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Niebla-Cárdenas A, Bareke H, Juanes-Velasco P, Landeira-Viñuela A, Hernández ÁP, Montalvillo E, Góngora R, Arroyo-Anlló E, Silvia Puente-González A, Méndez-Sánchez R, Fuentes M. Translational research into frailty from bench to bedside: Salivary biomarkers for inflammaging. Exp Gerontol 2023; 171:112040. [PMID: 36455696 DOI: 10.1016/j.exger.2022.112040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Frailty is a complex physiological syndrome associated with adverse ageing and decreased physiological reserves. Frailty leads to cognitive and physical disability and is a significant cause of morbidity, mortality and economic costs. The underlying cause of frailty is multifaceted, including immunosenescence and inflammaging, changes in microbiota and metabolic dysfunction. Currently, salivary biomarkers are used as early predictors for some clinical diseases, contributing to the effective prevention and treatment of diseases, including frailty. Sample collection for salivary analysis is non-invasive and simple, which are paramount factors for testing in the vulnerable frail population. The aim of this review is to describe the current knowledge on the association between frailty and the inflammatory process and discuss methods to identify putative biomarkers in salivary fluids to predict this syndrome. This study describes the relationship between i.-inflammatory process and frailty; ii.-infectious, chronic, skeletal, metabolic and cognitive diseases with inflammation and frailty; iii.-inflammatory biomarkers and salivary fluids. There is a limited number of previous studies focusing on the analysis of inflammatory salivary biomarkers and frailty syndrome; hence, the study of salivary fluids as a source for biomarkers is an open area of research with the potential to address the increasing demands for frailty-associated biomarkers.
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Affiliation(s)
- Alfonssina Niebla-Cárdenas
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
| | - Halin Bareke
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Institute of Health Sciences, Marmara University, Istanbul, Turkey; Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Pablo Juanes-Velasco
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Alicia Landeira-Viñuela
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Ángela-Patricia Hernández
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Department of Pharmaceutical Sciences: Organic Chemistry, Faculty of Pharmacy, University of Salamanca, CIETUS, IBSAL, 37007 Salamanca, Spain
| | - Enrique Montalvillo
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Rafael Góngora
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Eva Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, Faculty of Psychology, University of Salamanca, 37007 Salamanca, Spain
| | - Ana Silvia Puente-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain.
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain
| | - Manuel Fuentes
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Proteomics Unit, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca, Spain.
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Babaei M, Rezaei S, Saghafi Khadem S, Shirinbak I, Basir Shabestari S. The Role of Salivary C-Reactive Protein in Systemic and Oral Disorders: A Systematic Review. Med J Islam Repub Iran 2022; 36:138. [PMID: 36479533 PMCID: PMC9719583 DOI: 10.47176/mjiri.36.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Blood sampling is expensive, time-consuming, invasive, and requires technical facilities, which can be replaced by more convenient samples such as saliva. C-reactive protein (CRP) is a widely used biomarker in the management of many disorders and plasma CRP (pCRP) is suggested to be replaced by salivary CRP (sCRP). This study aimed to systematically review all available literature on the sCRP levels in systemic and oral disorders and how sCRP and pCRP levels correlate among these patients and healthy individuals. Methods: In this systematic review, a PubMed, Embase, Scopus, and Google Scholar search was conducted on October-2021 to identify all research investigating sCRP levels in systemic and oral disorders. Results: A total of 130 publications were analyzed in the review. Most of the studies reported that sCRP and pCRP levels are correlated, and sCRP is a reliable alternative for pCRP level for the diagnosis and management of medical conditions. sCRP has been measured in many different medical and oral disorders and significantly correlated with disease activity in most cases. Conclusion: Salivary CRP is a good alternative for Plasma CRP levels in most cases.
