Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study

Background: Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education. Objective: The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size. Methods: Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors. Results: Higher level of education were associated with decreased MS risk ( p trend = 0.001) with an OR of 0.53 (95% CI 0.41–0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44–0.83). The estimates remained similar when cases with disease onset before age 28 were excluded. Conclusion: These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk.

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Analytical epidemiology of multiple sclerosis in the Republic of Kabardino-Balkaria

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-1s-10-14 ◽

2021 ◽

Vol 13 (1S) ◽

pp. 10-14

Author(s):

L. B. Tlapshokova ◽

A. R. Zikhova

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Environmental Factors ◽

Scarlet Fever ◽

Disease Onset ◽

Clinical Manifestations ◽

Control Group ◽

Place Of Residence ◽

History Of ◽

The Republic

Multiple sclerosis (MS) is a common autoimmune disease, which etiology includes a complex of genetic and environmental factors. Data suggests that their interaction can influence the age of the clinical manifestations and the course of the disease. Therefore, the study of risk factors of MS in regions with different ethnic compositions of the population and climatic and geographical characteristics is of considerable interest.Objective: to study MS risk factors prevalence in the Republic of Kabardino-Balkaria (RKB).Patients and methods. This case-control study of the representation of risk factors included a cohort of 112 MS patients living in two regions of the RKB (Nalchik and the Prokhladnensky district). The MS diagnosis was established with the McDonald criteria (2017). MS risk factors were assessed with a unified questionnaire. 112 respondents (matched by the main demographic characteristics and place of residence) were included in the control group.Results and discussion. MS patients from the Prokhladnensky district were significantly more likely to contact harmful chemical compounds, had higher consumption of smoked meat products; and suffered from viral infections more often (all differences were significant, p<0.05). More patients with MS, regardless of their place of residence, had a history of scarlet fever than the controls (n=23; 19.5% and n=14; 13.4%, ratio indicator 0.43 (95% CI 0.32–1.01), p=0.041), and the maximum significance of this factor was found in patients who suffered from scarlet fever after the age of 15 years (n=7; 6.3% and n=1; 0.9%, ratio indicator 2.45 (95% CI 1.92–3.21), p=0.041). More patients with MS had a history of chickenpox (n=70; 62.5% and n=55; 41.1%; ratio indicator 0.78 (95% CI 0.65–0.94, p=0.032), the frequency of this factor was most significant in early (up to 7 years) disease onset. Regardless of the place of residence, patients with MS were more likely to suffer from tonsillitis and sinusitis in childhood (p=0.032).Conclusion. In the RKB, as in other regions of the Russian Federation, the risk of MS, along with a genetic predisposition, is primarily determined by environmental factors, such as contact with potentially harmful chemicals, history of somatic diseases, characteristics of the ecological situation, etc. Therefore, MS risk is higher in people exposed to these factors before the age of 7 years and does not depend on the place of residence.

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Introduction

Our Most Troubling Madness ◽

10.1525/california/9780520291089.003.0001 ◽

2016 ◽

Author(s):

T. M. Luhrmann

Keyword(s):

United States ◽

The United States ◽

Social Conditions ◽

Lower Socioeconomic Status ◽

Ethnic Density ◽

Cultural Interpretation ◽

Lower Socioeconomic ◽

The Social ◽

The Family ◽

History Of

The introduction lays out what we know about the social context of schizophrenia from the epidemiological literature: that risk of schizophrenia is particularly high for immigrants from predominantly dark-skinned countries to Europe; that risk increases with lower socioeconomic status at birth and even at parent’s birth; that risk increases with urban dwelling and seems to increase the longer time is spent in cities; that risk increases as ethnic density in the neighborhood declines. The chapter presents a history of the way schizophrenia has been understood in the United States, and the diagnostic complexities of serious psychotic disorder. It then discusses what ethnographers have observed so far about the social conditions which may shape the experience of psychosis: the local cultural interpretation of mental illness; the role and presence of the family; the structure of work; and the basic social environment. This becomes the ground for our case studies.

