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A Brain Capital Grand Strategy: toward economic reimagination
Abstract
‘I have not found among my possessions anything which I hold more dear than, or value so much as, my knowledge of the actions of great people, acquired by long experience in contemporary affairs, and a continual study of antiquity.’ The Prince, Machiavelli
... Despite the many challenges, innovative brain health initiatives and programs are being developed and established. For example, in addition to the initiatives and programs already discussed in this piece, there is the "Brain Capital Grand Strategy" which includes 4 major components: brain capital, brain economy, brain capital index, and an investment plan [32]. The concept of brain capital originated in a global business and economic conference on addiction and mental health in 2011 [32]. ...
... For example, in addition to the initiatives and programs already discussed in this piece, there is the "Brain Capital Grand Strategy" which includes 4 major components: brain capital, brain economy, brain capital index, and an investment plan [32]. The concept of brain capital originated in a global business and economic conference on addiction and mental health in 2011 [32]. Broadly, the concept takes into account the strengthening of the global economy by sustenance of productive capacity that stimulates investments in brain health research, education, prevention and care. ...
... Broadly, the concept takes into account the strengthening of the global economy by sustenance of productive capacity that stimulates investments in brain health research, education, prevention and care. The contention is that how a country uses its brain capital and well-being significantly impacts its economic competitiveness and prosperity [32]. Because the brain is best understood in terms of transdisciplinary thought, there needs to be a broad partnership between business and science. ...
Brain health initiatives and programs are gaining traction worldwide. Some are clinically based, others research based, and some are a combination of clinical and research action plans. Achievement of global brain health is a challenging endeavor with prerequisites including but not limited to multidisciplinary and multisectoral approaches, strengthening of neurologic policies at local and regional levels, global advocacy, leadership and collaboration amongst stakeholders, development of technical and guidance documents, and strengthening and interpretation of the relevant evidence. Over 1 billion persons worldwide are impacted by neurologic disorders, and brain health initiatives are needed to curb the human suffering and cost of these disorders. We provide a brief review of select brain health initiatives and programs and offer possible steps to achieve brain health globally.
... In partnership with the Organisation for Economic Co-operation and Development's (OECD) Brain Health Diplomacy Working Group and other key partners including the Latin American Brain Health Institute (BrainLat), a convening of multidisciplinary experts took place in 2021 with the expressed purpose of identifying opportunities to address the global challenge of brain health. 11,12 This group identified improved global brain performance as a priority need, along with the long-term objective of global health commitments on the brain. To generate global awareness of the need for these commitments and for implementing brain health-focused policies, the BHD Working Group endorsed the concept of a prototype toolkit underpinned by the BHD framework (Fig. 1). ...
... There is an increasing global focus and understanding of brain health as a key driver of health and wellbeing. 12,28 The COVID-19 pandemic brought the role of the brain into sharper focus given multiple impacts on mental health and cognitive function. Many of the multi-national, brain-focused organizations and initiatives pre-dated the pandemic. ...
... These approaches can help make the economic case for brain health and where the Brain Capital framework can also be highly beneficial for understanding the brain's centrality in economic thinking. 12,57 Summary & conclusions Diplomacy is necessary to transcend disciplinary and geographic boundaries and to mobilize resources to improve global brain health. This approach is essential to advance equity in brain health outcomes worldwide. ...
Maintaining and improving brain health, one of the most critical global challenges of this century, necessitates innovative, interdisciplinary, and collaborative strategies to address the growing challenges in Latin America and the Caribbean. This paper introduces Brain Health Diplomacy (BHD) as a pioneering approach to bridge disciplinary and geographic boundaries and mobilize resources to promote equitable brain health outcomes in the region. Our framework provides a toolkit for emerging brain health leaders, equipping them with essential concepts and practical resources to apply in their professional work and collaborations. By providing case studies, we highlight the importance of culturally sensitive, region-specific interventions to address unique needs of vulnerable populations. By encouraging dialogue, ideation, and cross-sector discussions, we aspire to develop new research, policy, and programmatic avenues. The novel BHD approach has the potential to revolutionize brain health across the region and beyond, ultimately contributing to a more equitable global cognitive health landscape.
... We have therefore previously termed and herein refer to these factors as brain health challenges. 17 We argue that challenges to brain health of individuals can ultimately "percolate up" to higher system levels, thus arguably influencing "collective" brain health of whole societies. As such, individual and collective brain health can be understood as inherently connected, contributing to the dynamics of social-ecological systems and their resilience, including the collective "outputs" of whole nations at societal, economic, and cultural levels. ...
... We recently proposed a novel asset-brain capital-which we believe has the potential to inform more nuanced policy development. 17,90 Brain capital can be defined as a new econometric asset which prioritizes, integrates, and optimizes for brain health and brain skills (e.g., resilience, creativity, wisdom). As such, gearing policies towards maximizing brain capital may serve as a new approach to drive economic empowerment, societal resilience, and stability of democratic institutions. ...
... As we noted previously, brain capital is not captured by any existing economic measures such as gross domestic product (GDP) and will require the development of novel metrics and unique tools to enable objective measurement and quantification of progress. 91 We previously articulated a Brain Capital Grand Strategy, 17 which has three main components: 1) considering brain capital in-all-policies; 2) developing a comprehensive investment plan to support brain capital; and 3) generating a dashboard for objective rather than subjective assessments of brain captial. 17 Brain capital in-all-policies is conceptually broad with implications and opportunities ranging from fighting poverty to promoting space flight. ...
Democracies are increasingly under siege. Beyond direct external (e.g., warfare) and internal (e.g., populism, extremism) threats to democratic nations, multiple democracy-weakening factors are converging in our modern world. Brain health challenges, including mental, neurologic, and substance use disorders, social determinants of health, long COVID, undesired effects of technology, mis- and disinformation, and educational, health, and gender disparities, are associated with substantial economic and sociopolitical impediments. Herein, we argue that thriving democracies can distinguish themselves through provision of environments that enable each citizen to achieve their full brain health potential conducive to both personal and societal well-being. Gearing policymaking towards equitable and quality brain health may prove essential to combat brain challenges, promote societal cohesion, and boost economic productivity. We outline emerging policy innovations directed at building “pro-democratic brain health” across individual, communal, national, and international levels. While extensive research is warranted to further validate these approaches, brain health-directed policymaking harbors potential as a novel concept for democracy strengthening.
... Brain capital is a complex framework that considers the contribution of optimal brain health throughout the lifespan, with obvious consequences for public health, the economy, and productivity 3,31 . Indeed, within this framework, brain health must be considered a global priority 32 since brain health clearly leads to social benefits, including education and wealth. ...
... TIP https://www.theinsightpartners.com. Sleep Tech Devices Market Report | Size, Share & Growth 2030, https://www.theinsightpartners.comreports/sleep-techdevices-market3 7 Steps for Igniting the Brain Capital Industrial Strategy, www.bakerinstitute.org/research/7-steps-igniting-brain-capital-industrial-strategy ...
... objectives to benefit all persons through the lens of diversity, equity, and inclusion (DEI). This brain capital strategy applies across neurological subspecialties to reduce mortality and sustain brain health within and across each generation (17). ...
... Continuity of life-course brain health must first advocate for the health and well-being of women during each pregnancy that will benefit multiple generations of children maturing into adulthood. This essential life-course perspective requires investment in a brain capital strategy which can be strengthened by interdisciplinary FNN training for multiple neurologic subspecialties (17). ...
Integrated fetal, neonatal, and pediatric training constitute an interdisciplinary fetal-neonatal neurology (FNN) program. A dynamic neural exposome concept strengthens curriculum content. Trainees participate in mentoring committee selection for guidance during a proposed two-year program. Prenatal to postnatal clinical learning re-enforces early toxic stressor interplay that influences gene–environment interactions. Maternal-placental-fetal triad, neonatal, or childhood diseases require diagnostic and therapeutic decisions during the first 1,000 days when 80 % of neural connections contribute to life-course phenotypic expression. Pediatric follow-up through 3 years adjusts to gestational ages of preterm survivors. Cumulative reproductive, pregnancy, pediatric and adult exposome effects require educational experiences that emphasize a principle-to-practice approach to a brain capital strategy across the lifespan. More rigorous training during fetal, neonatal, and pediatric rotations will be offered to full time trainees. Adult neurology residents, medical students, and trainees from diverse disciplines will learn essential topics during time-limited rotations. Curriculum content will require periodic re-assessments using educational science standards that maintain competence while promoting creative and collaborative problem-solving. Continued career-long learning by FNN graduates will strengthen shared healthcare decisions by all stakeholders. Recognition of adaptive or maladaptive neuroplasticity mechanisms requires analytic skills that identify phenotypes associated with disease pathways. Developmental origins and life-course concepts emphasize brain health across the developmental-aging continuum, applicable to interdisciplinary research collaborations. Social determinants of health recognize diversity, equity, and inclusion priorities with each neurological intervention, particularly for those challenged with disparities. Diagnostic and therapeutic strategies must address resource challenges particularly throughout the Global South to effectively lower the worldwide burden of neurologic disease. Sustainable development goals proposed by the World Health Organization offer universally applicable guidelines in response to ongoing global and regional polycrises. Gender, race, ethnicity, and socio-economic equality promote effective preventive, rescue and reparative neuroprotective interventions. Global synergistic efforts can be enhanced by establishing leadership within academic teaching hubs in FNN training to assist with structure and guidance for smaller healthcare facilities in each community that will improve practice, education and research objectives. Reduced mortality with an improved quality of life must prioritize maternal-pediatric health and well-being to sustain brain health across each lifespan with transgenerational benefits.
... Brain capital encompasses a nation's cognitive and emotional resources including (1) brain skills-cognitive capability, emotional intelligence and the ability to collaborate, be innovative and solve complex problems, (2) brain health which includes mental health, well-being and neurological disorders that critically impact the ability to deploy brain skills effectively, build and maintain positive relationships, and display resilience against challenges and uncertainties. 1 Although brain skills and brain health are commonly examined at an individual level, brain capital represents a broader, collective concept and national asset that is a fundamental contributor to economic and social productivity (Mental Wealth-box 1). ...
... However, when productivity demands (be they economic or social 61 62 ) exceed brain capital capacity, resilience can be undermined. This thesis gives rise to several questions: (1) where does the threshold lie beyond which demands in productivity growth exceed brain capital capacity, thereby reducing resilience, (2) can the threshold be raised by technological advances, reductions in inequality, and investments in brain and social capital infrastructures and (3) what is the optimal balance between economic and social productivity at a macro level needed to support multisystem resilience? These are important questions for further empirical exploration. ...