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Affiliation(s)
- Mahsa Babaei
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Rezaei
- Iran University of Medical Sciences, Tehran, Iran
| | - Shadi Saghafi Khadem
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Iman Shirinbak
- Oral and Maxillofacial Surgery, Alborz University of Medical Sciences, Karaj, Iran
| | - Samira Basir Shabestari
- Department of Oral Medicine, School of Dentistry, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran, Corresponding author:Samira Basir Shabestari,
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Fong TCT, Ho RTH, Yau JCY. Longitudinal associations between salivary cortisol to C-reactive protein ratios and psychological well-being in Chinese adults. Psychoneuroendocrinology 2022; 143:105824. [PMID: 35689984 DOI: 10.1016/j.psyneuen.2022.105824] [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: 01/19/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Salivary C-reactive protein (CRP) could be a viable biomarker of inflammation and has been associated with stress outcomes. The hypothalamic-pituitary-adrenal axis can modulate stress-related inflammation. This study aimed to evaluate the interaction effects of immune-endocrine markers on psychological outcomes. METHODS The study participants were 52 healthy Chinese adults who collected 10 saliva samples over 2 consecutive days at baseline. The participants completed validated measures on anxiety, depression, positive affect, and sleep disturbance at baseline and 1 month later. The stability and diurnal patterns of salivary cortisol and CRP were investigated via paired t-tests and repeated-measures analyses of variance. Regression analysis was used to examine the longitudinal associations between immune-endocrine markers and their interactions (cortisol [Cort]: morning CRP [CRPmorn] and Cort:CRPeven) and psychological measures. RESULTS Salivary cortisol and CRP displayed satisfactory stability over 2 consecutive days and diurnal patterns of abrupt and gradual decline during the day, respectively. Controlling for baseline psychological measures and confounding variables, Cortmorn and diurnal cortisol slope was significantly and negatively associated with anxiety symptoms and positive affect 1 month later, respectively. Cort:CRPeven and Cort:CRPmorn was significantly and positively associated with depressive symptoms and sleep disturbance 1 month later, respectively. CONCLUSION These findings offer initial support for the prognostic utility of salivary cortisol and CRP and their balance as determinants of psychological health in healthy adults.
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Affiliation(s)
- Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong; Dept of Social Work & Social Administration, The University of Hong Kong, Hong Kong.
| | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
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Lee S, Chey J, Ahn W, Woo C, Youm Y, Kim H, Oh N, Park H, Gim S, Lee E, Choi I. Psychological well‐being and salivary markers of inflammation: The moderating effect of age. Appl Psychol Health Well Being 2022; 15:466-478. [PMID: 35851762 DOI: 10.1111/aphw.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
Increasing evidence suggests a significant impact of higher psychological well-being (PWB) on health outcomes; however, such associations have been studied exclusively in middle-aged to older adults. This study examined the aging effect on PWB measures as well as the moderating effect of age on the link between PWB and inflammation, using salivary markers by comparing the younger adults (n = 127; Mage = 22.98 years) versus older adults (n = 75; Mage = 75.60 years). Older adults showed significantly lower levels of PWB, particularly regarding purpose in life and personal growth. Moreover, higher purpose in life was associated with lower salivary IL-1ß and IL-6 (b = 0.83, p < .001; b = 0.81, p < .01) only in the older adult group but not in younger adults. These findings highlight the potential buffering effect of the sense of living well on physiological pathways in later life.
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Affiliation(s)
- Sung‐Ha Lee
- Center for Happiness Studies Seoul National University Seoul South Korea
| | - Jeanyung Chey
- Department of Psychology Seoul National University Seoul South Korea
| | - Woo‐Young Ahn
- Department of Psychology Seoul National University Seoul South Korea
- Department of Brain and Cognitive Sciences Seoul National University Seoul South Korea
| | - Choong‐Wan Woo
- Department of Biomedical Engineering Sungkyunkwan University Suwon South Korea
- Center for Neuroscience Imaging Research Institute for Basic Science (IBS) Suwon South Korea
- Department of Intelligent Precision Healthcare Convergence Sungkyunkwan University Suwon South Korea
| | - Yoosik Youm
- Department of Sociology Yonsei University Seoul South Korea
| | - Hairin Kim
- Department of Psychology Seoul National University Seoul South Korea
- Department of Psychiatry Seoul National University College of Medicine and SMG‐SNU Boramae Medical Center Seoul South Korea
| | - Naeun Oh
- Department of Psychology Seoul National University Seoul South Korea
| | - Hyeyoung Park
- Department of Psychology Seoul National University Seoul South Korea
| | - Suhwan Gim
- Department of Biomedical Engineering Sungkyunkwan University Suwon South Korea
- Center for Neuroscience Imaging Research Institute for Basic Science (IBS) Suwon South Korea
- Department of Intelligent Precision Healthcare Convergence Sungkyunkwan University Suwon South Korea
| | - Eunjin Lee
- Department of Biomedical Engineering Sungkyunkwan University Suwon South Korea
