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Many people living with dementia experience sleep disturbance and there are no known effective treatments. Non-pharmacological treatment options should be the first-line sleep management. For family carers, relatives’ sleep disturbance leads to interruption of their sleep, low mood and breakdown of care. Our team developed and delivered DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non-pharmacological intervention, showing it to be feasible and acceptable. The aim of this randomised controlled trial is to establish whether DREAMS START is clinically cost-effective in reducing sleep disturbances in people living with dementia living at home compared with usual care.
We will recruit 370 participant dyads (people living with dementia and family carers) from memory services, community mental health teams and the Join Dementia Research Website in England. Those meeting inclusion criteria will be randomised (1:1) either to DREAMS START or to usual treatment. DREAMS START is a six-session (1 hour/session), manualised intervention delivered every 1–2 weeks by supervised, non-clinically trained graduates. Outcomes will be collected at baseline, 4 months and 8 months with the primary outcome being the Sleep Disorders Inventory score at 8 months. Secondary outcomes for the person with dementia (all proxy) include quality of life, daytime sleepiness, neuropsychiatric symptoms and cost-effectiveness. Secondary outcomes for the family carer include quality of life, sleep disturbance, mood, burden and service use and caring/work activity. Analyses will be intention-to-treat and we will conduct a process evaluation.
London—Camden & Kings Cross Ethics Committee (20/LO/0894) approved the study. We will disseminate our findings in high-impact peer-reviewed journals and at national and international conferences. This research has the potential to improve sleep and quality of life for people living with dementia and their carers, in a feasible and scalable intervention.
Complex, chronic or hard-to-heal wounds are a prevalent health problem worldwide, with significant physical, psychological and social consequences. This study aims to identify factors associated with the healing process of these wounds and develop a mobile application for wound care that incorporates these factors. A prospective multicentre cohort study was conducted in nine health units in Portugal, involving data collection through a mobile application by nurses from April to October 2022. The study followed 46 patients with 57 wounds for up to 5 weeks, conducting six evaluations. Healing time was the main outcome measure, analysed using the Mann–Whitney test and three Cox regression models to calculate risk ratios. The study sample comprised various wound types, with pressure ulcers being the most common (61.4%), followed by venous leg ulcers (17.5%) and diabetic foot ulcers (8.8%). Factors that were found to impair the wound healing process included chronic kidney disease (U = 13.50; p = 0.046), obesity (U = 18.0; p = 0.021), non-adherence to treatment (U = 1.0; p = 0.029) and interference of the wound with daily routines (U = 11.0; p = 0.028). Risk factors for delayed healing over time were identified as bone involvement (RR 3.91; p < 0.001), presence of odour (RR 3.36; p = 0.007), presence of neuropathy (RR 2.49; p = 0.002), use of anti-inflammatory drugs (RR 2.45; p = 0.011), stalled wound (RR 2.26; p = 0.022), greater width (RR 2.03; p = 0.002), greater depth (RR 1.72; p = 0.036) and a high score on the healing scale (RR 1.21; p = 0.001). Integrating the identified risk factors for delayed healing into the assessment of patients and incorporating them into a mobile application can enhance decision-making in wound care.
El propósito del estudio fue comprender las configuraciones socioculturales sobre las enfermedades construidas por un grupo de campesinos en el Departamento de Córdoba, Colombia, mediante un diseño micro etnográfico y la aplicación de entrevistas semiestructuradas, conversaciones y observaciones a 20 miembros de la comunidad, entre octubre de 2020 y marzo de 2021. Las entrevistas fueron transcritas, organizadas en matrices y procesadas para su posterior organización, categorización y análisis con apoyo de la técnica de Bardin. Se develan dos construcciones para concebir la enfermedad: estar enfermo es no poder trabajar y estar enfermo es intranquilidad y angustia; ambas configuraciones se construyen a partir del vínculo con las oportunidades para trabajar y realizar acciones de la vida cotidiana, pero están permeadas por el déficit en la prestación del servicio de salud y las dificultades para acceder a este. Se concluye que la configuración sociocultural de las enfermedades supera la visión de desequilibrio físico del individuo al enunciarse en el ámbito de las prácticas cotidianas, los modos de vivir y las redes de solidaridad tejidas por los campesinos como estrategia de resistencia ante el olvido estatal y la ineficacia de los abordajes del sector salud en zonas rurales colombianas.
Sr. Director: El Reglamento Sanitario Internacional (2005) exponía que las amenazas para la salud pública internacional en el siglo XXI se centraban en 7 campos: enfermedades epidemiógenas, enfermedades transmitidas por los alimentos, brotes accidentales, brotes intencionados, accidentes por sustancias químicas tóxicas, accidentes radio nucleares y desastres ambientales [Fragmento de texto].
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