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    <title>UTas ePrints - Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study</title>
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<meta content="OBJECTIVE: To examine whether past high sun exposure is associated with a reduced risk of multiple sclerosis. DESIGN: Population based case-control study. SETTING: Tasmania, latitudes 41-3 degrees S. PARTICIPANTS: 136 cases with multiple sclerosis and 272 controls randomly drawn from the community and matched on sex and year of birth. MAIN OUTCOME MEASURE: Multiple sclerosis defined by both clinical and magnetic resonance imaging criteria. RESULTS: Higher sun exposure when aged 6-15 years (average 2-3 hours or more a day in summer during weekends and holidays) was associated with a decreased risk of multiple sclerosis (adjusted odds ratio 0.31, 95% confidence interval 0.16 to 0.59). Higher exposure in winter seemed more important than higher exposure in summer. Greater actinic damage was also independently associated with a decreased risk of multiple sclerosis (0.32, 0.11 to 0.88 for grades 4-6 disease). A dose-response relation was observed between multiple sclerosis and decreasing sun exposure when aged 6-15 years and with actinic damage. CONCLUSION: Higher sun exposure during childhood and early adolescence is associated with a reduced risk of multiple sclerosis. Insufficient ultraviolet radiation may therefore influence the development of multiple sclerosis.
 
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<meta content="1.	Hemmer B, Cepok S, Nessler S, Sommer N. Pathogenesis of multiple sclerosis: an update on immunology. Curr Opin Neurol 2002; 15:227-31.
2.	Ebers GC, Sadovnick AD. The geographic distribution of multiple sclerosis: a review. Neuroepidemiology 1993; 12:1-5.
3.	Acheson ED. Some comments on the relationship of the distribution of multiple sclerosis to latitude, solar radiation, and other variables. Acta Neurol Scand 1960; 35:132-147.
4.	McMichael AJ, Hall AJ. Does immunosuppressive ultraviolet radiation explain the latitude gradient for multiple sclerosis? Epidemiology 1997; 8:642-5.
5.	Vieth R, Chan PC, MacFarlane GD. Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 2001; 73:288-94.
6.	Hayes CE. Vitamin D: a natural inhibitor of multiple sclerosis. Proc Nutr Soc 2000; 59:531-5.
7.	Hauser SL, Weiner HL, Che M, Shapiro ME, Gilles F, Letvin NL. Prevention of experimental allergic encephalomyelitis (EAE) in the SJL/J mouse by whole body ultraviolet irradiation. J Immunol 1984; 132:1276-81.
8.	van der Mei IA, Ponsonby AL, Blizzard L, Dwyer T. Regional variation in multiple sclerosis prevalence in Australia and its association with ambient ultraviolet radiation. Neuroepidemiology 2001; 20:168-74.
9.	Freedman DM, Dosemeci M, Alavanja MC. Mortality from multiple sclerosis and exposure to residential and occupational solar radiation: a case-control study based on death certificates. Occup Environ Med 2000; 57:418-21.
10.	Hammond SR, English DR, McLeod JG. The age-range of risk of developing multiple sclerosis: evidence from a migrant population in Australia. Brain 2000; 123:968-74.
11.	Hammond SR, McLeod JG, Millingen KS, et al. The epidemiology of multiple sclerosis in three Australian cities: Perth, Newcastle and Hobart. Brain 1988; 111:1-25.
12.	Paty DW, Oger JJ, Kastrukoff LF, et al. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 1988; 38:180-5.
13.	Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983; 13:227-31.
14.	Rubio JP, Bahlo M, Butzkueven H, et al. Genetic dissection of the human leukocyte antigen region by use of haplotypes of Tasmanians with multiple sclerosis. Am J Hum Genet 2002; 70:1125-37.
15.	Dwyer T, Blizzard L, Gies PH, Ashbolt R, Roy C. Assessment of habitual sun exposure in adolescents via questionnaire-a comparison with objective measurement using polysulphone badges. Melanoma Res 1996; 6:231-9.
16.	Jones G, Blizzard C, Riley MD, Parameswaran V, Greenaway TM, Dwyer T. Vitamin D levels in prepubertal children in Southern Tasmania: prevalence and determinants. Eur J Clin Nutr 1999; 53:824-9.
