UNDERSTANDING WELL-BEING AMONG CHILDREN BORN EXTREMELY PRETERM & THEIR CAREGIVERS

Background: Approximately 30-40% of extremely premature (EP) infants will develop a neurodevelopmental disorder. Individuals with neurodevelopmental disorders, and their caregivers, report lower quality of life and higher rates of stress as compared to the general population. Adverse outcomes which are further compounded by prevailing inequities in environment that disproportionately affect racial/ethnic minorities. Yet, despite the multiple risks associated with EP birth, there is still the possibility for positive health and well-being. However, literature focused on identifying and exploring potentially protective socio-environmental factors remains limited. Method: This was a multi-method, three-chapter dissertation. Paper 1 was a secondary analysis of existing ELGAN data whose purpose was to identified specific individual, and familial, characteristics at age 10 that was associated with positive health outcomes at age 15. Paper 2 was a qualitative meta-synthesis whose aim was to synthesize qualitative studies exploring how families from a racial/ethnic minority background in the United States experienced well-being and responded to challenges faced while caring for a child diagnosed with three selected neurodevelopmental disorders. Finally, paper 3 was a qualitative descriptive study focused on the perception, and experiences, of primary caregivers of extremely preterm children. Results: Well-being was identified throughout this dissertation as a complex, personal experience for primary caregivers of EP children with/without neurodevelopmental disorders; with what was emphasized as being essential to well-being varying by the neurodevelopmental health of the child. Conclusion: While well-being is a unique, personal experience, resilience in the face of multiple barriers is a necessity to develop well-being. Facilitators to well-being that were identified were: adaptation to an EP/neurodevelopmental diagnosis, becoming a resilient advocate and primary caregivers’ reliance on their spiritual/religious beliefs.Doctor of Philosoph

A Meta-Synthesis of Experiences of People with Autism Spectrum Disorder and that of their Family Members in Acute Care and Inpatient Settings

Individuals with Autism Spectrum Disorder (ASD) are 1.25 more likely to be hospitalized and much more likely to display negative behavior (i.e. biting, hurting self or others, and engaging in disruptive behavior) than individuals without ASD. Despite this, little research has been done to capture the experiences they or their caregivers face in acute care settings. This qualitative synthesis used the PRISMA guidelines to search for and integrate what is currently known from published qualitative research on the experiences of individuals with ASD and their caregivers when they require services in acute care settings. Three large databases were searched and resulted in 667 studies that were screened. Inclusion criteria included a) a diagnosis of Autism Spectrum Disorder b) qualitative studies that focused on experiences of either the individual or family member of the person diagnosed with ASD; c) Experiences had to be based on either acute care or inpatient settings d) Articles had to be published within ten years. Only nine articles met the inclusion criteria. Three broad themes were identified: 1) the unique challenges of ASD; 2) the socially constructed barriers encountered in some acute care settings; and, 3) suggestions to make these settings patient and family friendly to ASD needs. The findings highlight that insensitive cultures lead to socially constructed barriers. More research is needed to further uncover how socially constructed barriers develop and contribute to the disability and disparities in this population so that relevant interventions, policies, and research can be implemented.Bachelor of Art

Child and family factors associated with positive outcomes among youth born extremely preterm

BackgroundTo analyze the relationship of child behavioral and communication disorders, and adverse family events, to later-in-life child health and cognitive function among youth born extremely preterm.MethodsThe study participants were 694 children enrolled in the Extremely Low Gestational Age Newborn Study. At ages 2 and 10, we assessed internalizing and externalizing behaviors, and at age 10, we assessed adverse life events within the family. Associations were evaluated between these child and family factors and positive child health at age 10 years, and global health and cognitive function at age 15 years.ResultsLower T-scores for internalizing or externalizing behaviors at age 2 were associated with more positive health at age 10. The absence of internalizing behaviors at age 10 was associated with better global child health and better cognitive function at age 15. The absence of communication deficits at age 10 was associated with better cognitive function at age 15. The absence of parent job loss was associated with better global child health at age 15.ConclusionAmong individuals born extremely preterm, child health and cognitive outcomes might be improved by timely interventions to address child behavioral symptoms and the impact of adverse life events in the family.ImpactThe absence of child behavioral and communication disorders, and adverse family events, were associated with more positive health, higher global health, and better cognitive function among youth born extremely preterm.Interventions to address behavioral disorders in early childhood, and to reduce the impact of adverse life events on the family, might promote improved health and developmental outcomes for adolescents born extremely preterm

Prophylactic Supplementation of Bifidobacterium longum 51A Protects Mice from Ovariectomy-Induced Exacerbated Allergic Airway Inflammation and Airway Hyperresponsiveness

Asthma is a chronic inflammatory disease that affects more females than males after puberty, and its symptoms and severity in women change during menstruation and menopause. Recently, evidence has demonstrated that interactions among the microbiota, female sex hormones, and immunity are associated with the development of autoimmune diseases. However, no studies have investigated if therapeutic gut microbiota modulation strategies could affect asthma exacerbation during menstruation and menopause. Here we aimed to examine the preventive effects of a probiotic, Bifidobacterium longum 51A, on airway inflammation exacerbation in allergic ovariectomized mice. We first evaluated the gut microbiota composition and diversity in mice 10 days after ovariectomy. Next, we examined whether re-exposure of ovariectomized allergic mice to antigen (ovalbumin) would lead to exacerbation of lung inflammation. Finally, we evaluated the preventive and treatment effect of B. longum 51A on lung inflammation and airway hyperresponsiveness. Our results showed that whereas ovariectomy caused no alterations in the gut microbiota composition and diversity in this animal model, 10 days after ovariectomy, preventive use administration of B. longum 51A, rather than its use after surgery was capable of attenuate the exacerbated lung inflammation and hyperresponsiveness in ovariectomized allergic mice. This prophylactic effect of B. longum 51A involves acetate production, which led to increased fecal acetate levels and, consequently, increased Treg cells in ovariectomized allergic mice

A probiotic has differential effects on allergic airway inflammation in A/J and C57BL/6 mice and is correlated with the gut microbiome

Abstract The phenotypes of allergic airway diseases are influenced by the interplay between host genetics and the gut microbiota, which may be modulated by probiotics. We investigated the probiotic effects on allergic inflammation in A/J and C57BL/6 mice. C57BL/6 mice had increased gut microbiota diversity compared to A/J mice at baseline. Acetate producer probiotics differentially modulated and altered the genus abundance of specific bacteria, such as Akkermansia and Allistipes, in mouse strains. We induced airway inflammation followed by probiotic treatment and found that only A/J mice exhibited decreased inflammation, and the beneficial effects of probiotics in A/J mice were partially due to acetate production. To understand the relevance of microbial composition colonization in the development of allergic diseases, we implanted female C57BL/6 mice with A/J embryos to naturally modulate the microbial composition of A/J mice, which increased gut microbiota diversity and reduced eosinophilic inflammation in A/J. These data demonstrate the central importance of microbiota to allergic phenotype severity. Video Abstrac