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BackgroundShift work, which often results in sleep deprivation and circadian desynchrony, has been associated with increased risk of multiple sclerosis (MS). We aimed at studying the impact of sleep duration, circadian disruption and sleep quality on MS risk.MethodsWe used a Swedish population-based case-control study (2075 cases, 3164 controls). Aspects of sleep were associated with MS risk by calculating OR with 95% CIs using logistic regression models.ResultsCompared with sleeping 7–9 hours/night during adolescence, short sleep (ConclusionsInsufficient sleep and low sleep quality during adolescence seem to increase the risk of subsequently developing MS. Sufficient restorative sleep at young age, needed for adequate immune functioning, may be a preventive factor against MS.

BACKGROUND Parkinson’s disease (PD) is a complex, non-curable and progressive neurological disease affecting different areas of the human nervous system. PD is associated with both motor and non-motor symptoms, which negatively affect patients’ quality of life and may cause changes in socialisation such as intentional social withdrawal. This may further lead to social isolation and loneliness. The use of Information and communication technology (ICT) plays an important role in managing social isolation and loneliness. Currently, there is a lack of research focusing on designing and developing ICT solutions that specifically address social isolation and loneliness among people living with Parkinson’s disease (PwPs). OBJECTIVE This study aims to explore the barriers experienced by PwPs regarding social isolation, loneliness, and technology usage. Further, this study also aims to investigate the social needs necessary for creating an ICT solution that can address social isolation and loneliness among PwPs METHODS Two phases of data collection were conducted. During the first phase, healthcare professionals and PwPs were interviewed to understand how PD affects social life and technology usage. During the second phase, focus groups were conducted with PwPs to gather insights into their needs and identify ways to manage social isolation and loneliness. Thematic analysis was used to analyse both datasets and identify key themes. RESULTS The results showed that the barriers experienced by PwPs due to PD such as ‘fatigue’, ‘psychological changes’, ‘social stigma’ and ‘medication side effects’, affect their social life. PwPs also experience difficulties using a keyboard and mouse, remembering passwords, and navigating complex applications due to their PD-related physical and mental limitations. To manage their social isolation and loneliness, PwPs suggested having a simple and easy-to-use solution allowing them to participate in a digital community based on their interests, communicate with others, and receive recommendations for social events. CONCLUSIONS The new ICT solutions focusing on social isolation and loneliness among PwPs should consider the barriers restricting user’s social activities and technology usage. Given the wide range of needs and barriers experienced by PwPs, it is more suitable to adopt user-centred design approaches that emphasise the active participation of end users in the design process. Importantly, any ICT solution designed for PwPs should not encourage internet addiction, which will further contribute to the person’s withdrawal from society.

Background Smoking and occupational pulmonary irritants contribute to multiple sclerosis (MS) development. We aimed to study the association between ambient air pollution and MS risk and potential interaction with the human leukocyte antigen (HLA)-DRB1*15:01 allele. Methods Exposure to combustion-related air pollution was estimated as outdoor levels of nitrogen oxides (NOx) at the participants’ residence locations, by spatially resolved dispersion modelling for the years 1990–18. Using two population-based case-control studies (6635 cases, 8880 controls), NOx levels were associated with MS risk by calculating odds ratios (OR) with 95% confidence intervals (CI) using logistic regression models. Interaction between high NOx levels and the HLA-DRB1*15:01 allele regarding MS risk was calculated by the attributable proportion due to interaction (AP). In addition, a register study was performed comprising all MS cases in Sweden who had received their diagnosis between 1993 and 2018 (n = 22 173), with 10 controls per case randomly selected from the National Population register. Results Residential air pollution was associated with MS risk. NOx levels (3-year average) exceeding the 90th percentile (24.6 µg/m3) were associated with an OR of 1.37 (95% CI 1.10–1.76) compared with levels below the 25th percentile (5.9 µg/m3), with a trend of increasing risk of MS with increasing levels of NOx (P Conclusions Our findings indicate that moderate levels of combustion-related ambient air pollution may play a role in MS development.

