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The Relationship of Child Health and Parenting Stress to Child Neurocognitive Development
Get PDFProblem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was to examine the contributions of parenting stress and child health to NCD in a sample of diverse, urban mother-child dyads. In addition, the study aimed to describe maternal and child characteristics associated with child neurocognitive development (NCD) at age 3 years. We examined the differences in parenting stress levels in mothers of 3-year-old children with and without special health care needs. The primary factors of child health and parenting stress along with child and maternal characteristics and covariates (i.e., maternal depression, IQ, and knowledge of child development) were examined for their contributions to child NCD. Method. The Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study data was used for a secondary data analysis for this study after submission and approval of a Manuscript Analysis Plan Proposal (MAPP) from the CANDLE primary investigation team and IRB approval by University of Tennessee Health Science Center. The CANDLE study has a large, longitudinal collection of data on a diverse sample of urban mother-child dyads in the southern U.S. that examines contributions of maternal and child factors to child development. Applying the bioecological model of Bronfenbrenner, this study uses descriptive analysis, chi-square method, and linear models based of CANDLE study data to examine the relationship of parenting stress, child health, and child NCD at age three years and associated child and maternal characteristics. Finally, models will be created to explain the effect of child health and parenting stress on NCD, considering select covariates. Results. Sixteen percent, 171 of 1039 children met the criteria of special health care needs. Of the children identified with special healthcare needs, 25% of mothers reported concerns regarding their child’s health and or development compared to 9% of mothers of children who do not have any special health care needs. Nine percent of mothers of children not identified with special health care needs reported concerns over health and development. Parenting stress scores were significantly higher in mothers of children with special health care needs (odds ratio = 1.72; 95% CI = 1.158-2.6753; p=.0152). Cognitive scores were significantly different between children with and without special health care needs controlling for parenting stress with an effect of 0.5 (SE= 0.17; p=.0056). Models examining associations of child health and parenting stress, considering covariates, found that child health and parenting stress explained child NCD, specifically receptive communication. Implications. Efforts to increase child NCD in this population are needed. Reduction of parenting stress related to psychological, biological, and environmental factors can assist in promoting the development of children in this sample. Identifying, intervening, and reducing these sources of stress through appropriate screening, education, policies, and support is needed. In addition, the consequences of child health can influence parenting stress and child NCD. Support for child health initiatives such as health promotion, illness prevention, and appropriate early intervention will contribute to the reduction of parental stress and can improve child NCD. Sustained interventions to promote child health and reduce parenting stress will lead to a more optimistic future for children and their NCD
Effect of Botox and Therapy on Spasticity in Cerebral Palsy: A Critically Appraised Topic
Get PDFChildren diagnosed with Cerebral Palsy often experience upper limb spasticity. Research has shown Botox injections in combination with occupational therapy can reduce the effects of spasticity in the upper limb. This literature review aims to determine how long is the appropriate duration of occupational therapy to administer after Botox injections to see decreased spasticity in the upper limbs
The Co-expression of ROR1 and FZD2 in WNT5B Signaling in Osteosarcoma
Get PDFOsteosarcoma is the most common primary bone malignancy. There is currently no targeted therapy, so standard treatment involves surgical resection along with chemotherapy. There is a large subset of osteosarcoma that has a high expression of WNT5B, which is linked to a worse overall survival probability. The WNT5B pathway in osteosarcoma is not known, so we wanted to find out what receptors it signals through. We came up with two candidates, ROR1 and FZD2, then tested our hypothesis using immunohistochemistry. We first optimized the antigen retrieval step and ROR1 primary antibody for our immunohistochemistry protocol then proceeded to test our hypothesis. We found that when WNT5B is present in the tumor, ROR1 and FZD2 are also present, likewise, when WNT5B is absent ROR1 and FZD2 are also absent. We also noticed that these proteins are all confined to the tumor itself, not the stroma. Lastly, we saw that WNT5B, ROR1 and FZD2 appear to be in the same locations in each sample, suggesting a potential signaling relationship. We hope to one day use these receptors as druggable targets to disrupt the WNT5B pathway in patients that have osteosarcoma with WNT5B overexpression
Provider Attitude towards Postpartum Sexual Health
Get PDFBackground: The prevalence of female sexual dysfunction (FSD) worldwide is estimated to be 41%. FSD is even more prevalent in postpartum patients. There are significant barriers to addressing FSD in a busy clinic, and the use of a standardized screening questionnaire could be used to improve outcomes during postpartum appointments.
Methodology: Providers that care for postpartum patients at Regional One Health in Memphis, TN, were asked to complete an anonymous survey online. General knowledge and practices of providers were assessed.
Results: 79% of respondents answered that they felt very comfortable assessing for postpartum sexual health, and 88% of respondents expressed a need for continued education on sexual medicine. The most common response for barriers to care was a lack of time. None of the respondents reported using questionnaires to assess for sexual health.
