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BACKGROUND: Health seeking behaviour and health seeking pathways are interdependent concepts underpinning access to healthcare. Understanding these concepts is critical for appropriate and time-dependant stroke interventionsMETHOD: An explorative qualitative study design using one-on-one semi-structured interviews were conducted with 16 participants who were either stroke survivors or caregivers of stroke survivors. The Socio-Ecological Model (SEM) was used to guide data collection and the discussion of the findings in line with the objectives of this studyFINDINGS: The traditional health practitioners (n=11) were the most preferred first encounter followed by public hospital (n = 2) and private hospital (n=1) while others (n=2) self-medicated. On average, it took 30 days for stroke survivors to navigate the health system. The two themes emerging from this study, were 'health seeking delays', and 'the health seeking behaviour factor'CONCLUSIONS: A combination of factors influenced the health seeking delays at the levels of the SEM. The participants' health seeking behaviours were influenced by their knowledge, attitude, and beliefs at individual and interpersonal levels as well as dissatisfaction with health services at organizational and public policy levels of the SEM. In the South African rural settings, stroke survivors seek medical help from multiple service providers prior to consulting the public healthcare system due to diverse factors that affect them at interpersonal organizational, community and policy levels

Objectives: The aim of this systematic review was to inform the update of European League Against Rheumatism (EULAR) Recommendations for the management of Behçet's syndrome (BS), on the evidence for the treatment of skin, mucosa and joint involvement of BS. Methods: A systematic literature search, data extraction, statistical analyses and assessment of the quality of evidence were performed according to a pre-specified protocol using the PRISMA guidelines. Studies that assessed the efficacy of an intervention in comparison to an active comparator or placebo for oral ulcers, genital ulcers, papulopustular lesions, nodular lesions or arthritis were included. Where possible, risk ratios were calculated for binary outcomes and mean difference for continuous outcomes. Results: Among the 3927 references that were screened, 37 were included in the analyses. Twenty-seven of these assessed mucocutaneous and 17 assessed joint involvement. Twenty-one of these studies were randomised controlled trials (RCTs). RCTs with colchicine, azathioprine, interferon-alpha, thalidomide, etanercept and apremilast showed beneficial results with some differences according to lesion type and gender. These agents were generally well tolerated with few adverse events causing withdrawal from the study. Conclusions: RCTs comprised more than a half (21/37, 57%) of the sources included in the evidence synthesis related to skin, mucosa and joint involvement applicable for the EULAR Recommendations for the management of BS. Differences in the outcome measures that were used across the included studies often made it difficult to combine and compare the results. © 2018 Elsevier Inc.

Objective. To assess the efficacy and safety of treatment modalities for major organ involvement of Behçet’s syndrome (BS), in order to inform the update of the EULAR recommendations for the management of BS. Methods. A systematic literature review of all randomized controlled trials, controlled clinical trials, or open label trials assessing eye, vascular, nervous system or gastrointestinal system involvement of BS was performed. If controlled trials were not available for answering a specific research question, uncontrolled studies or case series were also included. Results. We reviewed the titles and abstracts of 3927 references and 161 studies met our inclusion criteria. There were only nine randomized controlled trials. Observational studies with IFN-α and monoclonal anti-TNF antibodies showed beneficial results for refractory uveitis. Meta-analysis of case-control studies showed that immunosuppressives decreased the recurrence rate of deep vein thrombosis significantly whereas anticoagulants did not. CYC and high dose glucocorticoids decreased mortality in pulmonary arterial aneurysms and postoperative complications in peripheral artery aneurysms. Beneficial results for gastrointestinal involvement were obtained with 5-ASA derivatives and AZA as first line treatment and with thalidomide and/or monoclonal anti-TNF antibodies in refractory cases. Observational studies for nervous system involvement showed improved outcome with immunosuppressives and glucocorticoids. Meta-analysis of case-control studies showed an increased risk of developing nervous system involvement with ciclosporin-A. Conclusion. The majority of studies related to major organ involvement that informed the updated EULAR recommendations for the management of BS were observational studies. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Several new treatment modalities with different mechanisms of action have been studied in patients with Behçet's syndrome (BS). The aim of the current effort was to update the recommendations in the light of these new data under the auspices of the European League Against Rheumatism (EULAR) Standing Committee for Clinical Affairs. A task force was formed that included BS experts from different specialties including internal medicine, rheumatology, ophthalmology, dermatology, neurology, gastroenterology, oral health medicine and vascular surgery, along with a methodologist, a health professional, two patients and two fellows in charge of the systematic literature search. Research questions were determined using a Delphi approach. EULAR standardised operating procedures was used as the framework. Results of the systematic literature review were presented to the task force during a meeting. The former recommendations were modified or new recommendations were formed after thorough discussions followed by voting. The recommendations on the medical management of mucocutaneous, joint, eye, vascular, neurological and gastrointestinal involvement of BS were modified; five overarching principles and a new recommendation about the surgical management of vascular involvement were added. These updated, evidence-based recommendations are intended to help physicians caring for patients with BS. They also attempt to highlight the shortcomings of the available clinical research with the aim of proposing an agenda for further research priorities. © 2018 Article author(s).

Formal institutional ecosystems management has been in existence since the creation of the Yellowstone National Park in the United States of America in 1872. Subsequently, many countries, including Zambia have evolved both legislative and policy frameworks for protecting various ecosystems. This move implied creating institutions to manage such areas accompanied by a statute to police the given area. Offenders are punished for breaking the law that protects the given resource. The results from such actions have been a growing conflict between the local communities and the ecosystem or resource management institution. In order to create harmony, ecosystems managements, in some sectors have evolved new strategies of sharing management responsibilities and benefits with local communities. This specific resource is in the wildlife sector in Zambia. The need to balance management costs and the benefits from the ecosystem services thus arises. However, in order to strike a reasonable balance, consideration should be given to adopting additional management tools for evaluating ecosystems so that one can place an economic value on any given resource. The major tool that has seen wide application in Zambia has been the Environmental Impact Assessment (EIA). However, methods for carrying out economic evaluation of ecosystems exist and have been developed over the years elsewhere. They include the Travel Cost Method (TCM). This method uses a surrogate market to estimate a consumer surplus and is site specific. The second common method is the Contingent Valuation Method (CVM) that solicits for a respondents willingness to pay (WTP) for an improvement to an environmental good or the willingness to accept (WTA) for a loss or partial loss of an environmental good using a hypothetical market. As a tool, the CVM can also be used in calculating a cost benefit analysis for a project in a given area and there by arriving at an economic decision. The method can also be used in a failed or derelict ecosystem reclamation and restoration efforts. Any conservation effort should consider the local community needs. Key words: Contingent valuation method (CVM), travel cost method (TCM), willingness to pay (WTP), willingness to accept (WTA), environmental impact assessment (EIA).