Publications by authors named "Ingrid van der Mei"

106 Publications

Development and psychometric properties of the Multiple Sclerosis Knowledge Assessment Scale: Rasch analysis of a novel tool for evaluating MS knowledge.

Mult Scler 2021 Apr 17;27(5):767-777. Epub 2020 Jun 17.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

Background: Multiple sclerosis (MS)-related knowledge is an important evaluation metric for health education interventions. However, few MS knowledge assessment tools are currently available for use.

Objectives: This study aims to develop a reliable and valid Multiple Sclerosis Knowledge Assessment Scale (MSKAS) for use in the MS community and the general public.

Methods: The MSKAS was developed using a Delphi study methodology and was administered to participants in the first open enrolment of the Understanding Multiple Sclerosis (UMS) online course. Rasch analysis was used to examine its psychometric properties and develop the final scale.

Results: Experts from across the MS community participated in the development of the MSKAS, resulting in an initial scale of 42 items. Five hundred and forty-three UMS participants completed the MSKAS; 89% were female and 30% were people with MS. The final unidimensional 22-item scale has a person separation index of 2.16, a person reliability index of 0.82, an item separation index of 11.19, and a Cronbach's alpha (kr-20) test reliability of 0.87.

Conclusion: The MSKAS is a unidimensional scale with good construct validity and internal consistency. The MSKAS has the potential to be useful for the assessment of MS knowledge in research and clinical practice.
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http://dx.doi.org/10.1177/1352458520929626DOI Listing
April 2021

Dietary patterns and associations with health outcomes in Australian people with multiple sclerosis.

Eur J Clin Nutr 2021 Feb 2. Epub 2021 Feb 2.

Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.

Background/objectives: Associations between patterns of food intake and health in people with multiple sclerosis (MS) are of increasing global interest; however, Australian data are lacking. This study aimed to assess the dietary habits and associations with health outcomes of Australians with MS.

Subjects/methods: This cross-sectional study used 2016 survey data from the Australian MS Longitudinal Study, including the Dietary Habits Questionnaire, Hospital Anxiety and Depression Scale, Assessment of Quality of Life, Fatigue Severity Scale, Patient-Determined Disease Steps Scale and 13 MS symptoms scales. Regression models were constructed using directed acyclic graphs.

Results: Almost all (94.3%) of the 1490 participants reported making an effort to eating healthy with 21.2% following one or more specific diets, although often not strictly. Overall, 7.9% reported not eating meat, 8.1% reported not consuming dairy, and 4.0% consumed neither food group. A healthier diet score was associated with better mental, physical and total quality of life, and lower depression, and pain scores, and fewer cognition, vision and bowel symptoms. Higher reported fibre, fruit, vegetable and healthy fat scores were positively associated with most health outcomes.

Conclusions: Healthier overall diet scores and higher fibre, fruit and vegetable scores were associated with better health outcomes in this sample of Australians adults with MS. However, the proportion of participants avoiding dairy and meat, or adhering to a specific MS diet was much lower than previously reported. Prospective dietary studies are needed to further understand whether dietary change is feasible and affects health outcomes over time.
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http://dx.doi.org/10.1038/s41430-021-00864-yDOI Listing
February 2021

Assessing the consistency and validity of self-reported year of diagnosis among participants in a longitudinal study of people with multiple sclerosis.

Mult Scler Relat Disord 2021 Jan 16;49:102755. Epub 2021 Jan 16.

Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000.

Background: Self-reported outcomes are important for epidemiological research but are vulnerable to bias.

Objective: In this study, we evaluated: 1) the consistency and validity of self-reported year of diagnosis among people living with MS, 2) factors associated with participant inconsistency, and 3) the impact of observed inconsistency on the calculation of the Multiple Sclerosis Severity Score (MSSS).

Methods: Using data collected by the Australian MS Longitudinal Study, we evaluated the consistency of self-reported year of diagnosis using correlation, mean differences, and percentage agreement. We examined the impact of participant characteristics using Cragg hurdle models, and determined the effect of the observed inconsistency on MSSS using simulations compared with paired t-tests.

Results: Of the 2,445 participants, 80.3% were within 1 year of their baseline year of diagnosis in all subsequent responses (range of 2-10 responses). Participant inconsistency was positively associated with age at first response and the number of years elapsed between the first and final response. However, the effect sizes of these associations were small. Finally, the observed inconsistency did not affect the calculation of MSSS (mean difference smaller than 0.01; p>0.90 for all comparisons).

Conclusion: This data provides support for the use of patient-reported year of diagnosis, as people with MS were consistent in reporting their year of diagnosis and the impact of any inconsistency on clinical outcomes, such as the MSSS, was negligible.
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http://dx.doi.org/10.1016/j.msard.2021.102755DOI Listing
January 2021

Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition.

Mult Scler 2020 12 11;26(14):1816-1821. Epub 2020 Nov 11.

Multiple Sclerosis International Federation, London, UK.

Background: High-quality epidemiologic data worldwide are needed to improve our understanding of disease risk, support health policy to meet the diverse needs of people with multiple sclerosis (MS) and support advocacy efforts.

Objectives: The Atlas of MS is an open-source global compendium of data regarding the epidemiology of MS and the availability of resources for people with MS reported at country, regional and global levels.

Methods: Country representatives reported epidemiologic data and their sources via survey between September 2019 and March 2020, covering prevalence and incidence in males, females and children, and age and MS type at diagnosis. Regional analyses and comparisons with 2013 data were conducted.

Results: A total of 2.8 million people are estimated to live with MS worldwide (35.9 per 100,000 population). MS prevalence has increased in every world region since 2013 but gaps in prevalence estimates persist. The pooled incidence rate across 75 reporting countries is 2.1 per 100,000 persons/year, and the mean age of diagnosis is 32 years. Females are twice as likely to live with MS as males.

Conclusions: The global prevalence of MS has risen since 2013, but good surveillance data is not universal. Action is needed by multiple stakeholders to close knowledge gaps.
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http://dx.doi.org/10.1177/1352458520970841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720355PMC
December 2020

Comorbidities are prevalent and detrimental for employment outcomes in people of working age with multiple sclerosis.

