Posted on Multiple Sclerosis, Women's Health

New study uncovers therapeutic inertia in the treatment of women with multiple sclerosis

A study has revealed significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), highlighting gender disparities that could impact long-term health outcomes for women of childbearing age.
A study has revealed significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), highlighting gender disparities that could impact long-term health outcomes for women of childbearing age.

The findings suggest that concerns related to pregnancy may result in delayed or reduced use of disease-modifying treatments (DMTs), even before pregnancy is considered.

The study also found that the difference in treatment became apparent after two years of disease duration for DMTs and as early as one year for HEDMTs. Notably, this gender-based treatment gap did not significantly change with patient age, suggesting that therapeutic inertia could persist regardless of the woman’s stage in life.

“These findings emphasize the crucial need to reconsider how we make treatment decisions for women with MS, especially those of childbearing age,” says Professor Sandra Vukusic, the lead author of the study. “Women may not be receiving the most effective therapies at the optimal time, often due to concerns about pregnancy risks that may never materialize. The use of Disease-Modifying Therapies (DMTs) and Highly Effective Disease-Modifying Therapies (HEDMTs) is frequently limited by potential and unknown risks associated with pregnancy, as there is often insufficient data available when these drugs first come to market.”

Both neurologists and patients contribute to therapeutic inertia, with many adopting a cautious approach and avoiding these treatments. “Neurologists may be reluctant to prescribe DMTs, especially if they are not comfortable managing pregnancy-related issues,” explains Professor Vukusic. “At the same time, women understandably do not want to take any risks for their child or pregnancy. Their primary concerns are congenital malformations, fetal loss, and fetal growth disorders. Women will also feel uncomfortable if their neurologist appears uncertain.”

Moving forward, the research team plans to further investigate the factors contributing to therapeutic inertia. They aim to improve treatment strategies prioritizing the long-term health of women with MS and their reproductive goals.

“The main impact of this inertia is the less effective control of disease activity during DMT-free periods, leading to the accumulation of lesions and an increased risk of long-term disability,” emphasizes Professor Vukusic. “This represents a real loss of opportunity for women, especially in an era where DMTs are so effective when used early.”

Posted on Diabetes, Exercise

Fear of hypoglycaemia remains a major barrier to exercise among diabetics

What is moderate and vigorous exercise?
Despite the high use of continuous glucose monitoring and insulin pump therapy, fear of hypoglycaemia (low blood sugar) remains a significant barrier to physical activity and exercise for adults with type 1 diabetes (T1D).


However, the findings suggest that if exercise and diabetes management are discussed in the clinic, this fear could be reduced. “Regular exercise can help individuals with diabetes to achieve their blood glucose goals, improve their body composition and fitness, as well as reduce their risk of heart attacks and strokes which is higher in people with type 1 diabetes,” explained lead author Dr Catriona Farrell from the University of Dundee, Scotland, UK. “Yet many people living with type 1 diabetes do not maintain a healthy body weight or manage to do the recommended amount of physical activity each week.” A number of previous studies have examined barriers to exercise in T1D, but these have been limited by their small sample size.


To fill this important evidence gap, researchers from the University of Dundee assessed knowledge and barriers to physical activity in adults with T1D and associated predictive factors.
Adults with T1D were recruited from the NHS Research Scotland Diabetes Network (research register) and internationally via social media. Overall, 463 adults, 221 men and 242 women, with T1D answered an anonymous web-based questionnaire to assess barriers to physical activity (measured on the modified Barriers to Physical Activity in Type 1 Diabetes [BAPAD-1] scale), diabetes management, and attitudes to exercise and sport. Participants were asked to rate on a 7-point Likert scale (1, extremely unlikely to 7, extremely likely) the chance that each of 13 factors would keep them from doing regular physical activity in the next 6 months. Factors included: loss of control over diabetes, the risk of hypoglycaemia, the fear of being tired, the fear of getting hurt, a low fitness level, and lack of social support.

Researchers calculated average scores for each factor and assessed which were most correlated with perceived barriers to physical activity, as well as identifying independent predictors.
The participant reported median age of respondents was 45-54 years, median disease duration 21-25 years, and median HbA1c 50-55 mmol/mol (an ideal level is 48 50-55 mmol/mol or below).
Over three-quarters (79%) of respondents reported using continuous or flash glucose monitoring, around two-thirds (64%) said they were treated with multiple daily insulin injections, and over a third (36%) reported used insulin pump therapy. The researchers identified that despite advances in technologies and diabetes management, risk of hypoglycaemia with exercise remains a significant barrier to physical activity.
 
