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He F, Zhang H, Zheng G, Zhou B, Fang Z, Zhu H, Dong Y, Hao G. Adverse childhood experiences and cardiometabolic biomarkers: A causal analysis. J Affect Disord 2025; 381:418-426. [PMID: 40194629 DOI: 10.1016/j.jad.2025.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 04/03/2025] [Accepted: 04/04/2025] [Indexed: 04/09/2025]
Abstract
BACKGROUND The associations between adverse childhood experiences (ACEs) and cardiometabolic biomarkers need to be further studied. Our objective was to investigate whether ACEs are causally associated with cardiometabolic biomarkers using observational study and two-sample Mendelian randomization (MR) analysis. METHODS The China Health and Retirement Longitudinal Study (CHARLS) data from 2014 to 2015 was used in the observational study. ACEs were divided into 4 groups (0, 1, 2, and 3 or more) according to whether they had experienced 12 items of negative experiences in childhood. A multilevel model was used to estimate the association between ACEs and each cardiometabolic biomarker. Further, we used two-sample MR to identify their potential causality. RESULTS A total of 11,422 participants (age:45-96) were eligible for the analyses in the observational study. Participants who experienced more ACEs were significantly higher in high-sensitivity C-reactive protein (hs-CRP) and high-density lipoprotein cholesterol (HDL-C) (all P < 0.05). Compared with those without ACE exposure, participants who experienced 3 or more ACEs had significantly lower total cholesterol (P < 0.05). In addition, a stronger association between ACEs and hs-CRP in males, as well as a stronger association between ACEs and HDL-C (Pinteraction = 0.036) in participants with higher education levels were observed. Consistently, in two-sample MR, we observed causal associations between DNA methylation loci and those cardiometabolic biomarkers. CONCLUSION Our results indicate that ACEs were causally associated with several cardiometabolic biomarkers. Further, adversity-associated DNA methylation loci might reflect buffering mechanisms against childhood adversity, which provides novel insight to the cardiovascular risk interventions.
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Affiliation(s)
- Fudong He
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Haofeng Zhang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Guangjun Zheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Biying Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhenger Fang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Haidong Zhu
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Guang Hao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
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2
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Templeton JM, Dixon WE, Williams S, Morelen D, Driggers-Jones L, Robertson C. The mediating role of social support on the link between adverse childhood experiences and adult mental health. J Exp Child Psychol 2025; 252:106148. [PMID: 39706049 DOI: 10.1016/j.jecp.2024.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 11/12/2024] [Accepted: 11/14/2024] [Indexed: 12/23/2024]
Abstract
Adverse childhood experiences (ACEs) have been associated with adult mental health, especially anxiety and depression. We aimed to explain these relationships by investigating perceived social support as a mediating factor. In this model, it is proposed that individuals who experience more ACEs will have less perceived social support in adulthood, which in turn will increase reported anxiety and depression symptoms. Data were collected on ACEs, anxiety, depression, and perceived social support using an anonymous REDCap survey distributed through various social media outlets and relevant listservs. Respondents (N = 494) were caregivers who primarily resided in the United States and identified as White, well-educated, middle class, and female. ACEs were measured using the expanded ACE questionnaire extracted from the Health-Resiliency-Stress Questionnaire. Anxiety and depression were measured by the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire 9-item scale, respectively. Social support was measured with the Multidimensional Scale of Perceived Social Support. Results confirmed partial mediating effects of social support on the relation between (a) ACEs and anxiety and (b) ACEs and depression. Increased exposure to ACEs was associated with less social support in adulthood and, consequently, to greater mental health symptomatology. Implications of these findings highlight the potential role of social support as a preventative strategy and adult social support as a mitigating strategy.
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Affiliation(s)
- Jessica M Templeton
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA
| | - Wallace E Dixon
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Stacey Williams
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA
| | - Diana Morelen
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA
| | | | - Chelsea Robertson
- Department of Psychology, Community College of Baltimore County, Hunt Valley, MD 21031, USA
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3
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Sagae SC, Paz EDR, Zanardini B, Amaral AC, Bronczek GA, Koehler-Santos P, de Oliveira JR, Franci CR, Donadio MVF, Holman PJ, Raineki C. Alternate-day fasting differentially affects body composition, metabolic and immune response to fasting in male rats exposed to early-life adversity: Modulatory role of cafeteria diet. PLoS One 2025; 20:e0313103. [PMID: 40029907 PMCID: PMC11875342 DOI: 10.1371/journal.pone.0313103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 12/11/2024] [Indexed: 03/06/2025] Open
Abstract
The increased risk for obesity and metabolic disorders following early-life adversity is aggravated by poor diet (e.g., cafeteria diet). Alternate-day fasting (ADF) is a dietary regimen shown to improve immune and metabolic dysfunction related to obesity. Here, we evaluate if ADF can ameliorate the negative effects of early-life adversity and/or cafeteria diet on biological, immune and metabolic parameters. At weaning, animals reared under normal or adverse conditions (i.e., low bedding) were fed either standard chow or cafeteria diets ad libitum or subjected to an ADF regimen. In adulthood, we measured 24-hour fasted cholesterol, triglycerides, cytokines, oxidative stress markers, and body composition parameters including perigonadal, retroperitoneal, and brown fat pad weight. Animals exposed to early-life adversity respond differently to cafeteria diet and ADF. Adverse reared animals fed chow diet in the ADF regimen showed the largest reduction in body weight and perigonadal and retroperitoneal fat pad weight, the smallest increase in corticosterone levels, and the largest increase in TNF-α levels. However, the differential effects of the ADF regimen on body, perigonadal and retroperitoneal fat weight observed in adversely reared animals fed chow diet compared to controls were not present if the adversely reared animals were fed cafeteria diet in the ADF regimen. Furthermore, adversely reared animals fed cafeteria diet in the ADF regimen showed high IL-1β and IL-6 levels. Together, the data suggest that the altered vulnerability to metabolic and immune dysfunction following early-life adversity is not just due to the type of diet but also how the diet is consumed.
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Affiliation(s)
- Sara C. Sagae
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual do Oeste do Paraná, Cascavel, Brazil
| | - Edson D. R. Paz
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual do Oeste do Paraná, Cascavel, Brazil
- Departamento de Fisiologia Geral do Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Bárbara Zanardini
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual do Oeste do Paraná, Cascavel, Brazil
| | - Ana Claudia Amaral
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual do Oeste do Paraná, Cascavel, Brazil
| | - Gabriela A. Bronczek
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual do Oeste do Paraná, Cascavel, Brazil
- Departmento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade de Campinas, Campinas, Brazil
| | - Patrícia Koehler-Santos
- Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Jarbas R. de Oliveira
- Laboratório de Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Celso R. Franci
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Márcio V. F. Donadio
- Laboratório de Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Departmento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Parker J. Holman
- Department of Psychology, Brock University, St. Catharines, Ontario, Canada
| | - Charlis Raineki
- Department of Psychology, Brock University, St. Catharines, Ontario, Canada
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4
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Lovett SM, Woo JMP, O'Brien KM, Parker SE, Sandler DP. Association of Early-life Trauma With Gestational Diabetes and Hypertensive Disorders of Pregnancy. Epidemiology 2025; 36:149-159. [PMID: 39739403 DOI: 10.1097/ede.0000000000001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
BACKGROUND Early-life trauma (before age of 18 years) is hypothesized to increase the risk for adverse pregnancy outcomes through stress pathways, yet epidemiologic findings are mixed. METHODS Sister Study participants (US women aged 35-74 years enrolled 2003-2009) completed an adapted Brief Betrayal Trauma Survey at the first follow-up visit. Lifetime history of gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP: pregnancy-related high blood pressure, pre-eclampsia/toxemia, or eclampsia) in pregnancies lasting ≥20 weeks was self-reported. We used log-binomial regression to estimate relative risks (RR) and 95% confidence intervals (CIs) for the association between early-life trauma (modeled using conventional measures [e.g., any experience, substantive domains, individual types] and latent classes of co-occurring traumas) and GDM or HDP among 34,879 parous women. RESULTS Approximately, 4% of participants reported GDM and 11% reported HDP. Relative to no early-life trauma, the RRs for any were 1.1 (95% CI = 1.0, 1.3) for GDM and 1.2 (95% CI = 1.2, 1.3) for HDP. Women reporting physical trauma had the highest risk of GDM and HDP in comparison to other substantive domains. In analyses using latent classes of early-life trauma, high trauma was associated with an elevated risk of both GDM (RR = 1.9, 95% CI = 1.5, 2.6) and HDP (RR = 1.7, 95% CI = 1.4, 2.0) compared with low trauma. CONCLUSIONS Women experiencing high levels of trauma in early life were at higher risk of GDM and HDP, adding to a growing evidence base for this association.
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Affiliation(s)
- Sharonda M Lovett
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Samantha E Parker
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
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Smyth R, McSherry D. ACE Enquiry in Primary care: A Qualitative Exploration of the Perspective of General Practitioners in Northern Ireland. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2025; 18:57-70. [PMID: 40098779 PMCID: PMC11910462 DOI: 10.1007/s40653-024-00660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2024] [Indexed: 03/19/2025]
Abstract
This study sought to identify gaps in the current literature base by exploring the perspectives of General Practitioners (GPs) in Northern Ireland in relation to the significance, relevance, and feasibility of conducting a comprehensive inquiry into Adverse Childhood Experiences (ACEs) with patients. Semi-structured, in-depth interviews were conducted with 10 qualified GPs using Zoom Videoconferencing technology. Interviews were audio recorded and transcribed verbatim. Qualitative data was analysed using Theoretical Thematic Analysis (Braun & Clarke Qualitative Research in Psychology 3(2):77-101, 2006). Analysis revealed nine key superordinate themes. These themes encompassed various aspects such as the role of a GP, trauma-informed training, the advantages and barriers associated with conducting an ACE assessment, and the impact of childhood adversity on subsequent physical and mental health. This study provides valuable primary care professional insights that contribute to the existing evidence base. It highlights the importance of recognising, discussing, and screening for ACEs in primary care settings. Furthermore, this study explores a range of practical adjustments that could support the implementation of routine ACE enquiry within the primary healthcare system in Northern Ireland.
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Affiliation(s)
- Rafael Smyth
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Dominic McSherry
- Reader in Psychology, Ulster University, Coleraine, Northern Ireland
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Rocha M, Daniels K, Chandrasekaran S, Michopoulos V. Trauma and Posttraumatic Stress Disorder as Important Risk Factors for Gestational Metabolic Dysfunction. Am J Perinatol 2024; 41:1895-1907. [PMID: 38307105 PMCID: PMC11436347 DOI: 10.1055/a-2260-5051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Gestational metabolic diseases adversely impact the health of pregnant persons and their offspring. Pregnant persons of color are impacted disproportionately by gestational metabolic disease, highlighting the need to identify additional risk factors contributing to racial-ethnic pregnancy-related health disparities. Trauma exposure and posttraumatic stress disorder (PTSD) are associated with increased risk for cardiometabolic disorders in nonpregnant persons, making them important factors to consider when identifying contributors to gestational metabolic morbidity and mortality health disparities. Here, we review current literature investigating trauma exposure and posttraumatic stress disorder as psychosocial risk factors for gestational metabolic disorders, inclusive of gestational diabetes, low birth weight and fetal growth restriction, gestational hypertension, and preeclampsia. We also discuss the physiological mechanisms by which trauma and PTSD may contribute to gestational metabolic disorders. Ultimately, understanding the biological underpinnings of how trauma and PTSD, which disproportionately impact people of color, influence risk for gestational metabolic dysfunction is critical to developing therapeutic interventions that reduce complications arising from gestational metabolic disease. KEY POINTS: · Gestational metabolic diseases disproportionately impact the health of pregnant persons of color.. · Trauma and PTSD are associated with increased risk for cardiometabolic disorders in nonpregnant per.. · Trauma and PTSD impact physiological cardiometabolic mechanisms implicated in gestational metabolic..