Mult Scler 2020 10 6;26(12):1550-1559. Epub 2019 Sep 6.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

Background: More work is needed to understand the burden of comorbidities in people with multiple sclerosis (MS).

Objective: To assess prevalence of 30 comorbidities and impacts of comorbidities on employment outcomes in a working-aged MS cohort.

Methods: Participants were from the Australian MS Longitudinal Study ( = 929). Information on specific comorbidity was obtained (whether or not each was present, doctor-diagnosed, limited their activities and being treated).

Results: Comorbidities most frequently reported to limit activities were osteoarthritis (51%), migraines (40%), anxiety (33%), depression (29%) and allergies (18%). Mean MS-related work productivity loss in past 4 weeks was 1.3 days for those without comorbidities and 2.5 days for those with any comorbidity. The annual population costs of work productivity loss were highest for people with depression, allergies, anxiety, migraines and osteoarthritis. Higher number of comorbidities was associated with more work productivity loss and a higher likelihood of not working. These associations were substantially reduced after adjustment for MS symptom severity.

Conclusions: Comorbidities substantially impact employment outcomes and these effects were mainly mediated through MS symptom severity. This suggests that optimal and simultaneous management of comorbidities may be a viable strategy to reduce MS symptom severity, which in turn could improve employment outcomes.
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http://dx.doi.org/10.1177/1352458519872644DOI Listing
October 2020

Physical activity, sitting time and exercise types, and associations with symptoms in Australian people with multiple sclerosis.

Disabil Rehabil 2020 Sep 17:1-9. Epub 2020 Sep 17.

Menzies Institute for Medical Research, The University of Tasmania, Tasmania, Australia.

Purpose: Multiple sclerosis (MS) often leads to reduced physical activity and exercise participation. Sedentary behaviour is associated with poor health, whereas exercise is effective in managing MS symptoms. This study assessed physical activity, exercise and sedentary sitting time, and identified associations with symptoms.

Material And Methods: Participants of the Australian MS Longitudinal Study completed surveys in 2016. We measured physical activity and sitting time via the International Physical Activity Questionnaire (short-form), and assessed participation in exercise (type and duration). Multivariable regression models assessed associations between physical activity, sitting time and exercise; and demographic characteristics and MS-related symptoms.

Results: Of the 1216 participants, 53.0% reported moderate-high physical activity levels (71.5% among those with no/mild disability). Median sitting time was 7 h/day. Most (78.4%) participated in aerobic exercise, while only 16.4% participated in strength training. Having a progressive MS onset, more severe symptoms (i.e., cognitive impairment, depression, fatigue, mobility impairment) and being male was indicative of lower physical activity levels and higher sitting time.

Conclusions: Health promotion efforts should encourage physical activity and exercise, in particular strength training, among people with MS. People with more severe symptoms and progressive disease may require focused exercise promotion from healthcare professionals. Implications for Rehabilitation Comprehensive MS management should include strategies to increase physical activity and exercise participation, with particular focus upon people with higher MS-symptom burden (i.e., depression, fatigue and mobility and cognitive impairment), men, and those with progressive onset MS. Efforts to promote physical activity guidelines for people with MS and address barriers to physical activity must be implemented in standard MS care, with a particular focus on adhering to strength training guidelines. Exercise type and duration varies among people with MS, and it would behove healthcare professionals and researchers to consider promoting activities which align with individuals preferences and abilities when promoting exercise.
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http://dx.doi.org/10.1080/09638288.2020.1817985DOI Listing
September 2020

Feelings of depression, pain and walking difficulties have the largest impact on the quality of life of people with multiple sclerosis, irrespective of clinical phenotype.

Mult Scler 2020 Sep 14:1352458520958369. Epub 2020 Sep 14.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

Background: The symptoms that have the largest impact on health-related quality of life (HRQoL) in people with multiple sclerosis (MS) may vary by MS phenotype (relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS)). Knowing these symptoms assists in symptom management.

Objective: To examine the associations between 13 common MS symptoms and HRQoL in the total sample and stratified by MS phenotype.

Method: The study included 1985 participants. HRQoL was measured with two multi-attribute utility instruments: assessment of quality of life with eight dimensions (AQoL-8D) and European quality of life with five dimensions and five levels for each dimension (EQ-5D-5L). Multivariable linear regression was used to identify the symptoms that had the largest impact on the HRQoLs.

Results: Feelings of depression, pain, fatigue, and feelings of anxiety were most strongly associated with AQoL-8D and EQ-5D-5L. Walking difficulties additionally contributed to reduced EQ-5D-5L. The strongest single predictors in the multivariable analyses were feelings of depression or pain for AQoL-8D and walking difficulties for EQ-5D-5L, irrespective of MS phenotype.

Conclusion: The strongest single predictors for the AQoL-8D and EQ-5D-5L were feelings of depression, pain and walking difficulties, irrespective of MS phenotype. Reducing these symptoms may have the largest impact on improving HRQoL in all MS phenotypes of people with MS.
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http://dx.doi.org/10.1177/1352458520958369DOI Listing
September 2020

Change and onset-type differences in the prevalence of comorbidities in people with multiple sclerosis.

J Neurol 2021 Feb 3;268(2):602-612. Epub 2020 Sep 3.

Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.

Background: Little is known about the change in prevalence of comorbidities during the disease course of people with multiple sclerosis (MS) and whether the prevalences vary by MS onset type.

Objective: To calculate the change in prevalence of comorbidities between symptom onset and the time of study, to compare the prevalences of comorbidities with those in the Australian population at the time of study and to examine onset-type differences.

Methods: Comorbidity data from 1518 participants of the Australian MS Longitudinal Study and Australian population comparator data (2014-2015 National Health Survey) were used. The change in prevalence between time points and prevalence ratios (PR) at the time of study (crude, age and sex adjusted, and stratified by onset type) was calculated.

Results: Comorbidities were common, and those with the largest increases in prevalence between MS symptom onset and the time of study were depression (+ 26.9%), anxiety (+ 23.1%), hypertension (+ 21.9%), elevated cholesterol (+ 16.3%), osteoarthritis (+ 17.1%), eye diseases (+ 11.6%), osteoporosis (+ 10.9%) and cancer (+ 10.3%). Compared to the general population and after age and sex adjustment, participants had a significantly higher prevalence for 14/19 comorbidities at the time of study. The associations were strongest for anaemia, cancer (both PR > 4.00), anxiety, depression, migraine (all PR > 3.00), psoriasis and epilepsy (both PR > 2.00). No significant differences were seen by onset type.

