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Bhat AC, Fenelon A, Almeida DM. Housing insecurity pathways to physiological and epigenetic manifestations of health among aging adults: a conceptual model. Front Public Health 2025; 13:1485371. [PMID: 39916715 PMCID: PMC11799248 DOI: 10.3389/fpubh.2025.1485371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 01/09/2025] [Indexed: 02/09/2025] Open
Abstract
Introduction Housing insecurity is a social determinant of health, as evidenced by its associations with mental, physical, and biological outcomes. The scientific understanding of the mechanisms by which housing insecurity is associated with health is still limited. This review adapts existing stress process models to propose a conceptual model illustrating potential pathways linking the specific stressor of housing insecurity to physiological and epigenetic manifestations of stress among aging adults. Methods This narrative review examines literature across multiple fields, including public health, psychology, and sociology. The literature selected for this review was identified through scientific databases including Web of Science, PubMed, JSTOR, and Google Scholar; primarily peer-reviewed empirical studies, literature reviews, and research reports published in English between 1981 and 2024; and principally based in the United States context. A synthesis of this literature is presented in a proposed conceptual model. Results The literature supports the existence of two main predictors of housing insecurity: sociodemographic characteristics and the historical/current context. The main mediating pathways between housing insecurity and manifestations of stress include health behaviors, psychosocial resources, and structural resources. Moderating factors affecting the associations between housing insecurity and manifestations of stress include government assistance, chronic discrimination/unfair treatment, and individual differences. These interdependent mediating and moderating mechanisms affect stressor reactivity, a proximal manifestation of stress, which contributes to the physiological and epigenetic distal manifestations of stress in aging adults. Discussion and implications The prevalence of housing insecurity among aging adults is growing in the United States, with significant implications for public health and health disparities, given the growing percentage of aging adults in the population. Further empirical testing of the mediating and moderating mechanisms proposed in the conceptual model will elucidate how housing insecurity is connected to health and provide insight into preventive strategies to ameliorate the adverse effects of housing insecurity on biological health among aging adults.
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Affiliation(s)
- Aarti C. Bhat
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, United States
- Population Research Institute, The Pennsylvania State University, University Park, PA, United States
| | - Andrew Fenelon
- School of Public Health, University of Minnesota-Twin Cities, Minneapolis, MN, United States
- Minnesota Population Center, University of Minnesota-Twin Cities, Minneapolis, MN, United States
- Life Course Center, University of Minnesota-Twin Cities, Minneapolis, MN, United States
| | - David M. Almeida
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, United States
- Population Research Institute, The Pennsylvania State University, University Park, PA, United States
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Marziali ME, Prins SJ, Gutkind S, Martins SS. Partner incarceration, maternal substance use, and the mediating role of social support: A longitudinal analysis using the future of families and child wellbeing study. Soc Sci Med 2024; 349:116896. [PMID: 38653185 PMCID: PMC11097120 DOI: 10.1016/j.socscimed.2024.116896] [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: 06/15/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION The United States is responsible for the highest incarceration rate globally. This study aimed to explore the impact of partner incarceration on maternal substance use and whether social support mediates the relationship between partner incarceration and maternal substance use. METHODS Using data from the Future of Families and Child Wellbeing Study, a longitudinal cohort following new parents and children, this analysis quantifies the relationship between paternal incarceration and maternal substance use (N = 2823). We analyzed maternal responses in years 3 (2001-2003), 5 (2003-2006), 9 (2007-2010), and 15 (2014-2017). We explored the role of financial support and emergency social support as potential mediators. Confirmatory factor analysis (CFA) was employed to construct support-related mediators. We modeled the impact of partner incarceration and maternal substance use using generalized estimating equations (GEE) to account for repeated measures, adjusting for appropriate confounders (age of mother at child's birth, race, education, employment, and history of intimate partner violence). RESULTS Nearly half (44.2%, N = 1247) of participants reported partner incarceration. Among mothers who experienced partner incarceration, the odds of reporting substance use were 110% greater than those who reported no partner incarceration (adjusted Odds Ratio [aOR]: 2.10; 95% Confidence Interval (CI):1.67-2.63). Financial support at year 5 accounted for 19.5% (95% CI: 6.03-33.06%) of the association between partner incarceration at year 3 and substance use at year 9; emergency social support at year 5 accounted for 6.4% (95% CI: 0.51-12.25%) of the association between partner incarceration and substance use at year 9. Neither financial nor emergency social support at year 9 were significant mediators between partner incarceration at year 3 and substance use at year 15. CONCLUSIONS These findings demonstrate that partner incarceration impacts maternal substance use. Financial and emergency support may partially mediate this relationship in the short term, which has important implications for families disrupted by mass incarceration.
