The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens

Ataque Cerebrovascular en jóvenes en la Unidad de ACV del Hospital de Clínicas de Montevideo

El ataque cerebrovascular (ACV) en jóvenes es menos frecuente que en los sujetos añosos, pero su incidencia se encuentra en aumento. La etiología puede ser diferente en ambas subpoblaciones, sin embargo los factores de riesgo cardiovascular clásicos cada vez juegan un rol más preponderante en los jóvenes. Se realizó un estudio descriptivo retrospectivo analizando las características de los ACV en dicho grupo etario durante los años 2009 y 2010 en la Unidad de Ataque Cerebrovascular del Hospital de Clínicas de Montevideo, Uruguay. Se identificaron 10 pacientes (8% del total de ACV). Encontramos una supremacía de la naturaleza hemorrágica por sobre la isquémica y una muy buena evolución funcional alejada. Los factores de riesgo cardiovasculares clásicos, como la hipertensión arterial jugaron un rol fundamental en las hemorragias cerebrales, no así en los infartos. En estos últimos, se constató una mayor frecuencia de patología protrombótica