Assessment of the information provided by the medical specialist on Alzheimer's disease and that retained by the patient caregivers

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Correlaciones clínico-radiológicas-patológicas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1159 "Ancho" => 1000 "Tamanyo" => 266281 ] ] "descripcion" => array:1 [ "en" => "Anatomical and histological study of the surgical sample from the same patient shown in <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>. (A) External appearance of the surgical sample shows severely deformed folds and sulci. (B) Lateral slice of the surgical sample shows irregular cortical thickness with highly myelinated white matter. (C) Histological preparation in which we observe isolated or grouped balloon cells in the cerebral cortex. Masson's trichrome stain 200×." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Pascual-Castroviejo, J.L. Hernández-Moneo, M.L. Gutiérrez-Molina, J. Viaño, S.I. Pascual-Pascual, R. Velazquez-Fragua, C. Morales, D. Quiñones" "autores" => array:8 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Pascual-Castroviejo" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Hernández-Moneo" ] 2 => array:2 [ "nombre" => "M.L." "apellidos" => "Gutiérrez-Molina" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Viaño" ] 4 => array:2 [ "nombre" => "S.I." "apellidos" => "Pascual-Pascual" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Velazquez-Fragua" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Morales" ] 7 => array:2 [ "nombre" => "D." 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Molinuevo, B. Hernández" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.L." "apellidos" => "Molinuevo" "email" => array:1 [ 0 => "JLMOLI@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:2 [ "colaborador" => "on behalf of the Working Group of the TRACE Study" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Clínic i Universitari, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Novartis Farmacéutica, S.A., Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la información suministrada por el médico especialista sobre la enfermedad de Alzheimer y de la retención lograda por los cuidadores del enfermo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 2115 "Tamanyo" => 180941 ] ] "descripcion" => array:1 [ "en" => "Medical specialists’ opinion on factors that could potentially facilitate the task of providing information to caregivers of AD patients. The mean and 95% CI are shown for scores." ] ] ] "textoCompleto" => "IntroductionAs life expectancies increase in developed countries, Alzheimer's disease (AD) is becoming the leading public health problem associated with the ageing population. In Spain, it is estimated that AD has a prevalence of 4.3% and an incidence of 9.5 cases per 1000 individuals per year.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> When care is provided by family members living with the patient, the family environment is affected by the stress, unease, and workload associated with the disease.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Cholinesterase inhibitors have been shown to be specific and useful, and they are therefore used as a first-line treatment, especially during early and middle stages. Several studies have shown that anti-dementia drugs improve or stabilise cognitive, behavioural, and functional disorders linked to AD. They also delay symptom onset and institutionalisation, reduce mortality rate, decrease caregiver burden, and lower healthcare spending. Moreover, they have been shown to modify the clinical course of the disease<a class="elsevierStyleCrossRefs" href="#bib0020">4–8</a> by halting its progression for periods of up to 4 years.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> The use of anti-dementia drugs in clinical daily practice is still limited,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and treatment adherence has a tendency to gradually decrease, especially when other treatments are being used concomitantly.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> These factors have a negative impact on treatment continuity, which is necessary in order to slow the progression of cognitive decline.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> According to some studies, 30% of patients undergoing treatment discontinue it during the first 60 days,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and 14% of the patients who continue treatment for 180 days pass through periods in which treatment is interrupted for as long as 6 weeks.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>Therapeutic compliance in AD largely depends on the patient's caregiver, the information available to that caregiver, his trust in the doctor and his expectations, and his solutions for overcoming the constant challenges of managing the disease. In this context, a patient-focused care approach aims to include the family and the caregiver in decision-making that affects the patient. The caregiver's personal preferences should be considered when choosing among different treatments.In this participatory approach to healthcare, the caregiver needs high-quality information that is easy to understand and adapted to fit his or her needs. It should include an explanation of the disease, its natural course, and different available treatment options so that the caregiver may make independent and responsible decisions. In many cases, information provided to caregivers has a decisive effect on quality of care, and it is unfairly overlooked in spite of its effect on treatment compliance, patient and caregiver quality of life, and perceived satisfaction with healthcare. Some professionals provide information to patients spontaneously and without prior analysis, often using too many technical terms and allowing their own values to create a bias. As a result, caregivers may perceive the information as excessively cryptic, even though doctors feel that it has been presented properly.Leaving other more specific communication deficiencies aside, there are several external factors contributing to information being insufficient. They include the patient's and the caregiver's cultural and intellectual levels, language barriers, conditions during the visit, factors affecting the doctor–patient relationship, the caregiver's emotional response to the course of the disease, etc. Therefore, studying and analysing the differences between doctors’ impressions (transmitted information) and AD patient caregivers’ impressions (retained information) may provide objective data to help neurologists reflect on the effectiveness and impact of their messages to the caregiver when diagnosing and treating AD patients.The main objective of this study is to analyse how effective the neurologist, psychiatrist or geriatrician treating AD patients is at providing information. To this end, we describe differences between the information about the disease and its treatment as intentionally presented by the professional and the information as it is understood by the caregiver. This approach should permit us to evaluate the factors that are usually associated with differences in the way that doctors and caregivers perceive medical information being imparted. It may also identify information on AD that is difficult for caregivers to understand, and areas in which the caregiver's judgment, attitude, or care may need improvement.Patients and methodsThe current study was carried out by gathering written questionnaires with similar content that were administered simultaneously to doctors and caregivers of AD patients. We then evaluated information provided by the doctor and that retained by the caregiver by using a total of 17 well-defined items of information (<a class="elsevierStyleCrossRef" href="#sec0070">Appendix B</a>). Informal caregivers of AD patients were included in the study during a six-month recruiting period, using a consecutive sampling method in neurology, psychiatry, and geriatric medicine departments at different Spanish public health centres providing diagnosis, follow-up, and treatment for AD patients. The criteria employed for AD diagnosis were elaborated by the National Institute of Neurological and Communicative Disorders and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA).<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Inclusion criteria for the study were as follows: patients diagnosed with AD without sex or age restrictions, and accompanied by their caregivers during a routine or follow-up consultation. Specialist researchers were directly responsible for monitoring patients and providing information to caregivers. All selected patients are typically accompanied by their caregivers during specialist visits, and both patients and caregivers were required to sign an informed consent form.Following the standard procedure, we selected patients of either sex who had been diagnosed with AD, were accompanied by their respective caregivers, and who had a diagnostic or follow-up appointment with the specialist. Researchers were required to participate directly in the patient's clinical monitoring and in providing information to the caregiver. As stated above, each patient and caregiver had to sign an appropriate informed consent form in order to be included. Caregiver-patient pairs were excluded if caregivers were unable to respond to the study questionnaire due to their educational level or a language barrier.Two questionnaires were used for every caregiver–patient pair meeting inclusion criteria: one for the medical specialist and the other for the caregiver. Items on the questionnaires are listed below. Immediately after the diagnostic or follow-up consultation with the AD patient, the specialist filled in a questionnaire with 2 different sections. The first was a general section requesting his or her professional opinion about the doctor's role in informing the patient or caregiver (completed only once), and the second section requested a professional opinion about how well he or she had provided information to the caregiver during the diagnostic or follow-up consultation. This second section included the AD patient's medical profile and treatment plan and the survey on the applicability of the information presented to caregivers about the disease and its treatment. After the recruitment visit, the caregiver was interviewed by auxiliary staff members. Meanwhile, caregivers completed their questionnaires, which also contained 2 sections. The first section recorded the caregiver's sociodemographic profile and psychological state, and the second section evaluated the applicability of the information about the disease and its treatment which was presented to the caregiver during the consultation.The second part of the questionnaire, completed by both researchers and caregivers, included the same 17 well-defined items formulated so as to assess the information presented, the information retained, and differences in perception between the 2 parties. These items refer to the following aspects: (1) concept of the disease, (2) debunking misinformation, (3) aetiopathogenesis, (4) natural history and prognosis of AD, (5) complications and risk situations, (6) genetic and heritable risks, (7) drugs and treatment alternatives, (8) expected treatment responses, (9) risks and adverse effects, (10) drug interactions, (11) treatment perspectives, (12) treatment dosages and recommendations, (13) adherence and risks associated with non-compliance with treatment, (14) anticipated benefits of complementary therapies, 15) social health resources and assistance, (16) family/caregiver associations, and (17) emotional and psychological support.In order to describe potential differences of opinion between specialists and caregivers regarding each item of information, we calculated for each question the frequency of responses on a scale of 1 to 5 (where 1 indicates “very detailed information” and 5 indicates “very little/no information”) for both the specialist and the caregiver groups. We calculated the average score assigned by each of the groups, in addition to the mean difference between the scores assigned by each group, for each item on the questionnaire. The statistical significance of any differences between the scores provided by each group was determined by performing a contrast hypothesis test for ordinal scales with paired data (Wilcoxon matched pairs/signed ranks test). The level of significance was established at .05.We calculated Cohen's kappa coefficient and its 95% confidence interval<a class="elsevierStyleCrossRef" href="#bib0085">17</a> as a corrected overall measure of inter-rater agreement for how doctors and caregivers assess information. Both of these groups were considered to be judges assessing the same action (the presentation of information during a clinical consultation). We used the Fleiss–Cohen (quadratic) weights method to calculate the relative importance of disagreements.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> The Bland–Altman method was used to interpret the coefficient (a value of 1 indicates perfect agreement and 0 indicates that the agreement is no better than one obtained by chance).