Colonial drivers and cultural protectors of brain health among Indigenous peoples internationally.

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.

Brain health and value diversity: A new implementation field for values-based practice?

Brain health has recently emerged as an overarching concept encompassing cognitive, sensory, social-emotional, behavioural and motor aspects of brain functioning, enabling individuals to achieve their potential for both health and wellbeing over their life course, independent of the presence or absence of disease.1 It is contingent on a continuous, complex interplay between interconnected determinants related to physical health, healthy environments, safety and security, learning and social connection, and access to quality services. Even though responsibility for optimizing brain health can be taken at an individual level, brain health is in fact heavily influenced by determinants far beyond the control of individuals and their families. For instance, protection from abuse and maltreatment or equitable access to health services depend on interacting social, financial, and political factors that can often only be minimally influenced by individual or small group initiatives.2,3 In addition, the voice of many people, including the very young, the very old, the sick, the disadvantaged, and those who live in poverty, may not be sufficiently influential, even though the decision-making process crucially affects the brain health and quality of life for these individuals. The breadth of determinants of brain health makes brain health a terrain that is justifiably shaped by a plethora of stakeholders with highly diverse values and hence potentially conflicting interests and albeit different degrees of power. Consequently, decision-making in such contexts embodies a thorny process that may render the negligence of the values, viewpoints, and perspectives of those directly involved in a given decision, particularly when the individual capacity to advocate for oneself and the willingness of society and governments to act on behalf of their citizens, are low. Values-based practice (VBP) is a toolkit for balancing interests, wishes, and values in contexts characterized by diverse values, which may be valuable in decision-making related to brain health.4 The implementation of this toolkit in different fields of healthcare (e.g., occupational therapy, orthopedics, primary care, psychiatry, psychology, radiotherapy) has been proposed, and training materials for healthcare professionals have been developed.5 VBP aims to include the differences in values, viewpoints, and perspectives of those directly concerned with a given decision so that communication and shared decision-making are facilitated. Based on the legacy of the Popperian open society,5 VBP treats values in the same way that democracy treats ideas and human voices. Hence, this decision-making toolkit is neither restricted to ethical codes nor prioritizes one value over others. It also does not endorse certain values while excluding others, provided that the values in play are compatible with legal, regulatory, and bioethical frameworks. The emphasis of VBP is on good process rather than predetermined 'correct' outcomes.6,7 Respect for differences between stakeholders results in the creation of a culture of mutual responsibility and in building up a positive relationship between all those concerned, so that everyone feels a sense of ownership of the decision made.4,6 Of note, according to VBP, the perspective of the health service user or of the individuals or community seeking to protect their brain health is the ideal starting point for any decision. This approach minimizes the negligence of the views, needs, values, competencies, resources, and aspirations of those trying to optimize their brain health in contexts where powerful socioeconomic and further interests may be at stake. The 'good process' of VBP is safeguarded by ten principles.4 Four of them pertain to clinical skills and practice - awareness raising regarding the involvement of values in a given decision-making process; use of a clear reasoning strategy to explore value diversity; knowledge about the values and facts that may be relevant to different contexts; and good communication skills. Two further principles underscore the importance of person-centred and multidisciplinary health service delivery. Other principles focus on the fact that all decisions are based on both values and facts, where the former become noticeable particularly when they are diverse or conflicting, especially in environments where variable choices are at the disposal of service users. The last principle of VBP is based on partnership in decision-making, including both service users and providers. In conclusion, VBP may become a valuable tool for making balanced decisions in the broad terrain of brain health. Its protective focus on the perspectives of service users and its democratic character may pave the way towards achieving equity in and optimization of brain health.

A framework for equitable virtual rehabilitation in the metaverse era: challenges and opportunities.

