Cooper Collection 063 (Heart Condition)

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Accordingly, 1 men were included. The ethics committee of the University of Gothenburg approved this study. During the period —, all enlisted men underwent standardized physical and cognitive examinations at one of six conscription centres. Weight, height, and blood pressure were measured, and morbidities were documented. As part of the physical evaluation, isometric muscle strength was measured in terms of knee extension, elbow flexion, and hand grip; the results were weighted and transformed into the stanine score 1—9.

Four cognitive tests were used, covering the following areas: logical, verbal, visuospatial, and technical cognition. The tests were slightly amended in Before , the verbal test examined the ability of concept discrimination; after , it examined the capability to select the correct synonym or antonym from a given set of words.

The cognitive performance tests have previously been described in detail. Before , raw data were not electronically recorded, and only stanine scores could be accessed for statistical analysis. Therefore, we used only stanine scores in the present study. The database integrates data from the labour market and educational and social sectors. The highest level achieved of either parent was used.

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There is mandatory reporting of discharge diagnoses for all inpatient care patients to the nationwide Hospital Discharge Register. Register coverage gradually increased from to ; it was complete by Since , diagnoses for patients in hospital outpatient care have also been recorded. HF was defined as follows: Because of overlapping HF aetiologies, we assigned mutually exclusive causes of HF in the following hierarchical order: 1, congenital heart disease and valvulopathies; 2, ischaemic heart disease, diabetes, or hypertension; 3, cardiomyopathy; and 4, other causes.

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We used the Cox proportional hazards regression model to estimate associations between adolescent IQ and potential confounders with the risk of future hospitalization for HF. We used IQ stanines 1—9 as a continuous variable for analyses. Muscle strength and cardiovascular fitness were scored 1—9 and classified as low 1—3 points , medium 4—6 points , or high 7—9 points.

The highest achieved parental education level was also trichotomized with the categories of mandatory education 1 , high school 2 , and university, postgraduate, or postgraduate research training 3. Age at conscription, BMI, body height, and systolic and diastolic blood pressure were continuous variables. We employed cubic restricted splines with knots placed at the 5th, 35th, 65th, and 95th percentiles for conscription year, BMI, and Wmax. The proportional hazards assumptions were demonstrated as tenable using plots based on weighted residuals. We undertook statistical calculations using SAS, version 9.

Table 1 shows the characteristics of the study population with respect to their IQ. The mean age at conscription was We observed increasing body height for higher IQ levels with a decrease in the proportion of overweight and obesity. No specific trend was evident for muscle strength. Table 2 displays the incidence of HF in the different IQ categories and divided into mutually exclusive associated conditions. Of those, HF was the main diagnosis in cases.

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The number of HF cases associated with congenital or acquired valvular disease was CHD, diabetes, or hypertension was associated with cases The total incidence of HF was There was a pattern of decreasing incidence with increasing IQ for HF of any cause as well as for the separate aetiologies. For all HF cases, the incidence ranged from The corresponding figures for HF associated with congenital or acquired valvular disease were 1. Further adjustments for body height, systolic and diastolic blood pressure, parental education, cardiorespiratory fitness, and muscle strength attenuated the observed associations moderately.

In the fully adjusted model, the HR for IQ stanine 1 was 3. For each standard deviation decrease in IQ, the corresponding HR was 1. Parental education and cardiorespiratory fitness showed no significant interactions for the effect of IQ on the development of HF. The present study shows that low cognitive performance in early adulthood is associated with increased risk of early incident HF and that the risk is greatest for people with the lowest IQ.

The results were similar regardless of concomitant associated conditions. The "back-in-stock" feature only sends this one-time email message from Jewelry Television. Own more of the jewelry you love with JTV payment options that let you choose how to pay! Get Details. Customer service is available 8 a.