<a class="elsevierStyleCrossRef" href="#bib0095">19</a> All statistical analyses were performed using SAS software, version 9.1 (SAS Institute Inc., Cary, NC).ResultsCharacteristics of the researchersThe study included 61 specialist researchers with a mean age (±SD) of 45.9±8.7 years; 62.3% were men. The mean time practising as specialists was 16.6±9.5 years. The most common specialty was neurology (78.7%), followed by geriatric medicine (11.5%) and psychiatry (4.9%). More than half of the professionals (52.6%) provided care through the public system; the most common types of centres were general hospitals (67.2%) and outpatient specialty centres (41.0%). Clinical care was mainly provided by general neurology units (55.7%) and dementia specialist units (29.5%).Sociodemographic and clinical description of AD patientsWe recruited a total of 679 patients who met all selection criteria. Women accounted for 67.2% of the total and mean age was 77.5±7.0 years. The average amount of time elapsed since the patients were diagnosed was 3.4±2.2 years and their mean MMSE score was 18.1±4.2. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>A includes all of the demographic and clinical data.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Sociodemographic and clinical description of caregiversThe caregivers of AD patients included in the study had a mean age of 57.2±14.8 years; mean period of time spent taking care of the patient was 27.6±28.0 months. We observed that most of the caregivers lived in the same household as the patient (64.9%) and that most were family members (93.6%).<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>B includes additional sociodemographic and clinical information describing the caregivers. It should be noted that 40.4% of the caregivers tested as likely or possible anxiety sufferers. Depression was also prevalent among caregivers, with 33.2% being possible or probable depression sufferers.Researchers’ and caregivers’ general opinion on information provided during the consultationResearchers listed factors that could potentially facilitate the task of presenting information to caregivers of AD patients. The importance of having enough time during the visit and the educational level of the patient were ranked as the most important factors in the process of providing information. Other important factors listed were absence of language barriers and being sure that information will be received in a positive way. These results are included in <a class="elsevierStyleCrossRef" href="#fig0050">Fig. 1</a>.<elsevierMultimedia ident="fig0050"></elsevierMultimedia>The analysis of caregivers’ opinions regarding their need for information on AD revealed that almost a quarter of the caregivers had important questions that remained unanswered after the doctor had finished presenting information (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 2</a>A). Moreover, in nearly 30% of the cases, the caregiver considered that the information he or she had received was useful, but insufficient (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 2</a>B).<elsevierMultimedia ident="fig0055"></elsevierMultimedia>Disagreement between doctors and caregivers about the information provided/receivedWe analysed the 17 items on the questionnaire regarding information provided and received. Items were scored on a scale from 1 to 5 (from more detailed to more limited information). We calculated the means of scores assigned by each of the groups (doctors and caregivers) and identified any significant differences between the 2 groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). <a class="elsevierStyleCrossRef" href="#fig0060">Fig. 3</a> is a graph displaying the differences observed between scores given by doctors and by caregivers given to the information provided.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0060"></elsevierMultimedia>Caregivers gave significantly better ratings to information on the concept of the disease, its aetiopathogenesis, drug dosages, and recommendations regarding treatment and treatment adherence (P<.05) On the contrary, medical specialists gave significantly better ratings to aspects such as debunking myths and correcting preconceived notions; possible complications, risks, adverse effects, and/or iatrogenesis; information about family associations; and emotional and psychological support for caregivers (P<.05).The qualitative assessment of agreement between doctors and caregivers on the subject of information was analysed by calculating the Kappa coefficient for each item of information in the study (a value of 1 indicates perfect agreement and 0 indicates that agreement is no better than might occur by chance). Overall, concordance between doctors and caregivers for the quality/quantity of the information received was weak (Kappa≤0.27) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Nevertheless, concordance was clearly poor for some items, such as aetiopathogenesis, risks and adverse effects, debunking misconceptions, treatment adherence, and benefits of complementary treatments.Factors associated with differing perceptions of informationIn order to identify factors that could contribute to differences of opinion between professionals and caregivers regarding the information provided and that retained, we formulated 17 new derived variables (qualitative and binomial), all permitting dichotomous classification of each item according to the difference between doctors’ and caregivers’ scores; each variable corresponds to one of the items of information under study. These derived variables were divided into two groups: “undervalued by the caregiver” when the caregiver's score for the transmitted information was less favourable than the doctor's (caregiver's score on the original scale is higher than the doctor's score), and “not undervalued by the caregiver” when the caregiver's score for the transmitted information was more favourable than the doctor's (caregiver's score on the original scale was the equal to or lower than the doctor's score).With the help of the steps listed above, we calculated the percentage of disagreement for variables in the category “undervalued by the caregiver”. These percentage scores were named “doctor–caregiver disagreement”, and were expressed on a scale from 0 to 1 (where 0 indicates no disagreement and 1 indicates maximum disagreement). The mean value in this study was 0.29, indicating a considerable degree of disagreement.Lastly, we identified any potential links between doctor–caregiver disagreement and characteristics of the caregiver's profile (age, sex, educational level, emotional state, time spent caring for patient, personal relationship and living arrangement with the patient) or of the patient's profile (age, sex, disease progression timeline, GDS (Reisberg) scale stage, score on the MMSE). The most significant result we obtained was that stage of progression (GDS scale) was the sole factor associated with a greater discrepancy between how doctors and caregivers perceived the information that had been provided/retained (P=.002) (<a class="elsevierStyleCrossRef" href="#fig0065">Fig. 4</a>).<elsevierMultimedia ident="fig0065"></elsevierMultimedia>DiscussionThe results of this study show that there is a significant difference in the way doctors and AD patient caregivers perceive the information which the doctor presents and that which the caregiver assimilates. The main purpose of the initial analysis included in this study was to compare clinical information presented by AD specialists with the information understood and retained by their patients’ caregivers. With this purpose in mind, we aimed to identify the main factors associated with the differences in how information is perceived by doctors and caregivers in order to propose ways to improve communication in the process of caring for patients with Alzheimer's disease.Prior studies have uncovered differences in how information about illnesses such as Alzheimer's disease is perceived. However, up to now, most of this evidence has been obtained from largely descriptive studies<a class="elsevierStyleCrossRef" href="#bib0015">3</a> that to a certain extent lack a methodology for systematic analysis and are undertaken in order to establish general clinical guidelines for treating patients.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a>For the first time in Spain, our results allow us to describe the types and categories of information which medical specialists provide and which are most likely to be perceived differently by professionals and AD patients/caregivers. These results provided a more in-depth view of the reasons why caregivers are frequently unable to retain useful instructions intended to promote patient stability and a more favourable course of the disease.Overall, our study shows that medical specialists need to have more time for consultations with patients. It also reports that the sociocultural characteristics of patients and caregivers (language, educational level, etc.) may hamper their understanding of the information the doctors present. These factors are very well known, not only in the field of AD management, but also in most of the illnesses treated in neurology consultations and specialty centres.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> On the other hand, our study confirms prior results by Kendall et al.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>: caregivers of AD patients frequently perceive that the information provided to them does not answer certain important questions. They feel that they do not have enough information, even if they do appreciate any efforts made to keep them informed.Our study differs from other current studies in that it refers to specific and well-defined areas of information transmitted to caregivers and patients. It lists areas of information that need improvement in order to improve communications between medical specialists and caregivers. This is especially true in the context of a serious illness like Alzheimer's disease, which imposes significant physical, economic and emotional burdens on the caregiver.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>Our study shows that caregivers of AD patients gave a positive rating to information they received regarding the concept of the disease, treatment recommendations, and treatment dosage. In clear contrast to the above, medical specialists were especially satisfied with the information they presented to debunk preconceived notions and warn caregivers about risk situations, and information on family associations, support groups, and similar resources. This obvious disparity in the subjective assessments of the information provided and that received (with poor objective values for concordance) highlights some of the communication problems present in neurology departments when following up on patients with AD. This disparity may also be related to a specific lack associated with treating common dementia problems and providing effective assistance to these patients’ caregivers: there is considerable need for better education and social support if caregivers are to overcome the emotional distress associated with AD, and this need is well-understood in primary care centres.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Leaving aside the discrepancies identified by the analytical tools used in our study, identifying those factors directly associated with the level of disagreement was problematic. We were only able to link the stage of AD progression to differences in perception of the information presented and that retained. Therefore, for more advanced stages of AD, we observed increased agreement between medical specialists and caregivers regarding information. This association could be related to the benefits of early diagnosis which caregivers report; early diagnosis may facilitate the assimilation, understanding and processing of information about the disease. In addition, it may be helpful in planning future care,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> in spite of the increasing responsibility and burden assumed by the caregiver as the physical and mental state of the AD patient worsens.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Such a finding calls attention to the importance of a properly integrated approach to providing information on AD. This vision takes into account the three basic pillars of the care process: the medical specialist, the patient, and the caregiver.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> Successfully presenting optimised and correctly selected information that can be retained by the caregiver would result in more efficient care from both the patient and the caregiver perspectives; this in turn would significantly lower the risk of the patient being admitted to a residence<a class="elsevierStyleCrossRef" href="#bib0145">29</a> and lower the social and health costs of caring for the patient.<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a>In conclusion, we should highlight that this study revealed significant discrepancies in the way the 2 groups (medical specialists and caregivers of AD patients) perceive information. For 10 of the 17 areas of information that were assessed, the information presented by the doctors and received by the caregivers was rated differently. The results of the study show that the doctor-patient communication process must be improved in order to optimise the quality and quantity of the information that caregivers effectively receive and retain. In this way, the excellent service they provide to our society will become increasingly efficient and sustainable.FundingThis study received financial support from Novartis Farmacéutica, S.A.Conflicts of interestDr. J.L. Molinuevo has received fees as a consultant for the following pharmaceutical companies: Pfizer, Ellan Pharmaceuticals, Roche, Bristol-Myers Squibb, Novartis, Lundbeck, Janssen-Cilag, General Electric, Bayer, and Innogenetics. Dr. B. Hernández is employed by Novartis Farmacéutica, S.A." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres170054" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Patients and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec158123" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres170055" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Pacientes y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec158122" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Characteristics of the researchers" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Sociodemographic and clinical description of AD patients" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Sociodemographic and clinical description of caregivers" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Researchers’ and caregivers’ general opinion on information provided during the consultation" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Disagreement between doctors and caregivers about the information provided/received" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Factors associated with differing perceptions of information" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack44768" "titulo" => "Acknowledgement" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-03-30" "fechaAceptado" => "2011-05-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec158123" "palabras" => array:6 [ 0 => "Alzheimer's disease" 1 => "Caregiver" 2 => "Information" 3 => "Education" 4 => "Retention" 5 => "Transmission" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec158122" "palabras" => array:6 [ 0 => "Enfermedad de Alzheimer" 1 => "Cuidador" 2 => "Información" 3 => "Educación" 4 => "Retención" 5 => "Transmisión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionThere is evidence of insufficient communication abilities by medical specialists as well as of the limited retentive capacities of patients with Alzheimer's disease (AD) and their caregivers. The main reasons for this include the personal limitations of the physician, as well as external, emotional and social-cultural factors associated with the patients and their caregivers.The aim of this study is to compare the clinical information on AD provided by the physicians and that perceived by caregivers and to assess factors associated with differences in perception. Patients and methodsWe carried out an observational national multicentre study based on questionnaires assessing the information provided by the physician and that retained by the caregiver for 17 items of information. The study involved 61 researchers and included a total of 679 patients who met the selection criteria. We evaluated the factors associated with the difference in perception of the information that was transmitted. ResultsParticipating caregivers had a mean age of 57.2±14.8 years, with an average care time of 27.6±28.0 months. Approximately half (50.9%) were children of the AD patient and most lived in the same household (64.9%). Caregivers assigned significantly higher ratings to information on concept of disease, aetiology, pathogenesis, dosage and treatment recommendations and adherence, while doctors assigned significantly higher ratings to information related to demystification and correcting preconceived notions, possible complications, adverse events and/or iatrogenesis, family associations, and emotional/psychological support to caregivers (P<.05). Concordance between the information provided and that received was classified between poor and weak (inter-rater agreement ≤0.27). The degree of disease progression using the Global Deterioration Scale (GDS) was a factor significantly associated with professional-carer information discrepancy (P=.002). ConclusionsMany areas of information showed large differences in perception between physicians and caregivers of AD patients, which highlights the need to improve the communication process in order to achieve higher quality." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónExisten evidencias de la insuficiente capacidad informativa por parte de los especialistas médicos, así como de las dificultades retentivas de los pacientes con enfermedad de Alzheimer (EA) y de sus cuidadores. Entre las diversas causas figuran tanto las limitaciones personales del profesional como los determinantes externos, emocionales y socioculturales del paciente y de su cuidador.Contrastar la información clínica proporcionada por los médicos sobre la EA y la percibida por los cuidadores y evaluar los factores asociados a las diferencias de percepción. Pacientes y métodosSe llevó a cabo un estudio observacional, multicéntrico y nacional mediante cuestionarios que evalúan la información suministrada por el médico y la retenida por el paciente en 17 aspectos informativos. Participaron 61 investigadores que incluyeron a un total de 679 pacientes que cumplían los criterios de selección. Se evaluaron los factores asociados a la diferencia de percepción sobre la información transmitida. ResultadosLos cuidadores participantes tenían una media de 57,2±14,8 años, habiendo dedicado un tiempo medio como cuidadores de 27,6±28,0 meses, y siendo el 50,9% hijos del paciente que mayoritariamente vivían en el mismo domicilio (64,9%). Los cuidadores valoraron significativamente mejor la información recibida sobre: concepto de la enfermedad, aspectos etiopatogénicos, posología y recomendaciones sobre el tratamiento y adherencia terapéutica, mientras que los médicos consideraron significativamente mejor la información referente a desmitificación y corrección de concepciones previas, posibles complicaciones, riesgos, efectos adversos y/o yatrogenia, asociaciones de familiares, y ayuda emocional/psicológica a cuidadores (p<0,05). La concordancia en la información suministrada y la recibida fue entre pobre y débil (Kappa ≤ 0,27). El grado de evolución de la enfermedad (escala GDS) fue un factor significativamente asociado con la discordancia profesional-cuidador (p=0,002). ConclusionesSe apreciaron diferencias de percepción entre médicos y cuidadores de pacientes con EA para numerosos aspectos informativos, evidenciando la necesidad de mejorar el proceso comunicativo para optimizar su calidad." ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Molinuevo JL, Hernández B. Evaluación de la información suministrada por el médico especialista sobre la enfermedad de Alzheimer y de la retención lograda por los cuidadores del enfermo. Neurología. 2012;27:453–71." ] 1 => array:2 [ "etiqueta" => "◊" "nota" => "The members of the Group are listed in <a class="elsevierStyleCrossRef" href="#sec0065">Appendix 1</a> at the end of article." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:4 [ "apendice" => "TRACE Working Group: Valero Pérez Camo (Unidad de Salud Mental Delicias, Zaragoza), María Concepción Ortiz Domingo (Hospital San Juan de Dios, Zaragoza), Paloma González García (Hospital San José, Teruel), Teresa Calatayud Noguera (Hospital Universitario Central de Asturias, Oviedo), Juan Antonio Gil López (Clínica de Neuropsiquiatría, Gijón), José Gutiérrez Rodríguez (Sociosanitaroa Larrañaga, Avilés), Eloy Rodríguez Rodríguez (Marqués de Valdecilla, Santander), Miguel Goñi Imizcoz (Hospital Divino Vallés, Burgos), Javier Ruiz Martinez (Hospital Donostia, San Sebastián), Jorge Aguirre Inchusta (Clínica Padre Menni, Pamplona), Lourdes San Martín Ganuza (La Vaguada, Pamplona), Agustín Urrutia Sanzberro (Centro Hospitalario Benito Menni, Elizondo), José Luís Sánchez Menoyo (Aita Menni Ospitalea, Bilbao), Javier Ruiz Ojeda, Bilbao), José Marey López (Centro Hospital Universitario A Coruña), Juan Carlos Porven Díaz (Hospital San José, Lugo), María Teresa Olcoz Chiva (Hospital Meixoeiro, Vigo), Margarita Vinuela Beneitez, Instituto Carbonell, Palma de Mallorca), Ana María Pujol Nuez (Clínica Juaneda, Palma de Mallorca), Fritz Nobbe (Clonus, Palma de Mallorca), Antonio García Trujillo (Mente, Palma de Mallorca), Cristóbal Díez-Aja López (Clínica Merced, Barcelona), Juan Hermenegildo Catena Mir (Hosptial Sant Andreu, Manresa), Alberto Molins Albanell (Hospital Josep Trueta, Girona), María del Mar Fernández Adarte (Centre Sociosanitari Bernat Jaume, Figueres), María Rosa Cano Castella (EAIA Trastornos Cognitivos, Reus), Jaume Burcet Darde (Hospital del Vendrell, El Vendrell), Ramón Cristofol Allué (Antic Hospital de Sant Jaume, Mataró), Ana Isabel Tercero Uribe (CAP II Cerdanyola, Ripollet), Sonsoles Abaceta Arilla (Parc Taulí, Sabadell), Montserrat Pujol Sabaté (Hospital Santa María, Lleida), Consuelo Almenar Monfort (Benito Menni, Sant Boi de Llobregat), Doménec Gil Saladie (Hospital Sagrat Cor, Martorell), Ramon Reñé Ramírez (Hosptial Bellvitge, L’Hospitalet de Llobregat), David Andrés Pérez Martínez (Hospital Infanta Cristina, Parla), Jerónimo Almajano Martínez (Hospital 12 de Octubre, Madrid), Julián Benito León (Hospital 12 de Octubre, Madrid), María de Toledo Heras (Hospital Severo Ochoa, Madrid), Miguel Ángel García Soldevilla (Hospital Príncipe de Asturias, Alcalá de Henares), Carmen Borrué Fernández (Hospital Infanta Sofía, San Sebastián de los Reyes), Pedro Emilio Bermejo Velasco (Hospital La Paz, Madrid), Pedro Gil Gregorio (Hospital Clínico San Carlos, Madrid), María Sagrario Manzano Palomo (Hospital Clínico San Carlos, Madrid), Jesús Cacho Gutiérrez (Hospital Universitario Salamanca), Camino Sevilla Gómez (Hospital de la Princesa, Madrid), Eloisa Navarro Merino (Centro de Especialidades Vicente Soldevilla, Madrid), Marta Ochoa Mulas (HM Monteprincipe, Boadilla del Monte), Pilar Sánchez Alonso (Hospital Puerta del Hierro, Majadahonda), Beatriz Mondejar Marín and Carlos Marsal Alonso (Hospital Virgen de la Salud, Toledo), José Luís Parrilla Ramírez (Hosptial Infanta Cristina, Badajoz), Ignacio Casado Naranjo (Hospital San Pedro de Alcántara, Cáceres), Martín Zurdo Hernández (Hospital Virgen del Puerto, Plasencia), Juan Miguel Girón Úbeda (Hospital de Jerez, Jerez de la Frontera), Ricardo de la Vega Cotarelo (Hospital Punta de Europa, Algeciras), Juan Carlos Durán Alonso (Geriátrico San Juan Grande, Jerez de la Frontera), María Teresa García López (Clínica Neurológica, Almería), Tomás Ojea Ortega (Hospital Regional Universitario Carlos Haya, Málaga), Manuel Romero Acebal (Clínica Neurológica, Málaga), Vicente Serrano Castro (Hospital Clínico de Málaga), José María Torralba Roses (Personalia Baena, Baena), Eduardo Aguera Morales (Hospital Reina Sofía, Córdoba), Eva Cuartero Rodríguez (Hospital Valme, Sevilla), Félix Viñuela Fernández (Hospital Virgen Macarena, Sevilla), Manuel Carballo Cordero (Hospital Universitario Virgen del Rocío, Sevilla), Antonio Alayón Fumero (Centro Neurológico Alayón, Santa Cruz de Tenerife), H. José Bueno Perdomo (Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife), Juan Andrés Cárdenas Rodolfo (Hospital General La Palma, Santa Cruz de Tenerife), María Carmen Pérez Vieitez (Hospital Doctor Negrín, Las Palmas de Gran Canaria), Joaquín Escudero Torrilla (Centro de Especialidades José María Haro, Valencia), María Dolores Martínez Lozano (Hospital La Magdalena, Castellón), Vicente Tordera Tordera (Unidad de Salud Mental de Xátiva), Antonio Campayo Ibáñez (Hospital Onteniente, Valencia), Esther López Jiménez (Hospital Perpetuo Socorro, Albacete), Inmaculada Feria Vilar (Hospital General Albacete), Inmaculada Abellán Miralles (Hospital San Vicente de Raspeig, Alicante), Jordi Alom Poveda (Hospital General de Elche), Juan Marín Muñoz (Unidad de Demencias Arrixaca, Murcia), Luís Carles Dies (Centro Carles Egea, Murcia), Luís Miguel Cabello Rodríguez (Hospital Naval, Cartagena), Antonio Salvador Aliaga (Hospital Clínico de Valencia), Rosario Muñoz Lacalle (Unidad de Salud Mental Sueca, Alzira)." "etiqueta" => "Appendix A" "titulo" => "TRACE Study Working Group" "identificador" => "sec0065" ] 1 => array:3 [ "apendice" => "<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia>" "etiqueta" => "Appendix B" "identificador" => "sec0070" ] ] ] ] "multimedia" => array:15 [ 0 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 2115 "Tamanyo" => 180941 ] ] "descripcion" => array:1 [ "en" => "Medical specialists’ opinion on factors that could potentially facilitate the task of providing information to caregivers of AD patients. The mean and 95% CI are shown for scores." ] ] 1 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1601 "Ancho" => 1671 "Tamanyo" => 96887 ] ] "descripcion" => array:1 [ "en" => "Assimilation of information by caregivers: (A) caregivers who still have relevant questions after hearing medical information and (B) caregivers’ perception of how important the information received is to the patient's care." ] ] 2 => array:7 [ "identificador" => "fig0060" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3704 "Ancho" => 2418 "Tamanyo" => 502440 ] ] "descripcion" => array:1 [ "en" => "Mean differences between doctor and caregiver scores regarding information provided during the consultation. The mean and 95% CI are shown for scores. Assessed items: (1) concept of the disease, (2) debunking misinformation, (3) aetiopathogenesis, (4) natural history and prognosis of AD, (5) complications and risk situations, (6) genetic and heritable risks, (7) drugs and treatment alternatives, (8) expected treatment responses, (9) risks and adverse effects, (10) drug interactions, (11) treatment perspectives, (12) dosage and treatment recommendations, (13) adherence and risks associated with non-compliance with treatment, (14) anticipated benefits of complementary therapies, (15) social health resources and assistance, (16) family/caregiver associations, and (17) emotional and psychological support." ] ] 3 => array:7 [ "identificador" => "fig0065" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 820 "Ancho" => 1660 "Tamanyo" => 65552 ] ] "descripcion" => array:1 [ "en" => "Stage of disease progression (GDS/Reisberg scale) and disagreement between doctors and caregivers regarding provided and received information." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">A)</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (female), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">456 (67.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.5±7.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Progression timeline for AD (years), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4±2.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Score on MMSE, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.1±4.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stage of progression on GDS, n (%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GDS-1, no cognitive decline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GDS-2, very mild cognitive decline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GDS-3, mild cognitive decline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">101 (15.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GDS-4, moderate cognitive decline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">316 (47.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GDS-5, moderately severe cognitive decline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">206 (31.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GDS-6, severe cognitive decline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GDS-7, very severe cognitive decline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab264979.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">B) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Caregiver</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (female), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">518 (76.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.2±14.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time spent caring for the patient (months), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.6±28.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Relationship to the patient, n (%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spouse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">225 (33.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Son/daughter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">343 (50.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other family member \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Professional caregiver \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of domicile, n (%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Caregiver lives in same household \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">437 (64.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Caregiver does not live in same household (day care) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">197 (29.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Caregiver does not share the same household (night care) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Educational level, n (%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No schooling/illiterate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Can read and write \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Completed primary school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">253 (37.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Completed secondary school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">179 (26.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Introductory university studies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 (12.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Advanced university studies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 (9.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HADS scale, mean±SD</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anxiety subscale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8±4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Depression subscale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.8±4.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HADS questionnaire,n(%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anxiety subscale</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No anxiety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">405 (59.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Possible case of anxiety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">145 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probable case of anxiety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (19.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Depression subscale</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">453 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Possible case of depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 (19.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probable case of depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96 (14.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab264977.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and clinical data of the patient (A) and the caregiver (B)." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Items \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Quantity/quality of the information provided regarding... \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Doctors (mean)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Caregivers (mean)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Kappa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Concordance \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concept of the disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Debunking myths and correcting preconceived notions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aetiopathogenesis of the disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Natural history of the disease and patient's prognosis (expected clinical progression, new symptoms, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.055 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Potential complications and risk situations (request for medical assistance, emergency medical attention, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Genetic and heritable risks, possibility of genetic diagnosis, etc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.294 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current drugs and treatment alternatives \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.181 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expected treatment responses, treatment effectiveness, duration, etc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.469 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risks/adverse effects/iatrogenesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Potential drug interactions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">New therapeutic perspectives \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dosage and recommendations for the prescribed treatment (periodicity, diet, dysphagia, refusal, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.038 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Importance of treatment adherence and risks associated with treatment non-compliance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expected benefits of complementary treatment (physiotherapy, speech therapy, occupational therapy, cognitive stimulation, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.088 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Information about the potential social health resources and assistance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.294 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Information about family/caregiver associations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.033 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Information about emotional and psychological support for caregivers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.026 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weak \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab264978.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Mean calculated from the scores provided by each group (doctors and caregivers) according to the following scale: 1=“very detailed”, 2=“complete”, 3=“basic”, 4=“superficial”, 5=“little or none”." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "The statistical significance of any differences between ratings provided by the 2 groups was determined using a Wilcoxon signed-rank test for matched pairs." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "*" "nota" => "Items rated more favourably by doctors or by caregivers are shown in bold where the differences between provided information and received information are significant (P<.05)." ] ] ] "descripcion" => array:1 [ "en" => "Evaluation of the different opinions of doctors and caregivers about information provided/received, and agreement between groups regarding evaluations." ] ] 6 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 3257 "Ancho" => 2691 "Tamanyo" => 608608 ] ] ] 7 => array:5 [ "identificador" => "fig0010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx2.jpeg" "Alto" => 4254 "Ancho" => 3344 "Tamanyo" => 1177773 ] ] ] 8 => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx3.jpeg" "Alto" => 4533 "Ancho" => 3366 "Tamanyo" => 1049048 ] ] ] 9 => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx4.jpeg" "Alto" => 3761 "Ancho" => 3185 "Tamanyo" => 846628 ] ] ] 10 => array:5 [ "identificador" => "fig0025" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx5.jpeg" "Alto" => 4561 "Ancho" => 3256 "Tamanyo" => 929987 ] ] ] 11 => array:5 [ "identificador" => "fig0030" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx6.jpeg" "Alto" => 9032 "Ancho" => 4650 "Tamanyo" => 1224285 ] ] ] 12 => array:5 [ "identificador" => "fig0035" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx7.jpeg" "Alto" => 3756 "Ancho" => 4768 "Tamanyo" => 577710 ] ] ] 13 => array:5 [ "identificador" => "fig0040" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx8.jpeg" "Alto" => 4122 "Ancho" => 3385 "Tamanyo" => 1128026 ] ] ] 14 => array:5 [ "identificador" => "fig0045" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx9.jpeg" "Alto" => 2671 "Ancho" => 2750 "Tamanyo" => 599409 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence, resource utilization and costs of vascular dementia compared to Alzheimer's dementia in a population setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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Evaluación de la información suministrada por el médico especialista sobre la enfermedad de Alzheimer y de la retención lograda por los cuidadores del enfermo

J.L. Molinuevoa,

Corresponding author

JLMOLI@clinic.ub.es

Corresponding author.

, B. Hernándezb, on behalf of the Working Group of the TRACE Study ◊

a Servicio de Neurología, Hospital Clínic i Universitari, Barcelona, Spain

