Higher exhaled nitric oxide at 6 weeks of age is associated with less bronchiolitis and wheeze in the first 12 months of age.

BACKGROUND: Nitric oxide in exhaled air (eNO) is used as a marker of type 2 immune response-induced airway inflammation. We aimed to investigate the association between eNO and bronchiolitis incidence and respiratory symptoms in infancy, and its correlation with eosinophil protein X (EPX). METHODS: We followed up infants at 6 weeks of age born to mothers with asthma in pregnancy and measured eNO during natural sleep using a rapid response chemiluminescense analyser (CLD88; EcoMedics), collecting at least 100 breaths, interpolated for an expiratory flow of 50 mL/s. EPX normalised to creatinine was measured in urine samples (uEPX/c). A standardised questionnaire was used to measure symptoms in first year of life. Associations were investigated using multiple linear regression and robust Poisson regression models. RESULTS: eNO levels were obtained in 184 infants, of whom 125/184 (68%) had 12 months questionnaire data available and 51/184 (28%) had uEPX/c measured. Higher eNO was associated with less respiratory symptoms during the first 6 weeks of life (n=184, ß-coefficient: -0.49, 95% CI -0.95 to -0.04, p=0.035). eNO was negatively associated with uEPX/c (ß-coefficient: -0.004, 95% CI -0.008 to -0.001, p=0.021). Risk incidence of bronchiolitis, wheeze, cold or influenza illness and short-acting beta-agonist use significantly decreased by 18%-24% for every unit increase in eNO ppb. CONCLUSION: Higher eNO levels at 6 weeks of age may be a surrogate for an altered immune response that is associated with less respiratory symptoms in the first year of life.

Sleep it off: Bullying and sleep disturbances in adolescents.

INTRODUCTION: Involvement in bullying is associated with negative health outcomes for adolescents. Recent studies suggest that bullying is related to sleep disturbances. The purpose of this study was to examine differences in sleep disturbances (bedtime fears, insomnia, parasomnias) between victims, bullies, and youth not involved in bullying, as well as to explore differences across various types of bullying behavior (verbal, physical, social, cyber). METHODS: High school students ages 14-17 years (mean = 16.0) in the United States (n = 885; 57.3% female; 87.5% White) completed The Children's Report of Sleep Patterns and questions about involvement in verbal, physical, social and cyberbullying. RESULTS: Differences in all three sleep disturbances were found across groups, with victims and bully-victims reporting more sleep disturbances than bullies and youth not involved. A similar pattern was found across all bullying types, with more sleep disturbances for victims and bullyvictims. CONCLUSIONS: The results of this cross-sectional study highlight the importance of screening youth for sleep disturbances that may indicate daytime issues with bullying or victimization, as well as the need for longitudinal studies to elucidate potential pathways between sleep and bullying/victimization.

Leadership styles of nursing home administrators and their association with staff turnover.

PURPOSE: The purpose of this study was to examine the associations between nursing home administrator (NHA) leadership style and staff turnover. DESIGN AND METHODS: We analyzed primary data from a survey of 2,900 NHAs conducted in 2005. The Online Survey Certification and Reporting database and the Area Resource File were utilized to extract organizational and local economic characteristics of the facilities. A general linear model (GLM) was used to estimate the effects of NHA leadership style, organizational characteristics, and local economic characteristics on nursing home staff turnover for registered nurses (RNs), licensed practical nurses (LPNs), and nurse's aides (NAs). RESULTS: The complete model estimates indicate that NHAs who are consensus managers (leaders who solicit, and act upon, the most input from their staff) are associated with the lowest turnover levels, 7% for RNs, 3% for LPNs, and 44% for NAs. Shareholder managers (leaders who neither solicit input when making a decision nor provide their staffs with relevant information for making decisions on their own) are associated with the highest turnover levels, 32% for RNs, 56% for LPNs, and 168% for NAs. IMPLICATIONS: The findings indicate that NHA leadership style is associated with staff turnover, even when the effects of organizational and local economic conditions are held constant. Because leadership strategies are amenable to change, the findings of this study may be used to develop policies for lowering staff turnover.

Organizational and environmental effects on voluntary and involuntary turnover.

BACKGROUND: There are few studies of voluntary and involuntary turnover in the nursing home literature. Previous research in this area has focused mainly on the linear effects of individual and organizational characteristics on total turnover. PURPOSES: The purpose of this study was to examine both linear and nonlinear effects of organizational and environmental conditions on voluntary and involuntary nursing home staff turnover. METHODOLOGY/APPROACH: We analyzed both primary and secondary data on 854 nursing homes in six states. A negative binomial regression model was used to study both linear and curvilinear effects of organizational and environmental factors on voluntary and involuntary turnover among registered nurses, licensed practical nurses, and nurse aides. FINDINGS: Staffing levels and deficiency citations were the organizational characteristics most consistently linked with turnover among all nurse types. Links were also found between unemployment and type of location (urban or rural) and turnover, indicating that the economic environment is influential for retention. PRACTICE IMPLICATIONS: The results of this study support the notion that policy makers need to consider both the organization and the environment when evaluating the nature of nursing home staff turnover. The findings also offer further evidence that the antecedents of voluntary and involuntary turnover are not necessarily the same.

The percentage of beds designated for medicaid in american nursing homes and nurse staffing ratios.

Previous analyses of the inverse relationship between a nursing home's Medicaid census and its quality of care have been based on samples limited to specific geographic regions, for-profit entities, or only skilled care facilities. The present study uses national-level data from the 1999 National Nursing Home Survey to examine the association between the proportion of beds designated for Medicaid residents and nurse staffing ratios. The results indicate that homes which designate a higher proportion of their beds for Medicaid recipients maintain lower ratios of registered nurses and nurse's aides to residents, even when key facility characteristics are controlled. It was also found that nursing homes with a higher proportion of Medicaid beds offer lower nursing ratios regardless of their profit status or the difference between private pay rates and Medicaid reimbursement rates. Since lower nursing ratios have been previously linked to negative outcomes, these findings suggest that homes which rely more heavily upon Medicaid recipients may be using cost-cutting strategies which have negative implications for quality.