Adverse Exposures Research Articles

Tympanoplasty Healing Outcomes With Use of Postoperative Otic Quinolones.

Tympanoplasty usually results in tympanic membrane perforation (TMP) closure, but healing may be suboptimal (e.g., excess scarring). Factors that have been linked to impaired TM healing have become widely adopted (especially, postoperative use of quinolone ear drops). The aim of this study is to assess the frequency of suboptimal tympanoplasty healing with the use of otic quinolones postoperatively. Retrospective chart review. Tertiary care facility. One hundred patients undergoing tympanoplasty for TMP. Tympanoplasty +/- canalplasty. Healing complications (e.g., granulation tissue, TMP, myringitis, bone exposure, lateralization, anterior blunting, medial canal fibrosis, and canal stenosis) and hearing loss. Charts were reviewed for postoperative healing issues and hearing outcomes at 1 to 2 years postoperatively. TMP closure was found in 93.2%, but 34.2% had healing issues at 1 to 2 years postoperatively, with 20.6% having adverse healing outcomes (perforation (6.9%), granulation tissue (6.9%), medial fibrosis (4.1%), and myringitis, bone exposure, and webbing (all 1.4%). Another 13.7% had notable postoperative issues, such as protracted otorrhea (11.0%), otitis externa (9.6%), otitis media (1.4%), and atelectasis (2.7%). No medical, surgical, or patient factors impacted outcomes. Average air-bone gap at 1 to 2 years did not differ between patients with and without healing issues and patients with other postoperative issues ( p = 0.5). Suboptimal healing is common after tympanoplasty. There may be significant opportunity to improve post-tympanoplasty healing beyond improving the TMP closure rate.

985-P: Is Insulin Titration Supported by a Titration App Safe? Safety Results of an RCT

A multicenter RCT in people with type 2 diabetes has shown that the use of a basal insulin titration app (myDose Coach) reduced A1c levels by 0.35 percentage points compared to titration without an app. Is the use of such a titration app associated with safety issues? We used negative binomial regressions to analyze the occurrence of adverse and serious adverse events (AE, SAE) and exposure to dangerously low (<54 mg/dl) or high (>250 mg/dl) glucose levels in 251 participants (age 60.0 years IQR 56.0 - 66.5; HbA1c 8.2 IQR 7.7 - 9.1%) randomized equally to the control and intervention groups. A total of 30 AEs (16 vs. 14 events) occurred in the control and intervention groups, of which 14 were SAEs (7 vs. 7 events). No event was judged to be associated with study participation or the interventions. The rates of dangerous low and high glucose in the control and intervention group were 0.12% vs. 0.10% for %< 54 mg/dl and 4.9% vs. 3.6% for %< 250 mg/dl, respectively (see Figure 1 for IRR and p values for superiority). A post-hoc non-inferiority test for the occurrence of %< 54 mg/dl and >250 mg/dl with non-inferiority margins of < 1% and < 5%, respectively, showed significant non-inferiority regarding the intervention group (both p < 0.01) with a post-hoc power by 75% respectively 55%. The results did not indicate an increased risk for insulin titration by the evaluated app compared to the control condition in terms of AE or extreme glucose excursions. Disclosure B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. K.Finke-groene: None. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. Funding Sanofi

Understanding PTSD among correctional workers in Manitoba, Canada: Key considerations of social variables

AbstractMounting evidence highlights the high prevalence of posttraumatic stress disorder (PTSD) among correctional workers. The current analysis draws on survey response data to present a social profile of correctional workers in the province of Manitoba (n = 580), Canada, who screened positive for PTSD (n = 196). We examined demographic information, professional history information, and adverse work exposure experiences, as well as treatment and support patterns. The analysis was not intended to identify correlates of PTSD development among correctional workers, but did identify the characteristics, professional and personal situations, and treatment experiences of correctional workers who screened positive for PTSD. The results highlight the multidimensional nature of work stressors, the pronounced problem of work–life conflict, and variations in seeking supports and treatments. Generally, participants screening positive for PTSD reported higher exposure to potentially psychologically traumatic events, higher environmental or occupational stressors at work, and many had prior work experience as public safety personnel. Correctional workers who screened positive for PTSD appeared more likely to access mental health supports. Promoting proactive support seeking for mental health treatment may help to mitigate the severity, frequency, stigma, and length of mental health challenges among correctional workers.

