Conducting member checking within a qualitative case study on health-related behaviours in a large European city: Appraising interpretations and co-constructing findings

Although member checking is a well-established strategy for appraising credibility, there is a lack of research reporting procedures and outcomes when using this strategy. In recent years, scholars have implemented new member checking strategies along with several epistemological stances. In this work, researchers conducted member checking in three neighbourhoods with different socioeconomic status in Madrid, Spain. Attendance at member checking meetings was lower than expected. Member checking meetings were conducted in public halls within each neighbourhood and lasted approximately 2 hours. During the first hour, researchers introduced the aim of the meetings and shared summarized research findings with attendees using a slideshow. During the second hour, attendees had the opportunity to comment on any aspect of the research. Researchers used grounded theory coding strategies and a constructivist approach informed the analysis of the transcribed member checking meetings. One core category emerged, and it was named 'Co-constructing findings and side effects of the interaction between researchers and participants in member checking'. Member checking attendees contributed to co-constructing findings by means of underscore and disagreement. It is possible that these meetings might have caused side effects such as unintended comparisons between neighbourhoods and negative health-related behaviours. Attendees wondered how the findings could improve their neighbourhoods. The meetings allowed interaction between participants and researchers and resulted in appraising and co-constructing qualitative research findings. More research is needed to advance knowledge about member checking.

Factors influencing dietary inequalities among adolescents in Madrid and Bilbao: a qualitative research project

OBJECTIVE

To describe the design and methodology of a qualitative study to explore the main factors influencing dietary inequalities in adolescents in Madrid and Bilbao, Spain.

METHOD

The study area included six neighborhoods (three in each city) of different socioeconomic status (SES): low, medium, and high. We sampled 12 secondary schools (six in each city: two per socioeconomic level). Our methodology comprised: 1) developing an ad hoc index to classify all neighborhoods according to their SES; 2) selecting the study area and sample; 3) conducting semi-structured interviews (n=36) and focus groups (n=24). Grounded theory and phenomenological analysis will be employed in data analysis. Initially, we found factors influencing in adolescents' diet such as gender, family environment, and SES.

CONCLUSIONS

Systematizing the selection of neighborhoods and secondary schools, along with using appropriate methods, could serve as a foundation for future studies on health inequalities among adolescents.

Correlates of eating behaviors in adolescence: a systematic review of qualitative studies

CONTEXT

Nutrition plays a critical role in adolescence. Adolescents are vulnerable to the impact of different factors that distance them from healthy habits, increasing their risk of chronic diseases in adulthood. Qualitative methodologies allow for a better understanding of these factors.

OBJECTIVE

This systematic review aims to consolidate qualitative research evidence from the past 10 years to analyze the facilitators and barriers influencing adolescents' eating behaviors.

DATA SOURCES

Databases searched for relevant studies were Scopus, Medline/PubMed, PsycINFO, and Web of Science.

DATA EXTRACTION

A total of 4176 records were identified. The authors used the GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative Research) quality-assessment tool.

RESULTS

Fifty articles with qualitative or mixed methodologies were finally included. The most applied techniques were focus groups and semi-structured interviews. The factors influencing adolescents' diets were classified into 4 dimensions: individual, social, community, and macrosystem factors. The most influential were the following-(1) at the individual level: gender (facilitator or barrier), taste and appearance of food (barrier), and lack of time (barrier); (2) at the social level: parents' and caregivers' influence (facilitator or barrier), peer group influence (barrier), and socioeconomic position (barrier); (3) at the community level: school food environment (facilitator or barrier), neighborhood food environment (barrier), household food environment (facilitator or barrier), food insecurity (barrier), and availability and affordability of ultra-processed foods (barrier); and (4) at the macrosystem level: digital tools (facilitator or barrier).

CONCLUSIONS

This systematic review identified several facilitators and barriers influencing eating behaviors among adolescents. Qualitative research provides a rich source of knowledge to inform interventions aimed at improving adolescents' diets. Qualitative research is very useful for collecting researches that help to implement intervention programs that improve adolescent nutrition.

