The intergenerational effects of war on the health of children

Maternal Perceptions and Responsiveness to Cry in Armed Conflict Zones: Links to Child Behavior Problems

Crying is a typical infant behavior that activates parental caregiving behaviors, acting as "human alarms" important for the infant's survival. When living under war-related threat, the auditory system may be sensitized given its importance for survival, potentially impacting maternal cry processing. Children living in armed-conflict zones are at increased risk for behavior problems, which may relate to both direct exposure and indirect effects through their parents' perceptions and behaviors. This hypothesis was examined in a sample of mothers and their first-born children (aged 10-45 months) living in the Gaza vicinity area in Israel, chronically exposed to missile alarms (high-exposure; n = 45), and a comparison group (low-exposure; n = 86). Group differences in child behavior problems and maternal perceptions of and responsiveness to cry were investigated. A moderated indirect-effect of maternal cry perceptions on child behavior problems via maternal responsiveness to cry was examined. In the high-exposure group, children had more externalizing problems and mothers rated cries as more aversive. Maternal cry perception was indirectly related to child behavior problems via responsiveness to cry only in the high-exposure group: higher perceptions of cry as aversive or the child as distressed were related to faster responding to crying, and faster cry responsiveness was linked with fewer behavior problems. Results suggest that in armed-conflict zones with auditory warning signals, the parental caring system may be easily activated by cries due to the strong association between alarms and threat. Furthermore, children may need their mothers to react faster when feeling distressed, possibly because of the surrounding threat.

Social determinants of respiratory health from birth: still of concern in the 21st century?

Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.

The impact of armed conflicts on the nutritional status of children: Evidence from Northern Nigeria

Armed conflicts often significantly exacerbate the magnitude and severity of malnutrition by increasing food insecurity. Evidence shows that malnutrition is among the leading causes of morbidity and mortality among children during conflicts. This study examines the impact of the armed conflicts in Northern Nigeria on nutritional status of children under the age of five. Three waves (2008, 2013, and 2018) of individual-level birth records data from the Nigeria Demographic and Health Survey (NDHS) dataset are spatially merged with information on conflict events drawn from the Armed Conflict Location and Events Dataset. All fatal incidents in the study region during the 5-year intervals 2004-2008, 2009-2013 and 2014-2018 are aggregated and mapped to the 2008, 2013 and 2018 NDHS clusters, respectively. A cluster is classified to be exposed to conflict if located within 5-10 km radius of an incident with at least 1 fatality. We use matching analysis in a difference-in-differences approach to estimate the effects of the conflicts on stunting, wasting, and underweight. We find that the impact of conflict exposure differs by the dimension of child nutritional status. While it significantly lowers the risk of stunting, it has no discernible significant effect on the likelihood of wasting or being underweight among under-fives. Though nutritional support/interventions in the conflict-affected areas are crucial and must be prioritised, an all-inclusive strategy for a long-term resolution of the conflict is needed to engender development, improve food security, reduce vulnerability to malnutrition, and improve the health and wellbeing of the residents of the region.

Seasonal patterns of communicable disease incidence and antibiotic prescribing in Moria refugee camp, Greece

BACKGROUND

Infectious diseases remain a major risk for refugees living in camps. Limited research has been undertaken into the burden and impact of infections in the current refugee crisis around the Mediterranean.This analysis examines the frequency and incidence rates of common infections, and use of antibiotics at a healthcare facility inside Moria refugee camp on the island of Lesvos, Greece, during the winter and summer seasons of 2019.

METHODS

This is a retrospective analysis of routinely, prospectively collected service data from the main acute healthcare facility inside Moria camp.

RESULTS

Of a total of 9601 consultations, 25.16% were for infections (winter: 31.53%, summer: 19.45%). Respiratory, skin and gastrointestinal infections were the most frequent, with incidence rates up to 3.5 times, 50 times and twice as high as those in Western Europe, respectively. Antibiotic prescribing was high (27.7% of all respiratory infections) with high use of broad-spectrum antibiotics (40.2%), raising concerns about induction of antimicrobial resistance.

CONCLUSIONS

The burden of infectious diseases in refugee camps remains high throughout all seasons. Antimicrobial stewardship programmes should be adapted to refugee camp settings to prevent the development of unnecessary antimicrobial resistance. Improving living conditions and access to healthcare in refugee camps is likely to reduce infection rates and antimicrobial resistance among refugees.

Rumination about the Russo-Ukrainian War and its related factors among individuals in Poland and Ukraine

The present study aimed to investigate the factors associated with the level of rumination about the war among people living in Poland and Ukraine. This cross-sectional study recruited internet users from advertisements on social media. Levels of rumination, Depression, Anxiety and Stress Scale (DASS), Impact of Event Scale-Revised (IES-R), time spent on news of the war, and related demographic variables were collected. The reliability and construct validity of rumination were estimated. Potential factors associated with the level of rumination were identified using univariate linear regression analysis, and further entered into a stepwise multivariate linear regression model to identify independent factors. Due to the non-normality of distribution, multivariate linear regression with 5000 bootstrap samples was used to verify the results. A total of 1438 participants were included in the analysis, of whom 1053 lived in Poland and 385 lived in Ukraine. The questionnaires on rumination were verified to have satisfactory reliability and validity. After analysis with stepwise and bootstrap regression, older age, female gender, higher DASS and IES-R scores, and longer time spent on news of the war were significantly associated with higher levels of rumination for both people living in Poland and Ukraine. Lower self-rated health status, history of chronic medical illness and coronavirus disease 2019 infection were also positively associated with rumination for people living in Poland. We identified several factors associated with the level of rumination about the Russo-Ukrainian War. Further investigations are warranted to understand how rumination affects individuals' lives during crises such as war.

The impacts of the Syrian conflict on child and adolescent health: a scoping review

BACKGROUND

The Syrian conflict has had a profound impact on Syrian children and adolescents. We sought to determine the extent and range of literature on the conflict's health effects on this vulnerable population.

