Health Of Multiple Sclerosis Patients Research Articles

Designing a Care System based on the Internet of Things for Patients with Multiple Sclerosis

Abstract: Multiple sclerosis (MS) is a neurodegenerative disease that is a major health problem. This issue requires the development of new tools to control patients' activity and reduce care costs. The monitoring system based on the Internet of things is a suitable solution for this concern. In this study, the researchers developed a tool that uses an Arduino board and four accelerometer sensors, heart rate and pulse oximetry sensors, temperature sensors, and Bluetooth modules to monitor the factors related to the health of multiple sclerosis patients. In this method, the information obtained from the sensors connected to the patient's body is placed on the memory board and displayed with the help of an LCD. In the next step, the Bluetooth module transmits the information obtained from these sensors to a mobile application. This application has the ability to share and store information. This information, together with the date display on the LCD, in addition to notifying the person of the resulting changes; it is also sent periodically to the doctor. In general, this tool, together with a mobile device, helps to increase the selfcare of patients, increases the interaction between the patient and the doctor, reduces the frequeI. nt visits of patients to care centers, and helps to improve the quality of life of patients..

Quality of life and mental health in multiple sclerosis patients during the COVID-19 Pandemic.

The COVID-19 pandemic had a profound impact on mental health symptoms and quality of life (QoL) in the general population due to necessary public health restrictions such as social distancing. The psychosocial effect of the pandemic on vulnerable groups such as people living with Multiple Sclerosis (PwMS) has been scarcely explored in countries with additional socioeconomical burdens such as access to healthcare disparities METHODS: A questionnaire exploring sociodemographic variables, quality of life, mental health determinants and sleep quality was applied to 92 PwMS to explore changes prior and during the pandemic regarding these domains RESULTS: 58.8% of the subjects were female, median age was 37.1 (± 8.5) years and relapsing-remitting MS was the predominant clinical subtype (83.5%). Unemployment rate significantly increased during the pandemic (12.3% vs 27.8%; p= 0.001). Only 46.4% received medical follow-up care during the pandemic. QoL was affected predominantly due to limitations in instrumented activities of daily life (IADL). Neuropsychiatric symptoms, requiring healthcare during the pandemic, anxiety prior to the pandemic and restricted IADL were predictors of MS-related physical impact worsening, while decreased physical/emotional wellbeing selfcare, neuropsychiatric symptoms, bad sleep quality, anxiety prior to the pandemic and restricted non-instrumental ADL predicted aggravation of MS-related psychological impact measured by the MSIS-29. Curiously, specific items regarding anxiety were more prevalent prior to the pandemic (anxious mood; p=0.02, helplessness; p=0.01), sleep problems; p=0.001 and cardiovascular symptoms; p=0.001, nevertheless, stability was observed for most items. Importantly, 77.3% of PwMS reported at least one neuropsychiatric symptom CONCLUSION: The deleterious effects of the COVID-19 pandemic on psychosocial wellbeing in PwMS, QoL and mental health outcomes are frequently overseen in vulnerable populations such as PwMS. Albeit the limitations of this study, our results may help implement policies that prevent negative outcomes on psychosocial wellbeing due to public health measures (e.g., social distancing) in MS and other neurological diseases that inexorably need constant follow-up.

The impact of religiosity on the disability, psychological well-being, and somatic health of multiple sclerosis patients

ABSTRACT The aim of the study was to predict disability, psychological wellbeing, and somatic health in multiple sclerosis (MS) patients with the mediating variable of religiosity. A sample of 128 patients was recruited, and were administered the Expanded Disability Status Scale, the World Health Organization-5 Well-Being Index, the Patient Health Questionnaire-15, and a Self-Rating Scale of Religiosity. Religiosity did not predict disability, psychological well-being, or somatic health. Religiosity was positively associated with MS duration and disability, but only in male patients. The predictors for predicting psychological wellbeing were age, disability, and somatic health. Patients with moderate/severe MS (EDSS >3) obtained higher mean scores on religiosity compared to patients with mild MS (EDSS ≤3) and, therefore, the severity of MS was a significant moderator between religiosity and psychological well-being. The findings suggest the importance of focusing on the type of religiosity, God representation, and attachment to God for clarifying the link between psychological well-being and religiosity among patients.

