Disability In People Research Articles

Effect of a Podiatric Health Education Intervention on the Level of Self-care in Patients with Diabetes Mellitus.

To test the effect of a podiatric health education activity on foot self-care and the degree of foot-related disability in a group of people with diabetes mellitus (DM) in the province of Seville. A pretest-posttest quasi-experimental design was used. Twenty-nine people with DM participated. The intervention was a podiatric health education activity consisting of a 1-hour informative talk. Foot pain-related disability was measured using the Manchester Foot Pain and Disability Index. The degree of foot self-care was measured with the University of Malaga Foot Self-care questionnaire. One month after the intervention, both parameters had improved significantly. The mean score on the Manchester Foot Pain and Disability Index increased from 59.96 (SD, 8.69) at baseline to 67.39 (SD, 6.99) at 1 month, and the mean score on the University of Malaga Foot Self-care questionnaire improved from 11.65 (SD, 20.07) at baseline to 4.52 (SD, 5.47) after 1 month. Therapeutic education increases the level of self-care and decreases the degree of foot-related disability in people with DM.

External validation and updating of prognostic models for predicting recovery of disability in people with (sub)acute neck pain was successful: broad external validation in a new prospective cohort

Can existing post-treatment prognostic models for predicting neck pain recovery (primarily in terms of disability and secondarily in terms of pain intensity and perceived improvement) be externally validated and updated at the end of the treatment period and at 6 and 12 weeks of follow-up in a new Dutch cohort of people with neck pain treated with guideline-based usual care physiotherapy? External validation and model updating in a new prospective cohort of three previously developed prognostic models. People with (sub)acute neck pain and registered for primary care physiotherapy treatment. Recovery of disability, pain intensity, and perceived recovery at 6 and 12 weeks and at the end of the treatment period. Discriminative performance (c-statistic) of the disability model at 6 weeks was 0.73 (95% CI 0.69 to 0.77) and reasonably well calibrated after intercept recalibration. The disability model at 12 weeks and at the end of the treatment period showed discriminative c-statistic performance values of 0.69 (95% CI 0.64 to 0.73) and 0.68 (95% CI 0.63 to 0.72), respectively, and was well calibrated. Pain models and perceived recovery models did not reach acceptable performance. Cervical mobility added value to the disability models and pain catastrophising to the disability and pain models at 6 weeks. Broad external validation of the disability model was successful in people with (sub)acute neck pain and clinicians may use this model in clinical practice with reasonable accuracy. Further research is required to assess the disability model's clinical impact and generalisability, and to identify additional valuable model predictors. https://osf.io/a6r3k/.

Optical Coherence Tomography (OCT) Measurements and Disability in Multiple Sclerosis (MS): Protocol of Systematic Review

Background: It is commonly used to assess the severity and functional impairments associated with multiple sclerosis (MS) using the disability scales such as the expanded disability status scale (EDSS). A number of studies have demonstrated a correlation between optical coherence tomography (OCT) measurements, which demonstrate optical neurodegeneration, and disability, though some studies failed to detect a significant correlation.Objectives: The purpose of this study is to investigate the relationship between optical coherence tomography (OCT) measurements and disability in people with multiple sclerosis (pwMS).Inclusion criteria: Eligible peer-reviewed English studies will include a correlation coefficient between disability scales and OCT measurements.Methods: The systematic review will be conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. MEDLINE/Pubmed, Scopus, Embase, and Web of Science will be searched to identify published studies without date restrictions. Studies with potential relevance will be screened by titles and abstracts, and the full texts of potentially relevant studies will be reviewed for eligibility and critical review of the methodologies. Those studies selected for inclusion will provide data that will be extracted. An analysis of the data will be carried out in a statistical meta-analysis to the extent possible.Clinical implications: The results of this study may serve as a guide for determining which OCT measurements can be used to predict disability among pwMS.