METHODS

A scoping review describing the impact of the Syrian conflict on children was undertaken while utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews methodology. Qualitative thematic analyses were undertaken to both identify patterns of morbidity and mortality and gaps in evidence.

RESULTS

A total of 982 articles meeting search criteria were identified between 1 January 2011 and 30 April 2021. After iterative screening, 12 were identified from academic databases and 4 were identified from grey literature and hand searching, yielding a total of 16 studies for final, full-text analysis. Four distinct themes recurred in the literature; these include children suffering from violent injury, a resurgence of communicable diseases, malnutrition and micronutrient deficiency and impacts on their mental health.

CONCLUSIONS

The health of children and adolescents in Syria has been significantly impacted by the indiscriminate attacks against civilians, flagrant human rights violations and the disintegration of the national health care system. Neonates were largely absent from the literature. The themes from this scoping review can inform health programming priorities by aid organizations.

The Long-Term Consequences of Early Life Exposure to Tsunami and Conflict on Adolescents in Sri Lanka

The consequences for adolescent health due to early life exposure to natural disasters combined with war are not known. We collected data from adolescents aged 12-13 years in Sri Lanka whose mothers were pregnant during the Indian Ocean tsunami in 2004 in a tsunami-affected region (n = 22), conflict-affected region (n = 35), conflict-plus-tsunami-affected region (n = 29), or controls in areas unaffected by either (n = 24). Adjusted body mass index (BMI)-for-age z-scores were 1.3, 1.0 and 2.0 for conflict, tsunami, and conflict-plus-tsunami, respectively, compared with the control group. Greater skinfold thickness and higher diastolic blood pressure were found in adolescents born in the conflict zone but no differences were found in height, head circumference, and waist circumference, or blood results, with the exception of serum insulin. Being born after a natural disaster or during conflict was associated with increased BMI and body fat during adolescent, which are associated with longer-term risk of noncommunicable disease.

Running Away from the War in Ukraine: The Impact on Mental Health of Internally Displaced Persons (IDPs) and Refugees in Transit in Poland

A growing body of research highlights how communities traumatized by conflict and displacement suffer from long-term mental and psychosocial illnesses. The Russian army's attack on Ukraine has resulted in an estimated 10 million people being internally or externally displaced from Ukraine, of whom more than 3.8 million have left Ukraine to seek refuge elsewhere in Europe. Soleterre has decided to launch an intervention to provide psychological support to Ukrainian refugees and IDPs, aimed at containing war trauma, assessing the severity of symptoms, and enabling those affected to receive psychological support. The intervention model envisioned the administration of an intake form to provide a rapid collection of qualitative and quantitative information for those arriving in Poland or Lviv from Ukraine. Our results showed how most of the samples reported high or very high levels of anxiety, depression, and sleep disturbances. Moreover, results highlighted how being close to families or being able to keep in touch with them work as a protective factor in enhancing resilience, as well as a support network. These findings underscored the importance of re-thinking our perception of "family" in a broader sense, considering the new facets it can take on in post-conflict situations.

Bioethical Implications of Vulnerability and Politics for Healthcare in Ethiopia and The Ways Forward

Vulnerability and politics are among the relevant and key topics of discussion in the Ethiopian healthcare context. Attempts by the formal bioethics structure in Ethiopia to deliberate on ethical issues relating to vulnerability and politics in healthcare have been limited, even though the informal analysis of bioethical issues has been present in traditional Ethiopian communities. This is reflected in religion, social values, and local moral underpinnings. Thus, the aim of this paper is to discuss the bioethical implications of vulnerability and politics for healthcare in Ethiopia and to suggest possible ways forward. First, we will briefly introduce what has been done to develop bioethics as a field in Ethiopia and what gaps remain concerning its implementation in healthcare practice. This will give a context for our second and main task - analyzing the healthcare challenges in relation to vulnerability and politics and discussing their bioethical implications. In doing so, and since these two concepts are intrinsically broad, we demarcate their scope by focusing on specific issues such as poverty, gender, health governance, and armed conflicts. Lastly, we provide suggestions for the ways forward.

A Whole-child, whole-family approach to health assessments for asylum-seeking children

In 2020, 21% of people who sought asylum in the UK were children. This population has complex interconnecting health and social needs. Assessment requires a holistic approach, with consideration of physical and mental health in addition to social and developmental well-being, within the whole family group. A trauma-informed life-cycle and intergenerational care approach is important. This article, aimed at all health professionals who may work with asylum-seeking families, outlines the best practice principles for undertaking health assessments in migrant children and young people.

Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

Self-efficacy and knowledge in pediatrics among family medicine physicians in Armenia: A survey study

Background

Armenia has trained physicians to practice family medicine (FM) for over 20 years. The pediatric population comprises a significant proportion of patients seen by FM practices, yet to date, there have been no studies assessing the knowledge and self-efficacy of FM physicians regarding pediatric care. As the first step is needs assessment to improve the quality of care, this study aims to assess the self-efficacy and knowledge of FM physicians regarding the care of pediatric patients.

Materials and Methods

We distributed a survey to attendees at an FM conference in Lori Province, Armenia. The survey instrument assessed demographics and experience, self-efficacy in providing pediatric care, and pediatric knowledge via questions adapted from the American Board of Family Medicine (ABFM).

Results

Eighty-seven percent of participants were female. Roughly half (45%) had trained through an FM residency program, while the remainder had retrained to become FM physicians following a residency in another field. Almost all (97%) practiced outside of the capital city, Yerevan. About half believed that their didactic (51%) and clinical education (48%) prepared them either "extremely" or "very" well. Overall, there was no clear relationship between participants' reported self-efficacy in a given area of pediatrics and their score in that area on the knowledge portion of the survey.

Conclusions

Our findings reveal opportunities for improvement in knowledge related to pediatric care in FM physicians in Armenia, as well as a lack of relationship between reported self-efficacy and knowledge. Thus, future programs should not rely solely on self-reported gaps to identify or prioritize areas of focus. Further study is recommended in other specialties in Armenia and internationally to improve future programs.