Importantly, participants who best understood the importance of adjusting insulin dose before and after exercise as well as adjusting carbohydrate intake for exercise were found to be less fearful of hypoglycaemia associated with physical activity. This knowledge is essential in order to adapt insulin and/or carbohydrate intake to prevent hypoglycaemia induced by exercise. The researchers also found that being asked about exercise or sport within a diabetes clinic was negatively correlated with fear of hypoglycaemia, and identified exercise confidence as the strongest independent predictor of fear of physical activity.
 
“Our findings demonstrate that in order to break down the barriers to physical activity, and empower our patients to exercise safely and effectively, we need to improve the education we provide and our dialogue about exercise in clinics,” said Dr Farrell. “In turn, this should help them to achieve the multitude of health benefits that exercise offers.”
Posted on Autism

Being autistic and a person who uses drugs

Please take note of the following text: “Millie is an individual with autism who uses drugs. In a video, they shared some personal journeys, explaining why they resorted to opioids to handle overstimulation and trauma. Their personal history and neurodivergent traits uniquely qualify them for their role in reducing harm related to substance use and addiction. Millie works as a peer support worker and is able to empathize directly with those seeking services, creating a judgment-free safe space for them.”

Posted on Autism

46 Phrases That Upset Autistic Brains

In this video, I’m sharing 46 phrases and questions that can be upsetting to individuals with autism. This list is not intended for diagnostic purposes and is just a lighthearted way to explore life on the autism spectrum.

Posted on Cognitive dysfunction, Diet

Can the MIND diet lower the risk of memory problems later in life?

People whose diet more closely resembles the MIND diet may have a lower risk of cognitive impairment
People whose diet more closely resembles the MIND diet may have a lower risk of cognitive impairment.

The MIND diet is a blend of the Mediterranean and DASH diets. It incorporates green leafy vegetables such as spinach, kale, and collard greens, as well as other vegetables. It emphasizes whole grains, olive oil, poultry, fish, beans, and nuts. The diet favours berries over other fruits and suggests consuming one or more servings of fish per week.

“Given the rising number of people with dementia due to the ageing population, it’s crucial to identify changes that can help delay or slow down the onset of cognitive issues,” stated Russell P. Sawyer, MD, a study author from the University of Cincinnati in Ohio and a member of the American Academy of Neurology. “We were particularly interested in determining whether diet influences the risk of cognitive impairment in both Black and white study participants.”

The study involved 14,145 people with an average age of 64. Of the participants, 70% were white, and 30% were Black. They were followed for an average of 10 years.

Participants filled out a questionnaire on their diet over the past year. Researchers looked at how closely the foods people ate matched the MIND diet.

Remember the following dietary guidelines:

– Consume three or more daily servings of whole grains

– Eat six or more weekly servings of green leafy vegetables

– Have one or more daily servings of other vegetables

– Include two or more weekly servings of berries in your diet

– Consume one or more weekly servings of fish

– Include two or more weekly servings of poultry

– Aim for three weekly servings of beans

– Consume five daily servings of nuts

– Limit red meat to four or fewer weekly servings

– Limit fast or fried foods to one or fewer weekly servings

Aim for one or more weekly servings of olive oil

– Limit butter or margarine to one or fewer tablespoons daily

– Keep pastries and sweets to five or fewer weekly servings

– Limit wine to one glass per day

The total number of points possible is 12.

Researchers then divided participants into three groups. The low group had an average diet score of five, the middle group had an average score of seven, and the high group had an average score of nine.

Thinking and memory skills were measured at the beginning and end of the study.

During the study, cognitive impairment developed in 532 people, or 12% of 4,456 people in the low diet group; in 617 people, or 11% of 5,602 people in the middle group; and in 402 people, or 10% of the 4,086 people in the high group.

After adjusting for factors such as age, high blood pressure and diabetes, researchers found people in the high group had a 4% decreased risk of cognitive impairment compared to those in the low group.

Researchers found a 6% decreased risk of cognitive impairment for female participants who closely followed the diet, but no decreased risk for male participants.

Researchers also looked at how quickly people’s thinking skills declined as they developed problems. They found that people who more closely followed the MIND diet declined more slowly than those who did not, and that association was stronger in Black participants than in white participants.

“These findings warrant further study, especially to examine these varying impacts among men and women and Black and white people, but it’s exciting to consider that people could make some simple changes to their diet and potentially reduce or delay their risk of cognitive issues,” said Sawyer.