Autonomy and Proxy Consent
In: IRB: ethics & human research, Band 4, Heft 10, S. 1
ISSN: 2326-2222
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In: IRB: ethics & human research, Band 4, Heft 10, S. 1
ISSN: 2326-2222
In: Journal of accounting and public policy, Band 20, Heft 1, S. 1-26
ISSN: 0278-4254
In: Social theory and practice: an international and interdisciplinary journal of social philosophy, Band 2, Heft 2, S. 189-195
ISSN: 2154-123X
In: Social theory and practice: an international and interdisciplinary journal of social philosophy, Band 2, Heft 2, S. 163-175
ISSN: 2154-123X
IntroductionExpert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies' accessibility and transmission, stigma, diagnostic manuals, data-sharing platforms, and use of behavioral insights (BIs) are not well known.MethodsWe investigated opinions among health professionals working on aging in LACs (N=3365) with regression models including expertise-related information (public policies, BI), individual differences (work, age, academic degree), and location.ResultsExperts specified low public policy knowledge (X2 =41.27, P<.001), high levels of stigma (X2 =2636.37, P<.001), almost absent BI knowledge (X2 =56.58, P<.001), and needs for regional diagnostic manuals (X2 =2893.63, df=3, P<.001) and data-sharing platforms (X2=1267.5, df=3, P<.001). Lack of dementia knowledge was modulated by different factors. An implemented BI-based treatment for a proposed prevention program improved perception across experts.DiscussionOur findings help to prioritize future potential actions of governmental agencies and non-governmental organizations (NGOs) to improve LACs' dementia knowledge.
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INTRODUCTION: Expert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies' accessibility and transmission, stigma, diagnostic manuals, data‐sharing platforms, and use of behavioral insights (BIs) are not well known. METHODS: We investigated opinions among health professionals working on aging in LACs (N = 3365) with regression models including expertise‐related information (public policies, BI), individual differences (work, age, academic degree), and location. RESULTS: Experts specified low public policy knowledge (X(2) = 41.27, P < .001), high levels of stigma (X(2) = 2636.37, P < .001), almost absent BI knowledge (X(2) = 56.58, P < .001), and needs for regional diagnostic manuals (X(2) = 2893.63, df = 3, P < .001) and data‐sharing platforms (X(2) = 1267.5, df = 3, P < .001). Lack of dementia knowledge was modulated by different factors. An implemented BI‐based treatment for a proposed prevention program improved perception across experts. DISCUSSION: Our findings help to prioritize future potential actions of governmental agencies and non‐governmental organizations (NGOs) to improve LACs' dementia knowledge.
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IntroductionExpert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies' accessibility and transmission, stigma, diagnostic manuals, data-sharing platforms, and use of behavioral insights (BIs) are not well known.MethodsWe investigated opinions among health professionals working on aging in LACs (N=3365) with regression models including expertise-related information (public policies, BI), individual differences (work, age, academic degree), and location.ResultsExperts specified low public policy knowledge (X2 =41.27, P<.001), high levels of stigma (X2 =2636.37, P<.001), almost absent BI knowledge (X2 =56.58, P<.001), and needs for regional diagnostic manuals (X2 =2893.63, df=3, P<.001) and data-sharing platforms (X2=1267.5, df=3, P<.001). Lack of dementia knowledge was modulated by different factors. An implemented BI-based treatment for a proposed prevention program improved perception across experts.DiscussionOur findings help to prioritize future potential actions of governmental agencies and non-governmental organizations (NGOs) to improve LACs' dementia knowledge.
