Given the rapid proliferation of trajectory-based approaches to study clinical consequences to stress and potentially traumatic events (PTEs), there is a need to evaluate emerging findings. This ...review examined convergence/divergences across 54 studies in the nature and prevalence of response trajectories, and determined potential sources of bias to improve future research. Of the 67 cases that emerged from the 54 studies, the most consistently observed trajectories following PTEs were resilience (observed in: n = 63 cases), recovery (n = 49), chronic (n = 47), and delayed onset (n = 22). The resilience trajectory was the modal response across studies (average of 65.7% across populations, 95% CI 0.616, 0.698), followed in prevalence by recovery (20.8% 0.162, 0.258), chronicity (10.6%, 0.086, 0.127), and delayed onset (8.9% 0.053, 0.133). Sources of heterogeneity in estimates primarily resulted from substantive population differences rather than bias, which was observed when prospective data is lacking. Overall, prototypical trajectories have been identified across independent studies in relatively consistent proportions, with resilience being the modal response to adversity. Thus, trajectory models robustly identify clinically relevant patterns of response to potential trauma, and are important for studying determinants, consequences, and modifiers of course following potential trauma.
•A review of n = 54 studies demonstrates that resilience is the modal response to major life stressors and potential trauma.•Resilience, recovery, chronicity, and delayed onset were consistently identified adjustment outcome trajectories.•Pattern stability across contextual factors indicates that the trajectories are likely phenotypic human stress responses.•Trait and state factors associated with trajectory membership have implications for risk identification and interventions.•Trajectory models provide a robust methodology to study clinically relevant responses to stress and potential trauma.
Although there is anecdotal evidence of ageism occurring at both the structural level (in which societal institutions reinforce systematic bias against older persons) and individual level (in which ...older persons take in the negative views of aging of their culture), previous systematic reviews have not examined how both levels simultaneously influence health. Thus, the impact of ageism may be underestimated. We hypothesized that a comprehensive systematic review would reveal that these ageism levels adversely impact the health of older persons across geography, health outcomes, and time.
A literature search was performed using 14 databases with no restrictions on region, language, and publication type. The systematic search yielded 13,691 papers for screening, 638 for full review, and 422 studies for analyses. Sensitivity analyses that adjusted for sample size and study quality were conducted using standardized tools. The study protocol is registered (PROSPERO CRD42018090857).
Ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. The studies reported ageism effects in all 45 countries, 11 health domains, and 25 years studied, with the prevalence of significant findings increasing over time (p < .0001). A greater prevalence of significant ageism-health findings was found in less-developed countries than more-developed countries (p = .0002). Older persons who were less educated were particularly likely to experience adverse health effects of ageism. Evidence of ageism was found across the age, sex, and race/ethnicity of the targeters (i.e., persons perpetrating ageism).
The current analysis which included over 7 million participants is the most comprehensive review of health consequences of ageism to date. Considering that the analysis revealed that the detrimental impact of ageism on older persons' health has been occurring simultaneously at the structural and individual level in five continents, our systematic review demonstrates the pernicious reach of ageism.
This systematic literature review appraises critically the mediating variables of stereotype threat. A bibliographic search was conducted across electronic databases between 1995 and 2015. The search ...identified 45 experiments from 38 articles and 17 unique proposed mediators that were categorized into affective/subjective (n = 6), cognitive (n = 7) and motivational mechanisms (n = 4). Empirical support was accrued for mediators such as anxiety, negative thinking, and mind-wandering, which are suggested to co-opt working memory resources under stereotype threat. Other research points to the assertion that stereotype threatened individuals may be motivated to disconfirm negative stereotypes, which can have a paradoxical effect of hampering performance. However, stereotype threat appears to affect diverse social groups in different ways, with no one mediator providing unequivocal empirical support. Underpinned by the multi-threat framework, the discussion postulates that different forms of stereotype threat may be mediated by distinct mechanisms.