장애인의 자기효능감, 대인관계, 자아존중감이 장애수용에 미치는 구조적 영향관계 분석

The purpose of this study is to confirm the relationship between self-efficacy, interpersonal relationships, and self-esteem on the acceptance of disabilities in people with disabilities, and to identify the mediating effect of self-esteem. SPSS 26.0 and WarpPLS 8.0 were used to analyze descriptive statistics and structural equation models for the research data. First, the self-efficacy of the disabled had a significant positive effect on self-esteem and had a positive effect on acceptance of disability. Second, interpersonal relationships had a significant positive effect on self-esteem and disability acceptance. Third, self-efficacy had a positive effect on disability acceptance through self-esteem as a partial medium, and interpersonal relationships had a positive effect on disability acceptance through self-esteem as a partial medium. Fourth, the interpersonal relationship of severely disabled people did not affect disability acceptance, but the interpersonal relationship of mildly disabled people had a significant positive effect on disability acceptance. The results of this study can be used as data for establishing welfare policies to strengthen disability acceptance, self-efficacy, interpersonal relationships and self-esteem of the disabled.

First Anatomy Annual Congress in Rwanda - October 13 – 15, 2022

Theme: Promoting anatomy to enlighten safe and effective clinical practice
 It is with a greater honor that I welcome you to this Anatomy Annual Congress, the first of its kind in Rwanda. Anatomy is an essential fundamental science in medical education and medical practice and it deserve to be vibrant scientifically. The S-CAR have been founded with the aim of growing the anatomy sciences and this congress is a wonderful outcome of this common commitment. The congress has 4 events that include: a pre-conference workshop on the peripheral nervous system, the S-CAR annual congress, the scientific conference and the world anatomy day (WAD).
 Reinforcing the importance of the PNS, Dr. David HAKIZIMANA, a Senior Consultant Neurosurgeon wrote this, I quote: “Peripheral nerve surgery is used to improve function and minimize pain and disability in people with peripheral nerve disorders, such as acute nerve injuries, entrapment neuropathies, and nerve sheath tumors. It involves rerouting healthy nerves to take over the function of the nerves affected by injury, disease, or condition. Surgical treatment for peripheral nerve injuries involves a team which may include: neurosurgeons, plastic surgeons, orthopedic surgeons. Globally the status of peripheral nerve surgery practice within the global landscape of surgery has long been in the shadow of the more prominent areas. The reasons are many, one of them plausibly being the conceptual frame of the very word “peripheral”, which evoke the notions of marginality and lesser importance especially for neurosurgeons. Some of the related common misconceptions are that neurological deficit in peripheral nerve injury is permanent and irreversible, that peripheral nerves do not have the ability to regenerate, that the results of surgical treatment are insignificant. In Rwanda and Africa in general peripheral nerve surgery in almost non-existing or at embryonic phase at best. Although peripheral nerve surgery is not a life-saving surgery, it has been proved to be a life-changing surgery, with a major impact on the quality of patient’s life, as it improves the patient’s ability to perform every day and professional activities and thus affects his/her physical and psychological well-being. Moreover, since most patients with peripheral nerve injuries and brachial plexus injuries belong to the working-age population, peripheral nerve surgery also has substantial socioeconomic implications. Contrary to the previously held view, the peripheral nerve system has been shown to have a huge regeneration potential, with significant results enhanced by different modalities of stimulation, whereby recent research on brain plasticity indicates that experience-dependent reorganization of neural networks plays an important role in functional recovery. For all these reasons, systematic research, education, and practice in peripheral nerve surgery is definitely worth the effort. The aim of this course will be to train residents and interested surgeons from Rwanda in peripheral nerve surgery skills”. The rich scientific conference program with 37 presentations subdivided in sessions on medical education, congenital defects, anatomy and anatomical variations, neurosciences, free presentations, closure lecture, scientific forum for PhD and MSC candidates, cadavers for education and research will give to you an excellent experience. On behalf of S-CAR, I am grateful to the sponsors (MoH, UR, UGHE, AUCA-ASOME, Operation Smile, CHUK and MMI).

The case for improving the detection and treatment of obstructive sleep apnea following stroke.

[See related research at www.cmaj.ca/lookup/doi/10.1503/cmaj.221063][1] KEY POINTS Stroke is a leading cause of death and disability for people in Canada. Beyond the initial brain injury, the sequelae of stroke may also include several comorbidities, with sleep disorders being among the most

Neighborhood Vulnerability and Disability in First Episode of Psychosis: A Multilevel Study.

