Outcome assessment (Health care)

Nigeria has the second largest HIV epidemic within the world and has one of the highest new infection rates in Sub-Saharan Africa [1]. Antiretroviral therapy (ART) is the mainstay within the management of people living with HIV (PLHIV). Adherence to antiretroviral medication is vital to achieving viral suppression in people initiated on antiretroviral medication. Adherence is clients' behavior of taking drugs consistently and correctly. According to Machtinger and Bangsberg [2] "Poor adherence will lead to treatment failure, evolution of drug resistance, and subsequent immunological and clinical failure". More than 95% of the doses got to be taken for best response whereas lesser degrees of adherence are more usually related to virological failure [3]. In all countries and settings, KPs are disproportionately laid low with HIV infection. Sadly, reaching KPs with HIV intervention may well be an enormous challenge as a results of stigma, discrimination, violence, and legislation of KPs lifestyles [4]. Key populations (KPs) include Men who have sex with Men (MSM), people who Inject medication (PWID), and Sex workers (SW), people in prisons and closed settings, and transgender people [4]. The purpose of this article is to identify various barriers to antiretroviral adherence and ways to removing these barriers to enhance maximum ART treatment outcomes.

Context : Inappropriate antibiotic prescribing remains a major driver of bacterial resistance worldwide, particularly in low-and middle-income countries. Antibiotic prescribing decision support systems (APDS) such as Antibioclic are promising tools for improving prescribing appropriateness and promoting the proper use of antibiotics. Objective : Evaluate the acceptability and use of an antibiotic prescription support system by clinicians in their daily practice, using Antibioclic as a reference model. Methods: A descriptive, cross-sectional, observational cohort study (exposed/unexposed) was conducted between January and June 2025 in several healthcare facilities in Haut-Katanga and Lualaba (Democratic Republic of Congo). Data were collected using electronic questionnaires administered to prescribing clinicians, pharmacy staff, and patients. Statistical analyses were performed using SPSS v30 and Epi Info 7.2.2.6, calculating frequencies, 95% confidence intervals, relative risks (RR), and chi-square tests. Results : The physician participation rate in the survey was 95.45%. Among them, 80.95% primarily used reference books (Vidal, Doroz, guides) as prescribing aids, while 85.71% stated they were willing to adopt Antibioclic in their practice. Patients who did not receive an explanation of their prescription had a 2.64 times higher relative risk of not purchasing their entire course of treatment (p < 0.05). Similarly, hospitalized patients were significantly less informed than outpatients (RR = 3.73; p < 0.05). The study reveals high acceptability of the Antibioclic SDPA (Single-Dose Prescription Drug) among Congolese clinicians, but its use remains limited in favor of traditional sources. A lack of explanation regarding prescriptions is a major obstacle to treatment adherence. The effective integration of SDPAs, accompanied by continuing education programs, is essential to improve prescribing quality and combat emerging antimicrobial resistance in sub-Saharan Africa.

Total arthroplasty is the basic method of orthopedic treatment of changes in the hip joint in the course of some rheumatic diseases. We can distinguish two main mechanisms leading to hip joint lesions. Coxarthrosis, via mechanism of various etiology, results in a gradual degeneration of the joint and gives a picture of a joint degeneration type. In other rheumatic diseases, the background is inflammatory and leads to destructive lesions. The main inflammatory rheumatic diseases include rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), spondylitis ankylopoetica (SpA) and psoriatic arthritis (PsA). In their case, there is a greater loss of bone tissue quality than in coxarthrosis- as result of the chronic course of the disease and long-term pharmacotherapy. One of the main problems is the systemic nature of the disease with involvement of other organs, advanced drug-induced osteoporosis, and the need for surgery at an early age. In this group of patients, endoprostheses with a conventional stem were usually implanted to ensure good and reliable stabilization in the femoral shaft. For many years, an increase in the amount of total hip replacements (THR) and progress in the field of biotechnology have been observed. Due to the greater availability of treatment, the age of patients undergoing surgery decreases, and with it - an increased risk of loosening of the applied implant and revision surgery. The use of short-stem implants saves primary bone resection and the possibility of using a conventional stem in the event of a reoperation, which extends the treatment sequence and is particularly important for young people to maintain the proper function of the hip joint in the future.
The subject of the study is to evaluate the results of total hip replacement using short stems in patients with rheumatic diseases, its effectiveness, impact on joint function, and to compare the results of surgical treatment and complications in the group of patients with osteoarthritis and other rheumatic diseases. The study was carried out at the Department of Rheumorthopedics of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw (PL) among 110 patients who underwent hip arthroplasty using a short stem in 2008-2014 (groups 2 and 3 according to the JISRF classification). Recruitment to the study took place after orthopedic and anaesthestetic assessments for surgery. The orthopedic assessment was based on a clinical examination and analysis of radiological examinations. The study included patients with bone morphology assessment according to Dorr's type A and B classification and with a cortical thickness index <0.75. Patients with II and III degree of obesity (BMI>35 and >40 respectively) were not qualified. There were 69 patients with osteoarthritis (62.7%), and 41 (37.3%) with other rheumatic diseases. 66 (60%) women and 44 (40%) men participated in the study. The age of the patients at the time of surgery ranged from 20 to 82 years (average 60.8). Hip function, pain intensity and treatment satisfaction before surgery and after 5 years of follow-up were assessed based on: clinical orthopedic examination with standard X-ray examination of both hips, Harris Hip Score (HHS) and visual assessment scale (VAS).
Two groups of patients undergoing hip arthroplasty with the use of a short stem were compared, with two etiologies of joint changes: the group with degenerative disease (OA) and the group with destructive changes in the joints in the course of other rheumatic diseases, which, however, gave an orthopedically similar type of joint changes (RA, JIA, PsA, SpA ). During statistical analysis, the influence of different variables on postoperative outcomes was examined. They were: sex of patients, body weight index, age, duration of the disease, type of short stem used (according to the JISRF). The incidence of complications was assessed in both groups of patients. Based on the conducted studies, an average improvement in pain by at least 9 points on the VAS scale was obtained in 88.4% in the group of patients with OA and in 90.2% of patients with other rheumatic diseases. In both groups of patients, regardless of gender, an extremely high level of satisfaction with the treatment was obtained after 5 years of follow-up. About 90% of patients were satisfied with 9/10 points (VAS). A comparable, high number of excellent and good results on the HHS scale was found in both groups. In the group of patients with OA in women, 73% and 81.2% in men, with an average change in score by 40.3 ± 14.8 points. In other rheumatic diseases, 69% in women and 83.4% in men, respectively, with an average change in the score by 47.1 ± 16.7 points. Bad results in both groups were more often achieved by women. In the group with osteoarthritis in women it was 16.2% vs. 24.1% in other rheumatic diseases. In men, 6.2% vs. 8.3%. Complications were found in 20 subjects with OA (29.0%) and in 11 subjects with other rheumatic diseases (26.8%).
The results of treatment with short stem arthroplasty in patients with other rheumatic diseases were comparable -in terms of pain relief and satisfaction- with surgery as the result of treatment in coxarthrosis. Both groups of patients obtained a similar absolute result of hip function as assessed by the HHS scale. Most of these results were excellent and good. The group of patients with rheumatic diseases other than osteoarthritis obtained a greater relative benefit from the treatment. There was no increased complication rate in patients with rheumatic diseases other than osteoarthritis with the use of a short stem. The material studied showed a significantly more frequent occurrence of complications in women, regardless of the etiology of joint changes. Better functional results were obtained with the use of short stems stabilized in the neck than with the femoral metaphysis.