When COVID-19 Met Families Living in Armed-Conflict Zones: The Importance of Maternal Trauma and Child Self-Regulation

The COVID-19 outbreak began in Israel at the end of February 2020, and on March 17, 2020, a general lockdown was announced. Families were instructed to stay at home and schools and non-essential businesses were closed. Aiming to understand how families who were already living in areas of high exposure to armed conflict would be affected by another external stressful condition, data were collected before and after the outbreak. Mothers and children (aged 10-45 months) were recruited from areas with high (n = 40) and low (n = 78) exposure to armed conflict. Mothers reported on their posttraumatic stress symptoms (PTSS) and on their child's effortful control tendencies prior to the outbreak. Toward the end of the first lockdown, mothers were interviewed regarding adverse effects of the outbreak on their family. No group differences were found for maternal perceptions of adverse effects of COVID-19. However, a moderation model was revealed, indicating that maternal PTSS as well as child effortful control predicted adverse effects of COVID-19 only in the high-exposure group. Results are discussed considering cumulative stress and risk factors.

Trauma Exposure and Intimate Partner Violence Among Young Pregnant Women in Liberia

Intimate partner violence (IPV) is a global threat to women's health and may be elevated among those exposed to traumatic events in post-conflict settings, such as Liberia. The purpose of this study was to examine potential mediators between lifetime exposure to traumatic events (i.e., war-related trauma, community violence) with recent experiences of IPV among 183 young, pregnant women in Monrovia, Liberia. Hypothesized mediators included mental health (depression, posttraumatic stress symptoms), insecure attachment style (anxious and avoidant attachment), and attitudes indicative of norms of violence (attitudes justifying wife beating). We tested a parallel multiple mediation model using the PROCESS method with bias-corrected and accelerated bootstrapping to test confidence intervals (CI). Results show that 45% of the sample had experienced any physical, sexual, or emotional IPV in their lifetime, and 32% in the 2 months prior to the interview. Exposure to traumatic events was positively associated with recent IPV severity (β = .40, p < .01). Taken together, depression, anxious attachment style, and justification of wife beating significantly mediated the relationship between exposure to traumatic events and experience of IPV (β = .15, 95% CI = [0.03, 0.31]). Only anxious attachment style (β = .07, 95% CI = [0.03, 0.16]) and justification of wife beating (β = .05, 95% CI = [0.01, 0.16]) were identified as individual mediators. This study reinforces pregnancy as an important window for both violence and mental health screening and intervention for young Liberian women. Furthermore, it adds to our theoretical understanding of mechanisms in which long-term exposure to traumatic events may lead to elevated rates of IPV in Liberia, and points to the need for trauma-informed counseling and multilevel gender transformative public health approaches to address violence against women.

Delivering non-communicable disease interventions to women and children in conflict settings: a systematic review

Background

Non-communicable diseases (NCDs) are the leading cause of death worldwide. In the context of conflict settings, population displacement, disrupted treatment, infrastructure damage and other factors impose serious NCD intervention delivery challenges, but relatively little attention has been paid to addressing these challenges. Here we synthesise the available indexed and grey literature reporting on the delivery of NCD interventions to conflict-affected women and children in low- and middle-income countries (LMICs).

Methods

A systematic search in MEDLINE, Embase, CINAHL and PsycINFO databases for indexed articles published between 1 January 1990 and 31 March 2018 was conducted, and publications reporting on NCD intervention delivery to conflict-affected women or children in LMICs were included. A grey literature search of 10 major humanitarian organisation websites for publications dated between 1 January 2013 and 30 November 2018 was also conducted. We extracted and synthesised information on intervention delivery characteristics and delivery barriers and facilitators.

Results

Of 27 included publications, most reported on observational research studies, half reported on studies in the Middle East and North Africa region and 80% reported on interventions targeted to refugees. Screening and medication for cardiovascular disease and diabetes were the most commonly reported interventions, with most publications reporting facility-based delivery and very few reporting outreach or community approaches. Doctors were the most frequently reported delivery personnel. No publications reported on intervention coverage or on the effectiveness of interventions among women or children. Limited population access and logistical constraints were key delivery barriers reported, while innovative technology use, training of workforce and multidisciplinary care were reported to have facilitated NCD intervention delivery.

Conclusion

Large and persistent gaps in information and evidence make it difficult to recommend effective strategies for improving the reach of quality NCD care among conflict-affected women and children. More rigorous research and reporting on effective strategies for delivering NCD care in conflict contexts is urgently needed.

PROSPERO registration number

CRD42019125221

Exploring African Immigrant Women's Pre- and Post-Migration Exposures to Stress and Violence, Sources of Resilience, and Psychosocial Outcomes

This qualitative study seeks to identify pre- and post-migration stressors experienced by African women who had immigrated to the United States along with the vulnerability and resilience factors that exacerbate or mitigate the negative health effects of these experiences. Seventeen interviews and six focus groups were conducted with 39 African immigrant women. Participants reported encountering experiences of political instability and armed conflict pre-migration and intimate partner violence pre- and post-migration. Religious faith was an important source of resilience for women. Findings support the design of culturally appropriate interventions to improve the mental health of vulnerable African immigrant women.

A Latent Class Analysis of Gender Attitudes and Their Associations with Intimate Partner Violence and Mental Health in the Democratic Republic of Congo

Gender role attitudes, views held by individuals regarding the roles men and women should play in society, are a powerful social determinant of health. However, work remains in elucidating the associations between gender attitudes and intimate partner violence (IPV) perpetration or victimization and mental health problems. We used latent class analysis to classify patterns of responses on survey items on gender attitudes by male and female adults in households that participated in an economic empowerment intervention and evaluation in rural villages in the Democratic Republic of Congo. Attitudes about IPV and gender equality were two subdomains to emerge from analysis and a 3-class model solution was found to best fit response patterns. Results indicated that, as compared to the least gender equitable class, individuals in the moderately gender equitable and fully gender equitable classes had lower odds of having experienced or perpetrated psychological abuse. Individuals within the moderately gender equitable class were at lower odds of having experienced or perpetrated physical or sexual violence. Further, individuals in the moderately gender equitable and fully gender equitable classes had significantly lower mean scores on symptoms associated with PTSD than individuals in the least gender equitable class. Future research should explore the relationships between gender attitudes, partner violence and mental health to build resilient families.

