Nurick Grades and Quality of Life Outcome in Cervical and Lumbar Spine Pathologies: A Cross-Sectional Study

Background: It is not known to what extent differences in radiological findings of individuals with spinal pathologies may be associated with their quality of life (QOL) and the degree of disabilities. Objective: This study aimed at determining if QoL and degree of disabilities differs in individuals with cervical and lumbar spine pathology with different magnetic resonance imaging (MRI) findings. Methods: This cross-sectional study of 185 purposively sampled patients was carried out at Radiological facilities in Rivers State, Nigeria. Magnetic resonance images were assessed for pathological findings, Nurick grade scales and Short Form Health survey (SF-36) QoL questionnaire were used to assess participant’s disability grade and QoL respectively. Results: Majority of the participants with cervical (n=49, 64%) and lumbar (n=86, 79.8%) spine pathologies were males. Degenerative spine pathology was the most common in both the cervical (75%) and lumbar (80.7%) spine regions. The patients with cervical (n=30, 39.5%) and lumbar (n=56, 50.5%) spine pathologies had Nurick grade I and Nurick grade II respectively. There were statistically significant differences in the physical functioning domain (k=12.27, p = 0.03) and role limitations due to emotional problem domain (k= 13.03, p = 0.02) among individuals with different Nurick grades. Conclusion: Males were commonly affected by the spinal pathologies. Degenerative spinal pathology was the most common in both the cervical and lumbar spine regions. The most prevalent degree of disabilities associated with cervical and/or lumbar spine pathologies was Nurick grade I and II respectively. Keywords: Disabilities, Pathology, Quality of lif

Adaptation and validation of the Nigerian (IGBO) version of the WHOQOL-OLD module

Objective: To adapt and validate the original English version of the World Health Organization Quality of Life Questionnaire-version for older adults (WHOQOL-OLD) in Igbo language, culture, and environment. Participants: Community-dwelling older adults (≥65 years) from Nnewi community in Nigeria. Methods: This was a cross-cultural adaptation and validation study. The original English version of the WHOQOL-OLD was translated into Igbo language, synthesized, backward translated into the English language, subjected to expert panel review, and pretested. The Igbo and English versions of the WHOQOL-OLD were then used to assess the quality of life among consecutively recruited 109 older adults through interviewer-administration. Findings: The structure of the Igbo version of the WHOQOL-OLD differed from that of the original WHOQOL-OLD. The Igbo version of the WHOQOL-OLD displayed acceptable internal consistency (0.63–0.95), known-group validity (0.60–0.99), convergent validity, and ceiling and floor effects. Conclusion: The I-WHOQOL-OLD is a reliable and valid tool and thus can be used as an outcome measure among Igbo-speaking older adults

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Pattern of Magnetic Resonance Imaging Findings in Lumbar Spine Pathologies and its Correlation with Demographic Variables in Rivers State

Introduction: Magnetic Resonance Imaging (MRI) currently is an excellent imaging modality of choice for the demonstration of pathologies of the lumbar spine and the intervertebral disc. A sound knowledge of the common pathologies of the lumbar spine in our setting will assist clinicians and radiologists in making accurate diagnosis. Aim: To determine the type and distribution of MRI findings in lumbar spine pathologies and its demographic correlation in Rivers State. Materials and Methods: This was an observational crosssectional study carried out among all symptomatic and asymptomatic patients who were referred for lumbar spine MRI at some selected Imaging Diagnostics Centres in Rivers State, from May 2020 to November 2020. The lumbar spine MRI examinations were performed using 0.35 Tesla MRI machines with both planar surface and multicoil phased array. The patients were evaluated for disabilities using the Nurick grading classifications. Data obtained were analysed using both descriptive (mean, deviation, frequency and percentage) and inferential (Pearson’s Correlation) statistical tools. The level of statistically significance was set at p <0.05. Results: Out of 151 patients that were included in this study, majority 78 (51.7%) of the patients were within the age group of 40-59 years with an overall mean age of 52.51±14 years. The majority 114 (75.50%) of the patients had single pathology. Among those that had single pathology, a greater proportion had spondylosis 65 (43.05%). A greater proportion 73 (48.34%) of the patients had single level of spinal involvement with lumbar vertebra four (L4) commonly affected in 26 (17.22%). Out of 151 patients, majority 49 (32.45%) had Nurick grade II and the least 7 (4.64%) had Nurick grade V. Conclusion: Lumbar spine pathologies frequently involve the fourth lumbar vertebra and middle-aged males are commonly affected

Magnetic resonance imaging findings in cervical and lumbar spine pathologies and their impact on the patients’ quality of life

AIMThis study was designed to evaluate the relationship between the magnetic resonance imaging (MRI) findings in cervical and lumbar spine pathologies and quality of life of the affected patients.MATERIALS AND METHODSThis was a cross-sectional study conducted among 242 patients diagnosed with cervical and lumbar spine pathologies. The Short-Form-36 questionnaire was used to collect data on the quality of life (Qol) outcomes. The data were analyzed using statistical tools.RESULTSThe Qol domains, all showed poor scores for lumbar pathologies; Physical-Function = 33.63 ± 12.07 and Role-Physical = 38.25 ±24.11). The Qol of patients with cervical pathologies were all poor with exception of role emotion (RE) reaching the 50% marks (51.65±22.91). The Chi-square (χ2) revealed statistically significant relationships between cervical spine pathologies and QoL parameters such as Vitality (2 = 228.663, p= 0.044) and social function ( χ2 = 269.089, p = 0.0000). There were statistically significant relationships between the lumbar spine pathologies and the QoL parameters; general health (χ2 = 308.916, p =0.000) and bodily pain (χ2 = 154.393, p = 0.000).CONCLUSIONSpondylotic changes were the commonest disease entity in both spinal regions. Participants with lumbar spine pathologies had poor quality of life in all subscales of the QoL domains and there was significant negative impact of the pathologies on the patients’ QoL. MRI practitioners can explore this aspect for protocol decision-making processes to optimize patient’s healthcare

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

BackgroundFuture trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050.MethodsUsing forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.FindingsIn the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]).InterpretationGlobally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.FundingBill & Melinda Gates Foundation.</p