Early Experience and Inflammation

In this featured symposium, three researchers explore how adverse exposures during childhood and adolescence relate to in vivo and in vitro measures of inflammatory functioning and cardiovascular health, as well as individual and social factors that help protect youth from these adverse impacts. In the first presentation, Greg Miller presents data on how direct and vicarious violence exposure relate to inflammatory responses to microbial challenge, and the role of the central executive network of the brain in modulating these associations. Hannah Schreier presents data on how family-level factors modify the associations between adversity and youth inflammation, the associations between child maltreatment and inflammation, and on a psychosocial intervention designed to alter CVD risk in youth. In the third presentation, Jonathan Turner examines associations between early life adversity and multiple aspects of inflammatory and immune-system functioning, revealing the role of immunometabolic pathways in immunosenescence. Combined, these talks demonstrate the importance of linking sophisticated measures of early adverse exposures with detailed mechanistic measures of neural, inflammatory, immune system and metabolic functioning to better reveal the biological pathways linking ELA with short and long-term health outcomes.

Air Pollution, Built Environment, and Early Cardiovascular Disease.

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Patterns in child stunting by age: A cross-sectional study of 94 low- and middle-income countries.

Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidityand cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0-59 months old in 94 low- and middle-income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age-presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months-presumably mostly due to further adverse exposures being less detrimental for older children, and catch-upgrowth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standardsand sex. Poorer countries and households had a higher prevalence at all agesand a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch-up growth may be achieved after age 2, screening around this time can be beneficial.

Functional neuroimaging of resilience to trauma: convergent evidence and challenges for future research.

Resilience is broadly defined as the ability to adapt successfully following stressful life events. Here, we review functional MRI studies that investigated key psychological factors that have been consistently linked to resilience to severe adversity and trauma exposure. These domains include emotion regulation (including cognitive reappraisal), reward responsivity, and cognitive control. Further, we briefly review functional imaging evidence related to emerging areas of study that may potentially facilitate resilience: namely social cognition, active coping, and successful fear extinction. Finally, we also touch upon ongoing issues in neuroimaging study design that will need to be addressed to enable us to harness insight from such studies to improve treatments for - or, ideally, guard against the development of - debilitating post-traumatic stress syndromes.

Aspects to consider in causality assessment of safety signals: broadening the thought process

In the field of drug safety, causality assessment aims to determine the level of plausibility of the relationship between an adverse event and exposure to a particular product. It is after the causality assessment process that we will be able to point out a product adverse reaction. While regulators often require pharmaceutical companies to use a structured approach for assessing the causality of their products, the available methods are challenged by a number of procedural differences, even when drawing from the same domain of elements. To mitigate these inconsistencies, as well as the additional challenges associated with incomplete information and differences in the application of clinical judgments at the individual case level, this paper proposes a holistic framework for causality assessment that utilizes a combination of expert judgment/global introspection, evidence-based medicine, and probabilistic method. The goal of the presented approach is to provide a guide of clues to causality reminding medical safety assessors to seek and examine all available streams of evidence in totality and to assess this evidence in a qualitative, structured way.

Factors predicting general health concerns and atypical behaviours in children with prenatal alcohol exposure and other adverse exposures.