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A logistic regression analysis of risk factors in ME/CFS pathogenesis

BMC Neurology ◽

10.1186/s12883-019-1468-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Eliana M. Lacerda ◽

Keith Geraghty ◽

Caroline C. Kingdon ◽

Luigi Palla ◽

Luis Nacul

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Regression Analysis ◽

Risk Factor ◽

Family History ◽

Disease Onset ◽

Healthy Controls ◽

Lower Income ◽

Wide Range ◽

History Of

Abstract Background Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease, whose exact cause remains unclear. A wide range of risk factors has been proposed that helps understanding potential disease pathogenesis. However, there is little consistency for many risk factor associations, thus we undertook an exploratory study of risk factors using data from the UK ME/CFS Biobank participants. We report on risk factor associations in ME/CFS compared with multiple sclerosis participants and healthy controls. Methods This was a cross-sectional study of 269 people with ME/CFS, including 214 with mild/moderate and 55 with severe symptoms, 74 people with multiple sclerosis (MS), and 134 healthy controls, who were recruited from primary and secondary health services. Data were collected from participants using a standardised written questionnaire. Data analyses consisted of univariate and multivariable regression analysis (by levels of proximity to disease onset). Results A history of frequent colds (OR = 8.26, P <= 0.001) and infections (OR = 25.5, P = 0.015) before onset were the strongest factors associated with a higher risk of ME/CFS compared to healthy controls. Being single (OR = 4.41, P <= 0.001), having lower income (OR = 3.71, P <= 0.001), and a family history of anxiety is associated with a higher risk of ME/CFS compared to healthy controls only (OR = 3.77, P < 0.001). History of frequent colds (OR = 6.31, P < 0.001) and infections before disease onset (OR = 5.12, P = 0.005), being single (OR = 3.66, P = 0.003) and having lower income (OR = 3.48, P = 0.001), are associated with a higher risk of ME/CFS than MS. Severe ME/CFS cases were associated with lower age of ME/CFS onset (OR = 0.63, P = 0.022) and a family history of neurological illness (OR = 6.1, P = 0.001). Conclusions Notable differences in risk profiles were found between ME/CFS and healthy controls, ME/CFS and MS, and mild-moderate and severe ME/CFS. However, we found some commensurate overlap in risk associations between all cohorts. The most notable difference between ME/CFS and MS in our study is a history of recent infection prior to disease onset. Even recognising that our results are limited by the choice of factors we selected to investigate, our findings are consistent with the increasing body of evidence that has been published about the potential role of infections in the pathogenesis of ME/CFS, including common colds/flu.

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A systematic review of modifiable risk factors in the progression of multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458517690270 ◽

2017 ◽

Vol 23 (4) ◽

pp. 525-533 ◽

Cited By ~ 27

Author(s):

Susanne Hempel ◽

Glenn D Graham ◽

Ning Fu ◽

Elena Estrada ◽

Annie Y Chen ◽

...

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Vitamin D ◽

Meta Analysis ◽

Clinical Manifestations ◽

Rapid Decline ◽

Modifiable Risk Factors ◽

Presenting Symptoms ◽

Increased Risk ◽

Vitamin D Levels

Background: The presenting symptoms and rate of progression of multiple sclerosis (MS) are very heterogeneous. The diverse clinical manifestations and the clinical course of the disease may vary with modifiable risk factors. Objective: To systematically review modifiable risk factors and exposures associated with MS progression. Methods: We searched six databases till March 2015, reference-mined reviews, and consulted with experts (PROSPERO 2015:CRD42015016461). Two reviewers screened and extracted data. We used random meta-analysis models and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the quality of evidence. Results: In total, 59 studies met inclusion criteria. Lower vitamin D levels were associated with higher Expanded Disability Status Scale (EDSS) scores ( r = −0.22; confidence interval (CI) = −0.32, −0.12; 11 studies; I2 = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I2 = 72%; seven studies), and there was no association of MS progression with the use of epidural analgesics during childbirth delivery (three studies). There was insufficient evidence to draw conclusions for 11 risk factors due to conflicting results or use of different predictor and outcome measures. Conclusion: MS progression was consistently associated with low vitamin D levels, and smoking was associated with a more rapid decline in MS disability. Studies used a variety of methods, predictors, and outcomes making it difficult to draw conclusions. Future studies should focus on prospective assessments.

