The aim of this research was to examine nurses' and health care assistants' perspectives of infection control practice on one hospital ward and use this as the basis for the development, implementation and evaluation of an education and support programme for improving practice on the ward. In Phase I of the study, nurses and health care assistants were interviewed using a semistructured interview schedule to explore their views and anxieties about infection control practice and identify their priorities for practice development. Qualitative and quantitative analysis of these data revealed that respondents' concerns related primarily to the use of Contact Precautions for patients with Clostridium difficile associated diarrhoea (CDAD) and Methicillin resistant Staphylococcus aureus (MRS A). Structured observations of practice were employed to confirm the prevalence of the issues raised in relation to this and provide an understanding of their context. The findings of Phase I informed the design of an intervention to improve practice. This involved the development of a practice guideline on Contact Precautions and the availability of practical instruction and support during its implementation. In Phase II of the study, participant observations of practice were conducted to gain an understanding of nurses' and health care assistants' behaviour and in particular, their responses to the supportive intervention. Their perceptions of its impact on their practice were ascertained in Phase III using semi-structured interviews. Qualitative analysis of these data revealed that participants experienced great difficulty understanding and implementing infection control recommendations. Factors that may help explain this include nurses' and health care assistants' knowledge and skills in infection control, their personal belief systems and self-preservation instincts. In addition, the recommendation to use Contact Precautions for patients with infectious conditions such as CDAD and MRS A may itself counteract attempts to promote the routine use of infection control precautions in clinical practice. It is suggested that in relation to infection control, there may be a need to radically re-think the ways in which health care workers are educated and supported in practice. Moreover, it is argued that until the ambivalent evidence base relating to the use of Contact Precautions is resolved, messages about infection control are likely to generate confusion amongst health care workers.

Previous research has shown that children with a parent with a chronic medical condition may face psychosocial difficulties. This thesis presents a series of studies to explore how children adjust to their parents’ Multiple Sclerosis (MS). Study 1: A systematic review of the literature showed a number of factors linked to children's adjustment and also that adolescents might be at increased risk of psychosocial problems compared to younger children with a parent with MS. Study 2: Following the systematic review, a qualitative interview study, is presented, with 15 adolescents with a parent with MS which showed how adolescents view their increased responsibilities and also the importance of the parent without MS to provide practical and emotional support. Study 3: Mixed methods were used in order to develop a questionnaire (Perceptions of Parental Illness Questionnaire, PPIQ) to measure adolescents’ beliefs about their parents’ MS. To assess the psychometric properties of the newly developed questionnaire, 104 adolescents completed the PPIQ together with standardised measures of emotional and behavioural adjustment and illness-related impairment. The PPIQ appeared to be valid and reliable. Study 4: Finally, the data of the questionnaire development study was used in a longitudinal design study in which 56 parents with MS, 40 partners without MS and 75 adolescent children were included. The findings showed that parents’ anxiety and depression symptoms, parents' emotional expression and adolescents' views about MS were associated with adolescents' adjustment. MS characteristics (e.g. MS severity, type, time since diagnosis, relapses) and adolescents' reports on parent-adolescent communication were not associated with their adjustment. Family environment and adolescents’ illness beliefs are important factors to be incorporated in future interventions to support adolescents’ adjustment to parental MS.

In recent years, interest in nostalgia and its many potential benefits has blossomed, yet the nature of nostalgia in older adulthood has remained largely unexplored. This is surprising, given that nostalgia serves many functions which are highly relevant to older adults and which could determine whether they adjust poorly or well to older adulthood. In order to address this shortfall, this thesis reports on research exploring nostalgia and wellbeing across the lifespan. First, I compare the content of nostalgic and ordinary autobiographical memories using multiple coding methods. Results highlight the strong social orientation of nostalgia in older adults (Chapter 2). Second, I examine psychological wellbeing across the lifespan and demonstrate that stability or gains in wellbeing are contingent on nostalgia (Chapter 3). Furthermore, these age-related differences in psychological wellbeing are at least partly driven by a perception of limited time (Chapter 4). Finally, I explore whether there are individual differences in those who stand to benefit most from nostalgia. Results suggest that nostalgia may not meet the affiliative needs of high growth adults as they get older. This is demonstrated across a wide variety of measures, including psychological wellbeing (Chapter 5), subjective wellbeing and health (Chapter 6). Overall, this thesis emphasises the value of taking a lifespan perspective on nostalgia.

