“Amazon Queen”, Iquitos, Peru.
Condescending comments, put-downs and sarcasm have become commonplace in the politically charged workplace, and a new study co-authored by a Michigan State University business scholar shows how this incivility may be spreading.
Reporting in the Journal of Applied Psychology, Russell Johnson and colleagues found that experiencing such rude behavior reduces employees’ self-control and leads them to act in a similar uncivil manner.
“People who are recipients of incivility at work feel mentally fatigued as a result, because uncivil behaviors are somewhat ambiguous and require employees to figure out whether there was any abusive intent,” said Johnson, associate professor of management. “This mental fatigue, in turn, led them to act uncivil toward other workers. In other words, they paid the incivility forward.”
While curt remarks and other forms of incivility do not involve openly hostile behavior such as bullying and threats, they are a frequent occurrence in the workplace and have a significant effect on employees, the study notes. According to estimates, workplace incivility has doubled over the past two decades and has an average annual impact on companies of $14,000 per employee due to loss of production and work time.
For the study, 70 employees filled out a survey relating to incivility and its effects three times a day for 10 consecutive workdays. Interestingly, the researchers found that “incivility spirals” – when acts of incivility lead to subsequent acts of incivility – can occur unintentionally.
“When employees are mentally fatigued, it is more difficult for them to keep their negative impulses and emotions in check, which leads them to be condescending and rude to colleagues,” Johnson said. “This happens even for employees who desire to be agreeable and polite; they simply lack the energy to suppress curt and impatient responses.”
The study also found that incivility spirals occurred in workplaces that were perceived as political (i.e., where co-workers “do what is best for them, not what is best for the organization”).
“Being the victim of incivility leaves employees depleted because they must expend energy to understand why they were targeted and how to respond,” the study states. This is made more complex in highly political environments where “intentions and motives of others are less clear.”
One way to reduce perceptions of politics, the study says, is by providing clear feedback to employees regarding the types of behaviors that are desired. “This can be accomplished informally, by enhancing the quality of feedback provided during day-to-day interactions, or more formally via the performance management process.”
Johnson’s co-authors are Christopher Rosen, professor at the University of Arkansas; Allison Gabriel, assistant professor at the University of Arizona; and Joel Koopman, an assistant professor at the University of Cincinnati who received his doctorate from MSU.
BOSTON (August 11) – Tufts Medical Center and Tufts University scientists have found exciting, new functions of the protein angiogenin (ANG) that play a significant role in the regulation of blood cell formation, important in bone marrow transplantation and recovery from radiation-induced bone marrow failure. Since current bone marrow transplantations have significant limitations, these discoveries may lead to important therapeutic interventions to help improve the effectiveness of these treatments. The findings were published in an article, “Angiogenin promotes hematopoietic regeneration by dichotomously regulating quiescence of stem and progenitor cells,” in the August 11, 2016 issue of the journal Cell.
In the paper, the researchers show for the first time that ANG simultaneously reduces proliferation of stem cells and promotes proliferation of myeloid progenitor cells that give rise to mature myeloid cells. They further report that these two-pronged processes are accomplished by a novel molecular regulating mechanism, a first-ever such finding.
These findings have significant implications for both human stem cell transplantation and for radiation exposure. Cancer patients undergoing stem cell transplantation face two hurdles: the short-term challenge of having enough white blood cells to fight possible infections immediately following the transplant and the long-term challenge of sustaining stem cell function to maintain immunity. People exposed to large doses of radiation face challenges due to bone marrow failure induced by such exposures.
“We knew that ANG was involved in promoting cell growth so it was not unexpected to find that ANG stimulates proliferation of myeloid progenitor cells,” said Guo-fu Hu, PhD, Investigator in the Molecular Oncology Research Institute at Tufts Medical Center, and the paper’s senior author. “But it was surprising to find that ANG also suppresses growth of stem cells and that it accomplishes these divergent promotion or suppression functions through RNA processing events specific to individual cell types. Our discoveries suggest considerable therapeutic potential.”