b Novartis Farmacéutica, S.A., Barcelona, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">As life expectancies increase in developed countries&#44; Alzheimer&#39;s disease &#40;AD&#41; is becoming the leading public health problem associated with the ageing population&#46; In Spain&#44; it is estimated that AD has a prevalence of 4&#46;3&#37; and an incidence of 9&#46;5 cases per 1000 individuals per year&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> When care is provided by family members living with the patient&#44; the family environment is affected by the stress&#44; unease&#44; and workload associated with the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cholinesterase inhibitors have been shown to be specific and useful&#44; and they are therefore used as a first-line treatment&#44; especially during early and middle stages&#46; Several studies have shown that anti-dementia drugs improve or stabilise cognitive&#44; behavioural&#44; and functional disorders linked to AD&#46; They also delay symptom onset and institutionalisation&#44; reduce mortality rate&#44; decrease caregiver burden&#44; and lower healthcare spending&#46; Moreover&#44; they have been shown to modify the clinical course of the disease<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;8</span></a> by halting its progression for periods of up to 4 years&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The use of anti-dementia drugs in clinical daily practice is still limited&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and treatment adherence has a tendency to gradually decrease&#44; especially when other treatments are being used concomitantly&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These factors have a negative impact on treatment continuity&#44; which is necessary in order to slow the progression of cognitive decline&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> According to some studies&#44; 30&#37; of patients undergoing treatment discontinue it during the first 60 days&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and 14&#37; of the patients who continue treatment for 180 days pass through periods in which treatment is interrupted for as long as 6 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Therapeutic compliance in AD largely depends on the patient&#39;s caregiver&#44; the information available to that caregiver&#44; his trust in the doctor and his expectations&#44; and his solutions for overcoming the constant challenges of managing the disease&#46; In this context&#44; a patient-focused care approach aims to include the family and the caregiver in decision-making that affects the patient&#46; The caregiver&#39;s personal preferences should be considered when choosing among different treatments&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this participatory approach to healthcare&#44; the caregiver needs high-quality information that is easy to understand and adapted to fit his or her needs&#46; It should include an explanation of the disease&#44; its natural course&#44; and different available treatment options so that the caregiver may make independent and responsible decisions&#46; In many cases&#44; information provided to caregivers has a decisive effect on quality of care&#44; and it is unfairly overlooked in spite of its effect on treatment compliance&#44; patient and caregiver quality of life&#44; and perceived satisfaction with healthcare&#46; Some professionals provide information to patients spontaneously and without prior analysis&#44; often using too many technical terms and allowing their own values to create a bias&#46; As a result&#44; caregivers may perceive the information as excessively cryptic&#44; even though doctors feel that it has been presented properly&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Leaving other more specific communication deficiencies aside&#44; there are several external factors contributing to information being insufficient&#46; They include the patient&#39;s and the caregiver&#39;s cultural and intellectual levels&#44; language barriers&#44; conditions during the visit&#44; factors affecting the doctor&#8211;patient relationship&#44; the caregiver&#39;s emotional response to the course of the disease&#44; etc&#46; Therefore&#44; studying and analysing the differences between doctors&#8217; impressions &#40;transmitted information&#41; and AD patient caregivers&#8217; impressions &#40;retained information&#41; may provide objective data to help neurologists reflect on the effectiveness and impact of their messages to the caregiver when diagnosing and treating AD patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main objective of this study is to analyse how effective the neurologist&#44; psychiatrist or geriatrician treating AD patients is at providing information&#46; To this end&#44; we describe differences between the information about the disease and its treatment as intentionally presented by the professional and the information as it is understood by the caregiver&#46; This approach should permit us to evaluate the factors that are usually associated with differences in the way that doctors and caregivers perceive medical information being imparted&#46; It may also identify information on AD that is difficult for caregivers to understand&#44; and areas in which the caregiver&#39;s judgment&#44; attitude&#44; or care may need improvement&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">The current study was carried out by gathering written questionnaires with similar content that were administered simultaneously to doctors and caregivers of AD patients&#46; We then evaluated information provided by the doctor and that retained by the caregiver by using a total of 17 well-defined items of information &#40;<a class="elsevierStyleCrossRef" href="#sec0070">Appendix B</a>&#41;&#46; Informal caregivers of AD patients were included in the study during a six-month recruiting period&#44; using a consecutive sampling method in neurology&#44; psychiatry&#44; and geriatric medicine departments at different Spanish public health centres providing diagnosis&#44; follow-up&#44; and treatment for AD patients&#46; The criteria employed for AD diagnosis were elaborated by the National Institute of Neurological and Communicative Disorders and the Alzheimer&#39;s Disease and Related Disorders Association &#40;NINCDS-ADRDA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Inclusion criteria for the study were as follows&#58; patients diagnosed with AD without sex or age restrictions&#44; and accompanied by their caregivers during a routine or follow-up consultation&#46; Specialist researchers were directly responsible for monitoring patients and providing information to caregivers&#46; All selected patients are typically accompanied by their caregivers during specialist visits&#44; and both patients and caregivers were required to sign an informed consent form&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Following the standard procedure&#44; we selected patients of either sex who had been diagnosed with AD&#44; were accompanied by their respective caregivers&#44; and who had a diagnostic or follow-up appointment with the specialist&#46; Researchers were required to participate directly in the patient&#39;s clinical monitoring and in providing information to the caregiver&#46; As stated above&#44; each patient and caregiver had to sign an appropriate informed consent form in order to be included&#46; Caregiver-patient pairs were excluded if caregivers were unable to respond to the study questionnaire due to their educational level or a language barrier&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Two questionnaires were used for every caregiver&#8211;patient pair meeting inclusion criteria&#58; one for the medical specialist and the other for the caregiver&#46; Items on the questionnaires are listed below&#46; Immediately after the diagnostic or follow-up consultation with the AD patient&#44; the specialist filled in a questionnaire with 2 different sections&#46; The first was a general section requesting his or her professional opinion about the doctor&#39;s role in informing the patient or caregiver &#40;completed only once&#41;&#44; and the second section requested a professional opinion about how well he or she had provided information to the caregiver during the diagnostic or follow-up consultation&#46; This second section included the AD patient&#39;s medical profile and treatment plan and the survey on the applicability of the information presented to caregivers about the disease and its treatment&#46; After the recruitment visit&#44; the caregiver was interviewed by auxiliary staff members&#46; Meanwhile&#44; caregivers completed their questionnaires&#44; which also contained 2 sections&#46; The first section recorded the caregiver&#39;s sociodemographic profile and psychological state&#44; and the second section evaluated the applicability of the information about the disease and its treatment which was presented to the caregiver during the consultation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The second part of the questionnaire&#44; completed by both researchers and caregivers&#44; included the same 17 well-defined items formulated so as to assess the information presented&#44; the information retained&#44; and differences in perception between the 2 parties&#46; These items refer to the following aspects&#58; &#40;1&#41; concept of the disease&#44; &#40;2&#41; debunking misinformation&#44; &#40;3&#41; aetiopathogenesis&#44; &#40;4&#41; natural history and prognosis of AD&#44; &#40;5&#41; complications and risk situations&#44; &#40;6&#41; genetic and heritable risks&#44; &#40;7&#41; drugs and treatment alternatives&#44; &#40;8&#41; expected treatment responses&#44; &#40;9&#41; risks and adverse effects&#44; &#40;10&#41; drug interactions&#44; &#40;11&#41; treatment perspectives&#44; &#40;12&#41; treatment dosages and recommendations&#44; &#40;13&#41; adherence and risks associated with non-compliance with treatment&#44; &#40;14&#41; anticipated benefits of complementary therapies&#44; 15&#41; social health resources and assistance&#44; &#40;16&#41; family&#47;caregiver associations&#44; and &#40;17&#41; emotional and psychological support&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In order to describe potential differences of opinion between specialists and caregivers regarding each item of information&#44; we calculated for each question the frequency of responses on a scale of 1 to 5 &#40;where 1 indicates &#8220;very detailed information&#8221; and 5 indicates &#8220;very little&#47;no information&#8221;&#41; for both the specialist and the caregiver groups&#46; We calculated the average score assigned by each of the groups&#44; in addition to the mean difference between the scores assigned by each group&#44; for each item on the questionnaire&#46; The statistical significance of any differences between the scores provided by each group was determined by performing a contrast hypothesis test for ordinal scales with paired data &#40;Wilcoxon matched pairs&#47;signed ranks test&#41;&#46; The level of significance was established at &#46;05&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We calculated Cohen&#39;s kappa coefficient and its 95&#37; confidence interval<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> as a corrected overall measure of inter-rater agreement for how doctors and caregivers assess information&#46; Both of these groups were considered to be judges assessing the same action &#40;the presentation of information during a clinical consultation&#41;&#46; We used the Fleiss&#8211;Cohen &#40;quadratic&#41; weights method to calculate the relative importance of disagreements&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The Bland&#8211;Altman method was used to interpret the coefficient &#40;a value of 1 indicates perfect agreement and 0 indicates that the agreement is no better than one obtained by chance&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> All statistical analyses were performed using SAS software&#44; version 9&#46;1 &#40;SAS Institute Inc&#46;&#44; Cary&#44; NC&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Characteristics of the researchers</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study included 61 specialist researchers with a mean age &#40;&#177;SD&#41; of 45&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7 years&#59; 62&#46;3&#37; were men&#46; The mean time practising as specialists was 16&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5 years&#46; The most common specialty was neurology &#40;78&#46;7&#37;&#41;&#44; followed by geriatric medicine &#40;11&#46;5&#37;&#41; and psychiatry &#40;4&#46;9&#37;&#41;&#46; More than half of the professionals &#40;52&#46;6&#37;&#41; provided care through the public system&#59; the most common types of centres were general hospitals &#40;67&#46;2&#37;&#41; and outpatient specialty centres &#40;41&#46;0&#37;&#41;&#46; Clinical care was mainly provided by general neurology units &#40;55&#46;7&#37;&#41; and dementia specialist units &#40;29&#46;5&#37;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sociodemographic and clinical description of AD patients</span><p id="par0075" class="elsevierStylePara elsevierViewall">We recruited a total of 679 patients who met all selection criteria&#46; Women accounted for 67&#46;2&#37; of the total and mean age was 77&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;0 years&#46; The average amount of time elapsed since the patients were diagnosed was 3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2 years and their mean MMSE score was 18&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>A includes all of the demographic and clinical data&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sociodemographic and clinical description of caregivers</span><p id="par0080" class="elsevierStylePara elsevierViewall">The caregivers of AD patients included in the study had a mean age of 57&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;8 years&#59; mean period of time spent taking care of the patient was 27&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;0 months&#46; We observed that most of the caregivers lived in the same household as the patient &#40;64&#46;9&#37;&#41; and that most were family members &#40;93&#46;6&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>B includes additional sociodemographic and clinical information describing the caregivers&#46; It should be noted that 40&#46;4&#37; of the caregivers tested as likely or possible anxiety sufferers&#46; Depression was also prevalent among caregivers&#44; with 33&#46;2&#37; being possible or probable depression sufferers&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Researchers&#8217; and caregivers&#8217; general opinion on information provided