OREGON STATE UNIVERSITY

heath and nutrition

Beyond antibiotics: “PPMOs” offer new approach to bacterial infection

CORVALLIS, Ore. – Researchers at Oregon State University and other institutions today announced the successful use of a new type of antibacterial agent called a PPMO, which appears to function as well or better than an antibiotic, but may be more precise and also solve problems with antibiotic resistance.

In animal studies, one form of PPMO showed significant control of two strains of Acinetobacter, a group of bacteria of global concern that has caused significant mortality among military personnel serving in Middle East combat.

The new PPMOs offer a fundamentally different attack on bacterial infection, researchers say.

They specifically target the underlying genes of a bacterium, whereas conventional antibiotics just disrupt its cellular function and often have broader, unwanted impacts. As they are further developed, PPMOs should offer a completely different and more precise approach to managing bacterial infection, or conceptually almost any disease that has an underlying genetic component.

The findings were published today in the Journal of Infectious Diseases, by researchers from OSU, the University of Texas Southwestern Medical Center, and Sarepta, Inc., a Corvallis, Ore., firm.

“The mechanism that PPMOs use to kill bacteria is revolutionary,” said Bruce Geller, a professor of microbiology in the OSU College of Science and lead author on the study. “They can be synthesized to target almost any gene, and in that way avoid the development of antibiotic resistance and the negative impacts sometimes associated with broad-spectrum antibiotics.

“Molecular medicine,” Geller said, “is the way of the future.”

PPMO stands for a peptide-conjugated phosphorodiamidate morpholino oligomer – a synthetic analog of DNA or RNA that has the ability to silence the expression of specific genes. Compared to conventional antibiotics, which are often found in nature, PPMOs are completely synthesized in the laboratory with a specific genetic target in mind.

In animal laboratory tests against A. baumannii, one of the most dangerous Acinetobacter strains, PPMOs were far more powerful than some conventional antibiotics like ampicillin, and comparable to the strongest antibiotics available today. They were also effective in cases where the bacteria were resistant to antibiotics.

PPMOs have not yet been tested in humans. However, their basic chemical structure, the PMO, has been extensively tested in humans and found safe. Although the addition of the peptide to the PPMO poses an uncertain risk of toxicity, the potency of PPMOs reduces the risk while greatly improving delivery of the PMOs into bacterial cells, Geller said.

Geller said research is being done with Acinetobacter in part because this pathogen has become a huge global problem, and is often spread in hospitals. It can cause respiratory infection, sepsis, and is a special concern to anyone whose immune system is compromised. Wounds in military battle conditions have led to numerous cases in veterans, and A. baumannii is now resistant to many antibiotics. “Urgent new approaches to therapeutics are needed,” the scientists said in their report.

Continued research and eventually human clinical trials will be required before the new compounds are available for health care, the researchers said. This and continued studies have been supported by the National Institutes of Health, the other collaborators and the N.L. Tartar fund.

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Editor’s Note: A scanning electron microscope image of A. baumannii is available online (please provide image credit as indicated at web site): http://bit.ly/GztejR

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Bruce Geller, 541-737-1845

Innovative approach could ultimately end deadly disease of sleeping sickness

CORVALLIS, Ore. – A tag team of two bacteria, one of them genetically modified, has a good chance to reduce or even eliminate the deadly disease African trypanosomiasis, or sleeping sickness, researchers at Oregon State University conclude in a recent mathematical modeling study.

African trypanosomiasis, caused by a parasite carried by the tsetse fly, infects 30,000 people in sub-Saharan Africa each year and is almost always fatal without treatment. In a 2008 epidemic, 48,000 people died.

In this research, scientists evaluated the potential for success of a new approach to combat the disease – creating a genetically modified version of the Sodalis bacteria commonly found in the gut of the flies that carry the disease, and using different bacteria called Wolbachia to drive the GMO version of Sodalis into fly populations.

When that’s done, the GMO version of Sodalis would kill the disease-causing trypanosome parasite. According to the analysis published in PLOS Neglected Tropical Diseases, researchers say this should work – and could offer a model system for other tropical, insect-carried diseases of even greater importance, including dengue fever and malaria.

“There are a few ‘ifs’ necessary for this to succeed, but none of them look like an obstacle that could not be overcome,” said Jan Medlock, an assistant professor in the OSU Department of Biomedical Sciences, and lead author on the new report.

