Roberta M. Malmgren

A case‐control study of multiple sclerosis

We conducted a study of 145 persons with multiple sclerosis who had been identified in a 1970 survey and 145 friend controls, to investigate whether the development of MS was associated with exposure to uncommon viruses or an older age at infection with 1 or more common viruses. The most striking finding was a strong positive association for history of infectious mononucleosis (IM), suggesting older age at exposure to Epstein-Barr virus, the most common etiologic agent of IM. We also found significant positive associations for number of different domiciles before adulthood and for visits outside the United States; both would be compatible with an increased likelihood among cases of exposures to uncommon viruses or to multiple strains of a common agent. Cases were younger at menarche, increasing the probability of viral exposure after puberty.

Genetic susceptibility to multiple sclerosis

Previous studies of histocompatibility (HLA) types in multiple sclerosis (MS) families did not provide convincing proof of an HLA-linked susceptibility factor. In 12 families we studied, all MS cases in each family shared at least one chromosome. The probability of this occurring in the absence of genetic linkage is approximately 0.001. The estimated penetrance is 5 percent, implying that the genetic susceptibility factor may be a necessary but not a sufficient cause of MS. Additional studies are needed to identify other differences between affected and unaffected susceptible individuals.

Onset symptoms as predictors of mortality and disability in multiple sclerosis

Abstract– 941 cases of definite/probable multiple sclerosis living in Los Angeles County, California and King and Pierce Counties, Washington in 1970 who had onset between 1960 and 1969 were followed for mortality and disability through 1980. Early age of onset and residence in Washington State were predictors of less rapid and severe subsequent course. Coordination symptoms at onset were prognostic of rapid progression to disability and/or early death, whereas early motor weakness was significantly predictive only for disability. The presence of sensory symptoms in addition to motor and/or coordination symptoms at onset, however, indicated a better prognosis than coordination and/or motor symptoms alone. This observation and the results of regression analyses indicated that specific groupings of symptoms at onset were more important for predicting course than the number of symptoms present at onset.

Underlying cause of death as recorded for multiple sclerosis patients: Associated factors

The coding of multiple sclerosis (MS) as underlying cause of death (UCD) on the death certificate provides an important epidemiologic resource for both descriptive and analytic studies. However, not all deaths among MS patients will be so coded. We investigated the effect on estimated occurrence of MS and on characteristics of MS patients when only UCD codes are used to identify cases. Of 2329 MS patients living in Los Angeles County (California) or King/Pierce Counties (Washington) in 1970, 438 had died by 1980. Only 53% of the deaths were coded to MS; 47% were attributed to other causes. Based on our comparisons, the use of only MS-coded deaths to describe decedents would: underestimate the age at MS onset; overestimate the female:male ratio; underestimate age at death; and underestimate duration of MS. Also, the percentage of MS-coded deaths decreased with lengthening duration of follow-up of these prevalent cases. The effect of using only UCD codes to report characteristics of decedents with other chronic diseases may well be similar.

Two populations with multiple sclerosis

SummaryCross-sectional data from 1,793 cases of definite or probable multiple sclerosis (MS) identified in an extensive population survey in King and Pierce (K-P) Counties, Washington and Los Angeles (LA) County, California, were analyzed. Compared to the U.S. population as a whole, patients were more likely to be divorced and to have more years of schooling. The prevalence of MS was higher for females, and for northern-born, regardless of sex. Reconstructed age-, sex-specific incidence rate estimates for natives of the two areas showed a much higher peak annual incidence occurring in an older age group in K-P than in LA. Earliest symptoms in both areas were numbness in the legs, double vision, and loss of vision in one or both eyes. Weakness in arms, speech difficulties, and urinary incontinence tended to be late symptoms. The overall assessment of disability levels showed more than half of the patients to be fully ambulatory at the time of the first interview, with a somewhat higher proportion of each sex severely disabled in California. The ages of onset tended to be younger in LA than in K-P. The earlier onset of disease and the higher proportion of patients with high disability in Los Angeles County suggest that the course of disease is more malignant in this low-prevalence area.ZusammenfassungEs wurden Durchschnittsdaten von 1793 Fällen definitiver und wahrscheinlicher Multipler Sklerose (MS) analysiert, die in umfangreichen Bevölkerungserhebungen identifiziert wurden, in den Landkreisen King und Pierce (K-P) in Washington und in dem Landkreis Los Angeles (LA). Verglichen mit der Gesamtbevölkerung der Vereinigten Staaten, waren die Patienten häufiger geschieden und hatten mehr Jahre Schulung. Das Auftreten von MS war häufiger bei weiblichen Personen und bei solchen, die im Norden geboren waren, ungeachtet des Geschlechts. Die Schätzungen der Rate der rekonstruierten alters- und geschlechtsspezifischen Fälle für die Einwohner der zwei Gebiete zeigt einen viel höheren Höchstwert von jährlichem Fallauftreten bei den älteren Altersgruppen in K-P als in LA. Erste Symptome in beiden Gegenden waren Gefühllosigkeit in den Beinen, Doppelsichtigkeit und Verlust des Sehvermögens auf einem oder beiden Augen. Schwäche in den Armen, Sprachschwierigkeiten und Harnfluß waren mehr spätere Symptome. Die Gesamtbewertung der Behinderungsstadien zeigte, daß mehr als die Hälfte der Patienten zur Zeit des ersten Interviews völlig ambulant waren, mit einem etwas höheren Anteil an schwer behinderten bei Personen von beiderlei Geschlecht in Kalifornien. Das Alter bei Beginn neigte in LA jünger zu sein als in K-P. Das frühere Anfangsalter der Krankheit und der höhere Anteil von Patienten mit schwerer Behinderung in dem Landkreis Los Angeles weist auf einen bösartigeren Verlauf in diesem Gebiet mit geringer Verbreitung.

