RESUMO
AIMS: To develop a clinical risk model to identify individuals at higher risk of developing new-onset diabetes and who might benefit more from weight loss pharmacotherapy. MATERIALS AND METHODS: A total of 21 143 patients without type 2 diabetes at baseline from two TIMI clinical trials of stable cardiovascular patients were divided into a derivation (~2/3) and validation (~1/3) cohort. The primary outcome was new-onset diabetes. Twenty-seven candidate risk variables were considered, and variable selection was performed using multivariable Cox regression. The final model was evaluated for discrimination and calibration, and for its ability to identify patients who experienced a larger benefit from the weight loss medication lorcaserin in terms of risk of new-onset diabetes. RESULTS: During a median (interquartile range) follow-up of 2.3 (1.8-2.7) years, new-onset diabetes occurred in 1013 patients (7.7%). The final model included five independent predictors (glycated haemoglobin, fasting glucose, age, body mass index, and triglycerides/high-density lipoprotein). The clinical risk model showed good discrimination (Harrell's C-indices 0.802, 95% confidence interval [CI] 0.788-0.817 and 0.807, 95% CI 0.788-0.826) in the derivation and validation cohorts. The calibration plot demonstrated adequate calibration (2.5-year area under the curve was 81.2 [79.1-83.5]). While hazard ratios for new-onset diabetes with a weight-loss therapy were comparable across risk groups (annual risks of <1%, 1%-5%, and >5%), there was a sixfold gradient in absolute risk reduction from lowest to highest risk group (p = 0.027). CONCLUSIONS: The developed clinical risk model effectively predicts new-onset diabetes, with potential implications for personalized patient care and therapeutic decision making.
RESUMO
Studies that distinguish parental monitoring (parent-driven behaviors) from parental knowledge often fail to find protective effects of monitoring on adolescent behavior problems. To answer whether parental monitoring is more strongly associated with adolescent behavior problems among adolescents who may need it most, this study applied group-based trajectory modeling to change in early- to mid-adolescent aggressive behavior problems and examined associations between parental monitoring with different subgroups. Three latent groups of adolescents were found: Low Aggression, Medium-Increasing Aggression, and High-Increasing Aggression. Results show that more maternal and paternal monitoring were associated with fewer adolescent aggressive behavior problems only for adolescents in the High-Increasing Group. This result suggests that parental monitoring is a protective factor against adolescent aggressive behavior problems for subgroups of adolescents who may need it most and less impactful for other adolescents.
RESUMO
The purpose of this study was to assess the factor structure and the measurement invariance of the Coparenting Relationship Scale (CRS) across 10 countries based on the seven-factor coparenting model (i.e., Coparenting Agreement, Coparenting Closeness, Exposure to Conflict, Coparenting Support, Endorsement of Partner's Parenting; Division of Labor) proposed by Feinberg (2003). The results of research on coparenting from numerous countries have documented its foundational importance for parent mental health, family relationship quality, child development, and psychopathology. Yet, a cross-country perspective is still lacking. Such a perspective can provide insight into which dimensions of coparenting are universally recognized and which are especially prone to variation. A unique multinational data set, comprised of 15 individual studies collected across 10 countries (Belgium, Brazil, China, Israel, Italy, Japan, Portugal, Switzerland, Turkey, USA) in nine languages was established (N = 9,292; 51.1% mothers). Measurement invariance analyses were conducted. A six-factor structure (original seven factors minus Division of Labor) of the measure was consistent across the different contexts and measurement invariance was achieved at the configural level. There was no support for metric or scalar invariance. These findings provide a basis for the CRS to be used across countries and should inspire future quantitative and qualitative research in cross-country coparenting research to understand what aspects are universal and what aspects of coparenting are linked to specific material, relational, or ideational conditions that underlie high-quality coparenting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Assuntos
Poder Familiar , Humanos , Feminino , Adulto , Masculino , Poder Familiar/psicologia , China , Japão , Itália , Bélgica , Brasil , Portugal , Israel , Turquia , Suíça , Estados Unidos , Comparação Transcultural , Psicometria/instrumentação , Psicometria/métodos , Relações Familiares/psicologia , Inquéritos e Questionários , Pessoa de Meia-Idade , Análise Fatorial , CriançaRESUMO
