scholarly journals Societal and equity challenges for Brain Health Services. A user manual for Brain Health Services—part 6 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Richard Milne ◽  
Daniele Altomare ◽  
Federica Ribaldi ◽  
José Luis Molinuevo ◽  
Giovanni B. Frisoni ◽  
...  
Keyword(s):  
Social Context ◽  
Health Services ◽  
Risk Reduction ◽  
Ethical Standards ◽  
Equitable Access ◽  
Brain Health ◽  
Novel Approach ◽  
Dementia Prevention ◽  
The Social ◽  
Risk Reduction Measures

AbstractBrain Health Services are a novel approach to the personalized prevention of dementia. In this paper, we consider how such services can best reflect their social, cultural, and economic context and, in doing so, deliver fair and equitable access to risk reduction. We present specific areas of challenge associated with the social context for dementia prevention. The first concentrates on how Brain Health Services engage with the “at-risk“ individual, recognizing the range of factors that shape an individual’s risk of dementia and the efficacy of risk reduction measures. The second emphasizes the social context of Brain Health Services themselves and their ability to provide equitable access to risk reduction. We then elaborate proposals for meeting or mitigating these challenges. We suggest that considering these challenges will enable Brain Health Services to address two fundamental questions: the balance between an individualized “high-risk” and population focus for public health prevention and the ability of services to meet ethical standards of justice and health equity.

scholarly journals Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Alina Solomon ◽  
Ruth Stephen ◽  
Daniele Altomare ◽  
Emmanuel Carrera ◽  
Giovanni B. Frisoni ◽  
...  
Keyword(s):  
Health Services ◽  
Risk Reduction ◽  
Risk Groups ◽  
Risk Scores ◽  
Current Evidence ◽  
Brain Health ◽  
Dementia Risk ◽  
Dementia Prevention ◽  
Multidomain Intervention ◽  
Prevention Trials

AbstractAlthough prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting several risk factors and disease mechanisms simultaneously, in individuals without dementia at baseline. Based on the findings, we formulate recommendations for implementing precision risk reduction strategies into new services called Brain Health Services. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: non-pharmacological multidomain interventions (i.e., combining two or more intervention domains), target population including individuals without dementia, and primary outcomes including cognitive/functional performance changes and/or incident cognitive impairment or dementia. Further literature searches covered the following topics: sub-group analyses assessing potential modifiers for the intervention effect on cognition in the multidomain prevention trials, dementia risk scores used as surrogate outcomes in multidomain prevention trials, dementia risk scores in relation to brain pathology markers, and cardiovascular risk scores in relation to dementia. Multidomain intervention studies conducted so far appear to have mixed results and substantial variability in target populations, format and intensity of interventions, choice of control conditions, and outcome measures. Most trials were conducted in high-income countries. The differences in design between the larger, longer-term trials that met vs. did not meet their primary outcomes suggest that multidomain intervention effectiveness may be dependent on a precision prevention approach, i.e., successfully identifying the at-risk groups who are most likely to benefit. One such successful trial has already developed an operational model for implementing the intervention into practice. Evidence on the efficacy of risk reduction interventions is promising, but not yet conclusive. More long-term multidomain randomized controlled trials are needed to fill the current evidence gaps, especially concerning low- and middle-income countries and integration of dementia prevention with existing cerebrovascular prevention programs. A precision risk reduction approach may be most effective for dementia prevention. Such an approach could be implemented in Brain Health Services.

scholarly journals Social vulnerability in cost-benefit analysis for flood risk management

2019 ◽  
Vol 25 (2) ◽  
pp. 115-134
Author(s):  
Jarl Kind ◽  
W. J. Wouter Botzen ◽  
Jeroen C. J. H. Aerts
Keyword(s):  
Social Welfare ◽  
Risk Reduction ◽  
Low Income ◽  
Flood Risk ◽  
Social Vulnerability ◽  
Cost Benefit ◽  
Financial Protection ◽  
The Social ◽  
Flood Risk Reduction ◽  
Risk Reduction Measures

AbstractTraditional cost-benefit analyses (CBAs) of flood risk reduction measures usually ignore distributions of damages over populations, which disadvantages the poor. Instead, a CBA based on social welfare includes individual social vulnerability through relative impacts on consumption. If vulnerabilities are high, floods are catastrophic and cause poverty, migration or indirect deaths, and risk reductions have high social welfare values. For non-catastrophic risks, social welfare values of risks are relatively higher for vulnerable low-income households. We present a framework to integrate social vulnerability into CBAs, and show how financial protection reduces social flood vulnerability and provides welfare benefits. A case study illustrates that traditional CBAs underestimate the social welfare value of flood risk reduction measures, up to a factor of 30. Data on financial protection is however scarce, which hampers estimation of the social welfare value in practice. A solution is to increase financial protection of individuals, in addition to offering physical flood protection.

