1
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Pannen ST, Gassmann R, Vorburger R, Rohrmann S, Sych J, Steinemann N. Development of a Multilingual Web-Based Food Frequency Questionnaire for Adults in Switzerland. Nutrients 2023; 15:4359. [PMID: 37892434 PMCID: PMC10610353 DOI: 10.3390/nu15204359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Dietary assessment is a major challenge in epidemiological research and is associated with a high time and financial burden. Automated food frequency questionnaires (FFQs) have the potential to rapidly collect dietary intake data in large studies while reducing human error risk during data processing. We developed a semiquantitative, multilingual, electronic FFQ for real-time dietary intake assessment in the Swiss adult population, called "Swiss eFFQ". The iterative development process involved stages of content identification, construction, pretesting, translation, and adaptation of the FFQ. Using 24 h dietary recalls from 2085 participants aged 18-75 years from a nationally representative survey, we conducted a stepwise regression analysis to identify foods contributing to >90% of the variance in intakes of energy and six nutrients. All 118 foods identified in the overall cohort or in any of the Swiss linguistic regions were selected and standardized to define the comprehensive 83-item food list, covering >90% of the intake of key nutrients in the entire study population. Once validated, the Swiss eFFQ can be used to classify individuals based on their habitual diets. The methodology described in this paper enhances the transparency of the Swiss eFFQ and may help researchers to develop multilingual dietary assessment tools for other populations.
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Affiliation(s)
- Sarah T. Pannen
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland; (S.T.P.); (N.S.)
| | - Roland Gassmann
- Institute of Computational Life Sciences, ZHAW School of Life Sciences and Facility Management, Schloss 1, CH-8820 Wädenswil, Switzerland; (R.G.); (R.V.)
| | - Robert Vorburger
- Institute of Computational Life Sciences, ZHAW School of Life Sciences and Facility Management, Schloss 1, CH-8820 Wädenswil, Switzerland; (R.G.); (R.V.)
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland; (S.T.P.); (N.S.)
| | - Janice Sych
- Institute of Food and Beverage Innovation, ZHAW School of Life Sciences and Facility Management, Grüentalstrasse 14, CH-8820 Wädenswil, Switzerland;
| | - Nina Steinemann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland; (S.T.P.); (N.S.)
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2
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Haag C, Steinemann N, Chiavi D, Kamm CP, Sieber C, Manjaly ZM, Horváth G, Ajdacic-Gross V, Puhan MA, von Wyl V. Blending citizen science with natural language processing and machine learning: Understanding the experience of living with multiple sclerosis. PLOS Digit Health 2023; 2:e0000305. [PMID: 37531365 PMCID: PMC10395829 DOI: 10.1371/journal.pdig.0000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023]
Abstract
The emergence of new digital technologies has enabled a new way of doing research, including active collaboration with the public ('citizen science'). Innovation in machine learning (ML) and natural language processing (NLP) has made automatic analysis of large-scale text data accessible to study individual perspectives in a convenient and efficient fashion. Here we blend citizen science with innovation in NLP and ML to examine (1) which categories of life events persons with multiple sclerosis (MS) perceived as central for their MS; and (2) associated emotions. We subsequently relate our results to standardized individual-level measures. Participants (n = 1039) took part in the 'My Life with MS' study of the Swiss MS Registry which involved telling their story through self-selected life events using text descriptions and a semi-structured questionnaire. We performed topic modeling ('latent Dirichlet allocation') to identify high-level topics underlying the text descriptions. Using a pre-trained language model, we performed a fine-grained emotion analysis of the text descriptions. A topic modeling analysis of totally 4293 descriptions revealed eight underlying topics. Five topics are common in clinical research: 'diagnosis', 'medication/treatment', 'relapse/child', 'rehabilitation/wheelchair', and 'injection/symptoms'. However, three topics, 'work', 'birth/health', and 'partnership/MS' represent domains that are of great relevance for participants but are generally understudied in MS research. While emotions were predominantly negative (sadness, anxiety), emotions linked to the topics 'birth/health' and 'partnership/MS' was also positive (joy). Designed in close collaboration with persons with MS, the 'My Life with MS' project explores the experience of living with the chronic disease of MS using NLP and ML. Our study thus contributes to the body of research demonstrating the potential of integrating citizen science with ML-driven NLP methods to explore the experience of living with a chronic condition.
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Affiliation(s)
- Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Deborah Chiavi
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Christian P Kamm
- Neurocentre, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Chloé Sieber
- Institute for Implementation Science in Health Care, University of Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Klinik, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Gábor Horváth
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Viktor von Wyl
- Institute for Implementation Science in Health Care, University of Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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3
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Hoepner R, Rodgers S, Stegmayer K, Steinemann N, Haag C, Calabrese P, Manjaly ZM, Salmen A, Kesselring J, Zecca C, Gobbi C, Puhan MA, Walther S, von Wyl V. Feelings of loneliness, COVID-19-specific-health anxiety and depressive symptoms during the first COVID-19 wave in Swiss persons with multiple sclerosis. Sci Rep 2022; 12:17829. [PMID: 36280696 PMCID: PMC9591317 DOI: 10.1038/s41598-022-22445-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/14/2022] [Indexed: 01/20/2023] Open
Abstract
The aim of our study was to investigate whether self-reported feeling of loneliness (FoL) and COVID-19-specific health anxiety were associated with the presence of depressive symptoms during the first coronavirus disease 2019 (COVID-19) wave. Questionnaires of 603 persons of the Swiss Multiple Sclerosis Registry (SMSR) were cross-sectionally analyzed using descriptive and multivariable regression methods. The survey response rate was 63.9%. Depressive symptoms were assessed by the Beck Depression Inventory-Fast Screen (BDI-FS). COVID-19-specific health anxiety and FoL were measured using two 5-item Likert scaled pertinent questions. High scoring FoL (2.52, 95% confidence interval (CI) (2.06-2.98)) and/or COVID-19 specific health anxiety (1.36, 95% CI (0.87-1.85)) were significantly associated with depressive symptoms. Further stratification analysis showed that the impact of FoL on depressive symptoms affected all age groups. However, it was more pronounced in younger PwMS, whereas an impact of COVID-19 specific health anxiety on depressive symptoms was particularly observed in middle-aged PwMS. FoL and COVID-19-specific health anxiety were age-dependently associated with depressive symptoms during the first COVID-19 wave in Switzerland. Our findings could guide physicians, health authorities, and self-help groups to better accompany PwMS in times of public health crises.
