BackgroundCurrent projections of the scale of the coming dementia epidemic assume that the age- and sex-specific prevalence of dementia will not vary over time, and that population ageing alone (increasing the number of older people at risk) drives the projected increases. The basis for this assumption is doubtful, and secular trends (that is, gradual decreases or increases in prevalence over long-term periods) are perfectly plausible.MethodsWe carried out a systematic review of studies of trends in prevalence, incidence and mortality for people with dementia, conducted since 1980.ResultsWe identified nine studies that had tracked dementia prevalence, eight that had tracked dementia incidence, and four that had tracked mortality among people with dementia. There was some moderately consistent evidence to suggest that the incidence of dementia may be declining in high-income countries. Evidence on trends in the prevalence of dementia were inconsistent across studies and did not suggest any clear overall effect. Declining incidence may be balanced by longer survival with dementia, although mortality trends have been little studied. There is some evidence to suggest increasing prevalence in East Asia, consistent with worsening cardiovascular risk factor profiles, although secular changes in diagnostic criteria may also have contributed.ConclusionsWe found no evidence to suggest that the current assumption of constant age-specific prevalence of dementia over time is ill-founded. However, there remains some uncertainty as to the future scale of the dementia epidemic. Population ageing seems destined to play the greatest role, and prudent policymakers should plan future service provision based upon current prevalence projections. Additional priorities should include investing in brain health promotion and dementia prevention programs, and monitoring the future course of the epidemic to chart the effectiveness of these measures.

IntroductionIn 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of people with dementia has increased. Here, we present an update of the global cost estimates.MethodsThis is a societal, prevalence-based global COI study.ResultsThe worldwide costs of dementia were estimated at United States (US) $818 billion in 2015, an increase of 35% since 2010; 86% of the costs occur in high-income countries. Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. The threshold of US $1 trillion will be crossed by 2018.DiscussionWorldwide costs of dementia are enormous and still inequitably distributed. The increase in costs arises from increases in numbers of people with dementia and in increases in per person costs.

BackgroundA wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations.MethodsA systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools.Results153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts.ConclusionsOf the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders. We recommend that, wherever possible, a chosen screening tool should be validated against a gold standard diagnostic assessment in the specific context in which it will be employed.

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BackgroundThere are several existing systematic reviews of prevalence of dementia for mainland China, Hong Kong and Taiwan, but several studies have been newly reported. The aim of this study is to update prevalence data in this region and test for variation across geographical areas and time periods using the new dataset.MethodsTwenty prevalence studies identified from World Alzheimer Report 2015 (January 2011–March 2015) and an updated search (March 2015–February 2017) were added to the original dataset (N = 76). Meta-regression was used to investigate geographical variation and time trends, taking methodological factors and characteristics of study population into account, and to estimate prevalence and number of people with dementia by geographical area.ResultsCompared with northern China, the prevalence of dementia was lower in the central China [-1.0; 95% confidence interval (CI):−2.2, 0.3], south China (−1.7; 95% CI: −3.1, −0.3), Hong Kong and Taiwan (−3.0; 95% CI: −5.0, −1.0) but appeared to be higher in western China (2.8; 95% CI: 0.1, 5.5) after adjusting for methodological variation. The increasing trend from pre-1990 to post-2010 periods was considerably attenuated when taking into account methodological factors and geographical areas. The updated estimated number of people with dementia in all these areas is 9.5 million (5.3%; 95% CI: 4.3, 6.3) in the population aged 60 or above.ConclusionsGeographical variation in dementia prevalence is confirmed in this update, whereas evidence on increasing trends is still insufficient. Differing societal development across areas provides an opportunity to investigate risk factors at the population level operating across diverse life course experiences. Such research could advance global primary prevention of dementia.

Antimicrobial resistance (AMR) is one of the greatest public health threats at this time. While there is a good understanding of the impacts of AMR on infectious diseases, an area of less focus is the effects AMR may be having on non-communicable health conditions (such as cancer) and healthcare services (such as surgery). Therefore, this study aimed to explore what impact AMR is currently having on non-communicable health conditions, or areas of health services, where AMR could be a complicating factor impacting on the ability to treat the condition and/or health outcomes. To do this, a rapid evidence assessment of the literature was conducted, involving a systematic approach to searching and reviewing the evidence. In total, 101 studies were reviewed covering surgery, organ transplants, cancer, ICUs, diabetes, paediatric patients, immunodeficiency conditions, liver and kidney disease, and physical trauma. The results showed limited research in this area and studies often use a selective population, making the results difficult to generalize. However, the evidence showed that for all health conditions and healthcare service areas reviewed, at least one study demonstrated a higher risk of death for patients with resistant infections, compared with no or drug-susceptible infections. Poor health outcomes were also associated with resistant infections in some instances, such as severe sepsis and failure of treatments, as well as a greater need for invasive medical support. While there are gaps in the evidence base requiring further research, efforts are also needed within policy and practice to better understand and overcome these challenges.

Harnessing the role of the public can help build accountability and trust, and also engage with the public about the benefits and risks associated with the science or technology BalancedKey lesson 1: It is important that oversight approaches aim to balance the conflicting benefits and risks associated with the emerging science or technology, as well as the needs of the different stakeholders Diverse and contextualKey lesson 2: There is no 'one-size-fits-all' approach to emerging science and technology oversight -it is vital to take into account the context within which the science or technology is developing Takes the initiativeKey lesson 3: Stakeholders that take the initiative to put in place oversight structures in a timely manner can take advantage of the opportunities provided by the emerging science or technology, and also help identify the risks Anticipatory Key lesson 4: It is helpful to anticipate the different potential paths an emerging science or technology could take as it evolves over time, as well as the ensuing impacts Embraces communication Key lesson 7: Effective communication between the main actors involved in the oversight process facilitates transparency and clarity of roles and responsibilities CollaborativeKey lesson 6: Adopting an inclusive and participatory approach to science and technology oversight helps build accountability and confidence AdaptableKey lesson 5: For an oversight approach to be effective, it helps to build in flexibility so that it can respond to changes and be adjusted over time as the science or technology evolves XIXWe are very grateful to Beth Thompson, Joseph Clift and Gemma Wardle at Wellcome Trust for their helpful guidance and support throughout the project. We would like to thank all of the respondents to our successful crowdsourcing exercise who provided examples of oversight, and the numerous individuals who contributed to the development of the case vignettes through interviews and discussions. We would also like to thank our reviewers, Advait Deshpande and Susan Guthrie, for their critical and constructive comments on earlier versions of this report during the quality assurance process. 10It is worth noting that the Protocol is still being negotiated, modified and used (Convention on Biological Diversity 2015).12 Interviewees are cited throughout the report using the identifier 'INTXX', where XX is a number between 01 and 10. 13These visionaries included the former foreign minister, Toomas Hendrik Ilves, and the former prime minister, Mart Laar (Runnel, Pruulmann and Reinsalu 2009). 14These websites were established to act as democratic forums where legislation could be proposed and discussed. 15Improving ICT-related skills through education has been a long-term oversight activity. The Information Technology Foundation for Education (known as HITSA), a non-profit association established jointly by the Republic of Estonia,

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