Active use and perceptions of parks as urban assets for physical activity: A mixed-methods study

Parks are potential key urban assets for improved population health; however, their use is not equal among all social groups. Individual and contextual factors could influence residents' perceptions of parks and how they interact with and, eventually, benefit from them. The use of complementary methodologies provides a deeper understanding of the relationship between park use, physical activity (PA), and residents' perceptions. Thus, we designed a mixed-methods study to analyze differences in park use and PA, and the perceptions of parks as urban assets for PA. We selected six parks from three neighborhoods in Madrid (Spain) with different neighborhood socioeconomic status (NSES) for systematic social observation. We registered park users by age, PA level (low, medium, and high), gender, and NSES using the System for Observing Play and Recreation in Communities (SOPARC) audit tool adapted for iOS software (iSOPARC). We also conducted 37 semi-structured interviews and 29 focus groups to analyze residents' perceptions of parks as urban assets for PA in the same neighborhoods. We adopted a convergent-parallel design to analyze both quantitative and qualitative data, and to describe the convergence and divergence areas between them. Parks within the high-NSES were more visited, showing a higher proportion of people performing high PA (11.9%) as compared to residents of the middle (9.3%) and low-NSES (3.2%). Female visitors showed lower PA levels compared to men, especially for parks within high-NSES. The following issues were reported as influence urban park use and perceptions: park maintenance and area perception, works constraints, insecurity and crime, differential perceptions by age, and the availability of organized activities in the parks. Residents from high-NSES reported fewer barriers to park use compared to residents from the other areas, who reported limitations such as less leisure time due to job constrains or perceived insecurity in parks. Senior participants reported that having parks with organized activities and a design oriented towards different age-groups are valuable. Our study shows consistency between the fewer and less intense use of parks registered in the middle and low-NSES neighborhoods, and the more barriers for PA reported in this areas during the qualitative analysis. Mixed-methods provided an insight of the potential causes leading to the differences in park use and PA within cities, which is essential in terms of environmental justice and health equity. Thus, a mixed-methods comprehensive approach to public health problems can help designing public policies addressing relevant factors related to urban health inequities.

Can we improve our neighbourhoods to be more physically active? Residents' perceptions from a qualitative urban health inequalities study

The objective of our study was to identify neighbourhood factors which prevent and encourage physical activity, according to the residents' perspective. We used qualitative methods, conducting 37 semi-structured interviews and 29 focus groups. The main results were that the type of physical activity that took place in every neighbourhood was different; access to sports facilities varied due to prices and safety issues; garbage and obstacles on sidewalks were a serious limitation to physical activity; economic instability had an impact on physical activity. These results might lead the perception and insights of residents to be considered in public health interventions.

Immigration and use of public spaces and food stores in a large city: A qualitative study on urban health inequalities

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In the low- and middle-SES neighbourhoods there were a difficult coexistence with immigrants.

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Some of the interviewees and participants in FGs identified the immigrants who lived in their neighbourhoods as a threat, specially in the use of the public space.

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The food stores managed by immigrants were rejected and denounced by scarce quality of their foods.

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Demand for small traditional food stores in all neighbourhoods.

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The lack of social contact can be harmful for the health of immigrants and native residents.

The analysis of urban health transformations must include the study of how neighbourhoods are influenced by demographic changes such as immigration. The objective of this study was to analyse how the relationship between native and immigrant residents in neighbourhoods with different socio-economic levels influenced the use of urban health assets, such as public spaces and food stores. Three Madrid neighbourhoods of different socio-economic levels were selected and studied by conducting 37 semi-structured interviews and 29 focus groups. Data analysis was based on qualitative sequential discourse.

The main finding was that the presence of immigrants in Madrid neighbourhoods, especially with low and medium socio-economic levels, was perceived negatively, affecting the use of public spaces and food stores. This negative perception unfolded in three dimensions: (1) difficulties for natives and immigrants to live together; (2) limitations on using public spaces caused by a feeling of insecurity; (3) criticism of immigrant food stores, especially Chinese-run food stores. Our findings showed a worrisome lack of social contact between immigrants and native residents, which affected the use of urban health assets, such as public spaces and food stores.

