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Background: The Movement Disorder Society-sponsored Nonmotor Rating Scale is an update of the existing Parkinson's disease Nonmotor Symptoms Scale modified to address some limitations in Nonmotor Symptoms Scale scoring, structure, and symptom coverage.Methods: PD patients were recruited from movement disorder centers in an international, multicenter study. The Movement Disorder Society Nonmotor Rating Scale, consisting of 13 domains plus a subscale for nonmotor fluctuations, was rater administered, along with the Nonmotor Symptoms Scale and other clinical assessments. Standard reliability and validity testing were conducted.Results: Four hundred and two PD patients were recruited (mean age ± standard deviation, 67.42 ± 9.96 years; mean age at PD onset ± standard deviation, 59.27 ± 10.67 years; median Hoehn and Yahr stage 2 (interquartile range 2-3). Data quality was satisfactory for all Movement Disorder Society Nonmotor Rating Scale domains except sexual (6.7% missing data). There were no floor or ceiling effects for the Movement Disorder Society Nonmotor Rating Scale and nonmotor fluctuations total score; domains had no ceiling effects, but some floor effects (13.5%-83.5%). The Movement Disorder Society Nonmotor Rating Scale and nonmotor fluctuations total score internal consistency were acceptable (average Cronbach's alpha, 0.66 and 0.84, respectively); interrater reliability was excellent (intraclass correlation coefficient, >0.95); for test-retest reliability, the intraclass correlation coefficient was 0.84 for the Movement Disorder Society Nonmotor Rating Scale and 0.70 for Movement Disorder Society nonmotor fluctuations total score, and precision was excellent for the Movement Disorder Society Nonmotor Rating Scale (standard error of measurement, 25.30) and fair for nonmotor fluctuations (standard error of measurement, 7.06). Correlations between Movement Disorder Society Nonmotor Rating Scale score and the corresponding Nonmotor Symptoms Scale and Movement Disorder Society UPDRS scores were high. There were no significant sex or age effects. The Movement Disorder Society Nonmotor Rating Scale score increased with increasing PD duration, disease severity, and PD medication dose (all P < 0.001).Conclusions: The Movement Disorder Society Nonmotor Rating Scale is a valid measure for measuring the burden of a wide range of Nonmotor Rating Scale scores, including nonmotor fluctuations, in PD patients. © 2019 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background: The Living with Chronic Illness (LW‐CI) Scale is a comprehensive patient‐reported outcome measure that evaluates the complex process of living with long‐term conditions. Objective: This study aimed to analyse the psychometric properties of the LW‐CI scale according to the classic test theory and the Rasch model among individuals living with different long‐term conditions. Design: This was an observational, international and cross‐sectional study. Methods: A total of 2753 people from six Spanish‐speaking countries living with type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, Parkinson's disease, hypertension and osteoarthritis were included. The acceptability, internal consistency and validity of the LW‐CI scale were analysed using the classical test theory, and fit to the model, unidimensionality, person separation index, item local independency and differential item functioning were analysed using the Rasch model. Results: Cronbach's α for the LW‐CI scale was.91, and correlation values for all domains of the LW‐CI scale ranged from.62 to.68, except for Domain 1, which showed correlation coefficients less than.30. The LW‐CI domains showed a good fit to the Rasch model, with unidimensionality, item local independency and moderate reliability providing scores in a true interval scale. Except for two items, the LW‐CI scale was free from bias by long‐term condition type. Discussion: After some adjustments, the LW‐CI scale is a reliable and valid measure showing a good fit to the Rasch model and is ready for use in research and clinical practice. Future implementation studies are suggested. Patient and Public Contribution: Patient and public involvement was conducted before this validation study ‐ in the pilot study phase. [ABSTRACT FROM AUTHOR]

