Stay Positive

"In the midst of winter I finally learned that there was in me an invincible summer." - Alert Camus

Monday, July 30, 2012

Pain: Can pain-free be drug-free? - Health - redOrbit

Medications aren't always the answer to pain relief.

Alternative methods have been used for generations - some with success, some not. As with any treatment, you should discuss this with your doctor. Many physicians incorporate alternative therapies with traditional medicine to find the best solutions for their patients.

If the pain is stress related, like many headaches and some backaches, some people may find stress relief from:
  • relaxation techniques
  • biofeedback
  • aromatherapy
  • massages
Other alternative therapies may also provide relief. These include:
  • chiropractic
  • acupuncture
There is nothing wrong with needing pain relief - it shows that you care for your health and well-being. In fact, if short-term pain is left untreated, it could worsen or progress to long-term pain. Make sure you ask your health care provider for a therapy that is best suited to you.

Pain: Can pain-free be drug-free? - Health - redOrbit

Wednesday, July 25, 2012

Mihaly Csikszentmihalyi Flow Thinking Allowed

Pronounced "chicks send me high" according to the Professor! lecture presented by Professor Mihaly Csikszentmihalyi

Mihaly Csikszentmihalyi Flow Thinking Allowed - YouTube

Mihaly Csikszentmihalyi: Flow, the secret to happiness | Video on

 Mihaly Csikszentmihalyi: Flow, the secret to happiness | Video on Mihaly Csikszentmihalyi has contributed pioneering work to our understanding of happiness, creativity, human fulfillment and the notion of "flow" -- a state of heightened focus and immersion in activities such as art, play and work.

Why you should listen to him:

Mihaly Csikszentmihalyi says creativity is a central source of meaning in our lives. A leading researcher in positive psychology, he has devoted his life to studying what makes people truly happy: "When we are involved in [creativity], we feel that we are living more fully than during the rest of life." He is the architect of the notion of "flow" -- the creative moment when a person is completely involved in an activity for its own sake. Csikszentmihalyi teaches psychology and management at Claremont Graduate University, focusing on human strengths such as optimism, motivation and responsibility. He's the director the the Quality of Life Research Center there. He has written numerous books and papers about the search for joy and fulfillment.
"A man obsessed by happiness."
Richard Flaste, New York Times  

Quotes by Mihaly Csikszentmihalyi

Tuesday, July 24, 2012

Sky News: Vitamins may reduce cancer risk

Don't forget your Vitamin 'D'

Vitamins may reduce cancer risk
Updated: 12:55, Tuesday July 24, 2012

Eating food which contain vitamins C, E and selenium could reduce the risk of pancreatic cancer.

People who have larger amounts of the antioxidants are 67 per cent less likely to develop the disease than those who take in lower amounts, according to scientists at Britain's University of East Anglia.

Researchers suggest that if the link turns out to be causal, one in 12 cases of pancreatic cancer might be prevented.

The study, published online in the journal Gut, examined data from almost 24,000 men and women aged between 40 and 74.

The participants, who were taking part in the Norfolk branch of the European Prospective Investigation of Cancer (EPIC) study, completed comprehensive food diaries for seven days.

Researchers examined the nutrient intakes of those who were diagnosed with pancreatic cancer and those of almost 4,000 controls using a specially diagnosed computer program.

Within 10 years of entering the study 49 people developed pancreatic cancer. On average, the patients survived five months after diagnosis.

Researchers found that for those who took the highest amount of selenium in a week - within the top 25 per cent - their risk of pancreatic cancer was halved compared with those whose intake was in the bottom 25 per cent.

And those whose vitamins C, E, and selenium intake was in the top 25 per cent of consumption were 67 per cent less likely to develop pancreatic cancer than those who were in the bottom 25 per cent.

If a causal association is confirmed by reporting consistent findings from other epidemiological studies, then population based dietary recommendations may help to prevent pancreatic cancer, the authors said.

Selenium is present in cereals, nuts, fish and meat. Vitamin E can be found in vegetable oils, nuts, seeds, margarine and egg yolk and vitamin C is in fruits and vegetables.

Researchers say that other trials using antioxidant supplements have not produced such encouraging results, but this may be because food sources of these nutrients may behave differently from those found in supplements.

Pancreatic cancer and it is the sixth commonest cause of cancer death.

Survival rates are the worst for any tumour. Only one in six patients survive beyond one year.

Genes, smoking and type 2 diabetes are all risk factors, but diet is also thought to have a role.


Sky News: Vitamins may reduce cancer risk

Sky News: MS, Parkinson's 'supplements' concern

 Caveat Emptor when it comes to brilliant new solutions to the M.S. problem

MS, Parkinson's 'supplements' concern
Updated: 23:04, Tuesday July 24, 2012

Parkinson's disease and multiple sclerosis (MS) sufferers are being targeted by companies claiming colostrum from cows can alleviate their symptoms, despite a lack of scientific evidence.

The products are available to buy over the internet and are accompanied by testimonials from people with multiple sclerosis and Parkinson's disease who claim the supplements have relieved their symptoms, including reducing tremors and tiredness.

A New Zealand company behind some of the supplements, New Image, sells its products, including powders and capsules, through direct marketing.

Sufferers have also been targeted by an advertisement featuring a testimonial in an Australian seniors' newspaper, which was found to breach sections of the Therapeutic Goods Act and Advertising Code, for an unnamed bovine colostrum product.

Bovine colostrum, like human colostrum, is a form of milk produced at the end of pregnancy which contains antibodies to protect newborns against disease.

Several websites promoting bovine colostrum-containing supplements from New Zealand claimed the products worked by stimulating adult stem cell production to repair parts of the body affected by degenerative disease.

A leading Australian stem cell expert said this would be impossible.

Professor Martin Pera from Stem Cells Australia and the University of Melbourne said bovine colostrum would probably be digested and broken down by the body before it could enter the bloodstream, let alone spur production of stem cells.

He said unless people were allergic to it, taking bovine colostrum would probably not cause any harm, but it would not do any good either.

'I'm not aware of any scientific evidence that colostrum is useful in any of those conditions (Parkinson's and multiple sclerosis),' Prof Pera told AAP.

