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

摘要 虐待儿童对身体健康的长期影响在自我报告中有很好的记录， 回顾性研究。然而，很少有客观的、纵向的、多方法的和性别的- 关于对压力的生理反应和与慢性病有关的症状发作的平衡研究， 从而减缓了预防和干预方案的进展。在前四波 数据，拟议的研究将解决关键差距的研究文献中的社会决定因素和 通过将生物标志物数据添加到包含以下内容的扩展纵向数据集， 全面的，前瞻性的措施，儿童虐待亚型，压力，应对和弹性，以及 作为健康的自我报告。生物标志物包括现场测量血压和脉搏率;身高 和体重，用于计算BMI和体脂百分比;以及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HDL， 血红蛋白（HbA 1c）。毛细管血清采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功能：爱泼斯坦-巴尔病毒抗体，指示剂 细胞介导的免疫功能，这已被证明是增加与急性和慢性压力 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保留用于将来的分析。我们将分别研究每个标记 并且在与非稳态负荷和生物学年龄的定义一致的多生物标志物算法中， 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，以及服务使用和求助行为， 睡眠、身体活动和饮食（饮食习惯和营养），以复制和扩大现有措施。与 现有的和新收集的数据，我们将分析：（1）儿童虐待的长期健康影响 新出现的慢性疾病的生物标志物亚型以及健康状况不佳和功能障碍的自我报告; (2)对压力的发展敏感性及其与儿童虐待和成人健康的关系;（3）保护性 早期（儿童）复原力和适应性应对的影响;（4）性别差异。该项目将 提高对易受伤害成年人中新出现的慢性疾病的认识，其中一些人患有亚临床疾病 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发作的风险 这种情况根深蒂固，难以处理。

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.