Objective: Neighborhood socioeconomic status seems to be related to functioning in patients with first episode of psychosis (FEP). The present study aimed to assess if neighborhood vulnerability and risk of social exclusion could predict functional outcomes in people with FEP after controlling for other key variables identified in previous literature.Methods: A total of 137 patients with FEP (DSM-IV-TR criteria) and 90 controls comprised the study sample from February 2013 to May 2019. Functioning was assessed with the WHO Disability Assessment Schedule. Neighborhood vulnerability was measured using a multidimensional socioeconomic deprivation index; data for the index were collected by the Madrid City Council and based on the participant's home address. Multilevel mixed-effects regression analyses were conducted to estimate the effects of neighborhood vulnerability on functioning.Results: Our results show that FEP patients could be more vulnerable to the effects of neighborhood-level characteristics than healthy controls (B = 1,570.173; z = 3.91; P < .001). In addition, our findings suggest that higher neighborhood vulnerability is related to greater functional disability in people with FEP, after controlling for other relevant confounders (B = 1,230.332; z = 2.59; P = .010).Conclusions: These results highlight the importance of incorporating contextual factors into assessment of patients with FEP, since psychosocial difficulties observed in these patients could be partially related to the quality of neighborhood social-related resources.

Pathology-supported genetic testing presents opportunities for improved disability outcomes in multiple sclerosis.

Background: Lipid metabolism may impact disability in people with multiple sclerosis (pwMS). Methods: Fifty-one pwMS entered an ultrasound and MRI study, of whom19 had followed a pathology-supported genetic testingprogram for more than10years (pwMS-ON). Genetic variation, blood biochemistry, vascular blood flow velocities, diet and exercise were investigated. Results: pwMS-ON had significantly lower (p<0.01) disability(Expanded Disability Status Scale) than pwMS not on the program (1.91±0.75 vs 3.87±2.32). A genetic variant in the lipid transporterFABP2 gene (rs1799883; 2445G>A, A54T) was significantly associated (p<0.01) with disability in pwMS not on the program, but not in pwMS-ON (p=0.88). Vascular blood flow velocities were lower in the presence of the A-allele. Conclusion: Pathology-supported genetic testingmay provide guidance for lifestyle interventions with a significant impact on improved disability in pwMS.

Effectiviness of a crisis comunity-based program in primary mental health care

IntroductionA crisis is defined as a disruption in equilibrium at the failure of own personal resources which results in important distress and functional impairment. Particularly after Covid-19 pandemic we have been attending an increased number of this kind of consultations in the mental health services.ObjectivesTo expose a new mental health program called PAIC (Ambulatory Intensive Community Program) started in March 2019 and addressed to people who are suffering a crises period, and to evaluate its effectiveness. The aim of this program is to reach prior stability, trying to avoid chronicity, clinical status perpetuation and sociofunctional impairment, as well as assessing suicidal risk and perform early prevention interventions.MethodsPAIC is proposed as an early, intensive, focused and psychotherapeutic intervention led by psychiatrist. Consist in an 8-week program of 30 to 60 minute weekly individual sessions. A total of a 205 patients were attended in PAIC during 2021 and 84,6% of the patients completed the program. Mixed-methods, clinical interviews and measurements using validated self-administrated questionnaires were used: CORE-OM pre/post treatment (“Clinical Outcomes in Routine Evaluation-Outcome Measure”), List of Threatening Experiences, LTE and Clinical Global Impression (CGI-I). Changes in CORE-OM Scale were analysed using t-student test and a descriptive analysis was used for CGI-results.ResultsCORE-OM (“Clinical Outcomes in Routine Evaluation-Outcome Measure”) showed improvement in all of four dimensions: subjective well-being (TW), problems/symptoms (PT), general function (TF) and risk (TR).Perception of clinical improving measured by CGI was 81,6%. There were no cases of clinical worsening.ConclusionsWe conclude that intensive and early programs are effective reducing the intensity of symptoms and the level of disability in people who are experiencing a psychological crisis. Also, it supports primary health care as well as helps to avoid saturation of specialized system.Disclosure of InterestNone Declared

The nonalcoholic fatty liver risk in prediction of unfavorable outcome after stroke: A nationwide registry analysis

