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Bianchi A, Matranga D, Patti F, Maniscalco L, Pilotto S, Di Filippo M, Zaffaroni M, Annovazzi P, Bertolotto A, Gasperini C, Quartuccio E, Centonze D, Fantozzi R, Gajofatto A, Gobbin F, Landi D, Granella F, Buccafusca M, Marfia GA, Chisari C, Naldi P, Bergamaschi R, Greco G, Zarbo IR, Rizzo V, Ulivelli M, Bezzini D, Florio L, Turazzini M, Di Gregorio M, Pugliatti M, Salemi G, Ragonese P. The role of ethnicity and native-country income in multiple sclerosis: the Italian multicentre study (MS-MigIT). J Neurol 2024; 271:2182-2194. [PMID: 38366072 PMCID: PMC11055772 DOI: 10.1007/s00415-024-12214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a complex disorder in which environmental and genetic factors interact modifying disease risk and course. This multicentre, case-control study involving 18 Italian MS Centres investigated MS course by ethnicity and native-country economic status in foreign-born patients living in Italy. METHODS We identified 457 MS patients who migrated to Italy and 893 age- and sex-matched native-born Italian patients. In our population, 1225 (93.2%) subjects were White Europeans and White Northern Americans (WENA) and 89 (6.8%) patients were from other ethnical groups (OEG); 1109 (82.1%) patients were born in a high-income (HI) Country and 241 (17.9%) in a low-middle-income (LMI) Country. Medical records and patients interviews were used to collect demographic and disease data. RESULTS We included 1350 individuals (973 women and 377 men); mean (SD) age was 45.0 (11.7) years. At onset, 25.45% OEG patients vs 12.47% WENA (p = 0.039) had > 3 STIR spine lesions. At recruitment, the same group featured mean (SD) EDSS score of 2.85 (2.23) vs 2.64 (2.28) (p = 0.044) reached in 8.9 (9.0) vs 12.0 (9.0) years (p = 0.018) and underwent 1.10 (4.44) vs. 0.99 (0.40) annual MRI examinations (p = 0.035). At disease onset, patients from LMI countries had higher EDSS score than HI patients (2.40 (1.43) vs 1.99 (1.17); p = 0.032). DISCUSSION Our results suggested that both ethnicity and socio-economic status of native country shape MS presentation and course and should be considered for an appropriate management of patients. To the best of our knowledge, this is the first study reporting on the impact of ethnicity in MS at an individual level and beyond an ecological population-perspective.
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Affiliation(s)
- Alessia Bianchi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, University College London, London, UK
| | - Domenica Matranga
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Laura Maniscalco
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Silvy Pilotto
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Centre, Hospital of Gallarate, ASST Della Valle Olona, Gallarate, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Centre, Hospital of Gallarate, ASST Della Valle Olona, Gallarate, Italy
| | - Antonio Bertolotto
- Ospedale Koelliker, Turin and Neuroscience Institute Cavalieri Ottolenghi, Orbassano, Italy
| | - Claudio Gasperini
- Department of Neurology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Diego Centonze
- Unit of Neurology, Department of Neurorehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Roberta Fantozzi
- Unit of Neurology, Department of Neurorehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Doriana Landi
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Multiple Sclerosis Clinical and Research Unit, Tor Vergata University Hospital, Rome, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Buccafusca
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, Messina, Italy
| | - Girolama Alessandra Marfia
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Multiple Sclerosis Clinical and Research Unit, Tor Vergata University Hospital, Rome, Italy
| | - Clara Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Paola Naldi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | | | | | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, Messina, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daiana Bezzini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Lucia Florio
- IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Maria Di Gregorio
- Azienda Ospedaliera Universitaria OO.RR. S.Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.
- Interdepartmental Research Centre On Migration (CIR "Migrare"), University of Palermo, Palermo, Italy.
