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Zhu K, Zhang ZX, Zhang M. Application value of machine learning models in predicting intraoperative hypothermia in laparoscopic surgery for polytrauma patients. World J Clin Cases 2024; 12:5513-5522. [DOI: 10.12998/wjcc.v12.i24.5513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/30/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications. Machine learning models offer a promising approach to predict the occurrence of intraoperative hypothermia.
AIM To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple trauma.
METHODS This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December 2023. Of these, 154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 ratio. In the training set, 53 cases experienced intraoperative hypothermia and 101 did not. Logistic regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic surgery. The area under the curve (AUC), sensitivity, and specificity were calculated.
RESULTS Comparison of the hypothermia and non-hypothermia groups found significant differences in sex, age, baseline temperature, intraoperative temperature, duration of anesthesia, duration of surgery, intraoperative fluid infusion, crystalloid infusion, colloid infusion, and pneumoperitoneum volume (P < 0.05). Differences between other characteristics were not significant (P > 0.05). The results of the logistic regression analysis showed that age, baseline temperature, intraoperative temperature, duration of anesthesia, and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery (P < 0.05). Calibration curve analysis showed good consistency between the predicted occurrence of intraoperative hypothermia and the actual occurrence (P > 0.05). The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets, respectively.
CONCLUSION Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery, which improved surgical safety and patient recovery.
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Affiliation(s)
- Kun Zhu
- The Second Department of Anesthesia, Tianjin Hospital, Tianjin 300211, China
| | - Zi-Xuan Zhang
- Department of War Rescue Training, Qingdao Special Servicemen Recuperation Center of PLA Navy, Qingdao 266001, Shandong Province, China
| | - Miao Zhang
- Department of Internal Medicine, Qingdao Fushan Elderly Apartments, Qingdao 266001, Shandong Province, China
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von Drathen S, Gold SM, Peper J, Rahn AC, Ramien C, Magyari M, Hansen HC, Friede T, Heesen C. Stress and Multiple Sclerosis - Systematic review and meta-analysis of the association with disease onset, relapse risk and disability progression. Brain Behav Immun 2024; 120:620-629. [PMID: 38906489 DOI: 10.1016/j.bbi.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/25/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024] Open
Abstract
OBJECTIVE This systematic review and meta-analysis address the evidence on the association of psychological stressors with onset of multiple sclerosis, inflammatory disease activity (relapses or new disease activity on magnetic resonance imaging, MRI) and disability progression. METHODS PubMed was searched from 1946 to 15 July 2022. Studies and certain stressors were selected when they assessed stressors independent from stress elicited by the disease process itself. Risk of bias was assessed by the CASP Case Control Study Checklist and the CASP Cohort Study Checklist. Normal-Normal Hierarchical Model (NNHM) for random-effects meta-analysis was used in the Bayesian framework. RESULTS 30 studies reporting data from 26 cohorts reporting on 24.781 cases could be identified. Ten studies addressed stressors and MS disease onset showing a weak to modest effect of psychological stressors. A meta-analysis of three studies investigating diagnosed stress disorders and MS risk showed a 1.87-fold (CI 1.061 to 3.429) increased MS risk. Stress and MS relapse risk were addressed in 19 heterogeneous studies. Meta-analyses from two independent cohorts investigating the same military threat of a population showed a threefold increased risk for relapses in association with war (relapse rate: 3.0, CI 1.56 to 5.81). In addition, two studies confirmed an association of stressful life events and MRI activity. Three studies of stressors and disease progression were included indicating some effect on disease progression. CONCLUSIONS Taken together studies indicate a minor to modest impact of psychological stressors on disease onset, inflammatory activity and progression of MS. Possible case-selection bias and lack of confounder analysis were present in many studies.
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Affiliation(s)
- Sönke von Drathen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Friedrich-Ebert-Krankenhaus, Friesenstraße 11, D-24534 Neumünster, Germany.
