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Ferrando L, Galea S, Sainz Cortón E, Mingote C, García Camba E, Fernandez Líria A, Gabriel R. Long-term psychopathology changes among the injured and members of the community after a massive terrorist attack. Eur Psychiatry 2020; 26:513-7. [DOI: 10.1016/j.eurpsy.2010.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 07/09/2010] [Accepted: 07/19/2010] [Indexed: 11/29/2022] Open
Abstract
AbstractBackground and aimTo document long-term prevalence trends and changes in Post-Traumatic Stress Disorder (PTSD), Current Major Depression (MD), Agoraphobia, Generalized Anxiety Disorder (GAD), and Panic Disorder, in two groups of people with different levels of exposure to a massive terrorist attack.MethodsCohort study. Two random samples of people exposed to a terrorist attack, the injured (n = 127) and community residents (n = 485) were followed and assessed, 2 and 18 months after the event.ResultsAmong the injured, 2 and 18 months after the attack, the prevalences were respectively, PTSD: 44.1% and 34%, MD: 31.5% and 23.7%, Agoraphobia: 23.8% and 20.7%, GAD: 13.4% and 12.4% and Panic Disorder: 9.4% and 11.3%. The corresponding figures among residents were PTSD: 12.3% and 3.5%, MD: 8.5% and 5.4%, Agoraphobia: 10.5% and 8.7%, GAD: 8.6%, and 8.2% and Panic Disorder 2.1% and 2.7%.ConclusionsTwo months after the event, the prevalence of mental disorders among both injured and residents was higher than expected levels at baseline conditions. Eighteen months after the event, psychopathological conditions did not change significantly among the injured but returned to the expected baseline rates among community residents.
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Abstract
Early childhood caries (ECC) is a largely preventable condition that occurs when children develop caries in their primary teeth before the age of six. National trends of ECC indicate that prevalence is decreasing, but disparities between various sociodemographic groups may be increasing, despite intervention efforts. Dynamic mechanisms in caries development are hypothesized to be responsible for the observed population distributions of disease. Agent-based models (ABMs) have been utilized to explore similar hypotheses in many areas of health research. Therefore, we developed an ABM of ECC development mechanisms and examined population outcomes of hypothetical preventive intervention scenarios. We found that risk-based targeting had minimal impact on population averages or disparities and was largely due to the strength of the dynamic mechanisms among those considered to be at high caries risk. Universally increasing intervention access reduced population caries prevalence, but increased disparities between different groups of caries risk profiles. We show that population distributions of ECC can emerge as a result of dynamic mechanisms that have been shown to drive disease development. Understanding the effectiveness of a proposed intervention in relation to the hypothesized mechanism(s) that contributes to the outcome of interest is critical to future efforts to address population disparities in ECC.
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Affiliation(s)
- B Heaton
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - S T Cherng
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - W Sohn
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.,Discipline of Population Oral Health, School of Dentistry, University of Sydney, Westmead, New South Wales, Australia
| | - R I Garcia
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - S Galea
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
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Weinberger AH, Gbedemah M, Martinez AM, Nash D, Galea S, Goodwin RD. Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychol Med 2018; 48:1308-1315. [PMID: 29021005 DOI: 10.1017/s0033291717002781] [Citation(s) in RCA: 311] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Major depression is associated with significant disability, morbidity, and mortality. The current study estimated trends in the prevalence of major depression in the US population from 2005 to 2015 overall and by demographic subgroups. METHODS Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual cross-sectional study of US persons ages 12 and over (total analytic sample N = 607 520). Past-year depression prevalence was examined annually among respondents from 2005 to 2015. Time trends in depression prevalence stratified by survey year were tested using logistic regression. Data were re-analyzed stratified by age, gender, race/ethnicity, income, and education. RESULTS Depression prevalence increased significantly in the USA from 2005 to 2015, before and after controlling for demographics. Increases in depression were significant for the youngest and oldest age groups, men, and women, Non-Hispanic White persons, the lowest income group, and the highest education and income groups. A significant year × demographic interaction was found for age. The rate of increase in depression was significantly more rapid among youth relative to all older age groups. CONCLUSIONS The prevalence of depression increased significantly in the USA from 2005 to 2015. The rate of increase in depression among youth was significantly more rapid relative to older groups. Further research into understanding the macro level, micro level, and individual factors that are contributing to the increase in depression, including factors specific to demographic subgroups, would help to direct public health prevention and intervention efforts.
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Affiliation(s)
- A H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University,Bronx, NY,USA
| | - M Gbedemah
- Department of Epidemiology and Biostatistics,CUNY School of Public Health,New York, NY,USA
| | - A M Martinez
- Department of Epidemiology,Mailman School of Public Health, Columbia University,New York, NY,USA
| | - D Nash
- Department of Epidemiology and Biostatistics,CUNY School of Public Health,New York, NY,USA
| | - S Galea
- Department of Epidemiology,Boston University School of Public Health,Boston, MA, NY,USA
| | - R D Goodwin
- Department of Epidemiology and Biostatistics,CUNY School of Public Health,New York, NY,USA
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Duncan LE, Ratanatharathorn A, Aiello AE, Almli LM, Amstadter AB, Ashley-Koch AE, Baker DG, Beckham JC, Bierut LJ, Bisson J, Bradley B, Chen CY, Dalvie S, Farrer LA, Galea S, Garrett ME, Gelernter JE, Guffanti G, Hauser MA, Johnson EO, Kessler RC, Kimbrel NA, King A, Koen N, Kranzler HR, Logue MW, Maihofer AX, Martin AR, Miller MW, Morey RA, Nugent NR, Rice JP, Ripke S, Roberts AL, Saccone NL, Smoller JW, Stein DJ, Stein MB, Sumner JA, Uddin M, Ursano RJ, Wildman DE, Yehuda R, Zhao H, Daly MJ, Liberzon I, Ressler KJ, Nievergelt CM, Koenen KC. Largest GWAS of PTSD (N=20 070) yields genetic overlap with schizophrenia and sex differences in heritability. Mol Psychiatry 2018; 23:666-673. [PMID: 28439101 PMCID: PMC5696105 DOI: 10.1038/mp.2017.77] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/19/2017] [Accepted: 02/15/2017] [Indexed: 12/12/2022]
Abstract
The Psychiatric Genomics Consortium-Posttraumatic Stress Disorder group (PGC-PTSD) combined genome-wide case-control molecular genetic data across 11 multiethnic studies to quantify PTSD heritability, to examine potential shared genetic risk with schizophrenia, bipolar disorder, and major depressive disorder and to identify risk loci for PTSD. Examining 20 730 individuals, we report a molecular genetics-based heritability estimate (h2SNP) for European-American females of 29% that is similar to h2SNP for schizophrenia and is substantially higher than h2SNP in European-American males (estimate not distinguishable from zero). We found strong evidence of overlapping genetic risk between PTSD and schizophrenia along with more modest evidence of overlap with bipolar and major depressive disorder. No single-nucleotide polymorphisms (SNPs) exceeded genome-wide significance in the transethnic (overall) meta-analysis and we do not replicate previously reported associations. Still, SNP-level summary statistics made available here afford the best-available molecular genetic index of PTSD-for both European- and African-American individuals-and can be used in polygenic risk prediction and genetic correlation studies of diverse phenotypes. Publication of summary statistics for ∼10 000 African Americans contributes to the broader goal of increased ancestral diversity in genomic data resources. In sum, the results demonstrate genetic influences on the development of PTSD, identify shared genetic risk between PTSD and other psychiatric disorders and highlight the importance of multiethnic/racial samples. As has been the case with schizophrenia and other complex genetic disorders, larger sample sizes are needed to identify specific risk loci.