OBJECTIVE: Prior studies have described risk factors associated with amputation in patients with concomitant diabetes and peripheral arterial disease (DM/PAD). However, the association between the severity and extent of tissue loss type and amputation risk remains less well-described. We aimed to quantify the role of different tissue loss types in amputation risk among patients with DM/PAD, in the context of demographic, preventive, and socioeconomic factors. METHODS: Applying International Classification of Diseases (ICD)-9 and ICD-10 codes to Medicare claims data (2007-2019), we identified all patients with continuous fee-for-service Medicare coverage diagnosed with DM/PAD. Eight tissue loss categories were established using ICD-9 and ICD-10 diagnosis codes, ranging from lymphadenitis (least severe) to gangrene (most severe). We created a Cox proportional hazards model to quantify associations between tissue loss type and 1- and 5-year amputation risk, adjusting for age, race/ethnicity, sex, rurality, income, comorbidities, and preventive factors. Regional variation in DM/PAD rates and risk-adjusted amputation rates was examined at the hospital referral region level. RESULTS: We identified 12,257,174 patients with DM/PAD (48% male, 76% White, 10% prior myocardial infarction, 30% chronic kidney disease). Although 2.2 million patients (18%) had some form of tissue loss, 10.0 million patients (82%) did not. The 1-year crude amputation rate (major and minor) was 6.4% in patients with tissue loss, and 0.4% in patients without tissue loss. Among patients with tissue loss, the 1-year any amputation rate varied from 0.89% for patients with lymphadenitis to 26% for patients with gangrene. The 1-year amputation risk varied from two-fold for patients with lymphadenitis (adjusted hazard ratio, 1.96; 95% confidence interval, 1.43-2.69) to 29-fold for patients with gangrene (adjusted hazard ratio, 28.7; 95% confidence interval, 28.1-29.3), compared with patients without tissue loss. No other demographic variable including age, sex, race, or region incurred a hazard ratio for 1- or 5-year amputation risk higher than the least severe tissue loss category. Results were similar across minor and major amputation, and 1- and 5-year amputation outcomes. At a regional level, higher DM/PAD rates were inversely correlated with risk-adjusted 5-year amputation rates (R2 = 0.43). CONCLUSIONS: Among 12 million patients with DM/PAD, the most significant predictor of amputation was the presence and extent of tissue loss, with an association greater in effect size than any other factor studied. Tissue loss could be used in awareness campaigns as a simple marker of high-risk patients. Patients with any type of tissue loss require expedited wound care, revascularization as appropriate, and infection management to avoid amputation. Establishing systems of care to provide these interventions in regions with high amputation rates may prove beneficial for these populations.
RESUMO
Myocardial infarction (MI) is a significant cardiovascular disease that restricts blood flow, resulting in massive cell death and leading to stiff and noncontractile fibrotic scar tissue formation. Recently, sustained oxygen release in the MI area has shown regeneration ability; however, improving its therapeutic efficiency for regenerative medicine remains challenging. Here, a combinatorial strategy for cardiac repair by developing cardioprotective and oxygenating hybrid hydrogels that locally sustain the release of stromal cell-derived factor-1 alpha (SDF) and oxygen for simultaneous activation of neovascularization at the infarct area is presented. A sustained release of oxygen and SDF from injectable, mechanically robust, and tissue-adhesive silk-based hybrid hydrogels is achieved. Enhanced endothelialization under normoxia and anoxia is observed. Furthermore, there is a marked improvement in vascularization that leads to an increment in cardiomyocyte survival by ≈30% and a reduction of the fibrotic scar formation in an MI animal rodent model. Improved left ventricular systolic and diastolic functions by ≈10% and 20%, respectively, with a ≈25% higher ejection fraction on day 7 are also observed. Therefore, local delivery of therapeutic oxygenating and cardioprotective hydrogels demonstrates beneficial effects on cardiac functional recovery for reparative therapy.
Assuntos
Hidrogéis , Infarto do Miocárdio , Oxigênio , Seda , Animais , Infarto do Miocárdio/patologia , Infarto do Miocárdio/tratamento farmacológico , Seda/química , Hidrogéis/química , Oxigênio/química , Adesivos Teciduais/química , Adesivos Teciduais/farmacologia , Injeções , Cardiotônicos/farmacologia , Cardiotônicos/administração & dosagem , Cardiotônicos/química , Quimiocina CXCL12/administração & dosagem , Quimiocina CXCL12/farmacologia , Quimiocina CXCL12/metabolismo , Miócitos Cardíacos/efeitos dos fármacos , RatosRESUMO
Cardiovascular disease (CVD) is the leading cause of death worldwide. MicroRNAs (MiRNAs) have attracted considerable attention for their roles in several cardiovascular disease states, including both the physiological and pathological processes. In this review, we will briefly describe microRNA-181 (miR-181) transcription and regulation and summarize recent findings on the roles of miR-181 family members as biomarkers or therapeutic targets in different cardiovascular-related conditions, including atherosclerosis, myocardial infarction, hypertension, and heart failure. Lessons learned from these studies may provide new theoretical foundations for CVD.
