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.
Background Studies suggest strong links between adverse childhood experiences (ACEs) and poor adult health and social outcomes. However, the use of such studies in non-US populations is relatively ...scarce. Methods Retrospective cross-sectional survey of 1500 residents and 67 substance users aged 18-70 years in a relatively deprived and ethnically diverse UK population. Results Increasing ACEs were strongly related to adverse behavioural, health and social outcomes. Compared with those with 0 ACEs, individuals with 4+ ACEs had adjusted odds ratios of the following: 3.96 95% confidence interval (CI): 2.74-5.73 for smoking; 3.72 (95% CI: 2.37-5.85) for heavy drinking; 8.83 (95% CI: 4.42-17.62) for incarceration and 3.02 (95% CI: 1.38-6.62) for morbid obesity. They also had greater risk of poor educational and employment outcomes; low mental wellbeing and life satisfaction; recent violence involvement; recent inpatient hospital care and chronic health conditions. Higher ACEs were also associated with having caused/been unintentionally pregnant aged <18 years and having been born to a mother aged <20 years. Conclusions ACEs contribute to poor life-course health and social outcomes in a UK population. That ACEs are linked to involvement in violence, early unplanned pregnancy, incarceration, and unemployment suggests a cyclic effect where those with higher ACE counts have higher risks of exposing their own children to ACEs.
...while the proportion of smokers in more advantaged groups is estimated at 15% for males and 13% for females in the most deprived groups levels are 39% and 34% respectively. 4 Recognising these ...disparities, a priority for smoking cessation services has been seen as helping people living in the most disadvantaged areas.
SETTING: Despite declining tuberculosis mortality per head of population, there was little change in tuberculosis case fatality in England and Wales from 1974 to 1987.OBJECTIVE: To determine the ...trend in tuberculosis case fatality for England and Wales from 1988 to 2001.DESIGN: Annual deaths to notifications ratios (DNRs) for tuberculosis were calculated using published notification and mortality data, and analysed by age group and three disease sites (central nervous system CNS, respiratory and other). DNRs for seven disease sites (miliary, bone and joint, CNS, respiratory, genitourinary, gastrointestinal and other) were calculated for 1998 and 1999 combined, using additional data from the enhanced tuberculosis surveillance programme.RESULTS: DNR for all ages and disease sites combined fell from 9.26% in 1988 to 5.59% in 2001 (r = −0.90; 95%CI −0.97-−0.70). DNRs for 1998-1999 combined were 41% for miliary disease, 17% for bone and joint disease, 8% for CNS disease, 7% for respiratory disease, 2% for genitourinary and gastrointestinal disease and 0.6% for other disease.CONCLUSIONS: Some of the decrease in DNRs may be due to improving notification rates. True declines in overall case fatality reflect increases in the proportion of tuberculosis patients in younger age groups and with low mortality extra-pulmonary disease.
Table 1 Effect of NHS smoking cessation services on the relative risk of smoking in people living in the most and least deprived quintiles using hypothetical smoking rates Pre-intervention ...Post-intervention Deprivation quintile Population* Smoking rate, %dagger Number of smokersdouble dagger Relative riskdouble dagger(95% CI)§ % Of population quitting* Number of quitters* Number of smokersdouble dagger Smoking rate, %dagger Relative risk(95% CI)double dagger§ Least deprived 187064 25 46766 0.05 85 46681 24.95 Most deprived 336800 25 84200 1 (0.99 to 1.01) 0.25 826 83374 24.75 0.99 (0.98 to 1.00) Least deprived 187064 5 59353 0.05 85 59268 4.95 Most deprived 336800 50 168400 1.58 (1.56 to 1.59) 0.25 826 167574 49.75 1.57 (1.56 to 1.58) Least deprived 187064 15 28060 0.05 85 27975 14.95 Most deprived 336800 39 131352 2.60 (2.57 to 2.63) 0.25 826 130526 38.75 2.59 (2.56 to 2.62) *Data from Lowey et al 2 ; daggersensitivity estimates including data from Lowey et al 2 ; double daggerdata calculated by us; §relative risk of smoking in most deprived compared with least deprived quintile.
Recent trends identify a global rise in the use of drugs such as ecstasy as part of nightlife behaviour. In order to protect young people's health, a variety of harm reduction interventions have been ...implemented, often focusing on the direct effects of substance use. However, the risk to health posed by substances is also related to the nightlife environment in which they are used. A healthy settings approach to nightclubs allows environmental issues and substance use to be tackled together. Consequently, a wider range of individuals and organisations feel capable of participating in the risk reduction process. Some countries have already developed integrated approaches to nightlife health. However, growth in international travel associated with nightlife and the additional risks posed by nightclubbing in an unfamiliar country mean that both interventions and basic health and safety measures are now required on an international basis.
In 68 human corpses over the age of 20 years, defined external body dimensions and the total lengths of peripheral nerves were measured, taking sex and constitutional type into consideration. The ...particular body dimension with the closest correlation to the lengths of the most frequently injured nerves of the extremities was determined by correlation computation. Using this external body dimension in regression equations and diagrams, it is possible to determine the average length of the nerves of the extremities with considerable accuracy directly in the patient. When the length of the nerve is known, the absolute value of the critical resection length of 3 per cent and the critical gap distance of 3-7 per cent (depending on the kind of nerve and the level of the separation) can be determined individually.
In many textbooks on applied mathematics, mechanics, or applied mechanics, the impression is still given that the only absolute systems of units are either the CGS system, using the gramme and dyne, ...or the British system using the pound and poundal and also that the only alternative system is a gravitational one in which either the unit of force or both the unit of force and the unit of mass vary with position; a few bodies do include the MKS system.
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