Disrupted social perception in frontotemporal dementia and Alzheimer's disease - Associated cognitive processes and clinical implications.

BACKGROUND: Social perception refers to the ability to adapt and update one's behaviour in accordance with the current context and provides the foundation for many complex social and emotional interactions. Alterations in social cognition are a hallmark of the behavioural variant of frontotemporal dementia (bvFTD), yet the capacity for social perception in this syndrome remains unclear. METHODS: We examined social perception in 18 bvFTD and 13 Alzheimer's disease (AD) patients, in comparison with 17 healthy older controls, using a social perception task derived from the Dewey Story Test. Participants also completed a comprehensive neuropsychological battery and carers provided ratings of behavioural and neuropsychiatric changes. RESULTS: Overall, bvFTD and AD performance diverged significantly from control ratings on the social perception task, however, no significant difference was found between patient groups. Standardised values relative to the mean control rating revealed considerable variability within the patient groups in terms of the direction of deviation, i.e., over- or under-rating the vignettes relative to healthy controls (range z-scores = -1.79 to +1.63). Greater deviation from control ratings was associated with more pronounced memory (p = .007) and behavioural (p = .009) disturbances in bvFTD; whilst social perception performance correlated exclusively with verbal fluency in AD (p = .003). CONCLUSIONS: Social perception is comparably disrupted in bvFTD and AD, yet likely reflects the differential breakdown of distinct cognitive processes in each dementia syndrome. Our findings have important clinical implications for the development of targeted interventions to manage disease-specific changes in social perception in dementia.

Aligning the planning, development, and implementation of complex interventions to local contexts with an equity focus: application of the PRISM/RE-AIM Framework.

For the fields of implementation science and health equity, understanding and being responsive to local contexts is of utmost importance to better inform the development, implementation, and evaluation of healthcare and public health interventions to increase their uptake and sustainment. Contexts are multi-level and include political, historical, economic, and social factors that influence health, as well as organizational characteristics, reflecting the richness of members' views, resources, values, and needs. Poor alignment between solutions and those contextual characteristics could have an impact on inequities. The PRISM (Practical Robust Implementation and Sustainability Model) is a context-based implementation science framework that incorporates RE-AIM outcomes (Reach, Effectiveness, Adoption, Implementation, Maintenance) and offers guidance to researchers, practitioners, and their patient and community partners on how to conceptualize, assess, and address contextual domains with a focus on health equity. Drawing from systems thinking, participatory engagement, and health equity principles, this commentary expands on previous work to 1) offer a novel perspective on how to align an intervention's core functions and forms with the PRISM's contextual domains, and 2) foster an ongoing and iterative engagement process with diverse partners throughout the research and practice process using a co-creation approach. We recommend intervention-to-context alignment through iterative cycles. To that end, we present the RE-AIM Framework's 'outcomes cascade' to illustrate touch points of opportunity and gaps within and across each of the five RE-AIM outcomes to illustrate 'where things go wrong'. We present a case study to illustrate and offer recommendations for research and practice efforts to increase contextual responsiveness, and enhance alignment with context before, during, and after implementation efforts and to ensure equity is being addressed. We strive to make a conceptual contribution to advance the field of pragmatic research and implementation of evidence-based practices through the application of the contextually-based PRISM framework with a focus on health equity.

Group-based trajectory models of integrated vaccine delivery and equity in low- and middle-income countries.

BACKGROUND: Integrated vaccine delivery - the linkage of routine vaccination with provision of other essential health services - is a hallmark of robust primary care systems that has been linked to equitable improvements in population health outcomes. METHODS: We gathered longitudinal data relating to routine immunization coverage and vaccination equity in 78 low- and middle-income countries that have ever received support from Gavi, the Vaccine Alliance, using multiple imputation to handle missing values. We then estimated several group-based trajectory models to describe the relationship between integrated vaccine delivery and vaccination equity in these countries. Finally, we used multinomial logistic regression to identify predictors of group membership. RESULTS: We identified five distinct trajectories of geographic vaccination equity across both the imputed and non-imputed datasets, along with two and four trajectories of socioeconomic vaccination equity in the imputed and non-imputed datasets, respectively. Integration was associated with reductions in the slope index of inequality of measles vaccination in the countries analyzed. Integration was also associated with an increase in the percentage of districts reporting high measles vaccination coverage. CONCLUSIONS: Integrated vaccine delivery is most strongly associated with improvements in vaccination equity in settings with high baseline levels of inequity. Continued scholarship is needed to further characterize the relationship between integration and health equity, as well as to improve measurement of vaccination coverage and integration.