Conclusion: Comorbidities are common at MS symptom onset and increase with MS duration. Having MS may thus contribute to accrual of comorbidities. This emphasises the importance of optimal screening for and management of comorbidities in early MS and throughout the disease course.
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http://dx.doi.org/10.1007/s00415-020-10194-xDOI Listing
February 2021

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

Mult Scler 2020 Sep 3:1352458520954167. Epub 2020 Sep 3.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

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.
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http://dx.doi.org/10.1177/1352458520954167DOI Listing
September 2020

Estimating the relative contribution of comorbidities in predicting health-related quality of life of people with multiple sclerosis.

J Neurol 2021 Feb 2;268(2):569-581. Epub 2020 Sep 2.

Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.

Background: Little is known about the relative contribution of comorbidities in predicting the health-related quality of life (HRQoL) of people with Multiple Sclerosis (PwMS).

Objective: To determine the associations between the number of and individual comorbidities and HRQoL and estimate the relative contribution of different comorbidities on HRQoL.

Methods: Cross-sectional analysis of data on self-reported presence of 30 comorbidities and HRQoL from the Australian MS Longitudinal Study (AMSLS) participants (n = 902). HRQoL was measured using the Assessment of Quality of Life-8 Dimensions (AQoL-8D). Linear regression and general dominance analysis were used.

Results: Higher number of comorbidities was associated with lower HRQoL (p trend p < 0.01). Comorbidities accounted for 18.1% of the variance in HRQoL. Mental health and musculoskeletal disorders were the strongest contributors to lower HRQoL. Of individual comorbidities, systemic lupus erythematosus (SLE) [β = - 0.16 (- 0.27, - 0.05)] and depression [β = - 0.15(- 0.18, - 0.13)] were most strongly associated with overall HRQoL, depression [β = - 0.14(- 0.16, - 0.11)] and anxiety [β = - 0.10 (- 0.13, - 0.07)] with psychosocial HRQoL, and SLE [β = - 0.18 (- 0.29, - 0.07)], rheumatoid arthritis [β = - 0.11 (- 0.19, - 0.02)] and hyperthyroidism [β = - 0.11 (- 0.19, - 0.03)) with physical HRQoL.

Conclusion: Comorbidities potentially make important contributions to HRQoL in PwMS. Our findings highlight groups of and individual comorbidities that could provide the largest benefits for the HRQoL of PwMS if they were targeted for prevention, early detection, and optimal treatment.
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http://dx.doi.org/10.1007/s00415-020-10195-wDOI Listing
February 2021

Comorbidities contribute substantially to the severity of common multiple sclerosis symptoms.

J Neurol 2021 Feb 2;268(2):559-568. Epub 2020 Sep 2.

Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.

Background: More research is needed to understand the contribution of comorbidities to MS symptomatology.

Objectives: To examine the dose-response relationship between the number of comorbidities and severity of MS symptoms and to assess the relative contribution of comorbidity groups and individual comorbidities to the severity of each symptom.

Methods: We surveyed 1223 participants of the Australian MS Longitudinal Study for the presence of 30 comorbidities and the severity of 13 MS symptoms (0-10 scale). The associations between comorbidities and symptoms were assessed using negative binomial regression. The relative contributions of comorbidities to the severity of symptoms were assessed using general dominance analysis.

Results: Higher number of comorbidities was most strongly associated with a higher severity of pain and feelings of anxiety and depression (ratios of means ≥ 0.12 per comorbidity increase). Comorbidities explained between 3.7% (spasticity) and 22.0% (feelings of anxiety) of the total variance of symptom severity. Mental health and musculoskeletal disorders contributed most strongly to the severity of the most common symptoms in MS.

Conclusions: Our findings support that early recognition and optimal management of comorbidities, particularly of mental health and musculoskeletal disorders, could have a positive impact on the severity of symptoms of people with MS.
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http://dx.doi.org/10.1007/s00415-020-10192-zDOI Listing
February 2021

High Prudent diet factor score predicts lower relapse hazard in early multiple sclerosis.

Mult Scler 2020 Jul 23:1352458520943087. Epub 2020 Jul 23.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

Background: Dietary patterns and their association with subsequent clinical course have not been well studied in early multiple sclerosis (MS).

Objectives: To describe dietary patterns in people in 5 years following first clinical demyelination and assess associations with MS conversion and relapse.

Methods: This study included baseline food frequency questionnaire dietary intake (entry to the Ausimmune Study) and 5-year follow-up; iterated principal factor analysis was applied. MS conversion and relapse risks were assessed by Cox proportional hazards models, adjusted for age, sex, study site, education, body mass index (BMI), smoking and omega-3 supplement use.

Results: In cases with a first clinical diagnosis of central nervous system (CNS) demyelination, we identified three major dietary patterns, 'Prudent', 'High-Vegetable' and 'Mixed', explaining 43%, 37% and 24% of diet variance in dietary intake, respectively. Fruits, vegetables, fish, wholegrains and nuts loaded highly on the Prudent pattern, starchy vegetables and legumes on the High-Vegetable pattern, and meats and alcohol on the Mixed pattern. Diet factor scores were not associated with MS conversion risk. Those with baseline Prudent scores above the median had significantly lower relapse risk (adjusted hazard ratio = 0.54, 95% confidence interval (CI) 0.37, 0.81) with some evidence of a plateau effect.

Conclusion: Prudent diet factor score above the median was prospectively associated with lower relapse risk in the 5 years following the first clinical demyelinating event.
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http://dx.doi.org/10.1177/1352458520943087DOI Listing
July 2020

COVID-19 in people with multiple sclerosis: A global data sharing initiative.

Mult Scler 2020 09 14;26(10):1157-1162. Epub 2020 Jul 14.

MS International Federation, London, UK.

Background: We need high-quality data to assess the determinants for COVID-19 severity in people with MS (PwMS). Several studies have recently emerged but there is great benefit in aligning data collection efforts at a global scale.