“If everything goes right, and we are optimistic that it will, this could be enormously important,” Medlock said. “There’s a potential here to completely solve this disease that has killed many thousands of people, and open new approaches to dealing with even more serious diseases such as malaria.”

Some of the “ifs” include: the transgenic Sodalis has to be reasonably effective at blocking the parasite, at or above a level of about 85 percent; the Wolbachia bacteria, which has some effect on the health of flies affected with it, must not kill too many of them; and the target species of fly has to be a majority of the tsetse flies in the areas being treated.

The research shows that dealing with all of those obstacles should be possible. If so, this might spell the end of a tropical disease that has plagued humans for hundreds, possibly thousands of years. African trypanosomiasis causes serious mental and physical deterioration – including the altered sleep patterns that give the disease its name – and is fatal without treatment. It’s still difficult to treat, and neurologic damage is permanent.

Past efforts to control the disease, including insect traps, insecticide spraying, and use of sterile insects have been of some value, but only in limited areas and the effects were not permanent.

The strength of the new approach, researchers say, is that once the process begins it should spread and be self-sustaining - it should not be necessary to repeatedly take action in the huge geographic areas of Africa. Due to some genetic manipulation, the flies carrying the Wolbachia bacteria should naturally increase their populations and have an inherent survival advantage over conventional tsetse flies.

As the flies carrying transgenic bacteria continue to dominate and their populations spread, trypanosomiasis should fairly rapidly disappear. Whether the mechanism of control could wane in effectiveness over time is an issue that requires further study, scientists said.

Work has begun on the GMO version of Sodalis that has the capability to resist trypanosomes . It’s not yet finalized, Medlock said, but it should be possible, and when complete, the bacteria will be very specific to tsetse flies.

Medlock, an expert in modeling the transmission of various diseases – including human influenza – says the analysis is clear that this approach has significant promise of success. Because of the relatively low infectiousness of the parasite and the ability of Wolbachia to drive the resistance genes, no part of the system has to be 100 percent perfect in order to ultimately achieve near eradication of this disease, he said.

Accomplishing a similar goal with diseases such as malaria may be more difficult, he said, because that disease historically has shown a remarkable ability to mutate and overcome many of the approaches used to attack it. However, at least some near-term gains may be possible, he said.

Collaborators on this study included scientists from the OSU College of Veterinary Medicine and the Yale School of Public Health. It was supported by the National Institutes of Health and the Miriam Weston Trust.

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Jan Medlock, 541-737-6874

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California’s new mental health system helps people live independently

CORVALLIS, Ore. – A new analysis by Oregon State University researchers of California’s mental health system finds that comprehensive, community-based mental health programs are helping people with serious mental illness transition to independent living.

Published in the October issue of the American Journal of Public Health, this study has important implications for the way that states finance and deliver mental health programs, and speaks to the effectiveness of well-funded, comprehensive community programs.

In November of 2004, California voters passed the Mental Health Services Act, which allocated more than $3 billion for comprehensive community mental health programs, known as Full Service Partnerships (FSP). While community-based, these programs are different from usual mental health services programs in most states because they provides a more intensive level of care and a broader range of mental health services and supports, such as medication management, crisis intervention, case management and peer support.

It also provides services such as food, housing, respite care and treatment for co-occurring disorders, such as substance abuse.

“We found that these programs promoted independent living in the community among people who had serious mental illness but had not been served or underserved previously,” said Jangho Yoon, an assistant professor of health policy and health economist in OSU’s College of Public Health and Human Sciences and lead author of the study. “Overall, it reduced their chance of living on the street or being incarcerated in jails and prisons.”

The researchers looked at data from 43 of California’s 53 counties, resulting in a sample of 9,208 adults over the course of four years. They found that participants who stayed enrolled in the program continuously, without interruption, were 13.5 percent more likely to successfully transition to independent living.

However, they found that non-white patients were less likely to live independently, and more likely to end up in jail or homeless.

“Although FSPs represent the most well-funded comprehensive community-based programs in the country, they are still community programs and therefore program participation is voluntary,” Yoon said.  “My guess is that minorities may not benefit fully from these programs in their communities possibly due to greater stigma, and less family/social supports. But it needs further investigation.”

Patients with schizophrenia and bipolar disorders were also less likely to benefit from the community programs, because of the nature and severity of their mental health issues.