Urban environment and dietary behaviours as perceived by residents living in socioeconomically diverse neighbourhoods: A qualitative study in a Mediterranean context

Scholars have determined that low socioeconomic status (SES) is associated with unhealthy dietary behaviours and that local food environments shape food inequality. Less is known about how residents' perceptions of their food environment affect their dietary behaviours. We conducted 37 semistructured interviews and 29 focus groups in three socioeconomically distinct neighbourhoods in Madrid. We identified the following main categories related to social and physical food environments: (a) perceptions of healthy and unhealthy dietary behaviours, (b) children's relationships with food, (c) precariousness and (d) residential food retailer types. Older adults were perceived as healthier consumers, whereas younger people were identified as fast-food consumers. In the low- and middle-SES neighbourhoods, residents saw home-cooked legume-based stews as healthy food. In the high-SES neighbourhood, television cooking programs were highlighted as a positive influence. In the low- and middle-SES neighbourhoods, grandparents played an essential role in the transmission of healthy eating habits to their grandchildren. In the high-SES neighbourhood, children's diets at home were determined by school menus. In the low- and middle-SES neighbourhoods, participants talked about a black market where food could be purchased. Food retailers with low-quality foods were also highlighted. In all neighbourhoods, residents missed traditional food stores, and in the low- and middle-SES neighbourhoods, immigrant-run food stores were not well accepted. Our study presents the concepts shaping how neighbourhood SES differences affect dietary behaviours according to residents of a large Mediterranean city.

Qualitative examination of the perceived effects of a comprehensive smoke-free law according to neighborhood socioeconomic status in a large city

Smoke-free legislations aim to protect non-smokers from second-hand smoke (SHS) exposure and improve population health outcomes. The aim of this study was to explore residents' perceptions to understand how people living in distinctive SES neighborhoods are differently affected by comprehensive smoke-free laws in a large city like Madrid, Spain. We conducted a qualitative project with 37 semi-structured interviews and 29 focus group discussions in three different SES neighborhoods within the city of Madrid. Constructivist grounded theory was used to analyze the transcripts. One core category arose in our analyses: Neighborhood inequalities in second-hand smoke (SHS) exposure in outdoor places. The enactment of the comprehensive smoke-free law resulted in unintended consequences that affected neighborhoods differently: relocation of smokers to outdoor setting, SHS exposure, noise disturbance and cigarette butt littering. Changes in the urban environment in the three neighborhoods resulted in the denormalization of smoking in outdoor public places, which was more clearly perceived in the high SES neighborhood. Changes in the built environment in outdoor areas of hospitality venues were reported to actually facilitate smoking. Comprehensive smoke-free laws resulted in denormalization of smoking, which might be effective in reducing SHS exposure. Extending smoking bans to outdoor areas like bus stops and hospitality venues is warranted and should include a public health inequalities perspective.

Family caregivers' perceptions of maltreatment of older adults with dementia: findings from the northwest of Spain

Dementia is a neurocognitive disorder that implies a risk factor of maltreatment by family caregivers. In this study, we analyzed both informal caregiver's perceptions of maltreatment and aspects of the caregiver and caregiving behavior that may be associated with maltreatment. We conducted five focus groups (FGs) in three Spanish cities: Segovia, Soria and León. The themes that were identified were related to two levels of maltreatment: (a) relational and (b) institutional. At the relational level, we observed the justification of maltreatment of Older Adults with Dementia (OAswD) by family caregivers during the occurrence of behavioral symptoms. At the institutional level, we noted that lack of support from the government was considered a type of maltreatment. These themes suggest that policy issues related to healthcare should be considered.

Resilience and social support as protective factors against abuse of patients with dementia: A study on family caregivers

OBJECTIVE

Scientific literature has identified different vulnerability factors associated to abuse in people with dementia (PWD), but little is known about the psychosocial protective variables against abuse. The main objective of this study is to investigate a set of caregiver and patient factors linked to abuse-related behavior of PWD.