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Affiliation(s)
- Megan E Marziali
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
| | - Seth J Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Sarah Gutkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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Cano M, Mendoza N, Ignacio M, Rahman A, Daniulaityte R. Overdose deaths involving synthetic opioids: Racial/ethnic and educational disparities in the eastern and western US. Drug Alcohol Depend 2023; 251:110955. [PMID: 37699286 PMCID: PMC11906140 DOI: 10.1016/j.drugalcdep.2023.110955] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND This study examined racial/ethnic and educational disparities in US synthetic opioid overdose mortality East and West of the Mississippi River. METHODS Using restricted-access 2018-2021 mortality data from the Centers for Disease Control and Prevention and population estimates from the American Community Survey, age-standardized rate ratios (SRRs) and 95% Confidence Intervals (CIs) were used to compare rates of synthetic opioid mortality by race/ethnicity and educational attainment level in the regions East and West of the Mississippi River. RESULTS Racial/ethnic disparities in synthetic opioid mortality rates, relative to the Non-Hispanic (NH) White population, were observed in the NH Black (SRR, 1.5 [95% CI, 1.5-1.6]) and NH American Indian/Alaska Native (SRR, 2.1 [95% CI, 1.9-2.2]) populations in the West, and the Puerto Rican (SRR, 1.3 [95% CI, 1.3-1.3]) and NH American Indian/Alaska Native (SRR, 1.5 [95% CI, 1.4-1.6]) populations in the East. Relative to those with a Bachelor's degree or higher: in the West, the synthetic opioid mortality rate was more than seven times as high for those with a high school diploma only (SRR 7.7 [95% CI, 7.4-8.0]), and in the East, approximately thirteen times as high for those with a high school diploma only (SRR, 13.0 [95% CI, 12.7-13.3]) or less than a high school diploma (SRR, 13.3 [95% CI, 13.0-13.7]). CONCLUSION Disparities in rates of synthetic opioid mortality differ in the eastern and western US, supporting tailored responses within each region.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ, USA.
| | - Natasha Mendoza
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Matt Ignacio
- School of Social Work, Arizona State University, Tucson, AZ, USA
| | - Abir Rahman
- Cabell-Huntington Health Department, Huntington, WV, USA
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Norman T, Power J, Clifton B, Murray J, Bourne A. People living with HIV who inject or have injected non-prescription drugs: Evidence of substantial differences in health inequalities and experiences of clinical care. Drug Alcohol Rev 2023; 42:1517-1528. [PMID: 37171154 DOI: 10.1111/dar.13681] [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: 09/14/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This study investigates differences in health and well-being associated with current, past or no injecting drug use (IDU) among people living with HIV (PLHIV) in Australia, identifying key health care considerations between injecting experiences. METHODS Data were extracted from the HIV Futures 9 study; a survey of PLHIV conducted in 2018-2019. Chi-square and analysis of variance analyses compared clinical and treatment characteristics, major physical and mental comorbidities, sexually transmitted infection diagnoses, and quality of life for those who reported current (last 12 months), past (12+ months ago) or no IDU. RESULTS Current IDU (n = 106) was associated with higher rates of sexually transmitted infection testing and diagnoses, higher frequency of self-reported antiretroviral therapy non-adherence due to drug use and greater social quality of life than past (n = 126) or no IDU (n = 508; total N = 740). Past and current IDUs were associated with more mental illness diagnoses and self-reported concern about drug use. Past IDU was associated with more physical comorbidities, lower satisfaction with clinical care and greater difficulty in affording health care than current or no IDU. DISCUSSION AND CONCLUSIONS Past and current IDUs are associated with unique health concerns. However, past IDU appears to be related to greater dissatisfaction in navigating health care than individuals with current IDU experience. Higher social connection and the types of services being accessed by individuals who currently inject may play a role in shaping service satisfaction. Peer-based interventions to help support individuals in accessing services that are affirming of their needs is an ongoing priority.