Royal Melbourne Hospital neurologist Dr Anneke Van Der Walt, who treats MS sufferers, said the products targeted vulnerable people.

'It is of concern that there are these websites that advertise products as if they have proven benefits for people with multiple sclerosis or other neurological diseases,' she told AAP.

'For the lay person, the information is often hard to verify as correct and it creates a false sense of hope that there's a miracle natural therapy.

'Therapies can only be applied to everyone with a particular disease when they have been trialled in a randomised control study.'

Medical experts who spoke to AAP could only point to one study, in 1987, that was a randomised control study of colostrum in MS patients. The results were negative.

An emailed statement from New Image, whose products are featured on independent sellers' websites along with the testimonials, conceded there was a lack of hard evidence supporting the effects of colostrum on MS and Parkinson's.

The statement, attributed to Research and Development general manager Peter Lehrke said the colostrum supplements were not designed to treat disease, but to support a healthy gut and immune system.

Parkinson's Victoria chief executive Ann Burgess said the organisation was familiar with the products and had 'great concerns'.

She said Parkinson's sufferers, their family and carers should focus on evidence-based treatments.

An MS Australia spokesperson said the organisation made the same evidence-based recommendations to their members.


Sky News: MS, Parkinson's 'supplements' concern

MS Society of Canada - Living with MS - MS Updates

Living with Multiple Sclerosis

Phase II trial shows promising results for Masitinib for progressive multiple sclerosis

MS Update

July 23, 2012


Results from a randomized, placebo-controlled, Phase II trial investigating the safety and efficacy of Masitinib, a selective oral tyrosine kinase inhibitor, for treatment of progressive MS were published in BMC Neurology and indicate a promising area of treatment for progressive MS. [Vermersch P, Benrabah R, Schmidt N, Zéphir H, Clavelou P, Vongsouthi C, Dubreuil P, Moussy A, Hermine O. BMC Neurol. 2012 Jun 12;12(1):36. Epub ahead of print]


Mast cells (immune cells that mediate inflammatory response) are implicated in the pathology of MS because of their ability to sustain CNS inflammation. Previous animal model studies have demonstrated that Masitinib, a selective oral tyrosine kinase inhibitor can effectively inhibit the survival and activity of mast cells. Thirty-five individuals with primary progressive MS and relapse-free secondary progressive MS were randomly selected to receive Masitinib orally at 3 to 6 mg/kg/day or placebo for at least 12 months to evaluate change as compared with baseline in the multiple sclerosis functional composite score (MSFC). An improvement on MSFC scores was observed in MS-related impairment in the Masitinib group as compared with those who received placebo.

Although Masitinib was generally well tolerated the most common side effects experienced included weakness, rash, nausea, edema (swelling), and diarrhea.

This study suggests that Masitinib may be of therapeutic benefit to individuals with primary progressive and relapse-free secondary progressive MS however further evidence from larger placebo controlled trials are warranted.

MSFC source: National MS Society (USA)
Disponible en français.
National Research and Programs

The Multiple Sclerosis Society of Canada is an independent, voluntary health agency and does not approve, endorse or recommend any specific product or therapy, but provides information to assist individuals in making their own decisions.

MS Society of Canada - Living with MS - MS Updates

Monday, July 23, 2012

FDA warns about seizures with MS drug Ampyra | Reuters

Having talked about this drug a number of posts back in hopeful terms, it is a important to follow-up with a caution delivered by the FDA. 

My local pharmacy was unable to fill my prescription for this drug last week.  Maybe it was good luck until we see what develops with the seizure risk.  Remember Viox?*...

WASHINGTON | Mon Jul 23, 2012 1:09pm EDT

(Reuters) - The U.S. Food and Drug Administration has issued a warning to patients and physicians about the increased risk of seizures in multiple sclerosis patients taking the drug Ampyra.

The drug was developed by Acorda Therapeutics Inc to improve walking ability in patients with multiple sclerosis. Biogen Idec Inc has rights to the drug in Europe where it is sold under the brand name Fampyra.

The FDA said that based on reports, it recently evaluated seizure risk in MS patients taking Ampyra and noted that the majority of seizures happened within days to weeks after starting the recommended dose and occurred in patients with no history of seizures.

Seizures are a known risk with Ampyra, the agency said, and the risk increases with higher blood levels of the drug. Since Ampyra is eliminated from the kidneys, patients with kidney impairment may develop higher blood levels of the drug, thus increasing their seizure risk, the FDA said.

As a result, the agency is updating the prescribing information for physicians, making clear that a patient's kidney function should be checked before starting Ampyra. Patients should be monitored at least once a year while the treatment continues.

In addition, patients who miss a dose should not take extra doses as an extra dose can increase seizure risk, the agency said.

The drug was approved in the United States in January 2010. Biogen received conditional approval for drug in Europe last July. Conditional approval is granted to drugs in which the benefit is seen to outweigh the risk but where additional information is needed to confirm that view.

As part of the conditions of approval, regulators recommended Biogen carry out an additional study to discover more about the drug's benefits and safety over the long term.

Biogen's shares fell 2.7 percent to $138.38 in afternoon trading on Nasdaq. Acorda's shares fell 1.2 percent to $24.73.

  • Acorda Therapeutics IncACOR.O
  • Biogen Idec IncBIIB.O

(Additional reporting by Anna Yukhananov; Editing by Maureen Bavdek)

FDA warns about seizures with MS drug Ampyra | Reuters

*Merck yanked Vioxx on Sept. 30 because a new study had found a higher rate of heart attacks and strokes in patients taking the drug than in those on a placebo.

Vitamin 'D'

Continued reports this week from the European Neurological Society (ENS) by Dr. Daniel M. Keller, PhD held in Prague, Czech Republic said that “Low vitamin D levels in patients with clinically isolated syndromes (CIS) predict a near-term conversion to clinically definite multiple sclerosis (CDMS).

Dr. Keller stated “Various studies show a geographical gradient of MS prevalence, with higher prevalence in regions farther from the equator, and the intensity of sun exposure is less in these regions.”

Dr. Xavier Montalban, MD, PhD, chairman of the Department of Neurology and director of the Multiple Sclerosis Center of Catalonia at Vall d'Hebron University Hospital and professor of neurology at the Autonomous University of Barcelona in Barcelona, Spain, who was not involved in the study, commented to Medscape Medical News that it is becoming increasingly clear that vitamin D plays a role in the genesis or evolution of MS.
 It still remains to be seen whether or not the medical community will recommend vitamin D supplements to the world at large, but it is clear more study is needed.

