Long-term Negative Health Effects Research Articles

Assessing the Effects of Household Wood Burning on Particulate Matter in Rwanda

Considerable efforts have been made to protect people from indoor air pollutant exposure as approximately 80% of people spend time indoors where pollution is often worse than outside. Further, vulnerable populations, including elderly, children, and pregnant women, spend an excessively of time indoors, exposing them to pollutants that are responsible for both short-term and long-term negative health effects, resulting an estimated 4 million premature deaths annually. Aim of this research was to assess impressions of domestic use of solid fuels (firewood and charcoals) burning on Particulate Matter PM2.5 and PM10, which are particles that are less than or equal to 2.5 and 10 micrograms (μm) in diameter respectively within Kigali the capital city of Rwanda. A sample of 31 households using only charcoals and woods for cooking were selected for targeted 72 hours of monitoring. Portable air quality sensors AirVisual Nodes were used to measure concentration levels of PM2.5 and PM10 in microgram per cubic meter (μg/m3). Results showed that homes using wood for cooking experience moderately high concentrations level of PM2.5 and PM10, over 1000 μg/m3 and 1200 μg/m3 respectively, whereas homes using charcoals for cooking had lower concentrations. This later direct to that: Outstanding to low market prices of these solid fuels, poorer households are highly exposed to indoor air pollution. So, an alternative reasonably priced domestic energy to be used for cooking are indorsed and pollution levels survey in households using combination or different types of fuels for cooking are recommended for future research.

When Love Hurts - Mental and Physical Health Among Recently Divorced Danes.

The last decades of research have consistently found strong associations between divorce and adverse health outcomes among adults. However, limitations of a majority of this research include (a) lack of “real-time” research, i.e., research employing data collected very shortly after juridical divorce where little or no separation periods have been effectuated, (b) research employing thoroughly validated and population-normed measures against which study results can be compared, and (c) research including a comprehensive array of previously researched sociodemographic- and divorce-related variables. The current cross-sectional study, including 1,856 recently divorced Danes, was designed to bridge these important gaps in the literature. Mental and physical health were measured using the Short Form 36 (SF-36)-2. Analyses included correlational analyses, t-test comparisons, and hierarchical multiple regression analyses. The study found that the health-related quality of life of Danish divorcees was significantly worse than the comparative background population immediately following divorce. Across gender, higher levels of divorce conflict were found to predict worse mental health, and worse physical health for women, even when controlling for other socio-demographic variables and divorce characteristics. Among men, lower age and higher income predicted better physical health, while more children, more previous divorces, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. Among women, higher income, fewer previous divorces, new partner status, and lower levels of divorce conflict predicted better physical health while higher income, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. The findings underscore the relevance of providing assistance to divorcees who experience higher levels of divorce conflict immediately following divorce, in seeking to reduce potential long-term negative health effects of divorce.

Predictors of intimate partner violence in patients attending general health services at rural health facilities in Makueni county, Kenya

Purpose: Intimate partner violence (IPV) is a significant but preventable public health problem. IPV can take the form of physical, sexual, verbal, emotional or economic abuse between two people who are in an intimate relationship. Despite the short and long-term negative health, social, cultural and economic consequences of IPV, there is paucity of research on IPV in Kenyan Context. This study sought to determine the different types of IPV and associated factors in both genders in Kenya. Methods: This was a cross-sectional study involving 8310 consenting respondents who had screened positive for common mental disorders on the mhGAP-IG. They were administered a socio-demographic questionnaire, a DSM-IV/ICD10 confirmatory diagnosis instrument, a epilepsy services questionnaire and WHO instrument for various types of IPV. Appropriate analyses were undertaken to determine the factors associated with of IPV across both genders. Results: Eighty two percent (82.4%) of the participants were confirmed to have a mental disorder. Those with confirmed DSM-IV diagnosis reported higher levels of IPV compared to those without mental disorders. Depression was the most common mental disorder among genders. All types of IPV were found in both genders with higher prevalence in females. Controlling behavior and emotional abuse were most common in both genders. Conclusion: IPV was found in both genders and was associated with various mental disorders. Predictive factors included: socio-demographic, economic factors and mental health disorders and in particular depression. Routine community-based awareness campaigns followed by voluntary screening for IPV and mental disorders for intimate partners are recommended.

