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Surachman A, Hamlat E, Zannas AS, Horvath S, Laraia B, Epel E. Grandparents' educational attainment is associated with grandchildren's epigenetic-based age acceleration in the National Growth and Health Study. Soc Sci Med 2024; 355:117142. [PMID: 39106784 DOI: 10.1016/j.socscimed.2024.117142] [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: 09/30/2022] [Revised: 01/03/2024] [Accepted: 07/12/2024] [Indexed: 08/09/2024]
Abstract
We examined three generations (grandparents, mothers, and grandchildren) to assess the association between grandparents' educational attainment and their grandchildren's epigenetic-based age acceleration and whether the association was mediated by parental educational attainment and mothers' life course health-related factors. Mothers were recruited to the NHLBI Growth and Health Study at 9-10 years and followed for 10 years (1987-1998). Mothers were then re-contacted three decades later (ages 37-42) to participate in the National Growth and Health Study (NGHS), and health information from their youngest child (i.e., grandchildren; N = 241, ages 2-17) was collected, including their saliva samples to calculate epigenetic age. Five epigenetic-based age acceleration measures were included in this analysis, including four epigenetic clock age accelerations (Horvath, Hannum, GrimAge, and PhenoAge) and DunedinPACE. Grandparents reported their highest education during the initial enrollment interviews. Parental educational attainment and mothers' life course health-related factors (childhood BMI trajectories, adult cardiovascular health behavioral risk score, and adult c-reactive protein) are included as mediators. Grandparents' education was significantly associated with Horvath age acceleration (b = -0.32, SE = 0.14, p = 0.021). Grandchildren with college-degree grandparents showed significantly slower Horvath age accelerations than those without college degrees. This association was partially mediated by parental education and mothers' health-related factors, especially adult cardiovascular health behavioral risk score and CRP, but not mothers' childhood BMI trajectory. This ability to conserve the speed of biological aging may have considerable consequences in shaping health trajectories across the lifespan.
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Affiliation(s)
- Agus Surachman
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, USA; College of Nursing and Health Profession, Drexel University, USA.
| | - Elissa Hamlat
- Center for Health and Community, School of Medicine, University of California, San Francisco, USA
| | - Anthony S Zannas
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA; Department of Genetics, University of North Carolina at Chapel Hill, USA
| | - Steve Horvath
- Department of Human Genetics, University of California, Los Angeles, USA; The Altos Institutes of Science, San Diego, USA
| | - Barbara Laraia
- School of Public Health, University of California, Berkeley, USA
| | - Elissa Epel
- Center for Health and Community, School of Medicine, University of California, San Francisco, USA; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, USA.
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Bazzano AN, Pies C, Lu MC, Parthasarathy P, Fine A, Kotelchuck M. Development and Unfolding of the Life Course Movement in the Field of Maternal and Child Health: An Oral History. Matern Child Health J 2024:10.1007/s10995-024-03938-y. [PMID: 39012423 DOI: 10.1007/s10995-024-03938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION A life course perspective in maternal, child, and family health allows for integrated exploration of outcomes, incorporating multifactorial determinants of health to interrogate sources of inequity and identify opportunities for intervention. This article explores the historical development, integration, and implications of the contemporary life course perspective in the field of maternal and child health (MCH), and particularly the people and events which institutionalized the framework as central to national and local MCH practice and research over the last decades. METHODS Drawing on an oral history approach, key leaders of the life course movement in MCH were interviewed. Lived experiences and personal recollections of six interviewees were recorded and synthesized using a narrative descriptive approach to portray the social ecology of the movement's origins. RESULTS We documented systematic efforts made in the first two decades of the 21st century to consciously promote life course through convening a National MCH Life Course Invitational Meeting, incorporating life course as a foundational framework for strategic planning at the Maternal Child Health Bureau, and development of tools and resources by MCH professional organizations. DISCUSSION The integration of life course theory into the MCH field signified a major shift towards addressing protective and social factors, which aligns with the field's historical emphasis on social justice and rights-based approaches, and parallels the broader public health movement towards social determinants of health and the need to address structural racism. The ongoing relevance of the life course approach in promoting reproductive justice and addressing inequities in health underscores the historical importance of its adoption and use in the current mainstream of MCH research, policy, and practice.
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Affiliation(s)
- Alessandra N Bazzano
- Department of Social, Behavioral, and Population Sciences; Center of Excellence in Maternal Child Health, Tulane School of Public Health and Tropical Medicine, New Orleans, USA.
| | - Cheri Pies
- University of California Berkeley, Berkeley, USA
| | - Michael C Lu
- University of California Berkeley, Berkeley, USA
| | | | - Amy Fine
- Health Policy Program Consultant, San Francisco, CA, USA
| | - Milton Kotelchuck
- Harvard Medical School, Department of Pediatrics, Division of General Academic Pediatrics Mass General Hospital for Children, Boston, USA
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Fuller-Thomson E, Grossman R, MacNeil A. Is the Health of Older Americans With a GED Equivalent to Their Peers With a High School Diploma? Int J Aging Hum Dev 2024; 99:47-65. [PMID: 37876216 PMCID: PMC11295392 DOI: 10.1177/00914150231208685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
The aim of this study was to identify differences in the prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, General Educational Development (GED) recipients, and high school graduates. This study used secondary analysis of the nationally representative 2017 American Community Survey. The sample included 20,489 GED recipients, 154,892 high school graduates, and 49,912 high school dropouts. Our findings indicate that there is a gradient in health outcomes among older Americans, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations among high school dropouts, followed by GED recipients, and the lowest among high school graduates. Although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine & Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Robin Grossman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
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Zima BT, Edgcomb JB, Fortuna LR. Identifying Precise Targets to Improve Child Mental Health Care Equity: Leveraging Advances in Clinical Research Informatics and Lived Experience. Child Adolesc Psychiatr Clin N Am 2024; 33:471-483. [PMID: 38823818 PMCID: PMC11268960 DOI: 10.1016/j.chc.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
To reduce child mental health disparities, it is imperative to improve the precision of targets and to expand our vision of social determinants of health as modifiable. Advancements in clinical research informatics and please state accurate measurement of child mental health service use and quality. Participatory action research promotes representation of underserved groups in informatics research and practice and may improve the effectiveness of interventions by informing research across all stages, including the identification of key variables, risk and protective factors, and data interpretation.
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Affiliation(s)
- Bonnie T Zima
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-384B, Los Angeles, CA 90024, USA.
| | - Juliet B Edgcomb
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-372A, Los Angeles, CA 90024, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Neuroscience, University of California Riverside, School of Medicine, 900 University Avenue, Riverside, CA 92521, USA
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Goel A, Reddy S, Goel P. Causes, Consequences, and Preventive Strategies for Childhood Obesity: A Narrative Review. Cureus 2024; 16:e64985. [PMID: 39161504 PMCID: PMC11332093 DOI: 10.7759/cureus.64985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
Childhood obesity is a complex public health challenge with profound implications for both physical and psychological well-being. A significant portion of the global population struggles with obesity. Sedentary lifestyles, increased consumption of ultra-processed foods, and socioeconomic disparities are major contributors. The COVID-19 pandemic has further exacerbated these issues, leading to a surge in obesity rates among children. The consequences of childhood obesity extend beyond immediate health issues like type 2 diabetes and cardiovascular diseases; obese children are at higher risk for psychological problems such as depression, anxiety, and low self-esteem, which can persist into adulthood. These health challenges also impose substantial economic burdens due to increased healthcare costs and reduced productivity. This paper synthesizes findings from various articles to provide an overview of the causes, consequences, and preventive strategies related to childhood obesity. It highlights the varied nature of obesity, including genetic, environmental, and lifestyle factors, and discusses the profound impact on physical health, socioemotional skills, and mental health. Additionally, it examines the global challenge of childhood obesity, particularly in developing nations, and emphasizes the importance of preventive measures, family and parental behaviors, and effective policy interventions.
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Affiliation(s)
- Ashish Goel
- Department of Cardiology, Fayth Clinic, Mumbai, IND
| | - Spoorti Reddy
- Department of General Medicine, Jan Sewa Hospital, Tantia University, Sri Ganganagar, IND
| | - Paula Goel
- Department of Pediatrics, Fayth Clinic, Mumbai, IND
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Hooten M, Ortega M, Oyeyemi A, Yu F, Ofori E. Investigating the relationships between motor skills, cognitive status, and area deprivation index in Arizona: a pilot study. Front Public Health 2024; 12:1385435. [PMID: 38983257 PMCID: PMC11231207 DOI: 10.3389/fpubh.2024.1385435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction Previous studies highlight the negative impact of adverse socioeconomic conditions throughout life on motor skills and cognitive health. Factors such as cognitive activity, physical activity, lifestyle, and socioeconomic position significantly affect general health status and brain health. This pilot study investigates the relationships among the Area Deprivation Index (ADI)-a measure of neighborhood-level socioeconomic deprivation, brain structure (cortical volume and thickness), and cognitive status in adults in Arizona. Identifying measures sensitive to ADI could elucidate mechanisms driving cognitive decline. Methods The study included 22 adults(mean age = 56.2 ± 15.2) in Arizona, residing in the area for over 10 years(mean = 42.7 ± 15.8). We assessed specific cognitive domains using the NeuroTrax™ cognitive screening test, which evaluates memory, executive function, visual-spatial processing, attention, information processing speed, and motor function. We also measured cortical thickness and volume in 10 cortical regions using FreeSurfer 7.2. Linear regression tests were conducted to examine the relationships between ADI metrics, cognitive status, and brain health measures. Results Results indicated a significant inverse relationship between ADI metrics and memory scores, explaining 25% of the variance. Both national and state ADI metrics negatively correlated with motor skills and global cognition (r's < -0.40, p's < 0.05). In contrast, ADI metrics generally positively correlated with motor-related volumetric and cortical thickness measures (r's > 0.40, p's < 0.05). Conclusion The findings suggest that neighborhood-level social deprivation might influence memory and motor status, primarily through its impact on motor brain health.
