The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country

Abstract Introduction: Trauma teams (TTs) improve outcomes in trauma patients. A multidisciplinary TT was conformed in September 2015 in a tertiary Level I trauma university hospital in southwestern Colombia, a middle-income war-influenced country. Objective: To evaluate the impact of a TT in admission-tomography and admission-surgery times as well as mortality in a tertiary center university hospital in a middle income country war influenced country. Material & Methods: Retrospective analytical study. Patients older than 17 years, admitted to the emergency room 15 months prior and 15 months after the TT implementation were included. Patients prior to the TT implementation were taken as controls. No exclusion criteria. 464 patients were included, 220 before the TT implementation (BTT) and 244 after (ATT). Demographic data, trauma characteristics, admission-tomography, and admission-surgery time interval as well as mortality were recorded. Requirement of CT scan or surgery was based on physician decision. The analysis was made on Stata 15.1®. Categorical variables were described as quantities and proportions, continuous variables as mean and standard deviation or median and interquartile range (IQR). Categorical variables were compared using Chi2 or Fisher's test and continuous variables using Student's T-test or Wilcoxon-Mann-Withney. A multiple logistic regression model was created to evaluate the impact of being treated in the ATT group on mortality, adjusted by age, trauma severity, and physiological response upon admission. Results: The admission-tomography time interval was 56 min (IQR 39-100) in the BTT group and 40 min (IQR 24-76) in the ATT group, p<0.001. The admission-surgery time interval was 116 min (IQR 63-214) in the BTT group and 52 min (IQR 24-76) in the ATT group, p<0.001. Mortality in the BTT group was 18.1% and 13.1% in the ATT group. Adjusted OR was 0.406 (0.215 - 0.789) P = 0.006 Conclusions: A trauma team conformation in a war-influenced middle-income country is feasible and reduces mortality as well as admission-surgery and admission-tomography time intervals in polytrauma patients.

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The Impact of Export Destination on Skills in a Middle-Income Country

Global Journal of Emerging Market Economies ◽

10.1177/09749101211040145 ◽

2021 ◽

Vol 13 (3) ◽

pp. 317-340

Author(s):

Adriana Peluffo

Keyword(s):

Manufacturing Firms ◽

Middle Income Country ◽

High Income ◽

Income Country ◽

Skilled Labor ◽

Middle Income ◽

Export Destination ◽

The Impact ◽

The Relationship

This study analyzes the relationship among exports to high-income countries on the demand for skilled labor. To this aim, we use a panel of Uruguayan manufacturing firms for the period 1997–2006. The results show that, contrary to studies for developed and other middle-income economies, exports to high-income countries do not result in a higher demand for skilled labor. The explanation for these results may lie in the productive specialization of the country.

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The impact of health insurance on outpatient utilization and expenditure: evidence from one middle-income country using national household survey data

Health Research Policy and Systems ◽

10.1186/1478-4505-5-6 ◽

2007 ◽

Vol 5 (1) ◽

Cited By ~ 26

Author(s):

Björn Ekman

Keyword(s):

Health Insurance ◽

Survey Data ◽

Household Survey ◽

Middle Income Country ◽

Income Country ◽

Middle Income ◽

National Household Survey ◽

Household Survey Data ◽

Outpatient Utilization ◽

The Impact

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Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review

Journal of Alzheimer s Disease ◽

10.3233/jad-210532 ◽

2021 ◽

pp. 1-24

Author(s):

Heather Yemm ◽

Dame Louise Robinson ◽

Stella-Maria Paddick ◽

Catherine Dotchin ◽

Michaela Louise Goodson ◽

...

Keyword(s):

Cognitive Impairment ◽

Diagnostic Accuracy ◽

Activities Of Daily Living ◽

Daily Living ◽

Middle Income ◽

Middle Income Countries ◽

Instrumental Activities ◽

The Impact ◽

Low And Middle Income

Background: The largest proportion of people with dementia worldwide live in low- and middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated, or adapted for use in LMICs to guide selection of such tools. Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n = 6), translated and adapted for cultural differences (n = 6), or newly developed for target LMIC populations (n = 7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.

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