Keywords: rheumatic diseases, rheumatoid arthritis, osteoarthritis, total hip replacement, short stem hip prosthesis

Background: Including eye and vision issues thyroid problems can result in a number of structural body and functional changes, which can be detrimental to a patient's well-being. Objective: To clinically assess ocular surface changes among patients with hyperthyroidism using standardized ocular surface evaluation parameters.

Medication errors represent a critical global jeopardy to clinical safety, directly triggering therapeutic failures, exacerbating antimicrobial resistance, and inflating healthcare expenditures. In response to human-error vulnerabilities inherent in conventional paper-based systems, numerous medical facilities have integrated electronic prescribing systems, augmented by Computerized Physician Order Entry (CPOE) and Clinical Decision Support Systems (CDSS). Nevertheless, this digital transition prompts academic discourse regarding its efficacy in mitigating baseline risks versus introducing novel operational vulnerabilities. This study aims to analyze the therapeutic capacity of e-prescribing technology, delineate contemporary technological and operational barriers in clinical settings, and evaluate the imperativeness of regulatory alignment to ensure optimized, rational pharmaceutical utilization.

The treatment and particularly the extension of surgical therapy of papillary thyroid carcinoma (PTC) remain still controversial in some issues, especially for the lack of preoperative information or variables that allow predicting the level of aggressiveness of the tumor. The purpose of the study was to assess the impact of the central node neck dissection (CNND) on surgical outcome and disease free-follow up of PTC-patients operated on at our center by evaluation of postoperative complications (parathyroid and recurrent nerve damage, hemorrhage rates) and pts rates presenting detectable serum Thyroglobulin (TG) or TG-Antibodies (TG-AB) values, at the time of 131 Iodine treatment and subsequently at 6-12 months, combined with neck high-resolution ultrasound (HRUS) The results of a prospective study on 149 pts preoperatively diagnosed and HR-US staged N0-PTC who underwent total thyroidectomy and CNND were compared with the results of a retrospective study on 114 similar postoperatively diagnosed PTC-pts who received total thyroidectomy, without nodes dissection. Materials and methods: 149 patients who underwent total thyroidectomy (TT)+CNND from March 2012 to August 2013 (group-A) and 114 patients who underwent TT from January to December 2011 (group-B) were compared on the following variables: gender, age, histological variant of PTC, tumor size, TNM stage, multifocality, vascular invasion, thyroiditis, expression of BRAF mutation, surgical complications (transient postoperative hypocalcemia and hypoparathyroidism, temporary or permanent dysphonia and hemorrhage), values of TG and anti-TG Ab in suspension or under TSH stimulus, in pre-ablation and on the last clinical and instrumental evaluation of the patient. Statistical analysis was performed using the Student t-test and Fisher. A p value less than 0.05 was considered statistically significant. Comparing the patients of group-A with group-B the following variables present with statistically significant differences: transient postoperative hypocalcemia (group-A 50.3% vs group-B 21.9% , p<0.0001) , association with lymphocitary chronic thyroiditis (group-A 63.1% vs group-B 37.7%, p<0.0001), median postoperative serum TG value (group-A 1,05 ng/L vs group-B 2,4 ng/L , p=0.01), median postoperative anti-TG antibodies value (group-A 903 kU/L vs group-B 118.5 kU/L, p=0.006 ), median value of anti-TG antibodies at the last follow up after radioiodine therapy (group-A 481,5 kU/L vs group-B 35 kU/L, p=0.0001). The following variables do not present statistically significant differences: gender (females 83.2% group-A vs group-B 82.5%, p ns), mean age at diagnosis (>45 years group-A 59.7% vs group-B 53.1%, p ns) , the histological subtypes (p ns), microcarcinomas (group-A 29,5% vs group-B 35%, p ns) , pT (p ns) , presence of multifocal lesions (group A 45.6% vs group B 55.3%, p ns), temporary dysphonia ( 7,4% group-A vs. group B 2.6%, p ns), definitive dysphonia (group-A 1,3% vs group-B 0,9%, p ns), post-operative hemorrhage (group-A 2% vs group-B 1.8%, p ns), radioiodine therapy (group-A 80.6% vs group-B 80.7%, p ns), rhTSH (group-A 88.3% vs group-B 82.6%, p ns), median value of TG at the last follow up after radioiodine therapy (group-A 0,2 ng/ml vs group-B 0,3 ng/ml, p ns), median value of TG at the last follow-up in patients not receiving therapy (group-A 0.4 ng/ml vs group-B 0.3 ng/ml, p ns). In our study we observed that the CNND has allowed a more complete postoperative staging, the TG values after surgery were lower in patients in group A vs group B patients (p<0.0001). Moreover, in group-A any recurrence occurred whereas in group B it was observed a case of relapse at 8 months.

