Frontiers in epidemiology最新文献

{"title":"Air pollution associated with hospital visits for mental and behavioral disorders in Northeast China.","authors":"Huo Liu, Hang Zhao, Jinling Huang, Miao He","doi":"10.3389/fepid.2023.1090313","DOIUrl":"10.3389/fepid.2023.1090313","url":null,"abstract":"<p><strong>Background: </strong>Related studies have found that air pollution is an important factor affecting mental and behavioral disorders. Thus, we performed this time-series study to evaluate the relationship between short-term exposure to ambient air pollutants and visits to hospital by patients with mental and behavioral disorders in northeastern China.</p><p><strong>Methods: </strong>We used quasi-Poisson regression models and generalized additive models to probe the links between air pollution and mental and behavioral disorders. The possible influences were also explored stratified by season, age and gender.</p><p><strong>Results: </strong>We found that sulfur dioxide (SO₂) had a cumulative effect on mental and behavioral disorders at lag04-lag07 and had the greatest effect at lag07 [Relative risk (RR) = 1.068, 95%CI = 1.021-1.117]. Particulate matter of size 2.5 μm (PM_2.5) and SO₂ had a cumulative effect on depression and both had the largest effect at lag07 (RR = 1.021, 95%CI = 1.002-1.041; RR = 1.103, 95%CI = 1.032-1.178); SO₂ also had a cumulative effect on anxiety disorders, with the largest effect at lag06 (RR = 1.058, 95%CI = 1.009-1.110). In the stratified analysis, people are more susceptible in the cold season compared to the warm season and females and the 18-60-year age group are more sensitive to air pollutants. It is suggested to strengthen management and preventive measures to decrease air pollution exposure.</p><p><strong>Conclusion: </strong>This study found an association between increased concentrations of air pollutants and increased outpatient visits for mental and behavioral disorders. We recommend that preventive and protective measures should be strengthened in an effort to reduce exposure to air pollution in order to maintain physical and mental health.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46691999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of chronic multimorbidity and temporary migration in a rural South African community in health transition: A cross-sectional population-based analysis.","authors":"Armstrong Dzomba, Carren Ginsburg, Chodziwadziwa W Kabudula, Rachel R Yorlets, Pedzisai Ndagurwa, Sadson Harawa, Mark N Lurie, Stephen T McGarvey, Stephen Tollman, Mark A Collinson, Michael J White, Francesc X Gomez-Olive","doi":"10.3389/fepid.2023.1054108","DOIUrl":"10.3389/fepid.2023.1054108","url":null,"abstract":"<p><strong>Introduction: </strong>In sub-Saharan African settings, the increasing non-communicable disease mortality is linked to migration, which disproportionately exposes sub-populations to risk factors for co-occurring HIV and NCDs.</p><p><strong>Methods: </strong>We examined the prevalence, patterns, and factors associated with two or more concurrent diagnoses of chronic diseases (i.e., multimorbidity) among temporary within-country migrants. Employing a cross-sectional design, our study sample comprised 2144 residents and non-residents 18-40 years interviewed and with measured biomarkers in 2018 in Wave 1 of the Migrant Health Follow-up Study (MHFUS), drawn from the Agincourt Health and Demographic Surveillance System (AHDSS) in rural north-eastern South Africa. We used modified Poisson regression models to estimate the association between migration status and prevalent chronic multimorbidity conditional on age, sex, education, and healthcare utilisation.</p><p><strong>Results: </strong>Overall, 301 participants (14%; 95% CI 12.6-15.6), median age 31 years had chronic multimorbidity. Multimorbidity was more prevalent among non-migrants (14.6%; 95% CI 12.8-16.4) compared to migrants (12.8%; 95% CI 10.3-15.7). Non-migrants also had the greatest burden of dual-overlapping chronic morbidities, such as HIV-obesity 5.7%. Multimorbidity was 2.6 times as prevalent (PR 2.65. 95% CI 2.07-3.39) among women compared to men. Among migrants, men, and individuals with secondary or tertiary education manifested lower prevalence of two or more conditions.</p><p><strong>Discussion: </strong>In a rural community with colliding epidemics, we found low but significant multimorbidity driven by a trio of conditions: HIV, hypertension, and obesity. Understanding the multimorbidity burden associated with early adulthood exposures, including potential protective factors (i.e., migration coupled with education), is a critical first step towards improving secondary and tertiary prevention for chronic disease among highly mobile marginalised sub-populations.