University of Leeds

Leeds, W.Yorkshire, United Kingdom

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Leeds Institute of Health Sciences (LIHS)
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School of Earth and Environment
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Institute of Psychological Sciences
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    ABSTRACT: Higher conscientiousness (C) predicts better health outcomes. Recent research suggests that stress may play an important role in explaining this relationship. The current study aimed to establish whether C moderates the relationship between daily hassle appraisals, daily affect, and physical symptoms. A daily diary design was used, where participants (N = 103) completed a baseline measure of C followed by a 14-day daily diary, providing daily details of hassles (primary and secondary appraisals) experienced as well as positive and negative affect and physical symptoms. Hierarchical linear modelling revealed that Total C (as well as two facets of C: Order and Industriousness) moderated the relationship between stress appraisals and positive affect. Specifically, the negative association between the daily appraisal of hassles as stressful (i.e., where perceived demands outweighed perceived resources) and positive affect was stronger for lower and average levels of C, Order, and Industriousness. No significant moderated effects were found for negative affect or physical symptoms. The Order facet was also found to be an important factor predicting attrition. The current study provided evidence that C and two of its facets can moderate the relationship between hassle appraisal and positive affect. C may exert part of its influence on health by modifying the effects of daily stressors. What is already known on this subject? Conscientiousness has a significant positive effect on longevity and health status. While the performance of health behaviours may partially account for this relationship, evidence suggests that it does not fully mediate the effect. Research has begun to look at stress as a possible additional explanatory variable, and there is evidence that Conscientiousness moderates the relationship between stress and health behaviours. What does this study add? Shows that Conscientiousness and two of its facets (Order and Industriousness) moderate the relationship between hassle appraisal and positive affect. Highlights the importance of studying lower order facets of personality in health research. Suggests that Conscientiousness may exert part of its influence on health by modifying the effects of daily stressors.
    British Journal of Health Psychology 11/2014; 19:311-328.
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    ABSTRACT: To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA). In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D. Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was -0.31 (-0.63 to 0.02) for PP and -0.15 (-0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (-£352, £1773) and -£128 (-£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher 'general satisfaction' scores than RLC in week 26. The results provide robust evidence to support non-inferiority of NLC in the management of RA. ISRCTN29803766.
    Annals of the rheumatic diseases 11/2014; 73(11):1975-82.
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    ABSTRACT: This paper studies a multi-criteria optimization problem which appears in the context of booking chemotherapy appointments. The main feature of the model under study is the requirement to book for each patient multiple appointments which should follow a pre-specified multi-day pattern. Each appointment involves several nurse activities which should also follow a pre-specified intra-day pattern. The main objectives are to minimize patients’ waiting times and peaks of nurses’ workload for an outpatient clinic. Our solution approach is based on the concept of a multi-level template schedule which is generated for a set of artificial patients with typical treatment patterns. There are two stages in template generation: the multi-day stage, which fixes appointment dates for all artificial patients, and the intra-day stage, which fixes for each day appointment starting times and patient allocation to nurses. The running schedule is created by considering actual patients one by one as they arrive to the clinic. Booking appointments for each new patient is performed by assigning appropriate dates and times of the template schedule following the prescribed multi-day and intra-day patterns. Additional rescheduling procedure is used to re-optimize intra-day schedules on a treatment day or shortly beforehand. The key stages of the scheduling process are modeled as integer linear programs and solved using CPLEX solver. We demonstrate the effectiveness of our approach through case-based scenarios derived from a real clinic and discuss the advantages that the multi-level template can bring.
    Operations Research for Health Care. 09/2014;


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British Journal of Social Psychology 12/2010; 40(4):471 - 499.

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