How much is dementia care worth?

Public health planning for dementia must start now

A global assessment of dementia, now and in the future

ABSTRACT: Several studies have used various datasets and methodologies to analyze the relationship between bilateral trade and income convergence among trading partners. However, most studies have not paid attention to the effect that income levels and nature of bilateral trade have on the speed of income convergence. In this paper, we argue that the income levels of trading partners and the nature of bilateral trade play important role in the relationship between bilateral trade and international income convergence. To account for the effect of income levels of trading partners, this paper presents an approach that explicitly accounts for bilateral trade among high-income (OECD) countries, bilateral trade between high-income and low-income (SSA) countries, and bilateral trade among low-income (SSA) countries. We also used total trade data for 25 OECD countries and 30 Sub-Saharan African countries over the period 1980-2018 to avoid the potential bias for selecting certain countries based on arbitrary percentage of trade relationship. We used the 2SLS estimations technique to avoid endogeneity problems due to the nature of the dataset. The paper finds that the bilateral trade-income convergence relationship for OECD to SSA is the strongest. This result throws light on the claim that the nature of bilateral trade between high-income and low-income countries promotes one directional knowledge spillover from high-income to low-income countries which enables low-income countries to adopt new technologies and grow faster than their high-income counterparts. Also, bilateral trade among OECD countries, which mostly comprises of differentiated products, promotes descent income convergence among them. However, bilateral trade among SSA countries has the least effect on income convergence. Findings of the study have important implications for bilateral trade among low-income countries and between low income and high income countries. First, if SSA countries want to develop and catch up with their rich counterparts, they should continue to promote free trade with high income countries by dismantling remaining protection policies. Second, the African Continental Free Trade Area's (AfCFTA) efforts to boost the manufacturing sector through industrialization is in the right direction to promote the production of more differentiated products in Africa which will create growth in income for member countries as they trade more. Finally, there is the need for SSA countries to increase investment rates and improve human capital accumulation to enable them to accelerate the adoption of new technologies and grow faster than their high-income counterparts, while bridging the income gap between them through trade.

Introduction Randomized controlled trials (RCTs) in low‐ and middle‐income countries (LMICs) offer significant potential for advancing global health. However, these RCTs often face conflicts between pharmaceutical industry incentives and global health priorities. The high costs, strict regulations, and extensive requirements of Phase 3 trials make LMICs more appealing than high income countries (HICs). For MT trials, LMICs offer advantages such as higher stroke rates, lower costs, more flexible regulations, shorter timelines, and a strong willingness to participate from both patients and local clinicians. However, the industry's motivations extend beyond these practical considerations. These collaborative trials present several ethical concerns, including power imbalances between industry or HICs investigators and those from LMICs, vulnerabilities of patients and clinicians in LMICs, health system unprepared for RCTs and the limited availability of interventions to locals once the RCTs are concluded. Major ethical issues include using control arms (SMT) that fall below the standard of care in HICs and inadequate post‐protocol treatment. Accepting inferior SMT and minimal post‐protocol care in LMICs hospital settings can introduce bias favoring experimental devices. Data from these RCTs, used for FDA approval, could lead to negative outcomes for patients in both LMICs and HICs. We plan to do a global mapping of current RCTs scenario in MT for acute ischemic stroke. Methodology: The search terms “Stroke,” “Large Vessel Occlusion,” and “Mechanical Thrombectomy” were entered into the ClinicalTrials.gov search form. Filters were then set to show only new RCTs that are either currently recruiting participants or are planning to recruit. RCTs that were completed, terminated, or had unknown statuses were excluded. Results Our search identified 44 ongoing RCTs across various countries. The USA leads with 14 trials (25.45%), followed by China with 13 trials (23.64%), and France with 8 trials (14.55%). Turkey and Brazil each have 3 trials (5.45%), while Spain has 2 trials (3.64%). Argentina, Canada, Germany, Hungary, India, Israel, Italy, the Netherlands, Pakistan, Paraguay, Poland, and Taiwan each have 1 trial (1.82%). In terms of funding sources, industry funded 18 trials (40.91%), the NIH funded 1 trial (2.27%), and other sources funded 25 trials (56.82%). Of the industry‐sponsored trials, 10 (55.55%) are conducted offshore, 5 (27.77%) are in the USA, and 3 (16.66%) involve both domestic and international sites. Conclusion Globalizing MT RCTs offers benefits but also risks if oversight is inadequate. It's crucial to ensure that trials benefit local populations and local needs. Advocacy should prioritize locally relevant, need based, investigator‐initiated stroke trials in LMICs, rather than industry‐driven “parasitic” or “parachute” RCTs that may exploit LMICs patients for drug approvals in HICs. Even non‐industry‐funded trials in LMICs can be influenced by industry interests through collaborating researchers from HICs who is getting industry benefits. Rigorous ethical oversight is essential to prevent exploitation and ensure the integrity of these trials.

Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity - regardless of geography New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action

Navigating the violent process of decolonisation in global health research: a guideline

A new path to mentorship for emerging global health leaders in low-income and middle-income countries

Objectives: To analyze the effect or impact of Digital Services Trade on economic growth (GDP) of a panel of Low, Middle and High Income Countries.
 Study Design: Panel Quantitative Study.
 Methodology: Dynamic Difference GMM (Diff-GMM) and System GMM (Sys-GMM), Panel pooled OLS (POLS) and Fixed Effects (FE) models were employed in the analyses.
 Results: The System GMM estimator seems to predict that, ceteris paribus, a 1 unit increase in digital services exports significantly impacts GDP growth in Low and High Income countries panels in the short run by 5.7% and 52.4% respectively. The panel POLS models estimate that digital services exports cause a significant long run increase in GDP in High income countries by 39.67% relative to 6.68% in the panel of Middle Income countries and negative growth in Low income countries of 7.74%. The FE models predict that for every 1 unit increase in the number of people using the internet, GDP significantly increases by 42.7%, 27.8% and 0.03% in the Middle, High, and Low Income countries panels respectively.
 Conclusion: The findings of this study indicate that generally, digital services trade seems to have a significant positive effect on GDP of all country panels. However, Low and Middle Income countries are lagging behind. Therefore, this study recommends that, to promote digital trade driven economic growth, the panel of Low and Middle Income countries’ policy makers should increase investments in both institutional and physical digital infrastructure that enable more people, Small and Medium enterprises(SMEs) and rural populations have access to stable, high speed and affordable digital services.

Says who? Northern ventriloquism, or epistemic disobedience in global health scholarship

Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Equity in Global Health Research.

Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study

Hemophilia, a genetic bleeding disorder caused by a deficiency in clotting factors, impacts millions of people worldwide. The quality of life (QoL) for those affected remains particularly suboptimal in low- and middle-income countries (LMICs). This article delves into the unmet needs in hemophilia care and management in LMICs, spotlighting various challenges and potential strategies for improvement. One of the primary challenges in LMICs is the limited access to comprehensive care which includes a multidisciplinary approach involving hematologists, physiotherapists, psychologists, and social workers. In many LMICs, the healthcare infrastructure is insufficient to provide such integrated services, leading to fragmented care and poorer health outcomes for individuals with hemophilia. Another significant issue is the challenge of prophylactic treatment. Prophylaxis, which involves regular infusions of clotting factor concentrates to prevent bleeding episodes, is the standard of care in high-income countries. However, in LMICs, prophylactic treatment is often not feasible due to the high cost and limited availability of clotting factor concentrates. This results in a reliance on on-demand treatment, which only addresses bleeding episodes as they occur and does not prevent the long-term complications associated with frequent bleeds. Pain management is another critical area with significant gaps. Chronic pain is a common issue for individuals with hemophilia due to repeated joint bleeds leading to joint damage. In many LMICs, access to effective pain management strategies, including both pharmacological and non-pharmacological treatments, is limited. Mental health support is also a crucial yet often overlooked aspect of hemophilia care. The chronic nature of the condition, combined with frequent hospital visits and the physical limitations imposed by the disease, can lead to mental health issues such as anxiety and depression. However, mental health services are frequently under-resourced in LMICs, and there is a lack of awareness about the mental health needs of individuals with hemophilia. Caregiver support playinga crucial role in managing the day-to-day needs of individuals with hemophilia, is another vital component of hemophilia care that is often insufficient in LMICs. Education and awareness about hemophilia are also lacking in many LMICs. There is often a limited understanding of the condition among the general public and even within the medical community, leading to misdiagnoses and delayed treatment. Employment and financial support are critical issues as well. The physical limitations and frequent medical needs associated with hemophilia can make it difficult for individuals to maintain stable employment, leading to financial strain. In many LMICs, social support systems are inadequate to address these challenges. Lastly, the integration of telehealth and digital health technologies presents a promising strategy to overcome some of these challenges providing remote access to specialist care, education, and support, which is particularly valuable in regions where healthcare resources are scarce. By adopting a multifaceted approach that involves collaboration between governments, healthcare systems, international organizations, and patient advocacy groups, it is possible to address these challenges and significantly improve the QoL for individuals with hemophilia in LMICs.

Implementation science and breast cancer control: A Breast Health Global Initiative (BHGI) perspective from the 2010 Global Summit

This chapter presents the significant challenges in practice health professionals’ face in providing care to people with advanced dementia. These challenges constitute all facets of care giving inclusive of physical, psychological and spiritual care. Worldwide advanced dementia is an increasingly burdensome health issue. People with advanced dementia have substantial care needs at the end of their life (Birch & Stokoe, 2010). The Alzheimer's Disease International report (2010) stated there were 35.6 million people living with dementia. The report estimates the number of people living with dementia worldwide will increase to 65.7 million by 2030 and 115.4 million by 2050 (Alzheimer’s Disease International, 2010). Further the majority of people will live in low and middle income countries (Alzheimer’s Disease International, 2010). In 2010, the financial burden of dementia was costed at US$ 604 billion (Alzheimer’s Disease International, 2010). The Alzheimer’s Disease International, 2010 report predicts that “these costs account for around 1% of the world’s gross domestic product, varying from 0.24% in low income countries, to 0.35% in low, middle income countries, 0.50% in high, middle income countries, and 1.24% in high income countries” (Alzheimer’s Disease International, 2010, p.5).