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Affiliation(s)
- Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Brent Clifton
- National Association of People with HIV Australia, Sydney, Australia
| | - Joel Murray
- National Association of People with HIV Australia, Sydney, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
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Naghizadeh S, Faramarzi E, Akbari H, Jafari N, Sarbakhsh P, Mohammadpoorasl A. Prevalence of smoking, alcohol consumption, and drug abuse in Iranian adults: Results of Azar Cohort Study. Health Promot Perspect 2023; 13:99-104. [PMID: 37600541 PMCID: PMC10439452 DOI: 10.34172/hpp.2023.12] [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: 01/17/2023] [Accepted: 05/05/2023] [Indexed: 08/22/2023] Open
Abstract
Background Substance abuse has significant health impacts on families and society as a whole. We aimed to provide detailed prevalence estimates of substance abuse among the Azar Cohort Study respondents in Tabriz, Iran. Methods Data on 15006 participants of Azar Cohort Study were analyzed. The variables included tobacco smoking, alcohol use, drug abuse, and socio-demographic characteristics. The prevalence of substance abuse (with a 95% confidence interval) was calculated using the direct standardization method. Results Overall, 9.3% and 6.2% of the participants were regular and heavy cigarette smokers, respectively. Also, 1.9% and 2.1% of participants reported a history of using illicit drugs and alcohol, respectively. Substance abuse was more prevalent among males than females. Substance abuse varied significantly with age and socioeconomic variables. Conclusion We identified specific demographic and socioeconomic groups with a higher prevalence of all studied behaviors. Such high-risk groups should be targeted when designing substance abuse prevention programs.
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Affiliation(s)
- Sahar Naghizadeh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Akbari
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Jafari
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asghar Mohammadpoorasl
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Kay ES, Creasy S, Batey DS, Coulter R, Egan JE, Fisk S, Friedman MR, Kinsky S, Krier S, Noble V, Turan B, Turan JM, Yu L, Hawk M. Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for people with HIV who use drugs: study protocol for a mixed-methods, multisite, observational study. BMJ Open 2022; 12:e067219. [PMID: 36113946 PMCID: PMC9486355 DOI: 10.1136/bmjopen-2022-067219] [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] [Received: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Our previous pilot work suggests relational harm reduction strengthens relationships between people with HIV (PWH) who use drugs and their healthcare providers and improves HIV health outcomes. However, there is limited research examining ways that structural (eg, strategies like syringe service programmes) and/or relational (patient-provider relationship) harm reduction approaches in HIV clinical settings can mitigate experiences of stigma, affect patient-provider relationships and improve outcomes for PWH who use drugs. Our mixed methods, multisite, observational study aims to fill this knowledge gap and develop an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings. METHODS AND ANALYSIS Aim 1 will explore the relationship between healthcare providers' stigmatising attitudes towards working with PWH who use drugs and providers' acceptance and practice of structural and relational harm reduction through surveys (n=125) and interviews (n=20) with providers. Aim 2 will explore the interplay between patient-perceived harm reduction, intersectional stigma and clinical outcomes related to HIV, hepatitis C (if applicable) and substance use-related outcomes through surveys (n=500) and focus groups (k=6, total n=36) with PWH who use drugs. We will also psychometrically evaluate a 25-item scale we previously developed to assess relational harm reduction, the Patient Assessment of Provider Harm Reduction Scale. Aim 3 will use human-centred design approaches to develop and pretest an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings. ETHICS AND DISSEMINATION This study was approved via expedited review by the University of Pittsburgh Institutional Review Board (STUDY21090002). Study findings will be presented in peer-reviewed journals and public health conferences as well as shared with patient participants, community advisory boards and harm reduction organisations. TRIAL REGISTRATION NUMBER NCT05404750.