Prenatal alcohol exposure (PAE) can have significant negative consequences on the health outcomes of children. Children with PAE often experience other prenatal and postnatal adverse exposures. Increased rates of general health concerns and atypical behaviours are seen in both children with PAE as well as with other patterns of adverse exposures, although these have not been systematically described. The association between multiple adverse exposures and adverse health concerns and atypical behaviours in children with PAE is unknown. Demographic information, medical history, adverse exposures, health concerns, and atypical behaviours were collected from children with confirmed PAE (n = 22; 14 males, age range = 7.9-15.9 years) and their caregivers. Support vector machine learning classification models were used to predict the presence of health concerns and atypical behaviours based on adverse exposures. Associations between the sums of adverse exposures, health concerns, and atypical behaviours were examined using correlation analysis. All children experienced health concerns, the most common being sensitivity to sensory inputs (64%; 14/22). Similarly, all children engaged in atypical behaviours, with atypical sensory behaviour (50%; 11/22) being the most common. Prenatal alcohol exposure was most important factor for predicting some health concerns and atypical behaviours, and alone and in combination with other factors. Simple associations between adverse exposures could not be identified for many health concerns and atypical behaviours. Children with PAE and other adverse exposures experience high rates of health concerns and atypical behaviours. This study demonstrates the complex effects of multiple adverse exposures on health and behaviour in children.

Reduced Sleep Efficiency Mediates the Association of Adverse Childhood Experience Exposure with Impaired Vascular Endothelial Function in Young Adults

Introduction: Adverse childhood experiences (ACEs) are severe psychosocial stressors during the first 18 years of life that promote substantial increases in lifetime risk of cardiovascular disease. ACEs are highly prevalent and associated with impaired vascular endothelial function (VEF) and poor sleep, established cardiovascular risk factors. The purpose of this study was to investigate the role of sleep efficiency (SE%) in the association of ACEs with impaired VEF in young adults. We hypothesized that SE% would mediate the association of ACEs with impaired VEF. μethods: In 22 young adults (75% Female; age = 26 ± 7 y), we assessed ACE exposure and anxiety and depressive symptoms using the Zung Self-Rating Anxiety and Center for Epidemiologic Studies Depression scales, respectively. We assessed SE% as the reported total sleep duration relative to the time-in-bed from the Pittsburgh Sleep Quality Index. We also measured VEF using the flow mediated dilation technique normalized to the shear rate area under the curve. Using zero-order correlations we examined relations among ACE exposure, anxiety and depression symptoms, SE%, VEF, and age. We then utilized multiple-linear regression to examine the effect of ACE exposure and SE% on VEF while accounting for anxiety and depression symptoms. Finally, to better understand the role of SE% in the association of ACE exposure with VEF, we conducted mediation analysis with SE% as the mediator using the bootstrapped bias-corrected percentile confidence interval method. Results: ACEs were highly prevalent (64% with ≥1 ACE; 32% with ≥3 ACEs) and variable (range = 0 – 8 ACEs) in our sample. ACE exposure was associated with anxiety (r=0.48, p=0.018) and depression symptoms (r=0.48, p=0.024), SE% (r=-0.46, p=0.03), and VEF (r=-0.63, p=0.002), but was not associated with age (p=0.96). SE% was associated with VEF (r=0.59, p=0.004), but not correlated with age, anxiety, or depressive symptoms (all p≥0.14). Multiple linear regression analyses indicated that ACE exposure (β=-0.54, p<0.01) and SE% (β=0.45, p=0.02) predicted VEF independently of anxiety and depression symptoms. Further, SE% mediated the association of ACE exposure with VEF (indirect path β-estimate = -0.08 [95% CI = -0.21 – -0.009). Conclusions: ACE exposure is negatively associated with endothelial function, while SE% is positively associated with endothelial function independently of anxiety or depression symptoms among young adults. Notably, SE% appears to be a mediator in the relation between ACE exposure and endothelial function. Larger studies will be needed to more precisely quantify the role of disturbed sleep in the association of ACE exposure with impaired VEF and to determine whether improving sleep causes improvements in vascular health among those with high ACE exposure. This project was supported, in part, by funding from a pilot grant from the Iowa Injury Prevention Research Center through the CDC (R49 CE003095; NDMJ), an Old Gold Summer Fellowship (University of Iowa; NDMJ), the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Cohort profile: Bangladesh Cook Stove Pregnancy Cohort Study (CSPCS)

PurposeThe Cook Stove Pregnancy Cohort Study (CSPCS) was designed to assess the effects of biomass fuel use on household air pollution (HAP) as well as the effects of HAP (fine...