The effects of armed conflict on the health of women and children

Women and children bear substantial morbidity and mortality as a result of armed conflicts. This Series paper focuses on the direct (due to violence) and indirect health effects of armed conflict on women and children (including adolescents) worldwide. We estimate that nearly 36 million children and 16 million women were displaced in 2017, on the basis of international databases of refugees and internally displaced populations. From geospatial analyses we estimate that the number of non-displaced women and children living dangerously close to armed conflict (within 50 km) increased from 185 million women and 250 million children in 2000, to 265 million women and 368 million children in 2017. Women's and children's mortality risk from non-violent causes increases substantially in response to nearby conflict, with more intense and more chronic conflicts leading to greater mortality increases. More than 10 million deaths in children younger than 5 years can be attributed to conflict between 1995 and 2015 globally. Women of reproductive ages living near high intensity conflicts have three times higher mortality than do women in peaceful settings. Current research provides fragmentary evidence about how armed conflict indirectly affects the survival chances of women and children through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health, but major systematic evidence is sparse, hampering the design and implementation of essential interventions for mitigating the harms of armed conflicts.

A century of sexual abuse victimisation: A birth cohort analysis

This study examined changes in the reported prevalence of adult and child sexual abuse over the last century and explored how changes in social and political circumstances may have affected rates. Data from two population-based face-to-face surveys conducted in New Zealand (samples of 2855 women in 2003 and 1464 women in 2019) were used to produce birth cohort prevalence estimates of three forms of sexual abuse including by an intimate partner (lifetime and 12-month), by non-partners, and child sexual abuse. A timeline of major population influences that might be associated with violence occurrence was developed. There were no changes in reported lifetime intimate partner sexual abuse prevalence estimates found over the past century. The most recent birth cohort reported the lowest rates of 12-month prevalence estimates for intimate partner sexual abuse, lifetime rates of non-partner sexual abuse, and also suggest lower reported rates of child sexual abuse. Macro-social events including feminist movements, changes in legislation, and an increase in public awareness might have contributed to women's awareness about the non-acceptability of violent behaviour, and their ability to leave relationships after violence has occurred. This may have contributed to the small recent decreases in reported 12-month rate of sexual IPV and CSA, as women's ability to leave relationships may be protective for their children. The recent decrease in reported non-partner sexual violence may also be attributed to women's greater awareness of, and agency to avoid sexual abuse. The lack of change for the lifetime prevalence of sexual IPV over the past century highlights the need for ongoing prevention efforts. While recent reductions in reported rates of child and adult sexual abuse are encouraging, even reduced rates are high and warrant sustained implementation of prevention policies and programs.

War-Related Mental Health Issues and Need for Yoga Intervention Studies: A Scoping Review

Conflicts and humanitarian crises lead to serious mental health disorders, including depression, anxiety, stress, and cognitive decline. Exposure to these circumstances in early life can lead to the development of disorders such as mild cognitive impairment, dementia, and Alzheimer's disease (AD), for which no treatments are available. In this review, various research papers have been compiled to develop an understanding about mental health of population affected due to wars and conflicts and how stress and depression can accelerate the development of dementia and AD. Due to failure of drugs in the treatment of dementia and AD, yoga and mindfulness-based approach has been proposed for future investigations. Although studies have shown that yoga and mindfulness can be helpful in the management of stress, anxiety, depression, and posttraumatic stress disorder in the war-afflicted areas, limited mechanistic studies in yoga and mindfulness remain the chief cause precluding its clinical application in such warzones. The molecular studies in the field of yoga can be undertaken by targeting these warzones. This review provides a scientific evaluation of mind-body techniques as a justification for mental health rehabilitation in the war-afflicted zones in face of failed clinical trials for various drugs. This may help reduce the risk of developing dementia and AD in this susceptible population.

The character of conflict: A bioarchaeological study of violence in the Nasca highlands of Peru during the Late Intermediate Period (950-1450 C.E.)

OBJECTIVES

This study uses osteological and radiocarbon datasets combined with formal quantitative analyses to test hypotheses concerning the character of conflict in the Nasca highlands during the Late Intermediate Period (LIP, 950-1450 C.E.). We develop and test osteological expectations regarding what patterns should be observed if violence was characterized by intragroup violence, ritual conflict, intermittent raiding, or internecine warfare.

MATERIALS AND METHODS

Crania (n = 267) were examined for antemortem and perimortem, overkill, and critical trauma. All age groups and both sexes are represented in the sample. One hundred twenty-four crania were AMS dated, allowing a detailed analysis of diachronic patterns in violence among various demographic groups.

RESULTS

Thirty-eight percent (102/267) of crania exhibit some form of cranial trauma, a significant increase from the preceding Middle Horizon era. There are distinct trauma frequencies within the three subphases of the LIP, but Phase III (1300-1450 C.E.) exhibits the highest frequencies of all trauma types. Males exhibit significantly more antemortem trauma than females, but both exhibit similar perimortem trauma rates.

DISCUSSION

There was chronic, internecine warfare throughout the Late Intermediate Period with important variations in violence throughout the three temporal phases. Evidence for heterogeneity in violent mortality shows a pattern consistent with social substitutability, whereby any and all members of the Nasca highland population were appropriate targets for lethal and sublethal violence. We argue that by testing hypotheses regarding the targets and types of conflict we are better able to explain the causes and consequences of human conflict.

Armed conflict and birth weight

This paper investigates the hidden yet persistent cost of conflict to birth weight outcomes for 53 developing countries experiencing conflict in the past three decades (1990-2018). Exploiting the variation across districts and conception months-years, we find that intrauterine exposure to armed conflict in the first trimester of pregnancy reduces child's weight at birth by 2.8% and raises the incidence of low birth weight by 3.2 percentage points. Infants born to poor and low educated mothers are especially vulnerable to the adverse repercussions of armed conflict. Given the long-lasting consequences of poor infant health over the life cycle, our findings call for global efforts in the prevention and mitigation of conflict. Extra attention should be directed to children and women from disadvantaged backgrounds.

