Apparent diffusion coefficient and T2* mapping on 3T MRI in normal and degenerative lumbar intervertebral discs.

Purpose: To assess the utility of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) maps and T2* mapping in quantitative analysis of nucleus pulposus (NP) and annulus fibrosus (AF) of lumbar intervertebral discs with its correlation with modified Pfirrmann grading (MPG) for lumbar degenerative disc disease (LDDD). Material and methods: One hundred subjects (20-74 years of age) underwent T2-weighted, DWI with ADC and T2* magnetic resonance imaging. MPG was applied to L3-L4, L4-L5, and L5-S1 discs, and ADC and T2* values of NP and AF were calculated in the mid-sagittal plane by segmenting each disc into 5 regions of interest (ROI) (NP-3, AF-2). Mean ADC and T2* values, their correlation, and cut-offs among different grades were calculated at different ROIs across different levels. Results: Out of total 300 discs analysed; 68 were normal (grade I) discs and 232 were degenerated (grade II to VIII) discs, based on MPG. T2* and ADC values in NP, AF, and the entire disc were significantly lower in degenerated discs than in normal discs. There was significant (p < 0.001) negative correlation between ADC and T2* values with MPG. ADC and T2* cut-off values were statistically significant across grades, with area under the curve (AUC) values in moderate to high accuracy range (0.8 to > 0.9) for assessing the degree of LDDD. Conclusions: T2* and ADC value-based grade scales are highly accurate in evaluating the degree of disc degeneration with a high degree of objectivity in comparison to visual assessment-based MPG. Reduced ADC and T2* values of NP could serve as markers of early LDDD.

Barriers to Cancer Diagnosis and Treatment: A Pilot Qualitative Study of Patient and Practitioner Perspectives in Rural India.

Introduction Cancer remains a critical global health issue, particularly in developing countries, where timely diagnosis and effective treatment are often hindered by numerous barriers. These obstacles exacerbate the cancer burden and contribute to disparities in care. This study explores the barriers to cancer diagnosis and treatment from the perspectives of patients and healthcare providers in rural India, aiming to inform targeted interventions and improve outcomes. Methods This qualitative study was conducted from April to May 2024 at a tertiary cancer hospital in rural Western Maharashtra, India. Nine semi-structured interviews were conducted with five cancer patients and four healthcare practitioners. Participants were selected through purposive sampling until information saturation was achieved. Interviews were conducted in local languages and analyzed using thematic analysis to identify key barriers and themes. Results The study identified several major themes related to barriers to cancer diagnosis and treatment. Patients highlighted a lack of awareness and understanding of cancer, significant financial burdens, challenges in accessing healthcare facilities, and emotional distress. Healthcare practitioners noted systemic issues, including inadequate diagnostic capabilities, insufficient healthcare infrastructure, and a shortage of specialized providers. Both groups emphasized the impact of cultural beliefs and stigma, as well as the limited support systems available to patients. Conclusion The findings highlight the complex interplay of factors contributing to delays in cancer diagnosis and treatment in rural India. Addressing these barriers requires multifaceted interventions, including increasing public awareness, improving healthcare infrastructure, and enhancing support systems for patients. Policy development should focus on these areas to reduce disparities and improve cancer care outcomes in resource-limited settings.

People's Perspective on Out-of-Pocket Expenditure for Healthcare: A Qualitative Study From Pune, India.

Background Out-Of-Pocket Expenditure (OOPE) directly reflects the burden of health expenses that households bear. Despite the availability of social security schemes providing healthcare benefits, a high proportion of Indian households are still incurring OOPE. In order to recognize the reasons behind OOPE, a comprehensive understanding of people's attitudes and behavior is needed. Methodology By purposive sampling, 16 in-depth interviews were conducted using an interview guide in the catchment area of urban and rural health centers of a tertiary healthcare hospital. Interviews were conducted in Marathi and Hindi and were audio tape-recorded after taking informed consent. The interviews were transcribed and translated into English, followed by a thematic analysis. Results Although most participants knew that government hospitals provide facilities and experienced doctors, inconvenience and unsatisfactory quality deter them from utilizing government facilities. A few had experiences with government schemes; almost all concur that the formality and procedure of claiming insurance are cumbersome and all have had bad experiences. Cost of medications and consultation accounted for the majority of the healthcare expenditures. While some participants had benefitted from insurance, few regretted not enrolling in one. Conclusion The awareness regarding government schemes was derisory. Government-financed health insurance schemes and their utilization are crucial to reducing OOPE. Efforts should be made to increase accessibility to public healthcare services. Nevertheless, there is potential to redress the barriers to improve scheme utilization.