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Purpose: Medication adherence is a multi-faceted construct associated with several positive consequences in people with chronic conditions. However, non-adherence currently represents a major issue in Parkinson’s, potentially due to low perceptions of control. This study investigated the predictive ability of several aspects of perceived control on adherence in people with Parkinson’s, while accounting for previously established predictors such as depression and medication variables. Materials and Methods: An online cross-sectional survey was carried out with 1210 adults with Parkinson’s from 15 English-speaking countries. Demographic and clinical questions, as well as measures of depression, aspects of perceived control, and medication adherence were included. Pearson’s correlations and a 4-block hierarchical regression analysis were performed to assess the relationship between the variables. Results: Perceived control explained a slightly higher amount of variance in medication adherence compared to medication variables when entered in the last block. Unexpectedly, depression was not significantly related with adherence. Internal locus of control was an independent negative predictor of adherence, while external dimensions of locus of control emerged as independent positive predictors. Conclusions: In people with Parkinson’s, perceptions of control may have a larger impact on adherence compared to medication variables. Implications for clinical practice and future research are discussed. Implications for Rehabilitation: - Perceived control and depression are considered important constructs for medication adherence in Parkinson’s, which in turn is often problematic for affected individuals. - The specific predictive value of different aspects of perceived control on medication adherence in Parkinson’s is currently unclear. - This large-scale study found that perceptions of control may have a larger impact on adherence compared to medication variables, while depression was unrelated to it. - A need for psychologically-informed interventions, person-centred approaches to medication management, and Parkinson-specific measures of adherence are highlighted.

Perceived control is an important construct for the psychological well-being of people affected by chronic conditions, and higher perceived control is associated with better outcomes. Psychosocial interventions have been trialled in these populations to improve both global and specific perceptions of control. However, most interventions involving people with Parkinson’s have focused on single-domain forms of control, while those addressing global perceived control are yet to be reviewed. This study aimed to identify and map the types of psychosocial interventions in individuals with Parkinson’s which have included forms of global perceived control as an outcome.

This is a scoping review protocol that aims to identify factors that impact or are associated with cultural competence in health and social care personnel.

Patients’ experiences of their diagnosis, condition, and treatment (including the impact on their lives), and their experiences surrounding expectations of care, are becoming increasingly important in shaping healthcare systems that meet the evolving needs and priorities of different patient communities over time; this is an ongoing goal of all healthcare stakeholders. Current approaches that capture patient experiences with data are fragmented, resulting in duplication of effort, numerous requests for information, and increased patient burden. Application of patient experience data to inform healthcare decisions is still emerging and there remains an opportunity to align diverse stakeholders on the value of these data to strengthen healthcare systems. Given the collective value of understanding patient experiences across multiple stakeholder groups, we propose a more aligned approach to the collection of patient experience data. This approach is built on the principle that the patients’ experiences are the starting point, and not just something to be considered at the end of the process. It must also be based on meaningful patient engagement, where patients are collaborators and decision makers at each step, thereby ensuring their needs and priorities are accurately reflected. The resulting data and evidence should be made available for all stakeholders, to inform their decision making and healthcare strategies in ways that meet patient priorities. We call for multi-stakeholder collaboration that will deliver healthcare systems and interventions that are better centered around and tailored to patient experiences, and that will help address patients’ unmet needs.

Background non-motor symptoms such as bladder dysfunction are common (80%) in people with Parkinson’s increasing the risk for falls with a negative impact on health-related costs and quality of life. We undertook STARTUP to evaluate the clinical and cost-effectiveness of using an adhesive electrode to stimulate the transcutaneous tibial nerve stimulation (TTNS) to treat bladder dysfunction in people with Parkinson’s disease (PD). Study design, materials and methods: STARTUP was a parallel two-arm, multi-centre, pragmatic, double-blind, randomised controlled trial. Each participant attended one clinic visit to complete consent, be randomised using a computer-generated system and to be shown how to use the device. The trial had two co-primary outcome measures: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Prostate Symptom Score (IPSS). These were completed at baseline, 6 and 12 weeks. A bladder frequency chart and resource questionnaire were also completed. Results two hundred forty two participants were randomised. About 59% of participants were male, the mean age was 69 years and mean time since diagnosis was 6 years. Questionnaire return rate was between 79 and 90%. There was a statistically significantly lower score in the active group at 6 weeks in the IPSS questionnaire (mean difference (Standard deviation, SD) 12.5 (6.5) vs 10.9 (5.5), effect size −1.49, 95% CI −2.72, −0.25). There was no statistically significant change in any other outcome. Conclusion TTNS was demonstrated to be safe with a high level of compliance. There was a significant change in one of the co-primary outcome measures at the end of the treatment period (i.e. 6 weeks), which could indicate a benefit. Further fully powered RCTs are required to determine effective treatments.