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Affiliation(s)
- Robert Hoepner
- grid.411656.10000 0004 0479 0855Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stephanie Rodgers
- grid.7400.30000 0004 1937 0650Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zürich, Switzerland
| | - Katharina Stegmayer
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Nina Steinemann
- grid.7400.30000 0004 1937 0650Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zürich, Switzerland
| | - Christina Haag
- grid.7400.30000 0004 1937 0650Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zürich, Switzerland
| | - Pasquale Calabrese
- grid.6612.30000 0004 1937 0642Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Zina-Mary Manjaly
- grid.415372.60000 0004 0514 8127Department of Neurology, Schulthess Clinic, Zürich, Switzerland ,grid.5801.c0000 0001 2156 2780Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH) Zurich, Zürich, Switzerland
| | - Anke Salmen
- grid.411656.10000 0004 0479 0855Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jürg Kesselring
- grid.483468.50000 0004 0563 7692Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Chiara Zecca
- grid.469433.f0000 0004 0514 7845Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland ,grid.29078.340000 0001 2203 2861Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Claudio Gobbi
- grid.469433.f0000 0004 0514 7845Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland ,grid.29078.340000 0001 2203 2861Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Milo A. Puhan
- grid.7400.30000 0004 1937 0650Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zürich, Switzerland
| | - Sebastian Walther
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Viktor von Wyl
- grid.7400.30000 0004 1937 0650Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zürich, Switzerland ,grid.7400.30000 0004 1937 0650Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland
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4
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Nève G, Bur L, Lampert L, Höchsmann C, Brombach C, Steinemann N, Schmidt-Trucksäss A. Validation of a Visually Aided Dietary Assessment Tool to Estimate Dietary Intake in an Adult Swiss Population. Front Nutr 2022; 9:844156. [PMID: 35571959 PMCID: PMC9097151 DOI: 10.3389/fnut.2022.844156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/18/2022] [Indexed: 01/11/2023] Open
Abstract
BackgroundAccurately assessing dietary intake is crucial for understanding how diet affects a person’s health. In large cohorts, paper-based dietary assessment tools (DAT) such as food recalls or food frequency questionnaires have emerged as valid tools with a low burden for participants.ObjectiveTo validate a visually aided DAT for use in studies with Swiss adults against the gold standard of a weighed 7-day food record (7 d-FR).DesignFifty-one adults (n = 24 women, n = 27 males) participated in the study and were recruited within two age groups (20–40 and 50–70 y). Each participant filled out the visually aided DAT, then the 7 d-FR. The DAT was compared to the 7 d-FR for total energy intake, macronutrients, sugar, water, and portions of fruits and vegetables. Pearson correlation and Bland–Altman analyses were used for statistical analyses.ResultsTotal correlations ranged from 0.288 (sugar, p < 0.05) to 0.729 (water, p < 0.01). The older age group showed higher correlations for total energy intake, protein, fats, carbohydrates, and sugar, but not for water (p < 0.05). Correlations were moderate at r > 0.5, whereas only water and protein reached those values in the young group. Both groups overestimated total calories in kcal (+14.0%), grams of protein (+ 44.6%), fats (+36.3%), and portions of fruits and vegetables (+16.0%) but strongly underestimated sugar intake (−50.9%).ConclusionThis DAT showed that all macronutrients and total energy intake were estimated more accurately by the older age group and therefore might be adequate to capture dietary habits in older Swiss adults.
