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Ghezelhesari EM, Nahayati MA, Heydari A, Ebrahimipour H, Khadivzadeh T. Understanding the meaning of the lived experience "maternal role" in women with multiple sclerosis and planning a supportive program: a combined exploratory study protocol. Reprod Health 2024; 21:59. [PMID: 38693529 PMCID: PMC11064364 DOI: 10.1186/s12978-024-01799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The maternal role is one of the most challenging yet rewarding roles that women experience in their lives. It begins when a woman becomes pregnant, and as the pregnancy progresses, she prepares to fulfill her role as a mother. A woman's health plays a crucial role in her ability to fulfill the maternal role. Multiple sclerosis (MS), as an autoimmune disease, presents unique challenges in achieving this role. Failing to fulfill the maternal role can have lasting consequences for both the mother and the baby. Given the increasing number of women with MS of reproductive age in Iran and the absence of specific programs for this group during pregnancy and postpartum, researchers have decided to develop a supportive program by exploring the meaning of the maternal role and identifying the needs of these women during this period. METHODS/MATERIALS This study will be conducted in 3 stages. The first stage involves a qualitative study to explore the meaning of the "maternal role" in women with MS through a descriptive and interpretive phenomenological approach based on Van Manen's method. Data will be collected through semi-structured interviews with pregnant women with MS and mothers with MS who have children under one-year-old, recruited from the Multiple Sclerosis Society of Mashhad, Iran. The second stage will involve designing a support program based on the findings of the phenomenological study, literature review, and exploratory interviews. A logical model will guide the development of the program, and validation will be conducted using the nominal group technique. DISCUSSION This study is the first of its kind in Iran to explore the meaning of the maternal role and develop a support program for women with MS. It is hoped that the results of this study will help address the challenges of motherhood faced by these women.
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Affiliation(s)
| | - Mohamad Ali Nahayati
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Ebrahimipour
- Department of Health Economics and Management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Health Sciences Reseach Center, Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh, Iran
| | - Talat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Ebn Sina Street, Mashhad, 9137913199, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
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Yamout B, Al-Jumah M, Sahraian MA, Almalik Y, Khaburi JA, Shalaby N, Aljarallah S, Bohlega S, Dahdaleh M, Almahdawi A, Khoury SJ, Koussa S, Slassi E, Daoudi S, Aref H, Mrabet S, Zeineddine M, Zakaria M, Inshasi J, Gouider R, Alroughani R. Consensus recommendations for diagnosis and treatment of Multiple Sclerosis: 2023 revision of the MENACTRIMS guidelines. Mult Scler Relat Disord 2024; 83:105435. [PMID: 38245998 DOI: 10.1016/j.msard.2024.105435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for Multiple Sclerosis (MS), most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and time and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of MS therapies is critical to maximize patient benefit. The current guidelines review the current diagnostic criteria for MS and the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, progressive MS, pediatric cases and pregnant women. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
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Affiliation(s)
- B Yamout
- Neurology Institute and Multiple Sclerosis Center, Harley Street Medical Center, Abu Dhabi, United Arab Emirates.
| | - M Al-Jumah
- InterHealth hospital, Multiple Sclerosis Center, Riyadh, Saudi Arabia
| | - M A Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Y Almalik
- Division of Neurology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - J Al Khaburi
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - N Shalaby
- Neurology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | | | - S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - A Almahdawi
- Consultant Neurologist, Neurology Unit, Baghdad Teaching Hospital, Medical City Complex, Iraq
| | - S J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Koussa
- Multiple Sclerosis Center, Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | - E Slassi
- Hôpital Cheikh Khalifa Ibn Zaid, Casablanca, Morocco
| | - S Daoudi
- Hospital Center Nedir Mohamed, Faculty of Medicine, University Mouloud Mammeri Tizi-Ouzou, Algeria
| | - H Aref
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - S Mrabet
- Department of Neurology, CIC, Razi Universitary Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - M Zeineddine
- Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS), Beirut, Lebanon
| | | | - J Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - R Gouider
- Department of Neurology, CIC, Razi Universitary Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - R Alroughani
- Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait
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3
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Malekifar P, Nedjat S, Abdollahpour I, Nazemipour M, Malekifar S, Mansournia MA. Impact of Alcohol Consumption on Multiple Sclerosis Using Model-based Standardization and Misclassification Adjustment Via Probabilistic Bias Analysis. ARCHIVES OF IRANIAN MEDICINE 2023; 26:567-574. [PMID: 38310413 PMCID: PMC10862089 DOI: 10.34172/aim.2023.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/06/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND The etiology of multiple sclerosis (MS) is still not well-demonstrated, and assessment of some risk factors like alcohol consumption has problems like confounding and measurement bias. To determine the causal effect of alcohol consumption on MS after adjusting for alcohol consumption misclassification bias and confounders. METHODS In a population-based incident case-control study, 547 patients with MS and 1057 healthy people were recruited. A minimally sufficient adjustment set of confounders was derived using the causal directed acyclic graph. The probabilistic bias analysis method (PBAM) using beta, logit-logistic, and triangular probability distributions for sensitivity/specificity to adjust for misclassification bias in self-reporting alcohol consumption and model-based standardization (MBS) to estimate the causal effect of alcohol consumption were used. Population attributable fraction (PAF) estimates with 95% Monte Carlo sensitivity analysis (MCSA) intervals were calculated using PBAM and MBS analysis. Bootstrap was used to deal with random errors. RESULTS The adjusted risk ratio (95% MCSA interval) from the probabilistic bias analysis and MBS between alcohol consumption and MS using the three distribution was in the range of 1.93 (1.07 to 4.07) to 2.02 (1.15 to 4.69). The risk difference (RD) in all three scenarios was 0.0001 (0.0000 to 0.0005) and PAF was in the range of 0.15 (0.010 to 0.50) to 0.17 (0.001 to 0.47). CONCLUSION After adjusting for measurement bias, confounding, and random error alcohol consumption had a positive causal effect on the incidence of MS.
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Affiliation(s)
- Pooneh Malekifar
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Abdollahpour
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Science, Isfahan, Iran
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Malekifar
- Department of Computer Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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4
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Goliroshan S, Babamohamadi H, Mohammadi E, Baghbanian SM, Asgari MR. Barriers to and Facilitators of Adjustment Among Iranian Multiple Sclerosis Patients: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1068-1079. [PMID: 37635305 DOI: 10.1177/10497323231196521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Patients with multiple sclerosis (MS) experience various physical symptoms and psychosocial problems that disrupt their normal life, and adapting to these conditions is vital for them. Many factors that serve as facilitators of and barriers to achieving adjustment should be identified to be able to help the patients. This study was conducted to explain the experiences of patients with MS regarding the facilitators of and barriers to adjustment using conventional content analysis. The participants consisted of 18 patients, one nurse, one physician, and one patient companion, who were selected from the Multiple Sclerosis Clinic of BouAli, northern Iran, through purposive sampling. Data were collected through individual, in-depth, and semi-structured interviews and analyzed using the method recommended by Elo and Kyngäs (2008). The data analysis generated five subcategories as facilitators and five subcategories as barriers. The subcategories of facilitators included family's appropriate behavior with the patient, occupation, studying and information gathering, religious beliefs, and turning attitude into disease simplification and optimism. The subcategories of barriers were concerns about the uncertain future of the disease, physicians' poor communication and behavior, society's poor attitude, economic problems, and unsatisfactory support by the government and insurance companies. The results showed that a set of individual, environmental, and social factors serves as facilitators of or barriers to the process of adjustment to MS in patients. Gaining knowledge about these factors in congruence with the sociocultural context of the society, as derived from people's real experiences, can help healthcare staff and the family of these patients provide more efficient assistance to the patients for achieving adjustment earlier.
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Affiliation(s)
- Soghra Goliroshan
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
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5
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Dastoorpoor M, Nabavi SM, Majdinasab N, Zare Javid A, Ahmadi Angali K, Seyedtabib M. A case-control study of drinking beverages and the risk of multiple sclerosis in Iran. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:22. [PMID: 36959679 PMCID: PMC10037787 DOI: 10.1186/s41043-023-00364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND There is no study in the world on the relationship between consuming black and green tea as beverages containing polyphenols and the risk of MS. This study aimed to determine the association between the consumption of green and black tea, coffee, non-alcoholic beer, milk, fruit juices and carbonated beverages with the risk of MS. METHODS AND MATERIALS This case-control study was performed on 150 patients with MS and 300 healthy individuals as a control group among patients who were referred to the ophthalmology ward of a referral hospital in Ahvaz with the groups matching for age. The data collection tool was a researcher-made questionnaire including demographic information and beverage consumption. Analysis was performed using univariate and multiple logistic regression models. RESULTS The mean age of patients at the time of diagnosis was 38.55 ± 8.88 years. The results showed that drinking milk (OR = 5.46), natural juice (OR = 2.49), and carbonated beverages (OR = 16.17) were associated with an increased chance of developing MS. However, drinking non-alcoholic beer (OR = 0.48), black tea (OR = 0.20), green tea (OR = 0.29) and coffee (OR = 0.07) were associated with a reduced chance of developing MS. CONCLUSION The results show that drinking black and green tea, non-alcoholic beer, and coffee are associated with a decrease in the chance of developing MS. The results of this study can be used to design interventional research and to change people's lifestyles to prevent MS.
