Introduction: Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term. Methods: This article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae 4 of 24 DE ERAUSQUIN ET AL.of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions.Results: Successful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively.Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe.Discussion: The Alzheimer's Association Global Consortium harmonized methodology is proposed as a model to study long-term neurocognitive sequelae of SARS-CoV-2 infection.
Background: According to the World Health Organization (WHO), vaccination has reduced the burden of infectious diseases to a significant extent. In recent times, however, the focus has been more on vaccine safety rather than effectiveness. As with any other public health program, immunizations and associated policies are designed to protect the health of the public. Compared to minor risks of side effects of vaccination, the risk of infection often rationalizes the use of vaccination. In states like Georgia, with fewer outbreaks associated with non-vaccination, the need to access community immunity remains constant. Though some articles have assessed parental refusal of childhood vaccination as an ethical concern, few have addressed the economic burden to society as a result of parental rights to refuse vaccination in the ethical contexts of rights, outbreak costs, and community safety. Methods:A literature review was conducted on both qualitative and quantitative studies that described the ethical issues associated with parental refusal of child vaccinations. Electronic databases through PubMed and EBSCO search engines were examined for studies conducted between 2012-2018. Five reviewers independently assessed those articles for content and relevance.Results: Forty-seven articles were identified by a subject matter expert and assessed by the five reviewers. Nineteen articles, based on relevance and theme were selected by consensus to include in this review. Article themes of "rights of parents," "community rights," and "costs associated with outbreak or mitigation of outbreak" were examined. Conclusions:Ethical issues of community safety and costs of the outbreak, as well as the rights of the child, should be considered in the debate of childhood vaccination. Research, policy, and parental education strategies should also take ethical implications into account to encourage well-informed policy and parental decision-making.
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