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Affiliation(s)
- L E Duncan
- Department of Psychiatry, Stanford University, Stanford, CA, USA
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Boston, MA, USA
- The Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - A E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - L M Almli
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - A B Amstadter
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - A E Ashley-Koch
- Department of Medicine, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - D G Baker
- Veterans Affairs San Diego Healthcare System and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - J C Beckham
- Veterans Affairs Durham Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - L J Bierut
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - J Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - B Bradley
- Atlanta VA Medical Center, Atlanta, GA, USA
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - C-Y Chen
- The Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard University, Cambridge, MA, USA
| | - S Dalvie
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - L A Farrer
- Biomedical Genetics, Boston University School of Medicine, Boston, MA, USA
| | - S Galea
- Boston University School of Public Health, Boston, MA, USA
| | - M E Garrett
- Department of Medicine, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - J E Gelernter
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare System, New Haven, CT, USA
| | - G Guffanti
- Department of Psychiatry, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - M A Hauser
- Department of Medicine, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - E O Johnson
- RTI International, Research Triangle Park, NC, USA
| | - R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N A Kimbrel
- Veterans Affairs Durham Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - A King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - N Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- MRC Unit on Anxiety & Stress Disorders, Groote Schuur Hospital, Cape Town, South Africa
| | - H R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and VISN 4 MIRECC, Crescenz VAMC, Philadelphia, PA, USA
| | - M W Logue
- VA Boston Healthcare System, Jamaica Plain, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - A X Maihofer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - A R Martin
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Boston, MA, USA
- The Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - M W Miller
- VA Boston Healthcare System, Jamaica Plain, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - R A Morey
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
| | - N R Nugent
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - J P Rice
- Department of Psychiatry, Washington University, St Louis, MO, USA
| | - S Ripke
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Boston, MA, USA
- The Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry and Psychotherapy, Charité, Campus Mitte, Berlin, Germany
| | - A L Roberts
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health Cambridge, MA, USA
| | - N L Saccone
- Department of Genetics, Washington University, St Louis, MO, USA
| | - J W Smoller
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- MRC Unit on Anxiety & Stress Disorders, Groote Schuur Hospital, Cape Town, South Africa
| | - M B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - J A Sumner
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY, USA
| | - M Uddin
- Department of Psychology and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - R J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - D E Wildman
- Department of Molecular & Integrative Physiology and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - R Yehuda
- James J. Peters Bronx Veterans Affairs and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - H Zhao
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - M J Daly
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Boston, MA, USA
- The Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - I Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health System, Ann Arbor, MI, USA
| | - K J Ressler
- Department of Psychiatry, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - C M Nievergelt
- Veterans Affairs San Diego Healthcare System and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - K C Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
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Lowe SR, Joshi S, Galea S, Aiello AE, Uddin M, Koenen KC, Cerdá M. Pathways from assaultive violence to post-traumatic stress, depression, and generalized anxiety symptoms through stressful life events: longitudinal mediation models. Psychol Med 2017; 47:2556-2566. [PMID: 28464960 PMCID: PMC5675529 DOI: 10.1017/s0033291717001143] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Assaultive violence events are associated with increased risk for adverse psychiatric outcomes, including post-traumatic stress (PTS), depression, and generalized anxiety. Prior research has indicated that economic, legal, and social stressors that could follow assaultive events may explain the increased risk for adverse psychiatric outcomes, yet longitudinal studies have not adequately examined this pathway. In the current study, we aimed to address this limitation. METHODS Participants (N = 1360) were part of a longitudinal population-based study of adults living in Detroit. At three waves, participants indicated their exposure to assaultive violence and economic, legal, and social stressors, and completed inventories of PTS, depression, and generalized anxiety. Longitudinal mediation models were used to test the hypothesized pathway from assaultive violence to each psychiatric outcome. RESULTS The hypothesized models evidenced good fit with the data and, in each, the paths from Wave 1 (W1) assaultive violence to W2 stressors, and from W2 stressors to W3 symptoms were significant (range of Standardized Estimates: 0.09-0.15, all p < 0.01). Additionally, the indirect paths from W1 assaultive violence to W3 symptoms were significant (range of Standardized Estimates: 0.01-0.02, all p < 0.05). CONCLUSIONS The findings illustrate that the economic, legal, and social stressors that could follow assaultive violence increase risk for a range of psychiatric symptoms. Although future research is needed, the results suggest that investment in interventions that prevent and mitigate assaultive violence survivors' exposure to such stressors may be an effective way to prevent mental illness in the aftermath of violent assaults.