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Affiliation(s)
- Maryam Dastoorpoor
- Department of Biostatistics and Epidemiology, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Massood Nabavi
- Department of Regenerative Biomedicine, Royan Institute for Stem Cell Biology and Technology, ACCR, Tehran, Iran
- Department of Brain and Cognition, Royan Institute for Stem Cell Biology and Technology, ACCR, Tehran, Iran
| | - Nastaran Majdinasab
- Department of Neurology, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Zare Javid
- Department of Nutritional Sciences, School of Allied Medical Sciences, Nutrition, and Metabolic Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Ahmadi Angali
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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6
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Amiri Z, Azmin M, Amiri S, Akbarisari A, Sahraian MA, Farzadfar F, Soleymani F. Prevalence of comorbidities in patients with multiple sclerosis using administrative data from 2007 to 2016 in Iran. Mult Scler Relat Disord 2023; 74:104693. [PMID: 37031549 DOI: 10.1016/j.msard.2023.104693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Research interest in the impact of comorbidities in MS has been expanding. Based on studies, certain comorbidities are more prevalent in MS population such as depression, anxiety, hypertension and hypercholesterolemia, diabetes, and hypothyroidism. OBJECTIVE This study aims to describe the prevalence of comorbidities in MS population based on the health insurance claims data. METHOD This retrospective database analysis was conducted using patient-level medicinal and pharmacy claims data from a leading insurance group (Iranian health insurance) in 2007-2016. MS population was identified based on their Disease Modifying Therapies prescribed by a neurologist (qualified to diagnose MS). Comorbidities in MS and non-MS population were assessed by their prescriptions. Crude and age-standardized prevalence rate (ASPR) of coverage of comorbidities in different age and sex groups and their odds ratio versus non-MS population were assessed. RESULTS The most common comorbidities were depression (15.50%) and anxiety (10.1%). Hypercholesterolemia, diabetes, hypertension, and hypothyroidism were prevalent in 6%, 3.6%, 3.5%, and 2.7% respectively. Anxiety and depression were more prevalent in middle age group (45-65 years old). But other comorbidities were more prevalent in older age groups. All comorbidities were more prevalent in female except hypertension in patients ≥45 years old. The odds of all comorbidities were higher for male patients with MS rather than their parallel age group in non-MS patients. These also applied for female patients with MS 18-44 years old (except hypertension). CONCLUSION Using claims data, the prevalence of taking treatment for selected comorbidities in MS population and their association with sex and age, can guide patients, healthcare providers, and policy makers to help improve MS patients' wellbeing.
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Affiliation(s)
- Zahra Amiri
- Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Azmin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Amiri
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran; Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbarisari
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Head of the National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Sina Hospital, Tehran University Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Soleymani
- Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Faraji F, Ahmadi F, Mohaghegh P, Talaie A. Temporal Incidence and Prevalence Trends of Multiple Sclerosis in Markazi Province, Iran. Mult Scler Relat Disord 2022; 60:103691. [PMID: 35217485 DOI: 10.1016/j.msard.2022.103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The epidemiology of multiple sclerosis (MS) exhibits significant variability all over the world. Additionally, the incidence and prevalence of the disease are geographically diverse in the different provinces of Iran. OBJECTIVES Due to the lack of a research about the epidemiology of MS in the Markazi province of Iran, the present study aimed to estimate its prevalence and incidence in this province. METHODS This cross-sectional register study was conducted according to the data related to the MS Society of Markazi province. The inclusion criteria were definite MS during 2010-2019, residence in Markazi province, and membership in the MS society of Markazi province. The annual incidence and prevalence of MS (per 100,000 person-years) were computed by sex and age groups. Further, age-standardized prevalence and incidence rates were calculated based on the Iranian population. A gamma regression model with log link was utilized for comparing the rates over time statistically. The prevalence and incidence rates were computed by using Excel, and R 4.0.5 was applied to fit the gamma model. RESULTS In the study, the total number of MS cases was 1,391, among whom 1,098 (78.9%) and 293 (21.1%) were females and males, respectively. The onset of MS occurred at the mean (S.D) age of 31.76 (8.98) years with a female/male ratio of 3.75. During the study period (2010-2019), the incidence rate of the disease was on the decline, while the prevalence rate elevated, by indicating a rising trend in MS prevalence in both sexes. CONCLUSION The results represented the decreasing and increasing trend of the incidence and prevalence of MS in Markazi province over the recent years. The province is one of the regions with a high prevalence and incidence rate of MS compared to the national and global statistical data.
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Affiliation(s)
- Fardin Faraji
- Associate professor of neurology, department of neurology, school of medicine, Arak University of Medical Sciences, Arak, Iran; Traditional and complementary medicine research center, Arak University of Medical Sciences, Arak, Iran; Applied neuroscience research center, Islamic Azad University, Arak branch, Arak, Iran
| | - Farzane Ahmadi
- Assistant Professor of Biostatistics, Department of Biostatistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Pegah Mohaghegh
- Assistant professor of community and preventive medicine, department of community medicine, school of medicine, Arak university of medical sciences, Arak, Iran.
| | - Afsoon Talaie
- PhD. of biochemistry, Msc of nutrition, Health department, Islamic Azad University, Arak branch, Arak, Iran
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8
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Amirsadri M, Rahimi F, Khajepour A. Cost of Illness of Multiple Sclerosis in Isfahan, Iran, From a Social Perspective: A Comparison of the Human-Capital and Friction-Cost Methods. Value Health Reg Issues 2022; 30:26-30. [PMID: 35042020 DOI: 10.1016/j.vhri.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/25/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that is characterized by demyelination and neurodegenerative changes and associated with high levels of disability. This study aimed to investigate direct and indirect costs of illness of patients with MS in Isfahan using and comparing human-capital and friction-cost methods from a societal perspective. METHODS A total of 300 patients with MS of 2 main centers of the disease in Isfahan, the MS center of Ayatollah Kashani hospital and Isfahan MS center, were included. Patient's demographic characteristics, disease information, and annual social costs (2018-2019) were collected using data collection form. Both the human-capital and friction-cost methods were applied and compared with value indirect costs because of loss of productivity. RESULTS From the social perspective, the average annual total cost of MS disease was estimated to be 1 441 163 710 rials (34 313 US dollar [USD]) per patient using the human-capital approach and 1 434 832 004 rials (34 162 USD) with the use of friction-cost method, from which 1 428 668 396 rials (34 016 USD) was related to direct costs. The main direct costs were related to disease-modifying therapies and referring to other physicians and hospitals. The cost of loss of production was greater with human-capital approach in comparison with friction-cost method. CONCLUSIONS The most prominent cost in MS disease is related to drug costs. The indirect costs were sensitive to the methods, applied in the study.
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Affiliation(s)
- Mohammadreza Amirsadri
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Farimah Rahimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azin Khajepour
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
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9
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Mirmosayyeb O, Shaygannejad V, Bagherieh S, Hosseinabadi AM, Ghajarzadeh M. Prevalence of multiple sclerosis (MS) in Iran: a systematic review and meta-analysis. Neurol Sci 2021; 43:233-241. [PMID: 34787755 DOI: 10.1007/s10072-021-05750-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prevalence of multiple sclerosis (MS) is increasing world-wide. Iran is not exception. As the prevalence reported differently in various provinces, we designed this systematic review and meta-analysis to estimate pooled prevalence of MS in Iran. METHODS Two researchers systematically searched Scientific Information Database (SID), PubMed, Scopus, EMBASE, Web of Science, and google scholar. They also searched references of the included studies, and conference abstracts which were published up to April 2021. The search strategy included the MeSH and text words as ((((Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Dis-seminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating)) AND (prevalence OR prevalences OR period prevalence OR prevalence, period OR point prevalence OR point prevalences OR prevalence, point) AND (Iran OR Islamic Republic of Iran)))). RESULTS The literature search revealed 2817 articles, after deleting duplicates 2184 remained. For the systematic review, 34 studies were included. The prevalence is highest in Tehran and lowest in Khuzestan and Sistan-Baluchestan provinces. The pooled prevalence was 0.001 (95% CI: 0.000-0.001) (I2=0, P<0.001). CONCLUSION The results of this study show that the pooled prevalence of MS in Iran is 100 in 100,000 which is high. The prevalence in provinces increases dramatically.
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Affiliation(s)
- Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Bagherieh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mahdi Hosseinabadi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Ghajarzadeh
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Koch-Henriksen N, Magyari M. Apparent changes in the epidemiology and severity of multiple sclerosis. Nat Rev Neurol 2021; 17:676-688. [PMID: 34584250 DOI: 10.1038/s41582-021-00556-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is an immunological disease that causes acute inflammatory lesions and chronic inflammation in the CNS, leading to tissue damage and disability. As awareness of MS has increased and options for therapy have come into use, a large amount of epidemiological data have been collected, enabling studies of changes in incidence and disease course over time. Overall, these data seem to indicate that the incidence of MS has increased, but the course of the disease has become milder, particularly in the 25 years since the first disease-modifying therapies (DMTs) became available. A clear understanding of these trends and the reasons for them is important for understanding the factors that influence the development and progression of MS, and for clinical management with respect to prevention and treatment decisions. In this Review, we consider the evidence for changes in the epidemiology of MS, focusing on trends in the incidence of the disease over time and trends in the disease severity. In addition, we discuss the factors influencing these trends, including refinement of diagnostic criteria and improvements in health-care systems that have increased diagnosis in people with mild disease, and the introduction and improvement of DMT.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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11
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Fattahi N, Saeedi Moghaddam S, Mohebi F, Rezaei N, Masinaei M, Fateh SM, Soleymani Hassanlouei E, Manoochehri F, Fattahi E, Sahraian MA, Moradi-Lakeh M, Mokdad AH, Naghavi M, Farzadfar F. Burden of multiple sclerosis in Iran from 1990 to 2017. BMC Neurol 2021; 21:400. [PMID: 34654397 PMCID: PMC8518301 DOI: 10.1186/s12883-021-02431-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/04/2021] [Indexed: 01/04/2023] Open
Abstract
Background Multiple Sclerosis (MS) is a burdensome, chronic and autoimmune disease of the central nervous system. We aimed to report the incidence, prevalence, mortality, and Disability Adjusted Life Years (DALYs) of MS in Iran at a national level for different age and sex groups over a period of 28 years (1990–2017). Methods Data were extracted from the Global Burden of Disease study (GBD) from 1990 to 2017, published by the Institute for Health Metrics and Evaluation. The incidence of DALYs and prevalence of MS were estimated to report the burden of MS based on sex and age in Iran from 1990 to 2017. Results At the national level, the Age-Standardized Incidence Rate (ASIR), Age-Standardized Prevalence Rate (ASPR), Age-Standardized DALYs Rate (ASDR) and the Age-Standardized Mortality Rate (ASMR) in Iran in 2017 were 2.4 (95% Uncertainty Interval [UI]: 2.1 to 2.7), 69.5 (62.1 to 77.8), 29.1 (23.6 to 34.7), and 0.4 (0.3 to 0.4) per 100,000 population, respectively. During the period of 1990 to 2017, all measures increased, and were higher among females. The incidence rate began upward trend at the age of 20 and attained its highest level at the age of 25. Conclusion In Iran, all of the age-standardized MS rates have been increasing during the 28 years from 1990 to 2017. Our findings can help policy makers and health planners to design and communicate their plans and to have a better resource allocation, depending on the incidence and prevalence of the growing numbers of MS patients in Iran.