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Clinical and epidemiological differences in the course of psoriasis in children depending on Vitamin D levels and genotypes of the TaqI polymorphic variant of the VDR gene

10.29328/journal.adr.1001014 ◽

2021 ◽

Vol 5 (1) ◽

pp. 006-012

Author(s):

Elvina Murzina

Keyword(s):

Vitamin D ◽

Clinical Presentation ◽

Disease Onset ◽

Serum Levels ◽

Polymorphic Variant ◽

Vdr Gene ◽

Epidemiological Features ◽

Vitamin D Levels ◽

Significant Difference ◽

History Of

When grouping children with psoriasis depending on TaqI (T/C) genotypes of the VDR gene, the youngest age of disease onset and the longest duration of dermatitis (5.60 ± 0.77 years and 4.90 ± 0.68 years, respectively) showed up in case of the CC genotype. In case of the TT genotype, disease onset coincided with an older age, and the history of present illness was the shortest (10.26 ± 0.64 years and 2.59 ± 0.58 years, respectively). PASI (20.32 ± 3.43) and BSA (40.00 ± 6.11) severity indices were the highest and of statistically significant difference to those in other groups in the presence of the CC genotype. In case of the TC genotype, the index PGA (2.80 ± 0.15) was the lowest and made a statistically significant difference to the values of other groups. A negative correlation between vitamin D levels and the PASI, PGA, BSA was identified in children holding CC and TC genotypes. Conclusion: The clinical presentation of dermatitis and its epidemiological features in children with psoriasis, namely the age of disease onset, duration of exacerbation, body surface area and the intensity of psoriasis symptoms depend on vitamin D serum levels and genotypes of the TaqI polymorphic variant of the VDR gene.

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POS0168 BONE MINERAL DENSITY IN PATIENTS WITH MULTIPLE SCLEROSIS. A DESCRIPTIVE STUDY FROM A UNIQUE CENTER FROM THE EAST OF SPAIN

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3214 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 296.2-297

Author(s):

E. Flores-Fernández ◽

C. Valera-Ribera ◽

I. Vázquez-Gómez ◽

A. V. Orenes Vera ◽

À. Martínez-Ferrer ◽

...

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Bone Mineral Density ◽

Vitamin D ◽

Specific Treatment ◽

Personal History ◽

Mineral Density ◽

Cross Sectional ◽

History Of ◽

Low Levels

Background:Several studies have suggested that multiple sclerosis (MS) patients have low bone mineral density (LBMD) compared to healthy adults of same age. This fact, combined with the functional impairment of the disease, increases the risk of fractures. However, information about the prevalence and the risk factors of LBMD in Spanish patients with MS is still quite limited1–3.Objectives:To evaluate the prevalence of LBMD and low vitamin D in patients with MS from a unique center from the east of Spain, describing the clinical features of these patients.Methods:Type of study: observational, cross-sectional, descriptive. Patients with MS from a local cohort have been consecutively recruited for this study since Apr-2020. A cross-sectional visit which included a clinical interview, analytic test (blood and urine) and a dual-energy X-ray absorptiometry (DXA) was performed. We defined LBMD as T score ≤-1SD in postmenopausal women and men over 50 years and a Z score ≤-2SD in premenopausal women and men under 50 years. Low levels of vitamin D were defined as < 20ng/mL. A descriptive and associative analysis of these data was carried out using the SPSS software.Results:From a cohort of 288 MS patients, due to the COVID-19 pandemia, we have only been able to assess 60 patients, and only 48 out of them have undergone all the tests required. These were 30 women and 18 men, with a mean age of 49 (SD 11,6) years. The main type of MS was relapsing-remiting (77,1%) and 25% of them were not taking any maintenance treatment. Some of the classical factors related to a LBMD are shown in table a1. A 43,8% of the patients had a LBMD and 40,5% had low levels of vitamin D. Despite these results, as far as 89% of patients had never received any specific treatment, not even calcium and/or vitamin D supplementation. Furthermore, 13 patients (27,1%) must have received specific treatment, according to latest guidelines4, and only 4 of them (8,5%) were being adequately treated.Table 1.Women/Men (n)30/18Mean age; SD (years)49; 11,6Non smokers/Smokers (%)58,4/41,7Alcohol abuse (%)8,3Personal history of fracture (%)10,4Personal history of nephrolithiasis (%)14,6Normal/Reduced mobility (%)77,1/22,9Sedentary lifestyle (%)66,7Conclusion:These preliminary results show that almost half of the MS patients have LBMD and a low vitamin D, most of them without taking any specific treatment. Taking this in mind, it is necessary to integrate the early diagnosis of LBMD in MS patients, working together with neurologists, to prevent the appearance of fractures and protect the quality of life of these patients. An analysis of our whole cohort of MS patients will help us in correctly assessing the magnitude of this problem.References:[1]López Méndez P, Sosa Henríquez M. Vitamin D and multiple sclerosis. Prevalence of hypovitaminosis D. Rev Osteoporos y Metab Miner. 2015;7(2):71-78.[2]Gupta S, Ahsan I, Mahfooz N, Abdelhamid N, Ramanathan M, Weinstock-Guttman B. Osteoporosis and multiple sclerosis: Risk factors, pathophysiology, and therapeutic interventions. CNS Drugs. 2014;28(8):731-742.[3]Moen S, E.Celius, L S, L N, E E, T H. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology. 2011;77(2):151-157.[4]Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2017;76(5):802-810.Disclosure of Interests:None declared

