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Kamenskikh EM, Krygina AY, Gomboeva SC, Zhailebaeva D, Koval DP, Kicherov NA, Otchurzhap CN, Birulina YG, Alifirova VM. [Biobanking in clinical trials involving multiple sclerosis patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:7-15. [PMID: 39175234 DOI: 10.17116/jnevro20241240727] [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] [Indexed: 08/24/2024]
Abstract
Investigation of multiple sclerosis (MS) pathogenesis requires sophisticated analytical tools of precision medicine, such as omics research, which include genomics, microbiomics and metabolomics (proteomics, lipidomics and glycomics). Such sensitive methods are based on careful preanalytical work with biomaterials to maintain quality and obtain objective results. Implementation of biobanking as a universal method for working with biomaterials will help to standardize the stages of research, compare different scientific team's results. Collaboration of MS researchers with large biobanks can also help to conduct multicenter and long-term prospective studies, to include a wide number of patients. In this article, we analyze the experience of biobanking practice technologies in studies of MS patients and share the experience of partnership between the Center for MS of the Tomsk Region and the Bank of Biological Material of the Siberian State Medical University.
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Affiliation(s)
| | - A Yu Krygina
- Siberian State Medical University, Tomsk, Russia
| | | | | | - D P Koval
- Siberian State Medical University, Tomsk, Russia
| | - N A Kicherov
- Siberian State Medical University, Tomsk, Russia
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Kapali A, Daltveit AK, Myhr KM, Bjornevik K, Baldin E, Pugliatti M, Riise T, Cortese M. Childbirth delivery mode and the risk of multiple sclerosis: a prospective population-based study. J Neurol Neurosurg Psychiatry 2023; 95:8-13. [PMID: 37479464 DOI: 10.1136/jnnp-2023-331241] [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: 02/04/2023] [Accepted: 06/20/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Caesarean section (CS) may affect the risk of developing multiple sclerosis (MS) in the offspring, possibly through changes in gut microbiota composition, but findings from previous studies are inconsistent. We investigated whether birth by CS was associated with the risk of adult-onset MS. METHODS We conducted a prospective population-based cohort study, including all individuals born in Norway between 1967 and 2003, using the Medical Birth Registry of Norway linked with the Norwegian Multiple Sclerosis Registry and Biobank. The follow-up was until 2021. We used multivariable Cox models to estimate HRs for MS risk with 95% CIs. RESULTS Among 2 046 637 individuals in the cohort, 4954 MS cases were identified. Being born by CS was associated with a modest increase in MS risk (HR=1.18, 95% CI 1.05 to 1.32). In the sibling-matched analysis, we found no association between CS and MS risk. We found an interaction between CS and gestational age (p=0.03): CS was associated with an increased risk of MS in individuals born preterm (HR=1.62, 95% CI 1.18 to 2.24), whereas there was no association in individuals born at term (HR=1.13, 95% CI 0.99 to 1.27). In a subgroup analysis of individuals born in 1988 and onwards, emergency CS was related to an elevated MS risk (HR=1.40, 95% CI 1.07 to 1.83), whereas planned CS was not (HR: 1.10, 95% CI 0.77 to 1.58). CONCLUSIONS CS was associated with a modestly higher risk of developing MS. However, the stronger associations seen in subgroups who likely experienced a more complicated pregnancy/delivery may point to confounding underlying these associations.
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Affiliation(s)
- Akash Kapali
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Kjell-Morten Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjetil Bjornevik
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Elisa Baldin
- Epidemiology and Biostatistics Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Emilia-Romagna, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Marianna Cortese
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
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Harding KE, Ingram G, Tallantyre EC, Joseph F, Wardle M, Pickersgill TP, Willis MD, Tomassini V, Pearson OR, Robertson NP. Contemporary study of multiple sclerosis disability in South East Wales. J Neurol Neurosurg Psychiatry 2023; 94:272-279. [PMID: 36328420 DOI: 10.1136/jnnp-2022-330013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND A contemporary understanding of disability evolution in multiple sclerosis (MS) is an essential tool for individual disease management and planning of interventional studies. We have used prospectively collected longitudinal data to analyse disability progression and variation in a British MS cohort. METHODS Cox proportional hazards regression was used to estimate hazard of Expanded Disability Status Scale (EDSS) 4.0 and 6.0. A continuous Markov model was used to estimate transitional probabilities for individual EDSS scores. Models were adjusted for age at MS onset, sex and disease-modifying treatments (DMTs) exposure. RESULTS 2135 patients were included (1487 (70%) female, 1922 (89%) relapsing onset). 865 (41%) had used DMTs. Median time to EDSS 4.0 and 6.0 was 18.2 years (95% CI 16.3 to 20.2) and 22.1 years (95% CI 20.5 to 24.5). In the Markov model, the median time spent at EDSS scores of <6 (0.40-0.98 year) was shorter than the time spent at EDSS scores of ≥6 (0.87-4.11 year). Hazard of change in EDSS was greatest at EDSS scores <6 (HR for increasing EDSS: 1.02-1.33; decreasing EDSS: 0.34-1.27) compared with EDSS scores ≥6 (HR for increasing EDSS: 0.08-0.61; decreasing EDSS: 0.18-0.54). CONCLUSIONS These data provide a detailed contemporary model of disability outcomes in a representative population-based MS cohort. They support a trend of increasing time to disability milestones compared with historical reference populations, and document disability variation with the use of transitional matrices. In addition, they provide essential information for patient counselling, clinical trial design, service planning and offer a comparative baseline for assessment of therapeutic interventions.