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Affiliation(s)
- Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnam Mohebi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Manoochehri
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Eghbal Fattahi
- Department of Internal Medicine, Tohid Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Ali Sahraian
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Afshar M, Sadat Z, Bagheri M. The Effect of Spiritual Counseling on Hope in Patients with Multiple Sclerosis: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2021; 9:313-324. [PMID: 34604400 PMCID: PMC8479289 DOI: 10.30476/ijcbnm.2021.88605.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
Background: Spiritual practices have recently emerged as beneficial to both mental and physical health. The present study was conducted to determine the effect
of spiritual counseling on hope among patients with Multiple Sclerosis (MS). Methods: This single blind randomized controlled clinical trial was conducted on the patients with MS in April-June 2020, Kashan, Iran.
50 patients were randomly assigned to two 25-member groups. The patients in the intervention group participated in eight 60-minute spiritual counseling program.
They were asked to fill out the demographic information questionnaire before the intervention and Herth Hope Index (HHI) before, immediately (in the 4th week of the study)
and a month after the intervention (in the 8th week of the study). Data were analyzed using Chi-square, independent samples t-test and
repeated measures ANOVA in SPSS version 16. The significance level was considered P<0.05. Results: The results showed that the differences between the two groups before the intervention were not statistically significant in terms of demographic variables (P>0.05)
and the mean score of hope (P=0.61). However, the total mean score of HHI in the intervention group was significantly different from the control group
immediately and a month after the intervention (44.95±1.42 VS. 31.66±2.45 and 43.25±1.84 VS. 30.58±2.24), respectively (P<0.001).
According to the results of the repeated measures ANOVA, the level of hope and its dimensions significantly changed in the intervention group over time (P<0.001). Conclusion: The results of the present study showed that spiritual counseling promoted the hope score in patients with MS.
It is recommended that spiritual counseling should be use as a complementary therapy along with other counseling treatments to increase hope in patients with MS. Trial Registration Number: IRCT20190819044567N
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Affiliation(s)
- Mohammad Afshar
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohhammad Bagheri
- Department of Psychiatric Nursing, Kashan University of Medical Sciences, Kashan, Iran
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13
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Mobasheri F, Fararouei M, Hasanzadeh J, Jaberi AR. 18-year temporal trend of multiple sclerosis in southern Iran. Mult Scler Relat Disord 2021; 52:103018. [PMID: 34023774 DOI: 10.1016/j.msard.2021.103018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/03/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) imposes significant burdens on patients, their families, and national healthcare systems particularly when there is a resource constraint. Proper prioritization and resource allocation are therefore essential for any effective disease management. Accordingly, we sought to assess the temporal profile of MS incidence over the past two decades in southeast Iran. METHODS A longitudinal design was employed using data from the Iranian multiple sclerosis registry system from March 2001 to March 2019 (n=6034). Annual age-standardized incidence rates of MS (cases of clinically isolated syndrome were also included) were calculated and the trend of incidence from 2001 to 2018 was analyzed. RESULTS The age-adjusted incidence rate of MS raised from 1.72/100,000 in 2001 to 11.29/100,000 in 2018 (average of 18-year incidence rate was 6.30/100,000), indicating a notable rise in the incidence of MS (P-Value<0.001). However, the female to male ratio of 3.62 remained relatively stable during the study period. CONCLUSION Our study suggests that, in Fars province, the incidence of MS has been remarkably rising over the past two decades. We recommend further studies to better understand the determinants of this pattern. Implementing effective policies in lowering the burden of MS is another important step in this regard.
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Affiliation(s)
- Farzaneh Mobasheri
- Student Research Committee; Shiraz University of medical science, Shiraz; Iran
| | - Mohammad Fararouei
- Professor, HIV/AIDS Research Center; Shiraz University of Medical Sciences; Iran.
| | - Jafar Hasanzadeh
- Professor, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimi Jaberi
- Assistant Professor, Clinical neurology research center, non-communicable disease research center, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Sarmadi M, Saravani H, Azizi O, Najafi F, Hadei M, Momeni J, Bazrafshan E. Temporal trends of incidence and prevalence of multiple sclerosis in Razavi Khorasan Province, Northeast Iran. Neurol Sci 2021; 43:583-591. [PMID: 33939041 DOI: 10.1007/s10072-021-05280-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The prevalence of multiple sclerosis (MS) in the Persian Gulf countries has been significantly increasing during the past decades. This study was conducted for investigating the prevalence and incidence of MS in Northeast Iran (Khorasan Razavi province). METHODS This cross-sectional study was conducted during 1 January 1988 and 23 September 2018. All patients with a clinically definite diagnosis of MS according to the McDonald criteria (2005) and MRI along with the medical diagnosis, recorded in the Khorasan MS society, were considered for calculation of crude and age-standardized prevalence, and incidence rates of MS. The periodic incidence rates were calculated based on the year of onset of MS. Also, we calculated gender ratios for prevalence and incidence rates. RESULTS The mean age-standardized prevalence and incidence rates of MS in the Khorasan Razavi were 8.69 (95% CI 8.05-9.41) per 100,000 (3.99 (95% CI 3.39-4.74) for males, 13.49 (95% CI 12.37-14.76) for females). Age-standardized prevalence was 48.87 (95% CI 48.37-49.35) per 100,000 (22.47 (95% CI 22.01-22.93) for males, 75.65 (95% CI 74.80-76.51) for females). Also, the mean incidence and prevalence for Mashhad County as capital of province were 11.38 and 59.09 per 100,000 populations, respectively. The female/male ratio was 3.33 for all age groups. CONCLUSION Our results showed that this region is a high-risk area for MS like central region of Iran. Our results revealed that the prevalence and incidence of MS in the study area have increased during the recent decades with a sharp slope.
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Affiliation(s)
- Mohammad Sarmadi
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Hanie Saravani
- Student of Emergency Nurse, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
- Imam Ali Research Hospital, School of nursing and midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Omid Azizi
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Department of Laboratory Sciences, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fereshteh Najafi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hadei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Jalil Momeni
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Edris Bazrafshan
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
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15
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Jamalianfar F, Riazi H, Firoozi A, Nasiri M, Montazeri A. The Effectiveness of ‘Good-Enough Sex Model’ on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09691-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Assessment of delayed diagnosis and treatment in multiple sclerosis patients during 1990-2016. Acta Neurol Belg 2021; 121:199-204. [PMID: 33180313 DOI: 10.1007/s13760-020-01528-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) is the most common inflammatory demyelinating disease in the central nervous system. It is one of the major causes of disability in young adults. Early diagnosis and treatment of this disease could decrease later disability and additional costs. In this cross-sectional analytical study, a total of 351 patients were selected from among the multiple sclerosis patients that went to MS clinic or neurologic clinic in 1990-2016. Data were collected and analysed by SPSS v16. This study was conducted on 82.6% females and 17.4% males. Family history of MS was positive in 12.8% of cases. Mean time of onset of symptoms till first medical visit was 3.25 months. Mean time from first medical visit to diagnosis was 14.98 months. Mean time from onset of symptoms till diagnosis was 18.01 months and the mean time from onset of symptoms till initiation of treatment was 18.73 months. Also, 29.3% of cases had delay in first medical visit and 42.2% of cases had delay in diagnosis of MS more than 6 weeks from first medical visit. Overall, delay in first medical visit and diagnosis of MS has decreased over the years. However, there is still delay in diagnosis of MS. Factors associated with delay are low education, male gender, living in rural areas, primary progressive MS, age at MS diagnosis and first clinical symptoms.
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17
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Mobasheri F, Jaberi AR, Hasanzadeh J, Fararouei M. Multiple sclerosis diagnosis delay and its associated factors among Iranian patients. Clin Neurol Neurosurg 2020; 199:106278. [DOI: 10.1016/j.clineuro.2020.106278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
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18
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Multiple sclerosis in Pakistan: Current status and future perspective. J Neurol Sci 2020; 418:117066. [PMID: 32823132 DOI: 10.1016/j.jns.2020.117066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/20/2022]
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) which commonly leads to disability. We reviewed articles on MS from Pakistan using PubMed, Google Scholar and Pak Medinet to present different aspects of the disease and the status of disease modifying treatments in Pakistan and South Asia. MS is not as uncommon in Pakistan as it has been previously thought to be. Estimated prevalence of MS in Pakistan may be 10 per 100,000 population. Data suggests that most features of MS found in Pakistan are similar to those found in the West. These features include a female preponderance, mean age of onset in the third decade of life and similar risk factors including viral infections, smoking, and vitamin D deficiency, as well as genetic risk factors. Relapsing-remitting multiple sclerosis (RRMS) is the most common disease pattern seen in Pakistan which is also consistent with data from other regions. Treatment modalities in Pakistan include immunomodulatory and immunosuppressive drugs. In order to improve care for MS patients in Pakistan, it is extremely important to obtain a population-based prevalence of MS in the country and a national MS registry, along with implementing programs for patients' awareness and the training of doctors, especially internists. There are many disease modifying therapies (DMT) available in Pakistan but no data is available on the utilization and impact of these DMTs.