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Affiliation(s)
- Emma Sophia Kay
- Magic City Research Institute, Birmingham AIDS Outreach, Birmingham, Alabama, USA
| | - Stephanie Creasy
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stuart Fisk
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Mackey Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah Krier
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Victor Noble
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Bulent Turan
- Department of Psychology, Koc Universitesi, Istanbul, Turkey
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lan Yu
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Effect of cerebral small vessel disease on cognitive impairment in Parkinson's disease. Acta Neurol Belg 2022; 123:487-495. [PMID: 36097211 DOI: 10.1007/s13760-022-02078-w] [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] [Received: 10/02/2021] [Accepted: 08/24/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To explore the association between cerebral small vessel disease (cSVD) and cognitive impairment (CI) in Parkinson's disease (PD). METHODS 81 PD patients were recruited into the study from September 2018 to December 2020. The demographic characteristics and radiologic and laboratory data were collected. Cognitive assessments were carried out using the Montreal Cognitive Assessment. The association between cSVD and cognitive impairment was analyzed using univariate and binary logistic regression analysis. RESULTS The binary logistic regression analysis showed that, after correcting for age, educational years, hyperhomocysteinemia, hypertension, and diabetes mellitus, total cSVD scores (OR 1.55, 95% CI 1.07-2.27, P = 0.02), the presence of paraventricular white matter hyperintensity (PVH) (OR 11.78, 95% CI 3.08-45.01, P < 0.001), white matter hyperintensity (WMH) (OR 7.95, 95% CI 2.28-27.79, P = 0.001), and perivascular space (PVS) (OR 6.66, 95% CI 2.08-21.40, P = 0.001) were independent risk factors for PD-CI. CONCLUSION The presence of cSVD was associated with cognitive dysfunction in patients with PD. It may be beneficial to manage cSVD to prevent the progression of cognitive impairment in patients with PD.
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Binge Drinking and Alcohol Problems Among Moderate Average-Level Drinkers. Am J Prev Med 2022; 63:324-330. [PMID: 35987558 DOI: 10.1016/j.amepre.2022.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A significant amount of binge drinking among adults escapes public health scrutiny because it occurs among individuals who drink at a moderate average level. This observational study examined the role of a binge pattern of drinking in predicting alcohol problems among moderate drinkers in a U.S. national sample of adults. METHODS Participants were 1,229 current drinkers aged ≥30 years from 2 waves of the study of Midlife Development in the United States, with a 9-year time lag (2004-2015) (analyzed in 2021‒2022). Negative binomial regression analyses were used to examine the number of alcohol problems, and binary logistic regression analyses were used to examine multiple (≥2) alcohol problems. RESULTS Independent of the average level of drinking, binge drinking was linked with an almost 3 times increase in the number of concurrent alcohol problems and a 40% increase in the number of alcohol problems prospectively 9 years later. Moderate average level drinkers accounted for most cases of binge drinking and multiple alcohol problems. Among moderate drinkers, binge drinking was linked with a close to 5 times increase in concurrent multiple alcohol problems and a >2 times increase in multiple alcohol problems prospectively 9 years later. CONCLUSIONS These results substantially broaden an increasing recognition that binge drinking is a public health concern among adults. Moderate average-level drinkers should be included in efforts to reduce alcohol problems in adults. These findings are applicable to primary and secondary prevention of alcohol problems with the potential to advance population health.
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Ballestar-Tarín ML, Ibáñez-del-Valle V, Cauli O, Navarro-Martínez R. Personal and Social Consequences of Psychotropic Substance Use: A Population-Based Internet Survey. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:65. [PMID: 35056373 PMCID: PMC8777796 DOI: 10.3390/medicina58010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Drug abuse has become a major worldwide health concern among all age groups. The present study analyses substance misuse and its social and personal consequences using a population-based internet survey in Spain. Materials and Methods: Screening for drug abuse (of alcohol, marijuana/hashish and psychostimulants) and its related risks and problems was performed using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) score. Socio-demographic factors, depressive, anxiety and stress symptoms as well as health habits were also evaluated. We used Linear regression methods to compare each variable's individual contribution so as to determine which one best explains the results. Results: In this population-based study, 1224 people completed and returned the online survey. Of all participants, 57% reported consuming at least one substance based on the CRAFFT scale. While increasing age reduces the probability of personal and social consequences of consumption, people who smoke receive up to three times more (OR = 3.370) recommendations from family and friends to reduce their consumption. As for the type of substance, the consumption of marijuana increases the risk of forgetting (OR = 2.33) and the consumption of other psychostimulant substances almost triples the risk of consuming alone (OR = 2.965). Combining substances can increase the rate of driving a vehicle after consumption by 3.4 times. Conclusions: Although age, smoking and the type of substances used increase the risk of suffering from social and personal consequences of the use or abuse of substances, future studies are needed to determine the influence of new variables as a potential tool for treating and minimizing the adverse consequences of drug abuse.