Association of maternal exposure to Superstorm Sandy and maternal cannabis use with development of psychopathology among offspring: the Stress in Pregnancy Study.

Early-life adverse experiences can elevate the magnitude of the risk of developmental psychopathology, but the potential synergistic effects of multiple factors have not been well studied. To determine whether prenatal exposures to maternal stress (Superstorm Sandy) and maternal cannabis use synergistically alter the risk of developmental psychopathology. The study included 163 children (53.4% girls), longitudinally tracked (ages 2-5 years) in relation to the effects of two early-life adverse exposures (Superstorm Sandy and maternal cannabis use). Offspring were grouped by exposure status (neither, only maternal cannabis use, only Superstorm Sandy or both). DSM-IV disorders for offspring were derived from structured clinical interviews; caregiver-reported ratings of family stress and social support were also assessed. A total of 40.5% had been exposed to Superstorm Sandy and 24.5% to maternal cannabis use. Offspring exposed to both (n = 13, 8.0%), relative to those exposed to neither, had a 31-fold increased risk of disruptive behavioural disorders (DBDs) and a seven-fold increased risk of anxiety disorders. The synergy index demonstrated that offspring with two exposures had synergistic elevation in risk of DBDs (synergy index, 2.06, P = 0.03) and anxiety disorders (synergy index, 2.60, P = 0.004), compared with the sum of single risks. Offspring with two exposures had the highest parenting stress and lowest social support. Our findings are consistent with the double-hit model suggesting that offspring with multiple early-life adverse exposures (Superstorm Sandy and maternal cannabis use) have synergistically increased risks of mental health problems. Given the increasing frequency of major natural disasters and cannabis use, especially among women under stress, these findings have significant public health implications.

«Pressure diuresis» phenomenon: mechanisms and physiological significance in diving medical support practice: prospective cohort study

INTRODUCTION: When staying in hyperbaric conditions there is an increase in diuresis, developing a negative water balance, loss of electrolytes and tissue dehydration after diving different in depth, duration, intensity and other parameters, which can be conditionally combined into specific physiological symptom complex – “pressure diuresis” phenomenon (or “diver diuresis”). OBJECTIVE: To investigate the mechanisms of “pressure diuresis” under the action of high gaseous medium pressure and determine the physiological nature of this phenomenon in divers. MATERIALS AND METHODS: 44 men aged 19–23 were examined. In the first study all the subjects had initial sustainability to hyperbaric adverse factors (decompression gas formation – DG, hypoxic hypoxia – HH, nitrogen toxic effect – NTE and oxygen toxic effect – OTE). Hormonal status and body’s osmotic homeostasis rates were defined in all the subjects. The second study evaluated changes of the subjects’ water-electrolyte metabolism, kidney function and osmotic homeostasis during the oral loading renal test with the water load in the baseline and conditions of hyperbaric adverse factor exposure on divers. Statistics: To perform statistical analysis, application packages of Statistica for Windows 10.0 were used. RESULTS: 17 (38,6 %), 29 (65,9 %), 20 (45,5 %) and 35 (79,6 %) subjects had medium and low resistance to DG, HH, OTE and NTE, respectively; 27 (61,4 %), 15 (34,1 %), 24 (54,5 %) and 9 (20,4 %) subjects had high resistance to DG, HH, OTE and NTE. Increase in the concentration of antidiuretic hormone was identified in the diving group with low and medium resistance to NTE, HH, and OTE (by 146,8, 141,1 and 93,2 %, respectively, compared to the results before hyperbaric adverse factor exposure). The highest concentration increase of aldosterone was found among the divers with low and medium resistance to OTE, DG and HH (by 41,5, 39,1 and 36,2 %, respectively). The increase in blood plasma osmolality was observed in the subjects with low and medium resistance to OTE (an increase by 6,6 % compared to the divers with high resistance). A significant reduction in blood plasma osmolality was recorded in the subject group with low and medium resistance to NTE and HH (reduction by 5,2 and 4,2 %, compared to the group with high resistance). The most significant decrease in urine osmolality was identified in the diving group with low and medium resistance to DG and OTE (reduction by 14,5 and 17,7 %, respectively). A significant increase in urine osmolality under the action of hyperbaric factors was defined in the diving group with low and medium resistance to NTE and HH (by 19,8 and 19,3 %). DISCUSSION: The data obtained indicate the emergence of a new body hydration status during person’s staying in hyperbaric conditions. Body hydration status will be connected with its individual resistance to hyperbaric adverse factor effect. Thus, with the development of marked DG iso-osmotic (isotonic) hyperhydration is formed, with OTE hyperosmotic (hypertonic) hyperhydration occurs, with NTE and HH hypo-osmolar (hypotonic) hyperhydration develops. CONCLUSION: The study showed a certain connection (correlation) between types of hyperhydration in the tissues of a diver’s body, mechanisms of occurrence, low and medium initial resistance to a particular hyperbaric factor. “Pressure diuresis” phenomenon (“diver diuresis”), that occurs in divers with high resistance to hyperbaric adverse factors, will be a normal body’s physiological response, aimed at eliminating hypervolemia and reduction in the volume of circulating plasma.