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19
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Molazadeh N, Mohebi F, Altafi D, Sahraian MA. Prevalence and incidence of multiple sclerosis in Ardabil, Northwest of Iran. Mult Scler Relat Disord 2020; 47:102605. [PMID: 33217696 DOI: 10.1016/j.msard.2020.102605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/17/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) epidemiology is studies in many populations; however, studying populations with unique characteristics could provide opportunities to deepen the understanding of the underlying reason of the disease. In this regard, we aimed to study the epidemiology of MS in Ardabil, a province in northwest Iran, where the majority are of Iranian Azerbaijanis. METHOD A retrospective population-based study was conducted from 2008 to 2018 in Ardabil, based on the data of Iran's Ministry Of Health. Collected information includes sex, age, age at disease onset, education and type of MS. We used t-test to compare means and chi-square test to analyze the association among variables. RESULTS The total number of patients was 760 with 533 (70.13%) females and 227 (29.87%) males. The crude prevalence was 59.37 per 100,000 in 2018 (95% CI: 55.31, 63.73). The crude incidence rate was 7.65 per 100,000 in 2018 (95% CI: 6.28, 9.32). The most frequent educational level was high school diploma (38.36%). The relapsing-remitting (RR) form was the most frequent type of MS (48.16%). The F/M ratio was 2.92:1 and the mean onset age was 33.14 (95% CI: 31.56, 34.72) in 2018, significantly higher in males (P value= 0.01). CONCLUSION Ardabil is a medium risk zone of MS. The different ethnicity of its population, climate and environmental features, may explain the factors modulating the risk of MS in similar areas and present windows of opportunity to understand the causes of MS.
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Affiliation(s)
- Negar Molazadeh
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnam Mohebi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Davar Altafi
- Department of Neurology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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20
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Ghajarzadeh M, Foroushani AR, Ghezelbash P, Ghoreishi A, Maghbooli M, Yousefi M, Rahgoshai BK, Maemodan FG, Mohammadifar M, Sahraian MA. Prevalence of Multiple Sclerosis (MS) in Zanjan Province of Iran. Int J Prev Med 2020; 11:116. [PMID: 33088444 PMCID: PMC7554562 DOI: 10.4103/ijpvm.ijpvm_419_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
Background: The prevalence of multiple sclerosis (MS) varies in different geographical regions and has dramatically increased in Iran. Revealing the high prevalence rate draws the attention of policymakers and helps them allocate necessary resources. The aim of this study is to determine the prevalence of MS in Zanjan province of Iran. Methods: We included all registered residents of Zanjan province with MS on the prevalence day (July 31, 2019). All cases met the McDonald criteria. All registered cases in Zanjan MS society were identified as index cases. Data regarding patient's national code, gender, age, age at the first symptom onset, city of residence, marital status, education level, occupation, ethnicity, family history of MS and the time span between symptom's onset and disease diagnosis were recorded. Results: We identified 758 patients, 551 of whom (72.7%) were female. The mean age at the first symptom onset was 28.9 ±8.7 years old. The crude prevalence was 71.6 per 100,000 population (95% CI 66.6–76.9). The disease was most prevalent in Zanjan city (100.5 per 100,000). The gender-specific prevalence per 100,000 population was 105.4 for women (95% CI: 96.8–114.6) and 38.7 for men (95% CI: 33.6–44.1), with female to male ratio of 2.6. The standardized mortality ratio (SMR) was calculated as expected/observed for both men and women as 2.3 (207/88.2) (551/234.1). Conclusions: Our data confirm that the MS prevalence rate is high in Zanjan province of Iran.
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Affiliation(s)
- Mahsa Ghajarzadeh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas R Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran, Iran
| | - Parviz Ghezelbash
- Department of Radiology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Abdoreza Ghoreishi
- Department of Neurology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran.,School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehdi Maghbooli
- Department of Neurology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehran Yousefi
- Department of Neurology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Babak K Rahgoshai
- Department of Neurology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farhad G Maemodan
- Department of Neurology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehdi Mohammadifar
- Department of Radiology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad A Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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21
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Mousavi-Shirazi-Fard Z, Mazloom Z, Izadi S, Fararouei M. The effects of modified anti-inflammatory diet on fatigue, quality of life, and inflammatory biomarkers in relapsing-remitting multiple sclerosis patients: a randomized clinical trial. Int J Neurosci 2020; 131:657-665. [DOI: 10.1080/00207454.2020.1750398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Zahra Mousavi-Shirazi-Fard
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Mazloom
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Masoudian N, Ehsani F, Nazari M, Zoghi M, Jaberzadeh S. Does M1 anodal transcranial direct current stimulation affects online and offline motor learning in patients with multiple sclerosis? Neurol Sci 2020; 41:2539-2546. [DOI: 10.1007/s10072-020-04359-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/16/2020] [Indexed: 02/07/2023]
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23
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Baghbanian SM, Cheraghmakani H, HabibiSaravi R, Azar A, Ghasemihamedani F. Does the multiple sclerosis (MS) map need to change again? An update of MS prevalence in Mazandaran province of Iran in 2018. BMC Neurol 2020; 20:52. [PMID: 32050931 PMCID: PMC7017621 DOI: 10.1186/s12883-020-1618-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Information of Previous studies on the prevalence of MS, including our study conducted 12 years ago, used to shape global prevalence map of MS. According to those results, Iran placed in medium-prevalence MS region in the world Atlas of MS 2013.This study aimed to investigate the prevalence of MS in Mazandaran province after 12 years and the need for possible changes in the global map of the prevalence of MS. METHODS We included all MS patients living in Mazandaran province in 2018 in this descriptive cross-sectional study. We updated our pre-existing registration questionnaires which included demographic information and medical data of MS patients by interview. We obtained the demographic profile of Mazandaran province from the most recent census in 2016 and the National Civil Registry of the Mazandaran province for calculating prevalence of MS. RESULTS The total number of MS patients in Mazandaran was 2418 (25.8% male and 74.2% female) with a female to male ratio of 2.9. Based on the local population of 3,332,556, (50.4% male and 49.6% female), this study showed a prevalence of 72.5 per 100,000 for MS in this region. The prevalence of this disease by gender was 37.1 per 100,000 for men and 108.5 per 100,000 for women. The mean (SD) age of the patients at the time of the study was 38.5 (10.1) years with a minimum of 15 and a maximum of 75 years. The most common type of MS was Relapsing-Remitting MS with 86%. CONCLUSIONS All recent studies showed significant upward trend in the prevalence of MS around the world. Based on the results of our study and many other studies in Iran, the Atlas of MS prevalence map needs to be update. Iran's status should be changed to the high-prevalence of MS in the new Atlas. Due to the increasing prevalence of MS, we suggest an adjustment in the Global MS Prevalence Scale.
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Affiliation(s)
- Seyed Mohammad Baghbanian
- Multiple Sclerosis Fellowship, Neurology Department, Boualicina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamed Cheraghmakani
- Neurology Department, Boualicina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza HabibiSaravi
- Multiple Sclerosis Clinic, Boualicina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Arash Azar
- School of Public health, Faculty of Medicine, University of Sydney, Sydney, Australia
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24
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Zeineddine MM. Treatment of multiple sclerosis in special populations: The case of refugees. Mult Scler J Exp Transl Clin 2020; 6:2055217319848466. [PMID: 31976080 PMCID: PMC6956602 DOI: 10.1177/2055217319848466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/01/2019] [Accepted: 04/07/2019] [Indexed: 12/04/2022] Open
Abstract
Multiple sclerosis was long considered a relatively rare entity in the Middle East, but research over the past 10 years and the publication of the Middle East North Africa Committee for Treatment and Research in Multiple Sclerosis guidelines for multiple sclerosis have allowed diagnosis and treatment to occur more efficiently. Most of the first and second-line disease-modifying therapies approved by the Food and Drug Administration and the European Medicine Agency are available in the Middle East. However, the availability of disease-modifying therapies is quite variable, with some countries having access to all multiple sclerosis disease-modifying therapies, while in others there is only one therapeutic option. Economic limitations remain a challenge for the management of multiple sclerosis, especially in countries of war. Moreover, the burden of multiple sclerosis treatment in Syrian and Palestinian refugees is likely high due to the non-availability of funds to cover the high cost of disease-modifying therapies.
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Affiliation(s)
- Maya M Zeineddine
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Lebanon
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Moghaddam V, Pakdel M, Hedstrom A, Marufi N, Hooshmand E, Mohammadi A, Marashi R, Kholgh N. Dramatic changes in multiple sclerosis prevalence in Iran: A descriptive study in ten regions of Iran. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2020. [DOI: 10.4103/iahs.iahs_60_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Jafarinia M, Amoon M, Javid A, Vakili S, Sadeghi E, Azadi D, Alsahebfosoul F. Male microchimerism in peripheral blood from women with multiple sclerosis in Isfahan Province. Int J Immunogenet 2019; 47:175-179. [PMID: 31833227 DOI: 10.1111/iji.12465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/24/2019] [Accepted: 11/27/2019] [Indexed: 12/20/2022]
Abstract
Multiple sclerosis (MS) is referred to as an organ-specific T-cell-mediated autoimmune disease of the central nervous system (CNS). Different genetic and environmental factors increase the risk of developing MS. In recent years, microchimerism (Mc) has been widely studied in autoimmune diseases, although the exact role of this phenomenon in human health is not known well. Microchimerism is the low level presence of DNA or cells from one individual into the tissue or circulation of another individual. In the current study, we evaluated the association of fetal microchimerism (FMc) with MS in Isfahan province. In this study, we enrolled 68 women in four groups. Two groups were MS patients with or without a pregnancy for a son, and the other two groups were MS-negative patients with or without a pregnancy for a son. The presence of the male genome assessed and compared in these groups. Four millilitres of peripheral blood were collected from all subjects in the tube containing EDTA and DNA was extracted. Real-time PCR assay was used for the DAZ (deleted in azoospermia) region Yq 11.23 as a marker for male microchimerism in all subjects. Our results showed that the percentage of DAZ (male genome)-positive women was significantly higher in MS-positive women given birth to a son in comparison with the other three groups. Our results also revealed no significant correlation between the percentage of DAZ-positive women and Expanded Disability Status Scale (EDSS) score and age of onset in the patients' group. For future studies, we suggest enrolling subjects who MS diagnosis occurred before and after pregnancy with a son. Comparing FMc in these two groups might provide a better understanding of the possible role of FMc in later development of MS.
