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Psychological distress is more common in cancer survivors than the general population, and is associated with adverse outcomes. This cross-sectional study aimed to assess the relationship between socioeconomic status (SES), race and psychological distress, using data from a nationally representative sample of cancer survivors in the United States. Outcomes of interest were mild, moderate, and severe psychological distress as assessed by the Patient Health Questionnaire-4 (PHQ-4). In our univariate model, there was no statistically significant difference in the PHQ-4 scores of Caucasian and African American respondents. On the other hand, a lower SES correlated with a higher likelihood of psychological distress, and this persisted in our multivariate model. This study brings additional awareness to the negative impact of a lower socioeconomic status on mental health outcomes in cancer survivors, and further highlights the importance of the timely identification and screening of individuals at a high risk of psychological distress, in order to limit missed opportunities for relevant mental health interventions in this population.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (US). It is often discussed within the context of women’s sexual health due to its association with cervical cancer. However, HPV is also associated with other cancers and conditions which affect men. Gay and bisexual males (GBM) in the US have higher risks of HPV infection and a higher incidence of HPV-associated anal cancer than heterosexual males. In addition, GBM in the US have a higher prevalence of some high-risk strains of HPV than in other regions. HPV vaccination is highly effective at preventing HPV-associated cancers and genital warts. Several resources have been directed towards improving HPV awareness in the US over the past couple of years to improve vaccination rates. Given the low rates of HPV vaccination among GBM in the US, this study aimed to assess the trends in HPV and HPV vaccine awareness using a nationally representative sample of GBM. We found an overall increase in HPV and HPV vaccine awareness between 2017 and 2020. However, the sociodemographic differences in awareness levels highlight the need for more interventions to improve vaccination rates, especially in this high-risk population.

Abstract Background The retinal microcirculation has been studied in various diseases including multiple sclerosis (MS). However, inter-eye correlations and potential differences of the retinal blood flow velocity (BFV) remain largely unstudied but may be important in guiding eye selection as well as the design and interpretation of studies assessing or utilizing retinal BFV. The primary aim of this study was to determine inter-eye correlations in BFVs in healthy controls (HCs). Since prior studies raise the possibility of reduced BFV in MS eyes, a secondary aim was to compare retinal BFVs between MS eyes, grouped based on optic neuritis (ON) history and HC eyes. Methods Macular arteriole and venule BFVs were determined using a retinal function imager (RFI) in both eyes of 20 HCs. One eye from a total of 38 MS patients comprising 13 eyes with ON (MSON) and 25 eyes without ON (MSNON) history were similarly imaged with RFI. Results OD (right) and OS (left) BFVs were not significantly different in arterioles (OD: 3.95 ± 0.59 mm/s; OS: 4.08 ± 0.60 mm/s, P = 0.10) or venules (OD: 3.11 ± 0.46 mm/s; OS: 3.23 ± 0.52 mm/s, P = 0.06) in HCs. Very strong inter-eye correlations were also found between arteriolar (r = 0.84, P

Psychological distress is more common in cancer survivors than the general population, and is associated with adverse outcomes. This cross-sectional study aimed to assess the relationship between socioeconomic status (SES), race and psychological distress, using data from a nationally representative sample of cancer survivors in the United States. Outcomes of interest were mild, moderate, and severe psychological distress as assessed by the Patient Health Questionnaire-4 (PHQ-4). In our univariate model, there was no statistically significant difference in the PHQ-4 scores of Caucasian and African American respondents. On the other hand, a lower SES correlated with a higher likelihood of psychological distress, and this persisted in our multivariate model. This study brings additional awareness to the negative impact of a lower socioeconomic status on mental health outcomes in cancer survivors, and further highlights the importance of the timely identification and screening of individuals at a high risk of psychological distress, in order to limit missed opportunities for relevant mental health interventions in this population. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (US). It is often discussed within the context of women's sexual health due to its association with cervical cancer. However, HPV is also associated with other cancers and conditions which affect men. Gay and bisexual males (GBM) in the US have higher risks of HPV infection and a higher incidence of HPV-associated anal cancer than heterosexual males. In addition, GBM in the US have a higher prevalence of some high-risk strains of HPV than in other regions. HPV vaccination is highly effective at preventing HPV-associated cancers and genital warts. Several resources have been directed towards improving HPV awareness in the US over the past couple of years to improve vaccination rates. Given the low rates of HPV vaccination among GBM in the US, this study aimed to assess the trends in HPV and HPV vaccine awareness using a nationally representative sample of GBM. We found an overall increase in HPV and HPV vaccine awareness between 2017 and 2020. However, the sociodemographic differences in awareness levels highlight the need for more interventions to improve vaccination rates, especially in this high-risk population. [ABSTRACT FROM AUTHOR]

