ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ...ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England.
A nationally representative survey was undertaken (n = 3885, aged 18-69, April-July 2013). Socio-demographically controlled proportional hazards analyses examined the associations between the number of ACE categories (<18 years; e.g. child abuse and family dysfunction such as domestic violence) and cancer, diabetes, stroke, respiratory, liver/digestive and cardiovascular disease. Sibling (n = 6983) mortality was similarly analysed as a measure of premature mortality.
Of the total, 46.4% of respondents reported ≥1 and 8.3% ≥4 ACEs. Disease development was strongly associated with increased ACEs (e.g. hazard ratios, HR, 0 versus ≥4 ACEs; cancer, 2.38 (1.48-3.83); diabetes, 2.99 (1.90-4.72); stroke, 5.79 (2.43-13.80, all P < 0.001). Individuals with ≥4 ACEs (versus no ACEs) had a 2.76 times higher rate of developing any disease before age 70 years. Adjusted HR for mortality was strongly linked to ACEs (≥4 versus 0 ACEs; HR, 1.97 (1.39-2.79), P < 0.001).
Radically different life-course trajectories are associated with exposure to increased ACEs. Interventions to prevent ACEs are available but rarely implemented at scale. Treating the resulting health costs across the life course is unsustainable.
Educational and employment outcomes are critical elements in determining the life course of individuals, yet through health and other mechanisms, those who suffer adverse childhood experiences (ACEs) ...may experience barriers to achieve in these domains. This study examines the association between ACEs and poor educational outcomes, before considering the impact of ACEs and education on employment in adulthood.
Retrospective cross-sectional surveys were conducted in England and Wales using a random stratified sampling methodology.
During face-to-face household interviews (n = 2881), data were collected on demographic factors, ACEs, self-rated childhood affluence, the highest qualification level attained and the current employment status.
While respondents with ≥4 ACEs were significantly more likely to have no formal qualifications (adjusted odds ratio AOR = 2.18; P < 0.001), among those who did achieve secondary level qualifications, the presence of ACEs did not further impact subsequent likelihood of going on to attain college or higher qualifications. However, results suggest a persisting independent impact of high (≥4) ACEs, which were found to be significantly associated with both current unemployment (AOR = 2.52, P < 0.001) and long-term sickness and disability (AOR = 3.94, P < 0.001). Modelled levels of not being in employment ranged from as little as 3% among those with 0 or 1 ACE and higher qualifications to 62% among those with no qualifications and ≥4 ACEs (adjusted for age, gender and childhood affluence effects).
Compulsory education may play a pivotal role in mitigating the effects of adversity, supporting the case for approaches within schools that build resilience and tackle educational inequalities. However, adults with ACEs should not be overlooked and efforts should be considered to support them in achieving meaningful employment.
•Adverse childhood experiences (ACEs) more than double the risk of having no educational qualifications.•ACEs do not limit further attainment once initial educational hurdles are overcome.•Those with ACEs are at much greater risk of unemployment.•Two of the five adults with ≥4 ACEs and secondary qualifications were unemployed.
Fuel moisture content (FMC) is an important fuel property for assessing wildfire hazard, since it influences fuel flammability and fire behavior. The relationship between FMC and fire activity ...differs among land covers and seems to be a property of each ecosystem. Our objectives were to analyze pre-fire FMC among different land covers and to propose a wildfire hazard classification for the Sierras Chicas in the Chaco Serrano subregion (Argentina), by analyzing pre-fire FMC distributions observed for grasslands, shrublands and forests and using percentiles to establish thresholds. For this purpose, we used a fire database derived from Landsat imagery (30 m) and derived FMC maps every 8 days from 2002 to 2016 using MODIS reflectance products and empirical equations of FMC. Our results indicated that higher FMC constrains the extent of wildfires, whereas at lower FMC there are other factors affecting their size. Extreme and high fire hazard thresholds for grasslands were established at FMC of 55% and 67% respectively, at 72% and 105% for forests and at 106% and 121% for shrublands. Our FMC thresholds were sensitive to detect extreme fire hazard conditions during years with high fire activity in comparison to average conditions. The differences in the distributions of pre-fire FMC among land covers and between ecosystems highlighted the need to locally determine land cover-specific FMC thresholds to assess wildfire hazard. Our wildfire hazard classification applied to FMC maps in an operational framework will contribute to improving early warning systems in the Sierras Chicas. However, moisture alone is not sufficient to represent true fire hazard in Chaco forests and the combination with other variables would provide better hazard assessments. These operational wildfire hazard maps will help to better allocation of fire protective resources to minimize negative impact on people, property and ecosystems. To the best of our knowledge, this is the first study analyzing pre-fire FMC over several fire seasons in a non-Mediterranean ecosystem, aiming at assessing wildfire hazard.