Assuntos
Biomarcadores , Doenças Cardiovasculares , MicroRNAs , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/metabolismo , Biomarcadores/metabolismo , AnimaisRESUMO
Study of fathers has gained significant traction over recent decades. However, the experience for men over the transition to parenthood remains focused on high-socioeconomic and socially advantaged fathers. Researchers have yet to thoroughly investigate how fathers may uniquely experience this transition period with a history of childhood maltreatment, given that childhood abuse is known to impact several components of development and relationship functioning into adulthood. The current study endeavored to fill this gap by evaluating the associations between fathers' childhood experiences of physical and emotional abuse and their relationship functioning over the transition to parenthood in terms of both the couple relationship and social adjustment in relationships with others. Using data from 399 fathers who participated in a randomized control trial during pregnancy, the results from stepwise regressions indicate fathers with a history of emotional abuse experience particular declines in their external relationships (reductions in social support and increases in social stress) from prenatal (Wave 1) to postpartum (Wave 2) reports. However, no significant association emerged between fathers' history of maltreatment and their relationship functioning with their partners. These results underscore the importance of investigating the impact of different types of abuse on men in fatherhood. Moreover, we emphasize the need to study further fathers' social adjustment over the transition to parenthood beyond the couple relationship and broad social support to address the needs of men with a history of maltreatment in their new role as fathers.
RESUMO
AIMS: Diabetes leads to dysregulated macrophage immunometabolism, contributing to accelerated atherosclerosis progression. Identifying critical factors to restore metabolic alterations and promote resolution of inflammation remains an unmet goal. MicroRNAs (miRs) orchestrate multiple signaling events in macrophages, yet their therapeutic potential in diabetes-associated atherosclerosis remains unclear. METHODS AND RESULTS: MiRNA profiling revealed significantly lower miR-369-3p expression in aortic intimal lesions from Ldlr-/- mice on a high-fat sucrose containing (HFSC) diet for 12 weeks. miR-369-3p was also reduced in peripheral blood mononuclear cells (PBMCs) from diabetic patients with coronary artery disease (CAD). Cell-type expression profiling showed miR-369-3p enrichment in aortic macrophages. In vitro, oxLDL treatment reduced miR-369-3p expression in mouse bone marrow-derived macrophages (BMDMs). Metabolic profiling in BMDMs revealed that miR-369-3p overexpression blocked the oxLDL-mediated increase in the cellular metabolite succinate and reduced mitochondrial respiration (OXPHOS) and inflammation (lL-1ß, TNF-a, IL-6). Mechanistically, miR-369-3p targeted the succinate receptor (GPR91) and alleviated the oxLDL-induced activation of inflammasome signaling pathways. Therapeutic administration of miR-369-3p mimics in HFSC-fed Ldlr-/- mice reduced GPR91 expression in lesional macrophages and diabetes-accelerated atherosclerosis, evident by a decrease in plaque size and pro-inflammatory Ly6Chi monocytes. RNA-seq analyses showed more pro-resolving pathways in plaque macrophages from miR-369-3p treated mice, consistent with an increase in macrophage efferocytosis in lesions. Finally, a GPR91 antagonist attenuated oxLDL-induced inflammation in primary monocytes from human subjects with diabetes. CONCLUSION: These findings establish a therapeutic role for miR-369-3p in halting diabetes-associated atherosclerosis by regulating GPR91 and macrophage succinate metabolism.
