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- Gong, J., et al.
(författare)
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Sex differences in dementia risk and risk factors: Individual-participant data analysis using 21 cohorts across six continents from the COSMIC consortium
- 2023
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Ingår i: Alzheimers & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 19:8, s. 3365-3378
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionSex differences in dementia risk, and risk factor (RF) associations with dementia, remain uncertain across diverse ethno-regional groups. MethodsA total of 29,850 participants (58% women) from 21 cohorts across six continents were included in an individual participant data meta-analysis. Sex-specific hazard ratios (HRs), and women-to-men ratio of hazard ratios (RHRs) for associations between RFs and all-cause dementia were derived from mixed-effect Cox models. ResultsIncident dementia occurred in 2089 (66% women) participants over 4.6 years (median). Women had higher dementia risk (HR, 1.12 [1.02, 1.23]) than men, particularly in low- and lower-middle-income economies. Associations between longer education and former alcohol use with dementia risk (RHR, 1.01 [1.00, 1.03] per year, and 0.55 [0.38, 0.79], respectively) were stronger for men than women; otherwise, there were no discernible sex differences in other RFs. DiscussionDementia risk was higher in women than men, with possible variations by country-level income settings, but most RFs appear to work similarly in women and men.
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- Mahalingam, G., et al.
(författare)
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Social connections and risk of incident mild cognitive impairment, dementia, and mortality in 13 longitudinal cohort studies of ageing
- 2023
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Ingår i: Alzheimers & Dementia. - 1552-5260. ; 19:11, s. 5114-5128
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionPrevious meta-analyses have linked social connections and mild cognitive impairment, dementia, and mortality. However, these used aggregate data from North America and Europe and examined a limited number of social connection markers. MethodsWe used individual participant data (N = 39271, M-age = 70.67 (40-102), 58.86% female, M-education = 8.43 years, Mfollow-up = 3.22 years) from 13 longitudinal ageing studies. A two-stage meta-analysis of Cox regression models examined the association between social connection markers with our primary outcomes. ResultsWe found associations between good social connections structure and quality and lower risk of incident mild cognitive impairment (MCI); between social structure and function and lower risk of incident dementia and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality. DiscussionDifferent aspects of social connections - structure, function, and quality - are associated with benefits for healthy aging internationally. HighlightsSocial connection structure (being married/in a relationship, weekly community group engagement, weekly family/friend interactions) and quality (never lonely) were associated with lower risk of incident MCI.Social connection structure (monthly/weekly friend/family interactions) and function (having a confidante) were associated with lower risk of incident dementia.Social connection structure (living with others, yearly/monthly/weekly community group engagement) and function (having a confidante) were associated with lower risk of mortality.Evidence from 13 longitudinal cohort studies of ageing indicates that social connections are important targets for reducing risk of incident MCI, incident dementia, and mortality.Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality.
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- Fazey, Ioan, et al.
(författare)
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Transforming knowledge systems for life on Earth : Visions of future systems and how to get there
- 2020
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Ingår i: Energy Research & Social Science. - : Elsevier. - 2214-6296 .- 2214-6326. ; 70
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Tidskriftsartikel (refereegranskat)abstract
- Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent.
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| 5. |
- Marcus, Maja E., et al.
(författare)
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Home-based HIV testing strategies for middle-aged and older adults in rural South Africa
- 2023
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Ingår i: AIDS. - : Wolters Kluwer. - 0269-9370 .- 1473-5571. ; 37:14, s. 2213-2221
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: More than one in four adults over 40 years with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing strategies for middle-aged and older adults in rural South Africa.DESIGN: Two thousand nine hundred and sixty-three individuals in the 'Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)' cohort study were randomized 1 : 1 : 1 to one of three types of home-based and home-delivered HIV testing modalities: rapid testing with counseling; self-testing, and both rapid testing with counselling and self-testing.METHOD: In OLS regression analyses, we estimated the treatment effects on HIV testing and HIV testing frequency at about 1 year after delivery. Finally, we assessed the potential adverse effects of these strategies on the secondary outcomes of depressive symptom as assessed by the CESD-20, linkage to care, and risky sexual behavior.RESULTS: There were no significant differences in HIV testing uptake or testing frequency across groups. However, respondents in the self-testing treatment arms were more likely to shift from testing at home and a facility [self-testing (HIVST), -8 percentage points (pp); 95% confidence interval (CI) -14 to -2 pp; self-testing plus rapid testing and counselling (ST+RT+C); -9 pp, 95% CI -15 to -3 pp] to testing only at home (HIVST 5 pp; 95% CI 2 to 9 pp; ST+RT+C: 5 pp, 95% CI 1 to 9 pp) - suggesting a revealed preference for self-testing in this population. We also found no adverse effects of this strategy on linkage to care for HIV and common comorbidities, recent sexual partners, or condom use. Finally, those in the self-testing only arm had significantly decreased depressive symptom scores by 0.58 points (95% CI -1.16 to -0.01).CONCLUSION: We find HIV self-testing to be a well tolerated and seemingly preferred home-based testing option for middle-aged and older adults in rural South Africa. This approach should be expanded to achieve the UNAIDS 95-95-95 targets.
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- Moe, S. Jannicke, et al.
(författare)
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Integrating climate model projections into environmental risk assessment : A probabilistic modeling approach
- 2024
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Ingår i: Integrated Environmental Assessment and Management. - 1551-3777 .- 1551-3793.
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Tidskriftsartikel (refereegranskat)abstract
- The Society of Environmental Toxicology and Chemistry (SETAC) convened a Pellston workshop in 2022 to examine how information on climate change could be better incorporated into the ecological risk assessment (ERA) process for chemicals as well as other environmental stressors. A major impetus for this workshop is that climate change can affect components of ecological risks in multiple direct and indirect ways, including the use patterns and environmental exposure pathways of chemical stressors such as pesticides, the toxicity of chemicals in receiving environments, and the vulnerability of species of concern related to habitat quality and use. This article explores a modeling approach for integrating climate model projections into the assessment of near- and long-term ecological risks, developed in collaboration with climate scientists. State-of-the-art global climate modeling and downscaling techniques may enable climate projections at scales appropriate for the study area. It is, however, also important to realize the limitations of individual global climate models and make use of climate model ensembles represented by statistical properties. Here, we present a probabilistic modeling approach aiming to combine projected climatic variables as well as the associated uncertainties from climate model ensembles in conjunction with ERA pathways. We draw upon three examples of ERA that utilized Bayesian networks for this purpose and that also represent methodological advancements for better prediction of future risks to ecosystems. We envision that the modeling approach developed from this international collaboration will contribute to better assessment and management of risks from chemical stressors in a changing climate. Integr Environ Assess Manag 2024;00:1-17. (c) 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC). A SETAC workshop was organized in 2022 to address the integration of future projections from global climate models (GCMs) into environmental risk assessment models.The modeling approach presented is based on deriving on robust climate information with relevance for the assessment: future climate projections from ensembles of GCMs, regionally downscaled, and summarized by statistical properties.Three case studies in Norway, Australia, and the United States were used to show examples of quantification of climate change impacts on traditional risk assessment components such as chemical exposure and hazard, as well as on the vulnerability of assessment endpoints to other stressors.The case studies also demonstrated that probabilistic modeling methods such as Bayesian networks can be useful for integrating all quantified climate change impacts on risk components, together with estimated uncertainty, into a probabilistic risk characterization.
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