Clinical characteristics. Fourteen studies investigated clinical characteristics, finding mixed evidence for a link with nocebo effects (see Table 2-11). Six studies of high quality looked at the effect of baseline symptom scores, finding mixed evidence for a link with nocebo effects. Two found no significant effects (Xxxxx-Xxxxxx et al., 2011; Xxxxxx et al., 2001). For the other four, results were mixed. Xxxxxx-Xxxxx, Xxxx, Xxxxxxxxxx, and Xxxxxx (2010) and de la Xxxx et al. (2010) found that higher symptom scores at baseline predicted higher symptom scores after exposure to sham EMF and treatment respectively, whereas Xxxxxx et al. (2003) and Xxxxx et al. (2008) found the opposite after drinking decaffeinated coffee and taking sham medication for Xxxxxxxxx’x respectively. Six studies of high quality looked at the effect of type of clinical condition, with five finding a significant effect. They showed that suffering from a condition that is exacerbated by the suggested sham exposure significantly increased symptom reporting compared to healthy volunteers, strongly supporting a link with nocebo effects. Xxxxxxxxxx et al. (2007) found that depression did not predict symptoms in response to a sham magnetic field. However, Xxxxxx et al. (2011), Xxxxxxx (2000), Xx Xxxxxx et al. (2005) and Xxxxxxxx et al. (2010) showed that suffering from atopic dermatitis, panic disorder, asthma or medically unexplained dyspnoea resulted in significantly more symptoms in response to sham histamine, sham panic disorder trigger, sham inhaler and breathing trials with room air, respectively, compared to healthy volunteers. In addition Xxxxxxxxxx et al. (2010) found that the level of perceived sensitivity to EMFs was positively correlated with symptom scores after sham EMF exposure. The remaining two studies looked at previous drug reactions finding weak evidence for a link with nocebo effects. Xxxxxxxx et al. (2008) found no significant effects of type or severity of previous drug reaction on symptoms in response to a sham allergen pill. However, a higher quality study by Mrna and Skrivanek (1985) found the reaction to another sham drug was significantly correlated with perceived drug effect.
Clinical characteristics. Potential clinical characteristics related to self-care include ACHD disease severity and comorbidities. ACHD severity has been associated with physical activity levels in ACHD, but relationship to overall self-care is unknown.5 Comorbidities increase the burden of self-care through complex medication regimens, difficulty distinguishing symptoms, and disease management conflicts.11 In the acquired HF population, comorbidities are associated with lower medication and diet adherence, difficulty interpreting healthcare professionals instructions for multiple illnesses, and decreased self-care confidence.11,60,61 In addition to risk for illness such as diabetes and hypertension due to age, adults experience other comorbidities related to pulmonary, renal, and hepatic function.62 Comorbidities are expected to influence self-care, but the relationship is untested in ACHD. Knowledge Although knowledge may be insufficient to explain level of self-care, it is recognized as an important prerequisite.11 In a study of young adults with ACHD, the majority knew something about their heart condition, but only 36% had a clear understanding of their heart defect.63 Another study found that young adults with ACHD were characterized by lack of knowledge and awareness about future health risks due to their heart defect.64 Surprisingly, one ACHD center found that 35% of adults could not name their defect, and 50% did not understand the reason for endocarditis and pregnancy related risks.65 In the development of a health knowledge questionnaire for ACHD, Moons et al found that patients generally understood their ACHD, however they had poor understanding of the reasons for follow up and the symptoms of decreased heart function.51 Another study by Van Deyk et al confirms these findings, with less than half of patients understanding the need for regular follow up to detect clinical deterioration.66 In a qualitative analysis of self-care in adolescents and young adults, Xxxxx et al found that those who could explain their heart defect in xxxxxx’x terms had higher levels of self-care.14 However, the relationship between knowledge and self-care in ACHD remains poorly understood.
Clinical characteristics. Diagnoses Psychiatric characteristics at admission were collected retrospectively from both clinical case notes about the time of admission and during the research interview one-month post discharge. Primary and secondary diagnoses were taken from ICD-10 psychiatric codes including depressive disorder (F32-39), bipolar disorder (F31), schizophrenia (F20-29), anxiety disorders (F40-41) and personality and behaviour disorder (F60-69). A separate variable was created to capture the presence of a personality disorder regardless of whether it was a primary or secondary diagnosis.
