Abstract
Background
Multiple sclerosis (MS) has a negative effect on employment status.
Objective
To present the preliminary results of a special questionnaire designed to collect employment ...information on patients with MS.
Methods
The questionnaire on the impact of MS on employment status was completed by 63 patients. Fatigue, cognition, and depression were also evaluated, and 33 healthy participants were recruited as a control group.
Results
Regarding the patients' employment status, we found rates of 31.7% of full-time employment, 28.6% of part-time employment, 7.9% of unemployment due to MS, 4.8% of housewives, 1.6% retirement due to age, 15.9% of retirement due to disability, 7.9% of medical leave due to MS, and 1.6% of medical leave for other reasons. The rate of unemployment among the patients was significantly higher compared with that of the control group. Out of 38 working patients, 31% had been absent from work for the previous 3 months due to MS, and 50% had to make changes in their work to remain employed. Out of the 19 unemployed patients, 78% said that walking difficulties were the cause of unemployment, while 52% thought cognitive impairment was the cause.
Conclusions
The questionnaire provides a record of the employment status of patients with MS and describes the impact on work from their point of view.
•Fear of relapse is a negative predictor of psychological resilience and QoL in PwMS.•Resilience mediates the relationship between fear of relapse and QoL.•Psychological resilience is a positive ...predictor of QoL.
The goal of this study was to examine the mediating role of psychological resilience in the relationship between fear of relapse and quality of life in a sample of patients with multiple sclerosis (PwMS). This cross-sectional study was developed online. A total of 240 PwMS were surveyed using the Multiple Sclerosis Quality of Life inventory, the Fear of Relapse Scale and the Connor-Davidson Resilience Scale. To perform the mediation analysis PROCESS macro was used. In our study, fear of relapse was a predictor of psychological resilience and quality of life, and psychological resilience was a predictor of quality of life. Finally, psychological resilience showed a mediating role in the relationship between fear of relapse and quality of life. Considering that resilience is a modifiable variable, the implementation of interventions aimed at enhancing resilience can have a favorable impact on the psychological well-being and quality of life of patients with multiple sclerosis.
•Psychological resilience plays a crucial role in PwMS.•The CD-RISC-10 showed satisfactory psychometric properties to measure resilience in PwMS.•Higher psychological resilience was associated with ...higher global quality of life in PwMS.•Patients with higher levels of psychological resilience showed lower levels of fear of relapse and fatigue.
Background: It is urgent to increase studies aimed at exploring and understanding the role that psychological resilience plays in PwMS. To achieve this objective, an important requirement is to have properly validated instruments that allow exploring psychological resilience in MS patients. The aim of this study was to evaluate the validity and reliability of the 10-item CD-RISC in a sample of Spanish-speaking patients with MS (PwMS). Methods: An online multicenter study was conducted on 214 MS patients from 11 Spanish-speaking countries (Argentina, Mexico, Dominican Republic, Chile, Spain, Cuba, Colombia, Uruguay, Paraguay, Peru, and El Salvador). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the 10-item CD-RISC. Model fits were assessed through the χ2/df value, comparative fit index (CFI), and root mean square error of approximation (RMSEA). Results: The 10-item CD-RISC showed good psychometric characteristics in our sample of PwMS. The single-factor model in the CFA yielded a good model fit (χ2=99.380(35), p<.001; χ2/df = 2.83; RMSEA=.090; CFI=.92). Cronbach's alpha of the CD-RISC-10 items version (Spanish version) was .88. The CD-RISC-10 was significantly correlated with quality of life scale (r = .420, p < .001), fear of relapse scale (r = -.327, p < .001), and fatigue scale (r = -.367, p < .001). Conclusions: The CD-RISC-10 has satisfactory psychometric properties and is a suitable tool for measuring resilience in Spanish-speaking patients with multiple sclerosis.
•Anxiety is prevalent in MS and has been associated with decreased quality of life.•Information from Latin America regarding psychiatric comorbidities in MS is scarce.•Our results show a high ...prevalence of anxiety in Argentinian MS outpatients.•Anxiety was strongly associated with depression and reduced quality of life .
There is scarce information in Latin America regarding the prevalence of anxiety in patients with multiple sclerosis (MS) and its association with different clinical-demographic factors.
We aimed to determine the prevalence of anxiety in Argentinian MS patients and to analyze associated factors.
A cross-sectional analysis was performed with consecutive MS outpatients from two centers in Buenos Aires, Argentina. Anxiety was evaluated according to the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A).
Eighty-three patients were included. Fifty-three (63%) were females, mean age: 46 (SD=13.9) years. Forty-five percent (n = 38) had anxiety according to the HADS-A. Patients with anxiety were significantly younger (42.2 vs 49.1 years, p = 0.02), had a shorter time since diagnosis (8.3 vs 12.3 years, p = 0.02), had a history of psychiatric disorders (36.8% vs 8.8%, p = 0.002), were depressed (57.8% vs 2.2%, p<0.001) and had worse health-related quality of life according to the COOP/Wonca questionnaire (mean score: 21.5 vs 15.2, p<0.001). Depression (OR: 15.2, 95% CI 1.4–157.3, p = 0.02) and worse health-related quality of life (OR: 1.2,95% CI 1–1.4, p = 0.008) remained significantly associated with anxiety after adjusting for all other significant variables. No differences were observed regarding sex, marital and occupational status, education, family history of psychiatric disorders, disease course and disability according to the EDSS.
The prevalence of anxiety in Argentinian MS outpatients was higher than previously reported in other populations. Anxiety was strongly associated with negative outcomes such as depression and reduced health-related quality of life. These results emphasize the burden of psychiatric morbidity in Argentinian MS patients.