Dr. Montalban said "The prevalence of MS has doubled in the past 50 years, so apart from vitamin D, which is important, there are other factors that escape our knowledge."

Vitamin D deficiency contributes to progression of CIS to clinically definite MS - Orlando multiple sclerosis |

Venus Williams - Vegan

Tennis star Venus Williams, who recently won the 2012 Wimbledon women's doubles title with her sister Serena, has been following a raw vegan diet since being diagnosed with Sjogren's syndrome last fall.

Sjogren's syndrome is an autoimmune disease that causes fatigue and joint pain and affects some 4 million Americans. There is no cure.

Venus, 32, dramatically overhauled her diet to deal with the chronic fatigue caused by her condition.

"Changing my diet has made a big difference," Williams told CBS News on July 9, 2012. "I'm not perfect, so I forgive myself when I make mistakes [with my vegan diet]. I do a lot of juicing as well, a lot of wheat grass shots...lots of fresh juices and things like that."

Venus, who pulled out of the 2011 U.S. Open after being diagnosed with Sjogren's, says the disease affects her entire body.

"Dry eyes and dry mouth are the hallmark symptoms, but fatigue can be so heavy that sitting in a chair is a huge effort," she says. "So, as a professional athlete, if you have fatigue, then that's tough. You can also have joint pain...issues with your internal systems."

Being constantly exhausted is a major challenge for Williams, but her condition has been improving since she became a vegan.

"I've made huge improvements since I was first diagnosed, so that has been huge for me, and it's a journey that I continue on," she says.

Click here to find out more!

, Celebrity Fitness and Health Examiner

Samantha Chang is the executive editor and co-owner of, an arts and entertainment website in New York City. A graduate of the University of Pennsylvania, Samantha is a former financial journalist who enjoys running, cycling and music. Contact her at

 By Smantha Chamng
Tennis ace Venus Williams became a raw vegan after autoimmune disease diagnosis - National Celebrity Fitness and Health |

Saturday, July 21, 2012

Psychological stress and the subsequent appearance... [Neurology. 2000] - PubMed - NCBI

Neurology. 2000 Jul 12;55(1):55-61.

Psychological stress and the subsequent appearance of new brain MRI lesions in MS.


University of California at San Francisco, CA 94115-1642, USA.



To examine the relationship between stressful life events and psychological distress, and the subsequent development of gadolinium-enhancing (Gd+) brain lesions.


It has long been speculated that stressful life events and psychological distress are associated with disease exacerbation in MS. This is the first prospective longitudinal study of the relationship between stressful life events, psychological distress, and disease activity as measured by Gd+ brain MRI.


Thirty-six patients (mean age, 44.4 years; 22 women, 14 men) with relapsing forms of MS were assessed once every 4 weeks for 28 to 100 weeks. Assessments included Gd+ MRI, the Social Readjustment Rating Scale (SRRS), the Hassles Scale, and the Profile of Mood States. The SRRS was altered in the following manner: 1) three items that confounded with MS were eliminated, 2) endorsed items were rated for intensity, and 3) the scale was divided into three subscales: major negative events, conflict and disruption in routine, and positive life events. Data were analyzed using mixed-effects logistic regression to account for intrasubject correlations. Stress and distress measures were used to predict concurrent and future MRI activity.


For the total sample of patients, increased conflict and disruption in routine was followed by increased odds of developing new Gd+ brain lesions 8 weeks later (odds ratio, 1.64; p = 0.00083). There was no strong evidence of a relationship between psychological stress or distress and clinical exacerbation.


These data provide support for the notion that conflict and disruption in routine are related to subsequent disease activity in MS. However, this relationship is not sufficiently robust to predict clinical exacerbations reliably in individual patients.

[PubMed - indexed for MEDLINE]

LinkOut - more resources

Psychological stress and the subsequent appearance... [Neurology. 2000] - PubMed - NCBI

Stress Reduction Therapy Prevents M.S. Brain Lesions : Northwestern University Newscenter

This is the news release reported in Psych Central...  being the first study to produce these results means waiting for more studies before full acceptance.  But every line of defense needs to be considered when you are trying to manage your symptoms and maintain your health.  Being proactive feels good when your doctor is puzzled by what to do to help you...

Stress Reduction Therapy Prevents M.S. Brain Lesions

First study to show stress counseling stops brain lesions in multiple sclerosis patients
By Marla Paul
CHICAGO --- A weekly stress management program for patients with multiple sclerosis (M.S.) prevented the development of new brain lesions, a marker of the disease’s activity in the brain, according to new Northwestern Medicine research.

Brain lesions in M.S. often precede flare-ups of symptoms such as loss of vision or use of limbs or pain.

“This is the first time counseling or psychotherapy has been shown to affect the development of new brain lesions,” said David Mohr, principal investigator of the study and professor of preventive medicine at Northwestern University Feinberg School of Medicine.

“In M.S., the prevention of new brain lesions is an important marker used to judge how effective medications are.”

“The new finding is an important step and the strongest evidence we have to date that stress is involved in M.S.,” Mohr added.

The results indicate that stress management therapy may be a useful adjunct treatment with drug therapy for M.S., but a larger clinical trial is needed to confirm this, Mohr said.

The study is published in the July 11, 2012 issue of Neurology®, the medical journal of the American Academy of Neurology. 

Mohr’s previous research showed a connection between psychological distress and the development of new brain lesions. 

Stress is one of many factors, he said, that influence whether the underlying M.S. disease processes escalate to the point of a new lesion or a relapse. 

Mohr has spent more than a decade studying the link between emotional distress, including a study on depression, and M.S.

For an event to be stressful, a person has to feel it is a threat to something important, and that he or she doesn’t have any control over it. 

“We taught patients strategies to evaluate how much of a threat something truly is,” Mohr said. “When people overestimate the threat of an event or underestimate their ability to manage it, we teach them how to evaluate their own thinking about the stress and how to challenge and change that thinking to a more realistic and helpful appraisal of the actual threat. That often leads to improved ability to manage stressful events.”

