Women veterans experience disproportionately high rates of military sexual trauma (MST). Nonetheless, many MST survivors delay or forgo health care, particularly within Veterans Health Administration ...(VHA) settings. Institutional betrayal (IB) has been posited as a potential explanation for this. Objective: The current study examined if IB was associated with women veterans' willingness to seek VHA and non-VHA mental health and medical care, prior use of VHA care, past year use of VHA care, and use of VHA and non-VHA MST-related care. Method: Participants were 242 women veterans who screened positive for MST and completed self-report measures of IB and willingness to seek VHA and non-VHA mental health and medical care. Use of VHA care was assessed through VA Corporate Data Warehouse data. Results: IB was associated with lower willingness to use VHA medical care and higher willingness to use non-VHA mental health care. Although IB was not significantly associated with prior use of VHA care, participants who reported more IB were more likely to have used VHA care in the past year and to have used both VHA and non-VHA MST-related care. Conclusion: These findings illuminate the relationship between the institutional response to MST with women's help-seeking willingness and use. Addressing IB may be important for increasing women MST survivors' willingness to use VHA medical care. Additionally, as IB was associated with greater willingness to use non-VHA mental health care, non-VHA institutions and providers should be prepared to serve women veterans who have experienced MST-related IB.
Clinical Impact StatementAmong women veterans who experience military sexual trauma (MST), those who experience institutional betrayal report that they are less willing to use Veterans Health Administration (VHA) medical care and are more willing to use non-VHA mental health care. Institutional betrayal is also associated with being more likely to have used VHA and non-VHA MST-related health care and VHA care in the past year. Clinicians in both non-VHA and VHA settings should be prepared to work with women MST survivors who have experienced institutional betrayal. Addressing institutional betrayal is recommended to increase women MST survivors' willingness to use VHA medical care.
Evidence of short-term effects of ultrafine particles (UFP) on health is still inconsistent and few multicenter studies have been conducted so far especially in Europe.
Within the UFIREG project, we ...investigated the short-term effects of UFP and fine particulate matter (particulate matter with an aerodynamic diameter less than 2.5 μm PM
) on daily cause-specific hospital admissions in five Central and Eastern European cities using harmonized protocols for measurements and analyses.
Daily counts of cause-specific hospital admissions focusing on cardiovascular and respiratory diseases were obtained for Augsburg and Dresden (Germany), 2011-2012; Chernivtsi (Ukraine), 2013 to March 2014; and Ljubljana (Slovenia) and Prague (Czech Republic), 2012-2013. Air pollution and meteorologic data were measured at fixed monitoring sites in all cities. We analyzed city-specific associations using confounder-adjusted Poisson regression models and pooled the city-specific effect estimates using metaanalysis methods.
A 2,750 particles/cm
increase (average interquartile range across all cities) in the 6-day average of UFP indicated a delayed and prolonged increase in the pooled relative risk of respiratory hospital admissions (3.4% 95% confidence interval, -1.7 to 8.8%). We also found increases in the pooled relative risk of cardiovascular (exposure average of lag 2-5, 1.8% 0.1-3.4%) and respiratory (6-d average exposure, 7.5% 4.9-10.2%) admissions per 12.4 μg/m
increase (average interquartile range) in PM
.
Our findings indicated delayed and prolonged effects of UFP exposure on respiratory hospital admissions in Central and Eastern Europe. Cardiovascular and respiratory hospital admissions increased in association with an increase in PM
. Further multicenter studies are needed using harmonized UFP measurements to draw definite conclusions on health effects of UFP.
