Introduction : The most appropriate use, type, and timing of contraception in people with multiple sclerosis (PwMS) is poorly understood, and specific guidance is absent.
Aims and Objectives : To ... provide insight into potential clinical guidelines for the use of contraception by PwMS through development of recommendations by a consensus-based program led by international clinical experts.
Methods : A multidisciplinary steering committee (SC) of 13 international expert healthcare professionals (HCPs) identified 15 key clinical questions on the use of contraception in PwMS, which addressed issues relating to patient-centred care, selection of contraception for PwMS, and time needed to use contraception since the last dose of disease modifying therapies (DMTs). Twenty-five clinical recommendations addressing the questions were drafted using evidence obtained from a comprehensive systematic literature review combined with expert opinion from the SC. An extended faculty of 32 HCPs from 18 countries including a patient association representative, and the SC members (n=12), voted on the recommendations. Consensus on recommendations was achieved when ⩾75% of respondents expressed an agreement score of 7–9, on a 9-point scale.
Results : Overall, consensus was achieved on 24 out of 25 clinical recommendations. In detail, consensus in the range of 90–100% was achieved on 11 recommendations, 12 recommendations achieved 80–89% consensus, and 1 recommendation achieved 75–79% consensus (n=44). The strength of recommendations ranged from 7–9. The one statement failing to achieve consensus scored 74.1%. Clinical recommendations are provided on the process of prescribing contraception for PwMS, including the recommended types of HCPs involved and optimal topics to discuss; the range of contraceptive options and the key considerations involved in selecting an appropriate method of contraception; and the timing of starting and stopping contraception in relation to the use of DMTs.
Conclusions : These expert recommendations were based on a robust consensus approach, providing timely and practical guidance on the use of contraception for HCPs treating PwMS and will form the basis of further publications and clinical tools.
Little is known about the impact of parental multiple sclerosis (MS) on offspring’s educational attainment. The objective of the study was to examine educational achievements in offspring of parents ...with MS compared with matched children of parents without MS in a nationwide register-based cohort study. Children of all Danish-born residents with onset between 1950 and 1986 were identified by linking the Danish Multiple Sclerosis Registry with the Civil Registration System. Twins, children with MS, and emigrated persons were excluded. The reference cohort consisted of randomly drawn individuals from the Civil Registration System without parental MS matched 8:1 to the MS offspring by sex and year of birth. Information about education was linked to the cohorts from nationwide educational registries. We included 4177 children of MS parents and 33,416 reference persons. Children of MS parents achieved statistically significant higher average grades than the reference cohort in their final exam of basic school with a mean grade difference of 0.46 (95 % CI 0.22–0.69;
p
= 0.0002). We found no difference in achievement of educational level above basic school (OR 1.04; 95 % CI 0.98–1.10;
p
= 0.20). There was a trend toward more MS offspring attaining health-related educations (OR 1.10; 95 % CI 1.00–1.21;
p
= 0.06). In conclusion, children of MS parents showed a small advantage in grade point average in final examinations in basic school, and they more often tended toward health-related educations. This study revealed no negative consequences of parental MS on grades and highest educational level achieved.
The purpose of this cross-sectional study was to determine the proportion of U.S. adults who participate in the resistance exercise modality of lifting weights (LWs) by demographic characteristics ...and to investigate the impact of LWs on the prevalence and risk of metabolic syndrome (MetS) in a national representative sample of U.S. adults. The sample (n = 5,618) in this cross-sectional study included adults aged ≥20 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. Approximately twice as many men (11.2%; 95% confidence interval CI 9.5, 13.1) reported LWs as women did (6.3%; 95% CI 5.2, 7.6) with non-Hispanic Whites (9.6%; 95% CI 8.1, 11.4) reporting the highest levels and Mexican Americans reporting the lowest levels (5.6%; 95% CI 4.4, 7.2) of engaging in LWs. Additionally, higher levels of socioeconomic status were associated with greater levels of self-reported LWs. MetS prevalence was found to be significantly lower among U.S. adults reporting LWs (24.6%; 95% CI 19.3, 30.9) compared with adults not reporting LWs (37.3%; 95% CI 35.5, 39.2) with associated risk reductions of 58% (p < 0.001) and 37% (p < 0.01) in the unadjusted model and model adjusted for demographic variables, respectively. These findings suggest that LWs may play a role in reducing the prevalence and risk of MetS among U.S. adults. Therefore, exercise professionals should strongly encourage the activity of LWs among adults of all ages to promote metabolic health and focus programs designed to increase the adoption of LWs among the subgroups who report the lowest levels of LWs.
Background
Initiation of fingolimod treatment is associated with a transient decrease of heart rate, and atrioventricular (AV) conduction block may occur.
Objective
To evaluate the therapeutic effect ...and safety of fingolimod treatment in MS patients in Denmark with focus on cardiac and pulmonary side effects at treatment onset.
Materials & methods
We analysed data from the first 496 fingolimod‐treated Danish patients, observed for at least 3 months. In a subset of 204 patients, we monitored cardiac and pulmonary adverse effects following treatment initiation.
Results
The overall annualized relapse rate (ARR) was 0.37 (95% CI 0.31–0.44); 0.22 (95% CI 0.03–0.81) in de novo‐treated patients, 0.29 (95% CI; 0.23–0.37) in patients switching from IFN‐beta or GA and 0.46 (9 5% CI 0.34–0.60) after natalizumab. In the subset of 204 patients, 8 (3.9%) required prolonged cardiac monitoring due to bradycardia and/or second‐degree AV block type I. All patients recovered spontaneously. Two patients discontinued fingolimod. Eleven (5.4%) patients reported respiratory complaints and two of these patients discontinued treatment.
Conclusions
Fingolimod appears to be safe and effective in MS patients in a clinical setting. Mild cardiac adverse effects occurred at a similar rate as in clinical trials.
Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging because of its episodic and heterogeneous ...nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network. We found that at least one of five diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, positive predictive value for a physician-confirmed diagnosis of AE, was 86% (95% confidence interval = 80–91). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% confidence interval = –0.3 to 1.9) and –1.3 years (95% confidence interval = –2.5 to –0.1), respectively. A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from The Health Improvement Network primary care electronic health records in the UK.
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