Objectives-Previous studies have shown that multiple sclerosis is very uncommon among Indian and Pakistani immigrants to England but that their children born in the United Kingdom, in the age groups available for study, have a similar risk of developing the disease as occurs in the general British population. The present study was to ascertain if these immigrants who enter England as children below the age of 15, have a higher risk of developing multiple sclerosis than those that enter after this age. Methods-A search was made in Greater London, the West Midlands, Leicester, Bradford, Halifax, and Huddersfield to find ethnic Indian, Pakistani, and Bangladeshi immigrants to England with multiple sclerosis. During the course of the study some immigrants from the Caribbean with multiple sclerosis were also found. The population at risk by ethnic group and age at entry was not available from the 1991 Census but was available in the annual Labour Force Surveys. Results-Indian and Pakistani immigrants who entered England younger than 15 had a higher risk of developing multiple sclerosis than those that entered after this age. Caribbean immigrants, who have a higher multiple sclerosis prevalence than Asian immigrants, did not show this diVerence. Conclusion-This study confirms previous studies which show that the environment during childhood is a major factor in determining the risk of developing multiple sclerosis.
SummaryIn the past, birthplace has frequently been omitted in completing the Sheet, but in 1976, over 91 per cent of all first admissions to psychiatric hospitals in South-East England were analysed by birthplace, sex, age-group and marital status. First admissions for schizophrenia were five times the expected number for immigrants from New Commonwealth America (the West Indies), four times the expected number for immigrants from New Commonwealth Africa (mostly ethnic Asians) and three times the expected number from India. Immigrants from Pakistan and the remaining New Commonwealth Asian countries did not show a significantly higher than expected number of admissions for schizophrenia, and their first admissions for alcoholic psychosis and alcoholism, psychoneuroses and personality and behaviour disorders were significantly fewer than expected. First admissions for schizophrenia were also significantly more than expected among immigrants from Ireland, Germany and Poland, but not from Italy.
To ascertain the prevalence of multiple sclerosis in the region of Osona in Catalonia, northern Spain, an intensive study was undertaken in a small population of 72 000 people over a period of five years, using many sources of information. Patients were classified according to the Poser criteria. Most of the patients presented with mild symptoms only and many had not seen a neurologist or attended a large hospital. The prevalence of definite and probable multiple sclerosis was 58 per 100 000. This is nine to 10 times higher than had been found previously in Catalonia and is a similar prevalence to that found in southern Spain, in Sicily, and in Greek speaking Cyprus.
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