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Affiliation(s)
- Gilles Nève
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- *Correspondence: Gilles Nève,
| | - Laura Bur
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Ladina Lampert
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Christine Brombach
- Institute of Food and Beverage Innovation, Zurich University of Applied Sciences, Life Sciences and Facility Management, Wädenswil, Switzerland
| | - Nina Steinemann
- Department of Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Arno Schmidt-Trucksäss,
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5
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Geys L, Parciak T, Pirmani A, McBurney R, Schmidt H, Malbaša T, Ziemssen T, Bergmann A, Rojas JI, Cristiano E, García-Merino JA, Fernández Ó, Kuhle J, Gobbi C, Delmas A, Simpson-Yap S, Nag N, Yamout B, Steinemann N, Seeldrayers P, Dubois B, van der Mei I, Stahmann A, Drulovic J, Pekmezovic T, Brola W, Tintore M, Kalkers N, Ivanov R, Zakaria M, Naseer MA, Van Hecke W, Grigoriadis N, Boziki M, Carra A, Pawlak MA, Dobson R, Hellwig K, Gallagher A, Leocani L, Dalla Costa G, de Carvalho Sousa NA, Van Wijmeersch B, Peeters LM. The Multiple Sclerosis Data Alliance Catalogue: Enabling Web-Based Discovery of Metadata from Real-World Multiple Sclerosis Data Sources. Int J MS Care 2022; 23:261-268. [PMID: 35035297 DOI: 10.7224/1537-2073.2021-006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background One of the major objectives of the Multiple Sclerosis Data Alliance (MSDA) is to enable better discovery of multiple sclerosis (MS) real-world data (RWD). Methods We implemented the MSDA Catalogue, which is available worldwide. The current version of the MSDA Catalogue collects descriptive information on governance, purpose, inclusion criteria, procedures for data quality control, and how and which data are collected, including the use of e-health technologies and data on collection of COVID-19 variables. The current cataloguing procedure is performed in several manual steps, securing an effective catalogue. Results Herein we summarize the status of the MSDA Catalogue as of January 6, 2021. To date, 38 data sources across five continents are included in the MSDA Catalogue. These data sources differ in purpose, maturity, and variables collected, but this landscaping effort shows that there is substantial alignment on some domains. The MSDA Catalogue shows that personal data and basic disease data are the most collected categories of variables, whereas data on fatigue measurements and cognition scales are the least collected in MS registries/cohorts. Conclusions The Web-based MSDA Catalogue provides strategic overview and allows authorized end users to browse metadata profiles of data cohorts and data sources. There are many existing and arising RWD sources in MS. Detailed cataloguing of MS RWD is a first and useful step toward reducing the time needed to discover MS RWD sets and promoting collaboration.
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Affiliation(s)
- Lotte Geys
- University MS Center, Hasselt-Pelt, Belgium (LG, TParciak, AP, BVW, LMP).,Biomedical Research Institute (BIOMED) (LG, TParciak, AP, BVW, LMP), University of Hasselt, Diepenbeek, Belgium.,Data Science Institute (LG, TParciak, AP, LMP), University of Hasselt, Diepenbeek, Belgium
| | - Tina Parciak
- University MS Center, Hasselt-Pelt, Belgium (LG, TParciak, AP, BVW, LMP).,Biomedical Research Institute (BIOMED) (LG, TParciak, AP, BVW, LMP), University of Hasselt, Diepenbeek, Belgium.,Data Science Institute (LG, TParciak, AP, LMP), University of Hasselt, Diepenbeek, Belgium.,University Medical Center Göttingen, Department of Medical Informatics, Germany (TParciak)
| | - Ashkan Pirmani
- University MS Center, Hasselt-Pelt, Belgium (LG, TParciak, AP, BVW, LMP).,Biomedical Research Institute (BIOMED) (LG, TParciak, AP, BVW, LMP), University of Hasselt, Diepenbeek, Belgium.,ESAT-STADIUS, KU Leuven, Leuven, Belgium (AP)
| | | | - Hollie Schmidt
- Accelerated Cure Project for MS, Waltham, MA, USA (RM, HS)
| | - Tanja Malbaša
- Association of Multiple Sclerosis Societies of Croatia, Zagreb (TM)
| | - Tjalf Ziemssen
- Center for Clinical Neuroscience, University Hospital Dresden, Germany (TZ)
| | | | - Juan I Rojas
- Neurology Department, Hospital Universitario de CEMIC, Buenos Aires, Argentina (JIR)
| | | | - Juan Antonio García-Merino
- Department of Neurology, Universidad Autonoma de Madrid, Spain (JAG-M).,Neurology Service, Puerta de Hierro Hospital, Majadahonda, Madrid, Spain (JAG-M)
| | - Óscar Fernández
- University of Malaga, Department of Pharmacology, Spain (OF)
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland (JK)
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland (CG).,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (CG)
| | - Amber Delmas
- Life Sciences Department, EHealthLine.com, Inc (AD)
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Australia (SS-Y, NN)
| | - Nupur Nag
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Australia (SS-Y, NN)
| | - Bassem Yamout
- Multiple Sclerosis Center, American University of Beirut Medical Center, Lebanon (BY)
| | - Nina Steinemann
- Data Center of the Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (NS)
| | | | - Bénédicte Dubois
- Department of Neurosciences, Laboratory for Neuroimmunology, KU Leuven, Leuven, Belgium (BD).,Leuven Brain Institute KU Leuven, Leuven, Belgium (BD).,Department of Neurology, University Hospitals Leuven, Leuven, Belgium (BD)
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart TAS, Australia (IvdM)
| | - Alexander Stahmann
- German MS-Registry, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany (AS)
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Belgrade, Serbia (JD)
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (TPekmezovic)
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland (WB)
| | - Mar Tintore
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Barcelona, Spain (MT)
| | - Nynke Kalkers
- Department of Neurology, OLVG, and Department of Neurology, Amsterdam UMC, Location VUMC, Amsterdam, the Netherlands (NK)
| | - Rumen Ivanov
- PMA - Pharma Marketing Advisors, Ltd, Sofia, Bulgaria (RI)
| | - Magd Zakaria
- Department of Neurology, Ain Shams University, Egypt (MZ)
| | | | | | - Nikolaos Grigoriadis
- Second Neurological University Department, Multiple Sclerosis Center, Aristotle University of Thessaloniki, AHEPA General University Hospital, Thessaloniki Greece (NG, MB)
| | - Marina Boziki
- Second Neurological University Department, Multiple Sclerosis Center, Aristotle University of Thessaloniki, AHEPA General University Hospital, Thessaloniki Greece (NG, MB)