RESUMO
Parental warmth during the transition from childhood to adolescence is a key protective factor against a host of adolescent problems, including substance use, maladjustment, and diminished well-being. Moreover, adolescents and parents often disagree in their perceptions of parenting quality, and these discrepancies may confer risk for problem outcomes. The current study applies latent profile analysis to a sample of 687 mother-father-6th grade adolescent triads to identify patterns of adolescent-parent convergence and divergence in perceptions of parental warmth. Five profiles were identified, and associations with adolescent positive well-being, substance use, and maladjustment outcomes in 9th grade were assessed. Patterns of divergence in which adolescents had a pronounced negative perception of parental warmth compared to parents, as well as those wherein pronounced divergence was present in only one adolescent-parent dyad, were associated with diminished positive well-being compared to adolescents who had more positive perceptions of warmth than parents. Having more negative perceptions of warmth compared to parents was also associated with elevated risk for alcohol and marijuana initiation, but only when the divergence was pronounced rather than more moderate. These findings add nuance to findings from previous between-family investigations of informant discrepancies, calling for further family-centered methods for investigating multiple perspectives.
RESUMO
The loss of John Schulenberg reverberates across the developmental and prevention sciences. In honor of his many contributions, this paper applies his ideas of developmental continuity and discontinuity to understand the process by which PROSPER delivered universal prevention programs (delivered in Grades 6 and 7) affect young adult outcomes. Guided by these developmental models, we deconstructed adolescent substance use initiation trajectories into two discrete phases-early and late adolescence, demarcated by substance use initiation levels at the end of 9th grade. We evaluated the effects of PROSPER interventions on these phases, and in turn, the effects of adolescent substance use initiation on young adult antisocial behavior, alcohol and drug use consequences, and depression symptoms. This sample included 1,984 young adults who participated in the PROSPER intervention trial in Grade 6 (two cohorts, 2002 and 2003), followed over 8 adolescent measurement occasions (Fall and Spring of Grade 6; Spring of Grades 7-12). Young adult outcomes were averaged across three waves (collected at ages 20, 23, and 25). PROSPER interventions were associated with reduced substance use initiation in early adolescence, but not escalation during late adolescence. In turn, substance use in both early and late adolescence was uniquely associated with young adult antisocial behavior, depression symptoms, and substance use consequences. PROSPER interventions were associated with young adult antisocial behavior and problematic substance use via reduced risk for early initiation status. Findings are discussed in terms of developmental continuity and discontinuity.
RESUMO
Diabetes-associated atherosclerosis involves excessive immune cell recruitment and plaque formation. However, the mechanisms remain poorly understood. Transcriptomic analysis of the aortic intima in Ldlr-/- mice on a high-fat, high-sucrose-containing (HFSC) diet identifies a macrophage-enriched nuclear long noncoding RNA (lncRNA), MERRICAL (macrophage-enriched lncRNA regulates inflammation, chemotaxis, and atherosclerosis). MERRICAL expression increases by 249% in intimal lesions during progression. lncRNA-mRNA pair genomic mapping reveals that MERRICAL positively correlates with the chemokines Ccl3 and Ccl4. MERRICAL-deficient macrophages exhibit lower Ccl3 and Ccl4 expression, chemotaxis, and inflammatory responses. Mechanistically, MERRICAL guides the WDR5-MLL1 complex to activate CCL3 and CCL4 transcription via H3K4me3 modification. MERRICAL deficiency in HFSC diet-fed Ldlr-/- mice reduces lesion formation by 74% in the aortic sinus and 86% in the descending aorta by inhibiting leukocyte recruitment into the aortic wall and pro-inflammatory responses. These findings unveil a regulatory mechanism whereby a macrophage-enriched lncRNA potently inhibits chemotactic responses, alleviating lesion progression in diabetes.