A multiscale microstructured brittle damage model is used to describe the behavior of confined rock materials. Plane strain and triaxial tests conducted at the laboratory scale are simulated in terms ...of boundary value problems. Simulations reveal good predictive qualities of the model to describe the macroscopic features of specimens at failure. The microstructures, oriented in different directions, allow the localization of the macroscopic strain along straight lines, emerging at the macroscale in the form of shear bands. The microstructured material model, characterized by recursive equidistant parallel cohesive-frictional faults, is fully defined by six elastic and inelastic material constants. The model was originally developed in a finite kinematics framework to simulate the dynamic behavior of confined brittle materials (Pandolfi et al. in J Mech Phys Solids 54:1972–2003, 2006). In linearized form, it has been extended and used for the simulation of in-field excavations (De Bellis et al. in: Eng Geol 215:10–24, 2016). The performance of the model in predicting the behavior of small scale rock tests in the laboratory, the object of the present study, has never been investigated. Numerical simulations show that the model is able to capture several important features observed in rocks, in particular the reduction of the overall stiffness for increasing deterioration of the material, fragile to ductile transition, strain localization, shear band formation, and more general size-effect.
Objectif évaluer l’efficacité d’un suivi de diabétiques de type 2 en difficultés par des infirmières libérales formées et intervenant dans le cadre de 10 réseaux de santé diabète. Matériels et ...méthodes l’intervention a consisté en une réunion de concertation pluridisciplinaire (RCP) avec élaboration d’un Plan Personnalisé de Santé, puis un suivi par infirmier pendant un an. Les infirmiers assuraient 5 consultations par patient et pouvaient déclencher des séances d’éducation, adapter la posologie de certains traitements et proposer des modifications thérapeutiques. Ils ont reçu une formation initiale de 2 jours puis une formation continue dans le cadre des réseaux. Le critère de jugement principal était le taux d’hospitalisation avant et après l’intervention. Résultats 443 patients, soit 60 % de l’objectif initial, ont été inclus par 257 médecins (généralistes à 80 %) pour un ou plusieurs motifs : déséquilibre persistant du diabète malgré les recours habituels (74,5 %), hospitalisation pour diabète > 5 jours depuis 1 an (29,6 %), barrière au traitement (non observance 52,5 % différence culturelle 25,5 %, isolement 18 %, précarité 16 %, addiction à l’alcool 6 %). 73 patients ont été perdus de vue dés l’inclusion, et 248 patients ont bénéficié d’un suivi complet. Le taux d’hospitalisation conventionnelle ou de jour de ces 248 patients est passé de 48 % à 24 %, et le recours aux urgences de 24 % à 12 %. L’HbA1c moyenne a baissé de 8,7 % à 7,9 %., de façon plus importante lorsque l’HbA1c initiale était > 8 %. Au moins une adaptation du traitement hypoglycémiant a eu lieu pour 41 % des patients et une adaptation du traitement anti-hypertenseur pour 5 %. Conclusion malgré des difficultés d’inclusion et de suivi liées à la complexité des patients et aux réticences des médecins, l’appui au suivi médical habituel de diabétiques en difficultés par des infirmiers intervenant dans le cadre de réseaux réduit leur recours à l’hôpital et améliore leur contrôle glycémique.
Alcohol use disorders (defined as DSM-IV alcohol dependence or abuse) are prevalent and serious problems among adolescents. As adolescence is marked by progressive hippocampal development, this brain ...region may be particularly susceptible to the adverse effects of adolescent alcohol use disorders. This study compared the hippocampal volumes of adolescents and young adults with adolescent-onset alcohol use disorders to those of healthy matched comparison subjects.