Dr. Hu also serves as faculty in the Biochemistry; Cell, Molecular & Developmental Biology; and Cellular & Molecular Physiology programs at the Sackler School of Graduate Biomedical Sciences at Tufts.
In a series of experiments, the team from Tufts MC and the Sackler School at Tufts, which collaborated with scientists at Massachusetts General Hospital, isolated and described the divergent regulatory functions of ANG. They demonstrated how ANG stimulates proliferation of myeloid progenitor cells. They showed how ANG maintains stem cells by inducing a state of quiescence, or cellular dormancy, the first known evidence of ANG’s suppressive activity. Quiescence preserves stem cells over time so that they will be available in the future to help maintain immunity.
In another novel finding, the team demonstrated that ANG achieves these dual functions by inducing RNA processing that is different in various cell types. In hematopoietic stem/progenitor cells, ANG induces processing of a specific type of RNA (tiRNA) that is quiescence-related whereas in myeloid progenitor cells, ANG induces processing of a specific type of RNA (rRNA) that is proliferation related. tiRNA is a type of small RNA that suppresses global protein synthesis, while rRNA or ribosomal RNA is a type of RNA molecule that enhances protein synthesis.
“Proper blood cell production is dependent on functioning hematopoietic stem and progenitor cells that are destroyed during conditioning procedures for transplantation or following bone marrow injury,” said the study’s first author Kevin A. Goncalves, who performed this research as part of his PhD studies in cellular and molecular physiology at the Sackler School. “Our study demonstrates that ANG regulates critical functions of both clinically-relevant cell types.”
In further studies, the researchers tested the capacity of ANG to prevent and mitigate radiation-induced bone marrow failure, and in pre-clinical models, they found that survival following radiation exposure was increased after treatment with recombinant ANG protein.
A complementary paper, “Proximity-Based Differential Single-Cell Analysis of the Niche to Identify Stem/Progenitor Cell Regulators,” published online on August 11, 2016 in the journal Cell Stem Cell, reports the discovery and confirmation of ANG as a niche regulator.
Additional authors are Shuping Li, MD, PhD, Miaofen G. Hu, MD, PhD from Tufts Medical Center; Hailing Yang, PhD, a recent graduate of the Sackler School; and Lev Silberstein, PhD and Nicolas Severe, PhD from Massachusetts General Hospital and Harvard University. David Scadden, MD, also from Massachusetts General Hospital and Harvard University is co-corresponding author.
This study was supported by the National Institutes of Health, specifically the National Cancer Institute (award R01CA105241), the National Institute of Neurological Disorders and Stroke (award R01NS065237), the National Heart, Lung, and Blood Institute (awards R01HL097794 and F31HL128127), and the National Institute of Diabetes and Digestive and Kidney Diseases (award R01DK050234); the United States Department of Defense (W81XWH-15-1-02070); the National Natural Science Foundation of China (81272674); the Leukemia & Lymphoma Research UK/Leukemia & Lymphoma Society fellowships; a Sackler Dean’s Fellow award; and a Sackler Families Collaborative Cancer Biology award.
Researchers at the Technical University of Munich (TUM) discovered that our brain actively takes sugar from the blood. Prior to this, researchers around the world had assumed that this was a purely passive process. An international team led by diabetes expert Matthias Tschöp reported in the journal ‘Cell’ that transportation of sugar into the brain is regulated by so-called glia cells that react to hormones such as insulin or leptin; previously it was thought that this was only possible for neurons.
The rapid rise in obesity and the associated spread of type 2 diabetes represent an enormous challenge for our society. No efficient and safe medicines to prevent or stop this development are available. The failure to develop adequate treatments is thought to be primarily due to the fact that the molecular machinery controlling systemic metabolism still remains mostly unknown.
METABOLIC CONTROL: FUEL FOR THE HEADQUARTERS
Matthias Tschöp of the Chair for Metabolic Diseases at TUM and Director of the Division of Metabolic Diseases and also of the Helmholtz Diabetes Center (HDC) at Helmholtz Zentrum München, is investigating how control centers in the brain remotely control our metabolism in order to adjust optimally to our environment. The brain has the highest sugar consumption of all organs and also controls for example hunger feelings.