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Affiliation(s)
- Mariana Rocha
- Graduate Program in Neuroscience, Emory University, Atlanta, Georgia
| | | | - Suchitra Chandrasekaran
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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7
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Fu C, Li C, Wan X, Yang Y, Zhang S, Hu J. The Relationship Between Adverse Childhood Experiences and Postpartum Depression: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:3066-3081. [PMID: 38516894 DOI: 10.1177/15248380241235639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Although numerous factors have been found to influence postpartum depression (PPD), no previous meta-analysis have systematically explored whether it is affected by adverse childhood experiences (ACEs). This study aimed to explore the influence of ACEs and their subtypes on PPD. A systematic literature search was conducted using Web of Science, PubMed, Embase, Wan Fang, China Science and Technology Journal Database, Chinese Biomedical Database, and China National Knowledge Infrastructure, and literature was screened according to inclusion and exclusion criteria. Methodological quality assessment and data extraction were performed on the included studies. A random-effects model was used to pool the effects. In total, 24 studies were included, and 73 independent effects were extracted from them. The meta-analysis revealed that ACE was a risk factor for PPD (odds ratio [OR] = 2.31, 95% confidence interval [CI] [2.04, 2.63]). The subgroup analysis results showed that emotional abuse was the ACE subtype most strongly related to the occurrence of PPD (OR = 2.95, 95% CI [2.08, 4.20]), followed by emotional neglect (OR = 2.87, 95% CI [1.89, 4.36]) and sexual abuse (OR = 2.81, 95% CI [1.93, 4.09]). In addition, family member incarceration (OR = 2.62, 95% CI [1.51, 4.54]), physical abuse (OR = 2.31, 95% CI [1.67, 3.19]), and physical neglect (OR = 2.15, 95% CI [1.36, 3.39]) also have strong effects on PPD. ACE is a risk factor for PPD. Early screening of ACE plays an important role in the prevention and intervention of PPD.
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Affiliation(s)
- Congrui Fu
- Hebei Medical University, Shijiazhuang, China
| | - Cong Li
- Hebei Medical University, Shijiazhuang, China
| | - Xin Wan
- Clinical College of Hebei Medical University, Shijiazhuang, China
| | - Yu Yang
- Hebei Medical University, Shijiazhuang, China
| | | | - Jie Hu
- Hebei Medical University, Shijiazhuang, China
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Kumar S, Campbell JA, Wang X, Xu Y, Nagavally S, Egede LE. Trends in prevalence of adverse childhood experiences by sociodemographic factors in the United States: Behavioral Risk Factor Surveillance System 2009-2022. BMC Public Health 2024; 24:2615. [PMID: 39334145 PMCID: PMC11438054 DOI: 10.1186/s12889-024-20125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Limited data exists on trends in prevalence of adverse childhood experiences (ACE) at the national level and sociodemographic correlates of having ACEs. This study examined trends in ACE prevalence and sociodemographic correlates in US adults over 14 years using nationally representative data. METHODS Data on 447,162 adults from the Behavioral Risk Factor Surveillance System (BRFSS) across four timepoints (2009-2010; 2011-2012; 2019-2020; 2021-2022) was analyzed and weighted for population estimates. The primary outcome was ACEs with 3 groups used (0 vs. 1 + ACEs; <4 vs. 4 + ACEs; 0 vs. 1 vs. 2 vs. 3 vs. 4 + ACEs). Sociodemographic factors included age, sex, race/ethnicity, employment, education, marital status, income and insurance status. Prevalence trends were examined by estimating prevalence of ACE groupings (0/1+; <4/4+; 0,1,2,3,4+) across the four timepoints and trend analysis was performed to determine if the differences over time were statistically significant. Unadjusted and adjusted prevalence ratios were estimated using log-binomial regression models with ACE groupings as the outcome and timepoints as the primary independent variable with sociodemographic factors as covariates. RESULTS Across the four time points, prevalence of ACEs was higher across groupings of ACEs by time. For ACEs 1+, prevalence was 62.2% (2009-2010); 62.2% (2011-2012); 64.5% (2019-2020); and 67.2% (2021-2022). For ACEs 4+, prevalence was 17.4% (2009-2010); 18.1% (2011-2012); 20.4% (2019-2020); and 22.6% (2021-2022). Prevalence of ACE 1 + was higher for older adults, Non-Hispanic Black adults, Non-Hispanic Other adults, and those with higher education. Prevalence of 4 + ACEs was higher for females, and lower for those with higher education and those with higher annual incomes. CONCLUSION This study shows an increased prevalence of having ACEs over a 14-year period and identified independent sociodemographic correlates of having ACEs in a nationally representative study. Targeted interventions are needed to reduce burden of ACEs using population-based approaches.
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Affiliation(s)
- Shivani Kumar
- Internal Medicine Residency Program, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Jennifer A Campbell
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Xuemeng Wang
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Yilin Xu
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Sneha Nagavally
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Campbell JA, Egede LE. Contextualizing risk, pathways, and solutions for the relationship between adverse childhood experiences (ACEs) and type 2 diabetes among inner-city African Americans: A qualitative analysis and development of a theoretical framework. J Affect Disord 2024; 361:522-527. [PMID: 38917888 PMCID: PMC11328455 DOI: 10.1016/j.jad.2024.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/29/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Adverse childhood experiences (ACEs) confer significant risk for diabetes in adulthood. The purpose of this study was to explore perceptions about risk, potential pathways leading to diabetes, and solutions based on the lived experience. METHODS Three focus groups were conducted. A semi-structured interview guide was used to explore prevalence and causes of ACEs, pathways to diabetes, and possible solutions. Grounded theory was used for analysis. Constant comparisons resulted in emergent themes that were indexed and compared with the rest of the data to establish analytical categories. Analytical categories were further refined as additional data was collected until groups of key themes or categories were identified and used to construct a theoretical framework. RESULTS Participants totaled 23 across 3 groups. All participants were African American. Average age was 49, average number of years living with diabetes was 13 years. Participants included both men and women. Participants experienced one or more occasions of sexual abuse, physical and verbal abuse, and neglect. The major themes can be classified as A. Cause, B. Pathway, and C. Treatment/solution. LIMITATIONS Findings may not generalize to the overall population with ACEs and diabetes. CONCLUSIONS Three major themes were identified: family instability and financial hardship as risks for ACEs, maladaptive coping leading to diabetes, and social structure as a potential solution. Future research is needed to examine quantitatively, pathways to inform prevention at the primary, secondary, and tertiary levels of care for both the prevention of ACEs, mitigating risk for diabetes, and improving overall health.
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Affiliation(s)
- Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
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10
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Leyden J, Uber A, Herrera-Escobar JP, Levy-Carrick NC. Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome. J Acad Consult Liaison Psychiatry 2024; 65:451-457. [PMID: 38431209 DOI: 10.1016/j.jaclp.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/08/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5-10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality. METHODS We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P < 0.05. RESULTS Seven thousand seven hundred fifty-six patients were admitted for DKA or HHS, 66.9% of whom had a concurrent psychiatric disorder. Of these patients, 54.5% were male, 70.4% were White, and they had an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of whom were male, 72.1% were White, and an average age of 68.2 years. A concurrent psychiatric disorder was associated with increased odds of rehospitalization (adjusted odds ratio [aOR] = 1.62 95% confidence interval [CI] 1.35-1.95, P < 0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% CI 1.002-1.035, P = 0.02), and of leaving AMA (aOR = 6.44 95% CI 4.46-9.63, P < 0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of -7.5 years (95% CI -9.3 to 5.8) compared to those without a psychiatric disorder. CONCLUSIONS Of patients with DKA/HHS, 66.9% have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and to have a lower age of mortality.
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Affiliation(s)
- Jacinta Leyden
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
| | - Amy Uber
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Juan P Herrera-Escobar
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Nomi C Levy-Carrick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
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11
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Bablis P, Day RR, Pollard H. Treatment of type 2 diabetes and stress using neuro-emotional technique: case report. Front Endocrinol (Lausanne) 2024; 15:1382757. [PMID: 39050563 PMCID: PMC11266090 DOI: 10.3389/fendo.2024.1382757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.
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Affiliation(s)
- Peter Bablis
- Department of Maternal and Child Health and Precision Medicine, University Research Institute, Athens, Greece
- Department of Integrative and Complementary Medicine, Universal Health, Sydney, NSW, Australia
| | - Ryan R. Day
- Department of Integrative and Complementary Medicine, Universal Health, Sydney, NSW, Australia
| | - Henry Pollard
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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12
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Stokes Y, Lewis KB, Tricco AC, Hambrick E, Jacob JD, Demery Varin M, Gould J, Aggarwal D, Cloutier P, Landriault C, Greenham S, Ward M, Kennedy A, Boggett J, Sheppard R, Murphy D, Robb M, Gandy H, Lavergne S, Graham ID. Trauma-Informed Care Interventions Used in Pediatric Inpatient or Residential Treatment Mental Health Settings and Strategies to Implement Them: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1737-1755. [PMID: 37694809 PMCID: PMC11155220 DOI: 10.1177/15248380231193444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Trauma-informed care (TIC) is an approach to care emerging in research and in practice that involves addressing the needs of individuals with histories of trauma. The aim of this scoping review was to examine the current literature relating to TIC interventions used in pediatric mental health inpatient and residential settings. We sought to answer the following two research questions: (a) What are the TIC interventions used in pediatric inpatient and residential treatment mental healthcare settings and what are their components? and (b) What are the implementation goals and strategies used with these TIC interventions? We conducted this scoping review according to JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. We included any primary study describing a TIC intervention that was implemented at a specific site which identified and described implementation strategies used. Of 1,571 identified citations and 54 full-text articles located by handsearching, 49 met the eligibility criteria and were included, representing 21 distinct TIC interventions. We present the reported aim, ingredients, mechanism, and delivery (AIMD) of TIC interventions as well as the implementation goals and strategies used, which varied in detail, ranging from very little information to more detailed descriptions. In the context of these findings, we emphasize the complexity of TIC and of TIC interventions, and the importance of identifying and clearly reporting TIC intervention goals, intervention details, and implementation strategies. We suggest applying intervention frameworks or reporting guidelines to support clear and comprehensive reporting, which would better facilitate replication and synthesis of published TIC interventions.