... In addition, through secondary and tertiary prevention efforts, we can optimize the brain health and function of older adults with mental illnesses before they develop dementia, and try to limit the progression of, or harm from, dementia in people who are already symptomatic. The linked concepts of brain health and brain capital, an emerging construct integrating cognitive, emotional and social brain resources, provide a new opportunity to bridge the lifespan-focused fields of brain and mental health by working with stakeholders across public and private enterprises to harness collective resources and cultivate transdisciplinary scientific, public health, and economic innovations (13)(14)(15)(16). The adoption of brain health initiatives by professionals working in mental health will allow a positive approach to risk reduction and promote unity with allied clinical neuroscience practitioners across the lifespan. ...
... With a confluence of major megatrendsclimate change, generative AI, quantum computing, political and economic instability, we believe brain capital is the world's most important resource (14) and the global economy increasingly relies on brain capital (17). The WHO noted that investing in building brain capital is fundamental to meet modern societal challenges and to drive innovation (4). ...
... Building on the human capital concept, the term 'Brain Capital' was coined in recognition of the need for economic reimagination, incorporating brain health and brain skills as contributors to a 'Brain Economy' [40]. There is mounting evidence that unless nations strengthen their human capital, they will be unable to achieve sustained, inclusive economic growth. ...
... Preparing the workforce for the demands of more highly skilled jobs in the future is required in order to be able to compete in the global economy [41]. In this light, Smith et al. has brought attention to the necessity of Brain Capital in this new era of the 'Brain Economy' , where 'most new jobs demand cognitive, emotional, and social, not manual, skills and where innovation is a tangible "deliverable" of employee productivity' [40]. ...
Background
A reconceptualised global strategy is key as nations begin to shift from crisis management to medium- and long-term planning to rebuild and strengthen their economic, social and public health systems. Efforts towards measuring, modelling, and forecasting Mental Wealth could serve as the catalyst for this reconceptualization. The Mental Wealth approach builds systemic resilience through investments which promote collective cognitive and emotional wellbeing. This paper presents the theoretical foundations for Mental Wealth. It presents, for the first time, literature across the disciplines of health and social sciences, economics, business, and humanities to underpin the development of an operational metric of Mental Wealth.
Discussion
An approach which embeds social and psychological dimensions of prosperity, alongside the economic, is needed to inform the effective allocation of investments in the post-pandemic world. The authors advocate for a transdisciplinary framework of Mental Wealth to be applied in innovating population-level policy interventions to address the growing challenges brought on by COVID-19. Mental Wealth highlights the value generated by the deployment of collective mental assets and supporting social infrastructure. In order to inform this position, a review of the literature on the concepts underpinning Mental Wealth is presented, limitations of current measurement tools of mental and social resources are evaluated, and a framework for development of a Mental Wealth metric is proposed.
Conclusion
There are challenges in developing an operational Mental Wealth metric. The breadth of conceptual foundations to be considered is extensive, and there may be a lack of agreement on the appropriate tools for its measurement. While variability across current measurement approaches in social resources, wellbeing and mental assets contributes to the difficulty creating a holistic and generic metric, these variations are now clearer. The operationalisation of the Mental Wealth metric will require comprehensive mapping of the elements to be included against the data available.
... It structures good deals for these banking transactions. CIB experiences fairly impressive performance management detailed monitoring of critical activities, as well as its customer-oriented branch team performance incentives making use of the balanced scorecard and in-depth training of their customer-oriented personnel (Smith et al., 2021;Hassouba, 2023). ...
... For instance, initiatives like the CDC's Healthy Brain Initiative seek to expand community-based support, which has shown promise in improving patient outcomes and caregiver experiences [43,44]. The growing emphasis on public-private partnerships and the exploration of value-based healthcare models also holds promise for accelerating innovation and improving care delivery outcomes at a lower cost [55,56]. ...
This study evaluates the effectiveness of public health policies and programs addressing Alzheimer's and dementia in the United States, focusing on early detection, disparities in access to care, and service quality variations between urban and rural healthcare facilities. Using data from the World Bank’s QoG, CDC’s Alzheimer’s Disease and Healthy Aging Data Portal, and the Alzheimer's Association, logistic regression models assessed the impact of early detection programs on patient outcomes. Disparities in care access were analyzed using regression models incorporating demographic and geographic data from the National Institute on Aging and the CDC. Service quality was examined through surveys targeting patients and healthcare providers in different settings. The findings highlight that while early detection programs are essential, their availability alone is insufficient without high-quality implementation. Significant disparities in access to care based on age and race were observed, along with pronounced differences in service quality between urban and rural areas. The study recommends enhancing program quality, addressing access disparities, and investing in rural healthcare infrastructure to improve care for Alzheimer's and dementia patients.
... Optimal brain health is essential to enabling major global skill-intensive economic transitions, such as the bio-economy, green, care economy, and digital transitions [7]. Brain capital, which encompasses brain health and brain skills, is a critical economic asset for the success of economies of the future [8][9][10]. The brain economy transformation from a brain-negative (brainunhealthy) economy, which depletes brain capital, to a brain-positive (brain-healthy) economy, which arrests and reverses the loss of brain capital, will be foundational to these major transitions. ...
... For instance, initiatives like the CDC's Healthy Brain Initiative seek to expand community-based support, which has shown promise in improving patient outcomes and caregiver experiences [46,47]. The growing emphasis on public-private partnerships and the exploration of value-based healthcare models also holds promise for accelerating innovation and improving care delivery outcomes at a lower cost [58,59]. ...
This study critically evaluates the effectiveness of public health policies and programs targeting Alzheimer's and dementia care in the United States, with a specific emphasis on early detection, disparities in access to care, and variations in service quality between urban and rural healthcare facilities. The research utilizes a representative sample sourced from national databases, including the World Bank's Quality of Government (QoG) dataset, CDC's Alzheimer's Disease and Healthy Aging Data Portal, and the Alzheimer's Association. Logistic regression models were employed to assess the influence of early detection programs on patient outcomes, while disparities in access to care were analyzed through regression models that incorporated demographic and geographic data from the National Institute on Aging and the CDC. The study also conducted extensive surveys targeting patients and healthcare providers across various settings to evaluate service quality. The findings reveal that while early detection programs are indispensable, their mere availability does not guarantee improved patient outcomes unless accompanied by high-quality implementation strategies. Significant disparities in access to care were identified, particularly along the lines of age and race, with minority groups and younger populations experiencing more significant barriers. Additionally, the study revealed pronounced differences in service quality between urban and rural areas, with rural healthcare facilities lagging in patient satisfaction, staff qualifications, and facility resources. The study recommends several targeted interventions: enhancing the quality and implementation of early detection programs, particularly in underserved areas; addressing disparities in care access by expanding Medicaid coverage and increasing funding for community health initiatives; and investing in rural healthcare infrastructure to bridge the gap in service quality and improve the overall care and support for Alzheimer's and dementia patients, particularly in marginalized communities.
... It is a stock of productive and complex capital that accumulates over a lifetime and provides the basis for defining brain issues and quantifying and tracking them. 1 Individual and collective brain capital can be enhanced by policies and investments. ...
The uncertainty that marks adolescence and early adulthood is heightened by the simultaneous crises of mental health, education and youth unemployment. This puts the brain capital of young people under threat. We must invest in youth brain health and skills that are orientated towards environmental sustainability. This can train future creatives to develop impactful solutions to the current climate crisis as well as develop citizens who are ecologically intelligent and willing to enact environmentally sustainable and resilient behaviors. In effect, we propose a youth green brain capital model. This approach aims to refine and advance this agenda, including specific policy innovations, new investment approaches, and the development of a dashboard of instruments to track green brain capital. Our vision is to empower the next generation with ecologically intelligent leadership skills to address the pressing challenges of the climate crisis.
... Contemporary economies have been referred to as a "brain economy" as most new jobs demand cognitive, emotional, and social skills, and not just manual application [7]. With increased automation, our global economy increasingly places a premium on cerebral, brain-based skills such as self-control, emotional intelligence, creativity, compassion, altruism, systems thinking, collective intelligence, and cognitive flexibility which are characteristic of humans [8]. Investments in brain health and brain skills underlie the economic renewal, reimagination, and economic resilience in times of crisis in an attempt to maintain a healthy ecosystem [9]. ...
Brain health is the complete functioning of the brain across the life course to support the full physical, mental, social, and spiritual well-being and quality of life of an individual towards attaining and maintaining the epitome of a meaningful, impactful, purposeful, and productive life. The determinants of brain health are complex and include at least in part, non-traditional risks such as interactions among social, economic, physical, and internal factors (e.g., emotions and adaptations to changing life experiences), and external factors such as environment, geography, and climate change. Thus, social determinants of health (e.g., where we work, live, and play) are those non-medical factors that influence health outcomes, and as non-traditional cardiovascular factors, may influence the development of traditional cardiovascular risks. Examples of the non-traditional cardiovascular factors include environmental stressors (e.g., climate change, air pollution), and psychological and physical abuse. In this article, we provide a discussion of social determinants of health and other non-traditional cardiovascular risks as they relate to brain health.
... Convergence Mental Health therefore helps operationalizing transdisciplinary research approaches tailored for what we consider extended mental health systems and mental-health-social-ecological systems (Fig. 1). This makes Convergence Mental Health as a form of transdisciplinary collaborations well suited in two ways: (1) It targets the development of preparedness and coping/resilience mechanisms to improve mental health and establish treatments for psychopathologies and neurodegenerative diseases (dementia, Alzheimer) [69]. The creation and promotion of "resilient brains" may find application to foster creativity in relation to latent vulnerability and may ultimately have potential to reduce mental illness through mental ill health, a paradox in itself. ...
Background
This paper discusses a paradox in mental health. It manifests as a relationship between adverse “bad” effects (suffering, clinical costs, loss of productivity) in individuals and populations and advantageous “good” aspects of mental disorders. These beneficial aspects (scientific, artistic and political accomplishments) emanate at the societal level through the frequently unprecedented creativity of people suffering from mental disorders and their relatives. Such gains can contribute to societal innovation and problem-solving. Especially in times of accelerated social-ecological change, approaches are needed that facilitate best-possible mental health care but also recognize creative ideas conducive to beneficial clinical and social-ecological innovations as soon as possible.
Discussion
This paper emphasizes the need to account for creativity as a crucial component in evolving mental health systems and societies. It highlights the need for wide-ranging approaches and discusses how research targeting multiple facets (e.g., brain level, cognitive neuroscience, psychiatry, neurology, socio-cultural, economic and other factors) might further our understanding of the creativity-mental disorder link and its importance for innovating mental health systems and societies.
Conclusion
Our discussion clarifies that considerable research will be needed to obtain a better understanding of how creativity associated with mental disorders may help to create more sustainable societies on a fast-changing planet through innovative ideas. Given the current-state-of-the-art of research and healthcare management, our discussion is currently speculative. However, it provides a basis for how pros and cons might be studied in the future through transdisciplinary research and collaborations across sectors of society.