INTRODUCTION Grading the strength of a body of diagnostic test evidence involves challenges over and above those related to grading the evidence from health care intervention studies. This chapter identifies challenges and outlines principles for grading the body of evidence related to diagnostic test performance. CHALLENGES Diagnostic test evidence is challenging to grade because standard tools for grading evidence were designed for questions about treatment rather than diagnostic testing; and the clinical usefulness of a diagnostic test depends on multiple links in a chain of evidence connecting the performance of a test to changes in clinical outcomes. PRINCIPLES Reviewers grading the strength of a body of evidence on diagnostic tests should consider the principle domains of risk of bias, directness, consistency, and precision, as well as publication bias, dose response association, plausible unmeasured confounders that would decrease an effect, and strength of association, simil...

Conduziu-se o presente experimento com o objetivo de avaliar a fertilidade do solo de diferentes usos agroflorestais na região central de Rondônia, Brasil. Adotou-se o delineamento experimental em blocos casualizados, com três repetições. Os tratamentos avaliados foram: T1: Sistema agroflorestal com cacaueiros e fruteiras perenes; T2: Trilhamento na capoeira com abertura de faixas de plantio de essências florestais; T3: Capoeira enriquecida com essências florestais e T4:  Floresta nativa. O cálcio e o alumínio foram os nutrientes que mais variaram nos diferentes tipos de cobertura e profundidades do solo. As propriedades pH, fósforo e matéria orgânica não apresentaram diferenças entre a floresta e os demais tratamentos.

As the population ages, there is a growing awareness of the need for vehicle safety to suit the older occupant. The ageing process makes older people more vulnerable to injury. It takes less energy to produce tissue damage and disruption, and their skeletal structures are more easily damaged through bone loss. Coupled with pre-existing health conditions, these factors tend to exaggerate the consequences of any assault. In short, there is a greater need to improve the crashworthiness of vehicles to provide better protection for older drivers in the event of a crash. Until recently, vehicle designers predominantly have focused their designs around young adult anthropometry and performance, which means that often the ergonomic speci-fications of modern vehicles do not necessarily take account of the needs of older people. There is now a large body of literature describing changes in physical and performance characteristics across the adult age span, yet this research has been largely ignored in the design of vehicles. One recent exception, worthy of comment is 'The Third-Age Suit' designed by the Ford motor vehicle manufacturer in the United States. The suit simulates some of the functional limitations associated with ageing to raise the awareness of ageing among their young designers 1 . Designers wear this suit as they design the vehicle to assist them in accommodating the needs of the older driver. The immense buying power of the older population makes them a key target group

Background. The reliable stratification of homogeneous subgroups and the prediction of future clinical outcomes within heterogeneous neurological disorders is a particularly challenging task. Nonetheless, it is essential for the implementation of targeted care and effective therapeutic interventions. Objective. This study was designed to assess the value of a recently developed regression tool from the family of unbiased recursive partitioning methods in comparison to established statistical approaches (eg, linear and logistic regression) for predicting clinical endpoints and for prospective patients’ stratification for clinical trials. Methods. A retrospective, longitudinal analysis of prospectively collected neurological data from the European Multicenter study about Spinal Cord Injury (EMSCI) network was undertaken on C4-C6 cervical sensorimotor complete subjects. Predictors were based on a broad set of early (&lt;2 weeks) clinical assessments. Endpoints were based on later clini...

Patients with severe neurological sequelae often experience profound motor deconditioning that, combined with impaired mucociliary clearance, reduced lung volume, and the presence of tracheostomy, predisposes them to pulmonary infections and serious respiratory complications. A 24-year-old male with spastic quadriplegia secondary to childhood cerebral hemorrhage from an arteriovenous malformation, tracheostomy with a cuffed cannula under mechanical ventilation, and hydrocephalus treated with a ventriculoperitoneal shunt, presented to the emergency department with fever unresponsive to paracetamol and ceftriaxone. Laboratory tests showed markedly elevated inflammatory indices (C-reactive protein 249.3 mg/dl), and chest computed tomography revealed extensive consolidation of the left lower lobe with an air bronchogram and endobronchial obstruction, consistent with aspiration pneumonia. Fibrobronchoscopy confirmed the presence of endobronchial material, and culture grew Acinetobacter baumannii. Given the patient's clinical and functional status, the physiatrists prescribed an Individual Rehabilitation Project (motor and respiratory reeducational programs, including passive mobilization of major joints, cautious trunk stabilization, and lung volume recruitment maneuvers) to support the effects of positivepressure ventilation. The case underscores the dual challenge of neurological impairment and pulmonary vulnerability, where immobilization further exacerbates respiratory compromise and infection risk, fostering sarcopenia and poor quality of life. In patients with spastic quadriplegia of cerebrovascular origin on long-term mechanical ventilation, a synergistic approach combining NIV optimization and individualized motor-respiratory rehabilitation may represent an effective strategy to control recurrent infections and maintain clinical stability. In this area, there is currently insufficient evidence, and urgent future research is needed.

Introduction: Surgical procedures are associated with a significant risk of preventable adverse events. The World Health Organization introduced the Surgical Safety Checklist (SSC) to improve perioperative safety through structured communication and standardized safety practices. However, checklist implementation and compliance remain variable, particularly in resource-limited settings. Materials and Methods: A prospective observational cohort study was conducted over 18 months among 1118 adult surgical patients in a tertiary care hospital. Compliance with the WHO Surgical Safety Checklist was assessed across Sign-In, Time-Out, and Sign-Out phases. Clinical outcomes including postoperative complications, intraoperative adverse events, length of hospital stay, and mortality were recorded. Data were analysed using descriptive statistics, Chi-square test, and independent t-test, with p < 0.05 considered statistically significant. Results: The SSC was implemented in 80.5% of cases, with overall compliance of 82%. Phase-wise compliance was highest during Sign-In (85%) and lowest during Time-Out (78.7%). Higher checklist compliance was associated with significantly shorter hospital stay. Although postoperative complication rates were slightly lower in the high-compliance group, the difference was not statistically significant. Emergency surgical workload, time constraints, and inadequate staff training were identified as major barriers to checklist adherence.

