Quality-of-life in dementia: Assessment in low-and-middle income countries

2017 ◽  
Author(s):  
Kia-Chong Chua ◽  
Jan R. Böhnke ◽  
Martin Prince ◽  
Sube Banerjee
Keyword(s):  
Measurement Invariance ◽  
Core Component ◽  
Middle Income ◽  
Middle Income Countries ◽  
People With Dementia ◽  
Dementia Research ◽  
American Spanish ◽  
The Uk ◽  
Low And Middle Income

The global burden of dementia is disproportionately higher in low-and-middle income countries yet systematic assessments of health-related quality-of-life (HRQL) mostly rely on measures developed in the UK/US. A recent systematic review of dementia-specific HRQL measures concluded that none could be recommended without further linguistic validation. Using a unique dataset from the 10/66 Dementia Research Group, we conducted one of the first in-depth studies to investigate the measurement invariance of dementia-specific HRQL measures for low-and-middle income countries. HRQL of people with dementia was assessed by self-report (DEMQOL) and informant-report (DEMQOL-Proxy) in a community memory clinic in the UK and population cohort surveys of the 10/66 Dementia Research Group in the Dominican Republic, Mexico, Cuba, Peru and Venezuela. Measurement invariance between the UK English and Ibero-American Spanish versions was investigated using multiple-group confirmatory bifactor modelling. Our findings showed that UK and Latin America older adults differ in how they respond to “positive emotion” items in the DEMQOL and DEMQOL-Proxy. The remaining items of DEMQOL and DEMQOL-Proxy showed no major difference in conceptual meaning, sensitivity to individual differences, and standards of difficulty between the UK English and Ibero-American Spanish versions. Furthermore, we found that the core components of self- and informant appraisal of HRQL may differ. Negative emotion may be a core component in self-appraisal of HRQL whereas social functioning may be a core component in how informants appraise HRQL of people with dementia. Measurement invariance of translated HRQL assessment warrant continued investigation, particularly in low-and-middle income countries, where the societal and fiscal impact of dementia needs urgent attention.

scholarly journals Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Jacy Zhou ◽  
Rebecca Blaylock ◽  
Matthew Harris
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Middle Income ◽  
Middle Income Countries ◽  
Service Delivery Models ◽  
Primary Care Settings ◽  
The Uk ◽  
Delivery Models ◽  
Low And Middle Income

Abstract Background In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. Methods We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. Results A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review showed that providing early medical abortion in primary care services is safe and feasible and “task-shifting” to mid-level providers can effectively replace doctors in providing abortion. Conclusion The way services are organised in LMICs, using a task-shifted and decentralised model, results in high quality services that should be considered for adoption in the UK. Collaboration with professional medical bodies and governmental departments is necessary to expand services from secondary to primary care.

scholarly journals The third millennium dementia epidemic

2018 ◽  
Vol 37 (1) ◽  
pp. 1
Author(s):  
Richard Tjan
Keyword(s):  
Older Persons ◽  
Steady Increase ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Third ◽  
People With Dementia ◽  
Third Millennium ◽  
The Future ◽  
Low And Middle Income

The global dementia epidemic now and in the future is mainly caused by the steady increase in the population of older persons, where around 2 billion people will be 60 years of age and older by 2050.<sup>(1,2)</sup> As a consequence, in that year  there will be 135 million people with dementia, particularly in low- and middle-income countries where 60% of the more than 47 million cases (2015 estimate) are living now.<sup>(2)</sup>

scholarly journals Global AgeWatch Index and Insights

2020 ◽  
Author(s):  
Gibran Cruz-Martinez ◽  
Gokce Cerev
Keyword(s):  
Older People ◽  
Composite Index ◽  
Quality Data ◽  
Transformative Change ◽  
Middle Income ◽  
Middle Income Countries ◽  
Good Quality Data ◽  
Low And Middle Income

Global AgeWatch Index and Insights by HelpAge International aim to contribute to achievement of long-term transformative change in respect to ageing and the lives of older people by advocating for better production of timely and good quality data to inform policy and program response.The Global AgeWatch Index is a composite index that measures quality of life of older people, and ranks countries based on four domains – income security, health status, enabling environment and capability. The index was developed in partnership with Professor Asghar Zaidi. The index was published during 2013-2015.The Global AgeWatch Insights is a research-based advocacy tool that examines situation of older people in low- and middle-income countries, assesses availability of relevant data and evidence to support the analysis, and identification of policy actions. The Insights are produced in partnership with AARP. The reports were launched in 2018 are planned to be released every three years with a different thematic focus. The first report focuses on the inequities of the health systems in twelve low- and middle-income countries.

Pediatric Hospital Medicine and Global Health: A Fitting Niche for an Emerging Subspecialty

2021 ◽  
Author(s):  
Heather Haq ◽  
Amy R. L. Rule ◽  
Alexandra Coria ◽  
Lineo K. Thahane ◽  
Regina M. Duperval ◽  
...  
Keyword(s):  
Global Health ◽  
North American ◽  
Hospital Medicine ◽  
Essential Elements ◽  
Pediatric Hospital ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Child Health ◽  
Low And Middle Income

As North American hospitals serve increasingly diverse patient populations, including recent immigrants, refugees, and returned travelers, all pediatric hospitalists (PHs) require foundational competency in global health, and a subset of PHs are carving out niches focused in global health. Pediatric hospitalists are uniquely positioned to collaborate with low- and middle-income country clinicians and child health advocates to improve the health of hospitalized children worldwide. Using the 2018 WHO standards for improving the quality of care for children and adolescents worldwide, we describe how PHs’ skills align closely with what the WHO and others have identified as essential elements to bring high-quality, sustainable care to children in low- and middle-income countries. Furthermore, North American global health hospitalists bring home expertise that reciprocally benefits their home institutions.

scholarly journals Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 375-384 ◽  
Author(s):  
Mekdes Demissie ◽  
Charlotte Hanlon ◽  
Rahel Birhane ◽  
Lauren Ng ◽  
Girmay Medhin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bipolar Disorder ◽  
Low Income ◽  
Hospital Admissions ◽  
Psychological Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundAdjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.AimsTo evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.MethodA systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.ResultsA total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.ConclusionsAdjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.Declaration of interestNone.

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