Neuroendocrine Correlates of Empathy and Stress Reactivity in Registered Nurses

Understanding the mechanisms of stress is essential to create safe healthcare environments. Intimidating and disruptive behaviors create a stressful and hostile work environment and result in serious adverse outcomes for nurses, and most importantly their patients.  Drawing on evidence from a neuroendocrine framework, individuals with oxytocin receptor gene (OXTR) polymorphism (GG allele) have higher levels of self-reported empathy and lower levels of stress reactivity than individuals with one or two copies of the A allele (AA and AG).  Thus, response to a stressful environment has both a genetic and neurohormonal influence as well as the hostile social environment itself. This is an exploratory feasibility study to examine the relationships among oxytocin receptor gene (OXTR) variation; self-reported empathy; self-reported stress reactivity; and perceived work stress, burnout and violence among acute care registered nurses and mid-level nurse managers.  Recruited nurses received a study packet with instructions to complete the questionnaires and collect buccal cells using an Isohelix collection kit.  This project provides pilot data for a larger study of the neuroendocrine correlates of empathy and stress reactivity in nurses and interventions to alter behavior and create safe healthcare environments for nurses and their patients. Primary Investigator: Kathe Hawes PhD.

Preschool Neurobehavior and Prenatal Antidepressant Exposure

Over 400,000 pregnant women and their fetuses experience Major Depressive Disorder (MDD) every year in the United States.   Serotonin/Norepinephrine Reuptake Inhibitors (SRIs), are the most commonly chosen antidepressant medications for MDD during pregnancy.  The original prenatal project focused on prenatal and postnatal development of infants whose mothers had MDD during pregnancy, with and without SRI treatment, compared to non-depressed mothers.  Our early findings suggest that prenatal MDD and SRI exposure are both associated with alterations in sensory-motor development in the fetal period and early infancy. We are now following these children and their families through the preschool years. We hypothesize that the early motor effects of prenatal SRI exposure are related to alterations in fetal serotonin development and that these effects will diminish in exposed children by preschool age.  By comparison, effects attributed to maternal MDD will be longer-lasting.  We are currently examining the role of maternal MDD and prenatal SRI exposure on child sensory-motor integration, gross and fine motor control (kinematics), temperament, behavioral and emotional development, and sleep state with circadian biomarkers (urinary melatonin sulfate levels) related to psychiatric symptoms.  We are also identifying potential epigenetic markers associated with these effects.  The rationale for the proposed research is that once we know how early SRI exposure affects these key areas related to serotonin function, we will be able to identify specific mechanistic pathways, including epigenetic targets and biomarkers, for psychopathology.  The expected outcomes will have a positive impact because they will lead to informed risk-benefit decision-making for pregnant women with MDD and provide new preventive and therapeutic targets for psychopathology in children.  This will further translate into enormous reductions in overall costs due to the social and functional disability that may result from such conditions. Primary Investigators:  Amy Salisbury PhD.

Rhode Island Consortium for Autism Research and Treatment (RI-CART)

RI-CART includes the state's leading experts on autism research, education, health and services and is currently enrolling new participants in its confidential statewide registry. The Center for Children and Families at Women & Infants is one of the primary recruitment sites for RICART and a key partner in the consortium.  RI-CART will initially enroll 2,000 children and adults living in Rhode Island and surrounding communities, carefully assessed clinically. The data collected from the group will help identify genes involved in autism spectrum disorders (ASDs) and related developmental disorders in order to better understand consequences of genetic changes in tissue culture studies. The registry will be a core resource to support a range of important studies on causes of ASD as well as treatments and supports for people with ASD. Primary Investigators: Stephen Sheinkopf PhD, Todd Levine MD, Eric Morrow MD PhD, Tom Anders, MD.

The Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI)

Infants born less than 30 weeks gestational age are at high risk for developing severe impairment including cognitive, language, and behavior disorders and autism. Unfortunately, there is no method to identify which of these infants will become impaired and which will not. The purpose of the NOVI study is to follow approximately 900 infants across six sites from hospital discharge to two years of age and to determine if our neurobehavioral exam (NNNS) , medical factors and epigenetic marks, can identify infants that will be impaired by age 2.  Acoustic cry measures will also be used to help identify infants at risk for autism. Early identification can lead to interventions that can ameliorate or prevent later deficits. Primary Investigator: Barry Lester, PhD

Treatment of Withdrawal from Opiates in Newborn Infants 

Heroine addicted pregnant women are often treated with methadone, a synthetic opiate that crosses the placenta and the fetus becomes addicted. Following delivery these babies undergo severe withdrawal (Neonatal Abstinence Syndrome or NAS). The two most common drugs used to treat these babies are methadone and morphine, gradually titrating the dose in the hospital until the baby is asymptomatic. This is a randomized, multi-site clinical trial comparing the efficacy and long term (2 year) effects of these drugs on medical, neurobehavioral (NNNS), genetic and epigenetic measures. Primary Investigator: Barry Lester PhD.