Subsequent Health Problems Research Articles

Social and Behavioral Factors, Oral Health, and Dental Care Utilization

Oral health status and dental care utilization is strongly associated with social and behavioral factors and health outcomes. The five papers in this symposium address how several of these factors affect oral health and dental care among diverse groups of older adults. Using data from the Health and Retirement Study, the first paper examined the impact of early childhood disadvantages on oral health in later life among adults age 51 and above in the U.S. The second paper used large-scale epidemiological data that addressed the relationship between acculturation and subsequent oral health problems. It also tested the moderating role of neighborhood disorder in such a relationship among older Chinese Americans. The third paper demonstrated the importance of examining different pathways among foreign-born and native-born Chinese older adults with regard to offspring’s support on their oral health outcomes. While increasing evidence shows that cognitive function is associated with oral health, limited studies have been conducted to examine the impact of cognitive impairment, e.g., Alzheimer’s Disease (AD) and related dementias (RD), on dental care utilization and costs in older adults. The fourth paper aimed to address this knowledge gap. Results showed that AD and RD had different impacts on different types of dental care utilization and costs. The fifth paper further displayed that individuals with cognitive impairment face a significant challenge in handling dental-related medications. This symposium provides policy and clinical implications on improving oral health and dental care utilization among older adults in the U.S. Oral Health Interest Group Sponsored Symposium.

IN2 A Model-Based Estimation of the Cost-of-Illness Associated with Neisseria gonorrhoea in England and the USA: Assessing the Potential Impact of Antimicrobial Resistance and Long-Term Health Problems

Both Neisseria gonorrhoeae (Ng) incidence and antimicrobial resistance (AMR) are increasing in England and the USA. Existing cost-of-illness analyses are limited, regarding quantification of AMR impact and long-term health consequences of Ng infection. We conducted a cost-of-illness study in these countries to specifically address these gaps. A Markov-model, using 2018 surveillance data, simulated Ng infections over a lifetime in three sexually-active cohorts aged 13-75 years: women, men-having-sex-with-men (MSM) and men-having-sex-with-women (MSW). A decision tree modelled the probabilities and costs of Ng infections and subsequent long-term health problems i.e., pelvic inflammatory disease (PID), infertility, human immunodeficiency virus (HIV) and prostate cancer, and AMR impact. All input parameters were from the literature. Discount rates of 3.5% (England) and 3% (USA) were applied. Scenarios explored varying AMR prevalence over time and AMR impact on long-term health problems. A total of 72,647 (England) / 988,396 (USA) Ng infections were estimated to occur over lifetime, with total discounted direct medical costs of £14,128,529 / $441,430,301 and an average cost per infection of £194 / $447. Women accounted for 55% / 69% of the total costs, with a higher average cost per infection of £293 / $807, versus £174 / $263 for MSM and £103 / $186 for MSW. Health-problems accounted for 52% / 72% of the total costs, with PID in women and HIV in MSM responsible for the majority of these costs. In AMR scenarios, total costs of up to £15,670,608 / $485,747,595 were estimated. Ng infections pose a substantial financial burden to healthcare systems, with the highest costs per infection observed in women. Differences in costs across countries are likely to be due to different healthcare systems. Given the expected rise in AMR, costs are likely to increase, underlining the need for prevention of Ng in both England and the USA.

Mental Health Status of Healthcare Workers in China for COVID-19 Epidemic.

Background:COVID-19 first appeared in China in December 2019, with a high rate of infectivity and morbidity, which brought tremendous psychological pressure to healthcare workers.Purpose:To understand the psychological health status of healthcare workers during the COVID-19 outbreak and decline, and to provide a theoretical reference for the future establishment of a psychological crisis intervention system.Methods:Healthcare workers were recruited using convenience sampling and snowball sampling methods, and the electronic version of the SCL-90 scale and a sociodemographic questionnaire were administered. In the pretest, a total of 5018 responses were collected; after six weeks, random sampling was performed. The SCL-90 and measures of other epidemic-related problems were administered, with 1570 responses received; then, the final data analysis was performed.Results:After six weeks, the post-test GSI score; SCL-90 total score; and PST, PSDI, O-C, I-S, DEP, ANX, PHOB, PAR, PSY, and HOS scores were significantly lower than the corresponding pretest scores (p < 0.05). The results by occupational category showed that the scores of nursing staff decreased significantly for 12 indexes and that the scores of the doctors and other hospital staff also significantly decreased. There was a significant difference between the pretest (50.78 ± 28.18) and post-test (45.00 ± 28.49) scores for the degree of worry about the epidemic. Healthcare workers believed that the top three aspects of life affected by the epidemic were economic problems (816 people), interpersonal communication problems (731 people), and mental health (728 people).Conclusion:Over the course of the epidemic, the item scores generally declined significantly. Therefore, during an outbreak period, attention should be paid to psychological crisis interventions for healthcare workers; problems caused by psychological pressure, and even other psychological conditions, can be significantly alleviated to reduce the probability of subsequent health problems.

