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Scalfari A, Traboulsee A, Oh J, Airas L, Bittner S, Calabrese M, Garcia Dominguez JM, Granziera C, Greenberg B, Hellwig K, Illes Z, Lycke J, Popescu V, Bagnato F, Giovannoni G. Smouldering-Associated Worsening in Multiple Sclerosis: An International Consensus Statement on Definition, Biology, Clinical Implications, and Future Directions. Ann Neurol 2024. [PMID: 39051525 DOI: 10.1002/ana.27034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
Despite therapeutic suppression of relapses, multiple sclerosis (MS) patients often experience subtle deterioration, which extends beyond the definition of "progression independent of relapsing activity." We propose the concept of smouldering-associated-worsening (SAW), encompassing physical and cognitive symptoms, resulting from smouldering pathological processes, which remain unmet therapeutic targets. We provide a consensus-based framework of possible pathological substrates and manifestations of smouldering MS, and we discuss clinical, radiological, and serum/cerebrospinal fluid biomarkers for potentially monitoring SAW. Finally, we share considerations for optimizing disease surveillance and implications for clinical trials to promote the integration of smouldering MS into routine practice and future research efforts. ANN NEUROL 2024.
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Affiliation(s)
- Antonio Scalfari
- Center of Neuroscience, Department of Medicine, Charing Cross Hospital, Imperial College, London, UK
| | | | - Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Laura Airas
- University of Turku and Turku University Hospital, Turku, Finland
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Cristina Granziera
- Translational Imaging in Neurology (THiNK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurology and MS Center, University Hospital Basel Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Basel, Switzerland
| | | | | | - Zsolt Illes
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jan Lycke
- Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Veronica Popescu
- University MS Centre Pelt-Hasselt, Noorderhart Hospital, Belgium Hasselt University, Pelt, Belgium
| | - Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, VA Hospital, TN Valley Healthcare System, Nashville, TN, USA
| | - Gavin Giovannoni
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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García-Rodríguez R, Vázquez-Rodríguez A, Bellahmar-Lkadiri S, Salmonte-Rodríguez A, Siverio-Díaz AR, De Paz-Pérez P, González-Pérez AM, Brito-Brito PR. Effectiveness of a Nurse-Led Telehealth Intervention to Improve Adherence to Healthy Eating and Physical Activity Habits in Overweight or Obese Young Adults. Nutrients 2024; 16:2217. [PMID: 39064660 PMCID: PMC11280283 DOI: 10.3390/nu16142217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Excess weight and obesity have high prevalence rates globally and are associated with significant morbidity and mortality rates. In the wake of the COVID-19 pandemic, telehealth emerged as an effective tool for promoting healthy behaviours in the management of chronic conditions. This study employed a three-month quasi-experimental design with pre- and post-intervention measurements, assessing the progress of 82 adults assigned either to an intervention group (IG) or a control group (CG). A total of 66 participants completed the study, with 33 in each group. The IG had access to a telehealth-based platform providing educational content on healthy lifestyle habits and were followed up both in-person and remotely. The CG were monitored as usual, i.e., at their primary care nurses' discretion. The IG exhibited a statistically significant reduction in weight, BMI, and abdominal circumference, along with improved adherence to a heart-healthy diet, specifically the Mediterranean diet, and higher levels of physical activity. The nurse-led intervention (Care4US+), utilising telehealth from primary care, has proven effective in enhancing healthy behaviours and reducing cardiovascular risk factors.
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Affiliation(s)
- R. García-Rodríguez
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
| | - A. Vázquez-Rodríguez
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
| | - S. Bellahmar-Lkadiri
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
| | - A. Salmonte-Rodríguez
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
| | - A. R. Siverio-Díaz
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
| | - P. De Paz-Pérez
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
| | - A. M. González-Pérez
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
- Nursing Department, Faculty of Healthcare Sciences, University of La Laguna, 38200 Santa Cruz de Tenerife, Canary Islands, Spain
| | - P. R. Brito-Brito
- La Laguna-Tenerife Norte Multiprofessional Family and Community Care Teaching Unit, Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Canary Islands, Spain; (R.G.-R.); (A.V.-R.); (S.B.-L.); (A.S.-R.); (A.R.S.-D.); (P.D.P.-P.); (A.M.G.-P.)
- Nursing Department, Faculty of Healthcare Sciences, University of La Laguna, 38200 Santa Cruz de Tenerife, Canary Islands, Spain
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Clina JG, Wyatt HR, Hill JO, Ferguson CC, Young H, Rimmer JH. Pilot evaluation of a behavioral weight loss program for adults with physical disabilities: State of Slim Everybody usability and feasibility. Obes Sci Pract 2024; 10:e750. [PMID: 38618520 PMCID: PMC11009485 DOI: 10.1002/osp4.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Abstract
Background People with physical disabilities (PWD) have a higher prevalence of obesity than populations without disability, but most evidence-based weight loss programs have not included this population. The State of Slim (SOS) program is an evidence-based weight loss program that has demonstrated success in producing weight loss in populations without disability, but it has not been adapted for or evaluated in PWD. Methods The SOS program was systematically adapted using the evidence-informed Guidelines, Recommendations, and Adaptations Including Disability (GRAIDs) framework. A total of 35 participants enrolled in the State of Slim Everybody program. The program was offered entirely online. Body weight, attendance, and food log completion were also tracked weekly. The program length was 16.5 h and included weekly group instruction, with optional one-on-one sessions provided upon request. Following completion, participants completed post-evaluation surveys on overall satisfaction with the program. The primary outcomes were program effectiveness (i.e., body weight), usability, and feasibility. Results Thirty-two out of 35 participants completed the program, representing a retention rate of 91.4%. Average weight loss was 10.9% (9.9 ± 0.7 kg (t (31) = -13.3, p =< 0.0001)). On a 1 (dissatisfied/completely useless) to 5 (very satisfied/completely helpful) Likert scale, the average score for overall program satisfaction was 4.8 ± 0.1 and program helpfulness 4.6 ± 0.1. Conclusion The State of Slim Everybody program demonstrated significant weight loss and good usability and feasibility in PWD. Existing adaptation frameworks can be used to create inclusive health promotion programs for adults with physical disabilities.
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Affiliation(s)
- Julianne G. Clina
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- University of Kansas Medical CenterKansas CityKansasUSA
| | - Holly R. Wyatt
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - James O. Hill
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Christine C. Ferguson
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Hui‐Ju Young
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - James H. Rimmer
- UAB Research CollaborativeUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Lechner-Scott J, Probst Y, Giovannoni G, Hawkes CH, Levy M, Yeh EA. What is the role of diet for multiple sclerosis? Why epidemiological studies don't give the full answer. Mult Scler Relat Disord 2024; 83:105457. [PMID: 38266607 DOI: 10.1016/j.msard.2024.105457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- J Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, Australia; Hunter Medical Research Institute, University of Newcastle, Australia.
| | - Y Probst
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | - G Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C H Hawkes
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - E A Yeh
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada
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