Julia L. Allan

A Taxometric Analysis of Type-D Personality

Objective: To test the dimensionality of Type-D personality, using taxometric procedures, to assess if Type-D personality is taxonic or dimensional. Type-D personality is treated as a categorical variable and caseness has been shown to be a risk factor for poor prognosis in coronary heart disease. However, at present, there is no direct evidence to support the assumption that Type D is categorical and able to differentiate true cases from noncases. Methods: In total, 1012 healthy young adults from across the United Kingdom and Ireland completed the DS14, the standard index of Type D, and scores were submitted to two taxometric procedures MAMBAC and MAXCOV. Results: Graphical representations (comparing actual with simulated data) and fit indices indicated that Type D is more accurately represented as a dimensional rather than categorical construct. Conclusion: Type D is better represented as a dimensional construct. Implications for theory development and clinical practice with respect to Type D are examined as well as the wider use of taxometrics within psychosomatic medicine (e.g., to investigate if there are medically unexplained syndrome taxons, such as a Gulf War Syndrome taxon). NA = negative affectivity; SI = social inhibition; MAMBAC = mean above minus below a cut; MAXCOV = maximum covariance; MAXEIG = maximum Eigenvalue; L-MODE = L-mode factor analysis; CCFI = curve comparison fit index.

Missed by an inch or a mile? Predicting the size of intention–behaviour gap from measures of executive control

Failing to achieve healthy intentions can have a direct impact on subsequent health. The extent of this impact is partially determined by the size of the discrepancy between intentions and behaviour, that is, on whether an unachieved behavioural target is missed by an inch or a mile. Over two studies, measures of ‘executive control’ ability were used to predict the size of the intention–behaviour gap for two dietary behaviours – eating fruits and vegetables and snacking. In Study 1, participants (n = 50) reported intended dietary intake, completed objective and self-report measures of executive control ability and recorded actual dietary intake over 3 days with computerised diaries. Using multiple regression, general executive control ability was found to account for 16–23% of the variance in the size of intention–behaviour gap for both the dietary behaviours. In Study 2 (n = 52), deviation from intentions about snacking was significantly related to individual differences in prepotent response inhibition. Overall, individuals with weak executive control ate less fruits and vegetables and more snacks than intended. Intention–behaviour ‘failures’ are not homogenous, but instead vary predictably with the availability of executive control resources. This suggests that individuals with large intention–behaviour shortfalls may benefit from interventions designed to reduce the demands on executive control.

Unintentional eating. What determines goal-incongruent chocolate consumption?

Overeating can be automatically triggered by the presence of palatable food. When presented with an opportunity to consume unlimited chocolate under the guise of a consumer study, chocolate consumption in individuals (n=62) with healthy dietary intentions could be predicted from a psychological measure of cognitive inhibition. Individuals who were less able to suppress goal-incongruent responses in an established inhibitory task: (a) ate more chocolate and (b) had a higher body mass index than others suggesting that these individuals were less able to exert dietary control in the presence of palatable but intention-incongruent foods.

A bidirectional relationship between physical activity and executive function in older adults

Physically active lifestyles contribute to better executive function. However, it is unclear whether high levels of executive function lead people to be more active. This study uses a large sample and multi-wave data to identify whether a reciprocal association exists between physical activity and executive function. Participants were 4555 older adults tracked across four waves of the English Longitudinal Study of Aging. In each wave executive function was assessed using a verbal fluency test and a letter cancelation task and participants reported their physical activity levels. Fixed effects regressions showed that changes in executive function corresponded with changes in physical activity. In longitudinal multilevel models low levels of physical activity led to subsequent declines in executive function. Importantly, poor executive function predicted reductions in physical activity over time. This association was found to be over 50% larger in magnitude than the contribution of physical activity to changes in executive function. This is the first study to identify evidence for a robust bidirectional link between executive function and physical activity in a large sample of older adults tracked over time.

