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Background There is public concern about the potential health effects of exposure to extremely low frequency electromagnetic fields (ELF-EMF) of high-voltage power lines (HVPLs). Some residents living near HVPLs believe ELF-EMF might cause non-specific health complaints. Objectives The present study is the first to prospectively investigate whether self-reported health complaints and causal beliefs increase after the construction of a new power line. Methods We used a quasi-experimental design with two pretests before and two posttests after a new HVPL was put into operation. Residents living near (0–300 m, n =229; 300–500 m, n =489) and farther away (500–2000 m, n =536) participated in the study. Linear mixed models were fitted to test whether symptom reports and beliefs that power lines caused health complaints increased more in residents living close to the new line compared to residents living farther away. Results A significantly ( p <.05) larger increase from baseline in symptom reports and causal beliefs was found in residents living within 300 m from the new power line when compared to residents living farther away. While symptom reports did not differ at baseline, the belief that a power line could cause these symptoms was at baseline already stronger for residents living close compared to residents living farther away. Conclusions We found a negative impact of a new HVPL on health perceptions of nearby residents, even before the line was put into operation. [ABSTRACT FROM AUTHOR]

Poor adherence to combination antiretroviral therapy (ART) is a major global challenge. In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient's level of immunoprotection, in order to improve adherence to ART. We randomized 28 people on ART to either a standard or augmented version of the smartphone application. The augmented version contained components that illustrated participants' current estimated plasma concentrations of antiretroviral drugs and the immune protection provided by ART. Adherence to ART was assessed at baseline and at 3 months using self-reported adherence, pharmacy dispensing records, and HIV viral load. Information was also collected on illness and medication beliefs and use of the application. Participants who received the augmented application showed a significantly higher level of self-reported adherence to ART at 3 months ( p=0.03) and decreased viral load ( p=0.023) as compared to individuals using the standard version. Greater usage of the extra components of the augmented application was associated with greater perceived understanding of HIV infection and increased perceived necessity for ART. Smartphone applications that incorporate personalized health-related visual imagery may have potential to improve adherence to ART. [ABSTRACT FROM AUTHOR]

Objectives Cardiac computed tomography angiography ( CCTA) is a commonly used diagnostic test for coronary artery disease. Despite its considerable clinical value, few studies have explored the psychological value of CCTA from the perspective of patients undergoing testing. This study aimed to investigate the patient-perceived value of diagnostic CCTA testing, specifically in relation to patients' perceptions of their heart health and health behaviours. Design The study used a qualitative methodology incorporating thematic analysis before and after testing. Methods Semi-structured interviews were conducted before and after the receipt of CCTA test results among 13 non-acute patients attending a heart clinic in New Zealand for diagnostic CCTA. Data analysis followed a thematic analysis approach applied at each interview time point. Results Three themes were identified from the pre-diagnostic interviews: expectations that testing would facilitate heart-related understanding; the role of CCTA as an essential requirement for considering the use of cardiac medication; and awareness of the importance of heart-healthy behaviours. Post-diagnostic interview analysis identified four themes: positive psychological responses to cardiac diagnosis; perceived value of viewing scan images; the potential impact of testing on health behaviour intentions; and patients' reflections on the procedure. Conclusions These results suggest that CCTA has the potential to meet knowledge-gaining expectations that patients bring to clinic and may increase motivation of health-protective behaviours. Diagnostic CCTA may therefore provide an ideal opportunity to address patients' illness understanding and behavioural intentions. The effective utilization of scan images as a supplement to consultation may enhance such practice objectives and warrants further investigation. Statement of contribution What is already known on this subject? Cardiac computed tomography angiography ( CCTA) is an advanced diagnostic test that is particularly useful for early diagnosis of coronary artery disease., Cardiac computed tomography angiography is able to produce highly detailed images of the formation and build-up of calcium deposits in coronary vasculature, thus providing a window into an otherwise unseen disease process., Although CCTA is increasingly utilized by clinicians, little is known about its psychological value for cardiac patients undergoing the test., What does this study add? Cardiac computed tomography angiography testing can be a potentially important experience for cardiac patients in understanding their cardiac health., Cardiac computed tomography angiography could provide an opportune time to address patients' health behaviour intentions and treatment beliefs., Effective utilization of CCTA scan images in consultation may help to enhance consultation objectives. [ABSTRACT FROM AUTHOR]