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Affiliation(s)
| | - Gillian Ingram
- Neurology Department, Swansea Bay University Health Board, Swansea, UK
| | - Emma Clare Tallantyre
- Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK.,Institute of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK
| | - Fady Joseph
- Department of Neurology, Aneurin Bevan University Health Board, Newport, UK
| | - Mark Wardle
- Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK
| | - Trevor P Pickersgill
- Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK
| | - Mark D Willis
- Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK
| | - Valentina Tomassini
- Institute of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK.,Institute of Advanced Biomedical Technologies (ITAB), Department of Neuroscience and Imaging and Clinical Sciences, Multiple Sclerosis Center, Neurological Clinic, SS Annunziata Hospital, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy
| | - Owen Rhys Pearson
- Neurology Department, Swansea Bay University Health Board, Swansea, UK
| | - Neil P Robertson
- Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK.,Institute of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK
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Grytten N, Myhr KM, Celius EG, Benjaminsen E, Midgard R, Vatne A, Aarseth JH, Mannseth J, Torkildsen Ø. Cancer related mortality in multiple sclerosis. A population based cohort study. Mult Scler Relat Disord 2023; 69:104417. [PMID: 36423459 DOI: 10.1016/j.msard.2022.104417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/27/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer is a major cause of death, but how cancer influences mortality risk in Multiple Sclerosis (MS) is unclear. OBJECTIVES Determine all-cause mortality and mortality following a cancer diagnosis among MS patients compared with matched population controls. METHODS Norwegian MS patients born 1930 - 1979 (n= 6950) followed-up 1953 - 2016, were matched with 37 922 controls. We compared incident cancer diagnosis from the Cancer Registry of Norway, date of death from the Cause of Death Registry, education from the National Education Database, by multivariate Cox proportional hazard regression. RESULTS Hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality among MS patients was 4.97 (4.64 - 5.33), and 2.61 (2.29 - 2.98) for mortality following a cancer diagnosis. Mortality in MS was highest following urinary- (2.53: 1.55 - 4.14), colorectal- (2.14: 1.47 - 3.11), hematological- (1.76: 1.08 - 2.88), ovarian - 2.30 (1.73-3.06) and breast cancer diagnosis (2.61: 1.85 - 3.68), compared to controls. High education was inversely associated with mortality among MS patients. CONCLUSIONS All-cause mortality was five- fold and mortality following a cancer diagnosis was two- fold increased among MS patients. Mortality following specific cancers raises the possibility of diagnostic neglect.
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Affiliation(s)
- Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, sDept. of Neurology, Haukeland University Hospital; Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway.
| | - Kjell-Morten Myhr
- Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth G Celius
- Dept of Neurology, Oslo University Hospital Ullevål, Oslo, Norway; Institute of clinical medicine, University of Oslo, Oslo, Norway
| | | | - Rune Midgard
- Dept. of Neurology, Molde Hospital, Molde, Norway; Norwegian University of Science and Technology
| | - Anita Vatne
- Dept. of Rehabilitation, Southern Norway Hospital
| | - Jan H Aarseth
- The Norwegian Multiple Sclerosis Registry and Biobank, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Janne Mannseth
- The Norwegian Multiple Sclerosis Registry and Biobank, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway; Dept. of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øivind Torkildsen
- Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway
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Liu J, Zhang C, Xie Y, Zhou L, Guo L, Li B, Jia Z, Zhang J, Sugimoto K, Gao Y. Demyelinating diseases of the central nervous system registry for patients with traditional Chinese medicine: Rationale and design of a prospective, multicenter, observational study. Front Pharmacol 2022; 13:981300. [DOI: 10.3389/fphar.2022.981300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Traditional Chinese medicine (TCM), a main form of complementary and alternative medicine provides a potential possibility for demyelinating disease of the central nervous system (DDC) management and has been applied in considerable amounts of patients with this disorder. Nevertheless, powerful real-world evidences regarding the epidemiological and clinical characteristics, safety, and outcomes of TCM in DDC are lacking. The primary objective of the Demyelinating Diseases of the Central Nervous System Registry for Patients with Traditional Chinese Medicine (DATE-TCM) is to create an organized multicenter data collection structure to define integrative characteristics of DDC patients treated with TCM in an endeavor to fill these knowledge gaps to better inform clinical care and health policy.Method: This study provides a prospective and voluntary registry by using a web-based system. Baseline data will be recorded and subsequently regular follow-up visits will be implemented every 3–6 months for a total of 5 years. The primary outcome is Annualized Aggregate Relapse Rate at 5-year follow-up.Results: DATE-TCM is currently designed to capture the multidimensional (epidemiologic, demographic, clinical, etc.) features of DDC patients receiving TCM treatment, the type and long-term safety and efficacy of TCM intervenes in the DDC populations, as well as the interaction of TCM treatments and disease modifying therapies in the management of DDC, aiming to include 2000 eligible adult DDC patients with TCM intervenes from 35 participating centers, covering 77.4% of provincial administrative regions of mainland China.Conclusion: DATE-TCM is the first, largest, most geographically extensive, and standard registry-based observational study that systematically document the real-world data regarding the TCM application in the DDC populations, which will be extraordinarily important for clarifying the comprehensive characteristics and outcomes of TCM in DDC, further shed light on standardizing and optimizing the TCM measures for DDC management and establishing evidence-based clinical practice guidelines for TCM application in DDC.
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Willumsen JS, Grytten N, Aarseth J, Myklebust TÅ, Myhr KM, Midgard R. Mortality and cause of death in multiple sclerosis in western Norway 1950-2021: a registry-based linkage study. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329169. [PMID: 36096665 PMCID: PMC9606487 DOI: 10.1136/jnnp-2022-329169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) have higher risk of mortality compared with the general population. Longitudinal studies are important for understanding the evolution of survival in pwMS. OBJECTIVE Examine changes in mortality among pwMS during the past seven decades. METHODS We followed pwMS from Hordaland and Møre and Romsdal in Western Norway, with disease onset from before 1950, identified from population-based epidemiological surveys and the Norwegian MS Registry and Biobank, until 1 January 2021. Data were linked to the Norwegian Cause of Death Registry to obtain underlying cause of death. We examined all-cause, and cause-specific mortality using standardised mortality ratios (SMR) and excess death rates (EDR). We calculated life expectancies and assessed survival stratified by sex, age and disease phenotype at onset. We compared hazard ratios (HRs) for mortality, in pwMS diagnosed before and after the era of disease-modifying treatment (DMT). RESULTS Of 3624 pwMS, 964 (55.5% women) had died, predominantly of multiple sclerosis (49.0%). Median life expectancy for pwMS was 74.3 years (95% CI 73.3 to 75.3), compared with 83.1 years for the general population (p<0.001). From disease onset, pwMS survived 14.6 years shorter than the general population (p<0.001). Overall, SMR was 2.3 (95% CI 2.13 to 2.42) and EDR was 6.8 (95% CI 6.42 to 7.09) for pwMS. Treatment-eligible pwMS diagnosed in the DMT era had the lowest risk of mortality, HR 0.49 (95% CI 0.34 to 0.70,p<0.001). CONCLUSION Excess mortality among pwMS declined during the past seven decades, possibly due to improved diagnostics, better symptomatic treatment and access to DMTs.