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Touil H, Mounts K, De Jager PL. Differential impact of environmental factors on systemic and localized autoimmunity. Front Immunol 2023; 14:1147447. [PMID: 37283765 PMCID: PMC10239830 DOI: 10.3389/fimmu.2023.1147447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
The influence of environmental factors on the development of autoimmune disease is being broadly investigated to better understand the multifactorial nature of autoimmune pathogenesis and to identify potential areas of intervention. Areas of particular interest include the influence of lifestyle, nutrition, and vitamin deficiencies on autoimmunity and chronic inflammation. In this review, we discuss how particular lifestyles and dietary patterns may contribute to or modulate autoimmunity. We explored this concept through a spectrum of several autoimmune diseases including Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE) and Alopecia Areata (AA) affecting the central nervous system, whole body, and the hair follicles, respectively. A clear commonality between the autoimmune conditions of interest here is low Vitamin D, a well-researched hormone in the context of autoimmunity with pleiotropic immunomodulatory and anti-inflammatory effects. While low levels are often correlated with disease activity and progression in MS and AA, the relationship is less clear in SLE. Despite strong associations with autoimmunity, we lack conclusive evidence which elucidates its role in contributing to pathogenesis or simply as a result of chronic inflammation. In a similar vein, other vitamins impacting the development and course of these diseases are explored in this review, and overall diet and lifestyle. Recent work exploring the effects of dietary interventions on MS showed that a balanced diet was linked to improvement in clinical parameters, comorbid conditions, and overall quality of life for patients. In patients with MS, SLE and AA, certain diets and supplements are linked to lower incidence and improved symptoms. Conversely, obesity during adolescence was linked with higher incidence of MS while in SLE it was associated with organ damage. Autoimmunity is thought to emerge from the complex interplay between environmental factors and genetic background. Although the scope of this review focuses on environmental factors, it is imperative to elaborate the interaction between genetic susceptibility and environment due to the multifactorial origin of these disease. Here, we offer a comprehensive review about the influence of recent environmental and lifestyle factors on these autoimmune diseases and potential translation into therapeutic interventions.
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Affiliation(s)
- Hanane Touil
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Kristin Mounts
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Philip Lawrence De Jager
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
- Columbia Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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3
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Hassani A, Khan G. What do animal models tell us about the role of EBV in the pathogenesis of multiple sclerosis? Front Immunol 2022; 13:1036155. [PMID: 36466898 PMCID: PMC9712437 DOI: 10.3389/fimmu.2022.1036155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/02/2022] [Indexed: 02/20/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS), marked primarily by demyelination, inflammation, and neurodegeneration. While the prevalence and incidence rates of MS are on the rise, the etiology of the disease remains enigmatic. Nevertheless, it is widely acknowledged that MS develops in persons who are both genetically predisposed and exposed to a certain set of environmental factors. One of the most plausible environmental culprits is Epstein-Barr virus (EBV), a common herpesvirus asymptomatically carried by more than 90% of the adult population. How EBV induces MS pathogenesis remains unknown. A comprehensive understanding of the biology of EBV infection and how it contributes to dysfunction of the immune system and CNS, requires an appreciation of the viral dynamics within the host. Here, we aim to outline the different animal models, including nonhuman primates (NHP), rodents, and rabbits, that have been used to elucidate the link between EBV and MS. This review particularly focuses on how the disruption in virus-immune interaction plays a role in viral pathogenesis and promotes neuroinflammation. We also summarize the effects of virus titers, age of animals, and route of inoculation on the neuroinvasiveness and neuropathogenic potential of the virus. Reviewing the rich data generated from these animal models could provide directions for future studies aimed to understand the mechanism(s) by which EBV induces MS pathology and insights for the development of prophylactic and therapeutic interventions that could ameliorate the disease.
