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Cannabis Does Not Improve Breathlessness During Exercise In Patients With Advanced COPD

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Inhaled vaporized cannabis does not appear to improve or worsen exercise performance and activity-related breathlessness in patients with advanced chronic obstructive pulmonary disease (COPD), according to a randomized controlled trial published online in the Annals of the American Thoracic Society.

In “Effect of Vaporized Cannabis on Exertional Breathlessness and Exercise Endurance in Advanced COPD: A Randomized Controlled Trial,” Sara J. Abdallah, a PhD candidate in exercise physiology at McGill University, and co-authors report that the trial did not find a difference between vaporized cannabis and placebo on lung volumes or heart rate at rest or during exercise. Nor did the study find that cannabis affected cognitive function, mood or psycho-activity.

The burden of breathlessness in patients with COPD is high. Even when on optimal medication for their lung disease, many patients with COPD continue to suffer from disabling breathlessness at rest and while performing basic activities of daily living.

“We first became aware of the therapeutic potential of cannabis in managing COPD symptoms from patients themselves,” Ms. Abdallah said.

“We decided to pursue this study because patients were reporting symptomatic relief of their COPD symptoms after cannabis use.”

In the 1970s, controlled studies reported that smoking cannabis opened the airways of adults with and without asthma. More recently, a large observational study found a positive association between cannabis use and forced expiratory volume (the amount of air that can be forcefully exhaled in one second) and forced vital capacity (the total amount of air that can be exhaled after taking a deep breath).

In the current crossover study of 16 patients with advanced COPD, all the patients were taking optimal medication for their lung disease: dual or triple inhalation therapy (long-acting muscarinic antagonist and long-acting beta2-agonist bronchodilator with or without an inhaled corticosteroid).

Participants were randomly selected to inhale a single dose of vaporized cannabis or a placebo before exercising on a stationary bike. Participants then “crossed over” to the other arm of the trial. Neither the researchers nor the patients knew when they were receiving the vaporized cannabis or the placebo.

Although the study did not find a clinically meaningful negative or positive effect of vaporized cannabis on breathlessness during exercise or on exercise performance, the researchers noted variability in responsiveness to the cannabis.

After inhaling vaporized cannabis, breathlessness during exercise improved in 4 of the 16 patients. In the remaining 12 patients, breathlessness during exercise did not change, or worsened.

Senior study author Dennis Jensen, PhD, associate professor of kinesiology and physical education and a scientist in the Translational Research in Respiratory Diseases Program at McGill University, said that trial results may not be generalizable because the number of participants was small and represented a relatively homogenous group of patients with stable, but advanced, COPD.

In addition to the fact that all the participants were on optimal COPD therapy, Dr. Jensen, who is also director of the McGill Research Centre for Physical Activity and Health, suggested a number of factors that may have limited the therapeutic benefit of cannabis in the study, including the dose of cannabis used, that it was inhaled rather than taken orally and that it was administered only once and not repeated.

“Future clinical trials are warranted and should evaluate the therapeutic potential of various doses of vaporized and oral cannabis, including oils and pills, administered over longer periods of time in patients with mild to moderate COPD,” he said.

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Parents, Kids Spend More Time Discussing How To Use Mobile Technology Than Talking About Content

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ANN ARBOR—Most parents would agree that one of the of the biggest modern parenting challenges is monitoring a child’s online activity.

A new study appearing in the Journal of Child and Family Studies found that parents spend more time talking with kids about the mechanics of using their mobile devices than they do about what their kids watch and download on those devices.

The findings came from a small, recent study of 75 children and their families, led by researcher Sarah Domoff, then a postdoctoral fellow at University of Michigan Center for Human Growth and Development. The children wore recording devices at home, which recorded talking, conversations or other sounds nearby, as well as audible screen media use.

Domoff, now an assistant professor at Central Michigan University, said the findings revealed some concerning trends in how families and children communicate about media today. Specifically, the researchers observed minimal conversation about the content of programming that children were watching.

Additionally, they learned that other family members appear to play an important role when content is discussed. Children––not parents––initiated most conversations about content, and older siblings played a much bigger role than parents in content mediation for younger siblings. Also, the study found that children as young as toddlers were exposed to multiple media sources at one time, or media multitasking.

Other findings include:

  • Negotiations and conflict are common among parents and children.
  • Parallel family media use is common, meaning different family members use their own devices at the same time.

“One of the most challenging aspects of parenting today is being aware of what children are exposed to online, particularly content delivered via mobile devices,” Domoff said.

“Thus, it is critical that parents utilize privacy settings and restrictions to protect children from certain content. Ideally, this would occur before the child received their own mobile device.”

Domoff recommends developing a family media plan. In 2016, The American Academy of Pediatrics released a tool that helps families set different goals and media use rules based on individual needs, she said.

