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PACEs in Pediatrics

ACEs Research Corner — October 2019

 

[Editor's note: Dr. Harise Stein at Stanford University edits a web site -- abuseresearch.info -- that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she's posting  the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! — Jane Stevens]

Zhang L, Zhang D, Sun Y.
Adverse Childhood Experiences and Early Pubertal Timing Among Girls: A Meta-Analysis. Int J Environ Res Public Health. 2019 Aug 13;16(16). pii: E2887. PMID: 31412531 
In a research review, not total ACEs, but father absence, sexual abuse, and family dysfunction were associated with small to medium effect on early onset of puberty among girls.

Rajan S, Branas CC, Myers D, Agrawal N.
Youth exposure to violence involving a gun: evidence for adverse childhood experience classification.  J Behav Med. 2019 Aug;42(4):646-657. PMID: 31367930
“Our findings provide evidence that youth gun violence exposure should be classified as an ACE. In addition to increasing access to resources for youth affected by gun violence, these findings may improve the likelihood of funding and research into gun violence, with direct implications for prevention and intervention efforts.”

Amemiya A, Fujiwara T, Shirai K, et. al.
Association between adverse childhood experiences and adult diseases in older adults: a comparative cross-sectional study in Japan and Finland. BMJ Open. 2019 Aug 24;9(8):e024609. PMID: 31446402
Comparing data from public health studies in Japan and Finland, 50% of Japanese and 37% of Finnish participants reported at least one measured ACE.  Increasing number of ACEs was associated with prevalence of poor self-reported health, cancer, heart disease or stroke, diabetes, current smoking, and increased body mass index in both countries. “This international comparative study suggests that the impact of ACEs on health is noteworthy and consistent across cultural and social environments.” 

Song MJ, Nikoo M, Choi F, Schütz CG, Jang K, Krausz RM.
Childhood Trauma and Lifetime Traumatic Brain Injury Among Individuals Who Are Homeless. J Head Trauma Rehabil. 2018 May/Jun;33(3):185-190. PMID: 28520660
Of 500 homeless adults from 3 cities in British Columbia, 63.6% reported a history of traumatic brain injury (TBI), and 87.7% childhood maltreatment.  After adjustment, 4+ types of childhood trauma, childhood emotional abuse, and childhood physical abuse were significantly associated with history of TBI.

Allen H, Wright BJ, Vartanian K, Dulacki K, Li HF.
Examining the Prevalence of Adverse Childhood Experiences and Associated Cardiovascular Disease Risk Factors Among Low-Income Uninsured Adults. Circ Cardiovasc Qual Outcomes. 2019 Sep;12(9):e004391. PMID: 31450964
For a group of 12,229 low-income, nonelderly uninsured adults in Oregon, ACE scores were high, with 40% of women and 30% of men reporting 4+ ACEs.  ACEs were statistically associated with higher rates of cardiovascular risk factors of obesity, smoking, and physical inactivity.

You DS, Albu S, Lisenbardt H, Meagher MW.
Cumulative Childhood Adversity as a Risk Factor for Common Chronic Pain Conditions in Young Adults. Pain Med. 2019 Mar 1;20(3):486-494. PMID: 30011037
From a study of 3,073 undergraduates, 72% female, mean age 18.8 years, cumulative childhood adverse events was a 1.2 – 1.3 fold increased risk factor for chronic pain conditions (any chronic pain, back pain, headache, and menstrual cramps).

Trent M, Dooley DG, Dougé J, et. al.
The Impact of Racism on Child and Adolescent Health. Pediatrics. 2019 Aug;144(2). pii: e20191765. PMID: 31358665
Statement from the American Academy of Pediatrics and review of this issue. “Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families.”  Full article. Recommendations are made to optimize clinical care, workforce development, professional education, systems engagement, and research. 

Sciolla AF, Wilkes MS, Griffin EJ.
Adverse Childhood Experiences in Medical Students: Implications for Wellness. Acad Psychiatry. 2019 Aug;43(4):369-374. PMID: 30850989
With a response rate of 88% of 98 third-year medical students to an ACE survey, 49% scored zero, 20% 1, 12% 2, 8% 3, and 12% 4+ (similar to the general public). Most students had low ACE scores and a high number of protective factors. In total, 1 in 5 students had been exposed to 3 or more ACEs, with increased vulnerability for burnout, depression, problems with academic performance, health risk behaviors, and suicidality both in training and in practice.  “It is no surprise that the ACE scores of our increasingly diverse student body mirror those of the general population. Possibly, what is unique about these diverse students is their resilience. Now, it is up to medical school administrators and educators to match those strengths with the curricular interventions and healthcare resources that can help them address the vulnerabilities this study has begun to characterize.”  Full text

Leasy M, O'Gurek DT, Savoy ML.
Unlocking Clues to Current Health in Past History: Childhood Trauma and Healing. Fam Pract Manag. 2019 Mar/Apr;26(2):5-10. PMID: 30855124
Nice review article with an adult patient case example of incorporating ACE’s screening and discussion into management of a medical issue. “Childhood trauma can have a lasting impact on health and well-being. Family physicians have a unique opportunity to affect individual and population health by understanding ACEs, screening for them, and using empathy, support, and action to facilitate health and disrupt the cycles of trauma.” 

Pearce J, Murray C, Larkin W.
Childhood adversity and trauma: experiences of professionals trained to routinely enquire about childhood adversity. Heliyon. 2019 Jul 22;5(7):e01900. PMID: 31372522
From interviews with healthcare providers from four different services working with children and families and who were trained to start ACEs screening, “The most significant finding suggests that change in practice and commitment to asking ACE questions is driven by practitioners' change in awareness toward more ACE-informed formulations of clients' difficulties. Suggestions are made with regard to the practicalities of routine enquiry and how services can best support practitioners.”  

Valeras AB, Cobb E, Prodger M, et. al.
Addressing adults with adverse childhood experiences requires a team approach. Int J Psychiatry Med. 2019 Sep;54(4-5):352-360. PMID: 31438755
“Subjects described aspects of the medical setting, including removal of clothing or physical touch, that triggered their past trauma. Subjects also reported sensing when their complexity resulted in negative interpersonal dynamics between team members, and they described fearing abandonment from their team.” The behavioral health clinician on the health care team served as an advocate and enhanced trust, continuity and access to care.

Lewis-O'Connor A, Warren A, Lee JV, et. al.
The state of the science on trauma inquiry. Womens Health (Lond). 2019 Jan Dec;15:1745506519861234. PMID: 31456510

  

 

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