... 5 A transformational framework called brain capital combines information, skills, competencies and tools to recognise brain health and skills as key factors in the modern knowledge economy. 6 How can the brain capital framework help develop a more integrated framework with environmental health? Here, we suggest that syndemic models of brain/environmental health and green brain capital represent two complementary avenues to enable a significant societal scaling, synergistically protecting brain health and ecological sustainability. ...
The importance of improving brain and mental health and developing sustainable environments is increasingly recognised. Understanding the syndemic interactions between these processes can help address contemporary societal challenges and foster global innovation. Here, we propose a green brain capital model that integrates environmental drivers of brain health and green skills necessary for long-term sustainability and discuss the role of interdisciplinary approaches in promoting individual and collective behavioural changes. We draw on existing literature and research to highlight the connections between brain health, environmental factors and green skills. Environmental factors and exposome can have long-lasting adverse effects on brain health, particularly in vulnerable populations. Investing in green brain capital can prepare societies to address global crises. Green skills, including creativity, ecological intelligence and digital literacy, are critical for promoting sustainable environments. Access to nature improves brain and mental health, and interdisciplinary fields such as neurourbanism can inform urban planning to benefit citizens’ well-being. Building brain capital and environmental sustainability interactions requires increasing future generations’ awareness, education and training. A comprehensive approach to green brain capital can enable greater societal scaling, synergistically protecting brain health and environmental sustainability.
... duce original ideas, result-orientation, solution of practical problems, originality and speed of thinking, openness to new experience and, tolerance for uncertainty. Especially in economic contexts, brain-based skills such as emotional intelligence, creativity, cognitive flexibility, self-control or system thinking matter more than manual skills. (Smith. et al. 2021). Various researchers (Lima and Alencar, 2014;Hosseini, 2011;Alencar and Fleith, 2010;Csikszentmihalyi et al., 2007;Jackson, 2006, Fryer, 2007Wisdom, 2007;Martizen, 2002) recognized that many educators do not know how to foster creativity in the educational setups. Actions speak louder than words; educators' creative abilities and perfor ...
... Collaboration between mental health clinicians, particularly with youth/young adult experience, and computer science experts with significant technical knowledge associated with online monitoring and analysis will be key to achieving a rigorous analysis. Involving private technology companies and investors will also be crucial to understanding the impact these subcultures have on the brain capital of traditional societies (Smith et al. 2021). ...
... For example, the OECD has played a significant role in promoting educational neuroscience for more than two decades, but its advocacy is far from apolitical. The OECD's Neuroscienceinformed Policy Initiative has begun exploring the economic value of 'Brain Capital', treating 'brain skills and brain health as an indispensable part of the knowledge economy' and education one area of public policy to be targeted (OECD 2021;Smith, 2021). Likewise, UNESCO has begun promoting neuroscience findings as the basis for its proposals for educational reform (Vickers 2022). ...
Biological sciences increasingly focus on the collection and analysis of bioinformation. In recent years, bioinformational approaches have been developed in research on education, especially through the use of neurotechnologies in educational neuroscience and molecular genomics technologies in educational genomics. In this chapter, educational neuroscience and genomics are conceptualized as an emerging form of bioinformational education science. A postdigital approach is taken to examine the methodologies and knowledge production of bioinformational education science, exploring the methods of the neural and genetic sciences as research assemblages constituted of a variety of situated social, epistemic, material, discursive, and institutional elements that make objects of investigation legible, explainable and understandable in new ways. The analysis of these research assemblages reveals the organizational arrangements that have taken shape around bioinformational investigation and knowledge production in education; the biodigital methods that are designed and deployed to make new discoveries about the biological aspects of educationally-relevant phenomena; and the particular characteristic forms of bioinformational knowledge they produce. Bioinformational education science represents a particular postdigital imbrication of digital technologies, biological sciences, and educational research, policy, and practice, which is assembling new biodigital objects of attention and analysis that collapse the boundary between the biological and the digital.
... On the basis of the definitions and ideas discussed earlier, brain health can be described as the complete functioning of the brain across the life course to support the full physical, mental, social and spiritual wellbeing and quality of life of an individual towards attaining and maintaining the epitome of a meaningful, impactful, purposeful and productive life (Fig. 1). Brain health is essential for brain skills, which are in turn central to the development of brain capital and a brain economy, that is, an economy that demands cognitive, emotional and social skills over manual skills 61 . Brain capital encompasses the creativity, knowledge and skills that individuals accrue and improve on during their lifetime, which enable them to realize their potential and contribute productively and meaningfully to the economy and society at large 61 . ...
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.
... The mechanisms of national accounting are said to have evolved to serve underlying political purposes, which leads to the question: 'What would they measure if other purposes were dominant?' 18 . As we look to current widespread efforts to shift societal trajectories (such as the movements to achieve greater equality, arrest climate change and catalyse post-pandemic reconstruction for enhanced well-being and community and system resilience 19 ), our efforts are likely to be impeded by the continued exclusion of socially productive activities from the dominant economic metric: GDP. ...
... Recently, the concept of a Brain Capital model (Smith et al. 2021) has been proposed to measure and encourage investment in brain health by both the public and private sectors. The Brain Capital model encourages employers and policy makers to cultivate the cognitive capacity of their employees by optimizing brain health and emphasizes an international partnership of business and science to develop actionable brain health care. ...
Mental disorders often begin early in life and constitute five of the top ten causes of disability. Their total cost across Europe is estimated at more than 4% of GDP (more than € 600 billion). The last study investigating the cost of mental disorders in France by our group was based on data from 2007 and yielded an estimated indirect and direct cost of € 109 billions. The objective of this study was thus to provide an overall updated cost of mental health in France ten years later and before the COVID-19 pandemic. We estimated the costs related to the direct healthcare and medico-social system, loss of productivity and loss of quality of life. We conducted a literature search to identify direct healthcare, medico-social, indirect (loss of productivity and income compensation) and loss of quality of life during 2018. We included costs related to major psychiatric disorders, including autism and intellectual disability, but excluded the costs related to dementia. Our estimate of the total cost of mental disorders in France, including medical (14%), social (8%), indirect (27%) and loss of quality of life (51%), was € 163 billions in 2018. This total cost includes money spend, forgone earnings and DALYs lost. We found a 50% increase in costs relative to our previous 2007 study. Large-scale cost-effective interventions such as specialized consultations or the development of ambulatory care could help decrease direct healthcare costs related to hospitalization and productivity loss while greatly improving the quality of life of patients.
... Neuroliberalism combines neoliberal ideas concerning the role of markets in addressing social problems with beliefs about human nature ostensibly grounded in the behavioural, psychological and neurological sciences (Whitehead et al. 2018). 1 In what follows, we focus on an aspect of neuroliberalism referred to as "brainhood … the quality or condition of being a brain" (Vidal 2009, p. 5), and associated calls to reimagine and transform education based on the "learning sciences", especially neuroscience (OECD 2002(OECD , 2007Chatterjee Singh and Duraiappah 2020). The Organisation for Economic Co-operation and Development (OECD), for example, has recently declared "brain skills and brain health" an "indispensable part of the knowledge economy", invoking "brain capital" alongside "human capital" (OECD n.d.; also see Smith et al. 2021). Despite this growing focus on "brainhood" in the global policyscape (e.g. ...
In addition to the longstanding threat posed by narrow economism, faith in the possibility of peace and progress through democratic politics – central to the humanistic vision of the 1972 Faure report – today faces additional challenges. These challenges include the ascendancy of neurocentrism in the global policyscape. Whereas the effects of neoliberalism on education have been extensively critiqued, the implications of a newer, related ideological framework known as neuroliberalism remain under-theorised. Neuroliberalism combines neoliberal ideas concerning the role of markets in addressing social problems with beliefs about human nature ostensibly grounded in the behavioural, psychological and neurological sciences. This article critically examines a recent initiative of one of UNESCO’s Category 1 Institutes – the Mahatma Gandhi Institute of Education for Peace and Sustainable Development (MGIEP) – that seeks to mainstream neuroscience and digital technology within global educational policy. Comparing the visions of the 1972 Faure, the 1996 Delors and the 2021 Futures of Education reports with MGIEP’s International Science and Evidence Based Education Assessment (ISEEA), the authors analyse continuity and change in UNESCO’s attempts to articulate a vision of “scientific humanism” which advocates the use of science for the betterment of humanity. They argue that ISEEA’s overall recommendations – as represented in its Summary for Decision Makers (SDM) – reinforce a reductive, depoliticised vision of education which threatens to exacerbate educational inequality while enhancing the profits and power of Big Tech. These recommendations exemplify a neuroliberal turn in global education policy discourse, marking a stark departure from the central focus on ethics and democratic politics characteristic of UNESCO’s landmark education reports. Reanimating, in cruder form, visions of a scientifically-organised utopia of the kind that attracted UNESCO’s inaugural Director-General, Julian Huxley, ISEEA’s recommendations actually point towards the sort of dystopian “brave new world” of which his brother, Aldous Huxley, warned.
... The WHO's increased focus on dementia as a priority, along with their Framework for Countries to Achieve an Integrated Continuum of Long-Term Care (WHO, 2021), are prime examples of these efforts (OECD, 2021). Initiatives such as the OECD's Neuroscience-Inspired Policy Initiative, which draws on the frameworks of brain health diplomacy and brain capital Ibáñez et al., 2021;Smith et al., 2021), are opportunities for further momentum. Additionally, the International Long-Term Care Policy Network's LTCcovid.org ...
... Brain Capital, neuroscience, psychiatry, policy, translation, implementation, economics, learning systems Brain capital is a conceptual framework incorporating brain health and brain skills in the knowledge economy [1]. This is based on the understanding that our brains are our greatest asset. ...
Question
The Green Brain Capital Model emphasises the bidirectional relationship between brain health and the environment, making it an environmentally focused type of brain capital. This work represents the initial stage of conceptualising the Green Brain Capital Model, which is essential to avoid ambiguity and misinterpretation while developing a quantitative model. Ecological intelligence (EI) is identified as a key component of the model in the literature. Therefore, the objective of this review was to systematically review the literature to define EI, its features and quantitative assessment tools, to develop comprehensive metrics for Green Brain Capital.
Study selection and analysis
We conducted a search in Scopus, ScienceDirect and Scopus secondary literature and identified 11 articles that provide definitions of EI and quantitative tools to assess it.
Findings
The study revealed that EI is a multifaceted concept with cognitive, affective and behavioural domains. Seven quantitative tools for measuring EI were identified, with the Ecological Intelligence Measurement Tool by Okur-Berberoglu and the Ecological Intelligence Scale by Akkuzu, demonstrating strong theoretical grounding, reliability and validity. Additionally, our review included searching open-access databases provided by reputable organisations, but no indicators for the assessment of EI were found in these databases.
Conclusions
All the available tools were designed to assess EI at the individual level and for research purposes within certain cultural contexts. There is a lack of global indicators reflecting countries’ EI development status and global positioning. Establishing country-level indicators across EI domains is essential for policymaking and public awareness.
Innovations in mobile neuromonitoring and brain–computer interfaces are increasingly used to inform understandings of human brains and behaviours while also catalysing imaginaries of neuroscientifically measured and enhanced economic productivity. In this paper, we focus on neurotechnologies that claim to capture, monitor, measure and train learners’ attention. We analyse a corpus of relevant scientific, governance, and commercial texts to explore how they reconfigure learners’ attention as an object of knowledge, intervention, and valorisation. We demonstrate that outcomes-driven neuroscience research and technological development tends to split attention into optimal and undesirable forms: externally versus internally oriented, and synchronised versus unsynchronised with others, which become the variables of intervention to optimise attention. Commercial wearables, in turn, envelop desirable forms of attention under logics of brain control, social discipline, and valorisation. This process is enacted within an international context of speculation on neurotechnology investments and their anticipated outcome of enhancing future human productivity. Circumscribing desirable forms of learner attention and subjectivity, these technologies provide expanded means to mould and monitor learners’ attention towards performativity regimes of economised education governance while enabling profit-making based on learners’ activity.
The concept of degrowth, which advocates for quantitatively more restrained economic growth, is much maligned in mainstream economics. The aim of this paper is to provide constructive critique for this theory promoting qualitative growth and to encourage in-depth professional dialogue. It points out that the current socio-economic configuration does not allow for the achievement of sustainable development, therefore a more radical shift towards quality growth is in order. It then critically reviews the concept of degrowth representing a shift towards qualitative growth. In doing so it highlights the concept’s shortcomings, the ambiguity of its nexus with capitalism and democracy, and the neglect of the relevant role of modern industrial policy. In addition to a narrow interpretation of the concept, the transdisciplinary nature of the degrowth transition is also explored, incorporating relevant aspects of evolutionary science, systems theory and neuroscience. Finally, five insights are elaborated that may catalyse a degrowth research agenda and a meaningful professional dialogue.
The emergence of e-commerce, digital technology, and the internet have all contributed to a revolutionary shift in the global landscape toward the digital economy, which is driving inventive development on a global scale. Simultaneously, China’s digital economy has entered a phase of high-quality development and has become a key driver of the global economic recovery. On the other hand, maintaining sustainability presents difficulties for the traditional growth paradigm. This paper explains the complex relationship between innovation and the digital economy across industries, economies, organizations, and innovation ecosystems by methodically reviewing the body of research on the topic. This report provides important recommendations through a comparative examination of digital economy strategy, current status, and difficulties across leading industrialized nations and China. These include developing all-encompassing plans, establishing strong regulatory frameworks, streamlining management procedures, and encouraging technology advancements and applications to strengthen the groundwork for China’s innovation development powered by the digital economy. Furthermore, this research advances the knowledge economy by aligning with the changing dynamics of digital transformation and innovation-driven growth.
The chapter’s contribution is threefold. Firstly, drawing on Michael Rothberg’s
figure of the implicated subject (Rothberg, 2019), it advances a new
theorisation of human rights in order to address complex scales of responsibility
for climate-related harms and injustices in the Anthropocene. Secondly,
it addresses mainstream sustainability education’s failure to articulate
the role of political-economic structures, cultural values, power relations,
and vested interests in perpetuating behaviours that result in ecological harm,
while discouraging those that mitigate climate-related injustices (Leichenko
et al., 2022; Wilhite, 2016). Highlighting the complex interaction between
wider social forces and individual behaviours, SERF transcends either/or approaches
to climate responsibility which privilege either personal actions or
the governance, practices and behaviours of corporations, governments, industry
and so on. Thirdly, it highlights the importance of foregrounding emotion
in discussions of global warming and provides concrete suggestions for
how to ethically confront children with the difficult knowledge of their own
implications in the climate crisis.
Adiponectin (APN) is an adipokine which predominantly expresses in adipocytes with neuroprotective and anti-inflammatory effects. We have recently indicated that circulatory trimeric APN can enter the brain by crossing the blood–brain barrier (BBB) and modulate microglia-mediated neuroinflammation. Here, we found that the microglial NLR family pyrin domain containing 3 (NLRP3)-inflammasome activation was exacerbated in APN−/−5xFAD mice in age-dependent manner. The focus of this study was to develop a new and tractable therapeutic approach for treating Alzheimer’s disease (AD)-related pathology in 5xFAD mice using peripheral APN gene therapy. We have generated and transduced adeno-associated virus (AAV2/8) expressing the mouse mutated APN gene (APNC39S) into the liver of 5xFAD mice that generated only low-molecular-weight trimeric APN (APNTri). Single dose of AAV2/8-APNC39S in the liver increased circulatory and cerebral APN levels indicating the overexpressed APNTri was able to cross the BBB. Overexpression of APNTri decreased both the soluble and fibrillar Aβ in the brains of 5xFAD mice. AAV2/8-APNTri treatment reduced Aβ-induced IL-1β and IL-18 secretion by suppressing microglial NLRP3-inflammasome activation. The memory functions improved significantly in AAV-APNTri-treated 5xFAD mice with reduction of dystrophic neurites. These findings demonstrate that peripheral gene delivery to overexpress trimeric APN can be a potential therapy for AD.
Graphical Abstract
Neurological conditions are the leading cause of death and disability combined. This public health crisis has become a global priority with the introduction of WHO's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP). 18 months after this plan was adopted, global neurology stakeholders, including representatives of the OneNeurology Partnership (a consortium uniting global neurology organisations), take stock and advocate for urgent acceleration of IGAP implementation. Drawing on lessons from relevant global health contexts, this Health Policy identifies two priority IGAP targets to expedite national delivery of the entire 10-year plan: namely, to update national policies and plans, and to create awareness campaigns and advocacy programmes for neurological conditions and brain health. To ensure rapid attainment of the identified priority targets, six strategic drivers are proposed: universal community awareness, integrated neurology approaches, intersectoral governance, regionally coordinated IGAP domestication, lived experience-informed policy making, and neurological mainstreaming (advocating to embed brain health into broader policy agendas). Contextualised with globally emerging IGAP-directed efforts and key considerations for intersectoral policy design, this novel framework provides actionable recommendations for policy makers and IGAP implementation partners. Timely, synergistic pursuit of the six drivers might aid WHO member states in cultivating public awareness and policy structures required for successful intersectoral roll-out of IGAP by 2031, paving the way towards brain health for all.
The coming years are likely to be turbulent due to a myriad of factors or polycrisis, including an escalation in climate extremes, emerging public health threats, weak productivity, increases in global economic instability and further weakening in the integrity of global democracy. These formidable challenges are not exogenous to the economy but are in some cases generated by the system itself. They can be overcome, but only with far-reaching changes to global economics. Our current socio-economic paradigm is insufficient for addressing these complex challenges, let alone sustaining human development, well-being and happiness. To support the flourishing of the global population in the age of polycrisis, we need a novel, person-centred and collective paradigm. The brain economy leverages insights from neuroscience to provide a novel way of centralising the human contribution to the economy, how the economy in turn shapes our lives and positive feedbacks between the two. The brain economy is primarily based on Brain Capital, an economic asset integrating brain health and brain skills, the social, emotional, and the diversity of cognitive brain resources of individuals and communities. People with healthy brains are essential to navigate increasingly complex systems. Policies and investments that improve brain health and hence citizens’ cognitive functions and boost brain performance can increase productivity, stimulate greater creativity and economic dynamism, utilise often underdeveloped intellectual resources, afford social cohesion, and create a more resilient, adaptable and sustainability-engaged population.
Fetal-neonatal neurologists (FNNs) consider diagnostic, therapeutic, and prognostic decisions strengthened by interdisciplinary collaborations. Bio-social perspectives of the woman’s health influence evaluations of maternal-placental-fetal (MPF) triad, neonate, and child. A dual cognitive process integrates “fast thinking-slow thinking” to reach shared decisions that minimize bias and maintain trust. Assessing the science of uncertainty with uncertainties in science improves diagnostic choices across the developmental-aging continuum. Three case vignettes highlight challenges that illustrate this approach. The first maternal-fetal dyad involved a woman who had been recommended to terminate her pregnancy based on an incorrect diagnosis of an encephalocele. A meningocele was subsequently identified when she sought a second opinion with normal outcome for her child. The second vignette involved two pregnancies during which fetal cardiac rhabdomyoma was identified, suggesting tuberous sclerosis complex (TSC). One woman sought an out-of-state termination without confirmation using fetal brain MRI or postmortem examination. The second woman requested pregnancy care with postnatal evaluations. Her adult child experiences challenges associated with TSC sequelae. The third vignette involved a prenatal diagnosis of an open neural tube defect with arthrogryposis multiplex congenita. The family requested prenatal surgical closure of the defect at another institution at their personal expense despite receiving a grave prognosis. The subsequent Management of Myelomeningocele Study (MOMS) would not have recommended this procedure. Their adult child requires medical care for global developmental delay, intractable epilepsy, and autism. These three evaluations involved uncertainties requiring shared clinical decisions among all stakeholders. Falsely negative or misleading positive interpretation of results reduced chances for optimal outcomes. FNN diagnostic skills require an understanding of dynamic gene-environment interactions affecting reproductive followed by pregnancy exposomes that influence the MPF triad health with fetal neuroplasticity consequences. Toxic stressor interplay can impair the neural exposome, expressed as anomalous and/or destructive fetal brain lesions. Functional improvements or permanent sequelae may be expressed across the lifespan. Equitable and compassionate healthcare for women and families require shared decisions that preserve pregnancy health, guided by person-specific racial-ethnic, religious, and bio-social perspectives. Applying developmental origins theory to neurologic principles and practice supports a brain health capital strategy for all persons across each generation.
An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype–genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene–environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders.
Introduction
The workplace typically affords one of the longest periods for continued brain health growth. Brain health is defined by the World Health Organization (WHO) as the promotion of optimal brain development, cognitive health, and well-being across the life course, which we expanded to also include connectedness to people and purpose. This work was motivated by prior work showing individuals, outside of an aggregate setting, benefitted from training as measured by significant performance gains on a holistic BrainHealth Index and its factors (i.e., clarity, connectedness, emotional balance). The current research was conducted during the changing remote work practices emerging post-pandemic to test whether a capacity-building training would be associated with significant gains on measures of brain health and components of burnout. The study also tested the influence of utilization of training modules and days in office for individuals to inform workplace practices.
Methods
We investigated whether 193 individuals across a firm’s sites would improve on measures of brain health and burnout from micro-delivery of online tactical brain health strategies, combined with two individualized coaching sessions, and practical exercises related to work and personal life, over a six-month period. Brain health was measured using an evidenced-based measure (BrainHealth™ Index) with its components (clarity, connectedness, emotional balance) consistent with the WHO definition. Burnout was measured using the Maslach Burnout Inventory Human Services Survey. Days in office were determined by access to digital workplace applications from the firm’s network. Regression analyses were used to assess relationships between change in BrainHealth factors and change in components of the Maslach Burnout Inventory.
Results
Results at posttest indicated that 75% of the individuals showed gains on a composite BrainHealth Index and across all three composite factors contributing to brain health. Benefits were directly tied to training utilization such that those who completed the core modules showed the greatest gains. The current results also found an association between gains on both the connectedness and emotional balance brain health factors and reduced on burnout components of occupational exhaustion and depersonalization towards one’s workplace. We found that fewer days in the office were associated with greater gains in the clarity factor, but not for connectedness and emotional balance.
Discussion
These results support the value of a proactive, capacity-building training to benefit all employees to complement the more widespread limited offerings that address a smaller segment who need mental illness assistance programs. The future of work may be informed by corporate investment in focused efforts to boost collective brain capital through a human-centered, capacity-building approach. Efforts are underway to uncover the value of better brain health, i.e., Brainomics© - which includes economic, societal, and individual benefits.
The potential for future prevention of Alzheimer’s disease and related dementias (ADRD) through healthy lifestyle change is spurring a positive brain health movement. However, most ADRD research continues to focus on mid- and later life. We lack evidence regarding risk exposure and protective factors in young adulthood, i.e., 18–39 years. Brain capital is an emerging framework that represents the combination of education, knowledge, skills, and optimal brain health that people accumulate over their lives. Building on this framework, we present a new model that focuses on optimizing brain health in young adulthood; namely, young adult brain capital. Increasing focus on younger populations is critical for developing citizens who are emotionally intelligent, resilient and can anticipate and cope with rapid changes in the world. By understanding the values that are key drivers and motivators for young adults, we can empower the next generation to become active agents in optimizing their brain health and reducing their risk for future ADRD.
This chapter presents a conceptual asset, Brain Capital, to inform novel policies. The concept builds on previous work, the Brain Capital Grand Strategy, that considers Brain Capital in all policies and offers a comprehensive investment plan and the development of an index or a dashboard. The premise, enablers, and barriers towards a Brain Capital Building Policy Agenda are outlined. Engagement with communities is proposed, and approaches for educating policymakers are described. Brain Capital building policies should be considered in sectors such as human development, migration, gender issues, social justice, multi-cultural affairs, economics, protections, and international relations. Novel approaches for public investment including brain bonds and social impact investing are considered.
The power of behavioral design lies in understanding the constraints to be considered and their implementation in the aims we intend to facilitate. In real life, behavioral design makes it possible to generate evidence-based and action-based awareness. It is a necessary form of knowledge for the agenda of sustainable innovation to progress, as it supports the improvement related to how people form mental images, understand, think, and make choices. Intentional behavioral design is a form of knowledge which has an educational and emancipatory role because it conveys actionable knowledge, operating on content architectures that improve people’s expertise and agentivity. Furthermore, behavioral design balances autonomy and heteronomy, dynamically transferring the locus and the focus of consumer-service control. When behavioral design is based on modeling, it becomes intentional. Behavioral design aims to build “brain capital” helping to develop and strengthen personal and collective objectives of change.
Nearly 1 in 5 children in the United States lives in a household whose income is below the official federal poverty line, and more than 40% of children live in poor or near-poor households. Research on the effects of poverty on children's development has been a focus of study for many decades and is now increasing as we accumulate more evidence about the implications of poverty. The American Academy of Pediatrics recently added “Poverty and Child Health” to its Agenda for Children to recognize what has now been established as broad and enduring effects of poverty on child development. A recent addition to the field has been the application of neuroscience-based methods. Various techniques including neuroimaging, neuroendocrinology, cognitive psychophysiology, and epigenetics are beginning to document ways in which early experiences of living in poverty affect infant brain development. We discuss whether there are truly worthwhile reasons for adding neuroscience and related biological methods to study child poverty, and how might these perspectives help guide developmentally based and targeted interventions and policies for these children and their families.
Alzheimer’s disease and related dementias often begin with symptoms of mild memory loss, eventually leading to more severe cognitive impairment, functional impairment, and ultimately, death. Data from the Behavioral Risk Factor Surveillance System core questions related to chronic diseases and from the cognitive decline optional module on subjective cognitive decline (SCD) from the years 2015-2018 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among U.S. adults aged 65 years and older, only 39.8% (95%CI=37.6-42.1) of those experiencing SCD reported discussing their SCD symptoms with a healthcare provider. The prevalence of discussing SCD symptoms with a provider was higher among those with at least one chronic condition than among those with no chronic conditions. 30.7% (28.6-32.8) of those aged 65 years and older reported that their SCD led to functional limitations and 28.8% (26.5-31.2) needed assistance with day-to-day activities. For patients aged 65 years and older, Welcome to Medicare visits and Medicare Annual Wellness Visits are critically underutilized primary care access points. Primary care providers can manage chronic conditions, cognitive health, and initiate referrals for testing. Efforts to promote the use of toolkits and diagnostic codes that are available to primary care providers to initiate conversations about memory loss with patients may be utilized to improve detection, diagnosis, and planning for memory problems. Discussions may lead to earlier detection and diagnosis of cognitive impairment, such as Alzheimer’s disease, or other treatable conditions such as delirium or pressure in the brain and avoid costly hospitalizations.
Social factors, such as social cognition skills (SCS) and social determinants of health (SDH), may be vital for mental health, even when compared with classical psycho-physical predictors (demographic, physical, psychiatric, and cognitive factors). Although major risk factors for psychiatric disorders have been previously assessed, the relative weight of SCS and SDH in relation to classical psycho-physical predictors in predicting symptoms of mental disorders remains largely unknown. In this study, we implemented multiple structural equation models (SEM) from a randomized sample assessed in the Colombian National Mental Health Survey of 2015 (CNMHS, n = 2947, females: 1348) to evaluate the role of SCS, SDH, and psycho-physical factors (totaling 17 variables) as predictors of mental illness symptoms (anxiety, depression, and other psychiatric symptoms). Specifically, we assessed the structural equation modeling of (a) SCS (emotion recognition and empathy skills); (b) SDH (including the experience of social adversities and social protective factors); (c) and classical psycho-physical factors, including psychiatric antecedents, physical–somatic factors (chronic diseases), and cognitive factors (executive functioning). Results revealed that the emotion recognition skills, social adverse factors, antecedents of psychiatric disorders and chronic diseases, and cognitive functioning were the best predictors of symptoms of mental illness. Moreover, SCS, particularly emotion recognition skills, and SDH (experiences of social adversities, familial, and social support networks) reached higher predictive values of symptoms than classical psycho-physical factors. Our study provides unprecedented evidence on the impact of social factors in predicting symptoms of mental illness and highlights the relevance of these factors to track early states of disease.
The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.
As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the world today must "flatten the curve" of spread of the virus, we argue that now is the time to "accelerate and bend the curve" on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further.
Social media is now being used to model mental well-being, and for understanding health outcomes. Computer scientists are now using quantitative techniques to predict the presence of specific mental disorders and symptomatology, such as depression, suicidality, and anxiety. This research promises great benefits to monitoring efforts, diagnostics, and intervention design for these mental health statuses. Yet, there is no standardized process for evaluating the validity of this research and the methods adopted in the design of these studies. We conduct a systematic literature review of the state-of-the-art in predicting mental health status using social media data, focusing on characteristics of the study design, methods, and research design. We find 75 studies in this area published between 2013 and 2018. Our results outline the methods of data annotation for mental health status, data collection and quality management, pre-processing and feature selection, and model selection and verification. Despite growing interest in this field, we identify concerning trends around construct validity, and a lack of reflection in the methods used to operationalize and identify mental health status. We provide some recommendations to address these challenges, including a list of proposed reporting standards for publications and collaboration opportunities in this interdisciplinary space.
Abstract This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of “big data” (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA’s activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors.
Background
Brain health diplomacy aims to influence the global policy environment for brain health (i.e. dementia, depression, and other mind/brain disorders) and bridges the disciplines of global brain health, international affairs, management, law, and economics. Determinants of brain health include educational attainment, diet, access to health care, physical activity, social support, and environmental exposures, as well as chronic brain disorders and treatment. Global challenges associated with these determinants include large-scale conflicts and consequent mass migration, chemical contaminants, air quality, socioeconomic status, climate change, and global population aging. Given the rapidly advancing technological innovations impacting brain health, it is paramount to optimize the benefits and mitigate the drawbacks of such technologies.
Objective
We propose a working model of Brain health INnovation Diplomacy (BIND).
Methods
We prepared a selective review using literature searches of studies pertaining to brain health technological innovation and diplomacy.
Results
BIND aims to improve global brain health outcomes by leveraging technological innovation, entrepreneurship, and innovation diplomacy. It acknowledges the key role that technology, entrepreneurship, and digitization play and will increasingly play in the future of brain health for individuals and societies alike. It strengthens the positive role of novel solutions, recognizes and works to manage both real and potential risks of digital platforms. It is recognition of the political, ethical, cultural, and economic influences that brain health technological innovation and entrepreneurship can have.
Conclusions
By creating a framework for BIND, we can use this to ensure a systematic model for the use of technology to optimize brain health.
Extensive psychological interventions primarily target the negative symptoms of depression and the deficits in positive resources have been systematically neglected. So far, little attention has been devoted to psychological capital (PsyCap) intervention from the perspective of developing positive resources. The aim of the present pilot study was to evaluate the efficacy of psychological capital intervention (PCI) for depression in a randomized controlled trial. A total of 56 patients were randomized to either care as usual (CAU) for normal medication or psychological capital intervention (PCI) group, where the normal medication was supplemented with the PCI. Participants were assessed at pre- and post-treatment, as well as 6-month follow-up, on measures of depressive symptoms and PsyCap. The PCI group displayed significantly larger improvements in PsyCap and larger reductions in depression symptoms from pre- to post treatment compared to control group. Improvements were sustained over the 6-month follow-up period. Targeting the positive resources intervention in the PCI may be effective against the treatment of depression.
Background:
Human capital is recognised as the level of education and health in a population and is considered an important determinant of economic growth. The World Bank has called for measurement and annual reporting of human capital to track and motivate investments in health and education and enhance productivity. We aim to provide a new comprehensive measure of human capital across countries globally.
Methods:
We generated a period measure of expected human capital, defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status using rates specific to each time period, age, and sex for 195 countries from 1990 to 2016. We estimated educational attainment using 2522 censuses and household surveys; we based learning estimates on 1894 tests among school-aged children; and we based functional health status on the prevalence of seven health conditions, which were taken from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016). Mortality rates specific to location, age, and sex were also taken from GBD 2016.
Findings:
In 2016, Finland had the highest level of expected human capital of 28·4 health, education, and learning-adjusted expected years lived between age 20 and 64 years (95% uncertainty interval 27·5-29·2); Niger had the lowest expected human capital of less than 1·6 years (0·98-2·6). In 2016, 44 countries had already achieved more than 20 years of expected human capital; 68 countries had expected human capital of less than 10 years. Of 195 countries, the ten most populous countries in 2016 for expected human capital were ranked: China at 44, India at 158, USA at 27, Indonesia at 131, Brazil at 71, Pakistan at 164, Nigeria at 171, Bangladesh at 161, Russia at 49, and Mexico at 104. Assessment of change in expected human capital from 1990 to 2016 shows marked variation from less than 2 years of progress in 18 countries to more than 5 years of progress in 35 countries. Larger improvements in expected human capital appear to be associated with faster economic growth. The top quartile of countries in terms of absolute change in human capital from 1990 to 2016 had a median annualised growth in gross domestic product of 2·60% (IQR 1·85-3·69) compared with 1·45% (0·18-2·19) for countries in the bottom quartile.
Interpretation:
Countries vary widely in the rate of human capital formation. Monitoring the production of human capital can facilitate a mechanism to hold governments and donors accountable for investments in health and education.
Funding:
Institute for Health Metrics and Evaluation.
This article examines how digital epidemiology and eHealth coalesce into a powerful health surveillance system that fundamentally changes present notions of body and health. In the age of Big Data and Quantified Self, the conceptual and practical distinctions between individual and population body, personal and public health, surveillance and health care are diminishing. Expanding on Armstrong's concept of "surveillance medicine" to "quantified self medicine" and drawing on my own research on the symbolic power of statistical constructs in medical encounters, this article explores the impact of digital health surveillance on people's perceptions, actions and subjectivities. It discusses the epistemic confusions and paradoxes produced by a health care system that increasingly treats patients as risk profiles and prompts them to do the same, namely to perceive and manage themselves as a bundle of health and security risks. Since these risks are necessarily constructed in reference to epidemiological data that postulate a statistical gaze, they also construct or make-up disembodied "individuals on alert".
From the robust to the nonreplicable, from the trivial to the groundbreaking, virtually
all findings in cognitive neuroscience stem from the same approach: divide and conquer.
Indeed, the field’s ethos has long been to decompose mental phenomena into a
series of separate mechanisms which can be individually operationalized. Imagine
we want to explore how the brain recognizes familiar faces. In a typical experiment,
first, we would select a number of well-known and unknown portraits; second, we
would break them down into a number of measurable features; third, we would retain
the faces from each set that are matched for those features; last, we would ask participants
to sit or lie down very still and to press a button each time they see a familiar
face, while we record behavioral, electrophysiological, or neuroimaging correlates of
their ongoing activity. The impact of every other cognitive domain, ranging from
memory to attention to perception to language to emotion and so on, is factored out
between conditions. Data are then preprocessed, analyzed, interpreted, reported, and
eventually published. The title of the paper is typically some variation along the lines
of “How the brain processes familiar faces” or “Neurological correlates of seeing a
familiar face”—if we are lucky, the authors will also throw in an amusing pun.
However, such titles and their accompanying conclusions are typically inflated
and interpreted beyond their actual scope. As it happens, the very participants who
performed the experiment will never again find themselves in such a scenario. The
moment they leave the laboratory and meet their friends on the street, facial recognition
is no longer stripped of the myriad influences of other neural, bodily, and environmental
factors. Moreover, in ecological settings, it is rarely the case that similar
stimuli appear successively in a fixed, pseudorandomized order. These manipulations
have been instrumental to model the inner workings of specific cognitive domains—
that is, theoretically isolatable processes associated with particular types of information,
partially recurring phenomenological attributes, and sometimes well-defined
neurological correlates, such as language, memory, emotion, and so on. However, the
ensuing findings are blind to the natural interplay among diverse aspects of experience
that characterizes our cognition millisecond after millisecond.
One would, thus, be tempted to measure the neural correlates of our mind and
behavior in natural settings, as has sometimes been done in the field. Unfortunately,
xii
the limitations of this approach are as evident as those of the previous one: as soon
as we stop controlling for the impact of confounding factors, whatever effect
emerges cannot be justifiably attributed to any process or system in particular;
hence, we are left with a bunch of uninterpretable noise.
In the last few years, we have often found ourselves pondering on these issues.
Typically, we would end up yielding to an unsavory and seemingly inescapable
conclusion: the field is
xiii
We believe this is one move in the right direction, albeit a minor one. While many
models consider interactions between one domain and another, ours are characterized
by placing the integration of neurocognitive mechanisms in the spotlight. In
presenting them against the background of our overarching epistemological rationale,
we aim to instantiate the latter in explicit terms rather than just enunciate it in
abstract. Moreover, in fleshing them out, we have endeavored to combine empirical,
translational, and meta-theoretical arguments. These are, indeed, the three strands
that nurtured the discussions behind all the contents below.
Chapter 1 introduces the premises of our framework and anticipates the dimensions
of context addressed by each of our models, namely the Social Context
Network Model (SCNM) and the Hand-Action-Network Dynamic Language
Embodiment (HANDLE) model. Specifically, the SCNM sets forth a macroanatomical
perspective on the networks supporting contextual modulations of social
cognition processes. In its turn, the HANDLE model constitutes a microanatomical
account of action-language coupling in immediate action settings.
Chapter 2 addresses the role of context in social cognition via the SCNM. First,
we describe the main sources of contextual constraints modulating socio-cognitive
domains. Second, we flesh out the SCNM, specifying the functions subserved by its
main anatomical hubs. Building on the model, we characterize the interplay among
social cognition, interoception, and emotion. To conclude, we discuss the clinical
relevance of our framework and outline outstanding issues for its development.
Chapter 3 introduces HANDLE to characterize the neurocognitive interplay of
manual actions and contextually relevant language. First, we present the model’s
neurocognitive architecture, functional principles, and notational devices. Then, we
summarize its main hypotheses and review critical evidence to test them. Next, we
discuss the relevance of action-language coupling paradigms for detecting early
cognitive deficits in motor disorders, with emphasis on Parkinson’s disease. Finally,
we identify key questions and challenges to be addressed in future research.
Chapter 4 offers a critical and prospective balance of our situated and integrative
proposal. We begin by discussing the salient features shared by the SCNM and
HANDLE. Next, we ponder on the implications of a renewed conception of context
in the light of key findings captured by our models. In particular, we set forth critical
meta-theoretical considerations on the holistic phenomenon of intercognition, a key
determinant of contextual effects. Thereupon, we consider extant and future methodological
possibilities to foster relevant breakthroughs, and address the prospects
for translational and educational innovations immanent in our approach.
The ideas we lay out in the following pages were mostly conceived in the privacy
of post-dinner lucubrations and were first hatched in the often meagre space of scientific
papers. It is most exciting to see them flow more openly and freely in the
present book. They are no longer exclusively ours, and that is positive in itself.
Whatever degree of support or disagreement they inspire should serve to illuminate
the sensus communis of our daily experience.
To identify digital biomarkers associated with cognitive function, we analyzed human–computer interaction from 7 days of smartphone use in 27 subjects (ages 18–34) who received a gold standard neuropsychological assessment. For several neuropsychological constructs (working memory, memory, executive function, language, and intelligence), we found a family of digital biomarkers that predicted test scores with high correlations (p < 10−4). These preliminary results suggest that passive measures from smartphone use could be a continuous ecological surrogate for laboratory-based neuropsychological assessment.
Purpose:
Mental disorders are a major contributor to the global burden of disease and disability, and can be extremely costly at both individual and community level. Social capital, (SC) defined as an individual's social relationships and participation in community networks, may lower the risk of mental disorders while increasing resilience capacity, adaptation and recovery. SC interventions may be a cost-effective way of preventing and ameliorating these conditions. However, the impact of these SC interventions on mental health still needs research.
Methods:
We conducted a systematic review of SC-based interventions to investigate their effect on mental health outcomes from controlled, quasi-experimental studies or pilot trials. We searched twelve academic databases, three clinical trials registries, hand-searched references and contacted field experts. Studies' quality was assessed with the Cochrane Risk of Bias tools for randomized and non-randomized studies.
Results:
Seven studies were included in the review, published between 2006 and 2016. There was substantial heterogeneity in the definitions of both SC and mental disorders among the studies, preventing us from calculating pooled effect sizes. The interventions included community engagement and educative programs, cognitive processing therapy and sociotherapy for trauma survivors, and neighbourhood projects.
Conclusions:
There are paucity of SC interventions investigating the effect on mental health outcomes. This study showed that both SC scores and mental health outcomes improved over time but there was little evidence of benefit compared to control groups in the long term. Further high-quality trials are needed, especially among adverse populations to assess sustainability of effect.
This book seeks to build bridges between neuroscience and social science empirical researchers and theorists working around the world, integrating perspectives from both fields, separating real from spurious divides between them and delineating new challenges for future investigation. Since its inception in the early 2000s, multilevel social neuroscience has dramatically reshaped our understanding of the affective and cultural dimensions of neurocognition. Thanks to its explanatory pluralism, this field has moved beyond long standing dichotomies and reductionisms, offering a neurobiological perspective on topics classically monopolized by non-scientific traditions, such as consciousness, subjectivity, and intersubjectivity. Moreover, it has forged new paths for dialogue with disciplines which directly address societal dynamics, such as economics, law, education, public policy making and sociology. At the same time, beyond internal changes in the field of neuroscience, new problems emerge in the dialogue with other disciplines.
Neuroscience and Social Science – The Missing Link puts together contributions by experts interested in the convergences, divergences, and controversies across these fields. The volume presents empirical studies on the interplay between relevant levels of inquiry (neural, psychological, social), chapters rooted in specific scholarly traditions (neuroscience, sociology, philosophy of science, public policy making), as well as proposals of new theoretical foundations to enhance the rapprochement in question.
By putting neuroscientists and social scientists face to face, the book promotes new reflections on this much needed marriage while opening opportunities for social neuroscience to plunge from the laboratory into the core of social life. This transdisciplinary approach makes Neuroscience and Social Science – The Missing Link an important resource for students, teachers, and researchers interested in the social dimension of human mind working in different fields, such as social neuroscience, social sciences, cognitive science, psychology, behavioral science, linguistics, and philosophy.
While e-health initiatives are poised to revolutionize delivery and access to mental health care, conducting clinical research online involves specific contextual and ethical considerations. Face-to-face psychosocial interventions can at times entail risk and have adverse psychoactive effects, something true for online mental health programs too. Risks associated with and specific to internet psychosocial interventions include potential breaches of confidentiality related to online communications (such as unencrypted email), data privacy and security, risks of self-selection and self-diagnosis as well as the shortcomings of receiving psychoeducation and treatment at distance from an impersonal website. Such ethical issues need to be recognized and proactively managed in website and study design as well as treatment implementation. In order for online interventions to succeed, risks and expectations of all involved need to be carefully considered with a focus on ethical integrity.
