Building Better Brain Health for All People : GCBH Recommendations on Removing Barriers and Improving Opportunities Around the World

The Global Council on Brain Health (GCBH) convened a series of sessions with international experts to explore the challenges to brain health faced by different communities around the world. In this report, we share what we have learned about the societal, political, and environmental factors that influence people’s opportunity to maintain the best possible brain health through the course of their lives. We explain why certain groups of the population face more difficult barriers to achieving this goal than others. And we offer recommendations on how to enhance this opportunity for all. The GCBH encourages individuals to embrace healthy lifestyles when that is possible, thereby empowering themselves to develop and sustain the best possible brain health regardless of their background or the barriers they may face. Too often, however, powerful forces and social conditions stand in the way of wholesome choices, negatively influencing people’s brain health. Within every country, public policies, political systems, economic conditions, social norms, and environmental factors influence health and wellness for better or worse. Discrimination based on age, race, ethnicity, gender and gender identity/roles, sexual orientation, national origin, caste, disabilities (visible as well as invisible), and genetic forms of neurological diseases contributes to poor physical and mental health in many societies. Barriers rooted in government policy, health care, institutional values, professional practice, and culture itself all may stand in the way of optimal brain health. To address these factors, the GCBH recommends a multifaceted approach grounded in the latest scientific research and informed by the lived experience of individuals with cognitive loss. Innovations in policy, research, technology, community engagement, infrastructure, environmental design, and family supports are all discussed in this report as parts of the answer. Progress requires strategic collaboration and the engagement of many stakeholders from different sectors. Improving the opportunities to optimize brain health is a long-term task that calls for new, inclusive solutions to address the entrenched barriers that so many face. Achieving equity will require, in the words of Thomas Kuhn, “shifting the paradigm” – transforming the existing scientific approach through innovative thinking and problem-solving to ensure that people are treated as individuals, and treated fairly, around the world

Do changes to the local street environment alter behaviour and quality of life of older adults? The ‘DIY Streets’ intervention

<p>Background: The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans ‘DIY Streets’) allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults’ activities, health and quality of life.</p> <p>Methods: Pre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records.</p> <p>Results: The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations.</p> <p>Conclusions: Our study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.</p&gt

Sports participation as an investment in (subjective) health: a time series analysis of the life course

Background: The causal relationship between sports participation, as physical activity, and subjective health is examined accounting for the London 2012 Olympic Games, which it was hoped would ‘inspire a generation’ by contributing to public health. Improvements to weaknesses in the literature are offered. First, stronger causal claims about the relationship between sports participation and health and second, the actual minutes and intensity of different measures of participation are used. Methods: The rolling monthly survey design of the annually reported Taking Part Survey (TPS) is used to create time series data. This is analysed using a time series modelling strategy. Results: Increases in the level of subjective health requires accelerating sport participation, but no effect from the 2012 Olympics is revealed. Reductions in the level of health are brought about by increases in sports participation in early adulthood, although this gets reversed in middle age. However, a reduction in health re-emerges for older males compared with females. Conclusions: For the population as a whole, sport can contribute to health, with diminishing impact, but impacts vary across the life course and genders. Policy accounting for these variations is necessary. Policy aspirations that London 2012 would produce health benefits from increased sports participation are misplaced

Talking to the people that really matter about their participation in pandemic clinical research: a qualitative study in four European countries

Background Pandemics of new and emerging infectious diseases are unpredictable, recurrent events that rapidly threaten global health and security. We aimed to identify public views regarding provision of information and consent to participate in primary and critical care clinical research during a future influenza-like illness pandemic. Methods Descriptive-interpretive qualitative study, using focus groups (n = 10) and semi-structured interviews (n = 16), with 80 members of the public (>18 years) in Belgium, Spain, Poland and the UK. Local qualitative researchers followed a scenario-based topic guide to collect data. Data were transcribed verbatim, translated into English and subject to framework analysis. Results Public understandings of pandemics were shaped by personal factors (illness during the previous H1N1 pandemic, experience of life-threatening illness) and social factors (historical references, media, public health information). Informants appreciated safeguards provided by ethically robust research procedures, but current enrolment procedures were seen as a barrier. They proposed simplified enrolment processes for higher risk research and consent waiver for certain types of low-risk research. Decision making about research participation was influenced by contextual, research and personal factors. Informants generally either carefully weighed up various approaches to research participation or responded instinctively. They supported the principle of using routinely collected, anonymized clinical biological samples for research without explicit consent, but regarded this as less acceptable if researchers were motivated primarily by commercial gain. Conclusions This bottom-up approach to ascertaining public views on pandemic clinical research has identified support for more proportionate research protection procedures for publically funded, low-risk studies

Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol

Background Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research? Methods/Design The project is a before-after study which planned to benefit from and extend existing regional and international networks. Over five years the project was designed to comprise five phases; pre-study, pre-intervention, intervention, outcome assessment and reporting/dissemination. The study was proposed to be conducted across seven project nodes: four in South East Asia and three in Australia. Each South East Asian study node was planned to be established within an existing department of obstetrics and gynaecology or neonatology and was intended to form the project coordinating centre and focus for evidence-based practice activities within that region. Nine hospitals in South East Asia planned to participate, representing a range of clinical settings. The three project nodes in Australia were intended to provide project support. The intervention was planned to consist of capacity-strengthening activities targeted at three groups: generators of evidence, users of evidence and teachers of evidence. The primary outcome was established as changes in adherence to recommended clinical practices from baseline to completion of the project and impact on health outcomes. Discussion The SEA-ORCHID project was intended to improve care during pregnancy and the perinatal period of mothers and their babies in South East Asia. The possible benefits extend beyond this however, as at the end of this project there is hoped to be an existing network of South East Asian researchers and health care providers with the capacity to generalise this model to other health priority areas. It is anticipated that this project facilitate ongoing development of evidence-based practice and policy in South East Asia through attracting long-term funding, expansion into other hospitals and community-based care and the establishment of nodes in other countries.David J Henderson-Smart, Pisake Lumbiganon, Mario R Festin, Jacqueline J Ho, Hakimi Mohammad, Steve J McDonald, Sally Green and Caroline A Crowther for the SEA-ORCHID Study Grou

Design for occupational safety and health of workers in construction in developing countries: A study of architects in Nigeria

Purpose. Design for safety (DfS) of workers is amongst the prominent ways of tackling poor occupational safety and health performance in construction. However, in developing countries there is extremely limited research on DfS. This study thus makes an important contribution to the subject of DfS in developing countries by specifically examining the awareness and practice of DfS amongst architects within the construction sector of Nigeria. Materials and methods. A survey of architects, yielding 161 valid responses, was conducted. Results. While there is high awareness of the concept of DfS, the actual practice is low. Additionally, although there is high interest in DfS training, the engagement in DfS training is low. Significantly, awareness of DfS, training and education related to DfS, and membership of a design professional body have very limited bearing on the practice of DfS by architects. Conclusions. The findings are thus symptomatic of the prevalence of influential DfS implementation barriers within the construction sector. Industry stakeholders should seek to raise the profile of DfS practice within the sector. Furthermore, similar empirical studies in the construction sector of other developing countries would be useful in shedding light on the status of DfS in these countries

Is peer review useful in assessing research proposals in Indigenous health? A case study

Background: There has been considerable examination and critique of traditional (academic) peer review processes in quality assessment of grant applications. At the same time, the use of traditional research processes in Indigenous research has been questioned. Many grant funding organisations have changed the composition of their peer review panels to reflect these concerns but the question remains do these reforms go far enough? In this project we asked people working in areas associated with Aboriginal health research in a number of capacities, their views on the use of peer review in assessing Indigenous research proposals. Methods: In semi-structured interviews we asked 18 individuals associated with an Australian Indigenous research funding organisation to reflect on their experience with peer review in quality assessment of grant applications. We also invited input from a steering group drawn from a variety of organisations involved in Aboriginal research throughout Australia and directly consulted with three Aboriginal-controlled health organisations. Results: There was consensus amongst all participants that traditional academic peer review is inappropriate for quality assessment in Indigenous research. Many expressed the view that using a competitive grant review system in Aboriginal health was counterintuitive, since good research transfer is based on effective collaboration. The consensus within the group favoured a system which built research in a collaborative manner incorporating a variety of different stakeholders in the process. In this system, one-off peer review was still seen as valuable in the form of a "critical friend" who provided advice as to how to improve the research proposal. Conclusion: Peer review in the traditional mould should be recognised as inappropriate in Aboriginal research. Building research projects relevant to policy and practice in Indigenous health may require a shift to a new way of selecting, funding and conducting research.Jackie Street, Fran Baum and Ian P.S. Anderso

How HIV/AIDS scale-up has impacted on non- HIV priority services in Zambia

Background: Much of the debate as to whether or not the scaling up of HIV service delivery in Africa benefits non-HIV priority services has focused on the use of nationally aggregated data. This paper analyses and presents routine health facility record data to show trend correlations across priority services. Methods: Review of district office and health facility client records for 39 health facilities in three districts of Zambia, covering four consecutive years (2004-07). Intra-facility analyses were conducted, service and coverage trends assessed and rank correlations between services measured to compare service trends within facilities. Results: VCT, ART and PMTCT client numbers and coverage levels increased rapidly. There were some strong positive correlations in trends within facilities between reproductive health services (family planning and antenatal care) and ART and PMTCT, with Spearman rank correlations ranging from 0.33 to 0.83. Childhood immunisation coverage also increased. Stock-outs of important drugs for non-HIV priority services were significantly more frequent than were stock-outs of antiretroviral drugs. Conclusions: The analysis shows scale-up in reproductive health service numbers in the same facilities where HIV services were scaling up. While district childhood immunisations increased overall, this did not necessarily occur in facility catchment areas where HIV service scale-up occurred. The paper demonstrates an approach for comparing correlation trends across different services, using routine health facility information. Larger samples and explanatory studies are needed to understand the client, facility and health systems factors that contribute to positive and negative synergies between priority services