| | - Stefan Michael Gold
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg; Charité Universitätsmedizin Berlin, Department of Psychiatry, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, D-12203 Berlin, Germany; Charité Universitätsmedizin Berlin, Medical Department, Section Psychosomatic Medicine, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, D-12203 Berlin, Germany
| | - Julia Peper
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Anne Christin Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Caren Ramien
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg
| | - Melinda Magyari
- Danish Multiple Sclerosis Center and The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Hans-Christian Hansen
- Department of Neurology, Friedrich-Ebert-Krankenhaus, Friesenstraße 11, D-24534 Neumünster, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany
| | - Christoph Heesen
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg
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Rakhshani T, Afroozeh S, Kashfi SM, Kamyab A, Khani Jeihooni A. The effect of education of self-care behaviors on the quality of life and resilience of multiple sclerosis patients. BMC Neurol 2024; 24:264. [PMID: 39080600 PMCID: PMC11290106 DOI: 10.1186/s12883-024-03777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most common causes of non-traumatic disability in young adults. Typically, doctors diagnose MS between the ages of 20 and 50. This study aims to determine the effect of educational intervention on self-care behaviors on MS patients' quality of life and resilience in Shiraz, Iran. METHODS This interventional study included 90 individuals, aged 15 to 50, who were members of the support association for MS patients in Shiraz city, Iran. The study employed a convenient sampling method. Patients were randomly assigned to two experimental and control groups, and the self-care educational program was conducted during six educational sessions. The quality of life and resilience of the patients were measured before and after the study. Information was collected by completing the questionnaires before and three months after the intervention. To analyze the data, SPSS 23 was used. To describe the data, frequency, percentage, mean, and standard deviation indicators were used, and for analysis, independent t-tests and paired t-tests were used. RESULTS This study examined a total of 90 MS patients. 50.4% of the people in the study were married, 40% of them had a high school diploma, and 78.5% were unemployed. The results of the t-test showed that there was a significant difference between all the components of self-care, quality of life, and resilience before and after the intervention (P < 0.05). CONCLUSION By accepting the responsibility of self-care, patients would improve the inadequacies and disabilities resulting from the disease, use the power of self-care to solve problems, and improve their quality of life and resilience.
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Affiliation(s)
- Tayebeh Rakhshani
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Afroozeh
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Mansour Kashfi
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Kamyab
- Department of Community Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Fauver M, Clark EM, Schwartz CE. A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis. Front Integr Neurosci 2024; 18:1365672. [PMID: 38957213 PMCID: PMC11218666 DOI: 10.3389/fnint.2024.1365672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design.
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Affiliation(s)
- Michelle Fauver
- Integral Health Program, California Institute for Human Science, Encinitas, CA, United States
| | - Eva M. Clark
- MIND based Healing, Santa Cruz, CA, United States
| | - Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, United States
- Department of Medicine and Departments of Orthopaedic Surgery, Tufts University Medical School, Boston, MA, United States
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Holz A, Obi N, Ahrens W, Berger K, Bohn B, Brenner H, Fischer B, Fricke J, Führer A, Gastell S, Greiser KH, Harth V, Heise JK, Holleczek B, Keil T, Klett-Tammen CJ, Leitzmann M, Lieb W, Meinke-Franze C, Michels KB, Mikolajczyk R, Nimptsch K, Peters A, Pischon T, Riedel O, Schikowski T, Schipf S, Schmidt B, Schulze MB, Stang A, Hellwig K, Riemann-Lorenz K, Heesen C, Becher H. Childhood and adolescence factors and multiple sclerosis: results from the German National Cohort (NAKO). BMC Neurol 2024; 24:123. [PMID: 38614986 PMCID: PMC11015562 DOI: 10.1186/s12883-024-03620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) represents the most common inflammatory neurological disease causing disability in early adulthood. Childhood and adolescence factors might be of relevance in the development of MS. We aimed to investigate the association between various factors (e.g., prematurity, breastfeeding, daycare attendance, weight history) and MS risk. METHODS Data from the baseline assessment of the German National Cohort (NAKO) were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between childhood and adolescence factors and risk of MS. Analyses stratified by sex were conducted. RESULTS Among a total of 204,273 participants, 858 reported an MS diagnosis. Male sex was associated with a decreased MS risk (HR 0.48; 95% CI 0.41-0.56), while overweight (HR 2.03; 95% CI 1.41-2.94) and obesity (HR 1.89; 95% CI 1.02-3.48) at 18 years of age compared to normal weight were associated with increased MS risk. Having been breastfed for ≤ 4 months was associated with a decreased MS risk in men (HR 0.59; 95% CI 0.40-0.86) compared to no breastfeeding. No association with MS risk was observed for the remaining factors. CONCLUSIONS Apart from overweight and obesity at the age of 18 years, we did not observe considerable associations with MS risk. The proportion of cases that can be explained by childhood and adolescence factors examined in this study was low. Further investigations of the association between the onset of overweight and obesity in childhood and adolescence and its interaction with physical activity and MS risk seem worthwhile.
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Affiliation(s)
- Anja Holz
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany.
