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BackgroundCOVID-19-related restrictions led to an increase in overall loneliness and social isolation. Before the pandemic, care partners reported higher levels of loneliness and higher loneliness prevalence compared to non-care partners. Because of the spread and severity of the infections, and the access to support spread, we expect a different impact of the COVID-19 pandemic on LATAM care partners.ObjectivesTo describe the loneliness levels of LATAM caregivers and to identify socioeconomic and health factors associated.DesignAn international online cross-sectional survey for care partners, embedded within the ‘Coping with Loneliness and Isolation during COVID-19’ (CLIC) Study conducted between June 2020– and November 2020.SettingWe analysed data from 246 family care partners living in Latin American countries (46% Mexico, 26% Chile,18% Brazil, and 10% from Argentina, Peru, Venezuela, Panama, Guatemala y Costa Rica).MeasurementsWe assessed loneliness using the 6-items of De Jong Gierveld loneliness Scale. We described the levels of overall, emotional, and social loneliness pre and during Covid, and reported the distribution of care partners who improved, worsened or maintained their levels of loneliness. Moreover, we used longitudinal multiple linear regression models with bootstraps errors of 1,000 iterations to identify factors associated with the levels of overall, emotional, and social loneliness during the pandemic.ResultsParticipants were mostly women, 50 years and older, in a partnership, highly educated and with finances meeting their needs, with good to excellent physical and mental health. Among the total of care partners, 55% perceived higher overall loneliness, 56% higher emotional loneliness, and 21% higher social loneliness during the pandemic in comparison with pre-COVID-19 levels. Perceived mental health was associated with the overall, emotional, and social loneliness.ConclusionsRegardless of their living and health situation, during the pandemic, loneliness increased in all groups of care partners. These should be taken in consideration when planning public health approaches for crises such as pandemics or other large-scale disruptive events.

Monitoring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) is critical for public health management of coronavirus disease. Sequencing is resource-intensive and incompletely representative, and not all isolates can be sequenced. Because wastewater SARS-CoV-2 RNA concentrations correlate with coronavirus disease incidence in sewersheds, tracking VOCs through wastewater is appealing. We developed digital reverse transcription PCRs to monitor abundance of select mutations in Alpha and Delta VOCs in wastewater settled solids, applied these to July 2020–August 2021 samples from 2 large US metropolitan sewersheds, and compared results to estimates of VOC abundance from case isolate sequencing. Wastewater measurements tracked closely with case isolate estimates (Alpha, rp 0.82–0.88; Delta, rp 0.97). Mutations were detected in wastewater even at levels

The rate of progression from Mild Cognitive Impairment (MCI) to Alzheimer's disease (AD) is estimated at >10% per year, reaching up to 80–90% after 6 years. MCI is considered an indicator of early-stage AD. In this context, the diagnostic screening of MCI is crucial for detecting individuals at high risk of AD before they progress and manifest further severe symptoms. Typically, MCI has been determined using neuropsychological assessment tools such as the Montreal Cognitive Assessment (MoCA) or Mini-Mental Status Examination (MMSE). Unfortunately, other diagnostic methods are not available or are unable to identify MCI in its early stages. Therefore, identifying new biomarkers for MCI diagnosis and prognosis is a significant challenge. In this framework, miRNAs in serum, plasma, and other body fluids have emerged as a promising source of biomarkers for MCI and AD-related cognitive impairments. Interestingly, miRNAs can regulate several signaling pathways via multiple and diverse targets in response to pathophysiological stimuli. This systematic review aims to describe the current state of the art regarding AD-related target genes modulated by differentially expressed miRNAs in peripheral fluids samples in MCI subjects to identify potential miRNA biomarkers in the early stages of AD. We found 30 articles that described five miRNA expression profiles from peripheral fluid in MCI subjects, showing possible candidates for miRNA biomarkers that may be followed up as fluid biomarkers or therapeutic targets of early-stage AD. However, additional research is needed to validate these miRNAs and characterize the precise neuropathological mechanisms.

The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.

Frontotemporal dementia (FTD) includes a group of clinically, genetically, and pathologically heterogeneous neurodegenerative disorders, affecting the fronto-insular-temporal regions of the brain. Clinically, FTD is characterized by progressive deficits in behavior, executive function, and language and its diagnosis relies mainly on the clinical expertise of the physician/consensus group and the use of neuropsychological tests and/or structural/functional neuroimaging, depending on local availability. The modest correlation between clinical findings and FTD neuropathology makes the diagnosis difficult using clinical criteria and often leads to underdiagnosis or misdiagnosis, primarily due to lack of recognition or awareness of FTD as a disease and symptom overlap with psychiatric disorders. Despite advances in understanding the underlying neuropathology of FTD, accurate and sensitive diagnosis for this disease is still lacking. One of the major challenges is to improve diagnosis in FTD patients as early as possible. In this context, biomarkers have emerged as useful methods to provide and/or complement clinical diagnosis for this complex syndrome, although more evidence is needed to incorporate most of them into clinical practice. However, most biomarker studies have been performed using North American or European populations, with little representation of the Latin American and the Caribbean (LAC) region. In the LAC region, there are additional challenges, particularly the lack of awareness and knowledge about FTD, even in specialists. Also, LAC genetic heritage and cultures are complex, and both likely influence clinical presentations and may modify baseline biomarker levels. Even more, due to diagnostic delay, the clinical presentation might be further complicated by both neurological and psychiatric comorbidity, such as vascular brain damage, substance abuse, mood disorders, among others. This systematic review provides a brief update and an overview of the current knowledge on genetic, neuroimaging, and fluid biomarkers for FTD in LAC countries. Our review highlights the need for extensive research on biomarkers in FTD in LAC to contribute to a more comprehensive understanding of the disease and its associated biomarkers. Dementia research is certainly reduced in the LAC region, highlighting an urgent need for harmonized, innovative, and cross-regional studies with a global perspective across multiple areas of dementia knowledge.

Abstract The SARS‐CoV‐2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS‐CoV‐2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.

Abstract Introduction Expert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies’ accessibility and transmission, stigma, diagnostic manuals, data‐sharing platforms, and use of behavioral insights (BIs) are not well known. Methods We investigated opinions among health professionals working on aging in LACs (N = 3365) with regression models including expertise‐related information (public policies, BI), individual differences (work, age, academic degree), and location. Results Experts specified low public policy knowledge (X2 = 41.27, P

Frontotemporal dementia (FTD) includes a group of clinically, genetically, and pathologically heterogeneous neurodegenerative disorders, affecting the fronto-insular-temporal regions of the brain. Clinically, FTD is characterized by progressive deficits in behavior, executive function, and language and its diagnosis relies mainly on the clinical expertise of the physician/consensus group and the use of neuropsychological tests and/or structural/functional neuroimaging, depending on local availability. The modest correlation between clinical findings and FTD neuropathology makes the diagnosis difficult using clinical criteria and often leads to underdiagnosis or misdiagnosis, primarily due to lack of recognition or awareness of FTD as a disease and symptom overlap with psychiatric disorders. Despite advances in understanding the underlying neuropathology of FTD, accurate and sensitive diagnosis for this disease is still lacking. One of the major challenges is to improve diagnosis in FTD patients as early as possible. In this context, biomarkers have emerged as useful methods to provide and/or complement clinical diagnosis for this complex syndrome, although more evidence is needed to incorporate most of them into clinical practice. However, most biomarker studies have been performed using North American or European populations, with little representation of the Latin American and the Caribbean (LAC) region. In the LAC region, there are additional challenges, particularly the lack of awareness and knowledge about FTD, even in specialists. Also, LAC genetic heritage and cultures are complex, and both likely influence clinical presentations and may modify baseline biomarker levels. Even more, due to diagnostic delay, the clinical presentation might be further complicated by both neurological and psychiatric comorbidity, such as vascular brain damage, substance abuse, mood disorders, among others. This systematic review provides a brief update and an overview of the current knowledge on genetic, neuroimaging, and fluid biomarkers for FTD in LAC countries. Our review highlights the need for extensive research on biomarkers in FTD in LAC to contribute to a more comprehensive understanding of the disease and its associated biomarkers. Dementia research is certainly reduced in the LAC region, highlighting an urgent need for harmonized, innovative, and cross-regional studies with a global perspective across multiple areas of dementia knowledge.

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.

Abstract Mild cognitive impairment (MCI) is often considered an early stage of dementia, with estimated rates of progression to dementia up to 80–90% after approximately 6 years from the initial diagnosis. Diagnosis of cognitive impairment in dementia is typically based on clinical evaluation, neuropsychological assessments, cerebrospinal fluid (CSF) biomarkers, and neuroimaging. The main goal of diagnosing MCI is to determine its cause, particularly whether it is due to Alzheimer’s disease (AD). However, only a limited percentage of the population has access to etiological confirmation, which has led to the emergence of peripheral fluid biomarkers as a diagnostic tool for dementias, including MCI due to AD. Recent advances in biofluid assays have enabled the use of sophisticated statistical models and multimodal machine learning (ML) algorithms for the diagnosis of MCI based on fluid biomarkers from CSF, peripheral blood, and saliva, among others. This approach has shown promise for identifying specific causes of MCI, including AD. After a PRISMA analysis, 29 articles revealed a trend towards using multimodal algorithms that incorporate additional biomarkers such as neuroimaging, neuropsychological tests, and genetic information. Particularly, neuroimaging is commonly used in conjunction with fluid biomarkers for both cross-sectional and longitudinal studies. Our systematic review suggests that cost-effective longitudinal multimodal monitoring data, representative of diverse cultural populations and utilizing white-box ML algorithms, could be a valuable contribution to the development of diagnostic models for AD due to MCI. Clinical assessment and biomarkers, together with ML techniques, could prove pivotal in improving diagnostic tools for MCI due to AD.

