Multiple sclerosis management during the COVID-19 pandemic

Background: People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. Objectives: To evaluate risk factors for COVID-19 susceptibility and describe the pandemic’s impact on healthcare delivery. Methods: Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d’Hebron-Centre d’Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. Results: There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Conclusion: Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption.

Download Full-text

The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated

Multiple Sclerosis Journal ◽

10.1177/1352458508099477 ◽

2009 ◽

Vol 15 (3) ◽

pp. 385-392 ◽

Cited By ~ 118

Author(s):

RA Marrie ◽

R Horwitz ◽

G Cutter ◽

T Tyry ◽

D Campagnolo ◽

...

Keyword(s):

Multiple Sclerosis ◽

Socioeconomic Status ◽

Depression Scale ◽

Epidemiologic Studies ◽

Lower Socioeconomic Status ◽

Research Committee ◽

The North ◽

Lower Socioeconomic ◽

Mental Comorbidities ◽

Mental Comorbidity

Background Mental comorbidity is common in multiple sclerosis (MS), but some studies suggest that mental comorbidity may be underrecognized and undertreated. Objective Using the North American Research Committee on MS Registry, we assessed the frequency of mental comorbidities in MS and sociodemographic characteristics associated with diagnosis and treatment of depression. Methods We queried participants regarding depression, anxiety, bipolar disorder, and schizophrenia. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD); a score ≥21 indicated probable major depression. Results Mental comorbidity affected 4264 (48%) responders; depression most frequently (4012, 46%). Among participants not reporting mental comorbidity, 751 (16.2%) had CESD scores ≥21 suggesting undiagnosed depression. Lower socioeconomic status was associated with increased odds of depression (Income $15,000–30,000 vs >$100,000 OR 1.34; 1.11–1.62), undiagnosed depression (Income $15,000–30,000 vs >$100,000 OR 1.52; 1.08–2.13), and untreated depression (<high school vs postgraduate degree OR 3.13; 1.65–5.99). Conclusions Mental comorbidity remains underdiagnosed and undertreated in MS. Patients of lower socioeconomic status bear a disproportionate share of the burden of depression.

Download Full-text

The Effects of Retirement on Sense of Purpose in Life: Crisis or Opportunity?

Psychological Science ◽

10.1177/09567976211024248 ◽

2021 ◽

pp. 095679762110242

Author(s):

Ayse Yemiscigil ◽

Nattavudh Powdthavee ◽

Ashley V. Whillans

Keyword(s):

Purpose In Life ◽

The United States ◽

Socioeconomically Disadvantaged ◽

Lower Socioeconomic Status ◽

Instrumental Variable Analysis ◽

Sense Of Purpose ◽

Existential Crisis ◽

Retirement Incentives ◽

Lower Socioeconomic ◽

Nationally Representative

Does retirement lead to an existential crisis or present an opportunity to experience a renewed sense of purpose in life? Prior research has documented a negative association between retirement and sense of purpose in life, suggesting that retirement could lead people to feel aimless and lost. We revisited these findings using a quasiexperimental approach and identified the causal impact of retirement on purpose in life. In a nationally representative panel of American adults ( N = 8,113), we applied an instrumental-variable analysis to assess how Social Security retirement incentives in the United States drove differences in the likelihood of retirement. Results showed a sizable increase in purpose in life as an outcome of retirement. These improvements were driven by individuals with lower socioeconomic status who retired from dissatisfying jobs. The findings suggest that retirement may provide an opportunity to experience a renewed sense of purpose, especially among socioeconomically disadvantaged populations.

Download Full-text

Risk factors for leaving employment due to multiple sclerosis and changes in risk over the past decades: Using competing risk survival analysis

Multiple Sclerosis Journal ◽

10.1177/1352458520954167 ◽

2020 ◽

pp. 135245852095416

Author(s):

Jing Chen ◽

Bruce Taylor ◽

Leigh Blizzard ◽

Steve Simpson-Yap ◽

Andrew J Palmer ◽

...

Keyword(s):

Multiple Sclerosis ◽

Survival Analysis ◽

Progressive Multiple Sclerosis ◽

Education Level ◽

Competing Risk ◽

Primary Progressive Multiple Sclerosis ◽

Lower Education Level ◽

Relapsing Remitting ◽

Lower Education ◽

Relapsing Remitting Multiple Sclerosis

Background: No studies have assessed changes in employment survival in multiple sclerosis (MS) populations over recent decades, including the introduction of disease-modifying therapies (DMTs). Objectives: To evaluate factors associated with leaving employment due to MS; to assess whether the risk of leaving employment has changed over recent decades in Australia, stratified by MS phenotype. Methods: We included 1240 participants who were working before MS diagnosis. Information on employment status, reasons for leaving employment and year of leaving were collected. Data were analysed using competing risk survival analysis. Results: Males, progressive MS, lower education level and older age at diagnosis were associated with a higher sub-distribution hazard of leaving employment. Compared to the period before 2010, the sub-distribution hazard during 2010–2016 for relapsing-remitting multiple sclerosis (RRMS) was reduced by 43% (sub-distribution hazard ratio (sHR) 0.67, 95% confidence interval (CI): 0.50 to 0.90), while no significant reduction was seen for primary-progressive multiple sclerosis (PPMS) (sHR 1.25, 95% CI: 0.72 to 2.16) or secondary-progressive multiple sclerosis (SPMS) (sHR 1.37, 95% CI: 0.84 to 2.25). Conclusion: Males, people with progressive MS and those of lower education level were at higher risk of leaving employment. The differential changed risk of leaving employment between people with different MS phenotype after 2010 coincides with the increased usage of high-efficacy DMTs for RRMS.