Assuntos
Doenças da Aorta , Aterosclerose , Diabetes Mellitus , Placa Aterosclerótica , RNA Longo não Codificante , Animais , Camundongos , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Quimiotaxia , Doenças da Aorta/genética , Doenças da Aorta/metabolismo , Doenças da Aorta/patologia , Aterosclerose/metabolismo , Macrófagos/metabolismo , Diabetes Mellitus/patologia , Camundongos Knockout , Camundongos Endogâmicos C57BL , Receptores de LDL , Placa Aterosclerótica/metabolismoRESUMO
Interparental conflict is known to negatively impact child well-being, including behavioral and physiological well-being. Children's empathy - that is, vicariously experiencing others' emotions - may increase children's sensitivity to and the biological repercussions of interparental conflict. Although empathy represents a valued trait and is an important part of socioemotional development, its influence on children's physical health is unknown. This study examined whether empathy moderates the association between perceived interparental conflict and both child systemic inflammation and parent-rated overall child health in a sample of children between the ages of seven to nine. Children and their parents participating in the long-term evaluation of the Family Foundations program, a randomized trial of a perinatal preventative intervention, provided data approximately eight years following enrollment into the program. We collected peripheral blood samples via dried blood spots, anthropometric measurements, and child and parent psychosocial questionnaires. Results indicated significant positive main effects of child empathy on both C-reactive protein (CRP; B = 0.26, SE = 0.11, p =.026) and Interleukin-6 (IL-6; B = 0.20, SE = 0.10, p =.045) levels. Further, child affective empathy moderated the associations between perceived interparental conflict and both CRP (B = 0.39, SE = 0.19, p =.050) and parent-reported child health (B = 0.30, SE = 0.13, p =.021), such that greater empathy strengthened the negative associations between interparental conflict and child health. Overall, findings suggests that there may be a biological cost of being more empathic in high-conflict environments and highlight the need for tools to help more empathic children appropriately manage vicarious emotions.
Assuntos
Saúde da Criança , Conflito Familiar , Criança , Humanos , Conflito Familiar/psicologia , Empatia , Relações Pais-Filho , EmoçõesRESUMO
The coronavirus disease (COVID-19) pandemic has necessitated the use of health-protective behaviors (HPB), such as social distancing, staying at home, frequent handwashing, and wearing facemasks to mitigate the transmission of disease. An investigation of interpersonal costs associated with the use of HPB can help inform strategies to promote their sustained implementation. This study examined the daily associations between the implementation of HPB and family functioning and assessed moderation by coparenting quality, economic strain, and the number of days that state-level stay-at-home policies had been in effect, during the early days of the pandemic. Mothers and fathers from 155 families with children who were 9 years old, on average, completed daily reports of HPB, parental stress, and family relationship quality over eight consecutive days in April or May of 2020. Hierarchal linear models showed that HPB was associated with increased levels of parental stress and interparental conflict. Negative coparenting relations exacerbated the next-day association between HPB and interparental conflict. HPB was also associated with increased levels of parent-child and interparental closeness, but these linkages dissipated for families who had spent more days under state-level stay-at-home policies. Although crucial for public health, the implementation of HPB may have detrimental short-term effects on daily family life. Family support and interventions are necessary to minimize the psychosocial burden of these important public health measures and increase their sustained adherence.
Assuntos
COVID-19 , Pandemias , Feminino , Humanos , Criança , Pandemias/prevenção & controle , COVID-19/prevenção & controle , Relações Familiares , Mães/psicologia , Conflito Familiar/psicologia , Pais/psicologiaRESUMO
The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well-being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016-2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = .21-.30). Toddlers in Recipe 4 Success exhibited greater self-regulation and had healthier eating habits (Cohen's d = |.16-.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life-long benefits.
Assuntos
Poder Familiar , Autocontrole , Feminino , Humanos , Pré-Escolar , Lactente , Masculino , Dieta Saudável/métodos , Pais , Hábitos , Comportamento Alimentar , PobrezaRESUMO
BACKGROUND: BETs (bromodomain and extraterminal domain-containing epigenetic reader proteins), including BRD4 (bromodomain-containing protein 4), orchestrate transcriptional programs induced by pathogenic stimuli, as intensively studied in cardiovascular disease and elsewhere. In endothelial cells (ECs), BRD4 directs induced proinflammatory, proatherosclerotic transcriptional responses; BET inhibitors, like JQ1, repress these effects and decrease atherosclerosis. While BET effects in pathogenic conditions have prompted therapeutic BET inhibitor development, BET action under basal conditions, including ECs, has remained understudied. To understand BET action in basal endothelial transcriptional programs, we first analyzed EC RNA-Seq data in the absence versus presence of JQ1 before using BET regulation to identify novel determinants of EC biology and function. METHODS: RNA-Seq datasets of human umbilical vein ECs without and with JQ1 treatment were analyzed. After identifying C12orf34, also known as FAM222A (family with sequence similarity 222 member A), as a previously unreported, basally expressed, potently JQ1-induced EC gene, FAM222A was studied in endothelial and angiogenic responses in vitro using small-interference RNA silencing and lentiviral overexpression, in vitro, ex vivo and in vivo, including aortic sprouting, matrigel plug assays, and murine neonatal oxygen-induced retinopathy. RESULTS: Resting EC RNA-Seq data indicate BETs direct transcriptional programs underlying core endothelial properties including migration, proliferation, and angiogenesis. BET inhibition in resting ECs also significantly induced a subset of mRNAs, including FAM222A-a unique BRD4-regulated gene with no reported EC role. Silencing endothelial FAM222A significantly decreased cellular proliferation, migration, network formation, aorta sprouting, and Matrigel plug vascularization through coordinated modulation of VEGF (vascular endothelial growth factor) and NOTCH mediator expression in vitro, ex vivo, in vivo; lentiviral FAM222A overexpression had opposite effects. In vivo, siFAM222A significantly repressed retinal revascularization in neonatal murine oxygen-induced retinopathy through similar angiogenic signaling modulation. CONCLUSIONS: BET control over the basal endothelial transcriptome includes FAM222A, a novel, BRD4-regulated, key determinant of endothelial biology and angiogenesis.
