Literature Collection

The relationship between adverse childhood experiences (ACEs) and lifetime suicide attempts among high-risk Latine remains underexplored. This study examined the understudied intersections of ACEs, Latine ethnicity, and lifetime suicide attempts among high-risk individuals entering behavioral health treatment. This secondary analysis involved 299 Latine adults entering integrated behavioral health treatment. A multivariate logistic regression analysis was conducted to assess ACE scores and lifetime suicide attempts, controlling for social drivers of health such as housing, employment, and education. Key findings show that 28% of the sample reported lifetime suicide attempts. Multivariate analysis found that for every unit increase in ACE scores, the odds of lifetime suicide attempts increased by 21% (OR = 1.21, 95% CI [1.07, 1.38]). Additionally, those who reported being unemployed were 2.39 times more likely to have attempted suicide in their lifetime compared to their counterparts, and those who self-identified as Puerto Rican were 2.04 times more likely to report a lifetime suicide attempt. This study underscores the importance of screening for ACEs and providing services such as employment training, trauma-informed care, and suicide prevention services to Latine individuals, especially those who identify as Puerto Rican. Additional research needs to be conducted on the effects of colonization on the health and mental health of individuals of Puerto Rican descent.

PURPOSE: To examine the associations between adverse childhood experiences (ACEs) scores from routine screenings in pediatric checkups and timing of puberty in a diverse cohort of adolescents. METHODS: A retrospective cohort study of 52,573 pediatric members of Kaiser Permanente Northern California, an integrated healthcare delivery system. Exposure was the total ACEs score, determined using caregiver- and self-reported scores across all well-child visits, and categorized into 0, 1-3, 4-6, or 7-10 ACEs. Outcomes were age at menarche and pubertal onset, using physician-assessed Sexual Maturity Ratings. RESULTS: Girls with ACEs had a substantially higher risk of earlier menarche and pubertal onset compared to those without ACEs. There were no associations between ACEs and boys' pubertal timing. DISCUSSION: These results highlight the importance of screening for ACEs in a clinical setting to address adolescents' psychological well-being and healthy lifestyle habits, which in turn may prevent adverse health outcomes associated with early puberty.

INTRODUCTION: Take-Home Naloxone programs have been introduced across North America in response to rising opioid overdose deaths. There is currently limited real-world data on bystander naloxone administration, overdose outcomes, and evidence related to adverse events following bystander naloxone administration. METHODS: The research team used descriptive statistics from Take-Home Naloxone administration forms. We explored reported demographic variables and adverse events among people who received by-stander administered naloxone in a suspected opioid overdose event between August 31, 2012 and December 31, 2018 in British Columbia. We examined and contextualized differences across years given policy, program and drug toxicity changes. We used multivariate logistic regression to examine whether an association exists between number of ampoules of naloxone administered and the odds that the recipient will experience withdrawal symptoms. RESULTS: A large majority (98.1%) of individuals who were administered naloxone survived their overdose and 69.2% had no or only mild withdrawal symptoms. Receiving three (Adjusted Odds Ratio (AOR) 1.64 (95% Confidence Interval (CI): 1.08-2.48)) or four or more (AOR 2.19 (95% CI: 1.32-3.62)) ampoules of naloxone was significantly associated with odds of moderate or severe withdrawal compared to receiving one ampoule of naloxone. CONCLUSIONS: This study provides evidence from thousands of bystander reversed opioid overdoses using Take-Home Naloxone kits in British Columbia, and suggests bystander-administered naloxone is safe and effective for opioid overdose reversal. Data suggests an emphasis on titration during bystander naloxone training in situations where the person experiencing overdose can be adequately ventilated may help avoid severe withdrawal symptoms. We identified a decreasing trend in the likelihood of moderate or severe withdrawal over the study period.

OBJECTIVE: To examine the short and long term adverse physical and mental health outcomes, all cause mortality, and natural and unnatural deaths in individuals with a diagnosis of an eating disorder compared with a matched cohort without these disorders. DESIGN: Primary care cohort study with linked secondary care and mortality records. SETTING: English primary care electronic health records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics for hospital records and the Office for National Statistics for mortality data, 1 January 1998 to 30 November 2018. PARTICIPANTS: 24 709 patients, aged 10-44 years, with a diagnosis of an eating disorder, matched by age, sex, and general practice with up to 20 comparators without an eating disorder (n=493 001). Disorders examined were anorexia nervosa, bulimia nervosa, binge eating disorder, and all other types combined. MAIN OUTCOME MEASURES: Physical health conditions, mental health conditions, and mortality (all cause and cause specific). Hazard ratios and cumulative incidences were calculated to compare outcomes. RESULTS: Individuals with eating disorders had substantially higher risks for coded adverse physical, mental health, and mortality outcomes. Within the first year after a diagnosis of an eating disorder, these individuals were six times more likely to develop renal failure (hazard ratio 6.0, 95% confidence interval (CI) 4.2 to 8.5; excess 15 events per 10 000 individuals, 95% CI 11 to 21) and nearly seven times more likely to develop liver disease (hazard ratio 6.7, 3.8 to 11.7; excess 6 per 10 000, 4 to 11). Risks were still increased after five years (hazard ratio for renal failure 2.6, 95% CI 2.0 to 3.4; hazard ratio for liver disease 3.7, 2.3 to 6.0), with cumulative excesses of 110 (95% CI 87 to 136) and 26 (17 to 39) per 10 000 individuals at 10 years for renal failure and liver disease, respectively. Mental health coded outcomes were markedly increased in the short term for depression (hazard ratio 7.3, 95% CI 6.6 to 8.1; excess 596 per 10 000 individuals, 95% CI 545 to 650) and self-harm (hazard ratio 9.4, 8.2 to 10.7; excess 309 per 10 000, 279 to 342) at one year. Mortality was also higher: within the first year, the risk of all cause mortality was more than fourfold (hazard ratio 4.6, 95% CI 3.1 to 7.0; excess 10 per 10 000 individuals, 95% CI 7 to 15) and was fivefold for unnatural deaths (hazard ratio 5.1, 2.2 to 11.9; excess 30 per 100 000, 13 to 61). Risks persisted beyond five years (hazard ratio 2.2, 95% CI 1.8 to 2.7 for all cause mortality; hazard ratio 3.2, 1.9 to 5.4 for unnatural deaths), corresponding to 43 (95% CI 33 to 54) excess all cause deaths per 10 000 individuals and 184 (125 to 262) excess unnatural deaths per 100 000 at five years. At 10 years, 95 (95% CI 75 to 118) excess all cause deaths per 10 000 individuals and 341 (236 to 479) unnatural deaths per 100 000 were found. Suicide risk was 13.7 times higher in the first year (95% CI 4.8 to 38.8; 24 excess deaths per 100 000 individuals, 95% CI 10 to 52) and remained increased at 10 years (hazard ratio 2.7, 1.3 to 5.8), accounting for 169 (103 to 266) excess deaths per 100 000 individuals. CONCLUSIONS: Individuals with a diagnosis of an eating disorder derived from coded primary care data were more likely to have recorded adverse physical and mental health outcomes, as well as higher mortality than individuals without an eating disorder matched by age, sex, and general practice. These findings highlight the need for integrated care strategies that deal with both the physical and mental health dimensions in the management of individuals with eating disorders.