Posttraumatic stress responses are characterized by a heterogeneity in clinical appearance and etiology. This heterogeneity impacts the field's ability to characterize, predict, and remediate ...maladaptive responses to trauma. Machine learning (ML) approaches are increasingly utilized to overcome this foundational problem in characterization, prediction, and treatment selection across branches of medicine that have struggled with similar clinical realities of heterogeneity in etiology and outcome, such as oncology. In this article, we review and evaluate ML approaches and applications utilized in the areas of posttraumatic stress, stress pathology, and resilience research, and present didactic information and examples to aid researchers interested in the relevance of ML to their own research. The examined studies exemplify the high potential of ML approaches to build accurate predictive and diagnostic models of posttraumatic stress and stress pathology risk based on diverse sources of available information. The use of ML approaches to integrate high‐dimensional data demonstrates substantial gains in risk prediction even when the sources of data are the same as those used in traditional predictive models. This area of research will greatly benefit from collaboration and data sharing among researchers of posttraumatic stress disorder, stress pathology, and resilience.
Resumen
Spanish s by Asociación Chilena de Estrés Traumático (ACET)
Aprendizaje de Máquinas para la Predicción del Estrés Postraumático y Resiliencia después del Trauma: Una Visión General de los Conceptos Básicos y Avances Recientes
APRENDIZAJE DE MAQUINAS Y ESTRÉS POSTRAUMÁTICO
Las respuestas al estrés postraumático se caracterizan por una heterogeneidad en el aspecto clínico y etiología. Esta heterogeneidad afecta la capacidad del campo para caracterizar, predecir y remediar respuestas desadaptativas al trauma. Los enfoques de aprendizaje maquinas (AM) son cada vez más utilizados para superar este problema fundamental en la caracterización, predicción y selección de tratamiento a través de las ramas de la medicina que han luchado con realidades clínicas similares de heterogeneidad en la etiología y resultados, como la oncología. En este artículo, revisamos y evaluamos los enfoques y las aplicaciones de AM utilizados en las áreas de estrés postraumático, patología del estrés, e investigación en resiliencia y presenta información didáctica y ejemplos para ayudar a investigadores interesados en la relevancia del AM para su propia investigación. Los estudios examinados ejemplifican el alto potencial de los enfoques de AM para construir modelos predictivos y de diagnóstico precisos de estrés postraumático y riesgo de estrés patológico basados en diversas fuentes de Información disponible. El uso de enfoques de AM para integrar datos multidimensionales demuestran ganancias sustanciales en la predicción del riesgo, incluso cuando las fuentes de datos son las mismas que las utilizadas en los modelos predictivos tradicionales. Esta área de investigación se beneficiará enormemente de la colaboración y el intercambio de datos entre los investigadores del trastorno de estrés postraumático, la patología del estrés y resiliencia.
抽象
Traditional and Simplified Chinese s by the Asian Society for Traumatic Stress Studies (AsianSTSS)
簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯
Machine Learning for Prediction of Posttraumatic Stress and Resilience following Trauma: An Overview of Basic Concepts and Recent Advances
Traditional Chinese
標題: 以機器學習法來預測個人受創後的創傷後壓力和恢復力:對基本概念和近期發展的回顧
撮要: 創傷後壓力反應可根據臨床表現和病原學的異質性來找出。這種異質性會影響業界對創傷後適應不良反應的特徵定義、預測和治療。在病原學和治療情況面對相似的臨床異質性的各種醫科, 如腫瘤學, 越來越多人採用機器學習法(ML)來解決特徵定義、預測和治療選擇的根本問題。本研究檢視和評核覆蓋創傷後壓力、壓力病理學和恢復力的研究中ML的方法和應用, 以及為有興趣使用ML的研究員提供教學資訊和例子。檢視的研究都展示了ML有很大機會可基於多元的資訊來源, 就創傷後壓力和壓力病理學風險建立準確的預測和診斷模型。即使數據來源與傳統預測模型所使用的一樣, 以ML來綜合高因次的數據在風險預測方面有顯著功效。研究創傷後壓力症、壓力病理學和恢復力的研究員如果合作並分享數據, 將大大有助這類研究發展。
Simplified Chinese
标题: 以机器学习法来预测个人受创后的创伤后压力和恢复力:对基本概念和近期发展的回顾
撮要: 创伤后压力反应可根据临床表现和病原学的异质性来找出。这种异质性会影响业界对创伤后适应不良反应的特征定义、预测和治疗。在病原学和治疗情况面对相似的临床异质性的各种医科, 如肿瘤学, 越来越多人采用机器学习法(ML)来解决特征定义、预测和治疗选择的根本问题。本研究检视和评核覆盖创伤后压力、压力病理学和恢复力的研究中ML的方法和应用, 以及为有兴趣使用ML的研究员提供教学信息和例子。检视的研究都展示了ML有很大机会可基于多元的信息来源, 就创伤后压力和压力病理学风险建立准确的预测和诊断模型。即使数据来源与传统预测模型所使用的一样, 以ML来综合高因次的数据在风险预测方面有显著功效。研究创伤后压力症、压力病理学和恢复力的研究员如果合作并分享数据, 将大大有助这类研究发展。
Mammalian social interactions are orchestrated by a wide array of neural circuits. While some aspects of social behaviors are driven by subcortical circuits, and are considered to be highly conserved ...and hard-wired, others require dynamic and context-dependent modulation that integrates current state, past experience and goal-driven action selection. These cognitive social processes are known to be dependent on the integrity of the prefrontal cortex. However, the circuit mechanisms through which the prefrontal cortex supports complex social functions are still largely unknown, and it is unclear if and how they diverge from prefrontal control of behavior outside of the social domain. Here we review recent studies exploring the role of prefrontal circuits in mammalian social functions, and attempt to synthesize these findings to a holistic view of prefrontal control of sociability.