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Affiliation(s)
- S. R. Lowe
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - S. Joshi
- Department of Epidemiology, University of Minnesota, Minneapolis, MN, USA
| | - S. Galea
- Departmentof Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - A. E. Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - M. Uddin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - K. C. Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - M. Cerdá
- Department Emergency Medicine, University of California at Davis, Davis, CA, USA
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Stanko K, Cherry K, Sampson L, Galea S. SOCIAL ENGAGEMENT AND HEALTH-RELATED QUALITY OF LIFE IN OLDER ADULTS AFTER MULTIPLE DISASTERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K.E. Stanko
- Psychology, Louisiana State University, Baton Rouge, Louisiana,
| | - K.E. Cherry
- Psychology, Louisiana State University, Baton Rouge, Louisiana,
| | - L. Sampson
- Boston University, Boston, Massachusetts
| | - S. Galea
- Boston University, Boston, Massachusetts
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Schep LJ, Slaughter RJ, Galea S, Newcombe D. Ibogaine for treating drug dependence. What is a safe dose? Drug Alcohol Depend 2016; 166:1-5. [PMID: 27426011 DOI: 10.1016/j.drugalcdep.2016.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 11/30/2022]
Abstract
The indole alkaloid ibogaine, present in the root bark of the West African rain forest shrub Tabernanthe iboga, has been adopted in the West as a treatment for drug dependence. Treatment of patients requires large doses of the alkaloid to cause hallucinations, an alleged integral part of the patient's treatment regime. However, case reports and case series continue to describe evidences of ataxia, gastrointestinal distress, ventricular arrhythmias and sudden and unexplained deaths of patients undergoing treatment for drug dependence. High doses of ibogaine act on several classes of neurological receptors and transporters to achieve pharmacological responses associated with drug aversion; limited toxicology research suggests that intraperitoneal doses used to successfully treat rodents, for example, have also been shown to cause neuronal injury (purkinje cells) in the rat cerebellum. Limited research suggests lethality in rodents by the oral route can be achieved at approximately 263mg/kg body weight. To consider an appropriate and safe initial dose for humans, necessary safety factors need to be applied to the animal data; these would include factors such as intra- and inter-species variability and for susceptible people in a population (such as drug users). A calculated initial dose to treat patients could be approximated at 0.87mg/kg body weight, substantially lower than those presently being administered to treat drug users. Morbidities and mortalities will continue to occur unless practitioners reconsider doses being administered to their susceptible patients.
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Affiliation(s)
- L J Schep
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
| | - R J Slaughter
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - S Galea
- Community Alcohol and Drug Services, Waitemata DHB, New Zealand; Social and Community Health and Centre for Addiction Research, University of Auckland, New Zealand
| | - D Newcombe
- Social and Community Health and Centre for Addiction Research, University of Auckland, New Zealand
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Sapra KJ, Buck Louis GM, Sundaram R, Joseph KS, Bates LM, Galea S, Ananth CV. Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort. Hum Reprod 2016; 31:887-96. [PMID: 26936888 DOI: 10.1093/humrep/dew010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/11/2016] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation? SUMMARY ANSWER Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not. WHAT IS KNOWN ALREADY Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss. STUDY DESIGN, SIZE, DURATION Population-based preconception cohort of 501 couples discontinuing contraception to try for pregnancy in 16 counties in Michigan and Texas, USA. Participants were followed daily until positive home pregnancy test or 12 months of trying without an hCG pregnancy; women who became pregnant were followed daily from 2 to 7 weeks post-conception. PARTICIPANTS, SETTING, METHODS Three hundred and forty-seven women had a positive home pregnancy test denoting hCG pregnancy. Three hundred and forty-one women remained after excluding ineligible pregnancies. Women recorded daily from 2 to 7 weeks post-conception their signs and symptoms, including vaginal bleeding (none, spotting, light, moderate and heavy), lower abdominal cramping, nausea and vomiting. Pregnancy losses were ascertained by a subsequent negative home pregnancy test, clinical confirmation or onset of menses, depending on gestational age at loss; time-to-loss was measured in days post-conception. Cumulative incidence functions and 95% confidence intervals (CIs) were constructed for each sign or symptom, and hazard ratios (HRs) and 95% CIs for presence compared with absence of signs or symptoms were estimated using Cox proportional hazard models. MAIN RESULTS AND THE ROLE OF CHANCE Women experienced lower abdominal cramping (85%), nausea (48%), vomiting (46%) and light/moderate/heavy vaginal bleeding (24%) during early pregnancy. Ninety-five (28%) women experienced a loss. Cumulative incidence of pregnancy loss varied by symptomatology: 19% for vomiting, 27% for lower abdominal cramping, 35% for nausea only, 52% for vaginal bleeding, 81% for vaginal bleeding with lower abdominal cramping. Incidence of pregnancy loss was increased among women with vaginal bleeding (HR: 3.62, 95% CI: 2.29-5.74) and among women with vaginal bleeding and lower abdominal cramping (HR: 5.03, 95% CI: 2.07-12.20). Incidence of pregnancy loss was decreased for women with vomiting (HR: 0.51, 95% CI: 0.30-0.86). In the setting of vaginal bleeding with lower abdominal cramping, vomiting reduced the incidence of pregnancy loss (HR: 0.24, 95% CI: 0.11-0.56). LIMITATIONS, REASONS FOR CAUTION There were few losses beyond 14 weeks gestation; thus, the precision of our findings related to losses occurring after the first trimester is limited. WIDER IMPLICATIONS OF THE FINDINGS By using sensitive home pregnancy tests, we are able to document and characterize the cumulative incidence of the earliest pregnancy losses, which constitute the majority of losses. The use of daily, prospective capture of signs and symptoms relative to ascertainment of pregnancy loss minimizes potential biases associated with reporting after rather than before a loss, which could potentially distort the relationship between signs and symptoms and pregnancy loss. The findings of our study suggest that it may be useful to develop prognostic models for pregnancy loss based on signs and symptoms. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract numbers N01-HD-3-3355; N01-HD-3-3356; N01-HD-3-3358). The authors have no conflict of interest to declare.
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Affiliation(s)
- K J Sapra
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - G M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - R Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - K S Joseph
- Department of Obstetrics and Gynaecology, School of Population and Public Health, University of British Columbia, The Children's and Women's Hospital of British Columbia, Vancouver, Canada
| | - L M Bates
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - S Galea
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA School of Public Health, Boston University, Boston, MA, USA
| | - C V Ananth
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA Department of Obstetrics and Gynecology, College of Physicians and Surgeons, New York, NY, USA
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Hermosilla S, El-Bassel N, Aifah A, Terlikbayeva A, Zhumadilov Z, Berikkhanova K, Darisheva M, Gilbert L, Schluger N, Galea S. Tuberculosis report among injection drug users and their partners in Kazakhstan. Public Health 2015; 129:569-75. [PMID: 25795015 DOI: 10.1016/j.puhe.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/05/2015] [Accepted: 01/21/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Tuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan. STUDY DESIGN Cross-sectional study. METHODS The authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009. RESULTS 16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older (odds ratio (OR) 7.26, 95% confidence interval (CI): 1.73, 30.43), male (OR 5.53, 95% CI: 2.74, 11.16), have a shorter duration of injection drug use (OR 0.17, 95% CI: 0.04, 0.65), have received high social support from their significant other (OR 2.13, 95% CI: 1.03, 4.40) and more likely (non-significantly) to have been incarcerated (OR 7.03, 95% CI: 0.64, 77.30). CONCLUSIONS Older men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia.