Overlap Between Exposure to Suicidal Behavior and Indirect Interpersonal Violence: Evidence for a More Integrated Approach to Violence Research.

This study examines the overlap between indirect exposure to forms of interpersonal violence and suicidal behavior, and the impact of the co-occurrence of these exposures on indicators of depressed mood and substance use among adolescents. Participants were a national sample of 3,917 youth aged 14-15 years, recruited online between June 2018 and March 2020, including an oversample of sexual and gender minority youth. Eight in ten (81.3%) youth reported exposure to indirect interpersonal violence and/or suicidal behavior in their lifetimes: 39.5% reported only interpersonal violence exposure, 5.9% only suicidal behavior exposure, and 35.9% reported both. Youth who reported exposure to interpersonal violence were almost three times more likely (adjusted odds ratio [OR] = 2.78, p < .001) to also report suicidal behavior exposure. Compared with youth having no indirect violence exposure, those with only interpersonal violence exposure were 2.25 times more likely (p < .001), those with only exposure to suicidal behavior 2.93 times more likely (p < .001), and those with both were 5.63 times more likely to report recent depressed mood. The unadjusted odds of any substance use was significantly elevated for each type of indirect violence exposure, with the highest odds seen among youth with dual interpersonal violence and suicide exposure (OR = 4.87, p < .001). For both outcomes, significant findings remained but were attenuated after adjusting for demographic characteristics, non-victimization adversity exposure, and cumulative direct victimization. Findings suggest that the combination of exposure to interpersonal violence and suicidal behavior appears to be particularly impactful. Results highlight that assessment of trauma exposure among adolescents needs to be more comprehensive and include not only direct and indirect interpersonal violence, but also knowledge of other people's suicidal thoughts and behaviors.

Hair Collection for Cortisol Among Youth Experiencing Homelessness.

Investigations of chronic physiological stress measured by hair cortisol are rapidly expanding among community samples of adolescents and adults. However, research examining physiological stress among youth experiencing homelessness is nascent despite the youth's increased risk for adverse exposures and subsequent impaired mental health. This article aimed to examine the feasibility of collecting hair for measuring cortisol among diverse youth experiencing homelessness and gain an understanding of variation in participation. Analysis of survey and hair participation data from three pilot studies among youth experiencing homelessness was conducted. Survey measures included sociodemographic characteristics (age, race and ethnicity, sex assigned at birth, and sexual orientation) and reasons for nonparticipation. Descriptive analysis examined participation rates in hair collection for cortisol measurement, including sociodemographic differences in participation. Participation in the hair sampling for cortisol was high for the combined sample (88.4%), with some variation across the three pilot studies. Insufficient hair for cutting was the most common reason for not participating; Black and multiracial youth, as well as male youth, had a higher prevalence of nonparticipation. The collection of hair for cortisol research among youth experiencing homelessness is feasible, and integration of physiological measures of stress into research with this vulnerable population should be considered, given their high risk for adversity and death by suicide and drug overdose. Methodological considerations and avenues for potential research are discussed.