Yoon is an expert on health management policy, specifically policy around the area of mental health. He said other states haven’t followed California’s lead, in part because of the cost of such extensive programming. Yoon said some of the funding made possible by the federal Patient Protection and Affordable Care Act, which includes $460 million for community mental health services for states to use, may help other states to create similar programs.

“Nobody would disagree that the public mental health system has historically been under-funded in the U.S.,” he said. “The message for other states is clear: investment in well-funded, recovery-oriented, comprehensive community mental health programs clearly improves lives of people with serious mental illness, and may also save money from reduced dependency and incarcerations in this population.”

Tim Bruckner of the University of California, Irvine, and Timothy Brown of the University of California, Berkeley, contributed to this study, which was jointly funded by the California Department of Mental Health and the California Health Care Foundation.

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Jangho Yoon, 541-737-3839

Gut microbes closely linked to range of health issues

CORVALLIS, Ore. –A new understanding of the essential role of gut microbes in the immune system may hold the key to dealing with some of the more significant health problems facing people in the world today, Oregon State University researchers say in a new analysis.

Problems ranging from autoimmune disease to clinical depression and simple obesity may in fact be linked to immune dysfunction that begins with a “failure to communicate” in the human gut, the scientists say. Health care of the future may include personalized diagnosis of an individual’s “microbiome” to determine what prebiotics or probiotics are needed to provide balance.

Appropriate sanitation such as clean water and sewers are good. But some erroneous lessons in health care may need to be unlearned – leaving behind the fear of dirt, the love of antimicrobial cleansers, and the outdated notion that an antibiotic is always a good idea. We live in a world of “germs” and many of them are good for us.

“Asked about their immune system, most people might think of white blood cells, lymph glands or vaccines,” said Dr. Natalia Shulzhenko, author of a new report in Clinical Reviews in Allergy and Immunology, and assistant professor and physician in the OSU Department of Biomedical Sciences. “They would be surprised that’s not where most of the action is. Our intestines contain more immune cells than the entire rest of our body.

“The human gut plays a huge role in immune function,” Shulzhenko said. “This is little appreciated by people who think its only role is digestion. The combined number of genes in the microbiota genome is 150 times larger than the person in which they reside. They do help us digest food, but they do a lot more than that.”

An emerging theory of disease, Shulzhenko said, is a disruption in the “crosstalk” between the microbes in the human gut and other cells involved in the immune system and metabolic processes.

“In a healthy person, these microbes in the gut stimulate the immune system as needed, and it in turn talks back,” Shulzhenko said. “There’s an increasing disruption of these microbes from modern lifestyle, diet, overuse of antibiotics and other issues. With that disruption, the conversation is breaking down.”

An explosion of research in the field of genomic sequencing is for the first time allowing researchers to understand some of this conversation and appreciate its significance, Shulzhenko said. The results are surprising, with links that lead to a range of diseases, including celiac disease and inflammatory bowel disease. Obesity may be related. And some studies have found relevance to depression, late-onset autism, allergies, asthma and cancer.

In the new review, researchers analyzed how microbe dysfunction can sometimes result in malabsorption and diarrhea, which affects tens of millions of children worldwide and is often not cured merely by better nutrition. In contrast, a high-fat diet may cause the gut microbes to quickly adapt to and prefer these foods, leading to increased lipid absorption and weight gain.

The chronic inflammation linked to most of the diseases that kill people in the developed world today – heart disease, cancer, diabetes – may begin with dysfunctional gut microbiota.

Understanding these processes is a first step to addressing them, Shulzhenko said. Once researchers have a better idea of what constitutes healthy microbiota in the gut, they may be able to personalize therapies to restore that balance. It should also be possible to identify and use new types of probiotics to mitigate the impact of antibiotics, when such drugs are necessary and must be used.

Such approaches are “an exciting target for therapeutic interventions” to treat health problems in the future, the researchers concluded.

The study, supported by OSU, included researchers from both the College of Veterinary Medicine and the College of Pharmacy.

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Dr. Natalia Shulzhenko, 541-737-1051

Self-identifying as disabled and developing pride in disability aid overall well-being

CORVALLIS, Ore. – Experiencing stigma, the severity of a disability and a person’s age and income level help determine whether someone with an impairment considers themselves to be a person with a disability, and experiencing stigma predicts whether those individuals will ultimately develop disability pride, new research from Oregon State University shows.