High Andean Páramos are very fragile neotropical ecosystems. Moreover, biodiversity in these areas is threatened by the anthropic activities of agriculture, cattle raising, and mining and has been little studied. Changes associated with potato farming and livestock grazing on microorganisms of Páramo soil of the Nevados National Natural Park (Nevados NNP) were assessed by (1) determination of physical and chemical properties (physicochemical matrix) and enzymatic activities associated (enzymatic activity matrix) with different biogeochemical cycles (C, N, and P); (2) microbial community functional diversity via evaluation of functional groups associated with carbon, nitrogen, and phosphorus cycles using cultivation-dependent techniques (arable functional group matrix and most probable number matrix); and (3) microbial diversity using cultivation-independent techniques that employ the hypervariable V5–V6 region of the 16S rRNA gene and pyrosequencing (16S-454 genus matrix and 16S-454 OTU matrix). Four of the six evaluated matrices (physicochemical, enzymatic activities, most probable number, and arable functional groups) revealed significant differences according to land use. The strategy adopted by the arable functional group matrix, in which the diversity of nitrogen fixation, phosphate solubilization, and cellulolytic compounds was evaluated, showed the most significant impacts of the different factors (land use, season, and elevation), especially those caused by potato cultivation and livestock. These results indicate that the initial impacts of potato farming and livestock grazing on the microbial community in El Bosque Village are better detected by functional diversity analysis than by molecular analysis of the 16S rRNA gene V5–V6 variable region. The results may have been caused by the type of molecular marker used in the analyses and the type of agricultural practices used by peasant farmers, which affect the functional diversity of the soil community. Among these practices are the maintenance of fallow periods greater than 7 years between each potato crop and the small proportion of cattle in relation to the total land area of the village. As the findings can be interpreted as an indicator of the early impacts of potato cultivation and livestock on microbial diversity, the effects of implementing community management plans, applying agroecological models, retaining biocultural memory, and changing agrarian structure are relevant for mitigating future changes.

ABSTRACT Páramo ecosystems are of great importance because they are considered hotspots within the Tropical Andes. They are also very important for their role as producers and regulators of water processes in the Neotropic. However, the human occupation of the Colombian Páramos has generated conflict between environmental benefits and productive land uses, specifically the potato cultivation and livestock. To assess possible changes associated with potato cultivation (Solanum tuberosum L.) and livestock on the microbial communities of Páramo soils, the objective of this research was to evaluate the possible effects of potato cultivation and livestock farming on the soil microorganisms associated with different functional groups (nitrogen fixers, phosphate solubilizers and cellulolytic) in the Páramo of Nevados National Natural Park (Nevados NNP), Colombia. Samples were collected from soils under potato cultivation, livestock, and Páramo conservation areas over two climatic seasons (rainy and dry) in three farms at different elevations (3769, 3590, and 3432 m a.s.l.). The microorganisms were isolated using selective culture media for each functional group and identified using molecular markers; microbial diversity was analyzed using multivariate statistical tools. Changes were dependent on land use, elevation, and climate and were statistically significant in the rainy season on all three farms and one of the farms during the dry season. Similarly, the results indicated that climate has a greater impact on the evaluated microbial communities than land use does; the changes were significantly different between the soil under potato cultivation and in conserved Páramo sites at most of the evaluated locations and between soil subjected to livestock farming and Páramo in certain locations. However, the differences between potato cultivation and livestock farming were smaller. This study showed for the first time that the microbial structure (abundance and composition) of microorganism functional groups was different as a result of potato cultivation and livestock farming on Páramo soils, although these changes were dependent on farm elevation and climate.

La perspectiva ambiental es una manera de interpretar la realidad, que pretende explicar las complejas relaciones que suceden entre los seres humanos y el resto de la naturaleza o, como lo propuso el maestro Augusto Ángel Maya, las relaciones ecosistema cultura (Angel, 1993; 1995; 1996). Esta última connotación, indica que la humanidad se apropia y transforma el resto del ordenamiento natural, a partir de las estructuras simbólicas del pensamiento, de sus distintas manifestaciones de organización (social, económica, política y militar) y de los instrumentos físicos que desarrolla a través de sus cambiantes plataformas tecnológicas. Pero en esa red compleja de acciones y reacciones entre el mundo ecosistémico y las acciones humanas, que daría la impresión a primera vista de no tener soluciones fáciles o de esconder truculentos caminos muchos de ellos sin salida, subyace una especie de mejor ruta para resolver esas complejidades, una suerte de guía hacia procesos de armonía, de caminos donde las cosas encuentran su sitio en el mundo, su razón de ser, su correspondencia única. Y esa ruta, que devela el justo sentido de la dimensión ambiental, pertenece al mundo de los símbolos y es ética y estética. No corresponde a la razón económica y esquiva los caminos del poder, incluso los de las sectas y fanatismos. Esa ruta que encausa lo bello y lo sensible con lo justo y lo equitativo, no requiere modelos matemáticos sino una predisposición individual de origen desconocido, que no necesita explicaciones, porque se conoce de antemano. Unos le llaman conciencia moral, otros la denominan intuición, otros consideran que es el balance necesario surgido del mismo asombro del vivir, de la misma expectación de la vida.