The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom.

BACKGROUND: Atopic dermatitis is known to be common among children, but there are few studies examining the epidemiology across the life course. In particular, there is a paucity of data on atopic dermatitis among older adults. OBJECTIVE: To evaluate participant characteristics, patterns of disease activity and severity, and calendar trends in older adult atopic dermatitis in comparison to other age groups in a large population-based cohort. METHODS: This was a cohort study of 9,154,936 individuals aged 0-99 years registered in The Health Improvement Network, a database comprised of electronic health records from general practices in the United Kingdom between 1994 and 2013. Atopic dermatitis was defined by a previously validated algorithm using a combination of at least one recorded atopic dermatitis diagnostic code in primary care and two atopic dermatitis therapies recorded on separate days. Cross-sectional analyses of disease prevalence were conducted at each age. Logistic mixed effect regression models were used to identify predictors of prevalent disease over time among children (0-17 years), adults (18-74 years), and older adults (75-99 years). RESULTS: Physician-diagnosed atopic dermatitis was identified in 894,454 individuals with the following proportions in each age group: 18.3% of children, 7.7% of adults, and 11.6% of older adults. Additionally, atopic dermatitis prevalence increased across the 2-decade period (beta from linear regression test for trend in the change in proportion per year = 0.005, p = 0.044). In older adults, atopic dermatitis was 27% less common among females (adjusted OR 0.73, 95% CI 0.70-0.76) and was more likely to be active (59.7%, 95% CI 59.5-59.9%) and of higher severity (mean annual percentage with moderate and severe disease: 31.8% and 3.0%, respectively) than in other age groups. CONCLUSION: In a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above. Compared to children ages 0-17 and adults ages 18-74, older adult atopic dermatitis was more active and severe. Because the prevalence of atopic dermatitis among older adults has increased over time, additional characterization of disease triggers and mechanisms and targeted treatment recommendations are needed for this population.

Typologies of violence against women in Brazil: A latent class analysis of how violence and HIV intersect.

We address the limited understanding around the overlap between violence and HIV in Brazil. Data was from two clinic-based samples of HIV-positive (n = 1534) and HIV-negative women (n = 1589) in São Paulo and Porto Alegre. We conducted latent class analysis and identified violence typologies by type of violence, life course timing, frequency, and perpetrator, stratified by city and HIV-status. Overall, HIV-positive women experienced more lifetime physical and sexual violence than HIV-negative women. Twelve unique violence latent classes were identified. In São Paulo, HIV-positive women were likely to have endured physical violence several times (Conditional Probability [CP]: 0.80) by an intimate partner (CP: 0.85), and sexual violence several times (CP: 0.46) by an intimate partner (CP: 0.62). In Porto Alegre, HIV-positive women endured physical violence several times (CP: 0.80) by an intimate partner (CP: 0.70) during childhood/adolescence (CP: 0.48), and sexual violence several times (CP: 0.54) by an intimate partner (CP: 0.60). Findings inform interventions to educate around gender equity, violence, and the health effects of violence including HIV, integrate HIV and violence services, and improve the provision of bio-medical HIV prevention among HIV-negative women who experience violence.

Adverse childhood experiences (ACEs) are associated with forced and very early sexual initiation among Black women accessing publicly funded STD clinics in Baltimore, MD.

PURPOSE: To examine the association between adverse childhood experiences (ACEs) and early sexual initiation. METHODS: We analyzed retrospective data of (n = 241) Black women recruited from public STD clinics in Baltimore, MD. Multinomial logistic and linear regression models estimated associations between ACEs and early sexual initiation; contextual variables at initiation were examined as mediators. RESULTS: Twelve percent of our sample reported very early sexual initiation (11-12 years) and 29% reported early sexual initiation (13-14 years). Each additional ACE reported was associated with greater risk of very early sexual initiation (RRR = 1.49; 95%CI:1.23,1.80). Specifically, emotional abuse (RRR = 3.71; 95%CI:1.55,8.89), physical abuse (RRR = 9.45; 95%CI:3.56,25.12), sexual abuse (RRR = 8.60; 95%CI:3.29,22.51), witnessing maternal abuse (RRR = 5.56; 95%CI:2.13,14.52), and household substance misuse (RRR = 3.21; 95%CI:1.38,7.47) at or before the age of 18 were associated with very early sexual initiation. As for context of initiation, age at sexual initiation was younger if the man at initiation was a non-partner (ß = -0.88; 95%CI:-1.36,-0.40), was ≥3 years older (ß = -1.30; 95%CI:-1.82,-0.77), had pressured or forced sexual intitiation (ß = -1.09; 95%CI:-1.58,-0.59), and was under the influence of drugs/alcohol (ß = -0.97; 95%CI:-1.62,-0.32). Contextual variables at first sex, including being pressured or forced, and the man being ≥3 years older fully mediated the association between ACEs and early sexual initiation. CONCLUSIONS: This study highlights the critical need to develop interventions that reduce the impact of ACEs on women's health and delay age at sexual initiation. Health education efforts are needed for clinicians and parents to identify and prevent childhood abuse and to identify and report sexual coercion and abuse for girls and adolescents.

Physiological Changes from Violence-Induced Stress and Trauma Enhance HIV Susceptibility Among Women.

PURPOSE OF REVIEW: This theoretical review identifies physiological mechanisms by which violence against women (VAW) may increase women's susceptibility to HIV through trauma, stress, and immune dysfunction. RECENT FINDINGS: Research documents systemic and local immune responses are related to stress and trauma from abuse across the life course (i.e., childhood, IPV, adulthood re-victimization). Findings are interpreted within a theoretical framework grounded in the Social Stress Theory and the concept of toxic stress, and highlight the current state of the science connecting: (1) VAW to the physiological stress response and immune dysfunction, and (2) the physiological stress response and inflammation to HIV susceptibility and infection in the female reproductive tract. Despite a dearth of research in human subjects, evidence suggests that VAW plays a significant role in creating a physiological environment conducive to HIV infection. We conclude with a discussion of promising future steps for this line of research.