“Roughly 15 percent of the world’s population has some kind of disability but just a fraction of those people actually identify themselves as people with disabilities. Disability identity is a critical step in accepting a disability and helps to reduce the stigma surrounding the label,” said Kathleen Bogart, an assistant professor of psychology in the College of Liberal Arts at Oregon State University

Those who self-identify are also more likely to develop pride in their disability, a shift in thinking that can help build resilience and change public attitudes about the “disabled” label, said Bogart, an expert on ableism, or prejudice about disabilities, whose research focuses on the psychosocial implications of disabilities.

“The challenge with disability as a label is that it’s so mired in stigma that people don’t want that label,” she said. “Can we reduce the stigma and reframe the label as a neutral label that is just useful as a category, like male or female? Or taking it even further, can we shift the label to the point where people have pride in that label?” 

Bogart explored issues around disability self-identification and disability pride in two new studies published recently in the journal Rehabilitation Psychology.

The first study examined who is most likely to self-identify as disabled. For the study, about 700 people over age 18 completed an online survey that asked them to identify health conditions they had by checking boxes, or if their condition was not listed, filling in a box. Among the most common impairments were allergies, anxiety, depression, migraines, back injury or pain, attention-deficit/hyperactivity disorder, respiratory disease, hypertension and chronic pain. 

Participants also were asked to rate characteristics of their health condition, such as whether it affects daily life, how often it causes physical pain and how often it is noticeable to other people. In addition, they completed a questionnaire about whether they experienced stigma and discrimination because of their condition. They were also asked whether they identify as a person with a disability. Only 12 percent of people with a health condition agreed or strongly agreed that they were a person with a disability.

The researchers found that experiencing stigma, along with severity of the impairment, were the biggest factors influencing whether someone with a disability identified that way. 

“The finding regarding stigma was a really powerful one,” Bogart said. “It supports the idea that the concept of disability is primarily a social construct, developed by society’s reaction to that impairment. It’s not just the physical impairment. It’s the way people treat you and the way society builds an environment that does or does not include you.”

The study results suggested that severe impairments lead to greater stigma, which increased the likelihood that people self-identified as disabled. 

In the second study, the researchers looked further at the role disability pride plays in overall wellbeing for people with disabilities. Developing pride in the disability – and rejecting the stigma of society on whole - shows promise as a way to protect against stigma and build self-esteem, Bogart said.

“Little is known about the good things that might come with embracing a disability identity,” Bogart said. “We believe developing pride may offer some protective effects for people with disabilities who experience stigma.” 

Using the same set of more than 700 survey participants from the previous study, but looking at additional questions, the researchers analyzed factors that influence whether someone has pride in their disability. They found that disability pride tended to be more prevalent among those who experience stigma, those who have strong social support and people of color. They also found that people experiencing greater stigma seemed to lead to more pride, and greater pride was associated with greater self-esteem.

“Disability pride is still a rare thing,” Bogart said. “Most disabilities are invisible and people have to choose to identify with them. Many people hide their disabilities to avoid discrimination. But not identifying also perpetuates the stigma that disability is undesirable. Developing disability pride seems to protect self-esteem against the negative effects of stigma. It’s a really valuable protection for people with disabilities. 

“A logical next step for the research would be to develop interventions designed to boost disability pride among people with disabilities and at a policy level, with the goal of improving overall well-being and reducing stigma.”

Social support within the disability community could be bolstered through social groups and mentoring. At a policy level, political activism, media representation featuring disability pride and disability pride events may support pride development.

Co-authors of the self-identification study are Adena Rottenstein of Eastern Michigan University; Emily M. Lund of Boston University; and Lauren Bouchard of Purdue University. Rottenstein and Lund are also co-authors on the pride study. The research was supported by a research grant from the OSU College of Liberal Arts.

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Kathleen Bogart, 541-737-1357, Kathleen.bogart@oregonstate.edu

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Coordinated care organizations lead to more timely prenatal care

CORVALLIS, Ore. – Pregnant women on Medicaid are more likely to receive timely prenatal care following Oregon’s implementation of coordinated care organizations, or CCOs, which are regional networks of health care providers who work together to treat patients, a new study has shown.

“We found that under the CCO model, the timeliness of prenatal care was significantly improved for Oregon women on Medicaid, with more women beginning care in the first trimester of their pregnancies,” said the study’s co-author, S. Marie Harvey, associate dean and distinguished professor in Oregon State University’s College of Public Health and Human Sciences.

“This is an indication that Oregon’s use of CCOs is helping close the gap in timeliness of care for women on Medicaid versus those who are not on Medicaid.”