Patients also were taught how to calm their physical reactions to stress through relaxation and meditation to cope with stressful events that couldn’t be avoided.

 The article gets technical at this point:

In the national clinical trial, 121 patients were randomized to receive stress management therapy for M.S. or be in a control group. Those in the therapy group received 16 sessions over a 24-week period during which they were taught coping skills to enhance their ability to prevent stressful events from occurring and to improve their capacity to manage their responses to stressful events that did arise. They also received a 24-week post-treatment follow-up. Two-thirds of the patients were women, who have a higher incidence of M.S.

MRI neuroimaging showed the stress management therapy reduced two types of new brain lesions common in multiple sclerosis.

The first type, gadolinium-enhancing brain lesions, indicates a breakdown of the blood-brain barrier, allowing the immune system access to attack and damage brain cells. Gadolinium is injected into an M.S. patient during the MRI and can be observed passing through the blood-brain barrier, if these types of lesions are present. These lesions may disappear over time or may leave more permanent damage in the brain.

The second type, a T2 brain lesion, is a more global marker of the effect of M.S. on the brain and is a more permanent lesion. These markers are commonly used in evaluating M.S. medications in Phase II trials. If the lesions are decreased, the implication is the drug is working.

Among patients who received stress management therapy, 55 percent had a new gadolinium-enhancing brain lesion during the treatment period, compared to 77 percent of those in the control group. Similarly, 43 percent receiving stress management therapy had a new T2 brain lesion during the treatment period, compared to 70 percent in the control group. The stress reduction prevented new lesions whether or not the patients were taking M.S. disease-modifying medications (e.g., beta-interferons or glatiramer acetate).

  Unforeseen Problem:

But the improvement in brain lesions didn’t last after the stress management program ended. 

 Possible Solution:

“This suggests that we will need to develop treatments that are more sustainable over longer periods of time,” Mohr said. “It’s difficult for people to come in for treatment once a week over long periods of time, due both to cost and time constraints. We are looking at telemedicine programs that can be delivered via a computer or a smartphone to people in their environment at much lower costs than traditional therapy.”

More work to do:

The study did not show a statistical difference in the rate of clinical M.S. symptoms, but Mohr said he didn’t expect one in such a small number of participants. 

The outcome goal of this trial was only to see if the stress reduction affected the brain lesions.

While the results are positive, Mohr said, it’s premature to make recommendations for patients regarding use of stress management therapy.

“I don’t want to see patients decide not to take their medication and use this instead,” he emphasized.    

Mohr has written stress management treatment manuals for patients and therapists published by Oxford Press.

Northwestern coauthors include Bruce Cohen and Juned Siddique.

The study was supported by the National Institute of Child Health & Human Development of the National Institutes of Health grant R01-HD043323.

Marla Paul is the health sciences editor. Contact her at

Stress Reduction Therapy Prevents M.S. Brain Lesions : Northwestern University Newscenter

Stress - Mihaly Csikszentmihalyi

Stress is a killer when it comes to making  m.s. symptoms worse and possibly hastening the progression of the disease.

"Patients with multiple sclerosis who receive stress management training experience less new disease activity, according to a study published in Neurology."


People who learn to control inner experience will be able to determine the quality of their lives, which is as close as any of us can come to being happy.

   - Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1990

People without an internalized symbolic system can all too easily become captives of the media.

  - Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1990

Pleasure is an important component of the quality of life, but by itself it does not bring happiness.  Pleasure helps to maintain order, but by itself cannot create a new order in consciousness.
  -  Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1990

Repression is not the way to virtue. When people restrain themselves out of fear, their lives are by necessity diminished. Only through freely chosen discipline can life be enjoyed and still kept within the bounds of reason.

- Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1990

The solution is to gradually become free of societal rewards and learn how to substitute for them rewards that are under one's own powers. This is not to say that we should abandon every goal endorsed by society; rather, it means that, in addition to or instead of the goals others use to bribe us with, we develop a set of our own.

 -  Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1990

There are two main strategies we can adopt to improve the quality of life. The first is to try making external conditions match our goals. The second is to change how we experience external conditions to make them fit our goals better.

 - Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1990

Those who seek consolation in existing churches often pay for their peace of mind with a tacit
agreement to ignore a great deal of what is known about the way the world works.

  -Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1990


Stress Management Prevents Brain Lesions in Multiple Sclerosis | Psych Central News

 With  headlines saying interferon beta will not slow the progression of the disease (m.s.) the thoughtful thing is to look to a new line of defense against progression which may be offered by stress management techniques

"Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis"

Home » News » Stress News » Stress Management Prevents Brain Lesions in Multiple Sclerosis

Stress Management Prevents Brain Lesions in Multiple Sclerosis

By Traci Pedersen Associate News Editor
Reviewed by John M. Grohol, Psy.D. on July 15, 2012 
Stress Management Training Prevents New Brain Lesions in Multiple Sclerosis

Patients with multiple sclerosis who receive stress management training experience less new disease activity, according to a study published in Neurology.

Half of the 121 participants in the study received stress management training, which included meeting with a therapist for 16 individual 50-minute sessions over five to six months.

They learned problem-solving skills, relaxation techniques, and how to increase positive activities and enhance social support. They were also given the option to choose extra sessions on topics such as fatigue management, anxiety reduction, pain management and insomnia treatment.

After the treatment ended, the stress management group was followed for another five to six months. The remaining participants were put on a waiting list as a control group. After 10 months, they attended a five-hour workshop on stress management.

During the treatment period, 77 percent of those in the stress management training group had no new lesions, or brain damage that indicates disease activity, compared to 55 percent of those in the control group.

“The size of the effect is similar to other recent phase II trials of new drug therapies for MS,” said study author David C. Mohr, PhD, of Northwestern University Feinberg School of Medicine in Chicago.

“While it’s premature to make any specific recommendations about using this type of stress management training to manage MS disease activity, it will be important to conduct more research to identify specifically how this treatment is benefiting people with MS.”
Furthermore, questionnaires revealed that those receiving the training had greater reductions in their stress levels than did those in the control group.

Interestingly, the positive effects of the training did not continue after the treatment period.
“This was unexpected,” Mohr said. “It’s possible that people were not able to sustain their new coping skills once the support ended, or that some aspect of the treatment other than stress management skills, such as the social support, was the most beneficial part of the treatment.”