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Affiliation(s)
| | - N El-Bassel
- Columbia University School of Social Work, USA
| | - A Aifah
- Columbia University School of Social Work, USA
| | | | | | | | - M Darisheva
- Global Health Research Center of Central Asia, USA
| | - L Gilbert
- Columbia University School of Social Work, USA
| | | | - S Galea
- Columbia University Medical Center, USA
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Johnson-Lawrence V, Kaplan G, Galea S. Socio-economic patterning in adulthood and depressive symptoms among a community sample of older adults in the United States. Public Health 2015; 129:594-6. [PMID: 25753277 DOI: 10.1016/j.puhe.2015.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 12/02/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
Affiliation(s)
- V Johnson-Lawrence
- University of Michigan-Flint, Department of Public Health and Health Sciences, Flint, MI, USA.
| | - G Kaplan
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
| | - S Galea
- Columbia University, New York, NY, USA.
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12
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Amstadter AB, Sumner JA, Acierno R, Ruggiero KJ, Koenen KC, Kilpatrick DG, Galea S, Gelernter J. Support for association of RORA variant and post traumatic stress symptoms in a population-based study of hurricane exposed adults. Mol Psychiatry 2013; 18:1148-9. [PMID: 23319003 PMCID: PMC3977702 DOI: 10.1038/mp.2012.189] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- AB Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - JA Sumner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - R Acierno
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - KJ Ruggiero
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - KC Koenen
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - DG Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - S Galea
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - J Gelernter
- Departments of Psychiatry, Genetics, & Neurobiology, Yale University School of Medicine, New Haven, CT, USA,VA CT Healthcare Center, West Haven, CT, USA
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13
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Meyers JL, Cerdá M, Galea S, Keyes KM, Aiello AE, Uddin M, Wildman DE, Koenen KC. Interaction between polygenic risk for cigarette use and environmental exposures in the Detroit Neighborhood Health Study. Transl Psychiatry 2013; 3:e290. [PMID: 23942621 PMCID: PMC3756291 DOI: 10.1038/tp.2013.63] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/04/2013] [Accepted: 07/10/2013] [Indexed: 01/31/2023] Open
Abstract
Cigarette smoking is influenced both by genetic and environmental factors. Until this year, all large-scale gene identification studies on smoking were conducted in populations of European ancestry. Consequently, the genetic architecture of smoking is not well described in other populations. Further, despite a rich epidemiologic literature focused on the social determinants of smoking, few studies have examined the moderation of genetic influences (for example, gene-environment interactions) on smoking in African Americans. In the Detroit Neighborhood Health Study (DNHS), a sample of randomly selected majority African American residents of Detroit, we constructed a genetic risk score (GRS), in which we combined top (P-value <5 × 10(-7)) genetic variants from a recent meta-analysis conducted in a large sample of African Americans. Using regression (effective n=399), we first tested for association between the GRS and cigarettes per day, attempting to replicate the findings from the meta-analysis. Second, we examined interactions with three social contexts that may moderate the genetic association with smoking: traumatic events, neighborhood social cohesion and neighborhood physical disorder. Among individuals who had ever smoked cigarettes, the GRS significantly predicted the number of cigarettes smoked per day and accounted for ~3% of the overall variance in the trait. Significant interactions were observed between the GRS and number of traumatic events experienced, as well as between the GRS and average neighborhood social cohesion; the association between genetic risk and smoking was greater among individuals who had experienced an increased number of traumatic events in their lifetimes, and diminished among individuals who lived in a neighborhood characterized by greater social cohesion. This study provides support for the utility of the GRS as an alternative approach to replication of common polygenic variation, and in gene-environment interaction, for smoking behaviors. In addition, this study indicates that environmental determinants have the potential to both exacerbate (traumatic events) and diminish (neighborhood social cohesion) genetic influences on smoking behaviors.
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Affiliation(s)
- J L Meyers
- Department of Epidemiology, Columbia University, New York, NY 10032, USA.
| | - M Cerdá
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - S Galea
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - K M Keyes
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - A E Aiello
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - M Uddin
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA,Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - D E Wildman
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - K C Koenen
- Department of Epidemiology, Columbia University, New York, NY, USA
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14
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Goodwin RD, Galea S, Perzanowski M, Jacobi F. Impact of allergy treatment on the association between allergies and mood and anxiety in a population sample. Clin Exp Allergy 2013. [PMID: 23181792 DOI: 10.1111/j.1365-2222.2012.04042.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have suggested an association between allergy and mood and anxiety disorders. Yet, extant work suffers from methodological limitations. OBJECTIVE To investigate the association between physician-diagnosed allergy and DSM-IV mood and anxiety disorders in the general population, and to examine the role of allergy treatment in this relationship. METHODS Data were drawn from the German National Health Interview and Examination Survey, a population-based, representative sample of 4,181 adults aged 18-65 in Germany. Allergy was diagnosed by physicians during medical examination and mental disorders were diagnosed using the CIDI. RESULTS Allergy was associated with an increased prevalence of any anxiety disorder [OR = 1.3 (1.1, 1.6)], panic attacks [OR = 1.6 (1.1, 2.1)], panic disorder [OR = 1.6 (1.01, 2.3)], GAD [OR = 1.8 (1.1, 3.0)], any mood disorder [OR = 1.4 (1.1, 1.7)], depression [OR = 1.4 (1.1, 1.7)] and bipolar disorder [OR = 2.0, (1.0, 3.8)]. After adjusting for desensitization treatment status, these relationships were no longer significant. Those treated for allergy were significantly less likely to have any mood or anxiety disorder [OR = 0.65 (0.4, 0.96)], compared to those untreated. All relationships were adjusted for age, gender and socioeconomic status (SES). CONCLUSIONS & CLINICAL RELEVANCE These findings provide the first evidence of a link between physician-diagnosed allergy and DSM-IV mood and anxiety disorders in a representative sample. Treatment for allergy may mitigate much of this relationship.
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Affiliation(s)
- R D Goodwin
- Department of Psychology, Queens College, City University of New York (CUNY), Flushing, NY, USA.
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15
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Abstract
BACKGROUND A defining feature of the US economic downturn of 2008-2010 was the alarming rate of home foreclosure. Although a substantial number of US households have experienced foreclosure since 2008, the effects of foreclosure on mental health are unknown. We examined the effects of foreclosure on psychiatric symptomatology in a prospective, population-based community survey. METHOD Data were drawn from the Detroit Neighborhoods and Health Study (DNHS), waves 1 and 2 (2008-2010). A probability sample of predominantly African-American adults in Detroit, Michigan participated (n=1547). We examined the association between home foreclosure between waves 1 and 2 and increases in symptoms of DSM-IV major depression and generalized anxiety disorder (GAD). RESULTS The most common reasons for foreclosure were an increase in monthly payments, an increase in non-medical expenses and a reduction in family income. Exposure to foreclosure between waves 1 and 2 predicted symptoms of major depression and GAD at wave 2, controlling for symptoms at wave 1. Even after adjusting for wave 1 symptoms, sociodemographics, lifetime history of psychiatric disorder at wave 1 and exposure to other financial stressors between waves 1 and 2, foreclosure was associated with an increased rate of symptoms of major depression [incidence density ratio (IDR) 2.4, 95% confidence interval (CI) 1.6-3.6] and GAD (IDR 1.9, 95% CI 1.4-2.6). CONCLUSIONS We provide the first prospective evidence linking foreclosure to the onset of mental health problems. These results, combined with the high rate of home foreclosure since 2008, suggest that the foreclosure crisis may have adverse effects on the mental health of the US population.