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Affiliation(s)
- Johannes Sverre Willumsen
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Jan Aarseth
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Norwegian MS Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Rune Midgard
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
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Butzkueven H, Moore N, Aydemir A, Sõnajalg J, Bezemer I, Korhonen P, Sabidó M. The CLARION study design and status update: a long-term, registry-based study evaluating adverse events of special interest in patients with relapsing multiple sclerosis newly started on cladribine tablets. Curr Med Res Opin 2022; 38:1167-1176. [PMID: 35357268 DOI: 10.1080/03007995.2022.2059977] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the design of the CLARION post-approval safety study (EU PAS Register number, EUPAS24484) and provide a status update, including characteristics of patients included up to 1 May 2021. METHODS CLARION aims to further evaluate adverse events of special interest in patients who are newly initiating treatment with cladribine tablets for relapsing multiple sclerosis (MS). The study population consists of two cohorts: patients newly initiating cladribine tablets (cladribine cohort) and patients newly initiating oral fingolimod tablets (comparator fingolimod cohort), with an aim to include 8000 patients (4000 patients per cohort). The study relies on secondary use of data from pre-existing MS registries/data sources (except in Germany, where primary data collection is performed). The study is projected to last 15 years, with an anticipated 5-year inclusion period. Study outcomes are: malignancies; severe infections; tuberculosis; progressive multifocal leukoencephalopathy; other opportunistic infections; herpes zoster; severe lymphopenia (Grade ≥ 3); and treatment discontinuation. RESULTS As of 1 May 2021, 2393 patients were included in CLARION from seven participating MS registries/data sources (cladribine cohort, n = 1266; fingolimod cohort, n = 1127). The majority of patients are female (cladribine cohort, 72.5%; fingolimod cohort, 68.0%), with mean age at onset of MS of 31.5 years for the cladribine cohort and 30.9 years for the fingolimod cohort. The majority of patients in both cohorts had relapsing MS (cladribine cohort, 92.1%; fingolimod cohort, 93.5%). CONCLUSION By providing further information on adverse events of special interest during long-term follow-up, CLARION will assist neurologists and patients regarding treatment decision-making for management of relapsing MS.
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Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
| | - Nicholas Moore
- Bordeaux PharmacoEpi (BPE), Université de Bordeaux, Bordeaux, France
| | - Aida Aydemir
- Global Biostatistics, EMD Serono Research & Development Institute, Inc, Billerica, MA, USA (an affiliate of Merck KGaA)
| | | | - Irene Bezemer
- Global Epidemiology and Outcomes Research, IQVIA, Amsterdam, The Netherlands
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Ezabadi SG, Sahraian MA, Maroufi H, Shahrbaf MA, Eskandarieh S. Global assessment of characteristics of multiple sclerosis registries; A systematic review. Mult Scler Relat Disord 2022; 63:103928. [DOI: 10.1016/j.msard.2022.103928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/14/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
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Osier N, Lim S, Gill E, Becker H, Stuifbergen A. Development and testing of a biobanking acceptability scale: A multistage effort to add a biobank to an existing longitudinal study. Appl Nurs Res 2022; 63:151520. [PMID: 35034698 DOI: 10.1016/j.apnr.2021.151520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND More biobanks linked to demographic, phenotypic, and clinical data are needed to advance multiple sclerosis (MS) research; however, little is known about biobanking attitudes among persons with MS, broadly, as well as willingness of participants in an existing longitudinal study to donate biospecimens, specifically. METHODS To assess biobanking attitudes in a cohort of MS patients in an ongoing longitudinal study, a new Biobanking Acceptability Scale (BAS) was developed, its reliability and predictive validity tested, and factors that influenced biobanking intent as well as behavior were explored. Analysis included descriptive statistics, factor analysis, Cronbach's α, and Pearson's bivariate correlation coefficients. RESULTS In 2018, 227 participants completed the 10-item BAS. Biobanking attitudes were generally positive (BAS total score, M = 38.8 out of 50; SD = 6.7), and most participants expressed willingness to donate hair (87%), saliva (85%), and/or blood (72%). In 2019, 143 participants consented to biobanking and were mailed supplies; 110 individuals provided at least one biospecimen, resulting in 110 saliva samples and 89 hair samples. The 10-item BAS displayed good internal consistency (α = 0.81). Demographic and clinical variables were not significantly associated with BAS score nor actual donation. Total BAS score was related to consent (r = 0.36, p < .001) and to actual donation of hair or saliva samples (r = 0.24, p < .01). CONCLUSION Overall, the participants had positive attitudes toward biobanking; the scale should be assessed in more diverse samples. The BAS predicted biobanking consent, and thus may be a useful measure to identify individuals most likely to donate biospecimens and/or identify potential barriers to biobanking that can be addressed through study design.
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Affiliation(s)
- Nico Osier
- University of Texas at Austin School of Nursing, Austin, TX, United States of America; Dell Medical School, Department of Neurology, Austin, TX, United States of America
| | - Sungju Lim
- University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Eliana Gill
- University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Heather Becker
- University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Alexa Stuifbergen
- University of Texas at Austin School of Nursing, Austin, TX, United States of America.