It’s also troubling that some apps downloaded by children include advertising or request in-app purchases, she said. Parents can identify these apps by using Common Sense Media’s app review.

Parents can also recruit older children to help younger siblings make good content choices.

The study aimed to identify themes of parental mediation and family communication around mobile media devices. There’s a dearth of scientific data in this area compared to television and video games, but studies show that parental mediation leads to better outcomes for children.

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Internet Therapy Apps Reduce Depression Symptoms

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BLOOMINGTON, Ind. — In a sweeping new study, Indiana University psychologists have found that a series of self-guided, internet-based therapy platforms effectively reduce depression.

The work, which reviewed 21 pre-existing studies with a total of 4,781 participants, was published in the November issue of the Journal of Medical Internet Research. The study was led by Lorenzo Lorenzo-Luaces, an assistant professor of clinical psychology in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences.

In the past several years, many internet-based apps and websites have made claims to treat depression. The subjects of the IU study were specifically those applications that provide treatment with cognitive behavioral therapy, a form of psychotherapy that focuses on changing thought patterns and behavior to alleviate symptoms of depression and other mental disorders.

Previous studies had examined the effectiveness of individual internet-based cognitive behavioral therapy apps, or iCBT, using a range of methods. Until this study, however, no review had examined whether the effects of these treatments were inflated by excluding patients with more severe depression or additional conditions such as anxiety or alcohol abuse.

“Before this study, I thought past studies were probably focused on people with very mild depression, those who did not have other mental health problems, and were at low risk for suicide,” Lorenzo-Luaces said.

“To my surprise, that was not the case. The science suggests that these apps and platforms can help a large number of people.”

For Lorenzo-Luaces, internet-based cognitive behavioral therapy apps are an important new tool for addressing a major public health issue: that individuals with mental health disorders like depression far outnumber the mental health providers available to treat them.

“Close to one in four people meet the criteria for major depressive disorder,” he said.

“If you include people with minor depression or who have been depressed for a week or a month with a few symptoms, the number grows, exceeding the number of psychologists who can serve them.”

People with depression are also expensive for the health care system, he added.

“They tend to visit primary-care physicians more often than others,” Lorenzo-Luaces said.

“They have more medical problems, and their depression sometimes gets in the way of their taking their medication for other medical problems.”

By conducting a “meta-regression analysis” of 21 studies, Lorenzo-Luaces and collaborators decisively determined that internet-based therapy platforms effectively alleviate depression. A central question was determining whether previous studies distorted the strength of these systems’ effects by excluding people with severe depression.

The conclusion was that the apps worked in cases of mild, moderate and severe depression.

Many of the studies in the analysis compared use of internet-based cognitive behavioral therapy apps to placement on a wait list for therapy or the use of a “fake app” that made weak recommendations to the user. In these cases, the iCBT apps worked significantly better.

“This is not to say that you should stop taking your medication and go to the nearest app store,” added Lorenzo-Luaces, who said both face-to-face therapy and antidepressants may still prove to be more effective than the iCBT apps alone.

“People tend to do better when they have a little bit of guidance,” he said. But he added that a 10- to 15-minute check-in may be sufficient for many people, freeing health care providers to see more patients.

App-based therapy also has an advantage in situations where access to face-to-face therapy is limited due to logistical barriers, such as long distances in rural areas or inflexible work schedules.

“ICBT apps take the methods we have learned and make them available to the many people who could benefit from them,” Lorenzo-Luaces said.

“It’s an exciting development.”

 

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New Study Finds Employee Incentives Can Lead To Unethical Behavior In The Workplace

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Considering end-of-year bonuses for your employees? Supervisors be forewarned, a new study finds that while incentive rewards can help motivate and increase employee performance it can also lead to unethical behavior in the workplace.

“Goal fixation can have a profound impact on employee behavior, and the damaging effects appear to be growing stronger in today’s competitive business landscape,” says Bill Becker, co-author of the study and associate professor of management in the Pamplin College of Business at Virginia Tech.

The study, “The effects of goals and pay structure on managerial reporting dishonesty,” provides valuable insight into the relationship between pay structures and motivation.

Findings suggest that setting compensation goals can increase dishonesty when managers are also paid a bonus for hitting certain targets.

“These unintended negative consequences can lead to dishonesty, unethical behavior, increased risk-taking, escalation of commitment, and depletion of self-control,” says Becker.

The study points to observations of unethical behaviors in the workplace that include employees falsifying or manipulating financial reporting information as well as time and expense reports.

For example, service professionals such as auditors, contractors, lawyers, and consultants who report hours billed against a target budget is often based on a fixed contract price.

“This causes potential for both under-reporting and over-reporting costs, which can undermine organizational objectives and negatively impact the interest of the firm,” says Becker.

“Using purely monetary incentives is almost always a double edged sword.”

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