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47444598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic retinopathy as a potential risk factor for ptosis: A 13-year nationwide population-based cohort study in Taiwan.","authors":"Chun-Ju Lin, Alan Y Hsu, Peng-Tai Tien, Cheng-Hsien Chang, Chun-Ting Lai, Ning-Yi Hsia, Yu-Cih Yang, Henry Bair, Huan-Sheng Chen, Wen-Lu Chen, Yi-Yu Tsai","doi":"10.3389/fepid.2023.1093064","DOIUrl":"10.3389/fepid.2023.1093064","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the risk of ptosis among diabetic retinopathy (DR) patients.</p><p><strong>Methods: </strong>This is a population-based, retrospective, matched-cohort study where DR patients were recruited from the Taiwan National Health Insurance Research Database (NHIRD) to investigate the risk of developing ptosis. Preexisting co-factors of interest included smoking status and medical comorbidities of hyperlipidemia and hypertension. Statistical analysis was performed using <i>T</i>-test, Cox-proportional hazard ratios adjusted for comorbidities (aHR), Wilcoxon rank sum test, Kaplan-Meier estimators, and log rank tests.</p><p><strong>Results: </strong>Follow-up data of 9,494 patients with DR and 37,976 matched control cohort (non-DR) from 2000 to 2012 were analyzed. DR patients were found to have significantly increased risk of developing ptosis (adjusted hazard ratio (HR) [95% CI]: 2.76 [1.74-4.38], <i>p</i> < 0.001) when compared to the control cohort. From analysis in different strata, adult age and non-smokers were shown to have higher risk for ptosis development among DR patients. Furthermore, DR patients was also found to have increased risk of developing ptosis when compared to matched controls, regardless of whether they had medical comorbidities of lipid metabolism disorders or hypertension.</p><p><strong>Conclusions: </strong>In this large-scale study using real-world data, our results showed that DR patients were found to have increased risk of developing ptosis. Female gender, adult age, and non-smokers were also shown to increase the risk of ptosis among DR patients. This has implications towards the care of diabetic patients, complications such as ptosis should be properly screened for when encountering such patients. Before ptosis surgery, the possibility of underlying diabetes or DR should be also scrutinized and treated properly to avoid undesirable postoperative dissension.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48575533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of care and survival for lung cancer: Results of the European population-based high-resolution study.","authors":"Milena Sant, Caterina Daidone, Kaire Innos, Rafael Marcos-Gragera, Katrijn Vanschoenbeek, Miguel Rodriguez Barranco, Ester Oliva Poch, Roberto Lillini","doi":"10.3389/fepid.2023.1109853","DOIUrl":"10.3389/fepid.2023.1109853","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate differences in lung cancer (LC) management and survival using data from European population cancer registries.</p><p><strong>Methods: </strong>We analysed 4,602 lung cancer cases diagnosed in 2010-2013, followed-up to 2019 in five countries. Multivariable logistic regression was used to calculate the Odds Ratio (OR) of surgery for stages I-II LC or chemo- or radiotherapy for stages III-IV LC. Relative survival (RS) was estimated by the actuarial method; Relative Excess Risk of death (RER), with 95% CI, was calculated by generalized linear models.</p><p><strong>Results: </strong>Diagnostic work-up was extensive for 65.9% patients (range 57%, Estonia, Portugal - 85% (Belgium). Sixty-six percent of stages I-II patients underwent surgery; compared to non-operated, their adjusted OR decreased with age and was associated with main bronchus cancer (OR vs. lobes 0.25, CI, 0.08-0.82), stage II (OR vs. stage I: 0.42, CI, 0.29-0.60), comorbidity (OR vs. absent: 0.55, CI, 0.33-0.93), country (ORs: Estonia 1.82, CI, 1.28-2.60; Belgium 0.62, CI, 0.42-0.91; Portugal 0.69, CI, 0.52-0.93).Almost half of stages III-IV patients received chemo- or radiotherapy only; the adjusted OR vs. non receiving decreased with age and was associated with unspecified cancer topography or morphology. The adjusted five-year RER increased with age and stage and was lower for women (0.78, CI, 0.72-0.86), above the reference for main bronchus cancer (1.37, CI, 1.21-1.54) and unspecified morphology (1.17, CI, 1.05-1.30). Surgery carried the lowest mortality (RS 56.9; RER 0.13, CI, 0.11-0.15) with RER above the mean in Estonia (1.20, CI, 1.10-1.30), below it in Portugal (0.88, CI, 0.82-0.93) and Switzerland (0.91, CI, 0.84-0.99). Comorbidity (1.21, CI, 1.09-1.35) and not smoking (0.68, CI, 0.57-0.81) were associated with RER.</p><p><strong>Conclusions: </strong>The survival benefit of early diagnosis, allowing curative surgery, was evident at the population level. Screening for subjects at risk and adhesion to standard care should be incremented across the EU by funding better equipment and training health personnel.