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Affiliation(s)
- María Luisa Ballestar-Tarín
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
| | - Vanessa Ibáñez-del-Valle
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
- Frailty and Cognitive Impairment Organized Group (FROG), Department of Nursing, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
- Frailty and Cognitive Impairment Organized Group (FROG), Department of Nursing, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain
| | - Rut Navarro-Martínez
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
- Frailty and Cognitive Impairment Organized Group (FROG), Department of Nursing, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain
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Li MT, Zhang J, Zhang DC, Che QQ, Liu ZL, Yang PW, Luo XW, Cai TS. Development and Psychometric Properties of the Synthetic Drug Dependence Scale in a Chinese Sample. Front Psychol 2021; 12:717029. [PMID: 34764905 PMCID: PMC8576389 DOI: 10.3389/fpsyg.2021.717029] [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: 05/30/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: In contrast to the drug situation in the rest of the world, synthetic drugs, rather than traditional drugs, have been the dominant abused drugs in China since 2019. However, the public misconception that synthetic drugs are not as addictive as traditional drugs, such as opioids and the scarcity of specific measurement instruments, have hindered the clinical diagnosis and treatment of synthetic drug abusers, thus the development of a localized instrument to evaluate dependence on synthetic drugs is in urgently needed. Method: Using a sample of 618 Chinese synthetic drug abusers (Mean age = 34.69 years; 44.17% female), the present study developed and examined the psychometric properties of a self-reporting instrument, the Synthetic Drug Dependence Scale (SDDS), which consists of four subscales: physical dependence, psychological dependence, health injury, and social function injury. Results: The SDDS revealed a three-factor model structure (weighted root mean square residual (WRMR) = 0.876, comparative fit index (CFI) = 0.965, Tucker–Lewis index (TLI) = 0.953, and Root mean square error of approximation (RMSEA) = 0.070), with good internal consistency (composite reliability = 0.912, alfa = 0.801) and convergent validity. Elevated scores on the SDDS were associated with a higher level of reward sensitivity, punishment sensitivity, and stronger impulsivity. Interestingly, psychological dependence was the only significant predictor (p < 0.05) of criterion variables compared with the other three subscales, implying the important role of psychological factors in synthetic drugs dependence. Adequate measurement equivalence across sex, age (18–30 and 31–57 years old), and employment group (employed and unemployed) was also established. Conclusion: The SDDS appears to be an effective and reliable instrument that could be used to further investigate the characteristics of synthetic and traditional drug dependence, promoting a deeper understanding of the physical and psychological roles in drug dependence.
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Affiliation(s)
- Mei-Ting Li
- The Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Zhang
- Department of Corrective Education, Hunan Judicial Police Vocational College, Changsha, China
| | - Dong-Cheng Zhang
- School of Education, South-Central University for Nationalities, Wuhan, China
| | - Qing-Qing Che
- The Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ze-Lan Liu
- The Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Pei-Wen Yang
- The Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xin-Wei Luo
- The Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Tai-Sheng Cai
- The Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, China
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11
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Qin W, Xu L, Wu S, Shao H. Income, Relative Deprivation and the Self-Rated Health of Older People in Urban and Rural China. Front Public Health 2021; 9:658649. [PMID: 34295864 PMCID: PMC8291363 DOI: 10.3389/fpubh.2021.658649] [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: 01/26/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Substantial evidence indicated that absolute income is directly associated with health. Few studies have, however, examined if relative income may be equally associated with health. This study aimed to investigate the association between absolute income/relative deprivation (RD) and self-rated health (SRH). We also investigated whether the urban-rural difference was existing in these associations. Methods: Using cross-sectional data of 7,070 participants in the Shandong Family Health Service Survey of older people, this study applied binary logistic model and semi-parametric model to estimate the effect of absolute income and relative deprivation on SRH of older people. The Kakwani Index was used as a measure of relative deprivation at the individual level. Results: Absolute income has a significant positive effect on the SRH among both urban and rural older people. When considered RD as a variable, both absolute income and RD have negative significant effects on SRH among all older people. In addition, the negative effect of RD on rural elderly is more pronounced than that of urban older populations. Semi-parametric regression results show that there was a complex non-linear relationship between income and SRH. Psychological distress substantially attenuated the association between relative deprivation and SRH. Conclusions: Relative deprivation is negatively associated with self-rated health in both urban and rural older people after controlling the absolute income. RD may partly explain the association between income inequality and worse health status. Compared with the urban elderly, the effect of income-based relative deprivation on SRH was more pronounced among the rural elderly, and more care should be given to the lower income and rural older populations.