- Center for Neuroscience Imaging Research Institute for Basic Science (IBS) Suwon South Korea
- Department of Intelligent Precision Healthcare Convergence Sungkyunkwan University Suwon South Korea
| | - Incheol Choi
- Center for Happiness Studies Seoul National University Seoul South Korea
- Department of Psychology Seoul National University Seoul South Korea
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Richards A, Inslicht SS, Yack LM, Metzler TJ, Huie JR, Straus LD, Dukes C, Hubachek SQ, Felmingham KL, Mathalon DH, Woodward SH, Neylan TC. The Relationship of Fear-Potentiated Startle and Polysomnography-Measured Sleep in Trauma-Exposed Men and Women with and without PTSD: Testing REM Sleep Effects and Exploring the Roles of an Integrative Measure of Sleep, PTSD Symptoms, and Biological Sex. Sleep 2021; 45:6430783. [PMID: 34792165 DOI: 10.1093/sleep/zsab271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/06/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Published research indicates that sleep is involved in emotional information processing. Using a fear-potentiated startle (FPS) and nap sleep protocol, we examined the relationship of emotional learning with REM sleep (REMS) in trauma-exposed participants. We also explored the roles of PTSD symptoms, biological sex, and an integrative measure of polysomnography-measured (PSG) sleep in the learning-sleep relationship. METHODS After an adaptation nap, participants (N=46) completed 2 more visits (counterbalanced): a stress-condition visit, which included FPS conditioning procedures prior to a nap and assessment of learning retention and fear extinction training after the nap, and a control visit, which included a nap opportunity without stressful procedures. FPS conditioning included a "fear" visual stimulus paired with an air blast to the neck and a "safety" visual stimulus never paired with an air blast. Retention and extinction involved presentation of the visual stimuli without the air blast. Primary analyses examined the relationship between FPS responses pre- and post- sleep with stress-condition REMS duration, controlling for control-nap REMS duration. RESULTS Higher safety learning predicted increased REMS and increased REMS predicted more rapid extinction learning. Similar relationships were observed with an integrative PSG sleep measure. They also showed unexpected effects of PTSD symptoms on learning and showed biological sex effects on learning-sleep relationships. CONCLUSIONS Findings support evidence of a relationship between adaptive emotional learning and REMS. They underscore the importance of examining sex effects in sleep-learning relationships. They introduce an integrative PSG sleep measure with potential relevance to studies of sleep and subjective and biological outcomes.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Sabra S Inslicht
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Leslie M Yack
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | | | - J Russell Huie
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Laura D Straus
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | - Cassandra Dukes
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | | | | | - Daniel H Mathalon
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Steven H Woodward
- National Center for PTSD and VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Thomas C Neylan
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
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The ratio of morning cortisol to CRP prospectively predicts first-onset depression in at-risk adolescents. Soc Sci Med 2021; 281:114098. [PMID: 34126291 DOI: 10.1016/j.socscimed.2021.114098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/25/2021] [Accepted: 05/31/2021] [Indexed: 12/22/2022]
Abstract
RATIONALE Early-onset adolescent depression is related to poor prognosis and a range of psychiatric and medical comorbidities later in life, making the identification of a priori risk factors for depression highly important. Increasingly, dysregulated levels of immune and neuroendocrine markers, such as C-reactive protein (CRP) and cortisol, have been demonstrated as both precursors to and consequences of depression. However, longitudinal research with adolescent populations is limited and demonstrates mixed immuno-endocrine-depression links. OBJECTIVE This study explored the putative bidirectional relationship between salivary measures of cortisol (Cort) and CRP, including the novel Cort:CRP ratio and depression. METHODS Participants from the randomized control trial 'Sleep and Education: learning New Skills Early' (SENSE) Study were 122 adolescents at risk for depression (73 females) aged 12-16 years (M = 12.71 years, SD = 1.01 years) assessed at baseline (T1), post-intervention (T2), and a two-year follow-up (T3). RESULTS Logistic regression results demonstrated that adolescents with higher T1 Cort:CRPmorn ratio levels were two-fold more likely to develop a first-onset depressive disorder from T2 to T3 as compared to adolescents with lower Cort:CRPmorn ratio levels, β = 0.73, t (36) = 2.15, p = .04, OR = 2.08. This effect was not moderated by treatment condition (β = -1.38, t (13) = -1.33, p = .20) and did not change when controlling for known risk factors for depression, including sex, age, body-mass index, socio-economic status, T1 anxiety disorder, nor T1 sleep disturbance, anxiety, or depressive symptoms (β = 0.91, t (31) = 2.14, p = .04). CONCLUSION Results highlight potential immuno-endocrine dysregulation as an underlying risk factor for adolescent first-onset depression, and may inform the development of targeted, preventative biobehavioral treatment strategies for youth depression.