Vitamin D Supplementation and Mental Health in Multiple Sclerosis Patients: A Systematic Review.

Vitamin D has a promising role in multiple sclerosis (MS) management, and it has been found to be beneficial for patients’ mental health, which is reduced in MS patients. The aim of the present study was to conduct a systematic review of the literature to assess the influence of vitamin D supplementation on mental health in MS patients. The systematic review was registered in the PROSPERO database (CRD42020155779) and it was conducted on the basis of the PRISMA guidelines. The search procedure was conducted using PubMed and Web of Science databases and it included studies published up until September 2021. Six studies were included in the systematic review. The risk of bias was analyzed using the Newcastle–Ottawa Scale (NOS). Within the included studies, there were two studies randomized against placebo and four other prospective studies. The studies presented vitamin D interventions randomized against placebo or not randomized, while supplementation was applied for various durations—from 4 weeks to 12 months, or the studies compared patients who applied vitamin D supplementation and those who did not apply it and verified the effect of the supplementation after a number of years. The mental health outcomes that were assessed included quality of life, depression/depressive symptoms, and fatigue as an additional element. The majority of studies supported the positive influence of vitamin D on the mental health of MS patients, including the study characterized as having the highest quality (randomized against placebo with the highest NOS score). All the studies that assessed the quality of life indicated the positive influence of vitamin D while the studies that did not find a positive influence of vitamin D were conducted for depression/depressive symptoms. In spite of the fact that only a small number of studies have been conducted so far, and only two studies were randomized against a placebo, some conclusions may be formulated. The systematic review allowed us to conclude that there may be a positive effect of vitamin D supplementation in MS patients, which was stated in all of the studies analyzing quality of life, as well as in one study analyzing depressive symptoms. Considering that vitamin D deficiency is common in MS patients, and the potential positive influence of supplementation on the quality of life, supplementation should be applied at least in doses that cover the recommended intake.

Well-being and disease severity of multiple sclerosis patients following a physical activity program

Abstract Introduction: Multiple sclerosis (MS) is a chronic disease of the central nervous system that mainly affects young adults, promoting a great impact on functionality. Fatigue is a very common symptom, associated with multiple impairments in sensitivity, muscle activity, neuromotor control, balance, cognition and problem-solving ability. MS leads to strong functional restrictions, particularly in the context of daily living activities, as well as in patient participation. Objective: To understand the implications of a self-regulation program in the perception of well-being and mental health in MS patients. Methods: A set of exercises was implemented for use in daily activities, supported by different studies with MS patients. Patients were asked to classify the severity of their disease and to use the Mental Health Inventory (MHI-38), at the beginning (time A) and at the end (time B) of the self-regulation program. We used the Statistical Package for the Social Sciences (SPSS) version 25. A non-parametric statistical hypothesis test (Wilcoxon test) was used to analyze the variables. Results: The mean age was 44 years old, with patients between the ages of 20 and 58. 58.3% were women, 37.5% were currently married, 67% were retired and the mean level of education was 12.5 years. The correlation between the perception of disease severity and psychological well-being before the self-regulation program (r = 0.26, p < 0.05) and after the intervention (r = 0.37, p < 0.01) suggests a low to moderate correlation. Conclusion: The implementation of the self-regulatory model, through the promotion of physical activity in patients with MS, had a positive impact of clinical rehabilitation, well-being, and perception of disease severity of these people.

The Correlation between Using Social Networks and the General Health of Multiple Sclerosis Patients