“We therefore suspected that a process as important as providing the brain with sufficient sugar was unlikely to be completely random,” so Dr. Cristina García-Cáceres, neurobiologist at the HDC and the study’s lead author. “We were misled by the fact that nerve cells apparently did not control this process and therefore first thought it to occur passively. Then we had the idea that glia cells such as astrocytes*, which had long been misunderstood as less important ‘support cells’, might have something to do with transporting sugar into the brain.”
The scientists therefore first examined the activity of insulin receptors on the surface of astrocytes, molecular structures which respond to insulin to influence cell metabolism. Here they found that if this receptor was missing on certain astrocytes the result was less activity in neurons that curb food uptake (proopiomelanocortin neurons).
At the same time, adaption of metabolism to challenges like sugar intake became impaired. With the help of advanced imaging technologies such as positron emission tomography, the scientists were able to show that hormones such as insulin and leptin act specifically on ‘support’ glia cells to regulate sugar intake into the brain, like a ‘sugar switch’. Without insulin receptors, astrocytes became less efficient in transporting glucose into the brain, particularly in the area of the satiety centers, which are located in the hypothalamus.
A PARADIGM SHIFT
“Our results showed for the first time that essential metabolic and behavioral processes are not regulated via neuronal cells alone and that other cell types in the brain, such as astrocytes, play a crucial role,” explains study leader Matthias Tschöp, who also heads the drug discovery division at the German Center for Diabetes Research (DZD). “This represents a paradigm shift and could help explain why it has been so difficult to find sufficiently efficient and save medicines for diabetes and obesity until now.”
According to the scientists, numerous new studies will now be necessary to adjust the old model of purely neural control of food intake and metabolism with a concept where astrocytes and possibly even immune cells in the brain also play a crucial role. Once there is a better understanding of the interaction between these various cells, the idea is to find ways and substances that modulate pathways on multiple cell types to curb sugar addiction and ultimately provide better treatment to the growing number of obese and diabetic individuals. “We have a lot of work ahead of us,” states García-Cáceres, “but at least now we have a better idea where to look.”
* Astrocytes are the most common cells in the brain. One of their jobs is to form the blood-brain barrier by enclosing the blood vessels that run in the brain and selectively allowing only certain substances through to the nerve cells.
Just recently the scientists had already shown that astrocytes react to leptin, a metabolic hormone (Kim et al., 2014). This is an important factor for satiety. Because now both leptin and insulin have been shown to influence astrocytes, the researchers propose to develop a new model which, in addition to the neurons, also takes into account the astrocytes as the adjustors of the metabolism and the feeling of hunger. They hope that the more detailed view this produces will provide new perspectives for drug development.
In a serious setback to the drive to eradicate polio from the world, two cases of paralysis caused by the virus have been detected in northeast Nigeria, the World Health Organization announced Thursday.
The discovery dashed the hopes of global health authorities to be able to declare the continent polio-free soon. Nigeria’s last case of wild polio virus was reported in July 2014. The continent’s last was reported in Somalia a month after that. The W.H.O. requires three years with no confirmed cases before declaring a region polio-free.
“We are deeply saddened by the news,” said Dr. Matshidiso Moeti, the W.H.O. regional director for Africa. “The overriding priority now is to immunize all children around the affected area.”
Polio paralyzes only about one child of every 200 infected, and in dangerous or remote regions, many cases of paralysis are never detected, so health authorities assume the virus is far more widespread than two cases would suggest.
Until Thursday, the last known cases of paralysis caused by “wild” virus were all in Pakistan and Afghanistan. (Vaccination in many countries is still done with oral drops containing weakened live virus, which sometimes mutates to become more dangerous and start outbreaks of “vaccine-derived polio,” which also can paralyze. While alarming, those outbreaks can usually be brought under control quickly with further vaccination.)
As recently as 2012, Nigeria accounted for more than half of all polio cases worldwide. Interrupting polio transmission in Africa was considered a major public health triumph. Only two diseases — smallpox and rinderpest, a veterinary disease — have ever been eradicated from the earth, and in both of them the last cases were found in Africa. The last few hundred cases of Guinea worm, or dracunculiasis, the only other disease as close to eradication as polio is, are also confined to Africa.