Download Full-text

High levels of alexithymia in patients with multiple sclerosis

Dementia & Neuropsychologia ◽

10.1590/1980-57642018dn12-020015 ◽

2018 ◽

Vol 12 (2) ◽

pp. 212-215 ◽

Cited By ~ 4

Author(s):

Audred Cristina Biondo Eboni ◽

Mariana Cardoso ◽

Felipe Moreira Dias ◽

Paulo Diniz da Gama ◽

Sidney Gomes ◽

...

Keyword(s):

Multiple Sclerosis ◽

Control Group ◽

Cross Sectional ◽

Group Data ◽

Lower Education Level ◽

Degree Of Disability ◽

Lower Education ◽

Had Scale ◽

Relevant Finding ◽

Control Study

Abstract Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce. Objective: The objective of the present study was to characterize findings of alexithymia in patients with MS. Methods: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used. Results: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia. Conclusion: Alexithymia was a relevant finding in patients with MS.

Download Full-text

Body composition and hypertension: a comparative study involving women from maroon communities and from the general population of Alagoas State, Brazil

Revista de Nutrição ◽

10.1590/s1415-52732013000500005 ◽

2013 ◽

Vol 26 (5) ◽

pp. 539-549 ◽

Cited By ~ 5

Author(s):

Haroldo da Silva Ferreira ◽

Wcleuton Oliveira Silva ◽

Ewerton Amorim dos Santos ◽

Myrtis Katille de Assunção Bezerra ◽

Bárbara Coelho Vieira da Silva ◽

...

Keyword(s):

Body Composition ◽

Prevalence Ratio ◽

The State ◽

The Body ◽

Age At Menarche ◽

Cross Sectional ◽

Lower Socioeconomic ◽

Lower Education Level ◽

Lower Education ◽

Measure Of Association

OBJECTIVE: This study investigated the body composition and prevalence of hypertension in maroon women from the State of Alagoas and compared these variables with those of non-maroon women from the same state. METHODS: The data were collected from two cross-sectional surveys done in 2005 and 2008. The first study included a representative sample of mothers of children aged 0 to 5 years from the State of Alagoas, and the second study included all women aged 18 to 60 years living in maroon communities (n=39) in the same state. Data were collected during home interviews. The prevalence ratio and respective 95% confidence interval given by the Poisson regression with robust adjustment of variance was used as the measure of association. RESULTS: The study assessed 1,631 maroon women and 1,098 non-maroon mothers. Maroon women had lower education level, more children, higher prevalence of hypertension and stunting, and higher age at menarche, body mass index, waist circumference, waist-to-height ratio, and waist-to-hip ratio. After adjustment for age, the following prevalences remained higher in maroon women: hypertension (PR=1.81; 95%CI: 1.49; 2.21), WC >80cm (PR=1.23 95%CI: 1.11; 1.37), WHtR >0.5 (PR=1.11; 95%CI: 1.02; 1.21), and WHR >0.85 (PR=1.64; 95%CI: 1.43; 1.88). CONCLUSION: Maroon women belong to lower socioeconomic classes than non-maroon women and are at greater risk of abdominal obesity and hypertension, characteristics that make them especially vulnerable to the morbidity and mortality caused by cardiovascular diseases, justifying the preferential implementation of measures of care.

Download Full-text

A Pilot Study and Ecological Model of Smoking Cues to Inform Mobile Health Strategies for Quitting Among Low-Income Smokers

Health Promotion Practice ◽

10.1177/1524839920942214 ◽

2020 ◽

pp. 152483992094221

Author(s):

Shuo Zhou ◽

Arnold H. Levinson ◽

Xuhong Zhang ◽

Jennifer D. Portz ◽

Susan L. Moore ◽

...

Keyword(s):

Smoking Cessation ◽

Mobile Health ◽

Low Income ◽

Ecological Model ◽

Environmental Cues ◽

Socioeconomically Disadvantaged ◽

Lower Socioeconomic Status ◽

Lower Socioeconomic ◽

Smoking Cues ◽

Pros And Cons

One crucial factor that leads to disparities in smoking cessation between groups with higher and lower socioeconomic status is more prevalent socioenvironmental smoking cues in low-income communities. Little is known about how these cues influence socioeconomically disadvantaged smokers in real-world scenarios and how to design interventions, especially mobile phone–based interventions, to counteract the impacts of various types of smoking cues. We interviewed 15 current smokers living in low-income communities and scanned their neighborhoods to explore smoking-related experiences and identify multilevel cues that may trigger them to smoke. Findings suggest four major types of smoking cues influence low-income smokers—internal, habitual, social, and environmental. We propose an ecological model of smoking cues to inform the design of mobile health (mHealth) interventions for smoking cessation. We suggest that user-triggered strategies will be most useful to address internal cues; server-triggered strategies will be most suitable in changing perceived social norms of smoking and routine smoking activities to address social and habitual cues; and context-triggered strategies will be most effective for counteracting environmental cues. The pros and cons of each approach are discussed regarding their cost-effectiveness, the potential to provide personalized assistance, and scale.

Download Full-text

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

Multiple Sclerosis Journal ◽

10.1177/1352458515579444 ◽

2015 ◽

Vol 22 (1) ◽

pp. 104-111 ◽

Cited By ~ 18

Author(s):

Kjetil Bjørnevik ◽

Trond Riise ◽

Marianna Cortese ◽

Trygve Holmøy ◽

Margitta T Kampman ◽

...

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Vitamin D ◽

Disease Onset ◽

Lower Socioeconomic Status ◽

Level Of Education ◽

Lower Socioeconomic ◽

Vitamin D Levels ◽

The Social ◽

History Of

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.

Download Full-text