The findings were published in the Maternal and Child Health Journal. Co-authors are Lisa Oakley, Jangho Yoon and Jeff Luck of OSU. It is the first study to be published from a five-year federal grant to study the impacts of the expansion of Medicaid in Oregon on the health of women of reproductive age and their children up to age 2.

Medicaid is a federal health insurance program for people with limited resources, including low-income adults, children, the elderly and people with disabilities. In Oregon, Medicaid is provided through the Oregon Health Plan.

OSU researchers are awaiting data to examine the impact of Medicaid expansion, which began in 2014. In the meantime, they examined how the coordinated care organization model, an innovative approach implemented in Oregon in 2012, affected access to and use of prenatal care, Harvey said.

CCOs are Oregon’s version of an accountable care organization; nine other states are also using accountable care models for their Medicaid programs and eight other states are considering adopting similar models.

Oregon implemented the CCO model – which includes coordination of physical health care, mental health care and dental care – for providing Medicaid services in 2012. The hope was to focus on prevention and better management of chronic conditions, ultimately improving care and reducing costs.

Each CCO is allocated a fixed sum of funds to provide all necessary patient services and incentives to meet specific benchmarks that are critical to overall health and wellbeing. Benchmarks include decreasing emergency room usage, increasing use of dental sealants for children, using electronic health records, screening for colorectal cancer and providing timely prenatal care.

Early and regular prenatal care throughout a pregnancy plays a critical role in the health and wellbeing of mother and baby, the researchers said. Women on Medicaid generally begin prenatal care later in pregnancy and have fewer medical visits during their pregnancy than their non-Medicaid enrolled peers.

“Prenatal care is important because these visits provide opportunities for practitioners to evaluate and address health concerns for both mom and baby and discuss other important topics such as risks of smoking, the importance of good nutrition and other issues that could impact a pregnancy,” said Oakley, the paper’s lead author and a post-doctoral researcher at OSU.

After the first year of CCO implementation, mothers on Medicaid were more likely to receive prenatal care starting in the first trimester of pregnancy compared to the year before implementation, the researchers found.  

However, the improvement was more prominent among white and Asian women and those in urban areas, suggesting more work is needed to reach women in other racial and ethnic groups and those living in rural areas, Harvey said.

“For women in rural areas, issues such as transportation may be keeping them from accessing coverage,” she said. “In addition, cultural or language barriers may prevent some women of color from obtaining care.”

Researchers also noted that they saw no improvement in the proportion of women receiving adequate prenatal care; adequate care was measured by the number of prenatal care appointments a woman received after taking into account when she began prenatal care and the age of the baby at birth.

“This study used only the first year of data after CCO implementation; because of the initial positive impact of CCOs on prenatal care timeliness, we hope that additional years of data will demonstrate improvements in prenatal care adequacy, as well,” Oakley said.

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S. Marie Harvey, 541-737-3824, Marie.harvey@oregonstate.edu

New findings suggest a genetic influence on aging into the 90s but not beyond

CORVALLIS, Ore. – Variants of a gene thought to be linked to longevity appear to influence aging into the 90s, but do not appear to affect exceptional longevity, or aging over 100, a new study has found.

The research challenges previous findings that indicated some variants of the gene, FOXO3, played a role in exceptional longevity, said Harold Bae, an assistant professor in the College of Public Health and Human Sciences at Oregon State University and the lead author of the study.

“These variants did seem to have some impact, but they do not appear to be as influential toward truly exceptional longevity as previously thought,” said Bae, a biostatistician who studies statistical genetics and genetic epidemiology, particularly in relation to healthy aging research. “These variants will help you live to a certain age – the early to mid-90s – but won’t get you to exceptional longevity.” 

The findings have been published in the Journals of Gerontology: Biological Sciences. Co-authors are Anastasia Gurinovich, Stacy L. Andersen, Thomas T. Perls and Paola Sebastiani of Boston University Schools of Medicine and Public Health; Gil Atzmon and Nir Barzila of Albert Einstein College of Medicine in New York; and Alberto Malovini, Francesco Villa and Annibale Puca of the University of Salerno, Italy.

People who live into their 90s or 100s – beyond the typical life expectancy near 80 for adults – can offer important lessons about healthy aging, Bae said. Centenarians experience slower aging throughout their lives; live independently well into their 90s and spend only the last relatively few years of their exceptionally long lives with significant diseases or disabilities. 