The effect of local unemployment on health: A longitudinal study of Irish mothers 2001-2011

The relationship between economic conditions and health is mixed, with some evidence from the most recent financial crisis finding a positive effect of periods of unemployment on heath behaviours. This study uses longitudinal data spanning the periods before, during and after the Irish crisis of 2007, to test the impact of economic expansion and contraction on mothers physical and mental health and health behaviours. Three waves of data from the Irish Lifeways Cohort Study for the period 2001-2011, and local area employment rates from the Irish Census, are used to capture the impact of a period of increased unemployment on health before, during and after the Irish recession, independent of individual employment status. The results from fixed effect linear probability models demonstrate that an additional unit of local area unemployment increases the probability of reporting poor self-rated health by 1-1.8 percentage points and of reporting poor mental well-being by 1.4 and 2.7 percentage points depending on the instrument used. There are decreases in the probability of consuming cigarettes by 3.3 percentage points, self-describing as a regular smoker by 2.9 percentage points and obesity by 0.9 percentage points. The probability of engaging in at least 20 minutes of strenuous or moderate exercise per week declines by 7.8 and 8.7 percentage points respectively, while the probability of engaging in at least 20 minutes of mild exercise rises by 10 percentage points. These results are largely consistent with the US literature, which is predominantly based on working men, thus demonstrating the universal impact of economic vulnerability on health.

Essential newborn care practices and determinants amongst mothers of infants aged 0-6 months in refugee settlements, Adjumani district, west Nile, Uganda

BACKGROUND

Despite recent improvements in child survival, neonatal mortality remains high in most developing countries. Countries affected by humanitarian emergencies continue to report the highest neonatal mortality rates.

OBJECTIVE

To assess essential newborn care practices and its determinants amongst mothers of infants aged 0-6 months in refugee settlements in Adjumani district.

METHODS

A cross-sectional study was conducted among mothers of infants aged 0-6 months in refugee settlements, Adjumani district. A total of 561 mothers of infants were selected using systematic sampling technique from households. Data were collected using a semi-structured questionnaire. A composite outcome variable, Essential Newborn Care practices was created by merging different care practices (neonatal feeding, thermal care, and cord care). Multiple logistic regression analysis was used to determine predictors of Essential Newborn Care.

RESULTS AND CONCLUSIONS

Over half (57%) of the mothers breastfed their newborns within one hour. Half (50.1%) of mothers cleaned the umbilical cord of their newborns. Only 17% of the newborns received optimal thermal care immediately after birth. Mothers aged 20-24 years (OR 0.38, CI 0.17-0.96) and those involved in subsistence farming (OR 0.67, CI 0.38-1.45) were less likely to practice good newborn care compared to those in other occupations. Newborn care practices were sub-optimal in this refugee setting. To improve newborn care practices, there is need to educate mothers through community-based health interventions in order to promote delayed bathing, ideal infant feeding, thermal and umbilical cord care.

A Point in the Heart: Concepts of Emotional Distress Among Albanian-Speaking Immigrants in Switzerland

Cultural variability regarding concepts of distress for common mental disorders (CMD) has been reported extensively in cultural clinical psychology across the globe. However, little is known about illness narratives in social communities from Southeast Europe. The purpose of this paper is to identify cultural concepts of distress (CCDs) among Albanian-speaking immigrants in Switzerland and to integrate the findings into literature from other parts of the world. Twenty semi-structured qualitative interviews were conducted using the Barts Explanatory Model Inventory (BEMI). A set of concepts was described through content analysis and semantic network analysis. The results show complex expressions of distress, which are mainly associated with post-migration living difficulties. Social problems and life-changing events mark the onset of the most common symptoms. Self-management and social support were described as the most important coping behaviors. Participants expressed trust in physical health care but little belief in psychotherapy. There is indication that mental illnesses are stigmatized in this population. It is therefore important to use non-stigmatizing terms in health communication. Moreover, individuals from this community consider suffering to be part of life, and they assume that this suffering must be endured with patience. It is vital to address these beliefs in psychological interventions.

Prenatal Maternal Stress Causes Preterm Birth and Affects Neonatal Adaptive Immunity in Mice

Maternal stress is a well-established risk factor for preterm birth and has been associated with adverse neonatal outcomes in the first and subsequent generations, including increased susceptibility to disease and lasting immunological changes. However, a causal link between prenatal maternal stress and preterm birth, as well as compromised neonatal immunity, has yet to be established. To fill this gap in knowledge, we used a murine model of prenatal maternal stress across three generations and high-dimensional flow cytometry to evaluate neonatal adaptive immunity. We report that recurrent prenatal maternal stress induced preterm birth in the first and second filial generations and negatively impacted early neonatal growth. Strikingly, prenatal maternal stress induced a systematic reduction in T cells and B cells, the former including regulatory CD4+ T cells as well as IL-4- and IL-17A-producing T cells, in the second generation. Yet, neonatal adaptive immunity gained resilience against prenatal maternal stress by the third generation. We also show that the rate of prenatal maternal stress-induced preterm birth can be reduced upon cessation of stress, though neonatal growth impairments persisted. These findings provide evidence that prenatal maternal stress causes preterm birth and affects neonatal immunity across generations, adverse effects that can be ameliorated upon cessation.

The Embodiment of War: Growth, Development, and Armed Conflict

Armed conflict regularly presents extremely adverse circumstances not only for combatants, but also for civilians. In fact, estimates from various wars over the past 70 years suggest that noncombatants comprise the majority of casualties. For survivors, war's effects are often embodied, leaving long-term effects on health and biology. Some of these effects, such as injuries and psychological trauma, are well known. Yet other effects may be subtle and may be elucidated by a developmental biological perspective. In early life, when growth rates are highest, conditions of war may have their greatest impact. Depending on local circumstances, a developing embryo, infant, or child growing in a place embroiled in armed conflict is likely to face—directly or indirectly—various stressors, including malnutrition, infectious disease, and/or psychological stress. Thus, the conditions of war and forced displacement may become embodied, getting under the skin for fundamental biological reasons.