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Affiliation(s)
- Yehudis Stokes
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Krystina B. Lewis
- University of Ottawa, ON, Canada
- University of Ottawa Heart Institute, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
| | - Andrea C. Tricco
- Queen’s University, Kingston, ON, Canada
- University of Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, ON, Canada
| | | | | | - Melissa Demery Varin
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Justine Gould
- CHEO Research Institute, Ottawa, Canada
- Queen’s University, Kingston, ON, Canada
| | - Dhiraj Aggarwal
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | | | | | - Stephanie Greenham
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Michelle Ward
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Allison Kennedy
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | | | | | - David Murphy
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Marjorie Robb
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Hazen Gandy
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Sonia Lavergne
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Ian D. Graham
- University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
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13
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Quiroz JC, Cooper J, McCracken C, Khanji MY, Laranjo L, Aung N, Lee AM, Simon J, Murphy T, Biasiolli L, Piechnik SK, Maurovich-Horvat P, Petersen SE, Raisi-Estabragh Z. The association between adverse childhood experiences and adult cardiac function in the UK Biobank. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae139. [PMID: 39741927 PMCID: PMC11686440 DOI: 10.1093/ehjimp/qyae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 12/06/2024] [Indexed: 01/03/2025]
Abstract
Aims The importance of early life factors in determining health in later adulthood is increasingly recognized. This study evaluated the association of adverse childhood experiences (ACEs) with cardiovascular magnetic resonance (CMR) phenotypes. Methods and results UK Biobank participants who had completed CMR and the self-reported questionnaire on traumatic childhood experiences were included. Images were analysed using automated pipelines to extract measures of left and right ventricular (LV and RV) structure and function, myocardial character, and arterial compliance. Multivariable linear regression was used to estimate the association of childhood adversity with CMR phenotypes adjusting for age, sex, deprivation, education, obesity, smoking, alcohol intake, exercise level, diabetes, hypertension, and hypercholesterolaemia. Amongst 30 814 participants analysed, 6023 (19.5%) experienced physical abuse, 2746 (8.9%) sexual abuse, 4685 (15.2%) emotional abuse, 6822 (22.1%) emotional neglect, and 4534 (14.7%) physical neglect. Except for physical abuse, women reported greater rates of childhood adversity than men. Collectively, all types of childhood adversity were associated with smaller LV and RV volumes, greater LV mass, a concentric pattern of LV remodelling, poorer LV and RV function, lower aortic compliance, and greater arterial stiffness. Sexual abuse was associated with unhealthy CMR phenotypes in age- and sex-adjusted models, but these relationships were attenuated in fully adjusted models. Physical neglect had the most prominent pattern of adverse cardiovascular remodelling. Conclusion ACEs were associated with unhealthy cardiovascular remodelling in adulthood, independent of traditional cardiovascular risk factors. These findings support the consideration of early life factors in cardiovascular disease risk assessment.
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Affiliation(s)
- Juan C Quiroz
- Centre for Big Data Research in Health (CBDRH), The University of New South Wales (UNSW), Level 2, AGSM Building G27, Botany St, Kensington, NSW 2033, Australia
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Celeste McCracken
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Liliana Laranjo
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), Sydney Medical School, The University of Sydney, Westmead, Australia
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Aaron Mark Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Theodore Murphy
- Department of Cardiology and Cardiovascular Imaging, Beacon Hospital, Dublin, Ireland
| | - Luca Biasiolli
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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14
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Trofimoff AS, Jones F, Bird CL, Wood M, Bisel K, Bider E, Poje A. Integrating Trauma-Informed Care into the University of Kansas School of Medicine Utilizing the Curriculum, a Student Interest Group, and Community Partnerships. Kans J Med 2024; 17:69-72. [PMID: 38859987 PMCID: PMC11164427 DOI: 10.17161/kjm.vol17.21695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Affiliation(s)
- Anna S Trofimoff
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Felicia Jones
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Cole L Bird
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Morgan Wood
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Emergency Medicine
| | - Kelly Bisel
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Psychiatry & Behavioral Sciences
| | - Erin Bider
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Psychiatry & Behavioral Sciences
| | - Albert Poje
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Psychiatry & Behavioral Sciences
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15
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Boswell Z, Williams C, Abdo J, Chedid R, Fastring D. Adverse Childhood Experiences and Diabetes Risk in Mississippi Adults. Cureus 2024; 16:e55875. [PMID: 38595867 PMCID: PMC11002710 DOI: 10.7759/cureus.55875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/09/2024] [Indexed: 04/11/2024] Open
Abstract
Despite Mississippi's high diabetes prevalence and the growing literature finding significant associations between adverse childhood experiences (ACEs) and diabetes, no research has examined the relationship between ACEs and diabetes risk in Mississippi adults. This study utilized data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) to determine if such a relationship existed. Data for Mississippi respondents were weighted to account for nonresponse bias and non-coverage errors. Each respondent's total ACE exposure score was calculated based on the number of ACE categories experienced. Multivariate logistic regression was utilized to model the relationship between diabetes and ACE categories and diabetes and total ACE exposure scores. Variables that were significant at p<0.05 were retained in the final (best-fitting) models. All models were adjusted for sex, age, race, level of education, income, and body mass index (BMI). After adjusting for covariates, those experiencing physical abuse (adjusted odds ratio (AOR) 1.72, 95% CI 1.69; 1.75) or sexual abuse (AOR 1.56, 95% CI 1.53; 1.58) had the highest odds of ever being diagnosed with diabetes. Experiencing one ACE (AOR 1.02, 95% CI 1.01; 1.03) was associated with slightly higher odds of having diabetes, while experiencing seven ACE categories (AOR 2.20, 95% CI 2.10; 2.31) had the highest odds. Overall, this study shows a strong association between ACEs and a diagnosis of diabetes in the state of Mississippi. This relationship represents an important focus area for prevention efforts in legislation, public health campaigns, and universal screening procedures in primary care that may decrease the prevalence and burden of diabetes in Mississippi.
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Affiliation(s)
- Zachary Boswell
- College of Osteopathic Medicine, William Carey University, Hattiesburg, USA
| | | | - Jamil Abdo
- College of Osteopathic Medicine, William Carey University, Hattiesburg, USA
| | - Roy Chedid
- College of Osteopathic Medicine, William Carey University, Hattiesburg, USA
| | - Danielle Fastring
- College of Osteopathic Medicine, William Carey University, Hattiesburg, USA
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16
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Choudhury S, Yeh PG, Zajack-Garcia KL, Markham CM. Exploring Sexual Orientation Disparities Regarding the Interplay of Childhood Sexual Abuse, Self-Reported Diabetes Status, and Depression Among Adults in the United States. JOURNAL OF CHILD SEXUAL ABUSE 2024; 33:26-42. [PMID: 37846854 DOI: 10.1080/10538712.2023.2270518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
Previous research has revealed a strong link between the experience of childhood sexual abuse (CSA) and diabetes in adulthood. Moreover, research has shown that sexual minorities (SM) are exposed to adverse childhood experiences (ACEs) (i.e. CSA) and experience depression at higher rates than their heterosexual counterparts. Thus, it is imperative to further investigate the role of depression and the differential associations of exposure to ACEs with diabetes prevalence by sexual orientation. We explored sexual orientation disparities regarding the relationship between CSA and diabetes and examined the moderating role of depression. A total of 29,903 participants from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) were included in this study. Secondary data analysis was conducted using the survey data, and weighted logistic regression and moderation analysis were performed. Heterosexuals who experienced CSA (AOR = 1.25; p < .05) and SM who experienced CSA (AOR = 2.13; p < .05) reported higher odds of having diabetes. Among heterosexuals, depression (AOR = 1.38; p < .001) was significantly associated with having diabetes. Additionally, depression was a significant moderator among heterosexuals with and without CSA. Further understanding of the impact of ACEs on diabetes among specific subgroups of SM should be assessed in future studies.
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Affiliation(s)
- Sumaita Choudhury
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Paul G Yeh
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Kaitlyn L Zajack-Garcia
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Christine M Markham
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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17
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Baca KJ, Salsbury SA. Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action. Chiropr Man Therap 2023; 31:30. [PMID: 37580756 PMCID: PMC10426155 DOI: 10.1186/s12998-023-00503-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/20/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Trauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs. DISCUSSION This commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas. CONCLUSION Given the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.
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Affiliation(s)
- Kira J Baca
- Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, 52803, USA.
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA, 52803, USA
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18
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Elsenburg LK, Bengtsson J, Rieckmann A, Rod NH. Childhood adversity and risk of type 2 diabetes in early adulthood: results from a population-wide cohort study of 1.2 million individuals. Diabetologia 2023; 66:1218-1222. [PMID: 37076640 DOI: 10.1007/s00125-023-05911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/21/2023] [Indexed: 04/21/2023]
Abstract
AIMS/HYPOTHESIS To examine whether childhood adversity is related to development of type 2 diabetes in early adulthood (16 to 38 years) among men and women. METHODS We used nationwide register data of 1,277,429 individuals born in Denmark between 1 January 1980 and 31 December 2001, who were still resident in Denmark and without diabetes at age 16 years. Individuals were divided into five childhood adversity groups based on their yearly exposure to childhood adversities (from age 0-15 years) across three dimensions: material deprivation, loss or threat of loss, and family dynamics. We estimated HR and hazard differences (HD) for type 2 diabetes according to the childhood adversity groups using Cox proportional hazards and Aalen additive hazards models. RESULTS During follow-up from age 16 to 31 December 2018, 4860 individuals developed type 2 diabetes. Compared with the low adversity group, the risk of type 2 diabetes was higher in all other childhood adversity groups among both men and women. For example, the risk was higher in the high adversity group characterised by high rates of adversity across all three dimensions among men (HR 2.41; 95% CI 2.04, 2.85) and women (1.58; 1.31, 1.91), translating into 36.2 (25.9, 46.5) additional cases of type 2 diabetes per 100,000 person-years among men and 18.6 (8.2, 29.0) among women. CONCLUSIONS/INTERPRETATION Individuals who experienced childhood adversity are at higher risk of developing type 2 diabetes in early adulthood. Intervening upon proximal determinants of adversity may help reduce the number of type 2 diabetes cases among young adults.
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Affiliation(s)
- Leonie K Elsenburg
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jessica Bengtsson
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Rieckmann
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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19
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Zahid U, Hosang GM, de Freitas DF, Mooney R, Bhui K. Ethnic inequality, multimorbidity and psychosis: can a syndemic framework resolve disputed evidence? SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:37. [PMID: 37296141 DOI: 10.1038/s41537-023-00367-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
Syndemic theory is described as population-level clustering or co-occurrence of health conditions in the context of shared aetiologies that interact and can act synergistically. These influences appear to act within specific places of high disadvantage. We suggest ethnic inequality in experiences and outcomes of multimorbidity, including psychosis, may be explained through a syndemic framework. We discuss the evidence for each component of syndemic theory in relation to psychosis, using psychosis and diabetes as an exemplar. Following this, we discuss the practical and theoretical adaptations to syndemic theory in order to apply it to psychosis, ethnic inequality and multimorbidity, with implications for research, policy, and practice.
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Affiliation(s)
- Uzma Zahid
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Daniela Fonseca de Freitas
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Roisin Mooney
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK.
- Queen Mary University London Global Policy Institute, London, UK.