Young adolescents’ experiences and views on eating and food

PurposePoor eating habits established during adolescence are likely to lead to negative long-term health consequences. The childhood obesity epidemic is a growing public health concern, largely attributed to obesogenic environments. This study aims to explore the multiple factors contributing positively or negatively to young consumers’ attitudes towards their food consumption.Design/methodology/approachIn total, 42 11- to 13-years-old (24 men and 18 women) from three secondary schools in Wales participated in five focus group discussions. The process of thematic analysis resulted in several identified themes that influenced young consumers’ eating habits.FindingsExtrapersonal factors compromised: education, peer pressure, parenting, availability and social media; and intrapersonal factors included: health consciousness, taste preferences, convenience and price consciousness. Contrary to previous research, the adolescent participants perceived their parents as more influential than their peer group, even during decision-making in the school canteen.Practical implicationsThese research findings are beneficial for policy-makers working to develop an age-appropriate multi-factorial approach to promote healthful dietary practices amongst young consumers. For instance, increasing easily accessible food-to-go choices that are not only convenient to purchase and consume but also healthful could improve dietary intake.Originality/valueA novel connection between peer pressure and convenience was discovered. Multiple factors contribute to young consumers’ attitudes towards food and their dietary habits.

Primary school children’s diet assessment with a 7-day diary – comparison between Italy and Poland

Abstract Background Dietary habits acquired in childhood are often followed in later life, and if unfavourable may result in negative long-term health consequences. The study aimed to assess diet of primary school children with an interactive 7-day food diary in the form of a colouring book. Methods At first the study was conducted among 428 primary school children from Calderara di Reno (Italy). After questionnaire's translation and adjustment, the study continued as a pilot-study among 83 children from Wałbrzych (Poland). Under supervision of parents and teachers children completed a 7-day food diary. The quality of diet was evaluated with KIDMED test. Composition of breakfast was rated due to content of water (+1), carbohydrates (+1), proteins (+1), fibre (+1), vitamins/minerals (+1), free sugars (-1), assuming adequate breakfast if scored > =3 points and contained source of protein or carbohydrates. Statistical analysis with chi-square test was performed. Results Adherence to the model diet was medium or high among 64.49% of Italian and 40% of Polish children (p < 0.001). Significantly more Italian children had adequate breakfast each day during a week (51.17% vs 27.71%, p < 0.001) and each school day (51.40% vs 34.94%, p = 0.006). There was no difference in number of children consuming well-balanced breakfast during a weekend (p = 0.749). Consumption of fruits and vegetables in both groups was far below recommended level- 75.9% of Italian and 81.9% of Polish children ate less than 3 portions of fruits and vegetables per day. Conclusions The study underlines the need for improvement of children's diet and increase in parent's awareness of family eating habits. This 7-day diary is a innovative tool, which allows identification of incorrect dietary behaviours among children and enables school professionals to design adapted health promotion activities and educational programmes for pupils and parents, aiming to increase knowledge about the role of diet and nutrition in health. Key messages There is a constant need for nutritional education and healthy lifestyle promotion among children, parents and teachers. Assessment of children’s diet and screening for unfavourable dietary habits may be helpful in planning health promotion and preventive activities at schools.

A sequential multiple assignment randomized trial (SMART) protocol for empirically developing an adaptive preventive intervention for college student drinking reduction

College student alcohol use and associated negative consequences are clear public health problems with consequences including damage to self, others, and institutions. This paper describes the protocol of a research study designed to answer a number of important questions in the development of an adaptive preventive intervention (API) to reduce high-risk drinking among first-year college students. The API is designed to educate students and to motivate heavy-drinking college students to engage in existing resources to support reducing high-risk alcohol use, by leveraging technology-based intervention modalities. The primary outcome is a reduction in binge drinking, with secondary outcomes of reducing negative alcohol-related consequences and increasing health services utilization. Adaptive preventive interventions have the potential to reduce the acute and long-term negative health consequences of young adult alcohol use.