Background: Comparative studies of characteristics of optic neuritis (ON) associated with myelin oligodendrocyte glycoprotein-IgG (MOG-ON) and aquaporin-4-IgG (AQP4-ON) seropositivity are limited. Objective: To compare visual and optical coherence tomography (OCT) measures following AQP4-ON, MOG-ON, and multiple sclerosis associated ON (MS-ON). Methods: In this cross-sectional study, 48 AQP4-ON, 16 MOG-ON, 40 MS-ON, and 31 healthy control participants underwent monocular letter-acuity assessment and spectral-domain OCT. Eyes with a history of ON >3 months prior to evaluation were analyzed. Results: AQP4-ON eyes exhibited worse high-contrast letter acuity (HCLA) compared to MOG-ON (−22.3 ± 3.9 letters; p < 0.001) and MS-ON eyes (−21.7 ± 4.0 letters; p < 0.001). Macular ganglion cell + inner plexiform layer (GCIPL) thickness was lower, as compared to MS-ON, in AQP4-ON (−9.1 ± 2.0 µm; p < 0.001) and MOG-ON (−7.6 ± 2.2 µm; p = 0.001) eyes. Lower GCIPL thickness was associated with worse HCLA in AQP4-ON (−16.5 ± 1.5 letters per 10 µm decrease; p < 0.001) and MS-ON eyes (−8.5 ± 2.3 letters per 10 µm decrease; p < 0.001), but not in MOG-ON eyes (−5.2 ± 3.8 letters per 10 µm decrease; p = 0.17), and these relationships differed between the AQP4-ON and other ON groups (p < 0.01 for interaction). Conclusion: AQP4-IgG seropositivity is associated with worse visual outcomes after ON compared with MOG-ON and MS-ON, even with similar severity of macular GCIPL thinning. [ABSTRACT FROM AUTHOR]

Background: People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. Objectives: To evaluate risk factors for COVID-19 susceptibility and describe the pandemic's impact on healthcare delivery. Methods: Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d'Hebron-Centre d'Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. Results: There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Conclusion: Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption. [ABSTRACT FROM AUTHOR]

Background: Studies evaluating associations between body mass index (BMI) and optical coherence tomography (OCT) measures in multiple sclerosis (MS) are lacking. Objective: To assess whether elevated BMI is associated with accelerated retinal atrophy. Methods: In this observational study, 513 MS patients were followed with serial spectral-domain OCT for a median of 4.4 years. Participants were categorized as normal weight (BMI: 18.5–24.9 kg/m2), overweight (BMI: 25–29.9 kg/m2), and obese (BMI: ⩾30 kg/m2). Participants with diabetes mellitus or uncontrolled hypertension and eyes with optic neuritis (ON) ⩽6 months prior to baseline OCT or during follow-up were excluded. Statistical analyses were performed with mixed-effects linear regression. Results: Obese patients (n = 146) exhibited accelerated rates of ganglion cell + inner plexiform layer (GCIPL) atrophy relative to normal weight patients (n = 214; –0.57%/year (95% confidence interval (CI): –0.65% to –0.48%) versus –0.42%/year (95% CI: –0.49% to –0.35%); p = 0.012). GCIPL atrophy rate did not differ between overweight (n = 153) and normal weight patients (–0.47%/year vs –0.42%/year; p = 0.41). Each 1 kg/m2 higher BMI was associated with accelerated GCIPL (–0.011%/year; 95% CI: –0.019% to –0.004%; p = 0.003) atrophy. Multivariable analyses accounting for age, sex, race, MS subtype, and ON history did not alter the above findings. Conclusions: Elevated BMI, in the absence of overt metabolic comorbidities, may be associated with accelerated GCIPL atrophy. Obesity, a modifiable risk factor, may be associated with accelerated neurodegeneration in MS. [ABSTRACT FROM AUTHOR]