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20
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Klimek M, Entringer S, Matras A, Blukacz M, Nenko I, Galbarczyk A, Jasienska G. Early-life adversities and later-life reproductive patterns in women with fully traced reproductive history. Sci Rep 2023; 13:9328. [PMID: 37291139 PMCID: PMC10250381 DOI: 10.1038/s41598-023-36226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
One of the most crucial determinants of early-life development is the experience of childhood adversities. However, limited evidence is available for how these experiences shape later-life reproductive outcomes in women. Here we test the association between early-life adversities and reproductive parameters in women. Post-reproductive women (N = 105; mean age = 59.7; SD = 10.09) were recruited at the Mogielica Human Ecology Study Site in Poland within a traditional population with a low prevalence of birth control usage and fully traced reproductive histories. Reproductive parameters, as well as exposure to early-life abuse and neglect, were assessed using questionnaires. Childhood adversity was associated negatively with age at menarche (p = 0.009). Analyses on specific subtypes revealed that compared to women who did not experience any kind of early-life adversities in childhood, those who were exposed to emotional (p = 0.007) and physical (p = 0.023) neglect had an earlier age at menarche, those who experienced emotional abuse reported an earlier age at first birth (p = 0.035), and those who were exposed to physical abuse gave birth to fewer number of sons (p = 0.010). Our results suggest that women exposed to childhood adversities experience earlier physiological reproductive readiness and timing of the first birth, but their overall biological condition might be impaired as they bear fewer sons.
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Affiliation(s)
- Magdalena Klimek
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
| | - Sonja Entringer
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Agnieszka Matras
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Blukacz
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Institute of Psychology, Faculty of Social Sciences, University of Silesia, Katowice, Poland
| | - Ilona Nenko
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Galbarczyk
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Grazyna Jasienska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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21
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Barker C, Ford S, Eglinton R, Quail S, Taggart D. The truth project paper one-how did victims and survivors experience participation? Addressing epistemic relational inequality in the field of child sexual abuse. Front Psychiatry 2023; 14:1128451. [PMID: 37333914 PMCID: PMC10272443 DOI: 10.3389/fpsyt.2023.1128451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
The last 30 years has seen an exponential increase in Historical Institutional Abuse Inquiries. One feature of these has been to place adult survivor voices at the center of Inquiry work, meaning that child abuse victims and survivors are engaging with Inquiries, sharing their experiences, with this participation often presented as empowering and healing. This initiative challenges long held beliefs that child sexual abuse survivors are unreliable witnesses, which has led to epistemic injustice and a hermeneutical lacunae in survivor testimony. However to date there has been limited research on what survivors say about their experiences of participation. The Truth Project was one area of work of the Independent Inquiry into Child Sexual Abuse in England and Wales. It invited survivors of Child Sexual Abuse to share their experiences including the impacts of abuse and their recommendations for change. The Truth Project concluded in 2021 and heard from more than 6,000 victims of child sexual abuse. The evaluation of the Trauma Informed Approach designed to support survivors through their engagement with the project was a mixed methods, two phase methodology. A total of 66 survey responses were received. Follow-up interviews were conducted with seven survey respondents. The Trauma Informed Approach was found to be predominantly helpful in attending to victim needs and minimizing harm. However, a small number of participants reported harmful effects post-session. The positive impacts reported about taking part in the Truth Project as a one-off engagement challenges beliefs that survivors of child sexual abuse cannot safely talk about their experiences. It also provides evidence of the central role survivors should have in designing services for trauma victims. This study contributes to the epistemic justice literature which emphasizes the central role of relational ethics in the politics of knowing, and the importance of developing a testimonial sensibility when listening to marginalized groups.
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Affiliation(s)
| | - Stephanie Ford
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | | | | | - Daniel Taggart
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
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22
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Sadeghpour A, Pogge DL, O'Donoghue EM, Bigdeli T, Rothbaum AO, Harvey PD. Intellectual performance correlates of trauma exposure in adolescent psychiatric inpatients. Psychiatry Res 2023; 325:115231. [PMID: 37148833 DOI: 10.1016/j.psychres.2023.115231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023]
Abstract
Half of individuals have experienced a trauma adequate to meet criteria for PTSD. Intelligence may correlate with trauma, with the causal direction unclear. The Childhood Trauma Questionnaire (CTQ) was administered to 733 child and adolescent inpatients. Intelligence and academic achievement was assessed using the Wechsler Scales. Clinician diagnoses came from the electronic medical record, as did data on exposure to substance abuse and other stressors. Multivariate analyses assessed associations between intelligence, diagnoses, experiences, and CTQ. Cases who met criteria for physical and sexual abuse performed more poorly across all intellectual domains. Other than for PTSD, there were no diagnostic differences in CTQ scores. Emotional abuse or neglect were not associated with intelligence, although exposure to substance abuse was associated with increased CTQ scores and lower intelligence. Exposure to substance abuse as a covariate did not eliminate the influence of CTQ scores on intelligence, but was consistently related to intelligence beyond CTQ scores. Intelligence and substance abuse are known to have genomic influences and recent studies have suggested a genomic signature associated with childhood abuse. Future genomic studies of the consequences of trauma exposure could add intelligence polygenic scores into their models, while considering genomic and nongenomic elements of family experiences.
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Affiliation(s)
- Angelo Sadeghpour
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA; Bruce W. Carter VA Medical Center, 1201 NW 16th St, Miami, FL 33125, USA
| | - David L Pogge
- Four Winds Hospital, 800 Cross River Rd, Katonah, NY 10536, USA; Fairleigh Dickinson University, 1000 River Rd, Teaneck, NJ 07666, USA
| | - Elizabeth M O'Donoghue
- Four Winds Hospital, 800 Cross River Rd, Katonah, NY 10536, USA; University of Toledo, 2801 Bancroft St, Toledo, OH 43606, USA
| | - Tim Bigdeli
- SUNY Downstate Medical Center, 2801 Bancroft St, Toledo, OH 43606, USA; New York Harbor VA Health Services Organization, 423 E 23rd St, New York, NY 1001, USA
| | - Alex O Rothbaum
- Skyland Trail, 961 North Druid Hills Rd., NE Atlanta, GA 30329, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA; Bruce W. Carter VA Medical Center, 1201 NW 16th St, Miami, FL 33125, USA.
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23
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Sukkarieh O, Egede LE, Bassil M. Relationship between social determinants of health and quality of life in low income adults with diabetes in Lebanon. Postgrad Med 2023; 135:169-178. [PMID: 36714928 DOI: 10.1080/00325481.2023.2172283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND & OBJECTIVE Global rates of type 2 diabetes (T2DM) are increasing, with the Middle East and North Africa (MENA) region having the second highest prevalence in the world. Populations from the MENA region, including Lebanon, are also witnessing massive waves of immigration to the western hemisphere. Limited data exist about how social determinants of health (SDOH) impact outcomes for T2DM in this population. Thus, the aim of this study was to assess the relationship between SDOH and quality of life (QoL) in Lebanese adults with T2DM. METHODS Adults with T2DM (n = 300) were recruited from primary healthcare centers in Lebanon. Demographic characteristics and WHO QoL domains (physical health, psychological wellbeing, social relationships, and environment) were assessed. SDOH included socioeconomic, neighborhood/built environment, and psychosocial variables. Partially and fully adjusted regression models were used to test for associations between SDOH and QoL domains. RESULTS Mean age of the participants was 60.3 years, 48% were women, 73% were married, and 64% had less than high-school education. Results from the fully adjusted regression models showed that psychosocial (i.e. adverse childhood experiences and depression), socioeconomic (i.e. employment, income, family size, insurance, financial status, and financial independence), and neighborhood/built environment (i.e. transportation, number of rooms in the household, and certain household items) variables were independent correlates of different QoL domains. CONCLUSIONS This study shows that psychosocial, socioeconomic, and neighborhood/built environment variables are differentially associated with different QoL domains, suggesting that SDOH factors are strongly associated with quality of life in low-income adults with T2DM in Lebanon.
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Affiliation(s)
- Ola Sukkarieh
- Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maya Bassil
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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24
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Wooldridge JS, Tynan M, Rossi FS, Gasperi M, McLean CL, Bosch J, Trivedi RB, Herbert MS, Afari N. Patterns of adverse childhood experiences and cardiovascular risk factors in U.S. adults. Stress Health 2023; 39:48-58. [PMID: 35618265 PMCID: PMC9699903 DOI: 10.1002/smi.3167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023]
Abstract
Adverse Childhood Experiences (ACEs) are associated with poor health yet, we know little about how distinct patterns of ACE types are associated with cardiovascular (cardiovascular (CVD)) risk factors. The current study 1) examined associations of latent ACE classes with modifiable CVD risk factors including high cholesterol, smoking, diabetes, hypertension, high triglycerides, physical inactivity, overweight/obesity, and lifetime depression; and 2) examined the impact of socioeconomic status-related (SES) factors on these relationships. Using a cross-sectional analysis of the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309) data, four latent classes of ACEs were previously identified: 1) low adversity, 2) primarily household dysfunction, 3) primarily maltreatment, and 4) multiple adversity types. We examined the association of these classes with CVD risk factors in adulthood and subsequently, the same model accounting for SES-related factors. Tobacco smoking, overweight/obesity, and lifetime depression were each associated with higher odds of being in classes 2, 3, and 4 than class 1, respectively. These relationships held after adjusting for SES-related factors. Class 4 was associated with the most CVD risk factors, including high triglycerides and high cholesterol after controlling for SES-related factors. The consistent associations between tobacco smoking, overweight/obesity, and lifetime depression with each adverse ACE profile, even after controlling for SES, suggest behavioural CVD prevention programs should target these CVD risk factors simultaneously.
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Affiliation(s)
- Jennalee S. Wooldridge
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
| | - Mara Tynan
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Fernanda S. Rossi
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Stanford University Department of Psychiatry and Behavioral Sciences
| | - Marianna Gasperi
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
| | - Caitlin L. McLean
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
| | - Jeane Bosch
- National Center for PTSD, Dissemination & Training Division
| | - Ranak B. Trivedi
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Public Mental Health and Population Sciences
| | - Matthew S. Herbert
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
| | - Niloofar Afari
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
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25
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Zara S, Brähler E, Sachser C, Fegert JM, Häuser W, Krakau L, Kampling H, Kruse J. Associations of different types of child maltreatment and diabetes in adulthood - the mediating effect of personality functioning: Findings from a population-based representative German sample. Ann Epidemiol 2023; 78:47-53. [PMID: 36586456 DOI: 10.1016/j.annepidem.2022.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to examine the role of personality functioning in the association between various types of child maltreatment (CM) (sexual, physical, and emotional abuse as well as physical and emotional neglect) and diabetes in adulthood. METHODS Analyses are based on representative data of the German population (N = 5,041) from 2016 to 2019. Self-report questionnaires assessed diagnosis of diabetes, child maltreatment (CTQ), personality functioning (OPD-SQS), and symptoms of depression/anxiety (PHQ-4). Odd ratios were calculated to examine the association between CM and diabetes, and mediation analyses including PHQ-4 as covariate were conducted to examine the role of personality functioning. RESULTS All CM types significantly elevated the odds of having diabetes in adulthood. Personality functioning mediated the association between abuse and diabetes (sexual: b = 0.012, 95% CI [.002, 0.022], PM = 25.0%, physical: b = 0.009, 95% CI [.001, 0.017], PM = 12.0%, and emotional: b = 0.013, 95% CI [.002, 0.024], PM = 59.8%), but not between neglect and diabetes. CONCLUSIONS CM is associated with an increased risk of diabetes, with personality functioning being a relevant mediator for CM abuse types. Hence, by focusing on CM prevention and considering impaired personality functioning in diabetes treatment, diabetes self-management and health behavior could be improved.