during the consultation</span><p id="par0090" class="elsevierStylePara elsevierViewall">Researchers listed factors that could potentially facilitate the task of presenting information to caregivers of AD patients&#46; The importance of having enough time during the visit and the educational level of the patient were ranked as the most important factors in the process of providing information&#46; Other important factors listed were absence of language barriers and being sure that information will be received in a positive way&#46; These results are included in <a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The analysis of caregivers&#8217; opinions regarding their need for information on AD revealed that almost a quarter of the caregivers had important questions that remained unanswered after the doctor had finished presenting information &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 2</a>A&#41;&#46; Moreover&#44; in nearly 30&#37; of the cases&#44; the caregiver considered that the information he or she had received was useful&#44; but insufficient &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Disagreement between doctors and caregivers about the information provided&#47;received</span><p id="par0100" class="elsevierStylePara elsevierViewall">We analysed the 17 items on the questionnaire regarding information provided and received&#46; Items were scored on a scale from 1 to 5 &#40;from more detailed to more limited information&#41;&#46; We calculated the means of scores assigned by each of the groups &#40;doctors and caregivers&#41; and identified any significant differences between the 2 groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0060">Fig&#46; 3</a> is a graph displaying the differences observed between scores given by doctors and by caregivers given to the information provided&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0060"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Caregivers gave significantly better ratings to information on the concept of the disease&#44; its aetiopathogenesis&#44; drug dosages&#44; and recommendations regarding treatment and treatment adherence &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; On the contrary&#44; medical specialists gave significantly better ratings to aspects such as debunking myths and correcting preconceived notions&#59; possible complications&#44; risks&#44; adverse effects&#44; and&#47;or iatrogenesis&#59; information about family associations&#59; and emotional and psychological support for caregivers &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The qualitative assessment of agreement between doctors and caregivers on the subject of information was analysed by calculating the Kappa coefficient for each item of information in the study &#40;a value of 1 indicates perfect agreement and 0 indicates that agreement is no better than might occur by chance&#41;&#46; Overall&#44; concordance between doctors and caregivers for the quality&#47;quantity of the information received was weak &#40;Kappa<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;27&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Nevertheless&#44; concordance was clearly poor for some items&#44; such as aetiopathogenesis&#44; risks and adverse effects&#44; debunking misconceptions&#44; treatment adherence&#44; and benefits of complementary treatments&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Factors associated with differing perceptions of information</span><p id="par0115" class="elsevierStylePara elsevierViewall">In order to identify factors that could contribute to differences of opinion between professionals and caregivers regarding the information provided and that retained&#44; we formulated 17 new derived variables &#40;qualitative and binomial&#41;&#44; all permitting dichotomous classification of each item according to the difference between doctors&#8217; and caregivers&#8217; scores&#59; each variable corresponds to one of the items of information under study&#46; These derived variables were divided into two groups&#58; &#8220;undervalued by the caregiver&#8221; when the caregiver&#39;s score for the transmitted information was less favourable than the doctor&#39;s &#40;caregiver&#39;s score on the original scale is higher than the doctor&#39;s score&#41;&#44; and &#8220;not undervalued by the caregiver&#8221; when the caregiver&#39;s score for the transmitted information was more favourable than the doctor&#39;s &#40;caregiver&#39;s score on the original scale was the equal to or lower than the doctor&#39;s score&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">With the help of the steps listed above&#44; we calculated the percentage of disagreement for variables in the category &#8220;undervalued by the caregiver&#8221;&#46; These percentage scores were named &#8220;doctor&#8211;caregiver disagreement&#8221;&#44; and were expressed on a scale from 0 to 1 &#40;where 0 indicates no disagreement and 1 indicates maximum disagreement&#41;&#46; The mean value in this study was 0&#46;29&#44; indicating a considerable degree of disagreement&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Lastly&#44; we identified any potential links between doctor&#8211;caregiver disagreement and characteristics of the caregiver&#39;s profile &#40;age&#44; sex&#44; educational level&#44; emotional state&#44; time spent caring for patient&#44; personal relationship and living arrangement with the patient&#41; or of the patient&#39;s profile &#40;age&#44; sex&#44; disease progression timeline&#44; GDS &#40;Reisberg&#41; scale stage&#44; score on the MMSE&#41;&#46; The most significant result we obtained was that stage of progression &#40;GDS scale&#41; was the sole factor associated with a greater discrepancy between how doctors and caregivers perceived the information that had been provided&#47;retained &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0065">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0065"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">The results of this study show that there is a significant difference in the way doctors and AD patient caregivers perceive the information which the doctor presents and that which the caregiver assimilates&#46; The main purpose of the initial analysis included in this study was to compare clinical information presented by AD specialists with the information understood and retained by their patients&#8217; caregivers&#46; With this purpose in mind&#44; we aimed to identify the main factors associated with the differences in how information is perceived by doctors and caregivers in order to propose ways to improve communication in the process of caring for patients with Alzheimer&#39;s disease&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Prior studies have uncovered differences in how information about illnesses such as Alzheimer&#39;s disease is perceived&#46; However&#44; up to now&#44; most of this evidence has been obtained from largely descriptive studies<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> that to a certain extent lack a methodology for systematic analysis and are undertaken in order to establish general clinical guidelines for treating patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">For the first time in Spain&#44; our results allow us to describe the types and categories of information which medical specialists provide and which are most likely to be perceived differently by professionals and AD patients&#47;caregivers&#46; These results provided a more in-depth view of the reasons why caregivers are frequently unable to retain useful instructions intended to promote patient stability and a more favourable course of the disease&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Overall&#44; our study shows that medical specialists need to have more time for consultations with patients&#46; It also reports that the sociocultural characteristics of patients and caregivers &#40;language&#44; educational level&#44; etc&#46;&#41; may hamper their understanding of the information the doctors present&#46; These factors are very well known&#44; not only in the field of AD management&#44; but also in most of the illnesses treated in neurology consultations and specialty centres&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> On the other hand&#44; our study confirms prior results by Kendall et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#58; caregivers of AD patients frequently perceive that the information provided to them does not answer certain important questions&#46; They feel that they do not have enough information&#44; even if they do appreciate any efforts made to keep them informed&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study differs from other current studies in that it refers to specific and well-defined areas of information transmitted to caregivers and patients&#46; It lists areas of information that need improvement in order to improve communications between medical specialists and caregivers&#46; This is especially true in the context of a serious illness like Alzheimer&#39;s disease&#44; which imposes significant physical&#44; economic and emotional burdens on the caregiver&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Our study shows that caregivers of AD patients gave a positive rating to information they received regarding the concept of the disease&#44; treatment recommendations&#44; and treatment dosage&#46; In clear contrast to the above&#44; medical specialists were especially satisfied with the information they presented to debunk preconceived notions and warn caregivers about risk situations&#44; and information on family associations&#44; support groups&#44; and similar resources&#46; This obvious disparity in the subjective assessments of the information provided and that received &#40;with poor objective values for concordance&#41; highlights some of the communication problems present in neurology departments when following up on patients with AD&#46; This disparity may also be related to a specific lack associated with treating common dementia problems and providing effective assistance to these patients&#8217; caregivers&#58; there is considerable need for better education and social support if caregivers are to overcome the emotional distress associated with AD&#44; and this need is well-understood in primary care centres&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Leaving aside the discrepancies identified by the analytical tools used in our study&#44; identifying those factors directly associated with the level of disagreement was problematic&#46; We were only able to link the stage of AD progression to differences in perception of the information presented and that retained&#46; Therefore&#44; for more advanced stages of AD&#44; we observed increased agreement between medical specialists and caregivers regarding information&#46; This association could be related to the benefits of early diagnosis which caregivers report&#59; early diagnosis may facilitate the assimilation&#44; understanding and processing of information about the disease&#46; In addition&#44; it may be helpful in planning future care&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> in spite of the increasing responsibility and burden assumed by the caregiver as the physical and mental state of the AD patient worsens&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Such a finding calls attention to the importance of a properly integrated approach to providing information on AD&#46; This vision takes into account the three basic pillars of the care process&#58; the medical specialist&#44; the patient&#44; and the caregiver&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Successfully presenting optimised and correctly selected information that can be retained by the caregiver would result in more efficient care from both the patient and the caregiver perspectives&#59; this in turn would significantly lower the risk of the patient being admitted to a residence<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> and lower the social and health costs of caring for the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">In conclusion&#44; we should highlight that this study revealed significant discrepancies in the way the 2 groups &#40;medical specialists and caregivers of AD patients&#41; perceive information&#46; For 10 of the 17 areas of information that were assessed&#44; the information presented by the doctors and received by the caregivers was rated differently&#46; The results of the study show that the doctor-patient communication process must be improved in order to optimise the quality and quantity of the information that caregivers effectively receive and retain&#46; In this way&#44; the excellent service they provide to our society will become increasingly efficient and sustainable&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">This study received financial support from Novartis Farmac&#233;utica&#44; S&#46;A&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">Dr&#46; J&#46;L&#46; Molinuevo has received fees as a consultant for the following pharmaceutical companies&#58; Pfizer&#44; Ellan Pharmaceuticals&#44; Roche&#44; Bristol-Myers Squibb&#44; Novartis&#44; Lundbeck&#44; Janssen-Cilag&#44; General Electric&#44; Bayer&#44; and Innogenetics&#46; Dr&#46; B&#46; Hern&#225;ndez is employed by Novartis Farmac&#233;utica&#44; S&#46;A&#46;</p></span></span>"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec158122"
