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McCombe PA. The role of sex and pregnancy in multiple sclerosis: what do we know and what should we do? Expert Rev Neurother 2022; 22:377-392. [PMID: 35354378 DOI: 10.1080/14737175.2022.2060079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is more prevalent in women than in men. The sex of the patient, and pregnancy, are reported to be associated with the clinical features of MS. The mechanism of this is unclear. AREAS COVERED This review summarizes data about sex differences in MS and the role of pregnancy. Possible mechanisms for the effects of sex and pregnancy are summarized, and practical suggestions for addressing these issues are provided. EXPERT OPINION There is considerable interdependence of the variables that are associated with MS. Men have a worse outcome of MS, and this could be due to the same factors that lead to greater incidence of neurodegenerative disease in men. The possible role of parity on the long-term outcome of MS is of interest. Future studies that look at the mechanisms of the effects of the sex of the patient on the outcome of MS are required. However, there are some actions that can be taken without further research. We can concentrate on public health measures that address the modifiable risk factors for MS and ensure that disease is controlled in women who intend to become pregnant and use appropriate disease modifying agents during pregnancy.
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Affiliation(s)
- Pamela A McCombe
- The University of Queensland, Centre for Clinical Research, Royal Brisbane and Women's Hospital, Herston, Australia
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Veillard D, Le Page E, Epstein J, Wiertlewski S, Gallien P, Hamonic S, Debouverie M, Edan G. Evaluation of the quality of the care pathway for patients with multiple sclerosis in France: Results of an original study of a cohort of 700 patients. Rev Neurol (Paris) 2021; 178:580-590. [PMID: 34893353 DOI: 10.1016/j.neurol.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Evaluating the quality of the care pathway for patients with chronic diseases, such as multiple sclerosis (MS), is an important issue. Process indicators are a recognized method for evaluating professional practices. However, these tools have been little developed in the field of MS, and few data are available. The aim of this study was to describe, retrospectively, with validated indicators, the quality of the care pathway in a population-based cohort of 700 patients with the first manifestations of the disease occurring between January 1, 2000 and December 31, 2001 and during the first 10 years of disease. METHOD This assessment was based on 48 indicators specific to MS. The information required for the calculation of each indicator was collected from the source files of the 700 patients of the cohort. RESULTS Data for the 10 years of follow-up were collected for 80% of the patients. In total, 36 indicators were calculated. These results reveal that there is room for improvement, particularly in terms of the initial assessment, access to ophthalmological evaluation, employment, obtaining an evaluation of the need for rehabilitation and access to such care. CONCLUSION The results of this survey provide access to unprecedented new data in France, that professionals and patients can appropriate to improve the targeting of actions, to improve the quality of care further for patients with MS in France. We propose to continue this process by submitting, for discussion, a targeted list of updated indicators relating to changes in guidelines, and in issues concerning the quality of patient management.
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Affiliation(s)
- D Veillard
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France; Équipe d'accueil 3279, centre d'études et de recherche sur les services de santé, Aix-Marseille Université, 13000 Marseille, France.
| | - E Le Page
- Inserm, service de neurologie, Clinical Neuroscience Center CIC-P 1414, CHU, 35000 Rennes, France.
| | - J Epstein
- Service d'épidémiologie, clinique du centre hospitalier universitaire and Clinical Investigation Center CIC 1433, 54000 Nancy, France.
| | - S Wiertlewski
- Clinique neurologique, CHU de Nantes, 44000 Nantes, France.
| | - P Gallien
- Pôle de médecine physique et de rehabilitation Saint-Hélier, 35000 Rennes, France.
| | - S Hamonic
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France.
| | - M Debouverie
- Équipe d'accueil 4360 adaptation, mesure et évaluation en santé, approches interdisciplinaires, service de neurologie, université de Lorraine, CHU de Nancy, 54000 Nancy, France.
| | - G Edan
- Inserm, Clinical Neuroscience Centre, CIC-P 1414, Université de Rennes 1, 35000 Rennes, France.