17.	Boiko A. Data collection guidelines for questionnaires to be used in case- control studies of multiple sclerosis. Neurology 1997; 49:S75-80.
18.	Fritschi L, Green A. Sun damage in teenagers' skin. Aust J Public Health 1995; 19:383-6.
19.	English DR, Armstrong BK, Kricker A. Reproducibility of reported measurements of sun exposure in a case-control study. Cancer Epidemiol Biomarkers Prev 1998; 7:857-63.
20.	Green AC. Premature ageing of the skin in a Queensland population. Med J Aust 1991; 155:473-4, 477-8.
21.	Holman CD, Evans PR, Lumsden GJ, Armstrong BK. The determinants of actinic skin damage: problems of confounding among environmental and constitutional variables. Am J Epidemiol 1984; 120:414-22.
22.	Beagley J, Bibson IM. Changes in skin condition in relation to degree of exposure to ultraviolet light. Perth: Western Australia Institute of Technology, School of Biology, 1980.
23.	Dwyer T, Muller HK, Blizzard L, Ashbolt R, Phillips G. The use of spectrophotometry to estimate melanin density in Caucasians. Cancer Epidemiol Biomarkers Prev 1998; 7:203-6.
24.	Cantorna MT, Woodward WD, Hayes CE, DeLuca HF. 1,25-dihydroxyvitamin D3 is a positive regulator for the two anti- encephalitogenic cytokines TGF-beta 1 and IL-4. J Immunol 1998; 160:5314-9.
25.	Garssen J, van Loveren H. Effects of ultraviolet exposure on the immune system. Crit Rev Immunol 2001; 21:359-97.
26.	Cantorna MT, Hayes CE, DeLuca HF. 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis. Proc Natl Acad Sci U S A 1996; 93:7861-4.
27.	Embry AF, Snowdon LR, Vieth R. Vitamin D and seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol 2000; 48:271-2.
28.	Nieves J, Cosman F, Herbert J, Shen V, Lindsay R. High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis. Neurology 1994; 44:1687-92.
29.	Goldberg P, Fleming MC, Picard EH. Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Med Hypotheses 1986; 21:193-200.
30.	Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001; 358:1500-3.
31.	Hammond SR. The Epidemiology of multiple sclerosis in Western Australia. Aust NZ J Med 1998:111.
32.	Hammond SR, de Wytt C, Maxwell IC, et al. The epidemiology of multiple sclerosis in Queensland, Australia. J Neurol Sci 1987; 80:185-204.
33.	Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain 1989; 112:133-46.
34.	Hillert J, Olerup O. HLA and MS. Neurology 1993; 43:2426-7.
35.	Francis DA, Thompson AJ, Brookes P, et al. Multiple sclerosis and HLA: is the susceptibility gene really HLA-DR or -DQ? Hum Immunol 1991; 32:119-24.
36.	Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol 2000; 39:57-106.
