Summary Background China is increasingly facing the challenge of control of the growing burden of non-communicable diseases. We assessed the epidemiology of Alzheimer's disease and other forms of ...dementia in China between 1990, and 2010, to improve estimates of the burden of disease, analyse time trends, and inform health policy decisions relevant to China's rapidly ageing population. Methods In our systematic review we searched for reports of Alzheimer's disease or dementia in China, published in Chinese and English between 1990 and 2010. We searched China National Knowledge Infrastructure, Wanfang, and PubMed databases. Two investigators independently assessed case definitions of Alzheimer's disease and dementia: we excluded studies that did not use internationally accepted case definitions. We also excluded reviews and viewpoints, studies with no numerical estimates, and studies not done in mainland China. We used Poisson regression and UN demographic data to estimate the prevalence (in nine age groups), incidence, and standardised mortality ratio of dementia and its subtypes in China in 1990, 2000, and 2010. Findings Our search returned 12 642 reports, of which 89 met the inclusion criteria (75 assessed prevalence, 13 incidence, and nine mortality). In total, the included studies had 340 247 participants, in which 6357 cases of Alzheimer's disease were recorded. 254 367 people were assessed for other forms of dementia, of whom 3543 had vascular dementia, frontotemporal dementia, or Lewy body dementia. In 1990 the prevalence of all forms of dementia was 1·8% (95% CI 0·0–44·4) at 65–69 years, and 42·1% (0·0–88·9) at age 95–99 years. In 2010 prevalence was 2·6% (0·0–28·2) at age 65–69 years and 60·5% (39·7–81·3) at age 95–99 years. The number of people with dementia in China was 3·68 million (95% CI 2·22–5·14) in 1990, 5·62 million (4·42–6·82) in 2000, and 9·19 million (5·92–12·48) in 2010. In the same period, the number of people with Alzheimer's disease was 1·93 million (1·15–2·71) in 1990, 3·71 million (2·84–4·58) people in 2000, and 5·69 million (3·85–7·53) in 2010. The incidence of dementia was 9·87 cases per 1000 person-years, that of Alzheimer's disease was 6·25 cases per 1000 person-years, that of vascular dementia was 2·42 cases per 1000 person-years, and that of other rare forms of dementia was 0·46 cases per 1000 person-years. We retrieved mortality data for 1032 people with dementia and 20 157 healthy controls, who were followed up for 3–7 years. The median standardised mortality ratio was 1·94:1 (IQR 1·74–2·45). Interpretation Our analysis suggests that previous estimates of dementia burden, based on smaller datasets, might have underestimated the burden of dementia in China. The burden of dementia seems to be increasing faster than is generally assumed by the international health community. Rapid and effective government responses are needed to tackle dementia in low-income and middle-income countries. Funding Nossal Institute of Global Health (University of Melbourne, Australia), the National 12th Five-Year Major Projects of China, National Health and Medical Research Council Australia–China Exchange Fellowship, Importation and Development of High-Calibre Talents Project of Beijing Municipal Institutions, and the Bill & Melinda Gates Foundation.
Technologies for global health Howitt, Peter, MA; Darzi, Ara, Prof; Yang, Guang-Zhong, Prof ...
The Lancet (British edition),
08/2012, Volume:
380, Issue:
9840
Journal Article
Peer reviewed
Mechanical ventilation and intravenous sedation were initiated. Because of continuing spasms, intrathecal baclofen (1200 µg per day) was started on day 3 with a good clinical response. No ...recommendations about tetanus prophylaxis procedures for wound man agement in patients with blood diseases are available, except for bone-marrow transplantation.
Abstract Background In the context of integrated care, multidisciplinary group (MDG) meetings involve participants who are not only from different professional groups but also from different ...organisational backgrounds within a complex local health economy. Such meetings therefore provide opportunities for participants to discuss complex care of individual patients, as well as ways to improve working within that local health economy—ie, working in a more integrative manner. We used an innovative coding scheme and method to explore the communication patterns within MDGs of a large-scale integrated care pilot (the North-West London Integrated Care Pilot). We investigated the extent to which case discussions foster an integrative way of working between MDG participants. Methods Case discussions in four MDG meetings were audio recorded and transcribed. Scripts were divided into utterances, or units of meaning, of about equal length representing a complete phrase or sentence. A second researcher then checked these utterances, and disagreements were resolved through consensus. Two coders independently coded utterances according to their integrative potential, which was defined against three independent domains: the level (ie, individual, collective, and systems); the valence (problem, information, and solution); and the focus (concrete and abstract). Utterances were coded first with respect to level, then valence, and then focus, to avoid any bias to code preferentially towards one permutation of the three codes. Inter-rater and intra-rater reliability was tested with kappa scores on one randomly selected case discussion. Intra-rater scores were taken 2 weeks apart to avoid possible code recall. We developed an ordinal scale based on mathematical weights for the 18 permutations of level, valence, and focus. Standardised mean integration scores were calculated for case discussions across utterance deciles, corresponding roughly to time deciles, indicating how integrative intensity changed during the conversation. Findings We transcribed and coded 23 case discussions in four different MDG groups. Inter-rater and intra-rater reliability was good, as shown by the prevalence and bias-adjusted kappa scores for one randomly selected case discussion. We coded 4209 utterances. The proportion of utterances differed according to participant type (consultant 14·6%; presenting general practitioner 38·8%; chair 7·8%; non-presenting general practitioner 2·3%; allied health professional 4·8%). Utterances were predominantly coded at low levels of integrative intensity. Allied health professionals accounted for a fairly low proportion of utterances; however, they tended to speak at higher integrative levels. We noted evidence for a gradual increase (R2 0·66) in integrative intensity during the case discussions, but on the basis of analysis of the minutes and action points arising from these discussions, this evidence did not translate into future actions. Interpretation We characterise the MDGs as having consultative characteristics with some trend towards collaboration, but best resemble community-based ward rounds. The increase in integration scores did not tend to translate into actions for the groups to take forward. The role of the chair and the improved participation of non-presenting general practitioners and allied health professionals seem important, especially because allied health professionals contribute greatly to higher integrative scores. Traditional communication patterns of medical dominance are being perpetuated in the MDGs, suggesting that more could be done to sensitise participants to the value of full participation from all members of the group. Case discussions in integrated care MDGs are opportunities for health professionals to learn from each other's cases and explore how services could work together better to improve care generally. Our characterisation of these MDGs shows that more could be done in this regard. Reviews of decision making and communication in primary and community care show a dearth of empirical research examining real-time dynamics. Our method enables researchers to detect evolutionary changes in the integrative intensity of the group over time and make comparisons between MDGs. Funding Imperial College Healthcare Charity.