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Westergaard K, Skovgaard L, Magyari M, Kristiansen M. Patient perspectives on patient-reported outcomes in multiple sclerosis treatment trajectories: A qualitative study of why, what, and how? Mult Scler Relat Disord 2021; 58:103475. [PMID: 34995975 DOI: 10.1016/j.msard.2021.103475] [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: 02/25/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interest in patient-reported outcomes has been growing in multiple sclerosis research and clinical care in recent years. This situation reflects the need for developing, testing, and integrating measures that adequately capture patients' perspectives on symptoms, functional capacity, health status, and health-related quality of life. However, the patient perspective on the relevance, content, and use of patient-reported outcomes is yet to be investigated. Hence, this study aims to investigate the perspectives of people with multiple sclerosis on the value of patient-reported outcomes in clinical encounters, the most important aspects of living with multiple sclerosis that should be reflected in these reports, and possible opportunities and barriers for integrating this data into clinical care. METHODS A qualitative study was conducted to capture patient perspectives in a Danish population of people with multiple sclerosis. Initially, two focus group interviews were conducted with a total of 11 participants to explore their perspectives on patient-reported outcomes and related prospects and barriers. Subsequently, nine individual interviews were conducted to further investigate the identified aspects, opportunities, and barriers to use patient-reported outcomes in clinical care and treatment. RESULTS In general, the informants were motivated to report patient-reported outcomes, and they believed these reports to be relevant in clinical encounters as well as to have potential to promote patient involvement by focusing on current challenges for others with this disease. However, differences in the perceived need for reporting patient-reported outcomes were detected regarding the stage in the multiple sclerosis care trajectory and in relation to the disease phenotypes. In terms of domains to be incorporated into patient-reported outcomes, a total of 28 were identified by the informants, including neurological symptoms, cognitive impairments, mental health and well-being, self-care activities, and social challenges. Several factors for integrating patient-reported outcomes into clinical care emerged as important, in particular related to timing and frequency of reporting patient reported outcomes, considerations of cognitive impairments, the need for individualized approaches to patient-reported outcomes, and the need for active use of these reports for adjustment of treatment approaches in clinical encounters. CONCLUSION From the perspective of people with multiple sclerosis, patient-reported outcomes hold important potential for enhanced patient involvement leading to a more multifaceted agenda in clinical consultations. However, patient-reported outcomes need to be comprehensive and encompass a broad range of measures regarding neurological symptoms, cognitive impairments, mental health and well-being, self-care activities, and social challenges to adequately capture and support the needs of people with multiple sclerosis in clinical encounters. It is important to address barriers for integration of patient-reported outcomes into clinical care, with the aim of preventing misuse. Future studies should focus on the synergy between perspectives from both patients and clinicians to understand how integration of patient-reported outcomes in clinical care can succeed.
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Affiliation(s)
- Katrine Westergaard
- The Danish Multiple Sclerosis Society, Valby, Denmark; The Danish Multiple Sclerosis Registry, Copenhagen University Hospital Rigshospitalet, Denmark.
| | | | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Denmark; The Danish Multiple Sclerosis Registry, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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11
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Azimzadeh M, Möhn N, Ghane Ezabadi S, Moghimi Esfandabadi Z, Soleimani A, Ranjbar E, Jahromi M, Seyedebrahimi R, Skripuletz T, Moharrami Kasmaie F. The Immunological Therapeutic Strategies for Controlling Multiple Sclerosis: Considerations during the COVID-19 Pandemic. Biomolecules 2021; 11:1372. [PMID: 34572585 PMCID: PMC8470206 DOI: 10.3390/biom11091372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
A growing body of evidence initially suggested that patients with multiple sclerosis (MS) might be more susceptible to coronavirus disease 2019 (COVID-19). Moreover, it was speculated that patients with MS treated with immunosuppressive drugs might be at risk to develop a severe diseases course after infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2). However, the recently published data have shown that MS patients do not have a higher risk for severe COVID-19. Although there is no indication that patients with MS and immunomodulatory/immunosuppressive therapy are generally at a higher risk of severe COVID-19, it is currently being emphasized that the hazards of poorly treated MS may outweigh the putative COVID-19 dangers. In this review, we discuss the challenges and considerations for MS patients in the COVID-19 pandemic.
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Affiliation(s)
- Maryam Azimzadeh
- Department of Medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran;
| | - Nora Möhn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Sajjad Ghane Ezabadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran;
| | | | - Alireza Soleimani
- Department of Medical Laboratory Sciences, Faculty of Paramedicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
| | - Elaheh Ranjbar
- Department of Paramedical Sciences, Gonabad University of Medical Sciences, Gonabad, Iran;
| | - Maliheh Jahromi
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran;
| | - Reihaneh Seyedebrahimi
- Department of Anatomical Sciences, School of Medicine, Qom University of Medical Sciences, Qom, Iran;
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Farshad Moharrami Kasmaie
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
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Eid K, Torkildsen ØF, Aarseth J, Flemmen HØ, Holmøy T, Lorentzen ÅR, Myhr KM, Riise T, Simonsen C, Torkildsen CF, Wergeland S, Willumsen JS, Øksendal N, Gilhus NE, Bjørk MH. Perinatal Depression and Anxiety in Women With Multiple Sclerosis: A Population-Based Cohort Study. Neurology 2021; 96:e2789-e2800. [PMID: 33883236 PMCID: PMC8205461 DOI: 10.1212/wnl.0000000000012062] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To assess the occurrence of perinatal depression and anxiety in women before and after diagnosis of multiple sclerosis (MS). Methods A total of 114,629 pregnant women were included in the Norwegian Mother, Father and Child Cohort study (1999–2008). We assessed depression and anxiety by questionnaires during and after pregnancy. Women with MS were identified from national health registries and hospital records and grouped into (1) MS diagnosed before pregnancy (n = 140) or MS diagnosed after pregnancy with (2) symptom onset before pregnancy (n = 98) or (3) symptom onset after pregnancy (n = 308). Thirty-five women were diagnosed with MS in the postpartum period. The reference group (n = 111,627) consisted of women without MS. Results Women with MS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% confidence interval, 1.2–3.1) for depression in the third trimester. Risk factors were adverse socioeconomic factors and history of psychiatric disease and physical/sexual abuse. The risk of anxiety was not increased. Women diagnosed with MS in the postpartum period had especially high risk of postpartum depression. Women with MS symptom onset within 5 years after pregnancy had increased risk of both depression and anxiety during pregnancy, whereas women with more than 5 years until symptom onset did not. Conclusion Women diagnosed with MS have increased risk of perinatal depression. Women with MS symptom onset within 5 years after pregnancy have increased risk of both depression and anxiety during pregnancy.
