food supply may provide improved assessment for cohort studies that include diverse populations.