HLA types and immunity in multiple sclerosis.

HLA types and levels of humoral and cell-mediated immune responses to several antigens were studied in a large group of patients with multiple sclerosis, and in controls. Patients were more likely than controls to have the DKw2 antigen. They had higher mean antibody titers to measles but not to cytomegalovirus, herpes 1, or herpes 2, and had less competent cell-mediated responses. Antibody titers to measles were lower and cell-mediated immune responses were more effective in patients with the DRw2 antigen than in patients without it. This apparent specificity for measles suggests that the etiology of multiple sclerosis is related to the immune response to measles or related viruses.

Epidemiologic correlates of willingness to be tested for HIV and prior testing among married men in India

There has been limited research in India on determinants of seeking HIV testing by Indian married couples. We analyzed data obtained from husbands of married couples participating in the National Family Health Survey 2005-06. Socio-demographic and behavioural predictors for willingness to be tested and self-reported prior testing were explored, using multivariate logistic regression. Factor scores were used to summarize knowledge variables related to HIV prevention and places of testing. Sixty-nine percent of the husbands were willing to be tested as part of National Family Health Survey 2005-06, and 7% reported some form of prior testing. Our results indicate that knowledge about HIV testing in hospitals and other health/welfare centres, knowledge about transmission of HIV, poor education, religion, economic status, occupation, early sexual debut, and use of contraceptives other than barrier methods were significant predictors for reported willingness to be tested. Knowledge about routes of transmission of HIV, younger age, educational level, religion other than Hindu or Muslim, economic status, occupation, history of blood transfusion, and condom use were significant correlates of previously being tested. Strategies to improve knowledge about HIV testing sites and HIV prevention may encourage married men to be tested and reduce the spread of infection from them to their wives.

Changes in immune response during relapses in MS patients

Changes in clinical status and in two measures of immune function were followed for 21 months (median) in 106 multiple sclerosis (MS) patients and cohabitant controls. Antibody titers to measles, cytomegalovirus, and herpesvirus l and 2, and leukocyte migration inhibition indexes (LMIs) to measles and streptokinase/streptodornase (SKSD) were measured at 3- to 6-month intervals and at time of exacerbation in the index case. There were 36 exacerbations in 25 patients. Mean baseline antibody titers and LMI to measles were higher in cases than in controls. No consistent changes occurred in antibody titers to any of the viruses, nor in LMI to SKSD. LMIs to measles were lower in most MS patients during exacerbations than before or after exacerbations. This apparent improvement in cell-mediated immune response to measles only during exacerbations may reflect aberrant immune regulation in MS patients, response to recrudescence of a latent agent, or some other phenomenon as yet undefined.

Chlamydia Trachomatis in Older Los Angeles County Residents, 1991–1998: Implications and Recommendations for the Detection of Sexually Transmitted Infections in Older Age Groups

OBJECTIVES: This study examined the incidence and implications of reported chlamydia cases in Los Angeles County residents aged 50 and older.

Role of Heat in Multiple Sclerosis Symptoms in a High- and a Low-Prevalence Area

A significantly higher proportion of Los Angeles County (State of California, USA) multiple sclerosis patient than of King-Pierce Counties (State of Washington, USA) patients, interviewed as part of a