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Articles by J. Gray
Total Records ( 4 ) for J. Gray
  H Henderson , W Wells , E. R Maguire and J. Gray
 

Research and theory on the effects of fair procedures has gained popularity over the past decade. This is understandable given the inherent appeal of these ideas and the supporting evidence. Research suggests that authorities are able to secure compliance from subordinates when they use fair procedures and when they are viewed as legitimate. Unfortunately, empirical studies of procedural justice and legitimacy are hampered by weak measures of key theoretical constructs. The purpose of this study is to examine the measurement properties of procedural justice in a sample of inmates. Results show that a one-factor model of procedural justice fits the data well, though the authors find evidence of a method effect. Results also demonstrate important differences between the use of a summated procedural justice scale and a scale derived from a factor analysis. These findings illustrate the importance of paying careful attention to construct validity in measures of procedural justice.

  C. Millett , K. Khunti , J. Gray , S. Saxena , G. Netuveli and A. Majeed
 

AimTo examine associations between obesity, ethnicity and intermediate clinical outcomes in diabetes.


MethodsPopulation-based, cross-sectional study using electronic primary care medical records of 7300 people with diabetes from White, Black and south Asian ethnic groups.


ResultsThe pattern of obesity differed within ethnic groups, with rates significantly higher in younger when compared to older Black (women, 63% vs. 44%, P=0.002; men, 37% vs. 20%, P=0.005) and south Asian (women, 47% vs. 27%,P=0.01; men, 21% vs. 13%, P=0.05) people. Obese people with diabetes were significantly less likely to achieve an established target for blood pressure control (adjusted odds ratio 0.50, 95% confidence interval 0.42, 0.59). Differences in mean systolic blood pressure in obese and normal weight persons were significant in the White group but not in the Black groups or south Asian groups (6.9 mmHg, 1.9 mmHg and 2.7 mmHg, respectively). Differences in mean diastolic blood pressure between obese and normal weight persons were 4.8 mmHg, 3.6 mmHg and 3.4 mmHg in the White, Black and south Asian groups. Mean HbA1c and achievement of an established treatment target did not differ significantly with obesity in any ethnic group.


ConclusionsObesity is more prevalent amongst younger people than older people with diabetes in ethnic minority groups. The relationship between obesity and blood pressure control in diabetes differs markedly across ethnic groups. Major efforts must be implemented, especially in young people, to reduce levels of obesity in diabetes and improve long-term outcomes.

  H. Haji Ali Afzali , J. Gray , J. Beilby , C. Holton , D. Banham and J. Karnon
 

Aims

To determine the cost-effectiveness of alternative models of practice nurse involvement in the management of type 2 diabetes within the primary care setting.

Methods

Linked routinely collected clinical data and resource use (general practitioner visits, hospital services and pharmaceuticals) were used to undertake a risk-adjusted cost-effectiveness analysis of alternative models of care for the management of diabetes patients. These models were based on the reported level of involvement of practice nurses in the provision of clinical-based activities. Potential confounders were controlled for by using propensity score-weighted regression analyses. The impact of alternative models of care on outcomes and costs was measured and incremental cost-effectiveness estimated. The uncertainty around the estimates of cost-effectiveness was illustrated through bootstrapping.

Results

Although the difference in total cost between two models of care was not statistically significant, the high-level model was associated with better outcomes (larger mean reductions in HbA1c). The upper 95% confidence intervals showed that the incremental cost per 1% decrease in HbA1c is only $454, and per one additional patient to achieve an HbA1c value of less than 53 mmol/mol (7.0%) is $323. Further analyses showed little uncertainty surrounding the decision to adopt the high-level model.

Conclusions

The results provide a strong indication that the high-level model is a cost-effective way of managing diabetes patients. Our findings highlight the need for effective incentives to encourage general practices to better integrate practice nurses in the provision of clinical services.

  A. Kroneman , L. Verhoef , J. Harris , H. Vennema , E. Duizer , Y. van Duynhoven , J. Gray , M. Iturriza , B. Bottiger , G. Falkenhorst , C. Johnsen , C.-H. von Bonsdorff , L. Maunula , M. Kuusi , P. Pothier , A. Gallay , E. Schreier , M. Hohne , J. Koch , G. Szucs , G. Reuter , K. Krisztalovics , M. Lynch , P. McKeown , B. Foley , S. Coughlan , F. M. Ruggeri , I. Di Bartolo , K. Vainio , E. Isakbaeva , M. Poljsak-Prijatelj , A. Hocevar Grom , J. Zimsek Mijovski , A. Bosch , J. Buesa , A. Sanchez Fauquier , G. Hernandez-Pezzi , K.-O. Hedlund and M. Koopmans
  The Foodborne Viruses in Europe network has developed integrated epidemiological and virological outbreak reporting with aggregation and sharing of data through a joint database. We analyzed data from reported outbreaks of norovirus (NoV)-caused gastroenteritis from 13 European countries (July 2001 to July 2006) for trends in time and indications of different epidemiology of genotypes and variants. Of the 13 countries participating in this surveillance network, 11 were capable of collecting integrated epidemiological and virological surveillance data and 10 countries reported outbreaks throughout the entire period. Large differences in the numbers and rates of reported outbreaks per country were observed, reflecting the differences in the focus and coverage of national surveillance systems. GII.4 strains predominated throughout the 5-year surveillance period, but the proportion of outbreaks associated with GII.4 rose remarkably during years in which NoV activity was particularly high. Spring and summer peaks indicated the emergence of genetically distinct variants within GII.4 across Europe and were followed by increased NoV activity during the 2002-2003 and 2004-2005 winter seasons. GII.4 viruses predominated in health care settings and in person-to-person transmission. The consecutive emergence of new GII.4 variants is highly indicative of immune-driven selection. Their predominance in health care settings suggests properties that facilitate transmission in settings with a high concentration of people such as higher virus loads in excreta or a higher incidence of vomiting. Understanding the mechanisms driving the changes in epidemiology and clinical impact of these rapidly evolving RNA viruses is essential to design effective intervention and prevention measures.
 
 
 
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