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Defer G, de Seze J, Bouee S, Courouve L, Longin J, Payet M, Deleglise AJ. Outcomes and treatment management of a French cohort suffering from multiple sclerosis: A retrospective epidemiological study. Mult Scler Relat Disord 2018; 25:276-281. [DOI: 10.1016/j.msard.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/13/2018] [Accepted: 08/03/2018] [Indexed: 11/26/2022]
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Bezzini D, Policardo L, Profili F, Meucci G, Ulivelli M, Bartalini S, Francesconi P, Battaglia MA. Multiple sclerosis incidence in Tuscany from administrative data. Neurol Sci 2018; 39:1881-1885. [DOI: 10.1007/s10072-018-3513-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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Schmedt N, Khil L, Berger K, Riedel O. Incidence of Multiple Sclerosis in Germany: A Cohort Study Applying Different Case Definitions Based on Claims Data. Neuroepidemiology 2017; 49:91-98. [DOI: 10.1159/000481990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/04/2017] [Indexed: 11/19/2022] Open
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Hammas K, Yaouanq J, Lannes M, Edan G, Viel JF. Small-area distribution of multiple sclerosis incidence in western France: in search of environmental triggers. Int J Health Geogr 2017; 16:35. [PMID: 28934989 PMCID: PMC5609066 DOI: 10.1186/s12942-017-0108-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/14/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite intensive research over several decades, the etiology of multiple sclerosis (MS) remains poorly understood, although environmental factors are supposedly implicated. Our goal was to identify spatial clusters of MS incident cases at the small-area level to provide clues to local environmental risk factors that might cause or trigger the disease. METHODS A population-based and multi-stage study was performed in the French Brittany region to accurately ascertain the clinical onset of disease during the 2000-2004 period. The municipality of residence at the time of clinical onset was geocoded. To test for the presence of MS incidence clusters and to identify their approximate locations, we used a spatial scan statistic. We adjusted for socioeconomic deprivation, known to be strongly associated with increased MS incident rates, and scanned simultaneously for areas with either high or low rates. Sensitivity analyses (focusing on relapsing-remitting forms and/or places of residence available within the year following clinical onset) were performed. RESULTS A total of 848 incident cases of MS were registered in Brittany, corresponding to a crude annual incidence rate of 5.8 per 100,000 inhabitants. The spatial scan statistic did not find a significant cluster of MS incidence in either the primary analysis (p value ≥ 0.56) or in the sensitivity analyses (p value ≥ 0.16). CONCLUSION The findings of this study indicate that MS incidence is not markedly affected across space, suggesting that in the years preceding the first clinical expression of the disease, no environmental trigger is operative at the small-area population level in the French Brittany region.
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Affiliation(s)
- Karima Hammas
- Department of Epidemiology and Public Health, University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Jacqueline Yaouanq
- Department of Epidemiology and Public Health, University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Morgane Lannes
- Department of Epidemiology and Public Health, University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Gilles Edan
- Department of Neurology, University Hospital, Rennes, France
| | - Jean-François Viel
- Department of Epidemiology and Public Health, University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France. .,INSERM-IRSET No 1085, Epidemiological Research on Environment, Reproduction and Development, University of Rennes 1, Rennes, France.
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Abstract
Multiple sclerosis is characterized by a non-homogeneous distribution around the world. Some authors in past described a latitude gradient, with increasing risk from the equator to North and South Poles, but this theory is still controversial. Regarding Europe, there are many articles in the literature concerning the epidemiology of this disease but, unfortunately, they are not always comparable due to different methodologies, they do not cover all countries in the continent, and most of them reported data of small areas and rarely at a national level. In 2012 there were 20 national registries that could help to describe the epidemiology of the disease and, in addition, there is an European Register for Multiple Sclerosis that collect data from already existing national or regional MS registries and databases. Another valid alternative to obtain epidemiological data, also at national level, in a routinely and cost-saving way is through administrative data that are of increasing interest in the last years.
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Ha-Vinh P, Nauleau S, Clementz M, Régnard P, Sauze L, Clavaud H. Geographic variations of multiple sclerosis prevalence in France: The latitude gradient is not uniform depending on the socioeconomic status of the studied population. Mult Scler J Exp Transl Clin 2016; 2:2055217316631762. [PMID: 28607717 PMCID: PMC5433399 DOI: 10.1177/2055217316631762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In France, two studies analysed multiple sclerosis prevalence nationwide: one was carried out in farmers, and the other one in employees. A south-north gradient of prevalence was found solely in farmers. Objective In order to better describe the latitude gradient in France, which is not uniform depending on the studied population, we assessed whether a gradient exists in another population than farmers and employees: independent workers. The same methods of case ascertainment have been used. Methods Altogether 4,165,903 persons insured by the French health insurance scheme for independent workers were included. We searched the database for (a) long term disease status ‘multiple sclerosis’, (b) domicile, (c) gender and (d) age. Results A total of 4182 cases of multiple sclerosis were registered giving a prevalence of 100.39/100,000. Adjustment by age and sex and spatial smoothing with a Bayesian analysis showed a gradual increase of prevalence from the southwest to the northeast of France. Standardised morbidity ratio was correlated with latitude and longitude (p<0.0001; p = 0.0031; adjusted R2 = 0.3038). Conclusion A discrepancy of geographic distribution between farmers and independent workers on the one hand and employees on the other cannot be attributable to environment. Assuming that socioeconomic status by itself is not associated with multiple sclerosis risk, employees’ geographic mobility at adulthood for professional reasons could have interfered with the gradient effect.
