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Inflammation In The Womb May Explain Why Some Babies Are More Prone To Sepsis After Birth

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Each year 15 million infants are born preterm and face high risks of short- and long-term complications, including sepsis, severe inflammation of the gut, and neurodevelopmental disorders. A new report in the American Journal of Pathology demonstrates a link between prenatal inflammation and postnatal immune status and organ function in preterm pigs, suggesting that early intervention (eg, antibiotics or anti-inflammatory drugs) may be warranted for infants born preterm with signs of inflammation of fetal membranes.

“Our study may urge clinicians to be more aware of the population of preterm infants with chorioamnionitis (inflammation of the fetal membrane) as they have higher risks of systemic inflammation and neonatal sepsis,” explained lead investigator Per T. Sangild, DVSc, DMSc, PhD, of the Section of Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark, and the Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.

“The data imply the importance of the integrity of barriers between epithelial tissues (eg, gut, lungs, and skin) and the circulation. Those barriers are more fragile in preterm neonates, and they can facilitate translocation of bacteria and inflammatory molecules, leading to systemic inflammation and internal organ disorders.”

To induce prenatal inflammation, the bacterial endotoxin lipopolysaccharide (LPS) was injected into the amniotic sacs of prenatal pigs. LPS and control groups were analyzed at birth, three days after birth, and five days after birth (formula feeding).

At birth, prenatal LPS induced mild histologic chorioamnionitis and strong fetal lung and gut innate immune responses with elevated inflammatory cytokines and neutrophil/macrophage infiltration. “We believe the epithelial responses were likely derived from direct exposure to intra-amniotic LPS or LPS-induced cytokines,” noted Dr. Sangild.

Five days later, the gut and lung inflammation subsided; however, the pigs exposed to LPS prenatally gradually developed systemic inflammation, with high levels of blood leukocyte subsets (eg, neutrophils, lymphocytes) and plasma cytokines (eg, IL-1?), similar to symptoms found in septic infants. Among those who survived, the pigs in the control group were on their feet and walked for the first time before the LPS-exposed animals. High levels of bacteria were also found in the spleen in the LPS-exposed pigs, indicating increased systemic infection or decreased capacity to clear translocated bacteria. The in utero death rate was higher in the LPS-exposed fetuses compared to the control group, as was the incidence of severe diarrhea. Interestingly, intra-amniotic LPS did not increase the incidence of formula-induced necrotizing enterocolitis (NEC) on Day 5. This is important as it has been suspected that systemic inflammation at birth might also predispose to later NEC in the gut of preterm infants; however, this hypothesis was not supported by this study.

“These data suggest that the postnatal systemic effects of short-term prenatal LPS were indirectly initiated from the preceding local inflammation of epithelial tissues in the fetal period, and the effects were gradually amplified systemically during the first few days after preterm birth,” commented Dr. Sangild.

The results of this study highlight the importance of early diagnosis of prenatal inflammation to facilitate nutritional, medical, or pharmaceutical interventions that attenuate the detrimental postnatal responses to prenatal inflammation. The problem still remains that a pregnant woman with intra-amniotic inflammation may be asymptomatic and, therefore, unaware she has an infection that could harm her baby.

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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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