Atmospheric warming is projected to increase global mean surface temperatures by 0.3 to 4.8 degrees Celsius above pre-industrial values by the end of this century. If anthropogenic emissions continue ...unchecked, the warming increase may reach 8-10 degrees Celsius by 2300 (ref. 2). The contribution that large ice sheets will make to sea-level rise under such warming scenarios is difficult to quantify because the equilibrium-response timescale of ice sheets is longer than those of the atmosphere or ocean. Here we use a coupled ice-sheet/ice-shelf model to show that if atmospheric warming exceeds 1.5 to 2 degrees Celsius above present, collapse of the major Antarctic ice shelves triggers a centennial- to millennial-scale response of the Antarctic ice sheet in which enhanced viscous flow produces a long-term commitment (an unstoppable contribution) to sea-level rise. Our simulations represent the response of the present-day Antarctic ice-sheet system to the oceanic and climatic changes of four representative concentration pathways (RCPs) from the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. We find that substantial Antarctic ice loss can be prevented only by limiting greenhouse gas emissions to RCP 2.6 levels. Higher-emissions scenarios lead to ice loss from Antarctic that will raise sea level by 0.6-3 metres by the year 2300. Our results imply that greenhouse gas emissions in the next few decades will strongly influence the long-term contribution of the Antarctic ice sheet to global sea level.
We propose to defined apathy as a quantitative reduction of goal-directed behaviour. As such, the neural bases of apathy rely on lesions or dysfunctions of the brain structures that generate and ...control goal-directed behaviour: the frontal lobes, the basal ganglia and the frontal-basal ganglia circuits. Lesions or dysfunctions of the limbic territories of the frontal lobes (the orbital-mesial prefrontal cortex) and the basal ganglia (e.g., the ventral striatum) lead to apathy through difficulties to provide the affective value of a given behavioural context. We also suggest that lesions or dysfunctions of the associative (“cognitive”) territories of the frontal lobes (the dorsal prefrontal cortex) and the basal ganglia (e.g., the dorsal caudate) contribute to apathy via a “cognitive inertia” — an inability to generate or activate strategies required to successfully complete a given program of actions. The most severe forms of apathy (“auto-activation deficit” syndrome), due to bilateral lesions in the prefrontal-basal ganglia circuits can be explained either by the addition of lesions in the cognitive and limbic territories or by a more general and elementary impairment that mirrored the presumed normal functions of the prefrontal-basal ganglia circuits, that is to selectively amplified the behaviour that one considers as the most adapted to one's personal needs or environmental demands. These lesions may limit the selective amplification of the signal that represents relevant thoughts and actions, leading to difficulties to disambiguate decision-making at the level of the prefrontal cortex.
