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      The Swedish MS registry – clinical support tool and scientific resource

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          Abstract

          The Swedish MS registry (SMSreg) is designed to assure quality health care for patients with multiple sclerosis (MS). It has been active since 2001 and web-based since 2004. It runs on government funding only and is used in all Swedish neurology departments. The SMSreg currently includes data on 14,500 of Sweden's estimated 17,500 prevalent patients with MS. One important function of SMSreg, to which participation is voluntary, is to serve as a tool for decision support and to provide an easy overview of the patient information needed at clinical visits. This is its core feature and explains why the majority of Swedish MS specialists contribute data. Another success factor for SMSreg is that entered data can be readily accessed, either through a query function into Excel format or through a set of predesigned tables and diagrams in which parameters can be selected. Recent development includes a portal allowing patients to view a summary of their registered data and to report a set of patient-reported outcomes. SMSreg data have been used in close to 100 published scientific reports. Current projects include an incidence cohort (EIMS), post-marketing cohorts of patients on novel disease-modifying drugs (IMSE), and a prevalence cohort (GEMS). As these studies combine physical sampling and questionnaire data with clinical documentation and possible linkage to other public registries, together they provide an excellent platform for integrated MS research.

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          Most cited references23

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          Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up.

          An incidence cohort consisting of 308 multiple sclerosis patients was followed up repeatedly during at least 25 years of disease. A number of clinical factors were analysed with respect to their validity in assessing the long-term prognosis. Of the onset characteristics, the type of course was the most important, with primary progressive patients experiencing a much more severe course. In patients with an acute onset, low onset age, high degree of remission at first exacerbation, symptoms from afferent nerve fibres and onset symptoms from only one region (as compared with polyregional symptoms) of the central nervous system, were factors significantly associated with a favourable long-term prognosis. Of factors known 5 years after onset, a low number of affected neurological systems, a low neurological deficit score and a high degree of remission from the last bout were the most important favourable prognostic factors.
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            Tobacco smoking, but not Swedish snuff use, increases the risk of multiple sclerosis.

            The aim of this study was to estimate the influence of tobacco smoking and Swedish snuff use on the risk of developing multiple sclerosis (MS). A population-based case-control study was performed in Sweden, using incident cases of MS (902 cases and 1,855 controls). A case was defined as a subject from the study base who had received a diagnosis of MS, and controls were randomly selected from the study base. The incidence of MS among smokers was compared with that of never-smokers. We also investigated whether the use of Swedish snuff had an impact on the risk of developing MS. Smokers of both sexes had an increased risk of developing MS (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.2-1.7 for women, and OR 1.8, 95% CI 1.3-2.5 for men). The increased risk was apparent even among subjects who had previously smoked moderately (< or =5 pack-years) prior to index, and the risk increased with increasing cumulative dose (p < 0.0001). The increased risk for MS associated with smoking remained up to 5 years after stopping smoking. In contrast, taking Swedish snuff for more than 15 years decreased the risk of developing MS (OR 0.3, 95% CI 0.1-0.8). Smokers of both sexes run an increased risk of developing multiple sclerosis (MS), and the risk increases with cumulative dose of smoking. However, the use of Swedish snuff is not associated with elevated risk for MS, which may indicate that nicotine is not the substance responsible for the increased risk of developing MS among smokers.
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              High nationwide prevalence of multiple sclerosis in Sweden.

              Few nationwide multiple sclerosis (MS) prevalence studies have been published. In Scandinavia, the nationwide MS prevalence was 173/100,000 in Denmark 2005 and 100/100,000 in Iceland 1990. Our aim with the present study was to determine the first population-based nationwide MS prevalence in Sweden, based on observed, registered patients and to investigate the presence of a north-south gradient of MS prevalence. By linking the Swedish National Patient Register, the Swedish Multiple Sclerosis Registry and the Swedish Total Population Register we obtained the number of patients who were diagnosed with MS before 2009, and who were registered, alive and resident in Sweden on the prevalence date 31 December 2008. We calculated the gender-specific nationwide MS prevalence in 1-year age intervals. The relationship between MS risk and latitude was studied in a logistic regression model including all individuals in the population of Sweden. The number of registered MS patients in 2008 was 17,485 out of the Swedish population of 9,256,347. The overall MS prevalence was 188.9/100,000 (95% CI 186.1-191.7), 113.4 (95% CI 110.3-116.5) for men and 263.6 (95% CI 258.9-268.3) for women. The female to male ratio was 2.35:1. The prevalence of MS significantly increased for each degree of north latitude with 1.5% in men (p = 0.013) and 1% in women (p = 0.015). The MS prevalence of 188.9/100,000 in Sweden is among the highest nationwide prevalence estimates in the world. In Sweden, the risk of MS increases with increasing north latitude for both men and women.
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                Author and article information

                Journal
                Acta Neurol Scand
                Acta Neurol. Scand
                ane
                Acta Neurologica Scandinavica
                John Wiley & Sons, Ltd (Chichester, UK )
                0001-6314
                1600-0404
                July 2015
                05 June 2015
                : 132
                : Suppl 199
                : 11-19
                Affiliations
                [1 ]Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
                [2 ]Department of Neurology, Karolinska University Hospital Stockholm, Sweden
                Author notes
                J. Hillert, Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden, Tel.: +46 70 5851021, Fax: +46 85 2483049, e-mail: Jan.Hillert@ 123456ki.se

                The copyright line for this article was changed on 22 July 2015 after original online publication.

                Article
                10.1111/ane.12425
                4657484
                26046553
                68adf79d-d554-44c2-bda0-dd165f36fea0
                Copyright © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 April 2015
                Categories
                Nordic Ms Epidemiology. Sponsored by an Unrestricted Educational Grant From Teva Nordic. Teva Had No Editorial Input in the Review Process

                multiple sclerosis,ms registry,national registry,electronic medical record,graphical medical records,clinical research,outcome measures,edss,disease-modifying drugs,multiple sclerosis epidemiology,multiple sclerosis genetics,multiple sclerosis immunology,mri,proms

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