Objectives Adjuvant endocrine therapy for early-stage breast cancer has greatly reduced the morbidity and mortality associated with breast cancer recurrence. Despite this, a significant proportion of women report fears of cancer recurrence. This study examined the associations between fear of cancer recurrence ( Fo R) and illness perceptions, medication beliefs, and treatment side effects in women taking adjuvant endocrine therapy following breast cancer. Methods A total of 153 post-menopausal women with early-stage breast cancer completed a postal survey. Analyses were conducted to examine the association between Fo R and illness perceptions, medication beliefs, treatment side effects, demographic factors, and emotional distress and to identify which of these factors would be most strongly associated with FoR in a regression model. Results All illness perceptions (apart from personal control) were associated with Fo R, as were patient beliefs about endocrine therapy. Although treatment side effects, being unemployed, and higher levels of anxiety and depression were associated with FoR, only illness perceptions (identity, treatment control, timeline, and emotional representation) and medication necessity beliefs were significantly correlated with FoR in the final model. Conclusions It appears that, in addition to directly targeting Fo R, it may be worthwhile to address the illness and medication beliefs supporting the fear. Additionally, helping women to differentiate everyday symptoms from those indicative of breast cancer may help to reduce fear of recurrence. Statement of Contribution What is already known on this subject? A significant proportion of women report fear of cancer recurrence following breast cancer. The literature shows that illness perceptions, side effects of treatment, and beliefs about medicines are related to fear of recurrence among cancer patients. However, because these variables have often been looked at in isolation, it is not clear whether some perceptions or cues are more likely to relate to fear of recurrence than others. What does this study add? This study shows illness perceptions and medication beliefs are strongly related to fears of cancer recurrence. The results point to ways in which the self-regulatory model of illness may be used to reduce patients' fear of recurrence. The study results show that women with higher fear of recurrence may be balancing a tension between believing that they need to take the medication to protect their future health alongside concerns that the treatment may not be working. [ABSTRACT FROM AUTHOR]

Objectives. We report on the development and psychometric properties of a scale to measure perceived sensitivity to medicines (PSM). Design. The internal consistency, test-retest reliability, criterion-related, and predictive validity of the PSM Scale were evaluated using data collected as part of four previously published studies and one unpublished data set. Methods. Participants ( n= 1,166) included patients receiving treatment for HIV infection and hypertension, individuals receiving a travel vaccination, and undergraduate students. Criterion-related validity was assessed by examining associations between the PSM and beliefs about medicines (Beliefs about Medicines Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale). Predictive validity was assessed by examining associations between the PSM and medication adherence and with symptom reports following vaccination. Test-retest reliability was assessed in an undergraduate sample who completed the PSM on two occasions, 2 weeks apart. Results. Test-retest reliability was high ( r= .89, p < .001). Cronbach's alpha ranged from 0.79-0.94. Consistent with expectations, high PSM scores were associated with negative beliefs about medicines in general, strong concerns about potential adverse effects of prescribed medicines, and doubts about the necessity for treatment. High PSM scores predicted non-adherence to anti-retroviral therapy and a higher incidence of symptoms following vaccination. Conclusion. The findings present preliminary evidence that the PSM is a valid and reliable measure of perceived sensitivity to medication. While further work is needed to develop and evaluate the scale, the findings support its use as a research tool in studies of the use and effects of medicines. Statement of contribution What is already known on this subject? It is now well understood that beliefs about medicines have an important influence on whether patients start and continue with treatment. Research spanning a range of long-term conditions and across different countries has shown that treatment uptake and adherence are consistently related to specific beliefs about prescribed medicines, such as how patients judge their personal need relative to concerns about potential adverse effects as well as more general beliefs about medicines as a class of treatment. What does this study add? The paper reports on the development and psychometric properties of a new scale to measure patients' perceptions of their sensitivity to medicines. In five studies involving different groups of individuals we found the Perceived Sensitivity to Medicines (PSM) Scale to be a reliable and valid measure. The PSM may be useful for researchers and clinicians in explaining treatment decisions, adherence and reported side-effects. [ABSTRACT FROM AUTHOR]