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Affiliation(s)
- Karine Eid
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway.
| | - Øivind Fredvik Torkildsen
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Aarseth
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Øyen Flemmen
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Trygve Holmøy
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Åslaug Rudjord Lorentzen
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell-Morten Myhr
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Riise
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Cecilia Simonsen
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Cecilie Fredvik Torkildsen
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Stig Wergeland
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Johannes Sverre Willumsen
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Øksendal
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Nils Erik Gilhus
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte-Helene Bjørk
- From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway
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Dietzel N, Kürten L, Karrer L, Reichold M, Köhler L, Nagel A, Chmelirsch C, Seebahn K, Hladik M, Meuer S, Kirchner A, Holm K, Selau M, Wendel M, Trinkwalter J, Prokosch HU, Graessel E, Kolominsky-Rabas PL. Digital Dementia Registry Bavaria-digiDEM Bayern: study protocol for a multicentre, prospective, longitudinal register study. BMJ Open 2021; 11:e043473. [PMID: 33558357 PMCID: PMC7871684 DOI: 10.1136/bmjopen-2020-043473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Dementia is one of the most relevant widespread diseases, with a prevalence of currently 50 million people with dementia worldwide. The care of people with dementia will be one of the major challenges for healthcare systems worldwide. Digitalisation offers new possibilities to improve both dementia healthcare and health outcomes research as a fundament for national healthcare planning. The 'Digital Dementia Registry Bavaria-digiDEM Bayern' aims to improve the understanding of the complexity and long-term progression of dementia and the current care situation in Bavaria. Moreover, by offering digital services, digiDEM will actively contribute to improving the care situation in Bavaria. METHODS AND ANALYSIS: digiDEM will recruit people with dementia and their family caregivers in all administrative regions of Bavaria. All participants will undergo dementia screening prior to study inclusion in order to identify people with mild cognitive impairment and mild-to-moderate dementia. Participants will be followed up over a period of three years. Sociodemographic data, type of dementia, symptoms, diagnosis, cognitive trajectories, activities of daily living, behavioural and psychological symptoms, falls, resource utilisation, caregiver burden, quality of life, needs of people with dementia and their caregivers, mobility, use of media and sources of information will be assessed. The project will implement a digital web-based platform for data collection. Data will be collected by means of standardised online or face-to-face interviews. ETHICS AND DISSEMINATION The study obtained ethical approval from the Ethics Committee of the Medical Faculty of Friedrich-Alexander-University Erlangen-Nürnberg (FAU) (application number: 253_20 B). Findings will be used for evidence-based decision-making for health decision-makers in order to optimise dementia healthcare in the state of Bavaria. Specific analyses will be conducted for the participating research partners. Results of the study will be published in peer-reviewed journals.
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Affiliation(s)
- Nikolas Dietzel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lara Kürten
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Linda Karrer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Reichold
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Laura Köhler
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Andreas Nagel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christina Chmelirsch
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kathrin Seebahn
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Markus Hladik
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Meuer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna Kirchner
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kristina Holm
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marina Selau
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marco Wendel
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Jörg Trinkwalter
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Banaye Yazdipour A, Sarbaz M, Dadpour B, Moshiri M, Kimiafar K. Development a national minimum data set for poisoning registry in Iran. Int J Health Plann Manage 2020; 35:1453-1467. [PMID: 32881066 DOI: 10.1002/hpm.3045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES In the developing countries with high mortality rates, poisoning is considered to be one of the most common causes of admission to emergency wards. Given the importance of registering data on poisoned patients, it is very important to have a complete poisoning Minimum Data Set (MDS). Therefore, the purpose of this study was to determine an MDS for poisoning registry in Iran. METHODS This applied and cross-sectional study was conducted through of Delphi technique in the poisoning ward of Imam Reza Hospital (northeastern Iran) in 2019. Literature reviews were initially carried out on such databases as PubMed, Web of Sciences, Scopus, and Embase. Then, Google search was done to retrieve poisoning forms and poisoning registry websites. Also, we considered International Classification of Diseases, 10th Revision coding guidelines of poisoning. Then, a questionnaire containing data elements of poisoning was developed. RESULTS In total, 558 data elements were developed during two rounds of Delphi technique. The MDS was divided into 10 categories including patient and communication data, encounter data, diagnostic data and medical history, exposure data, clinical data, treatment data, complications, paraclinical tests, biobank, and discharge data. CONCLUSIONS Establishing an MDS as the first and most important step towards implementing poisoning registry can be the standard basis for collecting poisoned patient data. The data registered in the poisoning registry can be used for planning, policy-making, prevention, and control purposes.
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Affiliation(s)
- Alireza Banaye Yazdipour
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sarbaz
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalil Kimiafar
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Willumsen JS, Aarseth JH, Myhr KM, Midgard R. High incidence and prevalence of MS in Møre and Romsdal County, Norway, 1950-2018. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e713. [PMID: 32217642 PMCID: PMC7136041 DOI: 10.1212/nxi.0000000000000713] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/17/2020] [Indexed: 12/24/2022]
Abstract
Objective To determine prevalence and longitudinal trends in incidence of MS in Møre and Romsdal County, Western Norway, from 1950 to 2018. Methods Retrospective longitudinal population-based observational study. All patients diagnosed, or living, with MS in Møre and Romsdal were identified as incident or prevalent cases from local, regional, and national sources. We compiled the data in the Norwegian Multiple Sclerosis Registry and Biobank and used the aggregated data set to calculate incidence and prevalence rates using population measures obtained from Statistics Norway. Results On January 1, 2018, the estimated prevalence was 335.8 (95% CI, 314.1–358.5) per 100,000 inhabitants, with a female:male ratio of 2.3. From 1950 through 2017, we observed a considerable (p < 0.001) increase in average annual incidence rates from 2.1 (95% CI, 1.3–3.3) to 14.4 (95% CI, 11.9–17.3) per 100,000. From 2005 through 2017, the incidence among women increased from 17.1 (95% CI, 14.0–20.7) to 23.2 (95% CI, 18.7–28.5) per 100,000, whereas the incidence among men declined from 10.3 (95% CI, 7.9–13.2) to 5.9 (95% CI, 3.4–8.8) per 100,000. Conclusion Møre and Romsdal County in Western Norway has the highest prevalence of MS reported in Norway. The incidence has steadily increased since 1950, and during the latest 15 years, we observed opposing trends in sex-specific incidence rates.
