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, but 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. Because parental beliefs about the etiology of ADHD likely influence which services are sought, more research is needed to examine this aspect of help-seeking behavior in order to address the unmet need among Latino families. Specifically, research needs to focus on cultural factors that likely 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 familismo, respeto, spirituality, and traditional gender roles in explaining parental etiological beliefs about ADHD in Latino parents. Participants in this study included 74 Latino parents. After watching a video portraying a Latino child exhibiting core symptoms and common functional problems associated with ADHD, parents completed a semi-structured interview that assessed etiological beliefs about the behavior of the child in the video, as well as a demographic questionnaire and measures of acculturation and cultural values. Neither Anglo orientation nor Latino orientation was significantly correlated with biopsychosocial or sociological/spiritual etiological beliefs. Additionally, none of the cultural values were significantly correlated with biopsychosocial etiological beliefs. The cultural values familismo and traditional gender roles were significantly positively correlated with sociological/spiritual beliefs. Exploratory analyses also were conducted to further examine sociological/spiritual beliefs. After controlling for SES, familismo and traditional gender roles accounted for 30.5% of the total variance in sociological/spiritual beliefs about ADHD. Finally, post hoc analyses were conducted to examine individual categories of etiological beliefs. The current study adds to our knowledge about how Latino parents understand child behavior and has important implications for both research and mental health services with Latino parents. The results support the inclusion of etiological beliefs and cultural factors in research examining help-seeking and access to mental health services among Latino families and suggest that the incorporation of alternative etiological beliefs about child behavior may be an important factor in culturally-appropriate mental health services

The Role of Acculturation Differences and Acculturation Conflict in Latino Family Mental Health

\u3eIn order to help address the mental health disparities that exist for Latino families in the U.S., the current study sought to examine the acculturation-mental health link within the context of the Latino family and to identify potential mechanisms for intervention to alleviate mental health problems in this population. Specifically, our goal was to examine how parent-adolescent acculturation differences were related to mental health in Latino adolescents and their parents and to understand the role of acculturation conflict and family functioning within the Latino family. Participants included 84 adolescent-parent dyads recruited through bilingual middle schools. We found partial support for our hypothesis that family functioning mediates the relationship between acculturation differences and mental health outcomes for Latino parents. Additionally, we found partial support for our moderated mediation hypothesis; specifically, a significant conditional indirect effect was found for Latino cognitive acculturation differences on adolescent externalizing problems via family functioning at high levels of acculturation conflict. Exploratory analyses also indicated that acculturation conflict moderates the relationship between family functioning and externalizing problems for Latino adolescents. Results highlight the importance of understanding acculturation within the context of the Latino family, as findings differed for adolescents and their parents. Additionally, findings suggest that differences in acculturation may not always be problematic and their impact likely depends on how families interpret such differences

The Role of Acculturation Differences and Acculturation Conflict in Latino Family Mental Health

In order to help address the mental health disparities that exist for Latino families in the U.S., the current study sought to examine the acculturation–mental health link within the context of Latino families and to identify potential mechanisms for intervention to alleviate mental health problems in this population. Specifically, our goal was to examine how parent–adolescent acculturation differences were related to mental health in Latino adolescents and their parents and to understand the role of acculturation conflict and family functioning within Latino families. Participants included 84 adolescent–parent dyads recruited through bilingual middle schools. We found partial support for our hypothesis that family functioning mediates the relationship between acculturation differences and mental health outcomes for Latino parents. Additionally, we found partial support for our moderated mediation hypothesis; specifically, a significant conditional indirect effect was found for Latino cognitive acculturation differences on adolescent externalizing problems via family functioning at high levels of acculturation conflict. Exploratory analyses also indicated that acculturation conflict moderates the relationship between family functioning and externalizing problems for Latino adolescents. Results highlight the importance of understanding acculturation within the context of Latino families, as findings differed for adolescents and their parents. Additionally, findings suggest that differences in acculturation may not always be problematic and their impact likely depends on how families interpret such differences

Chronic condition self-management support within a respiratory nursing service

By recognising the importance of the different phases of change involving diagnostic, planning, implementation, ongoing monitoring and review, but also the supporting tools for data collection, the readiness of staff for change, the mapping of barriers and enablers and planning for short- and long-term impacts, this Respiratory Service was able to embed effectively into practice a more coordinated service for patients with COPD across the inpatient/community continuum