The Royal College of Physicians The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. The RCP provides physicians in over 30 medical specialties with education, training and support throughout their careers. As an independent charity representing over 34,000 fellows and members worldwide, the RCP advises and works with government, patients, allied healthcare professionals and the public to improve health and healthcare.

Pancreas transplantation (PTx) represents the method of choice in type 1 diabetic patients with conservatively intractable hypoglycemia unawareness syndrome. In 2005, the Institute for Clinical and Experimental Medicine (IKEM) launched a program to investigate the safety potential of islet transplantation (ITx) in comparison to PTx. This study aims to compare the results of PTx and ITx regarding severe hypoglycemia elimination, metabolic control, and complication rate. We analyzed the results of 30 patients undergoing ITx and 49 patients treated with PTx. All patients were C-peptide-negative and suffered from hypoglycemia unawareness syndrome. Patients in the ITx group received a mean number of 12,349 (6,387-15,331) IEQ/kg/person administered percutaneously into the portal vein under local anesthesia and radiological control. The islet number was reached by 1-3 applications, as needed. In both groups, we evaluated glycated hemoglobin, insulin dose, fasting and stimulated C-peptide, ...

Context : Inappropriate antibiotic prescribing remains a major driver of bacterial resistance worldwide, particularly in low-and middle-income countries. Antibiotic prescribing decision support systems (APDS) such as Antibioclic are promising tools for improving prescribing appropriateness and promoting the proper use of antibiotics. Objective : Evaluate the acceptability and use of an antibiotic prescription support system by clinicians in their daily practice, using Antibioclic as a reference model. Methods: A descriptive, cross-sectional, observational cohort study (exposed/unexposed) was conducted between January and June 2025 in several healthcare facilities in Haut-Katanga and Lualaba (Democratic Republic of Congo). Data were collected using electronic questionnaires administered to prescribing clinicians, pharmacy staff, and patients. Statistical analyses were performed using SPSS v30 and Epi Info 7.2.2.6, calculating frequencies, 95% confidence intervals, relative risks (RR), and chi-square tests. Results : The physician participation rate in the survey was 95.45%. Among them, 80.95% primarily used reference books (Vidal, Doroz, guides) as prescribing aids, while 85.71% stated they were willing to adopt Antibioclic in their practice. Patients who did not receive an explanation of their prescription had a 2.64 times higher relative risk of not purchasing their entire course of treatment (p < 0.05). Similarly, hospitalized patients were significantly less informed than outpatients (RR = 3.73; p < 0.05). The study reveals high acceptability of the Antibioclic SDPA (Single-Dose Prescription Drug) among Congolese clinicians, but its use remains limited in favor of traditional sources. A lack of explanation regarding prescriptions is a major obstacle to treatment adherence. The effective integration of SDPAs, accompanied by continuing education programs, is essential to improve prescribing quality and combat emerging antimicrobial resistance in sub-Saharan Africa.

Objective: Malocclusion is a condition that negatively affects individuals' quality of life and is characterized by deviations in the ideal alignment of the teeth. Orthodontic anomalies and periodontal diseases can interact with each other. This study aims to evaluate the need for orthodontic treatment in individuals with periodontal disease. Materials and Methods: The study included 150 patients who presented with periodontal disease complaints at the

Objectives. To describe tracheobronchial disease in patients with granulomatosis with polyangiitis (GPA) and evaluate the utility of dynamic expiratory CT to detect large-airway disease. Methods. Demographic and clinical features associated with the presence of subglottic stenosis (SGS) or endobronchial involvement were assessed in a multicentre, observational cohort of patients with GPA. A subset of patients with GPA from a single-centre cohort underwent dynamic chest CT to evaluate the airways. Results. Among 962 patients with GPA, SGS and endobronchial disease were identified in 95 (10%) and 59 (6%) patients, respectively. Patients with SGS were more likely to be female (72% vs 53%, P < 0.01), younger at time of diagnosis (36 vs 49 years, P < 0.01), and have saddle-nose deformities (28% vs 10%, P < 0.01), but were less likely to have renal involvement (39% vs 62%, P < 0.01). Patients with endobronchial disease were more likely to be PR3-ANCA positive (85% vs 66%, P < 0.01), with more ENT involvement (97% vs 77%, P < 0.01) and less renal involvement (42% vs 62%, P < 0.01). Disease activity in patients with large-airway disease was commonly isolated to the subglottis/upper airway (57%) or bronchi (32%). Seven of 23 patients screened by dynamic chest CT had large-airway pathology, including four patients with chronic, unexplained cough, discovered to have tracheobronchomalacia. SGS and endobronchial disease occur in 10% and 6% of patients with GPA, respectively, and may occur without disease activity in other organs. Dynamic expiratory chest CT is a potential non-invasive screening test for largeairway involvement in GPA.

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the "patient journey") with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.

The role that sibling relationships play in socialization of children with autism spectrum disorder is very important but it is usually ignored especially when institutional support is limited. In this paper, the results of a qualitative endeavor of a sociological case study that was undertaken in Province 1, Nepal, are revisited to understand the role of sibling-mediated interactions in enhancing social participation, adaptive behavior and emotional well-being among children with autism. The information was gathered by using the in-depth interview and participant observation in the school and the home setting, which involved the siblings, parents and teachers. The results show that siblings often play major communication mediations, role models, emotional controls and mediators of social processes. These roles come about in real life situations as opposed to training in therapy and this illustrates how much sibling involvement in the learning process can influence learning in a social setting. The trends that were discovered during this research imply that children with autism that are actively involved in their sibling communication exhibit better social interactions and adaptive behavior. These effects are affected by factors like the birth order, quality of interaction and the cultural context. Within the Nepali context, brothers and sisters regularly assist in bargaining the social understanding of autism, lower social segregation, and adjust to the local cultural norms. The paper has brought to light the importance of family-based interventions in treating autism and sibling involvement as a viable and inexpensive option. The incorporation of sibling involvement to inclusive education and programs based on community can improve the social outcome of children with autism, especially over low-resource settings.