A Bidirectional Relationship between Executive Function and Health Behavior: Evidence, Implications, and Future Directions.

Physically active lifestyles and other health-enhancing behaviors play an important role in preserving executive function into old age. Conversely, emerging research suggests that executive functions facilitate participation in a broad range of healthy behaviors including physical activity and reduced fatty food, tobacco, and alcohol consumption. They do this by supporting the volition, planning, performance monitoring, and inhibition necessary to enact intentions and override urges to engage in health damaging behavior. Here, we focus firstly on evidence suggesting that health-enhancing behaviors can induce improvements in executive function. We then switch our focus to findings linking executive function to the consistent performance of health-promoting behaviors and the avoidance of health risk behaviors. We suggest that executive function, health behavior, and disease processes are interdependent. In particular, we argue that a positive feedback loop may exist whereby health behavior-induced changes in executive function foster subsequent health-enhancing behaviors, which in turn help sustain efficient executive functions and good health. We conclude by outlining the implications of this reciprocal relationship for intervention strategies, the design of research studies, and the study of healthy aging.

Nursing stress and patient care: real-time investigation of the effect of nursing tasks and demands on psychological stress, physiological stress, and job performance: study protocol

AIM To examine the effects of nursing tasks (including their physiological and psychological demands, and the moderating effects of reward and control) on distress and job performance in real time. BACKGROUND Nurses working in hospital settings report high levels of occupational stress. Stress in nurses has been linked to reduced physical and psychological health, reduced job satisfaction, increased sickness absence, increased staff turnover, and poorer job performance. In this study, we will investigate theoretical models of stress and use multiple methods, including real-time data collection, to assess the relationship between stress and different nursing tasks in general medical and surgical ward nurses. DESIGN A real-time, repeated measures design. METHODS During 2011/2012, 100 nurses from a large general teaching hospital in Scotland will: (a) complete self-reports of mood; (b) have their heart rate and activity monitored over two shifts to obtain physiological indices of stress and energy expenditure; (c) provide perceptions of the determinants of stress in complex ward environments; and (d) describe their main activities. All measures will be taken repeatedly in real time over two working shifts. DISCUSSION Data obtained in this study will be analysed to examine the relationships between nursing tasks, self-reported and physiological measures of stress and to assess the effect of occupational stress on multiple work outcomes. The results will inform theoretical understanding of nurse stress and its determinants and suggest possible targets for intervention to reduce stress and associated harmful consequences.

Developing a community-based intervention to improve quality of life in people with colorectal cancer: a complex intervention development study

Objectives To develop and pilot a theory and evidence-based intervention to improve quality of life (QoL) in people with colorectal cancer. Design A complex intervention development study. Setting North East Scotland and Glasgow. Participants Semistructured interviews with people with colorectal cancer (n=28), cancer specialists (n=16) and primary care health professionals (n=14) and pilot testing with patients (n=12). Interventions A single, 1 h nurse home visit 6–12 weeks after diagnosis, and telephone follow-up 1 week later (with a view to ongoing follow-up in future). Primary and secondary outcome measures Qualitative assessment of intervention feasibility and acceptability. Results Modifiable predictors of QoL identified previously were symptoms (fatigue, pain, diarrhoea, shortness of breath, insomnia, anorexia/cachexia, poor psychological well-being, sexual problems) and impaired activities. To modify these symptoms and activities, an intervention based on Control Theory was developed to help participants identify personally important symptoms and activities; set appropriate goals; use action planning to progress towards goals; self-monitor progress and identify (and tackle) barriers limiting progress. Interview responses were generally favourable and included recommendations about timing and style of delivery that were incorporated into the intervention. The pilot study demonstrated the feasibility of intervention delivery. Conclusions Through multidisciplinary collaboration, a theory-based, acceptable and feasible intervention to improve QoL in colorectal cancer patients was developed, and can now be evaluated.

