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Context: Health-related quality of life (HRQOL) is a multi-dimensional construct including aspects of life quality or function that are affected by physical health and symptoms, psychosocial factors, and psychiatric conditions. HRQOL gives a broader measure of the burden of disease than physical impairment or disability levels. Purpose: To identify factors associated with HRQOL among people with multiple sclerosis (MS) utilizing the SF-8 Health Survey. Methods: Data presented in this study were collected in a survey of 1,518 people with MS living in all 50 states. The survey sample was randomly selected from the database of the National Multiple Sclerosis Society, using ZIP codes to recruit the survey sample. A multiple linear regression model was employed to analyze the survey data, with the Physical Component Summary and the Mental Component Summary of the SF-8 the dependent variables. Independent variables were demographic characteristics, MS-disease characteristics, and health services utilized. Findings: People with MS in rural areas tended to report lower physically related HRQOL. Worsening MS symptoms were associated with reduced physical and mental dimensions of HRQOL. In addition, people with MS who received a diagnosis of depression tended to have reduced physical and mental dimensions of HRQOL. Receiving MS care at an MS clinic was associated with better physically related HRQOL, while having a neurologist as principal care physician was associated with better mental-related HRQOL. Conclusion: The challenge is to increase the access that people living with MS in rural areas have to MS-focused specialty care.

The Cognitive Function Study Group of the National Multiple Sclerosis Society has highlighted the problems with assessing affective disorders in patients with multiple sclerosis. It has been said that no single physical symptom of MS is as common as defects in mood and expression and control of emotion. These aspects of MS have received little attention from those involved in the care of MS patients, and doubtlessly contribute significantly to suffering. Numerous affective symptoms have been described in MS patients, including uncontrolled weeping and laughing, euphoria, depression, and mania. Unfortunately, limitations in research methods prevent comparison between published reports and a precise calculation of the prevalence and severity of these disorders. The Study Group makes recommendations for the evaluation of affective disorders in MS, which includes the recommendation for a structured interview. Although more expensive, and requiring the presence of trained personnel, the structured interview is far more reliable than self-report questionnaires for the assessment of affective disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients infected with the human immunodeficiency virus (HIV) are especially likely to have a deficiency of vitamin B12. Although this deficiency has been attributed to an abnormality of gastrointestinal function, the precise cause is not yet clear. A recent study has indicated that about 7 percent of asymptomatic HIV-infected patients have vitamin B12 deficiency, and the proportion rises to 15 percent among patients with symptomatic AIDS. Since a deficiency of vitamin B12 can adversely affect the function of the brain if the deficiency persists over time, a study was undertaken to determine the prevalence of vitamin B12 deficiency among HIV-infected patients with neurological symptoms. Forty-nine HIV-infected patients with possible neurological involvement were tested for vitamin B12 deficiency. Ten patients (20 percent of the group) were found to have some abnormality of vitamin B12 metabolism. Six had vitamin B12 levels that were less than normal. The other four patients had abnormalities on the Schilling test, which determines the absorption of vitamin B12 after the administration of an oral dose. The patients with vitamin B12 abnormalities tended to be further along in the progression of the disease and were also older than the patients with no detectable vitamin B12 abnormality. The vitamin B12 abnormality was associated with both neuropathy (disease of the nerves) and myelopathy (disease of the spinal cord). No patient without peripheral neuropathy had a vitamin B12 abnormality, and 67 percent of the patients with both neuropathy and myelopathy had this vitamin abnormality. Eight patients were treated with injections of vitamin B12, and five experienced relief of neuropathic symptoms. No relief of symptoms of myelopathy was achieved in any patient, however. The evidence indicates that vitamin B12 deficiency may be a common and treatable cause of neurologic deficits in some HIV-infected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dr Schiffer is director of the Center for Brain Health at the Cleveland Clinic in Ohio. He reports that he has 2000 shares of stock in Pfizer and is a [...]