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Affiliation(s)
- Asma Hassani
- Dept of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Boorgu DSSK, Venkatesh S, Lakhani CM, Walker E, Aguerre IM, Riley C, Patel CJ, De Jager PL, Xia Z. The impact of socioeconomic status on subsequent neurological outcomes in multiple sclerosis. Mult Scler Relat Disord 2022; 65:103994. [DOI: 10.1016/j.msard.2022.103994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
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Chopra S, Myers Z, Sekhon H, Dufour A. The Nerves to Conduct a Multiple Sclerosis Crime Investigation. Int J Mol Sci 2021; 22:2498. [PMID: 33801441 PMCID: PMC7958632 DOI: 10.3390/ijms22052498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative autoimmune disease characterized by the aberrant infiltration of immune cells into the central nervous system (CNS) and by the loss of myelin. Sclerotic lesions and various inhibitory factors hamper the remyelination processes within the CNS. MS patients typically experience gradual cognitive and physical disabilities as the disease progresses. The etiology of MS is still unclear and emerging evidence suggests that microbiome composition could play a much more significant role in disease pathogenesis than was initially thought. Initially believed to be isolated to the gut microenvironment, we now know that the microbiome plays a much broader role in various tissues and is essential in the development of the immune system. Here, we present some of the unexpected roles that the microbiome plays in MS and discuss approaches for the development of next-generation treatment strategies.
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Affiliation(s)
- Sameeksha Chopra
- McCaig Institute for Bone and Joint Health, Calgary, AB T2N 4N1, Canada; (S.C.); (Z.M.); (H.S.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Zoë Myers
- McCaig Institute for Bone and Joint Health, Calgary, AB T2N 4N1, Canada; (S.C.); (Z.M.); (H.S.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Henna Sekhon
- McCaig Institute for Bone and Joint Health, Calgary, AB T2N 4N1, Canada; (S.C.); (Z.M.); (H.S.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Antoine Dufour
- McCaig Institute for Bone and Joint Health, Calgary, AB T2N 4N1, Canada; (S.C.); (Z.M.); (H.S.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB T2N 4N1, Canada
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Moghaddam V, Tamaddon A, Nezhad M, Abbasi M, Seyedhasani S, Sarmadi M. Environmental factors: Possible reasons for higher incidence and prevalence of multiple sclerosis in high-income countries. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2021. [DOI: 10.4103/iahs.iahs_142_20] [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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7
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Oliveira M, Padrão A, Ramalho A, Lobo M, Teodoro AC, Gonçalves H, Freitas A. Geospatial Analysis of Environmental Atmospheric Risk Factors in Neurodegenerative Diseases: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228414. [PMID: 33202965 PMCID: PMC7697835 DOI: 10.3390/ijerph17228414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Despite the vast evidence on the environmental influence in neurodegenerative diseases, those considering a geospatial approach are scarce. We conducted a systematic review to identify studies concerning environmental atmospheric risk factors for neurodegenerative diseases that have used geospatial analysis/tools. PubMed, Web of Science, and Scopus were searched for all scientific studies that included a neurodegenerative disease, an environmental atmospheric factor, and a geographical analysis. Of the 34 included papers, approximately 60% were related to multiple sclerosis (MS), hence being the most studied neurodegenerative disease in the context of this study. Sun exposure (n = 13) followed by the most common exhaustion gases (n = 10 for nitrogen dioxide (NO2) and n = 5 for carbon monoxide (CO)) were the most studied atmospheric factors. Only one study used a geospatial interpolation model, although 13 studies used remote sensing data to compute atmospheric factors. In 20% of papers, we found an inverse correlation between sun exposure and multiple sclerosis. No consensus was reached in the analysis of nitrogen dioxide and Parkinson’s disease, but it was related to dementia and amyotrophic lateral sclerosis. This systematic review (number CRD42020196188 in PROSPERO’s database) provides an insight into the available evidence regarding the geospatial influence of environmental factors on neurodegenerative diseases.