Achieving and Maintaining Equitable Health Outcomes for all, Including for Future Generations.

Sustainable health equity means achieving and maintaining equitable health outcomes for all people, including for future generations. It encompasses realizing the right to health, setting the conditions for leading a healthy life, and fulfilling the full range of human rights. Achieving sustainable health equity requires that public services be designed and provided, and public policies be developed through empowering, inclusive, participatory, accountable, and democratic processes and mechanisms.

Maximizing Access and Minimizing Barriers to Research in Low- and Middle-Income Countries: Open Access and Health Equity.

Access to published research has always been difficult for researchers and clinicians in low- and middle-income countries, because of the cost of and lack of access to the relevant publications. The dramatic recent increase in electronic research publications has resulted in a marked improvement in reader access to these publications through their mainly Open Access policies, however the costs of processing of submissions and publication have now become the burden of the researchers wishing to publish, rather than the readers. For many researchers working in LMIC, the Article Processing Charges (APC) are prohibitive, hampering the publication of research being conducted in and relevant to these countries. A number of grant funding agencies and international not-for-profit organizations are trying to address these issues by including funding for article publications in their grants, or by supporting publishing entities by subsiding the cost of publication, but more needs to be done by major journal publishers through markedly reducing the APC being charged to researchers in LMIC for open access facilities.

Towards developing an intervention to support periodic health checks for adults with intellectual and developmental disabilities: Striving for health equity.

BACKGROUND: Although the Canadian Consensus Guidelines for Primary Care of Adults with Intellectual and Developmental Disabilities recommends conducting periodic health checks in primary care, uptake is lacking. This study seeks to understand factors influencing the conduct of periodic health checks and identify what needs to change to increase them. METHOD: Qualitative data from five stakeholder groups (adults with intellectual and developmental disabilities, primary care providers, administrative staff, family, disability support workers) was guided by the Behaviour Change Wheel and the Theoretical Domains Framework to identify barriers and 'what needs to change' to support periodic health checks. RESULTS: Stakeholders (n = 41) voiced multiple barriers. A total of 31 common and 2 unique themes were identified plus 33 items 'needing to change'. CONCLUSION: Despite barriers, stakeholders saw merit in periodic health checks as a preventative and equitable healthcare offering for adults with intellectual and developmental disabilities. Results will inform future intervention development steps.

Health equity for people with intellectual and developmental disability requires vast improvements to data collection: Lessons from the COVID-19 pandemic.

The COVID-19 pandemic drastically underscored the lack of proper health surveillance for people with intellectual and developmental disability (IDD) in the USA. This data equity failure resulted in researchers having to rely on nontraditional data sources to develop an understanding of how this population was faring during the pandemic. To begin addressing this data equity concern, in this commentary, we (1) discuss the difficulties in accessing data during the pandemic specifically related to people with IDD; (2) provide guidance regarding how existing data can be used to examine COVID-19 outcomes for people with IDD; and (3) provide recommendations for improving data collection for people with IDD in light of lessons learned during the pandemic. In sum, the data currently available to examine COVID-19 as well as other health outcomes among people with IDD are severely limited, compromising the ability to both understand and address health disparities among this population.

La figura de facilitación de acceso a la justicia. Comparación internacional de un reto formativo / Intermediaries in Access to Justice. International Comparison of a Training Challenge

El facilitador es un profesional que posibilita el ejercicio del derecho de acceso a la justicia a las personas con discapacidad intelectual y del desarrollo, favoreciendo los principios de equidad, participación, accesibilidad y autodeterminación. En el presente estudio, se realiza una revisión bibliográfica para determinar la presencia de esta figura en el panorama internacional y su perfil formativo. En el derecho internacional, actualmente, podemos encontrarla en algunos países nórdicos, Reino Unido, Israel, Azerbaiyán, Taiwán, Sudáfrica, Kenia, Canadá, varios estados de EE. UU., México y Chile, así como en parte del territorio australiano y Nueva Zelanda. En España, la figura aparece en la última reforma de la legislación civil y procesal (Ley 8/2021, de 2 de junio). En su perfil formativo encontramos tanto la educación formal como no formal de estos profesionales. El perfil del facilitador habrá de ajustarse a las necesidades de las personas con discapacidad intelectual y del desarrollo y del contexto que requiera la facilitación. (AU)