Background Multiple sclerosis (MS) threatens the patients' independency and ability to effectively participate in the society. The aim of this study was to determine the correlation between using social networks on the general health of multiple sclerosis patients. Methods This study was performed on 80 MS patients referring to Shiraz University of Medical Sciences, Chamran, and Imam Reza Hospital in 2017, whose condition had improved and were treated by a specialist physician. Tools for data collection were general health questionnaire (GHQ-28) and social networks use questionnaires. Results Amongst the 80 individuals with MS, 65 (81.3%) were female and 15 (18.8%) were male. Our results suggest that patients with higher levels of education had higher levels of health (P = 0.01). Telegram and WhatsApp, respectively, had a positive correlation with general health (P = 0.007, P = 0.007), anxiety (P = 0.003, P = 0.028), and social dysfunction (P = 0.007, P = 0.007). WhatsApp with 33.64% was the most popular application among MS patients. The correlation between general health and duration of using social networks was not statistically significant (r = 0.22, P = 0.06). Also, no significant correlation was found between the duration of using social networks and the general health (P = 0.62). Conclusion Our findings suggest that social networks, especially Telegram and WhatsApp, had a positive correlation with general health, anxiety, and social dysfunction of patients. Therefore, the use of social networks can be considered as a suitable option in reducing the aforementioned concerns among patients with MS. On the other hand, general health and mood status might as well influence the use of social network in MS patients.

Health locus of control and mental health in patients with multiple sclerosis: Mediating effect of coping strategies.

In patients with multiple sclerosis (MS), mental health is significantly affected and conditioned by many factors, including psychological ones. This study team aimed to determine whether different coping strategies mediate the relationship between health locus of control (HLC) and mental health in MS patients. In this cross-sectional study, a total of 382 patients with MS were included. The patients completed General Health Questionnaire-12, Coping Inventory for Stressful Situations, and Multidimensional Health Locus of Control Scale. The demographic and clinical characteristics of the patients were collected using a self-report survey and neurological assessment. A mediation analysis was used to test the study hypothesis. Problem-oriented coping was found to be a significant mediator in the relationship between internal HLC and mental health (indirect effect: -0.129 [95% confidence interval [CI]: -0.193, -0.079]; standardized indirect effect: -0.113 [95% CI: -0.165, -0.070]). Emotion-focused coping was found to be a significant mediator in the relationship between power of others HLC and mental health (indirect effect: 0.114 [95% CI: 0.058, 0.178]; standardized indirect effect: 0.125 [95% CI: 0.062, 0.195]). Emotion-focused coping was also found to be a significant mediator in the relationship between chance HLC and mental health (indirect effect: 0.215 [95% CI: 0.154, 0.281]; standardized indirect effect: 0.209 [95% CI: 0.149, 0.272]). Patients with internal HLC were found to have positive mental health due to their problem-focused coping strategies, while patients with external HLC had worse mental health as they used more emotion-focused strategies. Hence, problem-focused and emotion-focused coping strategies can be considered mediators of the relationship between HLC and mental health in patients with MS.

S1P1 deletion differentially affects TH17 and Regulatory T cells

Sphingosine-1 phosphate receptor 1 (S1P1) is critical for the egress of T and B cells out of lymphoid organs. Although S1P1 agonist fingolimod is currently used for the treatment of multiple sclerosis (MS) little is known how S1P1 signaling regulates Th17 and Treg cell homeostasis. To study the impact of S1P1 signaling on Th17 and Treg cell biology, we specifically deleted S1P1 in Th17 and Treg cells using IL-17ACre and Foxp3Cre mice, respectively. Deletion of S1P1 in Th17 cells conferred resistance to experimental autoimmune encephalomyelitis (EAE). On the other hand, permanent deletion of S1P1 in Treg cells resulted in autoimmunity and acute deletion rendered mice more susceptible to EAE. Importantly, our study revealed that S1P1 not only regulated the egress of Treg cells out of lymphoid organs and subsequent non-lymphoid tissue distribution but also their phenotypic diversity. Most of the Treg cells found in S1P1-deficient mice as well as MS patients on fingolimod therapy had an activated phenotype and were more prone to apoptosis, thus converted to effector Treg. Our results provide novel insight into the functions of S1P1 and potential impact of long term fingolimod use on Th17 and Treg cell biology and general health in MS patients.