Preventing Bullying: Consequences, Prevention, and Intervention

Bullying is considered to be a significant public health problem with both short- and long-term physical and social-emotional consequences for youth. A large body of research indicates that youth who have been bullied are at increased risk of subsequent mental, emotional, health, and behavioral problems, especially internalizing problems, such as low self-esteem, depression, anxiety, and loneliness. Given the growing awareness of bullying as a public health problem and the increasing evidence of short- and long-term physical, mental, emotional, and behavioral health and academic consequences of bullying behavior, there have been significant efforts at the practice, program, and policy levels to address bullying behavior. This article summarizes a recent consensus report from the National Academies of Sciences, Engineering, and Medicine, Preventing Bullying Through Science, Policy, and Practice, and what is known about the consequences of bullying behavior and interventions that attempt to prevent and respond to it.

Vaginal Mesh Survivorship

Current care for women who have experienced complications related to vaginal mesh is complex and fragmented. In cancer, survivors are those who continue to function during and after overcoming their cancer diagnosis. “Survivorship” encompasses issues related to the ability to access health care and follow-up treatment, late effects of treatment, second cancers, and quality of life. The multifaceted survivorship model creates a sense of community among patients and their health care providers. Key aspects of survivorship, relevant to vaginal mesh complications, include (1) surveillance and follow-up treatment, (2) late effects of treatment, (3) health promotion and disease prevention, (4) psychosocial well-being, (5) caregiver needs, and (6) communication and care coordination. The objective is to propose the concept of vaginal mesh survivorship, examine which aspects of the cancer survivorship framework are applicable to patients with vaginal mesh complications, and apply these accordingly. A literature review of vaginal mesh complications was performed to identify the current state of care received by patients and patient-reported outcomes. Subcategories from the cancer survivorship framework were compared with the current care of women with vaginal mesh complications. Areas of improvement and gaps in research were identified. Nearly all domains of the cancer survivorship framework are pertinent to women with vaginal mesh complications. The surveillance for secondary cancers is not relevant, but there is a need for follow-up care as many women report subsequent health problems. There are late effects of treatment, such as pain and pelvic floor dysfunction, in a significant proportion of women. The need for health promotion, addressing psychosocial well-being, caregiver needs, and coordination of care is also relevant. Literature on the above topics is limited, and patient-centered research is important. Psychosocial support is critical as it has been shown that depression rates are higher in women who undergo subsequent surgery related to transvaginal mesh complications. The cancer survivorship framework allows us to assess gaps in care for women with mesh-related complications. Optimal methods on how to assess and care for these patients in a holistic manner do not routinely exist and should be developed in a multidisciplinary collaborative effort that includes patient input.

The health effects of work-family conflict in men and women Japanese civil servants: a longitudinal study.

High level of work-family conflict (WFC) is an important risk factor for stress-related health outcomes. However, many studies are cross-sectional studies. In this study, we aimed to clarify how changes in WFC levels over a period 5 yr can affect workers’ mental and physical health, and to clarify whether there are gender differences of them. This study examined 1,808 civil servants (1,258 men and 550 women) aged 20–65 yr working in a local government in the west coast of Japan from 2003 to 2008. Logistic regression analyses were used to examine whether the change in WFC contributes to workers’ health problems and whether there are gender differences. This study revealed association sustained high WFC and deterioration of WFC conflict with poor mental health and poor job satisfaction for both men and women. In men high WFC conflict and deterioration was associated with poor mental health (OR=2.74). On the other hand, women had strong relationship between WFC changes and poor physical health (OR=2.64). WFC was an important factor as a social determinant of health of Japanese civil servants, and the change in WFC affects subsequent health problems with different trends in men and women.