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Affiliation(s)
- Johannes Sverre Willumsen
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim.
| | - Jan Harald Aarseth
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim
| | - Kjell-Morten Myhr
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim
| | - Rune Midgard
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim
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16
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Laakso SM, Viitala M, Kuusisto H, Sarasoja T, Hartikainen P, Atula S, Tienari PJ, Soilu‐Hänninen M. Multiple sclerosis in Finland 2018-Data from the national register. Acta Neurol Scand 2019; 140:303-311. [PMID: 31271648 DOI: 10.1111/ane.13145] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/20/2019] [Accepted: 06/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Finland is a high-risk multiple sclerosis (MS) region, but a national MS register has not existed until 2014. In this paper, we present the Finnish MS register variables and data collected by 31 December 2018. MATERIALS AND METHODS Numbers and data counts of MS patients in the register (ICD-10 code G35) are presented. The disease types and proportion of patients receiving disease-modifying treatments (DMTs) were analysed in five hospital districts with most complete data sets. MS prevalence in Finland was estimated using administrative hospital discharge data as an additional resource. RESULTS There were a total of 8722 MS patients in the Finnish MS register by 31 December 2018 (71.5% females). Mean age at MS diagnosis was 38.7 years and peak prevalence was at age 50-54 years. Disease course was relapsing remitting (RRMS) in 66.7%, secondary progressive (SPMS) in 13.5%, and primary progressive (PPMS) in 7.9% of the 5365 MS patients in the selected districts with most complete data. A total of 66.0% of RRMS patients, 19.6% of SPMS patients and 9.9% of PPMS patients were receiving DMTs. By combining MS register data with databases of those hospitals that had not joined the register, the nationwide prevalence estimate was between 10 and 11 thousand patients (corresponding to crude prevalence 180-200/100 000). CONCLUSIONS The Finnish MS register is currently used in 15/21 Finnish hospital districts. By register integration into the electronic patient files, the coverage of the register has increased to approximately 80% of the estimated Finnish MS population.
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Affiliation(s)
- Sini M. Laakso
- Neurocenter Helsinki University Hospital Helsinki Finland
- Department of Neurosciences University of Helsinki Helsinki Finland
| | - Matias Viitala
- Department of Mathematics and Statistics University of Turku Turku Finland
- StellarQ Ltd Turku Finland
| | - Hanna Kuusisto
- Department of Neurology Tampere University Hospital Tampere Finland
- Department of Health and Social management University of Eastern Finland Kuopio Finland
| | - Taneli Sarasoja
- Department of Neurology Central Hospital of Central Finland Jyväskylä Finland
| | - Päivi Hartikainen
- Department of Neurology Kuopio University Hospital Kuopio Finland
- Department of Neurology University of Eastern Finland Kuopio Finland
| | - Sari Atula
- Neurocenter Helsinki University Hospital Helsinki Finland
- Department of Neurosciences University of Helsinki Helsinki Finland
| | - Pentti J. Tienari
- Neurocenter Helsinki University Hospital Helsinki Finland
- Department of Neurosciences University of Helsinki Helsinki Finland
| | - Merja Soilu‐Hänninen
- Division of Clinical Neurosciences Turku University Hospital Turku Finland
- Department of Neurology University of Turku Turku Finland
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17
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Grytten N, Myhr KM, Celius EG, Benjaminsen E, Kampman M, Midgard R, Vatne A, Aarseth JH, Riise T, Torkildsen Ø. Risk of cancer among multiple sclerosis patients, siblings, and population controls: A prospective cohort study. Mult Scler 2019; 26:1569-1580. [DOI: 10.1177/1352458519877244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Risk of cancer in multiple sclerosis (MS) patients compared to their siblings is unknown. Objective: The objective was to prospectively investigate the risk of cancer among MS patients compared to siblings without MS and to population controls. Methods: We retrieved data on MS patients born between 1930 and 1979 from the Norwegian Multiple Sclerosis Registry and population studies and on cancer diagnosis from the Cancer Registry of Norway. We used adjusted Cox proportional hazard regression to estimate cancer risk among 6883 MS patients, 8918 siblings without MS, and 37,919 population controls. Results: During 65 years of follow-up, cancer risk among MS patients was higher than that among population controls (hazard ratio (HR) = 1.14, 95% confidence interval (CI): 1.05–1.23) in respiratory organs (HR = 1.66, 95% CI: 1.26–2.19), urinary organs (HR = 1.51, 95% CI: 1.12–2.04), and the central nervous system (HR = 1.52, 95% CI: 1.11–2. 09). Siblings had higher risk of hematological cancers compared with MS patients (HR = 1.82, 95% CI: 1.21–2.73) and population controls (HR = 1.72, 95% CI: 1.36–2.18). Conclusion: MS patients were associated with increased risk of cancer compared to population controls. Siblings had increased risk of hematological cancer. This indicates that MS and hematological cancer could share a common etiology.
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Affiliation(s)
- Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway/Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway/Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Margitta Kampman
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Rune Midgard
- Department of Neurology, Molde Hospital, Molde, Norway/Norwegian University of Science and Technology, Trondheim, Norway
| | - Anita Vatne
- Department of Rehabilitation, Hospital of Southern Norway, Kristiansand, Norway
| | - Jan H Aarseth
- Norwegian MS Registry and Biobank, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway/Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øivind Torkildsen
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway/Department of Clinical Medicine, University of Bergen, Bergen, Norway/Department of Neurology, Haukeland University Hospital, Bergen, Norway
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18
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Shahin S, Eskandarieh S, Moghadasi AN, Razazian N, Baghbanian SM, Ashtari F, bayati A, Manouchehrinia A, Beiki O, Mohebi F, Dezfuli MM, Sahraian MA. Multiple sclerosis national registry system in Iran: Validity and reliability of a minimum data set. Mult Scler Relat Disord 2019; 33:158-161. [DOI: 10.1016/j.msard.2019.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 11/25/2022]
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19
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Trojano M, Bergamaschi R, Amato MP, Comi G, Ghezzi A, Lepore V, Marrosu MG, Mosconi P, Patti F, Ponzio M, Zaratin P, Battaglia MA. The Italian multiple sclerosis register. Neurol Sci 2019; 40:155-165. [PMID: 30426289 PMCID: PMC6329744 DOI: 10.1007/s10072-018-3610-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
Abstract
The past decade has seen extraordinary increase in worldwide availability of and access to several large multiple sclerosis (MS) databases and registries. MS registries represent powerful tools to provide meaningful information on the burden, natural history, and long-term safety and effectiveness of treatments. Moreover, patients, physicians, industry, and policy makers have an active interest in real-world observational studies based on register data, as they have the potential to answer the questions that are most relevant to daily treatment decision-making. In 2014, the Italian MS Foundation, in collaboration with the Italian MS clinical centers, promoted and funded the creation of the Italian MS Register, a project in continuity with the existing Italian MS Database Network set up from 2001. Main objective of the Italian MS Register is to create an organized multicenter structure to collect data of all MS patients for better defining the disease epidemiology, improving quality of care, and promoting research projects in high-priority areas. The aim of this article is to present the current framework and network of the Italian MS register, including the methodology used to improve the quality of data collection and to facilitate the exchange of data and the collaboration among national and international groups.