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Affiliation(s)
- Morteza Jafarinia
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Amoon
- Department of Biology, Faculty of Science and Engineering, Science and Arts University, Yazd, Iran
| | - Ameneh Javid
- Department of Biology, Faculty of Science and Engineering, Science and Arts University, Yazd, Iran
| | - Sina Vakili
- Biochemistry Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Sadeghi
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.,Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Davood Azadi
- Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.,Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Fereshteh Alsahebfosoul
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Pakdel M, Hedström A, Bidkhori M, Hadei M, Kazemi Moghaddam V, Sarmadi M, Zohdi S, Marufi N. Do socioeconomic factors affect the prevalence of multiple sclerosis in Iran? Acta Neurol Scand 2019; 140:328-335. [PMID: 31291697 DOI: 10.1111/ane.13148] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/30/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND A rising trend for incidence of multiple sclerosis (MS) has been observed during the recent years in Iran. Several factors have been investigated as the reason, but socioeconomic determinants have been neglected. The present study aimed to investigate the relationship between Human Development Index (HDI), income and education and MS prevalence in the provinces of Iran. METHODS The data used in this study were obtained from three sources: (a) National Registry of MS for MS prevalence data from 2006 to 2013, (b) Statistical Centre of Iran for demographic, income, and percentage of educated people data, and (c) some previous studies for HDI data. RESULTS The findings showed high prevalence of MS in the provinces of Iran. Most patients were residents of provinces with a higher socioeconomic level. Significant relationships were found between the prevalence of MS and HDI, income and educational level (P = .002, P = .006, and P = .001, respectively). CONCLUSION Socioeconomic determinants in Iran are different from those in many other countries. It seems that Iranian provinces with a higher socioeconomic level have higher prevalence of MS. Further studies in smaller scale are needed to better understand the relationship between socioeconomic determinants and MS prevalence in the provinces of Iran.
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Affiliation(s)
- Manizhe Pakdel
- Students Research Committee Neyshabur University of Medical Sciences Neyshabur Iran
| | - Anna Hedström
- Department of Clinical Neuroscience and Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Mohammad Bidkhori
- Department of Epidemiology and Biostatistics, School of Public Health Tehran University of Medical Sciences Tehran Iran
| | - Mostafa Hadei
- Department of Environmental Health Engineering, School of Public Health Tehran University of Medical Science Tehran Iran
| | - Vahid Kazemi Moghaddam
- Department of Environmental Health Engineering Neyshabur University of Medical Sciences Neyshabur Iran
| | - Mohammad Sarmadi
- Department of Environmental Health Engineering, School of Health Torbat Heydariyeh University of Medical Sciences Torbat Heydariyeh Iran
- Health Sciences Research Center Torbat Heydariyeh University of Medical Sciences Torbat Heydariyeh Iran
| | - Sara Zohdi
- Students Research Committee Neyshabur University of Medical Sciences Neyshabur Iran
| | - Nilufar Marufi
- Students Research Committee Neyshabur University of Medical Sciences Neyshabur Iran
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Yamout B, Sahraian M, Bohlega S, Al-Jumah M, Goueider R, Dahdaleh M, Inshasi J, Hashem S, Alsharoqi I, Khoury S, Alkhawajah M, Koussa S, Al Khaburi J, Almahdawi A, Alsaadi T, Slassi E, Daodi S, Zakaria M, Alroughani R. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to the MENACTRIMS guidelines. Mult Scler Relat Disord 2019; 37:101459. [PMID: 31670208 DOI: 10.1016/j.msard.2019.101459] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of multiple sclerosis (MS) therapies is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, and progressive MS. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
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Affiliation(s)
- B Yamout
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon.
| | - M Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Al-Jumah
- King Fahad Medical Cit, MOH, Riyadh, Saudi Arabia
| | - R Goueider
- Service de Neurologie, Hôpital Razi, Manouba, Tunis
| | | | - J Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - S Hashem
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - I Alsharoqi
- Dept of Clinical Neurosciences, Salmaniya Medical Complex, Manama, Bahrain
| | - S Khoury
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Alkhawajah
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - S Koussa
- MS Center- Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | - J Al Khaburi
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - A Almahdawi
- Consultant neurologist, neurology unit, Baghdad Teaching Hospital, Medical City Complex, Iraq
| | - T Alsaadi
- American Center for Psychiatry & Neurology- UAE
| | - E Slassi
- Hôpital Cheikh Khalifa Ibn Zaid, Casablanca- Morocco
| | - S Daodi
- Hospital Center Nedir Mohamed, Faculty of Medicine University Mouloud Mammeri Tizi-ouzou Algeria
| | | | - R Alroughani
- Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait
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Emamnejad R, Sahraian M, Shakiba Y, Salehi Z, Masoomi A, Imani D, Najafi F, Laribi B, Shirzad H, Izad M. Circulating mesenchymal stem cells, stromal derived factor (SDF)-1 and IP-10 levels increased in clinically active multiple sclerosis patients but not in clinically stable patients treated with beta interferon. Mult Scler Relat Disord 2019; 35:233-238. [DOI: 10.1016/j.msard.2019.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/27/2019] [Accepted: 08/11/2019] [Indexed: 12/19/2022]
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Hosseinzadeh A, Baneshi MR, Sedighi B, Kermanchi J, Haghdoost AA. Incidence of multiple sclerosis in Iran: a nationwide, population-based study. Public Health 2019; 175:138-144. [PMID: 31476710 DOI: 10.1016/j.puhe.2019.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/22/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The incidence of multiple sclerosis (MS) is not well known in Iran. This study was conducted to estimate the trends in annual MS incidence in Iran from March 21, 2010, to March 20, 2016. STUDY DESIGN Longitudinal study. METHODS In this longitudinal study, data for all MS patients fulfilling McDonald criteria were obtained from a national registry, coordinated by the Ministry of Health (MOH). In Iran, all MS patients are eligible to receive public care and treatment services based on their records in this registry, and thus nearly all MS patients are registered in this database. The annual incidence rates were calculated based on year of diagnosis and were standardized using the World Health Organization (2000-2025) population as a standard. RESULTS In this registry, 36,287 (8202 [22.6%] males and 28,085 [77.4%] females) confirmed MS cases were registered by the MOH between 2010 and 2016. The female-to-male ratio was 3.11. The mean age of patients was 31.6 ± 0.9 years at the time of diagnosis. It was 31.3 ± 0.8 and 32.3 ± 0.9 for females and males, respectively. Overall incidence rate was 6.7/100,000 population (95% confidence interval [CI]: 6.2-7.2); 10.5 and 3.0 in females and males, respectively. The age-adjusted incidence rates increased significantly from 4.4 (95% CI: 4.3-4.6) in 2010 to 5.8 (95% CI: 5.7-6.0) in 2016, with its peak at 6.5 (95% CI: 6.3-6.6) in 2014. CONCLUSIONS This study revealed that Iran is a high-risk area for MS disease and that MS incidence and female-to-male ratio are more or less comparable with the dominant patterns in developed countries. Also, this study showed that the incidence trend of MS in Iran is similar to regional and global observed patterns.
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Affiliation(s)
- A Hosseinzadeh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - M R Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - B Sedighi
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - J Kermanchi
- Deputy of Curative Affairs, Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - A A Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Tahani S, Dehghani L, Jahanbani-Ardakani H, Shaygannejad V, Fazli A, Hamidavi A, Eskandari N. Elevated serum level of IL-4 in neuromyelitis optica and multiple sclerosis patients. J Immunoassay Immunochem 2019; 40:555-563. [PMID: 31422745 DOI: 10.1080/15321819.2019.1655649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mediators have important roles in the pathogenesis of autoimmune diseases. Interleukin 4 (IL-4) is one of the most important cytokines that has a regulatory effect on immune cells. In the current study, the serum level of IL-4 was assessed in the newly diagnosed neuromyelitis optica (NMO) and multiple sclerosis (MS) patients compared to healthy subjects. ELISA technique was used for assessment of the serum level of IL-4, and data analysis was performed by SPSS software. Serum level of IL-4 was elevated in both NMO and MS patients compared with healthy individuals (P < .001), but no statistically significant difference was identified between MS and NMO patients (P = .071). Furthermore, gender (female) and AQP4-Ab had significant impacts on the level of IL-4 in NMO patients (P < .001). These data show the crucial role of IL-4 in the pathogenesis of NMO and MS diseases. However, we suggest future studies to investigate the serum level of IL-4 in NMO and MS patients to clarify more roles of this cytokine in the pathogenesis of both diseases.