Genetic sequencing of the Nigerian virus suggests that the new cases were caused by a wild strain last detected in Borno State, Nigeria, in 2011, which implies that it circulated for five years without being detected. Raids by Boko Haram, the Islamic fundamentalist militia — including the kidnapping of 200 schoolgirls in Chibok two years ago — as well as fighting between Boko Haram and the Nigerian Army have made many areas off limits for vaccinators and surveillance specialists.
Massacres and fighting have driven thousands from their home villages. “That fluid movement of population complicates understanding of exactly where they’ve ended up,” said John F. Vertefeuille, director of polio eradication for the Centers for Disease Control and Prevention in Atlanta.
“This is a setback, but we need to double our effort to make sure we interrupt transmission,” he added.
Advances by the Nigerian Army this year have opened up new areas in Borno that were formerly off limits, and a case of paralysis caused by mutant polio vaccine was detected in March, prompting the increased surveillance that led to the discovery of the newest cases, Dr. Vertefeuille said.
The Bill and Melinda Gates Foundation has taken over much of the cost of the polio eradication drive from Rotary International, which began it in 1988. The cost has recently been over $1 billion a year. In a statement, the foundation said it was “deeply concerned” about the Nigeria cases but “remained strongly committed to supporting partners, governments and communities until the job is done.”
WASHINGTON — The Obama administration on Thursday said it was shifting $81 million away from biomedical research and antipoverty and health care programs to pay for the development of a Zika vaccine, resorting to extraordinary measures because Congress has failed to approve new funding to combat the virus.
Sylvia Mathews Burwell, the secretary of health and human services, told members of Congress in a letter that without the diverted funds, the National Institutes of Health and the Biomedical Advanced Research and Development Authority would run out of money to confront the mosquito-borne illness by the end of the month. That would force the development of a vaccine to stop at a critical time, as locally acquired cases of Zika infection increase in Miami.
As of last week, 7,350 cases of Zika had been reported in the United States, most in Puerto Rico, according to the Centers for Disease Control and Prevention. Ms. Burwell said that 15 infants had been born with Zika-related birth defects. The virus can cause abnormal brain development and other serious defects in children born to infected mothers.
The local spread of the illness in the continental United States, with the first cases reported late last month, has raised the political stakes surrounding the federal government’s response. Hillary Clinton on Tuesday made a campaign stop in Wynwood, the Miami neighborhood that has had a rash of locally transmitted Zika cases, and pressed Congress to return from its five-week break to approve emergency funding to fight the virus.
President Obama and congressional Republicans have been at odds for most of the year over Zika. In February, Mr. Obama requested $1.9 billion in emergency funding. Republicans balked, demanding a more detailed accounting of where the money would go.
Lawmakers have feuded for months over how much money should be earmarked and how it should be spent. Last month, Democrats blocked consideration of a Republican measure that would have allocated $1.1 billion to fight Zika but included provisions that would have banned funding for Planned Parenthood to provide contraception related to the virus, which can be sexually transmitted.
The deadlock prompted the White House in April to shift $589 million in Ebola funding to the Zika effort, about two-thirds of it designated for domestic use. On Thursday, Ms. Burwell said that her department had used most of that money, and that it would be gone by the end of August.
“The failure to pass a Zika emergency supplemental has forced the administration to choose between delaying critical vaccine development work and raiding other worthy government programs to temporarily avoid these delays,” Ms. Burwell wrote.
Democrats seized on the announcement to berate Republicans for failing to provide additional money for Zika. At a news conference, Representative Nancy Pelosi of California, the minority leader, called on Representative Paul D. Ryan, the House speaker, to bring Congress back to advance such a measure.
“Every possible option is being exhausted, and now we’re going into the National Institutes of Health, which is supposed to be a priority,” Ms. Pelosi said.
Aides to Mr. Ryan said that shifting the funds was a long-overdue step that the Obama administration had delayed to squeeze maximum political advantage out of the Zika issue.
