Multiple sclerosis is the most common inflammatory neurological disease in young adults. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic method of quantifying various effects of a given condition by demographic variables and geography. In this systematic analysis, we quantified the global burden of multiple sclerosis and its relationship with country development level.
Establishment of a national multiple sclerosis (MS) surveillance registry (MSSR) is a primary goal of the Department of Veterans Affairs (VA) MS Center of Excellence. The initial query of Veterans Health Administration (VHA) databases identified 25,712 patients (labeled "VHA MS User Cohort") from fiscal years 1998 to 2002 based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code; service-connection for MS; and/or disease-modifying agent (DMA) use. Because of ICD-9-CM limitations, the initial query was overinclusive and resulted in many non-MS cases. Thus, we needed a more rigorous case-finding method. Our gold standard was chart review of the Computerized Patient Record System for the mid-Atlantic VA medical centers. After chart review, we classified patients as not having MS or having MS/possible MS. We also applied a statistical algorithm to classify cases based on service-connection for MS, DMA use, and/or at least one healthcare encounter a year with MS coded as the primary diagnosis. We completed two analyses with kappa coefficient and sensitivity analysis. The first analysis (efficacy) was limited to cases with a definitive classification based on chart review (n = 600). The kappa coefficient was 0.85, sensitivity was 0.93, and specificity was 0.92. The second analysis (effectiveness) included unknown cases that were classified as MS/possible MS (N = 682). The kappa coefficient was 0.82, sensitivity was 0.93, and specificity was 0.90. These findings suggest that the database algorithm reliably eliminated non-MS cases from the initial MSSR population and is a reasonable case-finding method at this intermediate stage of MSSR development.
Abstract Mental health and its correlates were examined in U.S. Vietnam War veterans approximately fifty years after the War. The 2016-2017 VE-HEROeS (Vietnam Era Health Retrospective Observational Study) was a mail survey of the health of U.S. Vietnam War veterans who served between February 28, 1961 and May 7, 1975 and matched US non-veteran controls. ‘Veteran status’ represented wartime experience for three cohorts: ‘theater’ veterans with service in Vietnam, Cambodia, or Laos, non-theater veterans with service elsewhere, and non-veterans with no military service. Veterans and non-veterans, aged 58-99 years, were randomly selected from a veteran sampling frame (n=9.87 million) derived from the Department of Veterans Affairs’ USVETS dataset and a commercial address database, respectively. Questionnaires were mailed to 42,393 veterans and 6,885 non-veterans; the response rate for veterans was 45% (n=18,866) and 67% (n=4,530) for non-veterans. Weighted bivariate and multivariable analyses were conducted to examine poor overall mental health, via the SF-8TM Mental Health Component Summary score (MCS), and other mental health measures by veteran status and socioeconomic, health, and other military characteristics. Nearly 50% of all theater veterans reported poor overall mental health (MCS<50). Prevalence of mental health measures was greatest for theater veterans and successively decreased for non-theater veterans and non-veterans. Key correlates significantly (P< 0.02) associated with poor MCS included veteran status, race/ethnicity, income, physical health, health perception, trauma, distress, depression, posttraumatic stress disorder (Primary Care DSM-5 PTSD screen), and drug use. Results indicate a high burden of poor mental health among those who served in-theater.
Abstract We previously reported that a single nucleotide polymorphism (SNP) rs9282860 in serine threoninekinase 11 (STK11) gene which codes for liver kinase B1 (LKB1) has higher prevalence in Whiterelapsing-remitting multiple sclerosis (RRMS) patients than controls. To determine if this SNP is a riskfactor for MS in other populations, we assessed its prevalence in samples collected from AfricanAmerican (AA) persons with MS (PwMS) and controls at multiple Veterans Affairs (VA) Medical Centersand from a network of academic MS centers. There were no significant differences in average age atfirst symptom onset, diagnosis, disease duration, or disease severity between RRMS patients recruitedfrom VAMCs versus non-VAMCs. The SNP was more prevalent in AA than White PwMS, however onlyin secondary progressive MS (SPMS) patients was that difference statistically significant. AA SPMSpatients had higher STK11 SNP prevalence than non-MS controls; and in that cohort the SNP wasassociated with older age at symptom onset and at diagnosis. The results suggest that the STK11 SNPrepresents a risk factor for SPMS in AA patients, and is associated with an older age of symptom onsetand diagnosis.
We compared the telemedicine assessment of 20 patients with multiple sclerosis (MS) with the findings of a hands-on examiner. The remote specialist was a neurologist with expertise in MS; the hands-on examination was performed by an experienced mid-level practitioner. We also compared the findings of a second specialist viewing the examination in the room with the patient. The videoconference link operated at a bandwidth of 384 kbit/s. All three examiners independently completed a standardized rating scale for neurological functions. Cronbach's alpha for the three raters' total expanded disability status scale (EDSS) score was 0.99 with individual correlations ranging from 0.96-0.97. Agreement between raters for individual neurological domain scores was more variable. The most consistent assessments were for optic, bowel and bladder, and cerebral functions. The least consistent were for cerebellar and brain stem functions. Agreement between the remote and local examiners was similar to that reported for different neurological examiners directly assessing the same patient using the EDSS rating system.
Objective: To demonstrate the infrastructure and utility of an interactive health system database for multiple sclerosis (MS) we present the MS Surveillance Registry (MSSR) within the US VHA Health Care System. Background: Disease specific databases can be helpful in the management of neurological conditions but few are fully integrated into the electronic medical record and linked to health systems data. Creating a consistent information technology (IT) architecture and with ongoing support within disease specific registries has been a challenge. Methods: Building the MSSR was initiated by an iterative process with an IT team and MS specialists. A common "converged registry" platform shared by other VA disease specific registries (e.g. traumatic brain injury, cancer) was used to develop the IT infrastructure. MS cases were entered into an MS Assessment Tool through a web-based note at each regional MS clinic within the mid-Atlantic and Pacific Northwest regional network. Other large VHA databases linked to MSSR are reviewed. Patient demographic and clinical characteristics were compared and contrasted with the broader VHA population and other US registry populations. Results: Of some 25,000 patients with MS actively using the VA health care system between 2013-2015, we enrolled 930 in MSSR from two geographic regions. The mean age of patients was 56.0 years, with M:F ratio of 2.7. Among those with definite MS, the mean European Database for MS score was 5.1 and 47[percnt] were currently using a DMT. A summary electronic dashboard was developed for health care providers to easily access demographic and clinical data for individuals and groups of patients. Data on co-morbid conditions, pharmacy and prosthetics utilization, outpatient clinic and inpatient admission were documented for each patient. Conclusions: The MSSR is a unique electronic database that has enhanced clinical management of MS and serves as a national source for clinical outcomes.
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