Source: Northwestern University

Stress Management Prevents Brain Lesions in Multiple Sclerosis | Psych Central News

Stress Reduction is a Key to managing M.S.

Meditation: A simple, fast way to reduce stress

Meditation can wipe away the day's stress, bringing with it inner peace. See how you can easily learn to practice meditation whenever you need it most.

If stress has you anxious, tense and worried, consider trying meditation. Spending even a few minutes in meditation can restore your calm and inner peace.

Anyone can practice meditation. It's simple and inexpensive, and it doesn't require any special equipment. And you can practice meditation wherever you are — whether you're out for a walk, riding the bus, waiting at the doctor's office or even in the middle of a difficult business meeting.

Understanding meditation

Meditation has been practiced for thousands of years. Meditation originally was meant to help deepen understanding of the sacred and mystical forces of life. These days, meditation is commonly used for relaxation and stress reduction.

Meditation is considered a type of mind-body complementary medicine. Meditation produces a deep state of relaxation and a tranquil mind. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. This process results in enhanced physical and emotional well-being.

Benefits of meditation

Meditation can give you a sense of calm, peace and balance that benefits both your emotional well-being and your overall health. And these benefits don't end when your meditation session ends. Meditation can help carry you more calmly through your day and can even improve certain medical conditions.

Meditation and emotional well-being

When you meditate, you clear away the information overload that builds up every day and contributes to your stress.
The emotional benefits of meditation include:
  • Gaining a new perspective on stressful situations
  • Building skills to manage your stress
  • Increasing self-awareness
  • Focusing on the present
  • Reducing negative emotions
Meditation and illness

Meditation also might be useful if you have a medical condition, especially one that may be worsened by stress. While a growing body of scientific research supports the health benefits of meditation, some researchers believe it's not yet possible to draw conclusions about the possible benefits of meditation.
With that in mind, some research suggests that meditation may help such conditions as:
  • Allergies
  • Anxiety disorders
  • Asthma
  • Binge eating
  • Cancer
  • Depression
  • Fatigue
  • Heart disease
  • High blood pressure
  • Pain
  • Sleep problems
  • Substance abuse
Be sure to talk to your health care provider about the pros and cons of using meditation if you have any of these conditions or other health problems. In some cases, meditation can worsen symptoms associated with certain mental health conditions. Meditation isn't a replacement for traditional medical treatment. But it may be a useful addition to your other treatment.

Types of meditation

Meditation is an umbrella term for the many ways to a relaxed state of being. There are many types of meditation and relaxation techniques that have meditation components. All share the same goal of achieving inner peace.
Ways to meditate can include:
  • Guided meditation. Sometimes called guided imagery or visualization, with this method of meditation you form mental images of places or situations you find relaxing. You try to use as many senses as possible, such as smells, sights, sounds and textures. You may be led through this process by a guide or teacher.
  • Mantra meditation. In this type of meditation, you silently repeat a calming word, thought or phrase to prevent distracting thoughts.
  • Mindfulness meditation. This type of meditation is based on being mindful, or having an increased awareness and acceptance of living in the present moment. You broaden your conscious awareness. You focus on what you experience during meditation, such as the flow of your breath. You can observe your thoughts and emotions but let them pass without judgment.
  • Qi gong. This practice generally combines meditation, relaxation, physical movement and breathing exercises to restore and maintain balance. Qi gong (CHEE-gung) is part of traditional Chinese medicine.
  • Tai chi. This is a form of gentle Chinese martial arts. In tai chi (TIE-chee), you perform a self-paced series of postures or movements in a slow, graceful manner while practicing deep breathing.
  • Transcendental meditation. You use a mantra, such as a word, sound or phrase repeatedly silently, to narrow your conscious awareness and eliminate all thoughts from your mind. You focus exclusively on your mantra to achieve a state of perfect stillness and consciousness.
  • Yoga. You perform a series of postures and controlled breathing exercises to promote a more flexible body and a calm mind. As you move through poses that require balance and concentration, you're encouraged to focus less on your busy day and more on the moment.

Elements of meditation

Different types of meditation may include different features to help you meditate. These may vary depending on whose guidance you follow or who's teaching a class. Some of the most common features in meditation include:
  • Focused attention. Focusing your attention is generally one of the most important elements of meditation. Focusing your attention is what helps free your mind from the many distractions that cause stress and worry. You can focus your attention on such things as a specific object, an image, a mantra, or even your breathing.
  • Relaxed breathing. This technique involves deep, even-paced breathing using the diaphragm muscle to expand your lungs. The purpose is to slow your breathing, take in more oxygen, and reduce the use of shoulder, neck and upper chest muscles while breathing so that you breathe more efficiently.
  • A quiet setting. If you're a beginner, practicing meditation may be easier if you're in a quiet spot with few distractions — no television, radios or cellphones. As you get more skilled at meditation, you may be able to do it anywhere, especially in high-stress situations where you benefit the most from meditation, such as a traffic jam, a stressful work meeting or a long line at the grocery store.
  • A comfortable position. You can practice meditation whether you're sitting, lying down, walking or in other positions or activities. Just try to be comfortable so that you can get the most out of your meditation.