Stress in telephone helpline nurses is associated with failures of concentration, attention and memory, and with more conservative referral decisions

Nurses working for telephone-based medical helplines must maintain attentional focus while quickly and accurately processing information given by callers to make safe and appropriate treatment decisions. In this study, both higher levels of general occupational stress and elevated stress levels on particular shifts were associated with more frequent failures of attention, memory, and concentration in telephone nurses. Exposure to a stressful shift was also associated with a measurable increase in objectively assessed information-processing errors. Nurses who experienced more frequent cognitive failures at work made more conservative decisions, tending to refer patients on to other health professionals more often than other nurses. As stress is associated with cognitive performance decrements in telephone nursing, stress-reduction interventions could improve the quality and safety of care that callers to medical helplines receive.

Does real time variability in inhibitory control drive snacking behavior? An intensive longitudinal study.

Objective: Laboratory eating studies and cross-sectional surveys indicate individuals with inefficient executive function (EF) consume more unhealthy snacks than others. However, the importance of EF in determining snacking behavior in the “real world” has not been established. Contemporary behavioral and self-control theories posit EF as a dynamic resource fluctuating over time. Consequently, a test of the relevance of EF to behavior within individuals is required. This study tested within- and between-person effects of real-time variability in objectively measured inhibitory control (a core facet of EF) on subsequent snacking behavior in daily life. Method: A community sample of 64 adults recorded snacking behavior and completed a short Go/No-Go test (assessing inhibitory control) hourly over 7 consecutive days, yielding a total well-powered sample of 6,284 data-points. Generalized linear mixed models using lagged effects examined within-person and between-person effects of inhibitory control efficiency on snacking behavior. Results: When Go/No-Go test responses were 100 ms slower than the person-mean (indicating periods of poorer inhibitory control), snack consumption in the following hour was 25.67% higher, Exp (&ggr;) = 1.26, p = .002, 95% confidence interval (CI) [1.06, 1.49]. Between-individuals, person-mean reaction time (RT) did not predict snack consumption, Exp (&ggr;) = 1.02, p = .965, 95% CI [0.71, 1.46]. Conclusions: RT variability in inhibitory control efficiency is highly relevant to snacking behavior within individuals. Inhibitory control is an important driver of snacking in everyday life and an important target for interventions.

Total skin self-examination at home for people treated for cutaneous melanoma: development and pilot of a digital intervention

Objectives To develop a digital intervention to prompt, support, and respond to the outcomes of total skin self-examinations (TSSEs) at home by people treated for cutaneous melanoma. Design A complex intervention development study. Setting Northeast Scotland. Participants Semistructured scoping interviews; people previously treated for cutaneous melanoma (n=21). Pilot testing: people treated for melanoma stages 0–2C (n=20); general practitioners (n=6); and a nurse specialist in dermatology (n=1). Intervention A tablet-based digital intervention designed to prompt and support TSSEs comprising instructional videos and electronic reporting (including photographs) to a clinical nurse specialist in dermatology, with subsequent clinical triage. Primary and secondary outcome measures Qualitative assessment of intervention feasibility and acceptability, and quantitative assessment of intentions and confidence to perform TSSEs in pilot participants. Results The majority of pilot participants were strongly positive and adhered well to the intervention (n=15), with 7 of these reporting symptoms of concern at some point during the 6-month pilot. 4 patients complied intermittently, 3 reporting skin problems at least once during the pilot, and 1 withdrew. 2 patients underwent skin surgery as a result of participating in the pilot, with 1 diagnosed as having a recurrent melanoma and the other, a benign lesion. A number of practical issues to improve the usability of the intervention were identified. The proportion of participants reporting intention to check their skin at least monthly increased during the intervention as did confidence to conduct a skin check. Conclusions People previously treated for cutaneous melanoma are prepared to use digital technology to support them in conducting TSSE. An intervention has been developed which is practical, effective and safe, and after addressing minor practical issues, could now be evaluated for clinical outcomes in a randomised clinical trial.