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This is protection for 2 full years that will cover against almost all normal wear and tear. For additional international shipping options and rates please contact our Customer Experience Team We at JTV want you to be completely satisfied with your purchase. Conversely, for each standard deviation increase in Concerns, the odds of adherence decreases by a factor of 2. No research synthesis can transcend the limitations of the primary studies. The majority of the studies relied solely on self-reported adherence. Self-report measures have high face validity and high specificity for nonadherence, however they may be subject to self-presentation and recall bias [].

Thus some people may be reporting higher adherence rates than they actually attain. This bias does not diminish our confidence in the finding that beliefs were related to adherence, as there is no evidence that such a bias would be associated with medication beliefs. Indeed some patients with high Concerns and low Necessity beliefs may be expected to incorrectly report high adherence in order to present themselves positively. This pattern would attenuate the relationship found between adherence and medication beliefs, making it less likely that we would find an association between beliefs and adherence.

Moreover, given that this relationship remained when non-self report measures were used, we are confident that the observed relationships between beliefs and adherence are not an artifact arising from the limitations of self-report. Only published studies were included, creating a possible bias, since studies submitted for publication may be more likely to have positive results and larger effect sizes.

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Since for both Necessity beliefs and Concerns, the fail safe N indicated that the number of additional negative findings required to accept our null hypothesis was similar to the number of studies included in this meta-analysis, and there was little suggestion of publication bias through funnel plot analysis, our findings appear to reflect a true relationship between beliefs and adherence. Stratifying by long-term condition and adherence measurement revealed a need for further studies using objective measures, and highlighted some conditions, for example epilepsy and functional pain syndromes where further research is needed.

We do not know whether the Necessity-Concerns Framework will be of equal utility across medications administered by different routes e. The relationship was not reduced in these studies, supporting the proposal that medication beliefs can influence later adherence as part of the self-regulation of illness [14]. We did not restrict our inclusion criteria to studies published in English.

However, our search only identified one study published in any other language, despite the fact that the BMQ was translated into the native language for the study. Cultural values [] can impact on the way in which individuals interact with the healthcare system.


However, variations in treatment necessity and concerns and association between these beliefs and adherence were noted across different countries, languages and cultures. Further work is needed to investigate potential cultural variations in medication beliefs. The development of more effective methods for addressing nonadherence is a priority for research and practice [1] , [5].

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Necessity beliefs and Concerns may trigger intentional nonadherence, for example, if patients decide not to take their medication due to concerns regarding potential or actual adverse consequences, and unintentional nonadherence, e. Beliefs can have counter-balancing effects on adherence, such as when patients continue to take a medication they believe is essential for their health despite concerns regarding adverse effects Viewed from the perspective of biomedicine, nonadherence may seem irrational.

For some patients nonadherence might represent an informed choice. However, for others, evaluations of treatment necessity and concerns may be based on misconceptions about the illness and treatment. For example, the need for daily medication may seem less salient when symptoms are absent or cyclical [] — [].

Concerns about prescribed medication are not just related to side effects but are common, even when the medication is well tolerated.

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They are often related to beliefs about the negative effects of medication and include worries about long-term effects, dependence, cost of medication and dislike of having to rely on medicines [14] , []. Concerns are related to more general beliefs about pharmaceuticals as a class of treatment which are often perceived as intrinsically harmful and over-prescribed by doctors [] , []. The package information leaflets, dispensed with many prescription medicines may exacerbate concerns as they list all possible side effects, leaving patients with outstanding questions and making it difficult to understand the likely risk and place them in context with potential benefits [].

Nonadherence is often a hidden problem. Patients may be reluctant to express doubts or concerns about prescribed medication and to report nonadherence; sometimes because they fear that this will be perceived by the prescriber as a lack of faith in them. Adherence support should be tailored to the needs of the individual addressing perceptions e. Interventions attempting to improve adherence by applying these approaches have had encouraging results [] , [].

Nonadherence remains a fault-line in clinical practice. We would like to thank Christina Jackson for her help with the publication bias analysis, and the authors who sent additional data for their assistance. Conceived and designed the study: RH. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Objective To assess the utility of the NCF in explaining nonadherence to prescribed medicines. Study eligibility criteria Studies using the Beliefs about Medicines Questionnaire BMQ to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication.