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Affiliation(s)
- Madeline Hooten
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Marcus Ortega
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Adewale Oyeyemi
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Fang Yu
- Edson College of Nursing and Healthcare Innovation, Arizona State University, Phoenix, AZ, United States
| | - Edward Ofori
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Flink H, Hedenbjörk-Lager A, Liljeström S, Nohlert E, Tegelberg Å. Identification of Swedish caries active individuals aged 30-90 years using a life course perspective and SKaPa longitudinal national registry data over a 10-year period. Acta Odontol Scand 2024; 83:412-418. [PMID: 38899384 PMCID: PMC11302472 DOI: 10.2340/aos.v83.40955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To describe the occurrence of caries disease from a life course perspective using longitudinal data from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa). Material and Methods: Data from seven age cohorts (ages 30-90 years), each followed over 10 years, were retrieved from the SKaPa. Using a three-trajectory model, individuals were divided into three trajectories according to their caries development over time: high (15%), moderate (45%), or low (40%). Caries experience was expressed as the mean decayed, missing, and filled surfaces (DMFS) index. RESULTS Significant differences were found for all three trajectories and in all age groups over the 10 years. The mean DMFS index increase was significantly larger for the high trajectory group than for the moderate and low trajectory groups across all age cohorts. An increase in caries experience was observed for the older cohorts across all trajectories. CONCLUSIONS A three-trajectory model appears useful for identifying and quantifying caries experiences in longitudinal studies. Increased caries disease occurs over time, especially in the highest trajectory group and among older cohorts. These findings emphasise the need for greater attention and more efficient caries prevention methods.
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Affiliation(s)
- Håkan Flink
- Centre for Clinical Research Västerås, Uppsala University, Västerås, Sweden; Faculty of Odontology, Malmö University, Malmö, Sweden.
| | | | - Simon Liljeström
- Centre for Clinical Research Västerås, Uppsala University, Västerås, Sweden
| | - Eva Nohlert
- Centre for Clinical Research Västerås, Uppsala University, Västerås, Sweden
| | - Åke Tegelberg
- Centre for Clinical Research Västerås, Uppsala University, Västerås, Sweden; Faculty of Odontology, Malmö University, Malmö, Sweden
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Leung JH, Thorne PR, Purdy SC, Cheyne K, Steptoe B, Ambler A, Hogan S, Ramrakha S, Caspi A, Moffitt TE, Poulton R. Trajectories of Hearing From Childhood to Adulthood. Ear Hear 2024:00003446-990000000-00301. [PMID: 38898547 DOI: 10.1097/aud.0000000000001542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVES The Dunedin Multidisciplinary Health and Development Study provides a unique opportunity to document the progression of ear health and hearing ability within the same cohort of individuals from birth. This investigation draws on hearing data from 5 to 13 years and again at 45 years of age, to explore the associations between childhood hearing variables and hearing and listening ability at age 45. DESIGN Multiple linear regression analyses were used to assess associations between childhood hearing (otological status and mid-frequency pure-tone average) and (a) age 45 peripheral hearing ability (mid-frequency pure-tone average and high-frequency pure-tone average), and (b) age 45 listening ability (listening in spatialized noise and subjective questionnaire on listening experiences). Sex, childhood socioeconomic status, and adult IQ were included in the model as covariates. RESULTS Peripheral hearing and listening abilities at age 45 were consistently associated with childhood hearing acuity at mid-frequencies. Otological status was a moderate predicting factor for high-frequency hearing and utilization of spatial listening cues in adulthood. CONCLUSIONS We aim to use these findings to develop a foundational model of hearing trajectories. This will form the basis for identifying precursors, to be investigated in a subsequent series of analyses, that may protect against or exacerbate hearing-associated cognitive decline in the Dunedin Study cohort as they progress from mid-life to older age.
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Affiliation(s)
- Joan H Leung
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Eisdell Moore Centre for Hearing and Balance Research, School of Medicine, University of Auckland, Auckland, New Zealand
- Faculty of Science, Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Peter R Thorne
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Eisdell Moore Centre for Hearing and Balance Research, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Suzanne C Purdy
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Eisdell Moore Centre for Hearing and Balance Research, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Kirsten Cheyne
- Faculty of Science, Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Barbara Steptoe
- Faculty of Science, Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Antony Ambler
- Faculty of Science, Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Sean Hogan
- Faculty of Science, Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Faculty of Science, Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Center for Genomic and Computational Biology, Duke University, Durham, North Carolina, USA
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- PROMENTA, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Center for Genomic and Computational Biology, Duke University, Durham, North Carolina, USA
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- PROMENTA, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Richie Poulton
- Faculty of Science, Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
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McKinley Yoder C, Cantrell MA, Hinkle JL. Disparities in High School Graduation by Identity and Disability Using Intermediate and Long-Term Educational Outcomes. J Sch Nurs 2024; 40:266-274. [PMID: 35139668 DOI: 10.1177/10598405221078989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Multiple factors influence a student's success in high school graduation. Individual factors such as disability, racial or ethnic identity, and gender may result in inequity in the school environment, interfering with learning and possibly leading to poorer educational outcomes. This secondary analysis of student educational records (N = 3,782) from 2008-2018 tested the associations among the disability, racial or ethnic identity, gender, and 5th grade attendance on high school attendance and graduation. Linear and logistic regression analysis identified students without a disability had a 40% greater chance of graduation (AOR = 1.4 [95% CI = 1.15, 1.71]) than those with a disability. Students identifying as Black, Hispanic, or Native American had half the odds of graduating compared to White students. When controlling for 9th grade attendance, these disparities decreased. Attendance in 5th grade, disability, and racial and ethnic identity influenced attendance, being on track to graduate, and high school graduation.
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Affiliation(s)
| | - Mary Ann Cantrell
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Janice L Hinkle
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
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Wang LL, Xu RH. Development of a rapid tool for screening financial toxicity based on the comprehensive score for financial toxicity. J Cancer Policy 2024; 40:100475. [PMID: 38552715 DOI: 10.1016/j.jcpo.2024.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE This study aimed to use item response theory (IRT) to develop and validate a short version of the Chinese COmprehensive Score for financial Toxicity (COST-S-C) in patients with cancer. METHODS A total of 500 patients with cancer participated in the survey. Confirmatory factor analysis (CFA) was used to assess the factor structure of the COST-S-C. A two-parameter IRT model was used to examine the item fit of the COST-S-C. Item discrimination, item characteristic curves (ICCs), item information curves (IICs), and item fit were estimated. Differential item functioning (DIF) was assessed for participants' gender and age. Reliability, convergent and discriminant validity was examined as well as estimating the optimal cut-off points of the COST-S-C. RESULTS The CFA results supported the bi-factor structure of the COST-S-C. The IRT analysis findings revealed that several items showed problems with the ICCs, providing little information in terms of IICs as well as poor discrimination. Item 5 showed a negligible DIF problem with age. A valid 3-item COST-S-C scale and its optimal cut-off point was developed. CONCLUSIONS The COST-S-C is a valid and quick screening tool used to distinguish patients with cancer who report significant financial toxicity in various medical settings.
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Affiliation(s)
- Ling-Ling Wang
- Center for Health policy and management studies, Nanjing University, Nanjing, China; Department of Blood Transfusion Medicine, Jinling Hospital, School of Medicine, Nanjing, University Nanjing, China
| | - Richard Huan Xu
- Department of Rehabilitation Sciences, Faculty of Health and Social Science, the Hong Kong Polytechnic University, Hong Kong, China; JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China.
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Opotowsky AR, Khairy P, Diller G, Kasparian NA, Brophy J, Jenkins K, Lopez KN, McCoy A, Moons P, Ollberding NJ, Rathod RH, Rychik J, Thanassoulis G, Vasan RS, Marelli A. Clinical Risk Assessment and Prediction in Congenital Heart Disease Across the Lifespan: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:2092-2111. [PMID: 38777512 DOI: 10.1016/j.jacc.2024.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 05/25/2024]
Abstract
Congenital heart disease (CHD) comprises a range of structural anomalies, each with a unique natural history, evolving treatment strategies, and distinct long-term consequences. Current prediction models are challenged by generalizability, limited validation, and questionable application to extended follow-up periods. In this JACC Scientific Statement, we tackle the difficulty of risk measurement across the lifespan. We appraise current and future risk measurement frameworks and describe domains of risk specific to CHD. Risk of adverse outcomes varies with age, sex, genetics, era, socioeconomic status, behavior, and comorbidities as they evolve through the lifespan and across care settings. Emerging technologies and approaches promise to improve risk assessment, but there is also need for large, longitudinal, representative, prospective CHD cohorts with multidimensional data and consensus-driven methodologies to provide insight into time-varying risk. Communication of risk, particularly with patients and their families, poses a separate and equally important challenge, and best practices are reviewed.
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Affiliation(s)
- Alexander R Opotowsky
- Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, Montréal, Quebec, Canada
| | - Gerhard Diller
- Department of Cardiology III, University Hospital Münster, Münster, Germany
| | - Nadine A Kasparian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Heart and Mind Wellbeing Center, Cincinnati, Ohio, USA; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Brophy
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Keila N Lopez
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA
| | - Alison McCoy
- Vanderbilt Clinical Informatics Core, Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jack Rychik
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Thanassoulis
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Ramachandran S Vasan
- School of Public Health, University of Texas, San Antonio, Texas, USA; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, Quebec, Canada.
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Fikre R, Gerards S, Teklesilasie W, Gubbels J. Correlates of adverse outcomes of adolescent pregnancy in Sidama region, Ethiopia. An unmatched case-control study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:100986. [PMID: 38815452 DOI: 10.1016/j.srhc.2024.100986] [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: 10/04/2023] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Adolescent pregnancy has received little attention, despite being it is the leading cause of maternal mortality and morbidity in low-income countries, including Ethiopia. Sidama regional state is one of the regions in Ethiopia that has high rates of adolescent pregnancy. This study aimed to identify factors related to adverse outcomes of adolescent pregnancy, in the Sidama region, Ethiopia. METHODS A hospital-based unmatched case-control study was conducted among 120 cases and 240 controls of pregnant adolescents. Structured interviews and patient record reviews were used to examine the potential correlates and adverse outcomes of adolescent pregnancy. Using binary logistic analysis, adjusted odds ratio (AOR) with 95% confidence intervals, were computed to identify factors related to adverse outcomes of adolescent pregnancies. RESULTS A monthly income below the poverty level (AOR: 3.40; 95% CI, 1.21-9.58), lack of antenatal care follow-up (AOR: 4.22; 95% CI, 1.97-9.04), experiencing gender-based violence (AOR: 2.03; 95% CI, 1.16-3.57), and referral to a specialized health facility (AOR: 2.79; 95% CI,1.39, 5.62) were associated with higher odds of adverse pregnancy outcomes. CONCLUSION Several socio-economic and health care system-related determinants are associated with adverse outcomes of adolescent pregnancy. Therefore, it is crucial to improve free and accessible maternal health care services for adolescents, focusing on education, challenging social norms that condone gender-based violence as well as enhancing the referral system to lessen the burden of adverse outcomes of adolescent pregnancy.
