The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce-randomised controlled trial.

BACKGROUND: Large-scale trials of multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aim to determine if a lower intensity, personally tailored secondary dementia prevention programme for older people with subjective or mild objective memory decline, informed by behaviour change theory, reduces cognitive decline over 2 years. METHODS: A multi-site, single-blind randomised controlled trial recruiting 704 older adults at high dementia risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Participants are randomised using 1:1 allocation ratio to the APPLE Tree intervention versus control arm (dementia prevention information), stratified by site. The intervention explores and implements strategies to promote healthy lifestyle, increase pleasurable activities and social connections and improve long-term condition self-management. Two facilitators trained and supervised by a clinical psychologist deliver ten, 1-h group video call sessions over 6 months (approximately every fortnight), video-call 'tea breaks' (less structured, facilitated social sessions) in intervening weeks and individual goal-setting phone calls every 2 weeks. From 6 to 12 months, participants meet monthly for 'tea breaks', with those not attending receiving monthly goal-setting phone calls. Participants receive a food delivery, pedometer and website access to cognitive training and information about lifestyle modification. Follow-ups for all outcome measures are at 12 and 24 months. The primary outcome is cognition (Neuropsychological Test Battery (NTB) score) at 24 months. Secondary outcomes are quality of life, cost per quality-adjusted life year (QALY) and wellbeing and lifestyle factors the intervention targets (diet, vascular risk, body weight, activity, sleep, anxiety, depression, social networks and loneliness, alcohol intake and smoking). Participants from purposively selected sites participate in qualitative process evaluation interviews, which will be analysed using thematic analytic methods. DISCUSSION: If effective, the intervention design, involving remote delivery and non-clinical facilitators, would facilitate intervention roll-out to older people with memory concerns. TRIAL REGISTRATION: ISRCTN17325135 . Registration date 27 November 2019.

Newborn in the Pediatric Emergency Department: A Reality During the COVID-19 Pandemic

Introduction: We aimed to characterize newborns admitted to the pediatric emergency department in the first months of the coronavirus disease 2019 (COVID-19) pandemic. Methods: We conducted a retrospective observational study regarding newborns who presented to the pediatric emergency department during the pandemic period in comparison with the same period of the previous year. Data gathered concerning the neonatal characteristics included the length of postpartum stay in the nursery, age at presentation to the pediatric emergency department, source of referral to the pediatric emergency department, presenting complaint, need for complementary exams, diagnosis, final destination, and hospital readmission. Results: The number of births was 591 in the pandemic period and 709 in the homologous period. We analyzed 72 pediatric emergency department admissions in the pandemic period and 123 pediatric emergency department admissions in the homologous period. During the pandemic period, there was a decreased rate of neonatal admissions to the pediatric emergency department, but not as pronounced as for the total number of children. We found an increased rate of patients visiting the pediatric emergency department and without disease during the first 2 weeks of life. There were higher referral rates to the pediatric emergency department and to an ambulatory pediatrics appointment. No differences were found concerning the presenting complaints, need for complementary exams, diagnoses, and admission rates. Discussion: Although there was a decreased rate of neonatal admissions during the pandemic period, it was not as pronounced as for the total number of children, denotating a greater need to attend to the pediatric emergency department compared to the other age categories. The reduced access to primary care during the pandemic period and the decreased time of parental education in the nursery might have contributed to these findings. © Author(s) (or their employer(s)) and Portuguese Journal of Pediatrics 2022.