| | - Adriana Carra
- MS Center Hospital Britanico, Buenos Aires, Argentina (AC)
| | - Mikolaj A Pawlak
- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland (MAP)
| | - Ruth Dobson
- Wolfson Institute of Preventive Medicine, Charterhouse Square, London, UK (RD)
| | - Kerstin Hellwig
- Department of Neurology, Katholisches Klinikum, St Josef Hospital, Ruhr University Bochum, Bochum Germany (KH)
| | - Arlene Gallagher
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK (AG)
| | - Letizia Leocani
- Clinical Neurology Unit, San Raffaele University, Milan, Italy (LL, GDC)
| | | | | | - Bart Van Wijmeersch
- University MS Center, Hasselt-Pelt, Belgium (LG, TParciak, AP, BVW, LMP).,Biomedical Research Institute (BIOMED) (LG, TParciak, AP, BVW, LMP), University of Hasselt, Diepenbeek, Belgium.,Noorderhart, Rehabilitation and MS Center, Pelt, Belgium (BVW)
| | - Liesbet M Peeters
- University MS Center, Hasselt-Pelt, Belgium (LG, TParciak, AP, BVW, LMP).,Biomedical Research Institute (BIOMED) (LG, TParciak, AP, BVW, LMP), University of Hasselt, Diepenbeek, Belgium.,Data Science Institute (LG, TParciak, AP, LMP), University of Hasselt, Diepenbeek, Belgium
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6
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Ajdacic-Gross V, Steinemann N, Horváth G, Rodgers S, Kaufmann M, Xu Y, Kamm CP, Kesselring J, Manjaly ZM, Zecca C, Calabrese P, Puhan MA, von Wyl V. Onset Symptom Clusters in Multiple Sclerosis: Characteristics, Comorbidities, and Risk Factors. Front Neurol 2021; 12:693440. [PMID: 34295301 PMCID: PMC8290323 DOI: 10.3389/fneur.2021.693440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Multiple sclerosis (MS) symptoms are expected to aggregate in specific patterns across different stages of the disease. Here, we studied the clustering of onset symptoms and examined their characteristics, comorbidity patterns and associations with potential risk factors. Methods: Data stem from the Swiss Multiple Sclerosis Registry, a prospective study including 2,063 participants by November 2019. MS onset symptoms were clustered using latent class analysis (LCA). The latent classes were further examined using information on socio-demographic characteristics, MS-related features, potential risk factors, and comorbid diseases. Results: The LCA model with six classes (frequencies ranging from 12 to 24%) was selected for further analyses. The latent classes comprised a multiple symptoms class with high probabilities across several symptoms, contrasting with two classes with solitary onset symptoms: vision problems and paresthesia. Two gait classes emerged between these extremes: the gait-balance class and the gait-paralysis class. The last class was the fatigue-weakness-class, also accompanied by depression symptoms, memory, and gastro-intestinal problems. There was a moderate variation by sex and by MS types. The multiple symptoms class yielded increased comorbidity with other autoimmune disorders. Similar to the fatigue-weakness class, the multiple symptoms class showed associations with angina, skin diseases, migraine, and lifetime prevalence of smoking. Mononucleosis was more frequently reported in the fatigue-weakness and the paresthesia class. Familial aggregation did not differ among the classes. Conclusions: Clustering of MS onset symptoms provides new perspectives on the heterogeneity of MS. The clusters comprise different potential risk factors and comorbidities. They point toward different risk mechanisms.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nina Steinemann
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Gábor Horváth
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Yanhua Xu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.,Neurocentre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Milo A Puhan
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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7
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Ajdacic-Gross V, Ajdacic L, Xu Y, Müller M, Rodgers S, Wyss C, Olbrich S, Buadze A, Seifritz E, Wagner EYN, Radovanovic D, von Wyl V, Steinemann N, Landolt MA, Castelao E, Strippoli MPF, Gholamrezaee MM, Glaus J, Vandeleur C, Preisig M, von Känel R. Backtracing persistent biomarker shifts to the age of onset: A novel procedure applied to men’s and women’s white blood cell counts in post-traumatic stress disorder. Biomark Neuropsychiatry 2021. [DOI: 10.1016/j.bionps.2021.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rodgers S, Calabrese P, Ajdacic-Gross V, Steinemann N, Kaufmann M, Salmen A, Manjaly ZM, Kesselring J, Kamm CP, Kuhle J, Chan A, Gobbi C, Zecca C, Müller S, von Wyl V. Major depressive disorder subtypes and depression symptoms in multiple sclerosis: What is different compared to the general population? J Psychosom Res 2021; 144:110402. [PMID: 33631437 DOI: 10.1016/j.jpsychores.2021.110402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/04/2021] [Accepted: 02/13/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare and characterize major depressive disorder (MDD) subtypes (i.e., pure atypical, pure melancholic and mixed atypical-melancholic) and depression symptoms in persons with multiple sclerosis (PwMS) with persons without MS (Pw/oMS) fulfilling the DSM-5 criteria for a past 12-month MDD. METHODS MDD in PwMS (n = 92) from the Swiss Multiple Sclerosis Registry was compared with Pw/oMS (n = 277) from a Swiss community-based study. Epidemiological MDD diagnoses were based on the Mini-SPIKE (shortened form of the Structured Psychopathological Interview and Rating of the Social Consequences for Epidemiology). Logistic and multinomial regression analyses (adjusted for sex, age, civil status, depression and severity) were computed for comparisons and characterization. Latent class analysis (LCA) was conducted to empirically identify depression subtypes in PwMS. RESULTS PwMS had a higher risk for the mixed atypical-melancholic MDD subtype (OR = 2.22, 95% CI = 1.03-4.80) compared to Pw/oMS. MDD in PwMS was specifically characterized by a higher risk of the two somatic atypical depression symptoms 'weight gain' (OR = 6.91, 95% CI = 2.20-21.70) and 'leaden paralysis' (OR = 3.03, 95% CI = 1.35-6.82) and the symptom 'irritable/angry' (OR = 3.18, 95% CI = 1.08-9.39). CONCLUSIONS MDD in PwMS was characterized by a higher risk for specific somatic atypical depression symptoms and the mixed atypical-melancholic MDD subtype. The pure atypical MDD subtype, however, did not differentiate between PwMS and Pw/oMS. Given the high phenomenological overlap with MS symptoms, the mixed atypical-melancholic MDD subtype represents a particular diagnostic challenge.
