Multiple sclerosis in New Zealand Maori.

The prevalence of MS in New Zealand in 2006 was 73.2 (age standardized per 100,000) while for those with indigenous Maori ancestry it was 3.6 times lower at 20.6. Earlier regional surveys (1968-2001) all reported much lower, or zero, prevalence for Maori than European. There was no evidence for differences in MS between those with and without Maori ancestry in either clinical features or latitude, confirming that Maori ancestry does not produce the reported increase in prevalence with latitude. It is likely that prevalence is increasing in low risk Maori; however, MS prognosis is independent of Maori ancestry.

The increasing prevalence of multiple sclerosis in New Zealand.

BACKGROUND: New Zealand (NZ) has a high prevalence of multiple sclerosis (MS). Worldwide, the prevalence of MS appears to be increasing. OBJECTIVES: To review all published prevalence studies undertaken in NZ to determine whether the prevalence of MS in NZ is increasing. METHODS: PubMed, Medline, Scopus, Web of Knowledge, EMBASE, AMED and CINAHL were searched to identify studies reporting the prevalence of MS in NZ. Prevalence rates from the National MS Prevalence study in 2006 were compared with earlier prevalence rates for the same regions using Poisson regression. RESULTS: Prevalence rates reported in the earlier regional studies ranged from 23.6 to 68.5/100,000 population; in the same regions in 2006, the range was 47.6-134.2/100,000 population. Prevalence rates were significantly increased in all regions studied except for the Bay of Plenty. The increase in prevalence was seen in both sexes. The sex ratio remained constant over time. CONCLUSIONS: In studies spanning almost 40 years (1968-2006), the prevalence of MS within the same regions of NZ has significantly increased whereas the sex ratio and latitudinal gradient have remained stable.

Defining asymptomatic status following sports concussion: fact or fallacy?

The current management of sports concussion involves a return to the baseline 'asymptomatic' status prior to returning to play and training. Unfortunately, although the term 'asymptomatic' is widely used it has not been operationally defined. This review identifies the need to formally define the term 'asymptomatic' as used in sports concussion, discusses some of the challenges associated with its definition and offers some possible solutions for further debate. The operational definition of the term 'asymptomatic' may provide the stimulus for further informed discussion at a future meeting of the international Concussion in Sport group, and by other peak sports medicine bodies involved in management guideline development.

Spreading the word on sports concussion: citation analysis of summary and agreement, position and consensus statements on sports concussion.

BACKGROUND: the growing concern over concussion in sports has led to the publication of five major summary and agreement, position and consensus statements since 2000. The dissemination of information from these statements is largely unknown and difficult to quantify, but their impact on the research community can be quantified by analysing the number of citations to these key publications. The purpose of this review is to report the number and pattern of citations to the key published statements on sports concussion. METHODS: Web of Science, Scopus and PubMed were searched from 2000 to mid-December 2009 using two different search strategies. The first strategy used the search terms 'concussion' and 'first author' of the statement article, while the second used the 'title' of the target article as the key search term. RESULTS: the publications resulting from the three 'Concussion in Sport' (CIS) group conferences were cited by 532 journal articles, while the National Athletic Trainers' Association position statement was cited 123 times. The highest number of citations to each of the five identified statements was seen in 2009. British Journal of Sports Medicine was the most frequently cited journal. CONCLUSION: the citation analysis of the key statements on sports concussion has shown that the target papers have been widely cited in the research literature, with the highest number of citations being from the publications arising from the CIS group conferences. The authors have shown their preference to cite source articles published in the British Journal of Sports Medicine.

Disability profile of multiple sclerosis in New Zealand.

New Zealand is a high risk region for multiple sclerosis (MS). The aim of this study was to investigate demographic, clinical and temporal factors associated with disability status in the New Zealand National Multiple Sclerosis Prevalence Study (NZNMSPS) cohort. Data were obtained from the 2006 NZNMSPS with MS diagnosis based on the 2005 McDonald criteria. Disability was assessed using the Expanded Disability Status Scale (EDSS). Disability profiles were generated using multiple linear regression analysis. A total of 2917 persons with MS was identified, of whom disability data were available for 2422 (75% females). The overall disability was EDSS 4.4±standard deviation 2.6. Higher disability was associated with older age, longer disease duration, older and younger ages of onset, spinal cord syndromes with motor involvement at onset, and a progressive onset type. Lower disability was associated with sensory symptoms at onset and a relapsing onset type. Overall, the factors studied explained about one-third of the variation in disability, and of this, about two-thirds was accounted for by age, age of onset and disease duration and one-third by the nature of first symptoms and type of disease onset (progressive or relapsing). Current age, age at onset and disease duration all had independent associations with disability and their effects also interacted in contributing to higher disability levels over the course of the disease.

Deep grey matter MRI abnormalities and cognitive function in relapsing-remitting multiple sclerosis.