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Affiliation(s)
- Rekiku Fikre
- Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism; Department of Health Promotion; Faculty of Health, Medicine & Life Sciences, the Netherlands; Hawassa University, College of Medicine and Health Sciences, Department of Midwifery, Ethiopia.
| | - Sanne Gerards
- Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism; Department of Health Promotion; Faculty of Health, Medicine & Life Sciences, the Netherlands.
| | - Wondwosen Teklesilasie
- Hawassa University, College of Medicine and Health Sciences, Department of Midwifery, Ethiopia.
| | - Jessica Gubbels
- Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism; Department of Health Promotion; Faculty of Health, Medicine & Life Sciences, the Netherlands.
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Rovai G, Santana CAS, Brandão MDB, de Campos AC. Cross-cultural adaptation of the Rotterdam Transition Profile to Brazilian Portuguese: measuring autonomy in participation of Brazilian youth with cerebral palsy. Braz J Phys Ther 2024; 28:101080. [PMID: 38848627 PMCID: PMC11192777 DOI: 10.1016/j.bjpt.2024.101080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/14/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Autonomy in participation of young adults with cerebral palsy (CP) is not well understood due to the lack of appropriate instruments, especially for the Brazilian population. The Rotterdam Transition Profile (RTP) categorizes autonomy in Participation (education, employment, finances, housing, leisure, intimate relationships, sexuality, transportation) and Health Services (care demands, services and aids, and rehabilitation services) domains. OBJECTIVES To cross-culturally adapt the RTP for use in Brazil, and to describe the levels of autonomy in participation and associated factors of Brazilian youth with CP. METHODS RTP was translated and content validity was investigated through an expert panel (n = 4 researchers and n = 4 clinicians); 30 adolescents and young adults with CP provided data for construct validity and internal consistency analysis. To analyze influencing factors, 56 youth with CP, mean age 25 years (SD = 6.9 years), with good cognitive level remotely responded to the RTP, sociodemographic information, and functional classifications (gross motor, manual ability). RESULTS Following translation, content and construct validity were established, with changes made to improve the clarity of items. Cronbach's alpha (0.82) was considered good and test-reliability was fair to good for most items. High levels of autonomy were found in the areas of Leisure and Rehabilitation, with the lowest proportion of participants with autonomy in Housing, Intimate Relationships, and Finances. Autonomy in participation was associated with age, gross motor and manual ability classifications, and with context-related factors. CONCLUSION The Brazilian Portuguese version of the RTP was considered valid and reliable. Findings will support transition planning for young people with CP.
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Affiliation(s)
- Gabriela Rovai
- Child Development Analysis Laboratory, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Camila Araújo Santos Santana
- Child Development Analysis Laboratory, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Marina de Brito Brandão
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Carolina de Campos
- Child Development Analysis Laboratory, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
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Moroz H, Li Y, Marelli A. hART: Deep learning-informed lifespan heart failure risk trajectories. Int J Med Inform 2024; 185:105384. [PMID: 38395016 DOI: 10.1016/j.ijmedinf.2024.105384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/21/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Heart failure (HF) results in persistent risk and long-term comorbidities. This is particularly true for patients with lifelong HF sequelae of cardiovascular disease such as patients with congenital heart disease (CHD). PURPOSE We developed hART (heart failure Attentive Risk Trajectory), a deep-learning model to predict HF trajectories in CHD patients. METHODS hART is designed to capture the contextual relationships between medical events within a patient's history. It is trained to predict future HF risk by using the masked self-attention mechanism that forces it to focus only on the most relevant segments of the past medical events. RESULTS To demonstrate the utility of hART, we used a large cohort containing healthcare administrative data from the Quebec CHD database (137,493 patients, 35-year follow-up). hART achieves an area under the precision-recall of 28% for HF risk prediction, which is 33% improvement over existing methods. Patients with severe CHD lesion showed a consistently elevated predicted HF risks throughout their lifespan, and patients with genetic syndromes exhibited elevated HF risks until the age of 50. The impact of the birth condition decreases on long-term HF risk. The timing of interventions such as arrhythmia surgery had varying impacts on the lifespan HF risk among the individuals. Arrhythmic surgery performed at a younger age had minimal long-term effects on HF risk, while surgeries during adulthood had a significant lasting impact. CONCLUSION Together, we show that hART can detect meaningful lifelong HF risk in CHD patients by capturing both long and short-range dependencies in their past medical events.
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Affiliation(s)
- Harry Moroz
- Department of Medicine, McGill University of Health Centre, Montreal, QC, Canada
| | - Yue Li
- School of Computer Science, McGill University, Montreal, QC, Canada.
| | - Ariane Marelli
- Department of Medicine, McGill University of Health Centre, Montreal, QC, Canada.
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15
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Benner AD, Chen S, Fernandez CC, Hayward MD. The Potential for Using a Shortened Version of the Everyday Discrimination Scale in Population Research with Young Adults: A Construct Validation Investigation. SOCIOLOGICAL METHODS & RESEARCH 2024; 53:804-838. [PMID: 38813255 PMCID: PMC11136476 DOI: 10.1177/00491241211067512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Discrimination is associated with numerous psychological health outcomes over the life course. The nine-item Everyday Discrimination Scale (EDS) is one of the most widely used measures of discrimination; however, this nine-item measure may not be feasible in large-scale population health surveys where a shortened discrimination measure would be advantageous. The current study examined the construct validity of a combined two-item discrimination measure adapted from the EDS by Add Health (N = 14,839) as compared to the full nine-item EDS and a two-item EDS scale (parallel to the adapted combined measure) used in the National Survey of American Life (NSAL; N = 1,111) and National Latino and Asian American Study (NLAAS) studies (N = 1,055). Results identified convergence among the EDS scales, with high item-total correlations, convergent validity, and criterion validity for psychological outcomes, thus providing evidence for the construct validity of the two-item combined scale. Taken together, the findings provide support for using this reduced scale in studies where the full EDS scale is not available.
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Affiliation(s)
- Aprile D. Benner
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| | - Shanting Chen
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| | - Celeste C. Fernandez
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| | - Mark D. Hayward
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
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16
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Asiodu IV, Gay CL, Gates-Burgess B, Negrete G. Access to and interest in human milk research opportunities among Black pregnant and postpartum people. Front Nutr 2024; 11:1274833. [PMID: 38680532 PMCID: PMC11048474 DOI: 10.3389/fnut.2024.1274833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
Background Concerns exist regarding biomedical research participation in marginalized and historically disadvantaged communities. Objectives The purpose of this study was to understand critical barriers to participation in human milk research from the perspective of Black pregnant and postpartum people. Methods A national sample of Black pregnant and postpartum people (n = 104) was recruited to complete a cross-sectional online survey informed by the Life Course Perspective. Survey questions assessed research experiences and preferences, particularly related to human milk research, knowledge of historical events/policies targeting Black communities, and demographic characteristics. A socio-economic composite score was calculated as an indicator of socio-economic advantage. Survey data were summarized descriptively and potential correlates of research engagement were evaluated. Results Most (69%, n = 71) respondents reported previous participation in a research study, yet only 8 (8%) reported ever being asked to participate in a breastfeeding/chestfeeding or human milk study, and one respondent was unsure. Despite so few having been asked, 59% (n = 61) of respondents indicated they would donate breast/human milk to research if asked. Respondent characteristics associated with prior research participation included having greater socio-economic advantage (p = 0.027) and greater knowledge of discriminatory historical events/policies (p < 0.001). In contrast, the only respondent characteristic associated with willingness to donate human milk to research was younger age (p = 0.002). Conclusion Our findings suggest that Black pregnant and postpartum people are interested in biomedical research, specifically human milk and lactation research. However, greater intentionality and targeted recruitment of this underrepresented population is needed to increase diversity among human milk and lactation study samples. Structural and community-based interventions, informed by community members, are needed to address concerns and improve participant engagement.
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Affiliation(s)
- Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Caryl L. Gay
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | | | - Gabriela Negrete
- Department of Human Ecology, Human Development & Family Studies, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, United States
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Ventres WB, Stone LA, LaVallee LA, Loxterkamp D, Brown JR, Waxman DM, Dorward PS, Cawse-Lucas J, Mauksch LB, Kieber-Emmons AM, Crabtree BF, Miller WL, Brohm VM, Daaleman TP, Bossenbroek Fedoriw K. Storylines of family medicine VI: ways of being-in the office with patients. Fam Med Community Health 2024; 12:e002793. [PMID: 38609089 PMCID: PMC11029328 DOI: 10.1136/fmch-2024-002793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Lisa A LaVallee
- MAHEC Family Medicine Residency, Mountain Area Health Education Center, Asheville, North Carolina, USA
| | | | - Jonisha R Brown
- Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Dael M Waxman
- Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | | | - Jeanne Cawse-Lucas
- Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Larry B Mauksch
- Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Autumn M Kieber-Emmons
- Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Benjamin F Crabtree
- Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
- Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - William L Miller
- Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Veronica M Brohm
- Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Timothy P Daaleman
- Family Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Pasha VC, Gerchow L, Lyndon A, Clark-Cutaia M, Wright F. Understanding Food Insecurity as a Determinant of Health in Pregnancy Within the United States: An Integrative Review. Health Equity 2024; 8:206-225. [PMID: 38559844 PMCID: PMC10979674 DOI: 10.1089/heq.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Abstract
Background Food insecurity is a major public health concern in the United States, particularly for pregnant and postpartum individuals. In 2020, ∼13.8 million (10.5%) U.S. households experienced food insecurity. However, the association between food security and pregnancy outcomes in the United States is poorly understood. Purpose The purpose of this review was to critically appraise the state of the evidence related to food insecurity as a determinant of health within the context of pregnancy in the United States. We also explored the relationship between food insecurity and pregnancy outcomes. Methods PubMed, CINAHL, Web of Science, and Food and Nutrition Science databases were used. The inclusion criteria were peer-reviewed studies about food (in)security, position articles from professional organizations, and policy articles about pregnancy outcomes and breastfeeding practices. Studies conducted outside of the United States and those without an adequate definition of food (in)security were excluded. Neonatal health outcomes were also excluded. Included articles were critically appraised with the STROBE and Critical Appraisal Skills Program checklists. Results Nineteen studies met the inclusion criteria. Inconsistencies exist in defining and measuring household food (in)security. Pregnant and postpartum people experienced several adverse physiological and psychological outcomes that impact pregnancy compared with those who do not. Intersections between neighborhood conditions and other economic hardships were identified. Findings regarding the impact of food insecurity on breastfeeding behaviors were mixed, but generally food insecurity was not associated with poor breastfeeding outcomes in adjusted models. Conclusion Inconsistencies in definitions and measures of food security limit definitive conclusions. There is a need for standardizing definitions and measures of food insecurity, as well as a heightened awareness and policy change to alleviate experiences of food insecurity.
