Internet-based interventions for family carers of people with dementia

There is an urgent global need for accessible, usable, effective and scalable skills training and support programs for carers of people with dementia, particularly in LMICs. WHO's iSupport is filling this gap by providing such a program, accessible for translation and cultural adaptation worldwide. First steps have been undertaken to support the systematic and culturally fair translation and adaptation of the program in several countries. However, while web-based or online programs for dementia carers such as iSupport seem to be promising, the scaling of these programs remains challenging and is a common issue for digital health solutions. In fact, the findings of a first efficacy study from India highlight the need to understand carers' individual situation better and tailor support programs even more to their specific needs. Going forward, iSupport could be improved by adding a mobile phone application to offer more flexibility to users, including an interactive or moderated chat function or more audio-visual materials to the online program to increase its appeal. To assist carers who wish to use more traditional ways of learning, WHO has released the iSupport hardcopy manual, which presents the entire iSupport content in book format. Further robust cultural adaptations and high-quality research investigating the effectiveness of iSupport across different settings and for different groups of carers are required. Finally, in the context of the ongoing COVID-19 pandemic, digital support services such as iSupport are more important than ever and present a real opportunity to build back better, which will help to reach the global target set by WHO that 75% of countries will provide support and training programs for carers and families of people with dementia by 2025. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review.

BACKGROUND: The COVID-19 pandemic leads to disruptions of health services worldwide. To evaluate the particular impact on neurological services a rapid review was conducted. METHODS: Studies reporting the provision of neurological services during the pandemic and/or adopted mitigation strategies were included in this review. PubMed and World Health Organization's (WHO) COVID-19 database were searched. Data extraction followed categories used by WHO COVID-19 pulse surveys and operational guidelines on maintaining essential health services during COVID-19. FINDINGS: The search yielded 1101 articles, of which 369 fulfilled eligibility criteria, describing data from 210,419 participants, being adults (81%), children (11.4%) or both (7.3%). Included articles reported data from 105 countries and territories covering all WHO regions and World Bank income levels (low income: 1.9%, lower middle: 24.7%, upper middle: 29.5% and high income; 44.8%). Cross-sectoral services for neurological disorders were most frequently disrupted (62.9%), followed by emergency/acute care (47.1%). The degree of disruption was at least moderate for 75% of studies. Travel restrictions due to lockdowns (81.7%) and regulatory closure of services (65.4%) were the most commonly reported causes of disruption. Authors most frequently described telemedicine (82.1%) and novel dispensing approaches for medicines (51.8%) as mitigation strategies. Evidence for the effectiveness of these measures is largely missing. INTERPRETATION: The COVID-19 pandemic affects all aspects of neurological care. Given the worldwide prevalence of neurological disorders and the potential long-term neurological consequences of COVID-19, service disruptions are devastating. Different strategies such as telemedicine might mitigate the negative effects of the pandemic, but their efficacy and acceptability remain to be seen.