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The Rehabilitation Act of 1973 mandated improved access to services in the state-federal vocational rehabilitation system for individuals with severe disabilities. Using a 10% national sample of all case closures during the period 1977-1984, we found evidence that this mandate was being implemented: the percentage of all case closures who were severely disabled increased during the study period, both among individuals with physical disabilities and among individuals with psychiatric disabilities. However, on many indicators of change over time, there was a marked disparity between individuals with severe physical disabilities and individuals with severe psychiatric disabilities. A key finding is that among individuals with severe physical disabilities there was a 19.9% increase between 1977 and 1984 in the number who obtained employment in the competitive labor market, while among individuals with severe psychiatric disabilities, there was a 3.4% decrease. [ABSTRACT FROM AUTHOR]

Background: Fatigue is one of the most disabling symptoms reported by people with multiple sclerosis. Although behavioural and pharmacological interventions might be partly beneficial, their combined effects have not been evaluated for multiple sclerosis fatigue, or examined with sufficient consideration of characteristics that might affect treatment response. In this comparative effectiveness research trial, we compared the effectiveness of cognitive behavioural therapy (CBT), modafinil, and their combination for treating multiple sclerosis fatigue., Methods: This randomised, analyst-blinded, parallel-arm, comparative effectiveness trial was done at two universities in the USA. Adults (aged ≥18 years) with multiple sclerosis and problematic fatigue (Fatigue Severity Scale [FSS] score ≥4) were randomly assigned (1:1:1), using a web-based treatment assignment system with minimisation, to receive CBT, modafinil, or both for 12 weeks. Statisticians were masked to group assignment, but participants, study neurologists, CBT interventionalists, and coordinators were not masked to treatment assignment. The primary outcome was the change in Modified Fatigue Impact Scale (MFIS) from baseline to 12 weeks, assessed using multiple linear regression, adjusted for age, sex, study site, anxiety, pain, baselines MFIS score, and physical activity. Analyses were done by intent to treat. The trial was registered with clinicaltrials.gov, NCT03621761, and is completed., Findings: Between Nov 15, 2018, and June 2, 2021, 336 participants were randomly assigned treatment (114 assigned to CBT, 114 assigned to modafinil, and 108 assigned to combination therapy). At 12 weeks, CBT (n=103), modafinil (n=107), and combination therapy (n=102) were associated with clinically meaningful within-group MFIS reductions of 15·20 (SD 11·90), 16·90 (15·90), and 17·30 (16·20) points, respectively. Change in MFIS scores from baseline to 12 weeks did not differ between groups: relative to combination therapy, the adjusted total mean difference in MFIS change score was 1·88 (95% CI -2·21 to 5·96) for CBT and 1·20 (-2·83 to 5·23) for modafinil. Most common adverse events for modafinil-containing treatment groups included insomnia (eight [7%] for modafinil and eight [7%] for combination therapy) and anxiety (three [3%] for modafinil and nine [8%] for combination therapy)., Interpretation: Modafinil, CBT, and combination therapy were associated with similar reductions in the effects of multiple sclerosis fatigue at 12 weeks. Combination therapy was not associated with augmented improvement compared with the individual interventions. Further research is needed to determine whether effects of these interventions on multiple sclerosis-related fatigue is influenced by sleep hygiene and sleepiness. No serious adverse events related to the study drug were encountered., Funding: Patient-Centered Outcomes Research Institute and National Multiple Sclerosis Society., Competing Interests: Declaration of interests TJB reports current or recent grants from the National Institutes of Health, the International Progressive MS Alliance, and the National MS Society, and an award from the Patient-Centered Outcomes Research Institute. She has received support from Michigan Humane for her research. She has received travel and meeting support from Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and the American Academy of Neurology. She reports a patent held by the University of Michigan related to treatment of sleep apnoea. She receives material support, but no financial compensation, from Jazz Pharma for a National Institutes of Health-funded investigator-initiated trial. She holds unpaid service and leadership positions for the National MS Society and the ACTRIMS Program Committee. She has served as site principal investigator for trials of multiple sclerosis therapeutics sponsored by Genentech, Genyzme, and Novartis, but received no direct compensation for this work. KNA reports grants from the National Institutes of Health and the National MS Society and an award from the Patient-Centered Outcomes Research Institute. He has received royalties for licensing of materials to Actelion Pharmaceuticals. DME reports grants from the National Institutes of Health, the National MS Society, the National Institute of Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, and the State of Washington, and an award from the Patient-Centered Outcomes Research Institute. She receives honoraria from the American Psychological Association for her role as Editor for the journal Rehabilitation Psychology. She has received royalties for licensing of materials to Actelion Pharmaceuticals. She serves without compensation in leadership and service roles for the National MS Society National Advisory Board on Medical Rehabilitation Research and on the editorial board for Archives of Physical Medicine and Rehabilitation. GvG reports grants from the Patient-Centered Outcomes Research Institute and the National MS Society and a contract from Novartis; she also serves on a National Institute for Neurological Disorders and Stroke board. TRV reports a grant from the National MS Society. ARR reports research effort support from the National Institutes of Health and travel and meeting support from ACTRIMS. RDC reports grants from the National Institutes of Health and the National MS Society, and an award from the Patient-Centered Outcomes Research Institute. He receives royalties from UpToDate for roles as an editor and author and is a paid Eli Lilly consultant (contract through University of Michigan). He reports patents and copyrighted material held by the University of Michigan for screening, diagnosis, and treatment of sleep disorders. He has held unpaid leadership positions on the board of directors and as treasurer and president elect for the International Pediatric Sleep Association. He serves on the advisory board of The Pajama Program. BMS reports grants from the National Institute of Health and Wings for Life Foundation. He has received travel support from ACTRIMS and International Society for Neuroimmunology for speaking engagements and programmatic activities. He serves as Secretary and Director for the ACTRIMS Program Committee. He has participated on a data and safety monitoring board for Data Safety Monitoring Committee, AACI Trailblazer Clinical Trial, Eli Lilly (2020–21). He holds filed or issued patents for an immune cell based neuroregenerative therapy, a treatment for sleep apnoea, and lymphoid chemokines, through the Ohio State University, University of Michigan, and University of Rochester, respectively. ALK reports grants from the National Institutes of Health, the National MS Society, the Craig H Neilsen Foundation, the National Institute of Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, and the State of Michigan, and an award from the Patient-Centered Outcomes Research Institute. She receives honoraria from the American Psychological Association for her role as Editor for the journal Rehabilitation Psychology. She has received royalties for licensing of materials to Actelion Pharmaceuticals and she served as a paid consultant for Twill Health. She serves without compensation on committees for the United State Association for The Study of Pain and Society for Ambulatory Assessment and on the editorial boards for Journal of Pain and Arthritis Care & Research. RL, YTN, AJ, MH, MS, NL, YZ, and DC report no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

