Publications by authors named "Alejandra Machado"

Background: Work ability index (WAI) is an instrument that measures work ability in workplace surveys and health examinations in occupational health and research. It has been used in different population groups. But research is limited among people with multiple sclerosis (PwMS).

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The prodromal features of multiple sclerosis (MS) are non-specific and are prevalent in the general population. Several studies indicate an increased use of healthcare resources by individuals with MS in the years preceding their diagnosis, suggesting a trend of deteriorating health prior to the clinical manifestation of MS. This study aimed to capture the possible associations of sick leave with the timing of the diagnosis of MS.

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Article Synopsis
  • - The study analyzed how the COVID-19 pandemic affected the working lives of people with multiple sclerosis (PwMS) by surveying individuals aged 20-50 listed in the Swedish Multiple Sclerosis Registry.
  • - Out of over 8500 invited, 3887 respondents participated, with 93.7% being in paid work; 26.2% reported a specific impact from the pandemic, which varied by sex, MS severity, education, and profession.
  • - Key themes from respondents included direct occupational impacts, issues related to disclosing or concealing their condition at work, feelings of worry and uncertainty, and broader life changes; overall, many PwMS experienced little disruption to their work.
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Background: The risk of coronavirus disease 2019 among people with multiple sclerosis with different disease-modifying therapies is not well established.

Objective: To investigate the occurrence of coronavirus disease 2019 and the remaining symptoms among people with multiple sclerosis and the associations with different disease-modifying therapies.

Methods: Individuals aged 20-50 listed in the Swedish Multiple Sclerosis Registry were invited to participate in a survey in 2021.

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Background: People with multiple sclerosis (PwMS) face health and social challenges of living with a chronic and potentially disabling condition. To disclose or conceal MS at work may critically affect individuals' work situation, career opportunities, and health. PwMS may experience a dilemma when assessing if the possible benefits of disclosing the diagnosis outweigh the possible risks.

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Article Synopsis
  • Disease-modifying therapies (DMTs) have positively impacted the health and work productivity of individuals with multiple sclerosis (PwMS) in Sweden, leading to the study of their usage patterns.
  • A study analyzed DMT use trajectories among 1,395 PwMS starting treatment in 2014/2015 and found four distinct clusters of DMT usage, linking higher disability to some of these clusters.
  • Results indicated that PwMS on high-efficacy DMTs had a greater reduction in sickness absence and disability pension trends compared to those on lower-efficacy treatments, suggesting better outcomes for those starting high-efficacy therapies.
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Purpose: To explore the occurrence of work adjustments for people with multiple sclerosis (MS) across types of occupations (managerial, office, and manual workers).

Methods: All working-aged (20-50 years) residents in Sweden diagnosed with MS were invited to participate in a web-based survey in 2021. Responses were linked to individual-level nationwide registers.

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Gender differences in earnings exist worldwide. Gender segregation or familial status have been previously stated as possible explanations for these differences as well as health differences between women and men. Women are diagnosed with multiple sclerosis (MS) as twice much as men.

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Background And Objectives: Studies associate chronic kidney disease (CKD) with neurodegeneration. This study investigated the relationship between kidney function, blood, CSF, and structural brain MRI markers of neurodegeneration in a sample including individuals with and without CKD.

Methods: Participants from the Gothenburg H70 Birth Cohort Study, with data on plasma neurofilament light (P-NfL), estimated glomerular filtration rate (eGFR), and structural brain MRI were included.

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Article Synopsis
  • Multiple sclerosis (MS) significantly affects various life domains for people with MS (PwMS), impacting their work, family life, leisure activities, and friendships.
  • A survey of 4,052 working-age PwMS in Sweden revealed that about one-third reported no restrictions, while the rest experienced moderate to severe limitations, often due to fatigue.
  • Predictors of these restrictions included factors like age, sex, education, and type of MS, highlighting that even those with low disability levels can face challenges in daily life due to invisible symptoms.
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Background: There is limited information on the trajectories of disease-modifying therapy (DMT) use and their association with sickness absence and/or disability pension (SADP) among people with multiple sclerosis (PwMS). The objective of the study was to identify trajectories of DMT use over 10 years among PwMS, identify sociodemographic and clinical factors associated with the trajectories, and to assess the association between identified trajectories and SADP days.

Methods: A longitudinal register-based study was conducted, on a prospective data set linked across six nationwide registers, assessing treatment courses of PwMS with DMTs for the 10 years following multiple sclerosis (MS) onset.

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Background And Objective: Population-based estimates of the socioeconomic burden of multiple sclerosis (MS) are limited, especially regarding primary healthcare. This study aimed to estimate the excess costs of people with MS that could be attributed to their MS, including primary healthcare.

Methods: An observational study was conducted of the 2806 working-aged people with MS in Stockholm, Sweden and 28,060 propensity score matched references without MS.