Constructing Invisible Walls through National and Global Policy

Worldwide 37,000 people are forced to flee their homes every day due to conflict and persecution. The factors that lead people to leave their home countries often originate with economic deprivation and violence, escalated to a level that becomes a struggle for survival. Climate change, as it has accelerated over the last three to four decades and negatively impacted natural resources, contributes to a parallel increase in strife and migration. The US response to migration has been to construct an “Invisible Wall” of isolationist and xenophobic policies, many of which are especially harmful to children and their families. The southern US border is perhaps the most high profile location of the Invisible Wall’s construction, fortified by federal policies and a withdrawal from international cooperation. Global reengagement on climate change and migration, US ratification of the Convention on the Rights of the Child, and destruction of the Invisible Wall will help to create a world where children can thrive.

Being born in the aftermath of World War II increases the risk for health deficit accumulation in older age: results from the KORA-Age study

Morbidity trends may result from cohort experiences in critical developmental age. Our objective was to compare the health status of 65-71 year-olds who were in critical developmental age before (1937-June 1945), during (June 1945-June 1948) and after (June 1948-1950) the early reconstruction and food crisis (ERFC) period in Germany following World War II. Data originate from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study in Southern Germany. We used the 2008 baseline sample born 1937-1943 and the 2015 enrichment sample born 1944-1950. Health status was assessed as the number of accumulated health deficits using a Frailty Index (FI). Cohorts were defined based on co-occurrence of critical developmental age (gestation and the first 2 years of life) and the ERFC period. Cohort, age and sex effects on older-age health status were analyzed using generalized linear models. We included 590 (53% male) pre-war and war (PWW), 475 (51% male) ERFC and 171 post-currency reform (PCR) cohort participants (46% male). Adjusted for covariates, FI levels were significantly higher for the ERFC (Ratio 1.14, CL [1.06, 1.23]) but not for the PCR (Ratio 1.06, CL [0.94, 1.20]) as compared to the PWW cohort. Being in critical developmental age during the ERFC period increased FI levels in adults aged 65-71 years. Covariates did not explain these effects, suggesting a direct detrimental effect from being in critical developmental age during the ERFC period on older-age health. This expansion of morbidity in Germany was not detected in the PCR cohort.

Prenatal war exposure and schizophrenia in adulthood: evidence from the Sino-Japanese War of 1937-1945

PURPOSE

This study aimed to examine the long-term effect of prenatal exposure to the Sino-Japanese War during 1937-1945 on risk of schizophrenia in adulthood among Chinese wartime survivors.

METHODS

We obtained data from the Second National Sample Survey on Disability conducted in 31 provinces in 2006. We restricted our analysis to 369,469 adults born between 1931 and 1950. Schizophrenia was ascertained by psychiatrists based on the International Statistical Classification of Diseases 10th Revision. War intensity was assessed by the ratio of war-caused civilian casualties to the pre-war population. The effect of prenatal exposure to war on schizophrenia was estimated by difference-in-difference models, established by examining the variation of war across birth cohorts.

RESULTS

In the male population, war cohorts of 1937-1946 had no significant higher odds of schizophrenia compared with the pre-war cohorts of 1931-1936. In the female population, war cohorts were 1.16 (95% CI 1.01, 1.33) times more likely than pre-war cohorts to have schizophrenia. Sensitive analyses show that our estimates of war effect on schizophrenia were robust and valid.

CONCLUSIONS

Prenatal exposure to the Sino-Japanese War of 1937-1945 had long-run detrimental effect on risk of schizophrenia in the female adults. Further investigations are warranted to extend the enduring wartime impact on other health outcomes in China.

Supporting community-based care and deinstitutionalisation of mental health services in Eastern Europe: good practices from Bosnia and Herzegovina

In Eastern Europe, the Swiss Agency for Development and Cooperation is supporting various post-communist states in reforming their mental health systems to ensure equal access to high-quality services in community-based settings. The approach and new care models introduced have proven successful in most of these countries, one of which is Bosnia and Herzegovina.

Peace in Guatemala and Immigrant Health in the United States

Background:

The civil war between the indigenous Mayans and other Guatemalans lasted for 36 years, killed civilians, decimated villages, and resulted in many refugees. The Guatemalan Peace Agreement of 1996 aimed to alleviate the ongoing conflict. Studies of peace agreements more typically evaluate local political outcomes while neglecting global health outcomes.

Objective:

Our research quantified associations between pre-migration exposure to the peace agreement in Guatemala and the post-migration health status of Guatemalan immigrants in the United States.

Methods:

We used chi-square tests to compare the distribution of health status before and after peace. We used ordered probit regressions to estimate associations between peace in Guatemala and health in the United States, conditional on the observed distributions of age, age squared, age cubed, and linear time trends before and after peace.

Findings:

The study sample included 4,115 female and 5,282 male Guatemalan immigrants between the ages of 15 and 85. The mean age was 38.8 years for females (standard deviation, 14.2) and 35.4 years for males (standard deviation, 12.6). Chi-square tests found statistically significant differences in the distribution of health status before and after the peace agreement, for females (P < .001) and males (P < .001). In unadjusted results, the peace agreement was associated with a 7.3 percentage point increase in excellent post-migration health for females (95% confidence interval, 4.9 to 9.8) and a 6.0 percentage point increase for males (95% confidence interval, 3.8 to 8.2). In adjusted results, we found that the peace agreement was associated with a 6.1 percentage point increase in excellent post-migration health for females (95% confidence interval, 0.8 to 11.4) and a 5.5-percentage point increase for males (95% confidence interval, 1.0 to 10.0).

Conclusions:

The peace agreement in Guatemala was associated with statistically significant improvements in the health status of Guatemalan immigrants to the United States.