It has been suggested that parasitic infections, common in Latin American populations, may amplify the inflammatory response of the airways. There are several reports of atopic and asthmatic patients but few reports of parasitic infection in COPD patients. This study aimed to determine the prevalence of parasitic infections in COPD patients compared with atopic and asthmatic patients attending the Institute of Immunology outpatient clinics and the pneumology service of the University hospital. A case-control study was conducted compising 100 patients with bronchial asthma, 100 patients with COPD, 100 individuals with atopy without respiratory symptoms, and 100 healthy individuals. Serum-specific IgG antibodies against the parasites Ascaris lumbricoides ( Al ), Strongyloides stercolaris ( Ss ), and Toxocara canis ( Tc ) were measured by ELISA. IgE levels were used as an indirect indicator of atopy. Positive IgG for Al was observed in all groups, predominantly in the atopic cohort; Ss positiveness was recorded only in four COPD patients, and Tc positiveness was observed in all groups except in controls. Significant correlations exist between the values of Al and IgE in controls, atopic, and asthmatic patients without COPD. No correlation was found for Tc . IgE levels and the forced expiratory volume in 1 s (FEV1) correlate only in atopic and asthmatic patients. Parasitic infections are common in atopic patients and moderate and severe asthmatic and COPD patients. Anti-inflammatory treatment may be responsible for the increased frequency of infection in moderate and severe asthmatic and COPD patients.