The National Institutes of Health announced last week that it had begun clinical trials of a Zika vaccine on 80 human subjects, and hoped to begin a second phase in “Zika-endemic countries” in early 2017. But without more funding now, officials said Thursday, the research would halt in its tracks.
Another $47 million will be transferred to the Biomedical Advanced Research and Development Authority, which supports the development of drugs and vaccines to respond to public health emergencies. That money will come out of a variety of accounts, including $19 million from a program that supplies heating oil subsidies for low-income families and $4 million from substance abuse programs such as those for opioid addiction.
Even then, Ms. Burwell said, the additional money will last only through next month, at which point agencies would have to “severely curtail many of their critical efforts” against Zika without action from Congress.
In the last four months, the Centers for Disease Control and Preventionspent $60 million to help states protect pregnant women, $25 million to strengthen their Zika preparedness and response plans, and $16 million to help them create data-collection systems to quickly detect microcephaly and other Zika-related syndromes.
Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs primarily among opioid-exposed infants shortly after birth, often manifested by central nervous system irritability, autonomic overreactivity, and gastrointestinal tract dysfunction (1). During 2000–2012, the incidence of NAS in the United States significantly increased (2,3). Several recent publications have provided national estimates of NAS (2,3); however, data describing incidence at the state level are limited. CDC examined state trends in NAS incidence using all-payer, hospital inpatient delivery discharges compiled in the State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) during 1999–2013. Among 28 states with publicly available data in HCUP during 1999–2013, the overall NAS incidence increased 300%, from 1.5 per 1,000 hospital births in 1999, to 6.0 per 1,000 hospital births in 2013. During the study period, significant increases in NAS incidence occurred in 25 of 27 states with at least 3 years of data, with annual incidence rate changes ranging from 0.05 (Hawaii) to 3.6 (Vermont) per 1,000 births. In 2013, NAS incidence ranged from 0.7 cases per 1,000 hospital births (Hawaii) to 33.4 cases per 1,000 hospital births (West Virginia). The findings underscore the importance of state-based public health programs to prevent unnecessary opioid use and to treat substance use disorders during pregnancy, as well as decrease the incidence of NAS.
NAS is a postnatal withdrawal syndrome that comprises a constellation of symptoms in newborns, including central nervous system irritability (e.g., tremors, increased muscle tone, high-pitched crying, and seizures), gastrointestinal dysfunction (e.g., feeding difficulties), and temperature instability (1). Although other substances have been implicated, NAS is most often attributed to in utero opioid exposure. This exposure can result from maternal prescription opioid use, which has increased nationally in recent years (2,4), nonmedical opioid use, or medication-assisted treatment, which is long-term treatment with a longer acting but less euphoric opioid under medical supervision for opioid use disorder. Data on long-term developmental outcomes related to opioid exposure during pregnancy and NAS are limited.
The State Inpatient Databases include de-identified administrative data from all hospital inpatient discharges in a given state, regardless of payer. Data from State Inpatient Databases are compiled by state partners and then translated into a uniform format as part of HCUP, which is sponsored by the Agency for Healthcare Research and Quality. This analysis includes data from 28 states* whose data for 1999–2013 were publicly available on HCUP’s online central distributor (https://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp). Consistent with previous methodology (2,3), in-hospital births were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes V30.X–V39.X ending in 00 or 01 (indicating single or multiple live born infants), among all hospital discharge records during 1999–2013. Discharge records that did not have a principal or secondary diagnosis code indicating a hospital birth, or that indicated a transfer from another acute care hospital or health care facility, were excluded. Cases of NAS were identified with ICD-9-CM code 779.5 (drug withdrawal syndrome in a newborn). Cases of possible iatrogenic withdrawal, resulting from complications related to prolonged neonatal intensive care stay and not exposure during the antenatal period (ICD-9-CM codes: 765.01–765.05, 770.7, 772.1X, 779.7, 777.5X, 777.6), were excluded from the numerator.