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Affiliation(s)
- Stephanie Rodgers
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland.
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Neurocentre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
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Kaufmann M, Puhan MA, Salmen A, Kamm CP, Manjaly ZM, Calabrese P, Schippling S, Müller S, Kuhle J, Pot C, Gobbi C, Steinemann N, von Wyl V. 60/30: 60% of the Morbidity-Associated Multiple Sclerosis Disease Burden Comes From the 30% of Persons With Higher Impairments. Front Neurol 2020; 11:156. [PMID: 32210908 PMCID: PMC7068809 DOI: 10.3389/fneur.2020.00156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Multiple sclerosis (MS) is the most common chronic, non-traumatic, neurologic disease in young adults. While approximate values of the disease burden of MS are known, individual drivers are unknown. Objective: To estimate the age-, sex-, and disease severity-specific contributions to the disease burden of MS. Methods: We estimated the disease burden of MS using disability-adjusted life years (DALYs) following the Global Burden of Disease study (GBD) methodology. The data sources consisted of the Swiss MS Registry, a recent prevalence estimation, and the Swiss mortality registry. Results: The disease burden of MS in Switzerland in 2016 was 6,938 DALYs (95%-interval: 6,018-7,955), which corresponds to 97 DALYs per 100,000 adult inhabitants. Morbidity contributed 59% of the disease burden. While persons in an asymptomatic (EDSS-proxy 0) and mild (EDSS-proxy >0–3.5) disease stage represent 68.4% of the population, they make up 39.8% of the MS-specific morbidity. The remaining 60.2% of the MS-specific morbidity stems from the 31.6% of persons in a moderate (EDSS-proxy 4–6.5) or severe (EDSS-proxy ≥7) disease stage. Conclusions: Morbidity has a larger influence on the disease burden of MS than mortality and is shared in a ratio of 2:3 between persons in an asymptomatic/mild and moderate/severe disease stage in Switzerland. Interventions to reduce severity worsening in combination with tailored, symptomatic treatments are important future paths to lower the disease burden of MS.
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Affiliation(s)
- Marco Kaufmann
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.,Neurology and Neurorehabilitation Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Center for Neuroscience Zurich, University of Zurich and Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Caroline Pot
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claudio Gobbi
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.,Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Nina Steinemann
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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10
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Ajdacic-Gross V, Mutsch M, Rodgers S, Tesic A, Müller M, Seifritz E, Wagner EYN, von Känel R, Landolt MA, Steinemann N, von Wyl V, Castelao E, Strippoli MPF, Glaus J, Vandeleur C, Marques-Vidal PM, Vollenweider P, Preisig M. A step beyond the hygiene hypothesis-immune-mediated classes determined in a population-based study. BMC Med 2019; 17:75. [PMID: 30961604 PMCID: PMC6454751 DOI: 10.1186/s12916-019-1311-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/25/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Comorbidity patterns of childhood infections, atopic diseases, and adverse childhood experiences (ACE) are related to immune system programming conditions. The aim of this study was to make a step beyond the hygiene hypothesis and to comprehensively classify these patterns with latent class analysis (LCA). A second aim was to characterize the classes by associations with immunological, clinical, and sociodemographic variables. METHODS LCA was applied to data from the CoLaus|PsyCoLaus study (N = 4874, age range 35-82 years) separately for men and women. It was based on survey information on chickenpox, measles, mumps, rubella, herpes simplex, pertussis, scarlet fever, hay fever, asthma, eczema, urticaria, drug allergy, interparental violence, parental maltreatment, and trauma in early childhood. Subsequently, we examined how immune-mediated classes were reflected in leukocyte counts, inflammatory markers (IL-1β, IL-6, TNF-α, hsCRP), chronic inflammatory diseases, and mental disorders, and how they differed across social classes and birth cohorts. RESULTS LCA results with five classes were selected for further analysis. Latent classes were similar in both sexes and were labeled according to their associations as neutral, resilient, atopic, mixed (comprising infectious and atopic diseases), and ACE class. They came across with specific differences in biomarker levels. Mental disorders typically displayed increased lifetime prevalence rates in the atopic, the mixed, and the ACE classes, and decreased rates in the resilient class. The same patterns were apparent in chronic inflammatory diseases, except that the ACE class was relevant specifically in women but not in men. CONCLUSIONS This is the first study to systematically determine immune-mediated classes that evolve early in life. They display characteristic associations with biomarker levels and somatic and psychiatric diseases occurring later in life. Moreover, they show different distributions across social classes and allow to better understand the mechanisms beyond the changes in the prevalence of chronic somatic and psychiatric diseases.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 2019, CH-8021, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Margot Mutsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 2019, CH-8021, Zurich, Switzerland
| | - Anja Tesic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 2019, CH-8021, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 2019, CH-8021, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 2019, CH-8021, Zurich, Switzerland
| | - En-Young N Wagner