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48286310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement in extreme precipitation exposure assessment is modified by race and social vulnerability.","authors":"Kyle T Aune, Benjamin F Zaitchik, Frank C Curriero, Meghan F Davis, Genee S Smith","doi":"10.3389/fepid.2023.1128501","DOIUrl":"10.3389/fepid.2023.1128501","url":null,"abstract":"<p><p>Epidemiologic investigations of extreme precipitation events (EPEs) often rely on observations from the nearest weather station to represent individuals' exposures, and due to structural factors that determine the siting of weather stations, levels of measurement error and misclassification bias may differ by race, class, and other measures of social vulnerability. Gridded climate datasets provide higher spatial resolution that may improve measurement error and misclassification bias. However, similarities in the ability to identify EPEs among these types of datasets have not been explored. In this study, we characterize the overall and temporal patterns of agreement among three commonly used meteorological data sources in their identification of EPEs in all census tracts and counties in the conterminous United States over the 1991-2020 U.S. Climate Normals period and evaluate the association between sociodemographic characteristics with agreement in EPE identification. Daily precipitation measurements from weather stations in the Global Historical Climatology Network (GHCN) and gridded precipitation estimates from the Parameter-elevation Relationships on Independent Slopes Model (PRISM) and the North American Land Data Assimilation System (NLDAS) were compared in their ability to identify EPEs defined as the top 1% of precipitation events or daily precipitation >1 inch. Agreement among these datasets is fair to moderate from 1991 to 2020. There are spatial and temporal differences in the levels of agreement between ground stations and gridded climate datasets in their detection of EPEs in the United States from 1991 to 2020. Spatial variation in agreement is most strongly related to a location's proximity to the nearest ground station, with areas furthest from a ground station demonstrating the lowest levels of agreement. These areas have lower socioeconomic status, a higher proportion of Native American population, and higher social vulnerability index scores. The addition of ground stations in these areas may increase agreement, and future studies intending to use these or similar data sources should be aware of the limitations, biases, and potential for differential misclassification of exposure to EPEs. Most importantly, vulnerable populations should be engaged to determine their priorities for enhanced surveillance of climate-based threats so that community-identified needs are met by any future improvements in data quality.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10911001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42615851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the influence of substance use on mental health rating during COVID-19: A Canadian perspective.","authors":"Yadurshana Sivashankar, Ze Lin Chen","doi":"10.3389/fepid.2023.1067492","DOIUrl":"10.3389/fepid.2023.1067492","url":null,"abstract":"<p><strong>Introduction: </strong>Substance use and mental health symptoms (e.g., depression and anxiety) have increased during the COVID-19 pandemic, partly due to implementation of physical distancing measures aimed at containing the spread of the SARS-CoV-2 virus. However, there is limited pandemic-specific research that has examined the relationship between substance use and mental health with other correlates of well-being, including life satisfaction and social confidants.</p><p><strong>Methods: </strong>In the current study, we used ordered logistic regression analyses to examine whether a greater frequency of substance use (e.g., alcohol, cannabis, and opioids) during the pandemic predicted poorer ratings of self-reported mental health in a large sample of Canadians aged 15 to 64 years. We further considered whether life satisfaction and number of social confidants interacted with substance use to influence mental health, and stratified the models by sex and personal feelings of shame surrounding the use of substances (i.e., high and low shame).</p><p><strong>Results: </strong>Findings indicated that frequency of substance use was significantly associated with increased odds of reporting poorer mental health for males and females exhibiting both low and high shame. In females reporting low shame, we found that as frequency of cannabis use increased, life satisfaction has a much greater positive association with mental health. Whereas, in females disclosing high shame, maintaining social relations was particularly important to benefit the mental health of current users of opioids, relative to past and non-users. No such interaction was found in males.