METHODS

A total of 326 primary and family caregivers, residents of the Castilla and León community (Spain), were evaluated. All participants filled out a standardized protocol, which assessed the sociodemographic characteristics, patient and care-related variables, as well as the perceived burden, resilience, and social support. Abuse-related behavior was evaluated using the Caregiver Abuse Screen.

RESULTS

Results show that the severity of cognitive impairment and behavior disorders of PWD, a greater number of caregiving hours, a worse previous relationship with the caregiver, and perceived burden are positively related with abuse. However, resilience and social support showed a negative relationship with Caregiver Abuse Screen scores, suggesting a protective effect on abuse, even after controlling the effect of a number of covariates. Indeed, resilience was the only variable that remained significant after including the effect of burden.

CONCLUSIONS

This paper states the role of burden in abuse of PWD, while resilience and social support are abuse protective factors. These variables should be considered in future guidelines for the prevention of abuse against PWD.

Changing Neighborhoods and Residents' Health Perceptions: The Heart Healthy Hoods Qualitative Study

Cities, and therefore neighborhoods, are under constant change. Neighborhood changes may affect residents’ health in multiple ways. The Heart Healthy Hoods (HHH) project studies the association between neighborhood and residents’ health. Focusing on a middle–low-socioeconomic neighborhood in Madrid (Spain), our aim was to describe qualitatively its residents’ perceptions on the urban changes and their impacts on health. We designed a qualitative study using 16 semi-structured interviews including adult residents and professionals living or working in the area. Firstly, we described the perceived main social and neighborhood changes. Secondly, we studied how these neighborhood changes connected to residents’ health perceptions. Perceived major social changes were new demographic composition, new socio–cultural values and economic changes. Residents’ negative health perceptions were the reduction of social relationships, increase of stress and labor precariousness. Positive health perceptions were the creation of supportive links, assimilation of self-care activities and the change in traditional roles. Neighborhood changes yielded both negative and positive effects on residents’ health. These effects would be the result of the interrelation of different elements such as the existence or absence of social ties, family responsibilities, time availability, economic resources and access and awareness to health-promoting programs. These qualitative research results provide important insight into crafting urban health policies that may ultimately improve health outcomes in communities undergoing change.

A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study

Objective: To describe a holistic and comprehensive approach to the assessment of sufferer’s perceptio ns of health-related quality of life (HRQ oL) in a cohort of multiple sclerosis (MS) patients. Methods: The G EDMA (Grupo de Enfermedades Desmielinizantes de Madrid, in Spanish) study is an ongoing longitudinal survey using quantitative and qualitative methodologies. The baseline cohort consisted of a large sample of MS patients recruited from 13 hospitals in Madrid, Spain. Using a standardized protocol we collected data concerning the sociodemographic and health status characteristics of patients, as well as implementing a modified Spanish version of the Functio nal A ssessment of Multiple Sclerosis quality of life instrument. Primary caregivers were interviewed using a specific protocol combined with the Zarit Burden Interview. Results: The index cohort comprised 371 MS patients (68.7% female) of mean age 38.9 ± 0.9 years. A ge, sex and clinical form distribution were similar to other MS population-based surveys. There were 258 (69.5%) relapsing-remitting (RR) MS patients and 113 (30.5%) progressive MS patients. More than one-third of the married patients with progressive MS and almost a quarter of the RRMS patients separated or divorced following a diagnosis of MS; 71.3% of the progressive MS patients as well as 65.8% of the RRMS patients were unemployed as a consequence of the disease. Q ualitative analysis showed that friendship and family relationships and occupational status were the most significant dimensions influenced by MS. O n the other hand, the speech analysis of primary caregivers showed that emotional burden was related to patients’ physical disability. Furthermore, primary caregivers described the influence of MS on their own occupatio nal status, their nonacceptance of the disease, a perceptio n of a lack of support by other members of the family as well as a ‘selfish and intransigent’ attitude of the patients themselves. Conclusions: The analysis of the G EDMA cohort provides valuable information that helps clarify the impact of MS on patients’ HRQ oL.