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Affiliation(s)
- Soheil Tahani
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences , Isfahan , Iran.,Department of Medical Sciences, School of Medicine, Najafabad Branch, Islamic Azad University , Isfahan , Iran
| | - Leila Dehghani
- Department of Tissue Engineering and Regenerative Medicine, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | | | - Vahid Shaygannejad
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences , Isfahan , Iran
| | - Ali Fazli
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences , Isfahan , Iran
| | - Azin Hamidavi
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences , Isfahan , Iran
| | - Nahid Eskandari
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences , Isfahan , Iran
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Soleimani M, Soleymani A, Seyyedirad N. Elevated CSF concentration of CCL3 and CCL4 in relapsing remitting multiple sclerosis patients. J Immunoassay Immunochem 2019; 40:378-385. [DOI: 10.1080/15321819.2019.1613242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Mohammad Soleimani
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, The Islamic Republic of Iran
| | - Atiyeh Soleymani
- Department of Neurology, Islamic Azad University of Medical Sciences Qeshm International Branch, Tehran, The Islamic Republic of Iran
| | - Negarin Seyyedirad
- Department of Neurology, Islamic Azad University of Medical Sciences Qeshm International Branch, Tehran, The Islamic Republic of Iran
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Association study of G+2044A (R130Q) polymorphism in IL-13 gene with risk of developing Multiple Sclerosis in Iranian population. GENE REPORTS 2019. [DOI: 10.1016/j.genrep.2019.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Azami M, YektaKooshali MH, Shohani M, Khorshidi A, Mahmudi L. Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis. PLoS One 2019; 14:e0214738. [PMID: 30964886 PMCID: PMC6456231 DOI: 10.1371/journal.pone.0214738] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most common neurological disorders and is one of the main causes of disability. The prevalence and incidence of MS in Iran is reported to range from 5.3 to 89/ 100,000and 7 to 148.1/ 100,000, respectively. There are no systematic and meta-analysis studies on MS in Iran. Therefore, this study was conducted to investigate the prevalence and incidence of MS in Iran using meta-analysis. METHOD A systematic review of the present study focused on MS epidemiology in Iran based on PRISMA guidelines for systematic review and meta-analysis. We searched eight international databases including Scopus, PubMed, Science Direct, Cochrane Library, Web of Science, EMBASE, PsycINFO, Google Scholar search engine and six Persian databases for peer-reviewed studies published without time limit until May 2018. Data were analyzed using Comprehensive meta-analysis ver. 2 software. The review protocol has been registered in PROSPERO with ID: CRD42018114491. RESULTS According to searching on different databases, 39 (15%) articles finalized. The prevalence of MS in Iran was estimated 29.3/ 100,000 (95%CI: 25.6-33.5) based on random effects model. The prevalence of MS in men and women was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and 44.8/ 100,000 (95%CI: 36.3-61.6), respectively. The incidence of MS in Iran was estimated to be 3.4/ 100,000 (95%CI: 1.8-6.2) based on random effects model. The incidence of MS in men was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and the incidence of MS in women was 44.8/ 100,000 (95%CI: 36.3-61.6). The meta-regression model for prevalence and incidence of MS was significantly higher in terms of year of study (p<0.001). CONCLUSIONS The results of this study can provide a general picture of MS epidemiology in Iran. The current meta-analysis showed that the prevalence and incidence of MS in Iran is high and is rising over time.
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Affiliation(s)
- Milad Azami
- Student Research Committee, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Hossein YektaKooshali
- Student Research Committee, School of Nursing, Midwifery and Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoumeh Shohani
- Department of Nursing, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Khorshidi
- Department of Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Leily Mahmudi
- Faculty of Medicine, Dezful University of Medical Sciences, Dezful, Iran
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Rezaee M, Izadi S, Keshavarz K, Borhanihaghighi A, Ravangard R. Fingolimod versus natalizumab in patients with relapsing remitting multiple sclerosis: a cost-effectiveness and cost-utility study in Iran. J Med Econ 2019; 22:297-305. [PMID: 30561242 DOI: 10.1080/13696998.2018.1560750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS Multiple sclerosis (MS) is a chronic, autoimmune, and inflammatory disease. If the first-line medicines are not effective enough, specialists will prescribe second-line medicines, such as natalizumab and fingolimod. This study aimed to compare the cost-effectiveness and cost-utility of fingolimod with those of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) in Iran, Fars province in 2016. MATERIALS AND METHODS This study was a cost-effectiveness and cost-utility study in which a Markov model was used. The study used the census method to evaluate 81 patients with MS in Iran, Fars province who were being treated with fingolimod and natalizumab. In this study, costs were collected from the societal perspective, and the outcomes were the mean of relapse avoided rate and QALY. The cost data collection form, Kurtzke Expanded Disability Status Scale, and EQ-5D-3L questionnaire were used to collect the required data. RESULTS The results showed that, compared to natalizumab, patients who used fingolimod had decreased costs (58,087 vs 201,707), increased QALYs (8.09 vs 7.37), and a better relapse avoided rate (6.27 vs 5.83) per patient over the lifetime. The results of the sensitivity analysis showed that the results of the study were robust. Also, the results of the scatter plots showed that fingolimod was more cost-effective based on the QALY and relapse avoided rate in 62% and 56%, respectively, of the simulations for the thresholds below $15,657 for the studied patients. CONCLUSIONS According to the results of this study, the cost-effectiveness and cost-utility of fingolimod were higher than those of natalizumab. Therefore, it is recommended that treatment with fingolimod be the first priority of second-line treatment for MS patients, and policy-makers and health managers are encouraged to make efforts in order to increase insurance coverage and reduce the out-of-pocket payments of these patients.
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Affiliation(s)
- Mehdi Rezaee
- a Department of Health Economics, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran
- b Student Research Committee, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Sadegh Izadi
- c Clinical Neurology Research Center , Medical School, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Khosro Keshavarz
- a Department of Health Economics, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran
- d Health Human Resources Research Center, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Afshin Borhanihaghighi
- c Clinical Neurology Research Center , Medical School, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Ramin Ravangard
- d Health Human Resources Research Center, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran
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Moravejolahkami AR, Paknahad Z, Chitsaz A. Association of dietary patterns with systemic inflammation, quality of life, disease severity, relapse rate, severity of fatigue and anthropometric measurements in MS patients. Nutr Neurosci 2019; 23:920-930. [DOI: 10.1080/1028415x.2019.1580831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Zamzam Paknahad
- Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Chitsaz
- Department of Neurology, Isfahan University of Medical Sciences Isfahan, Iran
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Geographic variations of multiple sclerosis in Iran: A population based study. Mult Scler Relat Disord 2019; 28:244-249. [PMID: 30634104 DOI: 10.1016/j.msard.2019.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/22/2018] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The epidemiology of Multiple sclerosis (MS) has changed in recent decades. Considering that the incidence and geographical variations of MS is not well known in Iran. The present study was conducted to investigate the incidence of MS and its geographic variations in Iran. METHODS Data from a national registry, coordinated by the Ministry of Health (MOH), were collected for this study. In Iran, all MS patients are eligible to receive care and treatment services based on their records in this registry. Therefore, it seems that the related data are comprehensive with very high coverage, particularly in recent years. In this study, the annual incidence rates were calculated based on year of diagnosis of MS. RESULTS In this registry, 32,633 new cases were recorded between 2011 and 2016. After standardized for age, the mean annual incidence rate was 6.5 per 100,000 populations. It was 10.2 and 2.9 in women and men respectively. This incidence ranged from 1.7 to 12.8 in provincial level, with a higher intensity in the central part of the country. CONCLUSION It seems that the incidence rate of MS and its ratio in females and males are more or less comparable with the dominant patterns in developed countries, although its variation within the country is very considerable.
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38
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Tarameshlu M, Ghelichi L, Azimi AR, Ansari NN, Khatoonabadi AR. The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial. J Bodyw Mov Ther 2019; 23:171-176. [PMID: 30691748 DOI: 10.1016/j.jbmt.2018.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Dysphagia is common following Multiple Sclerosis (MS) and is associated with significant morbidity and mortality. The current rehabilitation program to swallowing therapy is Traditional Dysphagia Therapy (TDT), but there is a dearth of evidence about its effectiveness in MS patients. OBJECTIVES This study was aimed to determine the effects of the TDT on the swallowing function in MS patients with dysphagia. METHODS A pilot double blind randomized clinical trial was carried out on 20 patients with MS. Patients were randomly divided into experimental group (TDT) comprising sensorimotor exercises and swallowing maneuvers, and Usual Care (UC) comprising diet prescription and postural changes. Patients in both groups received treatments for 6 weeks, 18 treatment sessions, 3 times per week, every other day. The Mann Assessment of Swallowing Ability (MASA) was the main outcome measure. The swallowing ability was assessed before treatment (T0), after the end of 9th session (T1), after the end of 18th session (T2), and after 6 weeks follow-up (T3). Penetration-Aspiration Scale (PAS) and Pharyngeal Residue Rating Scale (PRRS) as secondary outcome measures were applied at T0 and T2. RESULTS Both groups had improved regarding MASA, PAS and PRRS scores over the time (P < 0.001). The improvements achieved in all outcomes were significantly greater in the TDT group than those of the UC group. The Main effect of the Time × Group interaction was significant for MASA score (P < 0.001). The large effect sizes were found for MASA score in both the TDT (d = 3.91) and the UC (d = 1.11) groups. CONCLUSIONS This pilot randomized controlled trial showed that the TDT significantly improved the swallowing function of the MS patients with dysphagia.
