Nonadherence to inhaled medication leads to poor asthma control and increased healthcare utilisation. Many studies exploring adherence determinants have been conducted, but summaries of the evidence are scarce. We performed a systematic review of observational research on determinants of asthma inhaler adherence among adults.We searched for articles in English reporting quantitative observational studies on inhaler adherence correlates among adults in developed countries, published in EMBASE, Medline, PsychInfo and PsychArticles in 1990–2014. Two coders independently assessed eligibility and extracted data, and assessed study quality. Results were summarised qualitatively into social and economic, and healthcare-, therapy-, condition- and patient-related factors.The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs, and possibly older age. There was limited evidence on the relevance of other determinants, partly due to study heterogeneity regarding the types of determinants examined. Methodological quality varied considerably and studies performed generally poorly on their definitions of variables and measures, risk of bias, sample size and data analysis.A broader adoption of common methodological standards and health behaviour theories is needed before cumulative science on the determinants of adherence to asthma inhalers among adults can develop further.

Objective: To compare the efficacy of low-frequency low-intensity electrotherapy and manual lymphatic drainage in the treatment of chronic upper limb breast cancer-related lymphoedema. Design: Cross-over single-blind random clinical trial. Setting: Rehabilitation service. Participants: Thirty-six women with chronic upper limb breast cancer-related lymphoedema. Methods: Patients were randomized to undergo 10 sessions of manual lymphatic drainage followed by 10 sessions of low-frequency low-intensity electrotherapy or to undergo first low-frequency low-intensity electrotherapy followed by manual lymphatic drainage. There was a month of washout time between treatments. Each patient was examined just before and after each treatment. Researchers and outcome assessors were blinded for assigned treatment. Measures: Outcomes were lymphoedema volume, pain, heaviness and tightness, and health-related quality of life measured with the Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer version 4 (FACT-B+4). Carry-over, period and treatment effects were analysed. Treatment effect was assessed using paired t-test. Results: Thirty patients finalized treatment. Comparing the changes in low-frequency low-intensity electrotherapy with manual lymphatic drainage changes, there were no significant differences. Low-frequency low-intensity electrotherapy did not reduce lymphoedema volume (mean of change = 19.77 mL, P = 0.36), but significant reductions were observed in pain, heaviness and tightness (mean of change = 13.1, 16.2 and 6.4 mm, respectively), and FACT-B+4 summaries improved significantly (Trial Outcome Index mean of change = 5.4, P = 0.015). Manual lymphatic drainage showed no significant changes in any of the outcomes Conclusion: Although there are no significant differences between treatment changes, the observed trend towards a better health-related quality of life is remarkable in low-frequency low-intensity electrotherapy.

Background: Chronic wounds give rise to major costs and resource consumption in health care systems, due to their protracted healing time. Incidence and prevalence data are scarce or nonexistent in community settings. Objective: The aim of the present epidemiological study was to analyse and determine the prevalence of chronic wounds in the community in the south of the province of Barcelona (Spain). Design: A cross-sectional, multicentre secondary data analysis study was conducted in the community (excluding nursing homes) in Barcelona between 16 April and 13 June 2013. It included 52 primary care centres that serve a total population of 1,217,564 inhabitants. Results: The observed prevalence was 0.11%. Venous ulcers presented the highest prevalence, at 0.04%, followed by pressure injuries, at 0.03%. The >74 age group presented the highest frequency of chronic wounds, accounting for 69.4% of cases. Conclusion: The results obtained are consistent with those reported in previous similar studies conducted in Spain and elsewhere. As with most studies that adjusted their variables for age and sex, we found that the prevalence of ulcers increased with age and was higher in women, except in the case of diabetic foot ulcers and ischaemic ulcers, which were more frequent in men.