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.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.

BackgroundSelf-management education (SME) is an important yet unacknowledged aspect of diabetes care. Despite the raise of diabetes and its complications with significant burden in developing countries, research on SME interventions in Morocco is lacking.AimsTo assess the effectiveness of a culturally tailored SME intervention on foot-care self-management practices among type 2 diabetes patients and to identify factors associated with practices variation.MethodsWe designed a pre-post prospective quasi-experimental study and recruited patients with type 2 diabetes aged 30 years old or above. The intervention consisted of an interactive group discussion using different materials: a narrative video, a PowerPoint presentation and a printed guide. Foot-care practices were assessed prior to the session and one month later using 2 items from the Summary of Diabetes Self-Care Activities (SDSCA). Binary logistic regression was performed to identify factors associated with a favorable variation, defined as an increase in the mean frequency score of foot-care by a minimum of 1 day/week.ResultsA total of 199 participants were recruited and 133 completed the second assessment. Mean age was 55.2 ± 11.2 years old. Women represented 67% and 72% of participants was illiterate. The foot-care score mean increased from 3.5 ± 2.9 days to 5.9 ± 1.8 days one month after the intervention (mean variation was 2.4 ± 3.1 days; p < 0.001). A favorable variation was found among 75 (37.7%) participants. In multivariate analysis, literacy was associated with higher likelihood of a favorable variation of foot-care practices (OR = 2.82; 95%CI: 1.09–7.31) while previous education about diabetic foot was associated with lower likelihood of a favorable variation (OR = 0.26; 95%CI: 0.08–0.78).ConclusionsThere was a general improvement in foot-care practices after the intervention. Our findings suggest the role of literacy and previous patient education in shaping the observed variation. Culturally tailored interventions targeting other disease management domains are needed in our context.

Background. On the announcement of the COVID-19 health emergency, the Marrakesh School of Medicine accelerated the digitization and the establishment of courses available to students through the faculty platform. We aimed to describe the students’ perspectives toward the online educational approach implemented during the COVID-19 pandemic and to investigate the factors that might affect the implementation of online teaching in the future. Methods. This was a cross-sectional study among medical students in Marrakesh during June-July 2020. Data collection was based on a self-administered electronic questionnaire distributed via the student platform. We studied the knowledge and previous practices of virtual technologies and students’ appreciation of distance learning during the lockdown. Univariate and multivariate analyses were performed using SPSS16.0 software. Results. A total of 111 students participated. The female-to-male sex ratio was 2.2 with an average age of 20.6 ± 1.8. The majority of students felt that they had a good knowledge of virtual technologies (on a scale of 1 to 10, 81% ≥ 5/10), and two-thirds reported using them in medical studies. Before the COVID-19 lockdown, 16.2% of the students used the platform and 39.6% did not attend in-person courses (16.0% in 1st cycle versus 49.2% in 2nd cycle, p = 0.01 ). During the pandemic, 79% of the students appreciated the virtual learning (54.0% in 1st cycle versus 89.0% in 2nd cycle, p < 0.001 ) and 80.2% thought that the online courses were understandable. Regarding to student’s preferences, 41.4% preferred blended education and 68.5% of the students would recommend continuing distance learning after the pandemic. Regarding satisfaction, previous use of the educational platform (OR = 66.3, CI 95% [1.9; 2.2 ∗ 103]), improvement of learning during distance learning (OR = 22.6, IC 95% [4.1, 123.7]), and professor support (OR = 7, IC95% [1.3, 38]) seemed to be the most powerful factors in the multivariate analysis. Conclusion. Our results will contribute to the implementation of actions by taking advantage of the experience during the health crisis. The institutionalization of virtual learning with more interaction in addition to the in-person courses is the main recommendation of this study.

Introduction. The COVID-19 pandemic has profoundly impacted the medical academic institutions and their activities. Our aim was to describe the research activity (COVID-19-related or preexisting research) of the academic staff at the medical school in Marrakesh, Morocco. Methodology. An online survey among faculty members explored the COVID-19-related research activity as well as the impact of the pandemic on preexisting research, related challenges, and coping strategies. The form was distributed via e-mail. Data analyses involved univariate and bivariate methods. Findings. We analyzed 55 responses. A proportion of 58.2% of respondents reported conducting COVID-19-related research, while 40% reported that routine research activities were suspended as a result of the pandemic. Major challenges to research in this context were the clinical activity workload, limited access to patients, and research personnel shortage. Coping strategies included adopting remote work and using communication technologies. Conclusion. Despite the many challenges facing the academic researchers to implement COVID-19-related research and to maintain preexisting research activity, there are opportunities to promote academic medical research in the developing world alongside at the global level. Our results should help in documenting and understanding the impact of this pandemic as well as framing appropriate strategies in the future to address similar situations.

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Hemodialysis‐related headache (HRH) is a well‐known clinical event. It is considered as one of the most commonly reported neurological symptoms among hemodialysis patients. Its epidemiological, physiological, clinical, and therapeutic data remain scarce and are poorly studied. Our aim was to determine the frequency of HRH in the region of Casablanca, Morocco, to describe its clinical characteristics and to explore the hypothesis that renal replacement techniques, such as conventional versus online hemodiafiltration may have an association on clinical adverse effects like HRH. A descriptive, cross‐sectional, and multicentric study was carried out among 100 chronic hemodialysis patients for at least 6 months. HRH was defined according to criteria published by the International Classification of Headache Disorder third edition beta version (ICHD3β) [1]. Two different HD‐modalities (standard HD and OL‐HDF) have been investigated in order to explore their impact on HRH. Headache was reported by 60% of the patients including 41.6% of hemodialysis‐related headache. HRH had on average a duration of 7.4 hours, pulsatile among 38% of interviewed patients and of moderate intensity in 48% of cases. In total, 51.3% of patients undergoing conventional hemodialysis modality reported HRH compared to 12.5% undergoing online hemodiafiltration technique (OL‐HDF) (P = .008). Hemodialysis‐related headache remains a poorly studied clinical event despite its high prevalence. Its diagnosis, management, and especially its prevention remain a challenge for the neurologist and the nephrologist. Our results suggest that OL‐HDF is a promising therapeutic and preventive tool to reduce the incidence of HRH.