Objectives: Our mission is to scale-up COVID-19 data collection efforts and provide the MS community with data-driven insights as soon as possible.

Methods: Numerous stakeholders were brought together. Small dedicated interdisciplinary task forces were created to speed-up the formulation of the study design and work plan. First step was to agree upon a COVID-19 MS core data set. Second, we worked on providing a user-friendly and rapid pipeline to share COVID-19 data at a global scale.

Results: The COVID-19 MS core data set was agreed within 48 hours. To date, 23 data collection partners are involved and the first data imports have been performed successfully. Data processing and analysis is an on-going process.

Conclusions: We reached a consensus on a core data set and established data sharing processes with multiple partners to address an urgent need for information to guide clinical practice. First results show that partners are motivated to share data to attain the ultimate joint goal: better understand the effect of COVID-19 in PwMS.
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http://dx.doi.org/10.1177/1352458520941485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361123PMC
September 2020

Measuring the health-related quality of life in Australians with multiple sclerosis using the assessment of quality of life-8-dimension (AQoL-8D) multi-attribute utility instrument.

Mult Scler Relat Disord 2020 Sep 3;44:102358. Epub 2020 Jul 3.

Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. Electronic address:

Background: Health-related quality of life (HRQoL) has not been assessed in Australians with multiple sclerosis (MS) using a preferentially sensitive multi-attribute utility instrument.

Objectives: To assess HRQoL and to quantify the impact of disability on health state utility values (HSUVs), and the physical and psychosocial health of people with MS using the Assessment of Quality of Life-8-Dimension (AQoL-8D) instrument.

Methods: We estimated HSUVs and the unique composite individual and super dimensional (physical and psychosocial) scores of the AQoL-8D for a large, representative sample (n=1,577) of Australians with MS. The estimates were compared to Australian general population norms and broken down by disability severity, classified as no disability (Expanded Disability Status Scale [EDSS] level: 0), mild (EDSS: 1-3.5), moderate (EDSS: 4-6) and severe (EDSS: 6.5-9.5). A multivariable regression model adjusted the association between MS disability severity and HSUVs for age, sex, MS onset type, DMTs usage status, and MS duration.

Results: Mean overall HSUV at 0.61 (95% confidence interval [CI]: 0.60-0.62) was 0.18 units lower than the Australian population norm. HSUV decreased with increasing disability severity: 0.81 (95% CI: 0.80-0.83), 0.65 (95% CI: 0.63-0.67), 0.54 (95% CI: 0.52-0.56) and 0.48 (95% CI: 0.46-0.50) for no, mild, moderate and severe disability, respectively. The mean Physical super-dimension score of 0.57 (95% CI: 56-0.58) was 0.21 units lower than the Australian norm and the Psychosocial super-dimension of 0.33(95% CI: 32-0.34) was 0.16 units lower. Lower HRQoL was primarily driven by reduced scores on Independent living (-0.23), Pain (-0.15), Relationships (-0.13), Coping (-0.12), and Self-worth (-0.12).

Conclusions: MS impacts all aspects of HRQoL. Effective pain management and support to maintain independent living, relationships, and self-worth can significantly improve the HRQoL of people with MS. Early diagnosis and affordable access to effective treatments to slow or prevent disability accumulation may also be helpful.
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http://dx.doi.org/10.1016/j.msard.2020.102358DOI Listing
September 2020

The increasing economic burden of multiple sclerosis by disability severity in Australia in 2017: Results from updated and detailed data on types of costs.

Mult Scler Relat Disord 2020 Sep 3;44:102247. Epub 2020 Jun 3.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia. Electronic address:

Background: Economic costs of Multiple Sclerosis (MS) in Australia were last estimated in 2010 and are likely to have changed over time, especially given this new era of increased access to higher efficacy disease modifying therapies (DMTs) with a strong focus on earlier MS diagnosis and treatment.

Objectives: To provide a comprehensive contemporary analysis of the updated direct and indirect costs of MS in Australia from a societal perspective and to examine how the cost landscape has changed overtime.

Methods: Costs were estimated from the 2016 Economic Impact Survey (EIS) of the Australian MS longitudinal Study (AMSLS) and were stratified by various (indirect and direct) cost categories/sub-categories and disability severity. Disability was assessed with the patient determined disease steps (PDDS) and mapped against the gold-standard Expanded Disability Status Scale (EDSS), and classified as no disability (EDSS level: 0), mild (EDSS 1-3.5), moderate (EDSS 4-6) and severe (EDSS 6.5-9.5). A generalized linear model (GLM) predicted covariate adjusted costs for each disability severity. All costs are presented in 2017 Australian dollars.

Results: 488 (15.5% of the 3,163) AMSLS participants completed the survey. Annual costs per person with MS increased 17% from 2010 to $68,382 in 2017, driven largely by increased direct costs (from $16,306 in 2010 to $30,346 in 2017) (particularly those related to DMTs, hospitalizations, consultations, and medical tests), but offset by decreased costs of lost wages (from $29,030 in 2010 to $21,858 in 2017) as a result of recent positive shifts in the employment landscape for Australians with MS. Costs increased with increasing disability severity: $30,561 (95% confidence intervals [CI]: $25,672-$35,451), $55,815 (95%CI: $47,503-$64,126), $76,915 (95%CI: $68,866-$84,964), and $114,813 (95%CI: $102,252-$127,374) for no, mild, moderate and severe disability, respectively. The differences in costs between the four disability groups remained statistically significant even after adjustment for age, sex, DMT usage status, disease course and areas of remoteness.

Conclusions: MS has an increasing economic burden in Australia. The study provides current economic data on MS in Australia that are important for policy development, priority setting and management of public health.
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http://dx.doi.org/10.1016/j.msard.2020.102247DOI Listing
September 2020

Validation of 0-10 MS symptom scores in the Australian multiple sclerosis longitudinal study.

Mult Scler Relat Disord 2019 Dec 18;39:101895. Epub 2019 Dec 18.

Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address:

Background: Multiple sclerosis (MS) symptom measurements often use multiple-item scales per symptom, creating a high burden when multiple symptoms are assessed. We aimed to examine the validity, stability and responsiveness of single-item 0-10 numeric rating MS Symptom Scores (MSSymS).