Everyday ways to practice meditation

Don't let the thought of meditating the "right" way add to your stress. Sure, you can attend special meditation centers or group classes led by trained instructors. But you also can practice meditation easily on your own.
And you can make meditation as formal or informal as you like — whatever suits your lifestyle and situation. Some people build meditation into their daily routine. For example, they may start and end each day with an hour of meditation. But all you really need is a few minutes of quality time for meditation.
Here are some ways you can practice meditation on your own, whenever you choose:
  • Breathe deeply. This technique is good for beginners because breathing is a natural function. Focus all attention on your breathing. Concentrate on feeling and listening as you inhale and exhale through your nostrils. Breathe deeply and slowly. When your attention wanders, gently return your focus to your breathing.
  • Scan your body. When using this technique, focus attention on different parts of your body. Become aware of your body's various sensations, whether that's pain, tension, warmth or relaxation. Combine body scanning with breathing exercises and imagine breathing heat or relaxation into and out of different parts of your body.
  • Repeat a mantra. You can create your own mantra, whether it's religious or secular. Examples of religious mantras include the Jesus Prayer in the Christian tradition, the holy name of God in Judaism, or the om mantra of Hinduism, Buddhism and other Eastern religions.
  • Walk and meditate. Combining a walk with meditation is an efficient and healthy way to relax. You can use this technique anywhere you're walking — in a tranquil forest, on a city sidewalk or at the mall. When you use this method, slow down the pace of walking so that you can focus on each movement of your legs or feet. Don't focus on a particular destination. Concentrate on your legs and feet, repeating action words in your mind such as lifting, moving and placing as you lift each foot, move your leg forward and place your foot on the ground.
  • Engage in prayer. Prayer is the best known and most widely practiced example of meditation. Spoken and written prayers are found in most faith traditions. You can pray using your own words or read prayers written by others. Check the self-help or 12-step-recovery section of your local bookstore for examples. Talk with your rabbi, priest, pastor or other spiritual leader about resources.
  • Read and reflect. Many people report that they benefit from reading poems or sacred texts, and taking a few moments to quietly reflect on their meaning. You also can listen to sacred music, spoken words or any music you find relaxing or inspiring. You may want to write your reflections in a journal or discuss them with a friend or spiritual leader.
  • Focus your love and gratitude. In this type of meditation, you focus your attention on a sacred object or being, weaving feelings of love and gratitude into your thoughts. You can also close your eyes and use your imagination or gaze at representations of the object.

Building your meditation skills

Don't judge your meditation skills, which may only increase your stress. Meditation takes practice. Keep in mind, for instance, that it's common for your mind to wander during meditation, no matter how long you've been practicing meditation. If you're meditating to calm your mind and your attention wanders, slowly return to the object, sensation or movement you're focusing on.
Experiment, and you'll likely find out what types of meditation work best for you and what you enjoy doing. Adapt meditation to your needs at the moment. Remember, there's no right way or wrong way to meditate. What matters is that meditation helps you with stress reduction and feeling better overall.

Meditation: Take a stress-reduction break wherever you are -

By Mayo Clinic staff

Blogger: The Mindful Gorilla - Edit post

Friday, July 20, 2012

Research Skills - Evaluating Sources

Evaluation of sources using CARRDS

Author? Credentials? Affiliations? Experience?  What evidence is offer of author's knowledge?

 Can facts, statistics or other information be verified through other sources?
Do there appear to be errors on the page, i.e., spelling, grammar. facts?

 The extent to which a source gives the same information as other sources
Does the source present a particular view or bias?
Is the information affiliated with an organization that has a particular political or social agenda?

 The relationship to focused topic or question
Does the information directly support the thesis or help to answer the question?
Can it be eliminated or ignored because it simply does not help?

 Does the report need current up to date information?
When was this web page created?  When was it last updated?

 Is the information based on primary or secondary resources?
Did the author document sources?
What kind of links or further reading did the author choose?

Scope and Purpose - The range of information a given topic and the reason behind its creation
Does the source addressthe thesis in a comprehensive or peripheral way?
Is it material that can easily be read and understood?

These questions should be posed each time a research source is considered.

The suffix identifies who the source of information is and therefore what their purpose in conveying information might be.

.ac or .edu for an educational institution
.com for a commercial site

.biz a business that could be trying to sell a product or service


 WWW.LIBRARY VIDEO.COM offers a model for explaining research skills and information literacy  he quality information checklist offers eight entertaining strategies for website evaluation  Springfield township virtual library catalogues, strategies, procedures and detailed examples for completing a research project.

Suggested Print Sources

 Spagenburg, Ray and Kit Moser. Savvy Surfing on the Internet: Searching and EvaluatingWeb Sites  Enslow Publishers Berkley hts, NJ

Valenza, Joyce Kasman.  Power Research Tools: Learning Activities and Posters.  American Library Assoc. Chicago

Wolinsky, Art Internet Power Research Using the Big6 pproach.  Enslow Pub. NJ

Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Reported In:

 The Journal of the American Medical Association

Where you can read the entire study report:


Context  Interferon beta is widely prescribed to treat multiple sclerosis (MS); however, its relationship with disability progression has yet to be established.

Objective  To investigate the association between interferon beta exposure and disability progression in patients with relapsing-remitting MS.


Among patients with relapsing-remitting MS, administration of interferon beta was not associated with a reduction in progression of disability, despite using a clinically relevant, important, and irreversible disability milestone as the main outcome. The lack of evidence for a strong association between interferon beta treatment and disability progression persisted whether a contemporary or a historical (pre–vs post–interferon beta era) untreated comparison cohort was considered, a secondary outcome (EDSS score of 4) was examined, or additional analyses were performed, including a propensity score–adjusted model ( eAppendix). The difference in the direction of the hazard of progression between the contemporary and historical approaches, which is informative for future studies, is of interest.

Previous postmarketing studies have suggested a positive association between interferon beta and MS disability outcomes.4 - 10 ,30 However, conducting adequately controlled longitudinal observational studies is challenging, and many such studies have faced methodological issues. One of the larger studies to date, from 2 Italian centers,10 was susceptible to immortal time bias13 ,15 because of differing baselines for the treated and untreated cohorts. The use of a propensity score method in that study10 could not address immortal time bias. An independent reanalysis found no apparent beneficial association with interferon beta treatment once this bias was considered.13 Another methodological issue included the use of a control group comprising individuals too ill to start interferon beta treatment (owing to significant comorbidities).10 Both of these issues could bias the study to show a treatment effect when one might not exist.12 - 13 Another relatively large Canadian study used patients as their own controls.5 This approach minimized some potential biases but may not have sufficiently acknowledged the variable and unpredictable individual progression profiles of MS patients.5 A sizable UK-based observational study was unable to demonstrate a beneficial association with the use of DMDs in relapsing-remitting MS after 2 years of treatment, finally concluding that further follow-up was needed.31

Our study endeavored to address these shortcomings. First, we considered interferon beta treatment as a time-dependent variable, thereby addressing immortal time bias13 ,15 and accounting for the changing treatment status of patients over time. Second, in the face of no single ideal comparison group, we adopted a dual approach, using both pre–and post–interferon beta era untreated cohorts. Third, we were able to access a large cohort of MS patients with a substantial follow-up and similar rates of disability assessment (thereby minimizing surveillance bias).32 Fourth, the unique health system in Canada allowed linkage between clinical and province-wide health administrative databases, creating a comprehensive and rich data source.

