Thesis (M.S.)--Oregon State University, 2001. / Typescript (photocopy). Includes bibliographical references (leaves 23-26). Also available online.

Bakgrund: Multipel skleros är en kronisk sjukdom som leder till att livet på ett eller annat sätt troligtvis kommer att förändras. I Sverige lider 12000 svenskar av multipel skleros (MS), två tredjedelar av dessa är kvinnor. MS är en livslång och handikappande sjukdom hos yngre vuxna som ofta påverkar livskvaliteten. Syfte: Syftet med denna studie var att belysa faktorer av betydelse för hur personer med multipel skleros upplever sin livskvalitet. Metod: Metoden som användes var en litteraturstudie som baserades på tretton vetenskapliga artiklar. Analysen gjordes med inspiration av Graneheim och Lundmans syn på innehållsanalys. Resultat: I resultatet framkom åtta kategorier, Att ha ett arbete, Begränsningar till följd av kognitiva försämringar, Att vara delaktig i stödgrupper, Relationen till närstående, Förändrad fysisk förmåga, Symtomens påverkan, Sjukdomens varaktighet och Skillnader mellan könen.

published_or_final_version / Medicine / Master / Master of Philosophy

Background Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system (CNS). In Hong Kong, the prevalence rates of MS is 4.8/100,000. First line disease modifying agent (DMA) type 1 interferon β (IFN-β) is the most commonly use therapy for relapsing and remitting MS(RRMS). Depending on the administration type and route of IFN-β, up to 80% of patients develop harmless binding antibody (BAb),which binds to IFN molecules but not necessary interfere its bioactivity. When IFN-β therapy continues, maturation of BAb response can lead to the formation of high affinity neutralizing antibody (NAb). About 45% of MS patients develop NAb against IFN-β in one year of IFN-β treatment. NAb shows a loss of IFN-β clinical effect by increasing MRI activity and disease progression. As the clinical effect of NAb is lagging behind the initial appearance of NAb in the body, it is suggested to develop a NAb assay to predict treatment failure and advice switching therapy for patients when NAb is present. Aim The aim of this study was: I. To develop and evaluate a qPCR-based method for the measurement of NAb to IFN-β in MS patient. II. To establish the normal reference range of NAb in Chinese population. III. To seek the possibility of using anti-IFN-β BAb assay and in vivo MxA gene expression assay as a screening test for NAb IV. To compare the performance between MxA induction qPCR, ELISA, WB assay and luciferase IFN-β reporter gene assay Materials and methods23Chinese RRMS patients who treated with IFN-β-1a therapy for a minimum of12 months were recruited in this study. Serum and PBMC were collected12 hours after the IFN-β-1a injection. MxA, IFNAR1 and IFNAR2 mRNA from PBMC were tested byin vivo MxA gene expression assay. NAb containing serum was tested by anti-IFN-β BAb assay, IFN-β reporter gene assay, in vitro MxA induction WB, ELISA and qPCR assay. In addition, blood samples from 3 Chinese volunteers without any known autoimmune disease history were collected to evaluate the baseline of NAb titer and MxA expression. Result The experimental condition of MxA induction qPCR assay was optimized by using 2.5×105A549 cells plating density, 10% FCS concentration,5 hours IFN-β stimulation time and GAPDH normalization. Assay accuracy was validated by reference anti-IFN-β antibody. Starting from 2.5 TRU, linear relationship could be observed (r2= 0.9873). The lower limit of quantification (LLOQ) was 0.02 LU/mL, the upper limit of quantification (ULOQ) was 16LU/mL and the limit of detection (LOD) was 0.002 LU/mL. The reproducibility of the assay was measured, the intra-and inter-assay imprecision(%CV)for high value were 5.95% and 7.17% respectively, while the intra-and inter-assay impression were8.31% and 15.95%respectively.Results of the qPCR-based method were concurring with that of luciferase IFN-β reporter gene assay. The upper limit of the NAb reference range in Chinese population was 40.3 TRU (n=3, 95% CI = 31.7-48.8). The performance observed in MxA induction ELISA assay swas unsatisfactory. The correlation of anti-IFN-β BAb assay and in vivoMxA gene expression assay results with NAb status indicated both tests were sensitive enough for NAb screening. Conclusion A normal range of NAb titer in Chinese population was established in this study. Anti-IFN-β BAb assay and in vivo MxA gene expression assay were proved suitable for NAb screening. The performance of the developed MxA induction qPCR assay was superior to MxA induction ELISA, WB assay and comparable to luciferase IFN-β reporter gene assay. By using MxA induction qPCR assay, actual efficacy of IFN-β therapy could be measured and monitored. Any treatment failure could be predicted earlier. / published_or_final_version / Pathology / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

No description available.

No description available.

Self-regulation theory was used to examine how people cope with the diagnosis and management of chronic neurological illness. Three studies are reported, all of which examined the three main elements of self-regulation theory as outlined by Leventhal et al (1984), people's representations of their condition, the actions they took to manage and their evaluation of those efforts, and the outcome as assessed by their feelings about themselves, their emotional wellbeing and severity of disability. A longitudinal study examined 20 people at three stages, before coming into hospital for tests and investigations for multiple sclerosis, 6 weeks and 6 months later. This study provided some support for representations as being important in guiding coping. However, both representations and people's own evaluations of their coping efforts were more predictive of outcome. The second, cross-sectional study compared people being investigated for three differing chronic diseases; the previous 20 people being investigated for multiple sclerosis, 11 and 22 people being investigated for motor neurone disease and liver disease respectively. Results showed that how people represented their condition, and not the diagnosis, was related to outcome. The third study was pseudo-longitudinal and examined people at different times since the diagnosis of multiple sclerosis. People at six months (n=20 from first study), 2 years (n=19), and over 7 years (n=25) from diagnosis were included. This study again highlighted the relationship between representations and outcome; perceiving more symptoms and adverse consequences being associated with poorer outcomes of all types. Coping was also associated with outcome, in particular, more social supports and greater satisfaction with that support being associated with higher Self Esteem, better emotional wellbeing and less severe disability. It is concluded that self-regulation theory is a useful framework within which to understand how people cope with chronic neurological illness, in chronic illnesses with no cure or effective palliative treatments people's representation of their condition and evaluation of their coping efforts predicted outcome. The low level of psychological distress found in all studies suggests that while no particular coping actions are associated with better outcomes, it may be that taking some kind of action, rather than taking no action, in a situation where there is nothing the medical profession can do is sufficiently motivating to minimise depression.

Thesis (PhD)--University of South Australia, 1995

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 7 uppsatser.