Methods: The study included 1,985 participants from the Australian Multiple Sclerosis Longitudinal Study. Thirteen MS symptoms were assessed using the MSSymS, of which we were able to validate six (walking difficulties, fatigue, pain, feelings of anxiety, feelings of depression and vision problems). Comparison measures included Patient Determined Disease Steps (PDDS), Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), and Assessment of Quality of Life (AQoL). We used spearman rank correlation for concurrent validity, linear regression for predictive validity, intra-class correlations for stability, and percentage change for responsiveness.

Results: We found high correlations between walking difficulties and PDDS (r = 0.82), pain and AQoL-pain (r = 0.77), fatigue and FSS (r = 0.72); moderate correlations between feelings of anxiety and HADS-Anxiety (r = 0.68), feelings of depression and HADS-Depression (r = 0.63); and low correlation between vision and AQoL-vision (r = 0.43) For predictive validity, the graphs with quality of life were largely overlapping and the R of the regression lines were generally similar. The stability and responsiveness of the MSSymS were adequate.

Conclusion: The six assessed symptoms of the MSSymS performed equally well compared to validated comparison measures in terms of concurrent and predictive validity, temporal stability and responsiveness.
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http://dx.doi.org/10.1016/j.msard.2019.101895DOI Listing
December 2019

The effect of emerging nutraceutical interventions for clinical and biological outcomes in multiple sclerosis: A systematic review.

Mult Scler Relat Disord 2020 Jan 2;37:101486. Epub 2019 Nov 2.

Murdoch Children's Research Institute, Royal Children's Hospital, Australia; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia.

Background: Due to the considerable burden of multiple sclerosis (MS)-related symptoms and the need to identify effective interventions to prevent disease progression, various nutraceutical interventions have been trialed as adjunctive treatments. The aim of this review was to investigate the efficacy and safety of nutraceutical interventions for clinical and biological outcomes in people with MS.

Methods: In accordance with PRISMA reporting guidelines, a systematic literature search was conducted using three electronic literature databases. Risk of bias was assessed using the Jadad scale.

Results: Thirty-seven randomized controlled trials, investigating fourteen nutraceuticals, were included in the review. Trials that investigated alpha lipoic acid (n = 4/6), ginkgo biloba (n = 3/5), vitamin A (n = 2/2), biotin (n = 1/2), carnitine (n = 1/2), green tea (n = 1/2), coenzyme Q10 (n = 1/1), probiotics (n = 1/1), curcumin (n = 1/1), Andrographis paniculata (n = 1/1), ginseng (n = 1/1), and lemon verbena (n = 1/1) were reported to improve biological (e.g. MRI brain volume change, antioxidant capacity) and/or clinical (e.g. fatigue, depression, Expanded Disability Status Scale) outcomes in multiple sclerosis compared to control. However, most trials were relatively small (average study sample size across included studies, n = 55) and there were few replicate studies per nutraceutical to validate the reported results. Furthermore, some nutraceuticals (e.g. green tea and inosine) should be used with caution due to reported adverse events. Risk of bias across most studies was low, with 31 studies receiving a score between 4 and 5 (out of 5) on the Jadad Scale.

Conclusion: The existing literature provides preliminary support for the use of a number of nutraceutical interventions in MS. However, sufficiently powered long-term trials are required to expand the currently limited literature and to investigate unexplored nutraceuticals that may target relevant pathways involved in MS such as the gut microbiome and mitochondrial dysfunction. Prospero ID: CRD42018111736.
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http://dx.doi.org/10.1016/j.msard.2019.101486DOI Listing
January 2020

Increasing prevalence of primary biliary cholangitis in Victoria, Australia.

J Gastroenterol Hepatol 2020 Apr 28;35(4):673-679. Epub 2019 Dec 28.

Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, Australia.

Background And Aim: The prevalence of primary biliary cholangitis (PBC) reported in different countries varies significantly and in some parts of the world appears to be increasing. The aim of this study was to determine the 2013 prevalence of PBC in Victoria, Australia, and to determine the time trend by comparing it with previous studies undertaken in 1991 and 2002.

Methods: Four case-finding methods were used to identify cases of PBC in Victoria: (1) physicians' survey; (2) tertiary hospital search; (3) liver transplant database search; and (4) private pathology antimitochondrial antibody search.

Results: The prevalence of PBC in Victoria, Australia, is 189.0 per million using all four methods. The average annual increase in prevalence from 1991 to 2013 was 7.7 per million per year. Using the same case-finding methods as the 1991 Victorian prevalence study (methods 1 and 2), the prevalence of PBC increased from 19.1 per million in 1991 to 49.4 per million in 2002 (P < 0.001) and to 80.7 per million in 2013 (P < 0.001).

Conclusions: The current prevalence of PBC in Victoria is significantly higher than previously reported. The use of private pathology-based case-finding methods is important in identifying the maximum number of PBC cases.
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http://dx.doi.org/10.1111/jgh.14924DOI Listing
April 2020

Redefining the Multiple Sclerosis Severity Score (MSSS): The effect of sex and onset phenotype.

Mult Scler 2020 11 31;26(13):1765-1774. Epub 2019 Oct 31.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

Background: The Multiple Sclerosis Severity Score (MSSS) is a widely used measure of the disability progression rate. However, the global MSSS may not be the best basis for comparison between all patient groups.

Objective: We evaluated sex-specific and onset phenotype-specific MSSS matrices to determine if they were more effective than the global MSSS as a basis for comparison within these subsets.

Methods: Using a large international dataset of multiple sclerosis (MS) patient records and the original MSSS algorithm, we constructed global, sex-specific and onset phenotype-specific MSSS matrices. We compared matrices using permutation analysis.

Results: Our final dataset included 30,203 MS cases, with 28.9% males and 6.5% progressive-onset cases. Our global MSSS matrix did not differ from previously published data ( > 0.05). The progressive-onset-specific matrix differed significantly from the relapsing-onset-specific matrix ( < 0.001), with lower MSSS attributed to cases with the same Expanded Disability Status Score (EDSS) and disease duration. When evaluated with a simulation, using an onset-specific MSSS improved statistical power in mixed cohorts. There were no significant differences by sex.