In this contribution air temperature differences among Local Climate Zone (LCZ) categories are analysed with special consideration of varying synoptic conditions. Analyses are based upon an LCZ ...mapping for the urban area of Augsburg (Bavaria, Southern Germany) and hourly air temperature data from a comprehensive logger network. Quality checked air temperature measurements have been stratified according to season, hour of the day and weather situation. For resulting subsamples thermal differences among LCZs have been determined and appropriate statistical tests have been applied. Results confirm that built up LCZs feature higher temperatures than natural LCZs and that most distinct differences among LCZs appear under undisturbed synoptic conditions. With increasing cloudiness and in particular with increasing wind speed differences among LCZs diminish. But, even for strongly disturbed synoptic conditions statistical significance of the influence of LCZs on thermal characteristics could be assured. Thus, our findings provide clear evidence that detectable thermal differences among LCZs are not restricted to „ideal “synoptic conditions but occur as well under disturbed conditions. However, to assure not only the statistical but also the climatological and in particular the bioclimatological and human health related relevance of the documented differences among LCZs further studies incorporating appropriate metrics are intended.
This study assessed the effect of temperature and thermal atmospheric conditions on all-cause and cardiovascular mortality in Bangladesh. In particular, differences in the response to elevated ...temperatures between urban and rural areas were investigated. Generalized additive models (GAMs) for daily death counts, adjusted for trend, season, day of the month and age were separately fitted for urban and rural areas. Breakpoint models were applied for determining the increase in mortality above and below a threshold (equivalent) temperature. Generally, a
’V’-shaped (equivalent) temperature–mortality curve with increasing mortality at low and high temperatures was observed. Particularly, urban areas suffered from heat-related mortality with a steep increase above a specific threshold. This adverse heat effect may well increase with ongoing urbanization and the intensification of the urban heat island due to the densification of building structures. Moreover, rising temperatures due to climate change could aggravate thermal stress.
► Temperature exhibits a strong influence on mortality in Bangladesh. ► Mortality increases at low and high end of the temperature range. ► Temperature is increased in the urban area of Dhaka, particular during summer. ► Urban areas are facing increased risk of heat-related mortality. ► Urbanization and climate change are likely to increase heat-related mortality.
Mortality in Bangladesh is strongly affected by thermal atmospheric conditions with particularly urban areas facing excess mortality above a specific threshold temperature.
American Indian and Alaska Natives (AI/ANs) veterans may be at elevated risk for suicide, but little is known about suicide among this population.
We conducted a retrospective cohort analysis of ...AI/AN veterans who received health care services provided or paid for by the Veterans Health Administration (VHA) between October 1, 2002, and September 30, 2014, and who were alive as of September 30, 2003. Age-specific and age-adjusted suicide rates through 2018, per 100,000 person-years (PY) at risk and 95% confidence intervals were computed.
Age-adjusted suicide rates among AI/AN veterans in this cohort more than doubled (19.1-47.0/100,000 PY) over the 15-year observation period. In the most recent observation period (2014-2018), the age-adjusted suicide rate was 47.0 per 100,000 PY, with the youngest age group (18-39) exhibiting the highest suicide rate (66.0/100,000 PY). The most frequently used lethal means was firearms (58.8%), followed by suffocation (19.3%), poisoning (17.2%), and other (4.7%).
Results suggest that: (1) suicide is an increasing problem among AI/AN VHA veterans; and (2) younger AI/AN VHA veterans are at particularly high risk and warrant focused prevention efforts. Findings are similar to those observed in general AI/AN population. There is a compelling need to review and strengthen VHA suicide prevention efforts directed towards AI/AN veterans.
•First study on the effects of air temperature on epigenetic age acceleration.•Medium-term exposures to high temperatures are associated with increased HorvathAA, HannumAA, GrimAA, and ...SkinBloodAA.•Long-term exposures to high temperatures are associated with increased HorvathAA, HannumAA, PhenoAA, GrimAA, and SkinBloodAA.•More pronounced associations between air temperature and epigenetic age acceleration are observed among women and people with obesity or diabetes.
