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Eizaguirre MB, Yastremiz C, Ciufia N, Sol Roman M, Alonso R, Silva BA, Garcea O, Cáceres F, Vanotti S. Relevance and Impact of Social Support on Quality of Life for Persons With Multiple Sclerosis. Int J MS Care 2023; 25:99-103. [PMID: 37250192 PMCID: PMC10211354 DOI: 10.7224/1537-2073.2022-012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Social support is crucial for persons with multiple sclerosis (MS). We sought to analyze differences in perceived social support in persons with MS vs controls; to study associations between perceived social support, clinical measures, and health-related quality of life (HRQOL) variables in persons with MS; and to establish a predictive value of perceived social support for HRQOL. METHODS We studied 151 persons with MS (mean ± SD: age, 42.01 ± 9.97 years; educational level, 14.05 ± 3.26 years) and 89 controls (mean ± SD: age, 41.46 ± 12.25 years; educational level, 14.60 ± 2.44 years) using the Medical Outcomes Study Social Support Survey (MOS-SSS), Expanded Disability Status Scale, Fatigue Severity Scale, Beck Depression Inventory, and Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire. Parametric and nonparametric statistical methods were used accordingly; P < .05. RESULTS Persons with MS exhibited lower scores on the MOS-SSS's overall support index (t238 = -1.98, P = .04) and on each functional subscale (t238 = -2.56 to -2.19, P < .05). No significant differences were found on the social support structural component (P > .05). Significant associations were observed between social support and depression and fatigue (r = -0.20 to -0.29, P < .05) and with MusiQoL dimensions (r = -0.18 to 0.48, P < .05). Multiple regression analysis showed all 4 tested models contributed to HRQOL-explained variance (41%-47%). The emotional/informational support model explained the most HRQOL variability (47%). CONCLUSIONS Persons with MS perceived reduced social support, presenting lower functional scores than controls. Perceived social support proved to be a predictor of HRQOL. These findings should be considered during therapeutic treatment.
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Affiliation(s)
- María Bárbara Eizaguirre
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
| | - Cecilia Yastremiz
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Natalia Ciufia
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
| | - María Sol Roman
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
- The Institute of Restorative Neurosciences, Buenos Aires, Argentina (MSR, FC, SV)
| | - Ricardo Alonso
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Berenice Anabel Silva
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Orlando Garcea
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Fernando Cáceres
- The Institute of Restorative Neurosciences, Buenos Aires, Argentina (MSR, FC, SV)
| | - Sandra Vanotti
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
- The Institute of Restorative Neurosciences, Buenos Aires, Argentina (MSR, FC, SV)
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Souza PVS, Afonso G, de Rezende Pinto WBV, de Lima Serrano P, de Mattos Lombardi Badia B, Farias IB, Dos Santos Jorge AC, Machado RIL, Pinto IFN, Barros GB, de Oliveira HB, Calil SR, Franz C, Oliveira ASB. Brazilian registry of patients with porphyria: REBRAPPO study. Orphanet J Rare Dis 2023; 18:49. [PMID: 36890577 PMCID: PMC9996884 DOI: 10.1186/s13023-023-02653-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Porphyrias are a rare group of disease due to inherited defects of heme synthesis with important systemic manifestations and great burden of disease for patients and families due to the exceptional course of disease with disabling chronic symptoms interposed by life-threatening acute attacks. Unfortunately, the porphyrias are usually underrecognized reflecting a lack of medical and disease awareness as well as few studies about natural history in large cohorts of patients. The main aim of this article is present consistent data about natural history and burden of disease in a large Brazilian cohort. METHODS We conducted a national cross-sectional registry with retrospective clinical data of Brazilian patients with porphyria collected with Brazilian patients Association with Porphyria in collaboration with a tertiary care center for rare diseases. RESULTS A cohort of 172 patients was analyzed in which 148 (86%) patients had the diagnosis of acute hepatic porphyria [AHP] that needed a mean of 62.04 medical visits and 9.6 years to achieve a definitive diagnosis. About AHP cohort, the most common first clinical manifestation were abdominal pain in 77 (52%) patients and acute muscle weakness in 23 (15.5%) with 73 (49.3%) patients presenting only one attack during disease course and 37 (25%) exhibiting 4 or more attacks in the last year. Of note, 105 patients with AHP reported chronic manifestations and the scores for quality of life are lower when compared with general healthy population. CONCLUSIONS Brazilian patients with AHP had a higher prevalence of chronic disabling manifestations and a poor quality of life like other cohorts and a higher proportion of patients with recurrent attacks than previously reported.