37.	Rosati G. The prevalence of multiple sclerosis in the world: an update. Neurol Sci 2001; 22:117-39.
38.	Gies HP. Ambient ultraviolet radiation. SPIE Ultraviolet Technoglogy V 1994; 2282:272-284.
 
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    <h1 class="ep_tm_pagetitle">Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study</h1>
    <p style="margin-bottom: 1em" class="not_ep_block"><span class="person_name">van der Mei, I.A.F.</span> and <span class="person_name">Ponsonby, A-L.</span> and <span class="person_name">Dwyer, T.</span> and <span class="person_name">Blizzard, Leigh</span> and <span class="person_name">Simmons, R.</span> and <span class="person_name">Taylor, B.V.</span> and <span class="person_name">Butzkueven, H.</span> and <span class="person_name">Kilpatrick, T.</span> (2003) <xhtml:em>Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study.</xhtml:em> British Medical Journal, 327 (7410). pp. 316-320. ISSN 0959-535X</p><p style="margin-bottom: 1em" class="not_ep_block"></p><table style="margin-bottom: 1em" class="not_ep_block"><tr><td valign="top" style="text-align:center"><a onmouseover="EPJS_ShowPreview( event, 'doc_preview_890' );" href="http://eprints.utas.edu.au/885/1/van_der_Mei_BMJ_2003.pdf" onmouseout="EPJS_HidePreview( event, 'doc_preview_890' );"><img alt="[img]" src="http://eprints.utas.edu.au/style/images/fileicons/application_pdf.png" class="ep_doc_icon" border="0" /></a><div class="ep_preview" id="doc_preview_890"><table><tr><td><img alt="" src="http://eprints.utas.edu.au/885/thumbnails/1/preview.png" class="ep_preview_image" border="0" /><div class="ep_preview_title">Preview</div></td></tr></table></div></td><td valign="top"><a href="http://eprints.utas.edu.au/885/1/van_der_Mei_BMJ_2003.pdf"><span class="ep_document_citation">PDF</span></a> - Requires a PDF viewer<br />110Kb</td></tr></table><p style="margin-bottom: 1em" class="not_ep_block">Official URL: <a href="http://dx.doi.org/10.1136/bmj.327.7410.316">http://dx.doi.org/10.1136/bmj.327.7410.316</a></p><div class="not_ep_block"><h2>Abstract</h2><p style="padding-bottom: 16px; text-align: left; margin: 1em auto 0em auto">OBJECTIVE: To examine whether past high sun exposure is associated with a reduced risk of multiple sclerosis. DESIGN: Population based case-control study. SETTING: Tasmania, latitudes 41-3 degrees S. PARTICIPANTS: 136 cases with multiple sclerosis and 272 controls randomly drawn from the community and matched on sex and year of birth. MAIN OUTCOME MEASURE: Multiple sclerosis defined by both clinical and magnetic resonance imaging criteria. RESULTS: Higher sun exposure when aged 6-15 years (average 2-3 hours or more a day in summer during weekends and holidays) was associated with a decreased risk of multiple sclerosis (adjusted odds ratio 0.31, 95% confidence interval 0.16 to 0.59). Higher exposure in winter seemed more important than higher exposure in summer. Greater actinic damage was also independently associated with a decreased risk of multiple sclerosis (0.32, 0.11 to 0.88 for grades 4-6 disease). A dose-response relation was observed between multiple sclerosis and decreasing sun exposure when aged 6-15 years and with actinic damage. CONCLUSION: Higher sun exposure during childhood and early adolescence is associated with a reduced risk of multiple sclerosis. Insufficient ultraviolet radiation may therefore influence the development of multiple sclerosis.&#13;
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</p></div><table style="margin-bottom: 1em" cellpadding="3" class="not_ep_block" border="0"><tr><th valign="top" class="ep_row">Item Type:</th><td valign="top" class="ep_row">Article</td></tr><tr><th valign="top" class="ep_row">Additional Information:</th><td valign="top" class="ep_row">http://www.bmj.com/cgi/content/full/327/7410/316</td></tr><tr><th valign="top" class="ep_row">Keywords:</th><td valign="top" class="ep_row">multiple sclerosis, case-control study, sun exposure, ultraviolet radiation, skin </td></tr><tr><th valign="top" class="ep_row">Subjects:</th><td valign="top" class="ep_row"><a href="http://eprints.utas.edu.au/view/subjects/321202.html">320000 Medical and Health Sciences &gt; 321200 Public Health and Health Services &gt; 321202 Epidemiology</a></td></tr><tr><th valign="top" class="ep_row">ID Code:</th><td valign="top" class="ep_row">885</td></tr><tr><th valign="top" class="ep_row">Deposited By:</th><td valign="top" class="ep_row"><span class="ep_name_citation"><span class="person_name">Dr Ingrid A F van der Mei</span></span></td></tr><tr><th valign="top" class="ep_row">Deposited On:</th><td valign="top" class="ep_row">29 Mar 2007</td></tr><tr><th valign="top" class="ep_row">Last Modified:</th><td valign="top" class="ep_row">09 Jan 2008 02:30</td></tr><tr><th valign="top" class="ep_row">ePrint Statistics:</th><td valign="top" class="ep_row"><a target="ePrintStats" href="/es/index.php?action=show_detail_eprint;id=885;">View statistics for this ePrint</a></td></tr></table><p align="right">Repository Staff Only: <a href="http://eprints.utas.edu.au/cgi/users/home?screen=EPrint::View&amp;eprintid=885">item control page</a></p>
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