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Affiliation(s)
- Veronica C. Pasha
- Department of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Lauren Gerchow
- Department of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Audrey Lyndon
- Department of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Maya Clark-Cutaia
- Department of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Fay Wright
- Department of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
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Smith LM, Harrison TM. Neurodevelopment in the Congenital Heart Disease Population as Framed by the Life Course Health Development Framework. J Cardiovasc Nurs 2024; 39:160-169. [PMID: 36752754 PMCID: PMC10406968 DOI: 10.1097/jcn.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Adverse neurodevelopment is a common comorbidity associated with congenital heart disease (CHD). The consequences of adverse neurodevelopment are seen across the life course. The cause of adverse neurodevelopment is multifactorial, and use of a life course perspective can assist with understanding and enhancing neurodevelopment in individuals with CHD. PURPOSE The purposes of this article are to (1) apply the Life Course Health Development framework to neurodevelopment in the population with CHD and (2) discuss how exposure to the pediatric cardiac intensive care unit (PCICU) environment during infancy is a point of intervention for improving neurodevelopmental outcomes. CONCLUSION Individuals with CHD are at an increased risk for adverse neurodevelopment across the life course. The PCICU environment is a point of intervention for improving neurodevelopmental outcomes. Stress can lead to changes in brain structure and function that are associated with negative outcomes in terms of outward behavioral and functional capacity, and the PCICU environment is a source of stressful stimuli. Infancy is a period of rapid brain growth, and the brain is more susceptible to stress during this period of the life course, putting infants receiving care in the PCICU at an increased risk of adverse neurodevelopment. CLINICAL IMPLICATIONS Interventions to support optimal neurodevelopment should focus on the PCICU environment during infancy. Developmentally supportive care models should be explored as a means of modifying the PCICU environment. In addition, more research is needed on the relationship between the PCICU and neurodevelopment. The conceptual model introduced can serve as a starting point for this research.
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Brochier A, Torres A, Tyrrell H, Paz KB, Wexler MG, Griffith M, Joiner T, Magardino A, Messmer E, Rogers S, Scheindlin B, Serwint JR, Sharif I, Shone LP, Stockwell MS, Tripodis Y, Garg A, Drainoni ML. Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks. Contemp Clin Trials 2024; 138:107436. [PMID: 38199577 PMCID: PMC10922627 DOI: 10.1016/j.cct.2024.107436] [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: 06/28/2023] [Revised: 12/06/2023] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Growing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices. METHODS We recruited eighteen pediatric practices in fourteen US states through two pediatric practice-based research networks. For this stepped wedge cluster RCT, practices serve as their own controls during the Usual Care phase and implement WE CARE during the intervention phase via one of two randomized implementation strategies: self-directed, pre-recorded webinar vs. study team-facilitated, live webinar. We collect data at practice, clinician/staff, and parent levels to assess outcomes grounded in the Proctor Conceptual Model of Implementation Research. We use generalized mixed effects models and differences in proportions to compare rates of resource referrals by implementation strategy, and intention-to-treat analysis to compare odds of engagement with new resources among families enrolled in the Usual Care vs. WE CARE phases. DISCUSSION Findings from this trial may inform decisions about broader dissemination of SDOH screening systems into a diverse spectrum of pediatric practices across the US and potentially minimize the impact of adverse SDOH on children and families.
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Affiliation(s)
- Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Alessandra Torres
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States of America.
| | - Hollyce Tyrrell
- Academic Pediatric Association, McLean, VA, United States of America
| | - Katherine Barahona Paz
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, Worcester, MA, United States of America
| | | | - Miranda Griffith
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States of America
| | - Terence Joiner
- Division of General Pediatrics, Department of Pediatrics, University of Michigan Medical School, and Ypsilanti Health Center, Ypsilanti, MI, United States of America
| | - Angela Magardino
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Emily Messmer
- Quality and Patient Experience, Mass General Brigham, Somerville, MA, United States of America
| | - Stephen Rogers
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Janet R Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Iman Sharif
- Harlem Hospital Center, New York, NY, United States of America; Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Laura P Shone
- Shone Sciences, DBA, Lowville, NY, United States of America
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Department of Population and Family Health, Mailman School of Public Health Columbia University, New York, NY, United States of America
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, Worcester, MA, United States of America; UMass Memorial Children's Medical Center, Worcester, MA, United States of America
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, United States of America; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States of America
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Chan SL, Ho CZH, Khaing NEE, Ho E, Pong C, Guan JS, Chua C, Li Z, Lim T, Lam SSW, Low LL, How CH. Frameworks for measuring population health: A scoping review. PLoS One 2024; 19:e0278434. [PMID: 38349894 PMCID: PMC10863900 DOI: 10.1371/journal.pone.0278434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/03/2023] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Many regions in the world are using the population health approach and require a means to measure the health of their population of interest. Population health frameworks provide a theoretical grounding for conceptualization of population health and therefore a logical basis for selection of indicators. The aim of this scoping review was to provide an overview and summary of the characteristics of existing population health frameworks that have been used to conceptualize the measurement of population health. METHODS We used the Population, Concept and Context (PCC) framework to define eligibility criteria of frameworks. We were interested in frameworks applicable for general populations, that contained components of measurement of health with or without its antecedents and applied at the population level or used a population health approach. Eligible reports of eligible frameworks should include at least domains and subdomains, purpose, or indicators. We searched 5 databases (Pubmed, EMBASE, Web of Science, NYAM Grey Literature Report, and OpenGrey), governmental and organizational sites on Google and websites of selected organizations using keywords from the PCC framework. Characteristics of the frameworks were summarized descriptively and narratively. RESULTS Fifty-seven frameworks were included. The majority originated from the US (46%), Europe (23%) and Canada (19%). Apart from 1 framework developed for rural populations and 2 for indigenous populations, the rest were for general urban populations. The numbers of domains, subdomains and indicators were highly variable. Health status and social determinants of health were the most common domains across all frameworks. Different frameworks had different priorities and therefore focus on different domains. CONCLUSION Key domains common across frameworks other than health status were social determinants of health, health behaviours and healthcare system performance. The results in this review serve as a useful resource for governments and healthcare organizations for informing their population health measurement efforts.
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Affiliation(s)
- Sze Ling Chan
- Health Services Research Centre, SingHealth, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Clement Zhong Hao Ho
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Nang Ei Ei Khaing
- Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Ezra Ho
- Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Candelyn Pong
- Health Services Research Centre, SingHealth, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jia Sheng Guan
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Calida Chua
- Care and Health Integration, Changi General Hospital, Singapore, Singapore
| | - Zongbin Li
- Preventive Medicine Residency, National University Health System, Singapore, Singapore
| | - Trudi Lim
- School of Computing and Information Systems, Singapore Management University, Singapore, Singapore
| | - Sean Shao Wei Lam
- Health Services Research Centre, SingHealth, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | - Choon How How
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- SingHealth Office of Regional Health, Changi General Hospital, Singapore, Singapore
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Morgan K, Wagg A, Purssell E, Kilburn A. Evaluation of a virtual practice placement: A model to increase student capacity. Nurse Educ Pract 2024; 75:103884. [PMID: 38245940 DOI: 10.1016/j.nepr.2024.103884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
AIM To describe the development and evaluation of a novel virtual practice placement. BACKGROUND Health systems around the world face the challenge of recruiting and retaining sufficient nursing staff to provide high quality care. The need to train more nurses makes it hard to provide sufficient and varied high quality student placements to all students. This paper reports the result of one approach to the provision of a novel virtual placement for pre-registration student nurses. DESIGN Online virtual placement evaluated by a questionnaire conducted after the placement. METHODS A total of 195 students attended the virtual practice placement between 10th October 2022 and the 10th March 2023. The survey consisted of eight questions, of which one invited a qualitative response. RESULTS A total of 188 students completed the questionnaire and provided feedback. Of these 84 were adult nursing students, 67 child, 36 mental health and one learning disability student. The virtual placement required considerable resources to run, however was deemed as valuable by most students. When asked to rate the overall experience out of 5, the median scores were consistently high: adult (Mdn=5), child (Mdn=4), learning disability (Mdn=5) and mental health (Mdn=5) and mean values consistently high across fields: adult (M=4.73), child (M=5), learning disability (M=5) and mental health (M=4.67). Qualitatively, there were four main themes that emerged from the questionnaire responses: increased understanding of community healthcare and holistic approaches to care; developing interpersonal skills; a positive impact on their future career opportunities and the value of realistic case studies. CONCLUSIONS Virtual placements are a viable addition to traditional placements. However, they require careful planning and considerable resources including experienced and dedicated facilitators. Principles for the delivery of virtual placements were produced to replicate and share best practice.
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Affiliation(s)
- Kate Morgan
- HCRG Care Group, The Health, Business and Technical Part, Runcorn, Cheshire WA7 4QX, UK
| | - Amanda Wagg
- Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK
| | - Edward Purssell
- Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex CM1 1SQ, UK.
| | - Alison Kilburn
- HCRG Care Group, The Health, Business and Technical Part, Runcorn, Cheshire WA7 4QX, UK
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Smith LH, Nist MD, Fortney CA, Warren B, Harrison T, Gillespie S, Herbell K, Militello L, Anderson CM, Tucker S, Ford J, Chang MW, Sayre C, Pickler R. Using the life course health development model to address pediatric mental health disparities. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12452. [PMID: 38368550 DOI: 10.1111/jcap.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 02/19/2024]
Abstract
TOPIC Early-life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long-term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. PURPOSE The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. SOURCES Peer-reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. CONCLUSIONS The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children.
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Affiliation(s)
- Laureen H Smith
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Marliese D Nist
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Christine A Fortney
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Barbara Warren
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Tondi Harrison
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Shannon Gillespie
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Kayla Herbell
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Lisa Militello
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Cindy M Anderson
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Sharon Tucker
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Jodi Ford
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Mei-Wei Chang
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Christine Sayre
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
| | - Rita Pickler
- College of Nursing, Martha S. Pitzer Center for Women Children and Youth, The Ohio State University, Columbus, Ohio, USA
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Litt JS, Halfon N, Msall ME, Russ SA, Hintz SR. Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2024; 11:146. [PMID: 38397258 PMCID: PMC10886801 DOI: 10.3390/children11020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Children born prematurely (<37 weeks' gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, and the profound stressors to families affect well-being during infancy, childhood, adolescence, and beyond. Specialized clinical programs provide medical and developmental follow-up care for preterm infants after hospital discharge. High-risk infant follow-up, like most post-discharge health services, has many shortcomings, including unclear goals, inadequate support for infants, parents, and families, fragmented service provisions, poor coordination among providers, and an artificially foreshortened time horizon. There are well-documented inequities in care access and delivery. We propose applying a life course health development framework to clinical follow-up for children born prematurely that is contextually appropriate, developmentally responsive, and equitably deployed. The concepts of health development, unfolding, complexity, timing, plasticity, thriving, and harmony can be mapped to key components of follow-up care delivery to address pressing health challenges. This new approach envisions a more effective version of clinical follow-up to support the best possible functional outcomes and the opportunity for every premature infant to thrive within their family and community environments over their life course.