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Affiliation(s)
- Paulo Victor Sgobbi Souza
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil.
| | | | - Wladimir Bocca Vieira de Rezende Pinto
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Paulo de Lima Serrano
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Bruno de Mattos Lombardi Badia
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Igor Braga Farias
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Ana Carolina Dos Santos Jorge
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Roberta Ismael Lacerda Machado
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Icaro França Navarro Pinto
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Glenda Barbosa Barros
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Helvia Bertoldo de Oliveira
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Samia Rogatis Calil
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
| | - Cibele Franz
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Acary Souza Bulle Oliveira
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Embaú Street, 67, Vila Clementino, São Paulo, SP, 04039-060, Brazil
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Moccia M, Fontana L, Palladino R, Falco F, Finiello F, Fedele M, Lanzillo R, Reppuccia L, Triassi M, Brescia Morra V, Iavicoli I. Determinants of early working impairments in multiple sclerosis. Front Neurol 2022; 13:1062847. [PMID: 36570442 PMCID: PMC9784221 DOI: 10.3389/fneur.2022.1062847] [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: 10/06/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Unemployment can directly affect social status and identity. Assessing and adjusting determinants of early working impairments in a chronic disease can thus reduce its long-term burden. Hereby, we aim to evaluate differences in occupational history and early working impairments between people with multiple sclerosis (MS) and healthy workers. Methods This is a cross-sectional study comparing 71 workers with MS [age 41.7 ± 9.4 years; females 59.1%; EDSS 2.0 (1.0-6.0)] and 71 controls (age 42.6 ± 11.9 years; females 33.8%). All participants filled in Work Ability Index (WAI), Work Productivity and Activity Impairment (WPAI), European Questionnaire for Quality of Life (EuroQoL), Beck Depression Inventory II (BDI-II), and Pittsburgh Sleep Quality Index (PSQI). In MS, we further collected expanded disability status scale (EDSS), MS Questionnaire for Job difficulties (MSQ-Job), Fatigue severity scale (FSS), and the Brief International Cognitive Assessment for MS (BICAMS). Results Workers with MS were more working disabled (p < 0.01), less exposed to workplace risks (p < 0.01), and more limited in fitness to work (p = 0.01), compared with controls. On linear regression models adjusted by age, sex, education, and type of contract, people with MS had worse WAI (Coeff=-5.47; 95% CI = -7.41, -3.53; p < 0.01), EuroQoL (Coeff = -4.24; 95% CI = -17.85, -6.50; p < 0.01), BDI-II (Coeff = 3.99; 95% CI = 2.37, 7.01; p < 0.01), and PSQI (Coeff = 4.74; 95% CI = 3.13, 7.61; p < 0.01), compared with controls, but no differences in WPAI (p = 0.60). EuroQoL, BDI-II, and PSQI were equally associated with both WAI and WPAI in MS and controls (all p< 0.01). In MS, worse MSQJob was associated with higher EDSS (Coeff = 5.22; 95% CI = 2.24, 7.95; p < 0.01), progressive disease (Coeff = 14.62; 95% CI = 5.56, 23.69; p < 0.01), EuroQoL (Coeff = 4.63; 95% CI = 2.92, 6.35; p < 0.01), FSS (Coeff = 0.55; 95% CI = 0.38, 0.72; p < 0.01), and cognitive impairment (Coeff = 4.42; 95% CI = 0.67, 8.22; p = 0.02). Discussion Early factors associated with working difficulties in MS include disability, fatigue, depression, and cognitive dysfunction. Early identification of clinical features potentially causing working difficulties should be considered to enhance job retention, along with targeted prevention and protection measures.
