Multiple Sclerosis impact on employment and income in New Zealand

BACKGROUND AND OBJECTIVES

We investigated the demographic, social and clinical characteristics associated with employment status and income for people with multiple sclerosis (MS) in New Zealand (NZ).

METHODS

The NZ National MS Prevalence study included all persons resident in NZ on census day 2006 diagnosed with MS (96.7% coverage). Factors associated with employment and income status among the working age population (25-64 years) were identified by linear regression.

RESULTS

Over 90% of working age people with MS (n=1727) had a work history, but 54% were not working. Work loss occurred early in the disease course, and at low disability (P<.001). Advancing age, progressive disease, longer disease duration, higher disability levels, partner loss and lower education were associated with work loss (P<.001). Working age people with MS had lower income than the NZ population (P<.0001). Higher qualifications yielded no additional income for MS females and about half the additional income for MS males (P<.0001).

CONCLUSIONS

MS profoundly reduces employment and income early in the disease course, and at low levels of disability, however, unemployment is not entirely accounted for by clinical, social and demographic factors. These findings suggest social supports should be explored early in the disease course to reduce loss of income and unemployment for people with MS.

Control of Bovine Brucellosis from Persistently Infected Holdings Using RB51 Vaccination with Test-and-Slaughter: A Comparative Case Report from a High Incidence Area in Portugal

Bovine brucellosis due to Brucella abortus infection causes significant reproductive and production losses in cattle and is a major zoonosis. Eradication of this disease has proved difficult to achieve in Portugal where it still occurs in some regions despite an ongoing national eradication programme. In 2004, the Alentejo region, a major cattle producing area, reported one of the highest levels of bovine brucellosis in the country, especially in one divisional area. In that area, bovine brucellosis was particularly problematic in a holding of ten herds, the largest extensive cattle unit in the country, which remained infected despite an extensive test-and-slaughter programme and depopulation of five herds. A 5-year programme of RB51 vaccination with biannual test-and-slaughter was thus implemented in 2004. The apparent animal seroprevalence decreased from 19% (646/3,400) to 3% (88/2930) on the third herd-level test and remained below 0.8% (27/3324) after the fourth test. After the tenth test, the holding had a prevalence of 0.1% (2/2332) and only one herd remained positive with a within-herd prevalence of 1.1% (2/177). The results were compared to all other herds (n = 10) in the divisional area that were also persistently infected but were subject only to test-and-slaughter before being depopulated. In these herds, the strategy of test-and-slaughter did not reduce the prevalence, which remained significantly higher than the vaccinated group (median = 0.48% and 8.5% in vaccinated versus non-vaccinated herds; Wilcoxon rank sum test; P < 0.01). The success of this pilot programme in continental Portugal provided a valuable case study to the official veterinary services by illustrating the value of RB51 vaccination with parallel testing and improved biosecurity as a comprehensive and sustainable strategy for bovine brucellosis control in persistently infected herds.

Risk associated with animals moved from herds infected with brucellosis in Northern Ireland

The movement of cattle from herds infected with Brucella abortus was investigated in order to assess the control measures for eradication of brucellosis from the cattle population of Northern Ireland. Using recorded cattle movement data, a historical cohort study was designed and carried out to quantify the risk of seropositivity in bovine animals moved from herds infected with brucellosis. The study found that 3.1% of animals, moved in the 6-month period prior to disclosure of infection in the source herd and subsequently tested, were interpreted as seropositive in their destination herds. The odds of seropositivity were approximately 19 (95% confidence interval: 7.8-46.4) times higher in this cohort compared with animals from herds with no history of infection. A multivariate logistic regression model was constructed to examine factors influencing the risk of seropositivity in the exposed cohort of animals, identifying maternal status (whether the dam had been a brucellosis reactor) and age at leaving the infected herd as the main risk factors.

