Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire).

OBJECTIVE: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) with a chronic course. Dysphagia represents one of the current challenges in clinical practice for the management of MS patients. Dysphagia starts to appear in mildly impaired MS subjects (EDSS 2-3) and becomes increasingly common in the most severely disabled subjects (EDSS 8-9). The aim of the present study was to evaluate the frequency and characteristics of patient-reported dysphagia in MS patients with a multicenter study using the recently developed DYMUS (DYsphagia in MUltiple Sclerosis) questionnaire. DESIGN: Data were collected in a multi-centre, cross-sectional study using a face-to-face structured questionnaire for clinical characteristics and the DYMUS questionnaire. RESULTS: 1875 patients were interviewed. The current study has shown a correlation between patient-reported dysphagia and EDSS and disease course but not with age, gender and disease duration. Questionnaires were divided into "patient-reported dysphagia-yes" (587, 31.3%) and "patient-reported dysphagia-no" (1288, 68.7%). Compared with the patient-reported dysphagia-no group, patients in patient-reported dysphagia-yes group had higher EDSS score (mean EDSS 4.6 vs. 2.8; p<0.001) and had a longer disease duration (mean duration 13 years vs. 11 years; p<0.001), while there was no significant difference in gender (32.7% vs. 30.5% male and 67.3% vs. 69.5% female) and in age composition (46.18 vs. 42.05). CONCLUSIONS: This study represents the largest, multi-centre sample of MS patients evaluated for patient-reported dysphagia utilizing an ad-hoc questionnaire for this condition.

Beta-2 microglobulin and neopterin as markers of disease activity in multiple sclerosis.

Multiple sclerosis (MS) is a predominately T helper 1-mediated autoimmune disease of the central nervous system. Magnetic resonance imaging (MRI) is the most useful tool for monitoring disease activity and progression. However, MRI is an expensive and time-consuming test. Therefore, the ability to measure biological markers in body fluids correlating with MRI disease activity is of great importance. Beta-2 microglobulin (beta2-MG) and neopterin have been found to correlate with disease activity in several autoimmune disorders and are used as pharmacodynamic markers of interferon beta treatment in MS. During the natural course of MS, beta2-MG is stable over time, and thus it is unlikely that monitoring its plasma levels will be a useful marker of disease changes. More controversial results have been found for neopterin evaluations in MS. Urinary excretion of neopterin is higher during a clinical relapse but blood levels of this molecule do not correlate with clinical and MRI measurements.

Survey of high school football team strength and conditioning programs.

This study examined the level of preseason conditioning and health maintenance for high school football players in Massachusetts. In July 1988, data were obtained through a survey of high school football coaches regarding players' conditioning programs and injury rates. A total of 286 surveys were distributed to public, private, and parochial schools that have interscholastic football programs. Of these, 182 correctly completed surveys were collected for a 64% return rate. Although many high schools offer a strength training program (88%), very few of the programs have high participation levels. Only two out of five programs had more than 60% player participation. Most high schools used free weights, and many included the use of machines for their conditioning programs. Although one purpose of preseason conditioning is injury prevention, many respondents reported preseason conditioning-related injuries-47% of which involved the low back area. While static stretching techniques were typically used, over 90% of the responding coaches said the stretched position was held no longer than 10 to 20 seconds. Based upon survey results, 10 guidelines were recommended for safe, effective, and efficient strength training. These include recommendations for mandatory preseason conditioning under the direct supervision of trained strength coaches, with careful attention to proper lifting technique and progression.