Background:
Although physical illnesses, routinely documented in electronic medical records (EMR), have been found to be a contributing factor to suicides, no automated systems use this information to predict suicide risk.
Objective:
The aim of this study is to quantify the impact of physical illnesses on suicide risk, and develop a predictive model that captures this relationship using EMR data.
Methods:
We used history of physical illnesses (except chapter V: Mental and behavioral disorders) from EMR data over different time-periods to build a lookup table that contains the probability of suicide risk for each chapter of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. The lookup table was then used to predict the probability of suicide risk for any new assessment. Based on the different lengths of history of physical illnesses, we developed six different models to predict suicide risk. We tested the performance of developed models to predict 90-day risk using historical data over differing time-periods ranging from 3 to 48 months. A total of 16,858 assessments from 7399 mental health patients with at least one risk assessment was used for the validation of the developed model. The performance was measured using area under the receiver operating characteristic curve (AUC).
Results:
The best predictive results were derived (AUC=0.71) using combined data across all time-periods, which significantly outperformed the clinical baseline derived from routine risk assessment (AUC=0.56). The proposed approach thus shows potential to be incorporated in the broader risk assessment processes used by clinicians.
Conclusions:
This study provides a novel approach to exploit the history of physical illnesses extracted from EMR (ICD-10 codes without chapter V-mental and behavioral disorders) to predict suicide risk, and this model outperforms existing clinical assessments of suicide risk.
Countries must learn how to capitalize on their citizens’ cognitive resources if they are to prosper, both economically and socially. Early interventions will be key.
Background:
Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders.
Methods:
In this global return on investment analysis, we used the mental health module of the OneHealth tool to calculate treatment costs and health outcomes in 36 countries between 2016 and 2030. We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labour participation and gross domestic product (GDP) per worker in each country.
Findings:
The net present value of investment needed over the period 2016-30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of 169 billion for anxiety disorders). Across country income groups, resulting benefit to cost ratios amount to 2·3-3·0 to 1 when economic benefits only are considered, and 3·3-5·7 to 1 when the value of health returns is also included.
Interpretation:
Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide.
Funding:
Grand Challenges Canada.
This article reviews case examples on the use of health in all policies (HiAP) and related approaches in large US cities. It also identifies common elements of HiAP initiatives and discusses challenges and recommendations to facilitate successful implementation of HiAP.
This Research Topic features several papers tapping the situated nature of emotion and social cognition processes. The volume covers a broad scope of methodologies [behavioral assessment, functional magnetic resonance imaging (fMRI), structural neuroimaging, event-related potentials (ERPs), brain connectivity, and peripheral measures], populations (non-human animals, neurotypical participants, developmental studies, and neuropsychiatric and pathological conditions), and article types (original research, review papers, and opinion articles). Through this wide-ranging proposal, we introduce a fresh approach to the study of contextual effects in emotion and social cognition domains.
We report four levels of evidence. First, we present studies examining how cognitive and neural functions are influenced by basic affective processes (interoception, motivation and reward, emotional impulsiveness, and appraisal of violent stimuli). A second set of behavioral and neuroscientific studies addresses how performance is modulated by different emotional variables (categorical and dimensional approaches to emotion, language-as-context for emotion, emotional suppression of the attentional blink, and reappraisal effects on the up-regulation of emotions). The studies in our third selection deal with different influences in social cognition (SC) domains (human and non-human comparative studies, long-term effects of social and physical stress, developmental theory of mind, neural bases of passionate love for others, social decision making in normal and psychopathic participants, and frontal lobe contributions to psychosocial adaptation models). Finally, the fourth set of papers investigates the blending of social and emotion-related processes (valence and social salience in amygdala networks, emotional contributions to identification of genuine and faked social expressions, emotional predispositions and social decision making bias, valence of fairness and social decisions, structural neuroimaging of emotional and social impairments in neurodegenerative diseases, and subjective reactivity to emotional stimuli and their association with moral cognition). A brief summary of all these studies is offered in the following sections.
Background:
Mental health is an important component of overall health and wellbeing and crucial for a happy and meaningful life. The prevalence of mental health problems amongst children and adolescent is high; with estimates suggesting 10-20% suffer from mental health problems at any given time. These mental health problems include internalising (e.g. depression and social anxiety) and externalising behavioural problems (e.g. aggression and anti-social behaviour). Although social capital has been shown to be associated with mental health/behavioural problems in young people, attempts to consolidate the evidence in the form of a review have been limited. This integrative systematic review identified and synthesised international research findings on the role and impact of family and community social capital on mental health/behavioural problems in children and adolescents to provide a consolidated evidence base to inform future research and policy development.
Methods:
Nine electronic databases were searched for relevant studies and this was followed by hand searching. Identified literature was screened using review-specific inclusion/exclusion criteria, the data were extracted from the included studies and study quality was assessed. Heterogeneity in study design and outcomes precluded meta-analysis/meta-synthesis, the results are therefore presented in narrative form.
Results:
After screening, 55 studies were retained. The majority were cross-sectional surveys and were conducted in North America (n = 33); seven were conducted in the UK. Samples ranged in size from 29 to 98,340. The synthesised results demonstrate that family and community social capital are associated with mental health/behavioural problems in children and adolescents. Positive parent-child relations, extended family support, social support networks, religiosity, neighbourhood and school quality appear to be particularly important.
Conclusions:
To date, this is the most comprehensive review of the evidence on the relationships that exist between social capital and mental health/behavioural problems in children and adolescents. It suggests that social capital generated and mobilised at the family and community level can influence mental health/problem behaviour outcomes in young people. In addition, it highlights key gaps in knowledge where future research could further illuminate the mechanisms through which social capital works to influence health and wellbeing and thus inform policy development.
To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1-6 month risk.
7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator).
In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 - 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 - 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83).
Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation.
Molecular Psychiatry publishes work aimed at elucidating biological mechanisms underlying psychiatric disorders and their treatment
Background
Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.
Methods
During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.
Findings
The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23–94; IQR 58–79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.
Interpretation
To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.
Funding
None.
Cambridge Core - Law and technology, science, communication - The Reasonable Robot - by Ryan Abbott
Adolescence (the stage between 10 and 24 years) is a period of life characterised by heightened sensitivity to social stimuli and the increased need for peer interaction. The physical distancing measures mandated globally to contain the spread of COVID-19 are radically reducing adolescents' opportunities to engage in face-to-face social contact outside their household. In this interdisciplinary Viewpoint, we describe literature from a variety of domains that highlight how social deprivation in adolescence might have far-reaching consequences. Human studies have shown the importance of peer acceptance and peer influence in adolescence. Animal research has shown that social deprivation and isolation have unique effects on brain and behaviour in adolescence compared with other stages of life. However, the decrease in adolescent face-to-face contact might be less detrimental due to widespread access to digital forms of social interaction through technologies such as social media. The findings reviewed highlight how physical distancing might have a disproportionate effect on an age group for whom peer interaction is a vital aspect of development.
In less than 6 months, the severe acute respiratory syndrome‐coronavirus type 2 (SARS‐CoV‐2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID‐19) also involves multiple other organs including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS‐CoV‐2 infection is rapidly accumulating. These may result from a variety of mechanisms including virus‐induced hyper‐inflammatory and hypercoagulable states, direct virus infection of the CNS, and post‐infectious immune mediated processes. Example of COVID‐19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis and endothelialitis. In the peripheral nervous system COVID‐19 is associated with dysfunction of smell and taste, muscle injury, the Guillain‐Barre syndrome and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID‐19 poses a global threat to the entire nervous system. While our understanding of SARS‐CoV‐2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID‐19.
Health care workers, as well as society at large, recognize that social isolation and loneliness (SI/L) are major public health concerns in higher-income countries. Almost one-fourth of community-dwelling older adults are socially isolated, while 35% of adults 45 years and older report feeling lonely.¹,2 Social isolation and loneliness increase mortality risk. Nearly 4 decades of research have produced robust evidence that scoring high on measures of social isolation in later life is associated with a significantly increased risk (25%) for premature mortality from all causes in controlled studies.³,4 The evidence is not as strong for loneliness, but it is mounting. However, empirical data informing the biological mechanisms of and interventions to reduce these conditions are negligible given the significance of the problem. Evidence-based interventions are almost nonexistent. For these reasons, the AARP Foundation commissioned the National Academies of Science, Engineering, and Medicine (NAM) to study the medical dimensions of and interventions for SI/L in persons 50 years or older. In this Viewpoint, I review the findings of the report,⁵ focusing on how these findings apply to mental health workers.
Facundo Manes
is an Argentinian neuroscientist. He was born in 1969, and spent his childhood and adolescence in Salto, Buenos Aires Province. He studied at the Faculty of Medicine, University of Buenos Aires, where he graduated in 1992, and then at the University of Cambridge, England (Master in Sciences). After completing his postgraduate training abroad (USA and England) he returned to the country with the firm commitment to develop local resources to improve clinical standards and research in cognitive neuroscience and neuropsychiatry. He created and currently directs INECO (Institute of Cognitive Neurology) and the Institute of Neurosciences, Favaloro Foundation in Buenos Aires City. Both institutions are world leaders in original scientific publications in cognitive neuroscience. He is also President of the World Federation of Neurology Research Group on Aphasia and Cognitive Disorders (RGACD) and of the Latin American Division of the Society for Social Neuroscience. Facundo Manes has taught at the University of Buenos Aires and the Universidad Católica Argentina. He is currently Professor of Neurology and Cognitive Neuroscience, Faculty of Medicine and Psychology of the Favaloro University and was appointed Professor of Experimental Psychology at the University of South Carolina, USA. He has published over 100 scientific papers in the most prestigious original specialised international journals such as Brain and Nature Neuroscience. He has also given lectures at several international scientific fora as the ‘Royal Society of Medicine’ (London) and the ‘New York Academy of Sciences’, among others. His current area of research is the neurobiology of mental processes. He believes in the importance of scientific disclosure for Society. He led the program ‘The Brain Enigmas’ on Argentina TV and wrote many scientific articles in the national press. Finally, Prof. Facundo Manes is convinced that the wealth of a country is measured by the value of human capital, education, science and technology, and that there is the basis for social development.In the last two decades, mainly in the developed world, we have seen a remarkable shift in how policies are made. Until the late 1990’s, the ranks of lead policymakers comprised of economists, lawyers, and financial experts. Behavioral scientists are now increasingly being asked to bring their insights and expertise from the laboratory into the ‘real’ world. As a result, many experts in behavioral sciences are playing a much greater role in policymaking across a range of sectors. We have seen the positive results of applying this scientific knowledge in diverse areas of public policy such as taxation, energy, and education, among others. The insights used to design these interventions were evidence-based cognitive and psycho-social discoveries such as the existence of cognitive biases and the importance of social norms in human behavior.