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Posterior cortical atrophy is a clinico-radiological syndrome characterized by progressive decline in visual processing and atrophy of posterior brain regions. With the majority of cases attributable to Alzheimer's disease and recent evidence for genetic risk factors specifically related to posterior cortical atrophy, the syndrome can provide important insights into selective vulnerability and phenotypic diversity. The present study describes the first major longitudinal investigation of posterior cortical atrophy disease progression. Three hundred and sixty-one individuals (117 posterior cortical atrophy, 106 typical Alzheimer's disease, 138 controls) fulfilling consensus criteria for posterior cortical atrophy-pure and typical Alzheimer's disease were recruited from three centres in the UK, Spain and USA. Participants underwent up to six annual assessments involving MRI scans and neuropsychological testing. We constructed longitudinal trajectories of regional brain volumes within posterior cortical atrophy and typical Alzheimer's disease using differential equation models. We compared and contrasted the order in which regional brain volumes become abnormal within posterior cortical atrophy and typical Alzheimer's disease using event-based models. We also examined trajectories of cognitive decline and the order in which different cognitive tests show abnormality using the same models. Temporally aligned trajectories for eight regions of interest revealed distinct (P < 0.002) patterns of progression in posterior cortical atrophy and typical Alzheimer's disease. Patients with posterior cortical atrophy showed early occipital and parietal atrophy, with subsequent higher rates of temporal atrophy and ventricular expansion leading to tissue loss of comparable extent later. Hippocampal, entorhinal and frontal regions underwent a lower rate of change and never approached the extent of posterior cortical involvement. Patients with typical Alzheimer's disease showed early hippocampal atrophy, with subsequent higher rates of temporal atrophy and ventricular expansion. Cognitive models showed tests sensitive to visuospatial dysfunction declined earlier in posterior cortical atrophy than typical Alzheimer's disease whilst tests sensitive to working memory impairment declined earlier in typical Alzheimer's disease than posterior cortical atrophy. These findings indicate that posterior cortical atrophy and typical Alzheimer's disease have distinct sites of onset and different profiles of spatial and temporal progression. The ordering of disease events both motivates investigation of biological factors underpinning phenotypic heterogeneity, and informs the selection of measures for clinical trials in posterior cortical atrophy. ; This work was supported by an Alzheimer's Research UK Senior Research Fellowship and ESRC/NIHR (ES/L001810/1) and EPSRC (EP/M006093/1) grants to S.J.C. K.Y. is funded by the Alzheimer's Society. The Dementia Research Centre is supported by Alzheimer's Research UK, Brain Research Trust, and The Wolfson Foundation. This work was also supported by the NIHR Queen Square Dementia Biomedical Research Unit, and the NIHR UCL/H Biomedical Research Centre. N.F. is funded by EPSRC (EP/M006093/1). R.V.M. was supported by the EPSRC Centre For Doctoral Training in Medical Imaging with grant EP/L016478/1. R.W.P. is an NIHR Academic Clinical lecturer. J.M.S. acknowledges the support of the Wolfson Foundation, EPSRC (EP/J020990/1), MRC (MR/L023784/1), ARUK (ARUK-Network 2012–6-ICE; ARUK-PG2017–1946), Brain Research Trust (UCC14191) and European Union's Horizon 2020 research and innovation programme (Grant 666992). T.J.S. was supported by an Alzheimer's Research UK Research Fellowship. J.W. was supported by funding from the Alzheimer's Society and the NIHR UCLH Biomedical Research Centre. Some authors (N.P.O., S.O., D.C.A., and J.M.S.) acknowledge funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 666992. The work was also supported by funding from National Institutes of Health R01-AG045611 (to G.D.R.), P50-AG23501 (to B.L.M. and G.D.R.)
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Altres ajuts: This work was in part supported by the Canadian Consortium on Neurodegeneration in Aging (E.R., M.Z.), the ALS Canada-Brain Canada Hudson Grant (J.R., E.R., L.Z.), James Hunter ALS Initiative and the Temerty Family Foundation (L.Z., J.R.), Alzheimer's Society grant #284 (R.F.), Argentine National Research Council (CONICET) (EIS), ALS Canada Clinical Research Fellowship (R.S.), National Institutes of Health (NIH) R35 NS097261, P50 AG016574, P01 NS084974 (RR), P50 AG016574 (N.R.G., D.W.D., J.E.P., B.F.B., R.C.P.), NIH P01 NS084974 (D.W.D.), NIH P01 AG019724 (B.L.M., W.W.S.), JPND PreFrontALS (733051042), JPND RiMOD (733051024), Memorabel-FTD (733050103) (J.C.v-S), the Flemish Government initiated Impulse Program on Networks for Dementia Research (VIND), the Methusalem Excellence Program, the Research Foundation Flanders (FWO) and the University of Antwerp Research Fund (C.V.B., J.v-d-Z.), NIH P01-AG-017586 (V.V.D.), "Investissements d'avenir" ANR-10-IAIHU-06, Assistance Publique-Hôpitaux de Paris (Clinical Research and Development Department), Programme Hospitalier de Recherche Clinique, FTLD-exome RCAOM-12123, the ANR-PRTS PREV-DEMALS project (I.L.B.), an MRC Clinician Scientist Fellowship (MR/M008525/1), the NIHR Rare Disease Translational Research Collaboration (BRC149/NS/MH), the MRC UK GENFI grant (MR/M023664/1) (J.D.R.), Swedish Research Council (Dnr 521-2010-3134, 529-2014-7504, 2015-02926), Alzheimer foundation Sweden, Brain Foundation Sweden, Swedish FTD Initiative, Swedish Brain Power, Karolinska Institutet doctoral funding, Gamla tjänarinnor, Stohnes foundation, Dementia foundation Sweden and the Stockholm County Council (ALF project) (CG), Ricerca Corrente, Italian Ministry of Health (G.R., G.B., L.B.), a National Health & Medical Research Council of Australia (NHMRC) Boosting Dementia Research Leadership Fellowship (1138223) (C.D.S.), NHMRC Senior Principal Research Fellowship (1079679) (G.M.H.), NHMRC Senior Research Fellowship (1103258) (O.P.), Fondazione CRF Grant 2015.0722, Fondo ...