Background: Non‐motor symptoms (NMS) are frequent in Parkinson's disease (PD). Objectives: To estimate the prevalence of NMS and of non‐motor fluctuations (NMF) using the Movement Disorders Society‐Non‐Motor Rating Scale (MDS‐NMS) and other scales assessing NMS, and their relationship with sex and PD severity. Methods: Cross‐sectional study with a sample of 402 PD patients. The Hoehn and Yahr staging system (HY), Clinical Impression of Severity Index for PD (CISI‐PD), MDS‐NMS (including NMF‐ subscale), Non‐Motor Symptoms scale (NMSS), and MDS‐Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) were applied. A NMS was considered present when scored ≥1. Differences in scores by sex and HY, CISI‐PD, and MDS‐UPDRS severity levels were calculated using Fisher's exact and chi‐squared tests. Results: Using the MDS‐NMS, NMS were present in 99.7% of patients and the mean number of NMS was 16.13 (SD: 9.36). The most prevalent NMS was muscle, joint or back pain (67.4% of the sample) and the least prevalent was dopamine dysregulation syndrome (2.2%). Feeling sad or depressed was significantly more prevalent in women. Using the MDS‐NMS revealed more NMS than the other scales assessing NMS. NMF were present in 41% of the sample, with fatigue being the most prevalent symptom (68.5% patients with NMF), and no differences by sex. Patients with greater PD severity had higher prevalence of NMS than patients with lower severity. Conclusions: Almost all patients with PD experience NMS, and many experience NMF. Prevalence rates for NMS using the MDS‐NMS are higher than on other scales used and increase with higher disease severity. [ABSTRACT FROM AUTHOR]

Postpartum can lead to cognitive impairment as well as mental health problems. To prevent these symptoms from getting worse, there needs to be a care method that the mother can easily implement while the infant is nearby. This exploratory pilot study examined that cognitive function improves with horticultural activity. Fifteen healthy women less than one year postpartum participated in this study. They participated in eight sessions of horticultural activity. Psychological tests were administered to assess participants' mental health and cognitive functioning before and after gardening activities. Compared with before gardening activity, the trail making test (TMT)-A and TMT-B were significantly decreased, and the Digit Symbol Substitution Test was significantly increased. Also, the scores for the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory, and anger-hostility, confusion-bewilderment, fatigue-inertia, tension-anxiety, Total Mood Disturbance of the Profile of Mood States 2 was significantly decreased, respectively. Vigor-activity and friendliness of the Profile of Mood States 2 were significantly increased. Given these positive benefits, horticultural activity may improve mental health and cognitive functions in postpartum women and may provide a great contribution to postpartum women's healthy life. [ABSTRACT FROM AUTHOR]

Most research has used individual or group features to explain why migrants have different preferred number of children. However, these features can be identified and subdivided infinitely, with none of them broadly answering the question "why migrants desire more or less children"? This paper identified "environmental shocks", which are a common experience for all migrants, as determinants of dissimilar preferred number of children across internal migrants in China. Environmental shocks refer to the uncertainty experienced by physical and sociocultural changes in the environment. Environmental shocks were treated as a variable rather than a constant in the analysis because shocks may differ between migrants. By sampling the 1667 internal migrants who participated in China's 2015 General Social Survey, a quantitative analysis revealed that a farther migration distance (meaning greater environmental shocks) leads to lower preferred number of children for migrants. However, the mitigation of environmental shocks by the period at the current residence has no significant influence. Semi-structured interviews conducted with internal migrants in China revealed that the time since migration could mitigate environmental shocks and increase desired number of children, but the time since migration brings other challenges that may decrease preferred number of children. This study improves our understanding of the determinants of migrants' childbearing willingness and suggests that the government need to help weaken the impact of environmental shocks and uncertainties on migrants to prevent their preferred number of children from decreasing. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the personal‐ and disease‐related factors that are associated with living with Parkinson's disease. Background: Living with Parkinson's disease affects the physical, psychological, social and spiritual areas of the person. Health professionals need to know which factors influence the daily living with Parkinson's disease, in order to facilitate a positive living. Design: A multicentre cross‐sectional study. Methods: A total of 324 patients with Parkinson's disease diagnoses were included in the study through a consecutive case sampling. Data were collected from January–June 2015, in specialised units of movement disorders of public and private and community centres, from Spain, Argentina, Mexico, Ecuador and Cuba. Nine measures were applied to evaluate personal‐related factors (age, gender, psychosocial function, satisfaction with life, social support, home economical situation) and Parkinson's disease‐related factors (duration of disease, motor symptoms and non‐motor symptoms). The STROBE checklist was used to ensure quality reporting during the study (see File S1). Multiple linear regression analysis was carried out. Results: Results indicated that social support, followed by satisfaction with life and home economical situation are the only three factors that significantly influence in living with Parkinson's disease. The rest of the factors analysed did not present significant influence in the daily living with this neurodegenerative disease. Conclusion: This study highlights the necessity to put more emphasis on the person and his/her daily living with the condition and less on symptoms and treatment. Health professionals need to develop person‐centred interventions that also deal with other elements of the experience of living with a long‐term condition like Parkinson's disease. Relevance to clinical practice: Interventions to foster positive living with Parkinson's disease in clinical practice should integrate strategies to tackle and prevent loneliness and interagency elements to increase community resources and systems of support. [ABSTRACT FROM AUTHOR]