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Affiliation(s)
- K A McLaughlin
- Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
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16
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17
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Salguero JM, Cano-Vindel A, Iruarrizaga I, Fernández-Berrocal P, Galea S. Trajectory and predictors of depression in a 12-month prospective study after the Madrid March 11 terrorist attacks. J Psychiatr Res 2011; 45:1395-403. [PMID: 21683961 DOI: 10.1016/j.jpsychires.2011.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/12/2011] [Accepted: 05/30/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few longitudinal studies have examined the trajectory of and the risk factors for depression in a representative sample of the population exposed to terrorism. A 12 month prospective study was conducted among a sample of Madrid city residents after the March 11, 2004 terrorist attacks. We aimed to document the trajectories of depressive symptoms and determine the risk factors associated with these trajectories. METHODS We conducted telephone surveys among a representative sample of Madrid citizens (N = 1589) to recruit baseline respondents approximately 1 month after the March 11 terrorist attacks. Participants were re-contacted at 6 and 12 months after baseline for further telephone interviews. RESULTS Findings reveal heterogeneity in the longitudinal trajectories of depression ranging from the absence of depressive symptoms over time, to transient or chronic depression. Life and recent stressors, experiencing direct exposure to the attacks, personality traits, poor physical health and other psychological disorders were principally associated with a worse trajectory of depression after this event. CONCLUSIONS Consistent with a stress diathesis model, ongoing stressors and intense event exposure are key drivers of a chronic depression trajectory after a mass traumatic event.
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Affiliation(s)
- J M Salguero
- University of Malaga, Campus de Teatinos S/N, Malaga, Spain.
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18
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White K, Borrell LN, Wong DW, Galea S, Ogedegbe G, Glymour MM. Racial/ethnic residential segregation and self-reported hypertension among US- and foreign-born blacks in New York City. Am J Hypertens 2011; 24:904-10. [PMID: 21509051 DOI: 10.1038/ajh.2011.69] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Research examining the association of residence in racially segregated neighborhoods with physical and mental health outcomes among blacks is mixed. Research elucidating the relationship between segregation and hypertension has been limited. This study examines the association between segregation and hypertension among US- and foreign-born blacks in New York City (NYC). METHODS Individual-level data from the NYC Community Health Survey (n = 4,499) were linked to neighborhood-level data from the US Census and Infoshare Online. Prevalence ratios (PRs) for the association between segregation and self-reported hypertension among US- and foreign-born blacks were estimated. RESULTS After adjusting for individual- and neighborhood-level covariates, segregation was not associated with hypertension among US-born blacks or foreign-born blacks under 65 years of age. Older foreign-born blacks in highly segregated areas had a 46% lower probability (PR = 0.54; 95% confidence interval, 0.40-0.72) of reporting hypertension than older foreign-born blacks residing in low segregation areas. CONCLUSIONS In this NYC-based sample, no association between segregation and hypertension was observed among US-born or younger foreign-born blacks; however, our results suggest possible benefits of segregation for older foreign-born blacks. Further studies should determine whether this association is observed in other cities and identify factors that may mitigate against the adverse effects of segregation.
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19
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Kaplan G, Galea S, Riddle M. O4-2.4 Complexity, epidemiology and the understanding of "what if". Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976b.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Abstract
Prior research suggests that the current global economic crisis may be negatively affecting population mental health. In that context, this paper has several goals: (1) to discuss theoretical and conceptual explanations for how and why economic downturns might negatively affect population mental health; (2) present an overview of the literature on the relationship between economic recessions and population mental health; (3) discuss the limitations of existing empirical work; and (4) highlight opportunities for improvements in both research and practice designed to mitigate any negative impact of economic declines on the mental health of populations. Research has consistently demonstrated that economic crises are negatively associated with population mental health. How economic downturns influence mental health should be considered in policies such as social protection programs that aim to promote recovery.
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Affiliation(s)
- K Zivin
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA.
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21
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Uddin M, Koenen KC, Aiello AE, Wildman DE, de los Santos R, Galea S. Epigenetic and inflammatory marker profiles associated with depression in a community-based epidemiologic sample. Psychol Med 2011; 41:997-1007. [PMID: 20836906 PMCID: PMC3065166 DOI: 10.1017/s0033291710001674] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 07/21/2010] [Accepted: 07/31/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent work suggests that epigenetic differences may be associated with psychiatric disorders. Here we investigate, in a community-based sample, whether methylation profiles distinguish between individuals with and without lifetime depression. We also investigate the physiologic consequences that may be associated with these profiles. METHOD Using whole blood-derived genomic DNA from a subset of participants in the Detroit Neighborhood Health Study (DNHS), we applied methylation microarrays to assess genome-wide methylation profiles for over 14 000 genes in 33 persons who reported a lifetime history of depression and 67 non-depressed adults. Bioinformatic functional analyses were performed on the genes uniquely methylated and unmethylated in each group, and inflammatory biomarkers [interleukin (IL)-6 and C-reactive protein (CRP)] were measured to investigate the possible functional significance of the methylation profiles observed. RESULTS Uniquely unmethylated gene sets distinguished between those with versus without lifetime depression. In particular, some processes (e.g. brain development, tryptophan metabolism) showed patterns suggestive of increased methylation among individuals with depression whereas others (e.g. lipoprotein) showed patterns suggestive of decreased methylation among individuals with depression. IL-6 and CRP levels were elevated among those with lifetime depression and, among those with depression only, IL-6 methylation showed an inverse correlation with circulating IL-6 and CRP. CONCLUSIONS Genome-wide methylation profiles distinguish individuals with versus without lifetime depression in a community-based setting, and show coordinated signals with pathophysiological mechanisms previously implicated in the etiology of this disorder. Examining epigenetic mechanisms in concert with other dynamic markers of physiologic functioning should improve our understanding of the neurobiology of depression.
