BackgroundMultiple sclerosis (MS) is the most common cause of neurological disability in young adults worldwide and approximately half of those affected are in Europe. The assessment of differential incidence and prevalence across populations can reveal spatial, temporal and demographic patterns which are important for identifying genetic and environmental factors contributing to MS. However, study methodologies vary and the quality of the methods can influence the estimates. This study aimed to systematically review European studies of incidence and prevalence of MS and to provide a quantitative assessment of their methodological quality.MethodsA comprehensive literature search was performed to obtain all original population-based studies of MS incidence and prevalence in European populations conducted and published between January 1985 and January 2011. Only peer-reviewed full-text articles published in English or French were included. All abstracts were screened for eligibility and two trained reviewers abstracted the data and graded the quality of each study using a tool specifically designed for this study.ResultsThere were 123 studies that met the inclusion criteria. The study estimates were highly heterogeneous, even within regions or countries. Quality was generally higher in the more recent studies, which also tended to use current diagnostic criteria. Prevalence and incidence estimates tended to be higher in the more recent studies and were higher in the Nordic countries and in northern regions of the British Isles. With rare exceptions, prevalence and incidence estimates were higher in women with ratios as high as 3:1. Few studies examined ethnicity. Epidemiological data at the national level was uncommon and there were marked geographical disparities in available data, with large areas of Europe unrepresented and other regions well-represented in the literature. Only 37% of the studies provided standardized estimates.ConclusionsDespite the breadth of the literature on the epidemiology of MS in Europe, inter-study comparisons are hampered by the lack of standardization. Further research should focus on regions not yet studied and the evaluation of ethnic differences in MS prevalence and incidence. National-level studies using current diagnostic criteria, validated case definitions and similar age- and sex-standardization would allow better geographical comparisons.

Background: The incidence and prevalence of multiple sclerosis (MS) varies considerably around the world. No previous study has performed a comprehensive review examining the incidence and prevalence of MS across the Americas. The purpose of this study was to systematically review and assess the quality of studies estimating the incidence and/or prevalence of MS in North, Central and South American regions. Methods: A comprehensive literature search was performed using MEDLINE and EMBASE from January 1985 to January 2011. Search terms included ‘multiple sclerosis’, ‘incidence’, ‘prevalence’ and ‘epidemiology’. Only full-text articles published in English or French were included. Study quality was assessed using an assessment tool based on recognized guidelines and designed specifically for this study. Results: A total of 3,925 studies were initially identified, with 31 meeting the inclusion criteria. The majority of studies examined North American regions (n = 25). Heterogeneity was high among all studies, even when stratified by country. Only half of the studies reported standardized rates, making comparisons difficult. Quality scores ranged from 3/8 to 8/8. Conclusion: This review highlights the gaps that still exist in the epidemiological knowledge of MS in the Americas, and the inconsistencies in methodologies and quality among the published studies. There is a need for future studies of MS prevalence and incidence to include uniform case definitions, employ comparable methods of ascertainment, report standardized results, and be performed on a national level. Other factors such as sex distribution, ethnic make-up and population lifestyle habits should also be considered.

Objective To assess the extent of prescriptions filled by pregnant women for drugs with recognised potential of fetal harm, and to document the outcomes of these pregnancies.Design Cross-sectional study.Population Quebec Pregnancy Registry.Methods We identified women who were pregnant during a fiveyear period and who were insured for prescription medications under the provincial drug plan. We obtained information on prescriptions filled during pregnancy for drugs with known potential of fetal harm.Main outcome measures Prescriptions filled for study drugs during the first, second and third trimesters of pregnancy; termination of pregnancy (TOP) or delivery, and whether the baby was diagnosed with a major congenital malformation (MCM).Results Of 109 344 women, 56% filled at least one prescription for a medication during pregnancy; 6.3% filled at least one prescription for a drug known to pose a risk to the fetus. Overall, 47% (95% CI, 45.8-48.2) of pregnancies exposed to drugs under study ended in TOP versus 36.2% (95% CI, 35.9-36.5) of those not exposed; 8.2% (95% CI, 8.0-10.0) of live births were diagnosed with an MCM during the first year of life versus 7.1% (95% CI, 6.9-7.3) of those not exposed.Conclusions This study documents an important level of prescriptions filled during pregnancy for drugs harmful to the developing fetus. The proportions of both TOPs and babies born with MCMs were elevated compared with the expected values. Clinicians caring for women during pregnancy should conduct a medication inventory prior to a planned pregnancy, or as soon as an unplanned pregnancy is recognised.