Objective To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. Methods In partnership with government, in 10 rural districts during 2018-2021 we: (i) trained community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) supported communities to establish emergency transport, food banks and emergency savings to reduce referral delays; (iii) ensured adequate drug supplies; (iv) trained health workers to treat severe malaria with injectable artesunate; and (v) monitored severe malaria cases and associated deaths via surveys, health facility data and a community monitoring system. Results Intervention communities accessed quality-assured rectal artesunate from trained community health volunteers, and follow-on treatment for severe malaria from health workers. Based on formal data from the health management information system, reported deaths from severe malaria reduced significantly from 3.1% (22/699; 95% confidence interval, CI: 2.0-4.2) to 0.5% (2/365; 95% CI: 0.0-1.1) in two demonstration districts, and from 6.2% (14/225; 95% CI: 3.6-8.8) to 0.6% (2/321; 95% CI: 0.0-1.3) in eight scale-up districts. Conclusion Despite the effects of the coronavirus disease, our results confirmed that pre-referral rectal artesunate administered by community health volunteers can be an effective intervention for severe malaria among young children. Our results strengthen the case for wider expansion of the pre-referral treatment in Zambia and elsewhere when combined with supporting interventions.

Drug-resistant tuberculosis (DR-TB) remains a major health problem in Indonesia. Decentralized care for DR-TB patients from hospital to primary health care (PHC) has been recommended to facilitate service access. Objective: This study aimed to compare the outcomes of DR-TB patients undergoing treatment in primary health care and hospital care. Methods: We used an analytic retrospective study design. Data were collected from medical records of DR-TB patients in Dr Soetomo Hospital between January 2015 and December 2016. Results: There were 165 patients included in this study, consisting of 116 (70.3%) patients who received treatment in PHC with an average age of 43.8 (±12.4) years old, while 49 (29.7%) patients received treatment at the hospital with an average age of 45.6 (±12.3) years old. The number of multidrug-resistant tuberculosis (MDR-TB) cases who received treatment in PHC vs Hospital were 80 (48.4%) vs 35 (21.2%) cases, Rifampicinresistant tuberculosis (RR-TB) cases PHC vs Hospital were 27 (16.3%) vs 10 (6%) cases, while pre-extensive drug-resistant (XDR-TB) cases in PHC vs hospital were 9 (5.4%) vs 3 (1.8%) cases and only 1 (0.6%) XDR-TB case in the hospital. The incident of lost to follow-up significantly lower than hospital setting (46.3% vs 65.3%; p < 0,05). The treatment outcome success rate also higher in PHC (33.6% vs 20.4%; p > 0,05). Conclusions: The lost to follow-up rate of DR-TB patients who treated in PHC is lower than the hospital, and the success rate patients who received treatment in PHC is higher than hospital.

Extracorporeal membrane oxygenation (ECMO) is an advanced respiratory support that is being adopted as salvage therapy in acute respiratory failure [1]. The widespread use of this technology came as a result of a large multicenter randomized UK study showing a survival benefit for severe acute respiratory distress syndrome (ARDS) patients transferred to an ECMO-capable specialist center [2]. Moreover, improvements in clinical management and advances in technology have gradually changed ECMO from a “rescue therapy of last resort” to a type of standardized therapy for severe impairment with clear indications and contraindications in many specialized centers around the globe, including for the treatment of COVID-19 patients.

Context: A recent Community Guide systematic review of effectiveness of school-based health centers (SBHCs) showed that SBHCs improved educational and health outcomes. This review evaluates the economic cost and benefit of SBHCs. Evidence acquisition: Using economic systematic review methods developed for The Community Guide, 6,958 papers were identified for the search period January 1985 to September 2014. After two rounds of screening, 21 studies were included in this review: 15 studies reported on cost and nine on benefit; three studies had both cost and benefit information. All expenditures in this review were presented in 2013 U.S. dollars. Evidence synthesis: Analyses were conducted in 2014. Intervention cost had two main components: start-up cost and operating cost. All but two of the cost studies reported operating cost only (ranging from $16,322 to $659,684 per SBHC annually). Benefits included healthcare cost averted and productivity and other loss averted. From the societal perspective, total annual benefit per SBHC ranged from $15,028 to $912,878. From healthcare payers' perspective, particularly Medicaid, SBHCs led to net savings ranging from $30 to $969 per visit. From patients' perspective, savings were also positive. Additionally, two benefit studies used regression analysis to show that Medicaid cost and hospitalization cost decreased with SBHCs. Finally, results from seven estimates in two cost-benefit studies showed that societal benefit per SBHC exceeded intervention cost, with the benefit-cost ratio ranging from 1.38:1 to 3.05:1. The economic benefit of SBHCs exceeds the intervention operating cost. Further, SBHCs result in net savings to Medicaid.

A presynaptic protein called α-synuclein plays a crucial role in synaptic function and neurotransmitter release. However, its misfolding and aggregation have been implicated in a variety of neurodegenerative diseases, particularly Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. Emerging evidence suggests that α-synuclein interacts with various cellular pathways, including mitochondrial dysfunction, oxidative stress, and neuroinflammation, which contributes to neuronal cell death. Moreover, α-synuclein has been involved in the propagation of neurodegenerative processes through prion-like mechanisms, where misfolded proteins induce similar conformational changes in neighboring neurons. Understanding the multifaced roles of α-synuclein in neurodegeneration not only aids in acquiring more knowledge about the pathophysiology of these diseases but also highlights potential biomarkers and therapeutic targets for intervention in alpha-synucleinopathies. In this review, we provide a summary of the mechanisms by which α-synuclein contributes to neurodegenerative processes, focusing on its misfolding, oligomerization, and the formation of insoluble fibrils that form characteristic Lewy bodies. Furthermore, we compare the potential value of α-synuclein species in diagnosing and differentiating selected neurodegenerative diseases.