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Affiliation(s)
- Mariana Oliveira
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
- Correspondence:
| | - André Padrão
- Faculty of Arts and Humanities, University of Porto, Via Panorâmica, s/n, 4150-564 Porto, Portugal;
| | - André Ramalho
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Mariana Lobo
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Ana Cláudia Teodoro
- Department of Geosciences, Environment and Land Planning, Faculty of Sciences, University of Porto, Rua do Campo Alegre 687, 4169-007 Porto, Portugal;
- Earth Sciences Institute (ICT), Pole of the FCUP, University of Porto, 4169-007 Porto, Portugal
| | - Hernâni Gonçalves
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Alberto Freitas
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
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Wändell P, Fredrikson S, Carlsson AC, Li X, Sundquist J, Sundquist K. Multiple sclerosis among first- and second-generation immigrant groups in Sweden. Acta Neurol Scand 2020; 142:339-349. [PMID: 32648932 DOI: 10.1111/ane.13314] [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: 12/09/2019] [Revised: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Risk of multiple sclerosis (MS) is low among first-generation immigrants in Sweden. We aimed to study incident MS in first- and second-generation immigrant groups. MATERIALS & METHODS We included adults aged 18 years and older in Sweden in first-generation (n = 6 042 891) and second-generation (n = 4 860 469) sub-studies. MS was defined via two diagnoses in the Swedish National Patient Register. MS risk was estimated by Cox regression, with hazard ratios (HRs) and 95% confidence intervals (CI), in different immigrant groups, using Swedish-born as referents in first-generation sub-study, and individuals with Swedish-born parents in the second-generation. Full models were adjusted for age, geographic residence in Sweden, educational level, marital status, neighborhood socioeconomic status, and co-morbidity. RESULTS MS was diagnosed among 10 746 individuals in the first-generation sub-study, (men 3055 and women 7691), and 11 737 in the second-generation sub-study (men 3549 and women 8188) in the period 1998-2015. The annual incidence rate was higher in Swedish-born compared to foreign-born, 11.5 vs 6.3 per 100 000 person-years (age-standardized to the European standard population). Fully adjusted HRs were lower in first-generation immigrant men (HR 0.72, 0.64-0.82) and women (HR 0.67, 0.62-0.73), and in second-generation immigrant men (HR 0.88, 0.79-0.97) and women (HR 0.79; 0.73-0.84). Among first-generation immigrants, lower HRs were found in most groups. SIGNIFICANCE The MS risk was lower in first- and second-generation immigrants compared to Swedish-born or individuals with Swedish-born parents.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care Department of Neurobiology, Care Sciences and Society Karolinska Institutet Huddinge Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience Division of Neurology Karolinska Institutet Huddinge Stockholm Sweden
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care Department of Neurobiology, Care Sciences and Society Karolinska Institutet Huddinge Sweden
- Academic Primary Health Care Centre Stockholm Region Stockholm Sweden
| | - Xinjun Li
- Center for Primary Health Care Research Lund University Malmö Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research Lund University Malmö Sweden
- Department of Family Medicine and Community Health Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Functional Pathology Center for Community‐based Healthcare Research and Education (CoHRE) School of Medicine Shimane University Matsue Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research Lund University Malmö Sweden
- Department of Family Medicine and Community Health Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Functional Pathology Center for Community‐based Healthcare Research and Education (CoHRE) School of Medicine Shimane University Matsue Japan
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Storm CS, Kia DA, Almramhi M, Wood NW. Using Mendelian randomization to understand and develop treatments for neurodegenerative disease. Brain Commun 2020; 2:fcaa031. [PMID: 32954289 PMCID: PMC7425289 DOI: 10.1093/braincomms/fcaa031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
Common neurodegenerative diseases are thought to arise from a combination of environmental and genetic exposures. Mendelian randomization is a powerful way to leverage existing genetic data to investigate causal relationships between risk factors and disease. In recent years, Mendelian randomization has gathered considerable traction in neurodegenerative disease research, providing valuable insights into the aetiology of these conditions. This review aims to evaluate the impact of Mendelian randomization studies on translational medicine for neurodegenerative diseases, highlighting the advances made and challenges faced. We will first describe the fundamental principles and limitations of Mendelian randomization and then discuss the lessons from Mendelian randomization studies of environmental risk factors for neurodegeneration. We will illustrate how Mendelian randomization projects have used novel resources to study molecular pathways of neurodegenerative disease and discuss the emerging role of Mendelian randomization in drug development. Finally, we will conclude with our view of the future of Mendelian randomization in these conditions, underscoring unanswered questions in this field.