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, Switzerland
| | - Markus A Landolt
- University Children's Hospital Zurich and Children's Research Center, Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland
| | - Marie-Pierre F Strippoli
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland
| | - Jennifer Glaus
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Caroline Vandeleur
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland
| | | | | | - Martin Preisig
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland
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11
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Barin L, Kamm CP, Salmen A, Dressel H, Calabrese P, Pot C, Schippling S, Gobbi C, Müller S, Chan A, Rodgers S, Kaufmann M, Ajdacic-Gross V, Steinemann N, Kesselring J, Puhan MA, von Wyl V. How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis. Mult Scler 2019; 26:489-500. [PMID: 31456464 PMCID: PMC7140343 DOI: 10.1177/1352458518823955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Diagnosing multiple sclerosis (MS) early is crucial to avoid future
disability. However, potentially preventable delays in the diagnostic
cascade from contact with a physician to definite diagnosis still occur and
their causes are still unclear. Objective: To identify the possible causes of delays in the diagnostic process. Methods: We analyzed the data of the Swiss MS Registry. With logistic regression, we
modeled the time from the first contact to the first consultation
(contact-to-evaluation time, ⩽1 month/>1 month) and the
evaluation-to-diagnosis time (⩽6 months/>6 months). Potential factors
were health system characteristics, sociodemographic variables, first
symptoms, and MS type. Results: We included 522 participants. Mostly, general practitioners (67%) were
contacted first, without delaying the diagnosis. In contrast, first symptoms
and MS type were the major contributors to delays: gait problems were
associated with longer contact-to-evaluation times, depression as a
concomitant symptom with longer evaluation-to-diagnosis times, and having
primary progressive MS prolonged both phases. In addition, living in
mountainous areas was associated with longer contact-to-evaluation times,
whereas diagnosis after 2000 was associated with faster diagnoses. Conclusion: For a quicker diagnosis, awareness of MS as a differential diagnosis of gait
disorders and the co-occurrence of depression at onset should be raised, and
these symptoms should be attentively followed.
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Affiliation(s)
- Laura Barin
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christian P Kamm
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland/Neurology and Neurorehabilitation Centre, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Anke Salmen
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Holger Dressel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland/Division of Occupational and Environmental Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - Caroline Pot
- Laboratories of Neuroimmunology, Division of Neurology and Neuroscience Research Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich, Zurich, Switzerland/Center for Neuroscience Zurich, Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Ospedale regionale di Lugano, Lugano, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andrew Chan
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Stephanie Rodgers
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland/Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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12
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Kaufmann M, Kuhle J, Puhan MA, Kamm CP, Chan A, Salmen A, Kesselring J, Calabrese P, Gobbi C, Pot C, Steinemann N, Rodgers S, von Wyl V. Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland. Mult Scler J Exp Transl Clin 2018; 4:2055217318814562. [PMID: 30559972 PMCID: PMC6293378 DOI: 10.1177/2055217318814562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/19/2018] [Accepted: 10/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Recent studies emphasise the importance of timely diagnosis and early initiation of disease-modifying treatment in the long-term prognosis of multiple sclerosis. OBJECTIVES The objective of this study was to investigate factors associated with extended time to diagnosis and time to disease-modifying treatment initiation in the Swiss Multiple Sclerosis Registry. METHODS We used retrospective data (diagnoses 1996-2017) of the survey-based Swiss Multiple Sclerosis Registry and fitted logistic regression models (extended time to diagnosis ≥2 years from first symptoms, extended time to disease-modifying treatment initiation ≥1 year from diagnosis) with demographic and a priori defined variables. RESULTS Our study, based on 996 persons with multiple sclerosis, suggests that 40% had an extended time to diagnosis, and extended time to disease-modifying treatment initiation was seen in 23%. Factors associated with extended time to diagnosis were primary progressive multiple sclerosis (odds ratio (OR) 5.09 (3.12-8.49)), diagnosis setting outside of hospital (neurologist (private practice) OR 1.54 (1.16-2.05)) and more uncommon first symptoms (per additional symptom OR 1.17 (1.06-1.30)). Older age at onset (per additional 5 years OR 0.84 (0.78-0.90)) and gait problems (OR 0.65 (0.47-0.89)) or paresthesia (OR 0.72 (0.54-0.95)) as first symptoms were associated with shorter time to diagnosis. Extended time to disease-modifying treatment initiation was associated with older age at diagnosis (per additional 5 years OR 1.18 (1.09-1.29)). In more recent years, time to diagnosis and time to disease-modifying treatment initiation tended to be shorter. CONCLUSIONS Even in recent periods, substantial and partially systematic variation regarding time to diagnosis and time to disease-modifying treatment initiation remains. With the emerging paradigm of early treatment, the residual variation should be monitored carefully.
