Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis

Interest is growing in the role of infectious agents in the pathogenesis of dementia, but current evidence is limited. We conducted a systematic review and meta-analysis to investigate the effect of any of eight human herpesviruses on development of dementia or mild cognitive impairment (MCI). We searched the Cochrane Library, Embase, Global Health, Medline, PsycINFO, Scopus, Web of Science, clinical trials registers and grey literature sources from inception to December 2017 for observational studies with cohort, case control or self-controlled designs, or randomised controlled trials of interventions against herpesviruses. Pooled effect estimates and 95% confidence intervals (CIs) were generated through random effects meta-analyses across studies with the same design, outcome, and virus type, method and site of measurement. We included 57 studies across various geographic settings. Past infection with herpesviruses, measured by IgG seropositivity, was generally not associated with dementia risk. A single cohort study rated moderate quality showed an association between varicella zoster virus reactivation (ophthalmic zoster) and incident dementia (HR 2.97; 95%CI, 1.89 to 4.66). Recent infection with, or reactivation of, herpes simplex virus type 1 or type 1/2 unspecified, cytomegalovirus and human herpes virus-6 measured by serum IgM, high titre IgG or clinical disease may be associated with dementia or MCI, though results were inconsistent across studies and overall evidence rated very low quality. Longitudinal population studies with robust repeated virus measurements taken sufficiently proximal to dementia onset are needed to establish whether, when and among whom herpesviruses affect dementia risk

Regional research priorities in brain and nervous system disorders

The characteristics of neurological, psychiatric, developmental and substance-use disorders in low-and middle-income countries are unique and the burden that they have will be different from country to country. Many of the differences are explained by the wide variation in population demographics and size, poverty, conflict, culture, land area and quality, and genetics. Neurological, psychiatric, developmental and substance-use disorders that result from, or are worsened by, a lack of adequate nutrition and infectious disease still afflict much of sub-Saharan Africa, although disorders related to increasing longevity, such as stroke, are on the rise. In the Middle East and North Africa, major depressive disorders and post-traumatic stress disorder are a primary concern because of the conflict-ridden environment. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions. The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. Although much knowledge has been gained over the past 10 years, the epidemiology of the conditions in low-and middle-income countries still needs more research. Prevention and treatments could be better informed with more longitudinal studies of risk factors. Challenges and opportunities for ameliorating nervous-system disorders can benefit from both local and regional research collaborations. The lack of resources and infrastructure for health-care and related research, both in terms of personnel and equipment, along with the stigma associated with the physical or behavioural manifestations of some disorders have hampered progress in understanding the disease burden and improving brain health. Individual countries, and regions within countries, have specific needs in terms of research priorities.Fil: Ravindranath, Vijayalakshmi. Indian Institute of Science; IndiaFil: Dang, Hoang Minh. Vietnam National University; VietnamFil: Goya, Rodolfo Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Bioquímicas de La Plata ; ArgentinaFil: Mansour, Hader. University of Pittsburgh; Estados Unidos. Mansoura University; EgiptoFil: Nimgaonkar, Vishwajit L.. University of Pittsburgh; Estados UnidosFil: Russell, Vivienne Ann. University of Cape Town; SudáfricaFil: Xin, Yu. Peking University; Chin

Climate, extreme weather and the health of older people: An umbrella review and framework for action

Background: Older people are affected more severely and unequally by disturbances in climate and ecosystems. Directly, from extreme weather events such as heat waves, flooding, and severe storms; and indirectly, through droughts and compromised water safety catalysing food insecurity, displacement and poverty. Limited understanding of the impacts and interfaces of climate and extreme weather on older people and subgroups at potential increased risk hinders our ability to plan and respond effectively to protecting older populations as climatic instability continues. Objectives: To progress this agenda, our work aims to i) systematically assess the health impacts of extreme weather on older people ii) synthesise the evidence to examine interfaces and subgroups at increased risk iii) develop a framework to inform responses. Methods: An umbrella review is being conducted to systematically examine and synthesise the links between extreme weather events and health impacts on older people. The review will include original or primary research published between 2013 and 2023. Electronic searches will be conducted in Medline via Ovid, Embase via Ovid, Web of Science, CINAHL via EbscoHost, Cochrane Library, ASSIA via Proquest and PsycINFO via EbscoHost. Reference lists of retrieved articles will be checked for further relevant studies and experts in the field will be consulted to identify any further potentially relevant papers. Quality will be assessed using STROBE checklists and a narrative synthesis of the results conducted. Findings: The results of this review will provide a comprehensive and up-to-date understanding of the impacts of climate instability and extreme weather events on the health and wellbeing of older people. It will be used to develop a framework demonstrating the interfaces between climate, extreme weather and the health of older people which will inform guidance on which subgroups are at increased risk and which actions and responses are needed

Climate, extreme weather and the health of older people: An umbrella review and framework for action

