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Technological advances by developed countries are producing safer, more potent vaccines. In addition, the transfer of the technology of vaccine production to some developing countries has been taking place during the past five decades, thereby making possible the participation of developing countries in the production and supply of the essential biologicals that are required for immunization programs. Examples of successful transfers of technology, the decisive elements and factors that contribute to the transfers, and the major obstacles to such transfers are presented.
Background: Alzheimer's drugs are believed to have limited availability and to be unaffordable in low- and middle-income countries compared to high-income countries. The price, availability and affordability of Alzheimer's drugs have not been reported before.
Methods: During 2007 an international survey was conducted in 21 countries in six continents (Argentina, Australia, Brazil, the Dominican Republic, France, India, Japan, Macedonia, Mexico, New Zealand, Nigeria, the Philippines, Portugal, Serbia, South Korea, Switzerland, Taiwan, Thailand, Uganda, the U.K. and the U.S.A.). Prices of Alzheimer's drugs were compared using the affordability index (the total number of units purchasable with one's daily income) derived from purchasing power parity (PPP) converted prices as well as raw prices.
Results: Donepezil is available in all 21 countries, whereas the newer drugs are less available. A 5 mg tablet of branded originator donepezil costs just US$0.26 in India and US$0.31 in Mexico, whereas it costs US$6.64 in the U.S.A. Pricing conditions of rivastigmine, galantamine and memantine appear to be similar to that of donepezil. The cheapest branded originators are from India and Mexico. However, in terms of PPP, Alzheimer's drugs in other low- and middle-income countries are much more expensive than in high-income countries. Most people in low- and middle-income countries cannot afford Alzheimer's drugs.
Conclusions: Alzheimer's drugs, albeit available, are often unaffordable for those who need them most. It is hoped that equitable differential pricing will be applied to Alzheimer's drugs.
The recognition of behavioral and psychological symptoms of dementia (BPSD) varies in Asian countries. In India, for example, symptoms such as repetition, forgetfulness, anxiety, and agitation are simply ignored in the rural setting and are of no concern to family members; other symptoms, such as wandering, are easily tolerated. This cultural acceptance of certain BPSD, combined with the difficulty in locating a physician skilled in the diagnosis and treatment of these symptoms, limits their assessment and treatment in India (International Psychogeriatric Association, 1998). Fortunately, in a few Asian countries, empiric data on the frequency of BPSD have been obtained using formal assessment instruments.
In 1996, the Japanese Ministry of Health and Welfare organized a working group to develop guidelines to assess the clinical efficacy of drugs used to treat dementia. The major issues discussed at that time included the definition of antidementia drugs, outcome measures, concomitant treatments, and placebo issues. Because the primary objective of this group was to develop guidelines for the symptomatic treatment of the disease, issues related to slowing of disease progression and behavioral and psychological symptoms of dementia (BPSD) were not discussed in detail. In 1997, the group submitted a draft report to the Japanese Ministry of Health and Welfare. It is hoped that in the future, this group will address issues not discussed in the draft guidelines.
Estimates of the prevalence rates for dementia vary significantly among countries. Such variation may be explained, at least in part, by methodologic differences in studies. The disparities in prevalence rates of dementia subtypes, particularly Alzheimer's disease and multi-infarct dementia, are especially apparent in studies conducted in Eastern and Western countries. In Japan and China, the prevalence of multi-infarct dementia exceeds that of Alzheimer's disease, whereas in the West, Alzheimer's disease predominates in the vast majority of studies. Clearly, cross-cultural studies of incidence using standard methods are needed to investigate whether a true difference in risk exists, and which risk factors differentially contribute to this variation. Migrant studies of genetically homogeneous populations offer a unique opportunity to answer these questions. This article explores the value of migrant studies, their application to etiologic questions of dementia and its subtypes, and recommendations concerning how to conduct such studies.
During an epidemiological survey conducted in Tokyo in 1988 by the Department of Psychiatry, Tokyo Metropolitan Institute of Gerontology, I met two demented elderly women in the course of interviewing city residents.
In this review article, we describe the historical background of gerontopsychiatry in Japan and elucidate research studies on dementia. To date, 19 relatively large-scale epidemiological investigations on dementia have been conducted in the community. These results suggest that approximately 4–5% of the population over age 65 has dementia. Multi-infarct dementia is more prevalent than the Alzheimer's type dementia. Three hypotheses for this finding are suggested. Finally, we propose a theoretical model correlating the relationship between degree of cognitive dysfunction and caregiver's stress.
The Cognitive Abilities Screening Instrument (CASI) has a score range of 0 to 100 and provides quantitative assessment on attention, concentration, orientation, short-term memory, long-term memory, language abilities, visual construction, list-generating fluency, abstraction, and judgment. Scores of the Mini-Mental State Examination, the Modified Mini-Mental State Test, and the Hasegawa Dementia Screening Scale can also be estimated from subsets of the CASI items. Pilot testing conducted in Japan and in the United States has demonstrated its cross-cultural applicability and its usefulness in screening for dementia, in monitoring disease progression, and in providing profiles of cognitive impairment. Typical administration time is 15 to 20 minutes. Record form, manual, videotape of test administration, and quizzes to qualify potential users on the administration and scoring of the CASI are available upon request.
Before evaluating behavioral distrubances of dementia (BDD), several factors should be considered. This includes the patient population, the properties of the rating scales to be used, and the assessor. The frequency of behavioral symptoms appears to vary between countries, making comparisons in multinational studies difficult. These variations may be caused by cultural differences, clinicians' attitudes to behavioral symptoms, and interrater variability. The psychometric properties of a rating scale may be affected by differences in clinicians' attitudes in different countries, which may, in turn, alter the frequency of diagnosis of BDD, causing problems in the interpretation of data in multinational studies. Consideration should be given to all these factors before initiating a multinational clinical trial.
A survey of twin births in Denmark in relation to the total number of births from 1911 to 1974 shows a significant decrease in the dizygotic twin birth rate for all maternal age groups. The possible environmental causes of such a decrease are discussed.
Chromosome examination was made in 22 monozygotic and 27 dizygotic twin pairs of whom one or both of each pair suffered or had suffered from manic-depressive disorder. We found a significantly higher frequency of chromosome variations among dizygotic twin pairs than was expected from population studies, but not in monozygotic pairs. There was no association between the chromosome variations and manic-depressive disorders. We found no greater intra-pair correlation in monozygotic twins compared with dizygotic twins as regards hypodiploidy, hyperdiploidy and unstable chromosome aberrations, which indicates that the aetiology of such aberrations is mainly of exogenic nature.
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