A Control-Based Multidimensional Approach to the Role of Optimism in the Use of Dementia Day Care Services

We examined whether grounded optimism and external locus of control are associated with admission to dementia day care centers (DCCs). A total of 130 informal caregivers were recruited from the Alzheimer's Association in Salamanca (northwest Spain). All caregivers completed an assessment protocol that included the Battery of Generalized Expectancies of Control Scales (BEEGC-20, acronym in Spanish) as well as depression and burden measures. The decision of the care setting at baseline assessment (own home vs DCC) was considered the main outcome measure in the logistic regression analyses. Grounded optimism was a preventive factor for admission (odds ratio [OR]: 0.34 and confidence interval [CI]: 0.15-0.75), whereas external locus of control (OR: 2.75, CI: 1.25-6.03) increased the probabilities of using DCCs. Depression mediated the relationship between optimism and DCCs, but this effect was not consistent for burden. Grounded optimism promotes the extension of care at home for patients with dementia.

Analysis of the Reasons for Non-Uptake of Predictive Testing for Huntington's Disease in Spain: A Qualitative Study

Children of persons affected by Huntington's disease (HD) have a 50% chance of inheriting the disease. Genetic testing in Spain is offered to individuals (presymptomatic test) or mothers of fetuses (prenatal) who run the risk of suffering from HD. The objective of this study is to analyze the factors that influence the decisions of adult children of persons affected with HD regarding predictive testing. A qualitative research methodology was used involving 4 focus groups (FGs) made up of adult children of persons with HD in different cities in Spain. The results of the study showed that over half of the focus group participants were inclined to decline genetic testing. The main explanatory determinants for taking or not taking the predictive test are: Maturity of the individual at risk, which was directly related to age; Ability to cope with a positive test result; Experience of living with HD sufferers; Information about testing and psychological support; Attitude of the family; Social visibility of genetic testing; Personality and temperament of each subject at risk of HD. These results imply that these factors should be analyzed in more detail in quantitative studies in order to help the Spanish Department of Health understand why some children of parents with HD decline genetic testing, so that they may and apply these data when creating specific policy regarding this issue.

Impaired health-related quality of life predicts progression of disability in multiple sclerosis

BACKGROUND AND PURPOSE

To determine the value of health-related quality of life (HRQOL) in predicting progression of disability in patients with multiple sclerosis (MS) over a period of 2 years.

METHODS

Patients with MS were recruited in 13 outpatient clinics in Madrid, Spain. Baseline HRQOL was quantified using the Functional Assessment of MS (FAMS) and disability with Kurtzke Expanded Disability Status (EDSS). A clinical meaningful deterioration of disability was defined as an increased of ≥1 point in baseline EDSS scores of ≤5.5 and an increase of ≥0.5 point in baseline EDSS scores of ≥6.0. We dichotomized the change in disability according to clinical meaningful deterioration (dependent variable) and performed a logistic regression analysis with the tertiles of the FAMS scores (the upper tertile [high HRQOL] was the reference) as independent variable, adjusting by socio-demographic and clinical variables.

RESULTS

Out of 371 enrolled patients, 61 patients with MS dropped out during the 2-year follow-up. Of the remaining 310, 94 (30.3%) had clinical meaningful deterioration of disability. The odds of clinical meaningful deterioration of disability were higher as HRQOL decreased with a significant dose-dependent effect. Adjusted odds ratios were 2.61 [95% confidence interval (CI) 95% = 1.12-6.09], [middle tertile vs. upper tertile (reference)]; and 3.27 (95% CI = 1.31-8.18), (lower tertile vs. upper tertile).

CONCLUSIONS

The identification of those patients with MS with poor HRQOL may be important in assessing the risk of future disability progression. Clearly, impaired HRQOL should be one of the primary concerns amongst clinicians who provide treatment to patients affected by MS.

Low morale is associated with increased risk of mortality in the elderly: a population-based prospective study (NEDICES)

OBJECTIVE

the study aimed to assess the association between morale and mortality.

DESIGN

we used data from the Neurological Disorders in Central Spain (NEDICES), a population-based study.

SUBJECTS

2,516 older persons (mean age 75.7 years) participated in the study.