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Affiliation(s)
- Wenzhe Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Health Commission (NHC) Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Health Commission (NHC) Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Shoucai Wu
- Department of Geriatrics, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, China
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
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12
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Abstract
Importance The association of socioeconomic status and cardiovascular outcomes has been well described, but little is known about whether longitudinal changes in wealth are associated with cardiovascular health status. Objective To evaluate the association between midlife wealth mobility and risk of cardiovascular events. Design, Setting, and Participants This longitudinal, retrospective cohort study included US adults 50 years or older who participated in the Health and Retirement Study. Participants in the primary analysis had no history of cardiovascular disease and had observations in at least two of three 5-year age intervals (50-54, 55-59, and 60-64 years) and follow-up after 65 years of age. Data were collected from January 1, 1992, to December 31, 2016, and analyzed from November 10, 2020, to April 26, 2021. Exposures Quintiles of wealth (reflecting total nonhousing assets) were defined within each of 4 birth cohorts (1931-1935, 1936-1940, 1941-1945, and 1946-1950). Wealth mobility was defined as an increase or a decrease of 1 or more wealth quintiles and was compared with wealth stability (same quintile over time) using covariate-adjusted Cox proportional hazards regression models. Main Outcomes and Measures Composite outcome of nonfatal cardiovascular event (myocardial infarction, heart failure, cardiac arrhythmia, or stroke) or cardiovascular death. Results A total of 5579 participants were included in the primary analysis (mean [SD] age, 54.2 [2.6] years; 3078 women [55.2%]). During a mean (SD) follow-up of 16.9 (5.8) years, 1336 participants (24.0%) experienced a primary end point of nonfatal cardiovascular event or cardiovascular death (14.4 [95% CI, 13.6-15.2] per 1000 patient-years). Higher initial wealth (per quintile) was associated with lower cardiovascular risk (adjusted hazard ratio [aHR] per quintile, 0.89 [95% CI, 0.84-0.95]; P = .001). When compared with stable wealth, participants who experienced upward wealth mobility (by at least 1 quintile) had independently lower hazards of a subsequent nonfatal cardiovascular event or cardiovascular death (aHR, 0.84 [95% CI, 0.73-0.97]; P = .02), and participants who experienced downward wealth mobility had higher risks (aHR, 1.15 [95% CI, 1.00-1.32]; P = .046). Conclusions and Relevance These findings suggest that upward wealth mobility relative to peers in late middle age is associated with lower risks of cardiovascular events or death after 65 years of age.
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Affiliation(s)
- Sara Machado
- Department of Health Policy, London School of Economics, London, United Kingdom
| | - Andrew Sumarsono
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas.,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, Texas
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
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13
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Glei DA, Lee C, Weinstein M. Socioeconomic disparities in U.S. mortality: The role of smoking and alcohol/drug abuse. SSM Popul Health 2020; 12:100699. [PMID: 33335972 PMCID: PMC7734303 DOI: 10.1016/j.ssmph.2020.100699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/22/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Prior studies have identified smoking as a key driver of socioeconomic disparities in U.S. mortality, but the growing drug epidemic leads us to question whether drug abuse is exacerbating those disparities, particularly for mortality from external causes. We use data from a national survey of midlife Americans to evaluate socioeconomic disparities in all-cause and cause-specific mortality over an 18-year period (1995-2013). Then, we use marginal structural modeling to quantify the indirect effects of smoking and alcohol/drug abuse in mediating those disparities. Our results demonstrate that alcohol/drug abuse makes little contribution to socioeconomic disparities in all-cause mortality, probably because the prevalence of substance abuse is low and socioeconomic differences in abuse are small, especially at older ages when most Americans die. Smoking prevalence is much higher than drug/alcohol abuse and socioeconomic differentials in smoking are large and have widened among younger cohorts. Not surprisingly, smoking accounts for the majority (62%) of the socioeconomic disparity in mortality from smoking-related diseases, but smoking also makes a substantial contribution to cardiovascular (38%) and all-cause mortality (34%). Based on the observed cohort patterns of smoking, we predict that smoking will further widen SES disparities in all-cause mortality until at least 2045 for men and even later for women. Although we cannot yet determine the mortality consequences of recent widening of the socioeconomic disparities in drug abuse, social inequalities in mortality are likely to grow even wider over the coming decades as the legacy of smoking and the recent drug epidemic take their toll.