Epidemiology of bovine brucellosis in Northern Ireland between 1990 and 2000

Between 1990 and 2000, 317 herds of cattle in Northern Ireland were identified as being seropositive to Brucella abortus, and 68 per cent of them were attributed to transmission from neighbouring herds or to local spread. Of particular significance were three primary outbreaks in 1997, which resulted in significant secondary and tertiary spread. Three spatial clusters were identified, corresponding to two of the primary outbreaks, and the herd density and within-herd spread were highest in the largest cluster. Abortions in an infected herd and the disease-risk status of the disclosure test were positively associated with an increased within-herd prevalence.

Motor neurone disease presenting as postoperative respiratory failure

We present the case of a woman who developed respiratory failure in the postoperative period secondary to previously unsuspected motor neurone disease. This case highlights the difficulty in detecting subtle neuromuscular weakness during anaesthetic pre-assessment.

The Northern Ireland programme for the control and eradication of Mycobacterium bovis

Bovine tuberculosis is endemic in Northern Ireland and a comprehensive eradication scheme has been in operation since 1959. The current programme involves annual testing, extensive computerized tracing, short-interval testing of herds contiguous to outbreaks and compulsory slaughter of positive cattle. Despite initial reductions in disease prevalence, eradication has proved elusive and potential explanatory factors include high cattle density and potential for between-herd contact, the impact of exotic diseases on resource priorities, and significant levels of bovine tuberculosis in a wildlife reservoir, the European badger (Meles meles). Both the role of the infected bovine and that of the badger in spreading disease have to be addressed to ensure progress towards eradication. Current measures are described and future options for enhancing the programme are outlined.

On-line coal analysis using fast neutron-induced gamma-rays

On-line measurement of bulk elemental composition is often best achieved with highly penetrative neutron-gamma techniques. CSIRO has developed and implemented one such technique, neutron inelastic-scattering and thermal-capture analysis (NITA). A distinctive feature of NITA is its use of fast neutron sources to generate inelastic scattering reactions, thus exciting gamma-rays from industrially important elements such as carbon and oxygen. A full-scale prototype for on-line coal quality measurement has been tested under simulated industrial conditions. The effect of sample compositional inhomogeneity and stream thickness will be discussed.

Depression in multiple sclerosis: a review

Several studies have reported high rates of depression in multiple sclerosis (MS) with a lifetime prevalence of approximately 50% and an annual prevalence of 20% not uncommon. Concern about the potential of new drug treatments to exacerbate or precipitate depression in MS has led to increased interest in the relation between MS and depression. This review on MS and depression identifies the following key issues: How common is depression in people with MS? Is depression in MS associated with lesions in specific regions of the central nervous system? Is there an increased risk of suicide in MS? Is there a higher than expected incidence of anxiety disorders in MS? Are fatigue and depressed mood related in MS? Is there a relation between depression and cognitive impairment in MS? Which psychosocial variables affect the development of depression in MS? Does treatment with interferon increase the risk of depression? How effective are treatments for MS patients with depression? Each of these issues is briefly reviewed with critical commentary, and some priorities for future research are suggested.

An on-belt elemental analyser for the cement industry

On-line control of raw mill feed composition is a key factor in the improved control of cement plants. A new and improved on-conveyor belt elemental analyser for cement raw mill feed based on neutron inelastic scatter and capture techniques has been developed and tested successfully in Adelaide Brighton's Birkenhead cement plant on highly segregated material with a depth range of 100 to 180 mm. Dynamic tests in the plant have shown analyser RMS total errors of 0.49, 0.52, 0.38 and 0.23 wt% (on a loss free basis) for CaO, SiO2, Al2O3 and Fe2O3 respectively, when 10-minute counting periods are used.