Total incidence rates of NAS (cases per 1,000 births) were calculated for 1999 and 2013, using data available from 14 and 21 states, respectively. In addition, incidence rates of NAS were calculated for each state and year with available data during 1999–2013. Linear trends were assessed using logistic regression with NAS incidence as the outcome variable and infant birth year as the independent variable for the 27 states with at least 3 years of data. Annual incidence rate changes, which reflect average annual change in the incidence rate of NAS over time, were calculated from the beta coefficient of the infant’s birth year with a state-specific intercept for states with significant linear trends. P-values <0.05 were considered to be statistically significant.
During 1999–2013, among 29,944,574 hospital births that occurred in the 28 states included in this report, 74,576 NAS cases occurred, reflecting an overall incidence rate of 2.5 cases per 1,000 hospital births. In 1999 (the first year), 2,419 NAS cases were identified among 1,610,733 births in 14 reporting states (1.5 per 1,000 births). In 2013, 8,270 NAS cases were identified among 1,385,371 births in 21 states (6.0 per 1,000 births).
Data for at least 5 consecutive years were available for 27 states (Table). In 1999, NAS incidence ranged from 0.3 per 1,000 births in Iowa to 7.6 per 1,000 births in Maryland. In 2013, NAS incidence ranged from 0.7 per 1,000 births in Hawaii to 33.4 per 1,000 births in West Virginia. During 2012–2013, three of 25 states (Maine, Vermont, and West Virginia), reported NAS incidence rates >30 per 1,000 hospital births (Figure). From 1999 to 2013, the incidence of NAS significantly increased in 25 of the 27 states with at least 3 years of data included in this report (Table). NAS incidence rates did not change significantly in California and South Dakota during 1999–2013. The annual incidence rate change over 1999–2013 was lowest in Hawaii (0.05 per 1,000 births) and highest in Vermont (3.6 per 1,000 births).
The overall incidence of NAS in the states included in this report has increased almost 300% during 1999–2013, from 1.5 to 6.0 cases per 1,000 hospital births. This increase in NAS incidence is consistent with that reported by other studies, which have described a national increase in incidence of 383% (from 1.2 cases per 1,000 hospital births in 2000 to 5.8 cases per 1,000 hospital births in 2012) (2,3). Substantial variation in NAS incidence and trends by state exist, with incidences in 2013 ranging from 0.7 (Hawaii) to 33.4 per 1,000 births (West Virginia). Differences in NAS incidence might be caused by variations across states in opioid prescribing rates (5), prevalence of illicit opioid use, or use of the ICD-9 code that identifies NAS.
State governments partially finance and fully administer Medicaid programs, direct block-grant funds relevant to treatment of substance use disorders and maternal and child health programs, and license health care professionals. Previous research indicates that Medicaid programs were financially responsible for approximately 80% of the estimated $1.5 billion in NAS-related annual hospital charges in 2012 (3). Taken together, these factors make state-specific NAS estimates important to the formulation of public health plans to improve the health of mothers and infants affected by opioid use.
The findings in this report are subject to at least four limitations. First, the State Inpatient Databases include de-identified administrative data, and counts of NAS cases are based on information collected at the delivery hospitalization. In this analysis, only cases at the originating hospitals were counted. Cases identified as transfers from another hospital were not counted, to minimize possible duplication of counts and thus, overreporting of infants with NAS who might need a higher level of care. However, these rates are likely underestimates, as hospital administrative data identify fewer cases of NAS than does clinical reporting (6). Second, these estimates are not generalizable to births that occur outside of the hospital; however, out-of-hospital deliveries represented only 1.5% of births in 2014 (7). Third, although statistically significant annual changes in incidence rates were observed, these changes might not represent large increases in actual numbers of affected infants, depending on the birth population in each state. Finally, data are not generalizable to the entire United States, but only to the 28 states included in this report.
