title: A questionnaire for multinational case-control studies of environmental risk factors in multiple sclerosis (EnvIMS-Q).
abstract: OBJECTIVE
  The increasing incidence of multiple sclerosis (MS) worldwide, especially in women, points to the crucial role of environmental and lifestyle risk factors in determining the disease occurrence. An international multicentre case-control study of Environmental Risk Factors In Multiple Sclerosis (EnvIMS) has been launched in Norway, Sweden, Italy, Serbia and Canada, aimed to examine MS environmental risk factors in a large study population and disclose reciprocal interactions. To ensure equivalent methodology in detecting age-related past exposures in individuals with and without MS across the study sites, a new questionnaire (EnvIMS-Q) is presented.
  
  
  METHODS
  EnvIMS-Q builds on previously developed guidelines for epidemiological studies in MS and is a 6-page self-administered postal questionnaire. Participants are de-identified through the use of a numerical code. Its content is identical for cases and controls including 'core' and population-specific questions as proxies for vitamin D exposure (sun exposure, dietary habits and supplementation), childhood infections (including infectious mononucleosis) and cigarette smoking. Information on possible confounders or effect modifiers is also obtained. EnvIMS-Q was initially drafted in English and subsequently translated into Italian, Serbian, Norwegian, Swedish and French-Canadian. EnvIMS-Q has been tested for acceptability, feasibility and reliability.
  
  
  CONCLUSIONS
  EnvIMS-Q has shown cross-cultural feasibility, acceptability and reliability in both patients with MS and healthy subjects from all sites. EnvIMS-Q is an efficient tool to ensure proper assessment of age-specific exposure to environmental factors in large multinational population-based case-control studies of MS risk factors.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. maurap@uniss.it
authors.forename: M
authors.initials: M
authors.lastname: Pugliatti
authors.forename: I
authors.initials: I
authors.lastname: Casetta
authors.forename: J
authors.initials: J
authors.lastname: Drulovic
authors.forename: E
authors.initials: E
authors.lastname: Granieri
authors.forename: T
authors.initials: T
authors.lastname: Holmøy
authors.forename: M T
authors.initials: MT
authors.lastname: Kampman
authors.forename: A-M
authors.initials: AM
authors.lastname: Landtblom
authors.forename: K
authors.initials: K
authors.lastname: Lauer
authors.forename: K-M
authors.initials: KM
authors.lastname: Myhr
authors.forename: M
authors.initials: M
authors.lastname: Parpinel
authors.forename: T
authors.initials: T
authors.lastname: Pekmezovic
authors.forename: T
authors.initials: T
authors.lastname: Riise
authors.forename: B
authors.initials: B
authors.lastname: Zhu
authors.forename: C
authors.initials: C
authors.lastname: Wolfson
mesh_terms: D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D004777:Environment; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008019:Life Style; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000208:ethnology; D009664:Norway / Q000453:epidemiology; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology