The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.

We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.

Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.

Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.

The COVID-19 pandemic has affected the continuity of cognitive rehabilitation (CR) worldwide. However, the use of teleneuropsychology (TNP) to provide CR has contributed significantly to the continuity of treatment. The objective of this study was to measure the effects of CR via the TNP on cognition, neuropsychiatric symptoms, and memory strategies in a cohort of patients with Mild Cognitive Impairment (MCI).

A sample of 60 patients (60% female; age: 72.4±6.96) with MCI according to Petersen criteria was randomly divided into two groups: 30 cases (treatment group) and 30 controls (waiting list group). Subjects were matched for age, sex, and MMSE or MoCA.

The treatment group received ten weekly CR sessions of 45 minutes weekly. Pre-treatment (week 0) and post-treatment (week 10) measures were assessed for both groups. Different Linear Mixed Models were estimated to test treatment effect (CR vs. Controls) on each outcome of interest over Time (Pre/Post), controlling for Diagnosis, Age, Sex, and MMSE/MoCA performance.

A significant Group (Control/Treatment) x Time (pre/post) interaction revealed that the treatment group at 10 weeks had better scores in cognitive variables: memory (RAVLT learning trials p=0.030; RAVLT delayed recall p=0.029), phonological fluency(p=0.001), activities of daily living (FAQ p=0.001), satisfaction with memory performance (MMQ Satisfaction p=0.004) and use of memory strategies (MMQ Strategy p=0.00), and a significant reduction of affective symptomatology: depression (GDS p=0.00), neuropsychiatric symptoms (NPIQ p=0.045), Forgetfulness (EDO-10 p=0.00), Stress (DAS Stress p=0.00).

This is the first study to test CR using teleNP in South America. Our results suggest that CR through teleNP is an effective intervention to improve performance on cognitive variables and reduce neuropsychiatric symptomatology compared to patients with MCI. These results have great significance in the context of the COVID-19 pandemic in South America, where teleNP is proving to be a valuable tool.

The objective of this study is to explore the impact on the mental health of caregivers of people with dementia during the period of mandatory preventive social isolation (ASPO) and to study which of these factors were predictors of caregiver overload.

During the first 3 months of the ASPO (June 2020 to september 2020). A sample of 112 caregivers (75.89% female; age 58.65 ± 14. 30) of patients with dementia from a Memory Center answered, remotely (online or telephone) a survey with the following questionnaires: the Zarit Caregiver Overload Scale (ZBI), Weekly hourly load dedicated to the care of patients with dementia), the use of time in unpaid activities through an activity diary, provided by Argentine National Institute of Statistics and Census (INDEC), the Caregiver Activities Survey (CAS) and the Anxiety, Depression and Stress Scale (DASS-21). These questionnaires evaluate the conditions and characteristics of caregiving tasks and their impact on the caregiver in the context of ASPO. Additionally, it was recorded whether the person with dementia, the caregiver, or persons living with them had had COVID-19.

Descriptively, a disparity in frequency was observed in the gender of caregivers of persons with dementia, i.e., caregiving is inequitably distributed between men (24.11%) and women (75.89%). This difference hinders direct comparison between men and women. A regularized L2 regression was performed for the identification of predictors of caregiver overload identifying the number of caregiving hours (β=0.090), DAS depression (β=0.085), DASS anxiety (β=0.099) DASS stress (β=0.164), fear of Covid (0.141) and lower patient cognitive performance according to MMSE (β=-0.41) and to lesser extent sex as the greatest contributors to patient overload. Additionally, a mediation analysis was performed in which the factors number of caregiving hours (CAS; r= 0.254,r= 0.292,r= 0.252,r= 0.252,r= -0.37), being a primary caregiver and fear of Covid-19 (r= 0.335,r= 0.432,r= 0.402,r= -0.496) were found to be mediators of the effect between anxiety, depression, stress (DASS) and overload (ZBI).

Caregivers of patients with dementia have suffered sequelae such as anxiety, stress, depression, and overload (caregivers’ burden) in the context of the COVID-19 virus spread and during mandatory preventive social isolation. Being a primary caregiver, dedicating more hours to caregiving, and fear of Covid-19 are factors that contribute significantly to caregiver burden and mediate between this burden and mood variables. Public policies to support caregivers and information about the disease could modify these variables and reduce caregiver burden.

Craft Story 21 is a practical, comprehensive, and freely available tool to assess logical memory in patients with memory impairment. Currently, the test does not have normative values in Spanish that adjust to our specific population. Furthermore, the original test does not have a recognition phase to increase the specificity of the memory profile by allowing a distinction between different amnesic profiles. Therefore, this study has two main aims: 1) the generation of normative data for the Craft Story 21 memory test, adjusting to the characteristics of our Spanish-speaking country according to sex, age, and educational level; and 2) the design and validation of the recognition phase of the test and the assessment of its psychometric properties.

The baremization sample comprised 81 healthy participants aged 41 to 91, assessed through the Uniform Data Set III (UDS III) battery of the National Alzheimer’s Coordinating Center (NACC). The design of the recognition phase included three steps: (1) construction of the scale and review by experts, (2) pilot study, and (3) analysis of its psychometric properties. In the latter, 190 participants were recruited and classified into two groups matched by age, sex, and educational level: Mild Cognitive Impairment (MCI n=96) according to Petersen’s (1999) criteria and healthy controls (HC n=94). In addition, the diagnostic accuracy of the test was studied by the ROC curve method, its concurrent validity by correlation with other memory tests (RAVLT), and its internal consistency with Cronbach’s alpha test.

The Baremization sample was divided into 16 groups: 4 age groups (41-51, 51-61, 6171 and >72 years), two educational levels (6-12 years and >12 years), and sex (male and female). Performance was significantly different between age groups (p < 0.003**). No significant differences were found in Craft Story 21 performance between education (p > 0.09) or sex (p > 0.56) groups within the same age group. Normative values in terms of means and standard deviations are presented for each group. Regarding the design of the recognition phase, the groups did not show significant differences in age (p= 0.13), sex (p= 0.88), or schooling (p= 0.33). The overall score of Craft Story 21 test showed the ability to discriminate between healthy controls from patients with MCI (sensitivity = 81.6% and specificity = 72.4%). Its diagnostic accuracy by phase (immediate AUC= 0.86; delayed AUC= 0.86 and recognition AUC= 0.75) was superior than Rey Auditory and Verbal Learning Test (RAVLT): immediate (AUC= 0.79), delayed (AUC= 0.82) and recognition (AUC= 0.74). It presented evidence of concurrent validity with RAVLT in its immediate (r=0.56, p<0.001), delayed (r= 0.66, p<0.001) and recognition (r= 0.37, p<0.001) trails. The instrument also presented evidence of reliability (a= 0.82).

The Craft Story 21 test is a practical, brief and multicultural scale. Thus having appropriate scales for the specific population to be assessed to a more accurate and precise description of the memory profile. Additionally, the new Recognition phase of the test showed evidence of validity and reliability for assessing memory processes.

Most psychiatric disorders are associated with several risk factors, but a few underlying psychopathological dimensions account for the common co-occurrence of disorders. If these underlying psychopathological dimensions mediate associations of the risk factors with psychiatric disorders, it would support a trans-diagnostic orientation to etiological research and treatment development.

An analysis was performed of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), a US nationally representative sample of non-institutionalized civilian adults, focusing on respondents who were aged ⩾21 (n = 34 712). Structural equation modeling was used to identify the psychopathological dimensions underlying psychiatric disorders; to examine associations between risk factors, psychopathological dimensions and individual disorders; and to test whether associations of risk factors occurring earlier in life were mediated by risk factors occurring later in life.

A bifactor model of 13 axis I disorders provided a good fit (CFI = 0.987, TLI = 0.982, and RMSEA = 0.011) including an overall psychopathology factor as measured by all 13 disorders and 2 specific factors, one for externalizing disorders and one for fear-related disorders. A substantial proportion of the total effects of the risk factors occurring early in life were indirectly mediated through factors occurring later in life. All risk factors showed a significant total effect on the general psychopathology, externalizing and fear-related factors. Only 23 of 325 direct associations of risk factors with psychiatric disorders achieved statistical significance.

Most risk factors for psychiatric disorders are mediated through broad psychopathological dimensions. The central role of these dimensions supports trans-diagnostic etiological and intervention research.

We summarize some of the past year's most important findings within climate change-related research. New research has improved our understanding about the remaining options to achieve the Paris Agreement goals, through overcoming political barriers to carbon pricing, taking into account non-CO2 factors, a well-designed implementation of demand-side and nature-based solutions, resilience building of ecosystems and the recognition that climate change mitigation costs can be justified by benefits to the health of humans and nature alone. We consider new insights about what to expect if we fail to include a new dimension of fire extremes and the prospect of cascading climate tipping elements.

A synthesis is made of 10 topics within climate research, where there have been significant advances since January 2020. The insights are based on input from an international open call with broad disciplinary scope. Findings include: (1) the options to still keep global warming below 1.5 °C; (2) the impact of non-CO2 factors in global warming; (3) a new dimension of fire extremes forced by climate change; (4) the increasing pressure on interconnected climate tipping elements; (5) the dimensions of climate justice; (6) political challenges impeding the effectiveness of carbon pricing; (7) demand-side solutions as vehicles of climate mitigation; (8) the potentials and caveats of nature-based solutions; (9) how building resilience of marine ecosystems is possible; and (10) that the costs of climate change mitigation policies can be more than justified by the benefits to the health of humans and nature.

How do we limit global warming to 1.5 °C and why is it crucial? See highlights of latest climate science.

Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls.

We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments.

Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology.

Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low- and middle-income countries.

Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear.

We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed.

This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model.

A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (P = 0.006). Controls showed a positive correlation between total grey matter volume and income (R = 0.14, P = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (R = −0.076, P = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.

Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.

Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time.

We used national register data from Chile including all people, 10–65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20–F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest.

We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18–39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7–19.1]. Multilevel Poisson regression identified a strong age–sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0–59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4–30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed.

Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.

The most effective rehabilitation model for job (re-)entry of people with mental illness is supported employment. A barrier to introducing supported employment into standard care is its temporally unlimited provision, which conflicts with health and social legislation in many European countries.

To test the impact of different ‘placement budgets’, i.e. a predefined maximum time budget for job seeking until take-up of competitive employment.

Participants (116) were randomly assigned to 25 h, 40 h or 55 h placement budgets in an intent-to-treat analysis. We applied the individual placement and support model over 24 months, following participants for 36 months. Primary outcome was employment in the labour market for at least 3 months.

The proportion of participants obtaining competitive employment was 55.1% in the 25 h group, 37.8% in the 40 h group and 35.8% in the 55 h group. In a Cox regression analysis, time to employment was slightly lower in the 25 h group relative to the 40 h (hazard ratio 1.78, 95% CI 0.88–3.57, P = 0.107) and 55 h groups (hazard ratio 1.74, 95% CI 0.86–3.49, P = 0.122), but this was not statistically significant. The vast majority of all participants who found a job did so within the first 12 months (80.4%).

A restricted time budget for job finding and placement does not affect the rate of successful employment. In accordance with legislation, a restriction of care provision seems justified and enhances the chances of supported employment being introduced in statutory services.