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Affiliation(s)
- M Uddin
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
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22
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Abstract
Ethnic minority groups are growing as a proportion of the British population. Although disparate, literature suggests inequalities in obesity risk within and among ethnic minority groups relative to Caucasians in the UK. We summarize and appraise the existing peer-reviewed literature about the prevalence and determinants of obesity among ethnic minority groups relative to Caucasians among children and adults in the UK. There was no consensus about obesity prevalence relative to Caucasians among South Asian or Black children or among South Asian adults relative to Caucasians. Black adults generally had higher risk for obesity than Caucasians. Both Chinese children and adults had lower risk for obesity than Caucasians. Few studies have considered differences in the aetiology of obesity by ethnicity. The lack of consensus regarding obesity risk among large ethnic minority groups relative to Caucasians in the UK, and the paucity of studies concerned with differences in obesity aetiology by ethnicity warrant further research in this area. Certain obesity metrics may bias obesity prevalence among particular ethnic groups relative to Caucasians. We summarize key methodological limitations to the current literature and suggest avenues for future research.
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Affiliation(s)
- A M El-Sayed
- Department of Public Health, University of Oxford, Oxford, UK.
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23
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Ornstein K, Galea S. Teaching Epidemiology: A Guide for Teachers in Epidemiology, Public Health and Clinical Medicine. Third Edition: Edited by Jorn Olsen, Rodolfo Saracci, and Dimitrios Trichopoulos. Am J Epidemiol 2010. [DOI: 10.1093/aje/kwq351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- K C Koenen
- Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA, USASchool of Public Health, University of Michigan, Ann Arbor, MI, USAMedical University of South Carolina, Charleston, SC, USAGelman Professor and Chair of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - M Uddin
- Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA, USASchool of Public Health, University of Michigan, Ann Arbor, MI, USAMedical University of South Carolina, Charleston, SC, USAGelman Professor and Chair of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - A B Amstadter
- Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA, USASchool of Public Health, University of Michigan, Ann Arbor, MI, USAMedical University of South Carolina, Charleston, SC, USAGelman Professor and Chair of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - S Galea
- Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA, USASchool of Public Health, University of Michigan, Ann Arbor, MI, USAMedical University of South Carolina, Charleston, SC, USAGelman Professor and Chair of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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25
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Cerdá M, Sagdeo A, Johnson J, Galea S. Genetic and environmental influences on psychiatric comorbidity: a systematic review. J Affect Disord 2010; 126:14-38. [PMID: 20004978 PMCID: PMC2888715 DOI: 10.1016/j.jad.2009.11.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 11/10/2009] [Accepted: 11/12/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this review is to systematically appraise the peer-reviewed literature about the genetic and environmental determinants of psychiatric comorbidity, focusing on four of the most prevalent types of psychopathology: anxiety disorders, depression, conduct disorder and substance abuse. METHODS We summarize existing empirical research on the relative contribution that genetic, nonshared and shared environmental factors make to the covariance between disorders, and evidence about specific genes and environmental characteristics that are associated with comorbidity. RESULTS Ninety-four articles met the inclusion criteria and were assessed. Genetic factors play a particularly strong role in comorbidity between major depression and generalized anxiety disorder or posttraumatic stress disorder, while the non-shared environments make an important contribution to comorbidity in affective disorders. Genetic and non-shared environmental factors also make a moderate-to-strong contribution to the relationship between CD and SA. A range of candidate genes, such as 5HTTLPR, MAOA, and DRD1-DRD4, as well as others implicated in the central nervous system, has been implicated in psychiatric comorbidity. Pivotal social factors include childhood adversity/life events, family and peer social connections, and socioeconomic and academic difficulties. LIMITATIONS Methodological concerns include the use of clinical case-control samples, the focus on a restricted set of individual-level environmental risk factors, and restricted follow-up times. CONCLUSIONS Given the significant mental health burden associated with comorbid disorders, population-based research on modifiable risk factors for psychiatric comorbidity is vital for the design of effective preventive and clinical interventions.
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Affiliation(s)
- M Cerdá
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, 10029, USA.
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26
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Kruk ME, Prescott MR, de Pinho H, Galea S. Equity and the child health Millennium Development Goal: the role of pro-poor health policies. J Epidemiol Community Health 2010; 65:327-33. [DOI: 10.1136/jech.2009.096081] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Perez V, Galea S, Kalbfleisch J, Monto A, Aiello A. The effect of influenza-like illness symptoms and laboratory confirmed influenza A on hand hygiene and other health habits among US University students. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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Kruk ME, Paczkowski MM, Tegegn A, Tessema F, Hadley C, Asefa M, Galea S. Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery. J Epidemiol Community Health 2009; 64:984-8. [DOI: 10.1136/jech.2009.087973] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Danforth E, Kruk M, Rockers P, Mbaruku G, Galea S. Household decision-making about delivery in health facilities: evidence from Tanzania. J Health Popul Nutr 2009; 27:696-703. [PMID: 19902806 PMCID: PMC2928090 DOI: 10.3329/jhpn.v27i5.3781] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This study investigated how partners' perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a health facility were agreement of partners on the importance of delivering in a health facility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility.
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Affiliation(s)
- E.J. Danforth
- Department of Anthropology, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida, 33620, USA
| | - M.E. Kruk
- Department of Health Management and Policy, University of Michigan School of Public Health, 109 Observatory Road, SPH II M3166, Ann Arbor, MI, 48109, USA and Averting Maternal Death and Disability Programme Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, Room B-320, New York, NY 10032, USA
| | - P.C. Rockers
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Road, SPH II M3166, Ann Arbor, MI, 48109, USA
| | - G Mbaruku
- Ifakara Health Institute and Averting Maternal Death and Disability, Mikocheni, PO Box 78373, Dar-es-salaam, Tanzania
| | - S Galea
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Road, SPH II M3166, Ann Arbor, MI, 48109, USA
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Goldstein MR, Mascitelli L, Pezzetta F, Haan MN, Cramer C, Kalbfleisch J, Langa K, Galea S. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2009; 72:1190-1. [PMID: 19332702 DOI: 10.1212/01.wnl.0000346461.00520.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kruk ME, Mbaruku G, McCord CW, Moran M, Rockers PC, Galea S. Bypassing primary care facilities for childbirth: a population-based study in rural Tanzania. Health Policy Plan 2009; 24:279-88. [DOI: 10.1093/heapol/czp011] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hadley C, Tegegn A, Tessema F, Cowan JA, Asefa M, Galea S. Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study. J Epidemiol Community Health 2009; 62:980-6. [PMID: 18854502 DOI: 10.1136/jech.2007.068460] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Common mental disorders are a major contributor to the burden of disease in developing countries. An assessment was carried out of whether food insecurity and exposure to stressful life events, two common features of life in sub-Saharan Africa (SSA), are associated with symptoms of mental disorders among adults. METHODS The Gilgel Gibe Growth and Development Study (GGGDS) is an ongoing cohort study in rural Ethiopia. Participants of the GGGDS were randomly selected from households from a complete census of persons living in the area. The Hopkins Symptom Checklist and the Harvard Trauma Questionnaire were used to assess anxiety and depression and post-traumatic stress symptoms. RESULTS Among 902 adult participants, food insecurity, stressful life events and symptoms of common mental disorders were highly prevalent. In separate multivariate models adjusting for potential confounders, food insecurity and stressful life events were independently associated with high symptoms of depression, anxiety and post-traumatic stress. CONCLUSIONS Potentially modifiable stressors may influence variation in common mental disorders in Ethiopia, and SSA more generally. These findings suggest that the negative effects of food insecurity extend beyond nutritional outcomes and that interventions that promote food security may also positively influence adult mental health in the region.