New Awareness of Blood Sugar Management, Self-Care Creates a Win-Win Situation

The diabetes population continues to grow worldwide both in terms of overall numbers and rate of increase. It is estimated that 642 million people will suffer from diabetes by 2040 (International Diabetes Federation, 2017). Diabetes was ranked the fifth main cause of death in Taiwan in 2017. (Department of Statistics, Ministry of Health and Welfare, Taiwan, ROC, 2019). Because of differences in the population in terms of disease cognition and disease control behaviors, despite recent advances in medicine and treatment efficacy, many diabetes patients continue to suffer from complications caused by improper blood sugar control, leading to a considerable number of subsequent health problems. Healthcare professionals, especially nurses, have critical roles to play in the health management of diabetes and metabolic-syndrome patients. In both the acute healthcare system and community homecare units, glycemic-related management of diabetes is important. We invite diabetes experts from academic and clinical practice units to share their professional knowledge and practical experiences, emphasizing patient-centered self-management principles. Related articles are expected to draw readers' attention to diabetes-related issues in order to gain new knowledge and skills related to blood sugar management.

The role of gender in the relationship between adverse childhood experiences and delinquency and substance use in adolescence

Adverse childhood experiences (ACEs), a construct measuring childhood adversity via abuse and household dysfunction, is linked to subsequent health problems and maladaptive behaviors. Theorized as a cumulative stressor, ACEs promote a chain of negative outcomes across the life-course. Though ample medical and health research has provided support for this proposition, less studies have examined the relationship between ACEs and delinquency, and very few have examined the role of gender. Analyzing data from the Project on Human Development in Chicago Neighborhoods, this study assesses the associations between ACEs and delinquency and substance use separately for boys (n = 964) and girls (n = 947). Hierarchical Generalized Linear Models show that ACEs may be uniquely associated with delinquency for boys and substance use for girls. Gender differences in criminological risk factors reveal potential intervening mechanisms in these relationships, suggesting that ACEs may operate through different pathways for boys and girls.

Family History: An Opportunity to Disrupt Transmission of Behavioral Health Problems.

Family history is a traditional clinical approach to identify potential genetic-related disorders within families. Research on brain development and life course health has raised awareness of the impact of childhood social experiences related to parenting behavior leading to subsequent health and mental health problems of children.1 The high and rising rates of mental health disorders, half of which have an onset by age 14 years,2 are now known to be due to genetic and social factors. Family history provides a special opportunity to identify risk and develop strategies to mitigate adverse social factors and experiences associated with parental mental health problems and promote resilience in children. Because some adverse parenting behaviors are related to adverse childhood experience, family history can be a clinical approach to identify such experiences because screening for them lacks reliability and validity.3 The family history is conventionally used to identify risk for genetically loaded physical conditions, such as cardiovascular disease. Yet, too often, behavioral and mental health problems that frequently run in families4–6 are not given comparable attention. Beyond genetic vulnerabilities for mental health problems, parents and grandparents convey multigenerational risk through role modeling and dysfunctional parenting behaviors, including harsh discipline, stress, abuse, and … Address correspondence to Barry Zuckerman, MD, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, 72 E Concord St, Room 324L, Boston, MA 02118. E-mail: barry.zuckerman{at}bmc.org

Optimal allocation of public parking spots in a smart city: problem characterisation and first algorithms

ABSTRACTHaving a mechanism to mathematically model the problem of the optimal allocation of parking spots within cities could bring great benefits to society. According to the International Parking Institute, about 38% of the cars circulating throughout a city are looking for available parking spots, leading to increased pollution and subsequent health problems, as well as economic losses due to wasted man-hours. In the work presented here, a new mathematical model describing the problem of the optimal allocation of parking spots is proposed, along with an evolutionary algorithm to demonstrate how this model can be used in practice. A simulated annealing algorithm was implemented to test the effectiveness of this approach. The proposed strategy will allow users to find parking more quickly and easily, as well as lead to new services for the hot-topic of smart mobility. For the definition of the problem, a real map of the city of Malaga, Spain, was used along with Sumo software to carry out the simulations. The results clearly demonstrated that the proposed mechanism is capable of minimising the global cost of parking, implying a direct benefit for users.