Introduction: Metaverse technology is spurring a transformation in healthcare and has the potential to cause a disruptive shift in rehabilitation interventions. The technology will surely be a promising field offering new resources to improve clinical outcomes, compliance, sustainability, and patients' interest in rehabilitation. Despite the growing interest in technologies for rehabilitation, various barriers to using digital services may continue to perpetuate a digital divide. This article proposes a framework with five domains and elements to consider when designing and implementing Metaverse-based rehabilitation services to reduce potential inequalities and provide best patient care. Methods: The framework was developed in two phases and was informed by previous frameworks in digital health, the Metaverse, and health equity. The main elements were extracted and synthesized via consultation with an interdisciplinary team, including a knowledge user. Results: The proposed framework discusses equity issues relevant to assessing progress in moving toward and implementing the Metaverse in rehabilitation services. The five domains of the framework were identified as equity, health services integration, interoperability, global governance, and humanization. Discussion: This article is a call for all rehabilitation professionals, along with other important stakeholders, to engage in developing an equitable, decentralized, and sustainable Metaverse service and not just be a spectator as it develops. Challenges and opportunities and their implications for future directions are highlighted.

Hope for brain health: impacting the life course and society.

Hope is a cognitive process by which an individual can identify their personal goals and develop actionable steps to achieve results. It has the potential to positively impact people's lives by building resilience, and can be meaningfully experienced at both the individual and group level. Despite this significance, there are sizable gaps in our understanding of the neurobiology of hope. In this perspective paper, the authors discuss why further research is needed on hope and its potency to be harnessed in society as a "tool" to promote brain health across healthy and patient populations. Avenues for future research in hope and the brain are proposed. The authors conclude by identifying strategies for the possible applications of hope in brain health promotion within the areas of technology, arts, media, and education.

Binge drinking and smoking are associated with worse academic performance in Canadian undergraduate students.

OBJECTIVE: Test the hypothesis that smoking, fast-food consumption, and binge drinking were negatively associated with academic performance in Canadian undergraduate students. PARTICIPANTS: Undergraduate students across Canada [n = 411 (335♀) aged: 22 ± 4 years] completed a questionnaire regarding their lifestyle behaviors and academic grades. METHODS: Relationships between lifestyle behaviors and academic performance were assessed via covariate-adjusted multiple regressions. Mediation models were used to test whether significant relationships between smoking/fast-food and grades were explained by binge drinking. RESULTS: Smoking (ß= -4.00, p < .001) and binge drinking (ß= -1.98, p = .002) were independent predictors of grades (average: 84 ± 8%). Binge drinking partially mediated the relationships between smoking (indirect effect ß= -1.19, 95%CI [-2.49, -0.08] and fast-food consumption (indirect effect: ß= -.75, 95%CI [-1.20, -0.29]), with grades. CONCLUSIONS: These findings highlight the negative influence of binge drinking, smoking, and fast-food consumption on academic success, with binge drinking as a partial mediator of these relationships.

Changes in Cognition and Brain Function After 26 Weeks of Progressive Resistance Training in Older Adults at Risk for Diabetes: A Pilot Randomized Controlled Trial.

OBJECTIVES: Type 2 diabetes is associated with deficits in cognition and brain health. Individuals with at least 1 risk factor for diabetes (i.e. obesity, prediabetes) already experience some neurocognitive impairment and are at risk for further decline. One way to combat these deficits is through exercise, but it is unknown whether resistance exercise can improve these functions in this at-risk group. METHODS: This study was a pilot randomized controlled trial. Participants were 60 to 80 years of age and had prediabetes (fasting capillary glucose 6.1 to 6.9 mmol/L) and/or were living with overweight or obesity (body mass index ≥25 kg/m2). Participants completed resistance training or balance and stretching exercises (control) thrice weekly for 6 months. Neuropsychological tests were used to assess cognitive ability, whereas functional magnetic resonance imaging was used to examine brain activation patterns. RESULTS: Resistance training led to improvements in task-switching, attention, and conflict resolution, as well as improved patterns of brain activation that may mimic healthy older adults. CONCLUSIONS: Resistance exercise may serve as an effective behavioural strategy to improve neurocognition in older adults at risk for type 2 diabetes. A large-scale powered trial is needed to further explore these findings.

Exercise behaviors and resource use among graduate students at a Canadian university: A cross-sectional study.