Participants Patients with long-term conditions. Study appraisal and synthesis methods Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. Limitations Few prospective longitudinal studies using objective adherence measures were identified. Funding: These authors have no support or funding to report. Introduction Prescribing medicines is fundamental to the medical management of most long-term conditions.

Selection of Results When Multiple Relationships between Beliefs and Adherence Were Reported Fifteen studies reported multiple associations of beliefs related to different adherence measurements details reported in Table 1. Download: PPT.

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Statistical Analysis The primary outcome measure was adherence to medication. Results Selection of Studies Ninety-four percent of the studies retrieved were rejected after checking the titles and abstracts against the selection criteria above Figure 1. Sample Characteristics The mean age of participants in the 94 included studies ranged from Effect Sizes Necessity beliefs. Figure 2. Forest plot of effect sizes for BMQ Necessity and medication adherence. Figure 3. Forest plot of effect sizes for BMQ Concerns and medication adherence.

Table 4. Study location. Study design. Measurement of adherence. Statistical power. Assessment of Risk of Publication Bias Necessity. Figure 4. Funnel plot for BMQ Necessity and medication adherence. Figure 5. Funnel plot for BMQ Concerns and medication adherence. Implications for Research and Practice The development of more effective methods for addressing nonadherence is a priority for research and practice [1] , [5].

Supporting Information. Supporting Information S1. Acknowledgments We would like to thank Christina Jackson for her help with the publication bias analysis, and the authors who sent additional data for their assistance. References 1. National Institute for Health and Clinical Excellence Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence CG Geneva: World Health Organisation. BMJ View Article Google Scholar 4. Accessed October 17 th View Article Google Scholar 7. Journal of Psychosomatic Research — View Article Google Scholar 8.

Neuropsychopharmacology — View Article Google Scholar 9. Colloca L, Benedetti F Nocebo hyperalgesia: how anxiety is turned into pain. Current Opinion in Anesthesiology — View Article Google Scholar Horne R Compliance, adherence and concordance. In: Taylor K, Harding G, editors. Pharmacy Practice. London: Taylor and Francis. The Lancet — London: Harwood Academic Press.

Horne R Treatment perceptions and self regulation. The self-regulation of health and illness behaviour. London: Routledge. Psychology and Health 1— Maidment R, Livingston G, Katona C Just keep taking the tablets: adherence to antidepressant treatment in older people in primary care. International Journal of Geriatric Psychiatry — Journal of Affective Disorders 51— Annals of Behavioural Medicine 46— A prospective cohort study.

Rheumatol Int — Llewellyn C, Miners A, Lee C, Harrington C, Weinman J The illness perceptions and treatment beliefs of individuals with severe haemophilia and their role in adherence to home treatment. Health Psychology — J Psychosom Res — Chronic Illness 6: — Ann Behav Med — J Asthma — Patient Educ Couns — Annals of Family Medicine 3: 23— AIDS Behav — J Behav Med.

Am Heart J — Health Qual Life Outcomes Unni E, Farris KB Determinants of different types of medication non-adherence in cholesterol lowering and asthma maintenance medications: a theoretical approach. Accessed Nov Journal of Educational Statistics 8: — Psychological Bulletin — Research in Social and Administrative Pharmacy 5: — British Journal of Haematology Supplement 1S: Rheumatology 43S: Value in Health 6: Diabetic medicine Supplement 21S: Rajpura JR, Nayak R The role of illness burden and medication beliefs in medication compliance of elderly with hypertension.

Value in Health 3 : A American Journal of Transplantation Lupus — Gadkari A, McHorney C Prevalence and predictors of unintentional nonadherence among adults with chronic disease who self-identify as being adherent to prescription medications. Value in Health 3: A International Journal of Pharmacy Practice 95— Gastroenterology 1: S