Conclusion: The differences in the disability accrual rate between progressive- and relapsing-onset MS have a significant effect on MSSS. An onset-specific MSSS should be used when comparing the rate of disability progression among progressive-onset cases and for mixed cohorts.
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http://dx.doi.org/10.1177/1352458519881994DOI Listing
November 2020

Higher fish consumption and lower risk of central nervous system demyelination.

Eur J Clin Nutr 2020 05 8;74(5):818-824. Epub 2019 Aug 8.

School of Public Health, Curtin University, Bentley, WA, 6102, Australia.

Background/objectives: The evidence for diet as a risk factor for multiple sclerosis (MS) is inconclusive. We examined the associations between fish consumption and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS.

Methods: The 2003-2006 Ausimmune Study was a case-control study examining environmental risk factors for FCD, with participants recruited from four regions of Australia and matched on age, sex, and study region. Dietary intake data were collected using a food frequency questionnaire. We used conditional logistic regression models to test associations between fish consumption (total, tinned, grilled, and fried) and risk of FCD (249 cases and 438 controls), adjusting for history of infectious mononucleosis, smoking, serum 25-hydroxyvitamin D concentrations, socio-economic status, omega-3 supplement use, dietary under-reporting, and total energy intake.

Results: Higher total fish consumption (per 30 g/day, equivalent to two serves/week) was associated with an 18% reduced risk of FCD (AOR 0.82; 95% CI 0.70, 0.97). While we found no statistically significant associations between grilled and fried fish consumption and risk of FCD, higher tinned fish consumption (per 30 g/day) was associated with a 41% reduced risk of FCD (AOR 0.59; 95% CI 0.39, 0.89).

Conclusions: Tinned fish is predominantly oily, whereas grilled and fried fish are likely to be a combination of oily and white types. Oily fish is high in vitamin D and very long chain polyunsaturated omega-3 fatty acids, both of which may be beneficial in relation to MS.
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http://dx.doi.org/10.1038/s41430-019-0476-zDOI Listing
May 2020

The role of nutritional factors during adolescence in multiple sclerosis onset: a population-based incident case-control study.

Nutr Neurosci 2019 Jul 31:1-8. Epub 2019 Jul 31.

f Ingrid van der Mei: Menzies Institute for Medical Research, University of Tasmania , Australia.

The potential role of nutritional factors in multiple sclerosis (MS) etiology is not clearly understood. The authors investigated the association between dietary intake during adolescence with MS. This was a population-based incident case-control study in Iran with 547 incident cases and 1057 general population controls (7/8/2013-17/2/2015). Logistic regression was used to test differences in dietary intake between cases and controls adjusted for confounders. We found that a higher dietary consumption during adolescence of fresh fish, canned tuna, poultry, cheese, yogurt, butter, fruit, vegetables and a number of dietary supplements were associated with a significantly reduced risk of MS, while red meat, shrimp, and margarine were not associated with MS. Fresh fish had a dose-response association of 0.71 (0.58-0.88) per category increase, and consuming >0.5 serves of canned tuna fish per week had an OR of 0.72 (0.56-0.90); fruit intake had an OR of 0.82 (0.71-0.94) per category increase and cheese consumption an OR of 0.78 (0.67-0.91) per category increase. We identified that a higher intake of a number of food groups generally viewed as healthy were associated with a reduced risk of MS. A healthier diet during adolescence may be protective of developing MS.
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http://dx.doi.org/10.1080/1028415X.2019.1647689DOI Listing
July 2019

Change in multiple sclerosis prevalence over time in Australia 2010-2017 utilising disease-modifying therapy prescription data.

Mult Scler 2020 10 26;26(11):1315-1328. Epub 2019 Jul 26.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.

Objective: Determine the prevalence of multiple sclerosis (MS) in Australia in 2017 using MS-specific disease-modifying therapy (DMT) prescription data and estimate the change in prevalence from 2010.

Methods: DMT prescriptions were extracted from Australia's Pharmaceutical Benefits Scheme (PBS) data for January-December 2017. Percentages of people with MS using DMTs (DMT penetrance) were calculated using data from the Australian MS Longitudinal Study. Prevalence was estimated by dividing the total number of monthly prescriptions by 12 (except alemtuzumab), adjusted for DMT penetrance and Australian population estimates. Prevalences in Australian states/territories were age-standardised to the Australian population. Comparisons with 2010 prevalence data were performed using Poisson regression.

Results: Overall DMT penetrance was 64%, and the number of people with MS in Australia in 2017 was 25,607 (95% confidence interval (CI): 24,874-26,478), a significant increase of 4324 people since 2010 ( < 0.001). The prevalence increased significantly from 95.6/100,000 (2010) to 103.7/100,000 (2017), with estimates highest in Tasmania in 2017 (138.7/100,000; 95% CI: 137.2-140.1) and lowest in Queensland (74.6/100,000; 95% CI: 73.5-75.6). From 2010 to 2017 using the median latitudes for each state/territory, the overall latitudinal variation in MS prevalence was an increase of 3.0% per degree-latitude.

Conclusion: Consistent with global trends, Australia's MS prevalence has increased; this probably reflecting decreased mortality, increased longevity and increased incidence.
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http://dx.doi.org/10.1177/1352458519861270DOI Listing
October 2020

Latitude continues to be significantly associated with the prevalence of multiple sclerosis: an updated meta-analysis.

J Neurol Neurosurg Psychiatry 2019 11 19;90(11):1193-1200. Epub 2019 Jun 19.

Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.

Objectives: Previous studies have demonstrated a strong latitudinal gradient in multiple sclerosis (MS) prevalence. Herein, we present a meta-analysis of the latitudinal gradient of MS prevalence including studies published since our 2011 review, seeking to assess the latitudinal gradient and whether it has changed since our previous analysis.

Methods: Studies published up to December 2018 were located via Embase, Web of Knowledge and PubMed, using standardised search terms; data were extracted from peer-reviewed studies and these studies added to those from our previous analysis. Where age-specific data were available, prevalence estimates were age-/sex-standardised to the 2009 European population. Prevalence estimates were adjusted for study prevalence year and ascertainment methods. The latitudinal association with MS prevalence was assessed by meta-regression.