L’apathie peut être définie par la réduction quantitative des comportements volontaires (ou dirigés vers un but). Elle apparaît quand les circuits cérébraux sous-tendant la génération et le contrôle de ces comportements sont atteints. Ces circuits sont principalement représentés par le cortex frontal et ses régions cibles dans les ganglions de la base. Ces circuits étant fonctionnellement et anatomiquement distincts, nous proposons que l’apathie résulte de mécanismes divers, sources de réduction des comportements volontaires. Ainsi, nous isolons au moins trois mécanismes d’apathie : 1) une difficulté à attribuer correctement une valeur affective à un comportement donné (« a-motivation »). Cette forme d’apathie serait secondaire à une altération de boucles reliant les régions ventro-médiales du cortex frontal aux régions limbiques des ganglions de la base (striatum ventral, pallidum ventral, entre autres) ; 2) une difficulté à élaborer la séquence d’actions à effectuer alors que la motivation est normale (« inertie cognitive »). Les lésions siègeraient plutôt dans le système dorsal (cortex préfrontal dorsolatéral, noyau caudé, pallidum dorsal) ; 3) une déconnexion entre la motivation et le système exécutif cognitif, empêchant les systèmes motivationnel et cognitif d’interagir. Les lésions seraient situées à l’interface entre les deux systèmes (cortex préfrontal médial) ou affecteraient les deux systèmes (atteintes des systèmes associatif et limbique des ganglions de la base). Cette synthèse a pour but de passer en revue les arguments étayant cette nouvelle conception clinique et physiopathologique de l’apathie.
In 2021, aducanumab, an immunotherapy targeting amyloid-β, was approved for Alzheimer's disease (AD) by the US Food and Drug Administration thanks to positive results on a putative biological ...surrogate marker. This approval has raised an unprecedented controversy. It was followed by a refusal of the European Medicine Agency, which does not allow the marketing of drugs solely on biological arguments and raised safety issues, and important US coverage limitations by the Centers for Medicare & Medicaid Services. Two other anti-amyloid immunotherapies showed significant results regarding a clinical outcome in phase 2 trials, and five drugs are being studied in phase 3 trials. Compared to those tested in previous trials of the 2010s, the common feature and novelty of these anti-amyloid immunotherapies is their ability to induce a high clearance of amyloid load, as measured with positron emission tomography, in the brain of early-stage biomarker-proven AD patients. Here, we review the available evidence regarding efficacy and safety data and medico-economical aspects for high-clearance anti-amyloid immunotherapies. We also perform frequentist and Bayesian meta-analyses of the clinical efficacy and safety of the highest dose groups from the two aducanumab phase 3 trials and the donanemab and lecanemab phase 2 trials. When pooled together, the data from high-clearance anti-amyloid immunotherapies trials confirm a statistically significant clinical effect of these drugs on cognitive decline after 18 months (difference in cognitive decline measured with CDR-SB after 18 months between the high dose immunotherapy groups vs. placebo = −0.24 points; P=0.04, frequentist random-effect model), with results on ADAS-Cog being the most statistically robust. However, this effect remains below the previously established minimal clinically relevant values. In parallel, the drugs significantly increased the occurrence of amyloid-related imaging abnormalities-edema (ARIA-E: risk ratio=13.39; P<0.0001), ARIA-hemorrhage (risk ratio=2.78; P=0.0002), and symptomatic and serious ARIA (7/1321=0.53% in the high dose groups versus 0/1446 in the placebo groups; risk ratio=6.44; P=0.04). The risk/benefit ratio of high-clearance immunotherapies in early AD is so far questionable after 18 months. Identifying subgroups of better responders, the perspective of combination therapies, and a longer follow-up may help improve their clinical relevance. Finally, the preliminary evidence from medico-economical analyses seems to indicate that the current cost of aducanumab in the US is not in reasonable alignment with its clinical benefits.
Progress on Understanding Ageism Levy, Sheri R.; Macdonald, Jamie L.
Journal of social issues,
03/2016, Letnik:
72, Številka:
1
Journal Article
Recenzirano
Almost 50 years ago, ageism (negative attitudes toward older adults) was introduced as a significant social issue. Since then, the worldwide population of adults ages 60 and over has rapidly become ...the fastest growing age group, making the study of ageism an even more pressing social issue. This review outlines three broad and intertwined themes as the field continues to develop a fuller understanding of ageism: studying both positive and negative aspects of ageism, taking a lifespan focus, and integrating the study of ageism with the study of aging. The review also focuses on several timely subthemes such as the need and benefits of expanding measures of ageism and intervening variables, expanding the diversity of study samples, expanding the research methodologies, and expanding the contexts under study toward greater cross‐cultural and within‐culture investigations. This review and the international, interdisciplinary research showcased in this special issue are intended to set the stage for the next wave of international research on ageism across the lifecycle and of effective interventions and public policies supporting older adults and positive intergenerational relations.
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