Assuntos
Doenças Retinianas , Fatores de Transcrição , Animais , Humanos , Camundongos , Angiogênese , Biologia , Proteínas que Contêm Bromodomínio , Proteínas de Ciclo Celular/genética , Proteínas de Ciclo Celular/metabolismo , Células Endoteliais da Veia Umbilical Humana/metabolismo , Proteínas Nucleares/genética , Proteínas Nucleares/metabolismo , Oxigênio , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Transcriptoma , Fator A de Crescimento do Endotélio Vascular/genéticaRESUMO
Parents' management of their children's sibling relationships, or sibling-focused parenting, has substantial theoretical and practical importance but is rarely studied. This study's goals were to describe dimensions of sibling-focused parenting and to examine sociocultural resources and challenges as potential correlates among Latinx mothers and fathers in 262 families with two children in middle childhood. Families were recruited from 11 public elementary schools, and caregivers (248 mother figures; 118 father figures) participated in a home visit and phone interviews at the onset of the study. Sibling-focused parenting included three dimensions: positive guidance (10 items), nonintervention (four items), and authoritarian control (five items). Parents rated positive guidance as their most frequent strategy, and comparisons of mothers and fathers from the same families revealed that mothers engaged in more sibling-focused parenting overall than fathers. Regarding correlates, mothers' familism values and mothers' and fathers' family cohesion reports were associated with more positive guidance and mothers' cohesion was negatively related to nonintervention in sibling conflicts. For mothers only, parenting stress was linked to all three dimensions of sibling-focused parenting-negatively to guidance and positively to authoritarian control and nonintervention; maternal depressive symptoms were positively linked to authoritarian control. Economic hardship was not a significant correlate of any dimension. Findings suggest that sibling-focused parenting is a key domain of parenting in need of further research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Assuntos
Poder Familiar , Irmãos , Feminino , Humanos , Criança , Masculino , Poder Familiar/psicologia , Irmãos/psicologia , Pais/psicologia , Mães/psicologia , Hispânico ou Latino , Pai/psicologiaRESUMO
Budget analysis entities often cannot capture the full downstream impacts of investments in prevention services, programs, and interventions. This study describes and applies an approach to synthesizing existing literature to more fully account for these effects. This study reviewed meta-analyses in PubMed published between Jan 1, 2010 and Dec 31, 2019. The initial search included meta-analyses on the association between health risk factors, including maternal behavioral health, intimate partner violence, child maltreatment, depression, and obesity, with a later health condition. Through a snowball sampling-type approach, the endpoints of the meta-analyses identified became search terms for a subsequent search, until each health risk was connected to one of the ten costliest health conditions. These results were synthesized to create a path model connecting the health risks to the high-cost health conditions in a cascade. Thirty-seven meta-analyses were included. They connected early-life health risk factors with six high-cost health conditions: hypertension, diabetes, asthma and chronic obstructive pulmonary disorder, mental disorders, heart conditions, and trauma-related disorders. If confounders could be controlled for and causality inferred, the cascading associations could be used to more fully account for downstream impacts of preventive interventions. This would support budget analysis entities to better include potential savings from investments in chronic disease prevention and promote greater implementation at scale.
Assuntos
Transtornos Mentais , Doença Pulmonar Obstrutiva Crônica , Criança , Humanos , Fatores de Risco , Doença Crônica , Avaliação de Resultados em Cuidados de SaúdeRESUMO
We are delighted to share with you our thirteenth Journal Club and highlight some of the most interesting papers published recently [...].