Magnetic resonance imaging was used to measure the hippocampal volumes and volumes of comparison brain regions in 12 subjects with alcohol use disorders and 24 comparison subjects matched on age, sex, and handedness.
Both left and right hippocampal volumes were significantly smaller in subjects with alcohol use disorders than in comparison subjects. Total hippocampal volume correlated positively with the age at onset and negatively with the duration of the alcohol use disorder. Intracranial, cerebral, and cortical gray and white matter volumes and measures of the mid-sagittal area of the corpus callosum did not differ between groups.
In the mature brain, chronic alcohol use disorders are associated with graded global brain dysmorphology. Although the etiology, neuropsychological consequences, and permanence of these hippocampal findings need to be further examined, these findings suggest that, during adolescence, the hippocampus may be particularly susceptible to the adverse effects of alcohol.
Brain development during childhood and adolescence is characterized by both progressive myelination and regressive pruning processes. However, sex differences in brain maturation remain poorly ...understood. Magnetic resonance imaging was used to examine the relationships between age and sex with cerebral gray and white matter volumes and corpus callosal areas in 118 healthy children and adolescents (61 males and 57 females), aged 6–17 years. Gender groups were similar on measures of age, handedness, socioeconomic status and Full Scale IQ. Significant age-related reductions in cerebral gray and increases in white matter volumes and corpus callosal areas were evident, while intracranial and cerebral volumes did not change significantly. Significant sex by age interactions were seen for cerebral gray and white matter volumes and corpus callosal areas. Specifically, males had more prominent age-related gray matter decreases and white matter volume and corpus callosal area increases compared with females. While these data are from a cross-sectional sample and need to be replicated in a longitudinal study, the findings suggest that there are age-related sex differences in brain maturational processes. The study of age-related sex differences in cerebral pruning and myelination may aid in understanding the mechanism of several developmental neuropsychiatric disorders.
The study aimed to identify, appraise and update evidence on the association between cold temperatures (i.e. <18°C) within homes (i.e. dwellings) and health and well-being outcomes.
This study was a ...systematic review.
Seven databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, APA PsycInfo, Applied Social Sciences Index and Abstracts, Coronavirus Research Database) were searched for studies published between 2014 and 2022, which explored the association between cold indoor temperatures and health and well-being outcomes. Studies were limited to those conducted in temperate and colder climates due to the increased risk of morbidity and mortality during winter in those climatic zones. Studies were independently quality assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Of 1209 studies, 20 were included for review. Study outcomes included cardiovascular (blood pressure, electrocardiogram abnormalities, blood platelet count), respiratory (chronic obstructive pulmonary disease symptoms, respiratory viral infection), sleep, physical performance and general health. Seventeen studies found exposure to cold indoor temperatures was associated with negative effects on health outcomes studied. Older individuals and those with chronic health problems were found to be more vulnerable to negative health outcomes.
Evidence suggests that indoor temperatures <18°C are associated with negative health effects. However, the evidence is insufficient to allow clear conclusions regarding outcomes from specific temperature thresholds for different population groups. Significant gaps in the current evidence base are identified, including research on the impacts of cold indoor temperatures on mental health and well-being, studies involving young children, and the long-term health effects of cold indoor temperatures.
•The novel Serendipity Virtual Elements are exploited to solve nonlinear elasticity problems in 2D.•Second order polynomials are adopted for the projection part.•Different stabilization approaches ...are proposed and compared.•Numerical simulations reproducing classical benchmarks provide encouraging results.
In this paper, the novel concept of Serendipity Virtual Elements is extended to the case of compressible hyper-elastic materials in 2D. Second order polynomials are adopted for the projection involved in the consistency part, while different stabilization techniques are proposed and critically compared with each other. Various numerical examples, involving very severe loading conditions, indicate that the proposed elements are very accurate and robust with respect to distortion. Furthermore the proposed virtual elements are inherently able to capture higher order deformation modes, such as bending states.
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