Effectiveness of Cognitive Behavioral Therapy on Mental Health in Multiple Sclerosis Patients

Effectiveness of Cognitive Behavioral Therapy on Mental Health in Multiple Sclerosis Patients

S1P1 deletion differentially affects TH17 and Regulatory T cells

Abstract Sphingosine-1 phosphate receptor 1 (S1P1) is a G-protein coupled receptor critical for the egress of T and B cells out of lymphoid organs. Although S1P1 agonists (such as fingolimod) are currently used for the treatment of multiple sclerosis (MS) little is known how S1P1 signaling regulates Th17 and Treg cell homeostasis. To study the impact of S1P1 signaling on Th17 and Treg biology, we specifically deleted S1P1 in Th17 and Treg cells using IL-17ACre and Foxp3Cremice, respectively. Deletion of S1P1 in Th17 cells conferred resistance to experimental autoimmune encephalomyelitis (EAE) characterized by reduced Th17 cell distribution across peripheral organs and diminished Th17 cell generation. On the other hand, permanent deletion of S1P1 in Treg cells resulted in autoimmunity and acute deletion rendered mice more susceptible to EAE. Importantly, our study revealed that S1P1 not only regulated the egress of Treg cells out of lymphoid organs and subsequent non-lymphoid tissue distribution but also their phenotypic diversity. Most of the Treg cells found in S1P1-deficient mice had an activated phenotype and were more prone to apoptosis, thus converted to effector Treg. The comparison of Treg cells obtained from MS patients treated with fingolimod to those treated with other oral drugs confirmed the switch of Treg cells into effector memory phenotype. Our results provide novel insight into the functions of S1P1 and potential impact of long term fingolimod use on Th17 and Treg cell biology and general health in MS patients.

Mental Health in Multiple Sclerosis Patients without Limitation of Physical Function: The Role of Physical Activity.

Multiple sclerosis (MS) patients, in general, show reduced physical function, physical activity, and quality of life. Positive associations between physical activity and quality of life have been reported. In particular, we were interested in the relation between physical activity and mental health in MS patients without limitation of physical function, since limitations of physical function may influence both physical activity and quality of life. Assessment comprised the Baecke questionnaire on physical activity, the Short Form 36 Health Survey (SF-36), and Beck Depression Inventory (BDI). We ranked our sample according to physical activity into four groups and performed an ANOVA to analyze the relationship between levels of physical activity and health-related quality of life (HRQoL). Then we performed a subgroup analysis and included patients with unlimited walking distance and a score of less than 18 in the BDI. Most active vs. inactive patients were compared for the mental subscales of the SF-36 and depression scores. From 632 patients, 265 met inclusion criteria and hence quartiles were filled with 67 patients each. Active and inactive patients did not differ considerably in physical function. In contrast, mental subscales of the SF-36 were higher in active patients. Remarkable and significant differences were found regarding vitality, general health perception, social functioning and mental health, all in favor of physically active patients. Our study showed that higher physical activity is still associated with higher mental health scores even if limitations of physical function are accounted for. Therefore, we believe that physical activity and exercise have considerable health benefits for MS patients.

Development of a cross-cultural item bank for measuring quality of life related to mental health in multiple sclerosis patients.

Quality of life (QoL) measurements are considered important outcome measures both for research on multiple sclerosis (MS) and in clinical practice. Computerized adaptive testing (CAT) can improve the precision of measurements made using QoL instruments while reducing the burden of testing on patients. Moreover, a cross-cultural approach is also necessary to guarantee the wide applicability of CAT. The aim of this preliminary study was to develop a calibrated item bank that is available in multiple languages and measures QoL related to mental health by combining one generic (SF-36) and one disease-specific questionnaire (MusiQoL). Patients with MS were enrolled in this international, multicenter, cross-sectional study. The psychometric properties of the item bank were based on classical test and item response theories and approaches, including the evaluation of unidimensionality, item response theory model fitting, and analyses of differential item functioning (DIF). Convergent and discriminant validities of the item bank were examined according to socio-demographic, clinical, and QoL features. A total of 1992 patients with MS and from 15 countries were enrolled in this study to calibrate the 22-item bank developed in this study. The strict monotonicity of the Cronbach's alpha curve, the high eigenvalue ratio estimator (5.50), and the adequate CFA model fit (RMSEA=0.07 and CFI=0.95) indicated that a strong assumption of unidimensionality was warranted. The infit mean square statistic ranged from 0.76 to 1.27, indicating a satisfactory item fit. DIF analyses revealed no item biases across geographical areas, confirming the cross-cultural equivalence of the item bank. External validity testing revealed that the item bank scores correlated significantly with QoL scores but also showed discriminant validity for socio-demographic and clinical characteristics. This work demonstrated satisfactory psychometric characteristics for a QoL item bank for MS in multiple languages. This work may offer a common measure for the assessment of QoL in different cultural contexts and for international studies conducted on MS.