</p><p><strong>Discussion: </strong>Overall, the findings of the current study showed the negative mental health consequences of substance use during COVID-19 in a large Canadian sample, and most importantly revealed a critical sex difference in the way in which social determinants interact with substance use to influence mental health.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10911007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48328344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality, and life expectancy in Epilepsy and Status epilepticus-current trends and future aspects.","authors":"Eugen Trinka, Lucas J Rainer, Claudia A Granbichler, Georg Zimmermann, Markus Leitinger","doi":"10.3389/fepid.2023.1081757","DOIUrl":"10.3389/fepid.2023.1081757","url":null,"abstract":"<p><p>Patients with epilepsy carry a risk of premature death which is on average two to three times higher than in the general population. The risk of death is not homogenously distributed over all ages, etiologies, and epilepsy syndromes. People with drug resistant seizures carry the highest risk of death compared to those who are seizure free, whose risk is similar as in the general population. Most of the increased risk is directly related to the cause of epilepsy itself. Sudden unexplained death in epilepsy patients (SUDEP) is the most important cause of epilepsy-related deaths especially in the young and middle-aged groups. Population based studies with long-term follow up demonstrated that the first years after diagnosis carry the highest risk of death, while in the later years the mortality decreases. Improved seizure control and being exposed to a specialized comprehensive care centre may help to reduce the risk of death in patients with epilepsy. The mortality of status epilepticus is substantially increased with case fatality rates between 4.6% and 39%, depending on its cause and duration, and the age of the population studied. The epidemiological data on overall and cause specific mortality as well as their determinants and risk factors are critically reviewed and methodological issues pertinent to the studies on mortality of epilepsy and Status epilepticus are discussed.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42945024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring how space, time, and sampling impact our ability to measure genetic structure across <i>Plasmodium falciparum</i> populations.","authors":"Rohan Arambepola, Sophie Bérubé, Betsy Freedman, Steve M Taylor, Wendy Prudhomme O'Meara, Andrew A Obala, Amy Wesolowski","doi":"10.3389/fepid.2023.1058871","DOIUrl":"10.3389/fepid.2023.1058871","url":null,"abstract":"<p><p>A primary use of malaria parasite genomics is identifying highly related infections to quantify epidemiological, spatial, or temporal factors associated with patterns of transmission. For example, spatial clustering of highly related parasites can indicate foci of transmission and temporal differences in relatedness can serve as evidence for changes in transmission over time. However, for infections in settings of moderate to high endemicity, understanding patterns of relatedness is compromised by complex infections, overall high forces of infection, and a highly diverse parasite population. It is not clear how much these factors limit the utility of using genomic data to better understand transmission in these settings. In particular, further investigation is required to determine which patterns of relatedness we expect to see with high quality, densely sampled genomic data in a high transmission setting and how these observations change under different study designs, missingness, and biases in sample collection. Here we investigate two identity-by-state measures of relatedness and apply them to amplicon deep sequencing data collected as part of a longitudinal cohort in Western Kenya that has previously been analysed to identify individual-factors associated with sharing parasites with infected mosquitoes. With these data we use permutation tests, to evaluate several hypotheses about spatiotemporal patterns of relatedness compared to a null distribution. We observe evidence of temporal structure, but not of fine-scale spatial structure in the cohort data. To explore factors associated with the lack of spatial structure in these data, we construct a series of simplified simulation scenarios using an agent based model calibrated to entomological, epidemiological and genomic data from this cohort study to investigate whether the lack of spatial structure observed in the cohort could be due to inherent power limitations of this analytical method. We further investigate how our hypothesis testing behaves under different sampling schemes, levels of completely random and systematic missingness, and different transmission intensities.