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Moriarity DP, Alloy LB. Back to Basics: The Importance of Measurement Properties in Biological Psychiatry. Neurosci Biobehav Rev 2021; 123:72-82. [PMID: 33497789 PMCID: PMC7933060 DOI: 10.1016/j.neubiorev.2021.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 01/02/2023]
Abstract
Biological psychiatry is a major funding priority for organizations that fund mental health research (e.g., National Institutes of Health). Despite this, some have argued that the field has fallen short of its considerable promise to meaningfully impact the classification, diagnosis, and treatment of psychopathology. This may be attributable in part to a paucity of research about key measurement properties ("physiometrics") of biological variables as they are commonly used in biological psychiatry research. Specifically, study designs informed by physiometrics are more likely to be replicable, avoid poor measurement that results in misestimation, and maximize efficiency in terms of time, money, and the number of analyses conducted. This review describes five key physiometric principles (internal consistency, dimensionality, method-specific variance, temporal stability, and temporal specificity), illustrates how lack of understanding about these characteristics imposes meaningful limitations on research, and reviews examples of physiometric studies featuring a variety of popular biological variables to illustrate how this research can be done and substantive conclusions drawn about the variables of interest.
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Szabo YZ, Slavish DC. Measuring salivary markers of inflammation in health research: A review of methodological considerations and best practices. Psychoneuroendocrinology 2021; 124:105069. [PMID: 33316694 PMCID: PMC8412951 DOI: 10.1016/j.psyneuen.2020.105069] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
There is an increasing interest in using saliva to measure inflammatory biomarkers. Compared to blood, saliva is non-invasive, requires a lower biosafety classification, and requires less specialized personnel to collect. As the assessment of inflammation in saliva becomes more popular in psychoneuroimmunology research, the development of gold-standard methodological practices is paramount. This paper reviews different considerations for designing studies to assess salivary measures of inflammation. We review saliva collection procedures, sample storage and processing considerations, assay techniques, flow rate, correspondence with blood-based markers, and potential demographic and health moderators of levels of salivary markers of inflammation. Together, this review highlights critical gaps for future research, including calls for standardization of study protocols, transparent reporting of results, assessing predictive validity of markers of salivary inflammation for disease, and the need for assessment of participants' oral and general health status. Although additional work is needed to elucidate gold standards for study design, measurement, and analysis, salivary markers of inflammation may be a useful tool for understanding oral and peripheral inflammation dynamics non-invasively.
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Affiliation(s)
- Yvette Z. Szabo
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA,Department of Health, Human Performance and Recreation, Baylor University, Waco, TX, USA, Corresponding Authors: Yvette Z. Szabo, 4800 Memorial Drive (151C), Waco, Texas 76711 (254) 297-3179;
| | - Danica C. Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
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Simpson CA, Adler C, du Plessis MR, Landau ER, Dashper SG, Reynolds EC, Schwartz OS, Simmons JG. Oral microbiome composition, but not diversity, is associated with adolescent anxiety and depression symptoms. Physiol Behav 2020; 226:113126. [PMID: 32777312 DOI: 10.1016/j.physbeh.2020.113126] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/07/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Depression and anxiety are highly prevalent disorders, whose significant burden is compounded by the presence of oral disease. Mental health disorders and oral health may be associated via changes to the oral microbiome, involving increased pro-inflammatory communication and cortisol in saliva. The present study provides the first culture-independent investigation of the oral microbiome considering depression and anxiety symptoms in adolescence, a critical age where these conditions begin to emerge and co-occur. It also investigates whether inflammation and cortisol moderate these relationships. METHODS Participants (N = 66) aged 14-18 years (69.70% female) self-reported oral health, depression and anxiety symptoms, and collected saliva samples across two days. Saliva was assayed for cortisol and C-reactive protein (CRP), and used for 16S rRNA gene sequencing to estimate the oral microbiome. Multivariate statistical analyses examined associations. RESULTS Overall diversity of the oral microbiome did not differ between adolescents by anxiety or depression grouping (low versus high symptoms), and was not associated with symptom measures. Depression and anxiety symptoms were instead associated with differential abundance of specific bacterial taxa, including Spirochaetaceae, Actinomyces, Treponema, Fusobacterium and Leptotrichia spp. Several host mood-microbial relationships were moderated by proposed mechanisms, including salivary cortisol and CRP. CONCLUSIONS Oral microbiome composition, but not diversity, was associated with adolescent anxiety and depression symptoms. Longitudinal studies considering these associations would improve mechanistic understanding. This research indicates that adolescence remains an essential developmental period to identify early targets for intervention.
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Affiliation(s)
- Carra A Simpson
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, VIC, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne and Melbourne Health, VIC, Australia.
| | - Christina Adler
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Mieke R du Plessis
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, South Africa
| | - Elizabeth R Landau
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, VIC, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne and Melbourne Health, VIC, Australia
| | - Stuart G Dashper
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, VIC, Australia
| | - Eric C Reynolds
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, VIC, Australia
| | - Orli S Schwartz
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, VIC, Australia
| | - Julian G Simmons
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, VIC, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne and Melbourne Health, VIC, Australia
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