Background and Purpose-The estimates on the prevalence and the risk of rupture of intracranial saccular aneurysms vary widely between studies. We conducted a systematic review on prevalence and risk of rupture of intracranial aneurysms and classified the data according to study design, study population, and aneurysm characteristics. Methods-We searched for studies published between 1955 and 1996 by means of a MEDLINE search and a cumulative review of the reference lists of all relevant publications. Two authors independently assessed eligibility of all studies and extracted data on study design and on numbers and characteristics of patients and aneurysms. Results-For data on prevalence we found 23 studies, totalling 56 304 patients; 6685 (12%) of these patients were from 15 angiography studies. Prevalence was 0.4% (95% confidence interval, 0.4% to 0.5%) in retrospective autopsy studies, 3.6% (3.1 to 4.1) for prospective autopsy studies, 3.7% (3.0 to 4.4) in retrospective angiography studies, and 6.0% (5.3 to 6.8) in prospective angiography studies. For adults without specific risk factors, the prevalence was 2.3% (1.7 to 3.1); it tended to increase with age. The prevalence was higher in patients with autosomal dominant polycystic kidney disease (relative risk [RR], 4.4 [2.7 to 7.2]), a familial predisposition (RR, 4.0 [2.7 to 6.0]), or atherosclerosis (RR, 2.3 [1.7 to 3.1]). Only 8% (5 to 11) of the aneurysms were Ͼ10 mm. For the risk of rupture, we found nine studies, totalling 3907 patient-years. The overall risk per year was 1.9% (1.5 to 2.4); for aneurysms ϭ10 mm, the annual risk was 0.7% (0.5 to 1.0). Key Words: subarachnoid hemorrhage Ⅲ aneurysms Ⅲ epidemiology Ⅲ systematic review U ncertainty surrounds the prevalence of unruptured saccular aneurysms on intracranial arteries. In angiographic and autopsy studies, estimates for prevalence vary between 2 and 90 per 1000.1,2 This wide range probably reflects methodological differences between studies: prospective or retrospective designs, diagnostic tools (angiography or autopsy), and study populations. Many studies have included patients with ruptured aneurysms, which results in too high a prevalence. On the other hand, studies reviewing routine autopsy records or angiograms of only a single carotid artery probably underestimate the prevalence. Accurate data on the prevalence of intracranial aneurysms are essential in evaluating the results of screening programs for aneurysms in patients with increased risk for SAH such as patients with ADPKD 3 or first-degree relatives of patients with SAH.4 Also, the management strategy for unruptured aneurysms is influenced by the prevalence; because the incidence of SAH has been properly assessed and is stable, 5 a higher than previously assumed prevalence of aneurysms would mean that unruptured aneurysms are less dangerous. We conducted a systematic review of all reports on prevalence of intracranial aneurysms and classified the data according to study design, diagnostic methods, and study population. To assess the accur...

While the prevalences of migraine and tension-type headache are comparable with those in Europe and the United States, a remarkably high percentage of the population of Georgia have headache on >/=15 days/month. This study demonstrates the importance of socioeconomic factors in a developing country and unmasks the unmet needs of people with headache disorders.

Objective: To identify the clinical, demographic, and socioeconomic factors that are associated with a poor quality of life in patients with epilepsy in Georgia. Methods: Clinical, demographic, and socioeconomic status data were collected from 115 adult epileptic outpatients being treated in the epilepsy programme at the Sarajishvili Institute of Neurology and Neurosurgery (SINN) in Tbilisi, Georgia. Health Related Quality of Life (HRQL) was measured by the Quality of Life in Epilepsy Inventory (QOLIE-31). Multiple regression analysis was used to determine which variables were associated with QOLIE-31 total and subcomponent scores. Results: Mean age of the patient population was 37.9 (SD 15.8) years; 43.5% were females; 51.8% did not have a partner; 39.1% had some university education; 82.6% were unemployed. Of 115 epileptic patients 83.3% had partial, and 16.7% had generalised seizures. Overall, 32.2% of patients were seizure free, and 28.7% experienced more than 10 seizures over the past year. The variables that most strongly predicted a lower QOLIE-31 total score were a low education level, high seizure frequency, and long duration of epilepsy. The QOLIE-31 all subcomponent scores correlated strongly with seizure frequency. Advanced age was a significant predictor for a low overall quality of life, energy/fatigue, and cognitive scores. Female sex was the factor that significantly predicted a low seizure worry score. Education level strongly correlated with overall quality of life, and cognitive and social functioning scores. Conclusions: Clinical factors such as high seizure frequency and long duration of epilepsy had a significant influence on HRQL. Advanced age, female sex, and a low education level were the demographic factors that correlated strongly with low quality of life scores.

BackgroundOne of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.MethodsA pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.ResultsThe results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.ConclusionProvider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.Abstract in RussianSee the full article online for a translation of this abstract in Russian.