The development of novel therapies for Alzheimer’s Disease (AD) is constrained by the lack of available methods for preclinical diagnosis, despite extensive research on biomarker identification. He ...

Background Annual health checks are recommended for people with severe mental illness, as they are at high risk of cardiovascular disease. We trained practice nurses from six primary care centres in Northampton, in the UK, how to deliver health checks for this population. Aims The purpose of this study was to examine patients' views about the physical health check delivered by a nurse trained in the Northampton Physical Health and Wellbeing (PhyHWell) project. Method We interviewed five patients from three primary care centres using a topic guide. Results From a total of 29 patients who were invited, five attended. They had a good understanding of the importance of a healthy diet and taking regular exercise, but did not appear to be aware of the risk of cardiovascular disease. Being treated consistently by the same healthcare professional and/or by a nurse was cited as a helpful factor in managing their physical health. Most of the patients were glad to be invited for a health check and thought that it was worthwhile. They would have liked more information about blood tests and medication. All of the patients reported that they had started to make changes to their lifestyle since the health check. Recommendations Training for practice nurses to provide physical health checks for people with severe mental illness should emphasise the patients' views of what will make them effective.

Levodopa initially provides good symptomatic control of the symptoms of Parkinson's disease, but motor complications often develop after long-term use. Other classes of antiparkinsonian drugs including dopamine agonists, catechol-O-methyl transferase inhibitors, or monoamine oxidase type B inhibitors are then added as adjuvant therapy. It is unclear whether one class of drug is more effective than another. This meta-analysis evaluates the comparative benefits and risks of these agents as adjuvant treatment in Parkinson's disease patients with motor complications.A systematic review of the literature from 1966 to the end of June 2010 was conducted to identify randomized trials involving a dopamine agonist, catechol-O-methyl transferase inhibitor, or monoamine oxidase type B inhibitor versus placebo, as adjuvant to levodopa therapy.Forty-five trials involving nearly 9,000 participants were included. The meta-analysis confirms reports from individual trials that compared with placebo, adjuvant therapy significantly reduces patient off-time and levodopa dose, with improved symptom severity scores (e.g., Unified Parkinson's Disease Rating Scale). However, dyskinesia and numerous other side effects are increased with adjuvant therapy. Few randomized comparisons between drugs have been undertaken, but indirect comparisons suggest that dopamine agonist therapy may be more effective than catechol-O-methyl transferase inhibitor and monoamine oxidase type B inhibitor therapy, which have comparable efficacy. No differences between drugs within each class were observed other than the catechol-O-methyl transferase inhibitor tolcapone appearing more efficacious than entacapone.This meta-analysis highlights the need for direct head-to-head randomized trials to assess the impact of adjuvant therapy on patient-rated quality of life and health economic outcomes.

To identify antigens of Chlamydia trachomatis recognized by synovial T cell clones from patients with reactive arthritis (ReA).C. trachomatis specific T cell clones were isolated from synovial fluid of 2 patients with chlamydia induced ReA. The particular antigens/epitopes recognized by these clones were identified using T cell immunoblotting and testing recombinant chlamydial proteins and synthetic peptides.Two sets of clones were shown by immunoblotting to recognize antigens of roughly 60 and 18 kilodaltons (kDa) respectively. By testing recombinant chlamydial proteins these antigens were identified as the 57 kDa heat shock protein and the 18 kDa histone-like protein, Hc1. Mapping the epitope in Hc1 using synthetic peptides identified a peptide containing a sequence motif compatible with binding to HLA-DR1, the restricting antigen for the Hc1 specific clones.These are the first 2 chlamydial antigens to be identified as targets of the synovial T cell response in chlamydia induced ReA. Both have properties that are shared with target antigens identified in ReA induced by enteric infection and relevant to the pathogenesis of joint inflammation.