Disturbing medical findings in war-related traumatic amputation patients: a clinical descriptive study from Gaza

ObjectivesThe aim of this study was to explore possible long-term negative health effects of injuries sustained by modern weaponry.SettingThe study was conducted in Gaza’s main hospital, Al-Shifa Hospital.ParticipantsDuring the last...

Evaluating Undergraduate Alcohol Health Literacy and Education Efficacy

This study examined the U.S. undergraduate students’ knowledge of the long-term health effects of alcohol consumption. It also examined the efficacy of alcohol education programs at informing students of health effects and influencing drinking behavior. A national online questionnaire was distributed to collect self-reported data from students. Findings indicate that student knowledge of the health risks of alcohol consumption is poor. Around half of undergraduate students are aware that alcohol is associated with some negative health effects, but far fewer are aware of alcohol’s specific health risks. Additionally, findings reaffirm that alcohol consumption and binge drinking remain common behaviors among students, and suggest that, despite widespread adoption, alcohol education programs are not very effective at reducing alcohol consumption. Most research participants reported that knowledge of negative long-term health effects of alcohol consumption was unlikely to influence their drinking behavior.

Severe postpartum hemorrhage increases risk of posttraumatic stress disorder: a prospective cohort study

Purpose To evaluate whether severe postpartum hemorrhage (PPH) is a risk factor for posttraumatic stress disorder (PTSD). Severe PPH can be experienced as a traumatic event. PTSD leads to negative mental health effects. Knowing risk factors for PTSD during childbirth offers opportunities for early interventions, which may prevent the development of PTSD. Materials and methods In this prospective study, we compared two groups of participants; women with ≥2000 mL of blood loss (severe PPH, patients) and women with ≤500 mL of blood loss (controls). Participants were screened for PTSD using the PCL-5 four to six weeks after delivery. Positive screening was followed by the CAPS-5 to diagnose PTSD. Results We included 187 PPH patients and 121 controls. Median PCL-5 scores were higher for PPH patients (5.0) than controls (4.0, p = 0.005). Thirteen PPH patients (7.0%) and two controls (1.7%) scored ≥32 on the PCL-5, indicative of probable PTSD (OR 4.45, 95% CI 0.99-20.06, p = 0.035). Significant more PPH patients than controls met criteria for a clinical diagnosis of PTSD on the CAPS-5 (n = 10, 5.6% vs n = 0, 0.0%; p = 0.007). Conclusions There is a significant and clinically relevant increased risk for developing PTSD after severe PPH. Gynecologists and midwives are advised to screen for PTSD at postpartum follow-up visits to prevent long-term negative mental health effects. Clinical Trial Registration NL50273.100.14

Secondary Hypertension in Children and Adolescents: Novel Insights.

Hypertension is a significant risk factor for cardiovascular morbidity and mortality, not only in adults, but in youths also, as it is associated with long-term negative health effects. The predominant type of hypertension in children is the secondary hypertension, with the chronic kidney disease being the most common cause, however, nowadays, there is a rising incidence of primary hypertension due to the rising incidence of obesity in children. Although office blood pressure has guided patient management for many years, ambulatory blood pressure monitoring provides useful information, facilitates the diagnosis and management of hypertension in children and adolescents, by monitoring treatment and evaluation for secondary causes or specific phenotypes of hypertension. In the field of secondary hypertension, there are numerous studies, which have reported a strong association between different determinants of 24-hour blood pressure profile and the underlying cause. In addition, in children with secondary hypertension, ambulatory blood pressure monitoring parameters offer the unique advantage to identify pediatric low- and high-risk children for target organ damage. Novel insights in the pathogenesis of hypertension, including the role of perinatal factors or new cardiovascular biomarkers, such as fibroblast growth factor 23, need to be further evaluated in the near future.