Unlike average aging, in the case of people who live into their late 90s and even into their 100s, centenarians appear to benefit from combinations of longevity-enabling genes that likely protect against aging and age-related diseases and disability, said Sebastiani, the article’s senior author.

FOXO3 could be playing such a role for people who live into their early to mid-90s.The gene had gained quite a bit of attention over the last 10 years as a possible contributor to longevity, but despite a lot of study, the mechanism by which FOXO3 helps people remains murky. 

The goal of the new study was to better understand the gene’s role in survival to not just the 90s but beyond to even more exceptional ages.

The researchers examined genetic data from blood samples of 2,072 extremely old subjects from four centenarian studies: the New England Centenarian Study; the Southern Italian Centenarian Study; The Longevity Genes Project at Albert Einstein College of Medicine; and the National Institutes on Aging-funded Long Life Family Study. Researchers conducting centenarian studies such as these are working together to discover the biological mechanisms that enable remarkable aging.

The researchers who published the Journals of Gerontology: Biological Sciences paper found that while FOXO3 did seem to play a role in longevity to a degree, that role did not generally affect living to ages 96 or older for men, or 100 for women - the oldest one percent of the population.

“We attended presentations and read scientific papers claiming associations between FOXO3 variants and longevity, yet when we tested for these associations among centenarians, we were unable to reproduce the findings,” said Perls, the director of the New England Centenarian Study, Boston Medical Center, and co-author of the paper. “We suspect that part of the reason may be because these earlier claims were coming from studies made up mostly of people in their 80s and 90s, and not those in their 100s.”

The researchers’ findings will likely prompt new areas of research as scientists continue to look for answers about genetic components of longevity and exceptional longevity, Bae said. 

“There’s still more to learn about this gene,” he said. “We know for sure it influences aging, but what we show is that it may not be a key player in achieving truly exceptional age.”

The research was supported by grants from the National Institute on Aging; The William M. Wood Foundation; and the Paulette and Marty Samowitz Family Foundation.

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Harold Bae, 541-737-3198, Harold.bae@oregonstate.edu; Thomas Perls, 617-733-7893, thperls@bu.edu

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Enrollment in early intervention services may be influenced by type of administering agency

CORVALLIS, Ore. – Children under age 3 who have or are at risk of a developmental disability are eligible for services to improve cognitive, behavioral and physical skills under the federal Individuals with Disabilities Education Improvement Act (IDEIA). 

But many eligible children do not enroll in those services and the rates of enrollment vary in part by which agency at the state level is serving as the lead, or administrator, for the programs, new research from Oregon State University has found.

Enrollment rates tend to be higher when the lead agency is health-focused and lower when the lead agency is education-focused, according to Megan MacDonald, an assistant professor in OSU’s College of Public Health and Human Sciences and one of the study’s authors.  

“There is a big gap between the number of children with disabilities or delays and the number of children enrolled in early intervention services,” MacDonald said. “And it seems to be tied, in part, to who is in charge.”

The findings were published recently in the Journal of Early Intervention. The lead author is Erica Twardzik, who worked on the project as a student at OSU and now is at the University of Michigan. Alicia Dixon-Ibarra, also of OSU, is a co-author.

The IDEIA is a federal mandate that is implemented by states. It is designed to ensure that children with disabilities through the age of 21 have access to free and appropriate educational services. Programs for children under age 3 are designed to address both diagnosed disabilities as well as delays that could affect a child’s school readiness and quality of life, such as speech or motor skills.

“It’s really intended to address any aspect of a child’s development that is delayed during the critical early years,” MacDonald said. “The longer a delay persists, the wider the gap may become. The one thing we know about early intervention is that earlier implementation is better.”

Early intervention may also reduce the need for some or all special education services when a child enters school, she said. That may allow for more inclusionary practices at school and also could lead to potential cost savings for states.

However, enrollment in these services is low across the country. While enrollment criteria varies from state to state, the variation alone has not accounted for the differences in enrollment rates, MacDonald said.

In their study, the researchers examined how the role of the administering body might influence enrollment rates. The administering body, or lead agency, plays a variety of roles in the support of the program, including allocating funding, sponsoring trainings and conferences and developing public awareness programs. In most states, the lead agency is either a department of health or a department of education, though in some states the agency may be the department of public welfare, developmental services, economic security or similar.