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Affiliation(s)
- Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, University Hospital and University of Basel, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Christian P Kamm
- Neurology and Neurorehabilitation Centre, Luzerner Kantonsspital, Switzerland
- Department of Neurology, University Hospital Bern and University of Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, University Hospital Bern and University of Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, University Hospital Bern and University of Bern, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Switzerland
| | - Claudio Gobbi
- Neurocentre of Southern Switzerland, Ospedale regionale di Lugano, Switzerland
| | - Caroline Pot
- Department of Clinical Neurosciences, University Hospital of Lausanne, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Stephanie Rodgers
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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Steinemann N, Kuhle J, Calabrese P, Kesselring J, Disanto G, Merkler D, Pot C, Ajdacic-Gross V, Rodgers S, Puhan MA, von Wyl V. The Swiss Multiple Sclerosis Registry (SMSR): study protocol of a participatory, nationwide registry to promote epidemiological and patient-centered MS research. BMC Neurol 2018; 18:111. [PMID: 30103695 PMCID: PMC6088400 DOI: 10.1186/s12883-018-1118-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/06/2018] [Indexed: 11/21/2022] Open
Abstract
Background Multiple sclerosis (MS) is one of the most frequently observed neurological conditions in Switzerland, but data sources for country-wide epidemiological trend monitoring are lacking. Moreover, while clinical and laboratory MS research are generally well established, there is a gap in patient-centered MS research to inform care management, or treatment decisions and policy making not only in Switzerland but worldwide. Methods In light of these research gaps, the Swiss Multiple Sclerosis Society initiated and funded the Swiss Multiple Sclerosis Registry (SMSR) an open-ended, longitudinal and prospective, nationwide, patient-centered study. The SMSR recruits adult persons with a suspected or confirmed MS diagnosis who reside or receive care in Switzerland. The SMSR has established a governance structure with clear rules and guidelines. It follows a citizen-science approach with direct involvement of persons with MS (PwMS), who contribute actively to registry development, operations, and research. Main scientific goals entail the study of MS epidemiology in Switzerland, health care access and provision, as well as life circumstances and wellbeing of persons with MS. The innovative study design (“layer model”) offers several participation options with different time commitments. Data collection is by means of regular surveys and medical record abstraction. Survey participation is offered in different modes (web, paper & pencil) and in the three main national languages (German, French, Italian). Participants also receive regular data feedbacks for personal use and self-monitoring, contextualized in the whole population of study participants. Data feedbacks are also used to solicit data corrections of key variables from participants. Discussion The SMSR combines the advantages of traditional and novel research methods in medical research and has recruited over 1600 PwMS in its first year. The future-oriented design and technology will enable a response not only to future technological innovations and research trends, but also to challenges in health care provision for MS. Trial registration ClinicalTrials.gov NCT02980640; December 6, 2016; retrospectively registered.
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Affiliation(s)
- Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Jens Kuhle
- Neurological Policlinic, University Hospital Basel, Basel, Switzerland
| | | | | | - Giulio Disanto
- Department of Neurology, Regional Hospital Lugano (EOC), Lugano, Switzerland
| | - Doron Merkler
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Caroline Pot
- Department of Clinical Neuroscience, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Stephanie Rodgers
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.
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Puhan MA, Steinemann N, Kamm CP, Müller S, Kuhle J, Kurmann R, Calabrese P, Kesselring J, von Wyl V, Swiss Multiple Sclerosis Registry Smsr. A digitally facilitated citizen-science driven approach accelerates participant recruitment and increases study population diversity. Swiss Med Wkly 2018; 148:w14623. [PMID: 29767828 DOI: 10.4414/smw.2018.14623] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
QUESTION UNDER STUDY Our aim was to assess whether a novel approach of digitally facilitated, citizen-science research, as followed by the Swiss Multiple Sclerosis Registry (Swiss MS Registry), leads to accelerated participant recruitment and more diverse study populations compared with traditional research studies where participants are mostly recruited in study centres without the use of digital technology. METHODS The Swiss MS Registry is a prospective, longitudinal, observational study covering all Switzerland. Participants actively contribute to the Swiss MS Registry, from defining research questions to providing data (online or on a paper form) and co-authoring papers. We compared the recruitment dynamics over the first 18 months with the a priori defined recruitment goals and assessed whether a priori defined groups were enrolled who are likely to be missed by traditional research studies. RESULTS The goal to recruit 400 participants in the first year was reached after only 20 days, and by the end of 18 months 1700 participants had enrolled in the Swiss MS Registry, vastly exceeding expectations. Of the a priori defined groups with potential underrepresentation in other studies, 645 participants (46.5%) received care at a private neurology practice, 167 participants (12%) did not report any use of healthcare services in the past 12 months, 32 (2.3%) participants lived in rural mountainous areas, and 20 (2.0% of the 1041 for whom this information was available) lived in a long-term care facility. Having both online and paper options increased diversity of the study population in terms of geographic origin and type and severity of disease, as well as use of health care services. In particular, paper enrolees tended to be older, more frequently affected by progressive MS types and more likely to have accessed healthcare services in the past 12 months. CONCLUSION Academic and industry-driven medical research faces substantial challenges in terms of patient involvement, recruitment, relevance and generalisability. Digital studies and stakeholder engagement may have enormous potential for medical research. But many digital studies are based on limited participant information and/or informed consent and unclear data ownership, and are subject to selection bias, confounding and information bias. The Swiss MS Registry serves as an example of a digitally enhanced, citizen-science study that leverages the advantages of both traditional medical research, with its established research methods, and novel societal and technological developments, while mitigating their ethical and legal disadvantages and risks.
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Affiliation(s)
- Milo A Puhan
- Medical Faculty, University of Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland / Department of Neurology, Cantonal Hospital Lucerne, Switzerland
| | - Stephanie Müller
- Department of Neurology, Cantonal Hospital St Gallen, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Switzerland
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Steinemann N, Grize L, Pons M, Rothe T, Stolz D, Turk A, Schindler C, Brombach C, Probst-Hensch N. Associations between Dietary Patterns and Post-Bronchodilation Lung Function in the SAPALDIA Cohort. Respiration 2018; 95:454-463. [DOI: 10.1159/000488148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/05/2018] [Indexed: 01/05/2023] Open
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Steinemann N, Grize L, Ziesemer K, Kauf P, Probst-Hensch N, Brombach C. Relative validation of a food frequency questionnaire to estimate food intake in an adult population. Food Nutr Res 2017; 61:1305193. [PMID: 28469546 PMCID: PMC5404419 DOI: 10.1080/16546628.2017.1305193] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/07/2017] [Indexed: 12/28/2022] Open
Abstract
Background: Scientifically valid descriptions of dietary intake at population level are crucial for investigating diet effects on health and disease. Food frequency questionnaires (FFQs) are the most common dietary tools used in large epidemiological studies. Objective: To examine the relative validity of a newly developed FFQ to be used as dietary assessment tool in epidemiological studies.
