Global synergistic actions to improve brain health for human development.

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.

Effect of Social Needs Case Management on Hospital Use Among Adult Medicaid Beneficiaries : A Randomized Study.

BACKGROUND: Case management programs assisting patients with social needs may improve health and avoid unnecessary health care use, but little is known about their effectiveness. OBJECTIVE: This large-scale study assessed the population-level impact of a case management program designed to address patients' social needs. DESIGN: Single-site randomized encouragement design with administrative enrollment from an eligible population and intention-to-treat analysis. Study participants were enrolled between August 2017 and December 2018 and followed for 1 year. (ClinicalTrials.gov: NCT04000074). SETTING: Contra Costa County, an economically and culturally diverse community in the San Francisco Bay Area. PARTICIPANTS: 57 972 randomized enrollments of adult Medicaid patients at elevated risk for health care use (top 15%) to the intervention or control group. INTERVENTION: Enrollees were offered 12 months of social needs case management, which provided more intensive services to patients with higher demonstrated needs. MEASUREMENTS: Medical use was measured via emergency department (ED) visits and inpatient admissions, some of which were classified as avoidable. RESULTS: Participants in the intervention group visited the ED at ratios of 0.96 (95% CI, 0.91 to 1.00) for all visits and 0.97 (CI, 0.92 to 1.03) for avoidable visits relative to the control group. The intervention group was hospitalized at ratios of 0.89 (CI, 0.81 to 0.98) for all admissions and 0.72 (CI, 0.55 to 0.88) for avoidable admissions. LIMITATIONS: Only 40% of the intervention group engaged with the program. The program was in continual development during the trial period. CONCLUSION: Although social needs case management programs may reduce health care use, these savings may not cover full program costs. More work is needed to identify ways to increase patient uptake and define characteristics of successful programs. PRIMARY FUNDING SOURCE: Contra Costa Health Services via the Medicaid waiver program.

Validation of the Fitbit One, Garmin Vivofit and Jawbone UP activity tracker in estimation of energy expenditure during treadmill walking and running.

OBJECTIVES: To determine the validity of energy expenditure estimation made by the Fitbit One, Garmin Vivofit and Jawbone UP activity trackers during treadmill walking and running. Determining validity of such trackers will inform the interpretation of the data they generate. DESIGN: Cross-sectional study. METHOD: Fourteen adults walked at 0.70, 1.25, 1.80 ms-1 and ran at 2.22, 2.78, 3.33 ms-1 on a treadmill wearing a Fitbit One, Garmin Vivofit and Jawbone UP. Estimation of energy expenditure from each tracker was compared to measurement from indirect calorimetry (criterion). Paired t-tests, correlation coefficients and Bland-Altman plots assessed agreement and proportional bias. Mean percentage difference assessed magnitude of difference between estimated and criterion energy expenditure for each speed. RESULTS: Energy expenditure estimates from the Fitbit One and Garmin Vivofit correlated significantly (p< 0.01; r= 0.702; 0.854) with criterion across all gait speeds (0.70-3.33 ms-1). Fitbit One, Garmin Vivofit and Jawbone UP correlated significantly (p < 0.05; r = 0.729; 0.711; 0.591) with criterion across all walking speeds (0.70-1.80 ms-1). However, only the Garmin Vivofit correlated significantly (p< 0.05; r = 0.346) with energy expenditure estimations from criterion across running speeds (2.22-3.33 ms-1). Bland-Altman plots showed proportional bias for the Fitbit One and Garmin Vivofit. Energy expenditure estimations of single speeds were overestimated by the Fitbit One and underestimated by the Garmin Vivofit. CONCLUSIONS: Energy expenditure reported by the devices distinguished between walking and running, with a general increase as exercise intensity increased. However, the reported energy expenditure from these devices should be interpreted with caution, given their potential bias and error. Practical implications Although devices report the same outcome of EE estimation, they are not equivalent to each other and differ from criterion measurements during walking and running. These devices are not suitable as research measurement tools for recording precise and accurate EE estimates but may be suitable for use in interventions of behaviour change as they provide feedback to user on trends in energy expenditure. If intending to use these devices in studies where precise measurements of energy expenditure are required, researchers need to undertake specific validation and reliability studies prior to interventions and the collection of cross-sectional data.