Background: Long term serum urate (SU) lowering to a target of <0.36 mmol/l (6 mg/dl) is recommended for effective gout management. However, many studies have reported low achievement of SU targets. The aim of this cross-sectional study was to examine the clinical and psychological factors associated with SU targets in patients with gout. Methods: Patients with gout for <10 years were recruited from primary and secondary care settings. SU target was defined as SU concentration <0.36 mmol/L at the time of the study visit. Both clinical and psychological factors associated with SU target were analysed. The relationship between SU target and measures of gout activity such as flare frequency, tophi, work absences, and Health Assessment Questionnaire-II was also analysed. Results: Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration <0.36 mmol/L. Uratelowering therapy (ULT) use was strongly associated with SU target (p < 0.001). In those patients prescribed ULT (n = 181), allopurinol dose, patient confidence to keep SU under control, female sex, and ethnicity were independently associated with SU target. Other patient psychological measures and health-related behaviours, including adherence scores, were not independently associated with SU target in those taking ULT. Creatinine clearance, diuretic use, age, and body mass index were not associated with SU target. Patients at SU target reported lower gout flare frequency, compared with those not at target (p = 0.03). Conclusions: ULT prescription and dosing are key modifiable factors associated with achieving SU target. These data support interventions focusing on improved use of ULT to optimise outcomes in patients with gout. [ABSTRACT FROM AUTHOR]

Modern health worries (MHW) are concerns related to modern or technological features of daily life (e.g., air pollution, x-rays, food additives, etc.), and have been associated with subjective health complaints (SHC) and health care use. The MHW scale was expected to predict aspects of health status in healthy individuals (e.g., health care visits, health perceptions, and medication use). SHC was thought to mediate the relationship between MHW and health care use. Likewise, negative affect was considered to mediate the relationship between MHW and SHC. University students ( n = 432) completed assessments for MHW, SHC, perceptions of health, medication use, and health care visits. MHW were positively related to the number of subjective health complaints with negative affect partially driving this relationship. MHW were negatively related to reports of present health and medication use. MHW were marginally related, whereas SHC were significantly associated with health care utilization. Concerns over modern technology appear to influence symptom reporting, perceptions of current health, medication use, and, to a degree, visits to health care providers even in young healthy samples. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to examine the influence of patients'' presurgery illness beliefs and cardiac risk factors on health-related outcomes 3 months following cardiac surgery. Methods: In a prospective design, 56 patients undergoing elective cardiac surgery (coronary artery bypass grafting (CABG), heart valve surgery, or a combined procedure) were approached on admission to hospital and reassessed 3 months after surgery. Presurgery assessment included cardiac risk factors and measures of illness severity. Illness beliefs were assessed using the Illness Perception Questionnaire–Revised (IPQ-R). Outcome measures included levels of illness-related disability, physical functioning, psychological well-being, and depressive symptoms. Results: Physical functioning of patients improved 3 months after surgery, while disability and psychological well-being did not change significantly. Cardiac risk factors prior to surgery were unrelated to the outcomes 3 months later. With the use of hierarchical multiple regression analyses, after controlling for demographic variables and baseline scores of outcome variables, patients'' beliefs about their illness predicted disability (adjusted R 2=.350, P<.01), physical functioning (adjusted R 2=.283, P<.01), and depressive symptoms (adjusted R 2=.302, P<.01). Illness severity measures did not mediate the association between illness beliefs and outcomes. Conclusion: Patients'' beliefs about their illness before surgery strongly influence recovery from cardiac surgery. The results suggest that patients could benefit from presurgery cognitive interventions aimed at changing maladaptive illness beliefs to improve physical functioning and disability following cardiac surgery. [Copyright &y& Elsevier]

Abstract: Objective: To further develop and trial a brief in-hospital illness perception intervention for myocardial infarction (MI) patients. Methods: One hundred and three patients admitted with acute MI were randomized to receive either standard care or standard care plus an illness perception intervention, which consisted of three half-hour patient sessions and one half-hour patient-and-spouse session delivered in hospital. Patients were followed up to 6 months. The main outcome was the difference between groups in rate of return to work. Results: The intervention group had a faster rate of return to work than the control group, and more patients in the intervention group had returned to full time work by 3 months than in the control group. At discharge, patients in the intervention group demonstrated changes in causal attributions regarding their MI and higher perceived understanding of their condition, which remained at the 6-month follow-up. They also reported a better understanding of the information given in hospital, higher intentions to attend cardiac rehabilitation classes, lower anxiety about returning to work, greater increases in exercise, and made fewer phone calls to their general practitioner about their heart condition at follow-up. Conclusion: This study replicates the findings of an earlier trial that a brief in-hospital illness perception intervention can change perceptions and improve rates of return to work in MI patients. It increases the generalizability of the intervention to the current broader definition of MI and to patients who have had previous infarcts. [Copyright &y& Elsevier]