Design: Validity was evaluated by comparing the FFQ and a 4-day weighed food record (4-d FR) at nutrient and food group levels, Spearman’s correlations, Bland–Altman analysis and Wilcoxon rank sum tests were used. Fifty-six participants completed a paper format FFQ and a 4-d FR within 4 weeks. Results: Corrected correlations between the two instruments ranged from 0.27 (carbohydrates) to 0.55 (protein), and at food group level from 0.09 (soup) to 0.92 (alcohol). Nine out of 25 food groups showed correlations > 0.5, indicating moderate validity. More than half the food groups were overestimated in the FFQ, especially vegetables (82.8%) and fruits (56.3%). Water, tea and coffee were underestimated (–14.0%). Conclusions: The FFQ showed moderate relative validity for protein and the food groups fruits, egg, meat, sausage, nuts, salty snacks and beverages. This study supports the use of the FFQ as an acceptable tool for assessing nutrition as a health determinant in large epidemiological studies.
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Affiliation(s)
- Nina Steinemann
- Institute of Food and Beverage Innovation, Zurich University of Applied Sciences, Life Sciences and Facility Management, Waedenswil, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Leticia Grize
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Katrin Ziesemer
- Institute of Food and Beverage Innovation, Zurich University of Applied Sciences, Life Sciences and Facility Management, Waedenswil, Switzerland
| | - Peter Kauf
- Institute of Applied Simulation, Zurich University of Applied Sciences, Life Sciences and Facility Management, Waedenswil, Switzerland.,PrognosiX AG, Richterswil, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christine Brombach
- Institute of Food and Beverage Innovation, Zurich University of Applied Sciences, Life Sciences and Facility Management, Waedenswil, Switzerland
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Ajdacic-Gross V, Schmid M, Mutsch M, Steinemann N, von Wyl V, Bopp M. The change in the sex ratio in multiple sclerosis is driven by birth cohort effects. Eur J Neurol 2016; 24:98-104. [DOI: 10.1111/ene.13160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 08/09/2016] [Indexed: 12/01/2022]
Affiliation(s)
- V. Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute; Swiss MS Registry; University of Zurich; Zurich Switzerland
| | - M. Schmid
- Epidemiology, Biostatistics and Prevention Institute; Swiss MS Registry; University of Zurich; Zurich Switzerland
| | - M. Mutsch
- Epidemiology, Biostatistics and Prevention Institute; Swiss MS Registry; University of Zurich; Zurich Switzerland
| | - N. Steinemann
- Epidemiology, Biostatistics and Prevention Institute; Swiss MS Registry; University of Zurich; Zurich Switzerland
| | - V. von Wyl
- Epidemiology, Biostatistics and Prevention Institute; Swiss MS Registry; University of Zurich; Zurich Switzerland
| | - M. Bopp
- Epidemiology, Biostatistics and Prevention Institute; Swiss MS Registry; University of Zurich; Zurich Switzerland
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Ajdacic-Gross V, Rodgers S, Aleksandrowicz A, Mutsch M, Steinemann N, von Wyl V, von Känel R, Bopp M. Cancer co-occurrence patterns in Parkinson's disease and multiple sclerosis-Do they mirror immune system imbalances? Cancer Epidemiol 2016; 44:167-173. [PMID: 27612279 DOI: 10.1016/j.canep.2016.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND To examine the site-specific cancer mortality among deaths registered with Parkinson's disease (PD) and multiple sclerosis (MS). We focused on the patterns related to the most frequent cancers. METHODS We analyzed Swiss mortality data over a 39-year period (1969-2007), using a statistical approach applicable to unique daabases, i.e. when no linkage with morbidity databases or disease registries is possible. It was based on a case-control design with bootstrapping to derive standardized mortality ratios (SMR). The cases were defined by the cancer-PD or cancer-MS co-registrations, whereas the controls were drawn from the remaining records with cancer deaths (matching criteria: sex, age, language region of Switzerland, subperiods 1969-1981, 1982-1994, 1995-2007). RESULTS For PD we found lower SMRs in lung and liver cancer and higher SMRs in melanoma/skin cancer, and in cancers of breast and prostate. As for MS, the SMR in lung cancer was lower than expected, whereas SMRs in colorectal, breast and bladder cancer were higher. CONCLUSIONS A common pattern of associations can be observed in PD and MS, with a lower risk of lung cancer and higher risk of breast cancer than expected. Thus, PD and MS resemble other conditions with similar (schizophrenia) or reversed patterns (rheumatoid arthritis, immunosuppression after organ transplantation).
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Switzerland; Psychiatric Hospital, University of Zurich, Switzerland, Switzerland.
| | - Stephanie Rodgers
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Switzerland; Psychiatric Hospital, University of Zurich, Switzerland, Switzerland
| | | | - Margot Mutsch
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Switzerland
| | - Roland von Känel
- Department of Neurology, Bern University Hospital, and Clinic Barmelweid, Switzerland
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Switzerland
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