Medication adherence across the lifespan: Theory, methods, interventions and six grand challenges

First paragraph: Taking medication as agreed with a health care provider ‘i.e. adherence’, is a critically important health behaviour throughout life for both the prevention and treatment of illness and the maintenance of health (Osterberg & Blaschke, 2005). From childhood use of antibiotics (Baguley, Lim, Bevan, Pallet, & Faust, 2012), to early adulthood use 15 of oral contraceptives (Molloy, Graham, & McGuinness, 2012) to older adulthood use of cardiovascular risk reduction medications (O’Carroll, Chambers, Dennis, Sudlow, & Johnston, 2014), evidence-based treatments such as these can have profound impact on health across the lifespan. Variability in the initiation, execution and persistence of med- ication taking behaviour plays a significant role in explaining the difference between 20 the trial-based efficacy and ‘real-world’ effectiveness for many medications (Blaschke, Osterberg, Vrijens, & Urquhart, 2012). Medication adherence has therefore been the focus of systematic investigation for several decades by both behavioural and clinical scientists (DiMatteo, 2004).Output Type: Editoria

Couple-based psychosexual support following prostate cancer surgery: results of a feasibility pilot randomized control trial

Surgery for prostate cancer can result in distressing side effects such as sexual difficulties, which are associated with lower levels of dyadic functioning. The study developed and tested an intervention to address sexual, relational, and emotional aspects of the relationship after prostate cancer by incorporating elements of family systems theory and sex therapy

Couple-based psychosexual support following prostate cancer surgery: Results of a feasibility pilot randomized control trial

Introduction: Surgery for prostate cancer can result in distressing side effects such as sexual difficulties, which are associated with lower levels of dyadic functioning. The study developed and tested an intervention to address sexual, relational, and emotional aspects of the relationship after prostate cancer by incorporating elements of family systems theory and sex therapy. Aims: To develop and test the feasibility and acceptability of relational psychosexual treatment for couples with prostate cancer, determine whether a relational-psychosexual intervention is feasible and acceptable for couples affected by prostate cancer, and determine the parameters for a full-scale trial. Methods: Forty-three couples were recruited for this pilot randomized controlled trial and received a six-session manual-based psychosexual intervention or usual care. Outcomes were measured before, after, and 6 months after the intervention. Acceptability and feasibility were established from recruitment and retention rates and adherence to the manual. Main Outcome Measures: The primary outcome measurement was the sexual bother subdomain of the Expanded Prostate Cancer Index Composite. The Hospital Anxiety and Depression Scale and the 15-item Systemic Clinical Outcome and Routine Evaluation (SCORE-15) were used to measure emotional and relational functioning, respectively. Results: The intervention was feasible and acceptable. The trial achieved adequate recruitment (38%) and retention (74%) rates. The intervention had a clinically and statistically significant effect on sexual bother immediately after the intervention. Small decreases in anxiety and depression were observed for the intervention couples, although these were not statistically significant. Practitioners reported high levels of adherence to the manual. Conclusion: The clinically significant impact on sexual bother and positive feedback on the study's feasibility and acceptability indicate that the intervention should be tested in a multicenter trial. The SCORE-15 lacked specificity for this intervention, and future trials would benefit from a couple-focused measurement

Investigating and evaluating evidence of the behavioural determinants of adherence to social distancing measures – A protocol for a scoping review of COVID-19 research

Background: The WHO has declared the outbreak of coronavirus disease 2019 (COVID-19) as a pandemic. With no vaccine currently available, using behavioural measures to reduce the spread of the virus within the population is an important tool in mitigating the effects of this pandemic. As such, social distancing measures are being implemented globally and have proven an effective tool in slowing the large-scale spread of the virus. Aim: This scoping review will focus on answering key questions about the state of the evidence on the behavioural determinants of adherence to social distancing measures in research on COVID-19. Methods: A scoping review will be conducted in accordance with guidelines for best practice. Literature searches will be conducted using online databases and grey literature sources. Databases will include Medline, Web of Science, Embase and PsycInfo, alongside relevant pre-print servers. Grey literature will be searched on Google Scholar. Screening, data extraction and quality appraisal will be conducted by members of the research team, with any discrepancies resolved by consensus discussion. Quality appraisal will be conducted using the Cochrane’s ROBINS-I tool, the Cochrane Risk of Bias tool, and the JBI Critical Appraisal Checklist where appropriate. Results will be analysed by mapping findings onto the Theoretical Domains Framework and visualising characteristics of the included studies using EviAtlas. This scoping review is pre-registered with Open Science Framework. Conclusions: The results of this study may facilitate the systematic development of behavioural interventions to increase adherence to social distancing measures

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Identification of the Apex of the Medial Longitudinal Arch Break in Progressive Collapsing Foot Disorder

Category: Midfoot/Forefoot Introduction/Purpose: Progressive Collapsing Foot Disorder (PCFD) is caused by failure of both dynamic and static structures. The aim of this study was to identify the anatomical location of the medial longitudinal arch break in symptomatic flat foot deformity and analyze its relationship with Meary's angle. Methods: We analyzed weight-bearing radiographs of 81 patients [mean age 53.7 years (range, 18-81) with 101 flat feet. The apex of the medial arch break was determined on the lateral foot radiographs as the intersection of the anatomical axis of the talus and the first metatarsal. Therefore, the overall centre of rotation of angulation (CORA) of the medial arch break was documented as the angle at its apex (Meary's angle). Each separate joint angulation was then calculated to determine if the overall CORA was made of separate CORAs. Correlations between the apex location, and the number of apices, with Meary's angle were conducted. Results: There was an isolated apex of deformity in 50.4% (51/101) of cases. These were localised at talonavicular joint (TNJ) in 47% (24/51), the naviculocuneiform joint (NCJ) in 52.9% (27/51) and none at the cuneiform-first metatarsal joint (C-1MTJ). The remaining 49.5% (50/101) had combination apices with the primary deformity being at TNJ in 58% (29/50), the NCJ in 40% (20/50), and 2% (1/50) at the C-1MTJ. The mean Meary's angle was -17.9° for isolated and -18° for combination which was not statistically significant (p=0.92). There was no statistical difference in the talonavicular uncoverage angle between the single and combination apices group (p= 0.99). Conclusion: The apex of the medial arch break occurs distal to the talonavicular joint in the majority of cases, and thereby the main insertion points of the posterior tibial tendon and spring ligament. In 52.9% (27/51) of cases, the deformity occurs solely distal to the TNJ and in 58% (29/50) cases, it involves joints in addition to the TNJ. These will involve pathology of other structures, including the naviculocuneiform ligament. Surgical strategies in successfully correcting Progressive Collapsing Foot Disorder will therefore need to address joints distal to the TNJ in the majority of cases. </jats:sec