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mHealth – Friend or Foe in Reducing Inequality? A Systematic Literature Review

10.31237/osf.io/w8qgj ◽

2018 ◽

Author(s):

Hannes Jarke

Keyword(s):

Systematic Review ◽

Socioeconomic Status ◽

Literature Review ◽

Systematic Literature Review ◽

Lower Socioeconomic Status ◽

Social Equality ◽

Level Of Education ◽

Disadvantaged Groups ◽

Lower Socioeconomic ◽

The Social

The rising availability of mHealth interventions—such as apps or text-based support—is seen as an unprecedented opportunity to enhance social equality in health matters. Results from various isolated studies support these assumptions, but no attempt has been made to aggregate and synthesise available evidence. This systematic review finds that while some disadvantaged groups can benefit from mHealth, the technology may also increase inequality in certain areas. Especially a low level of education and lower socioeconomic status appear to be barriers to benefit from mHealth. More coordinated research approaches focussing on specific topics and populations within the field of mHealth are needed to create evidence for informing the development of interventions that foster equality instead of expanding the social gap.

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Risk Factors Associated with Multiple Sclerosis: A Case-Control Study in Damascus, Syria

Multiple Sclerosis International ◽

10.1155/2021/8147451 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Maher Taan ◽

Farah Al Ahmad ◽

Mohammad Karim Ercksousi ◽

Ghassan Hamza

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Vitamin D ◽

Family History ◽

Vitamin D Deficiency ◽

Case Control Study ◽

Case Control ◽

Factors Associated ◽

History Of ◽

Control Study

Objectives. To assess the probable risk factors associated with Multiple sclerosis among Syrian patients in the city of Damascus. Method. In a case-control study conducted from May to September 2020, 140 MS patients and 140 healthy controls were selected from two main hospitals in Damascus. Data regarding risk factors associated with MS was collected via a structured questionnaire and complementary laboratory tests. The statistical analysis was carried out by the SPSS Statistical Software Version 26. Results. Factors such as smoking, family history of MS, migraine, and vitamin D deficiency were associated with a higher risk of developing MS: Smoking ( OR = 2.275 95% CI (1.348-3.841) P = 0.002 ). Family history of MS ( OR = 3.970 95% CI (1.807-8.719) P ≤ 0.001 ). Migraine ( OR = 3.011 95% CI (1.345-6.741) P = 0.005 ). Vitamin D deficiency ( OR = 4.778 95% CI (2.863-7.972) P ≤ 0.001 ). However, factors such as diabetes, hypertension, a surgical history of appendectomy, tonsillectomy, and being the first-born in a family were statistically irrelevant: Diabetes ( OR = 0.652 95% CI (0.226-1.882) P = 0.426 ). Hypertension ( OR = 1.445 95% CI (0.724-2.885) P = 0.295 ) Appendectomy ( OR = 1.269 95% CI (0.486-3.317) P = 0.626 ) Tonsillectomy ( OR = 1.280 95% CI (0.576-2.843) P = 0.544 ). First-born Child ( OR = 0.933 95% CI (0.558-1.562) P = 0.793 ). Conclusion. Our study suggests that smoking, vitamin D deficiency, family history of MS, and migraine are probable risk factors for multiple sclerosis. Therefore, engaging in outdoor activities and maintaining a healthy diet—for females in particular—is highly recommended.

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