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- University Bremen, Bremen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Beate Fischer
- Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Carolina J Klett-Tammen
- Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Michael Leitzmann
- Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Karin B Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Katharina Nimptsch
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tobias Pischon
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tamara Schikowski
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
- School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
| | - Kerstin Hellwig
- Katholisches Klinikum Bochum, Neurology Clinic, Clinic of Ruhr-Universität Bochum, Bochum, Germany
| | - Karin Riemann-Lorenz
- Center for Molecular Neurobiology Hamburg (ZMNH), Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heesen
- Center for Molecular Neurobiology Hamburg (ZMNH), Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Heiko Becher
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
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Freedman DE, Krysko KM, Feinstein A. Intimate partner violence and multiple sclerosis. Mult Scler 2024; 30:295-298. [PMID: 37732567 PMCID: PMC10935614 DOI: 10.1177/13524585231197926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/29/2023] [Accepted: 08/12/2023] [Indexed: 09/22/2023]
Abstract
People with MS may be at heightened risk of intimate partner violence (IPV) compared to the general population; however, little is known about the prevalence of IPV among people with MS or its effects on MS-specific clinical outcomes. Additionally, while MS clinicians often discuss family planning with patients, many clinicians may have received little training in detecting and responding to IPV. Moreover, no studies have investigated how to implement IPV case-finding and resource provision in the MS clinical setting. Overall, there are several scholarly, educational, and implementation-related gaps in IPV-associated care for people with MS. This article aims to summarize the available literature on IPV in people with MS, identify future research questions, and aid MS clinicians in safely addressing IPV while awaiting vital MS-specific knowledge.
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Affiliation(s)
- David E Freedman
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristen M Krysko
- BARLO MS Centre, Division of Neurology, Department of Medicine, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Polick CS, Darwish H, de Olivera LP, Watson A, Vissoci JRN, Calhoun PS, Ploutz-Snyder R, Connell CM, Braley TJ, Stoddard SA. Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.06.24302405. [PMID: 38370736 PMCID: PMC10871453 DOI: 10.1101/2024.02.06.24302405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Intro Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated. Aim To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience. Methods Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking. Results The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45). Conclusions This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.
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Affiliation(s)
- Carri S Polick
- School of Nursing, Duke University, Durham, NC, USA
- VA Healthcare System, Durham, NC, USA
| | - Hala Darwish
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | - Ali Watson
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Patrick S Calhoun
- VA Healthcare System, Durham, NC, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| | | | | | - Tiffany J Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
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8
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Eid K, Bjørk MH, Gilhus NE, Torkildsen Ø. Adverse Childhood Experiences and the Risk of Multiple Sclerosis Development: A Review of Potential Mechanisms. Int J Mol Sci 2024; 25:1520. [PMID: 38338799 PMCID: PMC10855716 DOI: 10.3390/ijms25031520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, contribute to long-term systemic toxic stress and inflammation that may last well into adulthood. Such early-life stressors have been associated with increased susceptibility to multiple sclerosis (MS) in observational studies and with the development of experimental autoimmune encephalomyelitis in animal models. In this review, we summarize the evidence for an ACE-mediated increase in MS risk, as well as the potential mechanisms for this association. ACEs dysregulate neurodevelopment, stress responses, and immune reactivity; they also alter the interplay between the immune system and neural networks. All of this may be relevant for MS risk. We further discuss how ACEs induce epigenetic changes and how the toxic stress caused by ACEs may reactivate the Epstein-Barr Virus (EBV), a key risk factor for MS. We conclude by suggesting new initiatives to obtain further insights into this topic.
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Affiliation(s)
- Karine Eid
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 71, 5053 Bergen, Norway; (M.-H.B.); (N.E.G.)
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
| | - Marte-Helene Bjørk
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 71, 5053 Bergen, Norway; (M.-H.B.); (N.E.G.)
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
- NorHead, Norwegian Center for Headache Research, 5021 Bergen, Norway
| | - Nils Erik Gilhus
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 71, 5053 Bergen, Norway; (M.-H.B.); (N.E.G.)
