Background Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. MethodsWe forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. FindingsWe estimated that the number of people with dementia would increase from 57•4 (95% uncertainty interval 50•4-65•1) million cases globally in 2019 to 152•8 (130•8-175•9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0•1% [-7•5 to 10•8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1•69 [1•64-1•73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1•67 [1•52-1•85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41-67]) and western Europe (74% [58-90]), and the largest in north Africa and the Middle East (367% [329-403]) and eastern sub-Saharan Africa (357% [323-395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. Interpretation Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected incr...

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Abstract Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.

Introduction Dementia is currently one of the leading causes of mortality globally, and mortality due to dementia will likely increase in the future along with corresponding increases in population growth and population aging. However, large inconsistencies in coding practices in vital registration systems over time and between countries complicate the estimation of global dementia mortality. Methods We meta‐analyzed the excess risk of death in those with dementia and multiplied these estimates by the proportion of dementia deaths occurring in those with severe, end‐stage disease to calculate the total number of deaths that could be attributed to dementia. Results We estimated that there were 1.62 million (95% uncertainty interval [UI]: 0.41–4.21) deaths globally due to dementia in 2019. More dementia deaths occurred in women (1.06 million [0.27–2.71]) than men (0.56 million [0.14–1.51]), largely but not entirely due to the higher life expectancy in women (age‐standardized female‐to‐male ratio 1.19 [1.10–1.26]). Due to population aging, there was a large increase in all‐age mortality rates from dementia between 1990 and 2019 (100.1% [89.1–117.5]). In 2019, deaths due to dementia ranked seventh globally in all ages and fourth among individuals 70 and older compared to deaths from other diseases estimated in the Global Burden of Disease (GBD) study. Discussion Mortality due to dementia represents a substantial global burden, and is expected to continue to grow into the future as an older, aging population expands globally.

Introduction: In the last few decades, the rates of international medical migration have continuously risen. In Psychiatry, there is great disparity in the workforce between high and low-income countries. Yet, little is known about the 'push' and 'pull' factors and the migratory intentions of trainees. This study aims to assess the factors impacting the decisions of psychiatric trainees in Portugal towards migration. Material and Methods: A questionnaire was developed in the Brain Drain study and was distributed to psychiatric trainees in Portugal. Results: The sample consists of 104 psychiatric trainees (60.6% female). Overall, 40.4% of the trainees had prior experience of living abroad and the majority (96.9%) felt that this experience influenced their attitude towards migration in a positive way. About 75% of trainees had 'ever' considered leaving the country, but the majority (70.0%) had not taken any 'practical steps' towards migration. The main reasons to stay in Portugal were personal, while the main reason to leave was financial. The majority of the trainees (55.7%) were dissatisfied or very dissatisfied with their income, working conditions and academic opportunities. Discussion: Working conditions, salaries and academic opportunities are the main triggers for the migration of psychiatric trainees from Portugal. Conclusion: These results may inform the decisions of stakeholders in the health and education sectors and point out the necessary investments required and the impact it may have on the workforce. RESUMOIntrodução: Nas últimas décadas, a migração médica internacional tem aumentado continuamente. Na Psiquiatria, existe uma grande disparidade de recursos humanos entre países desenvolvidos e com baixo desenvolvimento económico. No entanto, pouco se sabe sobre os fatores que atraem (push) ou afastam (pull) a mobilidade e quais as intenções migratórias dos internos de psiquiatria. O objetivo deste estudo é avaliar os fatores que influenciam o processo de tomada de decisão dos internos de Psiquiatria em Portugal relativamente à migração. Material e Métodos: Um questionário foi desenvolvido no âmbito do estudo Brain Drain, e foi enviado aos internos de Psiquiatria em Portugal.Resultados: A amostra é constituída por 104 internos de Psiquiatria (60,6% do sexo feminino). No geral, 40,4% dos internos tiveram uma experiência de mobilidade e a maioria (96,9%) sentiu que esta os influenciou positivamente na sua atitude em relação à migração. Cerca de 75% dos internos já considerou emigrar, mas a maioria (70,0%) não deu nenhum passo nessa direção. A principal razão para permanecer no país prende-se com factores pessoais, enquanto o principal motivo para emigrar é financeiro. A maioria (55,7%) dos internos estava insatisfeito ou muito insatisfeito com o seu salário, condições de trabalho e oportunidades académicas. Discussão: Condições de trabalho, salários e oportunidades académicas são os principais estímulos para a emigração nos internos de Psiquiatria em Portugal. Conclusão: Estes resultados poderão apoiar a...