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Affiliation(s)
- Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro" Policlinico, Italy Piazza Umberto I, Bari, Bari, Italy.
| | | | - Maria Pia Amato
- Department NEUROFARBA, MS Center AOU Careggi, University of Florence, Florence, Italy
| | - Giancarlo Comi
- Neurology Department and INSPE-Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy
| | - Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Va, Italy
| | - Vito Lepore
- Coreserach Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Paola Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Patti
- Department of Neurosciences G.F. Ingrassia, University of Catania, Catania, Italy
| | - Michela Ponzio
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy
| | - Paola Zaratin
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy
| | - Mario Alberto Battaglia
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy.
- Department of Life Sciences, University of Siena, Siena, Italy.
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20
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Derakhshani N, Azami-Aghdash S, Ghojazadeh M, Naghavi-Behzad M, Asl V, Samei B. A pilot study of fear of disease consequences and its relationship with quality of life, depression and anxiety in patients with multiple sclerosis. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2019. [DOI: 10.4103/iahs.iahs_9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Cortese M, Riise T, Bjørnevik K, Bhan A, Farbu E, Grytten N, Hogenesch I, Midgard R, Smith Simonsen C, Telstad W, Ascherio A, Myhr KM. Preclinical disease activity in multiple sclerosis: A prospective study of cognitive performance prior to first symptom. Ann Neurol 2017; 80:616-24. [PMID: 27554176 DOI: 10.1002/ana.24769] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To prospectively investigate potential signs of preclinical multiple sclerosis (MS) activity and when they are present prior to first symptom using data from a historical cohort. METHODS We linked the cognitive performance of all Norwegian men born 1950-1995 who underwent conscription examination at age 18 to 19 years to the Norwegian MS registry to identify those later developing MS, and randomly selected controls frequency-matched on year of birth from the Norwegian Conscript Service database. In this nested case-control study, cognitive test scores were available for 924 male cases and 19,530 male controls. We estimated mean score differences among cases and controls (Student t test) and the risk of developing MS comparing lower to higher scores (Cox regression) in strata of years to clinical onset. RESULTS Men developing first clinical MS symptoms up to 2 years after the examination scored significantly lower than controls (Δ = 0.80, p = 0.0095), corresponding to a 6 intelligence quotient (IQ)-point difference. Those scoring lowest, that is, >1 standard deviation below the controls' mean, had an increased MS risk during the 2 following years (relative risk = 2.81, 95% confidence interval = 1.52-5.20). Whereas results were similar for relapsing-remitting MS cases (RRMS), those developing primary-progressive MS (PPMS) scored a significant 4.6 to 6.9 IQ points lower than controls up to 20 years prior to first progressive symptoms. INTERPRETATION RRMS may start years prior to clinical presentation, and disease processes in PPMS could start decades prior to first apparent progressive symptoms. Cognitive problems could be present in both MS forms before apparent symptoms. Apart from potential implications for clinical practice and research, these findings challenge our thinking about the disease. Ann Neurol 2016;80:616-624.
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Affiliation(s)
- Marianna Cortese
- Department of Clinical Medicine, University of Bergen, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway.
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway
| | - Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway
| | - Alok Bhan
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Elisabeth Farbu
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Nina Grytten
- Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway.,Kristian Gerhard Jebsen Center for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ineke Hogenesch
- Department of Neurology, Haugesund Hospital, Haugesund, Norway
| | - Rune Midgard
- Department of Neurology, Molde Hospital, Molde, Norway.,Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Alberto Ascherio
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine of the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kjell-Morten Myhr
- Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway.,Kristian Gerhard Jebsen Center for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian MS Registry and Biobank, Haukeland University Hospital, Bergen, Norway
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22
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Rønning OM, Tornes KD. Need for symptomatic management in advanced multiple sclerosis. Acta Neurol Scand 2017; 135:529-532. [PMID: 27357364 DOI: 10.1111/ane.12631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE A majority of patients with advanced multiple sclerosis (MS) need symptomatic treatment. Many MS-related symptoms may not be recognized and thus are not treated. We conducted a study to estimate the prevalence of inadequate symptomatic treatment of patients with advanced MS. METHODS Patients with advanced MS admitted to a specialist MS rehabilitation clinic were included in this study. Severity was assessed using the Expanded Disability Status Scale (EDSS). The information we collected included age of onset, initial course, time to sustained disability, pharmacological treatment, degree of spasticity, pain and bladder dysfunction, and unmet needs of symptomatic treatment. RESULTS In total, we assessed demographic and clinical characteristics in 129 patients with a mean age of 56 years and a median EDSS of 7.5. The proportion with inadequate symptom treatment was regarding spasticity 46%, pain 28%, and bladder dysfunction 23%. DISCUSSION This study showed that a large proportion of patients with advanced MS had lack of symptomatic treatment. These patients probably underuse neurological specialist services. Better symptomatic treatment could contribute to improving quality of life of people with MS.
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Affiliation(s)
- O. M. Rønning
- Department of Neurology; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - K. D. Tornes
- Eiksåsen Multiple Sclerosis Rehabilitation Centre; Baerum Norway
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23
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Cortese M, Riise T, Bjørnevik K, Myhr KM. Body size and physical exercise, and the risk of multiple sclerosis. Mult Scler 2017; 24:270-278. [PMID: 28287051 DOI: 10.1177/1352458517699289] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whether large body size increases multiple sclerosis (MS) risk in men is not well understood. Concurrently, physical exercise could be an independent protective factor. OBJECTIVE To prospectively investigate the association between body mass index (BMI) and aerobic fitness, indicators of body size and exercise, and MS risk in men. METHODS We performed a population-based nested case-control study within the historical cohort of all Norwegian men, born in 1950-1975, undergoing mandatory conscription at the age of 19 years. 1016 cases were identified through linkage to the Norwegian MS registry, while 19,230 controls were randomly selected from the cohort. We estimated the effect of BMI and fitness at conscription on MS risk using Cox regression. RESULTS Higher BMI (≥25 vs 18.5-<25 kg/m2) was significantly associated with increased MS risk (adjusted relative risk (RRadj) = 1.36, 95% confidence interval (CI): 1.05-1.76). We also found a significant inverse association between aerobic fitness (high vs low) and MS risk independent of BMI (RRadj = 0.69, 95% CI: 0.55-0.88, p-trend = 0.003), remaining similar when men with MS onset within 10 years from conscription were excluded ( p-trend = 0.03). CONCLUSION These findings add weight to evidence linking being overweight to an increased MS risk in men. Furthermore, they suggest that exercise may be an additional modifiable protective factor for MS.