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Affiliation(s)
- Catherine S Storm
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
| | - Demis A Kia
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
| | - Mona Almramhi
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
| | - Nicholas W Wood
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
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Dobson R, Jitlal M, Marshall CR, Noyce AJ, Robson J, Cuzick J, Giovannoni G. Ethnic and Socioeconomic Associations with Multiple Sclerosis Risk. Ann Neurol 2020; 87:599-608. [DOI: 10.1002/ana.25688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Ruth Dobson
- Preventive Neurology Unit Wolfson Institute of Preventive Medicine, Queen Mary University of London
- Department of Neurology Royal London Hospital
| | - Mark Jitlal
- Preventive Neurology Unit Wolfson Institute of Preventive Medicine, Queen Mary University of London
| | - Charles R. Marshall
- Preventive Neurology Unit Wolfson Institute of Preventive Medicine, Queen Mary University of London
- Department of Neurology Royal London Hospital
| | - Alastair J. Noyce
- Preventive Neurology Unit Wolfson Institute of Preventive Medicine, Queen Mary University of London
- Department of Neurology Royal London Hospital
| | - John Robson
- Department of Primary Care Queen Mary University of London
| | - Jack Cuzick
- Preventive Neurology Unit Wolfson Institute of Preventive Medicine, Queen Mary University of London
| | - Gavin Giovannoni
- Preventive Neurology Unit Wolfson Institute of Preventive Medicine, Queen Mary University of London
- Department of Neurology Royal London Hospital
- Blizard Institute, Queen Mary University of London London United Kingdom
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Waubant E, Lucas R, Mowry E, Graves J, Olsson T, Alfredsson L, Langer‐Gould A. Environmental and genetic risk factors for MS: an integrated review. Ann Clin Transl Neurol 2019; 6:1905-1922. [PMID: 31392849 PMCID: PMC6764632 DOI: 10.1002/acn3.50862] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
Recent findings have provided a molecular basis for the combined contributions of multifaceted risk factors for the onset of multiple sclerosis (MS). MS appears to start as a chronic dysregulation of immune homeostasis resulting from complex interactions between genetic predispositions, infectious exposures, and factors that lead to pro-inflammatory states, including smoking, obesity, and low sun exposure. This is supported by the discovery of gene-environment (GxE) interactions and epigenetic alterations triggered by environmental exposures in individuals with particular genetic make-ups. It is notable that several of these pro-inflammatory factors have not emerged as strong prognostic indicators. Biological processes at play during the relapsing phase of the disease may result from initial inflammatory-mediated injury, while risk factors for the later phase of MS, which is weighted toward neurodegeneration, are not yet well defined. This integrated review of current evidence guides recommendations for clinical practice and highlights research gaps.
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Affiliation(s)
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health, Research School of Population HealthAustralian National UniversityCanberraAustralia
| | - Ellen Mowry
- Department of Neurology and EpidemiologyJohns Hopkins UniversityBaltimoreMaryland
| | | | - Tomas Olsson
- Department of NeurologyKarolinska Institutet, Department of Clinical NeuroscienceStockholmSweden
| | - Lars Alfredsson
- Department of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Annette Langer‐Gould
- Clinical & Translational NeuroscienceKaiser Permanente/Southern California Permanente Medical GroupLos AngelesCalifornia
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12
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Khaki-Khatibi F, Nourazarian A, Ahmadi F, Farhoudi M, Savadi-Oskouei D, Pourostadi M, Asgharzadeh M. Relationship between the use of electronic devices and susceptibility to multiple sclerosis. Cogn Neurodyn 2019; 13:287-292. [PMID: 31168332 PMCID: PMC6520423 DOI: 10.1007/s11571-019-09524-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/09/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune condition influenced by both genetic and environmental factors. Dirty electricity generated by electronic equipment is one of the environmental factors that may directly or indirectly impact MS susceptibility. The current Study aimed to evaluate the relationship between the usage time of electronic equipment and susceptibility to MS in North-West Iranian people. This approach was carried out upon 471 MS-diagnosed patients and 453 healthy participants as control group in East Province of Azerbaijan. By utilizing structured questionnaires, the information of all participants about usage status of some electronic devices was obtained. Data were analyzed by IBM SPSS Statistics version 18.0 and the quantitative variables were analyzed by Chi Square and Independent sample t tests. P values below or equal to 0.05 were considered as significant. Among the evaluated items in this approach, the utilization of cell phones and satellite television dishes were significantly higher in MS patients (p < 0.001, p = 0.07). Furthermore, a correlation was observed between sleeping with cell phone and/or laptop under the pillow (p = 0.011) and MS disease; however, there was no significant differences between MS patients and controls in computer using and television watching. Our study reinforces the concept that the utilization of some electronic devices and the continuous exposure to dirty electricity would increase the risk of MS disease thereupon by enhancing the cognizance of adverse effects of dirty electricity and reducing the time spent over electronic devices during adolescence and adulthood the occurrence probability of MS could be declined.