Abstract: Objective: To investigate whether a brief in-hospital illness perception intervention for myocardial infarction (MI) patients and their spouses could change spouses'' illness perceptions and reduce spouses'' anxiety about the illness. Methods: Fifty-seven spouses participated in a randomized controlled trial of an illness perception intervention for MI patients. Spouses of patients randomized to the intervention attended one half-hour patient-and-spouse session with a psychologist in addition to standard care. Spouses completed measures of illness perceptions, expectations, and illness anxiety at admission and at 1 week following discharge, and spouses'' illness worry was rated by the patients at 3 months. The main outcome for spouses was differences in anxiety between intervention and control groups. Results: One week following discharge, spouses in the intervention group had higher illness understanding, lower concern, stronger causal attributions to hereditary factors, and fewer questions about their partner''s heart condition compared to the control group. Intervention group spouses reported more positive expectations about the ability of the patient''s heart to recover, and lower perceived likelihood of another MI. They had lower anxiety about the patient doing physical activity and about the patient''s medications, and lower distress about the patient''s symptoms. Spouses in the intervention group were rated as less worried about the illness at 3 months. Conclusion: Spouses of patients represent a new target for illness perception interventions and these results demonstrate that a brief illness perception intervention can change illness perceptions and reduce anxiety about the illness in spouses of MI patients. [Copyright &y& Elsevier]

Abstract: Objective: Coronary angiography is a commonly used diagnostic test for ischemic heart disease. Little is known, however, about how undergoing the procedure impacts on the ways in which individuals perceive their illness. We sought to explore patients'' reactions to an angiogram in terms of changes in symptom appraisal, perceived consequences of their condition, and patients'' illness concern and emotional response to their condition after the receiving diagnostic results. Methods: The Brief IPQ was administered to patients undergoing a diagnostic coronary angiogram (N=57) before and immediately following the procedure. Changes in illness representations were then compared between patients diagnosed with diseased arteries and patients with normal arteries. Results: We found that the number of symptoms patients associated with their condition, illness consequences, and illness emotion decreased for patients receiving normal results but remained unchanged for patients receiving results showing diseased arteries. Illness concern decreased significantly for both patient groups. Conclusions: The results demonstrate that diagnostic results can have clear and immediate effects on how patients'' view and emotionally respond to their symptoms. The results also suggest that patients cognitively prepare themselves to receive an unfavorable diagnosis and the pattern suggests those receiving normal results modify their perceptions in a positive direction rather than those receiving an unfavorable diagnosis. [Copyright &y& Elsevier]

Objectives: We compared the quality of life of patients with acoustic neuroma (AN) with general population controls and other chronic illness patients. We also examined the types and significance of ongoing difficulties reported by AN patients and the types of positive benefits following their surgery. Design: A comparative questionnaire survey. Methods: A research questionnaire was sent to all 119 members of the Acoustic Neuroma Association of New Zealand. Responses were compared with those of matched general population controls and type 2 diabetes, recent angina, and dermatitis patients. Main Outcome Measures: The questionnaire contained the SF-36. a measure of the type of difficulties following surgery, as well as a measure of illness benefits. Results: AN patients reported an impaired quality of life compared with general population controls and other chronic illness groups, but AN patients reported better physical and general health outcomes. Hearing was the most frequent reported difficulty following surgery, and this impacted most on social functioning. The majority of patients named at least one positive outcome from their illness. AN patients who had facial difficulties following surgery were less likely to report positive outcomes. Conclusions: Treatment for AN results in a significant reduction in quality of life for patients. The major effect is in the psychological area, with increased rates of emotional distress and impaired social functioning even in comparison with patients with major illnesses. However, most AN patients do report finding some benefit from thoir illness experience. Patients with facial weakness are at the greatest risk of a poorer psychological outcome. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to evaluate whether the heart drawings of patients with heart failure are associated with their psychological, functional, and clinical status. Methods: Sixty patients with heart failure completed a written questionnaire that included a heart drawing task, measures of psychological functioning, and illness perceptions. Results: Patients drew their heart significantly bigger in height when they depicted their heart with failure as compared with how they depicted their heart before their heart failure. Greater levels of heart-specific anxiety were associated with significantly larger drawings as measured by height and overall area. Compared with those who drew no damage, patients who drew damage had significantly higher levels of depression and more negative beliefs about their illness. Drawings also had a significant relationship with the clinical markers of illness severity, B-type natriuretic peptide level, and sodium level. Conclusions: Heart drawings of patients with heart failure are associated with important psychological and clinical indicators of health status. Drawings offer an innovative way to understand patients'' perceptions of illness and personal models of heart failure. [Copyright &y& Elsevier]