Sensitivity and specificity in signal detection with the reporting odds ratio and the information component.

As measures of association between an adverse drug reaction (ADR) and exposure to a drug the reporting odds ratio (ROR) and the information component (IC) can be used. We sought to test the reliability of signal detection with these. We simulated ADR counts as binomially distributed random numbers for different expected ADR frequencies and theoretical reporting odds ratios (RORs). We then calculated the empirical IC and the empirical ROR and their confidence intervals. The rate of signals that was detected despite a theoretical ROR of 1 represented the false positive rate, and represented the sensitivity if the ROR was >1. For expected case counts below 1 the false positive rate oscillates from 0.01 to 0.1 even though 0.025 were intended. Even beyond expected case counts of 5 oscillations can cover a range of 0.018 to 0.035. The first n oscillations with the largest amplitude are eliminated if a minimum case count of n is required. To detect an ROR of 2 with a sensitivity of 0.8, a minimum of 12 expected ADRs are required. In contrast, 2 expected ADRs suffice to detect an ROR of 4. Summaries of measures for disproportionality should include the expected number of cases in the group of interest if a signal was detected. If no signal was detected the sensitivity for the detection of a representative ROR or the minimum ROR that could be detected with probability 0.8 should be reported.

Assessing unpredictability in caregiver-child relationships: Insights from theoretical and empirical perspectives.

There has been significant interest and progress in understanding the role of caregiver unpredictability on brain maturation, cognitive and socioemotional development, and psychopathology. Theoretical consensus has emerged about the unique influence of unpredictability in shaping children's experience, distinct from other adverse exposures or features of stress exposure. Nonetheless, the field still lacks theoretical and empirical common ground due to difficulties in accurately conceptualizing and measuring unpredictability in the caregiver-child relationship. In this paper, we first provide an overview of the role of unpredictability in theories of caregiving and childhood adversity and present four issues that are currently under-discussed but are crucial to the field. Focusing on how moment-to-moment and day-to-day dynamics are at the heart of caregiver unpredictability, we review three approaches aiming to address some of these nuances: Environmental statistics, entropy, and dynamic systems. Lastly, we conclude with a broad summary and suggest future research directions. Systematic progress in this field can inform interventions and policies aiming to increase stability in the lives of children.

Psychosocial model of burnout among humanitarian aid workers in Bangladesh: role of workplace stressors and emotion coping

BackgroundWhile trauma exposure is an established predictor of poor mental health among humanitarian aid workers (HAWs), less is known about the role of psychosocial work-related factors. This study aims to establish a psychosocial model for burnout and psychological distress in HAWs that tests and compares the effects of adversity exposure and workplace stressors in combination, and explores the potential mediating role of individual coping styles.MethodsPath analysis and model comparison using cross-sectional online survey data were collected from full-time international and local HAWs in Bangladesh between December 2020 and February 2021. HAWs self-reported on exposure to adversities, workplace psychosocial stressors (Third Copenhagen Psychosocial Questionnaire), coping styles (Coping Inventory for Stressful Situations), burnout (Maslach Burnout Inventory—Human Services Survey), and psychological distress (Kessler-6).ResultsAmong N = 111 HAWs, 30.6%, 16.4%, 12.7%, and 8.2% screened positive for moderate psychological distress (8 ≤ Kessler-6 ≤ 12), emotional exhaustion (EE ≥ 27), depersonalization (DP ≥ 13), and severe psychological distress (K-6 ≥ 13), respectively. 28.8% reported a history of mental disorder. The preferred model showed distinct pathways from adversity exposure and workplace stressors to burnout, with negative emotion-focused coping and psychological distress as significant intervening variables. While greater exposure to both types of stressors were associated with higher levels of burnout and distress, workplace stressors had a stronger association with psychological outcomes than adversity exposure did (β = .52, p ≤ .001 vs. β = .20, p = .032). Workplace stressors, but not adversities, directly influenced psychological distress (β = .45, p ≤ .001 vs. β = −.01, p = .927). Demographic variables, task-focused and avoidance-focused coping were not significantly associated with psychological outcomes.ConclusionsCompared to exposure to adversities, workplace stressors primarily influenced occupational stress syndromes. Reducing workplace stressors and enhancing adaptive coping may improve psychological outcomes in humanitarian staff.