No description available.

This thesis is based in two parallel strands of research. The first is an exploration of the theoretical distinctions between two competing paradigms dominant in sexual health research: social cognition models and discourse theory. The second is an exploration of the practical use of a discourse theoretical approach to research accounts from people in the forty-something' age bracket about their experience of developing new sexually intimate relationships. Some developments in connectionist theory are used to explore some possible distinctions between implicit and explicit knowledge. These distinctions are then used to explore the scope of the two paradigms and, drawing on findings from the practical research, to discuss some implications for sexual health research and intervention.

Mindfulness derives from meditative traditions and is a form of mental training that is increasingly incorporated into Western treatment approaches for common mental health problems. This thesis addresses the prophylactic effects of mindfulness practice and the implications for the treatment of anxiety. The first paper considers the role of attention as a predominant mechanism of mindfulness. The paper reviews the evidence for the effects of mindfulness on attentional subsets and suggests that mindfulness may in part exert its benefits by ameliorating maladaptive attentional processes that have been implicated in the aetiology of anxiety. The empirical paper reports the results of a randomised controlled trial that directly compared the prophylactic and differential effects of two mindfulness practices on pharmacologically-induced state anxiety and negative affect through inhalation of 7.5% carbon dioxide (CO2). 60 participants engaged in 10 minutes of focused mindfulness, open mindfulness or relaxation prior to a 20-minute inhalation of 7.5% CO2 or air. Consistent with the evidence-base, this study found that mindfulness reduced self-reported state anxiety and negative affect significantly more so than a period of relaxation. In the context of non-significant reductions in autonomic measures of arousal, these findings support that mindfulness exerts its benefits through specific rather than non-specific effects. The results are consistent with contemporary conceptualisations of mindfulness mechanisms that highlight the key role of attention and suggest that clinical effects are exerted through top-down control mechanisms that support emotion regulation.

Objective: There is a general agreement that physical activity (PA) has a beneficial effect on health and those who are more active have a reduced risk of developing many chronic diseases, such as coronary heart disease (CHD). However, the amount, type and intensity of PA deemed to be sufficient to achieve good health remains unclear. Different methods have been used to categorise activity behaviour, but the level of agreement, consistency and coherence between methods and how this might influence their relationship with CHD risk factors and estimated CHD (eCHD) risk are poorly understood. This uncertainty is reflected in many different messages communicated to the public as to how active they should be to prevent chronic diseases. The primary objective of this thesis was to determine whether the methods used to categorise PA (as either inactive/active or level of PA) influence the extent to which PA is associated with CHD risk factors and eCHD risk. Methods: This thesis was divided into two parts. The first part was to conduct a secondary analysis of data on activity and CHD risk factors (blood pressure and lipid profile) obtained from the 2004 UK National Diet and Nutrition Survey (NDNS) in 1658 adults aged 19-64 years. Using the information obtained from the NDNS 7-day diary, it was possible to extend the original observations and to re-categorise individuals according to measures of PA in terms of number of days and minutes of at least moderate PA, total activity expressed as metabolic-equivalents (METs) and self-perception of PA. Each of these methods was then used to examine the proportion of the variance in CHD risk factors and the eCHD risk attributable to differences in PA using General Linear Modelling with adjustment for BMI, age and smoking. Partial eta squared a “proportion of variance due to physical activity plus error that is attributed to physical activity alone” was used. In the second part, the concurrent validity of measures of PA derived from the NDNS 7-day diary, using different systems for coding and classifying of different physical activities, was compared against those measures of PA obtained from the International Physical Activity Questionnaire (IPAQ) in a group of medical students (n = 26). Results: Taken together, this thesis revealed: 1) poor agreement across different methods of categorisation of PA level, 2) no support to justify a curvilinear dose-response relationship between PA level and CHD risk factors and eCHD risk and that a linear model was sufficient, 3) the differences in CHD risk factors or eCHD risk that could be directly attributable to differences in PA in men was modest (generally < 5%) although no associations evident in the women, 4) effect was most obviously demonstrable as improvements in lipid profile, no demonstrable effect on blood pressure, 5) a potential problem might arise when using one system and applying its results to different guidelines established by different systems. Conclusion: These findings support the view that being physically active is associated with markers of better health and lower CHD risk; a small but consistent effect that was the same irrespective of which method of categorizing PA was used and even after adjustment for differences in age, BMI and smoking. The effects were most evident in men and largely attributable to improvements in lipid metabolism.

