Epidemiology of multiple sclerosis: results from a large observational study in the UK.

Multiple sclerosis (MS) progression to mortality may not be solely determined by the underlying autoimmune process. We conducted a study in a large cohort of MS patients with the aim of describing characteristics of MS patients and identification of predictors for all-cause mortality in this patient group. We performed a retrospective analysis of primary care data from the UK Clinical Practice Research Datalink. Incident MS cases diagnosed between 1993 and 2006 were identified and validated using electronic and original medical records. Patients were followed to identify deaths; hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional regression with age as time-scale. In total, 1713 incident MS cases were identified. Following MS diagnosis, frequent comorbidities were infections (80%), and depression (46%). Adjusted HRs (95% CIs) for all-cause mortality were: 2.0 (1.2-3.4) for current smoking; 7.6 (3.2-17.7) for alcohol abuse; 2.7 (1.6-4.5) for pneumonia and influenza; 4.1 (2.7-6.3) for urinary tract infections; 2.2 (1.2-4.2) for heart disease and 4.9 (2.9-8.0) for cancer. Our results suggest that MS survival is influenced not only by the underlying autoimmune process, but also by patient comorbidities and lifestyle factors.

Mortality of patients with multiple sclerosis: a cohort study in UK primary care.

We aimed to estimate rates, causes and risk factors of all-cause mortality in a large population-based cohort of multiple sclerosis (MS) patients compared with patients without MS. Using data from the UK General Practice Research Database, we identified MS cases diagnosed during 2001-2006 and validated using patients' original records where possible. We also included MS cases during 1993-2000 identified and validated in an earlier study. Cases were matched to up to ten referents without MS by age, sex, index date (date of first MS diagnosis for cases and equivalent reference date for controls), general practice and length of medical history before first MS diagnosis. Patients were followed up to identify deaths; hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox-proportional regression. MS patients (N = 1,822) had a significantly increased risk of all-cause mortality compared with referents (N = 18,211); adjusted HR 1.7 (95 % CI 1.4-2.1). Compared with referents, female MS patients had a higher but not significantly different HR for death than males; adjusted HR 1.86 (95 % CI 1.46-2.38) vs. HR 1.31 (95 % CI 0.93-1.84), respectively. The most commonly recorded cause of death in MS patients was 'MS' (41 %), with a higher proportion recorded among younger patients. A significantly higher proportion of referents than MS patients had cancer recorded as cause of death (40 vs. 19 %). Patients with MS have a significant 1.7-fold increased risk of all-cause mortality compared with the general population. MS is the most commonly recorded cause of death among MS patients.

Adverse reactions to over-the-counter cough and cold products among children: the cases managed out of hospitals.

BACKGROUND AND OBJECTIVE: Prompted by continuing concerns about the safety of over-the-counter (OTC) cough and cold medications, we examined the frequency and severity of pediatric adverse drug reactions (ADRs) to OTC cough and cold products reported to a major poison control center. The goal was to focus on cases that are usually managed out of hospitals and may not be recognized by the traditional adverse events surveillance and reporting programs. METHODS: We conducted a retrospective review of electronic records on ADRs reported to the New Jersey Poison Information and Education System (NJPIES) through the National Poison Data System. Analyses included ADRs involving a single OTC cough and cold product. The number and proportion of reported ADRs to OTC cough and cold medicines were examined and compared by severity level between children <2 years of age, and children from 2 through 11 years of age. RESULTS: A total of 91 pediatric ADRs to OTC cough and cold products were reported to the NJPIES from 2000 through 2007. Of these, 61 cases (67%) were of minor severity. A larger proportion of the children 2-11 years of age (21.2%), compared with children <2 years of age (8.0%), experienced a reaction of moderate to major severity. CONCLUSIONS: While we found fewer ADR cases of moderate to major severity in younger children, our results call for a further review of the safety of OTC cough and cold medicines in children 2 years of age and older.

Needle exchange use, sexual risk behaviour, and the prevalence of HIV, hepatitis B virus, and hepatitis C virus infections among Bulgarian injection drug users.

At a time when the rates of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) infections have risen among injection drug users (IDUs) in other countries in the region, little is known about the prevalence of these infections among Bulgarian injectors and about their sexual risk behaviours. IDUs (n = 773) in a community-based needle exchange programme (NEP) and two major drug treatment facilities in Sofia completed a structured interview and were tested for HIV, HBV, and HCV antibodies. While HCV prevalence in the sample was 73.9%, HBV and HIV prevalence was low -6% and 0.5%, respectively. Having more than 10 sexual partners, having sex with someone with hepatitis C or another IDU, and never using a condom with another IDU were common among those who were recruited through NEP. As 40% of the IDUs reported using NEP, it appears that needle exchange provides an opportunity to reach high-risk populations and prevent sexual transmission of blood-borne pathogens.

Outdoor exposure to airborne polycyclic organic matter and adverse reproductive outcomes: a pilot study.

BACKGROUND: To investigate the association between outdoor airborne polycyclic organic matter (POM) and adverse reproductive outcomes in New Jersey, we used a cross-sectional design combining air quality data from the USA EPA Cumulative Exposure Project and individual data on pregnancy outcomes from birth and fetal death certificates at the census tract level. METHODS: After excluding plural births and chromosomal anomalies, 221,406 live births and 1,591 fetal deaths registered in New Jersey during the years of 1990 and 1991 were included. The exposure estimates were derived from modeled average POM concentrations for each census tract in the state. RESULTS: After adjustment for potential confounders, the odds ratios (OR) for very low birth weight for the highest exposure compared to the lowest exposure group was 1.31 (95% CI 1.15-1.51); among term births, high POM exposure was associated with low birth weight OR = 1.31 (95% CI 1.21-1.43), with fetal death OR = 1.19 (95% CI 1.02-1.39) and with premature birth OR = 1.25 (95% CI 1.19-1.31). The univariate stratified analyses suggested effect modification of all observed associations by maternal alcohol consumption. CONCLUSIONS: This study found associations between outdoor exposure to modeled average airborne POM and several adverse pregnancy outcomes. The data and methods utilized in this pilot study may be useful for identifying hazardous air pollutants requiring in-depth investigation.

Associations of polycyclic organic matter in outdoor air with decreased birth weight: a pilot cross-sectional analysis.

The association between births that are small for gestational age and outdoor airborne polycyclic organic matter (POM) was examined in New Jersey, a highly urban state. This pilot study utilizes a cross-sectional investigation combining maternal and pregnancy outcome information from birth certificates with air toxics data from the U.S. Environmental Protection Agency Cumulative Exposure Project and census data at the census tract level. The exposure categories were based on tertiles of modeled average POM concentrations for each census tract in New Jersey. High POM exposure was positively associated with delivery of "small for gestational age" (SGA) births. After adjustment for potential individual-level confounding factors, the odds ratios for term, preterm, and all SGA were 1.22 (1.16-1.27), 1.26 (1.07-1.49), and 1.22 (1.17-1.27), respectively, for the highest exposure tertile in the urban population of the state (89% of the state's birth population). For group-level variables, the corresponding ORs were 1.12 (1.07-1.18), 1.23 (1.02-1.47), and 1.13 (1.07-1.18). The results of this study suggest that residential exposure to airborne polycyclic organic matter (POM) is associated with increased prevalence of "small for gestational age" births among urban population. Cross-sectional investigations combining air dispersion models with routinely collected population-based health and census data could be a useful approach for identifying the hazardous air pollutants of greatest public health concern.