Background: Older people are affected more severely and unequally by disturbances in climate and ecosystems. Directly, from extreme weather events such as heat waves, flooding, and severe storms; and indirectly, through droughts and compromised water safety catalysing food insecurity, displacement and poverty. Limited understanding of the impacts and interfaces of climate and extreme weather on older people and subgroups at potential increased risk hinders our ability to plan and respond effectively to protecting older populations as climatic instability continues. Objectives: To progress this agenda, our work aims to i) systematically assess the health impacts of extreme weather on older people ii) synthesise the evidence to examine interfaces and subgroups at increased risk iii) develop a framework to inform responses. Methods: An umbrella review is being conducted to systematically examine and synthesise the links between extreme weather events and health impacts on older people. The review will include original or primary research published between 2013 and 2023. Electronic searches will be conducted in Medline via Ovid, Embase via Ovid, Web of Science, CINAHL via EbscoHost, Cochrane Library, ASSIA via Proquest and PsycINFO via EbscoHost. Reference lists of retrieved articles will be checked for further relevant studies and experts in the field will be consulted to identify any further potentially relevant papers. Quality will be assessed using STROBE checklists and a narrative synthesis of the results conducted. Findings: The results of this review will provide a comprehensive and up-to-date understanding of the impacts of climate instability and extreme weather events on the health and wellbeing of older people. It will be used to develop a framework demonstrating the interfaces between climate, extreme weather and the health of older people which will inform guidance on which subgroups are at increased risk and which actions and responses are needed

Policies out of sync - are healthy ageing agendas fit for the future?

Abstract Background In both scale and impact, population ageing has far reaching implications for our planet, not least as a major driver of population growth and the ever-increasing human demands on natural resources and ecosystems. This fundamentally impacts sustainable development efforts to eradicate poverty, achieve food security, build inclusive and resilient communities, and ensure sustainable consumption. The overarching connections between global ageing and sustainability are clear: a focus on sustainable healthy ageing is fundamental to a healthy planet. Our responses to date have however largely been disconnected. To progress this dual agenda, our work aims to i) assess whether current national/international strategies addressing healthy ageing include a strategic focus on sustainability; ii) present the evidence for such alignments; and iii) develop a framework of sustainable actions and aligned policy. Methods A mixed-methods approach using content and applied thematic analysis was utilised to examine strategy documents, and develop an analytical framework derived from relevant theory to guide quantitative and qualitative analysis of the resultant data. Evidence themes were developed iteratively during analytical phases. Findings informed the development of the framework. Results We identified and analysed 36 strategies published from 2000 to 2021 containing over 600 wide-ranging policies. No strategies and only a minority of policies included a strategic sustainability focus. A larger subset made reference to links between ageing and sustainability or environmental elements yet these were largely theoretical and not carried through in the key strategic approaches or resulting polices. Conclusions This work provides valuable insights into strategic approaches to foster sustainable healthy ageing and identifies levers for greater alignment and sustainable action. The recently declared 2021-30 UN Decade of Healthy Ageing provides an ideal platform for action. Key messages • While the evidence for strong alignment is unequivocal, global healthy ageing and sustainability agendas are largely disconnected. • By strengthening the links between healthy ageing and sustainability agendas, stakeholders across sectors can reinforce and design approaches that meet human needs while protecting our planet. </jats:sec

Policies out of sync – are healthy ageing agendas fit for the future?

Background: In both scale and impact, population ageing has far reaching implications for our planet, not least as a major driver of population growth and the ever-increasing human demands on natural resources and ecosystems. This fundamentally impacts sustainable development efforts to eradicate poverty, achieve food security, build inclusive and resilient communities, and ensure sustainable consumption. The overarching connections between global ageing and sustainability are clear: a focus on sustainable healthy ageing is fundamental to a healthy planet. Our responses to date have however largely been disconnected. To progress this dual agenda, our work aims to i) assess whether current national/international strategies addressing healthy ageing include a strategic focus on sustainability; ii) present the evidence for such alignments; and iii) develop a framework of sustainable actions and aligned policy. Methods: A mixed-methods approach using content and applied thematic analysis was utilised to examine strategy documents, and develop an analytical framework derived from relevant theory to guide quantitative and qualitative analysis of the resultant data. Evidence themes were developed iteratively during analytical phases. Findings informed the development of the framework. Results: We identified and analysed 36 strategies published from 2000 to 2021 containing over 600 wide-ranging policies. No strategies and only a minority of policies included a strategic sustainability focus. A larger subset made reference to links between ageing and sustainability or environmental elements yet these were largely theoretical and not carried through in the key strategic approaches or resulting polices. Conclusions: This work provides valuable insights into strategic approaches to foster sustainable healthy ageing and identifies levers for greater alignment and sustainable action. The recently declared 2021-30 UN Decade of Healthy Ageing provides an ideal platform for action. Key messages: • While the evidence for strong alignment is unequivocal, global healthy ageing and sustainability agendas are largely disconnected. • By strengthening the links between healthy ageing and sustainability agendas, stakeholders across sectors can reinforce and design approaches that meet human needs while protecting our planet