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Affiliation(s)
- Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy,Multiple Sclerosis Clinical Unit, Federico II University Hospital, Naples, Italy,*Correspondence: Marcello Moccia
| | - Luca Fontana
- Occupational Health Unit, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, Federico II University of Naples, Naples, Italy,Department of Primary Care and Public Health, Imperial College, London, United Kingdom
| | - Fabrizia Falco
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Ferdinando Finiello
- Occupational Health Unit, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Mauro Fedele
- Occupational Health Unit, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Unit, Federico II University Hospital, Naples, Italy,Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Liberata Reppuccia
- Occupational Health Unit, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Unit, Federico II University Hospital, Naples, Italy,Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Ivo Iavicoli
- Occupational Health Unit, Department of Public Health, Federico II University of Naples, Naples, Italy
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Abstract
Social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are the non-medical factors that influence health outcomes. Evidence indicates that health behaviours, comorbidities and disease-modifying therapies all contribute to multiple sclerosis (MS) outcomes; however, our knowledge of the effects of social determinants — that is, the ‘risks of risks’ — on health has not yet changed our approach to MS. Assessing and addressing social determinants of health could fundamentally improve health and health care in MS; this approach has already been successful in improving outcomes in other chronic diseases. In this narrative Review, we identify and discuss the body of evidence supporting an effect of many social determinants of health, including racial background, employment and social support, on MS outcomes. It must be noted that many of the published studies were subject to bias, and screening tools and/or practical interventions that address these social determinants are, for the most part, lacking. The existing work does not fully explore the potential bidirectional and complex relationships between social determinants of health and MS, and the interpretation of findings is complicated by the interactions and intersections among many of the identified determinants. On the basis of the reviewed literature, we consider that, if effective interventions targeting social determinants of health were available, they could have substantial effects on MS outcomes. Therefore, funding for and focused design of studies to evaluate and address social determinants of health are urgently needed. Here, the authors discuss the potential effects of social determinants of health on multiple sclerosis risk and outcomes. They suggest that addressing these determinants of health could substantially improve the lives of individuals with multiple sclerosis and call for more research. Addressing an individual’s social determinants of health — that is, the conditions under which they are born, grow, live, work and age — could provide opportunities to reduce the burden of living with multiple sclerosis (MS). Individual factors that may influence MS-related outcomes include sex, gender and sexuality, race and ethnicity, education and employment, socioeconomic status, and domestic abuse. Societal infrastructures, including access to food, health care and social support, can also affect MS-related outcomes. Awareness of the specific circumstances of a patient with MS might help neurologists deliver better care. Social determinants of health are not static and can change according to wider sociopolitical contexts, as highlighted by the COVID-19 pandemic. Rigorous studies of interventions to ameliorate the effects of poor social determinants on people with MS are urgently needed.
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Cores EV, Steinberg J, Cuesta C, Curbelo MC, Osorio MA, Bauer JJ, Politis DG. Tracking the impact of multiple sclerosis on employment status: the development of a questionnaire. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:929-934. [PMID: 36351418 PMCID: PMC9770074 DOI: 10.1055/s-0042-1755344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) has a negative effect on employment status. OBJECTIVE To present the preliminary results of a special questionnaire designed to collect employment information on patients with MS. METHODS The questionnaire on the impact of MS on employment status was completed by 63 patients. Fatigue, cognition, and depression were also evaluated, and 33 healthy participants were recruited as a control group. RESULTS Regarding the patients' employment status, we found rates of 31.7% of full-time employment, 28.6% of part-time employment, 7.9% of unemployment due to MS, 4.8% of housewives, 1.6% retirement due to age, 15.9% of retirement due to disability, 7.9% of medical leave due to MS, and 1.6% of medical leave for other reasons. The rate of unemployment among the patients was significantly higher compared with that of the control group. Out of 38 working patients, 31% had been absent from work for the previous 3 months due to MS, and 50% had to make changes in their work to remain employed. Out of the 19 unemployed patients, 78% said that walking difficulties were the cause of unemployment, while 52% thought cognitive impairment was the cause. CONCLUSIONS The questionnaire provides a record of the employment status of patients with MS and describes the impact on work from their point of view.
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Affiliation(s)
- Evangelina Valeria Cores
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Hospital Interzonal de Agudos “Eva Perón”, Laboratorio de Deterioro Cognitivo, Buenos Aires, Argentina.,Universidad de Buenos Aires, Faculty of Psychology, Buenos Aires, Argentina.,Address for correspondence Evangelina Valeria Cores
| | - Judith Steinberg
- Hospital Británico, Demyelinating Diseases Area, Buenos Aires, Argentina.
| | - Carolina Cuesta
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Hospital Interzonal de Agudos “Eva Perón”, Laboratorio de Deterioro Cognitivo, Buenos Aires, Argentina.,Universidad de Buenos Aires, Faculty of Psychology, Buenos Aires, Argentina.
| | | | - Mabel Alicia Osorio
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Hospital Interzonal de Agudos “Eva Perón”, Laboratorio de Deterioro Cognitivo, Buenos Aires, Argentina.
| | | | - Daniel Gustavo Politis
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Hospital Interzonal de Agudos “Eva Perón”, Laboratorio de Deterioro Cognitivo, Buenos Aires, Argentina.,Universidad de Buenos Aires, Faculty of Psychology, Buenos Aires, Argentina.
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