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Affiliation(s)
- C Hadley
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
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Mair C, Diez Roux AV, Galea S. Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. J Epidemiol Community Health 2008; 62:940-6, 8 p following 946. [PMID: 18775943 DOI: 10.1136/jech.2007.066605] [Citation(s) in RCA: 243] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A review of published observational studies of neighbourhoods and depression/depressive symptoms was conducted to inform future directions for the field. Forty-five English-language cross-sectional and longitudinal studies that analysed the effect of at least one neighbourhood-level variable on either depression or depressive symptoms were analysed. Of the 45 studies, 37 reported associations of at least one neighbourhood characteristic with depression/depressive symptoms. Seven of the 10 longitudinal studies reported associations of at least one neighbourhood characteristic with incident depression. Socioeconomic composition was the most common neighbourhood characteristic investigated. The associations of depressive symptoms/depression with structural features (socioeconomic and racial composition, stability and built environment) were less consistent than with social processes (disorder, social interactions, violence). Among the structural features, measures of the built environment were the most consistently associated with depression but the number of studies was small. The extent to which these associations reflect causal processes remains to be determined. The large variability in studies across neighbourhood definitions and measures, adjustment variables and study populations makes it difficult to draw more than a few general qualitative conclusions. Improving the quality of observational work through improved measurement of neighbourhood attributes, more sophisticated consideration of spatial scale, longitudinal designs and evaluation of natural experiments will strengthen inferences regarding causal effects of area attributes on depression.
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Affiliation(s)
- C Mair
- Department of Epidemiology, Ann Arbor, MI 48109, USA
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Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2008; 71:344-50. [PMID: 18663180 DOI: 10.1212/01.wnl.0000319647.15752.7b] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Evidence of a relation between use of lipid lowering drugs and cognitive outcomes is mixed. This study aimed to test the association between use of statins and incidence of dementia and cognitive impairment without dementia (CIND) over 5 years of follow-up. METHODS Data were from a population-based cohort study comprising 1,789 older Mexican Americans. All participants had cognitive and clinical evaluations performed every 12 to 15 months. Participants who fell below specified cutpoints on cognitive tests were then evaluated clinically. Dementia diagnoses were finalized by an adjudication team. A total of 1,674 participants free of dementia/CIND at baseline were included in these analyses. Statin use was verified at each participant's home by medicine cabinet inspection. Cox proportional hazards models were used to evaluate the association between statin use and incidence of dementia/CIND. RESULTS Overall, 452 of 1,674 participants (27%) took statins at any time during the study. Over the 5-year follow-up period, 130 participants developed dementia/CIND. In Cox proportional hazards models adjusted for education, smoking status, presence of at least one APOE epsilon4 allele, and history of stroke or diabetes at baseline, persons who had used statins were about half as likely as those who did not use statins to develop dementia/CIND (HR = 0.52; 95% CI 0.34, 0.80). CONCLUSION Statin users were less likely to have incident dementia/cognitive impairment without dementia during a 5-year follow-up. These results add to the emerging evidence suggesting a protective effect of statin use on cognitive outcomes.
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Affiliation(s)
- C Cramer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Abstract
BACKGROUND Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated. RESULTS We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13). CONCLUSIONS The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.
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Affiliation(s)
- Y Neria
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA.
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Amesty S, Ompad DC, Galea S, Fuller CM, Wu Y, Koblin B, Vlahov D. Prevalence and Correlates of Previous Hepatitis B Vaccination and Infection Among Young Drug-users In New York City. J Community Health 2008; 33:139-48. [DOI: 10.1007/s10900-007-9082-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kruk ME, Pereira C, Vaz F, Bergström S, Galea S. Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. BJOG 2007; 114:1253-60. [PMID: 17877677 DOI: 10.1111/j.1471-0528.2007.01443.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (técnicos de cirurgia) and specialist physicians (surgeons and obstetrician/gynaecologists) in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages. Técnicos de cirurgia have been previously shown to have quality of care outcomes comparable to physicians. DESIGN Economic evaluation of costs and productivity of surgically trained assistant medical officers and specialist physicians. SETTING Hospitals and health science training institutions in Mozambique. POPULATION Surgically trained assistants, medical officers, surgeons and obstetrician/gynaecologists in Mozambique. METHODS The costs of training and deploying the two cadres of health workers were derived from a review of budgets, annual expenditure reports, enrolment registers, and accounting statements from training institutions and interviews with directors and administrators. Productivity estimates were based on a hospital survey of physicians and técnicos de cirurgia. MAIN OUTCOME MEASURES Cost per major obstetric surgical procedure over 30 years in 2006 US dollars. RESULTS The 30-year cost per major obstetric surgery was $38.9 for técnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists. Doubling the salaries of técnicos de cirurgia resulted in a smaller but still substantial difference in cost per surgery between the groups ($60.3 versus $144.1 per procedure). One-way sensitivity analysis to test the impact of varying other inputs did not substantially change the magnitude of the cost advantage of técnicos de cirurgia. CONCLUSION Training more mid-level health workers in surgery can be part of the response to the health worker shortage, which today threatens the achievement of the health Millennium Development Goals in developing countries.