Neural architecture in transected rabbit sciatic nerve after prolonged nonreinnervation

Observations have been made on the rabbit sciatic nerve distal to a transection, with survival periods of up to 26 mo and prevention of reinnervation. It was confirmed that the nerve becomes compartmented by fibroblast processes and that a zone of fine collagen fibrils develops around the Schwann cell columns that constitute the Büngner bands. The Schwann cells become progressively more atrophic but after 6 mo of denervation still expressed low affinity p75 nerve growth factor receptor (NGFR), the latest stage at which this was examined. NGFR was also expressed by the processes of the fibroblasts producing the endoneurial compartmentation. By 26 mo after transection the site of previous nerve fibres was indicated by sharply demarcated domains of approximately circular outline in transverse section consisting of densely packed longitudinally oriented collagen fibrils. Some of these domains still possessed centrally situated Schwann cells or residual basal lamina but many were acellular. The central collagen fibrils in these domains were of smaller diameter than those situated peripherally but were of larger size than those that form around the Büngner bands during wallerian degeneration. The peripherally located fibrils in the domains were of the same calibre as for normal endoneurial collagen. The collagen domains were encircled by fibroblast processes or at times enclosed in a perineurial cell ensheathment. Long-standing axonal loss therefore leads to a striking reorganisation of the internal architecture of peripheral nerve trunks. The findings may be relevant for the interpretation of the appearances in chronic peripheral neuropathies in man.

Mutual attraction between emigrant cells from transected denervated nerve

It is known that regenerating axons emerging from the proximal stump of a transected nerve are attracted towards the distal stump. It is not certain whether this neurotropic effect is on the axons themselves or whether it is on supporting cells such as Schwann cells that the axons then follow. In order to investigate this question in rats, segments of the sciatic nerve were either isolated or removed and reinserted as grafts, and then sutured into the opposing ends of double-Y silicone tubes. In these tubes, a central conduit was formed by connecting the centrally facing limb of each Y tube. The nerve segments were sutured into one of the limbs at either end. The third limbs of the Y tubes formed side arms, one of which was left open; a plug of mobilised fatty connective tissue was sutured into the other. A gap of 6 mm was left between the cut ends and the fat pads (or openings from the side arms). After 2-3 wk a significantly greater outgrowth (P < 0.001) was found to link the nerve segments than to invade the side arms. The major cell component in the outgrowth was Schwann cells, supported by fibroblasts and capillaries and surrounded by a lamellated layer of flattened fibroblasts. The growth into the side arms had a looser cellular architecture and contained considerably fewer Schwann cells. The results strongly suggest the existence of mutual attraction between emigrant Schwann cells, or possibly endoneurial fibroblasts, from the 2 cut ends of transected nerves. This conclusion has implications for the guidance of axons across gaps in nerves. It does not exclude an additional neurotropic effect from the distal stump on axons.

Neurotropic influence of the distal stump of transected peripheral nerve on axonal regeneration: absence of topographic specificity in adult nerve

Observations have been made on the growth of regenerating axons from transected rat sciatic nerve through Y-shaped silicone tubes. When the distal stump of the nerve was sutured into 1 distal limb of the tube and a fat pad into the other, a clear preference for the axons to regenerate towards the distal stump was found. In other experiments regenerating axons from the peroneal or tibial divisions of the sciatic nerve were given the choice of growing towards either the peroneal or tibial nerves, each being inserted into 1 of the 2 distal limbs of the Y-tube. No significant preference of the proximal stump to regenerate towards its appropriate distal stump was detected. A neurotropic influence of the distal stump on the nerve has therefore been confirmed, but topographic specificity of regeneration at the level of the nerve trunk has not been established.

Cisplatin neuropathy with Lhermitte's sign

Following chemotherapy with cis-diamminedichloroplatinum II (cisplatin) three patients developed Lhermitte's sign and peripheral neuropathy. The toxic side effects did not become apparent until after treatment had ceased. Because of increasing use of cisplatin to achieve lasting remission in patients with malignant disease proprioceptive and myelopathic side effects may become increasingly common.

Hypertelorism in Several Generations

Images