Peace in Guatemala and Immigrant Health in the United States

BACKGROUND

The civil war between the indigenous Mayans and other Guatemalans lasted for 36 years, killed civilians, decimated villages, and resulted in many refugees. The Guatemalan Peace Agreement of 1996 aimed to alleviate the ongoing conflict. Studies of peace agreements more typically evaluate local political outcomes while neglecting global health outcomes.

OBJECTIVE

Our research quantified associations between pre-migration exposure to the peace agreement in Guatemala and the post-migration health status of Guatemalan immigrants in the United States.

METHODS

We used chi-square tests to compare the distribution of health status before and after peace. We used ordered probit regressions to estimate associations between peace in Guatemala and health in the United States, conditional on the observed distributions of age, age squared, age cubed, and linear time trends before and after peace.

FINDINGS

The study sample included 4,115 female and 5,282 male Guatemalan immigrants between the ages of 15 and 85. The mean age was 38.8 years for females (standard deviation, 14.2) and 35.4 years for males (standard deviation, 12.6). Chi-square tests found statistically significant differences in the distribution of health status before and after the peace agreement, for females (P &lt; .001) and males (P &lt; .001). In unadjusted results, the peace agreement was associated with a 7.3 percentage point increase in excellent post-migration health for females (95% confidence interval, 4.9 to 9.8) and a 6.0 percentage point increase for males (95% confidence interval, 3.8 to 8.2). In adjusted results, we found that the peace agreement was associated with a 6.1 percentage point increase in excellent post-migration health for females (95% confidence interval, 0.8 to 11.4) and a 5.5-percentage point increase for males (95% confidence interval, 1.0 to 10.0).

CONCLUSIONS

The peace agreement in Guatemala was associated with statistically significant improvements in the health status of Guatemalan immigrants to the United States.

Post-conflict household structures and underweight: a multilevel analysis of a community-based study in northern Uganda

OBJECTIVE

To examine associations between household-level characteristics and underweight in a post-conflict population.

DESIGN

Nutritional status of residents in the Gulu Health and Demographic Surveillance Site was obtained during a community-based cross-sectional study, ~6 years after the civil war. Household-level factors included headship, polygamy, household size, child-to-adult ratio, child crowding, living with a stunted or overweight person, deprived area, distance to health centre and socio-economic status. Multilevel logistic regression models examined associations of household and community factors with underweight, calculating OR, corresponding 95 % CI and intraclass correlation coefficients. Effect modification by gender and age was examined by interaction terms and stratified analyses.

SETTING

Rural post-conflict area in northern Uganda.

SUBJECTS

In total, 2799 households and 11 312 individuals were included, representing all age groups.

RESULTS

Living in a female-headed v. male-headed household was associated (OR; 95 % CI) with higher odds for underweight among adult men (2·18; 1·11, 4·27) and girls <5 years (1·51; 0·97, 2·34), but lower odds among adolescent women aged 13-19 years (0·46; 0·22, 0·97). Higher odds was seen for residents living in deprived areas (1·37; 0·97, 1·94), with increasing distance to health services (P-trend <0·05) and among adult men living alone v. living in an average-sized household of seven members (3·23; 1·22, 8·59). Residents living in polygamous households had lower odds for underweight (0·79; 0·65, 0·97).

CONCLUSIONS

The gender- and age-specific associations between household-level factors and underweight are likely to reflect local social capital structures. Adapting to these is crucial before implementing health and nutrition interventions.

Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study

OBJECTIVES

We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR).

METHODS

We estimated the prevalence of overweight and obesity among children (2-19 years) and adults (≥20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach.

RESULTS

The prevalence of obesity increased for adults from 15.1% (95% UI 13.4-16.9) in 1980 to 20.7% (95% UI 18.8-22.8) in 2015. It increased from 4.1% (95% UI 2.9-5.5) to 4.9% (95% UI 3.6-6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages.

CONCLUSIONS

This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden.

Association of the World War II Finnish Evacuation of Children With Psychiatric Hospitalization in the Next Generation

IMPORTANCE

Although there is evidence that adverse childhood experiences are associated with worse mental health in adulthood, scarce evidence is available regarding an emerging concern that the next generation might also be affected.

OBJECTIVE

To compare the risk of psychiatric hospitalization in cousins whose parents were vs were not exposed to the Finnish evacuation policy that involved a mean 2-year stay with a Swedish foster family.

DESIGN, SETTING, AND PARTICIPANTS

This multigenerational, population-based cohort study of Finnish individuals and their siblings born between January 1, 1933, and December 31, 1944, analyzed the association of evacuee status as a child during World War II in the first generation with the risk of psychiatric hospitalization among offspring in the second generation. Evacuee status during World War II was determined using the Finnish National Archive's registry of participants in the Finnish evacuation. Data on evacuee status were linked to the psychiatric diagnoses in the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012, for offspring (n = 93 391) born between January 1, 1950, and December 31, 2010. Sex-specific Cox proportional hazards regression models were used to estimate hazard ratios for risk of psychiatric hospitalization during the follow-up period. Because offspring of evacuees and their nonevacuated siblings are cousins, the Cox proportional hazards regression models included fixed effects to adjust for confounding factors in families. Data analysis was performed from June 15, 2016, to August 26, 2017.

EXPOSURES

Parental participation in the evacuation during World War II (coded 1 for parents who were evacuated and placed in foster care and 0 for those not evacuated).

MAIN OUTCOMES AND MEASURES

Offspring's initial admission to the hospital for a psychiatric disorder, obtained from the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012.

RESULTS

Of the 93 391 study persons, 45 955 (49.2%) were women and 47 436 (50.8) were men; mean (SD) age in 2012 among survivors was 45.4 (6.58) years. Female offspring of mothers evacuated to Sweden during childhood had an elevated risk of psychiatric hospitalization (hazard ratio for any type of psychiatric disorder: 2.04 [95% CI, 1.04-4.01]; hazard ratio for mood disorder: 4.68 [95% CI, 1.92-11.42]). There was no excess risk of being hospitalized for a psychiatric disorder among women whose fathers were exposed to the Finnish evacuation policy during World War II or among men whose mothers or fathers were exposed.