          "palabras" => array:6 [
            0 => "Enfermedad de Alzheimer"
            1 => "Cuidador"
            2 => "Informaci&#243;n"
            3 => "Educaci&#243;n"
            4 => "Retenci&#243;n"
            5 => "Transmisi&#243;n"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There is evidence of insufficient communication abilities by medical specialists as well as of the limited retentive capacities of patients with Alzheimer&#39;s disease &#40;AD&#41; and their caregivers&#46; The main reasons for this include the personal limitations of the physician&#44; as well as external&#44; emotional and social-cultural factors associated with the patients and their caregivers&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to compare the clinical information on AD provided by the physicians and that perceived by caregivers and to assess factors associated with differences in perception&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We carried out an observational national multicentre study based on questionnaires assessing the information provided by the physician and that retained by the caregiver for 17 items of information&#46; The study involved 61 researchers and included a total of 679 patients who met the selection criteria&#46; We evaluated the factors associated with the difference in perception of the information that was transmitted&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Participating caregivers had a mean age of 57&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;8 years&#44; with an average care time of 27&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;0 months&#46; Approximately half &#40;50&#46;9&#37;&#41; were children of the AD patient and most lived in the same household &#40;64&#46;9&#37;&#41;&#46; Caregivers assigned significantly higher ratings to information on concept of disease&#44; aetiology&#44; pathogenesis&#44; dosage and treatment recommendations and adherence&#44; while doctors assigned significantly higher ratings to information related to demystification and correcting preconceived notions&#44; possible complications&#44; adverse events and&#47;or iatrogenesis&#44; family associations&#44; and emotional&#47;psychological support to caregivers &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; Concordance between the information provided and that received was classified between poor and weak &#40;inter-rater agreement &#8804;0&#46;27&#41;&#46; The degree of disease progression using the Global Deterioration Scale &#40;GDS&#41; was a factor significantly associated with professional-carer information discrepancy &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Many areas of information showed large differences in perception between physicians and caregivers of AD patients&#44; which highlights the need to improve the communication process in order to achieve higher quality&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Existen evidencias de la insuficiente capacidad informativa por parte de los especialistas m&#233;dicos&#44; as&#237; como de las dificultades retentivas de los pacientes con enfermedad de Alzheimer &#40;EA&#41; y de sus cuidadores&#46; Entre las diversas causas figuran tanto las limitaciones personales del profesional como los determinantes externos&#44; emocionales y socioculturales del paciente y de su cuidador&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Contrastar la informaci&#243;n cl&#237;nica proporcionada por los m&#233;dicos sobre la EA y la percibida por los cuidadores y evaluar los factores asociados a las diferencias de percepci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo un estudio observacional&#44; multic&#233;ntrico y nacional mediante cuestionarios que eval&#250;an la informaci&#243;n suministrada por el m&#233;dico y la retenida por el paciente en 17 aspectos informativos&#46; Participaron 61 investigadores que incluyeron a un total de 679 pacientes que cumpl&#237;an los criterios de selecci&#243;n&#46; Se evaluaron los factores asociados a la diferencia de percepci&#243;n sobre la informaci&#243;n transmitida&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los cuidadores participantes ten&#237;an una media de 57&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;8 a&#241;os&#44; habiendo dedicado un tiempo medio como cuidadores de 27&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;0 meses&#44; y siendo el 50&#44;9&#37; hijos del paciente que mayoritariamente viv&#237;an en el mismo domicilio &#40;64&#44;9&#37;&#41;&#46; Los cuidadores valoraron significativamente mejor la informaci&#243;n recibida sobre&#58; concepto de la enfermedad&#44; aspectos etiopatog&#233;nicos&#44; posolog&#237;a y recomendaciones sobre el tratamiento y adherencia terap&#233;utica&#44; mientras que los m&#233;dicos consideraron significativamente mejor la informaci&#243;n referente a desmitificaci&#243;n y correcci&#243;n de concepciones previas&#44; posibles complicaciones&#44; riesgos&#44; efectos adversos y&#47;o yatrogenia&#44; asociaciones de familiares&#44; y ayuda emocional&#47;psicol&#243;gica a cuidadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La concordancia en la informaci&#243;n suministrada y la recibida fue entre pobre y d&#233;bil &#40;Kappa &#8804; 0&#44;27&#41;&#46; El grado de evoluci&#243;n de la enfermedad &#40;escala GDS&#41; fue un factor significativamente asociado con la discordancia profesional-cuidador &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se apreciaron diferencias de percepci&#243;n entre m&#233;dicos y cuidadores de pacientes con EA para numerosos aspectos informativos&#44; evidenciando la necesidad de mejorar el proceso comunicativo para optimizar su calidad&#46;</p>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Molinuevo JL&#44; Hern&#225;ndez B&#46; Evaluaci&#243;n de la informaci&#243;n suministrada por el m&#233;dico especialista sobre la enfermedad de Alzheimer y de la retenci&#243;n lograda por los cuidadores del enfermo&#46; Neurolog&#237;a&#46; 2012&#59;27&#58;453&#8211;71&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara">The members of the Group are listed in <a class="elsevierStyleCrossRef" href="#sec0065">Appendix 1</a> at the end of article&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
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          0 => array:4 [
            "apendice" => "<p id="par0190" class="elsevierStylePara elsevierViewall">TRACE Working Group&#58; Valero P&#233;rez Camo &#40;Unidad de Salud Mental Delicias&#44; Zaragoza&#41;&#44; Mar&#237;a Concepci&#243;n Ortiz Domingo &#40;Hospital San Juan de Dios&#44; Zaragoza&#41;&#44; Paloma Gonz&#225;lez Garc&#237;a &#40;Hospital San Jos&#233;&#44; Teruel&#41;&#44; Teresa Calatayud Noguera &#40;Hospital Universitario Central de Asturias&#44; Oviedo&#41;&#44; Juan Antonio Gil L&#243;pez &#40;Cl&#237;nica de Neuropsiquiatr&#237;a&#44; Gij&#243;n&#41;&#44; Jos&#233; Guti&#233;rrez Rodr&#237;guez &#40;Sociosanitaroa Larra&#241;aga&#44; Avil&#233;s&#41;&#44; Eloy Rodr&#237;guez Rodr&#237;guez &#40;Marqu&#233;s de Valdecilla&#44; Santander&#41;&#44; Miguel Go&#241;i Imizcoz &#40;Hospital Divino Vall&#233;s&#44; Burgos&#41;&#44; Javier Ruiz Martinez &#40;Hospital Donostia&#44; San Sebasti&#225;n&#41;&#44; Jorge Aguirre Inchusta &#40;Cl&#237;nica Padre Menni&#44; Pamplona&#41;&#44; Lourdes San Mart&#237;n Ganuza &#40;La Vaguada&#44; Pamplona&#41;&#44; Agust&#237;n Urrutia Sanzberro &#40;Centro Hospitalario Benito Menni&#44; Elizondo&#41;&#44; Jos&#233; Lu&#237;s S&#225;nchez Menoyo &#40;Aita Menni Ospitalea&#44; Bilbao&#41;&#44; Javier Ruiz Ojeda&#44; Bilbao&#41;&#44; Jos&#233; Marey L&#243;pez &#40;Centro Hospital Universitario A Coru&#241;a&#41;&#44; Juan Carlos Porven D&#237;az &#40;Hospital San Jos&#233;&#44; Lugo&#41;&#44; Mar&#237;a Teresa Olcoz Chiva &#40;Hospital Meixoeiro&#44; Vigo&#41;&#44; Margarita Vinuela Beneitez&#44; Instituto Carbonell&#44; Palma de Mallorca&#41;&#44; Ana Mar&#237;a Pujol Nuez &#40;Cl&#237;nica Juaneda&#44; Palma de Mallorca&#41;&#44; Fritz Nobbe &#40;Clonus&#44; Palma de Mallorca&#41;&#44; Antonio Garc&#237;a Trujillo &#40;Mente&#44; Palma de Mallorca&#41;&#44; Crist&#243;bal D&#237;ez-Aja L&#243;pez &#40;Cl&#237;nica Merced&#44; Barcelona&#41;&#44; Juan Hermenegildo Catena Mir &#40;Hosptial Sant Andreu&#44; Manresa&#41;&#44; Alberto Molins Albanell &#40;Hospital Josep Trueta&#44; Girona&#41;&#44; Mar&#237;a del Mar Fern&#225;ndez Adarte &#40;Centre Sociosanitari Bernat Jaume&#44; Figueres&#41;&#44; Mar&#237;a Rosa Cano Castella &#40;EAIA Trastornos Cognitivos&#44; Reus&#41;&#44; Jaume Burcet Darde &#40;Hospital del Vendrell&#44; El Vendrell&#41;&#44; Ram&#243;n Cristofol Allu&#233; &#40;Antic Hospital de Sant Jaume&#44; Matar&#243;&#41;&#44; Ana Isabel Tercero Uribe &#40;CAP II Cerdanyola&#44; Ripollet&#41;&#44; Sonsoles Abaceta Arilla &#40;Parc Taul&#237;&#44; Sabadell&#41;&#44; Montserrat Pujol Sabat&#233; &#40;Hospital Santa Mar&#237;a&#44; Lleida&#41;&#44; Consuelo Almenar Monfort &#40;Benito Menni&#44; Sant Boi de Llobregat&#41;&#44; Dom&#233;nec Gil Saladie &#40;Hospital Sagrat Cor&#44; Martorell&#41;&#44; Ramon Re&#241;&#233; Ram&#237;rez &#40;Hosptial Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#41;&#44; David Andr&#233;s P&#233;rez Mart&#237;nez &#40;Hospital Infanta Cristina&#44; Parla&#41;&#44; Jer&#243;nimo Almajano Mart&#237;nez &#40;Hospital 12 de Octubre&#44; Madrid&#41;&#44; Juli&#225;n Benito Le&#243;n &#40;Hospital 12 de Octubre&#44; Madrid&#41;&#44; Mar&#237;a de Toledo Heras &#40;Hospital Severo Ochoa&#44; Madrid&#41;&#44; Miguel &#193;ngel Garc&#237;a Soldevilla &#40;Hospital Pr&#237;ncipe de Asturias&#44; Alcal&#225; de Henares&#41;&#44; Carmen Borru&#233; Fern&#225;ndez &#40;Hospital Infanta Sof&#237;a&#44; San Sebasti&#225;n de los Reyes&#41;&#44; Pedro Emilio Bermejo Velasco &#40;Hospital La Paz&#44; Madrid&#41;&#44; Pedro Gil Gregorio &#40;Hospital Cl&#237;nico San Carlos&#44; Madrid&#41;&#44; Mar&#237;a Sagrario Manzano Palomo &#40;Hospital Cl&#237;nico San Carlos&#44; Madrid&#41;&#44; Jes&#250;s Cacho Guti&#233;rrez &#40;Hospital Universitario Salamanca&#41;&#44; Camino Sevilla G&#243;mez &#40;Hospital de la Princesa&#44; Madrid&#41;&#44; Eloisa Navarro Merino &#40;Centro de Especialidades Vicente Soldevilla&#44; Madrid&#41;&#44; Marta Ochoa Mulas &#40;HM Monteprincipe&#44; Boadilla del Monte&#41;&#44; Pilar S&#225;nchez Alonso &#40;Hospital Puerta del Hierro&#44; Majadahonda&#41;&#44; Beatriz Mondejar Mar&#237;n and Carlos Marsal Alonso &#40;Hospital Virgen de la Salud&#44; Toledo&#41;&#44; Jos&#233; Lu&#237;s Parrilla Ram&#237;rez &#40;Hosptial Infanta Cristina&#44; Badajoz&#41;&#44; Ignacio Casado Naranjo &#40;Hospital San Pedro de Alc&#225;ntara&#44; C&#225;ceres&#41;&#44; Mart&#237;n Zurdo Hern&#225;ndez &#40;Hospital Virgen del Puerto&#44; Plasencia&#41;&#44; Juan Miguel Gir&#243;n &#218;beda &#40;Hospital de Jerez&#44; Jerez de la Frontera&#41;&#44; Ricardo de la Vega Cotarelo &#40;Hospital Punta de Europa&#44; Algeciras&#41;&#44; Juan Carlos Dur&#225;n Alonso &#40;Geri&#225;trico San Juan Grande&#44; Jerez de la Frontera&#41;&#44; Mar&#237;a Teresa Garc&#237;a L&#243;pez &#40;Cl&#237;nica Neurol&#243;gica&#44; Almer&#237;a&#41;&#44; Tom&#225;s Ojea Ortega &#40;Hospital Regional Universitario Carlos Haya&#44; M&#225;laga&#41;&#44; Manuel Romero Acebal &#40;Cl&#237;nica Neurol&#243;gica&#44; M&#225;laga&#41;&#44; Vicente Serrano Castro &#40;Hospital Cl&#237;nico de M&#225;laga&#41;&#44; Jos&#233; Mar&#237;a Torralba Roses &#40;Personalia Baena&#44; Baena&#41;&#44; Eduardo Aguera Morales &#40;Hospital Reina Sof&#237;a&#44; C&#243;rdoba&#41;&#44; Eva Cuartero Rodr&#237;guez &#40;Hospital Valme&#44; Sevilla&#41;&#44; F&#233;lix Vi&#241;uela Fern&#225;ndez &#40;Hospital Virgen Macarena&#44; Sevilla&#41;&#44; Manuel Carballo Cordero &#40;Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#41;&#44; Antonio Alay&#243;n Fumero &#40;Centro Neurol&#243;gico Alay&#243;n&#44; Santa Cruz de Tenerife&#41;&#44; H&#46; Jos&#233; Bueno Perdomo &#40;Hospital Universitario Nuestra Se&#241;ora de Candelaria&#44; Santa Cruz de Tenerife&#41;&#44; Juan Andr&#233;s C&#225;rdenas Rodolfo &#40;Hospital General La Palma&#44; Santa Cruz de Tenerife&#41;&#44; Mar&#237;a Carmen P&#233;rez Vieitez &#40;Hospital Doctor Negr&#237;n&#44; Las Palmas de Gran Canaria&#41;&#44; Joaqu&#237;n Escudero Torrilla &#40;Centro de Especialidades Jos&#233; Mar&#237;a Haro&#44; Valencia&#41;&#44; Mar&#237;a Dolores Mart&#237;nez Lozano &#40;Hospital La Magdalena&#44; Castell&#243;n&#41;&#44; Vicente Tordera Tordera &#40;Unidad de Salud Mental de X&#225;tiva&#41;&#44; Antonio Campayo Ib&#225;&#241;ez &#40;Hospital Onteniente&#44; Valencia&#41;&#44; Esther L&#243;pez Jim&#233;nez &#40;Hospital Perpetuo Socorro&#44; Albacete&#41;&#44; Inmaculada Feria Vilar &#40;Hospital General Albacete&#41;&#44; Inmaculada Abell&#225;n Miralles &#40;Hospital San Vicente de Raspeig&#44; Alicante&#41;&#44; Jordi Alom Poveda &#40;Hospital General de Elche&#41;&#44; Juan Mar&#237;n Mu&#241;oz &#40;Unidad de Demencias Arrixaca&#44; Murcia&#41;&#44; Lu&#237;s Carles Dies &#40;Centro Carles Egea&#44; Murcia&#41;&#44; Lu&#237;s Miguel Cabello Rodr&#237;guez &#40;Hospital Naval&#44; Cartagena&#41;&#44; Antonio Salvador Aliaga &#40;Hospital Cl&#237;nico de Valencia&#41;&#44; Rosario Mu&#241;oz Lacalle &#40;Unidad de Salud Mental Sueca&#44; Alzira&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "TRACE Study Working Group"
