Nurse-led versus doctor-led care for bronchiectasis.

BACKGROUND: Specialist nursing roles to manage stable disease populations are being used to meet the needs of both patients and health services. With increasing cost pressures on health departments, alternative models such as nurse-led care are gaining momentum as a substitute for traditional doctor-led care. This review evaluates the safety, effectiveness, and health outcomes of nurses practising in autonomous roles while using advanced practice skills, within the context of bronchiectasis management in subacute, ambulatory, and/or community care. OBJECTIVES: To compare the effectiveness of nurse-led care versus doctor-led care in the management of stable bronchiectasis. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register and bibliographies of selected papers in addition to grey literature such as electronic clinical trials registries. Searches were current as of March 2018. SELECTION CRITERIA: Randomised controlled trials were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two reviewers extracted and entered data from included studies. Primary outcomes were numbers of exacerbations requiring treatment with antibiotics, hospital admissions, and emergency department attendances. MAIN RESULTS: We included one United Kingdom (UK) study in the review. In this randomised controlled trial, a total of 80 participants, with a mean age of 58 years, were treated for 12 months by a specialist nurse or doctor, then were crossed over to the other clinician for the next 12 months. Two participants died during the study period. Six participants failed to cross over to nurse-led care because of unstable bronchiectasis. Overall, the level of study completion was high.Data show no difference in the numbers of exacerbations requiring treatment with antibiotics (rate ratio 1.09, 95% confidence interval (CI) 0.91 to 1.30, 80 participants, moderate-certainty evidence). Investigators reported more hospital admissions in the nurse-led care group (rate ratio 1.52, 95% CI 1.04 to 2.23, 80 participants, moderate-certainty evidence) and did not report emergency department attendance.For secondary outcomes, participants in the nurse-led care group used more healthcare resources during the first year of the trial. Increased admissions and greater use of resources made treatment costs for nurse-led groups' higher. Total costs for both years of the study were £8,464 and £5,228 for nurse-led care compared with doctor-led care. However, by the second year, treatment costs were almost equitable between the two groups, which may reflect the nurses' learning of how to better treat people with bronchiectasis. No statistically significant changes were observed in quality of life, exercise capacity, mortality, or lung function. Wide confidence intervals led to uncertainty regarding these results. Adverse events were not an outcome for this review. AUTHORS' CONCLUSIONS: This update of the review shows that only one trial met review criteria. Review authors were unable to demonstrate effectiveness of nurse-led care compared with doctor-led care on the basis of findings of a single study. The included study reported no significant differences, but limited evidence means that differences in clinical outcomes between nurse-led care and usual care within the setting of a specialist clinic remain unclear. Further research is required to determine whether nurse-led care is cost-effective, if guidelines and protocols for bronchiectasis management are followed does this increases costs and how effective nurse-led management of bronchiectasis is in other clinical settings such as inpatient and outreach.

Understanding parental locus of control in Latino parents: Examination of cultural influences and help-seeking intentions for childhood ADHD.

OBJECTIVE: To address the disparities that exist in utilization of mental health services for ADHD among Latino families and to further our understanding of factors that influence parents' decisions to seek treatment for ADHD, the goal of the current study was to examine parental locus of control (PLOC) in a community sample of Latino parents. Specifically, the current study investigated cultural influences on PLOC, as well as the influence of PLOC on help-seeking. METHOD: Seventy-four primarily Spanish-speaking, Latino parents of school-age children completed measures to assess their help-seeking intentions, PLOC, and cultural orientation. RESULTS: Results indicated that U.S. mainstream orientation was associated with increased feelings of parental control and decreased beliefs in fate/chance and several Latino cultural values were associated with increased beliefs in fate/chance, and decreased feelings of parental efficacy and parental control. In addition, 2 PLOC domains (e.g., parental efficacy and fate/chance) were associated with beliefs that the behaviors of a child with ADHD would go away on their own. CONCLUSIONS: Results highlight the need for interventions aimed at modifying parenting behavior to take parents' cultural beliefs and values into account in order to accommodate and engage Latino families more effectively.

Latino parental help seeking for childhood ADHD.

To better understand the help seeking process that occurs within Latino families when a child is exhibiting behaviors consistent with attention-deficit/hyperactivity disorder (ADHD), qualitative and quantitative data from 73 Latino parents were examined. Findings suggest that most Latino parents in the current sample recognized ADHD symptoms as concerning and in need of professional help and reported being motivated to seek help. Unfortunately, they also appeared to lack knowledge about the etiology of and effective treatment for ADHD, and many identified barriers to seeking help. Future research must involve community collaborations aimed at increasing awareness and knowledge of ADHD and decreasing barriers to seeking help in targeted Latino communities.

Acculturation, cultural values, and Latino parental beliefs about the etiology of ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental health disorders of childhood. Despite the availability of several evidence-based interventions, Latino children are more likely than non-minority children to have an unmet need for services related to ADHD. Given that parental beliefs about the etiology of ADHD likely influence service utilization, research needs to focus on cultural factors that may influence parental beliefs about the etiology of child behavior problems. Thus, the goal of the current study was to investigate the role of acculturation and cultural values of familism, respect, spirituality, and traditional gender roles in explaining parental etiological beliefs about ADHD in a sample of Latino parents. Findings suggest that behavioral acculturation was not significantly correlated with biopsychosocial or sociological/spiritual etiological beliefs; however, the cultural values of familism and traditional gender roles were positively correlated with sociological/spiritual beliefs. Further, exploratory analyses suggested that after controlling for SES, familism and traditional gender roles accounted for 30.5 % of the total variance in sociological/spiritual beliefs about ADHD. Finally, post hoc analyses revealed that cultural values were associated with several individual belief categories within the sociological/spiritual domain, including beliefs about friends, spirituality, and nature disharmony. The current study supports the inclusion of etiological beliefs and cultural factors in research examining help-seeking and access to mental health services among Latino families and suggests that the incorporation of alternative etiological beliefs about child behavior may be an important factor in culturally-appropriate mental health services.