METHODS

Cox models were used to estimate risk of mortality. Morale was assessed using the Philadelphia Geriatric Center Morale Scale.

RESULTS

489 (21.8%) participants died over a median follow-up of 5.9 years (range 0.1-7.7 years), including 253 (21.8%) deaths among 1,163 participants with low morale scores, 168 (19.3%) among 870 participants with moderate scores and 68 (14.1%) among participants with high scores. In an unadjusted Cox model, relative risk (RR) of mortality in participants with low morale scores = 1.69 (P < 0.001) and RR in participants with moderate scores = 1.47 (P < 0.01) were compared to the reference group (participants with high scores). In a Cox model that adjusted for a variety of demographic factors and co-morbidities, RR of mortality in participants with low morale scores = 1.35 (P <0.05) and moderate scores = 1.16 (not significant) were compared to the reference group.

CONCLUSION

low morale may be an independent predictor of mortality in the elderly. By assessing morale, practitioners might be better positioned to identify patients with poorer prognoses.

Burden and health-related quality of life of Spanish caregivers of persons with multiple sclerosis

Little information exists about caregivers of persons with multiple sclerosis (MS). Our aims were to describe the characteristics of a sample of caregivers of persons with MS, assess their perceived burden, health-related quality of life, and investigate factors influencing this burden. We studied 278 caregivers of persons with MS, recruited from a Spanish cross-sectional survey, measuring health-related quality of life by the 36-Item Short-Form Health Survey (SF-36) and burden by the Zarit Caregiver Burden Interview. Of the caregivers, 56.8% were female and their mean age was 50.1 ± 12.6 years. Their main relationship with the person with MS was spouse/partner (52.9%) and son or daughter (25.9%). Caregiver General Health, Mental Health, Bodily Pain, and Role-emotional Functioning were the most affected dimensions on the SF-36. Multiple regression analysis showed that independent and significant predictors of burden were Role-emotional Functioning and Vitality dimensions SF-36 scores of caregivers, and the Expanded Disability Status Scale scores. The total adjusted variance explained by these variables (adjusted R2) was 0.512. Emotional factors and the disability of the person with MS were major predictors of burden. Psychological and social support should be considered to reduce caregiver burden.

A review about the impact of multiple sclerosis on health-related quality of life

PURPOSE

There is increasing recognition that the global wellbeing of patients with chronic neurological disease is an important outcome in research and clinical practice alike. Many studies involving individuals with multiple sclerosis have demonstrated that the overall wellbeing is not a simple manifestation of impairment or disability. The strongest correlations with health-related quality of life appear to be patient rated emotional adjustment to illness and patient rated handicap. In recent years, health-related quality of life questionnaires that measure the physical, social, emotional, and occupational impact of illness have been developed and validated in populations with MS. Most questionnaires are now available in a range of languages. This development is likely to lead to increasing recognition of neuropsychiatric complications of MS in clinical practice and better quantification of treatment responses in clinical trials.

CONCLUSION

Further work is required to decide which scale is most suited to which purpose. Assessment of multiple sclerosis-specific health-related quality of life should be included in future clinical trials to provide a complete picture of patients' health status.

The diagnosis of Tourette's Syndrome: communication and impact

No study to date has investigated differences in perception regarding the manner in which a diagnosis of Tourette's Syndrome (TS) is communicated and the impact that this diagnosis can have on patients, as well as their relatives and physicians. The main objective was to explore the personal experiences regarding the communication and impact of a TS diagnosis on those who receive the diagnosis, their caregivers and physicians. A qualitative research methodology was used in this study, based on the use of focus groups (FGs). All health professionals, persons with TS and their relatives said that TS was difficult to diagnose. However, each group perceived different causes for the difficulty. Physicians cited the complexity of the symptoms, while the patients themselves noted the general lack of knowledge regarding the disease. In adittion, the physicians and the relatives both noted that the symptoms of TS were often hidden behind family guilt. The communication of the diagnosis to relatives of children with TS was not adequate because of poor understanding and interpretation of the clinical terminology. The most important conclusion was that the current method for communicating the diagnosis of TS to patients and relatives should be improved to facilitate better understanding and interpretation.