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Affiliation(s)
- Maryam Tarameshlu
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Leila Ghelichi
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Amir Reza Azimi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Sports Medicine Research Center, Tehran University of Medical Sciences, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Reza Khatoonabadi
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Taheri S, Sahraian MA, Yousefi N. Cost-effectiveness of alemtuzumab and natalizumab for relapsing-remitting multiple sclerosis treatment in Iran: decision analysis based on an indirect comparison. J Med Econ 2019; 22:71-84. [PMID: 30380350 DOI: 10.1080/13696998.2018.1543189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alemtuzumab and natalizumab are approved as second-line therapies for relapsing-remitting multiple sclerosis (RRMS) patients in Iran who have shown an inadequate response to other disease-modifying therapy (DMT). In the absence of head-to-head trials, evaluations based on decision analytic modeling may be a suitable alternative to compare alemtuzumab and natalizumab in RRMS. PURPOSE To evaluate the cost-effectiveness of alemtuzumab compared with natalizumab in RRMS in Iran, based on an indirect comparison of clinical trial data. METHODS A cost-utility analysis was conducted using a cohort-based Markov model to analyze cost-utility in a cohort of 1,000 RRMS patients treated with alemtuzumab or natalizumab who had failed at least one previous DMT. Costs were measured in 2018 US Dollars, and were estimated from both the societal and National Healthcare Service (NHS) perspective over a 20-year time horizon in Iran. One-way deterministic sensitivity analyses were carried out to investigate the impact of individual variables on model results. RESULTS Alemtuzumab dominated natalizumab in both NHS and societal perspective analyses. From the NHS perspective, the total discounted costs per patient were estimated at $147,417 and $150,579 for alemtuzumab and natalizumab, respectively, over 20 years. The discounted quality-adjusted life years were estimated to be 7.07 and 6.05, respectively. Results were similar for the societal perspective analysis. Results were most sensitive to acquisition costs and the time horizon, while no sensitivity was observed for Expanded Disability Status Scale (EDSS) health-states utility, relapse relative risk, adverse event or EDSS-related costs, and laboratory/monitoring costs. CONCLUSION Alemtuzumab was dominant in the treatment of RRMS compared with natalizumab due to lower total cost, greater efficacy and slowing of disease progression, and lower rate of relapses over a 20-year time horizon in Iran. Comparative head-to-head trials and long-term follow-up are needed to confirm these results.
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Affiliation(s)
- Saeed Taheri
- a Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Science , Tehran , Iran
| | - Mohammad Ali Sahraian
- b MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences , Tehran , Iran
| | - Nazila Yousefi
- a Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Science , Tehran , Iran
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Kolahkaj B, Zargar F, Majdinasab N. The Effect of Mindfulness-Based Stress Reduction (MBSR) Therapy on Quality of Life in Women with Multiple Sclerosis, Ahvaz, Iran. J Caring Sci 2018; 8:213-217. [PMID: 31915623 PMCID: PMC6942645 DOI: 10.15171/jcs.2019.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 11/10/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Low quality of life is one of the most common symptoms of Multiple Sclerosis (MS) which can reduce satisfaction with life, as well as increase death ratio and neuro-mental problems. The present study aimed to determine the effect of Mindfulness-Based Stress Reduction (MBSR) therapy on the quality of life in women with Multiple sclerosis in the city of Ahvaz. Methods: Forty eight patients who had referred to neurologists were selected by convenient sampling and were assigned into two groups (MBSR and control) randomly. The participants of the two groups answered the 36-item quality of life questionnaire. The experimental group was under treatment for 8 sessions while the control group did not receive any psychological treatment. Data were analyzed, using SPSSver.13 software by repeated measures analysis of variance. Results: In the MBSR group, the mean subscales of QOL had more significant reduction compare to control group. Also the improvement of all subscales of mental and physical QOL continued after two months later in follow up stage. Conclusion: The findings suggest that MBSR is useful for improving the quality of life in patients with MS.
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Affiliation(s)
- Bentolhoda Kolahkaj
- Department of Clinical Psychology, Isfahan (Khorasgan) Branch Faculty, Islamic Azad University, Isfahan, Iran
| | - Fatemeh Zargar
- Department of Health psychology, Health Psychology Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrin Majdinasab
- Department of Neurology, Musculoskeletal Rehabilitation Research Center, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran
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Dehghan M, Ghaedi-Heidari F. Environmental Risk Factors for Multiple Sclerosis: A Case-control Study in Kerman, Iran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:431-436. [PMID: 30386392 PMCID: PMC6178570 DOI: 10.4103/ijnmr.ijnmr_192_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have addressed the environmental risk factors for multiple sclerosis (MS). Concerning contradictory results and change of epidemiologic patterns and the role of environmental factors, in the present study, some risk factors, especially environmental factors, on MS were studied. MATERIALS AND METHODS This was a retrospective case-control study conducted among 120 patients with MS and 360 healthy individuals in Kerman, Iran. Inclusion criteria included (1) MS disease, diagnosed by a neurologist according to the McDonald criteria, and (2) tendency to participation in the study. Exclusion criteria included (1) suffering from cognitive disorders; (2) incomplete questionnaire; and (3) continuous migration. Data were collected using a questionnaire consisting of personal information and some environmental factors. Data were analyzed using descriptive and inferential statistics. RESULTS The results showed that diet was associated with a higher risk of MS with the odds ratio (OR) of 14.46 and 95% confidence interval (CI) of 3.02-69.21 (p < 0.001) for vegetarian and OR of 11.74, 95% CI of 4.66-29.57 (p < 0.001) for animal diets. Similarly, vitamin D supplementation contributed to MS risk (OR: 2.27, 95% CI: 1.32-3.89; p < 0.001). In contrast, history of using cow's milk during infancy resulted in a lower risk of MS (OR: 0.33, 95% CI: 0.20-0.52, p < 0.001). CONCLUSIONS This study suggests that different lifestyles including using cow's milk during infancy and avoiding only vegetarian and animal diets may reduce MS risk in southeastern Iran. More studies are suggested to investigate the controversial finding of the negative effect of vitamin D supplementation in this area.
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Affiliation(s)
- Mahlagha Dehghan
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Ghaedi-Heidari
- Nursing and Midwifery Care Research Center, Nursing and Midwifery School, Isfahan University of Medical Sciences, Isfahan, Iran
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Imani D, Azimi A, Salehi Z, Rezaei N, Emamnejad R, Sadr M, Izad M. Association of nod-like receptor protein-3 single nucleotide gene polymorphisms and expression with the susceptibility to relapsing-remitting multiple sclerosis. Int J Immunogenet 2018; 45:329-336. [DOI: 10.1111/iji.12401] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 05/13/2018] [Accepted: 08/16/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Danyal Imani
- Immunology Department, School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Amirreza Azimi
- Neurology Department, School of Medicine; Tehran University of Medical Sciences; Tehran Iran
- MS Research Center, Neuroscience Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Zahra Salehi
- Immunology Department, School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Nima Rezaei
- Immunology Department, School of Medicine; Tehran University of Medical Sciences; Tehran Iran
- Molecular Immunology Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Rahimeh Emamnejad
- Immunology Department, School of Medicine; Shahre-Kord University of Medical Sciences, Shahre-Kord; Iran
| | - Maryam Sadr
- Molecular Immunology Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Maryam Izad
- Immunology Department, School of Medicine; Tehran University of Medical Sciences; Tehran Iran
- MS Research Center, Neuroscience Institute; Tehran University of Medical Sciences; Tehran Iran
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Alsahebfosoul F, Jahanbani-Ardakani H, Ghavimi R, Sedaghat N, Etemadifar M. Serum level of interleukin 36 in patients with multiple sclerosis. J Immunoassay Immunochem 2018; 39:558-564. [PMID: 30252593 DOI: 10.1080/15321819.2018.1520128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Multiple sclerosis is a chronic autoimmune demyelinating disorder of central nervous system with unknown origin. In MS disease, T cells are pointed to myelin antigens and it leads to myelin loss and axonal degeneration. Cytokines are important regulators of immune system and has critical roles in MS pathogenesis. Interleukin 36, a member of interleukin 1 family, has been shown having important roles in some autoimmune disorders due to its proinflammatory actions and its role in host immunity. METHODS AND MATERIALS In the current study, 49 relapsing remitting multiple sclerosis patients and 41 healthy individuals were recruited. IL36 measurement was performed using enzyme-linked immunosorbent assay technique. RESULTS Mean age of RRMS patient and control group were 31.84 ± 6.89 and 34.27 ± 8.83 years, respectively. Serum level of IL36 were 61.91 ± 16.29 in MS patients and 42.26 ± 17.54 in healthy group (P < 0.001). CONCLUSION in this study for the first time, significantly higher serum level of IL36 was determined in RRMS patients comparing healthy individuals. This data may suggest important roles of this cytokine in MS pathogenesis.
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Affiliation(s)
- Fereshteh Alsahebfosoul
- a Department of Immunology, School of medicine , Isfahan University of Medical Sciences , Isfahan , Iran
| | | | - Reza Ghavimi
- c Department of Pharmaceutical Biotechnology , School of Pharmacy, Isfahan University of Medical Sciences , Isfahan , Iran
| | - Nahid Sedaghat
- a Department of Immunology, School of medicine , Isfahan University of Medical Sciences , Isfahan , Iran
| | - Masoud Etemadifar
- d Department of Neurology, School of Medicine , Isfahan University of Medical Sciences , Isfahan , Iran
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Lai W, Kinoshita M, Peng A, Li W, Qiu X, Zhu X, He S, Zhang L, Chen L. Does pregnancy affect women with multiple sclerosis? A prospective study in Western China. J Neuroimmunol 2018; 321:24-28. [DOI: 10.1016/j.jneuroim.2018.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/11/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
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Moghaddam VK, Sarmadi M, Tatari M, Najafi F, Esmaeili A, Hadei M. Epidemiology of Multiple Sclerosis in Torbat-e Heydarieh (Northeast of Iran) during 1982-2016. Mult Scler Relat Disord 2018; 24:184-189. [PMID: 30077941 DOI: 10.1016/j.msard.2018.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 11/30/2022]
Abstract
It was believed that the risk of multiple sclerosis (MS) is associated with latitude gradient. Due to the increasing prevalence of MS in some areas around the equator such as Iran, this theory has been criticized in recent years. Since the distribution of MS in Iran is not uniform, this study was designed to describe the prevalence and incidence of MS in the northeastern area of Iran. The patients were registered in the MS center of Torbat-e Heydarieh County and all of them were living in this county during the study period (during 1 January 1982 to 31 December 2016). Data of the patients were extracted from their files in the MS center. Because of the long-term span of this study, we used different diagnosis criteria according to the files of the patients to proven case missing. In addition, population data were obtained from the website of Statistical Centre of Iran. The total number of the MS patients during the study period was 110 cases. The prevalence of the disease at the beginning and end of the research period was 0.33 (95% CI, 0.008-1.85) and 30.48 (95% CI, 25.25-37.03) patients per 100,000 persons, respectively. The incidence of the disease in this 36-year period was 1.41 (95%CI, 1.15-1.69) patients per 100,000 persons. The average age of the patients was 35.01 (95% CI, 33.37-36.65) years and the female to male ratio was 2.8:1. The prevalence of MS has been increased in the 36-year period in Torbat-e Heydarieh, especially for women. More epidemiological studies are needed to determine the factors affecting this increasing trend.