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Affiliation(s)
- Sandra Zara
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Gießen, Germany.
| | - Elmar Brähler
- Department Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany; Integrated Research and Treatment Center for Adiposity Diseases, Behavioral Medicine Research Unit, University Medical Center Leipzig, Leipzig, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany; Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Lina Krakau
- Department Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Gießen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Gießen, Germany; Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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26
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Contemporary Developments in the Area of Non‐recent Child Sexual Abuse: Moving from What Is Wrong with You and What Happened to You, to What Are We Going To Do About It Now? BRITISH JOURNAL OF PSYCHOTHERAPY 2023. [DOI: 10.1111/bjp.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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27
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Strenth CR, Mo A, Kale NJ, Day PG, Gonzalez L, Green R, Cruz II, Schneider FD. Adverse Childhood Experiences and Diabetes: Testing Violence and Distress Mediational Pathways in Family Medicine Patients. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP23035-NP23056. [PMID: 35225043 DOI: 10.1177/08862605221076536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Type 2 diabetes mellitus (diabetes) is increasing in frequency and creating a significant burden on the United States healthcare system. Adverse childhood experiences (ACE) and interpersonal violence (IV) have been shown to have detrimental effects on mental and physical health. How ACE can influence IV as an adult and how this can influence the management of diabetes is not known. The purpose of the current study is to understand the relationship between violence and social determinants of health (SDoH), and its effect on patients with type 2 diabetes mellitus. A practiced-based research network (PBRN) of family medicine residency programs was utilized to collect cross-sectional data from seven family medicine residency program primary care clinics. In total, 581 participants with type 2 diabetes were recruited. A serial/parallel mediation model were analyzed. The majority of participants (58.3%) had a Hemoglobin A1c (HbA1c) that was not controlled. ACE was associated with an increase in Hurt-Insult-Threaten-Scream (HITS) scores, which in turn was positively associated with an increase in emotional burden, and finally, emotional burden decreased the likelihood that one's HbA1c was controlled (Effect = -.054, SE = .026 CI [-.115, -.013]). This indirect pathway remained significant even after controlling for several SDoH and gender. The impact of ACE persists into adulthood by altering behaviors that make adults more prone to experiencing family/partner violence. This in turn makes one more emotionally distressed about their diabetes, which influences how people manage their chronic condition. Family physicians should consider screening for both ACE and family/partner violence in those patients with poorly controlled diabetes.
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Affiliation(s)
| | - Albert Mo
- 23458Memorial Hermann Hospital, Houston, TX, USA
| | - Neelima J Kale
- 12252University of Kentucky College of Medicine, Lexington, KY, USA
| | - Philip G Day
- 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Ronya Green
- 427554TriStar Southern Hills Medical Center, Nashville, TN, USA
| | - Inez I Cruz
- 14742UT Health San Antonio, San Antonio, TX, USA
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28
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Miola A, De Filippis E, Veldic M, Ho AMC, Winham SJ, Mendoza M, Romo-Nava F, Nunez NA, Gardea Resendez M, Prieto ML, McElroy SL, Biernacka JM, Frye MA, Cuellar-Barboza AB. The genetics of bipolar disorder with obesity and type 2 diabetes. J Affect Disord 2022; 313:222-231. [PMID: 35780966 PMCID: PMC9703971 DOI: 10.1016/j.jad.2022.06.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bipolar disorder (BD) presents with high obesity and type 2 diabetes (T2D) and pathophysiological and phenomenological abnormalities shared with cardiometabolic disorders. Genomic studies may help define if they share genetic liability. This selective review of BD with obesity and T2D will focus on genomic studies, stress their current limitations and guide future steps in developing the field. METHODS We searched electronic databases (PubMed, Scopus) until December 2021 to identify genome-wide association studies, polygenic risk score analyses, and functional genomics of BD accounting for body mass index (BMI), obesity, or T2D. RESULTS The first genome-wide association studies (GWAS) of BD accounting for obesity found a promising genome-wide association in an intronic gene variant of TCF7L2 that was further replicated. Polygenic risk scores of obesity and T2D have also been associated with BD, yet, no genetic correlations have been demonstrated. Finally, human-induced stem cell studies of the intronic variant in TCF7L2 show a potential biological impact of the products of this genetic variant in BD risk. LIMITATIONS The narrative nature of this review. CONCLUSIONS Findings from BD GWAS accounting for obesity and their functional testing, have prompted potential biological insights. Yet, BD, obesity, and T2D display high phenotypic, genetic, and population-related heterogeneity, limiting our ability to detect genetic associations. Further studies should refine cardiometabolic phenotypes, test gene-environmental interactions and add population diversity.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ada Man-Choi Ho
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Stacey J Winham
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mariana Mendoza
- Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Miguel L Prieto
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Facultad de Medicina, Universidad de los Andes, Santiago, Chile; Mental Health Service, Clínica Universidad de los Andes, Santiago, Chile; Center for Biomedical Research and Innovation, Universidad de los Andes, Santiago, Chile
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanna M Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Alfredo B Cuellar-Barboza
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
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Adverse childhood experiences, diabetes and associated conditions, preventive care practices and health care access: A population-based study. Prev Med 2022; 160:107044. [PMID: 35398366 PMCID: PMC9218745 DOI: 10.1016/j.ypmed.2022.107044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/25/2022] [Accepted: 04/03/2022] [Indexed: 11/20/2022]
Abstract
Our objective was to examine how Adverse Childhood Experiences (ACEs) are associated with diabetes mellitus, diabetes-related conditions, and preventive care practices. We used data from the Behavioral Risk Factor Surveillance System (BRFSS) 2009-2012, a cross-sectional, population-based survey, to assess ACEs, diabetes, and health care access in 179,375 adults. In those with diabetes (n = 21,007), we assessed the association of ACEs with myocardial infarction, stroke, and five Healthy People 2020 (HP2020) diabetes-related preventive-care objectives (n = 13,152). Healthcare access indicators included lack of a regular health care provider, insurance, and difficulty affording health care. Regression analyses adjusted for age, sex, and race. The adjusted odds ratio (AOR) of diabetes increased in a stepwise fashion by ACE exposure, ranging from 1.2 (95% CI 1.1-1.3) for 1 ACE to 1.7 (95% CI 1.6-1.9) for ≥4 ACEs, versus having no ACEs. In persons with diabetes, those with ≥4 ACEs had an elevated adjusted odds of myocardial infarction (AOR = 1.6, 95% CI 1.2-2.0) and stroke (AOR = 1.8, 95% CI 1.3-2.4), versus having no ACEs. ACEs were also associated with a reduction in the adjusted percent of HP2020 diabetes objectives met: 72.9% (95% CI 71.3-74.5) for those with no ACEs versus only 66.5% (95% CI 63.8-69.3%) for those with ≥4 ACEs (p = 0.0002). Finally, ACEs predicted worse health care access in a stepwise fashion for all indicators. In conclusion, ACEs are associated with greater prevalence of diabetes and associated disease conditions, and with meeting fewer HP2020 prevention goals. Implementing ACE screening and trauma-informed health care practices are thus recommended.
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30
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Roth EG, Chard S. Affective Practices of Diabetes Self-Management Among Older Adults: Cumulative Effects of Childhood Adversity. THE GERONTOLOGIST 2022; 62:568-576. [PMID: 34406388 PMCID: PMC9019651 DOI: 10.1093/geront/gnab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A strong correlation exists between Type 2 diabetes mellitus and adverse childhood experiences. How adverse childhood experiences inform later-life diabetes management is less understood. This article examines diabetes management from the perspective of affective practice to explore the lingering impact of trauma biographies in diabetes management. RESEARCH DESIGN AND METHODS This secondary narrative analysis of 15 in-depth interviews with community-dwelling older adults with diabetes (subsample of the Subjective Experiences of Diabetes Study) focuses on the ways their reported childhood adversity affects perceptions of and responses to diabetes self-management. RESULTS The experiences of adversity in childhood accumulate, throughout the life course, in the affective practices informing diabetes self-management, from blood glucose testing, to food consumption, to the emotions invested in body size. We identify 3 thematic areas that emerged across participants: (a) undermining self-worth, (b) (over)eating and food as comfort, and (c) weight and body size. DISCUSSION AND IMPLICATIONS Our findings highlight affective practices as a mechanism through which adverse events accumulate and shape well-being over the life course. This analysis also suggests the potential for (de)accumulation of affective practices to improve diabetes management. The findings support recent calls for trauma-informed clinical care.
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Affiliation(s)
- Erin G Roth
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Sarah Chard
- Center for Aging Studies, University of Maryland Baltimore County, Baltimore, Maryland, USA
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, Maryland, USA
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Li Y, Thelen KM, Fernández KM, Nelli R, Fardisi M, Rajput M, Trottier NL, Contreras GA, Moeser AJ. Developmental alterations of intestinal SGLT1 and GLUT2 induced by early weaning coincides with persistent low-grade metabolic inflammation in female pigs. Am J Physiol Gastrointest Liver Physiol 2022; 322:G346-G359. [PMID: 34984921 PMCID: PMC9076411 DOI: 10.1152/ajpgi.00207.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Early-life adversity (ELA) is linked with the increased risk for inflammatory and metabolic diseases in later life, but the mechanisms remain poorly understood. Intestinal epithelial glucose transporters sodium-glucose-linked transporter 1 (SGLT1) and glucose transporter 2 (GLUT2) are the major route for intestinal glucose uptake but have also received increased attention as modulators of inflammatory and metabolic diseases. Here, we tested the hypothesis that early weaning (EW) in pigs, an established model of ELA, alters the development of epithelial glucose transporters and coincides with elevated markers of metabolic inflammation. The jejunum and ileum of 90-day-old pigs previously exposed to EW (16 days wean age), exhibited reduced SGLT1 activity (by ∼ 30%, P < 0.05) than late weaned (LW, 28 days wean age) controls. In contrast, GLUT2-mediated glucose transport was increased (P = 0.003) in EW pigs than in LW pigs. Reciprocal changes in SGLT1- and GLUT2-mediated transport coincided with transporter protein expression in the intestinal brush-border membranes (BBMs) that were observed at 90 days and 150 days of age. Ileal SGLT1-mediated glucose transport and BBM expression were inhibited by the β-adrenergic receptor (βAR) blocker propranolol in EW and LW pigs. In contrast, propranolol enhanced ileal GLUT2-mediated glucose transport (P = 0.015) and brush-border membrane vesicle (BBMV) abundance (P = 0.035) in LW pigs, but not in EW pigs. Early-weaned pigs exhibited chronically elevated blood glucose and C-reactive protein (CRP) levels, and adipocyte hypertrophy and upregulated adipogenesis-related gene expression in visceral adipose tissue. Altered development of intestinal glucose transporters by EW could underlie the increased risk for later life inflammatory and metabolic diseases.NEW & NOTEWORTHY These studies reveal that early-life adversity in the form of early weaning in pigs causes a developmental shift in intestinal glucose transport from SGLT1 toward GLUT2-mediated transport. Early weaning also induced markers of metabolic inflammation including persistent elevations in blood glucose and the inflammatory marker CRP, along with increased visceral adiposity. Altered intestinal glucose transport might contribute to increased risk for inflammatory and metabolic diseases associated with early-life adversity.