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Affiliation(s)
- Dana A. Glei
- Center for Population and Health, Georgetown University, 5985 San Aleso Court, Santa Rosa, 95409-3912, CA, USA
| | - Chioun Lee
- Department of Sociology, University of California, 1207 Watkins Hall, Riverside, 92521, CA, USA
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, 312 Healy Hall, 37th & O Streets, 20057-1197, Washington, DC, NW, USA
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14
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Glei DA, Weinstein M. Mental health, pain, and risk of drug misuse: A nationwide cohort study. Addict Behav 2020; 109:106467. [PMID: 32485544 PMCID: PMC7299126 DOI: 10.1016/j.addbeh.2020.106467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/15/2022]
Abstract
Evidence suggests that rising drug misuse, particularly of prescription painkillers, is more closely linked with period increases in reported pain among Americans of the same age range than with deterioration in mental health, but it is unclear whether those cross-sectional associations reflect causal effects of pain and mental health on drug misuse. Using data from the 1995-96, 2004-05, and 2013-14 waves of a nationwide cohort study, we evaluate the effects of pain and mental health on subsequent misuse of prescription painkillers and sedatives. Logistic regression is applied to model drug misuse (separately for painkillers and sedatives) as a function of predictors measured at the previous wave; respondents who reported misuse of that drug type at the prior wave are excluded from the analysis. Mental health is an important predictor of both painkiller and sedative misuse, whereas pain plays a much bigger role in painkiller misuse. Frequency of joint aches and stiffness has the strongest effect on subsequent painkiller misuse, although mental health yields substantial incremental predictive ability above and beyond pain. Negative affect, positive affect, and psychological well-being have notable effects on sedative misuse, while pain (particularly backache) makes only a small incremental contribution to sedative misuse. We suspect that increases over time in pain levels may have played a bigger role than mental health in explaining the rise in prescription painkiller misuse and may have contributed to growing misuse of sedatives. In contrast, deteriorating mental health was probably more important in explaining the rise of sedative misuse.
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Affiliation(s)
- Dana A Glei
- Center for Population and Health, Georgetown University, 5985 San Aleso Court, Santa Rosa, CA 95409-3912, United States.
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, 312 Healy Hall, 37th & O Streets NW, Washington, DC 20057-1197, United States.
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15
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Blanchflower DG, Oswald AJ. Trends in Extreme Distress in the United States, 1993-2019. Am J Public Health 2020; 110:1538-1544. [PMID: 32816546 DOI: 10.2105/ajph.2020.305811] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate changes from 1993 to 2019 in the percentage of US citizens suffering extreme distress.Methods. Using data on 8.1 million randomly sampled US citizens, we created a new proxy measure for exceptional distress (the percentage who reported major mental and emotional problems in all 30 of the last 30 days). We examined time trends for different groups and predictors of distress.Results. The proportion of the US population in extreme distress rose from 3.6% in 1993 to 6.4% in 2019. Among low-education midlife White persons, the percentage more than doubled, from 4.8% to 11.5%. Regression analysis revealed that (1) at the personal level, the strongest statistical predictor of extreme distress was "I am unable to work," and (2) at the state level, a decline in the share of manufacturing jobs was a predictor of greater distress.Conclusions. Increasing numbers of US citizens report extreme levels of mental distress. This links to poor labor-market prospects. Inequality of distress has also widened.Public Health Implications. Policymakers need to recognize the crisis of an ever-growing group of US citizens in extreme distress.
