| 1. |
- Dervish, Jessica, et al.
(författare)
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Disclosing or concealing multiple sclerosis in the workplace : two sides of the same coin-insights from a Swedish population-based survey
- 2024
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Ingår i: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: People with multiple sclerosis (PwMS) face health and social challenges of living with a chronic and potentially disabling condition. To disclose or conceal MS at work may critically affect individuals' work situation, career opportunities, and health. PwMS may experience a dilemma when assessing if the possible benefits of disclosing the diagnosis outweigh the possible risks. However, concealing in the long-term may have health implications and prevent opportunities for support and work adjustments. Few studies have examined what drives PwMS to disclose or conceal MS at work and the consequences of these ways of managing MS.Objectives: To explore the reasons PwMS report for disclosing and/or concealing their MS diagnosis in the workplace, as well as the consequences they have experienced.Methods: A web-based survey of PwMS was conducted in 2021. All individuals aged 20-50 listed in the Swedish MS registry were invited to participate. The response rate was 52% and among these participants, 3,810 (86%) completed questions regarding workplace disclosure and/or concealment of MS. Free-text responses on these topics were analyzed using inductive content analysis.Results: It was common to disclose MS in the workplace (85%). Identified drivers for disclosure and concealment related to four categories: Work-related, Social, Personal and Circumstantial. Work-related drivers focused on employment or protecting one's career, and changing one's work situation versus maintaining it. Social drivers included the need for support, addressing or preventing stigma, and being considerate of others. Personal drivers were linked to moral values/personal beliefs and processing of the diagnosis. Circumstantial drivers related to involuntary or unforeseen events, timing factors, one's medical condition and external opinion/advice. Identified consequences for disclosure and concealment related to three categories: Work-life, Social, and Personal. Work-life consequences included work arrangements, and career opportunities. Social consequences were linked to MS awareness, stigma, interactions and social support, as well as dynamics of work relationships. Personal consequences involved levels of disease acceptance, and attitudes toward managing MS.Conclusion: PwMS often described the question of disclosure as challenging and navigated it with caution, as both disclosure and concealment can yield favorable and unfavorable outcomes.
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| 2. |
- McKay, Kyla A, et al.
(författare)
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Military service and related risk factors for amyotrophic lateral sclerosis.
- 2021
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 143:1, s. 39-50
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Tidskriftsartikel (refereegranskat)abstract
- The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence.Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured amongst military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS.A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma, appeared to increase the risk of ALS among military personnel.There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavour to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organisations.
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| 3. |
- McKay, Kyla A, et al.
(författare)
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Risk of Multiple Sclerosis in People Living with HIV: An International Cohort Study.
- 2023
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Ingår i: Annals of neurology. - 1531-8249. ; 95:3, s. 487-94
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Tidskriftsartikel (refereegranskat)abstract
- There has been interest in a possible negative association between HIV and multiple sclerosis (MS). We aimed to compare the risk of MS in a cohort of individuals living with HIV to that in the general population.Population-based health data were accessed for 2 cohorts of HIV-positive persons from Sweden and British Columbia, Canada. Incident MS was identified using MS registries or a validated algorithm applied to administrative data. Individuals with HIV were followed from 1year after the first clinical evidence of HIV or the first date of complete administrative health data (Canada= April 1, 1992 and Sweden=January 1, 2001) until the earliest of incident MS, emigration, death, or study end (Canada=March 31, 2020 and Sweden=December 31, 2018). The observed MS incidence rate in the HIV-positive cohort was compared to the expected age-, sex-, calendar year-, income-specific, and region of birth-specific rates in a randomly selected sample of >20% of each general population. The standardized incidence ratio (SIR) for MS following the first antiretroviral therapy exposure ("ART-exposed") was also calculated.The combined Sweden-Canada cohort included 29,163 (75% men) HIV-positive persons. During 242,248 person-years of follow-up, 14 incident MS cases were observed in the HIV-positive cohort, whereas 26.19 cases were expected. The SIR for MS in the HIV-positive population was 0.53 (95% confidence interval [CI]=0.32-0.90). The SIR for MS following the first ART exposure was 0.55 (95% CI=0.31-0.96).This international population-based study demonstrated a lower risk of MS among HIV-positive individuals, and HIV-positive ART-exposed individuals. These findings provide support for further exploration into the relationship among HIV, ART, and MS. ANN NEUROL 2023.
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| 4. |
- McKay, Kyla, et al.
(författare)
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Environmental risk factors for amyotrophic lateral sclerosis (ALS) in a military context
- 2019
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Ingår i: The 13th CBRNe Protection Symposium.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- ALS is a rare disease with an incidence worldwide of 2-3 persons per 100 000 inhabitants. However, an increase in incidence among military personell has been identified in several studies. Approximately 10% of the ALS cases are inherited (familiar ALS); the remaining cases might be due to a combination of genetic and environmental factors (sporadic ALS). The most likely hypothesis regarding the onset of ALS is accumulation of incorrectly folded proteins around neurons in the brain. Incorrect protein folding may be due to a mutation in the enzyme SOD1. Such mutations can be initiated if the cell is exposed to prolonged physiological or environmental stress, for example from prolonged extreme physical exercise. Epidemiologically substantiated risk factors for ALS include lead exposure, head trauma, extreme physical training, pesticide exposure and exposure to electromagnetic radiation. In addition, toxins from cyanobacteria has been discussed as a potential risk factor. Military personnel constitute a typical occupational group with low grade, sometimes long-lasting and parallel exposure to several of the relevant environmental riskfactors. For example, correlations between elevated levels of lead in the blood and increased risk of ALS among United States Veterans has been found, as well as a correlation with exposure to pesticides. In addition, correlation of ALS incidence with head trauma incidents have been suggested. The inflammation that might occur locally after repeated hard physical exertion and/or repeated mild trauma can lead to oxidative stress in the cell. It is known that oxidative stress may cause corrupted/incorrectly folded proteins. These correlations can be part of the explanation for the increased risk of ALS seen in groups exposed to hard physical exertion and/or repeated mild trauma, such as military personnel and athletes. This presentation constitutes a review of epidemiologic data from military environments and also present result from environmental sampling of soils in Timbuctoo.The conclusion that can be drawn from sampling the environment in Timbuctoo is that it is unlikely that the personnel who reside in and around camp Nobel are exposed to cyanobacteria and their toxins
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| 5. |
- Teljas, Cecilia, et al.
(författare)
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Validating the diagnosis of multiple sclerosis using Swedish administrative data in Värmland County
- 2021
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Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 144:6, s. 680-686
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Multiple sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system. Identifying MS at the population level is important for disease surveillance and allocation of resources. The Swedish National Patient Registry (NPR) has been used to study the epidemiology of MS, but the accuracy of this resource is not known. We aimed to validate a definition of MS using the Swedish NPR in Varmland County using a longitudinal cohort design.Materials and Methods: Data were extracted from the NPR, the Total Population Register, the Swedish MS Register, and medical records for the years 2001-2013. Fifteen algorithms of hospitalizations and clinic visits for MS were developed and compared with findings in medical records, which acted as the "gold standard" definition. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were estimated.Results: Of 805 eligible persons identified in the NPR, 763 had MS (94.8%) according to medical records. Of these, 544 (71.3%) were also registered in the SMSreg. The case definition that had a well-balanced sensitivity and specificity required three or more clinic or hospital visits for MS (sensitivity of 85.3% (95% CI: 82.6-87.8) and specificity of 81.0% (95%CI: 65.9-91.4).Conclusions: Multiple case definitions with high sensitivity and moderate specificity were found, suggesting that the NPR can be used to accurately identify persons with MS.
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