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
| | - Øivind Torkildsen
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway
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9
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Polick CS, Rubenstein D, Shah S, Beckham JC, Calhoun PS, Noonan D. Addressing Smoking in Persons With Multiple Sclerosis: State of the Science and Need for a Targeted Intervention. Nicotine Tob Res 2024; 26:250-252. [PMID: 37625016 DOI: 10.1093/ntr/ntad159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Carri S Polick
- School of Nursing, Duke University, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
| | | | - Suma Shah
- Neurology Department, Duke University School of Medicine, Durham, NC, USA
- MS Center of Excellence, Durham VA Medical Center, Durham VA, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
| | - Devon Noonan
- School of Nursing, Duke University, Durham, NC, USA
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10
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Polick CS, Ploutz-Snyder R, Braley TJ, Connell CM, Stoddard SA. Fatigue, pain interference, and psychiatric morbidity in multiple sclerosis: The role of childhood stress. PLoS One 2023; 18:e0292233. [PMID: 37851620 PMCID: PMC10584096 DOI: 10.1371/journal.pone.0292233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive, autoimmune disease of the central nervous system that affects nearly one million Americans. Despite the existence of immunomodulatory therapies to slow physical and cognitive disability progression, interventions to ameliorate common symptoms of MS, including fatigue and pain, remain limited. Poor understanding of risk factors for these symptoms may contribute to treatment challenges. In recent years, childhood stress has been investigated as a risk factor for chronic autoimmune conditions including MS; yet remarkably few studies have investigated the relationship between childhood stressors and chronic MS symptoms. Our aim was to examine clusters of stressors and three key features of MS: fatigue, pain interference, and psychiatric morbidity. METHODS Cross-sectional data were collected from a sample of People with MS (PwMS) via a national web-based survey that assessed the presence and type of childhood stressors and MS clinical features. Hierarchical block regression was used to assess associations among emotional, physical, and environmental childhood stressors and three clinical features commonly experienced by PwMS. RESULTS N = 719 adults with MS (aged 21-85) completed the survey. Childhood emotional and physical stressors were significantly associated with overall presence of fatigue (p = 0.02; p<0.03) and pain interference (p<0.001; p<0.001) in adulthood, as well as the magnitude of both outcomes. Environmental stressors (p<0.001), in addition to emotional (p<0.001) and physical (p<0.001) stressors were significantly associated with psychiatric morbidity in PwMS. CONCLUSION Childhood stress may predict fatigue, psychiatric morbidity, and pain in adults with MS. Further research is needed to show cause and effect; however, if an association exists, strategies to mitigate the impact of childhood stress could offer new pathways to reduce the severity of these symptoms. Broadly, this work adds to the body of evidence supporting upstream preventive measures to help address the stress on children and families.
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Affiliation(s)
- Carri S. Polick
- School of Nursing, Duke University, Durham, NC, United States of America
- Durham VA Health Care System, Durham, NC, United States of America
| | - Robert Ploutz-Snyder
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Tiffany J. Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Cathleen M. Connell
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Sarah A. Stoddard
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
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Rehan ST, Khan Z, Shuja SH, Salman A, Hussain HU, Abbasi MS, Razak S, Cheema HA, Swed S, Surani S. Association of adverse childhood experiences with adulthood multiple sclerosis: A systematic review of observational studies. Brain Behav 2023; 13:e3024. [PMID: 37128143 PMCID: PMC10275535 DOI: 10.1002/brb3.3024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/12/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are proposed to increase the risk of developing multiple sclerosis (MS) later in life. This systematic review aimed to explore the correlation between ACEs and MS development, age of onset, quality of life in MS patients and MS relapse rates. METHODS We searched a total of six databases in June 2022 and retrieved the relevant studies. The population included adult (18+) individuals who either had been diagnosed or were at risk for developing MS and also had exposure to ACEs. Our primary outcomes include the risks of MS development, age of MS onset, and MS relapse rate in patients who were exposed to different types of ACEs. RESULTS A total of 11 studies were included in our review. A study reported that among 300 women diagnosed with MS, 71 (24%) reported a history of childhood abuse; moreover, with further research, it was concluded that ACEs were associated with the development of MS. Abuse that occurred 2-3 times per week was associated with an 18.81-fold increased risk of having MS when compared to the unexposed sample. The relapse rate of MS was found to be substantially greater in severe cases of ACEs compared to individuals who did not report any ACEs. CONCLUSIONS Results support a significant association between ACEs and the development of MS; individuals with a positive history of ACEs develop MS symptoms earlier. Moreover, the severity of ACEs is also linked with increased relapse rates of MS.
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Affiliation(s)
| | - Zayeema Khan
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Syed Hasan Shuja
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Afia Salman
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Hassan ul Hussain
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | | | - Sufyan Razak
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | | | - Sarya Swed
- Faculty of MedicineAleppo UniversityAleppoSyria
| | - Salim Surani
- Adjunct Clinical Professor of MedicineTexas A&M UniversityCollege StationTexasUSA
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