Abstract
Background
People with multiple sclerosis (MS) are a vulnerable group for severe COVID-19, particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the ...characteristics of COVID-19 severity in an international sample of people with MS.
Methods
Data from 12 data-sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl-fumarate, glatiramer-acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other) covariates were queried, alongside COVID-19 hospitalisation, admission to ICU, requiring artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression, adjusted for age, sex, MS phenotype, and EDSS.
Results
657 (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analysed. Among suspected+confirmed/confirmed-only COVID-19, 20.9%/26.9% were hospitalised, 5.4%/7.2% were admitted to ICU, 4.1%/5.4% required artificial ventilation, and 3.2%/3.9% died. Older age, progressive MS-phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl-fumarate, ocrelizumab and rituximab were associated with hospitalisation (aOR=1.56,95%CI=1.01-2.41; aOR=2.43,95%CI=1.48-4.02) and ICU admission (aOR=2.30,95%CI=0.98-5.39; aOR=3.93,95%CI=1.56-9.89), though only rituximab was associated with higher risk of artificial ventilation (aOR=4.00,95%CI=1.54-10.39). Importantly, associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death.
Conclusions
Despite the cross-sectional design of this study, the internal and external consistency of these results with prior studies suggests their use may be a risk factor for more severe COVID-19.
Key messages
Anti-CD20 DMTs may be associated with worse COVID-19 severity amongst people with multiple sclerosis.
•Satisfying the decisional control preferences of MS patients is an important component of providing quality care.•Our study assessed the decision-making process and related factors in a population ...of Argentinean MS patients.•A majority of Argentinean PwMS were satisfied with the information provided by their neurologist.•The most frequent patients’ decisional role was active role.•Passive role was associated with fewer years of education, fewer years of MS evolution and public health insurance.
There is scarce information regarding the decision-making process (DMP) in people with MS (PwMS) from Latin America.
To evaluate the DMP in Argentinean PwMS and to assess its relationship with patient preferences, and clinical-demographic characteristics.
PwMS from the patient organization Esclerosis Múltiple Argentina (n = 1275) were invited to participate in a self-administered web-based survey. Participants were asked to provide clinical-demographic information and to complete a questionnaire on their perceptions about the information provided by their physician, the Control Preference Scale, and the Satisfaction with the Decisions and Care Questionnaire, and were inquired on their preferred sources of information about MS.
The survey was completed by 379 PwMS. Most were females (67%); mean age: 40.3 (SD = 11.1) years; mean disease duration: 7.9 (SD = 7.2) years. Patients’ decisional control preferred role was active in 47%, shared in 27%, and passive in 26%. A moderate concordance (weighted kappa 0.55) was observed between patients’ preferences and self-reported DMP. Seventy-two percent participated in the DMP according to their preferences (concordance rates: active 66%, shared 87%, passive 51%). Most (83%) declared receiving information from their neurologists, matching their preferences (94%).
Argentinian PwMS have distinctive preferences regarding information management and decision making.
•The COVID-19 pandemic resulted in uncertain access to medical treatments for people with MS.•We investigated changes in health care delivery to MS patients from Latin America.•We found that all ...aspects of the routine care of MS patients were disrupted, including laboratory and MRI monitoring, DMT use, and access to rehabilitation services.
The COVID-19 pandemic has resulted in uncertain access to medical treatment for people with multiple sclerosis (pwMS) all over the world. However, there is no data regarding its impact on access to health care of pwMS from Latin America.
We investigated and described changes in health care delivery for pwMS from Latin America during the COVID-19 pandemic.
PwMS from 18 patient organizations of the region completed a web-based survey hosted from May to October 2020.
A total of 602 pwMS completed the questionnaire. Changes in disease-modifying therapies (DMTs) use: 6.7% of pwMS on continuous DMTs claimed to stopped them; 14.1% of those on infusion therapies declared to postpone their dosing; 68.8% declared delaying the initiation of a DMT. Disruptions in accessing rehabilitation services were reported by 65.7%. Changes in laboratory and MRI monitoring were reported by 30% and 33%, respectively. In a multivariable-adjusted logistic regression model, changes in laboratory monitoring were significantly associated with increased odds of postponing MRI monitoring (OR 4.09 CI95% 2.79–6.00, p < 0.001).
The COVID-19 pandemic has disrupted all aspects of the routine care for pwMS from Latin America. Consequences are yet to be determined.
Background
To date, there are no data available on the safety of COVID-19 vaccines in Latin American patients with Multiple Sclerosis (MS).
Objective
Characterize safety of COVID-19 vaccines in Latin ...American (LATAM) patients with Multiple Sclerosis (pwMS).
Methods
A cross-sectional study between February 1, 2021, and April 30, 2021. Individuals with MS from LATAM countries were invited to participate in a self-administered web-based survey, through MS patient organizations from the region.
Results
393 vaccinated pwMS from 10 different Latin American countries were included. The vaccines administered were: inactivated virus vaccines (IVV) in 38.2% of patients, adenovirus vector vaccines (AdV) in 48.8% and mRNA vaccines 13%. All patients received at least one dose of any of the COVID-19 vaccines and 123 (31.3%) declared receiving a second dose. Mean (SD) age 41.5 (11.8) years, 82.4% female, MS disease duration: 8.4 (8.2) years. No serious adverse events were reported with any of the COVID-19 vaccines after either the first or second dose. A lower frequency of adverse events was found with IVV (22%) in comparison with AdV (46.4%) and mRNA (35.3%) (p < 0.01). Five participants reported having an MS relapse after IVV first dose.
Conclusion
COVID-19 vaccines applied in LATAM proved safe for MS patients.
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