Primary prevention measures are important in curbing the incidence of NAS. In 2016, CDC released the Guideline for Prescribing Opioids for Chronic Pain, which recommends that clinicians 1) consider nonopioid pharmacologic therapy for chronic pain management, 2) discuss family planning and how long-term opioid use might affect future pregnancies before initiating opioid therapy in reproductive-aged women, and 3) prescribe the lowest effective dose when opioids are started (8). Individual states have implemented strategies to address the opioid epidemic and NAS. Prescription drug monitoring programs are operational or will be implemented in 49 states and the District of Columbia (www.cdc.gov/drugoverdose/pdmp) to track prescribing and dispensing of controlled prescription drugs; these programs have been shown to reduce inappropriate prescribing and overdose deaths (9). In addition, Florida, Georgia, Kentucky, and Tennessee have made NAS a reportable condition to state health departments to improve public health surveillance. Implementation of this type of passive surveillance of NAS can help states successfully target prevention and treatment measures, including access to medication-assisted treatment, the standard of care recommended by the American College of Obstetricians and Gynecologists for pregnant women with opioid use disorders (10). As part of the Protecting Our Infants Act of 2015,† CDC continues to provide technical assistance to states and American Indian tribes to improve NAS surveillance and to support implementation of effective public health measures.
Parents struggling to find and afford therapy for their child with autism may eventually be able to provide that therapy themselves with the help of telehealth training.
Findings from a federally funded pilot study on telehealth training at Michigan State University show the online program successfully helped parents of children with autism improve their child’s social communication using research-based intervention techniques. The results are published online in the international journal Autism and in the Journal of Autism and Developmental Disorders.
Further research is under way at MSU, but the findings offer hope that telehealth – or the delivery of health services and information via the Internet and related technologies – can fill a massive need. The prevalence of autism has increased dramatically in the past two decades without a corresponding growth in the availability of intervention services for parents.
“We now have good preliminary evidence that telehealth can increase access to parent training interventions for families of young children with autism spectrum disorder,” said Brooke Ingersoll, lead investigator on the study. “The ultimate goal is to use these types of methods to assist parents who live in rural and medically underserved areas, underrepresented groups, and even countries that don’t have the infrastructure for more intensive service delivery.”
Ingersoll, MSU associate professor of psychology and a licensed psychologist, has spent more than 15 years researching potential solutions for families of children with autism, a developmental disorder that affects an estimated 1 in 68 children and has economic costs of more than $250 billion per year in the United States annually. The pilot study was funded by the Department of Defense’s Congressionally Directed Medical Research Programs, which has made autism one of itspriorities.
The study involved 28 parents of children with autism. All parents completed one 75-minute self-directed online lesson per week, for a total of 12 weeks, and practiced the intervention techniques with their child. Half of the parents also received two 30-minute coaching sessions per week (24 total) from a therapist via video-conferencing.
Results indicate that telehealth training benefited parents and children in both groups. Parents saw improvement in their child’s social communication skills and their own competence regardless of which group they were in, although parents who received therapist assistance made greater gains in their ability to use the intervention techniques. Ingersoll noted that therapist assistance would come at a higher cost and be available only during certain times of day.
With her current research, Ingersoll is trying to understand which level of training intensity may be best for different families in order to develop a stepped-care model. That project is funded by the U.S. Health Resources and Services Administration, which is part of the U.S. Department of Health and Human Services.
“The general idea of stepped-care is that you can have low-intensity, low-cost service available to all families in the form of self-directed parent training, and then parents who need more support in learning the intervention techniques can be provided with coaching via videoconferencing. The key is to identify which families will need more support in order to benefit from telehealth training.”
In the pilot study, parents in both groups also saw improvements in their stress levels – an important finding, Ingersoll noted, as parents of children with autism often experience higher stress than other parents.
“Parents of children with autism can be highly stressed and oftentimes it’s because they don’t know how to communicate with their child. Many parents feel at a loss. So by giving them the skills to help communicate and engage with their child, it improves their sense of competence and decreases their stress.”
Ultimately, telehealth has improved care for people with chronic diseases and increased access to health information in other fields. The potential is there for autism as well.
“There is a lot of excitement about the use of telehealth technology for autism spectrum disorder, but at the same time we still need more research and information on how to best deliver it,” Ingersoll said.
Her fellow researchers include MSU graduate students Katherine Pickard, Allison Wainer and Natalie Berger.
Social and economic disadvantages play a significant role in why blacks face a much higher risk than whites of developing cognitive impairment later in life, indicates a national study led by a Michigan State University sociologist.