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Affiliation(s)
- Yihang Li
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Kyan M. Thelen
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Karina Matos Fernández
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Rahul Nelli
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Mahsa Fardisi
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Mrigendra Rajput
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Nathalie L. Trottier
- 3Department of Animal Science, Michigan State University, East Lansing, Michigan
| | - Genaro A. Contreras
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Adam J. Moeser
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan,2Department of Physiology, Michigan State University, East Lansing, Michigan
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Bergman BP, Mackay D, Pell JP. Type 2 diabetes in Scottish military veterans: a retrospective cohort study. BMJ Open 2022; 12:e057431. [PMID: 35115360 PMCID: PMC8814809 DOI: 10.1136/bmjopen-2021-057431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Type 2 diabetes is an important public health problem but the risk in UK military veterans is unknown. We used data from the Trends in Scottish Veterans' Health study to investigate the risk in comparison with people with no record of service. DESIGN Retrospective cohort study of a large national sample in Scotland, with up to 37 years follow-up. SETTING Pseudoanonymised extract of computerised Scottish National Health Service records, including a disease register and national vital records. PARTICIPANTS 78 000 veterans and 253 000 people with no record of service matched for age, sex and area of residence. OUTCOME MEASURES Cox proportional HRs for first record of type 2 diabetes in veterans compared with non-veterans, overall and by sex and birth cohort. Long-term trend, comorbidity with specific mental health outcomes and risk of limb loss. RESULTS Overall, 7.2% of veterans were diagnosed with type 2 diabetes, and were at slightly increased risk compared with non-veterans, Cox proportional HR 1.08, 95%CIs 1.04 to 1.11, p<0.001. The increased risk was confined to men, and to veterans born prior to 1960. There has been no change in HR over the last 25 years. Among veterans with post-traumatic stress disorder (PTSD), 12.1% had been diagnosed with type 2 diabetes, compared with 9.4% of non-veterans with PTSD. The difference was statistically significant, OR 1.29, 95% CI 1.04 to 1.59, p=0.021. Risk of limb loss was increased among the oldest veterans. CONCLUSIONS Older veterans in Scotland have an increased risk of type 2 diabetes in comparison with non-veterans, but there is no difference in respect of younger veterans, and the pattern of risk shows no evidence that it is changing. There is a positive association between type 2 diabetes and PTSD, especially in the presence of comorbid mood disorder, an important finding which should be noted by care providers.
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Affiliation(s)
- Beverly P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Umaefulam V, Premkumar K, Koole M. Perceptions on mobile health use for health education in an Indigenous population. Digit Health 2022; 8:20552076221092537. [PMID: 35449712 PMCID: PMC9016580 DOI: 10.1177/20552076221092537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Indigenous peoples in Canada face numerous health needs and challenges and
often have poor health status due to inequitable access to care. Providing
culturally appropriate support for health conditions, particularly chronic
conditions that require self-management, can assist in averting
complications and morbidity. Mobile health is a useful medium for delivering
health education across different populations. However, meaningful user
involvement is necessary because mobile health interventions suitable for
one population may not be appropriate for another. Indigenous people’s views
will inform the use of mobile health interventions in Indigenous
communities. Objective The study explored the perception of Indigenous women on using mobile health
as a tool for receiving health information. Methods This was a qualitative study, and participants comprised of 22 Indigenous
women (First Nations and Métis) with or at risk of diabetes, aged 18–69
years in Saskatoon, Canada. After 12 weeks of disseminating diabetic eye
care information via text messaging, data were collected via sharing circle
discussions and analyzed using thematic analysis. Results Participants indicated that the nature of messages such as the use of
Indigenous languages, the message content, frequency of messages, group
activities, and delivery formats such as voice messages, mobile
applications, Internet, two-way messaging, and text messages were essential
considerations in using mobile health as a tool for receiving health
information. Conclusion Different factors need to be considered in using mobile health as a tool for
health education among Indigenous peoples. These factors could be applicable
in implementing mobile health solutions in other populations for the
management of health conditions.
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Affiliation(s)
- Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marguerite Koole
- Educational Technology and Design, Department of Curriculum Studies, College of Education, University of Saskatchewan, Saskatoon, SK, Canada
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Merker JB, Dixon HD, Gluck R, Kim YJ, Powers A, Schwartz AC, Jovanovic T, Umpierrez G, Ressler KJ, Michopoulos V, Pace TWW, Gillespie CF, Seligowski AV. Heart rate variability and HbA1c predict plasma interleukin-6 response to psychosocial stress challenge in trauma-exposed women with type 2 diabetes. Brain Behav Immun Health 2021; 19:100400. [PMID: 34917989 PMCID: PMC8669354 DOI: 10.1016/j.bbih.2021.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a major public health problem in the United States. Although cardiovascular autonomic functioning, blood glucose control, and inflammation are known to play a role in T2DM, the interaction between these variables remains largely unexplored, particularly in the context of stress. To address this gap, we examined the relationship between these variables in a sample that is uniquely vulnerable to the health consequences of T2DM. Methods Participants were 37 trauma-exposed Black women with a diagnosis of T2DM. High frequency heart rate variability (HF-HRV), blood glucose control (HbA1c), and a stressor-evoked biomarker of inflammation (interleukin 6; IL-6) were obtained as part of a larger study of the genetic risk factors for and consequences of trauma exposure. Results The interaction of HbA1c and HF-HRV was significantly associated with IL-6 response calculated as area under the curve with respect to ground. Post-hoc simple slopes analyses revealed HbA1c, rather than HF-HRV, as the moderator in this association such that higher HF-HRV conferred higher circulating levels of IL-6 only in the presence of lower HbA1c, (β = 0.60, t = 3.51, p = .001). Conclusions Cardiovascular autonomic functioning and blood glucose control were significantly associated with stressor-evoked IL-6 responses when controlling for BMI and age. Moreover, the association between cardiovascular autonomic functioning and inflammation varied at different levels of HbA1c. This highlights the possibility that individuals with trauma exposure and T2DM may benefit from stratification by HbA1c levels for research analysis and treatment decision making. The interaction of blood glucose and vagal control was associated with IL-6 response. Higher vagal control conferred more inflammation only when blood glucose was low. Stratification by HbA1c levels may be useful for research analysis.
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Affiliation(s)
| | - H Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel Gluck
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ye Ji Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Guillermo Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerry J Ressler
- McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Yerkes National Primate Research Center, Atlanta, GA, USA
| | - Thaddeus W W Pace
- College of Nursing and College of Medicine (Psychiatry), University of Arizona, Tucson, AZ, USA
| | - Charles F Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Antonia V Seligowski
- McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Sonu S, Marvin D, Moore C. The Intersection and Dynamics between COVID-19, Health Disparities, and Adverse Childhood Experiences: "Intersection/Dynamics between COVID-19, Health Disparities, and ACEs". JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:517-526. [PMID: 34025900 PMCID: PMC8122187 DOI: 10.1007/s40653-021-00363-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is shining a spotlight on health disparities that have long been overlooked in our society. The intersection between Adverse Childhood Experiences (ACEs), longstanding health disparities, and COVID-19 cannot be ignored. The accumulation of traumatic events throughout the childhood and adolescent years can cause toxic stress in the absence of supportive adults. This repetitive activation of the stress response system can be a catalyst to long-term, negative effects on both the body and brain. A major factor to appreciate is that ACEs do not affect all populations equally. ACEs disproportionately affect groups that have been historically oppressed. The current COVID-19 pandemic highlights this point when observing both case rates and fatality rates of the virus and has the potential to create a new series of long-term health conditions that will disproportionately affect marginalized communities. A foundational first and critical step of adopting a trauma-informed approach will help lead to system change, advance equity, and create a setting of mutuality and empowerment for our patients.
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Affiliation(s)
- Stan Sonu
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - David Marvin
- Medical Student, Emory University School of Medicine, Atlanta, GA USA
| | - Charles Moore
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA USA
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36
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Ding R, He P. Associations between childhood adversities and late-life cognitive function: Potential mechanisms. Soc Sci Med 2021; 291:114478. [PMID: 34649168 DOI: 10.1016/j.socscimed.2021.114478] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 12/27/2022]
Abstract
RATIONALE Childhood adversity, which is related to negative cognitive consequences, is highly prevalent across the world. Nonetheless, there is still a scarcity of research on late-life cognitive function that accounted for multiple aspects of adverse events as well as the potential mediating mechanism of social context and individual's wellbeing in adulthood. OBJECTIVE This study aimed to investigate the relationship between childhood adversities and late-life cognitive function among the middle-aged and older Chinese population and to determine the mediating role of education attainment, marital status, financial status, and self-rated health in adulthood. METHODS We used three waves of data from China Health and Retirement Longitudinal Study from 2011 to 2015, which consisted of 23 807 participants aged 45 years and older. Generalized Estimating Equation and Structural Equation Model were applied to examine the association between childhood adversities and cognitive function (mental intactness and episodic memory) and the corresponding potential mechanisms. RESULTS Overall, 77.25%, 64.55%, 38.38%, and 15.03% of respondents experienced socioeconomic disadvantage, parental involved trauma, maladaptive parental trauma, and other trauma in childhood, respectively. Multivariate analyses suggest that all four types of childhood adversities were associated with a lower score of mental intactness and the first three were associated with episodic memory. A large proportion of the associations between childhood adversity and cognitive function was mainly mediated by education attainment, self-rated health and marital status in adulthood. CONCLUSION There are negative linkages between childhood adversities and cognitive function in the middle-aged and older Chinese population. Such associations were primarily functioning indirectly through adult social context and health conditions.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
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Islam SJ, Hwan Kim J, Joseph E, Topel M, Baltrus P, Liu C, Ko YA, Almuwaqqat Z, Mujahid MS, Sims M, Mubasher M, Ejaz K, Searles C, Dunbar SB, Pemu P, Taylor H, Bremner JD, Vaccarino V, Quyyumi AA, Lewis TT. Association Between Early Trauma and Ideal Cardiovascular Health Among Black Americans: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity. Circ Cardiovasc Qual Outcomes 2021; 14:e007904. [PMID: 34380328 PMCID: PMC8455434 DOI: 10.1161/circoutcomes.121.007904] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans. METHODS We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life's Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (<$50 000) interaction. RESULTS Higher levels of early trauma were associated with lower Life's Simple 7 scores (β, -0.05 [95% CI, -0.09 to -0.01], P=0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants (P value for interaction=0.04). Subtypes of early trauma linked to Life's Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life's Simple 7. CONCLUSIONS Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.
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Affiliation(s)
- Shabatun J Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Emma Joseph
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Matthew Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA. (P.B., M.M.).,National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA. (P.B.)
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.).,Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA. (C.L., Y.-A.K.)
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA. (C.L., Y.-A.K.)
| | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley (M.S.M.)
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.S.)
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA. (P.B., M.M.)
| | - Kiran Ejaz
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Charles Searles
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Sandra B Dunbar
- Rollins School of Public Health, and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. (S.B.D.)
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA. (P.P., H.T.)
| | - Herman Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA. (P.P., H.T.)
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. (J.D.B.).,Department of Radiology, Emory University School of Medicine, Atlanta, GA.(J.D.B.)
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.).,Department of Epidemiology, Emory University, Atlanta, GA. (V.V., T.T.L.)
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Tené T Lewis
- Department of Epidemiology, Emory University, Atlanta, GA. (V.V., T.T.L.)
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Fernandes SB, Patil ND, Meriaux S, Theresine M, Muller CP, Leenen FAD, Elwenspoek MMC, Zimmer J, Turner JD. Unbiased Screening Identifies Functional Differences in NK Cells After Early Life Psychosocial Stress. Front Immunol 2021; 12:674532. [PMID: 34394074 PMCID: PMC8363253 DOI: 10.3389/fimmu.2021.674532] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Early Life Adversity (ELA) is closely associated with the risk for developing diseases later in life, such as autoimmune diseases, type-2 diabetes and cardiovascular diseases. In humans, early parental separation, physical and sexual abuse or low social-economic status during childhood are known to have great impact on brain development, in the hormonal system and immune responses. Maternal deprivation (MD) is the closest animal model available to the human situation. This paradigm induces long lasting behavioral effects, causes changes in the HPA axis and affects the immune system. However, the mechanisms underlying changes in the immune response after ELA are still not fully understood. In this study we investigated how ELA changes the immune system, through an unbiased analysis, viSNE, and addressed specially the NK immune cell population and its functionality. We have demonstrated that maternal separation, in both humans and rats, significantly affects the sensitivity of the immune system in adulthood. Particularly, NK cells’ profile and response to target cell lines are significantly changed after ELA. These immune cells in rats are not only less cytotoxic towards YAC-1 cells, but also show a clear increase in the expression of maturation markers after 3h of maternal separation. Similarly, individuals who suffered from ELA display significant changes in the cytotoxic profile of NK cells together with decreased degranulation capacity. These results suggest that one of the key mechanisms by which the immune system becomes impaired after ELA might be due to a shift on the senescent state of the cells, specifically NK cells. Elucidation of such a mechanism highlights the importance of ELA prevention and how NK targeted immunotherapy might help attenuating ELA consequences.
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Affiliation(s)
- Sara B Fernandes
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.,Doctoral School in Systems and Molecular Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Neha D Patil
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.,Doctoral School in Systems and Molecular Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Sophie Meriaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Maud Theresine
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Claude P Muller
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Fleur A D Leenen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Martha M C Elwenspoek
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Jacques Zimmer
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.,Doctoral School in Systems and Molecular Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
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Novais M, Henriques T, Vidal-Alves MJ, Magalhães T. When Problems Only Get Bigger: The Impact of Adverse Childhood Experience on Adult Health. Front Psychol 2021; 12:693420. [PMID: 34335410 PMCID: PMC8318698 DOI: 10.3389/fpsyg.2021.693420] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/16/2021] [Indexed: 01/27/2023] Open
Abstract
Introduction: Previous studies have shown that adverse childhood experiences negatively impact child development, with consequences throughout the lifespan. Some of these consequences include the exacerbation or onset of several pathologies and risk behaviors. Materials and Methods: A convenience sample of 398 individuals aged 20 years or older from the Porto metropolitan area, with quotas, was collected. The evaluation was conducted using an anonymous questionnaire that included sociodemographic questions about exposure to adverse childhood experiences, a list of current health conditions, questions about risk behaviors, the AUDIT-C test, the Fagerström test and the Childhood Trauma Questionnaire-brief form. Variables were quantified to measure adverse childhood experiences, pathologies, and risk behaviors in adult individuals for comparison purposes. Results: Individuals with different forms of adverse childhood experiences present higher rates of smoking dependence, self-harm behaviors, victimization of/aggression toward intimate partners, early onset of sexual life, sexually transmitted infections, multiple sexual partners, abortions, anxiety, depression, diabetes, arthritis, high cholesterol, hypertension, and stroke. Different associations are analyzed and presented. Discussion and Conclusions: The results show that individuals with adverse childhood experiences have higher total scores for more risk behaviors and health conditions than individuals without traumatic backgrounds. These results are relevant for health purposes and indicate the need for further research to promote preventive and protective measures.
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Affiliation(s)
- Márcia Novais
- School of Medicine, Universidade do Porto (University of Porto), Porto, Portugal
| | - Teresa Henriques
- Department of Community Medicine, Information and Health Decisions, School of Medicine, University of Porto, Porto, Portugal
- Center for Research in Health Technologies and Services, School of Medicine, University of Porto, Porto, Portugal
| | - Maria João Vidal-Alves
- School of Medicine, Universidade do Porto (University of Porto), Porto, Portugal
- Department of Public and Forensic Health Sciences and Medical Education, School of Medicine, University of Porto, Porto, Portugal
- University Institute of Health Sciences - CESPU, Gandra, Portugal
| | - Teresa Magalhães
- School of Medicine, Universidade do Porto (University of Porto), Porto, Portugal
- Center for Research in Health Technologies and Services, School of Medicine, University of Porto, Porto, Portugal
- Department of Public and Forensic Health Sciences and Medical Education, School of Medicine, University of Porto, Porto, Portugal
- University Institute of Health Sciences - CESPU, Gandra, Portugal
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Mosley-Johnson E, Campbell JA, Garacci E, Walker RJ, Egede LE. Stress that Endures: Influence of Adverse Childhood Experiences on Daily Life Stress and Physical Health in Adulthood. J Affect Disord 2021; 284:38-43. [PMID: 33582431 PMCID: PMC8040325 DOI: 10.1016/j.jad.2021.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding the influence of ACEs on reported daily stress is needed to further address the role of ACEs on adult health and well-being. METHODS Data from 3,235 adults in the Midlife in the US (MIDUS) (Wave 1 (1995-1996) and Wave II (2004-2006)) were used. ACEs included emotional and physical abuse, household dysfunction, and financial strain. Daily stress was assessed using the National Study of Daily Experiences survey. Generalized Estimating Equations were used to examine the relationship between ACEs and Daily Stress. RESULTS ACE exposure was associated with higher number of reported stressors per day (p<.05), stressor severity (p<.05), number of physical symptoms reported (p<.05), and negative affect (p<.05). ACE count was significantly associated with multiple stressor types (OR=1.73, 95% 1.05-2.82) and number of days reported with stressor (RR=1.14, 95% 1.00-1.30). Abuse specifically was associated with a higher number of days reported with a stressor (RR=1.23, 95% CI 1.16 - 1.30). LIMITATIONS Assessment of ACEs is retrospective and self-reported. Secondly, this data is limited by ACE category. Specifically, sexual abuse and other forms of family dysfunction were not included in this dataset. CONCLUSIONS ACEs are associated with increased report of daily stress as an adult, reported physical symptoms as a result of stress, and reports of poor negative affect in adulthood. These findings highlight the role that ACEs play in the occurrence of reported daily stress during adulthood. Further investigation is needed to establish treatment and interventions for individuals who have experienced ACEs to avoid worsening health conditions and promote positive coping skills.
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Affiliation(s)
- Elise Mosley-Johnson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Emma Garacci
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA; Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA.
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Subramaniam M, Abdin E, Vaingankar JA, Chang S, Sambasivam R, Jeyagurunathan A, Seow LSE, Van Dam R, Chow WL, Chong SA. Association of adverse childhood experiences with diabetes in adulthood: results of a cross-sectional epidemiological survey in Singapore. BMJ Open 2021; 11:e045167. [PMID: 33722874 PMCID: PMC7959232 DOI: 10.1136/bmjopen-2020-045167] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Several studies have linked diabetes mellitus to adverse childhood experiences (ACEs). While a number of studies have examined the association between ACEs and diabetes in Western populations, few have done it in Asian populations. The current study aimed to examine (1) the association between ACEs and diabetes, including the association after age stratification, and (2) the association of comorbid depression, resource use and health-related quality of life (HRQoL) among those with diabetes and ACEs in Singapore. SETTINGS Participants were surveyed in their homes or any other preferred venue of their choice. PARTICIPANTS 6126 individuals aged 18 years and above were randomly selected among Singapore residents. DESIGN Cross-sectional nationwide epidemiological study. RESULTS Exposure to any ACE was not associated with increased odds of diabetes; however, those who had experienced parental separation, death or divorce of a parent had higher odds of diabetes. In addition, we observed significant interaction between age and ACEs in relation to odds of diabetes. ACEs were significantly associated with higher odds of diabetes mainly in the younger age group. The prevalence of major depressive disorder was significantly higher among those with diabetes and ACEs than those with diabetes alone (3.7% and 0.3% respectively). CONCLUSIONS Efforts to promote regular exercise and healthy lifestyles both in the population and among those with diabetes must continue for the prevention and management of diabetes. The findings emphasise the need to create more awareness of both the prevalence and impact of ACEs among those treating chronic diseases.
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Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore
- Epidemiology Domain, Saw Swee Hock School of Public Health, Singapore
| | | | | | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore
| | | | | | | | - Rob Van Dam
- Epidemiology Domain, Saw Swee Hock School of Public Health, Singapore
| | - Wai Leng Chow
- Epidemiology and Communicable Diseases Division, Ministry of Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Noel-London K, Ortiz K, BeLue R. Adverse childhood experiences (ACEs) & youth sports participation: Does a gradient exist? CHILD ABUSE & NEGLECT 2021; 113:104924. [PMID: 33461113 DOI: 10.1016/j.chiabu.2020.104924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/12/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Exposure to adverse childhood experiences (ACEs) may be an important factor in understanding sport participation in youth. Yet, very little research has examined this relationship directly using nationally representative data from the United States. OBJECTIVE This study aimed to examine the associations between ACEs and sport participation in adolescents. METHODS Using a 2017-2018 pooled dataset of the National Survey of Children's Health [NSCH], survey weighted chi-squared analysis and multivariable logistic regressions were implemented to assess the association between ACEs and sport participation among youth aged 10-17 years, comparing those without reports of ACEs (ref) to those reporting ACEs. The sample was also stratified to examine gendered differences. Models were adjusted for sociodemographic and child health covariates (physical activity, gender, age, BMI, race/ethnicity, parent reported child health, parental educational attainment, family structure, health insurance coverage, year and mental health conditions). RESULTS Of 23,557 youth included in our study (12,454 boys [51%], 11,303 girls [49%]; 21.9% reported 1 ACE, 10.1% reported 2 ACEs, and 14.3% reported 3 or more ACEs. In fully adjusted models, we observed significant associations between all levels of ACE exposure and decreased sport participation. When examined by gender, adjusted models revealed that only boys reporting 1ACE exhibited decreased odds of participating in sport OR = 0.70 (95% CI: 0.56, 0.89). CONCLUSIONS ACE exposure in adolescents is associated with reduced odds of sport participation. While sport is traditionally seen as an intervention for youth to build resilience, it may be prudent to consider targeted interventions that encourage sport participation in youth who experience ACEs. Special consideration may be needed for boys who experience ACEs. Additionally, the results suggest that utilising a trauma informed framework within the world of youth sport and sports medicine may be of value overall.
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Affiliation(s)
- Kemba Noel-London
- College for Public Health and Social Justice, Department of Health Management and Policy, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA.
| | - Kasim Ortiz
- Department of Sociology & Criminology, University of New Mexico, Albuquerque, New Mexico, NM, 87131, USA
| | - Rhonda BeLue
- College for Public Health and Social Justice, Department of Health Management and Policy, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA
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Chu WWE, Chu NF. Adverse childhood experiences and development of obesity and diabetes in adulthood-A mini review. Obes Res Clin Pract 2021; 15:101-105. [PMID: 33518485 DOI: 10.1016/j.orcp.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Accepted: 12/26/2020] [Indexed: 12/28/2022]
Abstract
Obesity has been steadily rising in the last few decades and to some extent, have been linked to exposure of adverse childhood experiences (ACEs). ACEs are intense stressors or traumatic events experienced or witnessed by children, ranging from all types of abuse (physical, emotional, and sexual), neglect, substance abuse or community violence. These traumatic events deprive the sense of safety and stability of a child, leaving psychological and physiological effects that span into adulthood. The prevalence of ACEs is common across developed and developing countries alike, though the rates differ across ethnicities. Using the United States as an example, the prevalence of ACEs experienced by communities of color is higher than white children. Children around the world could all be exposed to ACEs, hence the original questionnaire capturing the score of ACE has been adapted to different cultural situations. The mechanism linking ACEs to obesity during adulthood include biological, psychological, and environmental factors. Nevertheless, a higher ACE score heightens the risk of poor mental health, attempted suicide and development of obesity and diabetes in adulthood. Prevention of ACEs starts from building positive relationships within families, developing healthy relationship skills, and screening of ACEs during early and routine pediatrician's and primary care visits. Intervention needs to include case management services and psychosocial support programs. When these risk factors are intervened early, it lessens the risk of obesity and diabetes in adulthood.