Individual, familial, and sociocontextual correlates of maternal caregiving among African American adolescents in public housing

AbstractObjectiveAfrican American adolescents (N = 372), recruited from public housing in three large U.S. cities, participated in this study that explores individual, familial, and sociocontextual correlates of maternal caregiving profiles, based on supervision and encouragement.BackgroundMaternal caregivers play an important role in ensuring the safety and welfare of adolescents as they encounter multiple challenges in their social environment. Public housing magnifies the risk of experiencing such challenges for African American adolescents. Evidence on the experiences of African American adolescents living in public housing is scarce. Our study contributes to this body of knowledge by exploring profiles of maternal caregivers, based on supervision and encouragement, their association with demographics, and familial and sociocontextual challenges among adolescents in public housing.MethodUsing multinomial logistic regression, we explore the associations between profiles of maternal caregiving, based on supervision and encouragement and adolescent characteristics, adolescents' experiences, and assessment of their family (e.g., quality of parent–child relationship, family conflict) and sociocontextual (e.g., peer influence, victimization, witnessing of community violence).ResultsAdolescents living in households with high levels of maternal encouragement and supervision reported a high‐quality relationship with their caregivers and less witnessing of community violence. These adolescents were also less likely to report victimization.ConclusionsThe study identified parenting strategies that could potentially reduce risks of adverse exposures among urban African American youth in public housing. Practitioners and policymakers must consider programs to bolster these strategies and further serve urban African American adolescents in challenging environments.

Association between early life adversity and allostatic load in girls with precocious puberty

ContextThe mechanisms underlying the elevated long-term health risk in girls with precocious puberty remain unclear, but might result from physiological wear and tear associated with greater exposure to early life adversity. ObjectiveThis study aims to explore early life adversity in girls with precocious puberty and its association with allostatic load. MethodsEarly life adversity and hair cortisol concentration were measured among 213 girls with precocious puberty (8.21 ± 1.07). Allostatic load score is constructed by using 13 physiological biomarkers representing four systems and hair cortisol concentration. Multivariate linear regression models have estimated the associations between cumulative early life adversity exposure with total and system-specific allostatic load scores. Associations between cumulative early life adversity and the risk of high allostatic load (3 + high-risk biomarkers) were tested using binary logistics regression. ResultsMore than two-thirds (67.6%) of girls with central precocious puberty reported two or more early life adversity exposure. Compared to those with no early life adversity exposure, girls who reported early life adversity score ≥ 2 had significantly higher total allostatic load score (β: 1.20–1.64, P < 0.001). Metabolic system was more sensitive to cumulative early life adversity exposure, each form of early life adversity exposure was associated with 0.48-unit increases in metabolic allostatic load score (95%CI: 0.06, 0.90, P = 0.026). Girls reported early life adversity score ≥ 3 were three times more likely to have a high allostatic load compared with those without early life adversity exposure in both unadjusted and adjusted models (ORadjusted=3.83, 95%CI: 1.17, 12.55, P = 0.001). ConclusionMultisystem physiological dysregulation is observed in girls with central precocious puberty, which might result from cumulative wear-and-tear associated with early life adversity.