Use of assistive technology for persons with psychosocial disability: systematic review

Background: Assistive technology (AT) refers to assistive products (AP) and associated systems and services that are relevant for function, independence, well-being, and quality of life for individuals with disabilities. There is a high unmet need for AT for persons with disabilities and this is worse for persons with cognitive and mental or psychosocial disabilities (PDs). Further, information and knowledge on AT for PDs is limited. Objective: The aim of this review was to explore the pattern of AT use among persons with PDs and its associated socioeconomic and health benefits. Methods: The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), and we conducted systematic searches in the 4 databases: PubMed, Embase.com, APA PsycInfo (Ebsco), and Web of Science (Core Collection) with the following index terms: "Assistive Technology," "Self-Help Devices," "Quality of Life," "Activities of Daily Living," "Mental Disorders." We included only AT individuals with PDs can independently use without reliance on a provider. Identified papers were exported to EndNote (Clarivate) and we undertook a narrative synthesis of the included studies. Results: In total, 5 studies were included in the review which reported use of different AT for schizophrenia, bipolar disorder, depression and anxiety disorders. The APs described in the included studies are Palm tungsten T3 handheld computer, MOBUS, personal digital assistant, automated pill cap, weighted chain blankets, and smartphone function. All the AT products identified in the studies were found to be easily usable by individuals with PDs. The APs reported in the included studies have broad impact and influence on social function, productivity, and treatment or management. The studies were heterogeneous and were all conducted in high-income countries. Conclusions: Our study contributes to and strengthens existing evidence on the relevance of AT for PDs and its potential to support socioeconomic participation and health. Although AT has the potential to improve function and participation for individuals with PDs; this review highlights that research on the subject is limited. Further research and health policy changes are needed to improve research and AT service provision for individuals with PDs especially in low-income settings. Trial registration: PROSPERO CRD42022343735; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343735.</div

Use of assistive technology for persons with psychosocial disability: systematic review

Background: Assistive technology (AT) refers to assistive products (AP) and associated systems and services that are relevant for function, independence, well-being, and quality of life for individuals with disabilities. There is a high unmet need for AT for persons with disabilities and this is worse for persons with cognitive and mental or psychosocial disabilities (PDs). Further, information and knowledge on AT for PDs is limited. Objective: The aim of this review was to explore the pattern of AT use among persons with PDs and its associated socioeconomic and health benefits. Methods: The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), and we conducted systematic searches in the 4 databases: PubMed, Embase.com, APA PsycInfo (Ebsco), and Web of Science (Core Collection) with the following index terms: "Assistive Technology," "Self-Help Devices," "Quality of Life," "Activities of Daily Living," "Mental Disorders." We included only AT individuals with PDs can independently use without reliance on a provider. Identified papers were exported to EndNote (Clarivate) and we undertook a narrative synthesis of the included studies. Results: In total, 5 studies were included in the review which reported use of different AT for schizophrenia, bipolar disorder, depression and anxiety disorders. The APs described in the included studies are Palm tungsten T3 handheld computer, MOBUS, personal digital assistant, automated pill cap, weighted chain blankets, and smartphone function. All the AT products identified in the studies were found to be easily usable by individuals with PDs. The APs reported in the included studies have broad impact and influence on social function, productivity, and treatment or management. The studies were heterogeneous and were all conducted in high-income countries. Conclusions: Our study contributes to and strengthens existing evidence on the relevance of AT for PDs and its potential to support socioeconomic participation and health. Although AT has the potential to improve function and participation for individuals with PDs; this review highlights that research on the subject is limited. Further research and health policy changes are needed to improve research and AT service provision for individuals with PDs especially in low-income settings. Trial registration: PROSPERO CRD42022343735; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343735.</div

Global, regional, and national burden of epilepsy, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Epilepsy is one of the most common serious neurological disorders and affects individuals of all ages across the globe. The aim of this study is to provide estimates of the epilepsy burden on the global, regional, and national levels for 1990–2021. Methods: Using well established Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) methodology, we quantified the prevalence of active idiopathic (epilepsy of genetic or unknown origin) and secondary epilepsy (epilepsy due to an underlying abnormality of the brain structure or chemistry), as well as incidence, death, and disability-adjusted life-years (DALYs) by age, sex, and location (globally, 21 GBD regions and seven super-regions, World Bank country income levels, Socio-demographic Index [SDI], and 204 countries) and their trends from 1990 to 2021. Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy, largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). Findings: In 2021, there were 51·7 million (95% UI 44·9–58·9) people with epilepsy (idiopathic and secondary combined) globally, with an age-standardised prevalence of 658 per 100 000 (569–748). Idiopathic epilepsy had an age-standardised prevalence of 307 per 100 000 (235–389) globally, with 24·2 million (18·5–30·7) prevalent cases, and secondary epilepsy had a global age-standardised prevalence of 350 per 100 000 (322–380). In 2021, 0·7% of the population had active epilepsy (0·3% attributed to idiopathic epilepsy and 0·4% to secondary epilepsy), and the age-standardised global prevalence of epilepsy from idiopathic and secondary epilepsy combined increased from 1990 to 2021 by 10·8% (1·1–21·3), mainly due to corresponding changes in secondary epilepsy. However, age-standardised death and DALY rates of idiopathic epilepsy reduced from 1990 to 2021 (decline of 15·8% [8·8–22·8] and 14·5% [4·2–24·2], respectively). There were three-fold to four-fold geographical differences in the burden of active idiopathic epilepsy, with the bulk of the burden residing in low-income to middle-income countries: 82·1% (81·1–83·4) of incident, 80·4% prevalent (79·7–82·7), 84·7% (83·7–85·1) fatal epilepsy, and 87·9% (86·2–89·2) epilepsy DALYs. Interpretation: Although the global trends in idiopathic epilepsy deaths and DALY rates have improved in the preceding decades, in 2021 there were almost 52 million people with active epilepsy (24 million from idiopathic epilepsy and 28 million from secondary epilepsy), with the bulk of the burden (>80%) residing in low-income to middle-income countries. Better treatment and prevention of epilepsy are required, along with further research on risk factors of idiopathic epilepsy, good-quality long-term epilepsy surveillance studies, and exploration of the possible effect of stigma and cultural differences in seeking medical attention for epilepsy. Funding: Bill and Melinda Gates Foundatio