Few researches have looked at the relationship between nonalcoholic fatty liver disease (NAFLD) at the time of admission and the long-term outcomes of patients suffering from acute ischemic stroke (AIS). We aimed to probe the relationship between NAFLD risk evaluated by NAFLD indices and long-term endpoints, along with the prognostic value of merging NAFLD indices with established risk markers for the prognosis of AIS patients. The fatty liver index (FLI) and the Hepatic steatosis index (HSI) were used to evaluate NAFLD risk in the Third China National Stroke Registry (CNSR-III), a large, prospective, national, multicenter cohort registry study. NAFLD was defined as FLI ≥35 for males and FLI ≥ 20 for females, as well as HSI>36. Death or major disability (modified Rankin Scale score ≥3) were the primary outcomes following the beginning of a stroke. On patient outcomes, the prognostic performance of two objective NAFLD parameters was evaluated. NAFLD was detected in 32.10-51.90% of AIS patients. After 1-year, 14.5% of the participants had died or suffered a severe outcome. After controlling for known risk factors, NAFLD was associated with a modest probability of adverse outcome (odds ratio,0.72[95% CI, 0.61-0.86] for FLI; odds ratio,0.68[95% CI, 0.55-0.85] for HSI). The inclusion of the two NAFLD indicators in the conventional prediction model was justified by the integrated discrimination index, continuing to increase the model's overall predictive value for long-term adverse outcomes. NAFLD risk was linked to a lower risk of long-term death or major disability in people with AIS. The predictive value of objective NAFLD after AIS was demonstrated in our study.

Disproportionate disability in people with HIV

Successful HIV care has long been defined as consistent, long-term viral suppression; but the vast amount of literature assessing disease burden and health outcomes in people with HIV taking suppressive antiretroviral therapy, especially among long-term HIV survivors, shows a contrasting situation. Even with effective antiretroviral therapy, people with HIV have higher rates of episodic comorbidities, chronic comorbidities, and mental health disorders, as well as poorer quality of life, compared with people without HIV.

Explore the Influence of Reading Hellish Gags on Negative Emotions

Disparagement humor is a kind of communication that includes denigration but draws forth amusement, while a hellish gag is one of the typical forms of that. A hellish gag is a kind of joke that uses other people's disability, tragedy, illness, racial discrimination, war, occupation, death, etc., as a point of humor. This study modeled a mediation test using reading hellish gags, sympathy, and discrimination against blacks, and designed a single-blind experiment to test the null hypothesis. The results showed that reading hellish gags significantly impaired empathy. In addition, It was determined that diminished empathy fully mediated the relationship between reading hellish gags and increased discrimination against blacks, with the mediating effect accounting for 100% of the total effect. Also, some people may be offended and unable to appreciate the humor when the hellish gags involve something related to the group of people comprehending the humor.

Cardiovascular risk factors in diabetic patients with and without metabolic syndrome: a study based on the Rafsanjan cohort study

Cardiovascular disease (CVD) is the leading cause of death and disability in people with diabetes mellitus (DM), since finding the correlation between DM and CVD risk factors can be effective in preventing the incidence of morbidity and mortality in patients. This study aimed to determine the prevalence of cardiovascular risk factors in people with and without metabolic syndrome (MtS) in DM. This cross-sectional study was part of the Rafsanjan Cohort Study as part of the comprehensive Persian (Prospective Epidemiological Research Studies in IRAN) on 35–70-year old adults with and without MtS in DM. Indicators of CVD risk factors, including gender, age, blood pressure, dyslipidemia, smoking, alcohol consumption, fasting blood sugar, creatinine, blood urea, waist circumference, body mass index, family history, physical inactivity, and fruit and vegetable consumption, were collected in the Persian Cohort Questionnaire. The data was analyzed by SPSS software version 22. The prevalence of MtS in 1933 participants was estimated to be 80% (95% confidence interval 78.1–81.8%). In the logistic regression model, smoking, alcohol consumption, and triglycerides were identified as the factors associated with MtS. Our results show that, based on our study, the prevalence of cardiovascular risk factors in DM was high. The suggested solutions in this field are to reduce smoking and alcohol consumption, as well as to control hypertension, hyperlipidemia, and being overweight.