Multi-population cohort meta-analysis of human intestinal microbiota in early life reveals the existence of infant community state types (ICSTs)

Appropriate development of the intestinal microbiota during infancy is known to be important for human health. In fact, aberrant alterations of the microbial composition during childhood may cause short- and/or long-term negative health effects. Many factors influence the initial assembly and subsequent progression of the gut microbiota of a neonate, such as feeding type, delivery mode, gestational age, maternal metabolic status and antibiotic exposure.In the current study, the composition of the infant gut core-microbiota was explored, revealing particular variations of this core-microbiota during the first three years as influenced by delivery mode and feeding type. A multi-population cohort meta-analysis was performed by selecting 15 publicly available datasets pertaining to taxonomic profiles of 1035 fecal samples of healthy infants, as obtained by means of a 16S rRNA gene-based profiling approach. Interestingly, this multi-population cohort meta-analysis revealed great microbial complexity and specific taxonomic shifts in children older than six months, suggesting a major impact by the introduction of solid foods which prompts progression of infant gut microbiota towards that typical of adults. The taxonomic data sets employed in this multi-population cohort meta-analysis possess the statistical robustness to allow the identification of infant community state types (ICSTs). Our analysis therefore reveals the existence of specific taxonomic patterns that correspond to particular nutritional and developmental stages of early life, and that had previously been obscured by the high variability typical of such infant gut microbiota.

Environmental Tobacco Smoke Affects Lung Function of Preschoolers With Asthma Even After a Decade

To evaluate whether early tobacco smoke exposure has a long-term effect on lung function.Children (n = 105; mean age: 5.62 years) with a history of wheeze and bronchodilator response had been previously enrolled for a study evaluating the association between maternal smoking and preschool asthma. Children could not have taken corticosteroids in the previous 6 months nor have had a respiratory tract infection in the previous 2 weeks. These children were evaluated at a follow-up visit 10 years after the initial enrollment (n = 64; mean age: 14.22 years).The cohort in this study had been assessed at enrollment for environmental tobacco smoke exposure by urinary cotinine and questionnaires. At both enrollment and the 10-year follow-up, fractional exhaled nitric oxide (FeNO), impulse oscillometry (IOS), blood eosinophil counts, and allergic sensitization to indoor and outdoor aeroallergens were assessed. At the 10-year follow-up, children also performed spirometry and a methacholine challenge. Results were compared between enrollment and follow-up.At the 10-year follow-up, fewer children wheezed in the previous year (11% vs 83%), whereas more children had positive allergy testing results (92% vs 70%). Blood eosinophil count, FeNO, and total respiratory system resistance (resistance at 5 Hz [R5]), one of the IOS indices, were all decreased at follow-up. Forty-three percent of parents stopped smoking during the 10 years. Approximately one-third of children reported asthma symptoms and the need for asthma medications in the previous 2 months at the follow-up visit. None reported smoking. Being overweight correlated with forced expiratory volume in 1 second and/or forced vital capacity and the IOS indices (R5 and area under reactance), at the follow-up visit but did not correlate with the preschool urinary cotinine levels. However, preschool urinary cotinine levels did significantly correlate with increased FeNO scores, blood eosinophils, and R5 and decreased reactance (by 5) at the follow-up. No significant correlation was seen with forced expiratory volume in 1 second or methacholine challenge.Early tobacco smoke exposure is linked to the presence of airway inflammation and decreased lung function in older children with a history of asthma.Limitations included the lack of a control asthma group without preschool exposure to tobacco smoke, the small sample size, and lack of interval assessment during the 10-year period to evaluate the potential confounding effect of other environmental factors, socioeconomic factors, or the development of other comorbidities. The study also did not consider whether aeroallergen sensitization had an impact on lung function over time. IOS is not as commonly performed as spirometry for the assessment of asthma, so the use of IOS in assessing and managing asthma in a clinical practice needs further validation. Nevertheless, this study provides further proof that early exposure to tobacco smoke in childhood potentially has long-term negative health effects.

Estimation of the apnea-hypopnea index in a heterogeneous sleep-disordered population using optimised cardiovascular features

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder, which results in daytime symptoms, a reduced quality of life as well as long-term negative health consequences. OSA diagnosis and severity rating is typically based on the apnea-hypopnea index (AHI) retrieved from overnight poly(somno)graphy. However, polysomnography is costly, obtrusive and not suitable for long-term recordings. Here, we present a method for unobtrusive estimation of the AHI using ECG-based features to detect OSA-related events. Moreover, adding ECG-based sleep/wake scoring yields a fully automatic method for AHI-estimation. Importantly, our algorithm was developed and validated on a combination of clinical datasets, including datasets selectively including OSA-pathology but also a heterogeneous, “real-world” clinical sleep disordered population (262 participants in the validation set). The algorithm provides a good representation of the current gold standard AHI (0.72 correlation, estimation error of 0.56 ± 14.74 events/h), and can also be employed as a screening tool for a large range of OSA severities (ROC AUC ≥ 0.86, Cohen’s kappa ≥ 0.53 and precision ≥70%). The method compares favourably to other OSA monitoring strategies, showing the feasibility of cardiovascular-based surrogates for sleep monitoring to evolve into clinically usable tools.