OBJECTIVE: Participation in regular exercise among post-secondary students is often low. Our cross-sectional study aimed to assess exercise levels, perceived barriers/motivators to exercise, and knowledge and use of exercise resources in graduate students. PARTICIPANTS: We recruited graduate students across various disciplines at a large Canadian university. METHODS: Participants (n = 540) completed an anonymous mixed methods online survey. RESULTS: Approximately 11% of participants reported not participating in any form of weekly exercise, and only 9.4% met the Canadian Physical Activity Guidelines. The most common barrier and motivator to exercise was time commitment and improving physical health, respectively. Some participants were aware of available exercise services but most did not use them. Suggestions for improving services included having graduate-dedicated exercise space and resources. CONCLUSIONS: Low exercise participation among graduate students may be due to a lack of education of available resources or a lack of existing resources that meet their specific needs.

The Influence of Motivators and Barriers to Exercise on Attaining Physical Activity and Sedentary Time Guidelines among Canadian Undergraduate Students.

Canadian 24 h movement guidelines recommend engaging in >150 min/week of moderate-vigorous-intensity physical activity and ≤8 h/day of sedentary time. Half of Canadian post-secondary students do not meet physical activity or sedentary time guidelines. This pan-Canadian study aimed to (1) identify commonly cited motivators/barriers to exercise, and (2) determine which motivators/barriers were most influential for attaining physical and sedentary activity guidelines. A total of 341 respondents (279 females, 23 ± 4 years old, 53% met activity guidelines, 49% met sedentary guidelines) completed an online survey regarding undergraduate student lifestyle behaviours. Improved physical health (74% of respondents), mental health (67%), physical appearance (60%), and athletic performance (28%) were the most common motivators to exercise. The most common barriers were school obligations (68%), time commitments (58%), job obligations (32%), and lack of available fitness classes (26%). Students citing improved athletic performance (odds ratio (OR) = 1.94, p = 0.02) were more likely to adhere to activity guidelines, while those who selected physical health (OR = 0.56, p = 0.03) and physical appearance (OR = 0.46, p = 0.001) as motivators were less likely to meet activity guidelines. Students who cited school obligations as a barrier were less likely (OR = 0.59, p = 0.03) to meet sedentary guidelines. The motivators and barriers identified provide a foundation for university-led initiatives aimed at promoting physical activity and reducing sedentary time among undergraduate students. Strategies that positively re-frame students' physical health and appearance-based motivations for exercise may be particularly useful in helping more students achieve national activity recommendations.

Describing the views of Canadian post-secondary students in health-related disciplines on the recognition of obesity as a chronic disease.

OBJECTIVE: This cross-sectional study examined students' perspectives on the ramifications of obesity being recognized as a chronic disease in Canada. PARTICIPANTS: Undergraduate and graduate students (n = 150) in health-related programs at a major Canadian university. METHODS: An online survey featured open-ended questions to capture student perspectives on recognizing obesity as a disease. Data were evaluated using content analysis methods. RESULTS: Positive themes identified included: (a) treatment accessibility; (b) improved healthcare provider attitudes; (c) de-stigmatization of obesity; (d) promotion of health behaviors; and (e) greater research/funding. Negative themes included potential: (a) healthcare system burdens; (b) perpetuation of obesity stigma; (c) medicalization of obesity; and (d) de-emphasis on modifiable risk factors as contributing to obesity. CONCLUSIONS: There is a need to increase students' understanding of the multifaceted nature of obesity and the prevention of obesity-related stigma within healthcare. Findings may inform post-secondary health curricula and obesity initiatives.

Identification of Demographic Variables Influencing Dementia Literacy and Risk Perception Through a Global Survey.

Dementia literacy is important for risk mitigation and preventative strategies before disease onset. The aim of our study was to investigate dementia literacy and how demographic characteristics influence these perceptions in order to provide evidence for how dementia-centered public health initiatives should structure their focus. We conducted a globally administered online survey, through Amazon Mechanical Turk (mTurk). Survey items evaluated: (1) personal perception on the preventability of dementia, and (2) risk awareness of lifestyle factors. Differences in risk scoring between the 598 respondents were compared using Kruskal-Wallis testing factored by demographic categorizations. Most of the sample demonstrated understanding that lifestyle factors contribute some risk toward dementia, though these risk scores were generally low. Differences in risk scoring varied by demographic characteristics. Women, older adults, those with non-post-secondary attainment, below average income, and White background tended to report lower risk scores. Public health education and initiatives for dementia prevention should focus on lifestyle risk factors, in addition to considering the barriers related to the demographic factors identified that may prevent populations from accessing programs and information.