The Role of Fiber in Energy Balance.

Excessive energy intake is linked with obesity and subsequent diet-related health problems, and it is therefore a major nutritional challenge. Compared with the digestible carbohydrates starch and sugars, fiber has a low energy density and may have an attenuating effect on appetite. This narrative review attempts to clarify the net energy contributions of various fibers, and the effect of fiber on satiety and thus appetite regulation. Fibers, broadly defined as nonstarch polysaccharides, are a varied class of substances with vastly different physicochemical properties depending on their chemical arrangement. Thus, net energy content can vary from more than 10 kJ/g for soluble, nonviscous, and easily fermentable fibers such as those in many fruits, to less than zero for viscous fibers with anti-nutritive properties, such as certain types of fibers found in rye and other cereals. Likewise, some fibers will increase satiety by being viscous or contribute to large and/or swollen particles, which may facilitate mastication and increase retention time in the stomach, or potentially through fermentation and an ensuing satiety-inducing endocrine feedback from the colon. Thus, fibers may clearly contribute to energy balance. The metabolizable energy content is very often considerably lower than the commonly used level of 8 kJ per g fiber, and some fibers may reduce energy intake indirectly through satiety-inducing effects. A more precise characterization of fiber and its physicochemical effects are required before these beneficial effects can be fully exploited in human nutrition.

The prevalence of developmental defects of enamel, a prospective cohort study of adolescents in Western Sweden: a Barn I TAnadvarden (BITA, children in dental care) study

AimTo describe the prevalence of different types of developmental defects of the enamel (DDE) in varying age-cohorts and habitations, and to analyse if early trauma to the primary teeth and early subsequent serious health problems were related to DDE in the permanent dentition. Dental fear and anxiety, and aesthetic problems as a consequence of DDE were also investigated.MethodsDDE was registered over 5 years annually in three age cohorts (796 children). The DDE index (FDI Commision on Oral Health, Research and Epidemiology, Int Dent J 42:411–426, 1992) was used. Information on diseases in early childhood, trauma to the primary teeth, and dental fear and anxiety were collected.ResultsThe prevalence of DDE was 33.2% (boys 37.1%, girls 29.3%, p = 0.02). Demarcated opacities (DEO), solely, were the most frequent kind of defect, affecting 18%. Five percent (5%) had diffuse opacities (DIO) and 1% had hypoplasias, whereas 7% had teeth with both DEO and DIO. The most frequently affected teeth of DEO, as well as of DIO, were the first permanent molars and maxillary central incisors. Dental injuries to the primary anterior teeth raised the risk for DDE in the permanent teeth, but early serious health problems did not. Generalised DDE was common (8.4%). The paediatric dentists assessed the DDE in the maxillary anterior teeth as more serious than did the affected children and their parents.ConclusionsGeneralised DDE was more frequent than expected, as well as the occurrence of both DEO and DIO in the same individual. The first permanent molars and the upper central incisors were the most affected teeth.

Chemical Industry, the Environment, and Russian Provincial Society: The Case of the Kokshan Chemical Works (1850–1925)

This article explores interactions between the chemical industry, the environment, and Russian provincial society in the late nineteenth and early twentieth centuries, using the example of the Kokshan chemical works, in the Elabuga District, Viatka Province, Russian Empire (today Mendeleevsk District, Republic of Tatarstan, Russian Federation). The plant’s location facilitated its rapid development due to a number of factors, including a cheap labour force, the availability of raw materials, and the absence of local competition. However, the factory’s development came in conjunction with the deterioration of the environment and subsequent health problems for employees and the surrounding population. Conflicts connected with the Kokshan works illustrate differences between this case and similar examples in Russia and Europe. In Viatka Province, the local community remained mostly silent regarding these issues, and made no demands for improving sanitary control and working conditions or reducing pollution; rather, it was distant activists who personally suffered no harm who intervened in the interest of social justice. The history of the company reflects the contrast between the transfer of European technological innovations to Russia and laborious efforts to increase national wealth on the one hand, and the exploitation of the environment and endangerment of workers’ health on the other.

Life Course Patterns of Concurrent Trajectories of BMI and Affective Symptoms of Rural Mothers: Socioeconomic Antecedents and Disease Outcomes in Later Life.