Our findings are also relevant for the design of future related observational studies; we found that patients eligible for interferon beta treatment in the interferon beta era but who chose not to start treatment had a non–statistically significant more favorable overall outcome compared with those who started treatment in the same era. This may be explained by “indication bias,” whereby patients whose clinical status is not improving or is getting worse are prescribed drug therapy.33 This potential bias was also apparent in a reanalysis of the Italian study,10 ,13 which used a contemporary (post–interferon beta era) comparison cohort, but was not evident in our pre–interferon beta era comparison, for which the historical control group did not have the same access to DMD treatment. This provides a possible explanation for the differences in the direction of the HRs in our contemporary and historical approaches and encourages the use of more than 1 control group in observational studies whenever possible.34 Our estimated HR was greater than 1 in the contemporary approach, which may reflect residual confounding by indication, despite the adjustments made.

The decision to start (or not start) treatment is complex, and likely not all factors are captured by observational studies—this can particularly affect any “contemporary” analysis based on a post–interferon beta era untreated comparison cohort. In a health care system with free access to DMDs, possible reasons for not starting a DMD might include stable disease, needle phobia, unwillingness to receive or adhere to a noncurative treatment, planned pregnancy, and personal or religious concerns about using interferon beta, a human albumin–containing product. In our study, the contemporary untreated cohort had a lower annualized relapse rate and longer disease duration but similar disability level (EDSS score) at baseline compared with the treated cohort. Although these factors were adjusted for, they could indicate a more favorable outcome; a low or moderate initial relapse frequency (1-3 relapses during the first 5 years after onset of symptoms) has been associated with a subsequent nonprogressive MS course.35

Our data suggest that the historical control group might be the more appropriate choice; however, it has its own limitations, including the possibility that factors other than drug treatment may have changed over time, such as patient care and management and rates of disease progression. However, strong evidence to suggest a change in disease progression over time was not found in relapsing-onset MS patients in British Columbia.36 Nonetheless, in the event that further studies become available, future meta-analyses of similar observational data may be of value.

Our findings, however, are consistent with the longer-term clinical trial–related studies. A 16-year follow-up of MS patients originally randomized to receive placebo or interferon beta treatment in a 2-year clinical trial was unable to show benefit in the treatment group in terms of progression to an EDSS score of 6 or secondary progressive MS.37 There were few deaths in the study, although an unexpected excess occurred in the original placebo group; findings were considered hypothesis generating by the authors, who cautioned that no survival benefit could be confirmed.37 In addition, no effect of interferon beta treatment on disability progression could be found in patients with clinically isolated syndrome (considered at high risk of developing MS).38 Some have tried to evaluate the impact of delayed vs early or higher vs lower cumulative exposure to interferon beta treatment through open-label extension studies, reporting better outcomes with early or higher cumulative exposure.39 - 40 However, dropouts and lack of blinding have confounded findings.41

We also found that the lower SES quintiles (vs the highest quintile) were associated with a higher hazard of disability progression, although these findings were not statistically significant. Socioeconomic status is a complex concept, reflecting more than just income, and a low SES is a strong determinant of poor overall health.42 We were unable to find another study examining the association between SES and MS disability progression. Given that there are relatively few predictors of MS disease progression, further investigation of potentially modifiable factors such as psychosocial, behavioral, or environmental pathways that may attenuate SES is warranted.

Our study also has some limitations. We considered interferon beta drugs as a single therapeutic class, although given the complexity of the differing approval dates and product switching, a robust comparison between products would be extremely challenging. We were not able to consider neutralizing antibodies—high titers have been associated (somewhat controversially) with reduced interferon beta effectiveness.43 Our study was not designed to examine adverse events associated with interferon beta treatment. Although we considered a broad range of confounders, unmeasured confounding is possible, as with any observational study. We could consider only patients attending a BCMS clinic. This primarily affects recruitment into the untreated cohorts (because of virtual complete capture of patients taking interferon beta for their MS during the study period). It is possible that very mild or very severe disease would prevent attendance at clinic, although systematic occurrence of one of these scenarios appears unlikely.

In addition, we considered 1 main and 1 secondary outcome; both were based on reaching irreversible disability milestones. Although these are clinically relevant and important outcomes, and our conservative definitions served to minimize assessment variation and random fluctuations that have impeded the measurement of disease progression in clinical trials,44 - 45 it remains possible that interferon beta treatment might positively affect other outcomes not considered here. The EDSS has recognized limitations46 ; however, it is the most widely used and internationally recognized disability assessment tool in MS, its use being ubiquitous in MS clinical trials and observational studies. Limitations relevant to the study EDSS end points include reliance on ability to walk and an inability to capture well the myriad MS symptoms (cognition; fatigue; bowel, bladder, or sexual function; visual acuity; or health-related quality of life). Also, despite the propensity score adjustment, residual confounding by indication could still be present, as suggested by the estimated HR of greater than 1 in the contemporary approach. Finally, we cannot rule out the possibility that despite our sample size, our study may have been underpowered to detect an association between interferon beta treatment and disease progression.

In conclusion, we did not find evidence that administration of interferon beta was associated with a reduction in disability progression in patients with relapsing-remitting MS. The ultimate goal of treatment for MS is to prevent or delay long-term disability. Our findings bring into question the routine use of interferon beta drugs to achieve this goal in MS. It is, however, possible that a subgroup of patients benefit from interferon beta treatment and that this association would not be discernable in our comprehensive “real-world” study. Further work is needed to identify these potential patients; perhaps through pharmacogenomic or biomarker studies, paving the way for a tailored, personalized medicine approach. Our findings also encourage the investigation of novel therapeutics for MS.



Corresponding Author: Helen Tremlett, PhD, Division of Neurology, Department of Medicine, University of British Columbia, Room S178, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada (

Author Contributions: Dr Tremlett had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Shirani, Zhao, Kingwell, van der Kop, Petkau, Tremlett.

Acquisition of data: Shirani, Kingwell, van der Kop, Oger, Tremlett.