Results: A total of 94 studies met inclusion criteria, yielding 230 new prevalence points and 880 altogether with those from the prior study. There was a significant positive gradient in time-corrected MS prevalence with increasing latitude (5.27/100 000 per degree latitude), attenuating slightly to 4.34/100 000 on age-standardisation, these associations persisting on adjustment for ascertainment method. Of note, the age-standardised gradient was consistently significantly enhanced from our previous study, regardless of whether it was as-measured, time-corrected or adjusted for ascertainment methods. Certain areas, such as the Scandinavian and Atlantic Coast/Central Europe regions, showed changes in MS prevalence gradient over time, but other regional gradients were similar.

Conclusions: This new meta-analysis confirms that MS prevalence is still strongly positively associated with increasing latitude and that the gradient is increasing, suggesting that potentially modifiable environmental factors, such as sun exposure, are still strongly associated with MS risk.
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http://dx.doi.org/10.1136/jnnp-2018-320189DOI Listing
November 2019

A Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults.

J Nutr 2019 08;149(8):1385-1392

School of Public Health, Curtin University, Perth, Australia.

Background: The evidence associating diet and risk of multiple sclerosis (MS) is inconclusive.

Objectives: The aim of this study was to investigate associations between a Mediterranean diet and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS.

Methods: We used data from the 2003-2006 Ausimmune Study, an Australian multicenter, case-control study examining environmental risk factors for FCD, with participants matched on age, sex, and study region (282 cases, 558 controls; 18-59 y old; 78% female). The alternate Mediterranean diet score (aMED) was calculated based on data from a food-frequency questionnaire. We created a modified version of the aMED (aMED-Red) where ∼1 daily serving (65 g) of unprocessed red meat received 1 point. All other components remained the same as aMED. Conditional logistic regression (254 cases, 451 controls) was used to test associations between aMED and aMED-Red scores and categories and risk of FCD, adjusting for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, education, total energy intake, and dietary underreporting.

Results: There was no statistically significant association between aMED and risk of FCD [per 1-SD increase in aMED score: adjusted odds ratio (aOR): 0.89; 95% CI: 0.75, 1.06; P = 0.181]. There was evidence of a nonlinear relation between aMED-Red and risk of FCD when a quadratic term was used (P = 0.016). Compared with the lowest category of aMED-Red, higher categories were significantly associated with reduced risk of FCD, corresponding to a 37% (aOR: 0.63; 95% CI: 0.41, 0.98; P = 0.039), 52% (aOR: 0.48; 95% CI: 0.28, 0.83; P = 0.009), and 42% (aOR: 0.58; 95% CI: 0.35, 0.96; P = 0.034) reduced risk of FCD in categories 2, 3, and 4, respectively.

Conclusions: A Mediterranean diet, including unprocessed red meat, was associated with reduced risk of FCD in this Australian adult population. The addition of unprocessed red meat to a Mediterranean diet may be beneficial for those at high risk of MS.
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http://dx.doi.org/10.1093/jn/nxz089DOI Listing
August 2019

Modifiable factors associated with depression and anxiety in multiple sclerosis.

Acta Neurol Scand 2019 Sep 24;140(3):204-211. Epub 2019 Jun 24.

Disability and Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Objectives: Modifiable lifestyle factors are implicated in multiple sclerosis (MS) symptoms but their role in mood is unclear. This study aimed to investigate associations between lifestyle and depression and anxiety in Australian participants with MS.

Materials And Methods: Self-reported data from the Australian Multiple Sclerosis Longitudinal Study included the Hospital Anxiety and Depression Scale (HADS) and lifestyle measurements from 1500 participants. SNAP score (range 0-5) was the sum of non-smoking, sufficient fruit/vegetable intake, non-hazardous alcohol consumption, sufficient physical activity and healthy BMI. Analyses by log-binomial and linear regression were adjusted for confounding.

Results: Symptoms of depression and anxiety were prevalent in 27% and 40%, respectively; 20% had both. Mean SNAP score was 2.7/5; only 3% met all healthy lifestyle recommendations. Only 10% reported adequate fruit/vegetable intake, and 22% reported a combination of unhealthy BMI, inadequate physical activity and inadequate nutrition. A healthier SNAP score was associated with lower depression prevalence (adjusted prevalence ratio 0.83 [95% CI 0.75, 0.92] per unit increase) and depression severity (adjusted β-0.44 [95% CI -0.64, -0.24]), but not with anxiety.

Conclusions: Modifiable lifestyle factors are associated with lower frequency and severity of depression, but not anxiety, in Australian people with multiple sclerosis. The associations between a healthier SNAP score and lower depression are likely bi-directional. SNAP risk factor prevalence and co-occurrence, especially inadequate nutrition and low physical activity, were high among Australians with MS.
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http://dx.doi.org/10.1111/ane.13132DOI Listing
September 2019

Higher Non-processed Red Meat Consumption Is Associated With a Reduced Risk of Central Nervous System Demyelination.

Front Neurol 2019 19;10:125. Epub 2019 Feb 19.

School of Public Health, Curtin University, Perth, WA, Australia.

The evidence associating red meat consumption and risk of multiple sclerosis is inconclusive. We tested associations between red meat consumption and risk of a first clinical diagnosis of central nervous system demyelination (FCD), often presaging a diagnosis of multiple sclerosis. We used food frequency questionnaire data from the 2003-2006 Ausimmune Study, an incident, matched, case-control study examining environmental risk factors for FCD. We calculated non-processed and processed red meat density (g/1,000 kcal/day). Conditional logistic regression models (with participants matched on age, sex, and study region) were used to estimate odds ratios (ORs), 95% confidence intervals (95% CI) and values for associations between non-processed ( = 689, 250 cases, 439 controls) and processed ( = 683, 248 cases, 435 controls) red meat density and risk of FCD. Models were adjusted for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, race, education, body mass index and dietary misreporting. A one standard deviation increase in non-processed red meat density (22 g/1,000 kcal/day) was associated with a 19% reduced risk of FCD (AOR = 0.81; 95%CI 0.68, 0.97; = 0.02). When stratified by sex, higher non-processed red meat density (per 22 g/1,000 kcal/day) was associated with a 26% reduced risk of FCD in females ( = 519; AOR = 0.74; 95%CI 0.60, 0.92; = 0.01). There was no statistically significant association between non-processed red meat density and risk of FCD in males ( = 170). We found no statistically significant association between processed red meat density and risk of FCD. Further investigation is warranted to understand the important components of a diet that includes non-processed red meat for lower FCD risk.
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http://dx.doi.org/10.3389/fneur.2019.00125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389668PMC
February 2019

Modelling the impact of multiple sclerosis on life expectancy, quality-adjusted life years and total lifetime costs: Evidence from Australia.