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Affiliation(s)
- Fatemeh Khaki-Khatibi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Nourazarian
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ahmadi
- Department of Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahya Pourostadi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asgharzadeh
- Department of Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Biotechnology Research Center, Paramedical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Estudio del estatus laboral y el nivel socioeconómico en personas con esclerosis múltiple en 2 centros de Buenos Aires. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.neuarg.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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14
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Kavaliunas A, Danylaite Karrenbauer V, Gyllensten H, Manouchehrinia A, Glaser A, Olsson T, Alexanderson K, Hillert J. Cognitive function is a major determinant of income among multiple sclerosis patients in Sweden acting independently from physical disability. Mult Scler 2017; 25:104-112. [PMID: 29143553 DOI: 10.1177/1352458517740212] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), various aspects of cognitive function can be detrimentally affected, thus patients' employment and social functioning is commonly impacted. OBJECTIVE To analyse income among MS patients in relation to cognitive function, assessed with the Symbol Digit Modalities Test (SDMT). METHODS A cross-sectional study including 2080 MS patients was conducted linking national register-based data. Descriptive statistics and a two-part model were used to estimate differences in earnings and social benefits. RESULTS MS patients in the highest SDMT score quartile earned more than twice annually compared to patients in the lowest quartile, whereas patients in the lowest quartile received three times more income through social benefits. The difference in earnings and benefits across the SDMT performance quartiles remained statistically significant after adjusting for various clinical and socio-demographic variables, including physical disability. The corrected prevalence ratios for MS patients in the highest quartile for having income from earnings and benefits were 1.40 (95% confidence interval (CI): 1.29-1.49) and 0.81 (95% CI: 0.71-0.90), respectively, when compared to the patients in the lowest quartile. CONCLUSION Cognitive function affects the financial situation of MS patients negatively and independently of physical disability. This warrants cognitive testing as a routine measure in health care services for MS patients.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Virginija Danylaite Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Person-centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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15
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Amankwah N, Marrie RA, Bancej C, Garner R, Manuel DG, Wall R, Finès P, Bernier J, Tu K, Reimer K. Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts. Health Promot Chronic Dis Prev Can 2017; 37:37-48. [PMID: 28273039 PMCID: PMC5607528 DOI: 10.24095/hpcdp.37.2.02] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of multiple sclerosis (MS) in Canada over a 20-year time horizon (2011-2031). METHODS Using Statistics Canada's Population Health Microsimulation Model (POHEM) framework, specifically the population-based longitudinal, microsimulation model named POHEM-Neurological, we identified people with MS from health administrative data sources and derived incidence and mortality rate parameters from a British Columbia population-based cohort for future MS incidence and mortality projections. We also included a utility-based measure (Health Utilities Index Mark 3) reflecting states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of the neurological conditions. RESULTS The number of incident MS cases is expected to rise slightly from 4051 cases in 2011 to 4794 cases per 100 000 population in 2031, and the number of Canadians affected by MS will increase from 98 385 in 2011 to 133 635 in 2031. The total per capita health care cost (excluding out-of-pocket expenses) for adults aged 20 and older in 2011 was about $16 800 for individuals with MS, and approximately $2500 for individuals without a neurological condition. Thus, after accounting for additional expenditures due to MS (excluding out-of-pocket expenses), total annual health sector costs for MS are expected to reach $2.0 billion by 2031. As well, the average out-of-pocket expenditure for people with MS was around $1300 annually throughout the projection period. CONCLUSION MS is associated with a significant economic burden on society, since it usually affects young adults during prime career- and family-building years. Canada has a particularly high prevalence of MS, so research such as the present study is essential to provide a better understanding of the current and future negative impacts of MS on the Canadian population, so that health care system policymakers can best plan how to meet the needs of patients who are affected by MS. These findings also suggest that identifying strategies to prevent MS and more effectively treat the disease are needed to mitigate these future impacts.