Background: Non‐motor symptoms (NMS) are integral to Parkinson's disease (PD) and have a detrimental effect on patients and their caregivers. Clinical quantification has been aided by the development of comprehensive assessments such as the Non‐Motor Symptoms Questionnaire (NMSQuest) and Scale (NMSS). The NMSS has been widely used in clinical studies and trials; however, since its validation in 2007, our understanding of NMS has changed substantially. With the support of the International Parkinson and Movement Disorder Society (IPMDS), after a detailed peer review an initiative to develop an updated version of NMSS, the MDS‐NMS was launched in 2015. Objective: This paper encapsulates the data from the pre‐validation phases carried out under the auspices of the IPMDS Non‐Motor PD Study Group. Methods: Item selection and wording (formatted as a rater‐based tool) were based on the NMSS, literature review, and expert consensus. Neurologists, PD patients, and healthy controls were included in the cognitive pretesting and administration of the preliminary version of the MDS‐NMS. Primary data on acceptability and reliability were obtained. Results: The pilot study, carried out in English in the United Kingdom and the United States, demonstrated that the preliminary version of the MDS‐NMS was comprehensive, understandable, and appropriate. Data quality was excellent; moderate floor effect was present in patients for most MDS‐MNS domains, with some components showing weak internal consistency. The results led to additional instrument modifications. Conclusion: Qualitative and quantitative research results have led to an updated NMSS, the definitive version of the MDS‐NMS, which is currently being validated. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is a health determinant among middle-aged and older adults. In contrast, poor health is expected to have a negative impact on PA. This study sought to assess to what extent specific International Classification of Functioning, Disability and Health (ICF) health components were associated with PA among older adults.Methods: We used a sample of 864 persons aged ≥50 years, positively screened for disability or cognition in a cross-sectional community survey in Spain. Weekly energy expenditure during PA was measured with the Yale Physical Activity Survey (YPAS) scale. The associations between body function impairment, health conditions or World Health Organization Disability Assessment Schedule (WHODAS 2.0) disability scores and energy expenditure were quantified using negative-binomial regression, and expressed in terms of adjusted mean ratios (aMRs).Results: Mean energy expenditure was 4542 Kcal/week. A lower weekly energy expenditure was associated with: severe/extreme impairment of mental functions, aMR 0.38, 95% confidence interval, CI (0.21-0.68), and neuromusculoskeletal and movement functions, aMR 0.50 (0.35-0.72); WHODAS 2.0 disability, aMR 0.55 (0.34-0.91); dementia, aMR 0.45 (0.31-0.66); and heart failure, aMR 0.54 (0.34-0.87). In contrast, people with arthritis/osteoarthritis had a higher energy expenditure, aMR 1.27 (1.07-1.51).Conclusion: Our results suggest that there is a strong relationship between selected body function impairments, mainly mental, and PA. Although more research is needed to fully understand causal relationships, strategies to improve PA among the elderly may require targeting mental, neuromusculoskeletal and movement functions, disability determinants (including barriers), and specific approaches for persons with dementia or heart failure. [ABSTRACT FROM AUTHOR]

