Abstract Introduction In 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of ...people with dementia has increased. Here, we present an update of the global cost estimates. Methods This is a societal, prevalence-based global COI study. Results The worldwide costs of dementia were estimated at United States (US) $818 billion in 2015, an increase of 35% since 2010; 86% of the costs occur in high-income countries. Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. The threshold of US $1 trillion will be crossed by 2018. Discussion Worldwide costs of dementia are enormous and still inequitably distributed. The increase in costs arises from increases in numbers of people with dementia and in increases in per person costs.
Current projections of the scale of the coming dementia epidemic assume that the age- and sex-specific prevalence of dementia will not vary over time, and that population ageing alone (increasing the ...number of older people at risk) drives the projected increases. The basis for this assumption is doubtful, and secular trends (that is, gradual decreases or increases in prevalence over long-term periods) are perfectly plausible.
We carried out a systematic review of studies of trends in prevalence, incidence and mortality for people with dementia, conducted since 1980.
We identified nine studies that had tracked dementia prevalence, eight that had tracked dementia incidence, and four that had tracked mortality among people with dementia. There was some moderately consistent evidence to suggest that the incidence of dementia may be declining in high-income countries. Evidence on trends in the prevalence of dementia were inconsistent across studies and did not suggest any clear overall effect. Declining incidence may be balanced by longer survival with dementia, although mortality trends have been little studied. There is some evidence to suggest increasing prevalence in East Asia, consistent with worsening cardiovascular risk factor profiles, although secular changes in diagnostic criteria may also have contributed.
We found no evidence to suggest that the current assumption of constant age-specific prevalence of dementia over time is ill-founded. However, there remains some uncertainty as to the future scale of the dementia epidemic. Population ageing seems destined to play the greatest role, and prudent policymakers should plan future service provision based upon current prevalence projections. Additional priorities should include investing in brain health promotion and dementia prevention programs, and monitoring the future course of the epidemic to chart the effectiveness of these measures.
A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). ...Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations.
A systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools.
153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts.
Of the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders. We recommend that, wherever possible, a chosen screening tool should be validated against a gold standard diagnostic assessment in the specific context in which it will be employed.
There are several existing systematic reviews of prevalence of dementia for mainland China, Hong Kong and Taiwan, but several studies have been newly reported. The aim of this study is to update ...prevalence data in this region and test for variation across geographical areas and time periods using the new dataset.
Twenty prevalence studies identified from World Alzheimer Report 2015 (January 2011-March 2015) and an updated search (March 2015-February 2017) were added to the original dataset (N = 76). Meta-regression was used to investigate geographical variation and time trends, taking methodological factors and characteristics of study population into account, and to estimate prevalence and number of people with dementia by geographical area.
Compared with northern China, the prevalence of dementia was lower in the central China -1.0; 95% confidence interval (CI):-2.2, 0.3, south China (-1.7; 95% CI: -3.1, -0.3), Hong Kong and Taiwan (-3.0; 95% CI: -5.0, -1.0) but appeared to be higher in western China (2.8; 95% CI: 0.1, 5.5) after adjusting for methodological variation. The increasing trend from pre-1990 to post-2010 periods was considerably attenuated when taking into account methodological factors and geographical areas. The updated estimated number of people with dementia in all these areas is 9.5 million (5.3%; 95% CI: 4.3, 6.3) in the population aged 60 or above.
Geographical variation in dementia prevalence is confirmed in this update, whereas evidence on increasing trends is still insufficient. Differing societal development across areas provides an opportunity to investigate risk factors at the population level operating across diverse life course experiences. Such research could advance global primary prevention of dementia.
A comparative assessment of how AMR evolved as a policy problem alongside a similarly complex problem—climate change—and a relative success—tobacco control—can provide insight into how to better ...design future international AMR efforts and avoid problems encountered in other areas. Evidence review and consolidation has long been a prerequisite for policy-making (eg, the 1964 US Surgeon General’s report on Smoking and Health).6 Decision-makers also require information on the benefits of taking alternative courses of action (eg, the Stern Review on climate change and O’Neill Review on AMR). Climate change and tobacco control initiatives have faced difficulties in maintaining a coordinated global approach, largely due to lack of agreement on how individual country capabilities and priorities should be reflected.9 The Framework Convention on Tobacco Control was largely based on approaches already implemented in several high-income countries. Action on climate change has seen a gradual disintegration of ‘global’ governance with regional and local hubs of action emerging.10 Both for climate change and tobacco control, common goals may be best met through individual country targets and actions based on feasibility determined at the national level.11 The most effective strategies may be those that focus on polycentric governance and solving specific problems in particular local contexts, and carefully adapting rather than just adopting ‘best practice’ solutions.
Background
Digital technologies have been central to efforts to respond to the COVID-19 pandemic. In this context, a range of literature has reported on developments regarding the implementation of ...new digital technologies for COVID-19–related surveillance, prevention, and control.
Objective
In this study, scoping reviews of academic and nonacademic literature were undertaken to obtain an overview of the evidence regarding digital innovations implemented to address key public health functions in the context of the COVID-19 pandemic. This study aimed to expand on the work of existing reviews by drawing on additional data sources (including nonacademic sources) by considering literature published over a longer time frame and analyzing data in terms of the number of unique digital innovations.
Methods
We conducted a scoping review of the academic literature published between January 1, 2020, and September 15, 2020, supplemented by a further scoping review of selected nonacademic literature published between January 1, 2020, and October 13, 2020. Both reviews followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach.
Results
A total of 226 academic articles and 406 nonacademic articles were included. The included articles provided evidence of 561 (academic literature) and 497 (nonacademic literature) unique digital innovations. The most common implementation settings for digital innovations were the United States, China, India, and the United Kingdom. Technologies most commonly used by digital innovations were those belonging to the high-level technology group of integrated and ubiquitous fixed and mobile networks. The key public health functions most commonly addressed by digital innovations were communication and collaboration and surveillance and monitoring.
Conclusions
Digital innovations implemented in response to the COVID-19 pandemic have been wide ranging in terms of their implementation settings, the digital technologies used, and the public health functions addressed. However, evidence gathered through this study also points to a range of barriers that have affected the successful implementation of digital technologies for public health functions. It is also evident that many digital innovations implemented in response to the COVID-19 pandemic are yet to be formally evaluated or assessed.
Abstract
Antimicrobial resistance (AMR) is one of the greatest public health threats at this time. While there is a good understanding of the impacts of AMR on infectious diseases, an area of less ...focus is the effects AMR may be having on non-communicable health conditions (such as cancer) and healthcare services (such as surgery). Therefore, this study aimed to explore what impact AMR is currently having on non-communicable health conditions, or areas of health services, where AMR could be a complicating factor impacting on the ability to treat the condition and/or health outcomes. To do this, a rapid evidence assessment of the literature was conducted, involving a systematic approach to searching and reviewing the evidence. In total, 101 studies were reviewed covering surgery, organ transplants, cancer, ICUs, diabetes, paediatric patients, immunodeficiency conditions, liver and kidney disease, and physical trauma. The results showed limited research in this area and studies often use a selective population, making the results difficult to generalize. However, the evidence showed that for all health conditions and healthcare service areas reviewed, at least one study demonstrated a higher risk of death for patients with resistant infections, compared with no or drug-susceptible infections. Poor health outcomes were also associated with resistant infections in some instances, such as severe sepsis and failure of treatments, as well as a greater need for invasive medical support. While there are gaps in the evidence base requiring further research, efforts are also needed within policy and practice to better understand and overcome these challenges.
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