This study demonstrates that the majority of women suffering from epilepsy were treated with monotherapy rather than polytherapy during pregnancy. While most used other agents, an important number of women continued to use valproate in pregnancy despite the long standing evidence of its teratogenicity and increasing evidence of its neuro-toxicity to the fetus.

within 48 hours postpartum. Data from 48,366 women were entered into bivariate and descriptive analyses. Following the exclusion of patients for whom some data were missing, a regression analysis was performed on 44,641 patients. A separate regression analysis for primiparous women only, which included 18,165 patients, was also performed.At 48 hours, 43.3% of all women and 37.4% of primiparous women were not breast-feeding. Regression analysis found that breastfeeding rates increased with maternal age, parity, and social class. An independent association between intrapartum analgesia and breast-feeding was found, including both intramuscular opioids and epidural analgesia. Inhaled nitrous oxide was associated with increased breast-feeding rates in primiparous women only. Oxytocin alone or combined with ergometrine for the prevention of postpartum hemorrhage was associated with a 6% to 8% reduction in the breast-feeding rate. The administration of prostaglandins for labor induction was also associated with a significant reduction in the breast-feeding rate.Ergometrine alone was associated with the greatest reduction. Blood loss and need for transfusion were not associated with the use of uterotonics in the third state of labor.These associations between intrapartum medications and breast-feeding require further study, including investigations on the dose-response relationship. From the results of such studies, the optimal balance between successful breastfeeding and maternal health, particularly the prevention of postpartum hemorrhage, can hopefully be attained. P rescription medication use among North American women of childbearing age is rising, along with increasing numbers of drugs available for chronic health conditions. Much prescribing is done before the pregnancy is recognized. Many agents used regularly by women who are or soon to be pregnant are teratogenic, fetotoxic, or embryotoxic, with the potential to harm a developing embryo or fetus during prenatal exposure. Most pregnant women avoid use of these medications and many physicians avoid prescribing them; if a pregnancy occurs during treatment, therapeutic termination of pregnancy (TOP) may be indicated. Given the potential public health and human burdens, the authors assessed the patterns and extent of prescriptions filled by parturients for drugs contraindicated in pregnancy and the outcomes of these pregnancies.From the Quebec Pregnancy Registry, which holds data on all provincial pregnancies, women aged 15 to 45 years with a recognized pregnancy between January 1, 1998, and December 31, 2002, and who were continuously insured by the provincial drug plan for prescription medications were identified. From linked registries, data were obtained about the prescriptions of contraindicated drugs and the trimester in which prescriptions were filled, as well as maternal age, status of insurance, and area of residence. The list of drugs to be researched (those with recognized potential for fetal harm) came from validated sources reflecting the current knowl...

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Population-based studies have used DNA typing of Mycobacterium tuberculosis organisms to estimate the extent of ongoing tuberculosis transmission in various communities and to characterize associated risk factors. The finding of matched DNA "fingerprints" among isolates from an immigrant subgroup may reflect transmission in the adopted country but could also reflect limited diversity among M. tuberculosis organisms within that immigrant community. The authors sought to determine which hypothesis is more likely to explain the high frequency of matched isolates among Haitian-born tuberculosis patients in Montreal, Quebec, Canada. The authors determined the number of different bacterial genotypes in this community as compared with other foreign-born tuberculosis patients and applied a recently described measure of genetic similarity between M. tuberculosis organisms ("genetic distance"). Among 76 Haitian-born tuberculosis patients diagnosed during 1996-1998, the authors identified 47 distinct genotypes on the basis of standard IS6110 DNA typing and categorical analysis. In genetic distance analysis, these 47 genotypes showed as great a genetic diversity as that observed among the 191 distinct genotypes identified in 216 other foreign-born tuberculosis patients. A mycobacterial "founder effect" is unlikely to account for the high proportion of shared isolates among Haitian-born Montrealers. Recent transmission remains the most likely explanation.