Showing papers by "Robert F. Anda published in 2006"

The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology

Abstract: Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well–being. After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological “case example” of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "doseresponse" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggressionrelated domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.

Dementia and its implications for public health.

Abstract: Introduction With the aging of the U.S. population, a better understanding of the presentation and impact of dementia is essential to the future of public health. Dementia refers not to a single disorder but to a number of syndromes characterized by diverse behavioral, cognitive, and emotional impairments. Because dementia is costly in terms of both personal suffering and economic loss, an understanding of its prevalence, risk factors, and potential interventions is emerging as an increasingly important facet of public health and health care delivery. Recent advances in the understanding of its presentation, course, and relevant interventions have taken place. Methods We identified articles for review primarily by conducting a Medline search using the subject headings dementia, mild cognitive impairment, Alzheimer's disease, vascular dementia, frontotemporal dementia, and Lewy body dementia. Other relevant studies were elicited through a Medline search using the subject headings mental disorders and stigma. Results Dementia represents a diverse category of syndromes characterized by deficits in memory, cognitive function, and behavior. Symptoms associated with dementia appear to be distributed along a continuum, with even subsyndromal presentations affecting the health of older adults and meriting intervention. To promote cognitive functioning and independence among older adults, public health interventions need to facilitate both early detection and treatment of dementia. The availability of adult day care and respite services is important in maintaining the health and quality of life of individuals caring for older adults with dementia. Recent advances in the treatment of dementia may slow the course of cognitive decline, thereby enhancing the quality of life of older individuals as well as decreasing costs associated with institutional care. Conclusion Despite the growing availability of pharmacologic and psychosocial interventions that are potentially helpful to people with dementia and their caregivers, the majority of older adults with dementia do not receive appropriate treatment. With the aging of the U.S. population, efforts to foster recognition of dementia and its treatments and to destigmatize them are emerging as an increasingly important facet of public health intervention.

Re: asthma and the risk of lung cancer. findings from the Adverse Childhood Experiences (ACE).

Abstract: Using data from 8,896 men and women aged 50-89 years from the Adverse Childhood Experiences Study who were free of a self-reported history of lung cancer or any cancer at baseline, we examined the association between self-reported asthma and incident lung cancer. The prevalence of smoking was 33% among those who developed lung cancer (n = 52) and 7% among those who did not. Asthma was reported by 17% of adults who developed lung cancer and by 9% of those who did not. After adjustment for age, gender, race/ethnicity, educational attainment, smoking status, number of cigarettes smoked per day, and growing up with a parent who smoked the risk of lung cancer was 2.1 (95% CI: 1.0, 4.4) times greater among adults with a history of asthma compared to those without. Among nonsmokers, a similar result was observed, although it did not attain statistical significance (RR: 2.1; 95% CI: 0.9, 5.1). Smoking-attributable lung cancer incidence and mortality are in part a function of the prevalence of smoking in the population. Thus, decreases in the prevalence of smoking in the United States that have occurred since its peak in the 1960s will inevitably result in a decline in the proportion of lung cancer in the population caused by smoking. We hope that our findings and those of others will stimulate research of the biologic mechanism(s) underlying the occurrence of lung cancer among nonsmokers so that possible treatments and prevention strategies may be developed.

PEER REVIEWED: Dementia and Its Implications for Public Health

Abstract: Introduction With the aging of the U.S. population, a better understanding of the presentation and impact of dementia is essential to the future of public health. Dementia refers not to a single disorder but to a number of syndromes characterized by diverse behavioral, cognitive, and emotional impairments. Because dementia is costly in terms of both personal suffering and economic loss, an understanding of its prevalence, risk factors, and potential interventions is emerging as an increasingly important facet of public health and health care delivery. Recent advances in the understanding of its presentation, course, and relevant interventions have taken place.