Background: The retinal vasculature may be altered in multiple sclerosis (MS), potentially acting as a biomarker of disease processes. Objective: To compare retinal vascular plexus densities in people with MS (PwMS) and healthy controls (HCs), and examine correlations with visual function and global disability. Methods: In this cross-sectional study, 111 PwMS (201 eyes) and 50 HCs (97 eyes) underwent optical coherence tomography angiography (OCTA). Macular superficial vascular plexus (SVP) and deep vascular plexus (DVP) densities were quantified, and poor quality images were excluded according to an artifact-rating protocol. Results: Mean SVP density was 24.1% (SD = 5.5) in MS eyes (26.0% (SD = 4.7) in non-optic neuritis (ON) eyes vs. 21.7% (SD = 5.5) in ON eyes, p < 0.001), as compared to 29.2% (SD = 3.3) in HC eyes (p < 0.001 for all MS eyes and multiple sclerosis optic neuritis (MSON) eyes vs. HC eyes, p = 0.03 for MS non-ON eyes vs. HC eyes). DVP density did not differ between groups. In PwMS, lower SVP density was associated with higher levels of disability (expanded disability status scale (EDSS): R 2 = 0.26, p = 0.004; multiple sclerosis functional composite (MSFC): R 2 = 0.27, p = 0.03) and lower letter acuity scores (100% contrast: R 2 = 0.29; 2.5% contrast: R 2 = 0.40; 1.25% contrast: R 2 = 0.31; p < 0.001 for all). Conclusions: Retinal SVP density measured by OCTA is reduced across MS eyes, and correlates with visual function, EDSS, and MSFC scores. [ABSTRACT FROM AUTHOR]

Objective: Therapeutic development in progressive multiple sclerosis (PMS) has been hampered by a lack of reliable biomarkers to monitor neurodegeneration. Optical coherence tomography (OCT)-derived retinal measures have been proposed as promising biomarkers to fulfill this role. However, it is unclear whether retinal atrophy persists in PMS, exceeds normal aging, or can be distinguished from relapsing-remitting multiple sclerosis (RRMS).Methods: 178 RRMS, 186 PMS, and 66 control participants were followed with serial OCT for a median follow-up of 3.7 years.Results: The estimated proportion of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell + inner plexiform layer (GCIPL) thinning in multiple sclerosis (MS) attributable to normal aging increased from 42.7% and 16.7% respectively at age 25 years, to 83.7% and 81.1% at age 65 years. However, independent of age, PMS was associated with faster pRNFL (-0.34 ± 0.09%/yr, p < 0.001) and GCIPL (-0.27 ± 0.07%/yr, p < 0.001) thinning, as compared to RRMS. In both MS and controls, higher baseline age was associated with faster inner nuclear layer (INL) and outer nuclear layer (ONL) thinning. INL and ONL thinning were independently faster in PMS, as compared to controls (INL:-0.09 ± 0.04%/yr, p = 0.03; ONL:-0.12 ± 0.06%/yr, p = 0.04), and RRMS (INL:-0.10 ± 0.04%/yr, p = 0.01; ONL:-0.13 ± 0.05%/yr, p = 0.01), whereas they were similar in RRMS and controls. Unlike RRMS, disease-modifying therapies (DMTs) did not impact rates of retinal layer atrophy in PMS.Interpretation: PMS is associated with faster retinal atrophy independent of age. INL and ONL measures may be novel biomarkers of neurodegeneration in PMS that appear to be unaffected by conventional DMTs. The effects of aging on rates of retinal layer atrophy should be considered in clinical trials incorporating OCT outcomes. ANN NEUROL 2020;87:885-896. [ABSTRACT FROM AUTHOR]

Background: The effects of disease-modifying therapies (DMTs) on region-specific brain atrophy in multiple sclerosis (MS) are unclear. Objective: To determine the effects of higher versus lower efficacy DMTs on rates of brain substructure atrophy in MS. Methods: A non-randomized, observational cohort of people with MS followed with annual brain magnetic resonance imaging (MRI) was evaluated retrospectively. Whole brain, subcortical gray matter (GM), cortical GM, and cerebral white matter (WM) volume fractions were obtained. DMTs were categorized as higher (DMT-H: natalizumab and rituximab) or lower (DMT-L: interferon-beta and glatiramer acetate) efficacy. Follow-up epochs were analyzed if participants had been on a DMT for ⩾6 months prior to baseline and had at least one follow-up MRI while on DMTs in the same category. Results: A total of 86 DMT epochs (DMT-H: n = 32; DMT-L: n = 54) from 78 participants fulfilled the study inclusion criteria. Mean follow-up was 2.4 years. Annualized rates of thalamic (−0.15% vs −0.81%; p = 0.001) and putaminal (−0.27% vs −0.73%; p = 0.001) atrophy were slower during DMT-H compared to DMT-L epochs. These results remained significant in multivariate analyses including demographics, clinical characteristics, and T2 lesion volume. Conclusion: DMT-H treatment may be associated with slower rates of subcortical GM atrophy, especially of the thalamus and putamen. Thalamic and putaminal volumes are promising imaging biomarkers in MS. [ABSTRACT FROM AUTHOR]