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Affiliation(s)
- Jonathan S. Litt
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Social and Behavioral Pediatrics, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA
| | - Michael E. Msall
- Department of Pediatrics, Sections of Developmental and Behavioral Pediatrics and Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Shirley Ann Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA;
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25
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Oh J, Thomas MMC. The mediating role of neighborhood social cohesion and trust in the relationship between childhood material hardship and adolescent depression. Health Place 2024; 85:103162. [PMID: 38157741 DOI: 10.1016/j.healthplace.2023.103162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The purpose of this study is to examine the association between childhood material hardship and adolescent depression and how the relationship is mediated by neighborhood social cohesion and trust. Previous studies on childhood material hardship and adolescent depression have consistently pointed to the importance of social and environmental contexts in explaining health inequalities among children in socially disadvantaged families. However, little is known about the extent to which neighborhood social context contributes to increasing or decreasing the strength of the association between childhood material hardship and adolescent depression. METHOD Using data from the Future of Families and Child Wellbeing Study (FFCWS) waves 3 and 6, this study conducted Structural Equation Modeling (SEM) analysis to examine whether levels of neighborhood social cohesion and trust mediates the association between childhood material hardship and adolescent depression. The study sample consisted of 2,096 children at age 3 and 15. RESULTS Findings from the SEM analysis suggest that childhood material hardship is linked with higher levels of adolescent depression and this pathway is partially mediated by neighborhood social cohesion and trust. DISCUSSION Results suggest that neighborhood conditions played a role in mediating the association between childhood material hardship and adolescent depression. The implications of the findings are discussed in relation to policy and practice.
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Affiliation(s)
- Jihyun Oh
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, 90095, United States.
| | - Margaret M C Thomas
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, 60637, United States.
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26
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Perrigo JL, Block EP, Aguilar E, Beck C, Halfon N. Income is not an equalizer: health development inequities by ethnoracial backgrounds in California kindergartners. BMC Public Health 2023; 23:2474. [PMID: 38082324 PMCID: PMC10714585 DOI: 10.1186/s12889-023-17246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Early childhood health development is positively associated with income, but the strength of this relationship with ethnoracial background remains unclear. This study examined the extent of health development inequities among California kindergarteners based on ethnoracial backgrounds and neighborhood-level income. METHODS This cross-sectional study assessed health development inequities by analyzing neighborhood-level income, ethnoracial background, and health development data for California kindergarteners. Student-level data (n = 106,574) were collected through teacher report between 2010-2020 across 52 school districts and 964 schools. Student addresses were geocoded and linked to American Community Survey neighborhood income levels. Health development was measured using the Early Development Instrument, a population-level measure which includes physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge domains. Outcomes included being "on-track" in each domain as well as overall health development. RESULTS Using a Generalized Estimation Equation with a log-link function, while accounting for interactions between ethnoracial background, income, and income-squared, we found significant health development inequities by ethnoracial background and neighborhood-level income. Regarding overall health development, as well as the physical, social and emotional domains, Black students had a lower likelihood of being on-track compared to the weighted average across income levels, whereas Asian students surpassed the weighted average. White students exhibited the steepest slope, and at the lowest income levels, their health development scores were akin to their Black and Hispanic/Latino/a low-income counterparts but resembled their Asian counterparts at higher income levels. For the general knowledge and communication domain, white students consistently had the highest likelihood of being on-track, while Hispanic/Latino/a students had the lowest likelihood across all income levels. CONCLUSION This study examines health development inequities among California kindergarteners in diverse communities. Our analysis shows that the relationship between neighborhood-level income and kindergartners' health development varies by domain and is weaker for students of color. Given the scarcity of population-level data on health development outcomes, these analyses offer valuable insights for identifying ecosystems necessitating support in promoting equitable early childhood health development.
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Affiliation(s)
- Judith L Perrigo
- Department of Social Welfare, University of California, Los Angeles (UCLA), Luskin School of Public Affairs, 337 Charles E Young Dr E, Los Angeles, CA, 90095, USA.
| | - E Piper Block
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, Los Angeles, USA
| | - Efren Aguilar
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, Los Angeles, USA
| | - Chandler Beck
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, Los Angeles, USA
| | - Neal Halfon
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, Los Angeles, USA
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Kerr JA, Gillespie AN, O'Connor M, Deane C, Borschmann R, Dashti SG, Spry EA, Heerde JA, Möller H, Ivers R, Boden JM, Scott JG, Bucks RS, Glauert R, Kinner SA, Olsson CA, Patton GC. Intervention targets for reducing mortality between mid-adolescence and mid-adulthood: a protocol for a machine-learning facilitated systematic umbrella review. BMJ Open 2023; 13:e068733. [PMID: 37890970 PMCID: PMC10619087 DOI: 10.1136/bmjopen-2022-068733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION A rise in premature mortality-defined here as death during the most productive years of life, between adolescence and middle adulthood (15-60 years)-is contributing to stalling life expectancy in high-income countries. Causes of mortality vary, but often include substance misuse, suicide, unintentional injury and non-communicable disease. The development of evidence-informed policy frameworks to guide new approaches to prevention require knowledge of early targets for intervention, and interactions between higher level drivers. Here, we aim to: (1) identify systematic reviews with or without meta-analyses focused on intervention targets for premature mortality (in which intervention targets are causes of mortality that can, at least hypothetically, be modified to reduce risk); (2) evaluate the review quality and risk of bias; (3) compare and evaluate each review's, and their relevant primary studies, findings to identify existing evidence gaps. METHODS AND ANALYSIS In May 2023, we searched electronic databases (MEDLINE, PubMed, Embase, Cochrane Library) for peer-reviewed papers published in the English language in the 12 years from 2012 to 2023 that examined intervention targets for mortality. Screening will narrow these papers to focus on systematic reviews with or without meta-analyses, and their primary papers. Our outcome is death between ages 15 and 60 years; with potential intervention targets measured prior to death. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) will be used to assess quality and risk of bias within included systematic reviews. Results will be synthesised narratively due to anticipated heterogeneity between reviews and between primary studies contained within included reviews. ETHICS AND DISSEMINATION This review will synthesise findings from published systematic reviews and meta-analyses, and their primary reviewed studies, meaning ethics committee approval is not required. Our findings will inform cross-cohort consortium development, be published in a peer-reviewed journal, and be presented at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42022355861.
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Affiliation(s)
- Jessica A Kerr
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Alanna N Gillespie
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Meredith O'Connor
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, Victoria, Australia
| | - Camille Deane
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Health Equity, Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - S Ghazaleh Dashti
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Elizabeth A Spry
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Jessica A Heerde
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Social Work, The University of Melbourne, Parkville, Victoria, Australia
| | - Holger Möller
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph M Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - James G Scott
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Child and Youth Mental Health Service, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Romola S Bucks
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
- The Raine Study, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Rebecca Glauert
- The Raine Study, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Health Equity, Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
| | - Craig A Olsson
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Quiñones AR, McAvay G, Vander Wyk B, Han L, Nagel C, Allore HG. A Joint Model for Disability, Self-Rated Health, and Mortality Among Medicare Beneficiaries-Differences by Chronic Disease and Race/Ethnicity. J Aging Health 2023:8982643231210027. [PMID: 37879084 DOI: 10.1177/08982643231210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Quantifying interdependence in multiple patient-centered outcomes is important for understanding health declines among older adults. METHODS Medicare-linked National Health and Aging Trends Study data (2011-2015) were used to estimate a joint longitudinal logistic regression model of disability in activities of daily living (ADL), fair/poor self-rated health (SRH), and mortality. We calculated personalized concurrent risk (PCR) and typical concurrent risk (TCR) using regression coefficients. RESULTS For fair/poor SRH, highest odds were associated with COPD. For mortality, highest odds were associated with dementia, hip fracture, and kidney disease. Dementia and hip fracture were associated with highest odds of ADL disability. Hispanic respondents had highest odds of ADL disability. Hispanic and NH Black respondents had higher odds of fair/poor SRH, ADL disability, and mortality. PCRs/TCRs demonstrated wide variability for respondents with similar sociodemographic-multimorbidity profiles. DISCUSSION These findings highlight the variability of personalized risk in examining interdependent outcomes among older adults.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - Gail McAvay
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Brent Vander Wyk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ling Han
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Corey Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale University, New Haven, CT, USA
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van Meijeren-van Lunteren A, You Y, Raat H, Wolvius E, Kragt L. Caries Preventive Interventions and Oral Health Inequalities: A Scoping Review. JDR Clin Trans Res 2023; 8:311-325. [PMID: 35912710 PMCID: PMC10504820 DOI: 10.1177/23800844221109116] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Dental caries remains one of the most prevalent but preventable diseases among children worldwide and especially affects children with a lower socioeconomic status or ethnic minority background. It is important that all groups of children are reached by preventive interventions to reduce oral health inequalities. So far, it is unknown whether children from different social and ethnic groups benefit equally from potentially effective oral health interventions. OBJECTIVES This scoping review aimed to identify European public health interventions that report their effect on dental caries across different social groups. METHODS Four databases were searched for studies evaluating the effect of oral health interventions on dental caries among children from 0 to 12 y, and studies were included when results were presented by children of different social groups separately. RESULTS A total of 14 studies were included, representing 4 different countries: 3 randomized and 11 nonrandomized studies. Most studies were performed at schools. Six studies showed results indicative of a reduction in oral health inequalities, 4 studies showed results that potentially widen oral health inequalities, and 5 studies showed results that were indicative of no impact on oral health inequalities. Interventions that contain early approaches, with a high frequency, approaching multiple levels of influence, and including at least the broader organizational or public policy level, may have the potential to reduce oral health inequalities among children from birth to young adolescence. CONCLUSION We recommend researchers to perform high-quality intervention studies and to evaluate the effectiveness of oral health intervention always in different socioeconomic or ethnic groups separately, to better understand their contribution toward oral health (in)equalities. KNOWLEDGE TRANSFER STATEMENT This review offers insight in the differential effects that oral health interventions might have across different social groups. Its results can be used to develop interventions that might reduce oral health inequalities among children. Also, we recommend future researchers to always evaluate the effects of any preventive oral health measure in different social groups separately.