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Affiliation(s)
- David G Blanchflower
- David G. Blanchflower is with Dartmouth College, Hanover, NH. Andrew J. Oswald is with University of Warwick, Coventry, UK
| | - Andrew J Oswald
- David G. Blanchflower is with Dartmouth College, Hanover, NH. Andrew J. Oswald is with University of Warwick, Coventry, UK
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16
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Glei DA, Stokes A, Weinstein M. Changes in mental health, pain, and drug misuse since the mid-1990s: Is there a link? Soc Sci Med 2020; 246:112789. [PMID: 31978637 PMCID: PMC7064160 DOI: 10.1016/j.socscimed.2020.112789] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 01/04/2020] [Indexed: 11/21/2022]
Abstract
Drug-related mortality in the US grew dramatically in recent years, while mental health deteriorated among disadvantaged Americans and reported levels of pain increased over the same period. Here we investigate whether increased prevalence of drug misuse between the mid-1990s and early-2010s is associated with higher levels of mental distress and pain. Our results demonstrate higher drug misuse over this period, particularly for older and for socioeconomically disadvantaged Americans. After adjusting for sociodemographic characteristics, we estimate that the prevalence of drug misuse increased by 19 percentage points among those aged 50-76 in the bottom percentile of socioeconomic status (SES). Misuse increased much more at older than at younger ages for all drug types except sedatives, which increased to a similar degree in both age groups. Compared with measures of mental health, pain consistently accounted for a greater share of the period differential in drug misuse among both age groups and across all drug types. Misuse of prescription painkillers exhibited the largest difference in the contributions of pain versus mental health: among older individuals with the lowest SES, pain explained three times as much of the period trend as mental health (60% vs. 19%). Pain was more closely linked with the rise in misuse of prescription painkillers than other drugs. Mental health is a strong correlate of drug misuse (particularly sedative use), but growing drug misuse since the mid-1990s was more strongly linked with rising levels of reported pain than with deterioration in mental health. Pain could be a key factor underlying the association between trends in mental health and drug use: higher levels of pain may contribute to both mental distress and drug misuse. Given that pain, mental distress, and drug misuse are intertwined, successful intervention may require addressing all three factors.
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Affiliation(s)
- Dana A Glei
- Center for Population and Health, Georgetown University, Mailing Address: 5985 San Aleso Court, Santa Rosa, CA, 95409-3912, USA.
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, 312 Healy Hall, 37th & O Streets, NW, Washington, DC, 20057-1197, USA.
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17
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Hasler G, Haynes M, Müller ST, Tuura R, Ritter C, Buchmann A. The Association Between Adolescent Residential Mobility and Adult Social Anxiety, BDNF and Amygdala-Orbitofrontal Functional Connectivity in Young Adults With Higher Education. Front Psychiatry 2020; 11:561464. [PMID: 33408651 PMCID: PMC7779475 DOI: 10.3389/fpsyt.2020.561464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Large-scale epidemiological studies demonstrate that house moves during adolescence lead to an increase in anxiety and stress-sensitivity that persists into adulthood. As such, it might be expected that moves during adolescence have strong negative and long-lasting effects on the brain. We hypothesized that moves during adolescence impair fear circuit maturation, as measured by the connectivity between amygdala and orbitofrontal cortex, and expression of brain-derived neurotrophic factor (BDNF). Methods: We examined young adults with middle and high economic status recruited from the community using clinical interviews, self-report questionnaires, functional magnetic resonance imaging during an emotional faces task and during a 10 min rest phase, and serum BDNF serum concentration. Results: Out of 234 young adults, 164 did not move between ages 10 and 16 (i.e., moves with change of school), 50 moved once, and 20 moved twice or more than twice. We found relationships between adolescent moving frequency and social avoidance (pcorr = 0.012), right amygdala-orbitofrontal cortex connectivity (pcorr = 0.016) and low serum BDNF concentrations in young adulthood (pcorr = 0.012). Perceived social status of the mother partly mitigated the effects of moving on social avoidance and BDNF in adulthood. Conclusions: This study confirms previous reports on the negative and persistent effects of residential mobility during adolescence on mental health. It suggests that these effects are mediated by impairments in fear circuit maturation. Finally, it encourages research into protecting factors of moving during adolescents such as the perceived social status of the mother.
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Affiliation(s)
- Gregor Hasler
- Psychiatric University Hospital, University of Bern, Bern, Switzerland.,Unit of Psychiatry Research, University of Fribourg, Fribourg, Switzerland
| | - Melanie Haynes
- Psychiatric University Hospital, University of Bern, Bern, Switzerland
| | - Sabrina Theresia Müller
- Psychiatric University Hospital, University of Bern, Bern, Switzerland.,Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ruth Tuura
- Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christopher Ritter
- Psychiatric University Hospital, University of Bern, Bern, Switzerland.,Unit of Psychiatry Research, University of Fribourg, Fribourg, Switzerland.,Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Andreas Buchmann
- Psychiatric University Hospital, University of Bern, Bern, Switzerland.,Unit of Psychiatry Research, University of Fribourg, Fribourg, Switzerland.,Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
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