Intermediaries are professionals who enable the effective right of access to justice for people with intellectual and developmental disabilities, ensuring principles of equity, participation, accessibility and self-determination for them. This paper analyzes the presence and formative background of this figure from an international comparative perspective. Nowadays, we can find these professionals in the international law across different countries: some Nordic countries, United Kingdom, Israel, Azerbaijan, Taiwan, South Africa, Kenya, Canada, part of the USA, Mexico and Chile, Australia and New Zealand. In Spain, intermediaries are considered in the latest reform of the civil and procedural legislation (Law 8/2021, June the 2nd). This paper analyzes the formative background of this figure from an international comparative perspective. We find both formal and non-formal education in the background of these professionals. There is no doubt their profile must adjust to the needs of people with intellectual and developmental disabilities and the contexts that require the facilitation. (AU)

Sordera infantil con discapacidad asociada (DA+): recomendaciones CODEPEH / Deaf children with additional disabilities (AD+): CODEPEH recommendations

Aproximadamente el 40% de los niños con sordera tienen añadido un trastorno del desarrollo o un problema médico importante, que puede retrasar la edad de diagnóstico de la hipoacusia y/o precisar de la intervención de otros profesionales. Esta situación se designa como «hipoacusia o sordera con discapacidad añadida» (DA+). El motivo por el que la población de niños con problemas auditivos es más propensa a asociar discapacidades añadidas radica en que los factores de riesgo para la hipoacusia se superponen con los de muchas otras discapacidades. Estos factores pueden influir en diversos aspectos del desarrollo, incluida la adquisición del lenguaje. Es importante comprobar que se recibe la adecuada atención, la efectividad de audífonos o implantes, así como de las estrategias de intervención logopédica, y la adherencia de la familia a sesiones y citas. Los desafíos que plantea la DA+ son su detección precoz, para permitir una temprana y adecuada intervención, y la necesidad de una colaboración transdisciplinar fluida entre todos los profesionales que han de intervenir, junto con la implicación de la familia. (AU)

Approximately 40% of children with deafness have an additional developmental disorder or major medical problem, which may delay the age of diagnosis of hearing loss and/or require intervention by other professionals. This situation is referred to as “deafness with added disability” (AD+). The reason why the population of hearing-impaired children is more likely to have associated added disabilities is that the risk factors for hearing impairment overlap with those for many other disabilities. These factors can influence various aspects of development, including language acquisition. It is important to check that appropriate care is received, the effectiveness of hearing aids or implants, as well speech therapy intervention strategies, and family adherence to sessions and appointments. The challenge posed by AD+ is early detection, to allow early and appropriate intervention, and the need for fluid transdisciplinary collaboration between all professionals involved, together with the involvement of the family. (AU)

Por qué importa el género: agenda de inmunización 2030

La igualdad de género es un derecho humano fundamental y un poderoso motor para mejorar los resultados sanitarios en todo el mundo. Las intervenciones de inmunización solo lograrán ampliar la cobertura y el alcance cuando se comprendan, analicen y tengan en cuenta sistemáticamente los roles, las normas y las relaciones de género como parte de la planificación y la prestación de los servicios de inmunización. Este documento explica la necesidad de incorporar la perspectiva de género en los principios básicos y las prioridades estratégicas de la Agenda de Inmunización 2030 (AI2030). Su propósito es doble (i) mejorar la concienciación y la comprensión de cómo las barreras relacionadas con el género pueden afectar al rendimiento de los programas de inmunización; y (ii) proporcionar conceptos, herramientas y métodos prácticos y acciones que puedan utilizarse para integrar eficazmente una perspectiva de género en los programas de inmunización. Se trata de un recurso de fácil utilización para todos los que participan en el apoyo, la gestión o la ejecución de programas de inmunización: gestores y proveedores de servicios, así como el personal de los ministerios de salud y otros sectores (por ejemplo, ministerios de educación, ministerios de género, ministerios de finanzas), la sociedad civil, las organizaciones internacionales y los asociados donantes que participan en la realización de la visión IA2030 de un mundo en el que todas las personas, a todas las edades, se beneficien plenamente de las vacunas para gozar de buena salud y bienestar. El público destinatario son todas las personas que participan en el apoyo, la gestión o la ejecución de programas de inmunización: gestores y proveedores de servicios, así como el personal de los ministerios de sanidad y otros sectores (por ejemplo, ministerios de educación, ministerios de género, ministerios de hacienda), la sociedad civil, las organizaciones internacionales y los socios donantes que participan en la realización de la visión de la IA2030 de un mundo en el que todas las personas, a cualquier edad, se beneficien plenamente de las vacunas para gozar de buena salud y bienestar.