Using several national data sources, including the U.S. Census, the National Surveys of Children’s Health and state agency websites, the researchers found that the odds of a child enrolling in eligible services were significantly higher when the lead agency is health-focused. When the lead agency is education-focused, the odds are lowest.

Education agencies are less likely to come in contact with children until they enter preschool around age 3 or 4, or sometimes even later, at kindergarten. But most children have regular “well child” visits with their doctor and the physicians assess development and conduct initial screenings of children, MacDonald said. That’s likely why primary care physicians are the most common source of referral to services for children under age 3.

“For school-age kids, it makes sense that the lead agency providing services is the education department of a state,” MacDonald said. “But children who are not in school seem to be better served by a state’s health department, according to this study. When the health agency is in the lead, there’s a direct connection to service providers for families.”

The findings indicate that physicians and health agencies play an important role in identifying children who could benefit from early intervention services and referring them to the appropriate programs, but the finding is only one piece of a larger puzzle about low enrollment, MacDonald said.

Educating parents about the importance of developmental assessments and availability of services is also key to ensuring children get off to a good start, she said.

“The message to parents is that it’s OK to have these conversations with your pediatrician or other service providers,” she said. “There is no harm in seeking services or getting interventions for your child.”

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Megan MacDonald, 541-737-3273, Megan.MacDonald@oregonstate.edu

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Social emotional learning interventions show promise, warrant further study

CORVALLIS, Ore. – Developing a child’s social and emotional learning skills in early childhood is seen as a key to the child’s success in school, but researchers are still working to understand which interventions most effectively boost those skills.

Providing training for early childhood education teachers, embedding direct instruction and practice of targeted skills into daily practice and engaging families in these efforts help to boost the success of these kinds of interventions, Oregon State University researchers suggest in a new paper.

“We know these skills are essential for children, but there’s still a lot we don’t know about ways to enhance them,” said Megan McClelland, the Katherine E. Smith Healthy Children and Families Professor in Human Development and Family Sciences in OSU’s College of Public Health and Human Sciences. “The results to date have been mixed.”

“We don’t yet know what the ‘key ingredients’ are here, ” added McClelland, the paper’s lead author, “but we do have enough evidence to know we need to keep doing this work.”

The paper was published today in a special issue of the journal Future of Children that is focused on social and emotional learning. McClelland is a nationally recognized expert in child development. Co-authors of the paper are Shauna Tominey, an assistant professor of practice at OSU, Sara Schmitt of Purdue University and Robert Duncan of University of California, Irvine.

Much of McClelland’s research focuses on the important role of self-regulation skills – the social and emotional skills that help children pay attention, follow directions, stay on task, form healthy friendships and persist through difficulty.  

She has developed and tested social and emotional learning interventions focused on games such as “Red Light, Purple Light,” which is similar to “Red Light, Green Light.” A teacher uses construction-paper circles to represent stop and go. Children follow color cues, such as purple represents stop, orange signals go; then switch to the opposite, where purple means go and orange means stop.

Additional rules are added later to increase the complexity of the game. The game requires children to listen and remember instructions, pay attention to the adult leading the game and resist natural inclinations to stop or go. 

In the new paper, McClelland and her co-authors reviewed the theory and science behind a number of social emotional learning interventions in early childhood and found that while several such interventions hold promise, more research is needed to understand variations in results among different groups of children, including why some children appear to benefit more than others and whether the programs are cost effective.

There’s also a general lack of long-term studies that might give researchers a clearer picture of the programs’ effectiveness, McClelland said. Longer-term studies would also help explain “sleeper” effects, where short-term effects are small or not significant, but long-term effects, such as predictors of high school or college completion, are significant and substantive. 

“I look at the long term: Did the child complete college? Were they able to stay out of the criminal justice system?” McClelland said. “Those are some of the most important indicators of the social emotional learning.”

Overall, studies in the field indicate that children from low-income families tend to show the most gains from social emotional learning interventions, but results for other groups of students are more mixed, although a number of studies show positive effects. 

The review also showed that the most successful interventions tend to be low cost, easily implemented, are fun for kids, including training for teachers, and can be built in to classroom lessons on literacy and math, McClelland said.

“The bottom line here is that there’s a lot of subtlety to the findings of this work so far,” she said. “Fortunately, we do have some ideas about what’s working, and we have some ideas about where we need to go next in the field.”

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Study: The family dog could help boost physical activity for kids with disabilities

CORVALLIS, Ore. – The family dog could serve as a partner and ally in efforts to help children with disabilities incorporate more physical activity into their daily lives, a new study from Oregon State University indicates.