CONCLUSIONS AND RELEVANCE

In a prior follow-up study of the Finnish evacuees, girls evacuated to Swedish foster families during World War II were more likely to be hospitalized for a psychiatric disorder-in particular, a mood disorder-in adulthood than their nonevacuated sisters. The present study found that the offspring of these individuals were also at risk for mental health problems that required hospitalization and suggests that early-life adversities, including war-related exposures, may be associated with mental health disorders that persist across generations.

Changing views on child mortality and economic sanctions in Iraq: a history of lies, damned lies and statistics

In August 1990, Saddam Hussein's army invaded Kuwait and consequently the United Nations imposed economic sanctions on Iraq. In 1991, an international military alliance expelled the Iraqi army from Kuwait during a short war. Nevertheless, the economic sanctions remained in place-their removal required that Iraq should destroy its weapons of mass destruction. Subsequent years saw reports of acute suffering in Iraq. The sanctions undoubtedly greatly reduced the country's ability to import supplies of food and medicine. Particular concerns arose about the state of young children. These concerns crystalised in 1999 when, with cooperation from the Iraqi government, Unicef conducted a major demographic survey. The results of the survey indicated that the under-5 death rate in Iraq had increased hugely between 1990 and 1991 and had then continued at a very high level. The survey results were used both to challenge and support the case for the invasion of Iraq in 2003. And they were cited by Tony Blair in 2010 in his testimony to the Iraq Inquiry established by the British government. Indeed, the results of the 1999 Unicef/Government of Iraq survey are still cited. Since 2003, however, several more surveys dealing with child mortality have been undertaken. Their results show no sign of a huge and enduring rise in the under-5 death rate starting in 1991. It is therefore clear that Saddam Hussein's government successfully manipulated the 1999 survey in order to convey a very false impression-something that is surely deserving of greater recognition.

Examining the need & potential for biomedical engineering to strengthen health care delivery for displaced populations & victims of conflict

Conflict and the subsequent displacement of populations creates unique challenges in the delivery of quality health care to the affected population. Equitable access to quality care demands a multi-pronged strategy with a growing need, and role, for technological innovation to address these challenges. While there have been significant contributions towards alleviating the burden of conflict via data informatics and analytics, communication technology, and geographic information systems, little has been done within biomedical engineering. This article elaborates on the causes for gaps in biomedical innovation for refugee populations affected by conflict, tackles preconceived notions, takes stock of recent developments in promising technologies to address these challenges, and identifies tangible action items to create a stronger and sustainable pipeline for biomedical technological innovation to improve the health and well-being of an increasing group of vulnerable people around the world.

Heterogeneity in the long term health effects of warfare

This paper estimates the long-term heterogeneous legacies of exposures to war in utero and during early childhood on height in adulthood. Using a novel dataset on the regional WWII destruction in Germany, combined with the German Socio-Economic Panel (SOEP), we find that individuals who experienced warfare in utero and during childhood are an average of 2cm shorter as adults, suggesting that the negative scarring effect of WWII dominated the positive effect coming from a selection. Among war survivors, children from less privileged families who resided in highly destroyed regions, particularly girls, suffered the greatest health consequences of warfare. Our analyses also show that wartime children who lost their parents during the war years are an average of 1.3cm shorter as adults. However, the father's conscription during WWII had no long-term effect on adult height.

Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using Countdown indicators

Introduction

Women and children account for a disproportionate morbidity burden among conflict-affected populations, and yet they are not included in global accountability frameworks for women’s and children’s health. We use Countdown to 2015 (Millennium Development Goals) health indicators to provide an up-to-date review and analysis of the best available data on Syrian refugees in Jordan, Lebanon and Turkey and internally displaced within Syria and explore data challenges in this conflict setting.

Methods

We searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO Eastern Mediterranean Region Office and relevant development/humanitarian databases in all languages from January 2011 until December 2015. We met in person or emailed relevant key stakeholders in Lebanon, Jordan, Syria and Turkey to obtain any unpublished or missing data. We convened a meeting of experts working with these populations to discuss the results.

Results

The following trends were found based on available data for these populations as compared with preconflict Syria. Birth registration in Syria and in host neighbouring countries decreased and was very low in Lebanon. In Syria, the infant mortality rate and under-five mortality rate increased, and coverage of antenatal care (one visit with a skilled attendant), skilled birth attendance and vaccination (except for DTP3 vaccine) declined. The number of Syrian refugee women attending more than four antenatal care visits was low in Lebanon and in non-camp settings in Jordan. Few data were available on these indicators among the internally displaced. In conflict settings such as that of Syria, coverage rates of interventions are often unknown or difficult to ascertain because of measurement challenges in accessing conflict-affected populations or to the inability to determine relevant denominators in this dynamic setting.

Conclusion

Research, monitoring and evaluation in humanitarian settings could better inform public health interventions if findings were more widely shared, methodologies were more explicit and globally agreed definitions and indicators were used consistently.

Transgenerational effects of early environmental insults on aging and disease incidence

Adverse early life experiences are major influences on developmental trajectories with potentially life-long consequences. Prenatal or early postnatal exposure to stress, undernutrition or environmental toxicants may reprogram brain development and increase risk of behavioural and neurological disorders later in life. Not only experience within a single lifetime, but also ancestral experience affects health trajectories and chances of successful aging. The central mechanism in transgenerational programming of a disease may be the formation of epigenetic memory. This review explores transgenerational effects of early adverse experience on health and disease incidence in older age. First, we address mechanisms of developmental and transgenerational programming of disease and inheritance. Second, we discuss experimental and clinical findings linking early environmental determinants to adverse aging trajectories in association with possible parental contributions and sex-specific effects. Third, we outline the main mechanisms of age-related functional decline and suggest potential interventions to reverse negative effects of transgenerational programming. Thus, strategies that support healthy development and successful aging should take into account the potential influences of transgenerational inheritance.