The odds that blacks will develop cognitive impairment, including dementia, in later life were 2.52 times greater than the odds for whites. Much of that racial disparity was explained by childhood disadvantages, such as growing up poor and in the segregated South, and lower socioeconomic status in adulthood, particularly educational attainment.
Surprisingly, racial differences in health problems, such as heart disease and diabetes, and health behaviors, such as smoking and drinking, did not explain much of the racial gap in cognitive impairment, said Zhenmei Zhang, MSU associate professor of sociology.
While the findings do not fully explain blacks’ higher risk of cognitive impairment, they point to a strong need for policymakers to focus more on reducing racial gaps in socioeconomic resources over the lifespan, she said. The federally funded study is published in the Journal of Health and Social Behavior.
“Social policies such as increasing educational resources in low-income communities, providing economic support to poor students and their families, improving graduation rates in high schools and colleges, and eliminating discrimination against blacks in the job market may significantly reduce racial disparities in cognitive impairment in later life,” Zhang said.
Zhang and colleagues analyzed survey data from 8,946 participants in the Health and Retirement Study. The information was collected in multiple waves over a 12-year period (1998-2010); participants were aged 65 or older at the start of the study.
Once the researchers took into account the various socioeconomic factors, which include childhood disadvantages, the odds ratio of cognitive impairment between blacks and whites – or the racial gap – was reduced considerably, from 2.52 to 1.45. That means socioeconomic factors explained a significant amount of the racial gap.
Cognitive impairment among the elderly is a growing problem – spending on dementia care alone exceeds $100 billion a year in the United States – but it hits blacks particularly hard, Zhang noted. The Alzheimer’s Association has identified Alzheimer’s disease among blacks as an emerging public health crisis.
“As people live longer and longer, it becomes an even bigger issue,” Zhang said.
Her co-authors on the study were Mark Hayward, professor at the University of Texas, and Yan-Liang Yu, doctoral student at MSU. The study received funding from the National Institute on Aging and the National Institute of Child Health and Human Development, both part of the National Institutes of Health.
For men, an unhappy marriage may actually slow the development of diabetes and promote successful treatment once they do get the disease, finds a national study led by a Michigan State University sociologist.
Why? It may be because wives are constantly regulating their husband’s health behaviors, especially if he is in poor health or diabetic. And while this may improve the husband’s health, it also can be seen as annoying and provoke hostility and emotional distress.
“The study challenges the traditional assumption that negative marital quality is always detrimental to health,” said Hui Liu, MSU associate professor of sociology and lead investigator of the federally funded research. “It also encourages family scholars to distinguish different sources and types of marital quality. Sometimes, nagging is caring.”
Using data from the National Social Life, Health and Aging Project, Liu and colleagues analyzed survey results from 1,228 married respondents over five years. At the onset of the study, the respondents were 57 to 85 years old; 389 had diabetes at the end of the study.
Diabetes is the seventh leading cause of death in the United States. More than 29 million Americans had diabetes in 2012, or 9.3 percent of the population.
Liu, an expert in population-based health and family science, investigated the role of marital quality in diabetes risk and management and found two major gender differences:
*The most surprising finding was that, for men, an increase in negative marital quality lowered the risk of developing diabetes and increased the chances of managing the disease after its onset. Diabetes requires frequent monitoring that the wives could be prodding the husband to do, boosting his health but also increasing marital strain over time.
*For women, a good marriage was related to a lower risk of being diabetic five years later. Women may be more sensitive than men to the quality of a relationship and thus more likely to experience a health boost from a good-quality relationship, Liu said.
“Since diabetes is the fastest growing chronic condition in the United States, implementation of public policies and programs designed to promote marital quality should also reduce the risk of diabetes and promote health and longevity, especially for women at older ages,” the study says.
The study, published online in the Journals of Gerontology: Social Sciences, was co-authored by Shannon Shen, an MSU graduate, and Linda Waite, professor at the University of Chicago.
The research was partially funded by the National Institute on Aging, the National Institute of Child Health and Human Development and the Office of Behavioral and Social Sciences Research, which are all part of the National Institutes of Health.