The objective was to analyze the effectiveness of Psychosocial Care Centers (PCCs) for persons with mental disorders in Pelotas, Rio Grande do Sul State, Brazil. This was a prospective cohort study with users of the centers, based on two home visits. Three treatment exposure variables and two health status variables were compared and stratified according to treatment modality and time attending the health service. We interviewed 1,013 patients on the first visit and 875 on the second. The most frequent diagnoses were mood disorder (39%), schizophrenia (24%), and neuroses (13%). More than 50% were receiving intensive or semi-intensive care, and nearly 60% had attended the center for at least three years. There was a significant reduction in crisis reports (p = 0.000) and fewer hospitalizations among those in intensive treatment (p = 0.002) and with longer time attending the center (p = 0.003). Among non-intensive patients, there was a decrease in the use of medication (p = 0.032) and...

This study aimed to identify nursing quality care indicators for elderly patients who have suffered from stroke. The study consisted of two phases. In the beginning, focus group and semi structured interview were used to identify the perception of nursing quality care of the elderly patients suffering from stroke, their families, the physicians, and the nurses. The seventyfive care indicators of six nursing quality care aspects were emerged. Subsequently three-round Delphi study were used to find the 36 experts consensus regarding the important, the feasibility, and the face validity of the care indicators. For the result of the Delphi study, the number of pre-determined care indicators in each round was 75, 45 and 27. After round three, the twenty-five quality care indicators under six quality care aspects emerged. They were managing patient unit (5 indicators), nursing staff qualification (2 indicators), nursing care activity, (5 indicators), encouraging family participation in pa...

Background: Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. Information systems are necessary for community health volunteer programs to be effective, yet effectiveness evaluations of such information systems implemented at scale are rare. In October 2010, a network of female volunteers with little or no literacy, the Women's Development Army (WDA), was added to extend Ethiopia's Health Extension Program services to every household in the community. Between July 2013 and January 2015, a health management information system for the WDA's Community-Based Data for Decision-Making (CBDDM) strategy was implemented in 115 rural districts to improve the demand for and utilization of maternal and newborn health services. Using the CBDDM strategy, Health Extension Workers (HEWs) fostered the WDA and community leaders to inform, lead, own, plan, and monitor the maternal and newborn health interventions in their kebeles (communities). This paper examines the effectiveness of the CBDDM strategy. Methods: Using data from cross-sectional surveys in 2010-11 and 2014-15 from 177 kebeles, we estimated selfreported maternal and newborn care practices from women with children aged 0 to 11 months (2124 at baseline and 2113 at follow-up), and a CBDDM implementation strength score in each kebele. Using kebele-level randomeffects models, we assessed dose-response relationships between changes over time in implementation strength score and changes in maternal and newborn care practices between the two surveys. Results: Kebeles with relatively high increases in CBDDM implementation strength score had larger improvements in the coverage of neonatal tetanus-protected childbirths, institutional deliveries, clean cord care for newborns, thermal care for newborns, and immediate initiation of breastfeeding. However, there was no evidence of any effect of the intervention on postnatal care within 2 days of childbirth. Conclusions: This study shows the extent to which an information system for community health volunteers with low literacy was implemented at scale, and evidence of effectiveness at scale in improving maternal and newborn health care behaviors and practices.

Background: The expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government and its partners to improve the use of maternal health services, the coverage of postnatal care is persistently low in the country. This study examined the individual and community level determinants for the persistently low uptake of postnatal care in the project areas. Methods: The study used a cross-sectional population-based survey that measured maternal and newborn health care practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions. Multilevel random effects binary logistic regression analysis was used to assess the independent effects of community-and individual-level factors and moderating effects on the uptake of postnatal care. Results: This study identified region of residence, obstetric factors, and health service-related factors to be significant determinants for use of postnatal care. Obstetric factors include knowledge of obstetric danger signs (AOR: 1.30; 95% CI: 1.05-1.60), cesarean section mode of delivery (AOR: 1.96; 95% CI: 1.28-3.00), and institutional delivery (AOR: 10.29; 95% CI: 7.57-13.98). While the health service-related factors include attended family conversation during pregnancy (AOR: 1.48; 95% CI: 1.04-2.12), birth notification (AOR: 2.66; 95% CI: 2.15-3.29), home visits by community health workers (AOR: 1.98; 95% CI: 1.58-2.50), and being recognized as a model family (AOR: 1.27; 95% CI: 1.03-1.57). Conclusion: This study demonstrated that community-level interactions and promotive health services including antepartum home visits by community health workers, family conversation, birth notification, and model family, are important determinants to seek postnatal care. The findings also highlight the need for expansion of health facilities or design appropriate strategies to reach the disadvantaged communities. Program managers are recommended to strengthen community-based interventions to improve postnatal care utilization.

Background: Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low-and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. Methods: Before and after data from 134 intervention health centers were collected in April 2013 and July 2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. We estimated the dose-response relationships between outcome and explanatory variables of interest using regression methods. Results: The BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose-response relationship between the explanatory and outcome variables. For every unit increase in BEmONC implementation strength score there was a corresponding average of 4.5 percentage points (95% confidence interval: 2.1-6.9) increase in facility-based deliveries; while a higher score for BEmONC implementation strength of a health facility at follow-up was associated with a higher met need.

Knee Osteoarthritis (KOA) and aging are conditions that can compromise physical function and quality of life of human being. Thus, performance-based tests and specific self-reported measures related with KOA and general health-related quality of life (QoL) should be used in clinical intervention with elderlies. The study aim was to investigate which factors best predict the performance of the Timed "up-and-go" test in the elderly people with KOA. Eligibility criteria were age ≥ 60 years and uni or bilateral KOA. Subject performed physical tests [Timed "up-and-go" (TUG), Six Minutes Waking Test (6MWT), Five Repetition Sit-to-Stand Test (FRSTST)], Handgrip, 6 meters gait speed, Standing Balance], and filled self-reported questionnaires [Knee Injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EQ-5D-5F) and International Physical Activity Questionnaire (IPAQ)]. Pearson and Spearman coefficients were used for correlation analysis and multiple linear regression analysis to identify the significant predictors of Timed "up-and-go". Results: Final sample included 67 patients, 69±6 years of age. Timed "up-and-go" can be explained by two models. The best model (explained 80.7% of variance) included FRSTST, 6MWT, Gait Speed, KOOS ADL and EQ-5D-5F Self-Care variables. Conclusion: Functional strength, mobility, gait speed, and perceived limitation in activities of daily living influenced the TUG performance.