Operating theatres and surgeons are among the most expensive resources in any hospital, so it is vital that they are used efficiently. Due to the complexity of the challenges involved in theatre scheduling we split the problem into levels and address the tactical and day-to-day scheduling problems. Cognitive mapping is used to identify the important factors to consider in theatre scheduling and their interactions. This allows development and testing of our understanding with hospital staff, ensuring that the aspects of theatre scheduling they consider important are included in the quantitative modelling. At the tactical level, our model assists hospitals in creating new theatre timetables, which take account of reducing the maximum number of beds required, surgeons’ preferences, surgeons’ availability, variations in types of theatre and their suitability for different types of surgery, limited equipment availability and varying the length of the cycle over which the timetable is repeated. The weightings given to each of these factors can be varied allowing exploration of possible timetables. At the day-to-day scheduling level we focus on the advanced booking of individual patients for surgery. Using simulation a range of algorithms for booking patients are explored, with the algorithms derived from a mixture of scheduling literature and ideas from hospital staff. The most significant result is that more efficient schedules can be achieved by delaying scheduling as close to the time of surgery as possible, however, this must be balanced with the need to give patients adequate warning to make arrangements to attend hospital for their surgery. The different stages of this project present different challenges and constraints, therefore requiring different methodologies. As a whole this thesis demonstrates that a range of methodologies can be applied to different stages of a problem to develop better solutions.

No description available.

Bacteria such as Escherichia coli and Salmonella are capable of causing gastrointestinal illness if ingested with food. There is an urgent need within the food processing industry to improve the efficiency of both the sanitising processes used on fresh produce and the microbiological methods used to ensure its safety. The aims of this study were to develop novel microscopic methods to detect and quantify both indigenous leaf bacteria and viable human pathogens on salad leaves, without the need for recovery and culture, which may reduce the accuracy of quantification. The methods developed could then be used to quantify the number of indigenous and inoculated bacteria in situ on salad leaves as well as to identify factors affecting the quantity and spatial patterning of attachment. In addition, the efficacy of chemical biocides for the reduction of viable Salmonella on salad leaves was considered. Episcopic Differential Interference Contrast (EDIC) microscopy coupled with epifluorescence was used to rapidly and non-destructively view the natural microflora in situ on spinach leaves. Salmonella enterica serovar Thompson was inoculated onto spinach leaves in order to observe spatial and temporal patterning of colonisation under differing conditions. Salmonella enterica serovar Typhimurium mutants defective in curli fimbriae production were used to assess the role of curli in attachment to abiotic surfaces and leaves. Viability determination of potential viable but non-culturable (VNC), sub-lethally stressed cells was performed to assess the effect of chemical wash treatments on Salmonella attached to fresh spinach. The results obtained indicate that salad leaves are densely populated with naturally occurring bacteria; these are found predominantly in the margins between leaf epidermal cells as well as around leaf veins and stomata. Cells were present in complex three-dimensional aggregations, suggesting the presence of biofilms. Curli fimbriae were shown to be key in the attachment of Salmonella typhimurium to polystyrene but not to leaf surfaces. When Salmonella thompson was inoculated onto spinach leaves and then subjected to chemical washing in chlorine or Citrox, neither chemical was an effective biocide against the pathogen. Under-reporting of viable cell numbers by plate counting methods indicated that chlorine induced a viable but nonculturable (VNC) state amongst Salmonella. These findings have important implications for the sanitisation of salads; both stomatal penetration and the formation of biofilms could protect enteric bacteria on leaves from chemical and mechanical disinfection strategies. If human pathogens are able to spread to salad leaves from contaminated soil, irrigation water or directly from animal faeces, and actively penetrate the interior of the leaves, then the microbiological safety of ready-to-eat salads cannot be guaranteed. This study also suggests that current methods for detection of pathogenic bacteria in foods following processing may be under-reporting the threat to consumers due to the induction of the VNC state amongst pathogenic bacteria.