[The social and familial dimension: experiences of caregivers and people with multiple sclerosis. The GEDMA study]

INTRODUCTION

Comparing the perceptions of multiple sclerosis (MS) patients and caregivers with regard to the same social and familial issues, as well as delving deeper into the factors that determine the quality of life of these patients and their relatives by using a qualitative methodology, can help us to complete the information on the same topic that has already been collected using scales and quantitative protocols.

AIM

To analyse how a group of people with MS and their caregivers perceive the disease by examining the way they talk about their experience with it.

SUBJECTS AND METHODS

A qualitative methodology was used; more particularly, data were obtained by holding six discussion groups made up of patients and caregivers, who were members of MS patient associations.

RESULTS

People with MS reported the social stigma attached to suffering from the disease. Many of the caregivers thought that patients with MS did not accept the disease and felt that over-protection was of little help in coming to terms with the disease and should therefore be avoided. Remunerated work was described by caregivers as a factor that, at the same time, generated and protected the burden.

CONCLUSIONS

The social stigma, the lack of work and coming to terms with MS were the greatest issues for the patient, while support from the family network, the relationship that should be established with the patient, the impact of MS on children and the role played by remunerated work were the main dimensions of the disease for the caregiver.

[The NEDICES cohort of the elderly. Methodology and main neurological findings]

AIM

To summarise the methodological aspects and main findings of the NEDICES (Neurological Disorders in Central Spain) cohort study of the elderly population, with over 5000 participants.

DEVELOPMENT

The article outlines the findings concerning the following chronic neurological diseases (CND): dementia, Parkinson's disease and Parkinsonisms, stroke and essential, or senile, tremor. The NEDICES study examined the health, mortality and a series of sociological aspects of the cohort that are not discussed here. The paper does describe, however, the objectives, methods, population and development, with the baseline (1994) and incidence (1997) cut-off points, and the main findings regarding the CND under study are discussed.

CONCLUSIONS

The prevalence and incidence of the CND are comparable to those of other Spanish and European population-based studies, but with certain peculiarities, such as the fact that incidence of senile tremor is the highest of those reported in the literature and that this CND is associated with dementia. Over half the cases of Parkinson's disease were reported de novo with the study and Alzheimer's disease was associated with vascular risk factors.

Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing

Health-related quality of life (HRQoL) has been more intensively studied in multiple sclerosis (MS) than in any other neurological disorder. Traditional medical models of impairment and disability are an incomplete summary of disease burden. Quality of life can be thought of as the sum of all sources of satisfaction (including anticipated sources) minus all threats (including anticipated threats). Many psychosocial factors-including coping, mood, self-efficacy, and perceived support-influence the quality of life of patients with MS more than biological variables such as weakness or extent of MRI lesions. Neuropsychiatric complications such as cognitive impairment and fatigue are also important predictors, even in those patients in the early stages of the disease. We review generic and specific HRQoL measures to help clinicians choose the most appropriate therapies. Subjective (self-report) HRQoL measures may serve to alert clinicians to areas that would otherwise be overlooked. Studies of new interventions should include an assessment of HRQoL not just impairment or disability alone.

Methods and demographic findings of the baseline survey of the NEDICES cohort: a door-to-door survey of neurological disorders in three communities from Central Spain

OBJECTIVE

To describe the methods and general results of the baseline longitudinal survey in a defined cohort of elderly people from three areas of Central Spain (urban and rural). The survey was designed to study dementia, essential tremor, Parkinson's disease and stroke.

STUDY DESIGN

A population-based longitudinal study with door-to-door interviews.

METHODS

This study was carried out in two phases: Phase 1 (health status questionnaire and screening performed by lay interviewers) and Phase 2 (diagnosis of neurological illnesses by neurologists).

RESULTS

The study flow chart, screening instruments for neurological disorders, main demographic data (age, sex, educational attainment, occupation) and general health status of the 5,278 screened participants (2,238 men and 3,040 women) are given for the two phases. The response rate was 85.3%, and participation was higher in men and in the urban area.