Aims of this study are to evaluate: 1) if the 50% rule can identify MS diagnosed patients with red flags of better explanation (MS-Plus) that may actually carry a different underlying disease; 2) disease courses of MS-plus patients stratified according to CVS sign frequency. B Results: b 50% rule analysis: the rule was fulfilled by 28/28 (100%) MS patients (median PVL frequency 90,5%, range 68-100%) and by 30/52 (58%) MS-plus (median PVL frequency 70,5%, range 55-100%), whereas 22/52 (42%) of the MS-plus patients did not meet the rule, identifying a separate subset of patients with a median PVL frequency of 23,5% (range 10-48%). B Conclusions: b CVS frequency analysis shows that a subset of MS-plus patients (about 40%) does not meet the 50% rule and that the disease course of these patients seems milder than MS or MS-plus meeting the rule. These data suggest that the MS-plus patients with < 50%PVL probably carry MS-like syndromes sustained by different underlying disease(s) thus probably based on pathogenic mechanisms different from MS. [Extracted from the article]

Central pons lesions were increased slightly in 8.3% (9 out of 93) MS with VRF cases (mostly smokers) and specificity was reduced to 90.32 % 95%CI 82.4, 94.5, when MS with VRF was compared with non-MS with VRF. B Conclusions: b Although pons lesions are seen in a minority of patients, the presence of peripheral pons lesions is a useful discriminator for MS from vascular associated lesions and specificity does not seem to be influence by the presence of VRF in MS. The MS-severity-score, 5.15 vs. 0.88 (p=0.019), the T2 brainstem-, 1 vs. 0 (p=0.041), and the total intracranial contrast-enhancing lesion counts, 2 vs. 0 (p=0.000), were higher in patients with cranial nerve enhancement, compared to age-, disease duration-, and gender- matched MS patients. The analysis included patients with non-inflammatory neurological diseases (non-MS, n=29) and new onset multiple sclerosis (MS, n=42). [Extracted from the article]

Over recent years there have been significant advances in our understanding of the pathogenesis of Paediatric Multiple Sclerosis (MS) together with a growing recognition of the diverse range of disorders which can present as non-MS white matter lesions on brain and spine MRI in children and young people. B Objectives: b To assess the association between sNfL and MS demographic and disease characteristics as well as the impact of comorbidities on sNfL levels in a large heterogeneous cohort of MS patients. MS patients with sNfL-E vs. sNfL-N were compared with respect to walking speed, manual dexterity, and processing speed using linear models (GLMs) adjusting for age, sex, disease subtype/duration and MS therapy. B Results: b Of the 1969 MS patients (74% female; mean age 48y [SD: 12.0y]; 18% non-white), 483 (25%) participants were classified as sNfL-E. Relative to sNfL-N, MS patients with sNfL-E had slower walking and manual dexterity speeds (mean %difference [95% CI]: walking speed: 10% slower [6%, 14%]; p< 0.001; manual dexterity: 7% slower [5%, 10%]; p< 0.001) and lower processing speed scores (mean difference -3.78 [-4.84, -2.70]; p< 0.001). [Extracted from the article]

Purpose: Optical coherence tomography (OCT) is a reliable method used to quantify discrete layers of the retina. Spectralis OCT is a device used for this purpose. Spectralis OCT macular scan imaging acquisition can be obtained on either the horizontal or vertical plane. The vertical protocol has been proposed as favorable, due to postulated reduction in confound of Henle’s fibers on segmentation-derived metrics. Yet, agreement of the segmentation measures of horizontal and vertical macular scans remains unexplored. Our aim was to determine this agreement. Materials and methods: Horizontal and vertical macular scans on Spectralis OCT were acquired in 20 healthy controls (HCs) and 20 multiple sclerosis (MS) patients. All scans were segmented using Heidelberg software and a Johns Hopkins University (JHU)-developed method. Agreement was analyzed using Bland–Altman analyses and intra-class correlation coefficients (ICCs). Results: Using both segmentation techniques, mean differences (agreement at the cohort level) in the thicknesses of all macular layers derived from both acquisition protocols in MS patients and HCs were narrow (<1 µm), while the limits of agreement (LOA) (agreement at the individual level) were wider. Using JHU segmentation mean differences (and LOA) for the macular retinal nerve fiber layer (RNFL) and ganglion cell layer + inner plexiform layer (GCIP) in MS were 0.21 µm (−1.57–1.99 µm) and −0.36 µm (−1.44–1.37 µm), respectively. Conclusions: OCT segmentation measures of discrete retinal-layer thicknesses derived from both vertical and horizontal protocols on Spectralis OCT agree excellently at the cohort level (narrow mean differences), but only moderately at the individual level (wide LOA). This suggests patients scanned using either protocol should continue to be scanned with the same protocol. However, due to excellent agreement at the cohort level, measures derived from both acquisitions can be pooled for outcome purposes in clinical trials. [ABSTRACT FROM PUBLISHER]