Recent rising temperatures drive younger and southern Korean pine growth decline.

The Earth has experienced an unequivocal warming, with the warmest period of the past 150 years occurring in the last three decades. Korean pine (Pinus koraiensis), a key tree species in northeast Asia, is predicted to be particularly vulnerable to climate change. Here, we use dendrochronological methods to test whether the observed growth decline of Korean pine in northeast China is related to climate warming and whether climate-growth responses varied with age. A total of 628 cores from 401 trees across 16 sites were sampled over the entire distribution area of Korean pine in China. Samples were divided into three age classes: younger (50-130 years), middle (131-210 years), and older trees (>210 years), and measured by the ring-width index and basal area increment (BAI). Results showed a significant decline in BAI in most sites coinciding with an increase of temperature in the growing season and a decrease in precipitation since the 1980s. Meanwhile, we found that temperature-induced growth decline was significantly related to tree age. The BAI of younger trees decreased significantly and sharply (0.44 cm2 year-1, P < 0.0001), while old trees either decreased slightly or stabilized (0.04 cm2 year-1, P = 0.33). Tree growth in the southernmost locations was more likely to decline, what was most likely a result of forest-stand age. The age-related growth decline induced by climate warming might be explained by tree species traits, differences in growth rates between age classes and their relation to stress, changes in root system, competition/stand structure or physiological mechanisms. Our results might also predict that early stand process-thinning is exacerbated by warming and drying. This research informs that the age effect of growth response to rising temperature should be considered in forest management under climate change, and particularly models of future carbon cycle patterns and forest dynamics.

Working on Womanhood (WOW): A participatory formative evaluation of a community-developed intervention.

The well-documented disparities in availability, accessibility, and quality of behavioral health services suggest the need for innovative programs to address the needs of ethnic minority youth. The current study aimed to conduct a participatory, formative evaluation of "Working on Womanhood" (WOW), a community-developed, multifaceted, school-based intervention serving primarily ethnic minority girls living in underserved urban communities. Specifically, the current study aimed to examine the feasibility, acceptability, and initial promise of WOW using community-based participatory research (CBPR) and represented the third phase of a community-academic partnership. Qualitative and quantitative data were collected from 960 WOW participants in 21 urban public schools, as well as WOW counselors, parents, and school staff over the course of one academic year. Results demonstrated evidence of acceptability of WOW and noteworthy improvements for WOW participants in targeted outcomes, including mental health, emotion regulation, and academic engagement. Findings also indicated several challenges to implementation feasibility and acceptability, including screening and enrollment processes and curriculum length. Additionally, we discuss how, consistent with participatory and formative research, findings were used by program implementers to inform program improvements, including modifications to screening processes, timelines, curriculum, and trainings - all in preparation for a rigorous effectiveness evaluation.

Understanding and Measuring Functional Impairment in Diverse Children With ADHD: Development of the ADHD-FX Scale With an At-Risk, Community Sample.

OBJECTIVE: The current study sought to develop a culturally appropriate measure of functional impairment related to ADHD for diverse families, as research suggests that functional impairment may be a more culturally universal construct than symptomatology. METHOD: Seventy-four low-acculturated Latino parents (49 mothers and 25 fathers) of school-aged children provided quantitative and qualitative responses about problem recognition after viewing a language-free video of a child displaying symptoms and behaviors consistent with ADHD. RESULTS: Thirty-two items were developed for the ADHD-FX scale based on most common responses given from participants. The scale is available in Spanish and English and instructs parents to consider how much each item affects their child in his or her everyday life (from 0 = not at all to 3 = a lot). CONCLUSIONS: The scale can provide an overall impairment score, as well as subscale scores in the theoretically derived domains of academic, peer, and familial impairment. (J. of Att. Dis. 2016; 20(6) 487-500).

Acculturation and Latino adolescent mental health: integration of individual, environmental, and family influences.

In order to address the mental health disparities that exist for Latino adolescents in the United States, psychologists must understand specific factors that contribute to the high risk of mental health problems in Latino youth. Given the significant percentage of Latino youth who are immigrants or the children of immigrants, acculturation is a key factor in understanding mental health among this population. However, limitations in the conceptualization and measurement of acculturation have led to conflicting findings in the literature. Thus, the goal of the current review is to examine and critique research linking acculturation and mental health outcomes for Latino youth, as well as to integrate individual, environmental, and family influences of this relationship. An integrated theoretical model is presented and implications for clinical practice and future directions are discussed.

Assessing ADHD in Latino families: evidence for moving beyond symptomatology.

OBJECTIVE: In an effort to combat the mental health disparities that exist among Latinos, the current study aimed to add to our knowledge related to culturally appropriate assessments for Latino children presenting with ADHD. METHOD: As part of a larger study, a community sample of 68 Spanish-speaking, Latino parents completed the Spanish translation of the Disruptive Behavior Disorders Rating Scale (DBD-S), a commonly used, parent-report measure of ADHD. RESULTS: Results suggest that although both the Inattentive and Hyperactive/Impulsive subscales of the DBD-S are psychometrically sound, the Hyperactive/Impulsive subscale may not be culturally appropriate with some Latino families, particularly those who are less acculturated. This was further supported by preliminary evidence suggesting that this subscale also was not diagnostically useful with the current, community sample. CONCLUSION: The potential problems associated with the overemphasis on symptomatology when working with Latino families, the importance of examining functional impairment as part of a culturally appropriate assessment, and the need to replicate the current findings with a clinical sample are discussed.