Management of bronchiectasis: a tertiary health care perspective

Bronchiectasis is a chronic, progressive disease of the airways which is characterised by persistent cough, excessive sputum, difficulty in clearing airway secretions and recurrent infections. In the last decade several guidelines for the management of bronchiectasis have been developed. These guidelines are largely based on expert opinion as there continues to be a paucity of good quality research to guide management recommendations. Management guidelines are a convenient resource for clinicians that summarise the evidence and opinion of guide treatment choices. As a Respiratory Nurse Consultant working with adult Respiratory Chronic Disease patients, our service only sees approximately 15 bronchiectasis patients a year. When they are referred, they are usually significantly impacted by their health status, with a heavy symptom burden and a poor quality of life. This led me to question how adult bronchiectasis patients are being managed in our hospital and whether management might be improved if our nursing service had a greater role. This thesis focuses on adults with non-cystic fibrosis (non-CF) bronchiectasis and further reference to bronchiectasis within this paper relates to the non-CF bronchiectasis. An introduction to what is bronchiectasis, a background to how prevalent it is, what the recommended management is, the main guidelines available and how nurse-led care may play a role in management is featured in Chapter one. Chapter two identifies the overarching aim of this thesis is to identify ways to improve bronchiectasis management in adults. This will be achieved by 1) determine if management of bronchiectasis in outpatients at The Queen Elizabeth Hospital (TQEH) is compliant to the Thoracic Society of Australia and New Zealand (TSANZ) and British Thoracic Society (BTS) guideline, 2) evaluating the efficacy of care through review of exacerbation frequency, hospital and service utilisation, use of multidisciplinary team and 5 year mortality and 3) explore the respiratory nurse-led model of management of bronchiectasis to evaluate the effectiveness of nurse-led care verses doctor-led care in the management of stable bronchiectasis. In order to identifying ways to improve bronchiectasis management a review of current care was needed. This was achieved by firstly mapping the BTS and TSANZ guidelines to identify key management recommendations for outpatient care. A data extraction template was developed with the help of two respiratory consultants to assess patient medical records to determine how compliant management was with the recommendations. We then conducted a 3 separate time point retrospective audit each reviewing current bronchiectasis care in an outpatient setting to evaluate adherence to guidelines over a 12-month period in 2011, 2013 and 2016/ 2017 (Chapter 4). This currently unpublished manuscript identified there was incomplete compliance to guidelines with changes for better and worse over time. Improvements were seen in the taking of history for exacerbations, provision of action plans and emergency packs. The use of antibiotics both short and long-term did not have high compliance with recommended care. Vaccination and interval sputum sampling also showed low adherence. Clinical assessments at outpatient review for sputum, cough, breathlessness, and activity tolerance were often omitted in documentation. Breathlessness assessment may be used as an indicator for physiotherapy review. Our cohort of patients had lower referral rates to physiotherapy compared to the BTS 2017 audit. Respiratory Nurse referral increased from 34% in 2011 to 58% in 2016/17, however most of these referrals were for one-off education or coordination of home oxygen not rather than help with bronchiectasis management. This audit concluded that management of bronchiectasis in outpatients could be improved by sharing the audit findings with clinicians and the development of management prompts such as checklists or documentation abbreviated templates such as electronic medical record (EMR) acronyms. It is thought that Respiratory Nurses having a larger role in management of stable patients with bronchiectasis through a protocol/ guideline-based clinic may lead to an improvement in care, but referrals need to be made more consistently to evaluate this. Evaluation of the effectiveness of respiratory nurses in the management of bronchiectasis occurs in the Cochrane Review “Nurse-led care verses doctor-led care for bronchiectasis” (Chapter 5). This review was an update of an existing published review and updated the available evidence on bronchiectasis management and nurse-led care models. It also revised this Cochrane review to comply with the recommended methodological structure and renamed the review. We found one study, that was 20 years old, which was included in the original review, this study involving 80 participants from the United Kingdom was a single centre randomised control crossover trial. The study concluded that nurse-led care was not inferior to doctor-led care in stable bronchiectasis. The review concluded that further research was needed to determine 1) cost effectiveness of nurse-led care in bronchiectasis management, 2) if guidelines and protocols for bronchiectasis management are followed and 3) establish if nurse-led management of bronchiectasis was effective in other clinical settings such as inpatient and outreach. Chapter six discusses the significance and contribution to knowledge of the two manuscripts featured in Chapter four and five of this thesis. It also provides insights into limitations and problems encountered and future directions for ongoing research. Early examination of ongoing research which explores qualitative and quantitative opinions of health professionals working with bronchiectasis patients has identified that there is a lack of knowledge about bronchiectasis guidelines, and this may contribute to some of the inconsistencies in care. Further translational research is needed to explore how future evidence and updates to guidelines are distributed to bridge the gap between resource development and implementation into policy and practice. Evidence in this thesis also suggests there may be value in exploring a greater role for Respiratory Nurses in managing stable disease and further research should be undertaken to evaluate the nurse-led model in bronchiectasis. In conclusion this thesis confirms there are inconsistencies in bronchiectasis management and that documentation practices and lack of guideline awareness may be contributing factors. We identified that research is needed to determine how best to disseminate future guideline updates. We also confirm that respiratory nurses are underutilised but can safely manage stable bronchiectasis in a nurse-led clinic however more research is required to confirm how a nurse-led clinic would work in a modern setting.Thesis (MPhil) -- University of Adelaide, Adelaide Medical School, 202

Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? : A systematic review and narrative synthesis

BACKGROUND: Teamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information. OBJECTIVE: To systematically review articles that describe the use of team reflexivity in interprofessional hospital-based healthcare teams. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams.The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles' eligibility was validated by two second reviewers (5%). RESULTS: Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone. CONCLUSION: The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems. TRIAL REGISTRATION NUMBER: CRD42017055602

Do we want a human first, and a lawyer second?:Developing law student empathy through clinical legal education

In the UK, the legal profession is increasingly acknowledging the importance of emotional intelligence and empathy in legal practice. Furthermore, research has demonstrated that soft skills such as empathy can be taught, and these skills should be incorporated in legal education. This study uses the Basic Empathy Scale to examine whether law student participation in law clinic and tax clinic modules had any effect on students’ self-reported empathy levels. It is submitted that, in general, the students who worked in clinic experienced a statistically significant positive shift in their empathy levels. However, a few students who worked in clinic also experienced a decrease in their empathy levels, and the possible reasons for this are explored. In addition, this paper considers the impact of gender on students’ self-reported empathy levels

A Time to keep: history of the First United Methodist Church of Oviedo, Florida, 1873-1973.

Brief history of the church from its beginnings to 1973, including photographs of early members, changes in the church structure, the new church, and the first wedding performed in the new church. Also includes a list of pastors and other officers of the church.https://stars.library.ucf.edu/floridaheritage/1129/thumbnail.jp

Late toxicity and biochemical recurrence after external-beam radiotherapy combined with permanent-source prostate brachytherapy

BACKGROUND The combination of external-beam radiotherapy and brachytherapy is used commonly to treat men with prostate cancer. In this analysis, the authors examined the rate of biochemical recurrence (BR) and late grade ≥3 genitourinary (GU) and gastrointestinal (GI) toxicity after treatment with external-beam radiotherapy and brachytherapy in a multiinstitutional, cooperative group setting. METHODS All eligible patients received external-beam radiotherapy (45 Gray [Gy] in 25 fractions) followed 2 to 6 weeks later by an interstitial implant using iodine-125 to deliver an additional 108 Gy. BR was defined in 2 ways: according to the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Definition (ACD) and according to the Phoenix definition (PD) (prostate-specific antigen nadir +2 ng/mL). The Radiation Therapy Oncology Group(RTOG)/European Organization for Research and Treatment of Cancer late radiation morbidity scoring system was used to grade all toxicity. RESULTS One hundred thirty-eight patients were enrolled, and 130 were eligible for the current analysis. The median follow-up for surviving patients was 49 months (range, 20–60 months). The 48-month estimate of late grade ≥3 GU/GI toxicity was 15% (95% confidence interval [95% CI], 8–21%), and the 48-month estimate of BR was 19% (95% CI, 12–26%) and 14% (95% CI, 8–20%) according to the ACD and PD, respectively. CONCLUSIONS The morbidity observed in this multiinstitutional, cooperative group study was slightly higher than that reported in recent RTOG studies using brachytherapy alone or high-dose external-beam radiotherapy. The BR rate observed in this report was similar to that observed with high-dose external-beam radiotherapy alone in similar patients. Cancer 2007. © 2007 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55987/1/22560_ftp.pd