Multiple sclerosis and cancer incidence: A Danish nationwide cohort study.

BACKGROUND: Introduction of disease modifying treatment may have increased the cancer incidence in multiple sclerosis patients. Our aim was to estimate the incidence of any cancer, malignant melanoma, nonmelanoma skin cancer, and female breast cancer, and cancer specific mortality in multiple sclerosis patients diagnosed in 1995-2015 i.e. after introduction of disease modifying treatment. METHODS: Linking various Danish medical registers, we compared observed cancer incidence and cancer-specific mortality in multiple sclerosis patients versus expected based on general population rates. RESULTS: Among 10,752 multiple sclerosis patients, we identified 5.76 incident cancers per 1,000 person-years. The standardized incidence ratio was 0.98 (95% confidence interval [CI], 0.90-1.06) for any cancer, 0.99 (95% CI, 0.84-1.15) for non-melanoma skin cancer, and 0.98 (95% CI, 0.81-1.18) for female breast cancer. For malignant melanoma, the standardized incidence ratio was 1.51 (95% CI, 1.13-1.98) for the entire period (1995-2015) but 1.16 (95% CI, 0.62-1.99) for 2005-2015. The overall mortality rate was 1.31 (95% CI, 1.09-1.53) per 1000 person-years with a standardized mortality ratio of 0.99 (95% CI, 0.83-1.17). CONCLUSION: In this nationwide study, multiple sclerosis patients did not have increased cancer incidence or increased cancer-specific mortality. We observed an increased risk of malignant melanoma mainly attributed to increased risk in the first part of our study period.

Inter-rater reliability of a clinical test of standing function.

The Functional Standing Test (FST) has been proposed and described as an evaluative tool to assess a person's ability to perform one-handed reaching tasks while standing. The test items, several of which are identical to those in the Jebson Test of Hand Function, require the manipulation of objects on a counter top and on simulated kitchen shelves while the person is standing. The purpose of this study was to assess the inter-rater reliability of FST when it is administered to adolescents with spinal cord injuries who stand with braces, and to able-bodied young adults. Two testers administered the FST separately to three individuals with spinal cord injuries (SCI) below T-2 who stood with knee-ankle-foot orthoses (KAFOs) and to 10 able-bodied people who stood unassisted. The order in which the testers operated was randomized and the Intraclass Correlation Coefficient (ICC (2,1)) was used to analyze inter-rater reliability. Eighty percent of the subtests were found to be moderately to very reliable when applied to either group on the same day. Half of the test items were categorized as having the same level of inter-rater reliability between the two sample populations. A modified version of the test eliminating unreliable components could serve as a valuable and inexpensive means of evaluating the effectiveness of various therapies and technologies to provide or assist standing function. Validity and specificity of the test remain the focus of future research.