Objective: The aim of the study is to examine the effects of individuals awareness of periodontal disease on the quality of life by applying the Oral Health Impact Profile-14 (OHIP-14) questionnaire in relation to sociodemographic data, oral hygiene habits, oral health awareness levels and personal periodontal disease risk assessment. Materials and Method: 330 individuals who applied to Bülent Ecevit University Faculty of Dentistry Department of Periodontology were included in the study and the participants included the OHIP-14 questionnaire, a questionnaire containing sociodemographic information, oral hygiene habits questionnaire, dental background, questionnaire questioning periodontal awareness were used. Results: The results show there was no statistically significant difference between the sociodemographic data and OHIP-14 (p> 0.05). Periodontal awareness parameters were found to vary according to demographic data. Smoking lowers the OHIP-14 score (p <0.05). It was revealed that there is a significant relationship between age, gender, marital status and education levels and oral hygiene habits (p <0.05). and the higher the education level was positively correlated with the frequency of going to the dentist. Although there is no statistical relationship between periodontal awareness questions and OHIP-14 (p> 0.05), 71,2% of the population that we examined do not know what causes tooth and gum diseases. Conclusion: In the light of the results we have obtained, we think that individuals with poor awareness of periodontal disease may have a higher risk of disease and that awareness should be increased with written, visual and auditory methods.

Vitamin B 12 defciency may present with a myriad of symptoms. Rarely, skin hyperpigmentation may be the sole initial manifestation of this micronutrient defciency, which can easily be overlooked, leading to delayed diagnosis. This case report describes a 32-year-old Ghanaian male who presented with a 4-year history of progressive darkening of the dorsal aspects of the interphalangeal joints of both hands, the palms, and soles of the feet, for which he did not seek immediate medical attention. He later developed a worsening unsteady gait. Neurological assessment revealed mild weakness in both lower limbs, brisk knee refexes, diminished ankle refexes, and bilateral extensor plantar refexes. Additionally, he had decreased sensitivity to fne touch, impaired proprioception, and diminished vibration sense. His gait was ataxic with a positive Romberg's sign. Laboratory investigations showed macrocytosis with anemia and a markedly reduced serum vitamin B 12 level. Upper gastrointestinal endoscopy with biopsy identifed chronic gastritis. He was diagnosed with vitamin B 12 defciency secondary to chronic gastritis complicated by subacute combined degeneration of the cord. Following parenteral repletion of vitamin B 12 , the skin hyperpigmentation completely resolved. His neurological symptoms also signifcantly improved. This case report highlights the need to recognize skin hyperpigmentation as a potential initial symptom of cobalamin defciency, which is critical for early diagnosis and prompt initiation of treatment to prevent debilitating neurological complications.

We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

BACKGROUND: Women with a gynecologic cancer tend to be older, obese, and postmenopausal, characteristics that are associated with an increased risk for obstructive sleep apnea. However, there is limited investigation regarding the condition&#39;s prevalence in this population or its impact on postoperative outcomes. In other surgical populations, patients with obstructive sleep apnea have been observed to be at increased risk for adverse postoperative events. OBJECTIVE: We sought to estimate the prevalence of obstructive sleep apnea among gynecologic oncology patients undergoing elective surgery and to investigate for a relationship between obstructive sleep apnea and postoperative outcomes. STUDY DESIGN: Patients referred to an academic gynecologic oncology practice were approached for enrollment in this prospective, observational study. Patients were considered eligible for study enrollment if they were scheduled for a nonemergent inpatient surgery and could provide informed conse...

Background: High-risk patients are currently presenting for aortic valve replacement (AVR). Sutureless valves may decrease the operative risk in those patients. The objective of this study was to compare the short-term and one-year follow-up results of the sutureless Perceval valve versus bioprosthetic aortic valve. Methods: The data of patients who underwent elective AVR with bioprosthesis were collected From March 2012 to March 2017. The patients were divided into two groups; group 1 included the patients who had a sutureless aortic valve (Perceval) (n= 25; 3.57% of total AVR patients), and group 2 included patients who had conventional bioprosthesis (n= 50; 7.1% of total AVR patients). Results: The median age of patients in group 1 was 67 years (25th- 75th percentiles; 64-71), and in group 2 was 66 years  (25th- 75th percentiles: 63 to 69). There is no significant difference in the patients’ comorbidities between the two groups. The median duration of the ischemic time was signif...

Objective: To propose a framework for assessing the rigor of qualitative research that identifies and distinguishes between the diverse objectives of qualitative studies currently used in patient-centered outcomes and health services research (PCOR and HSR). Study Design: Narrative review of published literature discussing qualitative guidelines and standards in peerreviewed journals and national funding organizations that support PCOR and HSR. Principal Findings: We identify and distinguish three objectives of current qualitative studies in PCOR and HSR: exploratory, descriptive, and comparative. For each objective, we propose methodological standards that can be used to assess and improve rigor across all study phases—from design to reporting. Similar to quantitative studies, we argue that standards for qualitative rigor differ, appropriately, for studies with different objectives and should be evaluated as such. Conclusions: Distinguishing between different objectives of qualitat...

PurposeThe aim of the study was to estimate interfractional deviations in patient and prostate position, the impact of the frequency of online verification on the treatment margins, and to assess acute radiation reactions of high-dose external beam image-guided intensity-modulated radiotherapy (IG-IMRT) of localized prostate cancer.Patients and methodsIG-IMRT was performed by daily online verification of implanted fiducial prostate markers using a megavoltage electronic portal imaging device (EPID). A total of 1011 image-guided treatment fractions from 23 consecutive unselected prostate cancer patients were analyzed. The median total dose was 79.2 Gy (range 77.4–81.0 Gy). Acute radiation reactions were assessed weekly during radiotherapy using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.03.ResultsA relevant combined patient set-up and prostate motion population random error of 4–5 mm was observed. Compared to daily IGRT, image guidance every other day required an ...