Climate change poses a serious threat to human health worldwide, while aging populations increase. However, no study has ever investigated the effects of air temperature on epigenetic age acceleration. This study involved 1,725 and 1,877 participants from the population-based KORA F4 (2006–2008) and follow-up FF4 (2013–2014) studies, respectively, conducted in Augsburg, Germany. The difference between epigenetic age and chronological age was referred to as epigenetic age acceleration and reflected by Horvath’s epigenetic age acceleration (HorvathAA), Hannum’s epigenetic age acceleration (HannumAA), PhenoAge acceleration (PhenoAA), GrimAge acceleration (GrimAA), and Epigenetic Skin and Blood Age acceleration (SkinBloodAA). Daily air temperature was estimated using hybrid spatiotemporal regression-based models. To explore the medium- and long-term effects of air temperature modeled in time and space on epigenetic age acceleration, we applied generalized estimating equations (GEE) with distributed lag non-linear models, and GEE, respectively. We found that high temperature exposure based on the 8-week moving average air temperature (97.5th percentile of temperature compared to median temperature) was associated with increased HorvathAA, HannumAA, GrimAA, and SkinBloodAA: 1.83 (95% CI: 0.29–3.37), 11.71 (95% CI: 8.91–14.50), 2.26 (95% CI: 1.03–3.50), and 5.02 (95% CI: 3.42–6.63) years, respectively. Additionally, we found consistent results with high temperature exposure based on the 4-week moving average air temperature was associated with increased HannumAA, GrimAA, and SkinBloodAA: 9.18 (95% CI: 6.60–11.76), 1.78 (95% CI: 0.66–2.90), and 4.07 (95% CI: 2.56–5.57) years, respectively. For the spatial variation in annual average temperature, a 1 °C increase was associated with an increase in all five measures of epigenetic age acceleration (HorvathAA: 0.41 95% CI: 0.24–0.57, HannumAA: 2.24 95% CI: 1.95–2.53, PhenoAA: 0.32 95% CI: 0.05–0.60, GrimAA: 0.24 95%: 0.11–0.37, and SkinBloodAA: 1.17 95% CI: 1.00–1.35 years). In conclusion, our results provide first evidence that medium- and long-term exposures to high air temperature affect increases in epigenetic age acceleration.
Background. Recent studies on temperature-related mortality burden generally found higher cold-related deaths than heat-related deaths. In the future, it is anticipated that global warming will, on ...one hand result in larger heat-related mortality but on the other hand lead to less cold-related mortality. Thus, it remains unclear whether the net change in temperature-related mortality burden will increase in the future under climate change. Objectives. We aimed to quantify the impact of climate change on heat-, cold-, and the total temperature-related (net change) mortality burden taking into account the future demographic changes across five districts in Bavaria, Germany by the end of the 21st century. Methods. We applied location-specific age-specific exposure-response functions (ERFs) to project the net change in temperature-related mortality burden during the future period 2083-2099 as compared to the baseline period 1990-2006. The projections were under different combinations of five climate change scenarios (assuming a constant climate, Representative Concentration Pathway RCP 2.6, RCP4.5, RCP6.0, and RCP8.5) and six population projection scenarios (assuming a constant population, Shared Socio-economic Pathway SSP 1, SSP2, SSP3, SSP4, and SSP5). Our projections were under the assumption of a constant vulnerability of the future population. We furthered compared the results with projections using location-specific overall all-age ERFs, i.e. not considering the age-effect and population aging. Results. The net temperature-related mortality for the total population was found to increase significantly under all scenarios of climate and population change with the highest total increments under SSP5-RCP8.5 by 19.61% (95% empirical CI (eCI): 11.78, 30.91). Under the same scenario for age ≥ 75, the increment was by 30.46% (95% eCI: 18.60, 47.74) and for age <75, the increment was by 0.28% (95% eCI: −2.84, 3.24). Considering the combination SSP2-RCP2.6, the middle-of-the road population and the lowest climate change scenario, the net temperature-related mortality for the total population was found to still increase by 9.33% (95% eCI: 5.94, 12.76). Contrastingly, the mortality projection without consideration of an age-effect and population aging under the same scenario resulted in a decrease of temperature-related deaths by −0.23% (95% eCI −0.64, 0.14), thus showing an underestimation of temperature-related mortality. Furthermore, the results of climate-only effect showed no considerable changes, whereas, the population-only effect showed a high, up to 17.35% (95% eCI: 11.46, 22.70), increment in the net temperature-related deaths. Conclusion. The elderly population (age ≥ 75), highly vulnerable to both heat and cold, is projected to be about four folds the younger population (age < 75) in the future. Thus, the combined effect of global warming and population aging results in an increase in both the heat- and the cold-related deaths. The population-effect dominates the climate-effect. Mitigation and age-specific adaptation strategies might greatly reduce the temperature-related mortality burden in the future.