Despite the importance of inter-organisational information sharing (IOIS) in the public sector, such endeavours often fail. Existing research has shown that the values held by collaborating organisations are one important factor affecting these kinds of initiatives. However, research has sought only to a limited extent to address how value conflicts come into play over time. Therefore, this paper aims to explore how conflicting values shape an inter-organisational information-sharing practice in the public sector over time. Using the local/global network framework, we analyse four years’ worth of information sharing in an inter-organisational advisory group in the context of Swedish nuclear waste management. We conclude that different value conflicts are emphasised to different extents at different points in time. That is, values do not uniformly affect IOIS activities, and such conflicts over time reduce the set of potential IOIS activities. We also conclude that when IOIS activities are driven by an individual organisation’s values, individual value rational activities may co-exist with a dysfunctional long-term IOIS practice.

Inconclusive findings have been reported regarding the influence of smoking on outcomes in established rheumatoid arthritis (RA). We aimed to study the influence of smoking habits on disease activity and health-related quality of life in patients with RA.Patients with newly diagnosed RA (N=1531) from the population-based case-control study EIRA (Epidemiological Investigation of Rheumatoid Arthritis) were followed up to three years after recruitment. Using logistic regression models, patients with different smoking habits were compared regarding risk of unfavorable outcomes as measured by self-reported swollen and tender joint counts, the 36-Item Short-Form Health Survey, the Health Assessment questionnaire, and the Hospital Anxiety and Depression scale, by calculating odds ratios with 95% confidence intervals.At 1-year and 3-year follow-up, current smokers (compared with non-smokers) reported higher disease activity and lower health-related quality of life, both regarding physical and mental aspects. Patients who stopped smoking within 1-year post-baseline had less disease activity measured as swollen joint counts at 1-year follow-up compared to those who continued smoking. Patients who stopped smoking after 1-year follow-up had higher disease activity and lower health-related quality of life at baseline than smokers who did not quit, and late smoking cessation was not associated with more favorable outcomes compared to continued smoking.Current smoking is associated with increased disease activity and lower health-related quality of life among RA patients. Smoking cessation within the first year after baseline seems to have a favourable effect on disease activity.

Background: Infection with human herpesvirus 6A (HHV-6A) has been suggested to increase multiple sclerosis (MS) risk. However, potential interactions between HHV-6A and environmental/lifestyle risk factors for MS have not previously been studied. Methods: We used two Swedish population-based case-control studies comprising 5993 cases and 5995 controls. Using logistic regression models, subjects with different HHV-6A antibody levels, environmental exposures, and lifestyle habits were compared regarding MS risk, by calculating odds ratios (ORs) with 95% confidence intervals (CIs). Potential interactions between high HHV-6A antibody levels and common environmental exposures and lifestyle factors were evaluated on the additive scale. Results: High HHV-6A antibody levels were associated with increased risk of developing MS (OR = 1.5, 95% CI = 1.4–1.6). Regarding MS risk, significant interactions were observed between high HHV-6A antibody levels and both smoking (attributable proportion (AP) = 0.2, 95% CI = 0.1–0.3), low ultraviolet radiation (UVR) exposure (AP = 0.3, 95% CI = 0.1–0.4), and low vitamin D levels (AP = 0.3, 95% CI = 0.0–0.6). Conclusion: High HHV-6A antibody levels are associated with increased MS risk and act synergistically with common environmental/lifestyle risk factors for MS. Further research is needed to investigate potential mechanisms underlying the interactions presented in this study.

