A nurse-led mental health service for people with multiple sclerosis

The relationship of indoor radon gas concentration with multiple sclerosis: a case-control study

This case-control study aimed to investigate the relationship of indoor radon gas concentration and residential building characteristics with mental health with multiple sclerosis (MS) in Yazd City, Iran. The participants included 45 patients with MS and 100 healthy individuals. The participants' socio-economic status and residential building characteristics were investigated using a questionnaire. The radon gas concentration was also measured by CR-39 detectors over a 6-month period. Furthermore, the participants' mental health data were collected using General Health Questionnaire (GHQ-28). The mean concentrations of radon gas were 66.77 and 65.33 Bq/m³ in the homes of patients with MS and healthy individuals, respectively, but the difference was not significant (p = 0.882). However, the radon gas concentration had a significant relationship with the building's age (p = 0.038), ventilation (p = 0.053), and cooling system (p = 0.021). A significant difference was observed between the two study groups in terms of the mental health (p = 0.018), depression (p = 0.037), somatic symptoms (p ≤ 0.001), and physical activity (p = 0.030). Since the indoor radon gas concentration did not have any significant relationship with MS prevalence, more studies are required in this regard, especially in long-term exposure.

The Efficacy of Psychological Interventions for Managing Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background

Multiple sclerosis (MS) is a complex, demyelinating disease of the central nervous system. Fatigue is commonly reported by people with MS (PwMS). MS-related fatigue severely affects daily activities, employment, socioeconomic status, and quality of life.

Objective

We conducted this systematic review and meta-analysis to determine whether psychological interventions are effective in managing fatigue in PwMS.

Data sources

We performed systematic searches of Medline, EMBASE, PsycINFO, and CINAHL to identify relevant articles published from database inception to April 5, 2017. Reference lists from relevant reviews were also searched.

Study selection and design

Two independent reviewers screened the papers, extracted data, and appraised the included studies. A clinical psychologist verified whether interventions were psychological approaches. A narrative synthesis was conducted for all included studies. For relevant randomized controlled trials that reported sufficient information to determine standardized mean differences (SMDs) and 95% confidence intervals (CIs), meta-analyses were conducted using a random-effects model.

Results

Of the 353 identified articles, 20 studies with 1,249 PwMS were included in this systematic review. Narrative synthesis revealed that psychological interventions reduced fatigue in PwMS. Meta-analyses revealed that cognitive behavioral therapy decreased levels of fatigue compared with non-active controls (SMD = −0.32; 95% CI: −0.63 to −0.01) and compared with active controls (relaxation or psychotherapy) (SMD = −0.71; 95% CI: −1.05 to −0.37). Meta-analyses further showed that both relaxation (SMD = −0.90; 95% CI: −1.30 to −0.51), and mindfulness interventions (SMD = −0.62; 95% CI: −1.12 to −0.12), compared with non-active control, decreased fatigue levels. The estimates of heterogeneity for the four meta-analyses varied between none and moderate.

Conclusion

This study found that the use of psychological interventions for MS-related fatigue management reduced fatigue in PwMS. While psychological interventions are generally considered first-line therapy for MS-related fatigue, further studies are needed to explore the long-term effect of this therapy.