The current study, using prospective data over 25 years (1991-2015), concurrently investigates patterns of body mass index (BMI) and affective symptom trajectories in middle-aged mothers and the socioeconomic antecedents and disease outcomes of these patterns. Growth mixture modeling was used to identify latent classes of conjoint health risk trajectories (BMI, depressive symptoms, and anxiety symptoms) from 1991 to 2001. For each latent class, we identified mean trajectories of each health risk. Then, analyses were conducted identifying how these conjoint health risk classes were associated with respondents' socioeconomic background profiles in 1991 and subsequent chronic health problems in 2015. Socioeconomic background profiles were significantly associated with initially high-risk trajectories. There was a statistically significant association between membership in certain classes of conjoint trajectories and physical health outcomes in later years. Consistent patterns of association with changes in different health outcomes including onset of diseases were observed when classes of conjoint risk trajectories are examined. The identification of members of various conjoint risk trajectory groups provides a potentially useful prognostic tool for early preventive intervention efforts, treatment, and policy formation. Such interventions should promote and develop resiliency factors, thereby aiding in the redirection of middle-aged women's adverse risk trajectories.

Patient-reported outcomes in ovarian cancer

Ovarian cancer treatments may negatively impact the physical and functional quality of life domains of patients. Patient-reported outcomes (PROs) and health-related quality of life (HR-QoL) assess the health conditions of patients without interpretation by a clinician of the patient’s response. A broad spectrum of validated questionnaires investigating HR-QoL exist. However, none are considered as a gold standard of PRO measures. In clinical trials, PROs are a means of evaluating treatment benefit or risk in a way that complements the typical primary outcome of survival, and are necessary endpoints to support regulatory approval. In clinical practice, PROs are useful in monitoring the ability of patients to tolerate treatment and in identifying patients more at risk for subsequent health problems who would benefit from supportive care during and after treatment.

Long-term physical health consequences of perceived inequality: Results from a twin comparison design

RationalePrevious research has identified long-term exposure to stress as a risk factor for negative mental and physical health outcomes. This pattern of findings suggests that environmental stimuli that evoke feelings of stress or strain may also result in physiological responses, which may accumulate over the life course and ultimately increase the overall risk of various physical health conditions. This physiological “wear and tear” resulting from sustained levels of stress or strain has been previously operationalized as allostatic load (AL), a comprehensive indicator of stress exposure. ObjectiveThe current study examines the association between one potential environmental stressor—perceived inequality—and AL with a research design aimed at addressing both observed and unobserved sources of confounding; it also employs a more comprehensive AL measure (comprised of 24 biomarkers tapping seven physiological systems) than previous studies. MethodThe biomarker twin sample from the Midlife Development in the United States (MIDUS) study was used to estimate a series of twin comparison models, which include controls for latent sources of influence that cluster within families. The sibling comparison models also included additional controls for lifestyle choices, overall physical health, and demographics which may confound the examined associations. ResultsThe results revealed significant associations between greater perceptions of inequality and greater overall levels of AL. The association persisted even after including controls for both observed and unobserved influences that may confound the examined associations but was limited to more recent measures of perceived inequality. Associations involving earlier measures of perceived inequality, along with a lifetime measure, failed to reach conventional levels of significance. ConclusionPerceived inequality appears to be a robust predictor of AL and potentially contributes to subsequent physical health problems, particularly for more proximate forms of perceived inequality.

The long-term health risks of ART: Epidemiological data and research on animals indicate that in vitro fertilization might create health problems later in life.