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Background And Objectives: Several pathologic processes might contribute to the degeneration of the cholinergic system in aging. We aimed to determine the contribution of amyloid, tau, and cerebrovascular biomarkers toward the degeneration of cholinergic white matter (WM) projections in cognitively unimpaired individuals.

Methods: The contribution of amyloid and tau pathology was assessed through CSF levels of the Aβ ratio and phosphorylated tau (p-tau).

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Article Synopsis
  • The study investigates how multiple sclerosis (MS) affects work-related outcomes like sickness absence (SA) and disability pension (DP) across different types of employment, focusing on self-employed versus employed individuals.
  • Conducted over six years with a cohort of nearly 3,000 PwMS and over 13,000 matched references without MS, the research reveals that PwMS have significantly higher rates of SA and DP compared to those without MS, regardless of their employment status.
  • The findings show that self-employed individuals without MS experience lower SA levels than employed ones, while self-employed and employed PwMS have similar SA rates, highlighting a limited transition from employment to self-employment among individuals newly diagnosed with MS.
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Neurofilament light protein (NfL) in cerebrospinal fluid (CSF) and plasma (P) are suggested to be interchangeable markers of neurodegeneration. However, evidence is scarce from community-based samples. NfL was examined in a small-scale sample of 287 individuals from the Gothenburg H70 Birth cohort 1944 study, using linear models in relation to CSF and magnetic resonance imaging (MRI) biomarker evidence of neurodegeneration.

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Background: Multiple sclerosis (MS) can impact working life, sickness absence (SA) and disability pension (DP). Different types of occupations involve different demands, which may be associated with trajectories of SA/DP among people with MS (PwMS).

Objectives: To explore, among PwMS and references, if SA/DP differ according to type of occupation.

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Objective: Cognitive impairment is a key element in most mental disorders. Its objective assessment at initial patient contact in primary care can lead to better adjusted and timely care with personalised treatment and recovery. To enable this, we designed the Mindmore self-administrative cognitive screening battery.

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Introduction: As cerebrospinal fluid (CSF) neurofilament light protein (NfL) and the CSF/serum albumin ratio (Q) are used in the clinical routine, the impact of demographic factors on these biomarkers is important to understand.

Methods: Participants were derived from two Swedish samples: the population-based H70 Study (n = 308, age 70) and a clinical routine cohort (CSF NfL, n = 8995, Q, n = 39252, age 0 to 95). In the population-based study, Q and NfL were examined in relation to sex, cardiovascular risk factors, and cerebral white matter lesions (WMLs).

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The association between cerebrospinal fluid (CSF) amyloid beta (Aβ) Aβ38 or Aβ40 and brain grey- and white matter integrity is poorly understood. We studied this in 213 cognitively normal 70-year-olds, and in subgroups defined by presence/absence of the APOE ε4 allele and Aβ pathology: Aβ-/APOE-, Aβ+/APOE-, Aβ-/APOE+ and Aβ+/APOE+. CSF Aβ was quantified using ELISA and genotyping for APOE was performed.

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Background: The heterogeneity within Alzheimer's disease (AD) seriously challenges the development of disease-modifying treatments. We investigated volume of the basal forebrain, hippocampus, and precuneus in atrophy subtypes of AD and explored the relevance of subtype stratification in a small clinical trial on encapsulated cell biodelivery (ECB) of nerve growth factor (NGF) to the basal forebrain.

Methods: Structural MRI data was collected for 90 amyloid-positive patients and 69 amyloid-negative healthy controls at baseline, 6-, 12-, and 24-month follow-up.

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Different measurements of white matter signal abnormalities (WMSA) are often used across studies, which hinders combination of WMSA data from different cohorts. We investigated associations between three commonly used measurements of WMSA, aiming to further understand the association between them and their potential interchangeability: the Fazekas scale, the lesion segmentation tool (LST), and FreeSurfer. We also aimed at proposing cut-off values for estimating low and high Fazekas scale WMSA burden from LST and FreeSurfer WMSA, to facilitate clinical use and interpretation of LST and FreeSurfer WMSA data.

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The purpose of this study was to compare a new digitized cognitive test battery, Minnemera, with its correspondent traditional paper-based cognitive tests. Eighty-one healthy adults between the ages of 21 and 85 participated in the study. Participants performed the two different test versions (traditional paper-based and digitized) with an interval of four weeks between the tests.

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Subjective cognitive complaints in cognitively normal individuals are a relevant predictor of Alzheimer's disease (AD), cerebrovascular disease, and age-related tauopathy. Complaints starting after the age of 60 increase the likelihood of preclinical AD. However, this criterion is arbitrary and current data show that neurodegenerative disorders likely start before that age.

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To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases.

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Cognitive aging is highly complex. We applied a data-driven statistical method to investigate aging from a hierarchical, multidimensional, and multivariate approach. Orthogonal partial least squares to latent structures and hierarchical models were applied for the first time in a study of cognitive aging.

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