            "identificador" => "sec0065"
          ]
          1 => array:3 [
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            "etiqueta" => "Appendix B"
            "identificador" => "sec0070"
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      0 => array:7 [
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Medical specialists&#8217; opinion on factors that could potentially facilitate the task of providing information to caregivers of AD patients&#46; The mean and 95&#37; CI are shown for scores&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Assimilation of information by caregivers&#58; &#40;A&#41; caregivers who still have relevant questions after hearing medical information and &#40;B&#41; caregivers&#8217; perception of how important the information received is to the patient&#39;s care&#46;</p>"
        ]
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        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Mean differences between doctor and caregiver scores regarding information provided during the consultation&#46; The mean and 95&#37; CI are shown for scores&#46; Assessed items&#58; &#40;1&#41; concept of the disease&#44; &#40;2&#41; debunking misinformation&#44; &#40;3&#41; aetiopathogenesis&#44; &#40;4&#41; natural history and prognosis of AD&#44; &#40;5&#41; complications and risk situations&#44; &#40;6&#41; genetic and heritable risks&#44; &#40;7&#41; drugs and treatment alternatives&#44; &#40;8&#41; expected treatment responses&#44; &#40;9&#41; risks and adverse effects&#44; &#40;10&#41; drug interactions&#44; &#40;11&#41; treatment perspectives&#44; &#40;12&#41; dosage and treatment recommendations&#44; &#40;13&#41; adherence and risks associated with non-compliance with treatment&#44; &#40;14&#41; anticipated benefits of complementary therapies&#44; &#40;15&#41; social health resources and assistance&#44; &#40;16&#41; family&#47;caregiver associations&#44; and &#40;17&#41; emotional and psychological support&#46;</p>"
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        "etiqueta" => "Figure 4"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Stage of disease progression &#40;GDS&#47;Reisberg scale&#41; and disagreement between doctors and caregivers regarding provided and received information&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Sex &#40;female&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">456 &#40;67&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">77&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Progression timeline for AD &#40;years&#41;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Score on MMSE&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stage of progression on GDS&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GDS-1&#44; no cognitive decline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GDS-2&#44; very mild cognitive decline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GDS-3&#44; mild cognitive decline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;15&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GDS-4&#44; moderate cognitive decline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">316 &#40;47&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GDS-5&#44; moderately severe cognitive decline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">206 &#40;31&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GDS-6&#44; severe cognitive decline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GDS-7&#44; very severe cognitive decline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab264979.png"
              ]
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            1 => array:2 [
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                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">B&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex &#40;female&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">518 &#40;76&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time spent caring for the patient &#40;months&#41;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Relationship to the patient&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Spouse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225 &#40;33&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Son&#47;daughter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">343 &#40;50&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Other family member&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Professional caregiver&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type of domicile&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Caregiver lives in same household&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">437 &#40;64&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Caregiver does not live in same household &#40;day care&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">197 &#40;29&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Caregiver does not share the same household &#40;night care&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Educational level&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No schooling&#47;illiterate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Can read and write&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Completed primary school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">253 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Completed secondary school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179 &#40;26&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Introductory university studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;12&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Advanced university studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HADS scale&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Anxiety subscale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Depression subscale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">HADS questionnaire&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anxiety subscale</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No anxiety&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">405 &#40;59&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Possible case of anxiety&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Probable case of anxiety&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;19&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Depression subscale</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">453 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Possible case of depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;19&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Probable case of depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Items&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Quantity&#47;quality of the information provided regarding&#46;&#46;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Doctors &#40;mean&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Caregivers &#40;mean&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Kappa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Concordance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Concept of the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debunking myths and correcting preconceived notions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;6</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aetiopathogenesis of the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;8</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Natural history of the disease and patient&#39;s prognosis &#40;expected clinical progression&#44; new symptoms&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Potential complications and risk situations &#40;request for medical assistance&#44; emergency medical attention&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;5</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genetic and heritable risks&#44; possibility of genetic diagnosis&#44; etc&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;294&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Current drugs and treatment alternatives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Expected treatment responses&#44; treatment effectiveness&#44; duration&#44; etc&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;469&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Risks&#47;adverse effects&#47;iatrogenesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;4</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Potential drug interactions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;7</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">New therapeutic perspectives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosage and recommendations for the prescribed treatment &#40;periodicity&#44; diet&#44; dysphagia&#44; refusal&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;0</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;038</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Importance of treatment adherence and risks associated with treatment non-compliance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">1&#46;9</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Expected benefits of complementary treatment &#40;physiotherapy&#44; speech therapy&#44; occupational therapy&#44; cognitive stimulation&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Information about the potential social health resources and assistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;294&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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        "identificador" => "xack44768"
        "titulo" => "Acknowledgement"
        "texto" => "<p id="par0185" class="elsevierStylePara elsevierViewall">We would like to thank Emili Gonz&#225;lez-P&#233;rez &#40;Scientific Department at Trial Form Support&#44; Spain&#41; for his assistance with our study&#46;</p>"
      ]
    ]
  ]
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  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580812001551?idApp=UINPBA00004N"
]

Article information

ISSN: 21735808
Original language: English

DOI:10.1016/j.nrleng.2011.05.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	0	7
2024 October	20	9	29
2024 September	38	10	48
2024 August	16	5	21
2024 July	15	6	21
2024 June	14	11	25
2024 May	7	17	24
2024 April	14	9	23
2024 March	28	25	53
2024 February	13	32	45
2024 January	20	14	34
2023 December	11	19	30
2023 November	21	25	46
2023 October	30	47	77
2023 September	19	8	27
2023 August	21	13	34
2023 July	32	10	42
2023 June	38	22	60
2023 May	55	34	89
2023 April	53	9	62
2023 March	34	7	41
2023 February	12	5	17
2023 January	21	15	36
2022 December	18	10	28
2022 November	25	6	31
2022 October	31	11	42
2022 September	33	20	53
2022 August	27	13	40
2022 July	39	11	50
2022 June	31	12	43
2022 May	26	13	39
2022 April	19	13	32
2022 March	35	11	46
2022 February	41	7	48
2022 January	49	11	60
2021 December	39	11	50
2021 November	24	18	42
2021 October	19	15	34
2021 September	25	17	42
2021 August	12	3	15
2021 July	27	9	36
2021 June	47	11	58
2021 May	41	11	52
2021 April	69	25	94
2021 March	70	8	78
2021 February	21	8	29
2021 January	37	12	49
2020 December	35	10	45
2020 November	35	6	41
2020 October	24	5	29
2020 September	48	12	60
2020 August	49	10	59
2020 July	18	8	26
2020 June	29	6	35
2020 May	42	14	56
2020 April	31	6	37
2020 March	60	10	70
2020 February	23	9	32
2020 January	20	9	29
2019 December	38	13	51
2019 November	28	6	34
2019 October	31	10	41
2019 September	53	10	63
2019 August	33	7	40
2019 July	36	9	45
2019 June	64	43	107
2019 May	174	66	240
2019 April	104	26	130
2019 March	35	6	41
2019 February	43	9	52
2019 January	33	7	40
2018 December	21	6	27
2018 November	49	5	54
2018 October	42	7	49
2018 September	34	10	44
2018 August	17	2	19
2018 July	22	1	23
2018 June	19	5	24
2018 May	15	7	22
2018 April	35	8	43
2018 March	31	0	31
2018 February	13	0	13
2018 January	21	0	21
2017 December	15	0	15
2017 November	19	9	28
2017 October	21	2	23
2017 September	20	1	21
2017 August	20	5	25
2017 July	21	1	22
2017 June	23	5	28
2017 May	35	4	39
2017 April	15	19	34
2017 March	19	32	51
2017 February	16	0	16
2017 January	27	2	29
2016 December	38	9	47
2016 November	46	10	56
2016 October	32	14	46
2016 September	38	8	46
2016 August	45	4	49
2016 July	27	1	28
2016 June	33	11	44
2016 May	21	6	27
2016 April	28	11	39
2016 March	28	16	44
2016 February	53	10	63
2016 January	38	2	40
2015 December	26	10	36
2015 November	35	6	41
2015 October	47	8	55
2015 September	35	9	44
2015 August	61	2	63
2015 July	47	2	49
2015 June	27	1	28
2015 May	47	8	55
2015 April	33	2	35
2015 March	22	5	27
2015 February	35	8	43
2015 January	35	7	42
2014 December	102	12	114
2014 November	36	4	40
2014 October	56	6	62
2014 September	35	2	37
2014 August	50	5	55
2014 July	36	8	44
2014 June	35	2	37
2014 May	21	5	26
2014 April	30	4	34
2014 March	33	5	38
2014 February	20	2	22
2014 January	19	5	24
2013 December	27	5	32
2013 November	37	8	45
2013 October	56	4	60
2013 September	51	4	55
2013 August	55	9	64
2013 July	35	2	37

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