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Affiliation(s)
| | - Nain-Feng Chu
- Department of Medicine, Tri-Service General Hospital, School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
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Taggart D, Rouf K, Hisham IBI, Duckworth L, Sweeney A. Trauma, mental health and the COVID-19 crisis: are we really all in it together? J Ment Health 2021; 30:401-404. [PMID: 33522346 DOI: 10.1080/09638237.2021.1875415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Danny Taggart
- School of Health and Social Care, Faculty of Science and Engineering, University of Essex, Colchester, UK
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Lopizzo N, Mazzelli M, Zonca V, Begni V, D'Aprile I, Cattane N, Pariante CM, Riva MA, Cattaneo A. Alterations in 'inflammatory' pathways in the rat prefrontal cortex as early biological predictors of the long-term negative consequences of exposure to stress early in life. Psychoneuroendocrinology 2021; 124:104794. [PMID: 33429258 DOI: 10.1016/j.psyneuen.2020.104794] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
Early life stress, especially when experienced during the first period of life, affects the brain developmental trajectories leading to an enhanced vulnerability for stress-related psychiatric disorders later in life. Although both clinical and preclinical studies clearly support this association, the biological pathways deregulated by such exposure, and the effects in shaping the neurodevelopmental trajectories, have so far been poorly investigated. By using the prenatal stress (PNS) model, a well-established rat model of early life stress, we performed transcriptomic analyses in the prefrontal cortex of rats exposed or not to PNS and sacrificed at different postnatal days (PNDs 21, 40, 62). We first investigated the long-lasting mechanisms and pathways affected in the PFC. We have decided to focus on the prefrontal cortex because we have previously shown that this brain region is highly sensitive to PNS exposure. We found that adult animals exposed to PNS show alterations in 389 genes, mainly involved in stress and inflammatory signalling. We then wanted to establish whether PNS exposure could also affect the neurodevelopmental trajectories in order to identify the most critical temporal window. We found that PNS rats show the most significant changes during adolescence (between PND 40 versus PND 21), with alterations of several pathways related to stress, inflammation and metabolism, which were maintained until adulthood.
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Affiliation(s)
- Nicola Lopizzo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Monica Mazzelli
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Valentina Zonca
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Veronica Begni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Ilari D'Aprile
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nadia Cattane
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy.
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Monzer N, Hartmann M, Buckert M, Wolff K, Nawroth P, Kopf S, Kender Z, Friederich HC, Wild B. Associations of Childhood Neglect With the ACTH and Plasma Cortisol Stress Response in Patients With Type 2 Diabetes. Front Psychiatry 2021; 12:679693. [PMID: 34220585 PMCID: PMC8247465 DOI: 10.3389/fpsyt.2021.679693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cross-sectional as well as longitudinal studies have linked childhood maltreatment to type 2 diabetes in adulthood with childhood neglect showing the strongest effect on type 2 diabetes risk. However, the mechanisms that link childhood maltreatment to type 2 diabetes are still unclear. Alterations in the psychological and physiological stress response system, specifically the hypothalamus-pituitary-adrenal (HPA) axis are a common finding in samples with a background of childhood neglect and are associated with type 2 diabetes. In the present study, we investigated the association between childhood neglect and the physiological and psychological stress response in patients with type 2 diabetes and healthy control participants. Method: We assessed emotional and physical childhood neglect in a sample of n = 74 patients with type 2 diabetes and n = 50 healthy control participants. We used the trier social stress test (TSST) to induce a stress response. Blood ACTH and cortisol levels were measured before (T0), directly after (T1) as well as 30 (T2) and 60 (T3) min after the TSST. Participants' subjective experience was assessed via visual analog scales before, directly after as well as at 45 min after the TSST. We used multiple regression analyses to predict the change in self-reported tension between T0 and T1. Multilevel models were applied to predict cortisol and ACTH levels across all measurement points. Results: We found a significant association between moderate to severe childhood neglect and a stronger psychological stress response in patients with type 2 diabetes, that was not present in healthy controls. In type 2 diabetes patients, but not in healthy controls, higher ACTH levels across all measurement points were significantly associated with higher severity of emotional neglect and higher severity of physical neglect was significantly associated with a stronger increase in plasma cortisol from T0 to T1. Conclusions: This is the first study to investigate whether childhood maltreatment in patients with type 2 diabetes could be associated with a dysregulated stress response. Our results show a link between the psychological and physiological stress response and childhood neglect in type 2 diabetes patients. This pathway is thus a possible mechanism connecting type 2 diabetes and childhood neglect.
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Affiliation(s)
- Nelly Monzer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Magdalena Buckert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Kira Wolff
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Nawroth
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Heidelberg, Germany
| | - Stefan Kopf
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Heidelberg, Germany
| | - Zoltan Kender
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Tosato S, Bonetto C, Lopizzo N, Cattane N, Barcella M, Turco G, Ruggeri M, Provasi S, Tomassi S, Dazzan P, Cattaneo A. Childhood and Adulthood Severe Stressful Experiences and Biomarkers Related to Glucose Metabolism: A Possible Association? Front Psychiatry 2021; 12:629137. [PMID: 34054596 PMCID: PMC8160252 DOI: 10.3389/fpsyt.2021.629137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background: No study investigated the association between stress exposure in different stages of life and metabolic dysfunction. Aim: We explore the association between stress exposure and several biomarkers related to glucose metabolism (insulin, c-peptide, GIP, GLP-1, glucagon) in a group of 72 healthy individuals. Method: We used the Childhood Experience of Care and Abuse-Questionnaire (CECA-Q) and a modified version of the Life Events Scale to define exposure to stress, according to four categories: no exposure to childhood trauma (CT) nor to stressful life events (SLEs) (46%), only to CT (25%), only to SLEs (21%), to both (8%). Results: We found that c-peptide (p = 0.006) and insulin (p = 0.002) levels differed among the four categories: 0.77 ng/ml (SD 0.27) and 0.21 ng/ml (SD 0.06) for none, 0.77 (SD 0.37) and 0.20 (SD 0.08) for only SLEs, 0.88 (SD 0.39) and 0.27 (SD 0.12) for only CT, 1.33 (SD 0.57) and 0.40 (SD 0.28) for both, respectively. The highest levels of biomarkers were found in subjects exposed to both CT and SLEs. Conclusion: Our preliminary results seem to suggest that CT might be specifically associated with a dysfunction of glucose metabolism, which might increase the risk of poorer health outcomes in adulthood. This association seems to be even stronger in individuals additionally exposed to SLEs in adulthood. In conclusion, if confirmed in other studies, subjects exposed to both CT and SLEs appear the most vulnerable individuals, for whom preventative interventions, such as healthy lifestyle education programs, might ameliorate the risk of developing metabolic abnormalities.
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Affiliation(s)
- Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Lopizzo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Nadia Cattane
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Mara Barcella
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giorgia Turco
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefania Provasi
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Simona Tomassi
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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Ittoop T, Jeffrey K, Cheng CI, Reddy S. The Relationship Between Adverse Childhood Experiences and Diabetes in Central Michigan Adults. Endocr Pract 2020; 26:1425-1434. [PMID: 33471734 DOI: 10.4158/ep-2020-0239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/18/2020] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) predispose individuals to poor health outcomes as adults. Although a dose-response relationship between the number of ACEs and certain chronic illnesses has been shown, the impact of ACEs on diabetes is not thoroughly understood. We investigated the prevalence of ACEs in patients with diabetes and the potential relationship to the severity of diabetes. METHODS Patients with diabetes (both type 1 and type 2) or obesity were surveyed from the Endocrinology & Diabetes Center at McLaren Central Michigan in Mount Pleasant, Michigan. A validated, standard ACE questionnaire was administered to quantify the number of adverse childhood events that patients have experienced. A retrospective chart analysis was then conducted, addressing the relationship of ACEs with the severity of disease in the diabetes group and the obesity group. The number of ACEs was correlated with disease comorbidities, complications, and measurable quantities, such as body mass index (BMI) and hemoglobin A1c (HbA1c). RESULTS ACE scores in both diabetes and obesity groups were shown to have a greater prevalence compared to the general ACE average in Michigan. ACE scores also positively correlated to BMI and HbA1c in the diabetes group. Those with higher ACE scores in the diabetes group were also more likely to have depression and anxiety. CONCLUSION ACE screening may lead to a greater understanding of the severity of and progression of diabetes. Ultimately, these results could provide support to potential interventional studies leading to the altered management of diabetes in patients with ACEs, or preventative intervention to children with ACEs. ABBREVIATIONS ACE = adverse childhood experiences; BMI = body mass index; HbA1c = hemoglobin A1c; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus.
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Affiliation(s)
- Thomas Ittoop
- From (1)Central Michigan University, College of Medicine, Mount Pleasant, Michigan
| | - Kimberly Jeffrey
- McLaren Central Michigan, Endocrinology, Mount Pleasant, Michigan, and
| | - Chin-I Cheng
- Central Michigan University, Department of Statistics, Actuarial and Data Science, Mount Pleasant, Michigan
| | - Sethu Reddy
- From (1)Central Michigan University, College of Medicine, Mount Pleasant, Michigan,; McLaren Central Michigan, Endocrinology, Mount Pleasant, Michigan, and.
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Agarwal S, Kanapka LG, Raymond JK, Walker A, Gerard-Gonzalez A, Kruger D, Redondo MJ, Rickels MR, Shah VN, Butler A, Gonzalez J, Verdejo AS, Gal RL, Willi S, Long JA. Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:dgaa236. [PMID: 32382736 PMCID: PMC7457963 DOI: 10.1210/clinem/dgaa236] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. OBJECTIVE To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). DESIGN Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. SETTING Six diabetes centers across the United States. PARTICIPANTS A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). MAIN OUTCOME Racial-ethnic disparity in HbA1c levels. RESULTS Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black-White glycemic disparity. CONCLUSION This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Andrea Gerard-Gonzalez
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Maria J Redondo
- Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Michael R Rickels
- Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ashley Butler
- Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Jeffrey Gonzalez
- Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | | | - Steven Willi
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Judith A Long
- Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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50
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Folayan MO, Oginni O, Arowolo O, El Tantawi M. Association between adverse childhood experiences, bullying, self-esteem, resilience, social support, caries and oral hygiene in children and adolescents in sub-urban Nigeria. BMC Oral Health 2020; 20:202. [PMID: 32652974 PMCID: PMC7353770 DOI: 10.1186/s12903-020-01160-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/08/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases. METHODS This was a secondary analysis of data collected through a cross-sectional school survey of children 6-16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression. RESULTS Of the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85-0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97-1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09-1.17; p = 0.03). CONCLUSION There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olakunle Oginni
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olaniyi Arowolo
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Maha El Tantawi
- Faculty of Dentistry, Alexandria University, Qism Bab Sharqi, Egypt
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