CONCLUSIONS

Participation rates were good in both phases of the NEDICES baseline study, and this was influenced by age, sex and setting of the participants. Educational attainment, occupation and health status data are analogous to other Spanish studies performed in the elderly. As the study population was large and good participation rates were achieved, precise analysis of morbidity of the neurological disorders investigated will be possible.

Informal caregiving in multiple sclerosis patients: data from the Madrid Demyelinating Disease Group study

PURPOSE

To describe the profile of Multiple Sclerosis (MS) patient caregivers and assess their caregiving burden.

METHODS

A total of 91 MS patients, recruited from a Spanish longitudinal survey, and their corresponding caregivers were studied. Caregivers were administered a questionnaire that collected social and demographic data, and a generic caregiver burden interview (the Zarit scale). Furthermore, MS patients were administered a specific health-related quality of life (HRQoL) instrument (the modified Spanish version of the Functional Assessment of Multiple Sclerosis).

RESULTS

24.5% of the sample required caregivers to perform activities of daily life. Caregiver profile was as follows: 67% female; mean age, 51.5 +/- 14.1 years; and mean daily time devoted to care, 11.5 +/- 8.2 h. Most caregivers had some type of support, 67% informal and 31.9% formal. The amount of time spent in caring for relatives was the main item determining the burden of MS-patient caregivers. Moreover, MS patient's HRQoL showed a moderate inverse correlation with caregiver burden.

CONCLUSIONS

In contrast to previous studies, most Spanish MS-patient caregivers are female, and there is a considerable percentage of parent caregivers. A greater degree of formal support and an improvement in MS patients' HRQoL may serve to reduce caregiver burden.

Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients

The existing knowledge about the health-related quality of life (HRQoL) and its relationship to cognitive and/or emotional functioning in multiple sclerosis (MS) is scarce. We assessed differences between subgroups of MS outpatients (n = 209) on one HRQoL instrument: a version of the Functional Assessment of Multiple Sclerosis quality of life instrument; on two cognitive functioning tests: the Mini-Mental State Examination and the clock drawing test; and on two emotional functioning tests: the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Three disease-related characteristics were assessed: physical disability, duration of the illness, and clinical course. The results showed that each of these has an effect on at least one dimension of HRQoL and on one mental functioning test. Thus, the more severe, the more progressive, and the longer the illness duration, the lower the HRQoL. Likewise, cognitive mean scores decreased and emotional mean scores increased with greater illness severity and progressive the MS. Furthermore, we also found significant correlations between cognitive and emotional functioning tests and HRQoL dimensions. Thus, the worse cognitive functioning and the higher depressive and anxiety symptoms score the lower the HRQoL.

[Searching for more specific dimensions for the measurement of quality of life in multiple sclerosis]

INTRODUCTION AND OBJECTIVES

Study of the quality of life in multiple sclerosis (MS) should consider use of an instrument which includes social, psychological, physical and mental aspects. The objective of this study is to show the validated dimensions of the scale of quality of life Functional Assessment of Multiple Sclerosis (FAMS) in the Spanish population, and verify their consistency.

PATIENTS AND METHODS

308 patients with MS (clinically defined or with laboratory support, according to Poser s clinical criteria), referred from 10 Neurology Outpatient Clinics of Hospitals of the Autonomic Community of Madrid. The study was of transversal design, and carried out by direct interview. We used a questionnaire containing the FAMS scale and other variables related to different aspects (clinical, social, employment, psychological and cognitive).

RESULTS

The average age was 38.2 +/- 10.5 years with an average score on the Expanded Disability Status Scale (EDSS) of 3.6 +/- 2.3. The average scores of the parameters are lower than those obtained with the original version of FAMS; the internal consistency of these dimensions is slightly higher than those of the original FAMS. The parameters symptoms and general state of mind and also the FAMS in general had their internal consistency increased by the inclusion of eight variables which were originally excluded.

CONCLUSION

The FAMS scale is more consistent and reliable for the evaluation of quality of life if we include specific variables of MS which do not form part of the American version of the FAMS.