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Affiliation(s)
| | - Mohammad Sarmadi
- School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Maryam Tatari
- School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fereshteh Najafi
- School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Amir Esmaeili
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mostafa Hadei
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
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Dehghani A, Dehghan Nayeri N, Ebadi A. Features of Coping with Disease in Iranian Multiple Sclerosis Patients: a Qualitative Study. J Caring Sci 2018; 7:35-40. [PMID: 29637055 PMCID: PMC5889796 DOI: 10.15171/jcs.2018.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/28/2017] [Indexed: 02/03/2023] Open
Abstract
Introduction: Coping with disease is of the main
components improving the quality of life in multiple sclerosis patients.
Identifying the characteristics of this concept is based on the experiences of
patients. Using qualitative research is essential to improve the quality of
life. This study was conducted to explore the features of coping with the
disease in patients with multiple sclerosis.
Method: In this conventional
content analysis study, eleven multiple sclerosis patients from Iran MS Society
in Tehran (Iran) participated. Purposive sampling was used to select
participants. Data were gathered using semi structured interviews. To analyze
data, a conventional content analysis approach was used to identify meaning
units and to make codes and categories.
Results: Results showed that features
of coping with disease in multiple sclerosis patients consists of (a) accepting
the current situation, (b) maintenance and development of human interactions,
(c) self-regulation and (d) self-efficacy. Each of these categories is composed
of sub-categories and codes that showed the perception and experience of
patients about the coping with disease.
Conclusion: Accordingly, a unique set of features regarding
features of coping with the disease were identified among the patients with
multiple sclerosis. Therefore, working to ensure the emergence of, and
subsequent reinforcement of these features in MS patients can be an important
step in improving the adjustment and quality of their lives.
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Affiliation(s)
- Ali Dehghani
- Department of Nursing, Faculty of Nursing and Paramedical, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Nahid Dehghan Nayeri
- Department of Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Department of Nursing, Behavioral Sciences Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Increasing prevalence of familial recurrence of multiple sclerosis in Iran: a population based study of Tehran registry 1999-2015. BMC Neurol 2018; 18:15. [PMID: 29415659 PMCID: PMC5804012 DOI: 10.1186/s12883-018-1019-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tehran is the capital of Iran with an increasing multiple sclerosis (MS) prevalence. A retrospective population-based study was conducted to evaluate the trends of MS prevalence in Tehran. METHODS A population-based survey was conducted for the period 1999 to 2015, based on Iranian MS Society (IMSS) registry system of Tehran, the capital city of Iran. Point regression analysis was applied on MS trend data to find annual percent change (APC). The logistic regression analysis was used to estimate the odds ratio (OR) for individual variables in order to assess factors associating with familial recurrence of MS. P values < 0.05 were considered significant. RESULTS MS prevalence has significantly increased during the study period from 1999 to 2015 (56.22 per 100,000). Total point prevalence of MS was 115.94 per 100,000 persons in 2015 compared to general population. Positive family history of MS was observed among 12.4% of patients. The strongest association amongst first-degree relatives was found in siblings, p value ≤ 0.001. CONCLUSION MS prevalence is rising in Tehran and this city is one of the regions with highest MS prevalence in Asia. In this sample, the largest proportion of relatives with MS were found among first-degree relatives, particularly siblings. Familial recurrence correlated with relative type.
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Bove RM. Why monkeys do not get multiple sclerosis (spontaneously): An evolutionary approach. EVOLUTION MEDICINE AND PUBLIC HEALTH 2018; 2018:43-59. [PMID: 29492266 PMCID: PMC5824939 DOI: 10.1093/emph/eoy002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022]
Abstract
The goal of this review is to apply an evolutionary lens to understanding the origins of multiple sclerosis (MS), integrating three broad observations. First, only humans are known to develop MS spontaneously. Second, humans have evolved large brains, with characteristically large amounts of metabolically costly myelin. This myelin is generated over long periods of neurologic development—and peak MS onset coincides with the end of myelination. Third, over the past century there has been a disproportionate increase in the rate of MS in young women of childbearing age, paralleling increasing westernization and urbanization, indicating sexually specific susceptibility in response to changing exposures. From these three observations about MS, a life history approach leads us to hypothesize that MS arises in humans from disruption of the normal homeostatic mechanisms of myelin production and maintenance, during our uniquely long myelination period. This review will highlight under-explored areas of homeostasis in brain development, that are likely to shed new light on the origins of MS and to raise further questions about the interactions between our ancestral genes and modern environments.
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Affiliation(s)
- Riley M Bove
- Department of Neurology, UCSF, San Francisco, CA, USA
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Mousavizadeh A, Dastoorpoor M, Naimi E, Dohrabpour K. Time-trend analysis and developing a forecasting model for the prevalence of multiple sclerosis in Kohgiluyeh and Boyer-Ahmad Province, southwest of Iran. Public Health 2017; 154:14-23. [PMID: 29128732 DOI: 10.1016/j.puhe.2017.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/15/2017] [Accepted: 10/05/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was designed and implemented to assess the current situation and to estimate the time trend of multiple sclerosis (MS), as well as to explain potential factors associated with such a trend. METHODS This longitudinal study was carried out based on analysis of the data from the monitoring and treatment surveillance system for 421 patients with MS in Kohgiluyeh and Boyer-Ahmad Province, Iran, from 1990 to 2015. To this end, curve estimation approach was used to investigate the changes in prevalence and incidence of the disease, and univariate time series model analysis was applied in order to estimate the disease incidence in the next 10 years. RESULTS The mean and standard deviation of age were 29.78 and 8.5 years at the time of diagnosis, and the mean and 95% confidence interval of age were 29.18 (28.86-30.77) and 29.68 (28.06-31.30) at the time of diagnosis for women and men, respectively. The sex ratio (males to females) was estimated as 3.3, and the prevalence of the disease was estimated as 60.14 in 100,000 people. The diagram of the 35-year trend of the disease indicated three distinct patterns with a tendency to increase in recent years. CONCLUSION The prevalence and incidence trend of the disease in the study population is consistent with regional and global changes. Climatic and environmental factors such as extreme weather changes, dust particles, expansion of the application of new industrial materials, and regional wars with potential use of banned weapons are among the issues that may, in part, be able to justify the global and regional changes of the disease. Predictive models indicate a growing trend of the disease, highlighting the need for more regular monitoring of the disease trend in upcoming years.
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Affiliation(s)
- A Mousavizadeh
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
| | - M Dastoorpoor
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - E Naimi
- Department of Public Health, Faculty of Health, Yasuj University of Medical Sciences, Yasuj, Iran
| | - K Dohrabpour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Sanaeinasab H, Saffari M, Hashempour M, Karimi Zarchi AA, Alghamdi WA, Koenig HG. Effect of a transactional model education program on coping effectiveness in women with multiple sclerosis. Brain Behav 2017; 7:e00810. [PMID: 29075570 PMCID: PMC5651394 DOI: 10.1002/brb3.810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/12/2017] [Accepted: 07/20/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Multiple sclerosis (MS) is a chronic and progressive disease that causes stress due to its unpredictability and lack of definitive treatments. This study examined the effects of an educational program using a transactional model to help women with MS cope with their disease. MATERIALS AND METHODS In a randomized clinical trial, 80 female patients from the MS Society of Iran were randomized to the intervention (n = 40) or a control group (n = 40). Outcomes were assessed using Cohen's Perceived Stress Scale (PSS) and the Jalowiec Coping Scale (JCS), which were completed by both groups at baseline, 1 month, and 3 months after the intervention. The intervention consisted of six educational sessions administered over 2 months based on a transactional model. The data were analyzed using repeated measures ANOVA. RESULTS Average PSS scores decreased significantly over time in the intervention group, while increasing in the control group. Between-group differences were significant at both 1-month and 3-month follow-up (p < .001). Both problem-focused and emotion-focused coping styles improved over time in use and effectiveness in the intervention group, whereas little or no change occurred in these coping behaviors in the control group. CONCLUSION The transactional model-based education program tested here was successful in reducing stress levels and increasing healthy coping styles in women with MS. If these findings are replicated in future studies, widespread adoption of this program may help women with MS cope more successfully with their disease.
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Affiliation(s)
- Hormoz Sanaeinasab
- Health Education Department Faculty of Health Baqiyatallah University of Medical Sciences Tehran Iran
| | - Mohsen Saffari
- Health Education Department Faculty of Health Baqiyatallah University of Medical Sciences Tehran Iran.,Health Research Center Baqiyatallah University of Medical Sciences Tehran Iran
| | - Mahrokh Hashempour
- Health Education Department Faculty of Health Baqiyatallah University of Medical Sciences Tehran Iran
| | - Ali-Akbar Karimi Zarchi
- Department of Epidemiology and Biostatistics Faculty of Health Baqiyatallah University of Medical Sciences Tehran Iran
| | - Waleed A Alghamdi
- Department of Psychiatry King Abdul Aziz University Jeddah Saudi Arabia
| | - Harold G Koenig
- Department of Psychiatry and Behavioral Sciences Duke University Medical Center Durham NC USA.,King Abdulaziz University Jeddah Saudi Arabia.,Ningxia Medical University Yinchuan China
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