In a case study of one 10-year-old boy with cerebral palsy and his family’s dog, researchers found the intervention program led to a wide range of improvements for the child, including physical activity as well as motor skills, quality of life and human-animal interactions. 

“These initial findings indicate that we can improve the quality of life for children with disabilities, and we can get them to be more active,” said Megan MacDonald, an assistant professor in OSU’s College of Public Health and Human Sciences and corresponding author on the study. “And in this case, both are happening simultaneously, which is fantastic.”

The researchers detailed the child’s experience in the adapted physical activity intervention program in a case study just published in the journal Animals. Co-authors are Monique Udell of the OSU College of Agricultural Sciences; Craig Ruaux of the OSU College of Veterinary Medicine; Samantha Ross of the OSU College of Public Health and Human Sciences; Amanda Tepfer of Norwich University and Wendy Baltzer of Massey University in New Zealand. The research was supported by the Division of Health Sciences at OSU. 

Children with physical disabilities such as cerebral palsy spend significantly less time participating in physical activity compared to their peers and are considered a health disparity group, meaning they generally face more health concerns than their peers.

Researchers designed an adapted physical activity, animal-assisted intervention where the family dog would serve as a partner with the child in physical activities designed to help improve overall physical activity, motor skills and quality of life. The family dog is a good choice for this type of intervention because the animal is already known to the child and there is an existing relationship – and both the dog and the child will benefit from the activities, MacDonald said. 

Researchers took initial assessments of the child’s daily physical activity, motor skills and quality of life before starting the eight-week intervention. A veterinarian examined the dog’s fitness for participation and the human-animal interaction between the dog, a year-old Pomeranian, and the child was also assessed. 

Then the pair began the eight-week intervention, which included a supervised physical activity program once a week for 60 minutes and participation in activities such as brushing the dog with each hand; playing fetch and alternating hands; balancing on a wobble board; and marching on a balancing disc. 

“The dog would also balance on the wobble board, so it became a challenge for the child – if the dog can do it, I can, too,” MacDonald said. “It was so cool to see the relationship between the child and the dog evolve over time. They develop a partnership and the activities become more fun and challenging for the child. It becomes, in part, about the dog and the responsibility of taking care of it.”

The dog and the child also had “homework,” which included brushing the dog, playing fetch and going on daily walks. The child wore an accelerometer to measure physical activity levels at home. 

At the conclusion of the intervention, researchers re-assessed and found that the child’s quality of life had increased significantly in several areas, including emotional, social and physical health, as assessed by the child as well as the parent. In addition, the child’s sedentary behavior decreased and time spent on moderate to vigorous activity increased dramatically.

“The findings so far are very encouraging,” MacDonald said. “There’s a chance down the road we could be encouraging families to adopt a dog for the public health benefits. How cool would that be?” 

The researchers also found that the relationship between the dog and the child improved over the course of the therapy as they worked together on various tasks. The dog’s prosocial, or positive, behavior toward the child is a sign of wellbeing for both members of the team, said Udell, who is director of the Human-Animal Interaction Lab at OSU.

“A closer child-dog bond increases the likelihood of lasting emotional benefits and may also facilitate long-term joint activity at home, such as taking walks, simply because it is enjoyable for all involved,” she said. 

This study is one of the first to evaluate how a dog’s behavior and wellbeing are affected by their participation in animal-assisted therapy, Udell noted. From an animal welfare standpoint, it is promising that the dog’s behavior and performance on cognitive and physical tasks improved alongside the child’s.

Though the case study features only one child, the research team recruited several families with children with disabilities and their dogs to participate in the larger project, which was designed in part to test the design and methodology of the experiment and determine if it could be implemented on a larger scale. 

Based on the initial results, researchers hope to pursue additional studies involving children with disabilities and their family dogs, if funding can be secured. They would like to examine other benefits such a pairing might have, including the sense of responsibility the child appears to gain during the course of the intervention.

“We’re also learning a lot from our child participants,” MacDonald said. “They’re teaching us stuff about friendship with the animal and the responsibility of taking care of a pet, which allows us to ask more research questions about the influence of a pet on the child and their family.” 

Oregon families interested in learning more about future research projects related to this work can contact Megan MacDonald, megan.macdonald@oregonstate.edu, to be included on an interest list.

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Megan MacDonald, 541-737-3273, Megan.MacDonald@oregonstate.edu

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