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Affiliation(s)
- M E Kruk
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
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Larkin G, Tracy M, Galea S. 40: The Impact of the September 11 Terrorist Attack on Suicide Rates in New York City. Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Galea S, Blaney S, Nandi A, Silverman R, Vlahov D, Foltin G, Kusick M, Tunik M, Richmond N. Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol 2007; 166:534-43. [PMID: 17584756 DOI: 10.1093/aje/kwm102] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A prospective observational study of 4,653 consecutive cases of out-of-hospital cardiac arrest (OOHCA) occurring in New York City from April 1, 2002, to March 31, 2003, was used to assess racial/ethnic differences in the incidence of OOHCA and 30-day survival after hospital discharge among OOHCA patients. The age-adjusted incidence of OOHCA per 10,000 adults was higher among Blacks than among persons in other racial/ethnic groups, and age-adjusted survival from OOHCA was higher among Whites compared with other groups. In analyses restricted to 3,891 patients for whom complete data on all variables were available, the age-adjusted relative odds of survival from OOHCA among Blacks were 0.4 (95% confidence interval: 0.2, 0.7) as compared with Whites. A full multivariable model accounting for demographic factors, prior functional status, initial cardiac rhythm, and characteristics of the OOHCA event explained approximately 41 percent of the lower age-adjusted survival among Blacks. The lower prevalence of ventricular fibrillation as the initial cardiac rhythm among Blacks relative to Whites was the primary contributor. A combination of factors probably accounts for racial/ethnic disparities in OOHCA survival. Previously hypothesized factors such as delays in emergency medical service response or differences in the likelihood of receipt of cardiopulmonary resuscitation did not appear to be substantial contributors to these racial/ethnic disparities.
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Affiliation(s)
- S Galea
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
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Abstract
OBJECTIVE Across the US, firearms are used in approximately 60% of all suicide deaths. Little research has assessed the role and determinants of firearms in suicide in major urban areas. METHODS The authors collected data on all suicide deaths between 1990 and 2000 from the Office of the Chief Medical Examiner of New York City (NYC) and assessed trends and correlates of firearm related suicide deaths. RESULTS During the period studied, there were a total of 6008 suicides in NYC; 1200 (20.0%) were firearm related suicides. There was a decrease in total suicides, total firearm suicides, and the proportion of firearm related suicides. In multivariable modeling, characteristics of suicide decedents associated with a greater likelihood of firearm suicide were: male, black race, residing in the outer boroughs, and use of cannabis. CONCLUSIONS The proportion of suicides caused by firearms in NYC is low compared to other parts of the US; differential access to means of committing suicide and the differential importance of firearms in different racial and ethnic groups may contribute to this observation. Innovative, local population based interventions that target non-firearm related suicide may contribute to lower suicide mortality overall in urban areas.
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Affiliation(s)
- T M Piper
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA
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42
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Bryant WK, Ompad DC, Sisco S, Blaney S, Glidden K, Phillips E, Vlahov D, Galea S. Determinants of influenza vaccination in hard-to-reach urban populations. Prev Med 2006; 43:60-70. [PMID: 16684559 DOI: 10.1016/j.ypmed.2006.03.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Revised: 03/14/2006] [Accepted: 03/24/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Influenza vaccination rates among disadvantaged minority and hard-to-reach populations are lower than in other groups. We assessed the barriers to influenza vaccination in disadvantaged urban areas. METHODS We conducted a cross-sectional study, using venue-based sampling, collecting data on residents of eight neighborhoods throughout East Harlem and the Bronx, New York City. RESULTS Of 760 total respondents, 461 (61.6%) had received influenza vaccination at some point in their life. In multivariable models, having access to routine medical care, receipt of health or social services, having tested positive for HIV, and current interest in receiving influenza vaccination were significantly associated with having received influenza vaccination in the previous year. Of participants surveyed, 79.6% were interested in receiving an influenza vaccination at the time of survey. Among participants who had never previously received influenza vaccination in the past, 73.4% were interested in being vaccinated; factors significantly associated with an interest in being vaccinated were minority race, lower annual income, history of being homeless, being uninsured/underinsured, and not having access to routine medical care. CONCLUSIONS Participants who are unconnected to health or social services or government health insurance are less likely to have been vaccinated in the past although these persons are willing to receive vaccine if it were available.
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Affiliation(s)
- W K Bryant
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA
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Galea S, Messner S, Markham PT, Bucciarelli A, Frye V, Tardiff K, Vlahov D. Policing, Drugs, and Declining Homicide Levels in New York City in the 1990's. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s159-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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45
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Ahern J, Galea S. Explaining Variability in Population Health: The Role of Underlying Ecologic Vulnerabilities and Capacities. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s27-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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46
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Tracy M, Galea S. Post-traumatic Stress Disorder and Depression Among Older Adults After a Disaster: The Role of Ongoing Trauma and Stressors. ACTA ACUST UNITED AC 2006. [DOI: 10.1093/ppar/16.2.16] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vlahov D, Galea S, Ahern J, Rudenstine S, Resnick H, Kilpatrick D, Crum RM. Alcohol drinking problems among New York City residents after the September 11 terrorist attacks. Subst Use Misuse 2006; 41:1295-311. [PMID: 16861180 DOI: 10.1080/10826080600754900] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recent studies have shown an increase in alcohol use in New York City in the months after the September 11 terrorist attacks; thus far there have been no studies documenting changes in drinking problems. In 2002, a random digit dial phone survey was conducted of residents of New York City. This study provided us with estimates of the prevalence of alcohol drinking problems among residents of New York City 6 months after September 11 compared with the 6 months before September 11. Among 1,570 adults, the prevalence of drinking problems was 3.7% in the 6 months before September 11 and 4.2% in the 6 months after September 11. The incidence of drinking problems among those without drinking problems before September 11 was 2.2%. Persons with incident drinking problems were more likely than those without to report symptoms consistent with posttraumatic stress disorder (17.4% vs. 0.4% in those without drinking problems and 1.4% in nondrinkers), and depression (23.5% vs 5.6% vs. 4.9%, respectively) after September 11. After a disaster, a link between drinking problems and posttraumatic stress disorder or depression should be assessed.
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Affiliation(s)
- D Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, NY 10029, USA.
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Ahern J, Galea S. 540-S: Variability in Population Health among Vulnerable Neighborhoods: The Contribution of Individual Socioeconomic Distribution. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s135c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Ahern
- New York Academy of Medicine, Center for Urban Epidemiologic Studies, New York City, NY 10029
| | - S Galea
- New York Academy of Medicine, Center for Urban Epidemiologic Studies, New York City, NY 10029
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Affiliation(s)
- S Galea
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, 10029
| | - J Ahern
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, 10029
| | - D Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, 10029
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Galea S, Blaney S, Silverman R, Kusick M, Vlahov D, Richmond N. 201: Racial Differences in Incidence of and Survival from Out-of-Hospital Cardiac Arrest in New York City. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Galea
- Center for Urban Epidemiologic Studies, New York City, NY 10029
| | - S Blaney
- Center for Urban Epidemiologic Studies, New York City, NY 10029
| | - R Silverman
- Center for Urban Epidemiologic Studies, New York City, NY 10029
| | - M Kusick
- Center for Urban Epidemiologic Studies, New York City, NY 10029
| | - D Vlahov
- Center for Urban Epidemiologic Studies, New York City, NY 10029
| | - N Richmond
- Center for Urban Epidemiologic Studies, New York City, NY 10029
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