Aim: To carry out an analysis of the psychometric properties of the Disease Burden Morbidity Assessment (DBMA) according to the assumptions of the Classical Test Theory. Methods: A sample of 707 community-dwelling adults aged 65 years and older, living in Spain, completed the DBMA. Psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed. Results: The mean DBMA score was 6.8. Feasibility and acceptability were satisfactory, except for large floor effects (>50%), as well as a skewed distribution (1.8). Item-total corrected correlation ranged 0.10–0.49, item homogeneity index was 0.09 and Cronbach's alpha was 0.72. Disease burden correlated strongly with physical functioning (r = –0.56) and perceived health (r = –0.56), and moderately with depression (r = 0.41) and the Personal Wellbeing Index (r = –0.41). Exploratory factor analysis extracted five factors, explaining 44% of the variance. Conclusions: The DBMA is an acceptable and valid instrument for measuring disease burden in older adults. Future studies should include Rasch analysis to further assess dimensionality and explore other measurement properties. [ABSTRACT FROM AUTHOR]

Background: The goal of the study was to analyze the factors associated with quality of life (QoL) in institutionalized older adults with dementia, based on self and proxy ratings, and if these characteristics differ by dementia severity.Methods: Cross-sectional study of 525 people with dementia (PwD) and their caregivers (professional or family caregivers). Two different QoL questionnaires, leading to three measures, were used: QoL in Alzheimer's disease scale (QOL-AD), self and proxy-rated, and QoL in late-stage dementia scale (QUALID), proxy-rated. Multivariate linear regression models were tested for each QoL measure and for mild/moderate and severe stages of dementia.Results: Multiple regression analyses showed a significant association between the three QoL measures and depression. Functional ability was significantly associated with QoL when assessed by proxy. Other factors such as education level, leisure activities and frequency of visits were significantly related with QOL-AD by proxy. The associated factors that differed by dementia severity were education level for moderate dementia, and frequency of visits and who answered the questionnaire (professional vs. family member) for severe dementia.Conclusions: QoL was consistently associated with depressive symptoms independently of the measures as well as functional ability and social leisure activities when the QoL questionnaire was rated by proxy. Treating depressive symptoms, increasing social activities and maintaining the functional ability may decrease the deterioration of QoL in institutionalized older adults with dementia. [ABSTRACT FROM AUTHOR]

Objective: To estimate the magnitude in which Parkinson’s disease (PD) symptoms and health- related quality of life (HRQoL) determined PD costs over a 4-year period. Materials and Methods: Data collected during 3-month, each year, for 4 years, from the ELEP study, included sociodemographic, clinical and use of resources information. Costs were calculated yearly, as mean 3-month costs/patient and updated to Spanish €, 2012. Mixed linear models were performed to analyze total, direct and indirect costs based on symptoms and HRQoL. Results: One-hundred and seventy four patients were included. Mean (SD) age: 63 (11) years, mean (SD) disease duration: 8 (6) years. Ninety-three percent were HY I, II or III (mild or moderate disease). Forty-nine percent remained in the same stage during the study period. Clinical evaluation and HRQoL scales showed relatively slight changes over time, demonstrating a stable group overall. Mean (SD) PD total costs augmented 92.5%, from €2,082.17 (€2,889.86) in year 1 to €4,008.6 (€7,757.35) in year 4. Total, direct and indirect cost incremented 45.96%, 35.63%, and 69.69% for mild disease, respectively, whereas increased 166.52% for total, 55.68% for direct and 347.85% for indirect cost in patients with moderate PD. For severe patients, cost remained almost the same throughout the study. For each additional point in the SCOPA-Motor scale total costs increased €75.72 (p = 0.0174); for each additional point on SCOPA-Motor and the SCOPA-COG, direct costs incremented €49.21 (p = 0.0094) and €44.81 (p = 0.0404), respectively; and for each extra point on the pain scale, indirect costs increased €16.31 (p = 0.0228). Conclusions: PD is an expensive disease in Spain. Disease progression and severity as well as motor and cognitive dysfunctions are major drivers of costs increments. Therapeutic measures aimed at controlling progression and symptoms could help contain disease expenses. [ABSTRACT FROM AUTHOR]