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42434124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between childhood maltreatment and adult cortisol concentrations mediated through subjective health complaints.","authors":"Johanna Klinger-König, Anke Hannemann, Nele Friedrich, Matthias Nauck, Henry Völzke, Hans J Grabe","doi":"10.3389/fepid.2023.1098822","DOIUrl":"10.3389/fepid.2023.1098822","url":null,"abstract":"<p><strong>Background: </strong>Lower cortisol concentrations in adulthood were repeatedly associated with more severe childhood maltreatment. Additionally, childhood maltreatment was reported to promote health risk behavior, such as smoking or alcohol consumption, and to increase the risk of mental and somatic diseases during adulthood, such as major depressive disorders or obesity. The present study investigated if health risk behavior and disease symptoms in adults mediate the associations between past childhood maltreatment and present basal serum cortisol concentrations.</p><p><strong>Methods: </strong>Data from two independent adult cohorts of the general population-based Study of Health in Pomerania (SHIP-TREND-0: <i>N</i> = 3,517; SHIP-START-2: <i>N</i> = 1,640) was used. Childhood maltreatment was assessed <i>via</i> the Childhood Trauma Questionnaire (CTQ). Cortisol concentrations were measured in single-point serum samples. Health risk behavior and mental and physical symptoms were used as mediators. Mediation analyses were calculated separately for both cohorts; results were integrated <i>via</i> meta-analyses.</p><p><strong>Results: </strong>In mediator-separated analyses, associations between childhood maltreatment and basal serum cortisol concentrations were partly mediated by depressive symptoms (BDI-II: <i>β</i>_{indirect effect} = -.011, <i>p</i>_FDR= .017, 21.0% mediated) and subjective somatic health complaints (somatic complaints: <i>β</i>_{indirect effect}= -.010, <i>p</i>_FDR= .005, 19.4% mediated). In the second step, both mediators were simultaneously integrated into one mediation model. The model replicated the mediation effects of the subjective somatic health complaints (whole model: <i>β</i>_{indirect effect}= -.014, <i>p</i> = .001, 27.6% mediated; BDI-II: <i>β</i>_{indirect effect}= -.006, <i>p</i> = .163, 11.4% mediated, somatic complaints: <i>β</i>_{indirect effect}= -.020, <i>p</i> = .020, 15.5% mediated).</p><p><strong>Conclusion: </strong>The results support the hypothesis that the long-lasting effects of childhood maltreatment on the stress response system are partly mediated through self-perceived disease symptoms. However, no mediation was found for health risk behavior or physically measured mediators. Mediation models with multiple simultaneous mediators pointed to a relevant overlap between the potential mediators. This overlap should be focused on in future studies.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10911021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46445627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure to war and conflict: The individual and inherited epigenetic effects on health, with a focus on post-traumatic stress disorder.","authors":"Zara Raza, Syeda F Hussain, Victoria S Foster, Joseph Wall, Peter J Coffey, John F Martin, Renata S M Gomes","doi":"10.3389/fepid.2023.1066158","DOIUrl":"10.3389/fepid.2023.1066158","url":null,"abstract":"<p><p>War and conflict are global phenomena, identified as stress-inducing triggers for epigenetic modifications. In this state-of-the-science narrative review based on systematic principles, we summarise existing data to explore the outcomes of these exposures especially in veterans and show that they may result in an increased likelihood of developing gastrointestinal, auditory, metabolic and circadian issues, as well as post-traumatic stress disorder (PTSD). We also note that, despite a potential \"healthy soldier effect\", both veterans and civilians with PTSD exhibit the altered DNA methylation status in hypothalamic-pituitary-adrenal (HPA) axis regulatory genes such as <i>NR3C1</i>. Genes associated with sleep (<i>PAX8</i>; <i>LHX1</i>) are seen to be differentially methylated in veterans. A limited number of studies also revealed hereditary effects of war exposure across groups: decreased cortisol levels and a heightened (sex-linked) mortality risk in offspring. Future large-scale studies further identifying the heritable risks of war, as well as any potential differences between military and civilian populations, would be valuable to inform future healthcare directives.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46178234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}