University education facilitates uptake of disease-modifying therapies for multiple sclerosis: A community-based study using the UK MS Register

BACKGROUND

Higher education is associated with better job opportunities and higher income.

OBJECTIVES

Herein, the impact of education on the uptake of disease-modifying therapies (DMTs) for multiple sclerosis (MS) in a publicly funded health care system was examined using the UK MS Register.

METHODS

All adult participants with relapsing remitting MS diagnosed between 2008 and 2021 were included. Those without data regarding their education levels were excluded. Binary, multinomial and Cox regression models were used to examine the association between education levels and uptake of DMTs.

RESULTS

A total of 6317 participants fulfilled all inclusion and exclusion criteria. A total of 1826/2923 (62%) participants with a university education were treated with DMTs, compared to 1788/3394 (53%) participants with school/diploma received DMTs with an odds ratio of 1.318 (1.178-1.473). Participants with a university education were more likely to be treated with both moderate- and high-efficacy DMTs, compared to others, with odds ratios of 1.227 (1.087-1.385) and 1.545 (1.325-1.802), respectively. University education was also a positive predictor for faster initiation of DMTs, and, importantly, higher-efficacy DMTs.

CONCLUSION

In a publicly funded health care system, despite intended equality of access, university education was associated with a higher uptake of DMTs.

The association between deprivation and the access to disease modifying therapies for multiple sclerosis: An England wide community-based study in the UK MS Register

BACKGROUND

Deprivation can impact the access to health interventions in publicly funded health systems where cost is not the dominant barrier. In this study we examined whether deprivation affected the access to disease modifying therapies (DMTs) for multiple sclerosis (MS).

METHODS

All English adults on the UK MS register with relapsing remitting MS who were diagnosed between 2010 and 2017, and after the age of 29 years were included. Deprivation was measured using postcode-based 2015 English index of multiple deprivation (IMD), which was divided into quintiles.

RESULTS

A total of 1449 participants were eligible and 531/1449 (36.6%) received DMTs. Participants who lived in more deprived areas, based on their IMD scores, were significantly less likely to receive DMTs (odds ratio = 0.69, 95% Confidence interval = 0.49 to 0.98); barriers to housing and services contributed to this disparity. The Nagelkerke R² value of these models showed that 2% of variation in accessing DMTs were dependant on deprivation.

CONCLUSIONS

Deprivation, as measured by IMD, negatively influences the access to DMTs in England. Our findings also suggest that the lack of access to local MS DMT clinics in deprived areas may contribute to this disparity.

A potent transrepression domain in the retinoblastoma protein induces a cell cycle arrest when bound to E2F sites

An intact T/E1A-binding domain (the pocket) is necessary, but not sufficient, for the retinoblastoma protein (RB) to bind to DNA-protein complexes containing E2F and for RB to induce a G1/S block. Indirect evidence suggests that the binding of RB to E2F may, in addition to inhibiting E2F transactivation function, generate a complex capable of functioning as a transrepressor. Here we show that a chimera in which the E2F1 transactivation domain was replaced with the RB pocket could, in a DNA-binding and pocket-dependent manner, mimic the ability of RB to repress transcription and induce a cell cycle arrest. In contrast, a transdominant negative E2F1 mutant that is capable of blocking E2F-dependent transactivation did not. Fusion of the RB pocket to a heterologous DNA-binding domain unrelated to E2F likewise generated a transrepressor protein when scored against a suitable reporter. These results suggest that growth suppression by RB is due, at least in part, to transrepression mediated by the pocket domain bound to certain promoters via E2F.

Listeria monocytogenes empyema and bacteremia complicating chronic lymphocytic leukemia

A 60-year-old man receiving corticosteroid and cyclophosphamide therapy for chronic lymphocytic leukemia developed an empyema and bacteremia due to Listeria monocytogenes. The rapidly fulminant course of Listeria infections in immunosuppressed hosts and the necessity of prompt treatment of Listeria empyemas are emphasized.

Properties of ion-bombarded fused quartz for integrated optics

Development of techniques for production of carefully controlled, low-loss optical waveguides in solid dielectric materials is essential to development of integrated optical circuits for signal processing in future optical communications systems. Ion implantation offers an attractive possibility because of the refractive index and film thickness control possible by this technique. To evaluate this possibility we have investigated some of the optical properties of ion-bombarded fused quartz. A variety of ions ranging from helium ions to bismuth ions has been used. We have concentrated on refractive index and optical loss variations (on those implants into which a beam could be launched) as effected by (1) ion species and dose, (2) surface preparation, (3) surface temperature during bombardment, and (4) postbombardment annealing. This paper does not attempt to give an inclusive account of all the results obtained but principally discusses the best results so far, which are those using lithium ions. For lithium ion bombardment we have observed approximately linear variation of refractive index at 6328 A with dose n = n(0) + 2.1 x 10(-21)C, where n(0) is the prebombardment value (= 1.458 for fused quartz), and C is the ion concentration in ions/cm(3) (C < 2.2 x 10(19)). The optical absorption decreases significantly with increase in substrate temperature during implantation, and losses less than 0.2 dB/cm have been achieved. The refractive index change appears to be primarily due to disorder produced by the incident particles rather than a chemical doping effect as evidenced by postbombardment annealing studies.