Exposure to air pollution is associated with elevated cardiovascular risk. Evidence shows that omega-3 polyunsaturated fatty acids (omega-3 PUFA) may attenuate the adverse cardiovascular effects of ...exposure to fine particulate matter (PM
). However, it is unclear whether habitual dietary intake of omega-3 PUFA protects against the cardiovascular effects of short-term exposure to low-level ambient air pollution in healthy participants. In the present study, sixty-two adults with low or high dietary omega-3 PUFA intake were enrolled. Blood lipids, markers of vascular inflammation, coagulation and fibrinolysis, and heart rate variability (HRV) and repolarization were repeatedly assessed in 5 sessions separated by at least 7 days. This study was carried out in the Research Triangle area of North Carolina, USA between October 2016 and September 2019. Daily PM
and maximum 8-h ozone (O
) concentrations were obtained from nearby air quality monitoring stations. Linear mixed-effects models were used to assess the associations between air pollutant concentrations and cardiovascular responses stratified by the omega-3 intake levels.
The average concentrations of ambient PM
and O
were well below the U.S. National Ambient Air Quality Standards during the study period. Significant associations between exposure to PM
and changes in total cholesterol, von Willebrand factor (vWF), tissue plasminogen activator, D-dimer, and very-low frequency HRV were observed in the low omega-3 group, but not in the high group. Similarly, O
-associated adverse changes in cardiovascular biomarkers (total cholesterol, high-density lipoprotein, serum amyloid A, soluable intracellular adhesion molecule 1, and vWF) were mainly observed in the low omega-3 group. Lag-time-dependent biphasic changes were observed for some biomarkers.
This study demonstrates associations between short-term exposure to PM
and O
, at concentrations below regulatory standard, and subclinical cardiovascular responses, and that dietary omega-3 PUFA consumption may provide protection against such cardiovascular effects in healthy adults.
Women veterans are at increased risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans ...who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans’ needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research.
Post-9/11 women veterans (n = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting.
Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19–9.46; adjusting for demographics, military characteristics, mental health symptoms).
Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention.
Lyme borreliosis (LB) is caused by the transmission of Borrelia burgdorferi s.l. from ticks to humans. Climate affects tick abundance, and climate change is projected to promote shifts in abundance ...in Europe, potentially increasing human exposure. We analyzed serum samples collected between the years 2014-2019 from German National Cohort (NAKO) participants at four study sites (Augsburg, Berlin, Hanover, Münster) for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies using an enzyme-linked immunosorbent assay (ELISA) and line blot immunoassay as confirmatory test for positive and equivocal ELISA samples. We reported crude and weighted seropositivity proportions for local estimates. We used mixed model analysis to investigate associated factors, such as age, sex, migration background, or animal contacts. We determined the serostatus of 14,207 participants. The weighted seropositivity proportions were 3.4% (IgG) and 0.4% (IgM) in Augsburg, 4.1% (IgG) and 0.6% (IgM) in northern Berlin, 3.0% (IgG) and 0.9% (IgM) in Hanover, and 2.7% (IgG) and 0.6% (IgM) in Münster. We found higher odds for IgG seropositivity with advancing age (p < 0.001), among males compared to females (p < 0.001) and reduced odds among participants with migration background compared to those without (p = 0.001). We did not find evidence for an association between serostatus and depression, children within the household, or animal contact, respectively. We found low seropositivity proportions and indications of differences across the study locations, although between-group comparisons did not yield significant results. Comparisons to earlier research are subject to important limitations; however, our results indicate no major increases in seropositivity over time. Nevertheless, monitoring of seropositivity remains critical in light of potential climate-related Borrelia exposure.