Conclusion: The most significant barriers to assessing postpartum sexual health are a lack of time and provider knowledge. To overcome this, a standardized questionnaire should be created and improved continued education should be implemented
Ribonucleotide Reductase Subunit Switching in Hepatoblastoma Drug Response and Relapse
Get PDFHepatoblastoma is the most common primary liver cancer in infants and young children. Despite being a very rare cancer that accounts for only 0.5-2% if all childhood cancer cases, HB has the largest increase in incidence among childhood cancers in the United States and worldwide. The five-year survival rate of children with the aggressive forms of HB, including those that have developed metastatic or recurrent diseases, is less than 40% due to the lack of effective treatment. We aim to identify targetable mechanisms underlying the progression and drug resistance of high-risk HB. Our recent work on HB mouse and organoid models, patient-derived xenografts (PDX) and primary patient samples revealed a significant upregulation of ribonucleotide reductase (RNR) subunit M2 (RRM2) in high-risk HB. RNR is the sole enzymatic complex in mammal cells that converts ribonucleotides to deoxyribonucleotides and plays a critical role in regulating cell division and DNA repair. We found standard chemotherapy agents as well as two RRM2 inhibitors, triapine and MK1775, werecapable of reducing RRM2 expression effectively in vitro. However, we found a significant induction of another RNR subunit M2B (RRM2B) in treated cells in corresponding to RRM2 reduction. While no changes in drug response were noticed in RRM2B knockout (KO) HB cells. RRM2B levels in HB cells showed a strong impact on cells’ ability to recover after chemotherapy. RRM2BOE HB cells showed a significant increase in their colony formation potential after chemotherapy where RRM2BKO cells formed much fewer colonies after treatment compared to the control cells. Interestingly, we noticed a reversed subunit switch from RRM2B to RRM2 during the recovery period when cell proliferation was restored. RRM2, indeed, had a much higher enzymatic activity in converting ribonucleotides to deoxyribonucleotides than RRM2B and promoted cell growth much more efficiently than RRM2B when both were overexpressed in HB cells. Finally, combining the RRM2 inhibitor MK1775 with standard chemotherapy in HB PDX models, although showing no additional benefit in reducing tumor size, significantly delayed tumor relapse after drug withdrawal. In this study, we demonstrated an intriguing switching between two RNR subunits, RRM2 and RRM2B in HB cells undergoing drug treatment and during their recovery afterwards. Our data suggest that RRM2 supports HB growth while its switching to RRM2B is critical to tumor cell survival under drug treatment. When tumor relapses, there is a reversed subunit switch from RRM2B to RRM2 to supports the recurrent growth of the tumor, which can serve as a potential therapeutic target in preventing HB relapse
Depression Awareness Programs for Adolescents: A Scoping Review
Get PDFThe purpose of this DNP project is to determine if receiving school-based depression awareness education affects the depression scores of adolescents between 10 and 19 years of age
Cerebellar Coordination of Neuronal and Behavioral Rhythms
Get PDFLong known for its role in motor control, it is increasingly clear that the cerebellum is also involved in numerous cognitive and affective behaviors. Though the neuronal mechanism for the role of the cerebellum in cognition is still unclear, there is a consensus that it involves cerebellar interactions with the cerebral cortex. Recent studies suggest that the cerebellum monitors, and possibly coordinates, the precise phase alignment or coherence of neuronal oscillations in cerebral cortical areas. Here, we asked how loss of cerebellar function affects respiratory rhythms and the interactions of local field potential (LFP) oscillations between the lobulus simplex (LS) in the cerebellum, medial prefrontal cortex (mPFC), and dorsal CA1 (dCA1) using multisite in vivo extracellular recordings in freely moving mice. We compared a mouse model of cerebellar ataxia and their littermate controls. The ataxic mice were designed to have a genetically induced loss of Purkinje cell neurotransmission, resulting in an expected repertoire of cerebellar motor deficits. Here we asked whether these mice also have neurophysiological defects that are indicative of cognitive circuit dysfunction. We quantified respiratory interval regularity and rhythmicity, power spectra of LFP oscillations in each structure, the magnitudes of coherence of oscillations and Granger causality between each pair of structures using a nonparametric spectral method, and the phase amplitude coupling (PAC) of LFP oscillations within and between each structure. Resting-state coherence of gamma oscillations between LS and mPFC was significantly increased in ataxic mice relative to their controls. Ataxic animals also showed significantly larger Granger causality from the mPFC to cerebellar LS in gamma frequencies compared to littermate controls. Significant PAC within LS was observed at very high gamma frequencies. Our findings reveal that Purkinje cell neurotransmission is required for normal functional interactions between the cerebellum and cerebral cortex and between cerebral cortical areas involved in cognitive functions, suggesting an involvement of the cerebellum in the modulation or coordination of functional communication between brain areas
Risk for Preeclampsia Associated with Nutritional Deficiencies and Modified by APOL1 Genotype