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The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.
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The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.
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The SARS‐CoV‐2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS‐CoV‐2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.
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The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.
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In: Gao , Y , Wang , T , Yu , X , Ferrari , R , Hernandez , D G , Nalls , M A , Rohrer , J D , Ramasamy , A , Kwok , J B J , Dobson-Stone , C , Brooks , W S , Schofield , P R , Halliday , G M , Hodges , J R , Piguet , O , Bartley , L , Thompson , E , Haan , E , Hernández , I , Ruiz , A , Boada , M , Borroni , B , Padovani , A , Cruchaga , C , Cairns , N J , Benussi , L , Binetti , G , Ghidoni , R , Forloni , G , Albani , D , Galimberti , D , Fenoglio , C , Serpente , M , Scarpini , E , Clarimón , J , Lleó , A , Blesa , R , Waldö , M L , Nilsson , K , Nilsson , C , Mackenzie , I R A , Hsiung , G Y R , Mann , D M A , Grafman , J , Morris , C M , Attems , J , Griffiths , T D , McKeith , I G , Thomas , A J , Pietrini , P , Huey , E D , Wassermann , E M , Baborie , A , Jaros , E , Tierney , M C , Pastor , P , Razquin , C , Ortega-Cubero , S , Alonso , E , Perneczky , R , Diehl-Schmid , J , Alexopoulos , P , Kurz , A , Rainero , I , Rubino , E , Pinessi , L , Rogaeva , E , George-Hyslop , P S , Rossi , G , Tagliavini , F , Giaccone , G , Rowe , J B , Schlachetzki , J C M , Uphill , J , Collinge , J , Mead , S , Danek , A , Van Deerlin , V M , Grossman , M , Trojanowski , J Q , van der Zee , J , Cruts , M , Van Broeckhoven , C , Cappa , S F , Leber , I , Hannequin , D , Golfier , V , Vercelletto , M , Brice , A , Nacmias , B , Sorbi , S , Bagnoli , S , Piaceri , I , Nielsen , J E , Hjermind , L E , Riemenschneider , M , Mayhaus , M , Ibach , B , Gasparoni , G , Pichler , S , Gu , W , Rossor , M N , Fox , N C , Warren , J D , Spillantini , M G , Morris , H R , Rizzu , P , Heutink , P , Snowden , J S , Rollinson , S , Richardson , A , Gerhard , A , Bruni , A C , Maletta , R , Frangipane , F , Cupidi , C , Bernardi , L , Anfossi , M , Gallo , M , Conidi , M E , Smirne , N , Rademakers , R , Baker , M , Dickson , D W , Graff-Radford , N R , Petersen , R C , Knopman , D , Josephs , K A , Boeve , B F , Parisi , J E , Seeley , W W , Miller , B L , Karydas , A M , Rosen , H , van Swieten , J C , Dopper , E G P , Seelaar , H , Pijnenburg , Y A L , Scheltens , P , Logroscino , G , Capozzo , R , Novelli , V , Puca , A A , Franceschi , M , Postiglione , A , Milan , G , Sorrentino , P , Kristiansen , M , Chiang , H H , Graff , C , Pasquier , F , Rollin , A , Deramecourt , V , Lebouvier , T , Kapogiannis , D , Ferrucci , L , Pickering-Brown , S , Singleton , A B , Hardy , J , Momeni , P , Zhao , H , Zeng , P & International FTD-Genomics Consortium (IFGC) 2020 , ' Mendelian randomization implies no direct causal association between leukocyte telomere length and amyotrophic lateral sclerosis ' , Scientific Reports , vol. 10 , no. 1 , 12184 . https://doi.org/10.1038/s41598-020-68848-9
We employed Mendelian randomization (MR) to evaluate the causal relationship between leukocyte telomere length (LTL) and amyotrophic lateral sclerosis (ALS) with summary statistics from genome-wide association studies (n = ~ 38,000 for LTL and ~ 81,000 for ALS in the European population; n = ~ 23,000 for LTL and ~ 4,100 for ALS in the Asian population). We further evaluated mediation roles of lipids in the pathway from LTL to ALS. The odds ratio per standard deviation decrease of LTL on ALS was 1.10 (95% CI 0.93–1.31, p = 0.274) in the European population and 0.75 (95% CI 0.53–1.07, p = 0.116) in the Asian population. This null association was also detected between LTL and frontotemporal dementia in the European population. However, we found that an indirect effect of LTL on ALS might be mediated by low density lipoprotein (LDL) or total cholesterol (TC) in the European population. These results were robust against extensive sensitivity analyses. Overall, our MR study did not support the direct causal association between LTL and the ALS risk in neither population, but provided suggestive evidence for the mediation role of LDL or TC on the influence of LTL and ALS in the European population.
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