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Affiliation(s)
| | - Stève Nauleau
- Agence Régionale de Santé, Provence Alpes Côte d'Azur, France
| | | | | | - Laurent Sauze
- Agence Régionale de Santé, Provence Alpes Côte d'Azur, France
| | - Henri Clavaud
- Agence Régionale de Santé, Provence Alpes Côte d'Azur, France
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Leray E, Moreau T, Fromont A, Edan G. Epidemiology of multiple sclerosis. Rev Neurol (Paris) 2016; 172:3-13. [DOI: 10.1016/j.neurol.2015.10.006] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/17/2022]
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Otero-Romero S, Ramió-Torrentà L, Pericot I, Carmona O, Perkal H, Saiz A, Bufill E, Robles R, Simón E, Llufriu S, Vaqué-Rafart J, Sastre-Garriga J, Montalban X. Onset-adjusted incidence of multiple sclerosis in the Girona province (Spain): Evidence of increasing risk in the south of Europe. J Neurol Sci 2015; 359:146-50. [PMID: 26671104 DOI: 10.1016/j.jns.2015.10.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/25/2015] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent studies show an increasing incidence of multiple sclerosis (MS) in southern Europe. Although by its geographical location and genetic characteristics Spain is expected to be similar to other southern European regions, data on incidence are scarce. The aim of this study was to determine the onset-adjusted incidence of MS in the Girona province in Catalonia (Spain). METHODS A prospective incidence study pooling data from the population-based Catalonia MS Registry was performed. Incident cases were defined as patients who had the onset of symptoms compatible with a clinically isolated syndrome (CIS) suggestive of MS in 2009 and fulfilled McDonald-2005 criteria during follow-up. Age- and sex-specific incidence rates were obtained. RESULTS The Registry included 182 patients residing in Girona that presented a CIS from January 2009 to December 2013. Fifty one patients had the onset of symptoms in 2009, of whom 27 patients fulfilled the diagnostic criteria, giving an incidence of 3.6 per 100,000 (CI 95% 2.4-5.3) inhabitants; 4.3 (CI 95% 2.5-7.1) for women and 2.9 (CI 95% 1.4-5.2) for men. The age-adjusted incidence rate for the European population was 3.29 (CI 95% 3.2-3.3). CONCLUSION The incidence estimation derived in this study is consistent with recent epidemiological data of MS in southern Europe suggesting an increase in incidence in this region.
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Affiliation(s)
- S Otero-Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain; Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Ll Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - I Pericot
- Hospital Santa Caterina, Girona, Spain
| | | | - H Perkal
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - A Saiz
- Center of Neuroimmunology, Neurology Service, Hospital Clinic, Barcelona, Spain
| | - E Bufill
- Neurology Department, Hospital General de Vic, Barcelona, Spain
| | - R Robles
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - E Simón
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Llufriu
- Center of Neuroimmunology, Neurology Service, Hospital Clinic, Barcelona, Spain
| | - J Vaqué-Rafart
- Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - X Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain
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Kerbrat A, Hamonic S, Leray E, Tron I, Edan G, Yaouanq J. Ten-year prognosis in multiple sclerosis: a better outcome in relapsing−remitting patients but not in primary progressive patients. Eur J Neurol 2014; 22:507-e35. [DOI: 10.1111/ene.12600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A. Kerbrat
- Department of Neurology; University Hospital; Rennes France
- WENNE; Grand-Ouest France
| | - S. Hamonic
- Department of Epidemiology and Public Health; University Hospital; Rennes France
| | - E. Leray
- WENNE; Grand-Ouest France
- Epidemiology Department; EHESP School of Public Health; Rennes France
- CIC-P 1414 INSERM; University Hospital; Rennes France
| | - I. Tron
- Public Health Observatory (ORSB); Rennes France
| | - G. Edan
- Department of Neurology; University Hospital; Rennes France
- WENNE; Grand-Ouest France
- CIC-P 1414 INSERM; University Hospital; Rennes France
| | - J. Yaouanq
- Department of Epidemiology and Public Health; University Hospital; Rennes France
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