Risk and protective factors for substance use among youth experiencing homelessness

BackgroundThough research finds that youth experiencing homelessness (YEH) have high rates of substance use, which can lead to numerous long-term negative health effects, less is known about both risk and protective factors for substance use. Moreover, even less is known about whether these factors differ for lesbian, gay and bisexual (LGB) youth compared to non-LGB youth. In the current study, we compared risk and protective factors for binge drinking, marijuana use, and illicit drug use (i.e. substance use) among heterosexual and sexual minority YEH. MethodsThe sample included 322 young people experiencing homelessness in the Midwestern United States and who were between 16 and 26 years of age. Almost one-half of our sample were female (N = 146; 45%) and 68 youth (21%) identified as LGB. ResultsYouth who experienced more child physical abuse, ran away from home more frequently, and those who had a parent(s) with drug problems were more likely to have reported binge drinking in the past 30 days. Additionally, having parents with drug problems was associated with the use of marijuana and illicit drugs. Conversely, having higher parental monitoring while growing up reduced the likelihood of using marijuana and illicit drugs. Tests for interactions revealed that while self-efficacy had no relationship with the probability of binge drinking for heterosexual youth, as self-efficacy increased, the probability of binge drinking declined drastically for sexual minority youth suggesting this protective mechanism operates differently for these two groups of youth. Additionally, tests of interactions showed that the probability of binge drinking among heterosexual and sexual minority youth also varied by child sexual abuse and street sexual victimization. ConclusionStudy results have implications for service providers who serve YEH.

Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit.

Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.

How adolescents cope with food insecurity in Baltimore City: an exploratory study.

To increase our understanding about food insecurity among urban adolescents, we conducted a qualitative study in Baltimore City with adolescents to: (i) explore how adolescents experience and cope with food insecurity; and (ii) identify community-based approaches or interventions for addressing food insecurity. A total of eight focus groups were conducted across six neighbourhoods. To gather sociodemographic characteristics and personal data on food insecurity, all consented adolescents completed a brief questionnaire. Six purposively selected neighbourhoods in Baltimore City, USA. A total of fifty-three adolescents between the ages of 14 and 19 years participated in the study. Although half of our sample was classified as food insecure, everyone in the focus groups was aware of adolescents who engaged in risky behaviours to get money for food. Among girls, prostituting was the most commonly mentioned behaviour, whereas for boys, it was selling drugs or stealing to get money for food. Adolescents also described tremendous stigma associated with food insecurity and agreed that food insecurity has to be viewed within a broader set of economic challenges. Addressing food insecurity among adolescents in disadvantaged neighbourhoods should be a high priority for policy makers and practitioners. Current feeding programmes are not addressing the needs of adolescents; as a result, adolescents are at risk for a variety of harmful behaviours and outcomes, with long-term negative health and social consequences.

Shift work, DNA methylation and epigenetic age.

Shift work has been associated with increased risk of age-related morbidity and mortality. Biological age, estimated using DNA methylation (DNAm), may quantify the biological consequences of shift work on the risk of age-related disease. We examined whether prior employment in shift-working occupations was associated with epigenetic age acceleration. In a sample of non-Hispanic White women aged 35-74 (n = 2574), we measured DNAm using the Illumina Infinium Human450 BeadChip and calculated DNAm age using three established epigenetic clocks. Age-acceleration metrics were derived by regressing DNAm age on chronological age and predicting the residuals. Using linear regression, we estimated associations between shift work history and age acceleration. We also conducted an epigenome-wide association study using robust linear-regression models corrected with false discovery rate (FDR) q-values. Approximately 7% of women reported any shift work. Higher age acceleration was observed for a 1-year increase in overall [β = 0.11, 95% confidence interval (CI): 0.02-0.21] and night-specific shift work (β = 0.12, 95% CI: 0.03-0.21). The association was strongest for ≥10 years of night shift work (β = 3.16, 95% CI: 1.17-5.15). From the epigenome-wide association study, years of overall and night shift work were associated with DNAm at 66 and 85 CpG sites (FDR < 0.05), respectively. Years of night shift work was associated with lower methylation of a CpG in the gene body of ZFHX3 (cg04994202, q = 0.04), a gene related to circadian rhythm. Shift work was associated with differential CpG site methylation and with differential DNAm patterns, measured by epigenetic age acceleration, consistent with long-term negative health effects.