Intrinsic foot muscle size and associations with strength, pain and foot-related disability in people with midfoot osteoarthritis

BackgroundTo compare intrinsic foot muscle size between people with and without symptomatic midfoot osteoarthritis, and examine the association between muscle size and strength, pain and foot-related disability. MethodsTwenty-three participants with symptomatic midfoot osteoarthritis and 23 age, sex and BMI matched controls were included. Intrinsic foot muscle cross-sectional area was measured using MRI. Hand-held dynamometry was used to assess foot and ankle muscle strength, and foot-related pain and disability was measured using Manchester Foot Pain & Disability Index. FindingsSmall and non-statistically significant differences were found in intrinsic foot muscle cross-sectional area between the two groups (effect sizes 0.15–0.26, p > 0.05). Muscle strength was reduced in the midfoot osteoarthritis group, with differences of 12–33% (effect sizes 0.47–1.2). In the control group, moderate positive associations) existed between foot muscle cross-sectional area and lesser digits flexor strength (r = 0.5 to 0.7, p < 0.05). Conversely, in the midfoot osteoarthritis group, negligible positive associations were found (r < 0.3, p > 0.05). Associations between foot muscle cross-sectional with and pain and disability scores in the midfoot osteoarthritis group were negligible (r < −0.3, p > 0.05). InterpretationDespite reductions in maximal isometric muscle strength, midfoot osteoarthritis does not appear to be associated with reduced intrinsic foot muscle cross-sectional area measured by MRI. Muscle compositional or neural factors may explain the reductions in muscle strength and variation in symptoms in people with midfoot osteoarthritis and should be investigated.

EMPOWERMENT AND IMPROVEMENT OF FAMILY WELFARE GOVERNMENT PROGRAM FOR COUPLES WITH DISABILITIES AURA LENTERA BANYUWANGI

This research aims to overcome the problem of Empowerment and Inmprovement of Family Welfare for Couples with Disabilities Aura Lentera Banyuwangi. The purpose of this research is to overcome the problems of Partner Problems, namely there is still no continuity of empowerment programs carried out by the government for family couples with disabilities. Generally, training is only for persons who are still in their teens or in school. Some Based on these data, other problems can be identified as follows: 1. Many women and wives with disabilities become the main support for the family and help their husbands who have disabilities; 2. There are several couples, in general there are dominant partners who both have limitations as persons with disabilities, both husband and wife; 3. There is still a lack of Family Economic empowerment programs for people with visual impairments and other disabilities for people who are already married; 4. Lack of Accessibility Welfare Program for families with visual impairments and people with other visual impairments is still rare; 5. Pro-disability government policy programs. However, this information has not yet arrived or has not been reached by persons with disabilities; 6. Problems with limitations in improving the economy and family welfare of spouses with disabilities; 7. Government programs that have been made for all components of society are not yet accessible, especially for vulnerable groups, especially people with disabilities, both visually impaired and other handicapped; 8. Accessibility of information on economic empowerment and education is still not easily accessible to persons with disabilities, especially the visually impaired; 9. There is no family economic empowerment starting from family spiritual development; 10. Education is still rare in maintaining environmental cleanliness and health with healthy and halal eating patterns; 11. There has been no special socialization for groups of people with families who are already married to exercise regularly to be healthy and avoid various kinds of diseases; 12. Training is still rare in accordance with the limitations and competencies possessed by persons with disabilities, both visually impaired and other handicapped. Just a little like massage training. Forms of business skills to increase household income, such as home industry business skills to date are making cakes, and salted eggs. As well as some visually impaired persons who have vocal abilities and are members of the Al Mumtaz MSME arts community, which have not been accommodated in a sustainable manner. The solutions offered are 1. By holding a socialization of government programs for the disabled, inviting BLK and Welfare of the Banyuwangi Regency Government to share discussions; 2. Family economic empowerment, family spiritual development, self-actualization motivation in the fields of education, health, economy; 3. Socialization of healthy living, healthy and halal eating patterns; 4. Community motivation; 5. Accessibility of information on empowerment programs The output targets to be achieved are increased understanding of training participants, increased accessibility of Banyuwangi district government programs and hopes for improving the welfare of families with persons with disabilities; publication of online media and print media, compiling articles related to service in the form of national journals, photos and videos of activity documentation.Keywords: Empowerment; Accessibility; Women's Welfare; Government Program; Aura Lantern

Ensemble machine learning identifies genetic loci associated with future worsening of disability in people with multiple sclerosis