Background and Objectives: A recent report estimated that approximately 1 million adults were living with multiple sclerosis (MS) in the United States. Although MS is rarely the direct cause of death, its debilitating effects on normal body functions can result in considerable disruption to daily living and life roles including work, physical independence, mobility, social interaction, and participation in leisure activities. This study estimated the total economic burden of MS in the United States in 2019., Methods: This study used a prevalence-based approach to estimate the national economic burden of MS. Claims from 3 sources (Medicare Current Beneficiary Survey, Medicare Standard Analytical File, and Optum de-identified Normative Health Information System) were used to obtain direct costs and a survey was developed to collect indirect costs (e.g., labor market productivity losses, costs of paid and unpaid caregivers, home modification) from 946 patients with MS (PwMS). Direct medical costs reflected the difference in the total average annual amount paid for PwMS vs matched controls without MS. Future earnings loss due to premature death attributable to MS was calculated using Centers for Disease Control and Prevention mortality data and Medicare claims data., Results: The estimated total economic burden was $85.4 billion, with a direct medical cost of $63.3 billion and indirect and nonmedical costs of $22.1 billion. Retail prescription medication (54%); clinic-administered drugs, medication, and administration (12%); and outpatient care (9%) were the 3 largest components of the direct costs. The average excess per-person annual medical costs for PwMS was $65,612; at $35,154 per person, disease-modifying therapies (DMTs) accounted for the largest proportion of this cost. The cost per DMT user ranged from $57,202 to $92,719, depending on sex-age strata. The average indirect and nonmedical costs were $18,542 per PwMS and $22,875 per PwMS if caregivers' costs were included. Lost earnings due to premature death, presenteeism, and absenteeism losses were the largest indirect cost components., Discussion: MS is a costly chronic disease, with direct costs of prescription drugs and indirect productivity loss being important cost drivers. Our findings suggested that the burden of MS in the United States has been underestimated., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Background: The National Multiple Sclerosis Society (NMSS) strives to ensure that people affected by multiple sclerosis (MS) can live their best lives. This mission is reflected in the Society's strategic plan, which establishes the roadmap for the Society's continued commitment to a world free of MS., Objective: The purpose of this article is to add to the understanding of both the scope and complexity of the impact of MS and MS-related supports on quality of life (QOL)., Methods: A national sample of people with MS (n = 748) participated in the study by completing validated surveys assessing their QOL, physical and mental health, MS self-efficacy, resilience, participation in NMSS, perceived stress, emotional support, and social roles and activities. A path model was used to examine how the frequently identified MS QOL predictors, including demographic, MS, psychosocial, and physical functional status variables relate to each other and to QOL., Results: The model exhibited reasonable model fit with hypothesized paths being statistically significant and in the hypothesized direction., Conclusion: Findings revealed that the relationships among mental health, demographic factors, overall MS experiences, QOL, NMSS participation, and resonance with the mission of the NMSS are complex, highly nuanced, and yet strongly correlated. More importantly, the study highlights the strong influence of variables that are more readily amenable to change through programmatic and clinical intervention, and active self-management and participation.

Background: Multiple sclerosis adult day programs (MSADPs) offer life-enhancing services for individuals and informal caregivers affected by multiple sclerosis (MS), including medical care, rehabilitation therapies, nutrition therapy, cognitive training, tailored education, exercise programs, and social interaction. The purpose of this study was to examine the effects of MSADPs on health-related quality of life (HRQOL) and health care utilization of persons with MS and HRQOL and well-being of informal caregivers., Methods: Using a quasi-experimental design, outcomes between baseline and 1-year follow-up in persons with MS and informal caregivers who used MSADP services and a comparison group of similar persons with MS and caregivers who did not use MSADP services were compared. For persons with MS, outcomes included standardized measures of physical and mental HRQOL and health care utilization. For caregivers, outcomes included physical and mental HRQOL and well-being. Changes in outcomes between baseline and follow-up were examined using propensity score-weighted difference-in-differences regression analysis., Results: For persons with MS, MSADP use had a significant positive effect on 12-Item Short Form Health Survey physical component scores, although the difference was not clinically meaningful. Use of MSADPs did not have effects on any other outcomes for persons with MS or caregivers., Conclusions: Use of MSADPs did not show a clinically meaningful effect on HRQOL for persons with MS or informal caregivers. The MSADPs do not seem to offer sustained benefits to persons with MS or caregivers, but the possibility of initial short-term benefits cannot be ruled out., Competing Interests: The authors declare no conflicts of interest., (© 2020 Consortium of Multiple Sclerosis Centers.)