Although deep grey matter (GM) involvement in multiple sclerosis (MS) is well documented, in-vivo multi-parameter magnetic resonance imaging (MRI) studies and association with detailed cognitive measures are limited. We investigated volumetric, diffusion and perfusion metrics in thalamus, hippocampus, putamen, caudate nucleus and globus pallidum, and neuropsychological measures, spanning 4 cognitive domains, in 60 relapsing-remitting MS patients (RRMS) (mean disease duration of 5.1 years, median EDSS of 1.5) and 30 healthy controls. There was significantly reduced volume of thalamus, hippocampus and putamen in the RRMS patients, but no diffusion or perfusion changes in these structures. Decreased volume in these deep GM volumes in RRMS patients was associated with a modest reduction in cognitive performance, particularly information processing speed, consistent with a subtle disruption of distributed networks, that subserve cognition, in these patients. Future longitudinal studies are needed to elucidate the influence of deep GM changes on the evolution of cognitive deficits in MS.

Multiple sclerosis in New Zealand.

New Zealand (NZ) is a high risk country for multiple sclerosis (MS) with an overall age and sex standardised prevalence of 73.1 per 100,000 population. The age and sex standardised prevalence within the Maori population is substantially lower at 24.2 per 100,000 population. A latitudinal gradient exists with MS prevalence increasing threefold from the North (37°S) to the South (48°S) of NZ. Over 1600 (56.8%) persons with MS experience moderate to severe disability. Despite the high prevalence of MS and the significant degree of disability experienced by people with MS, the availability and prescribing guidelines for MS disease modifying treatments are more restrictive in NZ than in other developed nations.

Riding into the future: a snapshot of elderly mobility scooter riders and how they use their scooters.

AIM: The purpose of the study was to understand the typical mobility scooter rider, how they use their scooter and the role it plays in their lives. METHOD: A 30-item purpose designed questionnaire was used to collect data on rider demographics and mobility status, reasons for purchasing and using a mobility scooter, patterns of scooter use, and the role it plays in the individual's life. Riders aged 65 years and older were recruited from the wider Dunedin community. RESULTS: Thirty persons (15 males and 15 females) aged 65 to 90 years participated. Most experienced walking limitations with only 5 participants able to walk further than one block. The majority (80%) purchased their scooter to address their walking limitations. They had owned a scooter for a mean of 4.4 (range 1-19) years and most had purchased it privately without the input of a health professional. The majority of the group used their scooter 2-3 days per week. CONCLUSION: This study provides a snapshot profile of mobility scooter riders and how they use their scooters to increase their mobility within the community. This information is useful for service providers and planners working towards providing services and infrastructures for the aging population.

The understanding of the concept of 'rest' in the management of a sports concussion by physical therapy students: a descriptive study.

OBJECTIVES: To investigate physical therapy students' understanding of the concept of rest following a sport concussion and to ascertain if this understanding changes following a lecture based on current best practice concussion knowledge. DESIGN: Pre-post observational survey. SETTING: University classroom setting. PARTICIPANTS: A cohort of 118 (40 male, 78 female) physical therapy students participating in volunteer sports medic training. RESULTS: Participants provided 320 (pre) and 350 (post) responses depicting activities which should be restricted following a concussion. The responses were classified into three rest-related categories: 'Physical rest', 'Cognitive rest' and 'Mixed' (a combination of physical and cognitive rest). Pre-lecture, approximately 74% of the student's responses were categorized as Physical rest, and 25% under Mixed. There was a shift in the response pattern post-lecture, with 96% of the responses falling in the Mixed category. CONCLUSIONS: The results of the study highlight a lack of understanding of the concept of cognitive rest in concussion management among trainee sport medics. The need for wider dissemination of this concept as recommended by the recent consensus statement on sports concussion is indicated.

Does exercise evoke neurological symptoms in healthy subjects?

Concussion is a common injury in collision sports and is evidenced by a variety of signs and symptoms. The recording of neurological symptoms is an important component of screening for a concussion and in return-to-play decisions. However similar symptoms are prevalent in the general population and are reported to be associated with participation in physical activities. The purpose of this study was to document the neurological symptoms reported by healthy individuals following controlled bouts of exercise. A crossover randomised design with 2 levels of exercise intensity, moderate intensity and high intensity, each of 15min duration was used. Participants completed a standardised postconcussion symptom checklist prior to exercise (pre), immediately following exercise (post-1) and again after 15 min of rest (post-2). 60 participants were recruited into the study. A summed symptom score was calculated and analysed with a 2-way repeated measures ANOVA procedure. The intensityxtime interaction (F(2,118)=23.94, p<0.001) demonstrated a significant increase in symptom scores for the high intensity condition immediately following exercise (p<0.001). Although the moderate intensity showed a similar trend this was not significant. These findings suggest that sports medicine professionals need to be aware of the effect of exercise on symptom reporting when assessing and in making return-to-play decisions.