Mult Scler 2020 04 26;26(4):411-420. Epub 2019 Feb 26.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

Objectives: To quantify life expectancy (LE), quality-adjusted life years (QALYs) and total lifetime societal costs for a hypothetical cohort of Australians with multiple sclerosis (MS).

Methods: A 4-state Markov model simulated progression from no/mild to moderate and severe disability and death for a cohort of 35-year-old women over a lifetime horizon. Death risks were calculated from Australian life tables, adjusted by disability severity. State-dependent relapse probabilities and associated disutilities were considered. Probabilities of MS progression and relapse were estimated from AusLong and TasMSL MS epidemiological databases. Annual societal (direct and indirect) costs (2017 Australian dollars) and health-state utilities for each state were derived from the Australian MS Longitudinal Study. Costs were discounted at 5% annually.

Results: Mean (95% confidence interval (CI)) LE from age 35 years was 42.7 (41.6-43.8) years. This was 7.5 years less than the general Australian population. Undiscounted QALYs were 28.2 (26.3-30.0), a loss of 13.1 QALYs versus the Australian population. Discounted lifetime costs were $942,754 ($347,856-$2,820,219).

Conclusion: We have developed a health economics model of the progression of MS, calculating the impact of MS on LE, QALYs and lifetime costs in Australia. It will form the basis for future cost-effectiveness analyses of interventions for MS.
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http://dx.doi.org/10.1177/1352458519831213DOI Listing
April 2020

Lipid-related genetic polymorphisms significantly modulate the association between lipids and disability progression in multiple sclerosis.

J Neurol Neurosurg Psychiatry 2019 06 19;90(6):636-641. Epub 2019 Feb 19.

Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

Objective: To investigate whether lipid-related or body mass index (BMI)-related common genetic polymorphisms modulate the associations between serum lipid levels, BMI and disability progression in multiple sclerosis (MS).

Methods: The association between disability progression (annualised Expanded Disability Status Scale (EDSS) change over 5 years, ΔEDSS) and lipid-related or BMI-related genetic polymorphisms was evaluated in a longitudinal cohort (n=184), diagnosed with MS. We constructed a cumulative genetic risk score (CGRS) of associated polymorphisms (p<0.05) and examined the interactions between the CGRS and lipid levels (measured at baseline) in predicting ΔEDSS. All analyses were conducted using linear regression.

Results: Five lipid polymorphisms (rs2013208, rs9488822, rs17173637, rs10401969 and rs2277862) and one BMI polymorphism (rs2033529) were nominally associated with ΔEDSS. The constructed lipid CGRS showed a significant, dose-dependent association with ΔEDSS (p=1.4×10), such that participants having ≥6 risk alleles progressed 0.38 EDSS points per year faster compared with those having ≤3. This CGRS model explained 16% of the variance in ΔEDSS. We also found significant interactions between the CGRS and lipid levels in modulating ΔEDSS, including high-density lipoprotein (HDL; p=0.005) and total cholesterol:high-density lipoprotein ratio (TC:HDL; p=0.030). The combined model (combination of CGRS and the lipid parameter) explained 26% of the disability variance for HDL and 27% for TC:HDL.

Interpretation: In this prospective cohort study, both lipid levels and lipid-related polymorphisms individually and jointly were associated with significantly increased disability progression in MS. These results indicate that these polymorphisms and tagged genes might be potential points of intervention to moderate disability progression.
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http://dx.doi.org/10.1136/jnnp-2018-319870DOI Listing
June 2019

Oral health and behaviours of people living with Multiple Sclerosis in Australia.

Community Dent Oral Epidemiol 2019 06 7;47(3):201-209. Epub 2019 Jan 7.

School of Dentistry, The University of Queensland, Herston, Queensland, Australia.

Objectives: The literature describing the oral health of people with Multiple Sclerosis (MS) is scant and the findings equivocal. The aim of this study was to describe the oral health and oral self-care behaviours of people living with MS and compare it to the Australian population.

Methods: Participants enrolled with the Australian MS Longitudinal Study (AMSLS) were invited to participate in the survey using an online or paper-based questionnaire. Data were collected on level of disability, oral health, oral self-care and factors influencing attendance for oral health care.

Results: Completed questionnaires were received for 1523 respondents. Over one-fifth (n = 320; 22%) rated their oral health as fair or poor, and more than half (n = 840; 57%) reported toothache in the last 12 months. These proportions were higher than those for the general Australian adult population (oral health prevalence ratio (PR) = 1.25 [1.12, 1.40]; toothache PR = 3.63 [3.39, 3.88]), and this is despite comparable or better self-maintenance habits and dental attendance reported by respondents. People with MS reported high rates of mouth dryness (68.4%), teeth sensitivity (64.7%), change of taste (40.5%) and orofacial pain (39.0%); fewer than 10% experienced none of these. There was a lower prevalence of self-reported need for treatment (extraction or filling) than in the Australian adult population (15.8% vs 32.9%).

Conclusions: People with MS have a greater oral health burden, demonstrated by their poorer self-reported oral health than the Australian adult population. Furthermore, they experience high rates of toothache, mouth dryness, teeth sensitivity, change of taste and orofacial pain. These findings are contrary to their self-reported good oral self-care and dental attendance habits and suggest some of the oral health impacts are due to MS rather than dental behaviours.
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http://dx.doi.org/10.1111/cdoe.12445DOI Listing
June 2019

Vitamin D deficiency is an etiological factor for MS - Commentary.

Mult Scler 2019 04 30;25(5):641-643. Epub 2018 Nov 30.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

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http://dx.doi.org/10.1177/1352458518815605DOI Listing
April 2019