Limited studies have been conducted to identify and validate multiple sclerosis (MS) genetic loci associated with disability progression. We aimed to identify MS genetic loci associated with worsening of disability over time, and to develop and validate ensemble genetic learning model(s) to identify people with MS (PwMS) at risk of future worsening. We examined associations of 208 previously established MS genetic loci with the risk of worsening of disability; we learned ensemble genetic decision rules and validated the predictions in an external dataset. We found 7 genetic loci (rs7731626: HR 0.92, P = 2.4 × 10–5; rs12211604: HR 1.16, P = 3.2 × 10–7; rs55858457: HR 0.93, P = 3.7 × 10–7; rs10271373: HR 0.90, P = 1.1 × 10–7; rs11256593: HR 1.13, P = 5.1 × 10–57; rs12588969: HR = 1.10, P = 2.1 × 10–10; rs1465697: HR 1.09, P = 1.7 × 10–128) associated with risk worsening of disability; most of which were located near or tagged to 13 genomic regions enriched in peptide hormones and steroids biosynthesis pathways by positional and eQTL mapping. The derived ensembles produced a set of genetic decision rules that can be translated to provide additional prognostic values to existing clinical predictions, with the additional benefit of incorporating relevant genetic information into clinical decision making for PwMS. The present study extends our knowledge of MS progression genetics and provides the basis of future studies regarding the functional significance of the identified loci.

Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage.

Rebleeding is an important cause of death and disability in people with aneurysmal subarachnoid haemorrhage. Rebleeding is probably related to the dissolution of the blood clot at the site of the aneurysm rupture by natural fibrinolytic activity. This review is an update of previously published Cochrane Reviews. To assess the effects of antifibrinolytic treatment in people with aneurysmal subarachnoid haemorrhage. We searched the Cochrane Stroke Group Trials Register (May 2022), CENTRAL (in the Cochrane Library 2021, Issue 1), MEDLINE (December 2012 to May 2022), and Embase (December 2012 to May 2022). In an effort to identify further published, unpublished, and ongoing studies, we searched reference lists and trial registers, performed forward tracking of relevant references, and contacted drug companies (the latter in previous versions of this review). Randomised trials comparing oral or intravenous antifibrinolytic drugs (tranexamic acid, epsilon amino-caproic acid, or an equivalent) with control in people with subarachnoid haemorrhage of suspected or proven aneurysmal cause. Two review authors (MRG &amp; WJD) independently selected trials for inclusion, and extracted the data for the current update. In total, three review authors (MIB &amp; MRG in the previous update; MRG &amp; WJD in the current update) assessed risk of bias. For the primary outcome, we dichotomised the outcome scales into good and poor outcome, with poor outcome defined as death, vegetative state, or (moderate) severe disability, assessed with either the Glasgow Outcome Scale or the Modified Rankin Scale. We assessed death from any cause, rates of rebleeding, delayed cerebral ischaemia, and hydrocephalus per treatment group. We expressed effects as risk ratios (RR) with 95% confidence intervals (CI). We used random-effects models for all analyses. We assessed the quality of the evidence with GRADE. We included one new trial in this update, for a total of 11 included trials involving 2717 participants. The risk of bias was low in six studies. Five studies were open label, and we rated them at high risk of performance bias. We also rated one of these studies at high risk for attrition and reporting bias. Five trials reported on poor outcome (death, vegetative state, or (moderate) severe disability), with a pooled risk ratio (RR) of 1.03 (95% confidence interval (CI) 0.94 to 1.13; P = 0.53; 5 trials, 2359 participants; high-quality evidence), which showed no difference between groups. All trials reported on death from all causes, which showed no difference between groups, with a pooled RR of 1.02 (95% CI 0.90 to 1.16; P = 0.77; 11 trials, 2717 participants; high-quality evidence). In trials that combined short-term antifibrinolytic treatment (&lt; 72 hours) with preventative measures for delayed cerebral ischaemia, the RR for poor outcome was 0.98 (95% CI 0.81 to 1.18; P = 0.83; 2 trials, 1318 participants; high-quality evidence). Antifibrinolytic treatment reduced the risk of rebleeding, reported at the end of follow-up (RR 0.65, 95% CI 0.47 to 0.91; P = 0.01; 11 trials, 2717 participants; absolute risk reduction 7%, 95% CI 3 to 12%; moderate-quality evidence), but there was heterogeneity (I² = 59%) between the trials. The pooled RR for delayed cerebral ischaemia was 1.27 (95% CI 1.00 to 1.62; P = 0.05; 7 trials, 2484 participants; moderate-quality evidence). However, this effect was less extreme after the implementation of ischaemia preventative measures and &lt; 72 hours of treatment (RR 1.10, 95% CI 0.83 to 1.46; P = 0.49; 2 trials, 1318 participants; high-quality evidence). Antifibrinolytic treatment showed no effect on the reported rate of hydrocephalus (RR 1.09, 95% CI 0.99 to 1.20; P = 0.09; 6 trials, 1992 participants; high-quality evidence). The current evidence does not support the routine use of antifibrinolytic drugs in the treatment of people with aneurysmal subarachnoid haemorrhage. More specifically, early administration with concomitant treatment strategies to prevent delayed cerebral ischaemia does not improve clinical outcome. There is sufficient evidence from multiple randomised controlled trials to incorporate this conclusion in treatment guidelines.