Por que o gênero é importante: agenda de imunização 2030

A igualdade de gênero é um direito humano fundamental e um poderoso impulsionador de melhores resultados de saúde em todo o mundo. As intervenções de imunização só serão bem-sucedidas na expansão da cobertura e na ampliação do alcance quando os papéis, as normas e as relações de gênero forem compreendidos, analisados e sistematicamente considerados como parte do planejamento e da prestação de serviços de imunização. Este documento explica a necessidade da integração do gênero nos princípios fundamentais e nas prioridades estratégicas da Agenda 2030 de Imunização (IA2030). Seu objetivo é duplo: (i) aumentar a conscientização e a compreensão de como as barreiras relacionadas ao gênero podem afetar o desempenho do programa de imunização; e (ii) fornecer conceitos práticos de "como fazer", ferramentas, métodos e ações que podem ser usados para integrar efetivamente uma perspectiva de gênero nos programas de imunização. Este é um recurso de fácil utilização para todos os envolvidos no apoio, gerenciamento ou implementação de programas de imunização - gerentes e prestadores de serviços, bem como a equipe dos ministérios da saúde e de outros setores (por exemplo, ministérios da educação, ministérios de gênero, ministérios de finanças), sociedade civil, organizações internacionais e parceiros doadores envolvidos na concretização da visão da IA2030 de um mundo onde todos, em todas as idades, se beneficiem plenamente das vacinas para uma boa saúde e bem-estar. O público-alvo são todas as pessoas envolvidas no apoio, gerenciamento ou implementação de programas de imunização - gerentes e prestadores de serviços, bem como a equipe dos ministérios da saúde e de outros setores (por exemplo, ministérios da educação, ministérios de gênero, ministérios das finanças), sociedade civil, organizações internacionais e parceiros doadores envolvidos na concretização da visão da IA2030 de um mundo onde todos, em todas as idades, se beneficiem plenamente das vacinas para uma boa saúde e bem-estar.

[Bioethics and the right of access to health care.] / Bioética y el derecho al acceso a los cuidados de salud.

Access to health care is a universal human right and therefore should not be treated as a commodity only accessible to people with the economic means to acquire it. This study adopts a theoretical framework based on UNESCO's Universal Declaration on Bioethics and Human Rights. The discussion first explores the rationale for choosing human rights as a foundation for such an endeavor. Secondly, the notion of equity is presented as an indispensable principle that should be incorporated into such discussions, reinforcing the understanding that unequal people and populations must be treated in a differentiated and compensatory manner, with the aim of seeking true equality based on the humanitarian recognition of every individual's rights, accounting for their needs and differences. Thirdly, the text seeks to address the complex problem of prioritizing the allocation of scarce resources in order to ensure access to health care for as many people as possible. In summary, this article intends to demonstrate that access to health care for all people, regardless of their income level, should be considered to be a universal human right. Beyond the obligations of governments and the private sector to support inclusive programs, there is also a need to acknowledge social movements' legitimate struggles for achieving better living conditions and health outcomes for all people, without exception.

El acceso a los cuidados de salud es un derecho universal de todo ser humano y no debe ser reducido a un objeto de consumo disponible solo para las personas con capacidad económica de adquirirlo. Desde el referencial teórico de la Declaración Universal sobre Bioética y Derechos Humanos de la Unesco, en primer lugar, se discute la razón de elegir los derechos humanos como base para el trabajo; en segundo lugar, se presenta la equidad como un principio indispensable en el debate para reforzar la comprensión de que las personas y las poblaciones desiguales deben ser tratadas de manera desigual y compensatoria, con el objetivo de buscar la igualdad basada en el reconocimiento humanitario del derecho de cada individuo en función de sus necesidades y diferencias. En tercer lugar, el texto aborda el complejo problema de priorizar la asignación de recursos escasos para garantizar el acceso a la atención médica para la mayor cantidad posible de personas. En resumen, el artículo pretende mostrar que el acceso a la atención médica para todas las personas, independientemente de su nivel de ingresos, debe ser considerado como un derecho humano universal que, además de las responsabilidades gubernamentales y del sector privado en apoyar programas inclusivos, debe reconocer también la legitimidad de la lucha de los movimientos sociales en defensa de mejores condiciones de vida y salud para todas las personas sin distinción.