Potential health risks associated with assisted reproduction technology (ART) have been suspected ever since the first IVF baby, Louise Brown, was born in the UK in 1978. These risks have constantly been reassessed in light of epidemiological data as well as animal studies. Yet, even 39 years is not long enough to obtain conclusive proof of significantly increased levels of serious conditions, including cancer, cardiac, or metabolic diseases. However, evidence has been more than sufficient to stimulate further research across the whole spectrum of treatments for sub‐fertility, given that demand continues to grow around the globe. A number of factors combine to drive up assisted reproduction rates, including rising awareness among infertile couples, technical advances, growing medical tourism, and, above all, the trend among women, especially in developed countries, toward delaying pregnancy into the 30s. As a result, of the 6 million or so babies conceived via ART since 1978, about half were born during the past decade. In the USA, 72,913 babies were born via ART in 2015 representing 1.6% of all births, according to the US Centers for Disease Control and Prevention. > The risk of multiples alone means that ART babies are far more likely to suffer subsequent health problems associated with the greater incidence of being born prematurely. The situation is similar in Europe, where numbers of ART births increased by 7% between 2012 and 2013, according to the European Society of Human Reproduction and Embryology (ESHRE; https://focusonreproduction.eu/2016/07/05/6-5-million-ivf-babies-since-louise-brown/). The study also noted that ICSI (intra‐cytoplasmic sperm injection) now accounted for two‐thirds of all ART treatments in Europe, mainly owing to male infertility. In ICSI, the embryologist injects a single sperm directly into an ovum, compared with IVF where fertilization takes place in a dish and many sperm swarm around one or a few eggs. The ESHRE emphasized …

Airborne exposure to laboratory animal allergens

Exposure to laboratory animal allergens remains a significant cause of IgE-mediated occupational allergy and asthma. Since 2005, we have measured the major mouse and rat allergens (mus m 1 and rat n 1) collected on filters from air sampling in a range of UK and non-UK animal facilities. Supplied core data allowed us to construct an anonymized database of atmospheric results in ng m–3 containing 3080 mouse and 1392 rat analyses. Roughly twice as many static samples compared to personal samples had been sent for analysis. The medians (90th percentiles) for the mouse and rat allergens employing personal atmospheric sampling were 2.6 (60.6) and 0.4 (12.4) ng m–3 respectively; for static samples the equivalent values were 0.2 (3.7) and 0.1 (1.4) ng m–3. Where unequivocal sample descriptors were provided with samples, results were categorised to activities/areas. Medians and 90th percentiles in these categories suggest that staff undertaking cleaning out, dumping of soiled bedding and cleaning cages can still have very substantial potential exposures in some facilities. The move to filtered cages appears to reduce general exposure, but filter changing and/or cleaning can lead to high exposures. In some facilities, animal receipt can cause significant exposures, as well as activities such as bleeding, culling and dosing; all activities involving the handling of animals outside of cages. We believe that the data presented may help those using air measurements in such facilities to improve their control of exposure to such aeroallergens, and thus reduce the risk of both sensitisation and subsequent allergic health problems, including the development of allergic asthma.

Routine primary care screening for intimate partner violence and other adverse psychosocial exposures: what's the evidence?

BackgroundFamily physicians and other primary care practitioners are encouraged or expected to screen for an expanding array of concerns and problems including intimate partner violence (IPV). While there is no debate about the deleterious impact of violence and other adverse psychosocial exposures on health status, the key question raised here is about the value of routine screening in primary care for such exposures.DiscussionSeveral characteristics of IPV have led to consideration for routine IPV screening in primary care and during other healthcare encounters (e.g., emergency room visits) including: its high prevalence, concern that it may not be raised spontaneously if not prompted, and the burden of suffering associated with this exposure. Despite these factors, there are now three randomized controlled trials showing that screening does not reduce IPV or improve health outcomes. Yet, recommendations to routinely screen for IPV persist.Similarly, adverse childhood experiences (ACEs) have several characteristics (e.g., high frequency, predictive power of such experiences for subsequent health problems, and concerns that they might not be identified without screening) suggesting they too should be considered for routine primary care screening. However, demonstration of strong associations with health outcomes, and even causality, do not necessarily translate into the benefits of routine screening for such experiences. To date, there have been no controlled trials examining the impact and outcomes – either beneficial or harmful - of routine ACEs screening. Even so, there is an expansion of calls for routine screening for ACEs.SummaryWhile we must prioritize how best to support and intervene with patients who have experienced IPV and other adverse psychosocial exposures, we should not be lulled into a false sense of security that our routine use of “screeners” results in better health outcomes or less violence without evidence for such. Decisions about implementation of routine screening for psychosocial concerns need similar rigorous debate and scrutiny of empirical evidence as that recommended for proposed physical health screening (e.g., for prostate and breast cancer).

Resultados de una revisión sistemática sobre la influencia del acoso laboral en la salud de los trabajadores

Resultados de una revisión sistemática sobre la influencia del acoso laboral en la salud de los trabajadores