Perceived health effects of vaping among Hungarian adult e-cigarette-only and dual users: a cross-sectional internet survey

BackgroundKnowledge about the health effects of e-cigarette use (or vaping) among past and current combustible cigarette users is limited. Several studies have assessed vaping-related adverse events (AEs) and beneficial health effects, however, most studies focused on AEs in general and examined only a few physiological changes that vapers experience. This study aims to explore self-reported AEs and perceived health changes due to e-cigarette use among Hungarian adult e-cigarette-only users (former smokers who switched completely to e-cigarette use) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly).MethodsA cross-sectional, web-based survey of 1042 adult Hungarian e-cigarette users was conducted in 2015. Participants reported AEs and changes in physiological functions since they switched from smoking to e-cigarette use or while dually using e-cigarettes and combustible cigarettes. Confirmatory factor analysis with covariates was applied to explain perceived health changes due to e-cigarette-only use and dual use.ResultsDual users (17.6%) were significantly more likely to report AEs of vaping than e-cigarette-only users (26.2% vs. 11.8%, p < 0.001). Experiencing health improvements were significantly more likely among e-cigarette-only users than for dual users for all surveyed physiological functions. E-cigarette-only users reported larger effects of vaping on sensory, physical functioning, and mental health factors compared to dual users. Self-reported changes in sensory and physical functioning were significantly higher among individuals using e-cigarettes more than a year and people who were past heavy smokers (smoked ≥20 cigarettes per day). Gender was related to sensory improvement only; males reported greater improvement than females.ConclusionsThe majority of e-cigarette-only users reported more perceived beneficial changes in physiological functions and fewer AEs than dual users. Perceived short-term benefits of e-cigarette use may reinforce users despite the uncertainty of long-term health consequences. Health professionals should provide balanced information regarding the possible short- and long-term positive and negative health effects of e-cigarette use during consultations with patients.

Childhood Sexual Abuse and Depression among American Indians in Adulthood.

The present study investigated distal and proximal factors associated with depression among a sample of 479 American Indian (AI) adults in the Midwest. Distal factors included histories of childhood sexual abuse (CSA) and other childhood adversities. Proximal factors included levels of health self-efficacy and treatment for alcohol problems. The study also examined the moderating effect of treatment for alcohol problems on the relationship between CSA and depression. In model 1, results indicate that CSA was positively related to depression after controlling for demographic and background variables. In model 2, childhood adversities and treatment for alcohol problems were associated with increased depression in AI adults; CSA became nonsignificant. As a protective factor, level of health self-efficacy was negatively associated with depression. In model 3, treatment for alcohol problems magnified the effect of CSA on depression. These findings suggest that early traumatic experiences may have persistent, harmful effects on depression among AIs; one mechanism exacerbating the impact of CSA on depression is treatment for alcohol problems. Targeted interventions are needed to mitigate the long-term negative health effects of childhood trauma in this population and to strengthen proximal protective factors, such as health self-efficacy.

Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome.

The negative long-term health consequences of obesity are well known to both the medical profession and general public. Despite this, the number of obese and overweight individuals worldwide continues to steadily rise. Although obesity has long been associated with an increased risk for cardiovascular disease and mortality, the classification of a cardiomyopathy of obesity is a more recent development. Obesity cardiomyopathy is characterized as myocardial dysfunction or heart failure in obese individuals independent of other cardiovascular risk factors. The purpose of this report is to provide an overview of obesity cardiomyopathy and the proposed pathophysiological mechanisms underlying this disease, as well as to examine the link between obesity cardiomyopathy and sleep-related disorders.