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Affiliation(s)
- A.W. van Meijeren-van Lunteren
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
| | - Y. You
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
- Department of Public Health, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
| | - H. Raat
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
- Department of Public Health, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
| | - E.B. Wolvius
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
| | - L. Kragt
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, CA Rotterdam, the Netherlands
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Schlegel EC, Pickler RH, Tate JA, Alexander KA, Williams KP, Smith LH. 'Taking Care': A qualitative study of emerging adult-aged women's sexual and reproductive health definitions. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100877. [PMID: 37399761 PMCID: PMC10530474 DOI: 10.1016/j.srhc.2023.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/01/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Emerging adult-aged (EA;18-25 years) women have disproportionately high rates of unintended pregnancy and sexually transmitted infections compared to other women of reproductive age. Little is known about how EA women define and prioritize various aspects of sexual and reproductive health. The purpose of this study was to identify EA women determined definitions of sexual and reproductive health. METHODS Between September 2019 and September 2020, 13 women were interviewed about their sexual and reproductive health. Interview transcripts were used to conduct qualitative content analysis. RESULTS Definitions provided by participants were grouped according to three distinct thematic categories, Being Safe, Healthcare as a Tool, and Mind-Body Connection. Being Safe included using condoms and taking steps to prevent sexually transmitted infections. Healthcare as a Tool referred to utilization of healthcare services (e.g., an annual exam) to manage sexual and reproductive health. Mind-Body Connection included acknowledgement of both the physical and mental aspects of sexual and reproductive health, as well as awareness of physical and emotional discomfort related to it. These categories highlight EA women's holistic definitions of sexual and reproductive health. CONCLUSIONS Healthcare providers and researchers can use the holistic sexual and reproductive health definitions endorsed by EA women in this study as a starting point for creating and delivering sexual and reproductive healthcare and counseling that is developmentally appropriate and sensitive to population-specific needs.
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Affiliation(s)
- Emma C Schlegel
- Center for Nursing Research, Scholarship and Innovation, College of Nursing, Michigan State University, East Lansing, MI, USA; Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA.
| | - Rita H Pickler
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Judith A Tate
- Center for Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Laureen H Smith
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
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Hotez E, Hudson S. Expanding on "Screening, Diagnosis, and Intervention for Autism: Experiences of Black and Multiracial Families Seeking Care" to Support BIPOC Autistic Postsecondary Students. J Autism Dev Disord 2023; 53:3717-3721. [PMID: 37178427 DOI: 10.1007/s10803-023-06001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Emily Hotez
- Department of General Internal Medicine / Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, 911 Broxton Ave, Los Angeles, CA, 90095, USA.
| | - Shanice Hudson
- Hood Medicine Initiative, Inc, Indianapolis, IN, 46205, P.O. Box 55458, USA
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Thyden NH, Slaughter-Acey J, Widome R, Warren JR, Osypuk TL. Family deaths in the early life course and their association with later educational attainment in a longitudinal cohort study. Soc Sci Med 2023; 333:116161. [PMID: 37595424 PMCID: PMC10529887 DOI: 10.1016/j.socscimed.2023.116161] [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: 12/22/2022] [Revised: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
Due to structural racism and pathways between racism and health, Black and Native American people die at younger ages than white people. This means that those groups are likely to experience deaths of family members at younger ages. Evidence is mixed about whether family deaths affect educational attainment. We aim to 1) estimate the prevalence of family deaths by age and race 2) estimate the effect of a family death on later educational attainment and 3) analyze whether the effect of a family death varies by age, socioeconomic status, gender, and race. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is a nationally representative sample of U.S. adolescents in grades 7-12 at baseline in 1994-1995. Add Health has a large and racially diverse sample and records family deaths across the entire life course starting from birth. Participants were included in this analysis if they reported their educational attainment in Wave IV (N = 14,796). The racial group with the lowest proportion experiencing a sibling or parent death in the first 23 years of their lives was white participants (11.7%), followed by Asian (12.5%), Hispanic (15.0%), Black (24.3%) and Native American participants (30.3%). In adjusted models, those who experienced a family death had 0.60 times the odds (95% CI 0.51-0.71) of achieving a bachelor's degree compared to those without a family death. Mother deaths, father deaths, and sibling deaths were each harmful for obtaining a college degree and their effects were similar in magnitude. The age range when the effect of a family death was strongest was 10-13 years old (OR = 0.52 95% CI 0.40-0.67). The effect of a family death on college degree attainment did not vary by baseline parent education, participant sex, or race/ethnicity.
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Affiliation(s)
- Naomi Harada Thyden
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States; University of Minnesota, Minnesota Population Center, United States; University of Illinois Chicago, School of Public Health, Community Health Sciences, United States.
| | - Jaime Slaughter-Acey
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States
| | - Rachel Widome
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States
| | - John Robert Warren
- University of Minnesota, Minnesota Population Center, United States; University of Minnesota, Department of Sociology, United States
| | - Theresa L Osypuk
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States; University of Minnesota, Minnesota Population Center, United States
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Tenkorang EY. Physical, sexual, and psychosocial health impacts of child abuse: Evidence from Ghana. ADVANCES IN LIFE COURSE RESEARCH 2023; 57:100559. [PMID: 38054860 DOI: 10.1016/j.alcr.2023.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 12/07/2023]
Abstract
Child abuse is a significant global health problem. While data on child abuse in Ghana are scant, anecdotal evidence suggests the vast majority of Ghanaian children have experienced some form of physical or sexual abuse. This paper explores links between early childhood abuse and health outcomes using a life course perspective. Nationally representative cross-sectional data were collected from a sample of 2289 ever-married Ghanaian women in 2017. Women provided retrospective accounts of different types of violence in early childhood. Random-effects logit models were used to examine the impact of two dimensions of early childhood abuse (physical and sexual) on the physical, sexual, and psychosocial health outcomes of women in later years. Women who experienced childhood physical abuse, but not often, were significantly more likely to report physical disabilities in later years than women who did not experience it. Women reporting childhood sexual abuse were more likely to be depressed in later years than those who never experienced such abuse. They were also significantly more likely to report sexually transmitted diseases. Our findings provide support for the life course theory by showing abuse experienced in childhood could have a long-term impact. We therefore suggest the need for early interventions to address child abuse.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, NL A1C 5S7, Canada.
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Stone T, Trepal D, Lafreniere D, Sadler RC. Built and social indices for hazards in Children's environments. Health Place 2023; 83:103074. [PMID: 37482035 DOI: 10.1016/j.healthplace.2023.103074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023]
Abstract
Leveraging the capabilities of the Historical Spatial Data Infrastructure (HSDI) and composite indices we explore the importance of children's built and social environments on health. We apply contemporary GIS methods to a set of 2000 historical school records contextualized within an existing HSDI to establish seven variables measuring the relative quality of each child's built and social environments. We then combined these variables to create a composite index that assesses acute (short-term) health risks generated by their environments. Our results show that higher acute index values significantly correlated with higher presence of disease in the home. Further, higher income significantly correlated with lower acute index values, indicating that the relative quality of children's environments in our study area were constrained by familial wealth. This work demonstrates the importance of analyzing multiple activity spaces when assessing built and social environments, as well as the importance of spatial microdata.
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Affiliation(s)
- Timothy Stone
- Social Sciences Department, Michigan Technological University, USA.
| | - Dan Trepal
- Social Sciences Department, Michigan Technological University, USA
| | - Don Lafreniere
- Social Sciences Department, Michigan Technological University, USA
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Holmen IC, Waibel S, Kaarboe O. Emerging integrated care models for children and youth with mental health difficulties in Norway: a horizon scanning study. BMC Health Serv Res 2023; 23:860. [PMID: 37580679 PMCID: PMC10426212 DOI: 10.1186/s12913-023-09858-x] [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: 08/31/2022] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The implementation of Integrated Care Models (ICMs) represents a strategy for addressing the increasing issues of system fragmentation and improving service customization according to user needs. Available ICMs have been developed for adult populations, and less is known about ICMs specifically designed for children and youth. The study objective was to summarize and assess emerging ICMs for mental health services targeting children and youth in Norway. METHODS A horizon scanning study was conducted in the field of child and youth mental health. The study encompassed two key components: (i) the identification of ICMs through a review of both scientific and grey literature, as well as input from key informants, and (ii) the evaluation of selected ICMs using semi-structured interviews with key informants. The aim of the interviews was to identify factors that either promote or hinder the successful implementation or scale up of these ICMs. RESULTS Fourteen ICMs were chosen for analysis. These models encompassed a range of treatment philosophies, spanning from self-care and community care to specialized care. Several models placed emphasis on the referral process, prioritizing low-threshold access, and incorporating other sectors such as housing and child welfare. Four of the selected models included family or parents in their target group and five models extended their services to children and youth beyond the legal age of majority. Nine experts in the field willingly participated in the interview phase of the study. Identified challenges and facilitating factors associated with implementation or scale up of ICMs were related to the Norwegian healthcare system, mental health care delivery, as well as child and youth specific factors. CONCLUSION Care delivery targeting children and youth's mental health requires further adaptation to accommodate the intricate nature of their lives. ICMs have been identified as a means to address this complexity by offering accessible services and adopting a holistic approach. This study highlights a selection of promising ICMs that appear capable of meeting some of the specific needs of children and youth. However, it is recommended to subject these models to further assessment and refinement to ensure their effectiveness and the fulfilment of their intended outcomes.
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Affiliation(s)
| | - Sina Waibel
- Faculty of Medicine, University of British Columbia, 317 – 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Oddvar Kaarboe
- Department of Economics and IGS, University of Bergen, Bergen, Norway
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Cheng TL, Mistry KB. Clarity on Disparity: Who, What, When, Where, Why, and How. Pediatr Clin North Am 2023; 70:639-650. [PMID: 37422305 DOI: 10.1016/j.pcl.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
This article offers a framework of who, what, when, where, why, and how of health disparities that can serve as a systematic approach to move from description to understanding causes and taking action to ensure health equity.
