Undiagnosed and subclinical health problems in vulnerable adults exposed to stress and adversity

面临压力和逆境的弱势成年人的未诊断和亚临床健康问题

基本信息

批准号：
9891077
负责人：
TODD I HERRENKOHL
金额：
$ 12.75万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-11 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9891077
关键词：
6 year old Acute Address Adolescence Adult Age Algorithms Antibodies Bedside Testings Behavior Biological Biological Assay Biological Markers Blood Pressure Blood capillaries Body fat Buffers C-reactive protein Cause of Death Cells Child Child Abuse and Neglect Childhood Cholesterol Chronic Chronic Disease Chronic stress Collection Colon Carcinoma Data Data Collection Data Reporting Data Sources Deterioration Development Diabetes Mellitus Diagnosis Diet Diet Habits Disease Exposure to Family history of Foundations Future Gender Glycosylated Hemoglobin Health Health Policy Heart Diseases Height High Density Lipoproteins Human Herpesvirus 4 Hypertension Immune response Immune system Immunologic Markers Individual Inflammation Injury Knowledge Laboratories Life Style Literature Longitudinal Studies Measurement Measures Mediating Outcome PF4 Gene Pain Pathway interactions Patient Self-Report Physical activity Physiological Plant Roots Prevention program Preventive Intervention Process Public Health Publications Pulse Rates Research Retrospective Studies Risk Risk Factors SF-36 Sampling Serum Services Sexual abuse Shapes Site Skin Sleep Stress Stress and Coping Surveys Symptoms System Time United States Weight Work abuse neglect acute stress allostatic load arm base breast cancer diagnosis cardiovascular disorder risk childhood adversity coping early childhood elementary school emotional abuse functional disability gender difference health practice help-seeking behavior immune function improved intervention program longitudinal dataset maltreatment middle age multimodal data nutrition physical abuse physical conditioning prospective protective effect resilience response social determinants stress resilience theories

项目摘要

ABSTRACT The long-term physical health effects of child maltreatment are well documented in self-report, mostly retrospective, studies. However, there have been very few objective, longitudinal, multimethod and gender- balanced studies on physiological responses to stress and the onset of symptoms related to chronic disease, thereby slowing the advancement of prevention and intervention programs. Building on four earlier waves of data, the proposed study will address critical gaps in the research literature on social determinants and the biological embedding of stress by adding biomarker data to an expansive longitudinal dataset that contains comprehensive, prospective measures of child maltreatment subtypes, stress, coping, and resilience, as well as self-reports of health. Biomarkers include on-site measurements of blood pressure and pulse rate; height and weight for computing BMI and body fat percentage; and capillary serum collection and point-of-care testing to measure two markers of cardiovascular disease risk: total cholesterol and HDL, and glycosylated hemoglobin (HbA1c). Capillary serum collection will be used for laboratory analyses of two markers of immune function selected to represent different arms of the immune response: Epstein-Barr virus antibody, an indicator of cell-mediated immune function, which has been shown to increase with both acute and chronic stress exposure, and c-reactive protein, an indicator of both chronic and acute inflammation. Remaining serum volume not used for these assays will be retained for future analyses. We will study each marker separately and in multi-biomarker algorithms consistent with definitions of allostatic load and biological age to assess physiological dysregulation across multiple systems. Data collection will also include a short self-report survey on health and illnesses, pain, and functional disability, as well as service use and help-seeking behaviors, sleep, physical activity, and diet (eating habits and nutrition) to replicate and expand existing measures. With existing and newly collected data, we will analyze: (1) the long-term health effects of child maltreatment subtypes in biomarkers of emerging chronic illnesses and self-reports of poor health and functional impairment; (2) developmental sensitivity to stress and its relation to child maltreatment and adult health; (3) protective effects of early (childhood) resilience and adaptive coping; and (4) gender differences. This project will increase understanding of emerging chronic illness in vulnerable adults when some have subclinical disease symptoms that go unreported, and when lifestyle changes can still mitigate risk for the onset of serious health conditions that become deeply rooted and intractable.

抽象的虐待儿童对身体健康的长期影响在自我报告中有详细记录，大部分是回顾、研究。然而，客观的、纵向的、多方法的和性别的研究却很少。对压力的生理反应和与慢性疾病相关的症状发作的平衡研究，从而减缓了预防和干预计划的进展。建立在前四波浪潮的基础上数据，拟议的研究将解决关于社会决定因素和通过将生物标记数据添加到包含以下内容的广泛纵向数据集中来生物嵌入压力对儿童虐待亚型、压力、应对和复原力进行全面、前瞻性的衡量作为健康自我报告。生物标志物包括血压和脉搏率的现场测量；高度和体重，用于计算BMI和体脂百分比；和毛细血管血清采集和即时检测测量心血管疾病风险的两个标志物：总胆固醇和高密度脂蛋白以及糖基化血红蛋白 (HbA1c)。毛细管血清收集将用于两种免疫标志物的实验室分析选择代表免疫反应不同分支的函数：Epstein-Barr 病毒抗体，一个指标细胞介导的免疫功能，已被证明会随着急性和慢性压力而增强暴露和 C 反应蛋白（慢性和急性炎症的指标）。剩余血清未用于这些测定的体积将被保留用于将来的分析。我们将分别研究每个标记并在与稳态负荷和生物年龄的定义一致的多生物标志物算法中进行评估跨多个系统的生理失调。数据收集还将包括简短的自我报告调查关于健康和疾病、疼痛和功能性残疾，以及服务使用和寻求帮助的行为，睡眠、体力活动和饮食（饮食习惯和营养），以复制和扩展现有措施。和根据现有和新收集的数据，我们将分析：（1）虐待儿童对健康的长期影响新出现的慢性疾病的生物标志物的亚型以及健康状况不佳和功能障碍的自我报告； (2) 对压力的发育敏感性及其与虐待儿童和成人健康的关系； (3)防护性早期（儿童期）复原力和适应性应对的影响； (4)性别差异。该项目将当某些人患有亚临床疾病时，增加对易感成年人中新出现的慢性疾病的了解未报告的症状，以及生活方式的改变仍然可以减轻严重健康问题的风险条件变得根深蒂固且棘手。