Get PDFPreeclampsia (PE) is a hypertensive disorder of pregnancy that is associated with micronutrient deficiencies. Nutrients involved in placental health and maintenance, such as vitamin D and folate, are important nutrients to assess in the risk of PE. As gestational age increases, the levels of vitamin D and folate potentially have incrementally increasing concentrations associated with PE. In addition to micronutrient deficiencies, PE is also associated with the presence of APOL1 high-risk (HR) variants. It was also hypothesized that a potential additive effect exists between HR APOL1 genotype status and nutritional deficiencies that would place individuals at a higher risk of developing PE. A systematic and meta-analysis was conducted to assess the hypothesis that vitamin D and folate levels were risk factors for PE based on specific gestational time periods. Additionally, a case-control study was conducted using a subset of African American mother and infant dyads collected from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) cohort in Memphis, TN. This study included maternal blood samples that assessed serum vitamin D and folate levels during the 2nd and 3rd trimesters of pregnancy. Logistic regression model was used to further assess whether maternal or fetal apolipoprotein genotype status modified the association with PE and folate or vitamin D. In addition to maternal blood samples, reported micronutrient intake of calcium, magnesium, selenium and folate were also assessed. Low vitamin D and folate levels were associated with the development of PE in the systematic review and meta-analyses. Case-control studies further evaluated this association and expanded current understanding by assessing vitamin D and folate deficiencies in conjunction with APOL1 genotype status. When having a child with HR APOL1 genotype, African American women with 25(OH)D lower than 20 ng/mL in the 2nd or 3rd trimester were found to have a two-fold and six-fold increased odds of developing PE. We found a similar association with the assessment of folate levels. Individuals with plasma folate less than 15 ng/mL within the 2nd trimester and a child with fetal APOL1 HR genotype were at a three-fold risk of developing PE. Findings suggest the importance of nutrigenetics in future PE research
Using CRISPR Gene Editing to Prevent Accumulation of Lipids in Hepatocytes
Get PDFCRISPR gene editing is a molecular technology that can be used to silence gene expression. In this experiment, genes that are known to play a role in lipid accumulation in hepatocytes were targeted. Specifically, levels of fatty acid transport proteins 2 and 5 (FATP2 & 5) have been shown to be elevated in cases of non-alcoholic fatty liver disease. The goal of this experiment was to reduce expression of these genes by using a dead Cas9 (dCas9) protein with an attached inhibitory domain (KRAB) that acts on the promotor region. When measuring the mRNA expression, it was determined that the levels of the CRISPR-modified gene products were significantly reduced compared to the control. However, the same extent of inhibition was not consistently observed when conducting flow cytometry. Current work is aimed at discovering why lipid accumulation is not inhibited to the expected degree based on the results of mRNA expression
Central Line Associated Blood Stream Infection Prevention with use of Disinfection Caps: A Scoping Review
Get PDFPurpose/Background Central lines provide lifesaving uses, but they also place the patient at risk for central line associated blood stream infections (CLABSI). Catheter location, length of stay, handwashing, dressing changes, and disinfection of ports before use are all factors to prevent CLABSIs, yet sometimes these measures are not enough. Disinfecting caps are another way to decrease central line infection, however not all hospitals use this method. This scoping review aims to compare CLABSI rates with and without the use of disinfecting caps for the duration of central line use in intensive care patients.
Methods From August 2019 to September 2021, only published, peer-reviewed studies over the last nine years were included. Studies included compared infection rates with and without cap usage, quality improvement measures, implementation of caps, handwashing, dressing changes, CHG baths, and checklists. The search engine utilized was the University of Tennessee Health Science Center’s library engine.
Results This scoping review compared rates of blood stream infections before and after the use of disinfecting caps on central lines. The results are based on data extracted from ten peer reviewed, evidence-based literature sources which have been evaluated and critically appraised by all group members. The scoping review revealed that using disinfection caps, in addition to other infection prevention measures (CHG baths, dressing change protocols, checklist bundles) significantly reduced the number of central line associated blood stream infections in critically ill hospitalized patients. CLABSI prevention bundles were sometimes used in conjunction with disinfection caps to promote maximum effort in reduction of infection.
Implications for Nursing Practice Central lines are required for the care of some of our sickest patients, which are also at the largest risk of opportunistic infections. In addition to maintenance bundles that include sterile placement, routine dressing changes, and cleaning ports prior to access, the use of disinfecting caps provides a physical barrier from infection. With the use of disinfecting caps, maintenance bundles and continuous quality improvement efforts, the hope is to continue to decrease the number of CLABSI and provide patients with evidence-based care