Brain deficits in prediabetic adults: A systematic review.

Previous findings on the relationship between prediabetes (the precursor stage of type 2 diabetes) and brain health in humans are inconsistent. Thus, this systematic review of cross-sectional and longitudinal studies aimed to summarize what is currently known about brain deficits in prediabetic adults. Following the PRISMA reporting standards for systematic reviews, we conducted a comprehensive review of peer-reviewed journal articles published from 2009 to present, focusing on studies that assessed brain volume, structural connectivity, and cerebrovascular health in prediabetic adults and older adults (i.e., 18 years or older). We systematically searched PsychINFO, Scopus, Web of Science, Ovid MEDLINE, CINAHL, and EMbase databases. Quality assessment was based on the NIH Quality Assessment Tool for Observational and Cross-sectional Studies. In total, 19 studies were included in our review. Results from these studies show that prediabetes may be associated with deficits in brain structure and pathology, however, several studies also refute these findings. Moreover, we identified clear inconsistencies in study methodologies, including diabetes measures and classification, across studies that may account for these conflicting findings.

Feasibility of a 26-Week Exercise Program to Improve Brain Health in Older Adults at Risk for Type 2 Diabetes: A Pilot Study.

OBJECTIVES: Older adults at risk for type 2 diabetes (i.e. overweight individuals or those with prediabetes) experience accelerated cognitive and brain deficits. Aerobic training is known to improve these deficits, but the effects of resistance training are relatively unknown. Before conducting a large-scale, randomized, controlled trial to assess the effects of resistance training, we first conducted a pilot feasibility study to examine recruitment, attendance and retention rates in this population. METHODS: Program participants (aged 60 to 80 years, mean age 68.7±5.7 years, 50% females) at risk for type 2 diabetes (body mass index of ≥25 or fasting blood glucose of 6.1 to <7 mmol/L) underwent 26 weeks of thrice-weekly progressive resistance training (n=13) or balance-and-tone exercises (control group, n=11). Recruitment, attendance and retention rates were recorded, and study feedback from program participants and research assistants was collected via questionnaires. RESULTS: We recruited 72 older adults (total number enrolled = 24) over 17 months. Program retention and attendance were 95.8% and 84.4%, respectively. Program participants and research assistants expressed a high level of study enjoyment, and suggestions on how to improve study procedures were provided. CONCLUSIONS: Based on our findings, a large-scale study in this at-risk group of older adults is feasible, and key strategies to improving future trials were identified.

Feasibility of a 6-month pilot randomised controlled trial of resistance training on cognition and brain health in Canadian older adults at-risk for diabetes: study protocol.

INTRODUCTION: Type 2 diabetes (T2D) is associated with cognitive deficits and increased risk of dementia, and thus individuals at high risk for T2D (ie, those who are overweight or prediabetic) are also at greater risk for cognitive decline. Aerobic exercise is known to preserve and improve cognitive function, but the effects of resistance training (RT) are much less known in older adults. Moreover, research on the effects of RT on cognition and brain health (structure and function) in older adults at-risk for diabetes is limited. To address this question, a 6-month RT intervention is needed. Importantly, before conducting a full-scale randomised controlled trial (RCT), we are conducting a feasibility pilot study to assess potential recruitment rates, adherence and retention in this specific population. METHODS AND ANALYSIS: We are conducting a 6-month, thrice-weekly RT RCT. Participants (aged 60-80; sedentary; fasting plasma glucose of 6.1-7.0 mmol/L or body mass index ≥25) are randomised into one of two groups: (1) RT or (2) balance and tone (control). Based on other exercise trials using a similar population, we will consider our trial feasible if we have adherence and retention at 70%. Recruitment rate will be measured as time it takes to enrol 20 participants. To assess behavioural and MRI data, we will report descriptive statistics and estimation using a 95% CI. ETHICS AND DISSEMINATION: Our study has received ethics approval from the Health Sciences Research Ethics Board at Western University. As this is a small pilot study, data will only be made available to other researchers on request. Results from this study will be disseminated via academic publication. TRIAL REGISTRATION NUMBER: NCT03254381.