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Affiliation(s)
- Marianna Cortese
- Department of Clinical Medicine and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kjell-Morten Myhr
- The Norwegian MS Registry and Biobank and The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway/The KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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24
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Bjørnevik K, Riise T, Benjaminsen E, Celius EG, Dahl OP, Kampman MT, Løken-Amsrud KI, Midgard R, Myhr KM, Torkildsen Ø, Vatne A, Grytten N. Level of education and multiple sclerosis risk over a 50-year period: Registry-based sibling study. Mult Scler 2017; 23:213-219. [PMID: 27207453 PMCID: PMC5302076 DOI: 10.1177/1352458516646863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The conflicting results from studies on socioeconomic status (SES) and multiple sclerosis (MS) risk might be due to a change in the distribution of environmental exposures over time or to methodological limitations in previous research. OBJECTIVE To examine the association between SES and MS risk during 50 years. METHODS We included patients registered in Norwegian MS registries and prevalence studies born between 1930 and 1979, and identified their siblings and parents using the Norwegian Population Registry. Information on education was retrieved from the National Education Registry, categorized into four levels (primary, secondary, undergraduate and graduate) and compared in patients and siblings using conditional logistic regression. RESULTS A total of 4494 MS patients and 9193 of their siblings were included in the analyses. Level of education was inversely associated with MS risk ( p trend < 0.001) with an odds ratio (OR) of 0.73 (95% confidence interval (CI): 0.59-0.90) when comparing the highest and lowest levels. The effect estimates did not vary markedly between participants born before or after the median year of birth (1958), but we observed a significant effect modification by parental education ( p = 0.047). CONCLUSION Level of education was inversely associated with MS risk, and the estimates were similar in the earliest and latest birth cohorts.
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Affiliation(s)
- Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway/Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ole P Dahl
- Department of Neurology, Namsos Hospital, Namsos, Norway
| | - Margitta T Kampman
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | | | - Rune Midgard
- Molde Hospital, Molde, Norway/Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell-Morten Myhr
- The Kristian Gerhard Jebsen Centre for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway/The Kristian Gerhard Jebsen Centre for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anita Vatne
- Department of Neurology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Nina Grytten
- The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway/The Kristian Gerhard Jebsen Centre for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Increased levels of cell-free mitochondrial DNA in the cerebrospinal fluid of patients with multiple sclerosis. Mitochondrion 2016; 34:32-35. [PMID: 28017684 DOI: 10.1016/j.mito.2016.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/05/2016] [Accepted: 12/20/2016] [Indexed: 01/21/2023]
Abstract
Mitochondrial DNA (mtDNA) can act as damage-associated molecular pattern molecule (DAMP) and initiate an inflammatory response. We hypothesized that the concentration of mtDNA might reflect inflammatory activity in multiple sclerosis and investigated therefore levels of cell-free mitochondrial DNA in cerebrospinal fluid of patients with relapsing-remitting multiple sclerosis. Significantly higher levels of mtDNA were found in patients compared to controls and there was an inverse correlation between disease duration and mtDNA concentration. Our study suggests that mitochondria can be involved early in multiple sclerosis, but whether this is as an initiator of the inflammatory response or part of its maintenance is unclear. Further, our study suggests that changes in mtDNA may provide a novel marker for early disease activity.
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Ziemssen T, Kern R, Thomas K. Multiple sclerosis: clinical profiling and data collection as prerequisite for personalized medicine approach. BMC Neurol 2016; 16:124. [PMID: 27484848 PMCID: PMC4971685 DOI: 10.1186/s12883-016-0639-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a highly heterogeneous disease as it can present inter-individually as well as intra-individually, with different disease phenotypes emerging during different stages in the long-term disease course. In addition to advanced immunological, genetic and magnetic resonance imaging (MRI) profiling of the patient, the clinical profiling of MS patients needs to be widely implemented in clinical practice and improved by including a greater range of relevant parameters as patient-reported outcomes. It is crucial to implement a high standard of clinical characterization of individual patients as this is key to effective long-term observation and evaluation. To generate reliable real-world data, individual clinical data should be collected in specific MS registries and/or using intelligent software instruments as the Multiple Sclerosis Documentation System 3D. Computational analysis of biological processes will play a key role in the transition to personalized MS treatment. Major breakthroughs in the areas of bioinformatics and computational systems biology will be required to process this complex information to enable improved personalization of treatment for MS patients.
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Affiliation(s)
- Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany.
| | - Raimar Kern
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany
| | - Katja Thomas
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany
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Grytten N, Torkildsen Ø, Myhr KM. Reply to comments on the review article 'Time trends in the incidence and prevalence of multiple sclerosis in Norway during eight decades'. Acta Neurol Scand 2015; 132:368-9. [PMID: 26369381 DOI: 10.1111/ane.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Grytten
- KG Jebsen MS Research Centre; Department of Clinical Medicine; University of Bergen; Bergen Norway
- Norwegian Multiple Sclerosis Competence Centre; Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - Ø. Torkildsen
- KG Jebsen MS Research Centre; Department of Clinical Medicine; University of Bergen; Bergen Norway
- Norwegian Multiple Sclerosis Competence Centre; Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - KM. Myhr
- KG Jebsen MS Research Centre; Department of Clinical Medicine; University of Bergen; Bergen Norway
- Norwegian Multiple Sclerosis Registry and Biobank; Department of Neurology; Haukeland University Hospital; Bergen Norway
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28
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Andersen O. Conclusion: National incidence and risk factor assessments may become a basis for the evaluation of prevention trials – prospects from the Third Nordic MS Symposium. Acta Neurol Scand 2015; 132:71-5. [PMID: 26046562 DOI: 10.1111/ane.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
This symposium started with an overview of recent incidence and prevalence data from the Scandinavian national registers and continued with a critical analysis of several alleged risk factors for MS. These risk factors are constantly changing and therefore might explain current incidence changes. In addition, they may be the subject of preventive measures.
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Affiliation(s)
- O. Andersen
- Section of Clinical Neuroscience and Rehabilitation; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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