Analysis and interpretation of data: Shirani, Zhao, Karim, Evans, Kingwell, Oger, Gustafson, Petkau, Tremlett.

Drafting of the manuscript: Shirani, Tremlett.

Critical revision of the manuscript for important intellectual content: Shirani, Zhao, Karim, Evans, Kingwell, van der Kop, Oger, Gustafson, Petkau, Tremlett.

Statistical analysis: Shirani, Zhao, Karim, Gustafson, Petkau.

Obtained funding: Zhao, van der Kop, Gustafson, Petkau, Tremlett.

Administrative, technical, or material support: Shirani, Evans, Kingwell, Oger, Tremlett.

Study supervision: Tremlett.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Shirani reports receiving travel grants to present at and attend conferences from the endMS Research and Training Network and the European Committee for Treatment and Research in Multiple Sclerosis. Mr Karim reports having had travel and accommodation costs covered to present at a conference from the endMS Research and Training Network. Dr Evans reports receiving travel grants to present at and attend conferences from the endMS Research and Training Network and the European Committee for Treatment and Research in Multiple Sclerosis. Dr Kingwell reports having had travel and accommodation costs covered to present at and attend conferences from the endMS Research and Training Network, the International Society for Pharmacoepidemiology, and Bayer Schering Pharma. Dr Oger reports receiving speaker honoraria, consulting fees, travel grants, research grants, and/or educational grants from Aventis, Bayer, Biogen-Idec, BioMS, Corixa, Genentech, Novartis, Serono, Shering, Talecris, and Teva-Neurosciences. He receives fees for services from Bayer, Novartis, and Biogen Idec to serve on advisory committees. Dr Petkau reports having received research funds from Bayer Pharma and consulting fees and/or fees for service on data safety monitoring boards from Bayer Canada, Bayer Pharma, Bayhill Therapeutics, BTG International, Merck-Serono, and Novartis. Dr Tremlett reports having received speaker honoraria and/or travel expenses to speak at conferences from the Consortium of MS Centres, US National MS Society, Swiss Multiple Sclerosis Society, University of British Columbia Multiple Sclerosis Research Program, Bayer Pharmaceuticals (invited speaker, honoraria declined), and Teva Pharmaceuticals (invited speaker). Unless otherwise stated, all speaker honoraria are either donated to an MS charity or to an unrestricted grant for use by her research group. No other disclosures were reported.

Funding/Support: This study was s upported by grant MOP-93646 from the Canadian Institutes of Health Research (CIHR; principal investigator: Dr Tremlett) and grant RG 4202-A-2 from the National Multiple Sclerosis Society (NMSS; principal investigator: Dr Tremlett). Dr Shirani is funded through a postdoctoral fellowship from the Multiple Sclerosis Society of Canada and grants from the CIHR (MOP-93646) and the NMSS (RG 4202-A-2). Dr Zhao receives research funding from the CIHR, the Multiple Sclerosis Society of Canada, and the NMSS. Dr Evans is funded through grants from the CIHR (MOP-93646), the NMSS (RG 4202-A-2), and the Michael Smith Foundation for Health Research. Dr Kingwell is supported by postdoctoral fellowships from the Multiple Sclerosis Society of Canada and the Michael Smith Foundation for Health Research. Dr Oger receives support from the Christopher Foundation and the University of British Columbia (UBC). He receives fees for service from the Medical Services Commission of British Columbia. Dr Gustafson is supported by the Natural Sciences and Engineering Research Council of Canada. Dr Petkau holds research grants from the CIHR, the Multiple Sclerosis Society of Canada, the NMSS, and the Natural Sciences and Engineering Research Council of Canada. Dr Tremlett is funded by the Multiple Sclerosis Society of Canada (Don Paty Career Development Award), is a Michael Smith Foundation for Health Research Scholar, and is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. She has also received research support from the NMSS, CIHR, and UK Multiple Sclerosis Trust. The BCMS database has been funded from various sources (including the above) and also by an unrestricted grant from Donald Paty, MD, FRCPC, University of British Columbia, and the MS/MRI Research Group.

Role of the Sponsor: The funding institutions had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Online-Only Material: The Author Video Interview is available here.

Additional Contributions: We gratefully acknowledge the BCMS clinic neurologists who contributed to the study through patient examination and data collection (current members listed in alphabetical order): D. Adams, MD, FRCPC (Kelowna MS clinic); D. Craig, MD, FRCPC (Kelowna MS clinic); L. Daly, MD, FRCPC (Prince George MS clinic); V. Devonshire, MD, FRCPC (UBC MS clinic); S. Hashimoto, MD, FRCPC (UBC and Victoria MS clinics); J. Hooge, MD, FRCPC (UBC and Prince George MS clinics); O. Hrebicek, MD, FRCPC (Victoria MS clinic); L. Kastrukoff, MD, FRCPC (UBC and Prince George MS clinics); S. Meckling, MD, FRCPC (Kelowna MS clinic); D. Parton, MD, FRCPC (Victoria MS clinic); A.-L. Sayao, MD, FRCPC (UBC MS clinic); and A. Traboulsee, MD, FRCPC (UBC MS clinic). We also thank P. Rieckmann, MD (Sozialstiftung Bamberg Hospital, Bamberg, Germany) for helpful revisions of the original Canadian Institutes of Health Research grant. None have received compensation for their role in the study. We also thank the UBC MS clinic nurses and staff and the UBC's Clinical Trials Group. We are grateful to Tom Duggan, BA, University of British Columbia, for significant help with data manipulation and conversion and the Pharmacoepidemiology in MS Research Group for research support. We are thankful to Population Data BC and the British Columbia Ministry of Health for support with linkage to British Columbia administrative health care and health services data (hospital separations and medical service plan payment information), as well as PharmaNet for drug information. We also thank Feng Zhu,MSc, University of British Columbia, for help with code development. Finally, we are indebted to all MS patients who participated in this study. Messrs Duggan and Zhu were compensated through study research grants.



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Evaluating the Potential Benefit of Interferon Treatment in Multiple Sclerosis
JAMA. 2012;308(3):290-291.

Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis


Author Video Interviews

Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis (5:11)

Author Interview

JAMA: 2012-07-18, Vol. 308, No. 3, Author Interview (5:00)