There is a growing need for patient and public involvement (PPI) to inform the way that research is developed and performed. International randomized controlled trials are particularly likely to benefit from PPI, but guidance is lacking on how or when it should be incorporated. In this article, we describe the PPI process that occurred during the design and initiation of an international treatment clinical trial in MS. PPI was incorporated using a structured approach, aiming to minimize bias and achieve equivalence in study design, implementation, and interpretation. Methods included PPI representation within the study research team, and the use of focus groups, analyzed using thematic framework analysis. We report the outcomes of PPI and make recommendations on its use in other neurology clinical trials. By sharing our model for PPI, we aim to maximize effectiveness of future public involvement and to allow its effect to be better evaluated., (© 2019 American Academy of Neurology.)

Background: Multiple sclerosis (MS) is the most common chronic neurologic disease of young adults, placing a heavy burden on patients, families, and the healthcare system. Ongoing surveillance of the incidence and prevalence of MS is critical for health policy and research, but feasible options are limited in the United States and many other countries. We investigated the feasibility of monitoring the prevalence of MS using a large national telephone survey of the adult US population., Methods: We developed questions to estimate the lifetime prevalence and age of onset of MS using the US-based Behavioral Risk Factor Surveillance System (BRFSS) and piloted these questions in 4 states (MN, RI, MD, and TX). There was a total of 45,198 respondents aged 18 years and above. Analyses investigated individual state and combined prevalence estimates along with health-related comorbidities and limitations. MS prevalence estimates from the BRFSS were compared to estimates from multi-source administrative claims and traditional population-based methods., Results: The estimated lifetime prevalence of self-reported MS (per 100,000 adults) was 682 (95% CI 528-836); 384 (95% CI 239-529) among males and 957 (95% CI 694-1,220) among females. Estimates were consistent across the 4 states but much higher than recently published estimates using population-based administrative claims data. This was observed for both national results and for MS prevalence estimates from other studies within specific states (MN, RI, and TX). Prevalence estimates for Caucasian, African American, and Hispanic respondents were 824, 741, and 349 per 100,000 respectively. Age and sex distributions were consistent with prior epidemiologic reports. Comorbidity and functional limitations were more pronounced among female than male respondents., Conclusions: While yielding higher overall MS prevalence estimates compared to recent studies, this large-scale self-report telephone method yielded relative prevalence estimates (e.g., prevalence patterns of MS by sex, age, and race-ethnicity) that were generally comparable to other surveillance approaches. With certain caveats, population-based telephone surveys may eventually offer the ability to investigate novel disease correlates and are relatively feasible, and affordable. Further work is needed to create a valid question set and methodology for case ascertainment before this approach could be adopted to accurately estimate MS prevalence., (© 2020 S. Karger AG, Basel.)

Disease course in people with multiple sclerosis (MS) is heterogeneous. The impact of dietary and nutritional factors on MS prognosis is of interest to both patients and clinicians; differences in diet are hypothesized to contribute to disease evolution over time. However, studying diet, especially in people with MS, introduces methodologic complexity that should be recognized. In this review, we focus on methodological aspects relevant to the conduct of dietary interventions in people with MS, given our experience in leading such studies and the challenges we encountered in the realization of this work. We summarize key aspects of study design and important considerations, regardless of the specifics of the actual study (e.g. the particular diet of interest, target MS population, etc.). We discuss strategies for the design of the intervention as well as the selection of appropriate study endpoints. Finally, we provide an overview of strategies to improve the rigor of conducting dietary studies in people with MS., Competing Interests: Declaration of Competing Interest We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which they are associated and we certify that all financial and material support for this research and work are clearly identified in the Acknowledgments Section., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management., Methods: The National MS Society ("Society") convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care., Recommendations: Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society: Increased professional and patient awareness/education about the prevalence, impact, and appropriate management of cognitive symptoms. For adults and children (8+ years of age) with clinical or magnetic resonance imaging (MRI) evidence of neurologic damage consistent with MS: As a minimum, early baseline screening with the Symbol Digit Modalities Test (SDMT) or similarly validated test, when the patient is clinically stable; Annual re-assessment with the same instrument, or more often as needed to (1) detect acute disease activity; (2) assess for treatment effects (e.g. starting/changing a disease-modifying therapy) or for relapse recovery; (3) evaluate progression of cognitive impairment; and/or (4) screen for new-onset cognitive problems. For adults (18+ years): more comprehensive assessment for anyone who tests positive on initial cognitive screening or demonstrates significant cognitive decline, especially if there are concerns about comorbidities or the individual is applying for disability due to cognitive impairment. For children (<18 years): neuropsychological evaluation for any unexplained change in school functioning (academic or behavioral). Remedial interventions/accommodations for adults and children to improve functioning at home, work, or school.