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Affiliation(s)
- Nana Amankwah
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine (Neurology) and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Rochelle Garner
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Public and Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ron Wall
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Philippe Finès
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Julie Bernier
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Kim Reimer
- Population Health Surveillance and Clinical Prevention, British Columbia Ministry of Health, Victoria, British Columbia, Canada
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16
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Increased incidence of multiple sclerosis in systemic sclerosis: A nationwide cohort study. Prev Med 2016; 84:6-11. [PMID: 26724518 DOI: 10.1016/j.ypmed.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Previous studies showed inconsistent results on the association of systemic sclerosis (SSc) with multiple sclerosis (MS), and are limited by a lack of adjustment for sex and age. The goals of this retrospective cohort study were to evaluate whether SSc is associated with increased incident MS independent of sex and age. METHODS We enrolled patients with SSc from Taiwan's Registry of Catastrophic Illness Database and referent subjects from the National Health Insurance Research Database. Each SSc patient was matched to at most three referent subjects by sex, age, month and year of initial diagnosis of SSc. Incidence of MS in SSc patients and corresponding 95% confidence interval (95% CI) were calculated. Cox hazard regression was used to calculate the hazard ratio (HR) of MS. RESULTS The study enrolled 1171 patients with SSc and 3409 referent subjects. Patients with SSc had higher incidence of MS than referent subjects (9.35 per 1000 person-years, 95% CI=6.86-11.85; 0.13 per 1000 person-years, 95% CI=0.03-0.37, respectively). Similar results also occurred in both men and women. SSc was associated with increased incidence of MS after adjusting for sex and age (HR: 69.48, 95% CI=21.69-222.54). CONCLUSION SSc is associated with increased incidence of MS, independent of sex and age of the patients. Multidisciplinary teams should guide the assessment, treatment, and holistic care of SSc patients to reduce its morbidity.
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Ha-Vinh P, Nauleau S, Clementz M, Régnard P, Sauze L, Clavaud H. Geographic variations of multiple sclerosis prevalence in France: The latitude gradient is not uniform depending on the socioeconomic status of the studied population. Mult Scler J Exp Transl Clin 2016; 2:2055217316631762. [PMID: 28607717 PMCID: PMC5433399 DOI: 10.1177/2055217316631762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In France, two studies analysed multiple sclerosis prevalence nationwide: one was carried out in farmers, and the other one in employees. A south-north gradient of prevalence was found solely in farmers. Objective In order to better describe the latitude gradient in France, which is not uniform depending on the studied population, we assessed whether a gradient exists in another population than farmers and employees: independent workers. The same methods of case ascertainment have been used. Methods Altogether 4,165,903 persons insured by the French health insurance scheme for independent workers were included. We searched the database for (a) long term disease status ‘multiple sclerosis’, (b) domicile, (c) gender and (d) age. Results A total of 4182 cases of multiple sclerosis were registered giving a prevalence of 100.39/100,000. Adjustment by age and sex and spatial smoothing with a Bayesian analysis showed a gradual increase of prevalence from the southwest to the northeast of France. Standardised morbidity ratio was correlated with latitude and longitude (p<0.0001; p = 0.0031; adjusted R2 = 0.3038). Conclusion A discrepancy of geographic distribution between farmers and independent workers on the one hand and employees on the other cannot be attributable to environment. Assuming that socioeconomic status by itself is not associated with multiple sclerosis risk, employees’ geographic mobility at adulthood for professional reasons could have interfered with the gradient effect.
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Affiliation(s)
| | - Stève Nauleau
- Agence Régionale de Santé, Provence Alpes Côte d'Azur, France
| | | | | | - Laurent Sauze
- Agence Régionale de Santé, Provence Alpes Côte d'Azur, France
| | - Henri Clavaud
- Agence Régionale de Santé, Provence Alpes Côte d'Azur, France
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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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