Many patients are not reassured after receiving normal results following cardiac investigations. While previous studies have shown anxiety to be a contributing factor, little research has investigated the influence of patients’ illness perceptions on reassurance. In this study we investigated whether illness perceptions predicted patients’ reassurance following normal exercise stress test results. Sixty-two chest pain patients without prior diagnosed cardiac pathology completed questionnaires assessing anxiety and illness perceptions prior to exercise stress testing. Patients completed a reassurance questionnaire immediately following their appointment and again one month later. Illness perceptions (consequences, timeline, identity, illness concern, and emotional effect) but not anxiety, significantly predicted reassurance immediately following testing. We found both state anxiety and illness perceptions to predict reassurance one month later. After controlling for anxiety, longer timeline and lower treatment control beliefs predicted lower reassurance. The results suggest that an intervention targeting patients who have high anxiety and negative illness perceptions prior to testing may improve reassurance and decrease disability and the subsequent use of medical care. [ABSTRACT FROM AUTHOR]

Background: The psychological processes involved in the delay between noticing breast symptoms and seeking medical care are not well understood.Methods: We evaluated 85 women referred to a specialist breast clinic prior to their clinic appointment. We assessed the relationship between delay and the type of breast symptom, immediate emotional response to the symptom, perceived risk of breast cancer, fear of breast cancer treatment, and disclosure of the breast symptom to others.Results: Delay was unrelated to demographic factors but was related to the type of breast symptom; women who had a breast lump waited a significantly shorter time period before visiting the doctor than those without a breast lump. Initial symptom distress on the discovery of the breast symptom was also significantly related to delay. Knowledge of a friend or family member with breast cancer, perceived risk of breast cancer and fear of breast cancer treatment, and disclosure of the symptom to a partner or other person were all unrelated to delay.Conclusions: The results show the importance of the type of symptom and initial emotional distress in delay and highlight the importance of widening public perceptions of breast symptoms other than breast lumps in order to reduce delay times. [ABSTRACT FROM AUTHOR]

Objectives: Symptom misattribution is a central process in the nocebo effect but it is not accurately assessed in current side effect measures. We have developed a new measure, the Side Effect Attribution Scale (SEAS), which examines the degree to which people believe their symptoms are treatment side effects.Methods: The SEAS was tested in three New Zealand studies: a vaccination sample (n = 225), patients with gout or rheumatoid arthritis (n = 102), and patients switching to a generic medicine (n = 69). The internal reliability of the scale was examined using Cronbach's alpha. To assess validity, the Side Effect Attribution Total Score and Side Effect Attribution Binary Score were related to a number of psychological measures associated with side effect reporting.Results: The scale showed good internal reliability across the three studies, with Cronbach alphas ranging from 0.840 to 0.943. Analysis of the effect sizes showed that the Attribution Total Score was generally more strongly associated with nocebo responding than Attribution Binary Score. Participants had greater Side Effect Attribution Total Scores if they had higher expectations for vaccination side effects (r = 0.18, p = .028), more worry about future vaccine effects (r = 0.16, p = .046), a higher perceived sensitivity to medicines (r = 0.50, p < .001), greater anxiety (r = 0.25, p = .016), greater intentional non-adherence (r = 0.30, p = .003), greater medicine information seeking (r = 0.26, p = .010), lower trust in pharmaceutical agencies (r = -0.29, p = .026), and lower medicine efficacy beliefs (r = -0.46, p < .001).Conclusions: The SEAS provides a more nuanced assessment of symptom attribution beliefs. It appears to be more sensitive measure than just a side effect total, as it is associated with a greater number of relevant psychological variables. Future research should examine the scale in other populations and settings. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Worries about the risk to personal health from new technology and features of modern life have been shown to be associated with the use of health care services, health behaviours, mood and reporting of physical symptoms. We examined the frequency and nature of these concerns in a large national sample and the relationship of modern health worries to demographic factors, depression, symptom reporting and health-related quality of life. Methods: A representative sample of the German population (n=2485) completed a face-to-face survey which included demographic information, the Modern Health Worries Scale, as well as measures of depression, symptom reporting, and health-related quality of life. Results: The majority of the population reports high or extremely high concerns about aspects of modernity affecting their personal health, while only six percent reported no concerns at all. Higher levels of modern health worries were found in females but were not associated with income or age. Higher levels of modern health worries were significantly associated with depression, symptom reporting and lower health-related quality of life. We found the relationship between modern health worries and both symptom reporting and health-related quality of life was only partially explained by depression for most outcome variables, while the association between MHW and physical component (SF-12) was fully mediated by depression. Conclusions: Concerns about aspects of modernity affecting health are common in a general population sample and associated with depression, symptom reporting and quality of life. [Copyright &y& Elsevier]