Marital Satisfaction and Mental Health in Multiple Sclerosis Patients’ and Healthy Individuals’ Accordance to Sex

The aim of this study was to compare marital satisfaction and mental health in male and female multiple sclerosis patients with healthy males and females. In a correlation study, 59 MS patients in Tehran (31 female and 28 male, with a range of 25 to 55 years old) were selected by the random cluster sampling method and 59 healthy individuals were matched with them in sex and age. Then both groups filled in the marital satisfaction questionnaire of Enrich and GHQ. The test of multi-variance analysis showed that, regardless of the gender, for people with MS disease, the marital satisfaction and the whole of its subscales except the religion and the mental health and its all sub-scales, are established at a significantly low level. However, the comparison of these groups due to the gender showed that in the satisfaction elements and personality issues, the relationship between marital and leisure time of women patients is worse than men; however, healthy women scores in financial management are lower than healthy men. In addition, in the elements of mental health, women and men patients are similar to each other but healthy women have higher physical symptoms than healthy men (P

Risk of fractures in patients with multiple sclerosis: record-linkage study

BackgroundPatients with multiple sclerosis (MS) have been reported to be at higher risk of fracture than other people. We sought to test this hypothesis in a large database of hospital admissions in England.MethodsWe analysed a database of linked statistical records of hospital admissions and death certificates for the whole of England (1999–2010). Rate ratios for fractures were determined, comparing fracture rates in a cohort of all people in England admitted with MS and rates in a comparison cohort.ResultsSignificantly elevated risk for all fractures was found in patients with MS (rate ratio (RR) = 1.99, 95% confidence interval (CI) = 1.93-2.05)). Risks were particularly high for femoral fractures (femoral neck fracture RR = 2.79 (2.65-2.93); femoral shaft fracture RR 6.69 (6.12-7.29)), and fractures of the tibia or ankle RR = 2.81 (2.66-2.96).ConclusionsPatients with MS have an increased risk of fractures. Caregivers should aim to optimize bone health in MS patients.

Correlation of Circulating Omentin-1 with Bone Mineral Density in Multiple Sclerosis: The Crosstalk between Bone and Adipose Tissue

BackgroundPatients with multiple sclerosis (MS) are at increased risk of osteoporosis and fractures. Adipose tissue-derived adipokines may play important roles in the osteoimmunology of MS. In order to determine whether omentin-1 and vaspin may be related to bone health in MS patients, we compared circulating levels of these recently identified adipokines, between MS patients and healthy controls.MethodsA total of 35 ambulatory MS patients with relapsing-remitting courses were compared with 38 age- and sex-matched healthy controls. Bone mineral density (BMD) was determined for the lumbar spine (L2–L4) and the proximal femur using dual-energy x-ray absorptiometry. Circulating omentin-1, vaspin, osteocalcin, osteopontin, osteoprotegerin, the receptor activator of nuclear factor-κB ligand, matrix metalloproteinase 9, C-reactive protein and 25-hydroxy vitamin D levels were evaluated by highly specific enzyme-linked immunosorbent assay methods.ResultsThere was no significant difference between the two groups regarding bone-related cytokines, adipocytokines, and the BMD measurements of patients with MS and the healthy controls. However, in multiple regression analysis, serum omentin-1 levels were positively correlated with BMD at the femoral neck (β = 0.49, p = 0.016), total hip (β = 0.42, p = 0.035), osteopontin (β = 0.42, p = 0.030) and osteocalcin (β = 0.53, p = 0.004) in MS patients. No correlations were found between vaspin, biochemical, and BMD measures in both groups.ConclusionsElevated omentin-1 serum levels are correlated with BMD at the femoral neck and the serum levels of osteocalcin and osteopontin in MS patients. Therefore, there is crosstalk between adipose tissue and bone in MS.