ObjectiveIt has been debated whether the different clinical disease courses in multiple sclerosis (MS) are the consequence of different pathogenic mechanisms, with distinct risk factors, or if all MS clinical phenotypes are variations of similar underlying disease mechanisms. We aimed to study environmental risk factors and their interactions with human leucocyte antigen DRB1*15:01 with regards to relapsing-onset and progressive-onset MS.MethodsWe used two Swedish population-based case–control studies, including 7520 relapsing-onset cases, 540 progressive-onset cases and 11 386 controls matched by age, sex and residential area. Logistic regression was used to estimate ORs with 95% CIs for associations between the different MS phenotypes and a number of environmental and lifestyle factors. Interaction between the DRB1*15:01 allele and environmental risk factors was evaluated on the additive scale.ResultsAll environmental and lifestyle factors associated with risk of developing MS apply to both relapsing-onset and progressive-onset disease. Smoking, obesity and Epstein-Barr virus nuclear antigen-1 (EBNA-1) antibody levels were associated with increased risk of both MS phenotypes, whereas snuff use, alcohol consumption and sun exposure were associated with reduced risk. Additive interactions between DRB1*15:01 and smoking, obesity, EBNA-1 antibody levels and sun exposure, respectively, occurred to increase MS risk regardless of the clinical phenotype.InterpretationOur finding that the same environmental and lifestyle factors affect both relapsing-onset and progressive-onset MS supports the notion that the different clinical phenotypes share common underlying disease mechanisms.

ObjectiveWe aimed to investigate the influence of environmental risk factors for multiple sclerosis (MS) in different genetic contexts, and study if interactions between environmental factors and human leucocyte antigen (HLA) genes differ in magnitude according to heterozygocity and homozygocity for HLA-DRB1*15:01.MethodsUsing population-based case–control studies (6985 cases, 6569 controls), subjects with different genotypes and smoking, EBNA-1 status and adolescent Body Mass status, were compared regarding MS risk, by calculating OR with 95% CI employing logistic regression. The interaction between different genotypes and each environmental factor was evaluated on the additive scale.ResultsThe effect of each DRB1*15:01 allele on MS risk was additive on the log-odds scale for each additional allele. Interaction between DRB1*15:01 and each assessed environmental factor was of similar magnitude regardless of the number of DRB1*15:01 alleles, although ORs were affected. When any of the environmental factors were present in DRB1*15:01 carriers without the protective A*02:01 allele, a three-way interaction occurred and rendered high ORs, especially among DRB1*15:01 homozygotes (OR 20.0, 95% CI 13.1 to 30.5 among smokers, OR 21.9, 95% CI 15.0 to 31.8 among those with elevated EBNA-1 antibody levels, and OR 44.3, 95% CI 13.5 to 145 among those who reported adolescent overweight/obesity).ConclusionsThe strikingly increased MS risk among DRB*15:01 homozygotes exposed to any of the environmental factors is a further argument in favour of these factors acting on immune-related mechanisms. The data further reinforce the importance of preventive measures, in particular for those with a genetic susceptibility to MS.

Background: Surgical outcomes in patients with multiple sclerosis (MS) following metabolic surgery appear to be similar compared to those of the general bariatric population. Objective: To study the impact of metabolic surgery on the clinical course of MS. Methods: Using data from the Scandinavian Obesity Surgery Registry and the Swedish Multiple Sclerosis register, we compared disease outcomes in 122 cases of MS who had undergone metabolic surgery with those of 122 cases of MS without surgery, matched by a two-staged Propensity score match, including age at disease onset, sex, MS phenotype, body mass index, and preoperative severity of MS as measured by the Expanded Disability Status Scale. Results: The time to 6-month confirmed disability progression during the first five years postbaseline was shorter among the surgical patients (hazard ratio (HR) = 2.31, 95% confidence interval (CI) = 1.09–4.90; p = 0.03). No differences were observed regarding postoperative annual relapse rate ( p = 0.24) or time to first postoperative relapse ( p = 0.52). Conclusion: Although metabolic surgery appears to be a safe and efficient treatment of obesity in patients with MS, the clinical course of the disease might be negatively affected. Long-term nutritional follow-up after surgery and supplementation maintenance are crucial, particularly among those with preoperative deficits.