scholarly journals Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Janice M. Ranson ◽  
Timothy Rittman ◽  
Shabina Hayat ◽  
Carol Brayne ◽  
Frank Jessen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Services ◽  
Risk Reduction ◽  
Initial Assessment ◽  
Modifiable Risk Factors ◽  
Brain Health ◽  
Local Resources ◽  
Risk Profiling ◽  
Dementia Risk ◽  
Personalized Risk

AbstractWe envisage the development of new Brain Health Services to achieve primary and secondary dementia prevention. These services will complement existing memory clinics by targeting cognitively unimpaired individuals, where the focus is on risk profiling and personalized risk reduction interventions rather than diagnosing and treating late-stage disease. In this article, we review key potentially modifiable risk factors and genetic risk factors and discuss assessment of risk factors as well as additional fluid and imaging biomarkers that may enhance risk profiling. We then outline multidomain measures and risk profiling and provide practical guidelines for Brain Health Services, with consideration of outstanding uncertainties and challenges. Users of Brain Health Services should undergo risk profiling tailored to their age, level of risk, and availability of local resources. Initial risk assessment should incorporate a multidomain risk profiling measure. For users aged 39–64, we recommend the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) Dementia Risk Score, whereas for users aged 65 and older, we recommend the Brief Dementia Screening Indicator (BDSI) and the Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI). The initial assessment should also include potentially modifiable risk factors including sociodemographic, lifestyle, and health factors. If resources allow, apolipoprotein E ɛ4 status testing and structural magnetic resonance imaging should be conducted. If this initial assessment indicates a low dementia risk, then low intensity interventions can be implemented. If the user has a high dementia risk, additional investigations should be considered if local resources allow. Common variant polygenic risk of late-onset AD can be tested in middle-aged or older adults. Rare variants should only be investigated in users with a family history of early-onset dementia in a first degree relative. Advanced imaging with 18-fluorodeoxyglucose positron emission tomography (FDG-PET) or amyloid PET may be informative in high risk users to clarify the nature and burden of their underlying pathologies. Cerebrospinal fluid biomarkers are not recommended for this setting, and blood-based biomarkers need further validation before clinical use. As new technologies become available, advances in artificial intelligence are likely to improve our ability to combine diverse data to further enhance risk profiling. Ultimately, Brain Health Services have the potential to reduce the future burden of dementia through risk profiling, risk communication, personalized risk reduction, and cognitive enhancement interventions.

scholarly journals The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil

2020 ◽  
Vol 14 (10) ◽  
pp. 1185-1190
Author(s):  
Laura Terenciani Campoy ◽  
Luiz Henrique Arroyo ◽  
Antônio Vieira Ramos ◽  
Thais Zamboni Berra ◽  
Juliane Almeida Crispim ◽  
...  
Keyword(s):  
Social Context ◽  
Health Services ◽  
Family Health ◽  
Sao Paulo ◽  
The State ◽  
São Paulo ◽  
Hiv Coinfection ◽  
Health Strategy ◽  
The Social ◽  
Family Health Strategy

Introduction: Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. Methodology: Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. Results: There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. Conclusions: The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.

scholarly journals Assessment of Social Sustainability in Construction Projects Using Social Network Analysis

2018 ◽  
Vol 3 (6) ◽  
pp. 35-46 ◽  
Author(s):  
Essam Almahmoud ◽  
Hemanta Kumar Doloi
Keyword(s):  
Social Network ◽  
Social Network Analysis ◽  
Social Context ◽  
Network Analysis ◽  
Construction Projects ◽  
Dynamic Assessment ◽  
Social Sustainability ◽  
Assessment Model ◽  
Novel Approach ◽  
The Social

This paper aims to propose a framework that puts the stakeholders at the forefront of achieving sustainability in the social context. This research, thus, argues that the social sustainability outcomes in construction are best achieved by taking into account the satisfaction of the stakeholders. Based on sustainability and equity theories, a dynamic assessment model has been developed to evaluate the contributions of projects in a social context. Multiple stakeholders and their differing interests associated with the construction projects have been integrated using social network analysis. The mapping of the relationships between the project stakeholders, with respect to their relative stakes and seven social core functions, have been integrated into the assessment model. The findings of this research suggest that the degree of satisfying the needs of diverse stakeholders is highly significant in achieving social sustainability performance of projects. Using a case study from Saudi Arabia, the applicability and significance of the assessment model has been demonstrated. The application of the model provides the opportunity to identify any problems and to enhance the overall performance of projects in the social context. The functionality and efficacy of the model need to be further tested outside the Saudi Arabian region. The research is original in the sense that for the first time, a novel approach has been developed, putting the stakeholders at the forefront of achieving sustainability outcomes in construction projects

The Social Context of an Epidemic

1987 ◽  
Vol 32 (12) ◽  
pp. 1004-1007
Author(s):  
Gregory M. Herek
Keyword(s):  
Social Context ◽  
The Social

Attitudes in the Social Context

2001 ◽  
Author(s):  
Penny S. Visser ◽  
Robert R. Mirabile
Keyword(s):  
Social Context ◽  
The Social
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