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Affiliation(s)
- Tina L Cheng
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue. MLC 3016, Cincinnati, OH, USA.
| | - Kamila B Mistry
- US Department of Health and Human Services, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Room 06N03, Rockville, MD, USA; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Huang CX, Halfon N, Sastry N, Chung PJ, Schickedanz A. Positive Childhood Experiences and Adult Health Outcomes. Pediatrics 2023; 152:e2022060951. [PMID: 37337829 PMCID: PMC10312234 DOI: 10.1542/peds.2022-060951] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) can drive poor adult mental and physical health, but the impact of early life protective factors should not be overlooked. Positive childhood experiences (PCEs) measures quantify protective factors, but evidence is lacking on their link to health conditions independent of ACEs in nationally representative studies. This study examines associations between composite PCE score and adult health, adjusting for ACEs. METHODS The most recent 2017 wave of the Panel Study of Income Dynamics, a nationally representative study and its 2014 Childhood Retrospective Circumstances supplement (n = 7496) collected adult health outcomes, PCEs, and ACEs. Multivariable logistic regression assessed associations between PCE score and adult self-rated health or condition diagnosis, with and without ACEs adjustment. Cox proportional hazards models examined relationships between PCEs, ACEs, and annual risk of diagnosis. RESULTS Adults with 5 to 6 PCEs had 75% (95% confidence interval [CI], 0.58-0.93) of the risk of fair/poor overall health and 74% of the risk of any psychiatric diagnosis (CI, 0.59-0.89) compared with those with 0 to 2 PCEs, independent of ACEs. In survival analysis models accounting for PCEs and ACEs, reporting 5 to 6 PCEs was associated with a 16% lower annual hazard of developing any adult psychiatric or physical condition (hazard ratio, 0.84; CI, 0.75-0.94); reporting 3+ ACEs was associated with a 42% higher annual hazard (CI, 1.27-1.59). CONCLUSIONS PCEs were independently associated with lower risks of fair or poor adult health, adult mental health problems, and developing any physical or mental health condition at any given age after adjusting for ACEs.
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Affiliation(s)
- Cher X. Huang
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Neal Halfon
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles,California
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Narayan Sastry
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Paul J. Chung
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles,California
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles,California
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Krasnova A, Tom SE, Valeri L, Crane PK, Bennett DA. Direct Effect of Life-Course Socioeconomic Status on Late-Life Cognition and Cognitive Decline in the Rush Memory and Aging Project. Am J Epidemiol 2023; 192:882-894. [PMID: 36757185 PMCID: PMC10505419 DOI: 10.1093/aje/kwad033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/29/2022] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
The role of socioeconomic status (SES) across the life course in late-life cognition is unclear. We tested the hypotheses that: 1) High SES in childhood, young adulthood, midlife, and late life have independent causal effects on higher cognition level and slower cognitive decline; 2) Compared with stable low SES (referent), stable high SES has the largest estimated effect for higher cognition level and slower decline among life-course SES combinations. The Rush Memory and Aging Project enrolled 1,940 dementia-free older adults in northeastern Illinois (1997-2018). We used inverse probability-weighted marginal structural models to estimate the joint and independent effect of each life-course SES on global and domain-specific cognition. A total of 1,746 participants had, on average, 6 years of follow-up. High SES at each life-course stage starting in young adulthood had a protective estimated effect on global and domain-specific cognition intercepts. Compared with consistently low SES, consistently high SES (β = 0.64, 95% confidence interval: 0.48, 0.93) and high SES beyond childhood (β = 0.64, 95% confidence interval: 0.47, 0.83) had the largest benefit for global cognition intercepts. None of the life-course SES measures influenced rate of global or domain-specific decline. Additional understanding of life-course SES components influencing cognitive level is warranted.
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Affiliation(s)
- Anna Krasnova
- Correspondence to Anna Krasnova, Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 (e-mail: )
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Hotez E, Russ S, Halfon N. Introduction: Using the LCHD framework to understand and improve health outcomes for marginalized populations and promote equity from the start Part II. Curr Probl Pediatr Adolesc Health Care 2023; 53:101439. [PMID: 37923623 DOI: 10.1016/j.cppeds.2023.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Emily Hotez
- David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, University of California, Los Angeles (UCLA), 911 Broxton Ave, Los Angeles, CA 90095, United States; David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, University of California, Los Angeles (UCLA), 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States.
| | - Shirley Russ
- David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, University of California, Los Angeles (UCLA), 911 Broxton Ave, Los Angeles, CA 90095, United States; David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, University of California, Los Angeles (UCLA), 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Neal Halfon
- David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, University of California, Los Angeles (UCLA), 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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ANDERSON NATHANIELW, HALFON NEAL, EISENBERG DANIEL, MARKOWITZ ANNAJ, MOORE KRISTINANDERSON, ZIMMERMAN FREDERICKJ. Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring. Milbank Q 2023; 101:259-286. [PMID: 37052602 PMCID: PMC10262392 DOI: 10.1111/1468-0009.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 04/14/2023] Open
Abstract
Policy Points Social indicators of young peoples' conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being. There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators. Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people's lives.
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Affiliation(s)
| | - NEAL HALFON
- University of California Los Angeles Jonathan and Karin Fielding School of Public
- University of California Los Angeles David Geffen School of Medicine
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs
| | - DANIEL EISENBERG
- University of California Los Angeles Jonathan and Karin Fielding School of Public
| | - ANNA J. MARKOWITZ
- University of CaliforniaLos Angeles Graduate School of Education and Information Studies
| | | | - FREDERICK J. ZIMMERMAN
- University of California Los Angeles Jonathan and Karin Fielding School of Public
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs
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Liu PY, Spiker S, Holguin M, Schickedanz A. Innovations in social health delivery to advance equitable pediatric and adolescent life course health development: A review and roadmap forward. Curr Probl Pediatr Adolesc Health Care 2023; 53:101451. [PMID: 37957084 PMCID: PMC10802152 DOI: 10.1016/j.cppeds.2023.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Recognizing the influence of social determinants on health and development, health care has increasingly advocated for interventions that target upstream factors as part of routine pediatric care delivery. In response, clinic-based social risk screening and referral programs have proliferated wherein patients are screened for health-related social needs (HRSNs, such as food and housing insecurity) and referred to community-based organizations (CBOs) and social service providers to address those needs. In recent years, an array of digital platforms, known as Social Health Access and Referral Platforms (SHARPs), have emerged to facilitate the scale and implementation of these models amidst growing system demand. Recent evidence on the effectiveness of social risk screen and refer models and SHARPs has been mixed, giving researchers pause and calling for more nuanced understanding of the limitations of such models, especially for promoting child and family health. Design thinking informed by the Life-Course Health Development (LCHD) framework provides a particularly useful lens for synthesizing emerging limitations of such models in the pediatric context, given the dynamic and developmentally-driven circumstances that shape family health and well-being in the early life course. By (1) focusing on addressing deficits-based social risks, (2) scoping to act upon narrow, downstream needs, (3) timing to react to social needs that have already caused harm rather than preventing them, and (4) limiting scale to individual-by-individual responses rather than structural and population-wide interventions, the current design of prevailing social risk screen and refer programs fundamentally limits their potential impact and misses opportunities to improve health equity over the life course. How can health care, social care, and technology partners move forward in collaboration with families and communities to better support equitable lifelong health and social development? In this narrative review, we will summarize the current design, implementation, and limitations of the predominant social risk screen and refer approach in the context of early childhood and adolescent care delivery. We then will apply LCHD principles to advance and improve on this approach from a reactionary focus towards a Family Journey Model that better supports life course health development.
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Affiliation(s)
- Patrick Y Liu
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California, United States.
| | - Steve Spiker
- One Degree, Inc., 360 Grand Ave, Unit 190, Oakland, California, United States
| | - Monique Holguin
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, United States
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Lesnick J, Abrams LS, Angel K, Barnert ES. Credible messenger mentoring to promote the health of youth involved in the juvenile legal system: A narrative review. Curr Probl Pediatr Adolesc Health Care 2023; 53:101435. [PMID: 37914551 PMCID: PMC10823586 DOI: 10.1016/j.cppeds.2023.101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This narrative review examines the literature on credible messenger mentoring (CMM) as an intervention to promote the health and well-being of youth involved in the juvenile legal system. In the CMM model, individuals with shared life experiences (e.g., from the same neighborhoods or marginalized communities, with former gang or incarceration history) serve as mentors, leveraging their own history of transformation to engage youth involved in the juvenile legal system and promote individual and community change. CMM is an increasingly popular approach for working with youth involved in the juvenile legal system, yet the state of the research on this intervention is unclear. This article provides a narrative review of existing research on CMM to understand what is known, and unknown, about the intervention. Results find an emerging, but incomplete body of evidence supporting the impact of CMM for youth involved in the juvenile legal system, and for adult mentors. Qualitative and observational findings provide stronger support for the model, while quantitative findings provide more mixed evidence, indicating that CMM may be a promising life course health intervention, yet needs more empirical study. Findings from this review underscore the value of integrating community-informed evidence in the evaluation of health interventions. Future research can inform contemporary interest in the CMM approach and guide implementation and measurement standards for optimizing intervention delivery with youth involved in the juvenile legal system.
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Affiliation(s)
- Julia Lesnick
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, California, US.
| | - Laura S Abrams
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, California, US
| | - Kassandra Angel
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, California, US
| | - Elizabeth S Barnert
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, US
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Guerrero N, Yu X, Raphael J, O'Connor T. Racial Discrimination in Late Adolescence and Mental Health Outcomes Among Participants in the Panel Study of Income Dynamics. J Adolesc Health 2023:S1054-139X(23)00124-6. [PMID: 37140520 DOI: 10.1016/j.jadohealth.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To assess whether racial discrimination experienced at ages 18-21 years is associated with psychological distress and well-being, and investigate potential moderators of this relationship. METHODS We used panel data collected from 2005 to 2017 from 661 participants in the Transition into Adulthood Supplement of the Panel Study of Income Dynamics. The Everyday Discrimination Scale measured racial discrimination. The Kessler six and Mental Health Continuum Short Form assessed psychological distress and well-being, respectively. Generalized linear mixed modeling was used to model outcomes and test potential moderating variables. RESULTS Approximately 25% of participants experienced high levels of racial discrimination. In analyses of panel data, these participants had significantly worse psychological distress (odds ratio = 6.04, 95% confidence interval: 3.41, 8.67) and lower levels of emotional well-being (odds ratio = 4.61, 95% confidence interval: 1.87, 7.36) compared to those who did not. Race and ethnicity moderated the relationship. DISCUSSION Exposure to racial discrimination in late adolescence was associated with worse mental health outcomes. This study has important implications for interventions addressing the need for mental health support that is critical for adolescents who experience racial discrimination.
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Affiliation(s)
- Natalie Guerrero
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Xian Yu
- Center for Innovation in Quality, Effectiveness and Safety (IQuESt), Houston, Texas
| | - Jean Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Teresia O'Connor
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care 2023; 53:101433. [PMID: 37867057 DOI: 10.1016/j.cppeds.2023.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.