P01-298 - Effects of written emotional expression on general health of patients with multiple sclerosis

Introduction and objectivesMultiple Sclerosis (MS) is an acquired chronic neurological disorder. Studies have shown that prevalence of MS is more in some areas of Iran like as Azarbaijan(Tabriz) and Isfahan. General health problems are prevalent in MS patients. Written Emotional Expression (WEE) is one of the cost-effective self helpers' methods that its efficacy has been studied on mental health, but this method has never been studied on MS patients in Iran.AimsAim of this study was to evaluate efficacy of WEE on general health of MS patients.MethodsWith experimental study, 40 (8 male, 32 female) MS patients who had completed informed written consent and filled General Health Questionnaire (GHQ-28) were asked to write their negative feeling for 30 minutes daily for 4 consecutive days. After 15 days they filled GHQ again. Finally the Statistical analysis was done.ResultsAfter intervention of Written Emotional Expression, general health score in patients with multiple sclerosis decreased significantly. (p< 0.01)ConclusionsWritten Emotional Expression may be effective on general health of multiple sclerosis patients.

Psychosocial and neurological predictors of mental health in multiple sclerosis patients

Multiple Sclerosis (MS) is a chronic and unpredictable disease, largely uncontrolled by current treatment. Its effects vary from a mild course with minimal disabilities to a rapidly progressing or fluctuating course with devastating disabilities. No reliable indicators exist to assure patients that their status will remain stable or that disabilities will not emerge or progress. Furthermore, patients confront symptoms that frequently and unpredictably vary with respect to form and intensity, sometimes daily. Over the short and long term, the unpredictability and mutability of MS-related disabilities pose particular adjustment problems. For these reasons, there has been increasing interest in studying psychosocial adjustment in MS patients. Unfortunately, many studies of adjustment have suffered from methodological flaws (see, for review, Devins and Seland [l]). In particular, several studies fail to take adequate account of physiological disease factors in the assessment of psychological status. Assessment instruments have been employed that misclassify somatic complaints, often reflecting neurological dysfunction in MS, as evidence of psychopathology. The Minnesota Multiphasic Personality Inventory (MMPI) [2] and General Health Questionnaire (GHQ) [3] are examples of inventories that misclassify neurological impairment in this way, likely overestimating the prevalence of mood and personality disorders in MS patients [4,5]. Certainly, accounting for the effects of physical symptoms on psychological status is of major importance in evaluating factors affecting adjustment. Thus, the search for predictive factors requires multifactorial designs, evaluating theoretically cohesive models of adequately measured physical and psychosocial factors. In this study, we investigated a model that included disease status, physical disability, and psychosocial measures to identify key factors affecting the mental health of MS patients. Our goal was a model of factors that could guide intervention programs assisting psychosocial adjustment. We conceptualized five sets of factors: neurological impairment, disease duration, physical disability, disease-related symptoms, and psychosocial factors. In further specifying variables, in terms of neurological impairment, we considered both the current severity of neurological impairment and the duration of disease (measured from the onset of disease perceived by the patient) as potentially significant contributors to mental health status. Physical disability indices were used to assess whether the sickness-related disruption of physical functioning, affecting ambulation, mobility, and body care, would have

A comparison of mental health of multiple sclerosis patients with silver/mercury dental fillings and those with fillings removed.

In this study was compared the mental health status of 47 multiple sclerosis patients with silver/mercury tooth fillings (amalgams) to that of 50 patients with their fillings removed. On the Beck Depression Inventory the multiple sclerosis subjects with amalgams suffered significantly more depression while their scores on the State-Trait Anger Expression Inventory indicated the former group also exhibited significantly more anger. On the SCL-90 Revised, subjects with amalgam fillings had significantly more symptoms of depression, hostility, psychotism, and were more obsessive-compulsive than the patients with such fillings removed. On a questionnaire containing 18 mental health symptoms multiple sclerosis subjects with amalgam fillings reported a history of 43% more symptoms than those without amalgam fillings over the past 12 months. These data suggested that the poorer mental health status exhibited by multiple sclerosis subjects with dental amalgam fillings may be associated with mercury toxicity from the amalgam.