Work disability, economic situation, and societal costs of multiple sclerosis in Sweden

Background: Multiple sclerosis (MS) affects many aspects of life and often leads to a reduction in an individual’s work capacity. This reduction, referred to as work disability, may lead to the use of social protections to replace lost earnings upon being absent and societal costs from the lost production. This thesis aimed to investigate the working life and economic situation of individuals in the early stages of their MS as well as the societal costs of MS. Methods: Four cohort studies using Swedish register data of working-aged individuals were conducted. Work disability was operationalised as net days with sickness absence (SA) and/or disability pension (DP). In Study I, the heterogeneity of disposable income (DI) trajectories from 7 years before to 4 years after the diagnosis year (2008-9) of 1528 people with MS (PwMS) was explored with group-based trajectory modelling. The trajectory members were characterised through use of chi2-tests and multinomial logistic regressions. In Study II, common patterns of working life among 2652 PwMS diagnosed in 2008-11 were identified with sequence analysis. Sequences from 1 year before and 5 years after the diagnosis year were constructed and the members of the sequence types were characterised with multinomial logistic regressions and dependent t-tests. In Study III and IV, productivity losses were calculated with the human capital approach from the days with work disability. Healthcare costs included the costs of specialised out- and inpatient healthcare as well as dispensed drugs. Excess costs of MS were estimated by comparing the all-cause costs of PwMS with the costs of matched references with independent t-tests. Study III quantified the annual excess costs of 1988 PwMS and 7981 matched references without MS from 4 years before to 4 years after the diagnosis year (2010-12). Generalised estimation equation (GEE) models tested the interaction of MS and time. In Study IV, the excess costs from resource use in 2018 with bootstrapped 95% CIs were estimated for 2806 PwMS in Stockholm and 28,060 matched references without MS. Primary healthcare and disease modifying therapies were also costed, with analyses stratified by time since diagnosis. Results: Seven DI trajectories were identified in Study I: Four increasing with different gradients (39.0% of individuals), two constantly low (50.7%), and one decreasing (10.3%). Older age profiles and higher proportions of men were observed in the increasing trajectories and higher proportions with work disability and without university education in the decreasing and constantly low trajectories. In Study II, six types of working life sequences were identified: Stable High Activity (48.4% of the sequences), three types with mixed activity and varying SA/DP regarding the number of days per year and timing (32.6%), Stable High SA/DP (14.5%), and Other (4.5%). Stable High Activity had the highest odds for university education. All sequence types, except Stable High SA/DP, had higher DI in the final study year than the first. In Study III, excess costs of MS were observed already before MS diagnosis. Mean annual excess costs of MS of 2285 SEK (95% CI: 613-3956) per person for healthcare costs and 16,310 SEK (95% CI: 8980-23,640) for productivity losses were observed four years before diagnosis. The excess costs of MS increased thereafter and were reflected in the MS and time interaction estimates. In Study IV, the mean annual excess healthcare costs of MS were 77,383 SEK (95% CI: 73,299-81,950) per person with MS. Primary healthcare accounted for 9% and disease modifying therapies for 48% of the excess healthcare costs. The mean annual excess productivity losses of MS were 138,121 SEK (95% CI: 149,224-146,985) per person with MS, mostly due to DP (79%). The resource use behind the excess costs of MS differed by time since diagnosis. Conclusions: The findings describe the economic situation of PwMS and quantify the excess societal costs of early MS. Most PwMS were in work and had increasing or stable DI in the study periods close to MS diagnosis. However, work disability was often and increasingly a part of PwMS’ working life and was associated with decreasing DI trajectories or relatively low levels of DI as well as unstable working life sequences. Excess costs of MS for lost production and healthcare use were incurred already before MS diagnosis and increased thereafter. The progression of the excess costs of MS reflected different patterns of resource use with time from MS diagnosis. The increasing excess costs of MS from productivity losses began in the early stages of MS and may reflect unmet needs of PwMS regarding morbidity and work capacity which early intervention may ameliorate

11th European Headache Federation Congress jointly with 31st Congress of the Italian Society for the Study of Headaches : Rome, Italy. 01-03 December 2017

. Aims of the study were explore the relationship between peripheral chromatic and central visual dysfunction evaluating also the presence of functional receptor impairment in patients with migraine, with and without aura examined interictally

Universal Health Coverage

The chapters in this book contribute to the wide discussion on universal health coverage. The variety of topics discussed here confirms the importance of UHC for academics and health professionals and also the controversies and challenges of its implementation.I invite you to read the book and be involved in the discussions around the goals of universal health coverage

Investigating the potential causes of Mesoamerican Nephropathy (MeN)

Mesoamerican Nephropathy (MeN) has emerged as a major public health concern in Central America. MeN is not associated with traditional chronic kidney disease (CKD) risk factors, and the cause remains unknown. Our aim was to bring together evidence for and against potential causes of MeN. We used biosamples collected from 350 initially apparently healthy men and women aged 18-30 years from a population at risk of MeN to: (i) explore potential early biomarkers of kidney dysfunction, and (ii) quantify associations between possible nephrotoxins and change in renal function over a 2-year follow-up period. We quantified a range of serum and urinary markers of renal injury. Twelve metals and metalloids were analysed by inductively-coupled plasma-mass spectrometry. Twelve pesticides, their metabolites and two mycotoxins were analysed by liquid chromatography coupled to mass spectrometry. Differences in the creatinine-corrected urinary and serum concentrations of the measured exposures were examined between participants in different kidney function decline groups. Furthermore, the effect of heat and elevated fructose individually and in combination was assessed in vitro. The levels of urinary RBP, NGAL and serum UA were significantly elevated in the established kidney dysfunction group but did not help identify those with a normal baseline but declining function. Elevated levels of aluminium and total arsenic were observed across the population but no differences were identified between the different groups. Finally, in vitro experiments showed that heat stress suppressed the mRNA expression of MCP-1 but caused an early increase in expression of fibrogenic genes. Elevated fructose led to early mRNA increase in MCP-1, KIM-1, TGF-β, COLA1 and KIM-1 secretion. However, a number of these molecules were suppressed after longer term exposure. These findings provide evidence against the xenobiotic hypothesis investigated in this thesis as the primary cause(s) of MeN in Nicaragua. Future research priorities include examining alternative toxins not included in the present study and identification of more accurate biomarkers for the early detection of MeN

TB STIGMA – MEASUREMENT GUIDANCE

TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma