The Association between Maltreatment in Childhood and Pre-Pregnancy Obesity in Women Attending an Antenatal Clinic in Australia

Introduction

Obesity in pregnancy is associated with increased risk of complications and adverse outcomes in mother and child. Childhood adverse experiences are known to have numerous negative physical and emotional sequelae. We aimed to examine if exposure to abuse and/or neglect in childhood increased the likelihood of pre-pregnancy obesity.

Methods

Demographic and clinical data including weight, height, mental health as measured by the General Health Questionnaire and exposure to childhood trauma as measured by the childhood trauma questionnaire was collected from 239 women attending antenatal care at an Australian tertiary hospital.

Results

More than one quarter of women were obese prior to pregnancy and approximately 20% of women self reported experiencing moderate to severe physical, sexual or emotional abuse. Almost 60% of women scored in the clinical range on the GHQ. Pre-pregnancy obesity in women attending antenatal care was associated with a self-reported history of emotional or physical abuse with those exposed to moderate or severe emotional or physical abuse having increased odds of being obese prior to pregnancy (O.R. and 95% CI: 2.40; 1.19–4.84 and 2.38; 1.18–4.79 respectively). There was no significant association between other forms of childhood maltreatment, demographic or current mental health status and pre-pregnancy obesity.

Conclusions

The high rates of obesity, mental health problems and self reported childhood maltreatment in the Australian antenatal population are serious public health concerns due to the extra health risks conferred on mother and offspring. Exposure to physical or emotional abuse during childhood increases the likelihood of obesity in women attending antenatal care. Further research is required to determine reasons for this association.     

The Long-Term Health Consequences of Child Physical Abuse,Emotional Abuse,and Neglect: A Systematic Review and Meta-Analysis

Background

Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes.

Methods and Findings

A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16–2.04], emotional abuse [OR = 3.06; 95% CI 2.43–3.85], and neglect [OR = 2.11; 95% CI 1.61–2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67–2.20], emotional abuse [OR = 1.41; 95% CI 1.11–1.79], and neglect [OR = 1.36; 95% CI 1.21–1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17–5.32], emotional abuse [OR = 3.37; 95% CI 2.44–4.67], and neglect [OR = 1.95; 95% CI 1.13–3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50–2.10], emotional abuse [OR = 1.75; 95% CI 1.49–2.04], and neglect [OR = 1.57; 95% CI 1.39–1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships.

Conclusions

This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence. Please see later in the article for the Editors'' Summary     

Child Maltreatment Experience among Primary School Children: A Large Scale Survey in Selangor State,Malaysia

Official reports of child maltreatment in Malaysia have persistently increased throughout the last decade. However there is a lack of population surveys evaluating the actual burden of child maltreatment, its correlates and its consequences in the country. This cross sectional study employed 2 stage stratified cluster random sampling of public primary schools, to survey 3509 ten to twelve year old school children in Selangor state. It aimed to estimate the prevalence of parental physical and emotional maltreatment, parental neglect and teacher- inflicted physical maltreatment. It further aimed to examine the associations between child maltreatment and important socio-demographic factors; family functioning and symptoms of depression among children. Logistic regression on weighted samples was used to extend results to a population level. Three quarters of 10–12 year olds reported at least one form of maltreatment, with parental physical maltreatment being most common. Males had higher odds of maltreatment in general except for emotional maltreatment. Ethnicity and parental conflict were key factors associated with maltreatment. The study contributes important evidence towards improving public health interventions for child maltreatment prevention in the country.     

Association of Childhood Physical and Sexual Abuse with Intimate Partner Violence,Poor General Health and Depressive Symptoms among Pregnant Women

ObjectiveWe examined associations of childhood physical and sexual abuse with risk of intimate partner violence (IPV). We also evaluated the extent to which childhood abuse was associated with self-reported general health status and symptoms of antepartum depression in a cohort of pregnant Peruvian women.MethodsIn-person interviews were conducted to collect information regarding history of childhood abuse and IPV from 1,521 women during early pregnancy. Antepartum depressive symptomatology was evaluated using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).ResultsAny childhood abuse was associated with 2.2-fold increased odds of lifetime IPV (95%CI: 1.72–2.83). Compared with women who reported no childhood abuse, those who reported both, childhood physical and sexual abuse had a 7.14-fold lifetime risk of physical and sexual IPV (95%CI: 4.15–12.26). The odds of experiencing physical and sexual abuse by an intimate partner in the past year was 3.33-fold higher among women with a history of childhood physical and sexual abuse as compared to women who were not abused as children (95%CI 1.60–6.89). Childhood abuse was associated with higher odds of self-reported poor health status during early pregnancy (aOR = 1.32, 95%CI: 1.04–1.68) and with symptoms of antepartum depression (aOR = 2.07, 95%CI: 1.58–2.71).ConclusionThese data indicate that childhood sexual and physical abuse is associated with IPV, poor general health and depressive symptoms in early pregnancy. The high prevalence of childhood trauma and its enduring effects of on women’s health warrant concerted global health efforts in preventing violence.     

Childhood Experiences with Family Pets and Internalizing Symptoms in Early Adulthood

ABSTRACT

The purpose of this study was to investigate whether childhood experiences with family pets are associated with symptoms of depression and anxiety in early adulthood. Undergraduate students (n=318) responded to an online survey that included questions about bonding with childhood pets, exposure to family violence and human aggression directed toward family pets in childhood, and current symptoms of depression and anxiety. Two-way ANCOVAs were conducted with a measure of childhood emotional abuse included as a covariate, and significant interactions were observed between pet bonding and exposure to aggression toward pets (pet aggression). Among participants with medium-level bonds, those who were exposed to pet aggression had significantly higher depression and anxiety scores than those who were not exposed to pet aggression. Among participants who were not exposed to pet aggression, those with medium-level bonds had lower depression and anxiety scores than those with low-level bonds. Bearing in mind the limitations of the research design, the results are consistent with the assertion that bonding with pets may support mental health and that exposure to animal cruelty may lead to the development of internalizing symptoms. The results also support the contention that both bonding with pets and exposure to pet aggression should be considered when investigating the association between experiences with pets and mental health. Interventions for the protection of children may be indicated in cases of animal cruelty. Social workers who investigate child maltreatment may be advised to refer children who are exposed to animal cruelty for counseling. Clinicians should consider addressing issues that arise from exposure to pet aggression during the therapeutic process.     

Can the site conditions required for successful natural regeneration of juniper (Juniperus communis L.) be determined from a single species survey?

Background: Ecological surveys often aim to inform biodiversity conservation policy and practice. Survey types differ; all require clear aims and good design. A survey in Scotland was carried out to measure the distribution and health of juniper (Juniperus communis) and potential for its natural regeneration.

Aims: Explore if one-off national surveys can inform conservation action by examining, as an example, the Scottish juniper data set to: (1) determine site conditions favourable for juniper regeneration, (2) provide recommendations for site management for regeneration.

Methods: Associations between site conditions and juniper occurrence were investigated with principal component analysis (PCA) and using species distribution modelling (SDM). To identify changes in site conditions over time, we compared degree of site suitability for natural regeneration (PCA distance) and population age structure.

Results: Twenty-one per cent of the sites showed juniper regeneration. Compared to all juniper sites, conditions at regenerating sites were different (e.g. climatically wetter, lower site fertility). Change over time in conditions was suggested by patterns in population age structure.

Conclusions: Following the establishment of a juniper population, site conditions may change, becoming unsuitable for natural regeneration. Historical site information to confirm this is lacking. We cannot answer fundamental questions about the causal mechanisms of the natural regeneration of juniper and question whether one-off survey data can inform conservation management.     

Child abuse and mental disorders in Canada

Background:

Nationally representative Canadian data on the prevalence of child abuse and its relation with mental disorders are lacking. We used contemporary, nationally representative data to examine the prevalence of 3 types of child abuse (physical abuse, sexual abuse and exposure to intimate partner violence) and their association with 14 mental conditions, including suicidal ideation and suicide attempts.

Methods:

We obtained data from the 2012 Canadian Community Health Survey: Mental Health, collected from the 10 provinces. Respondents aged 18 years and older were asked about child abuse and were selected for the study sample (n = 23 395). The survey had a multistage stratified cluster design (household response rate 79.8%).

Results:

The prevalence of any child abuse was 32% (individual types ranged from 8% to 26%). All types of child abuse were associated with all mental conditions, including suicidal ideation and suicide attempts, after adjustment for sociodemographic variables (adjusted odds ratios ranged from 1.4 to 7.9). We found a dose–response relation, with increasing number of abuse types experienced corresponding with greater odds of mental conditions. Associations between child abuse and attention deficit disorder, suicidal ideation and suicide attempts showed stronger effects for women than men.

Interpretation:

We found robust associations between child abuse and mental conditions. Health care providers, especially those assessing patients with mental health problems, need to be aware of the relation between specific types of child abuse and certain mental conditions. Success in preventing child abuse could lead to reductions in the prevalence of mental disorders, suicidal ideation and suicide attempts.Child abuse is a major public health problem worldwide with serious adverse effects at later ages. The best estimates of the prevalence of child abuse in Canada come from 2 representative samples from Ontario, 1 from 1990 (Ontario Health Supplement, n = 9953, age ≥ 15 yr)1 and 1 from 2000–2001 (Ontario Child Health Study, n = 1893, age 21–35 yr).² The 1990 study indicated that 31% of males and 21% of females had experienced physical child abuse, and 4% of males and 13% of females had experienced sexual child abuse.¹ Similar trends were noted in data collected in 2000–2001.² Prevalence of sexual abuse was found to be higher in the Ontario Child Health Study, but this was thought to be related to the inclusion of sexual abuse committed by anyone (e.g., adolescents), rather than only adults, as was the case with the Ontario Health Supplement.^1,2 Data from Quebec collected in 2006 indicated that 23% of men and 17% of women had experienced physical child abuse; 10% of men and 22% of women had experienced sexual child abuse; and 22% of men and women had experienced psychological child abuse, including exposure to intimate partner violence.^3,4 Unfortunately, these estimates are dated, restricted to only 2 provinces, based on limited assessments of child abuse and, in the case of the Quebec data, involve a low response rate of 30%.Although the association between child abuse and subsequent mental conditions (including disorders, suicidal ideation and suicide attempts) is well established,^5–9 we know little about differential effects associated with several abuse types and specific mental disorders, and we currently have no nationally representative Canadian data. Filling this gap in knowledge would produce evidence-based Canadian findings that could inform policy, prevention and intervention efforts specifically aimed at reducing both child abuse and poor mental health outcomes.Our overall objective was to extend our understanding of the relation between child abuse and mental conditions (i.e., mental disorders, suicidal ideation and suicide attempts)^{6–8,10–19} with a more detailed examination of child abuse severity and mental health outcomes. We used a nationally representative Canadian sample to examine 3 types of child abuse (physical abuse, sexual abuse and exposure to intimate partner violence) and 14 mental conditions, including suicidal ideation and suicide attempts. The specific research objectives were to estimate the prevalence of 3 types of physical abuse, sexual abuse and exposure to intimate partner violence; to examine the association of mental conditions with types of child abuse and number of child abuse types experienced; and to determine whether sex differences exist in the associations between child abuse and mental conditions.     

Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan

BackgroundAcute lymphoblastic leukemia (ALL) is more common in children than in adults. Secondary neoplasms (SNs) in childhood ALL have been widely reported. However, only one study has demonstrated SNs in adult ALL. Because of the poorer survival of adult ALL, the incidence might be underestimated.ObjectiveTo evaluate the incidence and risk factors of secondary solid organ neoplasms among adult and child ALL patients.MethodsNewly diagnosed ALL patients between 1997 and 2011 were recruited from the Taiwan National Health Insurance database. Those who had antecedent or combined malignancies were excluded. Standardized incidence ratios (SIRs) were analyzed to compare the risk of our cohort to general population in the same age, sex and calendar year. Risk factors for SN development were analyzed by Cox proportional hazards models. Effects of treatments were treated as time-dependent variables.ResultsThe 15-year cumulative incidence of SN was 1.9% and 8.4% in 1,381 child and 2,154 adult ALL patients, respectively. The SIR was significantly increased in child ALL (SIR 6.06), but not in adult ALL (SIR 1.16). The SIRs of follow-up periods were 5.14, 2.24, .87 and .71 at ≥ 10 years, 5–10 years, 1–5 years and 0–1, respectively. Overall, 15 SNs developed, and CNS tumors (SIR 11.56) were the most common type. Multivariate analysis showed that age ≥ 20 years (hazard ratio [HR] 5.04), end-stage renal disease (HR 18.98) and cranial irradiation (HR 8.12) were independent risk factors for cancer development.ConclusionsWhen compared with the general population, child ALL shows a increased risk of developing SNs. CNS tumors are the most common type, and cranial irradiation is an independent risk factor. With longer follow-up, the risk of SNs increases. Hence, physicians need to pay more attention on the risk of developing SNs in long-term ALL survivors with risk factors.     

Childhood Hospitalisation with Infection and Cardiovascular Disease in Early-Mid Adulthood: A Longitudinal Population-Based Study

BackgroundPathogen-specific and overall infection burden may contribute to atherosclerosis and cardiovascular disease (CVD), but the effect of infection severity and timing is unknown. We investigated whether childhood infection-related hospitalisation (IRH, a marker of severity) was associated with subsequent adult CVD hospitalisation.MethodsUsing longitudinal population-based statutorily-collected administrative health data from Western Australia (1970-2009), we identified adults hospitalised with CVD (ischaemic heart disease, ischaemic stroke, and peripheral vascular disease) and matched them (10:1) to population controls. We used Cox regression to assess relationships between number and type of childhood IRH and adulthood CVD hospitalisation, adjusting for sex, age, Indigenous status, socioeconomic status, and birth weight.Results631 subjects with CVD-related hospitalisation in adulthood (≥ 18 years) were matched with 6310 controls. One or more childhood (< 18 years) IRH was predictive of adult CVD-related hospitalisation (adjusted hazard ratio, 1.3; 95% CI 1.1-1.6; P < 0.001). The association showed a dose-response; ≥ 3 childhood IRH was associated with a 2.2 times increased risk of CVD-related hospitalisation in adulthood (adjusted hazard ratio, 2.2; 95% CI 1.7-2.9; P < 0.001). The association was observed across all clinical diagnostic groups of infection (upper respiratory tract infection, lower respiratory tract infection, infectious gastroenteritis, urinary tract infection, skin and soft tissue infection, and other viral infection), and individually with CVD diagnostic categories (ischaemic heart disease, ischaemic stroke and peripheral vascular disease).ConclusionsSevere childhood infection is associated with CVD hospitalisations in adulthood in a dose-dependent manner, independent of population-level risk factors.     

Childhood Psychological,Physical, and Sexual Maltreatment in Outpatients with Binge Eating Disorder: Frequency and Associations with Gender,Obesity, and Eating‐Related Psychopathology

Objective: To examine rates of reported childhood maltreatment in binge eating disorder (BED), and to explore associations with obesity, gender, eating disorder features, and associated functioning. Research Methods and Procedures: Subjects were 145 consecutive outpatients with BED as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition. Subjects were interviewed and they completed questionnaires to assess eating disorder features and functioning. The Childhood Trauma Questionnaire was given to assess childhood maltreatment in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). Results: A total of 83% of BED patients reported some form of childhood maltreatment. A total of 59% of BED patients reported emotional abuse, 36% reported physical abuse, 30% reported sexual abuse, 69% reported emotional neglect, and 49% reported physical neglect. There were no differences in the distribution of any form of childhood maltreatment by gender or by obesity status. The different forms of maltreatment were not associated with variability in current body mass index, binge eating, or in the attitudinal features of eating disorders. Only one of the five forms of maltreatment (physical neglect) was associated with dietary restraint in women. Emotional abuse was significantly associated with greater body dissatisfaction, higher depression, and lower self‐esteem in men and women and sexual abuse was associated with greater body dissatisfaction in men. The different forms of maltreatment were unrelated to the age at onset of overweight, dieting, or binge eating. Discussion: BED outpatients reported a wide range of childhood experiences of maltreatment that do not differ by gender or obesity status. Different forms of maltreatment were not associated with the onset of overweight, dieting, or binge eating, or with variability in current body mass index or eating disorder features (except for one association between physical neglect and dietary restraint). Reports of emotional abuse were associated with greater body dissatisfaction and depression and lower self‐esteem in men and women and sexual abuse with greater body dissatisfaction in men.     

Disparities in Adverse Childhood Experiences among Sexual Minority and Heterosexual Adults: Results from a Multi-State Probability-Based Sample

Background

Adverse childhood experiences (e.g., physical, sexual and emotional abuse, neglect, exposure to domestic violence, parental discord, familial mental illness, incarceration and substance abuse) constitute a major public health problem in the United States. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences.

Purpose

To examine, using the ACE scale, prevalence of childhood physical, emotional, and sexual abuse and childhood household dysfunction among sexual minority and heterosexual adults.

Methods

Analyses were conducted using a probability-based sample of data pooled from three U.S. states’ Behavioral Risk Factor Surveillance System (BRFSS) surveys (Maine, Washington, Wisconsin) that administered the ACE scale and collected information on sexual identity (n = 22,071).

Results

Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers.

Conclusions

Sexual minority individuals have increased exposure to multiple developmental risk factors beyond physical, sexual and emotional abuse. We recommend the use of the Adverse Childhood Experiences scale in future research examining health disparities among this minority population.     

Childhood Maltreatment in Extremely Obese Male and Female Bariatric Surgery Candidates**

Objective: To examine rates of self‐reported childhood maltreatment in extremely obese bariatric surgery candidates and to explore associations with sex, eating disorder features, and psychological functioning. Research Methods and Procedures: Three hundred forty (58 men and 282 women) extremely obese consecutive candidates for gastric bypass surgery completed a questionnaire battery. The Childhood Trauma Questionnaire was given to assess childhood maltreatment. Results: Overall, 69% of patients self‐reported childhood maltreatment: 46% reported emotional abuse, 29% reported physical abuse, 32% reported sexual abuse, 49% reported emotional neglect, and 32% reported physical neglect. Except for higher rates of emotional abuse reported by women, different forms of maltreatment did not differ significantly by sex. Different forms of maltreatment were generally not associated with binge eating, current BMI, or eating disorder features. At the Bonferonni‐corrected significance level, emotional abuse was associated with higher eating concerns and body dissatisfaction, and emotional neglect was associated with higher eating concerns. In terms of psychological functioning, at the Bonferonni‐corrected level, emotional abuse and emotional neglect were associated with higher depression and lower self‐esteem, and physical abuse was associated with higher depression. Discussion: Extremely obese bariatric surgery candidates reported rates of maltreatment comparable with those reported by clinical groups and roughly two to three times higher than normative community samples. Reported experiences of maltreatment differed little by sex and were generally not significantly associated with current BMI, binge eating, or eating disorder features. In contrast, maltreatment—notably emotional abuse and neglect—were significantly associated with higher depression and lower self‐esteem.     

Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries

BackgroundSeveral studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC’s peacetime impact, limiting our understanding of UHC’s potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries’ progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage.Methods and findingsUsing a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a “high UHC index” group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries’ income group per the World Bank classification, countries’ geographical region as defined by WHO, and countries’ preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study’s primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes.ConclusionsWe observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.

In a difference-in-difference study, Sooyoung Kim and colleagues study associations between progress toward universal healthcare coverage and childhood immunizations before and during the COVID-19 pandemic.     

Childhood Maltreatment and BMI Trajectories to Mid-Adult Life: Follow-Up to Age 50y in a British Birth Cohort

Background

Childhood maltreatment including abuse and neglect has been associated with adult obesity, but evidence on life-course development of obesity or BMI gain is unclear. We aim to establish whether childhood maltreatments are related to obesity or BMI at different life-stages 7y-50y and to identify possible explanations for associations.

Methods

Childhood physical, psychological and sexual abuse, neglect and BMI at seven ages were recorded in the 1958 birth cohort (n~15,000). Associations of child maltreatments with BMI at separate ages were tested using linear regression or logistic regression for obesity, and with rate of child-to-adult BMI gain using multilevel models. We adjusted for potential covariates.

Results

Abuse was reported in ~12% of the population. Abuse was not associated with elevated childhood BMI, but adult associations were observed: i.e. the abused had faster child-adult BMI gain than the non-abused; associations were independent of adult covariates. For physical abuse in both genders there was a positive linear association of ~0.006/y zBMI gain with age after adjustment for all covariates. Similarly, there was a linear association of physical abuse with obesity risk: e.g. among females from a low OR_adjusted of 0.34 (0.16,0.71) at 7y to 1.67 (1.25,2.24) at 50y. In females faster zBMI gains with age of ~0.0034/y were observed for sexual abuse and increases in obesity risk were faster: from a low OR_adjusted of 0.23 (0.06,0.84) at 7y to 1.34 (0.86,2.10) at 50y. Psychological abuse and neglect associations were less consistent.

Conclusions

Childhood maltreatment associations with BMI or obesity varied across life: physical and, in females, sexual abuse were associated with faster lifetime BMI gains, which may have detrimental long-term health consequences.     

National,Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys

Background

Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region.

Methods and Findings

We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20–44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] ≥0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp = 0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy.

Conclusions

We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends. Please see later in the article for the Editors'' Summary     

Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana

IntroductionTo date, eleven countries have been validated as having eliminated trachoma as a public health problem, including Ghana in 2018. Surveillance for recrudescence is needed both pre- and post-validation but evidence-based guidance on appropriate strategies is lacking. We explored two potential surveillance strategies in Ghana.Methodology/principal findingsAmongst randomly-selected communities enrolled in pre-validation on-going surveillance between 2011 and 2015, eight were identified as having had trachomatous-inflammation follicular (TF) prevalence ≥5% in children aged 1–9 years between 2012 and 2014. These eight were re-visited in 2015 and 2016 and neighbouring communities were also added (“TF trigger” investigations). Resident children aged 1–9 years were then examined for trachoma and had a conjunctival swab to test for Chlamydia trachomatis (Ct) and a dried blood spot (DBS) taken to test for anti-Pgp3 antibodies. These investigations identified at least one community with evidence of probable recent Ct ocular transmission. However, the approach likely lacks sufficient spatio-temporal power to be reliable.A post-validation surveillance strategy was also evaluated, this reviewed the ocular Ct infection and anti-Pgp3 seroprevalence data from the TF trigger investigations and from the pre-validation surveillance surveys in 2015 and 2016. Three communities identified as having ocular Ct infection >0% and anti-Pgp3 seroprevalence ≥15.0% were identified, and along with three linked communities, were followed-up as part of the surveillance strategy. An additional three communities with a seroprevalence ≥25.0% but no Ct infection were also followed up (“antibody and infection trigger” investigations). DBS were taken from all residents aged ≥1 year and ocular swabs from all children aged 1–9 years. There was evidence of transmission in the group of communities visited in one district (Zabzugu-Tatale). There was no or little evidence of continued transmission in other districts, suggesting previous infection identified was transient or potentially not true ocular Ct infection.Conclusions/significanceThere is evidence of heterogeneity in Ct transmission dynamics in northern Ghana, even 10 years after wide-scale MDA has stopped. There is added value in monitoring Ct infection and anti-Ct antibodies, using these indicators to interrogate past or present surveillance strategies. This can result in a deeper understanding of transmission dynamics and inform new post-validation surveillance strategies. Opportunities should be explored for integrating PCR and serological-based markers into surveys conducted in trachoma elimination settings.     

A History of Abuse and Operative Delivery – Results from a European Multi-Country Cohort Study

Objective

The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult.

Design

The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations.

Results

Among 3308 primiparous women, sexual abuse as an adult (≥18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28–3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24–11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46–11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05–2.19).

Conclusion

Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.     

Early childhood undernutrition,preadolescent physical growth,and cognitive achievement in India: A population-based cohort study

BackgroundThere is a lack of nationally representative estimates for the consequences of early childhood undernutrition on preadolescent outcomes in India. Understanding this relationship is helpful to develop interventions that not only prevent child undernutrition but also mitigate its consequences.Methods and findingsIn this cohort study, we analyzed prospectively gathered data from 2 waves of the India Human Development Survey (IHDS) to investigate the association of undernutrition during early childhood (0 to 5 years) in 2004 to 2005 with physical and cognitive outcomes during preadolescent (8 to 11 years) years in 2011 to 2012. These surveys interviewed 41,554 households across all 33 states and union territories in India in 2004 to 2005 and reinterviewed 83% of the households in 2011 to 2012. Primary exposure was assessed using the Composite Index of Anthropometric Failure (CIAF) based on 2004 to 2005 survey. Primary outcomes were short stature (height-for-age z-score [HAZ] <−2), thinness (body mass index [BMI] <18.5 kg/m²), reading, and arithmetic skills during preadolescence based on the 2011 to 2012 survey. Survey-weighted generalized linear models were used, and effect modification based on child sex and sociodemographic variables were evaluated using 3-way interaction terms. Of the 7,868 children included in this analysis, 4,334 (57.3%) were undernourished. Being undernourished was associated with increased odds of short stature (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.45 to 2.06) and thinness (OR 1.52, 95% CI 1.33 to 1.73) during the preadolescent period, while it was associated with decreased odds of achieving a higher reading (cumulative odds ratio [cumOR]: 0.76, 0.66 to 0.87) and arithmetic (cumOR: 0.72, 0.63 to 0.82) outcomes. The disparity in outcomes based on CIAF increased with age, especially for female children. Increased level of female education within the household reduced the disadvantages of undernutrition among female children. Study limitations include observational and missing data, which limit our ability to draw strong causal inferences.ConclusionsIn this study, we found that early child undernutrition was associated with several adverse preadolescent physical and cognitive outcomes, especially among female children. Improved female education mitigates this association. Female education promotion should assume a central role in Indian public health policy making.

Apurv Soni and co-workers study child nutrition and developmental outcomes in India.     

COMT but not serotonin‐related genes modulates the influence of childhood abuse on anger traits

Anger‐related traits are regulated by genes as well as early environmental factors. Both childhood maltreatment and genes underlie vulnerability to suicidal behaviors, possibly by affecting the constitution of intermediate phenotypes such as anger traits. The aim of this study was to test the interaction between nine candidate genes and childhood maltreatment in modulating anger‐related traits in 875 adult suicide attempters. The State‐Trait Anger Expression Inventory and the Childhood Trauma Questionnaire were used to examine anger traits and traumatic childhood experiences, respectively. The functional polymorphism of the catecholamine‐O‐methyl‐transferase (COMT) gene Val158Met significantly modulated the association between sexual abuse and anger‐trait level (P = 0.001). In the presence of sexual abuse, individuals carrying the Val high‐activity allele displayed greater disposition toward anger than individuals homozygous for the Met allele (P = 0.0003). Notably, none of the serotonin‐related genes influenced the effect of childhood abuse on anger traits. The results of the present study suggest that anger‐trait level is influenced by the interaction between childhood abuse and functional polymorphism in the COMT gene. This study was carried out in a population with a high frequency of childhood abuse and a high disposition toward anger, and replication in healthy subjects is needed.     

Seroprevalence of IgG antibodies against SARS-CoV-2 among the general population and healthcare workers in India,June–July 2021: A population-based cross-sectional study

BackgroundIndia began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India experienced a severe second wave of COVID-19 during March–June 2021. We conducted a fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged ≥6 years and healthcare workers (HCWs).Methods and findingsWe did a cross-sectional study between 14 June and 6 July 2021 in the same 70 districts across 20 states and 1 union territory where 3 previous rounds of serosurveys were conducted. From each district, 10 clusters (villages in rural areas and wards in urban areas) were selected by the probability proportional to population size method. From each district, a minimum of 400 individuals aged ≥6 years from the general population (40 individuals from each cluster) and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test-adjusted seroprevalence of IgG antibodies against SARS-CoV-2, along with 95% CIs, based on the presence of antibodies to S1-RBD and/or nucleocapsid protein. Of the 28,975 individuals who participated in the survey, 2,892 (10%) were aged 6–9 years, 5,798 (20%) were aged 10–17 years, and 20,285 (70%) were aged ≥18 years; 15,160 (52.3%) participants were female, and 21,794 (75.2%) resided in rural areas. The weighted and test-adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged ≥6 years was 67.6% (95% CI 66.4% to 68.7%). Seroprevalence increased with age (p < 0.001) and was not different in rural and urban areas (p = 0.822). Compared to unvaccinated adults (62.3%, 95% CI 60.9% to 63.7%), seroprevalence was significantly higher among individuals who had received 1 vaccine dose (81.0%, 95% CI 79.6% to 82.3%, p < 0.001) and 2 vaccine doses (89.8%, 95% CI 88.4% to 91.1%, p < 0.001). The seroprevalence of IgG antibodies among 7,252 HCWs was 85.2% (95% CI 83.5% to 86.7%). Important limitations of the study include the survey design, which was aimed to estimate seroprevalence at the national level and not at a sub-national level, and the non-participation of 19% of eligible individuals in the survey.ConclusionsNearly two-thirds of individuals aged ≥6 years from the general population and 85% of HCWs had antibodies against SARS-CoV-2 by June–July 2021 in India. As one-third of the population is still seronegative, it is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions.

Manoj Murhekar and co-workers report on the seroprevalence of anti-SARS-CoV-2 antibodies in India.