Background: A chronic subdural hematoma (CSDH) is defined as chronic (≥3weeks) intracranial bleeding between the dura mater (which adheres to the skull), and the arachnoid mater which envelops the brain. It is usually traumatic and unilateral but rarely, spontaneous hematoma occurs especially in the elderly. Both could be bilateral. The neurological symptoms are usually non specific and may not be readily recognized in the absence of a clear history of head trauma. This is more so in resource limited environments where there is paucity of diagnostic facilities like the computerized tomography (CT) scan. We present a case of spontaneous bilateral acute on chronic hematoma masquerading as chronic headache in a 56 year old man. Method: The Case file of a 56 year old man admitted to the medical ward of the benue state university teaching hospital with chronic headache as well as literature search on the subject were used. Result: A 56 year old man was admitted with chronic headache and ...

Background: Covid-19 infection may necessitate ICU admission and mechanical ventilation support due to acute respiratory failure. Apart from respiratory decompensation, neurological manifestations are found to be quite common. Objective: The aim of this study is to evaluate the association of spontaneous subarachnoid hemorrhage and factors related to it.

BACKGROUND A clinical registry encompasses a selective set of rigorously collected and stored clinical data focused on a specific condition. Hyponatremia has multiple, complex underlying causes and is one of the most frequent laboratory abnormalities. No systematic registries of hyponatremic patients have been reported in the medical literature. The purpose of this project was to create a registry for hyponatremia in order to obtain epidemiological data that will help to better understand this condition. OBJECTIVE This paper describes the creation of a registry for hyponatremia within a single institution that employs industry-based approaches for quality management to optimize data accuracy and completeness. METHODS A prospective registry of incident hyponatremia cases was created for this study. A formalized statistically based quality control methodology was developed and implemented to analyze and monitor all the process indicators that were developed to ensure data quality. RES...

One-way sensitivity analyses were performed against all probability, utility, and cost values incorporated into this cost-effectiveness model. Results: In this analysis, AA provides substantial saving with $13,322 per patient versus ENZA. The main drivers of the model are drug costs, health utility values, and efficacy (OS and rPFS). The robustness of the results was supported by sensitivity analyses. ConClusions: Given similar OS benefits, AA is cost saving compared with ENZA for the treatment of patients with mCPRC post-docetaxel based on US data.

APPENDICE 1 DOMANDA DI CERTIFICAZIONE SICI-GISE DI CARDIOLOGO INTERVENTISTA Luogo e data________________________ La/Il sottoscritta/o Dr./Dr.ssa _________________________________________________ nata/o a___________________________________________il_______________________ CHIEDE Il rilascio della certificazione GISE di Cardiologo Interventista. Dichiara sotto la sua responsabilità di essere in possesso di Laurea in MEDICINA E CHIRURGIA conseguita il_________________presso________________________ Specializzazione in CARDIOLOGIA conseguita il_________________ presso________________________ A tal fine allega 1. Curriculum vitae in formato europeo 2. Prospetto dati di attività del centro di training relativi all’ultimo triennio 3. Attestazione delle procedure eseguite dal candidato come primo e secondo operatore rilasciato dal centro o dai centri presso cui è avvenuta la formazione 4. Modulo (allegato 2) compilato e firmato da parte del responsabile del centro dove ho svolto la formazion...

Abstract: The one-year outcome of the randomized controlled T.A.F.F. (Telephone based Adiposity prevention For Families) study is presented. Screening of overweight (BMI-SDS&gt; 90th centile) children 3.5–17.4 years was performed via the German CrescNet database, and candidates were randomized to an intervention group (IG) and control group (CG). The intervention consisted of computer-aided telephone counselling for one year, supported by mailed newsletters. The primary endpoint was change in BMI-SDS; secondary endpoints were eating behavior, physical activity, media consumption, quality of life. Data from 289 families (145 IG (51 % females); 144 CG OPEN ACCESS Int. J. Environ. Res. Public Health 2014, 11 10328 (50 % females)) were analyzed (Full Analysis Set: FAS; Per Protocol Set: PPS). Successful intervention was defined as decrease in BMI-SDS ≥ 0.2. In the FAS, 21 % of the IG was

Introduction: In low-resource neurosurgical settings, the choice of a reliable and efficient imaging tool for grading degenerative lumbar spinal stenosis (DLSS) is critical. The qualitative Schizas morphological classification and the quantitative Stenosis Ratio (SR) are two established methods, but their direct correlation and practical interchangeability in such environments are not well-documented. This study aimed to determine the correlation and inter-rater reliability between the Schizas grading system and the Stenosis Ratio in patients with symptomatic DLSS in a low-income country.

Methods: A retrospective cross-sectional radiological analysis was conducted on 50 consecutive patients scheduled for surgery. The researcher and two neuroradiologists independently graded the most stenotic axial T2-weighted MRI level using the Schizas system (Grades A-D) and measured the SR (dural sac area / bony canal area). Inter-rater reliability was assessed using Cohen’s Kappa and Intraclass Correlation Coefficient (ICC). Correlation between the two grading systems was evaluated using Spearman’s rank correlation (ρ).

Results: The cohort had a mean SR of 0.39 (SD 0.19). Schizas Grade C was the most prevalent (44%). Inter-rater reliability was excellent for both systems: SR (ICC = 0.984, p<0.001) and Schizas grade (κ = 0.90). A very strong, statistically significant negative correlation was  found between the Schizas grade and the SR (ρ = -0.821, p < 0.001), indicating convergent  validity.

Conclusion: This study demonstrates a strong radiological correlation and excellent reliability between the Schizas classification and the Stenosis Ratio. The findings validate the Schizas system as an efficient, reliable, and software-free tool for routine anatomical grading of DLSS in low-resource settings. The quantitative SR remains a precise option for complex cases, but the high concordance supports the primary use of the simpler qualitative method to optimise workflow in constrained environments.