Burden of disease scenarios by state in the USA, 2022–50: a forecasting analysis for the Global Burden of Disease Study 2021

Background: The capacity to anticipate future health issues is important for both policy makers and practitioners in the USA, as such insights can facilitate effective planning, investment, and implementation strategies. Forecasting trends in disease and injury burden is not only crucial for policy makers but also garners substantial interest from the general populace and leads to a better-informed public. Through the integration of new data sources, the refinement of methodologies, and the inclusion of additional causes, we have improved our previous forecasting efforts within the scope of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to produce forecasts at the state and national levels for the USA under various possible scenarios. Methods: We developed a comprehensive framework for forecasting life expectancy, healthy life expectancy (HALE), cause-specific mortality, and disability-adjusted life-years (DALYs) due to 359 causes of disease and injury burden from 2022 to 2050 for the USA and all 50 states and Washington, DC. Using the GBD 2021 Future Health Scenarios modelling framework, we forecasted drivers of disease, demographic drivers, risk factors, temperature and particulate matter, mortality and years of life lost (YLL), population, and non-fatal burden. In addition to a reference scenario (representing the most probable future trajectory), we explored various future scenarios and their potential impacts over the next several decades on human health. These alternative scenarios comprised four risk elimination scenarios (including safer environment, improved behavioural and metabolic risks, improved childhood nutrition and vaccination, and a combined scenario) and three USA-specific scenarios based on risk exposure or attributable burden in the best-performing US states (improved high adult BMI and high fasting plasma glucose [FPG], improved smoking, and improved drug use [encompassing opioids, cocaine, amphetamine, and others]). Findings: Life expectancy in the USA is projected to increase from 78·3 years (95% uncertainty interval 78·1–78·5) in 2022 to 79·9 years (79·5–80·2) in 2035, and to 80·4 years (79·8–81·0) in 2050 for all sexes combined. This increase is forecasted to be modest compared with that in other countries around the world, resulting in the USA declining in global rank over the 2022–50 forecasted period among the 204 countries and territories in GBD, from 49th to 66th. There is projected to be a decline in female life expectancy in West Virginia between 1990 and 2050, and little change in Arkansas and Oklahoma. Additionally, after 2023, we projected almost no change in female life expectancy in many states, notably in Oklahoma, South Dakota, Utah, Iowa, Maine, and Wisconsin. Female HALE is projected to decline between 1990 and 2050 in 20 states and to remain unchanged in three others. Drug use disorders and low back pain are projected to be the leading Level 3 causes of age-standardised DALYs in 2050. The age-standardised DALY rate due to drug use disorders is projected to increase considerably between 2022 and 2050 (19·5% [6·9–34·1]). Our combined risk elimination scenario shows that the USA could gain 3·8 additional years (3·6–4·0) of life expectancy and 4·1 additional years (3·9–4·3) of HALE in 2050 versus the reference scenario. Using our USA-specific scenarios, we forecasted that the USA could gain 0·4 additional years (0·3–0·6) of life expectancy and 0·6 additional years (0·5–0·8) of HALE in 2050 under the improved drug use scenario relative to the reference scenario. Life expectancy and HALE are likewise projected to be 0·4–0·5 years higher in 2050 under the improved adult BMI and FPG and improved smoking scenarios compared with the reference scenario. However, the increases in these scenarios would not substantially improve the USA's global ranking in 2050 (from 66th of 204 in life expectancy in the reference scenario to 63rd–64th in each of the three USA-specific scenarios), indicating that the USA's best-performing states are still lagging behind other countries in their rank throughout the forecasted period. Regardless, an estimated 12·4 million (11·3–13·5) deaths could be averted between 2022 and 2050 if the USA were to follow the combined scenario trajectory rather than the reference scenario. There would also be 1·4 million (0·7–2·2) fewer deaths over the 28-year forecasted period with improved adult BMI and FPG, 2·1 million (1·3–2·9) fewer deaths with improved exposure to smoking, and 1·2 million (0·9–1·5) fewer deaths with lower rates of drug use deaths. Interpretation: Our findings highlight the alarming trajectory of health challenges in the USA, which, if left unaddressed, could lead to a reversal of the health progress made over the past three decades for some US states and a decline in global health standing for all states. The evidence from our alternative scenarios along with other published studies suggests that through collaborative, evidence-based strategies, there are opportunities to change the trajectory of health outcomes in the USA, such as by investing in scientific innovation, health-care access, preventive health care, risk exposure reduction, and education. Our forecasts clearly show that the time to act is now, as the future of the country's health and wellbeing—as well as its prosperity and leadership position in science and innovation—are at stake. Funding: Bill & Melinda Gates Foundation.</p