Behavioral units needed to show significant results for a minimum or zero cost in order to prove their worth and thus, cement the incorporation of behavioral sciences into the public sphere. It is time to move on to a renewed level of complexity by designing more comprehensive interventions with deeper implications and long-term results.
The role of neurosciences has been much less explored but shows a promising potential to improve public policy, especially social policy. For instance, the design of anti-poverty programs based on scientific evidence about brain health would be extremely useful to improve the mental capital of persons living in poverty. Findings in neurosciences along the life cycle can be incorporated into the public policy sphere. Understanding the neuroscientific evidence on how to stimulate cognitive and socio-emotional skills among different types of populations is crucial to improve the design of policies and has relevant implications for the mental capital of nations.
Neurosciences can also facilitate the comprehension of those cognitive skills needed for the jobs of the future such as creativity, emotional intelligence, empathy, resilience, cognitive flexibility, and executive functions, among others. Public policy interventions can focus on promoting these skills, which are not fixed and which can be improved and enhanced. Other areas in which evidence from neurosciences can be utilized are: infant development, the adolescent brain, addictions (i.e., opioid epidemic, science and policy of marijuana), neuroeducation or the neuroscientific basis in teaching and learning (i.e., dyslexia), neurolaw (i.e. criminal responsibility, deception, juvenile justice, judges’ decision making, witness testimony), prejudice and empathy, violence and aggression, loneliness, normal aging, the future of mind-tech cyborgs, and the burden of brain disorders.
Behavioral insights are gaining popularity in developed countries. However, is this enough to create positive structural changes in the economy and in social welfare? While it is fair to say that nudges successfully allowed behavioral science to enter the world of policy we still have much work to do to reach social and health long-term improvements. In this regard, advances in neurosciences over the last years could help reshape the way we think about important policies and could be useful in helping individuals develop their maximum potential.
The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
As the proportion of older adults in the United States is projected to increase dramatically in the coming decades, it is imperative that public health address and maintain the cognitive health of this growing population. More than 5 million Americans live with Alzheimer’s disease and related dementias (ADRD) today, and this number is projected to more than double by 2050. The public health community must be proactive in outlining the response to this growing crisis. Promoting cognitive decline risk reduction, early detection and diagnosis, and increasing the use and availability of timely data are critical components of this response. To prepare state, local, and tribal organizations, CDC and the Alzheimer’s Association have developed a series of Road Maps that chart the public health response to dementia. Since the initial Healthy Brain Initiative (HBI) Road Map release in 2007, the Road Map has undergone two new iterations, with the most recent version, The HBI’s State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map, released in late 2018. Over the past several years, significant advances were made in the science of risk reduction and early detection of ADRD. As a result, the public health response requires a life-course approach that focuses on reducing risk and identifying memory issues earlier to improve health outcomes. The most recent Road Map was revised to accommodate these strides in the science and to effect change at the policy, systems, and environment levels. The 2018–2023 Road Map identifies 25 actions that state and local public health agencies and their partners can implement to promote cognitive health and address cognitive impairment and the needs of caregivers. The actions are categorized into four traditional domains of public health, and the Road Map can help public health and its partners chart a course for a dementia-prepared future.
The potential of parent training and professional development programs for improving early childhood experiences and later outcomes is well established. Yet traditional models of training and support, which largely consist of providing information to parents and teachers, have not met the needs of caregivers who experience the greatest levels of adversity. In this article, we describe the challenges faced by low‐income parents and nonparental caregivers, review traditional theoretical models used in parenting and professional development programs, and discuss a new approach focusing on building caregivers' self‐regulation and executive function skills. We review innovative program efforts focused on family goal setting, caregiver stress reduction, and reducing barriers that impede caregivers' core capabilities. Although there is still much to learn about these approaches, we conclude that addressing self‐regulation and executive function in caregivers is worthy of more theoretical and empirical study.
Research linking health and social capital is often cited in relation to global public health policies and programmes that mobilise local community participation in health promotion in marginalised settings. A long-standing criticism of this body of analysis and action is its inadequate attention to the power inequalities that drive poor health, often linked to macro-social forces beyond the reach of local community activism. Supplementing social capital research with attention to more ambitious and wide-ranging forms of health activism tackles this criticism. It puts the reproduction and transformation of health-relevant power inequalities at the heart of social capital research and community mobilisation strategies. We use the South African Treatment Action Campaign as a prototype for expanding understandings of social capital for health promotion. Existing social capital work currently focuses on facilitating community mobilisation to create co-operative bonding and bridging social capital (networks of solidarity within and between marginalised communities respectively), as well as linking social capital (networks uniting marginalised communities and more powerful champions). We call for an expanded focus that takes account of how these co-operative networks may serve as springboards for community involvement in adversarial social movements. In such cases, these networks of solidarity serve as launch pads for various forms of demand and protest where the marginalised and their allies confront power-holders in conflictual struggles over health-relevant social resources. We illustrate this expanded framework with two examples of collective action for mental health: the Movement for Global Mental Health and the UK Mental Health User and Survivor Movement. Both seek to use bonding, bridging and linking networks as the basis for movements to pressurise power-holders to increase access to appropriate psychiatric services, adequate welfare support and social respect and recognition for people living with mental distress.
The large and increasing burden of mental and substance use disorders, its association with social disadvantage and decreased economic output, and the substantial treatment gaps across country-income levels, are propelling mental health into the global spotlight. The inclusion of targets related to mental health and wellbeing in the UN's Sustainable Development Goals, as well as several national and global initiatives that formed during the past 5 years, signal an increasing momentum toward providing appropriate financing for global mental health. Drawing on the organisational and financial architecture of two successful global health scale-up efforts (the fight against HIV/AIDS and the improvement of maternal and child health) and the organisational models that have emerged to finance these and other global health initiatives, we propose a multi-sectoral and multi-organisational Partnership for Global Mental Health to serve two main functions. First is the mobilisation of funds, including raising, pooling, disbursing, and allocating. Second is stewardship, including supporting countries to use funds effectively, evaluate results, and hold stakeholders accountable. Such a partnership would necessarily involve stakeholders from the mental health field, civil society, donors, development agencies, and country-level stakeholders, organised into hubs responsible for financing, scale-up, and accountability.
Over the past eight years, there has been an increase in the use of pay for success (PFS) as a financing tool whereby private investors provide initial funding for preventive health and human service interventions. If an independent evaluator deems the interventions successful, investors are repaid by the government.
To better understand how PFS is used, we created a global landscape surveillance system to track and analyze data on all PFS projects that have launched through 2017. We focus on the potential for PFS to improve population health by funding interventions that target the social determinants of health.
Our findings show that all launched projects to date have implemented interventions aimed at improving the structural and intermediary social determinants of health, primarily in socioeconomically disadvantaged populations. Although there are some challenges associated with PFS, we believe it is a promising tool for financing interventions aimed at social determinants of health in underserved and marginalized populations.
This Brief introduces two empirically grounded models of situated mental phenomena: contextual social cognition (the collection of psychological processes underlying context-dependent social behavior) and action-language coupling (the integration of ongoing actions with movement-related verbal information). It combines behavioral, neuroscientific, and neuropsychiatric perspectives to forge a novel view of contextual influences on active, multi-domain processes. Chapters highlight the models' translational potential for the clinical field by focusing on diseases compromising social cognition (mainly illustrated by behavioral variant frontotemporal dementia) and motor skills (crucially, Parkinson’s disease). A final chapter sets forth metatheoretical considerations regarding intercognition, the constant binding of processes triggered by environmental and body-internal sources, which confers a sensus communis to our experience. In addition, the book includes two commentaries written by external peers pondering on advantages and limits of the proposal.
Contextual Cognition will be of interest to students, teachers, and researchers from the fields of cognitive science, neurology, psychiatry, neuroscience, psychology, behavioral science, linguistics, and philosophy.
Background
Underemployment (defined as when a person in paid employment works for fewer hours than their desired full working capacity) is increasingly recognised as a component of employment precarity. This paper sought to investigate the effects of underemployment on the mental health of people with disabilities.
Methods
Using 14 waves of the Household, Income and Labour Dynamics in Australia survey, we used fixed-effects models to assess whether the presence of a disability modified the association between underemployment and mental health. Both disability and underemployment were assessed as time-varying factors. Measures of effect measure modification were presented on the additive scale.
Results
The experience of underemployment was associated with a significantly greater decline in mental health when a person reported a disability (mean difference −1.38,95% CI −2.20 to −0.57) compared with when they did not report a disability (mean difference −0.49, 95% CI −0.84 to −0.14). The combined effect of being underemployed and having a disability was nearly one point greater than the summed independent risks of having a disability and being underemployed (−0.89, 95% CI −1.75 to –0.03).
Conclusion
People with disabilities are more likely to experience underemployment and more likely to have their mental health adversely affected by it. There is a need for more research and policy attention on how to ameliorate the effects of underemployment on the mental health of persons with disabilities.
The now recognized core construct of psychological capital, or simply PsyCap, draws from positive psychology in general and positive organizational behavior (POB) in particular. The first-order positive psychological resources that make up PsyCap include hope, efficacy, resilience, and optimism, or the HERO within. These four best meet the inclusion criteria of being theory- and research-based, positive, validly measurable, state-like, and having impact on attitudes, behaviors, performance and well-being. The article first provides the background and precise meaning of PsyCap and then comprehensively reviews its measures, theoretical mechanisms, antecedents and outcomes, levels of analysis, current status and needed research, and finally application. Particular emphasis is given to practical implications, which focuses on PsyCap development, positive leadership, and novel applications such as the use of video games and gamification techniques. The overriding theme throughout is that PsyCap has both scientific, evidence-based rigor and practical relevance. Expected final online publication date for the Annual Review of Organizational Psychology and Organizational Behavior Volume 4 is March 21, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
As the prevalence of Alzheimer's disease (AD) grows, so do the costs it imposes on society. Scientific, clinical, and financial interests have focused current drug discovery efforts largely on the single biological pathway that leads to amyloid deposition. This effort has resulted in slow progress and disappointing outcomes. Here, we describe a "portfolio approach" in which multiple distinct drug development projects are undertaken simultaneously. Although a greater upfront investment is required, the probability of at least one success should be higher with "multiple shots on goal," increasing the efficiency of this undertaking. However, our portfolio simulations show that the risk-adjusted return on investment of parallel discovery is insufficient to attract private-sector funding. Nevertheless, the future cost savings of an effective AD therapy to Medicare and Medicaid far exceed this investment, suggesting that government funding is both essential and financially beneficial.