Infraslow Neurofeedback Training Alters Effective Connectivity in Individuals with Chronic Low Back Pain: A Secondary Analysis of a Pilot Randomized Placebo-Controlled Study.

This study explored the effect of electroencephalographic infraslow neurofeedback (EEG ISF-NF) training on effective connectivity and tested whether such effective connectivity changes are correlated with changes in pain and disability in people with chronic low back pain. This involved secondary analysis of a pilot double-blinded randomised placebo-controlled study. Participants (n = 60) were randomised to receive ISF-NF targeting either the pregenual anterior cingulate cortex (pgACC), dorsal anterior cingulate and somatosensory cortex (dACC + S1), ratio of pgACC*2/dACC + S1, or Sham-NF. Resting-state EEG and clinical outcomes were assessed at baseline, immediately after intervention, and at one-week and one-month follow-up. Kruskal-Wallis tests demonstrated significant between-group differences in effective connectivity from pgACC to S1L at one-month follow up and marginal significant changes from S1L to pgACC at one-week and one-month follow up. Mann-Whitney U tests demonstrated significant increases in effective connectivity in the ISF-NF up-training pgACC group when compared to the Sham-NF group (pgACC to S1L at one-month (p = 0.013), and S1L to pgACC at one-week (p = 0.008) and one-month follow up (p = 0.016)). Correlational analyses demonstrated a significant negative correlation (ρ = -0.630, p = 0.038) between effective connectivity changes from pgACC to S1L and changes in pain severity at one-month follow-up. The ISF-NF training pgACC can reduce pain via influencing effective connectivity between pgACC and S1L.

Rehabilitation information systems: What we know and what we want

Per the definition of the World Health Organization, rehabilitation is a set of interventions designed to optimize performance and reduce disability in people with a varying range of health-related disorders in interacting with their environment. Like many other fields of the health-care realm, the application and integration of valid and reliable research are perceivably highly primitive. It is not possible to accurately measure or predict the need for rehabilitation services in general, and it is certainly difficult to do so for specific demographic or geographic classes. Service providers lack the tools to make objective policy and financial decision-making at the systemic level without accurate and reliable information management practices. To gain the capacity to transform the current guidelines of the ministry and make financial changes in the entire rehabilitation process, the rehabilitation sector needs a strong voice and a solid political base to guide the rehabilitation process therefrom. The current narrative review focuses on our knowledge of rehabilitation information systems and what we know and what we want.

How is neuromuscular fatigability affected by perceived fatigue and disability in people with multiple sclerosis?

Whereas fatigue is recognized to be the main complaint of patients with multiple sclerosis (PwMS), its etiology, and particularly the role of resistance to fatigability and its interplay with disability level, remains unclear. The purposes of this review were to (i) clarify the relationship between fatigue/disability and neuromuscular performance in PwMS and (ii) review the corticospinal and muscular mechanisms of voluntary muscle contraction that are altered by multiple sclerosis, and how they may be influenced by disability level or fatigue. Neuromuscular function at rest and during exercise are more susceptible to impairement, due to deficits in voluntary activation, when the disability is greater. Fatigue level is related to resistance to fatigability but not to neuromuscular function at rest. Neurophysiological parameters related to signal transmission such as central motor conduction time, motor evoked potentials amplitude and latency are affected by disability and fatigue levels but their relative role in the impaired production of torque remain unclear. Nonetheless, cortical reorganization represents the most likely explanation for the heightened fatigability during exercise for highly fatigued and/or disabled PwMS. Further research is needed to decipher how the fatigue and disability could influence fatigability for an ecological task, especially at the corticospinal level.