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Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States.
| | - Julianna Rava
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Allysa Ware
- Family Voices, 110 Hartwell Avenue, Lexington, MA, 02421, United States
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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Hotez E, Russ S, Halfon N. Introduction: Using the LCHD framework to understand and improve health outcomes for marginalized populations and promote equity from the start part I. Curr Probl Pediatr Adolesc Health Care 2023; 53:101437. [PMID: 37891033 DOI: 10.1016/j.cppeds.2023.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, USA; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, USA
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, USA; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
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Adams RS, Akobirshoev I, Brenner LA, Katon JG, Mitra M. Pregnancy, Fetal, and Neonatal Outcomes Among Women With Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E167-E176. [PMID: 36731040 PMCID: PMC10102258 DOI: 10.1097/htr.0000000000000807] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There have been no systematic studies of pregnancy outcomes among women with traumatic brain injury (TBI), potentially limiting informed clinical care for women with such injuries. The purpose of this exploratory study was to evaluate pregnancy and fetal/neonatal outcomes among women with a TBI diagnosis recorded during their delivery hospitalization compared with women without TBI. SETTING In this cross-sectional study, we identified women with delivery hospitalizations using 2004-2014 data from the Nationwide Inpatient Sample of the Health Care and Cost Utilization Project. PARTICIPANTS We identified deliveries to women with a TBI diagnosis on hospital discharge records, which included all diagnoses recorded during the delivery, and compared them with deliveries of women without a TBI diagnosis. MAIN MEASURES Pregnancy outcomes included gestational diabetes; preeclampsia/eclampsia; placental abruption; cesarean delivery; and others. Fetal/neonatal outcomes included preterm birth; stillbirth; and small or large gestational age. DESIGN We modeled risk for each outcome among deliveries to women with TBI compared with women without TBI, using multivariate Poisson regression. Models included sociodemographic and hospital characteristics; secondary models added clinical characteristics (eg, psychiatric disorders) that may be influenced by TBI. RESULTS We identified 3 597 deliveries to women with a TBI diagnosis and 9 106 312 deliveries to women without TBI. Women with TBI were at an increased risk for placental abruption (relative risk [RR] = 2.73; 95% CI, 2.26-3.30) and associated sequelae (ie, antepartum hemorrhage, cesarean delivery). Women with TBI were at an increased risk for stillbirth (RR = 2.55; 95% CI, 1.97-3.29) and having a baby large for gestational age (RR = 1.30; 95% CI, 1.09-1.56). Findings persisted after controlling for clinical characteristics. CONCLUSIONS Risk for adverse pregnancy outcomes, including placental abruption and stillbirth, were increased among women with TBI. Future research is needed to examine the association between TBI and pregnancy outcomes using longitudinal and prospective data and to investigate potential mechanisms that may heighten risk for adverse outcomes.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Lisa A. Brenner
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jodie G. Katon
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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Zhang YH, Chen XL, Wang YR, Hou YW, Zhang YD, Wang KJ. Prevention of malignant digestive system tumors should focus on the control of chronic inflammation. World J Gastrointest Oncol 2023; 15:389-404. [PMID: 37009320 PMCID: PMC10052658 DOI: 10.4251/wjgo.v15.i3.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 03/14/2023] Open
Abstract
Chronic inflammation, through a variety of mechanisms, plays a key role in the occurrence and development of digestive system malignant tumors (DSMTs). In this study, we feature and provide a comprehensive understanding of DSMT prevention strategies based on preventing or controlling chronic inflammation. The development and evaluation of cancer prevention strategies is a longstanding process. Cancer prevention, especially in the early stage of life, should be emphasized throughout the whole life course. Issues such as the time interval for colon cancer screening, the development of direct-acting antiviral drugs for liver cancer, and the Helicobacter pylori vaccine all need to be explored in long-term, large-scale experiments in the future.
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Affiliation(s)
- Yue-Hua Zhang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
- Henan International Joint Laboratory of Prevention and Treatment of Pediatric Diseases, Henan Children's Hospital Zhengzhou Children’s Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China
| | - Xiao-Lin Chen
- Department of Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yi-Ran Wang
- Henan International Joint Laboratory of Prevention and Treatment of Pediatric Diseases, Henan Children's Hospital Zhengzhou Children’s Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China
| | - Yu-Wei Hou
- Henan International Joint Laboratory of Prevention and Treatment of Pediatric Diseases, Henan Children's Hospital Zhengzhou Children’s Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China
| | - Yao-Dong Zhang
- Henan International Joint Laboratory of Prevention and Treatment of Pediatric Diseases, Henan Children's Hospital Zhengzhou Children’s Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China
| | - Kai-Juan Wang
- Henan International Joint Laboratory of Prevention and Treatment of Pediatric Diseases, Henan Children's Hospital Zhengzhou Children’s Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China
- Henan Children’s Hospital Zhengzhou Children’s Hospital, Children’s Hospital Affiliated to Zhengzhou University, Key Laboratory of Tumor Epidemiology of Henan Province, State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou 450001, Henan Province, China
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Sonik RA, Coleman-Jensen A, Creedon TB, Yang X. SNAP Participation and Emergency Department Use. Pediatrics 2023; 151:e2022058247. [PMID: 36710646 DOI: 10.1542/peds.2022-058247] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To examine whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with emergency department use among low-income children and whether any such association is mediated by household food hardship and child health status and/or moderated by special health care needs (SHCN) status. We hypothesized SNAP to be associated with reduced likelihoods of emergency department use, with greater effect sizes for children with SHCN and mediation by food hardship and health status. METHODS In this secondary analysis, we estimated a bivariate probit model (with state-level SNAP administrative policies as instruments) within a structural equation modeling framework using pooled cross-sectional samples of children in low-income households from the 2016 to 2019 iterations of the National Survey of Children's Health (n = 24 990). RESULTS Among children with and without SHCN, respectively, SNAP was associated with: 22.0 percentage points (pp) (95% confidence interval [CI] 12.2-31.8pp) and 17.1pp (95% CI 7.2-27.0pp) reductions in the likelihood of household food hardship exposure (4.8pp difference-in-differences, 95% CI 2.3-7.4pp), 9.7pp (95% CI 3.9-15.5pp) and 7.9pp (95% CI 2.2-13.6) increases in the likelihood of excellent health status (1.9pp difference-in-differences, 95% CI 0.7-3.0pp), and 7.7pp (95% CI 2.9-12.5pp) and 4.3pp (95% CI 1.0-7.6pp) reductions in the likelihood of emergency department use (3.4pp difference-in-differences, 95% CI 1.8-5.1pp). CONCLUSIONS We found SNAP participation was associated with lower likelihoods of emergency department use, that better food hardship and health statuses mediated this association, and that effect sizes were larger among children with SHCN. Food hardship relief may improve outcomes for vulnerable children and the health systems serving them.
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Affiliation(s)
- Rajan Anthony Sonik
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, California
| | - Alisha Coleman-Jensen
- Economic Research Service, United States Department of Agriculture, Washington, District of Columbia
| | - Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Xinyu Yang
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
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Lau MA, Temcheff CE, Poirier M, Commisso M, Déry M. Longitudinal relationships between conduct problems, depressive symptoms, and school dropout. J Sch Psychol 2023; 96:12-23. [PMID: 36641221 DOI: 10.1016/j.jsp.2022.10.005] [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: 11/14/2021] [Revised: 06/24/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
School dropout can be an ongoing process of academic failure and disengagement starting as early as elementary school. Given the multitude of factors involved and the importance of early identification of vulnerabilities, this study examined whether (a) initial levels of conduct problems and depressive symptoms predicted school dropout, (b) the rate of change in conduct problems and depressive symptoms predicted dropout, (c) the interaction between trajectories of conduct problems and depressive symptoms affected the likelihood of dropout, and (d) whether there were sex differences in these associations. Using a dataset of 364 children ages 6-9 (T1) years who had displayed conduct problems, mean trajectories of conduct problems and depressive symptoms over 6 years were drawn using parallel process latent growth curve modeling. Results showed that both the initial levels of and rate of change in conduct problems predicted dropout, whereas trajectories of depressive symptoms did not. The interaction between trajectories of conduct problems and depressive symptoms was non-significant and sex differences were not observed. These results suggest that, for boys and girls presenting early conduct problems, although a higher initial levels of conduct problems increases the risk of school dropout, a larger decrease in these problems over time may reduce this likelihood. Recognizing and treating conduct problems consistently may be crucial in reducing the risk of dropout in children with early-onset issues.
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Affiliation(s)
- Marianne A Lau
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal H3A 1Y2, Quebec, Canada.
| | - Caroline E Temcheff
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal H3A 1Y2, Quebec, Canada.
| | - Martine Poirier
- Department of Educational Science, Université du Québec à Rimouski, 300 allée des Ursulines, Rimouski G5L 3A1, Quebec, Canada.
| | - Melissa Commisso
- Department of Psychology, Concordia University, 7141 Sherbrooke West, PY-146, Montreal H4B 1R6, Quebec, Canada
| | - Michèle Déry
- Faculty of Education, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke J1K 2R1, Quebec, Canada.
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Carro N, Ibar C, D'Adamo P, Gonzalez D, Berg G, Fabre B, Lozada M. Hair cortisol reduction and social integration enhancement after a mindfulness-based intervention in children. Child Care Health Dev 2023; 49:73-79. [PMID: 35312189 DOI: 10.1111/cch.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Over recent decades, chronic stress at an early age has become a worrying health problem in children. We seek to evaluate an intervention involving mindfulness-based practices and prosocial activities in 7- to 8-year-old children. METHODS Stress levels were determined using hair cortisol concentration (HCC), and social integration was measured by means of a sociogram. The program had previously proven to be effective in decreasing salivary cortisol levels and in favouring social integration in children. A total of 35 children participated in the study: 18 constituted the intervention group and 17 the wait-list group. In both groups, HCC and social integration were evaluated before and after the intervention conducted throughout an entire school year. RESULTS The experimental group showed a significant reduction in HCC, as well as significant enhancement of social integration levels, whereas no changes were observed in the wait-list group. CONCLUSIONS This is the first research to show that HCC, a reliable neuroendocrine indicator, decreased as a result of a mindfulness-based program. This successful outcome adds new evidence to previous findings regarding the reduction of chronic stress in children following participation in this program.
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Affiliation(s)
- Natalia Carro
- INIBIOMA-CONICET, National University of Comahue, Neuquén, Argentina
| | - Carolina Ibar
- Faculty of Pharmacy and Biochemistry, Clinical Biochemistry Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Paola D'Adamo
- CyC IPEHCS-CONICET, National University of Comahue, Neuquén, Argentina
| | - Diego Gonzalez
- Faculty of Pharmacy and Biochemistry, Clinical Biochemistry Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriela Berg
- Faculty of Pharmacy and Biochemistry, Clinical Biochemistry Department, CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - Bibiana Fabre
- Faculty of Pharmacy and Biochemistry, INFIBIOC, Clinical Biochemistry Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Mariana Lozada
- INIBIOMA-CONICET, National University of Comahue, Neuquén, Argentina
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